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.

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.

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.

Temperature and Stresses Estimation in Reactivity Control Rods for CAREM-25 Reactor

International Nuclear Information System (INIS)

Markiewicz, Mario; Estevez, Esteban

2000-01-01

The reactivity control rods are a critical component regarding safety.Its correct operation when required must be ensured.For this purpose, this component must maintain its operating capacity during all its residence time and under any foreseen operation condition.To evaluate the behaviour of reactivity control rods, it is necessary to analyse the demands they are exposed to, determining from the mechanical point of view, the residence time in the reactor core.In this report, using analytical calculations, the parameters affecting the performance of the reactivity control rods are analysed, with the objective of determine from the mechanical point of view, its behaviour and residence time

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

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.

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.

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.

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

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

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.

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

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

Decolorization of reactive textile dyes using water falling film dielectric barrier discharge

International Nuclear Information System (INIS)

Dojcinovic, Biljana P.; Roglic, Goran M.; Obradovic, Bratislav M.; Kuraica, Milorad M.; Kostic, Mirjana M.; Nesic, Jelena; Manojlovic, Dragan D.

2011-01-01

Highlights: → Decolorization of four reactive textile dyes using non-thermal plasma reactor. → Influence of applied energy on decolorization. → Effects of initial pH and addition of homogeneous catalysts. → Toxicity evaluation using the brine shrimp as a test organism. - Abstract: Decolorization of reactive textile dyes Reactive Black 5, Reactive Blue 52, Reactive Yellow 125 and Reactive Green 15 was studied using advanced oxidation processes (AOPs) in a non-thermal plasma reactor, based on coaxial water falling film dielectric barrier discharge (DBD). Used initial dye concentrations in the solution were 40.0 and 80.0 mg/L. The effects of different initial pH of dye solutions, and addition of homogeneous catalysts (H 2 O 2 , Fe 2+ and Cu 2+ ) on the decolorization during subsequent recirculation of dye solution through the DBD reactor, i.e. applied energy density (45-315 kJ/L) were studied. Influence of residence time was investigated over a period of 24 h. Change of pH values and effect of pH adjustments of dye solution after each recirculation on the decolorization was also tested. It was found that the initial pH of dye solutions and pH adjustments of dye solution after each recirculation did not influence the decolorization. The most effective decolorization of 97% was obtained with addition of 10 mM H 2 O 2 in a system of 80.0 mg/L Reactive Black 5 with applied energy density of 45 kJ/L, after residence time of 24 h from plasma treatment. Toxicity was evaluated using the brine shrimp Artemia salina as a test organism.

Decolorization of reactive textile dyes using water falling film dielectric barrier discharge

Energy Technology Data Exchange (ETDEWEB)

Dojcinovic, Biljana P. [Institute of Chemistry, Technology and Metallurgy, Center of Chemistry, Studentski trg 12-16, 11000 Belgrade (Serbia); Roglic, Goran M. [Faculty of Chemistry, University of Belgrade, P.O. Box 158, 11000 Belgrade (Serbia); Obradovic, Bratislav M., E-mail: obrat@ff.bg.ac.rs [Faculty of Physics, University of Belgrade, P.O. Box 368, 11000 Belgrade (Serbia); Kuraica, Milorad M. [Faculty of Physics, University of Belgrade, P.O. Box 368, 11000 Belgrade (Serbia); Kostic, Mirjana M. [Faculty of Technology and Metallurgy, Department of Textile Engineering, Karnegijeva 4, 11000 Belgrade (Serbia); Nesic, Jelena; Manojlovic, Dragan D. [Faculty of Chemistry, University of Belgrade, P.O. Box 158, 11000 Belgrade (Serbia)

2011-08-30

Highlights: {yields} Decolorization of four reactive textile dyes using non-thermal plasma reactor. {yields} Influence of applied energy on decolorization. {yields} Effects of initial pH and addition of homogeneous catalysts. {yields} Toxicity evaluation using the brine shrimp as a test organism. - Abstract: Decolorization of reactive textile dyes Reactive Black 5, Reactive Blue 52, Reactive Yellow 125 and Reactive Green 15 was studied using advanced oxidation processes (AOPs) in a non-thermal plasma reactor, based on coaxial water falling film dielectric barrier discharge (DBD). Used initial dye concentrations in the solution were 40.0 and 80.0 mg/L. The effects of different initial pH of dye solutions, and addition of homogeneous catalysts (H{sub 2}O{sub 2}, Fe{sup 2+} and Cu{sup 2+}) on the decolorization during subsequent recirculation of dye solution through the DBD reactor, i.e. applied energy density (45-315 kJ/L) were studied. Influence of residence time was investigated over a period of 24 h. Change of pH values and effect of pH adjustments of dye solution after each recirculation on the decolorization was also tested. It was found that the initial pH of dye solutions and pH adjustments of dye solution after each recirculation did not influence the decolorization. The most effective decolorization of 97% was obtained with addition of 10 mM H{sub 2}O{sub 2} in a system of 80.0 mg/L Reactive Black 5 with applied energy density of 45 kJ/L, after residence time of 24 h from plasma treatment. Toxicity was evaluated using the brine shrimp Artemia salina as a test organism.

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.

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

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)

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.

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.

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.

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.

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.

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.

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

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.

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.

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.

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.

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.

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.

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...

Evaluation of five strategies to limit the impact of fouling in permeable reactive barriers

International Nuclear Information System (INIS)

Li Lin; Benson, Craig H.

2010-01-01

Ground water flow and geochemical reactive transport models were used to assess the effectiveness of five strategies used to limit fouling and to enhance the long-term hydraulic behavior of continuous-wall permeable reactive barriers (PRBs) employing granular zero valent iron (ZVI). The flow model accounted for geological heterogeneity and the reactive transport model included a geochemical algorithm for simulating iron corrosion and mineral precipitation reactions that have been observed in ZVI PRBs. The five strategies that were evaluated are pea gravel equalization zones, a sacrificial pre-treatment zone, pH adjustment, large ZVI particles, and mechanical treatment. Results of simulations show that installation of pea gravel equalization zones results in flow equalization and a more uniform distribution of residence times within the PRB. Residence times within the PRB are less affected by mineral precipitation when a pre-treatment zone is employed. pH adjustment limits the total amount of hydroxide ions in ground water to reduce porosity reduction and to retain larger residence times. Larger ZVI particles reduce porosity reduction as a result of the smaller iron surface area for iron corrosion, and retain longer residence time. Mechanical treatment redistributes the porosity uniformly throughout the PRB over time, which is effective in maintaining residence time.

[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.

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

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.

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.

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...

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...

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...

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...

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)

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

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...

Does resident ranking during recruitment accurately predict subsequent performance as a surgical resident?

Science.gov (United States)

Fryer, Jonathan P; Corcoran, Noreen; George, Brian; Wang, Ed; Darosa, Debra

2012-01-01

While the primary goal of ranking applicants for surgical residency training positions is to identify the candidates who will subsequently perform best as surgical residents, the effectiveness of the ranking process has not been adequately studied. We evaluated our general surgery resident recruitment process between 2001 and 2011 inclusive, to determine if our recruitment ranking parameters effectively predicted subsequent resident performance. We identified 3 candidate ranking parameters (United States Medical Licensing Examination [USMLE] Step 1 score, unadjusted ranking score [URS], and final adjusted ranking [FAR]), and 4 resident performance parameters (American Board of Surgery In-Training Examination [ABSITE] score, PGY1 resident evaluation grade [REG], overall REG, and independent faculty rating ranking [IFRR]), and assessed whether the former were predictive of the latter. Analyses utilized Spearman correlation coefficient. We found that the URS, which is based on objective and criterion based parameters, was a better predictor of subsequent performance than the FAR, which is a modification of the URS based on subsequent determinations of the resident selection committee. USMLE score was a reliable predictor of ABSITE scores only. However, when we compared our worst residence performances with the performances of the other residents in this evaluation, the data did not produce convincing evidence that poor resident performances could be reliably predicted by any of the recruitment ranking parameters. Finally, stratifying candidates based on their rank range did not effectively define a ranking cut-off beyond which resident performance would drop off. Based on these findings, we recommend surgery programs may be better served by utilizing a more structured resident ranking process and that subsequent adjustments to the rank list generated by this process should be undertaken with caution. Copyright © 2012 Association of Program Directors in Surgery

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)

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.

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.

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.

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

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

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…

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

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.

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...

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.

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.

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

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''

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.

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.

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.

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

Chemical Reactive Anchoring Lipids with Different Performance for Cell Surface Re-engineering Application.

Science.gov (United States)

Vabbilisetty, Pratima; Boron, Mallorie; Nie, Huan; Ozhegov, Evgeny; Sun, Xue-Long

2018-02-28

Introduction of selectively chemical reactive groups at the cell surface enables site-specific cell surface labeling and modification opportunity, thus facilitating the capability to study the cell surface molecular structure and function and the molecular mechanism it underlies. Further, it offers the opportunity to change or improve a cell's functionality for interest of choice. In this study, two chemical reactive anchor lipids, phosphatidylethanolamine-poly(ethylene glycol)-dibenzocyclooctyne (DSPE-PEG 2000 -DBCO) and cholesterol-PEG-dibenzocyclooctyne (CHOL-PEG 2000 -DBCO) were synthesized and their potential application for cell surface re-engineering via lipid fusion were assessed with RAW 264.7 cells as a model cell. Briefly, RAW 264.7 cells were incubated with anchor lipids under various concentrations and at different incubation times. The successful incorporation of the chemical reactive anchor lipids was confirmed by biotinylation via copper-free click chemistry, followed by streptavidin-fluorescein isothiocyanate binding. In comparison, the cholesterol-based anchor lipid afforded a higher cell membrane incorporation efficiency with less internalization than the phospholipid-based anchor lipid. Low cytotoxicity of both anchor lipids upon incorporation into the RAW 264.7 cells was observed. Further, the cell membrane residence time of the cholesterol-based anchor lipid was evaluated with confocal microscopy. This study suggests the potential cell surface re-engineering applications of the chemical reactive anchor lipids.

Chemical Reactive Anchoring Lipids with Different Performance for Cell Surface Re-engineering Application

Science.gov (United States)

2018-01-01

Introduction of selectively chemical reactive groups at the cell surface enables site-specific cell surface labeling and modification opportunity, thus facilitating the capability to study the cell surface molecular structure and function and the molecular mechanism it underlies. Further, it offers the opportunity to change or improve a cell’s functionality for interest of choice. In this study, two chemical reactive anchor lipids, phosphatidylethanolamine–poly(ethylene glycol)–dibenzocyclooctyne (DSPE–PEG2000–DBCO) and cholesterol–PEG–dibenzocyclooctyne (CHOL–PEG2000–DBCO) were synthesized and their potential application for cell surface re-engineering via lipid fusion were assessed with RAW 264.7 cells as a model cell. Briefly, RAW 264.7 cells were incubated with anchor lipids under various concentrations and at different incubation times. The successful incorporation of the chemical reactive anchor lipids was confirmed by biotinylation via copper-free click chemistry, followed by streptavidin-fluorescein isothiocyanate binding. In comparison, the cholesterol-based anchor lipid afforded a higher cell membrane incorporation efficiency with less internalization than the phospholipid-based anchor lipid. Low cytotoxicity of both anchor lipids upon incorporation into the RAW 264.7 cells was observed. Further, the cell membrane residence time of the cholesterol-based anchor lipid was evaluated with confocal microscopy. This study suggests the potential cell surface re-engineering applications of the chemical reactive anchor lipids. PMID:29503972

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.

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.

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.

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.

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.

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.

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

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

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.

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.

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

Identifying Gaps and Launching Resident Wellness Initiatives: The 2017 Resident Wellness Consensus Summit.

Science.gov (United States)

Zaver, Fareen; Battaglioli, Nicole; Denq, William; Messman, Anne; Chung, Arlene; Lin, Michelle; Liu, Emberlynn L

2018-03-01

Burnout, depression, and suicidality among residents of all specialties have become a critical focus for the medical education community, especially among learners in graduate medical education. In 2017 the Accreditation Council for Graduate Medical Education (ACGME) updated the Common Program Requirements to focus more on resident wellbeing. To address this issue, one working group from the 2017 Resident Wellness Consensus Summit (RWCS) focused on wellness program innovations and initiatives in emergency medicine (EM) residency programs. Over a seven-month period leading up to the RWCS event, the Programmatic Initiatives workgroup convened virtually in the Wellness Think Tank, an online, resident community consisting of 142 residents from 100 EM residencies in North America. A 15-person subgroup (13 residents, two faculty facilitators) met at the RWCS to develop a public, central repository of initiatives for programs, as well as tools to assist programs in identifying gaps in their overarching wellness programs. An online submission form and central database of wellness initiatives were created and accessible to the public. Wellness Think Tank members collected an initial 36 submissions for the database by the time of the RWCS event. Based on general workplace, needs-assessment tools on employee wellbeing and Kern's model for curriculum development, a resident-based needs-assessment survey and an implementation worksheet were created to assist residency programs in wellness program development. The Programmatic Initiatives workgroup from the resident-driven RWCS event created tools to assist EM residency programs in identifying existing initiatives and gaps in their wellness programs to meet the ACGME's expanded focus on resident wellbeing.

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...

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

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)

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.

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

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...

Identifying Gaps and Launching Resident Wellness Initiatives: The 2017 Resident Wellness Consensus Summit

Directory of Open Access Journals (Sweden)

Nicole Battaglioli

2018-02-01

Full Text Available Introduction: Burnout, depression, and suicidality among residents of all specialties have become a critical focus for the medical education community, especially among learners in graduate medical education. In 2017 the Accreditation Council for Graduate Medical Education (ACGME updated the Common Program Requirements to focus more on resident wellbeing. To address this issue, one working group from the 2017 Resident Wellness Consensus Summit (RWCS focused on wellness program innovations and initiatives in emergency medicine (EM residency programs. Methods: Over a seven-month period leading up to the RWCS event, the Programmatic Initiatives workgroup convened virtually in the Wellness Think Tank, an online, resident community consisting of 142 residents from 100 EM residencies in North America. A 15-person subgroup (13 residents, two faculty facilitators met at the RWCS to develop a public, central repository of initiatives for programs, as well as tools to assist programs in identifying gaps in their overarching wellness programs. Results: An online submission form and central database of wellness initiatives were created and accessible to the public. Wellness Think Tank members collected an initial 36 submissions for the database by the time of the RWCS event. Based on general workplace, needs-assessment tools on employee wellbeing and Kern’s model for curriculum development, a resident-based needs-assessment survey and an implementation worksheet were created to assist residency programs in wellness program development. Conclusion: The Programmatic Initiatives workgroup from the resident-driven RWCS event created tools to assist EM residency programs in identifying existing initiatives and gaps in their wellness programs to meet the ACGME’s expanded focus on resident wellbeing.

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.

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.

"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.

Population control of resident and immigrant microglia by mitosis and apoptosis.

Science.gov (United States)

Wirenfeldt, Martin; Dissing-Olesen, Lasse; Anne Babcock, Alicia; Nielsen, Marianne; Meldgaard, Michael; Zimmer, Jens; Azcoitia, Iñigo; Leslie, Robert Graham Quinton; Dagnaes-Hansen, Frederik; Finsen, Bente

2007-08-01

Microglial population expansion occurs in response to neural damage via processes that involve mitosis and immigration of bone marrow-derived cells. However, little is known of the mechanisms that regulate clearance of reactive microglia, when microgliosis diminishes days to weeks later. We have investigated the mechanisms of microglial population control in a well-defined model of reactive microgliosis in the mouse dentate gyrus after perforant pathway axonal lesion. Unbiased stereological methods and flow cytometry demonstrate significant lesion-induced increases in microglial numbers. Reactive microglia often occurred in clusters, some having recently incorporated bromodeoxyuridine, showing that proliferation had occurred. Annexin V labeling and staining for activated caspase-3 and terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling showed that apoptotic mechanisms participate in dissolution of the microglial response. Using bone marrow chimeric mice, we found that the lesion-induced proliferative capacity of resident microglia superseded that of immigrant microglia, whereas lesion-induced kinetics of apoptosis were comparable. Microglial numbers and responses were severely reduced in bone marrow chimeric mice. These results broaden our understanding of the microglial response to neural damage by demonstrating that simultaneously occurring mitosis and apoptosis regulate expansion and reduction of both resident and immigrant microglial cell populations.

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.

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

Elective time during dermatology residency: A survey of residents and program directors.

Science.gov (United States)

Uppal, Pushpinder; Shantharam, Rohini; Kaufmann, Tara Lynn

2017-12-15

Elective time during residency training provides residents with exposure to different subspecialties. This opportunity gives residents the chance tonurture growth in particular areas of interest and broaden their knowledge base in certain topics in dermatology by having the chance to work withexperts in the field. The purpose of this study was to assess the views of residency program directors and dermatology residents on the value of elective time through a cross sectional survey. An eight-questionIRB exempt survey was sent out to 113 residency program directors via email through the American Professors of Dermatology (APD) program director listserv. Program directors were asked to forward a separate set of 9 questions to their residents. The majority of programs that responded allowed for some elective time within their schedule, often duringthe PGY 4 (3rd year of dermatology training), but the amount of time allowed widely varied among many residency programs. Overall, residents and program directors agree that elective is important in residencytraining, but no standardization is established across programs.

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.

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.

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

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.

Reactivation of Latent HIV-1 Expression by Engineered TALE Transcription Factors.

Science.gov (United States)

Perdigão, Pedro; Gaj, Thomas; Santa-Marta, Mariana; Barbas, Carlos F; Goncalves, Joao

2016-01-01

The presence of replication-competent HIV-1 -which resides mainly in resting CD4+ T cells--is a major hurdle to its eradication. While pharmacological approaches have been useful for inducing the expression of this latent population of virus, they have been unable to purge HIV-1 from all its reservoirs. Additionally, many of these strategies have been associated with adverse effects, underscoring the need for alternative approaches capable of reactivating viral expression. Here we show that engineered transcriptional modulators based on customizable transcription activator-like effector (TALE) proteins can induce gene expression from the HIV-1 long terminal repeat promoter, and that combinations of TALE transcription factors can synergistically reactivate latent viral expression in cell line models of HIV-1 latency. We further show that complementing TALE transcription factors with Vorinostat, a histone deacetylase inhibitor, enhances HIV-1 expression in latency models. Collectively, these findings demonstrate that TALE transcription factors are a potentially effective alternative to current pharmacological routes for reactivating latent virus and that combining synthetic transcriptional activators with histone deacetylase inhibitors could lead to the development of improved therapies for latent HIV-1 infection.

Reactivation of Latent HIV-1 Expression by Engineered TALE Transcription Factors.

Directory of Open Access Journals (Sweden)

Pedro Perdigão

Full Text Available The presence of replication-competent HIV-1 -which resides mainly in resting CD4+ T cells--is a major hurdle to its eradication. While pharmacological approaches have been useful for inducing the expression of this latent population of virus, they have been unable to purge HIV-1 from all its reservoirs. Additionally, many of these strategies have been associated with adverse effects, underscoring the need for alternative approaches capable of reactivating viral expression. Here we show that engineered transcriptional modulators based on customizable transcription activator-like effector (TALE proteins can induce gene expression from the HIV-1 long terminal repeat promoter, and that combinations of TALE transcription factors can synergistically reactivate latent viral expression in cell line models of HIV-1 latency. We further show that complementing TALE transcription factors with Vorinostat, a histone deacetylase inhibitor, enhances HIV-1 expression in latency models. Collectively, these findings demonstrate that TALE transcription factors are a potentially effective alternative to current pharmacological routes for reactivating latent virus and that combining synthetic transcriptional activators with histone deacetylase inhibitors could lead to the development of improved therapies for latent HIV-1 infection.

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.

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

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.

Using spontaneous commentary of nursing home residents to develop resident-centered measurement tools: A case study.

Science.gov (United States)

Bangerter, Lauren R; Abbott, Katherine; Heid, Allison; Eshraghi, Karen; Van Haitsma, Kimberly

Nursing home (NH) residents routinely complete surveys that assess their health, well-being, preferences, and care needs. Such surveys reveal important information, however, are largely based on the concerns of providers as opposed to the concerns of residents. Thus, researchers must enhance efforts to ensure that these surveys are guided by the priorities, needs, and concerns of residents. We present a case study to demonstrate how spontaneous commentary of NH residents holds particular efficacy for ensuring that measurement tools are guided by the needs, concerns, and priorities of residents. Spontaneous comments from NH residents (N = 370) collected as part of a study developing the Preferences for Everyday Living Inventory for NH residents (PELI-NH) were used to refine the PELI-NH across key phases of measurement development. This work demonstrates how the spontaneous commentary of NH residents may contribute to the refinement of NH measurement tools, and allow researchers to base these tools on the needs and priorities of NH residents. Copyright © 2017 Elsevier Inc. All rights reserved.

Enrichment of herpes simplex virus type 2 (HSV-2) reactive mucosal T cells in the human female genital tract.

Science.gov (United States)

Posavad, C M; Zhao, L; Dong, L; Jin, L; Stevens, C E; Magaret, A S; Johnston, C; Wald, A; Zhu, J; Corey, L; Koelle, D M

2017-09-01

Local mucosal cellular immunity is critical in providing protection from HSV-2. To characterize and quantify HSV-2-reactive mucosal T cells, lymphocytes were isolated from endocervical cytobrush and biopsy specimens from 17 HSV-2-infected women and examined ex vivo for the expression of markers associated with maturation and tissue residency and for functional T-cell responses to HSV-2. Compared with their circulating counterparts, cervix-derived CD4+ and CD8+ T cells were predominantly effector memory T cells (CCR7-/CD45RA-) and the majority expressed CD69, a marker of tissue residency. Co-expression of CD103, another marker of tissue residency, was highest on cervix-derived CD8+ T cells. Functional HSV-2 reactive CD4+ and CD8+ T-cell responses were detected in cervical samples and a median of 17% co-expressed CD103. HSV-2-reactive CD4+ T cells co-expressed IL-2 and were significantly enriched in the cervix compared with blood. This first direct ex vivo documentation of local enrichment of HSV-2-reactive T cells in the human female genital mucosa is consistent with the presence of antigen-specific tissue-resident memory T cells. Ex vivo analysis of these T cells may uncover tissue-specific mechanisms of local control of HSV-2 to assist the development of vaccine strategies that target protective T cells to sites of HSV-2 infection.

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.

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.

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.

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.

Anesthesiology resident personality type correlates with faculty assessment of resident performance.

Science.gov (United States)

Schell, Randall M; Dilorenzo, Amy N; Li, Hsin-Fang; Fragneto, Regina Y; Bowe, Edwin A; Hessel, Eugene A

2012-11-01

To study the association between anesthesiology residents' personality preference types, faculty evaluations of residents' performance, and knowledge. Convenience sample and prospective study. Academic department of anesthesiology. Consenting anesthesiology residents (n = 36). All participants completed the Myers Briggs Type Indicator® (MBTI®). All residents' 6-month summation of daily focal evaluations completed by faculty [daily performance score (DPS); 1 = unsatisfactory, 2 = needs improvement, 3 = meets expectations, 4 = exceeds expectations], as well as a global assessment of performance (GAP) score based on placement of each resident into perceived quartile compared with their peers (ie,1 = first, or top, quartile) by senior faculty (n = 7) who also completed the MBTI, were obtained. The resident MBTI personality preferences were compared with the DPS and GAP scores, the United States Medical Licensing Examination (USMLE) I and II scores, and faculty MBTI personality type. There was no association between personality preference type and performance on standardized examinations (USMLE I, II). The mean GAP score was better (higher quartile score) for Extraverts than Introverts (median 2.0 vs 2.6, P = 0.0047) and for Sensing versus Intuition (median 2.0 vs 2.6, P = 0.0206) preference. Faculty evaluator MBTI preference type did not influence the GAP scores they assigned residents. Like GAP, the DPS was better for residents with Sensing versus Intuition preference (median 3.5 vs 3.3, P = 0.0111). No difference in DPS was noted between Extraverts and Introverts. Personality preference type was not associated with resident performance on standardized examinations, but it was associated with faculty evaluations of resident performance. Residents with Sensing personality preference were evaluated more favorably on global and focal faculty evaluations than those residents who chose the Intuition preference. Extraverted residents were evaluated more favorably on

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...

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.

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.

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…

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.

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.

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.

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.

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.

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

Decolorization of reactive black 5 using dielectric barrier discharge in the presence of inorganic salts

Directory of Open Access Journals (Sweden)

Dojčinović Biljana P.

2012-01-01

Full Text Available Inorganic salts improve the coloration of textiles, which increase pollution load on dyehouse effluent in general. Decolorization of reactive textile dye C.I. Reactive Black 5 was studied using Advanced Oxidation Processes (AOPs in a non-thermal plasma reactor, based on coaxial water falling film Dielectric Barrier Discharge (DBD. Initial dye concentration in the solution was 40.0 mg L-1. The effects of addition of inorganic salt different high concentrations (NaCl, Na2SO4 and Na2CO3 on the degree of decolorization were studied. Recirculation of dye solution through the DBD reactor with applied energy density 45-315 kJ L-1 was used. The influence of residence time was investigated after 5 minutes and 24 hours of plasma treatment. Decolorization of the dyes was monitored by spectrophotometric measurement. Changes of pH values and the conductivity of dye solution after each recirculation were tested. The most effective decolorization of over 90% was obtained with the addition of NaCl (50 g L-1, applied energy density of 135 kJ L-1 and after residence time of 24 hours of plasma treatment. Decolorization of solutions containing inorganic salts Na2SO4 and Na2CO3 were lower than for the solution without salt.

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

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)

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.

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

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.

Skin-resident CD4+ T cells protect against Leishmania major by recruiting and activating inflammatory monocytes

Science.gov (United States)

Glennie, Nelson D.; Volk, Susan W.

2017-01-01

Tissue-resident memory T cells are required for establishing protective immunity against a variety of different pathogens, although the mechanisms mediating protection by CD4+ resident memory T cells are still being defined. In this study we addressed this issue with a population of protective skin-resident, IFNγ-producing CD4+ memory T cells generated following Leishmania major infection. We previously found that resident memory T cells recruit circulating effector T cells to enhance immunity. Here we show that resident memory CD4+ T cells mediate the delayed-hypersensitivity response observed in immune mice and provide protection without circulating T cells. This protection occurs rapidly after challenge, and requires the recruitment and activation of inflammatory monocytes, which limit parasites by production of both reactive oxygen species and nitric oxide. Overall, these data highlight a novel role for tissue-resident memory cells in recruiting and activating inflammatory monocytes, and underscore the central role that skin-resident T cells play in immunity to cutaneous leishmaniasis. PMID:28419151

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.

The "resident's dilemma"? Values and strategies of medical residents for education interactions: a cellular automata simulation.

Science.gov (United States)

Heckerling, P S; Gerber, B S; Weiner, S J

2006-01-01

Medical residents engage in formal and informal education interactions with fellow residents during the working day, and can choose whether to spend time and effort on such interactions. Time and effort spent on such interactions can bring learning and personal satisfaction to residents, but may also delay completion of clinical work. Using hypothetical cases, we assessed the values and strategies of internal medicine residents at one hospital for both cooperative and non-cooperative education interactions with fellow residents. We then used these data and cellular automata models of two-person games to simulate repeated interactions between residents, and to determine which strategies resulted in greatest accrued value. We conducted sensitivity analyses on several model parameters, to test the robustness of dominant strategies to model assumptions. Twenty-nine of the 57 residents (50.9%) valued cooperation more than non-cooperation no matter what the other resident did during the current interaction. Similarly, thirty-six residents (63.2%) endorsed an unconditional always-cooperate strategy no matter what the other resident had done during their previous interaction. In simulations, an always-cooperate strategy accrued more value (776.42 value units) than an aggregate of strategies containing non-cooperation components (675.0 value units, p = 0.052). Only when the probability of strategy errors reached 50%, or when values were re-ordered to match those of a Prisoner's Dilemma, did non-cooperation-based strategies accrue the most value. Cooperation-based values and strategies were most frequent among our residents, and dominated in simulations of repeated education interactions between them.

Integrated Design and Control of Reactive and Non-Reactive Distillation Processes

DEFF Research Database (Denmark)

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

, an alternative approach is to tackle process design and controllability issues simultaneously, in the early stages of process design. This simultaneous synthesis approach provides optimal/near optimal operation and more efficient control of conventional (non-reactive binary distillation columns) (Hamid et al...... of methodologies have been proposed and applied on various problems to address the interactions between process design and control, and they range from optimization-based approaches to model-based methods (Sharifzadeh, 2013). In this work, integrated design and control of non-reactive distillation, ternary...... reactive distillation processes. The element concept (Pérez Cisneros et al., 1997) is used to translate a ternary system of compounds (A + B ↔ C) to a binary system of element (WA and WB). In the case of multicomponent reactive distillation processes the equivalent element concept is used to translate...

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

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...

Feasibility of an innovative third-year chief resident system: an internal medicine residency leadership study

Directory of Open Access Journals (Sweden)

Victor O. Kolade

2014-07-01

Full Text Available Introduction: The role of the internal medicine chief resident includes various administrative, academic, social, and educational responsibilities, fulfillment of which prepares residents for further leadership tasks. However, the chief resident position has historically only been held by a few residents. As fourth-year chief residents are becoming less common, we considered a new model for rotating third-year residents as the chief resident. Methods: Online surveys were given to all 29 internal medicine residents in a single university-based program after implementation of a leadership curriculum and specific job description for the third-year chief resident. Chief residents evaluated themselves on various aspects of leadership. Participation was voluntary. Descriptive statistics were generated using SPSS version 21. Results: Thirteen junior (first- or second-year resident responses reported that the chief residents elicited input from others (mean rating 6.8, were committed to the team (6.8, resolved conflict (6.7, ensured efficiency, organization and productivity of the team (6.7, participated actively (7.0, and managed resources (6.6. Responses from senior residents averaged 1 point higher for each item; this pattern repeated itself in teaching evaluations. Chief resident self-evaluators were more comfortable running a morning report (8.4 than with being chief resident (5.8. Conclusion: The feasibility of preparing internal medicine residents for leadership roles through a rotating PGY-3 (postgraduate year chief residency curriculum was explored at a small internal medicine residency, and we suggest extending the study to include other programs.

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

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,...

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

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.

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

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.

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.

Reactive microgliosis engages distinct responses by microglial subpopulations after minor central nervous system injury

DEFF Research Database (Denmark)

Wirenfeldt, Martin; Babcock, Alicia Anne; Ladeby, Rune

2005-01-01

Microglia are bone marrow-derived cells that constitute a facultative macrophage population when activated by trauma or pathology in the CNS. Endogenous CNS-resident microglia as well as exogenous (immigrant) bone marrow-derived cells contribute to reactive microgliosis, raising fundamental quest...

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)

Status of anesthesiology resident research education in the United States: structured education programs increase resident research productivity.

Science.gov (United States)

Ahmad, Shireen; De Oliveira, Gildasio S; McCarthy, Robert J

2013-01-01

The enhancement of resident research education has been proposed to increase the number of academic anesthesiologists with the skills and knowledge to conduct meaningful research. Program directors (PDs) of the U.S. anesthesiology residency programs were surveyed to evaluate the status of research education during residency training and to test the hypothesis that structured programs result in greater resident research productivity based on resident publications. Survey responses were solicited from 131 anesthesiology residency PDs. Seventy-four percent of PDs responded to the survey. Questions evaluated department demographic information, the extent of faculty research activity, research resources and research funding in the department, the characteristics of resident research education and resident research productivity, departmental support for resident research, and perceived barriers to resident research education. Thirty-two percent of programs had a structured resident research education program. Structured programs were more likely to be curriculum based, require resident participation in a research project, and provide specific training in presentation and writing skills. Productivity expectations were similar between structured and nonstructured programs. Forty percent of structured programs had > 20% of trainees with a publication in the last 2 years compared with 14% of departments with unstructured programs (difference, 26%; 99% confidence interval [CI], 8%-51%; P = 0.01). The percentage of programs that had research rotations for ≥2 months was not different between the structured and the nonstructured programs. A research rotation of >2 months did not increase the percentage of residents who had published an article within the last 2 months compared with a research rotation of 20% of residents with a publication in the last 2 years compared with 36% in programs with >20% of faculty involvement (difference, 21%; 99% CI, -4% to 46%; P = 0.03). Our

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)

Dietary patterns, metabolic markers and subjective sleep measures in resident physicians.

Science.gov (United States)

Mota, Maria Carliana; De-Souza, Daurea Abadia; Rossato, Luana Thomazetto; Silva, Catarina Mendes; Araújo, Maria Bernadete Jeha; Tufik, Sérgio; de Mello, Marco Túlio; Crispim, Cibele Aparecida

2013-10-01

Shiftwork is common in medical training and is necessary for 24-h hospital coverage. Shiftwork poses difficulties not only because of the loss of actual sleep hours but also because it can affect other factors related to lifestyle, such as food intake, physical activity level, and, therefore, metabolic patterns. However, few studies have investigated the nutritional and metabolic profiles of medical personnel receiving training who are participating in shiftwork. The aim of the present study was to identify the possible negative effects of food intake, anthropometric variables, and metabolic and sleep patterns of resident physicians and establish the differences between genders. The study included 72 resident physicians (52 women and 20 men) who underwent the following assessments: nutritional assessment (3-day dietary recall evaluated by the Adapted Healthy Eating Index), anthropometric variables (height, weight, body mass index, and waist circumference), fasting metabolism (lipids, cortisol, high-sensitivity C-reactive protein [hs-CRP], glucose, and insulin), physical activity level (Baecke questionnaire), sleep quality (Pittsburgh Sleep Quality Index; PSQI), and sleepiness (Epworth Sleepiness Scale; ESS). We observed a high frequency of residents who were overweight or obese (65% for men and 21% for women; p = 0.004). Men displayed significantly greater body mass index (BMI) values (p = 0.002) and self-reported weight gain after the beginning of residency (p = 0.008) than women. Poor diet was observed for both genders, including the low intake of vegetables and fruits and the high intake of sweets, saturated fat, cholesterol, and caffeine. The PSQI global scores indicated significant differences between genders (5.9 vs. 7.5 for women and men, respectively; p = 0.01). Women had significantly higher mean high-density lipoprotein cholesterol (HDL-C; p 100 mg/dL) were observed in most individuals. Higher than recommended hs-CRP levels were observed in 66% of the

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.)

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.

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.

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.

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

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.

Efficiency of a Malaria Reactive Test-and-Treat Program in Southern Zambia: A Prospective, Observational Study.

Science.gov (United States)

Deutsch-Feldman, Molly; Hamapumbu, Harry; Lubinda, Jailos; Musonda, Michael; Katowa, Ben; Searle, Kelly M; Kobayashi, Tamaki; Shields, Timothy M; Stevenson, Jennifer C; Thuma, Philip E; Moss, William J; For The Southern Africa International Centers Of Excellence For Malaria Research

2018-05-01

To improve malaria surveillance and achieve elimination, the Zambian National Malaria Elimination Program implemented a reactive test-and-treat program in Southern Province in 2013 in which individuals with rapid diagnostic test (RDT)-confirmed malaria are followed-up at their home within 1 week of diagnosis. Individuals present at the index case household and those residing within 140 m of the index case are tested with an RDT and treated with artemether-lumefantrine if positive. This study evaluated the efficiency of this reactive test-and-treat strategy by characterizing infected individuals missed by the RDT and the current screening radius. The radius was expanded to 250 m, and a quantitative polymerase chain reaction (qPCR) test was performed on dried blood spot specimens. From January 2015 through March 2016, 145 index cases were identified at health centers and health posts. A total of 3,333 individuals residing in 525 households were screened. Excluding index cases, the parasite prevalence was 1.1% by RDT (33 positives of 3,016 participants) and 2.4% by qPCR (73 positives of 3,016 participants). Of the qPCR-positive cases, 62% of 73 individuals tested negative by RDT. Approximately half of the infected individuals resided within the index case household (58% of RDT-positive individuals and 48% of qPCR-positive individuals). The low sensitivity of the RDT and the high proportion of secondary cases within the index case household decreased the efficiency of this reactive test-and-treat strategy. Reactive focal drug administration in index case households would be a more efficient approach to treating infected individuals associated with a symptomatic case.

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.

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....

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.

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

[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.

Canadian residents' perceived manager training needs.

Science.gov (United States)

Stergiopoulos, Vicky; Lieff, Susan; Razack, Saleem; Lee, A Curtis; Maniate, Jerry M; Hyde, Stacey; Taber, Sarah; Frank, Jason R

2010-01-01

Despite widespread endorsement for administrative training during residency, teaching and learning in this area remains intermittent and limited in most programmes. To inform the development of a Manager Train-the-Trainer program for faculty, the Royal College of Physicians and Surgeons of Canada undertook a survey of perceived Manager training needs among postgraduate trainees. A representative sample of Canadian specialty residents received a web-based questionnaire in 2009 assessing their perceived deficiencies in 13 Manager knowledge and 11 Manager skill domains, as determined by gap scores (GSs). GSs were defined as the difference between residents' perceived current and desired level of knowledge or skill in selected Manager domains. Residents' educational preferences for furthering their Manager knowledge and skills were also elicited. Among the 549 residents who were emailed the survey, 199 (36.2%) responded. Residents reported significant gaps in most knowledge and skills domains examined. Residents' preferred educational methods for learning Manager knowledge and skills included workshops, web-based formats and interactive small groups. The results of this national survey, highlighting significant perceived gaps in multiple Manager knowledge and skills domains, may inform the development of Manager curricula and faculty development activities to address deficiencies in training in this important area.

Reproductive Psychiatry Residency Training: A Survey of Psychiatric Residency Program Directors.

Science.gov (United States)

Osborne, Lauren M; MacLean, Joanna V; Barzilay, Erin Murphy; Meltzer-Brody, Samantha; Miller, Laura; Yang, Sarah Nagle

2018-04-01

The reproductive life cycle has unique influences on the phenotypic expression of mental illness in women. Didactic and clinical training focused on these sex-specific influences should be a vital component of the education of future psychiatrists. The authors sought to determine the current state of and attitudes toward reproductive psychiatry in resident education. The authors administered a web-based survey to psychiatry residency training directors. They assessed the availability of both mandated and optional didactic and clinical training experiences in reproductive psychiatry. Fifty residency program directors answered the survey, for a response rate of 28%. More than half of residency program directors (59%) reported requiring some training in reproductive psychiatry. Both the breadth and depth of topics covered varied greatly among programs. Lack of time (48%) and lack of qualified faculty (26%) were the most frequently cited barriers to more training. Only 40% of residency directors surveyed agreed that all residents should be competent in reproductive psychiatry. These findings suggest that specific training in reproductive psychiatry is inconsistent in US residency programs, and that training that does exist varies considerably in clinical time and content. Given that women comprise more than 50% of all psychiatric patients and most women will menstruate, give birth, and undergo menopause, future psychiatrists would benefit from more systematic instruction in this area. The authors propose the development of a national, standardized reproductive psychiatry curriculum to address this gap and aid in producing psychiatrists competent to treat women at all stages of life.

Redesigning journal club in residency

Directory of Open Access Journals (Sweden)

Al Achkar M

2016-05-01

Full Text Available Morhaf Al Achkar Department of Family Medicine, Indiana University, Indianapolis, IN, USA Abstract: The gap between production and implementation of knowledge is the main reason for the suboptimal quality of health care. To eliminate this gap and improve the quality of patient care, journal club (JC in graduate medical education provides an opportunity for learning the skills of evidence-based medicine. JC, however, continues to face many challenges mainly due to poorly defined goals, inadequate preparation, and lack of interest. This article presents an innovative model to prepare and present JC based on three pillars: dialogical learning through group discussion, mentored residents as peer teachers, and including JC as part of a structured curriculum to learn evidence-based medicine. This engaging model has the potential to transform JC from a moribund session that is daunting for residents into a lively discussion to redefine clinical practice using the most current evidence. Keywords: journal club, residents, peer teaching, evidence-based medicine, dialogical learning

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

Perioperative self-reflection among surgical residents.

Science.gov (United States)

Peshkepija, Andi N; Basson, Marc D; Davis, Alan T; Ali, Muhammad; Haan, Pam S; Gupta, Rama N; Hardaway, John C; Nebeker, Cody A; McLeod, Michael K; Osmer, Robert L; Anderson, Cheryl I

2017-09-01

We studied prevalence and predictors of meaningful self-reflection among surgical residents and with prompting/structured interventions, sought to improve/sustain resident skills. Residents from six programs recorded 1032 narrative self-reflective comments (120 residents), using a web-based platform. If residents identified something learned or to be improved, self-reflection was deemed meaningful. Independent variables PGY level, resident/surgeon gender, study site/Phase1: July2014-August2015 vs. Phase2: September2015-September2016) were analyzed. Meaningful self-reflection was documented in 40.6% (419/1032) of entries. PGY5's meaningfully self-reflected less than PGY1-4's, 26.1% vs. 49.6% (p = 0.002). In multivariate analysis, resident narratives during Phase 2 were 4.7 times more likely to engage in meaningful self-reflection compared to Phase1 entries (p self-reflection, compared to Phase1. Surgical residents uncommonly practice meaningful self-reflection, even when prompted, and PGY5/chief residents reflect less than more junior residents. Substantial/sustained improvements in resident self-reflection can occur with both training and interventions. Copyright © 2017 Elsevier Inc. All rights reserved.

Rudimentary, low tech incinerators as a means to produce reactive pozzolan out of sugar cane straw

International Nuclear Information System (INIS)

Martirena, Fernando; Middendorf, Bernhard; Day, Robert L.; Gehrke, Matthias; Roque, Pablo; Martinez, Lesday; Betancourt, Sergio

2006-01-01

The ashes of agricultural wastes from the processing of sugar cane are recognized as having pozzolanic properties. Burning of these wastes under controlled conditions, e.g. temperature and residence time results in significant improvement in reactivity. There are many reports of low-tech incinerators that have been successfully used to produce reactive rice husk ash in Asia. The paper presents the results of the evaluation of a rudimentary incinerator where sugar cane straw is burnt in order to obtain a reactive ash. The incinerator is designed and constructed according to state-of-the-art recommendations for this kind of device. Various burning trials were performed in order to obtain ash for the experiment. X-ray diffraction analysis performed on powdered ash shows significant presence of amorphous (glassy) material. Lime-pozzolana pastes were prepared. The pastes were subjected to X-ray diffraction, thermo-gravimetric analysis, chemical titration, and SEM observation, as a means to examine the pozzolanicity of the ash via the progress with time of calcium hydroxide consumption, and changes in the pore size distribution and strength. Calcium silicate hydrate phases are the main reaction product of the pozzolanic reaction. The long residence time of the ash in the burning chamber seems to be the reason for the fairly low reactivity of the ash; the reactivity of the ash was not significantly improved in comparison with that of the ash burnt in uncontrolled conditions in the open air

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.

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.

Reactive solute transport in physically and chemically heterogeneous porous media with multimodal reactive mineral facies: the Lagrangian approach.

Science.gov (United States)

Soltanian, Mohamad Reza; Ritzi, Robert W; Dai, Zhenxue; Huang, Chao Cheng

2015-03-01

Physical and chemical heterogeneities have a large impact on reactive transport in porous media. Examples of heterogeneous attributes affecting reactive mass transport are the hydraulic conductivity (K), and the equilibrium sorption distribution coefficient (Kd). This paper uses the Deng et al. (2013) conceptual model for multimodal reactive mineral facies and a Lagrangian-based stochastic theory in order to analyze the reactive solute dispersion in three-dimensional anisotropic heterogeneous porous media with hierarchical organization of reactive minerals. An example based on real field data is used to illustrate the time evolution trends of reactive solute dispersion. The results show that the correlation between the hydraulic conductivity and the equilibrium sorption distribution coefficient does have a significant effect on reactive solute dispersion. The anisotropy ratio does not have a significant effect on reactive solute dispersion. Furthermore, through a sensitivity analysis we investigate the impact of changing the mean, variance, and integral scale of K and Kd on reactive solute dispersion. Copyright © 2014 Elsevier Ltd. All rights reserved.

The problem resident behavior guide: strategies for remediation.

Science.gov (United States)

Williamson, Kelly; Quattromani, Erin; Aldeen, Amer

2016-04-01

In 2012, the ACGME supplemented the core competencies with outcomes-based milestones for resident performance within the six competency domains. These milestones address the knowledge, skills, abilities, attitudes, and experiences that a resident is expected to progress through during the course of training. Even prior to the initiation of the milestones, there was a paucity of EM literature addressing the remediation of problem resident behaviors and there remain few readily accessible tools to aid in the implementation of a remediation plan. The goal of the "Problem Resident Behavior Guide" is to provide specific strategies for resident remediation based on deficiencies identified within the framework of the EM milestones. The "Problem Resident Behavior Guide" is a written instructional manual that provides concrete examples of remediation strategies to address specific milestone deficiencies. The more than 200 strategies stem from the experiences of the authors who have professional experience at three different academic hospitals and emergency medicine residency programs, supplemented by recommendations from educational leaders as well as utilization of valuable education adjuncts, such as focused simulation exercises, lecture preparation, and themed ED shifts. Most recommendations require active participation by the resident with guidance by faculty to achieve the remediation expectations. The ACGME outcomes-based milestones aid in the identification of deficiencies with regards to resident performance without providing recommendations on remediation. The Problem Resident Behavior Guide can therefore have a significant impact by filling in this gap.

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…

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

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

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.

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.

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 ...

Resident Self-Assessment and Learning Goal Development: Evaluation of Resident-Reported Competence and Future Goals.

Science.gov (United States)

Li, Su-Ting T; Paterniti, Debora A; Tancredi, Daniel J; Burke, Ann E; Trimm, R Franklin; Guillot, Ann; Guralnick, Susan; Mahan, John D

2015-01-01

To determine incidence of learning goals by competency area and to assess which goals fall into competency areas with lower self-assessment scores. Cross-sectional analysis of existing deidentified American Academy of Pediatrics' PediaLink individualized learning plan data for the academic year 2009-2010. Residents self-assessed competencies in the 6 Accreditation Council for Graduate Medical Education (ACGME) competency areas and wrote learning goals. Textual responses for goals were mapped to 6 ACGME competency areas, future practice, or personal attributes. Adjusted mean differences and associations were estimated using multiple linear and logistic regression. A total of 2254 residents reported 6078 goals. Residents self-assessed their systems-based practice (51.8) and medical knowledge (53.0) competencies lowest and professionalism (68.9) and interpersonal and communication skills (62.2) highest. Residents were most likely to identify goals involving medical knowledge (70.5%) and patient care (50.5%) and least likely to write goals on systems-based practice (11.0%) and professionalism (6.9%). In logistic regression analysis adjusting for postgraduate year (PGY), gender, and degree type (MD/DO), resident-reported goal area showed no association with the learner's relative self-assessment score for that competency area. In the conditional logistic regression analysis, with each learner serving as his or her own control, senior residents (PGY2/3+s) who rated themselves relatively lower in a competency area were more likely to write a learning goal in that area than were PGY1s. Senior residents appear to develop better skills and/or motivation to explicitly turn self-assessed learning gaps into learning goals, suggesting that individualized learning plans may help improve self-regulated learning during residency. Copyright © 2015 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

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.

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.

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.

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.

Accuracy of electrocardiogram reading by family practice residents.

Science.gov (United States)

Sur, D K; Kaye, L; Mikus, M; Goad, J; Morena, A

2000-05-01

This study evaluated the electrocardiogram (EKG) reading skills of family practice residents. A multicenter study was carried out to evaluate the accuracy of EKG reading in the family practice setting. Based on the frequency and potential for clinical significance, we chose 18 common findings on 10 EKGs for evaluation. The EKGs were then distributed to residents at six family practice residencies. Residents were given one point for the identification of each correct EKG finding and scored based on the number correct over a total of 18. Sixty-one residents (20 first year, 23 second year, and 18 third year) completed readings for 10 EKGs and were evaluated for their ability to identify 18 EKG findings. The median score out of 18 possible points for all first-, second-, and third-year residents was 12, 12, and 11.5, respectively. Twenty-one percent of residents did not correctly identify a tracing of an acute myocardial infarction. Data analysis showed no statistically significant difference among the three groups of residents. We evaluated the accuracy of EKG reading skills of family practice residents at each year of training. This study suggests that EKG reading skills do not improve during residency, and further study of curricular change to improve these skills should be considered.

Regarding KUR Reactivity Measurement System

International Nuclear Information System (INIS)

Nakamori, Akira; Hasegawa, Kei; Tsuchiyama, Tatsuo; Yamamoto, Toshihiro; Okumura, Ryo; Sano, Tadafumi

2012-01-01

This article reported: (1) the outline of the reactivity measurement system of Kyoto University Research Reactor (KUR), (2) the calibration data of control rod, (3) the problems and the countermeasures for range switching of linear output meter. For the laptop PC for the reactivity measurement system, there are four input signals: (1) linear output meter, (2) logarithmic output meter, (3) core temperature gauge, and (4) control rod position. The hardware of reactivity measurement system is controlled with Labview installed on the laptop. Output, reactivity, reactor period, and the change in reactivity due to temperature effect or Xenon effect are internally calculated and displayed in real-time with Labview based on the four signals above. Calculation results are recorded in the form of a spreadsheet. At KUR, the reactor core arrangement was changed, so the control rod was re-calibrated. At this time, calculated and experimental values of reactivity based on the reactivity measurement system were compared, and it was confirmed that the reactivity calculation by Labview was accurate. The range switching of linear output meter in the nuclear instrumentation should automatically change within the laptop, however sometimes this did not function properly in the early stage. It was speculated that undefined percent values during the transition of percent value were included in the calculation and caused calculation errors. The range switching started working properly after fixing this issue. (S.K.)

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...

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.

An Innovative Clinical Skills “Boot Camp” for Dental Medicine Residents

Directory of Open Access Journals (Sweden)

Jenny Castillo

2017-05-01

Full Text Available During a 1-year hospital-based residency, dental residents are required to rotate through many departments including surgery, medicine, and emergency medicine. It became apparent that there was a gap between clinical skills knowledge taught in dental school curriculum and skills required for hospital-based patient care. In response, a simulation-based intensive clinical skill “boot camp” was created. The boot camp provided an intensive, interactive 3-day session for the dental residents. During the 3 days, residents were introduced to medical knowledge and skills that were necessary for their inpatient hospital rotations but were lacking in traditional dental school curriculum. Effectiveness of the boot camp was assessed in terms of knowledge base and comfort through presession and postsession surveys. According to resident feedback, this intensive introduction for the dental residents improved their readiness for their inpatient hospital-based residency.

Proliferating resident microglia express the stem cell antigen CD34 in response to acute neural injury

DEFF Research Database (Denmark)

Ladeby, Rune; Wirenfeldt, Martin; Dalmau, Ishar

2005-01-01

-activated microglia in the facial motor nucleus following peripheral axotomy. The results suggest lesion-reactive microglia to consist of functionally distinct subpopulations of cells; a major population of activated resident CD34(+)Mac-1(+) microglia with a high capacity for self-renewal, and a subpopulation of CD34...

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

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

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.

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.

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.

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

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.

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

Simulation Activity in Otolaryngology Residencies.

Science.gov (United States)

Deutsch, Ellen S; Wiet, Gregory J; Seidman, Michael; Hussey, Heather M; Malekzadeh, Sonya; Fried, Marvin P

2015-08-01

Simulation has become a valuable tool in medical education, and several specialties accept or require simulation as a resource for resident training or assessment as well as for board certification or maintenance of certification. This study investigates current simulation resources and activities in US otolaryngology residency programs and examines interest in advancing simulation training and assessment within the specialty. Web-based survey. US otolaryngology residency training programs. An electronic web-based survey was disseminated to all US otolaryngology program directors to determine their respective institutional and departmental simulation resources, existing simulation activities, and interest in further simulation initiatives. Descriptive results are reported. Responses were received from 43 of 104 (43%) residency programs. Simulation capabilities and resources are available in most respondents' institutions (78.6% report onsite resources; 73.8% report availability of models, manikins, and devices). Most respondents (61%) report limited simulation activity within otolaryngology. Areas of simulation are broad, addressing technical and nontechnical skills related to clinical training (94%). Simulation is infrequently used for research, credentialing, or systems improvement. The majority of respondents (83.8%) expressed interest in participating in multicenter trials of simulation initiatives. Most respondents from otolaryngology residency programs have incorporated some simulation into their curriculum. Interest among program directors to participate in future multicenter trials appears high. Future research efforts in this area should aim to determine optimal simulators and simulation activities for training and assessment as well as how to best incorporate simulation into otolaryngology residency training programs. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.

Anonymity and Electronics: Adapting Preparation for Radiology Resident Examination.

Science.gov (United States)

Chapman, Teresa; Reid, Janet R; O'Conner, Erin E

2017-06-01

Diagnostic radiology resident assessment has evolved from a traditional oral examination to computerized testing. Teaching faculty struggle to reconcile the differences between traditional teaching methods and residents' new preferences for computerized testing models generated by new examination styles. We aim to summarize the collective experiences of senior residents at three different teaching hospitals who participated in case review sessions using a computer-based, interactive, anonymous teaching tool, rather than the Socratic method. Feedback was collected from radiology residents following participation in a senior resident case review session using Nearpod, which allows residents to anonymously respond to the teaching material. Subjective resident feedback was uniformly enthusiastic. Ninety percent of residents favor a case-based board review incorporating multiple-choice questions, and 94% favor an anonymous response system. Nearpod allows for inclusion of multiple-choice questions while also providing direct feedback to the teaching faculty, helping to direct the instruction and clarify residents' gaps in knowledge before the Core Examination. Copyright © 2017 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

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.

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.

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

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

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

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.

Psychotherapy Training: Residents' Perceptions and Experiences.

Science.gov (United States)

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

2015-10-01

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

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

Association of General Surgery Resident Remediation and Program Director Attitudes With Resident Attrition.

Science.gov (United States)

Schwed, Alexander C; Lee, Steven L; Salcedo, Edgardo S; Reeves, Mark E; Inaba, Kenji; Sidwell, Richard A; Amersi, Farin; Are, Chandrakanth; Arnell, Tracey D; Damewood, Richard B; Dent, Daniel L; Donahue, Timothy; Gauvin, Jeffrey; Hartranft, Thomas; Jacobsen, Garth R; Jarman, Benjamin T; Melcher, Marc L; Mellinger, John D; Morris, Jon B; Nehler, Mark; Smith, Brian R; Wolfe, Mary; Kaji, Amy H; de Virgilio, Christian

2017-12-01

Previous studies of resident attrition have variably included preliminary residents and likely overestimated categorical resident attrition. Whether program director attitudes affect attrition has been unclear. To determine whether program director attitudes are associated with resident attrition and to measure the categorical resident attrition rate. This multicenter study surveyed 21 US program directors in general surgery about their opinions regarding resident education and attrition. Data on total resident complement, demographic information, and annual attrition were collected from the program directors for the study period of July 1, 2010, to June 30, 2015. The general surgery programs were chosen on the basis of their geographic location, previous collaboration with some coauthors, prior work in surgical education and research, or a program director willing to participate. Only categorical surgical residents were included in the study; thus, program directors were specifically instructed to exclude any preliminary residents in their responses. Five-year attrition rates (2010-2011 to 2014-2015 academic years) as well as first-time pass rates on the General Surgery Qualifying Examination and General Surgery Certifying Examination of the American Board of Surgery (ABS) were collected. High- and low-attrition programs were compared. The 21 programs represented different geographic locations and 12 university-based, 3 university-affiliated, and 6 independent program types. Programs had a median (interquartile range [IQR]) number of 30 (20-48) categorical residents, and few of those residents were women (median [IQR], 12 [5-17]). Overall, 85 of 966 residents (8.8%) left training during the study period: 15 (17.6%) left after postgraduate year 1, 34 (40.0%) after postgraduate year 2, and 36 (42.4%) after postgraduate year 3 or later. Forty-four residents (51.8%) left general surgery for another surgical discipline, 21 (24.7%) transferred to a different surgery

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)

Airway allergy and skin reactivity to aeroallergens in Riyadh

International Nuclear Information System (INIS)

Almogren, Adel

2009-01-01

To determine the pattern of skin prick test reactivity to aeroallergens in patients with asthma and rhinitis (airway allergy) residing in Riyadh region. This is a retrospective cross sectional study based on data analysis of skin prick test results of individuals with clinical diagnosis of airway allergy. Allergy skin prick test result data of 139 Saudi nationals from Riyadh region tested at King Khalid University Hospital between January 2003 and March 2004 was analyzed retrospectively. This group comprised of 53% females and 47% males, with a mean age of 27 +/- 12 years. A set of aeroallergens extracts for both indoor and outdoor allergens including fungal spores was used to test the patients. Seventy-five percent (105) of patients reacted to one or more allergen extracts. The most frequently reacting indoor allergen was house dust mite (77.8%) followed by the cat (33.6%) and cockroach (19.2%). Among the outdoor allergens Prosopis juliflora was tested positive in 72.1%, Bermuda grass in 53.8%, Chenopodium album in 47.1%, Rye grass in 36.5% and Salsola kali in 36.5%. A significant proportion of patients were also found reacting to Moulds (18.2%) and Aspergillus fumigatus (18.2%) extracts. Sensitivity to one or more aeroallergens was common in patients, indicating high level of aeroallergen sensitization in patients with airway allergy residing in Riyadh region. (author)

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.

Resident perceptions of the educational value of night float rotations.

Science.gov (United States)

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

2010-07-01

Night float rotations are being increasingly used in the era of resident physician work-hour regulations, but their impact on resident education is not clear. Our objective was to clarify resident perceptions of the educational aspects of night float rotations. An anonymous survey of internal medicine residents at a university-based residency program was completed. Responses were received from 116 of 163 surveyed residents (71%). Residents attended less residents' report (0.10 +/- .43 vs. 2.70 + 0.93 sessions/week, peducational value of night float, sleep cycle adjustment issues, and impact on their personal lives, which correlated with resident evaluations from the regular program evaluation process. In free responses, residents commented that they liked the autonomy and opportunity to improve triage skills on these rotations and confirmed their negative opinions about the sleep-wake cycle and interference with personal lives. Internal medicine residents at a university-based program have negative opinions regarding the educational value of night float rotations. Further work is necessary to determine whether problems exist across programs and specialties.

Cross-reactivity of human nickel-reactive T-lymphocyte clones with copper and palladium

NARCIS (Netherlands)

Pistoor, F. H.; Kapsenberg, M. L.; Bos, J. D.; Meinardi, M. M.; von Blomberg, M. E.; Scheper, R. J.

1995-01-01

Twenty Ni-reactive T-lymphocyte clones were obtained from eight different donors and analyzed for their ability to cross-react with other metals. All Ni-reactive T-lymphocyte clones were CD4+CD8- and recognized Ni in association with either HLA-DR or -DQ molecules. Based on the periodic table of the

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

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...

Impact of Residency Training Redesign on Residents' Clinical Knowledge.

Science.gov (United States)

Waller, Elaine; Eiff, M Patrice; Dexter, Eve; Rinaldo, Jason C B; Marino, Miguel; Garvin, Roger; Douglass, Alan B; Phillips, Robert; Green, Larry A; Carney, Patricia A

2017-10-01

The In-training Examination (ITE) is a frequently used method to evaluate family medicine residents' clinical knowledge. We compared family medicine ITE scores among residents who trained in the 14 programs that participated in the Preparing the Personal Physician for Practice (P4) Project to national averages over time, and according to educational innovations. The ITE scores of 802 consenting P4 residents who trained in 2007 through 2011 were obtained from the American Board of Family Medicine. The primary analysis involved comparing scores within each academic year (2007 through 2011), according to program year (PGY) for P4 residents to all residents nationally. A secondary analysis compared ITE scores among residents in programs that experimented with length of training and compared scores among residents in programs that offered individualized education options with those that did not. Release of ITE scores was consented to by 95.5% of residents for this study. Scores of P4 residents were higher compared to national scores in each year. For example, in 2011, the mean P4 score for PGY1 was 401.2, compared to the national average of 386. For PGY2, the mean P4 score was 443.1, compared to the national average of 427, and for PGY3, the mean P4 score was 477.0, compared to the national PGY3 score of 456. Scores of residents in programs that experimented with length of training were similar to those in programs that did not. Scores were also similar between residents in programs with and without individualized education options. Family medicine residency programs undergoing substantial educational changes, including experiments in length of training and individualized education, did not appear to experience a negative effect on resident's clinical knowledge, as measured by ITE scores. Further research is needed to study the effect of a wide range of residency training innovations on ITE scores over time.

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.

Degassing, gas retention and release in Fe(0) permeable reactive barriers.

Science.gov (United States)

Ruhl, Aki S; Jekel, Martin

2014-04-01

Corrosion of Fe(0) has been successfully utilized for the reductive treatment of multiple contaminants. Under anaerobic conditions, concurrent corrosion leads to the generation of hydrogen and its liberation as a gas. Gas bubbles are mobile or trapped within the irregular pore structure leading to a reduction of the water filled pore volume and thus decreased residence time and permeability (gas clogging). With regard to the contaminant transport to the reactive site, the estimation of surface properties of the reactive material indicated that individual gas bubbles only occupied minor contact areas of the reactive surface. Quantification of gas entrapment by both gravimetrical and tracer investigations revealed that development of preferential flow paths was not significant. A novel continuous gravimetrical method was implemented to record variations in gas entrapment and gas bubble releases from the reactive filling. Variation of grain size fractions revealed that the pore geometry had a significant impact on gas release. Large pores led to the release of comparably large gas amounts while smaller volumes were released from finer pores with a higher frequency. Relevant processes are explained with a simplified pictorial sequence that incorporates relevant mechanisms. Copyright © 2014 Elsevier B.V. All rights reserved.

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

An Analysis of Publication Productivity During Residency for 1506 Neurosurgical Residents and 117 Residency Departments in North America.

Science.gov (United States)

Khan, Nickalus R; Saad, Hassan; Oravec, Chesney S; Norrdahl, Sebastian P; Fraser, Brittany; Wallace, David; Lillard, Jock C; Motiwala, Mustafa; Nguyen, Vincent N; Lee, Siang Liao; Jones, Anna V; Ajmera, Sonia; Kalakoti, Piyush; Dave, Pooja; Moore, Kenneth A; Akinduro, Olutomi; Nyenwe, Emmanuel; Vaughn, Brandy; Michael, L Madison; Klimo, Paul

2018-05-30

Bibliometrics is defined as the study of statistical and mathematical methods used to quantitatively analyze scientific literature. The application of bibliometrics in neurosurgery continues to evolve. To calculate a number of publication productivity measures for almost all neurosurgical residents and departments within North America. These measures were correlated with survey results on the educational environment within residency programs. During May to June 2017, data were collected from departmental websites and Scopus to compose a bibliometric database of neurosurgical residents and residency programs. Data related to authorship value and study content were collected on all articles published by residents. A survey of residency program research and educational environment was administered to program directors and coordinators; results were compared with resident academic productivity. The median number of publications in residency was 3; median h-index and Resident index were 1 and 0.17 during residency, respectively. There was a statistically significant difference in academic productivity among male neurosurgical residents compared with females. The majority of articles published were tier 1 clinical articles. Residency program research support was significantly associated with increased resident productivity (P productivity. This study represents the most comprehensive bibliometric assessment of neurosurgical resident academic productivity during training to date. New benchmarks for individual and department academic productivity are provided. A supportive research environment for neurosurgical residents is associated with increased academic productivity, but a scholarly activity requirement was, surprisingly, not shown to have a positive effect.

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.

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.

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.

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.

A roadmap for OH reactivity research

Science.gov (United States)

Williams, Jonathan; Brune, William

2015-04-01

A fundamental property of the atmosphere is the frequency of gas-phase reactions with the OH radical, the atmosphere's primary oxidizing agent. This reaction frequency is called the OH reactivity and is the inverse the lifetime of the OH radical itself, which varies from a few seconds in the clean upper troposphere to below 10 ms in forests and polluted city environments. Ever since the discovery of the OH radical's importance to tropospheric chemistry, the characterization of its overall loss rate (OH reactivity) has remained a key question. At first, this property was assessed by summing the reactivity contributions of individually measured compounds; however, as improving analytical technology revealed ever more reactive species in ambient air, it became clear that this approach could provide only a lower limit. Approximately 15 years ago, the direct measurement of total OH reactivity was conceived independently by two groups. The first publications demonstrated direct OH reactivity measurements in the laboratory (Calpini et al., 1999) based on LIDAR and in the ambient air (Kovacs and Brune, 2001) based on in situ laser induced fluorescence detection of OH.

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)

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...

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.

Incorporating resident research into the dermatology residency program

Science.gov (United States)

Wagner, Richard F; Raimer, Sharon S; Kelly, Brent C

2013-01-01

Programmatic changes for the dermatology residency program at The University of Texas Medical Branch were first introduced in 2005, with the faculty goal incorporating formal dermatology research projects into the 3-year postgraduate training period. This curriculum initially developed as a recommendation for voluntary scholarly project activity by residents, but it evolved into a program requirement for all residents in 2009. Departmental support for this activity includes assignment of a faculty mentor with similar interest about the research topic, financial support from the department for needed supplies, materials, and statistical consultation with the Office of Biostatistics for study design and data analysis, a 2-week elective that provides protected time from clinical activities for the purpose of preparing research for publication and submission to a peer-reviewed medical journal, and a departmental award in recognition for the best resident scholarly project each year. Since the inception of this program, five classes have graduated a total of 16 residents. Ten residents submitted their research studies for peer review and published their scholarly projects in seven dermatology journals through the current academic year. These articles included three prospective investigations, three surveys, one article related to dermatology education, one retrospective chart review, one case series, and one article about dermatopathology. An additional article from a 2012 graduate about dermatology education has also been submitted to a journal. This new program for residents was adapted from our historically successful Dermatology Honors Research Program for medical students at The University of Texas Medical Branch. Our experience with this academic initiative to promote dermatology research by residents is outlined. It is recommended that additional residency programs should consider adopting similar research programs to enrich resident education. PMID:23901305

Incorporating resident research into the dermatology residency program.

Science.gov (United States)

Wagner, Richard F; Raimer, Sharon S; Kelly, Brent C

2013-01-01

Programmatic changes for the dermatology residency program at The University of Texas Medical Branch were first introduced in 2005, with the faculty goal incorporating formal dermatology research projects into the 3-year postgraduate training period. This curriculum initially developed as a recommendation for voluntary scholarly project activity by residents, but it evolved into a program requirement for all residents in 2009. Departmental support for this activity includes assignment of a faculty mentor with similar interest about the research topic, financial support from the department for needed supplies, materials, and statistical consultation with the Office of Biostatistics for study design and data analysis, a 2-week elective that provides protected time from clinical activities for the purpose of preparing research for publication and submission to a peer-reviewed medical journal, and a departmental award in recognition for the best resident scholarly project each year. Since the inception of this program, five classes have graduated a total of 16 residents. Ten residents submitted their research studies for peer review and published their scholarly projects in seven dermatology journals through the current academic year. These articles included three prospective investigations, three surveys, one article related to dermatology education, one retrospective chart review, one case series, and one article about dermatopathology. An additional article from a 2012 graduate about dermatology education has also been submitted to a journal. This new program for residents was adapted from our historically successful Dermatology Honors Research Program for medical students at The University of Texas Medical Branch. Our experience with this academic initiative to promote dermatology research by residents is outlined. It is recommended that additional residency programs should consider adopting similar research programs to enrich resident education.

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…

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.

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.

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.

Applying Expectancy Theory to residency training: proposing opportunities to understand resident motivation and enhance residency training.

Science.gov (United States)

Shweiki, Ehyal; Martin, Niels D; Beekley, Alec C; Jenoff, Jay S; Koenig, George J; Kaulback, Kris R; Lindenbaum, Gary A; Patel, Pankaj H; Rosen, Matthew M; Weinstein, Michael S; Zubair, Muhammad H; Cohen, Murray J

2015-01-01

Medical resident education in the United States has been a matter of national priority for decades, exemplified initially through the Liaison Committee for Graduate Medical Education and then superseded by the Accreditation Council for Graduate Medical Education. A recent Special Report in the New England Journal of Medicine, however, has described resident educational programs to date as prescriptive, noting an absence of innovation in education. Current aims of contemporary medical resident education are thus being directed at ensuring quality in learning as well as in patient care. Achievement and work-motivation theories attempt to explain people's choice, performance, and persistence in tasks. Expectancy Theory as one such theory was reviewed in detail, appearing particularly applicable to surgical residency training. Correlations between Expectancy Theory as a work-motivation theory and residency education were explored. Understanding achievement and work-motivation theories affords an opportunity to gain insight into resident motivation in training. The application of Expectancy Theory in particular provides an innovative perspective into residency education. Afforded are opportunities to promote the development of programmatic methods facilitating surgical resident motivation in education.

Workplace Violence and Harassment Against Emergency Medicine Residents.

Science.gov (United States)

Schnapp, Benjamin H; Slovis, Benjamin H; Shah, Anar D; Fant, Abra L; Gisondi, Michael A; Shah, Kaushal H; Lech, Christie A

2016-09-01

Several studies have shown that workplace violence in the emergency department (ED) is common. Residents may be among the most vulnerable staff, as they have the least experience with these volatile encounters. The goal for this study was to quantify and describe acts of violence against emergency medicine (EM) residents by patients and visitors and to identify perceived barriers to safety. This cross-sectional survey study queried EM residents at multiple New York City hospitals. The primary outcome was the incidence of violence experienced by residents while working in the ED. The secondary outcomes were the subtypes of violence experienced by residents, as well as the perceived barriers to safety while at work. A majority of residents (66%, 78/119) reported experiencing at least one act of physical violence during an ED shift. Nearly all residents (97%, 115/119) experienced verbal harassment, 78% (93/119) had experienced verbal threats, and 52% (62/119) reported sexual harassment. Almost a quarter of residents felt safe "Occasionally," "Seldom" or "Never" while at work. Patient-based factors most commonly cited as contributory to violence included substance use and psychiatric disease. Self-reported violence against EM residents appears to be a significant problem. Incidence of violence and patient risk factors are similar to what has been found previously for other ED staff. Understanding the prevalence of workplace violence as well as the related systems, environmental, and patient-based factors is essential for future prevention efforts.

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

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.

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....

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

Science.gov (United States)

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

2006-12-01

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

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

Evaluating Dermatology Residency Program Websites.

Science.gov (United States)

Ashack, Kurt A; Burton, Kyle A; Soh, Jonathan M; Lanoue, Julien; Boyd, Anne H; Milford, Emily E; Dunnick, Cory; Dellavalle, Robert P

2016-03-16

Internet resources play an important role in how medical students access information related to residency programs.Evaluating program websites is necessary in order to provide accurate information for applicants and provide information regarding areas of website improvement for programs. To date, dermatology residency websites (D  WS) have not been evaluated.This paper evaluates dermatology residency websites based on availability of predefined measures. Using the FREIDA (Fellowship and Residency Electronic Interactive Database) Online database, authors searched forall accredited dermatology program websites. Eligible programs were identified through the FREIDA Online database and had a functioning website. Two authors independently extracted data with consensus or third researcher resolution of differences. This data was accessed and archived from July 15th to July 17th, 2015.Primary outcomes measured were presence of content on education, resident and faculty information, program environment, applicant recruitment, schedule, salary, and website quality evaluated using an online tool (WooRank.com). Out of 117 accredited dermatology residencies, 115 had functioning webpages. Of these, 76.5% (75) had direct links found on the FRIEDA Online database. Most programs contained information on education, faculty, program environment, and applicant recruitment. However, website quality and marketing effectiveness were highly variable; most programs were deemed to need improvements in the functioning of their webpages. Also, additional information on current residents and about potential away rotations were lacking from most websites with only 52.2% (60) and 41.7% (48) of programs providing this content, respectively. A majority of dermatology residency websites contained adequate information on many of the factors we evaluated. However, many were lacking in areas that matter to applicants. We hope this report will encourage dermatology residencyprograms

Neuroscience and humanistic psychiatry: a residency curriculum.

Science.gov (United States)

Griffith, James L

2014-04-01

Psychiatry residencies with a commitment to humanism commonly prioritize training in psychotherapy, cultural psychiatry, mental health policy, promotion of human rights, and similar areas reliant upon dialogue and collaborative therapeutic relationships. The advent of neuroscience as a defining paradigm for psychiatry has challenged residencies with a humanistic focus due to common perceptions that it would entail constriction of psychiatric practice to diagnostic and psychopharmacology roles. The author describes a neuroscience curriculum that has taught psychopharmacology effectively, while also advancing effectiveness of language-based and relationship-based therapeutics. In 2000, the George Washington University psychiatry residency initiated a neuroscience curriculum consisting of (1) a foundational postgraduate year 2 seminar teaching cognitive and social neuroscience and its integration into clinical psychopharmacology, (2) advanced seminars that utilized a neuroscience perspective in teaching specific psychotherapeutic skill sets, and (3) case-based teaching in outpatient clinical supervisions that incorporated a neuroscience perspective into traditional psychotherapy supervisions. Curricular assessment was conducted by (1) RRC reaccreditation site visit feedback, (2) examining career trajectories of residency graduates, (3) comparing PRITE exam Somatic Treatments subscale scores for 2010-2012 residents with pre-implementation residents, and (4) postresidency survey assessment by 2010-2012 graduates. The 2011 RRC site visit report recommended a "notable practice" citation for "innovative neurosciences curriculum." Three of twenty 2010-2012 graduates entered neuroscience research fellowships, as compared to none before the new curriculum. PRITE Somatic Treatments subscale scores improved from the 23rd percentile to the 62nd percentile in pre- to post-implementation of curriculum (p neuroscience curriculum for a residency committed to humanistic psychiatry

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.

Perspective of ophthalmology residents in the United States about residency programs and competency in relation to the International Council of Ophthalmology guidelines.

Science.gov (United States)

Abdelfattah, Nizar Saleh; Radwan, Ahmed E; Sadda, Srinivas R

2016-09-01

To evaluate the perspective of ophthalmology residents in the US about their residency programs and compare the competency of residency programs to international competency levels set by the International Council of Ophthalmology (ICO). A cross-sectional web-based survey extracted from the ICO published competency standards was sent to program directors of ophthalmology residency programs in the US to forward it to current PGY-3, 4 residents, and residency graduates from 2011 to 2014. Eighty-seven responses were received, comprising 61 residents and 26 graduates. Most respondents were highly satisfied with their programs (93.6%). Clinic-based training was rated satisfactorily. Insufficient exposure to low-vision rehabilitation (38.5%), refraction and contact lenses prescription (38.5%), and vitreo-retinal surgeries (38.5%) was reported. Respondents were satisfied with their overall surgical experiences, with the vast majority (>83%) rating case volume, complexity, and variety as satisfactory or better. A significant group stated they had insufficient exposure to extra-capsular cataract extraction (26.3%), refractive surgery (19.7%), and orbital surgery (64.5%). All graduates surveyed passed their Ophthalmic Knowledge Assessment Program (OKAP) examinations, and 72% felt their residency programs adequately prepared them for the examinations. All respondents reported insufficient training in certain nonclinical areas, such as practice management, staffing, and administration skills. Ophthalmology residents in the US express high levels of satisfaction with their residency training programs. While most programs adequately address most ICO core objectives, certain curriculum modifications should be considered.

Uranium Removal from Groundwater by Permeable Reactive Barrier with Zero-Valent Iron and Organic Carbon Mixtures: Laboratory and Field Studies

Directory of Open Access Journals (Sweden)

Borys Kornilovych

2018-06-01

Full Text Available Zhovty Vody city, located in south-central Ukraine, has long been an important center for the Ukrainian uranium and iron industries. Uranium and iron mining and processing activities during the Cold War resulted in poorly managed sources of radionuclides and heavy metals. Widespread groundwater and surface water contamination has occurred, which creates a significant risk to drinking water supplies. Hydrogeologic and geochemical conditions near large uranium mine tailings storage facility (TSF were characterized to provide data to locate, design and install a permeable reactive barrier (PRB to treat groundwater contaminated by leachate infiltrating from the TSF. The effectiveness of three different permeable reactive materials was investigated: zero-valent iron (ZVI for reduction, sorption, and precipitation of redox-sensitive oxyanions; phosphate material to transform dissolved metals to less soluble phases; and organic carbon substrates to promote bioremediation processes. Batch and column experiments with Zhovty Vody site groundwater were conducted to evaluate reactivity of the materials. Reaction rates, residence time and comparison with site-specific clean-up standards were determined. Results of the study demonstrate the effectiveness of the use of the PRB for ground water protection near uranium mine TSF. The greatest decrease was obtained using ZVI-based reactive media and the combined media of ZVI/phosphate/organic carbon combinations.

Useful but Different: Resident Physician Perceptions of Interprofessional Feedback.

Science.gov (United States)

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

2016-01-01

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

Training Psychiatry Residents in Psychotherapy: The Role of Manualized Treatments.

Science.gov (United States)

Pagano, Joshua; Kyle, Brandon N; Johnson, Toni L; Saeed, Sy Atezaz

2017-06-01

Evidence-based treatment and manualized psychotherapy have a recent but rich history. As interest and research have progressed, defining the role of treatment manuals in resident training and clinical practice has become more important. Although there is not a universal definition of treatment manual, most clinicians and researchers agree that treatment manuals are an essential piece of evidence-based therapy, and that despite several limitations, they offer advantages in training residents in psychotherapy. Requirements for resident training in psychotherapy have changed over the years, and treatment manuals offer a simple and straightforward way to meet training requirements. In a search limited to only depression, two treatment manuals emerged with the support of research regarding both clinical practice and resident training. In looking toward the future, it will be important for clinicians to remain updated on further advances in evidence based manualized treatment as a tool for training residents in psychotherapy, including recent developments in online and smartphone based treatments.

Pregnancy among residents enrolled in general surgery (PREGS): a survey of residents in a single Canadian training program.

Science.gov (United States)

Merchant, Shaila; Hameed, Morad; Melck, Adrienne

2011-12-01

Interest in general surgery has declined, and lack of adequate accommodation for pregnancy and parenting may be a deterrent. We explored resident experiences with these issues within a single general surgery program. We surveyed residents enrolled in the University of British Columbia general surgery program from 1997 to 2009 using a Web-based survey tool. Information regarding demographics, pregnancy, postpartum issues and issues pertaining to maternity/parenting policies was obtained. We used the Student t test, Z test and Fisher exact test for statistical comparisons. Of the 81 residents surveyed, 53 responded (65% response rate). There were fewer pregnancies during residency among female residents than among partners of male residents (PMRs; 9 pregnancies for 6 of 25 residents v. 23 pregnancies for 15 of 28 PMRs, p = 0.002). One of 9 pregnancies among female residents and 5 of 23 among PMRs ended in miscarriage (p > 0.99). Female residents and PMRs reported pregnancy-related complications with equal frequency. All female residents breastfed for at least 6 months; however, 67% (4 of 6) felt their resident role prevented them from breastfeeding as long as they would have liked. Most (5 of 6, 83%) pursued a graduate degree or research during their "maternity leave." More than 50% of residents reported that their own workload increased because of a colleague's pregnancy. Many (36 of 53, 68%) were unaware of the existence of any maternity/parenting policy, and most were in favour of instituting such a policy. Resident mothers do not breastfeed for the desired duration, and precluding factors must be explored. Contingency plans are needed so colleagues are not overburdened when pregnant residents cannot perform clinical duties. General surgery programs must have a formal policy addressing these issues.

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.

The use of 234Th/238U disequilibrium to examine the fate of particle-reactive species on the Yangtze continental shelf

International Nuclear Information System (INIS)

McKee, B.A.; DeMaster, D.J.; Nittrouer, C.A.

1984-01-01

Measurements of 234 Th (tsub(1/2)=24.1 d) in water column and seabed samples from an area near the mouth of the Yangtze River (People's Republic of China) provide the following information: Most of the 234 Th in waters near the mouth of the Yangtze River is in particulate form, and horizontal transport and sedimentation of 234 Th-bearing particles dominate the 234 Th budget in this area. A model incorporating processes in at least two dimensions is required to understand the fate of particle-reactive species on the Yangtze continental shelf. The residence times of particle-reactive species (with respect to scavenging) range from 0.3 days (nearshore) to 4.0 days (offshore). The residence times (with respect to removal to the seabed) range from 0.5 day (nearshore) to 11.0 days (offshore). Scavenging residence times for 234 Th decrease as the concentration of suspended particles increases. The time for removal of 234 Th to the seabed increases with distance from shore (a variable which integrates such factors as scavenging rate, bathymetry, and frequency of resuspension). (orig.)

The Value of a Resident Aesthetic Clinic: A 7-Year Institutional Review and Survey of the Chief Resident Experience.

Science.gov (United States)

Weissler, Jason M; Carney, Martin J; Yan, Chen; Percec, Ivona

2017-10-16

With the evolving plastic surgery training paradigm, there is an increasing emphasis on aesthetic surgery education during residency. In an effort to improve aesthetic education and to encourage preparation for independent practice, our institution has supported a resident-run aesthetic clinic for over two decades. To provide insight into the educational benefits of a resident-run cosmetic clinic through longitudinal resident follow up and institutional experiential review. A retrospective review was conducted to identify all clinic-based aesthetic operations performed between 2009 and 2016. To capture residents' perspectives on the cosmetic resident clinic, questionnaires were distributed to the cohort. Primary outcome measures included: volume and types of cases performed, impact of clinic experience on training, confidence level performing cosmetic procedures, and satisfaction with chief clinic. Unpaired t tests were calculated to compare case volume/type with level of confidence and degree of preparedness to perform cosmetic procedures independently. Overall, 264 operations performed by 18 graduated chief residents were reviewed. Surveys were distributed to 28 chief residents (71.4% completion rate). Performing twenty or more clinic-based procedures was associated with higher levels of preparedness to perform cosmetic procedures independently (P = 0.037). Residents reported the highest confidence when performing cosmetic breast procedures when compared to face/neck (P = 0.005), body/trunk procedures (P = 0.39), and noninvasive facial procedures (P = 0.85). The continued growth of aesthetic surgery highlights the need for comprehensive training and preparation for the new generation of plastic surgeons. Performing cosmetic procedures in clinic is a valuable adjunct to the traditional educational curriculum and increases preparedness and confidence for independent practice. © 2017 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission

Surgical resident learning styles: faculty and resident accuracy at identification of preferences and impact on ABSITE scores.

Science.gov (United States)

Kim, Roger H; Gilbert, Timothy; Ristig, Kyle; Chu, Quyen D

2013-09-01

As a consequence of surgical resident duty hour restrictions, there is a need for faculty to utilize novel teaching methods to convey information in a more efficient manner. The current paradigm of surgical training, which has not changed significantly since the time of Halsted, assumes that all residents assimilate information in a similar fashion. However, recent data has shown that learners have preferences for the ways in which they receive and process information. The VARK model categorizes learners as visual (V), aural (A), read/write (R), and kinesthetic (K). The VARK learning style preferences of surgical residents have not been previously evaluated. In this study, the preferred learning styles of general surgery residents were determined, along with faculty and resident perception of resident learning styles. In addition, we hypothesized that American Board of Surgery In-Training Exam (ABSITE) scores are associated with preference for a read/write (R) learning style. The Fleming VARK learning styles inventory was administered to all general surgery residents at a university hospital-based program. Responses on the inventory were scored to determine the preferred learning style for each resident. Faculty members were surveyed to determine their accuracy in identifying the preferred learning style of each resident. All residents were also surveyed to determine their accuracy in identifying their peers' VARK preferences. Resident ABSITE scores were examined for association with preferred learning styles. Twenty-nine residents completed the inventory. Most (18 of 29, 62%) had a multimodal preference, although more than a third (11 of 29, 38%) demonstrated a single-modality preference. Seventy-six percent of all residents (22 of 29) had some degree of kinesthetic (K) learning, while under 50% (14 of 29) were aural (A) learners. Although not significant, dominant (R) learners had the highest mean ABSITE scores. Faculty identified residents' learning styles

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

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.

Workplace Violence and Harassment Against Emergency Medicine Residents

Directory of Open Access Journals (Sweden)

Benjamin H. Schnapp

2016-09-01

Full Text Available Introduction: Several studies have shown that workplace violence in the emergency department (ED is common. Residents may be among the most vulnerable staff, as they have the least experience with these volatile encounters. The goal for this study was to quantify and describe acts of violence against emergency medicine (EM residents by patients and visitors and to identify perceived barriers to safety. Methods: This cross-sectional survey study queried EM residents at multiple New York City hospitals. The primary outcome was the incidence of violence experienced by residents while working in the ED. The secondary outcomes were the subtypes of violence experienced by residents, as well as the perceived barriers to safety while at work. Results: A majority of residents (66%, 78/119 reported experiencing at least one act of physical violence during an ED shift. Nearly all residents (97%, 115/119 experienced verbal harassment, 78% (93/119 had experienced verbal threats, and 52% (62/119 reported sexual harassment. Almost a quarter of residents felt safe “Occasionally,” “Seldom” or “Never” while at work. Patient-based factors most commonly cited as contributory to violence included substance use and psychiatric disease. Conclusion: Self-reported violence against EM residents appears to be a significant problem. Incidence of violence and patient risk factors are similar to what has been found previously for other ED staff. Understanding the prevalence of workplace violence as well as the related systems, environmental, and patient-based factors is essential for future prevention efforts.

Mobile Application Use Among Obstetrics and Gynecology Residents.

Science.gov (United States)

Perry, Rachel; Burns, Roshan M; Simon, Rebecca; Youm, Julie

2017-10-01

Mobile applications (apps) are increasingly used in clinical settings, particularly among resident physicians. Apps available to patients and physicians are rapidly expanding. We aimed to describe obstetrics and gynecology (ob-gyn) residents' use of and attitudes toward ob-gyn-related mobile apps. We conducted a cross-sectional survey of residents at all 19 California ob-gyn programs using a web-based questionnaire. Responses were analyzed using descriptive and chi-square statistics. Of 386 residents contacted, 197 (51%) completed the survey. All respondents owned mobile devices (100% smartphone, 74% tablet), and 93% used apps in the clinical setting. Commonly used ob-gyn-related apps were pregnancy wheels (84%), cervical cancer screening algorithms (68%), and contraceptive eligibility guidelines (47%). Only 53% of respondents recommended apps to patients, with many reporting not being aware of appropriate apps. Sixty-two percent of respondents used apps for learning, but only 3 ob-gyn-specific apps were mentioned. Most chose apps based on recommendations from other residents. Residents viewed mobile technology as an important clinical tool (92%) that improves efficiency (89%). App use did not differ by gender, age, or postgraduate year. Mobile technology and ob-gyn-related app use are widely used among California ob-gyn residents, who feel that apps enhance their ability to care for patients. Context of app use varies, with most residents using apps during clinical care, but only half recommending apps to patients. Recommendations from other residents are the common resource for discovering new apps, suggesting a need for more formal guidance on finding and evaluating apps.

Workplace Violence and Harassment Against Emergency Medicine Residents

Science.gov (United States)

Schnapp, Benjamin H.; Slovis, Benjamin H.; Shah, Anar D.; Fant, Abra L.; Gisondi, Michael A.; Shah, Kaushal H.; Lech, Christie A.

2016-01-01

Introduction Several studies have shown that workplace violence in the emergency department (ED) is common. Residents may be among the most vulnerable staff, as they have the least experience with these volatile encounters. The goal for this study was to quantify and describe acts of violence against emergency medicine (EM) residents by patients and visitors and to identify perceived barriers to safety. Methods This cross-sectional survey study queried EM residents at multiple New York City hospitals. The primary outcome was the incidence of violence experienced by residents while working in the ED. The secondary outcomes were the subtypes of violence experienced by residents, as well as the perceived barriers to safety while at work. Results A majority of residents (66%, 78/119) reported experiencing at least one act of physical violence during an ED shift. Nearly all residents (97%, 115/119) experienced verbal harassment, 78% (93/119) had experienced verbal threats, and 52% (62/119) reported sexual harassment. Almost a quarter of residents felt safe “Occasionally,” “Seldom” or “Never” while at work. Patient-based factors most commonly cited as contributory to violence included substance use and psychiatric disease. Conclusion Self-reported violence against EM residents appears to be a significant problem. Incidence of violence and patient risk factors are similar to what has been found previously for other ED staff. Understanding the prevalence of workplace violence as well as the related systems, environmental, and patient-based factors is essential for future prevention efforts. PMID:27625721

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.

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.

Use of social media by residency program directors for resident selection.

Science.gov (United States)

Cain, Jeff; Scott, Doneka R; Smith, Kelly

2010-10-01

Pharmacy residency program directors' attitudes and opinions regarding the use of social media in residency recruitment and selection were studied. A 24-item questionnaire was developed, pilot tested, revised, and sent to 996 residency program directors via SurveyMonkey.com. Demographic, social media usage, and opinions on social media data were collected and analyzed. A total of 454 residency program directors completed the study (response rate, 46.4%). The majority of respondents were women (58.8%), were members of Generation X (75.4%), and worked in a hospital or health system (80%). Most respondents (73%) rated themselves as either nonusers or novice users of social media. Twenty percent indicated that they had viewed a pharmacy residency applicant's social media information. More than half (52%) had encountered e-professionalism issues, including questionable photos and posts revealing unprofessional attitudes, and 89% strongly agreed or agreed that information voluntarily published online was fair game for judgments on character, attitudes, and professionalism. Only 4% of respondents had reviewed applicants' profiles for residency selection decisions. Of those respondents, 52% indicated that the content had no effect on resident selection. Over half of residency program directors were unsure whether they will use social media information for future residency selection decisions. Residency program directors from different generations had different views regarding social media information and its use in residency applicant selections. Residency program directors anticipated using social media information to aid in future decisions for resident selection and hiring.

Development of a Comprehensive Communication Skills Curriculum for Pediatrics Residents.

Science.gov (United States)

Peterson, Eleanor B; Boland, Kimberly A; Bryant, Kristina A; McKinley, Tara F; Porter, Melissa B; Potter, Katherine E; Calhoun, Aaron W

2016-12-01

Effective communication is an essential element of medical care and a priority of medical education. Specific interventions to teach communication skills are at the discretion of individual residency programs. We developed the Resident Communication Skills Curriculum (RCSC), a formal curriculum designed to teach trainees the communication skills essential for high-quality practice. A multidisciplinary working group contributed to the development of the RCSC, guided by an institutional needs assessment, literature review, and the Accreditation Council for Graduate Medical Education core competencies. The result was a cohesive curriculum that incorporates didactic, role play, and real-life experiences over the course of the entire training period. Methods to assess curricular outcomes included self-reporting, surveys, and periodic faculty evaluations of the residents. Curricular components have been highly rated by residents (3.95-3.97 based on a 4-point Likert scale), and residents' self-reported communication skills demonstrated an improvement over the course of residency in the domains of requesting a consultation, providing effective handoffs, handling conflict, and having difficult conversations (intern median 3.0, graduate median 4.0 based on a 5-point Likert scale, P  ≤ .002). Faculty evaluations of residents have also demonstrated improvement over time (intern median 3.0, graduate median 4.5 based on a 5-point Likert scale, P  communication skills curriculum for pediatrics residents was implemented, with a multistep evaluative process showing improvement in skills over the course of the residency program. Positive resident evaluations and informal comments from faculty support its general acceptance. The use of existing resources makes this curriculum feasible.

Remediation of problematic residents--A national survey.

Science.gov (United States)

Bhatti, Nasir I; Ahmed, Aadil; Stewart, Michael G; Miller, Robert H; Choi, Sukgi S

2016-04-01

Despite careful selection processes, residency programs face the challenge of training residents who fall below minimal performance standards. Poor performance of a resident can endanger both patient safety and the reputation of the residency program. It is important, therefore, for a program to identify such residents and implement strategies for their successful remediation. The purpose of our study was to gather information on evaluation and remediation strategies employed by different otolaryngology programs. Cross-sectional survey. We conducted a national survey, sending a questionnaire to the program directors of 106 otolaryngology residency programs. We collected information on demographics of the program, identification of problematic residents, and remediation strategies. The response rate was 74.5%, with a 2% cumulative incidence of problematic residents in otolaryngology programs during the past 10 years. The most frequently reported deficiencies of problematic residents were unprofessional behavior with colleagues/staff (38%), insufficient medical knowledge (37%), and poor clinical judgment (34%). Personal or professional stress was the most frequently identified underlying problem (70.5%). Remediation efforts included general counseling (78%), frequent feedback sessions (73%), assignment of a mentor (58%), and extra didactics (47%). These remediation efforts failed to produce improvement in 23% of the identified residents, ultimately leading to their dismissal. The apparent deficiencies, underlying causes, and remediation strategies vary among otolaryngology residency programs. Based on the results of this survey, we offer recommendations for the early identification of problematic residents and a standardized remediation plan. NA. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

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

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.

Origin and Evolution of Reactive and Noble Gases Dissolved in Matrix Pore Water

Energy Technology Data Exchange (ETDEWEB)

Eichinger, F. [Hydroisotop GmbH, Schweitenkirchen (Germany); Rock-Water Interaction, Institute of Geological Sciences, University of Bern, Bern (Switzerland); Waber, H. N. [Rock-Water Interaction, Institute of Geological Sciences, University of Bern, Bern (Switzerland); Smellie, J. A.T. [Conterra AB, Stockholm (Sweden)

2013-07-15

Reactive and noble gases dissolved in matrix pore water of low permeable crystalline bedrock were successfully extracted and characterized for the first time based on drillcore samples from the Olkiluoto investigation site (SW Finland). Interaction between matrix pore water and fracture groundwater occurs predominately by diffusion. Changes in the chemical and isotopic composition of gases dissolved in fracture groundwater are transmitted and preserved in the pore water. Absolute concentrations, their ratios and the stable carbon isotope signature of hydrocarbon gases dissolved in pore water give valuable indications about the evolution of these gases in the nearby flowing fracture groundwaters. Inert noble gases dissolved in matrix pore water and their isotopes combined with their in situ production and accumulation rates deliver information about the residence time of pore water. (author)

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.

Practice gaps in patient safety among dermatology residents and their teachers: a survey study of dermatology residents.

Science.gov (United States)

Swary, Jillian Havey; Stratman, Erik J

2014-07-01

Curriculum and role modeling adjustments are necessary to address patient safety gaps occurring during dermatology residency. To identify the source of clinical practices among dermatology residents that affect patient safety and determine the best approach for overcoming gaps in knowledge and practice patterns that contribute to these practices. A survey-based study, performed at a national medical dermatology meeting in Itasca, Illinois, in 2012, included 142 dermatology residents from 44 residency programs in the United States and Canada. Self-reported rates of dermatology residents committing errors, identifying local systems errors, and identifying poor patient safety role modeling. Of surveyed dermatology residents, 45.2% have failed to report needle-stick injuries incurred during procedures, 82.8% reported cutting and pasting a previous author's patient history information into a medical record without confirming its validity, 96.7% reported right-left body part mislabeling during examination or biopsy, and 29.4% reported not incorporating clinical photographs of lesions sampled for biopsy in the medical record at their institution. Residents variably perform a purposeful pause ("time-out") when indicated to confirm patient, procedure, and site before biopsy, with 20.0% always doing so. In addition, 59.7% of residents work with at least 1 attending physician who intimidates the residents, reducing the likelihood of reporting safety issues they witness. Finally, 78.3% have witnessed attending physicians purposefully disregarding required safety steps. Our data reinforce the need for modified curricula, systems, and teacher development to reduce injuries, improve communication with patients and between physicians, residents, and other members of the health care team, and create an environment free of intimidation.

Intrinsic photocatalytic assessment of reactively sputtered TiO₂ films.

Science.gov (United States)

Rafieian, Damon; Driessen, Rick T; Ogieglo, Wojciech; Lammertink, Rob G H

2015-04-29

Thin TiO2 films were prepared by DC magnetron reactive sputtering at different oxygen partial pressures. Depending on the oxygen partial pressure during sputtering, a transition from metallic Ti to TiO2 was identified by spectroscopic ellipsometry. The crystalline nature of the film developed during a subsequent annealing step, resulting in thin anatase TiO2 layers, displaying photocatalytic activity. The intrinsic photocatalytic activity of the catalysts was evaluated for the degradation of methylene blue (MB) using a microfluidic reactor. A numerical model was employed to extract the intrinsic reaction rate constants. High conversion rates (90% degradation within 20 s residence time) were observed within these microreactors because of the efficient mass transport and light distribution. To evaluate the intrinsic reaction kinetics, we argue that mass transport has to be accounted for. The obtained surface reaction rate constants demonstrate very high reactivity for the sputtered TiO2 films. Only for the thinnest film, 9 nm, slightly lower kinetics were observed.

Groundwater residence time : tell me who you are and I will tell which information you may provide

Science.gov (United States)

Aquilina, Luc; Labasque, Thierry; Kolbe, Tamara; Marçais, Jean; Leray, Sarah; Abbott, Ben; de Dreuzy, Jean-Raynald

2016-04-01

geochemical processes. Among others, it is the case of (i) slow geochemical processes effective at large residence times such as silicate dissolution, (ii) biogeochemical reactivity activated by some modification of the flow structure, (iii) interactions between microbial diversity and biogeochemical reactivity. While first-order kinetics is commonly assumed, more advanced relations are developed between the nutrient and energy supply. O2 and NO3 nutrient relate to recharge processes on the one hand and Fe and S relate to dissolution in reducing environments on the other hand. Detailed studies of fractured aquifers in Brittany (France) are discussed.

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.

The Urology Residency Program in Israel—Results of a Residents Survey and Insights for the Future

Directory of Open Access Journals (Sweden)

Arnon Lavi

2017-10-01

Full Text Available Objective Urology practice has undergone several changes in recent years mainly related to novel technologies introduced. We aimed to get the residents’ perspective on the current residency program in Israel and propose changes in it. Methods A web-based survey was distributed among urology residents. Results 61 residents completed the survey out of 95 to whom it was sent (64% compliance. A total of 30% replied that the 9 months of mandatory general surgery rotation contributed to their training, 48% replied it should be shortened/canceled, and 43% replied that the Step A exam (a mandatory written certifying exam in general surgery was relevant to their training. A total of 37% thought that surgical exposure during the residency was adequate, and 28% considered their training “hands-on.” Most non-junior residents (post-graduate year 3 and beyond reported being able to perform simple procedures such as circumcision and transurethral resections but not complex procedures such as radical and laparoscopic procedures. A total of 41% of non-junior residents practice at a urology clinic. A total of 62% of residents from centers with no robotics replied its absence harmed their training, and 85% replied they would benefit from a robotics rotation. A total of 61% of residents from centers with robotics replied its presence harmed their training, and 72% replied they would benefit from an open surgery rotation. A total of 82% of the residents participated in post-graduate courses, and 81% replied they would engage in a clinical fellowship. Conclusion Given the survey results we propose some changes to be considered in the residency program. These include changes in the general surgery rotation and exam, better surgical training, possible exchange rotations to expose residents to robotic and open surgery (depending on the availability of robotics in their center, greater out-patient urology clinic exposure, and possible changes in the basic science

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)

Emotional intelligence in orthopedic surgery residents.

Science.gov (United States)

Chan, Kevin; Petrisor, Brad; Bhandari, Mohit

2014-04-01

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

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

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.

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.

Comparison of Emergency Medicine Malpractice Cases Involving Residents to Non-Resident Cases.

Science.gov (United States)

Gurley, Kiersten L; Grossman, Shamai A; Janes, Margaret; Yu-Moe, C Winnie; Song, Ellen; Tibbles, Carrie D; Shapiro, Nathan I; Rosen, Carlo L

2018-04-17

Data are lacking on how emergency medicine (EM) malpractice cases with resident involvement differs from cases that do not name a resident. To compare malpractice case characteristics in cases where a resident is involved (resident case) to cases that do not involve a resident (non-resident case) and to determine factors that contribute to malpractice cases utilizing EM as a model for malpractice claims across other medical specialties. We used data from the Controlled Risk Insurance Company (CRICO) Strategies' division Comparative Benchmarking System (CBS) to analyze open and closed EM cases asserted from 2009-2013. The CBS database is a national repository that contains professional liability data on > 400 hospitals and > 165,000 physicians, representing over 30% of all malpractice cases in the U.S (> 350,000 claims). We compared cases naming residents (either alone or in combination with an attending) to those that did not involve a resident (non-resident cohort). We reported the case statistics, allegation categories, severity scores, procedural data, final diagnoses and contributing factors. Fisher's exact test or t-test was used for comparisons (alpha set at 0.05). Eight hundred and forty-five EM cases were identified of which 732 (87%) did not name a resident (non-resident cases), while 113 (13%) included a resident (resident cases) (Figure 1). There were higher total incurred losses for non-resident cases (Table 1). The most frequent allegation categories in both cohorts were "Failure or Delay in Diagnosis/Misdiagnosis" and "Medical Treatment" (non-surgical procedures or treatment regimens i.e. central line placement). Allegation categories of Safety and Security, Patient Monitoring, Hospital Policy and Procedure and Breach of Confidentiality were found in the non-resident cases. Resident cases incurred lower payments on average ($51,163 vs. $156,212 per case). Sixty six percent (75) of resident vs 57% (415) of non-resident cases were high severity claims

Technical note: An inverse method to relate organic carbon reactivity to isotope composition from serial oxidation

Directory of Open Access Journals (Sweden)

J. D. Hemingway

2017-11-01

Full Text Available Serial oxidation coupled with stable carbon and radiocarbon analysis of sequentially evolved CO2 is a promising method to characterize the relationship between organic carbon (OC chemical composition, source, and residence time in the environment. However, observed decay profiles depend on experimental conditions and oxidation pathway. It is therefore necessary to properly assess serial oxidation kinetics before utilizing decay profiles as a measure of OC reactivity. We present a regularized inverse method to estimate the distribution of OC activation energy (E, a proxy for bond strength, using serial oxidation. Here, we apply this method to ramped temperature pyrolysis or oxidation (RPO analysis but note that this approach is broadly applicable to any serial oxidation technique. RPO analysis directly compares thermal reactivity to isotope composition by determining the E range for OC decaying within each temperature interval over which CO2 is collected. By analyzing a decarbonated test sample at multiple masses and oven ramp rates, we show that OC decay during RPO analysis follows a superposition of parallel first-order kinetics and that resulting E distributions are independent of experimental conditions. We therefore propose the E distribution as a novel proxy to describe OC thermal reactivity and suggest that E vs. isotope relationships can provide new insight into the compositional controls on OC source and residence time.

Technical note: An inverse method to relate organic carbon reactivity to isotope composition from serial oxidation

Science.gov (United States)

Hemingway, Jordon D.; Rothman, Daniel H.; Rosengard, Sarah Z.; Galy, Valier V.

2017-11-01

Serial oxidation coupled with stable carbon and radiocarbon analysis of sequentially evolved CO2 is a promising method to characterize the relationship between organic carbon (OC) chemical composition, source, and residence time in the environment. However, observed decay profiles depend on experimental conditions and oxidation pathway. It is therefore necessary to properly assess serial oxidation kinetics before utilizing decay profiles as a measure of OC reactivity. We present a regularized inverse method to estimate the distribution of OC activation energy (E), a proxy for bond strength, using serial oxidation. Here, we apply this method to ramped temperature pyrolysis or oxidation (RPO) analysis but note that this approach is broadly applicable to any serial oxidation technique. RPO analysis directly compares thermal reactivity to isotope composition by determining the E range for OC decaying within each temperature interval over which CO2 is collected. By analyzing a decarbonated test sample at multiple masses and oven ramp rates, we show that OC decay during RPO analysis follows a superposition of parallel first-order kinetics and that resulting E distributions are independent of experimental conditions. We therefore propose the E distribution as a novel proxy to describe OC thermal reactivity and suggest that E vs. isotope relationships can provide new insight into the compositional controls on OC source and residence time.

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

Introducing "optimal challenges" in resident training

DEFF Research Database (Denmark)

Sørensen, Anette Bagger; Christensen, Mette Krogh

Background: Residents are often caught between two interests: the resident’s desire to participate in challenging learning situations and the department’s work planning. However, these interests may clash if they are not coordinated by the senior doctors, and challenging learning situations risk...... that the residents benefit from the intervention because they experienced more optimal challenges than before the intervention. However, the matching of resident and case seems to work against the established culture in the department: The daily work has for many years been organized so that senior doctors have...... their “own” patients and they do not “share” patients with residents. Thus the patients were accustomed to have their “own” specialist doctor. Conclusion: The intervention generated optimal challenges, but revealed the need for more team-based organization of senior doctors and residents’ working...

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

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

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.

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.

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.

Preparing Future Leaders: An Integrated Quality Improvement Residency Curriculum.

Science.gov (United States)

Potts, Stacy; Shields, Sara; Upshur, Carole

2016-06-01

The Accreditation Council for Graduate Medical Education (ACGME) has recognized the importance of quality improvement (QI) training and requires that accredited residencies in all specialties demonstrate that residents are "integrated and actively participate in interdisciplinary clinical quality improvement and patient safety activities." However, competing demands in residency training may make this difficult to accomplish. The study's objective is to develop and evaluate a longitudinal curriculum that meets the ACGME requirement for QI and patient safety training and links to patient-centered medical home (PCMH) practices. Residents in the Worcester Family Medicine Residency (WFMR) participated in a faculty-developed quality improvement curriculum that included web-based tutorials, quality improvement projects, and small-group sessions across all 3 years of residency. They completed self-evaluations of knowledge and use of curricular activities annually and at graduation, and comparisons were made between two graduating classes, as well as comparison of end of PGY2 to end of PGY3 for one class. Graduating residents who completed the full 3 years of the curriculum rated themselves as significantly more skilled in nine of 15 areas assessed at end of residency compared to after PGY2 and reported confidence in providing future leadership in a focus group. Five areas were also rated significantly higher than prior-year residents. Involving family medicine residents in a longitudinal curriculum with hands-on practice in implementing QI, patient safety, and chronic illness management activities that are inclusive of PCMH goals increased their self-perceived skills and leadership ability to implement these new and emerging evidence-based practices in primary care.

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.

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.

Residents' experiences of abuse, discrimination and sexual harassment during residency training. McMaster University Residency Training Programs.

Science.gov (United States)

Cook, D J; Liutkus, J F; Risdon, C L; Griffith, L E; Guyatt, G H; Walter, S D

1996-06-01

To assess the prevalence of psychological abuse, physical assault, and discrimination on the basis of gender and sexual orientation, and to examine the prevalence and impact of sexual harassment in residency training programs. Self-administered questionnaire. McMaster University, Hamilton, Ont. Residents in seven residency training programs during the academic year from July 1993 to June 1994. Of 225 residents 186 (82.7%) returned a completed questionnaire, and 50% of the respondents were women. Prevalence of psychological abuse, physical assault and discrimination on the basis of gender and sexual orientation experienced by residents during medical training, prevalence and residents' perceived frequency of sexual harassment. Psychological abuse was reported by 50% of the residents. Some of the respondents reported physical assault, mostly by patients and their family members (14.7% reported assaults by male patients and family members, 9.8% reported assaults by female patients and family members), 5.4% of the female respondents reported assault by male supervising physicians. Discrimination on the basis of gender was reported to be common and was experienced significantly more often by female residents than by male residents (p sexual orientation. Most of the respondents experienced sexual harassment, especially in the form of sexist jokes, flirtation and unwanted compliments on their dress or figure. On average, 40% of the respondents, especially women (p sexual harassment to someone (p sexual harassment were embarassment (reported by 24.0%), anger (by 23.4%) and frustration (20.8%). Psychological abuse, discrimination on the basis of gender and sexual harassment are commonly experienced by residents in training programs. A direct, progressive, multidisciplinary approach is needed to label and address these problems.

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

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

Science.gov (United States)

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

2016-04-01

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

Anesthesiology residents' perspective about good teaching--a qualitative needs assessment.

Science.gov (United States)

Ortwein, Heiderose; Blaum, Wolf E; Spies, Claudia D

2014-01-01

Germany, like many other countries, will soon have a shortage of qualified doctors. One reason for the dissatisfaction amongst medical residents are the relatively unstructured residency training programs despite increasing importance of outcome-based education. The aim of our study was to identify characteristics and requirements for good teaching during anesthesiology residency training from the resident's point of view. A consensus workshop with residents from all medical universities in Germany was held. Participants were allocated to one of the three topics, chosen based on a 2009 nationwide evaluation of residency. The three topics were (A) characteristics of helpful/good teachers, (B) characteristics of helpful/good conditions and (C) characteristics of helpful/good curricular structure. Each group followed a nominal group technique consensus process to define and rank characteristics for a good residency. 31 (79.5%) resident representatives were present. The consented results put emphasis on the importance of structured curricula including transparent goals and objectives, in training formative assessments and quality assurance measures for the program. Residents further long for trained trainers with formal teaching qualifications and protected teaching time. Good residency training requires careful consideration of all stakeholders' needs. Results reflect and extend previous findings and are at least to some degree easily implemented. These findings are an important step to establish a broader consensus within the discipline.

Redesigning journal club in residency.

Science.gov (United States)

Al Achkar, Morhaf

2016-01-01

The gap between production and implementation of knowledge is the main reason for the suboptimal quality of health care. To eliminate this gap and improve the quality of patient care, journal club (JC) in graduate medical education provides an opportunity for learning the skills of evidence-based medicine. JC, however, continues to face many challenges mainly due to poorly defined goals, inadequate preparation, and lack of interest. This article presents an innovative model to prepare and present JC based on three pillars: dialogical learning through group discussion, mentored residents as peer teachers, and including JC as part of a structured curriculum to learn evidence-based medicine. This engaging model has the potential to transform JC from a moribund session that is daunting for residents into a lively discussion to redefine clinical practice using the most current evidence.

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.

A theory-informed, process-oriented Resident Scholarship Program.

Science.gov (United States)

Thammasitboon, Satid; Darby, John B; Hair, Amy B; Rose, Karen M; Ward, Mark A; Turner, Teri L; Balmer, Dorene F

2016-01-01

The Accreditation Council for Graduate Medical Education requires residency programs to provide curricula for residents to engage in scholarly activities but does not specify particular guidelines for instruction. We propose a Resident Scholarship Program that is framed by the self-determination theory (SDT) and emphasize the process of scholarly activity versus a scholarly product. The authors report on their longitudinal Resident Scholarship Program, which aimed to support psychological needs central to SDT: autonomy, competence, and relatedness. By addressing those needs in program aims and program components, the program may foster residents' intrinsic motivation to learn and to engage in scholarly activity. To this end, residents' engagement in scholarly processes, and changes in perceived autonomy, competence, and relatedness were assessed. Residents engaged in a range of scholarly projects and expressed positive regard for the program. Compared to before residency, residents felt more confident in the process of scholarly activity, as determined by changes in increased perceived autonomy, competence, and relatedness. Scholarly products were accomplished in return for a focus on scholarly process. Based on our experience, and in line with the SDT, supporting residents' autonomy, competence, and relatedness through a process-oriented scholarship program may foster the curiosity, inquisitiveness, and internal motivation to learn that drives scholarly activity and ultimately the production of scholarly products.

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

Life satisfaction of people with intellectual disability living in community residences: perceptions of the residents, their parents and staff members.

Science.gov (United States)

Schwartz, C; Rabinovitz, S

2003-02-01

Within the literature on quality of life (QoL), life satisfaction (LS) has emerged as a key variable by which to measure perceived well-being, which is referred to as subjective QoL. The LS self-reports of 93 residents with intellectual disability (ID) living in community-based residences were compared with reports about their LS completed by their staff and parents. The residents were interviewed on their LS by social workers who did not belong to the staff of the interviewee's residence. The instrument used was the Life Satisfaction Scale (LSS). Staff and parents completed the short version of the LSS. Residents and staff's LS reports were positively correlated. However, significant differences were found between these two groups of informants when the residents were characterized as high functioning, had a low score in challenging behaviour, worked in an integrative employment setting and lived in an apartment. As opposed to staff/resident discrepancies, no differences were found between parents' and residents' LS reports. If residents cannot to be interviewed about their LS, then the parent is the preferred person to respond on behalf of the resident. The current study highlights the importance of including both objective measures (e.g. functional assessment characteristics) and subjective measures (e.g. LS) in order to get a better understanding of the QoL of people with ID.

Experience with Emergency Ultrasound Training by Canadian Emergency Medicine Residents

Directory of Open Access Journals (Sweden)

Daniel J. Kim

2014-05-01

Full Text Available Introduction: Starting in 2008, emergency ultrasound (EUS was introduced as a core competency to the Royal College of Physicians and Surgeons of Canada (Royal College emergency medicine (EM training standards. The Royal College accredits postgraduate EM specialty training in Canada through 5-year residency programs. The objective of this study is to describe both the current experience with and the perceptions of EUS by Canadian Royal College EM senior residents. Methods: This was a web-based survey conducted from January to March 2011 of all 39 Canadian Royal College postgraduate fifth-year (PGY-5 EM residents. Main outcome measures were characteristics of EUS training and perceptions of EUS. Results: Survey response rate was 95% (37/39. EUS was part of the formal residency curriculum for 86% of respondents (32/37. Residents most commonly received training in focused assessment with sonography for trauma, intrauterine pregnancy, abdominal aortic aneurysm, cardiac, and procedural guidance. Although the most commonly provided instructional material (86% [32/37] was an ultrasound course, 73% (27/37 of residents used educational resources outside of residency training to supplement their ultrasound knowledge. Most residents (95% [35/37] made clinical decisions and patient dispositions based on their EUS interpretation without a consultative study by radiology. Residents had very favorable perceptions and opinions of EUS. Conclusion: EUS training in Royal College EM programs was prevalent and perceived favorably by residents, but there was heterogeneity in resident training and practice of EUS. This suggests variability in both the level and quality of EUS training in Canadian Royal College EM residency programs.

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.

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

Science.gov (United States)

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

2017-01-01

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

Surgical Pathology Resident Rotation Restructuring at a Tertiary Care Academic Center

Directory of Open Access Journals (Sweden)

Chelsea R. Mehr MD

2017-11-01

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

Informatics and Technology in Resident Education.

Science.gov (United States)

Niehaus, William

2017-05-01

Biomedical or clinical informatics is the transdisciplinary field that studies and develops effective uses of biomedical data, information technology innovations, and medical knowledge for scientific inquiry, problem solving, and decision making, with an emphasis on improving human health. Given the ongoing advances in information technology, the field of informatics is becoming important to clinical practice and to residency education. This article will discuss how informatics is specifically relevant to residency education and the different ways to incorporate informatics into residency education, and will highlight applications of current technology in the context of residency education. How informatics can optimize communication for residents, promote information technology use, refine documentation techniques, reduce medical errors, and improve clinical decision making will be reviewed. It is hoped that this article will increase faculty and trainees' knowledge of the field of informatics, awareness of available technology, and will assist practitioners to maximize their ability to provide quality care to their patients. This article will also introduce the idea of incorporating informatics specialists into residency programs to help practitioners deliver more evidenced-based care and to further improve their efficiency. Copyright © 2017 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

Measuring resident well-being: impostorism and burnout syndrome in residency.

Science.gov (United States)

Legassie, Jenny; Zibrowski, Elaine M; Goldszmidt, Mark A

2008-07-01

Assessing resident well-being is becoming increasingly important from a programmatic standpoint. Two measures that have been used to assess this are the Clance Impostor Scale (CIS) and the Maslach Burnout Inventory-Human Services Survey (MBI-HSS). However, little is known about the relationship between the two phenomena. To explore the prevalence and association between impostorism and burnout syndrome in a sample of internal medicine residents. Anonymous, cross-sectional postal survey. Forty-eight internal medicine residents (postgraduate year [PGY] 1-3) at the Schulich School of Medicine & Dentistry (62.3% response rate). Short demographic questionnaire, CIS and MBI-HSS. Impostorism and burnout syndrome were identified in 43.8% and 12.5% of residents, respectively. With the exception of a negative correlation between CIS scores and the MBI's personal accomplishment subscale (r = -.30; 95% CI -.54 to -.02), no other significant relations were identified. Foreign-trained residents were more likely to score as impostors (odds ratio [OR] 10.7; 95% CI 1.2 to 98.2) while senior residents were more likely to experience burnout syndrome (OR 16.5 95% CI 1.6 to 168.5). Both impostorism and burnout syndrome appear to be threats to resident well-being in our program. The lack of relationship between the two would suggest that programs and researchers wishing to address the issue of resident distress should consider using both measures. The finding that foreign-trained residents appear to be more susceptible to impostorism warrants further study.

Residences Satisfaction Towards Service Quality Provided By Bogor Local Government

OpenAIRE

Setiawan, Budi; Oswari, Teddy; Kuswanto, Adi

2011-01-01

The lowest local government as a frontline government has some crucial duties in­cludes residences administration, village development, residences identity, land ad­ministration, and other duties. Up to present, the performance of the lowest local government is measured based on the regulation, but has never been measured based on the perception of its residences that have had service directly. The objective of the study are(1) to explore whether there is a differences between the perception ...

Oral and maxillofacial surgery residents have poor understanding of biostatistics.

Science.gov (United States)

Best, Al M; Laskin, Daniel M

2013-01-01

The purpose of this study was to evaluate residents' understanding of biostatistics and interpretation of research results. A questionnaire previously used in internal medicine residents was modified to include oral and maxillofacial surgery (OMS) examples. The survey included sections to identify demographic and educational characteristics of residents, attitudes and confidence, and the primary outcome-knowledge of biostatistics. In 2009 an invitation to the Internet survey was sent to all 106 program directors in the United States, who were requested to forward it to their residents. One hundred twelve residents responded. The percentage of residents who had taken a course in epidemiology was 53%; biostatistics, 49%; and evidence-based dentistry, 65%. Conversely, 10% of OMS residents had taken none of these classes. Across the 6-item test of knowledge of statistical methods, the mean percentage of correct answers was 38% (SD, 22%). Nearly half of the residents (42%) could not correctly identify continuous, ordinal, or nominal variables. Only 21% correctly identified a case-control study, but 79% correctly identified that the purpose of blinding was to reduce bias. Only 46% correctly interpreted a clinically unimportant and statistically nonsignificant result. None of the demographic or experience factors of OMS residents were related to statistical knowledge. Overall, OMS resident knowledge was below that of internal medicine residents (Pbiostatistics and the interpretation of research and are thus unprepared to interpret the results of published clinical research. Residency programs should include effective biostatistical training in their curricula to prepare residents in evidence-based dentistry. Copyright © 2013 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Development of a UNIX network compatible reactivity computer

International Nuclear Information System (INIS)

Sanchez, R.F.; Edwards, R.M.

1996-01-01

A state-of-the-art UNIX network compatible controller and UNIX host workstation with MATLAB/SIMULINK software were used to develop, implement, and validate a digital reactivity calculation. An objective of the development was to determine why a Macintosh-based reactivity computer reactivity output drifted intolerably

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.

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.

An app to enhance resident education in otolaryngology.

Science.gov (United States)

Hsueh, Wayne D; Bent, John P; Moskowitz, Howard S

2017-12-07

Technological change is leading to an evolution in medical education. The objective of our study was to assess the impact of a medical knowledge app, called PulseQD, on resident education within our otolaryngology-head and neck surgery department at Montefiore Medical Center, Albert Einstein College of Medicine (Bronx, NY). A prospective cohort study was conducted within the Department of Otolaryngology-Head and Neck Surgery from July 2016 to June 2017. All faculty attendings and residents were asked to participate in the study and were included. A Web and mobile-based app, PulseQD, that allowed for collaborative learning was implemented. Questionnaires were given at the beginning and end of the academic year. Otolaryngology Training Exam (OTE) scores were collected RESULTS: A total of 20 residents and 13 faculty members participated in the study. Residents used online sources of medical information significantly more often than faculty (90% and 54%, respectively, P = 0.0179). Residents and faculty felt that PulseQD offered a valuable perspective on clinically relevant medical information (P = 0.0003), was a great way to test clinical and medical knowledge (P = 0.0001), and improved the sharing and discussing of medical knowledge (P academic year. The implementation of a novel mobile app, PulseQD, was well received by residents and faculty in the Department of Otolaryngology-Head and Neck Surgery. Preliminary data suggest that app-based learning may lead to improved performance on knowledge-based assessments. NA. Laryngoscope, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

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...

A case of reactive arthritis in a Ranger Indoctrination Program (RIP) student.

Science.gov (United States)

Hart, Robert S; Detro, John F

2009-01-01

Musculoskeletal complaints comprise the majority of cases encountered by military physicians when evaluating young active duty Soldier-athletes. This is a case of reactive arthritis in a 19-year-old active duty Soldier-athlete whose failure to improve with conservative therapy initiated further investigation. When evaluating what appear to be routine overuse injuries, it is important to actively include other potential causes of musculoskeletal complaints in the differential diagnosis. Further investigation of disease in patients whose symptoms and complaints do not improve with routine conservative care is paramount. Reactive arthritis, though self-limiting in two-thirds of those affected, can become a chronic disabling disease affecting as many as 40 out of 100 patients. Current theories suggest the persistent presence of non-culturable bacteria and bacterial antigens residing in the joint synovia as the etiology of the disease state. There is no curative therapy for reactive arthritis and management is focused on the treatment of symptoms with non-steroidal anti-inflammatory drugs (NSAIDs), immunomodulator therapy, and antibiotics if an infectious source is suspected.

Applying Expectancy Theory to residency training: proposing opportunities to understand resident motivation and enhance residency training

Directory of Open Access Journals (Sweden)

Shweiki E

2015-04-01

Full Text Available Ehyal Shweiki,1 Niels D Martin,2 Alec C Beekley,1 Jay S Jenoff,1 George J Koenig,1 Kris R Kaulback,1 Gary A Lindenbaum,1 Pankaj H Patel,1 Matthew M Rosen,1 Michael S Weinstein,1 Muhammad H Zubair,2 Murray J Cohen1 1Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA; 2Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA Abstract: Medical resident education in the United States has been a matter of national priority for decades, exemplified initially through the Liaison Committee for Graduate Medical Education and then superseded by the Accreditation Council for Graduate Medical Education. A recent Special Report in the New England Journal of Medicine, however, has described resident educational programs to date as prescriptive, noting an absence of innovation in education. Current aims of contemporary medical resident education are thus being directed at ensuring quality in learning as well as in patient care. Achievement and work-motivation theories attempt to explain people's choice, performance, and persistence in tasks. Expectancy Theory as one such theory was reviewed in detail, appearing particularly applicable to surgical residency training. Correlations between Expectancy Theory as a work-motivation theory and residency education were explored. Understanding achievement and work-motivation theories affords an opportunity to gain insight into resident motivation in training. The application of Expectancy Theory in particular provides an innovative perspective into residency education. Afforded are opportunities to promote the development of programmatic methods facilitating surgical resident motivation in education. Keywords: learning, education, achievement

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.

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.

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.

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.

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.

Does Residency Selection Criteria Predict Performance in Orthopaedic Surgery Residency?

Science.gov (United States)

Raman, Tina; Alrabaa, Rami George; Sood, Amit; Maloof, Paul; Benevenia, Joseph; Berberian, Wayne

2016-04-01

More than 1000 candidates applied for orthopaedic residency positions in 2014, and the competition is intense; approximately one-third of the candidates failed to secure a position in the match. However, the criteria used in the selection process often are subjective and studies have differed in terms of which criteria predict either objective measures or subjective ratings of resident performance by faculty. Do preresidency selection factors serve as predictors of success in residency? Specifically, we asked which preresidency selection factors are associated or correlated with (1) objective measures of resident knowledge and performance; and (2) subjective ratings by faculty. Charts of 60 orthopaedic residents from our institution were reviewed. Preresidency selection criteria examined included United States Medical Licensing Examination (USMLE) Step 1 and Step 2 scores, Medical College Admission Test (MCAT) scores, number of clinical clerkship honors, number of letters of recommendation, number of away rotations, Alpha Omega Alpha (AOA) honor medical society membership, fourth-year subinternship at our institution, and number of publications. Resident performance was assessed using objective measures including American Board of Orthopaedic Surgery (ABOS) Part I scores and Orthopaedics In-Training Exam (OITE) scores and subjective ratings by faculty including global evaluation scores and faculty rankings of residents. We tested associations between preresidency criteria and the subsequent objective and subjective metrics using linear correlation analysis and Mann-Whitney tests when appropriate. Objective measures of resident performance namely, ABOS Part I scores, had a moderate linear correlation with the USMLE Step 2 scores (r = 0.55, p communication skills" subsection of the global evaluations. We found that USMLE Step 2, number of honors in medical school clerkships, and AOA membership demonstrated the strongest correlations with resident performance. Our

Factors associated with the subspecialty choices of internal medicine residents in Canada.

Science.gov (United States)

Horn, Leora; Tzanetos, Katina; Thorpe, Kevin; Straus, Sharon E

2008-06-26

Currently, there are more residents enrolled in cardiology training programs in Canada than in immunology, pharmacology, rheumatology, infectious diseases, geriatrics and endocrinology combined. There is no published data regarding the proportion of Canadian internal medicine residents applying to the various subspecialties, or the factors that residents consider important when deciding which subspecialty to pursue. To address the concern about physician imbalances in internal medicine subspecialties, we need to examine the factors that motivate residents when making career decisions. In this two-phase study, Canadian internal medicine residents participating in the post graduate year 4 (PGY4) subspecialty match were invited to participate in a web-based survey and focus group discussions. The focus group discussions were based on issues identified from the survey results. Analysis of focus group transcripts grew on grounded theory. 110 PGY3 residents participating in the PGY4 subspecialty match from 10 participating Canadian universities participated in the web-based survey (54% response rate). 22 residents from 3 different training programs participated in 4 focus groups held across Canada. Our study found that residents are choosing careers that provide intellectual stimulation, are consistent with their personality, and that provide a challenge in diagnosis. From our focus group discussions it appears that lifestyle, role models, mentorship and the experience of the resident with the specialty appear to be equally important in career decisions. Males are more likely to choose procedure based specialties and are more concerned with the reputation of the specialty as well as the anticipated salary. In contrast, residents choosing non-procedure based specialties are more concerned with issues related to lifestyle, including work-related stress, work hours and time for leisure as well as the patient populations they are treating. This study suggests that internal

Factors associated with the subspecialty choices of internal medicine residents in Canada

Directory of Open Access Journals (Sweden)

Thorpe Kevin

2008-06-01

Full Text Available Abstract Background Currently, there are more residents enrolled in cardiology training programs in Canada than in immunology, pharmacology, rheumatology, infectious diseases, geriatrics and endocrinology combined. There is no published data regarding the proportion of Canadian internal medicine residents applying to the various subspecialties, or the factors that residents consider important when deciding which subspecialty to pursue. To address the concern about physician imbalances in internal medicine subspecialties, we need to examine the factors that motivate residents when making career decisions. Methods In this two-phase study, Canadian internal medicine residents participating in the post graduate year 4 (PGY4 subspecialty match were invited to participate in a web-based survey and focus group discussions. The focus group discussions were based on issues identified from the survey results. Analysis of focus group transcripts grew on grounded theory. Results 110 PGY3 residents participating in the PGY4 subspecialty match from 10 participating Canadian universities participated in the web-based survey (54% response rate. 22 residents from 3 different training programs participated in 4 focus groups held across Canada. Our study found that residents are choosing careers that provide intellectual stimulation, are consistent with their personality, and that provide a challenge in diagnosis. From our focus group discussions it appears that lifestyle, role models, mentorship and the experience of the resident with the specialty appear to be equally important in career decisions. Males are more likely to choose procedure based specialties and are more concerned with the reputation of the specialty as well as the anticipated salary. In contrast, residents choosing non-procedure based specialties are more concerned with issues related to lifestyle, including work-related stress, work hours and time for leisure as well as the patient populations

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

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

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.

The role of topography on catchment‐scale water residence time

Science.gov (United States)

McGuire, K.J.; McDonnell, Jeffery J.; Weiler, M.; Kendall, C.; McGlynn, B.L.; Welker, J.M.; Seibert, J.

2005-01-01

The age, or residence time, of water is a fundamental descriptor of catchment hydrology, revealing information about the storage, flow pathways, and source of water in a single integrated measure. While there has been tremendous recent interest in residence time estimation to characterize watersheds, there are relatively few studies that have quantified residence time at the watershed scale, and fewer still that have extended those results beyond single catchments to larger landscape scales. We examined topographic controls on residence time for seven catchments (0.085–62.4 km2) that represent diverse geologic and geomorphic conditions in the western Cascade Mountains of Oregon. Our primary objective was to determine the dominant physical controls on catchment‐scale water residence time and specifically test the hypothesis that residence time is related to the size of the basin. Residence times were estimated by simple convolution models that described the transfer of precipitation isotopic composition to the stream network. We found that base flow mean residence times for exponential distributions ranged from 0.8 to 3.3 years. Mean residence time showed no correlation to basin area (r2 organization (i.e., topography) rather than basin area controls catchment‐scale transport. Results from this study may provide a framework for describing scale‐invariant transport across climatic and geologic conditions, whereby the internal form and structure of the basin defines the first‐order control on base flow residence time.

Design and Development of Virtual Reactivity System for PWR

International Nuclear Information System (INIS)

Anwar, M. I.

2012-01-01

The reactivity monitoring and investigation is an important mean to ensure the safety operation of a nuclear power plant. But the reactivity of the nuclear reactor usually cannot be directly measured. It should be computed with certain estimation method. In this thesis, an effort has been made using an artificial neural network and highly fluctuating experimental data for predicting the total reactivity of the nuclear reactor based on all components of net reactivity. This virtual reactivity system is designed by taking advantage of neural network's nonlinear mapping capability. Based on analysis of the reactivity contributing factors, several neural network models are built separately for control rod, boron, poisons, fuel Doppler Effect and moderator effect. Extensive simulation and validation tests for PWR show that satisfied results have been obtained with the proposed approach. It presents a new idea to estimate the PWR's reactivity using artificial intelligence. All the design and simulation work is carried out in MATLAB and a real time programming environment is chosen for the computation and prediction of reactivity. (author)

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.

Resident dashboards: helping your clinical competency committee visualize trainees' key performance indicators.

Science.gov (United States)

Friedman, Karen A; Raimo, John; Spielmann, Kelly; Chaudhry, Saima

2016-01-01

Under the Next Accreditation System, programs need to find ways to collect and assess meaningful reportable information on its residents to assist the program director regarding resident milestone progression. This paper discusses the process that one large Internal Medicine Residency Program used to provide both quantitative and qualitative data to its clinical competency committee (CCC) through the creation of a resident dashboard. Program leadership at a large university-based program developed four new end of rotation evaluations based on the American Board of Internal Medicine (ABIM) and Accreditation Council of Graduated Medical Education's (ACGME) 22 reportable milestones. A resident dashboard was then created to pull together both milestone- and non-milestone-based quantitative data and qualitative data compiled from faculty, nurses, peers, staff, and patients. Dashboards were distributed to the members of the CCC in preparation for the semiannual CCC meeting. CCC members adjudicated quantitative and qualitative data to present their cohort of residents at the CCC meeting. Based on the committee's response, evaluation scores remained the same or were adjusted. Final milestone scores were then entered into the accreditation data system (ADS) on the ACGME website. The process of resident assessment is complex and should comprise both quantitative and qualitative data. The dashboard is a valuable tool for program leadership to use both when evaluating house staff on a semiannual basis at the CCC and to the resident in person.

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.

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....

Improving Resident Performance Through a Simulated Rapid Response Team: A Pilot Study.

Science.gov (United States)

Burke, Peter A; Vest, Michael T; Kher, Hemant; Deutsch, Joseph; Daya, Sneha

2015-07-01

The Joint Commission requires hospitals to develop systems in which a team of clinicians can rapidly recognize and respond to changes in a patient's condition. The rapid response team (RRT) concept has been widely adopted as the solution to this mandate. The role of house staff in RRTs and the impact on resident education has been controversial. At Christiana Care Health System, eligible residents in their second through final years lead the RRTs. To evaluate the use of a team-based, interdisciplinary RRT training program for educating and training first-year residents in an effort to improve global RRT performance before residents start their second year. This pilot study was administered in 3 phases. Phase 1 provided residents with classroom-based didactic sessions using case-based RRT scenarios. Multiple choice examinations were administered, as well as a confidence survey based on a Likert scale before and after phase 1 of the program. Phase 2 involved experiential training in which residents engaged as mentored participants in actual RRT calls. A qualitative survey was used to measure perceived program effectiveness after phase 2. In phase 3, led by senior residents, simulated RRTs using medical mannequins were conducted. Participants were divided into 5 teams, in which each resident would rotate in the roles of leader, nurse, and respiratory therapist. This phase measured resident performance with regard to medical decision making, data gathering, and team behaviors during the simulated RRT scenarios. Performance was scored by an attending and a senior resident. A total of 18 residents were eligible (N=18) for participation. The average multiple choice test score improved by 20% after didactic training. The average confidence survey score before training was 3.44 out of 5 (69%) and after training was 4.13 (83%), indicating a 14% improvement. High-quality team behaviors correlated with medical decision making (0.92) more closely than did high-quality data

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.

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.

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.

Twelve Theses on Reactive Rules for the Web

OpenAIRE

Bry, François; Eckert, Michael; Patranjan, Paula-Lavinia

2006-01-01

Reactivity, the ability to detect events and respond to them automatically through reactive programs, is a key requirement in many present-day information systems. Work on Web Services re ects the need for support of reactivity on a higher abstraction level than just message exchange by HTTP. This article presents the composite event query facilities of the reactive rule-based programming language XChange. Composite events are important in the dynamic world of the Web whe...

CPSP/HSE Postgraduate Overseas Rotational Programme: Residents' Perspective.

Science.gov (United States)

Gondal, Khalid Masood; Iqbal, Uzma; Arif, Seema; Ahmed, Arslan; Khan, Umair Ahmed

2016-04-01

To get direct upward feedback from the residents of first batch of CPSP/HSE Postgraduate Scholarship Programme. Mixed methods qualitative research study. CPSP, Regional Office, Lahore, in June 2015. It is a mixed-method study that was conducted in June, 2015. Data was collected through an email survey with 33 medical residents doing their rotation in Ireland; and focus group discussions were carried out with 8 residents, who had successfully completed their rotation. Data were collected through pre-designed questionnaires comprising of open- and close-ended questions. The data were entered into SPSS version 21 and analyzed. The mean age of residents was 29.9 ±1.1 years, 7 (21.2%) were females and 24 (72.7%) respondents were males. Residents agreed that HSE programme has improved their evidence-based decision making (mean score of 3.3 ±1.2) and enhanced professionalism (mean score of 3.6 ±1.1). They disagreed that training has polished their procedural skills (mean score 2.4 ±1.2). The identified strengths of the programme are: adopting a systematic approach towards patients, evidence-based decision making, better exposure and opportunities, financial stability and development of communication skills. The weaknesses are: less exposure to procedural skills, difficulty in synopsis and dissertation writing and difficulty in adjustment with rotational schedules. Residents of CPSP/HSE Programme believed that CPSP/HSE has improved their professionalism, communication skills and increased their future opportunities for career growth. Better communication between CPSP focal person and residents will help sort out many minor but important issues.

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).

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

Patient-Centered Handovers: Ethnographic Observations of Attending and Resident Physicians: Ethnographic Observations of Attending and Resident Physicians.

Science.gov (United States)

Mount-Campbell, Austin F; Rayo, Michael F; OʼBrien, James J; Allen, Theodore T; Patterson, Emily S

Handover communication improvement initiatives typically employ a "one size fits all" approach. A human factors perspective has the potential to guide how to tailor interventions to roles, levels of experience, settings, and types of patients. We conducted ethnographic observations of sign-outs by attending and resident physicians in 2 medical intensive care units at one institution. Digitally audiotaped data were manually analyzed for content using codes and time spent using box plots for emergent categories. A total of 34 attending and 58 resident physician handovers were observed. Resident physicians spent more time for "soon to be discharged" and "higher concern" patients than attending physicians. Resident physicians spent less time discussing patients which they had provided care for within the last 3 days ("handbacks"). The study suggested differences for how handovers were conducted for attending and resident physicians for 3 categories of patients; handovers differ on the basis of role or level of expertise, patient type, and amount of prior knowledge of the patient. The findings have implications for new directions for subsequent research and for how to tailor quality improvement interventions based upon the role, level of experience, level of prior knowledge, and patient categories.

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.

Pediatric dermatology training during residency: a survey of the 2014 graduating residents.

Science.gov (United States)

Akhavan, Alaleh; Murphy-Chutorian, Blair; Friedman, Adam

2015-01-01

Knowledge of pediatric dermatology is considered a core competency of dermatology training and should be expected of all practicing dermatologists. While the numbers of both pediatric dermatology fellowships and board certified pediatric dermatologists in the workforce have increased over the years, recent reports suggest that there is a gap in pediatric dermatology education during dermatology residency. The goal of this study is to assess the current state of pediatric education during residency, as well as the clinical experience, satisfaction and expectations of graduating dermatology residents. A 31-question self-report survey was distributed electronically to 294 third-year dermatology residents with questions pertaining to demographics, didactic education, resident experience in pediatric dermatology training, satisfaction with pediatric training and future plans. One hundred and twenty-three residents responded (41.8% response rate) representing approximately 29.1% of the total number of graduating residents. 69 (56.1%) residents reported academic time specifically devoted to pediatric dermatology, the majority (79.7%) of which was led by pediatric dermatologists. 82% of residents reported dedicated pediatric dermatology clinics at their program. 86.8% of respondents felt that their training in pediatric dermatology will allow them to confidently see pediatric dermatology patients in practice. This survey highlights a promising state of pediatric dermatology training among current graduating dermatology residents. The majority of current graduating dermatology residents are satisfied with their pediatric dermatology education, feel confident treating pediatric patients, and plan to see pediatric patients in clinical practice. © 2015 Wiley Periodicals, Inc.

Spring 5 & reactive streams

CERN Multimedia

CERN. Geneva; Clozel, Brian

2017-01-01

Spring is a framework widely used by the world-wide Java community, and it is also extensively used at CERN. The accelerator control system is constituted of 10 million lines of Java code, spread across more than 1000 projects (jars) developed by 160 software engineers. Around half of this (all server-side Java code) is based on the Spring framework. Warning: the speakers will assume that people attending the seminar are familiar with Java and Spring’s basic concepts. Spring 5.0 and Spring Boot 2.0 updates (45 min) This talk will cover the big ticket items in the 5.0 release of Spring (including Kotlin support, @Nullable and JDK9) and provide an update on Spring Boot 2.0, which is scheduled for the end of the year. Reactive Spring (1h) Spring Framework 5.0 has been released - and it now supports reactive applications in the Spring ecosystem. During this presentation, we'll talk about the reactive foundations of Spring Framework with the Reactor project and the reactive streams specification. We'll al...

Selection criteria of residents for residency programs in Kuwait.

Science.gov (United States)

Marwan, Yousef; Ayed, Adel

2013-01-19

In Kuwait, 21 residency training programs were offered in the year 2011; however, no data is available regarding the criteria of selecting residents for these programs. This study aims to provide information about the importance of these criteria. A self-administered questionnaire was used to collect data from members (e.g. chairmen, directors, assistants …etc.) of residency programs in Kuwait. A total of 108 members were invited to participate. They were asked to rate the importance level (scale from 1 to 5) of criteria that may affect the acceptance of an applicant to their residency programs. Average scores were calculated for each criterion. Of the 108 members invited to participate, only 12 (11.1%) declined to participate. Interview performance was ranked as the most important criteria for selecting residents (average score: 4.63/5.00), followed by grade point average (average score: 3.78/5.00) and honors during medical school (average score: 3.67/5.00). On the other hand, receiving disciplinary action during medical school and failure in a required clerkship were considered as the most concerning among other criteria used to reject applicants (average scores: 3.83/5.00 and 3.54/5.00 respectively). Minor differences regarding the importance level of each criterion were noted across different programs. This study provided general information about the criteria that are used to accept/reject applicants to residency programs in Kuwait. Future studies should be conducted to investigate each criterion individually, and to assess if these criteria are related to residents' success during their training.

Taxonomy of instructions given to residents in laparoscopic cholecystectomy.

Science.gov (United States)

Feng, Yuanyuan; Wong, Christopher; Park, Adrian; Mentis, Helena

2016-03-01

Although simulation-based training allows residents to become proficient in surgical skills outside the OR, residents still depend on senior surgeons' guidance in transferring skills accumulated from simulators into the operating room. This study aimed to identify and classify explicit instructions made by attending surgeons to their residents during laparoscopic surgery. Through these instructions, we examined the role gaze guidance plays in OR-based training. A total of ten laparoscopic cholecystectomy cases being performed by PGY4 residents were analyzed. The explicit directional instructions given by the mentoring attending surgeons to their residents were identified and classified into four categories based on their locations in the coordinate system. These categories were further combined into two classes, based on the target of instructions. The frequencies of instructions in the two classes were compared, and effect size was calculated. There were 1984 instructions identified in the ten cases. The instructions were categorized into instrument guidance (38.51%) and gaze guidance (61.49%). The instrument guidance focused on moving the instruments to perform surgical tasks, including directions to targets, instrument manipulation, and instrument interaction. The gaze guidance focused on achieving common ground during the operation, including target identification and target fixation. The frequency of gaze guidance is significantly higher than instrument guidance in a laparoscopic cholecystectomy (p guidance has become the main focus of OR-based training. The results show a tight connection between adopting expert gaze and performing surgical tasks and suggest that gaze training should be integrated into the simulation training.

Factors influencing resident's decision to reside in gated and guarded community

Science.gov (United States)

Shamsudin, Zarina; Shamsudin, Shafiza; Zainal, Rozlin

2017-10-01

Gated communities are residential areas developed with restricted access with strictly controlled entrances and surrounded by a close perimeter of wall or fences. Developers, conscious of the need to fulfill the requirement of living in modern and sophisticated lifestyle and gated properties become the trend and mushroomed over the past decade. Nowadays, it is obvious that gated and guarded communities become almost a dominant feature of Malaysia housing development projects. The focus of this paper is to identify the factors contribute resident's decision to reside in gated and guarded community and to study social interaction among gated communities' residents. 150 questionnaires were distributed to the residents of selected gated and guarded community area in order to achieve the objectives and analyzed by using Statistical Package for Social Science (SPSS) and descriptive analysis. The result was tabulated and presented in charts and graphs for a clear and better understanding. The five main factors contribute to resident decision to reside in gated communities were identified and ranked; there are privacy, security, location, lifestyle and prestige. Besides, the residents are feeling neutral towards the facilities and services provided in their gated and guarded residential area. A comprehensive improvement towards the facilities and services is needed to reach higher satisfaction from the residents.

Resident dashboards: helping your clinical competency committee visualize trainees’ key performance indicators

Directory of Open Access Journals (Sweden)

Karen A. Friedman

2016-03-01

Full Text Available Introduction: Under the Next Accreditation System, programs need to find ways to collect and assess meaningful reportable information on its residents to assist the program director regarding resident milestone progression. This paper discusses the process that one large Internal Medicine Residency Program used to provide both quantitative and qualitative data to its clinical competency committee (CCC through the creation of a resident dashboard. Methods: Program leadership at a large university-based program developed four new end of rotation evaluations based on the American Board of Internal Medicine (ABIM and Accreditation Council of Graduated Medical Education's (ACGME 22 reportable milestones. A resident dashboard was then created to pull together both milestone- and non-milestone-based quantitative data and qualitative data compiled from faculty, nurses, peers, staff, and patients. Results: Dashboards were distributed to the members of the CCC in preparation for the semiannual CCC meeting. CCC members adjudicated quantitative and qualitative data to present their cohort of residents at the CCC meeting. Based on the committee's response, evaluation scores remained the same or were adjusted. Final milestone scores were then entered into the accreditation data system (ADS on the ACGME website. Conclusions: The process of resident assessment is complex and should comprise both quantitative and qualitative data. The dashboard is a valuable tool for program leadership to use both when evaluating house staff on a semiannual basis at the CCC and to the resident in person.

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.

Incorporating Interpersonal Skills into Otolaryngology Resident Selection and Training.

Science.gov (United States)

Lu-Myers, Yemeng; Myers, Christopher G

2018-01-01

Increasing attention has been paid to the selection of otolaryngology residents, a highly competitive process but one with room for improvement. A recent commentary in this journal recommended that residency programs more thoroughly incorporate theory and evidence from personnel psychology (part of the broader field of organizational science) in the resident selection process. However, the focus of this recommendation was limited to applicants' cognitive abilities and independent work-oriented traits (eg, conscientiousness). We broaden this perspective to consider critical interpersonal skills and traits that enhance resident effectiveness in interdependent health care organizations and we expand beyond the emphasis on selection to consider how these skills can be honed during residency. We advocate for greater use of standardized team-based care simulations, which can aid in assessing and developing the key interpersonal leadership skills necessary for success as an otolaryngology resident.

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

Role of the Vasa Vasorum and Vascular Resident Stem Cells in Atherosclerosis

Directory of Open Access Journals (Sweden)

Jun-ichi Kawabe

2014-01-01

Full Text Available Atherosclerosis is considered an “inside-out” response, that begins with the dysfunction of intimal endothelial cells and leads to neointimal plaque formation. The adventitia of large blood vessels has been recognized as an active part of the vessel wall that is involved in the process of atherosclerosis. There are characteristic changes in the adventitial vasa vasorum that are associated with the development of atheromatous plaques. However, whether vasa vasorum plays a causative or merely reactive role in the atherosclerotic process is not completely clear. Recent studies report that the vascular wall contains a number of stem/progenitor cells that may contribute to vascular remodeling. Microvessels serve as the vascular niche that maintains the resident stem/progenitor cells of the tissue. Therefore, the vasa vasorum may contribute to vascular remodeling through not only its conventional function as a blood conducting tube, but also its new conceptual function as a stem cell reservoir. This brief review highlights the recent advances contributing to our understanding of the role of the adventitial vasa vasorum in the atherosclerosis and discusses new concept that involves vascular-resident factors, the vasa vasorum and its associated vascular-resident stem cells, in the atherosclerotic process.

Do otolaryngology residency applicants relocate for training?

Science.gov (United States)

Gebhard, Grant M; Hauser, Leah J; Dally, Miranda J; Weitzenkamp, David A; Cabrera-Muffly, Cristina

2016-04-01

To determine whether there is an association between the geographic location of an applicant's undergraduate school, medical school, and residency program among matched otolaryngology residency applicants. Observational. Otolaryngology residency program applications to our institution from 2009 to 2013 were analyzed. The geographic location of each applicant's undergraduate education and medical education were collected. Online public records were queried to determine the residency program location of matched applicants. Applicants who did not match or who attended medical school outside the United States were excluded. Metro area, state, and region were determined according to US Census Bureau definitions. From 2009 to 2013, 1,089 (78%) of 1,405 applicants who matched into otolaryngology residency applied to our institution. The number of subjects who attended medical school and residency in the same geographic region was 241 (22%) for metropolitan area, 305 (28%) for state, and 436 (40%) for region. There was no difference in geographic location retention by gender or couples match status of the subject. United States Medical Licensing Exam step 1 scores correlated with an increased likelihood of subjects staying within the same geographic region (P = .03). Most otolaryngology applicants leave their previous geographic area to attend residency. Based on these data, the authors recommend against giving weight to geography as a factor when inviting applicants to interview. NA. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

Results of the 2003 Association of Residents in Radiation Oncology (ARRO) surveys of residents and chief residents in the United States

International Nuclear Information System (INIS)

Jagsi, Reshma; Buck, David A.; Singh, Anurag K.; Engleman, Mark; Thakkar, Vipul; Frank, Steven J.; Flynn, Daniel

2005-01-01

Purpose: To document demographic characteristics of current residents, career motivations and aspirations, and training program policies and resources. Methods: In 2003, the Association of Residents in Radiation Oncology (ARRO) conducted two nationwide surveys: one of all U.S. radiation oncology residents and one of chief residents. Results: The Chief Residents' Survey was completed by representatives from all 77 programs (response rate, 100%). The Residents' Survey was returned by 229 respondents (response rate, 44%). In each, 32% of respondents were female. The most popular career after residency was private practice (46%), followed by permanent academic practice (28%). Changes that would entice those choosing private practice to consider an academic career included more research experience as a resident (76%), higher likelihood of tenure (69%), lesser time commitment (66%), and higher salary (54%). Although the majority of respondents were satisfied with educational experience overall, a number of programs were reported to provide fewer resources than required. Conclusions: Median program resources and numbers of outliers are documented to allow residents and program directors to assess the relative adequacy of experience in their own programs. Policy-making bodies and individual programs should consider these results when developing interventions to improve educational experiences of residents and to increase retention of radiation oncologists in academic practice

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...

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.

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.

The resident's view of residency training in Canada.

Science.gov (United States)

Fish, D G

1966-04-09

In the view of residents in their last year of specialty training, the Fellowship is now becoming the operative standard for obtaining hospital privileges in urban centres and they felt that this implied that the two standards, the Certificate and the Fellowship of the Royal College, were not achieving the purpose for which they were designed. Although 80% of the residents intended to write the Fellowship, few viewed a year in a basic science department or in research as of intrinsic value in terms of their future practice.The examinations of the Royal College were the subject of criticism, most residents feeling that the examinations did not test the knowledge and ability gained in training. Most expressed a desire for ongoing evaluation during the training period.Service responsibilities were generally regarded as too heavy.Despite the criticism of both training and examination, most residents felt that their training had provided them with the experience and background they needed to practise as specialists.

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.

Factors associated with primary care residents' satisfaction with their training.

Science.gov (United States)

Randall, C S; Bergus, G R; Schlechte, J A; McGuinness, G; Mueller, C W

1997-01-01

Satisfaction is known to impact work performance, learning, recruitment, and retention. This study identifies the factors associated with primary care residents' satisfaction with their training. We used a cross-sectional survey based on the Price-Mueller model of job satisfaction. The model included 14 job characteristics, four personal characteristics, and four demographic factors. Data were collected in February and March 1996 from residents in three primary care training programs (family practice, pediatrics, and internal medicine) at a large academic medical center. The same standardized, self-administered questionnaires were used in all three departments. Seventy-five percent (n = 119) of the residents returned questionnaires. Five job characteristics were positively associated with resident satisfaction: continuity of care, autonomy, collegiality, work that encourages professional growth, and work group loyalty. Role conflict, a sixth job characteristic, was negatively associated with satisfaction. The personal characteristic of having an optimistic outlook on life was also positively associated with satisfaction. The model explained 66% of the variation in self-reported satisfaction. The satisfaction of the residents was significantly associated with six job characteristics and one personal factor. Interventions based on these job characteristics may increase resident satisfaction and may lead to better patient outcomes, better work performance, greater patient satisfaction, and more success in recruiting top students into a residency.

Involving Students in Residence Halls in Hong Kong

Science.gov (United States)

Ting, S. Raymond; Chan, Rebecca; Lee, Esther

2016-01-01

This article reports a study based on A. W. Astin's (1984) involvement theory applied in residence halls at a public university in Hong Kong, China. The resident students who were involved as participants or student leaders in this study were found to be better developed in terms of leadership, career development, multicultural experience,…

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

Science.gov (United States)

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

2017-01-01

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

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

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.

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

Resident and attending physician perception of maladaptive response to stress in residents

Directory of Open Access Journals (Sweden)

Lee Ann Riesenberg

2014-11-01

Full Text Available Background: Residency stress has been shown to interfere with resident well-being and patient safety. We developed a survey research study designed to explore factors that may affect perception of a maladaptive response to stress. Methods: A 16-item survey with 12 Likert-type perception items was designed to determine how often respondents agreed or disagreed with statements regarding the resident on the trigger tape. A total of 438 respondents from multiple institutions completed surveys. Results: Attending physicians were more likely than residents to agree that the resident on the trigger tape was impaired, p<0.0001; needed to seek professional counseling, p=0.0003; should be removed from the service, p=0.002; was not receiving adequate support from the attending physician, p=0.007; and was a risk to patient safety, p=0.02. Attending physicians were also less likely to agree that the resident was a good role model, p=0.001, and that the resident should be able to resolve these issues herself/himself, p<0.0001. Conclusion: Our data suggest that resident physicians may not be able to adequately detect maladaptive responses to stress and that attending physicians may be more adept at recognizing this problem. More innovative faculty and resident development workshops should be created to teach and encourage physicians to better observe and detect residents who are displaying maladaptive responses to stress.

Menopause education: needs assessment of American obstetrics and gynecology residents.

Science.gov (United States)

Christianson, Mindy S; Ducie, Jennifer A; Altman, Kristiina; Khafagy, Ayatallah M; Shen, Wen

2013-11-01

This study aims to understand the current teaching of menopause medicine in American obstetrics and gynecology residency programs. A Web-based survey was e-mailed to all American obstetrics and gynecology residency directors, with a request that they forward it to their residents. Of 258 residency program directors contacted, 79 (30.6%) confirmed forwarding the survey. In all, 1,799 people received the survey, with 510 completions, for a response rate of 28.3%. Most residents reported that they had limited knowledge and needed to learn more about these aspects of menopause medicine: pathophysiology of menopause symptoms (67.1%), hormone therapy (68.1%), nonhormone therapy (79.0%), bone health (66.1%), cardiovascular disease (71.7%), and metabolic syndrome (69.5%). Among fourth-year residents who will be entering clinical practice soon, a large proportion also reported a need to learn more in these areas: pathophysiology of menopause symptoms (45.9%), hormone therapy (54.2%), nonhormone therapy (69.4%), bone health (54.2%), cardiovascular disease (64.3%), and metabolic syndrome (63.8%). When asked to rate the most preferred modalities for learning about menopause, the top choice was supervised clinics (53.2%), followed by case presentations (22.2%), formal lectures (21.3%), small groups (14.7%), Web-based learning (7.8%), and independent reading (5.2%). Only 20.8% of residents reported that their program had a formal menopause medicine learning curriculum, and 16.3% had a defined menopause clinic as part of their residency. It seems that some American residency programs do not fulfill the educational goals of their residents in menopause medicine. A curriculum would be beneficial for increasing knowledge and clinical experience on menopause issues.

The Quality of Written Feedback by Attendings of Internal Medicine Residents.

Science.gov (United States)

Jackson, Jeffrey L; Kay, Cynthia; Jackson, Wilkins C; Frank, Michael

2015-07-01

Attending evaluations are commonly used to evaluate residents. Evaluate the quality of written feedback of internal medicine residents. Retrospective. Internal medicine residents and faculty at the Medical College of Wisconsin from 2004 to 2012. From monthly evaluations of residents by attendings, a randomly selected sample of 500 written comments by attendings were qualitatively coded and rated as high-, moderate-, or low-quality feedback by two independent coders with good inter-rater reliability (kappa: 0.94). Small group exercises with residents and attendings also coded the utterances as high, moderate, or low quality and developed criteria for this categorization. In-service examination scores were correlated with written feedback. There were 228 internal medicine residents who had 6,603 evaluations by 334 attendings. Among 500 randomly selected written comments, there were 2,056 unique utterances: 29% were coded as nonspecific statements, 20% were comments about resident personality, 16% about patient care, 14% interpersonal communication, 7% medical knowledge, 6% professionalism, and 4% each on practice-based learning and systems-based practice. Based on criteria developed by group exercises, the majority of written comments were rated as moderate quality (65%); 22% were rated as high quality and 13% as low quality. Attendings who provided high-quality feedback rated residents significantly lower in all six of the Accreditation Council for Graduate Medical Education (ACGME) competencies (p service examination scores. Most attending written evaluation was of moderate or low quality. Attendings who provided high-quality feedback appeared to be more discriminating, providing significantly lower ratings of residents in all six ACGME core competencies, and across a greater range. Attendings' negative written comments on medical knowledge correlated with lower in-service training scores.

Pregnancy and Parenthood among Surgery Residents: Results of the First Nationwide Survey of General Surgery Residency Program Directors.

Science.gov (United States)

Sandler, Britt J; Tackett, John J; Longo, Walter E; Yoo, Peter S

2016-06-01

Although family and lifestyle are known to be important factors for medical students choosing a specialty, there is a lack of research about general surgery residency program policies regarding pregnancy and parenthood. Similarly, little is known about program director attitudes about these issues. We performed a cross-sectional survey of United States (US) general surgery residency program directors. Sixty-six respondents completed the survey: 70% male, 59% from university-based programs, and 76% between 40 and 59 years of age. Two-thirds (67%) reported having a maternity leave policy. Less than half (48%) reported having a leave policy for the non-childbearing parent (paternity leave). Leave duration was most frequently reported as 6 weeks for maternity leave (58%) and 1 week for paternity leave (45%). Thirty-eight percent of general surgery residency program directors (PDs) reported availability of on-site childcare, 58% reported availability of lactation facilities. Forty-six percent of university PDs said that the research years are the best time to have a child during residency; 52% of independent PDs said that no particular time during residency is best. Sixty-one percent of PDs reported that becoming a parent negatively affects female trainees' work, including placing an increased burden on fellow residents (33%). Respondents perceived children as decreasing female trainees' well-being more often than male trainees' (32% vs 9%, p leave, length of leave, as well as inconsistency in access to childcare and availability of spaces to express and store breast milk. Program directors perceived parenthood to affect the training and well-being of female residents more adversely than that of male residents. Copyright © 2016 American College of Surgeons. All rights reserved.

[Fifty years of residency in Psychiatry at the University of Montreal: relevance and necessity of the Residents' Association].

Science.gov (United States)

Thibault, Alexis

2015-01-01

In the context of the fiftieth anniversary celebrations of the Département de psychiatrie de l'Université de Montréal, the present article offers to retrace the history of the Psychiatry Resident's Association (ARPUM). Since the Association's activities and demands reflected the concerns of the time, a depiction of the Residency Program and exploration of the historical and administrative context, in each key period, is also undertaken. Multiple psychiatrists from every decade, who were once active members of the Association, were interviewed and asked to describe the Residency Program at their time, with its positive and negative aspects, based on their own personal experience as a resident, but also as a member of the organization. The interviewees were also invited to share their recollections of the various Association's demands, representations, activities and functioning, depending on the issues and periods. Various private and public archives were also used, in order to contextualize the residents' experiences and the Association's work. A brief exploration of the historical and political context that led to the creation of the organization is explained. Training and working conditions of residents at that time are reported, enabling the understanding of the first demands when the group was born. Historical jumps are then proposed, from decades to decades, in order to depict key issues, whether they were academic, clinical or organizational, through which the Association worked, over the evolution of the Residency Program. The internal functioning and its occasional problems throughout the years are also described, as is the role in organizing social and educational events. The Residency Program is in constant mutation, and the Association has played its part in shaping the psychiatric training at the Université de Montréal. Multiple positive and tangible impacts were and are still made possible from the collaborative work between the Département de

Mixed messages: residents' experiences learning cross-cultural care.