Investing in Community-Based Education to Improve the Quality, Quantity, and Retention of Physicians in Three African Countries

Science.gov (United States)

Talib, Zohray Moolani; Baingana, Rhona Kezabu; Sagay, Atiene Solomon; Van Schalkwyk, Susan Camille; Mehtsun, Sinit; Kiguli-Malwadde, Elsie

2014-01-01

Context The Medical Education Partnership Initiative (MEPI) is a $US 130 million program funded by the United States government supporting 13 African medical schools to increase the quantity, quality, and retention of physicians in underserved areas. This paper examines how community-based education (CBE) is evolving at MEPI schools to achieve these goals. Methods We utilized data from the first two years of site visits and surveys to characterize CBE efforts across the MEPI network and provide detailed descriptions of three models of CBE among the MEPI programs. Results There is widespread investment in CBE, with considerable diversity in the goals and characteristics of training activities among MEPI schools. Three examples described here show how schools are strengthening and evaluating different models of CBE to achieve MEPI goals. In Nigeria, students are being sent for clinical rotations to community hospitals to offload the tertiary hospital. In Uganda, the consistency and quality of teaching in CBE is being strengthened by adopting a competency-based curriculum and developing criteria for community sites. At Stellenbosch University in South Africa, students are now offered an elective year-long comprehensive rural immersion experience. Despite the diversity in CBE models, all schools are investing in e-learning and faculty development. Extensive evaluations are planned to examine the impact of CBE strategies on the health workforce and health services. Discussion The MEPI program is stimulating an evolution in CBE among African medical schools to improve the quality, quantity, and retention of physicians. Identifying the strategies within CBE that are reproducible, scalable and optimize outcomes will be instructive for health professions training programs across the continent. PMID:24200732

Mobility of US Rural Primary Care Physicians During 2000-2014.

Science.gov (United States)

McGrail, Matthew R; Wingrove, Peter M; Petterson, Stephen M; Bazemore, Andrew W

2017-07-01

Despite considerable investment in increasing the number of primary care physicians in rural shortage areas, little is known about their movement rates and factors influencing their mobility. We aimed to characterize geographic mobility among rural primary care physicians, and to identify location and individual factors that influence such mobility. Using data from the American Medical Association Physician Masterfile for each clinically active US physician, we created seven 2-year (biennial) mobility periods during 2000-2014. These periods were merged with county-level "rurality," physician supply, economic characteristics, key demographic measures, and individual physician characteristics. We computed (1) mobility rates of physicians by rurality; (2) linear regression models of county-level rural nonretention (departure); and (3) logit models of physicians leaving rural practice. Biennial turnover was about 17% among physicians aged 45 and younger, compared with 9% among physicians aged 46 to 65, with little difference between rural and metropolitan groups. County-level physician mobility was higher for counties that lacked a hospital (absolute increase = 5.7%), had a smaller population size, and had lower primary care physician supply, but area-level economic and demographic factors had little impact. Female physicians (odds ratios = 1.24 and 1.46 for those aged 45 or younger and those aged 46 to 65, respectively) and physicians born in a metropolitan area (odds ratios = 1.75 and 1.56 for those aged 45 or younger and those aged 46 to 65, respectively) were more likely to leave rural practice. These flndings provide national-level evidence of rural physician mobility rates and factors associated with both county-level retention and individual-level departures. Outcomes were notably poorer in the most remote locations and those already having poorer physician supply and professional support. Rural health workforce planners and policymakers must be cognizant of

Retention of skills 2 years after completion of a postpartum hemorrhage simulation training program in rural Rwanda.

Science.gov (United States)

Nathan, Lisa M; Patauli, Desire; Nsabimana, Damien; Bernstein, Peter S; Rulisa, Stephen; Goffman, Dena

2016-09-01

To evaluate the long-term retention of skills gained by rural physicians who completed a postpartum hemorrhage simulation-training program. A quasi-experimental pre-post intervention study enrolled a convenience sample of generalist physicians in rural Rwanda. Participants underwent initial simulation training including pre- and post-training testing in February 2012. Simulation drills to assess skill retention were conducted in March 2014. Participants were scored based on their communication, evaluation, and management skills. Median scores and inter-quartile ranges were calculated and the Wilcoxon signed-rank sum test was used to compare the pre-training, post-training, and retention scores. Physician confidence was assessed using a survey. In total, 11 physicians were enrolled; eight were available for the 2-year skill-retention evaluation. Significant improvements were observed when comparing participants' pre-training and post-training communication (P=0.03), evaluation (P=0.05), and management (P=0.02) scores, and there were no changes between participants' post-training and 2-year communication (P>0.99), evaluation (P=0.16), and management (P=0.46) scores. There were no differences in the self-reported confidence measures across the duration of the study. Simulation training is an effective method for teaching postpartum hemorrhage-management skills to generalist physicians in rural areas and skills are retained for at least 2 years. Further studies could determine the optimal time intervals for refresher training. Copyright © 2016 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

Patient-centered recruitment and retention for a randomized controlled study.

Science.gov (United States)

Chhatre, Sumedha; Jefferson, Ashlie; Cook, Ratna; Meeker, Caitlin R; Kim, Ji Hyun; Hartz, Kayla Marie; Wong, Yu-Ning; Caruso, Adele; Newman, Diane K; Morales, Knashawn H; Jayadevappa, Ravishankar

2018-03-27

Recruitment and retention strategies for patient-centered outcomes research are evolving and research on the subject is limited. In this work, we present a conceptual model of patient-centered recruitment and retention, and describe the recruitment and retention activities and related challenges in a patient-centered comparative effectiveness trial. This is a multicenter, longitudinal randomized controlled trial in localized prostate cancer patients. We recruited 743 participants from three sites over 15 months period (January 2014 to March 2015), and followed them for 24 months. At site 1, of the 773 eligible participants, 551 (72%) were enrolled. At site 2, 34 participants were eligible and 23 (68%) enrolled. Of the 434 eligible participants at site 3, 169 (39%) enrolled. We observed that strategies related to the concepts of trust (e.g., physician involvement, ensuring protection of information), communication (e.g., brochures and pamphlets in physicians' offices, continued contact during regular clinic visits and calling/emailing assessment), attitude (e.g., emphasizing the altruistic value of research, positive attitude of providers and research staff), and expectations (e.g., full disclosure of study requirements and time commitment, update letters) facilitated successful patient recruitment and retention. A stakeholders' advisory board provided important input for the recruitment and retention activities. Active engagement, reminders at the offices, and personalized update letters helped retention during follow-up. Usefulness of telephone recruitment was site specific and, at one site, the time requirement for telephone recruitment was a challenge. We have presented multilevel strategies for successful recruitment and retention in a clinical trial using a patient-centered approach. Our strategies were flexible to accommodate site-level requirements. These strategies as well as the challenges can aid recruitment and retention efforts of future large

Studying physician effects on patient outcomes: physician interactional style and performance on quality of care indicators.

Science.gov (United States)

Franks, Peter; Jerant, Anthony F; Fiscella, Kevin; Shields, Cleveland G; Tancredi, Daniel J; Epstein, Ronald M

2006-01-01

Many prior studies which suggest a relationship between physician interactional style and patient outcomes may have been confounded by relying solely on patient reports, examining very few patients per physician, or not demonstrating evidence of a physician effect on the outcomes. We examined whether physician interactional style, measured both by patient report and objective encounter ratings, is related to performance on quality of care indicators. We also tested for the presence of physician effects on the performance indicators. Using data on 100 US primary care physician (PCP) claims data on 1,21,606 of their managed care patients, survey data on 4746 of their visiting patients, and audiotaped encounters of 2 standardized patients with each physician, we examined the relationships between claims-based quality of care indicators and both survey-derived patient perceptions of their physicians and objective ratings of interactional style in the audiotaped standardized patient encounters. Multi-level models examined whether physician effects (variance components) on care indicators were mediated by patient perceptions or objective ratings of interactional style. We found significant physician effects associated with glycohemoglobin and cholesterol testing. There was also a clinically significant association between better patient perceptions of their physicians and more glycohemoglobin testing. Multi-level analyses revealed, however, that the physician effect on glycohemoglobin testing was not mediated by patient perceived physician interaction style. In conclusion, similar to prior studies, we found evidence of an apparent relationship between patient perceptions of their physician and patient outcomes. However, the apparent relationships found in this study between patient perceptions of their physicians and patient care processes do not reflect physician style, but presumably reflect unmeasured patient confounding. Multi-level modeling may contribute to better

Effects of fire ash on soil water retention

NARCIS (Netherlands)

Stoof, C.R.; Wesseling, J.G.; Ritsema, C.J.

2010-01-01

Despite the pronounced effect of fire on soil hydrological systems, information on the direct effect of fire on soil water retention characteristics is limited and contradictory. To increase understanding in this area, the effect of fire on soil water retention was evaluated using laboratory burning

Treatment of chemical warfare agent casualties: retention of knowledge and self-perceived competency among military physicians and paramedics.

Science.gov (United States)

Shiyovich, Arthur; Statlender, Liran; Abu-Tailakh, Muhammad; Plakht, Ygal; Shrot, Shai; Kassirer, Michael

2015-06-01

Specialized training of medical teams for chemical warfare agent (CWA) events is important to save lives. We aimed to evaluate the retention of knowledge (ROK) and self-perceived competency (SPC) of military medical personnel in delivering treatment during CWA events. A questionnaire and a multiple-choice examination were sent to military physicians and paramedics, evaluating their CWA, ROK, and SPC (study group [SG]). Their assessment was compared to medical personnel immediately post training (reference group [RG]). SG was subdivided into two groups: G1 ≤ 1 year and G2 > 1 year, past training. Overall, 135 participants responded (35-RG, 65% physicians). Self-reported ROK and SPC were significantly higher in RG compared to SG and in G1 compared to G2. Test scores were higher in RG compared to SG, but similar in G1 and G2 groups. SPC was lower compared to ROK in the entire cohort and subgroups. A moderate correlation was found between the self-and test-assessed scores (Pearson correlation coefficient 0.45, p ROK. Thus, we recommend CWA refresher training at least every year. Reprint & Copyright © 2015 Association of Military Surgeons of the U.S.

Effectiveness of a Unique Support Group for Physicians in a Physician Health Program.

Science.gov (United States)

Sanchez, Luis T; Candilis, Philip J; Arnstein, Fredrick; Eaton, Judith; Barnes Blood, Diana; Chinman, Gary A; Bresnahan, Linda R

2016-01-01

State Physician Health Programs (PHPs) assess, support, and monitor physicians with mental, behavioral, medical, and substance abuse problems. Since their formation in the 1970s, PHPs have offered support groups following the 12-step model for recovery from substance use disorders (SUDs). However, few programs have developed support groups for physicians without SUDs. This study at the Massachusetts PHP (Physician Health Services Inc.) represents the first effort to survey physician attitudes concerning a unique support group that goes beyond classic addiction models. The group was initiated because of the observation that physicians with problems other than SUDs did not fit easily into the 12-step framework. It was hypothesized that such a group would be effective in helping participants control workplace stress, improve professional and personal relationships, and manage medical and psychiatric difficulties. With a response rate of 43% (85 respondents), the survey identified a strong overall impact of the Physician Health Services Inc. support group, identifying positive effects in all areas of personal and professional life: family and friends, wellness, professional relationships, and career. Respondents identified the role of the facilitator as particularly important, underscoring the facilitator's capacity to welcome participants, manage interactions, set limits, and maintain a supportive emotional tone. The implications for physician health extend from supporting a broader application of this model to using a skilled facilitator to manage groups intended to reduce the stress and burnout of present-day medical practice. The results encourage PHPs, hospitals, medical practices, and physician groups to consider implementing facilitated support groups as an additional tool for maintaining physician health.

A national study of the retention of Irish opiate users in methadone substitution treatment

LENUS (Irish Health Repository)

Mullen, Louise

2012-07-02

Background: Retention in treatment is a key indicator of methadone treatment success. The study aims to identify factors that are associated with retention. Objectives: To determine retention in treatment at 12 months for Irish opiate users in methadone substitution treatment and to indicate factors that increase the likelihood of retention. Methods: National cohort study of randomly selected opiate users commencing methadone treatment in 1999, 2001, and 2003 (n = 1269). Results: Sixty-one percent of patients attending methadone treatment remained in continuous treatment for more than 1 year. Retention in treatment at 12 months was associated with age, gender, facility type, and methadone dose. Age and gender were no longer significant when adjusted for other variables in the model. Those who attended a specialist site were twice as likely to leave methadone treatment within 12 months compared with those who attended a primary care physician. The most important predictor of retention in treatment was methadone dose. Those who received <60 mg of methadone were three times more likely to leave treatment. Conclusion: Retention in methadone treatment is high in Ireland in a variety of settings. The main factors influencing retention in methadone treatment was an adequate methadone dose and access to a range of treatment settings including from primary care physicians. Scientific Significance: Providing an adequate dose of methadone during treatment will increase the likelihood of treatment retention. Methadone treatment by the primary care physician is a successful method of retaining opioid users in treatment.

The effect of explicit financial incentives on physician behavior.

Science.gov (United States)

Armour, B S; Pitts, M M; Maclean, R; Cangialose, C; Kishel, M; Imai, H; Etchason, J

2001-05-28

Managed care organizations use explicit financial incentives to influence physicians' use of resources. This has contributed to concerns regarding conflicts of interest for physicians and adverse effects on the quality of patient care. In light of recent publicized legislative and legal battles about this issue, we reviewed the literature and analyzed studies that examine the effect of these explicit financial incentives on the behavior of physicians. The method used to undertake the literature review followed the approach set forth in the Cochrane Collaboration handbook. Our literature review revealed a paucity of data on the effect of explicit financial incentives. Based on this limited evidence, explicit incentives that place individual physicians at financial risk appear to be effective in reducing physician resource use. However, the empirical evidence regarding the effectiveness of bonus payments on physician resource use is mixed. Similarly, our review revealed mixed effects of the influence of explicit financial incentives on the quality of patient care. The effect of explicit financial incentives on physician behavior is complicated by a lack of understanding of the incentive structure by the managed care organization and the physician. The lack of a universally acceptable definition of quality renders it important that future researchers identify the term explicitly.

Click it: assessment of classroom response systems in physician assistant education.

Science.gov (United States)

Graeff, Evelyn C; Vail, Marianne; Maldonado, Ana; Lund, Maha; Galante, Steve; Tataronis, Gary

2011-01-01

The effect that classroom response systems, or clickers, have on knowledge retention and student satisfaction was studied in a physician assistant program. A clicker, a device similar to a remote control, was used by students to answer questions during lectures. This new technology has been marketed to educators as beneficial in keeping students actively involved and increasing their attentiveness in the classroom. To date, the results of studies on knowledge retention with the use of clickers have been mixed. For this pilot study, the students were divided into two groups with a pre- and post-test given in order to evaluate knowledge retention. One group received lectures in a traditional format, while the other group received the lectures incorporating clicker response questions. After the test scores from four lectures were analyzed, the incorporation of clickers did not alter knowledge retention. Retention of knowledge from both groups was similar and no statistical difference was found. However, student satisfaction regarding the use of clickers was positive. Students reported that clickers kept them more actively involved, increased attentiveness, and made lectures more enjoyable. Although the pilot study did not show a greater improvement in knowledge retention with the use of clickers, further research is needed to assess their effectiveness.

The Causal Effects of Grade Retention on Behavioral Outcomes

Science.gov (United States)

Martorell, Paco; Mariano, Louis T.

2018-01-01

This study examines the impact of grade retention on behavioral outcomes under a comprehensive assessment-based student promotion policy in New York City. To isolate the causal effect of grade retention, we implement a fuzzy regression discontinuity (RD) design that exploits the fact that grade retention is largely determined by whether a student…

ACOG Committee Opinion No. 587: Effective patient-physician communication.

Science.gov (United States)

2014-02-01

Physicians' ability to effectively and compassionately communicate information is key to a successful patient-physician relationship. The current health care environment demands increasing clinical productivity and affords less time with each patient, which can impede effective patient-physician communication. The use of patient-centered interviewing, caring communication skills, and shared decision making improves patient-physician communication. Involving advanced practice nurses or physician assistants may improve the patient's experience and understanding of her visit. Electronic communication with established patients also can enhance the patient experience in select situations.

Wind Effects on Retention Time in Highway Ponds

DEFF Research Database (Denmark)

Bentzen, Thomas Ruby; Larsen, Torben; Rasmussen, Michael R.

2007-01-01

is to evaluate the quality of long term simulations based on historical rain series of the pollutant discharges from roads and highways. The idea of this paper is to evaluate the effects of wind on the retention time and compare the retention time for the situation of a spatial uniform wind shear stress...... with the situation of a "real" spatial non-uniform shear stress distribution on the surface of the pond. The result of this paper shows that wind plays a dominant role for the retention time and flow pattern. Furthermore, the results shows that the differences in retention time between the use of uniform and non...

Wind Effects on Retention Time in Highway Ponds

DEFF Research Database (Denmark)

Bentzen, Thomas Ruby; Larsen, Torben; Rasmussen, Michael R.

2008-01-01

is to evaluate the quality of long term simulations based on historical rain series of the pollutant discharges from roads and highways. The idea of this paper is to evaluate the effects of wind on the retention time and compare the retention time for the situation of a spatial uniform wind shear stress...... with the situation of a "real" spatial non-uniform shear stress distribution on the surface of the pond. The result of this paper shows that wind plays a dominant role for the retention time and flow pattern. Furthermore, the results shows that the differences in retention time between the use of uniform and non...

Guidelines for Improving Entry Into and Retention in Care and Antiretroviral Adherence for Persons With HIV: Evidence-Based Recommendations From an International Association of Physicians in AIDS Care Panel

Science.gov (United States)

Thompson, Melanie A.; Mugavero, Michael J.; Amico, K. Rivet; Cargill, Victoria A.; Chang, Larry W.; Gross, Robert; Orrell, Catherine; Altice, Frederick L.; Bangsberg, David R.; Bartlett, John G.; Beckwith, Curt G.; Dowshen, Nadia; Gordon, Christopher M.; Horn, Tim; Kumar, Princy; Scott, James D.; Stirratt, Michael J.; Remien, Robert H.; Simoni, Jane M.; Nachega, Jean B.

2014-01-01

Description After HIV diagnosis, timely entry into HIV medical care and retention in that care are essential to the provision of effective antiretroviral therapy (ART). ART adherence is among the key determinants of successful HIV treatment outcome and is essential to minimize the emergence of drug resistance. The International Association of Physicians in AIDS Care convened a panel to develop evidence-based recommendations to optimize entry into and retention in care and ART adherence for people with HIV. Methods A systematic literature search was conducted to produce an evidence base restricted to randomized, controlled trials and observational studies with comparators that had at least 1 measured biological or behavioral end point. A total of 325 studies met the criteria. Two reviewers independently extracted and coded data from each study using a standardized data extraction form. Panel members drafted recommendations based on the body of evidence for each method or intervention and then graded the overall quality of the body of evidence and the strength for each recommendation. Recommendations Recommendations are provided for monitoring of entry into and retention in care, interventions to improve entry and retention, and monitoring of and interventions to improve ART adherence. Recommendations cover ART strategies, adherence tools, education and counseling, and health system and service delivery interventions. In addition, they cover specific issues pertaining to pregnant women, incarcerated individuals, homeless and marginally housed individuals, and children and adolescents, as well as substance use and mental health disorders. Recommendations for future research in all areas are also provided. PMID:22393036

Bleeding talent: a lesson from industry on embracing physician workforce challenges.

Science.gov (United States)

Kneeland, Patrick P; Kneeland, Christine; Wachter, Robert M

2010-01-01

Shortages of both generalist and specialist physicians are intensifying as the US healthcare system confronts an unprecedented confluence of demographic pressures, including an aging population, the retirement of thousands of baby-boomer physicians, the growth of nonpractice opportunities for MDs, and physician demands for greater work-life balance. This work posits that the medical profession might benefit from recognizing how progressive nonmedical companies systematically approach similar "talent shortages" through a recruiting and retention strategy called "talent facilitation." It highlights the 4 actions of talent facilitation (attract, engage, develop, and retain) and provides examples of how each action might be utilized to address medicine's recruitment and retention challenges. Although other policy maneuvers are needed to address overall physician workforce shortages (such as the planned opening of more medical schools and changes in the payment system to promote primary care), the talent facilitation approach can help individual organizations meet their needs and those of their patients. Copyright 2010 Society of Hospital Medicine.

Deferred Personal Life Decisions of Women Physicians.

Science.gov (United States)

Bering, Jamie; Pflibsen, Lacey; Eno, Cassie; Radhakrishnan, Priya

2018-05-01

Inadequate work-life balance can have significant implications regarding individual performance, retention, and on the future of the workforce in medicine. The purpose of this study was to determine whether women physicians defer personal life decisions in pursuit of their medical career. We conducted a survey study of women physicians ages 20-80 from various medical specialties using a combination of social media platforms and women physicians' professional listservs with 801 survey responses collected from May through November 2015. The primary endpoint was whether women physicians deferred personal life decisions in pursuit of their medical career. Secondary outcomes include types of decisions deferred and correlations with age, hours worked per week, specialty, number of children, and career satisfaction. Respondents were categorized into deferred and nondeferred groups. Personal decision deferments were reported by 64% of respondents. Of these, 86% reported waiting to have children and 22% reported waiting to get married. Finally, while 85% of women in the nondeferment group would choose medicine again as a career, only 71% of women in the deferment group would do so (p job satisfaction, and insurance/administrative burden. The results of this survey have significant implications on the future of the workforce in medicine. Overall, our analysis shows that 64% of women physicians defer important life decisions in pursuit of their medical career. With an increase in the number of women physicians entering the workforce, lack of support and deferred personal decisions have a potential negative impact on individual performance and retention. Employers must consider the economic impact and potential workforce shortages that may develop if these issues are not addressed.

Development of physician leadership competencies: perceptions of physician leaders, physician educators and medical students.

Science.gov (United States)

McKenna, Mindi K; Gartland, Myles P; Pugno, Perry A

2004-01-01

Research regarding the development of healthcare leadership competencies is widely available. However, minimal research has been published regarding the development of physician leadership competencies, despite growing recognition in recent years of the important need for effective physician leadership. Usingdata from an electronically distributed, self-administered survey, the authors examined the perceptions held by 110 physician leaders, physician educators, and medical students regarding the extent to which nine competencies are important for effective physician leadership, ten activities are indicative of physician leadership, and seven methods are effective for the development of physician leadership competencies. Results indicated that "interpersonal and communication skills" and "professional ethics and social responsibility" are perceived as the most important competencies for effective physician leadership. Furthermore, respondents believe "influencing peers to adopt new approaches in medicine" and "administrative responsibility in a healthcare organization" are the activities most indicative of effective physician leadership. Finally, respondents perceive"coaching or mentoring from an experienced leader" and "on-job experience (e.g., a management position)" as the most effective methods for developing physician leadership competencies. The implications of these findings for the education and development of physician leaders are discussed.

The contributions of encoding, retention, and recall to the Hebb effect.

Science.gov (United States)

Oberauer, Klaus; Meyer, Nadine

2009-10-01

The article reports an experiment testing whether the Hebb repetition effect-the gradual improvement of immediate serial recall when the same list is repeated several times-depends on overt recall of the repeated lists. Previous reports which suggest that recall is critical confound the recall manipulation with retention interval. The present experiment orthogonally varies retention interval (0 or 9 s) and whether the list is to be recalled after the retention interval. Hebb repetition learning is assessed in a final test phase. A repetition effect was obtained in all four experimental conditions; it was larger for recalled than non-recalled lists, whereas retention interval had no effect. The results show that encoding is sufficient to generate cumulative long-term learning, which is strengthened by recall. Rehearsal, if it takes place in the retention interval at all, does not have the same effect on long-term learning as overt recall.

Continuing medical education effect on physician knowledge application and psychomotor skills: effectiveness of continuing medical education: American College of Chest Physicians Evidence-Based Educational Guidelines.

Science.gov (United States)

O'Neil, Kevin M; Addrizzo-Harris, Doreen J

2009-03-01

Recommendations for optimizing continuing medical education (CME) effectiveness in improving physician application of knowledge and psychomotor skills are needed to guide the development of processes that effect physician change and improve patient care. The guideline panel reviewed evidence tables and a comprehensive review of the effectiveness of CME developed by The Johns Hopkins Evidence-based Practice Center for the Agency for Healthcare Research and Quality (AHRQ Evidence Report). The panel considered studies relevant to the effect of CME on physician knowledge application and psychomotor skill development. From the 136 studies identified in the systematic review, 15 articles, 12 addressing physician application of knowledge and 3 addressing psychomotor skills, were identified and reviewed. Recommendations for optimizing CME were developed using the American College of Chest Physicians guideline grading system. The preponderance of evidence demonstrated improvement in physician application of knowledge with CME. The quality of evidence did not allow specific recommendations regarding optimal media or educational techniques or the effectiveness of CME in improving psychomotor skills. CME is effective in improving physician application of knowledge. Multiple exposures and longer durations of CME are recommended to optimize educational outcomes.

Direct-to-consumer pharmaceutical advertising: physician and public opinion and potential effects on the physician-patient relationship.

Science.gov (United States)

Robinson, Andrew R; Hohmann, Kirsten B; Rifkin, Julie I; Topp, Daniel; Gilroy, Christine M; Pickard, Jeffrey A; Anderson, Robert J

2004-02-23

Previous studies have shown that direct-to-consumer (DTC) pharmaceutical advertising can influence consumer behavior and that many physicians have negative views of these advertisements. Physician and public opinions about these advertisements and how they may affect the physician-patient relationship are not well established. Mail survey of 523 Colorado physicians and 261 national physicians and telephone survey of 500 Colorado households asking respondents to rate their agreement with statements about DTC advertising. Most physicians tended to view DTC advertisements negatively, indicating that such advertisements rarely provide enough information on cost (98.7%), alternative treatment options (94.9%), or adverse effects (54.8%). Most also believed that DTC advertisements affected interactions with patients by lengthening clinical encounters (55.9%), leading to patient requests for specific medications (80.7%), and changing patient expectations of physicians' prescribing practices (67.0%). Only 29.0% of public respondents agreed that DTC advertising is a positive trend in health care and 28.6% indicated that advertisements make them better informed about medical problems; fewer indicated that advertisements motivated them to seek care (10.5%) or led them to request specific medications from their physicians (13.3%). Most physicians have negative views of DTC pharmaceutical advertising and see several potential effects of these advertisements on the physician-patient relationship. Many public respondents have similarly negative views, and only a few agree that they change their expectations of or interactions with physicians. While these advertisements may be influencing only a few consumers, it seems that the impact on physicians and their interactions with patients may be significant.

Investing in Physicians Is Investing in Patients: Enhancing Patient Safety Through Physician Health and Well-being Research.

Science.gov (United States)

Brooks, Elizabeth; Gundersen, Doris C; Gendel, Michael H

2017-07-20

Keeping medical practitioners healthy is an important consideration for workforce satisfaction and retention, as well as public safety. However, there is limited evidence demonstrating how to best care for this group. The absence of data is related to the lack of available funding in this area of research. Supporting investigations that examine physician health often "fall through the cracks" of traditional funding opportunities, landing somewhere between patient safety and workforce development priorities. To address this, funders must extend the scope of current grant opportunities by broadening the scope of patient safety and its relationship to physician health. Other considerations are allocating a portion of doctors' licensing fees to support physician health research and encourage researchers to collaborate with interested stakeholders who can underwrite the costs of studies. Ultimately, funding studies of physician health benefits not only the community of doctors but also the millions of patients receiving care each year.

Cognitive and Other Strategies to Mitigate the Effects of Fatigue. Lessons from Staff Physicians Working in Intensive Care Units.

Science.gov (United States)

Henrich, Natalie; Ayas, Najib T; Stelfox, Henry T; Peets, Adam D

2016-09-01

Fatigue is common among physicians and adversely affects their performance. To identify strategies that attending physicians use when fatigued to maintain clinical performance in the intensive care unit (ICU). We conducted a qualitative study using focus groups and structured interviews of attending ICU physicians working in academic centers in Canada. In three focus group meetings, we engaged a total of 11 physicians to identify strategies used to prevent and cope with fatigue. In the focus groups, 21 cognitive strategies were identified and classified into 9 categories (minimizing number of tasks, using techniques to improve retention of details, using a structured approach to patient care, asking for help, improving opportunities for focusing, planning ahead, double-checking, adjusting expectations, and modulating alertness). In addition, various lifestyle strategies were mentioned as important in preventing fatigue (e.g., protecting sleep before call, adequate exercise, and limiting alcohol). Telephone interviews were then conducted (n = 15 physicians) with another group of intensivists. Structured questions were asked about the strategies identified in the focus groups that were most useful during ICU activities. In the interviews, the most useful and frequently used strategies were prioritizing tasks that need to be done immediately and postponing tasks that can wait, working systematically, using a structured approach, and avoiding distractions. ICU physicians reported using a variety of deliberate cognitive and lifestyle strategies to prevent and cope with fatigue. Given the low cost and intuitive nature of the majority of these strategies, further investigations should be done to better characterize their effectiveness in improving performance.

Rural retention of new medical graduates from the Collaborative Project to Increase Production of Rural Doctors (CPIRD): a 12-year retrospective study.

Science.gov (United States)

Techakehakij, Win; Arora, Rajin

2017-07-01

Physician scarcity in rural areas is a major obstacle to healthcare access, leading to health inequity worldwide. In Thailand, a special recruitment program of medical education [Collaborative Project to Increase Production of Rural Doctors (CPIRD)] was initiated with four different medical training tracks. No previous research has examined the rural retention of new medical graduates across the CPIRD tracks, compared with those receiving conventional medical education (Normal track). This study examines the public retention of rural physicians from different tracks of entry. A retrospective study was conducted in new medical graduates who entered Ministry of Public Health (MoPH) hospitals from January 2003 to October 2014, and followed up until June 2015, using administrative data from the Personnel Administration Division, MoPH. The CPIRD registry database was used to identify physicians' tracks of entry. Survival analyses and multiple logistic regression analyses were applied to compare the annual retention and the probability of 3-year retention of rural physicians. Results clearly demonstrated a high rural retention of CPIRD medical graduates, compared with their Normal track peers, regarding both lower annual resignation (HR 0.456, P rural retention were revealed across the different CPIRD tracks. Evidence from this study can be used as part of the information to reshape the physician production policy to reduce health inequity in rural areas. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

FRAMING EFFECTS ON PHYSICIANS' JUDGMENT AND DECISION MAKING.

Science.gov (United States)

Bui, Thanh C; Krieger, Heather A; Blumenthal-Barby, Jennifer S

2015-10-01

This study aimed to assess physicians' susceptibility to framing effects in clinical judgment and decision making. A survey was administered online to 159 general internists in the United States. Participants were randomized into two groups, in which clinical scenarios varied in their framings: frequency vs percentage, with cost information vs without, female patient vs male patient, and mortality vs survival. Results showed that physicians' recommendations for patients in hypothetical scenarios were significantly different when the predicted probability of the outcomes was presented in frequency versus percentage form and when it was presented in mortality rate vs survival rate of the same magnitude. Physicians' recommendations were not different for other framing effects.

The Effect of Supplemental Instruction on Retention: A Bivariate Probit Model

Science.gov (United States)

Bowles, Tyler J.; Jones, Jason

2004-01-01

Single equation regression models have been used to test the effect of Supplemental Instruction (SI) on student retention. These models, however, fail to account for the two salient features of SI attendance and retention: (1) both SI attendance and retention are categorical variables, and (2) are jointly determined endogenous variables. Adopting…

Managing Chemotherapy Side Effects: Swelling (Fluid Retention)

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N ational C ancer I nstitute Managing Chemotherapy Side Effects Swelling (Fluid retention) “My hands and feet were swollen and puffy. My nurse helped me understand why I had to stop eating salty ...

Thermal effect on water retention curve of bentonite: experiment and thermodynamic modeling

International Nuclear Information System (INIS)

Qin Bing; Chen Zhenghai; Sun Faxin; Liu Yuemiao; Wang Ju

2012-01-01

The thermal effects on water retention curve of GMZ bentonite were investigated experimentally and theoretically. Water retention tests were conducted on GMZ bentonite at five temperatures ranging from 20℃ to 100℃. Test results showed that the water retention capacity and the hysteresis of the water retention curve decreased with increasing temperature, and that the water retention curves at different temperatures were almost parallel to each other. Based on the thermodynamics of sorption, a model was established to describe the temperature influence on the water retention curve. The model was validated by comparing the model predictions and the test results. (authors)

IRS proposes ruling on physician recruitment. How a hospital recruits physicians would affect its tax-exempt status.

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Griffith, G M

1996-01-01

On March 15, 1995, the Internal Revenue Service (IRS) announced a proposed revenue ruling stating how certain physician recruitment practices could be implemented without threatening hospitals' tax-exemption. As proposed, the IRS ruling would provide flexibility for recruitment incentives rather than a list of strict physician recruitment guidelines. The proposed ruling is not legally binding until issued in final form, and there is no deadline for finalizing it. In the meantime, however, the standards outlined in the proposed ruling reflect arrangements the IRS likely would approve, which should be an incentive for tax-exempt hospitals to follow reasonable physician recruitment practices. Assuming a hospital complies with other legal requirements such as fraud and abuse laws, it must answer two key tax-exempt status questions for its recruitment or retention package: Will the incentives result in a disguised distribution of profits from the operation of the organization? Is the total incentive package reasonable under all the facts and circumstances, both in absolute total value for physician(s) recruited and in relation to services required by the hospital and the community? The proposed ruling also provides guidance on basic documentation requirements and a process for approving recruitment arrangements.

Effective recruitment and retention strategies in community health programs.

Science.gov (United States)

McCann, Jennifer; Ridgers, Nicola D; Carver, Alison; Thornton, Lukar E; Teychenne, Megan

2013-08-01

The aim of this project was to identify effective recruitment and retention strategies used by health-promotion organisations that focus on increasing physical activity and improving nutrition within the local community. Semistructured telephone or face-to-face interviews with 25 key informants from stakeholder organisations were conducted. Key informants discussed strategies used by their organisation to effectively recruit and retain participants into community-based healthy eating and/or physical activity programs. Transcribed data were analysed with NVivo software. Effective recruitment strategies included word of mouth, links with organisations, dissemination of printed materials, media, referrals, cross-promotion of programs and face-to-face methods. Effective retention strategies included encouraging a sense of community ownership, social opportunities, recruiting a suitable leader and offering flexibility and support. Fees and support for recruiting and retaining participants was also identified. This study provides novel insights to a greatly under researched topic in the field of health promotion. There are two key take-home messages from the present study that are applicable to health practitioners as well as developers and deliverers of community health-promotion programs: (1) it is imperative that all community health organisations report on the effectiveness of their recruitment and retention, both successes and failures; and (2) there is a clear need to tailor the recruitment and retention approach to the target population and the setting the program is occurring in. SO WHAT? These findings provide important insights for the development of future community-based healthy eating and physical activity programs.

Difficulties facing physician mothers in Japan.

Science.gov (United States)

Yamazaki, Yuka; Kozono, Yuki; Mori, Ryo; Marui, Eiji

2011-11-01

Despite recent increases in the number of female physicians graduating in Japan, their premature resignations after childbirth are contributing to the acute shortage of physicians. Previous Japanese studies have explored supportive measures in the workplace, but have rarely focused on the specific problems or concerns of physician-mothers. Therefore, this study explored the challenges facing Japanese physician-mothers in efforts to identify solutions for their retention. Open-ended questionnaires were mailed to 646 alumnae of Juntendo University School of Medicine. We asked subjects to describe their opinions about 'The challenges related to female physicians' resignations'. Comments gathered from alumnae who graduated between 6 and 30 years ago and have children were analyzed qualitatively. Overall, 249 physicians returned the questionnaire (response rate 38.5%), and 73 alumnae with children who graduated in the stated time period provided comments. The challenges facing physician-mothers mainly consisted of factors associated with Japanese society, family responsibilities, and work environment. Japanese society epitomized by traditional gender roles heightened stress related to family responsibilities and promoted gender discrimination at work environment. Additionally, changing Japanese society positively influenced working atmosphere and husband's support. Moreover, the introduction of educational curriculums that alleviated traditional gender role was proposed for pre- and post- medical students. Traditional gender roles encourage discrimination by male physicians or work-family conflicts. The problems facing female physicians involve more than just family responsibilities: diminishing the notion of gender role is key to helping retain them in the workforce. © 2011 Tohoku University Medical Press

Employer retention strategies and their effect on nurses' job satisfaction and intent to stay.

Science.gov (United States)

Ellenbecker, Carol Hall; Samia, Linda; Cushman, Margaret J; Porell, Frank W

2007-01-01

Faced with a nursing shortage and anticipated increase in demand, home care agencies are implementing retention strategies with little knowledge of their effectiveness. The purpose of this study is to describe the strategies implemented and their effect on nurse job satisfaction and intention to leave. Data were collected from a random sample of 123 New England agencies during in-person interviews. Most agencies reported implementing multiple recruitment and retention strategies. Regression results suggest that the effects of employer retention strategy on nurses' intent to stay are the indirect result of its effects on job satisfaction. The only retention intervention that made a statistically significant difference in job satisfaction was shared governance, and no retention strategy directly affected nurses' intention to stay in their jobs.

Physician gender effects in medical communication: a meta-analytic review.

Science.gov (United States)

Roter, Debra L; Hall, Judith A; Aoki, Yutaka

2002-08-14

Physician gender has been viewed as a possible source of variation in the interpersonal aspects of medical practice, with speculation that female physicians facilitate more open and equal exchange and a different therapeutic milieu from that of male physicians. However, studies in this area are generally based on small samples, with conflicting results. To systematically review and quantify the effect of physician gender on communication during medical visits. Online database searches of English-language abstracts for the years 1967 to 2001 (MEDLINE, AIDSLINE, PsycINFO, and Bioethics); a hand search was conducted of reprint files and the reference sections of review articles and other publications. Studies using a communication data source, such as audiotape, videotape, or direct observation, and large national or regional studies in which physician report was used to establish length of visit, were identified through bibliographic and computerized searches. Twenty-three observational studies and 3 large physician-report studies reported in 29 publications met inclusion criteria and were rated. The Cohen d was computed based on 2 reviewers' (J.A.H. and Y.A.) independent extraction of quantitative information from the publications. Study heterogeneity was tested using Q statistics and pooled effect sizes were computed using the appropriate effects model. The characteristics of the study populations were also extracted. Female physicians engage in significantly more active partnership behaviors, positive talk, psychosocial counseling, psychosocial question asking, and emotionally focused talk. There were no gender differences evident in the amount, quality, or manner of biomedical information giving or social conversation. Medical visits with female physicians are, on average, 2 minutes (10%) longer than those with male physicians. Obstetrics and gynecology may present a different pattern than that of primary care, with male physicians demonstrating higher levels of

Work hours and turnover intention among hospital physicians in Taiwan: does income matter?

Science.gov (United States)

Tsai, Yu-Hsuan; Huang, Nicole; Chien, Li-Yin; Chiang, Jen-Huai; Chiou, Shu-Ti

2016-11-21

Physician shortage has become an urgent and critical challenge to many countries. According to the workforce dynamic model, long work hours may be one major pressure point to the attrition of physicians. Financial incentive is a common tool to human power retention. Therefore, this large-scale physician study investigated how pay satisfaction may influence the relationship between work hours and hospital physician's turnover intention. Data were obtained from a nationwide survey of full-time hospital staff members working at 100 hospitals in Taiwan. The analysis sample comprised 2423 full-time physicians. Dependent variable was degree of the physicians' turnover intention to leave the current hospital. The pay satisfaction was assessed by physicians themselves. We employed ordinal logistic regression models to analyze the association between the number of work hours and turnover intention. To consider the cluster effect of hospitals, we used the "gllamm" command in the statistical software package Stata Version 12.1. The results show that 351 (14.5%) of surveyed physicians reported strong intention to leave current hospital. The average work hours per week among hospital physicians was 59.8 h. As expected, work hours exhibited an independent relationship with turnover intention. More importantly, pay satisfaction could not effectively moderate the positive relationship between work hours and intentions to leave current hospital. The findings show that overtime work is prevalent among hospital physicians in Taiwan. Both the Taiwanese government and hospitals must take action to address the emerging problem of physician high turnover rate. Furthermore, hospitals should not consider relying solely on financial incentives to solve the problem. This study encouraged tackling work hour problem, which would lead to the possibility of solving high turnover intention among hospital physicians in Taiwan.

Inter-Provincial Migration Intentions of Family Physicians in Canada: The Roles of Income and Community Characteristics.

Science.gov (United States)

Mou, Haizhen; Olfert, M Rose

2015-11-01

The inter-provincial migration patterns of family physicians in canada show that some provinces like newfoundland and saskatchewan experience persistent net out-migration, while others, including ontario and british columbia, are destinations more often than origins of migrants. Governments in provinces exhibiting net out-migration have responded with a number of incentive and recruitment programs. In this study, we investigate the determinants of the stated interprovincial migration intentions of 3,995 rural and urban family physicians in the 2010 wave of the national physician survey. We consider a range of physician characteristics, community attributes and working conditions. We find that in the intention to move, higher compensation has a modest effect, while the community characteristics have a consistently important influence. Our results suggest that policy and program designers should acknowledge the critical role of community-level living and working conditions in their family physician recruitment and retention efforts. Copyright © 2015 Longwoods Publishing.

Health care workplace discrimination and physician turnover.

Science.gov (United States)

Nunez-Smith, Marcella; Pilgrim, Nanlesta; Wynia, Matthew; Desai, Mayur M; Bright, Cedric; Krumholz, Harlan M; Bradley, Elizabeth H

2009-12-01

To examine the association between physician race/ ethnicity, workplace discrimination, and physician job turnover. Cross-sectional, national survey conducted in 2006-2007 of practicing physicians (n = 529) randomly identified via the American Medical Association Masterfile and the National Medical Association membership roster. We assessed the relationships between career racial/ethnic discrimination at work and several career-related dependent variables, including 2 measures of physician turnover, career satisfaction, and contemplation of career change. We used standard frequency analyses, odds ratios and chi2 statistics, and multivariate logistic regression modeling to evaluate these associations. Physicians who self-identified as nonmajority were significantly more likely to have left at least 1 job because of workplace discrimination (black, 29%; Asian, 24%; other race, 21%; Hispanic/Latino, 20%; white, 9%). In multivariate models, having experienced racial/ethnic discrimination at work was associated with high job turnover (adjusted odds ratio, 2.7; 95% CI, 1.4-4.9). Among physicians who experienced workplace discrimination, only 45% of physicians were satisfied with their careers (vs 88% among those who had not experienced workplace discrimination, p value workplace discrimination, p value Workplace discrimination is associated with physician job turnover, career dissatisfaction, and contemplation of career change. These findings underscore the importance of monitoring for workplace discrimination and responding when opportunities for intervention and retention still exist.

Classification of complementary and alternative medical practices: Family physicians' ratings of effectiveness.

Science.gov (United States)

Fries, Christopher J

2008-11-01

ABSTRACTOBJECTIVETo develop a classification of complementary and alternative medicine (CAM) practices widely available in Canada based on physicians' effectiveness ratings of the therapies.DESIGNA self-administered postal questionnaire asking family physicians to rate their "belief in the degree of therapeutic effectiveness" of 15 CAM therapies.SETTINGProvince of Alberta.PARTICIPANTSA total of 875 family physicians.MAIN OUTCOME MEASURESDescriptive statistics of physicians' awareness of and effectiveness ratings for each of the therapies; factor analysis was applied to the ratings of the 15 therapies in order to explore whether or not the data support the proposed classification of CAM practices into categories of accepted and rejected.RESULTSPhysicians believed that acupuncture, massage therapy, chiropractic care, relaxation therapy, biofeedback, and spiritual or religious healing were effective when used in conjunction with biomedicine to treat chronic or psychosomatic indications. Physicians attributed little effectiveness to homeopathy or naturopathy, Feldenkrais or Alexander technique, Rolfing, herbal medicine, traditional Chinese medicine, and reflexology. The factor analysis revealed an underlying dimensionality to physicians' effectiveness ratings of the CAM therapies that supports the classification of these practices as either accepted or rejected.CONCLUSIONThis study provides Canadian family physicians with information concerning which CAM therapies are generally accepted by their peers as effective and which are not.

Designing a physician leadership development program based on effective models of physician education.

Science.gov (United States)

Hopkins, Joseph; Fassiotto, Magali; Ku, Manwai Candy; Mammo, Dagem; Valantine, Hannah

2017-02-02

Because of modern challenges in quality, safety, patient centeredness, and cost, health care is evolving to adopt leadership practices of highly effective organizations. Traditional physician training includes little focus on developing leadership skills, which necessitates further training to achieve the potential of collaborative management. The aim of this study was to design a leadership program using established models for continuing medical education and to assess its impact on participants' knowledge, skills, attitudes, and performance. The program, delivered over 9 months, addressed leadership topics and was designed around a framework based on how physicians learn new clinical skills, using multiple experiential learning methods, including a leadership active learning project. The program was evaluated using Kirkpatrick's assessment levels: reaction to the program, learning, changes in behavior, and results. Four cohorts are evaluated (2008-2011). Reaction: The program was rated highly by participants (mean = 4.5 of 5). Learning: Significant improvements were reported in knowledge, skills, and attitudes surrounding leadership competencies. Behavior: The majority (80%-100%) of participants reported plans to use learned leadership skills in their work. Improved team leadership behaviors were shown by increased engagement of project team members. All participants completed a team project during the program, adding value to the institution. Results support the hypothesis that learning approaches known to be effective for other types of physician education are successful when applied to leadership development training. Across all four assessment levels, the program was effective in improving leadership competencies essential to meeting the complex needs of the changing health care system. Developing in-house programs that fit the framework established for continuing medical education can increase physician leadership competencies and add value to health care

The Hawthorne effect in direct observation research with physicians and patients.

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Goodwin, Meredith A; Stange, Kurt C; Zyzanski, Stephen J; Crabtree, Benjamin F; Borawski, Elaine A; Flocke, Susan A

2017-12-01

This study examines the degree to which a "Hawthorne effect" alters outpatient-visit content. Trained research nurses directly observed 4454 visits to 138 family physicians. Multiple data sources were used to examine the Hawthorne effect including differences in medical record documentation for observed visits and the prior visit by the same patient, time use during visits on the first versus the second observation day of each physician, and report by the patient, physician, and observer of the effect of observation. Visits on the first versus the second observation day were longer by an average of 1 minute (P effect of the observer on the interaction was reported by 74% of patients and 55% of physicians. Most of those that reported an affect indicated it was slight. Patients with non-White race, lower-educational level, and poorer health were more likely to report being affected by the observer. In a study that was designed to minimize the Hawthorne effect, the presence of an observer had little effect on most patient-physician visits but appeared to at least slightly effect a subgroup of vulnerable patients. © 2017 John Wiley & Sons, Ltd.

The relationship between physician humility, physician-patient communication, and patient health.

Science.gov (United States)

Ruberton, Peter M; Huynh, Ho P; Miller, Tricia A; Kruse, Elliott; Chancellor, Joseph; Lyubomirsky, Sonja

2016-07-01

Cultural portrayals of physicians suggest an unclear and even contradictory role for humility in the physician-patient relationship. Despite the social importance of humility, however, little empirical research has linked humility in physicians with patient outcomes or the characteristics of the doctor-patient visit. The present study investigated the relationship between physician humility, physician-patient communication, and patients' perceptions of their health during a planned medical visit. Primary care physician-patient interactions (297 patients across 100 physicians) were rated for the physician's humility and the effectiveness of the physician-patient communication. Additionally, patients reported their overall health and physicians and patients reported their satisfaction with the interaction. Within-physician fluctuations in physician humility and self-reported patient health positively predicted one another, and mean-level differences in physician humility predicted effective physician-patient communication, even when controlling for the patient's and physician's satisfaction with the visit and the physician's frustration with the patient. The results suggest that humble, rather than paternalistic or arrogant, physicians are most effective at working with their patients. Interventions to improve physician humility may promote better communication between health care providers and patients, and, in turn, better patient outcomes. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Student Mental Models of the Greenhouse Effect: Retention Months After Interventions

Science.gov (United States)

Harris, S. E.; Gold, A. U.

2013-12-01

Individual understanding of climate science, and the greenhouse effect in particular, is one factor important for societal decision-making. Ideally, learning opportunities about the greenhouse effect will not only move people toward expert-like ideas but will also have long-lasting effects for those individuals. We assessed university students' mental models of the greenhouse effect before and after specific learning experiences, on a final exam, then again a few months later. Our aim was to measure retention after students had not necessarily been thinking about, nor studying, the greenhouse effect recently. How sticky were the ideas learned? 164 students in an introductory science course participated in a sequence of two learning activities and assessments regarding the greenhouse effect. The first lesson involved the full class, then, for the second lesson, half the students completed a simulation-based activity and the other half completed a data-driven activity. We assessed student thinking through concept sketches, multiple choice and short answer questions. All students generated concept sketches four times, and completed a set of multiple choice (MCQs) and short answer questions twice. Later, 3-4 months after the course ended, 27 students ('retention students') completed an additional concept sketch and answered the questions again, as a retention assessment. These 27 students were nearly evenly split between the two contrasting second lessons in the sequence and included both high and low-achieving students. We then compared student sketches and scores to 'expert' answers. The general pattern over time showed a significant increase in student scores from before the lesson sequence to after, both on concept sketches and MCQs, then an additional increase in concept sketch score on the final exam (MCQs were not asked on the final exam). The scores for the retention students were not significantly different from the full class. Within the retention group

Effects of Physician-directed Pharmaceutical Promotion on Prescription Behaviors: Longitudinal Evidence.

Science.gov (United States)

Datta, Anusua; Dave, Dhaval

2017-04-01

Spending on prescription drugs (Rx) represents one of the fastest growing components of US healthcare spending and has coincided with an expansion of pharmaceutical promotional spending. Most (83%) of Rx promotion is directed at physicians in the form of visits by pharmaceutical representatives (known as detailing) and drug samples provided to physicians' offices. Such promotion has come under increased public scrutiny, with critics contending that physician-directed promotion may play a role in raising healthcare costs and may unduly affect physicians' prescribing habits towards more expensive, and possibly less cost-effective, drugs. In this study, we bring longitudinal evidence to bear upon the question of how detailing impacts physicians' prescribing behaviors. Specifically, we examine prescriptions and promotion for a particular drug class based on a nationally representative sample of 150,000 physicians spanning 24 months. The use of longitudinal physician-level data allows us to tackle some of the empirical concerns in the extant literature, virtually all of which have relied on aggregate national data. We estimate fixed-effects specifications that bypass stable unobserved physician-specific heterogeneity and address potential targeting bias. In addition, we also assess differential effects at both the extensive and intensive margins of prescribing behaviors and differential effects across physician-level and market-level characteristics, questions that have not been explored in prior work. The estimates suggest that detailing has a significant and positive effect on the number of new scripts written for the detailed drug, with an elasticity magnitude of 0.06. This effect is substantially smaller than those in the literature based on aggregate information, suggesting that most of the observed relationship between physician-directed promotion and drug sales is driven by selection bias. We find that detailing impacts selective brand-specific demand but does

Retention and effective diffusion of model metabolites on porous graphitic carbon.

Science.gov (United States)

Lunn, Daniel B; Yun, Young J; Jorgenson, James W

2017-12-29

The study of metabolites in biological samples is of high interest for a wide range of biological and pharmaceutical applications. Reversed phase liquid chromatography is a common technique used for the separation of metabolites, but it provides little retention for polar metabolites. An alternative to C18 bonded phases, porous graphitic carbon has the ability to provide significant retention for both non-polar and polar analytes. The goal of this work is to study the retention and effective diffusion properties of porous graphitic carbon, to see if it is suitable for the wide injection bands and long run times associated with long, packed capillary-scale separations. The retention of a set of standard metabolites was studied for both stationary phases over a wide range of mobile phase conditions. This data showed that porous graphitic carbon benefits from significantly increased retention (often >100 fold) under initial gradient conditions for these metabolites, suggesting much improved ability to focus a wide injection band at the column inlet. The effective diffusion properties of these columns were studied using peak-parking experiments with the standard metabolites under a wide range of retention conditions. Under the high retention conditions, which can be associated with retention after injection loading for gradient separations, D eff /D m ∼0.1 for both the C18-bonded and porous graphitic carbon columns. As C18 bonded particles are widely, and successfully utilized for long gradient separations without issue of increasing peak width from longitudinal diffusion, this suggests that porous graphitic carbon should be amenable for long runtime gradient separations as well. Copyright © 2017 Elsevier B.V. All rights reserved.

The impact of new-generation physicians on the function of academic anesthesiology departments.

Science.gov (United States)

Kapur, Patricia A

2007-12-01

Academic departments of anesthesiology have had to adapt a wide variety of clinical and educational work functions to the viewpoints, values and normative expectations of the newer generations of physicians who now present themselves for training as well as for faculty employment. This commentary will elaborate on key points that academic departments must recognize and incorporate into their functional and organizational imperatives in order to remain successful with regard to physician recruitment and retention. Recognition of differences between newer-generation vs. established physician issues and concerns include differences in: learning style, teaching style, approach to clinical schedules and the concept of life-work balance, academic and personal motivation, desire for control of their work experience, effective productivity incentives, as well as communication style issues and implications thereof. The spectrum of physicians who contribute to the impact of these factors on contemporary academic anesthesiology departments include faculty, nonfaculty staff physicians, residents and medical students. Academic departments of anesthesiology which can successfully incorporate the changes and most importantly the functional and organizational flexibility needed to respond to the newer generations' worldview and so-called balanced goals will be able to best attract high-caliber housestaff and future faculty.

Retention of Esperanto Is Affected by Delay-Interval Task and Item Closure: A Partial Resolution of the Delay-Retention Effect

Science.gov (United States)

Brosvic, Gary M.; Epstein, Michael L.; Dihoff, Roberta E.; Cook, Michael L.

2006-01-01

The present studies were undertaken to examine the effects of manipulating delay-interval task (Study 1) and timing of feedback (Study 2) on acquisition and retention. Participants completed a 100-item cumulative final examination, which included 50 items from each laboratory examination, plus 50 entirely new items. Acquisition and retention were…

The Effect of Pricing and Advertising on Customer Retention in a Liberalizing Market

NARCIS (Netherlands)

Polo, Yolanda; Javier Sese, F.; Verhoef, Peter C.

2011-01-01

This study investigates the drivers of customer retention in a liberalizing market. The authors address key, retention issues that allow them to contribute to existing retention research in several critical ways. They (1) examine the effects of pricing and mass advertising, (2) account for (new

The Effect of Pricing and Advertising on Customer Retention in a Liberalizing Market

NARCIS (Netherlands)

Polo, Yolanda; Javier Sese, F.; Verhoef, Peter C.

This study investigates the drivers of customer retention in a liberalizing market. The authors address key, retention issues that allow them to contribute to existing retention research in several critical ways. They (1) examine the effects of pricing and mass advertising, (2) account for (new

Work hours and turnover intention among hospital physicians in Taiwan: does income matter?

Directory of Open Access Journals (Sweden)

Yu-Hsuan Tsai

2016-11-01

Full Text Available Abstract Background Physician shortage has become an urgent and critical challenge to many countries. According to the workforce dynamic model, long work hours may be one major pressure point to the attrition of physicians. Financial incentive is a common tool to human power retention. Therefore, this large-scale physician study investigated how pay satisfaction may influence the relationship between work hours and hospital physician’s turnover intention. Methods Data were obtained from a nationwide survey of full-time hospital staff members working at 100 hospitals in Taiwan. The analysis sample comprised 2423 full-time physicians. Dependent variable was degree of the physicians’ turnover intention to leave the current hospital. The pay satisfaction was assessed by physicians themselves. We employed ordinal logistic regression models to analyze the association between the number of work hours and turnover intention. To consider the cluster effect of hospitals, we used the “gllamm” command in the statistical software package Stata Version 12.1. Results The results show that 351 (14.5% of surveyed physicians reported strong intention to leave current hospital. The average work hours per week among hospital physicians was 59.8 h. As expected, work hours exhibited an independent relationship with turnover intention. More importantly, pay satisfaction could not effectively moderate the positive relationship between work hours and intentions to leave current hospital. Conclusions The findings show that overtime work is prevalent among hospital physicians in Taiwan. Both the Taiwanese government and hospitals must take action to address the emerging problem of physician high turnover rate. Furthermore, hospitals should not consider relying solely on financial incentives to solve the problem. This study encouraged tackling work hour problem, which would lead to the possibility of solving high turnover intention among hospital physicians in

The gendered realities and talent management imperatives of women physicians.

Science.gov (United States)

Hoff, Timothy; Scott, Sarah

2016-01-01

U.S. medicine is increasingly a gender-balanced profession with half of all medical school graduates now female. Despite this reality and the potentially transformative nature of a large female physician cohort in U.S. health care, there is less examination of their workplace realities and the key talent management strategies for health care organizations employing women physicians. First, we identify current knowledge about U.S. women physician satisfaction, role challenges, and work tradeoffs. Gender theory is used to help interpret these workplace realities. Second, we use this information to identify talent management strategies health care organizations might consider to mitigate the realities and provide greater support for women physicians. To facilitate our analysis, we conducted a narrative review of published research that includes analysis focused on U.S. women physicians for the time period 2006-2014. Applying ideas from gender theory, we extrapolated key findings from that research related to three issues: satisfaction, role challenges, and tradeoffs. Then we synthesized the findings to identify general talent management strategies that could address these dynamics proactively while enhancing recruitment and retention with respect to women physicians. U.S. women physicians express strong levels of satisfaction, particularly with their careers, at the same time they continue to experience gender-based inequities, role challenges, and lack of work-life balance in their chosen specialty fields. Lack of suitable role models and appropriate mentoring for women physicians, in addition to barriers to career advancement, are also prevalent across different medical specialties. Similar to other occupations and industries, gender-based inequities and role strains are very real issues for women physicians. Health care organizations must acknowledge these issues and employ effective talent management strategies aimed at women doctors if they are to be viewed as an

Examining the Effects of Institutional and Cohort Characteristics on Retention Rates

Science.gov (United States)

Pike, Gary R.; Graunke, Steven S.

2015-01-01

Despite being criticized as unrepresentative and misleading, retention and graduation rates are an important part of college-search web sites and accountability systems, and they frequently have been used as indicators of institutional quality and effectiveness in educational research. Retention and graduation rates are often compared over time…

The Road to Rural Primary Care: A Narrative Review of Factors That Help Develop, Recruit, and Retain Rural Primary Care Physicians.

Science.gov (United States)

Parlier, Anna Beth; Galvin, Shelley L; Thach, Sarah; Kruidenier, David; Fagan, Ernest Blake

2018-01-01

To examine the literature documenting successes in recruiting and retaining rural primary care physicians. The authors conducted a narrative review of literature on individual, educational, and professional characteristics and experiences that lead to recruitment and retention of rural primary care physicians. In May 2016, they searched MEDLINE, PubMed, CINAHL, ERIC, Web of Science, Google Scholar, the Grey Literature Report, and reference lists of included studies for literature published in or after 1990 in the United States, Canada, or Australia. The authors identified 83 articles meeting inclusion criteria. They synthesized results and developed a theoretical model that proposes how the findings interact and influence rural recruitment and retention. The authors' proposed theoretical model suggests factors interact across multiple dimensions to facilitate the development of a rural physician identity. Rural upbringing, personal attributes, positive rural exposure, preparation for rural life and medicine, partner receptivity to rural living, financial incentives, integration into rural communities, and good work-life balance influence recruitment and retention. However, attending medical schools and/or residencies with a rural emphasis and participating in rural training may reflect, rather than produce, intention for rural practice. Many factors enhance rural physician identity development and influence whether physicians enter, remain in, and thrive in rural practice. To help trainees and young physicians develop the professional identity of a rural physician, multifactorial medical training approaches aimed at encouraging long-term rural practice should focus on rural-specific clinical and nonclinical competencies while providing trainees with positive rural experiences.

Ultrasound for internal medicine physicians: the future of the physical examination.

Science.gov (United States)

Dulohery, Megan M; Stoven, Samantha; Kurklinsky, Andrew K; Kurklinksy, Andrew; Halvorsen, Andrew; McDonald, Furman S; Bhagra, Anjali

2014-06-01

With the advent of compact ultrasound (US) devices, it is easier for physicians to enhance their physical examinations through the use of US. However, although this new tool is widely available, few internal medicine physicians have US training. This study sought to understand physicians' baseline knowledge and skill, provide education in US principles, and demonstrate that proper use of compact US devices is a skill that can be quickly learned. Training was performed at the Mayo Clinic in June 2010 and June 2011. The participants consisted of internal medicine residents. The workshop included didactics and hands-on US experiences with human and cadaver models in a simulation center. Pretests and posttests of residents' knowledge, attitudes, and skills with US were completed. We reassessed the 2010 group in the spring of 2012 with a long-term retention survey for knowledge and confidence in viewing images. A total of 136 interns completed the workshop. Thirty-nine residents completed the long-term retention survey. Posttest assessments showed a statistically significant improvement in the knowledge of US imaging, confidence in identifying structures, image identification, and image acquisition (P internal medicine training and practice. © 2014 by the American Institute of Ultrasound in Medicine.

The Exnovation of Chronic Care Management Processes by Physician Organizations

Science.gov (United States)

HENKE, RACHEL MOSHER; BIBI, SALMA; RAMSAY, PATRICIA P.; SHORTELL, STEPHEN M.

2016-01-01

Policy Points The rate of adoption of chronic care management processes (CMPs) by physician organizations has been fairly slow in spite of demonstrated effectiveness of CMPs in improving outcomes of chronic care.Exnovation (ie, removal of innovations) by physician organizations largely explains the slow population‐level increases in practice use of CMPs over time.Expanded health information technology functions may aid practices in retaining CMPs. Low provider reimbursement by Medicaid programs, however, may contribute to disinvestment in CMPs by physician organizations. Context Exnovation is the process of removal of innovations that are not effective in improving organizational performance, are too disruptive to routine operations, or do not fit well with the existing organizational strategy, incentives, structure, and/or culture. Exnovation may contribute to the low overall adoption of care management processes (CMPs) by US physician organizations over time. Methods Three national surveys of US physician organizations, which included common questions about organizational characteristics, use of CMPs, and health information technology (HIT) capabilities for practices of all sizes, and Truven Health Insurance Coverage Estimates were integrated to assess organizational and market influences on the exnovation of CMPs in a longitudinal cohort of 1,048 physician organizations. CMPs included 5 strategies for each of 4 chronic conditions (diabetes, asthma, congestive heart failure, and depression): registry use, nurse care management, patient reminders for preventive and care management services to prevent exacerbations of chronic illness, use of nonphysician clinicians to provide patient education, and quality of care feedback to physicians. Findings Over one‐third (34.1%) of physician organizations exnovated CMPs on net. Quality of care data feedback to physicians and patient reminders for recommended preventive and chronic care were discontinued by over one�

The Exnovation of Chronic Care Management Processes by Physician Organizations.

Science.gov (United States)

Rodriguez, Hector P; Henke, Rachel Mosher; Bibi, Salma; Ramsay, Patricia P; Shortell, Stephen M

2016-09-01

Policy Points The rate of adoption of chronic care management processes (CMPs) by physician organizations has been fairly slow in spite of demonstrated effectiveness of CMPs in improving outcomes of chronic care. Exnovation (ie, removal of innovations) by physician organizations largely explains the slow population-level increases in practice use of CMPs over time. Expanded health information technology functions may aid practices in retaining CMPs. Low provider reimbursement by Medicaid programs, however, may contribute to disinvestment in CMPs by physician organizations. Exnovation is the process of removal of innovations that are not effective in improving organizational performance, are too disruptive to routine operations, or do not fit well with the existing organizational strategy, incentives, structure, and/or culture. Exnovation may contribute to the low overall adoption of care management processes (CMPs) by US physician organizations over time. Three national surveys of US physician organizations, which included common questions about organizational characteristics, use of CMPs, and health information technology (HIT) capabilities for practices of all sizes, and Truven Health Insurance Coverage Estimates were integrated to assess organizational and market influences on the exnovation of CMPs in a longitudinal cohort of 1,048 physician organizations. CMPs included 5 strategies for each of 4 chronic conditions (diabetes, asthma, congestive heart failure, and depression): registry use, nurse care management, patient reminders for preventive and care management services to prevent exacerbations of chronic illness, use of nonphysician clinicians to provide patient education, and quality of care feedback to physicians. Over one-third (34.1%) of physician organizations exnovated CMPs on net. Quality of care data feedback to physicians and patient reminders for recommended preventive and chronic care were discontinued by over one-third of exnovators, while nurse

Psychological contracts: a new strategy for retaining reduced-hour physicians.

Science.gov (United States)

Hartwell, Jennifer K

2010-01-01

As a retention strategy, healthcare organizations offer reduced-hour schedules to physicians seeking better work-family balance. However, this quantitative study of 94 full-time and reduced-hour female physicians in the Boston area found that working fewer hours helps physicians achieve better balance but does not improve their burnout or career satisfaction, or impact their intention to quit or leave the field of medicine. Instead, the findings demonstrate that psychological contract fulfillment, which reflects the subjective nature of the employment relationship, is more important than work hours, an objective job condition, in predicting intention to quit and these other outcomes. A fine-grained analysis is initiated uncovering the multidimensionality of the psychological contract construct. To integrate successful reduced-hour arrangements for physicians, medical managers are directed to the importance of understanding the composition of reduced-hour physicians' psychological contracts, specifically, their need to do challenging work, receive high levels of supervisor support, and promotion opportunities.

Time to address gender inequalities against female physicians.

Science.gov (United States)

Hannawi, Suad; Al Salmi, Issa

2017-11-10

Although the health care system depends heavily on female physicians, it discriminates against women and tends to concentrate female physicians' work in lower status occupations. Gender discrimination has structural, social, and cultural dimensions. Such discrimination is perceived differently by various stakeholders and the public. In addition, there is reluctance to publicly acknowledge gender discrimination, especially in the culturally conservative Middle East region. Gender discrimination leads to underrepresentation of female physicians in leadership roles and certain specialties and hence leads to less attention and understanding of the working conditions of female physicians and their roles in the health care system. The lack of accessible data in the region regarding gender discrimination among physicians leads to stakeholders failing to recognize the existence and magnitude of this type of discrimination. This article takes up the relatively neglected issue of gender discrimination in the health care workforce among the stakeholders of the Ministry of Health and Prevention of the United Arab Emirates. Future research should explore the extent of gender discrimination among physicians and the gender remuneration gap, together with other sorts of discrimination, perception of equal opportunity, and dominant stereotypes of men and women working in health care in relation to job obligation, promotion, retention, remuneration, and education. Copyright © 2017 John Wiley & Sons, Ltd.

Understanding the motivations of the multigenerational physician assistant workforce.

Science.gov (United States)

Lopes, John E; Delellis, Nailya O

2013-10-01

Physician assistants (PAs) are more frequently finding themselves in positions where they are responsible for staff recruitment and retention. Staff turnover is associated with significant financial costs for organizations. Motivational theories focusing on job design indicate that paying attention to a combination of factors related to the work itself, in addition to the environment where the work is performed, increases satisfaction. This study asked a convenience sample of practicing PAs to rate the importance of a number of work-related factors known to influence job satisfaction. The results may be used as a basis for designing an environment to increase job satisfaction and improve recruitment and retention of highly qualified staff.

Physicians' perspectives of managing tensions around dimensions of effective communication in the emergency department.

Science.gov (United States)

Dean, Marleah; Oetzel, John G

2014-01-01

The purpose of this study was to explore emergency department (ED) physicians' perspectives of guidelines for effective communication. More specifically, the ways in which physicians manage the tensions among effective communication dimensions framed by relational dialectics theory are examined. This study used in-depth interviews with 17 ED physicians and 70 hours of observations to identify five dimensions of effective communication: efficiency, clarity/accuracy, relevance, comprehension, and rapport. Two communication tensions resulted from these dimensions: efficiency versus rapport and efficiency versus comprehension. In almost all instances, physicians chose efficient communication at the expense of comprehension or rapport. In addition, there was a tension between patient and physician perspectives of clarity and relevance that physicians tended to resolve by emphasizing what was relevant and clear from their own perspective. Implications for managing tensions in terms of efficiency and a physician-centered approach are discussed.

EBM E-learning: Feasible and Effective for Occupational Physicians in Different Countries.

Science.gov (United States)

Hugenholtz, Nathalie Ir; Sluiter, Judith K; van Dijk, Frank Jh; Nieuwenhuijsen, Karen

2012-09-01

Although evidence-based medicine (EBM) is a useful method for integrating evidence into the decision-making process of occupational physicians, occupational physicians lack EBM knowledge and skills, and do not have the time to learn the EBM method. In order to enable them to educate themselves at the time and place they prefer, we designed an electronic EBM course. We studied the feasibility and utility of the course as well as its effectiveness in increasing EBM knowledge, skills, and behaviour. Occupational physicians from various countries were included in a within-subjects study. Measurements were conducted on participants' EBM knowledge, skills, behaviour, and determinants of behaviour at baseline, directly after finishing the course and 2 months later (n = 36). The feasibility and utility of the course were evaluated directly after the course (n = 42). The course is applicable as an introductory course on EBM for occupational physicians in various countries. The course is effective in enhancing EBM knowledge and self-efficacy in practising EBM. No significant effect was found on EBM skills, behaviour, and determinants of behaviour. After the course, more occupational physicians use the international journals to solve a case. An electronic introductory EBM course is suitable for occupational physicians. Although it is an effective method for increasing EBM knowledge, it does not seem effective in improving skills and behaviour. We recommend integrating e-learning courses with blended learning, where it can be used side by side with other educational methods that are effective in changing behaviour.

Studying the effect of clinical uncertainty on physicians' decision-making using ILIAD.

Science.gov (United States)

Anderson, J D; Jay, S J; Weng, H C; Anderson, M M

1995-01-01

The influence of uncertainty on physicians' practice behavior is not well understood. In this research, ILIAD, a diagnostic expert system, has been used to study physicians' responses to uncertainty and how their responses affected clinical performance. The simulation mode of ILIAD was used to standardize the presentation and scoring of two cases to 46 residents in emergency medicine, internal medicine, family practice and transitional medicine at Methodist Hospital of Indiana. A questionnaire was used to collect additional data on how physicians respond to clinical uncertainty. A structural equation model was developed, estimated, and tested. The results indicate that stress that physicians experience in dealing with clinical uncertainty has a negative effect on their clinical performance. Moreover, the way that physicians respond to uncertainty has positive and negative effects on their performance. Open discussions with patients about clinical decisions and the use of practice guidelines improves performance. However, when the physician's clinical decisions are influenced by patient demands or their peers, their performance scores decline.

Market effects on electronic health record adoption by physicians.

Science.gov (United States)

Abdolrasulnia, Maziar; Menachemi, Nir; Shewchuk, Richard M; Ginter, Peter M; Duncan, W Jack; Brooks, Robert G

2008-01-01

Despite the advantages of electronic health record (EHR) systems, the adoption of these systems has been slow among community-based physicians. Current studies have examined organizational and personal barriers to adoption; however, the influence of market characteristics has not been studied. The purpose of this study was to measure the effects of market characteristics on EHR adoption by physicians. Generalized hierarchal linear modeling was used to analyze EHR survey data from Florida which were combined with data from the Area Resource File and the Florida Office of Insurance Regulation. The main outcome variable was self-reported use of EHR by physicians. A total of 2,926 physicians from practice sizes of 20 or less were included in the sample. Twenty-one percent (n = 613) indicated that they personally and routinely use an EHR system in their practice. Physicians located in counties with higher physician concentration were found to be more likely to adopt EHRs. For every one-unit increase in nonfederal physicians per 10,000 in the county, there was a 2.0% increase in likelihood of EHR adoption by physicians (odds ratio = 1.02, confidence interval = 1.00-1.03). Health maintenance organization penetration rate and poverty level were not found to be significantly related to EHR adoption. However, practice size, years in practice, Medicare payer mix, and measures of technology readiness were found to independently influence physician adoption. Market factors play an important role in the diffusion of EHRs in small medical practices. Policy makers interested in furthering the adoption of EHRs must consider strategies that would enhance the confidence of users as well as provide financial support in areas with the highest concentration of small medical practices and Medicare beneficiaries. Health care leaders should be cognizant of the market forces that enable or constrain the adoption of EHR among their practices and those of their competitors.

The effect of earthworm coprolites on the soil water retention curve

Science.gov (United States)

Smagin, A. V.; Prusak, A. V.

2008-06-01

The effect of earthworm coprolites on the water retention curves in soils of different geneses and textures was investigated by the method of equilibrium centrifuging. Coprolites sampled in the field were compared with the surrounding soil. The effect of earthworms on a soddy-podzolic light loamy soil (from Moscow oblast) was comprehensively analyzed in the course of a special model experiment in a laboratory. This experiment was necessary because it was difficult to separate the coprolites from the soil, in which additional coprolites could appear under natural conditions. In all the variants of the experiment, the differences between the water retention curves of the coprolites and the surrounding soil (or control substrates unaffected by earthworms) were statistically significant. The development of coprolites favored a considerable increase (up to 20 wt.% and more) of the soil water retention capacity upon equivalent water potentials within the range from 0 to -1000 kPa. In most cases, the soil water retention capacity increased within the entire range of the soil moisture contents. This could be explained by the fact that strongly swelling hygroscopic plant remains (detritus) were included into the coprolites and by the formation of a specific highly porous aggregate structure.

Effect of differentiated instructional strategies on students' retention ...

African Journals Online (AJOL)

The effect of differentiated instructional strategies on students' retention in geometry in senior secondary schools was examined. The study employed experimental research design of pretest, posttest control group. The area of this study is Abuja Municipal Area Council, the Federal Capital Territory. The target population ...

The Effect of Graduate Education Timing on the Retention of Surface Warfare Officers

Science.gov (United States)

2016-03-01

significance of graduate education timing within the SWO community and its effect on retention and job performance. Job performance is measured as promotion...d. Marriage Marital status was used in previous studies of SWO retention and is included within this study (Abunaz & Tobrun, 2012). Three binary...the Navy or to separate such as demand for billets variation across years, private sector job opportunities. 44 Figure 5. Basic Retention Model

Effects of Program and Patient Characteristics on Retention of Drug Treatment Patients.

Science.gov (United States)

Hser, Yih-Ing; Joshi, Vandana; Maglione, Margaret; Chou, Chih Ping; Anglin, M. Douglas

2001-01-01

Studied the effects of program and patient characteristics on patient retention in residential, out-patient, and methadone maintenance drug treatment programs. Data for 26,047 patients in 87 programs show that threshold retention rates were generally low for all 3 program types, although program practice and service provision played important…

Factors influencing physicians' choice of workplace: systematic review of drivers of attrition and policy interventions to address them.

Science.gov (United States)

El Koussa, Maria; Atun, Rifat; Bowser, Diana; Kruk, Margaret E

2016-12-01

The movement of skilled physicians from the public to the private sector is a key constraint to achieving universal health coverage and is currently affecting health systems worldwide. This systematic review aims to assess factors influencing physicians' choice of workplace, and policy interventions for retaining physicians in the public sector. Five literature databases were searched. Studies were included in the review if they focused on at least one of the following criteria: (i) incentives or motivators for retaining physicians in the public sector, (ii) pull factors that encouraged physicians to move to the private sector, (iii) push factors that forced physicians to leave the public sector, (iv) policy interventions or case studies that addressed physician retention in the public sector, and (v) qualitative reviews of policy interventions that were implemented in different health system settings. Nineteen articles met the inclusion criteria. Six major themes that affected physicians' choice of workplace were identified including: financial incentives, career development, infrastructure and staffing, professional work environment, workload and autonomy. The majority of the studies suggested that the use of financial incentives was a motivator in retaining physicians in the public sector. The review also identified policy interventions including: regulatory controls, incentives and management reforms. Regulatory controls and incentives were the two most frequently reported policy interventions. While factors affecting physicians' choice of workplace are country specific, financial incentives and professional development are core factors. Other factors are highly influenced by context, and thus, it would be useful for future cross-country research to use standardized data collection tools, allowing comparison of contextual factors as well as the examination of how context affects physician retention in the public sector.

Physician leadership styles and effectiveness: an empirical study.

Science.gov (United States)

Xirasagar, Sudha; Samuels, Michael E; Stoskopf, Carleen H

2005-12-01

The authors study the association between physician leadership styles and leadership effectiveness. Executive directors of community health centers were surveyed (269 respondents; response rate = 40.9 percent) for their perceptions of the medical director's leadership behaviors and effectiveness, using an adapted Multifactor Leadership Questionnaire (43 items on a 0-4 point Likert-type scale), with additional questions on demographics and the center's clinical goals and achievements. The authors hypothesize that transformational leadership would be more positively associated with executive directors' ratings of effectiveness, satisfaction with the leader, and subordinate extra effort, as well as the center's clinical goal achievement, than transactional or laissez-faire leadership. Separate ordinary least squares regressions were used to model each of the effectiveness measures, and general linear model regression was used to model clinical goal achievement. Results support the hypothesis and suggest that physician leadership development using the transformational leadership model may result in improved health care quality and cost control.

Developing a More Effective Recruitment and Retention Model.

Science.gov (United States)

Janke, Walter; Kelly, Gary

The purpose of a project was to develop a model for more effective recruitment and retention of people of color in the Associate Degree Interior Design and Diploma Interior Design Assistant Program at Milwaukee Area Technical College (MATC), Wisconsin. During Activity One, individuals in MATC's Student Development and High School Relations…

Perceptions of effective and ineffective nurse-physician communication in hospitals.

Science.gov (United States)

Robinson, F Patrick; Gorman, Geraldine; Slimmer, Lynda W; Yudkowsky, Rachel

2010-01-01

Nurse-physician communication affects patient safety. Such communication has been well studied using a variety of survey and observational methods; however, missing from the literature is an investigation of what constitutes effective and ineffective interprofessional communication from the perspective of the professionals involved. The purpose of this study was to explore nurse and physician perceptions of effective and ineffective communication between the two professions. Using focus group methodology, we asked nurses and physicians with at least 5 years' acute care hospital experience to reflect on effective and ineffective interprofessional communication and to provide examples. Three focus groups were held with 6 participants each (total sample 18). Sessions were audio recorded and transcribed verbatim. Transcripts were coded into categories of effective and ineffective communication. The following themes were found. For effective communication: clarity and precision of message that relies on verification, collaborative problem solving, calm and supportive demeanor under stress, maintenance of mutual respect, and authentic understanding of the unique role. For ineffective communication: making someone less than, dependence on electronic systems, and linguistic and cultural barriers. These themes may be useful in designing learning activities to promote effective interprofessional communication.

Migration analysis of physicians practicing in Hawai'i from 2009-2011.

Science.gov (United States)

Stephens, Laura D; Withy, Kelley M; Racsa, C Philip

2012-04-01

Hawai'i suffers a 20% shortage of physicians. Examining physician migration patterns into and out of Hawai'i may better inform physician recruitment and retention techniques. 2009-2011 practice location data on all non-military, practicing physicians in Hawai'i were compiled in a database maintained by the University of Hawai'i John A Burns School of Medicine, Area Health Education Center (AHEC). Medical school attended was extracted from an AMA Masterfile list. Physicians were contacted or searched online to ascertain practice location as of September 2011. Currently 3,187 physicians actively practice in Hawai'i; 2,707 (84.9%) trained at a total of 136 US medical schools. Nearly half of all US-trained physicians attended medical school in Hawai'i, California, New York, Illinois, or Pennsylvania. International medical graduates represented 191 medical schools from 67 distinct countries, primarily in the Philippines (23.1%). From 2009-2011, 238 physicians retired from clinical activity, and 329 physicians left Hawai'i to practice in other locations. California received the largest portion of Hawai'i's former physicians (26.4%). Only 15.5% of physicians returned to the state where they attended medical school. Medical schools with some of the most alumni practicing in Hawai'i (eg, Creighton, UCLA, Georgetown) all have active Hawai'i student clubs, suggesting a target for recruitment efforts. Physician emigration cannot be fully explained by geography of a physician's medical school alma mater. Analysis of physician residency locations and exit surveys of physicians leaving Hawai'i are recommended for future study.

Identifying research priorities for effective retention strategies in clinical trials.

Science.gov (United States)

Kearney, Anna; Daykin, Anne; Shaw, Alison R G; Lane, Athene J; Blazeby, Jane M; Clarke, Mike; Williamson, Paula; Gamble, Carrol

2017-08-31

The failure to retain patients or collect primary-outcome data is a common challenge for trials and reduces the statistical power and potentially introduces bias into the analysis. Identifying strategies to minimise missing data was the second highest methodological research priority in a Delphi survey of the Directors of UK Clinical Trial Units (CTUs) and is important to minimise waste in research. Our aim was to assess the current retention practices within the UK and priorities for future research to evaluate the effectiveness of strategies to reduce attrition. Seventy-five chief investigators of NIHR Health Technology Assessment (HTA)-funded trials starting between 2009 and 2012 were surveyed to elicit their awareness about causes of missing data within their trial and recommended practices for improving retention. Forty-seven CTUs registered within the UKCRC network were surveyed separately to identify approaches and strategies being used to mitigate missing data across trials. Responses from the current practice surveys were used to inform a subsequent two-round Delphi survey with registered CTUs. A consensus list of retention research strategies was produced and ranked by priority. Fifty out of seventy-five (67%) chief investigators and 33/47 (70%) registered CTUs completed the current practice surveys. Seventy-eight percent of trialists were aware of retention challenges and implemented strategies at trial design. Patient-initiated withdrawal was the most common cause of missing data. Registered CTUs routinely used newsletters, timeline of participant visits, and telephone reminders to mitigate missing data. Whilst 36 out of 59 strategies presented had been formally or informally evaluated, some frequently used strategies, such as site initiation training, have had no research to inform practice. Thirty-five registered CTUs (74%) participated in the Delphi survey. Research into the effectiveness of site initiation training, frequency of patient contact

An MBA: the utility and effect on physicians' careers.

Science.gov (United States)

Parekh, Selene G; Singh, Bikramjit

2007-02-01

Higher economic, legislative, legal, and administrative constraints in health-care services in the United States have led to an increase in physician dissatisfaction and a decrease in physician morale. In this study, we attempted to understand the motivation for a physician to enroll in a business school, and to discover the utility of the Master of Business Administration degree and how it changed the career path for the practicing clinician. We conducted a retrospective study in which a twenty-seven-question survey was distributed by the United States Postal Service and by e-mail to 161 physician graduates of three East Coast business schools. The results were evaluated, and a statistical analysis was performed. Eighty-seven physicians (54%) responded. Eight surveys were discarded because of incomplete data or stray marks, leaving seventy-nine surveys. The average age of the respondents was 41.4 years. The major motivations for going back to school included learning the business aspects of the health-care system (fifty-three respondents; 67%) and obtaining a more interesting job (forty-one respondents; 52%). The time that the respondents allocated for health-care-related activities before and after obtaining the degree was 58.3% and 31.8%, respectively, for patient care (p administrative responsibilities (p principles (thirty-three; 42%), working within a team (twenty-seven; 34%), and negotiating effectively (twenty-five; 32%). Sixty-four physicians (81%) believed that their business degree had been very useful or essential in the advancement of their careers. Many physicians decide to acquire a Master of Business Administration degree to understand the business of medicine. After they complete the degree program, their practice patterns substantially change, which is reflected particularly by an increase in time spent on administrative responsibilities. In order for physicians to overcome the multifaceted challenges of the evolving health-care system, it is

Nosewitness Identification: Effects of Lineup Size and Retention Interval.

Science.gov (United States)

Alho, Laura; Soares, Sandra C; Costa, Liliana P; Pinto, Elisa; Ferreira, Jacqueline H T; Sorjonen, Kimmo; Silva, Carlos F; Olsson, Mats J

2016-01-01

Although canine identification of body odor (BO) has been widely used as forensic evidence, the concept of nosewitness identification by human observers was only recently put to the test. The results indicated that BOs associated with male characters in authentic crime videos could later be identified in BO lineup tests well above chance. To further evaluate nosewitness memory, we assessed the effects of lineup size (Experiment 1) and retention interval (Experiment 2), using a forced-choice memory test. The results showed that nosewitness identification works for all lineup sizes (3, 5, and 8 BOs), but that larger lineups compromise identification performance in similarity to observations from eye- and earwitness studies. Also in line with previous eye- and earwitness studies, but in disagreement with some studies on odor memory, Experiment 2 showed significant forgetting between shorter retention intervals (15 min) and longer retention intervals (1-week) using lineups of five BOs. Altogether this study shows that identification of BO in a forensic setting is possible and has limits and characteristics in line with witness identification through other sensory modalities.

Physician self-referral and physician-owned specialty facilities.

Science.gov (United States)

Casalino, Lawrence P

2008-06-01

Physician self-referral ranges from suggesting a follow-up appointment, to sending a patient to a facility in which the doctor has an ownership interest or financial relationship. Physician referral to facilities in which the physicians have an ownership interest is becoming increasingly common and not always medically appropriate. This Synthesis reviews the evidence on physician self-referral arrangements, their effect on costs and utilization, and their effect on general hospitals. Key findings include: the rise in self-referral is sparked by financial, regulatory and clinical incentives, including patient convenience and doctors trying to preserve their income in the changing health care landscape. Strong evidence suggests self-referral leads to increased usage of health care services; but there is insufficient evidence to determine whether this increased usage reflects doctors meeting an unmet need or ordering clinically inappropriate care. The more significant a physician's financial interest in a facility, the more likely the doctor is to refer patients there. Arrangements through which doctors receive fees for patient referrals to third-party centers, such as "pay-per-click," time-share, and leasing arrangements, do not seem to offer benefits beyond increasing physician income. So far, the profit margins of general hospitals have not been harmed by the rise in doctor-owned facilities.

Does the physician's emotional intelligence matter? Impacts of the physician's emotional intelligence on the trust, patient-physician relationship, and satisfaction.

Science.gov (United States)

Weng, Hui-Ching

2008-01-01

Much of the literature pertinent to management indicates that service providers with high emotional intelligence (EI) receive higher customer satisfaction scores. Previous studies offer limited evidence regarding the impact of physician's EI on patient-physician relationship. Using a multilevel and multisource data approach, the current study aimed to build a model that demonstrated the impact of a physician's EI on the patient's trust and the patient-physician relationship. The survey sample included 983 outpatients and 39 physicians representing 11 specialties. Results of path analyses demonstrated that the ratio of patient's follow-up visits (p impact of patient's trust on patient's satisfaction was mediated by the patient-physician relationship at a significant level (p relationship had a significantly positive effect on patient's satisfaction (p relationship; however, mutual trust and professional respect between nurses and physicians play a critical role in reinforcing the patient-physician relationship to effect improvements in the provision of patient-centered care.

The Effect of Acute Exercise on Consolidation and Retention of Motor Memory

DEFF Research Database (Denmark)

Skriver, Kasper Christen

with the perspective of exploring the arguments for applying exercise systematically in the educational system. In addition, since a team sport could be more motivating to school children compared to e.g. running, we investigated the effects of both hockey and running on motor memory. Seventy-seven pre......There is substantial evidence that a single bout of exercise can improve cognitive functions and retention of certain types of declarative memory. However, it is unclear if a similar effect can be demonstrated when coupling physical activity with the acquisition and retention of a motor skill....... Hence, the overall aim of the present thesis was to investigate the relationship between acute exercise and motor memory, with special interest in investigating if exercise performed after motor skill learning could improve skill retention. Study I was designed to assess if a single bout of exercise...

Physician satisfaction and burnout at different career stages.

Science.gov (United States)

Dyrbye, Liselotte N; Varkey, Prathibha; Boone, Sonja L; Satele, Daniel V; Sloan, Jeff A; Shanafelt, Tait D

2013-12-01

To explore the work lives, professional satisfaction, and burnout of US physicians by career stage and differences across sexes, specialties, and practice setting. We conducted a cross-sectional study that involved a large sample of US physicians from all specialty disciplines in June 2011. The survey included the Maslach Burnout Inventory and items that explored professional life and career satisfaction. Physicians who had been in practice 10 years or less, 11 to 20 years, and 21 years or more were considered to be in early, middle, and late career, respectively. Early career physicians had the lowest satisfaction with overall career choice (being a physician), the highest frequency of work-home conflicts, and the highest rates of depersonalization (all Pcareer worked more hours, took more overnight calls, had the lowest satisfaction with their specialty choice and their work-life balance, and had the highest rates of emotional exhaustion and burnout (all Pcareer physicians were most likely to plan to leave the practice of medicine for reasons other than retirement in the next 24 months (4.8%, 12.5%, and 5.2% for early, middle, and late career, respectively). The challenges of middle career were observed in both men and women and across specialties and practice types. Burnout, satisfaction, and other professional challenges for physicians vary by career stage. Middle career appears to be a particularly challenging time for physicians. Efforts to promote career satisfaction, reduce burnout, and facilitate retention need to be expanded beyond early career interventions and may need to be tailored by career stage. Copyright © 2013 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

Strategies to improve recruitment and retention of older stroke survivors to a randomized clinical exercise trial.

Science.gov (United States)

Taylor-Piliae, Ruth E; Boros, Daniella; Coull, Bruce M

2014-03-01

Relatively few exercise randomized clinical trials (RCTs) among stroke survivors have reported the effectiveness of recruitment and retention strategies, despite its central importance to study integrity. Our objective is to examine recruitment and retention strategies used among a group of older community-dwelling stroke survivors for an exercise RCT. Recruitment strategies were multidimensional using both paid (ie, newspaper, radio and, television) and unpaid advertisements (ie, staff visits, flyers, and brochures placed at outpatient rehabilitation centers, physician offices, and community facilities working with older adults; free media coverage of the study, presentations at stroke support groups, relatives/friends, and study Web site) to obtain referrals. Retention strategies centered on excellent communication, the study participants' needs, and having dedicated study staff. Attrition rates and adherence to the intervention were used to examine the effectiveness of these retention strategies. A total of 393 referrals were received, 233 persons were screened, and 145 stroke survivors enrolled in the study. During 3 years of study recruitment, we achieved 97% of our enrollment target. We enrolled 62% of those screened. Study enrollment from paid advertising was 21.4% (n = 31), whereas unpaid advertisements resulted in 78.6% (n = 114) of our participants. Attrition was 10% (n = 14 dropouts), and adherence to the intervention was 85%. Recruitment and retention of participants in an exercise RCT are time and labor intensive. Multiple recruitment and retention strategies are required to ensure an adequate sample of community-dwelling stroke survivors. Many of these strategies are also relevant for exercise RCTs among adults with other chronic illnesses. Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

{sup 3}He retention and structural evolution in erbium tritides: Phase and aging effects

Energy Technology Data Exchange (ETDEWEB)

Zhou, X.S., E-mail: zlxs77@163.com [Institute of Nuclear Physics and Chemistry, China Academy of Engineering Physics, Mianyang 621900 (China); Thin Film Centre, Scottish Universities Physics Alliance (SUPA), University of West of Scotland, Paisley PA1 2BE, Scotland (United Kingdom); Zhang, L.; Wang, W.D.; Liu, Q. [Institute of Nuclear Physics and Chemistry, China Academy of Engineering Physics, Mianyang 621900 (China); Peng, S.M., E-mail: pengshuming@caep.cn [Institute of Nuclear Physics and Chemistry, China Academy of Engineering Physics, Mianyang 621900 (China); Ding, W.; Long, X.G.; Cheng, G.J.; Liang, J.H. [Institute of Nuclear Physics and Chemistry, China Academy of Engineering Physics, Mianyang 621900 (China); Fu, Y.Q. [Thin Film Centre, Scottish Universities Physics Alliance (SUPA), University of West of Scotland, Paisley PA1 2BE, Scotland (United Kingdom)

2015-06-15

Highlights: • Effects of phase changes on {sup 3}He retention of Er tritide films were investigated. • The α phase in Er tritide films had no apparent effect on {sup 3}He release/retention. • Tritium content in the β phase showed significant effects on {sup 3}He retention. • Evolution of {sup 3}He in the β phase was apparently influenced by the γ phase. • Effects of phase changes on structure evolution of Er tritides were investigated. - Abstract: Effects of phase changes on {sup 3}He release/retention and crystal lattice evolution during aging of erbium (Er) tritide films were investigated using X-ray diffraction. The contents of α phase and γ phase in the Er tritide films showed significant different effects on {sup 3}He release/retention. The initial tritium stoichiometry or excess tritium atoms accommodated in the octahedral sites and the microstructure (i.e., the texture and Er{sub 2}O{sub 3} oxide inclusions) played an important role for the {sup 3}He release and the evolution of {sup 3}He bubbles in the β phase Er tritide films. In the β + γ region, evolution of {sup 3}He in the β phase was apparently influenced by the γ phase, which could result in a strongly anisotropic lattice dilation and an earlier inflection point of the expansion rate of (1 1 1) lattice parameter. A preferred occupation of {sup 3}He in basal plane of the hexagonal γ phase and the lattice expansion along the hexagonal direction were identified.

effect of differentiated instructional strategies on students' retention

African Journals Online (AJOL)

PROF EKWUEME

show that retention ability was significantly higher in the experimental group ... Differentiated instruction, Lecture , Cognitive Achievement ,Retention ability, Geometry. ... thinking. Based on this knowledge, differentiated instruction applies an ...

Impurity effects of hydrogen isotope retention on boronized wall in LHD

International Nuclear Information System (INIS)

Oya, Yasuhisa; Okuno, Kenji; Ashikawa, Naoko; Nishimura, Kiyohiko; Sagara, Akio

2010-11-01

The impurity effect on hydrogen isotopes retention in the boron film deposited in LHD was evaluated by means of XPS and TDS. It was found that the impurity concentrations in boron film were increased after H-H main plasma exposure in LHD. The ratio of hydrogen retention trapped by impurity to total hydrogen retention during H-H main plasma exposure was reached to 70%, although that of deuterium retention by impurity in D 2 + implanted LHD-boron film was about 35%. In addition, the dynamic chemical sputtering of hydrogen isotopes with impurity as the form of water and / or hydrocarbons was occurred by energetic hydrogen isotopes irradiation. It was expected that the enhancement of impurity concentration during plasma exposure in LHD would induce the dynamic formation of volatile molecules and their re-emission to plasma. These facts would prevent stable plasma operation in LHD, concluding that the dynamic impurity behavior in boron film during plasma exposure is one of key issues for the steady-state plasma operation in LHD. (author)

Difficulties experienced by migrant physicians working in German hospitals: a qualitative interview study.

Science.gov (United States)

Klingler, Corinna; Marckmann, Georg

2016-09-23

With Germany facing a shortage of doctors, hospitals have been increasingly recruiting physicians from abroad. Studies in other countries have shown that migrant physicians experience various difficulties in their work, which might impact the quality of patient care, physician job satisfaction, and, accordingly, retention. The experiences of migrant doctors in Germany have not been systematically studied so far and will likely differ from experiences migrant physicians make in other contexts. A thorough understanding of challenges faced by this group, however, is needed to develop adequate support structures-as required by the WHO Global Code of Practice on the International Recruitment of Health Personnel. A qualitative study was conducted to give an overview of the multifaceted difficulties migrant physicians might face in German hospitals. Twenty semi-structured interviews with foreign-born and foreign-trained physicians were conducted in German. Participants were recruited via the State Chambers of Physicians and snowballing based on a maximum variation sampling strategy varying purposefully by source country and medical specialty. The interviews were recorded, transcribed verbatim, and analysed using qualitative content analysis. Participants described difficulties relating to healthcare institutions, own competencies, and interpersonal interactions. Participants experienced certain legal norms, the regulation of licensure and application for work, and the organization of the hospital environment as inadequate. Most struggled with their lack of setting-specific (language, cultural, clinical, and system) knowledge. Furthermore, behaviour of patients and co-workers was perceived as discriminating or inadequate for other reasons. This is the first study to describe the broad range of issues migrant physicians experience in Germany. Based on this information, institutional actors should devise support structures to ensure quality of care, physician wellbeing, and

Physician Order Entry Clerical Support Improves Physician Satisfaction and Productivity.

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Contratto, Erin; Romp, Katherine; Estrada, Carlos A; Agne, April; Willett, Lisa L

2017-05-01

To examine the impact of clerical support personnel for physician order entry on physician satisfaction, productivity, timeliness with electronic health record (EHR) documentation, and physician attitudes. All seven part-time physicians at an academic general internal medicine practice were included in this quasi-experimental (single group, pre- and postintervention) mixed-methods study. One full-time clerical support staff member was trained and hired to enter physician orders in the EHR and conduct previsit planning. Physician satisfaction, productivity, timeliness with EHR documentation, and physician attitudes toward the intervention were measured. Four months after the intervention, physicians reported improvements in overall quality of life (good quality, 71%-100%), personal balance (43%-71%), and burnout (weekly, 43%-14%; callousness, 14%-0%). Matched for quarter, productivity increased: work relative value unit (wRVU) per session increased by 20.5% (before, April-June 2014; after, April-June 2015; range -9.2% to 27.5%). Physicians reported feeling more supported, more focused on patient care, and less stressed and fatigued after the intervention. This study supports the use of physician order entry clerical personnel as a simple, cost-effective intervention to improve the work lives of primary care physicians.

Influencing Factors on Family Physician Retaining in Kohgilouye and Boyer Ahmad Province, Iran in 2009

OpenAIRE

SA Mosaviraja; AA Nasiripour; JM Malekzadeh

2014-01-01

Background & aim: Family Physician Plan in health and treatment services providing a relatively new plan beginning from 2005 by ministry of health in collaboration with general health insurance office to increase people's access to comprehensive health services. One of the main problems is the lack of retention of doctors in the workplace, particularly in deprived areas. The purpose of this study was to evaluate factors associated with survival in the workplace of family physicians in the Koh...

Are Flunkers Social Outcasts? A Multilevel Study of Grade Retention Effects on Same-Grade Friendships

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Demanet, Jannick; Van Houtte, Mieke

2016-01-01

We examine the association between grade retention and the number of same-grade friendships. Moreover, we investigate the effect of a school's proportion of retained students on these friendships and the moderating effect of this school characteristic on the relationship between retention and the number of same-grade friendships. Multilevel…

Effects of sodium polyacrylate on water retention and infiltration capacity of a sandy soil.

Science.gov (United States)

Zhuang, Wenhua; Li, Longguo; Liu, Chao

2013-01-01

Based on the laboratory study, the effects of sodium polyacrylate (SP) was investigated at 5 rates of 0, 0.08, 0.2, 0.5, and 1%, on water retention, saturated hydraulic conductivity(Ks), infiltration characteristic and water distribution profiles of a sandy soil. The results showed that water retention and available water capacity effectively increased with increasing SP rate. The Ks and the rate of wetting front advance and infiltration under certain pond infiltration was significantly reduced by increasing SP rate, which effectively reduced water in a sandy soil leaking to a deeper layer under the plough layer. The effect of SP on water distribution was obviously to the up layer and very little to the following deeper layers. Considering both the effects on water retention and infiltration capacity, it is suggested that SP be used to the sandy soil at concentrations ranging from 0.2 to 0.5%.

[Professional practices and perceptions about job retention systems for the chronically ill: a qualitative study in south-eastern France].

Science.gov (United States)

Saliba, M-L; Arnaud, S; Souville, M; Viau, A; François, G; Verger, P

2013-04-01

Continued employment of people with health problems that reduce their ability to work is a major social issue. The French measures to optimize job retention are characterized by a multiplicity of participants, and their efficacy depends largely on the capacity of these different participants to work together. The objective of this study was to document the perceived role, attitudes and practices of participants involved in these job retention measures and of general practitioners, as well as their difficulties in this domain. In 2009, 15 semi-directive interviews were conducted in the region of Provence-Alpes-Côte d'Azur (PACA) of occupational physicians, general practitioners, and other participants involved in the occupational reclassification of workers no longer completely fit for their job. The data collected were analyzed from a thematic perspective. The different groups of professionals questioned agreed on the primacy of the role of the occupational physician, on the importance of early consideration of each worker's case, and on the need to work together as partners to optimize the prospects of job retention. This study nonetheless showed numerous communication difficulties between the various professionals: although informal exchanges have developed over time, the efficacy of the system seems to be limited by a lack of clarity about the role of each institution, divergences of opinions on some key points including the role of the physicians caring for the patient, and, more largely, lack of information about the tools for job retention. The distribution of homogeneous knowledge, the development of multidisciplinary collaborative practices and the pooling of the lessons of experience between the different groups of participants are essential for the success of job retention procedures. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Effects of mineral additives on biochar formation: carbon retention, stability, and properties.

Science.gov (United States)

Li, Feiyue; Cao, Xinde; Zhao, Ling; Wang, Jianfei; Ding, Zhenliang

2014-10-07

Biochar is being recognized as a promising tool for long-term carbon sequestration, and biochar with high carbon retention and strong stability is supposed to be explored for that purpose. In this study, three minerals, including kaolin, calcite (CaCO3), and calcium dihydrogen phosphate [Ca(H2PO4)2], were added to rice straw feedstock at the ratio of 20% (w/w) for biochar formation through pyrolysis treatment, aiming to improve carbon retention and stabilization in biochar. Kaolin and CaCO3 had little effect on the carbon retention, whereas Ca(H2PO4)2 increased the carbon retention by up to 29% compared to untreated biochar. Although the carbon loss from the kaolin-modified biochar with hydrogen peroxide oxidation was enhanced, CaCO3 and Ca(H2PO4)2 modification reduced the carbon loss by 18.6 and 58.5%, respectively. Moreover, all three minerals reduced carbon loss of biochar with potassium dichromate oxidation from 0.3 to 38.8%. The microbial mineralization as CO2 emission in all three modified biochars was reduced by 22.2-88.7% under aerobic incubation and 5-61% under anaerobic incubation. Enhanced carbon retention and stability of biochar with mineral treatment might be caused by the enhanced formation of aromatic C, which was evidenced by cross-polarization magic angle spinning (13)C nuclear magnetic resonance spectra and Fourier transform infrared spectroscopy analysis. Our results indicated that the three minerals, especially Ca(H2PO4)2, were effective in increasing carbon retention and strengthening biochar stabilization, which provided a novel idea that people could explore and produce the designated biochar with high carbon sequestration capacity and stability.

Cost-effectiveness analysis of smoking-cessation counseling training for physicians and pharmacists.

Science.gov (United States)

Cantor, Scott B; Deshmukh, Ashish A; Luca, Nancy Stancic; Nogueras-González, Graciela M; Rajan, Tanya; Prokhorov, Alexander V

2015-06-01

Although smoking-cessation interventions typically focus directly on patients, this paper conducts an economic evaluation of a novel smoking-cessation intervention focused on training physicians and/or pharmacists to use counseling techniques that would decrease smoking rates at a reasonable cost. To evaluate the cost-effectiveness of interventions that train physicians and/or pharmacists to counsel their patients on smoking-cessation techniques. Using decision-analytic modeling, we compared four strategies for smoking-cessation counseling education: training only physicians, training only pharmacists, training both physicians and pharmacists (synergy strategy), and training neither physicians nor pharmacists (i.e., no specialized training, which is the usual practice). Short-term outcomes were based on results from a clinical trial conducted in 16 communities across the Houston area; long-term outcomes were calculated from epidemiological data. Short-term outcomes were measured using the cost per quit, and long-term outcomes were measured using the cost per quality-adjusted life-year (QALY). Cost data were taken from institutional sources; both costs and QALYs were discounted at 3%. Training both physicians and pharmacists added 0.09 QALY for 45-year-old men. However, for 45-year-old women, the discounted quality-adjusted life expectancy only increased by 0.01 QALY when comparing the synergy strategy to no intervention. The incremental cost-effectiveness ratio (ICER) of the synergy strategy with respect to the non-intervention strategy was US$868/QALY for 45-year-old men and US$8953/QALY for 45-year-old women. The results were highly sensitive to the quit rates and community size. Synergistic educational training for physicians and pharmacists could be a cost-effective method for smoking cessation in the community. Published by Elsevier Ltd.

Effects of supplementary private health insurance on physician visits in Korea.

Science.gov (United States)

Kang, Sungwook; You, Chang Hoon; Kwon, Young Dae; Oh, Eun-Hwan

2009-12-01

The coverage of social health insurance has remained limited, despite it being compulsory in Korea. Accordingly, Koreans have come to rely upon supplementary private health insurance (PHI) to cover their medical costs. We examined the effects of supplementary PHI on physician visits in Korea. This study used individual data from 11,043 respondents who participated in the Korean Labor and Income Panel Survey in 2001. We conducted a single probit model to identify the relationship between PHI and physician visits, with adjustment for the following covariates: demographic characteristics, socioeconomic status, health status, and health-related behavior. Finally, we performed a bivariate probit model to examine the true effect of PHI on physician visits, with adjustment for the above covariates plus unobservable covariates that might affect not only physician visit, but also the purchase of PHI. We found that about 38% of all respondents had one or more private health plans. Forty-five percent of all respondents visited one or more physicians, and 49% of those who were privately insured had physician visits compared with 42% of the uninsured. The single probit model showed that those with PHI were about 14 percentage points more likely to visit physicians than those who do not have PHI. However, this distinction disappears in the bivariate probit model. This result might have been a consequence of the nature of private health plans in Korea. Private insurance companies pay a fixed amount directly to their enrollees in case of illness/injury, and the individuals are responsible subsequently for purchasing their own healthcare services. This study demonstrated the potential of Korean PHI to address the problem of moral hazard. These results serve as a reference for policy makers when considering how to finance healthcare services, as well as to contain healthcare expenditure.

An intervention to increase patients' trust in their physicians. Stanford Trust Study Physician Group.

Science.gov (United States)

Thom, D H; Bloch, D A; Segal, E S

1999-02-01

To investigate the effect of a one-day workshop in which physicians were taught trust-building behaviors on their patients' levels of trust and on outcomes of care. In 1994, the study recruited 20 community-based family physicians and enrolled 412 consecutive adult patients from those physicians' practices. Ten of the physicians (the intervention group) were randomly assigned to receive a one-day training course in building and maintaining patients' trust. Outcomes were patients' trust in their physicians, patients' and physicians' satisfaction with the office visit, continuity in the patient-physician relationship, patients' adherence to their treatment plans, and the numbers of diagnostic tests and referrals. Physicians and patients in the intervention and control groups were similar in demographic and other data. There was no significant difference in any outcome. Although their overall ratings were not statistically significantly different, the patients of physicians in the intervention group reported more positive physician behaviors than did the patients of physicians in the control group. The trust-building workshop had no measurable effect on patients' trust or on outcomes hypothesized to be related to trust.

A qualitative study of factors influencing different generations of Newfoundland and Saskatchewan trained physicians to leave a work location.

Science.gov (United States)

Mathews, Maria; Seguin, Maureen; Chowdhury, Nurun; Card, Robert T

2012-07-25

retention initiatives, our findings highlight the importance of the work environment and organizational culture on the retention of physicians of all generations.

Knowledge-based errors in anesthesia: a paired, controlled trial of learning and retention.

Science.gov (United States)

Goldhaber-Fiebert, Sara N; Goldhaber-Fiebert, Jeremy D; Rosow, Carl E

2009-01-01

Optimizing patient safety by improving the training of physicians is a major challenge of medical education. In this pilot study, we hypothesized that a brief lecture, targeted to rare but potentially dangerous situations, could improve anesthesia practitioners' knowledge levels with significant retention of learning at six months. In this paired controlled trial, anesthesia residents and attending physicians at Massachusetts General Hospital took the same 14-question multiple choice examination three times: at baseline, immediately after a brief lecture, and six months later. The lecture covered material on seven "intervention" questions; the remaining seven were "control" questions. The authors measured immediate knowledge acquisition, defined as the change in percentage of correct answers on intervention questions between baseline and post-lecture, and measured learning retention as the difference between baseline and six months. Both measurements were corrected for change in performance on control questions. Fifty of the 89 subjects completed all three examinations. The post-lecture increase in percentage of questions answered correctly, adjusted for control, was 22.2% [95% confidence interval (CI) 16.0-28.4%; P learning at six months. Exposing residents or other practitioners to this type of inexpensive teaching intervention may help them to avoid preventable uncommon errors that are rooted in unfamiliarity with the situation or the equipment. The methods used for this study may also be applied to compare the effect of various other teaching modalities while, at the same time, preserving participant anonymity and making adjustments for ongoing learning.

Communicating clinical trial outcomes: Effects of presentation method on physicians' evaluations of new treatments

Directory of Open Access Journals (Sweden)

Francesco Marcatto

2013-01-01

Full Text Available Physicians expect a treatment to be more effective when its clinical outcomes are described as relative rather than as absolute risk reductions. We examined whether effects of presentation method (relative vs. absolute risk reduction remain when physicians are provided the baseline risk information, a vital piece of statistical information omitted in previous studies. Using a between-subjects design, ninety five physicians were presented the risk reduction associated with a fictitious treatment for hypertension either as an absolute risk reduction or as a relative risk reduction, with or without including baseline risk information. Physicians reported that the treatment would be more effective and that they would be more willing to prescribe it when its risk reduction was presented to them in relative rather than in absolute terms. The relative risk reduction was perceived as more effective than absolute risk reduction even when the baseline risk information was explicitly reported. We recommend that information about absolute risk reduction be made available to physicians in the reporting of clinical outcomes. Moreover, health professionals should be cognizant of the potential biasing effects of risk information presented in relative risk terms.

Dimensionality and Its Effect on Retention and Visual Scanning.

Science.gov (United States)

Abed, Farough

1994-01-01

Describes a study of eighth graders that compared the effects of two-dimensional and three-dimensional illustrated texts on eye movement strategies and on retention of information. Results are reported that support earlier research findings that realism in illustrations is not necessarily facilitating and may even be distracting. (Contains 19…

The effect of teaching method on long-term knowledge retention.

Science.gov (United States)

Beers, Geri W; Bowden, Susan

2005-11-01

Choosing a teaching strategy that results in knowledge retention on the part of learners can be challenging for educators. Studies on problem-based learning (PBL) have supported its effectiveness, compared to other, more traditional strategies. The results of a previous study comparing the effect of lecture versus PBL on objective test scores indicated there was no significant difference in scores. To measure long-term knowledge retention, the same groups were evaluated 1 year after instruction. The posttest administered in the original study was repeated, and the scores from a comprehensive adult health examination and the endocrine subsection were analyzed. At an alpha level of 0.05, a statistically significant difference was found in the scores on two of the measures. The scores of the PBL group were significantly higher on the endocrine section of the examination and the repeat posttest.

The Effect of Perceptual Learning on L2 Vocabulary Learning and Retention

OpenAIRE

BEDİR, Gülay; BEKTAŞ BEDİR, Sevgi

2018-01-01

It is thought that learning styles have an effecton learning foreign language. This study aims to determine effects ofperceptual learning styles on L2 vocabulary learning and retention. Learningstyle preferences were assessed in the current study through the section ofCohen et al.’s Learning Style Survey (LSS) corresponding to the perceptualmodalities and achievement tests developed by the researcher was used to assessvocabulary learning and retention. And an open-ended question is tried toan...

The influence of age on the effectiveness of DTPA in reducing 141Ce retention in rats

International Nuclear Information System (INIS)

Kargacin, B.; Kostial, K.; Landeka, M.

1983-01-01

The influence of age on the effectiveness of chelation treatment in reducing retention of radioactive cerium was studied in two- and six-week-old albino rats. 141 Ce was administered intraperitoneally, followed immediately and after 24 and 48 hours by intraperitoneal administration of the tri-sodium calcium salt of diethylenetriaminepentaacetic acid-Na 3 (CaDTPA) at 380 μmol/kg body weight. The whole-body retention was determined 2, 4 and 6 days after radiocerium administration, when the animals were killed and the organ retention was determined. The chelation therapy significantly reduced the whole-body retention of radiocerium. This treatment was however twice as effective in older as in younger animals. (author)

Factors for lifelong job retention among Swiss radiographers

International Nuclear Information System (INIS)

Lehmann, P.; Meystre, N. Richli; Mamboury, N.

2015-01-01

In Switzerland, a shortage of radiographers in the three radiology domains, radio-diagnostic, radiotherapy and nuclear medicine, is supposed to increase in the upcoming years. As job satisfaction has been shown to contribute to workplace retention, one purpose of the study was to explore the relationship between workplace retention and duration in the profession with job satisfaction. The study was based on two surveys. The institutional survey was addressed to all chiefs of radiology units in hospitals and ambulatory institutes (340, response rate 48%). All radiographers were asked to complete the individual survey (3000, response rate 25%). Two thirds of radiographers had been employed for five or more years in the same workplace, and nearly half intended to stay for 10 more years. The professional lifespan of radiographers is estimated to be approximately 27 years. 75% expressed their satisfaction with key aspects of professional activity, including the content of the work, autonomy, technology and their relationships with professionals and patients. These factors were not linked to a particular workplace, but to the profession itself. The radiographers build their own propitious work environment, even if salary and recognition by physicians are contributing to their dissatisfaction. The retention in the profession, consolidated by a high level of satisfaction, is an essential feature for a workforce policy. However, active measures for reinforcing retention are still necessary when considering that a lifelong career needs challenges and rewards. Additionally, the retention rate does not provide a guarantee adequacy for the future projected needs in the profession. - Highlights: • Retention in the profession, with a high level of satisfaction, is a major point for a workforce policy. • Job satisfaction of radiographers is not linked to a particular workplace, but to the profession itself. • The professional lifespan of radiographers in Switzerland is

Effect of periodic deuterium ion irradiation on deuterium retention and blistering in Tungsten

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M. Oya

2017-08-01

Full Text Available The effect of periodic irradiation on Deuterium (D retention and blistering in Tungsten (W was investigated. W samples were exposed to D plasma at a fixed fluence while varying the irradiation cycle number (1-shot, 2-shots and 3-shots. Exposure energy and flux were ∼50eV and ∼1 ×1022 D m−2 s−1, respectively. Sample temperatures were 537K and 643K. At 573K, D retention and blister density decreased with increasing number of irradiation cycle. In contrast at 643K, D retention showed no dependence on number of irradiation cycle. Therefore, sample temperature during irradiation is an important parameter in comparing the results of continuous and periodic irradiation, especially in studies involving extremely-high-flux (>1024 D m−2 s−1 irradiation and fluence dependency of D retention.

Radiation effect on 67Ga retention and distribution in mouse tissues

International Nuclear Information System (INIS)

Mainwaring, H.R.; Swartzendruber, D.C.; Lushbaugh, C.C.; Idoyaga-Vargas, N.L.; Watson, E.E.

1976-01-01

We have studied the effect of external x irradiation on the whole-body retention and tissue distribution of gallium-67 ( 67 Ga) in mice over a period of 20 days. Adult male C57BL/6 Cum mice were injected intraperitoneally with 5 μCi 67 Ga 24 hr before, immediately before, immediately after, or 24 hr after whole-body x-ray exposure to 450 R. Control mice received 67 Ga injections and sham irradiation. Increased excretion and reduced soft-tissue concentrations of 67 Ga occurred in irradiated mice. The greatest effect was observed when the radionuclide was injected 24 hr after irradiation and assayed 24 hr later. An analysis of variance of the retention data showed that the differences between the groups were significant at the 99 percent confidence level. Exponential least-squares analysis of whole-body counting results revealed three compartments in the biological retention data. The long-lived compartment possibly corresponds to 67 Ga bound relatively tightly in certain body tissues and lost slowly. The two remaining compartments have been tentatively identified as circulating unbound 67 Ga that is lost rapidly and circulating bound 67 Ga that is lost less rapidly

The effects of the macro-environment on treatment retention for problem cocaine users.

Science.gov (United States)

Lorenzoni, Valentina; Curzio, Olivia; Karakachoff, Matilde; Saponaro, Alessio; Sanza, Michele; Mariani, Fabio; Molinaro, Sabrina

2013-01-01

Client dropout is commonly used as an indicator of quality and effectiveness of drug treatment. Following increasing cocaine use in recent years, research has attempted to identify predictors of retention in treatment for cocaine users but there is no consensus about how individual characteristics and system variables (referral source, treatment setting), what we term here as the "macro-environment" - effect risk of dropout. This study sought to identify macro-environmental factors and examine the way these impact upon treatment retention. A retrospective longitudinal study of an admission cohort among drug services in Vasta Romagna in Emilia Romagna Region, Italy (up to 8 years of treatment or until discharge) was conducted to determine the effect of macro-environmental variables on retention among first time admitted cocaine-dependent clients in different treatment settings. The sample consisted of 1178 clients meeting DSM-IV-R criteria for cocaine dependence. The joint effect of individual and system factors had a significant impact on dropout rates. In particular, lower rates of dropout were observed for those treated in prison and those who had a stable home, HR: 0.09 (0.02-0.48), or lived in rehabilitation units, HR: 0.36 (0.15-0.88), and among clients referred by the local authority and those living with parents, HR: 0.60 (0.38-0.95). The combined effect of individual and system factors on retention in treatment sets a critical background necessary to assess any impact of organizational dynamics and delineate the trajectory for future interventions. Copyright © 2012 Elsevier B.V. All rights reserved.

Iranian Physicians' Perspectives Regarding Nurse-Physician Professional Communication: Implications for Nurses.

Science.gov (United States)

Esmaeilpour-Bandboni, Mohammad; Vaismoradi, Mojtaba; Salsali, Mahvash; Snelgrove, Sherrill; Sheldon, Lisa Kennedy

2017-08-01

Nurse-physician professional communication affects the effectiveness and performance of the health care team and the quality of care delivered to the patient. This study aimed to explore the perspectives and experiences of physicians on nurse-physician professional communication in an urban area of Iran. Semistructured interviews were conducted with 15 physicians selected using a purposive sampling method. Physicians from different medical specialties were chosen from 4 teaching hospitals in an urban area of Iran. The data were analyzed with content analysis and themes developed. Three themes developed during data analysis: "seeking the formal methods of communication to ensure patient care," "nurses' professional attributes for professional communication," and "patients' health conditions as the mediators of professional communication." Nurses need to be informed of the perspectives and experiences of physicians on professional communication. Our findings can improve nurses' understandings of professional communication that could inform the development of educational and training programs for nurses and physicians. There is a need to incorporate communication courses during degree education and design interprofessional training regarding communication in clinical settings to improve teamwork and patient care. Open discussions between nurses and physicians, training sessions about how to improve their knowledge about barriers to and facilitators of effective professional communication, and key terms and phrases commonly used in patient care are suggested.

Beginning Teacher Induction: A Report on Beginning Teacher Effectiveness and Retention.

Science.gov (United States)

Serpell, Zewelanji; Bozeman, Leslie A.

National statistics show a rise in the number of beginning teachers undergoing formal induction in their first year of teaching. This report discusses the effectiveness of induction programs and resulting outcomes for beginning teacher retention, beginning teacher effectiveness, and mentor participation. The various components of induction…

The Effect of Sleep on Children’s Word Retention and Generalization

Directory of Open Access Journals (Sweden)

Emma L. Axelsson

2016-08-01

Full Text Available In the first few years of life children spend a good proportion of time sleeping as well as acquiring the meanings of hundreds of words and their related associations. There is now ample evidence of the effects of sleep on memory in adults and the number of studies demonstrating the effects of napping and nocturnal sleep in children is also mounting. In particular, sleep appears to benefit children’s memory for recently-encountered novel words. The effect of sleep on children’s generalization of novel words across multiple items, however, is less clear. Given that sleep is polyphasic in the early years, made up of multiple episodes, and children’s word learning is gradual and strengthened slowly over time, it is highly plausible that sleep is a strong candidate in supporting children’s memory for novel words. Importantly, it appears that when children sleep shortly after exposure to novel word-object pairs retention is better than if sleep is delayed, suggesting that napping plays a vital role in long-term word retention for young children. Word learning is a complex, challenging and important part of development, thus the role that sleep plays in children’s retention of novel words is worthy of attention. As such, ensuring children get sufficient good quality sleep and regular opportunities to nap may be critical for strong language acquisition.

A qualitative study of factors influencing different generations of Newfoundland and Saskatchewan trained physicians to leave a work location

Directory of Open Access Journals (Sweden)

Mathews Maria

2012-07-01

location. While economic factors have largely been the focus of recruitment and retention initiatives, our findings highlight the importance of the work environment and organizational culture on the retention of physicians of all generations.

Box-ticking and Olympic high jumping - Physicians' perceptions and acceptance of national physician validation systems.

Science.gov (United States)

Sehlbach, Carolin; Govaerts, Marjan J B; Mitchell, Sharon; Rohde, Gernot G U; Smeenk, Frank W J M; Driessen, Erik W

2018-05-24

National physician validation systems aim to ensure lifelong learning through periodic appraisals of physicians' competence. Their effectiveness is determined by physicians' acceptance of and commitment to the system. This study, therefore, sought to explore physicians' perceptions and self-reported acceptance of validation across three different physician validation systems in Europe. Using a constructivist grounded-theory approach, we conducted semi-structured interviews with 32 respiratory specialists from three countries with markedly different validation systems: Germany, which has a mandatory, credit-based system oriented to continuing professional development; Denmark, with mandatory annual dialogs and ensuing, non-compulsory activities; and the UK, with a mandatory, portfolio-based revalidation system. We analyzed interview data with a view to identifying factors influencing physicians' perceptions and acceptance. Factors that influenced acceptance were the assessment's authenticity and alignment of its requirements with clinical practice, physicians' beliefs about learning, perceived autonomy, and organizational support. Users' acceptance levels determine any system's effectiveness. To support lifelong learning effectively, national physician validation systems must be carefully designed and integrated into daily practice. Involving physicians in their design may render systems more authentic and improve alignment between individual ambitions and the systems' goals, thereby promoting acceptance.

Effects of sodium polyacrylate on water retention and infiltration capacity of a sandy soil

OpenAIRE

Zhuang, Wenhua; Li, Longguo; Liu, Chao

2013-01-01

Based on the laboratory study, the effects of sodium polyacrylate (SP) was investigated at 5 rates of 0, 0.08, 0.2, 0.5, and 1%, on water retention, saturated hydraulic conductivity(Ks), infiltration characteristic and water distribution profiles of a sandy soil. The results showed that water retention and available water capacity effectively increased with increasing SP rate. The Ks and the rate of wetting front advance and infiltration under certain pond infiltration was significantly reduc...

Physician burnout: contributors, consequences and solutions.

Science.gov (United States)

West, C P; Dyrbye, L N; Shanafelt, T D

2018-06-01

Physician burnout, a work-related syndrome involving emotional exhaustion, depersonalization and a sense of reduced personal accomplishment, is prevalent internationally. Rates of burnout symptoms that have been associated with adverse effects on patients, the healthcare workforce, costs and physician health exceed 50% in studies of both physicians-in-training and practicing physicians. This problem represents a public health crisis with negative impacts on individual physicians, patients and healthcare organizations and systems. Drivers of this epidemic are largely rooted within healthcare organizations and systems and include excessive workloads, inefficient work processes, clerical burdens, work-home conflicts, lack of input or control for physicians with respect to issues affecting their work lives, organizational support structures and leadership culture. Individual physician-level factors also play a role, with higher rates of burnout commonly reported in female and younger physicians. Effective solutions align with these drivers. For example, organizational efforts such as locally developed practice modifications and increased support for clinical work have demonstrated benefits in reducing burnout. Individually focused solutions such as mindfulness-based stress reduction and small-group programmes to promote community, connectedness and meaning have also been shown to be effective. Regardless of the specific approach taken, the problem of physician burnout is best addressed when viewed as a shared responsibility of both healthcare systems and individual physicians. Although our understanding of physician burnout has advanced considerably in recent years, many gaps in our knowledge remain. Longitudinal studies of burnout's effects and the impact of interventions on both burnout and its effects are needed, as are studies of effective solutions implemented in combination. For medicine to fulfil its mission for patients and for public health, all stakeholders

The Effect Of Stem Degrees On The Performance And Retention Of Junior Officers In The U.S. Navy

Science.gov (United States)

2016-03-01

satisfaction as well as increase their opportunities to pursue technical graduate education. This thesis compares job performance and retention outcomes...degrees. This thesis evaluates other factors that affect retention such as job fit. The high demand for STEM graduates in the civilian labor market is...examined to determine their effects on officer job performance and retention . Previous research has provided inconclusive results on the effects of

Nurse-physician communication - An integrated review.

Science.gov (United States)

Tan, Tit-Chai; Zhou, Huaqiong; Kelly, Michelle

2017-12-01

To present a comprehensive review of current evidence on the factors which impact on nurse-physician communication and interventions developed to improve nurse-physician communication. The challenges in nurse-physician communication persist since the term 'nurse-doctor game' was first used in 1967, leading to poor patient outcomes such as treatment delays and potential patient harm. Inconsistent evidence was found on the factors and interventions which foster or impair effective nurse-physician communication. An integrative review was conducted following a five-stage process: problem identification, literature search, data evaluation, data analysis and presentation. Five electronic databases were searched from 2005 to April 2016 using key search terms: "improve*," "nurse-physician," "nurse," "physician" and "communication" in five electronic databases including the Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE, PubMed, Science Direct and Scopus. A total of 22 studies were included in the review. Four themes emerged from the data synthesis, namely communication styles; factors that facilitate nurse-physician communication; barriers to effective nurse-physician communication; and interventions to improve nurse-physician communication. This integrative review suggests that nurse-physician communication still remains ineffective. Current interventions only address information needs of nurses and physicians in limited situations and specific settings but cannot adequately address the interprofessional communication skills that are lacking in practice. The disparate views of nurses and physicians on communication due to differing training backgrounds confound the effectiveness of current interventions or strategies. Cross-training and interprofessional educational from undergraduate to postgraduate programmes will better align the training of nurses and physicians to communicate effectively. Further research is needed to determine the

Semantic Information Activated during Retrieval Contributes to Later Retention: Support for the Mediator Effectiveness Hypothesis of the Testing Effect

Science.gov (United States)

Carpenter, Shana K.

2011-01-01

Previous research has proposed that tests enhance retention more than do restudy opportunities because they promote the effectiveness of mediating information--that is, a word or concept that links a cue to a target (Pyc & Rawson, 2010). Although testing has been shown to promote retention of mediating information that participants were asked…

Principles of effective communication with patients who have intellectual disability among primary care physicians.

Science.gov (United States)

Werner, S; Yalon-Chamovitz, S; Tenne Rinde, M; Heymann, A D

2017-07-01

Examine physicians' implementation of effective communication principles with patients with intellectual disabilities (ID) and its predictors. Focus groups helped construct a quantitative questionnaire. The questionnaire (completed by 440 physicians) examined utilization of effective communication principles, attitudes toward individuals with ID, subjective knowledge and number of patients with ID. Subjective knowledge of ID and more patients with ID increased utilization of effective communication principles. Provision of knowledge that allows patients to make their own medical decisions was predicted by more patients with ID, lower attitudes that treatment of this population group is not desirable, less negative affect and greater perception that treatment of this group is part of the physician's role. Effective preparation of patients with ID for treatment was predicted by higher perception of treatment of this group as part of the physician's role, lower perception of this field as undesirable and higher perception of these individuals as unable to make their own choice. Simplification of information was predicted by a greater perception of treatment of this group as part of the physician's role and more negative affect. Greater familiarity may enhance care for these patients. Increase exposure to patients with ID within training. Copyright © 2017 Elsevier B.V. All rights reserved.

The Effects of Elaboration and Rehearsal on Long-Term Retention of Shape Names by Kindergarteners

Science.gov (United States)

Gallimore, Ronald; And Others

1977-01-01

Elaboration and overt rehearsal are compared as instructional paradigms for memory retention. Superior long-term retention was produced in the elaboration condition when the initial acquisition effects were statistically removed. Short-term data suggest acquisition was complexly affected by experimental condition, I.Q., and task. Elaboration…

Inadequate physician knowledge of the effects of diet on blood lipids and lipoproteins.

Directory of Open Access Journals (Sweden)

Sciamanna Christopher

2003-12-01

Full Text Available Abstract Background To assess the nutrition knowledge of physicians on the basic effects of diet on blood lipids and lipoproteins. Methods Anonymous mailed dietary knowledge surveys to 6000 randomly selected physicians in the United States licensed in either Internal Medicine or Cardiology. Results Response rate: 16% (n = 639. Half of the physicians did not know that canola oil and 26% did not know olive oil were good sources of monounsaturated fat. Ninety-three percent (84% of cardiologists vs. 96% of internists; p Conclusions If physicians are to implement dietary and cholesterol management guidelines, they will likely need to become more knowledgeable about nutrition.

The Moderating Effect of Job Satisfaction on Physicians' Motivation to Adhere to Financially Incentivized Clinical Practice Guidelines.

Science.gov (United States)

Waddimba, Anthony C; Beckman, Howard B; Mahoney, Thomas L; Burgess, James F

2017-04-01

We examined moderating effects of professional satisfaction on physicians' motivation to adhere to diabetes guidelines associated with pay-for-performance incentives. We merged cross-sectional survey data on attitudes, from 156 primary physicians, with prospective medical record-sourced data on guideline adherence and census data on ambulatory-care population characteristics. We examined moderating effects by testing theory-driven models for satisfied versus discontented physicians, using partial least squares structural equation modeling. Results show that attitudes motivated, while norms suppressed, adherence to guidelines among discontented physicians. Separate models for satisfied versus discontented physicians revealed motivational differences. Satisfied physicians disregarded intrinsic and extrinsic influences and biases. Discontented physicians, alienated by social pressure, favored personal inclinations. To improve adherence to guidelines among discontented physicians, incentives should align with personal attitudes and incorporate promotional campaigns countering resentment of peer and organizational pressure.

Effectiveness of tamsulosin in prevention of post-operative urinary retention: a randomized double-blind placebo-controlled study.

Science.gov (United States)

Madani, Ali Hamidi; Aval, Hamidreza Baghani; Mokhtari, Gholamreza; Nasseh, Hamidreza; Esmaeili, Samaneh; Shakiba, Maryam; Shakiba, Reza Shahrokhi; Seyed Damavand, Seyed Mohamad

2014-01-01

Urinary retention is one of the most common complications contributing to surgical procedures. Recent studies have shown the benefits of alpha-adrenergic blockers in preventing post-operative urinary retention (POUR). The aim of this prospective study was to compare the prophylactic effect of tamsulosin with placebo on postoperative urinary retention. In this randomized placebo controlled, clinical trial, 232 male patients aged 18 to 50 years old admitted to Razi University Hospital for varicocelectomy, inguinal herniorrhaphy, and scrotal surgery were randomly assigned to receive either three doses of 0.4mg tamsulosin (n = 118) or placebo (n = 114), 14 and 2 hours before, and 10 hours after surgery. Patients were closely monitored for the development of urinary retention 24 hours after surgical intervention. The primary endpoint was to investigate the effect of tamsulosin in prevention of post-operative urinary retention during the first 24 hours after surgical intervention. Collected data were analyzed using SPSS software version 18 and the P tamsulosin arm and 114 in placebo arm. POUR in patients who received tamsulosin was significantly lower than placebo, as 5.9% of the patients treated with tamsulosin and 21.1% placebo group, reported urinary retention following surgery (P = 0.001). No serious adverse effects were seen in both groups. This study suggests that short perioperative treatment with tamsulosin can reduce the incidence of urinary retention and the need for catheterization after varicocelectomy, inguinal herniorrhaphy, and scrotal surgery.

The effect of 2,3-dimercaptopropane sodium sulfonate on mercury retention in rats in relation to age

International Nuclear Information System (INIS)

Kostial, K.; Kargacin, B.; Blanusa, M.; Landeka, M.

1984-01-01

The effectiveness of DMPS (sodium 2,3-dimercaptopropane-l-sulfonate) in reducing inorganic mercury retention was studied in 2-, 6-, and 28-week-old albino rats. 203 Hg was administered IP. The chelating agent DMPS was administered by injection at a dose of 250 μmol/kg body weight three times, 1 day after 203 Hg administration and at 24 h intervals thereafter. The whole body retention determined 1, 2, 3, and 6 days after 203 Hg administration showed that DMPS decreased the body retention of mercury in all age groups, being about twice as effective in adult compared to suckling rats. The reduced effectiveness was due to the reduced efficacy of DMPS in reducing kidney retention in young animals. In other organs the effectiveness of DMPS was not age dependent. These and previous results obtained with different chelating agents and other metals indicate that age might be an important factor in chelation therapy in general. (orig.)

[Effect of psychosocial work environment and job satisfaction on burnout syndrome among specialist physicians].

Science.gov (United States)

Escribà-Agüir, Vicenta; Artazcoz, Lucía; Pérez-Hoyos, Santiago

2008-01-01

To describe the prevalence of burnout syndrome according to medical specialty and to examine the impact of work psychosocial risk factors, job satisfaction and professional characteristics on burnout syndrome among specialist physicians throughout Spain. A cross-sectional survey was carried out among 1,021 Spanish physicians. The outcome variables were the 3 dimensions of burnout syndrome: emotional exhaustion, depersonalization, and personal accomplishment. The explanatory variables were work psychosocial risk factors and job satisfaction evaluated by a stress scale specifically designed for physicians. Adjusted odds ratios and their 95% confidence intervals were calculated by logistic regression. The probability of high emotional exhaustion and depersonalization were greater in physicians exposed to a high level of contact with suffering and death and to a negative impact of work on home life. The probability of high emotional exhaustion was greater among physicians with a high work overload. The risk of low personal accomplishment was higher among physicians with low professional satisfaction and those without training activities. Dissatisfaction with relationships with patients and relatives had a negative effect on the 3 dimensions of burnout. Psychosocial work environment and job satisfaction have a negative effect on burnout syndrome, especially on emotional exhaustion and depersonalization.

RETENTION TIME EFFECT ON METAL REMOVAL BY PEAT COLUMNS

Energy Technology Data Exchange (ETDEWEB)

Nelson, E

2007-02-28

The potential use of a peat bed to treat the H-12 Outfall discharge to bring it to new compliance limits was previously investigated and reported utilizing a 7 hour retention time. The influence of retention time (contact time) of water with peat moss on the removal of copper from the water was investigated under laboratory conditions using vertical flow peat moss columns. Reduction of the necessary retention time has a large influence on the design sizing of any peat bed that would be constructed to treat the H-12 discharge on a full scale basis. Retention times of 5 hours, 3 hours and 1 hour were tested to determine the copper removal by the peat columns using vertical flow. Water samples were collected after 4, 8, 12, and 16 water volumes had passed through the columns and analyzed for a suite of metals, with quantitative emphasis on copper. Laboratory results indicated that copper removal was very high at each of the 3 retention times tested, ranging from 99.6 % removal at 5 and 3 hours to 98.8% removal at 1 hour. All these values are much lower that the new compliance limit for the outfall. The results also indicated that most divalent metals were removed to their normal reporting detection limit for the analytical methods used, including zinc. Lead levels in the H-12 discharge used in this study were below PQL in all samples analyzed. While each of the retention times studied removed copper very well, there were indications that 1 hour is probably too short for an operational, long-term facility. At that retention time, there was about 6% compaction of the peat in the column due to the water velocity, and this may affect long term hydraulic conductivity of the peat bed. At that retention time, copper concentration in the effluent was higher than the other times tested, although still very low. Because of the potential compacting and somewhat reduced removal efficiency at a 1 hour retention time, it would be prudent to design to at least a 3 hour retention

Redundancy Effect on Retention of Vocabulary Words Using Multimedia Presentation

Science.gov (United States)

Samur, Yavuz

2012-01-01

This study was designed to examine the effect of the redundancy principle in a multimedia presentation constructed for foreign language vocabulary learning on undergraduate students' retention. The underlying hypothesis of this study is that when the students are exposed to the material in multiple ways through animation, concurrent narration,…

Acquisition system environmental effects study. [for capillary-screen propellant retention devices

Science.gov (United States)

1975-01-01

The effects of vibration, warm gas exposure, and feed system startup/shutdown fluid dynamics on capillary-screen propellant retention capabilities are quantified. The existing technology is extended to the point where quantitative conlusions in terms of design criteria may be drawn.

Effects of various methodologic strategies: survey response rates among Canadian physicians and physicians-in-training.

Science.gov (United States)

Grava-Gubins, Inese; Scott, Sarah

2008-10-01

To increase the overall 2007 response rate of the National Physician Survey (NPS) from the survey's 2004 rate of response with the implementation of various methodologic strategies. Physicians were stratified to receive either a long version (12 pages) or a short version (6 pages) of the survey (38% and 62%, respectively). Mixed modes of contact were used-58% were contacted by e-mail and 42% by regular mail-with multiple modes of contact attempted for nonrespondents. The self-administered, confidential surveys were distributed in either English or French. Medical residents and students received e-mail surveys only and were offered a substantial monetary lottery incentive for completing their surveys. A professional communications firm assisted in marketing the survey and delivered advance notification of its impending distribution. Canada. A total of 62 441 practising physicians, 2627 second-year medical residents, and 9162 medical students in Canada. Of the practising physicians group, 60 811 participants were eligible and 19 239 replied, for an overall 2007 study response rate of 31.64% (compared with 35.85% in 2004). No difference in rate of response was found between the longer and shorter versions of the survey. If contacted by regular mail, the response rate was 34.1%; the e-mail group had a response rate of 29.9%. Medical student and resident response rates were 30.8% and 27.9%, respectively (compared with 31.2% and 35.6% in 2004). Despite shortening the questionnaires, contacting more physicians by e-mail, and enhancing marketing and follow-up, the 2007 NPS response rate for practising physicians did not surpass the 2004 NPS response rate. Offering a monetary lottery incentive to medical residents and students was also unsuccessful in increasing their response rates. The role of surveys in gathering information from physicians and physicians-in-training remains problematic. Researchers need to investigate alternative strategies for achieving higher rates of

The Effect of Internal Salary Increment Distributions on Retention Behaviors of Western New York Teachers

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Patterson, Michele M.

2013-01-01

This is a study of district internal salary distribution practices and its effect on retention. The study is a replication study as recommended by Jacobson (1986) and Lankford and Wyckoff (1997) whereby their research shows the prevalence of "back loading" and ineffectiveness relative to retention. In the case of this study, the…

New Estimates of the Effect of Unemployment on Enlisted Retention

Science.gov (United States)

1985-07-01

S14cw’tity lafication) New Estimates of the Effect of Umemployment on Enlisted Retention 12. PERSONAL AUTHOR(S) Ile, TYPE OF REPORT 3b~. TIME COVERED...wider swings in the umemployment rate during recent years, relative military pay has played at least as important a role as the unemployment rate in

Green roof stormwater retention: effects of roof surface, slope, and media depth.

Science.gov (United States)

VanWoert, Nicholaus D; Rowe, D Bradley; Andresen, Jeffrey A; Rugh, Clayton L; Fernandez, R Thomas; Xiao, Lan

2005-01-01

Urban areas generate considerably more stormwater runoff than natural areas of the same size due to a greater percentage of impervious surfaces that impede water infiltration. Roof surfaces account for a large portion of this impervious cover. Establishing vegetation on rooftops, known as green roofs, is one method of recovering lost green space that can aid in mitigating stormwater runoff. Two studies were performed using several roof platforms to quantify the effects of various treatments on stormwater retention. The first study used three different roof surface treatments to quantify differences in stormwater retention of a standard commercial roof with gravel ballast, an extensive green roof system without vegetation, and a typical extensive green roof with vegetation. Overall, mean percent rainfall retention ranged from 48.7% (gravel) to 82.8% (vegetated). The second study tested the influence of roof slope (2 and 6.5%) and green roof media depth (2.5, 4.0, and 6.0 cm) on stormwater retention. For all combined rain events, platforms at 2% slope with a 4-cm media depth had the greatest mean retention, 87%, although the difference from the other treatments was minimal. The combination of reduced slope and deeper media clearly reduced the total quantity of runoff. For both studies, vegetated green roof systems not only reduced the amount of stormwater runoff, they also extended its duration over a period of time beyond the actual rain event.

The effect of testing versus restudy on retention: a meta-analytic review of the testing effect.

Science.gov (United States)

Rowland, Christopher A

2014-11-01

Engaging in a test over previously studied information can serve as a potent learning event, a phenomenon referred to as the testing effect. Despite a surge of research in the past decade, existing theories have not yet provided a cohesive account of testing phenomena. The present study uses meta-analysis to examine the effects of testing versus restudy on retention. Key results indicate support for the role of effortful processing as a contributor to the testing effect, with initial recall tests yielding larger testing benefits than recognition tests. Limited support was found for existing theoretical accounts attributing the testing effect to enhanced semantic elaboration, indicating that consideration of alternative mechanisms is warranted in explaining testing effects. Future theoretical accounts of the testing effect may benefit from consideration of episodic and contextually derived contributions to retention resulting from memory retrieval. Additionally, the bifurcation model of the testing effect is considered as a viable framework from which to characterize the patterns of results present across the literature. (PsycINFO Database Record (c) 2014 APA, all rights reserved).

Effectiveness of tamsulosin in prevention of post-operative urinary retention: a randomized double-blind placebo-controlled study

Directory of Open Access Journals (Sweden)

Ali Hamidi Madani

2014-01-01

Full Text Available Purpose: Urinary retention is one of the most common complications contributing to surgical procedures. Recent studies have shown the benefits of alpha-adrenergic blockers in preventing post-operative urinary retention (POUR. The aim of this prospective study was to compare the prophylactic effect of tamsulosin with placebo on postoperative urinary retention. Materials and Methods: In this randomized placebo controlled, clinical trial, 232 male patients aged 18 to 50 years old admitted to Razi University Hospital for varicocelectomy, inguinal herniorrhaphy, and scrotal surgery were randomly assigned to receive either three doses of 0.4mg tamsulosin (n = 118 or placebo (n = 114, 14 and 2 hours before, and 10 hours after surgery. Patients were closely monitored for the development of urinary retention 24 hours after surgical intervention. The primary endpoint was to investigate the effect of tamsulosin in prevention of post-operative urinary retention during the first 24 hours after surgical intervention. Collected data were analyzed using SPSS software version 18 and the P < 0.05 was considered statistically significant. Results: One hundred and eighteen patients were included in tamsulosin arm and 114 in placebo arm. POUR in patients who received tamsulosin was significantly lower than placebo, as 5.9% of the patients treated with tamsulosin and 21.1% placebo group, reported urinary retention following surgery (P = 0.001. No serious adverse effects were seen in both groups. Conclusions: This study suggests that short perioperative treatment with tamsulosin can reduce the incidence of urinary retention and the need for catheterization after varicocelectomy, inguinal herniorrhaphy, and scrotal surgery.

The effect of reimbursement on medical decision making: do physicians alter treatment in response to a managed care incentive?

Science.gov (United States)

Melichar, Lori

2009-07-01

The empirical literature that explores whether physicians respond to financial incentives has not definitively answered the question of whether physicians alter their treatment behavior at the margin. Previous research has not been able to distinguish that part of a physician response that uniformly alters treatment of all patients under a physician's care from that which affects some, but not all of a physician's patients. To explore physicians' marginal responses to financial incentives while accounting for the selection of physicians into different financial arrangements where others could not, I use data from a survey of physician visits to isolate the effect that capitation, a form of reimbursement wherein physicians receive zero marginal revenue for a range of physician provided services, has on the care provided by a physician. Fixed effects regression results reveal that physicians spend less time with their capitated patients than with their non-capitated patients.

Effects of compensation methods and physician group structure on physicians' perceived incentives to alter services to patients.

Science.gov (United States)

Reschovsky, James D; Hadley, Jack; Landon, Bruce E

2006-08-01

To examine how health plan payment, group ownership, compensation methods, and other practice management tools affect physician perceptions of whether their overall financial incentives tilt toward increasing or decreasing services to patients. Nationally representative data on physicians are from the 2000-2001 Community Tracking Study Physician Survey (N=12,406). Ordered and multinomial logistic regression were used to explore how physician, group, and market characteristics are associated with physician reports of whether overall financial incentives are to increase services, decrease services, or neither. Seven percent of physicians report financial incentives are to reduce services to patients, whereas 23 percent report incentives to increase services. Reported incentives to reduce services were associated with reports of lower ability to provide quality care. Group revenue in the form of capitation was associated with incentives to reduce services whereas practice ownership and variable compensation and bonuses for employee physicians were mostly associated with incentives to increase services to patients. Full ownership of groups, productivity incentives, and perceived competitive markets for patients were associated with incentives to both increase and reduce services. Practice ownership and the ways physicians are compensated affect their perceived incentives to increase or decrease services to patients. In the latter case, this adversely affects perceived quality of care and satisfaction, although incentives to increase services may also have adverse implications for quality, cost, and insurance coverage.

Recruitment and Retention of Effective Teachers in Multicultural Classrooms: A Qualitative Study

Science.gov (United States)

Phan, Michael N.

2013-01-01

The purpose of this qualitative exploratory case study was to explore how pre-service training and professional development affected recruitment and retention of effective teachers serving in multicultural classrooms. The research questions under investigation were: (1) what pre-service training did effective educators receive before entering…

Effect of noble gas ion pre-irradiation on deuterium retention in tungsten

NARCIS (Netherlands)

Cheng, L.; Zhao, Z. H.; De Temmerman, G.; Yuan, Y.; Morgan, T. W.; Guo, L. P.; Wang, B.; Zhang, Y.; Wang, B. Y.; Zhang, P.; Cao, X. Z.; Lu, G. H.

2016-01-01

Impurity seeding of noble gases is an effective way of decreasing the heat loads onto the divertor targets in fusion devices. To investigate the effect of noble gases on deuterium retention, tungsten targets have been implanted by different noble gas ions and subsequently exposed to deuterium

Collaboration of Physician, Pharmacist and Director Model Toward the Improvement of Teamwork Effectiveness in Hospital

Directory of Open Access Journals (Sweden)

Widy S. Abdulkadir

2017-09-01

Full Text Available Collaboration of physicians and pharmacists is very important in providing treatment to patients. Collaboration includes an exchange of views or ideas that give perspective to all collaborators. In order to make collaborative relationship optimal, all members of the different professions should have a desire to cooperate. Pharmacists and physicians should plan and practice as colleagues, work interdependence within the limits of the scope of practice with a variety of values and knowledge. The role of director in cooperation between doctor and pharmacist takes decision-making which refers to treatment of patients to be decided together between health professionals (physician and pharmacist. The study was a quasi-experimental design with a pre-test-post-test control group design, using paired t-test analysis. The study was conducted from October 2012 until February 2013. The paired t-test results showed that the variable of teamwork effectiveness in M. M. Dunda Hospital increased significantly (p=0.038, which means that the three-party (physician-pharmacist-director collaboration model may increase teamwork effectiveness. Three-party collaboration model can improve physician-pharmacist relationship in the hospital. Leadership has a positive and significant effect on employees’ organizational commitment. Director can be an inspiration in the work and determine the direction and goals of the organization. Therefore, the three-party (physician-pharmacist-director collaboration model can improve the quality of the relationship between the two professions, physician and pharmacist.

The Effect of Opioid Prescribing Guidelines on Prescriptions by Emergency Physicians in Ohio.

Science.gov (United States)

Weiner, Scott G; Baker, Olesya; Poon, Sabrina J; Rodgers, Ann F; Garner, Chad; Nelson, Lewis S; Schuur, Jeremiah D

2017-12-01

The objective of our study is to evaluate the association between Ohio's April 2012 emergency physician guidelines aimed at reducing inappropriate opioid prescribing and the number and type of opioid prescriptions dispensed by emergency physicians. We used Ohio's prescription drug monitoring program data from January 1, 2010, to December 31, 2014, and included the 5 most commonly prescribed opioids (hydrocodone, oxycodone, tramadol, codeine, and hydromorphone). The primary outcome was the monthly statewide prescription total of opioids written by emergency physicians in Ohio. We used an interrupted time series analysis to compare pre- and postguideline level and trend in number of opioid prescriptions dispensed by emergency physicians per month, number of prescriptions stratified by 5 commonly prescribed opioids, and number of prescriptions for greater than 3 days' supply of opioids. Beginning in January 2010, the number of prescriptions dispensed by all emergency physicians in Ohio decreased by 0.3% per month (95% confidence interval [CI] -0.49% to -0.15%). The implementation of the guidelines in April 2012 was associated with a 12% reduction (95% CI -17.7% to -6.3%) in the level of statewide total prescriptions per month and an additional decline of 0.9% (95% CI -1.1% to -0.7%) in trend relative to the preguideline trend. The estimated effect of the guidelines on total monthly prescriptions greater than a 3-day supply was an 11.2% reduction in level (95% CI -18.8% to -3.6%) and an additional 0.9% (95% CI -1.3% to -0.5%) decline in trend per month after the guidelines. Guidelines were also associated with a reduction in prescribing for each of the 5 individual opioids, with various effect. In Ohio, emergency physician opioid prescribing guidelines were associated with a decrease in the quantity of opioid prescriptions written by emergency physicians. Although introduction of the guidelines occurred in parallel with other opioid-related interventions, our

The effects of generative testing on text retention and text comprehension

NARCIS (Netherlands)

Dirkx, Kim; Kester, Liesbeth; Kirschner, Paul A.

2011-01-01

Dirkx, K. J. H., Kester, L., & Kirschner, P. A. (2011, 30 August). The effects of generative testing methods on text retention and text comprehension. Paper presented at the annual meeting of the European Association for Research on Learning and Instruction, Exeter, United Kingdom.

Effects of Different Types of True-False Questions on Memory Awareness and Long-Term Retention

Science.gov (United States)

Schaap, Lydia; Verkoeijen, Peter; Schmidt, Henk

2014-01-01

This study investigated the effects of two different true-false questions on memory awareness and long-term retention of knowledge. Participants took four subsequent knowledge tests on curriculum learning material that they studied at different retention intervals prior to the start of this study (i.e. prior to the first test). At the first and…

["Something humane has been lost". Re-evaluation of the attitudes of senior physicians towards the G-DRG System - a qualitative normative analysis].

Science.gov (United States)

Knoll, Marco; Otte, Ina; Salloch, Sabine; Ruiner, Caroline; Kruppa, Esta; Vollmann, Jochen

2018-04-01

Only a few years after the implementation of the G-DRG (German Diagnosis Related Group) system physicians already began to complain of its negative effects on the quality of inpatient healthcare. The present study examines the recent experiences senior physicians have made with regard to the impact of the G-DRG system on the quality of healthcare and medical professionalism. Nine qualitative guided expert interviews were conducted focusing on the experiences of physicians in leading positions dealing with the G-DRG system in their everyday work. The interviewees report an intensification of work attributable to an increasing number of inpatient cases, a more lenient definition of medical indications and a reduction in patient retention time. The physicians interviewed have felt increasingly constrained by economic conditions. Additionally, they stated that the G-DRG system's incentive structure encourages the discrimination of older, care-dependent and multimorbid patients. Possible countermeasures include a political revision of incentive regulation as well as a strengthening of up-to-date professional ethical education and teaching. Copyright © 2018. Published by Elsevier GmbH.

Super enhanced permeability and retention (SUPR) effects in tumors following near infrared photoimmunotherapy

Science.gov (United States)

Kobayashi, Hisataka; Choyke, Peter L.

2016-06-01

To date, the delivery of nano-sized therapeutic agents to cancers largely relies on enhanced permeability and retention (EPR) effects that are caused by the leaky nature of cancer vasculature. However, nano-sized agents delivered in this way have demonstrated limited success in oncology due to the relatively small magnitude of the EPR effect. For achieving superior delivery of nano-sized agents, super-enhanced permeability and retention (SUPR) effects are needed. Near infrared photo-immunotherapy (NIR-PIT) is a recently reported therapy that treats tumors with light therapy and subsequently causes an increase in nano-drug delivery up to 24-fold compared with untreated tumors in which only the EPR effect is present. SUPR effects could enhance delivery into tumor beds of a wide variety of nano-sized agents including particles, antibodies, and protein binding small molecular agents. Therefore, taking advantage of the SUPR effects after NIR-PIT may be a promising avenue to utilize a wide variety of nano-drugs in a highly effective manner.

Ethical principles for physician rating sites.

Science.gov (United States)

Strech, Daniel

2011-12-06

During the last 5 years, an ethical debate has emerged, often in public media, about the potential positive and negative effects of physician rating sites and whether physician rating sites created by insurance companies or government agencies are ethical in their current states. Due to the lack of direct evidence of physician rating sites' effects on physicians' performance, patient outcomes, or the public's trust in health care, most contributions refer to normative arguments, hypothetical effects, or indirect evidence. This paper aims, first, to structure the ethical debate about the basic concept of physician rating sites: allowing patients to rate, comment, and discuss physicians' performance, online and visible to everyone. Thus, it provides a more thorough and transparent starting point for further discussion and decision making on physician rating sites: what should physicians and health policy decision makers take into account when discussing the basic concept of physician rating sites and its possible implications on the physician-patient relationship? Second, it discusses where and how the preexisting evidence from the partly related field of public reporting of physician performance can serve as an indicator for specific needs of evaluative research in the field of physician rating sites. This paper defines the ethical principles of patient welfare, patient autonomy, physician welfare, and social justice in the context of physician rating sites. It also outlines basic conditions for a fair decision-making process concerning the implementation and regulation of physician rating sites, namely, transparency, justification, participation, minimization of conflicts of interest, and openness for revision. Besides other issues described in this paper, one trade-off presents a special challenge and will play an important role when deciding about more- or less-restrictive physician rating sites regulations: the potential psychological and financial harms for

Direct-to-consumer advertising: physicians' views of its effects on quality of care and the doctor-patient relationship.

Science.gov (United States)

Murray, Elizabeth; Lo, Bernard; Pollack, Lance; Donelan, Karen; Lee, Ken

2003-01-01

The objective of the study was to determine physicians' views of the effects of Direct-to-Consumer Advertising (DTCA) on health service utilization, quality of care, and the doctor-patient relationship. Cross-sectional survey of a nationally representative sample of US physicians to determine their perceptions of the effects of patients discussing information from DTCA on time efficiency; requests for specific interventions; health outcomes; and the doctor-patient relationship. Physicians reported that more than half (56%) of patients who discussed information from DTCA in a visit did so because they wanted a specific intervention, such as a test, change in medication, or specialist referral. The physician deemed 49% of these requests clinically inappropriate. Physicians filled 69% of requests they deemed clinically inappropriate; 39% of physicians perceived DTCA as damaging to the time efficiency of the visit, and 13% saw it as helpful. Thirty-three percent of physicians thought discussing DTCA had improved the doctor-patient relationship; 8% felt it had worsened it. The effect on the relationship was strongly associated with doing what the patient wanted. DTCA can have good and bad effects on quality of care, the doctor-patient relationship, and health service utilization. The benefits might be maximized, and the harms minimized, by increasing the accuracy of information in advertisements; enhancing physicians' communication and negotiation skills; and encouraging patients to respect physicians' clinical expertise.

The work environment and its effect on engagement and retention of nuclear medicine technologists: differences between public and private sector workers.

Science.gov (United States)

Adams, Edwina J; Cox, Jennifer M; Adamson, Barbara J; Schofield, Deborah J

2010-06-01

The retention of Australian nuclear medicine technologists (NMTs) is poor with the future workforce size in question. As a consequence, the primary aim of this study was to determine Australian NMTs' level of work engagement and the factors influencing this to identify the issues surrounding retention. The job demands resource model assumes that each job has its own demands and resources and the balance between these can influence the level of work engagement. Lower levels of work engagement are predictive of an intention to leave. Work engagement levels can be measured using the Utrecht work engagement scale. This study used the Utrecht Work Engagement Scale in a self-report questionnaire with additional open-ended and closed-ended items designed to evaluate satisfying job characteristics. Members of the professional body in specific geographical locations of Australia were invited to participate. A 49.6% response rate was achieved (n=201); of these, 164 were practicing NMTs. Public sector workers had significantly lower total mean scores (P=0.05) on the Utrecht Work Engagement Scale and the subscale of dedication (P=0.005) compared with private NMTs. Seven of the 14 job satisfaction closed-ended items were statistically significantly lower for public NMTs: the level of decision making; feelings of importance with the tasks performed; feedback on tasks and roles; and relationships with physicians, staff and the organization. To improve the retention of NMTs, changes in the job resources and demands are needed. Advanced practice roles may improve retention by enhancing the job resources.

Perceptions of community health center impact on private primary care physician practice.

Science.gov (United States)

Duffrin, Christopher; Jackson, Natalie; Whetstone, Lauren; Cummings, Doyle; Watson, Ricky; Wu, Qiang

2014-01-01

Community health centers (CHCs) were created in the mid-1960s to expand access to care in impoverished and underserved areas. The number of CHC sites has more than tripled in eastern North Carolina from 28 primary care centers in 2000 to 89 in 2010. This study determined the perceptions of physicians on the impact of CHC expansion on the local practice environment. Descriptive statistics and correlations were used to compare responses regarding perceptions and differences between practice characteristics as well as physician ratios by year. Both CHC and private practice physician addresses were mapped using ArcGIS. Surveys were sent to 1422 (461 returns/32.5% response rate) primary care physicians residing in 43 predominantly rural eastern North Carolina counties. A large percentage of the respondents (82.7%) affirmed that they felt neutral or did not view CHCs to be competitors, whereas a minority (17%) did view them to be difficult to compete against. Forty-two percent of private practice respondents disagreed that CHCs offer a wider range of services despite significantly more CHC physicians than private practice respondents indicating that their facility provided basic services. The CHCs were perceived to offer a wider range of services, employ more staff, and have more practice locations than private practices. However, private practice physicians did not perceive CHCs to have a competitive advantage or to unfairly impact their practices, possibly due to inconsistent population growth in relation to the physician retention during the last 10 years.

Effective training strategies for teaching communication skills to physicians: an overview of systematic reviews.

Science.gov (United States)

Berkhof, Marianne; van Rijssen, H Jolanda; Schellart, Antonius J M; Anema, Johannes R; van der Beek, Allard J

2011-08-01

Physicians need good communication skills to communicate effectively with patients. The objective of this review was to identify effective training strategies for teaching communication skills to qualified physicians. PubMED, PsycINFO, CINAHL, and COCHRANE were searched in October 2008 and in March 2009. Two authors independently selected relevant reviews and assessed their methodological quality with AMSTAR. Summary tables were constructed for data-synthesis, and results were linked to outcome measures. As a result, conclusions about the effectiveness of communication skills training strategies for physicians could be drawn. Twelve systematic reviews on communication skills training programmes for physicians were identified. Some focused on specific training strategies, whereas others emphasized a more general approach with mixed strategies. Training programmes were effective if they lasted for at least one day, were learner-centred, and focused on practising skills. The best training strategies within the programmes included role-play, feedback, and small group discussions. Training programmes should include active, practice-oriented strategies. Oral presentations on communication skills, modelling, and written information should only be used as supportive strategies. To be able to compare the effectiveness of training programmes more easily in the future, general agreement on outcome measures has to be established. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Private sector contributions and their effect on physician emigration in the developing world.

Science.gov (United States)

Loh, Lawrence C; Ugarte-Gil, Cesar; Darko, Kwame

2013-03-01

The contribution made by the private sector to health care in a low- or middle-income country may affect levels of physician emigration from that country. The increasing importance of the private sector in health care in the developing world has resulted in newfound academic interest in that sector's influences on many aspects of national health systems. The growth in physician emigration from the developing world has led to several attempts to identify both the factors that cause physicians to emigrate and the effects of physician emigration on primary care and population health in the countries that the physicians leave. When the relevant data on the emerging economies of Ghana, India and Peru were investigated, it appeared that the proportion of physicians participating in private health-care delivery, the percentage of health-care costs financed publicly and the amount of private health-care financing per capita were each inversely related to the level of physician expatriation. It therefore appears that private health-care delivery and financing may decrease physician emigration. There is clearly a need for similar research in other low- and middle-income countries, and for studies to see if, at the country level, temporal trends in the contribution made to health care by the private sector can be related to the corresponding trends in physician emigration. The ways in which private health care may be associated with access problems for the poor and therefore reduced equity also merit further investigation. The results should be of interest to policy-makers who aim to improve health systems worldwide.

Effects of variable attachment shapes and aligner material on aligner retention.

Science.gov (United States)

Dasy, Hiltrud; Dasy, Andreas; Asatrian, Greg; Rózsa, Noémi; Lee, Hao-Fu; Kwak, Jin Hee

2015-11-01

To evaluate the retention of four types of aligners on a dental arch with various attachments. For this study, three casts were manufactured, two of which contained attachments (ellipsoid and beveled), and one without any attachments to serve as a control. Four types of aligners were thermoformed: Clear-Aligner (CA)-soft, CA-medium, and CA-hard, with various thicknesses, and Essix ACE. Measurements of vertical displacement force during aligner removal were performed with the Gabo Qualimeter Eplexor. Means and standard deviations were next compared between different aligner thicknesses and attachment shapes. CA-soft, CA-medium, and CA-hard did not present a significant increase in retention, except when used in the presence of attachments. Additionally, CA-medium and CA-hard required significantly more force for removal. Essix ACE demonstrated a significant decrease in retention when used with ellipsoid attachments. The force value for Essix ACE removal from the cast with beveled attachments was comparable to that of CA-medium. Forces for aligner removal from the model without attachments showed a linear trend. Essix ACE did not show a continuous increase in retention for each model. Overall, ellipsoid attachments did not present a significant change in retention. In contrast, beveled attachments improved retention. Ellipsoid attachments had no significant influence on the force required for aligner removal and hence on aligner retention. Essix ACE showed significantly less retention than CA-hard on the models with attachments. Furthermore, beveled attachments were observed to increase retention significantly, compared with ellipsoid attachments and when using no attachments.

Retention of Root Canal Posts

DEFF Research Database (Denmark)

Sahafi, A; Benetti, Ana Raquel; Flury, S

2015-01-01

The aim of this study was to investigate the effect of the cement film thickness of a zinc phosphate or a resin cement on retention of untreated and pretreated root canal posts. Prefabricated zirconia posts (CosmoPost: 1.4 mm) and two types of luting cements (a zinc phosphate cement [DeTrey Zinc...... received tribochemical silicate coating according to the manufacturer's instructions. Posts were then luted in the prepared root canals (n=30 per group). Following water storage at 37°C for seven days, retention of the posts was determined by the pull-out method. Irrespective of the luting cement......, pretreatment with tribochemical silicate coating significantly increased retention of the posts. Increased cement film thickness resulted in decreased retention of untreated posts and of pretreated posts luted with zinc phosphate cement. Increased cement film thickness had no influence on retention...

In Vitro Retentive Effect of Groove, Sandblasting, and Cement Type on Stainless Steel Crowns in Primary Molars.

Science.gov (United States)

Pathak, Sidhant; Shashibhushan, K K; Bharath, K P; Poornima, P; Reddy, V V Subba

2015-01-01

The purpose of this study was to evaluate and compare the effect of placing vertical grooves, sandblasting, and luting cements on the retention of stainless steel crowns (SSCs). Eighty extracted primary molars were mounted in acrylic blocks. Specimens were divided into Group 1 (RelyX U200) and Group 2 (Smart Cem2). Teeth in each group were further subdivided into Subgroup A (no vertical grooves and no sandblasting), Subgroup B (vertical grooves), Subgroup C (sandblasting of crowns), and Subgroup D (vertical grooves and sandblasting of crowns). After cementation, SSCs were pulled off using a universal testing machine. One-way analysis of variance was used for statistical analyses. In Groups 1 and 2, the highest retentive strengths were found in Subgroup D (1,124 and 783 kPa, respectively), followed by Subgroup C (1,066 and 748 kPa, respectively), Subgroup A (762 and 356 kPa, respectively), and Subgroup B (743 and 314 kPa, respectively). Retentive strength in Group one was significantly higher than in Group two; Subgroups A and B were significantly lower than C and D. RelyX U200 showed higher retentive strength than Smart Cem2. Sandblasting increased the retention strength, whereas a vertical groove had no significant effect on retention.

Enhancing retention of partial dentures using elastomeric retention rings

Directory of Open Access Journals (Sweden)

Kakkirala Revathi

2015-01-01

Full Text Available This report presents an alternative method for the retention of partial dentures that relies on the engagement of tooth undercuts by a lining material. The lab procedures are also presented. A new maxillary and mandibular acrylic partial dentures were fabricated using elastomeric retention technique for a partially dentate patient. A partially dentate man reported difficulty in retaining his upper removable partial denture (RPD. The maxillary RPD was designed utilizing elastomeric retention technique. During follow-up, it was necessary to replace the retention rings due to wear. The replacement of the retention rings, in this case, was done through a chairside reline technique. Elastomeric retention technique provides exceptionally good retention can be indicated to stabilize, cushion, splint periodontally involved teeth, no enough undercut for clasps, eliminate extractions, single or isolated teeth.

Hematuria and clot retention after transvaginal oocyte aspiration: a case report.

Science.gov (United States)

Modder, Joshua; Kettel, L Michael; Sakamoto, Kyoko

2006-09-01

To report a case of bladder injury with hematuria and urinary retention after transvaginal oocyte aspiration. Case report. Emergency room in a university medical center. A 28-year-old woman presented with urinary retention and suprapubic pain 8 hours after oocyte aspiration. Foley catheter, intravenous fluid bolus, bladder irrigation, and computed tomography with postvoid films that showed a blood clot in the bladder. Patient was discharged home with antibiotics and catheter in place. Clinical follow-up. Patient passed voiding trial 4 days later and was artificially inseminated. No further hematuria or voiding problems were reported, and she had a successful pregnancy. Patients who elect to undergo oocyte aspiration should be warned about the possibility of bladder injury because of the close proximity of the ovaries to the bladder, and physicians should have an appropriate treatment plan.

Physician-patient communication in HIV disease: the importance of patient, physician, and visit characteristics.

Science.gov (United States)

Wilson, I B; Kaplan, S

2000-12-15

-specific communication. In this study, female and homosexual physicians provided higher quality HIV-specific communication than male and heterosexual physicians. Better understanding the processes by which female and homosexual physicians achieve higher quality communication may help other physicians communicate more effectively. Health care providers and third-party payers should be aware that shorter visits may compromise physician-patient communication, and that this effect may be more consequential for male patients.

Effects of Rote Versus Note Presentations on Rhythm Learning and Retention.

Science.gov (United States)

Shehan, Patricia K.

1987-01-01

Reports a study which examined the effects of audio and visual approaches to rhythm reading and short-term retention in second and sixth grade students. Sixth graders learned the patterns twice as fast as younger children. Simultaneous use of both auditory and visual channels facilitates learning. (Author/AEM)

Effects of Mentoring Programs on New Teacher Retention: A Literature Review

Science.gov (United States)

Waterman, Sheryn; He, Ye

2011-01-01

Building upon previous literature reviews, this article highlights research and evaluation efforts regarding the effectiveness of mentoring programs for new teacher retention in the USA since 2005. Through the analysis of various mentoring program components, different research methods used, and major findings from these studies, we discuss the…

Anion effect on the retention of recoil atom of coordination crystalline compounds

International Nuclear Information System (INIS)

Dimotakis, P.N.; Papadopoulos, B.P.

1980-01-01

The anion effect of various cobaltic crystalline compounds - having the same cation and differing in anion -on the retention of neutron activated central cobalt atom has been studied. The cation was trans-dichloro(bis)ethylenediamine cobalt(III) and the anions were simple spherical anions (Cl - , Br - , I - ), planar anions (NO 3 - ), trigonal pyramidal anions (ClO 3 - , BrO 3 - ), tetrahedral anions (SO 4 2- , CrO 4 2- , MnO 4 - ) and linear anions (SCN - ). The cobalt-60 activity after reactor irradiation either in simple Co 2+ cation or in cobaltic complex cation determined the retention values. In all irradiations at ordinary temperature and at liquid nitrogen temperature the results showed an effect of the different anions, depending on the geometry, volume and charge, on the recombination of the recoil cobalt with the ligands in the coordination sphere. (author)

Retention of Mohs surgeons in academic dermatology.

Science.gov (United States)

Zhang, Shali; Mina, Mary Alice; Brown, Marc D; Zwald, Fiona O

2015-08-01

Retention of academic Mohs surgeons is important for the growth of this specialty and teaching of residents and students. To examine factors that influence retention of Mohs surgeons in academics and to better understand reasons for their departure. A survey was electronically distributed to academic Mohs surgeons in the American College of Mohs Surgery, asking them to rate the importance of several variables on their decision to remain in academia. Private practice Mohs surgeons who had left academics were also surveyed. Two hundred thirty-six dermatologic surgeons completed the survey. Twenty-nine percent work full time in academics, and approximately 7% work part time. The top reasons for practicing in the academic setting are intellectual stimulation, teaching opportunities, and collaboration with other university physicians and researchers. Seventy-one percent of respondents reported they would stay in academics, 7% indicated they would not, and 22% were unsure. Unfair compensation, inadequate support staff, poor leadership, increased bureaucracy, and decreased autonomy were top reasons that may compel a Mohs surgeon to leave. Opportunities for intellectual stimulation, collaboration, and teaching remain the main draw for academic Mohs surgeons. A supportive environment, strong leadership, and establishing fair compensation are imperative in ensuring their stay.

Effectiveness of Resident Physicians as Triage Liaison Providers in an Academic Emergency Department.

Science.gov (United States)

Weston, Victoria; Jain, Sushil K; Gottlieb, Michael; Aldeen, Amer; Gravenor, Stephanie; Schmidt, Michael J; Malik, Sanjeev

2017-06-01

Emergency department (ED) crowding is associated with detrimental effects on ED quality of care. Triage liaison providers (TLP) have been used to mitigate the effects of crowding. Prior studies have evaluated attending physicians and advanced practice providers as TLPs, with limited data evaluating resident physicians as TLPs. This study compares operational performance outcomes between resident and attending physicians as TLPs. This retrospective cohort study compared aggregate operational performance at an urban, academic ED during pre- and post-TLP periods. The primary outcome was defined as cost-effectiveness based upon return on investment (ROI). Secondary outcomes were defined as differences in median ED length of stay (LOS), median door-to-provider (DTP) time, proportion of left without being seen (LWBS), and proportion of "very good" overall patient satisfaction scores. Annual profit generated for physician-based collections through LWBS capture (after deducting respective salary costs) equated to a gain (ROI: 54%) for resident TLPs and a loss (ROI: -31%) for attending TLPs. Accounting for hospital-based collections made both profitable, with gains for resident TLPs (ROI: 317%) and for attending TLPs (ROI: 86%). Median DTP time for resident TLPs was significantly lower (phistorical control. Proportion of "very good" patient satisfaction scores and LWBS was improved for both resident and attending TLPs over historical control. Overall median LOS was not significantly different. Resident and attending TLPs improved DTP time, patient satisfaction, and LWBS rates. Both resident and attending TLPs are cost effective, with residents having a more favorable financial profile.

Effect of ceramic membrane channel diameter on limiting retentate protein concentration during skim milk microfiltration.

Science.gov (United States)

Adams, Michael C; Barbano, David M

2016-01-01

Our objective was to determine the effect of retentate flow channel diameter (4 or 6mm) of nongraded permeability 100-nm pore size ceramic membranes operated in nonuniform transmembrane pressure mode on the limiting retentate protein concentration (LRPC) while microfiltering (MF) skim milk at a temperature of 50°C, a flux of 55 kg · m(-2) · h(-1), and an average cross-flow velocity of 7 m · s(-1). At the above conditions, the retentate true protein concentration was incrementally increased from 7 to 11.5%. When temperature, flux, and average cross-flow velocity were controlled, ceramic membrane retentate flow channel diameter did not affect the LRPC. This indicates that LRPC is not a function of the Reynolds number. Computational fluid dynamics data, which indicated that both membranes had similar radial velocity profiles within their retentate flow channels, supported this finding. Membranes with 6-mm flow channels can be operated at a lower pressure decrease from membrane inlet to membrane outlet (ΔP) or at a higher cross-flow velocity, depending on which is controlled, than membranes with 4-mm flow channels. This implies that 6-mm membranes could achieve a higher LRPC than 4-mm membranes at the same ΔP due to an increase in cross-flow velocity. In theory, the higher LRPC of the 6-mm membranes could facilitate 95% serum protein removal in 2 MF stages with diafiltration between stages if no serum protein were rejected by the membrane. At the same flux, retentate protein concentration, and average cross-flow velocity, 4-mm membranes require 21% more energy to remove a given amount of permeate than 6-mm membranes, despite the lower surface area of the 6-mm membranes. Equations to predict skim milk MF retentate viscosity as a function of protein concentration and temperature are provided. Retentate viscosity, retentate recirculation pump frequency required to maintain a given cross-flow velocity at a given retentate viscosity, and retentate protein

Rise of Health Consumerism in China and Its Effects on Physicians' Professional Identity and the Physician-Patient Relationship and Communication.

Science.gov (United States)

Tang, Lu; Guan, Mengfei

2018-05-01

The physician-patient relationship in China is highly strained. This study examined the professional identity of physicians and their perceptions of the physician-patient relationship against the backdrop of the rise of health consumerism in China. Structured interviews with 29 physicians found that the marketization of medical care and the rise of health consumerism caused physicians to have a conflicted professional identity. The traditional bureaucratic relationship between physicians and patients based on implicit trust was gradually replaced by an arm's length relationship characterized by self-interest, opportunism, and mistrust. In addition, the transition from physician-centered communication to patient-centered communication in China was tenacious. Theoretical and practical implications of the current study are discussed.

Effect of Retention Time on Biogas Production from Poultry ...

African Journals Online (AJOL)

A study was carried out on different retention times in the anaerobic fermentation of slurry from poultry droppings and cassava peels. The system adopted in this work was batch-type. Daily gas production fell slightly from 130 to 32 litres as retention time was increased from 10 to 40 days for poultry droppings. For cassava ...

Effects of glibenclamide on memory retention of passive avoidance learning in rats

Directory of Open Access Journals (Sweden)

MH. Esmaeili

2017-08-01

Full Text Available Background: Glucose increases memory in rats, and inhibit memory impairments produced by morphine. One mechanism by which glucose might act on memory via regulating the ATP-sensitive potassium channel. Objective: The aim of present study was to investigate the effects of glibenclamide on memory retention of passive avoidance learning in rats. Methods: This experimental study has been conducted in Qazvin University of Medical Sciences (2016. Forty male Wistar rats were divided into: Control, DMSO and glibenclamide groups (n=8. All rats were trained in a passive avoidance task (50 Hz, 1 mA, 3 s. DMSO (0.2 ml or glibenclamide (1, 2, 5 mg/kg, i.p. were injected for 10 days before training. Retention test was done 48 h later. Memory retention of each animal was measured as latency takes to enter the dark chamber. Findings: The time spent in the light chamber area before entering to the dark area and total time spent in the light chamber in the glibenclamide groups were less than control group. These times in the glibenclamide (5 mg/kg group was significantly lower than control group (P<0.05, conversely total time spent in the dark chamber in the glibenclamide groups were higher than control group. Conclusion: Glibenclamide, as an ATP-sensitive potassium channel blocker, may reduce memory retention by increasing insulin levels and, consequently, reducing blood glucose levels.

The effect of retentive groove, sandblasting and cement type on the retentive strength of stainless steel crowns in primary second molars--an in vitro comparative study.

Science.gov (United States)

Veerabadhran, M M; Reddy, V; Nayak, U A; Rao, A P; Sundaram, M A

2012-01-01

This in vitro study was conducted to find out the effect of retentive groove, sand blasting and cement type on the retentive strength of stainless steel crowns in primary second molars. Thirty-two extracted intact human maxillary and mandibular primary second molars were embedded in aluminum blocks utilizing autopolymerising acrylic resin. After tooth preparation, the 3M stainless steel crown was adjusted to the prepared tooth. Then weldable buccal tubes were welded on the buccal and lingual surfaces of each crown as an attachment for the testing machine. A full factorial design matrix for four factors (retentive groove placement on the tooth, cement type, sandblasting and primary second molar) at two levels each was developed and the study was conducted as dictated by the matrix. The lower and upper limits for each factor were without and with retentive groove placement on the tooth, GIC and RMGIC, without and with sandblasting of crown, maxillary and mandibular second primary molar. For those teeth for which the design matrix dictated groove placement, the retentive groove was placed on the middle third of the buccal surface of the tooth horizontally and for those crowns for which sandblasting of the crowns are to be done, sandblasting was done with aluminium oxide with a particle size of 250 mm. The crowns were luted with either GIC or RMGIC, as dictated by the design matrix. Then the retentive strength of each sample was evaluated by means of an universal testing machine. The obtained data was analyzed using ANOVA for statistical analysis of the data and 't'- tests for pairwise comparison. The mean retentive strength in kg/cm 2 stainless steel crowns luted with RMGIC was 19.361 and the mean retentive strength of stainless steel crowns luted with GIC was 15.964 kg/cm 2 with a mean difference of 3.397 kg/cm 2 and was statistically significant. The mean retentive strength in kg/cm 2 of stainless steel crowns, which was not sandblasted, was 18.880 and which was

First and foremost, physicians: the clinical versus leadership identities of physician leaders.

Science.gov (United States)

Quinn, Joann Farrell; Perelli, Sheri

2016-06-20

Purpose - Physicians are commonly promoted into administrative and managerial roles in US hospitals on the basis of clinical expertise and often lack the skills, training or inclination to lead. Several studies have sought to identify factors associated with effective physician leadership, yet we know little about how physician leaders themselves construe their roles. The paper aims to discuss these issues. Design/methodology/approach - Phenomenological interviews were performed with 25 physicians at three organizational levels with physicians affiliated or employed by four hospitals within one health care organization in the USA between August and September 2010. A rigorous comparative methodology of data collection and analysis was employed, including the construction of analytic codes for the data and its categorization based on emergent ideas and themes that are not preconceived and logically deduced hypotheses, which is characteristic of grounded theory. Findings - These interviews reveal differences in how part- vs full-time physician leaders understand and value leadership roles vs clinical roles, claim leadership status, and identify as physician leaders on individual, relational and organizational basis. Research limitations/implications - Although the physicians in the sample were affiliated with four community hospitals, all of them were part of a single not-for-profit health care system in one geographical locale. Practical implications - These findings may be of interest to hospital administrators and boards seeking deeper commitment and higher performance from physician leaders, as well as assist physicians in transitioning into a leadership role. Social implications - This work points to a broader and more fundamental need - a modified mindset about the nature and value of physician leadership. Originality/value - This study is unique in the exploration of the nature of physician leadership from the perspective of the physician on an individual, peer

The Effects of Test Trial and Processing Level on Immediate and Delayed Retention

Science.gov (United States)

Chang, Sau Hou

2017-01-01

The purpose of the present study was to investigate the effects of test trial and processing level on immediate and delayed retention. A 2 × 2 × 2 mixed ANOVAs was used with two between-subject factors of test trial (single test, repeated test) and processing level (shallow, deep), and one within-subject factor of final recall (immediate, delayed). Seventy-six college students were randomly assigned first to the single test (studied the stimulus words three times and took one free-recall test) and the repeated test trials (studied the stimulus words once and took three consecutive free-recall tests), and then to the shallow processing level (asked whether each stimulus word was presented in capital letter or in small letter) and the deep processing level (whether each stimulus word belonged to a particular category) to study forty stimulus words. The immediate test was administered five minutes after the trials, whereas the delayed test was administered one week later. Results showed that single test trial recalled more words than repeated test trial in immediate final free-recall test, participants in deep processing performed better than those in shallow processing in both immediate and delayed retention. However, the dominance of single test trial and deep processing did not happen in delayed retention. Additional study trials did not further enhance the delayed retention of words encoded in deep processing, but did enhance the delayed retention of words encoded in shallow processing. PMID:28344679

The Effects of Test Trial and Processing Level on Immediate and Delayed Retention.

Science.gov (United States)

Chang, Sau Hou

2017-03-01

The purpose of the present study was to investigate the effects of test trial and processing level on immediate and delayed retention. A 2 × 2 × 2 mixed ANOVAs was used with two between-subject factors of test trial (single test, repeated test) and processing level (shallow, deep), and one within-subject factor of final recall (immediate, delayed). Seventy-six college students were randomly assigned first to the single test (studied the stimulus words three times and took one free-recall test) and the repeated test trials (studied the stimulus words once and took three consecutive free-recall tests), and then to the shallow processing level (asked whether each stimulus word was presented in capital letter or in small letter) and the deep processing level (whether each stimulus word belonged to a particular category) to study forty stimulus words. The immediate test was administered five minutes after the trials, whereas the delayed test was administered one week later. Results showed that single test trial recalled more words than repeated test trial in immediate final free-recall test, participants in deep processing performed better than those in shallow processing in both immediate and delayed retention. However, the dominance of single test trial and deep processing did not happen in delayed retention. Additional study trials did not further enhance the delayed retention of words encoded in deep processing, but did enhance the delayed retention of words encoded in shallow processing.

The Effects of Test Trial and Processing Level on Immediate and Delayed Retention

Directory of Open Access Journals (Sweden)

Sau Hou Chang

2017-03-01

Full Text Available The purpose of the present study was to investigate the effects of test trial and processing level on immediate and delayed retention. A 2 × 2 × 2 mixed ANOVAs was used with two between-subject factors of test trial (single test, repeated test and processing level (shallow, deep, and one within-subject factor of final recall (immediate, delayed. Seventy-six college students were randomly assigned first to the single test (studied the stimulus words three times and took one free-recall test and the repeated test trials (studied the stimulus words once and took three consecutive free-recall tests, and then to the shallow processing level (asked whether each stimulus word was presented in capital letter or in small letter and the deep processing level (whether each stimulus word belonged to a particular category to study forty stimulus words. The immediate test was administered five minutes after the trials, whereas the delayed test was administered one week later. Results showed that single test trial recalled more words than repeated test trial in immediate final free-recall test, participants in deep processing performed better than those in shallow processing in both immediate and delayed retention. However, the dominance of single test trial and deep processing did not happen in delayed retention. Additional study trials did not further enhance the delayed retention of words encoded in deep processing, but did enhance the delayed retention of words encoded in shallow processing.

Military physician recruitment and retention: a survey of students at the Uniformed Services University of the Health Sciences.

Science.gov (United States)

Holmes, Samuel L; Lee, Daniel J; Charny, Grigory; Guthrie, Jeff A; Knight, John G

2009-05-01

Recent strategies employed in response to military physician recruitment shortfalls have consisted of increasing financial incentives for students in the Health Professions Scholarship Program (HPSP) while offering no increased incentive for attendance at the Uniformed Services University of the Health Sciences (USUHS). To gauge the impact of these incentive increases on the decision of medical students to attend USUHS, a prospective e-mail survey of current USUHS medical students was conducted. The survey was distributed to 674 USUHS medical students from all four class years, of which 41% responded. Students were asked to prioritize incentives and disincentives for military service and USUHS, as well as respond to whether recent incentives applied solely to the HPSP would have affected their decision to attend USUHS. Data were assessed using a weighted scale with responses ranked highest receiving a score of 3, responses ranked second receiving a weighted score of 2, and those ranked third receiving a weighted score of 1. The total weighted sum for each question response across the respondent population was then tallied in aggregate and assigned a weighted score to identify factors consistently ranked highest among the students. Patriotic duty and serving uniformed personnel were ranked most appealing about military service. Combat and deployment considerations were ranked least appealing about military service. Also of note, numerous survey comment box responses highlighted the perceived advantages of pooling resources between the two programs to benefit military medical student recruitment and training. Survey results suggested that current enhanced financial incentives and shorter service obligation offered by the HPSP make attendance of USUHS less appealing for current USUHS students and may negatively impact recruitment and retention of USUHS medical officers. Commensurate incentives such as promotion and credit for time in service while attending USUHS were

Best practices in doctoral retention: Mentoring

Directory of Open Access Journals (Sweden)

Judie L. Brill

2014-06-01

Full Text Available  The aim of this critical literature review is to outline best practices in doctoral retention and the successful approach of one university to improve graduation success by providing effective mentorship for faculty and students alike. The focus of this literature review is on distance learning relationships between faculty and doctoral students, regarding retention, persistence, and mentoring models. Key phrases and words used in the search and focusing on mentoring resulted in over 20,000 sources. The search was narrowed to include only doctoral study and mentoring. Research questions of interest were: Why do high attrition rates exist for doctoral students? What are the barriers to retention? What are the benefits of doctoral mentoring? What programs do institutions have in place to reduce attrition? The researchers found a key factor influencing doctoral student retention and success is effective faculty mentorship. In particular, the design of a mentoring and faculty training program to increase retention and provide for success after graduation is important. This research represents a key area of interest in the retention literature, as institutions continue to search for ways to better support students during their doctoral programs and post-graduation. DOI: 10.18870/hlrc.v4i2.186

Managing Disruptive Physician Behavior: First Steps for Designing an Effective Online Resource

Directory of Open Access Journals (Sweden)

Derek Puddester

2011-03-01

Full Text Available Interviews with physician leaders from hospitals in a mid-sized Ontario City were conducted to determine their needs with regard to managing disruptive physician behaviour. These findings were used to inform the design of a two-day skill-development workshop for physician leaders on disruptive behaviour. The workshop was evaluated using a modified version of the Learner Experience Feedback Form, which was built to align with W(eLearn, http://www.ennovativesolution.com/WeLearn/ a framework developed to guide the design, delivery, development, and evaluation of online interprofessional courses and programs (MacDonald, Stodel, Thompson, & Casimiro, 2009. The surveys gathered information related to the content, media, service, structure, and outcomes of the workshop. The findings from the focus group interviews and workshop evaluation identify physician leaders’ needs with regard to disruptive behavior and were used to inform the design of the world’s first Online Physician Health and Wellness Resource http://www.ephysicianhealth.com/ an open access learning resources currently being used globally, in 91 countries. The resource was the recipient of the winner of the International Business/Professional 2010 International eLearning Award. The findings demonstrated the importance of conducting a needs analysis and using a framework to guide the design, delivery and evaluation of effective online healthcare education.

The Retention of Female Unrestricted Line Officers

National Research Council Canada - National Science Library

Pecenco, Elena G

2005-01-01

This thesis analyzes the retention of female Naval officers, focusing on the relationship between officer selection metrics and retention beyond minimum service obligation and the effect of lateral...

Biochar effects on wet and dry regions of the soil water retention curve of a sandy loam

DEFF Research Database (Denmark)

Arthur, Emmanuel; Moldrup, Per; Sun, Zhencai

2014-01-01

Reported beneficial effects of biochar on soil physical properties and processes include decreased soil density, and increased soil water transport, water holding capacity and retention (mainly for the wet region). Research is limited on biochar effects on the full soil water retention curve (wet...... and dry regions) for a given soil and biochar amendment scenarios. This study evaluates how biochar applied to a sandy loam field at rates from 0 to 50 Mg ha−1 yr–1 in 2011, 2012, or both years (2011+2012) influences the full water retention curve. Inorganic fertilizer and pig slurry were added to all...... treatments. Six months after the last biochar application, intact and disturbed soil samples were collected for analyses. Soil water retention was measured from −1 kPa to −100 kPa using tension tables and ceramic plates and from −10 MPa to −480 MPa using a Vapor Sorption Analyzer. Soil specific area...

Effect of Abutment Modification and Cement Type on Retention of Cement-Retained Implant Supported Crowns

OpenAIRE

Farzin, Mitra; Torabi, Kianoosh; Ahangari, Ahmad Hasan; Derafshi, Reza

2014-01-01

Objective: Provisional cements are commonly used to facilitate retrievability of cement-retained fixed implant restorations; but compromised abutment preparation may affect the retention of implant-retained crowns.The purpose of this study was to investigate the effect of abutment design and type of luting agent on the retentive strength of cement-retained implant restorations. Materials and Method: Two prefabricated abutments were attached to their corresponding analogs and embedded in an ac...

HPLC retention thermodynamics of grape and wine tannins.

Science.gov (United States)

Barak, Jennifer A; Kennedy, James A

2013-05-08

The effect of grape and wine tannin structure on retention thermodynamics under reversed-phase high-performance liquid chromatography conditions on a polystyrene divinylbenzene column was investigated. On the basis of retention response to temperature, an alternative retention factor was developed to approximate the combined temperature response of the complex, unresolvable tannin mixture. This alternative retention factor was based upon relative tannin peak areas separated by an abrupt change in solvent gradient. Using this alternative retention factor, retention thermodynamics were calculated. Van't Hoff relationships of the natural log of the alternative retention factor against temperature followed Kirchoff's relationship. An inverse quadratic equation was fit to the data, and from this the thermodynamic parameters for tannin retention were calculated. All tannin fractions exhibited exothermic, spontaneous interaction, with enthalpy-entropy compensation observed. Normalizing for tannin size, distinct tannin compositional effects on thermodynamic parameters were observed. The results of this study indicate that HPLC can be valuable for measuring the thermodynamics of tannin interaction with a hydrophobic surface and provides a potentially valuable alternative to calorimetry. Furthermore, the information gathered may provide insight into understanding red wine astringency quality.

Family physician perceptions of working with LGBTQ patients: physician training needs.

Science.gov (United States)

Beagan, Brenda; Fredericks, Erin; Bryson, Mary

2015-01-01

Medical students and physicians report feeling under-prepared for working with patients who identify as lesbian, gay, bisexual, transgender or queer (LGBTQ). Understanding physician perceptions of this area of practice may aid in developing improved education. In-depth interviews with 24 general practice physicians in Halifax and Vancouver, Canada, were used to explore whether, when and how the gender identity and sexual orientation of LGBTQ women were relevant to good care. Inductive thematic analysis was conducted using ATLAS.ti data analysis software. Three major themes emerged: 1) Some physicians perceived that sexual/gender identity makes little or no difference; treating every patient as an individual while avoiding labels optimises care for everyone. 2) Some physicians perceived sexual/gender identity matters primarily for the provision of holistic care, and in order to address the effects of discrimination. 3) Some physicians perceived that sexual/gender identity both matters and does not matter, as they strove to balance the implications of social group membership with recognition of individual differences. Physicians may be ignoring important aspects of social group memberships that affect health and health care. The authors hold that individual and socio-cultural differences are both important to the provision of quality health care. Distinct from stereotypes, generalisations about social group differences can provide valuable starting points, raising useful lines of inquiry. Emphasizing this distinction in medical education may help change physician approaches to the care of LGBTQ women.

Family physician perceptions of working with LGBTQ patients: physician training needs

Directory of Open Access Journals (Sweden)

Brenda Beagan

2015-04-01

Full Text Available Background: Medical students and physicians report feeling under-prepared for working with patients who identify as lesbian, gay, bisexual, transgender or queer (LGBTQ. Understanding physician perceptions of this area of practice may aid in developing improved education. Method: In-depth interviews with 24 general practice physicians in Halifax and Vancouver, Canada, were used to explore whether, when and how the gender identity and sexual orientation of LGBTQ women were relevant to good care. Inductive thematic analysis was conducted using ATLAS.ti data analysis software. Results: Three major themes emerged: 1 Some physicians perceived that sexual/gender identity makes little or no difference; treating every patient as an individual while avoiding labels optimises care for everyone. 2 Some physicians perceived sexual/gender identity matters primarily for the provision of holistic care, and in order to address the effects of discrimination. 3 Some physicians perceived that sexual/gender identity both matters and does not matter, as they strove to balance the implications of social group membership with recognition of individual differences. Conclusions: Physicians may be ignoring important aspects of social group memberships that affect health and health care. The authors hold that individual and socio-cultural differences are both important to the provision of quality health care. Distinct from stereotypes, generalisations about social group differences can provide valuable starting points, raising useful lines of inquiry. Emphasizing this distinction in medical education may help change physician approaches to the care of LGBTQ women.

Effects of Physician Volume on Readmission and Mortality in Elderly Patients with Heart Failure: Nationwide Cohort Study.

Science.gov (United States)

Lee, Joo Eun; Park, Eun Cheol; Jang, Suk Yong; Lee, Sang Ah; Choy, Yoon Soo; Kim, Tae Hyun

2018-03-01

Readmission and mortality rates of patients with heart failure are good indicators of care quality. To determine whether hospital resources are associated with care quality for cardiac patients, we analyzed the effect of number of physicians and the combined effects of number of physicians and beds on 30-day readmission and 1-year mortality. We used national cohort sample data of the National Health Insurance Service (NHIS) claims in 2002-2013. Subjects comprised 2345 inpatients (age: >65 years) admitted to acute-care hospitals for heart failure. A multivariate Cox regression was used. Of the 2345 patients hospitalized with heart failure, 812 inpatients (34.6%) were readmitted within 30 days and 190 (8.1%) had died within a year. Heart-failure patients treated at hospitals with low physician volumes had higher readmission and mortality rates than high physician volumes [30-day readmission: hazard ratio (HR)=1.291, 95% confidence interval (CI)=1.020-1.633; 1-year mortality: HR=2.168, 95% CI=1.415-3.321]. Patients admitted to hospitals with low or middle bed and physician volume had higher 30-day readmission and 1-year mortality rates than those admitted to hospitals with high volume (30-day readmission: HR=2.812, 95% CI=1.561-5.066 for middle-volume beds & low-volume physicians, 1-year mortality: HR=8.638, 95% CI=2.072-36.02 for middle-volume beds & low-volume physicians). Physician volume is related to lower readmission and mortality for heart failure. Of interest, 30-day readmission and 1-year mortality were significantly associated with the combined effects of physician and institution bed volume. © Copyright: Yonsei University College of Medicine 2018

Effective Retention Strategies for Diverse Employees.

Science.gov (United States)

Musser, Linda R.

2001-01-01

Discusses methods to determine why employees leave or stay, based on experiences at Pennsylvania State University libraries. Considers retention tools that work best to retain diverse employees, including mentoring, networking, career and learning opportunities, balance between work and home life, a welcoming climate, and support for research.…

Physicians and euthanasia: a Canadian print-media discourse analysis of physician perspectives.

Science.gov (United States)

Wright, David Kenneth; Fishman, Jennifer R; Karsoho, Hadi; Sandham, Sarah; Macdonald, Mary Ellen

2015-01-01

Recent events in Canada have mobilized public debate concerning the controversial issue of euthanasia. Physicians represent an essential stakeholder group with respect to the ethics and practice of euthanasia. Further, their opinions can hold sway with the public, and their public views about this issue may further reflect back upon the medical profession itself. We conducted a discourse analysis of print media on physicians' perspectives about end-of-life care. Print media, in English and French, that appeared in Canadian newspapers from 2008 to 2012 were retrieved through a systematic database search. We analyzed the content of 285 articles either authored by a physician or directly referencing a physician's perspective. We identified 3 predominant discourses about physicians' public views toward euthanasia: 1) contentions about integrating euthanasia within the basic mission of medicine, 2) assertions about whether euthanasia can be distinguished from other end-of-life medical practices and 3) palliative care advocacy. Our data showed that although some medical professional bodies appear to be supportive in the media of a movement toward the legalization of euthanasia, individual physicians are represented as mostly opposed. Professional physician organizations and the few physicians who have engaged with the media are de facto representing physicians in public contemporary debates on medical aid in dying, in general, and euthanasia, in particular. It is vital for physicians to be aware of this public debate, how they are being portrayed within it and its potential effects on impending changes to provincial and national policies.

Effectiveness of Resident Physicians as Triage Liaison Providers in an Academic Emergency Department

Directory of Open Access Journals (Sweden)

Victoria Weston

2017-04-01

Full Text Available Introduction: Emergency department (ED crowding is associated with detrimental effects on ED quality of care. Triage liaison providers (TLP have been used to mitigate the effects of crowding. Prior studies have evaluated attending physicians and advanced practice providers as TLPs, with limited data evaluating resident physicians as TLPs. This study compares operational performance outcomes between resident and attending physicians as TLPs. Methods: This retrospective cohort study compared aggregate operational performance at an urban, academic ED during pre- and post-TLP periods. The primary outcome was defined as cost-effectiveness based upon return on investment (ROI. Secondary outcomes were defined as differences in median ED length of stay (LOS, median door-to-provider (DTP time, proportion of left without being seen (LWBS, and proportion of “very good” overall patient satisfaction scores. Results: Annual profit generated for physician-based collections through LWBS capture (after deducting respective salary costs equated to a gain (ROI: 54% for resident TLPs and a loss (ROI: −31% for attending TLPs. Accounting for hospital-based collections made both profitable, with gains for resident TLPs (ROI: 317% and for attending TLPs (ROI: 86%. Median DTP time for resident TLPs was significantly lower (p<0.0001 than attending or historical control. Proportion of “very good” patient satisfaction scores and LWBS was improved for both resident and attending TLPs over historical control. Overall median LOS was not significantly different. Conclusion: Resident and attending TLPs improved DTP time, patient satisfaction, and LWBS rates. Both resident and attending TLPs are cost effective, with residents having a more favorable financial profile.

Effect of polymers on the retention and aging of enzyme on bioactive papers.

Science.gov (United States)

Khan, Mohidus Samad; Haniffa, Sharon B M; Slater, Alison; Garnier, Gil

2010-08-01

The effect of polymer on the retention and the thermal stability of bioactive enzymatic papers was measured using a colorimetric technique quantifying the intensity of the enzyme-substrate product complex. Alkaline phosphatase (ALP) was used as model enzyme. Three water soluble polymers: a cationic polyacrylamide (CPAM), an anionic polyacrylic acid (PAA) and a neutral polyethylene oxide (PEO) were selected as retention aids. The model polymers increased the enzyme adsorption on paper by around 50% and prevented enzyme desorption upon rewetting of the papers. The thermal deactivation of ALP retained on paper with polymers follows two sequential first order reactions. This was also observed for ALP simply physisorbed on paper. The retention aid polymers instigated a rapid initial deactivation which significantly decreased the longevity of the enzymatic papers. This suggests some enzyme-polymer interaction probably affecting the enzyme tertiary structure. A deactivation mathematical model predicting the enzymatic paper half-life was developed. Crown Copyright 2010. Published by Elsevier B.V. All rights reserved.

Effect of γ-exposure on retention of recoil 56Mn in permanganates

International Nuclear Information System (INIS)

Mishra, S.P.; Vijaya

2002-01-01

Full text: γ-exposure effect on recombination of recoil 56 Mn atom in La, Sr and Ba permanganates were studied with a special emphasis to pre-and post-activation γ-ray irradiation treatment using 60 Co source. Permanganates were inactivated by ionizing radiation as a function of γ-dose without neutron irradiation, however, pronounced effects were seen after neutron activation. Pre-irradiation increase the initial retention and promotes the annealing phenomenon as the introduction of defect into the lattice though on the other hand radiolytic phenomenon may also appear. Pre-activated sample gave higher retention value for lanthanum and barium permanganates in comparison to strontium permanganate at different γ-doses for desired period of gamma annealing than those obtained at corresponding γ-doses for similar length of time in case of post-activated targets. Kinetics of annealing by γ-radiolytic effects follow first order rate law. The observed results are discussed in the light of existing ideas for understanding the recoil stabilization phenomenon of parent reformation and the nature of precursors in permanganates

Job embeddedness and nurse retention.

Science.gov (United States)

Reitz, O Ed; Anderson, Mary Ann; Hill, Pamela D

2010-01-01

Nurse retention is a different way of conceptualizing the employer-employee relationship when compared with turnover. Job embeddedness (JE), a construct based on retention, represents the sum of reasons why employees remain at their jobs. However, JE has not been investigated in relation to locale (urban or rural) or exclusively with a sample of registered nurses (RNs). The purpose of this study was to determine what factors (JE, age, gender, locale, and income) help predict nurse retention. A cross-sectional mailed survey design was used with RNs in different locales (urban or rural). Job embeddedness was measured by the score on the composite, standardized instrument. Nurse retention was measured by self-report items concerning intent to stay. A response rate of 49.3% was obtained. The typical respondent was female (96.1%), white, non-Hispanic (87.4%), and married (74.9%). Age and JE were predictive of nurse retention and accounted for 26% of the explained variance in intent to stay. Although age was a significant predictor of intent to stay, it accounted for only 1.4% of the variance while JE accounted for 24.6% of the variance of nurse retention (as measured by intent to stay). Older, more "embedded" nurses are more likely to remain employed in their current organization. Based on these findings, JE may form the basis for the development of an effective nurse retention program.

Physician-centered management guidelines.

Science.gov (United States)

Pulde, M F

1999-01-01

The "Fortune 500 Most Admired" companies fully understand the irreverent premise "the customer comes second" and that there is a direct correlation between a satisfied work force and productivity, service quality, and, ultimately, organizational success. If health care organizations hope to recruit and retain the quality workforce upon which their core competency depends, they must develop a vision strategic plan, organizational structure, and managerial style that acknowledges the vital and central role of physicians in the delivery of care. This article outlines a conceptual framework for effective physician management, a "critical pathway," that will enable health care organizations to add their name to the list of "most admired." The nine principles described in this article are based on a more respectful and solicitous treatment of physicians and their more central directing role in organizational change. They would permit the transformation of health care into a system that both preserves the virtues of the physician-patient relationship and meets the demand for quality and cost-effectiveness.

Effects of starvation and protein depletion on mercury retention in two strains of chickens

Energy Technology Data Exchange (ETDEWEB)

Larkin, D V; Miller, V L; Bearse, G E; Hamilton, C M

1965-11-13

Experiments were performed in an attempt to show the effects of deprivation of feed and water on the liver and kidney mercury retention in two strains of chickens. The chickens to be depleted were fasted for 24 h and offered granulated sugar and drinking water containing vitamins. When the protein-depleted chickens has lost 30% of their body weight, they were injected intramuscularly with 3 mg phenylmercuric acetate (PMA) or mercuric chloride. A chemical analysis of the livers and kidneys of the chickens revealed that more mercury was retained in the organs from the protein-depleted chickens than from the control chickens. A difference was also found in the mercury retention in the kidneys in the two strains of chickens. Thus, alteration of the mercury retention patterns of these two strains of chickens may be accomplished by limiting their protein intake.

A new analytical formulation of retention effects on particle diffusion processes

Directory of Open Access Journals (Sweden)

Luiz Bevilacqua

2011-12-01

Full Text Available The ultimate purpose of this paper is to present a new analytical formulation to simulate diffusion with retention in a reactive medium under stable thermodynamic conditions. The analysis of diffusion with retention in a continuum medium is developed after the solution of an equivalent problem using a discrete approach. The new law may be interpreted as the reduction of all diffusion processes with retention to a unifying phenomenon that can adequately simulate the retention effect namely a circulatory motion. It is remarkable that the governing equation requires a fourth order differential term as suggested by the discrete approach. The relative fraction of diffusion particles β is introduced as a control parameter in the diffusion-retention law as suggested by the discrete approach. This control parameter is essential to avoid retention isolated from the diffusion process. Two matrices referring to material properties are introduced and related to the real phenomenon through the circulation hypothesis. The governing equation may be highly non-linear even if the material properties are constant, but the retention effect is a function of the concentration level, that is, β is a function of the concentration.O objetivo último desse trabalho é apresentar uma nova formulação analítica para simular difusão com retenção em um meio reativo sob condições termodinamicamente estáveis. A análise da difusão com retenção em um meio contínuo é desenvolvida a partir da solução de um problema equivalente usando uma abordagem discreta. A nova lei pode ser interpretada como a redução de todos os processos de difusão com retenção a um fenômeno unificador que pode simular adequadamente a retenção. O propósito principal desse trabalho é apresentar uma nova formulação analítica para simular difusão com retenção em meio reativo termodinamicamente estável. A análise da difusão com retenção em um meio contínuo é desenvolvido

The effect of podcast lectures on nursing students' knowledge retention and application.

Science.gov (United States)

Abate, Karen S

2013-01-01

This pilot study sought to evaluate the effectiveness of academic podcasts in promoting knowledge retention and application in nursing students. Nursing education no longer simply occurs in a fixed location or time. Computer-enhanced mobile learning technologies, such as academic podcasts, must be grounded in pedagogically sound characteristics to ensure effective implementation and learning in nursing education. A convenience sample of 35 female undergraduate nursing students was randomized into three groups: a traditional face-to-face lecture group, an unsegmented (non-stop) podcast lecture group, and a segmented podcast lecture group. Retention and application of information were measured through a multiple-choice quiz and a case study based on lecture content. Students in the segmented podcast lecture group demonstrated higher scores on multiple-choice and case-study assessments than those in the other two groups. Nurse educators should be aware of this finding when seeking to employ podcast lectures in nursing education.

Effects of phytase supplementation on phosphorus retention in broilers and layers: A meta-analysis

NARCIS (Netherlands)

Bougouin, A.; Appuhamy, J.A.D.R.N.; Kebreab, E.; Dijkstra, J.; Kwakkel, R.P.; France, J.

2014-01-01

Phytase, a widely used feed additive in poultry diets, increases P availability and subsequently reduces inorganic-P supplementation and P-excretion. Phytase supplementation effect on P-retention in poultry has been investigated, but the effect sizes were highly variable. The present study’s

Physician-industry relations. Part 1: individual physicians.

Science.gov (United States)

Coyle, Susan L

2002-03-05

This is part 1 of a 2-part paper on ethics and physician-industry relationships. Part 1 offers advice to individual physicians; part 2 gives recommendations to medical education providers and medical professional societies. Physicians and industry have a shared interest in advancing medical knowledge. Nonetheless, the primary ethic of the physician is to promote the patient's best interests, while the primary ethic of industry is to promote profitability. Although partnerships between physicians and industry can result in impressive medical advances, they also create opportunities for bias and can result in unfavorable public perceptions. Many physicians and physicians-in-training think they are impervious to commercial influence. However, recent studies show that accepting industry hospitality and gifts, even drug samples, can compromise judgment about medical information and subsequent decisions about patient care. It is up to the physician to judge whether a gift is acceptable. A very general guideline is that it is ethical to accept modest gifts that advance medical practice. It is clearly unethical to accept gifts or services that obligate the physician to reciprocate. Conflicts of interest can arise from other financial ties between physicians and industry, whether to outside companies or self-owned businesses. Such ties include honorariums for speaking or writing about a company's product, payment for participating in clinic-based research, and referrals to medical resources. All of these relationships have the potential to influence a physician's attitudes and practices. This paper explores the ethical quandaries involved and offers guidelines for ethical business relationships.

Women in rural family medicine: a qualitative exploration of practice attributes that promote physician satisfaction.

Science.gov (United States)

Hustedde, Carol; Paladine, Heather; Wendling, Andrea; Prasad, Rupa; Sola, Orlando; Bjorkman, Sarah; Phillips, Julie

2018-04-01

The USA needs more rural physicians. Although women represent half of all US trained medical students, the rural physician workforce has remained predominantly male. Insight is needed into what makes rural practice attractive for women and which practice characteristics allow women physicians to practice successfully in rural areas. This study's purpose was to examine aspects of the practice environment that impact women physicians' professional satisfaction and commitment to rural medicine. Twenty-five women family physicians practicing in rural areas of the USA were interviewed by phone using a semi-structured format. Transcribed interviews were analyzed using an immersion and crystallization approach. Emergent themes were identified, coded, and discussed until team consensus was attained. Interviews continued until saturation of themes was reached. Three themes emerged from the data, in relationship to practice and employment attributes that contribute to US women physicians' professional satisfaction and willingness to remain in a rural setting: professional relationships, practice characteristics, and support during times of transition. Participants placed high importance on professional relationships, both within and outside of their rural practice. Rural women physicians enjoyed practicing an expanded scope of care, valued loan repayment opportunities, and appreciated supportive practice partners. Importantly, women physicians who found themselves struggling to maintain rural careers often had experienced difficulty during times of practice transition, including maternity leaves. Understanding practice attributes valued by successful rural women family physicians in the USA will help rural health systems, practices, and physicians-in-training to develop and evaluate opportunities that will best contribute to successful rural practice. Supporting women physicians during periods of practice transition may improve retention.

Effects of online palliative care training on knowledge, attitude and satisfaction of primary care physicians.

Science.gov (United States)

Pelayo, Marta; Cebrián, Diego; Areosa, Almudena; Agra, Yolanda; Izquierdo, Juan Vicente; Buendía, Félix

2011-05-23

The Spanish Palliative Care Strategy recommends an intermediate level of training for primary care physicians in order to provide them with knowledge and skills. Most of the training involves face-to-face courses but increasing pressures on physicians have resulted in fewer opportunities for provision of and attendance to this type of training. The effectiveness of on-line continuing medical education in terms of its impact on clinical practice has been scarcely studied. Its effect in relation to palliative care for primary care physicians is currently unknown, in terms of improvement in patient's quality of life and main caregiver's satisfaction. There is uncertainty too in terms of any potential benefits of asynchronous communication and interaction among on-line education participants, as well as of the effect of the learning process.The authors have developed an on-line educational model for palliative care which has been applied to primary care physicians in order to measure its effectiveness regarding knowledge, attitude towards palliative care, and physician's satisfaction in comparison with a control group.The effectiveness evaluation at 18 months and the impact on the quality of life of patients managed by the physicians, and the main caregiver's satisfaction will be addressed in a different paper. Randomized controlled educational trial to compared, on a first stage, the knowledge and attitude of primary care physicians regarding palliative care for advanced cancer patients, as well as satisfaction in those who followed an on-line palliative care training program with tutorship, using a Moodle Platform vs. traditional education. 169 physicians were included, 85 in the intervention group and 84 in the control group, of which five were excluded. Finally 82 participants per group were analyzed. There were significant differences in favor of the intervention group, in terms of knowledge (mean 4.6; CI 95%: 2.8 to 6.5 (p = 0.0001), scale range 0-33), confidence

Effects of online palliative care training on knowledge, attitude and satisfaction of primary care physicians

Directory of Open Access Journals (Sweden)

Agra Yolanda

2011-05-01

Full Text Available Abstract Background The Spanish Palliative Care Strategy recommends an intermediate level of training for primary care physicians in order to provide them with knowledge and skills. Most of the training involves face-to-face courses but increasing pressures on physicians have resulted in fewer opportunities for provision of and attendance to this type of training. The effectiveness of on-line continuing medical education in terms of its impact on clinical practice has been scarcely studied. Its effect in relation to palliative care for primary care physicians is currently unknown, in terms of improvement in patient's quality of life and main caregiver's satisfaction. There is uncertainty too in terms of any potential benefits of asynchronous communication and interaction among on-line education participants, as well as of the effect of the learning process. The authors have developed an on-line educational model for palliative care which has been applied to primary care physicians in order to measure its effectiveness regarding knowledge, attitude towards palliative care, and physician's satisfaction in comparison with a control group. The effectiveness evaluation at 18 months and the impact on the quality of life of patients managed by the physicians, and the main caregiver's satisfaction will be addressed in a different paper. Methods Randomized controlled educational trial to compared, on a first stage, the knowledge and attitude of primary care physicians regarding palliative care for advanced cancer patients, as well as satisfaction in those who followed an on-line palliative care training program with tutorship, using a Moodle Platform vs. traditional education. Results 169 physicians were included, 85 in the intervention group and 84 in the control group, of which five were excluded. Finally 82 participants per group were analyzed. There were significant differences in favor of the intervention group, in terms of knowledge (mean 4.6; CI

Prosocial motivation and physicians' work attitudes. Effects of a triple synergy on prosocial orientation in a healthcare organization.

Science.gov (United States)

Kim, Young Shin

2015-01-01

Employees work attitudes are key determinants to organizational performance. This article proposes a model integrating servant leadership, prosocial motivation, and corporate social responsibility (CSR) in order to explain a mechanism through which prosocial motivation plays a central role in enhanding physicians' work attitudes. A cross sectional survey from a sample of physicians indicates that (1) prosocial motivation can be shaped from servant leadership when physicians perceive high value fit with their supervisors, (2) prosocial motivation improves physicians' job satisfaction. Its effects is strengthened when physicians perceive high CSR, and (3) job satisfaction improves organizational commitment. The results provide meaningful insights that a triple synergy of prosocial orientation among physicians, supervisors and organization enhances physicians' work attitudes.

Recruitment Combined with Retention Strategies Results in Institutional Effectiveness and Student Satisfaction.

Science.gov (United States)

Youngman, Curtis

In Winter 1994, the Marketing Department at Salt Lake Community College (SLCC) in Utah implemented an educational marketing plan that incorporated a focus on customer service to improve institutional effectiveness and student satisfaction. The plan includes a retention and recruitment program to strengthen the college's relationship with current…

Effect of Grade Retention in First Grade on Psychosocial Outcomes

OpenAIRE

Wu, Wei; West, Stephen G.; Hughes, Jan N.

2010-01-01

In a 4-year longitudinal study, the authors investigated effects of retention in first grade on children’s externalizing and internalizing behaviors; social acceptance; and behavioral, cognitive, and affective engagement. From a large multiethnic sample (n = 784) of children below the median on literacy at school entrance, 124 retained children were matched with 251 promoted children on the basis of propensity scores (probability of being retained in first grade estimated from 72 baseline var...

Specifying the effects of physician's communication on patients' outcomes: A randomised controlled trial.

Science.gov (United States)

van Osch, Mara; van Dulmen, Sandra; van Vliet, Liesbeth; Bensing, Jozien

2017-08-01

To experimentally test the effects of physician's affect-oriented communication and inducing expectations on outcomes in patients with menstrual pain. Using a 2×2 RCT design, four videotaped simulated medical consultations were used, depicting a physician and a patient with menstrual pain. In the videos, two elements of physician's communication were manipulated: (1) affect-oriented communication (positive: warm, emphatic; versus negative: cold, formal), and (2) outcome expectation induction (positive versus uncertain). Participants (293 women with menstrual pain), acting as analogue patients, viewed one of the four videos. Pre- and post video participants' outcomes (anxiety, mood, self-efficacy, outcome expectations, and satisfaction) were assessed. Positive affect-oriented communication reduced anxiety (pcommunication. Positive expectations increased feelings of self-efficacy (pcommunication and a positive expectation reduced anxiety (p=0.02), increased outcome expectancies (p=0.01) and satisfaction (p=0.001). Being empathic and inducing positive expectations have distinct and combined effects, demonstrating that both are needed to influence patients' outcomes for the best. Continued medical training is needed to harness placebo-effects of medical communication into practice. Copyright © 2017 Elsevier B.V. All rights reserved.

Physician buy-in for EMRs.

Science.gov (United States)

Yackanicz, Lori; Kerr, Richard; Levick, Donald

2010-01-01

Implementing an EMR in an ambulatory practice requires intense workflow analysis, introduction of new technologies and significant cultural change for the physicians and physician champion. This paper will relate the experience at Lehigh Valley Health Network in the implementation of an ambulatory EMR and with the physician champions that were selected to assist the effort. The choice of a physician champion involves political considerations, variation in leadership and communication styles, and a cornucopia of personalities. Physician leadership has been shown to be a critical success factor for any successful technology implementation. An effective physician champion can help develop and promote a clear vision of an improved future, enlist the support of the physicians and staff, drive the process changes needs and manage the cultural change required. The experience with various types of physician champions will be discussed, including, the "reluctant leader", the "techie leader", the "whiny leader", and the "mature leader". Experiences with each type have resulted in a valuable, "lessons learned" summary. LVHN is a tertiary academic community medical center consisting of 950 beds and over 450 employed physicians. LVHN has been named to the Health and Hospital Network's 100 Top Wired and 25 Most Wireless Hospitals.

Retention priorities for the intergenerational nurse workforce.

Science.gov (United States)

Wieck, K Lynn; Dols, Jean; Landrum, Peggy

2010-01-01

Retention of senior, Gen-X, and Millennial nurses is influenced by manager interactions and efforts to create a satisfying work experience. The purpose of this project was a generational assessment of job satisfaction, work environment, and desired characteristics of managers in an effort to improve nurse retention. Data from staff nurses at 22 southern hospitals collected by online survey included measures of job satisfaction and perceptions of safety, the Nurse Manager Desired Traits survey, and the Nursing Work Index-Revised. The satisfaction with work environment scores for the whole group (n = 1,773) were high. Subscale scores showed highest satisfaction with nurse/physician relationships; lowest was nurse control of practice. A specific satisfaction question showed the younger nurses were less satisfied than those over age 40. Nurse safety concerns were expressed by 40% of the sample. One third of Millennial nurses plan to leave their job within the next 2 years. Over two thirds plan to be gone within the next 5 years. Especially alarming is the fact that 61% of the nurse group stated they plan to leave their current jobs within 10 years. (a) Create model managers; (b) empower staff nurse councils; (c) stabilize staffing; (d) revamp incentives; and (e) focus on safety.

Physicians' preferences for asthma guidelines implementation.

Science.gov (United States)

Kang, Min-Koo; Kim, Byung-Keun; Kim, Tae-Wan; Kim, Sae-Hoon; Kang, Hye-Ryun; Park, Heung-Woo; Chang, Yoon-Seok; Kim, Sun-Sin; Min, Kyung-Up; Kim, You-Young; Cho, Sang-Heon

2010-10-01

Patient care based on asthma guidelines is cost-effective and leads to improved treatment outcomes. However, ineffective implementation strategies interfere with the use of these recommendations in clinical practice. This study investigated physicians' preferences for asthma guidelines, including content, supporting evidence, learning strategies, format, and placement in the clinical workplace. We obtained information through a questionnaire survey. The questionnaire was distributed to physicians attending continuing medical education courses and sent to other physicians by airmail, e-mail, and facsimile. A total of 183 physicians responded (male to female ratio, 2.3:1; mean age, 40.4±9.9 years); 89.9% of respondents were internists or pediatricians, and 51.7% were primary care physicians. Physicians preferred information that described asthma medications, classified the disease according to severity and level of control, and provided methods of evaluation/treatment/monitoring and management of acute exacerbation. The most effective strategies for encouraging the use of the guidelines were through continuing medical education and discussions with colleagues. Physicians required supporting evidence in the form of randomized controlled trials and expert consensus. They preferred that the guidelines be presented as algorithms or flow charts/flow diagrams on plastic sheets, pocket cards, or in electronic medical records. This study identified the items of the asthma guidelines preferred by physicians in Korea. Asthma guidelines with physicians' preferences would encourage their implementation in clinical practice.

Effectiveness of e-learning in continuing medical education for occupational physicians

NARCIS (Netherlands)

Hugenholtz, Nathalie I. R.; de Croon, Einar M.; Smits, Paul B.; van Dijk, Frank J. H.; Nieuwenhuijsen, Karen

2008-01-01

Background Within a clinical context e-learning is comparable to traditional approaches of continuing medical education (CME). However, the occupational health context differs and until now the effect of postgraduate e-learning among occupational physicians (OPs) has not been evaluated. Aim To

Environmental Effects on Data Retention in Flash Cells

Science.gov (United States)

Katz, Rich; Flowers, David; Bergevin, Keith

2017-01-01

Flash technology is being utilized in fuzed munition applications and, based on the development of digital logic devices in the commercial world, usage of flash technology will increase. Antifuse technology, prevalent in non-volatile field programmable gate arrays (FPGAs), will eventually be phased out as new devices have not been developed for approximately a decade. The reliance on flash technology presents a long-term reliability issue for both DoD and NASA safety- and mission-critical applications. A thorough understanding of the data retention failure modes and statistics associated with Flash data retention is of vital concern to the fuze safety community. A key retention parameter for a flash cell is the threshold voltage (VTH), which is an indirect indicator of the amount of charge stored on the cells floating gate. This paper will present the results of our on-going tests: long-term storage at 150 C for a small population of devices, neutron radiation exposure, electrostatic discharge (ESD) testing, and the trends of large populations (over 300 devices for each condition) exposed to three difference temperatures: 25 C, 125 C, and 150 C.

Credentialing and retention of visa trainees in post-graduate medical education programs in Canada.

Science.gov (United States)

Mathews, Maria; Kandar, Rima; Slade, Steve; Yi, Yanqing; Beardall, Sue; Bourgeault, Ivy; Buske, Lynda

2017-06-12

Visa trainees are international medical graduates (IMG) who come to Canada to train in a post-graduate medical education (PGME) program under a student or employment visa and are expected to return to their country of origin after training. We examined the credentialing and retention of visa trainees who entered PGME programs between 2005 and 2011. Using the Canadian Post-MD Education Registry's National IMG Database linked to Scott's Medical Database, we examined four outcomes: (1) passing the Medical Council of Canada Qualifying Examination Part 2 (MCCQE2), (2) obtaining a specialty designation (CCFP, FRCPC/SC), and (3) working in Canada after training and (4) in 2015. The National IMG Database is the most comprehensive source of information on IMG in Canada; data were provided by physician training and credentialing organizations. Scott's Medical Database provides data on physician locations in Canada. There were 233 visa trainees in the study; 39.5% passed the MCCQE2, 45.9% obtained a specialty designation, 24.0% worked in Canada after their training, and 53.6% worked in Canada in 2015. Family medicine trainees (OR = 8.33; 95% CI = 1.69-33.33) and residents (OR = 3.45; 95% CI = 1.96-6.25) were more likely than other specialist and fellow trainees, respectively, to pass the MCCQE2. Residents (OR = 7.69; 95% CI = 4.35-14.29) were more likely to obtain a specialty credential than fellows. Visa trainees eligible for a full license were more likely than those not eligible for a full license to work in Canada following training (OR = 3.41; 95% CI = 1.80-6.43) and in 2015 (OR = 3.34; 95% CI = 1.78-6.27). Visa training programs represent another route for IMG to qualify for and enter the physician workforce in Canada. The growth in the number of visa trainees and the high retention of these physicians warrant further consideration of the oversight and coordination of visa trainee programs in provincial and in pan

The effects of health information technology adoption and hospital-physician integration on hospital efficiency.

Science.gov (United States)

Cho, Na-Eun; Chang, Jongwha; Atems, Bebonchu

2014-11-01

To determine the impact of health information technology (HIT) adoption and hospital-physician integration on hospital efficiency. Using 2010 data from the American Hospital Association's (AHA) annual survey, the AHA IT survey, supplemented by the CMS Case Mix Index, and the US Census Bureau's small area income and poverty estimates, we examined how the adoption of HIT and employment of physicians affected hospital efficiency and whether they were substitutes or complements. The sample included 2173 hospitals. We employed a 2-stage approach. In the first stage, data envelopment analysis was used to estimate technical efficiency of hospitals. In the second stage, we used instrumental variable approaches, notably 2-stage least squares and the generalized method of moments, to examine the effects of IT adoption and integration on hospital efficiency. We found that HIT adoption and hospital-physician integration, when considered separately, each have statistically significant positive impacts on hospital efficiency. Also, we found that hospitals that adopted HIT with employed physicians will achieve less efficiency compared with hospitals that adopted HIT without employed physicians. Although HIT adoption and hospital-physician integration both seem to be key parts of improving hospital efficiency when one or the other is utilized individually, they can hurt hospital efficiency when utilized together.

The impact of the Department of Veterans Affairs Health Care Personnel Enhancement Act of 2004 on VA physicians' salaries and retention.

Science.gov (United States)

Weeks, William B; Wallace, Tanner A; Wallace, Amy E

2009-01-01

To determine whether the Department of Veterans Affairs Health Care Personnel Enhancement Act (the Act), which was designed to achieve VA physician salary parity with American Academy of Medical Colleges (AAMC) Associate Professors and enacted in 2006, had achieved its goal. Using VA human resources datasets and data from the AAMC, we calculated mean VA physician salaries, with 95 percent confidence intervals, for 15 different medical specialties. For each specialty, we compared VA salaries to the median, 25th, and 75th percentile of AAMC Associate Professors' incomes. The Act's passage resulted in a $20,000 annual increase in VA physicians' salaries. VA primary care physicians, medical subspecialists, and psychiatrists had salaries that were comparable to their AAMC counterparts prior to and after enactment of the Act. However, VA surgical specialists', anesthesiologists', and radiologists' salaries lagged their AAMC counterparts both before and after the Act's enactment. Income increases were negatively correlated with full-time workforce changes. VA does not appear to provide comparable salaries for physicians necessary for surgical care. In certain cases, VA should consider outsourcing surgical services.

The Effects of Hospital-Level Factors on Patients' Ratings of Physician Communication.

Science.gov (United States)

Al-Amin, Mona; Makarem, Suzanne C

2016-01-01

The quality of physician-patient communication influences patient health outcomes and satisfaction with healthcare delivery. Yet, little is known about contextual factors that influence physicians' communication with their patients. The main purpose of this article is to examine organizational-level factors that influence patient perceptions of physician communication in inpatient settings. We used the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey and American Hospital Association data to determine patients' ratings of physician communication at the hospital level, and to collect information about hospital-level factors that can potentially influence physician communication. Our sample consisted of 2,756 hospitals. We ran a regression analysis to determine the predictors of poor physician communication, measured as the percentage of patients in a hospital who reported that physicians sometimes or never communicated well. In our sample of hospitals, this percentage ranged between 0% and 21%, with 25% of hospitals receiving poor ratings from more than 6% of patients. Three organizational factors had statistically significant negative associations with physician communication: for-profit ownership, hospital size, and hospitalists providing care in the hospital, On the other hand, the number of full-time-equivalent physicians and dentists per 10,000 inpatient days, physician ownership of the hospital, Medicare share of inpatient days, and public ownership were positively associated with patients' ratings of physician communication. Physician staffing levels are an understudied area in healthcare research. Our findings indicate that physician staffing levels affect the quality of physician communication with patients. Moreover, for-profit and larger hospitals should invest more in physician communication given the role that HCAHPS plays in value-based purchasing.

The effect of using social pressure in cover letters to improve retention in a longitudinal health study: an embedded randomised controlled retention trial.

Science.gov (United States)

Cotterill, Sarah; Howells, Kelly; Rhodes, Sarah; Bower, Peter

2017-07-20

Retention of participants in cohort studies is important for validity. One way to promote retention is by sending a persuasive cover letter with surveys. The study aimed to compare the effectiveness of a covering letter containing social pressure with a standard covering letter on retention in a health cohort study. Social pressure involves persuading people to behave in a certain way by the promise that their actions will be made know to others. We implemented a mild form of social pressure, where the recipient was told that information about whether they responded to the current survey would be noted by the research team and printed on future correspondence from the research team to the recipient. The design was an embedded randomised controlled retention trial, conducted between July 2015 and April 2016 in Salford, UK. Participants in the host health cohort study were eligible. They received either: (1) a covering letter with two consecutive surveys (sent six and twelve months after recruitment), containing a social pressure intervention; or (2) a matching letter without the social pressure text. The primary outcome was retention in the host study, defined as return of both surveys. Randomisation was computer-generated, with stratification by household size. Participants were blinded to group assignment. Researchers were blinded for outcome ascertainment. Adults (n = 4447) aged over 65 years, with a long-term condition and enrolled in the host study, were randomly allocated to receive a social pressure covering letter (n = 2223) or control (n = 2224). All 4447 participants were included in the analysis. Both questionnaires were returned by 1577 participants (71%) sent the social pressure letters and 1511 (68%) sent control letters, a risk difference of 3 percentage points (adjusted odds ratio = 1.16 (95% confidence interval = 1.02-1.33)). A mild form of social pressure made a small but significant improvement in retention of older adults in

Effect of Methylphenidate on Retention and Retrieval of Passive Avoidance Memory in Young and Aged Mice

Directory of Open Access Journals (Sweden)

Arzi

2014-10-01

Full Text Available Background Several studies showed that dopamine and norepinephrine improve retention and retrieval of memory. Methylphenidate is an enhancer of dopamine and norepinephrine in brain. Objectives In the present study, the effect of methylphenidate was evaluated on retention and retrieval of memory in young and aged mice using passive avoidance apparatus. Materials and Methods Animals were divided into groups (n = 8 as follows: test groups received electric shock plus methylphenidate (2.5, 5 and 10mg kg-1, i. P., control group received electric shock plus normal saline and blank group received only electric shock. In all groups, step-down latency for both retention and retrieval test of memory was measured. Methylphenidate was administered immediately after receiving electric shock in the retention test, but methylphenidate was administered 23.5 hours after receiving electric shock in the retrieval test. Results The mean of step-down latency on day 4 was significantly higher compared to day 2 (P < 0.05 in all young and aged groups of mice. The best response was attained with 5 mg/kg of methylphenidate. In memory retention test, the mean of step-down latency in young groups that received 2.5 and 5 mg/kg methylphenidate was significantly longer(P < 0.05 than aged groups. However, this difference was not significant in memory retrieval test. Conclusions Methylphenidate may improve memory retention and retrieval.

Gas bubble retention and its effect on waste properties: Retention mechanisms, viscosity, and tensile and shear strengths

International Nuclear Information System (INIS)

Gauglitz, P.A.; Rassat, S.D.; Powell, M.R.

1995-08-01

Several of the underground nuclear storage tanks at Hanford have been placed on a flammable gas watch list, because the waste is either known or suspected to generate, store, and episodically release flammable gases. Because retention and episodic release of flammable gases from these tanks containing radioactive waste slurries are critical safety concerns, Pacific Northwest Laboratory (PNL) is studying physical mechanisms and waste properties that contribute to the episodic gas release from these storage tanks. This study is being conducted for Westinghouse Hanford Company as part of the PNL Flammable Gas project. Previous investigations have concluded that gas bubbles are retained by the slurry or sludge that has settled at the bottom of the tanks; however, the mechanisms responsible for the retention of these bubbles are not well understood. Understanding the rheological behavior of the waste, particularly of the settled sludge, is critical to characterizing the tendency of the waste to retain gas bubbles and the dynamics of how these bubbles are released from the waste. The presence of gas bubbles is expected to affect the rheology of the sludge, specifically its viscosity and tensile and shear strengths, but essentially no literature data are available to assess the effect of bubbles. The objectives of this study were to conduct experiments and develop theories to understand better how bubbles are retained by slurries and sludges, to measure the effect of gas bubbles on the viscosity of simulated slurries, and to measure the effect of gas bubbles on the tensile and shear strengths of simulated slurries and sludges. In addition to accomplishing these objectives, this study developed correlations, based on the new experimental data, that can be used in large-scale computations of waste tank physical phenomena

Gas bubble retention and its effect on waste properties: Retention mechanisms, viscosity, and tensile and shear strengths

Energy Technology Data Exchange (ETDEWEB)

Gauglitz, P.A.; Rassat, S.D.; Powell, M.R. [and others

1995-08-01

Several of the underground nuclear storage tanks at Hanford have been placed on a flammable gas watch list, because the waste is either known or suspected to generate, store, and episodically release flammable gases. Because retention and episodic release of flammable gases from these tanks containing radioactive waste slurries are critical safety concerns, Pacific Northwest Laboratory (PNL) is studying physical mechanisms and waste properties that contribute to the episodic gas release from these storage tanks. This study is being conducted for Westinghouse Hanford Company as part of the PNL Flammable Gas project. Previous investigations have concluded that gas bubbles are retained by the slurry or sludge that has settled at the bottom of the tanks; however, the mechanisms responsible for the retention of these bubbles are not well understood. Understanding the rheological behavior of the waste, particularly of the settled sludge, is critical to characterizing the tendency of the waste to retain gas bubbles and the dynamics of how these bubbles are released from the waste. The presence of gas bubbles is expected to affect the rheology of the sludge, specifically its viscosity and tensile and shear strengths, but essentially no literature data are available to assess the effect of bubbles. The objectives of this study were to conduct experiments and develop theories to understand better how bubbles are retained by slurries and sludges, to measure the effect of gas bubbles on the viscosity of simulated slurries, and to measure the effect of gas bubbles on the tensile and shear strengths of simulated slurries and sludges. In addition to accomplishing these objectives, this study developed correlations, based on the new experimental data, that can be used in large-scale computations of waste tank physical phenomena.

Manager-physician relationships: an organizational theory perspective.

Science.gov (United States)

Kaissi, Amer

2005-01-01

Manager-physician relationships are a critical determinant of the success of health care organizations. As the health care industry is moving toward a situation characterized by higher scarcity of resources, fiercer competition, more corporitization, and strict cost-containment approaches, managers and physicians should, more than ever, work together under conjoint or shared authority. Thus, their relationship can be described as one of high rewards, but also of high risk because of the wide range of differences that exist between them: different socializations and trainings resulting in different worldviews, value orientation and expectations and different cultures. In brief, managers and physicians represent different "tribes," each with its language, values, culture, thought patterns, and rules of the game. This article's main objective is to determine the underlying factors in the manager-physician relationship and to suggest ways that make this relationship more effective. Four different organizational perspectives will be used. The occupational perspective will give insights on the internal characteristics of the occupational communities of managers and physicians. The theory of deprofessionalization of physicians will also be discussed. The structuring perspective will look at the manager-physician relationship as a structure in the organization and will determine the effects of contextual factors (size, task uncertainty, strategy, and environment) on this relationship and the resulting effect on performance and effectiveness of the organization. The culture and control perspective will help detect the cultural differences between managers and physicians and how these interact to affect control over the decision-making areas in the hospital. The power, conflict, and dialectics perspective will shed the light on the conflicting interests of managers and physicians and how these shape the "power game" in the organization. Consequently, a theoretical model of

The Effects of Cooperative Learning on the Academic Achievement and Knowledge Retention

Science.gov (United States)

Tran, Van Dat

2014-01-01

This experimental study investigated the effects of cooperative learning on the achievement and knowledge retention of 110 first-year primary education students toward the psychology subject over the eight weeks of instruction at An Giang University. These tertiary students were divided into two matched groups of 55 to be taught by the same…

Colour in Learning: Its Effect on the Retention Rate of Graduate Students

Science.gov (United States)

Olurinola, Oluwakemi; Tayo, Omoniyi

2015-01-01

Cognitive psychologists have discovered different design principles to enhance memory performance. It has been said that retrieving process depends on many variables and one of them is colour. This paper provides an overview of research on colour and learning. It includes the effect of colour on attention, retention and memory performance, and…

Case study of physician leaders in quality and patient safety, and the development of a physician leadership network.

Science.gov (United States)

Hayes, Chris; Yousefi, Vandad; Wallington, Tamara; Ginzburg, Amir

2010-01-01

There is increasing recognition of the need for physician leadership in quality and patient safety, and emerging evidence that physician leadership contributes to improved care. Hospitals are beginning to establish physician leader positions; however, there is little guidance on how to define these roles and the strategies physician leaders can use toward improving care. This case study examines the roles of four physician leaders, describes their contribution to the design and implementation of hospital quality and patient safety agendas and discusses the creation of a physician network to support these activities. The positions were established between July 2006 and April 2009. All are corporate roles with varying reporting and accountability structures. The physician leads are involved in strategic planning, identifying and leading quality and safety initiatives, physician engagement and culture change. All have significantly contributed to the implementation of hospital improvement activities and are seen as influential among their peers as resources and mentors for local project success. Despite their accomplishments, these physician leads have been challenged by ambiguous role descriptions and difficulty identifying effective improvement strategies. As such, an expanding physician network was created with the goal of sharing approaches and tools and creating new strategies. Physician leaders are an important factor in the improvement of safety and quality within hospitals. This case study provides a template for the creation of such positions and highlights the importance of networking as an effective strategy for improving local care and advancing professional development of physician leaders in quality and patient safety.

Developing a Physician׳s Professional Identity Through Medical Education.

Science.gov (United States)

Olive, Kenneth E; Abercrombie, Caroline L

2017-02-01

Professionalism represents a fundamental characteristic of physicians. Professional organizations have developed professionalism competencies for physicians and medical students. The aim of teaching medical professionalism is to ensure the development of a professional identity in medical students. Professional identity formation is a process developed through teaching principles and appropriate behavioral responses to the stresses of being a physician. Addressing lapses and critical reflection is an important part of the educational process. The "hidden curriculum" within an institution plays an important role in professional identity formation. Assessment of professionalism involves multiple mechanisms. Steps in remediating professionalism lapses include (1) initial assessment, (2) diagnosis of problems and development of an individualized learning plan, (3) instruction encompassing practice, feedback and reflection and (4) reassessment and certification of competence. No reliable outcomes data exist regarding the effectiveness of different remediation strategies. Copyright © 2017 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.

The Effects of Different Doses of Curcuma longa Aqueous Extract on Memory Retention and Retrieval in Male Mice

Directory of Open Access Journals (Sweden)

2016-12-01

Full Text Available Background and Objectives: Curcumin belongs to ginger family, which is used as food and drug from ancient times. Different studies have shown beneficial effects of curcumin on peptic ulcer, rheumatoid arthritis, asthma, and various types of cancer. In this study, the effect of different doses of Curcuma longa aqueous extract on memory retention and retrieval of mice, was investigated using passive avoidance apparatus. Methods: Mice were divided into 6 groups of 8 each for memory retention test and 6 groups of 8 each for memory retrieval test {experimental groups receiving the extract intraperitoneally at doses of 100, 200, 400, 800mg/kg, blank group, and control group}. In memory retention test, the curcumin extract was administered immediately after electric shock, while in the memory retrieval test, it was administered 24 h after receiving electric shock. To compare the complete stepping in the experiment days, One-way ANOVA and post-test LSD were used. The level of significance was considered p<0.05. Results: In this study, curcuma longa aqueous extract significantly increased memory retention and retrieval on the 4th day compared to blank and control groups. The best response for memory retention was obtained at the dose of 100mg/kg and for memory retrieval at the dose of 200mg/kg. Conclusion: According to the results of this study, it seems that Curcuma longa aqueous extract improves memory retention and retrieval in healthy mice.  

Quality of work life of rural emergency department nurses and physicians: a pilot study.

Science.gov (United States)

Bragard, Isabelle; Fleet, Richard; Etienne, Anne-Marie; Archambault, Patrick; Légaré, France; Chauny, Jean-Marc; Lévesque, Jean-Frédéric; Ouimet, Mathieu; Poitras, Julien; Dupuis, Gilles

2015-04-01

Information about recruitment and retention factors and quality of work life (QWL) in rural emergency departments (EDs) is limited. A pilot study was used to determine the feasibility of a large-scale study of these variables in Quebec EDs. Two EDs, approximately 10,000 and 30,000 patients per year respectively, were selected as convenience samples. An online survey containing the Quality of Work Life Systemic Inventory (QWLSI; 34 items) and the Recruitment and Retention Factors Questionnaire (39 items) was sent to ED nurses and physicians of these two EDs. Descriptive statistics of percentage, mean and standard deviation and correlations were used to analyse the data. Forty out of 64 eligible workers (62%) gave their consent to participate, but only 20 had completed both questionnaires. Participants' mean age was 42 years (SD = 11.6). The average participants satisfaction with their access to continuing education was low (Mean = 1.6, SD = 0.8). However, their satisfaction with technical resources (Mean = 2.4, SD = 0.7), pre-hospital and inter-hospital transfer services (Mean = 2.5, SD = 0.6), relationships with colleagues (Mean = 2.7, SD = 0.6) and managers (Mean = 2.2, SD = 0.7), work-life balance (Mean = 2.4, SD = 0.6) and emergency patient access to other departments (Mean = 3.7, SD = 0.6) was in the average. The impact of several aspects of the rural environment (e.g. tranquility) on quality of life was also in the average (Mean = 2.5, SD = 0.7). QWL was in the average, excepted subscale 'support offered to employee' for which the QWL was lower. Data collection was difficult and the larger study will require strategies to improve recruitment such as a paper alternative. The study showed globally good recruitment and retention factors and QWL for these ED nurses and physicians. These results will help hospital administrations better plan initiatives aimed at improving retention and QWL.

Continuing medical education effect on physician knowledge: effectiveness of continuing medical education: American College of Chest Physicians Evidence-Based Educational Guidelines.

Science.gov (United States)

Bordage, Georges; Carlin, Brian; Mazmanian, Paul E

2009-03-01

Physicians are continuously engaging in continuing medical education (CME) activities. Whether CME activities actually improve their knowledge and whether multiple media, instructional techniques, and exposures are better than single experiences are questions that are still under discussion. The Johns Hopkins Evidence-based Practice Center for Healthcare Research and Quality conducted a systematic review of the effectiveness of CME (Agency for Healthcare Research and Quality Evidence Report) from which the guideline panel used 28 (+/- 2) studies to answer these questions about improvements in knowledge. The studies were selected based on the presence of an adequate control group from an initial pool of 136 studies on CME. Despite the heterogeneity of the studies reviewed and the low quality of the evidence, the results from the majority of the studies (79%) showed that CME activities were associated with improvements in physician knowledge. The evidence gathered about the use of media and instructional techniques and the frequency of exposure suggests that multimedia, multiple instructional techniques, and multiple exposures be used whenever possible in CME. Future studies of CME should include assessment of applied knowledge, and should incorporate programmatic and collaborative studies of CME.

Assessment of long-term knowledge retention following single-day simulation training for uncommon but critical obstetrical events

Science.gov (United States)

Vadnais, Mary A.; Dodge, Laura E.; Awtrey, Christopher S.; Ricciotti, Hope A.; Golen, Toni H.; Hacker, Michele R.

2013-01-01

Objective The objectives were to determine (i) whether simulation training results in short-term and long-term improvement in the management of uncommon but critical obstetrical events and (ii) to determine whether there was additional benefit from annual exposure to the workshop. Methods Physicians completed a pretest to measure knowledge and confidence in the management of eclampsia, shoulder dystocia, postpartum hemorrhage and vacuum-assisted vaginal delivery. They then attended a simulation workshop and immediately completed a posttest. Residents completed the same posttests 4 and 12 months later, and attending physicians completed the posttest at 12 months. Physicians participated in the same simulation workshop 1 year later and then completed a final posttest. Scores were compared using paired t-tests. Results Physicians demonstrated improved knowledge and comfort immediately after simulation. Residents maintained this improvement at 1 year. Attending physicians remained more comfortable managing these scenarios up to 1 year later; however, knowledge retention diminished with time. Repeating the simulation after 1 year brought additional improvement to physicians. Conclusion Simulation training can result in short-term and contribute to long-term improvement in objective measures of knowledge and comfort level in managing uncommon but critical obstetrical events. Repeat exposure to simulation training after 1 year can yield additional benefits. PMID:22191668

Pharmaceutical industry gifts to physicians: patient beliefs and trust in physicians and the health care system.

Science.gov (United States)

Grande, David; Shea, Judy A; Armstrong, Katrina

2012-03-01

Pharmaceutical industry gifts to physicians are common and influence physician behavior. Little is known about patient beliefs about the prevalence of these gifts and how these beliefs may influence trust in physicians and the health care system. To measure patient perceptions about the prevalence of industry gifts and their relationship to trust in doctors and the health care system. Cross sectional random digit dial telephone survey. African-American and White adults in 40 large metropolitan areas. Respondents' beliefs about whether their physician and physicians in general receive industry gifts, physician trust, and health care system distrust. Overall, 55% of respondents believe their physician receives gifts, and 34% believe almost all doctors receive gifts. Respondents of higher socioeconomic status (income, education) and younger age were more likely to believe their physician receives gifts. In multivariate analyses, those that believe their personal physician receives gifts were more likely to report low physician trust (OR 2.26, 95% CI 1.56-3.30) and high health care system distrust (OR 2.03, 95% CI 1.49-2.77). Similarly, those that believe almost all doctors accept gifts were more likely to report low physician trust (OR 1.69, 95% CI 1.25-2.29) and high health care system distrust (OR 2.57, 95% CI 1.82-3.62). Patients perceive physician-industry gift relationships as common. Patients that believe gift relationships exist report lower levels of physician trust and higher rates of health care system distrust. Greater efforts to limit industry-physician gifts could have positive effects beyond reducing influences on physician behavior.

The impact of economic and noneconomic exchange on physicians' organizational attitudes: The moderating effects of the Chief Medical Officer.

Science.gov (United States)

Trybou, Jeroen; Gemmel, Paul; Annemans, Lieven

2016-01-01

Hospital-physician relationships are critical to hospitals' organizational success. A distinction can be drawn between economic and noneconomic physician-hospital exchange. Physician senior leadership could be an important component of managerial strategies aimed at optimizing hospital-physician relationships. The purpose of this study was to investigate the moderating role of the quality of exchange with the Chief Medical Officer (CMO) in the relationship between economic and noneconomic exchange and physicians' key organizational attitudes. Self-employed physicians practicing at six Belgian hospitals were surveyed. Economic exchange was conceptualized by the concepts of distributive and procedural justice, whereas noneconomic exchange was conceptualized by the concepts of administrative and professional psychological contract. Our outcomes comprise three key organizational attitudes identified in the literature (job satisfaction, affective organizational commitment, and intention to leave). The moderating role of leader-member exchange with the CMO in these relationships was assessed. Our results showed a relationship between both psychological contract breach and organizational justice and physicians' organizational attitudes. The quality of exchange with the CMO buffered the negative effect of psychological contract breach and reinforced the positive effects of organizational justice with respect to physicians' organizational attitudes. Our results demonstrate that both economic and noneconomic aspects are important when considering physicians' key organizational attitudes. The reciprocity dynamic between physician and hospital can be enhanced by high-quality exchange with the CMO.

Effects of calcium carbonate and hydroxyapatite on zinc and iron retention in postmenopausal women

International Nuclear Information System (INIS)

Dawson-Hughes, B.; Seligson, F.H.; Hughes, V.A.

1986-01-01

We measured the effect of calcium carbonate and hydroxyapatite on whole-body retention of zinc-65 in 11 and iron-59 in 13 healthy, postmenopausal women. In a single-blind, controlled, crossover study, each subject, on three occasions, ingested a standard test meal supplemented with iron-59 or zinc-65 and capsules containing placebo or 500 mg elemental calcium as calcium carbonate or hydroxyapatite. Whole-body countings were performed prior to, 30 min after, and 2 wk after each meal. Mean (SEM) zinc retention was 18.1 +/- 1.0% with placebo (control) and did not vary significantly with calcium carbonate (110.0 +/- 8.6% of control) or hydroxyapatite (106.0 +/- 7.9% of control). Iron retention, 6.3 +/- 2.0% with placebo, was significantly reduced with both calcium carbonate (43.3 +/- 8.8% of control, p = 0.002) and hydroxyapatite (45.9 +/- 10.0% of control, p = 0.003). Iron absorption may be significantly reduced when calcium supplements are taken with meals

Effect of emergency physician burnout on patient waiting times.

Science.gov (United States)

De Stefano, Carla; Philippon, Anne-Laure; Krastinova, Evguenia; Hausfater, Pierre; Riou, Bruno; Adnet, Frederic; Freund, Yonathan

2018-04-01

Burnout is common in emergency physicians. This syndrome may negatively affect patient care and alter work productivity. We seek to assess whether burnout of emergency physicians impacts waiting times in the emergency department. Prospective study in an academic ED. All patients who visited the main ED for a 4-month period in 2016 were included. Target waiting times are assigned by triage nurse to patients on arrival depending on their severity. The primary endpoint was an exceeded target waiting time for ED patients. All emergency physicians were surveyed by a psychologist to assess their level of burnout using the Maslach Burnout Inventory. We defined the level of burnout of the day in the ED as the mean burnout level of the physicians working that day (8:30 to the 8:30 the next day). A logistic regression model was performed to assess whether burnout level of the day was independently associated with prolonged waiting times, along with previously reported predictors. Target waiting time was exceeded in 7524 patients (59%). Twenty-six emergency physicians were surveyed. Median burnout score was 35 [Interquartile (24-49)]. A burnout level of the day higher than 35 was independently associated with an exceeded target waiting time (adjusted odds ratio 1.54, 95% confidence interval 1.39-1.70), together with previously reported predictors (i.e., day of the week, time of the day, trauma, age and daily census). Burnout of emergency physicians was independently associated with a prolonged waiting time for patients visiting the ED.

The effects of nursing preceptorship on new nurses' competence, professional socialization, job satisfaction and retention: A systematic review.

Science.gov (United States)

Ke, Ya-Ting; Kuo, Chia-Chi; Hung, Chich-Hsiu

2017-10-01

The aim of this study was to determine the effects of nursing preceptorship on the competence, job satisfaction, professional socialization and retention of new nurses. Although studies have focused on the effects of nursing preceptorship on new nurses' competence and retention, a systematic review of the overall effects is lacking. A quantitative systematic review. Five English/Chinese databases were searched for original articles published before June 2015 and only six articles published between 2001-2014 were included in the final analysis. Joanna Briggs Methodology was used to process one randomization control trial, one quasi-experimental study and four observational studies. Two appraisers independently reviewed each study using the standardized critical appraisal tools from the Joanna Briggs Institute. The most adopted preceptorship was a fixed preceptor/preceptee model and one-on-one for 1-3-month duration. It showed that new nurses' overall competence increased significantly due to preceptorship. Only a few studies explored the effects of preceptorship on the job satisfaction and professional socialization of new nurses. Clear conclusions regarding the effect of preceptorship on nurses' retention rate could not be made because of inconsistent time points for calculation and a lack of control groups in the study design. Preceptorship can improve new nurses' nursing competence; however, more studies are needed to ascertain its effects on new nurses' retention rates, job satisfaction and professional socialization to promote nursing care quality and resolve nursing shortages. © 2017 John Wiley & Sons Ltd.

Chromatographic retention and structure roofing tile effect of isomers and its fine structure

NARCIS (Netherlands)

Walraven, J.J.; Ladon, A.W.; Keulemans, A.I.M.

1968-01-01

Logarithmic plots of gas chromatographic retention data for different classes of compds. on different pairs of stationary phases were constructed. A remarkable effect was found. Isomers are spread along parallel lines in a repeated pattern, forming a \\"roofing-tile\\" series. The scattering of points

Physician fees and managed care plans.

Science.gov (United States)

Zwanziger, Jack

2002-01-01

One of the objectives of managed care organizations (MCOs) has been to reduce the rate of growth of health care expenditures, including that of physician fees. Yet, due to a lack of data, no one has been able to determine whether MCOs have been successful in encouraging the growth of price competition in the market for physician services in order to slow the growth in physician fees. This study uses a unique, national-level data set to determine what factors influenced the physician fees that MCOs negotiated during the 1990-92 period. The most influential characteristics were physician supply and managed care penetration, which suggest that the introduction of competition into the health care market was an effective force in reducing physician fees.

Helium effects on tungsten surface morphology and deuterium retention

International Nuclear Information System (INIS)

Ueda, Y.; Peng, H.Y.; Lee, H.T.; Ohno, N.; Kajita, S.; Yoshida, N.; Doerner, R.; De Temmerman, G.; Alimov, V.; Wright, G.

2013-01-01

Recent experimental results on tungsten surface morphology, especially nano-structure (fuzz), induced by helium plasma exposure at temperatures between 1000 K and 2000 K are reviewed. This structure was firstly reported in 2006. In this review, most of experimental results reported so far including characteristics and formation conditions of the nano-structure in both linear plasma devices and magnetic confinement devices, erosion and arcing by steady-state plasma exposure and ELM-like pulsed heat or pulsed plasma exposure by a laser and a plasma gun are summarized. In addition, He effects on D retention under simultaneous D/He irradiation on tungsten are presented

Odor-context effects in free recall after a short retention interval: a new methodology for controlling adaptation.

Science.gov (United States)

Isarida, Takeo; Sakai, Tetsuya; Kubota, Takayuki; Koga, Miho; Katayama, Yu; Isarida, Toshiko K

2014-04-01

The present study investigated context effects of incidental odors in free recall after a short retention interval (5 min). With a short retention interval, the results are not confounded by extraneous odors or encounters with the experimental odor and possible rehearsal during a long retention interval. A short study time condition (4 s per item), predicted not to be affected by adaptation to the odor, and a long study time condition (8 s per item) were used. Additionally, we introduced a new method for recovery from adaptation, where a dissimilar odor was briefly presented at the beginning of the retention interval, and we demonstrated the effectiveness of this technique. An incidental learning paradigm was used to prevent overshadowing from confounding the results. In three experiments, undergraduates (N = 200) incidentally studied words presented one-by-one and received a free recall test. Two pairs of odors and a third odor having different semantic-differential characteristics were selected from 14 familiar odors. One of the odors was presented during encoding, and during the test, the same odor (same-context condition) or the other odor within the pair (different-context condition) was presented. Without using a recovery-from-adaptation method, a significant odor-context effect appeared in the 4-s/item condition, but not in the 8-s/item condition. Using the recovery-from-adaptation method, context effects were found for both the 8- and the 4-s/item conditions. The size of the recovered odor-context effect did not change with study time. There were no serial position effects. Implications of the present findings are discussed.

The Effects of Cultural Differences on the Physician-Patient Relationship

OpenAIRE

Manassis, Katharina

1986-01-01

Differences between patients' and physicians' perceptions of illness can result in poor communication and unsatisfactory treatment results. These differences are more likely when the patient's cultural background is different from the physician's. This article provides a case history of a cultural conflict between a patient, the patient's family, and the medical care system. The beliefs and practices of people unfamiliar with the North American health care system are discussed, and physicians...

Physicians' perspectives of pharmacist-physician collaboration in the United Arab Emirates: Findings from an exploratory study.

Science.gov (United States)

Hasan, S; Stewart, K; Chapman, C B; Kong, D C M

2018-03-28

Interprofessional collaborative care has been shown to improve patient outcomes. Physicians' views on collaboration with pharmacists give an insight into what contributes to a well-functioning team. Little is known about these views from low and ​middle-income countries and nothing from the United Arab Emirates (UAE). The purpose of this study is to investigate physicians' opinions on collaborative relationships with community pharmacists in the UAE. Semi-structured individual interviews and group discussions are conducted with a purposive sample of physicians. Thematic analysis based on the framework approach is used to generate themes. A total of 53 physicians participated. Three themes about collaboration emerged: perceived benefits of collaboration, facilitators of collaboration and perceived barriers to collaboration. Perceived benefits include reducing the burden on physicians, having the pharmacist as an extra safety check within the system, having the pharmacist assist patients to manage their medications: coping with side effects, reducing drug waste and costs, and attaining professional and health-system gains. Perceived facilitators included awareness and trust building, professional role definition, pharmacists' access to patient records and effective communication. Perceived barriers included patient and physician acceptance, logistic and financial issues and perceived pharmacist competence. This study has, for the first time, provided useful information to inform the future development of pharmacist-physician collaboration in the UAE and other countries with similar healthcare systems.

Physician practice management companies: should physicians be scared?

Science.gov (United States)

Scott-Rotter, A E; Brown, J A

1999-01-01

Physician practice management companies (PPMCs) manage nonclinical aspects of physician care and control physician groups by buying practice assets. Until recently, PPMCs were a favorite of Wall Street. Suddenly, in early 1998, the collapse of the MedPartners-PhyCor merger led to the rapid fall of most PPMC stock, thereby increasing wariness of physicians to sell to or invest in PPMCs. This article explores not only the broken promises made by and false assumptions about PPMCs, but also suggests criteria that physicians should use and questions would-be PPMC members should ask before joining. Criteria include: demonstrated expertise, a company philosophy that promotes professional autonomy, financial stability, freedom from litigation, and satisfied physicians already in the PPMC. The authors recommend that physicians seek out relatively small, single-specialty PPMCs, which hold the best promise of generating profits and permitting professional control over clinical decisions.

Gainsharing Strategies, Physician Champions, Getting Physician Buy In.

Science.gov (United States)

Anoushiravani, Afshin A; Nunley, Ryan M

2017-06-01

As healthcare spending continues to outpace economic growth, legislators and healthcare economists have explored many processes aimed at improving efficiency and reducing waste. Gainsharing or the general concept that organizations and their employees can work together to continually improve outcomes at reduced expenditures in exchange for a portion of the savings has been shown to be effective within the healthcare system. Although gainsharing principles may be applicable to healthcare organizations and their physician partners, specific parameters should be followed when implementing these arrangements. This article will discuss 10 gainsharing strategies aimed at properly aligning healthcare organizations and physicians, which if followed will ensure the successful implementation of gainsharing initiatives. Copyright © 2017. Published by Elsevier Inc.

How Hugh Hampton Young's treatment of President Woodrow Wilson's urinary retention and urosepsis affected the resolution of World War I.

Science.gov (United States)

Fogg, Ryan; Kutikov, Alexander; Uzzo, Robert G; Canter, Daniel

2011-09-01

President Woodrow Wilson was never able to gain ratification of the Treaty of Versailles, the peace accord to end World War I. Before he could convince the American people of the importance of ratification, Wilson suffered a stroke followed by life threatening urinary sepsis due to urinary retention, and was treated by the father of modern urology, Hugh Hampton Young. The effects of these health problems are examined in the context of their implications on international affairs. Biographical sources and primary documentation of Wilson's physicians were reviewed to determine the effect of Wilson's stroke on his voiding habits. Hugh Hampton Young's evaluation and decision making is examined in depth. In the fall of 1919 President Wilson was recovering from a stroke. Shortly after the stroke his preexisting voiding dysfunction progressed to urinary retention from which urinary sepsis developed. Hugh Hampton Young advised on Wilson's case and counseled patience over surgery. The President began voiding spontaneously and recovered from sepsis. The illness left him severely weakened and unable to mount an aggressive campaign to persuade the U.S. Senate of the importance of ratifying the Treaty of Versailles. His personal physician, Admiral Cary T. Grayson, stated that the President was mentally never the same after the sepsis. Wilson's voiding dysfunction contributed to his inability to win approval for the Treaty of Versailles and the League of Nations. As a result, the United States returned to a policy of isolationism and Europe plunged into 2 decades of upheaval, leading to World War II. Copyright © 2011 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Exploring the key predictors of retention in emergency nurses.

Science.gov (United States)

Sawatzky, Jo-Ann V; Enns, Carol L

2012-07-01

To explore the factors that predict the retention of nurses working in emergency departments. The escalating shortage of nurses is one of the most critical issues facing specialty areas, such as the emergency department. Therefore, it is important to identify the key influencing and intermediary factors that affect emergency department nurses' intention to leave. As part of a larger study, a cross-sectional survey was completed by 261 registered nurses working in the 12 designated emergency departments within rural, urban community and tertiary hospitals in Manitoba, Canada. Twenty-six per cent of the respondents will probably/definitely leave their current emergency department jobs within the next year. Engagement was the key predictor of intention to leave (P burnout (P nursing management, professional practice, collaboration with physicians, staffing resources and shift work emerged as significant influencing factors for engagement. Engagement plays a central role in emergency department nurses intention to leave. Addressing the factors that influence engagement may reduce emergency department nurses' intention to leave. This study highlights the value of research-based evidence as the foundation for developing innovative strategies for the retention of emergency department nurses. © 2012 Blackwell Publishing Ltd.

Moral distress, autonomy and nurse-physician collaboration among intensive care unit nurses in Italy.

Science.gov (United States)

Karanikola, Maria N K; Albarran, John W; Drigo, Elio; Giannakopoulou, Margarita; Kalafati, Maria; Mpouzika, Meropi; Tsiaousis, George Z; Papathanassoglou, Elizabeth D E

2014-05-01

To explore the level of moral distress and potential associations between moral distress indices and (1) nurse-physician collaboration, (2) autonomy, (3) professional satisfaction, (4) intention to resign, and (5) workload among Italian intensive care unit nurses. Poor nurse-physician collaboration and low autonomy may limit intensive care unit nurses' ability to act on their moral decisions. A cross-sectional correlational design with a sample of 566 Italian intensive care unit nurses. The intensity of moral distress was 57.9 ± 15.6 (mean, standard deviation) (scale range: 0-84) and the frequency of occurrence was 28.4 ± 12.3 (scale range: 0-84). The mean score of the severity of moral distress was 88.0 ± 44 (scale range: 0-336). The severity of moral distress was associated with (1) nurse-physician collaboration and dissatisfaction on care decisions (r = -0.215, P intention to resign (r = 0.244, P intention of nurses to resign (r = -0. 209, P intention to resign, whereas poor nurse-physician collaboration appears to be a pivotal factor accounting for nurses' moral distress. Enhancement of nurse-physician collaboration and nurses' participation in end-of-life decisions seems to be a managerial task that could lead to the alleviation of nurses' moral distress and their retention in the profession. © 2013 John Wiley & Sons Ltd.

HMO penetration and physicians' earnings.

Science.gov (United States)

Hadley, J; Mitchell, J M

1999-11-01

The goal of this study is to estimate whether cross-sectional variations in enrollment in health maintenance organizations (HMOs) affected physicians' earnings and hourly income in 1990. Using data from a nationally representative sample of 4,577 younger physicians (penetration is endogenous and used the instrumental variables approach to obtain unbiased estimates. HMO penetration had a negative and statistically significant impact on physicians earnings in 1990. A doubling of the average level of HMO penetration in the market is estimated to reduce annual earnings by 7% to 10.7%, and hourly earnings by approximately 6% to 9%. It appears that HMOs were successful in reducing physicians' annual and per hour earnings in 1990, presumably through a combination of fewer visits and lower payment rates for people covered by HMOs. Although these results cannot be generalized to all physicians, the experience of a younger cohort of physicians may still be a good indicator of the future effects of HMOs because younger physicians may be more susceptible to market forces than older and more established physicians. Moreover, these results may be somewhat conservative because they reflect market behavior in 1990, several years before the rapid growth and more aggressive market behavior of HMOs in recent years.

Effect of biochar amendment on nitrate retention in a silty clay loam soil

Directory of Open Access Journals (Sweden)

Angela Libutti

2016-08-01

Full Text Available Biochar incorporation into agricultural soils has been proposed as a strategy to decrease nutrient leaching. The present study was designed to assess the effect of biochar on nitrate retention in a silty clay loam soil. Biochar obtained from the pyrogasification of fir wood chips was applied to soil and tested in a range of laboratory sorption experiments. Four soil treatments were considered: soil only (control, soil with 2, 4 and 8% of biochar by mass. The Freundlich sorption isotherm model was used to fit the adsorbed amount of nitrate in the soil-biochar mixtures. The model performed very well in interpreting the experimental data according to a general linear regression (analysis of co-variance statistical approach. Nitrate retention in the soilbiochar mixtures was always higher than control, regardless the NO3 – concentration in the range of 0-400 mg L–1. Different sorption capacities and intensities were detected depending on the biochar application rate. The highest adsorption capacity was observed in the soils added with 2 and 4% of biochar, respectively. From the results obtained is possible to infer that nitrate retention is higher at lower biochar addition rate to soil (2 and 4% and at lower nitrate concentration in the soil water solution. These preliminary laboratory results suggest that biochar addition to a typical Mediterranean agricultural soil could be an effective management option to mitigate nitrate leaching.

The effect of extensive reading and paired-associate learning on long-term vocabulary retention: an event-related potential study.

Science.gov (United States)

Chun, Eunjin; Choi, Sungmook; Kim, Junsoo

2012-07-19

We investigated the relative efficacy of extensive reading (ER) and paired-associate learning (PAL) in the ability of second language (L2) learners to retain new vocabulary words. To that end, we combined behavioral measures (i.e., vocabulary tests) and an event-related potential (ERP) investigation with a focus on the N400 ERP component to track short- and long-term vocabulary retention as a consequence of the two different approaches. Behavioral results indicated that both ER and PAL led to substantial short-term retention of the target words. In contrast, on a long-term basis, ER was more effective than PAL to a considerable degree as indicated by a large-size effect (d=1.35). Evidence from the N400 effects (d=1.70) observed in the parietal electrode group (P3, Pz, P4) provided further support for the superior effects of ER over PAL on long-term vocabulary retention. The converging evidence challenges the assumptions of some L2 researchers and makes a significant contribution to the literature of vocabulary acquisition, because it provides the first ERP evidence that ER is more conducive to long-term vocabulary retention than PAL. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Kentucky physicians and politics.

Science.gov (United States)

VonderHaar, W P; Monnig, W B

1998-09-01

Approximately 19% of Kentucky Physicians are KEMPAC members or contribute to state legislative and Gubernatorial candidates. This limited study of political activity indicates that a small percentage of physicians participate in the political process. Despite the small number of contributors to state legislative candidates, KMA's legislative and lobbying effort is highly effective and members receive high quality service and representation in the political arena.

Generational differences in factors influencing physicians to choose a work location.

Science.gov (United States)

Mathews, M; Seguin, M; Chowdhury, N; Card, R T

2012-01-01

consideration when choosing a work location, regardless of generation. Likewise, residency training location, the ability to use their skills and knowledge fully, and the quality of recruitment efforts were important considerations in choosing a work location for all physicians. For some, remuneration was very influential in their work location decision; however, many physicians who chose to remain in their smaller 'home' provinces noted the lower cost of living in these provinces. Physicians who graduated in the 1980s and 1990s placed greater emphasis on work-life balance and spouse's employment opportunities than their older generation counterparts. In contrast, physicians who graduated in the 1960s and 1070s highlighted the medical need of the community, and the desire for adventure and to see new places as important. While many factors for choosing a work location appear to be stable over generations, a number of generational differences were found. Younger physicians placed greater emphasis on work-life balance and spouse's employment than older generation physicians. These differences may have important implications for small population regions which may not be able to support physician-spouse pairs or certain subspecialties. Although economic factors have largely been the focus of recruitment and retention initiatives in these provinces, the findings highlight the importance of addressing the needs and expectations of younger generation physicians in order to attract these physicians.

Health system tests CRM data base. Community Health Network uses direct mail to boost physicians.

Science.gov (United States)

Botvin, Judith D

2003-01-01

A six-month pilot patient retention project for Community Health Network (CHN), Indianapolis, ran from July 2002 to January 2003. It was a direct mail campaign on behalf of some members of the group practices owned by CHN, designed to test the use of the system's CRM database. Patients of the physicians received personal, dynamically-generated cards reminding them to schedule appointments and tests. Each mailing cost $1.76, including production and mailing.

Exploring the components of physician volunteer engagement: a qualitative investigation of a national Canadian simulation-based training programme.

Science.gov (United States)

Sarti, Aimee J; Sutherland, Stephanie; Landriault, Angele; DesRosier, Kirk; Brien, Susan; Cardinal, Pierre

2017-06-23

Conceptual clarity on physician volunteer engagement is lacking in the medical literature. The aim of this study was to present a conceptual framework to describe the elements which influence physician volunteer engagement and to explore volunteer engagement within a national educational programme. The context for this study was the Acute Critical Events Simulation (ACES) programme in Canada, which has successfully evolved into a national educational programme, driven by physician volunteers. From 2010 to 2014, the programme recruited 73 volunteer healthcare professionals who contributed to the creation of educational materials and/or served as instructors. A conceptual framework was constructed based on an extensive literature review and expert consultation. Secondary qualitative analysis was undertaken on 15 semistructured interviews conducted from 2012 to 2013 with programme directors and healthcare professionals across Canada. An additional 15 interviews were conducted in 2015 with physician volunteers to achieve thematic saturation. Data were analysed iteratively and inductive coding techniques applied. From the physician volunteer data, 11 themes emerged. The most prominent themes included volunteer recruitment, retention, exchange, recognition, educator network and quasi-volunteerism. Captured within these interrelated themes were the framework elements, including the synergistic effects of emotional, cognitive and reciprocal engagement. Behavioural engagement was driven by these factors along with a cue to action, which led to contributions to the ACES programme. This investigation provides a preliminary framework and supportive evidence towards understanding the complex construct of physician volunteer engagement. The need for this research is particularly important in present day, where growing fiscal constraints create challenges for medical education to do more with less. © Article author(s) (or their employer(s) unless otherwise stated in the text of

The Effects of Long-Duration Spaceflight on Training Retention and Transfer

Science.gov (United States)

Barshi, Immanuel; Healy, Alice; Dempsey, Donna L.; McGuire, Kerry M.; Landon, Lauren B.

2018-01-01

Training our crew members for long duration, exploration-class missions will have to maximize long-term retention and transfer of the trained skills. The expected duration of the missions, our inability to predict all the possible tasks the crew will be called upon to perform, and the low training-to-mission time ratio require that the training be maximally effective such that the skills acquired during training will be retained and will be transferrable across a wide range of specific tasks that are different from the particular tasks used during training. However, to be able to design training that can achieve these ambitious goals, we must first understand the ways in which long-duration spaceflight affects training retention and transfer. Current theories of training retention and transfer are largely based on experimental studies conducted at university laboratories using undergraduate students as participants. Furthermore, all such studies have been conducted on Earth. We do not know how well the results of these studies predict the performance of crew members. More specifically, we do not know how well the results of these studies predict the performance of crew members in space and especially during long-duration missions. To address this gap in our knowledge, the current on-going study seeks to test the null hypothesis that performance of university undergraduate students on Earth on training retention and transfer tests do in fact predict accurately the performance of crew members during long-duration spaceflights. To test this hypothesis, the study employs a single 16-month long experimental protocol with 3 different participant groups: undergraduate university students, crew members on the ground, and crew members in space. Results from this study will be presented upon its completion. This poster presents results of study trials of the two tasks used in this study: a data entry task and a mapping task. By researching established training principles, by

Physicians and euthanasia: a Canadian print-media discourse analysis of physician perspectives

Science.gov (United States)

Wright, David Kenneth; Karsoho, Hadi; Sandham, Sarah; Macdonald, Mary Ellen

2015-01-01

Background Recent events in Canada have mobilized public debate concerning the controversial issue of euthanasia. Physicians represent an essential stakeholder group with respect to the ethics and practice of euthanasia. Further, their opinions can hold sway with the public, and their public views about this issue may further reflect back upon the medical profession itself. Methods We conducted a discourse analysis of print media on physicians’ perspectives about end-of-life care. Print media, in English and French, that appeared in Canadian newspapers from 2008 to 2012 were retrieved through a systematic database search. We analyzed the content of 285 articles either authored by a physician or directly referencing a physician’s perspective. Results We identified 3 predominant discourses about physicians’ public views toward euthanasia: 1) contentions about integrating euthanasia within the basic mission of medicine, 2) assertions about whether euthanasia can be distinguished from other end-of-life medical practices and 3) palliative care advocacy. Interpretation Our data showed that although some medical professional bodies appear to be supportive in the media of a movement toward the legalization of euthanasia, individual physicians are represented as mostly opposed. Professional physician organizations and the few physicians who have engaged with the media are de facto representing physicians in public contemporary debates on medical aid in dying, in general, and euthanasia, in particular. It is vital for physicians to be aware of this public debate, how they are being portrayed within it and its potential effects on impending changes to provincial and national policies. PMID:26389090

Job stress and job satisfaction of physicians in private practice: comparison of German and Norwegian physicians.

Science.gov (United States)

Voltmer, Edgar; Rosta, Judith; Siegrist, Johannes; Aasland, Olaf G

2012-10-01

This study examined job satisfaction and job stress of German compared to Norwegian physicians in private practice. A representative sample of physicians in private practice of Schleswig-Holstein, Germany (N = 414) and a nationwide sample of Norwegian general practitioners and private practice specialists (N = 340) were surveyed in a cross-sectional design in 2010. The questionnaire comprised the standard instruments "Job Satisfaction Scale (JSS)" and a short form of the "Effort-Reward Imbalance Questionnaire (ERI)". Norwegian physicians scored significantly higher (job satisfaction scale compared to German physicians (M 5.57, SD 0.74 vs. M 4.78, SD 1.01). The effect size was highest for the items freedom to choose method (d = 1.012), rate of pay (d = 0.941), and overall job satisfaction (d = 0.931). While there was no significant difference in the mean of the overall effort scale between German and Norwegian physicians, Norwegian physicians scored significantly higher (p job satisfaction. Job satisfaction and reward were significantly higher in Norwegian than in German physicians. An almost threefold higher proportion of German physicians exhibited a high level of work-related stress. Findings call for active prevention and health promotion among stressed practicing physicians, with a special focus on improved working conditions.

Effect of preparation convergence on retention of multiple unit restorations - An in vitrostudy

Directory of Open Access Journals (Sweden)

Dileep Nag Vinnakota

2015-01-01

Full Text Available Background and Aim: Convergence angle (CA is one of the major determinant factors in the retention of single as well as multiple units. Hence, the aim of the present study was to determine the effect of preparation convergence on the retention of multiple unit restorations. Materials and Methods: Nickel-chromium alloy single crowns as well as three, six and nine multiple unit fixed partial dentures (FPDs were casted for standardized milled dies that simulate canine, premolar and molar teeth machined with two different degrees of convergence, 12 (n = 55 and 20 (n = 55. The dies were threaded on rectangular metal platforms with the help of retainer shaft in the proper position to model either single or multiple preparations. The casted crowns and FPDs were cemented and retention tested by securing the units in an Instron universal testing machine. The tabulated values were analyzed statistically using Mann-Whitney test. Results: Single and multiple units with 12° CA needed greater force to dislodge compared to 20°, but this difference was not statistically significant for single units of premolar (P > 0.05. Irrespective of the angle, there was a simultaneous statistically significant increase in retention as the number of units increased in FPDs, except for the difference between 3 and 6 units in 20° group (P > 0.05. Conclusion: This study highlights the importance of emphasizing on CA, during canine and molar preparation for single units as well as preparation of canines for 6 units FPDs.

The effect of hospital-physician integration on health information technology adoption.

Science.gov (United States)

Lammers, Eric

2013-10-01

The US federal government has recently made a substantial investment to enhance the US health information technology (IT) infrastructure. Previous literature on the impact of IT on firm performance across multiple industries has emphasized the importance of a process of co-invention whereby organizations develop complementary practices to achieve greater benefit from their IT investments. In health care, employment of physicians by hospitals can confer greater administrative control to hospitals over physicians' actions and resources and thus enable the implementation of new technology and initiatives aimed at maximizing benefit from use of the technology. In this study, I tested for the relationship between hospital employment of physicians and hospitals' propensity to use health IT. I used state laws that prohibit hospital employment of physicians as an instrument to account for the endogenous relationship with hospital IT use. Hospital employment of physicians is associated with significant increases in the probability of hospital health IT use. Therefore, subsidization of health IT among hospitals not employing physicians may be less efficient. Furthermore, state laws prohibiting hospitals from employing physicians may inhibit adoption of health IT, thus working against policy initiatives aimed at promoting use of the technology. Copyright © 2012 John Wiley & Sons, Ltd.

Relationship between potassium intake and radiocesium retention in the reindeer

International Nuclear Information System (INIS)

Holleman, D.F.; Luick, J.R.

1975-01-01

The effect of dietary potassium on radiocesium retention was studied in reindeer fed winter diets of lichens. Potassium added to the diet markedly decreased radiocesium retention; this suggests that seasonal changes in cesium retention observed earlier in reindeer might be caused largely by nutritional factors. Data indicate that a 20-fold increase in dietary potassium results in a 2-fold decrease in radiocesium retention

The effect of anchovy substrate application to fluor retention rate on Sprague Dawley rat tooth email (in vivo)

Science.gov (United States)

Zabrina, S.; Puspitawati, R.; Gunawan, H. A.

2017-08-01

Usage of anchovies (Stolephorus insularis), which contain a high fluoride concentration in a CaF2 compound, needs to be examined as a topical fluoridative agent. Aim: To study the effects of an anchovy substrate application, either by chewing or smearing, in increasing fluoride retention of enamel. Fourteen Sprague Dawley rats were divided into five groups: baseline, experimental (feeding and smearing), and negative controls. After 15 days, lower incisor teeth were extracted and fluoride retention on the enamel surface was measured using EDX. Data were analyzed by the independent samples t-test, the Mann-Whitney U test, and the Kruskal-Wallis test. There was a significant increase in fluoride retention on enamel from the experimental groups compared to the negative control group (p < 0.05). Fluoride retention levels of the experimental feeding group (6.823%) were slightly higher than those of the experimental smearing group (6.783%), though the difference was not statistically significant (p < 0.05). Anchovy substrate application, either by chewing or smearing, increases fluoride retention on tooth enamel.

Instructional strategy effects on the retention and transfer of procedures of different difficulty level

NARCIS (Netherlands)

Jelsma, Otto; Pieters, Julius Marie

1989-01-01

In the present study, the effects of two instructional strategies on the retention and transfer of procedures of different difficulty level were investigated. Difficulty level was manipulated by providing a different number of cues during training. The instructional strategies differed with respect

Effect of a retention groove on the shear bond strength of dentin-bonded restorations

NARCIS (Netherlands)

de Kok, P.; de Jager, N.; Veerman, I.A.M.; Hafeez, N.; Kleverlaan, C.J.; Roeters, J.F.M.

2016-01-01

Statement of problem. With the increasing use of minimally invasive restorations, effective adhesion becomes more important. Applying mechanical retention to a flat dentin surface might improve the adhesion of ceramic and composite resin restorations. Purpose. The purpose of this in vitro study was

Retention and failure morphology of prefabricated posts

DEFF Research Database (Denmark)

Sahafi, Alireza; Peutzfeldt, Anne; Asmussen, Erik

2004-01-01

PURPOSE: This study evaluated the effect of cement, post material, surface treatment, and shape (1) on the retention of posts luted in the root canals of extracted human teeth and (2) on the failure morphology. MATERIALS AND METHODS: Posts of titanium alloy (ParaPost XH), glass fiber (Para...... at 37 degrees C for 7 days, retention was determined by extraction of the posts. Failure morphology of extracted posts was analyzed and quantified stereomicroscopically. RESULTS: Type of luting cement, post material, and shape of post influenced the retention and failure morphology of the posts. Because...

Relationship between management styles and nurses' retention at ...

African Journals Online (AJOL)

Conclusion: Management style and nurses' retention were significantly interrelated in terms of exploitative/authoritative management style. Recommendation, the researcher recommended that hospital leaders should plan and implement effective strategies to promote nurse retention. This can be done through creating a ...

Recruiting and retaining primary care physicians in urban underserved communities: the importance of having a mission to serve.

Science.gov (United States)

Odom Walker, Kara; Ryan, Gery; Ramey, Robin; Nunez, Felix L; Beltran, Robert; Splawn, Robert G; Brown, Arleen F

2010-11-01

We examined factors influencing physician practice decisions that may increase primary care supply in underserved areas. We conducted in-depth interviews with 42 primary care physicians from Los Angeles County, California, stratified by race/ethnicity (African American, Latino, and non-Latino White) and practice location (underserved vs nonunderserved area). We reviewed transcriptions and coded them into themes by using standard qualitative methods. Three major themes emerged in relation to selecting geographic- and population-based practice decisions: (1) personal motivators, (2) career motivators, and (3) clinic support. We found that subthemes describing personal motivators (e.g., personal mission and self-identity) for choosing a practice were more common in responses among physicians who worked in underserved areas than among those who did not. By contrast, physicians in nonunderserved areas were more likely to cite work hours and lifestyle as reasons for selecting their current practice location or for leaving an underserved area. Medical schools and shortage-area clinical practices may enhance strategies for recruiting primary care physicians to underserved areas by identifying key personal motivators and may promote long-term retention through work-life balance.

Effect of exercise on deposition and subsequent retention of inhaled particles

International Nuclear Information System (INIS)

Bennett, W.D.; Messina, M.S.; Smaldone, G.C.

1985-01-01

To investigate the effect of exercise and its associated increase in ventilation on the deposition and subsequent retention of inhaled particles, we measured the fractional and regional lung deposition of a radioactively tagged (/sup 99m/Tc) monodisperse aerosol (2.6 microns mass median aerodynamic diam) in normal human subjects at rest and while exercising on a bicycle ergometer. Breath-by-breath deposition fraction (DF) was measured throughout the aerosol exposures by Tyndallometry. Following each exposure gamma camera analysis was used to 1) determine the regional distribution of deposited particles and 2) monitor lung retention for 2.5 h and again at 24 h. We found that DF was unchanged between ventilation at rest (6-10 l/min) and exercise (32-46 l/min). Even though mouth deposition was enhanced with exercise, it was not large enough to produce a significant difference in the deposition fraction of the lung (DFL) between resting and exercise exposures. The central-to-peripheral distribution of deposited aerosol was larger for the exercise vs. resting exposure, reflecting a shift of particle deposition to more central bronchial airways. Apical-to-basal distribution was not different for the two exposures. Retention at 2.5 h and 24 h (R24) was reduced following the exercise vs. the resting exposure, consistent with greater bronchial deposition during exercise. The product of DFL and R24 gave a measure of fractional burden at 24 h (B24), i.e., the fraction of inhaled aerosol residing in the lungs 24 h after exposure. B24 was not significantly different between rest and exercise exposures

Effect of Technetium-99 sources on its retention in low activity waste glass

Science.gov (United States)

Luksic, Steven A.; Kim, Dong-Sang; Um, Wooyong; Wang, Guohui; Schweiger, Michael J.; Soderquist, Chuck Z.; Lukens, Wayne; Kruger, Albert A.

2018-05-01

Small-scale crucible melting tests on simulated waste glass were performed with technetium-99 (Tc-99) introduced as different species in a representative low activity waste simulant. The glass saw an increase in Tc-99 retention when TcO2•2H2O and various Tc-minerals containing reduced tetravalent Tc were used compared to tests in which pertechnetate with heptavalent Tc was used. We postulate that the increase of Tc retention is likely caused by different reaction paths for Tc incorporation into glass during early stages of melting, rather than the low volatility of reduced tetravalent Tc compounds, which has been a generally accepted idea. Additional studies are needed to clarify the exact mechanisms relevant to the effect of reduced Tc compounds on Tc incorporation into or volatilization from the glass melt.

Effect of Technetium-99 Sources on Its Retention in Low Activity Waste Glass

Energy Technology Data Exchange (ETDEWEB)

Luksic, Steven A.; Kim, Dong-Sang; Um, Wooyong; Wang, Guohui; Schweiger, Michael J.; Soderquist, Chuck Z.; Lukens, Wayne W.; Kruger, Albert A.

2018-05-01

Small-scale crucible melting tests on simulated waste glass were performed with technetium-99 (Tc-99) introduced as different species in a representative low activity waste simulant. The glass saw an increase in Tc-99 retention when TcO2∙2H2O and various Tc-minerals containing reduced tetravalent Tc were used compared to tests in which pertechnetate with hexavalent Tc was used. We postulate that the increase of Tc retention is likely caused by different reaction paths for Tc incorporation into glass during early stages of melting, rather than the low volatility of reduced tetravalent Tc compounds, which has been a generally accepted idea. Additional studies are needed to clarify the exact mechanisms relevant to the effect of reduced Tc compounds on Tc incorporation into or volatilization from glass melt.

Rating the digital help: electronic medical records, software providers, and physicians.

Science.gov (United States)

Butler, Richard J; Johnson, William G

2016-09-01

To separate the effects of physicians' characteristics on the perceived productivity of EMRs from the effects of limitations on usability inherent in EMR design, a multivariate regression model is used to estimate the factors influencing physicians' rankings of five attributes of their EMRs, namely; ease of use and reliability; the EMRs effect on physician and staff productivity and the EMRs performance vs. vendor's promises. We divide the factors influencing the rankings into three groups: physician characteristics, EMR characteristics and practice characteristics (type of practice, size, and location). The data are from approximately 1800 practicing physicians in Arizona. Physician's characteristics influence perceived ease of use and physicians' productivity, but not staff productivity, reliability or vendors' promised performance. Practice type and EMR characteristics affect perceived productivity, reliability and performance versus vendors' promises. Vendor-specific effects are highly correlated across all five attributes and are always jointly significant. EMR characteristics are the most significant influence on physicians' perceptions of the EMRs effect on their productivity and that of their staff. Physicians' characteristics (particularly age) have a small but significant influence on perceived productivity.

Administrative skills for academic physicians.

Science.gov (United States)

Aluise, J J; Scmitz, C C; Bland, C J; McArtor, R E

1989-01-01

To function effectively within the multifaceted environment of the academic medical center, academic physicians need to heighten their understanding of the economics of the health care system, and further develop their leadership and managerial skills. A literature base on organizational development and management education now exists that addresses the unique nature of the professional organization, including academic medical centers. This article describes an administration development curriculum for academic physicians. Competency statements, instructional strategies and references provide the academic physician with guidelines for expanding their professional expertise to include organizational and management skills. The continuing success of the academic medical center as a responsive health care system may depend upon the degree to which academic physicians gain sophistication in self-management and organizational administration.

Physician Networks and Ambulatory Care-sensitive Admissions.

Science.gov (United States)

Casalino, Lawrence P; Pesko, Michael F; Ryan, Andrew M; Nyweide, David J; Iwashyna, Theodore J; Sun, Xuming; Mendelsohn, Jayme; Moody, James

2015-06-01

Research on the quality and cost of care traditionally focuses on individual physicians or medical groups. Social network theory suggests that the care a patient receives also depends on the network of physicians with whom a patient's physician is connected. The objectives of the study are: (1) identify physician networks; (2) determine whether the rate of ambulatory care-sensitive hospital admissions (ACSAs) varies across networks--even different networks at the same hospital; and (3) determine the relationship between ACSA rates and network characteristics. We identified networks by applying network detection algorithms to Medicare 2008 claims for 987,000 beneficiaries in 5 states. We estimated a fixed-effects model to determine the relationship between networks and ACSAs and a multivariable model to determine the relationship between network characteristics and ACSAs. We identified 417 networks. Mean size: 129 physicians; range, 26-963. In the fixed-effects model, ACSA rates varied significantly across networks: there was a 46% difference in rates between networks at the 25th and 75th performance percentiles. At 95% of hospitals with admissions from 2 networks, the networks had significantly different ACSA rates; the mean difference was 36% of the mean ACSA rate. Networks with a higher percentage of primary-care physicians and networks in which patients received care from a larger number of physicians had higher ACSA rates. Physician networks have a relationship with ACSAs that is independent of the physicians in the network. Physician networks could be an important focus for understanding variations in medical care and for intervening to improve care.

Patterns of 11C-PIB cerebral retention in mild cognitive impairment patients.

Science.gov (United States)

Banzo, I; Jiménez-Bonilla, J F; Martínez-Rodríguez, I; Quirce, R; de Arcocha-Torres, M; Bravo-Ferrer, Z; Lavado-Pérez, C; Sánchez-Juan, P; Rodríguez, E; Jiménez-Alonso, M; López-Defilló, J; Carril, J M

2016-01-01

To evaluate the patterns of cerebral cortical distribution of (11)C-PIB in patients with mild cognitive impairment (MCI). The study included 69 patients (37 male, age range 42-79 years) with MCI, sub-classified as 53 with amnestic-MCI (A-MCI), and 16 with non-amnestic-MCI (NA-MCI). Patients underwent (11)C-PIB PET/CT scan 60min after intravenous injection of the radiotracer. A visual analysis of the images was performed by 2 experienced physicians. (11)C-PIB-positive studies were considered when gray matter uptake was equal to or greater than white matter. According to the regions involved, (11)C-PIB-positive studies were classified into A-pattern (predominant retention in frontal, anterior cingulate, lateral temporal, and basal ganglia) and B-pattern (generalized retention). Thirty-nine of the 69 (56%) patients with MCI showed (11)C-PIB retention. Of the 53 A-MCI patients, 36 (68%) showed (11)C-PIB retention. Eleven out of 36 (30%) positive scans in A-MCI patients showed A-pattern, and 25 out of 36 (70%) patients had a B-pattern. Positive (11)C-PIB was observed in 3 out of 16 (19%) patients with NA-MCI. Regional distribution in these 3 patients showed A-pattern in 1, and B-pattern in 2 patients. Cortical retention of (11)C-PIB was more frequent in A-MCI than in NA-MCI patients, and also B-pattern than A-pattern in the (11)C-PIB positive group. The recognition of (11)C-PIB distribution patterns allows MCI patients to be classified, and the A-pattern may offer a therapeutic window for potential future treatments. Copyright © 2015 Elsevier España, S.L.U. and SEMNIM. All rights reserved.

Effects of Hydrocarbon-Based Grease on Rapid Prototype Material Used for Grease Retention Shrouds

Science.gov (United States)

Zakrajsek, Andrew J.; Valco, Daniel J.; Street, Kenneth W., Jr.

2010-01-01

Effects of hydrocarbon-based greases on specific rapid prototype (RP) materials used to fabricate grease retention shrouds (GRS) were explored in this study. Grease retention shrouds are being considered as a way to maintain adequate grease lubrication at the gear mesh in a prototype research transmission system. Due to their design and manufacturing flexibility, rapid prototype materials were chosen for the grease retention shrouds. In order to gain a better understanding of the short and long term effects grease pose on RP materials, research was conducted on the interaction of hydrocarbon-based grease with RP materials. The materials used in this study were durable polyamide (nylon), acrylonitrile butadiene styrene (ABS), and WaterClear 10120. Testing was conducted using Mobilgrease 28 and Syn-Tech 3913G grease (gear coupling grease). These greases were selected due to their regular use with mechanical components. To investigate the effect that grease has on RP materials, the following methods were used to obtain qualitative and quantitative data: Fourier transform infrared spectroscopy (FT-IR), interference profilometer measurements, digital camera imaging, physical shape measurement, and visual observations. To record the changes in the RP materials due to contact with the grease, data was taken before and after the grease application. Results showed that the WaterClear 10120 RP material provided the best resistance to grease penetration as compared to nylon and ABS RP materials. The manufacturing process, and thus resulting surface conditions of the RP material, played a key role in the grease penetration properties and resilience of these materials.

A Web-based course on infection control for physicians in training: an educational intervention.

Science.gov (United States)

Fakih, Mohamad G; Enayet, Iram; Minnick, Steven; Saravolatz, Louis D

2006-07-01

To evaluate the effectiveness of a Web-based course on infection control accessed by physicians in training. Educational intervention. A 607-bed urban teaching hospital. A total of 55 physicians in training beginning their first postgraduate year (the iPGY1 group) and 59 physicians completing their first, second, or third postgraduate year (the oPGY group). Individuals in the iPGY1 group took a Web-based course on infection control practices. Persons in the iPGY1 group who took the Web-based course completed an evaluation test consisting of 15 multiple-choice questions (total possible score, 15 points). The same test was given to persons in the oPGY group, who did not take the Web-based course. We compared scores of the Web-based test taken by subjects in the iPGY1 group immediately after the course with scores of the test they took 3 months after the course and with test scores of subjects in the oPGY group. The mean score (+/-SD) for subjects in the iPGY1 group who took the Web-based course was 10.6+/-2.2, compared with 8.0+/-2.5 for subjects in the oPGY group (P<.001). The mean score (+/-SD) for subjects in the iPGY1 group 3 months after completing the course decreased to 8.0+/-2.4 (P<.001 by the paired t test). For the oPGY group, significant differences were found between the scores (+/-SD) for subjects in the internal medicine (9.9+/-2.3), emergency medicine (8.4+/-1.7), pediatrics (7.0+/-1.7), and family medicine (5.8+/-1.6) residency programs (P<.001); there were no significant differences in scores according to the year of residency. Web-based infection control courses are an attractive teaching tool for physicians in training and need to be considered for teaching infection control. The evaluation of information retention will help identify physicians in training who require further training.

The Effect of Internal Marketing on Employee retention in Pakistani Banks

OpenAIRE

Naveed Ahmad; Nadeem Iqbal; Muhammad Sheeraz

2012-01-01

This research investigates the effects of internal marketing on employee retention in banking sector of district D. G. Khan, Pakistan. Marketing is the process by which the external customers are satisfied through exact identification of their needs and wants. When we do the same thing- satisfaction- with our employees then this is named as internal marketing. This approach is used to motivate, align and integrate the employees towards the achievement of organizational goals. The motto of int...

Faculty Personality: A Factor of Student Retention

Science.gov (United States)

Shaw, Cassandra S.; Wu, Xiaodong; Irwin, Kathleen C.; Patrizi, L. A. Chad

2016-01-01

The purpose of this study was to determine the relationship between student retention and faculty personality as it was hypothesized that faculty personality has an effect on student retention. The methodology adopted for this study was quantitative and in two parts 1) using linear regression models to examine the impact or causality of faculty…

[Gender as a key effect modifier of the relationship between physician work stressors and the acquired cardiovascular disorders].

Science.gov (United States)

Nedić, Olesja; Belkić, Karen; Filipović, Danka; Jocić, Neda

2008-01-01

To assess gender as an effect-modifier vis-â-vis exposure to work stressors and the acquired cardiovascular disorders (ACVDC). The Occupational Stress Index for physicians was used in a case-control study (>90% participation rate) among physicians in Novi Sad (Cases: 50 males and 51 females with ACVD, Referents: 46 males and 6l females without ACVD). Patterns of disease manifestation, sociodemography, risk factors, Minnesota Multiphasic Personality Inventory (MMPI) tendency and exposure to work stressors differed in male compared to female physicians with ACVD. Accounting for these covariates, the males with ACVD had significantly higher general-level threat avoidance vigilance scores (more witnessed accidents at work and expert-witnessing in court (p accounting for covariates. Females in the surgical care specialties with ACVD were exposed to significantly higher demands, speed-up, and need for constant high attention than their female colleagues without ACVD, after accounting for covariates. Gender is a key effect-modifier of the relationship between exposure to work stressors and ACVD among physicians. Intervention studies should consider gender-specific work stressors, as well as those specific to physicians.

Effect of gamma rays on grafting parameters and liquid retention property of cassava starch-g-PAN

International Nuclear Information System (INIS)

Kiatkamjornwong, S.; Chvajarernpun, J.; Nakason, C.

1992-01-01

Radiation modification on liquid retention properties of native cassava starch, gelatinized at 85 0 C, by graft copolymerization with acrylonitrile was carried out by mutual irradiation to γ-rays. A thin aluminium foil was used to cover the inner wall of the reaction vessel so that the extent of homo polymer could be reduced to be less than 1.6% with a distilled water retention value of 665 g/g of the dry weight of the saponified grafted product. Confirmations of graft copolymerization and saponification reactions were made by the infrared spectrophotometric technique. The combined effect of radiation parameters in terms of an irradiation time and a dose rate to the same total dose on the extent of grafting reaction expressed in terms of grafting parameters which directly influenced liquid retention values was evaluated in conjunction with statistical analysis

The Effect of Different Water Temperatures on Retention Loss and Material Degradation of Locator Attachments.

Science.gov (United States)

Chiu, Lillian Pui Yuk; Vitale, Nicola Di; Petridis, Haralampos; McDonald, Ailbhe

2017-08-01

To examine the changes in Locator attachments after exposure to different water temperatures and cyclic loading. Four groups of pink Locator attachments (3.0 lb. light retention replacement patrix attachments; 10 per group) were soaked for the equivalent of 5 years of use in distilled water at the following temperatures: 20°C, 37°C, 60°C. One group was kept dry to test the effect of water. A universal testing machine was used to measure the retention force of each treated attachment during 5500 insertion and removal cycles, simulating approximately 5 years of use. The results were compared using Kruskal-Wallis one-way ANOVA by ranks. Surface changes of tested attachments were examined using scanning electron microscopy (SEM). The exposure to 60°C water significantly increased the percentage of retention loss in Locator attachments (p < 0.05) compared to the 20°C water group and significantly reduced the final retention force compared to the other groups (p < 0.05). SEM examinations revealed severe cracking and material degradation in Locator attachments after exposure to 60°C water and cyclic loading, which were not evident in other groups. Cracking was observed after exposure to 60˚C water before cyclic loading. Exposure to 60°C water, potentially similar to denture cleansing procedures, could cause cracking in Locator attachments. Cracking is associated with hydrolytic degradation of nylon at 60°C. The change in structure could result in a significant loss of retention. © 2016 by the American College of Prosthodontists.

Non-physician practitioners in radiation oncology: advanced practice nurses and physician assistants

International Nuclear Information System (INIS)

Kelvin, Joanne Frankel; Moore-Higgs, Giselle J.; Maher, Karen E.; Dubey, Ajay K.; Austin-Seymour, Mary M.; Daly, Nancy Riese; Mendenhall, Nancy Price; Kuehn, Eric F.

1999-01-01

Purpose: With changes in reimbursement and a decrease in the number of residents, there is a need to explore new ways of achieving high quality patient care in radiation oncology. One mechanism is the implementation of non-physician practitioner roles, such as the advanced practice nurse (APN) and physician assistant (PA). This paper provides information for radiation oncologists and nurses making decisions about: (1) whether or not APNs or PAs are appropriate for their practice, (2) which type of provider would be most effective, and (3) how best to implement this role. Methods: Review of the literature and personal perspective. Conclusions: Specific issues addressed regarding APN and PA roles in radiation oncology include: definition of roles, regulation, prescriptive authority, reimbursement, considerations in implementation of the role, educational needs, and impact on resident training. A point of emphasis is that the non-physician practitioner is not a replacement or substitute for either a resident or a radiation oncologist. Instead, this role is a complementary one. The non-physician practitioner can assist in the diagnostic work-up of patients, manage symptoms, provide education to patients and families, and assist them in coping. This support facilitates the physician's ability to focus on the technical aspects of prescribing radiotherapy

Mobile Learning and Student Retention

Directory of Open Access Journals (Sweden)

Bharat Inder Fozdar

2007-06-01

Full Text Available Student retention in open and distance learning (ODL is comparatively poor to traditional education and, in some contexts, embarrassingly low. Literature on the subject of student retention in ODL indicates that even when interventions are designed and undertaken to improve student retention, they tend to fall short. Moreover, this area has not been well researched. The main aim of our research, therefore, is to better understand and measure students’ attitudes and perceptions towards the effectiveness of mobile learning. Our hope is to determine how this technology can be optimally used to improve student retention at Bachelor of Science programmes at Indira Gandhi National Open University (IGNOU in India. For our research, we used a survey. Results of this survey clearly indicate that offering mobile learning could be one method improving retention of BSc students, by enhancing their teaching/ learning and improving the efficacy of IGNOU’s existing student support system. The biggest advantage of this technology is that it can be used anywhere, anytime. Moreover, as mobile phone usage in India explodes, it offers IGNOU easy access to a larger number of learners. This study is intended to help inform those who are seeking to adopt mobile learning systems with the aim of improving communication and enriching students’ learning experiences in their ODL institutions.

Task and socioemotional behaviors of physicians: a test of reciprocity and social interaction theories in analogue physician-patient encounters.

Science.gov (United States)

Roberts, C A; Aruguete, M S

2000-02-01

The purpose of the present study is to assess social interaction and reciprocity theories as explanations for patient responses to a physician in a medical consultation. Social interaction theory predicts that patients mostly recognize and react to socioemotional behavior of their physicians due to a lack of understanding of physician task behaviors or a preoccupation with anxiety. Reciprocity theory predicts that patients recognize socioemotional and task behaviors of their physicians, and they respond to these behaviors in thematically similar ways. We examined these hypotheses by having subjects view one of four videotapes which varied in physician task behavior (thorough or minimum levels of explanation of etiology, symptoms, and treatment) and physician socioemotional behavior (high or low levels of concern and affection displayed verbally and non-verbally). Results supported the general proposition of social interaction theory in that high levels of socioemotional behavior of the physician increased measures of patient self-disclosure, trust, satisfaction, and likelihood of recommending the physician. Physician task behavior had no effect on patient response to the physician, a finding inconsistent with reciprocity theory.

The effect of dentifrice quantity and toothbrushing behaviour on oral delivery and retention of fluoride in vivo.

Science.gov (United States)

Creeth, Jonathan; Zero, Domenick; Mau, Melissa; Bosma, Mary Lynn; Butler, Andrew

2013-12-01

While toothpaste F(-) concentration and rinsing regimen have well-characterised impacts on fluoride's effectiveness, other aspects of brushing regimen have much less well-established effects, in particular, dentifrice quantity and brushing duration. An in vivo study (n = 42) of oral fluoride delivery (i.e. oral disposition post-brushing), and retention (i.e. concentration of F(-) in saliva post-brushing, a known efficacy predictor), was performed to compare effects observed with those of dentifrice F(-) concentration and rinsing regimen. Subjects brushed with a NaF-silica dentifrice (Aquafresh Advanced, 1,150 ppm F(-) ) or a control dentifrice (250 ppm F(-) , same base), for 45, 60, 120 or 180 seconds with 0.5 or 1.5 g dentifrice, and rinsed with 15 ml water once or three times in a cross-over design. The F(-) concentration was measured in post-brushing expectorate, rinse and toothbrush washing samples, and in saliva between 5-120 minutes after brushing. Using 1.5 g versus 0.5 g dentifrice increased F(-) in all samples: oral retention of F(-) was almost doubled by this increase. Increasing duration of brushing had more complex effects. The amount of F(-) in the expectorate increased but decreased in both rinse and toothbrush washing samples. Oral F(-) retention increased, but only in the period 30-120 minutes after brushing. Over the ranges investigated, the order of importance on oral F(-) retention was: dentifrice F(-) concentration > quantity > rinsing regimen > brushing duration. Hence, increasing dentifrice quantity and, to a lesser extent, the duration of brushing, can elevate oral fluoride post-brushing. Evidence is accumulating that the importance of these variables to fluoride efficacy may have been underestimated. © 2013 FDI World Dental Federation.

Administrative skills for academy physicians.

Science.gov (United States)

Aluise, J J; Schmitz, C C; Bland, C J; McArtor, R E

To function effectively within the multifaceted environment of the academic medical center, academic physicians need to heighten their understanding of the economics of the health care system, and further develop their leadership and managerial skills. A literature base on organizational development and management education is now available, which addresses the unique nature of the professional organization, including academic medical centers. This article describes an administration development curriculum for academic physicians. Competency statements, instructional strategies, and references provide health care educators with a model for developing administrative skills programs for academic physicians and other health care professionals. The continuing success of the academic medical center as a responsive health care system may depend on the degree to which academic physicians and their colleagues in other fields gain sophistication in self-management and organizational administration. Health care educators can apply the competencies and instructional strategies offered in this article to administrative development programs for physicians and other health professionals in their institutions.

Effects of audio-visual aids on foreign language test anxiety, reading and listening comprehension, and retention in EFL learners.

Science.gov (United States)

Lee, Shu-Ping; Lee, Shin-Da; Liao, Yuan-Lin; Wang, An-Chi

2015-04-01

This study examined the effects of audio-visual aids on anxiety, comprehension test scores, and retention in reading and listening to short stories in English as a Foreign Language (EFL) classrooms. Reading and listening tests, general and test anxiety, and retention were measured in English-major college students in an experimental group with audio-visual aids (n=83) and a control group without audio-visual aids (n=94) with similar general English proficiency. Lower reading test anxiety, unchanged reading comprehension scores, and better reading short-term and long-term retention after four weeks were evident in the audiovisual group relative to the control group. In addition, lower listening test anxiety, higher listening comprehension scores, and unchanged short-term and long-term retention were found in the audiovisual group relative to the control group after the intervention. Audio-visual aids may help to reduce EFL learners' listening test anxiety and enhance their listening comprehension scores without facilitating retention of such materials. Although audio-visual aids did not increase reading comprehension scores, they helped reduce EFL learners' reading test anxiety and facilitated retention of reading materials.

Exploring public sector physicians' resilience, reactions and coping strategies in times of economic crisis; findings from a survey in Portugal's capital city area.

Science.gov (United States)

Russo, Giuliano; Pires, Carlos André; Perelman, Julian; Gonçalves, Luzia; Barros, Pedro Pita

2017-03-15

Evidence is accumulating on the impact of the recent economic crisis on health and health systems across Europe. However, little is known about the effect this is having on physicians - a crucial resource for the delivery of healthcare services. This paper explores the adaptation to the crisis of public sector physicians and their ability to keep performing their functions, with the objective of gaining a better understanding of health workers' resilience under deteriorating conditions. We conducted a survey among 484 public primary care and hospital physicians in Portugal's capital city area and explored their perceptions of the crisis, adaptation and coping strategies. We used ordinal and logistic regression models to link changes in hours worked and intentions to migrate with physicians' characteristics and specific answers. We found little evidence of physicians changing their overall allocation of working time before and after the crisis, with their age, types of specialisation, valuation of job flexibility and independence significantly associated with changes in public sector hours between 2010 and 2015. Being divorced, not Portuguese, of younger age, and working a high number of hours per week, were found to increase the probability of physicians considering migration, the same as having a poor opinion of recent government health policies. On the other hand, enjoying their current working environment, not wanting to disrupt provision of service, and leisure time were found to protect against scaling down public sector hours or considering migration. Our work on Portuguese physicians contributes to the debate on health workers' resilience, showing the value of understanding the influence of personal characteristics and opinions on their adaptation to changing circumstances, before designing policies to improve their working conditions and retention.

Effect of the physicochemical parameters of benzimidazole molecules on their retention by a nonpolar sorbent from an aqueous acetonitrile solution

Science.gov (United States)

Shafigulin, R. V.; Safonova, I. A.; Bulanova, A. V.

2015-09-01

The effect of the structure of benzimidazoles on their chromatographic retention on octadecyl silica gel from an aqueous acetonitrile eluent was studied. One- and many-parameter correlation equations were obtained by linear regression analysis, and their prognostic potential in determining the retention factors of benzimidazoles under study was analyzed.

Patients' satisfaction with male versus female physicians: a meta-analysis.

Science.gov (United States)

Hall, Judith A; Blanch-Hartigan, Danielle; Roter, Debra L

2011-07-01

Female physicians have a more patient-centered practice style than male physicians, and patient satisfaction is predicted by a more patient-centered practice style. To assess whether there is a difference in patients' satisfaction with male versus female physicians and to examine moderators of this effect. MEDLINE and PsycINFO databases and citation search through 2009, using keywords pertaining to patient satisfaction and physician sex. English-language articles that compared patients' satisfaction in relation to their physicians' sex. Only studies of actual patients and physicians, including postgraduate trainees, were included. Forty-five studies reporting 28 effect sizes met inclusion criteria. Two coders independently extracted effect sizes (point-biserial correlations) and coded study attributes, then resolved disagreements through discussion. The satisfaction difference between male and female physicians was extremely small (r style and patients' values. Reasons for this disparity are discussed.

Aerosol retention in the flooded steam generator bundle during SGTR

International Nuclear Information System (INIS)

Lind, Terttaliisa; Dehbi, Abdel; Guentay, Salih

2011-01-01

Research highlights: → High retention of aerosol particles in a steam generator bundle flooded with water. → Increasing particle inertia, i.e., particle size and velocity, increases retention. → Much higher retention of aerosol particles in the steam generator bundle flooded with water than in a dry bundle. → Much higher retention of aerosol particles in the steam generator bundle than in a bare pool. → Bare pool models have to be adapted to be applicable for flooded bundles. - Abstract: A steam generator tube rupture in a pressurized water reactor may cause accidental release of radioactive particles into the environment. Its specific significance is in its potential to bypass the containment thereby providing a direct pathway of the radioactivity from the primary circuit to the environment. Under certain severe accident scenarios, the steam generator bundle may be flooded with water. In addition, some severe accident management procedures are designed to minimize the release of radioactivity into the environment by flooding the defective steam generator secondary side with water when the steam generator has dried out. To extend our understanding of the particle retention phenomena in the flooded steam generator bundle, tests were conducted in the ARTIST and ARTIST II programs to determine the effect of different parameters on particle retention. The effects of particle type (spherical or agglomerate), particle size, gas mass flow rate, and the break submergence on particle retention were investigated. Results can be summarized as follows: increasing particle inertia was found to increase retention in the flooded bundle. Particle shape, i.e., agglomerate or spherical structure, did not affect retention significantly. Even with a very low submergence, 0.3 m above the tube break, significant aerosol retention took place underlining the importance of the jet-bundle interactions close to the tube break. Droplets were entrained from the water surface with

Effect of Solvent Type and Drying Method on Protein Retention in ...

African Journals Online (AJOL)

There appears to be a link between the pKa of the acids and the degree of chitosan–solvent interaction on the one hand, and protein retention on the other hand. Increase in elution pH from 1.2 to 5.0 did not significantly (P>0.05) affect protein retention. Furthermore, there was no significant difference (p>0.05) between the ...

Physicians' fees and public medical care programs.

Science.gov (United States)

Lee, R H; Hadley, J

1981-01-01

In this article we develop and estimate a model of physicians' pricing that explicitly incorporates the effects of Medicare and Medicaid demand subsidies. Our analysis is based on a multiperiod model in which physicians are monopolistic competitors supplying services to several markets. The implications of the model are tested using data derived from claims submitted by a cohort of 1,200 California physicians during the years 1972-1975. We conclude that the demand for physician's services is relatively elastic; that increases in the local supply of physicians reduce prices somewhat; that physicians respond strategically to attempts to control prices through the customary-prevailing-reasonable system; and that price controls limit the rate of increase in physicians' prices. The analysis identifies a family of policies that recognize the monopsony power of public programs and may change the cost-access trade-off. PMID:7021479

Effects of eye contact and iconic gestures on message retention in human-robot interaction

NARCIS (Netherlands)

Dijk, van E.T.; Torta, E.; Cuijpers, R.H.

2013-01-01

The effects of iconic gestures and eye contact on message retention in human-robot interaction were investigated in a series of experiments. A humanoid robot gave short verbal messages to participants, accompanied either by iconic gestures or no gestures while making eye contact with the participant

Relation Between Physicians' Work Lives and Happiness.

Science.gov (United States)

Eckleberry-Hunt, Jodie; Kirkpatrick, Heather; Taku, Kanako; Hunt, Ronald; Vasappa, Rashmi

2016-04-01

Although we know much about work-related physician burnout and the subsequent negative effects, we do not fully understand work-related physician wellness. Likewise, the relation of wellness and burnout to physician happiness is unclear. The purpose of this study was to examine how physician burnout and wellness contribute to happiness. We sampled 2000 full-time physician members of the American Academy of Family Physicians. Respondents completed a demographics questionnaire, questions about workload, the Physician Wellness Inventory, the Maslach Burnout Inventory, and the Subjective Happiness Scale. We performed a hierarchical regression analysis with the burnout and wellness subscales as predictor variables and physician happiness as the outcome variable. Our response rate was 22%. Career purpose, personal accomplishment, and perception of workload manageability had significant positive correlations with physician happiness. Distress had a significant negative correlation with physician happiness. A sense of career meaning and accomplishment, along with a lack of distress, are important factors in determining physician happiness. The number of hours a physician works is not related to happiness, but the perceived ability to manage workload was significantly related to happiness. Wellness-promotion efforts could focus on assisting physicians with skills to manage the workload by eliminating unnecessary tasks or sharing workload among team members, improving feelings of work accomplishment, improving career satisfaction and meaning, and managing distress related to patient care.

Retention of gaseous isotopes

International Nuclear Information System (INIS)

Yarbro, O.O.; Mailen, J.C.; Stephenson, M.J.

1977-01-01

Retention of gaseous fission products during fuel reprocessing has, in the past, been limited to a modest retention of 131 I when processing fuels decayed less than about 180 days. The projected rapid growth of the nuclear power industry along with a desire to minimize environmental effects is leading to the reassessment of requirements for retention of gaseous fission products, including 131 I, 129 I, 85 Kr, 3 H, and 14 C. Starting in the late 1960s, a significant part of the LMFBR reprocessing development program has been devoted to understanding the behavior of gaseous fission products in plant process and effluent streams and the development of advanced systems for their removal. Systems for iodine control include methods for evolving up to 99% of the iodine from dissolver solutions to minimize its introduction and distribution throughout downstream equipment. An aqueous scrubbing system (Iodox) using 20 M HNO 3 as the scrubbing media effectively removes all significant iodine forms from off-gas streams while handling the kilogram quantities of iodine present in head-end and dissolver off-gas streams. Silver zeolite is very effective for removing iodine forms at low concentration from the larger-volume plant off-gas streams. Removal of iodine from plant liquid effluents by solid sorbents either prior to or following final vaporization appears feasible. Krypton is effectively released during dissolution and can be removed from the relatively small volume head-end and dissolver off-gas stream. Two methods appear applicable for removal and concentration of krypton: (1) selective absorption in fluorocarbons, and (2) cryogenic absorption in liquid nitrogen. The fluorocarbon absorption process appears to be rather tolerant of the normal contaminants (H 2 O, CO 2 , NOsub(x), and organics) present in typical reprocessing plant off-gas whereas the cryogenic system requires an extensive feed gas pretreatment system. Retention of tritium in a reprocessing plant is

Effect of soy protein isolate in the diet on retention by the rat of iron from radiolabeled test meals

International Nuclear Information System (INIS)

Thompson, D.B.; Erdman, J.W. Jr.

1984-01-01

The influence of soy protein isolate (SPI) in the diet on whole-body retention of extrinsically radiolabeled iron from test meals containing or not containing SPI was evaluated in marginally iron-deficient weanling rats. In experiment 1 SPI was compared with casein in a 2 X 2 factorial design: diets and test meals were either SPI-based or casein-based. Diets were fed for 13 days prior to the test meal and for 7 days subsequent to the test meal. Rats fed the SPI-based diet retained less iron from test meals than did rats fed the casein-based diet (66.1 vs. 74.8%, P less than 0.01). Experiment 2 showed that an SPI-based diet fed during the final 4 days of a 14-day pre-test meal period and subsequent to the test meal led to less iron retention compared to a casein-based diet. In addition to the observed diet effect, experiment 1 showed that iron retention was less from an SPI-based test meal than from a casein-based test meal, confirming previous reports of adverse effects of SPI on iron retention. The present experiments show that SPI can adversely affect from retention in two ways: by its presence in the diet before and after a test meal, and by its presence in a test meal

The Effects of Test Trial and Processing Level on Immediate and Delayed Retention

Science.gov (United States)

Chang, Sau Hou

2017-01-01

The purpose of the present study was to investigate the effects of test trial and processing level on immediate and delayed retention. A 2 × 2 × 2 mixed ANOVAs was used with two between-subject factors of test trial (single test, repeated test) and processing level (shallow, deep), and one within-subject factor of final recall (immediate,…

Effects of green-tree retention on abundance and guild composition of corticolous arthropods

Science.gov (United States)

Juraj Halaj; Charles B. Halpern; Hoonbok Yi

2009-01-01

We studied the effects of varying levels and patterns of green-tree retention on the community composition of bark-dwelling arthropods. Arthropods were sampled with crawl traps installed on 280 live trees and 260 snags (all Douglas-fir) at three locations (experimental blocks) in the western Cascade Range of Oregon and Washington. Sampling coincided with the breeding...

Cost-effectiveness of a nurse practitioner-family physician model of care in a nursing home: controlled before and after study.

Science.gov (United States)

Lacny, Sarah; Zarrabi, Mahmood; Martin-Misener, Ruth; Donald, Faith; Sketris, Ingrid; Murphy, Andrea L; DiCenso, Alba; Marshall, Deborah A

2016-09-01

To examine the cost-effectiveness of a nurse practitioner-family physician model of care compared with family physician-only care in a Canadian nursing home. As demand for long-term care increases, alternative care models including nurse practitioners are being explored. Cost-effectiveness analysis using a controlled before-after design. The study included an 18-month 'before' period (2005-2006) and a 21-month 'after' time period (2007-2009). Data were abstracted from charts from 2008-2010. We calculated incremental cost-effectiveness ratios comparing the intervention (nurse practitioner-family physician model; n = 45) to internal (n = 65), external (n = 70) and combined internal/external family physician-only control groups, measured as the change in healthcare costs divided by the change in emergency department transfers/person-month. We assessed joint uncertainty around costs and effects using non-parametric bootstrapping and cost-effectiveness acceptability curves. Point estimates of the incremental cost-effectiveness ratio demonstrated the nurse practitioner-family physician model dominated the internal and combined control groups (i.e. was associated with smaller increases in costs and emergency department transfers/person-month). Compared with the external control, the intervention resulted in a smaller increase in costs and larger increase in emergency department transfers. Using a willingness-to-pay threshold of $1000 CAD/emergency department transfer, the probability the intervention was cost-effective compared with the internal, external and combined control groups was 26%, 21% and 25%. Due to uncertainty around the distribution of costs and effects, we were unable to make a definitive conclusion regarding the cost-effectiveness of the nurse practitioner-family physician model; however, these results suggest benefits that could be confirmed in a larger study. © 2016 John Wiley & Sons Ltd.

A Study of the Effect of Color in Memory Retention When Used in Presentation Software.

Science.gov (United States)

McConnohie, Bruce Vernon

A study of the effects of color as used in presentation software on short-range (immediately following treatment) and long-range (one hour following treatment) memory retention was conducted. Previous studies have concentrated on color as cueing or coding mechanisms primarily in print media and have not explored the effect of individual colors as…

Effect of gavaged chemical form of 241Am on its retention in mice

International Nuclear Information System (INIS)

Hisamatsu, S.; Takizawa, Y.

1987-01-01

The retention of 241 Am in mice 48 h after administration by gavage is reported here. The 241 Am was given to mice in the form of either 241 Am nitrate or 241 Am citrate. The 241 Am was also injected into rats in the same form. The homogenized livers of those rats were subsequently administered by gavage to another group of mice. The retention of 241 Am citrate was 1.5 X 10(-2)% of the original dose and was the highest among the compounds examined. The retention of biologically incorporated 241 Am into the liver as 241 Am nitrate and as 241 Am citrate was 2.4 X 10(-3) and 2.6 X 10(-3)%, respectively, and was similar to the retention of 241 Am nitrate, which was 2.8 X 10(-3)%. The ratio of the retention in the carcass to that in the liver for the 241 Am citrate was lower than that of the 241 Am nitrate and the biologically incorporated 241 Am. This difference indicates that the distribution of 241 Am in the animal body depends on the chemical form administered. The retention of liver-incorporated 241 Am as citrate after autolysis of the liver is similar to that of fresh liver-incorporated 241 Am citrate

Physicians' obligations in radiation issues

International Nuclear Information System (INIS)

Loken, M.K.

1986-01-01

Physicians have responsibilities to develop effective radiation programs that will (1) protect the public's physical and emotional health, (2) prevent and/or minimize illnesses and injury, and (3) treat and rehabilitate all exposed individuals. To accomplish these goals, physicians should understand the basic elements of radiation physics, radiation biology, benefit/risk, radiation regulations, nuclear power production, and world energy needs

Physicians' perceptions of physician-nurse interactions and information needs in China.

Science.gov (United States)

Wen, Dong; Guan, Pengcheng; Zhang, Xingting; Lei, Jianbo

2018-01-01

Good communication between physicians and nurses is important for the understanding of disease status and treatment feedback; however, certain issues in Chinese hospitals could lead to suboptimal physician-nurse communication in clinical work. Convenience sampling was used to recruit participants. Questionnaires were sent to clinical physicians in three top tertiary Grade-A teaching hospitals in China and six hundred and seventeen physicians participated in the survey. (1) Common physician-nurse interactions were shift-change reports and provisional reports when needed, and interactions expected by physicians included face-to-face reports and communication via a phone or mobile device. (2) Most respondents believed that the need for information in physician-nurse interactions was high, information was moderately accurate and timely, and feedback regarding interaction time and satisfaction indicated that they were only average and required improvement. (3) Information needs in physician-nurse interactions differed significantly according to hospital category, role, workplace, and educational background (p < .05). There was a considerable need for information within physician-nurse interactions, and the level of satisfaction with the information obtained was average; requirements for the improvement of communication differed between physicians and nurses because of differences in their characteristics. Currently, the use of information technology in physician-nurse communication was less common but was highly expected by physicians.

Effects of Computer-Assisted Jigsaw II Cooperative Learning Strategy on Physics Achievement and Retention

Science.gov (United States)

Gambari, Isiaka Amosa; Yusuf, Mudasiru Olalere

2016-01-01

This study investigated the effects of computer-assisted Jigsaw II cooperative strategy on physics achievement and retention. The study also determined how moderating variables of achievement levels as it affects students' performance in physics when Jigsaw II cooperative learning is used as an instructional strategy. Purposive sampling technique…

Giving patients responsibility or fostering mutual response-ability: family physicians' constructions of effective chronic illness management.

Science.gov (United States)

Thille, Patricia H; Russell, Grant M

2010-10-01

Current visions of family medicine and models of chronic illness management integrate evidence-based medicine with collaborative, patient-centered care, despite critiques that these constructs conflict with each other. With this potential conflict in mind, we applied a critical discursive psychology methodology to present discursive patterns articulated by 13 family physicians in Ontario, Canada, regarding care of patients living with multiple chronic illnesses. Physicians constructed competing versions of the terms "effective chronic illness management" and "patient involvement." One construction integrated individual responsibility for health with primacy of "evidence," resulting in a conceptualization consistent with paternalistic care. The second constructed effective care as involving active partnership of physician and patient, implying a need to foster the ability of both practitioners and patients to respond to complex challenges as they arose. The former pattern is inconsistent with visions of family medicine and chronic illness management, whereas the latter embodies it.

Magnetite effect in radionuclide retention : cesium, strontium, molybdenum and selenium

International Nuclear Information System (INIS)

Rovira, M.; Casas, I.; Gimenez, J.; Clarens, F.; Pablo, J. de

2004-01-01

In this work we have investigated the interaction of magnetite with cesium, strontium, molybdenum and selenium, in the frame of radionuclide retention by canister corrosion products. For each radionuclide, the retention on magnetite has been studied as a function of pH and the mass/ volume ratio. The experimental results have been modeled by means of Surface Complexation Models (SCM), that constitute a tool that allows an approach to sorption mechanisms in a wide range of experimental conditions taking into account electrostatic interactions at the mineral-water interface.(Author)

Effects of systematic asymmetric discounting on physician-patient interactions: a theoretical framework to explain poor compliance with lifestyle counseling

Directory of Open Access Journals (Sweden)

Fleischer Alan B

2002-11-01

Full Text Available Abstract Background This study advances the use of a utility model to model physician-patient interactions from the perspectives of physicians and patients. Presentation of the hypothesis In cases involving acute care, patient counseling involves a relatively straightforward transfer of information from the physician to a patient. The patient has less information than the physician on the impact the condition and its treatment have on utility. In decisions involving lifestyle changes, the patient may have more information than the physician on his/her utility of consumption; moreover, differences in discounting future health may contribute significantly to differences between patients' preferences and physicians' recommendations. Testing the hypothesis The expectation of differences in internal discount rate between patients and their physicians is discussed. Implications of the hypothesis This utility model provides a conceptual basis for the finding that educational approaches alone may not effect changes in patient behavior and suggests other economic variables that could be targeted in the attempt to produce healthier behavior.

Effect of Abutment Modification and Cement Type on Retention of Cement-Retained Implant Supported Crowns

Science.gov (United States)

Farzin, Mitra; Torabi, Kianoosh; Ahangari, Ahmad Hasan; Derafshi, Reza

2014-01-01

Objective: Provisional cements are commonly used to facilitate retrievability of cement-retained fixed implant restorations; but compromised abutment preparation may affect the retention of implant-retained crowns.The purpose of this study was to investigate the effect of abutment design and type of luting agent on the retentive strength of cement-retained implant restorations. Materials and Method: Two prefabricated abutments were attached to their corresponding analogs and embedded in an acrylic resin block. The first abutment (control group) was left intact without any modifications. The screw access channel for the first abutment was completely filled with composite resin. In the second abutment, (test group) the axial wall was partially removed to form an abutment with 3 walls. Wax models were made by CAD/CAM. Ten cast copings were fabricated for each abutment. The prepared copings were cemented on the abutments by Temp Bond luting agent under standardized conditions (n=20). The assemblies were stored in 100% humidity for one day at 37°C prior to testing. The cast crown was removed from the abutment using an Instron machine, and the peak removal force was recorded. Coping/abutment specimens were cleaned after testing, and the testing procedure was repeated for Dycal luting agent (n=20). Data were analyzed with two- way ANOVA (α=0.05). Results: There was no significant difference in the mean transformed retention (Ln-R) between intact abutments (4.90±0.37) and the abutments with 3 walls (4.83±0.25) using Dycal luting agent. However, in TempBond group, the mean transformed retention (Ln-R) was significantly lower in the intact abutment (3.9±0.23) compared to the abutment with 3 walls (4.13±0.33, P=0.027). Conclusion: The retention of cement-retained implant restoration can be improved by the type of temporary cement used. The retention of cast crowns cemented to implant abutments with TempBond is influenced by the wall removal. PMID:25628660

Effect of abutment modification and cement type on retention of cement-retained implant supported crowns.

Directory of Open Access Journals (Sweden)

Mitra Farzin

2014-06-01

Full Text Available Provisional cements are commonly used to facilitate retrievability of cement-retained fixed implant restorations; but compromised abutment preparation may affect the retention of implant-retained crowns.The purpose of this study was to investigate the effect of abutment design and type of luting agent on the retentive strength of cement-retained implant restorations.Two prefabricated abutments were attached to their corresponding analogs and embedded in an acrylic resin block. The first abutment (control group was left intact without any modifications. The screw access channel for the first abutment was completely filled with composite resin. In the second abutment, (test group the axial wall was partially removed to form an abutment with 3 walls. Wax models were made by CAD/CAM. Ten cast copings were fabricated for each abutment. The prepared copings were cemented on the abutments by Temp Bond luting agent under standardized conditions (n=20. The assemblies were stored in 100% humidity for one day at 37°C prior to testing. The cast crown was removed from the abutment using an Instron machine, and the peak removal force was recorded. Coping/abutment specimens were cleaned after testing, and the testing procedure was repeated for Dycal luting agent (n=20. Data were analyzed with two- way ANOVA (α=0.05.There was no significant difference in the mean transformed retention (Ln-R between intact abutments (4.90±0.37 and the abutments with 3 walls (4.83±0.25 using Dycal luting agent. However, in TempBond group, the mean transformed retention (Ln-R was significantly lower in the intact abutment (3.9±0.23 compared to the abutment with 3 walls (4.13±0.33, P=0.027.The retention of cement-retained implant restoration can be improved by the type of temporary cement used. The retention of cast crowns cemented to implant abutments with TempBond is influenced by the wall removal.

Transmutation effects on long-term Cs retention in phyllosilicate minerals from first principles.

Science.gov (United States)

Sassi, Michel; Okumura, Masahiko; Machida, Masahiko; Rosso, Kevin M

2017-10-11

The accidental release and incorporation of radiocesium into soil minerals represents a massive environmental, technical and social challenge. Accurately forecasting the evolving distribution and fate of long- and medium-lived isotopes such as 137 Cs and 134 Cs over decadal time scales is essential. The cesium cation has long been modeled as a strongly and selectively sorbed species into clay mineral interlayers; however, because of the time scales involved by the radioisotopes half-lives, the effects of radioactive decay on Cs retention have been unknown. We report density functional theory (DFT) simulations of transmutation effects of radiocesium on long-term Cs retention in phlogopite. The calculations show that the progressive appearance of daughter product Ba 2+ is accompanied by a proportional increase in thermodynamic driving force to preferentially discharge remaining Cs, both radioactive and stable, back into aqueous solution. Based on thermodynamic analysis, the findings indicate that radiocesium transmutation provides a mean to weaken the binding of Cs in phyllosilicate minerals, therefore potentially involving a premature re-release of Cs back into the environment. In the case where radiogenic Ba 2+ ions accumulate in the mineral, collateral effects would ultimately be an increase in the overall interlayer binding energy and a lower resorption capacity.

Death by request in The Netherlands: facts, the legal context and effects on physicians, patients and families.

Science.gov (United States)

Kimsma, G K

2010-11-01

In this article I intend to describe an issue of the Dutch euthanasia practice that is not common knowledge. After some general introductory descriptions, by way of formulating a frame of reference, I shall describe the effects of this practice on patients, physicians and families, followed by a more philosophical reflection on the significance of these effects for the assessment of the authenticity of a request and the nature of unbearable suffering, two key concepts in the procedure towards euthanasia or physician-assisted suicide. This article does not focus on the arguments for or against euthanasia and the ethical justification of physician-assisted dying. These arguments have been described extensively in Kimsma and Van Leeuwen (Asking to die. Inside the Dutch debate about euthanasia, Kluwer Academic Publishers, Dordrecht, 1998).

Acute effects of the electromagnetic waves emitted by mobile phones on attention in emergency physicians.

Science.gov (United States)

Altuntas, Gurkan; Sadoglu, Davut; Ardic, Senol; Yilmaz, Hakan; Imamoglu, Melih; Turedi, Suleyman

2018-03-01

The purpose of this study was to investigate the acute effects of the electromagnetic waves (EMW) emitted by mobile phones on attention in emergency physicians. This single-center, prospective, randomized, double-blinded clinical study was performed among emergency physicians in a tertiary hospital. Thirty emergency physicians were enrolled in the study. Initial d2 test was applied in the evaluation of attention and concentration of all the physicians, who were randomly assigned into one of two groups. The control group members hold mobile phones in 'off' mode to their left ears for 15min. The members of the intervention group hold mobile phones in 'on' mode to their left ears for 15min, thus exposing them to 900-1800MHz EMW. The d2 test was re-applied to both groups after this procedure. Differences in attention and concentration levels between the groups were compared. Difference between initial and final d2 test in total performance (TN-E, p=0.319), in total number of figures marked (TN, p=0.177), in test performance percentile (PR, p=0.619) and in attention fluctuation (FR, p=0.083) were similar between the groups. However, difference in the number of figures missed (E1 selective attention, p=0.025), difference between numbers of incorrectly marked figures (E2, p=0,018) and difference in focus levels (E, p=0.016) were significantly in favor of the intervention group. According to our study findings, the EMW emitted by mobile phones has no deleterious effect on the attention and concentration levels of emergency physicians, and even has a positive impact on selective attention levels. Copyright © 2017 Elsevier Inc. All rights reserved.

Validation of the Physician-Pharmacist Collaborative Index for physicians in Malaysia.

Science.gov (United States)

Sellappans, Renukha; Ng, Chirk Jenn; Lai, Pauline Siew Mei

2015-12-01

Establishing a collaborative working relationship between doctors and pharmacists is essential for the effective provision of pharmaceutical care. The Physician-Pharmacist Collaborative Index (PPCI) was developed to assess the professional exchanges between doctors and pharmacists. Two versions of the PPCI was developed: one for physicians and one for pharmacists. However, these instruments have not been validated in Malaysia. To determine the validity and reliability of the PPCI for physicians in Malaysia. An urban tertiary hospital in Malaysia. This prospective study was conducted from June to August 2014. Doctors were grouped as either a "collaborator" or a "non-collaborator". Collaborators were doctors who regularly worked with one particular clinical pharmacist in their ward, while non-collaborators were doctors who interacted with any random pharmacist who answered the general pharmacy telephone line whenever they required assistance on medication-related enquiries, as they did not have a clinical pharmacist in their ward. Collaborators were firstly identified by the clinical pharmacist he/she worked with, then invited to participate in this study through email, as it was difficult to locate and approach them personally. Non-collaborators were sampled conveniently by approaching them in person as these doctors could be easily sampled from any wards without a clinical pharmacist. The PPCI for physicians was administered at baseline and 2 weeks later. Validity (face validity, factor analysis and discriminative validity) and reliability (internal consistency and test-retest) of the PPCI for physicians. A total of 116 doctors (18 collaborators and 98 non-collaborators) were recruited. Confirmatory factor analysis confirmed that the PPCI for physicians was a 3-factor model. The correlation of the mean domain scores ranged from 0.711 to 0.787. "Collaborators" had significantly higher scores compared to "non-collaborators" (81.4 ± 10.1 vs. 69.3 ± 12.1, p Malaysia.

Leadership training to improve nurse retention.

Science.gov (United States)

Wallis, Allan; Kennedy, Kathy I

2013-05-01

This paper discusses findings from an evaluation of a training programme designed to promote collaborative, team-based approaches to improve nurse retention within health care organizations. A year-long leadership training programme was designed and implemented to develop effective teams that could address retention challenges in a diverse set of organizations in Colorado ranging from public, private to non-profit. An evaluation, based on a combination of participant observation, group interviews, and the use of standardized tests measuring individual emotional intelligence and team dynamics was conducted to assess the effectiveness of the training programme. What role do the emotional intelligence of individual members and organizational culture play in team effectiveness? Out of five teams participating in the training programme, two performed exceptionally well, one experienced moderate success and two encountered significant problems. Team dynamics were significantly affected by the emotional intelligence of key members holding supervisory positions and by the existing culture and structure of the participating organizations. Team approaches to retention hold promise but require careful development and are most likely to work where organizations have a collaborative problem-solving environment. © 2012 Blackwell Publishing Ltd.

Investigating the Effectiveness of Audio Input Enhancement on EFL Learners' Retention of Intensifiers

Science.gov (United States)

Negari, Giti Mousapour; Azizi, Aliye; Arani, Davood Khedmatkar

2018-01-01

The present study attempted to investigate the effects of audio input enhancement on EFL learners' retention of intensifiers. To this end, two research questions were formulated. In order to address these research questions, this study attempted to reject two null hypotheses. Pretest-posttest control group quasi-experimental design was employed to…

Construction of a Physician Skills Inventory

Science.gov (United States)

Richard, George V.; Zarconi, Joseph; Savickas, Mark L.

2012-01-01

The current study applied Holland's RIASEC typology to develop a "Physician Skills Inventory". We identified the transferable skills and abilities that are critical to effective performance in medicine and had 140 physicians in 25 different specialties rate the importance of those skills. Principal component analysis of their responses produced…

Results of Large-Scale Testing on Effects of Anti-Foam Agent on Gas Retention and Release

Energy Technology Data Exchange (ETDEWEB)

Stewart, Charles W.; Guzman-Leong, Consuelo E.; Arm, Stuart T.; Butcher, Mark G.; Golovich, Elizabeth C.; Jagoda, Lynette K.; Park, Walter R.; Slaugh, Ryan W.; Su, Yin-Fong; Wend, Christopher F.; Mahoney, Lenna A.; Alzheimer, James M.; Bailey, Jeffrey A.; Cooley, Scott K.; Hurley, David E.; Johnson, Christian D.; Reid, Larry D.; Smith, Harry D.; Wells, Beric E.; Yokuda, Satoru T.

2008-01-03

The U.S. Department of Energy (DOE) Office of River Protection’s Waste Treatment Plant (WTP) will process and treat radioactive waste that is stored in tanks at the Hanford Site. The waste treatment process in the pretreatment facility will mix both Newtonian and non-Newtonian slurries in large process tanks. Process vessels mixing non-Newtonian slurries will use pulse jet mixers (PJMs), air sparging, and recirculation pumps. An anti-foam agent (AFA) will be added to the process streams to prevent surface foaming, but may also increase gas holdup and retention within the slurry. The work described in this report addresses gas retention and release in simulants with AFA through testing and analytical studies. Gas holdup and release tests were conducted in a 1/4-scale replica of the lag storage vessel operated in the Pacific Northwest National Laboratory (PNNL) Applied Process Engineering Laboratory using a kaolin/bentonite clay and AZ-101 HLW chemical simulant with non-Newtonian rheological properties representative of actual waste slurries. Additional tests were performed in a small-scale mixing vessel in the PNNL Physical Sciences Building using liquids and slurries representing major components of typical WTP waste streams. Analytical studies were directed at discovering how the effect of AFA might depend on gas composition and predicting the effect of AFA on gas retention and release in the full-scale plant, including the effects of mass transfer to the sparge air. The work at PNNL was part of a larger program that included tests conducted at Savannah River National Laboratory (SRNL) that is being reported separately. SRNL conducted gas holdup tests in a small-scale mixing vessel using the AZ-101 high-level waste (HLW) chemical simulant to investigate the effects of different AFAs, their components, and of adding noble metals. Full-scale, single-sparger mass transfer tests were also conducted at SRNL in water and AZ-101 HLW simulant to provide data for PNNL�

Medicare payment changes and physicians' incomes.

Science.gov (United States)

Weeks, William B; Wallace, Amy E

2002-01-01

An effort to control the physician portion of Medicare expenditures and to narrow the income gap between primary care and procedure-based physicians was effected through t he enactment of the Medicare Fee Schedule (MFS). To determine whether academic and private sector physicians' incomes had demonstrated changes consistent with payment changes, we collected income information from surveys of private sector physicians and academic physicians in six specialties: (1) family practice; (2) general internal medicine; (3) psychiatry; (4) general surgery; (5) radiology; and (6) anesthesiology. With the exception of general internal medicine, the anticipated changes in Medicare revenue were not closely associated with income changes in either the academic or private sector group. Academic physicians were underpaid, relative to their private sector counterparts, but modestly less so at the end of the period examined. Our findings suggest that using changes in payment schedules to change incomes in order to influence the attractiveness of different specialties, even with a very large payer, may be ineffective. Should academic incomes remain uncompetitive with private sector incomes, it may be increasingly difficult to persuade physicians to enter academic careers.

Effect of molecular interactions on retention and selectivity in reversed-phase liquid chromatography.

Science.gov (United States)

Szepesy, László

2002-06-25

The linear solvation energy relationships (LSERs) have been applied in the last years for description and prediction of retention and selectivity in reversed-phase liquid chromatography with good results. Widely different stationary phases have been compared and characterized by LSERs. In recent publications the influence of the type of the organic moderator and the composition of the mobile phase have also been described. However, the influence of the molecular properties of the solutes to be separated has never been discussed. According to the LSER model variation in retention factors (log k) with solute structure can be related to their potential for various intermolecular interactions. The retention factor is given as the sum of the terms of the LSER equation representing various types of molecular interactions. For this reason the influence of the structure and molecular properties of the solutes to be separated can also be investigated using the LSER equation. In this study we shall demonstrate how the specific molecular interactions influence chromatographic retention and selectivity. We intend to show that retention and selectivity depend on all participants of the system. In addition to the structure and properties of the stationary phase and the type and composition of the mobile phase the molecular properties of the solutes, characterized by the solvation parameters, will also influence the type and extent of the various molecular interactions governing retention and selectivity.

Are physicians and patients in agreement? Exploring dyadic concordance.

Science.gov (United States)

Coran, Justin J; Koropeckyj-Cox, Tanya; Arnold, Christa L

2013-10-01

Dyadic concordance in physician-patient interactions can be defined as the extent of agreement between physicians and patients in their perceptions of the clinical encounter. The current research specifically examined two types of concordance: informational concordance-the extent of agreement in physician and patient responses regarding patient information (education, self-rated health, pain); and interactional concordance-the extent of physician-patient agreement regarding the patient's level of confidence and trust in the physician and the perceived quality of explanations concerning diagnosis and treatment. Using a convenience sample of physicians and patients (N = 50 dyads), a paired survey method was tested, which measured and compared physician and patient reports to identify informational and interactional concordances. Factors potentially related to dyadic concordance were also measured, including demographic characteristics (patient race, gender, age, and education) and clinical factors (whether this was a first visit and physician specialty in family medicine or oncology). The paired survey showed informational discordances, as physicians tended to underestimate patients' pain and overestimate patient education. Interactional discordances included overestimating patients' understanding of diagnosis and treatment explanations and patients' level of confidence and trust. Discordances were linked to patient dissatisfaction with physician listening, having unanswered questions, and feeling the physician had not spent enough time. The paired survey method effectively identified physician-patient discordances that may interfere with effective medical practice; this method may be used in various settings to identify potential areas of improvement in health communication and education.

Prospective-pricing strategies for hospital and departmental effectiveness: the physician's response.

Science.gov (United States)

Shapleigh, C

1985-10-01

Physician-practice patterns are discussed, and programs of decentralization designed to reduce ancillary use are described. The New England Medical Center (NEMC) conducted a study with two other major hospitals in Boston comparing physician-practice patterns for patients who had had carotid endarterectomies. The indications for surgery for these patients did not appear to be different among the hospitals; however, average charges and length of stay varied considerably. Operating-room time and postoperative management also varied substantially. Strategies to change physician-practice patterns must address the issues of incentives to physicians and hospitals. At NEMC, a program of decentralization is being implemented that involves physician participation in budgeting hospital resources. A program of product pricing has been developed, whereby the NEMC offers an HMO a fixed price for certain kinds of cases upon admission. A daily use report was started to report resource use for specific cases compared with annual medians for that type of case. Case types from many different surgical specialties are involved. The reports show physicians the difference between the actual and expected costs in terms of variances. The NEMC has reoriented its budgeting process to include clinical divisions. Clinical services are planning to budget the use of intermediate products across different cost centers. The clinical budgeting program makes the planning process more objective, lowers the use of ancillary services, and reduces costs.

The effects of flow-path modification on water-quality constituent retention in an urban stormwater detention pond and wetland system, Orlando, Florida

Science.gov (United States)

Gain, W.S.

1996-01-01

Changes in constituent retention in a wet stormwater-detention pond and wetland system in Orlando, Florida, were evaluated following the 1988 installation of a flow barrier which approximately doubled the flow path and increased detention time in the pond. The pond and wetland were arranged in series so that stormwater first enters the pond and overflows into the wetland before spilling over to the regional stream system. Several principal factors that contribute to constituent retention were examined, including changes in pond-water quality between storms, stormwater quality, and pond-water flushing during storms. A simple, analytical pond-water mixing model was used as the basis for interpreting changes in retention efficiencies caused by pond modification. Retention efficiencies were calculated by a modified event-mean concentration efficiency method using a minimum variance unbiased estimator approach. The results of this study generally support the hypothesis that changes in the geometry of stormwater treatment systems can significantly affect the constituent retention efficiency of the pond and wetland system. However, the results also indicate that these changes in efficiency are caused not only by changes in residence time, but also by changes in stormwater mixing and pond water flushing during storms. Additionally, the use of average efficiencies as indications of treatment effectiveness may fail to account for biases associated with sample distribution and independent physical properties of the system, such as the range and concentrations of constituents in stormwater inflows and stormwater volume. Changes in retention efficiencies varied among chemical constituents and were significantly different in the pond and wetland. Retention efficiency was related to inflow concentration for most constituents. Increased flushing of the pond after modification caused decreases in retention efficiencies for constituents that concentrate in the pond between storms

Quality Induction: The Effects of Comprehensive Induction on New Teacher Retention and Job Satisfaction

Science.gov (United States)

Hendricks-Harris, Mary Therese

2012-01-01

This investigation examined the effect of a comprehensive new teacher induction program on teacher retention and job satisfaction in one suburban school district. New teachers are retained at low rates, and districts are spending resources in an attempt to decrease this number. New teacher induction includes supports for new teachers in their…

True Grit: Trait-level Perseverance and Passion for Long-term Goals Predicts Effectiveness and Retention among Novice Teachers.

Science.gov (United States)

Robertson-Kraft, Claire; Duckworth, Angela Lee

2014-01-01

Surprisingly little progress has been made in linking teacher effectiveness and retention to factors observable at the time of hire. The rigors of teaching, particularly in low-income school districts, suggest the importance of personal qualities that have so far been difficult to measure objectively. In this study, we examine the predictive validity of personal qualities not typically collected by school districts during the hiring process. Specifically, we use a psychological framework to explore how biographical data on grit, a disposition toward perseverance and passion for long-term goals, explains variance in novice teachers' effectiveness and retention. In two prospective, longitudinal samples of novice teachers assigned to schools in low-income districts (N = 154 and N = 307, respectively), raters blind to outcomes followed a 7-point rubric to rate grit from information on college activities and work experience extracted from teachers' résumés. We used independent-samples t-tests and binary logistic regression models to predict teacher effectiveness and retention from these grit ratings as well as from other information (e.g., SAT scores, college GPA, interview ratings of leadership potential) available at the time of hire. Grittier teachers outperformed their less gritty colleagues and were less likely to leave their classrooms mid-year. Notably, no other variables in our analysis predicted either effectiveness or retention. These findings contribute to a better understanding of what leads some novice teachers to outperform others and remain committed to the profession. In addition to informing policy decisions surrounding teacher recruitment and development, this investigation highlights the potential of a psychological framework to explain why some individuals are more successful than others in meeting the rigorous demands of teaching.

The practice of euthanasia and physician-assisted suicide in the United States: adherence to proposed safeguards and effects on physicians.

Science.gov (United States)

Emanuel, E J; Daniels, E R; Fairclough, D L; Clarridge, B R

1998-08-12

Despite intense debates about legalization, there are few data examining the details of actual euthanasia and physician-assisted suicide (PAS) cases in the United States. To determine whether the practices of euthanasia and PAS are consistent with proposed safeguards and the effect on physicians of having performed euthanasia or PAS. Structured in-depth telephone interviews. Randomly selected oncologists in the United States. Adherence to primary and secondary safeguards for the practice of euthanasia and PAS; regret, comfort, and fear of prosecution from performing euthanasia or PAS. A total of 355 oncologists (72.6% response rate) were interviewed on euthanasia and PAS. On 2 screening questions, 56 oncologists (15.8%) reported participating in euthanasia or PAS; 53 oncologists (94.6% response rate) participated in in-depth interviews. Thirty-eight of 53 oncologists described clearly defined cases of euthanasia or PAS. Twenty-three patients (60.5%) both initiated and repeated their request for euthanasia or PAS, but 6 patients (15.8%) did not participate in the decision for euthanasia or PAS. Thirty-seven patients (97.4%) were experiencing unremitting pain or such poor physical functioning they could not perform self-care. Physicians sought consultation in 15 cases (39.5%). Overall, oncologists adhered to all 3 main safeguards in 13 cases (34.2%): (1) having the patient initiate and repeat the request for euthanasia or PAS, (2) ensuring the patient was experiencing extreme physical pain or suffering, and (3) consulting with a colleague. Those who adhered to the safeguards had known their patients longer and tended to be more religious. In 28 cases (73.7%), the family supported the decision. In all cases of pain, patients were receiving narcotic analgesia. Fifteen patients (39.5%) were enrolled in a hospice. While 19 oncologists (52.6%) received comfort from having helped a patient with euthanasia or PAS, 9 (23.7%) regretted having performed euthanasia or PAS, and

Effect of Retention in Elementary Grades on Grade 9 Motivation for Educational Attainment

Science.gov (United States)

Cham, Heining; Hughes, Jan N.; West, Stephen G.; Im, Myung Hee

2014-01-01

This study investigated the effect of grade retention in elementary school on students’ motivation for educational attainment in grade 9. We equated retained and promoted students on 67 covariates assessed in grade 1 through propensity score weighting. Retained students (31.55%, nretained = 177) and continuously promoted students (68.45%, npromoted = 384) were compared on the bifactor model of motivation for educational attainment (Cham, Hughes, West, & Im, 2014). This model consists of a General factor (student’s overall motivation for educational attainment), and three specific factors: student perceived Teacher Educational Expectations, Peer Educational Aspirations, and Value of Education. Measurement invariance between retained and promoted groups was established. Retained students scored significantly higher than promoted students on each specific factor but not on the General factor. Results showed that the retained and promoted students did not significantly differ on the General factor. The retained students had significantly higher scores on each specific factor than the promoted students. The results suggested that grade retention may not have the negative effects so widely assumed in the published literature; it is an expensive intervention with minimal evidence of benefits to the retained student. PMID:25636258

Patient-physician trust: an exploratory study.

Science.gov (United States)

Thom, D H; Campbell, B

1997-02-01

Patients' trust in their physicians has recently become a focus of concern, largely owing to the rise of managed care, yet the subject remains largely unstudied. We undertook a qualitative research study of patients' self-reported experiences with trust in a physician to gain further understanding of the components of trust in the context of the patient-physician relationship. Twenty-nine patients participants, aged 26 to 72, were recruited from three diverse practice sites. Four focus groups, each lasting 1.5 to 2 hours, were conducted to explore patients' experiences with trust. Focus groups were audio-recorded, transcribed, and coded by four readers, using principles of grounded theory. The resulting consensus codes were grouped into seven categories of physician behavior, two of which related primarily to technical competence (thoroughness in evaluation and providing appropriate and effective treatment) and five of which were interpersonal (understanding patient's individual experience, expressing caring, communicating clearly and completely, building partnership/sharing power and honesty/respect for patient). Two additional categories were predisposing factors and structural/staffing factors. Each major category had multiple subcategories. Specific examples from each major category are provided. These nine categories of physician behavior encompassed the trust experiences related by the 29 patients. These categories and the specific examples provided by patients provide insights into the process of trust formation and suggest ways in which physicians could be more effective in building and maintaining trust.

Social media: physicians-to-physicians education and communication.

Science.gov (United States)

Fehring, Keith A; De Martino, Ivan; McLawhorn, Alexander S; Sculco, Peter K

2017-06-01

Physician to physician communication is essential for the transfer of ideas, surgical experience, and education. Social networks and online video educational contents have grown exponentially in recent years changing the interaction among physicians. Social media platforms can improve physician-to-physician communication mostly through video education and social networking. There are several online video platforms for orthopedic surgery with educational content on diagnosis, treatment, outcomes, and surgical technique. Social networking instead is mostly centered on sharing of data, discussion of confidential topics, and job seeking. Quality of educational contents and data confidentiality represent the major drawbacks of these platforms. Orthopedic surgeons must be aware that the quality of the videos should be better controlled and regulated to avoid inaccurate information that may have a significant impact especially on trainees that are more prone to use this type of resources. Sharing of data and discussion of confidential topics should be extremely secure according the HIPAA regulations in order to protect patients' confidentiality.

The neglected repercussions of a physician advertising ban.

Science.gov (United States)

Zwier, Sandra

2014-03-01

Although the adverse implications of physician advertising are the subject of a fierce and sustained debate, there is almost no scholarly discussion on the ethical repercussions of physician advertising bans. The present paper draws attention to these repercussions as they exist today in most of the world, with particular focus on three serious implications for the public: (a) uncertainty about the physician's interests, namely, that patients must trust the physician to put patient wellbeing ahead of possible gains when taking medical decisions; (b) uncertainty about alternative treatments, namely, that patients must trust in the physician's treatment decisions; and (c) uncertainty about the exclusive patient-physician relationship, namely, that patients must develop and maintain a good relationship with one physician. Physician advertising bans continue to tell the public in most of the modern world that these are irrelevant or inappropriate issues, meaning that they are effectively left to the public to resolve.

Effect of lowering dietary calcium intake on fractional whole body calcium retention

International Nuclear Information System (INIS)

Dawson-Hughes, B.; Stern, D.T.; Shipp, C.C.; Rasmussen, H.M.

1988-01-01

Although fractional calcium absorption is known to vary inversely with calcium intake, the extent and timing of individual hormonal and calcium absorption responses to altered calcium intake have not been defined. We measured fractional whole body retention of orally ingested 47 Ca, an index of calcium absorption, in nine normal women after they had eaten a 2000-mg calcium diet for 8 weeks and a 300-mg calcium diet for 1, 2, 4, and 8 weeks. After the diet change, serum intact PTH (32.2% increase; P = 0.005), serum 1,25-dihydroxyvitamin D [1,25-(OH)2D; 43.8% increase; P = 0.003], and fractional whole body calcium retention (42.8% increase; P = 0.004) increased within 1 week. Although the PTH and calcium retention responses remained fairly constant throughout the low calcium intake period, serum 1,25-(OH)2D concentrations declined toward baseline after week 1. Thus, the late increase in calcium retention may have resulted from calcium absorption that was independent of 1,25-(OH)2D stimulation

Waste activated sludge fermentation: effect of solids retention time and biomass concentration.

Science.gov (United States)

Yuan, Q; Sparling, R; Oleszkiewicz, J A

2009-12-01

Laboratory scale, room temperature, semi-continuous reactors were set-up to investigate the effect of solids retention time (SRT, equal to HRT hydraulic retention time) and biomass concentration on generation of volatile fatty acids (VFA) from the non-methanogenic fermentation of waste activated sludge (WAS) originating from an enhanced biological phosphorus removal process. It was found that VFA yields increased with SRT. At the longest SRT (10d), improved biomass degradation resulted in the highest soluble to total COD ratio and the highest VFA yield from the influent COD (0.14g VFA-COD/g TCOD). It was also observed that under the same SRT, VFA yields increased when the biomass concentration decreased. At a 10d SRT the VFA yield increased by 46%, when the biomass concentration decreased from 13g/L to 4.8g/L. Relatively high nutrient release was observed during fermentation. The average phosphorus release was 17.3mg PO(4)-P/g TCOD and nitrogen release was 25.8mg NH(4)-N/g TCOD.

The generation and gender shifts in medicine: an exploratory survey of internal medicine physicians

Directory of Open Access Journals (Sweden)

Lemaire Jane

2006-05-01

Full Text Available Abstract Background Two striking demographic shifts evident in today's workforce are also apparent in the medical profession. One is the entry of a new generation of physicians, Gen Xers, and the other is the influx of women. Both shifts are argued to have significant implications for recruitment and retention because of assumptions regarding the younger generation's and women's attitudes towards work and patient care. This paper explores two questions regarding the generations: (1 How do Baby Boomer and Generation X physicians perceive the generation shift in work attitudes and behaviours? and (2 Do Baby Boomer and Generation X physicians differ significantly in their work hours and work attitudes regarding patient care and life balance? Gen Xers include those born between 1965 and 1980; Baby Boomers are those born between 1945 and 1964. We also ask: Do female and male Generation X physicians differ significantly in their work hours and work attitudes regarding patient care and life balance? Methods We conducted exploratory interviews with 54 physicians and residents from the Department of Medicine (response rate 91% and asked about their perceptions regarding the generation and gender shifts in medicine. We limit the analyses to interview responses of 34 Baby Boomers and 18 Generation Xers. We also sent questionnaires to Department members (response rate 66%, and this analysis is limited to 87 Baby Boomers' and 65 Generation Xers' responses. Results The qualitative interview data suggest significant generation and gender shifts in physicians' attitudes. Baby Boomers generally view Gen Xer physicians as less committed to their medical careers. The quantitative questionnaire data suggest that there are few significant differences in the generations' and genders' reports of work-life balance, work hours and attitudes towards patient care. Conclusion A combined qualitative and quantitative approach to the generation shift and gender shift in

The ties that bind: interorganizational linkages and physician-system alignment.

Science.gov (United States)

Alexander, J A; Waters, T M; Burns, L R; Shortell, S M; Gillies, R R; Budetti, P P; Zuckerman, H S

2001-07-01

To examine the association between the degree of alignment between physicians and health care systems, and interorganizational linkages between physician groups and health care systems. The study used a cross sectional, comparative analysis using a sample of 1,279 physicians practicing in loosely affiliated arrangements and 1,781 physicians in 61 groups closely affiliated with 14 vertically integrated health systems. Measures of physician alignment were based on multiitem scales validated in previous studies and derived from surveys sent to individual physicians. Measures of interorganizational linkages were specified at the institutional, administrative, and technical core levels of the physician group and were developed from surveys sent to the administrator of each of the 61 physician groups in the sample. Two stage Heckman models with fixed effects adjustments in the second stage were used to correct for sample selection and clustering respectively. After accounting for sample selection, fixed effects, and group and individual controls, physicians in groups with more valued practice service linkages display consistently higher alignment with systems than physicians in groups that have fewer such linkages. Results also suggest that centralized administrative control lowers physician-system alignment for selected measures of alignment. Governance interlocks exhibited only weak associations with alignment. Our findings suggest that alignment generally follows resource exchanges that promote value-added contributions to physicians and physician groups while preserving control and authority within the group.

Effects of Digital Story on Academic Achievement, Learning Motivation and Retention among University Students

Science.gov (United States)

Aktas, Elif; Yurt, Serap Uzuner

2017-01-01

The aim of this study was to determine the effect of the learning environment where digital stories are used as a learning material on the motivation, academic success, retention, and students' opinions. The study was carried out with mixed method which is a combination of quantitative and qualitative research approach. The study was implemented…

The Effect of Case Teaching on Meaningful and Retentive Learning When Studying Genetic Engineering

Science.gov (United States)

Güccük, Ahmet; Köksal, Mustafa Serdar

2017-01-01

The purpose of this study is to investigate the effects of case teaching on how students learn about genetic engineering, in terms of meaningful learning and retention of learning. The study was designed as quasi-experimental research including 63 8th graders (28 boys and 35 girls). To collect data, genetic engineering achievement tests were…

The Effects of 3D Computer Simulation on Biology Students' Achievement and Memory Retention

Science.gov (United States)

Elangovan, Tavasuria; Ismail, Zurida

2014-01-01

A quasi experimental study was conducted for six weeks to determine the effectiveness of two different 3D computer simulation based teaching methods, that is, realistic simulation and non-realistic simulation on Form Four Biology students' achievement and memory retention in Perak, Malaysia. A sample of 136 Form Four Biology students in Perak,…

Enhanced Tumor Retention Effect by Click Chemistry for Improved Cancer Immunochemotherapy.

Science.gov (United States)

Mei, Ling; Liu, Yayuan; Rao, Jingdong; Tang, Xian; Li, Man; Zhang, Zhirong; He, Qin

2018-05-30

Because of the limited drug concentration in tumor tissues and inappropriate treatment strategies, tumor recurrence and metastasis are critical challenges for effectively treating malignancies. A key challenge for effective delivery of nanoparticles is to reduce uptake by reticuloendothelial system and to enhance the permeability and retention effect. Herein, we demonstrated Cu(I)-catalyzed click chemistry triggered the aggregation of azide/alkyne-modified micelles, enhancing micelles accumulation in tumor tissues. In addition, combined doxorubicin with the adjuvant monophosphoryl lipid A, an agonist of toll-like receptor4, generated immunogenic cell death, which further promoted maturity of dendritic cells, antigen presentation and induced strong effector T cells in vivo. Following combined with anti-PD-L1 therapy, substantial antitumor and metastasis inhibitory effects were achieved because of the reduced PD-L1 expression and regulatory T cells. In addition, effective long-term immunity from memory T cell responses protected mice from tumor recurrence.

Physician and Patient and Caregiver Health Attitudes and Their Effect on Medicare Resource Allocation for Patients With Advanced Cancer.

Science.gov (United States)

Rocke, Daniel J; Beumer, Halton W; Taylor, Donald H; Thomas, Steven; Puscas, Liana; Lee, Walter T

2014-06-01

Physicians must participate in end-of-life discussions, but they understand poorly their patients' end-of-life values and preferences. A better understanding of these preferences and the effect of baseline attitudes will improve end-of-life discussions. To determine how baseline attitudes toward quality vs quantity of life affect end-of-life resource allocation. Otolaryngology-head and neck surgery (OHNS) physicians were recruited to use a validated online tool to create a Medicare health plan for advanced cancer patients. During the exercise, participants allocated a limited pool of resources among 15 benefit categories. These data were compared with preliminary data from patients with cancer and their caregivers obtained from a separate study using the same tool. Attitudes toward quality vs quantity of life were assessed for both physicians and patients and caregivers. Participation in online assessment exercise. Medicare resource allocation. Of 9120 OHNS physicians e-mailed, 767 participated. Data collected from this group were compared with data collected from 146 patients and 114 caregivers. Compared with patients and caregivers, OHNS physician allocations differed significantly in all 15 benefit categories except home care. When stratified by answers to 3 questions about baseline attitudes toward quality vs quantity of life, there were 3 categories in which allocations of patients and caregivers differed significantly from the group with the opposite attitude for at least 2 questions: other medical care (question 1, P attitude question: cash (question 1, P = .02), drugs (question 2, P = .03), and home care (question 3, P = .048). Patients with cancer and their caregivers have different preferences from physicians. These preferences are, for these patients and their caregivers, affected by their baseline health attitudes, but physician preferences are not. Understanding the effect of baseline attitudes is important for effective end

The Effect of Instant Messaging on Lecture Retention

Science.gov (United States)

McVaugh, Nathan Kant

2012-01-01

The impact of instant message interruptions via computer on immediate lecture retention for college students was examined. While watching a 24-minute video of a classroom lecture, students received various numbers of related-to-lecture ("Is consistent use of the eye contact method necessary for success?") versus not-related-to lecture…

Effects of Sexual Harassment on Job Satisfaction, Retention, Cohesion, Commitment and Unit Effectiveness: The Case of the Air Force

Science.gov (United States)

2010-07-01

quid pro quo ). Examples of questions that were used in previous studies to measure crude/offensive behavior, as well as, other forms of sexual ...includes, but is not limited to, harassment in which submission is made a condition of employment (or quid pro quo ). Global or organizational...Effects of Sexual Harassment on Job Satisfaction, Retention, Cohesion, Commitment and Unit Effectiveness: The Case of the Air Force Dr. Brenda

The effect of amino acid lysine and methionine addition on feed toward the growth and retention on mud crab (Scylla serrata)

Science.gov (United States)

Alissianto, Y. R.; Sandriani, Z. A.; Rahardja, B. S.; Agustono; Rozi

2018-04-01

High market demand of mud crab (Scylla serrata) encourages farmers to increase the production of mud crab. However, mud crab can not synthesize essential amino acids, so it is necessary to supply essential amino acids such as lysine and methionine in the diet. This study aims to determine the effect of lysine and methionine on feeds to increase growth and retention of mud crabs (Scylla serrata). In this study the amount of lysine amino acid and methionine added to the trash fish diet were: P0 (0: 0%); P1 (0.75: 0.75%); P2 (1: 1%); P3 (1.25: 1.25%); P4 (1.5: 1.5%) with the ratio of lysine and methionine 1: 1. The parameters observed in this study were Survival Rate (SR), Specific Growth Rate (SGR), Feed Conversion Ratio (FCR), Efficiency Feed (EF), protein retention and energy retention. The results of the 35-day maintenance study showed significant differences (P protein retention and no significant effect (P> 0.05) on energy retention and Survival Rate (SR) on mud crab. The best results in this study were found in P4 treatment with addition of lysine amino acids and methionine (1.5: 1.5%).

Still on physicians' attitude to medical marijuana

OpenAIRE

Olukayode Abayomi; Emmanuel Babalola

2014-01-01

Desai and Patel highlighted in a recent review that and ldquo;there are several issues related to medical marijuana, which concern public health such as its medical use, harmful effects, laws and physicians role. and rdquo; Certainly, physician's perspectives and position on the relative harm and benefits of marijuana contribute to the growing controversy over its legalization in western countries. Interestingly, the seeming resistance of physicians in western countries to marijuana prescrip...

How to save distressed IDS-physician marriages: a case study.

Science.gov (United States)

Collins, H; Johnson, B A

1998-04-01

A hospital-driven IDS that encounters serious problems resulting from ownership of a physician practice should address those problems by focusing on three core areas: vision and leadership, effectiveness of operations, and physician compensation arrangements. If changes in these areas do not lead to improvements, the IDS may need to consider organizational restructuring. In one case study, a hospital-driven IDS faced the problem of owning a poorly performing MSO with a captive physician group. The IDS's governing board determined that the organization lacked effective communication with the physicians and that realization of the organization's vision would require greater physician involvement in organizational decision making. The organization is expected to undergo some corporate reorganization in which physicians will acquire an equity interest in the enterprise.

Communication Skills of Physicians and Patients’ Satisfaction

Science.gov (United States)

Biglu, Mohammad-Hossein; Nateq, Farnaz; Ghojazadeh, Morteza; Asgharzadeh, Ali

2017-01-01

Background: The communication skills of physicians is an effective step of making effective relationship between doctor and patient. It plays essential role through diagnosis and treatment processes. This current study was performed to investigate the impact of communication skillfulness of physicians on patients’ satisfaction. Methods: A cross-sectional descriptive study was done to determine the impact of communication capability of practitioners on patients’ satisfaction. The DiMatto’s Patient Satisfaction Scale was administered among patients referring to the all 8 specialized clinics of Tabriz University of Medical Sciences. The validity and reliability of Persian translation of questionnaire of DiMatto’s Patient Satisfaction was verified by 10 specialists. The validity of the questionnaire was measured by content and structural analysis, and Cronbach’s alpha coefficients. The data were analyzed by software package of SPSS version 16 using Pearson’s correlation coefficient, U Mann-Whitney, Kruskal-wallis Test, Regression. Results: The study showed that there was a significant correlation between patients’ satisfaction and the communication skills of physicians (devoting the appropriate time for visiting the patients, explaining diagnosis and treatment procedures). In addition, the therapeutic skills of physicians, their friendly manners, respecting the patients’ feelings, and careful examination of patients by physician, revealed a significant correlation with patient satisfaction (P Communication skills of physician play an important role on patients’ satisfaction; therefore, we propose strongly to improve the communication skills of physicians by improving the communication skills through related training courses. PMID:29109665

Communication Skills of Physicians and Patients' Satisfaction.

Science.gov (United States)

Biglu, Mohammad-Hossein; Nateq, Farnaz; Ghojazadeh, Morteza; Asgharzadeh, Ali

2017-09-01

The communication skills of physicians is an effective step of making effective relationship between doctor and patient. It plays essential role through diagnosis and treatment processes. This current study was performed to investigate the impact of communication skillfulness of physicians on patients' satisfaction. A cross-sectional descriptive study was done to determine the impact of communication capability of practitioners on patients' satisfaction. The DiMatto's Patient Satisfaction Scale was administered among patients referring to the all 8 specialized clinics of Tabriz University of Medical Sciences. The validity and reliability of Persian translation of questionnaire of DiMatto's Patient Satisfaction was verified by 10 specialists. The validity of the questionnaire was measured by content and structural analysis, and Cronbach's alpha coefficients. The data were analyzed by software package of SPSS version 16 using Pearson's correlation coefficient, U Mann-Whitney, Kruskal-wallis Test, Regression. The study showed that there was a significant correlation between patients' satisfaction and the communication skills of physicians (devoting the appropriate time for visiting the patients, explaining diagnosis and treatment procedures). In addition, the therapeutic skills of physicians, their friendly manners, respecting the patients' feelings, and careful examination of patients by physician, revealed a significant correlation with patient satisfaction (P Communication skills of physician play an important role on patients' satisfaction; therefore, we propose strongly to improve the communication skills of physicians by improving the communication skills through related training courses.

The effect of tissue decalcification on mRNA retention within bone for in-situ hybridization studies.

Science.gov (United States)

Walsh, L; Freemont, A J; Hoyland, J A

1993-06-01

Tissue decalcification is a routine part of the preparation of bone tissue for histological studies. Although in-situ hybridization has been employed to localize mRNA of collagenous and non-collagenous bone related proteins in skeletal tissue, little is known regarding the effects of decalcifying agents on mRNA retention within tissue. In this study in-situ hybridization using an oligonucleotide probe (i.e. a poly d(T) probe) to detect total messenger RNA has been employed to investigate the effects of the decalcifying agents nitric acid, formic acid and EDTA on mRNA retention compared to undeacalcified tissue. The results show that formalin fixation and EDTA decalcification preserve substantial amounts of mRNA within the tissue. In particular, this study illustrates that it is possible to perform in-situ hybridization on formalin fixed decalcified paraffin embedded tissue.

The Effect of Context (Humorous vs. Non-humorous on Vocabulary Acquisition and Retention of Iranian EFL Learners

Directory of Open Access Journals (Sweden)

Mohsen Ghaffari

2012-11-01

Full Text Available For almost four decades, ESL/EFL scholars have been trying to find which learning type, contextualized vs. decontextualized, leads to better vocabulary acquisition and retention. In an attempt to solve this problem, this study tried to examine the possible effectiveness of using humorous context on vocabulary acquisition and retention. Another issue that was undertaken in the present study was comparing the efficiency of contextualized and decontextualized vocabulary learning and retention. For this purpose, 58 Iranian EFL learners were categorized into 3 groups: a humorous, b non-humorous, and c decontextualized. The findings were analyzed using one-way ANOVA and Tukey post hoc test. As the results revealed, the participants in decontextualized group outperformed the participants in both humorous and non-humorous groups. However, it should be noted that the performance of humorous group was significantly better than the performance of non-humorous group.

Changing physician behavior: what works?

Science.gov (United States)

Mostofian, Fargoi; Ruban, Cynthiya; Simunovic, Nicole; Bhandari, Mohit

2015-01-01

There are various interventions for guideline implementation in clinical practice, but the effects of these interventions are generally unclear. We conducted a systematic review to identify effective methods of implementing clinical research findings and clinical guidelines to change physician practice patterns, in surgical and general practice. Systematic review of reviews. We searched electronic databases (MEDLINE, EMBASE, and PubMed) for systematic reviews published in English that evaluated the effectiveness of different implementation methods. Two reviewers independently assessed eligibility for inclusion and methodological quality, and extracted relevant data. Fourteen reviews covering a wide range of interventions were identified. The intervention methods used include: audit and feedback, computerized decision support systems, continuing medical education, financial incentives, local opinion leaders, marketing, passive dissemination of information, patient-mediated interventions, reminders, and multifaceted interventions. Active approaches, such as academic detailing, led to greater effects than traditional passive approaches. According to the findings of 3 reviews, 71% of studies included in these reviews showed positive change in physician behavior when exposed to active educational methods and multifaceted interventions. Active forms of continuing medical education and multifaceted interventions were found to be the most effective methods for implementing guidelines into general practice. Additionally, active approaches to changing physician performance were shown to improve practice to a greater extent than traditional passive methods. Further primary research is necessary to evaluate the effectiveness of these methods in a surgical setting.

Urinary retention in women.

Science.gov (United States)

Juma, Saad

2014-07-01

This review is a summary of the most pertinent published studies in the literature in the last 18 months that address cause, diagnosis, and management of urinary retention in women. Symptoms, uroflow, and pressure-flow studies have a low predictive value for and do not correlate with elevated postvoid residual urine (PVR). Anterior and posterior colporrhaphy do not cause de-novo bladder outlet obstruction in the majority of patients with elevated PVR, and the cause of elevated PVR may be other factors such as pain or anxiety causing abnormal relaxation of the pelvic floor and contributing to voiding difficulty. The risk of urinary retention in a future pregnancy after mid-urethral sling (MUS) is small. The risk of urinary tract infection and urinary retention after chemodenervation of the bladder with onabotulinumtoxin-A (100 IU) in patients with non-neurogenic urge incontinence is 33 and 5%, respectively. There is a lack of consensus among experts on the timing of sling takedown in the management of acute urinary retention following MUS procedures. There has been a significant progress in the understanding of the causation of urinary retention. Important areas that need further research (basic and clinical) are post-MUS and pelvic organ prolapse repair urinary retention and obstruction, and urinary retention owing to detrusor underactivity.

Early pregnancy failure management among family physicians.

Science.gov (United States)

Wallace, Robin; Dehlendorf, Christine; Vittinghoff, Eric; Gold, Katherine J; Dalton, Vanessa K

2013-03-01

Family physicians, as primary care providers for reproductive-aged women, frequently initiate or refer patients for management of early pregnancy failure (EPF). Safe and effective options for EPF treatment include expectant management, medical management with misoprostol, and aspiration in the office or operating room. Current practice does not appear to reflect patient preferences or to utilize the most cost-effective treatments. We compared characteristics and practice patterns among family physicians who do and do not provide multiple options for EPF care. We performed a secondary analysis of a national survey of women's health providers to describe demographic and practice characteristics among family physicians who care for women with EPF. We used multivariate logistic regression to identify correlates of providing more than one option for EPF management. The majority of family physicians provide only one option for EPF; expectant management was most frequently used among our survey respondents. Misoprostol and office-based aspiration were rarely used. Providing more than one option for EPF management was associated with more years in practice, smaller county population, larger proportions of Medicaid patients, intrauterine contraception provision, and prior training in office-based aspiration. Family physicians are capable of providing a comprehensive range of options for EPF management in the outpatient setting but few providers currently do so. To create a more patient-centered and cost-effective model of care for EPF, additional resources should be directed at education, skills training, and system change initiatives to prepare family physicians to offer misoprostol and office-based aspiration to women with EPF.

The confidence-accuracy relationship for eyewitness identification decisions: Effects of exposure duration, retention interval, and divided attention.

Science.gov (United States)

Palmer, Matthew A; Brewer, Neil; Weber, Nathan; Nagesh, Ambika

2013-03-01

Prior research points to a meaningful confidence-accuracy (CA) relationship for positive identification decisions. However, there are theoretical grounds for expecting that different aspects of the CA relationship (calibration, resolution, and over/underconfidence) might be undermined in some circumstances. This research investigated whether the CA relationship for eyewitness identification decisions is affected by three, forensically relevant variables: exposure duration, retention interval, and divided attention at encoding. In Study 1 (N = 986), a field experiment, we examined the effects of exposure duration (5 s vs. 90 s) and retention interval (immediate testing vs. a 1-week delay) on the CA relationship. In Study 2 (N = 502), we examined the effects of attention during encoding on the CA relationship by reanalyzing data from a laboratory experiment in which participants viewed a stimulus video under full or divided attention conditions and then attempted to identify two targets from separate lineups. Across both studies, all three manipulations affected identification accuracy. The central analyses concerned the CA relation for positive identification decisions. For the manipulations of exposure duration and retention interval, overconfidence was greater in the more difficult conditions (shorter exposure; delayed testing) than the easier conditions. Only the exposure duration manipulation influenced resolution (which was better for 5 s than 90 s), and only the retention interval manipulation affected calibration (which was better for immediate testing than delayed testing). In all experimental conditions, accuracy and diagnosticity increased with confidence, particularly at the upper end of the confidence scale. Implications for theory and forensic settings are discussed.

[Addicted colleagues: a blind spot amongst physicians?].

Science.gov (United States)

Rode, Hans; de Rond, Marlies; Dam, Ingrid

2013-01-01

Physician impairment due to substance abuse or dependence is at least as prevalent as amongst non-physicians and is a real challenge. Not only for the impaired physicians themselves, but also for their colleagues, family members and patients. A 68-year-old physician describes her experiences of being an alcoholic as well as a patient with concomitant psychiatric disorders, including the hurdles she had to get over to deal with her disease and remain abstinent. Although colleagues knew what was going on, some of them took no action. The initial treatment by her general practitioner proved compromised. Addressing addiction amongst fellow physicians can be challenging and for this reason the Royal Dutch Medical Association (KNMG) has started the ABS Programme. On prompt and adequate intervention, treatment in specialised facilities has proved to be highly and durably effective. Addicted physicians who have been successfully treated should be monitored and supported, thus enabling their safe return to practice.

Study protocol for improving asthma outcomes through cross-cultural communication training for physicians: a randomized trial of physician training.

Science.gov (United States)

Patel, Minal R; Thomas, Lara J; Hafeez, Kausar; Shankin, Matthew; Wilkin, Margaret; Brown, Randall W

2014-06-16

Massive resources are expended every year on cross-cultural communication training for physicians. Such training is a focus of continuing medical education nationwide and is part of the curriculum of virtually every medical school in America. There is a pressing need for evidence regarding the effects on patients of cross-cultural communication training for physicians. There is a need to understand the added benefit of such training compared to more general communication. We know of no rigorous study that has assessed whether cross-cultural communication training for physicians results in better health outcomes for their patients. The current study aims to answer this question by enhancing the Physician Asthma Care Education (PACE) program to cross cultural communication (PACE Plus), and comparing the effect of the enhanced program to PACE on the health outcomes of African American and Latino/Hispanic children with asthma. A three-arm randomized control trial is used to compare PACE Plus, PACE, and usual care. Both PACE and PACE Plus are delivered in two, two-hour sessions over a period of two weeks to 5-10 primary care physicians who treat African American and Latino/Hispanic children with asthma. One hundred twelve physicians and 1060 of their pediatric patients were recruited who self-identify as African American or Latino/Hispanic and experience persistent asthma. Physicians were randomized into receiving either the PACE Plus or PACE intervention or into the control group. The comparative effectiveness of PACE and PACE Plus on clinician's therapeutic and communication practices with the family/patient, children's urgent care use for asthma, asthma control, and quality of life, and parent/caretaker satisfaction with physician performance will be assessed. Data are collected via telephone survey and medical record review at baseline, 9 months following the intervention, and 21 months following the intervention. This study aims to reduce disparities in asthma

Effects of inactivating individual cerebellar nuclei on the performance and retention of an operantly conditioned forelimb movement.

Science.gov (United States)

Milak, M S; Shimansky, Y; Bracha, V; Bloedel, J R

1997-08-01

These experiments were designed to examine the effects of inactivating separately each of the major cerebellar nuclear regions in cats on the execution and retention of a previously learned, operantly conditioned volitional forelimb movement. The experiments test the postulates that the cerebellar nuclei, and particularly the interposed nuclei, contribute substantially to the spatial and temporal features of the interjoint coordination required to execute the task and that the engram necessary for the retention of this task is not located in any one of the cerebellar nuclei. All cats were trained to perform a task in which they were required to reach for and grasp a vertical bar at the sound of a tone and move the bar to a reward zone through a template consisting of two straight grooves in the shape of an inverted "L." After the task was learned, the effects of inactivating separately each nuclear region (the fastigial, interposed, and dentate nuclei) using muscimol microinjections were determined. Data were analyzed by quantifying several features of the movement's kinematics and by determining changes in the organization of the reaching component of the movement using an application of dimensionality analysis, an analysis that examines the correlation among the changes in joint angles and limb segment positions during the task. The retention of the previously learned task also was assessed after each injection. Injections of each nuclear region affected temporal and spatial features of the learned movement. However, the largest effects resulted from inactivating the interposed nuclei. These effects included an increased length of the reach trajectory, an accentuated deviation of the wrist trajectory from a straight line, cyclic movement of the distal extremity as the target was approached, a difficulty in grasping the bar, altered temporal features of the movement, and a highly characteristic change in the dimensionality measurements. The changes in

When authenticity matters most: Physicians' regulation of emotional display and patient satisfaction.

Science.gov (United States)

Yagil, Dana; Shnapper-Cohen, Moran

2016-10-01

The emotions expressed by physicians in medical encounters have significant impact on health outcomes and patient satisfaction. This study explored how physicians' regulation of displayed emotions affects patients' satisfaction, under low and high levels of patient distress and length of physician-patient acquaintance. Questionnaires were administered to 46 physicians and 230 of their patients (before and after the medical encounter) in outpatient clinics of two hospitals. Data were analyzed with hierarchical linear modeling which takes the nested data structure into account. We found a significant interaction effect of physician regulation of displayed emotions and patient distress on satisfaction: When distress was high, physician regulation of emotions was negatively related to patient satisfaction. The results also show a significant interaction effect of physician regulation of displayed emotions and length of physician-patient acquaintance: With a longer acquaintance, physician regulation of emotions was negatively related to patient satisfaction. The effect of the physicians' emotional display on patient satisfaction depends on contextual factors, such as patient distress and length of physician-patient acquaintance, which affect patients' emotional needs and expectations. When patients have high emotional involvement in the encounter it is suggested that physicians consider presenting genuine emotions to patients. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Ethics and the Legalization of Physician-Assisted Suicide: An American College of Physicians Position Paper.

Science.gov (United States)

Snyder Sulmasy, Lois; Mueller, Paul S

2017-10-17

Calls to legalize physician-assisted suicide have increased and public interest in the subject has grown in recent years despite ethical prohibitions. Many people have concerns about how they will die and the emphasis by medicine and society on intervention and cure has sometimes come at the expense of good end-of-life care. Some have advocated strongly, on the basis of autonomy, that physician-assisted suicide should be a legal option at the end of life. As a proponent of patient-centered care, the American College of Physicians (ACP) is attentive to all voices, including those who speak of the desire to control when and how life will end. However, the ACP believes that the ethical arguments against legalizing physician-assisted suicide remain the most compelling. On the basis of substantive ethics, clinical practice, policy, and other concerns articulated in this position paper, the ACP does not support legalization of physician-assisted suicide. It is problematic given the nature of the patient-physician relationship, affects trust in the relationship and in the profession, and fundamentally alters the medical profession's role in society. Furthermore, the principles at stake in this debate also underlie medicine's responsibilities regarding other issues and the physician's duties to provide care based on clinical judgment, evidence, and ethics. Society's focus at the end of life should be on efforts to address suffering and the needs of patients and families, including improving access to effective hospice and palliative care. The ACP remains committed to improving care for patients throughout and at the end of life.

Assessment of the nutrient removal effectiveness of floating treatment wetlands applied to urban retention ponds.

Science.gov (United States)

Wang, Chih-Yu; Sample, David J

2014-05-01

The application of floating treatment wetlands (FTWs) in point and non-point source pollution control has received much attention recently. Although the potential of this emerging technology is supported by various studies, quantifying FTW performance in urban retention ponds remains elusive due to significant research gaps. Actual urban retention pond water was utilized in this mesocosm study to evaluate phosphorus and nitrogen removal efficiency of FTWs. Multiple treatments were used to investigate the contribution of each component in the FTW system with a seven-day retention time. The four treatments included a control, floating mat, pickerelweed (Pontederia cordata L.), and softstem bulrush (Schoenoplectus tabernaemontani). The water samples collected on Day 0 (initial) and 7 were analyzed for total phosphorus (TP), total particulate phosphorus, orthophosphate, total nitrogen (TN), organic nitrogen, ammonia nitrogen, nitrate-nitrite nitrogen, and chlorophyll-a. Statistical tests were used to evaluate the differences between the four treatments. The effects of temperature on TP and TN removal rates of the FTWs were described by the modified Arrhenius equation. Our results indicated that all three FTW designs, planted and unplanted floating mats, could significantly improve phosphorus and nitrogen removal efficiency (%, E-TP and E-TN) compared to the control treatment during the growing season, i.e., May through August. The E-TP and E-TN was enhanced by 8.2% and 18.2% in the FTW treatments planted with the pickerelweed and softstem bulrush, respectively. Organic matter decomposition was likely to be the primary contributor of nutrient removal by FTWs in urban retention ponds. Such a mechanism is fostered by microbes within the attached biofilms on the floating mats and plant root surfaces. Among the results of the four treatments, the FTWs planted with pickerelweed had the highest E-TP, and behaved similarly with the other two FTW treatments for nitrogen removal

How do physicians discuss e-health with patients? the relationship of physicians' e-health beliefs to physician mediation styles.

Science.gov (United States)

Fujioka, Yuki; Stewart, Erin

2013-01-01

A survey of 104 physicians examined the role of physicians' evaluation of the quality of e-health and beliefs about the influence of patients' use of e-health in how physicians discuss e-health materials with patients. Physicians' lower (poor) evaluation of the quality of e-health content predicted more negative mediation (counter-reinforcement of e-health content). Perceived benefits of patients' e-health use predicted more positive (endorsement of e-health content). Physician's perceived concerns (negative influence) regarding patients' e-health use were not a significant predictor for their mediation styles. Results, challenging the utility of restrictive mediation, suggested reconceptualizing it as redirective mediation in a medical interaction. The study suggested that patient-generated e-health-related inquiries invite physician mediation in medical consultations. Findings and implications are discussed in light of the literature of physician-patient interaction, incorporating the theory of parental mediation of media into a medical context.

Effect of air-abrasion on the retention of zirconia ceramic crowns luted with different cements before and after artificial aging.

Science.gov (United States)

Shahin, Ramez; Kern, Matthias

2010-09-01

The purpose of this in vitro study was to evaluate the effect of intaglio surface air-abrasion on the retention of CAD/CAM produced zirconia ceramic crowns cemented with three different types of cement. In addition the influence of artificial aging in masticatory simulator and thermocycling was tested. Extracted human premolars were prepared for all-ceramic crowns (12 degrees taper, 3 mm axial length). CAD/CAM zirconia crowns were manufactured. Half of the crowns were air-abraded with 50 microm alumina particles at 0.25 MPa, the rest was left as machined. The crowns were luted with zinc phosphate cement (Hoffmann), glass ionomer cement (Ketac Cem), or composite resin (Panavia 21), subgroups were either stored for 3 days in 37 degrees water bath or stored for 150 days in 37 degrees water bath, with additional 37,500 thermal cycles (5-55 degrees) and 300,000 cycles dynamic loading with 5 kg in a masticatory simulator. Then crown retention was measured in tension at a crosshead speed of 2 mm/min using a universal testing machine. Statistical analysis was performed with three-way ANOVA. Mean retention values were ranged from 2.8 to 7.1 MPa after 3 days and from 1.6 to 6.1 MPa after artificial aging. Air-abrasion significantly increased crown retention (partificial aging decreased retention (p=0.017). In addition, the luting material had a significant influence on retention (p<0.001) with the adhesive luting resin providing the highest retention. The use of phosphate monomer containing composite resin on air-abraded zirconia ceramic can be recommended as most retentive luting method. Copyright 2010 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.

42 CFR 415.172 - Physician fee schedule payment for services of teaching physicians.

Science.gov (United States)

2010-10-01

... teaching physicians. 415.172 Section 415.172 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... PROVIDERS, SUPERVISING PHYSICIANS IN TEACHING SETTINGS, AND RESIDENTS IN CERTAIN SETTINGS Physician Services in Teaching Settings § 415.172 Physician fee schedule payment for services of teaching physicians. (a...

Quantitative assessment of surface functionality effects on microglial uptake and retention of PAMAM dendrimers

Science.gov (United States)

Liaw, Kevin; Gök, Ozgul; DeRidder, Louis B.; Kannan, Sujatha; Kannan, Rangaramanujam M.

2018-04-01

Dendrimers are a promising class of polymeric nanoparticles for delivery of therapeutics and diagnostics. Polyamidoamine (PAMAM) dendrimers have shown significant efficacy in many animal models, with performance dependent on surface functionalities. Understanding the effects of end groups on biological interactions is critical for rational design of dendrimer-mediated therapies. In this study, we quantify the cellular trafficking kinetics (endocytosis and exocytosis) of generation 4 neutral (D4-OH), cationic (D4-NH2), anionic (D3.5-COOH), and generation 6 neutral (D6-OH) PAMAM dendrimers to investigate the nanoscale effects of surface functionality and size on cellular interactions. Resting and LPS-activated microglia were studied due to their central roles in dendrimer therapies for central nervous system disorders. D4-OH exhibits greater cellular uptake and lower retention than the larger D6-OH. D4-OH and D3.5-COOH exhibit similar trafficking kinetics, while D4-NH2 exhibits significant membrane interactions, resulting in faster cell association but lower internalization. Cationic charge may also enhance vesicular escape for greater cellular retention and preferential partitioning to nuclei. LPS activation further improves uptake of dendrimers, with smaller and cationic dendrimers experiencing the greatest increases in uptake compared to resting microglia. These studies have implications for the dependence of trafficking pathway on dendrimer properties and inform the design of dendrimer constructs tailored to specific therapeutic needs. Cationic dendrimers are ideal for delivering genetic materials to nuclei, but toxicity may be a limiting factor. Smaller, neutral dendrimers are best suited for delivering high levels of therapeutics in acute neuroinflammation, while larger or cationic dendrimers provide robust retention for sustained release of therapeutics in longer-term diseases.

Family physicians' perspectives regarding palliative radiotherapy

International Nuclear Information System (INIS)

Samant, Rajiv S.; Fitzgibbon, Edward; Meng, Joanne; Graham, Ian D.

2006-01-01

Purpose: To assess family physicians' views on common indications for palliative radiotherapy and to determine whether this influences patient referral. Methods and materials: A 30-item questionnaire evaluating radiotherapy knowledge and training developed at the Ottawa Regional Cancer Centre (ORCC) was mailed to a random sample of 400 family physicians in eastern Ontario, Canada. The completed surveys were collected and analyzed, and form the basis of this study. Results: A total of 172 completed surveys were received for a net response rate of 50% among practicing family physicians. Almost all of the physicians (97%) had recently seen cancer patients in their offices, with 85% regularly caring for patient with advanced cancer. Fifty-four percent had referred patients in the past for radiotherapy and 53% had contacted a radiation oncologist for advice. Physicians who were more knowledgeable about the common indications for palliative radiotherapy were significantly more likely to refer patients for radiotherapy (P<0.01). Inability to contact a radiation oncologist was correlated with not having referred patients for radiotherapy (P<0.01). Only 10% of the physicians had received radiotherapy education during their formal medical training. Conclusions: Many of the family physicians surveyed were unaware of the effectiveness of radiotherapy in a variety of common palliative situations, and radiotherapy referral was correlated with knowledge about the indications for palliative radiotherapy. This was not surprising given the limited education they received in this area and the limited contact they have had with radiation oncologists. Strategies need to be developed to improve continuing medical education opportunities for family physicians and to facilitate more interaction between these physicians and radiation oncologists

Do Pocket Electronic Dictionaries Influence Word Retention and Reading Comprehension? Their Effects and Mediating Factors

OpenAIRE

小林, 千穂

2011-01-01

This study explores the effectiveness of pocket electronic dictionaries (EDs) compared with printed dictionaries (PDs) on searching behavior, word retention, and reading comprehension. It also investigates how factors such as test formats, learners' proficiency level, and text difficulty are related to the effects of EDs. Thirty-six Japanese university students participated in the study. They read an English text and answered comprehension questions, while circling the words they looked up. T...

Effect of retention in elementary grades on grade 9 motivation for educational attainment.

Science.gov (United States)

Cham, Heining; Hughes, Jan N; West, Stephen G; Im, Myung Hee

2015-02-01

This study investigated the effect of grade retention in elementary school on students' motivation for educational attainment in grade 9. We equated retained and promoted students on 67 covariates assessed in grade 1 through propensity score weighting. Retained students (31.55%, nretained=177) and continuously promoted students (68.45%, npromoted=384) were compared on the bifactor model of motivation for educational attainment (Cham, Hughes, West & Im, 2014). This model consists of a General factor (student's overall motivation for educational attainment), and three specific factors: student perceived Teacher Educational Expectations, Peer Educational Aspirations, and Value of Education. Measurement invariance between retained and promoted groups was established. Retained students scored significantly higher than promoted students on each specific factor but not on the General factor. Results showed that the retained and promoted students did not significantly differ on the General factor. The retained students had significantly higher scores on each specific factor than those of the promoted students. The results suggested that grade retention may not have the negative effects so widely assumed in the published literature; it is an expensive intervention with minimal evidence of benefits to the retained student. Copyright © 2014 Society for the Study of School Psychology. Published by Elsevier Ltd. All rights reserved.

Physician performance feedback in a Canadian academic center.

Science.gov (United States)

Garvin, Dennis; Worthington, James; McGuire, Shaun; Burgetz, Stephanie; Forster, Alan J; Patey, Andrea; Gerin-Lajoie, Caroline; Turnbull, Jeffrey; Roth, Virginia

2017-10-02

Purpose This paper aims at the implementation and early evaluation of a comprehensive, formative annual physician performance feedback process in a large academic health-care organization. Design/methodology/approach A mixed methods approach was used to introduce a formative feedback process to provide physicians with comprehensive feedback on performance and to support professional development. This initiative responded to organization-wide engagement surveys through which physicians identified effective performance feedback as a priority. In 2013, physicians primarily affiliated with the organization participated in a performance feedback process, and physician satisfaction and participant perceptions were explored through participant survey responses and physician leader focus groups. Training was required for physician leaders prior to conducting performance feedback discussions. Findings This process was completed by 98 per cent of eligible physicians, and 30 per cent completed an evaluation survey. While physicians endorsed the concept of a formative feedback process, process improvement opportunities were identified. Qualitative analysis revealed the following process improvement themes: simplify the tool, ensure leaders follow process, eliminate redundancies in data collection (through academic or licensing requirements) and provide objective quality metrics. Following physician leader training on performance feedback, 98 per cent of leaders who completed an evaluation questionnaire agreed or strongly agreed that the performance feedback process was useful and that training objectives were met. Originality/value This paper introduces a physician performance feedback model, leadership training approach and first-year implementation outcomes. The results of this study will be useful to health administrators and physician leaders interested in implementing physician performance feedback or improving physician engagement.

Effects of physician payment reform on provision of home dialysis.

Science.gov (United States)

Erickson, Kevin F; Winkelmayer, Wolfgang C; Chertow, Glenn M; Bhattacharya, Jay

2016-06-01

Patients with end-stage renal disease can receive dialysis at home or in-center. In 2004, CMS reformed physician payment for in-center hemodialysis care from a capitated to a tiered fee-for-service model, augmenting physician payment for frequent in-center visits. We evaluated whether payment reform influenced dialysis modality assignment. Cohort study of patients starting dialysis in the United States in the 3 years before and the 3 years after payment reform. We conducted difference-in-difference analyses comparing patients with traditional Medicare coverage (who were affected by the policy) to others with Medicare Advantage (who were unaffected by the policy). We also examined whether the policy had a more pronounced influence on dialysis modality assignment in areas with lower costs of traveling to dialysis facilities. Patients with traditional Medicare coverage experienced a 0.7% (95% CI, 0.2%-1.1%; P = .003) reduction in the absolute probability of home dialysis use following payment reform compared with patients with Medicare Advantage. Patients living in areas with larger dialysis facilities (where payment reform made in-center hemodialysis comparatively more lucrative for physicians) experienced a 0.9% (95% CI, 0.5%-1.4%; P home dialysis use following payment reform compared with patients living in areas with smaller facilities (where payment reform made in-center hemodialysis comparatively less lucrative for physicians). The transition from a capitated to a tiered fee-for-service payment model for in-center hemodialysis care resulted in fewer patients receiving home dialysis. This area of policy failure highlights the importance of considering unintended consequences of future physician payment reform efforts.

Effect of a Dengue Clinical Case Management Course on Physician Practices in Puerto Rico.

Science.gov (United States)

Han, George S; Gregory, Christopher J; Biggerstaff, Brad J; Horiuchi, Kalanthe; Perez-Guerra, Carmen; Soto-Gomez, Eunice; Matos, Desiree; Margolis, Harold S; Tomashek, Kay M

2016-11-15

 Prior to 2010, the clinical management of dengue in Puerto Rico was inconsistent with World Health Organization guidelines. A 4-hour classroom-style course on dengue clinical management was developed in 2009 and mandated for Puerto Rico medical licensure in 2010. Fifty physicians were trained as "master trainers" and gave this course to 7638 physicians. This study evaluated the effect of the course on the clinical management of hospitalized dengue patients.  Pre- and post-course test responses were compared. Changes in physician practices were assessed by reviewing medical records of 430 adult and 1075 pediatric dengue patients at the 12 hospitals in Puerto Rico that reported the most cases during 2008-2009 (pre-intervention) and 2011 (post-intervention). Mixed-effects logistic regression was used to compare key indicators of dengue management.  Physician test scores increased from 48% to 72% correct. Chart reviews showed that the percentage of adult patients who did not receive corticosteroids increased from 30% to 68% (odds ratio [OR], 5.9; 95% confidence interval [CI], 3.7-9.5) and from 91% to 96% in pediatric patients (OR, 2.7; 95% CI, 1.5-4.9). Usage of isotonic intravenous saline during the critical period increased from 57% to 90% in adult patients (OR, 6.2; 95% CI, 1.9-20.4) and from 25% to 44% in pediatric patients (OR, 3.4; 95% CI, 2.2-5.3).  Management of dengue inpatients significantly improved following implementation of a classroom-style course taught by master trainers. An online version of the course was launched in 2014 to expand its reach and sustainability. Published by Oxford University Press for the Infectious Diseases Society of America 2016. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Effect of Retention Time on Biogas Production from Poultry ...

African Journals Online (AJOL)

JPC

Daily gas production fell slightly from 130 to 32 litres as retention time was ... The continuing energy crisis has reawakened interest in the anaerobic ... and hydrogen sulfide (H2S2): 0.3 vol.%. ..... Nigerian Journal of Solar Energy 15: 80 – 85.

Encoding vs. retention: differential effects of cue manipulation on working memory performance in schizophrenia.

Science.gov (United States)

Javitt, Daniel C; Rabinowicz, Esther; Silipo, Gail; Dias, Elisa C

2007-03-01

Deficits in working memory performance are among the most widely replicated findings in schizophrenia. Roles of encoding vs. memory retention in working memory remain unresolved. The present study evaluated working memory performance in schizophrenia using an AX-type continuous performance test (AX-CPT) paradigm. Participants included 48 subjects with schizophrenia and 27 comparison subjects. Behavior was obtained in 3 versions of the task, which differed based upon ease of cue interoperability. In a simple cue version of the task, cue letters were replaced with red or green circles. In the complex cue version, letter/color conjunctions served as cues. In the base version of the task, patients showed increased rates of false alarms to invalidly cued targets, similar to prior reports. However, when the cue stimuli were replaced with green or red circles to ease interpretation, patients showed similar false alarm rates to controls. When feature conjunction cues were used, patients were also disproportionately affected relative to controls. No significant group by interstimulus interval interaction effects were observed in either the simple or complex cue conditions, suggesting normal retention of information even in the presence of overall performance decrements. These findings suggest first, that cue manipulation disproportionately affects AX-CPT performance in schizophrenia and, second, that substantial behavioral deficits may be observed on working memory tasks even in the absence of disturbances in mnemonic retention.

Impact of oxy-fuel combustion gases on mercury retention in activated carbons from a macroalgae waste: effect of water.

Science.gov (United States)

Lopez-Anton, M A; Ferrera-Lorenzo, N; Fuente, E; Díaz-Somoano, M; Suarez-Ruíz, I; Martínez-Tarazona, M R; Ruiz, B

2015-04-01

The aim of this study is to understand the different sorption behaviors of mercury species on activated carbons in the oxy-fuel combustion of coal and the effect of high quantities of water vapor on the retention process. The work evaluates the interactions between the mercury species and a series of activated carbons prepared from a macroalgae waste (algae meal) from the agar-agar industry in oxy-combustion atmospheres, focussing on the role that the high concentration of water in the flue gases plays in mercury retention. Two novel aspects are considered in this work (i) the impact of oxy-combustion gases on the retention of mercury by activated carbons and (ii) the performance of activated carbons prepared from biomass algae wastes for this application. The results obtained at laboratory scale indicate that the effect of the chemical and textural characteristics of the activated carbons on mercury capture is not as important as that of reactive gases, such as the SOx and water vapor present in the flue gas. Mercury retention was found to be much lower in the oxy-combustion atmosphere than in the O2+N2 (12.6% O2) atmosphere. However, the oxidation of elemental mercury (Hg0) to form oxidized mercury (Hg2+) amounted to 60%, resulting in an enhancement of mercury retention in the flue gas desulfurization units and a reduction in the amalgamation of Hg0 in the CO2 compression unit. This result is of considerable importance for the development of technologies based on activated carbon sorbents for mercury control in oxy-combustion processes. Copyright © 2015 Elsevier Ltd. All rights reserved.

Immediate And Retention Effects Of Teaching Games For Understanding Approach On Basketball Knowledge

Directory of Open Access Journals (Sweden)

Olosová Gabriela

2015-05-01

Full Text Available Teaching Games for Understanding (TGfU links tactics and skills by emphasizing the appropriate timing and application within the tactical context of the game. It has been linked to the development of enhanced tactical knowledge. The purpose of the study was to determine immediate and delayed effects of TGfU on procedural and declarative knowledge of basketball and to compare it with a technical approach. Experimental group (EG (11 fifth graders + 18 sixth graders was taught by TGfU and a control group (CG (16 fifth graders + 24 sixth graders was taught by a technical approach for 8 weeks in Physical Education (PE classes, both. A written test was constructed to evaluate pupils’ declarative and procedural knowledge of basketball. The test was applied after the intervention to determine immediate effects and 8 months after the intervention to determine retention effects of the experimental programme. Shapiro-Wilk test, Wilcoxon T-test, Man-Whitney U-test were used for statistical analysis of obtained data. Cohen’s d was used to calculate effect size. Generally basketball knowledge was better in EG than in CG after the intervention (p<0.05 what confirms moderate effect size. When declarative and procedural knowledge were analysed separately there was no significant difference between EG and CG. Nevertheless, moderate effect sizes indicate that the data are particularly meaningful in terms of school practice. Retention effects of both approaches were similar. Total knowledge and declarative knowledge were worse after 8 months than immediately after the intervention in both groups (p<0.01. In both groups, there was no significant difference in procedural knowledge between the test written immediately after the intervention and 8 months later. Differences of changes were not significant between the groups.

Physician Leadership: A Central Strategy to Transforming Healthcare.

Science.gov (United States)

Oostra, Randall D

2016-01-01

As the role of the physician leader becomes increasingly important in the transformation of healthcare, how hospitals, health systems, and other healthcare organizations define that role is undergoing radical change. Traditional physician leadership roles no longer are effective, and the independent medical staff approach is changing to a collaborative, team-oriented model. The dyad relationship between physician leaders and operational leaders is shifting from a rigid, siloed set of responsibilities to a model characterized by a distributed, situational framework of accountabilities, and the scope of influence of the physician leader and operational leader fluctuates depending on the situation and individuals involved. In addition, the focus of the physician leader is moving to one founded in servant leadership, with an increased emphasis on creating supportive models to enhance physicians' success and place them in the roles of leader and integrator of health.

Using internal communication as a marketing strategy: gaining physician commitment.

Science.gov (United States)

Heine, R P

1990-01-01

In the ambulatory care industry, increased competition and promotional costs are pressuring managers to design more creative and effective marketing strategies. One largely overlooked strategy is careful monitoring of the daily communication between physicians and ambulatory care staff providing physician services. Satisfying physician communication needs is the key to increasing physician commitment and referrals. This article outlines the steps necessary to first monitor, then improve the quality of all communication provided to physicians by ambulatory care personnel.

Identification of recruitment and retention strategies for rehabilitation professionals in Ontario, Canada: results from expert panels.

Science.gov (United States)

Tran, Diem; Hall, Linda McGillis; Davis, Aileen; Landry, Michel D; Burnett, Dawn; Berg, Katherine; Jaglal, Susan

2008-12-09

Demand for rehabilitation services is expected to increase due to factors such as an aging population, workforce pressures, rise in chronic and complex multi-system disorders, advances in technology, and changes in interprofessional health service delivery models. However, health human resource (HHR) strategies for Canadian rehabilitation professionals are lagging behind other professional groups such as physicians and nurses. The objectives of this study were: 1) to identify recruitment and retention strategies of rehabilitation professionals including occupational therapists, physical therapists and speech language pathologists from the literature; and 2) to investigate both the importance and feasibility of the identified strategies using expert panels amongst HHR and education experts. A review of the literature was conducted to identify recruitment and retention strategies for rehabilitation professionals. Two expert panels, one on Recruitment and Retention and the other on Education were convened to determine the importance and feasibility of the identified strategies. A modified-delphi process was used to gain consensus and to rate the identified strategies along these two dimensions. A total of 34 strategies were identified by the Recruitment and Retention and Education expert panels as being important and feasible for the development of a HHR plan for recruitment and retention of rehabilitation professionals. Seven were categorized under the Quality of Worklife and Work Environment theme, another seven in Financial Incentives and Marketing, two in Workload and Skill Mix, thirteen in Professional Development and five in Education and Training. Based on the results from the expert panels, the three major areas of focus for HHR planning in the rehabilitation sector should include strategies addressing Quality of Worklife and Work Environment, Financial Incentives and Marketing and Professional Development.

Simplified tools for measuring retention in care in antiretroviral treatment program in Ethiopia: cohort and current retention in care.

Science.gov (United States)

Assefa, Yibeltal; Worku, Alemayehu; Wouters, Edwin; Koole, Olivier; Haile Mariam, Damen; Van Damme, Wim

2012-01-01

Patient retention in care is a critical challenge for antiretroviral treatment programs. This is mainly because retention in care is related to adherence to treatment and patient survival. It is therefore imperative that health facilities and programs measure patient retention in care. However, the currently available tools, such as Kaplan Meier, for measuring retention in care have a lot of practical limitations. The objective of this study was to develop simplified tools for measuring retention in care. Retrospective cohort data were collected from patient registers in nine health facilities in Ethiopia. Retention in care was the primary outcome for the study. Tools were developed to measure "current retention" in care during a specific period of time for a specific "ART-age group" and "cohort retention" in care among patients who were followed for the last "Y" number of years on ART. "Probability of retention" based on the tool for "cohort retention" in care was compared with "probability of retention" based on Kaplan Meier. We found that the new tools enable to measure "current retention" and "cohort retention" in care. We also found that the tools were easy to use and did not require advanced statistical skills. Both "current retention" and "cohort retention" are lower among patients in the first two "ART-age groups" and "ART-age cohorts" than in subsequent "ART-age groups" and "ART-age cohorts". The "probability of retention" based on the new tools were found to be similar to the "probability of retention" based on Kaplan Meier. The simplified tools for "current retention" and "cohort retention" will enable practitioners and program managers to measure and monitor rates of retention in care easily and appropriately. We therefore recommend that health facilities and programs start to use these tools in their efforts to improve retention in care and patient outcomes.

Simplified tools for measuring retention in care in antiretroviral treatment program in Ethiopia: cohort and current retention in care.

Directory of Open Access Journals (Sweden)

Yibeltal Assefa

Full Text Available INTRODUCTION: Patient retention in care is a critical challenge for antiretroviral treatment programs. This is mainly because retention in care is related to adherence to treatment and patient survival. It is therefore imperative that health facilities and programs measure patient retention in care. However, the currently available tools, such as Kaplan Meier, for measuring retention in care have a lot of practical limitations. The objective of this study was to develop simplified tools for measuring retention in care. METHODS: Retrospective cohort data were collected from patient registers in nine health facilities in Ethiopia. Retention in care was the primary outcome for the study. Tools were developed to measure "current retention" in care during a specific period of time for a specific "ART-age group" and "cohort retention" in care among patients who were followed for the last "Y" number of years on ART. "Probability of retention" based on the tool for "cohort retention" in care was compared with "probability of retention" based on Kaplan Meier. RESULTS: We found that the new tools enable to measure "current retention" and "cohort retention" in care. We also found that the tools were easy to use and did not require advanced statistical skills. Both "current retention" and "cohort retention" are lower among patients in the first two "ART-age groups" and "ART-age cohorts" than in subsequent "ART-age groups" and "ART-age cohorts". The "probability of retention" based on the new tools were found to be similar to the "probability of retention" based on Kaplan Meier. CONCLUSION: The simplified tools for "current retention" and "cohort retention" will enable practitioners and program managers to measure and monitor rates of retention in care easily and appropriately. We therefore recommend that health facilities and programs start to use these tools in their efforts to improve retention in care and patient outcomes.

Krypton retention on solid adsorbents

International Nuclear Information System (INIS)

Monson, P.R. Jr.

1982-01-01

An experimental laboratory program was conducted to develop economical solid adsorbents for the retention of krypton from a dissolver off-gas stream. The study indicates that a solid adsorbent system is feasible and competitive with other developing systems which utilize fluorocarbon absorption nd cryogenic distillation. This technology may have potential applications not only in nuclear fuel reprocessing plants, but also in nuclear reactors and in environmental monitoring. Of the 13 prospective adsorbents evaluated with respect to adsorption capacity and cost, the commercially available hydrogen mordenite was the most cost-effective material at subambient temperatures (-40 0 to -80 0 C). Silver mordenite has a higher capacity for krypton retention, but is 50 times more expensive than hydrogen mordenite

Physician Compare

Data.gov (United States)

U.S. Department of Health & Human Services — Physician Compare, which meets Affordable Care Act of 2010 requirements, helps you search for and select physicians and other healthcare professionals enrolled in...

Measuring in-stream retention of copper by means of constant-rate additions.

Science.gov (United States)

Serra, A; Guasch, H; Martí, E; Geiszinger, A

2009-06-01

Human practices entail inputs of nutrients and toxicants such as heavy metals to the fluvial ecosystems. While nutrient dynamics in fluvial ecosystems have been widely studied for over three decades, dynamics of toxicants still remain unclear. In this investigation, the nutrient spiraling concept and associated methodologies to quantify nutrient retention in streams were applied to study copper (Cu) dynamics in streams. The present study aimed to quantify total dissolved Cu retention using a simplified system of indoor channels colonized with fluvial biofilms. Cu retention was studied at sub-toxic concentrations to avoid negative/lethal effects on biota. In addition, Cu retention was compared with retention estimates of a macronutrient, phosphate (PO(4)(3-)), which has been widely studied within the context of the nutrient spiraling concept. The methodology used allowed a successful quantification of Cu and PO(4)(3-) retention. The results showed higher retention efficiency for PO(4)(3-) than for Cu. The biofilm played a key role in retaining both solutes. Although retention efficiency for both solutes was higher in the experiments with colonized substrata compared to uncolonized substrata, we found a positive relationship between uptake rate and chlorophyll-a only for PO(4)(3-). Finally, retention efficiency for both solutes was influenced by water discharge, showing lower retention efficiencies under higher flow conditions. These results suggest that the fate and toxic effects of copper on stream biota may be strongly influenced by the prevailing environmental conditions. Our results indicate that the experimental approach considered can provide new insights into the investigation of retention of toxic compounds in fluvial systems and their controlling mechanisms.

The effects of fatigue and dissatisfaction on how physicians perceive their social responsibilities.

Science.gov (United States)

O'Donnell, Erin P; Humeniuk, Katherine M; West, Colin P; Tilburt, Jon C

2015-02-01

To examine how fatigue and dissatisfaction with practicing medicine relate to US physicians' perceptions of their professional responsibilities in a time of upheaval in health care. From May 30, 2012, through September 1, 2012, we mailed an 8-page paper survey, including measures of perceived social responsibility, fatigue, and satisfaction, to a random sample of 3897 physicians selected from the American Medical Association Physician Masterfile. We performed bivariate tests and multivariable logistic regression to examine associations between key predictors (fatigue and satisfaction) and 3 dependent variables: obligations to care for the uninsured and underinsured, obligations to address policy issues, and agreement with cost-containment. A total of 2556 physicians (65.6%) responded to the survey. Nearly half of physicians (1160 [45.4%]) reported high levels of fatigue, whereas most (1810 [70.8%]) expressed satisfaction with practicing medicine. Dissatisfaction in practicing medicine proved to be a significant predictor in how physicians perceive their professional responsibilities and in medical decision-making. Overall, physicians who rated themselves as very dissatisfied had a significantly reduced likelihood of favoring limiting reimbursement to expand basic coverage (odds ratio, 0.5; 95% CI, 0.3-0.7), recognizing an obligation to care for the uninsured (odds ratio, 0.5; 95% CI, 0.3-0.7), and addressing societal health policy issues (OR, 0.7; 95% CI, 0.5-0.9). Although fatigue and satisfaction are strongly associated, only satisfaction appears to correlate with physicians' perceived social responsibilities. Physicians who are dissatisfied with their profession may be less inclined to address health policy issues, embrace charity care, or practice cost containment. Copyright © 2015 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

Seed Implant Retention Score Predicts the Risk of Prolonged Urinary Retention After Prostate Brachytherapy

International Nuclear Information System (INIS)

Lee, Hoon K.; Adams, Marc T.; Shi, Qiuhu; Basillote, Jay; LaMonica, Joanne; Miranda, Luis; Motta, Joseph

2010-01-01

Purpose: To risk-stratify patients for urinary retention after prostate brachytherapy according to a novel seed implant retention score (SIRS). Patients and Methods: A total of 835 patients underwent transperineal prostate seed implant from March 1993 to January 2007; 197 patients had 125 I and 638 patients had 103 Pd brachytherapy. Four hundred ninety-four patients had supplemental external-beam radiation. The final downsized prostate volume was used for the 424 patients who had neoadjuvant hormone therapy. Retention was defined as reinsertion of a Foley catheter after the implant. Results: Retention developed in 7.4% of patients, with an average duration of 6.7 weeks. On univariate analysis, implant without supplemental external-beam radiation (10% vs. 5.6%; p = 0.02), neoadjuvant hormone therapy (9.4% vs. 5.4%; p = 0.02), baseline α-blocker use (12.5% vs. 6.3%; p = 0.008), and increased prostate volume (13.4% vs. 6.9% vs. 2.9%, >45 cm 3 , 25-45 cm 3 , 3 ; p = 0.0008) were significantly correlated with increased rates of retention. On multivariate analysis, implant without supplemental external-beam radiation, neoadjuvant hormone therapy, baseline α-blocker use, and increased prostate volume were correlated with retention. A novel SIRS was modeled as the combined score of these factors, ranging from 0 to 5. There was a significant correlation between the SIRS and retention (p < 0.0001). The rates of retention were 0, 4%, 5.6%, 9%, 20.9%, and 36.4% for SIRS of 0 to 5, respectively. Conclusions: The SIRS may identify patients who are at high risk for prolonged retention after prostate brachytherapy. A prospective validation study of the SIRS is planned.

Silica fume effect on retention characteristics of portland cement for uranium (VI)

International Nuclear Information System (INIS)

Tan Hongbin; Ma Xiaoling; Li Yuxiang

2005-01-01

With simulated groundwater as leachant, the retention capabilities of the portland cement, which contains different amount of silica fume, are investigated under 25 degree C and 42 days. The results indicate that silica fume can improve the retention capabilities of portland cement for uranium. When the cement contains 15% silica fume, the diffusion coefficient is 7 x 10 -3 cm 3 · -1 . It is only 5.5% of the cement without containing fume. (authors)

Sacral Nerve Stimulation For Urinary Urge Incontinence, Urgency-Frequency, Urinary Retention, and Fecal Incontinence

Science.gov (United States)

2005-01-01

��indicative analysis” and found that SNS was not more cost-effective than using incontinence supplies. However, the assessment did not account for quality of life. Conversely, the authors of the abstract found that SNS was more cost-effective than incontinence supplies alone; however, they noted that in the first year after SNS, it is much more expensive than only incontinence supplies. This is owing to the cost of the procedure, and the adjustments required to make the device most effective. They also noted the positive effects that SNS had on quality of life. Conclusions and Implications In summary, there is level 2 evidence to support the effectiveness of SNS to treat people with urge incontinence, urgency-frequency, or urinary retention. There is level 4 evidence to support the effectiveness of SNS to treat people with fecal incontinence. To qualify for SNS, people must meet the following criteria: Be refractory to behaviour and/or drug therapy Have had a successful test stimulation before implantation; successful test stimulation is defined by a 50% or greater improvement in voiding function based on the results of a voiding diary. Test stimulation periods range from 3 to 7 days for patients with urinary dysfunctions, and from 2 to 3 weeks for patients with fecal incontinence. Be able to record voiding diary data, so that clinical results of the implantation can be evaluated. Patients with stress incontinence, urinary retention due to obstruction and neurogenic conditions (such as diabetes with peripheral nerve involvement) are ineligible for sacral nerve stimulation. Physicians will need to learn how to use the InterStim System for Urinary Control. Requirements for training include these: Physicians must be experienced in the diagnosis and treatment of lower urinary tract disorders and should be trained in the implantation and use of the InterStim System for Urinary Control. Training should include the following: Participation in a seminar or workshop that includes

Bridging effective stress and soil water retention equations in deforming unsaturated porous media : A Thermodynamic Approach

NARCIS (Netherlands)

Huyghe, J. M.; Nikooee, E.; Hassanizadeh, S. M.

The finite deformation of an unsaturated porous medium is analysed from first principles of mixture theory. An expression for Bishop’s effective stress is derived from (1) the deformation-dependent Brooks and Corey’s water retention curve and (2) the restrictions on the constitutive relationships of

The grit effect: predicting retention in the military, the workplace, school and marriage.

Science.gov (United States)

Eskreis-Winkler, Lauren; Shulman, Elizabeth P; Beal, Scott A; Duckworth, Angela L

2014-01-01

Remaining committed to goals is necessary (albeit not sufficient) to attaining them, but very little is known about domain-general individual differences that contribute to sustained goal commitment. The current investigation examines the association between grit, defined as passion and perseverance for long-term goals, other individual difference variables, and retention in four different contexts: the military, workplace sales, high school, and marriage. Grit predicted retention over and beyond established context-specific predictors of retention (e.g., intelligence, physical aptitude, Big Five personality traits, job tenure) and demographic variables in each setting. Grittier soldiers were more likely to complete an Army Special Operations Forces (ARSOF) selection course, grittier sales employees were more likely to keep their jobs, grittier students were more likely to graduate from high school, and grittier men were more likely to stay married. The relative predictive validity of grit compared to other traditional predictors of retention is examined in each of the four studies. These findings suggest that in addition to domain-specific influences, there may be domain-general individual differences which influence commitment to diverse life goals over time.

The effect of additives on release and in vitro skin retention of flavonoids from emulsion and gel semisolid formulations.

Science.gov (United States)

Dyja, R; Jankowski, A

2017-08-01

To assess the effect of two different additives (propylene glycol (PG) and polyethylene glycol 400 (PEG 400)) on release and in vitro skin retention of quercetin and chrysin from semisolid bases (amphiphilic creams and acidic carbomer gels). For obtaining semisolid formulations, flavonoids were pre-dissolved in the liquid (PG or PEG 400) or directly suspended in the semisolid base. Three chrysin formulations ('cream 0', 'PG-cream' and 'PEG 400-cream') and five quercetin formulations ('cream 0', 'PG cream', 'PEG 400 cream', 'gel 0' and 'PG gel') were prepared. The release studies were carried out in Franz diffusion cells by means of a cellulose membrane. The porcine ear skin was used in in vitro skin retention studies. The dissolution was a prerequisite to increase the release rates of tested flavonoids from obtained semisolid formulations. The cumulative amount of chrysin released after 6 h from 'PEG 400 cream' containing partly dissolved form of that flavonoid was higher than that from 'cream 0' or 'PG cream' containing its suspended form. The formulations containing quercetin dissolved in PG ('PG cream', 'PG gel') or PEG 400 ('PEG 400 cream') exhibited higher release rates of that flavonoid than corresponding semisolid suspensions ('cream 0' or 'gel 0'). The effects of both liquid additives (PG and PEG 400) on the cumulative amount of quercetin released after 6 h were comparable. However, there was no correlation between the release rate and the skin retention. The amounts of the flavonoids found in the skin were strongly affected by the type of the used solvent. While PG increased the skin retention of both flavonoids, PEG 400 had no effect on chrysin skin retention and delayed quercetin skin absorption. The proper choice of the solvent added to the semisolid base is crucial for enhanced skin delivery of the tested flavonoids. PG is more efficient absorption promoter than PEG 400 of both chrysin and quercetin. © 2017 Society of Cosmetic Scientists and the Soci

U.K. physicians' attitudes toward active voluntary euthanasia and physician-assisted suicide.

Science.gov (United States)

Dickinson, George E; Lancaster, Carol J; Clark, David; Ahmedzai, Sam H; Noble, William

2002-01-01

A comparison of the views of geriatric medicine physicians and intensive care physicians in the United Kingdom on the topics of active voluntary euthanasia and physician-assisted suicide revealed rather different attitudes. Eighty percent of geriatricians, but only 52% of intensive care physicians, considered active voluntary euthanasia as never justified ethically. Gender and age did not play a major part in attitudinal differences of the respondents. If the variability of attitudes of these two medical specialties are anywhere near illustrative of other physicians in the United Kingdom, it would be difficult to formulate and implement laws and policies concerning euthanasia and assisted suicide. In addition, ample safeguards would be required to receive support from physicians regarding legalization.

The role of cultural diversity climate in recruitment, promotion, and retention of faculty in academic medicine.

Science.gov (United States)

Price, Eboni G; Gozu, Aysegul; Kern, David E; Powe, Neil R; Wand, Gary S; Golden, Sherita; Cooper, Lisa A

2005-07-01

Ethnic diversity among physicians may be linked to improved access and quality of care for minorities. Academic medical institutions are challenged to increase representation of ethnic minorities among health professionals. To explore the perceptions of physician faculty regarding the following: (1) the institution's cultural diversity climate and (2) facilitators and barriers to success and professional satisfaction in academic medicine within this context. Qualitative study using focus groups and semi-structured interviews. Nontenured physicians in the tenure track at the Johns Hopkins University School of Medicine. Focus groups and interviews were audio-taped, transcribed verbatim, and reviewed for thematic content in a 3-stage independent review/adjudication process. Study participants included 29 faculty representing 9 clinical departments, 4 career tracks, and 4 ethnic groups. In defining cultural diversity, faculty noted visible (race/ethnicity, foreign-born status, gender) and invisible (religion, sexual orientation) dimensions. They believe visible dimensions provoke bias and cumulative advantages or disadvantages in the workplace. Minority and foreign-born faculty report ethnicity-based disparities in recruitment and subtle manifestations of bias in the promotion process. Minority and majority faculty agree that ethnic differences in prior educational opportunities lead to disparities in exposure to career options, and qualifications for and subsequent recruitment to training programs and faculty positions. Minority faculty also describe structural barriers (poor retention efforts, lack of mentorship) that hinder their success and professional satisfaction after recruitment. To effectively manage the diversity climate, our faculty recommended 4 strategies for improving the psychological climate and structural diversity of the institution. Soliciting input from faculty provides tangible ideas regarding interventions to improve an institution's diversity

Which Physicians' Behaviors on Death Pronouncement Affect Family-Perceived Physician Compassion? A Randomized, Scripted, Video-Vignette Study.

Science.gov (United States)

Mori, Masanori; Fujimori, Maiko; Hamano, Jun; Naito, Akemi S; Morita, Tatsuya

2018-02-01

Although the death of a loved one is a devastating family event, little is known about which behaviors positively affect families' perceptions on death pronouncements. The objective of this study was to evaluate the effect of a compassionate death pronouncement on participant-perceived physician compassion, trust in physicians, and emotions. In this randomized, video-vignette study, 92 people (≥50 years) in Tokyo metropolitan area viewed two videos of death pronouncements by an on-call physician with or without compassion-enhanced behaviors, including five components: waiting until the families calm themselves down, explaining that the physician has received a sign-out about information of the patient's condition, performing examination respectfully, ascertaining the time of death with a wristwatch (vs. smartphone), and reassuring the families that the patient did not experience pain. Main outcomes were physician compassion score, trust in physician, and emotions. After viewing the video with compassion-enhanced behaviors compared with the video without them, participants assigned significantly lower compassion scores (reflecting higher physician compassion) (mean 26.2 vs. 36.4, F = 33.1, P vs. 3.00, F = 39.7, P vs. 3.78, F = 18.0, P sadness (3.42 vs. 3.85, F = 11.8, P = 0.001), fear (1.93 vs. 2.55, F = 15.8, P vs. 3.71, F = 19.4, P < 0.001). To convey compassion on death pronouncement, we recommend that physicians initiate prompt examination, explain that the physician has received a sign-out, perform examination respectfully, ascertain the time of death with a wristwatch, and reassure the families that the patient did not experience pain. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Evaluation of Physicians' Cognitive Styles.

Science.gov (United States)

Djulbegovic, Benjamin; Beckstead, Jason W; Elqayam, Shira; Reljic, Tea; Hozo, Iztok; Kumar, Ambuj; Cannon-Bowers, Janis; Taylor, Stephanie; Tsalatsanis, Athanasios; Turner, Brandon; Paidas, Charles

2014-07-01

Patient outcomes critically depend on accuracy of physicians' judgment, yet little is known about individual differences in cognitive styles that underlie physicians' judgments. The objective of this study was to assess physicians' individual differences in cognitive styles relative to age, experience, and degree and type of training. Physicians at different levels of training and career completed a web-based survey of 6 scales measuring individual differences in cognitive styles (maximizing v. satisficing, analytical v. intuitive reasoning, need for cognition, intolerance toward ambiguity, objectivism, and cognitive reflection). We measured psychometric properties (Cronbach's α) of scales; relationship of age, experience, degree, and type of training; responses to scales; and accuracy on conditional inference task. The study included 165 trainees and 56 attending physicians (median age 31 years; range 25-69 years). All 6 constructs showed acceptable psychometric properties. Surprisingly, we found significant negative correlation between age and satisficing (r = -0.239; P = 0.017). Maximizing (willingness to engage in alternative search strategy) also decreased with age (r = -0.220; P = 0.047). Number of incorrect inferences negatively correlated with satisficing (r = -0.246; P = 0.014). Disposition to suppress intuitive responses was associated with correct responses on 3 of 4 inferential tasks. Trainees showed a tendency to engage in analytical thinking (r = 0.265; P = 0.025), while attendings displayed inclination toward intuitive-experiential thinking (r = 0.427; P = 0.046). However, trainees performed worse on conditional inference task. Physicians capable of suppressing an immediate intuitive response to questions and those scoring higher on rational thinking made fewer inferential mistakes. We found a negative correlation between age and maximizing: Physicians who were more advanced in their careers were less willing to spend time and effort in an

The physicians and the nuclear war

International Nuclear Information System (INIS)

Arruda, W.O.

1985-01-01

This paper shows that a lot of physicians in the world are worried about a new nuclear war and they created the International Physicians for Prevention of Nuclear War. The main objectives of the IPPNNW are to amplify the public or people knowledge of the medical aspects of the nuclear war and promote and coordinate researches about the medical and psychological effects of the nuclear weapon race. (author)

Effect of Learning Cycle Approach-Based Science Teaching on Academic Achievement, Attitude, Motivation and Retention

Science.gov (United States)

Uyanik, Gökhan

2016-01-01

The purpose of this study was to examine the effect of learning cycle approach-based teaching on academic achievement, attitude, motivation and retention at primary school 4th grade science lesson. It was conducted pretest-posttest quasi-experimental design in this study. The study was conducted on a total of 65 students studying in two different…

Effect of temperature and hydraulic retention time on hydrogen producing granules: Homoacetogenesis and morphological characteristics

International Nuclear Information System (INIS)

Abreu, A. A.; Danko, A. S.; Alves, M. M.

2009-01-01

The effect of temperature and hydraulic retention time (HRT) on the homoacetogenesisi and on the morphological characteristics of hydrogen producing granules was investigated. Hydrogen was produced using an expanded granular sludge blanket (EGSB) reactor, fed with glucose and L-arabinose, under mesophilic (37 degree centigrade), thermophilic (55 degree centigrade), and hyper thermophilic (70 degree centigrade) conditions. (Author)

Physician heal thyself

African Journals Online (AJOL)

Compared to overweight or obese physicians, normal‑weight physicians were significantly more likely to discuss weight loss with their obese patients, according to a study among. 500 primary care physicians, undertaken by researchers at the Johns Hopkins Bloomberg School of Public Health.[4]. A recent, highly accessed ...

Illustrations in Text: A Retentional Role.

Science.gov (United States)

Duchastel, Philippe C.

1981-01-01

Describes the results of a study of the retentional role of illustrations in a text and their effect on enhancing long-term memory with 15-year-old secondary school students. Seven references are listed. (CHC)

Coherent oscillatory networks supporting short-term memory retention.

Science.gov (United States)

Payne, Lisa; Kounios, John

2009-01-09

Accumulating evidence suggests that top-down processes, reflected by frontal-midline theta-band (4-8 Hz) electroencephalogram (EEG) oscillations, strengthen the activation of a memory set during short-term memory (STM) retention. In addition, the amplitude of posterior alpha-band (8-13 Hz) oscillations during STM retention is thought to reflect a mechanism that protects fragile STM activations from interference by gating bottom-up sensory inputs. The present study addressed two important questions about these phenomena. First, why have previous studies not consistently found memory set-size effects on frontal-midline theta? Second, how does posterior alpha participate in STM retention? To answer these questions, large-scale network connectivity during STM retention was examined by computing EEG wavelet coherence during the retention period of a modified Sternberg task using visually-presented letters as stimuli. The results showed (a) increasing theta-band coherence between frontal-midline and left temporal-parietal sites with increasing memory load, and (b) increasing alpha-band coherence between midline parietal and left temporal/parietal sites with increasing memory load. These findings support the view that theta-band coherence, rather than amplitude, is the key factor in selective top-down strengthening of the memory set and demonstrate that posterior alpha-band oscillations associated with sensory gating are involved in STM retention by participating in the STM network.

Urinary Retention Associated with Atomoxetine Use: A Case Report

Directory of Open Access Journals (Sweden)

Nilfer Sahin

2016-02-01

Full Text Available Atomoxetine is a well-studied non-stimulant treatment agent, and is also the first-choice non-stimulant drug for the conventional treatment of Attention Deficit Hyperactivity Disorder owing to its effectiveness and tolerability. Urinary retention is a type of urological emergency that is associated with the inability to urinate despite the bladder being full and a strong urge to urinate. It is known that urinary retention can also develop due to the use of anticholinergic drugs. In this manuscript, we present a 12-year-old male case who developed acute urinary retention in the period following atomoxetine treatment.

Genetic programming based quantitative structure-retention relationships for the prediction of Kovats retention indices.

Science.gov (United States)

Goel, Purva; Bapat, Sanket; Vyas, Renu; Tambe, Amruta; Tambe, Sanjeev S

2015-11-13

The development of quantitative structure-retention relationships (QSRR) aims at constructing an appropriate linear/nonlinear model for the prediction of the retention behavior (such as Kovats retention index) of a solute on a chromatographic column. Commonly, multi-linear regression and artificial neural networks are used in the QSRR development in the gas chromatography (GC). In this study, an artificial intelligence based data-driven modeling formalism, namely genetic programming (GP), has been introduced for the development of quantitative structure based models predicting Kovats retention indices (KRI). The novelty of the GP formalism is that given an example dataset, it searches and optimizes both the form (structure) and the parameters of an appropriate linear/nonlinear data-fitting model. Thus, it is not necessary to pre-specify the form of the data-fitting model in the GP-based modeling. These models are also less complex, simple to understand, and easy to deploy. The effectiveness of GP in constructing QSRRs has been demonstrated by developing models predicting KRIs of light hydrocarbons (case study-I) and adamantane derivatives (case study-II). In each case study, two-, three- and four-descriptor models have been developed using the KRI data available in the literature. The results of these studies clearly indicate that the GP-based models possess an excellent KRI prediction accuracy and generalization capability. Specifically, the best performing four-descriptor models in both the case studies have yielded high (>0.9) values of the coefficient of determination (R(2)) and low values of root mean squared error (RMSE) and mean absolute percent error (MAPE) for training, test and validation set data. The characteristic feature of this study is that it introduces a practical and an effective GP-based method for developing QSRRs in gas chromatography that can be gainfully utilized for developing other types of data-driven models in chromatography science

Strategies to improve retention in randomised trials

Science.gov (United States)

Brueton, Valerie C; Tierney, Jayne; Stenning, Sally; Harding, Seeromanie; Meredith, Sarah; Nazareth, Irwin; Rait, Greta

2013-01-01

Background Loss to follow-up from randomised trials can introduce bias and reduce study power, affecting the generalisability, validity and reliability of results. Many strategies are used to reduce loss to follow-up and improve retention but few have been formally evaluated. Objectives To quantify the effect of strategies to improve retention on the proportion of participants retained in randomised trials and to investigate if the effect varied by trial strategy and trial setting. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, PreMEDLINE, EMBASE, PsycINFO, DARE, CINAHL, Campbell Collaboration's Social, Psychological, Educational and Criminological Trials Register, and ERIC. We handsearched conference proceedings and publication reference lists for eligible retention trials. We also surveyed all UK Clinical Trials Units to identify further studies. Selection criteria We included eligible retention trials of randomised or quasi-randomised evaluations of strategies to increase retention that were embedded in 'host' randomised trials from all disease areas and healthcare settings. We excluded studies aiming to increase treatment compliance. Data collection and analysis We contacted authors to supplement or confirm data that we had extracted. For retention trials, we recorded data on the method of randomisation, type of strategy evaluated, comparator, primary outcome, planned sample size, numbers randomised and numbers retained. We used risk ratios (RR) to evaluate the effectiveness of the addition of strategies to improve retention. We assessed heterogeneity between trials using the Chi2 and I2 statistics. For main trials that hosted retention trials, we extracted data on disease area, intervention, population, healthcare setting, sequence generation and allocation concealment. Main results We identified 38 eligible retention trials. Included trials evaluated six broad types of strategies to improve retention. These