WorldWideScience

Sample records for resid reactivity based

  1. Resident fatigue in otolaryngology residents: a Web based survey.

    Science.gov (United States)

    Nida, Andrew M; Googe, Benjamin J; Lewis, Andrea F; May, Warren L

    2016-01-01

    Resident fatigue has become a point of emphasis in medical education and its effects on otolaryngology residents and their patients require further study. The purpose of our study was to evaluate the prevalence and nature of fatigue in otolaryngology residents, evaluate various quality of life measures, and investigate associations of increased fatigue with resident safety. Anonymous survey. Internet based. United States allopathic otolaryngology residents. None. The survey topics included demographics, residency structure, sleep habits and perceived stress. Responses were correlated with a concurrent Epworth Sleep Scale questionnaire to evaluate effects of fatigue on resident training and quality of life. 190 residents responded to the survey with 178 completing the Epworth Sleep Scale questionnaire. Results revealed a mean Epworth Sleep Scale score of 9.9±5.1 with a median of 10.0 indicating a significant number of otolaryngology residents are excessively sleepy. Statistically significant correlations between Epworth Sleep Scale and sex, region, hours of sleep, and work hours were found. Residents taking in-house call had significantly fewer hours of sleep compared to home call (p=0.01). Residents on "head and neck" (typically consisting of a large proportion of head and neck oncologic surgery) rotations tended to have higher Epworth Sleep Scale and had significantly fewer hours of sleep (p=.003) and greater work hours (potolaryngology residents are excessively sleepy. Our data suggest that the effects of fatigue play a role in resident well-being and resident safety. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Residence-time framework for modeling multicomponent reactive transport in stream hyporheic zones

    Science.gov (United States)

    Painter, S. L.; Coon, E. T.; Brooks, S. C.

    2017-12-01

    Process-based models for transport and transformation of nutrients and contaminants in streams require tractable representations of solute exchange between the stream channel and biogeochemically active hyporheic zones. Residence-time based formulations provide an alternative to detailed three-dimensional simulations and have had good success in representing hyporheic exchange of non-reacting solutes. We extend the residence-time formulation for hyporheic transport to accommodate general multicomponent reactive transport. To that end, the integro-differential form of previous residence time models is replaced by an equivalent formulation based on a one-dimensional advection dispersion equation along the channel coupled at each channel location to a one-dimensional transport model in Lagrangian travel-time form. With the channel discretized for numerical solution, the associated Lagrangian model becomes a subgrid model representing an ensemble of streamlines that are diverted into the hyporheic zone before returning to the channel. In contrast to the previous integro-differential forms of the residence-time based models, the hyporheic flowpaths have semi-explicit spatial representation (parameterized by travel time), thus allowing coupling to general biogeochemical models. The approach has been implemented as a stream-corridor subgrid model in the open-source integrated surface/subsurface modeling software ATS. We use bedform-driven flow coupled to a biogeochemical model with explicit microbial biomass dynamics as an example to show that the subgrid representation is able to represent redox zonation in sediments and resulting effects on metal biogeochemical dynamics in a tractable manner that can be scaled to reach scales.

  3. Cerebrovascular reactivity among native-raised high altitude residents: an fMRI study

    Directory of Open Access Journals (Sweden)

    Zhang Jiaxing

    2011-09-01

    Full Text Available Abstract Background The impact of long term residence on high altitude (HA on human brain has raised concern among researchers in recent years. This study investigated the cerebrovascular reactivity among native-born high altitude (HA residents as compared to native sea level (SL residents. The two groups were matched on the ancestral line, ages, gender ratios, and education levels. A visual cue guided maximum inspiration task with brief breath holding was performed by all the subjects while Blood-Oxygenation-Level-Dependent (BOLD functional Magnetic Resonance Imaging (fMRI data were acquired from them. Results Compared to SL controls, the HA group showed generally decreased cerebrovascular reactivity and longer delay in hemodynamic response. Clusters showing significant differences in the former aspect were located at the bilateral primary motor cortex, the right somatosensory association cortex, the right thalamus and the right caudate, the bilateral precuneus, the right cingulate gyrus and the right posterior cingulate cortex, as well as the left fusiform gyrus and the right lingual cortex; clusters showing significant differences in the latter aspect were located at the precuneus, the insula, the superior frontal and temporal gyrus, the somatosensory cortex (the postcentral gyrus and the cerebellar tonsil. Inspiratory reserve volume (IRV, which is an important aspect of pulmonary function, demonstrated significant correlation with the amount of BOLD signal change in multiple brain regions, particularly at the bilateral insula among the HA group. Conclusions Native-born HA residents generally showed reduced cerebrovascular reactivity as demonstrated in the hemodynamic response during a visual cue guided maximum inspiration task conducted with BOLD-fMRI. This effect was particularly manifested among brain regions that are typically involved in cerebral modulation of respiration.

  4. Use and utility of Web-based residency program information: a survey of residency applicants.

    Science.gov (United States)

    Embi, Peter J; Desai, Sima; Cooney, Thomas G

    2003-01-01

    The Internet has become essential to the residency application process. In recent years, applicants and residency programs have used the Internet-based tools of the National Residency Matching Program (NRMP, the Match) and the Electronic Residency Application Service (ERAS) to process and manage application and Match information. In addition, many residency programs have moved their recruitment information from printed brochures to Web sites. Despite this change, little is known about how applicants use residency program Web sites and what constitutes optimal residency Web site content, information that is critical to developing and maintaining such sites. To study the use and perceived utility of Web-based residency program information by surveying applicants to an internal medicine program. Our sample population was the applicants to the Oregon Health & Science University Internal Medicine Residency Program who were invited for an interview. We solicited participation using the group e-mail feature available through the Electronic Residency Application Service Post-Office application. To minimize the possibility for biased responses, the study was confined to the period between submission of National Residency Matching Program rank-order lists and release of Match results. Applicants could respond using an anonymous Web-based form or by reply to the e-mail solicitation. We tabulated responses, calculated percentages for each, and performed a qualitative analysis of comments. Of the 431 potential participants, 218 responded (51%) during the study period. Ninety-nine percent reported comfort browsing the Web; 52% accessed the Web primarily from home. Sixty-nine percent learned about residency Web sites primarily from residency-specific directories while 19% relied on general directories. Eighty percent found these sites helpful when deciding where to apply, 69% when deciding where to interview, and 36% when deciding how to rank order programs for the Match. Forty

  5. Effects of a Short Video-Based Resident-as-Teacher Training Toolkit on Resident Teaching.

    Science.gov (United States)

    Ricciotti, Hope A; Freret, Taylor S; Aluko, Ashley; McKeon, Bri Anne; Haviland, Miriam J; Newman, Lori R

    2017-10-01

    To pilot a short video-based resident-as-teacher training toolkit and assess its effect on resident teaching skills in clinical settings. A video-based resident-as-teacher training toolkit was previously developed by educational experts at Beth Israel Deaconess Medical Center, Harvard Medical School. Residents were recruited from two academic hospitals, watched two videos from the toolkit ("Clinical Teaching Skills" and "Effective Clinical Supervision"), and completed an accompanying self-study guide. A novel assessment instrument for evaluating the effect of the toolkit on teaching was created through a modified Delphi process. Before and after the intervention, residents were observed leading a clinical teaching encounter and scored using the 15-item assessment instrument. The primary outcome of interest was the change in number of skills exhibited, which was assessed using the Wilcoxon signed-rank test. Twenty-eight residents from two academic hospitals were enrolled, and 20 (71%) completed all phases of the study. More than one third of residents who volunteered to participate reported no prior formal teacher training. After completing two training modules, residents demonstrated a significant increase in the median number of teaching skills exhibited in a clinical teaching encounter, from 7.5 (interquartile range 6.5-9.5) to 10.0 (interquartile range 9.0-11.5; P<.001). Of the 15 teaching skills assessed, there were significant improvements in asking for the learner's perspective (P=.01), providing feedback (P=.005), and encouraging questions (P=.046). Using a resident-as-teacher video-based toolkit was associated with improvements in teaching skills in residents from multiple specialties.

  6. An Evidence-based, Longitudinal Curriculum for Resident Physician Wellness: The 2017 Resident Wellness Consensus Summit.

    Science.gov (United States)

    Arnold, Jacob; Tango, Jennifer; Walker, Ian; Waranch, Chris; McKamie, Joshua; Poonja, Zafrina; Messman, Anne

    2018-03-01

    Physicians are at much higher risk for burnout, depression, and suicide than their non-medical peers. One of the working groups from the May 2017 Resident Wellness Consensus Summit (RWCS) addressed this issue through the development of a longitudinal residency curriculum to address resident wellness and burnout. A 30-person (27 residents, three attending physicians) Wellness Curriculum Development workgroup developed the curriculum in two phases. In the first phase, the workgroup worked asynchronously in the Wellness Think Tank - an online resident community - conducting a literature review to identify 10 core topics. In the second phase, the workgroup expanded to include residents outside the Wellness Think Tank at the live RWCS event to identify gaps in the curriculum. This resulted in an additional seven core topics. Seventeen foundational topics served as the framework for the longitudinal resident wellness curriculum. The curriculum includes a two-module introduction to wellness; a seven-module "Self-Care Series" focusing on the appropriate structure of wellness activities and everyday necessities that promote physician wellness; a two-module section on physician suicide and self-help; a four-module "Clinical Care Series" focusing on delivering bad news, navigating difficult patient encounters, dealing with difficult consultants and staff members, and debriefing traumatic events in the emergency department; wellness in the workplace; and dealing with medical errors and shame. The resident wellness curriculum, derived from an evidence-based approach and input of residents from the Wellness Think Tank and the RWCS event, provides a guiding framework for residency programs in emergency medicine and potentially other specialties to improve physician wellness and promote a culture of wellness.

  7. An Evidence-based, Longitudinal Curriculum for Resident Physician Wellness: The 2017 Resident Wellness Consensus Summit

    Directory of Open Access Journals (Sweden)

    Jacob Arnold

    2018-02-01

    Full Text Available Introduction: Physicians are at much higher risk for burnout, depression, and suicide than their non-medical peers. One of the working groups from the May 2017 Resident Wellness Consensus Summit (RWCS addressed this issue through the development of a longitudinal residency curriculum to address resident wellness and burnout. Methods: A 30-person (27 residents, three attending physicians Wellness Curriculum Development workgroup developed the curriculum in two phases. In the first phase, the workgroup worked asynchronously in the Wellness Think Tank – an online resident community – conducting a literature review to identify 10 core topics. In the second phase, the workgroup expanded to include residents outside the Wellness Think Tank at the live RWCS event to identify gaps in the curriculum. This resulted in an additional seven core topics. Results: Seventeen foundational topics served as the framework for the longitudinal resident wellness curriculum. The curriculum includes a two-module introduction to wellness; a seven-module “Self-Care Series” focusing on the appropriate structure of wellness activities and everyday necessities that promote physician wellness; a two-module section on physician suicide and self-help; a four-module “Clinical Care Series” focusing on delivering bad news, navigating difficult patient encounters, dealing with difficult consultants and staff members, and debriefing traumatic events in the emergency department; wellness in the workplace; and dealing with medical errors and shame. Conclusion: The resident wellness curriculum, derived from an evidence-based approach and input of residents from the Wellness Think Tank and the RWCS event, provides a guiding framework for residency programs in emergency medicine and potentially other specialties to improve physician wellness and promote a culture of wellness.

  8. Event-Based Modularization of Reactive Systems

    NARCIS (Netherlands)

    Malakuti Khah Olun Abadi, Somayeh; Aksit, Mehmet

    2014-01-01

    There is a large number of complex software systems that have reactive behavior. As for any other software system, reactive systems are subject to evolution demands. This paper defines a set requirements that must be fulfilled so that reuse of reactive software systems can be increased. Detailed

  9. Properties and reactivity of reactivated calcium-based sorbents

    Energy Technology Data Exchange (ETDEWEB)

    Davini, P. [Pisa University, Pisa (Italy). Dept. of Chemical Engineering

    2002-04-01

    Calcium-based sorbents used in the process of high temperature desulfurisation of flue gases are partly regenerable by hydration with steam; the best results are obtained for treatment temperatures of approximately 300{degree}C. The regeneration process, and the consequent increase in the sorbent consumption can be correlated to the surface characteristics (BET surface area, porosity and pore size distribution) of the sorbents themselves. In particular, the presence of suitable pore structure, also having pores large enough to let molecules easily penetrate the inner part of the sorbent particles, is very important. 27 refs., 9 figs., 2 tabs.

  10. Pay-as-bid based reactive power market

    International Nuclear Information System (INIS)

    Amjady, N.; Rabiee, A.; Shayanfar, H.A.

    2010-01-01

    In energy market clearing, the offers are stacked in increasing order and the offer that intersects demand curve, determines the market clearing price (MCP). In reactive power market, the location of reactive power compensator is so important. A low cost reactive producer may not essentially be favorable if it is far from the consumer. Likewise, a high cost local reactive compensator at a heavily loaded demand center of network could be inevitably an alternative required to produce reactive power to maintain the integrity of power system. Given the background, this paper presents a day-ahead reactive power market based on pay-as-bid (PAB) mechanism. Generators expected payment function (EPF) is used to construct a bidding framework. Then, total payment function (TPF) of generators is used as the objective function of optimal power flow (OPF) problem to clear the PAB based market. The CIGRE-32 bus test system is used to examine the effectiveness of the proposed reactive power market.

  11. Pay-as-bid based reactive power market

    Energy Technology Data Exchange (ETDEWEB)

    Amjady, N. [Department of Electrical Engineering, Semnan University, Semnan (Iran, Islamic Republic of); Rabiee, A., E-mail: Rabiee@iust.ac.i [Center of Excellence for Power System Automation and Operation, Department of Electrical Engineering, Iran University of Science and Technology, Tehran (Iran, Islamic Republic of); Shayanfar, H.A. [Center of Excellence for Power System Automation and Operation, Department of Electrical Engineering, Iran University of Science and Technology, Tehran (Iran, Islamic Republic of)

    2010-02-15

    In energy market clearing, the offers are stacked in increasing order and the offer that intersects demand curve, determines the market clearing price (MCP). In reactive power market, the location of reactive power compensator is so important. A low cost reactive producer may not essentially be favorable if it is far from the consumer. Likewise, a high cost local reactive compensator at a heavily loaded demand center of network could be inevitably an alternative required to produce reactive power to maintain the integrity of power system. Given the background, this paper presents a day-ahead reactive power market based on pay-as-bid (PAB) mechanism. Generators expected payment function (EPF) is used to construct a bidding framework. Then, total payment function (TPF) of generators is used as the objective function of optimal power flow (OPF) problem to clear the PAB based market. The CIGRE-32 bus test system is used to examine the effectiveness of the proposed reactive power market.

  12. CARBON-BASED REACTIVE BARRIER FOR NITRATE ...

    Science.gov (United States)

    Nitrate (NO3-) is a common ground water contaminant related to agricultural activity, waste water disposal, leachate from landfills, septic systems, and industrial processes. This study reports on the performance of a carbon-based permeable reactive barrier (PRB) that was constructed for in-situ bioremediation of a ground water nitrate plume caused by leakage from a swine CAFO (concentrated animal feeding operation) lagoon. The swine CAFO, located in Logan County, Oklahoma, was in operation from 1992-1999. The overall site remediation strategy includes an ammonia recovery trench to intercept ammonia-contaminated ground water and a hay straw PRB which is used to intercept a nitrate plume caused by nitrification of sorbed ammonia. The PRB extends approximately 260 m to intercept the nitrate plume. The depth of the trench averages 6 m and corresponds to the thickness of the surficial saturated zone; the width of the trench is 1.2 m. Detailed quarterly monitoring of the PRB began in March, 2004, about 1 year after construction activities ended. Nitrate concentrations hydraulically upgradient of the PRB have ranged from 23 to 77 mg/L N, from 0 to 3.2 mg/L N in the PRB, and from 0 to 65 mg/L N hydraulically downgradient of the PRB. Nitrate concentrations have generally decreased in downgradient locations with successive monitoring events. Mass balance considerations indicate that nitrate attenuation is dominantly from denitrification but with some component of

  13. A Reactive Balance Rating Method that Correlates with Kinematics after Trip-Like Perturbations on a Treadmill and Fall Risk Among Residents of Older Adult Congregate Housing.

    Science.gov (United States)

    Madigan, Michael L; Aviles, Jessica; Allin, Leigh J; Nussbaum, Maury A; Alexander, Neil B

    2018-04-16

    A growing number of studies are using modified treadmills to train reactive balance after trip-like perturbations that require multiple steps to recover balance. The goal of this study was thus to develop and validate a low-tech reactive balance rating method in the context of trip-like treadmill perturbations to facilitate the implementation of this training outside the research setting. Thirty-five residents of five senior congregate housing facilities participated in the study. Subjects completed a series of reactive balance tests on a modified treadmill from which the reactive balance rating was determined, along with a battery of standard clinical balance and mobility tests that predict fall risk. We investigated the strength of correlation between the reactive balance rating and reactive balance kinematics. We compared the strength of correlation between the reactive balance rating and clinical tests predictive of fall risk, with the strength of correlation between reactive balance kinematics and the same clinical tests. We also compared the reactive balance rating between subjects predicted to be at a high or low risk of falling. The reactive balance rating was correlated with reactive balance kinematics (Spearman's rho squared = .04 - .30), exhibited stronger correlations with clinical tests than most kinematic measures (Spearman's rho squared = .00 - .23), and was 42-60% lower among subjects predicted to be at a high risk for falling. The reactive balance rating method may provide a low-tech, valid measure of reactive balance kinematics, and an indicator of fall risk, after trip-like postural perturbations.

  14. Simulation-based interpersonal communication skills training for neurosurgical residents.

    Science.gov (United States)

    Harnof, Sagi; Hadani, Moshe; Ziv, Amitai; Berkenstadt, Haim

    2013-09-01

    Communication skills are an important component of the neurosurgery residency training program. We developed a simulation-based training module for neurosurgery residents in which medical, communication and ethical dilemmas are presented by role-playing actors. To assess the first national simulation-based communication skills training for neurosurgical residents. Eight scenarios covering different aspects of neurosurgery were developed by our team: (1) obtaining informed consent for an elective surgery, (2) discharge of a patient following elective surgery, (3) dealing with an unsatisfied patient, (4) delivering news of intraoperative complications, (5) delivering news of a brain tumor to parents of a 5 year old boy, (6) delivering news of brain death to a family member, (7) obtaining informed consent for urgent surgery from the grandfather of a 7 year old boy with an epidural hematoma, and (8) dealing with a case of child abuse. Fifteen neurosurgery residents from all major medical centers in Israel participated in the training. The session was recorded on video and was followed by videotaped debriefing by a senior neurosurgeon and communication expert and by feedback questionnaires. All trainees participated in two scenarios and observed another two. Participants largely agreed that the actors simulating patients represented real patients and family members and that the videotaped debriefing contributed to the teaching of professional skills. Simulation-based communication skill training is effective, and together with thorough debriefing is an excellent learning and practical method for imparting communication skills to neurosurgery residents. Such simulation-based training will ultimately be part of the national residency program.

  15. First-Year Residents Outperform Third-Year Residents after Simulation-Based Education in Critical Care Medicine

    Science.gov (United States)

    Singer, Benjamin D.; Corbridge, Thomas C.; Schroedl, Clara J.; Wilcox, Jane E.; Cohen, Elaine R.; McGaghie, William C.; Wayne, Diane B.

    2012-01-01

    Introduction Prior research shows that gaps exist in internal medicine residents’ critical care knowledge and skills. The purpose of this study was to compare the bedside critical care competency of first-year residents who received a simulation-based educational intervention plus clinical training to third-year residents who received clinical training alone. Methods During their first three months of residency, a group of first-year residents completed a simulation-based educational intervention. A group of traditionally-trained third-year residents who did not receive simulation-based training served as a comparison group. Both groups were evaluated using a 20-item clinical skills assessment at the bedside of a patient receiving mechanical ventilation at the end of their medical intensive care unit rotation. Scores on the skills assessment were compared between groups. Results Simulator-trained first-year residents (n=40) scored significantly higher compared to traditionally-trained third-year residents (n=27) on the bedside assessment, 91.3% (95% CI 88.2% to 94.3%) vs. 80.9% (95% CI 76.8% to 85.0%), P = simulation-based educational intervention demonstrated higher clinical competency than third-year residents who did not undergo simulation training. Critical care competency cannot be assumed after clinical ICU rotations; simulation-based curricula can help ensure residents are proficient to care for critically ill patients. PMID:23222546

  16. Lawful Permanent Residents Fiscal Year 2015 Core Based Statistical Area (CBSA) of Residence

    Data.gov (United States)

    Department of Homeland Security — Lawful permanent residents (LPRs) are foreign nationals who have been granted the right to reside permanently in the United States. LPRs are also known as 'permanent...

  17. Lawful Permanent Residents Fiscal Year 2016 Core Based Statistical Area (CBSA) of Residence

    Data.gov (United States)

    Department of Homeland Security — Lawful permanet residents (LPRs) are foreign nationals who have been gratned the right to reside permanently in the United States. LPRs are also known as 'permanent...

  18. Lawful Permanent Residents Fiscal Year 2011 Core Based Statistical Area (CBSA) of Residence

    Data.gov (United States)

    Department of Homeland Security — Lawful permanent residents (LPRs) are foreign nationals who have been granted the right to reside permanently in the United States. LPRs are also known as 'permanent...

  19. Lawful Permanent Residents Fiscal Year 2014 Core Based Statistical Area (CBSA) of Residence

    Data.gov (United States)

    Department of Homeland Security — Lawful permanent residents (LPRs) are foreign nationals who have been granted the right to reside permanently in the United States. LPRs are also known as 'permanent...

  20. Residence-Based Fear of Crime: A Routine Activities Approach.

    Science.gov (United States)

    Lai, Yung-Lien; Ren, Ling; Greenleaf, Richard

    2017-07-01

    Most fear-of-crime research uses resident's neighborhood as a key reference location to measure fear, yet the location effects of one's own dwelling unit on crime-specific fear has not been explicitly studied theoretically in the literature. Drawing upon routine activities theory, this study undertakes an investigation into the levels and determinants of residence-based fear of crime across three racial/ethnic groups-Whites, African Americans, and non-White Hispanics. Data used in the analyses were collected from a random-sample telephone survey of 1,239 respondents in Houston, Texas. The results derived from factor analyses revealed that residents do distinguish between fear in the neighborhood and fear at home. Proximity to motivated offenders measured by perception of crime was found to be the most salient predictor of fear, followed by the measures of target vulnerability and capable guardianship. In addition, residence-based fear varies significantly across racial/ethnic groups. The significance of these findings and the policy implications are highlighted.

  1. Digital reactivity meter construction based on PC

    International Nuclear Information System (INIS)

    Yusi-Eko-Yulianto; Kristedjo-Kurnianto

    2003-01-01

    The reactivitymeter is a core reactivity measuring equipment, which inform the reactor operator the neutron flux development in the core. This digital reactivitymeter is needed to replace analog reactivitymeter, whenever it fails in the future. The replacement of thus reactivitymeter can keep the continuation of reactor operation. The digital reactivitymeter is constructed by using the digital signal processing and computer. Thus real time signal processing is displayed on the monitor graphically. This reactivitymeter has been tested in RSG-GAS and perform a good work. This performance is worthy to use this digital reactivitymeter for RSG-GAS operation

  2. Development of a Case-based Reading Curriculum and Its Effect on Resident Reading.

    Science.gov (United States)

    Messman, Anne M; Walker, Ian

    2018-01-01

    Textbook reading plays a foundational role in a resident's knowledge base. Many residency programs place residents on identical reading schedules, regardless of the clinical work or rotation the resident is doing. We sought to develop a reading curriculum that takes into account the clinical work a resident is doing so their reading curriculum corresponds with their clinical work. Preliminary data suggests an increased amount of resident reading and an increased interest in reading as a result of this change to their reading curriculum.

  3. Reactivity index based on orbital energies.

    Science.gov (United States)

    Tsuneda, Takao; Singh, Raman K

    2014-05-30

    This study shows that the chemical reactivities depend on the orbital energy gaps contributing to the reactions. In the process where a reaction only makes progress through charge transfer with the minimal structural transformation of the reactant, the orbital energy gap gradient (OEGG) between the electron-donating and electron-accepting orbitals is proven to be very low. Using this relation, a normalized reaction diagram is constructed by plotting the normalized orbital energy gap with respect to the normalized intrinsic reaction coordinate. Application of this reaction diagram to 43 fundamental reactions showed that the majority of the forward reactions provide small OEGGs in the initial stages, and therefore, the initial processes of the forward reactions are supposed to proceed only through charge transfer. Conversely, more than 60% of the backward reactions are found to give large OEGGs implying very slow reactions associated with considerable structural transformations. Focusing on the anti-activation-energy reactions, in which the forward reactions have higher barriers than those of the backward ones, most of these reactions are shown to give large OEGGs for the backward reactions. It is also found that the reactions providing large OEGGs in the forward directions inconsistent with the reaction rate constants are classified into SN 2, symmetric, and methyl radical reactions. Interestingly, several large-OEGG reactions are experimentally established to get around the optimum pathways. This indicates that the reactions can take significantly different pathways from the optimum ones provided no charge transfer proceeds spontaneously without the structural transformations of the reactants. Copyright © 2014 Wiley Periodicals, Inc.

  4. Effectiveness of a Core-Competency-based Program on Residents' Learning and Experience.

    Science.gov (United States)

    Charles, Lesley; Triscott, Jean; Dobbs, Bonnie; Tian, Peter George; Babenko, Oksana

    2016-06-01

    The Care of the Elderly (COE) Diploma Program is a six-to-twelve-month enhanced skills program taken after two years of core residency training in Family Medicine. In 2010, we developed and implemented a core-competency-based COE Diploma program (CC), in lieu of one based on learning objectives (LO). This study assessed the effectiveness of the core-competency-based program on residents' learning and their training experience as compared to residents trained using learning objectives. The data from the 2007-2013 COE residents were used in the study, with nine and eight residents trained in the LO and CC programs, respectively. Residents' learning was measured using preceptors' evaluations of residents' skills/abilities throughout the program (118 evaluations in total). Residents' rating of training experience was measured using the Graduate's Questionnaire which residents completed after graduation. For residents' learning, overall, there was no significant difference between the two programs. However, when examined as a function of the four CanMEDS roles, there were significant increases in the CC residents' scores for two of the CanMEDS roles: Communicator/Collaborator/Manager and Scholar compared to residents in the LO program. With respect to residents' training experience, seven out of ten program components were rated by the CC residents higher than by the LO residents. The implementation of a COE CC program appears to facilitate resident learning and training experience.

  5. The electronic residency application service application can predict accreditation council for graduate medical education competency-based surgical resident performance.

    Science.gov (United States)

    Tolan, Amy M; Kaji, Amy H; Quach, Chi; Hines, O Joe; de Virgilio, Christian

    2010-01-01

    Program directors often struggle to determine which factors in the Electronic Residency Application Service (ERAS) application are important in the residency selection process. With the establishment of the Accreditation Council for Graduate Medical Education (ACGME) competencies, it would be important to know whether information available in the ERAS application can predict subsequent competency-based performance of general surgery residents. This study is a retrospective correlation of data points found in the ERAS application with core competency-based clinical rotation evaluations. ACGME competency-based evaluations as well as technical skills assessment from all rotations during residency were collected. The overall competency score was defined as an average of all 6 competencies and technical skills. A total of77 residents from two (one university and one community based university-affiliate) general surgery residency programs were included in the analysis. Receiving honors for many of the third year clerkships and AOA membership were associated with a number of the individual competencies. USMLE scores were predictive only of Medical Knowledge (p = 0.004). Factors associated with higher overall competency were female gender (p = 0.02), AOA (p = 0.06), overall number of honors received (p = 0.04), and honors in Ob/Gyn (p = 0.03) and Pediatrics (p = 0.05). Multivariable analysis showed honors in Ob/Gyn, female gender, older age, and total number of honors to be predictive of a number of individual core competencies. USMLE scores were only predictive of Medical Knowledge. The ERAS application is useful for predicting subsequent competency based performance in surgical residents. Receiving honors in the surgery clerkship, which has traditionally carried weight when evaluating a potential surgery resident, may not be as strong a predictor of future success. Copyright © 2010 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights

  6. A DFIG Islanding Detection Scheme Based on Reactive Power Infusion

    Science.gov (United States)

    Wang, M.; Liu, C.; He, G. Q.; Li, G. H.; Feng, K. H.; Sun, W. W.

    2017-07-01

    A lot of research has been done on photovoltaic (the “PV”) power system islanding detection in recent years. As a comparison, much less attention has been paid to islanding in wind turbines. Meanwhile, wind turbines can work in islanding conditions for quite a long period, which can be harmful to equipments and cause safety hazards. This paper presents and examines a double fed introduction generation (the “DFIG”) islanding detection scheme based on feedback of reactive power and frequency and uses a trigger signal of reactive power infusion which can be obtained by dividing the voltage total harmonic distortion (the "THD") by the voltage THD of last cycle to avoid the deterioration of power quality. This DFIG islanding detection scheme uses feedback of reactive power current loop to amplify the frequency differences in islanding and normal conditions. Simulation results show that the DFIG islanding detection scheme is effective.

  7. Mindfulness-based stress reduction for residents: A randomized controlled trial

    NARCIS (Netherlands)

    Verweij, H.; Ravesteijn, H.J. van; Hooff, M.L.M. van; Lagro-Janssen, A.L.M.; Speckens, A.E.M.

    2018-01-01

    Background: Burnout is highly prevalent in residents. No randomized controlled trials have been conducted measuring the effects of Mindfulness-Based Stress Reduction (MBSR) on burnout in residents. Objective: To determine the effectiveness of MBSR in reducing burnout in residents. Design: A

  8. The role of librarians in teaching evidence-based medicine to pediatric residents: a survey of pediatric residency program directors.

    Science.gov (United States)

    Boykan, Rachel; Jacobson, Robert M

    2017-10-01

    The research sought to identify the general use of medical librarians in pediatric residency training, to define the role of medical librarians in teaching evidence-based medicine (EBM) to pediatric residents, and to describe strategies and curricula for teaching EBM used in pediatric residency training programs. We sent a 13-question web-based survey through the Association of Pediatric Program Directors to 200 pediatric residency program directors between August and December 2015. A total of 91 (46%) pediatric residency program directors responded. Most (76%) programs had formal EBM curricula, and more than 75% of curricula addressed question formation, searching, assessment of validity, generalizability, quantitative importance, statistical significance, and applicability. The venues for teaching EBM that program directors perceived to be most effective included journal clubs (84%), conferences (44%), and morning report (36%). While 80% of programs utilized medical librarians, most of these librarians assisted with scholarly or research projects (74%), addressed clinical questions (62%), and taught on any topic not necessarily EBM (58%). Only 17% of program directors stated that librarians were involved in teaching EBM on a regular basis. The use of a librarian was not associated with having an EBM curriculum but was significantly associated with the size of the program. Smaller programs were more likely to utilize librarians (100%) than were medium (71%) or large programs (75%). While most pediatric residency programs have an EBM curriculum and engage medical librarians in various ways, librarians' expertise in teaching EBM is underutilized. Programs should work to better integrate librarians' expertise, both in the didactic and clinical teaching of EBM.

  9. Simulation-based education with mastery learning improves residents' lumbar puncture skills

    Science.gov (United States)

    Cohen, Elaine R.; Caprio, Timothy; McGaghie, William C.; Simuni, Tanya; Wayne, Diane B.

    2012-01-01

    Objective: To evaluate the effect of simulation-based mastery learning (SBML) on internal medicine residents' lumbar puncture (LP) skills, assess neurology residents' acquired LP skills from traditional clinical education, and compare the results of SBML to traditional clinical education. Methods: This study was a pretest-posttest design with a comparison group. Fifty-eight postgraduate year (PGY) 1 internal medicine residents received an SBML intervention in LP. Residents completed a baseline skill assessment (pretest) using a 21-item LP checklist. After a 3-hour session featuring deliberate practice and feedback, residents completed a posttest and were expected to meet or exceed a minimum passing score (MPS) set by an expert panel. Simulator-trained residents' pretest and posttest scores were compared to assess the impact of the intervention. Thirty-six PGY2, 3, and 4 neurology residents from 3 medical centers completed the same simulated LP assessment without SBML. SBML posttest scores were compared to neurology residents' baseline scores. Results: PGY1 internal medicine residents improved from a mean of 46.3% to 95.7% after SBML (p < 0.001) and all met the MPS at final posttest. The performance of traditionally trained neurology residents was significantly lower than simulator-trained residents (mean 65.4%, p < 0.001) and only 6% met the MPS. Conclusions: Residents who completed SBML showed significant improvement in LP procedural skills. Few neurology residents were competent to perform a simulated LP despite clinical experience with the procedure. PMID:22675080

  10. Reactive Distillation for Esterification of Bio-based Organic Acids

    Energy Technology Data Exchange (ETDEWEB)

    Fields, Nathan; Miller, Dennis J.; Asthana, Navinchandra S.; Kolah, Aspi K.; Vu, Dung; Lira, Carl T.

    2008-09-23

    The following is the final report of the three year research program to convert organic acids to their ethyl esters using reactive distillation. This report details the complete technical activities of research completed at Michigan State University for the period of October 1, 2003 to September 30, 2006, covering both reactive distillation research and development and the underlying thermodynamic and kinetic data required for successful and rigorous design of reactive distillation esterification processes. Specifically, this project has led to the development of economical, technically viable processes for ethyl lactate, triethyl citrate and diethyl succinate production, and on a larger scale has added to the overall body of knowledge on applying fermentation based organic acids as platform chemicals in the emerging biorefinery. Organic acid esters constitute an attractive class of biorenewable chemicals that are made from corn or other renewable biomass carbohydrate feedstocks and replace analogous petroleum-based compounds, thus lessening U.S. dependence on foreign petroleum and enhancing overall biorefinery viability through production of value-added chemicals in parallel with biofuels production. Further, many of these ester products are candidates for fuel (particularly biodiesel) components, and thus will serve dual roles as both industrial chemicals and fuel enhancers in the emerging bioeconomy. The technical report from MSU is organized around the ethyl esters of four important biorenewables-based acids: lactic acid, citric acid, succinic acid, and propionic acid. Literature background on esterification and reactive distillation has been provided in Section One. Work on lactic acid is covered in Sections Two through Five, citric acid esterification in Sections Six and Seven, succinic acid in Section Eight, and propionic acid in Section Nine. Section Ten covers modeling of ester and organic acid vapor pressure properties using the SPEAD (Step Potential

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

    Science.gov (United States)

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

    2017-12-01

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

  12. Minimizing Barriers in Learning for On-Call Radiology Residents-End-to-End Web-Based Resident Feedback System.

    Science.gov (United States)

    Choi, Hailey H; Clark, Jennifer; Jay, Ann K; Filice, Ross W

    2018-02-01

    Feedback is an essential part of medical training, where trainees are provided with information regarding their performance and further directions for improvement. In diagnostic radiology, feedback entails a detailed review of the differences between the residents' preliminary interpretation and the attendings' final interpretation of imaging studies. While the on-call experience of independently interpreting complex cases is important to resident education, the more traditional synchronous "read-out" or joint review is impossible due to multiple constraints. Without an efficient method to compare reports, grade discrepancies, convey salient teaching points, and view images, valuable lessons in image interpretation and report construction are lost. We developed a streamlined web-based system, including report comparison and image viewing, to minimize barriers in asynchronous communication between attending radiologists and on-call residents. Our system provides real-time, end-to-end delivery of case-specific and user-specific feedback in a streamlined, easy-to-view format. We assessed quality improvement subjectively through surveys and objectively through participation metrics. Our web-based feedback system improved user satisfaction for both attending and resident radiologists, and increased attending participation, particularly with regards to cases where substantive discrepancies were identified.

  13. Index-based reactive power compensation scheme for voltage regulation

    Science.gov (United States)

    Dike, Damian Obioma

    2008-10-01

    Increasing demand for electrical power arising from deregulation and the restrictions posed to the construction of new transmission lines by environment, socioeconomic, and political issues had led to higher grid loading. Consequently, voltage instability has become a major concern, and reactive power support is vital to enhance transmission grid performance. Improved reactive power support to distressed grid is possible through the application of relatively unfamiliar emerging technologies of "Flexible AC Transmission Systems (FACTS)" devices and "Distributed Energy Resources (DERS)." In addition to these infrastructure issues, a lack of situational awareness by system operators can cause major power outages as evidenced by the August 14, 2003 widespread North American blackout. This and many other recent major outages have highlighted the inadequacies of existing power system indexes. In this work, a novel "Index-based reactive compensation scheme" appropriate for both on-line and off-line computation of grid status has been developed. A new voltage stability index (Ls-index) suitable for long transmission lines was developed, simulated, and compared to the existing two-machine modeled L-index. This showed the effect of long distance power wheeling amongst regional transmission organizations. The dissertation further provided models for index modulated voltage source converters (VSC) and index-based load flow analysis of both FACTS and microgrid interconnected power systems using the Newton-Raphson's load flow model incorporated with multi-FACTS devices. The developed package has been made user-friendly through the embodiment of interactive graphical user interface and implemented on the IEEE 14, 30, and 300 bus systems. The results showed reactive compensation has system wide-effect, provided readily accessible system status indicators, ensured seamless DERs interconnection through new islanding modes and enhanced VSC utilization. These outcomes may contribute

  14. Development of a Case-based Reading Curriculum and Its Effect on Resident Reading

    Directory of Open Access Journals (Sweden)

    Anne M. Messman

    2017-12-01

    Full Text Available Textbook reading plays a foundational role in a resident’s knowledge base. Many residency programs place residents on identical reading schedules, regardless of the clinical work or rotation the resident is doing. We sought to develop a reading curriculum that takes into account the clinical work a resident is doing so their reading curriculum corresponds with their clinical work. Preliminary data suggests an increased amount of resident reading and an increased interest in reading as a result of this change to their reading curriculum.

  15. Improvements of the base bleed effect using reactive particles

    Energy Technology Data Exchange (ETDEWEB)

    Bournot, Herve; Daniel, Eric [Polytech' Marseille, IUSTI UMR CNRS 6595, 5, rue E. Fermi, Technopole de Chateau Gombert, 13453 Marseille cedex 13 (France); Cayzac, Roxan [Giat Industries, 7, Route de Guerry, F-18023 Bourges cedex (France)

    2006-11-15

    A numerical study of the base drag reduction of axisymmetric body projectiles in supersonic flight using a base bleed injection is presented in this paper. Unsteady computations of compressible viscous flow have been achieved in order to investigate the coupled effect of the bleed temperature and the bleed mass flow rate on the base pressure. The idea developed in the study, consists in the addition of metallic particles in the propellant composition used to provide the additional mass injected in order to obtain the lowest base drag. Indeed, for a low mass addition, a significant increase of the mixture energy is expected due to the particles combustion. Base flow with reactive two-phase injection is then simulated. Results show the ability of the method to describe such flows and the efficiency of the particles combustion to increase the base bleed reducing drag effect. (author)

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

    Science.gov (United States)

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

    2015-12-01

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

  17. Problem-based learning in laboratory medicine resident education: a satisfaction survey.

    Science.gov (United States)

    Lepiller, Quentin; Solis, Morgane; Velay, Aurélie; Gantner, Pierre; Sueur, Charlotte; Stoll-Keller, Françoise; Barth, Heidi; Fafi-Kremer, Samira

    2017-04-01

    Theoretical knowledge in biology and medicine plays a substantial role in laboratory medicine resident education. In this study, we assessed the contribution of problem-based learning (PBL) to improve the training of laboratory medicine residents during their internship in the department of virology, Strasbourg University Hospital, France. We compared the residents' satisfaction regarding an educational program based on PBL and a program based on lectures and presentations. PBL induced a high level of satisfaction (100%) among residents compared to lectures and presentations (53%). The main advantages of this technique were to create a situational interest regarding virological problems, to boost the residents' motivation and to help them identify the most relevant learning objectives in virology. However, it appears pertinent to educate the residents in appropriate bibliographic research techniques prior to PBL use and to monitor their learning by regular formative assessment sessions.

  18. Visual Programming of Subsumption-Based Reactive Behaviour

    Directory of Open Access Journals (Sweden)

    Omid Banyasad

    2008-11-01

    Full Text Available General purpose visual programming languages (VPLs promote the construction of programs that are more comprehensible, robust, and maintainable by enabling programmers to directly observe and manipulate algorithms and data. However, they usually do not exploit the visual representation of entities in the problem domain, even if those entities and their interactions have obvious visual representations, as is the case in the robot control domain. We present a formal control model for autonomous robots, based on subsumption, and use it as the basis for a VPL in which reactive behaviour is programmed via interactions with a simulation.

  19. Developing a vision and strategic action plan for future community-based residency training.

    Science.gov (United States)

    Skelton, Jann B; Owen, James A

    2016-01-01

    The Community Pharmacy Residency Program (CPRP) Planning Committee convened to develop a vision and a strategic action plan for the advancement of community pharmacy residency training. Aligned with the profession's efforts to achieve provider status and expand access to care, the Future Vision and Action Plan for Community-based Residency Training will provide guidance, direction, and a strategic action plan for community-based residency training to ensure that the future needs of community-based pharmacist practitioners are met. National thought leaders, selected because of their leadership in pharmacy practice, academia, and residency training, served on the planning committee. The committee conducted a series of conference calls and an in-person strategic planning meeting held on January 13-14, 2015. Outcomes from the discussions were supplemented with related information from the literature. Results of a survey of CPRP directors and preceptors also informed the planning process. The vision and strategic action plan for community-based residency training is intended to advance training to meet the emerging needs of patients in communities that are served by the pharmacy profession. The group anticipated the advanced skills required of pharmacists serving as community-based pharmacist practitioners and the likely education, training and competencies required by future residency graduates in order to deliver these services. The vision reflects a transformation of community residency training, from CPRPs to community-based residency training, and embodies the concept that residency training should be primarily focused on training the individual pharmacist practitioner based on the needs of patients served within the community, and not on the physical location where pharmacy services are provided. The development of a vision statement, core values statements, and strategic action plan will provide support, guidance, and direction to the profession of pharmacy to

  20. Resident evaluation of clinical teachers based on teachers' certification.

    Science.gov (United States)

    Steiner, Ivan P; Yoon, Philip W; Kelly, Karen D; Diner, Barry M; Donoff, Michel G; Mackey, Duncan S; Rowe, Brian H

    2003-07-01

    To examine the influence of emergency medicine (EM) certification of clinical teaching faculty on evaluations provided by residents. A prospective cohort analysis was conducted of assessments between July 1994 and July 2000 on residents' evaluations of EM faculty at the University of Alberta, Edmonton, Canada. Resident- and faculty-related variables were entered anonymously using the validated evaluation tool (ER Scale). Credentialing and demographic information on EM faculty was supplemented by data obtained through a nine-question survey. Groups were compared using ANOVA. The 562 residents returned 705 (91%) valid evaluation sheets on 115 EM faculty members. The four domains of didactic teaching, clinical teaching, approachability, and helpfulness were assessed. The majority of ratings were in the very good or superb categories for each domain. Instructors with certification in EM had higher scores in didactic, clinical teaching compared with others, and teachers without national certification scored lower in the helpful and approachable categories (p certifications either through training or practice eligibility did not affect scores. Instructors under the age of 40 years had higher scores than the older age groups in three of four categories (p certification in EM, academic track, rotation year, and site are all correlated with better teaching performance.

  1. Objective classification of residents based on their psychomotor laparoscopic skills

    NARCIS (Netherlands)

    M.K. Chmarra (Magdalena); S. Klein (Stefan); J.C.F. van Winter (Joost); F-W. Jansen (Frank-Willem); J. Dankelman (Jenny)

    2010-01-01

    textabstractBackground From the clinical point of view, it is important to recognize residents' level of expertise with regard to basic psychomotor skills. For that reason, surgeons and surgical organizations (e.g., Acreditation Council for Graduate Medical Education, ACGME) are calling for

  2. Unifying Model-Based and Reactive Programming within a Model-Based Executive

    Science.gov (United States)

    Williams, Brian C.; Gupta, Vineet; Norvig, Peter (Technical Monitor)

    1999-01-01

    Real-time, model-based, deduction has recently emerged as a vital component in AI's tool box for developing highly autonomous reactive systems. Yet one of the current hurdles towards developing model-based reactive systems is the number of methods simultaneously employed, and their corresponding melange of programming and modeling languages. This paper offers an important step towards unification. We introduce RMPL, a rich modeling language that combines probabilistic, constraint-based modeling with reactive programming constructs, while offering a simple semantics in terms of hidden state Markov processes. We introduce probabilistic, hierarchical constraint automata (PHCA), which allow Markov processes to be expressed in a compact representation that preserves the modularity of RMPL programs. Finally, a model-based executive, called Reactive Burton is described that exploits this compact encoding to perform efficIent simulation, belief state update and control sequence generation.

  3. Optimization of Occupancy Based Demand Controlled Ventilation in Residences

    DEFF Research Database (Denmark)

    Mortensen, Dorthe Kragsig; Walker, Iain; Sherman, Max

    2011-01-01

    Although it has been used for many years in commercial buildings, the application of demand controlled ventilation in residences is limited. In this study we used occupant exposure to pollutants integrated over time (referred to as "dose") as the metric to evaluate the effectiveness and air quality...... implications of demand controlled ventilation in residences. We looked at air quality for two situations. The first is that typically used in ventilation standards: the exposure over a long term. The second is to look at peak exposures that are associated with time variations in ventilation rates and pollutant...... when occupied. We used analytical solutions to the continuity equation to determine the ventilation effectiveness and the long-term chronic dose and peak acute exposure for a representative range of occupancy periods, pollutant generation rates and airflow rates. The results of the study showed that we...

  4. Teaching and Assessing Systems-based Competency in Ophthalmology Residency Training Programs

    NARCIS (Netherlands)

    Lee, Andrew G.; Beaver, Hilary A.; Greenlee, Emily; Oetting, Thomas A.; Boldt, H. Culver; Olson, Richard; Abramoff, Michael; Carter, Keith

    2007-01-01

    The Accreditation Council for Graduate Medical Education (ACGME) has mandated that residency programs, including ophthalmology, teach and assess specific competencies, including systems-based learning. We review the pertinent literature on systems-based learning for ophthalmology and recommend

  5. Development of polylactic acid-based materials through reactive modification

    Science.gov (United States)

    Fowlks, Alison Camille

    2009-12-01

    Polylactic acid (PLA)-based systems have shown to be of great potential for the development of materials requiring biobased content, biodegradation, and sufficient properties. The efforts in this study are directed toward addressing the current research need to overcome some of the inherent drawbacks of PLA. To meet this need, reactive extrusion was employed to develop new materials based on PLA by grafting, compounding, and polymer blending. In the first part of this work, maleic anhydride (MA) was grafted onto PLA by reactive extrusion. Two structurally different peroxides were used to initiate grafting and results were reported on the basis of grafting, molecular weight, and thermal behavior. An inverse relationship between degree of grafting and molecular weight was established. It was also found that, regardless of peroxide type, there is an optimum peroxid-to-MA ratio of 0.5:2 that promotes maximum grafting, beyond which degradation reactions become predominant. Overall, it was found that the maleated copolymer (MAPLA) could be used as an interfacial modifier in PLA-based composites. Therefore, MAPLA was incorporated into PLA-talc composites in varying concentrations. The influence of the MAPLA addition on the mechanical and thermal behavior was investigated. When added in an optimum concentration, MAPLA improved the tensile strength and crystallization of the composite. Furthermore, microscopic observation confirmed the compatibilization effect of MAPLA in PLA-talc composites. Vinyltrimethoxysilane was free-radically grafted onto the backbone of PLA and subsequently moisture crosslinked. The effects of monomer, initiator, and catalyst concentration on the degree of crosslinking and the mechanical and thermal properties were investigated. The presence of a small amount of catalyst showed to be a major contributor to the crosslinking formation in the time frame investigated, shown by an increase in gel content and decrease in crystallinity. Furthermore

  6. Flavours of XChange, a Rule-Based Reactive Language for the (Semantic) Web

    OpenAIRE

    Bailey, James; Bry, François; Eckert, Michael; Patrânjan, Paula Lavinia

    2005-01-01

    This article introduces XChange, a rule-based reactive language for the Web. Stressing application scenarios, it first argues that high-level reactive languages are needed for bothWeb and SemanticWeb applications. Then, it discusses technologies and paradigms relevant to high-level reactive languages for the (Semantic) Web. Finally, it presents the Event-Condition-Action rules of XChange.

  7. Web-based reactive transport modeling using PFLOTRAN

    Science.gov (United States)

    Zhou, H.; Karra, S.; Lichtner, P. C.; Versteeg, R.; Zhang, Y.

    2017-12-01

    Actionable understanding of system behavior in the subsurface is required for a wide spectrum of societal and engineering needs by both commercial firms and government entities and academia. These needs include, for example, water resource management, precision agriculture, contaminant remediation, unconventional energy production, CO2 sequestration monitoring, and climate studies. Such understanding requires the ability to numerically model various coupled processes that occur across different temporal and spatial scales as well as multiple physical domains (reservoirs - overburden, surface-subsurface, groundwater-surface water, saturated-unsaturated zone). Currently, this ability is typically met through an in-house approach where computational resources, model expertise, and data for model parameterization are brought together to meet modeling needs. However, such an approach has multiple drawbacks which limit the application of high-end reactive transport codes such as the Department of Energy funded[?] PFLOTRAN code. In addition, while many end users have a need for the capabilities provided by high-end reactive transport codes, they do not have the expertise - nor the time required to obtain the expertise - to effectively use these codes. We have developed and are actively enhancing a cloud-based software platform through which diverse users are able to easily configure, execute, visualize, share, and interpret PFLOTRAN models. This platform consists of a web application and available on-demand HPC computational infrastructure. The web application consists of (1) a browser-based graphical user interface which allows users to configure models and visualize results interactively, and (2) a central server with back-end relational databases which hold configuration, data, modeling results, and Python scripts for model configuration, and (3) a HPC environment for on-demand model execution. We will discuss lessons learned in the development of this platform, the

  8. Circulating and Tissue-Resident CD4+ T Cells With Reactivity to Intestinal Microbiota Are Abundant in Healthy Individuals and Function Is Altered During Inflammation.

    Science.gov (United States)

    Hegazy, Ahmed N; West, Nathaniel R; Stubbington, Michael J T; Wendt, Emily; Suijker, Kim I M; Datsi, Angeliki; This, Sebastien; Danne, Camille; Campion, Suzanne; Duncan, Sylvia H; Owens, Benjamin M J; Uhlig, Holm H; McMichael, Andrew; Bergthaler, Andreas; Teichmann, Sarah A; Keshav, Satish; Powrie, Fiona

    2017-11-01

    Interactions between commensal microbes and the immune system are tightly regulated and maintain intestinal homeostasis, but little is known about these interactions in humans. We investigated responses of human CD4 + T cells to the intestinal microbiota. We measured the abundance of T cells in circulation and intestinal tissues that respond to intestinal microbes and determined their clonal diversity. We also assessed their functional phenotypes and effects on intestinal resident cell populations, and studied alterations in microbe-reactive T cells in patients with chronic intestinal inflammation. We collected samples of peripheral blood mononuclear cells and intestinal tissues from healthy individuals (controls, n = 13-30) and patients with inflammatory bowel diseases (n = 119; 59 with ulcerative colitis and 60 with Crohn's disease). We used 2 independent assays (CD154 detection and carboxy-fluorescein succinimidyl ester dilution assays) and 9 intestinal bacterial species (Escherichia coli, Lactobacillus acidophilus, Bifidobacterium animalis subsp lactis, Faecalibacterium prausnitzii, Bacteroides vulgatus, Roseburia intestinalis, Ruminococcus obeum, Salmonella typhimurium, and Clostridium difficile) to quantify, expand, and characterize microbe-reactive CD4 + T cells. We sequenced T-cell receptor Vβ genes in expanded microbe-reactive T-cell lines to determine their clonal diversity. We examined the effects of microbe-reactive CD4 + T cells on intestinal stromal and epithelial cell lines. Cytokines, chemokines, and gene expression patterns were measured by flow cytometry and quantitative polymerase chain reaction. Circulating and gut-resident CD4 + T cells from controls responded to bacteria at frequencies of 40-4000 per million for each bacterial species tested. Microbiota-reactive CD4 + T cells were mainly of a memory phenotype, present in peripheral blood mononuclear cells and intestinal tissue, and had a diverse T-cell receptor Vβ repertoire. These

  9. Entrainer-based reactive distillation versus conventional reactive distillation for the synthesis of fatty acid esters

    NARCIS (Netherlands)

    Jong, de M.C.; Dimian, A.C.; Haan, de A.B.

    2008-01-01

    In this paper different reactive distillation configurations for the synthesis of isopropyl myristate were compared with the use of process models made in Aspen Plus. It can be concluded that the configurations in which an entrainer is added are more capable to reach the required conversion of

  10. Development of a robust model-based reactivity control system

    International Nuclear Information System (INIS)

    Rovere, L.A.; Otaduy, P.J.; Brittain, C.R.

    1990-01-01

    This paper describes the development and implementation of a digital model-based reactivity control system that incorporates a knowledge of the plant physics into the control algorithm to improve system performance. This controller is composed of a model-based module and modified proportional-integral-derivative (PID) module. The model-based module has an estimation component to synthesize unmeasurable process variables that are necessary for the control action computation. These estimated variables, besides being used within the control algorithm, will be used for diagnostic purposes by a supervisory control system under development. The PID module compensates for inaccuracies in model coefficients by supplementing the model-based output with a correction term that eliminates any demand tracking or steady state errors. This control algorithm has been applied to develop controllers for a simulation of liquid metal reactors in a multimodular plant. It has shown its capability to track demands in neutron power much more accurately than conventional controllers, reducing overshoots to almost negligible value while providing a good degree of robustness to unmodeled dynamics. 10 refs., 4 figs

  11. An instrument to characterize the environment for residents' evidence-based medicine learning and practice.

    Science.gov (United States)

    Mi, Misa; Moseley, James L; Green, Michael L

    2012-02-01

    Many residency programs offer training in evidence-based medicine (EBM). However, these curricula often fail to achieve optimal learning outcomes, perhaps because they neglect various contextual factors in the learning environment. We developed and validated an instrument to characterize the environment for EBM learning and practice in residency programs. An EBM Environment Scale was developed following scale development principles. A survey was administered to residents across six programs in primary care specialties at four medical centers. Internal consistency reliability was analyzed with Cronbach's coefficient alpha. Validity was assessed by comparing predetermined subscales with the survey's internal structure as assessed via factor analysis. Scores were also compared for subgroups based on residency program affiliation and residency characteristics. Out of 262 eligible residents, 124 completed the survey (response rate 47%). The overall mean score was 3.89 (standard deviation=0.56). The initial reliability analysis of the 48-item scale had a high reliability coefficient (Cronbach α=.94). Factor analysis and further item analysis resulted in a shorter 36-item scale with a satisfactory reliability coefficient (Cronbach α=.86). Scores were higher for residents with prior EBM training in medical school (4.14 versus 3.62) and in residency (4.25 versus 3.69). If further testing confirms its properties, the EBM Environment Scale may be used to understand the influence of the learning environment on the effectiveness of EBM training. Additionally, it may detect changes in the EBM learning environment in response to programmatic or institutional interventions.

  12. The art of medicine: arts-based training in observation and mindfulness for fostering the empathic response in medical residents.

    Science.gov (United States)

    Zazulak, Joyce; Sanaee, May; Frolic, Andrea; Knibb, Nicole; Tesluk, Eve; Hughes, Edward; Grierson, Lawrence E M

    2017-09-01

    Empathy is an essential attribute for medical professionals. Yet, evidence indicates that medical learners' empathy levels decline dramatically during medical school. Training in evidence-based observation and mindfulness has the potential to bolster the acquisition and demonstration of empathic behaviours for medical learners. In this prospective cohort study, we explore the impact of a course in arts-based visual literacy and mindfulness practice ( Art of Seeing ) on the empathic response of medical residents engaged in obstetrics and gynaecology and family medicine training. Following this multifaceted arts-based programme that integrates the facilitated viewing of art and dance, art-making, and mindfulness-based practices into a practitioner-patient context, 15 resident trainees completed the previously validated Interpersonal Reactivity Index, Compassion, and Mindfulness Scales. Fourteen participants also participated in semistructured interviews that probed their perceived impacts of the programme on their empathic clinical practice. The results indicated that programme participants improved in the Mindfulness Scale domains related to self-confidence and communication relative to a group of control participants following the arts-based programme. However, the majority of the psychometric measures did not reveal differences between groups over the duration of the programme. Importantly, thematic qualitative analysis of the interview data revealed that the programme had a positive impact on the participants' perceived empathy towards colleagues and patients and on the perception of personal and professional well-being. The study concludes that a multifaceted arts-based curriculum focusing on evidence-based observation and mindfulness is a useful tool in bolstering the empathic response, improving communication, and fostering professional well-being among medical residents. Published by the BMJ Publishing Group Limited. For permission to use (where not already

  13. Stress and burnout in residents: impact of mindfulness-based resilience training

    Directory of Open Access Journals (Sweden)

    Goldhagen BE

    2015-08-01

    Full Text Available Brian E Goldhagen,1 Karen Kingsolver,2 Sandra S Stinnett,1 Jullia A Rosdahl1 1Department of Ophthalmology, 2Department of Family and Community Medicine, Duke University Medical Center, Durham, NC, USABackground and objective: Stress and burnout impact resident physicians. This prospective study tests the hypothesis that a mindfulness-based resilience intervention would decrease stress and burnout in residents.Methods: Resident physicians from the Departments of Family Medicine, Psychiatry, and Anesthesia at Duke University, Durham, NC, USA, participated in two or three 1-hour sessions of mindfulness-based resilience activities, which introduced mindful-awareness and included practical exercises for nurturing resilience. Anonymous surveys were distributed before (completed by 47 residents and after the intervention (both completed by 30 residents; a follow-up survey was distributed 1 month later (seven residents completed all three surveys. The survey included the Depression Anxiety Stress Scale, 21-question version (DASS-21, the Oldenburg Burnout Inventory, the Mindful Attention Awareness Scale, and ten questions from the Cognitive Failures Questionnaire.Results: At baseline, most residents’ scores were in the normal range with respect to stress; however, female residents had higher DASS-21 scores than male residents (31.7, females vs 18.4, males; P=0.002. Most residents’ burnout scores were in the abnormal range, both with respect to exhaustion (38/47 residents, subscore ≥2.25 and disengagement (37/47 residents, subscore ≥2.1. Higher perceived levels of stress correlated with the instruments. Analysis of the surveys before and after the intervention showed no significant short-term change in stress, burnout, mindful-awareness, or cognitive failure. There was a trend for females and post-medical school graduate year 1 and 2 (PGY1 and PGY2 residents to have a reduction in DASS-21 scores after intervention. There was also a trend of

  14. Evidence-based practice for pain identification in cognitively impaired nursing home residents.

    Science.gov (United States)

    Sacoco, Christina; Ishikawa, Sally

    2014-09-01

    Pain identification of cognitively impaired elderly is very challenging. This project aimed to identify best practices for pain assessment in nursing home residents with cognitive impairment and to establish a standardized pain assessment guide to optimize nursing practice and resident outcomes. The Iowa Model of Evidence-Based Practice to Promote Quality of Care guided the project's process. Phase I of the project analyzed data gained from chart reviews on current practices of pain assessment, and Phase II used the results of Phase I to develop, implement, and evaluate an evidence-based practice standard for nursing assessment of pain for cognitively impaired residents. Copyright © 2014 Elsevier Inc. All rights reserved.

  15. A Learning-Based Approach to Reactive Security

    Science.gov (United States)

    Barth, Adam; Rubinstein, Benjamin I. P.; Sundararajan, Mukund; Mitchell, John C.; Song, Dawn; Bartlett, Peter L.

    Despite the conventional wisdom that proactive security is superior to reactive security, we show that reactive security can be competitive with proactive security as long as the reactive defender learns from past attacks instead of myopically overreacting to the last attack. Our game-theoretic model follows common practice in the security literature by making worst-case assumptions about the attacker: we grant the attacker complete knowledge of the defender's strategy and do not require the attacker to act rationally. In this model, we bound the competitive ratio between a reactive defense algorithm (which is inspired by online learning theory) and the best fixed proactive defense. Additionally, we show that, unlike proactive defenses, this reactive strategy is robust to a lack of information about the attacker's incentives and knowledge.

  16. Nucleophilic stabilization of water-based reactive ink for titania-based thin film inkjet printing

    DEFF Research Database (Denmark)

    Gadea, Christophe; Marani, Debora; Esposito, Vincenzo

    2017-01-01

    Drop on demand deposition (DoD) of titanium oxide thin films (<500 nm) is performed via a novel titanium-alkoxide-based solution that is tailored as a reactive ink for inkjet printing. The ink is developed as water-based solution by a combined use of titanium isopropoxide and n-methyldiethanolami...

  17. Applying health information technology and team-based care to residency education.

    Science.gov (United States)

    Brown, Kristy K; Master-Hunter, Tara A; Cooke, James M; Wimsatt, Leslie A; Green, Lee A

    2011-01-01

    Training physicians capable of practicing within the Patient-centered Medical Home (PCMH) is an emerging area of scholarly inquiry within residency education. This study describes an effort to integrate PCMH principles into teaching practices within a university-based residency setting and evaluates the effect on clinical performance. Using participant feedback and clinical data extracted from an electronic clinical quality management system, we retrospectively examined performance outcomes at two family medicine residency clinics over a 7-year period. Instructional approaches were identified and clinical performance patterns analyzed. Alumni ratings of the practice-based curriculum increased following institution of the PCMH model. Clinical performance outcomes indicated improvements in the delivery of clinical care to patients. Implementation of instructional methodologies posed some challenges to residency faculty, particularly in development of consistent scheduling of individualized feedback sessions. Residents required the greatest support and guidance in managing point-of-care clinical reminders during patient encounters. Teaching practices that take into consideration the integration of team-based care and use of electronic health technologies can successfully be used to deliver residency education in the context of the PCMH model. Ongoing assessment provides important information to residency directors and faculty in support of improving the quality of clinical instruction.

  18. Orion: a web-based application designed to monitor resident and fellow performance on-call.

    Science.gov (United States)

    Itri, Jason N; Kim, Woojin; Scanlon, Mary H

    2011-10-01

    Radiology residency and fellowship training provides a unique opportunity to evaluate trainee performance and determine the impact of various educational interventions. We have developed a simple software application (Orion) using open-source tools to facilitate the identification and monitoring of resident and fellow discrepancies in on-call preliminary reports. Over a 6-month period, 19,200 on-call studies were interpreted by 20 radiology residents, and 13,953 on-call studies were interpreted by 25 board-certified radiology fellows representing eight subspecialties. Using standard review macros during faculty interpretation, each of these reports was classified as "agreement", "minor discrepancy", and "major discrepancy" based on the potential to impact patient management or outcome. Major discrepancy rates were used to establish benchmarks for resident and fellow performance by year of training, modality, and subspecialty, and to identify residents and fellows demonstrating a significantly higher major discrepancy rate compared with their classmates. Trends in discrepancies were used to identify subspecialty-specific areas of increased major discrepancy rates in an effort to tailor the didactic and case-based curriculum. A series of missed-case conferences were developed based on trends in discrepancies, and the impact of these conferences is currently being evaluated. Orion is a powerful information technology tool that can be used by residency program directors, fellowship programs directors, residents, and fellows to improve radiology education and training.

  19. Effects of acid-base imbalance on vascular reactivity

    Directory of Open Access Journals (Sweden)

    A.C. Celotto

    2008-06-01

    Full Text Available Acid-base homeostasis maintains systemic arterial pH within a narrow range. Whereas the normal range of pH for clinical laboratories is 7.35-7.45, in vivo pH is maintained within a much narrower range. In clinical and experimental settings, blood pH can vary in response to respiratory or renal impairment. This altered pH promotes changes in vascular smooth muscle tone with impact on circulation and blood pressure control. Changes in pH can be divided into those occurring in the extracellular space (pHo and those occurring within the intracellular space (pHi, although, extracellular and intracellular compartments influence each other. Consistent with the multiple events involved in the changes in tone produced by altered pHo, including type of vascular bed, several factors and mechanisms, in addition to hydrogen ion concentration, have been suggested to be involved. The scientific literature has many reports concerning acid-base balance and endothelium function, but these concepts are not clear about acid-base disorders and their relations with the three known mechanisms of endothelium-dependent vascular reactivity: nitric oxide (NO/cGMP-dependent, prostacyclin (PGI2/cAMP-dependent and hyperpolarization. During the last decades, many studies have been published and have given rise to confronting data on acid-base disorder and endothelial function. Therefore, the main proposal of this review is to provide a critical analysis of the state of art and incentivate researchers to develop more studies about these issues.

  20. Interactive case-based learning improves resident knowledge and confidence in reproductive endocrinology and infertility.

    Science.gov (United States)

    Goldman, Kara N; Tiegs, Ashley W; Uquillas, Kristen; Nachtigall, Margaret; Fino, M Elizabeth; Winkel, Abigail F; Lerner, Veronica

    2017-06-01

    Resident physicians' scores on the REI section of the CREOG exam are traditionally low, and nearly 40% of house staff nation-wide perceive their REI knowledge to be poor. We aimed to assess whether an interactive case-based group-learning curriculum would narrow the REI knowledge gap by improving understanding and retention of core REI concepts under the time constraints affecting residents. A three-hour case-based workshop was developed to address four primary CREOG objectives. A multiple-choice test was administered immediately before and after the intervention and 7 weeks post-workshop, to evaluate both knowledge and confidence. Following the intervention, residents self-reported increased confidence with counseling and treatment of PCOS, ovulation induction cycle monitoring, counseling and treatment of POI, and breaking bad news related to infertility (p < 0.05). The multiple-choice exam was re-administered 7 weeks post-intervention, and scores remained significantly improved compared to pre-workshop scores (p < 0.05). At that time, all residents either strongly agreed (91.7%) or agreed (8.3%) that the case-based interactive format was preferable to traditional lecture-based teaching. In conclusion, a nontraditional curriculum aimed at teaching core REI concepts to residents through interactive case-based learning can be successfully integrated into a residency curriculum, and significantly improves knowledge and confidence of critical concepts in REI.

  1. Factors Affecting Gender-based Experiences for Residents in Radiation Oncology

    International Nuclear Information System (INIS)

    Barry, Parul N.; Miller, Karen H.; Ziegler, Craig; Hertz, Rosanna; Hanna, Nevine; Dragun, Anthony E.

    2016-01-01

    Purpose: Although women constitute approximately half of medical school graduates, an uneven gender distribution exists among many specialties, including radiation oncology, where women fill only one third of residency positions. Although multiple social and societal factors have been theorized, a structured review of radiation oncology resident experiences has yet to be performed. Methods and Materials: An anonymous and voluntary survey was sent to 611 radiation oncology residents practicing in the United States. Residents were asked about their gender-based experiences in terms of mentorship, their professional and learning environment, and their partnerships and personal life. Results: A total of 203 participants submitted completed survey responses. Fifty-seven percent of respondents were men, and 43% were women, with a mean age of 31 years (standard deviation=3.7 years). Although residents in general value having a mentor, female residents prefer mentors of the same gender (P<.001), and noted having more difficulty finding a mentor (P=.042). Women were more likely to say that they have observed preferential treatment based on gender (P≤.001), and they were more likely to perceive gender-specific biases or obstacles in their professional and learning environment (P<.001). Women selected residency programs based on gender ratios (P<.001), and female residents preferred to see equal numbers of male and female faculty (P<.001). Women were also more likely to perceive work-related strain than their male counterparts (P<.001). Conclusions: Differences in experiences for male and female radiation oncology residents exist with regard to mentorship and in their professional and learning environment.

  2. Factors Affecting Gender-based Experiences for Residents in Radiation Oncology

    Energy Technology Data Exchange (ETDEWEB)

    Barry, Parul N., E-mail: pnbarr01@louisville.edu [Department of Radiation Oncology, University of Louisville, School of Medicine, Louisville, Kentucky (United States); Miller, Karen H.; Ziegler, Craig [Department of Graduate Medical Education, University of Louisville, School of Medicine, Louisville, Kentucky (United States); Hertz, Rosanna [Departments of Women' s and Gender Studies and Sociology, Wellesley College, Wellesley, Massachusetts (United States); Hanna, Nevine [Department of Radiation Oncology, University of Utah, School of Medicine, Salt Lake City, Utah (United States); Dragun, Anthony E. [Department of Radiation Oncology, University of Louisville, School of Medicine, Louisville, Kentucky (United States)

    2016-07-01

    Purpose: Although women constitute approximately half of medical school graduates, an uneven gender distribution exists among many specialties, including radiation oncology, where women fill only one third of residency positions. Although multiple social and societal factors have been theorized, a structured review of radiation oncology resident experiences has yet to be performed. Methods and Materials: An anonymous and voluntary survey was sent to 611 radiation oncology residents practicing in the United States. Residents were asked about their gender-based experiences in terms of mentorship, their professional and learning environment, and their partnerships and personal life. Results: A total of 203 participants submitted completed survey responses. Fifty-seven percent of respondents were men, and 43% were women, with a mean age of 31 years (standard deviation=3.7 years). Although residents in general value having a mentor, female residents prefer mentors of the same gender (P<.001), and noted having more difficulty finding a mentor (P=.042). Women were more likely to say that they have observed preferential treatment based on gender (P≤.001), and they were more likely to perceive gender-specific biases or obstacles in their professional and learning environment (P<.001). Women selected residency programs based on gender ratios (P<.001), and female residents preferred to see equal numbers of male and female faculty (P<.001). Women were also more likely to perceive work-related strain than their male counterparts (P<.001). Conclusions: Differences in experiences for male and female radiation oncology residents exist with regard to mentorship and in their professional and learning environment.

  3. Putting residents in the office: an effective method to teach the systems-based practice competency.

    Science.gov (United States)

    Pulcrano, Marisa; Chahine, A Alfred; Saratsis, Amanda; Divine-Cadavid, Jamie; Narra, Vinod; Evans, Stephen R T

    2015-01-01

    Systems-based practice (SBP) was 1 of 6 core competencies established by the Accreditation Council for Graduate Medical Education and has proven to be one of the most difficult to effectively implement. This pilot study presents an immersion workshop as an effective tool to teach the SBP competency in a way that could easily be integrated into a residency curriculum. In 2006, 16 surgical residents rotated through 3 stations for 30 minutes each: coding and billing, scheduling operations and return appointments, and patient check-in. Participants were administered a pretest and posttest questionnaire evaluating their knowledge of SBP, and were asked to evaluate the workshop. Outpatient clinic at MedStar Georgetown University Hospital, Washington, DC. Residents in the general surgery residency training program at MedStar Georgetown University Hospital. Most residents (62.5%) improved their score after the workshop, whereas 31.25% showed no change and 6.25% demonstrated a decrease in score. Overall within their training levels, all groups demonstrated an increase in mean test score. Postgraduate year-2 residents demonstrated the greatest change in mean score (20%), whereas postgraduate year-4 residents demonstrated the smallest change in mean score (3.3%). An immersion workshop where general surgery residents gained direct exposure to SBP concepts in situ was an effective and practical method of integrating this core competency into the residency curriculum. Such a workshop could complement more formal didactic teaching and be easily incorporated into the curriculum. For example, this workshop could be integrated into the ambulatory care requirement that each resident must fulfill as part of their clinical training. Copyright © 2014 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  4. Evaluation of clinical teaching quality in competency-based residency training in Lithuania.

    Science.gov (United States)

    Vaižgėlienė, Eglė; Padaiga, Žilvinas; Rastenytė, Daiva; Tamelis, Algimantas; Petrikonis, Kęstutis; Fluit, Cornelia

    2017-12-01

    In 2013, all residency programs at the Lithuanian University of Health Sciences were renewed into the competency-based medical education curriculum (CBME). In 2015, we implemented the validated EFFECT questionnaire together with the EFFECT-System for quality assessment of clinical teaching in residency training. The aim of this study was to investigate the influence of characteristics of the resident (year of training) and clinical teacher (gender, age, and type of academic position) on teaching quality, as well as to assess areas for teaching quality improvement. Residents from 7 different residency study programs filled out 333 EFFECT questionnaires evaluating 146 clinical teachers. We received 143 self-evaluations of clinical teachers using the same questionnaire. Items were scored on a 6-point Likert scale. Main outcome measures were residents' mean overall (MOS), mean subdomain (MSS) and clinical teachers' self-evaluation scores. The overall comparisons of MOS and MSS across study groups and subgroups were done using Student's t test and ANOVA for trend. The intraclass correlation coefficient (ICC) was calculated in order to see how residents' evaluations match with self-evaluations for every particular teacher. To indicate areas for quality improvement items were analyzed subtracting their mean score from the respective (sub)domain score. MOS for domains of "role modeling", "task allocation", "feedback", "teaching methodology" and "assessment" valued by residents were significantly higher than those valued by teachers (Pevaluation questionnaires were rated significantly higher by residents in role modeling subdomains (Phigher than the female teachers (Phigher (Pevaluations of clinical teachers are influenced by teachers' age, gender, year of residency training, type of teachers' academic position and whether or not a clinical teacher performed self-evaluation. Development of CBME should be focused on the continuous evaluation of quality, clinical teachers

  5. Auto-reactive T cells revised. Overestimation based on methodology?

    DEFF Research Database (Denmark)

    Thorlacius-Ussing, Gorm; Sørensen, Jesper F; Wandall, Hans H

    2015-01-01

    . Thus, T cell antigen reactivities identified with unmodified antigens in vitro may in part represent in vitro T cell activation against neo-epitopes and not true in vivo autoreactivity as postulated. This methodological problem may have implications for the interpretation of the frequent reporting...... methodology applied to document T cell reactivity against unmodified protein or peptide may lead to overinterpretation of the reported frequencies of autoreactive CD4+ and CD8+ T cells....

  6. Evaluation of Problem- and Simulator-Based Learning in Lumbar Puncture in Adult Neurology Residency Training.

    Science.gov (United States)

    Sun, Chenjing; Qi, Xiaokun

    2018-01-01

    Lumbar puncture (LP) is an essential part of adult neurology residency training. Technologic as well as nontechnologic training is needed. However, current assessment tools mostly focus on the technologic aspects of LP. We propose a training method-problem- and simulator-based learning (PSBL)-in LP residency training to develop overall skills of neurology residents. We enrolled 60 neurology postgraduate-year-1 residents from our standardized residents training center and randomly divided them into 2 groups: traditional teaching group and PSBL group. After training, we assessed the extent that the residents were ready to perform LP and tracked successful LPs performed by the residents. We then asked residents to complete questionnaires about the training models. Performance scores and the results of questionnaires were compared between the 2 groups. Students and faculty concluded that PSBL provided a more effective learning experience than the traditional teaching model. Although no statistical difference was found in the pretest, posttest, and improvement rate scores between the 2 groups, based on questionnaire scores and number of successful LPs after training, the PSBL group showed a statistically significant improvement compared with the traditional group. Findings indicated that nontechnical elements, such as planning before the procedure and controlling uncertainties during the procedure, are more crucial than technical elements. Compared with traditional teaching model, PSBL for LP training can develop overall surgical skills, including technical and nontechnical elements, improving performance. Residents in the PSBL group were more confident and effective in performing LP. Copyright © 2017 Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

    Fok, Mark C; Wong, Roger Y

    2014-11-28

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

  8. Resident response to integration of simulation-based education into emergency medicine conference.

    Science.gov (United States)

    Wang, Ernest E; Beaumont, Jennifer; Kharasch, Morris; Vozenilek, John A

    2008-11-01

    Utilization of simulation-based training has become increasingly prevalent in residency training. The authors compared emergency medicine (EM) resident feedback for simulation sessions to traditional lectures from an EM residency didactic program. The authors performed a retrospective review of all written EM conference evaluations over a 29-month period. Evaluation questions were scored on a 1-9 Likert scale. Lectures and simulation accounted for 77.6 and 22.4% of the conferences, respectively. Scored means (+/-standard deviations [SDs]) were as follows: overall, lecture 7.97 +/- 0.74 versus simulation 8.373 +/- 0.44 (p higher than traditional lectures. The scores over time suggest that this preference for simulation can be sustainable long term. Residents perceive simulation as more desirable teaching method compared to the traditional lecture format.

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

    Science.gov (United States)

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

    2015-09-01

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

  10. Priority Queue Based Reactive Buffer Management Policy for Delay Tolerant Network under City Based Environments.

    Directory of Open Access Journals (Sweden)

    Qaisar Ayub

    Full Text Available Delay Tolerant Network (DTN multi-copy routing protocols are privileged to create and transmit multiple copies of each message that causes congestion and some messages are dropped. This process is known as reactive drop because messages were dropped re-actively to overcome buffer overflows. The existing reactive buffer management policies apply a single metric to drop source, relay and destine messages. Hereby, selection to drop a message is dubious because each message as source, relay or destine may have consumed dissimilar magnitude of network resources. Similarly, DTN has included time to live (ttl parameter which defines lifetime of message. Hence, when ttl expires then message is automatically destroyed from relay nodes. However, time-to-live (ttl is not applicable on messages reached at their destinations. Moreover, nodes keep replicating messages till ttl expires even-though large number of messages has already been dispersed. In this paper, we have proposed Priority Queue Based Reactive Buffer Management Policy (PQB-R for DTN under City Based Environments. The PQB-R classifies buffered messages into source, relay and destine queues. Moreover, separate drop metric has been applied on individual queue. The experiment results prove that proposed PQB-R has reduced number of messages transmissions, message drop and increases delivery ratio.

  11. Priority Queue Based Reactive Buffer Management Policy for Delay Tolerant Network under City Based Environments.

    Science.gov (United States)

    Ayub, Qaisar; Ngadi, Asri; Rashid, Sulma; Habib, Hafiz Adnan

    2018-01-01

    Delay Tolerant Network (DTN) multi-copy routing protocols are privileged to create and transmit multiple copies of each message that causes congestion and some messages are dropped. This process is known as reactive drop because messages were dropped re-actively to overcome buffer overflows. The existing reactive buffer management policies apply a single metric to drop source, relay and destine messages. Hereby, selection to drop a message is dubious because each message as source, relay or destine may have consumed dissimilar magnitude of network resources. Similarly, DTN has included time to live (ttl) parameter which defines lifetime of message. Hence, when ttl expires then message is automatically destroyed from relay nodes. However, time-to-live (ttl) is not applicable on messages reached at their destinations. Moreover, nodes keep replicating messages till ttl expires even-though large number of messages has already been dispersed. In this paper, we have proposed Priority Queue Based Reactive Buffer Management Policy (PQB-R) for DTN under City Based Environments. The PQB-R classifies buffered messages into source, relay and destine queues. Moreover, separate drop metric has been applied on individual queue. The experiment results prove that proposed PQB-R has reduced number of messages transmissions, message drop and increases delivery ratio.

  12. Education research: a case-based bioethics curriculum for neurology residents.

    Science.gov (United States)

    Tolchin, Benjamin; Willey, Joshua Z; Prager, Kenneth

    2015-03-31

    In 2012, the American Academy of Neurology (AAN) updated and expanded its ethics curriculum into Practical Ethics in Clinical Neurology, a case-based ethics curriculum for neurologists. We piloted a case-based bioethics curriculum for neurology residents using the framework and topics recommended by the AAN, matched to clinical cases drawn from Columbia's neurologic services. Our primary outcome was residents' ability to analyze and manage ethically complex cases as measured on precurriculum and postcurriculum multiple-choice quizzes. Secondary outcomes included precurriculum and postcurriculum self-assessed comfort in discussing and managing ethically complex cases, as well as attendance at ethics discussion sessions as compared to attendance at other didactic sessions. Resident performance on quizzes improved from 75.8% to 86.7% (p = 0.02). Comfort in discussing ethically complex cases improved from 6.4 to 7.4 on a 10-point scale (p = 0.03). Comfort in managing such cases trended toward improvement but did not reach statistical significance. Attendance was significantly better at ethics discussions (73.5%) than at other didactic sessions (61.7%, p = 0.04). Our formal case-based ethics curriculum for neurology residents, based on core topics drawn from the AAN's published curricula, was successfully piloted. Our study showed a statistically significant improvement in residents' ability to analyze and manage ethically complex cases as measured by multiple-choice tests and self-assessments. © 2015 American Academy of Neurology.

  13. Burnout in Medical Residents: A Study Based on the Job Demands-Resources Model

    Directory of Open Access Journals (Sweden)

    Panagiotis Zis

    2014-01-01

    Full Text Available Purpose. Burnout is a prolonged response to chronic emotional and interpersonal stressors on the job. The purpose of our cross-sectional study was to estimate the burnout rates among medical residents in the largest Greek hospital in 2012 and identify factors associated with it, based on the job demands-resources model (JD-R. Method. Job demands were examined via a 17-item questionnaire assessing 4 characteristics (emotional demands, intellectual demands, workload, and home-work demands’ interface and job resources were measured via a 14-item questionnaire assessing 4 characteristics (autonomy, opportunities for professional development, support from colleagues, and supervisor’s support. The Maslach Burnout Inventory (MBI was used to measure burnout. Results. Of the 290 eligible residents, 90.7% responded. In total 14.4% of the residents were found to experience burnout. Multiple logistic regression analysis revealed that each increased point in the JD-R questionnaire score regarding home-work interface was associated with an increase in the odds of burnout by 25.5%. Conversely, each increased point for autonomy, opportunities in professional development, and each extra resident per specialist were associated with a decrease in the odds of burnout by 37.1%, 39.4%, and 59.0%, respectively. Conclusions. Burnout among medical residents is associated with home-work interface, autonomy, professional development, and resident to specialist ratio.

  14. Informatics in radiology: web-based preliminary reporting system for radiology residents with PACS integration.

    Science.gov (United States)

    O'Connell, Timothy; Chang, Debra

    2012-01-01

    While on call, radiology residents review imaging studies and issue preliminary reports to referring clinicians. In the absence of an integrated reporting system at the training sites of the authors' institution, residents were typing and faxing preliminary reports. To partially automate the on-call resident workflow, a Web-based system for resident reporting was developed by using the free open-source xAMP Web application framework and an open-source DICOM (Digital Imaging and Communications in Medicine) software toolkit, with the goals of reducing errors and lowering barriers to education. This reporting system integrates with the picture archiving and communication system to display a worklist of studies. Patient data are automatically entered in the preliminary report to prevent identification errors and simplify the report creation process. When the final report for a resident's on-call study is available, the reporting system queries the report broker for the final report, and then displays the preliminary report side by side with the final report, thus simplifying the review process and encouraging review of all of the resident's reports. The xAMP Web application framework should be considered for development of radiology department informatics projects owing to its zero cost, minimal hardware requirements, ease of programming, and large support community.

  15. A longitudinal simulation-based ethical-legal curriculum for otolaryngology residents.

    Science.gov (United States)

    Fanous, Amanda; Rappaport, Jamie; Young, Meredith; Park, Yoon Soo; Manoukian, John; Nguyen, Lily H P

    2017-11-01

    To develop, implement, and evaluate a longitudinal, simulation-based ethics and legal curriculum designed specifically for otolaryngology residents. Otolaryngology residents were recruited to participate in a yearly half-day ethical-legal module, the curriculum of which spanned 4 years. Each module included: three simulated scenarios, small-group multisource feedback, and large-group debriefings. Scenarios involved encounters with standardized patients. Residents' ethical-legal knowledge was assessed pre- and postmodule with multiple-choice questions, and ethical reasoning was assessed by a variety of evaluators during the simulated scenario using a locally developed assessment tool. Participants completed an exit survey at the end of each module. Eighteen residents completed four modules from the academic years of 2008 to 2009 to 2011 to 2012. The first year was considered a pilot module, and data were collected for the following 3 years. Knowledge of legal issues improved significantly among residents (mean at pre = 3.40 and post = 4.60, P otolaryngology-head and neck surgery residents. This educational program resulted in a both objective and subjective improvement in legal and ethics knowledge and skills. NA. Laryngoscope, 127:2501-2509, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

  16. Burnout in medical residents: a study based on the job demands-resources model.

    Science.gov (United States)

    Zis, Panagiotis; Anagnostopoulos, Fotios; Sykioti, Panagiota

    2014-01-01

    Burnout is a prolonged response to chronic emotional and interpersonal stressors on the job. The purpose of our cross-sectional study was to estimate the burnout rates among medical residents in the largest Greek hospital in 2012 and identify factors associated with it, based on the job demands-resources model (JD-R). Job demands were examined via a 17-item questionnaire assessing 4 characteristics (emotional demands, intellectual demands, workload, and home-work demands' interface) and job resources were measured via a 14-item questionnaire assessing 4 characteristics (autonomy, opportunities for professional development, support from colleagues, and supervisor's support). The Maslach Burnout Inventory (MBI) was used to measure burnout. Of the 290 eligible residents, 90.7% responded. In total 14.4% of the residents were found to experience burnout. Multiple logistic regression analysis revealed that each increased point in the JD-R questionnaire score regarding home-work interface was associated with an increase in the odds of burnout by 25.5%. Conversely, each increased point for autonomy, opportunities in professional development, and each extra resident per specialist were associated with a decrease in the odds of burnout by 37.1%, 39.4%, and 59.0%, respectively. Burnout among medical residents is associated with home-work interface, autonomy, professional development, and resident to specialist ratio.

  17. Videoconferencing of a national program for residents on evidence-based practice: early performance evaluation.

    LENUS (Irish Health Repository)

    O'Regan, Kevin

    2010-01-01

    The aim of this study was to evaluate the effectiveness of the medium of videoconferencing for the delivery of a course for radiology residents in practice-based learning (PBL), including evidence-based practice, at centers geographically separated from the principal teaching site.

  18. Teaching Evidence-Based Medicine Skills through a Residency-Developed Guideline.

    Science.gov (United States)

    Epling, John; Smucny, John; Patil, Anita; Tudiver, Fred

    2002-01-01

    Describes a curriculum intended to culminate in a resident-produced, evidence-based guideline for the care of patients with diabetes. Evaluation of the curriculum showed that learners appreciated the skills and knowledge gained in devising guidelines in an evidence-based manner but were uncertain that their searches were complete. Clinical…

  19. Are general surgery residents adequately prepared for hepatopancreatobiliary fellowships? A questionnaire-based study

    Science.gov (United States)

    Osman, Houssam; Parikh, Janak; Patel, Shirali; Jeyarajah, D Rohan

    2015-01-01

    Background The present study was conducted to assess the preparedness of hepatopancreatobiliary (HPB) fellows upon entering fellowship, identify challenges encountered by HPB fellows during the initial part of their HPB training, and identify potential solutions to these challenges that can be applied during residency training. Methods A questionnaire was distributed to all HPB fellows in accredited HPB fellowship programmes in two consecutive academic years (n = 42). Reponses were then analysed. Results A total of 19 (45%) fellows responded. Prior to their fellowship, 10 (53%) were in surgical residency and the rest were in other surgical fellowships or surgical practice. Thirteen (68%) were graduates of university-based residency programmes. All fellows felt comfortable in performing basic laparoscopic procedures independently at the completion of residency and less comfortable in performing advanced laparoscopy. Eight (42%) fellows cited a combination of inadequate case volume and lack of autonomy during residency as the reasons for this lack of comfort. Thirteen (68%) identified inadequate preoperative workup and management as their biggest fear upon entering practice after general surgery training. A total of 17 (89%) fellows felt they were adequately prepared to enter HPB fellowship. Extra rotations in transplant, vascular or minimally invasive surgery were believed to be most helpful in preparing general surgery residents pursing HPB fellowships. Conclusions Overall, HPB fellows felt themselves to be adequately prepared for fellowship. Advanced laparoscopic procedures and the perioperative management of complex patients are two of the challenges facing HPB fellows. General surgery residents who plan to pursue an HPB fellowship may benefit from spending extra rotations on certain subspecialties. Focus on perioperative workup and management should be an integral part of residency and fellowship training. PMID:25387852

  20. Evaluation of a web-based portal to improve resident education by neonatology fellows

    Directory of Open Access Journals (Sweden)

    Ashwini Lakshmanan

    2014-07-01

    Full Text Available Background: Integration of web-based educational tools into medical training has been shown to increase accessibility of resources and optimize teaching. We developed a web-based educational portal (WBEP to support teaching of pediatric residents about newborn medicine by neonatology fellows. Objectives: 1 To compare residents’ attitudes about their fellow-led education in the NICU pre- and post-WBEP; including assessment of factors that impact their education and usefulness of teaching tools. 2 To compare fellow utilization of various teaching modalities pre- and post-WBEP. Design/methods: We queried residents about their attitudes regarding fellow-led education efforts and various teaching modalities in the NICU and logistics potentially impacting effectiveness. Based on these data, we introduced the WBEP – a repository of teaching tools (e.g., mock code cases, board review questions, journal articles, case-based discussion scenarios for use by fellows to supplement didactic sessions in a faculty-based curriculum. We surveyed residents about the effectiveness of fellow teaching pre- and post-WBEP implementation and the type of fellow-led teaching modalities that were used. Results: After analysis of survey responses, we identified that residents cited fellow level of interest as the most important factor impacting their education. Post-implementation, residents described greater utilization of various teaching modalities by fellows, including an increase in use of mock codes (14% to 76%, p<0.0001 and journal articles (33% to 59%, p=0.02. Conclusions: A web-based resource that supplements traditional curricula led to greater utilization of various teaching modalities by fellows and may encourage fellow involvement in resident teaching.

  1. Assessment of a Chief Complaint–Based Curriculum for Resident Education in Geriatric Emergency Medicine

    Directory of Open Access Journals (Sweden)

    Robert L Muelleman

    2011-05-01

    Full Text Available Introduction: We hypothesized that a geriatric chief complaint–based didactic curriculum would improve resident documentation of elderly patient care in the emergency department (ED. Methods: A geriatric chief complaint curriculum addressing the 3 most common chief complaints—abdominal pain, weakness, and falls—was developed and presented. A pre- and postcurriculum implementation chart review assessed resident documentation of the 5 components of geriatric ED care: 1 differential diagnosis/patient evaluation considering atypical presentations, 2 determination of baseline function, 3 chronic care facility/caregiver communication, 4 cognitive assessment, and 5 assessment of polypharmacy. A single reviewer assessed 5 pre- and 5 postimplementation charts for each of 18 residents included in the study. We calculated 95% confidence and determined that statistical significance was determined by a 2-tailed z test for 2 proportions, with statistical significance at 0.003 by Bonferroni correction. Results: For falls, resident documentation improved significantly for 1 of 5 measures. For abdominal pain, 2 of 5 components improved. For weakness, 3 of 5 components improved. Conclusion: A geriatric chief complaint–based curriculum improved emergency medicine resident documentation for the care of elderly patients in the ED compared with a non–age-specific chief complaint–based curriculum. [West J Emerg Med. 2011;12(4:484–488.

  2. Stress reactivity and personality in extreme sport athletes: The psychobiology of BASE jumpers.

    Science.gov (United States)

    Monasterio, Erik; Mei-Dan, Omer; Hackney, Anthony C; Lane, Amy R; Zwir, Igor; Rozsa, Sandor; Cloninger, C Robert

    2016-12-01

    This is the first report of the psychobiology of stress in BASE jumpers, one of the most dangerous forms of extreme sport. We tested the hypotheses that indicators of emotional style (temperament) predict salivary cortisol reactivity, whereas indicators of intentional goal-setting (persistence and character) predict salivary alpha-amylase reactivity during BASE jumping. Ninety-eight subjects completed the Temperament and Character Inventory (TCI) the day before the jump, and 77 also gave salivary samples at baseline, pre-jump on the bridge over the New River Gorge, and post-jump upon landing. Overall BASE jumpers are highly resilient individuals who are highly self-directed, persistent, and risk-taking, but they are heterogeneous in their motives and stress reactivity in the Hypothalamic-Pituitary-Adrenal (HPA) stress system (cortisol reactivity) and the sympathetic arousal system (alpha-amylase reactivity). Three classes of jumpers were identified using latent class analysis based on their personality profiles, prior jumping experience, and levels of cortisol and alpha-amylase at all three time points. "Masterful" jumpers (class 1) had a strong sense of self-directedness and mastery, extensive prior experience, and had little alpha-amylase reactivity and average cortisol reactivity. "Trustful" jumpers (class 2) were highly cooperative and trustful individuals who had little cortisol reactivity coincident with the social support they experienced prior to jumping. "Courageous" jumpers (class 3) were determined despite anxiety and inexperience, and they had high sympathetic reactivity but average cortisol activation. We conclude that trusting social attachment (Reward Dependence) and not jumping experience predicted low cortisol reactivity, whereas persistence (determination) and not jumping experience predicted high alpha-amylase reactivity. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

  3. Model-Based Testing of a Reactive System with Coloured Petri Nets

    DEFF Research Database (Denmark)

    Tjell, Simon

    2006-01-01

    In this paper, a reactive and nondeterministic system is tested. This is doneby applying a generic model that has been specified as a configurable Coloured PetriNet. In this way, model-based testing is possible for a wide class of reactive system atthe level of discrete events. Concurrently...

  4. Residents' surgical performance during the laboratory years: an analysis of rule-based errors.

    Science.gov (United States)

    Nathwani, Jay N; Wise, Brett J; Garren, Margaret E; Mohamadipanah, Hossein; Van Beek, Nicole; DiMarco, Shannon M; Pugh, Carla M

    2017-11-01

    Nearly one-third of surgical residents will enter into academic development during their surgical residency by dedicating time to a research fellowship for 1-3 y. Major interest lies in understanding how laboratory residents' surgical skills are affected by minimal clinical exposure during academic development. A widely held concern is that the time away from clinical exposure results in surgical skills decay. This study examines the impact of the academic development years on residents' operative performance. We hypothesize that the use of repeated, annual assessments may result in learning even without individual feedback on participants simulated performance. Surgical performance data were collected from laboratory residents (postgraduate years 2-5) during the summers of 2014, 2015, and 2016. Residents had 15 min to complete a shortened, simulated laparoscopic ventral hernia repair procedure. Final hernia repair skins from all participants were scored using a previously validated checklist. An analysis of variance test compared the mean performance scores of repeat participants to those of first time participants. Twenty-seven (37% female) laboratory residents provided 2-year assessment data over the 3-year span of the study. Second time performance revealed improvement from a mean score of 14 (standard error = 1.0) in the first year to 17.2 (SD = 0.9) in the second year, (F[1, 52] = 5.6, P = 0.022). Detailed analysis demonstrated improvement in performance for 3 grading criteria that were considered to be rule-based errors. There was no improvement in operative strategy errors. Analysis of longitudinal performance of laboratory residents shows higher scores for repeat participants in the category of rule-based errors. These findings suggest that laboratory residents can learn from rule-based mistakes when provided with annual performance-based assessments. This benefit was not seen with operative strategy errors and has important implications for

  5. The research rotation: competency-based structured and novel approach to research training of internal medicine residents

    Directory of Open Access Journals (Sweden)

    Dimitrov Vihren

    2006-10-01

    Full Text Available Abstract Background In the United States, the Accreditation Council of graduate medical education (ACGME requires all accredited Internal medicine residency training programs to facilitate resident scholarly activities. However, clinical experience and medical education still remain the main focus of graduate medical education in many Internal Medicine (IM residency-training programs. Left to design the structure, process and outcome evaluation of the ACGME research requirement, residency-training programs are faced with numerous barriers. Many residency programs report having been cited by the ACGME residency review committee in IM for lack of scholarly activity by residents. Methods We would like to share our experience at Lincoln Hospital, an affiliate of Weill Medical College Cornell University New York, in designing and implementing a successful structured research curriculum based on ACGME competencies taught during a dedicated "research rotation". Results Since the inception of the research rotation in 2004, participation of our residents among scholarly activities has substantially increased. Our residents increasingly believe and appreciate that research is an integral component of residency training and essential for practice of medicine. Conclusion Internal medicine residents' outlook in research can be significantly improved using a research curriculum offered through a structured and dedicated research rotation. This is exemplified by the improvement noted in resident satisfaction, their participation in scholarly activities and resident research outcomes since the inception of the research rotation in our internal medicine training program.

  6. Current situation and consideration of training base hospitals for residents of neurosurgical specialization in China

    Directory of Open Access Journals (Sweden)

    Feng-zeng JIAN

    2015-07-01

    Full Text Available Resident training of neurosurgical specialization will be tried and carried out in all over China. From the point of view of training base hospitals, a majority of 3A level hospitals have sufficient patients and good equipments which will ensure the success of training process; however, division of subspecialty, teaching motivation and teaching method still have a great potential to improve. In order to establish and improve training bases for residents of specialization, supervision from national administrative department should be strengthened; professional society also plays an important role in standardizing and controlling the training quality. Considering our nation's situation, integration of postgraduate education and resident training is worth of discussion. DOI: 10.3969/j.issn.1672-6731.2015.07.015

  7. Factors that affect implementation of web-based faculty evaluation forms: residents' perspectives from a developing country.

    Science.gov (United States)

    Ibrahim, S H; Ali, S K; Sadaf, S

    2010-08-01

    A web-based evaluation system for residents to provide feedback on faculty was piloted in four training programs at the Aga Khan University prior to institution-wide implementation. Of the four programs, less than 50% of forms were submitted by residents of three programs while more than 70% of forms were submitted by the residents of one program. This study was conducted to identify reasons for the varying participation rates of the four programs with a view to improving the system. A qualitative approach was employed using focus group discussions (FGDs). Volunteers were invited and three groups of eight to ten residents each were formed. Participants for FGDs were selected from all residency years. FGDs were used to identify residents' perceptions regarding the web-based faculty evaluation system and to identify residents' problems and concerns with completing the web-based faculty evaluating forms. Technical issues in completing and submitting the forms online were identified to be the main deterrents to completing the evaluation forms. Non-accessibility of a resource person for resolving technical problems with the software and the burden of taking time out to complete the forms were considered as limiting factors by many residents. Residents recommended a focused orientation session to the new system within the departments. Residents' confidence and support are key to promoting adequate participation in web-based evaluations. Focused orientation sessions, reinforcement, reminders, assurances of confidentiality, and removal of technical glitches should help to improve resident participation.

  8. The Effectiveness of Computer-Based Hypermedia Teaching Modules for Radiology Residents.

    Science.gov (United States)

    Azevedo, Roger; And Others

    This paper explains the rationale for utilizing computer-based, hypermedia tutorials for radiology education and presents the results of a field test of this educational technique. It discusses the development of the hypermedia tutorials at Montreal General Hospital (Quebec, Canada) in 1991-92 and their use in the radiology residency program. The…

  9. Development and Implementation of a Web-based Evaluation System for an Internal Medicine Residency Program.

    Science.gov (United States)

    Rosenberg, Mark E.; Watson, Kathleen; Paul, Jeevan; Miller, Wesley; Harris, Ilene; Valdivia, Tomas D.

    2001-01-01

    Describes the development and implementation of a World Wide Web-based electronic evaluation system for the internal medicine residency program at the University of Minnesota. Features include automatic entry of evaluations by faculty or students into a database, compliance tracking, reminders, extensive reporting capabilities, automatic…

  10. Perspectives on the changing healthcare system: teaching systems-based practice to medical residents

    Directory of Open Access Journals (Sweden)

    Johanna Martinez

    2013-09-01

    Full Text Available Purpose: The Accreditation Council for Graduate Medical Education restructured its accreditation system to be based on educational outcomes in six core competencies. Systems-based practice is one of the six core competencies. The purpose of this report is to describe Weill Cornell Medical College's Internal Medicine Residency program curriculum for systems-based practice (SBP and its evaluation process. Methods: To examine potential outcomes of the POCHS curriculum, an evaluation was conducted, examining participants': (1 knowledge gain; (2 course ratings; and (3 qualitative feedback. Results: On average, there was a 19 percentage point increase in knowledge test scores for all three cohorts. The course was rated overall highly, receiving an average of 4.6 on a 1–5 scale. Lastly, the qualitative comments supported that the material is needed and valued. Conclusion: The course, entitled Perspectives on the Changing Healthcare System (POCHS and its evaluation process support that systems-based practice is crucial to residency education. The course is designed not only to educate residents about the current health care system but also to enable them to think critically about the risk and benefits of the changes. POCHS provides a framework for teaching and assessing this competency and can serve as a template for other residency programs looking to create or restructure their SBP curriculum.

  11. Joint Residence-Workplace Location Choice Model Based on Household Decision Behavior

    Directory of Open Access Journals (Sweden)

    Pengpeng Jiao

    2015-01-01

    Full Text Available Residence location and workplace are the two most important urban land-use types, and there exist strong interdependences between them. Existing researches often assume that one choice dimension is correlated to the other. Using the mixed logit framework, three groups of choice models are developed to illustrate such choice dependencies. First, for all households, this paper presents a basic methodology of the residence location and workplace choice without decision sequence based on the assumption that the two choice behaviors are independent of each other. Second, the paper clusters all households into two groups, choosing residence or workplace first, and formulates the residence location and workplace choice models under the constraint of decision sequence. Third, this paper combines the residence location and workplace together as the choice alternative and puts forward the joint choice model. A questionnaire survey is implemented in Beijing city to collect the data of 1994 households. Estimation results indicate that the joint choice model fits the data significantly better, and the elasticity effects analyses show that the joint choice model reflects the influences of relevant factors to the choice probability well and leads to the job-housing balance.

  12. Fuzzy Analytic Hierarchy Process-based Chinese Resident Best Fitness Behavior Method Research.

    Science.gov (United States)

    Wang, Dapeng; Zhang, Lan

    2015-01-01

    With explosive development in Chinese economy and science and technology, people's pursuit of health becomes more and more intense, therefore Chinese resident sports fitness activities have been rapidly developed. However, different fitness events popularity degrees and effects on body energy consumption are different, so bases on this, the paper researches on fitness behaviors and gets Chinese residents sports fitness behaviors exercise guide, which provides guidance for propelling to national fitness plan's implementation and improving Chinese resident fitness scientization. The paper starts from the perspective of energy consumption, it mainly adopts experience method, determines Chinese resident favorite sports fitness event energy consumption through observing all kinds of fitness behaviors energy consumption, and applies fuzzy analytic hierarchy process to make evaluation on bicycle riding, shadowboxing practicing, swimming, rope skipping, jogging, running, aerobics these seven fitness events. By calculating fuzzy rate model's membership and comparing their sizes, it gets fitness behaviors that are more helpful for resident health, more effective and popular. Finally, it gets conclusions that swimming is a best exercise mode and its membership is the highest. Besides, the memberships of running, rope skipping and shadowboxing practicing are also relative higher. It should go in for bodybuilding by synthesizing above several kinds of fitness events according to different physical conditions; different living conditions so that can better achieve the purpose of fitness exercises.

  13. Conceptual framework for model-based analysis of residence time distribution in twin-screw granulation

    DEFF Research Database (Denmark)

    Kumar, Ashish; Vercruysse, Jurgen; Vanhoorne, Valerie

    2015-01-01

    Twin-screw granulation is a promising continuous alternative for traditional batchwise wet granulation processes. The twin-screw granulator (TSG) screws consist of transport and kneading element modules. Therefore, the granulation to a large extent is governed by the residence time distribution...... within each module where different granulation rate processes dominate over others. Currently, experimental data is used to determine the residence time distributions. In this study, a conceptual model based on classical chemical engineering methods is proposed to better understand and simulate...... the residence time distribution in a TSG. The experimental data were compared with the proposed most suitable conceptual model to estimate the parameters of the model and to analyse and predict the effects of changes in number of kneading discs and their stagger angle, screw speed and powder feed rate...

  14. Innovative partnerships to advance public health training in community-based academic residency programs

    Directory of Open Access Journals (Sweden)

    Lo JC

    2017-10-01

    Full Text Available Joan C Lo,1–3 Thomas E Baudendistel,2,3 Abhay Dandekar,3,4 Phuoc V Le,5 Stanton Siu,2,3 Bruce Blumberg6 1Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA; 2Department of Medicine, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA; 3Graduate Medical Education, Kaiser Permanente East Bay, Oakland, CA, USA; 4Department of Pediatrics, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA; 5School of Public Health, University of California Berkeley, Berkeley, CA, USA; 6Graduate Medical Education, Kaiser Permanente Northern California, Oakland, CA, USA Abstract: Collaborative partnerships between community-based academic residency ­training programs and schools of public health, represent an innovative approach to training future physician leaders in population management and public health. In Kaiser Permanente Northern California, development of residency-Masters in Public Health (MPH tracks in the Internal Medicine Residency and the Pediatrics Residency programs, with MPH graduate studies completed at the University of California Berkeley School of Public Health, enables physicians to integrate clinical training with formal education in epidemiology, biostatistics, health policy, and disease prevention. These residency-MPH programs draw on more than 50 years of clinical education, public health training, and health services research – creating an environment that sparks inquiry and added value by developing skills in patient-centered care through the lens of population-based outcomes. Keywords: graduate medical education, public health, master’s degree, internal medicine, pediatrics, residency training

  15. Evaluation of an Evidence-Based Tobacco Treatment Curriculum for Psychiatry Residency Training Programs

    Science.gov (United States)

    Prochaska, Judith J.; Fromont, Sebastien C.; Leek, Desiree; Hudmon, Karen Suchanek; Louie, Alan K.; Jacobs, Marc H.; Hall, Sharon M.

    2009-01-01

    Objective Smokers with mental illness and addictive disorders account for nearly one in two cigarettes sold in the United States and are at high risk for smoking-related deaths and disability. Psychiatry residency programs provide a unique arena for disseminating tobacco treatment guidelines, influencing professional norms, and increasing access to tobacco cessation services among smokers with mental illness. The current study evaluated the Rx for Change in Psychiatry curriculum, developed for psychiatry residency programs and focused on identifying and treating tobacco dependence among individuals with mental illness. Methods The 4-hour curriculum emphasized evidence-based, patient-oriented cessation treatments relevant for all tobacco users, including those not yet ready to quit. The curriculum was informed by comprehensive literature review, consultation with an expert advisory group, faculty interviews, and a focus group with psychiatry residents. This study reports on evaluation of the curriculum in 2005–2006, using a quasi-experimental design, with 55 residents in three psychiatry residency training programs in Northern California. Results The curriculum was associated with improvements in psychiatry residents’ knowledge, attitudes, confidence, and counseling behaviors for treating tobacco use among their patients, with initial changes from pre- to posttraining sustained at 3-months’ follow-up. Residents’ self-reported changes in treating patients’ tobacco use were substantiated through systematic chart review. Conclusion The evidence-based Rx for Change in Psychiatry curriculum is offered as a model tobacco treatment curriculum that can be implemented in psychiatry residency training programs and disseminated widely, thereby effectively reaching a vulnerable and costly population of smokers. PMID:19190293

  16. A Model-Based Methodology for Integrated Design and Operation of Reactive Distillation Processes

    DEFF Research Database (Denmark)

    Mansouri, Seyed Soheil; Sales-Cruz, Mauricio; Huusom, Jakob Kjøbsted

    2015-01-01

    and resolved. A new approach isto tackle process intensification and controllability issues in an integrated manner, in the early stages of process design. This integrated and simultaneous synthesis approach provides optimal operation and moreefficient control of complex intensified systems that suffice...... calculation of reactive bubble points. For an energy-efficient design, the driving-forc eapproach (to determine the optimal feed location) for a reactive system has been employed. For both thereactive McCabe-Thiele and driving force method, vapor-liquid equilibrium data are based on elements. Thereactive...... system of compounds (methanol, isobutene and MTBE) to a binary system ofelements (elements A and B). For a binary element system, a simple reactive McCabe-Thiele-type method (to determine the number of reactive stages) has been used. The reactive equilibrium curve is constructed through sequential...

  17. Knowledge and Attitudes of Oman Medical Specialty Board Residents towards Evidence-Based Medicine

    Directory of Open Access Journals (Sweden)

    Aiman Al Wahaibi

    2014-05-01

    Full Text Available Objective: This study aims to evaluate the knowledge and attitudes of Oman Medical Specialty Board (OMSB residents towards Evidence-Based Medicine (EBM. Methods: This cross sectional study was conducted on all OMSB residents through a self-administered online questionnaire between October 2012 and March 2013. An electronic survey was designed to identify and determine residents' knowledge and attitudes toward the use of EBM. Results: The survey was completed by 93 (21% OMSB residents, 76 (82% of whom took part in continuing education courses and 50 (54% belonged to professional practice-oriented organizations. On average, the residents were reportedly involved in patient care for approximately 70% (Standard Deviation [SD] 17% of their time, while 14% (SD 12% participated in research activities. The results showed that 53 respondents (57% were competent users of medical search engines compared to 23 residents (25% who rated their skills as neutral. Sixteen percent of the respondents strongly agreed and 46% only agreed that the facility supports the use of current research in practice. Fourteen percent strongly agreed and fifty-three percent only agreed that the foundation of EBM is part of OMSB academic preparation. On the other hand, 17% of the respondents thought that insufficient time is always a barrier against EBM, while another 27% perceived insufficient time as a usual barrier. The lack of information resources was reported to always be a barrier in 11% of the respondents while 32% thought that it usually acts as a barrier. Conclusion: Time constraints and skills in EBM were found to be the two major obstacles. This study was, however, limited by the low response rate of the survey; thus larger studies with a previously validated questionnaire should be conducted in the future.

  18. Efficient Kinect Sensor-Based Reactive Path Planning Method for Autonomous Mobile Robots in Dynamic Environments

    Energy Technology Data Exchange (ETDEWEB)

    Tuvshinjargal, Doopalam; Lee, Deok Jin [Kunsan National University, Gunsan (Korea, Republic of)

    2015-06-15

    In this paper, an efficient dynamic reactive motion planning method for an autonomous vehicle in a dynamic environment is proposed. The purpose of the proposed method is to improve the robustness of autonomous robot motion planning capabilities within dynamic, uncertain environments by integrating a virtual plane-based reactive motion planning technique with a sensor fusion-based obstacle detection approach. The dynamic reactive motion planning method assumes a local observer in the virtual plane, which allows the effective transformation of complex dynamic planning problems into simple stationary ones proving the speed and orientation information between the robot and obstacles. In addition, the sensor fusion-based obstacle detection technique allows the pose estimation of moving obstacles using a Kinect sensor and sonar sensors, thus improving the accuracy and robustness of the reactive motion planning approach. The performance of the proposed method was demonstrated through not only simulation studies but also field experiments using multiple moving obstacles in hostile dynamic environments.

  19. Efficient Kinect Sensor-Based Reactive Path Planning Method for Autonomous Mobile Robots in Dynamic Environments

    International Nuclear Information System (INIS)

    Tuvshinjargal, Doopalam; Lee, Deok Jin

    2015-01-01

    In this paper, an efficient dynamic reactive motion planning method for an autonomous vehicle in a dynamic environment is proposed. The purpose of the proposed method is to improve the robustness of autonomous robot motion planning capabilities within dynamic, uncertain environments by integrating a virtual plane-based reactive motion planning technique with a sensor fusion-based obstacle detection approach. The dynamic reactive motion planning method assumes a local observer in the virtual plane, which allows the effective transformation of complex dynamic planning problems into simple stationary ones proving the speed and orientation information between the robot and obstacles. In addition, the sensor fusion-based obstacle detection technique allows the pose estimation of moving obstacles using a Kinect sensor and sonar sensors, thus improving the accuracy and robustness of the reactive motion planning approach. The performance of the proposed method was demonstrated through not only simulation studies but also field experiments using multiple moving obstacles in hostile dynamic environments

  20. Competency-based residency training and the web log: modeling practice-based learning and enhancing medical knowledge

    Directory of Open Access Journals (Sweden)

    Matthew F. Hollon

    2015-12-01

    Full Text Available Background: By using web-based tools in medical education, there are opportunities to innovatively teach important principles from the general competencies of graduate medical education. Objectives: Postulating that faculty transparency in learning from uncertainties in clinical work could help residents to incorporate the principles of practice-based learning and improvement (PBLI in their professional development, faculty in this community-based residency program modeled the steps of PBLI on a weekly basis through the use of a web log. Method: The program confidentially surveyed residents before and after this project about actions consistent with PBLI and knowledge acquired through reading the web log. Results: The frequency that residents encountered clinical situations where they felt uncertain declined over the course of the 24 weeks of the project from a mean frequency of uncertainty of 36% to 28% (Wilcoxon signed rank test, p=0.008; however, the frequency with which residents sought answers when faced with uncertainty did not change (Wilcoxon signed rank test, p=0.39, remaining high at approximately 80%. Residents answered a mean of 52% of knowledge questions correct when tested prior to faculty posts to the blog, rising to a mean of 65% of questions correct when tested at the end of the project (paired t-test, p=0.001. Conclusions: Faculty role modeling of PBLI behaviors and posting clinical questions and answers to a web log led to modest improvements in medical knowledge but did not alter behavior that was already taking place frequently among residents.

  1. Effects of intergenerational Montessori-based activities programming on engagement of nursing home residents with dementia

    Directory of Open Access Journals (Sweden)

    Michelle M Lee

    2007-10-01

    Full Text Available Michelle M Lee1, Cameron J Camp2, Megan L Malone21Midwestern University, Department of Behavioral Medicine, Downers Grove, IL , USA; 2Myers Research Institute of Menorah Park Center for Senior Living, Beachwood, OH, USA Abstract: Fourteen nursing home residents on a dementia special care unit at a skilled nursing facility took part in one-to-one intergenerational programming (IGP with 15 preschool children from the facility’s on-site child care center. Montessori-based activities served as the interface for interactions between dyads. The amount of time residents demonstrated positive and negative forms of engagement during IGP and standard activities programming was assessed through direct observation using a tool developed for this purpose – the Myers Research Institute Engagement Scale (MRI-ES. These residents with dementia displayed the ability to successfully take part in IGP. Most successfully presented “lessons” to the children in their dyads, similar to the way that Montessori teachers present lessons to children, while persons with more severe cognitive impairment took part in IGP through other methods such as parallel play. Taking part in IGP was consistently related with higher levels of positive engagement and lower levels of negative forms of engagement in these residents with dementia than levels seen in standard activities programming on the unit. Implications of using this form of IGP, and directions for future research, are discussed.Keywords: Montessori-based activities, intergenerational programming, engagement, dementia

  2. Web-Based Learning for Emergency Airway Management in Anesthesia Residency Training.

    Science.gov (United States)

    Hindle, Ada; Cheng, Ji; Thabane, Lehana; Wong, Anne

    2015-01-01

    Introduction. Web-based learning (WBL) is increasingly used in medical education; however, residency training programs often lack guidance on its implementation. We describe how the use of feasibility studies can guide the use of WBL in anesthesia residency training. Methods. Two case-based WBL emergency airway management modules were developed for self-directed use by anesthesia residents. The feasibility of using this educational modality was assessed using a single cohort pretest/posttest design. Outcome measures included user recruitment and retention rate, perceptions of educational value, and knowledge improvement. The differences between pre- and postmodule test scores and survey Likert scores were analysed using the paired t test. Results. Recruitment and retention rates were 90% and 65%, respectively. User-friendliness of the modules was rated highly. There was a significant improvement in perceptions of the value of WBL in the postsurvey. There was a significant knowledge improvement of 29% in the postmodule test. Conclusions. Feasibility studies can help guide appropriate use of WBL in curricula. While our study supported the potential feasibility of emergency airway management modules for training, collaboration with other anesthesia residency programs may enable more efficient development, implementation, and evaluation of this resource-intensive modality in anesthesia education and practice.

  3. Web-Based Learning for Emergency Airway Management in Anesthesia Residency Training

    Directory of Open Access Journals (Sweden)

    Ada Hindle

    2015-01-01

    Full Text Available Introduction. Web-based learning (WBL is increasingly used in medical education; however, residency training programs often lack guidance on its implementation. We describe how the use of feasibility studies can guide the use of WBL in anesthesia residency training. Methods. Two case-based WBL emergency airway management modules were developed for self-directed use by anesthesia residents. The feasibility of using this educational modality was assessed using a single cohort pretest/posttest design. Outcome measures included user recruitment and retention rate, perceptions of educational value, and knowledge improvement. The differences between pre- and postmodule test scores and survey Likert scores were analysed using the paired t test. Results. Recruitment and retention rates were 90% and 65%, respectively. User-friendliness of the modules was rated highly. There was a significant improvement in perceptions of the value of WBL in the postsurvey. There was a significant knowledge improvement of 29% in the postmodule test. Conclusions. Feasibility studies can help guide appropriate use of WBL in curricula. While our study supported the potential feasibility of emergency airway management modules for training, collaboration with other anesthesia residency programs may enable more efficient development, implementation, and evaluation of this resource-intensive modality in anesthesia education and practice.

  4. A web-based test of residents' skills in diagnostic radiology

    International Nuclear Information System (INIS)

    Finlay, K.; Norman, G.R.; Keane, D.R.; Stolberg, H.

    2006-01-01

    To develop an objective, Web-based tool for evaluating residents' knowledge of diagnostic radiology. We developed and tested a Web-based evaluation tool (the Diagnostic Radiology Skills Test) that consists of 3 tests, one in each of 3 domains of diagnostic radiology: chest, gastrointestinal, and musculoskeletal imaging. Each test comprises 30 cases representing a range of difficulty in the domain, including normal states, normal variants, typical cases of common diagnoses, and cases with more subtle findings. Cases are presented with a long menu of domain-specific possible diagnoses (response options), each coded for diagnostic appropriateness. Our subjects were 21 residents in postgraduate year (PGY) 2 to 5 and 11 experts in diagnostic radiology. Subjects accessed the tool via a Web site on our Web server. Residents test results were compared for reliability and validity across domain, case, and training level. In addition, results were correlated with commonly used established and objective evaluation tools. The tool demonstrated consistent monotonic improvement in performance with training level. It showed acceptable reliability in discriminating between residents at different performance levels, both within and across training levels (r = 0.53 within level and 0.69 across levels). Test results also had concurrent validity against the American College of Radiology In-Training Examination, a widely accepted objective assessment tool (r = 0.65, P < 0.01), and 2 Objective Structured Clinical Examinations (OSCEs) focusing on diagnostic skills (r = 0.78 and r 0.69, P < 0.01, respectively). Our study demonstrates the feasibility of a Web-based, standardized, objective assessment method for evaluating residents' performance. (author)

  5. Using spaced retrieval and Montessori-based activities in improving eating ability for residents with dementia.

    Science.gov (United States)

    Lin, Li-Chan; Huang, Ya-Ju; Su, Su-Gen; Watson, Roger; Tsai, Belina W-J; Wu, Shiao-Chi

    2010-10-01

    To construct a training protocol for spaced retrieval (SR) and to investigate the effectiveness of SR and Montessori-based activities in decreasing eating difficulty in older residents with dementia. A single evaluator, blind, and randomized control trial was used. Eighty-five residents with dementia were chosen from three special care units for residents with dementia in long-term care facilities in Taiwan. To avoid any confounding of subjects, the three institutions were randomized into three groups: spaced retrieval, Montessori-based activities, and a control group. The invention consisted of three 30-40 min sessions per week, for 8 weeks. After receiving the intervention, the Edinburgh Feeding Evaluation in Dementia (EdFED) scores and assisted feeding scores for the SR and Montessori-based activity groups were significantly lower than that of the control group. However, the frequencies of physical assistance and verbal assistance for the Montessori-based activity group after intervention were significantly higher than that of the control group, which suggests that residents who received Montessori-based activity need more physical and verbal assistance during mealtimes. In terms of the effects of nutritional status after intervention, Mini-Nutritional Assessment (MNA) in the SR group was significantly higher than that of the control group. This study confirms the efficacy of SR and Montessori-based activities for eating difficulty and eating ability. A longitudinal study to follow the long-term effects of SR and Montessori-based activities on eating ability and nutritional status is recommended. Copyright © 2010 John Wiley & Sons, Ltd.

  6. Multiagent-Based Reactive Power Sharing and Control Model for Islanded Microgrids

    DEFF Research Database (Denmark)

    Chen, Feixiong; Chen, Minyou; Li, Qiang

    2016-01-01

    of the control model, in which the uncertainty of intermittent DGs, variations in load demands, as well as impacts of time delays are considered. The simulation results demonstrate the eectiveness of the control model in proportional reactive power sharing, and the plug and play capability of the control model......In islanded microgrids (MGs), the reactive power cannot be shared proportionally among distributed generators (DGs) with conventional droop control, due to the mismatch in feeder impedances. For the purpose of proportional reactive power sharing, a multiagent system (MAS) based distributed control...

  7. Entropy-based critical reaction time for mixing-controlled reactive transport

    DEFF Research Database (Denmark)

    Chiogna, Gabriele; Rolle, Massimo

    2017-01-01

    Entropy-based metrics, such as the dilution index, have been proposed to quantify dilution and reactive mixing in solute transport problems. In this work, we derive the transient advection dispersion equation for the entropy density of a reactive plume. We restrict our analysis to the case where...... the concentration distribution of the transported species is Gaussian and we observe that, even in case of an instantaneous complete bimolecular reaction, dilution caused by dispersive processes dominates the entropy balance at early times and results in the net increase of the entropy density of a reactive species...

  8. Review of reactive power dispatch strategies for loss minimization in a DFIG-based wind farm

    DEFF Research Database (Denmark)

    Zhang, Baohua; Hu, Weihao; Hou, Peng

    2017-01-01

    power control strategies are investigated. All of the combined strategies are formulated based on the comprehensive loss models of WFs, including the loss models of DFIGs, converters, filters, transformers, and cables of the collection system. Optimization problems are solved by a Modified Particle......This paper reviews and compares the performance of reactive power dispatch strategies for the loss minimization of Doubly Fed Induction Generator (DFIG)-based Wind Farms (WFs). Twelve possible combinations of three WF level reactive power dispatch strategies and fourWind Turbine (WT) level reactive...... Swarm Optimization (MPSO) algorithm. The effectiveness of these strategies is evaluated by simulations on a carefully designed WF under a series of cases with different wind speeds and reactive power requirements of the WF. The wind speed at each WT inside the WF is calculated using the Jensen wake...

  9. Training at a faith-based institution matters for obstetrics and gynecology residents: results from a regional survey.

    Science.gov (United States)

    Guiahi, Maryam; Westhoff, Carolyn L; Summers, Sondra; Kenton, Kimberly

    2013-06-01

    Prior data suggest that opportunities in family planning training may be limited during obstetrics and gynecology (Ob-Gyn) residency training, particularly at faith-based institutions with moral and ethical constraints, although this aspect of the Ob-Gyn curriculum has not been formally studied to date. We compared Ob-Gyn residents' self-rated competency and intentions to provide family planning procedures at faith-based versus those of residents at non-faith-based programs. We surveyed residents at all 20 Ob-Gyn programs in Illinois, Indiana, Iowa, and Wisconsin from 2008 to 2009. Residents were queried about current skills and future plans to perform family planning procedures. We examined associations based on program and residents' personal characteristics and performed multivariable logistic regression analysis. A total of 232 of 340 residents (68%) from 17 programs (85%) returned surveys. Seven programs were faith-based. Residents from non-faith-based programs were more likely to be completely satisfied with family planning training (odds ratio [OR]  =  3.4, 95% confidence limit [CI], 1.9-6.2) and to report they "understand and can perform on own" most procedures. Most residents, regardless of program type, planned to provide all surveyed family planning services. Despite similar intentions to provide family planning procedures after graduation, residents at faith-based training programs were less satisfied with their family planning training and rate their ability to perform family planning services lower than residents at non-faith-based training programs.

  10. Effects of intergenerational Montessori-based activities programming on engagement of nursing home residents with dementia.

    Science.gov (United States)

    Lee, Michelle M; Camp, Cameron J; Malone, Megan L

    2007-01-01

    Fourteen nursing home residents on a dementia special care unit at a skilled nursing facility took part in one-to-one intergenerational programming (IGP) with 15 preschool children from the facility's on-site child care center. Montessori-based activities served as the interface for interactions between dyads. The amount of time residents demonstrated positive and negative forms of engagement during IGP and standard activities programming was assessed through direct observation using a tool developed for this purpose--the Myers Research Institute Engagement Scale (MRI-ES). These residents with dementia displayed the ability to successfully take part in IGP. Most successfully presented "lessons" to the children in their dyads, similar to the way that Montessori teachers present lessons to children, while persons with more severe cognitive impairment took part in IGP through other methods such as parallel play. Taking part in IGP was consistently related with higher levels of positive engagement and lower levels of negative forms of engagement in these residents with dementia than levels seen in standard activities programming on the unit. Implications of using this form of IGP, and directions for future research, are discussed.

  11. Photo-reactive charge trapping memory based on lanthanide complex

    Science.gov (United States)

    Zhuang, Jiaqing; Lo, Wai-Sum; Zhou, Li; Sun, Qi-Jun; Chan, Chi-Fai; Zhou, Ye; Han, Su-Ting; Yan, Yan; Wong, Wing-Tak; Wong, Ka-Leung; Roy, V. A. L.

    2015-10-01

    Traditional utilization of photo-induced excitons is popularly but restricted in the fields of photovoltaic devices as well as photodetectors, and efforts on broadening its function have always been attempted. However, rare reports are available on organic field effect transistor (OFET) memory employing photo-induced charges. Here, we demonstrate an OFET memory containing a novel organic lanthanide complex Eu(tta)3ppta (Eu(tta)3 = Europium(III) thenoyltrifluoroacetonate, ppta = 2-phenyl-4,6-bis(pyrazol-1-yl)-1,3,5-triazine), in which the photo-induced charges can be successfully trapped and detrapped. The luminescent complex emits intense red emission upon ultraviolet (UV) light excitation and serves as a trapping element of holes injected from the pentacene semiconductor layer. Memory window can be significantly enlarged by light-assisted programming and erasing procedures, during which the photo-induced excitons in the semiconductor layer are separated by voltage bias. The enhancement of memory window is attributed to the increasing number of photo-induced excitons by the UV light. The charges are stored in this luminescent complex for at least 104 s after withdrawing voltage bias. The present study on photo-assisted novel memory may motivate the research on a new type of light tunable charge trapping photo-reactive memory devices.

  12. Simulation-based Assessment to Reliably Identify Key Resident Performance Attributes.

    Science.gov (United States)

    Blum, Richard H; Muret-Wagstaff, Sharon L; Boulet, John R; Cooper, Jeffrey B; Petrusa, Emil R; Baker, Keith H; Davidyuk, Galina; Dearden, Jennifer L; Feinstein, David M; Jones, Stephanie B; Kimball, William R; Mitchell, John D; Nadelberg, Robert L; Wiser, Sarah H; Albrecht, Meredith A; Anastasi, Amanda K; Bose, Ruma R; Chang, Laura Y; Culley, Deborah J; Fisher, Lauren J; Grover, Meera; Klainer, Suzanne B; Kveraga, Rikante; Martel, Jeffrey P; McKenna, Shannon S; Minehart, Rebecca D; Mitchell, John D; Mountjoy, Jeremi R; Pawlowski, John B; Pilon, Robert N; Shook, Douglas C; Silver, David A; Warfield, Carol A; Zaleski, Katherine L

    2018-04-01

    Obtaining reliable and valid information on resident performance is critical to patient safety and training program improvement. The goals were to characterize important anesthesia resident performance gaps that are not typically evaluated, and to further validate scores from a multiscenario simulation-based assessment. Seven high-fidelity scenarios reflecting core anesthesiology skills were administered to 51 first-year residents (CA-1s) and 16 third-year residents (CA-3s) from three residency programs. Twenty trained attending anesthesiologists rated resident performances using a seven-point behaviorally anchored rating scale for five domains: (1) formulate a clear plan, (2) modify the plan under changing conditions, (3) communicate effectively, (4) identify performance improvement opportunities, and (5) recognize limits. A second rater assessed 10% of encounters. Scores and variances for each domain, each scenario, and the total were compared. Low domain ratings (1, 2) were examined in detail. Interrater agreement was 0.76; reliability of the seven-scenario assessment was r = 0.70. CA-3s had a significantly higher average total score (4.9 ± 1.1 vs. 4.6 ± 1.1, P = 0.01, effect size = 0.33). CA-3s significantly outscored CA-1s for five of seven scenarios and domains 1, 2, and 3. CA-1s had a significantly higher proportion of worrisome ratings than CA-3s (chi-square = 24.1, P < 0.01, effect size = 1.50). Ninety-eight percent of residents rated the simulations more educational than an average day in the operating room. Sensitivity of the assessment to CA-1 versus CA-3 performance differences for most scenarios and domains supports validity. No differences, by experience level, were detected for two domains associated with reflective practice. Smaller score variances for CA-3s likely reflect a training effect; however, worrisome performance scores for both CA-1s and CA-3s suggest room for improvement.

  13. Case based teaching at the bed side versus in classroom for undergraduates and residents of pediatrics

    Directory of Open Access Journals (Sweden)

    MAHDI SHAHRIARI

    2014-07-01

    Full Text Available Introduction: Bedside teaching is defined as teaching in the presence of a patient, it is a vital component of medical education. The aim of this study was to evaluate the effectiveness of two methods of case based teaching (at the bedside and in the classroom in the teaching hospitals (for both undergraduates and residents of pediatrics. Methods: Thirty undergraduates and twenty pediatric residents were asked to study a topic of their curriculum from their text then pretest was taken from learners in the two levels; then either lecture with power point or case presentation or bed side discussion were conducted. One week later posttest was taken, and then evaluation of these three methods was done by a questionnaire from learners. Results: The majority of under-graduates and all of pediatric residents had evaluated case based teaching superior to bedside teaching and these two methods superior to lecture method. Conclusion: They believed that in the case based teaching they are more relaxed and have more self-esteem than at the bedside of the patients. Clinician teacher must involve patients and learners in the process of bedside teaching, by preparing a comfortable situation and by using available technolgy.

  14. Distributed Reactive Power Control based Conservation Voltage Reduction in Active Distribution Systems

    Directory of Open Access Journals (Sweden)

    EMIROGLU, S.

    2017-11-01

    Full Text Available This paper proposes a distributed reactive power control based approach to deploy Volt/VAr optimization (VVO / Conservation Voltage Reduction (CVR algorithm in a distribution network with distributed generations (DG units and distribution static synchronous compensators (D-STATCOM. A three-phase VVO/CVR problem is formulated and the reactive power references of D-STATCOMs and DGs are determined in a distributed way by decomposing the VVO/CVR problem into voltage and reactive power control. The main purpose is to determine the coordination between voltage regulator (VR and reactive power sources (Capacitors, D-STATCOMs and DGs based on VVO/CVR. The study shows that the reactive power injection capability of DG units may play an important role in VVO/CVR. In addition, it is shown that the coordination of VR and reactive power sources does not only save more energy and power but also reduces the power losses. Moreover, the proposed VVO/CVR algorithm reduces the computational burden and finds fast solutions. To illustrate the effectiveness of the proposed method, the VVO/CVR is performed on the IEEE 13-node test system feeder considering unbalanced loading and line configurations. The tests are performed taking the practical voltage-dependent load modeling and different customer types into consideration to improve accuracy.

  15. NHS-Esters As Versatile Reactivity-Based Probes for Mapping Proteome-Wide Ligandable Hotspots.

    Science.gov (United States)

    Ward, Carl C; Kleinman, Jordan I; Nomura, Daniel K

    2017-06-16

    Most of the proteome is considered undruggable, oftentimes hindering translational efforts for drug discovery. Identifying previously unknown druggable hotspots in proteins would enable strategies for pharmacologically interrogating these sites with small molecules. Activity-based protein profiling (ABPP) has arisen as a powerful chemoproteomic strategy that uses reactivity-based chemical probes to map reactive, functional, and ligandable hotspots in complex proteomes, which has enabled inhibitor discovery against various therapeutic protein targets. Here, we report an alkyne-functionalized N-hydroxysuccinimide-ester (NHS-ester) as a versatile reactivity-based probe for mapping the reactivity of a wide range of nucleophilic ligandable hotspots, including lysines, serines, threonines, and tyrosines, encompassing active sites, allosteric sites, post-translational modification sites, protein interaction sites, and previously uncharacterized potential binding sites. Surprisingly, we also show that fragment-based NHS-ester ligands can be made to confer selectivity for specific lysine hotspots on specific targets including Dpyd, Aldh2, and Gstt1. We thus put forth NHS-esters as promising reactivity-based probes and chemical scaffolds for covalent ligand discovery.

  16. Does Faculty Follow the Recommended Structure for a New Classroom-based, Daily Formal Teaching Session for Anesthesia Residents?

    DEFF Research Database (Denmark)

    Anwar, Anjum; Tanaka, Pedro; Madsen, Matias V

    2016-01-01

    BACKGROUND: A newly implemented 15-minute classroom-based, formal teaching session for anesthesia residents is given three times daily by the same faculty. The faculty member was provided a suggested template for the presentation. The template structure was developed by a group of residents......, and 31% used a clinical case vignette presentation to introduce the keyword. The most common visuals were the use of a picture (38%) and a chart or a graph (35%). We also saw that 65% of the sessions had active involvement of residents. With respect to time and slide limitations mentioned in the template...... of the residency curriculum more than two years after their implementation....

  17. Self-healing anticorrosive organic coating based on an encapsulated water reactive silyl ester: synthesis and proof of concept

    NARCIS (Netherlands)

    García, S.J.; Fischer, H.R.; White, P.A.; Mardel, J.; González-García, Y.; Mol, J.M.C.; Hughes, A.E.

    2011-01-01

    In this paper a self-healing anticorrosive organic coating based on an encapsulated water reactive organic agent is presented. A reactive silyl ester is proposed as a new organic reactive healing agent and its synthesis, performance, incorporation into an organic coating and evaluation of

  18. The Setting is the Service: How the Architecture of Sober Living Residences Supports Community Based Recovery.

    Science.gov (United States)

    Wittman, Fried; Jee, Babette; Polcin, Douglas L; Henderson, Diane

    2014-07-01

    The architecture of residential recovery settings is an important silent partner in the alcohol/drug recovery field. The settings significantly support or hinder recovery experiences of residents, and shape community reactions to the presence of sober living houses (SLH) in ordinary neighborhoods. Grounded in the principles of Alcoholics Anonymous, the SLH provides residents with settings designed to support peer based recovery; further, these settings operate in a community context that insists on sobriety and strongly encourages attendance at 12-step meetings. Little formal research has been conducted to show how architectural features of the recovery setting - building appearance, spatial layouts, furnishings and finishes, policies for use of the facilities, physical care and maintenance of the property, neighborhood features, aspects of location in the city - function to promote (or retard) recovery, and to build (or detract from) community support. This paper uses a case-study approach to analyze the architecture of a community-based residential recovery service that has demonstrated successful recovery outcomes for its residents, is popular in its community, and has achieved state-wide recognition. The Environmental Pattern Language (Alexander, Ishikawa, & Silverstein, 1977) is used to analyze its architecture in a format that can be tested, critiqued, and adapted for use by similar programs in many communities, providing a model for replication and further research.

  19. Reactive power and voltage control strategy based on dynamic and adaptive segment for DG inverter

    Science.gov (United States)

    Zhai, Jianwei; Lin, Xiaoming; Zhang, Yongjun

    2018-03-01

    The inverter of distributed generation (DG) can support reactive power to help solve the problem of out-of-limit voltage in active distribution network (ADN). Therefore, a reactive voltage control strategy based on dynamic and adaptive segment for DG inverter is put forward to actively control voltage in this paper. The proposed strategy adjusts the segmented voltage threshold of Q(U) droop curve dynamically and adaptively according to the voltage of grid-connected point and the power direction of adjacent downstream line. And then the reactive power reference of DG inverter can be got through modified Q(U) control strategy. The reactive power of inverter is controlled to trace the reference value. The proposed control strategy can not only control the local voltage of grid-connected point but also help to maintain voltage within qualified range considering the terminal voltage of distribution feeder and the reactive support for adjacent downstream DG. The scheme using the proposed strategy is compared with the scheme without the reactive support of DG inverter and the scheme using the Q(U) control strategy with constant segmented voltage threshold. The simulation results suggest that the proposed method has a significant improvement on solving the problem of out-of-limit voltage, restraining voltage variation and improving voltage quality.

  20. [Highlights of hospital-based internal medicine in 2010: chief residents' perspective].

    Science.gov (United States)

    Uhlmann, Marc; Burnard, Jérôme; Cosma Rochat, Monica; Gabus, Vincent; Micheloud, Valérie Geiser; Gobin, Niels; Laurent, Jean-Christophe; Marino, Laura; Méan, Marie; Merz, Laurent; Regamey, Julien; Stadelmann, Raphaël

    2011-02-02

    Applying knowledge acquired from recent medical studies to patient care poses a daily challenge to physicians. Chief residents from the Department of Internal Medicine at the University Hospital of Lausanne carried out a review of some of the issues they considered important. The conclusions of these various publications may have a significant impact on the daily practice of hospital-based internal medicine. Modern medicine based on scientific studies is a reminder that in spite of the essential importance of clinical experience, it is crucial to confront it with the results of relevant publications from the medical literature.

  1. Theoretical comparison of performance using transfer functions for reactivity meters based on inverse kinetic method and simple feedback method

    International Nuclear Information System (INIS)

    Shimazu, Yoichiro; Tashiro, Shoichi; Tojo, Masayuki

    2017-01-01

    The performance of two digital reactivity meters, one based on the conventional inverse kinetic method and the other one based on simple feedback theory, are compared analytically using their respective transfer functions. The latter one is proposed by one of the authors. It has been shown that the performance of the two reactivity meters become almost identical when proper system parameters are selected for each reactivity meter. A new correlation between the system parameters of the two reactivity meters is found. With this correlation, filter designers can easily determine the system parameters for the respective reactivity meters to obtain identical performance. (author)

  2. Research on the Direct Carbon Emission Forecast of CHINA'S Provincial Residents Based on Neural Network

    Science.gov (United States)

    Zhang, T.; Zhou, B.; Zhou, S.; Yan, W.

    2018-04-01

    Global climate change, which mainly effected by human carbon emissions, would affect the regional economic, natural ecological environment, social development and food security in the near future. It's particularly important to make accurate predictions of carbon emissions based on current carbon emissions. This paper accounted out the direct consumption of carbon emissions data from 1995 to 2014 about 30 provinces (the data of Tibet, Hong Kong, Macao and Taiwan is missing) and the whole of China. And it selected the optimal models from BP, RBF and Elman neural network for direct carbon emission prediction, what aim was to select the optimal prediction method and explore the possibility of reaching the peak of residents direct carbon emissions of China in 2030. Research shows that: 1) Residents' direct carbon emissions per capita of all provinces showed an upward trend in 20 years. 2) The accuracy of the prediction results by Elman neural network model is higher than others and more suitable for carbon emission data projections. 3) With the situation of residents' direct carbon emissions free development, the direct carbon emissions will show a fast to slow upward trend in the next few years and began to flatten after 2020, and the direct carbon emissions of per capita will reach the peak in 2032. This is also confirmed that China is expected to reach its peak in carbon emissions by 2030 in theory.

  3. A comparison of simulation-based education versus lecture-based instruction for toxicology training in emergency medicine residents.

    Science.gov (United States)

    Maddry, Joseph K; Varney, Shawn M; Sessions, Daniel; Heard, Kennon; Thaxton, Robert E; Ganem, Victoria J; Zarzabal, Lee A; Bebarta, Vikhyat S

    2014-12-01

    Simulation-based teaching (SIM) is a common method for medical education. SIM exposes residents to uncommon scenarios that require critical, timely actions. SIM may be a valuable training method for critically ill poisoned patients whose diagnosis and treatment depend on key clinical findings. Our objective was to compare medical simulation (SIM) to traditional lecture-based instruction (LEC) for training emergency medicine (EM) residents in the acute management of critically ill poisoned patients. EM residents completed two pre-intervention questionnaires: (1) a 24-item multiple-choice test of four toxicological emergencies and (2) a questionnaire using a five-point Likert scale to rate the residents' comfort level in diagnosing and treating patients with specific toxicological emergencies. After completing the pre-intervention questionnaires, residents were randomized to SIM or LEC instruction. Two toxicologists and three EM physicians presented four toxicology topics to both groups in four 20-min sessions. One group was in the simulation center, and the other in a lecture hall. Each group then repeated the multiple-choice test and questionnaire immediately after instruction and again at 3 months after training. Answers were not discussed. The primary outcome was comparison of immediate mean post-intervention test scores and final scores 3 months later between SIM and LEC groups. Test score outcomes between groups were compared at each time point (pre-test, post-instruction, 3-month follow-up) using Wilcoxon rank sum test. Data were summarized by descriptive statistics. Continuous variables were characterized by means (SD) and tested using t tests or Wilcoxon rank sum. Categorical variables were summarized by frequencies (%) and compared between training groups with chi-square or Fisher's exact test. Thirty-two EM residents completed pre- and post-intervention tests and comfort questionnaires on the study day. Both groups had higher post-intervention mean test

  4. Filling the Gap: Simulation-based Crisis Resource Management Training for Emergency Medicine Residents

    Directory of Open Access Journals (Sweden)

    Jessica R. Parsons

    2017-12-01

    Full Text Available Introduction In today’s team-oriented healthcare environment, high-quality patient care requires physicians to possess not only medical knowledge and technical skills but also crisis resource management (CRM skills. In emergency medicine (EM, the high acuity and dynamic environment makes CRM skills of physicians particularly critical to healthcare team success. The Accreditation Council of Graduate Medicine Education Core Competencies that guide residency program curriculums include CRM skills; however, EM residency programs are not given specific instructions as to how to teach these skills to their trainees. This article describes a simulation-based CRM course designed specifically for novice EM residents. Methods The CRM course includes an introductory didactic presentation followed by a series of simulation scenarios and structured debriefs. The course is designed to use observational learning within simulation education to decrease the time and resources required for implementation. To assess the effectiveness in improving team CRM skills, two independent raters use a validated CRM global rating scale to measure the CRM skills displayed by teams of EM interns in a pretest and posttest during the course. Results The CRM course improved leadership, problem solving, communication, situational awareness, teamwork, resource utilization and overall CRM skills displayed by teams of EM interns. While the improvement from pretest to posttest did not reach statistical significance for this pilot study, the large effect sizes suggest that statistical significance may be achieved with a larger sample size. Conclusion This course can feasibly be incorporated into existing EM residency curriculums to provide EM trainees with basic CRM skills required of successful emergency physicians. We believe integrating CRM training early into existing EM education encourages continued deliberate practice, discussion, and improvement of essential CRM skills.

  5. Web-based objective structured clinical examination with remote standardized patients and Skype: resident experience.

    Science.gov (United States)

    Langenau, Erik; Kachur, Elizabeth; Horber, Dot

    2014-07-01

    Using Skype and remote standardized patients (RSPs), investigators sought to evaluate user acceptance of a web-based objective structured clinical examination (OSCE) among resident physicians. After participating in four web-based clinical encounters addressing pain with RSPs, 59 residents from different training programs, disciplines and geographic locations completed a 52-item questionnaire regarding their experience with Skype and RSPs. Open-ended responses were solicited as well. The majority of participants (97%) agreed or strongly agreed the web-based format was convenient and a practical learning exercise, and 90% agreed or strongly agreed the format was effective in teaching communication skills. Although 93% agreed or strongly agreed they could communicate easily with RSPs using Skype, 80% preferred traditional face-to-face clinical encounters, and 58% reported technical difficulties during the encounters. Open-ended written responses supported survey results. Findings from this study expose challenges with technology and human factors, but positive experiences support the continued investigation of web-based OSCEs as a synchronous e-learning initiative for teaching and assessing doctor-patient communication. Such educational programs are valuable but unlikely to replace face-to-face encounters with patients. This web-based OSCE program provides physician learners with additional opportunity to improve doctor-patient communication. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  6. Utility of Combining a Simulation-Based Method With a Lecture-Based Method for Fundoscopy Training in Neurology Residency.

    Science.gov (United States)

    Gupta, Deepak K; Khandker, Namir; Stacy, Kristin; Tatsuoka, Curtis M; Preston, David C

    2017-10-01

    Fundoscopic examination is an essential component of the neurologic examination. Competence in its performance is mandated as a required clinical skill for neurology residents by the American Council of Graduate Medical Education. Government and private insurance agencies require its performance and documentation for moderate- and high-level neurologic evaluations. Traditionally, assessment and teaching of this key clinical examination technique have been difficult in neurology residency training. To evaluate the utility of a simulation-based method and the traditional lecture-based method for assessment and teaching of fundoscopy to neurology residents. This study was a prospective, single-blinded, education research study of 48 neurology residents recruited from July 1, 2015, through June 30, 2016, at a large neurology residency training program. Participants were equally divided into control and intervention groups after stratification by training year. Baseline and postintervention assessments were performed using questionnaire, survey, and fundoscopy simulators. After baseline assessment, both groups initially received lecture-based training, which covered fundamental knowledge on the components of fundoscopy and key neurologic findings observed on fundoscopic examination. The intervention group additionally received simulation-based training, which consisted of an instructor-led, hands-on workshop that covered practical skills of performing fundoscopic examination and identifying neurologically relevant findings on another fundoscopy simulator. The primary outcome measures were the postintervention changes in fundoscopy knowledge, skills, and total scores. A total of 30 men and 18 women were equally distributed between the 2 groups. The intervention group had significantly higher mean (SD) increases in skills (2.5 [2.3] vs 0.8 [1.8], P = .01) and total (9.3 [4.3] vs 5.3 [5.8], P = .02) scores compared with the control group. Knowledge scores (6.8 [3

  7. Competency-based evaluation tools for integrative medicine training in family medicine residency: a pilot study

    Directory of Open Access Journals (Sweden)

    Schneider Craig

    2007-04-01

    Full Text Available Abstract Background As more integrative medicine educational content is integrated into conventional family medicine teaching, the need for effective evaluation strategies grows. Through the Integrative Family Medicine program, a six site pilot program of a four year residency training model combining integrative medicine and family medicine training, we have developed and tested a set of competency-based evaluation tools to assess residents' skills in integrative medicine history-taking and treatment planning. This paper presents the results from the implementation of direct observation and treatment plan evaluation tools, as well as the results of two Objective Structured Clinical Examinations (OSCEs developed for the program. Methods The direct observation (DO and treatment plan (TP evaluation tools developed for the IFM program were implemented by faculty at each of the six sites during the PGY-4 year (n = 11 on DO and n = 8 on TP. The OSCE I was implemented first in 2005 (n = 6, revised and then implemented with a second class of IFM participants in 2006 (n = 7. OSCE II was implemented in fall 2005 with only one class of IFM participants (n = 6. Data from the initial implementation of these tools are described using descriptive statistics. Results Results from the implementation of these tools at the IFM sites suggest that we need more emphasis in our curriculum on incorporating spirituality into history-taking and treatment planning, and more training for IFM residents on effective assessment of readiness for change and strategies for delivering integrative medicine treatment recommendations. Focusing our OSCE assessment more narrowly on integrative medicine history-taking skills was much more effective in delineating strengths and weaknesses in our residents' performance than using the OSCE for both integrative and more basic communication competencies. Conclusion As these tools are refined further they will be of value both in improving

  8. "iBIM"--internet-based interactive modules: an easy and interesting learning tool for general surgery residents.

    Science.gov (United States)

    Azer, Nader; Shi, Xinzhe; de Gara, Chris; Karmali, Shahzeer; Birch, Daniel W

    2014-04-01

    The increased use of information technology supports a resident- centred educational approach that promotes autonomy, flexibility and time management and helps residents to assess their competence, promoting self-awareness. We established a web-based e-learning tool to introduce general surgery residents to bariatric surgery and evaluate them to determine the most appropriate implementation strategy for Internet-based interactive modules (iBIM) in surgical teaching. Usernames and passwords were assigned to general surgery residents at the University of Alberta. They were directed to the Obesity101 website and prompted to complete a multiple-choice precourse test. Afterwards, they were able to access the interactive modules. Residents could review the course material as often as they wanted before completing a multiple-choice postcourse test and exit survey. We used paired t tests to assess the difference between pre- and postcourse scores. Out of 34 residents who agreed to participate in the project, 12 completed the project (35.3%). For these 12 residents, the precourse mean score was 50 ± 17.3 and the postcourse mean score was 67 ± 14 (p = 0.020). Most residents who participated in this study recommended using the iBIMs as a study tool for bariatric surgery. Course evaluation scores suggest this novel approach was successful in transferring knowledge to surgical trainees. Further development of this tool and assessment of implementation strategies will determine how iBIM in bariatric surgery may be integrated into the curriculum.

  9. The effect of electronic health record software design on resident documentation and compliance with evidence-based medicine.

    Science.gov (United States)

    Rodriguez Torres, Yasaira; Huang, Jordan; Mihlstin, Melanie; Juzych, Mark S; Kromrei, Heidi; Hwang, Frank S

    2017-01-01

    This study aimed to determine the role of electronic health record software in resident education by evaluating documentation of 30 elements extracted from the American Academy of Ophthalmology Dry Eye Syndrome Preferred Practice Pattern. The Kresge Eye Institute transitioned to using electronic health record software in June 2013. We evaluated the charts of 331 patients examined in the resident ophthalmology clinic between September 1, 2011, and March 31, 2014, for an initial evaluation for dry eye syndrome. We compared documentation rates for the 30 evidence-based elements between electronic health record chart note templates among the ophthalmology residents. Overall, significant changes in documentation occurred when transitioning to a new version of the electronic health record software with average compliance ranging from 67.4% to 73.6% (p Electronic Health Record A had high compliance (>90%) in 13 elements while Electronic Health Record B had high compliance (>90%) in 11 elements. The presence of dialog boxes was responsible for significant changes in documentation of adnexa, puncta, proptosis, skin examination, contact lens wear, and smoking exposure. Significant differences in documentation were correlated with electronic health record template design rather than individual resident or residents' year in training. Our results show that electronic health record template design influences documentation across all resident years. Decreased documentation likely results from "mouse click fatigue" as residents had to access multiple dialog boxes to complete documentation. These findings highlight the importance of EHR template design to improve resident documentation and integration of evidence-based medicine into their clinical notes.

  10. The effect of electronic health record software design on resident documentation and compliance with evidence-based medicine.

    Directory of Open Access Journals (Sweden)

    Yasaira Rodriguez Torres

    Full Text Available This study aimed to determine the role of electronic health record software in resident education by evaluating documentation of 30 elements extracted from the American Academy of Ophthalmology Dry Eye Syndrome Preferred Practice Pattern. The Kresge Eye Institute transitioned to using electronic health record software in June 2013. We evaluated the charts of 331 patients examined in the resident ophthalmology clinic between September 1, 2011, and March 31, 2014, for an initial evaluation for dry eye syndrome. We compared documentation rates for the 30 evidence-based elements between electronic health record chart note templates among the ophthalmology residents. Overall, significant changes in documentation occurred when transitioning to a new version of the electronic health record software with average compliance ranging from 67.4% to 73.6% (p 90% in 13 elements while Electronic Health Record B had high compliance (>90% in 11 elements. The presence of dialog boxes was responsible for significant changes in documentation of adnexa, puncta, proptosis, skin examination, contact lens wear, and smoking exposure. Significant differences in documentation were correlated with electronic health record template design rather than individual resident or residents' year in training. Our results show that electronic health record template design influences documentation across all resident years. Decreased documentation likely results from "mouse click fatigue" as residents had to access multiple dialog boxes to complete documentation. These findings highlight the importance of EHR template design to improve resident documentation and integration of evidence-based medicine into their clinical notes.

  11. Development of the Calibrator of Reactivity Meter Using PC-Based DAQ System

    International Nuclear Information System (INIS)

    Edison; Mariatmo, A.; Sujarwono

    2007-01-01

    The reactivity meter calibrator has been developed by applying the PC-Based DAQ System programmed using LabVIEW. The Output of the calibrator is voltage proportional to neutron density n(t) corresponding to the step reactivity change ρ 0 . The “Kalibrator meter reactivitas.vi” program calculates seven roots and coefficients of solution n(t) of Reactor Kinetic equation using the in-hour equation. Based on data of dt = t k+1 - t k and t 0 = 0 input by user, the program approximates n(t) for each time interval t k ≤ t k+1 , where k = 0, 1, 2, 3, .... by a step function n(t) = n 0 ∑ j=1 7 A j e ω j t k . Then the program commands the DAQ device to output voltage V(t) = n(t) Volt at time t. The measurement of standard reactivity with the meter reactivity showed that the maximum deviation of measured reactivity from its standard were less than 1 %. (author)

  12. Genetic algorithm based reactive power dispatch for voltage stability improvement

    Energy Technology Data Exchange (ETDEWEB)

    Devaraj, D. [Department of Electrical and Electronics, Kalasalingam University, Krishnankoil 626 190 (India); Roselyn, J. Preetha [Department of Electrical and Electronics, SRM University, Kattankulathur 603 203, Chennai (India)

    2010-12-15

    Voltage stability assessment and control form the core function in a modern energy control centre. This paper presents an improved Genetic algorithm (GA) approach for voltage stability enhancement. The proposed technique is based on the minimization of the maximum of L-indices of load buses. Generator voltages, switchable VAR sources and transformer tap changers are used as optimization variables of this problem. The proposed approach permits the optimization variables to be represented in their natural form in the genetic population. For effective genetic processing, the crossover and mutation operators which can directly deal with the floating point numbers and integers are used. The proposed algorithm has been tested on IEEE 30-bus and IEEE 57-bus test systems and successful results have been obtained. (author)

  13. Multimodal wireless sensor network-based ambient assisted living in real homes with multiple residents.

    Science.gov (United States)

    Tunca, Can; Alemdar, Hande; Ertan, Halil; Incel, Ozlem Durmaz; Ersoy, Cem

    2014-05-30

    Human activity recognition and behavior monitoring in a home setting using wireless sensor networks (WSNs) provide a great potential for ambient assisted living (AAL) applications, ranging from health and wellbeing monitoring to resource consumption monitoring. However, due to the limitations of the sensor devices, challenges in wireless communication and the challenges in processing large amounts of sensor data in order to recognize complex human activities, WSN-based AAL systems are not effectively integrated in the home environment. Additionally, given the variety of sensor types and activities, selecting the most suitable set of sensors in the deployment is an important task. In order to investigate and propose solutions to such challenges, we introduce a WSN-based multimodal AAL system compatible for homes with multiple residents. Particularly, we focus on the details of the system architecture, including the challenges of sensor selection, deployment, networking and data collection and provide guidelines for the design and deployment of an effective AAL system. We also present the details of the field study we conducted, using the systems deployed in two different real home environments with multiple residents. With these systems, we are able to collect ambient sensor data from multiple homes. This data can be used to assess the wellbeing of the residents and identify deviations from everyday routines, which may be indicators of health problems. Finally, in order to elaborate on the possible applications of the proposed AAL system and to exemplify directions for processing the collected data, we provide the results of several human activity inference experiments, along with examples on how such results could be interpreted. We believe that the experiences shared in this work will contribute towards accelerating the acceptance of WSN-based AAL systems in the home setting.

  14. Multimodal Wireless Sensor Network-Based Ambient Assisted Living in Real Homes with Multiple Residents

    Directory of Open Access Journals (Sweden)

    Can Tunca

    2014-05-01

    Full Text Available Human activity recognition and behavior monitoring in a home setting using wireless sensor networks (WSNs provide a great potential for ambient assisted living (AAL applications, ranging from health and wellbeing monitoring to resource consumption monitoring. However, due to the limitations of the sensor devices, challenges in wireless communication and the challenges in processing large amounts of sensor data in order to recognize complex human activities, WSN-based AAL systems are not effectively integrated in the home environment. Additionally, given the variety of sensor types and activities, selecting the most suitable set of sensors in the deployment is an important task. In order to investigate and propose solutions to such challenges, we introduce a WSN-based multimodal AAL system compatible for homes with multiple residents. Particularly, we focus on the details of the system architecture, including the challenges of sensor selection, deployment, networking and data collection and provide guidelines for the design and deployment of an effective AAL system. We also present the details of the field study we conducted, using the systems deployed in two different real home environments with multiple residents. With these systems, we are able to collect ambient sensor data from multiple homes. This data can be used to assess the wellbeing of the residents and identify deviations from everyday routines, which may be indicators of health problems. Finally, in order to elaborate on the possible applications of the proposed AAL system and to exemplify directions for processing the collected data, we provide the results of several human activity inference experiments, along with examples on how such results could be interpreted. We believe that the experiences shared in this work will contribute towards accelerating the acceptance of WSN-based AAL systems in the home setting.

  15. Effect of a Community-Based Service Learning Experience in Geriatrics on Internal Medicine Residents and Community Participants.

    Science.gov (United States)

    Miller, Rachel K; Michener, Jennifer; Yang, Phyllis; Goldstein, Karen; Groce-Martin, Jennine; True, Gala; Johnson, Jerry

    2017-09-01

    Community-based service learning (CBSL) provides an opportunity to teach internal medicine residents the social context of aging and clinical concepts. The objectives of the current study were to demonstrate the feasibility of a CBSL program targeting internal medicine residents and to assess its effect on medical residents and community participants. internal medicine residents participated in a CBSL experience for half a day during ambulatory blocks from 2011 to 2014. Residents attended a senior housing unit or center, delivered a presentation about a geriatric health topic, toured the facility, and received information about local older adult resources. Residents evaluated the experience. Postgraduate Year 3 internal medicine residents (n = 71) delivered 64 sessions. Residents felt that the experience increased their ability to communicate effectively with older adults (mean 3.91 ± 0.73 on a Likert scale with 5 = strongly agree), increased their knowledge of resources (4.09 ± 1.01), expanded their knowledge of a health topic pertinent to aging (3.48 ± 1.09), and contributed to their capacity to evaluate and care for older adults (3.84 ± 0.67). Free-text responses demonstrated that residents thought that this program would change their practice. Of 815 older adults surveyed from 36 discrete teaching sessions, 461 (56%) thought that the medical residents delivered health information clearly (4.55 ± 0.88) and that the health topics were relevant (4.26 ± 0.92). Free-text responses showed that the program helped them understand their health concerns. This CBSL program is a feasible and effective tool for teaching internal medicine residents and older adults. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

  16. Synthesis and Reactivity of Tripodal Complexes Containing Pendant Bases

    Energy Technology Data Exchange (ETDEWEB)

    Blacquiere, Johanna M.; Pegis, Michael L.; Raugei, Simone; Kaminsky, Werner; Forget, Amelie; Cook, Sarah; Taguchi, Taketo; Borovik, Andrew S.; Mayer, James M.

    2014-09-02

    The synthesis of a new tripodal ligand family is reported, with tertiary-amine groups in the second-coordination sphere. The ligands are tris(amido)amine derivatives, with the pendant amines attached via a peptide coupling strategy. They were designed to be used in new catalysts for the oxygen reduction reaction (ORR), in which the pendant acid/base group could improve catalyst performance. Two members of the new ligand family were each metallated with Co(II) and Zn(II) to afford trigonal monopyramidal complexes. Reaction of the cobalt complexes, [Co(L)]-, with dioxygen reversibly generates a small amount of a Co(III)-superoxo species, which was characterized by EPR. Protonation of the zinc complex Zn[N{CH2CH2NC(O)CH2N(CH2Ph)2}3)-– ([Zn(TNBn)]-) with one equivalent of acid occurs with displacement and dissociation of an amide ligand. Addition of excess acid to the any of the complexes [M(L)]- results in complete proteolysis and formation of the ligands H3L. This decomposition limits the use of these complexes as catalysts for the ORR. An alternative ligand with two pyridyl arms was also prepared but could not be metallated. These studies highlight the importance of stability of the primary-coordination sphere of ORR electrocatalysts to both oxidative and acidic conditions. This research was supported as part of the Center for Molecular Electrocatalysis, an Energy Frontier Research Center funded by the U.S. Department of Energy, Office of Science, Office of Basic Energy Sciences.

  17. Uniting Evidence-Based Evaluation with the ACGME Plastic Surgery Milestones: A Simple and Reliable Assessment of Resident Operative Performance.

    Science.gov (United States)

    Kobraei, Edward M; Bohnen, Jordan D; George, Brian C; Mullen, John T; Lillemoe, Keith D; Austen, William G; Liao, Eric C

    2016-08-01

    Milestones evaluations in plastic surgery reflect a shift toward competency-based training but have created a number of challenges. The authors have incorporated the smartphone application evaluation tool, System for Improving and Measuring Procedural Learning (SIMPL), that was recently developed by a multi-institutional research collaborative. In this pilot study, the authors hypothesize that SIMPL can improve resident evaluation and also collect granular performance data to simplify compliance with the plastic surgery Milestones. SIMPL was prospectively piloted with a plastic surgery resident and faculty surgeon at Massachusetts General Hospital in this institutional review board-approved study. The study period was a 2-month interval corresponding to the resident's rotation. The resident-faculty combination performed 20 cases together. All cases were evaluated with SIMPL. SIMPL evaluations uniformly took under 1 minute to submit. The average time to completed evaluation from surgery completion was 5 hours (technology will support a shared vocabulary between residents and faculty to enhance intraoperative education.

  18. Field-based generation and social validation managers and staff competencies for small community residences.

    Science.gov (United States)

    Thousand, J S; Burchard, S N; Hasazi, J E

    1986-01-01

    Characteristics and competencies for four staff positions in community residences for individuals with mental retardation were identified utilizing multiple empirical and deductive methods with field-based practitioners and field-based experts. The more commonly used competency generation methods of expert opinion and job performance analysis generated a high degree of knowledge and skill-based competencies similar to course curricula. Competencies generated by incumbent practitioners through open-ended methods of personal structured interview and critical incident analysis were ones which related to personal style, interpersonal interaction, and humanistic orientation. Although seldom included in staff, paraprofessional, or professional training curricula, these latter competencies include those identified by Carl Rogers as essential for developing an effective helping relationship in a therapeutic situation (i.e., showing liking, interest, and respect for the clients; being able to communicate positive regard to the client). Of 21 core competency statements selected as prerequisites to employment for all four staff positions, the majority (17 of 21) represented interpersonal skills important to working with others, including responsiveness to resident needs, personal valuation of persons with mental retardation, and normalization principles.

  19. Loss Minimizing Operation of Doubly Fed Induction Generator Based Wind Generation Systems Considering Reactive Power Provision

    DEFF Research Database (Denmark)

    Baohua, Zhang; Hu, Weihao; Chen, Zhe

    2014-01-01

    The paper deals with control techniques for minimizing the operating loss of doubly fed induction generator based wind generation systems when providing reactive power. The proposed method achieves its goal through controlling the rotor side q-axis current in the synchronous reference frame...

  20. Agent-based Simulation of Reactive, Pro-active, and Social Animal Behaviour

    NARCIS (Netherlands)

    Jonker, C.M.; Treur, J.; Mira, J.

    1998-01-01

    In this paper it is shown how animal behaviour can be simulated in an agent-based manner. Different models are shown for different types of behaviour, varying from purely reactive behaviour to pro-active and social behaviour. The compositional development method for multi-agent systems DESIRE and

  1. Entrainer selection for the synthesis of fatty acid esters by entrainer-based reactive distillation

    NARCIS (Netherlands)

    Jong, de M.C.; Zondervan, E.; Dimian, A.C.; Haan, de A.B.

    2010-01-01

    In this research it is demonstrated that, due to the similarities between Entrainer-based Reactive Distillation and azeotropic distillation, the same selection rules can be applied to select a suitable entrainer. From a list of suitable entrainers for the azeotropic distillation of isopropanol and

  2. Lattice Boltzmann based multicomponent reactive transport model coupled with geochemical solver for scale simulations

    NARCIS (Netherlands)

    Patel, R.A.; Perko, J.; Jaques, D.; De Schutter, G.; Ye, G.; Van Breugel, K.

    2013-01-01

    A Lattice Boltzmann (LB) based reactive transport model intended to capture reactions and solid phase changes occurring at the pore scale is presented. The proposed approach uses LB method to compute multi component mass transport. The LB multi-component transport model is then coupled with the

  3. Optical acetone vapor sensors based on chiral nematic liquid crystals and reactive chiral dopants

    NARCIS (Netherlands)

    Cachelin, P.; Green, J.P.; Peijs, T.; Heeney, M.; Bastiaansen, C.W.M.

    2016-01-01

    Accurate monitoring of exposure to organic vapors, such as acetone, is an important part of maintaining a safe working environment and adhering to long- and short-term exposure limits. Here, a novel acetone vapor detection system is described based on the use of a reactive chiral dopant in a nematic

  4. Incidence of pneumonia in nursing home residents with dementia in the Netherlands: an estimation based on three differently designed studies.

    Science.gov (United States)

    Zomer, T P; VAN DER Maaden, T; VAN Gageldonk-Lafeber, A B; DE Greeff, S C; VAN DER Steen, J T; Verhoef, L

    2017-08-01

    Pneumonia leads to considerable morbidity and mortality in nursing home residents with dementia. We assessed pneumonia incidence based on data from three different studies: (1) real-time national surveillance of healthcare-associated infections in nursing home residents in 2009-2015; (2) a randomized controlled trial in 2012-2015 to assess effects of a practical guideline in nursing home residents with dementia and pneumonia; and (3) a study in 2007-2010 to assess quality of dying in newly admitted nursing home residents with dementia. In national surveillance data, pneumonia incidence was calculated separately for psychogeriatric and somatic beds, as a proxy for residents with and without dementia. Weekly pneumonia incidence was significantly lower per 1000 psychogeriatric beds (3·9; 95% confidence interval (CI) 3·2-4·6) compared with 1000 somatic beds (5·7; 95% CI 5·1-6·3). Annual incidence per 1000 psychogeriatric beds was similar in national surveillance (range 78·9-117·1) and the trial (range 71·0-94·3), and significantly higher in newly admitted dementia residents (range 267·3-363·2). The incidence was highest during the first months after admission when compared with residents with longer stay. In conclusion, follow-up of pneumonia in newly admitted dementia residents may result in higher incidence, possibly due to higher risk in this population.

  5. Intraoperative Noise Increases Perceived Task Load and Fatigue in Anesthesiology Residents: A Simulation-Based Study.

    Science.gov (United States)

    McNeer, Richard R; Bennett, Christopher L; Dudaryk, Roman

    2016-02-01

    Operating rooms are identified as being one of the noisiest of clinical environments, and intraoperative noise is associated with adverse effects on staff and patient safety. Simulation-based experiments would offer controllable and safe venues for investigating this noise problem. However, realistic simulation of the clinical auditory environment is rare in current simulators. Therefore, we retrofitted our operating room simulator to be able to produce immersive auditory simulations with the use of typical sound sources encountered during surgeries. Then, we tested the hypothesis that anesthesia residents would perceive greater task load and fatigue while being given simulated lunch breaks in noisy environments rather than in quiet ones. As a secondary objective, we proposed and tested the plausibility of a novel psychometric instrument for the assessment of stress. In this simulation-based, randomized, repeated-measures, crossover study, 2 validated psychometric survey instruments, the NASA Task Load Index (NASA-TLX), composed of 6 items, and the Swedish Occupational Fatigue Inventory (SOFI), composed of 5 items, were used to assess perceived task load and fatigue, respectively, in first-year anesthesia residents. Residents completed the psychometric instruments after being given lunch breaks in quiet and noisy intraoperative environments (soundscapes). The effects of soundscape grouping on the psychometric instruments and their comprising items were analyzed with a split-plot analysis. A model for a new psychometric instrument for measuring stress that combines the NASA-TLX and SOFI instruments was proposed, and a factor analysis was performed on the collected data to determine the model's plausibility. Twenty residents participated in this study. Multivariate analysis of variance showed an effect of soundscape grouping on the combined NASA-TLX and SOFI instrument items (P = 0.003) and the comparisons of univariate item reached significance for the NASA Temporal

  6. Consequences of the electronic tuning of latent ruthenium-based olefin metathesis catalysts on their reactivity

    KAUST Repository

    Żukowska, Karolina

    2015-08-20

    Two ruthenium olefin metathesis initiators featuring electronically modified quinoline-based chelating carbene ligands are introduced. Their reactivity in RCM and ROMP reactions was tested and the results were compared to those obtained with the parent unsubstituted compound. The studied complexes are very stable at high temperatures up to 140 °C. The placement of an electron-withdrawing functionality translates into an enhanced activity in RCM. While electronically modified precatalysts, which exist predominantly in the trans-dichloro configuration, gave mostly the RCM and a minor amount of the cycloisomerization product, the unmodified congener, which preferentially exists as its cis-dichloro isomer, shows a switched reactivity. The position of the equilibrium between the cis- and the trans-dichloro species was found to be the crucial factor governing the reactivity of the complexes.

  7. Consequences of the electronic tuning of latent ruthenium-based olefin metathesis catalysts on their reactivity

    KAUST Repository

    Żukowska, Karolina; Pump, Eva; Pazio, Aleksandra E; Woźniak, Krzysztof; Cavallo, Luigi; Slugovc, Christian

    2015-01-01

    Two ruthenium olefin metathesis initiators featuring electronically modified quinoline-based chelating carbene ligands are introduced. Their reactivity in RCM and ROMP reactions was tested and the results were compared to those obtained with the parent unsubstituted compound. The studied complexes are very stable at high temperatures up to 140 °C. The placement of an electron-withdrawing functionality translates into an enhanced activity in RCM. While electronically modified precatalysts, which exist predominantly in the trans-dichloro configuration, gave mostly the RCM and a minor amount of the cycloisomerization product, the unmodified congener, which preferentially exists as its cis-dichloro isomer, shows a switched reactivity. The position of the equilibrium between the cis- and the trans-dichloro species was found to be the crucial factor governing the reactivity of the complexes.

  8. Permanent resident

    Directory of Open Access Journals (Sweden)

    John F. Fisher

    2016-05-01

    Full Text Available The training of physicians in the past century was based primarily on responsibility and the chain-of-command. Those with the bulk of that responsibility in the fields of pediatrics and internal medicine were residents. Residents trained the medical students and supervised them carefully in caring for patients. Most attending physicians supervised their teams at arm's length, primarily serving as teachers of the finer points of diagnosis and treatment during set periods of the day or week with a perfunctory signature on write-ups or progress notes. Residents endeavored to protect the attending physician from being heavily involved unless they were unsure about a clinical problem. Before contacting the attending physician, a more senior resident would be called. Responsibility was the ultimate teacher. The introduction of diagnosis-related groups by the federal government dramatically changed the health care delivery system, placing greater emphasis on attending physician visibility in the medical record, ultimately resulting in more attending physician involvement in day-to-day care of patients in academic institutions. Without specified content in attending notes, hospital revenues would decline. Although always in charge technically, attending physicians increasingly have assumed the role once dominated by the resident. Using biographical experiences of more than 40 years, the author acknowledges and praises the educational role of responsibility in his own training and laments its declining role in today's students and house staff.

  9. Resident Space Object Characterization and Behavior Understanding via Machine Learning and Ontology-based Bayesian Networks

    Science.gov (United States)

    Furfaro, R.; Linares, R.; Gaylor, D.; Jah, M.; Walls, R.

    2016-09-01

    In this paper, we present an end-to-end approach that employs machine learning techniques and Ontology-based Bayesian Networks (BN) to characterize the behavior of resident space objects. State-of-the-Art machine learning architectures (e.g. Extreme Learning Machines, Convolutional Deep Networks) are trained on physical models to learn the Resident Space Object (RSO) features in the vectorized energy and momentum states and parameters. The mapping from measurements to vectorized energy and momentum states and parameters enables behavior characterization via clustering in the features space and subsequent RSO classification. Additionally, Space Object Behavioral Ontologies (SOBO) are employed to define and capture the domain knowledge-base (KB) and BNs are constructed from the SOBO in a semi-automatic fashion to execute probabilistic reasoning over conclusions drawn from trained classifiers and/or directly from processed data. Such an approach enables integrating machine learning classifiers and probabilistic reasoning to support higher-level decision making for space domain awareness applications. The innovation here is to use these methods (which have enjoyed great success in other domains) in synergy so that it enables a "from data to discovery" paradigm by facilitating the linkage and fusion of large and disparate sources of information via a Big Data Science and Analytics framework.

  10. Breaking Bad News Training Program Based on Video Reviews and SPIKES Strategy: What do Perinatology Residents Think about It?

    Science.gov (United States)

    Setubal, Maria Silvia Vellutini; Gonçalves, Andrea Vasconcelos; Rocha, Sheyla Ribeiro; Amaral, Eliana Martorano

    2017-10-01

    Objective  Resident doctors usually face the task to communicate bad news in perinatology without any formal training. The impact on parents can be disastrous. The objective of this paper is to analyze the perception of residents regarding a training program in communicating bad news in perinatology based on video reviews and setting, perception, invitation, knowledge, emotion, and summary (SPIKES) strategy. Methods  We performed the analysis of complementary data collected from participants in a randomized controlled intervention study to evaluate the efficacy of a training program on improving residents' skills to communicate bad news. Data were collected using a Likert scale. Through a thematic content analysis we tried to to apprehend the meanings, feelings and experiences expressed by resident doctors in their comments as a response to an open-ended question. Half of the group received training, consisting of discussions of video reviews of participants' simulated encounters communicating a perinatal loss to a "mother" based on the SPIKES strategy. We also offered training sessions to the control group after they completed participation. Twenty-eight residents who were randomized to intervention and 16 from the control group received training. Twenty written comments were analyzed. Results  The majority of the residents evaluated training highly as an education activity to help increase knowledge, ability and understanding about breaking bad news in perinatology. Three big categories emerged from residents' comments: SPIKES training effects; bad news communication in medical training; and doctors' feelings and relationship with patients. Conclusions  Residents took SPIKES training as a guide to systematize the communication of bad news and to amplify perceptions of the emotional needs of the patients. They suggested the insertion of a similar training in their residency programs curricula. Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil.

  11. A theory-based curriculum design for remediation of residents' communication skills.

    Science.gov (United States)

    Leung, Fok-Han; Martin, Dawn; Batty, Helen

    2009-12-01

    Residents requiring remediation are often deficient in communication skills, namely clinical interviewing skills. Residents have to digest large amounts of knowledge, and then apply it in a clinical interview. The patient-centered approach, as demonstrated in the Calgary-Cambridge model and Martin's Map, can be difficult to teach. Before implementing a remediation curriculum, the theoretical educational underpinnings must be sound; curriculum evaluation is often expensive. Before establishing metrics for curriculum evaluation, a starting point is to perform a mental experiment to test theoretical adherence. This article describes an experiential remedial curriculum for communication skills. Educational theories of Kolb, Knowles, Bandura, and Bloom are used to design the curriculum into theory-based design components. Kolb's experiential cycle models the natural sequence of experiencing, teaching, and learning interviewing skills. A curriculum structured around this cycle has multiple intercalations with the above educational theories. The design is strengthened by appropriately timed use of education strategies such as learning contracts, taped interviews, simulations, structured reflection, and teacher role modeling. Importantly, it also models the form of the clinical interview format desired. Through understanding and application of contemporary educational theories, a program to remediate interviewing skills can increase its potential for success.

  12. Agreement and repeatability of vascular reactivity estimates based on a breath-hold task and a resting state scan.

    Science.gov (United States)

    Lipp, Ilona; Murphy, Kevin; Caseras, Xavier; Wise, Richard G

    2015-06-01

    FMRI BOLD responses to changes in neural activity are influenced by the reactivity of the vasculature. By complementing a task-related BOLD acquisition with a vascular reactivity measure obtained through breath-holding or hypercapnia, this unwanted variance can be statistically reduced in the BOLD responses of interest. Recently, it has been suggested that vascular reactivity can also be estimated using a resting state scan. This study aimed to compare three breath-hold based analysis approaches (block design, sine-cosine regressor and CO2 regressor) and a resting state approach (CO2 regressor) to measure vascular reactivity. We tested BOLD variance explained by the model and repeatability of the measures. Fifteen healthy participants underwent a breath-hold task and a resting state scan with end-tidal CO2 being recorded during both. Vascular reactivity was defined as CO2-related BOLD percent signal change/mmHg change in CO2. Maps and regional vascular reactivity estimates showed high repeatability when the breath-hold task was used. Repeatability and variance explained by the CO2 trace regressor were lower for the resting state data based approach, which resulted in highly variable measures of vascular reactivity. We conclude that breath-hold based vascular reactivity estimations are more repeatable than resting-based estimates, and that there are limitations with replacing breath-hold scans by resting state scans for vascular reactivity assessment. Copyright © 2015. Published by Elsevier Inc.

  13. Agent-based reactive power management of power distribution networks with distributed energy generation

    International Nuclear Information System (INIS)

    Rahman, M.S.; Mahmud, M.A.; Oo, A.M.T.; Pota, H.R.; Hossain, M.J.

    2016-01-01

    Highlights: • A coordinated multi-agent system is proposed for reactive power management. • A linear quadratic regulator with a proportional integral controller is designed. • Proposed multi-agent scheme provides accurate estimation and control of the system. • Voltage stability is improved with proper power management for different scenarios. • Results obtained from the proposed scheme is compared to the traditional approach. - Abstract: In this paper, a new agent-based distributed reactive power management scheme is proposed to improve the voltage stability of energy distribution systems with distributed generation units. Three types of agents – distribution system agent, estimator agent, and control agent are developed within the multi-agent framework. The agents simultaneously coordinated their activities through the online information and energy flow. The overall achievement of the proposed scheme depends on the coordination between two tasks – (i) estimation of reactive power using voltage variation formula and (ii) necessary control actions to provide the estimated reactive power to the distribution networks through the distributed static synchronous compensators. A linear quadratic regulator with a proportional integrator is designed for the control agent in order to control the reactive component of the current and the DC voltage of the compensators. The performance of the proposed scheme is tested on a 10-bus power distribution network under various scenarios. The effectiveness is validated by comparing the proposed approach to the conventional proportional integral control approach. It is found that, the agent-based scheme provides excellent robust performance under various operating conditions of the power distribution network.

  14. Cadaver-Based Simulation Increases Resident Confidence, Initial Exposure to Fundamental Techniques, and May Augment Operative Autonomy.

    Science.gov (United States)

    Kim, Steven C; Fisher, Jeremy G; Delman, Keith A; Hinman, Johanna M; Srinivasan, Jahnavi K

    Surgical simulation is an important adjunct in surgical education. The majority of operative procedures can be simplified to core components. This study aimed to quantify a cadaver-based simulation course utility in improving exposure to fundamental maneuvers, resident and attending confidence in trainee capability, and if this led to earlier operative independence. A list of fundamental surgical procedures was established by a faculty panel. Residents were assigned to a group led by a chief resident. Residents performed skills on cadavers appropriate for PGY level. A video-recorded examination where they narrated and demonstrated a task independently was then graded by attendings using standardized rubrics. Participants completed surveys regarding improvements in knowledge and confidence. The course was conducted at the Emory University School of Medicine and the T3 Laboratories in Atlanta, GA. A total of 133 residents and 41 attendings participated in the course. 133 (100%) participating residents and 32 (78%) attendings completed surveys. Resident confidence in completing the assigned skill independently increased from 3 (2-3) to 4 (3-4), p 80%), p < 0.04. Attendings were more likely to grant autonomy in the operating room after this exercise (4 [3-5]). A cadaveric skills course focused on fundamental maneuvers with objective confirmation of success is a viable adjunct to clinical operative experience. Residents were formally exposed to fundamental surgical maneuvers earlier as a result of this course. This activity improved both resident and attending confidence in trainee operative skill, resulting in increased attending willingness to grant a higher level of autonomy in the operating room. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  15. Reactivation of Reward-Related Patterns from Single Past Episodes Supports Memory-Based Decision Making.

    Science.gov (United States)

    Wimmer, G Elliott; Büchel, Christian

    2016-03-09

    Rewarding experiences exert a strong influence on later decision making. While decades of neuroscience research have shown how reinforcement gradually shapes preferences, decisions are often influenced by single past experiences. Surprisingly, relatively little is known about the influence of single learning episodes. Although recent work has proposed a role for episodes in decision making, it is largely unknown whether and how episodic experiences contribute to value-based decision making and how the values of single episodes are represented in the brain. In multiple behavioral experiments and an fMRI experiment, we tested whether and how rewarding episodes could support later decision making. Participants experienced episodes of high reward or low reward in conjunction with incidental, trial-unique neutral pictures. In a surprise test phase, we found that participants could indeed remember the associated level of reward, as evidenced by accurate source memory for value and preferences to re-engage with rewarded objects. Further, in a separate experiment, we found that high-reward objects shown as primes before a gambling task increased financial risk taking. Neurally, re-exposure to objects in the test phase led to significant reactivation of reward-related patterns. Importantly, individual variability in the strength of reactivation predicted value memory performance. Our results provide a novel demonstration that affect-related neural patterns are reactivated during later experience. Reactivation of value information represents a mechanism by which memory can guide decision making. Copyright © 2016 the authors 0270-6474/16/362868-13$15.00/0.

  16. Theoretical study of the structure and reactivity of lanthanide and actinide based organometallic complexes

    International Nuclear Information System (INIS)

    Barros, N.

    2007-06-01

    In this PhD thesis, lanthanide and actinide based organometallic complexes are studied using quantum chemistry methods. In a first part, the catalytic properties of organo-lanthanide compounds are evaluated by studying two types of reactions: the catalytic hydro-functionalization of olefins and the polymerisation of polar monomers. The reaction mechanisms are theoretically determined and validated, and the influence of possible secondary non productive reactions is envisaged. A second part focuses on uranium-based complexes. Firstly, the electronic structure of uranium metallocenes is analysed. An analogy with the uranyl compounds is proposed. In a second chapter, two isoelectronic complexes of uranium IV are studied. After validating the use of DFT methods for describing the electronic structure and the reactivity of these compounds, it is shown that their reactivity difference can be related to a different nature of chemical bonding in these complexes. (author)

  17. Opposition-Based Improved PSO for Optimal Reactive Power Dispatch and Voltage Control

    Directory of Open Access Journals (Sweden)

    Shengrang Cao

    2015-01-01

    Full Text Available An opposition-based improved particle swarm optimization algorithm (OIPSO is presented for solving multiobjective reactive power optimization problem. OIPSO uses the opposition learning to improve search efficiency, adopts inertia weight factors to balance global and local exploration, and takes crossover and mutation and neighborhood model strategy to enhance population diversity. Then, a new multiobjective model is built, which includes system network loss, voltage dissatisfaction, and switching operation. Based on the market cost prices, objective functions are converted to least-cost model. In modeling process, switching operation cost is described according to the life cycle cost of transformer, and voltage dissatisfaction penalty is developed considering different voltage quality requirements of customers. The experiment is done on the new mathematical model. Through the simulation of IEEE 30-, 118-bus power systems, the results prove that OIPSO is more efficient to solve reactive power optimization problems and the model is more accurate to reflect the real power system operation.

  18. Innovative web-based multimedia curriculum improves cardiac examination competency of residents.

    Science.gov (United States)

    Criley, Jasminka M; Keiner, Jennifer; Boker, John R; Criley, Stuart R; Warde, Carole M

    2008-03-01

    Proper diagnosis of cardiac disorders is a core competency of internists. Yet numerous studies have documented that the cardiac examination (CE) skills of physicians have declined compared with those of previous generations of physicians, attributed variously to inadequate exposure to cardiac patients and lack of skilled bedside teaching. With growing concerns about ensuring patient safety and quality of care, public and professional organizations are calling for a renewed emphasis on the teaching and evaluation of clinical skills in residency training. The objective of the study was to determine whether Web training improves CE competency, whether residents retain what they learn, and whether a Web-based curriculum plus clinical training is better than clinical training alone. Journal of Hospital Medicine 2008;3:124-133. (c) 2008 Society of Hospital Medicine. This was a controlled intervention study. The intervention group (34 internal and family medicine interns) participated in self-directed use of a Web-based tutorial and three 1-hour teaching sessions taught by a hospitalist. Twenty-five interns from the prior year served as controls. We assessed overall CE competency and 4 subcategories of CE competency: knowledge, audio skills, visual skills, and audio-visual integration. The over mean score of the intervention group significantly improved, from 54 to 66 (P = .002). This improvement was retained (63.5, P = .05). When compared with end-of-year controls, the intervention group had significantly higher end-of-year CE scores (57 vs. 63.5, P = .05), knowledge (P = .04), and audio skills (P = .01). At the end of the academic year, all improvements were retained (P better than clinical training alone. (c) 2008 Society of Hospital Medicine.

  19. Automated data mining: an innovative and efficient web-based approach to maintaining resident case logs.

    Science.gov (United States)

    Bhattacharya, Pratik; Van Stavern, Renee; Madhavan, Ramesh

    2010-12-01

    Use of resident case logs has been considered by the Residency Review Committee for Neurology of the Accreditation Council for Graduate Medical Education (ACGME). This study explores the effectiveness of a data-mining program for creating resident logs and compares the results to a manual data-entry system. Other potential applications of data mining to enhancing resident education are also explored. Patient notes dictated by residents were extracted from the Hospital Information System and analyzed using an unstructured mining program. History, examination and ICD codes were obtained and compared to the existing manual log. The automated data History, examination, and ICD codes were gathered for a 30-day period and compared to manual case logs. The automated method extracted all resident dictations with the dates of encounter and transcription. The automated data-miner processed information from all 19 residents, while only 4 residents logged manually. The manual method identified only broad categories of diseases; the major categories were stroke or vascular disorder 53 (27.6%), epilepsy 28 (14.7%), and pain syndromes 26 (13.5%). In the automated method, epilepsy 114 (21.1%), cerebral atherosclerosis 114 (21.1%), and headache 105 (19.4%) were the most frequent primary diagnoses, and headache 89 (16.5%), seizures 94 (17.4%), and low back pain 47 (9%) were the most common chief complaints. More detailed patient information such as tobacco use 227 (42%), alcohol use 205 (38%), and drug use 38 (7%) were extracted by the data-mining method. Manual case logs are time-consuming, provide limited information, and may be unpopular with residents. Data mining is a time-effective tool that may aid in the assessment of resident experience or the ACGME core competencies or in resident clinical research. More study of this method in larger numbers of residency programs is needed.

  20. Pyridoxylamine reactivity kinetics as an amine based nucleophile for screening electrophilic dermal sensitizers

    Science.gov (United States)

    Chipinda, Itai; Mbiya, Wilbes; Adigun, Risikat Ajibola; Morakinyo, Moshood K.; Law, Brandon F.; Simoyi, Reuben H.; Siegel, Paul D.

    2015-01-01

    Chemical allergens bind directly, or after metabolic or abiotic activation, to endogenous proteins to become allergenic. Assessment of this initial binding has been suggested as a target for development of assays to screen chemicals for their allergenic potential. Recently we reported a nitrobenzenethiol (NBT) based method for screening thiol reactive skin sensitizers, however, amine selective sensitizers are not detected by this assay. In the present study we describe an amine (pyridoxylamine (PDA)) based kinetic assay to complement the NBT assay for identification of amine-selective and non-selective skin sensitizers. UV-Vis spectrophotometry and fluorescence were used to measure PDA reactivity for 57 chemicals including anhydrides, aldehydes, and quinones where reaction rates ranged from 116 to 6.2 × 10−6 M−1 s−1 for extreme to weak sensitizers, respectively. No reactivity towards PDA was observed with the thiol-selective sensitizers, non-sensitizers and prohaptens. The PDA rate constants correlated significantly with their respective murine local lymph node assay (LLNA) threshold EC3 values (R2 = 0.76). The use of PDA serves as a simple, inexpensive amine based method that shows promise as a preliminary screening tool for electrophilic, amine-selective skin sensitizers. PMID:24333919

  1. Reactivity to unpredictable threat as a treatment target for fear-based anxiety disorders.

    Science.gov (United States)

    Gorka, S M; Lieberman, L; Klumpp, H; Kinney, K L; Kennedy, A E; Ajilore, O; Francis, J; Duffecy, J; Craske, M G; Nathan, J; Langenecker, S; Shankman, S A; Phan, K L

    2017-10-01

    Heightened reactivity to unpredictable threat (U-threat) is a core individual difference factor underlying fear-based psychopathology. Little is known, however, about whether reactivity to U-threat is a stable marker of fear-based psychopathology or if it is malleable to treatment. The aim of the current study was to address this question by examining differences in reactivity to U-threat within patients before and after 12-weeks of selective serotonin reuptake inhibitors (SSRIs) or cognitive-behavioral therapy (CBT). Participants included patients with principal fear (n = 22) and distress/misery disorders (n = 29), and a group of healthy controls (n = 21) assessed 12-weeks apart. A well-validated threat-of-shock task was used to probe reactivity to predictable (P-) and U-threat and startle eyeblink magnitude was recorded as an index of defensive responding. Across both assessments, individuals with fear-based disorders displayed greater startle magnitude to U-threat relative to healthy controls and distress/misery patients (who did not differ). From pre- to post-treatment, startle magnitude during U-threat decreased only within the fear patients who received CBT. Moreover, within fear patients, the magnitude of decline in startle to U-threat correlated with the magnitude of decline in fear symptoms. For the healthy controls, startle to U-threat across the two time points was highly reliable and stable. Together, these results indicate that startle to U-threat characterizes fear disorder patients and is malleable to treatment with CBT but not SSRIs within fear patients. Startle to U-threat may therefore reflect an objective, psychophysiological indicator of fear disorder status and CBT treatment response.

  2. Shortening the Miles to the Milestones: Connecting EPA-Based Evaluations to ACGME Milestone Reports for Internal Medicine Residency Programs.

    Science.gov (United States)

    Choe, John H; Knight, Christopher L; Stiling, Rebekah; Corning, Kelli; Lock, Keli; Steinberg, Kenneth P

    2016-07-01

    The Next Accreditation System requires internal medicine training programs to provide the Accreditation Council for Graduate Medical Education (ACGME) with semiannual information about each resident's progress in 22 subcompetency domains. Evaluation of resident "trustworthiness" in performing entrustable professional activities (EPAs) may offer a more tangible assessment construct than evaluations based on expectations of usual progression toward competence. However, translating results from EPA-based evaluations into ACGME milestone progress reports has proven to be challenging because the constructs that underlay these two systems differ.The authors describe a process to bridge the gap between rotation-specific EPA-based evaluations and ACGME milestone reporting. Developed at the University of Washington in 2012 and 2013, this method involves mapping EPA-based evaluation responses to "milestone elements," the narrative descriptions within the columns of each of the 22 internal medicine subcompetencies. As faculty members complete EPA-based evaluations, the mapped milestone elements are automatically marked as "confirmed." Programs can maintain a database that tallies the number of times each milestone element is confirmed for a resident; these data can be used to produce graphical displays of resident progress along the internal medicine milestones.Using this count of milestone elements allows programs to bridge the gap between faculty assessments of residents based on rotation-specific observed activities and semiannual ACGME reports based on the internal medicine milestones. Although potentially useful for all programs, this method is especially beneficial to large programs where clinical competency committee members may not have the opportunity for direct observation of all residents.

  3. Randomized controlled resistance training based physical activity trial for central European nursing home residing older adults.

    Science.gov (United States)

    Barthalos, Istvan; Dorgo, Sandor; Kopkáné Plachy, Judit; Szakály, Zsolt; Ihász, Ferenc; Ráczné Németh, Teodóra; Bognár, József

    2016-10-01

    Nursing home residing older adults often experience fear of sickness or death, functional impairment and pain. It is difficult for these older adults to maintain a physically active lifestyle and to keep a positive outlook on life. This study evaluated the changes in quality of life, attitude to aging, assertiveness, physical fitness and body composition of nursing home residing elderly through a 15-week organized resistance training based physical activity program. Inactive older adults living in a state financed nursing home (N.=45) were randomly divided into two intervention groups and a control group. Both intervention groups were assigned to two physical activity sessions a week, but one of these groups also had weekly discussions on health and quality of life (Mental group). Data on anthropometric measures, fitness performance, as well as quality of life and attitudes to aging survey data were collected. Due to low attendance rate 12 subjects were excluded from the analyses. Statistical analysis included Paired Samples t-tests and Repeated Measures Analysis of Variance. Both intervention groups significantly improved their social participation, and their upper- and lower-body strength scores. Also, subjects in the Mental group showed improvement in agility fitness test and certain survey scales. No positive changes were detected in attitude towards aging and body composition measures in any groups. The post-hoc results suggest that Mental group improved significantly more than the Control group. Regular physical activity with discussions on health and quality of life made a more meaningful difference for the older adults living in nursing home than physical activity alone. Due to the fact that all participants were influenced by the program, it is suggested to further explore this area for better understanding of enhanced quality of life.

  4. Spatio-Temporal Characteristics of Resident Trip Based on Poi and OD Data of Float CAR in Beijing

    Science.gov (United States)

    Mou, N.; Li, J.; Zhang, L.; Liu, W.; Xu, Y.

    2017-09-01

    Due to the influence of the urban inherent regional functional distribution, the daily activities of the residents presented some spatio-temporal patterns (periodic patterns, gathering patterns, etc.). In order to further understand the spatial and temporal characteristics of urban residents, this paper research takes the taxi trajectory data of Beijing as a sample data and studies the spatio-temporal characteristics of the residents' activities on the weekdays. At first, according to the characteristics of the taxi trajectory data distributed along the road network, it takes the Voronoi generated by the road nodes as the research unit. This paper proposes a hybrid clustering method - based on grid density, which is used to cluster the OD (origin and destination) data of taxi at different times. Then combining with the POI data of Beijing, this research calculated the density of the POI data in the clustering results, and analyzed the relationship between the activities of residents in different periods and the functional types of the region. The final results showed that the residents were mainly commuting on weekdays. And it found that the distribution of travel density showed a concentric circle of the characteristics, focusing on residential areas and work areas. The results of cluster analysis and POI analysis showed that the residents' travel had experienced the process of "spatial relative dispersion - spatial aggregation - spatial relative dispersion" in one day.

  5. SPATIO-TEMPORAL CHARACTERISTICS OF RESIDENT TRIP BASED ON POI AND OD DATA OF FLOAT CAR IN BEIJING

    Directory of Open Access Journals (Sweden)

    N. Mou

    2017-09-01

    Full Text Available Due to the influence of the urban inherent regional functional distribution, the daily activities of the residents presented some spatio-temporal patterns (periodic patterns, gathering patterns, etc.. In order to further understand the spatial and temporal characteristics of urban residents, this paper research takes the taxi trajectory data of Beijing as a sample data and studies the spatio-temporal characteristics of the residents' activities on the weekdays. At first, according to the characteristics of the taxi trajectory data distributed along the road network, it takes the Voronoi generated by the road nodes as the research unit. This paper proposes a hybrid clustering method – based on grid density, which is used to cluster the OD (origin and destination data of taxi at different times. Then,combining with the POI data of Beijing, this research calculated the density of the POI data in the clustering results, and analyzed the relationship between the activities of residents in different periods and the functional types of the region. The final results showed that the residents were mainly commuting on weekdays. And it found that the distribution of travel density showed a concentric circle of the characteristics, focusing on residential areas and work areas. The results of cluster analysis and POI analysis showed that the residents' travel had experienced the process of "spatial relative dispersion – spatial aggregation – spatial relative dispersion" in one day.

  6. Burden of Clostridium difficile-associated disease among patients residing in nursing homes: a population-based cohort study.

    Science.gov (United States)

    Yu, Holly; Baser, Onur; Wang, Li

    2016-11-25

    Clostridium difficile (C. difficile) infection (CDI) is the leading cause of nosocomial diarrhea in the United States. This study aimed to examine the incidence of CDI and evaluate mortality and economic burden of CDI in an elderly population who reside in nursing homes (NHs). This was a population-based retrospective cohort study focusing on US NHs by linking Medicare 5% sample, Medicaid, Minimum Data Set (MDS) (2008-10). NH residents aged ≥65 years with continuous enrollment in Medicare and/or Medicaid Fee-for-Service plan for ≥12 months and ≥2 quarterly MDS assessments were eligible for the study. The incidence rate was calculated as the number of CDI episodes by 100,000 person-years. A 1:4 propensity score matched sample of cohorts with and without CDI was generated to assess mortality and health care costs following the first CDI. Among 32,807 NH residents, 941 residents had ≥1 episode of CDI in 2009, with an incidence of 3359.9 per 100,000 person-years. About 30% CDI episodes occurred in the hospital setting. NH residents with CDI (vs without CDI) were more likely to have congestive heart failure, renal disease, cerebrovascular disease, hospitalizations, and outpatient antibiotic use. During the follow-up period, the 30-day (14.7% vs 4.3%, P CDI residents vs non-CDI residents. Total health care costs within 2 months following the first CDI episode were also significantly higher for CDI residents ($28,621 vs $13,644, P CDI presents a serious public health issue in NHs. Mortality, health care utilization, and associated costs were significant following incident CDI episodes.

  7. Phospholipase A1-based cross-reactivity among venoms of clinically relevant Hymenoptera from Neotropical and temperate regions.

    Science.gov (United States)

    Perez-Riverol, Amilcar; Fernandes, Luís Gustavo Romani; Musacchio Lasa, Alexis; Dos Santos-Pinto, José Roberto Aparecido; Moitinho Abram, Débora; Izuka Moraes, Gabriel Hideki; Jabs, Frederic; Miehe, Michaela; Seismman, Henning; Palma, Mario Sergio; de Lima Zollner, Ricardo; Spillner, Edzard; Brochetto-Braga, Márcia Regina

    2018-01-01

    Molecular cross-reactivity caused by allergen homology or cross-reactive carbohydrate determinants (CCDs) is a major challenge for diagnosis and immunotherapy of insect venom allergy. Venom phospholipases A1 (PLA1s) are classical, mostly non-glycosylated wasp and ant allergens that provide diagnostic benefit for differentiation of genuine sensitizations from cross-reactivity. As CCD-free molecules, venom PLA1s are not causative for CCD-based cross-reactivity. Little is known however about the protein-based cross-reactivity of PLA1 within vespid species. Here, we address PLA1-based cross-reactivity among ten clinically relevant Hymenoptera venoms from Neotropical and temperate regions including Polybia paulista (paulistinha) venom and Vespula vulgaris (yellow jacket) venom. In order to evaluate cross-reactivity, sera of mice sensitized with recombinant PLA1 (rPoly p 1) from P. paulista wasp venom were used. Pronounced IgE and IgG based cross-reactivity was detected for wasp venoms regardless the geographical region of origin. The cross-reactivity correlated well with the identity of the primary sequence and 3-D models of PLA1 proteins. In contrast, these mice sera showed no reaction with honeybee (HBV) and fire ant venom. Furthermore, sera from patients monosensitized to HBV and fire ants did not recognize the rPoly p 1 in immunoblotting. Our findings reveal the presence of conserved epitopes in the PLA1s from several clinically relevant wasps as major cause of PLA1-based in vitro cross-reactivity. These findings emphasize the limitations but also the potential of PLA1-based HVA diagnostics. Copyright © 2017 Elsevier Ltd. All rights reserved.

  8. A retrospective review of required projects in systems-based practice in a single anesthesiology residency: a 10-year experience.

    Science.gov (United States)

    Sakai, Tetsuro; Emerick, Trent D; Patel, Rita M

    2015-09-01

    The Accreditation Council for Graduate Medical Education has emphasized in its core competencies and more recently, in its Milestones Project, that residents understand the importance of systems-based practice (SBP). The objectives of the study are to evaluate the quality of residents' SBP projects and to determine the degrees that were subsequently implemented. A retrospective educational observational study. A university-based anesthesiology training institution. One hundred forty-nine anesthesiology residents in their final (postgraduate year 4) year of training who completed SBP projects for the last 10 years (2004-2013). A structured SBP course was provided for postgraduate year 4 anesthesiology residents with deadlines set such as project identification, data collection, and proposal draft. Each resident's written SBP proposal received inputs by 2 members of the department executive steering committee. The SBP projects concluded with oral presentations by each resident to the department executive steering committee, who provided overall scores. All SBP projects were categorized into 7 categories: safety initiatives, economic analysis, process analysis, policy change recommendations, education initiatives, teamwork/communication, and operating room efficiency. Evaluation scores using a Likert scale (1-9, where 9 is the best) were analyzed. The rate of implementation of project ideas within the department based on the presentations to the executive committee was examined. Of 149 projects, policy change recommendations was the most frequently chosen category (46 projects; 30.9%), followed by process analysis (36 projects; 24.2%). The overall evaluation score was 7.6 ± 0.6 (mean ± SD). A total of 53 projects (35.6%) were implemented in the department. There was no statistical difference between SBPs with implementation vs SBPs without implementation in terms of evaluation scores, year of the presentation, or categories. This SBP project has given residents the

  9. Analyses of criticality and reactivity for TRACY experiments based on JENDL-3.3 data library

    International Nuclear Information System (INIS)

    Sono, Hiroki; Miyoshi, Yoshinori; Nakajima, Ken

    2003-01-01

    The parameters on criticality and reactivity employed for computational simulations of the TRACY supercritical experiments were analyzed using a recently revised nuclear data library, JENDL-3.3. The parameters based on the JENDL-3.3 library were compared to those based on two former-used libraries, JENDL-3.2 and ENDF/B-VI. In the analyses computational codes, MVP, MCNP version 4C and TWOTRAN, were used. The following conclusions were obtained from the analyses: (1) The computational biases of the effective neutron multiplication factor attributable to the nuclear data libraries and to the computational codes do not depend the TRACY experimental conditions such as fuel conditions. (2) The fractional discrepancies in the kinetic parameters and coefficients of reactivity are within ∼5% between the three libraries. By comparison between calculations and measurements of the parameters, the JENDL-3.3 library is expected to give closer values to the measurements than the JENDL-3.2 and ENDF/B-VI libraries. (3) While the reactivity worth of transient rods expressed in the $ unit shows ∼5% discrepancy between the three libraries according to their respective β eff values, there is little discrepancy in that expressed in the Δk/k unit. (author)

  10. A new concept for spatially divided Deep Reactive Ion Etching with ALD-based passivation

    International Nuclear Information System (INIS)

    Roozeboom, F; Kniknie, B; Lankhorst, A M; Winands, G; Knaapen, R; Smets, M; Poodt, P; Dingemans, G; Keuning, W; Kessels, W M M

    2012-01-01

    Conventional Deep Reactive Ion Etching (DRIE) is a plasma etch process with alternating half-cycles of 1) Si-etching with SF 6 to form gaseous SiF x etch products, and 2) passivation with C 4 F 8 that polymerizes as a protecting fluorocarbon deposit on the sidewalls and bottom of the etched features. In this work we report on a novel alternative and disruptive technology concept of Spatially-divided Deep Reactive Ion Etching, S-DRIE, where the process is converted from the time-divided into the spatially divided regime. The spatial division can be accomplished by inert gas bearing 'curtains' of heights down to ∼20 μm. These curtains confine the reactive gases to individual (often linear) injection slots constructed in a gas injector head. By horizontally moving the substrate back and forth under the head one can realize the alternate exposures to the overall cycle. A second improvement in the spatially divided approach is the replacement of the CVD-based C 4 F 8 passivation steps by ALD-based oxide (e.g. SiO 2 ) deposition cycles. The method can have industrial potential in cost-effective creation of advanced 3D interconnects (TSVs), MEMS manufacturing and advanced patterning, e.g., in nanoscale transistor line edge roughness using Atomic Layer Etching.

  11. Combined Active and Reactive Power Control of Wind Farms based on Model Predictive Control

    DEFF Research Database (Denmark)

    Zhao, Haoran; Wu, Qiuwei; Wang, Jianhui

    2017-01-01

    This paper proposes a combined wind farm controller based on Model Predictive Control (MPC). Compared with the conventional decoupled active and reactive power control, the proposed control scheme considers the significant impact of active power on voltage variations due to the low X=R ratio...... of wind farm collector systems. The voltage control is improved. Besides, by coordination of active and reactive power, the Var capacity is optimized to prevent potential failures due to Var shortage, especially when the wind farm operates close to its full load. An analytical method is used to calculate...... the sensitivity coefficients to improve the computation efficiency and overcome the convergence problem. Two control modes are designed for both normal and emergency conditions. A wind farm with 20 wind turbines was used to verify the proposed combined control scheme....

  12. Exposure in emergency general surgery in a time-based residency ...

    African Journals Online (AJOL)

    Objective: This paper aimed to characterize the resident exposure to acute general surgical conditions during a three-months rotation in a general surgical unit. Setting: The Department of Surgery, University of Nairobi and Kenyatta National Referral and Teaching Hospital in Nairobi. MethodS: Four residents (in their first to ...

  13. Evaluation of clinical teaching quality in competency-based residency training in Lithuania

    Directory of Open Access Journals (Sweden)

    Eglė Vaižgėlienė

    2017-12-01

    Conclusions: Resident evaluations of clinical teachers are influenced by teachers’ age, gender, year of residency training, type of teachers’ academic position and whether or not a clinical teacher performed self-evaluation. Development of CBME should be focused on the continuous evaluation of quality, clinical teachers educational support and the implementation of e-portfolio.

  14. Communication skills in pediatric training program: National-based survey of residents' perspectives in Saudi Arabia.

    Science.gov (United States)

    Alofisan, Tariq; Al-Alaiyan, Saleh; Al-Abdulsalam, Moath; Siddiqui, Khawar; Hussain, Ibrahim Bin; Al-Qahtani, Mohammad H

    2016-01-01

    Good communication skills and rapport building are considered the cardinal tools for developing a patient-doctor relationship. A positive, healthy competition among different health care organizations in Saudi Arabia underlines an ever increasing emphasis on effective patient-doctor relationship. Despite the numerous guidelines provided and programs available, there is a significant variation in the acceptance and approach to the use of this important tool among pediatric residents in this part of the world. To determine pediatric residents' attitude toward communication skills, their perception of important communication skills, and their confidence in the use of their communication skills in the performance of their primary duties. A cross-sectional study was conducted among all pediatrics trainee residents working in 13 different hospitals in Saudi Arabia. A standardized self-administered questionnaire developed by the Harvard Medical School was used. A total of 297 residents out of all trainees in these centers participated in the data collection. The 283 (95%) residents considered learning communication skills a priority in establishing a good patient-doctor relationship. Thirty four percent reported being very confident with regard to their communication skills. Few residents had the skills, and the confidence to communicate with children with serious diseases, discuss end-of-life issues, and deal with difficult patients and parents. Pediatric residents perceive the importance of communication skills and competencies as crucial components in their training. A proper comprehensive communication skills training should be incorporated into the pediatric resident training curriculum.

  15. Viability of a Web-Based Module for Teaching Electrocardiogram Reading Skills to Psychiatry Residents: Learning Outcomes and Trainee Interest.

    Science.gov (United States)

    DeBonis, Katrina; Blair, Thomas R; Payne, Samuel T; Wigan, Katherine; Kim, Sara

    2015-12-01

    Web-based instruction in post-graduate psychiatry training has shown comparable effectiveness to in-person instruction, but few topics have been addressed in this format. This study sought to evaluate the viability of a web-based curriculum in teaching electrocardiogram (EKG) reading skills to psychiatry residents. Interest in receiving educational materials in this format was also assessed. A web-based curriculum of 41 slides, including eight pre-test and eight post-test questions with emphasis on cardiac complications of psychotropic medications, was made available to all psychiatry residents via email. Out of 57 residents, 30 initiated and 22 completed the module. Mean improvement from pre-test to post-test was 25 %, and all 22 completing participants indicated interest in future web-based instruction. This pilot study suggests that web-based instruction is feasible and under-utilized as a means of teaching psychiatry residents. Potential uses of web-based instruction, such as tracking learning outcomes or patient care longitudinally, are also discussed.

  16. The impact of critical appraisal workshops on residents' evidence based medicine skills and knowledge

    Directory of Open Access Journals (Sweden)

    Nasr JA

    2018-04-01

    Full Text Available Justine A Nasr,1,2 John Falatko,1 Alexandra Halalau1,2 1Internal Medicine Department, Beaumont Hospital, Royal Oak, MI, USA; 2Internal Medicine Department, Oakland University William Beaumont School of Medicine, Rochester, MI, USA Objective: To assess the impact of four evidence based medicine (EBM critical appraisal education workshops in improving residents’ EBM knowledge and skills. Methods: The eligible participants in the workshops were 88 residents-in-training, postgraduate years one through four, rotating through the outpatient internal medicine clinic. Four EBM workshops, consisting of 3 days each (30 minutes daily, were taught by our faculty. Topics covered included critical appraisal of randomized controlled trials, case-control and cohort studies, diagnosis studies, and systematic reviews. Results: As a program evaluation, anonymous pre-workshop and post-workshop tests were administered. Each of the four sets of tests showed improvement in scores: therapy from 58% to 77% (42% response rate, harm from 65% to 73% (38% response rate, diagnosis from 49% to 68% (49% response rate, and systematic review from 57% to 72% (30% response rate. Conclusion: We found that teaching EBM in four short workshops improved EBM knowledge and critical appraisal skills related to the four topics. Keywords: evidence based medicine, medical education, assessment methods, graduate, instructional design, curriculum development, curriculum evaluation

  17. Simulation for Teaching Orthopaedic Residents in a Competency-based Curriculum: Do the Benefits Justify the Increased Costs?

    Science.gov (United States)

    Nousiainen, Markku T; McQueen, Sydney A; Ferguson, Peter; Alman, Benjamin; Kraemer, William; Safir, Oleg; Reznick, Richard; Sonnadara, Ranil

    2016-04-01

    Although simulation-based training is becoming widespread in surgical education and research supports its use, one major limitation is cost. Until now, little has been published on the costs of simulation in residency training. At the University of Toronto, a novel competency-based curriculum in orthopaedic surgery has been implemented for training selected residents, which makes extensive use of simulation. Despite the benefits of this intensive approach to simulation, there is a need to consider its financial implications and demands on faculty time. This study presents a cost and faculty work-hours analysis of implementing simulation as a teaching and evaluation tool in the University of Toronto's novel competency-based curriculum program compared with the historic costs of using simulation in the residency training program. All invoices for simulation training were reviewed to determine the financial costs before and after implementation of the competency-based curriculum. Invoice items included costs for cadavers, artificial models, skills laboratory labor, associated materials, and standardized patients. Costs related to the surgical skills laboratory rental fees and orthopaedic implants were waived as a result of special arrangements with the skills laboratory and implant vendors. Although faculty time was not reimbursed, faculty hours dedicated to simulation were also evaluated. The academic year of 2008 to 2009 was chosen to represent an academic year that preceded the introduction of the competency-based curriculum. During this year, 12 residents used simulation for teaching. The academic year of 2010 to 2011 was chosen to represent an academic year when the competency-based curriculum training program was functioning parallel but separate from the regular stream of training. In this year, six residents used simulation for teaching and assessment. The academic year of 2012 to 2013 was chosen to represent an academic year when simulation was used equally

  18. Theoretical study of some aspects of the nucleo-bases reactivity: definition of new theoretical tools for the study of chemical reactivity

    International Nuclear Information System (INIS)

    Labet, V.

    2009-09-01

    In this work, three kinds of nucleo-base damages were studied from a theoretical point of view with quantum chemistry methods based on the density-functional theory: the spontaneous deamination of cytosine and its derivatives, the formation of tandem lesion induced by hydroxyl radicals in anaerobic medium and the formation of pyrimidic dimers under exposition to an UV radiation. The complementary use of quantitative static methods allowing the exploration of the potential energy surface of a chemical reaction, and of 'conceptual DFT' principles, leads to information concerning the mechanisms involved and to the rationalization of the differences in the nucleo-bases reactivity towards the formation of a same kind of damage. At the same time, a reflexion was undertaken on the asynchronous concerted mechanism concept, in terms of physical meaning of the transition state, respect of the Maximum Hardness Principle, and determination of the number of primitive processes involved. Finally, a new local reactivity index was developed, relevant to understand the reactivity of a molecular system in an excited state. (author)

  19. Role of WhatsApp-based discussions in improving residents' knowledge of post-operative pain management: a pilot study.

    Science.gov (United States)

    Bakshi, Sumitra G; Bhawalkar, Pranay

    2017-10-01

    To provide a platform for the dissemination of basic knowledge of pain management, a WhatsApp group was created by residents and consultants. Common clinical scenarios, resident queries, and important instructions to be followed by residents with respect to running the Acute Pain Service were discussed in the group. This study evaluates the benefits of this interaction. This study was approved by the hospital ethics board and was registered with the Clinical Trial Registry of India. Second- and third-year anesthesia residents were included in a WhatsApp group, along with consultants (board certified anesthesiologists with a special interest in pain). Pain knowledge assessment was performed pre- and post-discussion using a standard 22-point questionnaire. A feedback form, which included self-rated confidence scores (1-10, 10-most confident) and opinions about the 3-month WhatsApp discussion, was collected. Improvements in the documentation in clinical sheets post-discussion were also analyzed. A total of 38 residents were included in the WhatsApp group. An improvement in the percentage of correct answers from 69.1% (pre-discussion) to 73.6% (post-discussion) was observed (P = 0.031). Improvements in the self-rated residents' confidence levels were also noted (P WhatsApp-based discussion was useful. Documentation of the details of epidural blockade in clinical sheets improved from 30% to 100%. The WhatsApp discussion improved residents' knowledge and confidence levels, and also resulted in improved documentation of essential details in the clinical notes. This form of education is promising and should be explored in future studies.

  20. Why wait until residency? Competency-based education in longitudinal integrated clerkships.

    Science.gov (United States)

    Gentles, John Quinn

    2017-02-01

    This essay was selected as the winner of the 2015 Canadian Undergraduate Surgical Education Committee student essay competition. It was written in response to the prompt: "How is your school preparing you for residency - be it surgical or medical?".

  1. Reactivity-based industrial volatile organic compounds emission inventory and its implications for ozone control strategies in China

    Science.gov (United States)

    Liang, Xiaoming; Chen, Xiaofang; Zhang, Jiani; Shi, Tianli; Sun, Xibo; Fan, Liya; Wang, Liming; Ye, Daiqi

    2017-08-01

    Increasingly serious ozone (O3) pollution, along with decreasing NOx emission, is creating a big challenge in the control of volatile organic compounds (VOCs) in China. More efficient and effective measures are assuredly needed for controlling VOCs. In this study, a reactivity-based industrial VOCs emission inventory was established in China based on the concept of ozone formation potential (OFP). Key VOCs species, major VOCs sources, and dominant regions with high reactivity were identified. Our results show that the top 15 OFP-based species, including m/p-xylene, toluene, propene, o-xylene, and ethyl benzene, contribute 69% of the total OFP but only 30% of the total emission. The architectural decoration industry, oil refinery industry, storage and transport, and seven other sources constituted the top 10 OFP subsectors, together contributing a total of 85%. The provincial and spatial characteristics of OFP are generally consistent with those of mass-based inventory. The implications for O3 control strategies in China are discussed. We propose a reactivity-based national definition of VOCs and low-reactive substitution strategies, combined with evaluations of health risks. Priority should be given to the top 15 or more species with high reactivity through their major emission sources. Reactivity-based policies should be flexibly applied for O3 mitigation based on the sensitivity of O3 formation conditions.

  2. Mastery of Status Epilepticus Management via Simulation-Based Learning for Pediatrics Residents

    Science.gov (United States)

    Malakooti, Marcelo R.; McBride, Mary E.; Mobley, Bonnie; Goldstein, Joshua L.; Adler, Mark D.; McGaghie, William C.

    2015-01-01

    Background Management of status epilepticus (SE) in the pediatric population is highly time-sensitive. Failure to follow a standard management algorithm may be due to ineffective provider education, and can lead to unfavorable outcomes. Objective To design a learning module using high-fidelity simulation technology to teach mastery achievement of a hospital algorithm for managing SE. Methods Thirty pediatrics interns were enrolled. Using the Angoff method, an expert panel developed the minimal passing score, which defined mastery. Scoring of simulated performance was done by 2 observers. Sessions were digitally recorded. After the pretest, participants were debriefed on the algorithm and required to repeat the simulation. If mastery (minimal passing score) was not achieved, debriefing and the simulation were repeated until mastery was met. Once mastery was met, participants graded their comfort level in managing SE. Results No participants achieved mastery at pretest. After debriefing and deliberate simulator training, all (n = 30) achieved mastery of the algorithm: 30% achieved mastery after 1 posttest, 63% after a second, and 6.7% after a third. The Krippendorff α was 0.94, indicating strong interrater agreement. Participants reported more self-efficacy in managing SE, a preference for simulation-based education for learning practice-based algorithms of critical conditions, and highly rated the educational intervention. Conclusions A simulation-based mastery learning program using deliberate practice dramatically improves pediatrics residents' execution of a SE management protocol. Participants enjoyed and benefited from simulation education. Future applications include improving adherence to other hospital protocols. PMID:26221431

  3. RESEARCH ON THE DIRECT CARBON EMISSION FORECAST OF CHINA'S PROVINCIAL RESIDENTS BASED ON NEURAL NETWORK

    Directory of Open Access Journals (Sweden)

    T. Zhang

    2018-04-01

    Full Text Available Global climate change, which mainly effected by human carbon emissions, would affect the regional economic, natural ecological environment, social development and food security in the near future. It’s particularly important to make accurate predictions of carbon emissions based on current carbon emissions. This paper accounted out the direct consumption of carbon emissions data from 1995 to 2014 about 30 provinces (the data of Tibet, Hong Kong, Macao and Taiwan is missing and the whole of China. And it selected the optimal models from BP, RBF and Elman neural network for direct carbon emission prediction, what aim was to select the optimal prediction method and explore the possibility of reaching the peak of residents direct carbon emissions of China in 2030. Research shows that: 1 Residents’ direct carbon emissions per capita of all provinces showed an upward trend in 20 years. 2 The accuracy of the prediction results by Elman neural network model is higher than others and more suitable for carbon emission data projections. 3 With the situation of residents’ direct carbon emissions free development, the direct carbon emissions will show a fast to slow upward trend in the next few years and began to flatten after 2020, and the direct carbon emissions of per capita will reach the peak in 2032. This is also confirmed that China is expected to reach its peak in carbon emissions by 2030 in theory.

  4. Prediction of indoor radon concentration based on residence location and construction

    International Nuclear Information System (INIS)

    Maekelaeinen, I.; Voutilainen, A.; Castren, O.

    1992-01-01

    We have constructed a model for assessing indoor radon concentrations in houses where measurements cannot be performed. It has been used in an epidemiological study and to determine the radon potential of new building sites. The model is based on data from about 10,000 buildings. Integrated radon measurements were made during the cold season in all the houses; their geographic coordinates were also known. The 2-mo measurement results were corrected to annual average concentrations. Construction data were collected from questionnaires completed by residents; geological data were determined from geological maps. Data were classified according to geographical, geological, and construction factors. In order to describe different radon production levels, the country was divided into four zones. We assumed that the factors were multiplicative, and a linear concentration-prediction model was used. The most significant factor in determining radon concentration was the geographical region, followed by soil type, year of construction, and type of foundation. The predicted indoor radon concentrations given by the model varied from 50 to 440 Bq m -3 . The lower figure represents a house with a basement, built in the 1950s on clay soil, in the region with the lowest radon concentration levels. The higher value represents a house with a concrete slab in contact with the ground, built in the 1980s, on gravel, in the region with the highest average radon concentration

  5. A value- and expectancy-based approach to understanding residents' intended response to a wildfire threat

    DEFF Research Database (Denmark)

    McNeill, Ilona M.; Dunlop, Patrick D.; Skinner, Timothy C.

    2016-01-01

    To motivate residents to evacuate early in case of a wildfire threat, it is important to know what factors underlie their response-related decision-making. The current paper examines the role of the value and expectancy tied to potential outcomes of defending vs evacuating on awareness...... or wait and see. These findings have important implications for strategies to influence residents' response-related decision-making....

  6. The Web-based CanMEDS Resident Learning Portfolio Project (WEBCAM): how we got started.

    Science.gov (United States)

    Glen, Peter; Balaa, Fady; Momoli, Franco; Martin, Louise; Found, Dorothy; Arnaout, Angel

    2016-12-01

    The CanMEDS framework is ubiquitous in Canadian postgraduate medical education; however, training programs do not have a universal method of assessing competence. We set out to develop a novel portfolio that allowed trainees to generate a longitudinal record of their training and development within the framework. The portfolio provided an objective means for the residency program director to document and evaluate resident progress within the CanMEDS roles.

  7. Feasibility Study for the Use of Green, Bio-Based, Efficient Reactive Sorbent Material to Neutralize Chemical Warfare Agents

    Science.gov (United States)

    2012-08-02

    REPORT Feasibility study for the use of green, bio-based, efficient reactive sorbent material to neutralize chemical warfare agents 14. ABSTRACT 16...way cellulose, lignin and hemicelluloses interact as well as whole wood dissolution occurs in ILs. The present project was conducted to 1. REPORT...Feasibility study for the use of green, bio-based, efficient reactive sorbent material to neutralize chemical warfare agents Report Title ABSTRACT Over the

  8. Prevalence and regional correlates of road traffic injury among Chinese urban residents: A 21-city population-based study.

    Science.gov (United States)

    Rockett, Ian R H; Jiang, Shuhan; Yang, Qian; Yang, Tingzhong; Yang, Xiaozhao Y; Peng, Sihui; Yu, Lingwei

    2017-08-18

    This study estimated the prevalence of road traffic injury among Chinese urban residents and examined individual and regional-level correlates. A cross-sectional multistage process was used to sample residents from 21 selected cities in China. Survey respondents reported their history of road traffic injury in the past 12 months through a community survey. Multilevel, multivariable logistic regression analysis was used to identify injury correlates. Based on a retrospective 12-month reporting window, road traffic injury prevalence among urban residents was 13.2%. Prevalence of road traffic injury, by type, was 8.7, 8.7, 8.5, and 7.7% in the automobile, bicycle, motorcycle, and pedestrian categories, respectively. Multilevel analysis showed that prevalence of road traffic injury was positively associated with minority status, income, and mental health disorder score at the individual level. Regionally, road traffic injury was associated with geographic location of residence and prevalence of mental health disorders. Both individual and regional-level variables were associated with road traffic injury among Chinese urban residents, a finding whose implications transcend wholesale imported generic solutions. This descriptive research demonstrates an urgent need for longitudinal studies across China on risk and protective factors, in order to inform injury etiology, surveillance, prevention, treatment, and evaluation.

  9. A core competency-based objective structured clinical examination (OSCE) can predict future resident performance.

    Science.gov (United States)

    Wallenstein, Joshua; Heron, Sheryl; Santen, Sally; Shayne, Philip; Ander, Douglas

    2010-10-01

    This study evaluated the ability of an objective structured clinical examination (OSCE) administered in the first month of residency to predict future resident performance in the Accreditation Council for Graduate Medical Education (ACGME) core competencies. Eighteen Postgraduate Year 1 (PGY-1) residents completed a five-station OSCE in the first month of postgraduate training. Performance was graded in each of the ACGME core competencies. At the end of 18 months of training, faculty evaluations of resident performance in the emergency department (ED) were used to calculate a cumulative clinical evaluation score for each core competency. The correlations between OSCE scores and clinical evaluation scores at 18 months were assessed on an overall level and in each core competency. There was a statistically significant correlation between overall OSCE scores and overall clinical evaluation scores (R = 0.48, p competencies of patient care (R = 0.49, p competencies. An early-residency OSCE has the ability to predict future postgraduate performance on a global level and in specific core competencies. Used appropriately, such information can be a valuable tool for program directors in monitoring residents' progress and providing more tailored guidance. © 2010 by the Society for Academic Emergency Medicine.

  10. Effects of mobile and digital support for a structured, competency-based curriculum in neurosurgery residency education.

    Science.gov (United States)

    Gonzalez, Nestor R; Dusick, Joshua R; Martin, Neil A

    2012-07-01

    Changes in neurosurgical practice and graduate medical education impose new challenges for training programs. We present our experience providing neurosurgical residents with digital and mobile educational resources in support of the departmental academic activities. A weekly mandatory conference program for all clinical residents based on the Accreditation Council for Graduate Medical Education competencies, held in protected time, was introduced. Topics were taught through didactic sessions and case discussions. Faculty and residents prepare high-quality presentations, equivalent to peer-review leading papers or case reports. Presentations are videorecorded, stored in a digital library, and broadcasted through our Website and iTunes U. Residents received mobile tablet devices with remote access to the digital library, applications for document/video management, and interactive teaching tools. Residents responded to an anonymous survey, and performances on the Self-Assessment in Neurological Surgery examination before and after the intervention were compared. Ninety-two percent reported increased time used to study outside the hospital and attributed the habit change to the introduction of mobile devices; 67% used the electronic tablets as the primary tool to access the digital library, followed by 17% hospital computers, 8% home computers, and 8% personal laptops. Forty-two percent have submitted operative videos, cases, and documents to the library. One year after introducing the program, results of the Congress of Neurological Surgeons-Self-Assessment in Neurological Surgery examination showed a statistically significant improvement in global scoring and improvement in 16 of the 18 individual areas evaluated, 6 of which reached statistical significance. A structured, competency-based neurosurgical education program supported with digital and mobile resources improved reading habits among residents and performance on the Congress of Neurological Surgeons

  11. Use of simulation-based education to improve resident learning and patient care in the medical intensive care unit: a randomized trial.

    Science.gov (United States)

    Schroedl, Clara J; Corbridge, Thomas C; Cohen, Elaine R; Fakhran, Sherene S; Schimmel, Daniel; McGaghie, William C; Wayne, Diane B

    2012-04-01

    The purpose of this study is to determine the effect of simulation-based education on the knowledge and skills of internal medicine residents in the medical intensive care unit (MICU). From January 2009 to January 2010, 60 first-year residents at a tertiary care teaching hospital were randomized by month of rotation to an intervention group (simulator-trained, n = 26) and a control group (traditionally trained, n = 34). Simulator-trained residents completed 4 hours of simulation-based education before their medical intensive care unit (MICU) rotation. Topics included circulatory shock, respiratory failure, and mechanical ventilation. After their rotation, residents completed a standardized bedside skills assessment using a 14-item checklist regarding respiratory mechanics, ventilator settings, and circulatory parameters. Performance of simulator-trained and traditionally trained residents was compared using a 2-tailed independent-samples t test. Simulator-trained residents scored significantly higher on the bedside skills assessment compared with traditionally trained residents (82.5% ± 10.6% vs 74.8% ± 14.1%, P = .027). Simulator-trained residents were highly satisfied with the simulation curriculum. Simulation-based education significantly improved resident knowledge and skill in the MICU. Knowledge acquired in the simulated environment was transferred to improved bedside skills caring for MICU patients. Simulation-based education is a valuable adjunct to standard clinical training for residents in the MICU. Copyright © 2012 Elsevier Inc. All rights reserved.

  12. Using reactor network for global identification based on residence time distribution theory

    Energy Technology Data Exchange (ETDEWEB)

    Hocine, S.; Pibouleau, L.; Azzaro-Pantel, C.; Domenech, S. [Laboratoire de Genie Chimique - UMR 5503 CNRS/ INPT ENSIACET, 31 - Toulouse (France)

    2006-07-01

    In the ventilation systems, the control of transfer contaminants is one of the principal problems during the design and control phases. The installation of a suitable ventilation system for the control of contaminant transfer is essential in industry, because it makes it possible to detect and to prevent chemical and radiological risks. Research on air distribution in ventilated rooms traditionally involves full-scale experiments, scale -model experiments and application of the computational fluid dynamics (C.F.D.) tools. Most of the time, particularly in our case of large and cluttered enclosures, the predictive approach based on C.F.D. codes can not be used. The solution retained here is the establishment of a model based on the well known residence time distribution. This model is widely used in chemical engineering to treat non-ideal flows. The proposed method is based on the experimental determination of the residence time distribution curve, generally obtained through the response of the system to tracer release. A superstructure involving the set of all the possible solutions corresponding to the physical reactor is then defined, and the model will be selected from this superstructure according to its simulated response. The superstructure is identified as a combination of elementary systems, representing ideal flow patterns, as perfect mixed flows, plug flows, continuous stirred tank reactors, etc. The selected model is derived from the comparison between the simulated response to a stimulus, and the experimental response. The structure and parameters of the model are simultaneously optimized in order to fit the experimental curve with a minimal number of elementary units, constituting a key point for future control purposes of the process. This problem is a dynamic M.I.N.L.P. (Mixed Integer Non Linear Programming) problem with bilinear equality constraints. Generally, these constraints lead to numerical difficulties for reaching an optimum solution (even a

  13. Coordinated Volt/Var Control in Distribution Systems with Distributed Generations Based on Joint Active and Reactive Powers Dispatch

    Directory of Open Access Journals (Sweden)

    Abouzar Samimi

    2016-01-01

    Full Text Available One of the most significant control schemes in optimal operation of distribution networks is Volt/Var control (VVC. Owing to the radial structure of distribution systems and distribution lines with a small X/R ratio, the active power scheduling affects the VVC issue. A Distribution System Operator (DSO procures its active and reactive power requirements from Distributed Generations (DGs along with the wholesale electricity market. This paper proposes a new operational scheduling method based on a joint day-ahead active/reactive power market at the distribution level. To this end, based on the capability curve, a generic reactive power cost model for DGs is developed. The joint active/reactive power dispatch model presented in this paper motivates DGs to actively participate not only in the energy markets, but also in the VVC scheme through a competitive market. The proposed method which will be performed in an offline manner aims to optimally determine (i the scheduled active and reactive power values of generation units; (ii reactive power values of switched capacitor banks; and (iii tap positions of transformers for the next day. The joint active/reactive power dispatch model for daily VVC is modeled in GAMS and solved with the DICOPT solver. Finally, the plausibility of the proposed scheduling framework is examined on a typical 22-bus distribution test network over a 24-h period.

  14. Void reactivity feedback analysis for U-based and Th-based LWR incineration cycles

    Energy Technology Data Exchange (ETDEWEB)

    Lindley, B.A.; Parks, G.T. [Cambridge University Engineering Department, Trumpington Street, Cambridge, CB2 1PZ (United Kingdom); Franceschini, F. [Westinghouse Electric Company LLC, Cranberry Township, PA (United States)

    2013-07-01

    In reduced-moderation LWRs, an external supply of transuranic (TRU) can be incinerated by mixing it with a fertile isotope ({sup 238}U or {sup 232}Th) and recycling all the actinides after each cycle. Performance is limited by coolant reactivity feedback - the moderator density coefficient (MDC) must be kept negative. The MDC is worse when more TRU is loaded, but TRU feed is also needed to maintain criticality. To assess the performance of this fuel cycle in different neutron spectra, three LWRs are considered: 'reference' PWRs and reduced-moderation PWRs and BWRs. The MDC of the equilibrium cycle is analysed by reactivity decomposition with perturbed coolant density by isotope and neutron energy. The results show that using {sup 232}Th as a fertile isotope yields superior performance to {sup 238}U. This is due essentially to the high resonance η of U bred from Th (U3), which increases the fissility of the U3-TRU isotope vector in the Th-fueled system relative to the U-fueled system, and also improves the MDC in a sufficiently hard spectrum. Spatial separation of TRU and U3 in the Th-fueled system renders further improvement by hardening the neutron spectrum in the TRU and softening it in the U3. This improves the TRU η and increases the negative MDC contribution from reduced thermal fission in U3. (authors)

  15. Simulation-Based Training for Residents in the Management of Acute Agitation: A Cluster Randomized Controlled Trial.

    Science.gov (United States)

    Vestal, Heather S; Sowden, Gillian; Nejad, Shamim; Stoklosa, Joseph; Valcourt, Stephanie C; Keary, Christopher; Caminis, Argyro; Huffman, Jeff

    2017-02-01

    Simulations are used extensively in medicine to train clinicians to manage high-risk situations. However, to our knowledge, no studies have determined whether this is an effective means of teaching residents to manage acutely agitated patients. This study aimed to determine whether simulation-based training in the management of acute agitation improves resident knowledge and performance, as compared to didactic-based instruction. Following a standard lecture on the management of agitated patients, first-year psychiatry residents were randomized (in clusters of three to four residents) to either the intervention (n = 15) or control arm (n = 11). Residents in the intervention arm then received simulation-based training on the management of acute agitation using a scenario with an agitated standardized patient. Those in the control arm received simulation-based training on a clinical topic unrelated to the management of agitation using a scenario with a non-agitated standardized patient who had suffered a fall. Baseline confidence and knowledge were assessed using pre-intervention self-assessment questionnaires and open-ended clinical case vignettes. Efficacy of the intervention as a teaching tool was assessed with post-intervention open-ended clinical case vignettes and videotaped simulation-based assessment, using a different scenario of an agitated standardized patient. Residents who received the agitation simulation-based training showed significantly greater improvement in knowledge (intervention = 3.0 vs. control = 0.3, p = 0.007, Cohen's d = 1.2) and performance (intervention = 39.6 vs control = 32.5, p = 0.001, Cohen's d = 1.6). Change in self-perceived confidence did not differ significantly between groups. In this study, simulation-based training appeared to be more effective at teaching knowledge and skills necessary for the management of acutely agitated patients, as compared to didactic-based instruction alone

  16. The reactivity meter and core reactivity

    International Nuclear Information System (INIS)

    Siltanen, P.

    1999-01-01

    This paper discussed in depth the point kinetic equations and the characteristics of the point kinetic reactivity meter, particularly for large negative reactivities. From a given input signal representing the neutron flux seen by a detector, the meter computes a value of reactivity in dollars (ρ/β), based on inverse point kinetics. The prompt jump point of view is emphasised. (Author)

  17. Comparison of 2 resident learning tools-interactive screen-based simulated case scenarios versus problem-based learning discussions: a prospective quasi-crossover cohort study.

    Science.gov (United States)

    Rajan, Shobana; Khanna, Ashish; Argalious, Maged; Kimatian, Stephen J; Mascha, Edward J; Makarova, Natalya; Nada, Eman M; Elsharkawy, Hesham; Firoozbakhsh, Farhad; Avitsian, Rafi

    2016-02-01

    Simulation-based learning is emerging as an alternative educational tool in this era of a relative shortfall of teaching anesthesiologists. The objective of the study is to assess whether screen-based (interactive computer simulated) case scenarios are more effective than problem-based learning discussions (PBLDs) in improving test scores 4 and 8 weeks after these interventions in anesthesia residents during their first neuroanesthesia rotation. Prospective, nonblinded quasi-crossover study. Cleveland Clinic. Anesthesiology residents. Two case scenarios were delivered from the Anesoft software as screen-based sessions, and parallel scripts were developed for 2 PBLDs. Each resident underwent both types of training sessions, starting with the PBLD session, and the 2 cases were alternated each month (ie, in 1 month, the screen-based intervention used case 1 and the PBLD used case 2, and vice versa for the next month). Test scores before the rotation (baseline), immediately after the rotation (4 weeks after the start of the rotation), and 8 weeks after the start of rotation were collected on each topic from each resident. The effect of training method on improvement in test scores was assessed using a linear mixed-effects model. Compared to the departmental standard of PBLD, the simulation method did not improve either the 4- or 8-week mean test scores (P = .41 and P = .40 for training method effect on 4- and 8-week scores, respectively). Resident satisfaction with the simulation module on a 5-point Likert scale showed subjective evidence of a positive impact on resident education. Screen-based simulators were not more effective than PBLD for education during the neuroanesthesia rotation in anesthesia residency. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Resident and proprietor perspectives on a recovery orientation in community-based housing.

    Science.gov (United States)

    Piat, Myra; Boyer, Richard; Fleury, Marie-Josée; Lesage, Alain; O'Connell, Maria; Sabetti, Judith

    2015-03-01

    Stable housing is a fundamental human right, and an important element for both mental health recovery and social inclusion among people with serious mental illness. This article reports findings from a study on the recovery orientation of structured congregate community housing services using the Recovery Self-Assessment Questionnaire (RSA) adapted for housing (O'Connell, Tondora, Croog, Evans, & Davidson, 2005). The RSA questionnaires were administered to 118 residents and housing providers from 112 congregate housing units located in Montreal, Canada. Residents rated their homes as significantly less recovery-oriented than did proprietors, which is contrary to previous studies of clinical services or Assertive Community Treatment where RSA scores for service users were significantly higher than service provider scores. Findings for both groups suggest the need for improvement on 5 of 6 RSA factors. While proprietors favored recovery training and education, and valued resident opinion and experience, vestiges of a traditional medical model governing this housing emerged in other findings, as in agreement between the 2 groups that residents have little choice in case management, or in the belief among proprietors that residents are unable to manage their symptoms. This study demonstrates that the RSA adapted for housing is a useful tool for creating recovery profiles of housing services. The findings provide practical guidance on how to promote a recovery orientation in structured community housing, as well as a novel approach for reaching a common understanding of what this entails among stakeholders. (PsycINFO Database Record (c) 2015 APA, all rights reserved).

  19. Resident and Proprietor Perspectives of a Recovery Orientation in Community-Based Housing

    Science.gov (United States)

    Piat, Myra; Boyer, Richard; Fleury, Marie-Josée; Lesage, Alain; O’Connell, Maria; Sabetti, Judith

    2016-01-01

    Objective Stable housing is a fundamental human right, and an important element for both mental health recovery and social inclusion among people with serious mental illness. This article reports findings from a study on the recovery orientation of structured congregate community housing services using the Recovery Self-Assessment Questionnaire (RSA) adapted for housing (O’Connell, Tondora, Croog, Evans, & Davidson, 2005). Methods The RSA questionnaires were administered to 118 residents and housing providers from 112 congregate housing units located in Montreal, Canada. Results Residents rated their homes as significantly less recovery-oriented than did proprietors, which is contrary to previous studies of clinical services or Assertive Community Treatment where RSA scores for service users were significantly higher than service provider scores. Findings for both groups suggest the need for improvement on 5 of 6 RSA factors. While proprietors favored recovery training and education, and valued resident opinion and experience, vestiges of a traditional medical model governing this housing emerged in other findings, as in agreement between the 2 groups that residents have little choice in case management, or in the belief among proprietors that residents are unable to manage their symptoms. Conclusions and Implications for Practice This study demonstrates that the RSA adapted for housing is a useful tool for creating recovery profiles of housing services. The findings provide practical guidance on how to promote a recovery orientation in structured community housing, as well as a novel approach for reaching a common understanding of what this entails among stakeholders. PMID:25559078

  20. Impact of Resident Surgeons on Procedure Length based on Common Pediatric Otolaryngology Cases

    Science.gov (United States)

    Puram, Sidharth V.; Kozin, Elliott D.; Sethi, Rosh; Alkire, Blake; Lee, Daniel J.; Gray, Stacey T.; Shrime, Mark G.; Cohen, Michael

    2015-01-01

    Background Surgical education remains an important mission of academic medical centers. Financial pressures, however, may favor improved operating room (OR) efficiency at the expense of surgical education. We aim to characterize resident impact on the duration of procedural time using common pediatric otolaryngologic cases which do not necessitate a surgical assistant and assess whether other factors modify the extent to which residents impact OR efficiency. Study Design We retrospectively reviewed resident and attending surgeon total OR and procedural times for isolated tonsillectomy, adenoidectomy, tonsillectomy with adenoidectomy (T&A) and bilateral myringotomy with tube insertion between 2009 and 2013. We included cases supervised or performed by one of four teaching surgeons in children with ASA otolaryngology procedures. While residents may increase operative times, addressing other system-wide issues may decrease impact of time needed for education and added efficiencies of resident participation may exist throughout the perioperative period. Our model is applicable to surgical education across specialties. Level of Evidence 4 PMID:25251257

  1. Soft sensor based composition estimation and controller design for an ideal reactive distillation column.

    Science.gov (United States)

    Vijaya Raghavan, S R; Radhakrishnan, T K; Srinivasan, K

    2011-01-01

    In this research work, the authors have presented the design and implementation of a recurrent neural network (RNN) based inferential state estimation scheme for an ideal reactive distillation column. Decentralized PI controllers are designed and implemented. The reactive distillation process is controlled by controlling the composition which has been estimated from the available temperature measurements using a type of RNN called Time Delayed Neural Network (TDNN). The performance of the RNN based state estimation scheme under both open loop and closed loop have been compared with a standard Extended Kalman filter (EKF) and a Feed forward Neural Network (FNN). The online training/correction has been done for both RNN and FNN schemes for every ten minutes whenever new un-trained measurements are available from a conventional composition analyzer. The performance of RNN shows better state estimation capability as compared to other state estimation schemes in terms of qualitative and quantitative performance indices. Copyright © 2010 ISA. Published by Elsevier Ltd. All rights reserved.

  2. Single-Phase Boost Inverter-Based Electric Vehicle Charger With Integrated Vehicle to Grid Reactive Power Compensation

    DEFF Research Database (Denmark)

    Wickramasinghe Abeywardana, Damith Buddika; Acuna, Pablo; Hredzak, Branislav

    2018-01-01

    Vehicle to grid (V2G) reactive power compensation using electric vehicle (EV) onboard chargers helps to ensure grid power quality by achieving unity power factor operation. However, the use of EVs for V2G reactive power compensation increases the second-order harmonic ripple current component...... from the grid, exposes the EV battery to these undesirable ripple current components for a longer period and discharges the battery due to power conversion losses. This paper presents a way to provide V2G reactive power compensation through a boost inverter-based single stage EV charger and a DC...

  3. Improving resident's skills in the management of circulatory shock with a knowledge-based e-learning tool.

    Science.gov (United States)

    Riaño, David; Real, Francis; Alonso, Jose Ramon

    2018-05-01

    Correct clinical management of circulatory shock in emergency departments (ER) and intensive care units (ICU) is critical. In this context, the transmission of professional skills by means of the practical supervision of real cases at the point of care entails important issues that can be widely overcome with the use of computer knowledge-based e-learning tools. Shock-Instructor is a web-based e-learning tool implementing the already tested training program model (TPM) that uses a knowledge base about the evidence found in the clinical practice guidelines about seven types of shock. This tool is expected to reduce the learning times and to improve the skills of hospital residents with regard to both the correct application of the guidelines and patient recovery, suppressing the risks of direct interventions. Shock-Instructor has been used to train residents in the Emergency Department of the Hospital Clínic de Barcelona (Spain) in order to reduce the learning cycle without affecting quality. A case-base with the description of 51 cases with shock and a knowledge-base with 137 clinical rules about the treatment of shock were incorporated to the Shock-Instructor system. A group of 33 residents was involved in a randomized controlled trial to check whether the use of Shock-Instructor can significantly improve the skills of clinicians after one week of problem-based training. No significant differences were found in the skill levels of the intervention (IG) and control (CG) groups prior to learning. However, we observed an improvement of the IG clinicians capacity to stabilize patients with shock in better clinical conditions (5% improvement, p = 0.004), and to reduce the risk of death in 19.52% (p = 0.004), after training. First-year residents in IG enhanced 14.3% their sensitivity in the correct application of guidelines (p = 0.01), and 14.9% the mean survival rate of their patients (p = 0.01), after being trained with Shock-Instructor for a week

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

    Science.gov (United States)

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

    2016-11-01

    Nursing aides provide most of the labor-intensive activities of daily living (ADL) care to nursing home (NH) residents. Currently, most NHs do not determine nurse aide staffing requirements based on the time to provide ADL care for their unique resident population. The lack of an objective method to determine nurse aide staffing requirements suggests that many NHs could be understaffed in their capacity to provide consistent ADL care to all residents in need. Discrete event simulation (DES) mathematically models key work parameters (eg, time to provide an episode of care and available staff) to predict the ability of the work setting to provide care over time and offers an objective method to determine nurse aide staffing needs in NHs. This study had 2 primary objectives: (1) to describe the relationship between ADL workload and the level of nurse aide staffing reported by NHs; and, (2) to use a DES model to determine the relationship between ADL workload and nurse aide staffing necessary for consistent, timely ADL care. Minimum Data Set data related to the level of dependency on staff for ADL care for residents in over 13,500 NHs nationwide were converted into 7 workload categories that captured 98% of all residents. In addition, data related to the time to provide care for the ADLs within each workload category was used to calculate a workload score for each facility. The correlation between workload and reported nurse aide staffing levels was calculated to determine the association between staffing reported by NHs and workload. Simulations to project staffing requirements necessary to provide ADL care were then conducted for 65 different workload scenarios, which included 13 different nurse aide staffing levels (ranging from 1.6 to 4.0 total hours per resident day) and 5 different workload percentiles (ranging from the 5th to the 95th percentile). The purpose of the simulation model was to determine the staffing necessary to provide care within each workload

  5. An OPF based approach for assessing the minimal reactive power support for generators in deregulated power systems

    International Nuclear Information System (INIS)

    Wu, H.; Yu, C.W.; Xu, N.; Lin, X.J.

    2008-01-01

    Reactive power support is an important ancillary service for secure and reliable operation in power markets. It has recently been recognized that the reactive power support for a generator has two components: one for supporting its own real power transmission and the other for supplying reactive demand, improving system security, and controlling system voltage; and that only the second part should receive financial compensation in competitive power markets. This makes the problem of separating these two components a new focus of current research. An OPF based reactive power optimization model along with a power flow tracing based method is proposed in this paper to tackle this problem. The methodology is tested on four test systems. Detailed analysis of the results of the 39-bus test system is reported. (author)

  6. Permanent health education based on research with professionals of a multidisciplinary residency program: case study

    Directory of Open Access Journals (Sweden)

    Cristiane Trivisiol da Silva

    Full Text Available This research aims to identify the perception of professional members of a multi-professional residency program on Permanent Health Education. It is a case study research using a qualitative approach, with sixteen members of a multi-professional residency program. The data were collected from January to May 2012, through semi-structured interviews, document analysis and systematic observation, and analyzed according to Thematic Content Analysis. Two categories were identified: Permanent Health Education establishing collective spaces of reflection of practices and Permanent Health Education that promotes integration between disciplines. The members of the multiprofessional residency team were found to be aware that permanent education permeates their training and enables reflection on their clinical practices and multidisciplinary action as producers of health actions.

  7. Evidence-based practice in radiology: Knowledge, attitude and perceived barriers to practice among residents in radiology

    Energy Technology Data Exchange (ETDEWEB)

    Anuradha, Chandramohan, E-mail: anuradhachandramohan@gmail.com [Department of Radiology, Christian Medical College, Vellore, Tamil Nadu 632 004 (India); Jacob, K.S., E-mail: ksjacob@cmcvellore.ac.in [Department of Psychiatry, Christian Medical College, Vellore, Tamil Nadu 632 004 (India); Specialist Mental Health Service for Older People, Suite 106, 64–68 Derby Street, Kingswood, Penrith 2750 (Australia); Shyamkumar, N.K., E-mail: aparnashyam@gmail.com [Department of Radiology, Christian Medical College, Vellore, Tamil Nadu 632 004 (India); Sridhar, Gibikote, E-mail: gibikote@cmcvellore.ac.in [Department of Radiology, Christian Medical College, Vellore, Tamil Nadu 632 004 (India)

    2013-05-15

    Aim: We examinted the attitude, knowledge and perceived barriers to evidence-based practice of radiology (EBPR) among residents in radiology. Study design and setting: We used the McColl questionnaire (1) and the BARRIERS scale (2) to assess the issues among radiology trainees attending an annual refresher course. Ninety six residents from 32 medical colleges from Southern India attended the course. Results: Eighty (83.3%) residents, 55 male and 25 female of age range 24–34 years, consented and returned the questionnaire. The majority of the participants had a positive attitude towards EBPR. However, 45% were unaware of sources for evidence based literature although many had access to Medline (45%) and the internet (80%). The majority (70%) were aware of the common technical terms (e.g. odds ratio, absolute and relative risk) but other complex details (e.g. meta-analysis, clinical effectiveness, confidence interval, publication bias and number needed to treat) were poorly understood. Though majority of residents (59%) were currently following guidelines and protocols laid by colleagues within their departments, 70% of residents were interested in learning the skills of EBPR and were willing to appraise primary literature or systematic reviews by themselves. Insufficient time on the job to implement new ideas (70.1%); relevant literature is not being complied in one place (68.9%); not being able to understand statistical methods (68.5%) were considered to be the major barriers to EBPR. Training in critical appraisal significantly influence usage of bibliographic databases (p < 0.0001). Attitude of collegues (p = 0.006) influenced attitude of the trainees towards EBPR. Those with higher knowledge scores (p = 0.02) and a greater awareness of sources for seeking evidence based literature (p = 0.05) held stronger beliefs that EBPR significantly improved patient care. Conclusions: The large knowledge gap related to EBPR suggests the need to incorporate structured

  8. Evidence-based practice in radiology: Knowledge, attitude and perceived barriers to practice among residents in radiology

    International Nuclear Information System (INIS)

    Anuradha, Chandramohan; Jacob, K.S.; Shyamkumar, N.K.; Sridhar, Gibikote

    2013-01-01

    Aim: We examinted the attitude, knowledge and perceived barriers to evidence-based practice of radiology (EBPR) among residents in radiology. Study design and setting: We used the McColl questionnaire (1) and the BARRIERS scale (2) to assess the issues among radiology trainees attending an annual refresher course. Ninety six residents from 32 medical colleges from Southern India attended the course. Results: Eighty (83.3%) residents, 55 male and 25 female of age range 24–34 years, consented and returned the questionnaire. The majority of the participants had a positive attitude towards EBPR. However, 45% were unaware of sources for evidence based literature although many had access to Medline (45%) and the internet (80%). The majority (70%) were aware of the common technical terms (e.g. odds ratio, absolute and relative risk) but other complex details (e.g. meta-analysis, clinical effectiveness, confidence interval, publication bias and number needed to treat) were poorly understood. Though majority of residents (59%) were currently following guidelines and protocols laid by colleagues within their departments, 70% of residents were interested in learning the skills of EBPR and were willing to appraise primary literature or systematic reviews by themselves. Insufficient time on the job to implement new ideas (70.1%); relevant literature is not being complied in one place (68.9%); not being able to understand statistical methods (68.5%) were considered to be the major barriers to EBPR. Training in critical appraisal significantly influence usage of bibliographic databases (p < 0.0001). Attitude of collegues (p = 0.006) influenced attitude of the trainees towards EBPR. Those with higher knowledge scores (p = 0.02) and a greater awareness of sources for seeking evidence based literature (p = 0.05) held stronger beliefs that EBPR significantly improved patient care. Conclusions: The large knowledge gap related to EBPR suggests the need to incorporate structured

  9. Burden of Clostridium difficile-associated disease among patients residing in nursing homes: a population-based cohort study

    Directory of Open Access Journals (Sweden)

    Holly Yu

    2016-11-01

    Full Text Available Abstract Background Clostridium difficile (C. difficile infection (CDI is the leading cause of nosocomial diarrhea in the United States. This study aimed to examine the incidence of CDI and evaluate mortality and economic burden of CDI in an elderly population who reside in nursing homes (NHs. Methods This was a population-based retrospective cohort study focusing on US NHs by linking Medicare 5% sample, Medicaid, Minimum Data Set (MDS (2008–10. NH residents aged ≥65 years with continuous enrollment in Medicare and/or Medicaid Fee-for-Service plan for ≥12 months and ≥2 quarterly MDS assessments were eligible for the study. The incidence rate was calculated as the number of CDI episodes by 100,000 person-years. A 1:4 propensity score matched sample of cohorts with and without CDI was generated to assess mortality and health care costs following the first CDI. Results Among 32,807 NH residents, 941 residents had ≥1 episode of CDI in 2009, with an incidence of 3359.9 per 100,000 person-years. About 30% CDI episodes occurred in the hospital setting. NH residents with CDI (vs without CDI were more likely to have congestive heart failure, renal disease, cerebrovascular disease, hospitalizations, and outpatient antibiotic use. During the follow-up period, the 30-day (14.7% vs 4.3%, P < 0.001, 60-day (22.7% vs 7.5%, P < 0.001, 6-month (36.3% vs 18.3%, P < 0.001, and 1-year mortality rates (48.2% vs 31.1%, P < 0.001 were significantly higher among the CDI residents vs non-CDI residents. Total health care costs within 2 months following the first CDI episode were also significantly higher for CDI residents ($28,621 vs $13,644, P < 0.001. Conclusions CDI presents a serious public health issue in NHs. Mortality, health care utilization, and associated costs were significant following incident CDI episodes.

  10. Rapid and quantitative detection of C-reactive protein based on quantum dots and immunofiltration assay

    Directory of Open Access Journals (Sweden)

    Zhang PF

    2015-09-01

    Full Text Available Pengfei Zhang,1,* Yan Bao,1,* Mohamed Shehata Draz,2,3,* Huiqi Lu,1 Chang Liu,1 Huanxing Han11Center for Translational Medicine, Changzheng Hospital, Second Military Medical University, Shanghai, People’s Republic of China; 2Zhejiang-California International Nanosystems Institute, Zhejiang University, Hangzhou, Zhejiang, People’s Republic of China; 3Faculty of Science, Tanta University, Tanta, Egypt*These authors contributed equally to this workAbstract: Convenient and rapid immunofiltration assays (IFAs enable on-site “yes” or “no” determination of disease markers. However, traditional IFAs are commonly qualitative or semi-quantitative and are very limited for the efficient testing of samples in field diagnostics. Here, we overcome these limitations by developing a quantum dots (QDs-based fluorescent IFA for the quantitative detection of C-reactive proteins (CRP. CRP, the well-known diagnostic marker for acute viral and bacterial infections, was used as a model analyte to demonstrate performance and sensitivity of our developed QDs-based IFA. QDs capped with both polyethylene glycol (PEG and glutathione were used as fluorescent labels for our IFAs. The presence of the surface PEG layer, which reduced the non-specific protein interactions, in conjunction with the inherent optical properties of QDs, resulted in lower background signal, increased sensitivity, and ability to detect CRP down to 0.79 mg/L with only 5 µL serum sample. In addition, the developed assay is simple, fast and can quantitatively detect CRP with a detection limit up to 200 mg/L. Clinical test results of our QD-based IFA are well correlated with the traditional latex enhance immune-agglutination aggregation. The proposed QD-based fluorescent IFA is very promising, and potentially will be adopted for multiplexed immunoassay and in field point-of-care test.Keywords: C-reactive proteins, point-of-care test, Glutathione capped QDs, PEGylation

  11. Developing an integrated evidence-based medicine curriculum for family medicine residency at the University of Alberta.

    Science.gov (United States)

    Allan, G Michael; Korownyk, Christina; Tan, Amy; Hindle, Hugh; Kung, Lina; Manca, Donna

    2008-06-01

    There is general consensus in the academic community that evidence-based medicine (EBM) teaching is essential. Unfortunately, many postgraduate programs have significant weakness in their EBM programs. The Family Medicine Residency committee at the University of Alberta felt their EBM curriculum would benefit from critical review and revision. An EBM Curriculum Committee was created to evaluate previous components and develop new strategies as needed. Input from stakeholders including faculty and residents was sought, and evidence regarding the teaching and practical application of EBM was gathered. The committee drafted goals and objectives, the primary of which were to assist residents to (1) become competent self-directed, lifelong learners with skills to effectively and efficiently keep up to date, and 2) develop EBM skills to solve problems encountered in daily practice. New curriculum components, each evidence based, were introduced in 2005 and include a family medicine EBM workshop to establish basic EBM knowledge; a Web-based Family Medicine Desktop promoting easier access to evidence-based Internet resources; a brief evidence-based assessment of the research project enhancing integration of EBM into daily practice; and a journal club to support peer learning and growth of rapid appraisal skills. Issues including time use, costs, and change management are discussed. Ongoing evaluation of the curriculum and its components is a principal factor of the design, allowing critical review and adaptation of the curriculum. The first two years of the curriculum have yielded positive feedback from faculty and statistically significant improvement in multiple areas of residents' opinions of the curriculum and comfort with evidence-based practice.

  12. Emergency medicine resident crisis resource management ability: a simulation-based longitudinal study

    Directory of Open Access Journals (Sweden)

    Samuel Clarke

    2014-12-01

    Full Text Available Background: Simulation has been identified as a means of assessing resident physicians’ mastery of technical skills, but there is a lack of evidence for its utility in longitudinal assessments of residents’ non-technical clinical abilities. We evaluated the growth of crisis resource management (CRM skills in the simulation setting using a validated tool, the Ottawa Crisis Resource Management Global Rating Scale (Ottawa GRS. We hypothesized that the Ottawa GRS would reflect progressive growth of CRM ability throughout residency. Methods: Forty-five emergency medicine residents were tracked with annual simulation assessments between 2006 and 2011. We used mixed-methods repeated-measures regression analyses to evaluate elements of the Ottawa GRS by level of training to predict performance growth throughout a 3-year residency. Results: Ottawa GRS scores increased over time, and the domains of leadership, problem solving, and resource utilization, in particular, were predictive of overall performance. There was a significant gain in all Ottawa GRS components between postgraduate years 1 and 2, but no significant difference in GRS performance between years 2 and 3. Conclusions: In summary, CRM skills are progressive abilities, and simulation is a useful modality for tracking their development. Modification of this tool may be needed to assess advanced learners’ gains in performance.

  13. Scenario Simulation-Based Assessment of Trip Difficulty for Urban Residents under Rainstorm Waterlogging

    Directory of Open Access Journals (Sweden)

    Yingyue Sun

    2012-05-01

    Full Text Available In this study, an experiment was performed to assess the trip difficulty for urban residents of different age groups walking in various depths of water, and the data were corroborated with the real urban rainstorm waterlogging scenarios in downtown (Daoli district Ha-Erbin (China. Mathematical models of urban rainstorm waterlogging were constructed using scenario simulation methods, aided by the GIS spatial analysis technology and hydrodynamic analysis of the waterway systems in the study area. Then these models were used to evaluate the impact of waterlogging on the safety of residents walking in the affected area. Results are summarized as: (1 for an urban rainstorm waterlogging scenario reoccurring once every 10 years, three grid regions would have waterlogging above 0.5 m moving at a velocity of 1.5 m/s. Under this scenario, waterlogging would accumulate on traffic roads only in small areas, affecting the safety and mobility of residents walking in the neighborhood; (2 for an urban rainstorm waterlogging scenario reoccurring once every 20 years, 13 grids experienced the same waterlogging situation affecting a larger area of the city; (3 for an urban rainstorm waterlogging scenario reoccurring once every 50 years, 86 grid regions were affected (waterlogging above 0.5 m moving at 1.5 m/s, and those areas would become impassable for residents.

  14. Google Glass for Residents Dealing With Pediatric Cardiopulmonary Arrest: A Randomized, Controlled, Simulation-Based Study.

    Science.gov (United States)

    Drummond, David; Arnaud, Cécile; Guedj, Romain; Duguet, Alexandre; de Suremain, Nathalie; Petit, Arnaud

    2017-02-01

    To determine whether real-time video communication between the first responder and a remote intensivist via Google Glass improves the management of a simulated in-hospital pediatric cardiopulmonary arrest before the arrival of the ICU team. Randomized controlled study. Children's hospital at a tertiary care academic medical center. Forty-two first-year pediatric residents. Pediatric residents were evaluated during two consecutive simulated pediatric cardiopulmonary arrests with a high-fidelity manikin. During the second evaluation, the residents in the Google Glass group were allowed to seek help from a remote intensivist at any time by activating real-time video communication. The residents in the control group were asked to provide usual care. The main outcome measures were the proportion of time for which the manikin received no ventilation (no-blow fraction) or no compression (no-flow fraction). In the first evaluation, overall no-blow and no-flow fractions were 74% and 95%, respectively. During the second evaluation, no-blow and no-flow fractions were similar between the two groups. Insufflations were more effective (p = 0.04), and the technique (p = 0.02) and rate (p Google Glass group than in the control group. Real-time video communication between the first responder and a remote intensivist through Google Glass did not decrease no-blow and no-flow fractions during the first 5 minutes of a simulated pediatric cardiopulmonary arrest but improved the quality of the insufflations and chest compressions provided.

  15. Japanese Resident Physicians' Attitudes, knowledge, and Perceived Barriers on the Practice of Evidence Based Medicine: a Survey

    Directory of Open Access Journals (Sweden)

    Emura Sei SE

    2011-09-01

    Full Text Available Abstract Background Evidence based medicine plays a crucial role as a tool that helps integrate research evidence into clinical practice. However, few reports have yet to examine its application in daily practice among resident physicians in Japan. The aim of this study was to assess the attitudes towards and knowledge of EBM among resident physicians in Japanese and determine perceived barriers to its use. Findings A cross-sectional, self-administered anonymous questionnaire was distributed to 60 resident staffs at Saga University Hospital in Japan. Forty residents completed and returned the questionnaire. Fifty four percent of respondents understood the basic terminology of EBM, 3% could explain this to others, and 41% indicated they would like to understand the terminology more. Thirteen percent admitted having a good understanding of EBM basic skills. Fifty respondents indicated having read EBM sources, but only 3% indicated that they use these sources in clinical decision making. The most prominent barriers of EBM application revealed in this study were insufficient time to access the sources, a lack of native language references, and insufficient basic EBM skills, but not scepticism about the EBM concept. Conclusions In general, respondents positively welcomed EBM, and moderately understood and knew basic EBM skill; however, barriers in its application were shown to exist.

  16. Performance of medical residents in sterile techniques during central vein catheterization: randomized trial of efficacy of simulation-based training.

    Science.gov (United States)

    Khouli, Hassan; Jahnes, Katherine; Shapiro, Janet; Rose, Keith; Mathew, Joseph; Gohil, Amit; Han, Qifa; Sotelo, Andre; Jones, James; Aqeel, Adnan; Eden, Edward; Fried, Ethan

    2011-01-01

    Catheter-related bloodstream infection (CRBSI) is a preventable cause of a potentially lethal ICU infection. The optimal method to teach health-care providers correct sterile techniques during central vein catheterization (CVC) remains unclear. We randomly assigned second- and third-year internal medicine residents trained by a traditional apprenticeship model to simulation-based plus video training or video training alone from December 2007 to January 2008, with a follow-up period to examine CRBSI ending in July 2009. During the follow-up period, a simulation-based training program in sterile techniques during CVC was implemented in the medical ICU (MICU). A surgical ICU (SICU) where no residents received study interventions was used for comparison. The primary outcome measures were median residents' scores in sterile techniques and rates of CRBSI per 1,000 catheter-days. Of the 47 enrolled residents, 24 were randomly assigned to the simulation-based plus video training group and 23 to the video training group. Median baseline scores in both groups were equally poor: 12.5 to 13 (52%-54%) out of maximum score of 24 (P = .95; median difference, 0; 95% CI, 0.2-2.0). After training, median score was significantly higher for the simulation-based plus video training group: 22 (92%) vs 18 (75%) for the video training group (P training in sterile techniques during CVC is superior to traditional training or video training alone and is associated with decreased rate of CRBSI. Simulation-based training in CVC should be routinely used to reduce iatrogenic risk. ClinicalTrials.gov; No.: NCT00612131; URL: clinicaltrials.gov.

  17. Removal of Selenium and Nitrate in Groundwater Using Organic Carbon-Based Reactive Mixtures

    Science.gov (United States)

    An, Hyeonsil; Jeen, Sung-Wook

    2016-04-01

    Treatment of selenium and nitrate in groundwater was evaluated through column experiments. Four columns consisting of reactive mixtures, either organic carbon-limestone (OC-LS) or organic carbon-zero valent iron (OC-ZVI), were used to determine the removal efficiency of selenium with different concentrations of nitrate. The source waters were collected from a mine site in Korea or were prepared artificially based on the mine drainage water or deionized water, followed by spiking of elevated concentrations of Se (40 mg/L) and nitrate (100 or 10 mg/L as NO3-N). The results for the aqueous chemistry showed that selenium and nitrate were effectively removed both in the mine drainage water and deionized water-based artificial input solution. However, the removal of selenium was delayed when selenium and nitrate coexisted in the OC-LS columns. The removal of selenium was not significant when the influent nitrate concentration was 100 mg/L as NO3-N, while most of nitrate was gradually removed within the columns. In contrast, 94% of selenium was removed when the influent nitrate concentration was reduced to 10 mg/L as NO3-N. In the OC-ZVI column, selenium and nitrate was removed almost simultaneously and completely even with the high nitrate concentration; however, a high concentration of ammonia was produced as a by-product of abiotic reaction between ZVI and nitrate. The elemental analysis for the solid samples after the termination of the experiments showed that selenium was accumulated in the reactive materials where removal of aqueous-phase selenium mostly occurred. The X-ray absorption near-edge structure (XANES) study indicated that selenium existed in the forms of SeS2 and Se(0) in the OC-LS column, while selenium was present in the forms of FeSe, SeS2 and absorbed Se(IV) in the OC-ZVI column. This study shows that OC-based reactive mixtures have an ability to remove selenium and nitrate in groundwater. However, the removal of selenium was influenced by the high

  18. THE PREVALENCE OF ELEVATED LEVELS OF C-REACTIVE PROTEIN AND ITS ASSOCIATION WITH TRADITIONAL RISK FACTORS AND MORBIDITY AMONG RESIDENTS OF THE RUSSIAN FEDERATION (ACCORDING TO THE ESSE-RF STUDY

    Directory of Open Access Journals (Sweden)

    S. E. Evstifeeva

    2015-09-01

    Full Text Available Aim. To study the association of high-sensitivity C-reactive protein (hsCRP level with socio-demographic, behavioral and traditional risk factors in different regions of the Russian Federation (RF.Material and methods. Data of the multicenter epidemiological study of cardiovascular disease in different regions of the Russian Federation (ESSE-RF were used. Representative sample of the unorganized male and female population aged 25-64 from 6 regions of the Russian Federation was drown. 3407 men and 6354 women (n=9761 were included into the study. Standard questionnaire was applied in all subjects. Gender, age, level of education, place of residence and region of residence, traditional risk factors and diseases were analyzed. HsCRP level (level ≥3.0 mg/l was defined as elevated one was evaluated to detect of indolent inflammation.Results. HsCRP levels in women was significantly higher compared to males (p<0.005. The average prevalence of elevated hsCRP in the regions was 24.2%, for men - 21.4%, and for women - 25.7% (p<0.005. Significant age-related dynamics of hsCRP (p<0.0001 was found. The average level of hsCRP was significantly lower (p<0.0001 in a cohort of persons with higher education against these with lower level of education. Level of hsCRP as well as prevalence of elevated hsCRP level were higher in villagers than this in the urban population (p<0.05. Prevalence of elevated hsCRP in patients with traditional risk factors after adjustment for sex, age, and region of residence showed that the elevated hsCRP was mostly associated with metabolic factors and diseases that were characterized by systemic inflammation.Conclusion. Elevated level of hsCRP (≥3.0 mg/l was significantly associated with female gender, with an older, less educated, and smoking population of Russians. After the multivariate adjustment there remained significant associations (p<0.0001 of elevated hsCRP level with obesity, including abdominal obesity, hyperglycemia

  19. THE PREVALENCE OF ELEVATED LEVELS OF C-REACTIVE PROTEIN AND ITS ASSOCIATION WITH TRADITIONAL RISK FACTORS AND MORBIDITY AMONG RESIDENTS OF THE RUSSIAN FEDERATION (ACCORDING TO THE ESSE-RF STUDY

    Directory of Open Access Journals (Sweden)

    S. E. Evstifeeva

    2014-01-01

    Full Text Available Aim. To study the association of high-sensitivity C-reactive protein (hsCRP level with socio-demographic, behavioral and traditional risk factors in different regions of the Russian Federation (RF.Material and methods. Data of the multicenter epidemiological study of cardiovascular disease in different regions of the Russian Federation (ESSE-RF were used. Representative sample of the unorganized male and female population aged 25-64 from 6 regions of the Russian Federation was drown. 3407 men and 6354 women (n=9761 were included into the study. Standard questionnaire was applied in all subjects. Gender, age, level of education, place of residence and region of residence, traditional risk factors and diseases were analyzed. HsCRP level (level ≥3.0 mg/l was defined as elevated one was evaluated to detect of indolent inflammation.Results. HsCRP levels in women was significantly higher compared to males (p<0.005. The average prevalence of elevated hsCRP in the regions was 24.2%, for men - 21.4%, and for women - 25.7% (p<0.005. Significant age-related dynamics of hsCRP (p<0.0001 was found. The average level of hsCRP was significantly lower (p<0.0001 in a cohort of persons with higher education against these with lower level of education. Level of hsCRP as well as prevalence of elevated hsCRP level were higher in villagers than this in the urban population (p<0.05. Prevalence of elevated hsCRP in patients with traditional risk factors after adjustment for sex, age, and region of residence showed that the elevated hsCRP was mostly associated with metabolic factors and diseases that were characterized by systemic inflammation.Conclusion. Elevated level of hsCRP (≥3.0 mg/l was significantly associated with female gender, with an older, less educated, and smoking population of Russians. After the multivariate adjustment there remained significant associations (p<0.0001 of elevated hsCRP level with obesity, including abdominal obesity, hyperglycemia

  20. Using acupressure and Montessori-based activities to decrease agitation for residents with dementia: a cross-over trial.

    Science.gov (United States)

    Lin, Li-Chan; Yang, Man-Hua; Kao, Chieh-Chun; Wu, Shiao-Chi; Tang, Sai-Hung; Lin, Jaung-Geng

    2009-06-01

    To explore the effectiveness of acupressure and Montessori-based activities in decreasing the agitated behaviors of residents with dementia. A double-blinded, randomized (two treatments and one control; three time periods) cross-over design was used. Six special care units for residents with dementia in long-term care facilities in Taiwan were the sites for the study. One hundred thirty-three institutionalized residents with dementia. Subjects were randomized into three treatment sequences: acupressure-presence-Montessori methods, Montessori methods-acupressure-presence and presence-Montessori methods-acupressure. All treatments were done once a day, 6 days per week, for a 4-week period. The Cohen-Mansfield Agitation Inventory, Ease-of-Care, and the Apparent Affect Rating Scale. After receiving the intervention, the acupressure and Montessori-based-activities groups saw a significant decrease in agitated behaviors, aggressive behaviors, and physically nonaggressive behaviors than the presence group. Additionally, the ease-of-care ratings for the acupressure and Montessori-based-activities groups were significantly better than for the presence group. In terms of apparent affect, positive affect in the Montessori-based-activities group was significantly better than in the presence group. This study confirms that a blending of traditional Chinese medicine and a Western activities program would be useful in elderly care and that in-service training for formal caregivers in the use of these interventions would be beneficial for patients

  1. Reactivity perturbation formulation for a discontinuous Galerkin-based transport solver and its use with adaptive mesh refinement

    International Nuclear Information System (INIS)

    Le Tellier, R.; Fournier, D.; Suteau, C.

    2011-01-01

    Within the framework of a Discontinuous Galerkin spatial approximation of the multigroup discrete ordinates transport equation, we present a generalization of the exact standard perturbation formula that takes into account spatial discretization-induced reactivity changes. It encompasses in two separate contributions the nuclear data-induced reactivity change and the reactivity modification induced by two different spatial discretizations. The two potential uses of such a formulation when considering adaptive mesh refinement are discussed, and numerical results on a simple two-group Cartesian two-dimensional benchmark are provided. In particular, such a formulation is shown to be useful to filter out a more accurate estimate of nuclear data-related reactivity effects from initial and perturbed calculations based on independent adaptation processes. (authors)

  2. 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.

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

    Science.gov (United States)

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

    2013-10-29

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

  4. Markers of Impaired Decision Making in Nursing Home Residents: Assessment by Nursing Home Staff in a Population-Based Study.

    Science.gov (United States)

    Fain, Kevin M; Rosenberg, Paul B; Pirard, Sandrine; Bogunovic, Olivera; Spira, Adam P

    2015-07-01

    Many nursing home residents have cognitive impairment that affects their decision making. In order to identify potential markers of impaired decision making, we investigated the association between a range of nursing home resident characteristics and impaired decision making in a population-based sample. Participants were 13,013 residents in the 2004 National Nursing Home Survey. We used logistic regression to determine the association between resident characteristics (ie, gender, age, race, mood, recent pain, falls, fractures, or hospitalizations, length of stay, number of activities of daily living (ADL) requiring help, and diagnoses of dementia, anxiety disorders, and depression) and impaired (vs independent) decision making. After controlling for depression and anxiety diagnoses, as well as gender, age, race, and recent hospitalization or pain, characteristics associated with impaired decision making included depressed, sad, or anxious mood ["mild" odds ratio (OR) = 1.39, 95% confidence interval (CI) = 1.23-1.58; "severe" OR = 2.69, 95% CI = 2.27-3.20); diagnosed dementia or living on a dementia hall (OR = 5.07, 95% CI = 4.52-5.67); number of ADL requiring assistance (with 5 ADL, OR = 10.69, 95% CI = 6.82-16.75); length of nursing home stay [101-365 days (OR = 1.60, 95% CI = 1.36-1.89); 366 days-2 years (OR = 1.60, 95% CI = 1.34-1.90); >2 years (OR = 2.25, 95% CI = 1.92-2.63)]; and history of falls or fractures in the last 6 months (OR = 1.19, 95% CI = 1.07-1.32)]. Residents reporting pain in the last week were less likely to have impaired decision making (OR = 0.58, 95% CI = 0.52-0.66). We found several independent markers of impaired decision making in nursing home residents, including depressed, sad, or anxious mood (independent of depression or anxiety diagnosis); dementia; and greater need for ADL assistance. Some of these factors, in particular mood, are modifiable and addressing them may help improve decision making. These markers should be explored

  5. An EEGLAB plugin to analyze individual EEG alpha rhythms using the "channel reactivity-based method".

    Science.gov (United States)

    Goljahani, A; Bisiacchi, P; Sparacino, G

    2014-03-01

    A recent paper [1] proposed a new technique, termed the channel reactivity-based method (CRB), for characterizing EEG alpha rhythms using individual (IAFs) and channel (CAFs) alpha frequencies. These frequencies were obtained by identifying the frequencies at which the power of the alpha rhythms decreases. In the present study, we present a graphical interactive toolbox that can be plugged into the popular open source environment EEGLAB, making it easy to use CRB. In particular, we illustrate the major functionalities of the software and discuss the advantages of this toolbox for common EEG investigations. The CRB analysis plugin, along with extended documentation and the sample dataset utilized in this study, is freely available on the web at http://bio.dei.unipd.it/crb/. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  6. Cytochromes c': Structure, Reactivity and Relevance to Haem-Based Gas Sensing.

    Science.gov (United States)

    Hough, Michael A; Andrew, Colin R

    2015-01-01

    Cytochromes c' are a group of class IIa cytochromes with pentacoordinate haem centres and are found in photosynthetic, denitrifying and methanotrophic bacteria. Their function remains unclear, although roles in nitric oxide (NO) trafficking during denitrification or in cellular defence against nitrosoative stress have been proposed. Cytochromes c' are typically dimeric with each c-type haem-containing monomer folding as a four-α-helix bundle. Their hydrophobic and crowded distal sites impose severe restrictions on the binding of distal ligands, including diatomic gases. By contrast, NO binds to the proximal haem face in a similar manner to that of the eukaryotic NO sensor, soluble guanylate cyclase and bacterial analogues. In this review, we focus on how structural features of cytochromes c' influence haem spectroscopy and reactivity with NO, CO and O2. We also discuss the relevance of cytochrome c' to understanding the mechanisms of gas binding to haem-based sensor proteins. © 2015 Elsevier Ltd. All rights reserved.

  7. Development and reactivity tests of Ce-Zr-based Claus catalysts for coal gas cleanup

    Energy Technology Data Exchange (ETDEWEB)

    No-Kuk Park; Dong Cheul Han; Gi Bo Han; Si Ok Ryu; Tae Jin Lee; Ki Jun Yoon [Yeungnam University, Gyeongbuk (Republic of Korea). National Research Laboratory, School of Chemical Engineering and Technology

    2007-09-15

    Claus reaction (2H{sub 2}S + SO{sub 2} {leftrightarrow} 3/nS{sub n} + 2H{sub 2}O) was used to clean the gasified coal gas and the reactivity of several metal oxide-based catalysts on Claus reaction was investigated at various operating conditions. In order to convert H{sub 2}S contained in the gasified coal gas to elemental sulfur during Claus reaction, the catalysts having the high activity under the highly reducing condition with the moisture should be developed. CeO{sub 2}, ZrO{sub 2}, and Ce{sub 1-x}Zr{sub x}O{sub 2} catalysts were prepared for Claus reaction and their reactivity changes due to the existence of the reducing gases and H{sub 2}O in the fuel gas was investigated in this study. The Ce-based catalysts shows that their activity was deteriorated by the reduction of the catalyst due to the reducing gases at higher than 220{sup o}C. Meanwhile, the effect of the reducing gases on the catalytic activity was not considerable at low temperature. The activities of all three catalysts were degraded on the condition that the moisture existed in the test gas. Specifically, the Ce-based catalysts were remarkably deactivated by their sulfation. The Ce-Zr-based catalyst had a high catalytic activity when the reducing gases and the moisture co-existed in the simulated fuel gas. The deactivation of the Ce-Zr-based catalyst was not observed in this study. The lattice oxygen of the Ce-based catalyst was used for the oxidation of H{sub 2}S and the lattice oxygen vacancy on the catalyst was contributed to the reduction of SO{sub 2}. ZrO{sub 2} added to the Ce-Zr-based catalyst improved the redox properties of the catalyst in Claus reaction by increasing the mobility of the lattice oxygen of CeO{sub 2}. 21 refs., 14 figs.

  8. Montessori-based activities for long-term care residents with advanced dementia: effects on engagement and affect.

    Science.gov (United States)

    Orsulic-Jeras, S; Judge, K S; Camp, C J

    2000-02-01

    Sixteen residents in long-term care with advanced dementia (14 women; average age = 88) showed significantly more constructive engagement (defined as motor or verbal behaviors in response to an activity), less passive engagement (defined as passively observing an activity), and more pleasure while participating in Montessori-based programming than in regularly scheduled activities programming. Principles of Montessori-based programming, along with examples of such programming, are presented. Implications of the study and methods for expanding the use of Montessori-based dementia programming are discussed.

  9. Attitudes of surgical residents toward trauma care: a Canadian-based study.

    Science.gov (United States)

    Girotti, M J; Leslie, K; Chinnick, B; Butcher, C; Holliday, R L

    1994-01-01

    Surgical residents (n = 330) registered in training programs in the province of Ontario, Canada were surveyed about their attitudes toward trauma care related issues. Questionnaires were returned by 48%. Overall, 84% felt that their clinical exposure to trauma was adequate; 78% noted that the emphasis placed on trauma topics in their educational programs was appropriate; 50% spend > 10% of their current clinical time in trauma care. Orthopedic residents (n = 43) were different; 79% devoted > 10% and 29% > or = 30% of their time to trauma. Future clinical activity in trauma as practicing surgeons was expressed by 83% of the trainees: 31% intended 30% of their future practices to be related to trauma. The major positive factors of trauma were the scope and excitement of trauma care. The major negative factors were the night/weekend activity and the time away from family. We are encouraged by the results of this survey in that a significant number of residents perceive trauma as a clinical endeavor to be incorporated into their future surgical practices.

  10. Processes of change in a school-based mindfulness programme: cognitive reactivity and self-coldness as mediators.

    Science.gov (United States)

    Van der Gucht, Katleen; Takano, Keisuke; Raes, Filip; Kuppens, Peter

    2018-05-01

    The underlying mechanisms of the effectiveness of mindfulness-based interventions for emotional well-being remain poorly understood. Here, we examined the potential mediating effects of cognitive reactivity and self-compassion on symptoms of depression, anxiety and stress using data from an earlier randomised controlled school trial. A moderated time-lagged mediation model based on multilevel modelling was used to analyse the data. The findings showed that post-treatment changes in cognitive reactivity and self-coldness, an aspect of self-compassion, mediated subsequent changes in symptoms of depression, anxiety and stress. These results suggest that cognitive reactivity and self-coldness may be considered as transdiagnostic mechanisms of change of a mindfulness-based intervention programme for youth.

  11. Image-based modeling of flow and reactive transport in porous media

    Science.gov (United States)

    Qin, Chao-Zhong; Hoang, Tuong; Verhoosel, Clemens V.; Harald van Brummelen, E.; Wijshoff, Herman M. A.

    2017-04-01

    Due to the availability of powerful computational resources and high-resolution acquisition of material structures, image-based modeling has become an important tool in studying pore-scale flow and transport processes in porous media [Scheibe et al., 2015]. It is also playing an important role in the upscaling study for developing macroscale porous media models. Usually, the pore structure of a porous medium is directly discretized by the voxels obtained from visualization techniques (e.g. micro CT scanning), which can avoid the complex generation of computational mesh. However, this discretization may considerably overestimate the interfacial areas between solid walls and pore spaces. As a result, it could impact the numerical predictions of reactive transport and immiscible two-phase flow. In this work, two types of image-based models are used to study single-phase flow and reactive transport in a porous medium of sintered glass beads. One model is from a well-established voxel-based simulation tool. The other is based on the mixed isogeometric finite cell method [Hoang et al., 2016], which has been implemented in the open source Nutils (http://www.nutils.org). The finite cell method can be used in combination with isogeometric analysis to enable the higher-order discretization of problems on complex volumetric domains. A particularly interesting application of this immersed simulation technique is image-based analysis, where the geometry is smoothly approximated by segmentation of a B-spline level set approximation of scan data [Verhoosel et al., 2015]. Through a number of case studies by the two models, we will show the advantages and disadvantages of each model in modeling single-phase flow and reactive transport in porous media. Particularly, we will highlight the importance of preserving high-resolution interfaces between solid walls and pore spaces in image-based modeling of porous media. References Hoang, T., C. V. Verhoosel, F. Auricchio, E. H. van

  12. Corrosion resistance and electrochemical potentiokinetic reactivation testing of some iron-base hardfacing alloys

    International Nuclear Information System (INIS)

    Cockeram, B.V.

    1999-01-01

    Hardfacing alloys are weld deposited on a base material to provide a wear resistant surface. Commercially available iron-base hardfacing alloys are being evaluated for replacement of cobalt-base alloys to reduce nuclear plant activation levels. Corrosion testing was used to evaluate the corrosion resistance of several iron-base hardfacing alloys in highly oxygenated environments. The corrosion test results indicate that iron-base hardfacing alloys in the as-deposited condition have acceptable corrosion resistance when the chromium to carbon ratio is greater than 4. Tristelle 5183, with a high niobium (stabilizer) content, did not follow this trend due to precipitation of niobium-rich carbides instead of chromium-rich carbides. This result indicates that iron-base hardfacing alloys containing high stabilizer contents may possess good corrosion resistance with Cr:C < 4. NOREM 02, NOREM 01, and NoCo-M2 hardfacing alloys had acceptable corrosion resistance in the as-deposited and 885 C/4 hour heat treated condition, but rusting from sensitization was observed in the 621 C/6 hour heat treated condition. The feasibility of using an Electrochemical Potentiokinetic Reactivation (EPR) test method, such as used for stainless steel, to detect sensitization in iron-base hardfacing alloys was evaluated. A single loop-EPR method was found to provide a more consistent measurement of sensitization than a double loop-EPR method. The high carbon content that is needed for a wear resistant hardfacing alloy produces a high volume fraction of chromium-rich carbides that are attacked during EPR testing. This results in inherently lower sensitivity for detection of a sensitized iron-base hardfacing alloy than stainless steel using conventional EPR test methods

  13. Objective assessment in residency-based training for transoral robotic surgery.

    Science.gov (United States)

    Curry, Martin; Malpani, Anand; Li, Ryan; Tantillo, Thomas; Jog, Amod; Blanco, Ray; Ha, Patrick K; Califano, Joseph; Kumar, Rajesh; Richmon, Jeremy

    2012-10-01

    To develop a robotic surgery training regimen integrating objective skill assessment for otolaryngology and head and neck surgery trainees consisting of training modules of increasing complexity leading up to procedure-specific training. In particular, we investigated applications of such a training approach for surgical extirpation of oropharyngeal tumors via a transoral approach using the da Vinci robotic system. Prospective blinded data collection and objective evaluation (Objective Structured Assessment of Technical Skills [OSATS]) of three distinct phases using the da Vinci robotic surgical system in an academic university medical engineering/computer science laboratory setting. Between September 2010 and July 2011, eight otolaryngology-head and neck surgery residents and four staff experts from an academic hospital participated in three distinct phases of robotic surgery training involving 1) robotic platform operational skills, 2) set up of the patient side system, and 3) a complete ex vivo surgical extirpation of an oropharyngeal tumor located in the base of tongue. Trainees performed multiple (four) approximately equally spaced training sessions in each stage of the training. In addition to trainees, baseline performance data were obtained for the experts. Each surgical stage was documented with motion and event data captured from the application programming interfaces of the da Vinci system, as well as separate video cameras as appropriate. All data were assessed using automated skill measures of task efficiency and correlated with structured assessment (OSATS and similar Likert scale) from three experts to assess expert and trainee differences and compute automated and expert assessed learning curves. Our data show that such training results in an improved didactic robotic knowledge base and improved clinical efficiency with respect to the set up and console manipulation. Experts (e.g., average OSATS, 25; standard deviation [SD], 3.1; module 1, suturing

  14. Shadowing emergency medicine residents by medical education specialists to provide feedback on non-medical knowledge-based ACGME sub-competencies.

    Science.gov (United States)

    Waterbrook, Anna L; Spear Ellinwood, Karen C; Pritchard, T Gail; Bertels, Karen; Johnson, Ariel C; Min, Alice; Stoneking, Lisa R

    2018-01-01

    Non-medical knowledge-based sub-competencies (multitasking, professionalism, accountability, patient-centered communication, and team management) are challenging for a supervising emergency medicine (EM) physician to evaluate in real-time on shift while also managing a busy emergency department (ED). This study examines residents' perceptions of having a medical education specialist shadow and evaluate their nonmedical knowledge skills. Medical education specialists shadowed postgraduate year 1 and postgraduate year 2 EM residents during an ED shift once per academic year. In an attempt to increase meaningful feedback to the residents, these specialists evaluated resident performance in selected non-medical knowledge-based Accreditation Council of Graduate Medical Education (ACGME) sub-competencies and provided residents with direct, real-time feedback, followed by a written evaluation sent via email. Evaluations provided specific references to examples of behaviors observed during the shift and connected these back to ACGME competencies and milestones. Twelve residents participated in this shadow experience (six post graduate year 1 and six postgraduate year 2). Two residents emailed the medical education specialists ahead of the scheduled shadow shift requesting specific feedback. When queried, five residents voluntarily requested their feedback to be included in their formal biannual review. Residents received milestone scores and narrative feedback on the non-medical knowledge-based ACGME sub-competencies and indicated the shadow experience and subsequent feedback were valuable. Medical education specialists who observe residents over the course of an entire shift and evaluate non-medical knowledge-based skills are perceived by EM residents to provide meaningful feedback and add valuable information for the biannual review process.

  15. Effects of Nursing Home Residency on Diabetes Care in Individuals with Dementia: An Explorative Analysis Based on German Claims Data

    Directory of Open Access Journals (Sweden)

    Larissa Schwarzkopf

    2017-02-01

    Full Text Available Aims: This claims data-based study compares the intensity of diabetes care in community dwellers and nursing home residents with dementia. Methods: Delivery of diabetes-related medical examinations (DRMEs was compared via logistic regression in 1,604 community dwellers and 1,010 nursing home residents with dementia. The intra-individual effect of nursing home transfer was evaluated within mixed models. Results: Delivery of DRMEs decreases with increasing care dependency, with more community-living individuals receiving DRMEs. Moreover, DRME provision decreases after nursing home transfer. Conclusion: Dementia patients receive fewer DRMEs than recommended, especially in cases of higher care dependency and particularly in nursing homes. This suggests lacking awareness regarding the specific challenges of combined diabetes and dementia care.

  16. ANALYSIS OF LANDSCAPE ELEMENTS THAT AFFECT PROPERTY VALUE BASED ON THE PERCEPTION OF HOUSING RESIDENTS IN SURABAYA

    Directory of Open Access Journals (Sweden)

    Nita Setiawati Wibisono

    2017-07-01

    Full Text Available This research is done to determine landscape elements that affect property value based on housing residents’ perception in Surabaya residential areas. The landscape elements that used in this research are natural elements such as vegetation and soil; and man-made element such as garden statue, road pattern, road width and hierarchy, park and plant, artificial lake, and road equipment. Purposive sampling technique is used to represent respondents in the residential areas that provide landscape elements in East and West Surabaya. Data analysis technique uses validity and reliability test, analysis factor, binary logistic regression, and the average of variable test. The result shows that majority of the residents of East Surabaya and West Surabaya residential areas approved that landscape consist of park and plant, road width and hierarchies, and road pattern affect their residential property values. The residents are also willing to contribute about 7.4% of their house price to improve the appearance of the residential landscape.

  17. Resident Load Influence Analysis Method for Price Based on Non-intrusive Load Monitoring and Decomposition Data

    Science.gov (United States)

    Jiang, Wenqian; Zeng, Bo; Yang, Zhou; Li, Gang

    2018-01-01

    In the non-invasive load monitoring mode, the load decomposition can reflect the running state of each load, which will help the user reduce unnecessary energy costs. With the demand side management measures of time of using price, a resident load influence analysis method for time of using price (TOU) based on non-intrusive load monitoring data are proposed in the paper. Relying on the current signal of the resident load classification, the user equipment type, and different time series of self-elasticity and cross-elasticity of the situation could be obtained. Through the actual household load data test with the impact of TOU, part of the equipment will be transferred to the working hours, and users in the peak price of electricity has been reduced, and in the electricity at the time of the increase Electrical equipment, with a certain regularity.

  18. Variation in Older Adult Characteristics by Residence Type and Use of Home- and Community-Based Services

    Science.gov (United States)

    Ewen, Heidi H.; Washington, Tiffany R.; Emerson, Kerstin G.; Carswell, Andrew T.; Smith, Matthew Lee

    2017-01-01

    Background: The majority of older adults prefer to remain in their homes, or to “age-in-place.” To accomplish this goal, many older adults will rely upon home- and community-based services (HCBS) for support. However, the availability and accessibility of HCBS may differ based on whether the older adult lives in the community or in a senior housing apartment facility. Methods: This paper reports findings from the Pathways to Life Quality study of residential change and stability among seniors in upstate New York. Data were analyzed from 663 older adults living in one of three housing types: service-rich facilities, service-poor facilities, and community-dwelling in single-family homes. A multinomial logistic regression model was used to examine factors associated with residence type. A linear regression model was fitted to examine factors associated with HCBS utilization. Results: When compared to community-dwelling older adults, those residing in service-rich and service-poor facilities were more likely to be older, report more activity limitations, and provide less instrumental assistance to others. Those in service-poor facilities were more likely to have poorer mental health and lower perceived purpose in life. The three leading HCBS utilized were senior centers (20%), homemaker services (19%), and transportation services (18%). More HCBS utilization was associated with participants who resided in service-poor housing, were older, were female, and had more activity limitations. More HCBS utilization was also associated with those who received instrumental support, had higher perceived purpose in life, and poorer mental health. Conclusions: Findings suggest that older adults’ residential environment is associated with their health status and HCBS utilization. Building upon the Person–Environment Fit theories, dedicated efforts are needed to introduce and expand upon existing HCBS available to facility residents to address physical and mental health needs

  19. Variation in Older Adult Characteristics by Residence Type and Use of Home- and Community-Based Services

    Directory of Open Access Journals (Sweden)

    Heidi H. Ewen

    2017-03-01

    Full Text Available Background: The majority of older adults prefer to remain in their homes, or to “age-in-place.” To accomplish this goal, many older adults will rely upon home- and community-based services (HCBS for support. However, the availability and accessibility of HCBS may differ based on whether the older adult lives in the community or in a senior housing apartment facility. Methods: This paper reports findings from the Pathways to Life Quality study of residential change and stability among seniors in upstate New York. Data were analyzed from 663 older adults living in one of three housing types: service-rich facilities, service-poor facilities, and community-dwelling in single-family homes. A multinomial logistic regression model was used to examine factors associated with residence type. A linear regression model was fitted to examine factors associated with HCBS utilization. Results: When compared to community-dwelling older adults, those residing in service-rich and service-poor facilities were more likely to be older, report more activity limitations, and provide less instrumental assistance to others. Those in service-poor facilities were more likely to have poorer mental health and lower perceived purpose in life. The three leading HCBS utilized were senior centers (20%, homemaker services (19%, and transportation services (18%. More HCBS utilization was associated with participants who resided in service-poor housing, were older, were female, and had more activity limitations. More HCBS utilization was also associated with those who received instrumental support, had higher perceived purpose in life, and poorer mental health. Conclusions: Findings suggest that older adults’ residential environment is associated with their health status and HCBS utilization. Building upon the Person–Environment Fit theories, dedicated efforts are needed to introduce and expand upon existing HCBS available to facility residents to address physical and

  20. Reactively loaded arrays based on overlapping sub-arrays with flat-top radiation pattern

    NARCIS (Netherlands)

    Maximidis, R. T.; Smolders, A. B.; Toso, G.; Caratelli, D.

    2017-01-01

    The design of reactively-loaded antenna arrays featuring a pulse-shaped radiation pattern for limited scan-angle applications is presented. The use of the reactive loading allows reducing the complexity of the feeding structure, eliminating the need for complex overlapping beam-forming networks and

  1. Comprehensive benefits analysis of steel structure modular residence based on the entropy evaluation

    Science.gov (United States)

    Zhang, Xiaoxiao; Wang, Li; Jiang, Pengming

    2017-04-01

    Steel structure modular residence is the outstanding residential industrialization. It has many advantages, such as the low whole cost, high resource recovery, a high degree of industrialization. This paper compares the comprehensive benefits of steel structural in modular buildings with prefabricated reinforced concrete residential from economic benefits, environmental benefits, social benefits and technical benefits by the method of entropy evaluation. Finally, it is concluded that the comprehensive benefits of steel structural in modular buildings is better than that of prefabricated reinforced concrete residential. The conclusion of this study will provide certain reference significance to the development of steel structural in modular buildings in China.

  2. Highly efficient indoor air purification using adsorption-enhanced-photocatalysis-based microporous TiO2 at short residence time.

    Science.gov (United States)

    Lv, Jinze; Zhu, Lizhong

    2013-01-01

    A short residence time is a key design parameter for the removal of organic pollutants in catalyst-based indoor air purification systems. In this study, we synthesized a series of TiO2 with different micropore volumes and studied their removal efficiency of indoor carbonyl pollutants at a short residence time. Our results indicated that the superior adsorption capability of TiO2 with micropores improved its performance in the photocatalytic degradation of cyclohexanone, while the photocatalytic removal of the pollutant successfully kept porous TiO2 from becoming saturated. When treated with 1 mg m(-3) cyclohexanone at a relatively humidity of 18%, the adsorption amount on microporous TiO2 was 5.4-7.9 times higher than that on P25. Removal efficiency via photocatalysis followed'the same order as the adsorption amount: TiO2-5 > TiO2-20 > TiO2-60 > TiO2-180 > P25. The advantage of microporous TiO2 over P25 became more pronounced when the residence time declined from 0.072 to 0.036 s. Moreover, as the concentration of cyclohexanone deceased from 1000 ppb to 500 ppb, removal efficiency by microporous TiO2 increased more rapidly than P25.

  3. The first proton sponge-based amino acids: synthesis, acid-base properties and some reactivity.

    Science.gov (United States)

    Ozeryanskii, Valery A; Gorbacheva, Anastasia Yu; Pozharskii, Alexander F; Vlasenko, Marina P; Tereznikov, Alexander Yu; Chernov'yants, Margarita S

    2015-08-21

    The first hybrid base constructed from 1,8-bis(dimethylamino)naphthalene (proton sponge or DMAN) and glycine, N-methyl-N-(8-dimethylamino-1-naphthyl)aminoacetic acid, was synthesised in high yield and its hydrobromide was structurally characterised and used to determine the acid-base properties via potentiometric titration. It was found that the basic strength of the DMAN-glycine base (pKa = 11.57, H2O) is on the level of amidine amino acids like arginine and creatine and its structure, zwitterionic vs. neutral, based on the spectroscopic (IR, NMR, mass) and theoretical (DFT) approaches has a strong preference to the zwitterionic form. Unlike glycine, the DMAN-glycine zwitterion is N-chiral and is hydrolytically cleaved with the loss of glycolic acid on heating in DMSO. This reaction together with the mild decarboxylative conversion of proton sponge-based amino acids into 2,3-dihydroperimidinium salts under air-oxygen was monitored with the help of the DMAN-alanine amino acid. The newly devised amino acids are unique as they combine fluorescence, strongly basic and redox-active properties.

  4. Reactive Systems

    DEFF Research Database (Denmark)

    Aceto, Luca; Ingolfsdottir, Anna; Larsen, Kim Guldstrand

    A reactive system comprises networks of computing components, achieving their goals through interaction among themselves and their environment. Thus even relatively small systems may exhibit unexpectedly complex behaviours. As moreover reactive systems are often used in safety critical systems......, the need for mathematically based formal methodology is increasingly important. There are many books that look at particular methodologies for such systems. This book offers a more balanced introduction for graduate students and describes the various approaches, their strengths and weaknesses, and when...... they are best used. Milner's CCS and its operational semantics are introduced, together with the notions of behavioural equivalences based on bisimulation techniques and with recursive extensions of Hennessy-Milner logic. In the second part of the book, the presented theories are extended to take timing issues...

  5. Monadic Functional Reactive Programming

    NARCIS (Netherlands)

    A.J. van der Ploeg (Atze); C Shan

    2013-01-01

    htmlabstractFunctional Reactive Programming (FRP) is a way to program reactive systems in functional style, eliminating many of the problems that arise from imperative techniques. In this paper, we present an alternative FRP formulation that is based on the notion of a reactive computation: a

  6. Accounting for the Decreasing Denitrification Potential of Aquifers in Travel-Time Based Reactive-Transport Models of Nitrate

    Science.gov (United States)

    Cirpka, O. A.; Loschko, M.; Wöhling, T.; Rudolph, D. L.

    2017-12-01

    Excess nitrate concentrations pose a threat to drinking-water production from groundwater in all regions of intensive agriculture worldwide. Natural organic matter, pyrite, and other reduced constituents of the aquifer matrix can be oxidized by aerobic and denitrifying bacteria, leading to self-cleaning of groundwater. Various studies have shown that the heterogeneity of both hydraulic and chemical aquifer properties influence the reactive behavior. Since the exact spatial distributions of these properties are not known, predictions on the temporal evolution of nitrate should be probabilistic. However, the computational effort of pde-based, spatially explicit multi-component reactive-transport simulations are so high that multiple model runs become impossible. Conversely, simplistic models that treat denitrification as first-order decay process miss important controls on denitrification. We have proposed a Lagrangian framework of nonlinear reactive transport, in which the electron-donor supply by the aquifer matrix is parameterized by a relative reactivity, that is the reaction rate relative to a standard reaction rate for identical solute concentrations (Loschko et al., 2016). We could show that reactive transport simplifies to solving a single ordinary dfferential equation in terms of the cumulative relative reactivity for a given combination of inflow concentrations. Simulating 3-D flow and reactive transport are computationally so inexpensive that Monte Carlo simulation become feasible. The original scheme did not consider a change of the relative reactivity over time, implying that the electron-donor pool in the matrix is infinite. We have modified the scheme to address the consumption of the reducing aquifer constituents upon the reactions. We also analyzed how a minimally complex model of aerobic respiration and denitrification could look like. With the revised scheme, we performed Monte Carlo simulations in 3-D domains, confirming that the uncertainty in

  7. A residence-time-based transport approach for the groundwater pathway in performance assessment models

    Science.gov (United States)

    Robinson, Bruce A.; Chu, Shaoping

    2013-03-01

    This paper presents the theoretical development and numerical implementation of a new modeling approach for representing the groundwater pathway in risk assessment or performance assessment model of a contaminant transport system. The model developed in the present study, called the Residence Time Distribution (RTD) Mixing Model (RTDMM), allows for an arbitrary distribution of fluid travel times to be represented, to capture the effects on the breakthrough curve of flow processes such as channelized flow and fast pathways and complex three-dimensional dispersion. Mathematical methods for constructing the model for a given RTD are derived directly from the theory of residence time distributions in flowing systems. A simple mixing model is presented, along with the basic equations required to enable an arbitrary RTD to be reproduced using the model. The practical advantages of the RTDMM include easy incorporation into a multi-realization probabilistic simulation; computational burden no more onerous than a one-dimensional model with the same number of grid cells; and straightforward implementation into available flow and transport modeling codes, enabling one to then utilize advanced transport features of that code. For example, in this study we incorporated diffusion into the stagnant fluid in the rock matrix away from the flowing fractures, using a generalized dual porosity model formulation. A suite of example calculations presented herein showed the utility of the RTDMM for the case of a radioactive decay chain, dual porosity transport and sorption.

  8. Identifying county characteristics associated with resident well-being: A population based study.

    Science.gov (United States)

    Roy, Brita; Riley, Carley; Herrin, Jeph; Spatz, Erica S; Arora, Anita; Kell, Kenneth P; Welsh, John; Rula, Elizabeth Y; Krumholz, Harlan M

    2018-01-01

    Well-being is a positively-framed, holistic assessment of health and quality of life that is associated with longevity and better health outcomes. We aimed to identify county attributes that are independently associated with a comprehensive, multi-dimensional assessment of individual well-being. We performed a cross-sectional study examining associations between 77 pre-specified county attributes and a multi-dimensional assessment of individual US residents' well-being, captured by the Gallup-Sharecare Well-Being Index. Our cohort included 338,846 survey participants, randomly sampled from 3,118 US counties or county equivalents. We identified twelve county-level factors that were independently associated with individual well-being scores. Together, these twelve factors explained 91% of the variance in individual well-being scores, and they represent four conceptually distinct categories: demographic (% black); social and economic (child poverty, education level [divorced); clinical care (% eligible women obtaining mammography, preventable hospital stays per 100,000, number of federally qualified health centers); and physical environment (% commuting by bicycle and by public transit). Twelve factors across social and economic, clinical care, and physical environmental county-level factors explained the majority of variation in resident well-being.

  9. Identifying county characteristics associated with resident well-being: A population based study.

    Directory of Open Access Journals (Sweden)

    Brita Roy

    Full Text Available Well-being is a positively-framed, holistic assessment of health and quality of life that is associated with longevity and better health outcomes. We aimed to identify county attributes that are independently associated with a comprehensive, multi-dimensional assessment of individual well-being.We performed a cross-sectional study examining associations between 77 pre-specified county attributes and a multi-dimensional assessment of individual US residents' well-being, captured by the Gallup-Sharecare Well-Being Index. Our cohort included 338,846 survey participants, randomly sampled from 3,118 US counties or county equivalents.We identified twelve county-level factors that were independently associated with individual well-being scores. Together, these twelve factors explained 91% of the variance in individual well-being scores, and they represent four conceptually distinct categories: demographic (% black; social and economic (child poverty, education level [resident well-being.

  10. Reactive Power from Distributed Energy

    Energy Technology Data Exchange (ETDEWEB)

    Kueck, John; Kirby, Brendan; Rizy, Tom; Li, Fangxing; Fall, Ndeye

    2006-12-15

    Distributed energy is an attractive option for solving reactive power and distribution system voltage problems because of its proximity to load. But the cost of retrofitting DE devices to absorb or produce reactive power needs to be reduced. There also needs to be a market mechanism in place for ISOs, RTOs, and transmission operators to procure reactive power from the customer side of the meter where DE usually resides. (author)

  11. Reactive Power from Distributed Energy

    International Nuclear Information System (INIS)

    Kueck, John; Kirby, Brendan; Rizy, Tom; Li, Fangxing; Fall, Ndeye

    2006-01-01

    Distributed energy is an attractive option for solving reactive power and distribution system voltage problems because of its proximity to load. But the cost of retrofitting DE devices to absorb or produce reactive power needs to be reduced. There also needs to be a market mechanism in place for ISOs, RTOs, and transmission operators to procure reactive power from the customer side of the meter where DE usually resides. (author)

  12. Varied Rates of Implementation of Patient-Centered Medical Home Features and Residents' Perceptions of Their Importance Based on Practice Experience.

    Science.gov (United States)

    Eiff, M Patrice; Green, Larry A; Jones, Geoff; Devlaeminck, Alex Verdieck; Waller, Elaine; Dexter, Eve; Marino, Miguel; Carney, Patricia A

    2017-03-01

    Little is known about how the patient-centered medical home (PCMH) is being implemented in residency practices. We describe both the trends in implementation of PCMH features and the influence that working with PCMH features has on resident attitudes toward their importance in 14 family medicine residencies associated with the P4 Project. We assessed 24 residency continuity clinics annually between 2007-2011 on presence or absence of PCMH features. Annual resident surveys (n=690) assessed perceptions of importance of PCMH features using a 4-point scale (not at all important to very important). We used generalized estimating equations logistic regression to assess trends and ordinal-response proportional odds regression models to determine if resident ratings of importance were associated with working with those features during training. Implementation of electronic health record (EHR) features increased significantly from 2007-2011, such as email communication with patients (33% to 67%), preventive services registries (23% to 64%), chronic disease registries (63% to 82%), and population-based quality assurance (46% to 79%). Team-based care was the only process of care feature to change significantly (54% to 93%). Residents with any exposure to EHR-based features had higher odds of rating the features more important compared to those with no exposure. We observed consistently lower odds of the resident rating process of care features as more important with any exposure compared to no exposure. Residencies engaged in educational transformation were more successful in implementing EHR-based PCMH features, and exposure during training appears to positively influence resident ratings of importance, while exposure to process of care features are slower to implement with less influence on importance ratings.

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

    Directory of Open Access Journals (Sweden)

    Kristine Schulz

    2013-10-01

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

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

    Science.gov (United States)

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

    2013-01-01

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

  15. Reactivity on the Web

    OpenAIRE

    Bailey, James; Bry, François; Eckert, Michael; Patrânjan, Paula Lavinia

    2005-01-01

    Reactivity, the ability to detect simple and composite events and respond in a timely manner, is an essential requirement in many present-day information systems. With the emergence of new, dynamic Web applications, reactivity on the Web is receiving increasing attention. Reactive Web-based systems need to detect and react not only to simple events but also to complex, real-life situations. This paper introduces XChange, a language for programming reactive behaviour on the Web,...

  16. Titanium dioxide-based DGT technique for in situ measurement of dissolved reactive phosphorus in fresh and marine waters

    DEFF Research Database (Denmark)

    Panther, Jared G.; Teasdale, Peter R.; Bennett, William W.

    2010-01-01

    A new diffusive gradients in a thin film (DGT) technique for measuring dissolved reactive phosphorus (DRP) in fresh and marine waters is reported. The new method, which uses a commercially available titanium dioxide based adsorbent (Metsorb), was evaluated and compared to the well-established fer...

  17. Measurement based analysis of active and reactive power losses in a distribution network with wind farms and CHPs

    DEFF Research Database (Denmark)

    Lund, Torsten

    2007-01-01

    The paper presents an investigation of the active and reactive power losses in a distribution network with wind turbines and combined heat and power plants. The investigation is based on 15 min average power measurements and load flow calculations in the power system simulation tool PowerFactory...

  18. The mediating effect of mindful non-reactivity in exposure-based cognitive behavior therapy for severe health anxiety.

    Science.gov (United States)

    Hedman, Erik; Hesser, Hugo; Andersson, Erik; Axelsson, Erland; Ljótsson, Brjánn

    2017-08-01

    Exposure-based cognitive behavior therapy (CBT) has been shown to be effective in the treatment of severe health anxiety, but little is known about mediators of treatment effect. The aim of the present study was to investigate mindful non-reactivity as a putative mediator of health anxiety outcome using data from a large scale randomized controlled trial. We assessed mindful non-reactivity using the Five Facets Mindfulness Questionnaire-Non-Reactivity scale (FFMQ-NR) and health anxiety with the Short Health Anxiety Inventory (SHAI). Participants with severe health anxiety (N=158) were randomized to internet-delivered exposure-based CBT or behavioral stress management (BSM) and throughout the treatment, both the mediator and outcome were measured weekly. As previously reported, exposure-based CBT was more effective than BSM in reducing health anxiety. In the present study, latent process growth modeling showed that treatment condition had a significant effect on the FFMQ-NR growth trajectory (α-path), estimate=0.18, 95% CI [0.04, 0.32], p=.015, indicating a larger increase in mindful non-reactivity among participants receiving exposure-based CBT compared to the BSM group. The FFMQ-NR growth trajectory was significantly correlated with the SHAI trajectory (β-path estimate=-1.82, 95% CI [-2.15, -1.48], panxiety. Copyright © 2017 Elsevier Ltd. All rights reserved.

  19. Human Emotion and Response in Surgery (HEARS): a simulation-based curriculum for communication skills, systems-based practice, and professionalism in surgical residency training.

    Science.gov (United States)

    Larkin, Anne C; Cahan, Mitchell A; Whalen, Giles; Hatem, David; Starr, Susan; Haley, Heather-Lyn; Litwin, Demetrius; Sullivan, Kate; Quirk, Mark

    2010-08-01

    This study examines the development and implementation of a pilot human factors curriculum during a 2-year period. It is one component of a comprehensive 5-year human factors curriculum spanning core competencies of interpersonal and communication skills, systems-based practice, and professionalism and using low-and high-fidelity simulation techniques. Members of the Department of Surgery and the Center for Clinical Communication and Performance Outcomes jointly constructed a curriculum for PGY1 and PGY2 residents on topics ranging from challenging communication to time and stress management. Video demonstrations, triggers, and simulated scenarios involving acting patients were created by surgeons and medical educators. Pre- and postintervention measures were obtained for communication skills, perceived stress level, and teamwork. Communication skills were evaluated using a series of video vignettes. The validated Perceived Stress Scale and Teamwork and Patient Safety Attitudes survey were used. Residents' perceptions of the program were also measured. Twenty-seven PGY1 residents and 15 PGY2 residents participated during 2 years. Analyses of video vignette tests indicated significant improvement in empathic communication for PGY1 (t = 3.62, p = 0.001) and PGY2 (t = 5.00, p = 0.004). There were no significant changes to teamwork attitudes. Perceived levels of stress became considerably higher. PGY1 residents reported trying 1 to 3 strategies taught in the time management session, with 60% to 75% reporting improvement post-training. This unique and comprehensive human factors curriculum is shown to be effective in building communication competency for junior-level residents in the human and emotional aspects of surgical training and practice. Continued refinement and ongoing data acquisition and analyses are underway. Copyright 2010 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  20. A Fast Reactive Power Optimization in Distribution Network Based on Large Random Matrix Theory and Data Analysis

    Directory of Open Access Journals (Sweden)

    Wanxing Sheng

    2016-05-01

    Full Text Available In this paper, a reactive power optimization method based on historical data is investigated to solve the dynamic reactive power optimization problem in distribution network. In order to reflect the variation of loads, network loads are represented in a form of random matrix. Load similarity (LS is defined to measure the degree of similarity between the loads in different days and the calculation method of the load similarity of load random matrix (LRM is presented. By calculating the load similarity between the forecasting random matrix and the random matrix of historical load, the historical reactive power optimization dispatching scheme that most matches the forecasting load can be found for reactive power control usage. The differences of daily load curves between working days and weekends in different seasons are considered in the proposed method. The proposed method is tested on a standard 14 nodes distribution network with three different types of load. The computational result demonstrates that the proposed method for reactive power optimization is fast, feasible and effective in distribution network.

  1. A reaction-based paradigm to model reactive chemical transport in groundwater with general kinetic and equilibrium reactions

    International Nuclear Information System (INIS)

    Zhang, Fan; Yeh, Gour-Tsyh; Parker, Jack C.; Brooks, Scott C; Pace, Molly; Kim, Young Jin; Jardine, Philip M.; Watson, David B.

    2007-01-01

    This paper presents a reaction-based water quality transport model in subsurface flow systems. Transport of chemical species with a variety of chemical and physical processes is mathematically described by M. partial differential equations (PDEs). Decomposition via Gauss-Jordan column reduction of the reaction network transforms M. species reactive transport equations into two sets of equations: a set of thermodynamic equilibrium equations representing NE equilibrium reactions and a set of reactive transport equations of M-NE kinetic-variables involving no equilibrium reactions (a kinetic-variable is a linear combination of species). The elimination of equilibrium reactions from reactive transport equations allows robust and efficient numerical integration. The model solves the PDEs of kinetic-variables rather than individual chemical species, which reduces the number of reactive transport equations and simplifies the reaction terms in the equations. A variety of numerical methods are investigated for solving the coupled transport and reaction equations. Simulation comparisons with exact solutions were performed to verify numerical accuracy and assess the effectiveness of various numerical strategies to deal with different application circumstances. Two validation examples involving simulations of uranium transport in soil columns are presented to evaluate the ability of the model to simulate reactive transport with complex reaction networks involving both kinetic and equilibrium reactions

  2. Transient voltage control of a DFIG-based wind power plant for suppressing overvoltage using a reactive current reduction loop

    Directory of Open Access Journals (Sweden)

    Geon Park

    2016-01-01

    Full Text Available This paper proposes a transient voltage control scheme of a doubly fed induction generator (DFIG-based wind power plant (WPP using a reactive current reduction loop to suppress the overvoltage at a point of interconnection (POI and DFIG terminal after a fault clearance. The change of terminal voltage of a DFIG is monitored at every predefined time period to detect the fault clearance. If the voltage change exceeds a set value, then the reactive current reduction loop reduces the reactive current reference in the DFIG controller using the step function. The reactive current injection of DFIGs in a WPP is rapidly reduced, and a WPP can rapidly suppress the overvoltage at a fault clearance because the reactive current reference is reduced. Using an electromagnetic transients program–released version (EMTP–RV simulator, the performance of the proposed scheme was validated for a model system comprising 20 units of a 5-MW DFIG considering various scenarios, such as fault and wind conditions. Test results show that the proposed scheme enables a WPP to suppress the overvoltage at the POI and DFIG terminal within a short time under grid fault conditions.

  3. A reaction-based paradigm to model reactive chemical transport in groundwater with general kinetic and equilibrium reactions.

    Science.gov (United States)

    Zhang, Fan; Yeh, Gour-Tsyh; Parker, Jack C; Brooks, Scott C; Pace, Molly N; Kim, Young-Jin; Jardine, Philip M; Watson, David B

    2007-06-16

    This paper presents a reaction-based water quality transport model in subsurface flow systems. Transport of chemical species with a variety of chemical and physical processes is mathematically described by M partial differential equations (PDEs). Decomposition via Gauss-Jordan column reduction of the reaction network transforms M species reactive transport equations into two sets of equations: a set of thermodynamic equilibrium equations representing N(E) equilibrium reactions and a set of reactive transport equations of M-N(E) kinetic-variables involving no equilibrium reactions (a kinetic-variable is a linear combination of species). The elimination of equilibrium reactions from reactive transport equations allows robust and efficient numerical integration. The model solves the PDEs of kinetic-variables rather than individual chemical species, which reduces the number of reactive transport equations and simplifies the reaction terms in the equations. A variety of numerical methods are investigated for solving the coupled transport and reaction equations. Simulation comparisons with exact solutions were performed to verify numerical accuracy and assess the effectiveness of various numerical strategies to deal with different application circumstances. Two validation examples involving simulations of uranium transport in soil columns are presented to evaluate the ability of the model to simulate reactive transport with complex reaction networks involving both kinetic and equilibrium reactions.

  4. Digital reactivity meter

    International Nuclear Information System (INIS)

    Akkus, B.; Anac, H.; Alsan, S.; Erk, S.

    1991-01-01

    Nowadays, various digital methods making use of microcomputers for neutron detector signals and determining the reactivity by numerical calculations are used in reactor control systems in place of classical reactivity meters. In this work, a calculation based on the ''The Time Dependent Transport Equation'' has been developed for determining the reactivity numerically. The reactivity values have been obtained utilizing a computer-based data acquisition and control system and compared with the analog reactivity meter values as well as the values calculated from the ''Inhour Equation''

  5. Nanoporous Hybrid Electrolytes for High-Energy Batteries Based on Reactive Metal Anodes

    Energy Technology Data Exchange (ETDEWEB)

    Tu, Zhengyuan [Department of Materials Science and Engineering, Cornell University, Ithaca NY 14850 USA; Zachman, Michael J. [School of Applied and Engineering Physics, Cornell University, Ithaca NY 14850 USA; Choudhury, Snehashis [School of Chemical Engineering and Biomolecular Engineering, Cornell University, Ithaca NY 14850 USA; Wei, Shuya [School of Chemical Engineering and Biomolecular Engineering, Cornell University, Ithaca NY 14850 USA; Ma, Lin [Department of Materials Science and Engineering, Cornell University, Ithaca NY 14850 USA; Yang, Yuan [Department of Chemistry and Geochemistry, Colorado School of Mines, Golden CO 80401 USA; Kourkoutis, Lena F. [School of Applied and Engineering Physics, Cornell University, Ithaca NY 14850 USA; Kavli Institute at Cornell for Nanoscale Science, Cornell University, Ithaca NY 14853 USA; Archer, Lynden A. [Department of Materials Science and Engineering, Cornell University, Ithaca NY 14850 USA; School of Chemical Engineering and Biomolecular Engineering, Cornell University, Ithaca NY 14850 USA

    2017-01-06

    Successful strategies for stabilizing electrodeposition of reactive metals, including lithium, sodium, and aluminum are a requirement for safe, high-energy electrochemical storage technologies that utilize these metals as anodes. Unstable deposition produces high-surface area dendritic structures at the anode/electrolyte interface, which causes premature cell failure by complex physical and chemical processes that have presented formidable barriers to progress. Here, it is reported that hybrid electrolytes created by infusing conventional liquid electrolytes into nanoporous membranes provide exceptional ability to stabilize Li. Electrochemical cells based on γ-Al2O3 ceramics with pore diameters below a cut-off value above 200 nm exhibit long-term stability even at a current density of 3 mA cm-2. The effect is not limited to ceramics; similar large enhancements in stability are observed for polypropylene membranes with less monodisperse pores below 450 nm. These findings are critically assessed using theories for ion rectification and electrodeposition reactions in porous solids and show that the source of stable electrodeposition in nanoporous electrolytes is fundamental.

  6. The Effect of Reactives Diluents to the Physical Properties of Acrylated Palm Oil Based Polyurethane Coatings

    Directory of Open Access Journals (Sweden)

    Onn Munirah

    2016-01-01

    Full Text Available The development of polyurethane with hydroxyl access in a molecule leads to a new alternative of low toxicity green product. Palm oil is one of the major commodities in Malaysia. The potential of palm oil to be used as coatings raw material such as alkyd is limited due to low unsaturated side on fatty acid chains. To overcome this limitation, palm oil was modified through transesterification process to produce polyol. Acrylated isocyanate (urethane oligomer was then grafted onto polyol to produce polyurethane with vinylic ends. The polyurethane was formulated with different cross-linkers (reactive diluents and cured under UV radiation. The effect of three different diluents; monoacrylate, diacrylate and triacrylate on the properties of cured polymer were studied in this research. Fourier Transform Infrared (FTIR, Hydroxyl Value Titration, Gel Content, and Volatile Organic Compound (VOC were used for characterization. Physical testing performed were Pencil Hardness and Pull-Off Adhesion test. Novel palm oil-based polyurethane coatings have been found to have good properties with mono acrylate functionality.

  7. Nanoporous Hybrid Electrolytes for High-Energy Batteries Based on Reactive Metal Anodes

    KAUST Repository

    Tu, Zhengyuan

    2017-01-06

    Successful strategies for stabilizing electrodeposition of reactive metals, including lithium, sodium, and aluminum are a requirement for safe, high-energy electrochemical storage technologies that utilize these metals as anodes. Unstable deposition produces high-surface area dendritic structures at the anode/electrolyte interface, which causes premature cell failure by complex physical and chemical processes that have presented formidable barriers to progress. Here, it is reported that hybrid electrolytes created by infusing conventional liquid electrolytes into nanoporous membranes provide exceptional ability to stabilize Li. Electrochemical cells based on γ-Al2O3 ceramics with pore diameters below a cut-off value above 200 nm exhibit long-term stability even at a current density of 3 mA cm−2. The effect is not limited to ceramics; similar large enhancements in stability are observed for polypropylene membranes with less monodisperse pores below 450 nm. These findings are critically assessed using theories for ion rectification and electrodeposition reactions in porous solids and show that the source of stable electrodeposition in nanoporous electrolytes is fundamental.

  8. Development of a reactive burn model based upon an explicit visco-plastic pore collapse model

    Science.gov (United States)

    Bouton, Eric; Lefrançois, Alexandre; Belmas, Robert

    2015-06-01

    Our aim in this study is to develop a reactive burn model based upon a microscopic hot spot model to compute the initiation and shock to detonation of pressed TATB explosives. For the sake of simplicity, the hot spots are supposed to result from the viscoplastic collapse of spherical micro-voids inside the composition. Such a model has been incorporated in a lagrangian hydrodynamic code. In our calculations, 8 different pore diameters, ranging from 100 nm to 1.2 μm, have been taken into account and the porosity associated to each pore size has been deduced from the PBX-9502 void distribution derived from the SAXS. The last ingredient of our model is the burn rate that depends on two main variables. The first one is the shock pressure as proposed by the developers of the CREST model. The second one is the number of effective chemical reaction sites calculated by the microscopic model. Furthermore, the function of the reaction progress variable of the burn rate is similar to that in the SURF model proposed by Menikoff. Our burn rate has been calibrated by using pressure profile, material velocities wave forms obtained with embedded particle velocity gauges and run distance to detonation. The comparison between the numerical and experimental results is really good and sufficient to perform a wide variety of simulations including single, double shock waves and the desensitization phenomenon. In conclusion, future works are described.

  9. Multi-objective Reactive Power Optimization Based on Improved Particle Swarm Algorithm

    Science.gov (United States)

    Cui, Xue; Gao, Jian; Feng, Yunbin; Zou, Chenlu; Liu, Huanlei

    2018-01-01

    In this paper, an optimization model with the minimum active power loss and minimum voltage deviation of node and maximum static voltage stability margin as the optimization objective is proposed for the reactive power optimization problems. By defining the index value of reactive power compensation, the optimal reactive power compensation node was selected. The particle swarm optimization algorithm was improved, and the selection pool of global optimal and the global optimal of probability (p-gbest) were introduced. A set of Pareto optimal solution sets is obtained by this algorithm. And by calculating the fuzzy membership value of the pareto optimal solution sets, individuals with the smallest fuzzy membership value were selected as the final optimization results. The above improved algorithm is used to optimize the reactive power of IEEE14 standard node system. Through the comparison and analysis of the results, it has been proven that the optimization effect of this algorithm was very good.

  10. Development and Testing of Screen-Based and Psychometric Instruments for Assessing Resident Performance in an Operating Room Simulator

    Directory of Open Access Journals (Sweden)

    Richard R. McNeer

    2016-01-01

    Full Text Available Introduction. Medical simulators are used for assessing clinical skills and increasingly for testing hypotheses. We developed and tested an approach for assessing performance in anesthesia residents using screen-based simulation that ensures expert raters remain blinded to subject identity and experimental condition. Methods. Twenty anesthesia residents managed emergencies in an operating room simulator by logging actions through a custom graphical user interface. Two expert raters rated performance based on these entries using custom Global Rating Scale (GRS and Crisis Management Checklist (CMC instruments. Interrater reliability was measured by calculating intraclass correlation coefficients (ICC, and internal consistency of the instruments was assessed with Cronbach’s alpha. Agreement between GRS and CMC was measured using Spearman rank correlation (SRC. Results. Interrater agreement (GRS: ICC = 0.825, CMC: ICC = 0.878 and internal consistency (GRS: alpha = 0.838, CMC: alpha = 0.886 were good for both instruments. Subscale analysis indicated that several instrument items can be discarded. GRS and CMC scores were highly correlated (SRC = 0.948. Conclusions. In this pilot study, we demonstrated that screen-based simulation can allow blinded assessment of performance. GRS and CMC instruments demonstrated good rater agreement and internal consistency. We plan to further test construct validity of our instruments by measuring performance in our simulator as a function of training level.

  11. The effectiveness of spaced retrieval combined with Montessori-based activities in improving the eating ability of residents with dementia.

    Science.gov (United States)

    Wu, Hua Shan; Lin, Li Chan; Wu, Shiao Chi; Lin, Ke Neng; Liu, Hsiu Chih

    2014-08-01

    To explore the long-term effects of standardized and individualized spaced retrieval combined with Montessori-based activities on the eating ability of residents with dementia. Eating difficulty is common in residents with dementia, resulting in low food intake, followed by eating dependence, weight loss and malnutrition. A single-blinded and quasi-experimental design with repeated measures. Ninety residents with dementia from four veterans' homes in Taiwan took part in this study. The intervention consisted of spaced retrieval combined with Montessori-based activities. Twenty-five participants in the standardized group received 24 intervention sessions over 8 weeks. Thirty-eight participants in the individualized group received tailored intervention sessions. The number of intervention sessions was adjusted according to the participant's recall responses in spaced retrieval. Twenty-seven participants in the control group received no treatment. The Chinese version of the Edinburgh Feeding Evaluation in Dementia was used, and eating amounts and body weight were measured pre-test, posttest and at 1-, 3- and 6-month follow-ups. Data were collected between July 2008-February 2010. Repeated measures of all dependent variables for the three groups were analysed by the linear mixed model. The standardized and individualized interventions could significantly decrease the scores for the Chinese version of the Edinburgh Feeding Evaluation in Dementia and increase the eating amount and body weight over time. Trained nurses in institutions can schedule the standardized or individualized intervention in usual activity time to ameliorate eating difficulty and its sequels. © 2014 John Wiley & Sons Ltd.

  12. A Simulation-Based Program to Train Medical Residents to Lead and Perform Advanced Cardiovascular Life Support

    Science.gov (United States)

    Stefan, Mihaela S.; Belforti, Raquel K.; Langlois, Gerard; Rothberg, Michael B.

    2014-01-01

    Background Medical residents are often responsible for leading and performing cardiopulmonary resuscitation; however, their levels of expertise and comfort as leaders of advanced cardiovascular life support (ACLS) teams vary widely. While the current American Heart Association ACLS course provides education in recommended resuscitative protocols, training in leadership skills is insufficient. In this article, we describe the design and implementation in our institution of a formative curriculum aimed at improving residents’ readiness for being leaders of ACLS teams using human patient simulation. Human patient simulation refers to a variety of technologies using mannequins with realistic features, which allows learners to practice through scenarios without putting patients at risk. We discuss the limitations of the program and the challenges encountered in implementation. We also provide a description of the initiation and organization of the program. Case scenarios and assessment tools are provided. Description of the Institutional Training Program Our simulation-based training curriculum consists of 8 simulated patient scenarios during four 1-hour sessions. Postgraduate year–2 and 3 internal medicine residents participate in this program in teams of 4. Assessment tools are utilized only for formative evaluation. Debriefing is used as a teaching strategy for the individual resident leader of the ACLS team to facilitate learning and improve performance. To evaluate the impact of the curriculum, we administered a survey before and after the intervention. The survey consisted of 10 questions answered on a 5-point Likert scale, which addressed residents’ confidence in leading ACLS teams, management of the equipment, and management of cardiac rhythms. Respondents’ mean presimulation (ie, baseline) and postsimulation (outcome) scores were compared using a 2-sample t test. Residents’ overall confidence score improved from 2.8 to 3.9 (P simulation-based training

  13. The Use of a Social Media Based Curriculum for Newly Matched Interns Transitioning into Emergency Medicine Residency

    Directory of Open Access Journals (Sweden)

    Joel C Park, MD

    2018-04-01

    Full Text Available Audience: This is an online social media curriculum aimed at the incoming Emergency Department (ED intern. This curriculum is designed to foster collaborative learning in preparation for the upcoming intern year. Introduction: Graduating medical students tend to have few clinical experiences at the end of their fourth year. For many students, their last ED rotation is six months or more before the start of their internship. In addition, the transition from being a medical student to an intern can be quite abrupt and jarring, with little time to adjust to the rigorous new clinical demands of internship. To ease this transition, the Slack channels provide an easy medium to share thoughts and ideas regarding clinical cases provided by the Emergency Medicine (EM faculty. After performing a PubMed, Google Scholar, and Medline search, we found that no interventions have been described utilizing social media for helping rising interns to transition from medical school to emergency medicine residency. Medical school curriculum varies widely, and medical students often struggle with this transition.1,2 Multiple authors have evaluated the use of pre-graduation or early internship boot camps as preparation for emergency medicine residencies, but to our knowledge, there is no existing curriculum that is designed specifically for the transition between medical school and internship.3,4,5 We designed a social media based curriculum that addressed several of the competencies targeted by these boot camp programs4 and based on Accreditation Council for Graduate Medical Education (ACGME level 1 milestones in patient care. This curriculum provides an interactive, case-based learning platform for incoming residents prior to the start of residency. Using Slack, learners can post responses in real-time that can be seen by the entire group of incoming interns. The incoming interns will be able to interact with other users, either in a public or private forum, and

  14. Economic-environmental active and reactive power scheduling of modern distribution systems in presence of wind generations: A distribution market-based approach

    International Nuclear Information System (INIS)

    Samimi, Abouzar; Kazemi, Ahad; Siano, Pierluigi

    2015-01-01

    Highlights: • A new market-based approach is proposed to schedule active and reactive powers. • Multi-component reactive power bidding structures for DERs is introduced. • A new economical/environmental operational scheduling method is proposed. • At distribution level, a reactive power market is developed in presence of DERs. - Abstract: Distribution System Operator (DSO) is responsible for active and reactive power scheduling in a distribution system. DSO purchases its active and reactive power requirements from Distributed Energy Resources (DERs) as well as the wholesale electricity market. In this paper, a new economical/environmental operational scheduling method based on sequential day-ahead active and reactive power markets at distribution level is proposed to dispatch active and reactive powers in distribution systems with high penetration of DERs. In the proposed model, after day-ahead active power market was cleared the participants submit their reactive power bids and then the reactive power market will be settled. At distribution level, developing a Var market, in which DERs like synchronous machine-based Distributed Generation (DG) units and Wind Turbines (WTs) could offer their reactive power prices, DERs are motivated to actively participate in the Volt/VAr Control (VVC) problem. To achieve this purpose, based on the capability curves of considered DERs, innovative multi-component reactive power bidding structures for DERs are introduced. Moreover, the effect of reactive power market clearing on the active power scheduling is explicitly considered into the proposed model by rescheduling of active power by usage of energy-balance service bids. On the other hand, environmental concerns that arise from the operation of fossil fuel fired electric generators are included in the proposed model by employing CO_2 emission penalty cost. The suggested reactive power market is cleared through a mixed-integer nonlinear optimization program. The

  15. Residents' experiences of relationships with nurses in community-based supported housing - a qualitative study based on Giorgi's method of analysis and self psychology.

    Science.gov (United States)

    Rønning, Solrun Brenk; Bjørkly, Stål

    2017-01-01

    One of the prioritizations in the World Health Organization's (WHO) Mental Health Action Plan 2013-2020 is the provision of community mental health and social care services, such as supported housing. The ongoing process of such deinstitutionalization has raised issues concerning the impact on users' quality of life. The purpose of this study was to explore how residents in supported housing experience receiving professional help and how they perceived their relationships with nurses. The second aim was to investigate the relevance of Giorgi's method of analysis and self psychology in analyzing these experiences. Four residents were interviewed individually. The interviews were based on a semi-structured interview guide and analyzed by Giorgi's method of analysis. Relations were interpreted within self psychology. The residents reported that they not only felt safe in the community but also felt a greater awareness of wanting to appear normal. They seemed to have an easier daily life and felt that the personnel met their selfobject needs when routines allowed for it. Professional awareness of empathic attunement and selfobject roles might enhance residents' self-cohesiveness. The interviews were analyzed by Giorgi's method of analysis, and the use of clinical concepts from self psychology was chosen to achieve a more dynamic understanding of the participants' relational experiences and needs in supported housing.

  16. Study of the cross-reactivity of fish allergens based on a questionnaire and blood testing.

    Science.gov (United States)

    Kobayashi, Yukihiro; Huge, Jiletu; Imamura, Shintaro; Hamada-Sato, Naoko

    2016-07-01

    Parvalbumin and collagen have been identified as cross-reactive allergens for fish allergies. Although doctors realize that various fish elicit allergies, the targets of food allergen labeling laws were only mackerels and salmons in Japan and mackerels in South Korea. This study aimed to reveal the causative species for fish allergy via questionnaires and blood tests. Questionnaire research was conducted in Japan via the internet concerning allergies for fish-allergic patients or their family members. Next, IgE reactivities and cross-reactivities of 26 fish species were analyzed using sera obtained from 16 Japanese patients who were allergic to fish parvalbumin or collagen by enzyme-linked immunosorbent assay (ELISA) and inhibition ELISA. Questionnaire research revealed that 88% patients cannot eat mackerel and salmon in addition to other fish. In addition, 85% respondents were not satisfied with the current food allergen labeling law. In ELISA analyses, we clarified that pooled serum obtained from patients with fish parvalbumin-specific allergies exhibited IgE reactivity to the extracts of most fish species, and pooled serum obtained from patients with fish collagen-specific allergies displayed IgE reactivity to the extracts of all types of fish. Inhibition ELISA experiments revealed cross-reactivities of parvalbumin or collagen to extracts from all fish tested. Most patients with fish allergies displayed allergic symptoms following the intake of various fish species. In addition, fish parvalbumin and collagen were causative factors of fish allergy and were highly cross-reactive fish panallergens. Therefore, current laws should be revised in Japan and South Korea. Copyright © 2016 Japanese Society of Allergology. Production and hosting by Elsevier B.V. All rights reserved.

  17. Impact of repository depth on residence times for leaking radionuclides in land-based surface water

    Science.gov (United States)

    Wörman, Anders; Marklund, Lars; Xu, Shulan; Dverstorp, Björn

    2007-03-01

    The multiple scales of landscape topography produce a wide distribution of groundwater circulation cells that control the hydro-geological environments surrounding geological repositories for nuclear waste. The largest circulation cells tend to discharge water into major river reaches, large freshwater systems or the nearby Baltic Sea. We investigated numerically the release of radionuclides from repositories placed in bedrock with depths between 100 to 2000 meters in a Swedish coastal area and found that leakage from the deeper positions emerges primarily in the major aquatic systems. In effect, radionuclides from the deeper repositories are more rapidly transported towards the Sea by the stream system compared to leakage from more shallow repositories. The release from the shallower repositories is significantly retained in the initial stage of the transport in the (superficial) landscape because the discharge occurs in or near low-order streams with high retention characteristics. This retention and residence time for radioactivity in the landscape control radiological doses to biota and can, thus, be expected to constitute an essential part of an associated risk evaluation.

  18. Teaching leadership in trauma resuscitation: Immediate feedback from a real-time, competency-based evaluation tool shows long-term improvement in resident performance.

    Science.gov (United States)

    Gregg, Shea C; Heffernan, Daithi S; Connolly, Michael D; Stephen, Andrew H; Leuckel, Stephanie N; Harrington, David T; Machan, Jason T; Adams, Charles A; Cioffi, William G

    2016-10-01

    Limited data exist on how to develop resident leadership and communication skills during actual trauma resuscitations. An evaluation tool was developed to grade senior resident performance as the team leader during full-trauma-team activations. Thirty actions that demonstrated the Accreditation Council for Graduate Medical Education core competencies were graded on a Likert scale of 1 (poor) to 5 (exceptional). These actions were grouped by their respective core competencies on 5 × 7-inch index cards. In Phase 1, baseline performance scores were obtained. In Phase 2, trauma-focused communication in-services were conducted early in the academic year, and immediate, personalized feedback sessions were performed after resuscitations based on the evaluation tool. In Phase 3, residents received only evaluation-based feedback following resuscitations. In Phase 1 (October 2009 to April 2010), 27 evaluations were performed on 10 residents. In Phase 2 (April 2010 to October 2010), 28 evaluations were performed on nine residents. In Phase 3 (October 2010 to January 2012), 44 evaluations were performed on 13 residents. Total scores improved significantly between Phases 1 and 2 (p = 0.003) and remained elevated throughout Phase 3. When analyzing performance by competency, significant improvement between Phases 1 and 2 (p competencies (patient care, knowledge, system-based practice, practice-based learning) with the exception of "communication and professionalism" (p = 0.56). Statistically similar scores were observed between Phases 2 and 3 in all competencies with the exception of "medical knowledge," which showed ongoing significant improvement (p = 0.003). Directed resident feedback sessions utilizing data from a real-time, competency-based evaluation tool have allowed us to improve our residents' abilities to lead trauma resuscitations over a 30-month period. Given pressures to maximize clinical educational opportunities among work-hour constraints, such a model may help

  19. Teaching and assessing systems-based practice: a pilot course in health care policy, finance, and law for radiation oncology residents.

    Science.gov (United States)

    Mitchell, James D; Parhar, Preeti; Narayana, Ashwatha

    2010-09-01

    Under the Accreditation Council for Graduate Medical Education (ACGME) Outcome Project, residency programs are required to provide data on educational outcomes and evidence for how this information is used to improve resident education. To teach and assess systems-based practice through a course in health care policy, finance, and law for radiation oncology residents, and to determine its efficacy. We designed a pilot course in health care policy, finance, and law related to radiation oncology. Invited experts gave lectures on policy issues important to radiation oncology and half of the participants attended the American Society for Therapeutic Radiation and Oncology (ASTRO) Advocacy Day. Participants completed pre- and postcourse tests to assess their knowledge of health policy. Six radiation oncology residents participated, with 5 (84%) completing all components. For the 5 residents completing all assessments, the mean precourse score was 64% and the mean postcourse score was 84% (P  =  .05). Improvement was noted in all 3 sections of health policy, finance, and medical law. At the end of the course, 5 of 6 residents were motivated to learn about health policy, and 4 of 6 agreed it was important for physicians to be involved in policy matters. Teaching radiation oncology residents systems-based practice through a course on health policy, finance, and law is feasible and was well received. Such a course can help teaching programs comply with the ACGME Outcome Project and would also be applicable to trainees in other specialties.

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

    Science.gov (United States)

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

    2015-04-01

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

  1. Sleep behaviors and attitudes among internal medicine housestaff in a U.S. university-based residency program.

    Science.gov (United States)

    Rosen, Ilene M; Bellini, Lisa M; Shea, Judy A

    2004-05-01

    Physicians-in-training are susceptible to fatigue given their prolonged duty hours. Sleep deprivation has been shown to alter perceptions of sleepiness and performance. This study examined the state of sleepiness and attitudes about sleep and performance of work- and non-work-related tasks among incoming and current housestaff; and how rotation, call cycle, and call status are related to acute and chronic sleep deprivation and perceptions of sleepiness. A survey instrument was administered in June 2001 to 53 incoming interns and 79 current housestaff at the University Pennsylvania School of Medicine, a university-based internal medicine residency program. All 132 participants (100%) completed the instrument. Acute sleep deprivation was experienced by 34% of the current housestaff and 64% of current housestaff were chronically sleep deprived. Current housestaff admitted to the possibility of dozing while performing various work-related tasks such as writing notes in charts (69%), reviewing medication lists (61%), interpreting labs (51%), and writing orders (46%). At least half of all respondents felt their patients received good care despite residents' sleepiness and as many believed sleep deprivation was a necessary part of training. Nearly half (48%) of current housestaff rotating on a ward service reported acute sleep deprivation, as did 81% of those who were postcall. Over two-thirds of the housestaff on wards and in the ICU reported chronic sleep deprivation. Subjective sleepiness did not vary much across rotations, call cycle, and call status. Chronic and acute sleep deprivation contribute to residents' fatigue. Education could be targeted at attitudes. Further investigation of factors contributing to chronic sleep deprivation in this population is warranted.

  2. Microcomputer-based equipment-control and data-acquisition system for fission-reactor reactivity-worth measurements

    International Nuclear Information System (INIS)

    McDowell, W.P.; Bucher, R.G.

    1980-01-01

    Material reactivity-worth measurements are one of the major classes of experiments conducted on the Zero Power research reactors (ZPR) at Argonne National Laboratory. These measurements require the monitoring of the position of a servo control element as a sample material is positioned at various locations in a critical reactor configuration. In order to guarantee operational reliability and increase experimental flexibility for these measurements, the obsolete hardware-based control unit has been replaced with a microcomputer based equipment control and data acquisition system. This system is based on an S-100 bus, dual floppy disk computer with custom built cards to interface with the experimental system. To measure reactivity worths, the system accurately positions samples in the reactor core and acquires data on the position of the servo control element. The data are then analyzed to determine statistical adequacy. The paper covers both the hardware and software aspects of the design

  3. Microcomputer-based equipment-control and data-acquisition system for fission-reactor reactivity-worth measurements

    Energy Technology Data Exchange (ETDEWEB)

    McDowell, W.P.; Bucher, R.G.

    1980-01-01

    Material reactivity-worth measurements are one of the major classes of experiments conducted on the Zero Power research reactors (ZPR) at Argonne National Laboratory. These measurements require the monitoring of the position of a servo control element as a sample material is positioned at various locations in a critical reactor configuration. In order to guarantee operational reliability and increase experimental flexibility for these measurements, the obsolete hardware-based control unit has been replaced with a microcomputer based equipment control and data acquisition system. This system is based on an S-100 bus, dual floppy disk computer with custom built cards to interface with the experimental system. To measure reactivity worths, the system accurately positions samples in the reactor core and acquires data on the position of the servo control element. The data are then analyzed to determine statistical adequacy. The paper covers both the hardware and software aspects of the design.

  4. Impact of fluorine based reactive chemistry on structure and properties of high moment magnetic material

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Xiaoyu, E-mail: xiaoyu.yang@wdc.com; Chen, Lifan; Han, Hongmei; Fu, Lianfeng; Sun, Ming; Liu, Feng; Zhang, Jinqiu [Western Digital Corporation, 44100 Osgood Road, Fremont, California 94539 (United States)

    2014-05-07

    The impact of the fluorine-based reactive ion etch (RIE) process on the structural, electrical, and magnetic properties of NiFe and CoNiFe-plated materials was investigated. Several techniques, including X-ray fluorescence, 4-point-probe, BH looper, transmission electron microscopy (TEM), and electron energy loss spectroscopy (EELS), were utilized to characterize both bulk film properties such as thickness, average composition, Rs, ρ, Bs, Ms, and surface magnetic “dead” layers' properties such as thickness and element concentration. Experimental data showed that the majority of Rs and Bs changes of these bulk films were due to thickness reduction during exposure to the RIE process. ρ and Ms change after taking thickness reduction into account were negligible. The composition of the bulk films, which were not sensitive to surface magnetic dead layers with nano-meter scale, showed minimum change as well. It was found by TEM and EELS analysis that although both before and after RIE there were magnetic dead layers on the top surface of these materials, the thickness and element concentration of the layers were quite different. Prior to RIE, dead layer was actually native oxidation layers (about 2 nm thick), while after RIE dead layer consisted of two sub-layers that were about 6 nm thick in total. Sub-layer on the top was native oxidation layer, while the bottom layer was RIE “damaged” layer with very high fluorine concentration. Two in-situ RIE approaches were also proposed and tested to remove such damaged sub-layers.

  5. Exploring the role of classroom-based learning in professional identity formation of family practice residents using the experiences, trajectories, and reifications framework.

    Science.gov (United States)

    Chen, Luke Y C; Hubinette, Maria M

    2017-08-01

    Classroom-based learning such as academic half day has undervalued social aspects. We sought to explore its role in the professional identity development of family medicine residents. In this case study, residents and faculty from four training sites in the University of British Columbia Department of Family Practice were interviewed. The "experiences, trajectories, and reifications (ETR) framework" was used as a sensitizing tool for modified inductive (thematic) analysis of the transcripts. Classroom-based learning provided a different context for residents' interpretation of their clinical experiences, characterized as a "home base" for rotating urban residents, and a connection to a larger academic community for residents in rural training sites. Both these aspects were important in creating a positive trajectory of professional identity formation. Teaching directed at the learning needs of family physicians, and participation of family practice faculty as teachers and role models was a precipitation of a curriculum "centered in family medicine." Interactions between family medicine residents and faculty in the classroom facilitated the necessary engagements to reify a shared understanding of the discipline of family practice. Classroom-based learning has substantial impact on professional identity formation at an individual and collective level.

  6. Consensus-based Distributed Control for Accurate Reactive, Harmonic and Imbalance Power Sharing in Microgrids

    DEFF Research Database (Denmark)

    Zhou, Jianguo; Kim, Sunghyok; Zhang, Huaguang

    2018-01-01

    This paper investigates the issue of accurate reactive, harmonic and imbalance power sharing in a microgrid. Harmonic and imbalance droop controllers are developed to proportionally share the harmonic power and the imbalance power among distributed generation (DG) units and improve the voltage...... voltage. With the proposed methods, the microgrid system reliability and flexibility can be enhanced and the knowledge of the line impedance is not required. And the reactive, harmonic and imbalance power can be proportionally shared among the DG units. Moreover, the quality of the voltage at PCC can...

  7. SO{sub 2} retention by reactivated CaO-based sorbent from multiple CO{sub 2} capture cycles

    Energy Technology Data Exchange (ETDEWEB)

    Vasilije Manovic; Edward J. Anthony [CANMET Energy Technology Centre-Ottawa, Ottawa, ON (Canada). Natural Resources Canada

    2007-06-15

    This paper examines the reactivation of spent sorbent, produced from multiple CO{sub 2} capture cycles, for use in SO{sub 2} capture. CaO-based sorbent samples were obtained from Kelly Rock limestone using three particle size ranges, each containing different impurities levels. Using a thermogravimetric analyzer (TGA), the sulfation behavior of partially sulfated and unsulfated samples obtained after multiple calcination-carbonation cycles in a tube furnace (TF), following steam reactivation in a pressurized reactor, is examined. In addition, samples calcined/sintered under different conditions after hydration are also examined. The results show that suitably treated spent sorbent has better sulfation characteristics than that of the original sorbent. Thus for example, after 2 h sulfation, {gt} 80% of the CaO was sulfated. In addition, the sorbent showed significant activity even after 4 h when {gt} 95% CaO was sulfated. The results were confirmed by X-ray diffraction (XRD) analysis, which showed that, by the end of the sulfation process, samples contained CaSO{sub 4} with only traces of unreacted CaO. The superior behavior of spent reactivated sorbent appears to be due to swelling of the sorbent particles during steam hydration. The surface area morphology of sorbent after reactivation was examined by scanning electron microscopy (SEM). Ca(OH){sub 2} crystals were seen, which displayed their regular shape, and their elemental composition was confirmed by energy-dispersive X-ray (EDX) analysis. These results allow the proposal of a new process for the use of CaO-based sorbent in fluidized bed combustion (FBC) systems, which incorporates CO{sub 2} capture, sorbent reactivation, and SO{sub 2} retention. 26 refs., 4 figs., 2 tabs.

  8. Development of a Theory-Based Intervention to Increase Clinical Measurement of Reactive Balance in Adults at Risk of Falls.

    Science.gov (United States)

    Sibley, Kathryn M; Brooks, Dina; Gardner, Paula; Janaudis-Ferreira, Tania; McGlynn, Mandy; OʼHoski, Sachi; McEwen, Sara; Salbach, Nancy M; Shaffer, Jennifer; Shing, Paula; Straus, Sharon E; Jaglal, Susan B

    2016-04-01

    Effective balance reactions are essential for avoiding falls, but are not regularly measured by physical therapists. Physical therapists report wanting to improve reactive balance assessment, and theory-based approaches are recommended as the foundation for the development of interventions. This article describes how a behavior change theory for health care providers, the theoretical domains framework (TDF), was used to develop an intervention to increase reactive balance measurement among physical therapists who work in rehabilitation settings and treat adults who are at risk of falls. We employed published recommendations for using the TDF-guided intervention development. We identified what health care provider behavior is in need of change, relevant barriers and facilitators, strategies to address them, and how we would measure behavior change. In this case, identifying strategies required selecting both a reactive balance measure and behavior change techniques. Previous research had determined that physical therapists need to increase reactive balance measurement, and identified barriers and facilitators that corresponded to 8 TDF domains. A published review informed the selection of the Balance Evaluation Systems Test (Reactive Postural Responses Section) as addressing the barriers and facilitators, and existing research informed the selection of 9 established behavior change techniques corresponding to each identified TDF domain. The TDF framework were incorporated into a 12-month intervention with interactive group sessions, local champions, and health record modifications. Intervention effect can be evaluated using health record abstraction, questionnaires, and qualitative semistructured interviews. Although future research will evaluate the intervention in a controlled study, the process of theory-based intervention development can be applied to other rehabilitation research contexts, maximizing the impact of this work.Video Abstract is available for more

  9. Livelihood Benefits from Post-Earthquake Nature-Based Tourism Development: A Survey of Local Residents in Rural China

    Directory of Open Access Journals (Sweden)

    Shuwen Liu

    2018-03-01

    Full Text Available Large-scale tourism development after a natural disaster often leads to substantial changes in the living conditions of local residents. Few studies have examined how these changes are perceived by residents and related to their support to tourism development. We conducted a household survey in Wolong National Nature Reserve, which is a popular nature-based tourist location severely devastated by a catastrophic earthquake in 2008. Structural equation modelling (SEM was employed to explore the association between residents’ expectation of tourism impacts and their willingness to support tourism development. Results indicated that they held high expectations about development and believed that it would be enhance Wolong’s economic progress and improve their personal living conditions. Expected economic benefits (EEB had a significant and positive relationship with the expected improvement of their personal living conditions, but not with their support to tourism development. The latter two variables, however, were associated with each other, suggesting that expected improvement of living conditions mediated between expected benefits and stated support to tourism development. Similar results were not found for resistance and concerns about tourism development. Policy-makers and tourism planners should recognize that public support to tourism development is not necessarily driven directly by expected economic benefits.

  10. Examining mindfulness-based stress reduction: Perceptions from minority older adults residing in a low-income housing facility

    Directory of Open Access Journals (Sweden)

    Connolly Amy B

    2011-05-01

    Full Text Available Abstract Background Mindfulness-based stress reduction (MBSR programs are becoming increasingly common, but have not been studied in low income minority older populations. We sought to understand which parts of MBSR were most important to practicing MBSR members of this population, and to understand whether they apply their training to daily challenges. Methods We conducted three focus groups with 13 current members of an MBSR program. Participants were African American women over the age of 60 in a low-income housing residence. We tape recorded each session and subsequently used inductive content analysis to identify primary themes. Results and discussion Analysis of the focus group responses revealed three primary themes stress management, applying mindfulness, and the social support of the group meditation. The stressors they cited using MBSR with included growing older with physical pain, medical tests, financial strain, and having grandchildren with significant mental, physical, financial or legal hardships. We found that participants particularly used their MBSR training for coping with medical procedures, and managing both depression and anger. Conclusion A reflective stationary intervention delivered in-residence could be an ideal mechanism to decrease stress in low-income older adult's lives and improve their health.

  11. Towards a Reactive Power Oscillation Damping Controller for Wind Power Plant Based on Full Converter Wind Turbines

    DEFF Research Database (Denmark)

    Knüppel, Thyge; Kumar, Sathess; Thuring, Patrik

    2012-01-01

    In this paper a power oscillation damping controller (POD) based on modulation of reactive power (Q POD) is analyzed where the modular and distributed characteristics of the wind power plant (WPP) are considered. For a Q POD it is essential that the phase of the modulated output is tightly...... contributes to a collective response. This ability is shown with a 150 wind turbine (WT) WPP with all WTs represented, and it is demonstrated that the WPP contributes to the inter-area damping. The work is based on a nonlinear, dynamic model of the 3.6 MW Siemens Wind Power WT....... controlled to achieve a positive damping contribution. It is investigated how a park level voltage, reactive power, and power factor control at different grid strengths interact with the Q POD in terms of a resulting phase shift. A WPP is modular and distributed and a WPP Q POD necessitate that each WT...

  12. Calculations of reactivity based in the solution of the Neutron transport equation in X Y geometry and Lineal perturbation theory

    International Nuclear Information System (INIS)

    Valle G, E. del; Mugica R, C.A.

    2005-01-01

    In our country, in last congresses, Gomez et al carried out reactivity calculations based on the solution of the diffusion equation for an energy group using nodal methods in one dimension and the TPL approach (Lineal Perturbation Theory). Later on, Mugica extended the application to the case of multigroup so much so much in one as in two dimensions (X Y geometry) with excellent results. Presently work is carried out similar calculations but this time based on the solution of the neutron transport equation in X Y geometry using nodal methods and again the TPL approximation. The idea is to provide a calculation method that allows to obtain in quick form the reactivity solving the direct problem as well as the enclosed problem of the not perturbed problem. A test problem for the one that results are provided for the effective multiplication factor is described and its are offered some conclusions. (Author)

  13. C-reactive protein, insulin resistance and risk of cardiovascular disease: a population-based study

    DEFF Research Database (Denmark)

    Hansen, T.W.; Olsen, M.H.; Rasmussen, S.

    2008-01-01

    BACKGROUND: C-reactive protein (CRP), a marker of inflammation, and insulin resistance (IR), a metabolic disorder, are closely related. CRP and IR have both been identified as significant risk factors of cardiovascular disease (CVD) after adjustment for conventional CVD risk factors...

  14. Neural Network Based Reactive Navigation for Mobile Robot in Dynamic Environment

    Czech Academy of Sciences Publication Activity Database

    Krejsa, Jiří; Věchet, S.; Ripel, T.

    2013-01-01

    Roč. 198, č. 2013 (2013), s. 108-113 ISSN 1012-0394 Institutional research plan: CEZ:AV0Z20760514 Institutional support: RVO:61388998 Keywords : mobile robot * reactive navigation * artificial neural networks Subject RIV: JD - Computer Applications, Robotics

  15. Model-Based Requirements Analysis for Reactive Systems with UML Sequence Diagrams and Coloured Petri Nets

    DEFF Research Database (Denmark)

    Tjell, Simon; Lassen, Kristian Bisgaard

    2008-01-01

    In this paper, we describe a formal foundation for a specialized approach to automatically checking traces against real-time requirements. The traces are obtained from simulation of Coloured Petri Net (CPN) models of reactive systems. The real-time requirements are expressed in terms of a derivat...

  16. Study of the cross-reactivity of fish allergens based on a questionnaire and blood testing

    Directory of Open Access Journals (Sweden)

    Yukihiro Kobayashi

    2016-07-01

    Conclusions: Most patients with fish allergies displayed allergic symptoms following the intake of various fish species. In addition, fish parvalbumin and collagen were causative factors of fish allergy and were highly cross-reactive fish panallergens. Therefore, current laws should be revised in Japan and South Korea.

  17. Shadowing emergency medicine residents by medical education specialists to provide feedback on non-medical knowledge-based ACGME sub-competencies

    Directory of Open Access Journals (Sweden)

    Waterbrook AL

    2018-05-01

    Full Text Available Anna L Waterbrook,1 Karen C Spear Ellinwood,2 T Gail Pritchard,3 Karen Bertels,1 Ariel C Johnson,4 Alice Min,1 Lisa R Stoneking1 1Department of Emergency Medicine, The University of Arizona College of Medicine, Tucson, AZ, USA; 2Department of Obstetrics and Gynecology, The University of Arizona College of Medicine, Tucson, AZ, USA; 3Department of Pediatrics, The University of Arizona College of Medicine, Tucson, AZ, USA; 4College of Medicine, The University of Arizona College of Medicine, Tucson, AZ, USA Objective: Non-medical knowledge-based sub-competencies (multitasking, professionalism, accountability, patient-centered communication, and team management are challenging for a supervising emergency medicine (EM physician to evaluate in real-time on shift while also managing a busy emergency department (ED. This study examines residents’ perceptions of having a medical education specialist shadow and evaluate their nonmedical knowledge skills.Methods: Medical education specialists shadowed postgraduate year 1 and postgraduate year 2 EM residents during an ED shift once per academic year. In an attempt to increase meaningful feedback to the residents, these specialists evaluated resident performance in selected non-medical knowledge-based Accreditation Council of Graduate Medical Education (ACGME sub-competencies and provided residents with direct, real-time feedback, followed by a written evaluation sent via email. Evaluations provided specific references to examples of behaviors observed during the shift and connected these back to ACGME competencies and milestones.Results: Twelve residents participated in this shadow experience (six post graduate year 1 and six postgraduate year 2. Two residents emailed the medical education specialists ahead of the scheduled shadow shift requesting specific feedback. When queried, five residents voluntarily requested their feedback to be included in their formal biannual review. Residents received

  18. An Integral Model to Provide Reactive and Proactive Services in an Academic CSIRT Based on Business Intelligence

    OpenAIRE

    Walter Fuertes; Francisco Reyes; Paúl Valladares; Freddy Tapia; Theofilos Toulkeridis; Ernesto Pérez

    2017-01-01

    Cyber-attacks have increased in severity and complexity. That requires, that the CERT/CSIRT research and develops new security tools. Therefore, our study focuses on the design of an integral model based on Business Intelligence (BI), which provides reactive and proactive services in a CSIRT, in order to alert and reduce any suspicious or malicious activity on information systems and data networks. To achieve this purpose, a solution has been assembled, that generates information stores, bein...

  19. Effects of Video-Based Visual Training on Decision-Making and Reactive Agility in Adolescent Football Players

    Directory of Open Access Journals (Sweden)

    Alfred Nimmerichter

    2015-12-01

    Full Text Available This study investigated the trainability of decision-making and reactive agility via video-based visual training in young athletes. Thirty-four members of a national football academy (age: 14.4 ± 0.1 years were randomly assigned to a training (VIS; n = 18 or a control group (CON; n = 16. In addition to the football training, the VIS completed a video-based visual training twice a week over a period of six weeks during the competition phase. Using the temporal occlusion technique, the players were instructed to react on one-on-one situations shown in 40 videos. The number of successful decisions and the response time were measured with a video-based test. In addition, the reactive-agility sprint test was used. VIS significantly improved the number of successful decisions (22.2 ± 3.6 s vs. 29.8 ± 4.5 s; p < 0.001, response time (0.41 ± 0.10 s vs. 0.31 ± 0.10 s; p = 0.006 and reactive agility (2.22 ± 0.33 s vs. 1.94 ± 0.11 s; p = 0.001 pre- vs. post-training. No significant differences were found for CON. The results have shown that video-based visual training improves the time to make decisions as well as reactive agility sprint-time, accompanied by an increase in successful decisions. It remains to be shown whether or not such training can improve simulated or actual game performance.

  20. Associations - Communities - Residents. Building together a citizen-based project of renewable energies - Methodological guide

    International Nuclear Information System (INIS)

    Ramard, Dominique; Fleury, Laurianne; Peyret, Albert; Ghesquiere, Christine; Kauber, Markus; Jourdain, Pierre

    2012-11-01

    This guide first outlines the challenges and stakes of citizen-based renewable energies: example of a necessary energy transition in Brittany, interest of a local production of renewable energies, examples in other European countries, and emergence of a citizen-based energy movement in France. The second part presents the four main phases of such a project (diagnosis, development, construction, and exploitation), the main issues to be addressed, and the main steps of a citizen-based renewable energy project (technical, legal and financial, and citizen-related aspects during the different phases). The third part describes how to elaborate a citizen-based project: by addressing the project dimensions, by defining a legal specification, by performing a provisional business model, by choosing an appropriate legal structure, by creating a project company, and by mobilizing local actors). The last part addresses how to finance the project: by building up own funds, by asking banks for support, and by citizen participation to investment

  1. Local and national laparoscopic skill competitions: residents' opinions and impact on adoption of simulation-based training.

    Science.gov (United States)

    McCreery, Greig L; El-Beheiry, Mostafa; Schlachta, Christopher M

    2017-11-01

    Dedicated practice using laparoscopic simulators improves operative performance. Yet, voluntary utilization is minimal. We hypothesized that skill competition between peers, at the local and national level, positively influences residents' use of laparoscopic simulators. A web-based survey evaluated the relationship between Canadian General Surgery residents' use of laparoscopic simulation and participation in competition. Secondary outcomes assessed attitudes regarding simulation training, factors limiting use, and associations between competition level and usage. One hundred ninety (23%) of 826 potential participants responded. Eighty-three percent rated their laparoscopic abilities as novice or intermediate. More than 70% agreed that use of simulation practice improves intra-operative performance, and should be a mandatory component of training. However, 58% employed simulator practice less than once per month, and 18% never used a simulator. Sixty-five percent engaged in simulator training for 5 h or less over the preceding 6 months. Seventy-three percent had participated in laparoscopic skill competition. Of those, 51% agreed that competition was a motivation for simulation practice. No association was found between those with competition experience and simulator use. However, 83% of those who had competed nationally reported >5 h of simulator use in the previous 6 months compared to those with no competition experience (26%), local competition (40%), and local national-qualifying competition (23%) (p simulation-based training, with only the minority of individuals competing at the national level demonstrated significantly higher simulation use. However, simulation training was perceived as a valuable exercise. Lack of time and access to simulators, as opposed to lack of interest, were the most commonly reported to limited use.

  2. [Simulation-based intervention to improve anesthesiology residents communication with families of critically ill patients--preliminary prospective evaluation].

    Science.gov (United States)

    Berkenstadt, Haim; Perlson, Daria; Shalomson, Orit; Tuval, Atalia; Haviv-Yadid, Yael; Ziv, Amitai

    2013-08-01

    Although effective communication with families of critically ill patients is a vital component of quality care, training in this field is neglected. The article aims to validate communication skills training program for anesthesiology residents in the intensive care set up. Ten anesthesia residents, following 3 months of Intensive Care Unit (ICU) rotation, had 4 hours of lectures and one day simulation-based communication skills training with families of critically ill patients. Participants completed an attitude questionnaire over 3 time periods--before training [t1], immediately following training (t2) and three months following training (t3). The participants' communication skills were assessed by two blinded independent observers using the SEGUE framework while performing a simulation-based scenario at t1 and t3. Seven participants finished the study protocol. Participants ndicated communication importance as 3.68 +/- 0.58 (t1), 4.05 +/- 0.59 (t2), 4.13 +/- 0.64 (t3); their communication ability as 3.09 +/- 0.90 (t1), 3.70 +/- 0.80 (t2), 3.57 +/- 0.64 (t3); the contribution of lecture to communication 3.04 +/- 0.43 (t1), 3.83 +/- 0.39 (t2), 3.87 +/- 0.51 (t3), and contribution of simulation training to communication 3.00 +/- 0.71 (t1), 4.04 +/- 0.52 (t2), 3.84 +/- 0.31 (t3). The differences did not reach statistical significance. Objective assessment of the communication skills using the SEGUE framework indicated that 6/7 participants improved their communication skills, with communication ability before training at 2.66 +/- 0.83 and 1 month following training it was 3.38 +/- 0.78 (p = 0.09). This preliminary study demonstrates the value of communication skills training in the intensive care environment.

  3. Preparing Dental Students and Residents to Overcome Internal and External Barriers to Evidence-Based Practice.

    Science.gov (United States)

    Coleman, Brandon G; Johnson, Thomas M; Erley, Kenneth J; Topolski, Richard; Rethman, Michael; Lancaster, Douglas D

    2016-10-01

    In recent years, evidence-based dentistry has become the ideal for research, academia, and clinical practice. However, barriers to implementation are many, including the complexity of interpreting conflicting evidence as well as difficulties in accessing it. Furthermore, many proponents of evidence-based care seem to assume that good evidence consistently exists and that clinicians can and will objectively evaluate data so as to apply the best evidence to individual patients' needs. The authors argue that these shortcomings may mislead many clinicians and that students should be adequately prepared to cope with some of the more complex issues surrounding evidence-based practice. Cognitive biases and heuristics shape every aspect of our lives, including our professional behavior. This article reviews literature from medicine, psychology, and behavioral economics to explore the barriers to implementing evidence-based dentistry. Internal factors include biases that affect clinical decision making: hindsight bias, optimism bias, survivor bias, and blind-spot bias. External factors include publication bias, corporate bias, and lack of transparency that may skew the available evidence in the peer-reviewed literature. Raising awareness of how these biases exert subtle influence on decision making and patient care can lead to a more nuanced discussion of addressing and overcoming barriers to evidence-based practice.

  4. SPATIO-TEMPORAL CHARACTERISTICS OF RESIDENT TRIP BASED ON POI AND OD DATA OF FLOAT CAR IN BEIJING

    OpenAIRE

    N. Mou; N. Mou; J. Li; L. Zhang; W. Liu; Y. Xu

    2017-01-01

    Due to the influence of the urban inherent regional functional distribution, the daily activities of the residents presented some spatio-temporal patterns (periodic patterns, gathering patterns, etc.). In order to further understand the spatial and temporal characteristics of urban residents, this paper research takes the taxi trajectory data of Beijing as a sample data and studies the spatio-temporal characteristics of the residents' activities on the weekdays. At first, according t...

  5. Possibility of retrospective follow up studies of mortality in the residents of Semipalatinsk region based on available archive data

    International Nuclear Information System (INIS)

    Bugembayeva, M.; Gaskov, A.; Valivach, M.; Musina, R.; Lipikhina, A.; Kurakina, N.; Kosatov, V.; Federbush, E.; Kusumi, S.

    2003-01-01

    Full text: Epidemiological follow up studies require the following basic data: exposure, people-years of observation, and registered events (incidence of diseases and/or deaths). Besides, it is important to register possible confounding factors such as sex, age, ethnicity, occupation, etc. Performing a joint Kazakhstan-Japanese project we are collecting such kind of data based on various archive documents. Retrospective radiation exposure reconstruction uses estimation methods with input data obtained from historic data, at present physical measurements and at present bio dosimetric measurements. Epidemiological studies is an important part of dose reconstruction, they provide the data on address history and occupation (for example, out-door or in-door job) in the period of atmospheric nuclear tests in 1949-1963. These data can be obtained from Household Books, which have been created and used by authorities for taxation purposes. Each Household Book cover a 2-3 year time band and contains lists of households (usually families), names, birth dates, occupation, ethnicity, and property. Unfortunately, Household Books have numerous mistakes in name spelling, birth dates, and handwriting is often bad. In addition, there are many cases when small children and old people are not mentioned in the lists. Correct data can be reconstructed by comparing the data of several subsequent Household Books and the data of ZAGSes (civilian registry offices). Such ZAGS document as birth certificate contains not only data on a newborn, but also correct names and birth dates of parents, place of birth. Marriage certificates include correct data on names and birth dates. If still there are any doubts, it is possible to collect additional information by interviewing old resident. Usually reconstruction of these data on a single person requires referral to 19 archive documents. A computer software designer A.Gaskov together with epidemiologists have developed a chain of technological

  6. Influence of iridium on the reactivity of LaFeO3 base perovskites

    DEFF Research Database (Denmark)

    Kindermann, L.; Das, D.; Bahadur, D.

    1998-01-01

    The influence of iridium on the reactivity of powder mixtures made of perovskites and 8 mol% yttria stabilized zirconia (8 YSZ) is reported. Iridium is added to the perovskites of the composition (La0.6M0.4)(z)Fe0.8TM0.2O3-delta (M = Sr, Ca; TM = Mn, Co; z = 0.90, 1.00) via the gaseous phase....... Iridium is present in the perovskite lattice as Ir4+ replacing iron as is evident from XRD and TEM/EDX results. Compatibility studies carried out at 1000 degrees C demonstrate that iridium has considerable influence on the reactivity. The results are discussed with respect to the stability...... of the perovskites, thermodynamic activities, Ir(IV)-O bonding, tolerance factor and oxygen migration....

  7. InTaO4-based nanostructures synthesized by reactive pulsed laser ablation

    International Nuclear Information System (INIS)

    Yoshida, Takehito; Toyoyama, Hirokazu; Umezu, Ikurou; Sugimura, Akira

    2008-01-01

    Nanostructured Ni-doped indium-tantalum-oxides (InTaO 4 ) were synthesized by a reactive pulsed laser ablation process, aiming at the final goal of direct splitting of water under visible sunbeam irradiation. The third harmonics beam of a Nd:YAG laser was focused onto a sintered In 0.9 Ni 0.1 TaO 4-δ target in pure oxygen background gases (0.05-1.00 Torr). Increasing the oxygen gas pressure, via thin films having nanometer-sized strong morphologies, single-crystalline nanoparticles were synthesized in the reactive vapor phases. The nanostructured deposited materials have the monoclinic layered wolframite-type structure of bulk InTaO 4 , without oxygen deficiency. (orig.)

  8. Study of the cross-reactivity of fish allergens based on a questionnaire and blood testing

    OpenAIRE

    Kobayashi, Yukihiro; Huge, Jiletu; Imamura, Shintaro; Hamada-Sato, Naoko

    2016-01-01

    Background: Parvalbumin and collagen have been identified as cross-reactive allergens for fish allergies. Although doctors realize that various fish elicit allergies, the targets of food allergen labeling laws were only mackerels and salmons in Japan and mackerels in South Korea. This study aimed to reveal the causative species for fish allergy via questionnaires and blood tests. Methods: Questionnaire research was conducted in Japan via the internet concerning allergies for fish-allergic ...

  9. Chemical conjugation of cowpea mosaic viruses with reactive HPMA-based polymers

    Czech Academy of Sciences Publication Activity Database

    Laga, Richard; Koňák, Čestmír; Šubr, Vladimír; Ulbrich, Karel; Suthiwangcharoen, N.; Niu, Q.; Wang, Q.

    2010-01-01

    Roč. 21, č. 12 (2010), s. 1669-1685 ISSN 0920-5063 R&D Projects: GA AV ČR KJB400500803; GA ČR GA202/09/2078; GA AV ČR KAN200200651 Institutional research plan: CEZ:AV0Z40500505 Keywords : acylthiazolidine-2-thione reactive groups * bioconjugation * coating Subject RIV: CD - Macromolecular Chemistry Impact factor: 1.842, year: 2010

  10. C-reactive protein levels and treatment resistance in schizophrenia - A Danish population-based cohort study

    DEFF Research Database (Denmark)

    Horsdal, Henriette Thisted; Wimberley, Theresa; Benros, Michael Eriksen

    2017-01-01

    -time schizophrenia diagnosis and a baseline C-reactive protein measurement (a commonly available marker of systemic inflammation) from 2000 to 2012. We defined treatment resistance as the earliest observed instance of either clozapine initiation or hospital admission due to schizophrenia after having received......OBJECTIVE: Schizophrenia is associated with increased levels of inflammatory markers. However, it remains unclear whether inflammatory markers are associated with treatment-resistant schizophrenia. METHODS: We conducted a population-based follow-up study among individuals with a first...... (4.0 vs. 3.1 mg/L, p = .13) was observed among the 52 (13.3%) treatment-resistant individuals. Increased levels of C-reactive protein (above 3 mg/L) at baseline were not associated with treatment resistance (adjusted hazard ratio = 0.99, 95% confidence interval [0.56, 1.73]). CONCLUSIONS: C...

  11. Containment and Consensus-based Distributed Coordination Control for Voltage Bound and Reactive Power Sharing in AC Microgrid

    DEFF Research Database (Denmark)

    Han, Renke; Meng, Lexuan; Ferrari-Trecate, Giancarlo

    2017-01-01

    This paper offers a highly flexible and reliable control strategy to achieve voltage bounded regulation and accurate reactive power sharing coordinately in AC Micro-Grids. A containment and consensus-based distributed coordination controller is proposed, by which each output voltage magnitude can...... be bounded within a reasonable range and the accurate reactive power sharing among distributed generators can be also achieved. Combined with the two proposed controllers and electrical part of the AC Micro-Grid, a small signal model is fully developed to analyze the sensitivity of different control...... parameters. The effectiveness of the proposed controller in case of load variation, communication failure, plug-and-play capability are verified by the experimental setup as an islanded Micro-Grid....

  12. Psychotherapy Training for Residents: Reconciling Requirements with Evidence-Based, Competency-Focused Practice

    Science.gov (United States)

    Weerasekera, Priyanthy; Manring, John; Lynn, David John

    2010-01-01

    Objective: The Accreditation Council for Graduate Medical Education (ACGME) and the Royal College of Physicians and Surgeons of Canada (RCPSC) changed the training requirements in psychotherapy, moving toward evidence-based therapies and emphasizing competence and proficiency as outcomes of training. This article examines whether the therapies…

  13. Site-Based Services for Residents of Single-Room Occupancy Hotels.

    Science.gov (United States)

    Shepard, Melanie

    1997-01-01

    Describes an evaluation of an innovative site-based service program, the Growth and Achievement Program (GAP). Results show that GAP clients had significantly higher gain scores than did the comparison group and were less likely to rely on public financial assistance as their primary source of income. (RJM)

  14. A Pilot Use of Team-Based Learning in Psychiatry Resident Psychodynamic Psychotherapy Education

    Science.gov (United States)

    Touchet, Bryan K.; Coon, Kim A.

    2005-01-01

    Objective: Demonstrating psychotherapy competency in trainees will test the resources of psychiatry training programs. The authors outline the phases of team-based learning (TBL). Methods: The University of Oklahoma College of Medicine, Tulsa (OUCM-T), Department of Psychiatry reorganized its psychodynamic psychotherapy didactic course using TBL.…

  15. Enhancing pediatric safety: assessing and improving resident competency in life-threatening events with a computer-based interactive resuscitation tool

    International Nuclear Information System (INIS)

    Lerner, Catherine; Gaca, Ana M.; Frush, Donald P.; Ancarana, Anjanette; Hohenhaus, Sue; Seelinger, Terry A.; Frush, Karen

    2009-01-01

    Though rare, allergic reactions occur as a result of administration of low osmolality nonionic iodinated contrast material to pediatric patients. Currently available resuscitation aids are inadequate in guiding radiologists' initial management of such reactions. To compare radiology resident competency with and without a computer-based interactive resuscitation tool in the management of life-threatening events in pediatric patients. The study was approved by the IRB. Radiology residents (n=19; 14 male, 5 female; 19 certified in basic life support/advanced cardiac life support; 1 certified in pediatric advanced life support) were videotaped during two simulated 5-min anaphylaxis scenarios involving 18-month-old and 8-year-old mannequins (order randomized). No advance warning was given. In half of the scenarios, a computer-based interactive resuscitation tool with a response-driven decision tree was available to residents (order randomized). Competency measures included: calling a code, administering oxygen and epinephrine, and correctly dosing epinephrine. Residents performed significantly more essential interventions with the computer-based resuscitation tool than without (72/76 vs. 49/76, P<0.001). Significantly more residents appropriately dosed epinephrine with the tool than without (17/19 vs. 1/19; P<0.001). More residents called a code with the tool than without (17/19 vs. 14/19; P = 0.08). A learning effect was present: average times to call a code, request oxygen, and administer epinephrine were shorter in the second scenario (129 vs. 93 s, P=0.24; 52 vs. 30 s, P<0.001; 152 vs. 82 s, P=0.025, respectively). All the trainees found the resuscitation tool helpful and potentially useful in a true pediatric emergency. A computer-based interactive resuscitation tool significantly improved resident performance in managing pediatric emergencies in the radiology department. (orig.)

  16. Recursive Pyramid Algorithm-Based Discrete Wavelet Transform for Reactive Power Measurement in Smart Meters

    Directory of Open Access Journals (Sweden)

    Mahin K. Atiq

    2013-09-01

    Full Text Available Measurement of the active, reactive, and apparent power is one of the most fundamental tasks of smart meters in energy systems. Recently, a number of studies have employed the discrete wavelet transform (DWT for power measurement in smart meters. The most common way to implement DWT is the pyramid algorithm; however, this is not feasible for practical DWT computation because it requires either a log N cascaded filter or O (N word size memory storage for an input signal of the N-point. Both solutions are too expensive for practical applications of smart meters. It is proposed that the recursive pyramid algorithm is more suitable for smart meter implementation because it requires only word size storage of L × Log (N-L, where L is the length of filter. We also investigated the effect of varying different system parameters, such as the sampling rate, dc offset, phase offset, linearity error in current and voltage sensors, analog to digital converter resolution, and number of harmonics in a non-sinusoidal system, on the reactive energy measurement using DWT. The error analysis is depicted in the form of the absolute difference between the measured and the true value of the reactive energy.

  17. Competency-based (CanMEDS) residency training programme in radiology: systematic design procedure, curriculum and success factors

    International Nuclear Information System (INIS)

    Jippes, Erik; Engelen, Jo M.L. van; Brand, Paul L.P.; Oudkerk, Matthijs

    2010-01-01

    Based on the CanMEDS framework and the European Training Charter for Clinical Radiology a new radiology curriculum was designed in the Netherlands. Both the development process and the resulting new curriculum are presented in this paper. The new curriculum was developed according to four systematic design principles: discursiveness, hierarchical decomposition, systematic variation and satisficing (satisficing is different from satisfying; in this context, satisficing means searching for an acceptable solution instead of searching for an optimal solution). The new curriculum is organ based with integration of radiological diagnostic techniques, comprises a uniform national common trunk followed by a 2-year subspecialisation, is competency outcome based with appropriate assessment tools and techniques, and is based on regional collaboration among radiology departments. The application of the systematic design principles proved successful in producing a new curriculum approved by all authorities. The principles led to a structured, yet flexible, development process in which creative solutions could be generated and adopters (programme directors, supervisors and residents) were highly involved. Further research is needed to empirically test the components of the new curriculum. (orig.)

  18. Home-based enterprise in social housing: enhancing the quality of life of residents?

    CSIR Research Space (South Africa)

    Matsebe, G

    2009-09-01

    Full Text Available as “ Breaking New Ground” (BNG) supports the use of the house as an economically productive asset, offering considerable opportunities for income generation and poverty alleviation (Dept. of Housing, 2004). Correspondingly, the house plays a key role... in their infancy stage (Finmark Trust, 2006). These HBEs are crucial in generating and Home-based enterprises in social housing developments Gertrude Matsebe 2 augmenting the household income, particularly for those who are unemployed and poor. The South...

  19. Do over 200 million healthy altitude residents really suffer from chronic Acid-base disorders?

    Science.gov (United States)

    Zubieta-Calleja, Gustavo; Zubieta-Castillo, Gustavo; Zubieta-Calleja, Luis; Ardaya-Zubieta, Gustavo; Paulev, Poul-Erik

    2011-01-01

    As the oxygen tension of inspired air falls with increasing altitude in normal subjects, hyperventilation ensues. This acute respiratory alkalosis, induces increased renal excretion of bicarbonate, returning the pH back to normal, giving rise to compensated respiratory alkalosis or chronic hypocapnia. It seems a contradiction that so many normal people at high altitude should permanently live as chronic acid-base patients. Blood gas analyses of 1,865 subjects at 3,510 m, reported a P(a)CO(2) (arterial carbon dioxide tension ± SEM) = 29.4 ± 0.16 mmHg and pH = 7.40 ± 0.005. Base excess, calculated with the Van Slyke sea level equation, is -5 mM (milliMolar or mmol/l) as an average, suggesting chronic hypocapnia. THID, a new term replacing "Base Excess" is determined by titration to a pH of 7.40 at a P(a)CO(2) of 5.33 kPa (40 mmHg) at sea level, oxygen saturated and at 37°C blood temperature. Since our new modified Van Slyke equations operate with normal values for P(a)CO(2) at the actual altitude, a calculation of THID will always result in normal values-that is, zero.

  20. Effects of Video-Based Visual Training on Decision-Making and Reactive Agility in Adolescent Football Players

    OpenAIRE

    Alfred Nimmerichter; Nikolaus J. R. Weber; Klaus Wirth; Andreas Haller

    2015-01-01

    This study investigated the trainability of decision-making and reactive agility via video-based visual training in young athletes. Thirty-four members of a national football academy (age: 14.4 ± 0.1 years) were randomly assigned to a training (VIS; n = 18) or a control group (CON; n = 16). In addition to the football training, the VIS completed a video-based visual training twice a week over a period of six weeks during the competition phase. Using the temporal occlusion technique, the playe...

  1. A population-based study on health-related quality of life among urban community residents in Shenyang, Northeast of China.

    Science.gov (United States)

    Song, Tian; Ding, Yan-wei; Sun, Yan; He, Yi-Ni; Qi, Dian-Jun; Wu, Ying; Wu, Bin; Lang, Lang; Yu, Kai; Zhao, Xin; Zhu, Liang-liang; Wang, Shuang; Yu, Xiao-Song

    2015-09-19

    Due to the rising standard of living environment and advances in public health and medical care in China, it has been a tendency in recent years that health-related quality of life (HRQoL) has been increasingly acknowledged in community health management. However, large-scale population-based study on evaluating HQRoL in northeast of China was not conducted. This article aims to investigate the HRQoL in community residents in Northeast China and explore the associated factors. Stratified multiple-stage sampling method was used in the cross-sectional survey to investigate HRQoL of community residents in northeast of China. Univariate analysis and multiple linear regressions were used to analyze the factors associated to HRQoL of the community residents. The results were confirmed that HRQoL in general population was well performed for the first time in northeast of China in a large scale population. Community residents had better mental health than physical health. The factors influencing HRQoL included gender, age, educational level, marital status, ethnic group, chronic disease status, having breakfast frequency weekly and sleep quality. However, drinking and smoking habits did not affect residents' HRQoL. In this study, the result of the large-scale survey was satisfactory in northeast of China, providing HRQoL status of community residents. Policies on specific health management in community public health would emphasize on lifestyle behaviors especially eating habits in order to improving HRQoL.

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

    Science.gov (United States)

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

    2015-01-01

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

  3. Implementation of a web-based, interactive polytrauma tutorial in computed tomography for radiology residents: How we do it

    International Nuclear Information System (INIS)

    Schlorhaufer, C.; Behrends, M.; Diekhaus, G.; Keberle, M.; Weidemann, J.

    2012-01-01

    Purpose: Due to the time factor in polytraumatized patients all relevant pathologies in a polytrauma computed tomography (CT) scan have to be read and communicated very quickly. During radiology residency acquisition of effective reading schemes based on typical polytrauma pathologies is very important. Thus, an online tutorial for the structured diagnosis of polytrauma CT was developed. Materials and methods: Based on current multimedia theories like the cognitive load theory a didactic concept was developed. As a web-environment the learning management system ILIAS was chosen. CT data sets were converted into online scrollable QuickTime movies. Audiovisual tutorial movies with guided image analyses by a consultant radiologist were recorded. Results: The polytrauma tutorial consists of chapterized text content and embedded interactive scrollable CT data sets. Selected trauma pathologies are demonstrated to the user by guiding tutor movies. Basic reading schemes are communicated with the help of detailed commented movies of normal data sets. Common and important pathologies could be explored in a self-directed manner. Conclusions: Ambitious didactic concepts can be supported by a web based application on the basis of cognitive load theory and currently available software tools.

  4. Implementation of a web-based, interactive polytrauma tutorial in computed tomography for radiology residents: How we do it

    Energy Technology Data Exchange (ETDEWEB)

    Schlorhaufer, C., E-mail: Schlorhaufer.Celia@mh-hannover.de [Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover (Germany); Behrends, M., E-mail: behrends.marianne@mh-hannover.de [Peter L. Reichertz Department of Medical Informatics, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover (Germany); Diekhaus, G., E-mail: Diekhaus.Gesche@mh-hannover.de [Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover (Germany); Keberle, M., E-mail: m.keberle@bk-paderborn.de [Department of Diagnostic and Interventional Radiology, Brüderkrankenhaus St. Josef Paderborn, Husener Str. 46, 33098 Paderborn (Germany); Weidemann, J., E-mail: Weidemann.Juergen@mh-hannover.de [Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover (Germany)

    2012-12-15

    Purpose: Due to the time factor in polytraumatized patients all relevant pathologies in a polytrauma computed tomography (CT) scan have to be read and communicated very quickly. During radiology residency acquisition of effective reading schemes based on typical polytrauma pathologies is very important. Thus, an online tutorial for the structured diagnosis of polytrauma CT was developed. Materials and methods: Based on current multimedia theories like the cognitive load theory a didactic concept was developed. As a web-environment the learning management system ILIAS was chosen. CT data sets were converted into online scrollable QuickTime movies. Audiovisual tutorial movies with guided image analyses by a consultant radiologist were recorded. Results: The polytrauma tutorial consists of chapterized text content and embedded interactive scrollable CT data sets. Selected trauma pathologies are demonstrated to the user by guiding tutor movies. Basic reading schemes are communicated with the help of detailed commented movies of normal data sets. Common and important pathologies could be explored in a self-directed manner. Conclusions: Ambitious didactic concepts can be supported by a web based application on the basis of cognitive load theory and currently available software tools.

  5. A cross-sectional case control study on genetic damage in individuals residing in the vicinity of a mobile phone base station.

    Science.gov (United States)

    Gandhi, Gursatej; Kaur, Gurpreet; Nisar, Uzma

    2015-01-01

    Mobile phone base stations facilitate good communication, but the continuously emitting radiations from these stations have raised health concerns. Hence in this study, genetic damage using the single cell gel electrophoresis (comet) assay was assessed in peripheral blood leukocytes of individuals residing in the vicinity of a mobile phone base station and comparing it to that in healthy controls. The power density in the area within 300 m from the base station exceeded the permissive limits and was significantly (p = 0.000) higher compared to the area from where control samples were collected. The study participants comprised 63 persons with residences near a mobile phone tower, and 28 healthy controls matched for gender, age, alcohol drinking and occupational sub-groups. Genetic damage parameters of DNA migration length, damage frequency (DF) and damage index were significantly (p = 0.000) elevated in the sample group compared to respective values in healthy controls. The female residents (n = 25) of the sample group had significantly (p = 0.004) elevated DF than the male residents (n = 38). The linear regression analysis further revealed daily mobile phone usage, location of residence and power density as significant predictors of genetic damage. The genetic damage evident in the participants of this study needs to be addressed against future disease-risk, which in addition to neurodegenerative disorders, may lead to cancer.

  6. Care staff training based on person-centered care and dementia care mapping, and its effects on the quality of life of nursing home residents with dementia.

    Science.gov (United States)

    Yasuda, Mami; Sakakibara, Hisataka

    2017-09-01

    To assess the effects of care staff training based on person-centered care (PCC) and dementia care mapping (DCM) on the quality of life (QOL) of residents with dementia in a nursing home. An intervention of staff training based on PCC and DCM was conducted with 40 care staff members at a geriatric nursing home. The effects of the staff training on the QOL of residents with dementia were evaluated by the DCM measurements of 40 residents with dementia three times at about one-month intervals (first, baseline; second, pre-intervention; third, post-intervention). The well-being and ill-being values (WIB values) of the residents with dementia measured by DCM were not different between the first and second rounds before the staff training (p = 0.211). Meanwhile, the WIB values increased from the first and second rounds to the third post-intervention round (p = 0.035 and p Staff training based on PCC and DCM could effectively improve the QOL of residents with dementia.

  7. Refining The Grain: Using Resident-Based Walkability Audits To Better Understand Walkable Urban Form.

    Science.gov (United States)

    Schlossberg, Marc; Johnson-Shelton, Deb; Evers, Cody; Moreno, Geraldine

    Researchers use measures of street connectivity to assess neighborhood walkability and many studies show a relationship between neighborhood design and walking activity. Yet, the core of those connectivity measures are based on constructs designed for analyzing automobile mobility - the street network - not pedestrian movement. This paper examines the effect of a finer grained characterization of street connectivity and illustrates the idea using parent ratings of street and intersection walkability for children throughout a suburban school district in Oregon. Several policy and practice recommendations are presented, including a discussion that extends Michael Southworth's (1993; 2005) foundational representation of streets and the walkable city using a refined, more pedestrian-centered approach to visualizing connectivity and walkable urban form.

  8. Knowledge and uptake of community-based health insurance scheme among residents of Olowora, Lagos

    Directory of Open Access Journals (Sweden)

    O A Ibukun

    2013-01-01

    Full Text Available Background and Objective: The informal sector population in developing nations has low health coverage from Community Based Health Insurance (CBHI and problems such as limited awareness about the potential impact of prepayment health financing and the limited resources to finance health care can impede success. This study assessed the community based health insurance scheme uptake and determinants in Olowora, Lagos State. Methods: This was a descriptive cross sectional study carried out in July 2010 in all households of 12 out of 41 streets in Olowora,by multistage sampling. Four hundred and sixteen interviewer-administered questionnaires were completed and returned. Analysis was by Epi- info version 3.5.1 software. Results: Although 75.5% of respondents were aware of the Community Health Insurance scheme at Olowora, just about half (49.5% of them had good knowledge of the scheme. A substantial proportion (44.2% of respondents did not believe in contributing money for illness yet to come, and majority (72.3% of such respondents prefers payment for health care when ill. While about half (53% of respondentshad enrolled into the community health insurance scheme, 45.6% of those who had not enrolled were not aware of the scheme. Lack of money was the main reason (51.5% why some enrollees had defaulted. Conclusion: The study identified information gaps and poor understanding of the scheme as well as poverty as factors that have negatively affected uptake. The scheme management has to re-evaluate its sensitization programmes, and also strengthen marketing strategies with special emphasis on the poor.

  9. Atomistic-level non-equilibrium model for chemically reactive systems based on steepest-entropy-ascent quantum thermodynamics

    International Nuclear Information System (INIS)

    Li, Guanchen; Al-Abbasi, Omar; Von Spakovsky, Michael R

    2014-01-01

    This paper outlines an atomistic-level framework for modeling the non-equilibrium behavior of chemically reactive systems. The framework called steepest- entropy-ascent quantum thermodynamics (SEA-QT) is based on the paradigm of intrinsic quantum thermodynamic (IQT), which is a theory that unifies quantum mechanics and thermodynamics into a single discipline with wide applications to the study of non-equilibrium phenomena at the atomistic level. SEA-QT is a novel approach for describing the state of chemically reactive systems as well as the kinetic and dynamic features of the reaction process without any assumptions of near-equilibrium states or weak-interactions with a reservoir or bath. Entropy generation is the basis of the dissipation which takes place internal to the system and is, thus, the driving force of the chemical reaction(s). The SEA-QT non-equilibrium model is able to provide detailed information during the reaction process, providing a picture of the changes occurring in key thermodynamic properties (e.g., the instantaneous species concentrations, entropy and entropy generation, reaction coordinate, chemical affinities, reaction rate, etc). As an illustration, the SEA-QT framework is applied to an atomistic-level chemically reactive system governed by the reaction mechanism F + H 2 ↔ FH + H

  10. Evaluation of a web-based asynchronous pediatric emergency medicine learning tool for residents and medical students.

    Science.gov (United States)

    Burnette, Kreg; Ramundo, Maria; Stevenson, Michelle; Beeson, Michael S

    2009-12-01

    To examine the effectiveness of an asynchronous learning tool consisting of web-based lectures for trainees covering major topics pertinent to pediatric emergency medicine (PEM) and to assess resident and student evaluation of this mode of education. PEM faculty and fellows created a 21-lecture, web-based curriculum. These 20-minute online lectures used Microsoft PowerPoint with the voice-over feature. A 75-question test was created to assess the effectiveness of the web-based learning model, administered online before and after the rotation in the pediatric emergency department (PED). All fourth-year medical students and residents (across all specialties) rotating through the PED were required to complete 10 of the 21 lectures during their 1-month rotation. The main outcome variable was difference in score between pre- and post-rotation tests of participants who viewed no lectures and those who viewed at least one lecture. Evaluation of the program was assessed by anonymous survey using 5-point discrete visual analog scales. Responses of 4 or 5 were considered positive for analysis. One hundred eleven residents and fourth-year medical students participated in the program. An initial 32 completed testing before implementation of the on-line lectures (March 2007-August 2007), and another five did not complete the on-line lectures after implementation (September 2007-February 2008). Seventy-one completed testing and on-line lectures, and all but three completed at least 10 on-line lectures during their rotation. Fourteen of 111 trainees did not complete the pre- or post-test (including two who viewed the lectures). The mean change in score was a 1% improvement from pre-test to post-test for trainees who viewed no lectures and a 6.2% improvement for those who viewed the lectures (mean difference = 5.2%, 95% confidence interval = 2.5% to 7.9%). In the linear regression model, the estimate of the coefficient was 0.43 (p lecture viewed, post-test score rose by 0

  11. Towards the new heterocycle based molecule: Synthesis, characterization and reactivity study

    Science.gov (United States)

    Murthy, P. Krishna; Sheena Mary, Y.; Suneetha, V.; Panicker, C. Yohannan; Armaković, Stevan; Armaković, Sanja J.; Giri, L.; Suchetan, P. A.; Van Alsenoy, C.

    2017-06-01

    4-Chloro-2-(3-fluorophenyl)-2,3-dihydro-1H-pyrrolo[3,4-c]pyridin-1-one (CFPDPPO) have been synthesized by hydride transfer from Et3SiH to carbenium ions(reduction reaction), which is formed by reaction between 4-chloro-2-(3-fluorophenyl)-3-hydroxy-2,3-dihydro-1H-pyrrolo[3,4-c]pyridin-1-one with TFA, the single crystals were grown in acetonitrile by slow evaporation technique at room temperature and characterized by single crystal X-ray diffraction, FT-IR, FT-Raman, 1H NMR, 13C NMR and ESI-MS. The experimental vibrational spectra were compared with the calculated spectra and each vibrational wavenumber was assigned on the basis of potential energy distribution (PED). Gauge-including atomic orbital 1H NMR and 13C NMR chemical shifts calculations were carried out and compared with experimental data. The HOMO and LUMO analysis is used to determine the charge transfer within the molecule. The stability of the molecule arising from hyper-conjugative interactions and charge delocalization has been analysed using NBO analysis. First hyperpolarizability is calculated in order to find its role in non-linear optics. Besides molecular electrostatic potential (MEP), global reactivity descriptors, thermodynamic properties, and Mullikan charge analysis of the title compound were computed with the same method in gas phase, theoretically. Further, employing combination of DFT calculations and molecular dynamics (MD) simulations, we have investigated in detail reactive properties of the title molecule. Investigation of local reactive properties encompassed calculations of average local ionization energies (ALIE) and Fukui functions. Stability in water has been investigated by calculations of radial distribution functions (RDF), while sensitivity towards the mechanism of autoxidation has been investigated by calculations of bond dissociation energies (BDE). The docked ligand forms a stable complex with human alpha9 nicotinic acetylcholine receptor antagonist and can be a lead

  12. Urea impedimetric biosensor based on reactive RF magnetron sputtered zinc oxide nanoporous transducer

    International Nuclear Information System (INIS)

    Mozaffari, Sayed Ahmad; Rahmanian, Reza; Abedi, Mohammad; Amoli, Hossein Salar

    2014-01-01

    Graphical abstract: - Highlights: • Application and optimization of reactive RF magnetron sputtering for homogeneous nanoporous ZnO thin film formation. • Exploiting nanoporous ZnO thin film as a good porous framework with large surface area/volume for having stable immobilized enzyme with minimum loss of activity. • Application of impedimetric assessment for urea biosensing due to its rapidity, sensitivity, and repeatability. - Abstract: Uniform sputtered nanoporous zinc oxide (Nano-ZnO) thin film on the conductive fluorinated-tin oxide (FTO) layer was applied to immobilize urease enzyme (Urs) for urea detection. Highly uniform nanoporous ZnO thin film were obtained by reactive radio frequency (RF) magnetron sputtering system at the optimized instrumental deposition conditions. Characterization of the surface morphology and roughness of ZnO thin film by field emission-scanning electron microscopy (FE-SEM) exhibits cavities of nanoporous film as an effective biosensing area for enzyme immobilization. Step by step monitoring of FTO/Nano-ZnO/Urs biosensor fabrication were performed using electrochemical methods such as cyclic voltammetry (CV) and electrochemical impedance spectroscopy (EIS) techniques. Fabricated FTO/Nano-ZnO/Urs biosensor was used for urea determination using EIS experiments. The impedimetric results show high sensitivity for urea detection within 0.83–23.24 mM and limit of detection as 0.40 mM

  13. Assessing future reactive nitrogen inputs into global croplands based on the shared socioeconomic pathways

    Science.gov (United States)

    Mogollón, J. M.; Lassaletta, L.; Beusen, A. H. W.; van Grinsven, H. J. M.; Westhoek, H.; Bouwman, A. F.

    2018-04-01

    Reactive nitrogen (N) inputs in agriculture strongly outpace the outputs at the global scale due to inefficiencies in cropland N use. While improvement in agricultural practices and environmental legislation in developed regions such as Western Europe have led to a remarkable increase in the N use efficiency since 1985, this lower requirement for reactive N inputs via synthetic fertilizers has yet to occur in many developing and transition regions. Here, we explore future N input requirements and N use efficiency in agriculture for the five shared socioeconomic pathways. Results show that under the most optimistic sustainability scenario, the global synthetic fertilizer use in croplands stabilizes and even shrinks (85 Tg N yr‑1 in 2050) regardless of the increase in crop production required to feed the larger estimated population. This scenario is highly dependent on projected increases in N use efficiency, particularly in South and East Asia. In our most pessimistic scenario, synthetic fertilization application rates are expected to increase almost threefold by 2050 (260 Tg N yr‑1). Excepting the sustainability scenario, all other projected scenarios reveal that the areal N surpluses will exceed acceptable limits in most of the developing regions.

  14. Synthesis and Characterization of Core-Shell Acrylate Based Latex and Study of Its Reactive Blends

    Directory of Open Access Journals (Sweden)

    Ying Nie

    2008-03-01

    Full Text Available Techniques in resin blending are simple and efficient method for improving the properties of polymers, and have been used widely in polymer modification field. However, polymer latex blends such as the combination of latexes, especially the latexes with water-soluble polymers, were rarely reported. Here, we report a core-shell composite latex synthesized using methyl methacrylate (MMA, butyl acrylate (BA, 2-ethylhexyl acrylate (EHA and glycidyl methacrylate (GMA as monomers and ammonium persulfate and sodium bisulfite redox system as the initiator. Two stages seeded semi-continuous emulsion polymerization were employed for constructing a core-shell structure with P(MMA-co-BA component as the core and P(EHA-co-GMA component as the shell. Results of Transmission Electron Microscopy (TEM and Dynamics Light Scattering (DLS tests confirmed that the particles obtained are indeed possessing a desired core-shell structural character. Stable reactive latex blends were prepared by adding the latex with waterborne melamine-formaldehyde resin (MF or urea-formaldehyde resin (UF. It was found that the glass transition temperature, the mechanical strength and the hygroscopic property of films cast from the latex blends present marked enhancements under higher thermal treatment temperature. It was revealed that the physical properties of chemically reactive latexes with core-shell structure could be altered via the change of crosslinking density both from the addition of crosslinkers and the thermal treatment.

  15. High-fidelity simulation-based team training in urology: evaluation of technical and nontechnical skills of urology residents during laparoscopic partial nephrectomy.

    Science.gov (United States)

    Abdelshehid, Corollos S; Quach, Stephen; Nelson, Corey; Graversen, Joseph; Lusch, Achim; Zarraga, Jerome; Alipanah, Reza; Landman, Jaime; McDougall, Elspeth M

    2013-01-01

    The use of low-risk simulation training for resident education is rapidly expanding as teaching centers integrate simulation-based team training (SBTT) sessions into their education curriculum. SBTT is a valuable tool in technical and communication skills training and assessment for residents. We created a unique SBTT scenario for urology residents involving a laparoscopic partial nephrectomy procedure. Urology residents were randomly paired with a certified registered nurse anesthetists or an anesthesia resident. The scenario incorporated a laparoscopic right partial nephrectomy utilizing a unique polyvinyl alcohol kidney model with an embedded 3cm lower pole exophytic tumor and the high-fidelity SimMan3G mannequin. The Urology residents were instructed to pay particular attention to the patient's identifying information provided at the beginning of the case. Two scripted events occurred, the patient had an anaphylactic reaction to a drug and, after tumor specimen was sent for a frozen section, the confederate pathologist called into the operating room (OR) twice, first with the wrong patient name and subsequently with the wrong specimen. After the scenario was complete, technical performance and nontechnical performance were evaluated and assessed. A debriefing session followed the scenario to discuss and assess technical performance and interdisciplinary nontechnical communication between the team. All Urology residents (n = 9) rated the SBTT scenario as a useful tool in developing communication skills among the OR team and 88% rated the model as useful for technical skills training. Despite cuing to note patient identification, only 3 of 9 (33%) participants identified that the wrong patient information was presented when the confederate "pathologist" called in to report pathology results. All urology residents rated SBTT sessions as useful for the development of communication skills between different team members and making residents aware of unlikely but

  16. Sport-based physical activity recommendations and modifications in C-reactive protein and arterial thickness.

    Science.gov (United States)

    Cayres, Suziane Ungari; de Lira, Fabio Santos; Kemper, Han C G; Codogno, Jamile Sanches; Barbosa, Maurício Fregonesi; Fernandes, Romulo Araújo

    2018-04-01

    We analyzed the effects of 1 year of engagement in ≥ 300 min/week of organized sports on inflammatory levels and vascular structure in adolescents. The sample was composed of 89 adolescents (11.6 ± 0.7 years old [43 boys and 46 girls]), stratified according to engagement in ≥ 300 min/week of sport practice during at least 12 months of follow-up (n = 15, sport practice; n = 74, non-sport practice). Arterial thickness (carotid and femoral) was assessed by ultrasound scan, while high sensitive C-reactive protein levels were used to assess inflammatory status. Trunk fatness (densitometry scanner), biological maturation (age at peak height velocity), blood pressure, and skipping breakfast were treated as covariates. Independently of body fatness and biological maturation, the group engaged in sports presented a higher reduction in C-reactive protein (mean difference -1.559 mg/L [95%CI -2.539 to -0.579]) than the non-sport group (mean difference -0.414 mg/L [95%CI -0.846 to 0.017]) (p = 0.040). There was a significant relationship between changes in C-reactive protein and changes in femoral intima-media thickness in the non-sport group (r = 0.311 [95%CI 0.026 to 0.549]). Inflammation decreased in adolescents engaged in organized sports, independently of trunk fatness and biological maturation. Moreover, inflammation was related to arterial thickening only in adolescents not engaged in sports. What is Known: • Intima media thickness is a relevant marker of cardiovascular disease in pediatric groups, being affected by obesity and inflammation. • The importance of monitoring inflammatory markers from childhood is enhanced by the fact that alterations in these inflammatory markers in early life predict inflammation and alterations in carotid IMT in adulthood. What is New: • Anti-inflammatory properties related to physical exercise performed at moderate intensity, on inflammation and alterations in IMT are not clear in pediatric

  17. Chronic diseases among older people and co-resident psychological morbidity: a 10/66 Dementia Research Group population-based survey.

    Science.gov (United States)

    Honyashiki, Mina; Ferri, Cleusa P; Acosta, Daisy; Guerra, Mariella; Huang, Yueqin; Jacob, K S; Llibre-Rodrigues, Juan J; Salas, Aquiles; Sosa, Ana Luisa; Williams, Joseph; Prince, Martin J

    2011-11-01

    This is the first study to investigate the associations between chronic health conditions of older people and their impact on co-resident psychological morbidity using population-based samples in low and middle income countries (LAMICs). Single-phase cross-sectional catchment area surveys were undertaken in urban sites in Cuba, Dominican Republic and Venezuela, and in rural and urban catchment areas in Mexico, Peru, India and China. All residents aged 65 years and over were interviewed with a co-resident key informant. Exposures were structured clinical diagnoses (10/66 and DSM-IV dementia and ICD-10 depression), self-reported diagnosis (stroke) and physical impairments. Mediating variables were dependence and disability (WHODAS 2.0), and the outcome was co-resident psychological morbidity assessed using SRQ-20. Poisson regression analysis was used to estimate the prevalence ratios (PRs) for the associations between health conditions and psychological morbidity in each site, and meta-analysis was used to pool the estimates. 11,988 pairs comprising a participant and a co-resident informant were included in the analysis. After meta-analysis, independent effects were noted for depression (PR2.11; 95% CI 1.82-2.45), dementia (PR 1.98; 95% CI 1.72-2.28), stroke (PR 1.42; 95% CI 1.17-1.71) and physical impairments (PR 1.17; 95% CI 1.13-1.21). The effects were partly mediated through disability and dependence. The mean population attributable fraction of total chronic conditions was 30.1%. The prevalence of co-resident psychological morbidity is higher among co-residents of older people with chronic conditions. This effect was prominent for, but not confined to, depression and dementia. Attention needs to be directed to chronic conditions.

  18. Suicide among nursing home residents in Australia: A national population-based retrospective analysis of medico-legal death investigation information.

    Science.gov (United States)

    Murphy, Briony J; Bugeja, Lyndal C; Pilgrim, Jennifer L; Ibrahim, Joseph E

    2018-05-01

    Suicide among nursing home residents is a growing public health concern, currently lacking in empirical research. This study aims to describe the frequency and nature of suicide among nursing home residents in Australia. This research comprised a national population-based retrospective analysis of suicide deaths among nursing home residents in Australia reported to the Coroner between July 2000 and December 2013. Cases were identified using the National Coronial Information System, and data collected from paper-based coroners' records on individual, incident, and organizational factors, as well as details of the medico-legal death investigation. Data analysis comprised univariate and bivariate descriptive statistical techniques; ecological analysis of incidence rates using population denominators; and comparison of age and sex of suicide cases to deaths from other causes using logistic regression. The study identified 141 suicides among nursing home residents, occurring at a rate of 0.02 deaths per 100 000 resident bed days. The ratio of deaths from suicide to deaths from any other cause was higher in males than females (OR = 3.56, 95%CI = 2.48-5.12, P = home for less than 12 months (n = 71, 50.3%). Common major life stressors identified in suicide cases included the following: health deterioration (n = 112, 79.4%); isolation and loneliness (n = 60, 42.6%); and maladjustment to nursing home life (n = 42, 29.8%). This research provides a foundational understanding of suicide among nursing home residents in Australia and contributes important new information to the international knowledge base. Copyright © 2018 John Wiley & Sons, Ltd.

  19. Research on killing Escherichia Coli by reactive oxygen species based on strong ionization discharging plasma

    International Nuclear Information System (INIS)

    Li, Y J; Tian, Y P; Zhang, Z T; Li, R H; Cai, L J; Gao, J Y

    2013-01-01

    Reactive oxygen species solution produced by strong ionization discharging plasma was used to kill Escherichia coli by spraying. Several effect factors such as pH value, solution temperature, spraying time and exposure time were observed in this study, and their effects on killing rate of Escherichia coli were discussed and analysed. Results show that the treating efficiency of ROS solution for Escherichia coli is higher in alkaline solution than that in acid solution. The killing rate of Escherichia coli increases while the spraying time and exposure time are longer and the temperature is lower. The effects of different factors on killing rate of Escherichia coli are as follows: spraying time > pH value > exposure time > solution temperature.

  20. C-reactive protein, insulin resistance and risk of cardiovascular disease: a population-based study

    DEFF Research Database (Denmark)

    Jeppesen, Jørgen; Hansen, Tine Willum; Olsen, Michael H

    2008-01-01

    were recorded at baseline. CRP was determined by a high-sensitivity assay, and IR was determined by the homoeostasis model assessment (HOMA-IR) method. RESULTS: Over a median follow-up of 9.4 years, the incidence of the prespecified CV event, defined as the composite event of CV death, nonfatal...... and HOMA-IR, the hazard ratio (95% confidence interval) of a CV event was 1.33 (1.14-1.55; PHOMA-IR level. CONCLUSION......BACKGROUND: C-reactive protein (CRP), a marker of inflammation, and insulin resistance (IR), a metabolic disorder, are closely related. CRP and IR have both been identified as significant risk factors of cardiovascular disease (CVD) after adjustment for conventional CVD risk factors...

  1. Selection of Shared and Neoantigen-Reactive T Cells for Adoptive Cell Therapy Based on CD137 Separation

    Directory of Open Access Journals (Sweden)

    Sivan Seliktar-Ofir

    2017-10-01

    Full Text Available Adoptive cell therapy (ACT of autologous tumor infiltrating lymphocytes (TIL is an effective immunotherapy for patients with solid tumors, yielding objective response rates of around 40% in refractory patients with metastatic melanoma. Most clinical centers utilize bulk, randomly isolated TIL from the tumor tissue for ex vivo expansion and infusion. Only a minor fraction of the administered T cells recognizes tumor antigens, such as shared and mutation-derived neoantigens, and consequently eliminates the tumor. Thus, there are many ongoing effects to identify and select tumor-specific TIL for therapy; however, those approaches are very costly and require months, which is unreasonable for most metastatic patients. CD137 (4-1BB has been identified as a co-stimulatory marker, which is induced upon the specific interaction of T cells with their target cell. Therefore, CD137 can be a useful biomarker and an important tool for the selection of tumor-reactive T cells. Here, we developed and validated a simple and time efficient method for the selection of CD137-expressing T cells for therapy based on magnetic bead separation. CD137 selection was performed with clinical grade compliant reagents, and TIL were expanded in a large-scale manner to meet cell numbers required for the patient setting in a GMP facility. For the first time, the methodology was designed to comply with both clinical needs and limitations, and its feasibility was assessed. CD137-selected TIL demonstrated significantly increased antitumor reactivity and were enriched for T cells recognizing neoantigens as well as shared tumor antigens. CD137-based selection enabled the enrichment of tumor-reactive T cells without the necessity of knowing the epitope specificity or the antigen type. The direct implementation of the CD137 separation method to the cell production of TIL may provide a simple way to improve the clinical efficiency of TIL ACT.

  2. Communication dated 16 July 2008 received from the Resident Representative of Japan to the Agency concerning an International Initiative on 3S-Based Nuclear Energy Infrastructure

    International Nuclear Information System (INIS)

    2008-01-01

    The Director General has received a communication dated 16 July 2008 from the Resident Representative of Japan attaching a document entitled 'International Initiative on 3S-based Nuclear Energy Infrastructure'. The communication, and as requested therein, its attachment, are circulated herewith for information

  3. Population-based study of high plasma C-reactive protein concentrations among the Inuit of Nunavik.

    Science.gov (United States)

    Labonté, Marie-Eve; Dewailly, Eric; Chateau-Degat, Marie-Ludivine; Couture, Patrick; Lamarche, Benoît

    2012-01-01

    The shift away from traditional lifestyle in the Inuit population over the past few decades has been associated with an increased prevalence of coronary heart disease (CHD) risk factors such as obesity, high blood pressure (BP) and diabetes. However, the impact of this transition on the pro-inflammatory marker high-sensitivity C-reactive protein (hs-CRP) has not been documented. To examine the prevalence of elevated plasma hs-CRP concentrations in Inuit from Nunavik in the province of Quebec (Canada) and identify anthropometric, biochemical and lifestyle risk factors associated with elevated hs-CRP. A population-representative sample of 801 Inuit residents from 14 villages of Nunavik, aged between 18 and 74 years, was included in the analyses. Subjects participated in a clinical session and completed questionnaires on lifestyle. Multivariate logistic regression was used to determine risk factors for elevated hs-CRP. Elevated plasma hs-CRP concentrations (≥ 2 mg/L) were present in 32.7% (95% confidence interval (CI) 29.5-35.8) of the Inuit adult population and were more prevalent among women than among men (36.7% vs. 29.0%, p=0.007). Multivariate logistic regression analysis indicated that every 1 mmHg increase in systolic BP was associated with a 3% increase in the odds of having hs-CRP concentrations ≥ 2 mg/L in the Inuit population (95% CI 1.01-1.04). The combination of older age (≥ 50 vs. Inuit with values that are similar to those seen in Canadian Caucasian populations. Sex, age, waist circumference and systolic BP are major factors that increase the risk of this inflammatory phenotype among Inuit from Nunavik, despite their different lifestyle background compared with Caucasians.

  4. Toxicological Assessment and UV/TiO2-Based Induced Degradation Profile of Reactive Black 5 Dye

    Science.gov (United States)

    Bilal, Muhammad; Rasheed, Tahir; Iqbal, Hafiz M. N.; Hu, Hongbo; Wang, Wei; Zhang, Xuehong

    2018-01-01

    In this study, the toxicological and degradation profile of Reactive Black 5 (RB5) dye was evaluated using a UV/TiO2-based degradation system. Fourier transform infrared spectroscopy (FT-IR), thin layer chromatography (TLC), high-performance liquid chromatography (HPLC) and ultra-performance liquid chromatography coupled with mass spectrometry (UPLC-MS) techniques were used to evaluate the degradation level of RB5. The UV-Vis spectral analysis revealed the disappearance of peak intensity at 599 nm (λmax). The FT-IR spectrum of UV/TiO2 treated dye sample manifest appearance of new peaks mainly because of the degraded product and/or disappearance of some characteristics peaks which were present in the untreated spectrum. The HPLC profile verified the RB5 degradation subject to the formation of metabolites at different retention times. A stable color removal higher than 96% with COD removal in the range of 74-82.3% was noted at all evaluated dye concentrations. The tentative degradation pathway of RB5 is proposed following a careful analysis of the intermediates identified by UPLC-MS. Toxicity profile of untreated and degraded dye samples was monitored using three types of human cell lines via MTT assay and acute toxicity testing with Artemia salina. In conclusion, the UV/TiO2-based degradation system could be effectively employed for the remediation of textile wastewater comprising a high concentration of reactive dyes.

  5. Active-Reactive Additional Damping Control of a Doubly-Fed Induction Generator Based on Active Disturbance Rejection Control

    Directory of Open Access Journals (Sweden)

    Yanfeng Ma

    2018-05-01

    Full Text Available Large-scale wind power interfacing to the power grid has an impact on the stability of the power system. However, with an additional damping controller of the wind generator, new ways for improving system damping and suppressing the low frequency oscillation (LFO of power systems can be put forward. In this paper, an active-reactive power additional damping controller based on active disturbance rejection control (ADRC is proposed. In order to improve the precision of the controller, the theory of data driven control is adopted, using the numerical algorithms for subspace state space system identification (N4SID to obtain the two order model of the ADRC controlled object. Based on the identification model, the ADRC additional damping controller is designed. Taking a 2-area 4-machine system containing the doubly fed induction generator (DFIG wind farm as an example, it is verified that the active-reactive additional damping controller designed in this paper performs well in suppressing negative-damping LFO and forced power oscillation. When the operation state of the power system changes, it can still restrain the LFO effectively, showing stronger robustness and better effectiveness compared to the traditional proportional–integral–derivative (PID additional damping controller.

  6. Prediction of the Chapman-Jouguet chemical equilibrium state in a detonation wave from first principles based reactive molecular dynamics.

    Science.gov (United States)

    Guo, Dezhou; Zybin, Sergey V; An, Qi; Goddard, William A; Huang, Fenglei

    2016-01-21

    The combustion or detonation of reacting materials at high temperature and pressure can be characterized by the Chapman-Jouguet (CJ) state that describes the chemical equilibrium of the products at the end of the reaction zone of the detonation wave for sustained detonation. This provides the critical properties and product kinetics for input to macroscale continuum simulations of energetic materials. We propose the ReaxFF Reactive Dynamics to CJ point protocol (Rx2CJ) for predicting the CJ state parameters, providing the means to predict the performance of new materials prior to synthesis and characterization, allowing the simulation based design to be done in silico. Our Rx2CJ method is based on atomistic reactive molecular dynamics (RMD) using the QM-derived ReaxFF force field. We validate this method here by predicting the CJ point and detonation products for three typical energetic materials. We find good agreement between the predicted and experimental detonation velocities, indicating that this method can reliably predict the CJ state using modest levels of computation.

  7. A study of Knowledge, Attitude and Self-Assessment of Residents on Evidence-Based Dentistry at Faculty of Dentistry of Tabriz University of Medical Sciences

    Directory of Open Access Journals (Sweden)

    Maryam Pourkazemi

    2016-06-01

    Full Text Available Introduction: Evidence-based dentistry is the combination of individual clinical experiences withthe highest-quality evidence available as the result of systematic studies.Evidence-based dentistryis an approach in which the clinician uses the best evidence available to make the most appropriatedecision for the patient. In this descriptive study, the knowledge, attitude and self-assessment ofTabriz dental school residents were examined on evidence-based dentistry in the academic year2014-2015. Methods: All residents of Tabriz Dentistry Faculty (100 in total were enrolled in the study.Thedata collection tool was a questionnaire, and the validity of the questionnaire was determined inprevious studies. To determine the reliability of the questionnaire, it was distributed among the20 residents ina pilot study. Descriptive statistical methods were used to study the data obtained.Chi-square, t-test, and Kruskal-Wallis tests were used to assess the relationship between variablesusing SPSS 20. Results: The results showed that the level of residents’ knowledge on evidence-based dentistrywas moderate and 94.4% of residents had a positive attitude toward EBD. The highest and lowestself-assessments were related to the terms PubMed and Cochrane Collaboration (CI=29.27-30.73,CI=42.06-43.32 CI=28.69-31.09with 95%confidence interval, respectively. Conclusion: Given the increasing importance of evidence-based dentistry and considering themoderate knowledge of the residents on the topic, a need is felt for proper planning to teach itat Tabriz University of Medical Sciences. Considering dentists’ positive attitude toward EBD, Itseems that there is an appropriate background for EBD education in the country

  8. A community-based study on prevalence and correlates of erectile dysfunction among Kinondoni District Residents, Dar Es Salaam, Tanzania.

    Science.gov (United States)

    Pallangyo, Pedro; Nicholaus, Paulina; Kisenge, Peter; Mayala, Henry; Swai, Noel; Janabi, Mohamed

    2016-11-29

    Globally, erectile dysfunction burden (ED) is rising appreciably and it is projected to affect about 332 million men by the year 2025. This rise is attributable to the rising incidence of conditions associated with ED including obesity, diabetes, hypertension, coronary artery disease and depression. We conducted this community-based screening to elucidate on the prevalence of ED and its associated factors among men residing in an urban community in Tanzania. We conducted a cross-sectional community-based study and interviewed 441 men aged at least 18 years. Diabetes and hypertension were defined as per the International Diabetes Federation (IDF) and the 7th Report of the Joint National Committee (JNC 7) respectively. The 5-item version of the International Index of Erectile Function (IIEF-5) Scale was used to assess for erectile dysfunction. Multivariate logistic regression analyses were performed to explore the factors associated with ED. The mean age was 47.1 years, 57.6 % had excess body weight, 8.2 % had diabetes and 61.5 % had high blood pressure. Overall, 24 % (106/441) of men in this study had some form of ED. Participants with age ≥55, positive smoking history, obesity, diabetes and hypertension displayed highest rates of ED in their respective subgroups. However, age ≥40 and diabetes were ultimately the strongest factors for ED after multivariate logistic regression analyses, (OR 5.0, 95 % CI 2.2-11.2, p Erectile dysfunction affects about a quarter of adult men living in Kinondoni district. Old age, obesity, smoking, hypertension and diabetes have the potential to increase the odds of ED up-to 5 times. In view of this, men with diabetes and hypertension should be offered screening services and treatment of ED as an integral component in their management.

  9. Systems-Based Aspects in the Training of IMG or Previously Trained Residents: Comparison of Psychiatry Residency Training in the United States, Canada, the United Kingdom, India, and Nigeria

    Science.gov (United States)

    Jain, Gaurav; Mazhar, Mir Nadeem; Uga, Aghaegbulam; Punwani, Manisha; Broquet, Karen E.

    2012-01-01

    Objectives: International medical graduates (IMGs) account for a significant proportion of residents in psychiatric training in the United States. Many IMGs may have previously completed psychiatry residency training in other countries. Their experiences may improve our system. Authors compared and contrasted psychiatry residency training in the…

  10. Indium oxide-based transparent conductive films deposited by reactive sputtering using alloy targets

    Science.gov (United States)

    Miyazaki, Yusuke; Maruyama, Eri; Jia, Junjun; Machinaga, Hironobu; Shigesato, Yuzo

    2017-04-01

    High-quality transparent conductive oxide (TCO) films, Sn-doped In2O3 (ITO) and In2O3-ZnO (IZO), were successfully deposited on either synthetic silica or polyethylene terephthalate (PET) substrates in the “transition region” by reactive dc magnetron sputtering using In-Zn and In-Sn alloy targets, respectively, with a specially designed plasma emission feedback system. The composition, crystallinity, surface morphology, and electrical and optical properties of the films were analyzed. All of the IZO films were amorphous, whereas the ITO films were polycrystalline over a wide range of deposition conditions. The minimum resistivities of the IZO and ITO films deposited on the heated PET substrates at 150 °C were 3.3 × 10-4 and 5.4 × 10-4 Ω·cm, respectively. By applying rf bias to unheated PET substrates, ITO films with a resistivity of 4.4 × 10-4 Ω·cm were deposited at a dc self-bias voltage of -60 V.

  11. Microstructural characterization of copper based alloys produced by reactive milling; caracterizacion microestructural de aleaciones base cobre obtenidas mediante molienda reactiva

    Energy Technology Data Exchange (ETDEWEB)

    Palma, R.; Sepulveda, A.; Zuniga, A.; Donoso, E.; Dianez, M. J.; Criado, J. M.

    2010-07-01

    The micro and nano structure of Cu-Al, Cu-V and Cu-Ti alloys produced by reactive milling were analyzed using X-ray diffraction (XRD) and transmission electron microscopy (TEM). Samples with different milling times (t= 0, 10, 20 and 30 h) were considered. The grain size, dislocation density and residual micro strain were evaluated form the XRD data using the Williamson-Hall and Klug-Alexander methods. The evolution of texture as a function of milling time was also studied using XRD. It was found, using TEM, that the grain size and dispersoid size were nano metric in all three alloys considered. (Author) 12 refs.

  12. Magnetic permeability based diagnostic test for the determination of the canine C-reactive protein concentration in undiluted whole blood

    International Nuclear Information System (INIS)

    Ibraimi, Filiz; Kriz, Kirstin; Merin, Henrik; Kriz, Dario

    2009-01-01

    We describe an one-step 11-min magnetic permeability based two-site immunoassay for C-reactive protein (CRP) utilizing polyclonal anti-canine CRP antibody conjugated dextran iron oxide nanoparticles (79 nm) as superparamagnetic labels and polyclonal anti-canine CRP conjugated silica microparticles (15 to 40 μm) as carriers. An inductance based magnetic permeability reader was used to detect the target analyte, CRP, in 10 μL whole blood samples, by measuring the magnetic permeability increase of the silica microparticle sediment due to immuno complex superparamagnetic nanoparticles. Measurements on standards showed a linear response between 0 and 17.5 mg/L CRP. Measurements performed on 16 whole blood samples from mixed breeds showed good correlation with a commercially available ELISA assay.

  13. External Quality Control for Dried Blood Spot Based C-reactive Protein Assay: Experience from the Indonesia Family Life Survey and the Longitudinal Aging Study in India

    Science.gov (United States)

    Hu, Peifeng; Herningtyas, Elizabeth H.; Kale, Varsha; Crimmins, Eileen M.; Risbud, Arun R.; McCreath, Heather; Lee, Jinkook; Strauss, John; O’Brien, Jennifer C.; Bloom, David E.; Seeman, Teresa E.

    2015-01-01

    Measurement of C-reactive protein, a marker of inflammation, in dried blood spots has been increasingly incorporated in community-based social surveys internationally. Although the dried blood spot based CRP assay protocol has been validated in the United States, it remains unclear whether laboratories in other less developed countries can generate C-reactive protein results of similar quality. We therefore conducted external quality monitoring for dried blood spot based C-reactive protein measurement for the Indonesia Family Life Survey and the Longitudinal Aging Study in India. Our results show that dried blood spot based C-reactive protein results in these two countries have excellent and consistent correlations with serum-based values and dried blood spot based results from the reference laboratory in the United States. Even though the results from duplicate samples may have fluctuations in absolute values over time, the relative order of C-reactive protein levels remains similar and the estimates are reasonably precise for population-based studies that investigate the association between socioeconomic factors and health. PMID:25879265

  14. Exploiting the role of endogenous lymphoid-resident dendritic cells in the priming of NKT cells and CD8+ T cells to dendritic cell-based vaccines.

    Directory of Open Access Journals (Sweden)

    Troels R Petersen

    2011-03-01

    Full Text Available Transfer of antigen between antigen-presenting cells (APCs is potentially a physiologically relevant mechanism to spread antigen to cells with specialized stimulatory functions. Here we show that specific CD8+ T cell responses induced in response to intravenous administration of antigen-loaded bone marrow-derived dendritic cells (BM-DCs, were ablated in mice selectively depleted of endogenous lymphoid-resident langerin+ CD8α+ dendritic cells (DCs, suggesting that the antigen is transferred from the injected cells to resident APCs. In contrast, antigen-specific CD4+ T cells were primed predominantly by the injected BM-DCs, with only very weak contribution of resident APCs. Crucially, resident langerin+ CD8α+ DCs only contributed to the priming of CD8+ T cells in the presence of maturation stimuli such as intravenous injection of TLR ligands, or by loading the BM-DCs with the glycolipid α-galactosylceramide (α-GalCer to recruit the adjuvant activity of activated invariant natural killer-like T (iNKT cells. In fact, injection of α-GalCer-loaded CD1d-/- BM-DCs resulted in potent iNKT cell activation, suggesting that this glycolipid antigen can also be transferred to resident CD1d+ APCs. While iNKT cell activation per se was independent of langerin+ CD8α+ DCs, some iNKT cell-mediated activities were reduced, notably release of IL-12p70 and transactivation of NK cells. We conclude that both protein and glycolipid antigens can be exchanged between distinct DC species. These data suggest that the efficacy of DC-based vaccination strategies may be improved by the incorporation of a systemic maturation signal aimed to engage resident APCs in CD8+ T cell priming, and α-GalCer may be particularly well suited to this purpose.

  15. Self-healing of drying shrinkage cracks in cement-based materials incorporating reactive MgO

    Science.gov (United States)

    Qureshi, T. S.; Al-Tabbaa, A.

    2016-08-01

    Excessive drying shrinkage is one of the major issues of concern for longevity and reduced strength performance of concrete structures. It can cause the formation of cracks in the concrete. This research aims to improve the autogenous self-healing capacity of traditional Portland cement (PC) systems, adding expansive minerals such as reactive magnesium oxide (MgO) in terms of drying shrinkage crack healing. Two different reactive grades (high ‘N50’and moderately high ‘92-200’) of MgO were added with PC. Cracks were induced in the samples with restraining end prisms through natural drying shrinkage over 28 days after casting. Samples were then cured under water for 28 and 56 days, and self-healing capacity was investigated in terms of mechanical strength recovery, crack sealing efficiency and improvement in durability. Finally, microstructures of the healing materials were investigated using FT-IR, XRD, and SEM-EDX. Overall N50 mixes show higher expansion and drying shrinkage compared to 92-200 mixes. Autogenous self-healing performance of the MgO containing samples were much higher compared to control (only PC) mixes. Cracks up to 500 μm were sealed in most MgO containing samples after 28 days. In the microstructural investigations, highly expansive Mg-rich hydro-carbonate bridges were found along with traditional calcium-based, self-healing compounds (calcite, portlandite, calcium silicate hydrates and ettringite).

  16. External Hand Forces Exerted by Long-Term Care Staff to Push Floor-Based Lifts: Effects of Flooring System and Resident Weight.

    Science.gov (United States)

    Lachance, Chantelle C; Korall, Alexandra M B; Russell, Colin M; Feldman, Fabio; Robinovitch, Stephen N; Mackey, Dawn C

    2016-09-01

    The aim of this study was to investigate the effects of flooring type and resident weight on external hand forces required to push floor-based lifts in long-term care (LTC). Novel compliant flooring is designed to reduce fall-related injuries among LTC residents but may increase forces required for staff to perform pushing tasks. A motorized lift may offset the effect of flooring on push forces. Fourteen female LTC staff performed straight-line pushes with two floor-based lifts (conventional, motor driven) loaded with passengers of average and 90th-percentile resident weights over four flooring systems (concrete+vinyl, compliant+vinyl, concrete+carpet, compliant+carpet). Initial and sustained push forces were measured by a handlebar-mounted triaxial load cell and compared to participant-specific tolerance limits. Participants rated pushing difficulty. Novel compliant flooring increased initial and sustained push forces and subjective ratings compared to concrete flooring. Compared to the conventional lift, the motor-driven lift substantially reduced initial and sustained push forces and perceived difficulty of pushing for all four floors and both resident weights. Participants exerted forces above published tolerance limits only when using the conventional lift on the carpet conditions (concrete+carpet, compliant+carpet). With the motor-driven lift only, resident weight did not affect push forces. Novel compliant flooring increased linear push forces generated by LTC staff using floor-based lifts, but forces did not exceed tolerance limits when pushing over compliant+vinyl. The motor-driven lift substantially reduced push forces compared to the conventional lift. Results may help to address risk of work-related musculoskeletal injury, especially in locations with novel compliant flooring. © 2016, Human Factors and Ergonomics Society.

  17. Cardiovascular reactivity in young adults with hypertensive and normotensive parents: A gender based comparative study

    Directory of Open Access Journals (Sweden)

    Anjali Verma

    2017-01-01

    Full Text Available Introduction: Essential hypertension begins due to mutation of specific genes that contribute to the risk of developing hypertension. Genetic contribution was recognized 25 years ago, now formulated from time to time. Some studies have also proven that the hypertension in father had strong contribution in their individual than mother. The aim of the study is to compare the cardiovascular reactivity in male and female subjects with hypertensive and normotensive parents. Materials and methods: This comparative study was conducted in physiology department of Teerthanker Mahaveer medical college and research center, Moradabad. The research work was initiated after taken the ethical clearance from the ethical committee of the college. Three different stressors: cold pressor task, cycling and videogame were used. Total 120 subjects were taken for the study in which 77 were male and 43 were female. Result: Male subjects of normotensive parents had slightly higher HR rate (mean: 76.73/min compared to the female subjects (mean: 75/min with p value >0.05. Female subjects of hypertensive parents had higher HR rate (mean: 82.72/min compared to the male subjects (mean: 73.95/min with p value <0.001. Conclusion: Male subjects with normotensive parents had higher resting HR, SBP &DBP than Female subjects with normotensive parents, but the difference was significant only in SBP. Female subjects with hypertensive parents group was showing higher resting HR than male subjects with hypertensive parents group, remains higher after stress also with insignificant difference. Thus, subjects with hypertensive parents showing increased CVR to stress are more likely to develop future hypertension, and the risk is greater for male subjects.

  18. Degradation of reactive orange 4 dye using hydrodynamic cavitation based hybrid techniques.

    Science.gov (United States)

    Gore, Mohan M; Saharan, Virendra Kumar; Pinjari, Dipak V; Chavan, Prakash V; Pandit, Aniruddha B

    2014-05-01

    In the present work, degradation of reactive orange 4 dye (RO4) has been investigated using hydrodynamic cavitation (HC) and in combination with other AOP's. In the hybrid techniques, combination of hydrodynamic cavitation and other oxidizing agents such as H2O2 and ozone have been used to get the enhanced degradation efficiency through HC device. The hydrodynamic cavitation was first optimized in terms of different operating parameters such as operating inlet pressure, cavitation number and pH of the operating medium to get the maximum degradation of RO4. Following the optimization of HC parameters, the degradation of RO4 was carried out using the combination of HC with H2O2 and ozone. It has been found that the efficiency of the HC can be improved significantly by combining it with H2O2 and ozone. The mineralization rate of RO4 increases considerably with 14.67% mineralization taking place using HC alone increases to 31.90% by combining it with H2O2 and further increases to 76.25% through the combination of HC and ozone. The synergetic coefficient of greater than one for the hybrid processes of HC+H2O2 and HC+Ozone has suggested that the combination of HC with other oxidizing agents is better than the individual processes for the degradation of dye effluent containing RO4. The combination of HC with ozone proves to be the most energy efficient method for the degradation of RO4 as compared to HC alone and the hybrid process of HC and H2O2. Copyright © 2013 Elsevier B.V. All rights reserved.

  19. Characterization of the Gacka River basin karst aquifer (Croatia): Hydrochemistry, stable isotopes and tritium-based mean residence times

    Energy Technology Data Exchange (ETDEWEB)

    Ozyurt, Nur N. [Department of Geological Engineering, Hacettepe University, 06800 Ankara (Turkey); Lutz, Hans O. [Stable Isotope Laboratory, Medical Faculty, Rijeka University, 51000 Rijeka (Croatia); Faculty of Physics, Bielefeld University, 33615 Bielefeld (Germany); Hunjak, Tamara; Mance, Diana [Stable Isotope Laboratory, Medical Faculty, Rijeka University, 51000 Rijeka (Croatia); Roller-Lutz, Zvjezdana, E-mail: roller@medri.uniri.hr [Stable Isotope Laboratory, Medical Faculty, Rijeka University, 51000 Rijeka (Croatia)

    2014-07-01

    aquifer volumes. - Highlights: • The Gacka River karst aquifer is part of the strategic water resource of Croatia. • The discharge of springs indicates a long mean residence times of ground water. • Tritium-based models yield MRTs of ca. 12 years and a large reservoir volume. • Areal recharge mainly in the cold season; plug flow conditions are dominant.

  20. Reactive Arthritis

    Directory of Open Access Journals (Sweden)

    Eren Erken

    2013-06-01

    Full Text Available Reactive arthritis is an acute, sterile, non-suppurative and inflammatory arthropaty which has occured as a result of an infectious processes, mostly after gastrointestinal and genitourinary tract infections. Reiter syndrome is a frequent type of reactive arthritis. Both reactive arthritis and Reiter syndrome belong to the group of seronegative spondyloarthropathies, associated with HLA-B27 positivity and characterized by ongoing inflammation after an infectious episode. The classical triad of Reiter syndrome is defined as arthritis, conjuctivitis and urethritis and is seen only in one third of patients with Reiter syndrome. Recently, seronegative asymmetric arthritis and typical extraarticular involvement are thought to be adequate for the diagnosis. However, there is no established criteria for the diagnosis of reactive arthritis and the number of randomized and controlled studies about the therapy is not enough. [Archives Medical Review Journal 2013; 22(3.000: 283-299

  1. Relationship between C-reactive protein and stroke: a large prospective community based study.

    Directory of Open Access Journals (Sweden)

    Yanfang Liu

    Full Text Available Previous studies have suggested that C-reactive protein (CRP was associated with risk of stroke. There were few studies in Asian population, or on stroke subtypes other than ischemic stroke. We thus investigated the relationship between CRP and the risks of all stroke and its subtypes in a Chinese adult population.In the current study, we included 90,517 Chinese adults free of stroke and myocardial infarction at baseline (June 2006 to October 2007 in analyses. Strokes were classified as ischemic stroke (IS, intracranial heamorrhage (ICH and subarachnoid heamorrhage (SAH. High-sensitivity CRP (hs-CRP were categorized into three groups: 3 mg/L. Cox proportional hazards regression was used to calculate the association between hs-CRP concentrations and all stroke, as well as its subtypes.During a median follow-up time of 49 months, we documented 1,472 incident stroke cases. Of which 1,049 (71.3% were IS, 383 (26.0% were ICH, and 40 (2.7% were SAH. After multivariate adjustment, hs-CRP concentrations ≥1 mg/L were associated with increased risks of all stroke (hs-CRP 1-3 mg/L: hazard ratio (HR 1.17, 95% confidential interval (CI 1.03-1.33; hs-CRP>3 mg/L: HR 1.25, 95% CI 1.07-1.46 and IS (hs-CRP 1-3 mg/L: HR 1.17, 95% CI 1.01-1.36; hs-CRP>3 mg/L: HR 1.33, 95% CI 1.11-1.60, but not with ICH and SAH. Subgroup analyses showed that higher hs-CRP concentration was more prone to be a risk factor for all stroke and IS in non-fatal stroke, male and hypertensive participants.We found that higher hs-CRP concentrations were associated with a higher risk of IS, particularly for non-fatal stroke, male and hypertensive subjects. In contrast, we did not observe significant associations between hs-CRP and ICH/SAH.

  2. Daytime napping, sleep duration and serum C reactive protein: a population-based cohort study.

    Science.gov (United States)

    Leng, Yue; Ahmadi-Abhari, Sara; Wainwright, Nick W J; Cappuccio, Francesco P; Surtees, Paul G; Luben, Robert; Brayne, Carol; Khaw, Kay-Tee

    2014-11-11

    To explore whether daytime napping and sleep duration are linked to serum C reactive protein (CRP), a pro-inflammatory marker, in an older aged British population. Cross-sectional study. European Prospective Investigation into Cancer and Nutrition (EPIC)-Norfolk study. A total of 5018 men and women aged 48-92 years reported their sleep habits and had serum CRP levels measured. CRP was measured (mg/L) during 2006-2011 in fresh blood samples using high-sensitivity methods. Participants reported napping habits during 2002-2004, and reported sleep quantity during 2006-2007. Multivariable linear regression models were used to examine the association between napping and log-transformed CRP, and geometric mean CRP levels were calculated. After adjustment for age and sex, those who reported napping had 10% higher CRP levels compared with those not napping. The association was attenuated but remained borderline significant (β=0.05 (95% CI 0.00 to 0.10)) after further adjustment for social class, education, marital status, body mass index, physical activity, smoking, alcohol intake, self-reported health, pre-existing diseases, systolic blood pressure, hypnotic drug use, depression and in women-only hormone replacement therapy use. The geometric means (95% CI) of CRP levels were 2.38 (2.29 to 2.47) mg/L and 2.26 (2.21 to 2.32) mg/L for those who reported napping and no napping, respectively. A U-shaped association was observed between time spent in bed at night and CRP levels, and nighttime sleep duration was not associated with serum CRP levels. The association between napping and CRP was stronger for older participants, and among extremes of time spent in bed at night. Daytime napping was associated with increased CRP levels in an older aged British population. Further studies are needed to determine whether daytime napping is a cause for systemic inflammation, or if it is a symptom or consequence of underlying health problems. Published by the BMJ Publishing Group Limited

  3. Impact of a Simulation-Based Communication Workshop on Resident Preparedness for End-of-Life Communication in the Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Abraham Markin

    2015-01-01

    Full Text Available Introduction. Although residents frequently lead end-of-life (EOL discussions in the intensive care unit (ICU, training in EOL care during residency has been required only recently, and few educational interventions target EOL communication in the ICU. This study evaluated a simulation-based intervention designed to improve resident EOL communication skills with families in the ICU. Methods. Thirty-four second-year internal medicine residents at a large urban teaching hospital participated in small group sessions with faculty trained in the “VitalTalk” method. A Likert-type scale questionnaire measured self-assessed preparedness before, immediately following, and approximately 9 months after intervention. Data were analyzed using Wilcoxon rank-sum analysis. Results. Self-assessed preparedness significantly improved for all categories surveyed (preintervention mean; postintervention mean; p value, including discussing bad news (3.3; 4.2; p<0.01, conducting a family conference (3.1; 4.1; p<0.01, discussing treatment options (3.2; 3.9; p<0.01, discussing discontinuing ICU treatments (2.9; 3.5; p<0.01, and expressing empathy (3.9; 4.5; p<0.01. Improvement persisted at follow-up for all items except “expressing empathy.” Residents rated the educational quality highly. Conclusion. This study provides evidence that brief simulation-based interventions can produce lasting improvements in residents’ confidence to discuss EOL care with family members of patients in the ICU.

  4. Health status of radiation exposed residents living near the Semipalatinsk Nuclear Test Site based on health assessment by interview

    International Nuclear Information System (INIS)

    Hirabayashi, Kyoko; Kawano, Noriyuki; Ohtaki, Megu; Harada, Yuka; Hoshi, Masaharu; Hadara, Hironori; Muldagaliyev, Talgat; Apsalikov, Kazbek

    2008-01-01

    The purpose of the present paper is to examine the aftereffects of radiation exposure on residents of villages near the Semipalatinsk Nuclear Test Site (SNTS) in Kazakhstan. Our Hiroshima University (Japan) research team began field research in 2002 by means of health assessments conducted via interviews. We focus on persons who responded to questions concerning their medical conditions and symptoms. In this paper, we summarize and analyze, using multiple linear logistic regression analysis, the answers obtained by questionnaire survey. The results show: 31% of the residents reported that they felt bad or were in very poor health. Residents living in villages having higher radiation levels were more likely to report having poor or very poor health, minor complaints such as loss of sleep, headaches, nighttime sweating and swollen arms or legs, and the need for nursing care in performing activities of daily living. Symptoms reported by over 40% of the respondents included high blood pressure, heart disease and arthralgia/lower back pain/arthritis. Our results suggest that radiation exposure in the Semipalatinsk area is one of the causes of poor health in general among residents. There is also a possibility that radiation exposure has influenced the incidence of some specific medical conditions. (author)

  5. Impact of sleep deprivation on anaesthesia residents' non-technical skills: a pilot simulation-based prospective randomized trial.

    Science.gov (United States)

    Neuschwander, A; Job, A; Younes, A; Mignon, A; Delgoulet, C; Cabon, P; Mantz, J; Tesniere, A

    2017-07-01

    Sleep deprivation is common in anaesthesia residents, but its impact on performance remains uncertain. Non-technical skills (team working, situation awareness, decision making, and task management) are key components of quality of care in anaesthesia, particularly in crisis situations occurring in the operating room. The impact of sleep deprivation on non-technical skills is unknown. We tested the hypothesis that in anaesthesia residents sleep deprivation is associated with impaired non-technical skills. Twenty anaesthesia residents were randomly allocated to undergo a simulation session after a night shift [sleep-deprived (SLD) group, n =10] or after a night of rest [rested (R) group, n =10] from January to March 2015. The simulated scenario was a situation of crisis management in the operating room. The primary end point was a composite score of anaesthetists' non-technical skills (ANTS) assessed by two blinded evaluators. Non-technical skills were significantly impaired in the SLD group [ANTS score 12.2 (interquartile range 10.5-13)] compared with the R group [14.5 (14-15), P technical skills of anaesthesia residents in a simulated anaesthesia intraoperative crisis scenario. NCT02622217. © The Author 2017. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com

  6. Health status of radiation exposed residents living near the Semipalatinsk Nuclear Test Site based on health assessment by interview.

    Science.gov (United States)

    Hirabayashi, Kyoko; Kawano, Noriyuki; Ohtaki, Megu; Harada, Yuka; Harada, Hironori; Muldagaliyev, Talgat; Apsalikov, Kazbek; Hoshi, Masaharu

    2008-03-01

    The purpose of the present paper is to examine the aftereffects of radiation exposure on residents of villages near the Semipalatinsk Nuclear Test Site (SNTS) in Kazakhstan. Our Hiroshima University (Japan) research team began field research in 2002 by means of health assessments conducted via interviews. We focus on persons who responded to questions concerning their medical conditions and symptoms. In this paper, we summarize and analyze, using multiple linear logistic regression analysis, the answers obtained by questionnaire survey. The results show: (1) 31% of the residents reported that they felt bad or were in very poor health. (2) Residents living in villages having higher radiation levels were more likely to report having poor or very poor health, minor complaints such as loss of sleep, headaches, nighttime sweating and swollen arms or legs, and the need for nursing care in performing activities of daily living. (3) Symptoms reported by over 40% of the respondents included high blood pressure, heart disease and arthralgia/ lower back pain/ arthritis. Our results suggest that radiation exposure in the Semipalatinsk area is one of the causes of poor health in general among residents. There is also a possibility that radiation exposure has influenced the incidence of some specific medical conditions.

  7. Consultants' opinion on a new practice-based assessment programme for first-year residents in anaesthesiology

    DEFF Research Database (Denmark)

    Ringsted, C; ØStergaard, D; Scherpbier, A

    2002-01-01

    for first-year residency in anaesthesiology appears to be appropriate regarding the range of competencies assessed, the appropriateness as a basis for pass/fail decisions, and regarding the content of the tests used for pass/fail decisions. Further studies are needed to assess the feasibility...

  8. From Leros asylum to community-based facilities: levels of functioning and quality of life among hostel residents in Greece.

    Science.gov (United States)

    Zissi, A; Barry, M M

    1997-01-01

    The pattern of mental health care in Greece is undergoing a major transformation. The Leros Projects I and II supported the development of 13 community hostels located throughout the Greek mainland. These hostels provide residential care to more than 100 former psychiatric inpatients, mainly from Leros asylum. The present study evaluates the impact of the resettlement process on the residents' perceived quality of life (QoL) together with an examination of the residents' psychiatric and behavioural functioning four years after the move from hospital. The target sample (n = 99) comprised of individuals who may be considered 'chronic' psychiatric patients with a long history of institutionalisation and many are socially deprived with few family ties. The residents' functioning profile indicates a range of different levels of abilities. The QoL findings show that the majority of residents (70%) perceived the movement from the traditional hospital regime to the community hostels as being a positive change and expressed their satisfaction (74%) with the new living situation. This study demonstrates that even the most dependent, chronic psychiatric patients in Greece can be maintained in community settings and are able to articulate generally reliable and valid responses concerning the impact of service changes.

  9. Validation of the behavior and concept based assessment of professionalism competence in postgraduate first-year residents

    Directory of Open Access Journals (Sweden)

    Ying-Ying Yang

    2013-04-01

    Conclusion: The current study suggests that the p-OSCE, p-360° evaluation, and p-mini-CEX are feasible methods for evaluating professionalism in clinical training of PGY1 residents. Combination of the above three evaluations, participation, and support from multiple constituencies and multiple representatives provides good reliability and adds credibility in the assessment of professionalism competence.

  10. Video-Based Learning vs Traditional Lecture for Instructing Emergency Medicine Residents in Disaster Medicine Principles of Mass Triage, Decontamination, and Personal Protective Equipment.

    Science.gov (United States)

    Curtis, Henry A; Trang, Karen; Chason, Kevin W; Biddinger, Paul D

    2018-02-01

    Introduction Great demands have been placed on disaster medicine educators. There is a need to develop innovative methods to educate Emergency Physicians in the ever-expanding body of disaster medicine knowledge. The authors sought to demonstrate that video-based learning (VBL) could be a promising alternative to traditional learning methods for teaching disaster medicine core competencies. Hypothesis/Problem The objective was to compare VBL to traditional lecture (TL) for instructing Emergency Medicine residents in the American College of Emergency Physicians (ACEP; Irving, Texas USA) disaster medicine core competencies of patient triage and decontamination. A randomized, controlled pilot study compared two methods of instruction for mass triage, decontamination, and personal protective equipment (PPE). Emergency Medicine resident learning was measured with a knowledge quiz, a Likert scale measuring comfort, and a practical exercise. An independent samples t-test compared the scoring of the VBL with the TL group. Twenty-six residents were randomized to VBL (n=13) or TL (n=13). Knowledge score improvement following video (14.9%) versus lecture (14.1%) did not differ significantly between the groups (P=.74). Comfort score improvement also did not differ (P=.64) between video (18.3%) and lecture groups (15.8%). In the practical skills assessment, the VBL group outperformed the TL group overall (70.4% vs 55.5%; Plearning vs traditional lecture for instructing emergency medicine residents in disaster medicine principles of mass triage, decontamination, and personal protective equipment. Prehosp Disaster Med. 2018;33(1):7-12.

  11. Numerical algorithms based on Galerkin methods for the modeling of reactive interfaces in photoelectrochemical (PEC) solar cells

    Science.gov (United States)

    Harmon, Michael; Gamba, Irene M.; Ren, Kui

    2016-12-01

    This work concerns the numerical solution of a coupled system of self-consistent reaction-drift-diffusion-Poisson equations that describes the macroscopic dynamics of charge transport in photoelectrochemical (PEC) solar cells with reactive semiconductor and electrolyte interfaces. We present three numerical algorithms, mainly based on a mixed finite element and a local discontinuous Galerkin method for spatial discretization, with carefully chosen numerical fluxes, and implicit-explicit time stepping techniques, for solving the time-dependent nonlinear systems of partial differential equations. We perform computational simulations under various model parameters to demonstrate the performance of the proposed numerical algorithms as well as the impact of these parameters on the solution to the model.

  12. Versatile and biomass synthesis of iron-based nanoparticles supported on carbon matrix with high iron content and tunable reactivity

    International Nuclear Information System (INIS)

    Zhang Dongmao; Shi, Sheldon Q.; Pittman, Charles U.; Jiang Dongping; Che Wen; Gai Zheng; Howe, Jane Y.; More, Karren L.; Antonyraj, Arockiasamy

    2012-01-01

    Iron-based nanoparticles supported on carbon (FeNPs-C) have enormous potential for environmental applications. Reported is a biomass-based method for FeNP-C synthesis that involves pyrolysis of bleached wood fiber pre-mixed with Fe 3 O 4 nanoparticles. This method allows synthesis of iron-based nanoparticles with tunable chemical reactivity by changing the pyrolysis temperature. The FeNP-C synthesized at a pyrolysis temperature of 500 °C (FeNP-C-500) reacts violently (pyrophoric) when exposed to air, while FeNP-C prepared at 800 °C (FeNP-C-800) remains stable in ambient condition for at least 3 months. The FeNPs in FeNP-C-800 are mostly below 50 nm in diameter and are surrounded by carbon. The immediate carbon layer (within 5–15 nm radius) on the FeNPs is graphitized. Proof-of-concept environmental applications of FeNPs-C-800 were demonstrated by Rhodamine 6G and arsenate (V) removal from water. This biomass-based method provides an effective way for iron-based nanoparticle fabrication and biomass utilization.

  13. A pilot study of the utility of a laboratory-based spinal fixation training program for neurosurgical residents.

    Science.gov (United States)

    Sundar, Swetha J; Healy, Andrew T; Kshettry, Varun R; Mroz, Thomas E; Schlenk, Richard; Benzel, Edward C

    2016-05-01

    OBJECTIVE Pedicle and lateral mass screw placement is technically demanding due to complex 3D spinal anatomy that is not easily visualized. Neurosurgical and orthopedic surgery residents must be properly trained in such procedures, which can be associated with significant complications and associated morbidity. Current training in pedicle and lateral mass screw placement involves didactic teaching and supervised placement in the operating room. The objective of this study was to assess whether teaching residents to place pedicle and lateral mass screws using navigation software, combined with practice using cadaveric specimens and Sawbones models, would improve screw placement accuracy. METHODS This was a single-blinded, prospective, randomized pilot study with 8 junior neurosurgical residents and 2 senior medical students with prior neurosurgery exposure. Both the study group and the level of training-matched control group (each group with 4 level of training-matched residents and 1 senior medical student) were exposed to a standardized didactic education regarding spinal anatomy and screw placement techniques. The study group was exposed to an additional pilot program that included a training session using navigation software combined with cadaveric specimens and accessibility to Sawbones models. RESULTS A statistically significant reduction in overall surgical error was observed in the study group compared with the control group (p = 0.04). Analysis by spinal region demonstrated a significant reduction in surgical error in the thoracic and lumbar regions in the study group compared with controls (p = 0.02 and p = 0.04, respectively). The study group also was observed to place screws more optimally in the cervical, thoracic, and lumbar regions (p = 0.02, p = 0.04, and p = 0.04, respectively). CONCLUSIONS Surgical resident education in pedicle and lateral mass screw placement is a priority for training programs. This study demonstrated that compared with a

  14. The price of 'free'. Quantifying the costs incurred by rural residents attending publically funded outpatient clinics in rural and base hospitals.

    Science.gov (United States)

    Fearnley, David; Kerse, Ngaire; Nixon, Garry

    2016-09-01

    INTRODUCTION Rural living is associated with increased costs in many areas, including health care. However, there is very little local data to quantify these costs, and their unknown quantity means that costs are not always taken into account in health service planning and delivery. AIM The aim of this study was to calculate the average time and travel costs of attending rural and base hospital outpatient clinics for rural Central Otago residents. METHODS A survey of 51 people attending rural hospital outpatient clinics. Individual costs in terms of travel and time were quantified and an average cost of both rural and base hospital attendance was calculated. RESULTS The average travel and lost time cost of attending a rural outpatient clinic was NZ$182 and 61% of respondents reported this cost had a significant effect on their weekly budget. The average cost incurred by residents associated with a base hospital attendance in Dunedin was NZ$732. DISCUSSION This study data show that costs are substantial and probably higher than most people might expect for both rural and base hospital attendances. It seems likely that these costs are a potential barrier to service access. However, the full implications of the personal costs incurred by rural residents in accessing health services are largely unstudied and therefore remain unknown in New Zealand.

  15. Label-free detection of C-reactive protein using reflectometric interference spectroscopy-based sensing system

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Hyung Woo; Sakata, Yasuhiko [Graduate School of Engineering, Kobe University, 1-1 Rokkodai-cho, Nada-ku, Kobe 657-8501 (Japan); Kurihara, Yoshikazu [Graduate School of Engineering, Kobe University, 1-1 Rokkodai-cho, Nada-ku, Kobe 657-8501 (Japan); KONICA MINOLTA OPTO, Inc., 1 Sakura-machi, Hino-shi, Tokyo 191-8511 (Japan); Ooya, Tooru [Graduate School of Engineering, Kobe University, 1-1 Rokkodai-cho, Nada-ku, Kobe 657-8501 (Japan); Takeuchi, Toshifumi, E-mail: takeuchi@gold.kobe-u.ac.jp [Graduate School of Engineering, Kobe University, 1-1 Rokkodai-cho, Nada-ku, Kobe 657-8501 (Japan)

    2012-05-30

    Highlights: Black-Right-Pointing-Pointer A new RIfS-based label-free biosensing system for C-reactive protein was developed. Black-Right-Pointing-Pointer Silicon-based inexpensive chips and the simple optical setup were employed. Black-Right-Pointing-Pointer Owing to the TMS treatment and the use of protein A, the sensitivity was enhanced. Black-Right-Pointing-Pointer It can be applied to other target as a substitute of SPR-based expensive sensors. - Abstract: Reflectometric interference spectroscopy (RIfS) is a label-free, time-resolved technique, and suitable for detecting antibody-antigen interaction. This work describes a continuous flow biosensor for C-reactive protein (CRP), involving an effective immobilization method of a monoclonal antibody against CRP (anti-CRP) to achieve highly sensitive RIfS-based detection of CRP. The silicon nitride-coated silicon chip (SiN chip) for the RIfS sensing was first treated with trimethylsilylchloride (TMS), followed by UV-light irradiation to in situ generation of homogeneous silanols on the surface. Following amination by 3-aminopropyltriethoxysilane, carboxymethyldextran (CMD) was grafted, and subsequently, protein A was immobilized to create the oriented anti-CRP surface. The immobilization process of protein A and anti-CRP was monitored with the RIfS system by consecutive injections of an amine coupling reagent, protein A and anti-CRP, respectively, to confirm the progress of each step in real time. The sensitivity was enhanced when all of the processes were adopted, suggesting that the oriented immobilization of anti-CRP via protein A that was coupled with the grafted CMD on the aminated surface of TMS-treated SiN chip. The feasibility of the present sensing system was demonstrated on the detection of CRP, where the silicon-based inexpensive chips and the simple optical setup were employed. It can be applied to other target molecules in various fields of life science as a substitute of surface plasmon resonance-based

  16. Reactivity between carbon cathode materials and electrolyte based on industrial and laboratory data

    CSIR Research Space (South Africa)

    Chauke, L

    2013-07-01

    Full Text Available Interaction between electrolyte and carbon cathodes during the electrolytic production of aluminium decreases cell life. This paper describes the interaction between carbon cathode materials and electrolyte, based on industrial and laboratory data...

  17. Copper electrowinning in a moving-bed cell based on reactive electrodialysis

    Directory of Open Access Journals (Sweden)

    Cifuentes, L.

    2008-04-01

    Full Text Available A two-compartment lab-scale reactive electrodialysis (RED cell with a moving particulate cathode has been used for copper electrowinning. The cathodic reaction was copper electrodeposition on a bed of copper particles forced to circulate inside a fixed cylindrical enclosure by the action of rotating paddles; the anodic reaction was ferrous to ferric ion oxidation on an anode made of static graphite bars. The anolyte (aqueous FeSO4 + H2SO4 and catholyte (aqueous CuSO4 + H2SO4 are kept separate by an anion membrane which prevents cation transport between the electrolytes. Experiments were carried out in order to characterize cell performance under various conditions. When operating with 40 g/L Cu (II, I = 6 A, T = 50°C, 40 rpm paddle rotation and 990 mL/min electrolyte recirculation flowrate, the specific energy consumption (SEC for copper electrowinning was 2.25 kWh/kg. An optimization of cell dimensions gave an improved SEC of 1.55 kWh/kg whereas a temperature increase from 50 to 56°C (without changing cell dimensions produced a SEC of 1.50 kWh/kg, which is 25% lower than normal values for conventional copper electrowinning cells. A comparison was drawn between the performance of this cell and a squirrel-cage cell previously developed by the authors.

    Una celda a escala laboratorio de electrodiálisis reactiva (EDR, de dos compartimientos con cátodo particulado móvil, se ha utilizado para electroobtener cobre. La reacción catódica fue la electrodeposición de cobre sobre un lecho de partículas de cobre que circulan dentro de un cilindro fijo por la acción de paletas rotatorias; la reacción anódica fue la oxidación de ión ferroso a ión férrico sobre un ánodo hecho de barras de grafito estáticas. El anolito (FeSO4 + H2SO4 acuoso y el catolito (CuSO4 + H2SO4 acuoso se mantienen separados por una

  18. Improved Safety and Cost Savings from Reductions in Cast-Saw Burns After Simulation-Based Education for Orthopaedic Surgery Residents.

    Science.gov (United States)

    Bae, Donald S; Lynch, Hayley; Jamieson, Katherine; Yu-Moe, C Winnie; Roussin, Christopher

    2017-09-06

    The purpose of this investigation was to characterize the clinical efficacy and cost-effectiveness of simulation training aimed at reducing cast-saw injuries. Third-year orthopaedic residents underwent simulation-based instruction on distal radial fracture reduction, casting, and cast removal using an oscillating saw. The analysis compared incidences of cast-saw injuries and associated costs before and after the implementation of the simulation curriculum. Actual and potential costs associated with cast-saw injuries included wound care, extra clinical visits, and potential total payment (indemnity and expense payments). Curriculum costs were calculated through time-derived, activity-based accounting methods. The researchers compared the costs of cast-saw injuries and the simulation curriculum to determine overall savings and return on investment. In the 2.5 years prior to simulation, cast-saw injuries occurred in approximately 4.3 per 100 casts cut by orthopaedic residents. For the 2.5-year period post-simulation, the injury rate decreased significantly to approximately 0.7 per 100 casts cut (p = 0.002). The total cost to implement the casting simulation was $2,465.31 per 6-month resident rotation. On the basis of historical data related to cast-saw burns (n = 6), total payments ranged from $2,995 to $25,000 per claim. The anticipated savings from averted cast-saw injuries and associated medicolegal payments in the 2.5 years post-simulation was $27,131, representing an 11-to-1 return on investment. Simulation-based training for orthopaedic surgical residents was effective in reducing cast-saw injuries and had a high theoretical return on investment. These results support further investment in simulation-based training as cost-effective means of improving patient safety and clinical outcomes. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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

    Science.gov (United States)

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

    2016-01-01

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

  20. Assessment of differences in psychosocial resources and state of health of rural and urban residentsbased on studies carried out on students during examination stress

    Directory of Open Access Journals (Sweden)

    Danuta Zarzycka

    2014-11-01

    Full Text Available [b]introduction[/b]. Civilization changes of the environment shaping the psychosocial resources from rural to urban influence human health. [b]aim.[/b] The study aimed to identify the differences due to the place of residence (rural, urban as far as health resources are concerned (social support, sense of coherence, dehydroepiandrosterone sulfate concentration in plasma and health in examination stress situations. The study also determined the concentration of dehydroepiandrosterone sulfate (health resource and cortisol (stress indicator. [b]material and methods.[/b] The psychosocial variables were assessed using the scales: ISEL-48v. Coll., SOC-29, SF-36v.2™ o and analogue scale (perception of examination stress. The study included, based on a stratified sampling (year of study and purposive sampling (written examination, major, 731 students representing the six universities in Lublin, south-east Poland. Among the respondents, 130 students were rural residents. [b]results.[/b] Health resources of students living in rural and urban areas generally differ statistically significantly in social support and the subscales of availability of tangible support, availability of appreciative support, the availability of cognitive-evaluative support and a sense of resourcefulness. The study recorded a sstatistically significantly larger network of family ties among students living in rural areas. The demonstrated diversity of resources did not substantially affect the perceived health, with the exception of pain sensation. Examination stress assessed by subjective opinion of the respondents and plasma cortisol levels vary relative to the place of residence. Students residing in rural areas showed significantly lower cortisol levels values, but subjectively perceived the situation of examation as more stressful. [b]conclusions[/b]. Differences in health resources and their mechanism of impact on health, to a limited extent, were conditioned by the place

  1. Influence of Internet Accessibility and Demographic factors on utilization of Web-based Health Information Resources by Resident Doctors in Nigeria.

    Science.gov (United States)

    Ajuwon, G A; Popoola, S O

    2014-09-01

    The internet is a huge library with avalanche of information resources including healthcare information. There are numerous studies on use of electronic resources by healthcare providers including medical practitioners however, there is a dearth of information on the patterns of use of web-based health information resource by resident doctors in Nigeria. This study therefore investigates the influence of internet accessibility and demographic factors on utilization of web-based health information resources by resident doctors in tertiary healthcare institutions in Nigeria. Descriptive survey design was adopted for this study. The population of study consisted of medical doctors undergoing residency training in 13 tertiary healthcare institutions in South-West Nigeria. The tertiary healthcare institutions were Federal Medical Centres, University Teaching Hospitals and Specialist Hospitals (Neuropsychiatric and Orthopaedic). A pre-tested, self-administered questionnaire was used for data collection. The Statistical Package for the Social Sciences (SPSS) was used for data analysis. Data were analyzed using descriptive statistics, Pearson Product Moment correlation and multiple regression analysis. The mean age of the respondents was 34 years and males were in the majority (69.0%). A total of 96.1% respondents had access to the Internet. E-mail (X̄=5.40, SD=0.91), Google (X̄=5.26, SD=1.38), Yahoo (X̄=5.15, SD=4.44) were used weekly by the respondents. Preparation for Seminar/Grand Round presentation (X̄=8.4, SD=1.92), research (X̄=7.8, SD=2.70) and communication (X̄=7.6, SD=2.60) were ranked high as purposes for use of web-based information resources. There is a strong, positive and significant relationship between internet accessibility and utilization of web-based health information resources (r=0.628, pdesignation (B=-0.343) educational qualification (B=2.411) significantly influence utilization of web-based health information resources of the respondents. A

  2. Calculation of effect of burnup history on spent fuel reactivity based on CASMO5

    International Nuclear Information System (INIS)

    Li Xiaobo; Xia Zhaodong; Zhu Qingfu

    2015-01-01

    Based on the burnup credit of actinides + fission products (APU-2) which are usually considered in spent fuel package, the effect of power density and operating history on k_∞ was studied. All the burnup calculations are based on the two-dimensional fuel assembly burnup program CASMO5. The results show that taking the core average power density of specified power plus a bounding margin of 0.0023 to k_∞, and taking the operating history of specified power without shutdown during cycle and between cycles plus a bounding margin of 0.0045 to k_∞ can meet the bounding principle of burnup credit. (authors)

  3. Effects of reactive filters based on modified zeolite in dairy industry wastewater treatment process

    Directory of Open Access Journals (Sweden)

    Kolaković Srđan

    2013-01-01

    Full Text Available Application of adsorbents based on organo-zeolites has certain advantages over conventional methods applied in food industry wastewater treatment process. The case study presented in this paper examines the possibilities and effects of treatment of dairy industry wastewater by using adsorbents based on organo-zeolites. The obtained results indicate favorable filtration properties of organo-zeolite, their high level of adsorption of organic matter and nitrate nitrogen in the analyzed wastewater. This paper concludes with recommendations of optimal technical and technological parameters for the application of these filters in practice.

  4. Changes in Perceived Supervision Quality After Introduction of Competency-Based Orthopedic Residency Training: A National 6-Year Follow-Up Study.

    Science.gov (United States)

    van Vendeloo, Stefan N; Brand, Paul L P; Kollen, Boudewijn J; Verheyen, Cees C P M

    2018-04-27

    To evaluate the perceived quality of the learning environment, before and after introduction of competency-based postgraduate orthopedic education. From 2009 to 2014, we conducted annual surveys among Dutch orthopedic residents. The validated Dutch Residency Educational Climate Test (D-RECT, 50 items on 11 subscales) was used to assess the quality of the learning environment. Scores range from 1 (poor) to 5 (excellent). Dynamic cohort follow-up study. All Dutch orthopedic residents were surveyed during annual compulsory courses. Over the 6-year period, 641 responses were obtained (response rate 92%). Scores for "supervision" (95% CI for difference 0.06-0.28, p = 0.002) and "coaching and assessment" (95% CI 0.11-0.35, p < 0.001) improved significantly after introduction of competency-based training. There was no significant change in score on the other subscales of the D-RECT. After the introduction of some of the core components of competency-based postgraduate orthopedic education the perceived quality of "supervision" and "coaching and assessment" improved significantly. Copyright © 2018 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  5. Information-seeking behavior during residency is associated with quality of theoretical learning, academic career achievements, and evidence-based medical practice: a strobe-compliant article.

    Science.gov (United States)

    Oussalah, Abderrahim; Fournier, Jean-Paul; Guéant, Jean-Louis; Braun, Marc

    2015-02-01

    Data regarding knowledge acquisition during residency training are sparse. Predictors of theoretical learning quality, academic career achievements and evidence-based medical practice during residency are unknown. We performed a cross-sectional study on residents and attending physicians across several residency programs in 2 French faculties of medicine. We comprehensively evaluated the information-seeking behavior (I-SB) during residency using a standardized questionnaire and looked for independent predictors of theoretical learning quality, academic career achievements, and evidence-based medical practice among I-SB components using multivariate logistic regression analysis. Between February 2013 and May 2013, 338 fellows and attending physicians were included in the study. Textbooks and international medical journals were reported to be used on a regular basis by 24% and 57% of the respondents, respectively. Among the respondents, 47% refer systematically (4.4%) or frequently (42.6%) to published guidelines from scientific societies upon their publication. The median self-reported theoretical learning quality score was 5/10 (interquartile range, 3-6; range, 1-10). A high theoretical learning quality score (upper quartile) was independently and strongly associated with the following I-SB components: systematic reading of clinical guidelines upon their publication (odds ratio [OR], 5.55; 95% confidence interval [CI], 1.77-17.44); having access to a library that offers the leading textbooks of the specialty in the medical department (OR, 2.45, 95% CI, 1.33-4.52); knowledge of the specialty leading textbooks (OR, 2.12; 95% CI, 1.09-4.10); and PubMed search skill score ≥5/10 (OR, 1.94; 95% CI, 1.01-3.73). Research Master (M2) and/or PhD thesis enrolment were independently and strongly associated with the following predictors: PubMed search skill score ≥5/10 (OR, 4.10; 95% CI, 1.46-11.53); knowledge of the leading medical journals of the specialty (OR, 3.33; 95

  6. Information-seeking Behavior During Residency Is Associated With Quality of Theoretical Learning, Academic Career Achievements, and Evidence-based Medical Practice

    Science.gov (United States)

    Oussalah, Abderrahim; Fournier, Jean-Paul; Guéant, Jean-Louis; Braun, Marc

    2015-01-01

    Abstract Data regarding knowledge acquisition during residency training are sparse. Predictors of theoretical learning quality, academic career achievements and evidence-based medical practice during residency are unknown. We performed a cross-sectional study on residents and attending physicians across several residency programs in 2 French faculties of medicine. We comprehensively evaluated the information-seeking behavior (I-SB) during residency using a standardized questionnaire and looked for independent predictors of theoretical learning quality, academic career achievements, and evidence-based medical practice among I-SB components using multivariate logistic regression analysis. Between February 2013 and May 2013, 338 fellows and attending physicians were included in the study. Textbooks and international medical journals were reported to be used on a regular basis by 24% and 57% of the respondents, respectively. Among the respondents, 47% refer systematically (4.4%) or frequently (42.6%) to published guidelines from scientific societies upon their publication. The median self-reported theoretical learning quality score was 5/10 (interquartile range, 3–6; range, 1–10). A high theoretical learning quality score (upper quartile) was independently and strongly associated with the following I-SB components: systematic reading of clinical guidelines upon their publication (odds ratio [OR], 5.55; 95% confidence interval [CI], 1.77–17.44); having access to a library that offers the leading textbooks of the specialty in the medical department (OR, 2.45, 95% CI, 1.33–4.52); knowledge of the specialty leading textbooks (OR, 2.12; 95% CI, 1.09–4.10); and PubMed search skill score ≥5/10 (OR, 1.94; 95% CI, 1.01–3.73). Research Master (M2) and/or PhD thesis enrolment were independently and strongly associated with the following predictors: PubMed search skill score ≥5/10 (OR, 4.10; 95% CI, 1.46–11.53); knowledge of the leading medical journals of the

  7. Stabilization techniques for reactive aggregate in soil-cement base course : technical summary.

    Science.gov (United States)

    2003-01-01

    The objectives of this research are 1) to identify the mineralogical properties of soil-cement bases which have heaved or can potentially heave, 2) to simulate expansion of cement-stabilized soil in the laboratory, 3) to correlate expansion with the ...

  8. Complex catalysts from self-repairing ensembles to highly reactive air-based oxidation systems

    Science.gov (United States)

    Craig L. Hill; Laurent Delannoy; Dean C. Duncan; Ira A. Weinstock; Roman F. Renneke; Richard S. Reiner; Rajai H. Atalla; Jong Woo Han; Daniel A. Hillesheim; Rui Cao; Travis M. Anderson; Nelya M. Okun; Djamaladdin G. Musaev; Yurii V. Geletii

    2007-01-01

    Progress in four interrelated catalysis research efforts in our laboratory are summarized: (1) catalytic photochemical functionalization of unactivated CeH bonds by polyoxometalates (POMs); (2) self-repairing catalysts; (3) catalysts for air-based oxidations under ambient conditions; and (4) terminal oxo complexes of the late-transition metal elements and their...

  9. Nanoporous Hybrid Electrolytes for High-Energy Batteries Based on Reactive Metal Anodes

    KAUST Repository

    Tu, Zhengyuan; Zachman, Michael J.; Choudhury, Snehashis; Wei, Shuya; Ma, Lin; Yang, Yuan; Kourkoutis, Lena F.; Archer, Lynden A.

    2017-01-01

    electrolytes created by infusing conventional liquid electrolytes into nanoporous membranes provide exceptional ability to stabilize Li. Electrochemical cells based on γ-Al2O3 ceramics with pore diameters below a cut-off value above 200 nm exhibit long

  10. Evaluation and application of a paper-based device for the determination of reactive phosphate in soil solution.

    Science.gov (United States)

    Jayawardane, B Manori; Wongwilai, W; Grudpan, K; Kolev, S D; Heaven, M W; Nash, D M; McKelvie, I D

    2014-05-01

    The evaluation and validation of a new low-cost microfluidic paper-based analytical device (μPAD) for the determination of reactive phosphate in soil solution is described. This device allows up to 15 replicate measurements of reactive phosphate on one credit card-sized device and requires only a desktop or hand scanner for signal detection and quantification. The proposed method showed a linear response between 0.1 and 1.0 mg L and between 1.0 and 10.0 mg L P with a limit of detection of 0.05 mg L P. When applied to the analysis of soil solution, there was excellent agreement between results obtained using the μPAD and those obtained by a reference spectrophotometric method, as indicated by the following regression equation: [P] = (0.997 ± 0.005)[P] - (0.020 ± 0.008) ( = 0.997; = 110). It was found that the ambient temperature storage stability of the μPAD could be extended to 15 d by incorporating a removable polymeric interleaving sheet between the adjacent paper layers of the device. The observed sensitivity of the μPADs to sunlight, which was manifested by photoreduction of the chromogenic molybdate reagent used in the assay, was overcome by preparing the μPADs with an ultraviolet-filtering laminating material. The proposed method is rapid, with a reaction time of only 10 min, is easy to perform, and is suitable for application in the field. Copyright © by the American Society of Agronomy, Crop Science Society of America, and Soil Science Society of America, Inc.

  11. Error causes in the determination of the acid-base reactivity of oxi-hydroxides

    International Nuclear Information System (INIS)

    Duc, M.; Lefevre, G.; Fedoroff, M.

    2004-01-01

    The long term safety of radioactive waste depositories is based on the sorption of radionuclides from underground water onto engineered and natural barriers. For a quantitative prediction of the migration in such barriers, we need accurate sorption data. Models should be in agreement with the sorption mechanism. Surface complexation is the most often used model for oxides and hydroxides. In fact, there are several types of surface complexation models such as 1-pK and 2-pK monosite, 1-pK and 2-pK multisite, pK-distribution models. Furthermore, there are several ways to describe the distribution of the electrostatic potential in the vicinity of the solid surface (CCM, DLM, BSM, TLM,..). However, all these models are based on the acid-base properties of superficial hydroxide or oxide groups of the solid. It is necessary to determine the surface charge versus pH (titration curves), the point of zero charge (pzc), the surface density of sites active towards protons and hydroxides in aqueous solutions, the acid-base constants of these sites. These parameters are then used for calculating the sorption constants of ions other than protons and hydroxide ions. It is therefore important to determine these parameters very accurately. A comparison of acid-base parameters published in the literature shows a large scatter for the ''same'' oxides [1,2]. Several causes could explain this scatter. One reason is the use of different models, each electrostatic models leading to different values of site density and constants. However, titration curves and pzc are independent of the model chosen. Another reason may be uncontrolled differences in the composition and purity of oxides. Finally, other causes could be found in the titration procedure, in the solubility and the stability of the solid. In order to understand more about the acid-base properties of oxides and about the origin of the discrepancies between measurements, we have performed a systematic experimental study of several

  12. Chinese Gini Coefficient from 2005 to 2012, Based on 20 Grouped Income Data Sets of Urban and Rural Residents

    Directory of Open Access Journals (Sweden)

    Jiandong Chen

    2015-01-01

    Full Text Available Data insufficiency has become the primary factor affecting research on income disparity in China. To resolve this issue, this paper explores Chinese income distribution and income inequality using distribution functions. First, it examines 20 sets of grouped data on family income between 2005 and 2012 by the China Yearbook of Household Surveys, 2013, and compares the fitting effects of eight distribution functions. The results show that the generalized beta distribution of the second kind has a high fitting to the income distribution of urban and rural residents in China. Next, these results are used to calculate the Chinese Gini ratio, which is then compared with the findings of relevant studies. Finally, this paper discusses the influence of urbanization on income inequality in China and suggests that accelerating urbanization can play an important role in narrowing the income gap of Chinese residents.

  13. Connectedness to nature and public (skin) health perspectives: results of a representative, population-based survey among Austrian residents.

    Science.gov (United States)

    Haluza, Daniela; Simic, Stana; Höltge, Jan; Cervinka, Renate; Moshammer, Hanns

    2014-01-20

    Connectedness to nature (CN) influences motivation to have contact with outdoor natural environments. Spending leisure time in natural environments is beneficial for human health and well-being. Besides these positive effects, health risks of open-air activities are mainly related to unprotected sun light exposure-associated acute and chronic skin hazards. Thus, we conducted a cross-sectional, representative telephone survey among Austrian residents to study the association of perceived CN level with sun-exposure knowledge, tanning habits, and sun protective behaviour. In total, 1,500 study subjects (50.5% females) participated in this questionnaire survey. Although knowledge about tanning and motives to tan were similar among genders, females performed more photoprotective measures and were more connected to nature (all p nature connectedness and skin health-relevant recreational habits of Austrian residents. The findings suggest to integrate hitherto neglected gender-specific Public (Skin) Health promotion when counselling on the manifold health advantages of outdoor activities.

  14. The effect of a resident-led quality improvement project on improving communication between hospital-based and outpatient physicians.

    Science.gov (United States)

    Kalanithi, Lucy; Coffey, Charles E; Mourad, Michelle; Vidyarthi, Arpana R; Hollander, Harry; Ranji, Sumant R

    2013-01-01

    This article reports on a resident-led quality improvement program to improve communication between inpatient internal medicine residents and their patients' primary care physicians (PCPs). The program included education on care transitions, standardization of documentation, audit and feedback of documented PCP communication rates with public reporting of performance, rapid-cycle data analysis and improvement projects, and a financial incentive. At baseline, PCP communication was documented in 55% of patients; after implementation of the intervention, communication was documented in 89.3% (2477 of 2772) of discharges during the program period. The program was associated with a significant increase in referring PCP satisfaction with communication at hospital admission (baseline, 27.7% "satisfied" or "very satisfied"; postintervention, 58.2%; P communication for patient care and audit and feedback of their performance as the principal drivers of their engagement in the project.

  15. Optimization Based Shunt APF Controller to Mitigate Reactive Power, Burden of Neutral Conductor, Current Harmonics and Improve cosɸ

    Directory of Open Access Journals (Sweden)

    P. Anjana

    2017-03-01

    Full Text Available This paper presents a Modified Gravitational Search Algorithm (MGSA to improve the performance of PI controller in varying load condition. The proposed approach is capable of mitigating reactive power, neutral current, source current THD and significant improvement in power factor nearly unity (0.997. The DC link voltage across the capacitor is controlled by PI controller which is deciding the performance of shunt APF. Hence, the robust optimization technique based integral time square error (ITSE with consideration of weight factor (α & β, maximum overshoot ((|(∆_Ve ̅〖(n〗_max | and setling time t_s-t_0, is providing the optimum solution of Kp & Ki. The robustness of proposed objective function and algorithm compared with GSA based three other error criterion techniques. The efficiency of the proposed controller has been tested over nonlinear and unbalance loading condition. The performance of ITSE based MGSA-PI controller is batter then other three error criterion techniques. The values of THD are below the mark of 5% specified in IEEE-519 standard.

  16. AI based HealthCare Platform for Real Time, Predictive and Prescriptive Analytics using Reactive Programming

    Science.gov (United States)

    Kaur, Jagreet; Singh Mann, Kulwinder, Dr.

    2018-01-01

    AI in Healthcare needed to bring real, actionable insights and Individualized insights in real time for patients and Doctors to support treatment decisions., We need a Patient Centred Platform for integrating EHR Data, Patient Data, Prescriptions, Monitoring, Clinical research and Data. This paper proposes a generic architecture for enabling AI based healthcare analytics Platform by using open sources Technologies Apache beam, Apache Flink Apache Spark, Apache NiFi, Kafka, Tachyon, Gluster FS, NoSQL- Elasticsearch, Cassandra. This paper will show the importance of applying AI based predictive and prescriptive analytics techniques in Health sector. The system will be able to extract useful knowledge that helps in decision making and medical monitoring in real-time through an intelligent process analysis and big data processing.

  17. Multi-Step Deep Reactive Ion Etching Fabrication Process for Silicon-Based Terahertz Components

    Science.gov (United States)

    Jung-Kubiak, Cecile (Inventor); Reck, Theodore (Inventor); Chattopadhyay, Goutam (Inventor); Perez, Jose Vicente Siles (Inventor); Lin, Robert H. (Inventor); Mehdi, Imran (Inventor); Lee, Choonsup (Inventor); Cooper, Ken B. (Inventor); Peralta, Alejandro (Inventor)

    2016-01-01

    A multi-step silicon etching process has been developed to fabricate silicon-based terahertz (THz) waveguide components. This technique provides precise dimensional control across multiple etch depths with batch processing capabilities. Nonlinear and passive components such as mixers and multipliers waveguides, hybrids, OMTs and twists have been fabricated and integrated into a small silicon package. This fabrication technique enables a wafer-stacking architecture to provide ultra-compact multi-pixel receiver front-ends in the THz range.

  18. Boron-nitrogen based hydrides and reactive composites for hydrogen storage

    DEFF Research Database (Denmark)

    Jepsen, Lars H.; Ley, Morten B.; Lee, Young-Su

    2014-01-01

    Hydrogen forms chemical compounds with most other elements and forms a variety of different chemical bonds. This fascinating chemistry of hydrogen has continuously provided new materials and composites with new prospects for rational design and the tailoring of properties. This review highlights...... a range of new boron and nitrogen based hydrides and illustrates how hydrogen release and uptake properties can be improved. © 2014 Elsevier Ltd....

  19. Nanoengineered Carbon-Based Materials For Reactive Adsorption of Toxic Industrial Compounds

    Science.gov (United States)

    2015-01-13

    ABSTRACT 2. REPORT TYPE 17. LIMITATION OF ABSTRACT 15. NUMBER OF PAGES 5d. PROJECT NUMBER 5e. TASK NUMBER 5f. WORK UNIT NUMBER 5c. PROGRAM ELEMENT...07 2013): 0. doi: 10.1016/j.carbon.2013.06.081 Camille Petit, Karifala Kante , Teresa J. Bandosz. The role of sulfur-containing groups in ammonia... Kante , Cesar Nieto-Delgado, J. Rene Rangel-Mendez, Teresa J. Bandosz. Spent coffee-based activated carbon: Specific surface features and their

  20. Orifice microreactor for the production of an organic peroxide – non-reactive and reactive characterization

    NARCIS (Netherlands)

    Illg, T.; Hessel, V.; Löb, P.; Schouten, J.C.

    2012-01-01

    In this article, the transfer of a two-step, biphasic, and exothermic peroxide synthesis into a microreactor assisted process is discussed as well as the non-reactive and reactive characterization of the developed orifice microreactor. Residence time distribution measurements showed nearly ideal

  1. Association between C reactive protein and coronary heart disease: mendelian randomisation analysis based on individual participant data

    DEFF Research Database (Denmark)

    Wensley, Frances; Gao, Pei; Burgess, Stephen

    2011-01-01

    To use genetic variants as unconfounded proxies of C reactive protein concentration to study its causal role in coronary heart disease.......To use genetic variants as unconfounded proxies of C reactive protein concentration to study its causal role in coronary heart disease....

  2. An experimental test of assessment reactivity within a web-based brief alcohol intervention study for college students.

    Science.gov (United States)

    Fazzino, Tera L; Rose, Gail L; Helzer, John E

    2016-01-01

    Web-based brief alcohol intervention (WBI) programs have efficacy in a wide range of college students and have been widely disseminated to universities to address heavy alcohol use. In the majority of efficacy studies, web-based research assessments were conducted before the intervention. Web-based research assessments may elicit reactivity, which could inflate estimates of WBI efficacy. The current study tested whether web-based research assessments conducted in combination with a WBI had additive effects on alcohol use outcomes, compared to a WBI only. Undergraduate students (n=856) from universities in the United States and Canada participated in this online study. Eligible individuals were randomized to complete 1) research assessments+WBI or 2) WBI-only. Alcohol consumption, alcohol-related problems, and protective behaviors were assessed at one-month follow up. Multiple regression using 20 multiply imputed datasets indicated that there were no significant differences at follow up in alcohol use, alcohol-related problems, or protective behaviors used when controlling for variables with theoretical and statistical relevance. A repeated measures analysis of covariance revealed a significant decrease in peak estimated blood alcohol concentration in both groups, but no differential effects by randomized group. There were no significant moderating effects from gender, hazardous alcohol use, or motivation to change drinking. Web-based research assessments combined with a web-based alcohol intervention did not inflate estimates of intervention efficacy when measured within-subjects. Our findings suggest universities may be observing intervention effects similar to those cited in efficacy studies, although effectiveness trials are needed. Copyright © 2015 Elsevier Ltd. All rights reserved.

  3. Residency Allocation Database

    Data.gov (United States)

    Department of Veterans Affairs — The Residency Allocation Database is used to determine allocation of funds for residency programs offered by Veterans Affairs Medical Centers (VAMCs). Information...

  4. A refinement-based approach to developing software controllers for reactive systems

    Energy Technology Data Exchange (ETDEWEB)

    Winter, V.L.; Kapur, D.; Berg, R.S.

    1999-12-09

    The purpose of this paper is to demonstrate how transformation can be used to derive a high integrity implementation of a train controller from an algorithmic specification. The paper begins with a general discussion of high consequence systems (e.g., software systems) and describes how rewrite-based transformation systems can be used in the development of such systems. The authors then discuss how such transformations can be used to derive a high assurance controller for the Bay Area Rapid Transit (BART) system from an algorithmic specification.

  5. Reactive power and voltage control based on general quantum genetic algorithms

    DEFF Research Database (Denmark)

    Vlachogiannis, Ioannis (John); Østergaard, Jacob

    2009-01-01

    This paper presents an improved evolutionary algorithm based on quantum computing for optima l steady-state performance of power systems. However, the proposed general quantum genetic algorithm (GQ-GA) can be applied in various combinatorial optimization problems. In this study the GQ-GA determines...... techniques such as enhanced GA, multi-objective evolutionary algorithm and particle swarm optimization algorithms, as well as the classical primal-dual interior-point optimal power flow algorithm. The comparison demonstrates the ability of the GQ-GA in reaching more optimal solutions....

  6. Magnetic and Mössbauer Study of Cerium-Based Reactive Sorbent

    Czech Academy of Sciences Publication Activity Database

    Jirásková, Yvonna; Buršík, Jiří; Životský, O.; Luňáček, J.; Janos, P.

    2017-01-01

    Roč. 131, č. 4 (2017), s. 1096-1098 ISSN 0587-4246. [CSMAG 2016 - Czech and Slovak Conference on Magnetism /16./. Košice, 13.06.2016-17.06.2016] R&D Projects: GA MŠk(CZ) LQ1601 Institutional support: RVO:68081723 Keywords : Cerium-based sorbent * magnetic properties * phase composition * composite Subject RIV: BM - Solid Matter Physics ; Magnetism OBOR OECD: Condensed matter physics (including formerly solid state physics, supercond.) Impact factor: 0.469, year: 2016

  7. Exploring attitudes of healthcare professionals towards ICT-based interventions for nursing home residents with dementia: a mixed-methods approach.

    Science.gov (United States)

    O'Sullivan, Julie Lorraine; Gellert, Paul; Hesse, Britta; Jordan, Laura-Maria; Möller, Sebastian; Voigt-Antons, Jan-Niklas; Nordheim, Johanna

    2018-02-01

    Information and Communication Technologies (ICTs) could be useful for delivering non-pharmacological therapies (NPTs) for dementia in nursing home settings. To identify technology-related expectations and inhibitions of healthcare professionals associated with the intention to use ICT-based NPTs. Cross-sectional multi-method survey. N = 205 healthcare professionals completed a quantitative survey on usage and attitudes towards ICTs. Additionally, N = 11 semi-structured interviews were conducted. Participants were classified as intenders to use ICTs (53%), non-intenders (14%) or ambivalent (32%). A MANCOVA revealed higher perceived usefulness for intenders compared to non-intenders and ambivalent healthcare professionals (V =.28, F(12, 292)= 3.94, p ICTs in the workplace. Furthermore, benefits for residents emerged as a key requirement. Staff trainings should stress specific benefits for residents and healthcare professionals to facilitate successful implementation and acceptance of ICTs in nursing home settings.

  8. Novel epoxy-benzoxazine water-based emulsions with reactive benzoxazine surfactants for coatings

    Directory of Open Access Journals (Sweden)

    M. Krajnc

    2014-08-01

    Full Text Available Novel epoxy-benzoxazine emulsions designed for water-based coatings were prepared and investigated. Bisphenol A-based epoxy resins with molar weights of 340, 377 and 1750 g/mol along with epoxidized soybean oil were emulsified using mono- and bi-functional benzoxazine surfactants, which are able to react with epoxy resins at their cure temperature. The structure of synthesized surfactants carrying one or two polyether chains was confirmed using Fourier transform infrared spectroscopy, 1H nuclear magnetic resonance and differential scanning calorimetry. Stability of emulsions was verified by particle diameters measurements. Coatings, made directly from emulsions, were dried and cured at elevated temperature using 3,3'-dimetoxybenzidine as curing agent to ensure a highly cross-linked structure of thermosetting films. Curing process, thermal properties and hardness of cured films were investigated. It was found that benzoxazine molecules were well incorporated into the epoxy network upon curing, which ensures no void structure of cured copolymer and enhanced coating properties.

  9. Mitochondria: Targeting mitochondrial reactive oxygen species with mitochondriotropic polyphenolic-based antioxidants.

    Science.gov (United States)

    Teixeira, José; Deus, Cláudia M; Borges, Fernanda; Oliveira, Paulo J

    2018-04-01

    Mitochondrial function and regulation of redox balance is fundamental in controlling cellular life and death pathways. Antioxidants have been used to counteract disruption of redox networks, normally associated with progressive loss of cell homeostasis and disease pathophysiology, although therapeutic success is limited mainly due to pharmacokinetic drawbacks. Attempts to improve mitochondrial function in a range of diseases spurred active drug discovery efforts. Currently, the most effective strategy to deliver drugs to mitochondria is the covalent link of lipophilic cations to the bioactive compound. Although targeting mitochondrial oxidative stress with antioxidants has been demonstrated, clinical use has been hampered by several challenges, with no FDA-approved drug so far. Development of new mitochondriotropic antioxidant agents based on dietary polyphenols has recently gained momentum. Due to their nature, mitochondria-targeted multi-functional antioxidants can trigger stress responses and contribute to tissue protection through hormesis mechanisms, inhibiting excessive mitochondrial ROS production and associated diseases. Copyright © 2018 Elsevier Ltd. All rights reserved.

  10. Sexual Health Education: A Psychiatric Resident's Perspective

    Science.gov (United States)

    Waineo, Eva; Arfken, Cynthia L.; Morreale, Mary K.

    2010-01-01

    Objective: This report discusses psychiatric residents' perceptions of sexual health education and their opinions regarding curricular improvements. Methods: An anonymous, web-based survey was sent to residents in one general psychiatry program (N = 33). The response rate was 69.7%. Results: Residents reported inadequate experience in multiple…

  11. Thermally reactive Thiazolo[5,4-d]thiazole based copolymers for high photochemical stability in polymer solar cells

    DEFF Research Database (Denmark)

    Helgesen, Martin; Vesterager Madsen, Morten; Andreasen, Birgitta

    2011-01-01

    New thermally reactive copolymers based on dithienylthiazolo[5,4-d]thiazole (DTZ) and silolodithiophene (SDT) have been synthesized and explored in bulk heterojunction solar cells as mixtures with [6,6]-phenyl-C61-butyric acid methyl ester (PCBM). In thin films the polymers had optical band gaps...... in the range of 1.64-1.80 eV. For solubility the polymers have incorporated alkyl groups on the SDT unit and thermally removable ester groups on the DTZ unit that can be eliminated around 200 °C for improved photochemical stability in thin films. The bulkiness of the alkyl chains on the SDT unit proved...... to be very significant in terms of photovoltaic performance of the polymer:PCBM solar cells. Polymers based on 4,4-dihexyl-4H-silolo[3,2-b:4,5-b′]dithiophene reached power conversion efficiencies (PCEs) up to 1.45% but changing the alkyl groups to more bulky ethylhexyl chains reduced the PCE to 1.17%. More...

  12. Stabilization of mercury over Mn-based oxides: Speciation and reactivity by temperature programmed desorption analysis

    Energy Technology Data Exchange (ETDEWEB)

    Xu, Haomiao [School of Environmental Science and Engineering, Shanghai Jiao Tong University, Shanghai 200240 (China); Ma, Yongpeng [Henan Collaborative Innovation Center of Environmental Pollution Control and Ecological Restoration, Zhengzhou University of Light Industry, No. 136, Science Avenue, Zhengzhou 450001 (China); Huang, Wenjun; Mei, Jian; Zhao, Songjian; Qu, Zan [School of Environmental Science and Engineering, Shanghai Jiao Tong University, Shanghai 200240 (China); Yan, Naiqiang, E-mail: nqyan@sjtu.edu.cn [School of Environmental Science and Engineering, Shanghai Jiao Tong University, Shanghai 200240 (China)

    2017-01-05

    Highlights: • Hg-TPD method was used for speciation of mercury species. • Different elements modified MnO{sub x} have different mercury binding state. • Understanding mercury existed state was beneficial for designing novel materials. - Abstract: Mercury temperature-programmed desorption (Hg-TPD) method was employed to clarify mercury species over Mn-based oxides. The elemental mercury (Hg{sup 0}) removal mechanism over MnO{sub x} was ascribed to chemical-adsorption. HgO was the primary mercury chemical compound adsorbed on the surface of MnO{sub x}. Rare earth element (Ce), main group element (Sn) and transition metal elements (Zr and Fe) were chosen for the modification of MnO{sub x}. Hg-TPD results indicated that the binding strength of mercury on these binary oxides followed the order of Sn-MnO{sub x} < Ce-MnO{sub x} ∼ MnO{sub x} < Fe-MnO{sub x} < Zr-MnO{sub x}. The activation energies for desorption were calculated and they were 64.34, 101.85, 46.32, 117.14, and 106.92 eV corresponding to MnO{sub x}, Ce-MnO{sub x}, Sn-MnO{sub x}, Zr-MnO{sub x} and Fe-MnO{sub x}, respectively. Sn-MnO{sub x} had a weak bond of mercury (Hg-O), while Zr-MnO{sub x} had a strong bond (Hg≡O). Ce-MnO{sub x} and Fe-MnO{sub x} had similar bonds compared with pure MnO{sub x}. Moreover, the effects of SO{sub 2} and NO were investigated based on Hg-TPD analysis. SO{sub 2} had a poison effect on Hg{sup 0} removal, and the weak bond of mercury can be easily destroyed by SO{sub 2}. NO was favorable for Hg{sup 0} removal, and the bond strength of mercury was enhanced.

  13. Needs Assessment for Incoming PGY-1 Residents in Neurosurgical Residency.

    Science.gov (United States)

    Brandman, David M; Haji, Faizal A; Matte, Marie C; Clarke, David B

    2015-01-01

    Residents must develop a diverse range of skills in order to practice neurosurgery safely and effectively. The purpose of this study was to identify the foundational skills required for neurosurgical trainees as they transition from medical school to residency. Based on the CanMEDS competency framework, a web-based survey was distributed to all Canadian academic neurosurgical centers, targeting incoming and current PGY-1 neurosurgical residents as well as program directors. Using Likert scale and free-text responses, respondents rated the importance of various cognitive (e.g. management of raised intracranial pressure), technical (e.g. performing a lumbar puncture) and behavioral skills (e.g. obtaining informed consent) required for a PGY-1 neurosurgical resident. Of 52 individuals contacted, 38 responses were received. Of these, 10 were from program directors (71%), 11 from current PGY-1 residents (58%) and 17 from incoming PGY-1 residents (89%). Respondents emphasized operative skills such as proper sterile technique and patient positioning; clinical skills such as lesion localization and interpreting neuro-imaging; management skills for common scenarios such as raised intracranial pressure and status epilepticus; and technical skills such as lumbar puncture and external ventricular drain placement. Free text answers were concordant with the Likert scale results. We surveyed Canadian neurosurgical program directors and PGY-1 residents to identify areas perceived as foundational to neurosurgical residency education and training. This information is valuable for evaluating the appropriateness of a training program's goals and objectives, as well as for generating a national educational curriculum for incoming PGY-1 residents.

  14. DFT-based prediction of reactivity of short-chain alcohol dehydrogenase

    Science.gov (United States)

    Stawoska, I.; Dudzik, A.; Wasylewski, M.; Jemioła-Rzemińska, M.; Skoczowski, A.; Strzałka, K.; Szaleniec, M.

    2017-06-01

    The reaction mechanism of ketone reduction by short chain dehydrogenase/reductase, ( S)-1-phenylethanol dehydrogenase from Aromatoleum aromaticum, was studied with DFT methods using cluster model approach. The characteristics of the hydride transfer process were investigated based on reaction of acetophenone and its eight structural analogues. The results confirmed previously suggested concomitant transfer of hydride from NADH to carbonyl C atom of the substrate with proton transfer from Tyr to carbonyl O atom. However, additional coupled motion of the next proton in the proton-relay system, between O2' ribose hydroxyl and Tyr154 was observed. The protonation of Lys158 seems not to affect the pKa of Tyr154, as the stable tyrosyl anion was observed only for a neutral Lys158 in the high pH model. The calculated reaction energies and reaction barriers were calibrated by calorimetric and kinetic methods. This allowed an excellent prediction of the reaction enthalpies (R2 = 0.93) and a good prediction of the reaction kinetics (R2 = 0.89). The observed relations were validated in prediction of log K eq obtained for real whole-cell reactor systems that modelled industrial synthesis of S-alcohols.

  15. Non-nitric oxide based metallovasodilators: synthesis, reactivity and biological studies.

    Science.gov (United States)

    Sá, Denise S; Fernandes, André F; Silva, Carlos D S; Costa, Paula P C; Fonteles, Manassés C; Nascimento, Nilberto R F; Lopes, Luiz G F; Sousa, Eduardo H S

    2015-08-14

    There is an increasing number of compounds developed to target one or more pathways involved in vasodilation. Some studies conducted with azaindole and indazole derivatives showed cardiovascular activity associated with these compounds. Fast and easy structural modification of these organic molecules can be achieved using metal complexes promoting a much larger spatial change than organic strategies, potentially leading to novel drugs. Here, we have prepared a series of complexes with a formula cis-[RuCl(L)(bpy)(2)]PF(6), where L = 7-azaindole (ain), 5-azaindole (5-ain), 4-azaindole (4-ain), indazole (indz), benzimidazole (bzim) or quinoline (qui), which were characterized by spectroscopic and electrochemical techniques (CV, DPV). These compounds showed reasonable stability exhibiting photoreactivity only at low wavelength along with superoxide scavenger activity. Cytotoxicity assays indicated their low activity preliminarily supporting in vivo application. Interestingly, vasodilation assays conducted in rat aorta exhibited great activity that largely improved compared to free ligands and even better than the well-studied organic compound (BAY 41-42272), with IC(50) reaching 55 nM. These results have validated this strategy opening new opportunities to further develop cardiovascular agents based on metallo-bicyclic rings.

  16. Structure-reactivity modeling using mixture-based representation of chemical reactions.

    Science.gov (United States)

    Polishchuk, Pavel; Madzhidov, Timur; Gimadiev, Timur; Bodrov, Andrey; Nugmanov, Ramil; Varnek, Alexandre

    2017-09-01

    We describe a novel approach of reaction representation as a combination of two mixtures: a mixture of reactants and a mixture of products. In turn, each mixture can be encoded using an earlier reported approach involving simplex descriptors (SiRMS). The feature vector representing these two mixtures results from either concatenated product and reactant descriptors or the difference between descriptors of products and reactants. This reaction representation doesn't need an explicit labeling of a reaction center. The rigorous "product-out" cross-validation (CV) strategy has been suggested. Unlike the naïve "reaction-out" CV approach based on a random selection of items, the proposed one provides with more realistic estimation of prediction accuracy for reactions resulting in novel products. The new methodology has been applied to model rate constants of E2 reactions. It has been demonstrated that the use of the fragment control domain applicability approach significantly increases prediction accuracy of the models. The models obtained with new "mixture" approach performed better than those required either explicit (Condensed Graph of Reaction) or implicit (reaction fingerprints) reaction center labeling.

  17. Detection of airborne carbon nanotubes based on the reactivity of the embedded catalyst.

    Science.gov (United States)

    Neubauer, N; Kasper, G

    2015-01-01

    A previously described method for detecting catalyst particles in workplace air((1,2)) was applied to airborne carbon nanotubes (CNT). It infers the CNT concentration indirectly from the catalytic activity of metallic nanoparticles embedded as part of the CNT production process. Essentially, one samples airborne CNT onto a filter enclosed in a tiny chemical reactor and then initiates a gas-phase catalytic reaction on the sample. The change in concentration of one of the reactants is then determined by an IR sensor as measure of activity. The method requires a one-point calibration with a CNT sample of known mass. The suitability of the method was tested with nickel containing (25 or 38% by weight), well-characterized multi-walled CNT aerosols generated freshly in the lab for each experiment. Two chemical reactions were investigated, of which the oxidation of CO to CO2 at 470°C was found to be more effective, because nearly 100% of the nickel was exposed at that temperature by burning off the carbon, giving a linear relationship between CO conversion and nickel mass. Based on the investigated aerosols, a lower detection limit of 1 μg of sampled nickel was estimated. This translates into sampling times ranging from minutes to about one working day, depending on airborne CNT concentration and catalyst content, as well as sampling flow rate. The time for the subsequent chemical analysis is on the order of minutes, regardless of the time required to accumulate the sample and can be done on site.

  18. Early resident-to-resident physics education in diagnostic radiology.

    Science.gov (United States)

    Kansagra, Akash P

    2014-01-01

    The revised ABR board certification process has updated the method by which diagnostic radiology residents are evaluated for competency in clinical radiologic physics. In this work, the author reports the successful design and implementation of a resident-taught physics course consisting of 5 weekly, hour-long lectures intended for incoming first-year radiology residents in their first month of training. To the author's knowledge, this is the first description of a course designed to provide a very early framework for ongoing physics education throughout residency without increasing the didactic burden on faculty members. Twenty-six first-year residents spanning 2 academic years took the course and reported subjective improvement in their knowledge (90%) and interest (75%) in imaging physics and a high level of satisfaction with the use of senior residents as physics educators. Based on the success of this course and the minimal resources required for implementation, this work may serve as a blueprint for other radiology residency programs seeking to develop revised physics curricula. Copyright © 2014 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  19. An optimal reactive power control strategy for a DFIG-based wind farm to damp the sub-synchronous oscillation of a power system

    DEFF Research Database (Denmark)

    Zhao, Bin; Li, Hui; Wang, Mingyu

    2014-01-01

    This study presents the auxiliary damping control with the reactive power loop on the rotor-side converter of doubly-fed induction generator (DFIG)-based wind farms to depress the sub-synchronous resonance oscillations in nearby turbogenerators. These generators are connected to a series capaciti...

  20. An Adult Education Model of Resident Participation: Building Community Capacity and Strengthening Neighborhood-Based Activities in a Comprehensive Community Initiative (CCI.

    Directory of Open Access Journals (Sweden)

    Daniel Brisson

    2008-12-01

    Full Text Available Comprehensive Community Initiatives (CCIs are of growing interest to social work and the social services field as they are an effort to move away from remediation of individual problems within neighborhoods to a comprehensive change effort that builds resident and institutional capacity for long term sustainability of healthy communities. Built on ongoing lessons learned from the community development field, CCIs are largely foundation supported projects that engage low-income neighborhood residents in a holistic change effort. However, based on what is known about community organizing, CCIs will likely face challenges as long as they involve a top-down approach with an outside funder entering a community to make change. This manuscript frames an adult education model of resident participation that can be used in CCIs and provides a case example illustrating the model in action. A discussion of how the model can be an effective means for communities to take advantage of outside resources while maintaining their power and voice for change is offered in conclusion.

  1. Impact of radiofrequency radiation on DNA damage and antioxidants in peripheral blood lymphocytes of humans residing in the vicinity of mobile phone base stations.

    Science.gov (United States)

    Zothansiama; Zosangzuali, Mary; Lalramdinpuii, Miriam; Jagetia, Ganesh Chandra

    2017-01-01

    Radiofrequency radiations (RFRs) emitted by mobile phone base stations have raised concerns on its adverse impact on humans residing in the vicinity of mobile phone base stations. Therefore, the present study was envisaged to evaluate the effect of RFR on the DNA damage and antioxidant status in cultured human peripheral blood lymphocytes (HPBLs) of individuals residing in the vicinity of mobile phone base stations and comparing it with healthy controls. The study groups matched for various demographic data including age, gender, dietary pattern, smoking habit, alcohol consumption, duration of mobile phone use and average daily mobile phone use. The RF power density of the exposed individuals was significantly higher (p base stations, showed significantly (p base station/s. The analysis of various antioxidants in the plasma of exposed individuals revealed a significant attrition in glutathione (GSH) concentration (p < 0.01), activities of catalase (CAT) (p < 0.001) and superoxide dismutase (SOD) (p < 0.001) and rise in lipid peroxidation (LOO) when compared to controls. Multiple linear regression analyses revealed a significant association among reduced GSH concentration (p < 0.05), CAT (p < 0.001) and SOD (p < 0.001) activities and elevated MN frequency (p < 0.001) and LOO (p < 0.001) with increasing RF power density.

  2. Cost savings from reduced catheter-related bloodstream infection after simulation-based education for residents in a medical intensive care unit.

    Science.gov (United States)

    Cohen, Elaine R; Feinglass, Joe; Barsuk, Jeffrey H; Barnard, Cynthia; O'Donnell, Anna; McGaghie, William C; Wayne, Diane B

    2010-04-01

    Interventions to reduce preventable complications such as catheter-related bloodstream infections (CRBSI) can also decrease hospital costs. However, little is known about the cost-effectiveness of simulation-based education. The aim of this study was to estimate hospital cost savings related to a reduction in CRBSI after simulation training for residents. This was an intervention evaluation study estimating cost savings related to a simulation-based intervention in central venous catheter (CVC) insertion in the Medical Intensive Care Unit (MICU) at an urban teaching hospital. After residents completed a simulation-based mastery learning program in CVC insertion, CRBSI rates declined sharply. Case-control and regression analysis methods were used to estimate savings by comparing CRBSI rates in the year before and after the intervention. Annual savings from reduced CRBSIs were compared with the annual cost of simulation training. Approximately 9.95 CRBSIs were prevented among MICU patients with CVCs in the year after the intervention. Incremental costs attributed to each CRBSI were approximately $82,000 in 2008 dollars and 14 additional hospital days (including 12 MICU days). The annual cost of the simulation-based education was approximately $112,000. Net annual savings were thus greater than $700,000, a 7 to 1 rate of return on the simulation training intervention. A simulation-based educational intervention in CVC insertion was highly cost-effective. These results suggest that investment in simulation training can produce significant medical care cost savings.

  3. Giant Negative Piezoresistive Effect in Diamond-like Carbon and Diamond-like Carbon-Based Nickel Nanocomposite Films Deposited by Reactive Magnetron Sputtering of Ni Target

    DEFF Research Database (Denmark)

    Meškinis, Šaru Nas; Gudaitis, Rimantas; Šlapikas, Kęstutis

    2018-01-01

    deposited by either reactive HIPIMS or dc magnetron sputtering of Ni target was explained by possible clustering of the sp2-bonded carbon and/or formation of areas with the decreased hydrogen content. It was suggested that the tensile stress-induced rearrangements of these conglomerations have resulted......Piezoresistive properties of hydrogenated diamond-like carbon (DLC) and DLC-based nickel nanocomposite (DLC:Ni) films were studied in the range of low concentration of nickel nanoparticles. The films were deposited by reactive high power pulsed magnetron sputtering (HIPIMS) of Ni target, and some...... samples were deposited by direct current (dc) reactive magnetron sputtering for comparison purposes. Raman scattering spectroscopy, energy-dispersive X-ray spectrometry (EDS), and X-ray photoelectron spectroscopy (XPS) were used to study the structure and chemical composition of the films. A four...

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

    Science.gov (United States)

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

    2015-11-06

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

  5. Theoretical study for pyridinium-based ionic liquid 1-ethylpyridinium trifluoroacetate: synthesis mechanism, electronic structure, and catalytic reactivity.

    Science.gov (United States)

    Zhu, Xueying; Cui, Peng; Zhang, Dongju; Liu, Chengbu

    2011-07-28

    By performing density functional theory calculations, we have studied the synthesis mechanism, electronic structure, and catalytic reactivity of a pyridinium-based ionic liquid, 1-ethylpyridinium trifluoroacetate ([epy](+)[CF(3)COO](-)). It is found that the synthesis of the pyridinium salt follows a S(N)2 mechanism. The electronic structural analyses show that multiple H bonds are generally involved in the pyridinium-based ionic liquid, which may play a decisive role for stabilizing the ionic liquid. The cation-anion interaction mainly involves electron transfer between the lone pair of the oxygen atom in the anion and the antibonding orbital of the C*-H bond (C* denotes the carbon atom at the ortho-position of nitrogen atom in the cation). This present work has also given clearly the catalytic mechanism of [epy](+)[CF(3)COO](-) toward to the Diels-Alder (D-A) reaction of acrylonitrile with 2-methyl-1,3-butadiene. Both the cation and anion are shown to play important roles in promoting the D-A reaction. The cation [epy](+), as a Lewis acid, associates the C≡N group by C≡N···H H bond to increase the polarity of the C═C double bond in acrylonitrile, while the anion CF(3)COO(-) links with the methyl group in 2-methyl-1,3-butadiene by C-H···O H bond, which weakens the electron-donating capability of methyl and thereby lowers the energy barrier of the D-A reaction. The present results are expected to provide valuable information for the design and application of pyridinium-based ionic liquids. © 2011 American Chemical Society

  6. Crisis Resources for Emergency Workers (CREW II): results of a pilot study and simulation-based crisis resource management course for emergency medicine residents.

    Science.gov (United States)

    Hicks, Christopher M; Kiss, Alex; Bandiera, Glen W; Denny, Christopher J

    2012-11-01

    Emergency department resuscitation requires the coordinated efforts of an interdisciplinary team. Aviation-based crisis resource management (CRM) training can improve safety and performance during complex events. We describe the development, piloting, and multilevel evaluation of "Crisis Resources for Emergency Workers" (CREW), a simulation-based CRM curriculum for emergency medicine (EM) residents. Curriculum development was informed by an a priori needs assessment survey. We constructed a 1-day course using simulated resuscitation scenarios paired with focused debriefing sessions. Attitudinal shifts regarding team behaviours were assessed using the Human Factors Attitude Survey (HFAS). A subset of 10 residents participated in standardized pre- and postcourse simulated resuscitation scenarios to quantify the effect of CREW training on our primary outcome of CRM performance. Pre/post scenarios were videotaped and scored by two blinded reviewers using a validated behavioural rating scale, the Ottawa CRM Global Rating Scale (GRS). Postcourse survey responses were highly favourable, with the majority of participants reporting that CREW training can reduce errors and improve patient safety. There was a nonsignificant trend toward improved team-based attitudes as assessed by the HFAS (p  =  0.210). Postcourse performance demonstrated a similar trend toward improved scores in all categories on the Ottawa GRS (p  =  0.16). EM residents find simulation-based CRM instruction to be useful, effective, and highly relevant to their practice. Trends toward improved performance and attitudes may have arisen because our study was underpowered to detect a difference. Future efforts should focus on interdisciplinary training and recruiting a larger sample size.

  7. Asthma exacerbation and proximity of residence to major roads: a population-based matched case-control study among the pediatric Medicaid population in Detroit, Michigan

    Directory of Open Access Journals (Sweden)

    Wahl Robert

    2011-04-01

    Full Text Available Abstract Background The relationship between asthma and traffic-related pollutants has received considerable attention. The use of individual-level exposure measures, such as residence location or proximity to emission sources, may avoid ecological biases. Method This study focused on the pediatric Medicaid population in Detroit, MI, a high-risk population for asthma-related events. A population-based matched case-control analysis was used to investigate associations between acute asthma outcomes and proximity of residence to major roads, including freeways. Asthma cases were identified as all children who made at least one asthma claim, including inpatient and emergency department visits, during the three-year study period, 2004-06. Individually matched controls were randomly selected from the rest of the Medicaid population on the basis of non-respiratory related illness. We used conditional logistic regression with distance as both categorical and continuous variables, and examined non-linear relationships with distance using polynomial splines. The conditional logistic regression models were then extended by considering multiple asthma states (based on the frequency of acute asthma outcomes using polychotomous conditional logistic regression. Results Asthma events were associated with proximity to primary roads with an odds ratio of 0.97 (95% CI: 0.94, 0.99 for a 1 km increase in distance using conditional logistic regression, implying that asthma events are less likely as the distance between the residence and a primary road increases. Similar relationships and effect sizes were found using polychotomous conditional logistic regression. Another plausible exposure metric, a reduced form response surface model that represents atmospheric dispersion of pollutants from roads, was not associated under that exposure model. Conclusions There is moderately strong evidence of elevated risk of asthma close to major roads based on the results obtained

  8. Asthma exacerbation and proximity of residence to major roads: a population-based matched case-control study among the pediatric Medicaid population in Detroit, Michigan

    Science.gov (United States)

    2011-01-01

    Background The relationship between asthma and traffic-related pollutants has received considerable attention. The use of individual-level exposure measures, such as residence location or proximity to emission sources, may avoid ecological biases. Method This study focused on the pediatric Medicaid population in Detroit, MI, a high-risk population for asthma-related events. A population-based matched case-control analysis was used to investigate associations between acute asthma outcomes and proximity of residence to major roads, including freeways. Asthma cases were identified as all children who made at least one asthma claim, including inpatient and emergency department visits, during the three-year study period, 2004-06. Individually matched controls were randomly selected from the rest of the Medicaid population on the basis of non-respiratory related illness. We used conditional logistic regression with distance as both categorical and continuous variables, and examined non-linear relationships with distance using polynomial splines. The conditional logistic regression models were then extended by considering multiple asthma states (based on the frequency of acute asthma outcomes) using polychotomous conditional logistic regression. Results Asthma events were associated with proximity to primary roads with an odds ratio of 0.97 (95% CI: 0.94, 0.99) for a 1 km increase in distance using conditional logistic regression, implying that asthma events are less likely as the distance between the residence and a primary road increases. Similar relationships and effect sizes were found using polychotomous conditional logistic regression. Another plausible exposure metric, a reduced form response surface model that represents atmospheric dispersion of pollutants from roads, was not associated under that exposure model. Conclusions There is moderately strong evidence of elevated risk of asthma close to major roads based on the results obtained in this population-based

  9. Preparation of alumina-chromium composites by reactive hot-pressing Al + Cr2O3 based powders

    International Nuclear Information System (INIS)

    Osso, D.; Mocellin, A.; Caer, G. le; Pianelli, A.

    1993-01-01

    Chromium-Alumina based composites have been obtained by reactive sintering under load and vacuum of various powder blends. The starting mixtures have been prepared from commercially available aluminium metal, chromium and aluminium oxides, and a thermally unstable titanium compound respectively. Differential thermal analysis (DTA) and differential calorimetry (DSC) as well as X-ray diffraction were used to identify chemical transformations taking place within the system. Microstructure changes were observed via scanning electron microscopy (SEM) with an energy dispersive spectroscopy system (EDS). Chemical reactions in relevant binary subsystems have been investigated qualitatively in order to understand the course of events in the more complex quaternary mixtures. The possibilities of forming intermetallic phases in both the Al-Ti and Cr-Ti systems and of dissolving some Cr 2 O 3 into the product Al 2 O 3 phase have been considered. The influence of such parameters as thermal schedule and initial aluminium content on those side reactions and the resulting microstructures was investigated. (orig.)

  10. Developing the next generation of graphene-based platforms for cancer therapeutics: The potential role of reactive oxygen species.

    Science.gov (United States)

    Tabish, Tanveer A; Zhang, Shaowei; Winyard, Paul G

    2018-05-01

    Graphene has a promising future in applications such as disease diagnosis, cancer therapy, drug/gene delivery, bio-imaging and antibacterial approaches owing to graphene's unique physical, chemical and mechanical properties alongside minimal toxicity to normal cells, and photo-stability. However, these unique features and bioavailability of graphene are fraught with uncertainties and concerns for environmental and occupational exposure. Changes in the physicochemical properties of graphene affect biological responses including reactive oxygen species (ROS) production. Lower production of ROS by currently available theranostic agents, e.g. magnetic nanoparticles, carbon nanotubes, gold nanostructures or polymeric nanoparticles, restricts their clinical application in cancer therapy. Oxidative stress induced by graphene accumulated in living organs is due to acellular factors which may affect physiological interactions between graphene and target tissues and cells. Acellular factors include particle size, shape, surface charge, surface containing functional groups, and light activation. Cellular responses such as mitochondrial respiration, graphene-cell interactions and pH of the medium are also determinants of ROS production. The mechanisms of ROS production by graphene and the role of ROS for cancer treatment, are poorly understood. The aim of this review is to set the theoretical basis for further research in developing graphene-based theranostic platforms. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

  11. Developing the next generation of graphene-based platforms for cancer therapeutics: The potential role of reactive oxygen species

    Directory of Open Access Journals (Sweden)

    Tanveer A. Tabish

    2018-05-01

    Full Text Available Graphene has a promising future in applications such as disease diagnosis, cancer therapy, drug/gene delivery, bio-imaging and antibacterial approaches owing to graphene's unique physical, chemical and mechanical properties alongside minimal toxicity to normal cells, and photo-stability. However, these unique features and bioavailability of graphene are fraught with uncertainties and concerns for environmental and occupational exposure. Changes in the physicochemical properties of graphene affect biological responses including reactive oxygen species (ROS production. Lower production of ROS by currently available theranostic agents, e.g. magnetic nanoparticles, carbon nanotubes, gold nanostructures or polymeric nanoparticles, restricts their clinical application in cancer therapy. Oxidative stress induced by graphene accumulated in living organs is due to acellular factors which may affect physiological interactions between graphene and target tissues and cells. Acellular factors include particle size, shape, surface charge, surface containing functional groups, and light activation. Cellular responses such as mitochondrial respiration, graphene-cell interactions and pH of the medium are also determinants of ROS production. The mechanisms of ROS production by graphene and the role of ROS for cancer treatment, are poorly understood. The aim of this review is to set the theoretical basis for further research in developing graphene-based theranostic platforms.

  12. Genetic and caregiving-based contributions to infant attachment: unique associations with distress reactivity and attachment security.

    Science.gov (United States)

    Raby, K Lee; Cicchetti, Dante; Carlson, Elizabeth A; Cutuli, J J; Englund, Michelle M; Egeland, Byron

    2012-09-01

    In the longitudinal study reported here, we examined genetic and caregiving-based contributions to individual differences in infant attachment classifications. For 154 mother-infant pairs, we rated mothers' responsiveness to their 6-month-old infants during naturalistic interactions and classified infants' attachment organization at 12 and 18 months using the Strange Situation procedure. These infants were later genotyped with respect to the serotonin-transporter-linked polymorphic region (5-HTTLPR). Maternal responsiveness uniquely predicted infants' attachment security. Infants' 5-HTTLPR variation uniquely predicted their subtype of attachment security at 12 months and their subtype of attachment insecurity at 12 and 18 months. The short allele for 5-HTTLPR was associated with attachment classifications characterized by higher emotional distress. These findings suggest that 5-HTTLPR variation contributes to infants' emotional reactivity and that the degree to which caregivers are responsive influences how effectively infants use their caregivers for emotion regulation. Theoretical implications for the study of genetic and caregiving influences are discussed.

  13. Process-based reactive transport model to quantify arsenic mobility during aquifer storage and recovery of potable water.

    Science.gov (United States)

    Wallis, Ilka; Prommer, Henning; Pichler, Thomas; Post, Vincent; Norton, Stuart B; Annable, Michael D; Simmons, Craig T

    2011-08-15

    Aquifer storage and recovery (ASR) is an aquifer recharge technique in which water is injected in an aquifer during periods of surplus and withdrawn from the same well during periods of deficit. It is a critical component of the long-term water supply plan in various regions, including Florida, USA. Here, the viability of ASR as a safe and cost-effective water resource is currently being tested at a number of sites due to elevated arsenic concentrations detected during groundwater recovery. In this study, we developed a process-based reactive transport model of the coupled physical and geochemical mechanisms controlling the fate of arsenic during ASR. We analyzed multicycle hydrochemical data from a well-documented affected southwest Floridan site and evaluated a conceptual/numerical model in which (i) arsenic is initially released during pyrite oxidation triggered by the injection of oxygenated water (ii) then largely complexes to neo-formed hydrous ferric oxides before (iii) being remobilized during recovery as a result of both dissolution of hydrous ferric oxides and displacement from sorption sites by competing anions.

  14. Lack of cross-reactivity between 5-aminosalicylic acid-based drugs: a case report and review of the literature.

    Science.gov (United States)

    Kung, Shiang-Ju; Choudhary, Cuckoo; McGeady, Stephen J; Cohn, John R

    2006-09-01

    5-Aminosalicylic acid (5-ASA)-containing drugs are the mainstay of therapy in inflammatory bowel disease, but adverse reactions to these medications are relatively common. Because there may be a lack of cross-reactivity among the various 5-ASA formulations, treatment with alternative preparations is sometimes possible even after an apparent allergic reaction to a 5-ASA product. To describe a patient with a possible allergy to 2 different 5-ASA drugs who tolerated a third. A 27-year-old man with Crohn disease developed a rash while taking mesalamine (Pentasa and Asacol). Treatment with 5-ASA products was discontinued, and 6-mercaptopurine and prednisone were prescribed. He then experienced multiorgan failure secondary to herpes simplex infection, which required discontinuation of the immunosuppressive therapy. After recovery from the acute infection, he underwent successful graded challenge with balsalazide. The patient continued treatment with balsalazide for 9 months, with good control of his inflammatory bowel disease and no adverse effects. Adverse reactions to 1 or more 5-ASA medications do not necessarily preclude the use of others in the same class. A treatment algorithm for patients with adverse reactions to 5-ASA is outlined based on the case report and review of the literature.

  15. A reactive, scalable, and transferable model for molecular energies from a neural network approach based on local information

    Science.gov (United States)

    Unke, Oliver T.; Meuwly, Markus

    2018-06-01

    Despite the ever-increasing computer power, accurate ab initio calculations for large systems (thousands to millions of atoms) remain infeasible. Instead, approximate empirical energy functions are used. Most current approaches are either transferable between different chemical systems, but not particularly accurate, or they are fine-tuned to a specific application. In this work, a data-driven method to construct a potential energy surface based on neural networks is presented. Since the total energy is decomposed into local atomic contributions, the evaluation is easily parallelizable and scales linearly with system size. With prediction errors below 0.5 kcal mol-1 for both unknown molecules and configurations, the method is accurate across chemical and configurational space, which is demonstrated by applying it to datasets from nonreactive and reactive molecular dynamics simulations and a diverse database of equilibrium structures. The possibility to use small molecules as reference data to predict larger structures is also explored. Since the descriptor only uses local information, high-level ab initio methods, which are computationally too expensive for large molecules, become feasible for generating the necessary reference data used to train the neural network.

  16. Halogen bonding from a hard and soft acids and bases perspective: investigation by using density functional theory reactivity indices.

    Science.gov (United States)

    Pinter, Balazs; Nagels, Nick; Herrebout, Wouter A; De Proft, Frank

    2013-01-07

    Halogen bonds between the trifluoromethyl halides CF(3)Cl, CF(3)Br and CF(3)I, and dimethyl ether, dimethyl sulfide, trimethylamine and trimethyl phosphine were investigated using Pearson's hard and soft acids and bases (HSAB) concept with conceptual DFT reactivity indices, the Ziegler-Rauk-type energy-decomposition analysis, the natural orbital for chemical valence (NOCV) framework and the non-covalent interaction (NCI) index. It is found that the relative importance of electrostatic and orbital (charge transfer) interactions varies as a function of both the donor and acceptor molecules. Hard and soft interactions were distinguished and characterised by atomic charges, electrophilicity and local softness indices. Dual-descriptor plots indicate an orbital σ hole on the halogen similar to the electrostatic σ hole manifested in the molecular electrostatic potential. The predicted high halogen-bond-acceptor affinity of N-heterocyclic carbenes was evidenced in the highest complexation energy for the hitherto unknown CF(3) I·NHC complex. The dominant NOCV orbital represents an electron-density deformation according to a n→σ*-type interaction. The characteristic signal found in the reduced density gradient versus electron-density diagram corresponds to the non-covalent interaction between contact atoms in the NCI plots, which is the manifestation of halogen bonding within the NCI theory. The unexpected C-X bond strengthening observed in several cases was rationalised within the molecular orbital framework. Copyright © 2013 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  17. Adipokines, C-reactive protein and Amyotrophic Lateral Sclerosis - results from a population- based ALS registry in Germany.

    Science.gov (United States)

    Nagel, Gabriele; Peter, Raphael S; Rosenbohm, Angela; Koenig, Wolfgang; Dupuis, Luc; Rothenbacher, Dietrich; Ludolph, Albert C

    2017-06-29

    To investigate the associations of leptin, adiponectin and high-sensitive (hs) C-reactive protein (CRP) with risk and prognosis of amyotrophic lateral sclerosis (ALS). Data from a population-based case-control study in Southern Germany (10/2010-6/2014) of 289 ALS patients (mean age of 65.7 (SD 10.5) years, 59.5% men) and 506 controls were included. During median follow-up of 14.5 months of 279 ALS patients 104 (53.9% men, 68.9 (10.3) years) died. Serum samples were measured for leptin, adiponectin and hs-CRP. Conditional logistic regression was used to estimate ALS risk. Survival models were used to appraise the prognostic value. ALS patients were characterized by lower levels of school education, BMI and smoking prevalence. Adjusted for covariates, leptin was inversely associated with ALS risk (top vs. bottom quartile: OR 0.49; 95% CI 0.29-0.80), while for adiponectin a positive association was found (OR 2.89; 95% CI 1.78-4.68). Among ALS patients increasing leptin concentrations were associated with longer survival (p for trend 0.002), while for adiponectin no association was found (p for trend 0.55). For hs-CRP no association was found. Leptin and adiponectin, two key hormones regulating energy metabolism, were strongly and independently related with ALS risk. Leptin levels were further negatively related with overall survival of ALS patients.

  18. Phosphate-based glass fiber vs. bulk glass: Change in fiber optical response to probe in vitro glass reactivity.

    Science.gov (United States)

    Massera, J; Ahmed, I; Petit, L; Aallos, V; Hupa, L

    2014-04-01

    This paper investigates the effect of fiber drawing on the thermal and structural properties as well as on the glass reactivity of a phosphate glass in tris(hydroxymethyl)aminomethane-buffered (TRIS) solution and simulated body fluid (SBF). The changes induced in the thermal properties suggest that the fiber drawing process leads to a weakening and probable re-orientation of the POP bonds. Whereas the fiber drawing did not significantly impact the release of P and Ca, an increase in the release of Na into the solution was noticed. This was probably due to small structural reorientations occurring during the fiber drawing process and to a slight diffusion of Na to the fiber surface. Both the powders from the bulk and the glass fibers formed a Ca-P surface layer when immersed in SBF and TRIS. The layer thickness was higher in the calcium and phosphate supersaturated SBF than in TRIS. This paper for the first time presents the in vitro reactivity and optical response of a phosphate-based bioactive glass (PBG) fiber when immersed in SBF. The light intensity remained constant for the first 48h after which a decrease with three distinct slopes was observed: the first decrease between 48 and 200h of immersion could be correlated to the formation of the Ca-P layer at the fiber surface. After this a faster decrease in light transmission was observed from 200 to ~425h in SBF. SEM analysis suggested that after 200h, the surface of the fiber was fully covered by a thin Ca-P layer which is likely to scatter light. For immersion times longer than ~425h, the thickness of the Ca-P layer increased and thus acted as a barrier to the dissolution process limiting further reduction in light transmission. The tracking of light transmission through the PBG fiber allowed monitoring of the fiber dissolution in vitro. These results are essential in developing new bioactive fiber sensors that can be used to monitor bioresponse in situ. Copyright © 2014 Elsevier B.V. All rights reserved.

  19. Microstructure and strain rate effects on the mechanical behavior of particle reinforced epoxy-based reactive materials

    Science.gov (United States)

    White, Bradley William

    The effects of reactive metal particles on the microstructure and mechanical properties of epoxy-based composites is investigated in this work. Particle reinforced polymer composites show promise as structural energetic materials that can provide structural strength while simultaneously being capable of releasing large amounts of chemical energy through highly exothermic reactions occurring between the particles and with the matrix. This advanced class of materials is advantageous due to the decreased amount of high density inert casings needed for typical energetic materials and for their ability to increase payload expectancy and decrease collateral damage. Structural energetic materials can be comprised of reactive particles that undergo thermite or intermetallic reactions. In this work nickel (Ni) and aluminum (Al) particles were chosen as reinforcing constituents due to their well characterized mechanical and energetic properties. Although, the reactivity of nickel and aluminum is well characterized, the effects of their particle size, volume fractions, and spatial distribution on the mechanical behavior of the epoxy matrix and composite, across a large range of strain rates, are not well understood. To examine these effects castings of epoxy reinforced with 20--40 vol.% Al and 0--10 vol.% Ni were prepared, while varying the aluminum nominal particle size from 5 to 50 mum and holding the nickel nominal particle size constant at 50 mum. Through these variations eight composite materials were produced, possessing unique microstructures exhibiting different particle spatial distributions and constituent makeup. In order to correlate the microstructure to the constitutive response of the composites, techniques such as nearest-neighbor distances, and multiscale analysis of area fractions (MSAAF) were used to quantitatively characterize the microstructures. The composites were investigated under quasi-static and dynamic compressive loading conditions to characterize

  20. An Optimal Reactive Power Control Strategy for a DFIG-Based Wind Farm to Damp the Sub-Synchronous Oscillation of a Power System

    Directory of Open Access Journals (Sweden)

    Bin Zhao

    2014-05-01

    Full Text Available This study presents the auxiliary damping control with the reactive power loop on the rotor-side converter of doubly-fed induction generator (DFIG-based wind farms to depress the sub-synchronous resonance oscillations in nearby turbogenerators. These generators are connected to a series capacitive compensation transmission system. First, the damping effect of the reactive power control of the DFIG-based wind farms was theoretically analyzed, and a transfer function between turbogenerator speed and the output reactive power of the wind farms was introduced to derive the analytical expression of the damping coefficient. The phase range to obtain positive damping was determined. Second, the PID phase compensation parameters of the auxiliary damping controller were optimized by a genetic algorithm to obtain the optimum damping in the entire subsynchronous frequency band. Finally, the validity and effectiveness of the proposed auxiliary damping control were demonstrated on a modified version of the IEEE first benchmark model by time domain simulation analysis with the use of DigSILENT/PowerFactory. Theoretical analysis and simulation results show that this derived damping factor expression and the condition of the positive damping can effectively analyze their impact on the system sub-synchronous oscillations, the proposed wind farms reactive power additional damping control strategy can provide the optimal damping effect over the whole sub-synchronous frequency band, and the control effect is better than the active power additional damping control strategy based on the power system stabilizator.

  1. Identification of protective postexposure mycobacterial vaccine antigens using an immunosuppression-based reactivation model in the zebrafish

    Directory of Open Access Journals (Sweden)

    Henna Myllymäki

    2018-03-01

    Full Text Available Roughly one third of the human population carries a latent Mycobacterium tuberculosis infection, with a 5-10% lifetime risk of reactivation to active tuberculosis and further spreading the disease. The mechanisms leading to the reactivation of a latent Mycobacterium tuberculosis infection are insufficiently understood. Here, we used a natural fish pathogen, Mycobacterium marinum, to model the reactivation of a mycobacterial infection in the adult zebrafish (Danio rerio. A low-dose intraperitoneal injection (∼40 colony-forming units led to a latent infection, with mycobacteria found in well-organized granulomas surrounded by a thick layer of fibrous tissue. A latent infection could be reactivated by oral dexamethasone treatment, which led to disruption of the granuloma structures and dissemination of bacteria. This was associated with the depletion of lymphocytes, especially CD4+ T cells. Using this model, we verified that ethambutol is effective against an active disease but not a latent infection. In addition, we screened 15 mycobacterial antigens as postexposure DNA vaccines, of which RpfB and MMAR_4207 reduced bacterial burdens upon reactivation, as did the Ag85-ESAT-6 combination. In conclusion, the adult zebrafish-M. marinum infection model provides a feasible tool for examining the mechanisms of reactivation in mycobacterial infections, and for screening vaccine and drug candidates. This article has an associated First Person interview with the first author of the paper.

  2. [Hyper-reactive malarial splenomegaly].

    Science.gov (United States)

    Maazoun, F; Deschamps, O; Barros-Kogel, E; Ngwem, E; Fauchet, N; Buffet, P; Froissart, A

    2015-11-01

    Hyper-reactive malarial splenomegaly is a rare and severe form of chronic malaria. This condition is a common cause of splenomegaly in endemic areas. The pathophysiology of hyper-reactive malarial splenomegaly involves an intense immune reaction (predominantly B cell-driven) to repeated/chronic infections with Plasmodium sp. The diagnosis may be difficult, due to a poorly specific clinical presentation (splenomegaly, fatigue, cytopenias), a long delay between residence in a malaria-endemic area and onset of symptoms, and a frequent absence of parasites on conventional thin and thick blood smears. A strongly contributive laboratory parameter is the presence of high levels of total immunoglobulin M. When the diagnostic of hyper-reactive malarial splenomegaly is considered, search for anti-Plasmodium antibodies and Plasmodium nucleic acids (genus and species) by PCR is useful. Diagnosis of hyper-reactive malarial splenomegaly relies on the simultaneous presence of epidemiological, clinical, biological and follow-up findings. Regression of both splenomegaly and hypersplenism following antimalarial therapy allows the differential diagnosis with splenic lymphoma, a common complication of hyper-reactive malarial splenomegaly. Although rare in Western countries, hyper-reactive malarial splenomegaly deserves increased medical awareness to reduce the incidence of incorrect diagnosis, to prevent progression to splenic lymphoma and to avoid splenectomy. Copyright © 2015 Société nationale française de médecine interne (SNFMI). Published by Elsevier SAS. All rights reserved.

  3. Prognostic value of the C-reactive protein to albumin ratio: a novel inflammation-based prognostic indicator in osteosarcoma

    Directory of Open Access Journals (Sweden)

    Li YJ

    2017-11-01

    Full Text Available Yong-Jiang Li,1,* Kai Yao,2,* Min-Xun Lu,2 Wen-Biao Zhang,1 Cong Xiao,2 Chong-Qi Tu2 1Department of Oncology, 2Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, People’s Republic of China *These authors contributed equally to this work Abstract: The prognostic role of the C-reactive protein to albumin ratio (CRP/Alb ratio in patients with osteosarcoma has not been investigated. A total of 216 osteosarcoma patients were enrolled in the study. Univariate and multivariate survival analyses between the groups were performed and Kaplan–Meier analysis was conducted to plot the survival curves. Receiver operating characteristic curves were generated and areas under the curve (AUCs were compared to assess the discriminatory ability of the inflammation-based indicators, including CRP/Alb ratio, Glasgow prognostic score (GPS, neutrophil–lymphocyte ratio (NLR, and platelet–lymphocyte ratio (PLR. The optimal cutoff value was 0.210 for CRP/Alb ratio with a Youden index of 0.319. Higher values of CRP/Alb ratio were significantly associated with poorer overall survival in univariate (HR =2.62, 95% CI =1.70–4.03; P<0.001 and multivariate (HR =2.21, 95% CI =1.40–3.49; P=0.001 analyses. In addition, the CRP/Alb ratio had significantly higher AUC values compared with GPS (P=0.003, NLR (P<0.001, and PLR (P<0.001. The study demonstrated that the CRP/Alb ratio is an effective inflammation-based prognostic indicator in osteosarcoma, which potentially has a discriminatory ability superior to that of other inflammatory indicators including GPS, NLR, and PLR. Keywords: osteosarcoma, CRP to albumin ratio, prognosis

  4. An Integral Model to Provide Reactive and Proactive Services in an Academic CSIRT Based on Business Intelligence

    Directory of Open Access Journals (Sweden)

    Walter Fuertes

    2017-11-01

    Full Text Available Cyber-attacks have increased in severity and complexity. That requires, that the CERT/CSIRT research and develops new security tools. Therefore, our study focuses on the design of an integral model based on Business Intelligence (BI, which provides reactive and proactive services in a CSIRT, in order to alert and reduce any suspicious or malicious activity on information systems and data networks. To achieve this purpose, a solution has been assembled, that generates information stores, being compiled from a continuous network transmission of several internal and external sources of an organization. However, it contemplates a data warehouse, which is focused like a correlator of logs, being formed by the information of feeds with diverse formats. Furthermore, it analyzed attack detection and port scanning, obtained from sensors such as Snort and Passive Vulnerability Scanner, which are stored in a database, where the logs have been generated by the systems. With such inputs, we designed and implemented BI systems using the phases of the Ralph Kimball methodology, ETL and OLAP processes. In addition, a software application has been implemented using the SCRUM methodology, which allowed to link the obtained logs to the BI system for visualization in dynamic dashboards, with the purpose of generating early alerts and constructing complex queries using the user interface through objects structures. The results demonstrate, that this solution has generated early warnings based on the level of criticality and level of sensitivity of malware and vulnerabilities as well as monitoring efficiency, increasing the level of security of member institutions.

  5. A KDE-Based Random Walk Method for Modeling Reactive Transport With Complex Kinetics in Porous Media

    Science.gov (United States)

    Sole-Mari, Guillem; Fernà ndez-Garcia, Daniel; Rodríguez-Escales, Paula; Sanchez-Vila, Xavier

    2017-11-01

    In recent years, a large body of the literature has been devoted to study reactive transport of solutes in porous media based on pure Lagrangian formulations. Such approaches have also been extended to accommodate second-order bimolecular reactions, in which the reaction rate is proportional to the concentrations of the reactants. Rather, in some cases, chemical reactions involving two reactants follow more complicated rate laws. Some examples are (1) reaction rate laws written in terms of powers of concentrations, (2) redox reactions incorporating a limiting term (e.g., Michaelis-Menten), or (3) any reaction where the activity coefficients vary with the concentration of the reactants, just to name a few. We provide a methodology to account for complex kinetic bimolecular reactions in a fully Lagrangian framework where each particle represents a fraction of the total mass of a specific solute. The method, built as an extension to the second-order case, is based on the concept of optimal Kernel Density Estimator, which allows the concentrations to be written in terms of particle locations, hence transferring the concept of reaction rate to that of particle location distribution. By doing so, we can update the probability of particles reacting without the need to fully reconstruct the concentration maps. The performance and convergence of the method is tested for several illustrative examples that simulate the Advection-Dispersion-Reaction Equation in a 1-D homogeneous column. Finally, a 2-D application example is presented evaluating the need of fully describing non-bilinear chemical kinetics in a randomly heterogeneous porous medium.

  6. Reactive Programming in Standard ML

    OpenAIRE

    Pucella, Riccardo

    2004-01-01

    Reactive systems are systems that maintain an ongoing interaction with their environment, activated by receiving input events from the environment and producing output events in response. Modern programming languages designed to program such systems use a paradigm based on the notions of instants and activations. We describe a library for Standard ML that provides basic primitives for programming reactive systems. The library is a low-level system upon which more sophisticated reactive behavi...

  7. Kinetics of biological decolorisation of anthraquinone based Reactive Blue 19 using an isolated strain of Enterobacter sp.F NCIM 5545.

    Science.gov (United States)

    Holkar, Chandrakant R; Pandit, Aniruddha B; Pinjari, Dipak V

    2014-12-01

    In the present study, an attempt was made to evaluate the bacterial decolorisation of Reactive Blue 19 by an Enterobacter sp.F which was isolated from a mixed culture from anaerobic digester for biogas production. Phenotypic characterization and phylogenetic analysis based on DNA sequencing comparisons indicate that Enterobacter sp.F was 99.7% similar to Enterobacter cloacae ATCC13047. The kinetics of Reactive Blue 19 dye decolorisation by bacterium had been estimated. Effects of substrate concentration, oxygen, temperature, pH, glucose and glucose to microbe weight ratio on the rate of decolorisation were investigated to understand key factor that determines the performance of dye decolorisation. The maximum decolorisation efficiency of Reactive Blue 19 was 90% over period of 24 h for optimized parameter. To the best of our knowledge, this research study is the report where Enterobacter sp.F has been reported with about 90% decolorizing ability against anthraquinone based Reactive Blue 19 dye. Copyright © 2014 Elsevier Ltd. All rights reserved.

  8. A new islanding detection technique for multiple mini hydro based on rate of change of reactive power and load connecting strategy

    International Nuclear Information System (INIS)

    Laghari, J.A.; Mokhlis, H.; Bakar, A.H.A.; Karimi, M.

    2013-01-01

    Highlights: • The requirement of DG interconnection with existing power system is discussed. • Various islanding detection techniques are discussed with their merits and demerits. • New islanding detection strategy is proposed for multiple mini hydro type DGs. • The proposed strategy is based on dq/dt and load connecting strategy. • The effectiveness of strategy is verified on various other cases. - Abstract: The interconnection of distributed generation (DG) into distribution networks is undergoing a rapid global expansion. It enhances the system’s reliability, while simultaneously reduces pollution problems related to the generation of electrical power. To fully utilize the benefits of DGs, certain technical issues need to be addressed. One of the most important issues in this context is islanding detection. This paper presents a new islanding detection technique that is suitable for multiple mini-hydro type DG units. The proposed strategy is based on the rate of change of reactive power and load connecting strategy to detect islanding within the system. For a large power mismatch, islanding is detected by rate of change of reactive power only. However, for a close power mismatch, the rate of change of reactive power initiates a load connecting strategy, which in turn alters the load on the distribution network. This load variation in the distribution network causes a variation in the rate of change of reactive power, which is utilized to distinguish islanding and other events. The simulation results show that the proposed strategy is effective in detecting islanding occurrence in a distribution network

  9. Reactive power compensator

    Science.gov (United States)

    El-Sharkawi, Mohamed A.; Venkata, Subrahmanyam S.; Chen, Mingliang; Andexler, George; Huang, Tony

    1992-01-01

    A system and method for determining and providing reactive power compensation for an inductive load. A reactive power compensator (50,50') monitors the voltage and current flowing through each of three distribution lines (52a, 52b, 52c), which are supplying three-phase power to one or more inductive loads. Using signals indicative of the current on each of these lines when the voltage waveform on the line crosses zero, the reactive power compensator determines a reactive power compensator capacitance that must be connected to the lines to maintain a desired VAR level, power factor, or line voltage. Alternatively, an operator can manually select a specific capacitance for connection to each line, or the capacitance can be selected based on a time schedule. The reactive power compensator produces control signals, which are coupled through optical fibers (102/106) to a switch driver (110, 110') to select specific compensation capacitors (112) for connections to each line. The switch driver develops triggering signals that are supplied to a plurality of series-connected solid state switches (350), which control charge current in one direction in respect to ground for each compensation capacitor. During each cycle, current flows from ground to charge the capacitors as the voltage on the line begins to go negative from its positive peak value. The triggering signals are applied to gate the solid state switches into a conducting state when the potential on the lines and on the capacitors reaches a negative peak value, thereby minimizing both the potential difference and across the charge current through the switches when they begin to conduct. Any harmonic distortion on the potential and current carried by the lines is filtered out from the current and potential signals used by the reactive power compensator so that it does not affect the determination of the required reactive compensation.

  10. Reactive power compensator

    Energy Technology Data Exchange (ETDEWEB)

    El-Sharkawi, Mohamed A. (Renton, WA); Venkata, Subrahmanyam S. (Woodinville, WA); Chen, Mingliang (Kirkland, WA); Andexler, George (Everett, WA); Huang, Tony (Seattle, WA)

    1992-01-01

    A system and method for determining and providing reactive power compensation for an inductive load. A reactive power compensator (50,50') monitors the voltage and current flowing through each of three distribution lines (52a, 52b, 52c), which are supplying three-phase power to one or more inductive loads. Using signals indicative of the current on each of these lines when the voltage waveform on the line crosses zero, the reactive power compensator determines a reactive power compensator capacitance that must be connected to the lines to maintain a desired VAR level, power factor, or line voltage. Alternatively, an operator can manually select a specific capacitance for connection to each line, or the capacitance can be selected based on a time schedule. The reactive power compensator produces control signals, which are coupled through optical fibers (102/106) to a switch driver (110, 110') to select specific compensation capacitors (112) for connections to each line. The switch driver develops triggering signals that are supplied to a plurality of series-connected solid state switches (350), which control charge current in one direction in respect to ground for each compensation capacitor. During each cycle, current flows from ground to charge the capacitors as the voltage on the line begins to go negative from its positive peak value. The triggering signals are applied to gate the solid state switches into a conducting state when the potential on the lines and on the capacitors reaches a negative peak value, thereby minimizing both the potential difference and across the charge current through the switches when they begin to conduct. Any harmonic distortion on the potential and current carried by the lines is filtered out from the current and potential signals used by the reactive power compensator so that it does not affect the determination of the required reactive compensation.

  11. Ambulatory-based education in internal medicine: current organization and implications for transformation. Results of a national survey of resident continuity clinic directors.

    Science.gov (United States)

    Nadkarni, Mohan; Reddy, Siddharta; Bates, Carol K; Fosburgh, Blair; Babbott, Stewart; Holmboe, Eric

    2011-01-01

    Many have called for ambulatory training redesign in internal medicine (IM) residencies to increase primary care career outcomes. Many believe dysfunctional, clinic environments are a key barrier to meaningful ambulatory education, but little is actually known about the educational milieu of continuity clinics nationwide. We wished to describe the infrastructure and educational milieu at resident continuity clinics and assess clinic readiness to meet new IM-RRC requirements. National survey of ACGME accredited IM training programs. Directors of academic and community-based continuity clinics. Two hundred and twenty-one out of 365 (62%) of clinic directors representing 49% of training programs responded. Wide variation amongst continuity clinics in size, structure and educational organization exist. Clinics below the 25th percentile of total clinic sessions would not meet RRC-IM requirements for total number of clinic sessions. Only two thirds of clinics provided a longitudinal mentor. Forty-three percent of directors reported their trainees felt stressed in the clinic environment and 25% of clinic directors felt overwhelmed. The survey used self reported data and was not anonymous. A slight predominance of larger clinics and university based clinics responded. Data may not reflect changes to programs made since 2008. This national survey demonstrates that the continuity clinic experience varies widely across IM programs, with many sites not yet meeting new ACGME requirements. The combination of disadvantaged and ill patients with inadequately resourced clinics, stressed residents, and clinic directors suggests that many sites need substantial reorganization and institutional commitment.New paradigms, encouraged by ACGME requirement changes such as increased separation of inpatient and outpatient duties are needed to improve the continuity clinic experience.

  12. Comparative evaluation of particle properties, formation of reactive oxygen species and genotoxic potential of tungsten carbide based nanoparticles in vitro

    Energy Technology Data Exchange (ETDEWEB)

    Kuehnel, Dana, E-mail: dana.kuehnel@ufz.de [Department of Bioanalytical Ecotoxicology, Helmholtz-Centre for Environmental Research Leipzig - UFZ, Permoserstr. 15, 04318 Leipzig (Germany); Scheffler, Katja [Department of Bioanalytical Ecotoxicology, Helmholtz-Centre for Environmental Research Leipzig - UFZ, Permoserstr. 15, 04318 Leipzig (Germany); Department of Cell Techniques and Applied Stem Cell Biology, University of Leipzig, Deutscher Platz 5, 04103 Leipzig (Germany); Wellner, Peggy [Department of Bioanalytical Ecotoxicology, Helmholtz-Centre for Environmental Research Leipzig - UFZ, Permoserstr. 15, 04318 Leipzig (Germany); Meissner, Tobias; Potthoff, Annegret [Fraunhofer-Institute for Ceramic Technologies and Systems (IKTS), Winterbergstr. 28, 01277 Dresden (Germany); Busch, Wibke [Department of Bioanalytical Ecotoxicology, Helmholtz-Centre for Environmental Research Leipzig - UFZ, Permoserstr. 15, 04318 Leipzig (Germany); Springer, Armin [Centre for Translational Bone, Cartilage and Soft Tissue Research, University Hospital Carl Gustav Carus, Technical University Dresden, Fetscherstrasse 74, 01307 Dresden (Germany); Schirmer, Kristin [Eawag, Swiss Federal Institute of Aquatic Science and Technology, 8600 Duebendorf (Switzerland); EPF Lausanne, School of Architecture, Civil and Environmental Engineering, 1015 Lausanne (Switzerland); ETH Zuerich, Institute of Biogeochemistry and Pollutant Dynamics, 8092 Zuerich (Switzerland)

    2012-08-15

    Highlights: Black-Right-Pointing-Pointer Assessment of toxic potential of tungsten carbide-based nanoparticles. Black-Right-Pointing-Pointer Evaluation of ROS and micronuclei induction of three hard metal nanomaterials. Black-Right-Pointing-Pointer Dependency of observed toxic effects on the materials physical-chemical properties. Black-Right-Pointing-Pointer Differences in several particle properties seem to modulate the biological response. - Abstract: Tungsten carbide (WC) and cobalt (Co) are constituents of hard metals and are used for the production of extremely hard tools. Previous studies have identified greater cytotoxic potential of WC-based nanoparticles if particles contained Co. The aim of this study was to investigate whether the formation of reactive oxygen species (ROS) and micronuclei would help explain the impact on cultured mammalian cells by three different tungsten-based nanoparticles (WC{sub S}, WC{sub L}, WC{sub L}-Co (S: small; L: large)). The selection of particles allowed us to study the influence of particle properties, e.g. surface area, and the presence of Co on the toxicological results. WC{sub S} and WC{sub L}/WC{sub L}-Co differed in their crystalline structure and surface area, whereas WC{sub S}/WC{sub L} and WC{sub L}-Co differed in their cobalt content. WC{sub L} and WC{sub L}-Co showed neither a genotoxic potential nor ROS induction. Contrary to that, WC{sub S} nanoparticles induced the formation of both ROS and micronuclei. CoCl{sub 2} was tested in relevant concentrations and induced no ROS formation, but increased the rate of micronuclei at concentrations exceeding those present in WC{sub L}-Co. In conclusion, ROS and micronuclei formation could not be associated with the presence of Co in the WC-based particles. The contrasting responses elicited by WC{sub S} vs. WC{sub L} appear to be due to large differences in crystalline structure.

  13. Web-based sex diaries and young adult men who have sex with men: assessing feasibility, reactivity, and data agreement.

    Science.gov (United States)

    Glick, Sara Nelson; Winer, Rachel L; Golden, Matthew R

    2013-10-01

    We compared quantitative diary data with retrospective survey data collected from a cohort of young adult men who have sex with men (MSM) in Seattle, Washington. Ninety-five MSM, aged 16-30 years, completed web-based surveys every 3 months and were randomized to 4 diary submission schedules: every 2 weeks, once a week, twice a week, or never. We calculated diary completion rates and assessed agreement between daily diary data and aggregate retrospective survey data for sexual behavior measures. Over 6 months, 78 % of participants completed at least 80 % of their diary days, and the 2-week schedule had the highest and most consistent completion rate. The majority of sexual behavior and substance use measures had strong agreement between the diary and retrospective survey data (i.e., kappa >0.80 or concordance correlation coefficient ≥0.75), although we observed poorer agreement for some measures of numbers of anal sex acts. There were no significant differences in mean responses across diary schedules. We observed some evidence of reactivity (i.e., a difference in behavior associated with diary completion). Participants not assigned diaries reported significantly more unprotected anal sex acts and were more likely to be newly diagnosed with HIV or another sexually transmitted infection compared to those assigned active diary schedules. This study suggests that sexual behavior data collected from young adult MSM during 3-month retrospective survey--an interval commonly used in sexual behavior research--are likely valid. Diaries, however, may have greater utility in sexual behavioral research in which counts, timing, sequence, or within-person variation over time are of particular import.

  14. Socioeconomic and racial/ethnic differentials of C-reactive protein levels: a systematic review of population-based studies

    Directory of Open Access Journals (Sweden)

    Victora Cesar G

    2007-08-01

    Full Text Available Abstract Background Socioeconomic and racial/ethnic factors strongly influence cardiovascular disease outcomes and risk factors. C-reactive protein (CRP, a non-specific marker of inflammation, is associated with cardiovascular risk, and knowledge about its distribution in the population may help direct preventive efforts. A systematic review was undertaken to critically assess CRP levels according to socioeconomic and racial/ethnic factors. Methods Medline was searched through December 2006 for population-based studies examining CRP levels among adults with respect to indicators of socioeconomic position (SEP and/or race/ethnicity. Bibliographies from located studies were scanned and 26 experts in the field were contacted for unpublished work. Results Thirty-two relevant articles were located. Cross-sectional (n = 20 and cohort studies (n = 11 were included, as was the control group of one trial. CRP levels were examined with respect to SEP and race/ethnicity in 25 and 15 analyses, respectively. Of 20 studies that were unadjusted or adjusted for demographic variables, 19 found inverse associations between CRP levels and SEP. Of 15 similar studies, 14 found differences between racial/ethnic groups such that whites had the lowest while blacks, Hispanics and South Asians had the highest CRP levels. Most studies also included adjustment for potential mediating variables in the causal chain between SEP or race/ethnicity and CRP. Most of these studies showed attenuated but still significant associations. Conclusion Increasing poverty and non-white race was associated with elevated CRP levels among adults. Most analyses in the literature are underestimating the true effects of racial/ethnic and socioeconomic factors due to adjustment for mediating factors.

  15. The effect of aerobic versus strength-based training on high-sensitivity C-reactive protein in older adults.

    Science.gov (United States)

    Martins, Raul A; Neves, Ana P; Coelho-Silva, Manuel J; Veríssimo, Manuel T; Teixeira, Ana Maria

    2010-09-01

    Increased levels of inflammatory markers, namely, high-sensitive C-reactive protein (hs-CRP), have been associated with several chronic diseases including atherosclerosis, type 2 diabetes and hypertension. Forty-five women and men aged >64 years participated in the study and were randomly assigned to two exercise intervention groups and a non-exercising control group. The participants assigned to the exercising groups followed a 16-week exercise protocol based either on aerobic training (AT) or strength training (ST) followed by a further 16 weeks off-training period. The control group (C) remained sedentary throughout the study. Evaluation of body mass, BMI, waist circumference, aerobic endurance, lower-body strength, upper-body strength, triglycerides, total cholesterol, LDL-cholesterol, HDL-cholesterol and hs-CRP were performed at baseline, after 16 weeks (post-training for the exercise groups) and at 32 weeks (follow-up). Both, AT and ST groups significantly increased functional fitness at the end of the exercise programs when compared to baseline values. hs-CRP concentrations were maintained throughout the study for the C group, while decreasing 10% at 16 weeks and 51% at 32 weeks for the AT group. In the ST group the hs-CRP concentrations decreased by 11 and 39% at 16 and 32 weeks, respectively. Decreases in hs-CRP concentrations were statistically significant for the AT and ST groups at the 32-week evaluation when compared to baseline. Reduction in hs-CRP concentrations seemed to be associated with strength gains and adiposity loss.

  16. Reactive oxygen species responsive drug releasing nanoparticle based on chondroitin sulfate-anthocyanin nanocomplex for efficient tumor therapy.

    Science.gov (United States)

    Jeong, Dooyong; Bae, Byoung-Chan; Park, Sin-Jung; Na, Kun

    2016-01-28

    To develop a reactive oxygen species (ROS) sensitive drug carrier, a chondroitin sulfate (CS)-anthocyanin (ATC) based nanocomplex was developed. Doxorubicin hydrochloride (DOX) was loaded in the CS-ATC nanocomplex (CS-ATC-DOX) via intermolecular stacking interaction. The nanocomplex was fabricated by a simple mixing method in the aqueous phase. The morphology and size of CS-ATC-DOX were determined by ATC content. In the group with 1.5mg/ml of ATC loaded CS-ATC-DOX (CS-ATC2-DOX), the drug content and loading efficiency were 8.5% and 99.1%, respectively. The ROS sensitive drug release of CS-ATC2-DOX was confirmed under in vitro physiological conditions. The results demonstrated that 1.67 times higher DOX release occurred in CS-ATC2-DOX for 48h compared to CS-DOX (ATC absent sample). Drug release and nanocomplex destruction were induced by ROS mediated ATC degradation. We determined that 66.7% of ROS was scavenged by CS-ATC2-DOX. Additionally, an HCT-116 tumor bearing animal model was used to confirm ROS sensitive therapeutic effects of CS-ATC2-DOX. The results indicate that DOX was released from the intravenously injected CS-ATC2-DOX in the tumor tissue. Thus, nuclei shrinkage and dead cells were observed in H&E staining and TUNEL assay, respectively. These data suggest that the tumor growth was effectively inhibited. This study means that CS-ATC2-DOX has potential in improving tumor therapy. Copyright © 2015 Elsevier B.V. All rights reserved.

  17. One year observations of atmospheric reactive gases (O3, CO, NOx, SO2) at Jang Bogo base in Terra Nova Bay, Antarctica

    Science.gov (United States)

    Siek Rhee, Tae; Seo, Sora

    2016-04-01

    Antarctica is a remote area surrounded by the Southern Ocean and far from the influence of human activities, giving us unique opportunity to investigate the background variation of trace gases which are sensitive to the human activities. Korean Antarctic base, Jang Bogo, was established as a unique permanent overwintering base in Terra Nova Bay in February, 2014. One year later, we installed a package of instruments to monitor atmospheric trace gases at the base, which includes long-lived greenhouse gases, CO2, CH4, and N2O, and reactive gases, O3, CO, NOx, and SO2. The atmospheric chemistry observatory, where these scientific instruments were installed, is located ca. 1 km far from the main building and power plant, minimizing the influence of pollution that may come from the operation of the base. Here we focus on the reactive gases measured in-situ at the base; O3 displays a typical seasonal variation with high in winter and low in summer with seasonal amplitude of ~18 ppb, CO was high in September at ~56 ppb, probably implying the invasion of lower latitude air mass with biomass burning, and low in late summer due to photochemical oxidation. NO did not show clear seasonal variation, but SO2 reveals larger values in summer than in winter. We will discuss potential atmospheric processes behind these first observations of reactive gases in Terra Nova Bay, Antarctica.

  18. Effect of Relative Humidity and CO2 Concentration on the Properties of Carbonated Reactive MgO Cement Based Materials

    Science.gov (United States)

    Bilan, Yaroslav

    Sustainability of modern concrete industry recently has become an important topic of scientific discussion, and consequently there is an effort to study the potential of the emerging new supplementary cementitious materials. This study has a purpose to investigate the effect of reactive magnesia (reactive MgO) as a replacement for general use (GU) Portland Cements and the effect of environmental factors (CO2 concentrations and relative humidity) on accelerated carbonation curing results. The findings of this study revealed that improvement of physical properties is related directly to the increase in CO2 concentrations and inversely to the increase in relative humidity and also depends much on %MgO in the mixture. The conclusions of this study helped to clarify the effect of variable environmental factors and the material replacement range on carbonation of reactive magnesia concrete materials, as well as providing an assessment of the optimal conditions for the effective usage of the material.

  19. Local and national trends in general surgery residents' operative experience: do work hour limitations negatively affect case volume in small community-based programs?

    Science.gov (United States)

    Markelov, Alexey; Sakharpe, Aniket; Kohli, Harjeet; Livert, David

    2011-12-01

    The goals of this study were to analyze the impact of work hour restrictions on the operative case volume at a small community-based general surgery residency training program and compare changes with the national level. Annual national resident case log data from Accreditation Council for Graduate Medical Education (ACGME) website and case logs of graduating Easton Hospital residents (years 2002-2009) were used for analysis. Weighted average change in total number of cases in our institution was -1.20 (P = 0.52) vs 1.78 (P = 0.07) for the national program average with statistically significant difference on comparison (P = 0.027). We also found significant difference in case volume changes at the national level compared with our institution for the following ACGME defined subcategories: alimentary tract [8.19 (P < 0.01) vs -1.08 (P = 0.54)], abdomen [8.48 (P < 0.01) vs -6.29 (P < 0.01)], breast [1.91 (P = 0.89) vs -3.6 (P = 0.02)], and vascular [4.03 (P = 0.02) vs -3.98 (P = 0.01)]. Comparing the national trend to the community hospital we see that there is total increase in cases at the national level whereas there is a decrease in case volume at the community hospital. These trends can also be followed in ACGME defined subcategories which form the major case load for a general surgical training such as alimentary tract, abdominal, breast, and vascular procedures. We hypothesize that work hour restrictions have been favorable for the larger programs, as these programs were able to better integrate the night float system, restructure their call schedule, and implement institutional modifications which are too resource demanding for smaller training programs.

  20. Resident Characteristics Report

    Data.gov (United States)

    Department of Housing and Urban Development — The Resident Characteristics Report summarizes general information about households who reside in Public Housing, or who receive Section 8 assistance. The report...