When policy meets physiology: the challenge of reducing resident work hours.

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Lockley, Steven W; Landrigan, Christopher P; Barger, Laura K; Czeisler, Charles A

2006-08-01

Considerable controversy exists regarding optimal work hours for physicians and surgeons in training. In a series of studies, we assessed the effect of extended work hours on resident sleep and health as well as patient safety. In a validated nationwide survey, we found that residents who had worked 24 hours or longer were 2.3 times more likely to have a motor vehicle crash following that shift than when they worked hours, and that the monthly risk of a crash increased by 16.2% after each extended duration shift. We also found in a randomized trial that interns working a traditional on-call schedule slept 5.8 hours less per week, had twice as many attentional failures on duty overnight, and made 36% more serious medical errors and nearly six times more serious diagnostic errors than when working on a schedule that limited continuous duty to 16 hours. While numerous opinions have been published opposing reductions in extended work hours due to concerns regarding continuity of patient care, reduced educational opportunities, and traditionally-defined professionalism, there are remarkably few objective data in support of continuing to schedule medical trainees to work shifts > 24 hours. An evidence-based approach is needed to minimize the well-documented risk that current work hour practices confer on resident health and patient safety while optimizing education and continuity of care.

29 CFR 785.22 - Duty of 24 hours or more.

Science.gov (United States)

2010-07-01

... employee is required to be on duty for 24 hours or more, the employer and the employee may agree to exclude... from hours worked, provided adequate sleeping facilities are furnished by the employer and the employee... of sleeping time and lunch periods constitute hours worked. (Armour v. Wantock, 323 U.S. 126 (1944...

The declining demand for hospital care as a rationale for duty hour reform.

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Jena, Anupam B; DePasse, Jacqueline W; Prasad, Vinay

2014-10-01

The regulation of duty hours of physicians in training remains among the most hotly debated subjects in medical education. Although recent duty hour reforms have been chiefly motivated by concerns about resident well-being and medical errors attributable to resident fatigue, the debate surrounding duty hour reform has infrequently involved discussion of one of the most important secular changes in hospital care that has affected nearly all developed countries over the last 3 decades: the declining demand for hospital care. For example, in 1980, we show that resident physicians in US teaching hospitals provided, on average, 1,302 inpatient days of care per resident physician compared to 593 inpatient days in 2011, a decline of 54%. This decline in the demand for hospital care by residents provides an under-recognized economic rationale for reducing residency duty hours, a rationale based solely on supply and demand considerations. Work hour reductions and growing requirements for outpatient training can be seen as an appropriate response to the shrinking demand for hospital care across the health-care sector.

Resident perceptions of the impact of duty hour restrictions on resident-attending interactions: an exploratory study.

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Gerjevic, Kristen A; Rosenbaum, Marcy E; Suneja, Manish

2017-07-18

The institution of duty hour reforms by the Accreditation Council for Graduate Medical Education in 2003 has created a learning environment where residents are consistently looking for input from attending physicians with regards to balancing duty hour regulations and providing quality patient care. There is a paucity of literature regarding resident perceptions of attending physician actions or attitudes towards work hour restrictions. The purpose of this study was to identify attending physician behaviors that residents perceived as supportive or unsupportive of their compliance with duty hour regulations. Focus group interviews were conducted with residents exploring their perceptions of how duty hour regulations impact their interactions with attending physicians. Qualitative analysis identified key themes in residents' experiences interacting with faculty in regard to duty hour regulations. Forty residents from five departments in two hospital systems participated. Discussion of these interactions highlighted that attending physicians demonstrate behaviors that explicitly or implicitly either lend their support and understanding of residents' need to comply with these regulations or imply a lack of support and understanding. Three major themes that contributed to the ease or difficulty in addressing duty hour regulations included attending physicians' explicit communication of expectations, implicit non-verbal and verbal cues and the program's organizational culture. Resident physicians' perception of attending physicians' explicit and implicit communication and residency programs organization culture has an impact on residents' experience with duty hour restrictions. Residency faculty and programs could benefit from explicitly addressing and supporting the challenges that residents perceive in complying with duty hour restrictions.

The Media Response to the ACGME's 2017 Relaxed Resident Duty-Hour Restrictions.

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Zhang, Zi; Krauthamer, Alan V; Rosenkrantz, Andrew B

2018-03-01

In March 2017, the ACGME relaxed resident duty-hour restrictions to allow first-year residents to work 24-hour shifts, affecting the internship experience of incoming radiology residents. The aim of this study was to assess the media response to this duty-hour change, comparing news articles with favorable and unfavorable views. Google News was used to identify 36 relevant unique news articles published over a 4-week period after the announcement. Articles' stance was categorized as favorable, unfavorable, or neutral. Additional article characteristics were explored. Article sources were 58% national, 22% local, and 20% medical news. Article stance was most commonly unfavorable for national news sources (48%), compared with neutral for local (62%) and medical (72%) news sources. Most common reasons for unfavorable stance were sleep deprivation (n = 11), medical errors (n = 11), residents' health (n = 9), risk for car accidents (n = 9), a patriarchal hazing system (n = 6), and work-life balance (n = 5). Most common reasons for favorable stance were impact on resident education (n = 7) and continuity of care (n = 7). Supporting data were cited by 38% of unfavorable and 100% of favorable articles. Unfavorable articles most commonly quoted physicians affiliated with resident advocacy groups; favorable articles most commonly quoted physicians affiliated with the ACGME. The relaxed duty-hour restrictions received an overall unfavorable media response, particularly in nonmedical news sources, driven by concerns regarding sleep-deprived doctors. Favorable articles ubiquitously cited data supporting the safety of relaxed duty hour restrictions. Further research is warranted to better understand the impact of relaxed resident duty-hour limits on sleep deprivation, residents' health and education, and the quality of patient care. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.

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

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

2016-02-25

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

Effect of the 2011 vs 2003 duty hour regulation-compliant models on sleep duration, trainee education, and continuity of patient care among internal medicine house staff: a randomized trial.

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Desai, Sanjay V; Feldman, Leonard; Brown, Lorrel; Dezube, Rebecca; Yeh, Hsin-Chieh; Punjabi, Naresh; Afshar, Kia; Grunwald, Michael R; Harrington, Colleen; Naik, Rakhi; Cofrancesco, Joseph

2013-04-22

On July 1, 2011, the Accreditation Council for Graduate Medical Education implemented further restrictions of its 2003 regulations on duty hours and supervision. It remains unclear if the 2003 regulations improved trainee well-being or patient safety. To determine the effects of the 2011 Accreditation Council for Graduate Medical Education duty hour regulations compared with the 2003 regulations concerning sleep duration, trainee education, continuity of patient care, and perceived quality of care among internal medicine trainees. Crossover study design in an academic research setting. Medical house staff. General medical teams were randomly assigned using a sealed-envelope draw to an experimental model or a control model. We randomly assigned 4 medical house staff teams (43 interns) using a 3-month crossover design to a 2003-compliant model of every fourth night overnight call (control) with 30-hour duty limits or to one of two 2011-compliant models of every fifth night overnight call (Q5) or a night float schedule (NF), both with 16-hour duty limits. We measured sleep duration using actigraphy and used admission volumes, educational opportunities, the number of handoffs, and satisfaction surveys to assess trainee education, continuity of patient care, and perceived quality of care. RESULTS The study included 560 control, 420 Q5, and 140 NF days that interns worked and 834 hospital admissions. Compared with controls, interns on NF slept longer during the on call period (mean, 5.1 vs 8.3 hours; P = .003), and interns on Q5 slept longer during the postcall period (mean, 7.5 vs 10.2 hours; P = .05). However, both the Q5 and NF models increased handoffs, decreased availability for teaching conferences, and reduced intern presence during daytime work hours. Residents and nurses in both experimental models perceived reduced quality of care, so much so with NF that it was terminated early. Compared with a 2003-compliant model, two 2011 duty hour regulation

Views of surgery program directors on the current ACGME and proposed IOM duty-hour standards.

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Willis, Ross E; Coverdill, James E; Mellinger, John D; Collins, J Craig; Potts, John R; Dent, Daniel L

2009-01-01

The purpose of this study was to survey the experiences of surgery program directors with the current Accreditation Council for Graduate Medical Education (ACGME) duty-hour standards and views of the Institute of Medicine (IOM) proposed duty-hour recommendations. A total of 118 program directors (47.6% of all surgery programs in the US) responded to the survey. Results showed that the current duty-hour standards have hindered clinical education opportunities by reducing or eliminating rotations on many services, didactic teaching conferences, and clinical bedside teaching opportunities. Additionally, patient safety has been compromised by frequent hand offs of care. Most IOM recommendations were perceived as extremely difficult or impossible to implement, with the exception of the moonlighting recommendation. The results indicated that adopting the IOM recommendations is not feasible given current workforce limitations, and most program directors supported maintaining the current duty-hour standards until such time as there is evidence-based outcomes research to direct change. The conclusion was that the current ACGME duty-hour standards have reduced teaching opportunities and narrowed the scope of training.

Program Director Perceptions of Surgical Resident Training and Patient Care under Flexible Duty Hour Requirements.

Science.gov (United States)

Saadat, Lily V; Dahlke, Allison R; Rajaram, Ravi; Kreutzer, Lindsey; Love, Remi; Odell, David D; Bilimoria, Karl Y; Yang, Anthony D

2016-06-01

The Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST) trial was a national, cluster-randomized, pragmatic, noninferiority trial of 117 general surgery programs, comparing standard ACGME resident duty hour requirements ("Standard Policy") to flexible, less-restrictive policies ("Flexible Policy"). Participating program directors (PDs) were surveyed to assess their perceptions of patient care, resident education, and resident well-being during the study period. A survey was sent to all PDs of the general surgery residency programs participating in the FIRST trial (N = 117 [100% response rate]) in June and July 2015. The survey compared PDs' perceptions of the duty hour requirements in their arm of the FIRST trial during the study period from July 1, 2014 to June 30, 2015. One hundred percent of PDs in the Flexible Policy arm indicated that residents used their additional flexibility in duty hours to complete operations they started or to stabilize a critically ill patient. Compared with the Standard Policy arm, PDs in the Flexible Policy arm perceived a more positive effect of duty hours on the safety of patient care (68.9% vs 0%; p care (98.3% vs 0%; p care (71.8%), continuity of care (94.0%), quality of resident education (83.8%), and resident well-being (55.6%) would be improved with a hypothetical permanent adoption of more flexible duty hours. Program directors involved in the FIRST trial perceived improvements in patient safety, continuity of care, and multiple aspects of resident education and well-being with flexible duty hours. Copyright © 2016 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Teaching hospital financial status and patient outcomes following ACGME duty hour reform.

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Navathe, Amol S; Silber, Jeffrey H; Small, Dylan S; Rosen, Amy K; Romano, Patrick S; Even-Shoshan, Orit; Wang, Yanli; Zhu, Jingsan; Halenar, Michael J; Volpp, Kevin G

2013-04-01

To examine whether hospital financial health was associated with differential changes in outcomes after implementation of 2003 ACGME duty hour regulations. Observational study of 3,614,174 Medicare patients admitted to 869 teaching hospitals from July 1, 2000 to June 30, 2005. Interrupted time series analysis using logistic regression to adjust for patient comorbidities, secular trends, and hospital site. Outcomes included 30-day mortality, AHRQ Patient Safety Indicators (PSIs), failure-to-rescue (FTR) rates, and prolonged length of stay (PLOS). All eight analyses measuring the impact of duty hour reform on mortality by hospital financial health quartile, in postreform year 1 ("Post 1") or year 2 ("Post 2") versus the prereform period, were insignificant: Post 1 OR range 1.00-1.02 and Post 2 OR range 0.99-1.02. For PSIs, all six tests showed clinically insignificant effect sizes. The FTR rate analysis demonstrated nonsignificance in both postreform years (OR 1.00 for both). The PLOS outcomes varied significantly only for the combined surgical sample in Post 2, but this effect was very small, OR 1.03 (95% CI 1.02, 1.04). The impact of 2003 ACGME duty hour reform on patient outcomes did not differ by hospital financial health. This finding is somewhat reassuring, given additional financial pressure on teaching hospitals from 2011 duty hour regulations. © Health Research and Educational Trust.

[Staff Satisfaction within Duty Hour Models: Longitudinal Survey on Suitability and Legal Conformity at a Surgical Maximum Care Department].

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Langelotz, C; Koplin, G; Pascher, A; Lohmann, R; Köhler, A; Pratschke, J; Haase, O

2017-12-01

Background Between the conflicting requirements of clinic organisation, the European Working Time Directive, patient safety, an increasing lack of junior staff, and competitiveness, the development of ideal duty hour models is vital to ensure maximum quality of care within the legal requirements. To achieve this, it is useful to evaluate the actual effects of duty hour models on staff satisfaction. Materials and Methods After the traditional 24-hour duty shift was given up in a surgical maximum care centre in 2007, an 18-hour duty shift was implemented, followed by a 12-hour shift in 2008, to improve handovers and reduce loss of information. The effects on work organisation, quality of life and salary were analysed in an anonymous survey in 2008. The staff survey was repeated in 2014. Results With a response rate of 95% of questionnaires in 2008 and a 93% response rate in 2014, the 12-hour duty model received negative ratings due to its high duty frequency and subsequent social strain. Also the physical strain and chronic tiredness were rated as most severe in the 12-hour rota. The 18-hour duty shift was the model of choice amongst staff. The 24-hour duty model was rated as the best compromise between the requirements of work organisation and staff satisfaction, and therefore this duty model was adapted accordingly in 2015. Conclusion The essential basis of a surgical department is a duty hour model suited to the requirements of work organisation, the Working Time Directive and the needs of the surgical staff. A 12-hour duty model can be ideal for work organisation, but only if augmented with an adequate number of staff members, the implementation of this model is possible without the frequency of 12-hour shifts being too high associated with strain on surgical staff and a perceived deterioration of quality of life. A staff survey should be performed on a regular basis to assess the actual effects of duty hour models and enable further optimisation. The much

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

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

2018-04-14

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

The relationship of on-call work with fatigue, work-home interference, and perceived performance difficulties

NARCIS (Netherlands)

Ziebertz, C.M.; Hooff, M.L.M. van; Beckers, D.G.J.; Hooftman, W.E.; Kompier, M.A.J.; Geurts, S.A.E.

2015-01-01

This study examined the relationship between on-call duty exposure (active and total on-call hours a month, number of calls per duty) and employees’ experiences of being on-call (stress due to unpredictability, ability to relax during inactive on-call periods, restrictions during on-call duties,

Patient Perceptions of Whom is Most Involved in Their Care with Successive Duty Hour Limits.

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Arora, Vineet M; Prochaska, Micah T; Farnan, Jeanne M; Meltzer, David O

2015-09-01

Although direct patient care is necessary for experiential learning during residency, inpatient perceptions of the roles of resident and attending physicians in their care may have changed with residency duty hours. We aimed to assess if patients' perceptions of who is most involved in their care changed with residency duty hours. This was a prospective observational study over 12 years at a single institution. Participants were 22,408 inpatients admitted to the general medicine teaching service from 2001 to 2013, who completed a 1-month follow-up phone interview. Percentage of inpatients who reported an attending, resident, or intern as most involved in their care by duty hour period (pre-2003, post-2003-pre-2011, post-2011). With successive duty hour limits, the percentage of patients who reported the attending as most involved in their care increased (pre-2003 20 %, post-2003-pre-2011 29 %, post-2011 37 %, p care (pre-2003 20 %, post-2003-pre-2011 17 %, post-2011 12 %, p duty hours limits, hospitalized patients were more likely to report the attending physician and less likely to report the resident or intern as most involved in their hospital care. Given the importance of experiential learning to the formation of clinical judgment for independent practice, further study on the implications of these trends for resident education and patient safety is warranted.

A Systematic Review of the Effects of Resident Duty Hour Restrictions in Surgery

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Devitt, Katharine S.; Keshet, Itay; Spicer, Jonathan; Imrie, Kevin; Feldman, Liane; Cools-Lartigue, Jonathan; Kayssi, Ahmed; Lipsman, Nir; Elmi, Maryam; Kulkarni, Abhaya V.; Parshuram, Chris; Mainprize, Todd; Warren, Richard J.; Fata, Paola; Gorman, M. Sean; Feinberg, Stan; Rutka, James

2014-01-01

Background: In 2003, the Accreditation Council for Graduate Medical Education (ACGME) mandated 80-hour resident duty limits. In 2011 the ACGME mandated 16-hour duty maximums for PGY1 (post graduate year) residents. The stated goals were to improve patient safety, resident well-being, and education. A systematic review and meta-analysis were performed to evaluate the impact of resident duty hours (RDH) on clinical and educational outcomes in surgery. Methods: A systematic review (1980–2013) was executed on CINAHL, Cochrane Database, Embase, Medline, and Scopus. Quality of articles was assessed using the GRADE guidelines. Sixteen-hour shifts and night float systems were analyzed separately. Articles that examined mortality data were combined in a random-effects meta-analysis to evaluate the impact of RDH on patient mortality. Results: A total of 135 articles met the inclusion criteria. Among these, 42% (N = 57) were considered moderate-high quality. There was no overall improvement in patient outcomes as a result of RDH; however, some studies suggest increased complication rates in high-acuity patients. There was no improvement in education related to RDH restrictions, and performance on certification examinations has declined in some specialties. Survey studies revealed a perception of worsened education and patient safety. There were improvements in resident wellness after the 80-hour workweek, but there was little improvement or negative effects on wellness after 16-hour duty maximums were implemented. Conclusions: Recent RDH changes are not consistently associated with improvements in resident well-being, and have negative impacts on patient outcomes and performance on certification examinations. Greater flexibility to accommodate resident training needs is required. Further erosion of training time should be considered with great caution. PMID:24662409

Limitation of duty hour regulations for pediatric resident wellness: A mixed methods study in Japan.

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Nomura, Osamu; Mishina, Hiroki; Kobayashi, Yoshinori; Ishiguro, Akira; Sakai, Hirokazu; Kato, Hiroyuki

2016-09-01

Duty hour regulations have been placed in residency programs to address mental health concerns and to improve wellness. Here, we elucidate the prevalence of depressive symptoms after implementing an overnight call shift system and the factors associated with burnout or depression among residents.A sequential exploratory mixed methods study was conducted in a tertiary care pediatric and perinatal hospital in Tokyo, Japan. A total of 41 pediatric residents participated in the cross-sectional survey. We determined and compared the prevalence of depressive symptoms and the number of actual working hours before and after implementing the shift system. A follow-up focus-group interview with 4 residents was conducted to explore the factors that may trigger or prevent depression and burnout.Mean working hours significantly decreased from 75.2 hours to 64.9 hours per week. Prevalence of depressive symptoms remained similar before and after implementation of the shift system. Emotional exhaustion and depersonalization from the burnout scale were markedly associated with depression. High workload, stress intolerance, interpersonal difficulties, and generation gaps regarding work-life balance could cause burnout. Stress tolerance, workload monitoring and balancing, appropriate supervision, and peer support could prevent burnout.Although the overnight call shift system was effective in reducing working hours, its effectiveness in managing mental health issues among pediatric residents remains unclear. Resident wellness programs represent an additional strategy and they should be aimed at fostering peer support and improvement of resident-faculty interactions. Such an approach could be beneficial to the relationship between physicians of different generations with conflicting belief structures.

Impact of the 2011 ACGME resident duty hour reform on hospital patient experience and processes-of-care.

Science.gov (United States)

Rajaram, Ravi; Saadat, Lily; Chung, Jeanette; Dahlke, Allison; Yang, Anthony D; Odell, David D; Bilimoria, Karl Y

2016-12-01

In 2011, the Accreditation Council for Graduate Medical Education (ACGME) expanded restrictions on resident duty hours. While studies have shown no association between these restrictions and improved outcomes, process-of-care and patient experience measures may be more sensitive to resident performance, and thus may be impacted by duty hour policies. The objective of this study was to evaluate the association between the 2011 resident duty hour reform and measures of processes-of-care and patient experience. Hospital Consumer Assessment of Healthcare Providers and Systems survey data and process-of-care scores were obtained from the Centers for Medicare and Medicaid Services Hospital Compare website for 1 year prior to (1 July 2010 to 30 June 2011) and 1 year after (1 July 2011 to 30 June 2012) duty hour reform implementation. Using a difference-in-differences model, non-teaching and teaching hospitals were compared before and after the 2011 reform to test the association of this policy with changes in process-of-care and patient experience measure scores. Duty hour reform was not associated with a change in the five patient experience measures evaluated, including patients rating a hospital 9 or 10 (coefficient -0.003, 95% CI -0.79 to 0.79) or stating they would 'definitely recommend' a hospital (coefficient -0.28, 95% CI -1.01 to 0.44). For all 10 process-of-care measures examined, such as antibiotic timing (coefficient -0.462, 95% CI -1.502 to 0.579) and discontinuation (0.188, 95% CI -0.529 to 0.904), duty hour reform was not associated with a change in scores. The 2011 ACGME duty hour reform was not associated with improvements in process-of-care and patient experience measures. These data should be considered when considering reform of resident duty hour policies. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

The impact of transitioning from a 24-hour to a 16-hour call model amongst a cohort of Canadian anesthesia residents at McMaster University – a survey study

Directory of Open Access Journals (Sweden)

Sussman D

2015-08-01

Full Text Available David Sussman, James E Paul Department of Anesthesia, McMaster University, Hamilton, ON, Canada Purpose: The primary objective of this study was to assess anesthesia residents' opinions and perceptions on wellness/burnout, fatigue, education, and patient safety after the initiation of a reduced call model (16-hour call. Methods: A prospective cohort study was conducted at three time points during the 2013–2014 academic year. A web-based questionnaire consisting of 23 questions was electronically distributed to all anesthesia residents from postgraduate years (PGY 1 to 5 who were part of the active call roster (n=84 at McMaster University in Hamilton, Ontario. Descriptive summaries were calculated, counts and percentages were used for categorical variables, and answers to open text questions were reviewed for themes. Results: A response rate of 67% was obtained for this study. A majority of anesthesia residents (65% approved of 16-hour call, felt that their overall quality of life as a senior resident (PGY3 or greater or junior resident (PGY2 and below had improved (73% and 55%, respectively, and reported overall feeling less fatigued. Most respondents indicated that the quality of education remained unchanged (47%, or had improved (31%. And most felt better prepared for the royal college exam (52%. Most felt patient safety had improved or was unchanged (both 48%. Conclusion: The study demonstrates that 16-hour call improved resident wellness, reduced burnout and fostered an environment where residents are less fatigued and more satisfied with their educational experience promoting an environment of patient safety. Overall, the anesthesia residency group demonstrated that not only is 16-hour call preferred but beneficial. Keywords: resident wellness, reduced call model, duty hours, patient safety, cohort study, fatigue 

Increased Academic Productivity of Orthopaedic Surgery Residents Following 2011 Duty Hour Reform.

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Johnson, Joey P; Savage, Kevin; Gil, Joseph A; Eberson, Craig P; Mulcahey, Mary K

2017-12-19

In 2003 and again in 2011, the Accreditation Council for Graduate Medical Education (ACGME) mandated increasingly stringent resident duty hour restrictions. With less time required at the hospital, residents theoretically have more time for other academic activities, such as research. Our study seeks to examine whether the number of research publications by orthopaedic residents increased following implementation of the 2011 ACGME duty hour restrictions. Pubmed was queried using publicly available alumni lists from programs across the United States. The years 2008 to 2011 were included to assess pre-2011 productivity. The years 2012 to 2015 were included in the post 2011 group. Paired t tests were used to assess differences between groups. Statistical significance was set to p care in any meaningful way. In our study, there was a statistically significant increase in publications after 2011; however, the number of publications between NIH funded and non-NIH funded programs did not differ. Our study is the first to demonstrate that with increasing duty hour restrictions, orthopaedic surgery residents may be using more of their free time to conduct research. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Duty hours and pregnancy outcome among residents in obstetrics and gynecology.

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Gabbe, Steven G; Morgan, Maria A; Power, Michael L; Schulkin, Jay; Williams, Sterling B

2003-11-01

To assess the present status of resident duty hours in obstetrics and gynecology, identify existing policies concerning work schedules during pregnancy, and evaluate pregnancy outcome in female house officers. A questionnaire-based study was administered to residents taking the 2001 Council on Residency Education in Obstetrics and Gynecology examination. More than 90% of the residents reported that their institution had a maternity leave policy. The leave was usually 4-8 weeks long and was paid. Nearly 95% of residents reported that they had to take over the work of residents on maternity leave. Most women residents worked more than 80 hours weekly throughout pregnancy, and few took time off before delivery. Most pregnancies occurred during the fourth year of training and did not seem to be adversely affected by the long work hours. This study, performed before the institution of the new Accreditation Council for Graduate Medical Education resident duty hour policies, demonstrated that, although women house officers continued to work more than 80 hours per week during pregnancy, most had a good pregnancy outcome. Nevertheless, there was a higher frequency of preterm labor, preeclampsia, and fetal growth restriction in female residents than in spouses or partners of male residents.

Impacts of extended working hours in logging

Science.gov (United States)

Dana Mitchell; Tom Gallagher

2008-01-01

Last year at the 2007 AIM in Minneapolis, MN, the authors presented the human factors impacts to consider when implementing extended working hours in the logging industry. In a continuation of this project, we have researched existing literature to identify possible actions that logging business owners can take to reduce the impact of extended working hours on their...

Extended working hours: Impacts on workers

Science.gov (United States)

D. Mitchell; T. Gallagher

2010-01-01

Some logging business owners are trying to manage their equipment assets by increasing the scheduled machine hours. The intent is to maximize the total tons produced by a set of equipment. This practice is referred to as multi-shifting, double-shifting, or extended working hours. One area often overlooked is the impact that working non-traditional hours can have on...

Surgeon distress as calibrated by hours worked and nights on call.

Science.gov (United States)

Balch, Charles M; Shanafelt, Tait D; Dyrbye, Lotte; Sloan, Jeffrey A; Russell, Thomas R; Bechamps, Gerald J; Freischlag, Julie A

2010-11-01

The relationships of working hours and nights on call per week with various parameters of distress among practicing surgeons have not been previously examined in detail. More than 7,900 members of the American College of Surgeons responded to an anonymous, cross-sectional survey. The survey included self-assessment of their practice setting, a validated depression screening tool, and standardized assessments of burnout and quality of life. There was a clear gradient between hours and burnout, with the prevalence of burnout ranging from 30% for surgeons working hours/week, 44% for 60 to 80 hours/week, and 50% for those working >80 hours/week (p hours and nights on call (both p worked >80 hours/week reported a higher rate of medical errors compared with those who worked hours/week (10.7% versus 6.9%; p work and home conflicts were higher among surgeons who worked longer hours or had ≥2 nights on call. A significantly higher proportion of surgeons who worked >80 hours/week or had >2 nights on call/week would not become a surgeon again (p hours worked and nights on call per week appear to have a substantial impact on surgeons, both professionally and personally. These factors are strongly related to burnout, depression, career satisfaction, and work and home conflicts. Copyright © 2010 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

The relationship of on-call work with fatigue, work-home interference, and perceived performance difficulties

NARCIS (Netherlands)

Ziebertz, C.M.; Hooff, M.L.M. van; Beckers, D.G.J.; Hooftman, W.E.; Kompier, M.A.J.; Geurts, S.A.E.

2015-01-01

Objectives. This study examined the relationship between on-call duty exposure (active and total on-call hours a month, number of calls per duty) and employees’ experiences of being on-call (stress due to unpredictability, ability to relax during inactive on-call periods, restrictions during on-call

Assessing the functional performance of post-call hospital doctors using a Nintendo Wii.

LENUS (Irish Health Repository)

Clancy, K

2012-02-01

Sleep deprivation is an established part of the working life for Non-Consultant Hospital Doctors (NCHDs) in Ireland. Concern exists about the effect of extended NCHD work hours. We utilised a Nintendo Wii to evaluate motor function of NCHDs both prior to their on-call shift and the day afterwards. Data was exported to SPSS ver. 15 for statistical analysis with p < 0.05 considered significant. A total of 72 NCHDs were invited to participate in this study. There was a 62.5% (45) rate of follow-up. Overall 27 (60%) NCHDs were on medical call, with 18 (40%) on surgical call. There was no statistically significant difference between NCHDs pre-and post-call motor assessment scores. The majority of study participants (75.5%, n = 34) had four or more hours sleep. On-call duty allows for a greater than anticipated amount of sleep per on-call shift and therefore has a negligible effect on the motor skills of medical staff.

Nurses' extended work hours: Patient, nurse and organizational outcomes.

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Kunaviktikul, W; Wichaikhum, O; Nantsupawat, A; Nantsupawat, R; Chontawan, R; Klunklin, A; Roongruangsri, S; Nantachaipan, P; Supamanee, T; Chitpakdee, B; Akkadechanunt, T; Sirakamon, S

2015-09-01

Nursing shortages have been associated with increased nurse workloads that may result in work errors, thus impacting patient, nurse and organizational outcomes. To examine for the first time in Thailand nurses' extended work hours (working more than 40 h per week) and its relationship to patient, nurse and organizational outcomes. Using multistage sampling, 1524 registered nurses working in 90 hospitals across Thailand completed demographic forms: the Nurses' Extended Work Hours Form; the Patient, Nurse, Organizational Outcomes Form; the Organizational Productivity Questionnaire and the Maslach Burnout Inventory. The data were analysed using descriptive statistics, Spearman's rank correlation and logistic regression. The average extended work hour of respondents was 18.82 h per week. About 80% worked two consecutive shifts. The extended work hours had a positive correlation with patient outcomes, such as patient identification errors, pressure ulcers, communication errors and patient complaints and with nurse outcomes of emotional exhaustion and depersonalization. Furthermore, we found a negative correlation between extended work hours and job satisfaction as a whole, intent to stay and organizational productivity. Nurses who had extended work hours of >16 h per week were significantly more likely to perceive all four adverse patient outcomes than participants working an extended ≤8 h per week. Patient outcomes were measured by respondents' self-reports. This may not always reflect the real occurrence of adverse events. Associations between extended work hours and outcomes for patients, nurses and the organization were found. The findings demonstrate that working two shifts (16 h) more than the regular work hours lead to negative outcomes for patients, nurses and the organization. Our findings add to increasing international evidence that nurses' poor working conditions result in negative outcomes for professionals, patients and health systems

Resident operative experience in general surgery, plastic surgery, and urology 5 years after implementation of the ACGME duty hour policy.

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Simien, Christopher; Holt, Kathleen D; Richter, Thomas H; Whalen, Thomas V; Coburn, Michael; Havlik, Robert J; Miller, Rebecca S

2010-08-01

Resident duty hour restrictions were implemented in 2002-2003. This study examines changes in resident surgical experience since these restrictions were put into place. Operative log data for 3 specialties were examined: general surgery, urology, and plastic surgery. The academic year immediately preceding the duty hour restrictions, 2002-2003, was used as a baseline for comparison to subsequent academic years. Operative log data for graduating residents through 2007-2008 were the primary focus of the analysis. Examination of associated variables that may moderate the relationship between fewer duty hours and surgical volume was also included. Plastic surgery showed no changes in operative volume following duty hour restrictions. Operative volume increased in urology programs. General surgery showed a decrease in volume in some operative categories but an increase in others. Specifically the procedures in vascular, plastic, and thoracic areas showed a consistent decrease. There was no increase in the percentage of programs' graduates falling below minimum requirements. Procedures in pancreas, endocrine, and laparoscopic areas demonstrated an increase in volume. Graduates in larger surgical programs performed fewer procedures than graduates in smaller programs; this was not the case for urology or plastic surgery programs. The reduction of duty hours has not resulted in an across the board decrease in operative volume. Factors other than duty hour reforms may be responsible for some of the observed findings.

Hospitalized Patients' Perceptions of Resident Fatigue, Duty Hours, and Continuity of Care.

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Drolet, Brian C; Hyman, Charles H; Ghaderi, Kimeya F; Rodriguez-Srednicki, Joshua; Thompson, Jordan M; Fischer, Staci A

2014-12-01

Physicians' perceptions of duty hour regulations have been closely examined, yet patient opinions have been largely unstudied to date. We studied patient perceptions of residency duty hours, fatigue, and continuity of care following implementation of the Accreditation Council for Graduate Medical Education 2011 Common Program Requirements. A cross-sectional survey was administered between June and August 2013 to inpatients at a large academic medical center and an affiliated community hospital. Adult inpatients on teaching medical and surgical services were eligible for inclusion in the study. Survey response rate was 71.3% (513 of 720). Most respondents (57.1%, 293 of 513) believed residents should not be assigned to shifts longer than 12 hours, and nearly half (49.7%, 255 of 513) wanted to be notified if a resident caring for them had worked longer than 12 hours. Most patients (63.2%, 324 of 513) believed medical errors commonly occurred because of fatigue, and fewer (37.4%, 192 of 513; odds ratio, 0.56; P care. Given the choice between a familiar physician who "may be tired from a long shift" or a "fresh" physician who had received sign-out, more patients chose the fresh but unfamiliar physician (57.1% [293 of 513] versus 42.7% [219 of 513], P care.

Morbidity, mortality, and health care costs for patients undergoing spine surgery following the ACGME resident duty-hour reform: Clinical article.

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Babu, Ranjith; Thomas, Steven; Hazzard, Matthew A; Lokhnygina, Yuliya V; Friedman, Allan H; Gottfried, Oren N; Isaacs, Robert E; Boakye, Maxwell; Patil, Chirag G; Bagley, Carlos A; Haglund, Michael M; Lad, Shivanand P

2014-10-01

The Accreditation Council for Graduate Medical Education (ACGME) implemented resident duty-hour restrictions on July 1, 2003, in concern for patient and resident safety. Whereas studies have shown that duty-hour restrictions have increased resident quality of life, there have been mixed results with respect to patient outcomes. In this study, the authors have evaluated the effect of duty-hour restrictions on morbidity, mortality, length of stay (LOS), and charges in patients who underwent spine surgery. The Nationwide Inpatient Sample was used to evaluate the effect of duty-hour restrictions on complications, mortality, LOS, and charges by comparing the prereform (2000-2002) and postreform (2005-2008) periods. Outcomes were compared between nonteaching and teaching hospitals using a difference-in-differences (DID) method. Results A total of 693,058 patients were included in the study. The overall complication rate was 8.6%, with patients in the postreform era having a significantly higher rate than those in the pre-duty-hour restriction era (8.7% vs. 8.4%, p duty-hour reform era. The DID analysis to compare the magnitude in change between teaching and nonteaching institutions revealed that teaching institutions to had a significantly greater increase in complications during the postreform era (p = 0.0002). The overall mortality rate was 0.37%, with no significant difference between the pre- and post-duty-hour eras (0.39% vs. 0.36%, p = 0.12). However, the mortality rate significantly decreased in nonteaching hospitals in the postreform era (0.30% vs. 0.23%, p = 0.0008), while remaining the same in teaching institutions (0.46% vs. 0.46%, p = 0.75). The DID analysis to compare the changes in mortality between groups revealed that the difference between the effects approached significance (p = 0.069). The mean LOS for all patients was 4.2 days, with hospital stay decreasing in nonteaching hospitals (3.7 vs. 3.5 days, p duty-hour reform era, increasing from $40,000 in

Physician alert: the legal risks associated with 'on-call' duties in the USA.

Science.gov (United States)

Paterick, Zachary R; Patel, Nachiket J; Paterick, Timothy Edward

2018-06-13

On-call physicians encounter a diverse aggregate of interfaces with sundry persons concerning patient care that may surface potential legal peril. The duties and obligations of an on-call physician, who must act as a fiduciary to all patients, create a myriad of circumstances where there is a risk of falling prey to legal ambiguities. The understanding of the doctor-patient relationship, the obligations of physicians under the Emergency Medical Treatment and Labor Act, the meaning of medical informed consent and the elements of negligence will help physicians avoid the legal risk associated with the various encounters of being on call. After introducing the legal concepts, we will explore the interactions that may put physicians at legal risk and outline how to mitigate that risk. Being on call is time consuming and arduous. While on call, physicians have a duty to act morally and ethically in the best interest of the patients. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Quantitative and qualitative perceptions of the 2011 residency duty hour restrictions: a multicenter, multispecialty cross-sectional study.

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Tierney, William S; Elkin, Rachel L; Nielsen, Craig D

2015-03-25

July 2011 saw the implementation of the newest duty hour restrictions, further limiting the working hours of first year residents and necessitating a variety of adaptations on the part of residency programs. The present study sought to characterize the perceived impact of these restrictions on residency program personnel using a multi-specialty and multi-site approach. We developed and administered a survey to internal medicine and general surgery residency programs at three academic medical centers within an urban region. The survey combined quantitative and qualitative components to gain a broader understanding of the impact of the newest regulations. Quantitative responses were compared between Internal Medicine and General Surgery programs with Student t-tests. Other comparisons were performed using ANOVA or Kruskal-Wallis testing as appropriate. For all comparisons, the threshold for significance was set at 0.01. Two independent reviewers coded all qualitative data and assigned one or more themes based on content. Descriptive statistics were calculated and the diversity of themes identified. No between-group comparisons were conducted with the qualitative data. We found significant differences in the overall perceptions of duty hour restrictions across specialty (internal medicine more positive than general surgery) and across position (first year residents more positive than senior residents and faculty). Notably, individuals who trained at osteopathic medical schools reported significantly more negative views of the duty hour restrictions than those who had trained at allopathic or international medical schools, suggesting an influence of undergraduate medical training. The complementary qualitative data offered insights into the perceived strengths and weaknesses of the duty hour restrictions, as well as actionable suggestions that could help to improve residency program function. This study characterizes responses to the new duty hour restrictions from a

Impact of resident duty hour limits on safety in the intensive care unit: a national survey of pediatric and neonatal intensivists.

Science.gov (United States)

Typpo, Katri V; Tcharmtchi, M Hossein; Thomas, Eric J; Kelly, P Adam; Castillo, Leticia D; Singh, Hardeep

2012-09-01

Resident duty-hour regulations potentially shift the workload from resident to attending physicians. We sought to understand how current or future regulatory changes might impact safety in academic pediatric and neonatal intensive care units. Web-based survey. U.S. academic pediatric and neonatal intensive care units. Attending pediatric and neonatal intensivists. We evaluated perceptions on four intensive care unit safety-related risk measures potentially affected by current duty-hour regulations: 1) attending physician and resident fatigue; 2) attending physician workload; 3) errors (self-reported rates by attending physicians or perceived resident error rates); and 4) safety culture. We also evaluated perceptions of how these risks would change with further duty-hour restrictions. We administered our survey between February and April 2010 to 688 eligible physicians, of whom 360 (52.3%) responded. Most believed that resident error rates were unchanged or worse (91.9%) and safety culture was unchanged or worse (84.4%) with current duty-hour regulations. Of respondents, 61.9% believed their own work-hours providing direct patient care increased and 55.8% believed they were more fatigued while providing direct patient care. Most (85.3%) perceived no increase in their own error rates currently, but in the scenario of further reduction in resident duty-hours, over half (53.3%) believed that safety culture would worsen and a significant proportion (40.3%) believed that their own error rates would increase. Pediatric intensivists do not perceive improved patient safety from current resident duty-hour restrictions. Policies to further restrict resident duty-hours should consider unintended consequences of worsening certain aspects of intensive care unit safety.

Making sense: duty hours, work flow, and waste in graduate medical education.

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Bush, Roger W; Philibert, Ingrid

2009-12-01

Parsimony, and not industry, is the immediate cause of the increase of capital. Industry, indeed, provides the subject which parsimony accumulates. But whatever industry might acquire, if parsimony did not save and store up, the capital would never be the greater.Adam Smith, The Wealth of Nations, book 2, chapter 31In 2003, the Accreditation Council for Graduate Medical Education implemented resident duty hour limits that included a weekly limit and limits on continuous hours. Recent recommendations for added reductions in resident duty hours have produced concern about concomitant reductions in future graduates' preparedness for independent practice. The current debate about resident hours largely does not consider whether all hours residents spend in the educational and clinical-care environment contribute meaningfully either to residents' learning or to effective patient care. This may distract the community from waste in the current clinical-education model. We propose that use of "lean production" and quality improvement methods may assist teaching institutions in attaining a deeper understanding of work flow and waste. These methods can be used to assign value to patient- and learner-centered activities and outputs and to optimize the competing and synergistic aspects of all desired outcomes to produce the care the Institute of Medicine recommends: safe, effective, efficient, patient-centered, timely, and equitable. Finally, engagement of senior clinical faculty in determining the culture of the care and education system will contribute to an advanced social-learning and care network.

Assessing the Effects of the 2003 Resident Duty Hours Reform on Internal Medicine Board Scores

Science.gov (United States)

Romano, Patrick S.; Itani, Kamal M.F.; Rosen, Amy K.; Small, Dylan; Lipner, Rebecca S.; Bosk, Charles L.; Wang, Yanli; Halenar, Michael J.; Korovaichuk, Sophia; Even-Shoshan, Orit; Volpp, Kevin G.

2014-01-01

Purpose To determine whether the 2003 Accreditation Council for Graduate Medical Education (ACGME) duty hours reform affected medical knowledge as reflected by written board scores for internal medicine (IM) residents. Method The authors conducted a retrospective cohort analysis of postgraduate year 1 (PGY-1) Internal Medicine residents who started training before and after the 2003 duty hour reform using a merged data set of American Board of Internal Medicine (ABIM) Board examination and the National Board of Medical Examiners (NMBE) United States Medical Licensing Examination (USMLE) Step 2 Clinical Knowledge test scores. Specifically, using four regression models, the authors compared IM residents beginning PGY-1 training in 2000 and completing training unexposed to the 2003 duty hours reform (PGY-1 2000 cohort, n = 5,475) to PGY-1 cohorts starting in 2001 through 2005 (n = 28,008), all with some exposure to the reform. Results The mean ABIM board score for the unexposed PGY-1 2000 cohort (n = 5,475) was 491, SD = 85. Adjusting for demographics, program, and USMLE Step 2 exam score, the mean differences (95% CI) in ABIM board scores between the PGY-1 2001, 2002, 2003, 2004 and 2005 cohorts minus the PGY-1 2000 cohort were −5.43 (−7.63, −3.23), −3.44 (−5.65, −1.24), 2.58 (0.36, 4.79), 11.10 (8.88, 13.33) and 11.28 (8.98, 13.58) points respectively. None of these differences exceeded one-fifth of an SD in ABIM board scores. Conclusions The duty hours reforms of 2003 did not meaningfully affect medical knowledge as measured by scores on the ABIM board examinations. PMID:24556772

The Interventional Arm of the Flexibility In Duty-Hour Requirements for Surgical Trainees Trial: First-Year Data Show Superior Quality In-Training Initiative Outcomes.

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Mirmehdi, Issa; O'Neal, Cindy-Marie; Moon, Davis; MacNew, Heather; Senkowski, Christopher

With the implementation of strict 80-hour work week in general surgery training, serious questions have been raised concerning the quality of surgical education and the ability of newly trained general surgeons to independently operate. Programs that were randomized to the interventional arm of the Flexibility In duty-hour Requirements for Surgical Trainees (FIRST) Trial were able to decrease transitions and allow for better continuity by virtue of less constraints on duty-hour rules. Using National Surgical Quality Improvement Program Quality In-Training Initiative data along with duty-hour violations compared with old rules, it was hypothesized that quality of care would be improved and outcomes would be equivalent or better than the traditional duty-hour rules. It was also hypothesized that resident perception of compliance with duty hour would not change with implementation of new regulations based on FIRST trial. Flexible work hours were implemented on July 1, 2014. National Surgical Quality Improvement Program Quality In-Training Initiative information was reviewed from July 2014 to January 2015. Patient risk factors and outcomes were compared between institutional resident cases and the national cohort for comparison. Residents' duty-hour logs and violations during this period were compared to the 6-month period before the implementation of the FIRST trial. The annual Accreditation Council for Graduate Medical Education resident survey was used to assess the residents' perception of compliance with duty hours. With respect to the postoperative complications, the only statistically significant measures were higher prevalence of pneumonia (3.4% vs. 1.5%, p flexible duty hours. All other measures of postoperative surgical complications showed no difference. The total number of duty-hour violations decreased from 54 to 16. Had the institution not been part of the interventional arm of the FIRST trial, this number would have increased to 238. The residents

The Accreditation Council for Graduate Medical Education resident duty hour new standards: history, changes, and impact on staffing of intensive care units.

Science.gov (United States)

Pastores, Stephen M; O'Connor, Michael F; Kleinpell, Ruth M; Napolitano, Lena; Ward, Nicholas; Bailey, Heatherlee; Mollenkopf, Fred P; Coopersmith, Craig M

2011-11-01

The Accreditation Council for Graduate Medical Education recently released new standards for supervision and duty hours for residency programs. These new standards, which will affect over 100,000 residents, take effect in July 2011. In response to these new guidelines, the Society of Critical Care Medicine convened a task force to develop a white paper on the impact of changes in resident duty hours on the critical care workforce and staffing of intensive care units. A multidisciplinary group of professionals with expertise in critical care education and clinical practice. Relevant medical literature was accessed through a systematic MEDLINE search and by requesting references from all task force members. Material published by the Accreditation Council for Graduate Medical Education and other specialty organizations was also reviewed. Collaboratively and iteratively, the task force corresponded by electronic mail and held several conference calls to finalize this report. The new rules mandate that all first-year residents work no more than 16 hrs continuously, preserving the 80-hr limit on the resident workweek and 10-hr period between duty periods. More senior trainees may work a maximum of 24 hrs continuously, with an additional 4 hrs permitted for handoffs. Strategic napping is strongly suggested for trainees working longer shifts. Compliance with the new Accreditation Council for Graduate Medical Education duty-hour standards will compel workflow restructuring in intensive care units, which depend on residents to provide a substantial portion of care. Potential solutions include expanded utilization of nurse practitioners and physician assistants, telemedicine, offering critical care training positions to emergency medicine residents, and partnerships with hospitalists. Additional research will be necessary to evaluate the impact of the new standards on patient safety, continuity of care, resident learning, and staffing in the intensive care unit.

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

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

2018-02-08

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

Sleep and recovery in physicians on night call: a longitudinal field study

Directory of Open Access Journals (Sweden)

Malmberg Birgitta

2010-08-01

Full Text Available Abstract Background It is well known that physicians' night-call duty may cause impaired performance and adverse effects on subjective health, but there is limited knowledge about effects on sleep duration and recovery time. In recent years occupational stress and impaired well-being among anaesthesiologists have been frequently reported for in the scientific literature. Given their main focus on handling patients with life-threatening conditions, when on call, one might expect sleep and recovery to be negatively affected by work, especially in this specialist group. The aim of the present study was to examine whether a 16-hour night-call schedule allowed for sufficient recovery in anaesthesiologists compared with other physician specialists handling less life-threatening conditions, when on call. Methods Sleep, monitored by actigraphy and Karolinska Sleep Diary/Sleepiness Scale on one night after daytime work, one night call, the following first and second nights post-call, and a Saturday night, was compared between 15 anaesthesiologists and 17 paediatricians and ear, nose, and throat surgeons. Results Recovery patterns over the days after night call did not differ between groups, but between days. Mean night sleep for all physicians was 3 hours when on call, 7 h both nights post-call and Saturday, and 6 h after daytime work (p Conclusions Despite considerable sleep loss during work on night call, and unexpectedly short sleep after ordinary day work, the physicians' self-reports indicate full recovery after two nights' sleep. We conclude that these 16-hour night duties were compatible with a short-term recovery in both physician groups, but the limited sleep duration in general still implies a long-term health concern. These results may contribute to the establishment of safe working hours for night-call duty in physicians and other health-care workers.

Physiological and psychological impacts of extended work hours in logging operations

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Dana Mitchell; Tom Gallagher

2007-01-01

A study was initiated in 2006 to develop an understanding of the considerations of using extended work hours in the logging industry in the southeastern United States. Through semistructured interviews, it was obvious that loggers were individually creating ways of successfully implementing extended working hours without understanding the impacts that extended working...

Where do out-of-hours calls to a consultant microbiologist come from?

LENUS (Irish Health Repository)

Humphreys, H

2009-08-01

There is little in the literature about out-of-hours calls to medical microbiologists. The calls taken by a consultant medical microbiologist over a five-year period in an Irish tertiary referral hospital were reviewed. Excluding calls on weekend mornings and significant evening positive blood cultures, the mean annual number of calls on a one-in-four rota was 89 (range 70-111). Over 90% of calls were received before midnight and 51% were from specialist registrars. Medical specialties, neurosurgery and intensive care were the most common departments seeking advice. Two-thirds of calls related to the management of an individual patient, but advice on infection prevention and control is increasingly requested. Calls out-of-hours are not insignificant but little is known about how these vary between hospitals and what contribution they make to patient care.

Association of the 2011 ACGME resident duty hour reform with general surgery patient outcomes and with resident examination performance.

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Rajaram, Ravi; Chung, Jeanette W; Jones, Andrew T; Cohen, Mark E; Dahlke, Allison R; Ko, Clifford Y; Tarpley, John L; Lewis, Frank R; Hoyt, David B; Bilimoria, Karl Y

2014-12-10

In 2011, the Accreditation Council for Graduate Medical Education (ACGME) restricted resident duty hour requirements beyond those established in 2003, leading to concerns about the effects on patient care and resident training. To determine if the 2011 ACGME duty hour reform was associated with a change in general surgery patient outcomes or in resident examination performance. Quasi-experimental study of general surgery patient outcomes 2 years before (academic years 2009-2010) and after (academic years 2012-2013) the 2011 duty hour reform. Teaching and nonteaching hospitals were compared using a difference-in-differences approach adjusted for procedural mix, patient comorbidities, and time trends. Teaching hospitals were defined based on the proportion of cases at which residents were present intraoperatively. Patients were those undergoing surgery at hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP). General surgery resident performance on the annual in-training, written board, and oral board examinations was assessed for this same period. National implementation of revised resident duty hour requirements on July 1, 2011, in all ACGME accredited residency programs. Primary outcome was a composite of death or serious morbidity; secondary outcomes were other postoperative complications and resident examination performance. In the main analysis, 204,641 patients were identified from 23 teaching (n = 102,525) and 31 nonteaching (n = 102,116) hospitals. The unadjusted rate of death or serious morbidity improved during the study period in both teaching (11.6% [95% CI, 11.3%-12.0%] to 9.4% [95% CI, 9.1%-9.8%], P adverse outcome. Mean (SD) in-training examination scores did not significantly change from 2010 to 2013 for first-year residents (499.7 [ 85.2] to 500.5 [84.2], P = .99), for residents from other postgraduate years, or for first-time examinees taking the written or oral board

Gender-Based Differences in Surgical Residents' Perceptions of Patient Safety, Continuity of Care, and Well-Being: An Analysis from the Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST) Trial.

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Ban, Kristen A; Chung, Jeanette W; Matulewicz, Richard S; Kelz, Rachel R; Shea, Judy A; Dahlke, Allison R; Quinn, Christopher M; Yang, Anthony D; Bilimoria, Karl Y

2017-02-01

Little is known about gender differences in residency training experiences and whether duty hour policies affect these differences. Using data from the Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST) trial, we examined gender differences in surgical resident perceptions of patient safety, education, health and well-being, and job satisfaction, and assessed whether duty hour policies affected gender differences. We compared proportions of male and female residents expressing dissatisfaction or perceiving a negative effect of duty hours on aspects of residency training (ie patient safety, resident education, well-being, job satisfaction) overall and by PGY. Logistic regression models with robust clustered SEs were used to test for significant gender differences and interaction effects of duty hour policies on gender differences. Female PGY2 to 3 residents were more likely than males to be dissatisfied with patient safety (odds ratio [OR] = 2.50; 95% CI, 1.29-4.84) and to perceive a negative effect of duty hours on most health and well-being outcomes (OR = 1.51-2.10; all p duty hours reduced gender differences in career dissatisfaction among interns (p = 0.028), but widened gender differences in negative perceptions of duty hours on patient safety (p duty hour policies. Copyright © 2016 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Interactionability in Computer Game: Call of Duty

Directory of Open Access Journals (Sweden)

masoud Kowsari

2009-11-01

Full Text Available For a long time communication theorists have criticized public media for being unilateral. What they prescript is to transform pattern of communication into bilateral one; in other words, to make media interactional. Telephone is the first fully interactional, however, there was a long road to the contemporary communication and information media which are highly interactional. Nevertheless, not all the modern media are equally interactional. Therefore, it is necessary to evaluate levels of interactionability in modern media and strength them. As other concepts in communication, interaction has different definitions, implying various aspects of the audience-media relation. And this feature of multi-dimensionality is to be considered. Quistis (2002 suggests a model in which all the technical, social, and comprehensive aspects of interaction are inherent. In other words, not only the technical aspect of media, but also audience’s perception plays a key role in the model. Visual-computer games are good instance of interactionability in modern media. However, not all games are equally interactional. Analyzing a well-known computer game “Call of Duty”, this article attempts to study different levels of interactionability. The main question is: how can one offer a pragmatic definition of three dimensions of interactionability to study computer games; and how this features are in Call of Duty applied?

Training on the clock: family medicine residency directors' responses to resident duty hours reform.

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Peterson, Lars E; Johnson, Hillary; Pugno, Perry A; Bazemore, Andrew; Phillips, Robert L

2006-12-01

The Accreditation Council for Graduate Medical Education's 2003 restrictions on resident duty hours (RDH) raised concerns among educators about potential negative impacts on residents' training. In the early wake of these restrictions, little is known about how RDH reform impacts training in primary care. The authors surveyed family medicine (FM) residency program directors (PDs) for their perceptions of the impact of RDH regulations on training in primary care. All PDs of 472 FM residency programs were asked via list-serve to complete an anonymous Internet-based survey in the fall of 2004. The survey solicited PDs' opinions about changes in staff and in residents' training experiences with respect to implementation of RDH regulations. Descriptive and qualitative analyses were conducted. There were 369 partial and 328 complete responses, for a response rate of 69% (328/472). Effects of the RDH regulations are varied. Fifty percent of FMPDs report increased patient-care duties for attendings, whereas 42% report no increase. Nearly 80% of programs hired no additional staff. Sixty percent of programs eliminated postcall clinics, and nearly 40% implemented a night-float system. Administrative hassles and losses of professionalism, educational opportunity, and continuity of care were common concerns, but a sizeable minority feel that residents will be better off under the new regulations. Many FMPDs cited increased faculty burden and the risk of lower-quality educational experiences for their trainees. Innovations for increasing the effectiveness of teaching may ultimately compensate for lost educational time. If not, alternatives such as extending the length of residency must be considered.

The effect of duty hour regulation on resident surgical case volume in otolaryngology.

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Curtis, Stuart H; Miller, Robert H; Weng, Cindy; Gurgel, Richard K

2014-10-01

Evaluate the effect of duty hour regulation on graduating otolaryngology resident surgical case volume and analyze trends in surgical case volume for Accreditation Council for Graduate Medical Education (ACGME) key indicator cases from 1996 to 2011. Time-trend analysis of surgical case volume. Nationwide sample of otolaryngology residency programs. Operative logs from the American Board of Otolaryngology and ACGME for otolaryngology residents graduating in the years 1996 to 2011. Key indicator volumes and grouped domain volumes before and after resident duty hour regulations (2003) were calculated and compared. Independent t test was performed to evaluate overall difference in operative volume. Wilcoxon rank sum test evaluated differences between procedures per time period. Linear regression evaluated trend. The average total number of key indicator cases per graduating resident was 440.8 in 1996-2003 compared to 500.4 cases in 2004-2011, and overall average per number of key indicators was 31.5 and 36.2, respectively (P = .067). Four key indicator cases showed statistically significant (P otolaryngology residents. The overall trend in operative volume is increasing for several specific key indicators. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2014.

Development and evaluation of a hand held computer based on-call pack for health protection out of hours duty: A pilot study

Directory of Open Access Journals (Sweden)

Williams Christopher J

2005-04-01

Full Text Available Abstract Background The on call service for health protection in most parts of the UK is provided by general public health consultants, registrars and nurses as the first tier of response backed up by medical consultants in health protection. The first tier responder usually carries a large bag of papers containing both local and national guidance on the management of common cases/incidents. An electronic on call pack may provide a suitable practical alternative to large paper based systems and help professionals deliver out of hours health protection advice and response to incidents. Methods We developed and piloted an electronic on call pack in Hertfordshire for use at the health protection unit level containing key local and national guidelines, contact information and useful references. The on-call pack was initially piloted using a laptop and more recently using a personal digital assistant (PDA. The use of the on-call pack was evaluated. Results Key advantages of the electronic system include reduced size, faster access to information that is clearly indexed and the relative ease of updating information. As part of the pilot, the electronic on call pack was presented to a local and regional training meeting with good response from participants using qualitative and quantitative methods. Conclusion It is anticipated that with suitable evaluation this system can be adapted and utilised by other health protection practitioners. This system provides a fast, reliable and easily maintained source of information for the public health on-call team.

Duty hour restrictions and surgical complications for head and neck key indicator procedures.

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Smith, Aaron; Jain, Nikhita; Wan, Jim; Wang, Lei; Sebelik, Merry

2017-08-01

Graduate medical education has traditionally required long work hours, allowing trainees little time for adequate rest. Based on concerns over performance deterioration with sleep deprivation and its effect on patient outcomes, duty hour restrictions have been mandated. We sought to characterize complications from otolaryngology key indicator procedures performed before and after duty hour reform. Retrospective cross-sectional analysis of National Inpatient Sample (NIS). The NIS was queried for procedure codes associated with head and neck key indicator groupings for the years 2000-2002 (45,363 procedures) and 2006-2008 (51,144 procedures). Hospitals were divided into three groups: nonteaching hospitals (NTH), teaching hospitals without otolaryngology programs (TH), and teaching hospitals with otolaryngology programs (TH-OTO). Surgical complication rates, length of stay, and mortality rates were analyzed using logistic and linear regression. The number of procedures increased (12.7%), with TH-OTO contributing more in postrestriction years (21% to 30%). Overall complication rates between the two periods revealed no difference, regardless of hospital setting. Subset analysis showed some variation within each complication within each grouping. Length of stay increased at TH-OTO (2.75 to 2.78 days) and decreased at NTH (2.28 to 2.24 days) and TH (2.39 to 2.36 days). Mortality did not increase among the three hospital types (NTH, P key indicator procedures. Moreover, concerns about reduced surgical case numbers appear unfounded, especially for otolaryngology programs. 2c Laryngoscope, 127:1797-1803, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

Medical Decisions of Pediatric Residents Turn Riskier after a 24-Hour Call with No Sleep.

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Aran, Adi; Wasserteil, Netanel; Gross, Itai; Mendlovic, Joseph; Pollak, Yehuda

2017-01-01

Despite a gradual reduction in the workload during residency, 24-hour calls are still an integral part of most training programs. While sleep deprivation increases the risk propensity, the impact on medical risk taking has not been studied. This study aimed to assess the clinical decision making and psychomotor performance of pediatric residents following a limited nap time during a 24-hour call. A neurocognitive battery (IntegNeuro) and a medical decision questionnaire were completed by 44 pediatric residents at 2 time points: after a 24-hour call and following 3 nights with no calls (sleep ≥5 hours). To monitor sleep, residents wore actigraphs and completed sleep logs. Nap time during the shift was change in risk taking) or 2 to 3 hours (4% decreased risk taking) (difference between groups, P = 0.001). Risk-taking tendency inversely correlated with sustained attention scores (Pearson = -0.433, P = 0.003). Sustained attention was the neurocognitive domain most affected by sleep deprivation (effect size = 0.29, P = 0.025). This study suggests that residents napping less than an hour during a night shift are prone to riskier clinical decisions. Hence, enabling residents to nap at least 1 hour during shifts is recommended. © The Author(s) 2016.

ZENK expression in the auditory pathway of black-capped chickadees (Poecile atricapillus) as a function of D note number and duty cycle of chick-a-dee calls.

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Scully, Erin N; Schuldhaus, Brenna C; Congdon, Jenna V; Hahn, Allison H; Campbell, Kimberley A; Wilson, David R; Sturdy, Christopher B

2018-06-08

Black-capped chickadees (Poecile atricapillus) use their namesake chick-a-dee call for multiple functions, altering the features of the call depending on context. For example, duty cycle (the proportion of time filled by vocalizations) and fine structure traits (e.g., number of D notes) can encode contextual factors, such as predator size and food quality. Wilson and Mennill [1] found that chickadees show stronger behavioral responses to playback of chick-a-dee calls with higher duty cycles, but not to the number of D notes. That is, independent of the number of D notes in a call, but dependent on the overall proportion of time filled with vocalization, birds responded more to higher duty cycle playback compared to lower duty cycle playback. Here we presented chickadees with chick-a-dee calls that contained either two D (referred to hereafter as 2 D) notes with a low duty cycle, 2 D notes with a high duty cycle, 10 D notes with a high duty cycle, or 2 D notes with a high duty cycle but played in reverse (a non-signaling control). We then measured ZENK expression in the auditory nuclei where perceptual discrimination is thought to occur. Based on the behavioral results of Wilson and Mennill [1], we predicted we would observe the highest ZENK expression in response to forward-playing calls with high duty cycles; we predicted we would observe no significant difference in ZENK expression between forward-playing high duty cycle playbacks (2 D or 10 D). We found no significant difference between forward-playing 2 D and 10 D high duty cycle playbacks. However, contrary to our predictions, we did not find any effects of altering the duty cycle or note number presented. Copyright © 2018 Elsevier B.V. All rights reserved.

Effects of a night-team system on resident sleep and work hours.

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Chua, Kao-Ping; Gordon, Mary Beth; Sectish, Theodore; Landrigan, Christopher P

2011-12-01

In 2009, Children's Hospital Boston implemented a night-team system on general pediatric wards to reduce extended work shifts. Residents worked 5 consecutive nights for 1 week and worked day shifts for the remainder of the rotation. Of note, resident staffing at night decreased under this system. The objective of this study was to assess the effects of this system on resident sleep and work hours. We conducted a prospective cohort study in which residents on the night-team system logged their sleep and work hours on work days. These data were compared with similar data collected in 2004, when there was a traditional call system. In 2004 and 2009, mean shift length was 15.22 ± 6.86 and 12.92 ± 5.70 hours, respectively (P = .161). Daily work hours were 10.49 ± 6.85 and 8.79 ± 6.42 hours, respectively (P = .08). Nightly sleep time decreased from 6.72 ± 2.60 to 4.77 ± 2.46 hours (P team system was unexpectedly associated with decreased sleep hours. As residency programs create work schedules that are compliant with the 2011 Accreditation Council for Graduate Medical Education duty-hour standards, resident sleep should be monitored carefully.

Recovery of Sleep, Performance, and Mood Following 38 Hours of Sleep Deprivation Using Naps as a Countermeasure

National Research Council Canada - National Science Library

Caldwell, J

1998-01-01

In certain situations, soldiers must continue to perform their duties over an extended period of time, knowing that their regular sleep period will be missed and their time awake will extend well past 24 hours...

Effect of 16-hour duty periods on patient care and resident education.

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McCoy, Christopher P; Halvorsen, Andrew J; Loftus, Conor G; McDonald, Furman S; Oxentenko, Amy S

2011-03-01

To measure the effect of duty periods no longer than 16 hours on patient care and resident education. As part of our Educational Innovations Project, we piloted a novel resident schedule for an inpatient service that eliminated shifts longer than 16 hours without increased staffing or decreased patient admissions on 2 gastroenterology services from August 29 to November 27, 2009. Patient care variables were obtained through medical record review. Resident well-being and educational variables were collected by weekly surveys, end of rotation evaluations, and an electronic card-swipe system. Patient care metrics, including 30-day mortality, 30-day readmission rate, and length of stay, were unchanged for the 196 patient care episodes in the 5-week intervention month compared with the 274 episodes in the 8 weeks of control months. However, residents felt less prepared to manage cross-cover of patients (P = .006). There was a nonsignificant trend toward decreased perception of quality of education and balance of personal and professional life during the intervention month. Residents reported working fewer weekly hours overall during the intervention (64.3 vs 68.9 hours; P = .40), but they had significantly more episodes with fewer than 10 hours off between shifts (24 vs 2 episodes; P = .004). Inpatient hospital services can be staffed with residents working shifts less than 16 hours without additional residents. However, cross-cover of care, quality of education, and time off between shifts may be adversely affected.

On-call work and physicians' well-being: testing the potential mediators.

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Heponiemi, T; Puttonen, S; Elovainio, M

2014-07-01

On-call duties have been rated to be among the most stressful aspects of physicians' work. On-call work has been associated, for example, with medical errors, injuries and lower well-being. Thus, because it is not possible to remove on-call duties, measures to decrease the negative ramifications of on-call work are needed. To examine whether working on-call would predict psychological distress, job satisfaction and work ability in a 4-year follow-up and whether sleeping problems or work interference with family (WIF) would act as mechanisms in these associations. Questionnaires in 2006 and 2010 among physicians in Finland. The mediation analyses were conducted using methods suggested by Preacher and Hayes to examine direct and indirect effects with multiple mediators. There were 1541 respondents (60% women) of whom 52% had on-call duties. Sleeping problems and WIF acted as mechanisms in the association of existence of on-call duties with high distress, low job satisfaction and low work ability. On-call work was associated with higher levels of sleeping problems and WIF, and the number of active on-call hours was associated with higher levels of WIF, but not with sleeping problems. According to our results, one way to attenuate on-call work's negative ramifications is to make it easier for on-call physicians to connect work and family lives and develop work arrangements to promote better sleep and protected sleep time. © The Author 2014. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

The Relationship of On-Call Work with Fatigue, Work-Home Interference, and Perceived Performance Difficulties.

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Ziebertz, Carla M; van Hooff, Madelon L M; Beckers, Debby G J; Hooftman, Wendela E; Kompier, Michiel A J; Geurts, Sabine A E

2015-01-01

This study examined the relationship between on-call duty exposure (active and total on-call hours a month, number of calls per duty) and employees' experiences of being on-call (stress due to unpredictability, ability to relax during inactive on-call periods, restrictions during on-call duties, on-call work demands, and satisfaction with compensation for on-call duties) on the one hand and fatigue, strain-based and time-based work-home interference (WHI), and perceived on-call performance difficulties (PPD) on the other hand. Cross-sectional survey data were collected among a large heterogeneous sample of Dutch employees (N = 5437). The final sample consisted of 157 on-call workers (23-69 years, 71% males). Data were analyzed by means of hierarchical regression analyses (controlling for age and job characteristics). Differences in on-call work exposure were not systematically related to fatigue, WHI, and PPD (all p's >0.50). The experience of being on-call explained a medium proportion of the variation in fatigue and strain-based WHI and a medium to large proportion of the variation in time-based WHI and PPD over and above the control variables. Our results suggest that it is employees' experience of being on-call, especially the experience of stress due to the unpredictability, rather than the amount of exposure, that is related to fatigue, WHI, and perceived on-call performance difficulties.

Graphics, Playability and Social Interaction, the Greatest Motivations for Playing Call of Duty. Educational Reflections

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Marcano Lárez, Beatriz Elena

2014-01-01

War videogames raise a lot of controversy in the educational field and are by far the most played videogames worldwide. This study explores the factors that encouraged gamers to choose war videogames with a sample of 387 Call of Duty players. The motivational factors were pinpointed using a non-experimental descriptive exploratory study through an…

The effect of the Accreditation Council for Graduate Medical Education Duty Hours Policy on plastic surgery resident education and patient care: an outcomes study.

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Basu, Chandrasekhar Bob; Chen, Li-Mei; Hollier, Larry H; Shenaq, Saleh M

2004-12-01

The Accreditation Council for Graduate Medical Education (ACGME) Work-Hours Duty Policy became effective on July 1, 2003, mandating the reduction of resident duty work hours. The Baylor College of Medicine Multi-Institutional Integrated Plastic Surgery Program instituted a resident duty work-hours policy on July 1, 2002 (1 year ahead of the national mandate). Outcomes data are needed to facilitate continuous improvements in plastic surgical residency training while maintaining high-quality patient care. To assess the effect of this policy intervention on plastic surgery resident education as measured through the six core competencies and patient/resident safety, the investigators surveyed all categorical plastic surgery residents 6 months after implementation of the policy. This work represents the first empiric study investigating the effect of duty hours reduction on plastic surgery training and education. The categorical plastic surgery residents at the Baylor College of Medicine Multi-Institutional Integrated Plastic Surgery Program completed a 68-item survey on a five-point Likert scale (1 = strongly disagree to 5 = strongly agree). Residents were asked to rate multiple parameters based on the ACGME six core competencies, including statements on patient care and clinical/operative duties, resident education, resident quality of life, and resident perceptions on this policy. All surveys were completed anonymously. The sample size was n = 12 (program year 3 through program year 6), with a 100 percent response rate. Univariate and bivariate statistical analysis was conducted with SPSS version 10.0 statistical software. Specifically, interquartile deviations were used to find consensus among resident responses to each statement. Descriptive statistics indicated higher percentages of agreement on a majority of statements in three categories, including patient care and clinical/operative duties, academic duties, and resident quality of life. Using interquartile

Pilot trial of IOM duty hour recommendations in neurology residency programs: unintended consequences.

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Schuh, L A; Khan, M A; Harle, H; Southerland, A M; Hicks, W J; Falchook, A; Schultz, L; Finney, G R

2011-08-30

To study the potential effect of the 2008 Institute of Medicine (IOM) work duty hour (WDH) recommendations on neurology residency programs. This study evaluated resident sleepiness, personal study hours, quality of life, and satisfaction and faculty satisfaction during a control month using the Accreditation Council for Graduate Medical Education WDH requirements and during an intervention month using the IOM WDH recommendations. Resident participation in both schedules was mandatory, but both resident and faculty participation in the outcome measures was voluntary. Thirty-four residents (11 postgraduate year [PGY]-4, 9 PGY-3, and 14 PGY-2) participated. End-of-work shift sleepiness, mean weekly sleep hours, personal study hours, and hours spent in lectures did not differ between the control and intervention months. Resident quality of life measured by the Maslach Burnout Inventory declined for 1 subscore in the intervention month (p = 0.03). Resident education satisfaction declined during the intervention month for issues related to continuity of care, patient hand-offs, and knowledge of their patients. Faculty satisfaction declined during the intervention month, without a decline in quality of life. The results from 3 residency programs suggest that the IOM WDH recommendations may negatively affect neurology resident education. This study was limited by the short duration of implementation, negative bias against the IOM recommendations, and inability to blind faculty. Additional study of the IOM WDH recommendations is warranted before widespread implementation.

The Relationship of On-Call Work with Fatigue, Work-Home Interference, and Perceived Performance Difficulties

Directory of Open Access Journals (Sweden)

Carla M. Ziebertz

2015-01-01

Full Text Available Objectives. This study examined the relationship between on-call duty exposure (active and total on-call hours a month, number of calls per duty and employees’ experiences of being on-call (stress due to unpredictability, ability to relax during inactive on-call periods, restrictions during on-call duties, on-call work demands, and satisfaction with compensation for on-call duties on the one hand and fatigue, strain-based and time-based work-home interference (WHI, and perceived on-call performance difficulties (PPD on the other hand. Methods. Cross-sectional survey data were collected among a large heterogeneous sample of Dutch employees (N=5437. The final sample consisted of 157 on-call workers (23–69 years, 71% males. Data were analyzed by means of hierarchical regression analyses (controlling for age and job characteristics. Results. Differences in on-call work exposure were not systematically related to fatigue, WHI, and PPD (all p’s >0.50. The experience of being on-call explained a medium proportion of the variation in fatigue and strain-based WHI and a medium to large proportion of the variation in time-based WHI and PPD over and above the control variables. Conclusions. Our results suggest that it is employees’ experience of being on-call, especially the experience of stress due to the unpredictability, rather than the amount of exposure, that is related to fatigue, WHI, and perceived on-call performance difficulties.

Exploring the safety measures by doctors on after-hours house call services.

Science.gov (United States)

Ifediora, Chris

2015-01-01

Aggression against doctors involved in after-hours house calls (AHHC) is widely perceived to be high. It is, however, unclear how doctors who perform this service manage the risk of aggressive patients during home visits. The aim of this paper is to explore if and how doctors manage the risk of violence against them during AHHC. A survey was designed and administered to all 300 Australian-based doctors engaged in AHHC under the National Home Doctor Service (NHDS). The survey was conducted from September 2014 to November 2014. There were 172 responses (57.3 per cent). Only 43 per cent of respondents adopted personal protective measures. The remaining 57 per cent had none; of those 6 per cent had never considered protective measures, and 31.8 per cent were aware of the risk of violence, but were unsure of what to do. Measures adopted include the use of chaperones/security personnel (34.1 per cent), dependence on surgery policies (31.2 per cent), de-escalation techniques (15.2 per cent), panic buttons (7.2 per cent), personal alarms (6.1 per cent), and others (6.5 per cent). Females were more likely to adopt personal protective measures than males (OR 4.94; pdoctors were less likely to do so relative to overseas-trained doctors (OR 0.35; p=0.04; CI 0.12-0.99). Just over half of the doctors involved in AHHC took no precautions against aggressive attacks while on duty, and nearly one-third relied on the policies of their employing surgeries.

Medical education and the ACGME duty hour requirements: assessing the effect of a day float system on educational activities.

Science.gov (United States)

Roey, Steve

2006-01-01

In July 2003, the Accreditation Council for Graduate Medical Education (ACGME) instituted new resident work hour mandates, which are being shown to improve resident well-being and patient safety. However, there are limited data on the impact these new mandates may have on educational activities. To assess the impact on educational activities of a day float system created to meet ACGME work hour mandates. The inpatient ward coverage was changed by adding a day float team responsible for new patient admissions in the morning, with the on-call teams starting later and being responsible for new patient admissions thereafter. I surveyed the residents to assess the impact of this new system on educational activities-resident autonomy, attending teaching, conference attendance, resident teaching, self-directed learning, and ability to complete patient care responsibilities. There was no adverse effect of the day float system on educational activities. House staff reported increased autonomy, enhanced teaching from attending physicians, and improved ability to complete patient care responsibilities. Additionally, house staff demonstrated improved compliance with the ACGME mandates. The implementation of a novel day float system for the inpatient medicine ward service improved compliance with ACGME work duty requirements and did not adversely impact educational activities of the residency training program.

Surgical training, duty-hour restrictions, and implications for meeting the Accreditation Council for Graduate Medical Education core competencies: views of surgical interns compared with program directors.

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Antiel, Ryan M; Van Arendonk, Kyle J; Reed, Darcy A; Terhune, Kyla P; Tarpley, John L; Porterfield, John R; Hall, Daniel E; Joyce, David L; Wightman, Sean C; Horvath, Karen D; Heller, Stephanie F; Farley, David R

2012-06-01

To describe the perspectives of surgical interns regarding the implications of the new Accreditation Council for Graduate Medical Education (ACGME) duty-hour regulations for their training. We compared responses of interns and surgery program directors on a survey about the proposed ACGME mandates. Eleven general surgery residency programs. Two hundred fifteen interns who were administered the survey during the summer of 2011 and a previously surveyed national sample of 134 surgery program directors. Perceptions of the implications of the new duty-hour restrictions on various aspects of surgical training, including the 6 ACGME core competencies of graduate medical education, measured using 3-point scales (increase, no change, or decrease). Of 215 eligible surgical interns, 179 (83.3%) completed the survey. Most interns believed that the new duty-hour regulations will decrease continuity with patients (80.3%), time spent operating (67.4%), and coordination of patient care (57.6%), while approximately half believed that the changes will decrease their acquisition of medical knowledge (48.0%), development of surgical skills (52.8%), and overall educational experience (51.1%). Most believed that the changes will improve or will not alter other aspects of training, and 61.5% believed that the new standards will decrease resident fatigue. Surgical interns were significantly less pessimistic than surgery program directors regarding the implications of the new duty-hour restrictions on all aspects of surgical training (P training under the new paradigm of duty-hour restrictions have significant concerns about the effect of these regulations on the quality of their training.

“Invading Your Hearts and Minds”: Call of Duty®and the (ReWriting of Militarism in U.S. Digital Games and Popular Culture

Directory of Open Access Journals (Sweden)

Frédérick Gagnon 1

2010-11-01

Full Text Available The goal of this article is to discuss how digital war games such as the Call of Duty series elicit consent for the U.S. military, militarism and the wars waged by the U.S. and its allies abroad. Building bridges between the humanities approach to Game Studies, American Studies, International Relations and Critical Geopolitics, we start from the assumption that digital games are more than “kid’s games”; they are sophisticated vehicles inhabiting and disseminating specific ideologies (Leonard 2004. Accordingly, our goal is to conduct a content analysis (Sisler 2008 of Call of Duty 4: Modern Warfare and Call of Duty: Modern Warfare 2 to show how these games contain images and narratives that (1 resonate with and reinforce a tabloid imaginary of post-9/11 geopolitics (Debrix 2008; (2 glorify military power and elicit consent for the idea that state violence and wars are inevitable; and (3 encourage our myopia by depicting a sanitized vision of war and downplaying the negative consequences of state violence (Stahl 2006. The conclusion invites players to think about ways to criticize the way games like Call of Duty employ and deploy values that (rewrite the militarist mindset that has often pervaded the post-9/11 U.S. national security debate.

Effects of duty hour restrictions on core competencies, education, quality of life, and burnout among general surgery interns.

Science.gov (United States)

Antiel, Ryan M; Reed, Darcy A; Van Arendonk, Kyle J; Wightman, Sean C; Hall, Daniel E; Porterfield, John R; Horvath, Karen D; Terhune, Kyla P; Tarpley, John L; Farley, David R

2013-05-01

To measure the implications of the new Accreditation Council for Graduate Medical Education duty hour regulations for education, well-being, and burnout. Longitudinal study. Eleven university-based general surgery residency programs from July 2011 to May 2012. Two hundred thirteen surgical interns. Perceptions of the impact of the new duty hours on various aspects of surgical training, including the 6 Accreditation Council for Graduate Medical Education core competencies, were measured on 3-point scales. Quality of life, burnout, balance between personal and professional life, and career satisfaction were measured using validated instruments. Half of all interns felt that the duty hour changes have decreased the coordination of patient care (53%), their ability to achieve continuity with hospitalized patients (70%), and their time spent in the operating room (57%). Less than half (44%) of interns believed that the new standards have decreased resident fatigue. In longitudinal analysis, residents' beliefs had significantly changed in 2 categories: less likely to believe that practice-based learning and improvement had improved and more likely to report no change to resident fatigue (P life. Compared with the normal US population, 50 interns (32%) were 0.5 SD less than the mean on the 8-item Short Form Health Survey mental quality of life score. Approximately one-third of interns demonstrated weekly symptoms of emotional exhaustion (28%) or depersonalization (28%) or reported that their personal-professional balance was either "very poor" or "not great" (32%). Although many interns (67%) reported that they daily or weekly reflect on their satisfaction from being a surgeon, 1 in 7 considered giving up their career as a surgeon on at least a weekly basis. The first cohort of surgical interns to train under the new regulations report decreased continuity with patients, coordination of patient care, and time spent in the operating room. Furthermore, suboptimal quality of

Revisiting the rotating call schedule in less than 80 hours per week.

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Roses, Robert E; Foley, Paul J; Paulson, Emily C; Pray, Lori; Kelz, Rachel R; Williams, Noel N; Morris, Jon B

2009-01-01

The Accreditation Council for Graduate Medical Education (ACGME) work-hour restrictions have prompted many surgical training programs to adopt a night-float resident coverage system (NF). Dissatisfaction with NF prompted us to transition to a rotating junior resident call model (Q4) with 24-hour call shifts at the outset of the 2007-2008 academic year. We performed a prospective study to determine the influence of this transition on resident education, morale, and quality of life, as well as on ACGME work rule compliance and American Board of Surgery In-Training Examination (ABSITE) scores. Residents were surveyed after 1 year of NF and again 1 year after the introduction of Q4. Responses to a series of statements about the influence of the call model (NF or Q4) on educational opportunities and morale were solicited. The survey used a 5-point Likert response scale (1 = complete disagreement to 5 = complete agreement). Median values of participant responses were calculated and compared using the Wilcoxon rank-sum test. Compliance with ACGME work rules, ABSITE scores, and operative case logs from the 2006-2007 and 2007-2008 academic years were also compared. Residents were significantly more enthusiastic about Q4 compared with NF, particularly when asked about the influence these systems had on morale (median response = 4.0 [Q4] compared with 2.0 [NF]; p = 0.001) and engagement of residents by the teaching faculty (median response = 4.0 [Q4] compared with 1.0 [NF]; p = 0.001). Case logs revealed a similar operative experience for first-year residents irrespective of the call schedule (p = 0.51). Excellent compliance with ACGME work rules was maintained as reflected by the percentage of monthly 80-hour violations per resident months worked (3% [Q4] compared with 0.7% [NF]). No difference was observed in the ABSITE scores of first-year residents (a mean percentile point increase of 1 was found after the introduction of Q4). Educational opportunities, compliance with

Flexible work in call centres: Working hours, work-life conflict & health.

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Bohle, Philip; Willaby, Harold; Quinlan, Michael; McNamara, Maria

2011-01-01

Call-centre workers encounter major psychosocial pressures, including high work intensity and undesirable working hours. Little is known, however, about whether these pressures vary with employment status and how they affect work-life conflict and health. Questionnaire data were collected from 179 telephone operators in Sydney, Australia, of whom 124 (69.3%) were female and 54 (30.2%) were male. Ninety-three (52%) were permanent full-time workers, 37 (20.7%) were permanent part-time, and 49 (27.4%) were casual employees. Hypothesised structural relationships between employment status, working hours and work organisation, work-life conflict and health were tested using partial least squares modelling in PLS (Chin, 1998). The final model demonstrated satisfactory fit. It supported important elements of the hypothesised structure, although four of the proposed paths failed to reach significance and the fit was enhanced by adding a path. The final model indicated that casual workers reported more variable working hours which were relatively weakly associated with greater dissatisfaction with hours. The interaction of schedule control and variability of hours also predicted dissatisfaction with hours. Conversely, permanent workers reported greater work intensity, which was associated with both lower work schedule control and greater work-life conflict. Greater work-life conflict was associated with more fatigue and psychological symptoms. Labour market factors and the undesirability of longer hours in a stressful, high-intensity work environment appear to have contributed to the results. Copyright © 2010 Elsevier Ltd and The Ergonomics Society. All rights reserved.

Association of Otolaryngology Resident Duty Hour Restrictions With Procedure-Specific Outcomes in Head and Neck Endocrine Surgery

Science.gov (United States)

Smith, Aaron; Braden, Lauren; Wan, Jim

2017-01-01

Importance Graduate medical education has undergone a transformation from traditional long work hours to a restricted plan to allow adequate rest for residents. The initial goal of this restriction is to improve patient outcomes. Objective To determine whether duty hour restrictions had any impact on surgery-specific outcomes by analyzing complications following thyroid and parathyroid procedures performed before and after duty hour reform. Design, Setting, and Participants Retrospective cross-sectional analysis of the National Inpatient Sample (NIS).The NIS was queried for procedure codes associated with thyroid and parathyroid procedures for the years 2000 to 2002 and 2006 to 2008. Hospitals were divided based on teaching status into 3 groups: nonteaching hospitals (NTHs), teaching hospitals without otolaryngology programs (THs), and teaching hospitals with otolaryngology programs (THs-OTO). Main Outcomes and Measures Procedure-specific complication rates, length of stay, and mortality rates were collected. SAS statistical software (version 9.4) was used for analysis with adjustment using Charlson comorbidity index. Results Total numbers of head and neck endocrine procedures were 34 685 and 39 770 (a 14.7% increase), for 2000 to 2002 and 2006 to 2008, respectively. THs-OTO contributed a greater share of procedures in 2006 to 2008 (from 18% to 25%). With the earlier period serving as the reference, length of stay remained constant (2.1 days); however, total hospital charges increased (from $12 978 to $23 708; P otolaryngology programs. PMID:28196195

Communication between residents and attending doctors on call after hours.

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Novoselsky Persky, Michal A; Yinnon, Amos M; Freier-Dror, Yossi; Henshke-Bar-Meir, Ruth

2013-12-01

Off-hours medical care in hospitals is provided by residents, while attendings on call are available for assistance. This study evaluated the gap between residents' expectations and professional guidelines' requirements of attendings on call and what actually occurs during night shifts, while comparing surgical and medical specialties. Two questionnaires based on professional guidelines were filled by residents. The first queried about residents' expectations of attendings on call, and the second asked about communication with the attendings during actual night shifts. While 91 (100%) of residents expected the attending on call to be available by phone during the shift, only 44 (48%) expected the attending to initiate contact, and only 17 (19%) expected the attending to visit the ward or emergency department (ED) without being requested to do so. In 127 shifts (84%), some form of communication occurred. Residents called their attendings during 105 shifts (70%). However, attendings initiated contact with residents at the beginning or during the shift in only 67 (44%) and 62 (41%) shifts, respectively, and initiated a visit to the ward/ED during the shift in only 41 cases (27%). Surgical attendings initiated contact in these three ways significantly more frequently than medical attendings [21 (28%) versus 46 (61%), 20 (26%) versus 42 (56%) and 4 (5%) versus 37 (50%), respectively; P communication during night shifts between residents and attendings occurs in most shifts, attendings initiate far less contact with residents than is required by the guidelines. © 2013 John Wiley & Sons Ltd.

Learning Strategies in Play during Basic Training for Medal of Honor and Call of Duty Video Games

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Ziaeehezarjeribi, Yadi

2010-01-01

This study, based on experiential play methodology was used to explore student engagement while playing "Medal of Honor (2002)" and "Call of Duty (2003)". It identifies some of the key issues related to the use of video games and simulations during the training phase of game play. Research into the effects of gaming in education has been extremely…

Heart Rate Variability in Obstetricians Working 14-Hour Call Compared to 24-Hour Call in Labour and Delivery.

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Thurman, Robin H; Yoon, Eugene; Murphy, Kellie E; Windrim, Rory; Farrugia, M Michéle

2017-12-01

Obstetricians have stressful and demanding jobs that may impact their health. A physiological measurement of cardiac function which varies with stress is heart rate variability (HRV). By measuring the cyclic variations in R-R intervals, or beat-to-beat differences, HRV reflects the continuous interplay of the controlling forces in the autonomic nervous system. Studies have shown HRV to be reduced during periods of work-induced stress, including 24-hour shifts. Our study aimed to determine if there was a correlation between length of shift worked and HRV. We hypothesised that working for a full 24-hour period is more stressful than a shorter, nighttime-only period, and HRV analyses were used to measure this objectively. Obstetricians wore an HRV monitor for 24 hours during both a regular day followed by a 14-hour night shift and a continuous 24-hour shift in labour and delivery. The 24-hour samples were analysed using standard HRV measurements. HRV measurements obtained from each physician were then compared according to shift type, with each physician acting as his or her own comparator. There were no statistically significant differences in the most important measures of HRV between 24-hour periods which included either a 14-hour overnight shift or a continuous 24-hour shift on labour and delivery. We found no significant differences in key HRV measures in obstetricians working 14 hours versus 24 hours in labour and delivery. An anecdotal increase in physician awareness of his/her own health related to working conditions was noted during the study. Future studies should attempt to control for the hours prior to a night shift, assess associated endocrine variations, and focus upon HRV in the post-shift period. Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.

A call of duty in hard times: Duty to vote and the Spanish Economic Crisis

Directory of Open Access Journals (Sweden)

Carol Galais

2014-06-01

Full Text Available Although scarce, the literature addressing the effects of the economy on voter turnout and political attitudes has yielded mixed results. By using individual, longitudinal data from Spain—a country devastated by the Great Recession—our study illuminates how the latest economic crisis has impacted citizens’ perceptions of voting. We analyze how economic conditions and perceptions of the economy have transformed the belief that voting is a civic duty, which is one of the strongest attitudinal predictors of turnout. Our results suggest that hard times slightly weaken citizens’ sense of civic duty, particularly among the youngest. However, the adverse effects of the economic crisis are compensated by the positive effects of the electoral context, and as a consequence there is no aggregate decline in civic duty during the period examined (2010–2012.

A Narrative Review of High-Quality Literature on the Effects of Resident Duty Hours Reforms.

Science.gov (United States)

Lin, Henry; Lin, Emery; Auditore, Stephanie; Fanning, Jon

2016-01-01

To summarize current high-quality studies evaluating the effect and efficacy of resident duty hours reforms (DHRs) on patient safety and resident education and well-being. The authors searched PubMed and Medline in August 2012 and again in May 2013 for literature (1987-2013) about the effects of DHRs. They assessed the quality of articles using the Medical Education Research Study Quality Instrument (MERSQI) scoring system. They considered randomized controlled trials (RCTs), partial RCTs, and all studies with a MERSQI score ≥ 14 to be "high-quality" methodology studies. A total of 72 high-quality studies met inclusion criteria. Most studies showed no change or slight improvement in mortality and complication rates after DHRs. Resident well-being was generally improved, but there was a perceived negative impact on education (knowledge acquisition, skills, and cognitive performance) following DHRs. Eleven high-quality studies assessed the impact of DHR interventions; all reported a neutral to positive impact. Seven high-quality studies assessed costs associated with DHRs and demonstrated an increase in hospital costs. The results of most studies that allow enough time for DHR interventions to take effect suggest a benefit to patient safety and resident well-being, but the effect on the quality of training remains unknown. Additional methodologically sound studies on the impact of DHRs are necessary. Priorities for future research include approaches to optimizing education and clinical proficiency and studies on the effect of intervention strategies on both education and patient safety. Such studies will provide additional information to help improve duty hours policies.

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

Science.gov (United States)

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

2004-01-01

New York State Code 405 and societal/political pressure have led the RRC and ACGME to mandate strict limitations on resident work hours. In an attempt to meet these limitations, we have switched from the previous Q3 call schedule to a specialized night float (NF) system, the continuity-care system (CCS). The purpose of this CCS is to maximize resident duty time spent on direct patient care, operative experience, and outpatient clinics, while reducing duty hours spent on performing routine tasks and call coverage. The implementation of the CCS is the fundamental step in the restructuring of our residency program. In addition to a change in the call system, we added physician assistants to aid in performing some service tasks. We performed a 360 degrees evaluation of this work in progress. In May 2002, the standard Q3 call system was abolished on the general surgery services at the New York Presbyterian Hospital, Columbia campus. Two dedicated teams were created to provide day and night coverage, a day continuity-care team (DCT) and a night continuity-care team (NCT). The DCTs, consisting of PGY1-5 residents, provide daily in-house coverage from 6 AM to 5 PM with no regular weekday night-call responsibilities. The DCT residents provide Friday night, Saturday, and daytime Sunday call coverage 3 to 4 days per month. The NCT, consisting of 5 PGY1-5 residents, provides nightly continuous care, 5 PM to 6 AM, Sunday through Thursday, with no other weekend call responsibilities. This system creates a schedule with less than 80 duty hours per week, on average, with one 24-hour period off a week, one complete weekend off per month, and no more than 24 hours of consecutive duty time. After 1 year of use, the system was evaluated by a 360 degrees method in which residents, residents' spouses, nurses, and faculty were surveyed using a Likert-type scale. Statistical significance was calculated using the Student t-test. Patient satisfaction was measured both by internal review of

Resident work hours: why keeping the status quo may not be such a bad thing

Directory of Open Access Journals (Sweden)

Roshan Razik

2013-09-01

Full Text Available Resident duty hours have become an increasingly debated topic in post-graduate medical education. Work-hour restrictions have been implemented for first-year residents in the US and more recently for all residents in Quebec. Current and future work-hour rules affect a variety of stakeholders: government, hospitals, residency training programs, patients, and most of all residents. In this article, we hope to examine the issue from a Canadian perspective and delineate some of the reasons why changing the current call structure may have potentially deleterious effects to all those concerned.

Effects of resident duty hour reform on surgical and procedural patient safety indicators among hospitalized Veterans Health Administration and Medicare patients.

Science.gov (United States)

Rosen, Amy K; Loveland, Susan A; Romano, Patrick S; Itani, Kamal M F; Silber, Jeffrey H; Even-Shoshan, Orit O; Halenar, Michael J; Teng, Yun; Zhu, Jingsan; Volpp, Kevin G

2009-07-01

Improving patient safety was a strong motivation behind duty hour regulations implemented by Accreditation Council for Graduate Medical Education on July 1, 2003. We investigated whether rates of patient safety indicators (PSIs) changed after these reforms. Observational study of patients admitted to Veterans Health Administration (VA) (N = 826,047) and Medicare (N = 13,367,273) acute-care hospitals from July 1, 2000 to June 30, 2005. We examined changes in patient safety events in more versus less teaching-intensive hospitals before (2000-2003) and after (2003-2005) duty hour reform, using conditional logistic regression, adjusting for patient age, gender, comorbidities, secular trends, baseline severity, and hospital site. Ten PSIs were aggregated into 3 composite measures based on factor analyses: "Continuity of Care," "Technical Care," and "Other" composites. Continuity of Care composite rates showed no significant changes postreform in hospitals of different teaching intensity in either VA or Medicare. In the VA, there were no significant changes postreform for the technical care composite. In Medicare, the odds of a Technical Care PSI event in more versus less teaching-intensive hospitals in postreform year 1 were 1.12 (95% CI; 1.01-1.25); there were no significant relative changes in postreform year 2. Other composite rates increased in VA in postreform year 2 in more versus less teaching-intensive hospitals (odds ratio, 1.63; 95% CI; 1.10-2.41), but not in Medicare in either postreform year. Duty hour reform had no systematic impact on PSI rates. In the few cases where there were statistically significant increases in the relative odds of developing a PSI, the magnitude of the absolute increases were too small to be clinically meaningful.

After-hours/on-call experience during primary care nurse practitioner education utilizing standard scenarios and simulated patients.

Science.gov (United States)

Kelly, Michelle M; Blunt, Elizabeth; Nestor, Kelly

2017-12-01

Few nurse practitioner (NP) programs include an after-hours/on-call component in their clinical preparation of NP students. This role is expected in many primary and specialty care practices, and is one that students feel unprepared to competently navigate. Utilizing simulated callers as patients or parents, NP students participated in a simulated after-hours/on-call experience that included receiving the call, managing the patient, and submitting documentation of the encounter. Students completed pre- and postparticipation evaluations, and were evaluated by the simulated patient callers and faculty using standardized evaluation tools. NP students rated the experience as an educationally valuable experience despite feeling anxious and nervous about the experience. Several essential skills were identified including critical thinking, clear communication, self-confidence, and access to resources. After participation NP students were more receptive to an NP position with an on-call component. Inclusion of a simulated on-call experience is a feasible component of NP education and should be added to the NP curriculum. ©2017 American Association of Nurse Practitioners.

Work shift duration: a review comparing eight hour and 12 hour shift systems.

Science.gov (United States)

Smith, L; Folkard, S; Tucker, P; Macdonald, I

1998-04-01

Shiftwork is now a major feature of working life across a broad range of industries. The features of the shift systems operated can impact on the wellbeing, performance, and sleep of shiftworkers. This paper reviews the current state of knowledge on one major characteristic of shift rotas-namely, shift duration. Evidence comparing the relative effects of eight hour and 12 hour shifts on fatigue and job performance, safety, sleep, and physical and psychological health are considered. At the organisational level, factors such as the mode of system implementation, attitudes towards shift rotas, sickness absence and turnover, overtime, and moonlighting are discussed. Manual and electronic searches of the shiftwork research literature were conducted to obtain information on comparisons between eight hour and 12 hour shifts. The research findings are largely equivocal. The bulk of the evidence suggests few differences between eight and 12 hour shifts in the way they affect people. There may even be advantages to 12 hour shifts in terms of lower stress levels, better physical and psychological wellbeing, improved durations and quality of off duty sleep as well as improvements in family relations. On the negative side, the main concerns are fatigue and safety. It is noted that a 12 hour shift does not equate with being active for only 12 hours. There can be considerable extension of the person's time awake either side of the shift. However, the effects of longer term exposure to extended work days have been relatively uncharted in any systematic way. Longitudinal comparative research into the chronic impact of the compressed working week is needed.

Lithium-ion backup batteries for coping extended loss of AC power (ELAP)

International Nuclear Information System (INIS)

Chang, Choong-koo

2017-01-01

Per NRC Regulations Title 10, Code of Federal Regulations (CFR) 50.63 'Loss of all alternating current power' all Korean nuclear power plants have a coping capability for SBO conditions for a limited time ranging from approximately eight (8) to sixteen (16) hours. The 125V DC systems are designed for eight (8) hours range except Class 1E channel A and B 125V DC system of which duty cycle is 2 hours in APR1400. The strategies proposed by this paper for coping extended loss of AC power (ELAP) involve a three-phase approach. In the first extend class 1E batteries' backup time until 24 hours. Then augment class 1E batteries with Lithium-ion batteries by 72 hours from the event initiation. In addition, obtain additional capability and redundancy from off-site equipment until power systems are restored or commissioned. (author)

Abolishment of 24-hour continuous medical call duty in quebec: a quality of life survey of general surgical residents following implementation of the new work-hour restrictions.

Science.gov (United States)

Hamadani, Fadi T; Deckelbaum, Dan; Sauve, Alexandre; Khwaja, Kosar; Razek, Tarek; Fata, Paola

2013-01-01

The implementation of work hour restrictions across North America have resulted in decreased levels of self injury and medical errors for Residents. An arbitration ruling in Quebec has led to further curtailment of work hours beyond that proposed by the ACGME. This may threaten Resident quality of life and in turn decrease the educational quality of surgical residency training. We administered a quality of life questionnaire with an integrated education quality assessment tool to all General Surgery residents training at McGill 6 months after the work hour restrictions. Across several strata respondents reveal a decreased sense of educational quality and quality of life. The arbitration argued that work- hour restrictions would be necessary to improve quality of life for trainees and hence improve patient safety. Results from this study demonstrate the exact opposite in a large majority of respondents, who report a poorer quality of life and a self-reported inability on their part to provide continuous and safe patient care. Copyright © 2013 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Communication skills for extended duties dental nurses: the childsmile perspective.

Science.gov (United States)

O'Keefe, Emma

2015-02-01

Good communication and influencing skills are key competency areas for dental nurses and are highly relevant when working with children and their families/carers in Childsmile, a national oral health improvement programme for children in Scotland. The General Dental Council (GDC) identifies communication skills as one of the nine principles for registrants; a large number of complaints seen by the GDC relate to allegations around communication and patient expectations not being fully met. Much time and investment has been spent in researching the role of the Extended Duties Dental Nurse (EDDN) and ensuring appropriate training is provided. While there is specific training for EDDNs delivering the Childsmile programme, the programme appreciates that good communication skills are a core component of all training programmes for dental nurses. This paper sets out to explore the role of EDDNs in Childsmile and specifically looks at the importance of good communication skills and how it facilitates and impacts on the delivery of the Childsmile programme in a variety of settings.

Evolution of high duty cycle echolocation in bats

DEFF Research Database (Denmark)

Fenton, M. B.; Faure, P. A.; Ratcliffe, J. M.

2012-01-01

Duty cycle describes the relative 'on time' of a periodic signal. In bats, we argue that high duty cycle (HDC) echolocation was selected for and evolved from low duty cycle (LDC) echolocation because increasing call duty cycle enhanced the ability of echolocating bats to detect, lock onto and track...... relative to background objects and their prey. HDC echolocators are particularly sensitive to amplitude and frequency glints generated by the wings of fluttering insects. We hypothesize that narrowband/CF calls produced at high duty cycle, and combined with neurobiological specializations for processing....... In contrast, bats using HDC echolocation emit long duration, narrowband calls dominated by a single constant frequency (CF) separated by relatively short periods of silence. HDC bats separate pulse and echo in frequency by exploiting information contained in Doppler-shifted echoes arising from their movements...

Heart rate variability changes in physicians working on night call.

Science.gov (United States)

Malmberg, Birgitta; Persson, Roger; Flisberg, Per; Ørbaek, Palle

2011-03-01

Adverse effects by night-call duty have become an important occupational health issue. The aim of this study was to investigate whether the heart rate variability (HRV) differed during recovery from day work and night-call duty between distinct physician specialities. We studied the impact of a 16-h night-call duty on autonomic balance, measured by HRV, among two physician groups differing with respect to having to deal with life-threatening conditions while on call. Nineteen anaesthesiologists (ANEST) and 16 paediatricians and ear, nose and throat surgeons (PENT) were monitored by ambulatory digital Holter electrocardiogram (ECG). Heart rate variability was analysed between 21:00 and 22:00 after an ordinary workday, on night call and in the evening post-call. Absolute and normalized high-frequency power (HF, HFnu) were the main outcome variables, expressing parasympathetic influence on the heart. ANEST had lower HF power than PENT while on night call and post-daytime work (p work compared with post-night-call duty (p balance and did not differ between specialities. However, the less dynamic HRV after daytime work and during night-call duty in the ANEST group may indicate a higher physiological stress level. These results may contribute to the improvement of night-call schedules within the health care sector.

Out-of-hours service in rural areas. An observational study of accessibility, attitudes and quality standards among general practitioners in Iceland.

Science.gov (United States)

Olafsson, G; Sigurdsson, J A

2000-06-01

To examine the access, workload, duties, commitments and quality standards of primary care physicians (GPs) resulting from out-of-hours service. All GPs (n = 96) in rural Iceland. Answers to a postal survey. The participation rate was 80%. The GPs estimated that in 97% of the cases they could be contacted within 5 minutes in an emergency. Under usual circumstances (weather conditions) and within a distance of 10 km, 70% of them could reach the patient within 30 minutes of receiving the call. In severe weather conditions, 50% of the GPs in smaller districts (650-6000 inhabitants) estimated that it could take up to 5 hours or more to reach the patient (which could happen once a year). In the least populated districts, 84% of the GPs had to be on call 14 days or more per month. Serious emergencies (involving special training such as cardiac resuscitation or tracheal intubation) were relatively rare, and GPs expressed the necessity for regular refresher courses in such fields. Modern telecommunication networks guarantee good access to out-of-hours service. The workload and on-call duties are great and do not comply with European Union (EU) recommendations regarding minimal rest time. If GPs in rural areas are to be expected to provide frontline health care, including in severe emergency situations, regular training courses are needed.

The determinants and engagement patterns of chaperones and chauffeurs by Australian doctors in after-hours house-call services.

Science.gov (United States)

Ifediora, Chris Onyebuchi

2017-01-01

The use of escorts (chauffeurs and chaperones) while on duty in after-hours-house-call (AHHC) is one key protective option available to doctors in the service, and has been linked to low burnout and increased satisfaction in AHHC. This study aims to explore the patterns of engagement of escorts in Australian AHHC. This is a questionnaire-based, electronic survey of all 300 doctors involved in AHHC through the National Home Doctor Service (NHDS), Australia's largest providers of the service. The survey explored the doctor's experiences over the 12-month period from October 2013 to September 2014. This survey received a total of 168 valid responses, giving a response rate of 56%. Nearly 61% of the doctors involved in AHHC engaged escorts (chauffeurs and chaperones). Of those doctors that engage chauffeurs, three-quarters do so "all or most times", while only one-quarter engaged chaperones to the same degree of frequency. Hiring escorts is very popular among Brisbane (91.7%) and Sydney-based (88.2%) practitioners, but is unpopular in the City of Gold Coast (26.1%). There were moderate patronages in Adelaide (52.9%) and Melbourne Area (46.4%). Compared to males, females were less likely to drive themselves without escorts (OR 0.20; P  doctors involved in the Australian AHHC, particularly given their proven benefits in the service. Future studies may be needed to fully explore the real reasons behind the significant associations identified in this study.

Assessing communication skills of clinical call handlers working at an out-of-hours centre: development of the RICE rating scale.

Science.gov (United States)

Derkx, Hay P; Rethans, Jan-Joost E; Knottnerus, J André; Ram, Paul M

2007-05-01

Out-of-hours centres provide telephone support to patients with medical problems. In most of these centres specially-trained nurses handle incoming telephone calls. They assess patients' needs, the degree of urgency, and determine the level of care required. Assessment of the medical problem and the quality of 'care-by-phone' depend on the medical and communication skills of the call handlers. To develop a valid, reliable, and practical rating scale to evaluate the communication skills of call handlers working at an out-of-hours centre and to improve quality of communication. Qualitative study with focus groups followed by validation of the rating scale and measurement of reliability (internal consistency). Out-of-hours centres in the Netherlands. A focus group developed the rating scale. Experts with experience in training and evaluating communication skills of medical students and GPs commented on the scale to ensure content validity. The reliability of the rating scale was tested in a pilot in which ten specially-trained assessors scored six telephone calls each. The scale, known as the RICE rating scale, has 17 items divided over four different phases of the telephone consultation: Reason for calling; Information gathering; Conclusion; and Evaluation (RICE). Content validity of the scale was assessed by two experts. Reliability of the scale tested in the pilot was 0.73 (Cronbach's alpha). Establishing a rating scale to assess the communication skills of call handlers which meets common scientific demands, such as content validity and reliability, proved successful. This instrument can be used to give feedback to call handlers.

An observational pre-post study of re-structuring Medicine inpatient teaching service: Improved continuity of care within constraint of 2011 duty hours.

Science.gov (United States)

Cheung, Joseph Y; Mueller, Daniel; Blum, Marissa; Ravreby, Hannah; Williams, Paul; Moyer, Darilyn; Caroline, Malka; Zack, Chad; Fisher, Susan G; Feldman, Arthur M

2015-09-01

Implementation of more stringent regulations on duty hours and supervision by the Accreditation Council for Graduate Medical Education in July 2011 makes it challenging to design inpatient Medicine teaching service that complies with the duty hour restrictions while optimizing continuity of patient care. To prospectively compare two inpatient Medicine teaching service structures with respect to residents' impression of continuity of patient care (primary outcome), time available for teaching, resident satisfaction and length-of-stay (secondary endpoints). Observational pre-post study. Surveys were conducted both before and after Conventional Medicine teaching service was changed to a novel model (MegaTeam). Academic General Medicine inpatient teaching service. Surveys before and after MegaTeam implementation were completed by 68.5% and 72.2% of internal medicine residents, respectively. Comparing conventional with MegaTeam, the % of residents who agreed or strongly agreed that the (i) ability to care for majority of patients from admission to discharge increased from 29.7% to 86.6% (pcare, decreases number of handoffs, provides adequate supervision and teaching of interns and medical students, increases resident overall satisfaction and decreases length-of-stay. Copyright © 2015 Elsevier Inc. All rights reserved.

Reducing hours of work of preregistration house officers: report on a shift system.

Science.gov (United States)

Nasmyth, D G; Pickersgill, A; Hogarth, M

1991-01-12

To determine the advantages and disadvantages of a shift system of working compared with the conventional on call system for preregistration house officers. A shift system of working was employed in the unit from 1 August 1989 to 31 July 1990. During attachments of three or six months four house officers rotated at intervals of one month among three daytime shifts and one night shift (Mondays to Fridays only). Weekends (48 hours) were worked on a one in three rota by the doctors working a day shift. The views of the house officers working this shift system were sought in writing and by direct interview. Professorial surgical unit, Royal Liverpool Hospital. The 14 house officers who were attached to the unit for three or six months during their preregistration year. The shift system was preferred to conventional on call without exception. The incidence of chronic tiredness was reduced and formal hand-over between shifts resulted in more informed decision making by doctors while on call. During annual leave it was sometimes necessary to revert to the conventional one in three on call system to ensure that daytime work was completed. Other disadvantages were the long weekend shift and an inequitable distribution of the night shift. The house officers recommended extending the shifts to weekends and working the night shift one week in four. A shift system of working was effective in reducing chronic tiredness among house officers, who found it preferable to conventional on call arrangements. Shift working is feasible only if the daytime duties of the doctor working at night can be completed by the other doctors on the rota.

NREL/Industry Range-Extended Electric Vehicle for Package Delivery

Energy Technology Data Exchange (ETDEWEB)

Farrell, John T [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Kelly, Kenneth J [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Duran, Adam W [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Lammert, Michael P [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Miller, Eric S [National Renewable Energy Laboratory (NREL), Golden, CO (United States)

2018-01-15

Range-extended electric vehicle (EV) technology can be a viable option for reducing fuel consumption from medium-duty (MD) and heavy-duty (HD) engines by approximately 50 percent or more. Such engines have wide variations in use and duty cycles, however, and identifying the vocations/duty cycles most suitable for range-extended applications is vital for maximizing the potential benefits. This presentation provides information about NREL's research on range-extended EV technologies, with a focus on NREL's real-world data collection and analysis approach to identifying the vocations/duty cycles best suited for range-extender applications and to help guide related powertrain optimization and design requirements. The presentation also details NREL's drive cycle development process as it pertains to package delivery applications.

19 CFR 101.6 - Hours of business.

Science.gov (United States)

2010-04-01

... 19 Customs Duties 1 2010-04-01 2010-04-01 false Hours of business. 101.6 Section 101.6 Customs... GENERAL PROVISIONS § 101.6 Hours of business. Except as specified in paragraphs (a) through (g) of this section, each CBP office shall be open for the transactions of general CBP business between the hours of 8...

Duty Rosters and Workloads of Obstetricians in Germany: Results of a Germany-wide Survey.

Science.gov (United States)

Neimann, Johannes; Knabl, Julia; Puppe, Julian; Bayer, Christian Michael; Gass, Paul; Gabriel, Lena; Seelbach-Goebel, Birgit; Lermann, Johannes; Schott, Sarah

2017-08-01

Compiling a daily hospital roster which complies with existing laws and tariff regulations and meets the requirements for ongoing professional training while also taking the legal regulations on the health of employees into account makes planning the duty roster a challenge. The aim of this study was to obtain a realistic picture of existing duty roster systems and of the current workloads of obstetricians in Germany. This online survey was sent to 2770 physicians training to become obstetricians or specializing in specific areas of obstetric care. The survey consisted of an anonymized 95-item questionnaire which collected data on different types of duty roster systems and the workload of obstetricians in Germany for the period from 17.02.2015 to 16.05.2015. Out of a total of 2770 physicians who were contacted, 437 (16%) completed the questionnaire. Across all forms of care, the care provided outside normal working hours usually (75%) consisted of a combination of regular working times and on-call duty or even consisted entirely of standby duty. Level I perinatal centers were most likely 20% (n = 88) to have a shift system in place. Working a shift system was significantly more common in care facilities which had previously carried out a job analysis. The number of physicians in hospitals who are present during the night shift was higher in facilities with higher numbers of births and in facilities which offered higher levels of care. In addition to regularly working overtime and the fact that often not all the hours worked were recorded, it was notable that the systems used to compile duty rosters often did not comply with legal regulations or with collectively agreed working hours nor were they compatible with the staff planning requirements. The results of this study show that the conditions of work, the working times, and the organization of working times in obstetric departments are in need of improvement. Recording the actual times worked together with an

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

Science.gov (United States)

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

2016-09-01

Surgeons frequently report frustration and loss of efficiency with electronic medical record (EMR) systems. Together, surgery residents and a programmer at Augusta University created a rounds report (RR) summarizing 24 hours of vitals, intake/output, labs, and other values for each inpatient that were previously transcribed by hand. The objective of this study was to evaluate the RR's effect on surgery residents. Surgery residents were queried to assess the RR's impact. Outcome measures were time spent preparing for rounds, direct patient care time, educational activity time, rates of incorrect/incomplete data on rounds, and rate of duty hour violations. Hospital wide, 17,200 RRs were generated in the 1-month study. Twenty-three surgery residents participated. Time spent preparing for rounds decreased per floor patient (15.6 ± 3.0 vs 6.0 ± 1.2, P care unit patient (19.9 ± 2.9 vs 7.5 ± 1.2 P care increased from 45.1 ± 5.6 to 54.0 ± 5.7 per cent (P = 0.0044). Educational activity time increased from 35.2 ± 5.4 to 54.7 ± 7.1 minutes per resident per day (P = 0.0004). Reported duty hour violations decreased 58 per cent (P care at academic medical centers.

Working Hours and Productivity

OpenAIRE

Collewet, Marion; Sauermann, Jan

2017-01-01

This paper studies the link between working hours and productivity using daily information on working hours and performance of a sample of call centre agents. We exploit variation in the number of hours worked by the same employee across days and weeks due to central scheduling, enabling us to estimate the effect of working hours on productivity. We find that as the number of hours worked increases, the average handling time for a call increases, meaning that agents become less productive. Th...

Return to Flying Duties Following Centrifuge or Vibration Exposures

Science.gov (United States)

Scheuring, Richard A.; Clarke, Jonathan; Jones, Jeffrey A.

2009-01-01

Introduction: In an effort to determine the human performance limits for vibration in spacecraft being developed by NASA, astronauts were evaluated during a simulated launch profile in a centrifuge/vibration environment and separate vibration-only simulation. Current USAF and Army standards for return to flight following centrifuge exposures require 12-24 hours to pass before a crewmember may return to flying duties. There are no standards on vibration exposures and return to flying duties. Based on direct observation and provocative neurological testing of the astronauts, a new standard for return to flying duties following centrifuge and/or vibration exposures was established. Methods: 13 astronaut participants were exposed to simulated launch profiles in a + 3.5 Gx bias centrifuge/vibration environment and separately on a vibration table at the NASA-Ames Research Center. Each subject had complete neurological evaluations pre- and post-exposure for the centrifuge/vibration runs with the NASA neurological function rating scale (NFRS). Subjects who participated in the vibration-only exposures had video oculography performed with provocative maneuvers in addition to the NFRS. NFRS evaluations occurred immediately following each exposure and at 1 hour post-run. Astronauts who remained symptomatic at 1 hour had repeat NFRS performed at 1 hour intervals until the crewmember was asymptomatic. Results: Astronauts in the centrifuge/vibration study averaged a 3-5 point increase in NFRS scores immediately following exposure but returned to baseline 3 hours post-run. Subjects exposed to the vibration-only simulation had a 1-3 point increase following exposure and returned to baseline within 1-2 hours. Pre- and post- vibration exposure video oculography did not reveal any persistent ocular findings with provocative testing 1 hour post-exposure. Discussion: Based on direct observations and objective measurement of neurological function in astronauts following simulated launch

Impact of new duty-hour rules on residency training.

Science.gov (United States)

Duran-Nelson, Alisa; Van Camp, Joan; Ling, Louis

2010-11-01

On the surface, changing the rules related to the number of hours residents work per day and per week sounds like a good idea. Theoretically, residents who work fewer hours would be less tired and provide better patient care. But even small changes in residency training programs have implications for the quality of the educational experience and the cost of training, as well as patient care. This article highlights the challenges that two Minnesota residency programs are facing as they adapt to the new rules around residents' work hours.

Physicians' attentional performance following a 24-hour observation period: do we need to regulate sleep prior to work?

Science.gov (United States)

Smyth, P; Maximova, K; Jirsch, J D

2017-08-01

The tradition of physicians working while sleep deprived is increasingly criticised. Medical regulatory bodies have restricted resident physician duty-hours, not addressing the greater population of physicians. We aimed to assess factors such as sleep duration prior to a 24-hour observation period on physicians' attention. We studied 70 physicians (mean age 38 years old (SD 10.8 years)): 36 residents and 34 faculty from call rosters at the University of Alberta. Among 70 physicians, 52 (74%) performed overnight call; 18 did not perform overnight call and were recruited to control for the learning effect of repetitive neuropsychological testing. Attentional Network Test (ANT) measured physicians' attention at the beginning and end of the 24-hour observation period. Participants self-reported ideal sleep needs, sleep duration in the 24 hours prior to (ie, baseline) and during the 24-hour observation period (ie, follow-up). Median regression models examined effects on ANT parameters. Sleep deprivation at follow-up was associated with reduced attentional accuracy following the 24-hour observation period, but only for physicians more sleep deprived at baseline. Other components of attention were not associated with sleep deprivation after adjusting for repetitive testing. Age, years since medical school and caffeine use did not impact changes in ANT parameters. Our study suggests that baseline sleep before 24 hours of observation impacts the accuracy of physicians' attentional testing at 24 hours. Further study is required to determine if optimising physician sleep prior to overnight call shifts is a sustainable strategy to mitigate the effects of sleep deprivation. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Graphics, playability and social interaction, the greatest motivations for playing Call of Duty. Educational reflections

Directory of Open Access Journals (Sweden)

Beatriz Elena Marcano Lárez

2014-01-01

Full Text Available War videogames raise a lot of controversy in the educational field and are by far the most played videogames worldwide. This study explores the factors that encouraged gamers to choose war videogames with a sample of 387 Call of Duty players. The motivational factors were pinpointed using a non-experimental descriptive exploratory study through an online Likert-type survey that was valid and reliable (Cronbach’s α = 0.897, Kaiser-Meyer-Olkin coefficient, KMO: 0.903. A factor analysis with varimax rotation was applied, which yielded 7 dimensions: graphics/playability; social interaction; learning; challenge/overcoming; fantasy; fun; and competition. Considering the score obtained for each dimension, it can be concluded that the most influential motivational factors were game graphics/playability game and the social interaction allowed by its multiplayer online status, both of them being factors determined by game design elements. These aspects should be considered in the design of educational activities so as to make them impactful and motivational.

Do Hospitals Owe A So-Called 'Non-Delegable' Duty of Care to their Patients?

Science.gov (United States)

Beuermann, Christine

2018-02-01

It is not uncommon for the duty of care owed by a hospital to its patients to be described as 'non-delegable'. Use of this label suggests that a hospital may be held strictly liable to a patient for the wrongdoing of a third party beyond the circumstances in which vicarious liability might be imposed. To date, no higher court has used the label to impose such liability. Notwithstanding, it was assumed by Lord Sumption in Woodland v Swimming Teachers Association that the duty of care owed by a hospital to a patient could be so described when formulating his test for determining the existence of a 'non-delegable duty of care'. This article challenges that assumption and, in turn, the veracity of the test devised by Lord Sumption.

78 FR 41852 - Hours of Service for Commercial Motor Vehicle Drivers; Regulatory Guidance Concerning Off-Duty Time

Science.gov (United States)

2013-07-12

... provided: 1. The driver is relieved of all duty and responsibility for the care and custody of the vehicle... Service for Commercial Motor Vehicle Drivers; Regulatory Guidance Concerning Off-Duty Time AGENCY: Federal... motor vehicle (CMV) driver to record meal and other routine stops made during a work shift as off-duty...

Are Canadian general surgery residents ready for the 80-hour work week? A nationwide survey.

Science.gov (United States)

Sudarshan, Monisha; Hanna, Wael C; Jamal, Mohammed H; Nguyen, Lily H P; Fraser, Shannon A

2012-02-01

The purpose of this study was to describe Canadian general surgery residents' perceptions regarding potential implementation of work-hour restrictions. An ethics review board-approved, Web-based survey was submitted to all Canadian general surgery residency programs between April and July 2009. Questions evaluated the perceived effects of an 80-hour work week on length of training, operative exposure, learning and lifestyle. We used the Fisher exact test to compare senior and junior residents' responses. Of 360 residents, 158 responded (70 seniors and 88 juniors). Among them, 79% reported working 75-100 hours per week. About 74% of seniors believed that limiting their work hours would decrease their operative exposure; 43% of juniors agreed (p seniors and juniors thought limiting their work hours would improve their lifestyle (86% v. 96%, p = 0.12). Overall, 60% of residents did not believe limiting work hours would extend the length of their training. Regarding 24-hour call, 60% of juniors thought it was hazardous to their health; 30% of seniors agreed (p = 0.001). Both senior and junior residents thought abolishing 24-hour call would decrease their operative exposure (84% v. 70%, p = 0.21). Overall, 31% of residents supported abolishing 24-hour call. About 47% of residents (41% seniors, 51%juniors, p = 0.26) agreed with the adoption of the 80-hour work week. There is a training-level based dichotomy of opinion among general surgery residents in Canada regarding the perceived effects of work hour restrictions. Both groups have voted against abolishing 24-hour call, and neither group strongly supports the implementation of the 80-hour work week.

Associations of excessive sleepiness on duty with sleeping hours and number of days of overnight work among medical residents in Japan.

Science.gov (United States)

Wada, Koji; Sakata, Yumi; Theriault, Gilles; Narai, Rie; Yoshino, Yae; Tanaka, Katsutoshi; Aizawa, Yoshiharu

2007-11-01

Despite long-standing concerns regarding the effects of working hours on the performance and health of medical residents, and the patients' safety, prior studies have not shown an association of excessive sleepiness with the number of sleeping hours and days of overnight work among medical residents. In August 2005, a questionnaire was mailed to 227 eligible participants at 16 teaching hospitals. The total number of sleeping hours in the last 30 d was estimated from the average number of sleeping hours during regular days and during days with overnight work, and the number of days of overnight work. Multiple logistic regression analysis was used to adjust for potentially associated variables. A total of 149 men and 47 women participated in this study. The participation rate was 86.3%. Among the participants, 55 (28.1%) suffered from excessive sleepiness. Excessive sleepiness was associated with sleeping for less than 150 h in the last 30 d (corrected odds ratio [cOR]=1.57; 95% confidence interval [CI], 1.02-2.16). The number of days of overnight work in the last 30 d showed no association with excessive sleepiness. Excessive sleepiness was also associated with smoking (cOR, 1.65; 95%CI, 1.01-2.32). Medical residents who slept for less than 150 h in the last 30 d and smoked had a significantly higher risk of excessive sleepiness on duty.

Longer Working Hours? More Flexible Work Schedules? Do Austrian Economic Policymakers Need to Act?

OpenAIRE

Alfred Stiglbauer

2004-01-01

On September 23, 2004, the Oesterreichische Nationalbank (OeNB) hosted a workshop to discuss extending working hours and increasing working time flexibility. After Peter Mooslechner (OeNB) outlined the development of the present discussion in the media and presented some facts, the participants delivered their statements. Erhard Fu‹rst (Federation of Austrian Industry and Austria perspektiv) called for more flexibility rather than for an extension of working hours. He supported this view by p...

High duty cycle to low duty cycle: echolocation behaviour of the hipposiderid bat Coelops frithii.

Science.gov (United States)

Ho, Ying-Yi; Fang, Yin-Ping; Chou, Cheng-Han; Cheng, Hsi-Chi; Chang, Hsueh-Wen

2013-01-01

Laryngeally echolocating bats avoid self-deafening (forward masking) by separating pulse and echo either in time using low duty cycle (LDC) echolocation, or in frequency using high duty cycle (HDC) echolocation. HDC echolocators are specialized to detect fluttering targets in cluttered environments. HDC echolocation is found only in the families Rhinolophidae and Hipposideridae in the Old World and in the New World mormoopid, Pteronotus parnellii. Here we report that the hipposiderid Coelops frithii, ostensibly an HDC bat, consistently uses an LDC echolocation strategy whether roosting, flying, or approaching a fluttering target rotating at 50 to 80 Hz. We recorded the echolocation calls of free-flying C. frithii in the field in various situations, including presenting bats with a mechanical fluttering target. The echolocation calls of C. frithii consisted of an initial narrowband component (0.5±0.3 ms, 90.6±2.0 kHz) followed immediately by a frequency modulated (FM) sweep (194 to 113 kHz). This species emitted echolocation calls at duty cycles averaging 7.7±2.8% (n = 87 sequences). Coelops frithii approached fluttering targets more frequently than did LDC bats (C.frithii, approach frequency  = 40.4%, n = 80; Myotis spp., approach frequency  = 0%, n = 13), and at the same frequency as sympatrically feeding HDC species (Hipposideros armiger, approach rate  = 53.3%, n = 15; Rhinolophus monoceros, approach rate  = 56.7%, n = 97). We propose that the LDC echolocation strategy used by C. frithii is derived from HDC ancestors, that this species adjusts the harmonic contents of its echolocation calls, and that it may use both the narrowband component and the FM sweep of echolocations calls to detect fluttering targets.

High duty cycle to low duty cycle: echolocation behaviour of the hipposiderid bat Coelops frithii.

Directory of Open Access Journals (Sweden)

Ying-Yi Ho

Full Text Available Laryngeally echolocating bats avoid self-deafening (forward masking by separating pulse and echo either in time using low duty cycle (LDC echolocation, or in frequency using high duty cycle (HDC echolocation. HDC echolocators are specialized to detect fluttering targets in cluttered environments. HDC echolocation is found only in the families Rhinolophidae and Hipposideridae in the Old World and in the New World mormoopid, Pteronotus parnellii. Here we report that the hipposiderid Coelops frithii, ostensibly an HDC bat, consistently uses an LDC echolocation strategy whether roosting, flying, or approaching a fluttering target rotating at 50 to 80 Hz. We recorded the echolocation calls of free-flying C. frithii in the field in various situations, including presenting bats with a mechanical fluttering target. The echolocation calls of C. frithii consisted of an initial narrowband component (0.5±0.3 ms, 90.6±2.0 kHz followed immediately by a frequency modulated (FM sweep (194 to 113 kHz. This species emitted echolocation calls at duty cycles averaging 7.7±2.8% (n = 87 sequences. Coelops frithii approached fluttering targets more frequently than did LDC bats (C.frithii, approach frequency  = 40.4%, n = 80; Myotis spp., approach frequency  = 0%, n = 13, and at the same frequency as sympatrically feeding HDC species (Hipposideros armiger, approach rate  = 53.3%, n = 15; Rhinolophus monoceros, approach rate  = 56.7%, n = 97. We propose that the LDC echolocation strategy used by C. frithii is derived from HDC ancestors, that this species adjusts the harmonic contents of its echolocation calls, and that it may use both the narrowband component and the FM sweep of echolocations calls to detect fluttering targets.

On-call work and physicians' turnover intention: the moderating effect of job strain.

Science.gov (United States)

Heponiemi, Tarja; Presseau, Justin; Elovainio, Marko

2016-01-01

Physician shortage and turnover are major problems worldwide. On-call duties may be among the risk factors of high turnover rates among physicians. We investigated whether having on-call duties is associated with physicians' turnover intention and whether job strain variables moderate this association. The present study was a cross-sectional questionnaire study among 3324 (61.6% women) Finnish physicians. The analyses were conducted using analyses of covariance adjusted for age, gender, response format, specialization status and employment sector. The results showed that job strain moderated the association between being on-call and turnover intention. The highest levels of turnover intention were among those who had on-call duties and high level of job strain characterized by high demands and low control opportunities. The lowest levels of turnover intention were among those who were not on-call and who had low strain involving low demands and high control. Also, job demands moderated the association between being on-call and turnover intention; turnover intention levels were higher among those with on-call duties and high demands than those being on-call and low demands. To conclude, working on-call was related to physicians' turnover intention particularly in those with high job strain. Health care organizations should focus more attention on working arrangements and scheduling of on-call work, provide a suitable working pace and implement means to increase physicians' participation and control over their job.

Provision of out-of-hours interventional radiology services in the London Strategic Health Authority

International Nuclear Information System (INIS)

Illing, R.O.; Ingham Clark, C.L.; Allum, C.

2010-01-01

Aim: To review the provision of out-of-hours interventional radiology (IR) services in the London Strategic Health Authority (SHA). Materials and methods: All 29 acute hospitals in the London SHA were contacted between November 2008 and January 2009. A questionnaire based on the Royal College of Radiologists (RCR) guidelines assessed the provision of out-of-hours IR services. An 'ad-hoc' service was defined as on-call provision where not all the radiologists could perform intervention: If IR was required out of hours, an interventionalist came in when off-duty or the patient was transferred. Results: Seventeen out of the 29 (59%) hospitals provided ad-hoc out-of-hours services, eight (28%) provided a 24-hour rota, and four (14%) provide no out-of-hours cover. No ad-hoc service had formal transfer arrangements to a centre providing a 24 h service. Only two hospitals providing a 24 h service had six radiologists on the rota. Conclusion: Strategic planning for out-of-hours IR across London is recommended. This is likely to be welcomed by the hospitals involved, allowing informal arrangements to be formalized, and collaboration to provide comprehensive regional networks, provided appropriate funding is made available. A national audit is recommended; it is unlikely these findings are unique to London.

Provision of out-of-hours interventional radiology services in the London Strategic Health Authority

Energy Technology Data Exchange (ETDEWEB)

Illing, R.O., E-mail: rowland@doctors.org.u [University College London Hospitals NHS Foundation Trust, 235 Euston Road, London NW1 2BU (United Kingdom); Ingham Clark, C.L.; Allum, C. [Whittington Hospital NHS Trust, London (United Kingdom)

2010-04-15

Aim: To review the provision of out-of-hours interventional radiology (IR) services in the London Strategic Health Authority (SHA). Materials and methods: All 29 acute hospitals in the London SHA were contacted between November 2008 and January 2009. A questionnaire based on the Royal College of Radiologists (RCR) guidelines assessed the provision of out-of-hours IR services. An 'ad-hoc' service was defined as on-call provision where not all the radiologists could perform intervention: If IR was required out of hours, an interventionalist came in when off-duty or the patient was transferred. Results: Seventeen out of the 29 (59%) hospitals provided ad-hoc out-of-hours services, eight (28%) provided a 24-hour rota, and four (14%) provide no out-of-hours cover. No ad-hoc service had formal transfer arrangements to a centre providing a 24 h service. Only two hospitals providing a 24 h service had six radiologists on the rota. Conclusion: Strategic planning for out-of-hours IR across London is recommended. This is likely to be welcomed by the hospitals involved, allowing informal arrangements to be formalized, and collaboration to provide comprehensive regional networks, provided appropriate funding is made available. A national audit is recommended; it is unlikely these findings are unique to London.

Exposing physicians to reduced residency work hours did not adversely affect patient outcomes after residency.

Science.gov (United States)

Jena, Anupam B; Schoemaker, Lena; Bhattacharya, Jay

2014-10-01

In 2003, work hours for physicians-in-training (residents) were capped by regulation at eighty hours per week, leading to the hotly debated but unexplored issue of whether physicians today are less well trained as a result of these work-hour reforms. Using a unique database of nearly all hospitalizations in Florida during 2000-09 that were linked to detailed information on the medical training history of the physician of record for each hospitalization, we studied whether hospital mortality and patients' length-of-stay varied according to the number of years a physician was exposed to the 2003 duty-hour regulations during his or her residency. We examined this database of practicing Florida physicians, using a difference-in-differences analysis that compared trends in outcomes of junior physicians (those with one-year post-residency experience) pre- and post-2003 to a control group of senior physicians (those with ten or more years of post-residency experience) who were not exposed to these reforms during their residency. We found that the duty-hour reforms did not adversely affect hospital mortality and length-of-stay of patients cared for by new attending physicians who were partly or fully exposed to reduced duty hours during their own residency. However, assessment of the impact of the duty-hour reforms on other clinical outcomes is needed. Project HOPE—The People-to-People Health Foundation, Inc.

Comparative study of alertness and performance on 8-hour and 12-hour evening and night shifts for nuclear power plant operators

International Nuclear Information System (INIS)

Baker, T.L.

1990-01-01

Twenty males aged 25-40 years, many with extensive shiftwork and/or power plant operations experience, volunteered for a laboratory study to compare 8-hour and 12-hour shift schedules. Experiments were conducted in workplace simulation laboratories of the Human Alertness Research Center (HARC) at the Institute for Circadian Physiology in Boston, MA. This unique facility includes a simulated control room with process control simulator, control panels, and self-contained residential apartments where subjects sleep and spend off-duty hours. The design of the study is described. Subjects learn the operation of the process control simulator in multiple practice sessions prior to the experiment. They also practice computer-based performance tests, learn work shift protocols and assignments, and procedures for keeping subjective rating scales for alertness, mood and performance. By the time the first experimental shift begins, all subjects are prepared to perform their simulated work shift duties. These duties include monitoring of four video display terminals for silent (visual cues only) and auditory (visual and auditory) alarms, acknowledging the alarms with computer controls, and keeping log records of alarm activity. The process control simulator simultaneously keeps records of subject performance of these tasks by recording storing all times of alarm activity and alarm acknowledgement by the subject

Effects of 24 h working on-call on psychoneuroendocrine and oculomotor function: a randomized cross-over trial.

Science.gov (United States)

Ernst, Florian; Rauchenzauner, Markus; Zoller, Heinz; Griesmacher, Andrea; Hammerer-Lercher, Angelika; Carpenter, Roger; Schuessler, Gerhard; Joannidis, Michael

2014-09-01

On-call duty (OCD) is frequently associated with health and safety risks for both physicians and patients. The lack of studies conducted in clinical care environments and the ongoing public dialogue concerning OCD led to a detailed investigation of a working schedule including sleep fragmentation and extended work hours. Within-person randomized cross-over trial. Comparison of a 24h on-call shift (OCD) compared to a routine working-day (non on call, NOC) in hospital. 30 residents and senior physicians of the Department of Internal Medicine, Neurology and Otorhinolaryngology at the University Hospital Innsbruck. Sleep variables, cognitive performance (Concentration-Endurance d2 test), emotional status (Eigenschaftswoerterliste 60S), serum-cortisol, urinary cortisol and noradrenaline, heart-rate variability, and saccadic eye movements were determined before and after OCD and NOC respectively. Concentration-endurance performance was significantly reduced after OCD as compared to NOC by 16.4% (preduced after OCD (p<0.05) compared to NOC. 24 h OCD alters both, the sympathetic-adrenomedullary system as well as the hypothalamic pituitary-adrenocortical axis. Moreover, physicians' emotional state, cognitive and oculomotor performance seems to be influenced independently from sleep interruptions. The discrepancy between subjective feeling and objective cognitive impairments pose a risk for performing complex manual and cognitive tasks. Hence, our findings argue against an oversimplified interpretation of alterations in the physicians' psychoneuroendocrine structure in terms of impaired mood and neurocognitive deterioration combined with up-/dysregulated stress axes associated with OCD as a consequence of sleep deprivation. Copyright © 2014 Elsevier Ltd. All rights reserved.

Changing the formula of residents' work hours in internal medicine: moving from "years in training" to "hours in training".

Science.gov (United States)

Mansi, Ishak A

2011-03-01

In a recent report, the Institute of Medicine recommended more restrictions on residents' working hours. Several problems exist with a system that places a weekly limit on resident duty hours: (1) it assumes the presence of a linear relationship between hours of work and patient safety; (2) it fails to consider differences in intensity among programs; and (3) it does not address increases in the scientific content of medicine, and it places the burden of enforcing the duty hour limits on the Accreditation Council for Graduate Medical Education. An innovative method of calculating credit hours for graduate medical education would shift the focus from "years of residency" to "hours of residency." For example, internal medicine residents would be requested to spend 8640 hours of total training hours (assuming 60 hours per week for 48 weeks annually) instead of the traditional 3 years. This method of counting training hours is used by other professions, such as the Intern Development Program of the National Council of Architectural Registration Boards. The proposed approach would allow residents and program directors to pace training based on individual capabilities. Standards for resident education should include the average number of patients treated in each setting (inpatient or outpatient). A possible set of "multipliers" based on these parameters, and possibly others such as resident evaluation, is devised to calculate the "final adjusted accredited hours" that count toward graduation. Substituting "years of training" with "hours of training" may resolve many of the concerns with the current residency education model, as well as adapt to the demands of residents' personal lives. It also may allow residents to pace their training according to their capabilities and learning styles, and contribute to reflective learning and better quality education.

Improving health, safety, and profits in extended hours operations (shiftwork).

Science.gov (United States)

Kerin, Alex; Aguirre, Acacia

2005-01-01

Circadian Technologies, Inc. (CIRCADIAN) is an international consulting firm that for over 20 yr has helped employees better cope with shiftwork, while ensuring their employers reduce costs and maximize profits. This paper describes two of the methods employed to reduce accidents, absenteeism, and turnover, while improving morale and productivity in extended hour operations (shiftwork). Shiftworkers rarely receive on-the-job training to help them cope better with the rigors of working nights, evenings, and early mornings. A pre- and post-training study by CIRCADIAN demonstrated improvements in health and fatigue indices, and an increase in daytime sleep length. Companies who provide shiftwork lifestyle training also have lower rates of absenteeism and turnover compared to companies that do not provide training. The second intervention described in this paper is a novel method of shift scheduling. There are thousands of potential schedules, so how does a company choose the best schedule for their facility? The answer lies in allowing employees to be involved in the process of selection. This results in a workforce that experiences less fatigue, turnover and absenteeism, and higher morale.

The determinants and engagement patterns of chaperones and chauffeurs by Australian doctors in after-hours house-call services

Directory of Open Access Journals (Sweden)

Chris Onyebuchi Ifediora

2017-04-01

Full Text Available Objectives The use of escorts (chauffeurs and chaperones while on duty in after-hours-house-call (AHHC is one key protective option available to doctors in the service, and has been linked to low burnout and increased satisfaction in AHHC. This study aims to explore the patterns of engagement of escorts in Australian AHHC. Method This is a questionnaire-based, electronic survey of all 300 doctors involved in AHHC through the National Home Doctor Service (NHDS, Australia’s largest providers of the service. The survey explored the doctor’s experiences over the 12-month period from October 2013 to September 2014. Results This survey received a total of 168 valid responses, giving a response rate of 56%. Nearly 61% of the doctors involved in AHHC engaged escorts (chauffeurs and chaperones. Of those doctors that engage chauffeurs, three-quarters do so “all or most times”, while only one-quarter engaged chaperones to the same degree of frequency. Hiring escorts is very popular among Brisbane (91.7% and Sydney-based (88.2% practitioners, but is unpopular in the City of Gold Coast (26.1%. There were moderate patronages in Adelaide (52.9% and Melbourne Area (46.4%. Compared to males, females were less likely to drive themselves without escorts (OR 0.20; P < 0.01; CI [0.07–0.57], but more likely to engage chauffeurs (OR 5.87; P = 0.03; CI [1.16–29.77]. Practitioners who were apprehensive were three times more likely to either engage escorts as chauffeurs (OR 3.10; P = 0.04; CI [1.05–9.15] or as an accompanying chaperone if they self-drive (OR 3.03; P = 0.02; CI [1.16–7.89]. Conclusion More needs to be done to increase the engagement of escorts by doctors involved in the Australian AHHC, particularly given their proven benefits in the service. Future studies may be needed to fully explore the real reasons behind the significant associations identified in this study.

Understanding the Multidimensional Effects of Resident Duty Hours Restrictions: A Thematic Analysis of Published Viewpoints in Surgery.

Science.gov (United States)

Devitt, Katharine S; Kim, Michael J; Gotlib Conn, Lesley; Wright, Frances C; Moulton, Carol-Anne; Keshet, Itay; Ahmed, Najma

2018-02-01

Individuals representing various surgical disciplines have expressed concerns with the impact of resident duty hours (RDH) restrictions on resident education and patient outcomes. This thematic review of published viewpoints aimed to describe the effects of these restrictions in surgery. The authors conducted a qualitative systematic review of non-research-based literature published between 2003 and 2015. Articles were included if they focused on the RDH restrictions in surgery and resident wellness, health promotion, resident safety, resident education and/or training, patient safety, medical errors, and/or heterogeneity regarding training or disciplines. A thematic analysis approach guided data extraction. Contextual data were abstracted from the included articles to aid in framing the identified themes. Of 1,482 identified articles, 214 were included in the review. Most were from authors in the United States (144; 67%) and focused on the 80-hour workweek (164; 77%). The emerging themes were organized into three overarching categories: (1) impact of the RDH restrictions, (2) surgery has its own unique culture, and (3) strategies going forward. Published opinions suggested that RDH restrictions alone are insufficient to achieve the desired outcomes and that careful consideration of the surgical training model is needed to maintain the integrity of educational outcomes. Opinions from the surgical community highlight the complexity of issues surrounding the RDH restrictions and suggest that recent changes are not achieving all the desired outcomes and have resulted in unintended outcomes. From the perceptions of the various stakeholders in surgical education studied, areas for new policies were identified.

Fatigue Risk Management: The Impact of Anesthesiology Residents' Work Schedules on Job Performance and a Review of Potential Countermeasures.

Science.gov (United States)

Wong, Lily R; Flynn-Evans, Erin; Ruskin, Keith J

2018-04-01

Long duty periods and overnight call shifts impair physicians' performance on measures of vigilance, psychomotor functioning, alertness, and mood. Anesthesiology residents typically work between 64 and 70 hours per week and are often required to work 24 hours or overnight shifts, sometimes taking call every third night. Mitigating the effects of sleep loss, circadian misalignment, and sleep inertia requires an understanding of the relationship among work schedules, fatigue, and job performance. This article reviews the current Accreditation Council for Graduate Medical Education guidelines for resident duty hours, examines how anesthesiologists' work schedules can affect job performance, and discusses the ramifications of overnight and prolonged duty hours on patient safety and resident well-being. We then propose countermeasures that have been implemented to mitigate the effects of fatigue and describe how training programs or practice groups who must work overnight can adapt these strategies for use in a hospital setting. Countermeasures include the use of scheduling interventions, strategic naps, microbreaks, caffeine use during overnight and extended shifts, and the use of bright lights in the clinical setting when possible or personal blue light devices when the room lights must be turned off. Although this review focuses primarily on anesthesiology residents in training, many of the mitigation strategies described here can be used effectively by physicians in practice.

Working hours and productivity

NARCIS (Netherlands)

Collewet, Marion; Sauermann, Jan

2017-01-01

This paper studies the link between working hours and productivity using daily information on working hours and performance of a sample of call centre agents. We exploit variation in the number of hours worked by the same employee across days and weeks due to central scheduling, enabling us to

Perspective: creating an ethical workplace: reverberations of resident work hours reform.

Science.gov (United States)

Lopez, Lenny; Katz, Joel T

2009-03-01

Medical professionals are a community of highly educated individuals with a commitment to a core set of ideals and principles. This community provides both technical and ethical socialization. The development of ethical physicians is highly linked to experiences in the training period. Moral traits are situation-sensitive psychological and behavioral dispositions. The consequence of long duty hours on the moral development of physicians is less understood. The clinical environment of medical training programs can be so intense as to lead to conditions that may actually deprofessionalize trainees. The dynamic relationship between individual character traits and the situational dependence of their expression suggests that a systems approach will help promote and nurture moral development. Ethical behavior can be supported by systems that make it more difficult to veer from the ideal. Work hours limits are a structural change that will help preserve public safety by preventing physicians from taking the moral shortcuts that can occur with increasing work and time pressures. Work hours rules are beneficial but insufficient to optimize an ethical work and training environment. Additional measures need to be put in place to ensure that ethical tensions are not created between the patient's well-being and the resident's adherence to work hours rules. The ethical ideals of physician autonomy, selflessness, and accountability to the patient must be protected through the judicious and flexible use of work hours limits, physician extenders, census caps, nonteaching services, and high-quality handoffs.

Changing the Formula of Residents' Work Hours in Internal Medicine: Moving From “Years in Training” to “Hours in Training”

Science.gov (United States)

Mansi, Ishak A

2011-01-01

Background In a recent report, the Institute of Medicine recommended more restrictions on residents' working hours. Several problems exist with a system that places a weekly limit on resident duty hours: (1) it assumes the presence of a linear relationship between hours of work and patient safety; (2) it fails to consider differences in intensity among programs; and (3) it does not address increases in the scientific content of medicine, and it places the burden of enforcing the duty hour limits on the Accreditation Council for Graduate Medical Education. Proposal An innovative method of calculating credit hours for graduate medical education would shift the focus from “years of residency” to “hours of residency.” For example, internal medicine residents would be requested to spend 8640 hours of total training hours (assuming 60 hours per week for 48 weeks annually) instead of the traditional 3 years. This method of counting training hours is used by other professions, such as the Intern Development Program of the National Council of Architectural Registration Boards. The proposed approach would allow residents and program directors to pace training based on individual capabilities. Standards for resident education should include the average number of patients treated in each setting (inpatient or outpatient). A possible set of “multipliers” based on these parameters, and possibly others such as resident evaluation, is devised to calculate the “final adjusted accredited hours” that count toward graduation. Anticipated Benefits Substituting “years of training” with “hours of training” may resolve many of the concerns with the current residency education model, as well as adapt to the demands of residents' personal lives. It also may allow residents to pace their training according to their capabilities and learning styles, and contribute to reflective learning and better quality education. PMID:22379516

BUSINESS MODELS FOR EXTENDING OF 112 EMERGENCY CALL CENTER CAPABILITIES WITH E-CALL FUNCTION INSERTION

Directory of Open Access Journals (Sweden)

Pop Dragos Paul

2010-12-01

Full Text Available The present article concerns present status of implementation in Romania and Europe of eCall service and the proposed business models regarding eCall function implementation in Romania. eCall system is used for reliable transmission in case of crush between In Vehicle System and Public Service Answering Point, via the voice channel of cellular and Public Switched Telephone Network (PSTN. eCall service could be initiated automatically or manual the driver. All data presented in this article are part of researches made by authors in the Sectorial Contract Implementation study regarding eCall system, having as partners ITS Romania and Electronic Solution, with the Romanian Ministry of Communication and Information Technology as beneficiary.

[Travel time and distances to Norwegian out-of-hours casualty clinics].

Science.gov (United States)

Raknes, Guttorm; Morken, Tone; Hunskår, Steinar

2014-11-01

Geographical factors have an impact on the utilisation of out-of-hours services. In this study we have investigated the travel distance to out-of-hours casualty clinics in Norwegian municipalities in 2011 and the number of municipalities covered by the proposed recommendations for secondary on-call arrangements due to long distances. We estimated the average maximum travel times and distances in Norwegian municipalities using a postcode-based method. Separate analyses were performed for municipalities with a single, permanently located casualty clinic. Altogether 417 out of 430 municipalities were included. We present the median value of the maximum travel times and distances for the included municipalities. The median maximum average travel distance for the municipalities was 19 km. The median maximum average travel time was 22 minutes. In 40 of the municipalities (10 %) the median maximum average travel time exceeded 60 minutes, and in 97 municipalities (23 %) the median maximum average travel time exceeded 40 minutes. The population of these groups comprised 2 % and 5 % of the country's total population respectively. For municipalities with permanent emergency facilities(N = 316), the median average flight time 16 minutes and median average distance 13 km.. In many municipalities, the inhabitants have a long average journey to out-of-hours emergency health services, but seen as a whole, the inhabitants of these municipalities account for a very small proportion of the Norwegian population. The results indicate that the proposed recommendations for secondary on-call duty based on long distances apply to only a small number of inhabitants. The recommendations should therefore be adjusted and reformulated to become more relevant.

Double-duty caregivers: healthcare professionals juggling employment and informal caregiving. A survey on personal health and work experiences.

Science.gov (United States)

Boumans, Nicolle P G; Dorant, Elisabeth

2014-07-01

This study compared the work-related experiences and personal health status of double-duty caregivers with those of caregivers who do not provide informal care to a family member or close friend in need. The interest in providing informal care alongside employment is growing. However, little attention has been paid to the dual role of the healthcare professional who also has caregiving responsibilities for a needy person in his/her private situation. It is important to study the negative and positive consequences of this combination of professional and family care giving. A cross-sectional study. In 2011, we distributed a digital questionnaire to employees with a professional care function working at a healthcare organization in the Netherlands. Descriptive statistics, analyses of covariance and tests of linearity were performed. Analyses of variance demonstrated that as professional healthcare workers provide more hours of informal care in their private lives, their mental and physical health significantly worsens, while their need for recovery increases. Also, statistical significant increases were seen for emotional exhaustion, presenteeism and negative experiences with Work-Home and Home-Work Interferences. Remarkably, positive Home-Work Interference increased significantly with increasing hours of informal care. Double-duty caregivers appeared to be equally motivated and satisfied with their work as their co-workers. No differences were seen with respect to absenteeism. Double-duty caregivers prove to be employees who are at risk of developing symptoms of overload. This finding calls for special attention, with long-term solutions at both legislative and organizational level. © 2013 John Wiley & Sons Ltd.

The eighty-hour workweek: surgical attendings' perspectives.

Science.gov (United States)

Griner, Devan; Menon, Rema P; Kotwall, Cyrus A; Clancy, Thomas V; Hope, William W

2010-01-01

The year 2008 was a sentinel year in resident education; this was the first graduating general surgery class trained entirely under the 80-hour workweek. The purpose of this study was to evaluate attending surgeon perceptions of surgical resident attitudes and performance before and after duty-hour restrictions. An electronic survey was sent to all surgical teaching institutions in North Carolina. Both surgeon and hospital characteristics were documented. The survey consisted of questions designed to assess residents' attitudes/performance before and after the implementation of the work-hour restriction. In all, 77 surveys were returned (33% response rate). The survey demonstrated that 92% of educators who responded to the survey recognized a difference between the restricted residents (RRs) and the nonrestricted residents (NRRs), and most respondents (67%) attributed this to both the work-hour restrictions and the work ethic of current residents. Most attending surgeons reported no difference between the RRs and the NRRs in most categories; however, they identified a negative change in the areas of work ethic, technical skills development, decision-making/critical-thinking skills, and patient ownership among the RR group. Most surgeons expressed less trust (55%) with patient care and less confidence (68%) in residents' ability to operate independently in the RR group. Eighty-nine percent indicated that additional decreases in work hours would continue to hamper the mission of timely and comprehensive resident education. The perception of surgical educators was that RRs are clearly different from the NRRs and that the primary difference is in work ethic and duty-hour restrictions. Although similar in most attributes, RRs are perceived as having a lower baseline work ethic and a less developed technical skill set, decision-making ability, and sense of patient ownership. Subsequent study is needed to evaluate these concerns. Copyright 2010 Association of Program

Going on holiday? Travelling on duty? Do you know what to do if your mobile phone is lost or stolen?

CERN Multimedia

2015-01-01

It’s summertime and many of us will be going on holiday, perhaps far away from Geneva. Duty travel also takes many of us far away from CERN from time to time. You probably know how to cancel your credit cards if they are lost or stolen, but do you know how to block your CERN mobile phone from use?   Recently, one user waited until returning to CERN to block theirs which was enough time for the thief to run up a substantial phone bill. Please make sure the same doesn’t happen to you! If your phone is lost or stolen: during working hours: call the Telecom Lab on +41 22 767 2480 or the CERN Switchboard on +41 22 767 6111 as soon as possible and provide: - your telephone number, - your name / first name / department. outside working hours: call the Swisscom hotline as soon as possible on: - +41 800 55 64 64 (in Switzerland) or, - +41 62 286 12 12 (outside Switzerland). You will also need to report the loss or theft in accordance with CERN’s offic...

CRIMES AGAINST OFFICIAL DUTY IN THE REPUBLIC OF MACEDONIA

Directory of Open Access Journals (Sweden)

Darko Majhosev

2015-07-01

Full Text Available The paper analyzes the legal provisions of the Criminal Code of the Republic of Macedonia relating to crimes against official duty. Crimes against official duty represent a group of criminal offenses that occupy a special place in criminal law. This kind of crimes is also called civil servants crimes, that is, they are defined as a violation of duty made by an official in performing his/her official duty. In this paper we will analyze all articles of the Criminal Code that regulate the group of criminal offenses against official duty. Most frequent cases of misuse of official duty are cases of misuse of official position and authorization, unprincipled operation within the service, defraud in the service, receiving a bribe, giving a bribe, unlawful mediation, disclosing an official secret, falsifying an official document and other. The paper will define the terms official and responsible person. In the context of the paper we will show the research referring to the number of registered and accused of crimes against official duty in the Republic of Macedonia in the period from 2004 to 2013.

Work hours restrictions as an ethical dilemma for residents: a descriptive survey of violation types and frequency.

Science.gov (United States)

Carpenter, Robert O; Spooner, John; Arbogast, Patrick G; Tarpley, John L; Griffin, Marie R; Lomis, Kimberly D

2006-01-01

The Accreditation Council for Graduate Medical Education (ACGME) implemented requirements regarding allowable duty hours for resident training in the United States in July 2003. In a previous pilot study at Vanderbilt University Medical Center, a significant number of residents reported violation of requirements. In addition, almost half of those individuals admitted under-reporting their hours worked. The authors' goal was to further delineate the type and frequency of violations and under-reporting. A survey tool was designed to assess specific types of violations as well as factors that influence the number of hours residents worked and reported. Approval was obtained from the Vanderbilt Institutional Review Board and Office of Graduate Medical Education before enrollment of subjects. The program directors of Pediatrics, Internal Medicine, Medicine-Pediatrics, and General Surgery supported the participation of their residents. A voluntary anonymous survey of these residents was conducted 1 year after the pilot study. Of 263 eligible residents, 175 were surveyed. Of 175 residents, 125 (71%) residents responded. Eighty-five percent of residents reported violation of duty-hour requirements within the preceding 3 months. Residents reported violation of specific requirements as follows: 1 day off in 7, 28%; 80-hour weekly average, 65%; and "24+6" consecutive hours, 85%. Residents were asked to estimate the number of hours by which they exceeded requirements. Hours over the 80-hour weekly requirement were reported as follows: 1 hour, 12%; 2 hours, 15%; 3 hours, 21%; 4 hours, 5%; 5 hours, 14%; and 6 or more hours, 33%. Hours over the "24+6" requirement were reported as follows: 1 hour, 30%; 2 hours, 42%; 3 hours, 18%; 4 hours, 7%; 5 hours, 1%; and 6 or more hours, 2%. Forty-eight percent of respondents admitted under-reporting violations to their program director. Eighty-five percent of residents reported at least 1 violation, and 48% admitted under

Duty hours for post-graduate resident doctors need for change

Directory of Open Access Journals (Sweden)

Sushil Kumar

2013-01-01

Full Text Available Post Graduate training involves Patient care, education and administrative activities. But in today's modern life, the patient doctor ratio is so high that it leads to long working hours among PG residents which leads to fatigue & stress, which ultimately affects the care-giver as well as the patients. A survey was done among 20 PG residents to analyse performance, behavior, attitude and practices in patient care by PG Residents and to understand the affliction of their personal life. It was found that the PG Residents are working for an average time of 110 hrs/week ranging from 80–132 hours/week. It was also found to affect their performance, self-care, needle stick injuries & personal life.

Development of out-of-hours primary care by general practitioners (GPs) in The Netherlands: from small-call rotations to large-scale GP cooperatives.

Science.gov (United States)

van Uden, Caro J T; Giesen, Paul H J; Metsemakers, Job F M; Grol, Richard P T M

2006-09-01

Over the last 10 years, care outside office hours by primary care physicians in The Netherlands has experienced a radical change. While Dutch general practitioners (GPs) formerly performed these services in small-call rotations, care is nowadays delivered by large-scale GP cooperatives. We searched the literature for relevant studies on the effect of the out-of-hours care reorganization in The Netherlands. We identified research that included before- and afterintervention studies, descriptive studies, and surveys. These studies focused on the consequences of reorganizing several aspects of out-of-hours care, such as patient and GP satisfaction, patient characteristics, utilization of care, and costs. Various studies showed that the reorganization has successfully addressed many of the critical issues that Dutch GPs were confronted with delivering these services. GPs' job satisfaction has increased, and patients seem to be satisfied with current out-of-hours care. Several aspects of out-of-hours care are discussed, such as telephone triage, self referrals, and future expectations, which should receive extra attention by researchers and health policy makers in the near future.

Due diligence duties for an environmental liability

International Nuclear Information System (INIS)

Huebsch, M.

2000-04-01

Jurisdiction turned out well to create a basic ruling for due diligence duties. These due diligence duties are high standards for the law of torts (outside of contracts) within the Austrian civil law and represent a liability-extension for the holder of the source of danger. They establish an action for injunction in particular for preventing (further) damages. Therewith due diligence duties get a general sense in the range of a civil law for environmental liability. The responsible holder of a danger zone will therefore influence his way of acting to protect potential victims and the environment. The burden of proof is on the plaintiff (victims) under the Civil Code. Victims have specific sources of danger including high endangering special facilities in their argumentation with the so-called prima-facie-proof or first-appearance-proof. A turning back of the presentation of evidence to the polluter is wrong. The polluter himself has a continuing liability for dangerous activities and his clerks in the case of an extremely high danger of damage. All due diligence duties can be arranged in three areas: in information-, danger-avoidance- and danger-prevention-duties. The determination of range and essence of the duties has to be adjusted to each individual case. The range of the specific danger area is the essential link. The intensity of due diligence duties is increasing with the size of danger in the way of a movable system depending on the protected interest. Due diligence duties have to be kept within reasonable limits with two criterions: necessarity and demand. Proportionality of actions is a third criterion to avoid exaggeration of due diligence duties to obtain an effective protection for victims including the environment. (author)

Are there high-risk groups among physicians that are more vulnerable to on-call work?

Science.gov (United States)

Heponiemi, Tarja; Aalto, Anna-Mari; Pekkarinen, Laura; Siuvatti, Eeva; Elovainio, Marko

2015-05-01

Work done in the emergency departments is one stressful aspect of physicians' work. Numerous previous studies have highlighted the stressfulness of on-call work and especially of night on call. In addition, previous studies suggest that there may be individual differences in adjusting to changes in circadian rhythms and on-call work. The objective of this study was to examine whether physicians' on-call work is associated with perceived work-related stress factors and job resources and whether there are groups that are more vulnerable to on-call work according to sex, age, and specialization status. This was a cross-sectional questionnaire study among 3230 Finnish physicians (61.5% women). The analyses were conducted using analyses of covariance adjusted for sex, age, specialization status, and employment sector. Physicians with on-call duties had more time pressure and stress related to team work and patient information systems compared with those who did not have on-call duties. In addition, they had less job control opportunities and experienced organization as less fair and team climate as worse. Older physicians and specialists seemed to be especially vulnerable to on-call work regarding stress factors, whereas younger and specialist trainees seemed vulnerable to on-call work regarding job resources. Focusing on team issues and resources is important for younger physicians and trainees having on-call duties, whereas for older and specialists, attention should be focused on actual work load and time pressure. Copyright © 2015 Elsevier Inc. All rights reserved.

Achieving Accreditation Council for Graduate Medical Education duty hours compliance within advanced surgical training: a simulation-based feasibility assessment.

Science.gov (United States)

Obi, Andrea; Chung, Jennifer; Chen, Ryan; Lin, Wandi; Sun, Siyuan; Pozehl, William; Cohn, Amy M; Daskin, Mark S; Seagull, F Jacob; Reddy, Rishindra M

2015-11-01

Certain operative cases occur unpredictably and/or have long operative times, creating a conflict between Accreditation Council for Graduate Medical Education (ACGME) rules and adequate training experience. A ProModel-based simulation was developed based on historical data. Probabilistic distributions of operative time calculated and combined with an ACGME compliant call schedule. For the advanced surgical cases modeled (cardiothoracic transplants), 80-hour violations were 6.07% and the minimum number of days off was violated 22.50%. There was a 36% chance of failure to fulfill any (either heart or lung) minimum case requirement despite adequate volume. The variable nature of emergency cases inevitably leads to work hour violations under ACGME regulations. Unpredictable cases mandate higher operative volume to ensure achievement of adequate caseloads. Publically available simulation technology provides a valuable avenue to identify adequacy of case volumes for trainees in both the elective and emergency setting. Copyright © 2015 Elsevier Inc. All rights reserved.

PROVISION OF THE DUTY SERVICE IN GYNECOLOGY AND OBSTETRICS IN SLOVENIA

Directory of Open Access Journals (Sweden)

Iztok Takač

2018-02-01

Full Text Available Background: Duty service of gyecology and obstetrics in Slovenia is organized on the regional basis and consists of ten regional hospitals, two hospitals for gynecology and obstetrics and two university clinical centres. Methods: Heads of hospitals where duty service is performed, have answered the questionnaires about the doctors who perform duty service. Results: Specialists and trainees in gynecology and obstetrics perform duty service on 21 posts and on 6 on-call posts. In Slovenia there are 287 active specialists in gynecology and obstetrics. 139 (48.4% among them are active on the primary level (outpatient clinics and 148 (51.6% in the hospitals and both clinical centres. Among hospital gynecologists and obstetricians 54 (36.5% of them are older than 55 years. Conclusions: Duty service of gyecology and obstetrics in Slovenia does not meet legislation criteria regard- ing doctors’ work time. Adequate changes for increasing the number of available doctors for duty service are proposed.

Características sociológicas de videojugadores online y el e-sport. El caso de Call of duty.

Directory of Open Access Journals (Sweden)

Beatriz Marcano Lárez

2012-01-01

ón.--------------------------------------------------------------------The proliferation of online multiplayer videogames has produced video game player communities around each one of them. Their members share game experiences, ask for help for installation as well as for the solution of technical problems or invitation to game parties and be informed about main game activities. The high number of sales and demands for this recreation alternative (54% among other options challenges us to approach these game communities in order to know the sociological profile of their members as a component of our knowledge society. Our objective was to know the sociological characteristics of video game players (gender, age, background and occupation as well as their player habits (weekly time dedicated to play, membership to game clans, teams and competition participation. A non experimental exploratory field ---e-research-- was designed. 368 video game players of the Call of Duty game constituted our sample. The outcomes were analyzed by SPSS 15.0 simple and combined frequencies. The participant general profile can be briefly described as men, students, less than 21 years of age, Spaniards, who play less than 11hours a week, belonging to clans and participants of teams and competitions. The sport connotation given to the game practice is to be underlined due to their sense of responsibility toward their clans engagement and dedication. Finally, we propose to focus research attention on these virtual communities as selective manner areas of self-organized non-formal training. From the perspective of social pedagogy that is emerging as another action field.

Conduits to care: call lights and patients’ perceptions of communication

Science.gov (United States)

Montie, Mary; Shuman, Clayton; Galinato, Jose; Patak, Lance; Anderson, Christine A; Titler, Marita G

2017-01-01

Background Call light systems remain the primary means of hospitalized patients to initiate communication with their health care providers. Although there is vast amounts of literature discussing patient communication with their health care providers, few studies have explored patients’ perceptions concerning call light use and communication. The specific aim of this study was to solicit patients’ perceptions regarding their call light use and communication with nursing staff. Methods Patients invited to this study met the following inclusion criteria: proficient in English, been hospitalized for at least 24 hours, aged ≥21 years, and able to communicate verbally (eg, not intubated). Thirty participants provided written informed consent, were enrolled in the study, and completed interviews. Results Using qualitative descriptive methods, five major themes emerged from patients’ perceptions (namely; establishing connectivity, participant safety concerns, no separation: health care and the call light device, issues with the current call light, and participants’ perceptions of “nurse work”). Multiple minor themes supported these major themes. Data analysis utilized the constant comparative methods of Glaser and Strauss. Discussion Findings from this study extend the knowledge of patients’ understanding of not only why inconsistencies occur between the call light and their nurses, but also why the call light is more than merely a device to initiate communication; rather, it is a direct conduit to their health care and its delivery. PMID:29075125

Conduits to care: call lights and patients' perceptions of communication.

Science.gov (United States)

Montie, Mary; Shuman, Clayton; Galinato, Jose; Patak, Lance; Anderson, Christine A; Titler, Marita G

2017-01-01

Call light systems remain the primary means of hospitalized patients to initiate communication with their health care providers. Although there is vast amounts of literature discussing patient communication with their health care providers, few studies have explored patients' perceptions concerning call light use and communication. The specific aim of this study was to solicit patients' perceptions regarding their call light use and communication with nursing staff. Patients invited to this study met the following inclusion criteria: proficient in English, been hospitalized for at least 24 hours, aged ≥21 years, and able to communicate verbally (eg, not intubated). Thirty participants provided written informed consent, were enrolled in the study, and completed interviews. Using qualitative descriptive methods, five major themes emerged from patients' perceptions (namely; establishing connectivity, participant safety concerns, no separation: health care and the call light device, issues with the current call light, and participants' perceptions of "nurse work"). Multiple minor themes supported these major themes. Data analysis utilized the constant comparative methods of Glaser and Strauss. Findings from this study extend the knowledge of patients' understanding of not only why inconsistencies occur between the call light and their nurses, but also why the call light is more than merely a device to initiate communication; rather, it is a direct conduit to their health care and its delivery.

CBO Testimony: The Effects of Reserve Call-Ups on Civilian Employers

National Research Council Canada - National Science Library

2005-01-01

...) recent analysis of the effects of reserve call-ups on civilian employers. The military reserves provide trained service members and units that are available for active military duty during peacetime and war...

To Assess Sleep Quality among Pakistani Junior Physicians (House ...

African Journals Online (AJOL)

Background: Sleep deprivation among junior physicians (house officers) is of growing concern. In developed countries, duty hours are now mandated, but in developing countries, junior physicians are highly susceptible to develop sleep impairment due to long working hours, on‑call duties and shift work schedule. Aim: We ...

Euro VI technologies and costs for Heavy Duty vehicles: the expert panels summary of stakeholders responses

NARCIS (Netherlands)

Gense, N.L.J.; Riemersma, I.J.; Such, C.l; Ntziachristos, L.

2006-01-01

This report is the result of the work carried out under on the Europeans Commission’s call for tender regarding “Technical support for the Commission DG Environment on the development of Euro 5 standards for light-duty vehicles and Euro VI standards for heavy-duty vehicles” (Reference:

Experience With Flexible Hours of Work

Science.gov (United States)

Hartley, Jo

1976-01-01

A summary of an 80-page booklet called Hours of Work When Workers Can Choose is presented. The booklet reports a survey and focuses on the benefits of flexible hours of work. It was published by the Business and Professional Women's Foundation and is available from that organization. (EC)

Call Centre- Computer Telephone Integration

Directory of Open Access Journals (Sweden)

Dražen Kovačević

2012-10-01

Full Text Available Call centre largely came into being as a result of consumerneeds converging with enabling technology- and by the companiesrecognising the revenue opportunities generated by meetingthose needs thereby increasing customer satisfaction. Regardlessof the specific application or activity of a Call centre, customersatisfaction with the interaction is critical to the revenuegenerated or protected by the Call centre. Physical(v, Call centreset up is a place that includes computer, telephone and supervisorstation. Call centre can be available 24 hours a day - whenthe customer wants to make a purchase, needs information, orsimply wishes to register a complaint.

29 CFR 778.221 - “Call-back” pay.

Science.gov (United States)

2010-07-01

... 29 Labor 3 2010-07-01 2010-07-01 false âCall-backâ pay. 778.221 Section 778.221 Labor Regulations...Regular Rateâ Payments Not for Hours Worked § 778.221 “Call-back” pay. (a) General. In the interest of... payments consist of a specified number of hours' pay at the applicable straight time or overtime rates...

The role of the nonphysician educator in general surgery residency training: from outcome project and duty-hours restrictions to the next accreditation system and milestones.

Science.gov (United States)

Tarpley, Margaret J; Davidson, Mario A; Tarpley, John L

2014-01-01

In 2002 and 2003 the ACGME Outcome Project (assessing residents based on competencies) and duty-hours restrictions were implemented. One strategy for assisting PDs in the increased workload was to hire nonphysician educators with training and experience in curriculum design, teaching techniques, adult learning theories, and research methods. This study sought to document prevalence and responsibilities of nonphysician educators. IRB approval was received for a two-part study. All 247 general surgery PDs were e-mailed the question, "Do you have a nonphysician educator as a member of your surgery education office?" Those who replied "yes" or volunteered "not currently but in the past" were e-mailed a link to an electronic survey concerning the role of the nonphysician educator. Residency training programs in general surgery. General surgery program directors. Of the 126 PDs who responded to the initial query, 37 said "yes" and 4 replied "not currently but in the past". Thirty-two PDs of the initial 41 respondents completed the survey. Significant findings included: 65% were hired in the last 6 years; faculty rank is held by 69%; and curriculum development was the most common responsibility but teaching, research, and administrative duties were often listed. PDs perceived that faculty, residents, and medical students had mostly positive attitudes towards nonphysician educators. The overall results seem to support the notion that nonphysician educators serve as vital members of the team. Copyright © 2014 Association of Program Directors in Surgery. All rights reserved.

Work Hours Constraints: Impacts and Policy Implications

OpenAIRE

Constant, Amelie F.; Otterbach, Steffen

2011-01-01

If individuals reveal their preference as consumers, then they are taken seriously. What happens if individuals, as employees, reveal their preferences in working hours? And what happens if there is a misalignment between actual hours worked and preferred hours, the so-called work hours constraints? How does this affect the productivity of workers, their health, and overall life satisfaction? Labor supply and corresponding demand are fundamental to production. Labor economists know for long t...

A workplace modified duty program for employees in an oncology center.

Science.gov (United States)

Soteriades, Elpidoforos S

2017-01-01

Workplace modified duty programs may provide reasonable accommodations to employees who have partial temporary job disability and could work on duty accommodations until they fully recover. However, little is known about the implementation barriers and effectiveness of such programs. This study is aimed at evaluating the implementation of a modified duty program for employees in an oncology center. A modified duty program for employees working at the Bank of Cyprus Oncology Center, a non profit organization with 200 employees located in the Republic of Cyprus was evaluated based on the health records of the occupational medicine department. Employees' participation in the program was 3%. A total of 12 employees participated (6 each year). The participants were all women and the mean participation period was 21.6 days (range 10 - 65 days). The two most frequent reasons for a modified duty assignment were pregnancy and back pain. Employees were assigned either on limited duties or on a combination of limited duties and reduced work hours. Employees reported being very satisfied with their participation based on a follow-up narrative oral assessment. The small participation rate does not allow for advanced statistical analyses. Further studies from larger organizations are urgently needed to evaluate the effectiveness of modified duty programs. The development of a legal framework for such modified duty programs in Cyprus as well as internationally may promote their implementation in order to facilitate the effective management of temporary partial job disability for the benefit of both employees and businesses.

Extended Emotions

DEFF Research Database (Denmark)

Krueger, Joel; Szanto, Thomas

2016-01-01

beyond the neurophysiological confines of organisms; some even argue that emotions can be socially extended and shared by multiple agents. Call this the extended emotions thesis (ExE). In this article, we consider different ways of understanding ExE in philosophy, psychology, and the cognitive sciences...

State duties of protection and fundamental rights

Directory of Open Access Journals (Sweden)

C Starck

2000-05-01

, the principle of proportionality can be adopted to test whether the protection is effective. Insofar as protection can be achieved without infringements of rights, one must attempt to test the effectiveness of protection by some other means. Where the legislature omits to protect at all, the court should limit itself to establishing the existence of a duty and to querying its non-fulfilment. The Court may not pass protective regulations or impose a duty to pass specific regulations. Where general statutory norms apply, protective duties can be realised through the so-called indirect third-party effect of fundamental rights. In its reaching its decision, the German Federal Constitutional Court is responsible for preserving the political discretion of the legislature in protecting interests and remembering the structural distinction between "hard" defensive rights and "soft" protective duties in order to prevent the erosion of the directly binding nature of defensive rights.

24-hour society and working environment; 24 jikan shakai to rodo kankyo

Energy Technology Data Exchange (ETDEWEB)

Fujita, Jun' ichi [Kansai Electric Power Corp., Osaka (Japan)

1999-07-25

Naturally, a human being has a rhythm with a period of about one day for hormone distribution and body temperature. This rhythm is called circadian rhythm. An ecological watch controlling this rhythm exists in supraoptic nucleus of brain, and its inherent period is clarified to be about 25 hours. Light, temperature, sound, smell and the like are the elements to improve arousal degree of brain and adjust the interior watch. However, a strong light does not only have the direct effect on improving immediately arousal degree and performance but can also shift the interior watch. Specifically, the interior watch becomes slower when a human body is bathed in an intensive light in midnight, whereas it becomes faster when bathed in an intensive light at daybreak. Consequently, this phenomenon can be used to shift the sleepy peak of a person on night duty from the working time to daytime sleeping time zone. The technology using light to improve arousal degree is utilized in space shuttles, atomic power plants, petroleum refineries and the like in USA. (NEDO)

77 FR 31684 - Hours of Service of Drivers: RockTenn, Exemption Application

Science.gov (United States)

2012-05-29

... place of business. Its shipping and receiving departments are on opposite sides of the paper mill... mandatory 10 hours off-duty requirement, RockTenn schedules these drivers' shifts to start later than other... approval of their request would be for the convenience of the applicant, with no assurance of safety...

Medical support for law enforcement-extended operations incidents.

Science.gov (United States)

Levy, Matthew J; Tang, Nelson

2014-01-01

As the complexity and frequency of law enforcement-extended operations incidents continue to increase, so do the opportunities for adverse health and well-being impacts on the responding officers. These types of clinical encounters have not been well characterized nor have the medical response strategies which have been developed to effectively manage these encounters been well described. The purpose of this article is to provide a descriptive epidemiology of the clinical encounters reported during extended law enforcement operations, as well as to describe a best practices approach for their effective management. This study retrospectively examined the clinical encounters of the Maryland State Police (MSP) Tactical Medical Unit (TMU) during law enforcement extended operations incidents lasting 8 or more hours. In addition, a qualitative analysis was performed on clinical data collected by federal law enforcement agencies during their extended operations. Forty-four percent of missions (455/1,047) supported by the MSP TMU lasted 8 or more hours. Twenty-six percent of these missions (117/455) resulted in at least one patient encounter. Nineteen percent of patient chief complaints (45/238) were related to heat illness/ dehydration. Fifteen percent of encounters (36/238) were for musculoskeletal injury/pain. Eight percent of patients (19/238) had nonspecific sick call (minor illness) complaints. The next most common occurring complaints were cold-related injuries, headache, sinus congestion, and wound/laceration, each of which accounted for 7 percent of patients (16/238), respectively. Analysis of federal law enforcement agencies' response to such events yielded similar clinical encounters. A wide range of health problems are reported by extended law enforcement operations personnel. Timely and effective treatment of these problems can help ensure that the broader operations mission is not compromised. An appropriate operational strategy for managing health complaints

Extending Mondrian Memory Protection

Science.gov (United States)

2010-11-01

a kernel semaphore is locked or unlocked. In addition, we extended the system call interface to receive notifications about user-land locking...operations (such as calls to the mutex and semaphore code provided by the C library). By patching the dynamically loadable GLibC5, we are able to test... semaphores , and spinlocks. RTO-MP-IST-091 10- 9 Extending Mondrian Memory Protection to loading extension plugins. This prevents any untrusted code

Periodic self-rostering in shift work: correspondence between objective work hours, work hour preferences (personal fit), and work schedule satisfaction

NARCIS (Netherlands)

Ingre, M.; Äkerstedt, T.; Ekstedt, M.; Kecklund, L.G.

2012-01-01

Objectives The main objective of the present study was to investigate relative personal fit as the association between rated needs and preferences for work hours, on the one hand, and actual work hours, on the other hand, in three groups (hospital, call-center, and police) working with periodic

Nurses negotiating professional-familial care boundaries: striving for balance within double duty caregiving.

Science.gov (United States)

Ward-Griffin, Catherine; Brown, Judith Belle; St-Amant, Oona; Sutherland, Nisha; Martin-Matthews, Anne; Keefe, Janice; Kerr, Mickey

2015-02-01

The purpose of this sequential, two-phase mixed-methods study was to examine the health of male and female nurses who provided care to older relatives (i.e., double duty caregivers). We explored the experiences of 32 double duty caregivers, which led to the development of an emergent grounded theory, Negotiating Professional-Familial Care Boundaries with two broad dialectical processes: professionalizing familial care and striving for balance. This article examines striving for balance, which is the process that responds to familial care expectations in the midst of available resources and reflects the health experiences of double duty caregivers. Two subprocesses of striving for balance, reaping the benefits and taking a toll, are presented in three composite vignettes, each representing specific double duty caregiving (DDC) prototypes (making it work, working to manage, living on the edge). This emergent theory extends current thinking of family caregiving that will inform the development and refinement of practices and policies relevant to DDC. © The Author(s) 2014.

Calling behavior of mass-reared and wild Anastrepha serpentina (Diptera: Tephritidae).

Science.gov (United States)

Castrejón-Gómez, Victor R; Lascares, Shaila; Malo, Edi A; Toledo, Jorge; Rojas, Julio C

2007-08-01

The calling behavior of mass-reared and wild males of Anastrepha serpentina (Wiedemann) (Diptera: Tephritidae) was studied both in the laboratory and in field cage tests. In the laboratory, density (1, 5, and 10 males per container), age, and hour of day significantly affected calling behavior. Mass-reared males called independently of density, whereas wild males only called at densities of 5 and 10 individuals. Males of both strains started calling when they were 5-7 d old. The daily pattern of male calling was similar in both strains, starting at 0730 hours, and reaching a peak at 1330-1630 hours. Field cage tests showed that mass-reared males started calling when they were 5d old; the period of peak calling was when males were 8-9 d old. In contrast, wild males began calling when they were 10 d old, reaching peaks when males were 13, 15, and 18 d old. Wild males tended to form leks to call during each day of the experiment, whereas mass-reared males only formed leks during 2 d, both strains displaying very low levels. During field cage tests, males, independently of strain, displayed two calling peaks, one peak in the morning and one peak in the afternoon, whereas males observed in the laboratory only showed a single calling peak. The results are discussed in view of the effects of mass rearing A. serpentina males in relation to potential use of the sterile insect technique.

The Impact of 2011 ACGME Duty Hour Restrictions on Internal Medicine Resident Workload and Education

Science.gov (United States)

Vucicevic, Darko; Mookadam, Farouk; Webb, Brandon J.; Labonte, Helene R.; Cha, Stephen S.; Blair, Janis E.

2015-01-01

The Accreditation Council for Graduate Medical Education (ACGME) implemented work hour restrictions for physicians in training in 2003 that were revised July 1, 2011. Current published data are insufficient to assess whether such work hour restrictions will have long-term impact on residents' education. We searched computer-generated reports…

Evaluation of particulate filtration efficiency of retrofit particulate filters for light duty vehicles

International Nuclear Information System (INIS)

Van Asch, R.; Verbeek, R.

2009-10-01

In the light of the currently running subsidy programme for particulate filters in the Netherlands, the Dutch ministry of spatial planning and environment (VROM) asked TNO to execute a desk study to evaluate the particulates filtration efficiency of retrofit particulate filters for light duty vehicles (passenger cars and vans). The typical retrofit particulate filters for light duty vehicles are also called 'open' or 'half-open' filters, because a part of the exhaust gas can pass through the particulate filter unfiltered. From design point they are very different from the majority of the factory installed particulate filters, which are also called wall-flow or 'closed' particulate filters. Due to these differences there is a large difference in filtration efficiency. Whereas the 'dosed' particulate filters show a filtration efficiency of larger than 90%, the filtration efficiency of 'open' particulate filters is generally lower (type approval minimum 30%), and strongly dependent on the conditions of use. The objective of the current project was to assess the average filtration efficiency of retrofit (open) particulate fillters on light duty vehicles in real world day to day driving, based on available literature data. Also, the reasons of a possible deviation with the type approval test results (minimum filtration efficiency of 30%) was investigated.

Idle emissions from medium heavy-duty diesel and gasoline trucks.

Science.gov (United States)

Khan, A B M S; Clark, Nigel N; Gautam, Mridul; Wayne, W Scott; Thompson, Gregory J; Lyons, Donald W

2009-03-01

Idle emissions data from 19 medium heavy-duty diesel and gasoline trucks are presented in this paper. Emissions from these trucks were characterized using full-flow exhaust dilution as part of the Coordinating Research Council (CRC) Project E-55/59. Idle emissions data were not available from dedicated measurements, but were extracted from the continuous emissions data on the low-speed transient mode of the medium heavy-duty truck (MHDTLO) cycle. The four gasoline trucks produced very low oxides of nitrogen (NOx) and negligible particulate matter (PM) during idle. However, carbon monoxide (CO) and hydrocarbons (HCs) from these four trucks were approximately 285 and 153 g/hr on average, respectively. The gasoline trucks consumed substantially more fuel at an hourly rate (0.84 gal/hr) than their diesel counterparts (0.44 gal/hr) during idling. The diesel trucks, on the other hand, emitted higher NOx (79 g/hr) and comparatively higher PM (4.1 g/hr), on average, than the gasoline trucks (3.8 g/hr of NOx and 0.9 g/hr of PM, on average). Idle NOx emissions from diesel trucks were high for post-1992 model year engines, but no trends were observed for fuel consumption. Idle emissions and fuel consumption from the medium heavy-duty diesel trucks (MHDDTs) were marginally lower than those from the heavy heavy-duty diesel trucks (HHDDTs), previously reported in the literature.

Conduits to care: call lights and patients’ perceptions of communication

Directory of Open Access Journals (Sweden)

Montie M

2017-09-01

Full Text Available Mary Montie,1 Clayton Shuman,1 Jose Galinato,1 Lance Patak,2 Christine A Anderson,1 Marita G Titler1 1Department of Systems, Populations, and Leadership, School of Nursing, University of Michigan, Ann Arbor, MI, 2Department of Anesthesiology and Pain Medicine, Seattle Children’s Hospital, Seattle, WA, USA Background: Call light systems remain the primary means of hospitalized patients to initiate communication with their health care providers. Although there is vast amounts of literature discussing patient communication with their health care providers, few studies have explored patients’ perceptions concerning call light use and communication. The specific aim of this study was to solicit patients’ perceptions regarding their call light use and communication with nursing staff. Methods: Patients invited to this study met the following inclusion criteria: proficient in English, been hospitalized for at least 24 hours, aged ≥21 years, and able to communicate verbally (eg, not intubated. Thirty participants provided written informed consent, were enrolled in the study, and completed interviews. Results: Using qualitative descriptive methods, five major themes emerged from patients’ perceptions (namely; establishing connectivity, participant safety concerns, no separation: health care and the call light device, issues with the current call light, and participants’ perceptions of “nurse work”. Multiple minor themes supported these major themes. Data analysis utilized the constant comparative methods of Glaser and Strauss. Discussion: Findings from this study extend the knowledge of patients’ understanding of not only why inconsistencies occur between the call light and their nurses, but also why the call light is more than merely a device to initiate communication; rather, it is a direct conduit to their health care and its delivery. Keywords: nurse–patient communication, medical technology, quality of care, qualitative research

Director´s Fiduciary Duties Before Insolvency: Events Of Equity Loss

Directory of Open Access Journals (Sweden)

Felipe Suescún de Roa

2015-12-01

Full Text Available Directors owe fiduciary duties to the company and its shareholders. Before insolvency, more specifically, when corporations are facing events of equity loss, directors should refrain from initiating new transactions and should call for a shareholders meeting. By not doing so, directors would be jointly and severally liable for corporate debts after the equity loss took place.

Impact of the Accreditation Council for Graduate Medical Education work-hour regulations on neurosurgical resident education and productivity.

Science.gov (United States)

Jagannathan, Jay; Vates, G Edward; Pouratian, Nader; Sheehan, Jason P; Patrie, James; Grady, M Sean; Jane, John A

2009-05-01

Recently, the Institute of Medicine examined resident duty hours and their impact on patient safety. Experts have suggested that reducing resident work hours to 56 hours per week would further decrease medical errors. Although some reports have indicated that cutbacks in resident duty hours reduce errors and make resident life safer, few authors have specifically analyzed the effect of the Accreditation Council for Graduate Medical Education (ACGME) duty-hour limits on neurosurgical resident education and the perceived quality of training. The authors have evaluated multiple objective surrogate markers of resident performance and quality of training to determine the impact of the 80-hour workweek. The United States Medical Licensing Examination (USMLE) Step 1 data on neurosurgical applicants entering ACGME-accredited programs between 1998 and 2007 (before and after the implementation of the work-hour rules) were obtained from the Society of Neurological Surgeons. The American Board of Neurological Surgery (ABNS) written examination scores for this group of residents were also acquired. Resident registration for and presentations at the American Association of Neurological Surgeons (AANS) annual meetings between 2002 and 2007 were examined as a measure of resident academic productivity. As a case example, the authors analyzed the distribution of resident training hours in the University of Virginia (UVA) neurosurgical training program before and after the institution of the 80-hour workweek. Finally, program directors and chief residents in ACGME-accredited programs were surveyed regarding the effects of the 80-hour workweek on patient care, resident training, surgical experience, patient safety, and patient access to quality care. Respondents were also queried about their perceptions of a 56-hour workweek. Despite stable mean USMLE Step 1 scores for matched applicants to neurosurgery programs between 2000 and 2008, ABNS written examination scores for residents

Training for the future NHS: training junior doctors in the United Kingdom within the 48-hour European working time directive.

Science.gov (United States)

Datta, Shreelatta T; Davies, Sally J

2014-01-01

Since August 2009, the National Health Service of the United Kingdom has faced the challenge of delivering training for junior doctors within a 48-hour working week, as stipulated by the European Working Time Directive and legislated in the UK by the Working Time Regulations 1998. Since that time, widespread concern has been expressed about the impact of restricted duty hours on the quality of postgraduate medical training in the UK, particularly in the "craft" specialties--that is, those disciplines in which trainees develop practical skills that are best learned through direct experience with patients. At the same time, specialist training in the UK has experienced considerable change since 2007 with the introduction of competency-based specialty curricula, workplace-based assessment, and the annual review of competency progression. The challenges presented by the reduction of duty hours include increased pressure on doctors-in-training to provide service during evening and overnight hours, reduced interaction with supervisors, and reduced opportunities for learning. This paper explores these challenges and proposes potential responses with respect to the reorganization of training and service provision.

The duty of the pharmacist and the pharmaceutical industry.

Science.gov (United States)

Dwyer, Peter

2003-01-01

The common law duty of care, an essential element of the tort of negligence, focuses on conduct. Accordingly, any discussion of the existence, nature and content of the duty of care of a pharmaceutical manufacturer and of a pharmacist, requires analysis of their respective functions. Also relevant are the special nature and effects of drug products and their approval for and acceptance in, human therapy based upon a balancing of risks and benefits. Critical to a manufacturer's potential tortuous liability is the so-called 'learned intermediary, role of pharmacists, prescribers and other health professionals and whether they have current and accurate drug product information. Manufacturers are not necessarily the only source of drug information available to health professionals. These responsibilities serve patients who also need to be adequately informed so as to achieve optimal safety and efficacy when using prescribed medications.

Out-of-hours MRI provision in the UK and models of service delivery

International Nuclear Information System (INIS)

Hauptfleisch, J.; Meagher, T.M.; King, D.; López de Heredia, L.; Hughes, R.J.

2013-01-01

Aim: To examine current out-of-hours magnetic resonance imaging (MRI) provision through a snapshot survey of National Health Service (NHS) trusts and to assay how radiographer staffing cover was provided for out-of-hours services. Materials and methods: A snapshot postal survey was mailed to heads of service of all 234 trusts in England and Wales. A literature search on the models of service delivery and correlation with the authors' internal MRI rota, which has provided a full on-call service for 20 years was undertaken. Results: The response rate was 45.7% (107 of 234); 14% of responders provided full access to MRI 24 h a day; 63% provided extended weekday service, typically to 20.00 h; and 81% provided a weekend daytime service. The radiographers running the service were typically from the core MRI team. Approximately one-third (29.9%) of trusts provided training in basic brain and spine MRI to non-core MRI team members, but they typically did not participate in out-of-hours provision. Conclusion: There is currently a paucity of information on the provision of out-of-hours MRI in the NHS. However, there is increasing pressure to provide complex imaging out of hours, and in the future, trauma centres may be required to provide MRI to assess spinal injury. The authors describe a system to provide access to MRI at no additional cost to the organization based on 20 years of experience. A minority of surveyed acute NHS trusts have full out-of-hours access to MRI. Demand for MRI provision out of core hours is likely to increase

Acute Stress and Anxiety in Medical Residents on the Emergency Department Duty

Directory of Open Access Journals (Sweden)

Joaquín M. González-Cabrera

2018-03-01

Full Text Available The objectives of this longitudinal study were to compare salivary cortisol release patterns in medical residents and their self-perceived anxiety levels between a regular working day and a day when on call in the emergency department (ED-duty day and to determine any differences in cortisol release pattern as a function of years of residency or sex. The study included 35 residents (physicians-in-training of the Granada University Hospital, Granada, Spain. Acute stress was measured on a regular working day and an ED-duty day, evaluating anxiety-state with the Spanish version of the State-Trait Anxiety Inventory. Physiological stress assessment was based on salivary cortisol levels. Cortisol release concentrations were higher on an ED-duty day than on a regular working day, with a significantly increased area under the curve (AUC (p < 0.006. This difference slightly attenuated with longer residency experience. No gender difference in anxiety levels was observed (p < 0.001. According to these findings, the hypothalamic-pituitary-adrenal axis activity and anxiety levels of medical residents are higher on an ED-duty day than on a regular working day.

Impact of Extended Daylight Saving Time on National Energy Consumption Report to Congress

Energy Technology Data Exchange (ETDEWEB)

Belzer, D. B.; Hadley, S. W.; Chin, S-M.

2008-10-01

The Energy Policy Act of 2005 (Pub. L. No. 109-58; EPAct 2005) amended the Uniform Time Act of 1966 (Pub. L. No. 89-387) to increase the portion of the year that is subject to Daylight Saving Time. (15 U.S.C. 260a note) EPAct 2005 extended the duration of Daylight Saving Time in the spring by changing its start date from the first Sunday in April to the second Sunday in March, and in the fall by changing its end date from the last Sunday in October to the first Sunday in November. (15 U.S.C. 260a note) EPAct 2005 also called for the Department of Energy to evaluate the impact of Extended Daylight Saving Time on energy consumption in the United States and to submit a report to Congress. (15 U.S.C. 260a note) This report presents the results of impacts of Extended Daylight Saving Time on the national energy consumption in the United States. The key findings are: (1) The total electricity savings of Extended Daylight Saving Time were about 1.3 Tera Watt-hour (TWh). This corresponds to 0.5 percent per each day of Extended Daylight Saving Time, or 0.03 percent of electricity consumption over the year. In reference, the total 2007 electricity consumption in the United States was 3,900 TWh. (2) In terms of national primary energy consumption, the electricity savings translate to a reduction of 17 Trillion Btu (TBtu) over the spring and fall Extended Daylight Saving Time periods, or roughly 0.02 percent of total U.S. energy consumption during 2007 of 101,000 TBtu. (3) During Extended Daylight Saving Time, electricity savings generally occurred over a three- to five-hour period in the evening with small increases in usage during the early-morning hours. On a daily percentage basis, electricity savings were slightly greater during the March (spring) extension of Extended Daylight Saving Time than the November (fall) extension. On a regional basis, some southern portions of the United States exhibited slightly smaller impacts of Extended Daylight Saving Time on energy savings

78 FR 57881 - Monosodium Glutamate from China and Indonesia; Institution of Antidumping and Countervailing Duty...

Science.gov (United States)

2013-09-20

... than fair value and alleged to be subsidized by the Governments of China and Indonesia. Unless the... duties will each be collectively allocated one hour within which to make an oral presentation at the... investigations. Parties may file written testimony in connection with their presentation at the conference no...

Impact of reduction in working hours for doctors in training on postgraduate medical education and patients' outcomes: systematic review.

Science.gov (United States)

Moonesinghe, S R; Lowery, J; Shahi, N; Millen, A; Beard, J D

2011-03-22

To determine whether a reduction in working hours of doctors in postgraduate medical training has had an effect on objective measures of medical education and clinical outcome. Systematic review. Medline, Embase, ISI Web of Science, Google Scholar, ERIC, and SIGLE were searched without language restriction for articles published between 1990 and December 2010. Reference lists and citations of selected articles. Studies that assessed the impact of a change in duty hours using any objective measure of outcome related to postgraduate medical training, patient safety, or clinical outcome. Any study design was eligible for inclusion. 72 studies were eligible for inclusion: 38 reporting training outcomes, 31 reporting outcomes in patients, and three reporting both. A reduction in working hours from greater than 80 hours a week (in accordance with US recommendations) does not seem to have adversely affected patient safety and has had limited effect on postgraduate training. Reports on the impact of European legislation limiting working hours to less than 56 or 48 a week are of poor quality and have conflicting results, meaning that firm conclusions cannot be made. Reducing working hours to less than 80 a week has not adversely affected outcomes in patient or postgraduate training in the US. The impact of reducing hours to less than 56 or 48 a week in the UK has not yet been sufficiently evaluated in high quality studies. Further work is required, particularly in the European Union, using large multicentre evaluations of the impact of duty hours' legislation on objective educational and clinical outcomes.

On-call work and health: a review

Directory of Open Access Journals (Sweden)

Botterill Jackie S

2004-12-01

Full Text Available Abstract Many professions in the fields of engineering, aviation and medicine employ this form of scheduling. However, on-call work has received significantly less research attention than other work patterns such as shift work and overtime hours. This paper reviews the current body of peer-reviewed, published research conducted on the health effects of on-call work The health effects studies done in the area of on-call work are limited to mental health, job stress, sleep disturbances and personal safety. The reviewed research suggests that on-call work scheduling can pose a risk to health, although there are critical gaps in the literature.

The French 35-hour workweek: a wide-ranging social change.

Science.gov (United States)

Prunier-Poulmaire, S; Gadbois, C

2001-12-01

The reduction of the legal working week to 35 hours in France has generated wide-ranging social change. We examine the resulting changes in working-time patterns as well as their repercussions on the use of the time gained and on the quality of life and health. To compensate the reduction in the length of the working week, companies have modified the working-time patterns, by extending operation time (shiftwork, atypical schedules) and by matching the on-site workforce to production requirements (flexible working hours). They have sought to make more efficient use of working time: job intensification or job compression. The effects on the off-the-job life and health are linked to the shiftwork and atypical schedules designed to increase the company's operating time, and adjustments to the company's need for flexibilization impose working time/free time patterns that are at odds with biological rhythms and social life patterns. Changes to working-time patterns have unexpected consequences for work organization: heightened difficulties for the individual and the crew. These changes may generate a range of health problems related to overwork and stress. The way some companies have adapted may call into question the usefulness of work done by employees, thus damaging their social identity and mental well-being.

Administrative circular No. 20 (Rev. 2) – Use of private vehicules for journeys on official duty

CERN Multimedia

HR Department

2011-01-01

Administrative Circular No. 20 (Rev. 2) entitled "Use of private vehicles for journeys on official duty", adopted following discussion in the Standing Concertation Committee meeting of 21 September 2010 and entering into force on 1 January 2011, is available on the intranet site of the Human Resources Department: http://cern.ch/hr-docs/admincirc/admincirc.asp It cancels and replaces Administrative Circular No. 20 (Rev. 1) entitled "Use of private vehicles on official duty" of April 1993. This new version introduces, in particular, the payment of a kilometer allowance in case of emergency during standby duty or when on call and a simplified calculation of the allowance for journeys between sites. This circular also clarifies the type of permitted private vehicles. Department Head Office  

Overcoming the Range Limitation of Medium-Duty Battery Electric Vehicles through the use of Hydrogen Fuel-Cells

Energy Technology Data Exchange (ETDEWEB)

Wood, E.; Wang, L.; Gonder, J.; Ulsh, M.

2013-10-01

Battery electric vehicles possess great potential for decreasing lifecycle costs in medium-duty applications, a market segment currently dominated by internal combustion technology. Characterized by frequent repetition of similar routes and daily return to a central depot, medium-duty vocations are well positioned to leverage the low operating costs of battery electric vehicles. Unfortunately, the range limitation of commercially available battery electric vehicles acts as a barrier to widespread adoption. This paper describes the National Renewable Energy Laboratory's collaboration with the U.S. Department of Energy and industry partners to analyze the use of small hydrogen fuel-cell stacks to extend the range of battery electric vehicles as a means of improving utility, and presumably, increasing market adoption. This analysis employs real-world vocational data and near-term economic assumptions to (1) identify optimal component configurations for minimizing lifecycle costs, (2) benchmark economic performance relative to both battery electric and conventional powertrains, and (3) understand how the optimal design and its competitiveness change with respect to duty cycle and economic climate. It is found that small fuel-cell power units provide extended range at significantly lower capital and lifecycle costs than additional battery capacity alone. And while fuel-cell range-extended vehicles are not deemed economically competitive with conventional vehicles given present-day economic conditions, this paper identifies potential future scenarios where cost equivalency is achieved.

76 FR 43343 - Large Power Transformers From Korea; Institution of Antidumping Duty Investigation and Scheduling...

Science.gov (United States)

2011-07-20

..., that are alleged to be sold in the United States at less than fair value. Unless the Department of... duties will each be collectively allocated one hour within which to make an oral presentation at the... investigation. Parties may file written testimony in connection with their presentation at the conference no...

78 FR 44969 - Ferrosilicon From Russia and Venezuela; Institution of Antidumping Duty Investigations and...

Science.gov (United States)

2013-07-25

... From Russia and Venezuela; Institution of Antidumping Duty Investigations and Scheduling of Preliminary... of an industry in the United States is materially retarded, by reason of imports from Russia and... United States at less than fair value. Unless the Department of Commerce extends the time for initiation...

Long Working Hours and Emotional Well-Being in Korean Manufacturing Industry Employees

OpenAIRE

Lee, Kyoung-Hye; Kim, Jong-Eun; Kim, Young-Ki; Kang, Dong-Mug; Yun, Myeong-Ja; Park, Shin-Goo; Song, Jae-Seok; Lee, Sang-Gil

2013-01-01

Objectives Korea is well known for its long work hours amongst employees. Because workers of the manufacturing industry are constantly exposed to extended work hours, this study was based on how long work hours affect their emotional well-being. Methods The analysis was done using the secondary Korean Working Condition Survey (KWCS). Long work hours were defined to be more than 48 hours, and they were subcategorized into units of 52 hours and 60 hours. Based on the WHO (five) well-being index...

Impact of Protected Sleep Period for Internal Medicine Interns on Overnight Call on Depression, Burnout, and Empathy

Science.gov (United States)

Shea, Judy A.; Bellini, Lisa M.; Dinges, David F.; Curtis, Meredith L.; Tao, Yuanyuan; Zhu, Jingsan; Small, Dylan S.; Basner, Mathias; Norton, Laurie; Novak, Cristina; Dine, C. Jessica; Rosen, Ilene M.; Volpp, Kevin G.

2014-01-01

Background Patient safety and sleep experts advocate a protected sleep period for residents. Objective We examined whether interns scheduled for a protected sleep period during overnight call would have better end-of-rotation assessments of burnout, depression, and empathy scores compared with interns without protected sleep periods and whether the amount of sleep obtained during on call predicted end-of-rotation assessments. Methods We conducted a randomized, controlled trial with internal medicine interns at the Philadelphia Veterans Affairs Medical Center (PVAMC) and the Hospital of the University of Pennsylvania (HUP) in academic year 2009–2010. Four-week blocks were randomly assigned to either overnight call permitted under the 2003 duty hour standards or a protected sleep period from 12:30 am to 5:30 am. Participants wore wrist actigraphs. At the beginning and end of the rotations, they completed the Beck Depression Inventory (BDI-II), Maslach Burnout Inventory (MBI-HSS), and Interpersonal Reactivity Index (IRI). Results A total of 106 interns participated. There were no significant differences between groups in end-of-rotation BDI-II, MBI-HSS, or IRI scores at either location (P > .05). Amount of sleep while on call significantly predicted lower MBI-Emotional Exhaustion (P < .003), MBI-Depersonalization (P < .003), and IRI-Personal Distress (P < .006) at PVAMC, and higher IRI-Perspective Taking (P < .008) at HUP. Conclusions A protected sleep period produced few consistent improvements in depression, burnout, or empathy, although depression was already low at baseline. Possibly the amount of protected time was too small to affect these emotional states or sleep may not be directly related to these scores. PMID:24949128

Maximizing time from the constraining European Working Time Directive (EWTD): The Heidelberg New Working Time Model.

Science.gov (United States)

Schimmack, Simon; Hinz, Ulf; Wagner, Andreas; Schmidt, Thomas; Strothmann, Hendrik; Büchler, Markus W; Schmitz-Winnenthal, Hubertus

2014-01-01

The introduction of the European Working Time Directive (EWTD) has greatly reduced training hours of surgical residents, which translates into 30% less surgical and clinical experience. Such a dramatic drop in attendance has serious implications such compromised quality of medical care. As the surgical department of the University of Heidelberg, our goal was to establish a model that was compliant with the EWTD while avoiding reduction in quality of patient care and surgical training. We first performed workload analyses and performance statistics for all working areas of our department (operation theater, emergency room, specialized consultations, surgical wards and on-call duties) using personal interviews, time cards, medical documentation software as well as data of the financial- and personnel-controlling sector of our administration. Using that information, we specifically designed an EWTD-compatible work model and implemented it. Surgical wards and operating rooms (ORs) were not compliant with the EWTD. Between 5 pm and 8 pm, three ORs were still operating two-thirds of the time. By creating an extended work shift (7:30 am-7:30 pm), we effectively reduced the workload to less than 49% from 4 pm and 8 am, allowing the combination of an eight-hour working day with a 16-hour on call duty; thus, maximizing surgical resident training and ensuring patient continuity of care while maintaining EDTW guidelines. A precise workload analysis is the key to success. The Heidelberg New Working Time Model provides a legal model, which, by avoiding rotating work shifts, assures quality of patient care and surgical training.

Electric refuse collection vehicle with a range extender; Elektrisches Abfallsammelfahrzeug mit Range Extender

Energy Technology Data Exchange (ETDEWEB)

Fuchs, Andreas

2012-10-15

At the Frankfurt Motor Show IAA 2012, MAN will be presenting the Metropolis, a heavy-duty truck for use in urban areas that produces no emissions and is ultra-quiet. Using mains electricity generated from renewable sources, it can operate without producing any CO{sub 2}. The truck's modular lithium-ion battery is located under the ab. A quiet and efficient diesel engine from the Volkswagen Group generates power as needed and functions as a range extender for the truck. At the end of 2012, the MAN Metropolis will start a two-year field test as a refuse collection vehicle. (orig.)

The Impact of the 2011 Accreditation Council for Graduate Medical Education Duty Hour Reform on Quality and Safety in Trauma Care.

Science.gov (United States)

Marwaha, Jayson S; Drolet, Brian C; Maddox, Suma S; Adams, Charles A

2016-06-01

In 2011, the ACGME limited duty hours for residents. Although studies evaluating the 2011 policy have not shown improvements in general measures of morbidity or mortality, these outcomes might not reflect changes in specialty-specific practice patterns and secondary quality measures. All trauma admissions from July 2009 through June 2013 at an academic Level I trauma center were evaluated for 5 primary outcomes (eg, mortality and length of stay), and 10 secondary quality measures and practice patterns (eg, operating room [OR] visits). All variables were compared before and after the reform (July 1, 2011). Piecewise regression was used to study temporal trends in quality. There were 11,740 admissions studied. The reform was not strongly associated with changes in any primary outcomes except length of stay (7.98 to 7.36 days; p = 0.01). However, many secondary quality metrics changed. The total number of OR and bedside procedures per admission (6.72 to 7.34; p care might have changed after the reform. Indeed, a consistent change in resource use patterns was manifested by substantial post-reform increases in measures such as bedside procedures and OR visits. No secondary quality measures exhibited improvements strongly associated with the reform. Several factors, including attending oversight, might have insulated major outcomes from change. Our findings show that some less-commonly studied quality metrics related to costs of care changed after the 2011 reform at our institution. Copyright © 2016 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Free-piston Stirling engine/linear alternator 1000-hour endurance test

Science.gov (United States)

Rauch, J.; Dochat, G.

1985-01-01

The Free Piston Stirling Engine (FPSE) has the potential to be a long lived, highly reliable, power conversion device attractive for many product applications such as space, residential or remote site power. The purpose of endurance testing the FPSE was to demonstrate its potential for long life. The endurance program was directed at obtaining 1000 operational hours under various test conditions: low power, full stroke, duty cycle and stop/start. Critical performance parameters were measured to note any change and/or trend. Inspections were conducted to measure and compare critical seal/bearing clearances. The engine performed well throughout the program, completing more than 1100 hours. Hardware inspection, including the critical clearances, showed no significant change in hardware or clearance dimensions. The performance parameters did not exhibit any increasing or decreasing trends. The test program confirms the potential for long life FPSE applications.

Medium- and Heavy-Duty Vehicle Duty Cycles for Electric Powertrains

Energy Technology Data Exchange (ETDEWEB)

Kelly, Kenneth; Bennion, Kevin; Miller, Eric; Prohaska, Bob

2016-03-02

NREL's Fleet Test and Evaluation group has extensive in-use vehicle data demonstrating the importance of understanding the vocational duty cycle for appropriate sizing of electric vehicle (EV) and power electronics components for medium- and heavy-duty EV applications. This presentation includes an overview of recent EV fleet evaluation projects that have valuable in-use data that can be leveraged for sub-system research, analysis, and validation. Peak power and power distribution data from in-field EVs are presented for four different vocations, including class 3 delivery vans, class 6 delivery trucks, class 8 transit buses, and class 8 port drayage trucks, demonstrating the impacts of duty cycle on performance requirements.

Working hours of obstetrics and gynaecology trainees in Australia and New Zealand.

Science.gov (United States)

Acton, Jade; Tucker, Paige E; Bulsara, Max K; Cohen, Paul A

2017-10-01

The importance of doctors' working hours has gained significant attention with evidence suggesting long hours and fatigue may compromise the safety and wellbeing of both patients and doctors. This study aims to quantify the working hours of The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) specialist trainees in order to better inform discussions of working hours and safety within our region. An anonymous, online survey of RANZCOG trainees was conducted. Demographic data were collected. The primary outcomes were: hours per week at work and hours per week on-call. Secondary outcomes included the frequency of long days (>12 h) and 24-h shifts, time spent studying, staff shortages and opinions regarding current rostering. Response rate was 49.5% (n = 259). Full-time trainees worked an average of 53.1 ± 10.0 h/week, with 11.6% working on-call. Long-day shifts were reported by 85.8% of respondents, with an average length of 14.2 h. Fifteen percent reported working 24-h shifts, with a median duration of uninterrupted sleep during this shift being 1-2 h. Trainees in New Zealand worked 7.0 h/week more than Australian trainees (P ≤0.001), but reported less on-call (P = 0.021). Trainees in Western Australia were more likely to work on-call (P ≤0.001) and 24-h shifts (P ≤0.001). While 53.1 h/week at work is similar to the average Australian hospital doctor, high rates of long days and 24-h shifts with minimal sleep were reported by RANZCOG trainees in this survey. © 2017 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

40 CFR 86.1818-12 - Greenhouse gas emission standards for light-duty vehicles, light-duty trucks, and medium-duty...

Science.gov (United States)

2010-07-01

... 40 Protection of Environment 19 2010-07-01 2010-07-01 false Greenhouse gas emission standards for... Complete Otto-Cycle Heavy-Duty Vehicles § 86.1818-12 Greenhouse gas emission standards for light-duty... group of six greenhouse gases: Carbon dioxide, nitrous oxide, methane, hydrofluorocarbons...

Hennepin County`s experience with heavy-duty ethanol vehicles

Energy Technology Data Exchange (ETDEWEB)

NONE

1998-01-01

From November 1993 to October 1996, Hennepin County, which includes Minneapolis, field-tested two heavy-duty snowplow/road maintenance trucks fueled by ethanol. The overall objective of this program was to collect data from original equipment manufacturer alternative fuel heavy-duty trucks, along with comparable data from a similarly configured diesel-powered vehicle, to establish economic, emissions, performance, and durability data for the alternative fuel technology. These ethanol trucks, along with an identical third truck equipped with a diesel engine, were operated year round to maintain the Hennepin county roads. In winter, the trucks were run in 8-hour shifts plowing and hauling snow from urban and suburban roads. For the rest of the year, the three trucks were used to repair and maintain these same roads. As a result of this project, a considerable amount of data was collected on E95 fuel use, as well as maintenance, repair, emissions, and operational characteristics. Maintenance and repair costs of the E95 trucks were considerably higher primarily due to fuel filter and fuel pump issues. From an emissions standpoint, the E95 trucks emitted less particulate matter and fewer oxides of nitrogen but more carbon monoxide and hydrocarbons. Overall, the E95 trucks operated as well as the diesel, as long as the fuel filters were changed frequently. This project was a success in that E95, a domestically produced fuel from a renewable energy source, was used in a heavy-duty truck application and performed the same rigorous tasks as the diesel counterparts. The drawbacks to E95 as a heavy-duty fuel take the form of higher operational costs, higher fuel costs, shorter range, and the lack of over-the-road infrastructure.

busy hour traffic congestion analysis in mobile macrocells

African Journals Online (AJOL)

HOD

*Corresponding author tel: + 234 – 803 – 054 – 7650. BUSY HOUR ... demand, radio frequency (RF) optimization teams use the KPIs to ... In practice, the performance can be monitored at ..... [8] I. Kennedy, Lost Call Theory, Lecture Notes,.

Correlation of 2 hour, 4 hour, 8 hour and 12 hour urine protein with 24 hour urinary protein in preeclampsia.

Directory of Open Access Journals (Sweden)

Savita Rani Singhal

2014-09-01

Full Text Available To find shortest and reliable time period of urine collection for determination of proteinuria.It is a prospective study carried out on 125 pregnant women with preeclampsia after 20 weeks of gestation having urine albumin >1 using dipstick test. Urine was collected in five different time intervals in colors labeled containers with the assistance of nursing staff; the total collection time was 24 hours. Total urine protein of two-hour, four-hour, eight-hour, 12-hour and 24-hour urine was measured and compared with 24-hour collection. Data was analyzed using the Pearson correlation coefficient.There was significant correlation (p value < 0.01 in two, four, eight and 12-hour urine protein with 24-urine protein, with correlation coefficient of 0.97, 0.97, 0.96 and 0.97, respectively. When a cut off value of 25 mg, 50 mg. 100 mg, and 150 mg for urine protein were used for 2-hour, 4-hours, 8-hour and 12-hour urine collection, a sensitivity of 92.45%, 95.28%, 91.51%, and 96.23% and a specificity of 68.42%, 94.74%, 84.21% and 84.21% were obtained, respectively.Two-hour urine proteins can be used for assessment of proteinuria in preeclampsia instead of gold standard 24-hour urine collection for early diagnosis and better patient compliance.

Distributed scheduling to support a call center: A cooperative multiagent approach

NARCIS (Netherlands)

Brazier, F.M.T.; Jonker, C.M.; Jüngen, F.J.; Treur, J.

1999-01-01

This article describes a multiagent system architecture to increase the value of 24-hour-a day call center service. This system supports call centers in making appointments with clients on the basis ofknowledge ofemployees and their schedules. Relevant activities are scheduled for employees in

Natural Motives and the Motive of Duty: Hume and Kant on Our Duties to Others

OpenAIRE

Korsgaard, Christine M.

2009-01-01

Hume and Kant disagree about the motives involved in the performance of our duties to others. Hume thinks that natural virtues such as benevolence are best performed from “natural” motives, but that there are no natural motives for the performance of the “artificial” virtues, such as justice and fidelity to promises, which are performed from a sense of duty. Kant thinks all duties should be done from the motive of duty. In this paper, I examine the roots of the disagreement. If by a natural m...

Echolocation in the bat, Rhinolophus capensis: the influence of clutter, conspecifics and prey on call design and intensity

Directory of Open Access Journals (Sweden)

Kayleigh Fawcett

2015-07-01

Full Text Available Echolocating bats are exposed not only to the echoes of their own calls, but often the signals of conspecifics and other bats. For species emitting short, frequency modulated signals e.g. vespertilionoids, adjustments in both the frequency and time domain have been observed in such situations. However, bats using long duration, constant frequency calls may confront special challenges, since these bats should be less able to avoid temporal and frequency overlap. Here we investigated echolocation call design in the highduty cycle bat, Rhinolophus capensis, as bats flew with either a conspecific or heterospecific in a large outdoor flight-room. We compared these recordings to those made of bats flying alone in the same flight-room, and in a smaller flight room, alone, and hunting tethered moths. We found no differences in duty cycle or peak frequency of the calls of R. capensis across conditions. However, in the presence of a conspecific or the vespertilionoid, Miniopterus natalensis, R. capensis produced longer frequency-modulated downward sweeps at the terminus of their calls with lower minimum frequencies than when flying alone. In the presence of the larger high-duty cycle bat, R. clivosus, R. capensis produced shorter calls than when flying alone or with a conspecific. These changes are similar to those of vespertilionoids when flying from open to more cluttered environments. They are not similar to those differences observed in vespertilionoids when flying with other bats. Also unlike vespertilinoids, R. capensis used calls 15 dB less intense in conspecific pairs than when alone.

Restricted working hours in Austrian residency programs : Survey results.

Science.gov (United States)

Bergmeister, Konstantin D; Aman, Martin; Podesser, Bruno K

2018-04-27

New regulations for working hours of medical doctors have been implemented in Austria based on the European directive 2003/88/EG, limiting on-duty working hours to 48 h per week. Clinical work is, therefore, substantially reduced compared to previous decades, and little is known on physician and students' opinions on this matter. We illustrate survey results concerning on-job training, its difficulties, and implications for restricted working hours. We conducted an internal survey among M.D. and Ph.D. students and medical staff members at the Medical University of Vienna using the MedCampus system (CAMPUSOnline, Graz, Austria) and SPSS (V.21, IBM Corp, Armonk, NY, USA). Participants were 36.5% staff members and 63.5% students. Students rated continuous education of physicians high at 9.19 ± 1.76 and staff members at 8.90 ± 2.48 on a 1-10 (1 unimportant, 10 most important) scale. Students rated limited time resources, while staff considered financial resources as the greatest challenge for in-hospital education. Overall, 28.85% thought that restricted working hours can positively influence education, while 19.04% thought the opposite and 52.11% were undecided. Considering the limited available time and financial resources, education of tomorrow's medical doctors remains an important but difficult task. While participants of our survey rated education as very important despite its many challenges, the opinions towards limited working hours were not as clear. Given that over 50% are still undecided whether reduced work hours may also positively influence medical education, it clearly presents an opportunity to include the next generations of physicians in this undertaking.

Are long physician working hours harmful to patient safety?

Science.gov (United States)

Ehara, Akira

2008-04-01

Pediatricians of Japanese hospitals including not only residents but also attending physicians work long hours, and 8% work for >79 h per week. Most of them work consecutively for >or=32 h when they are on call. The aim of the present study was to evaluate the effect of long work hours on patient safety. The electronic databases MEDLINE and EMBASE to searched identify the English- and Japanese-language literature for studies on work hours, medical errors, patient safety, and malpractice for years 1966-2005. Studies that analyzed the relationship between physician work hours and outcomes directly related to patient safety were selected. Seven studies met the criteria. Four studies suggest that reduction of work hours has a favorable effect on patient safety indicators. In the other three studies no significant changes of the indicators were observed, but no report found that shorter work hours were harmful to patient safety. Decrease of physician work hours is not harmful but favorable to patient safety.

An empirical analysis of the corporate call decision

International Nuclear Information System (INIS)

Carlson, M.D.

1998-01-01

An economic study of the the behaviour of financial managers of utility companies was presented. The study examined whether or not an option pricing based model of the call decision does a better job of explaining callable preferred share prices and call decisions compared to other models. In this study, the Rust (1987) empirical technique was extended to include the use of information from preferred share prices in addition to the call decisions. Reasonable estimates were obtained from data of shares of the Pacific Gas and Electric Company (PGE) for the transaction costs associated with a call. It was concluded that the managers of the PGE clearly take into account the value of the option to delay the call when making their call decisions

Sleep Quality of Call Handlers Employed in International Call Centers in National Capital Region of Delhi, India.

Science.gov (United States)

Raja, J D; Bhasin, S K

2016-10-01

Call center sector in India is a relatively new and fast growing industry driving employment and growth in modern India today. Most international call centers in National Capital Region (NCR) of Delhi operate at odd work hours corresponding to a time suitable fortheir international customers. The sleep quality of call handlers employed in these call centers is in jeopardy owing to their altered sleep schedule. To assess the sleep quality and determine its independent predictors among call handlers employed in international call centers in NCR of Delhi. A cross-sectional questionnaire-based study was conducted on 375 call handlers aged 18-39 years employed in international call centers in NCR of Delhi. Sleep quality was assessed using Athens Insomnia scale along with a pre-tested, structured questionnaire. The mean age of respondents was 24.6 (SD 2.4) years. 78% of participants were male. 83.5% of respondents were unmarried. 44.3% of call handlers were cigarette smokers. Physical ailments were reported by 37% call handlers. 77.6% of call handlers had somesuspicion of insomnia or suspected insomnia; the rest had no sleep problem. Smoking, poor social support, heavy workload, lack of relaxation facility at office, and prolonged travel time to office were independent predictors of sleep quality (pSafeguarding their health becomes an occupational health challenge to public health specialists.

A comparison of the effects of transcranial direct current stimulation and caffeine on vigilance and cognitive performance during extended wakefulness.

Science.gov (United States)

McIntire, Lindsey K; McKinley, R Andy; Goodyear, Chuck; Nelson, Justin

2014-01-01

Sleep deprivation from extended duty hours is a common complaint for many occupations. Caffeine is one of the most common countermeasures used to combat fatigue. However, the benefits of caffeine decline over time and with chronic use. Our objective was to evaluate the efficacy of anodal transcranial direct current stimulation (tDCS) applied to the pre-frontal cortex at 2 mA for 30 min to remediate the effects of sleep deprivation and to compare the behavioral effects of tDCS with those of caffeine. Three groups of 10 participants each received either active tDCS with placebo gum, caffeine gum with sham tDCS, or sham tDCS with placebo gum during 30 h of extended wakefulness. Our results show that tDCS prevented a decrement in vigilance and led to better subjective ratings for fatigue, drowsiness, energy, and composite mood compared to caffeine and control in sleep-deprived individuals. Both the tDCS and caffeine produced similar improvements in latencies on a short-term memory task and faster reaction times in a psychomotor task when compared to the placebo group. Interestingly, changes in accuracy for the tDCS group were not correlated to changes in mood; whereas, there was a relationship for the caffeine and sham groups. Our data suggest that tDCS could be a useful fatigue countermeasure and may be more beneficial than caffeine since boosts in performance and mood last several hours. Published by Elsevier Inc.

Viability and fertility of cooled equine semen diluted with skimmed milk or glycine egg yolk-based extenders

Directory of Open Access Journals (Sweden)

Guilherme Pugliesi

2012-12-01

Full Text Available Two semen extenders were compared for their ability to maintain viability of horse semen during 24 hours of cold preservation, and for the pregnancy rate after artificial insemination. In the experiment 1, five ejaculates from three stallions were split-diluted in either a skimmed milk-based extender (Kenney extender or a glycine egg yolk-based extender (Foote extender and cooled at 6-8 ºC for 24 hours. Semen samples stored in Kenney extender for 24 hours had higher motility and spermatic vigor compared with those stored in Foote extender. However, samples stored in Foote extender had higher number of reactive sperm by hypoosmotic test and greater viability by epifluorescence test compared with those in Kenney extender. In the experiment 2, 17 and 23 ejaculates from two stallions were split-diluted with Kenney extender and Foote extender. The sperm concentration in each extender was adjusted to 500 million viable sperms per insemination dose. Semen was cooled to 6-8 ºC and stored for 24 hours. Seventy-four cycles of crossbred mares were inseminated with either semen diluted in Kenney extender or semen diluted in Foote extender. The pregnancy rate was higher from semen diluted in Kenney extender than that from semen in Foote extender (0.553 vs. 0.306. The Kenney extender is effective in preserving the motility, vigor and fertility of stallion semen after 24 hours of cold storage, whereas the Foote extender is not acceptable.

75 FR 39251 - Control of Air Pollution From New Motor Vehicles: Announcement of Public Workshop for Heavy-Duty...

Science.gov (United States)

2010-07-08

... ENVIRONMENTAL PROTECTION AGENCY [FRL-9173-5] Control of Air Pollution From New Motor Vehicles: Announcement of Public Workshop for Heavy-Duty Diesel Engines Employing Selective Catalyst Reduction Technology... engine manufacturers have recently begun utilizing a NO X emission control technology called selective...

The Call to Duty: An Historic Overview of How Education Responds to Changes in the Economy

Science.gov (United States)

Sky Lark, Taj'ullah

2011-01-01

An educated populace is vital to economic growth. Throughout the history of education in America, society has found it necessary to call upon education to address its economic challenges. During the twentieth century, the call for education to address technological advances, economic inequities, and to rescue free enterprise was dire. The U.S.…

Rights and duties in parenting practices

Directory of Open Access Journals (Sweden)

Ana Paula Solans

2015-10-01

Full Text Available The aim of this presentation is to present the results of three qualitative research on the exercise of rights and duties on Parenting Practices (PP, held in Buenos Aires, Argentina. They included interviews with mothers of children with Unsatisfied Basic Needs concretized between 2009 and 2013. Their analysis revealed that in this set of households were carried out three types of PP: imposition, guide and free will, the latter was the most used. As part of this practice, children managed their hours of sleep, wakefulness and leisure, without the intervention of their parents. It was noted, for example, that children over 10 years decided on matters concerning their schooling, absenting progressively to school, to abandonment. These practices were respected by their parents. By default, the postponement of pleasure (tolerance to frustration will not be exercised: they let children do at will. A trend of teenage pregnancy and the formation of pairs of children between 14-16 years with parental consent was also noted. In this sense, even when children lived in a house in contact with their parents, with a supply of food and available school, the indiscriminate exercise of free will put children's health at risk and full development, curtailing their rights. We recommend further studies such timely interventions to promote programs and projects designed to guide parents on issues related to the development of children as subjects of Rights and Duties.

Perilaku Kreatif Pekerja Call Center: Peran Komunikasi dan Dukungan Training Center

Directory of Open Access Journals (Sweden)

Nugroho J. Setiadi

2013-11-01

Full Text Available Call center business in Indonesia is growing rapidly worldwide. This condition has had repercussions for a growing number of call center workers needed. They are forced to be more creative in performing their duties. This study aims to determine the role of communication and training center in supporting the creative performance of workers in call centers. The survey was conducted by distributing questionnaires to 100 respondents (employees of the 3 major companies in the field of telecommunication services in Indonesia. Regression analysis was used to analyze the data to examine the role of communication and training support center on creative performance. The results indicated that communication and training support center significantly influence the creative behavior in call center workers. Communication quality shown in the telecommunication service provider companies, such as the media quality, simplicity of information, dissemination of information, loads of information, and accuracy of messages, has shown good quality. In addition, the training program has shown its support for call center workers in the form of program effectiveness through research and data collection, determining the materials, training methods, choosing a coach, preparing facilities, selecting and implementing the program.

Shifting perceptions: a pre-post study to assess the impact of a senior resident rotation bundle.

Science.gov (United States)

Fabreau, Gabriel; Elliott, Meghan; Khanna, Suneil; Minty, Evan; Wallace, Jean E; de Grood, Jill; Lewin, Adriane; Brown, Garielle; Bharwani, Aleem; Gilmour, Janet; Lemaire, Jane B

2013-08-29

Extended duty hours for residents are associated with negative consequences. Strategies to accommodate duty hour restrictions may also have unintended impacts. To eliminate extended duty hours and potentially lessen these impacts, we developed a senior resident rotation bundle that integrates a night float system, educational sessions on sleep hygiene, an electronic handover tool, and a simulation-based medical education curriculum. The aim of this study was to assess internal medicine residents' perceptions of the impact of the bundle on three domains: the senior residents' wellness, ability to deliver quality health care, and medical education experience. This prospective study compared eligible residents' experiences (N = 67) before and after a six-month trial of the bundle at a training program in western Canada. Data was collected using an on-line survey. Pre- and post-intervention scores for the final sample (N = 50) were presented as means and compared using the t-test for paired samples. Participants felt that most aspects of the three domains were unaffected by the introduction of the bundle. Four improved and two worsened perception shifts emerged post-intervention: less exposure to personal harm, reduced potential for medical error, more successful teaching, fewer disruptions to other rotations, increased conflicting role demands and less staff physician supervision. The rotation bundle integrates components that potentially ease some of the perceived negative consequences of night float rotations and duty hour restrictions. Future areas of study should include objective measures of the three domains to validate our study participants' perceptions.

Crew Factors in Flight Operations. 8; A Survey of Fatigue Factors in Corporate/Executive A Viation Operations

Science.gov (United States)

Rosekind, Mark R.; Co, Elizabeth L.; Gregory, Kevin B.; Miller, Donna L.

2000-01-01

Corporate flight crews face unique challenges including unscheduled flights, quickly changing schedules, extended duty days, long waits, time zone changes, and peripheral tasks. Most corporate operations are regulated by Part 91 FARs which set no flight or duty time limits. The objective of this study was to identify operationally significant factors that may influence fatigue, alertness, and performance in corporate operations. In collaboration with the National Business Aircraft Association and the Flight Safety Foundation, NASA developed and distributed a retrospective survey comprising 107 questions addressing demographics, home sleep habits, flight experience, duty schedules, fatigue during operations, and work environment. Corporate crewmembers returned 1,488 surveys. Respondents averaged 45.2 years of age, had 14.9 years of corporate flying experience, and 9,750 total flight hours. The majority (89%) rated themselves as 'good' or 'very good' sleepers at home. Most (82%) indicated they are subject to call for duty and described an average duty day of 9.9 h. About two-thirds reported having a daily duty time limit and over half (57%) reported a daily flight time limit. Nearly three-quarters (71%) acknowledged having 'nodded off' during a flight. Only 21% reported that their flight departments offer training on fatigue issues. Almost three-quarters (74%) described fatigue as a 'moderate' or 'serious' concern, and a majority (61%) characterized it as a common occurrence. Most (85%) identified fatigue as a 'moderate' or 'serious' safety issue.

Surface Airways Observations (SAO) Hourly Data 1928-1948 (CDMP)

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — The dataset consists of hourly U.S. surface airways observations (SAO). These observations extend as far back as 1928, from the time when commercial aviation began...

40 CFR Appendix Xii to Part 86 - Tables for Production Compliance Auditing of Heavy-Duty Engines and Heavy-Duty Vehicles...

Science.gov (United States)

2010-07-01

... 40 Protection of Environment 19 2010-07-01 2010-07-01 false Tables for Production Compliance Auditing of Heavy-Duty Engines and Heavy-Duty Vehicles, Including Light-Duty Trucks XII Appendix XII to... Appendix XII to Part 86—Tables for Production Compliance Auditing of Heavy-Duty Engines and Heavy-Duty...

Long working hours and emotional well-being in korean manufacturing industry employees.

Science.gov (United States)

Lee, Kyoung-Hye; Kim, Jong-Eun; Kim, Young-Ki; Kang, Dong-Mug; Yun, Myeong-Ja; Park, Shin-Goo; Song, Jae-Seok; Lee, Sang-Gil

2013-12-05

Korea is well known for its long work hours amongst employees. Because workers of the manufacturing industry are constantly exposed to extended work hours, this study was based on how long work hours affect their emotional well-being. The analysis was done using the secondary Korean Working Condition Survey (KWCS). Long work hours were defined to be more than 48 hours, and they were subcategorized into units of 52 hours and 60 hours. Based on the WHO (five) well-being index, emotional state was subdivided into three groups - reference group, low-mood group, and possible depression group- where 28 points and 50 points were division points, and two groups were compared at a time. Association between long work hours and emotional state was analyzed using binary and multinomial logistic regression analysis. Working for extended working hours in the manufacturing industry showed a statistically significant increase (t test p work-related characteristics were fixed as controlled variables, as work hours increased the odds ratio of the possible depression group increased compared to the reference group, and especially the odds ratio was 2.73 times increased for work hours between 48-52 and 4.09 times increased for 60 hours or more and both were statistically significant. In comparing the low-mood group and possible depression group, as work hours increased the odds ratio increased to 1.73, 2.39, and 4.16 times, and all work hours from working 48-52 hours, 53-60 hours, and 60 hours or more were statistically significant. Multinomial logistic regression analysis also showed that among the reference group and possible group, the possible depression group was statistically significant as odds ratio increased to 2.94 times in working 53-60 hours, and 4.35 times in 60 hours or more. Long work hours have an adverse effect on emotional well-being. A more diversified research towards variables that affect long work hours and emotional well-being and how they interact with each

The impact of the implementation of work hour requirements on residents' career satisfaction, attitudes and emotions.

Science.gov (United States)

Choi, Dongseok; Dickey, Jamie; Wessel, Kristen; Girard, Donald E

2006-10-17

To assess the impact of work hours' limitations required by the Accreditation Council for Graduate Medical Education (ACGME) on residents' career satisfaction, emotions and attitudes. A validated survey instrument was used to assess residents' levels of career satisfaction, emotions and attitudes before and after the ACGME duty hour requirements were implemented. The "pre" implementation survey was distributed in December 2002 and the "post" implementation one in December 2004. Only the latter included work-hour related questions. The response rates were 56% for the 2002 and 72% for the 2004 surveys respectively. Although career satisfaction remained unchanged, numerous changes occurred in both emotions and attitudes. Compared to those residents who did not violate work-hour requirements, those who did were significantly more negative in attitudes and emotions. With the implementation of the ACGME work hour limitations, the training experience became more negative for those residents who violated the work hour limits and had a small positive impact on those who did not violate them. Graduate medical education leaders must innovate to make the experiences for selected residents improved and still maintain compliance with the work hour requirements.

7 CFR 3550.158 - Active military duty.

Science.gov (United States)

2010-01-01

... 7 Agriculture 15 2010-01-01 2010-01-01 false Active military duty. 3550.158 Section 3550.158... AGRICULTURE DIRECT SINGLE FAMILY HOUSING LOANS AND GRANTS Regular Servicing § 3550.158 Active military duty...-time active military duty after a loan is closed not exceed six percent. Active military duty does not...

19 CFR 159.38 - Rates for estimated duties.

Science.gov (United States)

2010-04-01

... TREASURY (CONTINUED) LIQUIDATION OF DUTIES Conversion of Foreign Currency § 159.38 Rates for estimated duties. For purposes of calculating estimated duties, the port director shall use the rate or rates... 19 Customs Duties 2 2010-04-01 2010-04-01 false Rates for estimated duties. 159.38 Section 159.38...

Extended thermodynamics

CERN Document Server

Müller, Ingo

1993-01-01

Physicists firmly believe that the differential equations of nature should be hyperbolic so as to exclude action at a distance; yet the equations of irreversible thermodynamics - those of Navier-Stokes and Fourier - are parabolic. This incompatibility between the expectation of physicists and the classical laws of thermodynamics has prompted the formulation of extended thermodynamics. After describing the motifs and early evolution of this new branch of irreversible thermodynamics, the authors apply the theory to mon-atomic gases, mixtures of gases, relativistic gases, and "gases" of phonons and photons. The discussion brings into perspective the various phenomena called second sound, such as heat propagation, propagation of shear stress and concentration, and the second sound in liquid helium. The formal mathematical structure of extended thermodynamics is exposed and the theory is shown to be fully compatible with the kinetic theory of gases. The study closes with the testing of extended thermodynamics thro...

CHIS – Opening hours of UNIQA offices during end-of-year closure

CERN Multimedia

2013-01-01

The office of UNIQA at CERN (Main Building) will be closed during the end-of-year closure.   During that period, the Geneva offices of UNIQA will be open on 23, 26, 27 and 30 December as well as on 2 and 3 January. Opening hours: 8 a.m. to 12.30 p.m. and 1.30 p.m. to 5 p.m. During these hours, you can also call 022 718 63 00. Mail sent to uniqa.assurances@cern.ch will be handled only during these opening hours. For urgent medical assistance, you may call +43 512 224 22, 24h/day.  Please note that this service only provides medical advice and is not in a position to inform you on your administrative situation nor on the coverage by CHIS of medical expenses. HR Department Tel.: 74125

40 CFR 94.105 - Duty cycles.

Science.gov (United States)

2010-07-01

... 40 Protection of Environment 20 2010-07-01 2010-07-01 false Duty cycles. 94.105 Section 94.105... EMISSIONS FROM MARINE COMPRESSION-IGNITION ENGINES Test Procedures § 94.105 Duty cycles. (a) Overview. For....8(e), engines shall be tested using the appropriate duty cycles described in this section. (b...

Climate Change and Individual Duties

OpenAIRE

Augustin Fragnière

2016-01-01

Tackling climate change has often been considered the responsibility of national governments. But do individuals also have a duty to act in the face of this problem? In particular do they have a duty to adopt a greener lifestyle or to press their government to act? This review critically examines the arguments provided for and against such duties in the relevant philosophic literature. It first discusses the problem of causal inefficacy—namely the fact that individual greenhouse gas emissions...

SEE: improving nurse-patient communications and preventing software piracy in nurse call applications.

Science.gov (United States)

Unluturk, Mehmet S

2012-06-01

Nurse call system is an electrically functioning system by which patients can call upon from a bedside station or from a duty station. An intermittent tone shall be heard and a corridor lamp located outside the room starts blinking with a slow or a faster rate depending on the call origination. It is essential to alert nurses on time so that they can offer care and comfort without any delay. There are currently many devices available for a nurse call system to improve communication between nurses and patients such as pagers, RFID (radio frequency identification) badges, wireless phones and so on. To integrate all these devices into an existing nurse call system and make they communicate with each other, we propose software client applications called bridges in this paper. We also propose a window server application called SEE (Supervised Event Executive) that delivers messages among these devices. A single hardware dongle is utilized for authentication and copy protection for SEE. Protecting SEE with securities provided by dongle only is a weak defense against hackers. In this paper, we develop some defense patterns for hackers such as calculating checksums in runtime, making calls to dongle from multiple places in code and handling errors properly by logging them into database.

Banking and Financial Services Series. Duty Task List.

Science.gov (United States)

Oklahoma State Dept. of Vocational and Technical Education, Stillwater. Curriculum and Instructional Materials Center.

This document contains the occupational duty/task lists for five occupations in the banking and financial services series. Each occupation is divided into seven or eight duties. A separate page for each duty in the occupation lists the tasks in that duty along with its code number and columns to indicate whether that particular duty has been…

Gender Differences and Predictors of Work Hours in a Sample of Ontario Dentists.

Science.gov (United States)

McKay, Julia C; Ahmad, Atyub; Shaw, Jodi L; Rashid, Faahim; Clancy, Alicia; David, Courtney; Figueiredo, Rafael; Quiñonez, Carlos

2016-11-01

To determine the influence of gender on weekly work hours of Ontario dentists. In 2012, a 52-item survey was sent to a random sample of 3000 Ontario dentists (1500 men and 1500 women) to collect information on personal, professional and sociodemographic characteristics. The resulting data were analyzed using descriptive statistics and linear regression modeling. The 867 respondents included 463 men, 401 women and 3 people whose gender was unreported, yielding a response rate of 29%.Most dentists worked full-time, with men working, on average, 2 h/week longer than women. Younger dentists worked more than older dentists. Practice ownership increased weekly work hours, and men reported ownership more often than women. Canadian-trained women worked significantly fewer hours than those trained internationally. Women were more likely than men to work part time and take parental leave and more often reported being primary caregivers and solely responsible for household chores. Women with partner support for such tasks worked more hours than those who were solely responsible. Dentists with children ≤ 3 years of age worked fewer hours than those without children; however, after controlling for spousal responsibility for caregiver duties, this effect was eliminated. More women than men reported making concessions in their career to devote time to family. Gender, age, practice ownership, training location and degree of spousal support for household and caregiving responsibilities were predictors of weekly work hours. For women specifically, training location and household and caregiving responsibilities predicted weekly work hours.

Analysis and Design of Bi-Directional DC-DC Converter in the Extended Run Time DC UPS System Based on Fuel Cell and Supercapacitor

DEFF Research Database (Denmark)

Zhang, Zhe; Thomsen, Ole Cornelius; Andersen, Michael A. E.

2009-01-01

Abstract-In this paper, an extended run time DC UPS system structure with fuel cell and supercapacitor is investigated. A wide input range bi-directional dc-dc converter is described along with the phase-shift modulation scheme and phase-shift with duty cycle control, in different modes. The deli......Abstract-In this paper, an extended run time DC UPS system structure with fuel cell and supercapacitor is investigated. A wide input range bi-directional dc-dc converter is described along with the phase-shift modulation scheme and phase-shift with duty cycle control, in different modes...

Acoustic model optimisation for a call routing system

CSIR Research Space (South Africa)

Kleynhans, N

2012-11-01

Full Text Available and results and a discussion are presented in Section V. Lastly, the conclusion and possible future work appear in Section VI. II. BACKGROUND A. AutoSecretary IVR System Figure 1 shows the high level call flow of the AutoSecretary call routing system... to be difficult Corpus Name # utterances duration in hours Lwazi English 5843 5.03 Lwazi English plus Lwazi language prompts 7770 5.57 NCHLT English 106018 76.97 AST English (5 dialects) 51745 29.80 TABLE I THE NUMBER OF TRAINING UTTERANCES AND DURATION...

32 CFR 47.4 - Policy.

Science.gov (United States)

2010-07-01

... under a curfew. (2) Requiring members to work extended hours or unusual shifts. (3) Changing duty... situated to the Women's Air Forces Service Pilots of World War II. (2) Have rendered service to the United...

77 FR 12407 - Statement of Agency Policy and Interpretation on the Hours of Service Laws as Amended; Response...

Science.gov (United States)

2012-02-29

... 10 hours or 48 or 72 hours after working 6 or 7 days), and is released from that call prior to the... Transportation (Secretary), has long administered statutory hours of service requirements for the three groups of..., in the next 24 hours, and must get 10 hours off either after working that 12 hours or at the end of...

Electrofishing power requirements in relation to duty cycle

Science.gov (United States)

Miranda, L.E.; Dolan, C.R.

2004-01-01

Under controlled laboratory conditions we measured the electrical peak power required to immobilize (i.e., narcotize or tetanize) fish of various species and sizes with duty cycles (i.e., percentage of time a field is energized) ranging from 1.5% to 100%. Electrofishing effectiveness was closely associated with duty cycle. Duty cycles of 10-50% required the least peak power to immobilize fish; peak power requirements increased gradually above 50% duty cycle and sharply below 10%. Small duty cycles can increase field strength by making possible higher instantaneous peak voltages that allow the threshold power needed to immobilize fish to radiate farther away from the electrodes. Therefore, operating within the 10-50% range of duty cycles would allow a larger radius of immobilization action than operating with higher duty cycles. This 10-50% range of duty cycles also coincided with some of the highest margins of difference between the electrical power required to narcotize and that required to tetanize fish. This observation is worthy of note because proper use of duty cycle could help reduce the mortality associated with tetany documented by some authors. Although electrofishing with intermediate duty cycles can potentially increase effectiveness of electrofishing, our results suggest that immobilization response is not fully accounted for by duty cycle because of a potential interaction between pulse frequency and duration that requires further investigation.

Heavy-Duty Vehicle Thermal Management | Transportation Research | NREL

Science.gov (United States)

Heavy-Duty Vehicle Thermal Management Heavy-Duty Vehicle Thermal Management Infrared image of a control materials and equipment on heavy-duty vehicles. Photo by Dennis Schroeder, NREL Illustration of a Ray David, NREL National Renewable Energy Laboratory (NREL) researchers are assisting heavy-duty

The Duty to Recognize Culture

DEFF Research Database (Denmark)

Nielsen, Morten Ebbe Juul

2012-01-01

On Taylor and Honneth's theories of recognition and whether one can derive a "duty to recognize Culture" from these......On Taylor and Honneth's theories of recognition and whether one can derive a "duty to recognize Culture" from these...

Heavy-Duty Diesel Fuel Analysis

Science.gov (United States)

EPA's heavy-duty diesel fuel analysis program sought to quantify the hydrocarbon, NOx, and PM emission effects of diesel fuel parameters (such as cetane number, aromatics content, and fuel density) on various nonroad and highway heavy-duty diesel engines.

Military Internal Medicine Resident Decision to Apply to Fellowship and Extend Military Commitment.

Science.gov (United States)

Barsoumian, Alice E; Hartzell, Joshua D; Bonura, Erin M; Ressner, Roseanne A; Whitman, Timothy J; Yun, Heather C

2018-02-06

Nationally, the number of internal medicine physicians practicing in primary care has decreased amidst increasing interest in hospitalist medicine. Current priorities in the Military Health System include access to primary care and retention of trained personnel. Recently, we have conducted a study of military internal medicine residents' decision to enter infectious disease. As part of our larger effort, we saw an opportunity to characterize factors impacting decision making of internal medicine residents' desire to apply for subspecialty training and to extend active duty service obligations. Questions were developed after discussion with various military graduate medical education and internal medicine leaders, underwent external review, and were added to a larger question set. The survey link was distributed electronically to all U.S. military affiliated residencies' graduating internal medicine residents in December 2016-January 2017. Data were analyzed by decision to apply to fellowship and decision to extend military obligation using Fisher's exact test or Pearon's chi-square test. Sixty-eight residents from 10 of 11 military residency programs responded, for a response rate of 51%. The majority (62%) applied to fellowship to start after residency completion. Reasons cited for applying to fellowship included wanting to become a specialist as soon as possible (74%), wishing to avoid being a general internist (57%), and because they are unable to practice as a hospitalist in the military (52%). Fellowship applicants were more likely to plan to extend their military obligation than non-applicants, as did those with longer duration of military commitments. No other factors, including Uniformed Services University attendance or participation in undergraduate military experiences, were found to impact plan to extend active duty service commitment. The majority of graduating internal medicine residents apply for fellowship and report a desire to avoid being a

Heavy duty plasma spray gun

International Nuclear Information System (INIS)

Irons, G.C.; Klein, J.F.; Lander, R.D.; Thompson, H.C.; Trapani, R.D.

1984-01-01

A heavy duty plasma spray gun for extended industrial service is disclosed. The gun includes a gas distribution member made of a material having a coefficient of expansion different from that of the parts surrounding it. The gas distribution member is forcibly urged by a resilient member such as a coiled spring against a seal so as to assure the plasma gas is introduced into the gun arc in a manner only defined by the gas distribution member. The gun has liquid cooling for the nozzle (anode) and the cathode. Double seals are provided between the coolant and the arc region and a vent is provided between the seals which provides an indication when a seal has failed. Some parts of the gun are electrically isolated from others by an intermediate member which is formed as a sandwich of two rigid metal face pieces and an insulator disposed between them. The metal face pieces provide a rigid body to attach the remaining parts in proper alignment therewith

Firefighters and on-duty deaths from coronary heart disease: a case control study

Directory of Open Access Journals (Sweden)

Soteriades Elpidoforos S

2003-11-01

Full Text Available Abstract Background Coronary heart disease (CHD is responsible for 45% of on-duty deaths among United States firefighters. We sought to identify occupational and personal risk factors associated with on-duty CHD death. Methods We performed a case-control study, selecting 52 male firefighters whose CHD deaths were investigated by the National Institute for Occupational Safety and Health. We selected two control populations: 51 male firefighters who died of on-duty trauma; and 310 male firefighters examined in 1996/1997, whose vital status and continued professional activity were re-documented in 1998. Results The circadian pattern of CHD deaths was associated with emergency response calls: 77% of CHD deaths and 61% of emergency dispatches occurred between noon and midnight. Compared to non-emergency duties, fire suppression (OR = 64.1, 95% CI 7.4–556; training (OR = 7.6, 95% CI 1.8–31.3 and alarm response (OR = 5.6, 95% CI 1.1–28.8 carried significantly higher relative risks of CHD death. Compared to the active firefighters, the CHD victims had a significantly higher prevalence of cardiovascular risk factors in multivariate regression models: age ≥ 45 years (OR 6.5, 95% CI 2.6–15.9, current smoking (OR 7.0, 95% CI 2.8–17.4, hypertension (OR 4.7, 95% CI 2.0–11.1, and a prior diagnosis of arterial-occlusive disease (OR 15.6, 95% CI 3.5–68.6. Conclusions Our findings strongly support that most on-duty CHD fatalities are work-precipitated and occur in firefighters with underlying CHD. Improved fitness promotion, medical screening and medical management could prevent many of these premature deaths.

Automatic control of clock duty cycle

Science.gov (United States)

Feng, Xiaoxin (Inventor); Roper, Weston (Inventor); Seefeldt, James D. (Inventor)

2010-01-01

In general, this disclosure is directed to a duty cycle correction (DCC) circuit that adjusts a falling edge of a clock signal to achieve a desired duty cycle. In some examples, the DCC circuit may generate a pulse in response to a falling edge of an input clock signal, delay the pulse based on a control voltage, adjust the falling edge of the input clock signal based on the delayed pulse to produce an output clock signal, and adjust the control voltage based on the difference between a duty cycle of the output clock signal and a desired duty cycle. Since the DCC circuit adjusts the falling edge of the clock cycle to achieve a desired duty cycle, the DCC may be incorporated into existing PLL control loops that adjust the rising edge of a clock signal without interfering with the operation of such PLL control loops.

Out-of-hours GPs and palliative care-a qualitative study exploring information exchange and communication issues.

Science.gov (United States)

Taubert, Mark; Nelson, Annmarie

2010-08-12

Out-of-hours general practitioners (GPs) cover the community over a significant proportion of a given week, and palliative care patients are seen as a priority. Little is known about how well these GPs feel supported in their line of work and whether communication exchanges work well for the proportion of their patients who have palliative care needs. For this study, GPs who provide out-of-hours care were interviewed in order to explore factors that they identified as detrimental or beneficial for good communication between themselves, patients, relatives and other professionals, specifically to palliative care encounters. Nine GPs were interviewed using face-to-face semi-structured interviews. All nine GPs worked regular out-of-hours sessions. Data from transcripts was analysed using Interpretative Phenomenological Analysis. A predominant theme expressed by GPs related to constraints within the system provided by the local private company owned out-of-hours provider. A strong feeling of 'being alone out there' emerged, with some GPs more willing to call for help than others, and others expressing their concern at access to pharmacies and medication being very inconsistent.Out-of-hours GPs felt left alone on occasion, unable to access daytime services and not knowing who to call for advice. Information hand-over systems from in-hours to out-of-hours with regard to palliative care were felt to be inadequate. Out-of-hours doctors interviewed felt left out of the care loop; handover sheets from specialist palliative care providers were a rarity. Out-of-hours services need to be mindful of the needs of the GPs they employ, in particular relating to the palliative care they provide in this setting. Other healthcare professionals should aim to keep their local out-of-hours service informed about palliative care patients they may be called to see.

Out-of-hours GPs and palliative care-a qualitative study exploring information exchange and communication issues

Directory of Open Access Journals (Sweden)

Taubert Mark

2010-08-01

Full Text Available Abstract Background Out-of-hours general practitioners (GPs cover the community over a significant proportion of a given week, and palliative care patients are seen as a priority. Little is known about how well these GPs feel supported in their line of work and whether communication exchanges work well for the proportion of their patients who have palliative care needs. For this study, GPs who provide out-of-hours care were interviewed in order to explore factors that they identified as detrimental or beneficial for good communication between themselves, patients, relatives and other professionals, specifically to palliative care encounters. Methods Nine GPs were interviewed using face-to-face semi-structured interviews. All nine GPs worked regular out-of-hours sessions. Data from transcripts was analysed using Interpretative Phenomenological Analysis. Results A predominant theme expressed by GPs related to constraints within the system provided by the local private company owned out-of-hours provider. A strong feeling of 'being alone out there' emerged, with some GPs more willing to call for help than others, and others expressing their concern at access to pharmacies and medication being very inconsistent. Out-of-hours GPs felt left alone on occasion, unable to access daytime services and not knowing who to call for advice. Information hand-over systems from in-hours to out-of-hours with regard to palliative care were felt to be inadequate. Out-of-hours doctors interviewed felt left out of the care loop; handover sheets from specialist palliative care providers were a rarity. Conclusions Out-of-hours services need to be mindful of the needs of the GPs they employ, in particular relating to the palliative care they provide in this setting. Other healthcare professionals should aim to keep their local out-of-hours service informed about palliative care patients they may be called to see.

Distributed Scheduling to Support a Call Centre: a Co-operative Multi-Agent Approach

NARCIS (Netherlands)

Brazier, F.M.; Jonker, C.M.; Jungen, F.J.; Treur, J.; Nwana, H.S.

1998-01-01

This paper describes a multi-agent system architecture to increase the value of 24 hour a day call centre service. This system supports call centres in making appointments with clients on the basis of knowledge of employees and their schedules. Relevant activities of employees are scheduled for

7 CFR 1250.336 - Duties.

Science.gov (United States)

2010-01-01

..., education, or promotion programs, advertising agencies, public relations firms, public or private research... AND ORDERS; MISCELLANEOUS COMMODITIES), DEPARTMENT OF AGRICULTURE EGG RESEARCH AND PROMOTION Egg Research and Promotion Order Egg Board § 1250.336 Duties. The Board shall have the following duties: (a) To...

Evidence of circadian and extended shift effects on reactor transient frequency

International Nuclear Information System (INIS)

Maloney, S.

1992-01-01

An extensive body of knowledge exists documenting the significant swings in error rates, perception, judgment, and overall alertness levels in the course of a day. The literature also demonstrates pronounced differences in performance levels whereby night workers routinely underperform day workers in any set of tasks. The performance split widens with task complexity. Rotating shift workers, such as nuclear power plant operators, have been shown to experience performance problems comparable to straight night workers. Finally, sleep research also documents that extended hours, such as the so-called 4-day work week, can undermine alertness levels, particularly in the last 2 to 3 h of a daily shift. These issues suggest that cyclical performance by shift workers may be evident in nuclear plant operators. This paper seeks evidence of such cyclical performance by examining operating transients at nuclear power plants involving human error

40 CFR Appendix X to Part 86 - Sampling Plans for Selective Enforcement Auditing of Heavy-Duty Engines and Light-Duty Trucks

Science.gov (United States)

2010-07-01

... 40 Protection of Environment 19 2010-07-01 2010-07-01 false Sampling Plans for Selective Enforcement Auditing of Heavy-Duty Engines and Light-Duty Trucks X Appendix X to Part 86 Protection of... Plans for Selective Enforcement Auditing of Heavy-Duty Engines and Light-Duty Trucks Table 1—Sampling...

HEAVY-DUTY GREENHOUSE GAS EMISSIONS MODEL ...

Science.gov (United States)

Class 2b-8 vocational truck manufacturers and Class 7/8 tractor manufacturers would be subject to vehicle-based fuel economy and emission standards that would use a truck simulation model to evaluate the impact of the truck tires and/or tractor cab design on vehicle compliance with any new standards. The EPA has created a model called “GHG Emissions Model (GEM)”, which is specifically tailored to predict truck GHG emissions. As the model is designed for the express purpose of vehicle compliance demonstration, it is less configurable than similar commercial products and its only outputs are GHG emissions and fuel consumption. This approach gives a simple and compact tool for vehicle compliance without the overhead and costs of a more sophisticated model. Evaluation of both fuel consumption and CO2 emissions from heavy-duty highway vehicles through a whole-vehicle operation simulation model.

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

Science.gov (United States)

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

2011-01-01

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

Effect of different extenders on ram sperm traits during storage

Directory of Open Access Journals (Sweden)

Zdeňka Hegedűšová

2012-01-01

Full Text Available The aim of the study was to test commercial extenders used for short-term and long-term sperm preservation. Semen was collected in the reproduction season, i.e. from June to December. The ejaculates were obtained from single services and the routine analysis of the semen was performed immediately after the collection. The examination included semen volume, colour and texture, sperm concentration and motility, ejaculate turbulence and percentage of sperm with abnormal morphology. The semen was diluted with an extender in the ratio of 1:4. The processed semen was transported in an insulated container at 16–18 °C to the laboratory and stored in a stationary thermostat under the same temperature. Sperm motility tests were performed 24, 48, 72 and 96 hours after the placement in to thermostat. Ejaculates diluted with Ovipro, Optidyl, Triladyl and Andromed CSS gave very good results of viability (81.23 %–83.41 % after 24 hours of storage. After 48 hours, Ovipro, Andromed, Optidyl and Triladyl gave values above 75 %. The Triladyl extender proved to be a good stabilizing agent, showing consistent results during a long-term storage. It was chosen as a control one for overall assessment. Other preservation media did not show any improving or worsening effects. The extender Ovipro showed a high motility effect in the first 48 hours only, and hence it appears to be the best solution for the short-term preservation.

Review: the legal duty of care for nurses and other health professionals.

Science.gov (United States)

Young, Andy

2009-11-01

To explore the nature and extent of the legal duty of care in relation to contemporary healthcare practice. The paper seeks to re-frame and update the legal duty of care for clinical nursing practice in the 21st century, taking into account collaborative and partnership working in healthcare practice. Doctrinal legal 'approach'. 'Black letter' legal research methodology used for data collection and analysis. Literature search using Westlaw and LexisNexis database(s) to identify recent common law decisions. There has been a perceptible doctrinal shift away from paternalism and toward patient empowerment and autonomy in the last decade. This has implications for nurses and other healthcare professionals in terms of consenting patients and acting reasonably to ensure quality patient care. A number of experienced nurses are currently assuming extended roles and some are completing medical tasks, traditionally allocated to doctors. These specialist practitioners must remember that additional responsibility invariably means increased professional risk and accountability. Therefore, it is essential that those engaging in advanced nursing practice, fully understand the nature and reach of their professional duty of care and the significance of statutory and common law developments. Nurses and other healthcare professionals must update their clinical skills and practice within a legal framework and to certain standards. The cases cited and discussed are relevant to all branches of nursing and indeed to all health professions.

Did liberalising bar hours decrease traffic accidents?

Science.gov (United States)

Green, Colin P; Heywood, John S; Navarro, Maria

2014-05-01

Legal bar closing times in England and Wales have historically been early and uniform. Recent legislation liberalised closing times with the object of reducing social problems thought associated with drinking to "beat the clock." Indeed, using both difference in difference and synthetic control approaches we show that one consequence of this liberalisation was a decrease in traffic accidents. This decrease is heavily concentrated among younger drivers. Moreover, we provide evidence that the effect was most pronounced in the hours of the week directly affected by the liberalisation: late nights and early mornings on weekends. This evidence survives a series of robustness checks and suggests at least one socially positive consequence of extending bar hours. Copyright © 2014 Elsevier B.V. All rights reserved.

46 CFR 111.25-15 - Duty cycle.

Science.gov (United States)

2010-10-01

... 46 Shipping 4 2010-10-01 2010-10-01 false Duty cycle. 111.25-15 Section 111.25-15 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) ELECTRICAL ENGINEERING ELECTRIC SYSTEMS-GENERAL REQUIREMENTS Motors § 111.25-15 Duty cycle. Each motor must be rated for continuous duty, except a motor for an...

Effects of an extension of the equilibration period up to 96 hours on the characteristics of cryopreserved bull semen.

Science.gov (United States)

Fleisch, A; Malama, E; Witschi, U; Leiding, C; Siuda, M; Janett, F; Bollwein, H

2017-02-01

This study was designed to investigate the effects of an equilibration period up to 96 hours and three extenders (AndroMed, OPTIXcell, and Triladyl) on the quality of cryopreserved bull semen and to evaluate, whether an extension of the equilibration time to 72 hours does affect fertility in the field. One ejaculate of 17 bulls was collected and divided into three equal aliquots and diluted, respectively, with the three extenders. Each aliquot was again divided into five parts and equilibrated for 4, 24, 48, 72, and 96 hours before freezing in an automatic freezer. Sperm motility, plasma membrane and acrosome integrity (PMAI), and DNA fragmentation index (% DFI) were measured during equilibration. In addition to the parameters measured during equilibration, the percentage of viable sperm cells with high mitochondrial membrane potential (HMMP) was measured immediately after thawing, and after 3 hours of incubation at 37 °C. Sperm motility was assessed using CASA, and PMAI, HMMP, and % DFI were measured using flow cytometry. Equilibration time did affect all parameters before freezing (P semen characteristics during 3 hours of incubation were also dependent on the equilibration time and the extender used in all parameters (P semen of nine bulls was collected thrice weekly, processed using Triladyl egg yolk extender, and frozen in 0.25 mL straws with 15 × 10 6 spermatozoa per straw. In total, the nonreturn rates on Day 90 after insemination (NRR90) of 263,816 inseminations in two periods were evaluated. Whereas semen collected on Mondays and Wednesdays was equilibrated for 24 hours in both periods, semen collected on Fridays was equilibrated for 4 hours in period one and equilibrated for 72 hours in period 2. No differences in NRR90 could be found (P > 0.05). In conclusion, extension of the equilibration time from 4 hours to 24-72 hours can improve motility and viability of cryopreserved semen after thawing. The extent of improvement in semen quality

38 CFR 17.31 - Duty periods defined.

Science.gov (United States)

2010-07-01

... Definitions and Active Duty § 17.31 Duty periods defined. Full-time duty as a member of the Women's Army Auxiliary Corps, Women's Reserve of the Navy and Marine Corps and Women's Reserve of the Coast Guard. [34 FR..., 1996, § 17.31(b)(5) was redesignated as § 17.31. Protection of Patient Rights ...

Radiation monitoring data representation for duty personnel

Energy Technology Data Exchange (ETDEWEB)

Gavrilov, S.L.; Kiselev, V.P.; Krasnoperov, S.N.; Kudeshov, E.V.; Maslov, S.Y.; Semin, N.N.; Sirotinskiy, S.E.; Yakovlev, V.Y. [Nuclear Safety Institute of the Russian Academy of Sciences (NSI RAS), Moscow (Russian Federation)

2014-07-01

Currently, Web-GIS technologies are widely used to generate a reliable and intuitive web-based interface to monitor the current radiation situation in various regions of the Russian Federation. The developed 'Server Web-Monitoring' web-application is intended for duty personnel and can operate not only on desktop computers but also on mobile devices. The subsystem of duty personnel notification about any Off-Normal Situation (ONS) (such as: critical threshold exceedances or failures in operation of monitoring systems) is also considered in the paper. Three types of Automated Radiation Monitoring Systems (ARMS) are available for monitoring: - regional ARMS; - facility-level ARMS; - ARMS of nuclear power plant surveillance areas. Google Maps and Google Maps API toolbox are used as the cartographic basis. In the general-monitoring window only general information on each of the local systems is available. Next, the operator can move to monitoring of local ARMS he is interested in. The operator can either view a list of Radiation Situation Monitoring Posts (RSMP) showing the current data in the right frame or hide it and use the map only. Viewing the log of critical threshold exceedances for 24 hours and a report on all RSMPs of a given system over the last 7 days is also possible. The report contains maximum values of measurements for every day and for each RSMP. The developed web-application includes: - monitoring of the radiation situation and its changes on the general map of the Russian Federation and on maps of local ARMS; - displaying 7-day reports for all RSMPs of the selected ARMS; - displaying the log of critical threshold exceedances recorded over the past day. The notification subsystem informs duty personnel on all ONS, namely, on critical threshold exceedances in the incoming data and failures in operation of monitoring systems. The key features of the notification subsystem are: - round-the-clock functioning; - automatic notification in case of

Health and psychosocial effects of flexible working hours.

Science.gov (United States)

Janssen, Daniela; Nachreiner, Friedhelm

2004-12-01

To examine whether any impairments in health and social lives can be found under different kinds of flexible working hours, and whether such effects are related to specific characteristics of these working hours. Two studies -- a company based survey (N=660) and an internet survey (N=528) -- have been conducted. The first one was a questionnaire study (paper and pencil) on employees working under some 'typical' kinds of different flexible working time arrangements in different companies and different occupational fields (health care, manufacturing, retail, administration, call centres). The second study was an internet-based survey, using an adaptation of the questionnaire from the first study. The results of both studies consistently show that high variability of working hours is associated with increased impairments in health and well-being and this is especially true if this variability is company controlled. These effects are less pronounced if variability is self-controlled; however, autonomy does not compensate the effects of variability. Recommendations for an appropriate design of flexible working hours should be developed in order to minimize any impairing effects on health and psychosocial well-being; these recommendations should include -- besides allowing for discretion in controlling one's (flexible) working hours -- that variability in flexible working hours should be kept low (or at least moderate), even if this variability is self-controlled.

Restricted duty hours for surgeons and impact on residents quality of life, education, and patient care: a literature review

Directory of Open Access Journals (Sweden)

Pfeifer Roman

2009-02-01

Full Text Available Abstract Background Work-hour limitations have been implemented by the Accreditation Council for Graduate Medical Education (ACGME in July 2003 in order to minimize fatigue related medical adverse events. The effects of this regulation are still under intense debate. In this literature review, data of effects of limited work-hours on the quality of life, surgical education, and patient care was summarized, focusing on surgical subspecialities. Methods Studies that assessed the effects of the work-hour regulation published following the implementation of ACGME guidelines (2003 were searched using PubMed database. The following search modules were selected: work-hours, 80-hour work week, quality of life, work satisfaction, surgical education, residency training, patient care, continuity of care. Publications were included if they were completed in the United States and covered the subject of our review. Manuscrips were analysed to identify authors, year of publication, type of study, number of participants, and the main outcomes. Review Findings Twenty-one articles met the inclusion criteria. Studies demonstrate that the residents quality of life has improved. The effects on surgical education are still unclear due to inconsistency in studies. Furthermore, according to several objective studies there were no changes in mortality and morbidity following the implementation. Conclusion Further studies are necessary addressing the effects of surgical education and studying the objective methods to assess the technical skill and procedural competence of surgeons. In addition, patient surveys analysing their satisfaction and concerns can contribute to recent discussion, as well.

Increased error rates in preliminary reports issued by radiology residents working more than 10 consecutive hours overnight.

Science.gov (United States)

Ruutiainen, Alexander T; Durand, Daniel J; Scanlon, Mary H; Itri, Jason N

2013-03-01

To determine if the rate of major discrepancies between resident preliminary reports and faculty final reports increases during the final hours of consecutive 12-hour overnight call shifts. Institutional review board exemption status was obtained for this study. All overnight radiology reports interpreted by residents on-call between January 2010 and June 2010 were reviewed by board-certified faculty and categorized as major discrepancies if they contained a change in interpretation with the potential to impact patient management or outcome. Initial determination of a major discrepancy was at the discretion of individual faculty radiologists based on this general definition. Studies categorized as major discrepancies were secondarily reviewed by the residency program director (M.H.S.) to ensure consistent application of the major discrepancy designation. Multiple variables associated with each report were collected and analyzed, including the time of preliminary interpretation, time into shift study was interpreted, volume of studies interpreted during each shift, day of the week, patient location (inpatient or emergency department), block of shift (2-hour blocks for 12-hour shifts), imaging modality, patient age and gender, resident identification, and faculty identification. Univariate risk factor analysis was performed to determine the optimal data format of each variable (ie, continuous versus categorical). A multivariate logistic regression model was then constructed to account for confounding between variables and identify independent risk factors for major discrepancies. We analyzed 8062 preliminary resident reports with 79 major discrepancies (1.0%). There was a statistically significant increase in major discrepancy rate during the final 2 hours of consecutive 12-hour call shifts. Multivariate analysis confirmed that interpretation during the last 2 hours of 12-hour call shifts (odds ratio (OR) 1.94, 95% confidence interval (CI) 1.18-3.21), cross

Supervision Duty of School Principals

Directory of Open Access Journals (Sweden)

Kürşat YILMAZ

2009-04-01

Full Text Available Supervision by school administrators is becoming more and more important. The change in the roles ofschool administrators has a great effect on that increase. At present, school administrators are consideredmore than as technical directors, but as instructional leaders. This increased the importance of schooladministrators’ expected supervision acts. In this respect, the aim of this study is to make a conceptualanalysis about school administrators’ supervision duties. For this reason, a literature review related withsupervision and contemporary supervision approaches was done, and the official documents concerningsupervision were examined. As a result, it can be said that school administrators’ supervision duties havebecome very important. And these duties must certainly be carried out by school administrators.

Extended Station Blackout Analyses of an APR1400 with MARS-KS

International Nuclear Information System (INIS)

Kim, WoongBae; Jang, HyungWook; Oh, Seungjong; Lee, Sangyong

2016-01-01

The Fukushima Dai-ichi nuclear power plant accident shows that natural disasters such as earthquakes and the subsequent tsunamis can cause station blackout for several days. The electricity required for essential systems during a station blackout is provided from the emergency backup batteries installed at the nuclear power plant. In South Korea, in the event of an extended station blackout, the life of these emergency backup batteries has recently been extended from 8 hours to 24 hours at Shin-Kori 5, 6 and APR1400 for design certification. For a battery life of 24 hours, available safety means system, equipment and procedures are studied and analyzed in their ability to cope with an extended station blackout. A sensitivity study of reactor coolant pump seal leakage is performed to verify how different seal leakages could affect the system. For simulating of extended station blackout scenarios, the best estimate MARS-KS was used. In this paper, an APR1400 RELAP5 input deck was developed for station blackout scenario to analyze operation strategy by manually depressurizing the reactor coolant system through the steam generator's secondary side. Additionally, a sensitivity study was performed on reactor coolant pump seal leakage

Extended Station Blackout Analyses of an APR1400 with MARS-KS

Energy Technology Data Exchange (ETDEWEB)

Kim, WoongBae; Jang, HyungWook; Oh, Seungjong; Lee, Sangyong [KEPCO International Nuclear Graduate School, Ulsan (Korea, Republic of)

2016-10-15

The Fukushima Dai-ichi nuclear power plant accident shows that natural disasters such as earthquakes and the subsequent tsunamis can cause station blackout for several days. The electricity required for essential systems during a station blackout is provided from the emergency backup batteries installed at the nuclear power plant. In South Korea, in the event of an extended station blackout, the life of these emergency backup batteries has recently been extended from 8 hours to 24 hours at Shin-Kori 5, 6 and APR1400 for design certification. For a battery life of 24 hours, available safety means system, equipment and procedures are studied and analyzed in their ability to cope with an extended station blackout. A sensitivity study of reactor coolant pump seal leakage is performed to verify how different seal leakages could affect the system. For simulating of extended station blackout scenarios, the best estimate MARS-KS was used. In this paper, an APR1400 RELAP5 input deck was developed for station blackout scenario to analyze operation strategy by manually depressurizing the reactor coolant system through the steam generator's secondary side. Additionally, a sensitivity study was performed on reactor coolant pump seal leakage.

Towards Extended Vantage Theory

Science.gov (United States)

Glaz, Adam

2010-01-01

The applicability of Vantage Theory (VT), a model of (colour) categorization, to linguistic data largely depends on the modifications and adaptations of the model for the purpose. An attempt to do so proposed here, called Extended Vantage Theory (EVT), slightly reformulates the VT conception of vantage by capitalizing on some of the entailments of…

Six- and three-hourly meteorological observations from 223 USSR stations

Energy Technology Data Exchange (ETDEWEB)

Razuvaev, V.N.; Apasova, E.B.; Martuganov, R.A. [All-Russian Research Inst. of Hydrometeorologicl Information, Obninsk (Russia). World Data Centre; Kaiser, D.P. [Oak Ridge National Lab., TN (United States)

1995-04-01

This document describes a database containing 6- and 3-hourly meteorological observations from a 223-station network of the former Soviet Union. These data have been made available through cooperation between the two principal climate data centers of the United States and Russia: the National Climatic Data Center (NCDC), in Asheville, North Carolina, and the All-Russian Research Institute of Hydrometeorological Information -- World Data Centre (RIHMI-WDC) in Obninsk. Station records consist of 6- and 3-hourly observations of some 24 meteorological variables including temperature, weather type, precipitation amount, cloud amount and type, sea level pressure, relative humidity, and wind direction and speed. The 6-hourly observations extend from 1936 to 1965; the 3-hourly observations extend from 1966 through the mid-1980s (1983, 1984, 1985, or 1986; depending on the station). These data have undergone extensive quality assurance checks by RIHMI-WDC, NCDC, and the Carbon Dioxide Information Analysis Center (CDIAC). The database represents a wealth of meteorological information for a large and climatologically important portion of the earth`s land area, and should prove extremely useful for a wide variety of regional climate change studies. These data are available free of charge as a numeric data package (NDP) from CDIAC. The NDP consists of this document and 40 data files that are available via the Internet or on 8mm tape. The total size of the database is {approximately}2.6 gigabytes.

Quality of life and educational benefit among orthopedic surgery residents: a prospective, multicentre comparison of the night float and the standard call systems.

Science.gov (United States)

Zahrai, Ali; Chahal, Jaskarndip; Stojimirovic, Dan; Schemitsch, Emil H; Yee, Albert; Kraemer, William

2011-02-01

Given recent evolving guidelines regarding postcall clinical relief of residents and emphasis on quality of life, novel strategies are required for implementing call schedules. The night float system has been used by some institutions as a strategy to decrease the burden of call on resident quality of life in level-1 trauma centres. The purpose of this study was to determine whether there are differences in quality of life, work-related stressors and educational experience between orthopedic surgery residents in the night float and standard call systems at 2 level-1 trauma centres. We conducted a prospective cohort study at 2 level-1 trauma hospitals comprising a standard call (1 night in 4) group and a night float (5 14-hour shifts [5 pm-7 am] from Monday to Friday) group for each hospital. Over the course of a 6-month rotation, each resident completed 3 weeks of night float. The remainder of the time on the trauma service consists of clinical duties from 6:30 am to 5:30 pm on a daily basis and intermittent coverage of weekend call only. Residents completed the Short Form-36 (SF-36) general quality-of-life questionnaire, as well as questionnaires on stress level and educational experience before the rotation (baseline) and at 2, 4 and 6 months. We performed an analysis of covariance to compare between-group differences using the baseline scores as covariates and Wilcoxon signed-rank tests (nonparametric) to determine if the residents' SF-36 scores were different from the age- and sex-matched Canadian norms. We analyzed predictors of resident quality of life using multivariable mixed models. Seven residents were in the standard call group and 9 in the night float group, for a total of 16 residents (all men, mean age 35.1 yr). Controlling for between-group differences at baseline, residents on the night float rotation had significantly lower role physical, bodily pain, social function and physical component scale scores over the 6-month observation period. Compared

19 CFR 151.22 - Estimated duties on raw sugar.

Science.gov (United States)

2010-04-01

... 19 Customs Duties 2 2010-04-01 2010-04-01 false Estimated duties on raw sugar. 151.22 Section 151... THE TREASURY (CONTINUED) EXAMINATION, SAMPLING, AND TESTING OF MERCHANDISE Sugars, Sirups, and Molasses § 151.22 Estimated duties on raw sugar. Estimated duties shall be taken on raw sugar, as defined...

19 CFR 12.62 - Enforcement; duties of Customs officers.

Science.gov (United States)

2010-04-01

... 19 Customs Duties 1 2010-04-01 2010-04-01 false Enforcement; duties of Customs officers. 12.62 Section 12.62 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND SECURITY...; duties of Customs officers. (a) In accordance with the authority contained in sections 10 and 12 of the...

19 CFR 10.625 - Refunds of excess customs duties.

Science.gov (United States)

2010-04-01

... 19 Customs Duties 1 2010-04-01 2010-04-01 false Refunds of excess customs duties. 10.625 Section 10.625 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND SECURITY; DEPARTMENT... and Apparel Goods § 10.625 Refunds of excess customs duties. (a) Applicability. Section 205 of the...

19 CFR 141.1 - Liability of importer for duties.

Science.gov (United States)

2010-04-01

... Customs by the broker. (c) Claim against estate of importer. The claim of the Government for unpaid duties... 19 Customs Duties 2 2010-04-01 2010-04-01 false Liability of importer for duties. 141.1 Section 141.1 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND SECURITY; DEPARTMENT...

Recognizing the signs of time in the perspective of Jesus’ call to the evangelization

Directory of Open Access Journals (Sweden)

Dariusz Adamczyk

2008-12-01

Full Text Available The call of Jesus to recognize the signs of time from Mt 16, 3 has a timeless character. The investigation and explanation of the Gospel light is the duty of the Church. This has a fundamental importance for the effectiveness of evangelization. The signs of time can be correlated directly with God’s initiative to save us. The sign of time can be considered the sign of God in which God’s freedom addresses our freedom, calling us to create history. God, thanks to the signs of time, not so much manifests his definite will, but rather directs us towards freedom. The signs of time show the direction of behaviour for the development of the world which is unanimous with the thought of God. They are God’s calls, which are directed towards men, therefore, recognizing the signs of time has mainly a practical dimen- sion, not a theoretical one. Recognizing signs nowadays allows us to discover new and current elements in the Gospel.

Light-Duty Vehicle Thermal Management | Transportation Research | NREL

Science.gov (United States)

Light-Duty Vehicle Thermal Management Light-Duty Vehicle Thermal Management Image of a semi improving the thermal efficiency of light-duty vehicles (LDVs) while maintaining the thermal comfort that utility vehicles, vans, and light trucks in use on U.S. roads, and the average American drives 11,300

40 CFR 1033.530 - Duty cycles and calculations.

Science.gov (United States)

2010-07-01

... 40 Protection of Environment 32 2010-07-01 2010-07-01 false Duty cycles and calculations. 1033.530... CONTROLS CONTROL OF EMISSIONS FROM LOCOMOTIVES Test Procedures § 1033.530 Duty cycles and calculations. This section describes how to apply the duty cycle to measured emission rates to calculate cycle...

Liquid Storage of Boar Semen Using Commercial Extenders

Directory of Open Access Journals (Sweden)

Liviu BOGDAN

2018-05-01

Full Text Available The research was focused on the modern evaluation of boar semen parameters, using computer assisted sperm analysis (CASA, before and after liquid storage at 15ºC. Semen was collected from 15 sexually mature boars by manual stimulation. Macroscopical and microscopical evaluation of semen was performed, followed by a detailed CASA analysis of all ejaculates. Subsequently, semen was diluted using 4 different extenders (Semtest, Androstar, MIII and Cronos and stored at 15ºC for 24 hours. Next, evaluation of progressive motility, total motility and viability was performed, using the same CASA system. All experiments were performed in triplicates and results were statistically analyzed. The average progressive motility after 24 hours was as follows: 69.56 ± 6.38 for MIII, 65.92% ± 2.63 for Semtest, 67.07% ± 5.58 for Androstar Plus and 68.93% ± 3.40 for Cronos. The viability results after 24 hours were: 86.34% ± 1.38 for Semtest extender, 93.55% ± 3.38% for Androstrar Plus, 89.19% ± 3.42 for MIII and 91.35% ± 2.37 for Cronos. The findings of this study suggest that the use of commercial extenders for short-term storage of swine semen is important in order to increase sperm longevity with minimal sperm function deterioration.

Automated medical resident rotation and shift scheduling to ensure quality resident education and patient care.

Science.gov (United States)

Smalley, Hannah K; Keskinocak, Pinar

2016-03-01

At academic teaching hospitals around the country, the majority of clinical care is provided by resident physicians. During their training, medical residents often rotate through various hospitals and/or medical services to maximize their education. Depending on the size of the training program, manually constructing such a rotation schedule can be cumbersome and time consuming. Further, rules governing allowable duty hours for residents have grown more restrictive in recent years (ACGME 2011), making day-to-day shift scheduling of residents more difficult (Connors et al., J Thorac Cardiovasc Surg 137:710-713, 2009; McCoy et al., May Clin Proc 86(3):192, 2011; Willis et al., J Surg Edu 66(4):216-221, 2009). These rules limit lengths of duty periods, allowable duty hours in a week, and rest periods, to name a few. In this paper, we present two integer programming models (IPs) with the goals of (1) creating feasible assignments of residents to rotations over a one-year period, and (2) constructing night and weekend call-shift schedules for the individual rotations. These models capture various duty-hour rules and constraints, provide the ability to test multiple what-if scenarios, and largely automate the process of schedule generation, solving these scheduling problems more effectively and efficiently compared to manual methods. Applying our models on data from a surgical residency program, we highlight the infeasibilities created by increased duty-hour restrictions placed on residents in conjunction with current scheduling paradigms.

Long working hours, occupational health and the changing nature of work organization.

Science.gov (United States)

Johnson, Jeffrey V; Lipscomb, Jane

2006-11-01

The impact of long working hours on health has been of major concern since the late 19th Century. Working hours are again increasing in the US. An overview of historical, sociological, and health-related research presented at an international conference on long working hours is discussed as an introduction to a special section in this issue. Research indicates that long working hours are polarizing along class lines with professionals working regular though longer hours and less well-educated workers having fewer though more irregular hours. Extended and irregular hours are associated with acute reactions such as stress and fatigue, adverse health behavior such as smoking, and chronic outcomes such as cardiovascular and musculoskeletal disorders. Improved methodologies are needed to track exposure to long working hours and irregular shifts longitudinally. Research should focus on the adverse impact that sleep-deprived and stressed workers may have on the health of the public they serve. A variety of protective efforts should be undertaken and evaluated. Copyright (c) 2006 Wiley-Liss, Inc.

The effects of anticipating a high-stress task on sleep and performance during simulated on-call work.

Science.gov (United States)

Sprajcer, Madeline; Jay, Sarah M; Vincent, Grace E; Vakulin, Andrew; Lack, Leon; Ferguson, Sally A

2018-04-22

On-call work is used to manage around the clock working requirements in a variety of industries. Often, tasks that must be performed while on-call are highly important, difficult and/or stressful by nature and, as such, may impact the level of anxiety that is experienced by on-call workers. Heightened anxiety is associated with poor sleep, which affects next-day cognitive performance. Twenty-four male participants (20-35 years old) spent an adaptation, a control and two counterbalanced on-call nights in a time-isolated sleep laboratory. On one of the on-call nights they were told that they would be required to do a speech upon waking (high-stress condition), whereas on the other night they were instructed that they would be required to read to themselves (low-stress condition). Pre-bed anxiety was measured by the State Trait Anxiety Inventory form x-1, and polysomnography and quantitative electroencephalogram analyses were used to investigate sleep. Performance was assessed across each day using the 10-min psychomotor vigilance task (09:30 hours, 12:00 hours, 14:30 hours, 17:00 hours). The results indicated that participants experienced no significant changes in pre-bed anxiety or sleep between conditions. However, performance on the psychomotor vigilance task was best in the high-stress condition, possibly as a result of heightened physiological arousal caused by performing the stressful task that morning. This suggests that performing a high-stress task may be protective of cognitive performance to some degree when sleep is not disrupted. © 2018 European Sleep Research Society.

A Dutch Book of Hours from the 15th Century

DEFF Research Database (Denmark)

Vrieland, Seán D.; Hansen, Anne Mette

2016-01-01

Private books of hours were the European bestseller of the 14th-16th centuries, especially among the aristocracy and urban élite. They typically began with a calendar, which listed saints’ days and other religious holidays, the most important of which were written in red – the so-called “red-lett...

Extended station blackout analyses of an APR1400 with MARS-KS

Directory of Open Access Journals (Sweden)

Kim Woongbae

2016-01-01

Full Text Available The Fukushima Daiichi nuclear power plant accident shows that natural disasters such as earthquakes and the subsequent tsunamis can cause station blackout for several days. The electric energy required for essential systems during a station blackout is provided from emergency backup batteries installed at the nuclear power plant. In South Korea, in the event of an extended station blackout, the life of these emergency backup batteries has recently been extended from 8 hours to 24 hours at Shin-Kori 5, 6, and APR1400 for design certification. For a battery life of 24 hours, available safety means system, equipment and procedures are studied and analyzed in their ability to cope with an extended station blackout. A sensitivity study of reactor coolant pump seal leakage is performed to verify how different seal leakages could affect the system. For simulating extended station blackout scenarios, the best estimate MARS-KS computer code was used. In this paper, an APR1400 RELAP5 input deck was developed for station blackout scenario to analyze operation strategy by manually depressurizing the reactor coolant system through the steam generator's secondary side. Additionally, a sensitivity study on reactor coolant pump seal leakage was carried out.

An Environment for Analyzing Space Optimizations in Call-by-Need Functional Languages

Directory of Open Access Journals (Sweden)

Nils Dallmeyer

2017-01-01

Full Text Available We present an implementation of an interpreter LRPi for the call-by-need calculus LRP, based on a variant of Sestoft's abstract machine Mark 1, extended with an eager garbage collector. It is used as a tool for exact space usage analyses as a support for our investigations into space improvements of call-by-need calculi.

Call Forecasting for Inbound Call Center

Directory of Open Access Journals (Sweden)

Peter Vinje

2009-01-01

Full Text Available In a scenario of inbound call center customer service, the ability to forecast calls is a key element and advantage. By forecasting the correct number of calls a company can predict staffing needs, meet service level requirements, improve customer satisfaction, and benefit from many other optimizations. This project will show how elementary statistics can be used to predict calls for a specific company, forecast the rate at which calls are increasing/decreasing, and determine if the calls may stop at some point.

Challenges posed by alien culture diffusion for employees of call centers in Mumbai

OpenAIRE

Hegde, Sandeep

2016-01-01

Since the last decade, there has been a tremendous growth in the call center businesses in several metropolitan and urban cities in India. Mumbai city is no exception to this sudden boom. The call center businesses employ over 500,000 nascent employees in the age group of 18-28 yrs in Mumbai. The nature of outsourced work along with the odd working hours in this industry leads to high employee attrition in the call centers. Job satisfaction, high levels of stress, health issues, employee safe...

[A case study on duty of care in professional nursing].

Science.gov (United States)

Huang, Hui-Man; Liao, Chi-Chun

2013-08-01

Nurses are expected to discharge their duty of care effectively and professionally to prevent medical negligence. Only three articles have previously focused on medical negligence. Duty of care and medical negligence in nursing are topics that have been neglected in Taiwan. (1) Classify the duty of care of professional nurses; (2) Investigate the facts and disputes in the current case; (3) Clarify the legal issues involved with regard to duty-of-care violations in the current case; (4) Explore the causal relationships in a legal context between nurses' duty-of-care violations and patient harm / injury. Literature analysis and a case study are used to analyze Supreme Court Verdict No.5550 (2010). Duty of care for nursing professionals may be classified into seven broad categories. Each category has its distinct correlatives. In nursing practice, every nursing behavior has a corresponding duty. In this case, the case study nurse did not discharge her obstetric professional duty and failed to inform the doctor in a timely manner. Negligence resulted in prenatal death and the case study nurse was found guilty. In order to prevent committing a crime, nurses should gain a better understanding of their duty of care and adequately discharge these duties in daily practice.

Towards a Duty of Care for Biodiversity

Science.gov (United States)

Earl, G.; Curtis, A.; Allan, C.

2010-04-01

The decline in biodiversity is a worldwide phenomenon, with current rates of species extinction more dramatic than any previously recorded. Habitat loss has been identified as the major cause of biodiversity decline. In this article we suggest that a statutory duty of care would complement the current mix of policy options for biodiversity conservation. Obstacles hindering the introduction of a statutory duty of care include linguistic ambiguity about the terms ‘duty of care’ and ‘stewardship’ and how they are applied in a natural resource management context, and the absence of a mechanism to guide its implementation. Drawing on international literature and key informant interviews we have articulated characteristics of duty of care to reduce linguistic ambiguity, and developed a framework for implementing a duty of care for biodiversity at the regional scale. The framework draws on key elements of the common law ‘duty of care’, the concepts of ‘taking reasonable care’ and ‘avoiding foreseeable harm’, in its logic. Core elements of the framework include desired outcomes for biodiversity, supported by current recommended practices. The focus on outcomes provides opportunities for the development of innovative management practices. The framework incorporates multiple pathways for the redress of non-compliance including tiered negative sanctions, and positive measures to encourage compliance. Importantly, the framework addresses the need for change and adaptation that is a necessary part of biodiversity management.

Sleep inertia during a simulated 6-h on/6-h off fixed split duty schedule.

Science.gov (United States)

Hilditch, Cassie J; Short, Michelle; Van Dongen, Hans P A; Centofanti, Stephanie A; Dorrian, Jillian; Kohler, Mark; Banks, Siobhan

Sleep inertia is a safety concern for shift workers returning to work soon after waking up. Split duty schedules offer an alternative to longer shift periods, but introduce additional wake-ups and may therefore increase risk of sleep inertia. This study investigated sleep inertia across a split duty schedule. Sixteen participants (age range 21-36 years; 10 females) participated in a 9-day laboratory study with two baseline nights (10 h time in bed, [TIB]), four 24-h periods of a 6-h on/6-h off split duty schedule (5-h TIB in off period; 10-h TIB per 24 h) and two recovery nights. Two complementary rosters were evaluated, with the timing of sleep and wake alternating between the two rosters (2 am/2 pm wake-up roster versus 8 am/8 pm wake-up roster). At 2, 17, 32 and 47 min after scheduled awakening, participants completed an 8-min inertia test bout, which included a 3-min psychomotor vigilance test (PVT-B), a 3-min Digit-Symbol Substitution Task (DSST), the Karolinska Sleepiness Scale (KSS), and the Samn-Perelli Fatigue Scale (SP-Fatigue). Further testing occurred every 2 h during scheduled wakefulness. Performance was consistently degraded and subjective sleepiness/fatigue was consistently increased during the inertia testing period as compared to other testing times. Morning wake-ups (2 am and 8 am) were associated with higher levels of sleep inertia than later wake-ups (2 pm and 8 pm). These results suggest that split duty workers should recognise the potential for sleep inertia after waking, especially during the morning hours.

Increasing Teachers' Workloads in the Form of Quantitative Expansion in Extracurricular Activities: Aggregated Data Analysis of Past Working Hours Using a General Linear Model

Science.gov (United States)

Kanbayashi, Toshiyuki

2016-01-01

In recent years, teachers' increased workloads have become an issue for policy, and have been multiply pointed out, deriving as they do from peripheral duties such as paperwork, in academic research as well. However, these mentions have not been based on sufficiently solid proof. Here, this paper compares teacher working hours surveys extant from…

38 CFR 3.6 - Duty periods.

Science.gov (United States)

2010-07-01

... arrest, or a cerebrovascular accident which occurred during such training. (Authority: 38 U.S.C. 101(24... the preparatory schools of the United States Air Force Academy, the United States Military Academy, or... school without a release from active duty, and for other individuals who have a commitment to active duty...

Basket call option pricing for CCVG using sparse grids

KAUST Repository

Crocce, Fabian

2016-01-06

The use of processes with jumps to overcome the shortcomings of the classical Black and Scholes when modelling stock prices has became very popular. One of the best-known models is the Common Clock Variance Gamma model (CCVG), introduced by Madan and Seneta in the 1990 [3]. We propose a method to price European basket call options modelled by the CCVG. The method could be extended to other model obtained by the subordination of a multidimensional Brownian motion and to more general options. To simplify the expositions we consider calls under the CCVG.

Basket call option pricing for CCVG using sparse grids

KAUST Repository

Crocce, Fabian; Hä ppö lä , Juho; Iania, Alessandro; Tempone, Raul

2016-01-01

The use of processes with jumps to overcome the shortcomings of the classical Black and Scholes when modelling stock prices has became very popular. One of the best-known models is the Common Clock Variance Gamma model (CCVG), introduced by Madan and Seneta in the 1990 [3]. We propose a method to price European basket call options modelled by the CCVG. The method could be extended to other model obtained by the subordination of a multidimensional Brownian motion and to more general options. To simplify the expositions we consider calls under the CCVG.

The Effects of Progressive Taxation on Labor Supply when Hours and Wages Are Jointly Determined

Science.gov (United States)

Aaronson, Daniel; French, Eric

2009-01-01

This paper extends a standard intertemporal labor supply model to account for progressive taxation as well as the joint determination of hourly wages and hours worked. We show that these two factors can have implications for both estimating labor supply elasticities as well as for using these elasticities in tax analysis. Failure to account for…

Analyzing Local Spatio-Temporal Patterns of Police Calls-for-Service Using Bayesian Integrated Nested Laplace Approximation

Directory of Open Access Journals (Sweden)

Hui Luan

2016-09-01

Full Text Available This research investigates spatio-temporal patterns of police calls-for-service in the Region of Waterloo, Canada, at a fine spatial and temporal resolution. Modeling was implemented via Bayesian Integrated Nested Laplace Approximation (INLA. Temporal patterns for two-hour time periods, spatial patterns at the small-area scale, and space-time interaction (i.e., unusual departures from overall spatial and temporal patterns were estimated. Temporally, calls-for-service were found to be lowest in the early morning (02:00–03:59 and highest in the evening (20:00–21:59, while high levels of calls-for-service were spatially located in central business areas and in areas characterized by major roadways, universities, and shopping centres. Space-time interaction was observed to be geographically dispersed during daytime hours but concentrated in central business areas during evening hours. Interpreted through the routine activity theory, results are discussed with respect to law enforcement resource demand and allocation, and the advantages of modeling spatio-temporal datasets with Bayesian INLA methods are highlighted.

Forgiveness and the Limits of Duty

NARCIS (Netherlands)

Archer, Alfred

2017-01-01

Can there be a duty to forgive those who have wronged us? According to a popular view amongst philosophers working on forgiveness the answer is no. Forgiveness, it is claimed, is always elective. This view is rejected by Gamlund (2010a; 2010b) who argues that duties to forgive do exist and then

Alertness, performance and off-duty sleep on 8-hour and 12-hour night shifts in a simulated continuous operations control room setting

Energy Technology Data Exchange (ETDEWEB)

Baker, T.L. [Institute for Circadian Physiology, Boston, MA (United States)

1995-04-01

A growing number of nuclear power plants in the United States have adopted routine 12-hr shift schedules. Because of the potential impact that extended work shifts could have on safe and efficient power plant operation, the U.S. Nuclear Regulatory Commission funded research on 8-hr and 12-hr shifts at the Human Alertness Research Center (HARC) in Boston, Massachusetts. This report describes the research undertaken: a study of simulated 8-hr and 12-hr work shifts that compares alertness, speed, and accuracy at responding to simulator alarms, and relative cognitive performance, self-rated mood and vigor, and sleep-wake patterns of 8-hr versus 12-hr shift workers.

Alertness, performance and off-duty sleep on 8-hour and 12-hour night shifts in a simulated continuous operations control room setting

International Nuclear Information System (INIS)

Baker, T.L.

1995-04-01

A growing number of nuclear power plants in the United States have adopted routine 12-hr shift schedules. Because of the potential impact that extended work shifts could have on safe and efficient power plant operation, the U.S. Nuclear Regulatory Commission funded research on 8-hr and 12-hr shifts at the Human Alertness Research Center (HARC) in Boston, Massachusetts. This report describes the research undertaken: a study of simulated 8-hr and 12-hr work shifts that compares alertness, speed, and accuracy at responding to simulator alarms, and relative cognitive performance, self-rated mood and vigor, and sleep-wake patterns of 8-hr versus 12-hr shift workers

19 CFR 191.173 - Imported duty-paid derivatives (no manufacture).

Science.gov (United States)

2010-04-01

... 19 Customs Duties 2 2010-04-01 2010-04-01 false Imported duty-paid derivatives (no manufacture). 191.173 Section 191.173 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND... § 191.173 Imported duty-paid derivatives (no manufacture). When the basis for drawback under 19 U.S.C...

Epistemic Duties and Failure to Understand one's Evidence

Directory of Open Access Journals (Sweden)

Scott Stapleford

2012-08-01

Full Text Available http://dx.doi.org/10.5007/1808-1711.2012v16n1p147   The paper defends the thesis that our epistemic duty is the duty to proportion our beliefs to the evidence we possess. An inclusive view of evidenced possessed is put forward on the grounds that it makes sense of our intuitions about when it is right to say that a person ought to believe some proposition P. A second thesis is that we have no epistemic duty to adopt any particular doxastic attitudes. The apparent tension between the two theses is resolved by applying the concept of duty to belief indirectly.

Characterization of In-Use Medium Duty Electric Vehicle Driving and Charging Behavior: Preprint

Energy Technology Data Exchange (ETDEWEB)

Duran, A.; Ragatz, A.; Prohaska, R.; Kelly, K.; Walkowicz, K.

2014-11-01

The U.S. Department of Energy's American Recovery and Reinvestment Act (ARRA) deployment and demonstration projects are helping to commercialize technologies for all-electric vehicles (EVs). Under the ARRA program, data from Smith Electric and Navistar medium duty EVs have been collected, compiled, and analyzed in an effort to quantify the impacts of these new technologies. Over a period of three years, the National Renewable Energy Laboratory (NREL) has compiled data from over 250 Smith Newton EVs for a total of over 100,000 days of in-use operation. Similarly, data have been collected from over 100 Navistar eStar vehicles, with over 15,000 operating days having been analyzed. NREL has analyzed a combined total of over 4 million kilometers of driving and 1 million hours of charging data for commercial operating medium duty EVs. In this paper, the authors present an overview of medium duty EV operating and charging behavior based on in-use data collected from both Smith and Navistar vehicles operating in the United States. Specifically, this paper provides an introduction to the specifications and configurations of the vehicles examined; discusses the approach and methodology of data collection and analysis, and presents detailed results regarding daily driving and charging behavior. In addition, trends observed over the course of multiple years of data collection are examined, and conclusions are drawn about early deployment behavior and ongoing adjustments due to new and improving technology. Results and metrics such as average daily driving distance, route aggressiveness, charging frequency, and liter per kilometer diesel equivalent fuel consumption are documented and discussed.

Circadian long call distribution in wild orangutans Distribution circadienne des cris longs (long calls chez l’orang-outan en milieu naturel

Directory of Open Access Journals (Sweden)

Thomas Geissmann

2009-10-01

Full Text Available We present first data on circadian long call distribution of wild orangutans in Northwest Borneo. Data were collected during two months in Batang Ai National Park. A total of 151 male long calls were heard, exhibiting a bimodal distribution pattern with peaks at 05:00-06:00 hours and 18:00-19:00 hours. An earlier study found pronounced differences between the calling rates of Bornean orangutans, which showed an almost unimodal call distribution with its peak at mid-morning, and those of Sumatran orangutans, which showed a bimodal call distribution with a distinct calling peak at predawn and a more moderate peak near dusk (MacKinnon 1974. Our findings from Batang Ai resemble more closely the pattern reported for Sumatra than those reported for other Bornean localities and, therefore, contradict earlier reports suggesting a Sumatra-Borneo dichotomy in orangutan call distribution. In addition, orangutans in Batang Ai were heard to regularly emit long calls throughout the night. This behaviour is unusual for a diurnal species.Nous présentons les premières données sur la distribution circadienne des cris longs (long calls chez les mâles orangs-outans vivant en milieu naturel au nord-ouest de Bornéo. Les données ont été récoltées lors d’une étude de terrain de deux mois au Parc National de Batang Ai. Les 151 cris longs entendus montraient une distribution bimodale, caractérisée par des pics à 05:00-06:00 et 18:00-19:00 heures. Une étude précédente avait révélé des différences profondes entre les taux de cris longs des orangs-outans de Bornéo et de Sumatra. Alors que la distribution des cris longs à Bornéo était presque unimodale et montrait un pic en milieu d’avant-midi, la distribution à Sumatra était bimodale et montrait un pic distinct avant l’aube et un second pic plus modéré au crépuscule (MacKinnon 1974. Nos résultats à Batang Ai ressemblent davantage au schéma rapporté précédemment à Sumatra qu�

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

Science.gov (United States)

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

2011-01-01

A minimum of 10 hours off duty should be scheduled between shiftsResident physician input into work redesign should be actively solicitedSchedules should be designed that adhere to principles of sleep and circadian science; this includes careful consideration of the effects of multiple consecutive night shifts, and provision of adequate time off after night work, as specified in the IOM reportResident physicians should not be scheduled up to the maximum permissible limits; emergencies frequently occur that require resident physicians to stay longer than their scheduled shifts, and this should be anticipated in scheduling resident physicians' work shiftsHospitals should anticipate the need for iterative improvement as new schedules are initiated; be prepared to learn from the initial phase-in, and change the plan as neededAs resident physician work hours are redesigned, attending physicians should also be considered; a potential consequence of resident physician work hour reduction and increased supervisory requirements may be an increase in work for attending physicians; this should be carefully monitored, and adjustments to attending physician work schedules made as needed to prevent unsafe work hours or working conditions for this group"Home call" should be brought under the overall limits of working hours; work load and hours should be monitored in each residency program to ensure that resident physicians and fellows on home call are getting sufficient sleepMedicare funding for graduate medical education in each hospital should be linked with adherence to the Institute of Medicine limits on resident physician work hours. MOONLIGHTING BY RESIDENT PHYSICIANS: The Institute of Medicine report recommended including external as well as internal moonlighting in working hour limits. The recommendation is: All moonlighting work hours should be included in the ACGME working hour limits and actively monitored. (ABSTRACT TRUNCATED)

Assessing the Battery Cost at Which Plug-In Hybrid Medium-Duty Parcel Delivery Vehicles Become Cost-Effective

Energy Technology Data Exchange (ETDEWEB)

Ramroth, L. A.; Gonder, J. D.; Brooker, A. D.

2013-04-01

The National Renewable Energy Laboratory (NREL) validated diesel-conventional and diesel-hybrid medium-duty parcel delivery vehicle models to evaluate petroleum reductions and cost implications of hybrid and plug-in hybrid diesel variants. The hybrid and plug-in hybrid variants are run on a field data-derived design matrix to analyze the effect of drive cycle, distance, engine downsizing, battery replacements, and battery energy on fuel consumption and lifetime cost. For an array of diesel fuel costs, the battery cost per kilowatt-hour at which the hybridized configuration becomes cost-effective is calculated. This builds on a previous analysis that found the fuel savings from medium duty plug-in hybrids more than offset the vehicles' incremental price under future battery and fuel cost projections, but that they seldom did so under present day cost assumptions in the absence of purchase incentives. The results also highlight the importance of understanding the application's drive cycle specific daily distance and kinetic intensity.

7 CFR 1221.110 - Powers and duties.

Science.gov (United States)

2010-01-01

... Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (MARKETING... INFORMATION ORDER Sorghum Promotion, Research, and Information Order Sorghum Promotion, Research, and Information Board § 1221.110 Powers and duties. The Board shall have the following powers and duties: (a) To...

A cross-site vascular radiology on-call service: the Manchester experience

International Nuclear Information System (INIS)

Ashleigh, R.J.; Butterfield, J.S.; Asquith, J.; Chalmers, N.; Murphy, G.

2005-01-01

AIM: A cross-site vascular radiology on-call service was established 5 years ago to cover two vascular centres in Manchester. We aimed to review the service. MATERIALS AND METHODS: A prospective audit of out-of hours referrals and procedures over a three month period (March-May 2003) was undertaken. RESULTS: There were 52 incidents in 49 patients (mean 4 calls per week). Nine involved telephone advice only, the remainder (82%) required a procedure. Angiography was performed on 88% of patients and therapeutic radiological intervention on 50%. 71% of calls occurred at a weekend. 50% of the calls were from vascular surgery and 50% from other sources. The consultant vascular radiologist was present for 93% of procedures. CONCLUSIONS: The workload suggests that a vascular radiology on call service is justified in Manchester. There have been no major problems with its implementation and operation. This is a consultant led service, with very few cases being devolved to a specialist registrar (SpR)

Extending Pickering Fuel Channel Life to 247,000 EFPH (2020)

International Nuclear Information System (INIS)

Malek, I.

2013-01-01

This presentation is about extending the life of PNGS Pressure tubes from 210,000 EFPH (Effective Full Power Hours) to 247,000 EFPH. The l license renewal is in 2013 (R & D defined in 2009). The unknowns are the extent of degradation in some key areas. There are regulatory requirements for fuel channel extended life. It is necessary to integrate inspection capability and do-ability in outages. This would result in safe operation and demonstrated margin to extend life with operation to 2020.

Why Shops Close Again : An Evolutionary Perspective on the Deregulation of Shopping Hours

OpenAIRE

Kosfeld, M.

1999-01-01

This paper introduces a new perspective on the deregulation of shopping hours based on ideas from evolutionary game theory. We study a retail economy where shopping hours have been deregulated recently. It is argued that first, the deregulation leads to a coordination problem between store owners and customers, and second, the ‘solution’ to this problem depends on the specific cost structure of stores and the preferences of customers. In particular, it may happen that, even if extended shoppi...

75 FR 7426 - Tier 2 Light-Duty Vehicle and Light-Duty Truck Emission Standards and Gasoline Sulfur Control...

Science.gov (United States)

2010-02-19

... 2060-AI23; 2060-AQ12 Tier 2 Light-Duty Vehicle and Light-Duty Truck Emission Standards and Gasoline.... The rulemaking also required oil refiners to limit the sulfur content of the gasoline they produce. Sulfur in gasoline has a detrimental impact on catalyst performance and the sulfur requirements have...

Epistemic duties and failure to understand one’s evidence

Directory of Open Access Journals (Sweden)

Scott Stapleford

2012-04-01

Full Text Available The paper defends the thesis that our epistemic duty is the duty to proportion our beliefs to the evidence we possess. An inclusive view of evidenced possessed is put forward on the grounds that it makes sense of our intuitions about when it is right to say that a person ought to believe some proposition P. A second thesis is that we have no epistemic duty to adopt any particular doxastic attitudes. The apparent tension between the two theses is resolved by applying the concept of duty to belief indirectly.

RAPPORT-BUILDING THROUGH CALL IN TEACHING CHINESE AS A FOREIGN LANGUAGE: AN EXPLORATORY STUDY

Directory of Open Access Journals (Sweden)

Wenying Jiang

2005-05-01

Full Text Available Technological advances have brought about the ever-increasing utilisation of computer-assisted language learning (CALL media in the learning of a second language (L2. Computer-mediated communication, for example, provides a practical means for extending the learning of spoken language, a challenging process in tonal languages such as Chinese, beyond the realms of the classroom. In order to effectively improve spoken language competency, however, CALL applications must also reproduce the social interaction that lies at the heart of language learning and language use. This study draws on data obtained from the utilisation of CALL in the learning of L2 Chinese to explore whether this medium can be used to extend opportunities for rapport-building in language teaching beyond the face-to-face interaction of the classroom. Rapport's importance lies in its potential to enhance learning, motivate learners, and reduce learner anxiety. To date, CALL's potential in relation to this facet of social interaction remains a neglected area of research. The results of this exploratory study suggest that CALL may help foster learner-teacher rapport and that scaffolding, such as strategically composing rapport-fostering questions in sound-files, is conducive to this outcome. The study provides an instruction model for this application of CALL.

Fitness for duty - a regulator's view

International Nuclear Information System (INIS)

Johnson, E.H.; Hall, R.E.

1987-01-01

Fitness for duty is a legal, moral, emotional, and political issue. It is therefore that type of issue that one would expect industry to run from, opting instead for government intervention and prescriptive regulations. This would allow the industry to hide behind the shield of doing what is necessary to comply. But fitness for duty is also a rational business issue. It involves getting a reasonable return on the investment in the people who are necessary to run the nuclear industry. It is within this context that the US Nuclear Regulatory Commission (NRC) has exercised its discretion to not undertake new rule making, instead giving the industry the mandate of pursuing this issue. The NRC has deferred rule making as long as the industry programs are effective in producing the desired results. The NRC has also retained the right to follow up on operational events and to evaluate the effectiveness of the programs in place. The industry, under the leadership of NUMARC, has risen to this challenge and has adopted the August 1985 Edison Electric Institute (EEI) fitness-for-duty program guidelines for implementation by all utilities. In evaluating the effectiveness of programs, the NRC is conducting inspections at some utilities. These inspections have confirmed that the EEI guidelines are being used as the basis for fitness-for-duty programs. Even though the nuclear industry has taken a generally strong stand on fitness for duty and has adopted reasonable guidelines for its assurance, there still remain several challenges

20 CFR 702.402 - Employer's duty to furnish; duration.

Science.gov (United States)

2010-04-01

... Care and Supervision § 702.402 Employer's duty to furnish; duration. It is the duty of the employer to furnish appropriate medical care (as defined in § 702.401(a)) for the employee's injury, and for such... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Employer's duty to furnish; duration. 702.402...

28 CFR 49.2 - Duties of custodian.

Science.gov (United States)

2010-07-01

... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Duties of custodian. 49.2 Section 49.2 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) ANTITRUST CIVIL PROCESS ACT § 49.2 Duties of custodian. (a) Upon taking physical possession of documentary material, answers to interrogatories, or...

The effectiveness of television advertising campaigns on generating calls to a national Quitline by Māori.

Science.gov (United States)

Wilson, N; Grigg, M; Graham, L; Cameron, G

2005-08-01

To examine the effectiveness of four mass media campaigns on calls to a national Quitline by Māori (the indigenous people of New Zealand). Monthly Quitline call data and calls within one hour of a television commercial (TVC) being shown were analysed for the 2002-2003 period. Data on target audience rating points (TARPs) and expenditure on TVCs were also used (n = 2319 TVC placements). Māori were found to register with the Quitline at higher rates during the most intense six campaign months (15% more registrations compared to less intense months). The most effective campaign generated 115 calls per 100 TARPs by Māori callers within one hour of TVC airing (the "Every cigarette" campaign). A more Māori orientated campaign with both health and cultural themes generated 91 calls per 100 TARPs from Māori callers. For these two campaigns combined, the advertising cost per new registration with the Quitline by a Māori caller was NZD 30-48. Two second hand smoke campaigns that did not show the Quitline number were much less effective at 25 and 45 calls per 100 TARPs. These television advertising campaigns were effective and cost effective in generating calls to a national Quitline by Māori. Health authorities should continue to explore the use of both "threat appeal" style media campaigns and culturally appropriate campaigns to support Quitline use by indigenous peoples.

New Approach To Hour-By-Hour Weather Forecast

Science.gov (United States)

Liao, Q. Q.; Wang, B.

2017-12-01

Fine hourly forecast in single station weather forecast is required in many human production and life application situations. Most previous MOS (Model Output Statistics) which used a linear regression model are hard to solve nonlinear natures of the weather prediction and forecast accuracy has not been sufficient at high temporal resolution. This study is to predict the future meteorological elements including temperature, precipitation, relative humidity and wind speed in a local region over a relatively short period of time at hourly level. By means of hour-to-hour NWP (Numeral Weather Prediction)meteorological field from Forcastio (https://darksky.net/dev/docs/forecast) and real-time instrumental observation including 29 stations in Yunnan and 3 stations in Tianjin of China from June to October 2016, predictions are made of the 24-hour hour-by-hour ahead. This study presents an ensemble approach to combine the information of instrumental observation itself and NWP. Use autoregressive-moving-average (ARMA) model to predict future values of the observation time series. Put newest NWP products into the equations derived from the multiple linear regression MOS technique. Handle residual series of MOS outputs with autoregressive (AR) model for the linear property presented in time series. Due to the complexity of non-linear property of atmospheric flow, support vector machine (SVM) is also introduced . Therefore basic data quality control and cross validation makes it able to optimize the model function parameters , and do 24 hours ahead residual reduction with AR/SVM model. Results show that AR model technique is better than corresponding multi-variant MOS regression method especially at the early 4 hours when the predictor is temperature. MOS-AR combined model which is comparable to MOS-SVM model outperform than MOS. Both of their root mean square error and correlation coefficients for 2 m temperature are reduced to 1.6 degree Celsius and 0.91 respectively. The

32 CFR 935.21 - Civil rights, powers, and duties.

Science.gov (United States)

2010-07-01

... INSULAR REGULATIONS WAKE ISLAND CODE Civil Law § 935.21 Civil rights, powers, and duties. In any case in... the laws of the United States or this part, the civil rights, powers, and duties as they obtain under... 32 National Defense 6 2010-07-01 2010-07-01 false Civil rights, powers, and duties. 935.21 Section...

Return-to-Duty Rates Following Minimally Invasive Spine Surgery Performed on Active Duty Military Patients in an Ambulatory Surgery Center.

Science.gov (United States)

Granger, Elder; Prada, Stefan; Bereczki, Zoltan; Weiss, Michael; Wade, Chip; Davis, Reginald

2018-05-21

Low back pain is a primary health care utilization driver in the US population. Health care evaluation visits for low back pain are as common as medical evaluation for the common cold. Low back pain is the most common reason for reductions in activities of daily living and work activity in the general population. Although these statistics are compelling, in the military population, there is arguably a significantly greater economic impact on the military population, as the cost to train, retain, and deploy a service member is a tremendous cost. The current study retrospectively examines surgical outcomes, return to duty, and patient-centric outcomes among 82 active duty or reserve military patients who underwent an outpatient minimally invasive spine surgery Laminotomy Foraminotomy Decompression for the treatment of lumbar spinal stenosis in an ambulatory surgery center. Overall, our results indicate that within the 82 active duty military service members, 100% of the service members return to duty within 3 mo. Additionally, there was a significant reduction in self-reported pain and disability 12 mo postoperative, whereas the average length of surgery was 62 min with an average estimated blood loss of 30.64 mL. The current study indicates that minimally invasive procedures for the treatment of lumbar spinal stenosis in an ambulatory surgery center setting are an effective option for active duty servicemen to reduce return-to-duty rates and symptomatic back-related pain and disability.

Wi-Fi Coexistence with Duty Cycled LTE-U

Directory of Open Access Journals (Sweden)

Yimin Pang

2017-01-01

Full Text Available Coexistence of Wi-Fi and LTE-Unlicensed (LTE-U technologies has drawn significant concern in industry. In this paper, we investigate the Wi-Fi performance in the presence of duty cycle based LTE-U transmission on the same channel. More specifically, one LTE-U cell and one Wi-Fi basic service set (BSS coexist by allowing LTE-U devices to transmit their signals only in predetermined duty cycles. Wi-Fi stations, on the other hand, simply contend the shared channel using the distributed coordination function (DCF protocol without cooperation with the LTE-U system or prior knowledge about the duty cycle period or duty cycle of LTE-U transmission. We define the fairness of the above scheme as the difference between Wi-Fi performance loss ratio (considering a defined reference performance and the LTE-U duty cycle (or function of LTE-U duty cycle. Depending on the interference to noise ratio (INR being above or below −62 dbm, we classify the LTE-U interference as strong or weak and establish mathematical models accordingly. The average throughput and average service time of Wi-Fi are both formulated as functions of Wi-Fi and LTE-U system parameters using probability theory. Lastly, we use the Monte Carlo analysis to demonstrate the fairness of Wi-Fi and LTE-U air time sharing.

Comparison of different extenders on the preservability of rabbit semen stored at 5°C for 72 hours

Directory of Open Access Journals (Sweden)

Michele Di Iorio

2014-10-01

Full Text Available This study was designed to compare Cortalap® extender with tris-citric acid-glucose (TCG, Lepus® and Merk III®, to assess the in vitro preservability of rabbit spermatozoa stored for 72 h at 5°C. The best extender identified in vitro was then compared with fresh semen to determine fertility and prolificacy rates in vivo. Eight semen pools were split into four subsamples and each of them was diluted to a ratio of 1:10 (volume:volume with four different extenders (Lepus®, Cortalap®, TCG and Merk III® and stored at 5°C for 72 h. Sperm motility, viability, sperm membrane and acrosome integrity were evaluated in both fresh and chilled semen at 4, 24, 48 and 72 h of storage. The results showed that Cortalap® was the best extender to preserve the quality of rabbit semen in vitro over 72 h in comparison with the other extenders (P<0.05. Then, Cortalap® was used for an artificial insemination (AI trial to be compared with fresh semen. Two groups of does (n=30 each were inseminated with fresh and chilled semen. The fertility and prolificacy rates for the does inseminated with chilled semen were significantly lower compared with those inseminated with fresh semen (P<0.05. In conclusion, although Cortalap® proved to be the best extender to preserve semen quality in vitro after 72 h at 5°C, the in vivo results showed that its use is not recommended in AI programmes.

Inversion of the ‘Duty of Care’

DEFF Research Database (Denmark)

Tsinovoi, Alexei; Adler-Nissen, Rebecca

2017-01-01

technologies and the proliferation of new security threats. In recent years the state’s duty of care has received fresh political and scholarly attention, but Diplomatic Studies have so far overlooked how the recent waves of neoliberal reforms have introduced a new political rationality into policy......The concept of ‘duty of care’ for citizens abroad is grounded in a political rationality where the population is seen as an object for protection by the state. In today’s globalised world, however, this rationality is challenged by increased citizen mobility, budget cuts, new information...... of the duty of care through new citizen-based practices, steered at a distance by the state....

The role of calling EMS versus using private transportation in improving the management of stroke in France.

Science.gov (United States)

Gache, Kristel; Couralet, Melanie; Nitenberg, Gérard; Leleu, Henri; Minvielle, Etienne

2013-01-01

To compare the time from symptom onset to brain imaging between patients calling emergency medical services (EMS) and those using private means for transportation. We focused on symptom onset-to-brain imaging times of ≤2 hours and ≤3 hours 30 minutes, assuming a one-hour interval between imaging and thrombolysis. Other variables were the patient's age, gender, stroke type, National Institutes of Health Stroke Scale (NIHSS) score, presence of an on-site stroke unit, and period of symptom onset. Univariate analyses and a hierarchical linear regression model were used, as appropriate, and adjusted for these variables. A total of 1,105 stroke patients (28%) were included in the analyses, 40.6% of them transported by EMS. Patients using EMS were significantly older (72.8 vs. 70.5 years; p = 0.008), they had a higher NIHSS score (8 vs. 6.1; p = 0.0001), fewer were ischemic (85.1% vs. 90.6%; p = 0.005), and more of them reached hospitals with an on-site stroke unit (81.3% vs. 72.9%; p = 0.002). For the EMS-call patients, the median symptom onset-to-brain imaging time was significantly shorter (3 hours 21 minutes vs. 5 hours 57 minutes), and after adjustment, maximum delays of 2 hours and 3 hours 30 minutes were independently associated with EMS call: 28% vs. 18% (p = 0.015) and 66% vs. 45% (p < 0.0001) of patients, respectively, leading to an adjusted odds ratio of 2.77 (95% confidence interval, 2.007-3.828; p < 0.0001) for the threshold of 3 hours 30 minutes. The symptom onset-to-brain imaging time was significantly shorter in case of EMS transportation, but most patients did not reach the hospital in time to be eligible for thrombolysis. Efforts are still needed to reduce delays, especially public education and EMS activation. These efforts should be combined with new approaches for the quality management of stroke patients.

How Do Stamp Duties Affect the Housing Market?

OpenAIRE

Davidoff, Ian; Leigh, Andrew

2013-01-01

Land transfer taxes are a substantial portion of the cost of moving house in many developed countries. Since stamp duties are endogenous with respect to the house price, we create an instrumental variable that is the stamp duty on a property, given that postcode's starting house price and the national house price trend. In a specification with postcode and year fixed effects, this instrument effectively captures policy changes and nonlinearities in the stamp duty schedule. We find that the im...

Modeling and Analysis of Energy Conservation Scheme Based on Duty Cycling in Wireless Ad Hoc Sensor Network

Science.gov (United States)

Chung, Yun Won; Hwang, Ho Young

2010-01-01

In sensor network, energy conservation is one of the most critical issues since sensor nodes should perform a sensing task for a long time (e.g., lasting a few years) but the battery of them cannot be replaced in most practical situations. For this purpose, numerous energy conservation schemes have been proposed and duty cycling scheme is considered the most suitable power conservation technique, where sensor nodes alternate between states having different levels of power consumption. In order to analyze the energy consumption of energy conservation scheme based on duty cycling, it is essential to obtain the probability of each state. In this paper, we analytically derive steady state probability of sensor node states, i.e., sleep, listen, and active states, based on traffic characteristics and timer values, i.e., sleep timer, listen timer, and active timer. The effect of traffic characteristics and timer values on the steady state probability and energy consumption is analyzed in detail. Our work can provide sensor network operators guideline for selecting appropriate timer values for efficient energy conservation. The analytical methodology developed in this paper can be extended to other energy conservation schemes based on duty cycling with different sensor node states, without much difficulty. PMID:22219676

Modeling and Analysis of Energy Conservation Scheme Based on Duty Cycling in Wireless Ad Hoc Sensor Network

Directory of Open Access Journals (Sweden)

Yun Won Chung

2010-06-01

Full Text Available In sensor network, energy conservation is one of the most critical issues since sensor nodes should perform a sensing task for a long time (e.g., lasting a few years but the battery of them cannot be replaced in most practical situations. For this purpose, numerous energy conservation schemes have been proposed and duty cycling scheme is considered the most suitable power conservation technique, where sensor nodes alternate between states having different levels of power consumption. In order to analyze the energy consumption of energy conservation scheme based on duty cycling, it is essential to obtain the probability of each state. In this paper, we analytically derive steady state probability of sensor node states, i.e., sleep, listen, and active states, based on traffic characteristics and timer values, i.e., sleep timer, listen timer, and active timer. The effect of traffic characteristics and timer values on the steady state probability and energy consumption is analyzed in detail. Our work can provide sensor network operators guideline for selecting appropriate timer values for efficient energy conservation. The analytical methodology developed in this paper can be extended to other energy conservation schemes based on duty cycling with different sensor node states, without much difficulty.

Evaluation of duty cycles for heavy-duty urban vehicles : final report of IEA AMF Annex 29

Energy Technology Data Exchange (ETDEWEB)

Nylund, N.O.; Erkkila, K. [VTT Technical Research Centre of Finland, Espoo (Finland); Clark, N. [West Virginia Univ., Morgantown, WV (United States); Rideout, G. [Environment Canada, Ottawa, ON (Canada). Environmental Technology Centre, Emissions Research and Measurement Div

2007-07-01

Heavy-duty vehicles in Europe and North America will require incylinder measures or exhaust gas after-treatment technology to control emissions and meet ever stringent emission requirements. Alternatively, manufacturers can choose clean burning alternative fuels such as natural gas. Although there are no international standards for heavy-duty vehicle chassis dynamometer testing at present, the IEA Implementing Agreements offer excellent platforms for international collaborative research. Harmonization of test methods for vehicles and fuels is one important task. This paper reported on the work of 3 laboratories that have produced emission results for complete heavy-duty vehicles. VTT Technical Research of Finland, Environment Canada and West Virginia University measured standard size urban buses driving various duty cycles on chassis dynamometers. The number of transient test cycles per laboratory varied from 6 to 16. European and North American diesel and natural gas vehicles were included in the vehicle matrix. The objective was to demonstrate how the driving cycle affects the emission performance of conventional and advanced urban buses. Several driving cycles were run on urban buses to better understand the characteristics of different duty cycles; produce a key for cross-interpretation of emission results generated with different cycles; and study the interaction between vehicle, exhaust after-treatment and fuel technologies and test procedures. Fuel consumption and exhaust emissions were measured. The results varied significantly not only by test cycle, but also by vehicle technology. In general, vehicles emissions were directly proportioned to the amount of fuel consumed, with the exception of NOx-emissions from SCR-vehicles. There was a clear difference in the emission profiles of European and North American vehicles. In Europe, fuel efficiency was emphasized, while in North America, more focus was given to regulated exhaust emissions, especially low

[Work-family conflict in call center].

Science.gov (United States)

Ghislieri, Chiara; Ricotta, Simona; Colombo, Lara

2012-01-01

The working environment of call centers, which have seen a significant growth in recent years, has been the subject of several studies aiming at understanding its specific dynamics, with particular attention to the possible causes of stress and discomfort. Despite the fact that the work-family conflict is considered a source of stress responsible for undermining workers' well-being, and as such has been explored in many work environments, there is still very little research specific to call centers. This study had the following aims: to explore work-family conflict perceived by call-center operators taking account of any differences related to respondents'professional and personal characteristics; to understand which demands and resources can have an impact on work-family conflict in this context. The study was carried out on a sample of 898 call center operators in a telecommunications company through the administration of a self-reporting questionnaire. Data analysis included: t-test, one-way analysis of variance, linear correlations and multiple regressions. A higher perception of work-family conflict among workers having a full-time contract was observed compared to those having part-time contracts. Multiple regression analysis identified as sources of influence on work-family conflict: emotional dissonance, uneasiness due customer dissatisfaction, workload, avoidance coping and working hours. Work-family conflict in the context studied is not particularly critical: it is in part influenced by professional and personal characteristics of respondents and primarily caused by work demands. Managerial implications are discussed, especially referred to training activities.

On pandemics and the duty to care: whose duty? who cares?

Science.gov (United States)

Ruderman, Carly; Tracy, C Shawn; Bensimon, Cécile M; Bernstein, Mark; Hawryluck, Laura; Shaul, Randi Zlotnik; Upshur, Ross EG

2006-01-01

Background As a number of commentators have noted, SARS exposed the vulnerabilities of our health care systems and governance structures. Health care professionals (HCPs) and hospital systems that bore the brunt of the SARS outbreak continue to struggle with the aftermath of the crisis. Indeed, HCPs – both in clinical care and in public health – were severely tested by SARS. Unprecedented demands were placed on their skills and expertise, and their personal commitment to their profession was severely tried. Many were exposed to serious risk of morbidity and mortality, as evidenced by the World Health Organization figures showing that approximately 30% of reported cases were among HCPs, some of whom died from the infection. Despite this challenge, professional codes of ethics are silent on the issue of duty to care during communicable disease outbreaks, thus providing no guidance on what is expected of HCPs or how they ought to approach their duty to care in the face of risk. Discussion In the aftermath of SARS and with the spectre of a pandemic avian influenza, it is imperative that we (re)consider the obligations of HCPs for patients with severe infectious diseases, particularly diseases that pose risks to those providing care. It is of pressing importance that organizations representing HCPs give clear indication of what standard of care is expected of their members in the event of a pandemic. In this paper, we address the issue of special obligations of HCPs during an infectious disease outbreak. We argue that there is a pressing need to clarify the rights and responsibilities of HCPs in the current context of pandemic flu preparedness, and that these rights and responsibilities ought to be codified in professional codes of ethics. Finally, we present a brief historical accounting of the treatment of the duty to care in professional health care codes of ethics. Summary An honest and critical examination of the role of HCPs during communicable disease

40 CFR Appendix II to Part 1039 - Steady-State Duty Cycles

Science.gov (United States)

2010-07-01

... 40 Protection of Environment 32 2010-07-01 2010-07-01 false Steady-State Duty Cycles II Appendix... Appendix II to Part 1039—Steady-State Duty Cycles (a) The following duty cycles apply for constant-speed engines: (1) The following duty cycle applies for discrete-mode testing: D2 mode number Engine speed...

40 CFR Appendix II to Part 1042 - Steady-State Duty Cycles

Science.gov (United States)

2010-07-01

... 40 Protection of Environment 32 2010-07-01 2010-07-01 false Steady-State Duty Cycles II Appendix..., App. II Appendix II to Part 1042—Steady-State Duty Cycles (a) The following duty cycles apply as specified in § 1042.505(b)(1): (1) The following duty cycle applies for discrete-mode testing: E3 mode No...

Number of 24-hour diet recalls needed to estimate energy intake.

Science.gov (United States)

Ma, Yunsheng; Olendzki, Barbara C; Pagoto, Sherry L; Hurley, Thomas G; Magner, Robert P; Ockene, Ira S; Schneider, Kristin L; Merriam, Philip A; Hébert, James R

2009-08-01

Twenty-four-hour diet recall interviews (24HRs) are used to assess diet and to validate other diet assessment instruments. Therefore it is important to know how many 24HRs are required to describe an individual's intake. Seventy-nine middle-aged white women completed seven 24HRs over a 14-day period, during which energy expenditure (EE) was determined by the doubly labeled water method (DLW). Mean daily intakes were compared to DLW-derived EE using paired t tests. Linear mixed models were used to evaluate the effect of call sequence and day of the week on 24HR-derived energy intake while adjusting for education, relative body weight, social desirability, and an interaction between call sequence and social desirability. Mean EE from DLW was 2115 kcal/day. Adjusted 24HR-derived energy intake was lowest at call 1 (1501 kcal/day); significantly higher energy intake was observed at calls 2 and 3 (2246 and 2315 kcal/day, respectively). Energy intake on Friday was significantly lower than on Sunday. Averaging energy intake from the first two calls better approximated true energy expenditure than did the first call, and averaging the first three calls further improved the estimate (p=0.02 for both comparisons). Additional calls did not improve estimation. Energy intake is underreported on the first 24HR. Three 24HRs appear optimal for estimating energy intake.

[Duties of physicians or other healthcare workers connected with diagnosis, treatment, dissemination of information, assessment and registration of TB patients].

Science.gov (United States)

Zielonka, Tadeusz M

2015-01-01

Effective laws provide a series of duties to be performed by physicians and other medical personnel associated with TB. Every TB case and death resulting from TB as well as any case of undesirable result of BCG test requires notification and filling in of a special form. The physician has a duty to inform TB patients their legal guardians, close relatives or friends about the need to undergo sanitary and diagnostic procedure, treatment or vaccination, as well as on how to prevent disease from spreading. Persons failing to comply with the relevant numerous legal requirements in this respect are subject to a fine.TB patients can use special sick benefits extending up to 270 days. There is a requirement to use appropriate codes to define TB irrespective of LCD-10 classification.

Investigating Teachers’ and Students’ Beliefs and Assumptions about CALL Programme at Caledonian College of Engineering

Directory of Open Access Journals (Sweden)

Holi Ibrahim Holi Ali

2012-01-01

Full Text Available This study is set to investigate students’ and teachers’ perceptions and assumptions about newly implemented CALL Programme at the School of Foundation Studies, Caledonian College of Engineering, Oman. Two versions of questionnaire were administered to 24 teachers and 90 students to collect their beliefs and assumption about CALL programame. The results shows that the great majority of the students report that CALL is very interesting, motivating and useful to them and they learn a lot form it. However, the number of CALL hours should be increased, lab should be equipped and arranged in user friendly way, assessment should be integrated into CALL, and smart boards, black boards should be incorporated into the programme.

The Affordable Care Act: the ethical call to transform the organizational culture.

Science.gov (United States)

Piper, Llewellyn E

2014-01-01

The Patient Protection and Affordable Care Act will require health care leaders and managers to develop strategies and implement organizational tactics for their organization to survive and thrive under the federal mandates of this new health care law. Successful health care organizations and health care systems will be defined by their adaptability in the new value-based marketplace created by the Affordable Care Act. The most critical underlining challenge for this success will be the effective transformation of the organizational culture. Transformational value-based leadership is now needed to answer the ethical call for transforming the organizational culture. This article provides a model and recommendations to influence change in the most difficult leadership duty-transforming the organizational culture.

Duty periods for establishing eligibility for health care. Final rule.

Science.gov (United States)

2013-12-26

The Department of Veterans Affairs (VA) is amending its medical regulations concerning eligibility for health care to re-establish the definitions of "active military, naval, or air service,'' "active duty,'' and "active duty for training.'' These definitions were deleted in 1996; however, we believe that all duty periods should be defined in part 17 of the Code of Federal Regulations (CFR) to ensure proper determination of eligibility for VA health care. We are also providing a more complete definition of "inactive duty training.''

Stress and sleep quality in doctors working on-call shifts are associated with functional gastrointestinal disorders.

Science.gov (United States)

Lim, Soo-Kyung; Yoo, Seung Jin; Koo, Dae Lim; Park, Chae A; Ryu, Han Jun; Jung, Yong Jin; Jeong, Ji Bong; Kim, Byeong Gwan; Lee, Kook Lae; Koh, Seong-Joon

2017-05-14

To investigate the role of sleep quality and psychosocial problems as predictors of functional gastrointestinal disorders (FGIDs) in doctors that work 24 hour-on-call shifts. In this cross-sectional observation study, using the Rome III Questionnaire and Pittsburgh Sleep Quality Index (PSQI), we analyzed 170 doctors with 24 hour-on-call shifts. Among the participants that had experienced a 24 hour-on-call shift within the last 6 mo, 48 (28.2%) had FGIDs. Overall prevalence of irritable bowel syndrome (IBS) and functional dyspepsia (FD) were 16.5% and 17.1%, respectively, with 5.3% exhibiting both. Sleep scores (PSQI) (8.79 ± 2.71 vs 7.30 ± 3.43, P = 0.008), the presence of serious psychosocial alarm (83.3% vs 56.6%, P = 0.004), and the proportion of doctors who experienced over two months of recent on-call work (81.2% vs 68.9%, P = 0.044) were significantly different between individuals with or without FGIDs. Multivariate analysis revealed that presenting serious psychosocial alarm was an independent risk factor for prevalence of FD (OR = 5.47, 95%CI: 1.06-28.15, P = 0.042) and poor sleep quality (PSQI ≥ 6) was a predictor of IBS (OR = 4.17, 95%CI: 1.92-19.02, P = 0.016). Physicians should recognize the role of sleep impairment and psychological stress in the development of FGIDs and a comprehensive approach should be considered to manage patients with FGIDs.

Fleet average NOx emission performance of 2004 model year light-duty vehicles, light-duty trucks and medium-duty passenger vehicles

International Nuclear Information System (INIS)

2006-05-01

The On-Road Vehicle and Engine Emission Regulations came into effect on January 1, 2004. The regulations introduced more stringent national emission standards for on-road vehicles and engines, and also required that companies submit reports containing information concerning the company's fleets. This report presented a summary of the regulatory requirements relating to nitric oxide (NO x ) fleet average emissions for light-duty vehicles, light-duty trucks, and medium-duty passenger vehicles under the new regulations. The effectiveness of the Canadian fleet average NO x emission program at achieving environmental performance objectives was also evaluated. A summary of the fleet average NO x emission performance of individual companies was presented, as well as the overall Canadian fleet average of the 2004 model year based on data submitted by companies in their end of model year reports. A total of 21 companies submitted reports covering 2004 model year vehicles in 10 test groups, comprising 1,350,719 vehicles of the 2004 model year manufactured or imported for the purpose of sale in Canada. The average NO x value for the entire Canadian LDV/LDT fleet was 0.2016463 grams per mile. The average NO x values for the entire Canadian HLDT/MDPV fleet was 0.321976 grams per mile. It was concluded that the NO x values for both fleets were consistent with the environmental performance objectives of the regulations for the 2004 model year. 9 tabs

Chemistry, Courtrooms, and Common Sense. Part I: Negligence and Duty.

Science.gov (United States)

Gass, J. Ric

1990-01-01

Discussed are concepts involved in legal liability for laboratory accidents. The focus of this article is on negligence, duty, and responsibility issues. Highlighted are the basis of a lawsuit, negligent tort, duty and breech of duty, and cause and harm. Thirty-one cases are cited. (CW)

Legal, ethical and professional aspects of duty of care for nurses.

Science.gov (United States)

Dowie, Iwan

2017-12-13

Duty of care is a fundamental aspect of nursing, and many nurses consider this to be an important part of their professional duties as a nurse. However, the legal underpinnings of duty of care are often overlooked, and, as such, nurses may be unsure about when to act if they encounter emergency situations or serious incidents, especially when they are off duty. This article examines the legal, ethical and professional aspects of duty of care, what these mean for nurses in practice, and how duty of care is intrinsically linked with standards of care and negligence. ©2017 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.

The disinfection of flexible fibre-optic nasendoscopes out-of-hours: confidential telephone survey of ENT units in England

NARCIS (Netherlands)

Kanagalingam, J.; Zainal, A.; Georgalas, C.; Paun, S.; Tolley, N. S.

2002-01-01

We present the results of a confidential telephone survey of ENT units in England on the disinfection of flexible fibre-optic nasendoscopes out-of-hours. The on-call residents of 124 units were contacted and questioned. In 35.1 per cent of units surveyed, the on-call resident was primarily

32 CFR 13.4 - Duties and responsibilities of the defense.

Science.gov (United States)

2010-07-01

... COMMISSIONS RESPONSIBILITIES OF THE CHIEF DEFENSE COUNSEL, DETAILED DEFENSE COUNSEL, AND CIVILIAN DEFENSE COUNSEL § 13.4 Duties and responsibilities of the defense. (a) Regular duties. The Defense shall perform... 32 National Defense 1 2010-07-01 2010-07-01 false Duties and responsibilities of the defense. 13.4...

49 CFR 1103.15 - The practitioner's duty to clients, generally.

Science.gov (United States)

2010-10-01

... 49 Transportation 8 2010-10-01 2010-10-01 false The practitioner's duty to clients, generally... Practitioner's Duties and Responsibilities Toward A Client § 1103.15 The practitioner's duty to clients... all clients to observe the statutory law to the best of his knowledge or as interpreted by competent...

Antidumping duties, undertakings and foreign direct investment in the EU

NARCIS (Netherlands)

Belderbos, R.A.; Vandenbussche, H.; Veugelers, R.

2004-01-01

We study the effects of EU antidumping policy when foreign firms can ‘jump’ antidumping duties through foreign direct investment (FDI) in the EU. We show that duty jumping or duty pre-empting FDI occurs if the EU administration has broader objectives than protecting EU industry's profitability and

40 CFR 66.61 - Duty to pay.

Science.gov (United States)

2010-07-01

... 40 Protection of Environment 15 2010-07-01 2010-07-01 false Duty to pay. 66.61 Section 66.61... COLLECTION OF NONCOMPLIANCE PENALTIES BY EPA Payment § 66.61 Duty to pay. (a) Except where the owner or... who submits a petition pursuant to § 66.52 shall pay the penalty amount calculated by the owner or...

Always Be Closing: Experiencing and theorizing time and wage in a UK call center

OpenAIRE

Pitts, Frederick

2015-01-01

This article reports the author's experience of working in telesales. Through a call center, the case study company sells home improvements. The article describes the everyday organizational life of the telesales unit. Using this autoethnographic experience, the article analyses the organization of work-timein call centers. In particular, the article probes how commission constitutes a form of piece-wage. This piece-wage assists the manipulation of working hours. It does so by masking their e...

Determining your duties.

Science.gov (United States)

Summers, J

1989-04-01

This issue's discussion has two goals. First, we shall examine the reasons clinical personnel gravitate to the Kantian concept of duty. Second, we shall examine a technique used within Kantian theory that will help you decide when an ethical dilemma obligates you to act regardless of the consequences.

Effects of Fatigue on Driving Safety: A Comparison of Brake Reaction Times in Night Float and Postcall Physicians in Training.

Science.gov (United States)

Talusan, Paul G; Long, Theodore; Halim, Andrea; Guliani, Laura; Carroll, Nicole; Reach, John

2014-12-01

Concerns about duty hour and resident safety have fostered discussion about postshift fatigue and driving impairment. We assessed how converting to a night float schedule for overnight coverage affected driving safety for trainees. Brake reaction times were measured for internal medicine and orthopaedic surgery resident volunteers after a traditional 28-hour call shift and after a night float shift. We conducted matched paired t tests of preshift and postshift reaction time means. Participants also completed the Epworth Sleepiness Scale pre- and postshift. From June to July 2013, we enrolled 58 interns and residents (28 orthopaedic surgery, 30 internal medicine). We included 24 (41%) trainees on night float rotations and 34 (59%) trainees on traditional 28-hour call shifts. For all residents on night float rotations, there was no significant difference pre- and postshift. An increase in reaction times was noted among trainees on 28-hour call rotations. This included no effect on reaction times for internal medicine trainees pre- and postshift, and an increase in reaction times for orthopaedic trainees. For both night float and traditional call groups, there were significant increases in the Epworth Sleepiness Scale. Trainees on traditional 28-hour call rotations had significantly worse postshift brake reaction times, whereas trainees on night float rotations had no difference. Orthopaedic trainees had significant differences in brake reaction times after a traditional call shift.

Job search, hours restrictions, and desired hours of work

NARCIS (Netherlands)

Bloemen, H.G.

2008-01-01

A structural empirical job search model is presented that incorporates the labor supply decision of individuals. The arrival of a job offer is modeled as a random draw from a wage-hours offer distribution. Subjective information is used on desired working hours to identify optimal hours from offered

76 FR 66925 - Guidance for 1-Hour SO2

Science.gov (United States)

2011-10-28

...The EPA is announcing an extension of the public comment period for its draft non-binding guidance titled, ``Guidance for 1-Hour SO2 SIP Submissions.'' The draft of the guidance document is currently on the EPA's Web site. The EPA is extending the comment period for an additional 30-day period and invites public comments on this guidance during this period. The EPA plans to issue an updated version of the guidance after reviewing timely submitted comments.

The administration of renoprotective agents extends warm ischemia in a rat model.

Science.gov (United States)

Cohen, Jacob; Dorai, Thambi; Ding, Cheng; Batinic-Haberle, Ines; Grasso, Michael

2013-03-01

Extended warm ischemia time during partial nephrectomy leads to considerable renal injury. Using a rat model of renal ischemia, we examined the ability of a unique renoprotective cocktail to ameliorate warm ischemia-reperfusion injury and extend warm ischemia time. A warm renal ischemia model was developed using Sprague-Dawley rats, clamping the left renal artery for 40, 50, 60, and 70 minutes, followed by 48 hours of reperfusion. An improved renoprotective cocktail referred to as I-GPM (a mixture of specific renoprotective growth factors, porphyrins, and mitochondria-protecting amino acids) was administered -24 hours, 0 hours, and +24 hours after surgery. At 48 hours, both kidneys were harvested and examined with hematoxylin and eosin and periodic acid-Schiff stains for the analysis of renal tubular necrosis. Creatinine, protein, and gene expression levels were also analyzed to evaluate several ischemia-specific and antioxidant response markers. I-GPM treated kidneys showed significant reversal of morphologic changes and a significant reduction in specific ischemic markers lipocalin-2, galectin-3, GRP-78, and HMGB1 compared with ischemic controls. These experiments also showed an upregulation of the stress response protein, heat shock protein (HSP)-70, as well as the phosphorylated active form of the transcription factor, heat shock factor (HSF)-1. In addition, quantitative RT-PCR analyses revealed a robust upregulation of several antioxidant pathway response genes in I-GPM treated animals. By histopathologic and several molecular measures, our unique renoprotective cocktail mitigated ischemia-reperfusion injury. Our cocktail minimized oxidative stress in an ischemic kidney rat model while at the same time protecting the global parenchymal function during extended periods of ischemia.

Value-driven Security Agreements in Extended Enterprises

NARCIS (Netherlands)

Nunes Leal Franqueira, V.; Wieringa, Roelf J.

2010-01-01

Today organizations are highly interconnected in business networks called extended enterprises. This is mostly facilitated by outsourcing and by new economic models based on pay-as-you-go billing; all supported by IT-as-a-service. Although outsourcing has been around for some time, what is now new

Energy saving of benzene separation process for environmentally friendly gasoline using an extended DWC (divided wall column)

International Nuclear Information System (INIS)

Kim, Young Han

2016-01-01

Benzene is a known carcinogen, and is desired to be removed from the gasoline additive for environmental reason. A benzene removal process from the additive, reformate of catalytic reformers, is proposed utilizing an extended DWC (divided wall column). The DWC reduces the processing load of the whole process especially in extractor, which employs high boiling point solvent requiring large amount of energy and costly utility. In this study the design of the proposed process is addressed along with the evaluation of energy saving, economics and thermodynamic efficiency. The evaluation results indicate the heating duty reduction of 56.8% from the proposed process over the conventional process and 64.6% reduction of cooling duty. The economics reveals the 26% reduction of investment and 56% reduction of utility cost from the proposed process. However, no significant improvement of thermodynamic efficiency is yielded. - Highlights: • Energy saving benzene separation process is proposed. • Extraction load is reduced by feed separation. • Heat duty saving of 57% is yielded. • Investment and utility cost savings are 26% and 56%. • Commercially proven DWC is utilized.

30 CFR 772.13 - Coal exploration compliance duties.

Science.gov (United States)

2010-07-01

... 30 Mineral Resources 3 2010-07-01 2010-07-01 false Coal exploration compliance duties. 772.13... INTERIOR SURFACE COAL MINING AND RECLAMATION OPERATIONS PERMITS AND COAL EXPLORATION SYSTEMS UNDER REGULATORY PROGRAMS REQUIREMENTS FOR COAL EXPLORATION § 772.13 Coal exploration compliance duties. (a) All...

INTEGRATING CORPUS-BASED RESOURCES AND NATURAL LANGUAGE PROCESSING TOOLS INTO CALL

Directory of Open Access Journals (Sweden)

Pascual Cantos Gomez

2002-06-01

Full Text Available This paper ainis at presenting a survey of computational linguistic tools presently available but whose potential has been neither fully considered not exploited to its full in modern CALL. It starts with a discussion on the rationale of DDL to language learning, presenting typical DDL-activities. DDL-software and potential extensions of non-typical DDL-software (electronic dictionaries and electronic dictionary facilities to DDL . An extended section is devoted to describe NLP-technology and how it can be integrated into CALL, within already existing software or as stand alone resources. A range of NLP-tools is presentcd (MT programs, taggers, lemn~atizersp, arsers and speech technologies with special emphasis on tagged concordancing. The paper finishes with a number of reflections and ideas on how language technologies can be used efficiently within the language learning context and how extensive exploration and integration of these technologies might change and extend both modern CAI,I, and the present language learning paradigiii..

Radiology Physician Extenders: A Literature Review of the History and Current Roles of Physician Extenders in Medical Imaging.

Science.gov (United States)

Sanders, Vicki L; Flanagan, Jennifer

2015-01-01

The purpose of the literature review was to assess the origins of radiology physician extenders and examine the current roles found in the literature of advanced practice physician extenders within medical imaging. Twenty-six articles relating to physician assistants (PAs), nurse practitioners (NPs), radiologist assistants (RAs), and nuclear medicine advanced associates (NMAAs) were reviewed to discern similarities and differences in history, scope of practice, and roles in the medical imaging field. The literature showed PAs and NPs are working mostly in interventional radiology. PAs, NPs, and RAs perform similar tasks in radiology, including history and physicals, evaluation and management, preprocedure work-up, obtaining informed consent, initial observations/reports, and post-procedure follow-up. NPs and PAs perform a variety of procedures but most commonly vascular access, paracentesis, and thoracentesis. RAs perform gastrointestinal, genitourinary, nonvascular invasive fluoroscopy procedures, and vascular access procedures. The review revealed NMAAs are working in an advanced role, but no specific performances of procedures was found in the literature, only suggested tasks and clinical competencies. PAs, NPs, and RAs are currently the three main midlevel providers used in medical imaging. These midlevel providers are being used in a variety of ways to increase the efficiency of the radiologist and provide diagnostic and therapeutic radiologic procedures to patients. NMAAs are being used in medical imaging but little literature is available on current roles in clinical practice. More research is needed to assess the exact procedures and duties being performed by these medical imaging physician extenders.

Fluid approximation analysis of a call center model with time-varying arrivals and after-call work

Directory of Open Access Journals (Sweden)

Yosuke Kawai

2015-12-01

Full Text Available Important features to be included in queueing-theoretic models of the call center operation are multiple servers, impatient customers, time-varying arrival process, and operator’s after-call work (ACW. We propose a fluid approximation technique for the queueing model with these features by extending the analysis of a similar model without ACW recently developed by Liu and Whitt (2012. Our model assumes that the service for each quantum of fluid consists of a sequence of two stages, the first stage for the conversation with a customer and the second stage for the ACW. When the duration of each stage has exponential, hyperexponential or hypo-exponential distribution, we derive the time-dependent behavior of the content of fluid in each stage of service as well as that in the waiting room. Numerical examples are shown to illustrate the system performance for the cases in which the input rate and/or the number of servers vary in sinusoidal fashion as well as in adaptive ways and in stationary cases.

Setting standards for planning off duty and audit of practice.

Science.gov (United States)

Walker, Linda; Minchin, Anne; Pickard, Jane

The off duty or rostering system is an important part of managing any ward or department. This article looks at the issues that need to be considered when drawing up and managing off duty. It recommends standards for off-duty planning and shares the results of an audit carried out against some of these standards in one NHS trust.

Why Stamp Duties are an Increasing Financial Burden on Australian Home Buyers

OpenAIRE

Wood, Gavin A.

1994-01-01

The purchaser of housing incurs stamp duty liabilities in all Australian States. These stamp duties are levied on the conveyance of residential property and mortgage sums secured. In general, stamp duties were a growing financial burden on home buyers during the period 1985-1991. This paper examines the role of house price inflation in causing increases in average rates of stamp duty, the responsiveness of average rates of stamp duty to future changes in the nominal tax base and the effective...

Responsibilities and duties in the realm of work

Directory of Open Access Journals (Sweden)

Babić Jovan

2009-01-01

Full Text Available Employee responsibilities are prior to working rights and they are an equally important part of business ethics. There are three main parts in articulation of these responsibilities: 1. general responsibilities and duties in the process of work and in workplace, where we face the challenges of honesty, confidence, reliability, and such. 2. specific professional duties tied with profession that has heghtened responsibility of some sort, where we may find characteristic virtues connected with those professions. 3. managerial duties and responsibilities based on specific positions of managers and leaders as deciders in most important issues in business. The decisions that managers and leaders have to make have great impact to all those involved in business, and temptations they face are hard and far-reaching. The issues analyzed in the paper include work discipline, loyalty to the company, conflicts of various kinds of interests, limits of obedience, virtues accompanying various kinds of duties and obligations. .

Conflicting duties over confidentiality in Argentina and Peru.

Science.gov (United States)

Cavallo, Mercedes

2011-02-01

The medical duty of confidentiality represents a key element for the provision of reproductive and sexual health services. In some Latin American countries, such as Argentina and Peru, the legal systems impose—or are interpreted as imposing—on health professionals the duty of confidentiality, but also the duty to report the commission of a public order offense that they know about owing to the practicing of their profession. In these countries, the conflicting duties and the criminalization of abortion cause severe public health and human rights problems when health professionals assist their patients for post-abortion treatment. Typically, patients are deterred from seeking prompt medical care, and their privacy, autonomy, and dignity are violated. A 2010 ruling from the Supreme Court of Argentina and a 2004 ruling from the Inter-American Court of Human Rights emerge as important instruments that grant a more adequate protection of medical confidentiality. © 2010 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

THE EVOLUTION AND COMPLEXITY OF DIRECTORS' DUTY OF CARE

Directory of Open Access Journals (Sweden)

Adina Ponta

2015-11-01

Full Text Available The duty of care, which sets the standard of conduct of a „good director” is currently governed by the Romanian Companies Act and the Civil Code. The corroboration of the two legal acts is challenging, the paper in hand aims at a comparative view of the legal norms and at the appraisal of the content of this fiduciary duty in the modern context of the competitive economy. The nature of this fiduciary duty and the cases when it can be defied according to the Romanian Law are discussed in terms of the literature and the case law that inspired the legislator. By creating parallels between the content of the agency and the traditional characters of the director's office, mainly tagged with legal prerogatives, the study will reveal the importance of the fiduciary characters of the director’s function. The conclusions will catch the effects of standardizing the substantive exercise of the duty of care and the importance of defining the fiduciary character of directors’ duties, both with respect to case law and as well for healthy business relationships.

Out-of-hours demand in primary care: frequency, mode of contact and reasons for encounter in Switzerland.

Science.gov (United States)

Huber, Carola A; Rosemann, Thomas; Zoller, Marco; Eichler, Klaus; Senn, Oliver

2011-02-01

To investigate the demand for traditional out-of-hours general practitioner (GP) emergency care in Switzerland including GPs' satisfaction and reasons for encounter (RFE). During a 2-month period (2009), a questionnaire-based, cross-sectional study was performed in GPs participating in the mandatory out-of-hours service in the city of Zurich, Switzerland. The number and mode of patient contacts were assessed to investigate the demand for GP care in traditional out-of-hours services. GPs and patient characteristics, including RFE according to the International Classification of Primary Care, were noted. Descriptive statistics and non-parametric tests were conducted. Out of the 295 out-of-hours episodes during the study period, 148 (50%) duty periods were documented by a total of 93 GPs (75% men) with a mean (SD) age of 48.0 (6.2) years. The median (interquartile range) number of out-of-hours contacts was 5 (3-8) and the demand for home visits was significantly more common compared with practice and telephone consultations. A total of 112 different RFEs were responsible for the 382 documented patient contacts with fever accounting for the most common complaint (13.9%). Although 80% of GPs agreed to be satisfied overall with their profession as primary care provider, 57.6% among them were dissatisfied with the current out-of-hours service. Inappropriate payment and interference with their daily work in practice were most frequently reported. Our findings indicate that there is still strong patient demand for out-of-hours care with special need for home visits, suggesting that new organizational models such as integrating GPs into emergency care may not be an appropriate approach for all patients. Therefore, the ongoing reorganization of the out-of-hours-service in many health care systems has to be evaluated carefully in order not to miss important patient needs. © 2010 Blackwell Publishing Ltd.

The Community Orthopaedic Surgeon Taking Trauma Call: Pediatric Forearm Shaft Fracture Pearls and Pitfalls.

Science.gov (United States)

Herman, Martin J; Simon, Matthew; Mehlman, Charles T

2017-11-01

Pediatric forearm shaft fractures are the third most common fracture in children, and the forearm is the third most mobile joint in the body (with a nearly 180 degree arc of motion). The goals of treatment are aimed squarely at achieving satisfactory anatomic alignment (within defined parameters) as the consequences of malunion can be permanent forearm stiffness and deformity. Nonoperative treatment approaches still dominate care of the youngest age groups while surgical intervention has become increasingly common in older children. This article will offer evidence and experience-based tips intended to benefit the community orthopedic surgeon caring for children during the course of their on-call duties.

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

Science.gov (United States)

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

2014-01-01

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

Neighborhood walkability, income, and hour-by-hour physical activity patterns.

Science.gov (United States)

Arvidsson, Daniel; Eriksson, Ulf; Lönn, Sara Larsson; Sundquist, Kristina

2013-04-01

This study aimed to investigate both the mean daily physical activity and the hour-by-hour physical activity patterns across the day using accelerometry and how they are associated with neighborhood walkability and individual income. Moderate physical activity (MPA) was assessed by accelerometry in 2252 adults in the city of Stockholm, Sweden. Neighborhood walkability (residential density, street connectivity, and land use mix) was objectively assessed within 1000m network buffers around the participants' residence and individual income was self-reported. Living in a high walkability neighborhood was associated with more mean daily MPA compared with living in a low walkability neighborhood on weekdays and weekend days. Hour-by-hour analyses showed that this association appeared mainly in the afternoon/early evening during weekdays, whereas it appeared across the middle of the day during weekend days. Individual income was associated with mean daily MPA on weekend days. On weekdays, the hour-by-hour analyses showed that high income was associated with more MPA around noon and in late afternoon/early evening, whereas low income was associated with more MPA at the hours before noon and in the early afternoon. During the weekend, high income was more consistently associated with higher MPA. Hour-by-hour accelerometry physical activity patterns provides a more comprehensive picture of the associations between neighborhood walkability and individual income and physical activity and the variability of these associations across the day.

Formulation and Evaluation of Extended- Release Tablet of Zolpidem Tartrate by Wet Granulation Technique

Directory of Open Access Journals (Sweden)

Fatemeh Pourhashem

2016-06-01

Full Text Available The goal of this study was to design and evaluate extended - release system of the hypnotic agent, Zolpidem tartrate usefulness for the treatment of insomnia. The half-life of this drug is about 1.9 - 3 hours that indicating it a candidate for the extended release formulation. Our investigation relates to development of extended drug delivery system based on Hydroxy propyl methyl cellulose (HPMCK4M as release retardant, polyvinyl pyrrolidone (PVP k30 as binder and Magnesium Stearate using Factorial design. In vitro release study of matrix tablets was carried out in 0.01N HCl for 2 hours. All prepared matrix tablets were evaluated for physicochemical evaluation and drug content. The formulation that had release profile according to United State Pharmacopoeia selected for stability study according to ICH guidelines.

The effects of extended working hours on health and social well-being--a comparative analysis of four independent samples.

Science.gov (United States)

Wirtz, Anna; Nachreiner, Friedhelm

2010-07-01

Using structural equation modeling, it can be shown that long weekly working hours and work on weekends, nights, and in shifts have detrimental effects on psychovegetative health. Employees' reported subjective work-life balance also decreases with increasing number of hours worked/week, days worked on weekends, or at nights, and with working shifts. A decrease in work-life balance in turn increases the risk of psychovegetative impairments (PVIs). Thus, long and unusual working hours increase the risk of psychovegetative health impairments both directly and indirectly, moderated by the subjective work-life balance. In fact, the indirect effects of working time on PVIs via the work-life balance seem to be stronger than the direct effects. Results of a cross-validation study of four independent and representative samples from Germany and the European Union (N > 50,000) indicate high structural stability of these results and thus an increased validity and range for generalization.

The patient's duty to adhere to prescribed treatment: an ethical analysis.

Science.gov (United States)

Resnik, David B

2005-04-01

This article examines the ethical basis for the patient's duty to adhere to the physician's treatment prescriptions. The article argues that patients have a moral duty to adhere to the physician's treatment prescriptions, once they have accepted treatment. Since patients still retain the right to refuse medical treatment, their duty to adhere to treatment prescriptions is a prima facie duty, which can be overridden by their other ethical duties. However, patients do not have the right to refuse to adhere to treatment prescriptions if their non-adherence poses a significant threat to other people. This paper also discusses the use of written agreements between physicians and patients as a strategy for promoting patient adherence.

On-call work: To sleep or not to sleep? It depends.

Science.gov (United States)

Ferguson, Sally A; Paterson, Jessica L; Hall, Sarah J; Jay, Sarah M; Aisbett, Brad

On-call working time arrangements are increasingly common, involve work only in the event of an unpredictable incident and exist primarily outside of standard hours. Like other non-standard working time arrangements, on-call work disrupts sleep and can therefore have negative effects on health, safety and performance. Unlike other non-standard working time arrangements, on-call work often allows sleep opportunities between calls. Any sleep obtained during on-call periods will be beneficial for waking performance. However, there is evidence that sleep while on call may be of substantially reduced restorative value because of the expectation of receiving the call and apprehension about missing the call. In turn, waking from sleep to respond to a call may be associated with temporary increases in performance impairment. This is dependent on characteristics of both the preceding sleep, the tasks required upon waking and the availability and utility of any countermeasures to support the transition from sleep to wake. In this paper, we critically evaluate the evidence both for and against sleeping during on-call periods and conclude that some sleep, even if it is of reduced quality and broken by repeated calls, is a good strategy. We also note, however, that organisations utilising on-call working time arrangements need to systematically manage the likelihood that on-call sleep can be associated with temporary performance impairments upon waking. Given that the majority of work in this area has been laboratory-based, there is a significant need for field-based investigations of the magnitude of sleep inertia, in addition to the utility of sleep inertia countermeasures. Field studies should include working with subject matter experts to identify the real-world impacts of changes in performance associated with sleeping, or not sleeping, whilst on call.

Work hours and sleep/wake behavior of Australian hospital doctors.

Science.gov (United States)

Ferguson, Sally A; Thomas, Matthew J W; Dorrian, Jillian; Jay, Sarah M; Weissenfeld, Adrian; Dawson, Drew

2010-07-01

The objective of the study was to describe the work and sleep patterns of doctors working in Australian hospitals. Specifically, the aim was to examine the influence of work-related factors, such as hospital type, seniority, and specialty on work hours and their impact on sleep. A total of 635 work periods from 78 doctors were analyzed together with associated sleep history. Work and sleep diary information was validated against an objective measure of sleep/wake activity to provide the first comprehensive database linking work and sleep for individual hospital doctors in Australia. Doctors in large and small facilities had fewer days without work than those doctors working in medium-sized facilities. There were no significant differences in the total hours worked across these three categories of seniority; however, mid-career and senior doctors worked more overnight and weekend on-call periods than junior doctors. With respect to sleep, although higher work hours were related to less sleep, short sleeps (work) were observed at all levels of prior work history (including no work). In this population of Australian hospital doctors, total hours worked do impact sleep, but the pattern of work, together with other nonwork factors are also important mediators.

7 CFR 46.32 - Duties of growers' agents.

Science.gov (United States)

2010-01-01

... fails to perform any specification or duty, express or implied, is in violation of the Act and may be... or duty, express or implied, arising out of any undertaking in connection with transactions subject... statement describing the terms and conditions under which he will handle the produce of the grower during...

31 CFR 406.4 - Duties of customs officers.

Science.gov (United States)

2010-07-01

... 31 Money and Finance: Treasury 2 2010-07-01 2010-07-01 false Duties of customs officers. 406.4... 1934 AND GOLD REGULATIONS § 406.4 Duties of customs officers. The appropriate officials of the Bureau of Customs are hereby authorized and designated as the officers who shall perform such administrative...

Norwegian NOx emissions excise duty hits shipping and offshore industry

International Nuclear Information System (INIS)

Gulseth, Oeystein Arff; Fjeld-Nielsen, Siri

2007-01-01

The regulatory framework concerning the new excise duty appears as complex and unfinished, raising more questions than providing answers. The duty will entail a significant expense item for the businesses liable to register and it is therefore important to have an overview of how the regulatory framework should be understood. Errors made since 1 January 2007 may lead to future reassessments of duties, with interest (author) (ml)

15 CFR 270.105 - Duties of a Team.

Science.gov (United States)

2010-01-01

... 15 Commerce and Foreign Trade 1 2010-01-01 2010-01-01 false Duties of a Team. 270.105 Section 270... OF STANDARDS AND TECHNOLOGY, DEPARTMENT OF COMMERCE NATIONAL CONSTRUCTION SAFETY TEAMS NATIONAL CONSTRUCTION SAFETY TEAMS Establishment and Deployment of Teams § 270.105 Duties of a Team. (a) A Team's Lead...

45 CFR 1618.5 - Duties of the Corporation.

Science.gov (United States)

2010-10-01

... 45 Public Welfare 4 2010-10-01 2010-10-01 false Duties of the Corporation. 1618.5 Section 1618.5 Public Welfare Regulations Relating to Public Welfare (Continued) LEGAL SERVICES CORPORATION ENFORCEMENT PROCEDURES § 1618.5 Duties of the Corporation. (a) Whenever there is reason to believe that a recipient or an...

Out-of-office hours nurse-driven acute telephone counselling service in a large diabetes outpatient clinic

DEFF Research Database (Denmark)

Due-Christensen, Mette; Kaldan, Gudrun; Almdal, Thomas P

2015-01-01

OBJECTIVE: To map the usage of out-of-office hours acute telephone counselling (ATC) provided by diabetes specialist nurses (n=18) for diabetes patients to explore potentials for improvement. METHODS: A mixed methods study involved mapping of ATC-usage during 6 months and a retrospective audit...... attending the clinic (pcommunity (n=619) and general nurses and nursing assistants based in care homes (n=1018). The majority (75......%) of patients called less than five times. However, 8% called 16 times or more accounting for 52% of all calls. A retrospective audit identified them as physically and/or psychologically fragile patients. CONCLUSION: Hyperglycaemia was the most frequent reason for calling, and insulin dose adjustment the most...

47 CFR 25.273 - Duties regarding space communications transmissions.

Science.gov (United States)

2010-10-01

... 47 Telecommunication 2 2010-10-01 2010-10-01 false Duties regarding space communications transmissions. 25.273 Section 25.273 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES SATELLITE COMMUNICATIONS Technical Operations § 25.273 Duties regarding space...

Working hours and roster structures of surgical trainees in Australia and New Zealand.

Science.gov (United States)

O'Grady, Gregory; Loveday, Benjamin; Harper, Simon; Adams, Brandon; Civil, Ian D; Peters, Matthew

2010-12-01

The working hours of surgical trainees are a subject of international debate. Excessive working hours are fatiguing, and compromise performance, learning and work-life balance. However, reducing hours can impact on continuity of care, training experience and service provision. This study defines the current working hours of Australasian trainees, to inform the working hours debate in our regions. An online survey was conducted of all current Australasian trainees. Questions determined hours spent at work (AW) and off-site on-call (OC) per week, and roster structures were evaluated by training year, specialty and location. The response rate was 55.3%. Trainees averaged 61.4 ± 11.7 h/week AW, with 5% working ≥80 h. OC shifts were worked by 73.5%, for an average of 27.8 ± 14.3 h/week. Trainees of all levels worked similar hours (P= 0.10); however, neurosurgical trainees worked longer hours than most other specialties (P hours (P= 0.01) and rural rotations more OC (P Long days (>12 h) were worked by 86%; median frequency 1:4.4 days; median duration 15 h. OC shifts of 24-h duration were worked by 75%; median frequency 1:4.2 days; median sleep: 5-7 h/shift; median uninterrupted sleep: 3-5 h/shift. This study has quantified the working hours and roster structures of Australasian surgical trainees. By international standards, Australasian trainee working hours are around average. However, some rosters demand long hours and/or induce chronic sleep loss, placing some trainees at risk of fatigue. Ongoing efforts are needed to promote safe rostering practices. © 2010 The Authors. ANZ Journal of Surgery © 2010 Royal Australasian College of Surgeons.

Screw expander for light duty diesel engines

Science.gov (United States)

1983-01-01

Preliminary selection and sizing of a positive displacement screw compressor-expander subsystem for a light-duty adiabatic diesel engine; development of a mathematical model to describe overall efficiencies for the screw compressor and expander; simulation of operation to establish overall efficiency for a range of design parameters and at given engine operating points; simulation to establish potential net power output at light-duty diesel operating points; analytical determination of mass moments of inertia for the rotors and inertia of the compressor-expander subsystem; and preparation of engineering layout drawings of the compressor and expander are discussed. As a result of this work, it was concluded that the screw compressor and expander designed for light-duty diesel engine applications are viable alternatives to turbo-compound systems, with acceptable efficiencies for both units, and only a moderate effect on the transient response.

Firefighter health and fitness assessment: a call to action.

Science.gov (United States)

Storer, Thomas W; Dolezal, Brett A; Abrazado, Marlon L; Smith, Denise L; Batalin, Maxim A; Tseng, Chi-Hong; Cooper, Christopher B

2014-03-01

Sudden cardiac deaths experienced by firefighters in the line of duty account for the largest proportion of deaths annually. Several fire service standards for fitness and wellness have been recommended but currently only 30% of U.S. fire departments are implementing programs for this purpose. The Department of Homeland Security Science and Technology Directorate has initiated the Physiological Health Assessment System for Emergency Responders (PHASER) program aiming to reduce these line-of-duty deaths through an integration of medical science and sensor technologies. Confirming previous reports, PHASER comprehensive risk assessment has identified lack of physical fitness with propensity for overexertion as a major modifiable risk factor. We sought to determine if current levels of fitness and cardiovascular disease (CVD) risk factors in a contemporary cohort of firefighters were better than those reported over the past 30 years. Fifty-one firefighters from a Southern California department were characterized for physical fitness and CVD risk factors using standard measures. Overall, physical fitness and risk factors were not different from previous reports of firefighter fitness and most subjects did not achieve recommended fitness standards. Considering the lack of widespread implementation of wellness/fitness programs in the U.S. fire service together with our findings that low physical fitness and the presence of CVD risk factors persist, we issue a call to action among health and fitness professionals to assist the fire service in implementing programs for firefighters that improve fitness and reduce CVD risk factors. Fitness professionals should be empowered to work with fire departments lending their expertise to guide programs that achieve these objectives, which may then lead to reduced incidence of sudden cardiac death or stroke.

The duty to do the best for one's patient.

Science.gov (United States)

Crisp, Roger

2015-03-01

This paper is a discussion of the duty of doctors to do what is best for their patients. What is required by this duty is shown to depend on the circumstances, including any financial constraints on the doctor. The duty to do the best is a duty of benevolence, and this virtue itself has to be understood as bounded by other virtues, including justice and professional responsibility. An Aristotelian account of medical benevolence is developed, and the issues of supererogation and individual judgement are discussed within this framework. The paper ends with the claim that the patient-centred conception of benevolence defended in the paper is in line with consequentialist and deontological ethical traditions. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Driving behaviors and on-duty road accidents: a French case-control study.

Science.gov (United States)

Fort, Emmanuel; Chiron, Mireille; Davezies, Philippe; Bergeret, Alain; Charbotel, Barbara

2013-01-01

A case-control study was carried out to identify driving behaviors associated with the risk of on-duty road accident and to compare driving behaviors according to the type of journey (on duty, commuting, and private) for on-duty road accident victims. Cases were recruited from the Rhône Road Trauma Registry between January 2004 and October 2005 and were on duty at the time of the accident. Control subjects were recruited from the electoral rolls of the case subjects' constituencies of residence. Cases' and controls' driving behavior data were collected by self-administered questionnaire. A logistic regression was performed to identify behavioral risk factors for on-duty road accidents, taking into account age, sex, place of residence, road accident risk exposure, socio-occupational category, and type of road user. A second analysis focused specifically on the case subjects, comparing their self-assessed usual behaviors according to the type of journey. Significant factors for multivariate analysis of on-duty road accidents were female gender, history of on-duty road accidents during the previous 10 years, severe time pressure at work, and driving a vehicle not belonging to the driver. On-duty road accident victims reported behavioral risk factors more frequently in relation to driving for work than driving for private reasons or commuting: nonsystematic seat belt use, cell phone use at least once daily while driving, and history of accidents with injury during the previous 10 years. This study provides knowledge on behavioral risk factors for on-duty road accidents and differences in behavior according to the type of journey for subjects who have been on-duty road accident victims. These results will be useful for the design of on-duty road risk prevention.

Lessons from Queensland's last-drinks legislation: The use of extended trading permits.

Science.gov (United States)

Zahnow, Renee; Miller, Peter; Coomber, Kerri; de Andrade, Dominique; Ferris, Jason

2018-05-01

The association between alcohol availability, alcohol consumption and, in turn, alcohol-related harms is well established. Policies to reduce alcohol-related harms focus on limiting accessibility through the regulation of the liquor industry, including trading hours. On 1 July 2016, the Queensland Government introduced legislation to reduce ordinary liquor trading hours, replacing 5 am closing times with 3 am cessation of liquor sales in designated entertainment precincts and 2 am cessation of sales across the rest of the state. However, the amendment was under-inclusive and did not apply to temporary extended trading permits, a provision of the Liquor Act 1992 allowing one-off variations in trading hours for special events. We use 24 months of data (1 January 2015 to 31 December 2016) from the Office of Liquor Gaming and Regulation to explore patterns of extended trading permit use across Queensland, pre- and post- 1 July 2016. We find that following the Amendment in 2016 there was also a distinct shift in the utilisation of temporary extended trading permits, with a 63% increase in approved permits between 2015 and 2016. Temporal clustering around key calendar events dissipated following 1 July 2016 with consistent concentration of permit utilisation over consecutive weeks. Using temporary extended trading permits venue owners avoided earlier closing times and continued to operate until 5 am. The findings provide lessons for future policy implementation by illustrating the capacity for under-inclusive legislation to result in the dilution of intended effects. © 2018 Australasian Professional Society on Alcohol and other Drugs.

Clinical negligence and duty of candour.

Science.gov (United States)

Shekar, Vinita; Singh, Mark; Shekar, Kishore; Brennan, Peter

2011-12-01

The Department of Health is considering imposing a legal duty of candour on health care providers to ensure that an apology and explanation are given to patients when errors occur during medical treatment. This aims to improve quality of care and reduce adverse events during medical treatment. We present the current system of clinical negligence and the future of medical ethics. We discuss relevant cases with regard to duty of candour, and highlight the existence of serious imbalances in which patients' rights and corresponding ethical duties of professionals predominate over the responsibilities of patients themselves. It is known that most adverse events arise because of multiple factors for which no individual should be blamed. To improve healthcare services there is a need for a system in which lessons can be learnt from mistakes, and services can be improved in the interest of patient safety, and for transparency in the broad principles on which the decisions are based within which clinical performance is supervised and monitored. Copyright © 2010 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

General regulatory guide for the operator staff on duty, II-1

International Nuclear Information System (INIS)

1989-01-01

This, second chapter of regulations includes the rights and duties of the operator's staff: head of the team, operator on duty, mechanic of the system, electrician, reactor mechanic, operation dosimetryst on duty. Procedures and obligations are described for each individual staff member on duty during preparations for reactor start-up, regular operation at nominal power, approach to preset power level, change of the operating regime without shutdown, approach to a certain power level of the xenon poisoned core, stop reactor operation and bringing the reactor into shutdown state [sr

25 CFR 11.1003 - Law enforcement officer's duties.

Science.gov (United States)

2010-04-01

... 25 Indians 1 2010-04-01 2010-04-01 false Law enforcement officer's duties. 11.1003 Section 11.1003 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR LAW AND ORDER COURTS OF INDIAN OFFENSES AND LAW AND ORDER CODE Juvenile Offender Procedure § 11.1003 Law enforcement officer's duties. A law enforcement officer who takes a minor into...

Lower wages for less hours? A simultaneous wage-hours model for Germany

OpenAIRE

Wolf, Elke

2000-01-01

In this paper the impact of working hours on the gross hourly wage rate of West German women is analyzed. We use a simultaneous wage-hours model which takes into account the participation decision. First, our estimates show that the hourly wage rate is strongly a¤ected by the working hours. In order to avoid any assumptions about the functional form, we estimate linear spline functions. Second, we detect di¤erent wage-hours profiles for specific groups of individuals. Despite these di¤erences...

Provision of out-of-hours interventional radiology services in Scotland

International Nuclear Information System (INIS)

Zealley, I.A.; Gordon, T.J.; Robertson, I.; Moss, J.G.; Gillespie, I.N.

2012-01-01

Aim: To evaluate the availability of out-of-hours (OOH) interventional radiology (IR) services in Scotland and discuss implications for service redesign. Materials and methods: Data were gathered via a survey conducted by telephone/e-mail interview. The setting was hospitals in Scotland with acute medical and/or surgical beds. The interviewees were consultant interventional radiologists representing each of the 14 geographical Health Boards in Scotland. Results: Three of the 14 geographical Health Boards provided a formal, prospectively planned OOH IR service in at least one hospital. Fourteen of the 34 acute hospitals provided an in-hours IR service, which includes endovascular haemorrhage control. Eight of the 34 acute hospitals had formal, prospectively planned on-call IR arrangements, 12 had an ad-hoc service, and 20 transferred patients to other facilities. Thirty-eight of the 223 consultant radiologists in Scotland were able to perform endovascular haemorrhage control procedures: only 18 of these 38 (47%) were included in on-call rotas. A further 42 radiologists were able to perform nephrostomy and a further 61 were able to perform abscess drainage. Eighty-two radiologists did not perform any interventional procedures. Conclusions: The provision of OOH IR services in Scotland is limited and available resources, both skills and equipment, are being underutilized. These data will be used to inform a process of OOH IR service redesign in Scotland.

7 CFR 1230.39 - Powers and duties of the Delegate Body.

Science.gov (United States)

2010-01-01

... 7 Agriculture 10 2010-01-01 2010-01-01 false Powers and duties of the Delegate Body. 1230.39... Order National Pork Producers Delegate Body § 1230.39 Powers and duties of the Delegate Body. The Delegate Body shall have the following powers and duties: (a) To meet annually; (b) To recommend the rate...

The effect of pouring time on the dimensional stability of casts made from conventional and extended-pour irreversible hydrocolloids by 3D modelling

Directory of Open Access Journals (Sweden)

Hasan Ö. Gümüş

2015-09-01

Conclusion: All of the conventional and extended-pour impression materials tested in this study can be poured up to 24 hours with accuracy, if impressions are correctly stored. Extended-pour impression materials (ColorChange, Hydrogum 5, and Hydrocolor 5 can be poured up to 120 hours, if stored correctly.

On-road emissions of light-duty vehicles in europe.

Science.gov (United States)

Weiss, Martin; Bonnel, Pierre; Hummel, Rudolf; Provenza, Alessio; Manfredi, Urbano

2011-10-01

For obtaining type approval in the European Union, light-duty vehicles have to comply with emission limits during standardized laboratory emissions testing. Although emission limits have become more stringent in past decades, light-duty vehicles remain an important source of nitrogen oxides and carbon monoxide emissions in Europe. Furthermore, persisting air quality problems in many urban areas suggest that laboratory emissions testing may not accurately capture the on-road emissions of light-duty vehicles. To address this issue, we conduct the first comprehensive on-road emissions test of light-duty vehicles with state-of-the-art Portable Emission Measurement Systems. We find that nitrogen oxides emissions of gasoline vehicles as well as carbon monoxide and total hydrocarbon emissions of both diesel and gasoline vehicles generally remain below the respective emission limits. By contrast, nitrogen oxides emissions of diesel vehicles (0.93 ± 0.39 grams per kilometer [g/km]), including modern Euro 5 diesel vehicles (0.62 ± 0.19 g/km), exceed emission limits by 320 ± 90%. On-road carbon dioxide emissions surpass laboratory emission levels by 21 ± 9%, suggesting that the current laboratory emissions testing fails to accurately capture the on-road emissions of light-duty vehicles. Our findings provide the empirical foundation for the European Commission to establish a complementary emissions test procedure for light-duty vehicles. This procedure could be implemented together with more stringent Euro 6 emission limits in 2014. The envisaged measures should improve urban air quality and provide incentive for innovation in the automotive industry.

Performance concerns for high duty fuel cycle

International Nuclear Information System (INIS)

Esposito, V.J.; Gutierrez, J.E.

1999-01-01

One of the goals of the nuclear industry is to achieve economic performance such that nuclear power plants are competitive in a de-regulated market. The manner in which nuclear fuel is designed and operated lies at the heart of economic viability. In this sense reliability, operating flexibility and low costs are the three major requirements of the NPP today. The translation of these three requirements to the design is part of our work. The challenge today is to produce a fuel design which will operate with long operating cycles, high discharge burnup, power up-rating and while still maintaining all design and safety margins. European Fuel Group (EFG) understands that to achieve the required performance high duty/energy fuel designs are needed. The concerns for high duty design includes, among other items, core design methods, advanced Safety Analysis methodologies, performance models, advanced material and operational strategies. The operational aspects require the trade-off and evaluation of various parameters including coolant chemistry control, material corrosion, boiling duty, boron level impacts, etc. In this environment MAEF is the design that EFG is now offering based on ZIRLO alloy and a robust skeleton. This new design is able to achieve 70 GWd/tU and Lead Test Programs are being executed to demonstrate this capability. A number of performance issues which have been a concern with current designs have been resolved such as cladding corrosion and incomplete RCCA insertion (IRI). As the core duty becomes more aggressive other new issues need to be addressed such as Axial Offset Anomaly. These new issues are being addressed by combination of the new design in concert with advanced methodologies to meet the demanding needs of NPP. The ability and strategy to meet high duty core requirements, flexibility of operation and maintain acceptable balance of all technical issues is the discussion in this paper. (authors)

Aberration retrieval for high-NA optical systems using the Extended Nijboer-Zernike theory

NARCIS (Netherlands)

Dirksen, P.; Braat, J.J.M.; Janssen, A.J.E.M.; Leeuwestein, A.

2005-01-01

Previously, we have given a detailed description of the so-called Extended Nijboer-Zernike approach and its application to aberration measurements of the optical projection system in a wafer scanner in the case of a low or medium high-NA system. The Extended Nijboer-Zernike theory provides an

76 FR 54537 - Swap Data Repositories: Registration Standards, Duties and Core Principles

Science.gov (United States)

2011-09-01

... Part 49 Swap Data Repositories: Registration Standards, Duties and Core Principles; Final Rule #0;#0...: Registration Standards, Duties and Core Principles AGENCY: Commodity Futures Trading Commission. ACTION: Final... registration requirements, statutory duties, core principles and certain compliance obligations for registered...

28 CFR 549.13 - Programming, duty, and housing restrictions.

Science.gov (United States)

2010-07-01

... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Programming, duty, and housing... INSTITUTIONAL MANAGEMENT MEDICAL SERVICES Infectious Disease Management § 549.13 Programming, duty, and housing restrictions. (a) The CD will assess any inmate with an infectious disease for appropriateness for programming...

The internal-Rawlsian unsustainability of Rawls's duty of assistance

NARCIS (Netherlands)

Kamminga, Menno R.

2018-01-01

Philosophers interested in John Rawls’s international political theorizing have paid considerable attention to the duty of assistance as a key notion of his Law of Peoples. However, in focusing on contentious-theoretical and practical implications of this duty, they have not thoroughly examined the

Appraisal of circulation routine duties in academic libraries | Hassan ...

African Journals Online (AJOL)

... of brown charging system, book reservation, keeping of reserved collection, circulation of reserved books, treatment of overdue, lost of books on loan and library statistics among other as duties perform in circulation department of libraries. Keywords: Library Service, Circulation Duties, Challenges, Academic Libraries ...

25 CFR 11.1103 - Law enforcement officer's duties.

Science.gov (United States)

2010-04-01

... 25 Indians 1 2010-04-01 2010-04-01 false Law enforcement officer's duties. 11.1103 Section 11.1103 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR LAW AND ORDER COURTS OF INDIAN OFFENSES AND LAW AND ORDER CODE Minor-in-Need-of-Care Procedure § 11.1103 Law enforcement officer's duties. Upon taking a minor into custody the officer...

Medium and Heavy Duty Vehicle Field Evaluations (Presentation)

Energy Technology Data Exchange (ETDEWEB)

Walkowicz, K.

2014-06-01

This presentation discusses field evaluations of medium- and heavy-duty vehicles performed by NREL. The project provides medium-duty (MD) and heavy-duty (HD) test results, aggregated data, and detailed analysis, including 3rd party unbiased data (data that would not normally be shared by industry in an aggregated and detailed manner). Over 5.6 million miles of advanced technology MD and HD truck data have been collected, documented, and analyzed on over 240 different vehicles since 2002. Data, analysis, and reports are shared within DOE, national laboratory partners, and industry for R&D planning and strategy. The results help guide R&D for new technology development, help define intelligent usage of newly developed technology, and help fleets/users understand all aspects of advanced technology.

The impact of long work hours and shift work on cognitive errors in nurses.

Science.gov (United States)

Rhéaume, Ann; Mullen, Jane

2018-01-01

Pilot study to examine the impact of long work hours and shift work on cognitive errors in nurses. Twelve-hour shifts are more commonly used in hospital settings and there is growing concern over the impact that extended and irregular work hours have on nurses' well-being and performance. Twenty-eight nurses working different shifts (8-hr days and 12-hr rotation) participated in this study. Nurses were assessed at the beginning of four consecutive shifts using actigraphy, a sleep diary and an after work questionnaire. Nurses working 12-hr rotations had less total sleep time and less sleep efficiency than 8-hr day nurses. Twelve-hour rotation nurses also napped more than their counterparts. There were no differences between the two groups with respect to cognitive errors. Twelve-hour rotations have a negative effect on nurses' sleep patterns. There is no evidence indicating 12-hr rotations increased errors. Nurse managers can implement specific strategies, such as greater shift work flexibility and designated quiet time, to reduce the effects of disturbed sleep patterns in nurses. © 2017 John Wiley & Sons Ltd.

Effects of extended work shifts and shift work on patient safety, productivity, and employee health.

Science.gov (United States)

Keller, Simone M

2009-12-01

It is estimated 1.3 million health care errors occur each year and of those errors 48,000 to 98,000 result in the deaths of patients (Barger et al., 2006). Errors occur for a variety of reasons, including the effects of extended work hours and shift work. The need for around-the-clock staff coverage has resulted in creative ways to maintain quality patient care, keep health care errors or adverse events to a minimum, and still meet the needs of the organization. One way organizations have attempted to alleviate staff shortages is to create extended work shifts. Instead of the standard 8-hour shift, workers are now working 10, 12, 16, or more hours to provide continuous patient care. Although literature does support these staffing patterns, it cannot be denied that shifts beyond the traditional 8 hours increase staff fatigue, health care errors, and adverse events and outcomes and decrease alertness and productivity. This article includes a review of current literature on shift work, the definition of shift work, error rates and adverse outcomes related to shift work, health effects on shift workers, shift work effects on older workers, recommended optimal shift length, positive and negative effects of shift work on the shift worker, hazards associated with driving after extended shifts, and implications for occupational health nurses. Copyright 2009, SLACK Incorporated.

75 FR 42380 - Revocation of Antidumping Duty Order on Sorbitol From France

Science.gov (United States)

2010-07-21

... Duty Order on Sorbitol From France AGENCY: Import Administration, International Trade Administration... sunset review of the antidumping duty order on sorbitol from France. See Initiation of Five-year... the existing antidumping duty order on sorbitol from France would not be likely to lead to...

The effect of limiting residents' work hours on their surgical training: a Canadian perspective.

Science.gov (United States)

Romanchuk, Ken

2004-05-01

Restrictions in residents' work hours have been in place in Canada for roughly a decade, having been negotiated rather than imposed. The changes in residents' schedules that resulted are roughly equivalent to the limitation of 80 duty hours per week in the United States. When work-hours restrictions began, surgery faculty were worried that residents' experience would be compromised. But these fears have not materialized. Why? The author maintains there are many reasons. (1) Most surgical procedures are now faster, and lengthy inpatient care has diminished, all of which saves time. (2) Formerly difficult or risky procedures are now performed more frequently and safely, which increases residents' education about difficult conditions. (3) A variety of resources (e.g., skills-transfer courses, surgical simulators, etc.) are now available for residents to learn and evolve surgical techniques, and residents take advantage of these resources, being highly motivated to learn the best in the time available to them. (4) There have been positive changes in residents' education that have helped them become more efficient learners than before, with improved resources and skills for faster access to information. The author maintains that in his present surgery residency program, the residents still work extremely hard but are more protected from the unending demands for patient care. They have more time for orderly study and greater opportunities to develop skills other than technical ones. They are in a happier work setting, which the author strongly believes facilitates improved patient care.

IMPACT OF CPO EXPORT DUTIES ON MALAYSIAN PALM OIL INDUSTRY

OpenAIRE

Ibragimov Abdulla; Fatimah Mohamed Arshad; B. K. Bala; Kusairi Mohd Noh; Muhammad Tasrif

2014-01-01

In January 2013, Malaysia reduced the export duty structure to be in line with the Indonesia’s duty structure. Both countries export crude and processed palm oil. Since Malaysia and Indonesia are close competitors and they compete in the same market, a change in export duty rate in one country will affect the other. Indonesia, as the world’s biggest palm oil producer, has drastically widened the values between the crude palm oil and refined palm oil export taxes since October 2011...

The legal nature of the duty of care and skill: Contract or delict ...

African Journals Online (AJOL)

This article evaluates the legal nature of the duty of care and skill of directors. In terms of the Companies Act 71 of 2008 this duty is essentially delictual in nature. This article evaluates whether the duty is in fact delictual in nature. Case law, which considered the duty of care and skill and where it had been sought to establish ...

Improving access to antiretrovirals in rural South Africa – a call to ...

African Journals Online (AJOL)

Improving access to antiretrovirals in rural South Africa – a call to action. South Africa (SA) already has the world's biggest antiretroviral (ARV) programme. With the introduction of extended criteria for initiating ARVs, the National Department of Health (NDoH) wishes to increase the number of people on ARVs by around.

EPA Nonregulatory Nonroad Duty Cycles

Science.gov (United States)

EPA nonregulatory, nonroad duty cycles for equipment such as agricultural tractors, backhoe loaders,crawlers tractors, excavators, arc welding skid steer loaders, and wheel loaders. Also,test procedures, laboratory methods, and emissions for this equipmen

The ethanol heavy-duty truck fleet demonstration project

Energy Technology Data Exchange (ETDEWEB)

NONE

1997-06-01

This project was designed to test and demonstrate the use of a high- percentage ethanol-blended fuel in a fleet of heavy-duty, over-the- road trucks, paying particular attention to emissions, performance, and repair and maintenance costs. This project also represents the first public demonstration of the use of ethanol fuels as a viable alternative to conventional diesel fuel in heavy-duty engines.

Patient safety, resident well-being and continuity of care with different resident duty schedules in the intensive care unit: a randomized trial.

Science.gov (United States)

Parshuram, Christopher S; Amaral, Andre C K B; Ferguson, Niall D; Baker, G Ross; Etchells, Edward E; Flintoft, Virginia; Granton, John; Lingard, Lorelei; Kirpalani, Haresh; Mehta, Sangeeta; Moldofsky, Harvey; Scales, Damon C; Stewart, Thomas E; Willan, Andrew R; Friedrich, Jan O

2015-03-17

Shorter resident duty periods are increasingly mandated to improve patient safety and physician well-being. However, increases in continuity-related errors may counteract the purported benefits of reducing fatigue. We evaluated the effects of 3 resident schedules in the intensive care unit (ICU) on patient safety, resident well-being and continuity of care. Residents in 2 university-affiliated ICUs were randomly assigned (in 2-month rotation-blocks from January to June 2009) to in-house overnight schedules of 24, 16 or 12 hours. The primary patient outcome was adverse events. The primary resident outcome was sleepiness, measured by the 7-point Stanford Sleepiness Scale. Secondary outcomes were patient deaths, preventable adverse events, and residents' physical symptoms and burnout. Continuity of care and perceptions of ICU staff were also assessed. We evaluated 47 (96%) of 49 residents, all 971 admissions, 5894 patient-days and 452 staff surveys. We found no effect of schedule (24-, 16- or 12-h shifts) on adverse events (81.3, 76.3 and 78.2 events per 1000 patient-days, respectively; p = 0.7) or on residents' sleepiness in the daytime (mean rating 2.33, 2.61 and 2.30, respectively; p = 0.3) or at night (mean rating 3.06, 2.73 and 2.42, respectively; p = 0.2). Seven of 8 preventable adverse events occurred with the 12-hour schedule (p = 0.1). Mortality rates were similar for the 3 schedules. Residents' somatic symptoms were more severe and more frequent with the 24-hour schedule (p = 0.04); however, burnout was similar across the groups. ICU staff rated residents' knowledge and decision-making worst with the 16-hour schedule. Our findings do not support the purported advantages of shorter duty schedules. They also highlight the trade-offs between residents' symptoms and multiple secondary measures of patient safety. Further delineation of this emerging signal is required before widespread system change. ClinicalTrials.gov, no. NCT00679809. © 2015 Canadian Medical

Evaluation of patient preferences towards treatment during extended hours for patients receiving radiation therapy for the treatment of cancer: A time trade-off study

International Nuclear Information System (INIS)

Brown, Alison M.; Atyeo, John; Field, Nikki; Cox, Jennifer; Bull, Colin; Gebski, Val J.

2009-01-01

Background: To reduce the waiting time between diagnosis and the start of radiation therapy, some departments have introduced appointments outside of conventional working hours, but the inconvenience this may cause to patients is unknown. We examined, from the patient's perspective, whether reduced waiting times to treatment would be sufficient to trade off against potentially inconvenient appointment times. Method: We interviewed patients receiving radiation therapy at a major teaching hospital between January and May 2005. Two patient groups were considered: those treated during conventional working hours (8.30 am to 4.30 pm), and those treated outside these hours. Patients were asked to trade a reduction in waiting time to the start of treatment against treatment outside conventional working hours. Results: Of 129 patients interviewed, 77 were treated during conventional working hours and 52 outside these hours. Fifty-seven (44%) were male and 52 (40%) were aged over 60 years. To prefer treatment out of working hours, patients being treated during conventional working hours required a larger reduction in waiting time (odds ratio 2.36, 95% CI 0.97-5.76). Patients with curable disease and those who had made few changes in their lifestyle throughout the treatment were more likely to accept treatment outside of conventional working hours. Conclusion: It is impractical to satisfy the treatment-time preferences of all patients. However, many patients prefer treatment outside of normal treatment times if this would reduce the time until the start of radiation therapy. Evaluating the effect of waiting times on patients' perceptions of their disease control provides important information in allocating treatment hours and appointment times

The fiduciary duties of healthcare directors in the "zone of insolvency".

Science.gov (United States)

Peregrine, Michael W; Schwartz, James R; Burgdorfer, James E; Gordon, David C

2002-01-01

Directors of healthcare organizations normally owe fiduciary duties to their shareholders or, in the case of nonprofits, to the charitable mission of the organization. As an organization descends to bankruptcy, however, the board's duties may shift. At some point, the board may be imposed with different and often conflicting obligations to the corporate enterprise as a whole, with a primary criterion being the interests of creditors. In this article, the authors analyze the murky areas of the Zone and give guidance as to when the board's duty may shift-and as to how directors should proceed both in determining their duties and in working to fulfill them.

Strips of hourly power options. Approximate hedging using average-based forward contracts

International Nuclear Information System (INIS)

Lindell, Andreas; Raab, Mikael

2009-01-01

We study approximate hedging strategies for a contingent claim consisting of a strip of independent hourly power options. The payoff of the contingent claim is a sum of the contributing hourly payoffs. As there is no forward market for specific hours, the fundamental problem is to find a reasonable hedge using exchange-traded forward contracts, e.g. average-based monthly contracts. The main result is a simple dynamic hedging strategy that reduces a significant part of the variance. The idea is to decompose the contingent claim into mathematically tractable components and to use empirical estimations to derive hedging deltas. Two benefits of the method are that the technique easily extends to more complex power derivatives and that only a few parameters need to be estimated. The hedging strategy based on the decomposition technique is compared with dynamic delta hedging strategies based on local minimum variance hedging, using a correlated traded asset. (author)

Formulation and Evaluation of Extended- Release Tablet of Zolpidem Tartrate by Wet Granulation Technique

OpenAIRE

Fatemeh Pourhashem; Mohammad Reza Avadi

2016-01-01

The goal of this study was to design and evaluate extended - release system of the hypnotic agent, Zolpidem tartrate usefulness for the treatment of insomnia. The half-life of this drug is about 1.9 - 3 hours that indicating it a candidate for the extended release formulation. Our investigation relates to development of extended drug delivery system based on Hydroxy propyl methyl cellulose (HPMCK4M) as release retardant, polyvinyl pyrrolidone (PVP k30) as binder and Magnesium S...

Hourly differences in air pollution and risk of respiratory disease in the elderly: a time-stratified case-crossover study.

Science.gov (United States)

Yorifuji, Takashi; Suzuki, Etsuji; Kashima, Saori

2014-08-13

Epidemiological studies have shown adverse effects of short-term exposure to air pollution on respiratory disease outcomes; however, few studies examined this association on an hourly time scale. We evaluated the associations between hourly changes in air pollution and the risk of respiratory disease in the elderly, using the time of the emergency call as the disease onset for each case. We used a time-stratified case-crossover design. Study participants were 6,925 residents of the city of Okayama, Japan, aged 65 or above who were taken to hospital emergency rooms between January 2006 and December 2010 for onset of respiratory disease. We calculated city-representative hourly average concentrations of air pollutants from several monitoring stations. By using conditional logistic regression models, we estimated odds ratios per interquartile-range increase in each pollutant by exposure period prior to emergency call, adjusting for hourly ambient temperature, hourly relative humidity, and weekly numbers of reported influenza cases aged ≥60. Suspended particulate matter (SPM) exposure 24 to respiratory disease. For example, following one interquartile-range increase, odds ratios were 1.05 (95% confidence interval: 1.01, 1.09) for SPM exposure 24 to respiratory disease of SPM or ozone. Overall, the effect estimates for chronic obstructive pulmonary disease and allied conditions were equivocal. This study provides further evidence that hourly changes in air pollution exposure increase the risks of respiratory disease, and that SO2 may be related with more immediate onset of the disease than other pollutants.

What effects have resident work-hour changes had on education, quality of life, and safety? A systematic review.

Science.gov (United States)

Harris, Joshua D; Staheli, Greg; LeClere, Lance; Andersone, Diana; McCormick, Frank

2015-05-01

More than 15 years ago, the Institute of Medicine (IOM) identified medical error as a problem worthy of greater attention; in the wake of the IOM report, numerous changes were made to regulations to limit residents' duty hours. However, the effect of resident work-hour changes remains controversial within the field of orthopaedics. We performed a systematic review to determine whether work-hour restrictions have measurably influenced quality-of-life measures, operative and technical skill development, resident surgical education, patient care outcomes (including mortality, morbidity, adverse events, sentinel events, complications), and surgeon and resident attitudes (such as perceived effect on learning and training experiences, personal benefit, direct clinical experience, clinical preparedness). We performed a systematic review of PubMed, Scopus, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and Google Scholar using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Inclusion criteria were any English language peer-reviewed articles that analyzed the effect(s) of orthopaedic surgery resident work-hour restrictions on patient safety, resident education, resident/surgeon quality of life, resident technical operative skill development, and resident surgeon attitudes toward work-hour restrictions. Eleven studies met study inclusion criteria. One study was a prospective analysis, whereas 10 studies were of level IV evidence (review of surgical case logs) or survey results. Within our identified studies, there was some support for improved resident quality of life, improved resident sleep and less fatigue, a perceived negative impact on surgical operative and technical skill, and conflicting evidence on the topic of resident education, patient outcomes, and variable attitudes toward the work-hour changes. There is a paucity of high-level or clear evidence evaluating the effect of the changes to resident work

High call volume at poison control centers: identification and implications for communication.

Science.gov (United States)

Caravati, E M; Latimer, S; Reblin, M; Bennett, H K W; Cummins, M R; Crouch, B I; Ellington, L

2012-09-01

High volume surges in health care are uncommon and unpredictable events. Their impact on health system performance and capacity is difficult to study. To identify time periods that exhibited very busy conditions at a poison control center and to determine whether cases and communication during high volume call periods are different from cases during low volume periods. Call data from a US poison control center over twelve consecutive months was collected via a call logger and an electronic case database (Toxicall®).Variables evaluated for high call volume conditions were: (1) call duration; (2) number of cases; and (3) number of calls per staff member per 30 minute period. Statistical analyses identified peak periods as busier than 99% of all other 30 minute time periods and low volume periods as slower than 70% of all other 30 minute periods. Case and communication characteristics of high volume and low volume calls were compared using logistic regression. A total of 65,364 incoming calls occurred over 12 months. One hundred high call volume and 4885 low call volume 30 minute periods were identified. High volume periods were more common between 1500 and 2300 hours and during the winter months. Coded verbal communication data were evaluated for 42 high volume and 296 low volume calls. The mean (standard deviation) call length of these calls during high volume and low volume periods was 3 minutes 27 seconds (1 minute 46 seconds) and 3 minutes 57 seconds (2 minutes 11 seconds), respectively. Regression analyses revealed a trend for fewer overall verbal statements and fewer staff questions during peak periods, but no other significant differences for staff-caller communication behaviors were found. Peak activity for poison center call volume can be identified by statistical modeling. Calls during high volume periods were similar to low volume calls. Communication was more concise yet staff was able to maintain a good rapport with callers during busy call periods

32 CFR 199.16 - Supplemental Health Care Program for active duty members.

Science.gov (United States)

2010-07-01

... 32 National Defense 2 2010-07-01 2010-07-01 false Supplemental Health Care Program for active duty... (CHAMPUS) § 199.16 Supplemental Health Care Program for active duty members. (a) Purpose and applicability... the supplemental health care program for active duty members of the uniformed services, the provision...

49 CFR 371.10 - Duties and obligations of brokers.

Science.gov (United States)

2010-10-01

... 49 Transportation 5 2010-10-01 2010-10-01 false Duties and obligations of brokers. 371.10 Section... SAFETY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION FEDERAL MOTOR CARRIER SAFETY REGULATIONS BROKERS OF PROPERTY § 371.10 Duties and obligations of brokers. Where the broker acts on behalf of a person bound by...

76 FR 44574 - Antidumping Duty Investigation and Countervailing Duty Investigation of Hard Red Spring Wheat...

Science.gov (United States)

2011-07-26

... Investigation and Countervailing Duty Investigation of Hard Red Spring Wheat From Canada: Notice of Court... of Appeals for the Federal Circuit (``CAFC''), in Canadian Wheat Board v. United States, 2010-1083 (Fed. [[Page 44575

Typology of after-hours care instructions for patients

Science.gov (United States)

Bordman, Risa; Bovett, Monica; Drummond, Neil; Crighton, Eric J.; Wheler, David; Moineddin, Rahim; White, David

2007-01-01

OBJECTIVE To develop a typology of after-hours care (AHC) instructions and to examine physician and practice characteristics associated with each type of instruction. DESIGN Cross-sectional telephone survey. Physicians’ offices were called during evenings and weekends to listen to their messages regarding AHC. All messages were categorized. Thematic analysis of a subset of messages was conducted to develop a typology of AHC instructions. Logistic regression analysis was used to identify associations between physician and practice characteristics and the instructions left for patients. SETTING Family practices in the greater Toronto area. PARTICIPANTS Stratified random sample of family physicians providing office-based primary care. MAIN OUTCOME MEASURES Form of response (eg, answering machine), content of message, and physician and practice characteristics. RESULTS Of 514 after-hours messages from family physicians’ offices, 421 were obtained from answering machines, 58 were obtained from answering services, 23 had no answer, 2 gave pager numbers, and 10 had other responses. Message content ranged from no AHC instructions to detailed advice; 54% of messages provided a single instruction, and the rest provided a combination of instructions. Content analysis identified 815 discrete instructions or types of response that were classified into 7 categories: 302 instructed patients to go to an emergency department; 122 provided direct contact with a physician; 115 told patients to go to a clinic; 94 left no directions; 76 suggested calling a housecall service; 45 suggested calling Telehealth; and 61 suggested other things. About 22% of messages only advised attending an emergency department, and 18% gave no advice at all. Physicians who were female, had Canadian certification in family medicine, held hospital privileges, or had attended a Canadian medical school were more likely to be directly available to their patients. CONCLUSION Important issues identified

Fretting fatigue cracking of a center guide bolt supporting the combustion chamber in a heavy-duty gas turbine engine

Energy Technology Data Exchange (ETDEWEB)

Neidel, Andreas; Fischer, Boromir; Gaedicke, Tobias [Siemens AG, Energy Sector, Gasturbinenwerk Berlin (Germany). Werkstoffprueflabor

2018-04-01

The slotted center guide bolt of the center guide feature of the lower part of the outer shell of an annular combustion chamber was found fractured in a heavy-duty gas turbine engine used for power generation, after approximately 5.500 operating hours. The incident was a one-off event and not a recurring incident. No similar events were reported from the fleet; hence the failure was not considered a field issue. The metallurgical root cause investigation that was ordered to determine the failure mechanism revealed that the incident center guide bolt failed by fretting fatigue cracking, a high cycle fatigue (HCF) phenomenon.

Does Extended Telephone Callback Counselling Prevent Smoking Relapse?

Science.gov (United States)

Segan, C. J.; Borland, R.

2011-01-01

This randomized controlled trial tested whether extended callback counselling that proactively engaged ex-smokers with the task of embracing a smoke-free lifestyle (four to six calls delivered 1-3 months after quitting, i.e. when craving levels and perceived need for help had declined) could reduce relapse compared with a revised version of…

Deep venous thrombophlebitis: detection with 4-hour versus 24-hour platelet scintigraphy

International Nuclear Information System (INIS)

Seabold, J.E.; Conrad, G.R.; Ponto, J.A.; Kimball, D.A.; Frey, E.E.; Ahmed, F.; Coughlan, J.D.; Jensen, K.C.

1987-01-01

Thirty-one nonheparinized patients with suspected deep venous thrombophlebitis (DVT) underwent contrast venography and indium-111 platelet scintigraphy (In-111 PS). Venography permitted identification of acute DVT in 12 of 31 cases (39%). One additional patient was considered to have acute DVT despite nonconclusive venography results. In-111 PS results were positive at 4 hours in nine of 13 cases (69%) and at 24 hours in 12 of 13 cases (92%). Two of four patients with false-negative 4-hour In-111 PS studies had received warfarin. Thus, the sensitivity of 4-hour In-111 PS in patients not receiving anticoagulants was 82%. Venography results were negative for acute DVT in 18 cases, and 4-hour In-111 PS studies were negative or equivocal in each. In-111 PS is an alternative to contrast venography for detecting acute DVT. If 4-hour In-111 PS results are positive, anticoagulation can be initiated. Delayed images are necessary if the 4-hour images are negative or equivocal

An Alternative Approach to the Extended Drude Model

Science.gov (United States)

Gantzler, N. J.; Dordevic, S. V.

2018-05-01

The original Drude model, proposed over a hundred years ago, is still used today for the analysis of optical properties of solids. Within this model, both the plasma frequency and quasiparticle scattering rate are constant, which makes the model rather inflexible. In order to circumvent this problem, the so-called extended Drude model was proposed, which allowed for the frequency dependence of both the quasiparticle scattering rate and the effective mass. In this work we will explore an alternative approach to the extended Drude model. Here, one also assumes that the quasiparticle scattering rate is frequency dependent; however, instead of the effective mass, the plasma frequency becomes frequency-dependent. This alternative model is applied to the high Tc superconductor Bi2Sr2CaCu2O8+δ (Bi2212) with Tc = 92 K, and the results are compared and contrasted with the ones obtained from the conventional extended Drude model. The results point to several advantages of this alternative approach to the extended Drude model.

1 ITALIAN COLONISATION & LIBYAN RESISTANCE THE AL ...

African Journals Online (AJOL)

Ike Odimegwu

centre and Kufra the capital of the Sanusi, under his leadership the call extended to ... organisation from Libya to the rocky oasis of Gouro near the eastern edge of .... for legitimate sweeping social change (Parthajee 1, 7). Nationalism has ..... duty and shared in the sacrifices, in men or money - due to the wars with France ...

40 CFR 1048.510 - What transient duty cycles apply for laboratory testing?

Science.gov (United States)

2010-07-01

... 40 Protection of Environment 32 2010-07-01 2010-07-01 false What transient duty cycles apply for... Procedures § 1048.510 What transient duty cycles apply for laboratory testing? (a) Starting with the 2007 model year, measure emissions by testing the engine on a dynamometer with the duty cycle described in...

Circadian polymorphisms in night owls, in bipolars, and in non-24-hour sleep cycles.

Science.gov (United States)

Kripke, Daniel F; Klimecki, Walter T; Nievergelt, Caroline M; Rex, Katharine M; Murray, Sarah S; Shekhtman, Tatyana; Tranah, Gregory J; Loving, Richard T; Lee, Heon-Jeong; Rhee, Min Kyu; Shadan, Farhad F; Poceta, J Steven; Jamil, Shazia M; Kline, Lawrence E; Kelsoe, John R

2014-10-01

People called night owls habitually have late bedtimes and late times of arising, sometimes suffering a heritable circadian disturbance called delayed sleep phase syndrome (DSPS). Those with DSPS, those with more severe progressively-late non-24-hour sleep-wake cycles, and those with bipolar disorder may share genetic tendencies for slowed or delayed circadian cycles. We searched for polymorphisms associated with DSPS in a case-control study of DSPS research participants and a separate study of Sleep Center patients undergoing polysomnography. In 45 participants, we resequenced portions of 15 circadian genes to identify unknown polymorphisms that might be associated with DSPS, non-24-hour rhythms, or bipolar comorbidities. We then genotyped single nucleotide polymorphisms (SNPs) in both larger samples, using Illumina Golden Gate assays. Associations of SNPs with the DSPS phenotype and with the morningness-eveningness parametric phenotype were computed for both samples, then combined for meta-analyses. Delayed sleep and "eveningness" were inversely associated with loci in circadian genes NFIL3 (rs2482705) and RORC (rs3828057). A group of haplotypes overlapping BHLHE40 was associated with non-24-hour sleep-wake cycles, and less robustly, with delayed sleep and bipolar disorder (e.g., rs34883305, rs34870629, rs74439275, and rs3750275 were associated with n=37, p=4.58E-09, Bonferroni p=2.95E-06). Bright light and melatonin can palliate circadian disorders, and genetics may clarify the underlying circadian photoperiodic mechanisms. After further replication and identification of the causal polymorphisms, these findings may point to future treatments for DSPS, non-24-hour rhythms, and possibly bipolar disorder or depression.

25 CFR 11.706 - Appointment and duties of appraiser.

Science.gov (United States)

2010-04-01

... 25 Indians 1 2010-04-01 2010-04-01 false Appointment and duties of appraiser. 11.706 Section 11... OFFENSES AND LAW AND ORDER CODE Probate Proceedings § 11.706 Appointment and duties of appraiser. (a) Upon ordering an estate to be probated, the court shall appoint a disinterested and competent person as an...

31 CFR 401.4 - Duties of Bureau of Customs.

Science.gov (United States)

2010-07-01

... 31 Money and Finance: Treasury 2 2010-07-01 2010-07-01 false Duties of Bureau of Customs. 401.4... TRANSPORT COUNTERFEIT COINS, OBLIGATIONS, SECURITIES, AND PARAPHERNALIA § 401.4 Duties of Bureau of Customs... director of customs pursuant to the said act of August 9, 1939, and the regulations in this part, the...

Fitness for duty in the nuclear power industry: A review of technical issues

International Nuclear Information System (INIS)

Barnes, V.; Fleming, I.; Grant, T.

1988-09-01

This report presents information gathered and analyzed in support of the United States Nuclear Regulatory Commission's (NRC's) efforts to develop a rule that will ensure that workers with unescorted access to protected areas in nuclear power plants are fit for duty. The primary potential fitness-for-duty concern addressed in the report is impairment caused by substance abuse, although other sources of impairment on the job are discussed. The report examines the prevalence of fitness-for-duty problems and discusses the use and effects of illicit drugs, prescription drugs, over-the-counter preparations and alcohol. The ways in which fitness-for-duty concerns are being addressed in both public- and private-sector industries are reviewed, and a description is provided of fitness-for-duty practices in six organizations that, like the nuclear industry, are regulated and whose operations can affect public health and safety. Methods of ensuring fitness for duty in the nuclear industry are examined in detail. The report also addresses methods of evaluating the effectiveness of fitness-for-duty programs in the nuclear power industry

49 CFR 99.735-81 - Post-employment duties and responsibilities.

Science.gov (United States)

2010-10-01

... benefit an employee's prospective private employer. All Government employees and special Government... RESPONSIBILITIES AND CONDUCT Responsibilities of the Government Employee and Special Government Employee Following Departure From Government Service § 99.735-81 Post-employment duties and responsibilities. The duties and...

Duty to disclose in medical genetics: a legal perspective.

Science.gov (United States)

Pelias, M Z

1991-06-01

As technical knowledge and public information in medical genetics continue to expand, the geneticist may expect to be held responsible for informing patients and clients about new developments in research and diagnosis. The long legal evolution of the physician's duty to disclose, and more recent findings of a physician's duty to recall former patients to inform them about newly discovered risks of treatment, indicate that medical geneticists may have a duty to disclose both current and future information about conditions that are or could be inherited. Recent case law supports findings of professional liability for both present and future disclosure, even in the absence of an active physician-patient relationship. The requirement of candid and complete disclosure will affect the counseling approach in testing for deleterious genes and in providing medical treatment for minors with hereditary diseases. Finding a duty to recall may impose further professional burdens on the geneticist to reach beyond the immediate counseling arena and to recontact patients, perhaps years after their initial visit to genetics clinic.

40 CFR Appendix II to Part 1054 - Duty Cycles for Laboratory Testing

Science.gov (United States)

2010-07-01

... 40 Protection of Environment 32 2010-07-01 2010-07-01 false Duty Cycles for Laboratory Testing II.... 1054, App. II Appendix II to Part 1054—Duty Cycles for Laboratory Testing (a) Test handheld engines with the following steady-state duty cycle: G3 mode No. Engine speed a Torque(percent) b Weighting...

The Way to Wealth and the Way to Leisure: The Impact of College Education on Graduates' Earnings and Hours of Work

Science.gov (United States)

Zhang, Liang

2008-01-01

This study extends the analysis of the economic return of college education up to 10 years after college education and further examines the impact of college education on graduates' hours of work. The results suggest that variation in hours of work explains a portion of earnings differentials among college graduates. Graduates from high-quality…

Extended piano techniques : in theory, history and performance practice

NARCIS (Netherlands)

Vaes, Luc Paul Frank

2009-01-01

So-called "extended techniques" have suffered a consistent lack of understanding from a theoretical, historical and practical point of view. Although most of them – e.g. playing directly on the strings, cluster- and glissando-techniques – exist in a substantial part of the repertoire for the piano