Analyzing reflective narratives to assess the ethical reasoning of pediatric residents.

PubMed

Moon, Margaret; Taylor, Holly A; McDonald, Erin L; Hughes, Mark T; Beach, Mary Catherine; Carrese, Joseph A

2013-01-01

A limiting factor in ethics education in medical training has been difficulty in assessing competence in ethics. This study was conducted to test the concept that content analysis of pediatric residents' personal reflections about ethics experiences can identify changes in ethical sensitivity and reasoning over time. Analysis of written narratives focused on two of our ethics curriculum's goals: 1) To raise sensitivity to ethical issues in everyday clinical practice and 2) to enhance critical reflection on personal and professional values as they affect patient care. Content analysis of written reflections was guided by a tool developed to identify and assess the level of ethical reasoning in eight domains determined to be important aspects of ethical competence. Based on the assessment of narratives written at two times (12 to 16 months/apart) during their training, residents showed significant progress in two specific domains: use of professional values, and use of personal values. Residents did not show decline in ethical reasoning in any domain. This study demonstrates that content analysis of personal narratives may provide a useful method for assessment of developing ethical sensitivity and reasoning.

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.

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

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

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.

δ2H and δ18O of human body water: a GIS model to distinguish residents from non-residents in the contiguous USA.

PubMed

Podlesak, David W; Bowen, Gabriel J; O'Grady, Shannon; Cerling, Thure E; Ehleringer, James R

2012-06-01

An understanding of the factors influencing the isotopic composition of body water is important to determine the isotopic composition of tissues that are used to reconstruct movement patterns of humans. The δ(2)H and δ(18)O values of body water (δ(2)H(bw) and δ(18)O(bw)) are related to the δ(2)H and δ(18)O values of drinking water (δ(2)H(dw) and δ(18)O(dw)), but clearly distinct because of other factors including the composition of food. Here, we develop a mechanistic geographical information system (GIS) model to produce spatial projections of δ(2)H(bw) and δ(18)O(bw) values for the USA. We investigate the influence of gender, food, and drinking water on the predicted values by comparing them with the published values. The strongest influence on the predicted values was related to the source of δ(2)H(dw) and δ(18)O(dw) values. We combine the model with equations that describe the rate of turnover to produce estimates for the time required for a non-resident to reach an isotopic equilibrium with a resident population.

Resident perceptions of the educational value of night float rotations.

PubMed

Luks, Andrew M; Smith, C Scott; Robins, Lynne; Wipf, Joyce E

2010-07-01

Night float rotations are being increasingly used in the era of resident physician work-hour regulations, but their impact on resident education is not clear. Our objective was to clarify resident perceptions of the educational aspects of night float rotations. An anonymous survey of internal medicine residents at a university-based residency program was completed. Responses were received from 116 of 163 surveyed residents (71%). Residents attended less residents' report (0.10 +/- .43 vs. 2.70 + 0.93 sessions/week, p< .001) and fewer grand rounds sessions (0.14 +/- 0.25 vs. 0.43 +/- 0.28 sessions/week, p< .001) and spent less time reading, (2.63 +/- 2.0 vs. 3.33 +/- 1.6 hr/week, p< .001) interacting with attending physicians (0.57 +/- 1.1 vs. 2.97 +/- 1.5 hr/week, p< .001) and sleeping at home (6.3 +/- 1.2 vs. 7.10 +/- 0.9 hr/day, p< .001) on night float rotations than on non-night float rotations. Residents had strongly negative opinions about the educational value of night float, sleep cycle adjustment issues, and impact on their personal lives, which correlated with resident evaluations from the regular program evaluation process. In free responses, residents commented that they liked the autonomy and opportunity to improve triage skills on these rotations and confirmed their negative opinions about the sleep-wake cycle and interference with personal lives. Internal medicine residents at a university-based program have negative opinions regarding the educational value of night float rotations. Further work is necessary to determine whether problems exist across programs and specialties.

Can a Resident's Publication Record Predict Fellowship Publications?

PubMed Central

Prasad, Vinay; Rho, Jason; Selvaraj, Senthil; Cheung, Mike; Vandross, Andrae; Ho, Nancy

2014-01-01

Background Internal medicine fellowship programs have an incentive to select fellows who will ultimately publish. Whether an applicant's publication record predicts long term publishing remains unknown. Methods Using records of fellowship bound internal medicine residents, we analyzed whether publications at time of fellowship application predict publications more than 3 years (2 years into fellowship) and up to 7 years after fellowship match. We calculate the sensitivity, specificity, positive and negative predictive values and likelihood ratios for every cutoff number of application publications, and plot a receiver operator characteristic curve of this test. Results Of 307 fellowship bound residents, 126 (41%) published at least one article 3 to 7 years after matching, and 181 (59%) of residents do not publish in this time period. The area under the receiver operator characteristic curve is 0.59. No cutoff value for application publications possessed adequate test characteristics. Conclusion The number of publications an applicant has at time of fellowship application is a poor predictor of who publishes in the long term. These findings do not validate the practice of using application publications as a tool for selecting fellows. PMID:24658088

Can a resident's publication record predict fellowship publications?

PubMed

Prasad, Vinay; Rho, Jason; Selvaraj, Senthil; Cheung, Mike; Vandross, Andrae; Ho, Nancy

2014-01-01

Internal medicine fellowship programs have an incentive to select fellows who will ultimately publish. Whether an applicant's publication record predicts long term publishing remains unknown. Using records of fellowship bound internal medicine residents, we analyzed whether publications at time of fellowship application predict publications more than 3 years (2 years into fellowship) and up to 7 years after fellowship match. We calculate the sensitivity, specificity, positive and negative predictive values and likelihood ratios for every cutoff number of application publications, and plot a receiver operator characteristic curve of this test. Of 307 fellowship bound residents, 126 (41%) published at least one article 3 to 7 years after matching, and 181 (59%) of residents do not publish in this time period. The area under the receiver operator characteristic curve is 0.59. No cutoff value for application publications possessed adequate test characteristics. The number of publications an applicant has at time of fellowship application is a poor predictor of who publishes in the long term. These findings do not validate the practice of using application publications as a tool for selecting fellows.

The Target Residence Time of Antihistamines Determines Their Antagonism of the G Protein-Coupled Histamine H1 Receptor

PubMed Central

Bosma, Reggie; Witt, Gesa; Vaas, Lea A. I.; Josimovic, Ivana; Gribbon, Philip; Vischer, Henry F.; Gul, Sheraz; Leurs, Rob

2017-01-01

The pharmacodynamics of drug-candidates is often optimized by metrics that describe target binding (Kd or Ki value) or target modulation (IC50). However, these metrics are determined at equilibrium conditions, and consequently information regarding the onset and offset of target engagement and modulation is lost. Drug-target residence time is a measure for the lifetime of the drug-target complex, which has recently been receiving considerable interest, as target residence time is shown to have prognostic value for the in vivo efficacy of several drugs. In this study, we have investigated the relation between the increased residence time of antihistamines at the histamine H1 receptor (H1R) and the duration of effective target-inhibition by these antagonists. Hela cells, endogenously expressing low levels of the H1R, were incubated with a series of antihistamines and dissociation was initiated by washing away the unbound antihistamines. Using a calcium-sensitive fluorescent dye and a label free, dynamic mass redistribution based assay, functional recovery of the H1R responsiveness was measured by stimulating the cells with histamine over time, and the recovery was quantified as the receptor recovery time. Using these assays, we determined that the receptor recovery time for a set of antihistamines differed more than 40-fold and was highly correlated to their H1R residence times, as determined with competitive radioligand binding experiments to the H1R in a cell homogenate. Thus, the receptor recovery time is proposed as a cell-based and physiologically relevant metric for the lead optimization of G protein-coupled receptor antagonists, like the H1R antagonists. Both, label-free or real-time, classical signaling assays allow an efficient and physiologically relevant determination of kinetic properties of drug molecules. PMID:29033838

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.

Comment on ''the relative concentrations of radon daughter products in surface air and the significance of their ratios'' by C. Rangarajan, S. Gopalakrishnan, V. R. Chandrasekaran, and C. D. Eapen

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

Marenco, A.; Fontan, J.

1975-12-20

Measurement of the ratio beweeen the short-lived radon daughters and $sup 210$Pb in order to determine the aerosol residence time in the troposphere is discussed. It is concluded that the various residence time values obtained experimentally with radioactive elements make it possible to determine parameters representing the processes of vertical exchanges and of scavenging which prevail on a large scale in the troposphere, thus making it possible to use numerical models of simulation for calculating the tropospheric residence time of any other element. (HLW)

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.

Optimization of torrefaction conditions of coffee industry residues using desirability function approach.

PubMed

Buratti, C; Barbanera, M; Lascaro, E; Cotana, F

2018-03-01

The aim of the present study is to analyze the influence of independent process variables such as temperature, residence time, and heating rate on the torrefaction process of coffee chaff (CC) and spent coffee grounds (SCGs). Response surface methodology and a three-factor and three-level Box-Behnken design were used in order to evaluate the effects of the process variables on the weight loss (W L ) and the Higher Heating Value (HHV) of the torrefied materials. Results showed that the effects of the three factors on both responses were sequenced as follows: temperature>residence time>heating rate. Data obtained from the experiments were analyzed by analysis of variance (ANOVA) and fitted to second-order polynomial models by using multiple regression analysis. Predictive models were determined, able to obtain satisfactory fittings of the experimental data, with coefficient of determination (R 2 ) values higher than 0.95. An optimization study using Derringer's desired function methodology was also carried out and the optimal torrefaction conditions were found: temperature 271.7°C, residence time 20min, heating rate 5°C/min for CC and 256.0°C, 20min, 25°C/min for SCGs. The experimental values closely agree with the corresponding predicted values. Copyright © 2017 Elsevier Ltd. All rights reserved.

Twelve tips for overnight teaching.

PubMed

Richards, Jeremy B; Wilcox, Susan R; Roberts, David H; Schwartzstein, Richard M

2014-03-01

The European Working Time Directive and the United States' duty hour restrictions have changed resident physicians' schedules, specifically increasing overnight shifts and decreasing overall time spent in the hospital. As residents' perception of night shifts is that they have little educational value, efforts to improve educational opportunities and night attending teaching are desirable. However, resources about and recommendations for best practices for overnight teaching by faculty are scarce. To provide 12 tips to highlight strategies intended to optimize attending physicians' overnight teaching skills and strategies. The tips provided are based on our experiences and reflections as in-house faculty supervising residents working overnight, by our experience and group discussions as medical educators, and the available literature. The 12 tips presented offer specific strategies to optimize attending physicians' overnight teaching for resident physicians, specifically highlighting the unique logistics, pedagogy and follow-up of overnight teaching. Preparation for teaching is important in any environment, but understanding the unique timing and circumstances associated with overnight teaching is vital to ensure that overnight teaching is effective. Acknowledging and addressing the physical and cognitive obstacles associated with overnight teaching and learning is necessary to maximize the educational value of overnight teaching.

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.

Alkylsulfonic acid phenylesters (ASEs, Mesamoll®) in dust samples of German residences and daycare centers (LUPE 3).

PubMed

Fromme, Hermann; Schwarzbauer, Jan; Lahrz, Thomas; Kraft, Martin; Fembacher, Ludwig

2017-04-01

For decades, plasticizers have been produced in high quantities to improve the flexibility and durability of products. One possible replacement product is alkylsulfonic acid phenylesters (ASEs), marketed as Mesamoll ® . This study aimed to quantify the ASE dust contamination of residences and daycare centers to obtain insight into the recent exposure situation. ASEs were quantified in dust samples collected from 25 residences and 25 daycare centers using GC/MS measurements. Median (95th percentile) values of the sum of tetra- to heptadecylphenylesters are higher in daycare centers, with a value of 19.6mg/kg (216mg/kg), compared to residences, with a value of 7.6mg/kg (171mg/kg). A daily non-dietary intake of 0.08 and 0.86μg/kg b.w., respectively, was observed using the median and 95th percentile values obtained from dust samples. These levels are 1250 and 115 times below a previously set temporary tolerable daily intake value. Nevertheless, the fact that basic data on toxicity and exposure via other pathways are limited or unavailable at present has to be considered. Copyright © 2016 Elsevier GmbH. All rights reserved.

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.

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.

Impact of adding additional providers to resident workload and the resident experience on a medical consultation rotation.

PubMed

Fang, Michele; Linson, Eric; Suneja, Manish; Kuperman, Ethan F

2017-02-22

Excellence in Graduate Medical Education requires the right clinical environment with an appropriate workload where residents have enough patients to gain proficiency in medicine with optimal time for reflection. The Accreditation Council for Graduate Medical Education (ACGME) has focused more on work hours rather than workload; however, high resident workload has been associated with lower resident participation in education and fatigue-related errors. Recognizing the potential risks associated with high resident workload and being mindful of the costs of reducing resident workload, we sought to reduce residents' workload by adding an advanced practice provider (APP) to the surgical comanagement service (SCM) and study its effect on resident satisfaction and perceived educational value of the rotation. In Fiscal Year (FY) 2014 and 2015, an additional faculty member was added to the SCM rotation. In FY 2014, the faculty member was a staff physician, and in FY 2015, the faculty member was an APP.. Resident workload was assessed using billing data. We measured residents' perceptions of the rotation using an anonymous electronic survey tool. We compared FY2014-2015 data to the baseline FY2013. The number of patients seen per resident per day decreased from 8.0(SD 3.3) in FY2013 to 5.0(SD 1.9) in FY2014 (p < 0.001) and 5.7(SD 2.0) in FY2015 (p < 0.001). A higher proportion of residents reported "just right" patient volume (64.4%, 91.7%, 96.7% in FY2013, 2014, 2015 respectively p < 0.001), meeting curricular goals (79.9%, 95.0%, 97.2%, in FY2013, 2014 and 2015 respectively p < 0.001), and overall educational value of the rotation (40.0%, 72.2%, 72.6% in FY2013, 2014, 2015 respectively, p < 0.001). Decreasing resident workload through adding clinical faculty (both staff physician and APPs) was associated with improvements on resident perceived educational value and clinical experience of a medical consultation rotation.

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

PubMed

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

2018-02-01

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

A cost-construction model to assess the total cost of an anesthesiology residency program.

PubMed

Franzini, L; Berry, J M

1999-01-01

Although the total costs of graduate medical education are difficult to quantify, this information may be of great importance for health policy and planning over the next decade. This study describes the total costs associated with the residency program at the University of Texas--Houston Department of Anesthesiology during the 1996-1997 academic year. The authors used cost-construction methodology, which computes the cost of teaching from information on program description, resident enrollment, faculty and resident salaries and benefits, and overhead. Surveys of faculty and residents were conducted to determine the time spent in teaching activities; access to institutional and departmental financial records was obtained to quantify associated costs. The model was then developed and examined for a range of assumptions concerning resident productivity, replacement costs, and the cost allocation of activities jointly producing clinical care and education. The cost of resident training (cost of didactic teaching, direct clinical supervision, teaching-related preparation and administration, plus the support of the teaching program) was estimated at $75,070 per resident per year. This cost was less than the estimated replacement value of the teaching and clinical services provided by residents, $103,436 per resident per year. Sensitivity analysis, with different assumptions regarding resident replacement cost and reimbursement rates, varied the cost estimates but generally identified the anesthesiology residency program as a financial asset. In most scenarios, the value of the teaching and clinical services provided by residents exceeded the cost of the resources used in the educational program.

Residents' values and fuels management approaches

Treesearch

Gwo-Bao Liou; Christine Vogt; Greg Winter; Sarah McCaffrey

2008-01-01

The research utilizes the Forest Value and Salient Value Similarity Scales to examine homeowners' value orientations and relate them to attitudes toward and support for fuels management approaches. Data were collected from homeowners living in the wildland-urban interface of the Huron- Manistee National Forest at two time periods, in 2002 and 2006. The panel data...

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

PubMed

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

2016-01-01

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

Do medical house officers value the health of veterans differently from the health of non-veterans?

PubMed Central

Yi, Michael S; Luckhaupt, Sara; Mrus, Joseph M; Tsevat, Joel

2004-01-01

Background Little information is available regarding medical residents' perceptions of patients' health-related quality of life. Patients cared for by residents have been shown to receive differing patterns of care at Veterans Affairs facilities than at community or university settings. We therefore examined: 1) how resident physicians value the health of patients; 2) whether values differ if the patient is described as a veteran; and 3) whether residency-associated variables impact values. Methods All medicine residents in a teaching hospital were asked to watch a digital video of an actor depicting a 72-year-old patient with mild-moderate congestive heart failure. Residents were randomized to 2 groups: in one group, the patient was described as a veteran of the Korean War, and in the other, he was referred to only as a male. The respondents assessed the patient's health state using 4 measures: rating scale (RS), time tradeoff (TTO), standard gamble (SG), and willingness to pay (WTP). We also ascertained residents' demographics, risk attitudes, residency program type, post-graduate year level, current rotation, experience in a Veterans Affairs hospital, and how many days it had been since they were last on call. We performed univariate and multivariable analyses using the RS, TTO, SG and WTP as dependent variables. Results Eighty-one residents (89.0% of eligible) participated, with 36 (44.4%) viewing the video of the veteran and 45 (55.6%) viewing the video of the non-veteran. Their mean (SD) age was 28.7 (3.1) years; 51.3% were female; and 67.5% were white. There were no differences in residents' characteristics or in RS, TTO, SG and WTP scores between the veteran and non-veteran groups. The mean RS score was 0.60 (0.14); the mean TTO score was 0.80 (0.20); the mean SG score was 0.91 (0.10); and the median (25th, 75th percentile) WTP was $10,000 ($7600, $20,000) per year. In multivariable analyses, being a resident in the categorical program was associated with assigning higher RS scores, but no residency-associated variables were associated with the TTO, SG or WTP scores. Conclusion Physicians in training appear not to be biased either in favor of or against military veterans when judging the value of a patient's health. PMID:15070409

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.

Food Web Bioaccumulation Model for Resident Killer Whales from the Northeastern Pacific Ocean as a Tool for the Derivation of PBDE-Sediment Quality Guidelines.

PubMed

Alava, Juan José; Ross, Peter S; Gobas, Frank A P C

2016-01-01

Resident killer whale populations in the NE Pacific Ocean are at risk due to the accumulation of pollutants, including polybrominated diphenyl ethers (PBDEs). To assess the impact of PBDEs in water and sediments in killer whale critical habitat, we developed a food web bioaccumulation model. The model was designed to estimate PBDE concentrations in killer whales based on PBDE concentrations in sediments and the water column throughout a lifetime of exposure. Calculated and observed PBDE concentrations exceeded the only toxicity reference value available for PBDEs in marine mammals (1500 μg/kg lipid) in southern resident killer whales but not in northern resident killer whales. Temporal trends (1993-2006) for PBDEs observed in southern resident killer whales showed a doubling time of ≈5 years. If current sediment quality guidelines available in Canada for polychlorinated biphenyls are applied to PBDEs, it can be expected that PBDE concentrations in killer whales will exceed available toxicity reference values by a large margin. Model calculations suggest that a PBDE concentration in sediments of approximately 1.0 μg/kg dw produces PBDE concentrations in resident killer whales that are below the current toxicity reference value for 95 % of the population, with this value serving as a precautionary benchmark for a management-based approach to reducing PBDE health risks to killer whales. The food web bioaccumulation model may be a useful risk management tool in support of regulatory protection for killer whales.

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

PubMed

Gilani, Nima; Malcolm, Paul; Johnson, Glyn

2017-04-01

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

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

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

An analytical study of nitrogen oxides and carbon monoxide emissions in hydrocarbon combustion with added nitrogen - Preliminary results

NASA Technical Reports Server (NTRS)

Bittker, D. A.

1980-01-01

The influence of ground-based gas turbine combustor operating conditions and fuel-bound nitrogen (FBN) found in coal-derived liquid fuels on the formation of nitrogen oxides and carbon monoxide is investigated. Analytical predictions of NOx and CO concentrations are obtained for a two-stage, adiabatic, perfectly-stirred reactor operating on a propane-air mixture, with primary equivalence ratios from 0.5 to 1.7, secondary equivalence ratios of 0.5 or 0.7, primary stage residence times from 12 to 20 msec, secondary stage residence times of 1, 2 and 3 msec and fuel nitrogen contents of 0.5, 1.0 and 2.0 wt %. Minimum nitrogen oxide but maximum carbon monoxide formation is obtained at primary zone equivalence ratios between 1.4 and 1.5, with percentage conversion of FBN to NOx decreasing with increased fuel nitrogen content. Additional secondary dilution is observed to reduce final pollutant concentrations, with NOx concentration independent of secondary residence time and CO decreasing with secondary residence time; primary zone residence time is not observed to affect final NOx and CO concentrations significantly. Finally, comparison of computed results with experimental values shows a good semiquantitative agreement.

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

PubMed

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

2012-08-01

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

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.

Decreased Radiation Exposure Among Orthopedic Residents Is Maintained When Using the Mini C-Arm After Undergoing Radiation Safety Training.

PubMed

Gendelberg, David; Hennrikus, William L; Sawyer, Carissa; Armstrong, Douglas; King, Steven

2017-09-01

The resident curriculum of the American Board of Orthopaedic Surgery emphasizes radiation safety. Gendelberg showed that, immediately after a program on fluoroscopic safety, residents used less radiation when using the mini C-arm to reduce pediatric fractures. The current study evaluated whether this effect lasted. Residents underwent a new annual 3-hour session on mini C-arm use and radiation. Group A included 53 reductions performed before training. Group B included 45 reductions performed immediately after training. Group C included 46 reductions performed 11 months later. For distal radius fractures, exposure time and amount were 38.1 seconds and 83.1 mR, respectively, for group A; 26.7 seconds and 32.6 mR, respectively, for group B; and 24.1 seconds and 40.0 mR, respectively, for group C. When radiation time and amount were compared between group B and group C, P values were .525 and .293, respectively. When group C and group A were compared, P values were <.05 and <.01, respectively. For both bone forearm fractures, exposure time and amount were 41.2 seconds and 90.9 mR, respectively, for group A; 28.9 seconds and 30.4 mR, respectively, for group B; and 31.2 seconds and 43.6 mR, respectively, for group C. When radiation time and amount were compared between group B and group C, P values were .704 and .117, respectively. When group C and group A were compared, P values were .183 and .004, respectively. No significant difference in radiation exposure was noted immediately after training vs 11 months later. A sustained decrease in radiation exposure occurred after an educational program on safe mini C-arm use. [Orthopedics. 2017; 40(5):e788-e792.]. Copyright 2017, SLACK Incorporated.

A New Dimensionless Number for Redox Conditions within the Hyporheic Zone: Morphological and Biogeochemical Controls

NASA Astrophysics Data System (ADS)

Marzadri, A.; Tonina, D.; Bellin, A.

2012-12-01

We introduce a new Damköhler number, Da, to quantify the biogeochemical status of the hyporheic zone and to upscale local hyporheic processes to reach scale. Da is defined as the ratio between the median hyporheic residence time, τup,50, which is a representative time scale of the hyporheic flow, and a representative time scale of biogeochemical reactions, which we define as the time τlim needed to consume dissolved oxygen to a prescribed threshold concentration below which reducing reactions are activated: Da = τup,50/τlim. This approach accounts for streambed topography and surface hydraulics via the hyporheic residence time and biogeochemical reaction via the time limit τlim. Da can readily evaluate the redox status of the hyporheic zone. Values of Da larger than 1 indicate prevailing anaerobic conditions, whereas values smaller than 1 prevailing aerobic conditions. This new Damköhler number can quantify the efficiency of hyporheic zone in transforming dissolved inorganic nitrogen species such as ammonium and nitrate, whose transformation depends on the redox condition of the hyporheic zone. We define a particular value of Da, Das, that indicates when the hyporheic zone is a source or a sink of nitrate. This index depends only on the relative abundance of ammonium and nitrate. The approach can be applied to any hyporheic zone of which the median hyporheic residence time is known. Application to streams with pool-riffle morphology shows that Da increases passing from small to large streams implying that the fraction of the hyporheic zone in anaerobic conditions increases with stream size.

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.

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.

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

NASA Astrophysics Data System (ADS)

Pestryaev, E. M.

2018-07-01

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

Orthopedic surgery fellowships: the effects of interviewing and how residents establish a rank list.

PubMed

Niesen, Matthew C; Wong, Jeffrey; Ebramzadeh, Edward; Sangiorgio, Sophia; SooHoo, Nelson Fong; Luck, James V; Eckardt, Jeffrey

2015-03-01

The Orthopaedic Fellowship Match was established in 2008 to streamline and improve the process of matching residents and fellowships. The purpose of this study was to quantify the factors that affect the application process and to determine how residents establish a rank list. The Orthopaedic Fellowship Match has improved the ability of residents and programs to consider their options more carefully and to focus on finding the best match. However, this process introduces new factors for all parties involved to consider. The costs of the interview process and time away from service for residents may be larger than anticipated. Ultimately, residents value operative experience and staff members at a fellowship more than all other factors when selecting a fellowship. Copyright 2015, SLACK Incorporated.

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.

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.

Hidden in plain sight: the formal, informal, and hidden curricula of a psychiatry clerkship.

PubMed

Wear, Delese; Skillicorn, Jodie

2009-04-01

To examine perceptions of the formal, informal, and hidden curricula in psychiatry as they are observed and experienced by (1) attending physicians who have teaching responsibilities for residents and medical students, (2) residents who are taught by those same physicians and who have teaching responsibilities for medical students, and (3) medical students who are taught by attendings and residents during their psychiatry rotation. From June to November 2007, the authors conducted focus groups with attendings, residents, and students in one midwestern academic setting. The sessions were audiotaped, transcribed, and analyzed for themes surrounding the formal, informal, and hidden curricula. All three groups offered a similar belief that the knowledge, skills, and values of the formal curriculum focused on building relationships. Similarly, all three suggested that elements of the informal and hidden curricula were expressed primarily as the values arising from attendings' role modeling, as the nature and amount of time attendings spend with patients, and as attendings' advice arising from experience and intuition versus "textbook learning." Whereas students and residents offered negative values arising from the informal and hidden curricula, attendings did not, offering instead the more positive values they intended to encourage through the informal and hidden curricula. The process described here has great potential in local settings across all disciplines. Asking teachers and learners in any setting to think about how they experience the educational environment and what sense they make of all curricular efforts can provide a reality check for educators and a values check for learners as they critically reflect on the meanings of what they are learning.

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.

The value of internship in graduate medical education: survey of emergency medicine residents and program directors.

PubMed

Ray, Adam M

2007-01-01

To assess the opinions of emergency medicine (EM) residents and program directors about the value of completing a nonrequired 1-year internship before entering an EM residency program accredited by the Accreditation Council for Graduate Medical Education (ACGME). An eight-question, self-administered online survey was e-mailed to EM residents who had completed a nonrequired internship before entering ACGME-accredited residency programs. A separate, six-question survey was e-mailed to program directors of ACGME-accredited programs that do not require an internship who had ever had a resident who had completed a nonrequired internship. Forty-six (27 [59%] osteopathic, 19 [41%] allopathic) of 113 residents and 40 of 124 program directors responded to the survey questions. Less than 4% of residents completed a separate nonrequired 1-year internship. The most common reason for completing a nonrequired internship was to obtain licensure by the American Osteopathic Association (19 [41%]). Most residents believed that they were more proficient with history-taking and physical examinations (38 [83%]) and procedures (34 [74%]) during the first year of residency than their colleagues who did not complete an internship, but this percentage decreased over time. The program directors had similar opinions. Most osteopathic residents who completed the internship for osteopathic licensure would not have done so if it were not required. Most (39 of 40) program directors would not recommend taking a nonrequired internship. Completing a 1-year internship before entering an EM residency program may better prepare physicians for their first year of residency in terms of basic clinical competancy, but further study is needed in this area.

Using continuous underway isotope measurements to map water residence time in hydrodynamically complex tidal environments

USGS Publications Warehouse

Downing, Bryan D.; Bergamaschi, Brian; Kendall, Carol; Kraus, Tamara; Dennis, Kate J.; Carter, Jeffery A.; von Dessonneck, Travis

2016-01-01

Stable isotopes present in water (δ2H, δ18O) have been used extensively to evaluate hydrological processes on the basis of parameters such as evaporation, precipitation, mixing, and residence time. In estuarine aquatic habitats, residence time (τ) is a major driver of biogeochemical processes, affecting trophic subsidies and conditions in fish-spawning habitats. But τ is highly variable in estuaries, owing to constant changes in river inflows, tides, wind, and water height, all of which combine to affect τ in unpredictable ways. It recently became feasible to measure δ2H and δ18O continuously, at a high sampling frequency (1 Hz), using diffusion sample introduction into a cavity ring-down spectrometer. To better understand the relationship of τ to biogeochemical processes in a dynamic estuarine system, we continuously measured δ2H and δ18O, nitrate and water quality parameters, on board a small, high-speed boat (5 to >10 m s–1) fitted with a hull-mounted underwater intake. We then calculated τ as is classically done using the isotopic signals of evaporation. The result was high-resolution (∼10 m) maps of residence time, nitrate, and other parameters that showed strong spatial gradients corresponding to geomorphic attributes of the different channels in the area. The mean measured value of τ was 30.5 d, with a range of 0–50 d. We used the measured spatial gradients in both τ and nitrate to calculate whole-ecosystem uptake rates, and the values ranged from 0.006 to 0.039 d–1. The capability to measure residence time over single tidal cycles in estuaries will be useful for evaluating and further understanding drivers of phytoplankton abundance, resolving differences attributable to mixing and water sources, explicitly calculating biogeochemical rates, and exploring the complex linkages among time-dependent biogeochemical processes in hydrodynamically complex environments such as estuaries.

Residency characteristics that matter most to plastic surgery applicants: a multi-institutional analysis and review of the literature.

PubMed

Sinno, Sammy; Mehta, Karan; Squitieri, Lee; Ranganathan, Kavitha; Koeckert, Michael S; Patel, Ashit; Saadeh, Pierre B; Thanik, Vishal

2015-06-01

The National Residency Matching Program Match is a very unique process in which applicants and programs are coupled to each other based on a ranking system. Although several studies have assessed features plastic surgery programs look for in applicants, no study in the present plastic surgery literature identifies which residency characteristics are most important to plastic surgery applicants. Therefore, we sought to perform a multi-institutional assessment as to which factors plastic surgery residency applicants consider most important when applying for residency. A validated and anonymous questionnaire containing 37 items regarding various program characteristics was e-mailed to 226 applicants to New York University, Albany, University of Michigan, and University of Southern California plastic surgery residency programs. Applicants were asked to rate each feature on a scale from 1 to 10, with 10 being the most important. The 37 variables were ranked by the sum of the responses. The median rating and interquartile range as well as the mean for each factor was then calculated. A Wilcoxon signed rank test was used to compare medians in rank order. A total of 137 completed questionnaires were returned, yielding a 61% response rate. The characteristics candidates considered most important were impressions during the interview, experiences during away rotations, importance placed on resident training/support/mentoring by faculty, personal experiences with residents, and the amount of time spent in general surgery. The characteristics candidates considered least important were second-look experiences, compensation/benefits, program reputation from Internet forums, accessibility of program coordinator, opportunity for laboratory research, and fellowship positions available at the program. Applicants value personal contact and time spent in general surgery when selecting residency programs. As the number of integrated programs continues to grow, programs will benefit from learning what factors their applicants value most.

Residency Mini-fellowships in the PGY-5 Year: Is There Added Value?

PubMed

Shenoy-Bhangle, Anuradha S; Eisenberg, Ronald L; Fineberg, Tabitha; Slanetz, Priscilla J

2018-06-01

With the restructuring of radiology board certification, many residencies created PGY-5 "mini-fellowships," during which residents spend focused time pursuing advanced subspecialty training or developing nonclinical skills in leadership, health policy and health-care economics, education, quality improvement, informatics, research, or global health. We surveyed graduates of an academic diagnostic radiology residency to assess the relative value and impact of PGY-5 mini-fellowships on career satisfaction and success. From 2012 to 2016, 39 radiology residents at our institution were offered the opportunity to pursue a 3- to 6-month mini-fellowship during the PGY-5 year. Thirty of 39 radiology residents (77%) participated, whereas 9 of 39 (23%) opted out. Of 39 residents, 13 completed two clinical mini-fellowships, 3 completed research mini-fellowships only, and 14 completed one nonclinical and one clinical mini-fellowship. Through SurveyMonkey, 23 of 39 residents (59%) responded to a questionnaire that collected basic demographic information and asked respondents about the value of this experience as it relates to fellowship choice and career using a five-point Likert scale. Of 23 respondents (14 male, 8 female,1 not specified), 78.3% practice in an academic university-based setting, with 8.7% in a community-based hospital practice, 4.3% in the veterans system, and 4.3% in a private practice setting. Of 23 respondents, the most popular clinical mini-fellowships were magnetic resonance imaging (31.6%), neuroradiology (21.1%), and interventional radiology (15.8%). For nonclinical mini-fellowships, the most popular were research (10.5%), education (10.5%), global health (5.3%), and healthcare economics (5.3%). Of 23 respondents who did mini-fellowships, 95% felt that the mini-fellowship prepared them well for their career, 85% felt it gave them the necessary skills to succeed, 85% cited that it gave them additional skills beyond their peers, and 40% felt it helped them create a life-long connection to a mentor. Ninety-five percent of respondents would choose to do the mini-fellowship again. Respondents suggested increasing the duration to 6-9 months and to develop a more structured curriculum and mentorship component. Only one respondent felt that the nonclinical mini-fellowship took away time from furthering clinical skills. Graduates of a university-affiliated academic radiology residency who participated in clinical and nonclinical mini-fellowships during the PGY-5 year of residency greatly value this experience and uniformly recommend that this type of program continue to be offered to trainees given its ability to develop skills perceived to be vital to ultimate career satisfaction and success. Published by Elsevier Inc.

A [32P]-NAD+-based method to identify and quantitate long residence time enoyl-ACP reductase inhibitors

PubMed Central

Yu, Weixuan; Neckles, Carla; Chang, Andrew; Bommineni, Gopal Reddy; Spagnuolo, Lauren; Zhang, Zhuo; Liu, Nina; Lai, Christina; Truglio, James; Tonge, Peter J.

2015-01-01

The classical methods for quantifying drug-target residence time (tR) use loss or regain of enzyme activity in progress curve kinetic assays. However, such methods become imprecise at very long residence times, mitigating the use of alternative strategies. Using the NAD(P)H-dependent FabI enoyl-ACP reductase as a model system, we developed a Penefsky column-based method for direct measurement of tR, where the off-rate of the drug was determined with radiolabeled [adenylate-32P] NAD(P+) cofactor. Twenty-three FabI inhibitors were analyzed and a mathematical model was used to estimate limits to the tR values of each inhibitor based on percent drug-target complex recovery following gel filtration. In general, this method showed good agreement with the classical steady state kinetic methods for compounds with tR values of 10-100 min. In addition, we were able to identify seven long tR inhibitors (100-1500 min) and to accurately determine their tR values. The method was then used to measure tR as a function of temperature, an analysis not previously possible using the standard kinetic approach due to decreased NAD(P)H stability at elevated temperatures. In general, a 4-fold difference in tR was observed when the temperature was increased from 25 °C to 37 °C . PMID:25684450

Incorporation of core competency questions into an annual national self-assessment examination for residents in physical medicine and rehabilitation: results and implications.

PubMed

Webster, Joseph B

2009-03-01

To determine the performance and change over time when incorporating questions in the core competency domains of practice-based learning and improvement (PBLI), systems-based practice (SBP), and professionalism (PROF) into the national PM&R Self-Assessment Examination for Residents (SAER). Prospective, longitudinal analysis. The national Self-Assessment Examination for Residents (SAER) in Physical Medicine and Rehabilitation, which is administered annually. Approximately 1100 PM&R residents who take the examination annually. Inclusion of progressively more challenging questions in the core competency domains of PBLI, SBP, and PROF. Individual test item level of difficulty (P value) and discrimination (point biserial index). Compared with the overall test, questions in the subtopic areas of PBLI, SBP, and PROF were relatively easier and less discriminating (correlation of resident performance on these domains compared with that on the total test). These differences became smaller during the 3-year time period. The difficulty level of the questions in each of the subtopic domains was raised during the 3 year period to a level close to the overall exam. Discrimination of the test items improved or remained stable. This study demonstrates that, with careful item writing and review, multiple-choice items in the PBLI, SBP, and PROF domains can be successfully incorporated into an annual, national self-assessment examination for residents. The addition of these questions had value in assessing competency while not compromising the overall validity and reliability of the exam. It is yet to be determined if resident performance on these questions corresponds to performance on other measures of competency in the areas of PBLI, SBP, and PROF.

Teaching Medicine Through the Study of Literature: Implementing a Fourth-Year Distance Learning Elective.

PubMed

Welch, Tana Jean; Harrison, Suzanne Leonard

2016-03-01

The amount of time medical students must devote to the residency application process has increased, often at the expense of students' education. The fourth year is still a crucial component of medical education, especially for preparing students for the transition to residency. To maintain flexibility during the residency interview season and provide students with the opportunity to hone critical skills, faculty at the Florida State University College of Medicine developed a literature and medicine distance learning elective for fourth-year students. The four-week course was offered five times per academic year from 2012 to 2014. Participating students and faculty chose a topic and reading list, which guided both students' written reflections and the weekly discussions held via video conference. Nineteen students participated, and 13 completed a postcourse survey to gauge their overall impressions of the elective and its effects on their learning. Participants valued the course for six principal reasons: It (1) provided the opportunity to consider others' perspectives, (2) improved their ability to think as a physician and examine personal biases, (3) provided the opportunity to discuss nonmedical literature, (4) provided the opportunity to use different cognitive skills, (5) afforded flexibility, and (6) improved their ability to communicate about difficult topics. The long-term value of a distance learning elective in the humanities remains uncertain. The authors have begun to study students' perceptions of the elective's value after entering residency. However, they believe that the initial positive feedback justifies the course's replication at other institutions.

[Research of prevalence of schistosomiasis in Hunan province, 1984-2015].

PubMed

Li, F Y; Tan, H Z; Ren, G H; Jiang, Q; Wang, H L

2017-03-10

Objective: To analyze the prevalence of schistosomiasis in Hunan province, and provide scientific evidence for the control and elimination of schistosomiasis. Methods: The changes of infection rates of Schistosoma ( S .) japonicum among residents and cattle in Hunan from 1984 to 2015 were analyzed by using dynamic trend diagram; and the time regression model was used to fit the infection rates of S. japonicum , and predict the recent infection rate. Results: The overall infection rates of S. japonicum in Hunan from 1984 to 2015 showed downward trend (95.29% in residents and 95.16% in cattle). By using the linear regression model, the actual values of infection rates in residents and cattle were all in the 95% confidence intervals of the value predicted; and the prediction showed that the infection rates in the residents and cattle would continue to decrease from 2016 to 2020. Conclusion: The prevalence of schistosomiasis was in decline in Hunan. The regression model has a good effect in the short-term prediction of schistosomiasis prevalence.

Structure-mechanics property relationship of waste derived biochars.

PubMed

Das, Oisik; Sarmah, Ajit K; Bhattacharyya, Debes

2015-12-15

The widespread applications of biochar in agriculture and environmental remediation made the scientific community ignore its mechanical properties. Hence, to examine the scope of biochar's structural applications, its mechanical properties have been investigated in this paper through nanoindentation technique. Seven waste derived biochars, made under different pyrolysis conditions and from diverse feedstocks, were studied via nanoindentation, infrared spectroscopy, X-ray crystallography, thermogravimetry, and electron microscopy. Following this, an attempt was made to correlate the biochars' hardness/modulus with reaction conditions and their chemical properties. The pine wood biochar made at 900°C and 60min residence time was found to have the highest hardness and elastic modulus of 4.29 and 25.01GPa, respectively. It was shown that a combination of higher heat treatment (≥500°C) temperature and longer residence time (~60min) increases the values of hardness and modulus. It was further realized that pyrolysis temperature was a more dominant factor than residence time in determining the final mechanical properties of biochar particles. The degree of aromaticity and crystallinity of the biochar were also correlated with higher values of hardness and modulus. Copyright © 2015 Elsevier B.V. All rights reserved.

Deconstruction of lignocellulosic biomass with hydrated cerium (III) chloride in water and ethanol

DOE PAGES

Akalin, Mehmet K.; Das, Parthapratim; Alper, Koray; ...

2017-08-08

Lignocellulosic biomass was decomposed to produce crude bio-oil in water and ethanol using hydrated cerium (III) chloride as a catalyst. Use of the catalyst affected not only the yield of crude bio-oil but also the composition of bio-crude for both water and ethanol. The catalyst had a detrimental effect on the crude bio-oil yields obtained from water processing for all runs. However, in ethanol, use of the catalyst improved the crude bio-oil yields in all tested runs. The solid residue yields decreased with the catalyst use in the runs with water but increased in all studies with ethanol, except thosemore » with the shortest tested residence time of 10 min. The highest crude bio-oil yield of 48.2 wt% was obtained at 300 °C using 5 mmol of hydrated cerium (III) chloride at a residence time of 90 min in ethanol. The heating values of the crude bio-oils increased with the catalyst use for both water and ethanol processing. In conclusion, the highest heating value of 33.3 MJ kg –1 was obtained with hydrated cerium (III) chloride at 300 °C and a residence time of 120 min.« less

Deconstruction of lignocellulosic biomass with hydrated cerium (III) chloride in water and ethanol

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

Akalin, Mehmet K.; Das, Parthapratim; Alper, Koray

Lignocellulosic biomass was decomposed to produce crude bio-oil in water and ethanol using hydrated cerium (III) chloride as a catalyst. Use of the catalyst affected not only the yield of crude bio-oil but also the composition of bio-crude for both water and ethanol. The catalyst had a detrimental effect on the crude bio-oil yields obtained from water processing for all runs. However, in ethanol, use of the catalyst improved the crude bio-oil yields in all tested runs. The solid residue yields decreased with the catalyst use in the runs with water but increased in all studies with ethanol, except thosemore » with the shortest tested residence time of 10 min. The highest crude bio-oil yield of 48.2 wt% was obtained at 300 °C using 5 mmol of hydrated cerium (III) chloride at a residence time of 90 min in ethanol. The heating values of the crude bio-oils increased with the catalyst use for both water and ethanol processing. In conclusion, the highest heating value of 33.3 MJ kg –1 was obtained with hydrated cerium (III) chloride at 300 °C and a residence time of 120 min.« less

Training and retaining community pharmacy leaders: Career pathways after completing a PGY1 community pharmacy residency affiliated with a large supermarket chain.

PubMed

Hohmeier, Kenneth C; Borja-Hart, Nancy; Cooper, Maureen; Kirby, James; Fisher, Cindy

To determine pharmacist career paths and resident perceptions after completion of a PGY1 community pharmacy residency with a national supermarket pharmacy chain. Cross-sectional nationwide survey. Overall, 65% (n = 24) of residents who responded accepted a position with Kroger immediately after graduation. When asked about the degree of value the residency had on obtaining the resident's ideal position, 29 (76%) reported that it was "very valuable" and the remaining 9 (24%) reported that it was "somewhat valuable." Positions that these pharmacists held immediately after residency completion were: clinical pharmacist (clinical coordinators, patient care specialists, or patient care managers; 54%), staff pharmacist (21%), split/mixed (mixed clinical and staffing components; 21%), and pharmacy manager (4%). Residency trained pharmacists were retained by the pharmacy chain where they practiced, and the majority of those pharmacists held split or full-time clinical pharmacist roles within the chain supermarket pharmacy. Copyright © 2017 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

Improving Resident Performance in Knee Arthroscopy: A Prospective Value Assessment of Simulators and Cadaveric Skills Laboratories.

PubMed

Camp, Christopher L; Krych, Aaron J; Stuart, Michael J; Regnier, Terry D; Mills, Karen M; Turner, Norman S

2016-02-03

Cadaveric skills laboratories and virtual reality simulators are two common methods used outside of the operating room to improve residents' performance of knee arthroscopy. We are not aware of any head-to-head comparisons of the educational values of these two methodologies. The purpose of this prospective randomized trial was to assess the efficacy of these training methods, compare their rates of improvement, and provide economic value data to programs seeking to implement such technologies. Orthopaedic surgery residents were randomized to one of three groups: control, training on cadavera (cadaver group), and training with use of a simulator (simulator group). Residents completed pretest and posttest diagnostic knee arthroscopies on cadavera that were timed and video-recorded. Between the pretest and posttest, the control group performed no arthroscopy, the cadaver group performed four hours of practice on cadavera, and the simulator group trained for four hours on a simulator. All tests were scored in a blinded, randomized fashion using the validated Arthroscopy Surgical Skill Evaluation Tool (ASSET). The mean improvement in the ASSET score and in the time to complete the procedure were compared between the pretest and posttest and among the groups. Forty-five residents (fifteen per group) completed the study. The mean difference in the ASSET score from the pretest to the posttest was -0.40 (p = 0.776) in the control group, +4.27 (p = 0.002) in the cadaver group, and +1.92 (p = 0.096) in the simulator group (p = 0.015 for the comparison among the groups). The mean difference in the test-completion time (minutes:seconds) from the pretest to the posttest was 0:07 (p = 0.902) in the control group, 3:01 (p = 0.002) in the cadaver group, and 0:28 (p = 0.708) in the simulator group (p = 0.044 for the comparison among groups). Residents in the cadaver group improved their performance at a mean of 1.1 ASSET points per hour spent training whereas those in the simulator group improved 0.5 ASSET point per hour of training. Cadaveric skills laboratories improved residents' performance of knee arthroscopy compared with that of matched controls. Residents practicing on cadaveric specimens improved twice as fast as those utilizing a high-fidelity simulator; however, based on cost estimation specific to our institution, the simulator may be more cost-effective if it is used at least 300 hours per year. Additional study of this possibility is warranted. Copyright © 2016 by The Journal of Bone and Joint Surgery, Incorporated.

Neurocritical Care Education During Residency: Opinions (NEURON) Study.

PubMed

Lerner, David P; Kim, Jennifer; Izzy, Saef

2017-02-01

The American Academy of Neurology (AAN) has established a core curriculum of topics for residency training in neurocritical care. At present there is limited data evaluating neurology residency education within the neurological intensive care unit. This study evaluates learner concerns with the neurological intensive care unit. The Communication Committee and Resident & Fellow Taskforce within the Neurocritical Care Society (NCS) developed an online survey that consisted of 20 selection and free-text based questions. The survey was distributed to NCS members and then to neurology residency program directors. Statistical analysis of neurocritical care exposure were completed with t or Fisher exact test with p-value <0.05 considered significant. A total of 95 individuals from 32 different residency programs (36.5 % response rate) responded to the questionnaire. Most individuals train with neurocritical care attendings, fellows and advanced practitioners and have neurocritical care exposure during multiple years of residency training. 54 % of responders cite improvement in education as a means to improve neurocritical care training. Those that raised concern had no difference in time in the neurocritical care unit (9.4 weeks vs 8.8 weeks), exposure to trained neurointensivists, neurocritical care fellows or advanced providers (p value 0.53, 0.19, 0.83, respectively). There is significant learner concern regarding education within the neurointensive care unit. Although there are educational guidelines and focused neurocritical care educational materials, these alone do not satisfy residents' educational needs. This study demonstrates the need for educational changes, but it does not assess best strategies nor curricular content.

Measuring Value in Internal Medicine Residency Training Hospitals Using Publicly Reported Measures.

PubMed

Schickedanz, Adam; Gupta, Reshma; Arora, Vineet M; Braddock, Clarence H

2018-03-01

Graduate medical education (GME) lacks measures of resident preparation for high-quality, cost-conscious practice. The authors used publicly reported teaching hospital value measures to compare internal medicine residency programs on high-value care training and to validate these measures against program director perceptions of value. Program-level value training scores were constructed using Centers for Medicare & Medicaid Services Value-Based Purchasing (VBP) Program hospital quality and cost-efficiency data. Correlations with Association of Program Directors in Internal Medicine Annual Survey high-value care training measures were examined using logistic regression. For every point increase in program-level VBP score, residency directors were more likely to agree that GME programs have a responsibility to contain health care costs (adjusted odds ratio [aOR] 1.18, P = .04), their faculty model high-value care (aOR 1.07, P = .03), and residents are prepared to make high-value medical decisions (aOR 1.07, P = .09). Publicly reported clinical data offer valid measures of GME value training.

Improving the medical school-residency transition.

PubMed

Morgan, Helen; Skinner, Bethany; Marzano, David; Fitzgerald, James; Curran, Diana; Hammoud, Maya

2017-10-01

In response to calls to improve the continuum between undergraduate and graduate medical education, many medical schools are creating electives designed to prepare students for residency training. There is a need for data that link improvements from these residency preparation courses to residency itself. Data is needed that links improvements from these residency preparation courses to residency OBJECTIVE: To examine senior medical student performance on the Association of Professors of Gynecology and Obstetrics (APGO) Preparation for Residency Knowledge Assessment before and after an obstetrics and gynaecology residency preparation elective, and to determine whether the knowledge improvements persisted to the start of the residency. All 13 students enrolled in the course completed the APGO knowledge assessment on the first and last day of the elective. Three months later, the students were asked to re-take the assessment immediately prior to the start of their residency. There was improvement in mean scores from the pre-test score of 66.4 per cent to the post-test score of 77.4 per cent. At the time of the pre-test, three of the 13 students (23%) had passing scores (70% or greater), and at the time of the post-test, 11 of the 13 (85%) had passing scores. Nine of the 13 students (69%) completed the APGO knowledge assessment immediately prior to the start of their residency. Those nine students had a mean pre-residency score of 76.4 per cent. Eight of the nine students (89%) passed the pre-residency test. Our data support the value of residency preparation electives for improving knowledge, and suggest that senior medical school electives can help to bridge the continuum between undergraduate and graduate medical education. © 2016 John Wiley & Sons Ltd and The Association for the Study of Medical Education.

Social worker assessment of bad news delivery by emergency medicine residents: a novel direct-observation milestone assessment.

PubMed

Min, Alice Ann; Spear-Ellinwood, Karen; Berman, Melissa; Nisson, Peyton; Rhodes, Suzanne Michelle

2016-09-01

The skill of delivering bad news is difficult to teach and evaluate. Residents may practice in simulated settings; however, this may not translate to confidence or competence during real experiences. We investigated the acceptability and feasibility of social workers as evaluators of residents' delivery of bad news during patient encounters, and assessed the attitudes of both groups regarding this process. From August 2013 to June 2014, emergency medicine residents completed self-assessments after delivering bad news. Social workers completed evaluations after observing these conversations. The Assessment tools were designed by modifying the global Breaking Bad News Assessment Scale. Residents and social workers completed post-study surveys. 37 evaluations were received, 20 completed by social workers and 17 resident self-evaluations. Social workers reported discussing plans with residents prior to conversations 90 % of the time (18/20, 95 % CI 64.5, 97.8). Social workers who had previously observed the resident delivering bad news reported that the resident was more skilled on subsequent encounters 90 % of the time (95 % CI 42.2, 99). Both social workers and residents felt that prior training or experience was important. First-year residents valued advice from social workers less than advice from attending physicians, whereas more experienced residents perceived advice from social workers to be equivalent with that of attending physicians (40 versus 2.9 %, p = 0.002). Social worker assessment of residents' abilities to deliver bad news is feasible and acceptable to both groups. This formalized self-assessment and evaluation process highlights the importance of social workers' involvement in delivery of bad news, and the teaching of this skill. This method may also be used as direct-observation for resident milestone assessment.

The State of Communication Education in Family Medicine Residencies.

PubMed

Jansen, Kate L; Rosenbaum, Marcy E

2016-06-01

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

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

PubMed

Koochi, Hakimeh; Ebrahimi, Fatemeh

2014-09-07

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

Preliminary estimates of residence times and apparent ages of ground water in the Chesapeake Bay watershed, and water-quality data from a survey of springs

USGS Publications Warehouse

Focazio, Michael J.; Plummer, Niel; Bohlke, John K.; Busenberg, Eurybiades; Bachman, L. Joseph; Powars, David S.

1998-01-01

Knowledge of the residence times of the ground-water systems in Chesapeake Bay watershed helps resource managers anticipate potential delays between implementation of land-management practices and any improve-ments in river and estuary water quality. This report presents preliminary estimates of ground-water residence times and apparent ages of water in the shallow aquifers of the Chesapeake Bay watershed. A simple reservoir model, published data, and analyses of spring water were used to estimate residence times and apparent ages of ground-water discharge. Ranges of aquifer hydraulic characteristics throughout the Bay watershed were derived from published literature and were used to estimate ground-water residence times on the basis of a simple reservoir model. Simple combinations of rock type and physiographic province were used to delineate hydrogeomorphic regions (HGMR?s) for the study area. The HGMR?s are used to facilitate organization and display of the data and analyses. Illustrations depicting the relation of aquifer characteristics and associated residence times as a continuum for each HGMR were developed. In this way, the natural variation of aquifer characteristics can be seen graphically by use of data from selected representative studies. Water samples collected in September and November 1996, from 46 springs throughout the watershed were analyzed for chlorofluorocarbons (CFC?s) to estimate the apparent age of ground water. For comparison purposes, apparent ages of water from springs were calculated assuming piston flow. Additi-onal data are given to estimate apparent ages assuming an exponential distribution of ages in spring discharge. Additionally, results from previous studies of CFC-dating of ground water from other springs and wells in the watershed were compiled. The CFC data, and the data on major ions, nutrients, and nitrogen isotopes in the water collected from the 46 springs are included in this report. The apparent ages of water discharging from 30 of the 46 springs sampled were less than 20 years, including 5 that were 'modern' (0-4 years). Four samples had apparent ages of 22 to 34 years, and two others from thermal springs were 40 years or greater. The remaining ten samples were contaminated with local sources of CFC and could not be dated. Nitrate concentrations and nitrate delta 15 nitrogen (15N) values in water from many springs are similar to those in shallow ground water beneath fertilized fields, and some values are high enough to indicate a probable source from animal-waste components. The nitrogen data reported here highlight the significance of the springs sampled during this study as pathways for nutrient transport in the Chesapeake Bay watershed. Ground-water samples were collected from springs during an unusually high flow period and thus may not be representative of low base-flow conditions. Residence times estimated from plausible ranges of aquifer properties and results of previous age-dating analyses generally corroborate the apparent-age analysis made in the current study and suggests that some residence times could be much longer. The shortest residence times tend to be in the Blue Ridge and northern carbonate areas; however, the data are preliminary and not appropriate for statistical tests of significance or variance. Because the age distributions in the aquifer discharging to the springs are not known, and because the apparent ages of water from the springs are based on various com-binations of CFC criteria, the apparent ages and calculated residence times are compared for illustrative purposes but are considered preliminary until further work is accomplished.

Protected block time for teaching and learning in a postgraduate family practice residency program

PubMed Central

Jung, Piera; Kennedy, Maggie; Winder, Mary J.

2012-01-01

Abstract Objective To explore the elements necessary for a high-quality educational experience in a family practice residency program with respect to scheduling, learning environment, and approaches to teaching and learning. Design An interpretative, qualitative study using a generative-inquiry approach. Setting The Nanaimo Site of the University of British Columbia Family Practice Residency Program. Participants Fifteen physician instructors and 16 first- and second-year residents. Methods Data were gathered from 2 qualitative focus group interviews with residents; 2 qualitative focus group interviews with physician instructors; and structured and semistructured observation of 2 in-class seminars, with a focus on residents’ engagement with the class. Results were analyzed and categorized into themes independently and collectively by the researchers. Main findings Protected block time for teaching and learning at the Nanaimo Site has been effective in fostering a learning environment that supports collegial relationships and in-depth instruction. Residents and physician instructors benefit from the week-long academic schedule and the opportunity to teach and learn collaboratively. Participants specifically value the connections among learning environment, collegiality, relationships, reflective learning, and the teaching and learning process. Conclusion These findings suggest that strategic planning and scheduling of teaching and learning sessions in residency programs are important to promoting a comprehensive educational experience. PMID:22700741

National Defense Budget Estimates for FY 1999

DTIC Science & Technology

1998-03-01

National Product (GNP) to the Gross Domestic Product (GDP). Both GNP and GDP measure output at market prices, but in a slightly different manner. GNP...measures the market value of all goods and services produced during a particular time period by U.S. individuals, businesses and government; it...residents of the rest of the world. GDP measures the market value of all goods and services produced during a particular time period by individuals

Characteristics of Highly Rated Internal Medicine Attendings Before and After the 2004 Work-Hour Restrictions.

PubMed

Mallory, Renee; Jackson, Jeffrey L; Mondragon, Donald; Hatzigeorgiou, Christos; DeZee, Kent J; Greenburg, David; O'Malley, Patrick G

2016-01-01

To describe the characteristics of top-rated Internal Medicine attendings and whether they changed after implementation of the 2004 work-hour restrictions. Mixed methods study of resident ratings of medicine attendings (Period 1: 1994-1996, n = 250 and Period 2: 2007-2009, n = 152). Residents evaluated 17 attending characteristics. The top 25% of "overall" ratings were classified as "highly rated." Two free-text questions included "What was your attending's best characteristic?" and "How could your attending best improve?" and were coded in duplicate, using grounded qualitative methods. There were no differences in the characteristics of highly rated attendings in the two time periods. Characteristics associated with being a top-rated attending included enthusiasm (odds ratio [OR]: 5.69, 2.78-11.67), balanced teaching style (OR: 3.63, 1.64-8.02), promoting independent thinking (OR: 2.90, 0.96-8.74), fund of knowledge (OR: 2.73, 1.13-6.58), and time management (OR: 1.78, 1.14-2.80). Among the 1,410 utterances, valued attending attributes included helpfulness, promoting independent thinking, and having strong medical knowledge. The characteristics valued by residents in attendings did not change over time despite a major structural change in work hours and patterns of teaching. These valued characteristics continue to be a strong general fund of knowledge, enthusiasm for teaching, and balance between didactic and bedside approaches. Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.

Effect of Deep Drying and Torrefaction Temperature on Proximate, Ultimate Composition, and Heating Value of 2-mm Lodgepole Pine (Pinus contorta) Grind

PubMed Central

Tumuluru, Jaya Shankar

2016-01-01

Deep drying and torrefaction compose a thermal pretreatment method where biomass is heated in the temperature range of 150–300 °C in an inert or reduced environment. The process parameters, like torrefaction temperature and residence time, have a significant impact on the proximate, ultimate, and energy properties. In this study, torrefaction experiments were conducted on 2-mm ground lodgepole pine (Pinus contorta) using a thermogravimetric analyzer. Both deep drying and torrefaction temperature (160–270 °C) and time (15–120 min) were selected. Torrefied samples were analyzed for the proximate, ultimate, and higher heating value. The results indicate that moisture content decreases with increases in torrefaction temperature and time, where at 270 °C and 120 min, the moisture content is found to be 1.15% (w.b.). Volatile content in the lodgepole pine decreased from about 80% to about 45%, and ash content increased from 0.77% to about 1.91% at 270 °C and 120 min. The hydrogen, oxygen, and sulfur content decreased to 3%, 28.24%, and 0.01%, whereas the carbon content and higher heating value increased to 68.86% and 23.67 MJ/kg at 270 °C and 120 min. Elemental ratio of hydrogen to carbon and oxygen to carbon (H/C and O/C) calculated at 270 °C and a 120-min residence time were about 0.56 and 0.47. Based on this study, it can be concluded that higher torrefaction temperatures ≥230 °C and residence time ≥15 min influence the proximate, ultimate, and energy properties of ground lodgepole pine. PMID:28952578

Training Family Medicine Residents to Perform Home Visits: A CERA Survey.

PubMed

Sairenji, Tomoko; Wilson, Stephen A; D'Amico, Frank; Peterson, Lars E

2017-02-01

Home visits have been shown to improve quality of care, save money, and improve outcomes. Primary care physicians are in an ideal position to provide these visits; of note, the Accreditation Council for Graduate Medical Education no longer requires home visits as a component of family medicine residency training. To investigate changes in home visit numbers and expectations, attitudes, and approaches to training among family medicine residency program directors. This research used the Council of Academic Family Medicine Educational Research Alliance (CERA) national survey of family medicine program directors in 2015. Questions addressed home visit practices, teaching and evaluation methods, common types of patient and visit categories, and barriers. There were 252 responses from 455 possible respondents, representing a response rate of 55%. At most programs, residents performed 2 to 5 home visits by graduation in both 2014 (69% of programs, 174 of 252) and 2015 (68%, 172 of 252). The vast majority (68%, 172 of 252) of program directors expect less than one-third of their graduates to provide home visits after graduation. Scheduling difficulties, lack of faculty time, and lack of resident time were the top 3 barriers to residents performing home visits. There appeared to be no decline in resident-performed home visits in family medicine residencies 1 year after they were no longer required. Family medicine program directors may recognize the value of home visits despite a lack of few formal curricula.

Interactions with the pharmaceutical industry: experiences and attitudes of psychiatry residents, interns and clerks.

PubMed Central

Hodges, B

1995-01-01

OBJECTIVE: To examine the type and number of interactions of psychiatry residents, interns and clerks with sales representatives of pharmaceutical companies and the attitudes of physicians-in-training toward these interactions. DESIGN: Survey conducted with the use of a self-report questionnaire. SETTING: Seven teaching hospitals affiliated with the Department of Psychiatry, University of Toronto. PARTICIPANTS: All 105 residents, interns and clerks training in psychiatry at the seven teaching hospitals between October 1993 and February 1994 were eligible; 74 completed questionnaires, for a response rate of 70%. One respondent was excluded from the analysis. OUTCOME MEASURES: Number of personal meetings and "drug lunches" attended, number of drug samples and promotional items received and estimated value of gifts received by each physician-in-training during a 1-year period as well as attitudes of residents, interns and clerks about interactions with pharmaceutical representatives. RESULTS: Median number of personal meetings reported was 1 (range 0 to 35), of drug lunches attended was 10 (range 0 to 70), of promotional items received was 2 (range 0 to 75) and of drug samples received was 1 (range 0 to 20). Trainees' median estimate of the value of gifts received was $20 (range $0 to $800 Fewer than one third felt that pharmaceutical representatives were a source of accurate information about drugs; however, 71% (52/73) disagreed with the statement that representatives should be banned from making presentations. Although only 15% (11/73) felt they had sufficient training about meeting with pharmaceutical representatives, 34% (25/73) felt that discussions with representatives would have no impact on their prescribing practices, and 56% (41/73) felt that receiving gifts would have no impact on prescribing. Fewer than half said they would maintain the same degree of contact with representatives if they did not receive promotional gifts. The more money and promotional items a physician-in-training had received, the more likely he or she was to believe that discussions with representatives did not affect prescribing (p < 0.05). Clerks, interns and junior (first-year and second-year) residents attended two to three times more drug lunches than senior (third-year and fourth-year) residents, and significantly more junior than senior residents felt that pharmaceutical representatives have a valuable teaching role. Junior residents were three times more likely than senior residents to have received drug samples. CONCLUSIONS: Interactions between pharmaceutical representatives and psychiatry residents, interns and clerks are common. The physicians-in-training perceive little educational value in these contacts and many, especially clerks, interns and junior residents, disavow the potential of these interactions to influence prescribing. Therefore, supervisors of postgraduate medical training programs may wish to provide instruction concerning potential conflicts of interest inherent in these types of interactions. PMID:7641153

Residency Program Directors' View on the Value of Teaching.

PubMed

Korte, Catherine; Smith, Andrew; Pace, Heather

2016-08-01

There is no standardization for teaching activities or a requirement for residency programs to offer specific teaching programs to pharmacy residents. This study will determine the perceived value of providing teaching opportunities to postgraduate year 1 (PGY-1) pharmacy residents in the perspective of the residency program director. The study will also identify the features, depth, and breadth of the teaching experiences afforded to PGY-1 pharmacy residents. A 20-question survey was distributed electronically to 868 American Society of Health-System Pharmacists-accredited PGY-1 residency program directors. The survey was completed by 322 program directors. Developing pharmacy educators was found to be highly valued by 57% of the program directors. Advertisement of teaching opportunities was found to be statistically significant when comparing program directors with a high perceived value for providing teaching opportunities to program demographics. Statistically significant differences were identified associating development of a teaching portfolio, evaluation of Advanced Pharmacy Practice Experiences students, and delivery of didactic lectures with program directors who highly value developing pharmacy educators. Future residency candidates interested in teaching or a career in academia may utilize these findings to identify programs that are more likely to value developing pharmacy educators. The implementation of a standardized teaching experience among all programs may be difficult. © The Author(s) 2015.

Teaching and learning the physician manager role: psychiatry residents' perspectives.

PubMed

Stergiopoulos, Vicky; Maggi, Julie; Sockalingam, Sanjeev

2010-01-01

Despite widespread consensus that additional training in administration is needed to prepare physicians for practice, little is known about how best to teach managerial competencies and how to integrate teaching into existing postgraduate curricula. This study aimed to elicit resident perspectives on administrative curriculum development following exposure to a pilot physician manager curriculum at the University of Toronto. The authors held five focus groups of psychiatry residents at the University of Toronto during 2008, engaging 40 trainees. Resident perspectives on barriers to teaching and learning administrative skills, preferred curriculum content and format and suggestions for integration of administrative training into the residency programme were elicited. Identified barriers to learning include lack of physician manager role clarity, dearth of learning opportunities and multiple competing demands on residents' time. Residents value a formal administrative curriculum and propose additional opportunities for experiential learning such as elective rotations and mentorship opportunities. Suggested strategies for integrating administrative teaching into residency include faculty development, rotation-specific administrative objectives and end of rotation resident evaluations. Our findings provide valuable learner input into an emerging educational framework aiming to address barriers to teaching administrative skills during residency and facilitate longitudinal reinforcement of learning.

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

PubMed

Wang, Lizhang; Zhao, Yuemin

2010-01-01

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

The value of case-based teaching vignettes in clinical microbiology rounds.

PubMed

Spicer, Jennifer O; Kraft, Colleen S; Burd, Eileen M; Armstrong, Wendy S; Guarner, Jeannette

2014-03-01

To describe the implementation and evaluation of a case-based microbiology curriculum during daily microbiology rounds. Vignettes consist of short cases with images and questions that facilitate discussion among microbiologists, pathologists, infectious disease physicians, and trainees (residents and fellows). We performed a survey to assess the value of these vignettes to trainees. Motivation to come to rounds on time increased from 60% to 100%. Trainees attending rounds after implementation of the vignettes perceived the value of microbiology rounds to be significantly higher compared with those who attended rounds before implementation (P = .04). Pathology residents found that vignettes were helpful for retaining knowledge (8.3 of 10 points). The vignettes have enhanced the value of microbiology rounds by serving as a formalized curriculum exposing trainees from multiple specialties to various microbiology topics. Emphasis on interdisciplinary interactions between clinical and laboratory personnel was highlighted with this case-based curriculum.

Compound Selectivity and Target Residence Time of Kinase Inhibitors Studied with Surface Plasmon Resonance.

PubMed

Willemsen-Seegers, Nicole; Uitdehaag, Joost C M; Prinsen, Martine B W; de Vetter, Judith R F; de Man, Jos; Sawa, Masaaki; Kawase, Yusuke; Buijsman, Rogier C; Zaman, Guido J R

2017-02-17

Target residence time (τ) has been suggested to be a better predictor of the biological activity of kinase inhibitors than inhibitory potency (IC 50 ) in enzyme assays. Surface plasmon resonance binding assays for 46 human protein and lipid kinases were developed. The association and dissociation constants of 80 kinase inhibitor interactions were determined. τ and equilibrium affinity constants (K D ) were calculated to determine kinetic selectivity. Comparison of τ and K D or IC 50 values revealed a strikingly different view on the selectivity of several kinase inhibitors, including the multi-kinase inhibitor ponatinib, which was tested on 10 different kinases. In addition, known pan-Aurora inhibitors resided much longer on Aurora B than on Aurora A, despite having comparable affinity for Aurora A and B. Furthermore, the γ/δ-selective PI3K inhibitor duvelisib and the δ-selective drug idelalisib had similar 20-fold selectivity for δ- over γ-isoform but duvelisib resided much longer on both targets. Copyright © 2016 Elsevier Ltd. All rights reserved.

Proficiency-based cervical cancer brachytherapy training.

PubMed

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

2018-04-25

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

Hydraulic effects on nitrogen removal in a tidal spring-fed river

NASA Astrophysics Data System (ADS)

Hensley, Robert T.; Cohen, Matthew J.; Korhnak, Larry V.

2015-03-01

Hydraulic properties such as stage and residence time are important controls on riverine N removal. In most rivers, these hydraulic properties vary with stochastic precipitation forcing, but in tidal rivers, hydraulics variation occurs on a predictable cycle. In Manatee Springs, a highly productive, tidally influenced spring-fed river in Florida, we observed significant reach-scale N removal that varied in response to tidally driven variation in hydraulic properties as well as sunlight-driven variation in assimilatory uptake. After accounting for channel residence time and stage variation, we partitioned the total removal signal into assimilatory (i.e., plant uptake) and dissimilatory (principally denitrification) pathways. Assimilatory uptake was strongly correlated with primary production and ecosystem C:N was concordant with tissue stoichiometry of the dominant autotrophs. The magnitude of N removal was broadly consistent in magnitude with predictions from models (SPARROW and RivR-N). However, contrary to model predictions, the highest removal occurred at the lowest values of τ/d (residence time divided by depth), which occurred at low tide. Removal efficiency also exhibited significant counterclockwise hysteresis with incoming versus outgoing tides. This behavior is best explained by the sequential filling and draining of transient storage zones such that water that has spent the longest time in the storage zone, and thus had the most time for N removal, drains back into the channel at the end of an outgoing tide, concurrent with shortest channel residence times. Capturing this inversion of the expected relationship between channel residence time and N removal highlights the need for nonsteady state reactive transport models.

Attitudes Toward Research During Residency: A Survey of Canadian Residents in Obstetrics and Gynecology.

PubMed

Clancy, Aisling A; Posner, Glenn

2015-01-01

Obstetrics and Gynecology (Ob/Gyn) residency programs in Canada mandate participation in scholarly research activity, yet there remains a lack of literature on trainees' opinions regarding its value, feasibility, and perceived effect on future practice. An understanding of resident attitudes toward research during residency is essential in effectively engaging trainees and fostering a robust research community in the field. We sought to identify factors reported to influence involvement in resident research, including perceived barriers. Anonymous data were collected via an online survey distributed to all residents enrolled in accredited Ob/Gyn residency programs throughout Canada. The 10-minute, previously piloted questionnaire covered questions related to demographic information, research experience, career goals, current research activities, opinions on research environment, and opinions regarding the effect of research on future practice. Descriptive statistics were used to describe demographics, research background, and current research activities. Categorical variables were compared using the chi-square analysis and continuous variables were compared using the Mann-Whitney rank sum tests. A total of 175 residents completed the survey; 61% agreed/strongly agreed that they participate in research solely because it is mandated by their program, 22% felt that their training environment did not promote research, 19% disagreed/strongly disagreed that research is a positive experience, while 70% agreed/strongly agreed that they would prefer to complete another educational activity other than a research project. Time constraints owing to residency duties, time constraints owing to personal reasons, and lack of statistical knowledge were reported as barriers to research involvement by 97%, 90%, and 74% of trainees, respectively. Residents with graduate degrees were less likely to report lack of training on research design as a moderate/extreme barrier (7% vs 32%, p = 0.007). There exists considerable disparity in enthusiasm for scholarly research activity among Ob/Gyn residents. Curricular development should focus on addressing resident-reported barriers, including the provision of protected time for research and access to statistical support and education, particularly for residents without graduate degrees. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Fostering professional formation in residency: development and evaluation of the "forum" seminar series.

PubMed

Nothnagle, Melissa; Reis, Shmuel; Goldman, Roberta E; Anandarajah, Gowri

2014-01-01

Residency training is a critical time for physicians' professional formation. However, few structured interventions exist to support residents in this transformative process of integrating personal and professional values, a process that is essential to physician identity formation and preservation of core values such as service and compassion. The authors created a seminar series, the "Forum," to support resident professional formation and address the hidden curriculum as part of a larger intervention to support self-directed learning skills such as goal setting and reflection. Ninety-minute sessions with senior residents and faculty held every other month include opportunities for individual reflection, small- and large-group discussion, and brief didactic components focused on skills such as teaching and leadership. The qualitative program evaluation included analyses of individual semistructured interviews with resident and faculty participants from 2008 to 2011 and of notes recorded by an observer during the 1st year's sessions. Residents appreciated the focus on relevant issues, presence of faculty, opportunities for reflection and interactivity, and inclusion of practical skills. Effects attributed to the Forum included gaining practical skills, feeling a deeper connection to one another and a sense of community, and recognizing progress in their own professional development and growth. Elements described in the literature as essential to professional formation, including encouraging reflection, use of narrative, role modeling, addressing the hidden curriculum, and fostering an authentic community, were recognized by participants as integral to the Forum's success. A group forum for reflection and discussion with peers and role models, tailored to local needs, offers an effective structure to foster professional formation in residency.

Residents' views of the role of classroom-based learning in graduate medical education through the lens of academic half days.

PubMed

Chen, Luke Y C; McDonald, Julie A; Pratt, Daniel D; Wisener, Katherine M; Jarvis-Selinger, Sandra

2015-04-01

To examine the role of classroom-based learning in graduate medical education through the lens of academic half days (AHDs) by exploring residents' perceptions of AHDs' purpose and relevance and the effectiveness of teaching and learning in AHDs. The authors invited a total of 186 residents in three programs (internal medicine, orthopedic surgery, and hematology) at the University of British Columbia Faculty of Medicine to participate in semistructured focus groups from October 2010 to February 2011. Verbatim transcripts of the interviews underwent inductive analysis. Twenty-seven residents across the three programs volunteered to participate. Two major findings emerged. Purpose and relevance of AHDs: Residents believed that AHDs are primarily for knowledge acquisition and should complement clinical learning. Classroom learning facilitated consolidation of clinical experiences with expert clinical reasoning. Social aspects of AHDs were highly valued as an important secondary purpose. Perceived effectiveness of teaching and learning: Case-based teaching engaged residents in critical thinking; active learning was valued. Knowledge retention was considered suboptimal. Perspectives on the concept of AHDs as "protected time" varied in the three programs. Findings suggest that (1) engagement in classroom learning occurs through participation in clinically oriented discussions that highlight expert reasoning processes; (2) formal classroom teaching, which focuses on knowledge acquisition, can enhance informal learning occurring during clinical activity; and (3) social aspects of AHDs, including their role in creating communities of practice in residency programs and in professional identity formation, are an important, underappreciated asset for residency programs.

Latitude of residence and position in time zone are predictors of cancer incidence, cancer mortality, and life expectancy at birth.

PubMed

Borisenkov, Mikhail F

2011-03-01

According to the hypothesis of circadian disruption, external factors that disturb the function of the circadian system can raise the risk of malignant neoplasm and reduce life span. Recent work has shown that the functionality of the circadian system is dependent not only on latitude of residence but also on the region's position in the time zone. The purpose of the present research was to examine the influence of latitude and time zone on cancer incidence, cancer mortality, and life expectancy at birth. A stepwise multiple regression analysis was carried out on residents of 59 regions of the European part of the Russian Federation (EPRF) using age-standardized parameters (per 100,000) of cancer incidence (CI), cancer mortality (CM), and life expectancy at birth (LE, yrs) as dependent variables. The geographical coordinates (latitude and position in the time zone) of the regions were used as independent variables, controlling for the level of economic development in the regions. The same analysis was carried out for LE in 31 regions in China. Latitude was the strongest predictor of LE in the EPRF population; it explained 48% and 45% of the variability in LE of women and men, respectively. Position within the time zone accounted for an additional 4% and 3% variability of LE in women and men, respectively. The highest values for LE were observed in the southeast of the EPRF. In China, latitude was not a predictor of LE, whereas position in the time zone explained 15% and 18% of the LE variability in women and men, respectively. The highest values of LE were observed in the eastern regions of China. Both latitude and position within the time zone were predictors for CI and CM of the EPRF population. Latitude was the best predictor of stomach CI and CM; this predictor explained 46% and 50% of the variability, respectively. Position within the time zone was the best predictor of female breast CM; it explained 15% of the variability. In most cases, CI and CM increased with increasing latitude of residence, from the eastern to the western border of the time zone, and with increasing level of economic development within the region. The dependence of CI, CM, and LE on the geographical coordinates of residence is in agreement with the hypothesis of circadian disruption.

Teaching physics to radiology residents.

PubMed

Hendee, William R

2009-04-01

The complexity of diagnostic imaging has expanded dramatically over the past two decades. Over the same period, the time and effort devoted to teaching physics (the science and technology of the discipline) have diminished. This paradox compromises the ability of future radiologists to master imaging technologies so that they are used in an efficient, safe, and cost-effective manner. This article addresses these issues. Efforts involving many professional organizations are under way to resolve the paradox of the expanding complexity of medical imaging contrasted with the declining emphasis on physics in radiology residency programs. These efforts should help to reestablish physics education as a core value in radiology residency programs.

Development of Electronic Medical Record-Based "Rounds Report" Results in Improved Resident Efficiency, More Time for Direct Patient Care and Education, and Less Resident Duty Hour Violations.

PubMed

Ham, Phillip B; Anderton, Toby; Gallaher, Ryan; Hyrman, Mike; Simmerman, Erika; Ramanathan, Annamalai; Fallaw, David; Holsten, Steven; Howell, Charles Gordon

2016-09-01

Surgeons frequently report frustration and loss of efficiency with electronic medical record (EMR) systems. Together, surgery residents and a programmer at Augusta University created a rounds report (RR) summarizing 24 hours of vitals, intake/output, labs, and other values for each inpatient that were previously transcribed by hand. The objective of this study was to evaluate the RR's effect on surgery residents. Surgery residents were queried to assess the RR's impact. Outcome measures were time spent preparing for rounds, direct patient care time, educational activity time, rates of incorrect/incomplete data on rounds, and rate of duty hour violations. Hospital wide, 17,200 RRs were generated in the 1-month study. Twenty-three surgery residents participated. Time spent preparing for rounds decreased per floor patient (15.6 ± 3.0 vs 6.0 ± 1.2, P < 0.0001) and per intensive care unit patient (19.9 ± 2.9 vs 7.5 ± 1.2 P < 0.0001). The work day spent in direct patient care increased from 45.1 ± 5.6 to 54.0 ± 5.7 per cent (P = 0.0044). Educational activity time increased from 35.2 ± 5.4 to 54.7 ± 7.1 minutes per resident per day (P = 0.0004). Reported duty hour violations decreased 58 per cent (P < 0.0001). American Board of Surgery in Training exam scores trended up, and estimates of departmental annual financial savings range from $66,598 to $273,141 per year. Significant improvements occur with surgeon designed EMR tools like the RR. Hospitals and EMR companies should pair interested surgeons with health information technology developers to facilitate EMR enhancements. Improvements like RRs can have broad ranging, multidisciplinary impact and should be standard in all EMRs used for inpatient care at academic medical centers.

[Oral and maxillofacial surgery residency training in the United States: what can we learn].

PubMed

Ren, Y F

2017-04-09

China is currently in the process of establishing formal residency training programs in oral and maxillofacial surgery and other medical and dental specialties. Regulatory agencies, and educational and academic institutions in China are exploring mechanisms, goals and standards of residency training that meet the needs of the Chinese healthcare system. This article provides an introduction of residency training in oral and maxillofacial surgery in the United States, with emphasis on the accreditation standard by the Commission on Dental Accreditation. As there are fundamental differences in the medical and dental education systems between China and United States, the training standards in the United States may not be entirely applicable in China. A competency-based training model that focus on overall competencies in medical knowledge, clinical skills and values at the time of graduation should be taken into consideration in a Chinese residency training program in oral and maxillofacial surgery.

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.

Assessing the predictive value of the American Board of Family Practice In-training Examination.

PubMed

Replogle, William H; Johnson, William D

2004-03-01

The American Board of Family Practice In-training Examination (ABFP ITE) is a cognitive examination similar in content to the ABFP Certification Examination (CE). The ABFP ITE is widely used in family medicine residency programs. It was originally developed and intended to be used for assessment of groups of residents. Despite lack of empirical support, however, some residency programs are using ABFP ITE scores as individual resident performance indicators. This study's objective was to estimate the positive predictive value of the ABFP ITE for identifying residents at risk for poor performance on the ABFP CE or a subsequent ABFP ITE. We used a normal distribution model for correlated test scores and Monte Carlo simulation to investigate the effect of test reliability (measurement errors) on the positive predictive value of the ABFP ITE. The positive predictive value of the composite score was .72. The positive predictive value of the eight specialty subscales ranged from .26 to .57. Only the composite score of the ABFP ITE has acceptable positive predictive value to be used as part of a comprehension resident evaluation system. The ABFP ITE specialty subscales do not have sufficient positive predictive value or reliability to warrant use as performance indicators.

Axial dispersion, holdup and slip velocity of dispersed phase in a pulsed sieve plate extraction column by radiotracer residence time distribution analysis.

PubMed

Din, Ghiyas Ud; Chughtai, Imran Rafiq; Inayat, Mansoor Hameed; Khan, Iqbal Hussain

2008-12-01

Axial dispersion, holdup and slip velocity of dispersed phase have been investigated for a range of dispersed and continuous phase superficial velocities in a pulsed sieve plate extraction column using radiotracer residence time distribution (RTD) analysis. Axial dispersion model (ADM) was used to simulate the hydrodynamics of the system. It has been observed that increase in dispersed phase superficial velocity results in a decrease in its axial dispersion and increase in its slip velocity while its holdup increases till a maximum asymptotic value is achieved. An increase in superficial velocity of continuous phase increases the axial dispersion and holdup of dispersed phase until a maximum value is obtained, while slip velocity of dispersed phase is found to decrease in the beginning and then it increases with increase in superficial velocity of continuous phase.

Development of a gastroenterology educational curriculum for pediatric residents using fellows as teachers.

PubMed

Pentiuk, Scott; Baker, Raymond

2012-02-01

At many institutions, the teaching provided on subspecialty gastroenterology rotations is not structured. The purpose of the present study was to describe the development, implementation, and assessment of a structured gastroenterology curriculum for pediatric residents. A needs assessment was performed via a survey of former pediatric resident graduates presently working in general pediatrics. Topics for the curriculum were developed based upon the needs assessment. Second-year residents on the inpatient gastroenterology rotation attended 4 case-based, small group sessions per week for 1 month. Sessions were taught primarily by upper-level gastroenterology fellows. The curriculum was assessed via a pre-posttest, postrotation survey, and group feedback sessions. Resident rating of education received during the rotation was high. Posttest scores increased slightly but significantly compared with pretest values. The curriculum has continued to be used >4 years after its development. The creation of a structured subspecialty curriculum with the use of fellows as teachers is both feasible and effective despite limitations in available time for resident teaching.

Choosing academia versus private practice: factors affecting oral maxillofacial surgery residents' career choices.

PubMed

Lanzon, Jesse; Edwards, Sean P; Inglehart, Marita R

2012-07-01

This study explored how residents who intend to enter private practice versus academic careers differ in their background and educational characteristics, engagement in different professional activities, professional values, and satisfaction. Survey data were collected from 257 residents in oral and maxillofacial surgery programs in the United States. The responses of the respondents who planned a career in private practice (65%) and who considered academia (35%) were compared with χ(2) and independent-sample t tests. Residents who considered academia were more likely to be women (29% vs 8%; P < .001), from non-European American backgrounds (37% vs 20%; P = .006), were less likely to be married (43% vs 71%; P < .001), and were less likely to have children (17% vs 40%; P < .001) than residents who planned to become private practitioners. A larger percentage of residents with interest in private practice reported having debts of $301,000 to $400,000 compared with the percentage of residents interested in academia. No differences were found in the way they financed their education or in their financial considerations. However, the 2 groups differed in the importance they placed on different characteristics of their professional lives and in their job-related satisfaction. Residents interested in academia responded less positively to the statement that they are extremely satisfied with their career compared with residents interested in private practice. Future clinicians placed a higher value on having manageable hours and more time performing outpatient procedures than future educators. These findings showed, first, that the characteristics at the beginning of residency programs that are likely to indicate an increased interest in academic careers are being a woman, from a non-European American background, and having an interest in research. Second, once residents are admitted, different types of surgeries and different types of professional activities tend to appeal to residents who want to practice in private practice settings versus work in academia. Third, residents interested in academia have a relatively lower level of satisfaction compared with residents interested in practicing outside of academia. Copyright © 2012 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Perceived service quality, perceived value, overall satisfaction and happiness of outlook for long-term care institution residents.

PubMed

Lin, Jesun; Hsiao, Chih-Tung; Glen, Robert; Pai, Jar-Yuan; Zeng, Sin-Huei

2014-06-01

To investigate the psychometric properties and relationships of perceived service quality, perceived value and overall satisfaction for residents with respect to their long-term care institutions. The five-point Likert scale questionnaire administered through facetoface interviews. Fourteen long-term care institutions located in central and southern Taiwan stratified according to services and accommodation population. One hundred and eighty long-term institutional care residents. Perceived service quality (the SERVPERF model), perceived value and overall satisfaction (models based on the literature on perceived value and satisfaction). Student's t-test on institutional location shows a significant difference between overall satisfaction for central and southern institution long-term care recipients. The correlation test revealed that the higher a resident's level of education, the higher the scores for perceived value. The factor loading results of confirmation factor analysis show acceptable levels of reliability and index-of-model fits for perceived service, perceived value and overall satisfaction. In addition, the results suggest that an additional construct, a positive attitude (happiness of outlook) towards long-term care institutions, is also an important factor in residents' overall satisfaction. The primary goal of long-term institutional care policy in Taiwan, as in other countries, is to provide residents with practical, cost-effective but high-quality care. On the basis of the results of in-depth interviews with long-term institutional care residents, this study suggests long-term care institutions arrange more family visit days to increase the accessibility and interaction of family and residents and thereby increase the happiness of outlook of the residents. © 2012 John Wiley & Sons Ltd.

Charge and energy dependence of the residence time of cosmic ray nuclei below 15 GeV/nucleon

NASA Technical Reports Server (NTRS)

Soutoul, A.; Engelmann, J. J.; Ferrando, P.; Koch-Miramond, L.; Masse, P.; Webber, W. R.

1985-01-01

The relative abundance of nuclear species measured in cosmic rays at Earth has often been interpreted with the simple leaky box model. For this model to be consistent an essential requirement is that the escape length does not depend on the nuclear species. The discrepancy between escape length values derived from iron secondaries and from the B/C ratio was identified by Garcia-Munoz and his co-workers using a large amount of experimental data. Ormes and Protheroe found a similar trend in the HEAO data although they questioned its significance against uncertainties. They also showed that the change in the B/C ratio values implies a decrease of the residence time of cosmic rays at low energies in conflict with the diffusive convective picture. These conclusions crucially depend on the partial cross section values and their uncertainties. Recently new accurate cross sections of key importance for propagation calculations have been measured. Their statistical uncertainties are often better than 4% and their values significantly different from those previously accepted. Here, these new cross sections are used to compare the observed B/C+O and (Sc to Cr)/Fe ratio to those predicted with the simple leaky box model.

Using a Learning Coach to Develop Family Medicine Residents' Goal-Setting and Reflection Skills

PubMed Central

George, Paul; Reis, Shmuel; Dobson, Margaret; Nothnagle, Melissa

2013-01-01

Background Self-directed learning (SDL) skills, such as self-reflection and goal setting, facilitate learning throughout a physician's career. Yet, residents do not often formally engage in these activities during residency. Intervention To develop resident SDL skills, we created a learning coach role for a junior faculty member to meet with second-year residents monthly to set learning goals and promote reflection. Methods The study was conducted from 2008–2010 at the Brown Family Medicine Residency in Pawtucket, Rhode Island. During individual monthly meetings with the learning coach, residents entered their learning goals and reflections into an electronic portfolio. A mixed-methods evaluation, including coach's ratings of goal setting and reflection, coach's meeting notes, portfolio entries, and resident interviews, was used to assess progress in residents' SDL abilities. Results Coach ratings of 25 residents' goal-setting ability increased from a mean of 1.9 to 4.6 (P < .001); ratings of reflective capacity increased from a mean of 2.0 to 4.7 (P < .001) during each year. Resident portfolio entries showed a range of domains for goal setting and reflection. Resident interviews demonstrated progressive independence in setting goals and appreciation of the value of reflection for personal development. Conclusions Introducing a learning coach, use of a portfolio, and providing protected time for self-reflected learning allowed residents to develop SDL skills at their own pace. The learning coach model may be applicable to other residency programs in developing resident lifelong learning skills. PMID:24404275

Results of the determination of He in cenozoic aquifers using the GC method.

PubMed

Kotowski, Tomasz; Najman, Joanna

2015-04-01

Applications of the Helium (He) method known so far consisted mainly of 4He measurements using a special mass spectrometer. 4He measurements for groundwater dating purposes can be replaced by total He (3He+4He) concentration measurements because the content of 3He can be ignored. The concentrations of 3He are very low and 3He/4 He ratios do not exceed 1.0·10(-5) in most cases. In this study, the total He concentrations in groundwater were determined using the gas chromatographic (GC) method as an alternative to methods based on spectrometry measurement. He concentrations in groundwater were used for the determination of residence time and groundwater circulation. Additionally, the radiocarbon method was used to determine the value of the external He flux (JHe) in the study area. Obtained low He concentrations and their small variation within the ca. 65 km long section along which groundwater flows indicate that it is likely there is relatively short residence time and a strong hydraulic connection between the aquifers. The estimated residence time (ca. 3000 years) is heavily dependent on the great uncertainty of the He concentration resulting from the low concentrations of He, the external 4He flux value adopted for calculation purposes and the 14C ages used to estimate the external 4He flux. © 2015, National Ground Water Association.

The Projected Responses of Residency-Sponsoring Institutions to a Reduction in Medicare Support for Graduate Medical Education: A National Survey.

PubMed

Riaz, Mahrukh; Palermo, Tia; Yen, Michael; Edelman, Norman H

2015-10-01

To assess the projected responses of residency-sponsoring institutions to the proposed reduction in Medicare's indirect medical education (IME) payments. In 2012, the authors surveyed directors of graduate medical education (GME) programs, examining (1) overall responses to a reduction in IME reimbursement and (2) the value of individual residencies to the institution from the economic/operational and educational/public service points of view, to determine which programs may be at risk for downsizing. Responses from 192 of 555 institutions (35% response rate) varied by the size of the institution's GME program. Of large programs (six or more residencies), 33 (33%) would downsize at a 10% reduction in IME reimbursement, focusing cuts on specific programs. Small programs (five or fewer residencies) were more likely to retain their existing residencies with modest IME payment reductions and to make across-the-board cuts. The economic/operational value of specialties varied widely, with hospital-intensive residencies valued highest. Family medicine was valued highly from an economic/operational point of view only by small programs. Educational/public service value scores varied less and were higher for all specialties. Preventive medicine was not highly valued in either category. Even a modest decrease in IME reimbursement could trigger institutions to downsize their GME programs. Programs at the greatest risk for cuts may be those with modest economic/operational value but high societal value, like family medicine. The retention or expansion of training in family medicine may be most easily accomplished then at smaller institutions.

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

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

Koochi, Hakimeh; Ebrahimi, Fatemeh, E-mail: f-ebrahimi@birjand.ac.ir; Solar Energy Research Group, University of Birjand, Birjand

2014-09-07

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

A proposed solution to integrating cognitive-affective neuroscience and neuropsychiatry in psychiatry residency training: The time is now.

PubMed

Torous, John; Stern, Adam P; Padmanabhan, Jaya L; Keshavan, Matcheri S; Perez, David L

2015-10-01

Despite increasing recognition of the importance of a strong neuroscience and neuropsychiatry education in the training of psychiatry residents, achieving this competency has proven challenging. In this perspective article, we selectively discuss the current state of these educational efforts and outline how using brain-symptom relationships from a systems-level neural circuit approach in clinical formulations may help residents value, understand, and apply cognitive-affective neuroscience based principles towards the care of psychiatric patients. To demonstrate the utility of this model, we present a case of major depressive disorder and discuss suspected abnormal neural circuits and therapeutic implications. A clinical neural systems-level, symptom-based approach to conceptualize mental illness can complement and expand residents' existing psychiatric knowledge. Copyright © 2015 Elsevier B.V. All rights reserved.

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

PubMed Central

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

2017-01-01

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

Effect of Deep Drying and Torrefaction Temperature on Proximate, Ultimate Composition, and Heating Value of 2-mm Lodgepole Pine (Pinus contorta) Grind

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

Tumuluru, Jaya

Deep drying and torrefaction is a thermal pretreatment method, where biomass is heated in the temperature range of 150–300°C in an inert or reduced environment. The process parameters like temperature and residence time has a significant impact on proximate, ultimate, and energy properties of the biomass. In the present study, torrrefaction experiments were conducted on 2 mm lodgepole pine grind using a thermogravimetric analyzer. Both deep drying and torrefaction temperature (160–270°C) and time (15–120 min) were selected. Torrefied samples were analyzed for proximate, ultimate and energy properties. Results indicated that moisture content decreased with increases in torrefaction temperature and time,more » where at 270°C and 120 min, the moisture content was found to be 1.15% (w.b.). Volatile content in the biomass decreased from about 80% to about 45%, and ash content increased from 0.77 to about 1.91% at 270°C and 120 min. The hydrogen, oxygen and sulfur content decreased to 3%, 28.24%, and 0.01 whereas carbon content and higher heating value increased to 68.86% and 23.67 MJ/kg at 270°C and 120 min. H/C and O/C ratio calculated at 270°C and 120 min residence time were about 0.56 and 0.47. This study indicated that higher torrefaction temperatures >230°C and residence time >15 min influenced the proximate, ultimate, and energy properties.« less

Attitudes and Beliefs of Pathology Residents Regarding the Subspecialty of Clinical Chemistry: Results of a Survey.

PubMed

Haidari, Mehran; Yared, Marwan; Olano, Juan P; Alexander, C Bruce; Powell, Suzanne Z

2017-02-01

-Previous studies suggest that training in pathology residency programs does not adequately prepare pathology residents to become competent in clinical chemistry. -To define the beliefs of pathology residents in the United States regarding their preparation for practicing clinical chemistry in their career, their attitude toward the discipline, and the attractiveness of clinical chemistry as a career. -The residents of all pathology residency programs in the United States were given the opportunity to participate in an online survey. -Three hundred thirty-six pathology residents responded to the survey. Analysis of the survey results indicates that pathology residents are more likely to believe that their income may be lower if they select a career that has a clinical chemistry focus and that their faculty do not value clinical chemistry as much as the anatomic pathology part of the residency. Residents also report that clinical chemistry is not as enjoyable as anatomic pathology rotations during residency or preferable as a sole career path. A large proportion of residents also believe that they will be slightly prepared or not prepared to practice clinical chemistry by the end of their residency and that they do not have enough background and/or time to learn clinical chemistry during their residency programs to be able to practice this specialty effectively post graduation. -Our survey results suggest that many pathology residents do not have a positive attitude toward clinical chemistry and do not experience a supportive learning environment with an expectation that they will become competent in clinical chemistry with a residency alone.

Empowering fourth-year medical students: the value of the senior year.

PubMed

Cosgrove, Ellen M; Ryan, Michael J; Wenrich, Marjorie D

2014-04-01

In this issue of Academic Medicine, Wolf et al explore the purposes and value of the senior year of medical school as viewed by graduating students at their institution. Using data from student focus groups and questionnaires, they report that students all found there to be significant value in but identified different purposes for the fourth year. The authors of this commentary believe that study adds to the discussion of fourth-year curriculum reform an important voice that has been lacking-that of students.Previous articles focusing on the perceived lack of clarity of educational purpose in the senior year curriculum have reflected a faculty perspective and have led some to call for increasing the structure of, decreasing the elective time in, or even completely eliminating the fourth year. In this commentary, the authors ask for a pause in this debate to consider the implications of the student perspective as well as important trends in the medical education continuum that affect the senior student (e.g., milestones that will set new expectations for first-year residents, increasing pressure associated with matching to a residency). They propose that providing students with time for career exploration and for focusing on areas of interest would allow them to individualize their preparation for residency and to be more sure of their career choices. They share the University of Washington School of Medicine's planned new fourth-year approach as an example of a flexible, individualized senior year curriculum.

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

PubMed

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

2017-01-01

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

Otolaryngology Residency Program Research Resources and Scholarly Productivity.

PubMed

Villwock, Jennifer A; Hamill, Chelsea S; Nicholas, Brian D; Ryan, Jesse T

2017-06-01

Objective To delineate research resources available to otolaryngology residents and their impact on scholarly productivity. Study Design Survey of current otolaryngology program directors. Setting Otolaryngology residency programs. Subjects and Methods An anonymous web-based survey was sent to 98 allopathic otolaryngology training program directors. Fisher exact tests and nonparametric correlations were used to determine statistically significant differences among various strata of programs. Results Thirty-nine percent (n = 38) of queried programs responded. Fourteen (37%) programs had 11 to 15 full-time, academic faculty associated with the residency program. Twenty (53%) programs have a dedicated research coordinator. Basic science lab space and financial resources for statistical work were present at 22 programs (58%). Funding is uniformly provided for presentation of research at conferences; a minority of programs (13%) only funded podium presentations. Twenty-four (63%) have resident research requirements beyond the Accreditation Council for Graduate Medical Education (ACGME) mandate of preparing a "manuscript suitable for publication" prior to graduation. Twenty-five (67%) programs have residents with 2 to 3 active research projects at any given time. None of the investigated resources were significantly associated with increased scholarly output. There was no uniformity to research curricula. Conclusions Otolaryngology residency programs value research, evidenced by financial support provided and requirements beyond the ACGME minimum. Additional resources were not statistically related to an increase in resident research productivity, although they may contribute positively to the overall research experience during training. Potential future areas to examine include research curricula best practices, how to develop meaningful mentorship and resource allocation that inspires continued research interest, and intellectual stimulation.

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.

Getting By: Underuse of Interpreters by Resident Physicians

PubMed Central

Schenker, Yael; Curry, Leslie; Bradley, Elizabeth H.; Fernandez, Alicia

2008-01-01

Background Language barriers complicate physician–patient communication and adversely affect healthcare quality. Research suggests that physicians underuse interpreters despite evidence of benefits and even when services are readily available. The reasons underlying the underuse of interpreters are poorly understood. Objective To understand the decision-making process of resident physicians when communicating with patients with limited English proficiency (LEP). Design Qualitative study using in-depth interviews. Participants Internal medicine resident physicians ( = 20) from two urban teaching hospitals with excellent interpreter services. Approach An interview guide was used to explore decision making about interpreter use. Results Four recurrent themes emerged: 1) Resident physicians recognized that they underused professional interpreters, and described this phenomenon as “getting by;” 2) Resident physicians made decisions about interpreter use by weighing the perceived value of communication in clinical decision making against their own time constraints; 3) The decision to call an interpreter could be preempted by the convenience of using family members or the resident physician’s use of his/her own second language skills; 4) Resident physicians normalized the underuse of professional interpreters, despite recognition that patients with LEP are not receiving equal care. Conclusions Although previous research has identified time constraints and lack of availability of interpreters as reasons for their underuse, our data suggest that the reasons are far more complex. Residents at the study institutions with interpreters readily available found it easier to “get by” without an interpreter, despite misgivings about negative implications for quality of care. Findings suggest that increasing interpreter use will require interventions targeted at both individual physicians and the practice environment. PMID:19089503

Will urban commuting time affect housing prices and vehicle emissions?

DOT National Transportation Integrated Search

2016-03-01

The transportation cost is an essential factor that impacts land and house values in urban areas. In a classical monocentric city model, residents who work in the Central Business District (CBD) are facing a tradeoff between rent and commuting dis...

Bringing Rounds Back to the Patient: A One-Year Evaluation of the Chiefs' Service Model for Inpatient Teaching.

PubMed

Bennett, Nadia L; Flesch, Judd D; Cronholm, Peter; Reilly, James B; Ende, Jack

2017-04-01

The Chiefs' Service (CS), a structured approach to inpatient teaching rounds, focuses on resident education and patient-centered care without disrupting patient census sizes or admitting cycles. It has five key elements: morning huddles; bedside rounds; diagnostic "time-outs"; day-of-discharge rounds; and postdischarge follow-up rounds. The authors hypothesized the CS model would be well received by residents and considered more effective than more-traditional rounds. The CS was implemented on Penn Presbyterian Medical Center's general medicine inpatient service using a quasi-experimental design. Its first year (January 2013-January 2014) was evaluated with a mixed-methods approach. Residents completed end-of-rotation evaluation questionnaires; 20 CS and 10 traditional service (TS) residents were interviewed. Measures of resident agreement on questionnaire items were compared across groups using independent sample t testing. A modified grounded theory approach was used to assess CS residents' perspectives on the CS elements and identify emergent themes. The questionnaires were completed by 183/188 residents (response rate 97%). Compared with TS residents, CS residents reported significantly greater satisfaction in the domains of resident education and patient care, and they rated the overall value of the rotation significantly higher. The majority of CS residents found the CS elements to be effective. CS residents described the CS as focused on resident education, patient-centered care, and collaboration with an interdisciplinary team. The CS approach to inpatient rounding is seen by residents as valuable and is associated with positive outcomes in terms of residents' perceptions of learning, interdisciplinary communication, and patient care.

A Survey of American and Canadian Psychiatry Residents on Their Training, Teaching Practices, And Attitudes toward Teaching

PubMed Central

Isenberg-Grzeda, Elie; Weiss, Andrea; Blackmore, Michelle; Shen, Megan Johnson; Abrams, Madeleine Seifter; Woesner, Mary E.

2017-01-01

Objective Formal training for residents-as-teachers in psychiatry is increasingly emphasized. However, little is known about the quantity and content of residents’ teaching, their attitudes toward teaching, or the training received on how to teach. Methods An online survey was disseminated to American and Canadian psychiatry residents. Results Three hundred eighty-two residents from all postgraduate years (PGY) responded, representing about 7% of all trainees. About half of PGY-1 have not received residents-as-teachers training, but by PGY-3 most have. The majority of respondents reported teaching, most commonly 1–5 hours. Most found teaching enjoyable or rewarding (n=304; 87%); however, 40% (n=138) found teaching burdensome, 43% (n=151) lacked sufficient time to teach, and many (n=226; 64%) reported insufficient feedback from supervisors. Conclusions Although the sampling methodology and low response rate limit the generalizability of findings, respondents typically seemed to value teaching, though the majority felt that they lacked feedback on their teaching skills. PMID:26842486

"Rewarding and challenging at the same time": emergency medicine residents' experiences caring for patients who are homeless.

PubMed

Doran, Kelly M; Curry, Leslie A; Vashi, Anita A; Platis, Stephanie; Rowe, Michael; Gang, Maureen; Vaca, Federico E

2014-06-01

The objectives were to examine how emergency medicine (EM) residents learn to care for patients in the emergency department (ED) who are homeless and how providing care for patients who are homeless influences residents' education and professional development as emergency physicians. We conducted in-depth, one-on-one interviews with EM residents from two programs. A random sample of residents stratified by training year was selected from each site. Interviews were digitally recorded and professionally transcribed. A team of researchers with diverse content-relevant expertise reviewed transcripts independently and applied codes to text segments using a grounded theory approach. The team met regularly to reconcile differences in code interpretations. Data collection and analysis occurred iteratively, and interviews continued until theoretical saturation was achieved. Three recurring themes emerged from 23 resident interviews. First, residents learn unique aspects of EM by caring for patients who are homeless. This learning encompasses both specific knowledge and skills (e.g., disease processes infrequently seen in other populations) and professional development as an emergency physician (e.g., the core value of service in EM). Second, residents learn how to care for patients who are homeless through experience and informal teaching rather than through a formal curriculum. Residents noted little formal curricular time dedicated to homelessness and instead learned during clinical shifts through personal experience and by observing more senior physicians. One unique method of learning was through stories of "misses," in which patients who were homeless had bad outcomes. Third, caring for patients who are homeless affects residents emotionally in complex, multifaceted ways. Emotions were dominated by feelings of frustration. This frustration was often related to feelings of futility in truly helping homeless patients, particularly for patients who were frequent visitors to the ED and who had concomitant alcohol dependence. Caring for ED patients who are homeless is an important part of EM residency training. Our findings suggest the need for increased formal curricular time dedicated to the unique medical and social challenges inherent in treating patients who are homeless, as well as enhanced support and resources to improve the ability of residents to care for this vulnerable population. Future research is needed to determine if such interventions improve EM resident education and, ultimately, result in improved care for ED patients who are homeless. © 2014 by the Society for Academic Emergency Medicine.

Supplementing Resident Research Funding Through a Partnership With Local Industry.

PubMed

Skube, Steven J; Arsoniadis, Elliot G; Jahansouz, Cyrus; Novitsky, Sherri; Chipman, Jeffrey G

2018-01-17

To develop a model for the supplementation of resident research funding through a resident-hosted clinical immersion with local industry. Designated research residents hosted multiple groups of engineers and business professionals from local industry in general surgery-focused clinical immersion weeks. The participants in these week-long programs are educated about general surgery and brought to the operating room to observe a variety of surgeries. This study was performed at the University of Minnesota, in Minneapolis, Minnesota, at a tertiary medical center. Ten designated research residents hosted general surgery immersion programs. Fifty-seven engineers and business professionals from 5 different local biomedical firms have participated in this program. General surgery research residents (in collaboration with the University of Minnesota's Institute for Engineering in Medicine) have hosted 9 clinical immersion programs since starting the collaborative in 2015. Immersion participant response to the experiences was very positive. Two full-time resident research positions can be funded annually through participation in this program. With decreasing funding available for surgical research, particularly resident research, innovative ways to fund resident research are needed. The general surgery clinical immersion program at the University of Minnesota has proven its value as a supplement for resident research funding and may be a sustainable model for the future. Copyright © 2018 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Scaling properties of a rice-pile model: inertia and friction effects.

PubMed

Khfifi, M; Loulidi, M

2008-11-01

We present a rice-pile cellular automaton model that includes inertial and friction effects. This model is studied in one dimension, where the updating of metastable sites is done according to a stochastic dynamics governed by a probabilistic toppling parameter p that depends on the accumulated energy of moving grains. We investigate the scaling properties of the model using finite-size scaling analysis. The avalanche size, the lifetime, and the residence time distributions exhibit a power-law behavior. Their corresponding critical exponents, respectively, tau, y, and yr, are not universal. They present continuous variation versus the parameters of the system. The maximal value of the critical exponent tau that our model gives is very close to the experimental one, tau=2.02 [Frette, Nature (London) 379, 49 (1996)], and the probability distribution of the residence time is in good agreement with the experimental results. We note that the critical behavior is observed only in a certain range of parameter values of the system which correspond to low inertia and high friction.

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

NASA Astrophysics Data System (ADS)

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

2018-03-01

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

Teaching "global mental health": psychiatry residency directors' attitudes and practices regarding international opportunities for psychiatry residents.

PubMed

Belkin, Gary S; Yusim, Anna; Anbarasan, Deepti; Bernstein, Carol Ann

2011-11-01

The authors surveyed Psychiatry Residency Training Directors' (RTDs') attitudes about the role and feasibility of international rotations during residency training. A 21-question survey was electronically distributed that explored RTDs' beliefs about the value, use, and availability of international clinical and research experiences during residency. Of 171 RTDs, 59 (34.5%) completed the survey; 83% of respondents rated the importance of global mental health education as 3-or-above on a scale of 1 (least important) to 5 (most important), but only 42% indicated that such opportunities were made available. The value of such opportunities was thought to lie primarily in professional development and cultural exposure, less so for enhancing core knowledge competencies. Obstacles to such opportunities included lack of accreditation, financial resources, and faculty/administrative support and supervision. RTD respondents endorsed the value of international experiences during residency, but their availability and educational impact are not fully supported.

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

PubMed

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

2011-06-01

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

Spectrum of tablet computer use by medical students and residents at an academic medical center.

PubMed

Robinson, Robert

2015-01-01

Introduction. The value of tablet computer use in medical education is an area of considerable interest, with preliminary investigations showing that the majority of medical trainees feel that tablet computers added value to the curriculum. This study investigated potential differences in tablet computer use between medical students and resident physicians. Materials & Methods. Data collection for this survey was accomplished with an anonymous online questionnaire shared with the medical students and residents at Southern Illinois University School of Medicine (SIU-SOM) in July and August of 2012. Results. There were 76 medical student responses (26% response rate) and 66 resident/fellow responses to this survey (21% response rate). Residents/fellows were more likely to use tablet computers several times daily than medical students (32% vs. 20%, p = 0.035). The most common reported uses were for accessing medical reference applications (46%), e-Books (45%), and board study (32%). Residents were more likely than students to use a tablet computer to access an electronic medical record (41% vs. 21%, p = 0.010), review radiology images (27% vs. 12%, p = 0.019), and enter patient care orders (26% vs. 3%, p < 0.001). Discussion. This study shows a high prevalence and frequency of tablet computer use among physicians in training at this academic medical center. Most residents and students use tablet computers to access medical references, e-Books, and to study for board exams. Residents were more likely to use tablet computers to complete clinical tasks. Conclusions. Tablet computer use among medical students and resident physicians was common in this survey. All learners used tablet computers for point of care references and board study. Resident physicians were more likely to use tablet computers to access the EMR, enter patient care orders, and review radiology studies. This difference is likely due to the differing educational and professional demands placed on resident physicians. Further study is needed better understand how tablet computers and other mobile devices may assist in medical education and patient care.

Spectrum of tablet computer use by medical students and residents at an academic medical center

PubMed Central

2015-01-01

Introduction. The value of tablet computer use in medical education is an area of considerable interest, with preliminary investigations showing that the majority of medical trainees feel that tablet computers added value to the curriculum. This study investigated potential differences in tablet computer use between medical students and resident physicians. Materials & Methods. Data collection for this survey was accomplished with an anonymous online questionnaire shared with the medical students and residents at Southern Illinois University School of Medicine (SIU-SOM) in July and August of 2012. Results. There were 76 medical student responses (26% response rate) and 66 resident/fellow responses to this survey (21% response rate). Residents/fellows were more likely to use tablet computers several times daily than medical students (32% vs. 20%, p = 0.035). The most common reported uses were for accessing medical reference applications (46%), e-Books (45%), and board study (32%). Residents were more likely than students to use a tablet computer to access an electronic medical record (41% vs. 21%, p = 0.010), review radiology images (27% vs. 12%, p = 0.019), and enter patient care orders (26% vs. 3%, p < 0.001). Discussion. This study shows a high prevalence and frequency of tablet computer use among physicians in training at this academic medical center. Most residents and students use tablet computers to access medical references, e-Books, and to study for board exams. Residents were more likely to use tablet computers to complete clinical tasks. Conclusions. Tablet computer use among medical students and resident physicians was common in this survey. All learners used tablet computers for point of care references and board study. Resident physicians were more likely to use tablet computers to access the EMR, enter patient care orders, and review radiology studies. This difference is likely due to the differing educational and professional demands placed on resident physicians. Further study is needed better understand how tablet computers and other mobile devices may assist in medical education and patient care. PMID:26246973

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.

Residents' perceptions of their teachers: facilitative behaviour and the learning value of rotations.

PubMed

Kendrick, S B; Simmons, J M; Richards, B F; Roberge, L P

1993-01-01

Despite changes in modern medicine the role of the clinical teacher remains central to medical residents' education and rotations continue to be their dominant educational context. Residents have strong positive feelings for clinical teachers who are perceived as interested in teaching and for those rotations that provide a balance of educational opportunities and patient care responsibilities. Research in residency education has focused on teacher behaviours used to teach medical residents clinical information or patient care skills but has neglected teacher behaviours used to facilitate effective learning relationships with residents. To explore the impact of clinical teachers' use of facilitative behaviours on residents' educational experience, we use concepts stemming from the psychologist Carl Rogers' work previously shown to be associated with positive learning outcomes--empathy, unconditional positive regard, and congruence. These constructs are measured by the use of the four scales of the Barrett-Lennard Relationship Inventory (BLRI)--level of regard, unconditionality of regard, congruence and empathy. Our study measures the correlation between residents' perceptions of clinical teachers' use of facilitative behaviours and residents' evaluation of the learning value of rotations. Thirty-three residents completed the BLRI on a different clinical teacher for each of six monthly rotations. A total of 158 surveys were returned. There were strong positive correlations between three of the BLRI variables and residents' perception of the learning value of rotations. Potential uses of these findings are discussed.

Useful but Different: Resident Physician Perceptions of Interprofessional Feedback.

PubMed

Vesel, Travis P; O'Brien, Bridget C; Henry, Duncan M; van Schaik, Sandrijn M

2016-01-01

Phenomenon: Based on recently formulated interprofessional core competencies, physicians are expected to incorporate feedback from other healthcare professionals. Based on social identity theory, physicians likely differentiate between feedback from members of their own profession and others. The current study examined residents' experiences with, and perceptions of, interprofessional feedback. In 2013, Anesthesia, Obstetrics-Gynecology, Pediatrics, and Psychiatry residents completed a survey including questions about frequency of feedback from different professionals and its perceived value (5-point scale). The authors performed an analysis of variance to examine interactions between residency program and profession of feedback provider. They conducted follow-up interviews with a subset of residents to explore reasons for residents' survey ratings. Fifty-two percent (131/254) of residents completed the survey, and 15 participated in interviews. Eighty percent of residents reported receiving written feedback from physicians, 26% from nurses, and less than 10% from other professions. There was a significant interaction between residency program and feedback provider profession, F(21, 847) = 3.82, p < .001, and a significant main effect of feedback provider profession, F(7, 847) = 73.7, p < .001. On post hoc analyses, residents from all programs valued feedback from attending physicians higher than feedback from others, and anesthesia residents rated feedback from other professionals significantly lower than other residents. Ten major themes arose from qualitative data analysis, which revealed an overall positive attitude toward interprofessional feedback and clarified reasons behind residents' perceptions and identified barriers. Insights: Residents in our study reported limited exposure to interprofessional feedback and valued such feedback less than intraprofessional feedback. However, our data suggest opportunities exist for effective utilization of interprofessional feedback.

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.

Use of a seagrass residency index to apportion commercial fishery landing values and recreation fisheries expenditure to seagrass habitat service.

PubMed

Jackson, Emma L; Rees, Siân E; Wilding, Catherine; Attrill, Martin J

2015-06-01

Where they dominate coastlines, seagrass beds are thought to have a fundamental role in maintaining populations of exploited species. Thus, Mediterranean seagrass beds are afforded protection, yet no attempt to determine the contribution of these areas to both commercial fisheries landings and recreational fisheries expenditure has been made. There is evidence that seagrass extent continues to decline, but there is little understanding of the potential impacts of this decline. We used a seagrass residency index, that was trait and evidence based, to estimate the proportion of Mediterranean commercial fishery landings values and recreation fisheries total expenditure that can be attributed to seagrass during different life stages. The index was calculated as a weighted sum of the averages of the estimated residence time in seagrass (compared with other habitats) at each life stage of the fishery species found in seagrass. Seagrass-associated species were estimated to contribute 30%-40% to the value of commercial fisheries landings and approximately 29% to recreational fisheries expenditure. These species predominantly rely on seagrass to survive juvenile stages. Seagrass beds had an estimated direct annual contribution during residency of €58-91 million (4% of commercial landing values) and €112 million (6% of recreation expenditure) to commercial and recreational fisheries, respectively, despite covering <2% of the area. These results suggest there is a clear cost of seagrass degradation associated with ineffective management of seagrass beds and that policy to manage both fisheries and seagrass beds should take into account the socioeconomic implications of seagrass loss to recreational and commercial fisheries. © 2015 Society for Conservation Biology.

Oxygen, hydrogen, and helium isotopes for investigating groundwater systems of the Cape Verde Islands, West Africa

USGS Publications Warehouse

Heilweil, V.M.; Solomon, K.D.; Gingerich, S.B.; Verstraeten, Ingrid M.

2009-01-01

Stable isotopes (??18O, ??2H), tritium (3H), and helium isotopes (3He, 4He) were used for evaluating groundwater recharge sources, flow paths, and residence times of three watersheds in the Cape Verde Islands (West Africa). Stable isotopes indicate the predominance of high-elevation precipitation that undergoes little evaporation prior to groundwater recharge. In contrast to other active oceanic hotspots, environmental tracers show that deep geothermal circulation does not strongly affect groundwater. Low tritium concentrations at seven groundwater sites indicate groundwater residence times of more than 50 years. Higher tritium values at other sites suggest some recent recharge. High 4He and 3He/4He ratios precluded 3H/3He dating at six sites. These high 3He/4He ratios (R/Ra values of up to 8.3) are consistent with reported mantle derived helium of oceanic island basalts in Cape Verde and provided end-member constraints for improved dating at seven other locations. Tritium and 3H/3He dating shows that S??o Nicolau Island's Ribeira Faj?? Basin has groundwater residence times of more than 50 years, whereas Fogo Island's Mosteiros Basin and Santo Ant??o Island's Ribeira Paul Basin contain a mixture of young and old groundwater. Young ages at selected sites within these two basins indicate local recharge and potential groundwater susceptibility to surface contamination and/or salt-water intrusion. ?? Springer-Verlag 2009.

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.

What the Building Boom Says about Campus Values

ERIC Educational Resources Information Center

Bonfiglio, Robert A.

2004-01-01

Some construction projects that colleges and universities have recently undertaken--residence halls, dining halls, student centers, athletic and recreation centers--have attracted significant criticism. Critics have taken issue with the proliferation and design of buildings intended to structure the use of students' free time and attract…

Landowner values, water quality, and recreation in the Lake Champlain Basin

Treesearch

Walter F. Kuentzel; Donald F. Dennis

1998-01-01

This study describes landowner values about water quality among resident landowners in the LaPlatte River watershed, tests whether suburbanization is producing a new mix of social values, analyzes the relationship between values and behaviors, and explores the link between recreation and water quality advocacy. Results showed that residents hold pro-environmental...

A Learner-Created Virtual Patient Curriculum for Surgical Residents: Successes and Failures.

PubMed

McKendy, Katherine M; Posel, Nancy; Fleiszer, David M; Vassiliou, Melina C

2016-01-01

To determine the feasibility and effectiveness of a learner-created virtual patient (VP) curriculum for postgraduate year 2 surgical residents. Using a social-constructivist model of learning, we designed a learner-created VP curriculum to help postgraduate year 2 residents prepare for their in-training surgical examination. Each resident was assigned to create a VP curriculum based on the learning objectives for this examination, and VP cases were then disseminated to all residents for completion. To measure the learning effects of the curriculum, participants completed 2 simulated in-training examinations, both at the beginning and at the end of the intervention. Study participants also participated in a focus group and completed an online questionnaire about the perceived learning value of the curriculum. The study was conducted at the McGill University Health Centre, a tertiary care hospital in Montreal, Canada. In total, 24 residents from 7 surgical specialties completed both the pretest and posttest, as well as took part in the creation of a VP curriculum. Of those 24 residents, only 19 residents completed the cases created by their peers, with 7 completing greater than 50% of the cases and 12 completing less than 50%. In all 17 residents responded to the online questionnaire and 11 residents participated in the focus group. The VP curriculum failed to improve scores from pretest (59.6%, standard deviation = 8.1) to posttest (55.4%, standard deviation = 6.6; p = 0.01) on the simulated in-training examination. Nonetheless, survey results demonstrated that most residents felt that creating a VP case (89%) and completing cases created by their peers (71%) had educational value. Overall, 71% preferred active participation in a curriculum to traditional didactic teaching. The focus group identified time-related constraints, concern about the quality of the peer-created cases, and questioning of the relationship between the curriculum and the Surgical Foundations examination as barriers to the success of the curriculum. Despite the fact that a learner-created VP curriculum did not improve scores on a mock in training examination, residents viewed this intervention as a valuable educational experience. Although there were barriers to the implementation of a learner-created curriculum, it is nonetheless important to try and integrate pedagogical concepts into the instructional design of curricula for surgical residents. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

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

NASA Astrophysics Data System (ADS)

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

2018-05-01

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

Can teenage novel users perform as well as General Surgery residents upon initial exposure to a robotic surgical system simulator?

PubMed

Mehta, A; Patel, S; Robison, W; Senkowski, T; Allen, J; Shaw, E; Senkowski, C

2018-03-01

New techniques in minimally invasive and robotic surgical platforms require staged curricula to insure proficiency. Scant literature exists as to how much simulation should play a role in training those who have skills in advanced surgical technology. The abilities of novel users may help discriminate if surgically experienced users should start at a higher simulation level or if the tasks are too rudimentary. The study's purpose is to explore the ability of General Surgery residents to gain proficiency on the dVSS as compared to novel users. The hypothesis is that Surgery residents will have increased proficiency in skills acquisition as compared to naive users. Six General Surgery residents at a single institution were compared with six teenagers using metrics measured by the dVSS. Participants were given two 1-h sessions to achieve an MScoreTM in the 90th percentile on each of the five simulations. MScoreTM software compiles a variety of metrics including total time, number of attempts, and high score. Statistical analysis was run using Student's t test. Significance was set at p value <0.05. Total time, attempts, and high score were compared between the two groups. The General Surgery residents took significantly less Total Time to complete Pegboard 1 (PB1) (p = 0.043). No significant difference was evident between the two groups in the other four simulations across the same MScoreTM metrics. A focused look at the energy dissection task revealed that overall score might not be discriminant enough. Our findings indicate that prior medical knowledge or surgical experience does not significantly impact one's ability to acquire new skills on the dVSS. It is recommended that residency-training programs begin to include exposure to robotic technology.

Chest teleradiology in a teaching hospital emergency practice.

PubMed

Steckel, R J; Batra, P; Johnson, S; Zucker, M; Sayre, J; Goldin, J; Lee, M; Patel, M; Morrison, H

1997-06-01

New standards for hospital accreditation and health care reimbursement may require that faculty subspecialists be more available after regular working hours to supervise residents in academic radiology departments. We designed a receiver operating characteristic study to determine whether a thoracic radiologist who evaluated computed radiography (CR) images of the chest at a home-based teleradiology workstation could add significant value to a junior resident's interpretations of films within the hospital for acutely ill patients. Using a hybrid cassette, we obtained analog chest films and CR images simultaneously for each of 252 acutely ill patients in the emergency department and in an intensive care unit. Interpretations of the analog films by three first-year residents were analyzed for 11 parameters deemed critical for patient management. Likewise, CR images of the same chest studies were viewed on a home teleradiology workstation by a faculty thoracic radiologist who analyzed the images for these 11 interpretive parameters. All interpretations by radiology residents and by the home-based thoracic radiologist were then compared with the interpretations of a consensus panel consisting of another thoracic radiologist and a full-time emergency department radiologist. Analysis of the pooled results from the three junior residents as a group failed to show significant differences between their interpretations of chest films and the interpretations of CR images by a thoracic radiologist at a home workstation. However, we observed significant differences for several image interpretation parameters between individual residents and the home-based radiology subspecialist. The data confirm that significant value can be added to the interpretations of chest films by individual junior residents when a home-based thoracic radiologist uses teleradiology to provide expert interpretations. Accordingly, it is reasonable to infer that on-line supervision by faculty subspecialists via teleradiology could be used to complement the scheduled visits that are being made now by individual faculty members of our institution to interpret films periodically with a radiology resident during overnight and weekend periods.

Finding the Perfect Match: Factors That Influence Family Medicine Residency Selection.

PubMed

Wright, Katherine M; Ryan, Elizabeth R; Gatta, John L; Anderson, Lauren; Clements, Deborah S

2016-04-01

Residency program selection is a significant experience for emerging physicians, yet there is limited information about how applicants narrow their list of potential programs. This study examines factors that influence residency program selection among medical students interested in family medicine at the time of application. Medical students with an expressed interest in family medicine were invited to participate in a 37-item, online survey. Students were asked to rate factors that may impact residency selection on a 6-point Likert scale in addition to three open-ended qualitative questions. Mean values were calculated for each survey item and were used to determine a rank order for selection criteria. Logistic regression analysis was performed to identify factors that predict a strong interest in urban, suburban, and rural residency programs. Logistic regression was also used to identify factors that predict a strong interest in academic health center-based residencies, community-based residencies, and community-based residencies with an academic affiliation. A total of 705 medical students from 32 states across the country completed the survey. Location, work/life balance, and program structure (curriculum, schedule) were rated the most important factors for residency selection. Logistic regression analysis was used to refine our understanding of how each factor relates to specific types of residencies. These findings have implications for how to best advise students in selecting a residency, as well as marketing residencies to the right candidates. Refining the recruitment process will ensure a better fit between applicants and potential programs. Limited recruitment resources may be better utilized by focusing on targeted dissemination strategies.

Student pharmacists' perceptions of community pharmacy residency programs.

PubMed

Datar, Manasi V; Holmes, Erin R; Adams, Alex J; Stolpe, Samuel F

2013-01-01

To compare penultimate-year (next-to-last) and final-year student pharmacists' perceptions of the educational value of community pharmacy residency programs (CPRPs) and to compare student pharmacists' perceptions of the educational value of CPRPs and health-system residency programs (HSRPs). A self-administered online survey was sent to administrators at 119 Accreditation Council for Pharmacy Education-accredited schools of pharmacy for ultimate distribution to penultimate- and final-year student pharmacists. The survey included demographic measures and a 20-item residency program "perceived value of skill development" scale developed for this study. 1,722 completed surveys were received and analyzed. Penultimate-year students attributed greater value to CPRPs more frequently than final-year students. Students more often attributed higher value to CPRPs for skills related to business management, practice management, and medication therapy management, while they attributed higher value to HSRPs for skills related to teaching, research, and clinical knowledge. The results of this study suggest students' perceived value of CPRPs may be related to their year of pharmacy school and the pharmacy practice skill in question.

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

Perceived service quality, perceived value, overall satisfaction and happiness of outlook for long‐term care institution residents

PubMed Central

Lin, Jesun; Hsiao, Chih‐Tung; Glen, Robert; Pai, Jar‐Yuan; Zeng, Sin‐Huei

2012-01-01

Abstract Objective  To investigate the psychometric properties and relationships of perceived service quality, perceived value and overall satisfaction for residents with respect to their long‐term care institutions. Design  The five‐point Likert scale questionnaire administered through facetoface interviews. Setting  Fourteen long‐term care institutions located in central and southern Taiwan stratified according to services and accommodation population. Participants  One hundred and eighty long‐term institutional care residents. Main outcome measures  Perceived service quality (the SERVPERF model), perceived value and overall satisfaction (models based on the literature on perceived value and satisfaction). Results  Student’s t‐test on institutional location shows a significant difference between overall satisfaction for central and southern institution long‐term care recipients. The correlation test revealed that the higher a resident’s level of education, the higher the scores for perceived value. The factor loading results of confirmation factor analysis show acceptable levels of reliability and index‐of‐model fits for perceived service, perceived value and overall satisfaction. In addition, the results suggest that an additional construct, a positive attitude (happiness of outlook) towards long‐term care institutions, is also an important factor in residents’ overall satisfaction. Conclusion  The primary goal of long‐term institutional care policy in Taiwan, as in other countries, is to provide residents with practical, cost‐effective but high‐quality care. On the basis of the results of in‐depth interviews with long‐term institutional care residents, this study suggests long‐term care institutions arrange more family visit days to increase the accessibility and interaction of family and residents and thereby increase the happiness of outlook of the residents. PMID:22429448

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

PubMed

Wesley, Tiffany; Hamer, Diana; Karam, George

2018-04-18

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

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

S.K. Kawatra; B. Anamerie; T.C. Eisele

The pig iron nugget process was developed as an alternative to the traditional blast furnace process by Kobe Steel. The process aimed to produce pig iron nuggets, which have similar chemical and physical properties to blast furnace pig iron, in a single step. The pig iron nugget process utilizes coal instead of coke and self reducing and fluxing dried green balls instead of pellets and sinters. In this process the environmental emissions caused by coke and sinter production, and energy lost between pellet induration (heat hardening) and transportation to the blast furnace can be eliminated. The objectives of this researchmore » were to (1) produce pig iron nuggets in the laboratory, (2) characterize the pig iron nugget produced and compare them with blast furnace pig iron, (3) investigate the furnace temperature and residence time effects on the pig iron nugget production, and (4) optimize the operational furnace temperatures and residence times. The experiments involved heat treatment of self reducing and fluxing dried green balls at various furnace temperatures and residence times. Three chemically and physically different products were produced after the compete reduction of iron oxides to iron depending on the operational furnace temperatures and/or residence times. These products were direct reduced iron (DRI), transition direct reduced iron (TDRI), and pig iron nuggets. The increase in the carbon content of the system as a function of furnace temperature and/or residence time dictated the formation of these products. The direct reduced iron, transition direct reduced iron, and pig iron nuggets produced were analyzed for their chemical composition, degree of metallization, apparent density, microstructure and microhardness. In addition, the change in the carbon content of the system with the changing furnace temperature and/or residence time was detected by optical microscopy and Microhardness measurements. The sufficient carbon dissolution required for the production of pig iron nuggets was determined. It was determined that pig iron nuggets produced had a high apparent density (6.7-7.2 gr/cm3), highly metallized, slag free structure, high iron content (95-97%), high microhardness values (> 325 HVN) and microstructure similar to white cast iron. These properties made them a competitive alternative to blast furnace pig iron.« less

Strategies to accommodate resident work-hour restrictions: impact on surgical education.

PubMed

Freiburg, Carter; James, Ted; Ashikaga, Takamura; Moalem, Jacob; Cherr, Greg

2011-01-01

The introduction of duty-hour restrictions has impacted surgical training. Several strategies were introduced by training programs in response to these restrictions. The purpose of this study was to assess the various strategies employed by residency programs to comply with work-hour restrictions with respect to the impact on the quality of surgical education. A national survey was developed and distributed to resident members of the Resident and Associate Society of the American College of Surgeons in all accredited residency programs across North America. Questions in the survey addressed 10 separate accommodation strategies used by training programs to adhere to resident work-hour restrictions. Resident respondents completed a 5-point Likert scale rating each strategy according to its impact on surgical education (detrimental, not very helpful, neutral, somewhat helpful, and very helpful). A total of 599 (9.7%) responses were received from 6186 members of the Resident Associate Society. The use of health information technology (IT), nurse practitioners, and physician assistants were most highly rated. Hiring clinical fellows, establishing nonteaching services, and shift-work scheduling were the three most poorly rated accommodations to work-hour restrictions with respect to resident education. Hospital IT and nonphysician care providers were rated by residents to optimize surgical education in the current work-hour limitation environment. We infer that strategies which lead to increased efficiency and redistribution of resident workload allow surgical trainees to spend more time on activities perceived to have higher educational value. Copyright © 2011 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Factors Influencing American Plastic Surgery Residents Toward an Academic Career.

PubMed

Chetta, Matthew D; Sugg, Kristoffer B; Diaz-Garcia, Rafael J; Kasten, Steven J

2018-02-01

Plastic surgery residency program directors have an interest in recruiting applicants who show an interest in an academic practice. Medical school achievements (ie, United States Medical Licensing Examination® scores, publications, and Alpha Omega Alpha status) are metrics assessed to grade applicants but may not correlate with ultimately choosing an academic career. This study was designed to investigate factors influencing residents' choices for or against academic careers. A 25-item online questionnaire was designed to measure baseline interest in academic plastic surgery and factors that influence decisions to continue on or abandon that career path. This questionnaire was disseminated to the integrated/combined plastic surgery residents during the 2013 to 2014 academic year. One hundred twenty-five respondents indicated that they were currently interested in pursuing academic practice (n = 78) or had lost interest in academic practice (n = 47). Among all respondents, 92.8% (n = 116) stated they were interested in academic careers at the time of residency application, but one-third (n = 41) subsequently lost interest. Those residents who retained interest in academic careers indicated resident/medical student educational opportunities (57%) and complexity of patients (52%) as reasons. Those who lost interest cited a lack of autonomy (43%), publishing requirements (32%), and income discrepancy (26%) as reasons. Many residents report losing interest in academics during residency. Traditional metrics valued in the recruitment process may not serve as positive predictors of an academic career path. Reasons why residents lose interest are not easily correctable, but mentorship, adequate career counseling, and research opportunities during training remain factors that can be addressed across all residency programs.

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

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

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

The impact of persistent visually disabling vitreous floaters on health status utility values.

PubMed

Zou, Haidong; Liu, Haiyun; Xu, Xun; Zhang, Xi

2013-08-01

To assess the time trade-off (TTO) utility values in patients with persistent visually disabling vitreous floaters (DVF) and to determine the reliability and validity of TTO methods in DVF patients. Prospective cross-sectional questionnaire survey: Eligible patients with persistent DVF referred to the Shanghai First People's Hospital outpatient service between January 2006 and February 2010, and randomly selected normal vision general population residents, were enrolled. All participants underwent TTO utility value evaluation. After 4-5 weeks, the patients were asked to undergo second TTO utility value evaluation during the follow-up interview. The mean initial utility values of the 107 persistent DVF patients were 0.904 ± 0.054. Regression analyses revealed that length of education, visual acuity in the poorer-vision eye and employment status were associated with utility values (all P < 0.01). All patients took part in the follow-up interview; the intra-class correlation coefficient for TTO utility values at the initial and follow-up interviews was 0.855. In the 91 general population residents, the mean utility value was 0.923 ± 0.032, which was statistically higher than that of active study patients (t = 3.01, P < 0.01). Persistent DVF can substantially diminish the patients' perception of their life, and can be measured by TTO utility values with high reliability and construct validity.

Influence of Clinical Experience and Productivity on Emergency Medicine Faculty Teaching Scores

PubMed Central

Clyne, Brian; Smith, Jessica L.; Napoli, Anthony M.

2012-01-01

Background Commonly cited barriers to effective teaching in emergency medicine include lack of time, competing demands for patient care, and a lack of formal teaching experience. Teaching may be negatively affected by demands for increased clinical productivity, or positively influenced by clinical experience. Objective To examine the association between faculty teaching scores and clinical productivity, years of clinical experience, and amount of clinical contact with resident physicians. Methods We conducted a retrospective, observational study with existing data on full-time faculty at a high-volume, urban emergency medicine residency training program for academic year 2008–2009. Residents rated faculty on 9 domains of teaching, including willingness to teach, enthusiasm for teaching, medical knowledge, preparation, and communication. Clinical productivity data for relative value units per hour and number of patients per hour, years of clinical experience, and annual clinical hours were obtained from existing databases. Results For the 25 core faculty members included in the study, there was no relationship between faculty teaching scores and clinical productivity measures (relative value units per hour: r2  =  0.01, P  =  .96, patients per hour: r2  =  0.00, P  =  .76), or between teaching scores and total clinical hours with residents (r2  =  0.07, P  =  .19). There was a significant negative relationship between years of experience and teaching scores (r2  =  0.27, P < .01). Conclusions Our study demonstrated that teaching scores for core emergency medicine faculty did not correlate with clinical productivity or amount of clinical contact with residents. Teaching scores were inversely related to number of years of clinical experience, with more experienced faculty earning the lowest teaching scores. Further study is necessary to determine if there are clinical measures that identify good educators. PMID:24294418

Comparison of Microscopy, Nested-PCR, and Real-Time-PCR Assays Using High-Throughput Screening of Pooled Samples for Diagnosis of Malaria in Asymptomatic Carriers from Areas of Endemicity in Myanmar

PubMed Central

Wang, Bo; Han, Soe-Soe; Cho, Cho; Han, Jin-Hee; Cheng, Yang; Lee, Seong-Kyun; Galappaththy, Gawrie N. L; Thimasarn, Krongthong; Soe, Myat Thu; Oo, Htet Wai; Kyaw, Myat Phone

2014-01-01

Asymptomatic infection is an important obstacle for controlling disease in countries where malaria is endemic. Because asymptomatic carriers do not seek treatment for their infections, they can have high levels of gametocytes and constitute a reservoir available for new infection. We employed a sample pooling/PCR-based molecular detection strategy for screening malaria infection in residents from areas of Myanmar where malaria is endemic. Blood samples (n = 1,552) were collected from residents in three areas of malaria endemicity (Kayin State, Bago, and Tanintharyi regions) of Myanmar. Two nested PCR and real-time PCR assays showed that asymptomatic infection was detected in about 1.0% to 9.4% of residents from the surveyed areas. The sensitivities of the two nested PCR and real-time PCR techniques were higher than that of microscopy examination (sensitivity, 100% versus 26.4%; kappa values, 0.2 to 0.5). Among the three regions, parasite-positive samples were highly detected in subjects from the Bago and Tanintharyi regions. Active surveillance of residents from regions of intense malaria transmission would reduce the risk of morbidity and mitigate transmission to the population in these areas of endemicity. Our data demonstrate that PCR-based molecular techniques are more efficient than microscopy for nationwide surveillance of malaria in countries where malaria is endemic. PMID:24648557

Emergency Medicine Resident Perceptions of Medical Professionalism.

PubMed

Jauregui, Joshua; Gatewood, Medley O; Ilgen, Jonathan S; Schaninger, Caitlin; Strote, Jared

2016-05-01

Medical professionalism is a core competency for emergency medicine (EM) trainees; but defining professionalism remains challenging, leading to difficulties creating objectives and performing assessment. Because professionalism is dynamic, culture-specific, and often taught by modeling, an exploration of trainees' perceptions can highlight their educational baseline and elucidate the importance they place on general conventional professionalism domains. To this end, our objective was to assess the relative value EM residents place on traditional components of professionalism. We performed a cross-sectional, multi-institutional survey of incoming and graduating EM residents at four programs. The survey was developed using the American Board of Internal Medicine's "Project Professionalism" and the Accreditation Council of Graduate Medical Education definition of professionalism competency. We identified 27 attributes within seven domains: clinical excellence, humanism, accountability, altruism, duty and service, honor and integrity, and respect for others. Residents were asked to rate each attribute on a 10-point scale. We analyzed data to assess variance across attributes as well as differences between residents at different training levels or different institutions. Of the 114 residents eligible, 100 (88%) completed the survey. The relative value assigned to different professional attributes varied considerably, with those in the altruism domain valued significantly lower and those in the "respect for others" and "honor and integrity" valued significantly higher (p<0.001). Significant differences were found between interns and seniors for five attributes primarily in the "duty and service" domain (p<0.05). Among different residencies, significant differences were found with attributes within the "altruism" and "duty and service" domains (p<0.05). Residents perceive differences in the relative importance of traditionally defined professional attributes and this may be useful to educators. Explanations for these differences are hypothesized, as are the potential implications for professionalism education. Because teaching professional behavior is taught most effectively via behavior modeling, faculty awareness of resident values and faculty development to address potential gaps may improve professionalism education.

Work stress and reduced health in young physicians: prospective evidence from Swiss residents.

PubMed

Buddeberg-Fischer, Barbara; Klaghofer, Richard; Stamm, Martina; Siegrist, Johannes; Buddeberg, Claus

2008-10-01

Job stress, investigated by the effort-reward model in various working environments in different countries, has been widely reported, yet studies addressing physicians are lacking. The present study investigated the perceived job stress, its association with the amount of working hours, and its impact on young physicians' self-reported health and their satisfaction with life during residency. In a prospective study design, a cohort of Swiss medical school graduates was followed up, beginning in 2001. In their second and fourth years of residency, 433 physicians assessed their effort-reward imbalance, overcommitment, physical and mental well-being and satisfaction in life. Taking the longitudinal design into account, four categories of stressed residents were defined: (1) subjects not reporting high work stress at either measurement, (2) subjects reporting high work stress in the second but not in the fourth year of residency, (3) subjects with onset of high work stress in fourth year and (4) residents reporting high work stress at both measurements. All components of the perceived stress at work were significantly correlated with the amount of working hours, effort showing the highest correlation. While two-thirds of the participants do not report high work stress, assessed by the extrinsic part of the effort-reward imbalance model (the ratio between effort and reward) and 12% show a decrease of stress over time, there are 15% with an increase of stress over time, and 10% with persistently high stress experience. In terms of the intrinsic stress component (overcommitment), 71% show low values, 12% show a decrease, 9% an increase and 8% constantly high values. The groups with constant and increasing extrinsic and intrinsic stress experience exhibit significantly worse health and life satisfaction compared to the remaining groups, after controlling for gender and baseline health. Stress at work in young physicians, especially when being experienced over a longer period in postgraduate training, has to be a matter of concern because of its negative impact on health and life satisfaction and the risk of developing symptoms of burnout in the long run.

Clinical governance in the management of induction of labour.

PubMed

Zuberi, Nadeem Faiyaz; Siddiqui, Salva; Qureshi, Rahat Najam

2003-02-01

To determine whether dissemination of explicit guidelines, developed in consensus with stakeholders, for the processes of induction of labour (IOL), results in reduction of variability in clinical practice. A prospective behaviour modification interventional study. The study was conducted in the department of Obstetrics and Gynaecology at the Aga Khan University, Karachi, between January 1 and August 31, 2002. In a total of 142 conveniently sampled women, undergoing IOL, pre-identified quality assessment indicators were measured. After collection of data from initial 71-women (pre-intervention group) mutually agreed guidelines for clinical practice were disseminated, over a period of time, among consultants, residents and nurses. These indicators were again measured in subsequent 71 women (post-intervention group) to evaluate magnitude of residual non-conformities in these processes. Following behaviour modification interventions, nonconformities in consultants and residents-dependent processes like timely review of patients by consultants (72 vs 1.4%, p value <0.0001), documentation of indication for IOL (66.2 vs 16.9%, p value <0.0001), method of induction for IOL (56.3 vs 28.2%, p value 0.0001), and calculation of Bishop score before IOL (38.0 vs 4.2 %, p value <0.0001) were significantly reduced. Dissemination of explicit guidelines developed in consensus with stakeholders significantly reduces variability in clinical practice. Our model can be used for improving quality of care in other areas of obstetric health care.

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.

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

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

Post, Richard F.

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

Educational role of nurse practitioners in a family practice centre: perspectives of learners and nurses.

PubMed

Walsh, Allyn; Moore, Ainsley; Barber, Anne; Opsteen, Joanne

2014-06-01

To examine the role of nurse practitioners (NPs) as educators of family medicine residents in order to better understand the interprofessional educational dynamics in a clinical teaching setting. A qualitative descriptive approach, using purposive sampling. A family practice centre that is associated with an academic department of family medicine and is based in an urban area in southern Ontario. First-year (8 of 9) and second-year (9 of 10) family medicine residents whose training program was based at the family practice centre, and all NPs (4 of 4) who worked at the centre. Semistructured interviews were conducted, which were audiotaped and transcribed. An iterative approach was used for coding and analysis. Data management software guided organization and analysis of the data. Four interconnected themes were identified: role clarification, professional identity formation, factors that enhance the educational role of NPs, and factors that limit the educational role of NPs. Although residents recognized NPs' value in team functioning and areas of specialized knowledge, they were unclear about NPs' scope of practice. Depending on residents' level of training, residents tended to respond differently to teaching by NPs. More of the senior residents believed they needed to think like physicians and preferred clinical teaching from physician teachers. Junior residents valued the step-by-step instructional approach used by NPs, and they had a decreased sense of vulnerability when being taught by NPs. Training in teaching skills was helpful for NPs. Barriers to providing optimal education included opportunity, time, and physician attitudes. The lack of an intentional orientation of family medicine residents to NPs' scope of practice and educational role can lead to difficulties in interprofessional education. More explicit recognition of the evolving professional identity of family medicine residents might decrease resistance to teaching by NPs and ensure that interprofessional teaching and learning strategies are effective. Faculty development opportunities for all educators are required to manage these issues, both to ensure teaching competencies and to reinforce positive interprofessional collaboration. Copyright© the College of Family Physicians of Canada.

Teaching and learning in the operating room is a two-way street: resident perceptions.

PubMed

Vikis, Elena A; Mihalynuk, Tanis V; Pratt, Dan D; Sidhu, Ravi S

2008-05-01

The transformation of a trainee into a surgeon is influenced strongly by communication patterns in the operating room (OR). In the current era of limited educational opportunities, elucidation of teaching and learning strategies in this environment is critical. The aim of this study was to further understand the elements of an effective communicative instructional interaction (CII) as perceived by surgical residents. Qualitative research methodology was used to explore University of British Columbia surgery residents' perceptions of what constitutes an effective CII in the OR. Purposeful sampling was used to select participants from various years of training. Eighteen residents participated in semistructured interviews to facilitate reflection of their OR experiences. Interviews were transcribed, analyzed, and fed back to residents to confirm their accuracy. Independent coding and analysis led to the development of key emergent themes. Themes represented the interplay of ideals expressed by the residents. The primary emergent theme was that both teacher and learner play a major role in the creation of an effective CII. The ideal teacher had an instructional plan, facilitated surgical independence, and showed support and empathy for the surgical resident. The ideal resident was receptive, prepared, and acknowledged limitations. The contextual constraints of the OR played a central role in learning, and residents identified ways to maintain educational value despite primarily nonmodifiable contextual elements (ie, time constraints). In a unique environment such as the OR, both teacher and learner may benefit by an enhanced understanding of the elements of an effective CII.

Living Arrangements of Ever-Married Older Lebanese Women: Is Living with Married Children Advantageous?

PubMed Central

Mehio-Sibai, Abla; Tohme, Rania A.

2016-01-01

In many Middle Eastern countries including Lebanon, the family as a social institution is greatly valued and local norms regarding family ties and living arrangements are especially important for older adults, in particular older women. While the presence of an adult child is often seen as responsive to the financial, health and social needs of older parents, it is not clear whether co-residence with married children offers a similar advantage as in the case of co-residence with unmarried children. Using data from a national Population and Housing Survey, this study examines associations of co-residence with adult children among ever-married women aged 65 years and older in Lebanon. Results showed a considerable proportion of elderly women who were living alone (18%) at the time of the survey. Co-residence was more frequent with unmarried than married children, but the gender ratio of the co-residing child varied with the marital status of both the older woman and the child. Moreover, among those co-residing with married children, results indicate a greater likelihood of co-residence with married sons over married daughters. Co-residence with an adult child associated positively with the availability of surviving children and negatively with the socioeconomic status of the woman and her spouse. Compared to other living arrangements, co-residence with a married child entailed the least advantageous Household Socioeconomic Status (HSES) score in terms of housing characteristics, infrastructure, and material possessions, for both married and unmarried women. PMID:18283537

Admission factors associated with international medical graduate certification success: a collaborative retrospective review of postgraduate medical education programs in Ontario.

PubMed

Grierson, Lawrence E M; Mercuri, Mathew; Brailovsky, Carlos; Cole, Gary; Abrahams, Caroline; Archibald, Douglas; Bandiera, Glen; Phillips, Susan P; Stirrett, Glenna; Walton, J Mark; Wong, Eric; Schabort, Inge

2017-11-24

The failure rate on certification examinations of The College of Family Physicians of Canada (CFPC) and the Royal College of Physicians and Surgeons of Canada (RCPSC) is significantly higher for international medical graduates than for Canadian medical school graduates. The purpose of the current study was to generate evidence that supports or refutes the validity of hypotheses proposed to explain the lower success rates. We conducted retrospective analyses of admissions and certification data to determine the factors associated with success of international medical graduate residents on the certification examinations. International medical graduates who entered an Ontario residency program between 2005 and 2012 and had written a certification examination by the time of the analysis (2015) were included in the study. Data available at the time of admission for each resident, including demographic characteristics, previous experiences and previous professional experiences, were collected from each of the 6 Ontario medical schools and matched with certification examination results provided by The CFPC and the RCPSC. We developed logistic regression models to determine the association of each factor with success on the examinations. Data for 900 residents were analyzed. The models revealed resident age to be strongly associated with performance across all examinations. Fluency in English, female sex and the Human Development Index value associated with the country of medical school training had differential associations across the examinations. The findings should contribute to an improved understanding of certification success by international medical graduates, help residency programs identify at-risk residents and underpin the development of specific educational and remedial interventions. In considering the results, it should be kept in mind that some variables are not amenable to changes in selection criteria. Copyright 2017, Joule Inc. or its licensors.

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.

Quantification of the Dedolomitization Rate for Correction of Groundwater 14C Ages in Aquifers of the Sacramento Mountains, New Mexico

NASA Astrophysics Data System (ADS)

Morse, J. T.; Phillips, F. M.; Land, L. A.

2009-12-01

Ion chemistry of groundwater from the western part of the Roswell Basin, New Mexico, are consistent with groundwater quality evolution driven by dedolomitization. Measured, uncorrected, 14C values in groundwater yield an apparent residence time of 4700 years for the western part of the Roswell Basin. We have employed a simple model incorporating the changes in bicarbonate, magnesium and 14C along the flow-path to quantify the in-situ rate of dedolomitization and thereby to correct the 14C values for inorganic carbon dilution. The model yielded a corrected residence time of 1300 years at the distal end of the flowpath and a regional hydraulic conductivity of 5×10-4cm/s. Prior studies have inferred that underflow from the Sacramento Mountains constitutes an important component of recharge to the Artesian Aquifer of the Roswell Basin but it has not been possible to quantify this contribution. The information from the corrected 14C dating will allow an improved assessment of the groundwater resources available in this overstressed basin.

Design and performance characterization strategy using modeling for biofiltration control of odorous hydrogen sulfide.

PubMed

Martin, Ronald W; Mihelcic, James R; Crittenden, John C

2004-07-01

Biofilter, dynamic modeling software characterizing contaminant removal via biofiltration, was used in the preliminary design of a biofilter to treat odorous hydrogen sulfide (H2S). Steady-state model simulations were run to generate performance plots for various influent concentrations, loadings, residence times, media sizes, and temperatures. Although elimination capacity and removal efficiency frequently are used to characterize biofilter performance, effluent concentration can be used to characterize performance when treating to a target effluent concentration. Model simulations illustrate that, at a given temperature, a biofilter cannot reduce H2S emissions below a minimum value, no matter how large the biofilter or how long the residence time. However, a higher biofilter temperature results in lower effluent H2S concentrations. Because dynamic model simulations show that shock loading can significantly increase the effluent concentration above values predicted by the steady-state model simulations, it is recommended that, to consistently meet treatment objectives, dynamic feed conditions should be considered. This study illustrates that modeling can serve as a valuable tool in the design and performance optimization of biofilters.

Subcritical hydrothermal liquefaction of cattle manure to bio-oil: Effects of conversion parameters on bio-oil yield and characterization of bio-oil.

PubMed

Yin, Sudong; Dolan, Ryan; Harris, Matt; Tan, Zhongchao

2010-05-01

In this study, cattle manure was converted to bio-oil by subcritical hydrothermal liquefaction in the presence of NaOH. The effects of conversion temperature, process gas, initial conversion pressure, residence time and mass ratio of cattle manure to water on the bio-oil yield were studied. The bio-oil was characterized in terms of elemental composition, higher heating value, ultraviolet-visible (UV/Vis) spectroscopy, Fourier transform infrared spectroscopy (FTIR), gas chromatography (GC) and gas chromatography-mass spectrometry (GC-MS). Results showed that the bio-oil yield depended on the conversion temperature and the process gas. Higher initial conversion pressure, longer residence time and larger mass ratio of cattle manure to water, however, had negative impacts on the bio-oil yield. The higher heating value of bio-oil was 35.53MJ/kg on average. The major non-polar components of bio-oil were toluene, ethyl benzene and xylene, which are components of crude oil, gasoline and diesel. Copyright 2010 Elsevier Ltd. All rights reserved.

ABR Core examination preparation: results of a survey of fourth-year radiology residents who took the 2013 examination.

PubMed

Shetty, Anup S; Grajo, Joseph R; Decker, Summer; Heitkamp, Darel E; DeStigter, Kristen K; Mezwa, Duane G; Deitte, Lori

2015-01-01

A survey was administered to fourth-year radiology residents after receiving their results from the first American Board of Radiology (ABR) Core examination in 2013. The purpose was to gather information regarding resources and study strategies to share with program directors and future resident classes. An online survey was distributed to examinees nationwide. The survey included free-response and multiple choice questions that covered examination results, perceived value of enumerated study resources, case-based and didactic teaching conferences, board reviews, study materials for noninterpretive skills, multidisciplinary conference attendance, and free-form comments. Two hundred sixty-six of 1186 residents who took the Core examination responded to the survey. Some resources demonstrated a significant difference in perceived value between residents who passed the examination and residents who failed, including internal board reviews (1.10, P < .01), daily didactic conferences (1.51, P < .01), and daily case conferences (1.43, P < .01). Residents who passed reported that conferences and review sessions at their institutions were modified with multiple choice questions, audience response, and integration of clinical physics and patient safety topics compared to residents who failed. Radiology residents and residency programs have adapted their preparations for the ABR Core examination in a variety of ways. Certain practices and study tools, including daily conferences and internal board reviews, had greater perceived value by residents who passed the examination than by residents who failed. This survey provides insights that can be used to assess and modify current preparation strategies for the ABR Core examination. Copyright © 2015 AUR. Published by Elsevier Inc. All rights reserved.

Pediatrics Residents' Confidence and Performance Following a Longitudinal Quality Improvement Curriculum.

PubMed

Courtlandt, Cheryl; Noonan, Laura; Koricke, Maureen Walsh; Zeskind, Philip Sanford; Mabus, Sarah; Feld, Leonard

2016-02-01

Quality improvement (QI) training is an integral part of residents' education. Understanding the educational value of a QI curriculum facilitates understanding of its impact. The purpose of this study was to evaluate the effects of a longitudinal QI curriculum on pediatrics residents' confidence and competence in the acquisition and application of QI knowledge and skills. Three successive cohorts of pediatrics residents (N = 36) participated in a longitudinal curriculum designed to increase resident confidence in QI knowledge and skills. Key components were a succession of progressive experiential projects, QI coaching, and resident team membership culminating in leadership of the project. Residents completed precurricular and postcurricular surveys and demonstrated QI competence by performance on the pediatric QI assessment scenario. Residents participating in the Center for Advancing Pediatric Excellence QI curriculum showed significant increases in pre-post measures of confidence in QI knowledge and skills. Coaching and team leadership were ranked by resident participants as having the most educational value among curriculum components. A pediatric QI assessment scenario, which correlated with resident-perceived confidence in acquisition of QI skills but not QI knowledge, is a tool available to test pediatrics residents' QI knowledge. A 3-year longitudinal, multimodal, experiential QI curriculum increased pediatrics residents' confidence in QI knowledge and skills, was feasible with faculty support, and was well-accepted by residents.

[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.

Quantification of pathogen inactivation efficacy by free chlorine disinfection of drinking water for QMRA.

PubMed

Petterson, S R; Stenström, T A

2015-09-01

To support the implementation of quantitative microbial risk assessment (QMRA) for managing infectious risks associated with drinking water systems, a simple modeling approach for quantifying Log10 reduction across a free chlorine disinfection contactor was developed. The study was undertaken in three stages: firstly, review of the laboratory studies published in the literature; secondly, development of a conceptual approach to apply the laboratory studies to full-scale conditions; and finally implementation of the calculations for a hypothetical case study system. The developed model explicitly accounted for variability in residence time and pathogen specific chlorine sensitivity. Survival functions were constructed for a range of pathogens relying on the upper bound of the reported data transformed to a common metric. The application of the model within a hypothetical case study demonstrated the importance of accounting for variable residence time in QMRA. While the overall Log10 reduction may appear high, small parcels of water with short residence time can compromise the overall performance of the barrier. While theoretically simple, the approach presented is of great value for undertaking an initial assessment of a full-scale disinfection contactor based on limited site-specific information.

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.

Value of a regional family practice residency training program site: perceptions of residents, nurses, and physicians.

PubMed

Fletcher, Sarah; Mullett, Jennifer; Beerman, Steve

2014-09-01

To examine the perceptions of residents, nurses, and physicians about the effect of a regional family practice residency site on the delivery of health services in the community, as well as on the community health care providers. Interviews and focus groups were conducted. Nanaimo, BC. A total of 16 residents, 15 nurses, and 20 physicians involved with the family practice residency training program at the Nanaimo site. A series of semistructured interviews and focus groups was conducted. Transcripts of interviews and focus groups were analyzed thematically by the research team. Overall, participants agreed that having a family practice residency training site in the community contributed to community life and to the delivery of health services in the following ways: increased community capacity and social capital; motivated positive relationships and attitudes in the hospital and community settings; improved communication and teamwork, as well as accessibility and understanding of the health care system; increased the standard of care; and facilitated the recruitment and retention of family physicians. This family practice residency training site was beneficial for the community it served. Future planning for distributed medical education sites should take into account the effects of these sites on the health care community and ensure that they continue to be positive influences. Further research in this area could focus on patients' perceptions of how residency programs affect their care, as well as on the effect of residency programs on wait times and workload for physicians and nurses. Copyright© the College of Family Physicians of Canada.

Preparing emergency physicians for malpractice litigation: a joint emergency medicine residency-law school mock trial competition.

PubMed

Drukteinis, Dainius A; O'Keefe, Kelly; Sanson, Tracy; Orban, David

2014-01-01

Fear of malpractice affects the daily life of many emergency physicians. Educational programs to prepare for litigation are lacking. An educational collaboration between an emergency medicine residency and a law school, whereby a medical malpractice mock trial competition is used to teach residents basic skills for testifying in legal proceedings. Ten residents in an academic emergency medicine program volunteered as witnesses in a malpractice mock trial competition at a law school. Residents testified two or three times and, after each appearance, were provided feedback to prepare them for subsequent rounds of testimony. They were also given access to videotaped testimony. Judges rated each resident using a nine-question survey scored on a 10-point Likert scale. Scores were compared as a group between rounds of testimony. Participants demonstrated significant improvement in seven of nine measured categories. p-Values reached significance in: Worked Well on Direct Examination (p < 0.001), Demeanor/Body Language (p < 0.001), Was Not Arrogant/Did Not Lose Poise on Cross-Examination (p = 0.001), Convincing Witness (p = 0.001), Appeared Knowledgeable (p = 0.012), Courtroom Attire (p = 0.012), and Expressed Themselves Clearly (p = 0.017). In addition, residents anonymously reported broad educational benefit. This novel educational collaboration taught residents about the process of litigation. It improved their communication skills and expanded their knowledge of documentation pitfalls, problems with staff interaction, and consequences of medical errors. This mutually beneficial partnership between a medical residency and a law school solidified it as a permanent feature of the residency program. Copyright © 2014 Elsevier Inc. All rights reserved.

Teambuilding and Leadership Training in an Internal Medicine Residency Training Program

PubMed Central

Stoller, James K; Rose, Mark; Lee, Rita; Dolgan, Colleen; Hoogwerf, Byron J

2004-01-01

OBJECTIVE The purpose of this report is to describe and evaluate the impact of a 1-day retreat focused on developing leadership skills and teambuilding among postgraduate year 1 residents in an internal medicine residency. METHOD A group of organizers, including members of the staff, the chief medical residents, administrative individuals in the residency office, and an internal organizational development consultant convened to organize an off-site retreat with activities that would provide experiential learning regarding teamwork and leadership, including a “reef survival exercise” and table discussions regarding the characteristics of ideal leaders. In addition, several energizing activities and recreational free time was provided to enhance the interaction and teamwork dimensions of the retreat. To evaluate the impact of the retreat, attendees completed baseline and follow-up questionnaires regarding their experience of the retreat. RESULTS Attendees universally regarded the retreat as having value for them. Comparison of baseline to postretreat responses indicated that attendees felt that the retreat enhanced their abilities to be better physicians, resident supervisors, and leaders. Follow-up responses indicated significant increases in attendees’ agreement that good leaders challenge the process, make decisions based on shared visions, allow others to act, recognize individual contributions, and serve as good role models. Results on the survival exercise indicated a high frequency with which team-based decisions surpassed individual members’ decisions, highlighting the importance and value of teamwork to attendees. CONCLUSIONS Our main findings were that: participants universally found this 1-day retreat beneficial in helping to develop teamwork and leadership skills and the experiential learning aspects of the retreat were more especially highly rated and highlighted the advantages of teamwork. In the context that this 1-day retreat was deemed useful by faculty and residents alike, further study is needed to assess the impact of this learning on actual clinical practice and the durability of these lessons. PMID:15209609

Family physician clinical compensation in an academic environment: moving away from the relative value unit

PubMed Central

Lochner, Jennifer; Trowbridge, Elizabeth; Kamnetz, Sandra; Pandhi, Nancy

2016-01-01

Background and Objectives Primary care physician compensation structures have remained largely volume-based, lagging behind changes in reimbursement that increasingly include population approaches such as capitation, bundled payments, and care management fees. We describe a population health-based physician compensation plan developed for two departmental family medicine faculty groups (residency teaching clinic faculty and community clinic faculty) along with outcomes before and after the plan’s implementation. Methods An observational study was conducted. A pre-post email survey assessed satisfaction with the plan, salary, and salary equity. Physician retention, panel size, and relative value unit (RVU) productivity metrics also were assessed before and after the plan’s implementation. Results Before implementation of the new plan, 18% of residency faculty and 33% of community faculty were satisfied or very satisfied with compensation structure. After implementation, those numbers rose to 47% for residency physicians and 74% for community physicians (p<0.01). Satisfaction with the amount of compensation also rose from 33% to 68% for residency faculty and from 26% to 87% for community faculty (p<0.01). For both groups, panel size per clinical full-time equivalent increased and RVUs moved closer to national benchmarks. RVUs decreased for residency faculty and increased for community faculty. Conclusions Aligning a compensation plan with population health delivery by moving rewards away from RVU productivity and towards panel management resulted in improved physician satisfaction and retention, as well as larger panel sizes. RVU changes were less predictable. Physician compensation is an important component of care model redesign that emphasizes population health. PMID:27272423

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.

Integration of scanned document management with the anatomic pathology laboratory information system: analysis of benefits.

PubMed

Schmidt, Rodney A; Simmons, Kim; Grimm, Erin E; Middlebrooks, Michael; Changchien, Rosy

2006-11-01

Electronic document management systems (EDMSs) have the potential to improve the efficiency of anatomic pathology laboratories. We implemented a novel but simple EDMS for scanned documents as part of our laboratory information system (AP-LIS) and collected cost-benefit data with the intention of discerning the value of such a system in general and whether integration with the AP-LIS is advantageous. We found that the direct financial benefits are modest but the indirect and intangible benefits are large. Benefits of time savings and access to data particularly accrued to pathologists and residents (3.8 h/d saved for 26 pathologists and residents). Integrating the scanned document management system (SDMS) into the AP-LIS has major advantages in terms of workflow and overall simplicity. This simple, integrated SDMS is an excellent value in a practice like ours, and many of the benefits likely apply in other practice settings.

Breast and cervical cancer screening among women in metropolitan areas of the United States by county-level commuting time to work and use of public transportation, 2004 and 2006.

PubMed

Coughlin, Steven S; King, Jessica

2010-03-19

Commuting times and behaviors have been associated with a variety of chronic disease outcomes and health behaviors. We examined the relationships between ecologic measures of commuting time and use of public transportation in relation to breast and cervical cancer screening among women in U.S. metropolitan areas who participated in the 2004 and 2006 Behavioral Risk Factor Surveillance System (BRFSS) surveys. Self-reported county of residence was used to classify respondents as residents of metropolitan statistical areas (MSAs). Only BRFSS respondents who resided in the 39 MSAs with a population of > or = 1.5 million in 2007--representing a total of 337 counties--were included in this analysis. A total of 76,453 women aged > or = 40 years were included in analyses on mammography. Analyses on Pap testing were limited to women aged > or =18 years with no history of hysterectomy (n = 80,959). Area-based measures of socio-economic status (SES) were obtained by utilizing county-level information from the 2000 U.S. Census. With adjustment for age, no important associations were observed between receipt of a recent mammogram and either a county-level measure of commute time or residence in an area where more residents had access to a car. Similarly, women living in counties where at least four percent of the residents used public transportation were as likely to have had a recent mammogram or Pap test compared with women in areas where less than four percent of residents used public transportation. However, women living in counties where < 2% of residents had no access to a car were somewhat more likely to have had a Pap test in the past 3 years than women in areas where > or = 3% of the residents had no access to a car (87.3% versus 84.5%; p-value for test for trend < 0.01). In multivariate analysis, living in a county with a median commute time of at least 30 minutes was not significantly associated with having had a Pap test in the past 3 years (adjusted odds ratio (OR) = 1.1, 95% CI 0.9-1.2, p = .50), or with having had a mammogram in the past 2 years (adjusted OR = 0.9, 95% CI 0.9-1.1, p = .28). A weak positive association was observed between residence in a county with less use of public transportation and having had a Pap test in the past 3 years, which was of borderline significance (adjusted OR 1.2, 95% CI 1.0-1.4, p = .05). In large U.S. metropolitan areas, transportation issues may play a role in whether a woman obtains cancer screening along with other factors (e.g., Hispanic ethnicity, low income, and no physician visit in the past year). In this contextual analysis, a longer commute time was not associated with breast and cervical cancer screening.

Classification of Animal Movement Behavior through Residence in Space and Time.

PubMed

Torres, Leigh G; Orben, Rachael A; Tolkova, Irina; Thompson, David R

2017-01-01

Identification and classification of behavior states in animal movement data can be complex, temporally biased, time-intensive, scale-dependent, and unstandardized across studies and taxa. Large movement datasets are increasingly common and there is a need for efficient methods of data exploration that adjust to the individual variability of each track. We present the Residence in Space and Time (RST) method to classify behavior patterns in movement data based on the concept that behavior states can be partitioned by the amount of space and time occupied in an area of constant scale. Using normalized values of Residence Time and Residence Distance within a constant search radius, RST is able to differentiate behavior patterns that are time-intensive (e.g., rest), time & distance-intensive (e.g., area restricted search), and transit (short time and distance). We use grey-headed albatross (Thalassarche chrysostoma) GPS tracks to demonstrate RST's ability to classify behavior patterns and adjust to the inherent scale and individuality of each track. Next, we evaluate RST's ability to discriminate between behavior states relative to other classical movement metrics. We then temporally sub-sample albatross track data to illustrate RST's response to less resolved data. Finally, we evaluate RST's performance using datasets from four taxa with diverse ecology, functional scales, ecosystems, and data-types. We conclude that RST is a robust, rapid, and flexible method for detailed exploratory analysis and meta-analyses of behavioral states in animal movement data based on its ability to integrate distance and time measurements into one descriptive metric of behavior groupings. Given the increasing amount of animal movement data collected, it is timely and useful to implement a consistent metric of behavior classification to enable efficient and comparative analyses. Overall, the application of RST to objectively explore and compare behavior patterns in movement data can enhance our fine- and broad- scale understanding of animal movement ecology.

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

NASA Astrophysics Data System (ADS)

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

2016-01-01

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

Wisdom of Generations: A Pilot Study of the Values Transmitted in Ethical Wills of Nursing Home Residents and Student Volunteers

ERIC Educational Resources Information Center

Cohen-Mansfield, Jiska; Regier, Natalie G.; Peyser, Hedy; Stanton, Joshua

2009-01-01

Purpose: This is a pilot study that provides a description of the values older persons report in ethical wills and their reasoning for the values they chose, and compares the values in ethical wills of seniors and students. Nursing home residents rarely get the opportunity or venue to discuss these topics and the ethical will enables them to have…

Struggling to be self-directed: residents' paradoxical beliefs about learning.

PubMed

Nothnagle, Melissa; Anandarajah, Gowri; Goldman, Roberta E; Reis, Shmuel

2011-12-01

Self-directed learning (SDL) skills serve as the basis for physician lifelong learning; however, residency training does not typically emphasize SDL skills. To understand residents' needs regarding SDL curricula, the authors used qualitative methods to examine the residency learning culture and residents' views of SDL. The authors conducted individual, in-depth, semistructured interviews with all 13 final-year residents at the Brown University Family Medicine Residency Program. Interviews were audio taped and transcribed verbatim. Using an iterative individual and group process, four researchers conducted a qualitative analysis of the transcripts, identifying major themes and higher-order interpretations. Major themes included resident beliefs about learning, the learning culture in residency, and developmental progress in learning. Four paradoxes emerged in the analysis: (1) Residents understand and value the concept of SDL, but they engage in limited goal setting and reflection and report lack of skills to manage their own learning, particularly in the clinical setting. (2) Despite being immersed in what aims to be a learner-centered culture, many residents still value traditional, teacher-centered approaches. (3) Residents recognize patient care as the most powerful stimulus for SDL, but they often perceive patient care and learning as competing priorities. (4) Residents desire external guidance for SDL. Graduating residents lacked confidence in their SDL skills and their ability to manage their learning, especially in clinical settings. Fostering SDL skills during residency will likely require training and guidance for SDL as well as changes in the structure and culture of residency.

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.

Building sustainable communities using sense of place indicators in three Hudson River Valley, NY, tourism destinations: An application of the limits of acceptable change process

Treesearch

Laura E. Sullivan; Rudy M. Schuster; Diane M. Kuehn; Cheryl S. Doble; Duarte Morais

2010-01-01

This study explores whether measures of residents' sense of place can act as indicators in the Limits of Acceptable Change (LAC) process to facilitate tourism planning and management. Data on community attributes valued by residents and the associated values and meanings were collected through focus groups with 27 residents in three Hudson River Valley, New York,...

Measuring Perceived Educational Impact of a Resident-Led Research Newsletter.

PubMed

Aftab, Awais; Lackamp, Jeanne; Cerny, Cathleen

2017-06-01

To determine the perceived educational impact of a resident-led psychiatry research newsletter ('Research Watch') on the psychiatry residents at the authors' residency program. An anonymous, voluntary paper questionnaire was distributed to all psychiatry residents at the program. The survey inquired about the degree of exposure (quantified as 'exposure index') and contribution to the newsletter. A set of questions asked residents to estimate how much of the improvement they attributed to the influence of the newsletter, rating the attribution between 0 and 100%, in the areas of interest in scholarly activities/research, knowledge of current psychiatric research, and participation in scholarly activities/research. The survey also inquired if the newsletter had any impact on their clinical practice. Of 29 residents in the program who received the survey, 27 (93%) responded. The percentage of residents reporting perceived non-zero impact of the newsletter on specific areas of improvement was as follows: interest in scholarly activities/research (44%), knowledge of current psychiatric research (48%), participation in scholarly activities/research (40%), and clinical practice (40%). Exposure index significantly and positively correlated with self-reported percentage attribution for knowledge (correlation coefficient 0.422, p value 0.028) and self-reported impact on clinical practice (correlation coefficient 0.660, p value 0.000), and degree of contribution significantly and positively correlated with self-reported percentage attribution for knowledge (correlation coefficient 0.488, p value 0.010). A resident-led research newsletter can have a positive perceived impact on the residents' interest, knowledge, and participation in research, as well as a positive perceived impact on clinical practice.

Neurohospitalists enhance resident perception of the educational and clinical value of a night float rotation.

PubMed

Greene, James G

2013-10-01

Neurology residency training programs have been profoundly impacted by recent changes in resident duty hours, workloads, and supervisory requirements. In response, many programs have adopted a night float coverage system to minimize the requirements for overnight call. The majority involves residents working a block of night shifts in what is typically a service-oriented rotation. Recently, concerns have arisen regarding the impact of this design on resident education and patient care. We have developed a novel on-site nighttime neurohospitalist model for the explicit purpose of steepening the initial learning curve for neurology residents in an effort to rapidly improve their neurological skills and, in conjunction, overnight patient care. We surveyed residents after the initiation of this system to assess their perception of the impact of direct overnight supervision on education and patient care. As part of ongoing quality improvement efforts, surveys were administered to neurology house staff at a tertiary academic medical center after they had completed service on the night float rotation both with and without an attending in the hospital using a retrospective pre/postdesign. There was a robust positive impact on resident's perception of overall quality, educational value, and clinical quality on the night float rotation with an attending on-site. Despite an overall perception that their autonomy was maintained, residents believed barriers to contact the attending were lower, and attending interaction during critical decision making was more frequent. Direct overnight supervision by a neurohospitalist enhances the educational value and care quality on overnight resident rotations.

Surgical Training and Education in Promoting Professionalism: a comparative assessment of virtue-based leadership development in otolaryngology-head and neck surgery residents

PubMed Central

Schulz, Kristine; Puscas, Liana; Tucci, Debara; Woodard, Charles; Witsell, David; Esclamado, Ramon M.; Lee, Walter T.

2013-01-01

Introduction Surgical Training and Education in Promoting Professionalism (STEPP) was developed in 2011 to train tomorrow's leaders during residency. It is based on virtue ethics and takes an approach similar to West Point military academy. The purpose of this research was: (i) to compare the virtue profiles of our residents with that of the military cohort using a standardized virtue assessment tool; and (ii) to assess the value of virtue education on residents. Methods As part of STEPP, otolaryngology residents participated in a virtue-based validated assessment tool called Virtue in Action (VIA) Inventory. This was completed at the initiation of STEPP in July 2011 as well as 1 year later in June 2012. Comparison of the VIA to a military cohort was performed. Leadership ‘Basic Training’ is a series of forums focused on virtues of initiative, integrity, responsibility, self-discipline, and accountability. A pre- and post-test was administered assessing resident perceptions of the value of this ‘Basic Training’. Results Virtues are shared between otolaryngology residents (n=9) and military personnel (n=2,433) as there were no significant differences in strength scores between two military comparison groups and otolaryngology-head and neck surgery (OHNS) residents. There was a significant improvement (p<0.001) in the understanding of components of the leadership vision and a significant improvement in the understanding of key leadership concepts based on ‘Basic Training’. All residents responded in the post-test that the STEPP program was valuable, up from 56%. Conclusions A virtue-based approach is valued by residents as a part of leadership training during residency. PMID:24172053

Surgical Training and Education in Promoting Professionalism: a comparative assessment of virtue-based leadership development in otolaryngology-head and neck surgery residents.

PubMed

Schulz, Kristine; Puscas, Liana; Tucci, Debara; Woodard, Charles; Witsell, David; Esclamado, Ramon M; Lee, Walter T

2013-10-29

Surgical Training and Education in Promoting Professionalism (STEPP) was developed in 2011 to train tomorrow's leaders during residency. It is based on virtue ethics and takes an approach similar to West Point military academy. The purpose of this research was: (i) to compare the virtue profiles of our residents with that of the military cohort using a standardized virtue assessment tool; and (ii) to assess the value of virtue education on residents. As part of STEPP, otolaryngology residents participated in a virtue-based validated assessment tool called Virtue in Action (VIA) Inventory. This was completed at the initiation of STEPP in July 2011 as well as 1 year later in June 2012. Comparison of the VIA to a military cohort was performed. Leadership 'Basic Training' is a series of forums focused on virtues of initiative, integrity, responsibility, self-discipline, and accountability. A pre- and post-test was administered assessing resident perceptions of the value of this 'Basic Training'. Virtues are shared between otolaryngology residents (n=9) and military personnel (n=2,433) as there were no significant differences in strength scores between two military comparison groups and otolaryngology-head and neck surgery (OHNS) residents. There was a significant improvement (p<0.001) in the understanding of components of the leadership vision and a significant improvement in the understanding of key leadership concepts based on 'Basic Training'. All residents responded in the post-test that the STEPP program was valuable, up from 56%. A virtue-based approach is valued by residents as a part of leadership training during residency.

Surgical Training and Education in Promoting Professionalism: a comparative assessment of virtue-based leadership development in otolaryngology-head and neck surgery residents.

PubMed

Schulz, Kristine; Puscas, Liana; Tucci, Debara; Woodard, Charles; Witsell, David; Esclamado, Ramon M; Lee, Walter T

2013-01-01

Introduction Surgical Training and Education in Promoting Professionalism (STEPP) was developed in 2011 to train tomorrow's leaders during residency. It is based on virtue ethics and takes an approach similar to West Point military academy. The purpose of this research was: (i) to compare the virtue profiles of our residents with that of the military cohort using a standardized virtue assessment tool; and (ii) to assess the value of virtue education on residents. Methods As part of STEPP, otolaryngology residents participated in a virtue-based validated assessment tool called Virtue in Action (VIA) Inventory. This was completed at the initiation of STEPP in July 2011 as well as 1 year later in June 2012. Comparison of the VIA to a military cohort was performed. Leadership 'Basic Training' is a series of forums focused on virtues of initiative, integrity, responsibility, self-discipline, and accountability. A pre- and post-test was administered assessing resident perceptions of the value of this 'Basic Training'. Results Virtues are shared between otolaryngology residents (n=9) and military personnel (n=2,433) as there were no significant differences in strength scores between two military comparison groups and otolaryngology-head and neck surgery (OHNS) residents. There was a significant improvement (p<0.001) in the understanding of components of the leadership vision and a significant improvement in the understanding of key leadership concepts based on 'Basic Training'. All residents responded in the post-test that the STEPP program was valuable, up from 56%. Conclusions A virtue-based approach is valued by residents as a part of leadership training during residency.

A novel program to improve patient safety by integrating peer review into the emergency medicine residency curriculum.

PubMed

Strayer, Reuben J; Shy, Bradley D; Shearer, Peter L

2014-12-01

Evaluating the quality of care as part of a quality improvement process is required in many clinical environments by accrediting bodies. It produces metrics used to evaluate department and individual provider performance, provides outcomes-based feedback to clinicians, and identifies ways to reduce error. To improve patient safety and train our residents to perform peer review, we expanded our quality assurance program from a narrow, administrative process carried out by a small number of attendings to an educationally focused activity of much greater scope incorporating all residents on a monthly basis. We developed an explicit system by which residents analyze sets of high-risk cases and record their impressions onto structured databases, which are reviewed by faculty. At monthly meetings, results from the month's case reviews are presented, learning points discussed, and corrective actions are proposed. By integrating Clinical Quality Review (CQR) as a core, continuous component of the residency curriculum, we increased the number of cases reviewed more than 10-fold and implemented a variety of clinical process improvements. An anonymous survey conducted after 2 years of resident-led CQR indicated that residents value their exposure to the peer review process and feel it benefits them as clinicians, but also that the program requires a significant investment of time that can be burdensome. Copyright © 2014 Elsevier Inc. All rights reserved.

Controlled short residence time coal liquefaction process

DOEpatents

Anderson, Raymond P.; Schmalzer, David K.; Wright, Charles H.

1982-05-04

Normally solid dissolved coal product and a distillate liquid product are produced by continuously passing a feed slurry comprising raw feed coal and a recycle solvent oil and/or slurry together with hydrogen to a preheating-reaction zone (26, alone, or 26 together with 42), the hydrogen pressure in the preheating-reaction zone being at least 1500 psig (105 kg/cm.sup.2), reacting the slurry in the preheating-reaction zone (26, or 26 with 42) at a temperature in the range of between about 455.degree. and about 500.degree. C. to dissolve the coal to form normally liquid coal and normally solid dissolved coal. A total slurry residence time is maintained in the reaction zone ranging from a finite value from about 0 to about 0.2 hour, and reaction effluent is continuously and directly contacted with a quenching fluid (40, 68) to substantially immediately reduce the temperature of the reaction effluent to below 425.degree. C. to substantially inhibit polymerization so that the yield of insoluble organic matter comprises less than 9 weight percent of said feed coal on a moisture-free basis. The reaction is performed under conditions of temperature, hydrogen pressure and residence time such that the quantity of distillate liquid boiling within the range C.sub.5 -455.degree. C. is an amount at least equal to that obtainable by performing the process under the same conditions except for a longer total slurry residence time, e.g., 0.3 hour. Solvent boiling range liquid is separated from the reaction effluent and recycled as process solvent.

Rounds Today: A Qualitative Study of Internal Medicine and Pediatrics Resident Perceptions.

PubMed

Rabinowitz, Raphael; Farnan, Jeanne; Hulland, Oliver; Kearns, Lisa; Long, Michele; Monash, Bradley; Bhansali, Priti; Fromme, H Barrett

2016-10-01

Attending rounds is a key component of patient care and education at teaching hospitals, yet there is an absence of studies addressing trainees' perceptions of rounds. To determine perceptions of pediatrics and internal medicine residents about the current and ideal purposes of inpatient rounds on hospitalist services. In this multi-institutional qualitative study, the authors conducted focus groups with a purposive sample of internal medicine and pediatrics residents at 4 teaching hospitals. The constant comparative method was used to identify themes and codes. The study identified 4 themes: patient care, clinical education, patient/family involvement, and evaluation. Patient care included references to activities on rounds that forwarded care of the patient. Clinical education pertained to teaching/learning on rounds. Patient/family involvement encompassed comments about incorporating patients and families on rounds. Evaluation described residents demonstrating skill for attendings. Resident perceptions of the purposes of rounds aligned with rounding activities described by prior observational studies of rounds. The influence of time pressures and the divergent needs of participants on today's rounds placed these identified purposes in tension, and led to resident dissatisfaction in the achievement of all of them. Suboptimal congruency exists between perceived resident clinical education and specialty-specific milestones. These findings suggest a need for education of multiple stakeholders by (1) enhancing faculty teaching strategies to maximize clinical education while minimizing inefficiencies; (2) informing residents about the value of patient interactions and family-centered rounds; and (3) educating program directors in proper alignment of inpatient rotational objectives to the milestones.

24 hours on-call and acute fatigue no longer worsen resident mood under the 80-hour work week regulations.

PubMed

Kiernan, Michael; Civetta, Joseph; Bartus, Christine; Walsh, Stephen

2006-01-01

Studies in on-call residents have shown that mood is worsened by fatigue as indicated by increased scores on measures of depression, anxiety, confusion, and anger using the Profile of Mood States (POMS). In prior sleep deprivation studies, mood has been shown to be more affected than either cognitive or motor performances. The purpose of this study was to examine the effect of the 80-hour work week regulations on resident mood in general and in a post-call period (PC). Institutional Review Board approval was obtained to survey the residents and publish the results. POMS is a 65-item adjective questionnaire that includes subscales for measuring tension-anxiety, anger-hostility, depression-dejection, vigor-activity, fatigue-inertia, and confusion-bewilderment, with the summation of the scales forming a total mood disturbance score. Surgical residents were tested at a 9 am didactic curriculum session (9 am has been shown to correlate with the nadir of performance). Residents were tested after nights off call (NOC) or after PC. Time asleep in the preceding 24 hours and other demographic data were also collected. Acute fatigue (AF) was defined as <4 hours sleep. The two-sample t-test and linear regression were used to assess differences between groups. A total of 123 standardized POMS mood questionnaires were administered on 4 occasions to 51 surgical residents, 35 men and 16 women at levels PGY-1 through PGY-5. Overall, 33 tests (27%) were taken after PC and 90 (73%) were taken after NOC. Acute fatigue residents had a mean sleep time of 2.2 (+/-1.5) hours, whereas rested (R) residents had a mean sleep time of 6.7 (+/-2.2) hours (whether PC or NOC). No statistical differences in mean values of vigor, anger, depression, concentration, fatigue, tension, or total score were observed between PC and NOC or between AF and R residents. There was no significant relationship between acute sleep deprivation and total mood disturbance, whether PC or NOC. In linear relationships, NOC total score and hours slept had r2 = 0.01 (p = 0.44), whereas PC total score and hours slept had r2 = 0.07 (p = 0.14). Although POMS was given 4 times, only 27% were PC, which reflects our 1 in 4 night in-house coverage. In contrast to earlier studies, resident mood, as measured by POMS, is no longer related to PC/NOC or acute fatigue. Previous studies have shown that loss of sleep was associated with declining mood. The lack of such a relationship in this study may be related to the new regulations. It has been assumed that people can adapt to chronic sleep loss but have a harder time coping with the effects of acute sleep deprivation. If, however, the new regulations have relieved chronic sleep deprivation, then a well-rested resident can periodically cope with the effects of acute sleep deprivation. Perhaps by eliminating chronic sleep debt, work hour restrictions seem to have removed the negative impact of PC seen in the prior era. Further studies should increase the number of residents studied, have numerous repeat NOC and PC pairs in same subjects, compare different services with different workloads, junior and senior residents, and in-house and at-home call schedules.

Individual dose reconstruction among residents living in the vicinity of the Semipalatinsk nuclear test site using EPR spectroscopy of tooth enamel.

PubMed

Ivannikov, A I; Zhumadilov, Zh; Gusev, B I; Miyazawa, Ch; Jiao, L; Skvortsov, V G; Stepanenko, V F; Takada, J; Hoshi, M

2002-08-01

Individual accumulated doses were determined by EPR spectroscopy of tooth enamel for 26 adult persons residing in territories adjacent to the Semipalatinsk Nuclear Test Site (SNTS). The absorbed dose values due to radiation from nuclear tests were obtained after subtracting the contribution of natural background radiation from the total accumulated dose. The determined dose values ranged up to 250 mGy, except for one person from Semipalatinsk city with a measured dose of 2.8 +/- 0.4 Gy. Increased dose values were determined for the individuals whose teeth were formed before 1962, the end of the atmospheric nuclear tests. These values were found to be significantly larger than those obtained for a group of younger residents of heavily exposed territories and the residents of territories not exposed to radioactive fallout. These increased dose values are consistent with those based on officially registered data for the Northeastern part of Kazakstan adjacent to SNTS, which was exposed to high levels of radioactive fallout from nuclear tests in period 1949-1962.

Value Added: the Case for Point-of-View Camera use in Orthopedic Surgical Education.

PubMed

Karam, Matthew D; Thomas, Geb W; Taylor, Leah; Liu, Xiaoxing; Anthony, Chris A; Anderson, Donald D

2016-01-01

Orthopedic surgical education is evolving as educators search for new ways to enhance surgical skills training. Orthopedic educators should seek new methods and technologies to augment and add value to real-time orthopedic surgical experience. This paper describes a protocol whereby we have started to capture and evaluate specific orthopedic milestone procedures with a GoPro® point-of-view video camera and a dedicated video reviewing website as a way of supplementing the current paradigm in surgical skills training. We report our experience regarding the details and feasibility of this protocol. Upon identification of a patient undergoing surgical fixation of a hip or ankle fracture, an orthopedic resident places a GoPro® point-of-view camera on his or her forehead. All fluoroscopic images acquired during the case are saved and later incorporated into a video on the reviewing website. Surgical videos are uploaded to a secure server and are accessible for later review and assessment via a custom-built website. An electronic survey of resident participants was performed utilizing Qualtrics software. Results are reported using descriptive statistics. A total of 51 surgical videos involving 23 different residents have been captured to date. This includes 20 intertrochanteric hip fracture cases and 31 ankle fracture cases. The average duration of each surgical video was 1 hour and 16 minutes (range 40 minutes to 2 hours and 19 minutes). Of 24 orthopedic resident surgeons surveyed, 88% thought capturing a video portfolio of orthopedic milestones would benefit their education. There is a growing demand in orthopedic surgical education to extract more value from each surgical experience. While further work in development and refinement of such assessments is necessary, we feel that intraoperative video, particularly when captured and presented in a non-threatening, user friendly manner, can add significant value to the present and future paradigm of orthopedic surgical skill training.

Value Added: the Case for Point-of-View Camera use in Orthopedic Surgical Education

PubMed Central

Thomas, Geb W.; Taylor, Leah; Liu, Xiaoxing; Anthony, Chris A.; Anderson, Donald D.

2016-01-01

Abstract Background Orthopedic surgical education is evolving as educators search for new ways to enhance surgical skills training. Orthopedic educators should seek new methods and technologies to augment and add value to real-time orthopedic surgical experience. This paper describes a protocol whereby we have started to capture and evaluate specific orthopedic milestone procedures with a GoPro® point-of-view video camera and a dedicated video reviewing website as a way of supplementing the current paradigm in surgical skills training. We report our experience regarding the details and feasibility of this protocol. Methods Upon identification of a patient undergoing surgical fixation of a hip or ankle fracture, an orthopedic resident places a GoPro® point-of-view camera on his or her forehead. All fluoroscopic images acquired during the case are saved and later incorporated into a video on the reviewing website. Surgical videos are uploaded to a secure server and are accessible for later review and assessment via a custom-built website. An electronic survey of resident participants was performed utilizing Qualtrics software. Results are reported using descriptive statistics. Results A total of 51 surgical videos involving 23 different residents have been captured to date. This includes 20 intertrochanteric hip fracture cases and 31 ankle fracture cases. The average duration of each surgical video was 1 hour and 16 minutes (range 40 minutes to 2 hours and 19 minutes). Of 24 orthopedic resident surgeons surveyed, 88% thought capturing a video portfolio of orthopedic milestones would benefit their education Conclusions There is a growing demand in orthopedic surgical education to extract more value from each surgical experience. While further work in development and refinement of such assessments is necessary, we feel that intraoperative video, particularly when captured and presented in a non-threatening, user friendly manner, can add significant value to the present and future paradigm of orthopedic surgical skill training. PMID:27528828

Perceived value and outcomes of residency projects.

PubMed

Murphy, J E; Downhour, N

2001-05-15

Residency program directors' attitudes toward residency projects were studied. A questionnaire about the residency project experience was mailed in January 2000 to 446 pharmacy practice residency program and specialty residency program directors in the program database of the American Society of Health-System Pharmacists. Recipients responded to opinion statements on a 5-point scale. Responses to the opinion statements were separated into seven categories for analysis. A total of 278 usable questionnaires were returned, for a raw response rate of 63.6%. During the preceding three years, residency directors had served as primary advisors on 917 projects; 171 had served as advisor on at least one of every type of project allowed in the accreditation standards. Of the 917 projects, 364 were presented at national professional meetings, 124 were published, and 484 were believed to have resulted in a positive change in pharmacy services. There were no significant differences in total response scores among any of the subgroups analyzed. There was strong agreement that residency projects were valuable and should continue to be part of the residency program experience. The directors' views of the importance of original research as a project option were more neutral. Overall residency program directors had positive perceptions of the value of residency projects to both residents and institutions and believed that they should continue to be a requirement of residency programs.

Adult foster care for the elderly in Oregon: a mainstream alternative to nursing homes?

PubMed Central

Kane, R A; Kane, R L; Illston, L H; Nyman, J A; Finch, M D

1991-01-01

BACKGROUND. In Oregon, adult foster care (AFC) homes, which are private residences where a live-in manager cares for one to five disabled residents, have been covered by Medicaid since 1981 and seem to offer a mainstream alternative to nursing homes. They house almost 6000 older people, two thirds of which pay privately. METHODS. In a cross-sectional study, we interviewed 400 AFC and 400 nursing home residents. Data analyses included descriptive cross-tabulations; hierarchial loglinear models for judging the effects of care setting and payment status on resident characteristics; and logit analyses for predicting care setting and payment status within care settings. RESULTS. On average, nursing home residents were more physically and cognitively impaired than AFC residents, but there was considerable overlap in patterns of frailty in the two settings. Medicaid AFC residents were less disabled than privately paying AFC residents. AFC residents reported more social activity, even when we controlled for disability status. AFC residents and their families were more likely to value privacy and homelike settings when choosing a care setting, whereas nursing home residents were more likely to value rehabilitation and organized activity programs. CONCLUSIONS. Both AFC and nursing homes are viable components of a long-term care repertoire. The greater disability levels of private-pay AFC residents refutes the criticisms that disabled Medicaid residents were being inappropriately channeled to AFC. PMID:1951820

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

PubMed Central

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

2014-01-01

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

Impact of a competency based curriculum on quality improvement among internal medicine residents.

PubMed

Fok, Mark C; Wong, Roger Y

2014-11-28

Teaching quality improvement (QI) principles during residency is an important component of promoting patient safety and improving quality of care. The literature on QI curricula for internal medicine residents is limited. We sought to evaluate the impact of a competency based curriculum on QI among internal medicine residents. This was a prospective, cohort study over four years (2007-2011) using pre-post curriculum comparison design in an internal medicine residency program in Canada. Overall 175 post-graduate year one internal medicine residents participated. A two-phase, competency based curriculum on QI was developed with didactic workshops and longitudinal, team-based QI projects. The main outcome measures included self-assessment, objective assessment using the Quality Improvement Knowledge Assessment Tool (QIKAT) scores to assess QI knowledge, and performance-based assessment via presentation of longitudinal QI projects. Overall 175 residents participated, with a response rate of 160/175 (91%) post-curriculum and 114/175 (65%) after conducting their longitudinal QI project. Residents' self-reported confidence in making changes to improve health increased and was sustained at twelve months post-curriculum. Self-assessment scores of QI skills improved significantly from pre-curriculum (53.4 to 69.2 percent post-curriculum [p-value 0.002]) and scores were sustained at twelve months after conducting their longitudinal QI projects (53.4 to 72.2 percent [p-value 0.005]). Objective scores using the QIKAT increased post-curriculum from 8.3 to 10.1 out of 15 (p-value for difference <0.001) and this change was sustained at twelve months post-project with average individual scores of 10.7 out of 15 (p-value for difference from pre-curriculum <0.001). Performance-based assessment occurred via presentation of all projects at the annual QI Project Podium Presentation Day. The competency based curriculum on QI improved residents' QI knowledge and skills during residency training. Importantly, residents perceived that their QI knowledge improved after the curriculum and this also correlated to improved QIKAT scores. Experiential QI project work appeared to contribute to sustaining QI knowledge at twelve months.

Do lab-derived distribution coefficient values of pesticides match distribution coefficient values determined from column and field-scale experiments? A critical analysis of relevant literature.

PubMed

Vereecken, H; Vanderborght, J; Kasteel, R; Spiteller, M; Schäffer, A; Close, M

2011-01-01

In this study, we analyzed sorption parameters for pesticides that were derived from batch and column or batch and field experiments. The batch experiments analyzed in this study were run with the same pesticide and soil as in the column and field experiments. We analyzed the relationship between the pore water velocity of the column and field experiments, solute residence times, and sorption parameters, such as the organic carbon normalized distribution coefficient ( ) and the mass exchange coefficient in kinetic models, as well as the predictability of sorption parameters from basic soil properties. The batch/column analysis included 38 studies with a total of 139 observations. The batch/field analysis included five studies, resulting in a dataset of 24 observations. For the batch/column data, power law relationships between pore water velocity, residence time, and sorption constants were derived. The unexplained variability in these equations was reduced, taking into account the saturation status and the packing status (disturbed-undisturbed) of the soil sample. A new regression equation was derived that allows estimating the values derived from column experiments using organic matter and bulk density with an value of 0.56. Regression analysis of the batch/column data showed that the relationship between batch- and column-derived values depends on the saturation status and packing of the soil column. Analysis of the batch/field data showed that as the batch-derived value becomes larger, field-derived values tend to be lower than the corresponding batch-derived values, and vice versa. The present dataset also showed that the variability in the ratio of batch- to column-derived value increases with increasing pore water velocity, with a maximum value approaching 3.5. American Society of Agronomy, Crop Science Society of America, and Soil Science Society of America.

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

PubMed Central

Wesley, Tiffany; Hamer, Diana; Karam, George

2018-01-01

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

Nigerian resident doctors on strike: insights from and policy implications of job satisfaction among resident doctors in a Nigerian teaching hospital.

PubMed

Akinyemi, Oluwaseun; Atilola, Olayinka

2013-01-01

The Nigerian health system has been engulfed in a crisis occasioned by a deluge of strike actions by resident doctors in recent times. Dissatisfaction with conditions of service has been cited as the bone of contention. Job satisfaction studies among doctors have provided insights into the contributory factors to recurrent industrial disputes in other climes. This study aims to determine the predictors of job satisfaction among resident doctors in a tertiary healthcare centre in Nigeria. This is with a view to gain some insights into the possible contributory factors to industrial disputes and to discuss the policy implications of such findings. A semi-structured questionnaire was used to obtain socio-demographic characteristics and job-related determinants of job satisfaction among resident doctors. Logistic regression analysis was carried out to determine predictors of job satisfaction. A total of 163 resident doctors completed the study. Overall, 90 (55.2%) of the resident doctors were satisfied with their jobs. Lower age, career advancement opportunities, autonomy of practice, alignment of job with core personal and professional values, and working environment predicted job satisfaction. To restore satisfaction and possibly stem industrial disputes by resident doctors, government of Nigeria needs to sustain current wages while introducing non-financial benefits. There is a need to adopt policies geared towards increasing government spending on health especially in the area of human capacity and infrastructural development, so as to afford resident doctors opportunities for skill acquisition and career development. Copyright © 2012 John Wiley & Sons, Ltd.

Value of a regional family practice residency training program site

PubMed Central

Fletcher, Sarah; Mullett, Jennifer; Beerman, Steve

2014-01-01

Abstract Objective To examine the perceptions of residents, nurses, and physicians about the effect of a regional family practice residency site on the delivery of health services in the community, as well as on the community health care providers. Design Interviews and focus groups were conducted. Setting Nanaimo, BC. Participants A total of 16 residents, 15 nurses, and 20 physicians involved with the family practice residency training program at the Nanaimo site. Methods A series of semistructured interviews and focus groups was conducted. Transcripts of interviews and focus groups were analyzed thematically by the research team. Main findings Overall, participants agreed that having a family practice residency training site in the community contributed to community life and to the delivery of health services in the following ways: increased community capacity and social capital; motivated positive relationships and attitudes in the hospital and community settings; improved communication and teamwork, as well as accessibility and understanding of the health care system; increased the standard of care; and facilitated the recruitment and retention of family physicians. Conclusion This family practice residency training site was beneficial for the community it served. Future planning for distributed medical education sites should take into account the effects of these sites on the health care community and ensure that they continue to be positive influences. Further research in this area could focus on patients’ perceptions of how residency programs affect their care, as well as on the effect of residency programs on wait times and workload for physicians and nurses. PMID:25217693

Patient-Centered Collaborative Care: The Impact of a New Approach to Postpartum Rounds on Residents' Perception of Their Work Environment

PubMed Central

Baldwin, Maureen; Hashima, Jason; Guise, Jeanne-Marie; Gregory, William Thomas; Edelman, Alison; Segel, Sally

2010-01-01

Objective At our institution, traditional postpartum rounds consisted of separate visits from all members of the obstetric team. This led to patient care inefficiencies and miscommunication. In an effort to improve patient care, patient-centered collaborative care (PCCC) was established, whereby physicians, residents, medical students, nurses, case managers, and social workers conduct rounds as a team. The goal of this observational study was to evaluate how PCCC rounds affected resident physicians' assessment of their work environment. Methods Obstetrics and gynecology residents completed a 13-question written survey designed to assess their sense of workflow, education, and workplace cohesion. Surveys were completed before and 6 months after the implementation of PCCC. Responses were compared in aggregate for preintervention and postintervention with Pearson χ2 test. Results Ninety-two percent of the obstetrics residents (n  =  23) completed the preintervention survey, and 79% (n  =  19) completed the postintervention survey. For most measures, there was no difference in resident perception between the 2 time points. After implementation of PCCC rounds, fewer residents felt that rounds were educational (preintervention  =  39%, postintervention  =  7%; P  =  .03). Conclusion Residents did not report negative impacts on workflow, cohesion, or general well-being after the implementation of PCCC rounds. However, there was a perception that PCCC rounds negatively impacted the educational value of postpartum rounds. This information will help identify ways to improve the resident physician experience in the obstetric service while optimizing patient care. PMID:21975886

Using Simulation Technology to Teach Diabetes Care Management Skills to Resident Physicians

PubMed Central

Sperl-Hillen, John; O’Connor, Patrick; Ekstrom, Heidi; Rush, William; Asche, Stephen; Fernandes, Omar; Appana, Deepika; Amundson, Gerald; Johnson, Paul

2013-01-01

Background Simulation is widely used to teach medical procedures. Our goal was to develop and implement an innovative virtual model to teach resident physicians the cognitive skills of type 1 and type 2 diabetes management. Methods A diabetes educational activity was developed consisting of (a) a curriculum using 18 explicit virtual cases, (b) a web-based interactive interface, (c) a simulation model to calculate physiologic outcomes of resident actions, and (d) a library of programmed feedback to critique and guide resident actions between virtual encounters. Primary care residents in 10 U.S. residency programs received the educational activity. Satisfaction and changes in knowledge and confidence in managing diabetes were analyzed with mixed quantitative and qualitative methods. Results Pre- and post-education surveys were completed by 92/142 (65%) of residents. Likert scale (five-point) responses were favorably higher than neutral for general satisfaction (94%), recommending to colleagues (91%), training adequacy (91%), and navigation ease (92%). Finding time to complete cases was difficult for 50% of residents. Mean ratings of knowledge (on a five-point scale) posteducational activity improved by +0.5 (p < .01) for use of all available drug classes, +0.9 (p < .01) for how to start and adjust insulin, +0.8 (p < .01) for interpreting blood glucose values, +0.8 (p < .01) for individualizing treatment goals, and +0.7 (p < .01) for confidence in managing diabetes patients. Conclusions A virtual diabetes educational activity to teach cognitive skills to manage diabetes to primary care residents was successfully developed, implemented, and well liked. It significantly improved self-assessed knowledge and confidence in diabetes management. PMID:24124951

Relationships between highway noise, noise mitigation, and residential housing values.

DOT National Transportation Integrated Search

1980-01-01

This report presents the findings of a study of the relationship between different noise levels and market values for a sample of 206 single-family residences abutting I-495 in Northern Virginia and for a sample of 207 residences along two heavily tr...

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.

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

PubMed

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

2014-12-01

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

Uranium isotopes and dissolved organic carbon in loess permafrost: Modeling the age of ancient ice

USGS Publications Warehouse

Ewing, Stephanie A.; Paces, James B.; O'Donnell, J.A.; Jorgenson, M.T.; Kanevskiy, M.Z.; Aiken, George R.; Shur, Y.; Harden, Jennifer W.; Striegl, Robert G.

2015-01-01

The residence time of ice in permafrost is an indicator of past climate history, and of the resilience and vulnerability of high-latitude ecosystems to global change. Development of geochemical indicators of ground-ice residence times in permafrost will advance understanding of the circumstances and evidence of permafrost formation, preservation, and thaw in response to climate warming and other disturbance. We used uranium isotopes to evaluate the residence time of segregated ground ice from ice-rich loess permafrost cores in central Alaska. Activity ratios of 234U vs. 238U (234U/238U) in water from thawed core sections ranged between 1.163 and 1.904 due to contact of ice and associated liquid water with mineral surfaces over time. Measured (234U/238U) values in ground ice showed an overall increase with depth in a series of five neighboring cores up to 21 m deep. This is consistent with increasing residence time of ice with depth as a result of accumulation of loess over time, as well as characteristic ice morphologies, high segregated ice content, and wedge ice, all of which support an interpretation of syngenetic permafrost formation associated with loess deposition. At the same time, stratigraphic evidence indicates some past sediment redistribution and possibly shallow thaw among cores, with local mixing of aged thaw waters. Using measures of surface area and a leaching experiment to determine U distribution, a geometric model of (234U/238U) evolution suggests mean ages of up to ∼200 ky BP in the deepest core, with estimated uncertainties of up to an order of magnitude. Evidence of secondary coatings on loess grains with elevated (234U/238U) values and U concentrations suggests that refinement of the geometric model to account for weathering processes is needed to reduce uncertainty. We suggest that in this area of deep ice-rich loess permafrost, ice bodies have been preserved from the last glacial period (10–100 ky BP), despite subsequent fluctuations in climate, fire disturbance and vegetation. Radiocarbon (14C) analysis of dissolved organic carbon (DOC) in thaw waters supports ages greater than ∼40 ky BP below 10 m. DOC concentrations in thaw waters increased with depth to maxima of >1000 ppm, despite little change in ice content or cryostructures. These relations suggest time-dependent production of old DOC that will be released upon permafrost thaw at a rate that is mediated by sediment transport, among other factors.

Defining Service and Education in Pediatrics.

PubMed

Boyer, Debra; Gagne, Josh; Kesselheim, Jennifer C

2017-11-01

Program directors (PDs) and trainees are often queried regarding the balance of service and education during pediatric residency training. We aimed to use qualitative methods to learn how pediatric residents and PDs define service and education and to identify activities that exemplify these concepts. Focus groups of pediatric residents and PDs were performed and the data qualitatively analyzed. Thematic analysis revealed 4 themes from focus group data: (1) misalignment of the perceived definition of service; (2) agreement about the definition of education; (3) overlapping perceptions of the value of service to training; and (4) additional suggestions for improved integration of education and service. Pediatric residents hold positive definitions of service and believe that service adds value to their education. Importantly, the discovery of heterogeneous definitions of service between pediatric residents and PDs warrants further investigation and may have ramifications for Accreditation Council for Graduate Medical Education and those responsible for residency curricula.

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...

Teaching "Global Mental Health:" Psychiatry Residency Directors' Attitudes and Practices regarding International Opportunities for Psychiatry Residents

ERIC Educational Resources Information Center

Belkin, Gary S.; Yusim, Anna; Anbarasan, Deepti; Bernstein, Carol Ann

2011-01-01

Objective: The authors surveyed Psychiatry Residency Training Directors' (RTDs') attitudes about the role and feasibility of international rotations during residency training. Method: A 21-question survey was electronically distributed that explored RTDs' beliefs about the value, use, and availability of international clinical and research…

Resident camp directors, spirituality, and wilderness

Treesearch

Michael Rule; Edward Udd

2002-01-01

A vast majority of resident camp directors in this study perceived wilderness to hold spiritual qualities. In addition, resident camp directors also valued educational components for campers and staff as important before they ventured into wilderness areas. Resident camp directors influence the lives of millions of youth and they are an important provider of wilderness...

The Impact of Different Postgraduate Year Training in Neurosurgery Residency on 30-Day Return to Operating Room: A National Surgical Quality Improvement Program Study.

PubMed

Macki, Mohamed; Fakih, Mohamed; Kandagatla, Pridvi; Rubinfeld, Ilan; Chang, Victor

2018-06-01

Because of the health care initiative on quality improvement projects in academic medicine, this study explores the impact of different postgraduate years (PGYs) on unexpected re-operation rates. Using the National Surgical Quality Improvement Program 2005-2014, adult neurosurgical cases were divided into subspecialties: spine, open vascular, cranial, and functional. Comparison groups were cases involving junior residents (PGY 1-PGY 3), mid-level residents (PGY 4 + PGY 5), and senior residents (PGY 6 + PGY 7). Comorbidity disease burden was measured by frailty index. The primary outcome measure was 30-day unintended return to the operating room. Of the 9782 cases, re-operations were higher for those cases featuring a senior resident (5.6%) compared with mid-level resident (4.1%) and junior resident (3.8%) (P = 0.001). Although senior residents operated on patients with a statistically significantly higher neurologic disease burden, greater relative value units, longer operative times, and more 30-day postoperative adverse events, the level of resident training did not have an impact on revision surgery after multivariable logistical regression. The strongest predictors of return to the operating room included the frailty index (adjusted odds ratio [OR adj ] = 5.18, P < 0.001), functional subspecialty (OR adj  = 2.65, P < 0.001), and Wound Class 4 - dirty/infected wound (OR adj  = 2.33, P = 0.016). Resident participation in neurosurgical cases does not affect 30-day unplanned re-operation rates, which were affected by frailty index, functional subspecialty, and wound class. Copyright © 2018 Elsevier Inc. All rights reserved.

Change in hyporheic zone residence time under different surface flow states

NASA Astrophysics Data System (ADS)

Liu, Suning; Chui, Ting Fong May

2017-04-01

Hyporheic zone (HZ), which is the ecotone immediately below or adjacent to a stream, plays an important role in a stream ecological system. One of the most common metrics in evaluating the functioning of an HZ is residence time (RT) which is the duration a water molecule or a solute remains within the HZ. Many factors, such as meandering of a stream, heterogeneity of streambed, can influence the RT of an HZ. Stream discharge is another governing but less discussed factor. Different discharge values produce different flow states (i.e.., subcritical, critical and supercritical) and alluvial stream bed forms. This study examined the changes of RT in discharges of different states and their corresponding induced bed forms. It employed a toolbox developed by Stonedahl et al. (2015) within Netlogo to simulate the RT of an HZ, considering three discharge values in each of the supercritical, critical and subcritical states. It approximated the bed forms as sinusoidal waves with amplitudes and periods selected for each flow state. The simulated results suggest that the RT is minimum when the flow is critical, and it is longer for both subcritical and supercritical flows. For subcritical flow, the RT, as well as the fraction remained within the streambed during particle tracing, increases with the increase in discharge value. However, there is no such variation among the different discharge values of supercritical flow. Therefore, for supercritical flow, one combination of discharge value and bed form might be sufficient and representative. However, for subcritical flow, the variations of discharge values and their induced bed forms should be considered. Reference: Stonedahl, S.H., Roche, K.R., Stonedahl, F., & Packman, A.I. (2015). Visualizing Hyporheic Flow Through Bedforms Using Dye Experiments and Simulation. J. Vis. Exp. (105), e53285. doi: 10.3791/53285

Seasonal variations on the residence times and partitioning of short-lived radionuclides (234Th, 7Be and 210Pb) and depositional fluxes of 7Be and 210Pb in Tampa Bay, Florida

USGS Publications Warehouse

Baskaran, M.; Swarzenski, P.W.

2007-01-01

Historically, Tampa Bay has been impacted heavily by a wide range of anthropogenic perturbations that may include, agricultural-, shipping-, phosphate mining/distribution-related activities, as well as a burgeoning coastal population. Due to the presence of U-rich underlying sediments, elevated activities of U- and Th-series daughter products may be naturally released into this system. This region is also known for summer thunderstorms and corresponding increases in precipitation and surface water runoff. Only limited work has been conducted on the partitioning of particle-reactive radionuclides (such as 7Be, 210Pb, and 234Th) in such a dynamic coastal system. We investigated both the removal residence time and partitioning of these radionuclides between filter-retained particulate matter (≥ 0.5 μm) and the filtrate ( Our results indicate that the partitioning of 7Be, 210Pb, and 234Th between filtrate and filter-retained phase is controlled foremost by enhanced bottom resuspension events during summer thunderstorms. As a consequence, no significant relationship exists between the distribution coefficients (Kd values) of these isotopes and the concentration of suspended particulate matter (SPM). Relatively faster recycling rates of atmospheric water vapor derived from the ocean results in lower atmospheric depositional fluxes of 210Pb to the study site than predicted. The relationship between 7Be and 210Pb in bulk (wet + dry) deposition is compared to their respective water column activities. The residence times of particulate and dissolved 234Th, 7Be and 210Pb, as well the distribution coefficients of these radionuclides, are then compared to values reported in other coastal systems.

Experiential leadership training for pediatric chief residents: impact on individuals and organizations.

PubMed

Doughty, Robert A; Williams, Patricia D; Brigham, Timothy P; Seashore, Charles

2010-06-01

The past decade has seen a proliferation of leadership training programs for physicians that teach skills outside the graduate medical education curriculum. To determine the perceived value and impact of an experiential leadership training program for pediatric chief residents on the chief residents and on their programs and institutions. The authors conducted a retrospective study. Surveys were sent to chief residents who completed the Chief Resident Training Program (CRTP) between 1988 and 2003 and to their program directors and department chairs asking about the value of the program, its impact on leadership capabilities, as well as the effect of chief resident training on programs and institutions. Ninety-four percent of the chief residents and 94% of program directors and department chairs reported that the CRTP was "very" or "somewhat" relevant, and 92% of the chief residents indicated CRTP had a positive impact on their year as chief resident; and 75% responded it had a positive impact beyond residency. Areas of greatest positive impact included awareness of personality characteristics, ability to manage conflict, giving and receiving feedback, and relationships with others. Fifty-six percent of chief residents reported having held a formal leadership position since chief residency, yet only 28% reported having received additional leadership training. The study demonstrates a perceived positive impact on CRTP participants and their programs and institutions in the short and long term.

Fundamentals of Laparoscopic Surgery: A Surgical Skills Assessment Tool in Gynecology

PubMed Central

Arden, Deborah; Dodge, Laura E.; Zheng, Bin; Ricciotti, Hope A.

2011-01-01

Objective: To describe our experience with the Fundamentals of Laparoscopic Surgery (FLS) program as a teaching and assessment tool for basic laparoscopic competency among gynecology residents. Methods: A prospective observational study was conducted at a single academic institution. Before the FLS program was introduced, baseline FLS testing was offered to residents and gynecology division directors. Test scores were analyzed by training level and self-reported surgical experience. After implementing a minimally invasive gynecologic surgical curriculum, third-year residents were retested. Results: The pass rates for baseline FLS skills testing were 0% for first-year residents, 50% for second-year residents, and 75% for third- and fourth-year residents. The pass rates for baseline cognitive testing were 60% for first- and second-year residents, 67% for third-year residents, and 40% for fourth-year residents. When comparing junior and senior residents, there was a significant difference in pass rates for the skills test (P=.007) but not the cognitive test (P=.068). Self-reported surgical experience strongly correlated with skills scores (r-value=0.97, P=.0048), but not cognitive scores (r-value=0.20, P=.6265). After implementing a curriculum, 100% of the third-year residents passed the skills test, and 92% passed the cognitive examination. Conclusions: The FLS skills test may be a valuable assessment tool for gynecology residents. The cognitive test may need further adaptation for applicability to gynecologists. PMID:21902937

Cosmogenic, radiogenic, and stable isotopic constraints on groundwater residence time in the nubian aquifer, western desert of egypt

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

Patterson, Leslie J.; Sturchio, Neil C.; Kennedy, B.Mack

2004-06-01

Measurements of radiochlorine ({sup 36}Cl), radiogenic noble gases ({sup 4}He and {sup 40}Ar), and stable chlorine isotope ratios were obtained to assess the residence time of groundwater in the Nubian Aquifer of the Western Desert of Egypt. Measured {sup 36}Cl/Cl ratios yield apparent residence times from {approx}0.2 to 1.2 x 10{sup 6} years in the deep (600-1200 m) groundwater (assuming constant Cl) and {le} 0.16 x 10{sup 6} years in the shallow (<600 m) groundwater. Values of {delta}{sup 37}Cl in the groundwater strengthen the application of the {sup 36}Cl dating method by constraining Cl sources and identifying groundwater mixing. Dissolvedmore » gases were measured in some of the deep groundwater samples. Measured {sup 4}He concentrations indicate accumulation of radiogenic {sup 4}He that is qualitatively consistent with the age progression indicated by the {sup 36}Cl/Cl ratios, but the flux of external {sup 4}He from the underlying crust has not been quantified and is not constant throughout the aquifer. Concentrations of {sup 40}Ar range from 3.3 to 6.7 x 10{sup -4} ccSTP/g and indicate excess air incorporation at recharge. Measured {sup 40}Ar/{sup 36}Ar ratios do not exceed the atmospheric ratio. A two-dimensional numerical hydrodynamic transect of the aquifer was modeled from the area of the Uweinat Uplift to the northern Bahariya Oasis. Predicted groundwater velocities in the deep portion of the aquifer are 0.5-3.5 m/yr with groundwater residence times up to 9 x 10{sup 5} years; residence times up to 1.3 x 10{sup 6} years are predicted in the confining shale. Aquifer properties are estimated by using the model to fit the measured {sup 36}Cl/Cl ratios. Under these conditions, hydrodynamic residence times are within about 30 percent of those calculated from {sup 36}Cl when mixing of Cl{sup -} is accounted for in the highest-Cl{sup -} deep groundwaters. By mutually calibrating multiple methods (hydrodynamic, {sup 36}Cl, and {sup 4}He), a consistent picture of the Nubian Aquifer has emerged in which lateral flow from a southern recharge area dominates the deep horizons, while shallow horizons contain younger, autochthonous recharge.« less

Residents' evaluation of urban environments: attraction of urban life and anxiety associated with traffic accidents and urban crimes.

PubMed

Tachikawa, Tomoko; Hashimoto, Shusa

2007-12-01

The results of questionnaire and interview surveys conducted in Mitaka and Musashino cities are presented for investigating of residents' evaluation of their urban environment, particularly regarding its attractiveness. A special attention was paid to residents' evaluation with regard to anxiety associated with traffic accidents and urban crimes. The urban infrastructure and residents' responses were examined using a Geographic Information System (GIS). Attractiveness associated with the urban environment was classified into two categories: "attractiveness in daily life" and "attractiveness in non-daily life." The residents valued opportunities for relaxing and living in comfort. In non-daily life, the residents specifically valued improved living conditions and harmony between the natural environment and commercial facilities. They attributed crime anxiety to trees, narrow streets, obstructed views, dark areas and a gloomy atmosphere. Residents regarded violent crimes as being prevalent, but considered trespassing and property crimes infrequent. The residents' anxiety about traffic accidents was caused by reckless driving habits, narrow streets, lack of separation between roadway and pedestrians' ways, heavy traffic, and obstructed views. Residents cited main roads and intersections as locations of anxiety, which concurred with frequent accidents.

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.

Comparison of parameterized nitric acid rainout rates using a coupled stochastic-photochemical tropospheric model

NASA Technical Reports Server (NTRS)

Stewart, Richard W.; Thompson, Anne M.; Owens, Melody A.; Herwehe, Jerold A.

1989-01-01

A major tropospheric loss of soluble species such as nitric acid results from scavenging by water droplets. Several theoretical formulations have been advanced which relate an effective time-independent loss rate for soluble species to statistical properties of precipitation such as the wet fraction and length of a precipitation cycle. In this paper, various 'effective' loss rates that have been proposed are compared with the results of detailed time-dependent model calculations carried out over a seasonal time scale. The model is a stochastic precipitation model coupled to a tropospheric photochemical model. The results of numerous time-dependent seasonal model runs are used to derive numerical values for the nitric acid residence time for several assumed sets of preciptation statistics. These values are then compared with the results obtained by utilizing theoretical 'effective' loss rates in time-independent models.

Perception of Teaching and Assessing Technical Proficiency in American College of Veterinary Surgeons Small Animal Surgery Residency Programs.

PubMed

Kim, Stanley E; Case, J Brad; Lewis, Daniel D; Ellison, Gary W

2015-08-01

To determine how American College of Veterinary Surgeons (ACVS) small animal surgery residency programs are teaching and assessing technical skills, and ascertain the perceived value of those methods. Internet-based survey. Residents and Diplomate supervisors of ACVS small animal residency programs. Residents and supervisors were surveyed on their experience of surgery instruction, use of different resources for teaching, type and frequency of feedback, and perceived effectiveness of their programs in imparting technical proficiency. A total of 130 residents (62%) and 119 supervisors (44%) participated. Both residents and supervisors estimated the resident was the primary surgeon for a mean of 64% of cases, although this proportion varied widely between participants. The majority of residents and supervisors considered that direct intraoperative guidance was the most effective way for residents to develop technical skills. Verbal interactions between supervisor and resident occurred frequently and were highly valued. Regular wet laboratories and access to simulation models were uncommon. Despite over 90% of all participants reporting that a sufficient level of technical aptitude would be attained, only 58% of residents were satisfied with their technical skills training. Residents relied on direct interaction with supervisors to develop technical skills. The traditional mode of instruction for veterinary residents is the apprenticeship model, which is partly driven by ACVS requirements of supervisory support. Exposure to other teaching and assessment methods was variable. The current structure of residency programs is successful in imparting technical competency as perceived by supervisors and residents. However, consideration of a more formal method of residency training with structured assessment of technical skills as in human medicine should not be dismissed. © Copyright 2015 by The American College of Veterinary Surgeons.

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

Code of Federal Regulations, 2013 CFR

2013-04-01

...)Example. (6)Highest principal balance. (7)Other methods provided by the Commissioner. (8)Anti-abuse rule... adjusted purchase price and fair market value. (1)Adjusted purchase price. (i)In general. (ii)Adjusted purchase price of a qualified residence acquired incident to divorce. (iii)Examples. (2)Fair market value...

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

Code of Federal Regulations, 2014 CFR

2014-04-01

...)Example. (6)Highest principal balance. (7)Other methods provided by the Commissioner. (8)Anti-abuse rule... adjusted purchase price and fair market value. (1)Adjusted purchase price. (i)In general. (ii)Adjusted purchase price of a qualified residence acquired incident to divorce. (iii)Examples. (2)Fair market value...

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

Code of Federal Regulations, 2012 CFR

2012-04-01

...)Example. (6)Highest principal balance. (7)Other methods provided by the Commissioner. (8)Anti-abuse rule... adjusted purchase price and fair market value. (1)Adjusted purchase price. (i)In general. (ii)Adjusted purchase price of a qualified residence acquired incident to divorce. (iii)Examples. (2)Fair market value...

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.

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.

Hydrogeologic Characteristics of the St. Croix River Basin, Minnesota and Wisconsin: Implications for the Susceptibility of Ground Water to Potential Contamination

USGS Publications Warehouse

Juckem, Paul F.

2007-01-01

Population growth in the St. Croix River Basin in Minnesota and Wisconsin has intensified concerns of county resource managers and the National Park Service, which is charged with protecting the St. Croix National Scenic Riverway, about the potential for ground-water contamination in the basin. This report describes a previously developed method that was adapted to illustrate potential ground-water-contamination susceptibility in the St. Croix River Basin. The report also gives an estimate of ground-water-residence time and surface-water/ground-water interaction as related to natural attenuation and movement of contaminants in five tributary basins. A ground-water-contamination-susceptibility map was adapted from a state-wide map of Wisconsin to the St. Croix River Basin by use of well-driller construction records and regional maps of aquifer properties in Minnesota and Wisconsin. Measures of various subsurface properties were combined to generate a spatial index of susceptibility. The subjective index method developed for the State of Wisconsin by Schmidt (1987) was not derived from analyses of water-quality data or physical processes. Nonetheless, it was adapted for this report to furnish a seamless map across state boundaries that would be familiar to many resource managers. Following this method, areas most susceptible to contamination appear to have coarse-grained sediments (sands or gravels) and shallow water tables or are underlain by carbonate-bedrock aquifers. The least susceptible areas appear to have fine-grained sediments and deep water tables. If an aquifer becomes contaminated, the ground-water-residence time can affect potential natural attenuation along the ground-water-flow path. Mean basin ground-water-residence times were computed for the Apple, Kettle, Kinnickinnic, Snake and Sunrise River Basins, which are tributary basins to the St. Croix Basin, by use of average aquifer properties of saturated thickness, porosity, and recharge rates. The Apple River Basin had the shortest mean ground-water-residence times (20-120 years), owing largely to the moderate saturated thickness and high recharge rate in the basin. The Kinnickinnic and Sunrise River Basins had the longest mean residence times (60-350 and 70-390 years, respectively) chiefly because of the relatively large saturated thickness of the basins. Owing to limitations of the residence-time calculations, actual ground-water-residence times will vary around the mean values within each basin and may range from days or weeks in karst carbonate aquifers to millennia in deep confined sandstone aquifers. Areas of relatively short residence time (less than the median residence time in each basin) were identified by use of ground-water-flow models for each of the five tributary basins. Results of simulations show that these areas, in which contaminants may have relatively less time for natural attenuation along the short flow paths, generally occur near streams and rivers where ground water discharges to the surface. Finally, the ground-water-flow models were used to simulate ground-water/surface-water interaction in the five tributary basins. Results of simulations show that some lakes and reservoirs leak surface water into the ground-water-flow system on their downgradient side, where the surface-water outflow has been restricted by a dam or a naturally constricted outlet. These locations are noteworthy because contaminated surface waters could potentially enter the ground-water-flow system at these locations.

Nurses' perceptions of nurse residency: identifying barriers to implementation.

PubMed

Wierzbinski-Cross, Heather; Ward, Kristin; Baumann, Paula

2015-01-01

The purpose of this project was to describe the benefits and components of successful nurse residency programs, as well as gain insight into the perceptions of staff nurses, nurse educators, and nurse leaders regarding value, feasibility, and barriers to implementing nurse residency programs in acute care settings. This study has important implications for implementing an effective residency program.

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.

Residence times and mixing of water in river banks: implications for recharge and groundwater - surface water exchange

NASA Astrophysics Data System (ADS)

Unland, N. P.; Cartwright, I.; Cendón, D. I.; Chisari, R.

2014-02-01

The residence time of groundwater within 50 m of the Tambo River, South East Australia, has been estimated through the combined use of 3H and 14C. Groundwater residence times increase towards the Tambo River which implies a gaining river system and not increasing bank storage with proximity to the Tambo River. Major ion concentrations and δ2H and δ18O values of bank water also indicate that bank infiltration does not significantly impact groundwater chemistry under baseflow and post-flood conditions, suggesting that the gaining nature of the river may be driving the return of bank storage water back into the Tambo River within days of peak flood conditions. The covariance between 3H and 14C indicates the leakage and mixing between old (~17 200 yr) groundwater from a semi-confined aquifer and younger groundwater (<100 yr) near the river where confining layers are less prevalent. The presence of this semi-confined aquifer has also been used to help explain the absence of bank storage, as rapid pressure propagation into the semi-confined aquifer during flooding will minimise bank infiltration. This study illustrates the complex nature of river groundwater interactions and the potential downfall in assuming simple or idealised conditions when conducting hydrogeological studies.

Breast and cervical cancer screening among women in metropolitan areas of the United States by county-level commuting time to work and use of public transportation, 2004 and 2006

PubMed Central

2010-01-01

Background Commuting times and behaviors have been associated with a variety of chronic disease outcomes and health behaviors. We examined the relationships between ecologic measures of commuting time and use of public transportation in relation to breast and cervical cancer screening among women in U.S. metropolitan areas who participated in the 2004 and 2006 Behavioral Risk Factor Surveillance System (BRFSS) surveys. Methods Self-reported county of residence was used to classify respondents as residents of metropolitan statistical areas (MSAs). Only BRFSS respondents who resided in the 39 MSAs with a population of ≥ 1.5 million in 2007--representing a total of 337 counties--were included in this analysis. A total of 76,453 women aged ≥ 40 years were included in analyses on mammography. Analyses on Pap testing were limited to women aged ≥18 years with no history of hysterectomy (n = 80,959). Area-based measures of socio-economic status (SES) were obtained by utilizing county-level information from the 2000 U.S. Census. Results With adjustment for age, no important associations were observed between receipt of a recent mammogram and either a county-level measure of commute time or residence in an area where more residents had access to a car. Similarly, women living in counties where at least four percent of the residents used public transportation were as likely to have had a recent mammogram or Pap test compared with women in areas where less than four percent of residents used public transportation. However, women living in counties where < 2% of residents had no access to a car were somewhat more likely to have had a Pap test in the past 3 years than women in areas where ≥ 3% of the residents had no access to a car (87.3% versus 84.5%; p-value for test for trend < 0.01). In multivariate analysis, living in a county with a median commute time of at least 30 minutes was not significantly associated with having had a Pap test in the past 3 years (adjusted odds ratio (OR) = 1.1, 95% CI 0.9-1.2, p = .50), or with having had a mammogram in the past 2 years (adjusted OR = 0.9, 95% CI 0.9-1.1, p = .28). A weak positive association was observed between residence in a county with less use of public transportation and having had a Pap test in the past 3 years, which was of borderline significance (adjusted OR 1.2, 95% CI 1.0-1.4, p = .05). Conclusions In large U.S. metropolitan areas, transportation issues may play a role in whether a woman obtains cancer screening along with other factors (e.g., Hispanic ethnicity, low income, and no physician visit in the past year). In this contextual analysis, a longer commute time was not associated with breast and cervical cancer screening. PMID:20302614

Training Laparoscopic Skills at Home: Residents' Opinion of a New Portable Tablet Box Trainer.

PubMed

van der Aa, Jessica E; Schreuder, Henk W R

2016-04-01

To determine residents' opinion about a new portable box trainer, to see if they would be interested in using this for training at home, and to give an overview of the box trainers that could be used at home. An expert opinion study was performed among 27 gynecology residents to determine the value of the portable box trainer in training their laparoscopic skills and the value of using it at home. Their opinions were scored on a 5-point Likert scale. Gynecology residents very much appreciated the portable box trainer in its design, size, visualization, light source, ability to record, and instruments (all median 4). They felt that the portable box trainer would be effective in training laparoscopic skills in general; in training hand-eye coordination, 3D perception, and tying knots (all median 4); and especially in training basic skills (median 5). Almost all residents would use the portable box trainer if they had one at home (median 5). The literature supports the hypothesis that training laparoscopic skills at home using a box trainer may be effective in acquiring and maintaining laparoscopic skills. Training laparoscopic skills at home using a portable box trainer may be of added value in the laparoscopic training of surgical residents. Residents feel positive about using the new portable box trainer that is presented and appreciate the possibility of training at home. © The Author(s) 2015.

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

Describing a residency program developed for newly graduated nurse practitioners employed in retail health settings.

PubMed

Thabault, Paulette; Mylott, Laura; Patterson, Angela

2015-01-01

Retail health clinics are an expanding health care delivery model and an emerging new practice site for nurse practitioners (NPs). Critical thinking skills, clinical competence, interprofessional collaboration, and business savvy are necessary for successful practice in this highly independent and autonomous setting. This article describes a pilot residency partnership program aimed at supporting new graduate NP transition to practice, reducing NP turnover, and promoting academic progression. Eight new graduate NPs were recruited to the pilot and paired with experienced clinical NP preceptors for a 12-month program that focused on increasing clinical and business competence in the retail health setting. The residency program utilized technology to facilitate case conferences and targeted Webinars to enhance learning and peer-to-peer sharing and support. An on-line doctoral-level academic course that focused on interprofessional collaboration in health care, population health, and business concepts was offered. Both NPs and preceptors were highly satisfied with the academic-service residency program between MinuteClinic and Northeastern University School of Nursing in Boston, MA. New NPs particularly valued the preceptor model, the clinical case conferences, and business Webinars. Because their priority was in gaining clinical experience and learning the business acumen relevant to managing the processes of care, they did not feel ready for the doctoral course and would have preferred to take later in their practice. The preceptors valued the academic course and felt that it enhanced their precepting and leadership skills. At the time of this article, 6 months post completion of the residency program, there has been no turnover. Our experience supports the benefits for residency programs for newly graduated NPs in retail settings. The model of partnering with academia by offering a course within a service organization's educational programs can enable academic progression. Copyright © 2015 Elsevier Inc. All rights reserved.

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.

A Study to Assess Knowledge and Attitude Regarding Hand Hygiene amongst Residents and Nursing Staff in a Tertiary Health Care Setting of Bhopal City.

PubMed

Maheshwari, Veena; Kaore, Navin Chandra M; Ramnani, Vijay Kumar; Gupta, Sanjay Kumar; Borle, Amod; Kaushal, Rituja

2014-08-01

Infection due to hospital-acquired microbes is an evolving problem worldwide, and horizontal transmission of bacterial organism continues to cause a high nosocomial infection rate in health care settings. Most nosocomial infections are thought to be transmitted by the hands of health care workers.The application of hand hygiene is effective in reducing infection rates. To assess the level of knowledge and attitude regarding hand hygiene practices amongst the health care professionals and to identify areas of gaps in their knowledge and attitude. A cross-sectional study. A total 160 respondents were studied about their knowledge and attitude towards hand hygiene practices and significant difference with a p-value of 0.0025 was observed regarding most frequent source of germs responsible for health care associated infections among resident and nurses. A significant difference with p-value of 0.0001 & 0.04 was observed in colonization due to jewellery and artificial nail among the study groups. The attitude regarding correct hand hygiene practices to be followed at all times was found to be better among nurses (62.5%) as compared to residents (21.3%) which was found to be highly significant with p-value <0.001. Present study highlights the need of repeated training sessions regarding hand hygiene practices among the health care workers to provide the current knowledge in the area with a behavioral change in attitudes and practices leading to reduction of nosocomial infections.

High-Value Consults: A Curriculum to Promote Point-of-Care, Evidence-Based Recommendations.

PubMed

Nandiwada, Deepa Rani; Kohli, Amar; McNamara, Megan; Smith, Kenneth J; Zimmer, Shanta; McNeil, Melissa; Spagnoletti, Carla; Rubio, Doris; Berlacher, Kathryn

2017-10-01

In an era when value-based care is paramount, teaching trainees to explicitly communicate the evidence behind recommendations fosters high-value care (HVC) in the consultation process. To implement an HVC consult curriculum highlighting the need for clear consult questions, evidence-based recommendations to improve consult teaching, clinical decision-making, and the educational value of consults. A pilot curriculum was implemented for residents on cardiology consult electives utilizing faculty and fellows as evidence-based medicine (EBM) coaches. The curriculum included an online module, an EBM teaching point template, EBM presentations on rounds, and "coach" feedback on notes. A total of 15 residents and 4 fellows on cardiology consults participated, and 87% (13 of 15) of residents on consults felt the curriculum was educationally valuable. A total of 80% (72 of 90) of residents on general medicine rotations responded to the survey, and 25 of 72 residents (35%) had a consult with the EBM template. General medicine teams felt the EBM teaching points affected clinical decision-making (48%, 12 of 25) and favored dissemination of the curriculum (90%, 72 of 80). Checklist-guided chart review showed a 22% improvement in evidence-based summaries behind recommendations (7 of 36 precurriculum to 70 of 146 charts postcurriculum, P  = .015). The HVC consult curriculum during a cardiology elective was perceived by residents to influence clinical decision-making and evidence-based recommendations, and was found to be educationally valuable on both parties in the consult process.

Efficacy and acceptance of professional dental cleaning among nursing home residents.

PubMed

Barbe, Anna Greta; Kottmann, Hannah Elisa; Hamacher, Stefanie; Derman, Sonja Henny Maria; Noack, Michael Johannes

2018-05-13

To determine the impact of general and oral health status of nursing home residents in Germany on efficacy and acceptance of professional dental cleaning performed by a dental nurse. Participants (N = 41; mean age 83 ± 8 years) living in a nursing home were included. Personal and general health, oral health, oral hygiene habits, and needs were investigated. Individual acceptance regarding professional dental cleaning via different devices (scaler, interdental brushes, ultrasonic cleaning) was assessed, as was the efficacy of this method using after-cleaning indices. Oral health among nursing home residents was impaired and independent from dementia status. Most residents (33/41) performed oral hygiene procedures independently and showed better index values than those in need of external help. Residents requiring help with oral hygiene showed increased risk profiles (higher age, more often immobile, demented, more xerostomia). The dental cleaning procedure required a mean time of 37 ± 11 min, was widely accepted (36/41), and achieved clean results (plaque index 0.1 ± 0.5, oral hygiene index 0.2 ± 1.6, Volpe-Manhold index 0.4 ± 1.6); food residues were reduced to 0 independent from cognitive status. Regarding the cleaning methods, scalers were accepted best without difference between demented and non-demented residents. Professional dental cleaning in nursing homes is an accepted and efficacious oral hygiene procedure among nursing home residents. Professional dental cleaning is an efficacious and accepted method as a first step in line with strategies to improve oral health and should be considered in nursing home residents.

Utility of Interobserver Agreement Statistics in Establishing Radiology Resident Learning Curves During Self-directed Radiologic Anatomy Training.

PubMed

Tureli, Derya; Altas, Hilal; Cengic, Ismet; Ekinci, Gazanfer; Baltacioglu, Feyyaz

2015-10-01

The aim of the study was to ascertain the learning curves for the radiology residents when first introduced to an anatomic structure in magnetic resonance images (MRI) to which they have not been previously exposed to. The iliolumbar ligament is a good marker for testing learning curves of radiology residents because the ligament is not part of a routine lumbar MRI reporting and has high variability in detection. Four radiologists, three residents without previous training and one mentor, studied standard axial T1- and T2-weighted images of routine lumbar MRI examinations. Radiologists had to define iliolumbar ligament while blinded to each other's findings. Interobserver agreement analyses, namely Cohen and Fleiss κ statistics, were performed for groups of 20 cases to evaluate the self-learning curve of radiology residents. Mean κ values of resident-mentor pairs were 0.431, 0.608, 0.604, 0.826, and 0.963 in the analysis of successive groups (P < .001). The results indicate that the concordance between the experienced and inexperienced radiologists started as weak (κ <0.5) and gradually became very acceptable (κ >0.8). Therefore, a junior radiology resident can obtain enough experience in identifying a rather ambiguous anatomic structure in routine MRI after a brief instruction of a few minutes by a mentor and studying approximately 80 cases by oneself. Implementing this methodology will help radiology educators obtain more concrete ideas on the optimal time and effort required for supported self-directed visual learning processes in resident education. Copyright © 2015 AUR. Published by Elsevier Inc. All rights reserved.

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.

Two-Finger Tightness: What Is It? Measuring Torque and Reproducibility in a Simulated Model.

PubMed

Acker, William B; Tai, Bruce L; Belmont, Barry; Shih, Albert J; Irwin, Todd A; Holmes, James R

2016-05-01

Residents in training are often directed to insert screws using "two-finger tightness" to impart adequate torque but minimize the chance of a screw stripping in bone. This study seeks to quantify and describe two-finger tightness and to assess the variability of its application by residents in training. Cortical bone was simulated using a polyurethane foam block (30-pcf density) that was prepared with predrilled holes for tightening 3.5 × 14-mm long cortical screws and mounted to a custom-built apparatus on a load cell to capture torque data. Thirty-three residents in training, ranging from the first through fifth years of residency, along with 8 staff members, were directed to tighten 6 screws to two-finger tightness in the test block, and peak torque values were recorded. The participants were blinded to their torque values. Stripping torque (2.73 ± 0.56 N·m) was determined from 36 trials and served as a threshold for failed screw placement. The average torques varied substantially with regard to absolute torque values, thus poorly defining two-finger tightness. Junior residents less consistently reproduced torque compared with other groups (0.29 and 0.32, respectively). These data quantify absolute values of two-finger tightness but demonstrate considerable variability in absolute torque values, percentage of stripping torque, and ability to consistently reproduce given torque levels. Increased years in training are weakly correlated with reproducibility, but experience does not seem to affect absolute torque levels. These results question the usefulness of two-finger tightness as a teaching tool and highlight the need for improvement in resident motor skill training and development within a teaching curriculum. Torque measuring devices may be a useful simulation tools for this purpose.

[Work stress, health and satisfaction of life in young doctors. Results of a longitudinal study in Switzerland].

PubMed

Buddeberg-Fischer, B; Stamm, M; Buddeberg, C; Bauer, G; Hämmig, O; Klaghofer, R

2008-11-01

Based on the Effort-Reward-Imbalance Model by Siegrist a study was undertaken to find out (a) in what way young doctors assess effort and reward during their specialist training; (b) whether there are certain job stress patterns over time; and (c) what the correlations are, if any, between perceived job stress, health and satisfaction with life. Within the framework of a prospective study (2001 - 2007) 370 doctors who had just qualified and were residents in the German-speaking part of Switzerland were assessed four times by means of anonymized questionnaires. Job stress, measured by the Effort-Reward-Imbalance scale, as well as health and satisfaction with life were assessed in these doctors' 2nd (T2), 4th (T3), and 6th (T4) year of specialist training ("residents"). Stress patterns of the participants were evaluated, based on the effort and reward scale values at T2, T3, and T4, by two-step cluster analysis. Gender differences between the clusters were calculated by the 2 test and differences in the continuous variables by analysis of variance with repeated measurements. During residency the percentage of doctors who experienced an Effort-Reward-Imbalance (ratio between effort and reward ERI > 1) increased from 18% at T2 to 20 % at T3 to 25 % at T4. The cluster analysis revealed two clusters: Type 1 (67%) with effort values below average and reward values above average (ER balance) across the three measurement points, and type 2 (33 %) with effort values above average and reward values below average (ER imbalance). Subjects in cluster 2 showed unfavorable values, when compared with those in cluster 1, in overcommitment, in workload and in the health variables (anxiety, depression, physical and psychological well-being), as well as in their assessed satisfaction with life at all three measurement points. One third of the doctors experienced stress at work, caused by an effort-reward imbalance. This had a negative impact on their health and satisfaction with life. Regular supervision and goal-oriented career counselling provided by senior physicians could contribute to young doctors not feeling so much stressed at work, feeling well and being more content with their work.

Short residence time coal liquefaction process including catalytic hydrogenation

DOEpatents

Anderson, R.P.; Schmalzer, D.K.; Wright, C.H.

1982-05-18

Normally solid dissolved coal product and a distillate liquid product are produced by continuously passing a feed slurry comprising raw feed coal and a recycle solvent oil and/or slurry together with hydrogen to a preheating-reaction zone, the hydrogen pressure in the preheating-reaction zone being at least 1,500 psig (105 kg/cm[sup 2]), reacting the slurry in the preheating-reaction zone at a temperature in the range of between about 455 and about 500 C to dissolve the coal to form normally liquid coal and normally solid dissolved coal. A total slurry residence time is maintained in the reaction zone ranging from a finite value from about 0 to about 0.2 hour, and reaction effluent is continuously and directly contacted with a quenching fluid to substantially immediately reduce the temperature of the reaction effluent to below 425 C to substantially inhibit polymerization so that the yield of insoluble organic matter comprises less than 9 weight percent of said feed coal on a moisture-free basis. The reaction is performed under conditions of temperature, hydrogen pressure and residence time such that the quantity of distillate liquid boiling within the range C[sub 5]-454 C is an amount at least equal to that obtainable by performing the process under the same condition except for a longer total slurry residence time, e.g., 0.3 hour. Solvent boiling range liquid is separated from the reaction effluent and recycled as process solvent. The amount of solvent boiling range liquid is sufficient to provide at least 80 weight percent of that required to maintain the process in overall solvent balance. 6 figs.

Short residence time coal liquefaction process including catalytic hydrogenation

DOEpatents

Anderson, Raymond P.; Schmalzer, David K.; Wright, Charles H.

1982-05-18

Normally solid dissolved coal product and a distillate liquid product are produced by continuously passing a feed slurry comprising raw feed coal and a recycle solvent oil and/or slurry together with hydrogen to a preheating-reaction zone (26, alone, or 26 together with 42), the hydrogen pressure in the preheating-reaction zone being at least 1500 psig (105 kg/cm.sup.2), reacting the slurry in the preheating-reaction zone (26, or 26 with 42) at a temperature in the range of between about 455.degree. and about 500.degree. C. to dissolve the coal to form normally liquid coal and normally solid dissolved coal. A total slurry residence time is maintained in the reaction zone ranging from a finite value from about 0 to about 0.2 hour, and reaction effluent is continuously and directly contacted with a quenching fluid (40, 68) to substantially immediately reduce the temperature of the reaction effluent to below 425.degree. C. to substantially inhibit polymerization so that the yield of insoluble organic matter comprises less than 9 weight percent of said feed coal on a moisture-free basis. The reaction is performed under conditions of temperature, hydrogen pressure and residence time such that the quantity of distillate liquid boiling within the range C.sub.5 -454.degree. C. is an amount at least equal to that obtainable by performing the process under the same condition except for a longer total slurry residence time, e.g., 0.3 hour. Solvent boiling range liquid is separated from the reaction effluent (83) and recycled as process solvent (16). The amount of solvent boiling range liquid is sufficient to provide at least 80 weight percent of that required to maintain the process in overall solvent balance.

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

NASA Astrophysics Data System (ADS)

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

2016-12-01

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

Four years of training in family medicine: implications for residency redesign.

PubMed

Sigmon, J Lewis; McPherson, Vanessa; Little, John M

2012-09-01

In light of the ongoing consideration for extending the length of residency education in family medicine in the United States, this paper reports the findings from a retrospective, qualitative study of six family physicians that elected to extend their residency training from 3 to 4 years. Each participant completed a written questionnaire and a structured personal interview focusing on various aspects of career development resulting from the additional year of training. The authors independently evaluated these interviews to identify major themes. All the participants were found to have been involved in teaching medicine, valued a more flexible and expanded curriculum, and appreciated their individualized curricula-based on their respective career interests. Given the opportunity, each would opt again for a fourth year of training. There were mixed opinions as to whether the fourth year should be required of all family medicine residents. Other perceived benefits reported were: a better opportunity to find a personally satisfactory practice, additional time for gaining clarity about career plans, and a higher beginning salary as a result of the additional skills and experiences gained. This study of mid-career physicians supports that a fourth-year (PGY4) curriculum in family medicine may enhance subsequent career satisfaction. Further studies of residents in other PGY4 training programs are necessary to assess outcomes comparing our findings as well as guide the discipline's leaders in residency redesign.

A national cross-sectional survey of social networking practices of U.S. anesthesiology residency program directors.

PubMed

Barker, Andrew L; Wehbe-Janek, Hania; Bhandari, Naumit S; Bittenbinder, Timothy M; Jo, ChanHee; McAllister, Russell K

2012-12-01

To determine the social networking practices of directors of anesthesiology residency programs. Cross-sectional survey. Online and paper survey tool. 132 anesthesiology residency program directors in the United States. A 13-item survey including dichotomous and multiple choice responses was administered using an online survey tool and a paper survey. Data analysis was conducted by descriptive and analytical statistics (chi-square test). A P-value < 0.05 indicated statistical significance. 50% of anesthesiology program directors responded to the survey (66/132). Policies governing social networking practices were in place for 30.3% (n=20) of the programs' hospitals. The majority of program directors (81.8%, 54) reported never having had an incident involving reprimand of a resident or fellow for inappropriate social networking practices. The majority (66.7%, n=44) of responding programs reported that departments did not provide lectures or educational activities related to appropriate social networking practices. Monitoring of social networking habits of residents/fellows by program directors mainly occurs if they are alerted to a problem (54.5%, n=36). Frequent use of the Internet for conducting searches on a resident applicant was reported by 12.1% (n=8) of program directors, 30.3% (n=20) reported use a few times, and 57.6% (n=38) reported never using the Internet in this capacity. Residency programs should have a written policy related to social media use. Residency program directors should be encouraged to become familiar with the professionalism issues related to social media use in order to serve as adequate resident mentors within this new and problematic aspect of medical ethics and professionalism. Copyright © 2012 Elsevier Inc. All rights reserved.

Parent Involvement in the Pediatric Resident Applicant Interview.

PubMed

Dandekar, Abhay; Weintraub, Miranda L Ritterman; McFeely, Eric D; Chasnovitz, Rebecca

2018-03-19

Parents and patients are actively involved in the clinical learning environment, yet scant literature exists about their involvement in the residency interview process. We aimed to pilot a process of including parents in resident interviews and to determine its value. During the 2016-17 residency interview cycle, 22 parent volunteers, blinded to applicant credentials, conducted brief structured interviews with 118 applicants. We then surveyed all parents and applicants with the use of mixed methods: descriptive statistics to analyze 5-point Likert-type-scale responses, and content analysis to identify themes from open-ended questions. Although parent interviews were not used in ranking, we later compared final composite parent interview scores (1-10, with 10 being high) among the final rank and match list candidates. Response rates were high for both groups (parents 100%; resident applicants 98.3%). Parents felt strongly positive about meeting applicants (mean ± SD, 5.00 ± 0.00), the value of parent participation (4.90 ± 0.30), and their own experience (4.95 ± 0.22). Applicants felt positive about meeting parents (4.45 ± 0.70), the value of parent participation (3.92 ± 0.84), and their own experience (4.51 ± 0.67). Several themes emerged from both groups, with the most salient parent themes including the value of patient-centered perspectives and appreciation and joy of meeting applicants. Parent interview scores correlated with the final match list, with matched applicants scoring higher (9.08 vs 8.51; P = .05). Involvement of parents in the pediatric residency interview process is achievable, is perceived positively by parents and applicants, and may provide valuable perspectives for consideration in residency selection. Copyright © 2018 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Soil organic matter persistence as a stochastic process: age and transit time distributions of carbon in soils

NASA Astrophysics Data System (ADS)

Sierra, Carlos

2017-04-01

The question of why some organic matter is more persistent than other that decomposes quickly in soils has sparkled a large amount of research in recent years. Persistence is commonly characterized as the turnover or mean residence time of specific compounds or soil organic matter (SOM) pools. However, turnover and residence times are ambiguous measures of persistence, which is better characterized by the probability distribution of ages in the system and in particular pools. We calculated age distributions for a wide range of SOM models, which showed long-tail distributions far from the mean value. Age and transit time distributions from a variety of models also showed: 1) transit times are lower than ages of SOM, 2) turnover times differ significantly from mean ages in slow cycling pools, 3) change in the inputs, without changes in the allocation of photosynthetic products, has no effect on transit times, but does affect system and pool ages. We propose an index to assess persistence of C in soils that can be derived from observations alone or from models. We also ask whether random chance is an important contributor to the persistence of SOM.

Contrasting residence times and fluxes of water and sulfate in two small forested watersheds in Virginia, USA

USGS Publications Warehouse

Böhlke, J.K.; Michel, R.L.

2009-01-01

Watershed mass balances for solutes of atmospheric origin may be complicated by the residence times of water and solutes at various time scales. In two small forested headwater catchments in the Appalachian Mountains of Virginia, USA, mean annual export rates of SO4= differ by a factor of 2, and seasonal variations in SO4= concentrations in atmospheric deposition and stream water are out of phase. These features were investigated by comparing 3H, 35S, ??34S, ??2H, ??18O, ??3He, CFC-12, SF6, and chemical analyses of open deposition, throughfall, stream water, and spring water. The concentrations of SO4= and radioactive 35S were about twice as high in throughfall as in open deposition, but the weighted composite values of 35S/S (11.1 and 12.1 ?? 10- 15) and ??34S (+ 3.8 and + 4.1???) were similar. In both streams (Shelter Run, Mill Run), 3H concentrations and ??34S values during high flow were similar to those of modern deposition, ??2H and ??18O values exhibited damped seasonal variations, and 35S/S ratios (0-3 ?? 10- 15) were low throughout the year, indicating inter-seasonal to inter-annual storage and release of atmospheric SO4= in both watersheds. In the Mill Run watershed, 3H concentrations in stream base flow (10-13??TU) were consistent with relatively young groundwater discharge, most ??34S values were approximately the same as the modern atmospheric deposition values, and the annual export rate of SO4= was equal to or slightly greater than the modern deposition rate. In the Shelter Run watershed, 3H concentrations in stream base flow (1-3??TU) indicate that much of the discharging ground water had been deposited prior to the onset of atmospheric nuclear bomb testing in the 1950s, base flow ??34S values (+ 1.6???) were significantly lower than the modern deposition values, and the annual export rate of SO4= was less than the modern deposition rate. Concentrations of 3H and 35S in Shelter Run base flow, and of 3H, 3He, CFC-12, SF6, and 35S in a spring discharging to Shelter Run, all were consistent with a bimodal distribution of discharging ground-water ages with approximately 5-20% less than a few years old and 75-95% more than 40??years old. These results provide evidence for 3 important time-scales of SO4= transport through the watersheds: (1) short-term (weekly to monthly) storage and release of dry deposition in the forest canopy between precipitation events; (2) mid-term (seasonal to interannual) cycles in net storage in the near-surface environment, and (3) long-term (decadal to centennial) storage in deep ground water that appears to be related to relatively low SO4= concentrations in spring discharge that dominates Shelter Run base flow. It is possible that the relatively low concentrations and low ??34S values of SO4= in spring discharge and Shelter Run base flow may reflect those of atmospheric deposition before the middle of the 20th century. In addition to storage in soils and biota, variations in ground-water residence times at a wide range of time scales may have important effects on monitoring, modeling, and predicting watershed responses to changing atmospheric deposition in small watersheds.

Use of a formal assessment instrument for evaluation of resident operative skills in pediatric neurosurgery.

PubMed

Hadley, Caroline; Lam, Sandi K; Briceño, Valentina; Luerssen, Thomas G; Jea, Andrew

2015-08-28

OBJECT Currently there is no standardized tool for assessment of neurosurgical resident performance in the operating room. In light of enhanced requirements issued by the Accreditation Council for Graduate Medical Education's Milestone Project and the Matrix Curriculum Project from the Society of Neurological Surgeons, the implementation of such a tool seems essential for objective evaluation of resident competence. Beyond compliance with governing body guidelines, objective assessment tools may be useful to direct early intervention for trainees performing below the level of their peers so that they may be given more hands-on teaching, while strong residents can be encouraged by faculty members to progress to conducting operations more independently with passive supervision. The aims of this study were to implement a validated assessment tool for evaluation of operative skills in pediatric neurosurgery and determine its feasibility and reliability. METHODS All neurosurgery residents completing their pediatric rotation over a 6-month period from January 1, 2014, to June 30, 2014, at the authors' institution were enrolled in this study. For each procedure, residents were evaluated by means of a form, with one copy being completed by the resident and a separate copy being completed by the attending surgeon. The evaluation form was based on the validated Objective Structured Assessment of Technical Skills for Surgery (OSATS) and used a 5-point Likert-type scale with 7 categories: respect for tissue; time and motion; instrument handling; knowledge of instruments; flow of operation; use of assistants; and knowledge of specific procedure. Data were then stratified by faculty versus resident (self-) assessment; postgraduate year level; and difficulty of procedure. Descriptive statistics (means and SDs) were calculated, and the results were compared using the Wilcoxon signed-rank test and Student t-test. A p value < 0.05 was considered statistically significant. RESULTS Six faculty members, 1 fellow, and 8 residents completed evaluations for 299 procedures, including 32 ventriculoperitoneal (VP) shunt revisions, 23 VP shunt placements, 19 endoscopic third ventriculostomies, and 18 craniotomies for tumor resection. There was no significant difference between faculty and resident self-assessment scores overall or in any of the 7 domains scores for each of the involved residents. On self-assessment, senior residents scored themselves significantly higher (p < 0.02) than junior residents overall and in all domains except for "time and motion." Faculty members scored senior residents significantly higher than junior residents only for the "knowledge of instruments" domain (p = 0.05). When procedure difficulty was considered, senior residents' scores from faculty members were significantly higher (p = 0.04) than the scores given to junior residents for expert procedures only. Senior residents' self-evaluation scores were significantly higher than those of junior residents for both expert (p = 0.03) and novice (p = 0.006) procedures. CONCLUSIONS OSATS is a feasible and reliable assessment tool for the comprehensive evaluation of neurosurgery resident performance in the operating room. The authors plan to use this tool to assess resident operative skill development and to improve direct resident feedback.

The Hospitalist Huddle: a 1-year experience of teaching Hospital Medicine utilizing the concept of peer teaching in medical education.

PubMed

Elhassan, Mohammed

2017-01-01

The relatively new specialty of Hospital Medicine in the USA is one of the fastest growing fields in internal medicine. Academic hospitalists are largely involved in the medical education of postgraduate residents and medical students. Little is known about the effectiveness of peer-to-peer teaching in internal medicine residency training programs and how the medical residents perceive its educational value in learning Hospital Medicine. The Hospitalist Huddle is a weekly educational activity newly established by our Hospitalist Division to facilitate the concept of peer-to-peer teaching. It requires medical residents to teach and educate their peers about the clinical topics related to Hospital Medicine. Faculty hospitalists serve as facilitators during the teaching sessions. A survey disseminated at the end of the first year of its implementation examined the residents' perception of the educational value of this new teaching activity. Most residents reported that they see the Huddle as a useful educational forum which may improve their skills in teaching, create a better educational and learning environment during their inpatient rotation, and improve their understanding of Hospital Medicine. Most residents also prefer that their peers, rather than faculty hospitalists, run the activity and do the teaching. The survey results support the notion that teaching and learning with flat hierarchies can be an appealing educational method to medical residents to help them understand Hospital Medicine during their medical wards rotation. Some areas need to be improved and others need to be continued and emphasized in order to make this novel educational activity grow and flourish in terms of its educational value and residents' satisfaction.

Use of a Self-Reflection Tool to Enhance Resident Learning on an Adolescent Medicine Rotation.

PubMed

Greenberg, Katherine Blumoff; Baldwin, Constance

2016-08-01

Adolescent Medicine (AM) educators in pediatric residency programs are seeking new ways to engage learners in adolescent health. This mixed-methods study presents a novel self-reflection tool and addresses whether self-reflection enhanced residents' perception of the value of an adolescent rotation, in particular, its relevance to their future practice. The self-reflection tool included 17 Likert scale items on residents' comfort with the essential tasks of adolescent care and open-ended questions that promoted self-reflection and goal setting. Semi-structured, postrotation interviews encouraged residents to discuss their experiences. Likert scale data were analyzed using descriptive statistics, and interview notes and written comments on the self-reflection tool were combined for qualitative data analysis. Residents' pre-to post-self-evaluations showed statistically significant increases in comfort with most of the adolescent health care tasks. Four major themes emerged from our qualitative analysis: (1) the value of observing skilled attendings as role models; (2) the comfort gained through broad and frequent adolescent care experiences; (3) the career relevance of AM; and (4) the ability to set personally meaningful goals for the rotation. Residents used the self-reflection tool to mindfully set goals and found their AM education valuable and relevant to their future careers. Our tool helped make explicit to residents the norms, values, and beliefs of the hidden curriculum applied to the care of adolescents and helped them to improve the self-assessed quality of their rapport and communications with adolescents. We conclude that a structured self-reflection exercise can enhance residents' experiences on an AM rotation. Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

24 CFR 972.224 - Necessary conditions for HUD approval of conversion.

Code of Federal Regulations, 2012 CFR

2012-04-01

... and market value analysis. (2) Benefit to residents, PHA, and the community. (i) The benefit to residents, the PHA, and the community may be demonstrated in the rental market analysis, the analysis of the impact on the neighborhood, the market value analysis, and the proposed future use of the development. In...

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.

Ion chromatographic determination of lithium at trace level concentrations. Application to a tracer experiment in a high-mountain lake.

PubMed

Nickus, U; Thies, H

2001-06-22

The water residence time of a high-mountain seepage lake in the Austrian Alps was derived from the flushing rate of a tracer substance. A diluted lithium chloride solution was injected into the lake during holomictic conditions in order to favour the homogeneous distribution of the tracer. The exponential decline of the mass of lithium in the lake revealed a water residence time of 1.5 to 3 months for summer and almost no lake water exchange during winter. Lithium concentrations ranged from background values of 0.06 microg l(-1) to about 3 microg l(-1) immediately after the tracer injection. Lake water samples were analyzed with ion-exchange chromatography using a Dionex device with a CS 12A separation column. The method detection limit determined according to the definition of the US Envirinmental Protection Agency amounted to 0.009 microg l(-1).

Organochlorine pollutants and stable isotopes in resident and migrant passerine birds from northwest Michoacán, Mexico.

PubMed

Mora, Miguel A

2008-10-01

Although concentrations of organochlorine compounds (OCs) in birds from most of the United States and Canada have decreased over the last 30 years, there is still concern that migrant birds might be exposed to elevated concentrations of OCs during migration in Latin America. The Lerma-Chapala Basin in west-central Mexico is an important migration corridor and wintering area for many species. The objectives of this study were to assess if resident and migrant birds wintering in western Michoacán, Mexico accumulated elevated concentrations of OCs during fall and spring and to determine if the stable isotopes delta(15)N, delta(13)C, and deltaD could be used to predict burdens and origins of DDE accumulation. Resident and migrant passerine insectivorous birds were collected during fall and spring (2001-2002) in northwest Michoacán, near Chapala Lake, Mexico. The carcasses were analyzed for OCs and tail feathers were analyzed for stable isotopes delta(15)N, delta(13)C, and deltaD. The OCs detected in more than 50% of the samples were: oxychlordane (79%), p,p'-DDE (100%), p,p'-DDT (57%), and total PCBs (100%). p,p'-DDE was the OC detected at the highest concentrations, whereas residues of other OCs were near or below detection limits. Overall, there were no significant differences in concentrations of OCs between seasons or between resident and migrant birds. Concentrations of DDE and oxychlordane were somewhat higher in migrant and resident birds during spring than in fall; however, concentrations were significantly different only for oxychlordane. Two resident birds collected in fall and spring had DDE residues >10 microg/g wet weight in carcass. There were no significant differences in delta(13)C and delta(15)N values among species, between seasons, or between migrant and resident birds. However, deltaD values were clearly different between species and helped differentiate migrant from resident birds. deltaD values also were negatively and significantly correlated with DDE concentrations in carcass. Birds with more depleted deltaD values in feathers tended to have higher DDE concentrations than those with less depleted deltaD values, suggesting a potential latitudinal accumulation of DDE. Overall, our results suggest that during fall and spring, there is not a significant buildup of persistent OCs in migrant and resident passerine insectivorous birds in northwest Michoacán, Mexico.

Systematic pain assessment in nursing homes: a cluster-randomized trial using mixed-methods approach.

PubMed

Mamhidir, Anna-Greta; Sjölund, Britt-Marie; Fläckman, Birgitta; Wimo, Anders; Sköldunger, Anders; Engström, Maria

2017-02-28

Chronic pain affects nursing home residents' daily life. Pain assessment is central to adequate pain management. The overall aim was to investigate effects of a pain management intervention on nursing homes residents and to describe staffs' experiences of the intervention. A cluster-randomized trial and a mixed-methods approach. Randomized nursing home assignment to intervention or comparison group. The intervention group after theoretical and practical training sessions, performed systematic pain assessments using predominately observational scales with external and internal facilitators supporting the implementation. No measures were taken in the comparison group; pain management continued as before, but after the study corresponding training was provided. Resident data were collected baseline and at two follow-ups using validated scales and record reviews. Nurse group interviews were carried out twice. Primary outcome measures were wellbeing and proxy-measured pain. Secondary outcome measures were ADL-dependency and pain documentation. Using both non-parametric statistics on residential level and generalized estimating equation (GEE) models to take clustering effects into account, the results revealed non-significant interaction effects for the primary outcome measures, while for ADL-dependency using Katz-ADL there was a significant interaction effect. Comparison group (n = 66 residents) Katz-ADL values showed increased dependency over time, while the intervention group demonstrated no significant change over time (n = 98). In the intervention group, 13/44 residents showed decreased pain scores over the period, 14/44 had no pain score changes ≥ 30% in either direction measured with Doloplus-2. Furthermore, 17/44 residents showed increased pain scores ≥ 30% over time, indicating pain/risk for pain; 8 identified at the first assessment and 9 were new, i.e. developed pain over time. No significant changes in the use of drugs was found in any of the groups. Nursing pain related documentation was sparse. In general, nurses from the outset were positive regarding pain assessments. Persisting positive attitudes seemed strengthened by continued assessment experiences and perceptions of improved pain management. The implementation of a systematic work approach to pain issues in nursing homes indicates that an increased awareness, collaboration across and shared understanding among the team members of the pain assessment results can improve pain management and lead to decreased physical deterioration or the maintenance of physical and functional abilities among NH residents. However, pain (proxy-measured) and wellbeing level did not reveal any interaction effects between the groups over time. The study was registered in ISRCTN71142240 in September 2012, retrospectively registered.

An evaluation of plastic surgery resident selection factors.

PubMed

Liang, Fan; Rudnicki, Pamela A; Prince, Noah H; Lipsitz, Stuart; May, James W; Guo, Lifei

2015-01-01

Our purpose was to provide a metric by which evaluation criteria are prioritized during resident selection. In this study, we assessed which residency applicant qualities are deemed important by members of the American Association of Plastic Surgeons (AAPS). A survey was distributed to all 580 AAPS members, and 295 responded to rate the importance of resident metrics, including measures of competency and personal characteristics. Demographic information, background training, and interaction with residents were also noted. Using SAS v9.2 (SAS Institute, Cary, NC), outcomes were analyzed across demographic groups with column trend exact (CTE) test for ordinal variables, Mantel-Haenszel trend test for interval variables, and Fisher exact test for discrete variables. Regarding competency metrics, letters of recommendation from known sources is the most important factor, whereas letters from unknown sources ranks the lowest. Character evaluations identified honesty as the most desirable trait; dishonesty was the most despised. Across demographic groups, academic surgeons and program directors value letters from known sources more than nonacademicians or nonprogram directors (CTE p = 0.005 and 0.002, respectively). Academicians and current program directors regard research more highly than their counterparts do (CTE p = 0.022 and 0.022, respectively). Currently, practicing surgeons, academicians, and program directors value hard work more than others (CTE p = 0.008, 0.033, and 0.029, respectively). Program directors emphasize maturity and patient commitment and are less tolerant of narcissism (CTE p = 0.002, 0.005, and 0.003, respectively). Lastly, academic surgeons and program directors look more favorably upon strong team players (CTE p < 0.00001 and p = 0.008, respectively), but less so over time (Mantel-Haenszel trend p = 0.006). We have examined applicant metrics that were deemed important by AAPS members and assessed their demographic interpretation. We hope this article provides a framework for plastic surgery resident selection and a guide for applicants to ascertain which qualities are highly regarded by programs. Although these attributes are highly desirable, future studies could identify if they are predictive of successful and productive plastic surgery residencies and careers. Copyright © 2014 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

42 CFR 483.35 - Dietary services.

Code of Federal Regulations, 2013 CFR

2013-10-01

..., palatable, well-balanced diet that meets the daily nutritional and special dietary needs of each resident... nutritional needs of residents in accordance with the recommended dietary allowances of the Food and Nutrition...) Substitutes offered of similar nutritive value to residents who refuse food served. (e) Therapeutic diets...

42 CFR 483.35 - Dietary services.

Code of Federal Regulations, 2012 CFR

2012-10-01

..., palatable, well-balanced diet that meets the daily nutritional and special dietary needs of each resident... nutritional needs of residents in accordance with the recommended dietary allowances of the Food and Nutrition...) Substitutes offered of similar nutritive value to residents who refuse food served. (e) Therapeutic diets...

42 CFR 483.35 - Dietary services.

Code of Federal Regulations, 2014 CFR

2014-10-01

..., palatable, well-balanced diet that meets the daily nutritional and special dietary needs of each resident... nutritional needs of residents in accordance with the recommended dietary allowances of the Food and Nutrition...) Substitutes offered of similar nutritive value to residents who refuse food served. (e) Therapeutic diets...

Shots by STFM: value of immunization software to family medicine residency directors: a CERA study.

PubMed

Nowalk, Mary Patricia; Clinch, C Randall; Tarn, Derjung M; Chang, Tammy; Ncube, Collette N; Troy, Judith A; Zimmerman, Richard K

2012-01-01

The Group on Immunization Education (GIE) of the Society of Teachers of Family Medicine (STFM) has developed Shots by STFM immunization software, which is available free of charge for a variety of platforms. It is routinely updated with the Center for Disease Control and Prevention's (CDC's) most recent immunization schedules. Successful development and marketing of teaching resources requires periodic evaluation of their use and value to their target audience. This study was undertaken to evaluate the 2011 version of Shots by STFM. Family medicine residency directors were surveyed about their use of Shots by STFM for teaching residents and their ratings of its features. The response rate for the survey was 38% (172/452). While awareness of Shots by STFM among responding residency directors was low (57%), ratings by those using the resource were excellent. Thirty percent of respondents recommend or require their residents to use Shots by STFM. Better marketing of Shots by STFM to family medicine residency directors seems to be indicated.

Practical Implications for an Effective Radiology Residency Quality Improvement Program for Milestone Assessment.

PubMed

Leddy, Rebecca; Lewis, Madelene; Ackerman, Susan; Hill, Jeanne; Thacker, Paul; Matheus, Maria; Tipnis, Sameer; Gordon, Leonie

2017-01-01

Utilization of a radiology resident-specific quality improvement (QI) program and curriculum based on the Accreditation Council for Graduate Medical Education (ACGME) milestones can enable a program's assessment of the systems-based practice component and prepare residents for QI implementation post graduation. This article outlines the development process, curriculum, QI committee formation, and resident QI project requirements of one institution's designated radiology resident QI program. A method of mapping the curriculum to the ACGME milestones and assessment of resident competence by postgraduate year level is provided. Sample projects, challenges to success, and lessons learned are also described. Survey data of current trainees and alumni about the program reveal that the majority of residents and alumni responders valued the QI curriculum and felt comfortable with principles and understanding of QI. The most highly valued aspect of the program was the utilization of a resident education committee. The majority of alumni responders felt the residency quality curriculum improved understanding of QI, assisted with preparation for the American Board of Radiology examination, and prepared them for QI in their careers. In addition to the survey results, outcomes of resident project completion and resident scholarly activity in QI are evidence of the success of this program. It is hoped that this description of our experiences with a radiology resident QI program, in accordance with the ACGME milestones, may facilitate the development of successful QI programs in other diagnostic radiology residencies. Copyright © 2017 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

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

Consumption value theory and the marketing of public health: an effective formative research tool.

PubMed

Nelson, Douglas G; Byus, Kent

2002-01-01

Contemporary public health requires the support and participation of its constituency. This study assesses the capacity of consumption value theory to identify the basis of this support. A telephone survey design used simple random sampling of adult residents of Cherokee County, Oklahoma. Factor analysis and stepwise discriminant analysis was used to identify and classify personal and societal level support variables. Most residents base societal level support on epistemic values. Direct services clientele base their support on positive emotional values derived from personal contact and attractive programs. Residents are curious about public health and want to know more about the health department. Where marketing the effectiveness of public health programs would yield relatively little support, marketing health promotion activities may attract public opposition. This formative research tool suggests a marketing strategy for public health practitioners.

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...

Modelling study of three-dimensional circulation and particle movement over the Sable Gully of Nova Scotia

NASA Astrophysics Data System (ADS)

Shan, Shiliang; Sheng, Jinyu; Greenan, Blair John William

2014-01-01

The Sable Gully is a broad deep underwater canyon located to the east of Sable Island on the edge of the Scotian Shelf. Being the home of many marine species including the endangered Northern Bottlenose Whale, the Gully was designated as a marine protected area (MPA) in 2004. Better understanding of physical environmental conditions over this MPA is needed for sustainable ecosystem management. In this study, a multi-nested ocean circulation model and a particle tracking model are used to examine the three-dimensional (3D) circulation and movement of particles carried passively by the flow over the Sable Gully. The 3D circulation model is driven by tides, wind, and surface heat/freshwater fluxes. The model performance is assessed by comparing the results with the previous numerical tidal results and current meter observations made in the Gully. The simulated tidal circulation over the Gully and adjacent waters is relatively strong on shallow banks and relatively weak on the continental slope. Below the depth of the Gully rim ( ˜ 200 m), the tidal currents are constrained by the thalweg of the Gully and amplified toward the Gully head. The simulated subtidal circulation in the Gully has a complex spatial structure and significant seasonal variability. The simulated time-dependent 3D flow fields are then used in a particle tracking model to study the particle movements, downstream and upstream areas, and residence time of the Gully. Based on the movements of particles released at the depth of the Gully rim and tracked forward in time, the e-folding residence time is estimated to be about 7 and 13 days in February and August 2006, respectively. The Gully flanks are identified as high retention areas with the typical residence time of 10 and 20 days in February and August 2006, respectively. Tracking particles with and without tides reveals that tidal circulation reduces the value of residence time in the Gully, particularly along the Gully flanks.

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

Structure and dynamics of the CrIII ion in aqueous solution: Ab initio QM/MM molecular dynamics simulation.

PubMed

Kritayakornupong, Chinapong; Plankensteiner, Kristof; Rode, Bernd M

2004-10-01

Structural and dynamical properties of the Cr(III) ion in aqueous solution have been investigated using a combined ab initio quantum mechanical/molecular mechanical (QM/MM) molecular dynamics simulation. The hydration structure of Cr(III) was determined in terms of radial distribution functions, coordination numbers, and angular distributions. The QM/MM simulation gives coordination numbers of 6 and 15.4 for the first and second hydration shell, respectively. The first hydration shell is kinetically very inert but by no means rigid and variations of the first hydration shell geometry lead to distinct splitting in the vibrational spectra of Cr(H(2)O)(6) (3+). A mean residence time of 22 ps was obtained for water ligands residing in the second hydration shell, which is remarkably shorter than the experimentally estimated value. The hydration energy of -1108 +/- 7 kcal/mol, obtained from the QM/MM simulation, corresponds well to the experimental hydration enthalpy value. Copyright 2004 Wiley Periodicals, Inc.

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

PubMed Central

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

2012-01-01

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

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

PubMed

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

2012-01-01

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

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.

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

PubMed

Chapman, Teresa; Chew, Felix S

2013-03-01

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

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.

Heat flow vs. atmospheric greenhouse on early Mars

NASA Technical Reports Server (NTRS)

Fanale, F. P.; Postawko, S. E.

1991-01-01

Researchers derived a quantitative relationship between the effectiveness of an atmospheric greenhouse and internal heat flow in producing the morphological differences between earlier and later Martian terrains. The derivation is based on relationships previously derived by other researchers. The reasoning may be stated as follows: the CO2 mean residence time in the Martian atmosphere is almost certainly much shorter than the total time span over which early climate differences are thought to have been sustained. Therefore, recycling of previously degassed CO2 quickly becomes more important than the ongoing supply of juvenile CO2. If so, then the atmospheric CO2 pressure, and thereby the surface temperature, may be approximated mathematically as a function of the total degassed CO2 in the atmosphere plus buried material and the ratio of the atmospheric and regolith mean residence times. The latter ratio can also be expressed as a function of heat flow. Hence, it follows that the surface temperature may be expressed as a function of heat flow and the total amount of available CO2. However, the depth to the water table can simultaneously be expressed as a function of heat flow and the surface temperature (the boundary condition). Therefore, for any given values of total available CO2 and regolith conductivity, there exist coupled independent equations which relate heat flow, surface temperature, and the depth to the water table. This means we can now derive simultaneous values of surface temperature and the depth of the water table for any value of the heat flow. The derived relationship is used to evaluate the relative importance of the atmospheric greenhouse effect and the internal regolith thermal gradient in producing morphological changes for any value of the heat flow, and to assess the absolute importance of each of the values of the heat flow which are thought to be reasonable on independent geophysical grounds.

Perceived benefits of a radiology resident mentoring program: comparison of residents with self-selected vs assigned mentors.

PubMed

Yamada, Kei; Slanetz, Priscilla J; Boiselle, Phillip M

2014-05-01

It has been suggested that assigned mentoring relationships are less successful than those that develop by free choice. This study evaluates radiology residents' overall experience with a mentoring program and compares the responses of those who self-selected mentors with those who were assigned mentors. A voluntary Web-based survey was sent to 27 radiology residents in postgraduate years 3-5. Data collected included the following: year in residency, method of mentor assignment, duration of relationship, frequency and types of communication, perceived value of mentoring, overall satisfaction with the program, and the perceived impact of mentoring. Twenty-five of 27 residents (93%) responded, with 14 having self-selected mentors (56%) and 11 having assigned mentors (44%). Both groups unanimously agreed that mentoring is beneficial or critical to their training; however, those residents with self-selected mentors were significantly more satisfied with the mentoring program (4 vs 3.3; P = .04) and more likely to consider their mentor as their primary mentor compared with those with assigned mentors (11 [79%] vs 4 [36%]; P = .049). Although all residents perceived a benefit, residents with self-selected mentors rated almost all mentoring parameters more positively than those with assigned mentors, although most of these parameters did not reach statistical significance. Residents highly value the importance of mentoring. However, residents who self-select their mentors are more likely to be satisfied with a mentoring program. Copyright © 2014 Canadian Association of Radiologists. Published by Elsevier Inc. All rights reserved.

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.

Trimming the fat: optimizing overall educational value by defining factors associated with overall educational value and service-to-education ratio.

PubMed

Reinke, Caroline E; Kelz, Rachel R; Pray, Lori; Williams, Noel; Bleier, Joshua; Murayama, Kenric; Morris, Jon B

2012-01-01

The Accreditation Council for Graduate Medical Education work rules have forced programs to critically appraise the overall educational value (OEV) of rotations. Successful rotations must satisfy Residency Review Committee mandates and optimize the service-to-education ratio (SER). This study was designed to examine the relationship between the OEV and SER and identify rotation characteristics (RC) associated with both. The Division of Surgery Education at the Hospital of the University of Pennsylvania administered a survey in FY2011 to all residents detailing resident perceptions regarding OEV, SER, and other RC. Responses were linked to additional rotation data. The relationship between OEV and SER was examined before and after controlling for significant RC identified in univariate analyses. Subgroup analyses by junior (CY1-2) and senior (CY3-5) resident status were performed. The survey was sent to 85 residents participating in 48 general surgery rotations, with an overall response rate of 87%. OEV was inversely proportional to SER. All RC were significant predictors of OEV in univariate models except rotation length, patient care participation and the presence of fellows. SER alone was a significant predictor of OEV (coefficient = -1.24, p < 0.001) and explained 68% of the variation in OEV. After including other RC, SER remained a significant predictor (coefficient = -1.08, p < 0.001) and the model explained 85% of the variation in OEV. In subgroup analysis, SER remained a significant predictor of OEV for junior residents (coefficient = -1.27, p = < 0.001), but not for senior residents (coefficient = -0.46, p = 0.15). The SER is inversely correlated with the OEV of general surgery rotations for the aggregate group of surgical residents, but this relationship appears to be attenuated by other factors in the senior resident group. Identification of the factors that affect junior surgical residents may provide the ability to improve the SER for junior residents and allow for significant improvements in perceived OEV for the resident body as a whole. Copyright © 2012 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

The Value of Assessing Public Perceptions: Wildland Fire and Defensible Space

ERIC Educational Resources Information Center

Monroe, Martha C.; Nelson, Kristen C.

2004-01-01

Fire is a challenge in the wildland-urban interface. Although resource managers encourage residents to create defensible space, many do not. This study illustrates the value of using a needs assessment to better understand perceptions of an audience in order to develop meaningful messages and materials. In this case, our audience is residents of…

Sense of place: Mount Desert Island residents and Acadia National Park

Treesearch

Nicole L. Ballinger; Robert E. Manning

1998-01-01

The framework of sense of place, developed by humanistic geographers, has been employed by researchers in their efforts to explain the range of attachments, values, and meanings assigned to natural areas. This study used an exploratory approach to address the range of values and meanings assigned by local residents to places in Acadia National Park. Qualitative...

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.

Physician Experiences With High Value Care in Internal Medicine Residency: Mixed-Methods Study of 2003-2013 Residency Graduates.

PubMed

Ryskina, Kira L; Holmboe, Eric S; Shea, Judy A; Kim, Esther; Long, Judith A

2018-01-01

Phenomenon: High healthcare costs and relatively poor health outcomes in the United States have led to calls to improve the teaching of high value care (defined as care that balances potential benefits of interventions with their harms including costs) to physicians-in-training. Numerous interventions to increase high value care in graduate medical education were implemented at the national and local levels over the past decade. However, there has been little evaluation of their impact on physician experiences during training and perceived preparedness for practice. We aimed to assess trends in U.S. physician experiences with high value care during residency over the past decade. This mixed-methods study used a cross-sectional survey mailed July 2014 to January 2015 to 902 internists who completed residency in 2003-2013, randomly selected from the American Medical Association Masterfile. Quantitative analyses of survey responses and content analysis of free-text comments submitted by respondents were performed. A total of 456 physicians (50.6%) responded. Fewer than one fourth reported being exposed to teaching about high value care at least frequently (23.6%, 106/450). Only 43.8% of respondents (193/446) felt prepared to use overtreatment guidelines in conversations with patients, whereas 85.8% (379/447) felt prepared to participate in shared decision making with patients at the conclusion of their training, and 84.4% (380/450) reported practicing generic prescribing. Physicians who completed residency more recently were more likely to report practicing generic prescribing and feeling well prepared to use overtreatment guidelines in conversations with patients (p < .01 for both). Insights: In a national survey, recent U.S. internal medicine residency graduates were more likely to experience high value care during training, which may reflect increased national and local efforts in this area. However, being exposed to high value care as a trainee may not translate into specific tools for practice. In fact, many U.S. internists reported inadequate exposure to prepare them for patient discussions about costs and the use of overtreatment guidelines in practice.

A multimodal high-value curriculum affects drivers of utilization and performance on the high-value care component of the internal medicine in-training exam.

PubMed

Chau, Tom; Loertscher, Laura

2018-01-01

Background : Teaching the practice of high-value care (HVC) is an increasingly important function of graduate medical education but best practices and long-term outcomes remain unknown. Objective : Whether a multimodal curriculum designed to address specific drivers of low-value care would affect resident attitudes, skills, and performance of HVC as tested by the Internal Medicine In-Training Exam (ITE). Methods : In 2012, we performed a baseline needs assessment among internal medicine residents at a community program regarding drivers of healthcare utilization. We then created a multimodal curriculum with online interactive worksheets, lectures, and faculty buy-in to target specific skills, knowledge, and culture deficiencies. Perceived drivers of care and performance on the Internal Medicine ITE were assessed yearly through 2016. Results : Fourteen of 27 (52%) residents completed the initial needs assessment while the curriculum was eventually seen by at least 24 of 27 (89%). The ITE was taken by every resident every year. Long-term, 3-year follow-up demonstrated persistent improvement in many drivers of utilization (patient requests, reliance on subspecialists, defensive medicine, and academic curiosity) and improvement with sustained high performance on the high-value component of the ITE. Conclusion : A multimodal curriculum targeting specific drivers of low-value care can change culture and lead to sustained improvement in the practice of HVC.

Residents' perspectives of the value of a simulation curriculum in a general surgery residency program: a multimethod study of stakeholder feedback.

PubMed

Wehbe-Janek, Hania; Colbert, Colleen Y; Govednik-Horny, Cara; White, Bobbie Ann A; Thomas, Scott; Shabahang, Mohsen

2012-06-01

Simulation has altered surgical curricula throughout residency programs. The purpose of this multimethod study was to explore residents' perceptions of simulation within surgical residency as relevant stakeholder feedback and program evaluation of the surgery simulation curriculum. Focus groups were held with a sample of surgery residents (n = 25) at a university-affiliated program. Residents participated in focus groups based on level of training and completed questionnaires regarding simulation curricula. Groups were facilitated by nonsurgeon faculty. Residents were asked: "What is the role of simulation in surgical education?" An interdisciplinary team recorded narrative data and performed content analyses. Quantitative data from questionnaires were summarized using descriptive statistics and frequencies. Major themes from the qualitative data included: concerns regarding simulation in surgical education (28%), exposure to situations and technical skills in a low-stress learning environment (24%), pressure by external agencies (19%), an educational tool (17%), and quality assurance for patient care (12%). Laparoscopy and cadaver lab were the most prevalent simulation training during residency, in addition to trauma simulations, central lines/chest tubes/IV access, and stapling lab. In response to the statement: "ACGME should require a simulation curriculum in surgery residency," 52.1% responded favorably and 47.8% responded nonfavorably. Residents acknowledge the value of simulation in patient safety, quality, and exposure to procedures before clinical experience, but remain divided on efficacy and requirement of simulation within curricula. The greater challenge to residency programs may be strategic implementation of simulation curricula within the right training context. Copyright © 2012 Mosby, Inc. 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...

A physical workload index to evaluate a safe resident handling program for nursing home personnel.

PubMed

Kurowski, Alicia; Buchholz, Bryan; Punnett, Laura

2014-06-01

The aim of this study was to obtain a comprehensive analysis of the physical workload of clinical staff in long-term care facilities, before and after a safe resident handling program (SRHP). Ergonomic exposures of health care workers include manual handling of patients and many non-neutral postures. A comprehensive assessment requires the integration of loads from these varied exposures into a single metric. The Postures, Activities, Tools, and Handling observational protocol, customized for health care, was used for direct observations of ergonomic exposures in clinical jobs at 12 nursing homes before the SRHP and 3, 12, 24, and 36 months afterward. Average compressive forces on the spine were estimated for observed combinations of body postures and manual handling and then weighted by frequencies of observed time for the combination. These values were summed to obtain a biomechanical index for nursing assistants and nurses across observation periods. The physical workload index (PWI) was much higher for nursing assistants than for nurses and decreased more after 3 years (-24% versus -2.5%). Specifically during resident handling, the PWI for nursing assistants decreased by 41% of baseline value. Spinal loading was higher for nursing assistants than for nurses in long-term care centers. Both job groups experienced reductions in physical loading from the SRHP, especially the nursing assistants and especially while resident handling. The PWI facilitates a comprehensive investigation of physical loading from both manual handling and non-neutral postures. It can be used in any work setting to identify high-risk tasks and determine whether reductions in one exposure are offset by increases in another.

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.

The role the Great Barrier Reef plays in resident wellbeing and implications for its management.

PubMed

Larson, Silva; Stoeckl, Natalie; Farr, Marina; Esparon, Michelle

2015-04-01

Improvements in human wellbeing are dependent on improving ecosystems. Such considerations are particularly pertinent for regions of high ecological, but also social and cultural importance that are facing rapid change. One such region is the Great Barrier Reef (GBR). Although the GBR has world heritage status for its 'outstanding universal value', little is known about resident perceptions of its values. We surveyed 1545 residents, finding that absence of visible rubbish; healthy reef fish, coral cover, and mangroves; and iconic marine species, are considered to be more important to quality of life than the jobs and incomes associated with industry (most respondents were dissatisfied with the benefits they received from industry). Highly educated females placed more importance on environmental non-use values than other respondents; less educated males and those employed in mining found non-market use-values relatively more important. Environmental non-use values emerged as the most important management priority for all.

Personal inhalation exposure to polycyclic aromatic hydrocarbons and their nitro-derivatives in rural residents in northern Thailand.

PubMed

Orakij, Walaiporn; Chetiyanukornkul, Thaneeya; Chuesaard, Thanyarat; Kaganoi, Yuichi; Uozaki, Waka; Homma, Chiharu; Boongla, Yaowatat; Tang, Ning; Hayakawa, Kazuichi; Toriba, Akira

2017-09-18

A personal inhalation exposure and cancer risk assessment of rural residents in Lampang, Thailand, was conducted for the first time. This highlighted important factors that may be associated with the highest areal incidence of lung cancer. Personal exposure of rural residents to polycyclic aromatic hydrocarbons (PAHs) and their nitro-derivatives (NPAHs) through inhalation of fine particulate matter (PM 2.5 ) was investigated in addition to stationary air sampling in an urban area. The personal exposure of the subjects to PM 2.5 ranged from 44.4 to 316 μg/m 3 , and the concentrations of PAHs (4.2-224 ng/m 3 ) and NPAHs (120-1449 pg/m 3 ) were higher than those at the urban site, indicating that personal exposure was affected by microenvironments through individual activities. The smoking behaviors of the rural residents barely affected their exposure to PAHs and NPAHs compared to other sources. The most important factor concerning the exposure of rural populations to PAHs was cooking activity, especially the use of charcoal open fires. The emission sources for rural residents and urban air were evaluated using diagnostic ratios, 1-nitropyrene/pyrene, and benzo[a]pyrene/benzo[ghi]perylene. Their analyses showed a significant contribution to emission from residents' personal activities in addition to the atmospheric environment. Furthermore, the personal inhalation cancer risks for all rural subjects exceeded the USEPA guideline value, suggesting that the residents have a potentially increased cancer risk. The use of open fires showed the highest cancer risk. A reduction in exposure to air pollutants for the residents could potentially be achieved by using clean fuel such as liquid petroleum gas or electricity for daily cooking.

Communication skills training in orthopaedics.

PubMed

Lundine, Kristopher; Buckley, Richard; Hutchison, Carol; Lockyer, Jocelyn

2008-06-01

Communication skills play a key role in many aspects of both medical education and clinical patient care. The objectives of this study were to identify the key components of communication skills from the perspectives of both orthopaedic residents and their program directors and to understand how these skills are currently taught. This study utilized a mixed methods design. Quantitative data were collected with use of a thirty-item questionnaire distributed to all Canadian orthopaedic residents. Qualitative data were collected through focus groups with orthopaedic residents and semistructured interviews with orthopaedic program directors. One hundred and nineteen (37%) of 325 questionnaires were completed, twelve residents participated in two focus groups, and nine of sixteen program directors from across the country were interviewed. Both program directors and residents identified communication skills as being the accurate and appropriate use of language (i.e., content skills), not how the communication was presented (i.e., process skills). Perceived barriers to effective communication included time constraints and the need to adapt to the many personalities and types of people encountered daily in the hospital. Residents rarely have explicit training in communication skills. They rely on communication training implicitly taught through observation of their preceptors and clinical experience interacting with patients, peers, and other health-care professionals. Orthopaedic residents and program directors focus on content and flexibility within communication skills as well as on the importance of being concise. They value the development of communication skills in the clinical environment through experiential learning and role modeling. Education should focus on developing residents' process skills in communication. Care should be taken to avoid large-group didactic teaching sessions, which are perceived as ineffective.

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.

Accreditation Council for Graduate Medical Education Core Competencies at a Community Teaching Hospital: Is There a Gap in Awareness?

PubMed

Al-Temimi, Mohammed; Kidon, Michael; Johna, Samir

2016-01-01

Reports evaluating faculty knowledge of the Accreditation Council for Graduate Medical Education (ACGME) core competencies in community hospitals without a dedicated residency program are uncommon. Faculty evaluation regarding knowledge of ACGME core competencies before a residency program is started. Physicians at the Kaiser Permanente Fontana Medical Center (N = 480) were surveyed for their knowledge of ACGME core competencies before starting new residency programs. Knowledge of ACGME core competencies. Fifty percent of physicians responded to the survey, and 172 (71%) of respondents were involved in teaching residents. Of physicians who taught residents and had complete responses (N = 164), 65 (39.7%) were unsure of their knowledge of the core competencies. However, most stated that they provided direct teaching to residents related to the knowledge, skills, and attitudes stated in each of the 6 competencies as follows: medical knowledge (96.3%), patient care (95.7%), professionalism (90.7%), interpersonal and communication skills (86.3%), practice-based learning (85.9%), and system-based practice (79.6%). Physician specialty, years in practice (1-10 vs > 10), and number of rotations taught per year (1-6 vs 7-12) were not associated with knowledge of the competencies (p > 0.05); however, full-time faculty (teaching 10-12 rotations per year) were more likely to provide competency-based teaching. Objective assessment of faculty awareness of ACGME core competencies is essential when starting a residency program. Discrepancy between knowledge of the competencies and acclaimed provision of competency-based teaching emphasizes the need for standardized teaching methods that incorporate the values of these competencies.

Important Skills for Internship and the Fourth-Year Medical School Courses to Acquire Them: A National Survey of Internal Medicine Residents.

PubMed

Pereira, Anne G; Harrell, Heather E; Weissman, Arlene; Smith, Cynthia D; Dupras, Denise; Kane, Gregory C

2016-06-01

To obtain feedback from internal medicine residents, a key stakeholder group, regarding both the skills needed for internship and the fourth-year medical school courses that prepared them for residency. This feedback could inform fourth-year curriculum redesign efforts. All internal medicine residents taking the 2013-2014 Internal Medicine In-Training Examination were asked to rank the importance of learning 10 predefined skills prior to internship and to use a dropdown menu of 11 common fourth-year courses to rank the 3 most helpful in preparing for internship. The predefined skills were chosen based on a review of the literature, a national subinternship curriculum, and expert consensus. Chi-square statistics were used to test for differences in responses between training levels. Of the 24,820 internal medicine residents who completed the exam, 20,484 (83%) completed the survey, had complete identification numbers, and consented to have their responses used for research. The three skills most frequently rated as very important were identifying when to seek additional help and expertise, prioritizing clinical tasks and managing time efficiently, and communicating with other providers around care transitions. The subinternship/acting internship was most often selected as being the most helpful course in preparing for internship. These findings indicate which skills and fourth-year medical school courses internal medicine residents found most helpful in preparing for internship and confirm the findings of prior studies highlighting the perceived value of subinternships. Internal medicine residents and medical educators agree on the skills students should learn prior to internship.

Underserved Areas and Pediatric Resident Characteristics: Is There Reason for Optimism?

PubMed

Laraque-Arena, Danielle; Frintner, Mary Pat; Cull, William L

2016-01-01

To examine whether resident characteristics and experiences are related to practice in underserved areas. Cross-sectional survey of a national random sample of pediatric residents (n = 1000) and additional sample of minority residents (n = 223) who were graduating in 2009 was conducted. Using weighted logistic regression, we examined relationships between resident characteristics (background, values, residency experiences, and practice goals) and reported 1) expectation to practice in underserved area and 2) postresidency position in underserved area. Response rate was 57%. Forty-one percent of the residents reported that they had an expectation of practicing in an underserved area. Of those who had already accepted postresidency positions, 38% reported positions in underserved areas. Service obligation in exchange for loans/scholarships and primary care/academic pediatrics practice goals were the strongest predictors of expectation of practicing in underserved areas (respectively, adjusted odds ratio 4.74, 95% confidence interval 1.87-12.01; adjusted odds ratio 3.48, 95% confidence interval 1.99-6.10). Other significant predictors include hospitalist practice goals, primary care practice goals, importance of racial/ethnic diversity of patient population in residency selection, early plan (before medical school) to care for underserved families, mother with a graduate or medical degree, and higher score on the Universalism value scale. Service obligation and primary care/academic pediatrics practice goal were also the strongest predictors for taking a postresidency job in underserved area. Trainee characteristics such as service obligations, values of humanism, and desire to serve underserved populations offer the hope that policies and public funding can be directed to support physicians with these characteristics to redress the maldistribution of physicians caring for children. Copyright © 2016 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Development of a high-value care subscore on the internal medicine in-training examination.

PubMed

Ryskina, Kira L; Korenstein, Deborah; Weissman, Arlene; Masters, Philip; Alguire, Patrick; Smith, Cynthia D

2014-11-18

Although high-value care (HVC) that balances benefits of tests or treatments against potential harms and costs has been a recently emphasized competency for internal medicine (IM) residents, few tools to assess residents' knowledge of HVC are available. To describe the development and initial results of an HVC subscore of the Internal Medicine In-Training Examination (IM-ITE). The HVC concepts were introduced to IM-ITE authors during question development. Three physicians independently reviewed each examination question for selection in the HVC subscore according to 6 HVC principles. The final subscore was determined by consensus. Data from the IM-ITE administered in October 2012 were analyzed at the program level. U.S. IM residency programs. 362 U.S. IM residency programs with IM-ITE data for at least 10 residents. Program-level performance on the HVC subscore was compared with performance on the overall IM-ITE, the Dartmouth Atlas hospital care intensity (HCI) index of the program's primary training hospital, and residents' attitudes about HVC assessed with a voluntary survey. The HVC subscore comprised 38 questions, including 21 (55%) on managing conservatively when appropriate and 14 (37%) on identifying low-value care. Of the 362 U.S. IM programs in the sample, 41% were in a different quartile when ranked based on the HVC subscore compared with overall IM-ITE performance. Rankings by HVC subscore and HCI index were modestly inversely associated, with 30% of programs ranked in the same quartile based on both measures. Knowledge of HVC assessed from examination vignettes may not reflect practice of HVC. Although the HVC subscore has face validity and can contribute to evaluation of residents' HVC knowledge, additional tools are needed to accurately measure residents' proficiency in HVC. None.

Quality of Life of Nursing Home Residents with Dementia: A Comparison of Perspectives of Residents, Family, and Staff

ERIC Educational Resources Information Center

Crespo, Maria; Bernaldo de Quiros, Monica; Gomez, M. Mar; Hornillos, Carlos

2012-01-01

Purpose: Quality of Life (QoL) has become increasingly valued as a key outcome in dementia both in clinical practice and in research. This study compares the QoL of long-term residents with dementia as assessed by the individuals, their relatives, and their care staff. Design and Methods: Data on residents with dementia were collected in 11…

Recognition and assessment of resident' deterioration in the nursing home setting: A critical ethnography.

PubMed

Laging, Bridget; Kenny, Amanda; Bauer, Michael; Nay, Rhonda

2018-04-01

To explore the recognition and assessment of resident deterioration in the nursing home setting. There is a dearth of research exploring how nurses and personal-care-assistants manage a deteriorating nursing home resident. Critical ethnography. Observation and semi-structured interviews with 66 participants (general medical practitioners, nurses, personal-care-assistants, residents and family members) in two Australian nursing homes. The study has been reported in accordance with the Consolidated Criteria for Reporting Qualitative Research guidelines. The value of nursing assessment is poorly recognised in the nursing home setting. A lack of clarity regarding the importance of nursing assessments associated with resident care has contributed to a decreasing presence of registered nurses and an increasing reliance on personal-care-assistants who had inadequate skills and knowledge to recognise signs of deterioration. Registered nurses experienced limited organisational support for autonomous decision-making and were often expected to undertake protocol-driven decisions that contributed to potentially avoidable hospital transfers. Nurses need to demonstrate the importance of assessment, in association with day-to-day resident care and demand standardised, regulated, educational preparation of an appropriate workforce who are competent in undertaking this role. Workforce structures that enhance familiarity between nursing home staff and residents could result in improved resident outcomes. The value of nursing assessment, in guiding decisions at the point of resident deterioration, warrants further consideration. © 2018 John Wiley & Sons Ltd.

Internal Medicine Residents' Perceptions of Team-Based Care and its Educational Value in the Continuity Clinic: A Qualitative Study.

PubMed

Soones, Tacara N; O'Brien, Bridget C; Julian, Katherine A

2015-09-01

In order to teach residents how to work in interprofessional teams, educators in graduate medical education are implementing team-based care models in resident continuity clinics. However, little is known about the impact of interprofessional teams on residents' education in the ambulatory setting. To identify factors affecting residents' experience of team-based care within continuity clinics and the impact of these teams on residents' education. This was a qualitative study of focus groups with internal medicine residents. Seventy-seven internal medicine residents at the University of California San Francisco at three continuity clinic sites participated in the study. Qualitative interviews were audiotaped and transcribed. The authors used a general inductive approach with sensitizing concepts in four frames (structural, human resources, political and symbolic) to develop codes and identify themes. Residents believed that team-based care improves continuity and quality of care. Factors in four frames affected their ability to achieve these goals. Structural factors included communication through the electronic medical record, consistent schedules and regular team meetings. Human resources factors included the presence of stable teams and clear roles. Political and symbolic factors negatively impacted team-based care, and included low staffing ratios and a culture of ultimate resident responsibility, respectively. Regardless of the presence of these factors or resident perceptions of their teams, residents did not see the practice of interprofessional team-based care as intrinsically educational. Residents' experiences practicing team-based care are influenced by many principles described in the interprofessional teamwork literature, including understanding team members' roles, good communication and sufficient staffing. However, these attributes are not correlated with residents' perceptions of the educational value of team-based care. Including residents in interprofessional teams in their clinic may not be sufficient to teach residents how team-based care can enhance their overall learning and future practice.

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.

Voice recognition technology implementation in surgical pathology: advantages and limitations.

PubMed

Singh, Meenakshi; Pal, Timothy R

2011-11-01

Voice recognition technology (VRT) has been in use for medical transcription outside of laboratories for many years, and in recent years it has evolved to a level where it merits consideration by surgical pathologists. To determine the feasibility and impact of making a transition from a transcriptionist-based service to VRT in surgical pathology. We have evaluated VRT in a phased manner for sign out of general and subspecialty surgical pathology cases after conducting a pilot study. We evaluated the effect on turnaround time, workflow, staffing, typographical error rates, and the overall ability of VRT to be adapted for use in surgical pathology. The stepwise implementation of VRT has resulted in real-time sign out of cases and improvement in average turnaround time from 4 to 3 days. The percentage of cases signed out in 1 day improved from 22% to 37%. Amendment rates for typographical errors have decreased. Use of templates and synoptic reports has been facilitated. The transcription staff has been reassigned to other duties and is successfully assisting in other areas. Resident involvement and exposure to complete case sign out has been achieved resulting in a positive impact on resident education. Voice recognition technology allows for a seamless workflow in surgical pathology, with improvements in turnaround time and a positive impact on competency-based resident education. Individual practices may assess the value of VRT and decide to implement it, potentially with gains in many aspects of their practice.

Opioid Prescribing Education in Surgical Residencies: A Program Director Survey.

PubMed

Yorkgitis, Brian K; Bryant, Elizabeth; Raygor, Desiree; Brat, Gabriel; Smink, Douglas S; Crandall, Marie

Opioid abuse and misuse is a public health crisis. A national effort to reduce this phenomenon is ongoing. Residents represent a large pool of opioid prescribers but, are often not the target for opioid prescribing education (OPE). We developed a survey to assess current opioid prescribing practices and education among surgical residents. An Institutional Review Board and Association of Program Directors in Surgery approved survey was electronically mailed to surgical program directors (PDs). The survey included questions regarding residency type, location, number of graduates per year, perceived value of OPE, residency policy on prescribing outpatients controlled substances, presence of OPE, and preferred method of OPE. A total of 248 PDs were e-mailed the survey with 110 complete responses (44.4%). Of all 104 (94.5%) allow residents to prescribe outpatient opioids with 24 (23.1%) limiting the opioid class prescribed. A total of 29 (27.9%) programs require residents to obtain their own Drug Enforcement Administration registration. Only 22 (20.0%) programs had in place mandatory OPE, 7 (6.4%) PDs were unsure if OPE was a mandatory educational requirement. Furthermore, 70 (79.5%) of programs currently without OPE are considering adding it. Didactic lecture (18, 81.8%) is the most common modality for OPE. The mode time dedicated to OPE was 1 hour. When PDs were asked about which method would be best to deliver OPE, the most common response was case-based scenarios (39, 35.5%). Bivariate statistics were performed and no association was found between OPE and program characteristics'. Most surgical residency programs allow residents to prescribe outpatient opioids, very few require OPE. The most common method of OPE was didactic lectures. To enhance a resident's knowledge in prescribing opioids, programs should incorporate OPE into their curriculum. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

RESIDENTIAL EXPOSURE TO EXTREMELY LOW FREQUENCY ELECTRIC AND MAGNETIC FIELDS IN THE CITY OF RAMALLAH-PALESTINE.

PubMed

Abuasbi, Falastine; Lahham, Adnan; Abdel-Raziq, Issam Rashid

2018-04-01

This study was focused on the measurement of residential exposure to power frequency (50-Hz) electric and magnetic fields in the city of Ramallah-Palestine. A group of 32 semi-randomly selected residences distributed amongst the city were under investigations of fields variations. Measurements were performed with the Spectrum Analyzer NF-5035 and were carried out at one meter above ground level in the residence's bedroom or living room under both zero and normal-power conditions. Fields' variations were recorded over 6-min and some times over few hours. Electric fields under normal-power use were relatively low; ~59% of residences experienced mean electric fields <10 V/m. The highest mean electric field of 66.9 V/m was found at residence R27. However, electric field values were log-normally distributed with geometric mean and geometric standard deviation of 9.6 and 3.5 V/m, respectively. Background electric fields measured under zero-power use, were very low; ~80% of residences experienced background electric fields <1 V/m. Under normal-power use, the highest mean magnetic field (0.45 μT) was found at residence R26 where an indoor power substation exists. However, ~81% of residences experienced mean magnetic fields <0.1 μT. Magnetic fields measured inside the 32 residences showed also a log-normal distribution with geometric mean and geometric standard deviation of 0.04 and 3.14 μT, respectively. Under zero-power conditions, ~7% of residences experienced average background magnetic field >0.1 μT. Fields from appliances showed a maximum mean electric field of 67.4 V/m from hair dryer, and maximum mean magnetic field of 13.7 μT from microwave oven. However, no single result surpassed the ICNIRP limits for general public exposures to ELF fields, but still, the interval 0.3-0.4 μT for possible non-thermal health impacts of exposure to ELF magnetic fields, was experienced in 13% of the residences.

Service-Based Learning for Residents: A Success for Communities and Medical Education.

PubMed

Gefter, Liana; Merrell, Sylvia Bereknyei; Rosas, Lisa G; Morioka-Douglas, Nancy; Rodriguez, Eunice

2015-01-01

Community-based service-learning opportunities could support residents' acquisition of Accreditation Council for Graduate Medical Education (ACGME) competencies, but this concept has not been tested, and such programs are difficult to find. The objective of this work was to assess the value and the ACGME competency relevance of a service-learning program for residents that could be easily replicated nationally. Forty-one family medicine residents from three training programs participated in the Stanford Youth Diabetes Coaches Program at six high schools in California and Georgia serving minority students of low socioeconomic status. Residents completed online surveys to provide qualitative feedback and assess the program's impact on their acquisition of residency program competencies and self-management support proficiencies, including prior use and planned use of action plans-a key self-management support strategy. Ninety-five percent of residents indicated that the program was a valuable experience that contributed to acquisition of residency program competencies, including interpersonal and communication skills and communication with teens. Compared with baseline, significantly more residents reported intention to use action plans with patients following participation. Themes from qualitative feedback included: valuing the overall experience, increasing opportunities to practice teaching, enhancing their ability to communicate with adolescents, contributing to the health of the community, recognizing the potential of action plans, and increasing intent to use action plans. This pilot demonstrated that a brief service-learning program can enhance standard residency curriculum by encouraging acquisition of ACGME competencies and promoting utilization of self-management support in clinical practice.

A non-discrete method for computation of residence time in fluid mechanics simulations.

PubMed

Esmaily-Moghadam, Mahdi; Hsia, Tain-Yen; Marsden, Alison L

2013-11-01

Cardiovascular simulations provide a promising means to predict risk of thrombosis in grafts, devices, and surgical anatomies in adult and pediatric patients. Although the pathways for platelet activation and clot formation are not yet fully understood, recent findings suggest that thrombosis risk is increased in regions of flow recirculation and high residence time (RT). Current approaches for calculating RT are typically based on releasing a finite number of Lagrangian particles into the flow field and calculating RT by tracking their positions. However, special care must be taken to achieve temporal and spatial convergence, often requiring repeated simulations. In this work, we introduce a non-discrete method in which RT is calculated in an Eulerian framework using the advection-diffusion equation. We first present the formulation for calculating residence time in a given region of interest using two alternate definitions. The physical significance and sensitivity of the two measures of RT are discussed and their mathematical relation is established. An extension to a point-wise value is also presented. The methods presented here are then applied in a 2D cavity and two representative clinical scenarios, involving shunt placement for single ventricle heart defects and Kawasaki disease. In the second case study, we explored the relationship between RT and wall shear stress, a parameter of particular importance in cardiovascular disease.

A non-discrete method for computation of residence time in fluid mechanics simulations

NASA Astrophysics Data System (ADS)

Esmaily-Moghadam, Mahdi; Hsia, Tain-Yen; Marsden, Alison L.

2013-11-01

Cardiovascular simulations provide a promising means to predict risk of thrombosis in grafts, devices, and surgical anatomies in adult and pediatric patients. Although the pathways for platelet activation and clot formation are not yet fully understood, recent findings suggest that thrombosis risk is increased in regions of flow recirculation and high residence time (RT). Current approaches for calculating RT are typically based on releasing a finite number of Lagrangian particles into the flow field and calculating RT by tracking their positions. However, special care must be taken to achieve temporal and spatial convergence, often requiring repeated simulations. In this work, we introduce a non-discrete method in which RT is calculated in an Eulerian framework using the advection-diffusion equation. We first present the formulation for calculating residence time in a given region of interest using two alternate definitions. The physical significance and sensitivity of the two measures of RT are discussed and their mathematical relation is established. An extension to a point-wise value is also presented. The methods presented here are then applied in a 2D cavity and two representative clinical scenarios, involving shunt placement for single ventricle heart defects and Kawasaki disease. In the second case study, we explored the relationship between RT and wall shear stress, a parameter of particular importance in cardiovascular disease.

A non-discrete method for computation of residence time in fluid mechanics simulations

PubMed Central

Esmaily-Moghadam, Mahdi; Hsia, Tain-Yen; Marsden, Alison L.

2013-01-01

Cardiovascular simulations provide a promising means to predict risk of thrombosis in grafts, devices, and surgical anatomies in adult and pediatric patients. Although the pathways for platelet activation and clot formation are not yet fully understood, recent findings suggest that thrombosis risk is increased in regions of flow recirculation and high residence time (RT). Current approaches for calculating RT are typically based on releasing a finite number of Lagrangian particles into the flow field and calculating RT by tracking their positions. However, special care must be taken to achieve temporal and spatial convergence, often requiring repeated simulations. In this work, we introduce a non-discrete method in which RT is calculated in an Eulerian framework using the advection-diffusion equation. We first present the formulation for calculating residence time in a given region of interest using two alternate definitions. The physical significance and sensitivity of the two measures of RT are discussed and their mathematical relation is established. An extension to a point-wise value is also presented. The methods presented here are then applied in a 2D cavity and two representative clinical scenarios, involving shunt placement for single ventricle heart defects and Kawasaki disease. In the second case study, we explored the relationship between RT and wall shear stress, a parameter of particular importance in cardiovascular disease. PMID:24046509

A Study to Assess Knowledge and Attitude Regarding Hand Hygiene amongst Residents and Nursing Staff in a Tertiary Health Care Setting of Bhopal City

PubMed Central

kaore, Navin Chandra M; Ramnani, Vijay Kumar; Gupta, Sanjay Kumar; Borle, Amod; Kaushal, Rituja

2014-01-01

Background: Infection due to hospital-acquired microbes is an evolving problem worldwide, and horizontal transmission of bacterial organism continues to cause a high nosocomial infection rate in health care settings. Most nosocomial infections are thought to be transmitted by the hands of health care workers.The application of hand hygiene is effective in reducing infection rates. Objectives: To assess the level of knowledge and attitude regarding hand hygiene practices amongst the health care professionals and to identify areas of gaps in their knowledge and attitude. Materials and Methods: A cross-sectional study. Result: A total 160 respondents were studied about their knowledge and attitude towards hand hygiene practices and significant difference with a p-value of 0.0025 was observed regarding most frequent source of germs responsible for health care associated infections among resident and nurses. A significant difference with p-value of 0.0001 & 0.04 was observed in colonization due to jewellery and artificial nail among the study groups. The attitude regarding correct hand hygiene practices to be followed at all times was found to be better among nurses (62.5%) as compared to residents (21.3%) which was found to be highly significant with p-value <0.001. Conclusion: Present study highlights the need of repeated training sessions regarding hand hygiene practices among the health care workers to provide the current knowledge in the area with a behavioral change in attitudes and practices leading to reduction of nosocomial infections. PMID:25302193

Quality of care in Norwegian nursing homes - typology of family perceptions.

PubMed

Vinsnes, Anne G; Nakrem, Sigrid; Harkless, Gene E; Seim, Arnfinn

2012-01-01

This study aimed to elucidate the understandings and beliefs about quality held by family members of residents of Norwegian nursing homes. The objective reported in the study considers how family member judge factors that enhance or hamper high care quality. The percentage of those who will require care in a nursing home some time before the end of their lives will increase dramatically in the next 20 years. Therefore, anticipating this pressure to expand nursing home availability, it is urgent that these services are developed from a keen understanding of what creates the best value. Care quality from the family's perspective is just one piece of the nursing home experience that must be understood for optimal value in care to be realised. Qualitative methodology. Three focus group interviews; purposive sampling was used to recruit the 16 family members of residents in nursing homes. Three domains emerged that served as anchors for a typology of family perceptions of the quality care continuum: resident contentment, suitability of staff and environmental context. Each domain was developed with categories describing high- to low-quality markers, which were then clarified by enhancing and hindering factors. This typology provides a family perspective framework that may be useful to nursing leadership at all levels of the nursing home organisation to identify important quality of care strengths as well as markers of poor care. Overall, the typology is offered to expand nurses' understanding of quality, both practically and conceptually, to provide the best value in nursing care. © 2011 Blackwell Publishing Ltd.

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.

Addressing Health Insurance Literacy Gaps in an Urban African American Population: A Qualitative Study.

PubMed

Ali, Nida M; Combs, Ryan M; Muvuka, Baraka; Ayangeakaa, Suur D

2018-06-20

Health insurance and health systems literacy needs are evolving with changes to the U.S. healthcare system. Following the implementation of the Affordable Care Act, many residents in West Louisville, Kentucky, a predominantly African American community, gained health insurance coverage for the first time. A qualitative study was conducted to assess residents' health insurance and health systems needs and to identify ways of assisting residents with navigating the healthcare system and utilizing their health insurance coverage. Twelve focus groups were conducted with a total of eighty-seven residents. Round one explored participants' experiences with health insurance, and round two examined their health information delivery preferences. An inductive thematic analysis was performed. Participants revealed the complexity of the health insurance system, many citing difficulty understanding health insurance concepts and finding suitable healthcare providers. High costs, mistrust in the healthcare system, and perceived public-private disparities were barriers to effective health insurance utilization. Health insurance materials in their current form have limited value in translating health insurance and health systems information to the West Louisville population. Alternative forms of information delivery, such as locally accessible and culturally competent community health workers may be better received and more successfully utilized by the community.

Studying Behaviors Among Neurosurgery Residents Using Web 2.0 Analytic Tools.

PubMed

Davidson, Benjamin; Alotaibi, Naif M; Guha, Daipayan; Amaral, Sandi; Kulkarni, Abhaya V; Lozano, Andres M

Web 2.0 technologies (e.g., blogs, social networks, and wikis) are increasingly being used by medical schools and postgraduate training programs as tools for information dissemination. These technologies offer the unique opportunity to track metrics of user engagement and interaction. Here, we employ Web 2.0 tools to assess academic behaviors among neurosurgery residents. We performed a retrospective review of all educational lectures, part of the core Neurosurgery Residency curriculum at the University of Toronto, posted on our teaching website (www.TheBrainSchool.net). Our website was developed using publicly available Web 2.0 platforms. Lecture usage was assessed by the number of clicks, and associations were explored with lecturer academic position, timing of examinations, and lecture/subspecialty topic. The overall number of clicks on 77 lectures was 1079. Most of these clicks were occurring during the in-training examination month (43%). Click numbers were significantly higher on lectures presented by faculty (mean = 18.6, standard deviation ± 4.1) compared to those delivered by residents (mean = 8.4, standard deviation ± 2.1) (p = 0.031). Lectures covering topics in functional neurosurgery received the most clicks (47%), followed by pediatric neurosurgery (22%). This study demonstrates the value of Web 2.0 analytic tools in examining resident study behavior. Residents tend to "cram" by downloading lectures in the same month of training examinations and display a preference for faculty-delivered lectures. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Brand Name Statin Prescribing in a Resident Ambulatory Practice: Implications for Teaching Cost-Conscious Medicine.

PubMed

Ryskina, Kira L; Pesko, Michael F; Gossey, J Travis; Caesar, Erica Phillips; Bishop, Tara F

2014-09-01

Several national initiatives aim to teach high-value care to residents. While there is a growing body of literature on cost impact of physicians' therapeutic decisions, few studies have assessed factors that influence residents' prescribing practices. We studied factors associated with intensive health care utilization among internal medicine residents, using brand name statin prescribing as a proxy for higher-cost care. We conducted a retrospective, cross-sectional analysis of statin prescriptions by residents at an urban academic internal medicine program, using electronic health record data between July 1, 2010, and June 30, 2011. For 319 encounters by 90 residents, patients were given a brand name statin in 50% of cases. When categorized into quintiles, the bottom quintile of residents prescribed brand name statins in 2% of encounters, while the top quintile prescribed brand name statins in 98% of encounters. After adjusting for potential confounders, including patient characteristics and supervising attending, being in the primary care track was associated with lower odds (odds ratio [OR], 0.38; P  =  .02; 95% confidence interval [CI], 0.16-0.86), and graduating from a medical school with an above-average hospital care intensity index was associated with higher odds of prescribing brand name statins (OR, 1.70; P  =  .049; 95% CI, 1.003-2.88). We found considerable variation in brand name statin prescribing by residents. Medical school attended and residency program type were associated with resident prescribing behavior. Future interventions should raise awareness of these patterns in an effort to teach high-value, cost-conscious care to all residents.

Organochlorine pollutants and stable isotopes in resident and migrant passerine birds from northwest Michoacán, Mexico

USGS Publications Warehouse

Mora, Miguel A.

2008-01-01

Although concentrations of organochlorine compounds (OCs) in birds from most of the United States and Canada have decreased over the last 30 years, there is still concern that migrant birds might be exposed to elevated concentrations of OCs during migration in Latin America. The Lerma-Chapala Basin in west-central Mexico is an important migration corridor and wintering area for many species. The objectives of this study were to assess if resident and migrant birds wintering in western Michoacán, Mexico accumulated elevated concentrations of OCs during fall and spring and to determine if the stable isotopes δ15N, δ13C, and δD could be used to predict burdens and origins of DDE accumulation. Resident and migrant passerine insectivorous birds were collected during fall and spring (2001–2002) in northwest Michoacán, near Chapala Lake, Mexico. The carcasses were analyzed for OCs and tail feathers were analyzed for stable isotopes δ15N, δ13C, and δD. The OCs detected in more than 50% of the samples were: oxychlordane (79%), p,p’-DDE (100%), p,p′-DDT (57%), and total PCBs (100%). p,p′-DDE was the OC detected at the highest concentrations, whereas residues of other OCs were near or below detection limits. Overall, there were no significant differences in concentrations of OCs between seasons or between resident and migrant birds. Concentrations of DDE and oxychlordane were somewhat higher in migrant and resident birds during spring than in fall; however, concentrations were significantly different only for oxychlordane. Two resident birds collected in fall and spring had DDE residues >10 μg/g wet weight in carcass. There were no significant differences in δ13C and δ15N values among species, between seasons, or between migrant and resident birds. However, δD values were clearly different between species and helped differentiate migrant from resident birds. δD values also were negatively and significantly correlated with DDE concentrations in carcass. Birds with more depleted δD values in feathers tended to have higher DDE concentrations than those with less depleted δD values, suggesting a potential latitudinal accumulation of DDE. Overall, our results suggest that during fall and spring, there is not a significant buildup of persistent OCs in migrant and resident passerine insectivorous birds in northwest Michoacán, Mexico.

Using a composite grid approach in a complex coastal domain to estimate estuarine residence time

USGS Publications Warehouse

Warner, John C.; Geyer, W. Rockwell; Arango, Herman G.

2010-01-01

We investigate the processes that influence residence time in a partially mixed estuary using a three-dimensional circulation model. The complex geometry of the study region is not optimal for a structured grid model and so we developed a new method of grid connectivity. This involves a novel approach that allows an unlimited number of individual grids to be combined in an efficient manner to produce a composite grid. We then implemented this new method into the numerical Regional Ocean Modeling System (ROMS) and developed a composite grid of the Hudson River estuary region to investigate the residence time of a passive tracer. Results show that the residence time is a strong function of the time of release (spring vs. neap tide), the along-channel location, and the initial vertical placement. During neap tides there is a maximum in residence time near the bottom of the estuary at the mid-salt intrusion length. During spring tides the residence time is primarily a function of along-channel location and does not exhibit a strong vertical variability. This model study of residence time illustrates the utility of the grid connectivity method for circulation and dispersion studies in regions of complex geometry.

Paleoclimatic and deforestation effect on the chemical and isotopic composition of the coastal fresh groundwater resources of South-east Ivory Coast

NASA Astrophysics Data System (ADS)

Adiaffi, B.; Marlin, C.; Yei, O. M.-S.; Massault, M.; Noret, A.; Biemi, J.

2009-04-01

Since a half of century, the forest surface area of the South Ivory Coast has been decreased for the benefit of agriculture (15 000 km2 in 1993 versus 83 000 km2 in 1955-1958). This area also undergoes climate change. Vegetation cover has gradually changed from rainforests (C3 plants) to savanna (C4 plants) and agricultural plants. In the Abidjan area (5.00-6.00°N, 2.40-4.40°W), the mean rainfall amount and temperature value evolve during the 20th century (1912 mm/year and 26.3°C/year during the first decennial to 1613 mm/year and 26.9°C/year during the last ten years). The Paleoproterozoïc fractured bedrock (PB) and the Continental Terminal (CT) deposits groundwater are studied to show the climate change and deforestation effect on the area groundwater resources using stable isotopes (18O, 2H and 13C) contents, radiocarbon (14C) contents and chemical data on a set of 25 groundwater samples. The residence time of the groundwaters is estimated by the 14C using two models: (i) the model of well-mixed reservoir (WMR model) and (ii) the piston flow model (PF model). The range of the PB groundwater residence time (15 000 - 8 000 to ~ 300 - 100 a BP) for both models shows that the recharge has started at the beginning of the post-glacial period whereas the CT aquifer recharge is much more recent (from 300 a BP to today). The PB groundwater provides information about paleoclimatic conditions that occurred over the studied area during the late Pleistocene. It is demonstrated, through this study, that the evolution of vegetation cover (from forests to savanna and agriculture plants) is shown in groundwater by the trend in 13C content from old groundwater (confined bedrock groundwater: residence time of ~ 15 000 a BP) to the recent groundwater (unconfined bedrock groundwater and CT groundwater: residence times: ~ 300 a BP and lower than 100 a BP, respectively). The δ18O and δ2H values also increase with time from the beginning of the post-glacial period (~ 15 000 a BP) to the present day (< 100 a BP), showing the evolution of the climate from cold to warm conditions. This study has shown the paleoclimate effect on the water resources in Ivory Coast and are consistent with the results obtained by some authors in Western Africa (Ghana, Liberia, Mali and Niger).

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 ...

Analysis of metolachlor ethane sulfonic acid (MESA) chirality in groundwater: A tool for dating groundwater movement in agricultural settings.

PubMed

Rice, Clifford P; McCarty, Gregory W; Bialek-Kalinski, Krystyna; Zabetakis, Kara; Torrents, Alba; Hapeman, Cathleen J

2016-08-01

To better address how much groundwater contributes to the loadings of pollutants from agriculture we developed a specific dating tool for groundwater residence times. This tool is based on metolachlor ethane sulfonic acid, which is a major soil metabolite of metolachlor. The chiral forms of metolachlor ethane sulfonic acid (MESA) and the chiral forms of metolachlor were examined over a 6-year period in samples of groundwater and water from a groundwater-fed stream in a riparian buffer zone. This buffer zone bordered cropland receiving annual treatments with metolachlor. Racemic (rac) metolachlor was applied for two years in the neighboring field, and subsequently S-metolachlor was used which is enriched by 88% with the S-enantiomer. Chiral analyses of the samples showed an exponential increase in abundance of the S-enantiomeric forms for MESA as a function of time for both the first order riparian buffer stream (R(2)=0.80) and for groundwater within the riparian buffer (R(2)=0.96). However, the S-enrichment values for metolachlor were consistently high indicating different delivery mechanisms for MESA and metolachlor. A mean residence time of 3.8years was determined for depletion of the initially-applied rac-metolachlor. This approach could be useful in dating groundwater and determining the effectiveness of conservation measures. A mean residence time of 3.8years was calculated for groundwater feeding a first-order stream by plotting the timed-decay for the R-enantiomer of metolachlor ethane sulfonic acid. Published by Elsevier B.V.

"It Feels Like a Lot of Extra Work": Resident Attitudes About Quality Improvement and Implications for an Effective Learning Health Care System.

PubMed

Butler, Jorie M; Anderson, Katherine A; Supiano, Mark A; Weir, Charlene R

2017-07-01

The learning health care system promotes development and application of evidence generated within the health care system to enhance the quality of patient care. The purpose of this study was to understand resident attitudes about quality improvement (QI) in Accreditation Council for Graduate Medical Education-approved programs. Four focus groups were conducted with 45 residents at the University of Utah School of Medicine during September and October 2014. Residents discussed the perceived value of QI and their experiences with QI. Qualitative analysis was conducted iteratively, resulting in a set of constructs that were then consolidated into overarching themes. Five themes emerged from the qualitative analysis. Four of these represented QI participation barriers: challenges with understanding the vision of QI, confusion about basic aspects of QI, a sense that resident contributions to QI are not valued/valuable to the QI process, and challenges with prioritizing responsibilities relating to QI compared with other responsibilities. One theme represented a facilitator of successful QI: factors that make QI work successfully (e.g., clear goals and a sense of being on the "same page"). If resident attitudes about QI do not improve, the culture of the learning health care system is threatened. An important step in enhancing the perceived value of QI is resolving the perceived tension between providing excellent patient care and satisfying other goals. Involving residents more effectively in QI may result in improved attitudes and promote development of a better-functioning learning health care system.

Sun Series program for the REEDA System. [predicting orbital lifetime using sunspot values

NASA Technical Reports Server (NTRS)

Shankle, R. W.

1980-01-01

Modifications made to data bases and to four programs in a series of computer programs (Sun Series) which run on the REEDA HP minicomputer system to aid NASA's solar activity predictions used in orbital life time predictions are described. These programs utilize various mathematical smoothing technique and perform statistical and graphical analysis of various solar activity data bases residing on the REEDA System.

Taking potential probability function maps to the local scale and matching them with land use maps

NASA Astrophysics Data System (ADS)

Garg, Saryu; Sinha, Vinayak; Sinha, Baerbel

2013-04-01

Source-Receptor models have been developed using different methods. Residence-time weighted concentration back trajectory analysis and Potential Source Contribution Function (PSCF) are the two most popular techniques for identification of potential sources of a substance in a defined geographical area. Both techniques use back trajectories calculated using global models and assign values of probability/concentration to various locations in an area. These values represent the probability of threshold exceedances / the average concentration measured at the receptor in air masses with a certain residence time over a source area. Both techniques, however, have only been applied to regional and long-range transport phenomena due to inherent limitation with respect to both spatial accuracy and temporal resolution of the of back trajectory calculations. Employing the above mentioned concepts of residence time weighted concentration back-trajectory analysis and PSCF, we developed a source-receptor model capable of identifying local and regional sources of air pollutants like Particulate Matter (PM), NOx, SO2 and VOCs. We use 1 to 30 minute averages of concentration values and wind direction and speed from a single receptor site or from multiple receptor sites to trace the air mass back in time. The model code assumes all the atmospheric transport to be Lagrangian and linearly extrapolates air masses reaching the receptor location, backwards in time for a fixed number of steps. We restrict the model run to the lifetime of the chemical species under consideration. For long lived species the model run is limited to < 4 hrs as spatial uncertainty increases the longer an air mass is linearly extrapolated back in time. The final model output is a map, which can be compared with the local land use map to pinpoint sources of different chemical substances and estimate their source strength. Our model has flexible space- time grid extrapolation steps of 1-5 minutes and 1-5 km grid resolution. By making use of high temporal resolution data, our model can produce maps for different times of the day, thus accounting for temporal changes and activity profiles of different sources. The main advantage of our approach compared to geostationary numerical methods that interpolate measured concentration values of multiple measurement sites to produce maps (gridding) is that the maps produced are more accurate in terms of spatial identification of sources. The model was applied to isoprene and meteorological data recorded during clean post-monsoon season (1 October- 7 October, 2012) between 11 am and 4 pm at a receptor site in the North-West Indo-Gangetic Plains (IISER Mohali, 30.665° N, 76.729°E, 300 m asl), near the foothills of the Himalayan range. Considering the lifetime of isoprene, the model was run only 2 hours backward in time. The map shows highest residence time weighted concentration of isoprene (up to 3.5 ppbv) over agricultural land with high number of trees (>180 trees/gridsquare); moderate concentrations for agricultural lands with low tree density (1.5-2.5 ppbv for 250 μg/m3 for traffic hotspots in Chandigarh City are observed. Based on the validation against the land use maps, the model appears to do an excellent job in source apportionment and identifying emission hotspots. Acknowledgement: We thank the IISER Mohali Atmospheric Chemistry Facility for data and the Ministry of Human Resource Development (MHRD), India and IISER Mohali for funding the facility. Chinmoy Sarkar is acknowledged for technical support, Saryu Garg thanks the Max Planck-DST India Partner Group on Tropospheric OH reactivity and VOCs for funding the research.

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.

Impact of personal goals on the internal medicine R4 subspecialty match: a Q methodology study.

PubMed

Daniels, Vijay J; Kassam, Narmin

2013-12-21

There has been a decline in interest in general internal medicine that has resulted in a discrepancy between internal medicine residents' choice in the R4 subspecialty match and societal need. Few studies have focused on the relative importance of personal goals and their impact on residents' choice. The purpose of this study was to assess if internal medicine residents can be grouped based on their personal goals and how each group prioritizes these goals compared to each other. A secondary objective was to explore whether we could predict a resident's desired subspecialty choice based on their constellation of personal goals. We used Q methodology to examine how postgraduate year 1-3 internal medicine residents could be grouped based on their rankings of 36 statements (derived from our previous qualitative study). Using each groups' defining and distinguishing statements, we predicted their subspecialties of interest. We also collected the residents' first choice in the subspecialty match and used a kappa test to compare our predicted subspecialty group to the residents' self-reported first choice. Fifty-nine internal medicine residents at the University of Alberta participated between 2009 and 2010 with 46 Q sorts suitable for analysis. The residents loaded onto four factors (groups) based on how they ranked statements. Our prediction of each groups' desired subspecialties with their defining and/or distinguishing statements are as follows: group 1 - general internal medicine (variety in practice); group 2 - gastroenterology, nephrology, and respirology (higher income); group 3 - cardiology and critical care (procedural, willing to entertain longer training); group 4 - rest of subspecialties (non-procedural, focused practice, and valuing more time for personal life). There was moderate agreement (kappa = 0.57) between our predicted desired subspecialty group and residents' self-reported first choice (p < 0.001). This study suggests that most residents fall into four groups based on a constellation of personal goals when choosing an internal medicine subspecialty. The key goals that define and/or distinguish between these groups are breadth of practice, lifestyle, desire to do procedures, length of training, and future income potential. Using these groups, we were able to predict residents' first subspecialty group with moderate success.

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.

Fast growing, healthy and resident green turtles (Chelonia mydas) at two neritic sites in the central and northern coast of Peru: implications for conservation.

PubMed

Velez-Zuazo, Ximena; Quiñones, Javier; Pacheco, Aldo S; Klinge, Luciana; Paredes, Evelyn; Quispe, Sixto; Kelez, Shaleyla

2014-01-01

In order to enhance protection and conservation strategies for endangered green turtles (Chelonia mydas), the identification of neritic habitats where this species aggregates is mandatory. Herein, we present new information about the population parameters and residence time of two neritic aggregations from 2010 to 2013; one in an upwelling dominated site (Paracas ∼14°S) and the other in an ecotone zone from upwelling to warm equatorial conditions (El Ñuro ∼4°S) in the Southeast Pacific. We predicted proportionally more adult individuals would occur in the ecotone site; whereas in the site dominated by an upwelling juvenile individuals would predominate. At El Ñuro, the population was composed by (15.3%) of juveniles, (74.9%) sub-adults, and (9.8%) adults, with an adult sex ratio of 1.16 males per female. Times of residence in the area ranged between a minimum of 121 and a maximum of 1015 days (mean 331.1 days). At Paracas the population was composed by (72%) of juveniles and (28%) sub-adults, no adults were recorded, thus supporting the development habitat hypothesis stating that throughout the neritic distribution there are sites exclusively occupied by juveniles. Residence time ranged between a minimum of 65 days and a maximum of 680 days (mean 236.1). High growth rates and body condition index values were estimated suggesting healthy individuals at both study sites. The population traits recorded at both sites suggested that conditions found in Peruvian neritic waters may contribute to the recovery of South Pacific green turtles. However, both aggregations are still at jeopardy due to pollution, bycatch and illegal catch and thus require immediate enforcing of conservation measurements.

Fast Growing, Healthy and Resident Green Turtles (Chelonia mydas) at Two Neritic Sites in the Central and Northern Coast of Peru: Implications for Conservation

PubMed Central

Velez-Zuazo, Ximena; Quiñones, Javier; Pacheco, Aldo S.; Klinge, Luciana; Paredes, Evelyn; Quispe, Sixto; Kelez, Shaleyla

2014-01-01

In order to enhance protection and conservation strategies for endangered green turtles (Chelonia mydas), the identification of neritic habitats where this species aggregates is mandatory. Herein, we present new information about the population parameters and residence time of two neritic aggregations from 2010 to 2013; one in an upwelling dominated site (Paracas ∼14°S) and the other in an ecotone zone from upwelling to warm equatorial conditions (El Ñuro ∼4°S) in the Southeast Pacific. We predicted proportionally more adult individuals would occur in the ecotone site; whereas in the site dominated by an upwelling juvenile individuals would predominate. At El Ñuro, the population was composed by (15.3%) of juveniles, (74.9%) sub-adults, and (9.8%) adults, with an adult sex ratio of 1.16 males per female. Times of residence in the area ranged between a minimum of 121 and a maximum of 1015 days (mean 331.1 days). At Paracas the population was composed by (72%) of juveniles and (28%) sub-adults, no adults were recorded, thus supporting the development habitat hypothesis stating that throughout the neritic distribution there are sites exclusively occupied by juveniles. Residence time ranged between a minimum of 65 days and a maximum of 680 days (mean 236.1). High growth rates and body condition index values were estimated suggesting healthy individuals at both study sites. The population traits recorded at both sites suggested that conditions found in Peruvian neritic waters may contribute to the recovery of South Pacific green turtles. However, both aggregations are still at jeopardy due to pollution, bycatch and illegal catch and thus require immediate enforcing of conservation measurements. PMID:25409240

Coaching for Success: A Residency Search Primer and Update for Preceptors and Faculty

PubMed Central

Adams, Alex J.; Ulbrich, Timothy R.; Soric, Mate M.

2015-01-01

Pharmacy residency programs have become increasingly competitive in recent years, and changes to the residency search and application process have altered the process for matching with a residency. In this article, major residency topics, from the benefits of residency training to searching for and ranking programs, are summarized. A discussion of tips and tricks for applying for residencies and interviewing for positions is included along with specific suggestions developed with data following the implementation of the Pharmacy Online Residency Centralized Application Service (PhORCAS). The article is organized in a question and answer format to help facilitate understanding of key concepts and common questions that may arise from applicants. Many changes have taken place in the residency search and application process in recent years, and the process of obtaining a residency is complex. Residency applicants and those advising applicants may find value in the answers to commonly asked residency application questions to help ensure the greatest chance of a successful residency match. PMID:26405338

Expert training with standardized operative technique helps establish a successful penile prosthetics program for urologic resident education.

PubMed

King, Ashley B; Klausner, Adam P; Johnson, Corey M; Moore, Blake W; Wilson, Steven K; Grob, B Mayer

2011-10-01

The challenge of resident education in urologic surgery programs is to overcome disparity imparted by diverse patient populations, limited training times, and inequalities in the availability of expert surgical educators. Specifically, in the area of prosthetic urology, only a small proportion of programs have full-time faculty available to train residents in this discipline. To examine whether a new model using yearly training sessions from a recognized expert can establish a successful penile prosthetics program and result in better outcomes, higher case volumes, and willingness to perform more complex surgeries. A recognized expert conducted one to two operative training sessions yearly to teach standardized technique for penile prosthetics to residents. Each session consisted of three to four operative cases performed under the direct supervision of the expert. Retrospective data were collected from all penile prosthetic operations before (February, 2000 to June, 2004: N = 44) and after (July, 2004 to October, 2007: N = 79) implementation of these sessions. Outcomes reviewed included patient age, race, medical comorbidities, operative time, estimated blood loss, type of prosthesis, operative approach, drain usage, length of stay, and complications including revision/explantation rates. Statistical analysis was performed using Student's t-tests, Fisher's tests, and survival curves using the Kaplan-Meier technique (P value ≤ 0.05 to define statistical significance). Patient characteristics were not significantly different pre- vs. post-training. Operative time and estimated blood loss significantly decreased. Inflatable implants increased from 19/44 (43.2%, pre-training) to 69/79 (87.3%, post-training) (P < 0.01). Operations per year increased from 9.96 (pre-training) to 24 (post-training) (P < 0.01). Revision/explantation occurred in 11/44 patients (25%, pre-training) vs. 7/79 (8.9%, post-training) (P < 0.05). These data demonstrate that yearly sessions with a recognized expert can improve surgical outcomes, type, and volume of implants and can reduce explantation/revision rates. This represents an excellent model for improved training of urologic residents in penile prosthetics surgery. © 2011 International Society for Sexual Medicine.

Differences in Ostomy Pouch Seal Leakage Occurrences Between North American and European Residents.

PubMed

Fellows, Jane; Forest Lalande, Louise; Martins, Lina; Steen, Anne; Størling, Zenia M

The purpose of this study was to compare experiences and concerns about pouch seal leakage between persons with ostomies residing in North America (Canada and the United States) and Europe (United Kingdom, Netherlands, Sweden, Germany, Belgium, France, and Italy). Differences in reported pouch wear time and accessories used between the 2 groups were also examined. Secondary analysis of data from a cross-sectional study (Ostomy Life Study). Responses from persons residing in European countries (n = 1939) were compared with responses of 1387 individuals residing in North American countries. Persons with an ostomy completed a questionnaire that focused on 4 topics related to the daily use of an ostomy pouching system (pouch seal leakage, ballooning, appearance of pouching system such as color and size of the pouch and whether it is discrete under clothing, and coupling failure of 2-piece pouching systems). Pouch seal leakage was defined as stomal effluent seeping between the skin and the wafer of the ostomy pouching system. Statistical analysis was performed using a proportional odds model including various variable effects. Special attention was given to frequency of pouch seal leakage occurrences. All tests were 2-sided; P values ≤.05 were deemed statistically significant. Participants living in the North American countries indicated they were more likely to experience leakage from the ostomy (odds ratio = 2.610, 95% CI 2.187-3.115; P < .0001). Findings also indicated they were more likely to worry about pouch seal leakage than those in the European countries' data set (odds ratio = 2.722, 95% CI 2.283-3.246; P < .0001). Participants residing in the North American countries had significantly longer wear times than those participants in the European countries (P < .0001, χ test). The use of accessories was associated with a longer pouching system wear time. Study results suggest that participants from the North American countries indicated significantly more experience with and worries about leakage and longer wear time than the participants from the European population. Additional research is needed to determine the reasons for these differences.

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.

Wisdom of generations: a pilot study of the values transmitted in ethical wills of nursing home residents and student volunteers.

PubMed

Cohen-Mansfield, Jiska; Regier, Natalie G; Peyser, Hedy; Stanton, Joshua

2009-08-01

This is a pilot study that provides a description of the values older persons report in ethical wills and their reasoning for the values they chose, and compares the values in ethical wills of seniors and students. Nursing home residents rarely get the opportunity or venue to discuss these topics and the ethical will enables them to have conversations about issues they feel are important. The 22 Questions for Ethical Wills(c) assessment was administered to 15 residents of a large nursing home in suburban Maryland and to 11 student volunteers. Raters identified recurring themes and independently analyzed the text from the ethical wills based on the themes. Questions that prompted similar responses were combined in the analyses. The most prevalent theme among both nursing home residents and students was "interpersonal relations." Differences between groups of respondents were especially evident for the theme of "education," which was given by over a half of the older persons and none of the students. Greater variability was found in the responses of the older participants, as was a greater likelihood of providing detailed explanations for their relayed values. The 22 Questions for Ethical Wills(c) is a useful methodology to elicit meaningful discussions of values and life lessons in persons both young and old. This process offers an intriguing comparison between the similarities and differences of life views of persons at opposite ends of the age spectrum.

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.

Residents' perspectives on the final year of medical school

PubMed Central

Obrien, Bridget; Niehaus, Brian; Teherani, Arianne; Young, John Q.

2012-01-01

Objectives To characterize junior residents’ perspectives on the purpose, value, and potential improvement of the final year of medical school. Methods Eighteen interviews were conducted with junior residents who graduated from nine different medical schools and who were in internal medicine, surgery, and psychiatry programs at one institution in the United States. Interview transcripts were coded and analyzed inductively for themes. Results Participants’ descriptions of the purpose of their recently completed final year of medical school contained three primary themes: residency-related purposes, interest- or need-based purposes, and transitional purposes. Participants commented on the most valued aspects of the final year. Themes included opportunities to: prepare for residency; assume a higher level of responsibility in patient care; pursue experiences of interest that added breadth of knowledge, skills and perspective; develop and/or clarify career plans; and enjoy a period of respite. Suggestions for improvement included enhancing the learning value of clinical electives, augmenting specific curricular content, and making the final year more purposeful and better aligned with career goals. Conclusions The final year of medical school is a critical part of medical education for most learners, but careful attention is needed to ensure that the year is developmentally robust. Medical educators can facilitate this by creating structures to help students define personal and professional goals, identify opportunities to work toward these goals, and monitor progress so that the value of the final year is optimized and not exclusively focused on residency preparation. PMID:28029642

Groundwater residence times in Shenandoah National Park, Blue Ridge Mountains, Virginia, USA: A multi-tracer approach

USGS Publications Warehouse

Plummer, Niel; Busenberg, E.; Böhlke, J.K.; Nelms, D.L.; Michel, R.L.; Schlosser, P.

2001-01-01

Chemical and isotopic properties of water discharging from springs and wells in Shenandoah National Park (SNP), near the crest of the Blue Ridge Mountains, VA, USA were monitored to obtain information on groundwater residence times. Investigated time scales included seasonal (wet season, April, 1996; dry season, August–September, 1997), monthly (March through September, 1999) and hourly (30-min interval recording of specific conductance and temperature, March, 1999 through February, 2000). Multiple environmental tracers, including tritium/helium-3 (3H/3He), chlorofluorocarbons (CFCs), sulfur hexafluoride (SF6), sulfur-35 (35S), and stable isotopes (δ18O and δ2H) of water, were used to estimate the residence times of shallow groundwater discharging from 34 springs and 15 wells. The most reliable ages of water from springs appear to be based on SF6 and 3H/3He, with most ages in the range of 0–3 years. This range is consistent with apparent ages estimated from concentrations of CFCs; however, CFC-based ages have large uncertainties owing to the post-1995 leveling-off of the CFC atmospheric growth curves. Somewhat higher apparent ages are indicated by 35S (>1.5 years) and seasonal variation of δ18O (mean residence time of 5 years) for spring discharge. The higher ages indicated by the 35S and δ18O data reflect travel times through the unsaturated zone and, in the case of 35S, possible sorption and exchange of S with soils or biomass. In springs sampled in April, 1996, apparent ages derived from the 3H/3He data (median age of 0.2 years) are lower than those obtained from SF6 (median age of 4.3 years), and in contrast to median ages from 3H/3He (0.3 years) and SF6 (0.7 years) obtained during the late summer dry season of 1997. Monthly samples from 1999 at four springs in SNP had SF6apparent ages of only 1.2 to 2.5±0.8 years, and were consistent with the 1997 SF6 data. Water from springs has low excess air (0–1 cm3 kg−1) and N2–Ar temperatures that vary seasonally. Concentrations of He and Ne in excess of solubility equilibrium indicate that the dissolved gases are not fractionated. The seasonal variations in N2–Ar temperatures suggest shallow, seasonal recharge, and the excess He and Ne data suggest waters mostly confined to gas exchange in the shallow, mountain-slope, water-table spring systems. Water from wells in the fractured rock contains up to 8 cm3 kg−1 of excess air with ages in the range of 0–25 years. Transient responses in specific conductance and temperature were observed in spring discharge within several hours of large precipitation events in September, 1999; both parameters increased initially, then decreased to values below pre-storm base-flow values. The groundwater residence times indicate that flushing rates of mobile atmospheric constituents through groundwater to streams draining the higher elevations in SNP average less than 3 years in base-flow conditions.

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.

Relational Autonomy in Assisted Living: A Focus on Diverse Care Settings for Older Adults

PubMed Central

Perkins, Molly M.; Ball, Mary M.; Whittington, Frank J.; Hollingsworth, Carole

2012-01-01

Consistent with Western cultural values, the traditional liberal theory of autonomy, which places emphasis on self-determination, liberty of choice, and freedom from interference by others, has been a leading principle in health care discourse for several decades. In context to aging, chronic illness, disability, and long-term care, increasingly there has been a call for a relational conception of autonomy that acknowledges issues of dependency, interdependence, and care relationships. Although autonomy is a core philosophy of assisted living (AL) and a growing number of studies focus on this issue, theory development in this area is lagging and little research has considered race, class, or cultural differences, despite the growing diversity of AL. We present a conceptual model of autonomy in AL based on over a decade of research conducted in diverse facility settings. This relational model provides an important conceptual lens for understanding the dynamic linkages between varieties of factors at multiple levels of social structure that shape residents' ability to maintain a sense of autonomy in this often socially challenging care environment. Social and institutional change, which is ongoing, as well as the multiple and ever-changing cultural contexts within which residents are embedded, are important factors that shape residents' experiences over time and impact resident-facility fit and residents' ability to age in place. PMID:22707852

Implementation of a Longitudinal Introduction to Radiology Course During Internship Year Improves Diagnostic Radiology Residents' Academic and Clinical Skills: A Canadian Experience.

PubMed

Darras, Kathryn E; Worthington, Anne; Russell, David; Hou, Daniel J; Forster, Bruce B; Hague, Cameron J; Mar, Colin; Chang, Silvia D

2016-07-01

In order to ease the transition from internship to diagnostic radiology residency, a year-long didactic introduction to radiology course was offered to post-graduate year one (PGY-1) diagnostic radiology residents during their internship, which consisted of 27 hours of lecture over 9 months. The purpose of this study was to determine the quantitative and qualitative educational value of this course and its effect with respect to on-call preparedness. Two consecutive cohorts of Diagnostic Radiology residents were included: the first cohort (PGY-1s in 2011-2012) did not participate in the new course (Old Curriculum Residents) and the second cohort (PGY-1s in 2012-2013) completed the new course (New Curriculum Residents). These two cohorts were compared both qualitatively and quantitatively. Scores were compared from the standardized Canadian National Pre-Call Observed Standardized Clinical Examination and American College of Radiology Diagnostic Radiology In-Training examination, which are taken in the PGY-2 year, at months 5 and 7, respectively. In addition, staff observation of on-call resident performance and resident self-reported preparedness were considered. Cohorts were compared using Mann-Whitney U test with significance defined as P value <0.05. P values from 0.05 to 0.10 were noted as possibly significant and further analyzed using a Cohen d test where the difference was determined to be small (0.2), medium (0.5), or large (0.8). New Curriculum Residents reported that the content of the PGY1 curriculum was more appropriate than the old curriculum to prepare them for call in PGY2 (P = 0.013). New Curriculum Residents scored better than the Old Curriculum Residents on the Diagnostic Radiology In-Training examination (P = 0.039) and on the emergency cases of the Canadian National Pre-Call Observed Standardized Clinical Examination (P = 0.035). Staff radiologists, who were not blinded, reported that the New Curriculum Residents were better prepared for daytime (P = 0.006) and overnight (P = 0.008) independent call were better prepared to perform common ultrasound examinations alone (P = 0.049), and required less guidance while on call for nine competency areas. There was, however, no statistical difference between the residents' self-reported preparedness for independent call. Participation in a lecture-based introductory radiology curriculum during the PGY-1 internship year improved both radiology residents' preparedness for call and their performance in PGY-2. Copyright © 2016 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

Unraveling the complexities of the velocity dependency of E. coli retention and release parameters in saturated porous media.

PubMed

Sasidharan, Salini; Bradford, Scott A; Torkzaban, Saeed; Ye, Xueyan; Vanderzalm, Joanne; Du, Xinqiang; Page, Declan

2017-12-15

Escherichia coli transport and release experiments were conducted to investigate the pore-water velocity (v) dependency of the sticking efficiency (α), the fraction of the solid surface area that contributed to retention (S f ), the percentage of injected cells that were irreversibly retained (M irr ), and cell release under different (10-300mM) ionic strength (IS) conditions. Values of α, S f , and M irr increased with increasing IS and decreasing v, but the dependency on v was greatest at intermediate IS (30 and 50mM). Following the retention phase, successive increases in v up to 100 or 150mday -1 and flow interruption of 24h produced negligible amounts of cell release. However, excavation of the sand from the columns in excess electrolyte solution resulted in the release of >80% of the retained bacteria. These observations were explained by: (i) extended interaction energy calculations on a heterogeneous sand collector; (ii) an increase in adhesive strength with the residence time; and (iii) torque balance consideration on rough surfaces. In particular, α, S f , and M irr increased with IS due to lower energy barriers and stronger primary minima. The values of α, S f , and M irr also increased with decreasing v because the adhesive strength increased with the residence time (e.g., an increased probability to diffuse over the energy barrier) and lower hydrodynamic forces diminished cell removal. The controlling influence of lever arms at microscopic roughness locations and grain-grain contacts were used to explain negligible cell removal with large increases in v and large amounts of cell recovery following sand excavation. Results reveal the underlying causes (interaction energy, torque balance, and residence time) of the velocity dependency of E. coli retention and release parameters (k sw , α, and S f ) that are not accounted for in colloid filtration theory. Copyright © 2017 Elsevier B.V. All rights reserved.

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…

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.

Activating Public Space: How to Promote Physical Activity in Urban Environment

NASA Astrophysics Data System (ADS)

Kostrzewska, Małgorzata

2017-10-01

Physical activity is an essential component of a healthy lifestyle. The quality and equipment of urban public space plays an important role in promoting physical activity among people (residents, tourists). In order for recreation and sports activities to be undertaken willingly, in a safe and comprehensive manner, certain spatial conditions and requirements must be met. The distinctive feature of contemporary large cities is the disappearance of local, neighbourly relations, and the consequent loneliness, alienation, and atomization of the residents. Thus, the design of public spaces should be an expression of the values of social inclusion and integration. A properly designed urban space would encourage people to leave their homes and integrate, also by undertaking different forms of physical activities. This, in turn, can lead to raising the quality of the space, especially in the context of its “familiarization” and “domestication”. The aim of the research was to identify the architectural and urban features of the public spaces of contemporary cities that can contribute to the promotion of physical activity. The paper presents the research results and the case studies of such spatial solutions and examples of good practices, which invite residents to undertake different forms of physical activities in public spaces. The issue of the integrating, inclusionary, and social function of physical recreation and sport is discussed as well, and so are the possibilities of translating these values into physical characteristics of an urban space. The main conclusions are that taking into account the diverse needs of different social groups, participation in the design and construction process, aesthetic and interesting design, vicinity of the residence, open access for all age groups and the disabled would be the most important spatial determinants of a properly designed, physically activating public space. Strategies of planning the sports and recreation infrastructure should also make sure of their multifunctionality and variability in time to adjust it to the changing needs of the residents.

A 10-Year Longitudinal Study of Effects of a Multifaceted Residency Spiritual Care Curriculum: Clinical Ability, Professional Formation, End of Life, and Culture.

PubMed

Anandarajah, Gowri; Roseman, Janet; Lee, Danny; Dhandhania, Nupur

2016-12-01

Although spiritual care (SC) is recognized as important in whole-person medicine, physicians infrequently address patients' spiritual needs, citing lack of training. Although many SC curricula descriptions exist, few studies report effects on physicians. To broadly examine immediate and long-term effects of a required, longitudinal, residency SC curriculum, which emphasized inclusive patient-centered SC, compassion, and spiritual self-care. We conducted in-depth individual interviews with 26 physicians (13 intervention; 13 comparison) trained at a 13-13-13 residency. We interviewed intervention physicians three times over 10 years-1) preintervention, as PGY1s, 2) postintervention, as PGY3s, 3) eight-year postintervention, as practicing physicians. We interviewed comparison physicians as PGY3s. Interviews were audio-recorded, transcribed, and analyzed by four researchers. Forty-nine interviews were analyzed. General: Both groups were diverse regarding personal importance of spirituality/religion. All physicians endorsed the value of SC, sharing rich patient stories particularly related to end of life and cultural diversity. Curricular effects: 1) skills/barriers-intervention physicians demonstrated progressive improvements in clinical approach, accompanied by diminishing worries related to SC. PGY3 comparison physicians struggled with SC skills and worries more than PGY3 intervention physicians, 2) physician formation-most physicians described residency as profoundly challenging and transformative. Even after eight years, many intervention physicians noted that reflection on their diverse beliefs and values in safety, coupled with compassion shown to them through this curriculum, had deeply positive effects. High impact training: patient-centered spiritual assessment; chaplain rounds; spiritual self-care workshop/retreats; multicultural SC framework. A longitudinal, multifaceted residency SC curriculum can have lasting positive effects on physicians' SC skills and their professional/personal formation. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Participating in a Community of Learners enhances resident perceptions of learning in an e-mentoring program: proof of concept

PubMed Central

2011-01-01

Background Community learning and e-mentoring, learning methods used in higher education, are not used to any extent in residency education. Yet both have the potential to enhance resident learning and, in the case of community learning, introduce residents to basic lifelong learning skills. We set out to determine whether residents participating in an Internet based e-mentoring program would, with appropriate facilitation, form a community of learners (CoL) and hold regular community meetings. We also determined resident and faculty perceptions of CoL and Internet sessions as effective learning experiences. Methods A six-month e-mentoring pilot was offered to 10 Radiology residents in the Aga Khan University Postgraduate Medical Education Program in Nairobi, Kenya (AKUHN) with a Professor of Radiology, located at University of Virginia, USA, acting as the e-mentor. Monthly Internet case-based teaching sessions were facilitated by the e-mentor. In addition, residents were coached by a community facilitator to form CoL and collectively work through clinical cases at weekly face-to-face CoL sessions. Event logs described observed resident activity at CoL sessions; exit survey and interviews were used to elicit perceptions of CoL and Internet sessions as effective learning experiences. Results Resident adoption of CoL behaviors was observed, including self-regulation, peer mentoring and collaborative problem solving. Analysis revealed high resident enthusiasm and value for CoL. Surveys and interviews indicated high levels of acceptance of Internet learning experiences, although there was room for improvement in audio-visual transmission technologies. Faculty indicated there was a need for a larger multi-specialty study. Conclusions The pilot demonstrated resident acceptance of community building and collaborative learning as valued learning experiences, addressing one barrier to its formal adoption in residency education curricula. It also highlighted the potential of e-mentoring as a means of expanding faculty and teaching materials in residency programs in developing countries. PMID:21266070

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.

New perspectives on health professions students' e-learning: Looking through the lens of the "visitor and resident" model.

PubMed

Druce, Maralyn; Howden, Stella

2017-07-01

The growth of e-learning in health professional education reflects expansion of personal use of online resources. Understanding the user perspective in a fast-changing digital world is essential to maintain the currency of our approach. Mixed methods were used to investigate a cohort of postgraduate, e-learning healthcare students' perspectives on their use of online resources for personal and/or professional roles, via questionnaire and student-constructed diagrams, capturing use of online resources (underpinned by White's model of "resident" and "visitor" online engagement). Semistructured interviews explored the use and value of resources afforded via the online environment. The 45 study participants described a range of prior experiences with online resources in personal and professional capacities, but overall students tended to use online "tools" ("visitor" mode) rather than highly collaborative networks ("resident" mode). In relation to e-learning, the dominant interview theme was valuing knowledge transfer from the tutor and using "visitor" behaviors to maximize knowledge acquisition. Peer-learning opportunities were less valued and barriers to collaborative "resident" modes were identified. These findings help to inform e-learning course design to promote engagement. The results enable recommendations for use of the "Visitor and Residents" model and for planning activities that learners might utilize effectively.

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.

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

PubMed

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

2018-04-05

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

Pharmacokinetics of amoxycillin and clavulanic acid in haemodialysis patients following intravenous administration of Augmentin.

PubMed Central

Davies, B E; Boon, R; Horton, R; Reubi, F C; Descoeudres, C E

1988-01-01

1. Serum concentrations of amoxycillin and clavulanic acid were measured in patients with end-stage renal disease (ESRD) following intravenous administration of 1.2 g Augmentin. Augmentin was administered on a non-dialysis day and 2 h prior to a 4 h dialysis session. 2. The mean values of total serum clearance, mean residence time, volume of distribution at steady state, and terminal half-life for amoxycillin on the non-dialysis day were 14.4 ml min-1, 19.2 h, 14.9 l and 13.6 h, respectively. 3. The mean values of dialysis clearance, total serum clearance during dialysis, fractional drug removal during haemodialysis and half-life during dialysis for amoxycillin were 77.1 ml min-1, 91.5 ml min-1, 0.64 and 2.30 h, respectively. 4. The mean values of total serum clearance, mean residence time, volume of distribution at steady state, and terminal half-life for clavulanic acid on the non-dialysis day were 43.6 ml min-1, 4.4 h, 11.0 l and 3.05 h, respectively. 5. The mean values of dialysis clearance, total serum clearance during dialysis, fractional drug removal during haemodialysis and half-life during dialysis for clavulanic acid were 92.8 ml min-1, 136 ml min-1, 0.65 and 1.19 h, respectively. 6. The total serum clearance on the non-dialysis day, which represents non-renal clearance, was lower than that in normal subjects for both amoxycillin and clavulanic acid. These data would suggest some degree of hepatic impairment in patients with ESRD.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3190988

[Study on the neutralization capacity of different types of human measles virus vaccine and the epidemic strains].

PubMed

Feng, Yan; Lu, Yi-yu; Yan, Ju-ying; Jiang, Xiao-hui; Shi, Wen; Xu, Chang-ping; Li, Zhen

2007-11-01

To explore the neutralization capacities of different types of human serum to measles virus epidemic strains and vaccine strain. Neutralization antibody (NT) to Shanghai 191 and measles virus isolates in 2005 were tested using acute and convalescent serum samples from diagnosed measles patients, children serum samples collected before and after vaccination and serum samples of migrant residents, from 3 different regions. Additionally, animal immune serum referring to vaccine strain and 3 epidemic strains were prepared and used to undergo crossing neutralization test with corresponding strains mentioned-above. Antigenic ratios were calculated. GMT value of NT of after-immune serum to vaccine strains was 50.82,1.86 times higher than that to MVi/ZJ/05/7 (GMT was 27.35), whereas GMT value of convalescent serum to MVi/ZJ/05/7 (GMT was 386.95) was obviously higher than that to vaccine strain (GMT was 1:151.83),and GMT value of migrant residents' serum in 3 regions to MVi/ZJ/05/7 were 2.22-4.17 times lower than that to vaccine strain. Meanwhile,the antigenic ratios between MVi/ZJ/ 99/1, MVi/ZJ/04/1, MVi/ZJ/05/7 and vaccine strain were found to be 4.28,5.24 and 5.66 respectively. Additionally,low NT titers to vaccine strain were found in patients' acute sera and GMT value was over 1:4. There were obvious differences on neutralization antibody of different types of serum to measles vaccine strain and epidemic strains which indicating the antigenic diversity of epidemic strains had influenced the protective effectiveness of vaccine antibody to epidemic strains. It was of significance to carry on research projects on the antigenic diversity and effectiveness of measles vaccine.

An assessment of cultural values and resident-centered culture change in U.S. nursing facilities.

PubMed

Banaszak-Holl, Jane; Castle, Nicholas G; Lin, Michael; Spreitzer, Gretchen

2013-01-01

Culture change initiatives propose to improve care by addressing the lack of managerial supports and prevalent stressful work environments in the industry; however, little is known about how culture change facilities differ from facilities in the industry that have not chosen to affiliate with the resident-centered care movements. The aim of this study was to evaluate representation of organizational culture values within a random sample of U.S. nursing home facilities using the competing values framework and to determine whether organizational values are related to membership in resident-centered culture change initiatives. We collected reports of cultural values using a well-established competing values framework instrument in a random survey of facility administrators and directors of nursing within all states. We received responses from 57% of the facilities that were mailed the survey. Directors of nursing and administrators did not differ significantly in their reports of culture and facility measures combined their responses. Nursing facilities favored market-focused cultural values on average, and developmental values, key to innovation, were the least common across all nursing homes. Approximately 17% of the facilities reported that all cultural values were strong within their facilities. Only high developmental cultural values were linked to participation in culture change initiatives. Culture change facilities were not different from non-culture change facilities in the promotion of employee focus as organizational culture, as emphasized in group culture values. Likewise, culture change facilities were also not more likely to have hierarchical or market foci than non-culture change facilities. Our results counter the argument that culture change facilities have a stronger internal employee focus than facilities more generally but do show that culture change facilities report stronger developmental cultures than non-culture change facilities, which indicates a potential to be innovative in their strategies. Facilities are culturally ready to become resident centered and may face other barriers to adopting these practices.

Validity of a smartphone protractor to measure sagittal parameters in adult spinal deformity.

PubMed

Kunkle, William Aaron; Madden, Michael; Potts, Shannon; Fogelson, Jeremy; Hershman, Stuart

2017-10-01

Smartphones have become an integral tool in the daily life of health-care professionals (Franko 2011). Their ease of use and wide availability often make smartphones the first tool surgeons use to perform measurements. This technique has been validated for certain orthopedic pathologies (Shaw 2012; Quek 2014; Milanese 2014; Milani 2014), but never to assess sagittal parameters in adult spinal deformity (ASD). This study was designed to assess the validity, reproducibility, precision, and efficiency of using a smartphone protractor application to measure sagittal parameters commonly measured in ASD assessment and surgical planning. This study aimed to (1) determine the validity of smartphone protractor applications, (2) determine the intra- and interobserver reliability of smartphone protractor applications when used to measure sagittal parameters in ASD, (3) determine the efficiency of using a smartphone protractor application to measure sagittal parameters, and (4) elucidate whether a physician's level of experience impacts the reliability or validity of using a smartphone protractor application to measure sagittal parameters in ASD. An experimental validation study was carried out. Thirty standard 36″ standing lateral radiographs were examined. Three separate measurements were performed using a marker and protractor; then at a separate time point, three separate measurements were performed using a smartphone protractor application for all 30 radiographs. The first 10 radiographs were then re-measured two more times, for a total of three measurements from both the smartphone protractor and marker and protractor. The parameters included lumbar lordosis, pelvic incidence, and pelvic tilt. Three raters performed all measurements-a junior level orthopedic resident, a senior level orthopedic resident, and a fellowship-trained spinal deformity surgeon. All data, including the time to perform the measurements, were recorded, and statistical analysis was performed to determine intra- and interobserver reliability, as well as accuracy, efficiency, and precision. Statistical analysis using the intra- and interclass correlation coefficient was calculated using R (version 3.3.2, 2016) to determine the degree of intra- and interobserver reliability. High rates of intra- and interobserver reliability were observed between the junior resident, senior resident, and attending surgeon when using the smartphone protractor application as demonstrated by high inter- and intra-class correlation coefficients greater than 0.909 and 0.874 respectively. High rates of inter- and intraobserver reliability were also seen between the junior resident, senior resident, and attending surgeon when a marker and protractor were used as demonstrated by high inter- and intra-class correlation coefficients greater than 0.909 and 0.807 respectively. The lumbar lordosis, pelvic incidence, and pelvic tilt values were accurately measured by all three raters, with excellent inter- and intra-class correlation coefficient values. When the first 10 radiographs were re-measured at different time points, a high degree of precision was noted. Measurements performed using the smartphone application were consistently faster than using a marker and protractor-this difference reached statistical significance of p<.05. Adult spinal deformity radiographic parameters can be measured accurately, precisely, reliably, and more efficiently using a smartphone protractor application than with a standard protractor and wax pencil. A high degree of intra- and interobserver reliability was seen between the residents and attending surgeon, indicating measurements made with a smartphone protractor are unaffected by an observer's level of experience. As a result, smartphone protractors may be used when planning ASD surgery. Copyright © 2017 Elsevier Inc. All rights reserved.

Duty Hour Reporting: Conflicting Values in Professionalism.

PubMed

Byrne, John M; Loo, Lawrence K; Giang, Dan W

2015-09-01

Duty hour limits challenge professional values, sometimes forcing residents to choose between patient care and regulatory compliance. This may affect truthfulness in duty hour reporting. We assessed residents' reasons for falsifying duty hour reports. We surveyed residents in 1 sponsoring institution to explore the reasons for noncompliance, frequency of violations, falsification of reports, and the residents' awareness of the option to extend hours to care for a single patient. The analysis used descriptive statistics. Linear regression was used to explore falsification of duty hour reports by year of training. The response rate was 88% (572 of 650). Primary reasons for duty hour violations were number of patients (19%) and individual patient acuity/complexity (19%). Junior residents were significantly more likely to falsify duty hours (R = -0.966). Of 124 residents who acknowledged falsification, 51 (41%) identified the primary reason as concern that the program will be in jeopardy of violating the Accreditation Council for Graduate Medical Education (ACGME) duty hour limits followed by fear of punishment (34, 27%). This accounted for more than two-thirds of the primary reasons for falsification. Residents' falsification of duty hour data appears to be motivated by concerns about adverse actions from the ACGME, and fear they might be punished. To foster professionalism, we recommend that sponsoring institutions educate residents about professionalism in duty hour reporting. The ACGME should also convey the message that duty hour limits be applied in a no-blame systems-based approach, and allow junior residents to extend duty hours for the care of individual patients.

Residents values in a rational decision-making model: an interest in academics in emergency medicine.

PubMed

Burkhardt, John Christian; Smith-Coggins, Rebecca; Santen, Sally

2016-10-01

Academic physicians train the next generation of doctors. It is important to understand the factors that lead residents to choose an academic career to continue to effectively recruit residents who will join the national medical faculty. A decision-making theory-driven, large scale assessment of this process has not been previously undertaken. To examine the factors that predict an Emergency resident's interest in pursuing an academic career at the conclusion of training. This study employs the ABEM Longitudinal Survey (n = 365). A logistic regression model was estimated using an interest in an academic career in residency as the dependent variable. Independent variables include gender, under-represented minority status, survey cohort, number of dependent children, possession of an advanced degree, ongoing research, publications, and the appeal of science, independence, and clinical work in choosing EM. Logistic regression resulted in a statistically significant model (p < 0.001). Residents who chose EM due to the appeal of science, had peer-reviewed publications and ongoing research were more likely to be interested in an academic career at the end of residency (p < 0.05). An increased number of children (p < 0.05) was negatively associated with an interest in academics. Individual resident career interests, research productivity, and lifestyle can help predict an interest in pursuing an academic career. Recruitment and enrichment of residents who have similar values and behaviors should be considered in programs interested in generating more graduates who enter an academic career.

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.

Prognostic value of resident clinical performance ratings.

PubMed

Williams, Reed G; Dunnington, Gary L

2004-10-01

This study investigated the concurrent and predictive validity of end-of-rotation (EOR) clinical performance ratings. Surgeon EOR ratings of residents were collected and compared with end-of-year (EOY) progress decisions and to EOR and EOY confidential judgments of resident ability to provide patient care without direct supervision. Eighty percent to 85% of EOR ratings were Excellent or Very Good. Five percent or fewer were Fair or Poor. Almost all residents receiving Excellent or Very Good EOR ratings also received positive EOR judgments about ability to provide patient care without direct supervision. Residents rated Fair or Poor received negative EOR judgments about ability to provide patient care without direct supervision. As the cumulative percent of Good, Fair, and Poor EOR ratings increased, the number of residents promoted without stipulations at the end of the year decreased and the percentage of faculty members who judged the residents capable of providing effective patient care without direct supervision at the end of the year declined. All residents receiving 40% or more EOR ratings below Very Good had stipulations associated with their promotion. Despite use of descriptive anchors on the scale, clinical performance ratings have no direct meaning. Their meaning needs to be established in the same manner as is done in setting normal values for diagnostic tests, ie, by establishing the relationship between EOR ratings and practice outcomes.

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.

An evaluation of the success of a surgical resident learning portfolio.

PubMed

Webb, Travis P; Merkley, Taylor R

2012-01-01

Learning portfolios have gained modest acceptance in graduate medical education because of challenges related to user satisfaction, time and resource commitment, and quality assessment. In 2001, the Department of Surgery implemented the Surgical Learning and Instructional Portfolio (SLIP) to help residents develop a case-based portfolio demonstrating practice-based learning. In 2008, the format was changed to a Web-based platform with open viewing of portfolios for all learners. This study was performed to evaluate the SLIP program using resident and faculty perspectives in the domains of satisfaction, compliance, and educational value. Likert scale surveys were distributed to residents to assess satisfaction. Using a semistructured format with subsequent qualitative analysis of the meeting transcript, a focus group discussion was held with the SLIP director, SLIP facilitator, and program coordinator. An analysis of the program compliance was performed by review of SLIP entry dates. Finally, the quality of the SLIP entries (n = 420) was analyzed in a blinded manner using a locally developed standardized SLIP assessment tool. Data analysis was performed using Pearson's correlation and Cronbach's alpha. Residents were satisfied with the program and felt the Web-based format promoted self-reflection. They perceived that time spent was appropriate. Residents also believed they gained medical knowledge of their own specific entry topics but did not learn routinely from others' entries. Faculty asserted that the Web-based platform eased the administrative burden but did not necessarily alter the quality of the SLIP entries. Compliance with the assignment was 100%. SLIP entry analysis demonstrated the reflection and understanding of the topics chosen. However, the overall quality assessment of entries was hindered by suboptimal interrater reliability (inter-rater reliability (IR) = 0.636). The SLIP program allows residents to demonstrate practice-based learning and improvement of medical knowledge. The Web-based format provides transparency and ease of administration. Quality assessment of individual portfolio entries remains a challenge to the widespread adoption of portfolios. Copyright © 2012 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Daily variation of radon gas and its short-lived progeny concentration near ground level and estimation of aerosol residence time

NASA Astrophysics Data System (ADS)

M, Mohery; A, M. Abdallah; A, Ali; S, S. Baz

2016-05-01

Atmospheric concentrations of radon (222Rn) gas and its short-lived progenies 218Po, 214Pb, and 214Po were continuously monitored every four hours at the ground level in Jeddah city, Kingdom of Saudi Arabia. The measurements were performed three times every week, starting from November 2014 to October 2015. A method of electrostatic precipitation of positively charged 218Po and 214Po by a positive voltage was applied for determining 222Rn gas concentration. The short-lived 222Rn progeny concentration was determined by using a filter holder connected with the alpha-spectrometric technique. The meteorological parameters (relative air humidity, air temperature, and wind speed) were determined during the measurements of 222Rn and its progeny concentrations. 222Rn gas as well as its short-lived progeny concentration display a daily and seasonal variation with high values in the night and early morning hours as compared to low values at noon and in the afternoon. The observed monthly atmospheric concentrations showed a seasonal trend with the highest values in the autumn/winter season and the lowest values in the spring/summer season. Moreover, and in parallel with alpha-spectrometric measurements, a single filter-holder was used to collect air samples. The deposited activities of 214Pb and the long-lived 222Rn daughter 210Pb on the filter were measured with the gamma spectrometric technique. The measured activity concentrations of 214Pb by both techniques were found to be relatively equal largely. The highest mean seasonally activity concentrations of 210Pb were observed in the autumn/winter season while the lowest mean were observed in the spring/summer season. The mean residence time (MRT) of aerosol particles in the atmospheric air could be estimated from the activity ratios of 210Pb/214Pb. Project supported by the Deanship of Scientific Research (DSR), King Abdulaziz University, Jeddah (Grant No. 291/965/1434).

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

Challenges of interprofessional team training: a qualitative analysis of residents' perceptions.

PubMed

van Schaik, Sandrijn; Plant, Jennifer; O'Brien, Bridget

2015-01-01

Simulation-based interprofessional team training is thought to improve patient care. Participating teams often consist of both experienced providers and trainees, which likely impacts team dynamics, particularly when a resident leads the team. Although similar team composition is found in real-life, debriefing after simulations puts a spotlight on team interactions and in particular on residents in the role of team leader. The goal of the current study was to explore residents' perceptions of simulation-based interprofessional team training. This was a secondary analysis of a study of residents in the pediatric residency training program at the University of California, San Francisco (United States) leading interprofessional teams in simulated resuscitations, followed by facilitated debriefing. Residents participated in individual, semi-structured, audio-recorded interviews within one month of the simulation. The original study aimed to examine residents' self-assessment of leadership skills, and during analysis we encountered numerous comments regarding the interprofessional nature of the simulation training. We therefore performed a secondary analysis of the interview transcripts. We followed an iterative process to create a coding scheme, and used interprofessional learning and practice as sensitizing concepts to extract relevant themes. 16 residents participated in the study. Residents felt that simulated resuscitations were helpful but anxiety provoking, largely due to interprofessional dynamics. They embraced the interprofessional training opportunity and appreciated hearing other healthcare providers' perspectives, but questioned the value of interprofessional debriefing. They identified the need to maintain positive relationships with colleagues in light of the teams' complex hierarchy as a barrier to candid feedback. Pediatric residents in our study appreciated the opportunity to participate in interprofessional team training but were conflicted about the value of feedback and debriefing in this setting. These data indicate that the optimal approach to such interprofessional education activities deserves further study.

The case for case reports.

PubMed

Bhattacharrya, Shamik; Miller, Julie; Ropper, Allan H

2014-10-01

Case reports have seemingly fallen upon hard times. Once esteemed by William Osler and C. Miller Fisher, these reports are now considered anachronistic. Nonetheless, case reports remain valuable and formed the largest proportion of publications written last year by residents in our training program (the Partners Neurology Residency). Although they are easy to produce, it is reasonable to ask if these modern exercises are of equal significance to the narratives of migraine by John Graham in the 1950s or descriptions of Parkinson disease by James Parkinson in 1817. Even a brief reading of currently published case reports raises doubts about the value of many of them but also emphasizes their utility. We argue here that the case report format remains of considerable merit, especially to the aspiring academic clinician. © 2014 American Neurological Association.

Characterization of coffee (Coffea arabica) husk lignin and degradation products obtained after oxygen and alkali addition

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

de Carvalho Oliveira, Fernanda; Srinivas, Keerthi; Helms, Gregory L.

The full use of biomass in future biorefineries has stimulated studies on utilization of lignin from agricultural crops, such as coffee husk, a major residue from coffee processing. This study focuses on characterizing the lignin obtained from coffee husk and its further wet oxidation products as a function of alkali loading, temperature and residence time. The lignin fraction after diluted acid and alkali pretreatments is composed primarily of p-hydroxylphenyl units (≥ 49%), with fewer guaiacyl and syringyl units. Linkages appear to be mainly β-O-4 ether linkages. Thermal degradation of pretreated lignin occurred in two stages. Carboxylic acids were the mainmore » degradation product. Due to the condensed structure of this lignin, relatively low yields of aromatic aldehydes were achieved, except from conditions with temperatures over 210 °C, 5 min residence time and 11.7wt% NaOH. Optimization of the pretreatment and oxidation parameters are important to maximizing yield of higher-value bioproducts from lignin.« less

System Validation Experiments for Obtaining Tracer Laser-Induced Fluorescence Data at Elevated Pressure and Temperature.

PubMed

Hartwig, Jason; Mittal, Gaurav; Kumar, Kamal; Sung, Chih-Jen

2018-04-01

This paper presents a set of system validation experiments that can be used to qualify either static or flow experimental systems for gathering tracer photophysical data or conducting laser diagnostics at high pressure and temperature in order to establish design and operation limits and reduce uncertainty in data interpretation. Tests demonstrated here quantify the effect of tracer absorption at the test cell walls, stratification, photolysis, pyrolysis, adequacy of mixing and seeding, and reabsorption of laser light using acetone as the tracer and 282 nm excitation. Results show that acetone exhibits a 10% decrease in fluorescence signal over 36 000 shots at 127.4 mJ/cm 2 , and photolysis is negligible below 1000 shots collected. Meanwhile, appropriately chosen gas residence times can mitigate risks due to pyrolysis and inadequate mixing and seeding; for the current work 100 ms residence time ensured <0.5% alteration of tracer number density due to thermal destruction. Experimental results here are compared to theoretical values from the literature.

NPITxt, a 21st-Century Reporting System: Engaging Residents in a Lean-Inspired Process.

PubMed

Raja, Pushpa V; Davis, Michael C; Bales, Alicia; Afsarmanesh, Nasim

2015-05-01

Operational waste, or workflow processes that do not add value, is a frustrating but nonetheless largely tolerated barrier to efficiency and morale for medical trainees. In this article, the authors tested a novel reporting system using several submission formats (text messaging, e-mail, Web form, mobile application) to allow residents to report various types of operational waste in real time. This system informally promoted "lean" principles of waste identification and continuous improvement. In all, 154 issues were submitted between March 30, 2011, and June 30, 2012, and categorized as closely as possible into lean categories of operational waste; 131 issues were completely addressed with the requested outcome partially or fully implemented or with successful clarification of existing policies. A real-time, voluntary reporting system can effectively capture trainee observations of waste in health care and training processes, give trainees a voice in a hierarchical system, and lead to meaningful operations improvement. © 2014 by the American College of Medical Quality.

[Evaluation of resource exploitation value and ecosystem service loss in Mentougou District of Beijing City].

PubMed

Liu, Xu-Sheng; Li, Feng; Zhao, Dan; Wang, Bei-Bei

2009-06-01

By using the evaluation approach of ecosystem services (including market value, opportunity cost, restoration cost, and shadow project approaches), and combining with situation investigation, the ecosystem service loss in Mentougou District of Beijing City caused by coal resource exploitation in 1949-2006 was systematically evaluated. In the study area, coal mining mainly induced the cost increase of solid waste disposal and sink reclamation, and the losses in food production, water self-preserving, residents moving, and water and soil resources. The ecosystem service loss caused by the coal mining in 1949-2006 was about 54.3 billion Yuan RMB, approximately 9 times high of its market economic benefit (5.9 billion Yuan RMB). It was very difficult or needed a long time to restore the damaged ecosystem.

Psychiatry and emergency medicine: medical student and physician attitudes toward homeless persons.

PubMed

Morrison, Ann; Roman, Brenda; Borges, Nicole

2012-05-01

The purpose of the study was to explore changes in medical students' attitudes toward homeless persons during the Psychiatry and Emergency Medicine clerkships. Simultaneously, this study explored attitudes toward homeless persons held by Psychiatry and Emergency Medicine residents and faculty in an attempt to uncover the "hidden curriculum" in medical education, in which values are communicated from teacher to student outside of the formal instruction. A group of 79 students on Psychiatry and 66 on Emergency Medicine clerkships were surveyed at the beginning and end of their rotation regarding their attitudes toward homeless persons by use of the Health Professionals' Attitudes Toward the Homeless Inventory (HPATHI). The HPATHI was also administered to 31 Psychiatry residents and faculty and 41 Emergency Medicine residents and faculty one time during the course of this study. For Psychiatry clerks, t-tests showed significant differences pre- and post-clerkship experiences on 2 of the 23 items on the HPATHI. No statistically significant differences were noted for the Emergency Medicine students. An analysis of variance revealed statistically significant differences on 7 out of the 23 survey questions for residents and faculty in Psychiatry, as compared with those in Emergency Medicine. Results suggest that medical students showed small differences in their attitudes toward homeless people following clerkships in Psychiatry but not in Emergency Medicine. Regarding resident and faculty results, significant differences between specialties were noted, with Psychiatry residents and faculty exhibiting more favorable attitudes toward homeless persons than residents and faculty in Emergency Medicine. Given that medical student competencies should be addressing the broader social issues of homelessness, medical schools need to first understand the attitudes of medical students to such issues, and then develop curricula to overcome inaccurate or stigmatizing beliefs.

A year in transition: a qualitative study examining the trajectory of first year residents’ well-being

PubMed Central

2013-01-01

Background It is generally understood that trainees experience periods of heightened stress during first year residency, yet there is little information on variations in stress and well-being over the transition period or those factors that contribute to these variations. This qualitative study explored the trajectory of well-being described by first year residents in the context of challenges, supports and adaptations over time. Methods In-depth interviews were conducted face-to-face with 17 first year residents at the University of Toronto. Participants drew a graph of their well-being over the course of their first year and described critical periods of challenge and adaptation. Interviews were audio-taped and transcribed. Results were organized into a thematic analysis using NVivo software. Results Residents described a pattern of well-being that varied in accordance with changes in rotations. Well-being increased when residents perceived high levels of team support, felt competent and experienced valued learning opportunities. Well-being decreased with low team support, heavy work demands, few learning opportunities and poor orientations. Anxiety and excitement in the beginning of the year gave way to heightened confidence but increased fatigue and apathy towards the year’s end. Residents used a number of cognitive, behavioural and self-care strategies to cope with transitional challenges. Conclusions Residents experienced a pattern of highly fluctuating well-being that coincided with changes in rotations. Residents’ well-being varied according to levels of supervisor and colleague support, learning opportunities, and work demands. Residents’ well-being may be improved by program interventions that facilitate better team and supervisory supports, maintain optimal service to learning ratios, establish effective fatigue and risk management systems, offer wellness support services and integrate skills based resiliency training into the curriculum. PMID:23842470

A Study of the Role of Small Ethnic Retail Grocery Stores in Urban Renewal in a Social Housing Project, Toronto, Canada.

PubMed

Komakech, Morris D C; Jackson, Suzanne F

2016-06-01

Urban renewal often drives away the original residents, replacing them with higher income residents who can afford the new spaces, leading to gentrification. Urban renewal that takes place over many years can create uncertainties for retailers and residents, exacerbating the gentrification process. This qualitative study explored how the urban renewal process in a multi-cultural social housing neighborhood in Toronto (Regent Park) affected the small ethnic retail grocery stores (SERGS) that supplied ethnic foods and items to the ethnic populations living there. Interviews were conducted with ten SERGS store owners/managers and 16 ethnic residents who lived in Regent Park before renewal and were displaced, or who were displaced and returned. The SERGS stated that they provided culturally familiar items and offered a social credit scheme that recognized existing social relationships and allowed low-income residents to afford food and other amenities in a dignified manner and pay later, without penalty or interest. At the same time, the SERGS were unsupported during the renewal, were excluded from the civic planning processes, could not compete for space in the new buildings, and experienced declining sales and loss of business. The residents stated that the SERGS were trusted, provided a valued cultural social spaces for ethnic identity formation, and ethnic food security but they faced many uncertainties about the role of SERGS in a renewed neighborhood. Based on this study, it is recommended that ethnic retailers be recognized for the role they play in formulating ethnic identities and food security in mixed-use mixed-income communities and that they be included in planning processes during urban renewal. Such recognition may enable more former residents to return and lessen the gentrification.

Accreditation Council for Graduate Medical Education Core Competencies at a Community Teaching Hospital: Is There a Gap in Awareness?

PubMed Central

Al-Temimi, Mohammed; Kidon, Michael; Johna, Samir

2016-01-01

Context Reports evaluating faculty knowledge of the Accreditation Council for Graduate Medical Education (ACGME) core competencies in community hospitals without a dedicated residency program are uncommon. Objective Faculty evaluation regarding knowledge of ACGME core competencies before a residency program is started. Design Physicians at the Kaiser Permanente Fontana Medical Center (N = 480) were surveyed for their knowledge of ACGME core competencies before starting new residency programs. Main Outcome Measures Knowledge of ACGME core competencies. Results Fifty percent of physicians responded to the survey, and 172 (71%) of respondents were involved in teaching residents. Of physicians who taught residents and had complete responses (N = 164), 65 (39.7%) were unsure of their knowledge of the core competencies. However, most stated that they provided direct teaching to residents related to the knowledge, skills, and attitudes stated in each of the 6 competencies as follows: medical knowledge (96.3%), patient care (95.7%), professionalism (90.7%), interpersonal and communication skills (86.3%), practice-based learning (85.9%), and system-based practice (79.6%). Physician specialty, years in practice (1–10 vs > 10), and number of rotations taught per year (1–6 vs 7–12) were not associated with knowledge of the competencies (p > 0.05); however, full-time faculty (teaching 10–12 rotations per year) were more likely to provide competency-based teaching. Conclusion Objective assessment of faculty awareness of ACGME core competencies is essential when starting a residency program. Discrepancy between knowledge of the competencies and acclaimed provision of competency-based teaching emphasizes the need for standardized teaching methods that incorporate the values of these competencies. PMID:27768565

Assessing the cost of a cardiology residency program with a cost construction model.

PubMed

Franzini, L; Chen, S C; McGhie, A I; Low, M D

1999-09-01

Although the total costs of graduate medical education are difficult to quantify, this information is of great importance in planning over the next decade. A cost construction model was used to quantify the costs of teaching faculty, cardiology fellows' salaries and benefits, overhead (physical plant, equipment, and support staff), and other costs associated with the cardiology residency program at the University of Texas-Houston during the 1996 to 1997 academic year. Surveys of cardiology faculty and fellows, checked by the program director, were conducted to determine the time spent in teaching activities; access to institutional and departmental financial records was obtained to quantify associated costs. The model was then developed and examined for a range of assumptions concerning cardiology fellows' productivity, replacement costs, and the cost allocation of activities jointly producing clinical care and education. The instructional cost of training (cost of didactic, direct clinical supervision, preparation for teaching, and teaching-related administration, plus the support of the teaching program) was estimated at $73,939 per cardiology fellow per year. This cost was less than the estimated replacement value of the teaching and clinical services provided by cardiology fellows, $100,937 per cardiology fellow per year. Sensitivity analysis, with different assumptions on cardiology fellows' productivity and replacement costs, varied the cost estimates but generally represented the cardiology residency program as an asset. Cost construction models can be used as a tool to estimate variations in resource requirements resulting from changes in curriculum or educators' costs. In this residency, the value of the teaching and clinical services provided by cardiology fellows exceeded the cost of the resources used in the educational program.

The public mock oral: a useful tool for examinees and the audience in preparation for the American Board of Surgery Certifying Examination.

PubMed

Aboulian, Armen; Schwartz, Samuel; Kaji, Amy H; de Virgilio, Christian

2010-01-01

The objective of the study was to investigate the value of an educational program instituted in our general surgery residency training in preparation for the American Board of Surgery (ABS) Certifying Examination (CE). From 2006 to 2009, a series of public mock oral examinations were administered by the program director to PGY residents 4 through 6 on a variety of surgery topics in front of all residents, faculty, and medical students. Anonymous surveys (5-point Likert scale) were collected from both the examinees and the audience to determine the perceived utility of the mock oral. Performance on the ABS CE for residents who partook in the program was compared with the five previous years. The study was undertaken at Harbor-University of California at Los Angeles (UCLA) Medical Center, a level I trauma center in Los Angeles County. Overall 201 surveys were collected, 170 from the audience and 31 from examinees. The surveys demonstrated a high and equal level of satisfaction for both examinees (4.8) and the audience (4.6, p = 0.12). First-time pass rates on the ABS CE increased from 88% (38/43) before the public mock oral to 100% (19/19) after the mock oral (p = 0.3). The mock oral examination, which is conducted in a conference format in front of an audience of faculty and trainees, is a valuable educational tool as it helps both the examinee and the audience in preparation for the ABS CE. In addition, it has an educational value for those who are not preparing for the CE as it is perceived to expand surgical knowledge. Copyright 2010 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

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.

Interactive value-based curriculum: a pilot study.

PubMed

Bowman Peterson, Jill M; Duffy, Briar; Duran, Alisa; Gladding, Sophia P

2018-03-06

Current health care costs are unsustainable, with a large percentage of waste attributed to doctor practices. Medical educators are developing curricula to address value-based care (VBC) in education. There is, however, a paucity of curricula and assessments addressing levels higher than 'knows' at the base of Miller's pyramid of assessment. Our objective was to: (1) teach residents the principles of VBC using active learning strategies; and (2) develop and pilot a tool to assess residents' ability to apply principles of VBC at the higher level of 'knows how' on Miller's pyramid. Residents in medicine, medicine-paediatrics and medicine-dermatology participated in a 5-week VBC morning report curriculum using active learning techniques. Early sessions targeted knowledge and later sessions emphasised the application of VBC principles. Medical educators are developing curricula to address value-based care in education RESULTS: Thirty residents attended at least one session and completed both pre- and post-intervention tests, using a newly developed case-based assessment tool featuring a 'waste score' balanced with 'standard of care'. Residents, on average, reduced their waste score from pre-intervention to post-intervention [mean 8.8 (SD 6.3) versus mean 4.7 (SD 4.6), p = 0.001]. For those who reduced their waste score, most maintained or improved their standard of care. Our results suggest that residents may be able to decrease health care waste, with the majority maintaining or improving their management of care in a case-based assessment after participation in the curriculum. We are working to further incorporate VBC principles into more morning reports, and to develop further interventions and assessments to evaluate our residents at higher levels on Miller's pyramid of assessment. © 2018 John Wiley & Sons Ltd and The Association for the Study of Medical Education.

Advanced Cardiac Life Support Training by Problem-Based Method: Effect on the Trainee's Skills, Knowledge and Evaluation of Trainers.

PubMed

Hosseini, Seyed Kianoosh; Ghalamkari, Marziyeh; Yousefshahi, Fardin; Mireskandari, Seyed Mohammad; Rezaei Hamami, Mohsen

2013-10-28

Cardiopulmonary-cerebral resuscitation (CPCR) training is essential for all hospital workers, especially junior residents who might become the manager of the resuscitation team. In our center, the traditional CPCR knowledge training curriculum for junior residents up to 5 years ago was lecture-based and had some faults. This study aimed to evaluate the effect of a problem-based method on residents' CPCR knowledge and skills as well as their evaluation of their CPCR trainers. This study, conducted at Tehran University of Medical Sciences, included 290 first-year residents in 2009-2010 - who were trained via a problem-based method (the problem-based group) - and 160 first-year residents in 2003-2004 - who were trained via a lecture-based method (the lecture-based group). Other educational techniques and facilities were similar. The participants self-evaluated their own CPCR knowledge and skills pre and post workshop and also assessed their trainers' efficacy post workshop by completing special questionnaires. The problem-based group, trained via the problem-based method, had higher self-assessment scores of CPCR knowledge and skills post workshop: the difference as regards the mean scores between the problem-based and lecture-based groups was 32.36 ± 19.23 vs. 22.33 ± 20.35 for knowledge (p value = 0.003) and 10.13 ± 7.17 vs. 8.19 ± 8.45 for skills (p value = 0.043). The residents' evaluation of their trainers was similar between the two study groups (p value = 0.193), with the mean scores being 15.90 ± 2.59 and 15.46 ± 2.90 in the problem-based and lecture-based groups - respectively. The problem-based method increased our residents' self-evaluation score of their own CPCR knowledge and skills.

Use of Munsell color charts to measure skin tone objectively in nursing home residents at risk for pressure ulcer development.

PubMed

McCreath, Heather E; Bates-Jensen, Barbara M; Nakagami, Gojiro; Patlan, Anabel; Booth, Howard; Connolly, Dana; Truong, Cyndi; Woldai, Agazi

2016-09-01

To assess the feasibility of classifying skin tone using Munsell color chart values and to compare Munsell-based skin tone categories to ethnicity/race to predict pressure ulcer risk. Pressure ulcer classification uses level of visible tissue damage, including skin discoloration over bony prominences. Prevention begins with early detection of damage. Skin discoloration in those with dark skin tones can be difficult to observe, hindering early detection. Observational cohort of 417 nursing home residents from 19 nursing homes collected between 2009-2014, with weekly skin assessments for up to 16 weeks. Assessment included forearm and buttocks skin tone based on Munsell values (Dark, Medium, Light) at three time points, ethnicity/race medical record documentation, and weekly skin assessment on trunk and heels. Inter-rater reliability was high for forearm and buttock values and skin tone. Mean Munsell buttocks values differed significantly by ethnicity/race. Across ethnicity/race, Munsell value ranges overlapped, with the greatest range among African Americans. Trunk pressure ulcer incidence varied by skin tone, regardless of ethnicity/race. In multinomial regression, skin tone was more predictive of skin damage than ethnicity/race for trunk locations but ethnicity/race was more predictive for heels. Given the overlap of Munsell values across ethnicity/race, color charts provide more objective measurement of skin tone than demographic categories. An objective measure of skin tone can improve pressure ulcer risk assessment among patients for whom current clinical guidelines are less effective. © 2016 John Wiley & Sons Ltd.

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.

[Epidemiology of Minamata Disease--Focus on the Clinical Features Related to the 1977 Diagnostic Criteria].

PubMed

Futatsuka, Makoto

2015-01-01

Large-scale food poisoning caused by methylmercury was identified in Minamata, Japan, in the 1950s (Minamata Disease). Although the diagnostic criteria for the disease was controversial and difficult during that time, we, the Kumamoto University Study Group, carried out a large-scale study to assess the clinical features in 1972-1973. The author tried to reassess the results of that study to appraise the diagnostic criteria established in 1977 on the basis of those results. A substantial number of residents in the exposed area exhibited neurologic signs, especially paresthesia of only the extremities, namely, the male residents of Minamata City showed a positive predictive value of 0.73 and a negative predictive value of 0.23. The relative risks of paresthesia only were 2.6 (2.0-3.3) and 1.2 (0.9-1.5), in Minamata and Goshonoura related to Ariake (control), respectively. At least until 1977, the diagnostic criteria remained valid, although it was inadequate. Nevertheless, presently, a follow-up study of the certified patients may lead to the development of efficient new diagnostic criteria.

Relations between hydrology, water quality, and taste-and-odor causing organisms and compounds in Lake Houston, Texas, April 2006-September 2008

USGS Publications Warehouse

Beussink, Amy M.; Graham, Jennifer L.

2011-01-01

Lake Houston is a surface-water-supply reservoir and an important recreational resource for the city of Houston, Texas. Growing concerns over water quality in Lake Houston prompted a detailed assessment of water quality in the reservoir. The assessment focused on water-quality constituents that affect the aesthetic quality of drinking water. The hydrologic and water-quality conditions influencing the occurrence of taste-and-odor causing organisms and compounds in Lake Houston were assessed using discrete and continuously monitored water-quality data collected during April 2006– September 2008. The hydrology of Lake Houston is characterized by rapidly changing conditions. During inflow events, water residence time can change by orders of magnitude within a matter of hours. Likewise, the reservoir can stratify and destratify over a period of several hours, even during non-summer and at relatively short water residence times, given extended periods with warm temperatures and little wind. The rapidly changing hydrology likely influences all other aspects of water quality in Lake Houston, including the occurrence of taste-and-odor causing organisms and compounds. Water quality in Lake Houston varied with respect to season and water residence time but typically was indicative of turbid, eutrophic to hypereutrophic conditions. In general, turbidity and nutrient concentrations were largest during non-summer (October–May) and when water residence times were relatively short (less than 100 days), which reflects the influence of inflow events on water-quality conditions. Large inflow events can cause substantial changes in water-quality conditions over relatively short periods of time (hours). The taste-and-odor causing organisms cyanobacteria and actinomycetes bacteria were always present in Lake Houston. Cyanobacterial biovolume was largest during summer (June– September) and when water residence time was greater than 100 days. Annual maxima in cyanobacterial biovolume occurred during July-September of each year, when temperatures were larger than 27 degrees Celsius and water residence times were longer than 400 days. In contrast, actinomycetes bacteria were most abundant during non-summer and when water residence times were less than 100 days, reflecting the close association between these organisms and transport of suspended sediments. Geosmin and 2-methylisoborneol are the taste-and-odor causing compounds most commonly produced by cyanobacteria and actinomycetes bacteria. Geosmin was detected more frequently (62 percent of samples) than 2-methylisoborneol (29 percent of samples) in Lake Houston. Geosmin exceeded the human detection threshold (10 nanograms per liter) only once during the study period and 2-methylisoborneol exceeded the human detection threshold twice. Manganese is a naturally occurring trace element that can occasionally cause taste-andodor problems in drinking water. Manganese concentrations exceeded the human detection threshold (about 50 micrograms per liter) in about 50 percent of samples collected near the surface and 84 percent of samples collected near the bottom. The cyanotoxin microcystin was detected relatively infrequently (16 percent of samples) and at small concentrations (less than or equal to 0.2 micrograms per liter). The abundance of the taste-and-odor causing organisms cyanobacteria and actinomycetes bacteria in Lake Houston was coupled with inflow events and subsequent changes in water-quality conditions. Cyanobacterial biovolume (biomass) in Lake Houston was largest during warm periods with little inflow and relatively small turbidity values. In contrast, actinomycetes bacteria were most abundant following inflow events when turbidity was relatively large. Severe taste-and-odor problems were not observed during the study period, precluding quantification of the hydrologic and water-quality conditions associated with large concentrations of taste-and-odor causing compounds and development of predictive models. Reservoir inflow (water residence time) and turbidity, variables related to the abundance of potential taste-andodor causing organisms, are currently (2011) continuously measured in Lake Houston, and predictive models could be developed in the future when the hydrologic and water-quality conditions associated with taste-and-odor problems have been better quantified. Seasonal and water residence time influences on water-quality conditions altered relations between hydrologic and water-quality conditions and taste-and-odor causing organisms and compounds. Future data collection and development of predictive models need to account for the variability associated with season and water residence time. 

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.

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.

Vital correspondence: Exploring tactile experience with resident-focused mandalas in long-term care (Innovative practice).

PubMed

Graham, Megan E; Fabricius, Andréa

2018-01-01

The materiality of long-term care and its relationship to a resident's identity is often overlooked. In response to the call for more attention to the meaningful aspects of doing art, the tactile experience of residents with dementia is considered in the context of a mandala project at a Canadian seniors' long-term care facility. The significance of making mandalas for residents is explored through three key themes: identity integration through gesture, the importance of artistic discernment and decision-making, and the value of corresponding with recalcitrant materials. Residents' experiences are analysed through a phenomenological lens.

AN ASSESSMENT OF CULTURAL VALUES AND RESIDENT-CENTERED CULTURE CHANGE IN US NURSING FACILITIES

PubMed Central

Banaszak-Holl, Jane; Castle, Nicholas G.; Lin, Michael; Spreitzer, Gretchen

2012-01-01

Background Culture Change initiatives propose to improve care by addressing the lack of managerial supports and prevalent stressful work environments in the industry; however, little is known about how Culture Change facilities differ from facilities in the industry that have not chosen to affiliate with the resident-centered care movements. Purpose To evaluate representation of organizational culture values within a random sample of U.S. nursing home facilities using the Competing Values Framework (CVF) and to determine whether organizational values are related to membership in resident-centered Culture Change initiatives. Design and Methods We collected reports of cultural values using a well-established CVF instrument in a random survey of facility administrators and directors of nursing within all states. We received responses from 57% of the facilities that were mailed the survey. Directors of nursing and administrators did not vary significantly in their reports of culture and facility measures combine their responses. Findings Nursing facilities favored market-focused cultural values on average and developmental values, key to innovation, were the least common across all nursing homes. Approximately 17% of facilities reported all cultural values were strong within their facilities. Only high developmental cultural values were linked to participation in culture change initiatives. Culture Change facilities were not different from non-Culture Change facilities in the promotion of employee focus as organizational culture, as is emphasized in group culture values. Likewise, Culture Change facilities were also not any more likely to have hierarchical or market foci than non-Culture Change facilities. Practice Implications Our results counter the argument that Culture Change facilities have a stronger internal employee focus than facilities more generally but does show that Culture Change facilities report stronger developmental cultures than non-Culture Change facilities, which indicates a potential to be innovative in their strategies. Facilities are culturally ready to become resident-centered and may face other barriers to adopting these practices. PMID:22936002

Resident performance on the in-training and board examinations in obstetrics and gynecology: implications for the ACGME Outcome Project.

PubMed

Withiam-Leitch, Matthew; Olawaiye, Alexander

2008-01-01

The Accreditation Council on Graduate Medical Education (ACGME) Outcomes Project has endorsed the in-training examination (ITE) as an example of a multiple-choice question examination that is a valid measure of a resident's attainment of medical knowledge. An outcome measure for performance on the ITE would be the subsequent performance on the board certification examination. However, there are few reports that attempt to correlate a resident's performance on the ITE to subsequent performance on the board certification examination. The Council on Resident Education in Obstetrics and Gynecology (CREOG) has administered the ITE annually since 1970. This study tested the hypothesis that the CREOG-ITE score is a valid assessment tool to predict performance on the American Board of Obstetrics and Gynecology (ABOG) written examination. CREOG-ITE and ABOG written board examination results were collected for 69 resident graduates between the years 1998 and 2005. Logistic regression and receiver operating characteristic analyses were used to estimate the relationship between a resident's score on the CREOG-ITE and subsequent performance on the ABOG written examination. Fifty-seven resident graduates passed (82.6%) and 12 graduates failed (17.4%) the ABOG written examination. The correlation between the CREOG-ITE overall score and performance on the ABOG examination was weak (correlation coefficient =.38, p =.001). Receiver operating characteristic analysis for the CREOG-ITE overall scores and the probability of passing or failing the ABOG examination revealed moderate accuracy (area under the curve = 0.77, 95% CI = 0.62-0.92) with a CREOG-ITE score of 187.5 yielding the best trade-off between specificity (0.79) and sensitivity (0.75). At the cutoff value of 187.5 there was a weak positive predictive value of 43% (i.e., 43% of residents with a score less than 187.5 will fail the ABOG exam) and a strong negative predictive value of 94% (i.e., 94% of the residents with a score above 187.5 will pass the ABOG exam). Logistic regression analysis also revealed a statistically significant relationship between the CREOG-ITE overall score and performance on the ABOG written examination (p = .003). Similar to other specialties, resident performance on the CREOG-ITE is a weak assessment tool to predict the probability of a resident failing the ABOG written examination. Our study highlights the need, in the spirit of the ACGME Outcome Project, for residency and board specialty organizations to coordinate efforts to develop more reliable and correlative measures of a resident's medical knowledge and ability to pass the boards.

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.

A Proposed Alternative Measure for Climate Change Potential

NASA Astrophysics Data System (ADS)

DeGroff, F. A.

2015-12-01

Background/Issue There currently exists no comprehensive metric to measure and value anthropogenic changes in carbon flux between geospheric carbon sinks. We propose that changes in carbon residence time within geospheres be used as a metric to assess anthropogenic changes in carbon flux, and the term 'carbon quality' (cq) be used to describe such changes. Carbon residence time represents the inverse of carbon flux; as carbon flux increases, the corresponding cq will decrease, and vice versa. Focusing on atmospheric carbon emissions as a measure of anthropogenic activity on the environment ignores the fungible characteristics of carbon that are crucial in both the biosphere and the worldwide economy. The ubiquitous carbon molecule enables the enormous diversity in the biosphere, as well as the widespread, strategic economic presence of carbon in the world economy. Focusing on a single form of inorganic carbon as a proxy metric for the plethora of anthropogenic activity and carbon compounds will prove inadequate, convoluted, and unmanageable. A broader, more basic metric is needed to capture the breath and scope of carbon activity. Results/Conclusions We propose a logarithmic vector scale for cq to measure anthropogenic carbon flux. The distance between vector points, e.g. the starting and ending residence times, would represent the change in cq. A base-10 logarithmic scale would allow the addition and subtraction of exponents to calculate changes in cq. As carbon moves between carbon reservoirs, the change in cq is measured as: cq = b ( log10 [mean carbon residence time] ) where b represents the carbon price coefficient for a particular country. For any country, cq measures the climate change potential for any organic carbon when converted to inorganic CO2, or to any lower residence time carbon state. The greater the carbon fees for a country, the larger the b coefficient would be, and the greater the import fees would be to achieve carbon parity on imports from countries with lower carbon fees. By assessing embodied carbon within imports for carbon parity with domestic production, cq would eliminate the incentives to use spatial shifts in carbon emissions to avoid carbon fees. Similarity, cq would temper the incentives to use temporal displacement of carbon emissions, such as with biomass or CCS, to reduce carbon fees.

Resident guide to advocacy in dermatology.

PubMed

Park, Kelly K

2015-12-01

Many opportunities exist for residents to get involved in advocacy in dermatology, from national to grassroots levels. Residents also should be aware of opportunities to get involved in patient advocacy and become familiar with the myriad of patient advocacy groups that exist. These groups offer support and education for patients and initiate research efforts for specific dermatologic conditions that provide support for patients beyond what can be offered during a standard office visit. The value of resident involvement in advocacy also is discussed.

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.

Implications of soil mixing for NAPL source zone remediation: Column studies and modeling of field-scale systems

NASA Astrophysics Data System (ADS)

Olson, Mitchell R.; Sale, Tom C.

2015-06-01

Soil remediation is often inhibited by subsurface heterogeneity, which constrains contaminant/reagent contact. Use of soil mixing techniques for reagent delivery provides a means to overcome contaminant/reagent contact limitations. Furthermore, soil mixing reduces the permeability of treated soils, thus extending the time for reactions to proceed. This paper describes research conducted to evaluate implications of soil mixing on remediation of non-aqueous phase liquid (NAPL) source zones. The research consisted of column studies and subsequent modeling of field-scale systems. For column studies, clean influent water was flushed through columns containing homogenized soils, granular zero valent iron (ZVI), and trichloroethene (TCE) NAPL. Within the columns, NAPL depletion occurred due to dissolution, followed by either column-effluent discharge or ZVI-mediated degradation. Complete removal of TCE NAPL from the columns occurred in 6-8 pore volumes of flow. However, most of the TCE (> 96%) was discharged in the column effluent; less than 4% of TCE was degraded. The low fraction of TCE degraded is attributed to the short hydraulic residence time (< 4 days) in the columns. Subsequently, modeling was conducted to scale up column results. By scaling up to field-relevant system sizes (> 10 m) and reducing permeability by one-or-more orders of magnitude, the residence time could be greatly extended, potentially for periods of years to decades. Model output indicates that the fraction of TCE degraded can be increased to > 99.9%, given typical post-mixing soil permeability values. These results suggest that remediation performance can be greatly enhanced by combining contaminant degradation with an extended residence time.

Distribution of marine boundary layer ammonia over the Atlantic and Indian Oceans during the Aerosols99 cruise

NASA Astrophysics Data System (ADS)

Norman, Michael; Leck, Caroline

2005-08-01

Over the Atlantic Ocean and southern Indian Ocean an overall large variation in gas phase ammonia was encountered with peak values occurring in regions heavily influenced by the smoke plume from biomass combustion and continental sources on the African continent. Concentrations were typically in the range 7 to 22 nmol m-3. Over the remote clean South Atlantic and Indian Oceans, median gas phase ammonia concentrations ranged between 1.1 and 3.2 nmol m-3, but were occasionally as high as 8.1 nmol m-3 or as low as 0.3 nmol m-3. It was reasonable to assume that the ocean was a net emitter of ammonia to the atmosphere and thus responsible for the ammonia levels measured. An average residence time of the order of a few hours was estimated. One implication of such a rapid removal of ammonia is that it prevented attainment of equilibrium between the gas phase and particulate phase ammonium. In areas under the influence of African biomass burning or dust, however, the particulate phase ammonium was concluded to be in equilibrium with the gas phase ammonia. The removal of atmospheric ammonia during the time of travel from the African continent to the position of the ship was estimated using a simplified Lagrangian approach. A response or residence time of 20 to 130 hours resulted. Thus, in order to explain the observed atmospheric ammonia levels at the ship, it seemed necessary to allow for an ammonia residence time of the order of several days within the plume which differs widely from previous reported estimates.

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

Predictors of performance in an ophthalmology residency program.

PubMed

Alfawaz, Abdullah M; Al-Dahmash, Saad A

2016-06-01

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

Age at first reproduction and economic change in the context of differing kinship ecologies.

PubMed

Leonetti, Donna L; Nath, Dilip C

2009-01-01

Kinship systems which tend to be based on ecologies of subsistence also assign differential power, privilege, and control to human connections that present pathways for manipulation of resource access and transfer. They can be used in this way to channel resource concentrations in women and hence their reproductive value. Thus, strategic female life course trade-offs and their timing are likely to be responsive to changing preferences for qualities in women as economic conditions change. Female life histories are studied in two ethnic groups with differing kinship systems in NE India where the competitive market economy is now being felt by most households. Patrilineal Bengali (599 women) practice patrilocal residence with village exogamy and matrilineal Khasi (656 women) follow matrilocal residence with village endogamy, both also normatively preferring three-generation extended households. These households have helpful senior women and significantly greater income. Age at first reproduction (AFR), achieved adult growth (height) and educational level (greater than 6 years or less) are examined in reproductive women, ages 16-50. In both groups, women residing normatively are older at AFR and taller than women residing nonnormatively. More education is also associated with senior women. Thus, normative residence may place a woman in the best reproductive location, and those with higher reproductive and productive potential are often chosen as households face competitive market conditions. In both groups residing in favorable reproductive locations is associated with a faster pace of fertility among women, as well as lower offspring mortality among Khasi, to compensate for a later start. 2009 Wiley-Liss, Inc.

Critique of the transitional year internship and its relationship to radiology residency.

PubMed

Baker, Stephen R; Tilak, Gauri S; Thakur, Uma

2008-05-01

The purpose of the study is to determine if transitional year program (TYP) requirements foster realization of standards of excellence and clinical relevance for future radiologists and to explore demographic and economic factors pertinent to TYPs. A list of accredited TYPs were obtained from the American Medical Association's Graduate Medical Education (ACGME) Directory 2006-2007. Specialty distribution of TYP graduates was examined from statistics provided by the ACGME, and data from the 2007 Main Residency Match was analyzed. Data derived from a concurrent survey of the perception of the value of internship sent to all current radiology residents and fellows was assessed. The institutional costs of employing TYP interns versus physician assistants were also calculated. Forty-one of the 125 TYPs lack residencies in internal medicine (IM), general surgery (GS), or both, and approximately two-third of these lack full medical school affiliation. The interns who will graduate from these 41 programs account for 103 of the 1,128 radiology residents in their post-graduate year 2. Despite the longest elective time offered in TYPs compared to conventional preliminary programs, current radiology trainees who had participated in preliminary IM or GS internships were more satisfied compared to trainees completing TYPs. The requirements of the transitional internship and compliance with them need to be carefully assessed to determine their efficacy. Despite the strong economic impetus for hiring TYP interns, the availability of open slots in existing preliminary programs in IM and GS, coupled with radiology residents' greater level of satisfaction with traditional over transitional internships, makes the existence of TYPs less compelling.

Po-210 and Pb-210 as atmospheric tracers and global atmospheric Pb-210 fallout: a review.

PubMed

Baskaran, M

2011-05-01

Over the past ∼ 5 decades, the distribution of (222)Rn and its progenies (mainly (210)Pb, (210)Bi and (210)Po) have provided a wealth of information as tracers to quantify several atmospheric processes that include: i) source tracking and transport time scales of air masses; ii) the stability and vertical movement of air masses iii) removal rate constants and residence times of aerosols; iv) chemical behavior of analog species; and v) washout ratios and deposition velocities of aerosols. Most of these applications require that the sources and sink terms of these nuclides are well characterized. Utility of (210)Pb, (210)Bi and (210)Po as atmospheric tracers requires that data on the (222)Rn emanation rates is well documented. Due to low concentrations of (226)Ra in surface waters, the (222)Rn emanation rates from the continent is about two orders of magnitude higher than that of the ocean. This has led to distinctly higher (210)Pb concentrations in continental air masses compared to oceanic air masses. The highly varying concentrations of (210)Pb in air as well the depositional fluxes have yielded insight on the sources and transit times of aerosols. In an ideal enclosed air mass (closed system with respect to these nuclides), the residence times of aerosols obtained from the activity ratios of (210)Pb/(222)Rn, (210)Bi/(210)Pb, and (210)Po/(210)Pb are expected to agree with each other, but a large number of studies have indicated discordance between the residence times obtained from these three pairs. Recent results from the distribution of these nuclides in size-fractionated aerosols appear to yield consistent residence time in smaller-size aerosols, possibly suggesting that larger size aerosols are derived from resuspended dust. The residence times calculated from the (210)Pb/(222)Rn, (210)Bi/(210)Pb, and (210)Po/(210)Pb activity ratios published from 1970's are compared to those data obtained in size-fractionated aerosols in this decade and possible reasons for the discordance is discussed with some key recommendations for future studies. The existing global atmospheric inventory data of (210)Pb is re-evaluated and a 'global curve' for the depositional fluxes of (210)Pb is established. A current global budget for atmospheric (210)Po and (210)Pb is also established. The relative importance of dry fallout of (210)Po and (210)Pb at different latitudes is evaluated. The global values for the deposition velocities of aerosols using (210)Po and (210)Pb are synthesized. Copyright © 2010 Elsevier Ltd. All rights reserved.

Analysis of potential influence factors on background urinary benzene concentration among a non-smoking, non-occupationally exposed general population sample.

PubMed

Campagna, Marcello; Satta, Giannina; Campo, Laura; Flore, Valeria; Ibba, Antonio; Meloni, Michele; Tocco, Maria Giuseppina; Avataneo, Giuseppe; Flore, Costantino; Fustinoni, Silvia; Cocco, Pierluigi

2014-01-01

Analytical difficulties and lack of a biological exposure index and reference values have prevented using unmetabolized urinary benzene (UB) excretion as a biomarker of low-level environmental exposure. To explore what environmental factors beyond active smoking may contribute to environmental exposure to benzene, we monitored UB excretion in a non-smoking, non-occupationally exposed sample of the general population. Two spot urine samples were obtained from 86 non-smoking, non-occupationally exposed subjects, selected among a random sample of the general population of the metropolitan area of Cagliari (Sardinia, Italy), at 8:00 a.m. (UBm) and 8:00 p.m. (UBe). UB was measured by headspace solid-phase microextraction (HS-SPME) followed by gas chromatography-mass spectrometry analysis. Questionnaire information on personal and environmental exposures during the sampling day was gathered with personal interviews. Multivariate analysis of variance and multiple regression model were applied to investigate the role of such variables on the level of UB. The ninety-fifth percentile of UBe in this population was 311.5 ng/L, which is tentatively proposed as the UB guidance value for unexposed populations. UBm and urban residence were the only predictors of a significant increase in UBe excretion. Self-reported residential vehicular traffic will not account for the excess median value among urban residents; commuting time among urban residents showed a suggestive nonsignificant linear correlation with UBe, but the small sample size prevented reliable inference to be drawn. Age, environmental tobacco smoking, employment status and body mass index did not affect UB excretion. Our findings support the use of unmetabolized UB as a specific and sensitive biomarker of low-level environmental exposure to benzene.

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.

On the use of Li isotopes as a proxy for water-rock interaction in fractured crystalline rocks: A case study from the Gotthard rail base tunnel

NASA Astrophysics Data System (ADS)

Wanner, Christoph; Bucher, Kurt; Pogge von Strandmann, Philip A. E.; Waber, H. Niklaus; Pettke, Thomas

2017-02-01

We present Li isotope measurements of groundwater samples collected during drilling of the 57 km long Gotthard rail base tunnel in Switzerland, to explore the use of Li isotope measurements for tracking water-rock interactions in fractured crystalline rocks at temperatures of up to 43 °C. The 17 groundwater samples originate from water-conducting fractures within two specific crystalline rock units, which are characterized by a similar rock mineralogy, but significantly different fluid composition. In particular, the aqueous Li concentrations observed in samples from the two units vary from 1-4 mg/L to 0.01-0.02 mg/L. Whereas δ7Li values from the unit with high Li concentrations are basically constant (δ7Li = 8.5-9.1‰), prominent variations are recorded for the samples from the unit with low Li concentrations (δ7Li = 10-41‰). This observation demonstrates that Li isotope fractionation can be highly sensitive to aqueous Li concentrations. Moreover, δ7Li values from the unit with low Li concentrations correlate well with reaction progress parameters such as pH and [Li]/[Na] ratios, suggesting that δ7Li values are mainly controlled by the residence time of the fracture groundwater. Consequently, 1D reactive transport modeling was performed to simulate mineral reactions and associated Li isotope fractionation along a water-conducting fracture system using the code TOUGHREACT. Modeling results confirm the residence time hypothesis and demonstrate that the absence of δ7Li variation at high Li concentrations can be well explained by limitation of the amount of Li that is incorporated into secondary minerals. Modeling results also suggest that Li uptake by kaolinite forms the key process to cause Li isotope fractionation in the investigated alkaline system (pH >9), and that under slow flow conditions (<10 m/year), this process is associated with a very large Li isotope fractionation factor (ε ≈ -50‰). Moreover, our simulations demonstrate that for simple and well-defined systems with known residence times and low Li concentrations, δ7Li values may help to quantify mineral reaction rates if more thermodynamic data about the temperature-dependent incorporation of Li in secondary minerals as well as corresponding fractionation factors become available in the future. In conclusion, δ7Li values may be a powerful tool to track water-rock interaction in fractured crystalline rocks at temperature higher than those at the Earth's surface, although their use is restricted to low Li concentrations and well defined flow systems.

Age-related accumulation of the advanced glycation endproduct pentosidine in human articular cartilage aggrecan: the use of pentosidine levels as a quantitative measure of protein turnover.

PubMed

Verzijl, N; DeGroot, J; Bank, R A; Bayliss, M T; Bijlsma, J W; Lafeber, F P; Maroudas, A; TeKoppele, J M

2001-11-01

During aging, non-enzymatic glycation results in the formation and accumulation of the advanced glycation endproduct pentosidine in long-lived proteins, such as articular cartilage collagen. In the present study, we investigated whether pentosidine accumulation also occurs in cartilage aggrecan. Furthermore, pentosidine levels in aggrecan subfractions of different residence time were used to explore pentosidine levels as a quantitative measure of aggrecan turnover. In order to compare protein turnover rates, protein residence time was measured as racemization of aspartic acid. As has previously been shown for collagen, pentosidine levels increase with age in cartilage aggrecan. Consistent with the faster turnover of aggrecan compared to collagen, the rate of pentosidine accumulation was threefold lower in aggrecan than in collagen. In the subfractions of aggrecan, pentosidine levels increased with protein residence time. These pentosidine levels were used to estimate the half-life of the globular hyaluronan-binding domain of aggrecan to be 19.5 years. This value is in good agreement with the half-life of 23.5 years that was estimated based on aspartic acid racemization. In aggrecan from osteoarthritic (OA) cartilage, decreased pentosidine levels were found compared with normal cartilage, which reflects increased aggrecan turnover during the OA disease process. In conclusion, we showed that pentosidine accumulates with age in aggrecan and that pentosidine levels can be used as a measure of turnover of long-lived proteins, both during normal aging and during disease.

Travel Time Influences Readmission Risk: Geospatial Mapping of Surgical Readmissions.

PubMed

Turrentine, Florence E; Buckley, Patrick J; Sohn, Min-Woong; Williams, Michael D

2017-06-01

The University of Virginia (UVA) has recently become an Accountable Care Organization (ACO), intensifying efforts to provide better care for individuals. UVA's ACO population resides across the entire Commonwealth, with a large percentage of patients living in rural areas. To provide better health for this population, the central tenet of the ACO mission, we identified geographic risk factors influencing hospital readmission. We analyzed the relationship between the distance of patients' residence to the nearest hospital and 30-day readmission in general surgery patients. A retrospective chart review using January 1, 2011 through October 31, 2013 American College of Surgeons National Surgical Quality Improvement Program data for general surgery procedures was conducted. ArcGIS mapped street addresses provided graphical representation of distance between surgical population and the nearest hospital. We analyzed the impact on readmission, of time traveled, insurance status, and median household income. Each increase of 10 minutes in travel time from the patient's residence to the nearest hospital, not just UVA, was associated with a 9 per cent increase in the probability of readmission after adjusting for patient characteristics, preoperative comorbidities, laboratory values, and postoperative complications before or after discharge (odds ratio = 1.09; 95% confidence interval = 1.01-1.17; P = 0.019). Unlike urban hospitals, those serving rural populations may be at particular risk of postsurgical readmissions. Patients living furthest from a hospital facility are most at risk for readmission after a general surgery procedure. This vulnerable population may benefit most from comprehensive discharge planning.

Evaluation of Rib Fractures on a Single-in-plane Image Reformation of the Rib Cage in CT Examinations.

PubMed

Dankerl, Peter; Seuss, Hannes; Ellmann, Stephan; Cavallaro, Alexander; Uder, Michael; Hammon, Matthias

2017-02-01

This study aimed to evaluate the diagnostic performance of using a reformatted single-in-plane image reformation of the rib cage for the detection of rib fractures in computed tomography (CT) examinations, employing different levels of radiological experience. We retrospectively evaluated 10 consecutive patients with and 10 patients without rib fractures, whose CT scans were reformatted to a single-in-plane image reformation of the rib cage. Eight readers (two radiologists, two residents in radiology, and four interns) independently evaluated the images for the presence of rib fractures using a reformatted single-in-plane image and a multi-planar image reformation. The time limit was 30 seconds for each read. A consensus of two radiologist readings was considered as the reference standard. Diagnostic performance (sensitivity, specificity, positive predictive value [PPV], and negative predictive value [NPV]) was assessed and evaluated per rib and per location (anterior, lateral, posterior). To determine the time limit, we prospectively analyzed the average time it took radiologists to assess the rib cage, in a bone window setting, in 50 routine CT examinations. McNemar test was used to compare the diagnostic performances. Single image reformation was successful in all 20 patients. The sensitivity, specificity, PPV, and NPV for the detection of rib fractures using the conventional multi-planar read were 77.5%, 99.2%, 89.9%, and 98.0% for radiologists; 46.3%, 99.7%, 92.5%, and 95.3% for residents; and 29.4%, 99.4%, 82.5%, and 93.9% for interns, respectively. Sensitivity, PPV, and NPV increased across all three groups of experience, using the reformatted single-in-plane image of the rib cage (radiologists: 85.0%, 98.6%, and 98.7%; residents: 80.0%, 92.8%, and 98.2%; interns: 66.9%, 89.9%, and 97.1%), whereas specificity did not change significantly (99.9%, 99.4%, and 99.3%). The diagnostic performance of the interns and residents was significantly better when evaluating the single-in-plane image reformations (P < .01). The diagnostic performance of the radiologists was better when evaluating the single-in-plane image reformations; however, there was no significant difference (statistical power: 0.32). The diagnostic performance for the detection of rib fractures, using CT images that have been reformatted to a single-in-plane image, improves for readers from different educational levels when the evaluation time is restricted to 30 seconds or less. Copyright © 2017 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

Improving plant water isotope models with precise estimates of source water δ2H and δ18O values for trees from precipitation δ2H and δ18O values

NASA Astrophysics Data System (ADS)

Kahmen, A.; Brinkmann, N.; Seeger, S.; Buchmann, N. C.; Eugster, W.; Weiler, M.

2016-12-01

δ2H and δ18O values in plant water and plant organic compounds have established as powerful tools in ecology, biogeochemistry and paleoclimatology. In general, the δ2H and δ18O values in plants are driven by (i) the isotope composition of the plants' source water, (ii) the evaporative 2H or 18O enrichment of foliar water, and (iii) fractionations during the biosynthesis of organic compounds. While we have a robust understanding of what determines the evaporative 2H or 18O enrichment in plant water and biosynthetic fractionation factors have also been reasonably well constrained, our understanding how a plant's source water δ2H and δ18O values are linked to seasonal variation in precipitation δ2H and δ18O values is surprisingly poor. Precise estimates of a plant's source water δ2H and δ18O values, e.g. from the GNIP database are thus not possible and limit the application of plant water isotope models for the interpretation of δ2H and δ18O in plants. Here we present a four-year dataset of precipitation, soil water (0 - 80 cm) and plant source water δ2H and δ18O values from a mixed temperate forest. We employed this dataset to (i) estimate the link between precipitation and soil water δ2H and δ18O values at different soil depths, (ii) apply a hydrological model to estimate the mean residence time of precipitation water in different soil depths and (iii) estimate the integration time of seasonal precipitation for the source water δ2H and δ18O values of four tree species. Our data show a seasonal amplitude in δ2H and δ18O of precipitation of xx and xx, respectively. This seasonal variability in precipitation is transferred into the soil, where it declines with soil depth. Mean residence time of precipitation is xx days in the upper soil layers (5 cm) and increases to xx days in the lower soil layers (80 cm). The trees' source water originated from soil depths between 20 and 70 cm. The δ2H and δ18O values of the trees source water resemble mean precipitation δ2H and δ18O values of the preceding 3 - 4 months but not mean annual precipitation as is often assumed. Knowing the integration times of precipitation in a plant's source water will substantially improve the application of plant water isotope models in the interpretation of δ2H and δ18O values in plant water, tree ring cellulose of leaf wax lipids.

Missed opportunities: a descriptive assessment of teaching and attitudes regarding communication skills in a surgical residency.

PubMed

Hutul, Olivia A; Carpenter, Robert O; Tarpley, John L; Lomis, Kimberly D

2006-01-01

The Accreditation Council for Graduate Medical Education (ACGME) requires that "residents must be able to demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, their patients' families, and professional associates." The authors sought to assess current methods of teaching and attitudes regarding communication skills in their surgical residency. After obtaining Institutional Review Board (IRB) exemption, voluntary anonymous surveys were completed by a sample of convenience at the Vanderbilt University Medical Center: surgical residents at Grand Rounds and attending surgeons in a faculty meeting. Data were evaluated from 49 respondents (33 of 75 total surgical residents, 16 representative attending surgeons). One hundred percent of respondents rated the importance of communication to the successful care of patients as "4" or "5" of 5. Direct attending observation of residents communicating with patients/families was confirmed by residents and faculty. Residents reported varying levels of comfort with different types of conversations. Residents were "comfortable" or "very comfortable" as follows: obtaining informed consent, 91%; reporting operative findings, 64%; delivering bad news, 61%; conducting a family conference, 40%; discussing do not resuscitate (DNR) orders, 36%; and discussing transition to comfort care, 24%. Resident receptiveness to communication skills education varied with proposed venues: 84% favored teaching in the course of routine clinical care, 52% via online resources, and 46% in workshops. Residents were asked how frequently they received feedback specific to their communication skills during the past 6 months: Most residents reported 0 (39%) or 1 (21%) feedback episode. Only 30% of resident respondents reported receiving feedback that they perceived helpful. Attending surgeons reported that they did provide residents feedback specific to their communication skills. When asked to estimate the number of feedback episodes in the last 6 months, 16 faculty members reported a total of 67 feedback episodes, whereas 33 residents reported a total of only 24 episodes. Most faculty members rated their comfort with providing feedback specific to communication skills as "very comfortable" (56%) or "comfortable" (19%). "Time constraints" was the most frequently cited barrier to teaching communication skills. Communication skills are valued as integral to patient care by both residents and faculty in this study. Residents are most receptive to teaching of communication skills in the clinical setting. Faculty members report they are providing feedback to residents. Although residents report direct observation by faculty, currently only a minority (30%) are receiving feedback regarding communication that they consider helpful. A need exists to facilitate the feedback process to resolve this discrepancy. The authors propose that an evaluation instrument regarding communication skills may strengthen the feedback process.

Seasonal progression of uranium series isotopes in subglacial meltwater: Implications for subglacial storage time

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

Arendt, Carli A.; Aciego, Sarah M.; Sims, Kenneth W. W.

The residence time of subglacial meltwater impacts aquifer recharge, nutrient production, and chemical signals that reflect underlying bedrock/substrate, but is inaccessible to direct observation. We report the seasonal evolution of subglacial meltwater chemistry from the 2011 melt season at the terminus of the Athabasca Glacier, Canada. We also measured major and trace analytes and U-series isotopes for twenty-nine bulk meltwater samples collected over the duration of the melt season. This dataset, which is the longest time-series record of ( 234U/ 238U) isotopes in a glacial meltwater system, provides insight into the hydrologic evolution of the subglacial system during active melting.more » Meltwater samples, measured from the outflow, were analyzed for ( 238U), ( 222Rn) and ( 234U/ 238U)activity, conductivity, alkalinity, pH and major cations. Subglacial meltwater varied in [238U] and (222Rn) from 23 to 832 ppt and 9 to 171 pCi/L, respectively. Activity ratios of ( 234U/ 238U) ranged from 1.003 to 1.040, with the highest ( 238U), ( 222Rn) and ( 234U/ 238U)activity values occurring in early May when delayed-flow basal meltwater composed a significant portion of the bulk melt. Furthemore, from the chemical evolution of the meltwater, we posit that the relative subglacial water residence times decrease over the course of the melt season. This decrease in qualitative residence time during active melt is consistent with prior field studies and model-predicted channel switching from a delayed, distributed network to a fast, channelized network flow. As such, our study provides support for linking U-series isotopes to storage lengths of meltwater beneath glacial systems as subglacial hydrologic networks evolve with increased melting and channel network efficiency.« less

Seasonal progression of uranium series isotopes in subglacial meltwater: Implications for subglacial storage time

DOE PAGES

Arendt, Carli A.; Aciego, Sarah M.; Sims, Kenneth W. W.; ...

2017-07-31

The residence time of subglacial meltwater impacts aquifer recharge, nutrient production, and chemical signals that reflect underlying bedrock/substrate, but is inaccessible to direct observation. We report the seasonal evolution of subglacial meltwater chemistry from the 2011 melt season at the terminus of the Athabasca Glacier, Canada. We also measured major and trace analytes and U-series isotopes for twenty-nine bulk meltwater samples collected over the duration of the melt season. This dataset, which is the longest time-series record of ( 234U/ 238U) isotopes in a glacial meltwater system, provides insight into the hydrologic evolution of the subglacial system during active melting.more » Meltwater samples, measured from the outflow, were analyzed for ( 238U), ( 222Rn) and ( 234U/ 238U)activity, conductivity, alkalinity, pH and major cations. Subglacial meltwater varied in [238U] and (222Rn) from 23 to 832 ppt and 9 to 171 pCi/L, respectively. Activity ratios of ( 234U/ 238U) ranged from 1.003 to 1.040, with the highest ( 238U), ( 222Rn) and ( 234U/ 238U)activity values occurring in early May when delayed-flow basal meltwater composed a significant portion of the bulk melt. Furthemore, from the chemical evolution of the meltwater, we posit that the relative subglacial water residence times decrease over the course of the melt season. This decrease in qualitative residence time during active melt is consistent with prior field studies and model-predicted channel switching from a delayed, distributed network to a fast, channelized network flow. As such, our study provides support for linking U-series isotopes to storage lengths of meltwater beneath glacial systems as subglacial hydrologic networks evolve with increased melting and channel network efficiency.« less

Economic Analysis of Obtaining a PharmD Degree and Career as a Pharmacist

PubMed Central

Gatwood, Justin; Spivey, Christina A.

2015-01-01

Objective. To evaluate the economic value of pharmacy education/career and the effects of the cost of private or public pharmacy school, the length of degree program, residency training, and pharmacy career path on net career earnings. Methods. This study involved an economic analysis using Markov modeling. Estimated costs of education including student loans were considered in calculating net career earnings of 4 career paths following high school graduation: (1) immediate employment; (2) employment with bachelor’s degree in chemistry or biology; (3) employment as a pharmacist with no residency training; and (4) employment as a pharmacist after completing one or two years of residency training. Results. Models indicated that throughout their careers (up to age 67), PharmD graduates may accumulate net career earnings of $5.66 million to $6.29 million, roughly 3.15 times more than high school graduates and 1.57 to 1.73 times more than those with bachelor’s degrees in biology or chemistry. Attending a public pharmacy school after completing 3 years of prepharmacy education generally leads to higher net career earnings. Community pharmacists have the highest net career earnings, and PGY-1 residency-trained hospital pharmacists have greater net career earnings than those who immediately started their careers in a hospital setting. Conclusion. The economic models presented are based on assumptions described herein; as conditions are subject to variability, these models should not be used to predict future earnings. Nevertheless, the findings demonstrate investment in a pharmacy education yields favorable financial return. Application of results to schools of pharmacy, students, and graduates is discussed. PMID:26689560

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...

The use of free online educational resources by Canadian emergency medicine residents and program directors.

PubMed

Purdy, Eve; Thoma, Brent; Bednarczyk, Joseph; Migneault, David; Sherbino, Jonathan

2015-03-01

Introduction Online educational resources (OERs) are increasingly available for emergency medicine (EM) education. This study describes and compares the use of free OERs by the Royal College of Physicians and Surgeons of Canada (RCPSC) EM residents and program directors (PDs) and investigates the relationship between the use of OERs and peer-reviewed literature. A bilingual, online survey was distributed to RCPSC-EM residents and PDs using a modified Dillman method. The chi-square test and Fisher's exact test were used to compare the responses of residents and PDs. The survey was completed by 214/350 (61%) residents and 11/14 (79%) PDs. Free OERs were used by residents most frequently for general EM education (99.5%), procedural skills training (96%), and learning to interpret diagnostic tests (92%). OER modalities used most frequently included wikis (95%), file-sharing websites (95%), e-textbooks (94%), and podcasts (91%). Residents used wikis, podcasts, vodcasts, and file-sharing websites significantly more frequently than PDs. Relative to PDs, residents found entertainment value to be more important for choosing OERs (p<0.01). Some residents (23%) did not feel that literature references were important, whereas all PDs did. Both groups reported that OERs increased the amount of peer-reviewed literature (75% and 60%, respectively) that they read. EM residents make extensive use of OERs and differ from their PDs in the importance that they place on their entertainment value and incorporation of peer-reviewed references. OERs may increase the use of peer-reviewed literature in both groups. Given the prevalence of OER use for core educational goals among RCPSC-EM trainees, future efforts to facilitate critical appraisal and appropriate resource selection are warranted.

Duty Hour Reporting: Conflicting Values in Professionalism

PubMed Central

Byrne, John M.; Loo, Lawrence K.; Giang, Dan W.

2015-01-01

Background Duty hour limits challenge professional values, sometimes forcing residents to choose between patient care and regulatory compliance. This may affect truthfulness in duty hour reporting. Objective We assessed residents' reasons for falsifying duty hour reports. Methods We surveyed residents in 1 sponsoring institution to explore the reasons for noncompliance, frequency of violations, falsification of reports, and the residents' awareness of the option to extend hours to care for a single patient. The analysis used descriptive statistics. Linear regression was used to explore falsification of duty hour reports by year of training. Results The response rate was 88% (572 of 650). Primary reasons for duty hour violations were number of patients (19%) and individual patient acuity/complexity (19%). Junior residents were significantly more likely to falsify duty hours (R = −0.966). Of 124 residents who acknowledged falsification, 51 (41%) identified the primary reason as concern that the program will be in jeopardy of violating the Accreditation Council for Graduate Medical Education (ACGME) duty hour limits followed by fear of punishment (34, 27%). This accounted for more than two-thirds of the primary reasons for falsification. Conclusions Residents' falsification of duty hour data appears to be motivated by concerns about adverse actions from the ACGME, and fear they might be punished. To foster professionalism, we recommend that sponsoring institutions educate residents about professionalism in duty hour reporting. The ACGME should also convey the message that duty hour limits be applied in a no-blame systems-based approach, and allow junior residents to extend duty hours for the care of individual patients. PMID:26457145

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.

[Professionalism: Values and competences in specialized medical training].

PubMed

Giménez, N; Alcaraz, J; Gavagnach, M; Kazan, R; Arévalo, A; Rodríguez-Carballeira, M

To determine the perception of healthcare professionals (tutors, residents and teaching collaborators) involved in specialist medical training on the core values and skills to develop their tasks. A tailor-made questionnaire aimed at healthcare professionals in 9health care centres and a referral hospital. Questionnaire: 4 sections and 51 variables (scale 1-10). A total of 287 professionals participated, which included 97% tutors (n=59), 38% residents (n=61), and 56% others (97 teaching collaborators and 70 not associated with teaching). The alfa Cronbach coefficient was 0.945. Best rated values were work compliance (8.7 points), ethics in professional practice (8.6 points), and respect for their team (8.3 points). The best rated competence was communication with patients and families (8.1 points), followed by self-motivating leadership (7.9 points), and the practical application of medical and healthcare theoretical knowledge (7.8 points). The values received, on average, 0.7 points above competences (95% CI: 0.5-0.9). There were no differences between tutors and residents, although differences were found between doctors and nurses, and between males and females. Most of the professionals (tutors, residents, and teaching collaborators) share the same perception of the values and competencies that influence their professional development. This perception was influenced by the professional category and gender, but not age or working in a hospital or primary health care. Copyright © 2016 SECA. Publicado por Elsevier España, S.L.U. All rights reserved.

Extinction and Scattering Properties of Soot Emitted from Buoyant Turbulent Diffusion Flames. Appendix F

NASA Technical Reports Server (NTRS)

Krishnan, S. S.; Lin, K.-C.; Faeth, G. M.; Yuan, Z.-G. (Technical Monitor); Urban, D. L. (Technical Monitor); Yuan, Z.-G. (Technical Monitor)

2001-01-01

Extinction and scattering properties at wavelengths of 250-5200 nm were studied for soot emitted from buoyant turbulent diffusion flames in the long residence time regime where soot properties are independent of position in the overfire region and characteristic flame residence times. Flames burning in still air and fueled with gas (acetylene, ethylene, propane, and propylene) and liquid (benzene, toluene, cyclohexane, and n-heptane) hydrocarbon fuels were considered. Measured scattering patterns and ratios of total scattering/absorption cross sections were in good agreement with predictions based on the Rayleigh-Debye-Gans (RDG) scattering approximation in the visible. Measured depolarization ratios were roughly correlated by primary particle size parameter, suggesting potential for completing RDG methodology needed to make soot scattering predictions as well as providing a nonintrusive way to measure primary soot particle diameters. Measurements of dimensionless extinction coefficients were in good agreement with earlier measurements for similar soot populations and were independent of fuel type and wavelength except for reduced values as the near ultraviolet was approached. The ratios of the scattering/absorption refractive index functions were independent of fuel type within experimental uncertainties and were in good agreement with earlier measurements. The refractive index junction for absorption was similarly independent of fuel type but was larger than earlier reflectometry measurements in the infrared. Ratios of total scattering/absorption cross sections were relatively large in the visible and near infrared, with maximum values as large as 0.9 and with values as large as 0.2 at 2000 nm, suggesting greater potential for scattering from soot particles to affect flame radiation properties than previously thought.

Extinction and Scattering Properties of Soot Emitted from Buoyant Turbulent Diffusion Flames. Appendix D

NASA Technical Reports Server (NTRS)

Krishnan, S. S.; Lin, K.-C.; Faeth, G. M.; Urban, D. L. (Technical Monitor); Yuan, Z.-G. (Technical Monitor)

2001-01-01

Extinction and scattering properties at wavelengths of 250-5200 nm were studied for soot emitted from buoyant turbulent diffusion flames in the long residence time regime where soot properties are independent of position in the overfire region and characteristic flame residence times. Flames burning in still air and fueled with gas (acetylene, ethylene, propane, and propylene) and liquid (benzene, toluene, cyclohexane, and n-heptane) hydrocarbon fuels were considered Measured scattering patterns and ratios of total scattering/absorption cross sections were in good agreement with predictions based on the Rayleigh-Debye-Gans (RDG) scattering approximation in the visible. Measured depolarization ratios were roughly correlated by primary particle size parameter, suggesting potential for completing RDG methodology needed to make soot scattering predictions as well as providing a nonintrusive way to measure primary soot particle diameters. Measurements of dimensionless extinction coefficients were in good agreement with earlier measurements for similar soot populations and were independent of fuel type and wavelength except for reduced values as the near ultraviolet was approached. The ratios of the scattering/absorption refractive index functions were independent of fuel type within experimental uncertainties and were in good agreement with earlier measurements. The refractive index function for absorption was similarly independent of fuel type but was larger than earlier reflectometry measurements in the infrared. Ratios of total scattering/absorption cross sections were relatively large in the visible and near infrared, with maximum values as large as 0.9 and with values as large as 0.2 at 2000 nm, suggesting greater potential for scattering from soot particles to affect flame radiation properties than previously thought.

[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.

Residents' training to retinal photocoagulation: virtual reality compared to conventional apprenticeship

NASA Astrophysics Data System (ADS)

Peugnet, Frederic; Dubois, Patrick; Rouland, Jean-Francois

1998-06-01

Virtual reality is one of these recent technologies which can provide an efficient help in the field of surgical apprenticeship. We achieved an original training simulator for retinal photocoagulation destined to the residents of the ophthalmological department. This paper describes the comparison between this new training tool and the conventional practice. Two groups of residents, randomly selected, were trained exclusively by one of these methods. These two groups were under the responsibility of two distinct experts. A final evaluation was made by a third and different expert, ignoring the training mode practiced by each of the residents. The study lasted six months. The results show that this new training mode is at least as efficient as the current one in terms of elapsed time and efficiency. It may even reduce the training duration. These results confirm that a pedagogical simulator could give a new approach in the medical teaching, particularly in its management. Such a device may solve the problems of practitioner's lack of disponibility and of patients' safety and comfort during a conventional training. Furthermore, it could bring an objective way to value the students; practical ability. On the other hand, this preliminary study emphasizes the difficulties in introducing a new modality in a traditional teaching environment.

How should unmatched otolaryngology applicants proceed?

PubMed

Schwan, Josianna; Abaza, Mona; Cabrera-Muffly, Cristina

2015-10-01

To determine the attitudes of otolaryngology residency program directors and chairpersons toward unmatched residency applicants, including whether a surgical internship or research year is preferred in considering repeat applicants. Cross-sectional survey. Approval was obtained from the Colorado Multiple Institution Review Board. A 12-question Web-based survey was sent to otolaryngology residency program directors and chairpersons three times over a 6-week period. Responses collected from respondents were anonymous, with no identifying characteristics. Forty-five percent of those contacted responded to the survey. The most commonly recommended course of action for an unmatched applicant was completion of a general surgery intern year (43%) or a year of research (31%). Program directors were more likely than chairpersons to recommend a year of research (P value 0.014). Ninety-seven percent of the respondents felt it was important or essential to obtain new letters of recommendation. Respondents ranked poor interview skills as the most common reason for applicants remaining unmatched (29%). Otolaryngology residency match is even more competitive for previously unmatched applicants. Unmatched applicants should be advised to proceed with either a research year or postgraduate year 1 general surgery year. Before applying again, applicants should obtain new letters of recommendation, and the importance of improving poor interviewing skills should be emphasized by advisors. N/A. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

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.

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.

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

Mixing and residence times of stormwater runoff in a detection system

USGS Publications Warehouse

Martin, Edward H.

1989-01-01

Five tracer runs were performed on a detention pond and wetlands system to determine mixing and residence times in the system. The data indicate that at low discharges and with large amounts of storage, the pond is moderately mixed with residence times not much less than the theoretical maximum possible under complete mixing. At higher discharges and with less storage in the pond, short-circuiting occurs, reducing the amount of mixing in the pond and appreciably reducing the residence times. The time between pond outlet peak concentrations and wetlands outlet peak concentrations indicate that in the wetlands, mixing increases with decreasing discharge and increasing storage.

A new method for measuring lung deposition efficiency of airborne nanoparticles in a single breath

NASA Astrophysics Data System (ADS)

Jakobsson, Jonas K. F.; Hedlund, Johan; Kumlin, John; Wollmer, Per; Löndahl, Jakob

2016-11-01

Assessment of respiratory tract deposition of nanoparticles is a key link to understanding their health impacts. An instrument was developed to measure respiratory tract deposition of nanoparticles in a single breath. Monodisperse nanoparticles are generated, inhaled and sampled from a determined volumetric lung depth after a controlled residence time in the lung. The instrument was characterized for sensitivity to inter-subject variability, particle size (22, 50, 75 and 100 nm) and breath-holding time (3-20 s) in a group of seven healthy subjects. The measured particle recovery had an inter-subject variability 26-50 times larger than the measurement uncertainty and the results for various particle sizes and breath-holding times were in accordance with the theory for Brownian diffusion and values calculated from the Multiple-Path Particle Dosimetry model. The recovery was found to be determined by residence time and particle size, while respiratory flow-rate had minor importance in the studied range 1-10 L/s. The instrument will be used to investigate deposition of nanoparticles in patients with respiratory disease. The fast and precise measurement allows for both diagnostic applications, where the disease may be identified based on particle recovery, and for studies with controlled delivery of aerosol-based nanomedicine to specific regions of the lungs.

Testing optimal foraging theory in a penguin-krill system.

PubMed

Watanabe, Yuuki Y; Ito, Motohiro; Takahashi, Akinori

2014-03-22

Food is heterogeneously distributed in nature, and understanding how animals search for and exploit food patches is a fundamental challenge in ecology. The classic marginal value theorem (MVT) formulates optimal patch residence time in response to patch quality. The MVT was generally proved in controlled animal experiments; however, owing to the technical difficulties in recording foraging behaviour in the wild, it has been inadequately examined in natural predator-prey systems, especially those in the three-dimensional marine environment. Using animal-borne accelerometers and video cameras, we collected a rare dataset in which the behaviour of a marine predator (penguin) was recorded simultaneously with the capture timings of mobile, patchily distributed prey (krill). We provide qualitative support for the MVT by showing that (i) krill capture rate diminished with time in each dive, as assumed in the MVT, and (ii) dive duration (or patch residence time, controlled for dive depth) increased with short-term, dive-scale krill capture rate, but decreased with long-term, bout-scale krill capture rate, as predicted from the MVT. Our results demonstrate that a single environmental factor (i.e. patch quality) can have opposite effects on animal behaviour depending on the time scale, emphasizing the importance of multi-scale approaches in understanding complex foraging strategies.

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.

Consolidated Academic and Research Exposition: A Pilot Study of an Innovative Education Method to Increase Residents' Research Involvement

PubMed Central

Basu Ray, Indranill; Henry, Tracey L.; Davis, William; Alam, Jawed; Amedee, Ronald G.; Pinsky, William W.

2012-01-01

Background Internal medicine residents at the Ochsner Clinic Foundation stay engaged with clinical work and have difficulty initiating and completing research and publishing their scholarly activities. Commonly cited barriers include lack of knowledge about institutional research programs, lack of confidence regarding medical writing skills, lack of time, and failure to understand the value of research. The residency directors at Ochsner initiated the Consolidated Academic and Research Exposition (CARE) program to teach basic research skills and encourage residents' interest and productivity in research. Methods The CARE program includes 4 core components: house staff mentoring and the Resident Career Development Program, a journal club, medical writing instruction, and research engagement. Particular emphasis is given to projects that could be completed within a 1-month period and result in publication, enabling residents to use a 1-month elective rotation during their first postgraduate year. The sessions are mandatory for residents, except for those on specified rotations, including the critical care service and the night float rotation and those who are postcall. Results In 2010-2011, 6 residents submitted abstracts to the Louisiana Chapter of the American College of Physicians Associates meeting; 2 abstracts were accepted for presentation. In 2011-2012, there were 14 submissions, 4 of which were accepted for presentation. In 2010-2011, there were 4 submissions to the Southern Hospitalist Conference, which increased to 7 submissions in 2011-2012. The second best presentation award at the Southern Hospitalist Conference was also earned by a resident of this institution. The program saw a 110% total increase in scholarly activity from 2010-2011 to 2011-2012. Discussion The CARE program has been in existence for approximately 1 year. Preliminary results were tabulated based on research proposals, posters, abstracts, case reports, and presentations submitted and/or accepted at leading medical conferences over the past year as compared to the same period 1 year ago. Residents, based on the Accreditation Council for Graduate Medical Education Resident Survey responses, were more satisfied with the opportunities provided to them to participate in research or scholarly activities. Our preliminary results suggest that an organized, structured research curriculum in internal medicine residency programs is critical to promoting, initiating, and completing scholarly activity during a residency program. Conclusion Ochsner's CARE program has appreciably enhanced internal medicine residents' interest in research-related activity, resulting in a significant increase in resident-authored research papers, abstracts, posters, and case reports being accepted at leading national medical conferences. PMID:23267266

Temporal dynamics of instream wood in headwater streams draining mixed Carpathian forests

NASA Astrophysics Data System (ADS)

Galia, Tomáš; Šilhán, Karel; Ruiz-Villanueva, Virginia; Tichavský, Radek; Stoffel, Markus

2017-09-01

Instream wood can reside in fluvial systems over varying periods depending on its geographical context, instream position, tree species, piece size, and fluvial environment. In this paper, we investigate the residence time of two typical species representing a majority of instream wood in steep headwaters of the Carpathians and located under mixed forest canopy. Residence times of individual logs were then confronted with other wood parameters (i.e., wood dimensions, mean annual increment rate, tree age, class of wood stabilisation and decay, geomorphic function of wood pieces, and the proportion of the log length within the active channel). Norway spruce (Picea abies (L.) Karst.) samples indicated more than two times longer mean and maximal residence times as compared to European beech (Fagus sylvatica L.) based on the successful cross-dating of 127 logs. Maximum residence time in the headwaters was 128 years for P. abies and 59 years for F. sylvatica. We demonstrate that log age and log diameter played an important role in the preservation of wood in the fluvial system, especially in the case of F. sylvatica instream wood. By contrast, we did not observe any significant trends between wood residence time and total wood length. Instream wood with geomorphic functions (i.e., formation of steps and jams) did not show any differences in residence time as compared to nonfunctional wood. Nevertheless, we found shorter residence times for hillslope-stabilised pieces when compared to pieces located entirely in the channel (either unattached or stabilised by other wood or bed sediments). We also observed changes of instream wood orientation with respect to wood residence time. This suggests some movement of instream wood (i.e., its turning or short-distance transport), including pieces longer than channel width in the steep headwaters studied here (1.5 ≤ W ≤ 3.5 m), over the past few decades.

Does framing of cancer survival affect perceived value of care? A willingness-to-pay survey of US residents.

PubMed

Lin, Pei-Jung; Concannon, Thomas W; Greenberg, Dan; Cohen, Joshua T; Rossi, Gregory; Hille, Jeffrey; Auerbach, Hannah R; Fang, Chi-Hui; Nadler, Eric S; Neumann, Peter J

2013-08-01

To investigate the relationship between the framing of survival gains and the perceived value of cancer care. Through a population-based survey of 2040 US adults, respondents were randomized to one of the two sets of hypothetical scenarios, each of which described the survival benefit for a new treatment as either an increase in median survival time (median survival), or an increase in the probability of survival for a given length of time (landmark survival). Each respondent was presented with two randomly selected scenarios with different prognosis and survival improvements, and asked about their willingness to pay (WTP) for the new treatments. Predicted WTP increased with survival benefits and respondents' income, regardless of how survival benefits were described. Framing therapeutic benefits as improvements in landmark rather than median time survival increased the proportion of the population willing to pay for that gain by 11-35%, and the mean WTP amount by 42-72% in the scenarios we compared. How survival benefits are described may influence the value people place on cancer care.

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 association between frequency of self-reported medical errors and anesthesia trainee supervision: a survey of United States anesthesiology residents-in-training.

PubMed

De Oliveira, Gildasio S; Rahmani, Rod; Fitzgerald, Paul C; Chang, Ray; McCarthy, Robert J

2013-04-01

Poor supervision of physician trainees can be detrimental not only to resident education but also to patient care and safety. Inadequate supervision has been associated with more frequent deaths of patients under the care of junior residents. We hypothesized that residents reporting more medical errors would also report lower quality of supervision scores than the ones with lower reported medical errors. The primary objective of this study was to evaluate the association between the frequency of medical errors reported by residents and their perceived quality of faculty supervision. A cross-sectional nationwide survey was sent to 1000 residents randomly selected from anesthesiology training departments across the United States. Residents from 122 residency programs were invited to participate, the median (interquartile range) per institution was 7 (4-11). Participants were asked to complete a survey assessing demography, perceived quality of faculty supervision, and perceived causes of inadequate perceived supervision. Responses to the statements "I perform procedures for which I am not properly trained," "I make mistakes that have negative consequences for the patient," and "I have made a medication error (drug or incorrect dose) in the last year" were used to assess error rates. Average supervision scores were determined using the De Oliveira Filho et al. scale and compared among the frequency of self-reported error categories using the Kruskal-Wallis test. Six hundred four residents responded to the survey (60.4%). Forty-five (7.5%) of the respondents reported performing procedures for which they were not properly trained, 24 (4%) reported having made mistakes with negative consequences to patients, and 16 (3%) reported medication errors in the last year having occurred multiple times or often. Supervision scores were inversely correlated with the frequency of reported errors for all 3 questions evaluating errors. At a cutoff value of 3, supervision scores demonstrated an overall accuracy (area under the curve) (99% confidence interval) of 0.81 (0.73-0.86), 0.89 (0.77-0.95), and 0.93 (0.77-0.98) for predicting a response of multiple times or often to the question of performing procedures for which they were not properly trained, reported mistakes with negative consequences to patients, and reported medication errors in the last year, respectively. Anesthesiology trainees who reported a greater incidence of medical errors with negative consequences to patients and drug errors also reported lower scores for supervision by faculty. Our findings suggest that further studies of the association between supervision and patient safety are warranted. (Anesth Analg 2013;116:892-7).

Social and recovery capital amongst homeless hostel residents who use drugs and alcohol.

PubMed

Neale, Joanne; Stevenson, Caral

2015-05-01

Homeless people who use drugs and alcohol have been described as one of the most marginalised groups in society. In this paper, we explore the relationships of homeless drug and alcohol users who live in hostels in order to ascertain the nature and extent of their social and recovery capital. Data were collected during 2013 and 2014 from three hostels. Each hostel was in a different English city and varied in size and organisational structure. Semi-structured interviews were conducted with 30 residents (21 men; 9 women) who self-reported current drink and/or drug problems. Follow-up interviews were completed after 4-6 weeks with 22 residents (16 men; 6 women). Audio recordings of all interviews were transcribed verbatim, systematically coded and analysed using Framework. Participants' main relationships involved family members, professionals, other hostel residents, friends outside of hostels, current and former partners, and enemies. Social networks were relatively small, but based on diverse forms of, often reciprocal, practical and emotional support, encompassing protection, companionship, and love. The extent to which participants' contacts provided a stable source of social capital over time was, nonetheless, uncertain. Hostel residents who used drugs and alcohol welcomed and valued interaction with, and assistance from, hostel staff; women appeared to have larger social networks than men; and hostels varied in the level of enmity between residents and antipathy towards staff. Homeless hostel residents who use drugs and alcohol have various opportunities for building social capital that can in turn foster recovery capital. Therapies that focus on promoting positive social networks amongst people experiencing addiction seem to offer a valuable way of working with homeless hostel residents who use drugs and alcohol. Gains are, however, likely to be maximised where hostel management and staff are supportive of, and actively engage with, therapy delivery. Copyright © 2015 The Authors. Published by Elsevier B.V. All rights reserved.

Undergraduate radiology education in private and public teaching hospitals in Karachi, Pakistan: teaching duties, methodologies, and rewards

PubMed Central

Nadeem, Naila; Khawaja, Ranish Deedar Ali; Beg, Madiha; Naeem, Muhammad; Majid, Zain

2013-01-01

Background In an integrated method of education, medical students are introduced to radiology in their preclinical years. However, no study has been conducted in Pakistan to demonstrate an academic framework of medical radiology education at an undergraduate level. Therefore, we aimed to document and compare the current level of teaching duties, teaching methodologies, and teaching rewards among radiologists and residents in private and public teaching hospitals in Karachi, Pakistan. Methods A survey was conducted among 121 radiologists and residents in two private and two public teaching hospitals in Karachi, Pakistan. Radiologists who were nationally registered with the Pakistan Medical and Dental Council either part-time or full-time were included. Radiology residents and fellows who were nationally registered with the Pakistan Medical and Dental Council were also included. Self-administered questionnaires addressing teaching duties, methods, and rewards were collected from 95 participants. Results The overall response rate was 78.51% (95/121). All of the radiologists were involved in teaching residents and medical students, but only 36% reported formal training in teaching skills. Although most of the respondents (76%) agreed that medical students appeared enthusiastic about learning radiology, the time spent on teaching medical students was less than five hours per week annually (82%). Only 37% of the respondents preferred dedicated clerkships over distributed clerkships (41%). The most common preferred teaching methodology overall was one-on-one interaction. Tutorials, teaching rounds, and problem-based learning sessions were less favored by radiologists than by residents. Teaching via radiology films (86%) was the most frequent mode of instruction. Salary (59%) was the most commonly cited teaching reward. The majority of respondents (88%) were not satisfied with their current level of teaching rewards. Conclusion All radiologists and residents working in an academic radiology department are involved in teaching undergraduate students at multiple levels. The most valued teaching methodology involves use of images, with one-on-one interaction between the trainer and trainee. The monetary reward for teaching is inbuilt into the salary. The methodology adopted for teaching purposes was significantly different between respondents from private hospitals and those from public teaching hospitals. Because of low satisfaction among the respondents, efforts should be made to provide satisfying teaching rewards. PMID:23745098

Nursing home staff's views on residents' dignity: a qualitative interview study.

PubMed

Oosterveld-Vlug, Mariska G; Pasman, H Roeline W; van Gennip, Isis E; Willems, Dick L; Onwuteaka-Philipsen, Bregje D

2013-09-16

Maintaining dignity is an important element of end-of-life care and also of the care given in nursing homes. Factors influencing personal dignity have been studied from both nursing home residents' and staff's perspective. Little is however known about the way nursing home staff perceive and promote the personal dignity of individual residents in daily practice, or about staff's experiences with preserving dignity within the nursing home. The aim of this study is to gain more insight in this. A qualitative descriptive interview study was designed, in which in-depth interviews were performed with 13 physicians and 15 nurses. They expressed their views on the personal dignity of 30 recently admitted nursing home residents on the general medical wards of four nursing homes in The Netherlands. Interviews were transcribed and analyzed following the principles of thematic analysis. According to both physicians and nurses, physical impairment and being dependent on others threatened the residents' dignity. Whether or not this led to a violation of an individual resident's dignity, depended--in staff's opinion--on the resident's ability to show resilience and to keep his/her individuality. Staff mentioned treating residents with respect and taking care of their privacy as most important elements of dignity-conserving care and strived to treat the residents as they would like to be treated themselves. They could often mention aspects that were important for a particular resident's dignity. But, when asked what they could contribute to a particular resident's dignity, they often mentioned general aspects of dignity-conserving care, which could apply to most nursing home residents. By attempting to give dignity-conserving care, physicians and nurses often experienced conflicting values in daily care and barriers caused by the lack of resources. Tailoring dignity-conserving care to an individual nursing home resident appears hard to bring about in daily practice. Both attention to solve contextual barriers within the nursing home as well as more awareness of staff members for their own values, which they take as a reference point in treating residents, is needed to promote personal dignity in the nursing home setting.

Refractive indices at visible wavelengths of soot emitted from buoyant turbulent diffusion flames

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

Wu, J.S.; Krishnan, S.K.; Faeth, G.M.

1996-11-01

Measurements of the optical properties of soot, emphasizing refractive indices, are reported for visible wavelengths. The experiments considered soot in the fuel-lean (overfire) region of buoyant turbulent diffusion flames in the long residence time regime where soot properties are independent of position in the overfire region and residence time. Flames fueled with acetylene, propylene, ethylene and propane burning in still air provided a range of soot physical and structure properties. Measurements included soot composition, density, structure, gravimetric volume fraction, scattering properties and absorption properties. These data were analyzed to find soot fractal dimensions, refractive indices and dimensionless extinction coefficients, assumingmore » Rayleigh-Debye-Gans scattering for polydisperse mass fractal aggregates (RDG-PFA theory). RDG-PFA theory was successfully evaluated, based on measured scattering patterns. Soot fractal dimensions were independent of both fuel type and wavelength, yielding a mean value of 1.77 with a standard deviation of 0.04. Refractive indices were independent of fuel type within experimental uncertainties and were in reasonably good agreement with earlier measurements for soot in the fuel-lean region of diffusion flames due to Dalzell and Sarofim (1969). Dimensionless extinction coefficients were independent of both fuel type and wavelength, yielding a mean value of 5.1 with a standard deviation of 0.5, which is lower than earlier measurements for reasons that still must be explained.« less

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...

METHODOLOGICAL PLURALISM AND MIXED METHODOLOGY TO STRENGTHEN COMMUNITY PSYCHOLOGY RESEARCH: AN EXAMPLE FROM OXFORD HOUSE

PubMed Central

May, Emily M.; Hunter, Bronwyn A.; Jason, Leonard A.

2017-01-01

This article evaluates how a plurality of research methods has served a research program that has functioned in a much-needed area of research: the role of housing and recovery residences in addiction recovery. The review focuses on one mutually supportive recovery residence model, called Oxford House, which represents more than 1,700 democratic, self-governing residences. To date, there has been no comprehensive evaluation of the research methods used with Oxford House or any other recovery residence. In this article, research methods, including study designs and data analyses, are summarized for 114 peer-reviewed empirical studies that included data on Oxford Houses or Oxford House residents. This review of a pluralistic research program can inform community researchers about the value of recovery residences, the many ways in which recovery residences may be assessed, and the benefits of using multiple methods. Implications for future recovery residence research are discussed. PMID:28839344

METHODOLOGICAL PLURALISM AND MIXED METHODOLOGY TO STRENGTHEN COMMUNITY PSYCHOLOGY RESEARCH: AN EXAMPLE FROM OXFORD HOUSE.

PubMed

May, Emily M; Hunter, Bronwyn A; Jason, Leonard A

2017-01-01

This article evaluates how a plurality of research methods has served a research program that has functioned in a much-needed area of research: the role of housing and recovery residences in addiction recovery. The review focuses on one mutually supportive recovery residence model, called Oxford House, which represents more than 1,700 democratic, self-governing residences. To date, there has been no comprehensive evaluation of the research methods used with Oxford House or any other recovery residence. In this article, research methods, including study designs and data analyses, are summarized for 114 peer-reviewed empirical studies that included data on Oxford Houses or Oxford House residents. This review of a pluralistic research program can inform community researchers about the value of recovery residences, the many ways in which recovery residences may be assessed, and the benefits of using multiple methods. Implications for future recovery residence research are discussed.

Family Satisfaction With Nursing Home Care.

PubMed

Shippee, Tetyana P; Henning-Smith, Carrie; Gaugler, Joseph E; Held, Robert; Kane, Robert L

2017-03-01

This article explores the factor structure of a new family satisfaction with nursing home care instrument and determines the relationship of resident quality of life (QOL) and facility characteristics with family satisfaction. Data sources include (1) family satisfaction interviews ( n = 16,790 family members), (2) multidimensional survey of resident QOL ( n = 13,433 residents), and (3) facility characteristics ( n = 376 facilities). We used factor analysis to identify domains of family satisfaction and multivariate analyses to identify the role of facility-level characteristics and resident QOL on facility-mean values of family satisfaction. Four distinct domains were identified for family satisfaction: "care," "staff," "environment," and "food." Chain affiliation, higher resident acuity, more deficiencies, and large size were all associated with less family satisfaction, and resident QOL was a significant (albeit weak) predictor of family satisfaction. Results suggest that family member satisfaction is distinct from resident QOL but is associated with resident QOL and facility characteristics.

Making sense: duty hours, work flow, and waste in graduate medical education.

PubMed

Bush, Roger W; Philibert, Ingrid

2009-12-01

Parsimony, and not industry, is the immediate cause of the increase of capital. Industry, indeed, provides the subject which parsimony accumulates. But whatever industry might acquire, if parsimony did not save and store up, the capital would never be the greater.Adam Smith, The Wealth of Nations, book 2, chapter 31In 2003, the Accreditation Council for Graduate Medical Education implemented resident duty hour limits that included a weekly limit and limits on continuous hours. Recent recommendations for added reductions in resident duty hours have produced concern about concomitant reductions in future graduates' preparedness for independent practice. The current debate about resident hours largely does not consider whether all hours residents spend in the educational and clinical-care environment contribute meaningfully either to residents' learning or to effective patient care. This may distract the community from waste in the current clinical-education model. We propose that use of "lean production" and quality improvement methods may assist teaching institutions in attaining a deeper understanding of work flow and waste. These methods can be used to assign value to patient- and learner-centered activities and outputs and to optimize the competing and synergistic aspects of all desired outcomes to produce the care the Institute of Medicine recommends: safe, effective, efficient, patient-centered, timely, and equitable. Finally, engagement of senior clinical faculty in determining the culture of the care and education system will contribute to an advanced social-learning and care network.

Making Sense: Duty Hours, Work Flow, and Waste in Graduate Medical Education

PubMed Central

Bush, Roger W.; Philibert, Ingrid

2009-01-01

Parsimony, and not industry, is the immediate cause of the increase of capital. Industry, indeed, provides the subject which parsimony accumulates. But whatever industry might acquire, if parsimony did not save and store up, the capital would never be the greater. Adam Smith, The Wealth of Nations, book 2, chapter 31 In 2003, the Accreditation Council for Graduate Medical Education implemented resident duty hour limits that included a weekly limit and limits on continuous hours. Recent recommendations for added reductions in resident duty hours have produced concern about concomitant reductions in future graduates' preparedness for independent practice. The current debate about resident hours largely does not consider whether all hours residents spend in the educational and clinical-care environment contribute meaningfully either to residents' learning or to effective patient care. This may distract the community from waste in the current clinical-education model. We propose that use of “lean production” and quality improvement methods may assist teaching institutions in attaining a deeper understanding of work flow and waste. These methods can be used to assign value to patient- and learner-centered activities and outputs and to optimize the competing and synergistic aspects of all desired outcomes to produce the care the Institute of Medicine recommends: safe, effective, efficient, patient-centered, timely, and equitable. Finally, engagement of senior clinical faculty in determining the culture of the care and education system will contribute to an advanced social-learning and care network. PMID:21976000

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.

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.

Uranium levels in the diet of São Paulo City residents.

PubMed

Garcia, F; Barioni, A; Arruda-Neto, J D T; Deppman, A; Milian, F; Mesa, J; Rodriguez, O

2006-07-01

Natural levels of uranium in the diet of São Paulo City residents were studied, and radionuclide concentrations were measured by the fission track method on samples of typical adult food items. This information was used to evaluate the daily intake of uranium in individuals living in São Paulo City which is, according to our findings, around 0.97 microg U/day. Using the ICRP Uranium-model, we estimated the uranium accumulation and committed doses in some tissues and organs, as function of time. We compared the output of the ICRP uranium biokinetic model, tailored for the conditions prevailing in São Paulo, with experimental data from other localities. Such comparison was possible by means of a simple method we developed, which allows normalization among experimental results from different regions where distinct values of chronic daily intake are observed.

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.

Predictive value of the korean academy of family medicine in-training examination for certifying examination.

PubMed

Cho, Jung-Jin; Kim, Ji-Yong

2011-09-01

In-training examination (ITE) is a cognitive examination similar to the written test, but it is different from the Clinical Practice Examination of the Korean Academy of Family Medicine (KAFM) Certification Examination (CE). The objective of this is to estimate the positive predictive value of the KAFM-ITE for identifying residents at risk for poor performance on the three types of KAFM-CE. 372 residents who completed the KAFM-CE in 2011 were included. We compared the mean KAFM-CE scores with ITE experience. We evaluated the correlation and the positive predictive value (PPV) of ITE for the multiple choice question (MCQ) scores of 1st written test & 2nd slide examination, the total clinical practice examination scores, and the total sum of 2nd test. 275 out of 372 residents completed ITE. Those who completed ITE had significantly higher MCQ scores of 1st written test than those who did not. The correlation of ITE scores with 1st written MCQ (0.627) was found to be the highest among the other kinds of CE. The PPV of the ITE score for 1st written MCQ scores was 0.672. The PPV of the ITE score ranged from 0.376 to 0.502. The score of the KAFM ITE has acceptable positive predictive value that could be used as a part of comprehensive evaluation system for residents in cognitive field.

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 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.

Values Guide Us in Times of Uncertainty: DACA and Graduate Medical Education.

PubMed

Poll-Hunter, Norma I; Young, Geoffrey H; Shick, Matthew

2017-11-01

With a new administration and Congress, there is uncertainty surrounding the future of the Deferred Action for Childhood Arrivals (DACA) program. In light of this uncertainty, medical schools have tried to better understand how they can support trainees with DACA. In their article in this issue, Nakae and colleagues describe the issues often encountered by medical students with DACA as they prepare for residency and by the program directors who receive their applications. They offer recommendations for best practices to support these trainees. The authors of this Invited Commentary expand on these important considerations, based on their experiences at a national level. They argue that the core values in academic medicine should drive decision making, the student voice is critical, teamwork is essential, and wellness deserves attention. Academic medicine is part of a larger movement with partners across the health professions and higher education focused on advancing the values of access and opportunity for all. The authors of this Invited Commentary argue that remaining steadfast and committed to the core values in medicine will allow the academic medicine community to successfully navigate these uncertain times.

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.

Family Satisfaction With Nursing Home Care: The Role of Facility Characteristics and Resident Quality-of-Life Scores

PubMed Central

Shippee, Tetyana P.; Henning-Smith, Carrie; Gaugler, Joseph E.; Held, Robert; Kane, Robert L.

2018-01-01

This article explores the factor structure of a new family satisfaction with nursing home care instrument and determines the relationship of resident quality of life (QOL) and facility characteristics with family satisfaction. Data sources include (1) family satisfaction interviews (n = 16,790 family members), (2) multidimensional survey of resident QOL (n = 13,433 residents), and (3) facility characteristics (n = 376 facilities). We used factor analysis to identify domains of family satisfaction and multivariate analyses to identify the role of facility-level characteristics and resident QOL on facility-mean values of family satisfaction. Four distinct domains were identified for family satisfaction: “care,” “staff,” “environment,” and “food.” Chain affiliation, higher resident acuity, more deficiencies, and large size were all associated with less family satisfaction, and resident QOL was a significant (albeit weak) predictor of family satisfaction. Results suggest that family member satisfaction is distinct from resident QOL but is associated with resident QOL and facility characteristics. PMID:26534835

Socio-Cultural and Economic Valuation of Ecosystem Services Provided by Mediterranean Mountain Agroecosystems

PubMed Central

Bernués, Alberto; Rodríguez-Ortega, Tamara; Ripoll-Bosch, Raimon; Alfnes, Frode

2014-01-01

The aim of this work was to elucidate the socio-cultural and economic value of a number of ecosystem services delivered by mountain agroecosystems (mostly grazing systems) in Euro-Mediterranean regions. We combined deliberative (focus groups) and survey-based stated-preference methods (choice modelling) to, first, identify the perceptions of farmers and other citizens on the most important ecosystem services and, second, to value these in economic terms according to the willingness to pay of the local (residents of the study area) and general (region where the study area is located) populations. Cultural services (particularly the aesthetic and recreational values of the landscape), supporting services (biodiversity maintenance) and some regulating services (particularly fire risk prevention) were clearly recognized by both farmers and citizens, with different degrees of importance according to their particular interests and objectives. The prevention of forest fires (≈50% of total willingness to pay) was valued by the general population as a key ecosystem service delivered by these agroecosystems, followed by the production of specific quality products linked to the territory (≈20%), biodiversity (≈20%) and cultural landscapes (≈10%). The value given by local residents to the last two ecosystem services differed considerably (≈10 and 25% for biodiversity and cultural landscape, respectively). The Total Economic Value of mountain agroecosystems was ≈120 € person−1 year−1, three times the current level of support of agro-environmental policies. By targeting and quantifying the environmental objectives of the European agri-environmental policy and compensating farmers for the public goods they deliver, the so-called “green” subsidies may become true Payments for Ecosystems Services. PMID:25036276

Socio-cultural and economic valuation of ecosystem services provided by Mediterranean mountain agroecosystems.

PubMed

Bernués, Alberto; Rodríguez-Ortega, Tamara; Ripoll-Bosch, Raimon; Alfnes, Frode

2014-01-01

The aim of this work was to elucidate the socio-cultural and economic value of a number of ecosystem services delivered by mountain agroecosystems (mostly grazing systems) in Euro-Mediterranean regions. We combined deliberative (focus groups) and survey-based stated-preference methods (choice modelling) to, first, identify the perceptions of farmers and other citizens on the most important ecosystem services and, second, to value these in economic terms according to the willingness to pay of the local (residents of the study area) and general (region where the study area is located) populations. Cultural services (particularly the aesthetic and recreational values of the landscape), supporting services (biodiversity maintenance) and some regulating services (particularly fire risk prevention) were clearly recognized by both farmers and citizens, with different degrees of importance according to their particular interests and objectives. The prevention of forest fires (≈50% of total willingness to pay) was valued by the general population as a key ecosystem service delivered by these agroecosystems, followed by the production of specific quality products linked to the territory (≈20%), biodiversity (≈20%) and cultural landscapes (≈10%). The value given by local residents to the last two ecosystem services differed considerably (≈10 and 25% for biodiversity and cultural landscape, respectively). The Total Economic Value of mountain agroecosystems was ≈120 € person(-1) year(-1), three times the current level of support of agro-environmental policies. By targeting and quantifying the environmental objectives of the European agri-environmental policy and compensating farmers for the public goods they deliver, the so-called "green" subsidies may become true Payments for Ecosystems Services.

DETERMINANTS OF SPECIALTY CHOICE OF RESIDENT DOCTORS; CASE STUDY--AMONG RESIDENT DOCTORS IN NIGERIA.

PubMed

Osuoji, Roland I; Adebanji, Atinuke; Abdulsalam, Moruf A; Oludara, Mobolaji A; Abolarinwa, Abimbola A

2015-01-01

This study examined medical specialty selection by Nigerian resident doctors using a marketing research approach to determine the selection criteria and the role of perceptions, expected remuneration, and job placement prospects of various specialties in the selection process. Data were from the Community of residents from April 2014 to July 2014. The cohort included 200 residents, but only 171 had complete information. Data were obtained from a cross section of resident doctors in the Lagos State University Teaching Hospital and at the 2014 Ordinary General Meeting of the National Association of Resident Doctors(NARD) where representatives from over 50 Teaching hospitals in Nigeria attended. Using a client behaviour model as a framework, a tripartite questionnaire was designed and administered to residents to deduce information on their knowledge about and interests in various specialties, their opinions of sixteen specialties, and the criteria they used in specialty selection. A total of 171 (85.5%) questionnaires were returned. ln many instances, consistency between selection criteria and perceptions of a specialty were accompanied by interest in pursuing the specialty. Job security, job availability on completion of programme, duration of training and qualifying examinations were highly correlated with p value < 0.05. Results of the Principal Component Analysis show two components (with Eigen values greater than one) explaining 65.3% of the total variance. The first component had placement and training and practice related variables loaded on it while the second component was loaded with job security and financial remuneration related variables. Using marketing research concepts for medical specialty selection (Weissmanet al 2012) stipulates that choice of speciality is influenced by criteria and perception. This study shows that job security expected financial remuneration, and examination requirements for qualification are major determinants of the choice of speciality for residents.

Impact of climate change on mean groundwater residence time in several Mediterranean Spanish aquifers

NASA Astrophysics Data System (ADS)

Pulido-Velazquez, David; Marín-Lechado, Carlos; Martos-Rosillo, Sergio; Collados-Lara, Antonio-Juan; Ruíz-Constan, Ana

2017-04-01

The mean residence time in an aquifer, also known as natural turnover time or renewable period, can be obtained as the relation (R / St) between its storage capacity (St) and its recharge (R). It is an excellent indicator of the aquifer response capacity to its exploitation. Aquifers in which R is close to St values are extremely vulnerable to exploitation, even when it is less than the average recharge. This is especially relevant in Mediterranean climate areas, where long and intensive drought periods appear and will be exacerbated in future scenarios of global change. The natural turnover time depends on the recharge and the Global Change can produce important changes on it in the future. In this research we propose a method for a detailed estimation of natural turnover time by combining detailed 3D geological modelling of the case studies, estimated fields of specific yield for the aquifers (based on the analysis of multiple field sample), and rainfall-recharge models in several aquifer with different ratios of natural turnover time. These detailed 3D geological models have been defined by integrating information coming from seismic profiles, boreholes, magnetotelluric, electromagnetic and electrical sounding, digital elevation models, previous geological maps and new structural dates. They also allow us to deduce the reserve curve as a function of the elevation. On the other hand, different ensemble and downscaling techniques will be used to define potential future global climate change scenarios for the test-regions based on the data coming from simulations with different Regional Circulation Models (RCMs). These precipitation and temperature scenarios will be employed to feed the previously calibrated rainfall-recharge models in order to estimated future recharge and turnover time values. The methodology applied in this work could be a tool of special interest to identify at regional level which aquifers are most vulnerable to exploitation considering hydrogeological and climate change aspects. This research has been supported by the CGL2013-48424-C2-2-R (MINECO) Project.

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.

Are Nursing Students Appropriate Partners for the Interdisciplinary Training of Surgery Residents?

PubMed

Stefanidis, Dimitrios; Ingram, Katherine M; Williams, Kristy H; Bencken, Crystal L; Swiderski, Dawn

2015-01-01

Interdisciplinary team training in a simulation center recreates clinical team interactions and holds promise in improving teamwork of clinicians by breaking down educational silos. The objective of our study was to assess the appropriateness of interdisciplinary training with general surgery residents and nursing students. Over 2 consecutive academic years (2012-2013 and 2013-2014), general surgery residents participated in interdisciplinary team-training simulation-based sessions with senior nursing students. Scenario objectives included demonstration of appropriate teamwork and communication, and clinical decision making; sessions incorporated interdisciplinary debriefing of the scenarios. Participants were asked to assess their team-training experience and the appropriateness of their team-training partner. Responses were compared. A total of 16 team-training sessions were conducted during the study period. Overall, 12 surgery residents (67%) and 44 nursing students (63%) who had participated in at least 1 session responded to the survey. Although both residents and nursing students indicated that the knowledge and team skills acquired during these sessions were useful to them in clinical practice (73% vs 86%, respectively; p = not significant), residents rated their educational value lower (3.3 vs 4.3 on a 5-point scale, respectively; p < 0.01) and only 18% of the residents felt that these sessions should be continued compared with 90% of nursing students (p < 0.05). Most useful components of the sessions were participation in the scenario (73%) and debriefing (54%) for residents and for the nursing students, debriefing (91%), observation of others (68%), and interaction with resident physicians (66%) ranked highest; 48% of student nurses preferred residents as team-training partners whereas 100% residents preferred practicing nurses and 0% with nursing students owing to their limited clinical experience. Interdisciplinary team training and debriefing of surgery residents with nursing students is feasible and highly valued by nursing students. Nevertheless, our experience indicates that residents do not prefer nursing students as team-training partners owing to their limited clinical experience and would rather train with experienced nurses. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Impact of Dean Vortices on the Integrity Testing of a Continuous Viral Inactivation Reactor.

PubMed

Amarikwa, Linus; Orozco, Raquel; Brown, Matthew; Coffman, Jon

2018-05-26

We propose a standard protocol for integrity testing the residence-time distribution (RTD) in a "Jig in a Box" design (JIB)-a previously described tortuous-path, tubular, low-pH, continuous viral inactivation reactor, ensuring that biopharmaceutical products will be incubated for the required minimum residence time, t min . t min is the time by which just 0.001% of the total product containing virus has exited the incubation chamber (i.e., t 0.00001 ). This t 0.00001 is selected to ensure a >4-log reduction in viral load. As current tracers and in-line analytical technologies may not be able to detect tracers at the 0.001% level, an alternative approach is required. The authors describe a method for deriving t min from t 0.005 (i.e., the time at which 0.5% of the product has emerged from the reactor outlet) and an experimentally confirmed offset value, t offset  = t 0.005 -t 0.00001 . The authors also evaluate tracer candidates-including 100-nm-diameter gold nanoparticles, dextrose, monoclonal antibody, and riboflavin-for pre-process acceptability and the effects of viscosity, molecular diffusion coefficient, and particle size. The authors show that a JIB will yield t min and RTDs that are nearly identical for multiple tracers due to Dean vortex induced mixing. Results indicate that almost any small-molecule tracer that is generally recognized as safe can be used in pre-use integrity testing of a continuous viral inactivation reactor under the Deans values (De) of 119-595. © 2018 Boehringer Ingelheim Fremont Inc. Biotechnology Journal published by Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim.

Single-dose toxicokinetics of permethrin in broiler chickens.

PubMed

Gögebakan, T; Eraslan, G

2015-01-01

Single-dose toxicokinetics of permethrin was investigated in broiler chickens. A total of 20 male broiler chickens were assigned at random to two groups of 10 at 30 days of age. A single dose of 10 mg/kg body weight of permethrin was administered intravenously to the first group; in the second group, the same dose was administered into the crop. Serum permethrin was measured using an electron capture detector and gas chromatography equipment. The derived serum permethrin concentration/time curve demonstrated that the distribution kinetics of permethrin was well described by a two-compartment open model. For intravenous permethrin administration, the half-life at λ phase (t1/2λ), mean residence time (MRT) and area under the concentration-time curve in 0→∞ (AUC0→∞) values respectively were 4.73 ± 1.00 h, 5.06 ± 1.05 h and 16.45 ± 3.28 mg/h/l. In contrast, the Cmax, tmax, t1/2λ, MRT and AUC0→∞ values respectively of the group given intra-crop permethrin were 0.60 ± 0.42 μg/ml, 0.55 ± 0.19 h, 5.54 ± 0.78 h, 7.06 ± 0.63 h and 1.95 ± 0.97 mg/h/l. The bioavailability of permethrin was 0.11. For both administration routes, the residence time of permethrin in the body was short and the bioavailability of permethrin was low. These results are relevant for assessing the use and safety of permethrin.