WorldWideScience

Sample records for reside changing constructions

  1. Where heart and home reside: changing constructions of place and identity

    Science.gov (United States)

    Daniel R. Williams; Norman McIntyre

    2001-01-01

    Globalization has expanded the scope and geographic scale of leisure and tourism practices and their consequent impacts on society. Yet studies of such topics as community, home, migration, and tourism remain infused with outdated assumptions of a geographically rooted subject. In the future, the changing nature of employment, retirement, and lifestyles are likely to...

  2. 20th Annual Residence Hall Construction Report

    Science.gov (United States)

    Agron, Joe

    2009-01-01

    Even in difficult economic times, colleges and universities continue to invest in residence hall construction projects as a way to attract new students and keep existing ones on campus. According to data from "American School & University"'s 20th annual Residence Hall Construction Report, the median new project completed in 2008 was…

  3. Changes in Personal Relationships During Residency and Their Effects on Resident Wellness: A Qualitative Study.

    Science.gov (United States)

    Law, Marcus; Lam, Michelle; Wu, Diana; Veinot, Paula; Mylopoulos, Maria

    2017-11-01

    Residency poses challenges for residents' personal relationships. Research suggests residents rely on family and friends for support during their training. The authors explored the impact of residency demands on residents' personal relationships and the effects changes in those relationships could have on their wellness. The authors used a constructivist grounded theory approach. In 2012-2014, they conducted semistructured interviews with a purposive and theoretical sample of 16 Canadian residents from various specialties and training levels. Data analysis occurred concurrently with data collection, allowing authors to use a constant comparative approach to explore emergent themes. Transcripts were coded; codes were organized into categories and then themes to develop a substantive theory. Residents perceived their relationships to be influenced by their evolving professional identity: Although personal relationships were important, being a doctor superseded them. Participants suggested they were forced to adapt their personal relationships, which resulted in the evolution of a hierarchy of relationships that was reinforced by the work-life imbalance imposed by their training. This poor work-life balance seemed to result in relationship issues and diminish residents' wellness. Participants applied coping mechanisms to manage the conflict arising from the adaptation and protect their relationships. To minimize the effects of identity dissonance, some gravitated toward relationships with others who shared their professional identity or sought social comparison as affirmation. Erosion of personal relationships could affect resident wellness and lead to burnout. Educators must consider how educational programs impact relationships and the subsequent effects on resident wellness.

  4. The Changing Scenario of Obstetrics and Gynecology Residency Training

    Science.gov (United States)

    Gupta, Natasha; Dragovic, Kristina; Trester, Richard; Blankstein, Josef

    2015-01-01

    Background Significant changes have been noted in aspects of obstetrics-gynecology (ob-gyn) training over the last decade, which is reflected in Accreditation Council for Graduate Medical Education (ACGME) operative case logs for graduating ob-gyn residents. Objective We sought to understand the changing trends of ob-gyn residents' experience in obstetric procedures over the past 11 years. Methods We analyzed national ACGME procedure logs for all obstetric procedures recorded by 12 728 ob-gyn residents who graduated between academic years 2002–2003 and 2012–2013. Results The average number of cesarean sections per resident increased from 191.8 in 2002–2003 to 233.4 in 2012–2013 (17%; P obstetric logs demonstrated decreases in volume of vaginal, forceps, and vacuum deliveries, and increases in cesarean and multifetal deliveries. Change in experience may require use of innovative strategies to help improve residents' basic obstetric skills. PMID:26457146

  5. Effect on construction of design changes

    International Nuclear Information System (INIS)

    Aldersebaes, J.K.; Starner, A.E.

    1976-01-01

    Some design changes during construction are inevitable. Whether inevitable or desirable, their impact on construction can be measured as schedule extension and/or increased project cost. Achieving more complete design ahead of construction, restraining changes that are merely desirable, achieving a better understanding and evaluation of the impact of any design change, and optimizing those design changes which do have to be made are essential. This accommodation can include: more on-site design detail interference resolution; speedier liaison between the field construction and home design; better and more liaison between responsible schedulers and design personnel; and earlier liaison between design personnel and those in charge of the startup program

  6. The Changing Scenario of Obstetrics and Gynecology Residency Training.

    Science.gov (United States)

    Gupta, Natasha; Dragovic, Kristina; Trester, Richard; Blankstein, Josef

    2015-09-01

    Significant changes have been noted in aspects of obstetrics-gynecology (ob-gyn) training over the last decade, which is reflected in Accreditation Council for Graduate Medical Education (ACGME) operative case logs for graduating ob-gyn residents. We sought to understand the changing trends of ob-gyn residents' experience in obstetric procedures over the past 11 years. We analyzed national ACGME procedure logs for all obstetric procedures recorded by 12 728 ob-gyn residents who graduated between academic years 2002-2003 and 2012-2013. The average number of cesarean sections per resident increased from 191.8 in 2002-2003 to 233.4 in 2012-2013 (17%; P vacuum deliveries declined from 23.8 to 17.6 (26%; P training experience changed substantially over the past decade. ACGME obstetric logs demonstrated decreases in volume of vaginal, forceps, and vacuum deliveries, and increases in cesarean and multifetal deliveries. Change in experience may require use of innovative strategies to help improve residents' basic obstetric skills.

  7. Do changes in residents' fear of crime impact their walking? Longitudinal results from RESIDE.

    Science.gov (United States)

    Foster, Sarah; Knuiman, Matthew; Hooper, Paula; Christian, Hayley; Giles-Corti, Billie

    2014-05-01

    To examine the influence of fear of crime on walking for participants in a longitudinal study of residents in new suburbs. Participants (n=485) in Perth, Australia, completed a questionnaire about three years after moving to their neighbourhood (2007-2008), and again four years later (2011-2012). Measures included fear of crime, neighbourhood perceptions and walking (min/week). Objective environmental measures were generated for each participant's neighbourhood, defined as the 1600 m road network distance from home, at each time-point. Linear regression models examined the impact of changes in fear of crime on changes in walking, with progressive adjustment for other changes in the built environment, neighbourhood perceptions and demographics. An increase in fear of crime was associated with a decrease in residents' walking inside the local neighbourhood. For each increase in fear of crime (i.e., one level on a five-point Likert scale) total walking decreased by 22 min/week (p=0.002), recreational walking by 13 min/week (p=0.031) and transport walking by 7 min/week (p=0.064). This study provides longitudinal evidence that changes in residents' fear of crime influence their walking behaviours. Interventions that reduce fear of crime are likely to increase walking and produce public health gains. Copyright © 2014 Elsevier Inc. All rights reserved.

  8. Surgical resident learning styles have changed with work hours.

    Science.gov (United States)

    Quillin, Ralph C; Cortez, Alexander R; Pritts, Timothy A; Hanseman, Dennis J; Edwards, Michael J; Davis, Bradley R

    2016-01-01

    The Accreditation Council for Graduate Medical Education instituted the 80-h workweek for residency programs in 2003. This presented a unique challenge for surgery residents who must acquire a medical and technical knowledge base during training. Therefore, learning should be delivered in an environment congruent with an individual's learning style. In this study, we evaluated the learning styles of general surgery residents to determine how learning styles changed after the implementation to the 80-h workweek. Kolb learning style inventory was taken by general surgery residents at the University of Cincinnati's Department of Surgery, and results from 1999-2012 were analyzed. Statistical analysis was performed using the chi-squared, logistic regression and Wilcoxon rank-sum test. Significance was defined as a P value of learning styles after the institution of the 80-h workweek to converging (43.9%) and accommodating (40.4%, P learning. This change paralleled the transition to a more team-based approach to patient care with the implementation of the 80-h workweek. These findings are important for surgical educators to consider in the development of surgical resident curriculum. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Change of Job and Change of Residence - Geographical Mobility of the Labour Force

    DEFF Research Database (Denmark)

    Deding, Mette; Filges, Trine

    Solving regional labour market discrepancies through geographical mobility has gained increased political interest. The decision of changing job is closely related to the decision of changing residence as either change may imply a change in commuting cost. In this paper we set up a search model...... that can explain the residence and job changing behaviour of workers. The model is a double search model, in the sense that workers search for better jobs and dwellings simultaneously. Results show that the interrelationship between change of job and change of residence is very complex. However, scope...

  10. Body weight changes in elderly psychogeriatric nursing home residents

    NARCIS (Netherlands)

    Knoops, K.T.B.; Slump, E.; Groot, de C.P.G.M.; Wouters-Wesseling, W.; Brouwer, M.L.; Staveren, van W.A.

    2005-01-01

    Objective. This study was undertaken to identify predictors of body weight change in nursing home patients with possible to severe dementia. Methods. For 24 weeks, 108 elderly residents of a nursing home were followed. Body weight was measured every 2 weeks. Other anthropometric characteristics,

  11. Exploring the Changing Landscape of Surgical Residency Training

    NARCIS (Netherlands)

    C.J. Hopmans (Niels)

    2017-01-01

    textabstractWithin the past decade, the structure and format of surgical residency training has changed radically by the introduction of competency-based training programs, the progressive fragmentation of general surgery into subspecialties, and the implementation of stringent work hour

  12. [Basic research during residency in Israel: is change needed?].

    Science.gov (United States)

    Fishbain, Dana; Shoenfeld, Yehuda; Ashkenazi, Shai

    2013-10-01

    conservation. Nevertheless, alternative formats which might be suitable for some residents should be considered, and auxiliary tools to help residents fulfill their potential in research and raise the quality of written research papers should be constructed.

  13. 25 CFR 115.409 - How is an address for a minor's residence changed?

    Science.gov (United States)

    2010-04-01

    ... 25 Indians 1 2010-04-01 2010-04-01 false How is an address for a minor's residence changed? 115... minor's residence changed? (a) To change an address for a minor's residence, the custodial parent, legal... guardianship order, where applicable; (4) The new address of the minor's residence; and (5) The signature, mark...

  14. Calculation of high-rise construction limitations for non-resident housing fund in megacities

    Science.gov (United States)

    Iliashenko, Oksana; Krasnov, Sergey; Sergeev, Sergey

    2018-03-01

    The paper is devoted to topical issues of urban planning in terms of high-rise construction of a non-resident housing stock in relation to megacities. We consider this issue taking into account the limitations of natural, communal and social resources. The problem is especially acute for the overwhelming majority of the state capitals, as well as cities with historical heritage that are of great interest due to the rapid development of tourism and the high mobility of the population in the world. The growth of the population of many states capitals led to the use of high-rise buildings as a non-resident housing stock. However, there are a number of restrictions on the high-rise construction of non-resident housing stock in megacities. The authors formalize the problem of determining the optimal ratio of the volume of urban buildings belonging to the high-rise buildings types and intended for non-residents to a common housing fund. We conduct economic calculations to determine the quantitative indicators. It can be used as the basis for administrative measures aimed at limiting the people flow arriving with the intention of temporarily deploying in megacities.

  15. Changes in the Danish construction sector

    DEFF Research Database (Denmark)

    Kristiansen, Kristian; Emmitt, Stephen; Bonke, Sten

    2005-01-01

    Like the building sector in many other countries the Danish construction sector was criticised heavily in a number of government sponsored reports in the 1990s. The sector was seen to be unresponsive to change and ‘locked-in’ to familiar working practices, and so development was needed. And, like...

  16. Understanding how residents' preferences for supervisory methods change throughout residency training: a mixed-methods study.

    Science.gov (United States)

    Olmos-Vega, Francisco; Dolmans, Diana; Donkers, Jeroen; Stalmeijer, Renée E

    2015-10-16

    A major challenge for clinical supervisors is to encourage their residents to be independent without jeopardising patient safety. Residents' preferences according to level of training on this regard have not been completely explored. This study has sought to investigate which teaching methods of the Cognitive Apprenticeship (CA) model junior, intermediate and senior residents preferred and why, and how these preferences differed between groups. We invited 301 residents of all residency programmes of Javeriana University, Bogotá, Colombia, to participate. Each resident was asked to complete a Maastricht Clinical Teaching Questionnaire (MCTQ), which, being based on the teaching methods of CA, asked residents to rate the importance to their learning of each teaching method and to indicate which of these they preferred the most and why. A total of 215 residents (71 %) completed the questionnaire. All concurred that all CA teaching methods were important or very important to their learning, regardless of their level of training. However, the reasons for their preferences clearly differed between groups: junior and intermediate residents preferred teaching methods that were more supervisor-directed, such as modelling and coaching, whereas senior residents preferred teaching methods that were more resident-directed, such as exploration and articulation. The results indicate that clinical supervision (CS) should accommodate to residents' varying degrees of development by attuning the configuration of CA teaching methods to each level of residency training. This configuration should initially vest more power in the supervisor, and gradually let the resident take charge, without ever discontinuing CS.

  17. Staging constructions of authenticity in organizational change

    DEFF Research Database (Denmark)

    Dupret, Katia

    2018-01-01

    that are emotionally charged. Through a socio-material perspective this paper seeks to explore how change processes in organizations challenges the idea of authentic leadership as a merely individual ability or personality trait and suggest that the authentic leader is distributed into the practices of change....... The paper explores how staged organizational change where authentic role-play and scripts from everyday life combined with meta-reflection and feedback construct new forms of reflection where its ethical side-effects should be discussed....

  18. [Construction of abridged life table for health evaluation of local resident using Excel program].

    Science.gov (United States)

    Chen, Qingsha; Wang, Feng; Li, Xiaozhen; Yang, Jian; Yu, Shouyi; Hu, Jun

    2012-05-01

    To provide an easy computational tool for evaluating the health condition of local residents. An abridged life table was programmed by applying mathematical functions and formula in Excel program and tested with the real study data to evaluate the results computed. The Excel was capable of computing group death probability of age in the life table ((n)q(x)), number of survivors (l(x)), number of death ((n)d(x)), survival per person-year ((n)L(x)), survival total per person-year (T(x)) and life expectancy (e(x)). The calculated results were consistent with those by SAS. The abridged life table constructed using Microsoft Excel can conveniently and accurately calculate the relevant indices for evaluating the health condition of the residents.

  19. Design and construction of a demonstration residence utilizing natural thermal storage

    Science.gov (United States)

    Jones, R. F.; Ghaffari, H. T.

    The Brookhaven House is an energy conserving residence which demonstrates how thermal mass combined with solar energy can be used to reduce heating costs in a conventional single family house. The purpose of the project was to develop a prototypical house design that could result in immediate energy savings by being an acceptable, attractive design to developers, builders, and home buyers. Investigations were limited to only materials and methods of construction that were considered presently available and of Natural Thermal Storage design. Natural thermal storage is simply the heat storage obtained through architectural application of massive building materials integrated into the living space and structure of a residence. It has been concluded that relatively thin mass walls of masonry directly irradiated through a multiglazed south facing aperture can significantly reduce annual heating requirements.

  20. Staging constructions of authenticity in organizational change

    DEFF Research Database (Denmark)

    Dupret, Katia

    2018-01-01

    that are emotionally charged. Through a socio-material perspective this paper seeks to explore how change processes in organizations challenges the idea of authentic leadership as a merely individual ability or personality trait and suggest that the authentic leader is distributed into the practices of change......Authenticity in organizations has gained increased focus in recent years. Authentic management and leadership are ways to motivate and make sustainable changes in the organization. But authenticity is also strategically worked with in order to serve social and political functions....... The paper explores how staged organizational change where authentic role-play and scripts from everyday life combined with meta-reflection and feedback construct new forms of reflection where its ethical side-effects should be discussed....

  1. Determination of the hydraulic residence time of two subsurface-flow constructed wetlands using radiotracers

    International Nuclear Information System (INIS)

    Debien, Bruno R.

    2013-01-01

    The adoption of constructed wetland systems (CW's) with subsuperficial drainage for sewage treatment is increasingly growing in places with low technological resources and available land. The efficient removal of pollutants depends on the internal flow characteristics in the CW and on its hydraulic residence time (HRT). In the present work 82 Br - a gamma radiation emitter, produced from soluble potassium bromide irradiated in the TRIGA reactor at the Centre for the Development of Nuclear Energy (CDTN) - was used as a pseudo-conservative tracer for the comparative study of aqueous phase flow dynamics in two CW's: one in which plants were grown (WP) whereas the other had no plants (WNP). Experimental hydraulic residence time values were found to be very close to the theoretical one, while dispersion numbers obtained for both CW's were quite small. Besides these measured hydrodynamic parameters, the residence time distribution (RTD) curves of the tracer test and the results of modeling of experimental data also demonstrate the tendency of the units to display a plug flow-like effluent hydraulic transport within their systems, as expected from their designs, considering the large length/width ratio (L/W=8). (author)

  2. Determination of the hydraulic residence time of two subsurface-flow constructed wetlands using radiotracers

    Energy Technology Data Exchange (ETDEWEB)

    Debien, Bruno R., E-mail: brunordebien@gmail.com [Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil). Dept de Geografia. Lab. de Geomorfologia; Barreto, Alberto A.; Pinto, Amenonia M.F.; Moreira, Rubens M., E-mail: aab@cdtn.br, E-mail: amfp@cdtn.br, E-mail: rubens@cdtn.br [Centro de Desenvolvimento da Tecnologia Nuclear (CDTN/CNEN-MG), Belo Horizonte, MG (Brazil)

    2013-07-01

    The adoption of constructed wetland systems (CW's) with subsuperficial drainage for sewage treatment is increasingly growing in places with low technological resources and available land. The efficient removal of pollutants depends on the internal flow characteristics in the CW and on its hydraulic residence time (HRT). In the present work {sup 82}Br - a gamma radiation emitter, produced from soluble potassium bromide irradiated in the TRIGA reactor at the Centre for the Development of Nuclear Energy (CDTN) - was used as a pseudo-conservative tracer for the comparative study of aqueous phase flow dynamics in two CW's: one in which plants were grown (WP) whereas the other had no plants (WNP). Experimental hydraulic residence time values were found to be very close to the theoretical one, while dispersion numbers obtained for both CW's were quite small. Besides these measured hydrodynamic parameters, the residence time distribution (RTD) curves of the tracer test and the results of modeling of experimental data also demonstrate the tendency of the units to display a plug flow-like effluent hydraulic transport within their systems, as expected from their designs, considering the large length/width ratio (L/W=8). (author)

  3. Phase-change materials in masonry construction

    Science.gov (United States)

    Lang, M.

    1982-01-01

    A demonstration project leading to commercialization of a passive thermal wall using phase change storage materials (PCM) in masonry construction is reported. Techniques of vacuum forming have been identified and characterized making it possible to produce high-volume low-cost packages for insertion into the core of cement blocks. PCM filled packages with aluminum laminated film produces a long life product capable of operating to store and release solar heat over long periods of time. Accelerated tests indicate operability over the life of the building. Five hundred accelerated test cycles have shown insignificant deterioration of capacity of the phase change material. The testing program shows that the wall is capable of both storing and transmitting heat in a similar manner to conventional trombe walls, but with increased thermal capability. Product cost data on return on investment estimates are low enough to be economically attractive.

  4. 31 CFR 215.9 - Change of legal residence by members of the Armed Forces.

    Science.gov (United States)

    2010-07-01

    ... legal residence of a member of the Armed Forces for tax withholding purposes, the head of an agency at... change of legal residence of a member of the Armed Forces shall become effective for tax withholding... 31 Money and Finance: Treasury 2 2010-07-01 2010-07-01 false Change of legal residence by members...

  5. Change in residents' perceptions of teaching: following a one day "Residents as Teachers" (RasT) workshop.

    Science.gov (United States)

    Aiyer, Meenakshy; Woods, Gordon; Lombard, Gwen; Meyer, Lynne; Vanka, Anita

    2008-05-01

    The objective of this study was to assess the perceptions and attitudes of resident physicians toward teaching before and after participation in a mandatory "Residents as Teachers" (RasT) workshop in four domains: (1) setting goals and expectations, (2) use of clinical microskills in teaching, (3) evaluation and feedback, and (4) enthusiasm and preparedness toward teaching. Pre- and postintervention questionnaires were utilized. Data were analyzed for all respondents. Subgroup analyses were performed for each academic year and for primary care versus nonprimary care specialties. Over a 5-year period, 15 RasT workshops were presented to 276 residents from 10 different residency programs. Eighty-six percent completed the questionnaire before participation in the workshop, and 88% completed the questionnaire immediately after participation. The difference between the mean post-RasT and pre-RasT ratings on each item was used to measure the change in that item resulting from participation in the workshop. Overall, residents' self-assessed ratings of their attitudes toward teaching were positively impacted by participation in a RasT workshop. Further subanalysis showed that residents in primary care specialties showed a significantly greater increase in their ratings than residents in nonprimary care specialties.

  6. Constructing the meaning of quality of life for residents in care homes in the Lebanon: perspectives of residents, staff and family.

    Science.gov (United States)

    Adra, Marina Gharibian; Hopton, John; Keady, John

    2015-12-01

    Located in two care homes in Lebanon, the study explores the perspectives of quality of life for a sample of older residents, care staff and family caregivers. Quality of life for older people living in care homes is traditionally reported in the literature as a Westernised construct and so far little is known about its meanings from an Arabic cultural perspective and context. There is also a knowledge gap about the conditions of older people living in care homes in Lebanon. The study was a qualitative exploration of perspectives of quality of life of older residents, care staff and family caregivers. Two care homes for older people situated in Beirut took part in the study. Between 2010 and 2011 semi-structured interviews were undertaken with a sample of 20 residents, eight family caregivers and 11 care staff. Data were analysed using the constant comparative method. Four categories emerged from this analytical process: (i) maintaining family connectedness; (ii) engaging in worthwhile activities; (iii) maintaining and developing significant relationships; and (iv) holding and practicing spiritual beliefs. The emergence of these categories confirmed the complex, interrelated and multidimensional nature of quality of life for residents and other stakeholders. The findings supplement an emerging body of knowledge about the composition of quality of life for older residents in Lebanon. Improving the quality of life of older residents will require action in respect of all of the domains identified in study. Moving nursing practice from task-based care to relationship-centred approaches was seen as pivotal in helping to develop quality of life for residents living in the participating care homes. The findings have implications for education, nursing practice and research in Lebanon and help start an evidence base for care. © 2015 John Wiley & Sons Ltd.

  7. The Changing Selenium Nutritional Status of Chinese Residents

    Directory of Open Access Journals (Sweden)

    Sumei Li

    2014-03-01

    Full Text Available The selenium (Se content in human hair is useful as an indicator of human Se intake and status. In this regard, when measuring the hair Se concentrations in Chinese inhabitants across northeast to southeast China, the results indicated that generally 84% of all residents have normal hair Se content. Between the sexes, the average hair Se content of males was higher than that of females, irrespective of districts. When comparing geographical regions, the average hair Se content of southern residents was greater than that of northern residents, regardless of gender. Historically, the overall hair Se content of today’s inhabitants decreased between 24% and 46% when compared with the inhabitants living in the same geographic region 20 years ago. The decrease of hair Se content may be related to the overall decrease of grain consumption and the lower Se content in the staple food rice.

  8. Higher Education Change and Its Managers: Alternative Constructions

    Science.gov (United States)

    Hotho, Sabine

    2013-01-01

    This article is based on a case study conducted in the context of UK higher education change. The article argues that "change" is a construct created in discourses of change policy and change management, and resulting in reductivist change management discourses which may impede rather than facilitate effective change management in the…

  9. Paradoxical Change and Construction of Identity in an Educational Organization

    Science.gov (United States)

    Puusa, Anu; Kuittinen, Matti; Kuusela, Pekka

    2013-01-01

    This article focuses on the construction of organizational identity and the strategic change in an educational organization. The aim of this empirical study is to examine how the members of an educational organization construct the meaning of "who we are" during an ongoing change. In addition, we examine whether it is reasonable to…

  10. Changing the Past: Retrocausality and Narrative Construction

    NARCIS (Netherlands)

    van Putten, C.

    2006-01-01

    This article is a reply to Jeanne Peijnenburg's argument for retrocausality in "Shaping Your Own Life." Although it is perfectly possible to make sense of the way Peijnenburg deals with the subject of changing the past, there is no need to think this implies retrocausality. © 2006 Metaphilosophy LLC

  11. Constructing Legitimacy for Climate Change Planning

    DEFF Research Database (Denmark)

    Cashmore, Matthew Asa; Wejs, Anja

    2014-01-01

    in a specific case study context, Aarhus Municipality in Denmark. The concept of legitimacy is used as an analytical lens to examine institutionalisation patterns and practices. Based on a perspective grounded in new institutional theory, the research investigates how legitimacy affects the institutionalisation...... of climate change planning and how legitimacy is, in turn, affected by the interplay between agency and structure. The analytical foregrounding of the concept of legitimacy is concluded to generate ‘thicker’, more nuanced insights into why climate change planning practices take particular forms in specific...... patterns and prac- tices of institutionalisation, whereas normative imperatives based on moral or ethical arguments are rarely invoked in relation to legitimacy. This indicates that the role of structures vis-a-vis agency (particularly in terms of the often cited case of institutional entrepreneurship...

  12. Strategies change as nuclear plant construction declines

    International Nuclear Information System (INIS)

    Knight, H.B.

    1980-01-01

    As conditions in the nuclear industry change some companies are taking a positive approach to falling orders by moving into the area of servicing existing plant. How Newport News Industrial Corporation has made just such a move by offering preventive maintenance services is described. The company has several advantages to offer: large existing facilities and a wide range of skills available from their 23000 employees. (author)

  13. A Systematic Approach to Modelling Change Processes in Construction Projects

    Directory of Open Access Journals (Sweden)

    Ibrahim Motawa

    2012-11-01

    Full Text Available Modelling change processes within construction projects isessential to implement changes efficiently. Incomplete informationon the project variables at the early stages of projects leads toinadequate knowledge of future states and imprecision arisingfrom ambiguity in project parameters. This lack of knowledge isconsidered among the main source of changes in construction.Change identification and evaluation, in addition to predictingits impacts on project parameters, can help in minimising thedisruptive effects of changes. This paper presents a systematicapproach to modelling change process within construction projectsthat helps improve change identification and evaluation. Theapproach represents the key decisions required to implementchanges. The requirements of an effective change processare presented first. The variables defined for efficient changeassessment and diagnosis are then presented. Assessmentof construction changes requires an analysis for the projectcharacteristics that lead to change and also analysis of therelationship between the change causes and effects. The paperconcludes that, at the early stages of a project, projects with a highlikelihood of change occurrence should have a control mechanismover the project characteristics that have high influence on theproject. It also concludes, for the relationship between changecauses and effects, the multiple causes of change should bemodelled in a way to enable evaluating the change effects moreaccurately. The proposed approach is the framework for tacklingsuch conclusions and can be used for evaluating change casesdepending on the available information at the early stages ofconstruction projects.

  14. The professionalism curriculum as a cultural change agent in surgical residency education.

    Science.gov (United States)

    Hochberg, Mark S; Berman, Russell S; Kalet, Adina L; Zabar, Sondra R; Gillespie, Colleen; Pachter, H Leon

    2012-01-01

    Teaching professionalism effectively to fully engaged residents is a significant challenge. A key question is whether the integration of professionalism into residency education leads to a change in resident culture. The goal of this study was to assess whether professionalism has taken root in the surgical resident culture 3 years after implementing our professionalism curriculum. Evidence was derived from 3 studies: (1) annual self-assessments of the residents' perceived professionalism abilities to perform 20 defined tasks representing core Accrediting Council on Graduate Medical Education professionalism domains, (2) objective metrics of their demonstrated professionalism skills as rated by standardized patients annually using the objective structure clinical examination tool, and (3) a national survey of the Surgical Professionalism and Interpersonal Communications Education Study Group. Study 1: aggregate perceived professionalism among surgical residents shows a statistically significant positive trend over time (P = .016). Improvements were seen in all 6 domains: accountability, ethics, altruism, excellence, patient sensitivity, and respect. Study 2: the cohort of residents followed up over 3 years showed a marked improvement in their professionalism skills as rated by standardized patients using the objective structure clinical examination tool. Study 3: 41 members of the national Surgical Professionalism and Interpersonal Communications Education Study Group rated their residents' skills in admitting mistakes, delivering bad news, communication, interdisciplinary respect, cultural competence, and handling stress. Twenty-nine of the 41 responses rated their residents as "slightly better" or "much better" compared with 5 years ago (P = .001). Thirty-four of the 41 programs characterized their department's leadership view toward professionalism as "much better" compared with 5 years ago. All 3 assessment methods suggest that residents feel increasingly

  15. Giving residents tools to talk about behavior change: a motivational interviewing curriculum description and evaluation.

    Science.gov (United States)

    Childers, Julie W; Bost, James E; Kraemer, Kevin L; Cluss, Patricia A; Spagnoletti, Carla L; Gonzaga, Alda Maria R; Arnold, Robert M

    2012-11-01

    To determine whether a motivational interviewing (MI) curriculum is effective in teaching internal medicine residents core MI skills and the empathic, nonjudgmental MI style. Nineteen third-year residents met for 12 h with a faculty instructor. Teaching methods included lecture, written exercises, a simulated patient exercise, and discussion of residents' behavior change issues. Residents' adoption of MI skills was evaluated before and after the course with the Helpful Responses Questionnaire. Residents decreased use of closed-ended questions (from a score of 1.13 to 0.37, p=0.036) and MI roadblocks (4.00-1.08, pcommunication skills in a written measure, and was highly rated. Future work should examine whether teaching of the empathic, collaborative MI stance impacts patient outcomes. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  16. General design, construction, and operation guidelines: Constructed wetlands wastewater treatment systems for small users including individual residences. Second edition

    Energy Technology Data Exchange (ETDEWEB)

    Steiner, G.R.; Watson, J.T.

    1993-05-01

    One of the Tennessee Valley Authority`s (TVA`s) major goals is cleanup and protection of the waters of the Tennessee River system. Although great strides have been made, point source and nonpoint source pollution still affect the surface water and groundwater quality in the Tennessee Valley and nationally. Causes of this pollution are poorly operating wastewater treatment systems or the lack of them. Practical solutions are needed, and there is great interest and desire to abate water pollution with effective, simple, reliable and affordable wastewater treatment processes. In recognition of this need, TVA began demonstration of the constructed wetlands technology in 1986 as an alternative to conventional, mechanical processes, especially for small communities. Constructed wetlands can be downsized from municipal systems to small systems, such as for schools, camps and even individual homes.

  17. A Buberian approach to the co-construction of relationships between professional caregivers and residents in nursing homes.

    Science.gov (United States)

    Westerhof, Gerben J; van Vuuren, Mark; Brummans, Boris H J M; Custers, Annette F J

    2014-06-01

    This article demonstrates the value of a Buberian approach to relationships between professional caregivers and residents in nursing homes. Extant research on relationships between professional caregivers and residents typically distinguishes between task-centered and person-centered communication yet tends to privilege either the perspective of professionals or residents. To address this issue, we develop an approach that addresses the co-construction of I-It and I-Thou relationships, based on Martin Buber's social existentialist philosophy. In turn, we show the merit of this approach by using it to analyze interactional data from an observational study on morning care in Dutch nursing homes. As these examples illustrate, our analytical perspective is useful because it highlights how different caregiver-resident relationships are co-created and unfold over time. Thus, by revealing how these relationships are worked out in everyday interactions through subtle shifts between task-centered and person-centered communicative practices, this article offers important insights for improving the quality of care in nursing homes.

  18. "Dioxins are the easiest topic to mention": Resident activists' construction of knowledge about low-level exposure to toxic chemicals.

    Science.gov (United States)

    Andersen, Nina Blom

    2016-04-01

    This article discusses how residents in a local area contributed to the construction of knowledge in regard to scientific assessments in relation to a fire in a storage dump of burnable waste. Building on analytical concepts primarily from Social Worlds theory as well as some concepts from Actor-Network Theory, the analysis shows how dissent and a number of scientific controversies were initiated by some residents living nearby the waste dump who proved to be excellent network builders and who built a number of alliances with media and independent scientists, thus questioning the authorities' and their experts' legitimacy. Furthermore, the situated analysis identifies how a few persons--not very organized--were able to create a debate about scientific matters using their combined resources and strong alliance-building abilities, thus proving that in some cases there is no need for a higher level of organization. © The Author(s) 2014.

  19. Effecting Change in an Evidence-Based Medicine Curriculum: Librarians' Role in a Pediatric Residency Program.

    Science.gov (United States)

    Zeblisky, Kathy; Birr, Rebecca A; Sjursen Guerrero, Anne Marie

    2015-01-01

    Librarians for the joint Phoenix Children's Hospital/Maricopa Medical Center Pediatric Residency Program were asked to assist on the Evidence-Based Medicine (EBM) Subcommittee for the program. Faculty was open to recommendations for revising and improving the curriculum and desired librarian assistance in completing the task. The annual program review and conference evaluations revealed a gap between the objectives of the EBM curriculum and the residents' perceived abilities to integrate knowledge into meaningful literature searches. This column demonstrates how librarians can collaborate with their residency programs to revise and improve processes to effect change in their program's EBM curriculum.

  20. Changes in the personal dignity of nursing home residents: a longitudinal qualitative interview study.

    Directory of Open Access Journals (Sweden)

    Mariska G Oosterveld-Vlug

    Full Text Available BACKGROUND: Most nursing home residents spend the remainder of their life, until death, within a nursing home. As preserving dignity is an important aim of the care given here, insight into the way residents experience their dignity throughout their entire admission period is valuable. AIM: To investigate if and how nursing home residents' personal dignity changes over the course of time, and what contributes to this. DESIGN: A longitudinal qualitative study. METHODS: Multiple in-depth interviews, with an interval of six months, were carried out with 22 purposively sampled nursing home residents of the general medical wards of four nursing homes in The Netherlands. Transcripts were analyzed following the principles of thematic analysis. RESULTS: From admission onwards, some residents experienced an improved sense of dignity, while others experienced a downward trend, a fluctuating one or no change at all. Two mechanisms were especially important for a nursing home resident to maintain or regain personal dignity: the feeling that one is in control of his life and the feeling that one is regarded as a worthwhile person. The acquirement of both feelings could be supported by 1 finding a way to cope with one's situation; 2 getting acquainted with the new living structures in the nursing home and therefore feeling more at ease; 3 physical improvement (with or without an electric wheelchair; 4 being socially involved with nursing home staff, other residents and relatives; and 5 being amongst disabled others and therefore less prone to exposures of disrespect from the outer world. CONCLUSION: Although the direction in which a resident's personal dignity develops is also dependent on one's character and coping capacities, nursing home staff can contribute to dignity by creating optimal conditions to help a nursing home resident recover feelings of control and of being regarded as a worthwhile person.

  1. Changes in resident attitudes towards tourism development and conservation in the Okavango Delta, Botswana.

    Science.gov (United States)

    Mbaiwa, Joseph E; Stronza, Amanda L

    2011-08-01

    Negative attitudes of resident communities towards conservation are associated with resource decline in developing countries. In Botswana, Community-Based Natural Resource Management (CBNRM) was adopted to address this challenge. CBNRM links rural development and conservation. However, the impact of CBNRM on changes of resident attitudes towards conservation and tourism is not adequately researched. This paper, therefore, assesses the impacts of CBNRM on resident attitudes towards tourism development and conservation in the Okavango Delta, Botswana. The study purposively sampled villages of Khwai, Mababe and Sankoyo. Household data using variables like: economic benefits from CBNRM; level of satisfaction with CBNRM; co-management of natural resources between resident communities and government agencies; and collective action was collected. This data was supplemented by secondary and ethnographic data. Using qualitative and quantitative analysis, results indicate changes in resident attitudes from being negative to positive towards tourism and conservation. These changes are triggered by economic benefits residents derived from CBNRM, co-management in resource management; and, collective action of communities in CBNRM development. Positive attitudes towards conservation and tourism are the first building blocks towards achieving conservation in nature-based tourism destinations. As a result, decision-makers should give priority to CBNRM and use it as a tool to achieve conservation and improved livelihoods in nature-based tourism destinations of developing countries. Copyright © 2011 Elsevier Ltd. All rights reserved.

  2. Change of residence in Switzerland and Swiss "Attestation de départ" (departure certificate)

    CERN Multimedia

    HR Department

    2009-01-01

    1. Change of residence in Switzerland Members of the personnel residing in Switzerland are advised to notify the competent Swiss authorities in their canton of residence of any change of address. a) Procedure for those residing in the Canton of Geneva: – go in person to the “Accueil” Section of the Office Cantonal de la Population, 88 Route de Chancy, 1213 Onex (open Mondays to Fridays from 9.00 a.m. to 3.30 p.m., tel. 022 546 48 88, http://www.ge.ch/ocp), or – complete the form “Annonce de changement d’adresse” (available at: (http://www.geneve.ch/ocp/formulaires.html) and send it by post to the Office Cantonal de la Population, Service des étrangers et confédérés, case postale 2652, 1211 Genève 2. b) Procedure for those residing in the Canton of Vaud: –\tgo in person to the offices of the Contrôle de l’habitant of your commune of residence. This does not, however, release members of the personnel from the obligation to inform CERN of any change o...

  3. [A cross-sectional study on the changes in dietary behavior stages in resident].

    Science.gov (United States)

    Xu, Liang-wen; Ma, Hai-yan; Yang, Ting-zhong; Liu, Ting-jie

    2004-05-01

    To explore the possibility of applying the concept of various stages of dietary behavior changes in Hangzhou residents. The dietary behavior was surveyed and analyzed in 1 388 Hangzhou residents with 18 year-old and older using the various dietary behavior change model model and stages of change. The proportion of Hangzhou residents with unhealthy dietary behavior was high and associated with gender and education level. The changes of dietary behavior could be divided into 5 stages, i.e. preintention, intention, preparation, action and maintenance. These stages of change happen consecutively. The changes of unhealthy dietary behavior do not match the improvement of health knowledge. Although a significant proportion of the residents understand that it is unhealthy to eat too much fat, pickles and high salt food, there are only a few of them really take action to reduce the consumption of these foods and to consume more milk, fruit and vegetable. There are multiple factors that affect the changes of dietary behavior in people. The changes of dietary behavior occur in various consecutive stages. Different intervention measures should be applied to people in different dietary behavior changes.

  4. Temporal change in radiocesium intake for USSR residents

    International Nuclear Information System (INIS)

    Uchiyama, Masafumi; Nakamura, Yuji; Kobayashi, Sadayoshi

    1993-01-01

    The body burden of 137 Cs in individuals from the USSR who visited Japan and Japanese who returned from the USSR after various periods of stay there, was measured with a whole-body counter at the National Institute of Radiological Sciences. A compartment model was used to describe the temporal change in radiocesium body burden following the continuous ingestion of radiocesium. The daily amount of radiocesium intake in mBq per kg of body weight was estimated to have decreased with a half-time ranging from 391 to 920 days for adults in Kiev Ukraine after the Chernobyl nuclear power plant accident. Countermeasures against the consequences of the accident appear to have exempted the inhabitants from aggregation of radiocesium in their bodies. Differences in foodstuffs consumed should be taken into account when radiation health risks are compared with different age groups. (author)

  5. Constructing neighborhoods from the bottom up: the case for resident-enerated GIS

    OpenAIRE

    E Talen

    1999-01-01

    As in other areas of planning practice, the use of GIS in neighborhood planning has assumed a technical top-down approach. Given the fact that GIS are essentially about providing and analyzing spatial data, it is difficult to envision how their use in local communities could be construed otherwise. In this paper I make a case for the need to channel intellectual energy into developing an approach and methodology for resident-generated GIS . Specifically I argue that there is a need to exploit...

  6. Construct validation and test-retest reliability of a mealtime satisfaction questionnaire for retirement home residents

    NARCIS (Netherlands)

    Pizzola, L.; Martos, Z.; Pfisterer, K.; Groot, de C.P.G.M.; Keller, H.

    2013-01-01

    Mealtime satisfaction is an important component of quality of life (QOL) in residential care, yet there currently is no self-administered tool described in the literature. The purpose of this study is to investigate internal and test–retest reliability, and construct validity of a mealtime

  7. Constructional change, paradigmatic structure and the orientation of usage processes

    DEFF Research Database (Denmark)

    Heltoft, Lars

    2014-01-01

    construction from the 18th century to the present, a specialisation process parallel to the one described for English by Colleman & De Clerck (2011), though not identical to it. The semantics of constructions is described in terms of linguistic content, as distinct from conceptual structure, and the linguistic...... stems from one already existing construction type to another. Thus, structural descriptions allow us to orient and interpret usage processes.......This article presents a model analysis of the interplay between structure and usage in the semantic change of constructions, with a focus on the role of content structure in the sense of paradigmatically organised semantic structure. The case at hand the development of the Danish indirect object...

  8. Planning safer suburbs: do changes in the built environment influence residents' perceptions of crime risk?

    Science.gov (United States)

    Foster, Sarah; Wood, Lisa; Christian, Hayley; Knuiman, Matthew; Giles-Corti, Billie

    2013-11-01

    A growing body of evidence has reiterated the negative impacts that crime and perceptions of insecurity can have on the health and wellbeing of local residents. Strategies that reduce residents' perceived crime risk may contribute to improved health outcomes; however interventions require a better understanding of the neighbourhood influences on residents perceptions of crime and safety. We examined the impact of changes in the objective built environment following relocation on changes in residents' perceived crime risk for participants in a longitudinal study of people moving to new neighbourhoods in Perth, Western Australia (n = 1159). They completed a questionnaire before moving to their new neighbourhood, and again 36 months after relocation. Individual-level objective environmental measures were generated at both time points using Geographic Information Systems, focussing on the characteristics that comprise a 'walkable neighbourhood'. Linear regression models examined the influence of objective environmental changes between the two environments on perceived crime risk, with progressive adjustment for other change variables (i.e., perceptions of the physical and social environment, reported crime). We found that increases in the proportion of land allocated to shopping/retail land-uses increased residents' perceived crime risk (β = 11.875, p = 0.001), and this relationship remained constant, despite controlling for other influences on perceived crime risk (β = 9.140, p = 0.004). The findings highlight an important paradox: that the neighbourhood characteristics known to enhance one outcome, such as walking, may negatively impact another. In this instance, the 'strangers' that retail destinations attract to a neighbourhood may be interpreted by locals as a threat to safety. Thus, in areas with more retail destinations, it is vital that other environmental strategies be employed to balance any negative effects that retail may have on residents' perceptions of

  9. Changes in the Personal Dignity of Nursing Home Residents: A Longitudinal Qualitative Interview Study

    Science.gov (United States)

    Oosterveld-Vlug, Mariska G.; Pasman, H. Roeline W.; van Gennip, Isis E.; Willems, Dick L.; Onwuteaka-Philipsen, Bregje D.

    2013-01-01

    Background Most nursing home residents spend the remainder of their life, until death, within a nursing home. As preserving dignity is an important aim of the care given here, insight into the way residents experience their dignity throughout their entire admission period is valuable. Aim To investigate if and how nursing home residents’ personal dignity changes over the course of time, and what contributes to this. Design A longitudinal qualitative study. Methods Multiple in-depth interviews, with an interval of six months, were carried out with 22 purposively sampled nursing home residents of the general medical wards of four nursing homes in The Netherlands. Transcripts were analyzed following the principles of thematic analysis. Results From admission onwards, some residents experienced an improved sense of dignity, while others experienced a downward trend, a fluctuating one or no change at all. Two mechanisms were especially important for a nursing home resident to maintain or regain personal dignity: the feeling that one is in control of his life and the feeling that one is regarded as a worthwhile person. The acquirement of both feelings could be supported by 1) finding a way to cope with one’s situation; 2) getting acquainted with the new living structures in the nursing home and therefore feeling more at ease; 3) physical improvement (with or without an electric wheelchair); 4) being socially involved with nursing home staff, other residents and relatives; and 5) being amongst disabled others and therefore less prone to exposures of disrespect from the outer world. Conclusion Although the direction in which a resident’s personal dignity develops is also dependent on one’s character and coping capacities, nursing home staff can contribute to dignity by creating optimal conditions to help a nursing home resident recover feelings of control and of being regarded as a worthwhile person. PMID:24069235

  10. Detecting areal changes in tidal flats after sea dike construction ...

    Indian Academy of Sciences (India)

    The main objective of this study was to estimate changes in the area of tidal flats that occurred after sea dike construction on the western coast of South Korea using Landsat-TM images. Applying the ISODATA method of unsupervised classification for Landsat-TM images, the tidal flats were identified, and the resulting areas ...

  11. Noticing climate change in electricity network design and construction

    International Nuclear Information System (INIS)

    Syri, S.; Martikeinen, A.; Lehtonen, M.

    2007-01-01

    The climate change is widely known to cause remarkable effects to electricity network systems on the whole. Some of the changes are good but the most of the changes cause disadvantages to electricity network. Consequence of climate change, blackouts can be long-standing which affect remarkable society and economic life. Most of electricity networks are coming to a renovation phase and the solutions, that are being made nowadays, affect still after decades. Taking account of climate change, now when networks are being developed and planned, it is possible to avoid possible large repair operation and increase reliability of distribution in the future. The aim of this project is to clarify how climate change should be noticed in planning and construction processes. According to the results of this project electricity network companies can be prepared for climate change by developing planning processes and network cost effectively. Also construction processes are being developed but emphasis is on planning process. The results and developed knowledge of VTT research project 'Impacts of climate change on electricity network business' are exploited in this project. In addition, impacts of climate change on cables and transformers are analyzed in collaboration with TKK in the project. (orig.)

  12. The social construct of climate and climate change

    International Nuclear Information System (INIS)

    Stehr, N.

    1994-01-01

    Different time scales of climate change and their differential perception in society are discussed. A historical examination of natural climate changes during the past millennium suggests that short-term changes, especially crucial changes, trigger a significant response in and by society. Short-term changes correspond to the 'time horizon of everyday life', that is, to a time scale from days and weeks to a few years. The anticipated anthropogenic climate changes, however, are expected to occur on a longer time scale. They require a response by society not on the basis of primary experience but on the basis of scientifically constructed scenarios and ways in which such information is represented in the modern media for example. Socio-economic impact research relies on concepts that are based on the premise of perfectly informed actors for the development of optimal adaptation strategies. In contrast to such a conception, we develop the concept of a 'social construct of climate' as decisive for the public perception of scientific knowledge about climate and for public policy on climate change. The concept is illustrated using a number of examples. (orig.)

  13. 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.

  14. The Role of Strategic Leadership in Creating Change for Construction Innovation: A North Cyprus Perspective

    OpenAIRE

    Yitman, İbrahim; Taneri, Cem

    2006-01-01

    Driving forces in construction industry indicate that the ability to innovate is quickly becoming a competitive necessity. However construction industry has been generally slow to embrace innovation and radical changes as fundamental changes in construction processes require shifts in the conservative management perspectives of construction contractors. Thus the strategic leadership has a crucial role in change initiatives for innovation in construction contractors. Our researc...

  15. Correlations between Climate Change and the Modern European Construction

    Science.gov (United States)

    Gumińska, Anna

    2017-10-01

    The aim of the study was to analyze the links between climate change and the way modern cities are structured and responded to climate change. How do these changes affect building materials and technologies, or does climate change affect the type of technology and materials used? The most important results are the effects of analysing selected examples of a modern European building, the use of materials and technology, the adaptation of buildings to the changing climate. Selected examples of contemporary architecture from Germany, Italy and Denmark, Norway and Sweden. There are also examples in photographic documentation. The most important criteria affecting the objects are elements that shape the changing climate, as well as existing legal and technical requirements. The main conclusion was that modern urban space is adapted to the changing climate. Unprecedented climatic phenomena in this area: intense and sudden rain, snow, floods, strong winds, abundant sunshine, high temperature changes, greenhouse effect of the city - “island heat”, atmospheric pollution. Building materials and technologies contribute to the optimal conservation of natural resources, buildings are shaped in such a way as to ensure safety, resilience and environmental protection. However, there is still a need for continuous monitoring of climate change, criteria affecting the design and construction of urban and central facilities. Key words: energy efficiency, renewable energy, climate change, contemporary architecture.

  16. Pricing strategy for aesthetic surgery: economic analysis of a resident clinic's change in fees.

    Science.gov (United States)

    Krieger, L M; Shaw, W W

    1999-02-01

    The laws of microeconomics explain how prices affect consumer purchasing decisions and thus overall revenues and profits. These principles can easily be applied to the behavior aesthetic plastic surgery patients. The UCLA Division of Plastic Surgery resident aesthetics clinic recently offered a radical price change for its services. The effects of this change on demand for services and revenue were tracked. Economic analysis was applied to see if this price change resulted in the maximization of total revenues, or if additional price changes could further optimize them. Economic analysis of pricing involves several steps. The first step is to assess demand. The number of procedures performed by a given practice at different price levels can be plotted to create a demand curve. From this curve, price sensitivities of consumers can be calculated (price elasticity of demand). This information can then be used to determine the pricing level that creates demand for the exact number of procedures that yield optimal revenues. In economic parlance, revenues are maximized by pricing services such that elasticity is equal to 1 (the point of unit elasticity). At the UCLA resident clinic, average total fees per procedure were reduced by 40 percent. This resulted in a 250-percent increase in procedures performed for representative 4-month periods before and after the price change. Net revenues increased by 52 percent. Economic analysis showed that the price elasticity of demand before the price change was 6.2. After the price change it was 1. We conclude that the magnitude of the price change resulted in a fee schedule that yielded the highest possible revenues from the resident clinic. These results show that changes in price do affect total revenue and that the nature of these effects can be understood, predicted, and maximized using the tools of microeconomics.

  17. Change of residence and functional status within three months and one year following hip fracture surgery

    DEFF Research Database (Denmark)

    Ariza-Vega, Patrocinio; Jiménez-Moleón, José Juan; Kristensen, Morten Tange

    2014-01-01

    PURPOSE: To study the recovery of patients in terms of 18 activities of daily living and change of residence within the year following a hip fracture. METHOD: This prospective cohort study was carried out in a trauma service of an acute hospital in southern Spain including 159 patients with a hip...... fracture, 65 years or older and allowed weight-bearing after surgery. Patients or their relatives were interviewed about their residential status and functional level at pre-fracture, three months and one year after surgery, using the Functional Independence Measure. RESULTS: Losses of function...... for patients who lived in their own home (73% before fracture to 58% at one year). CONCLUSIONS: The loss of independence in the first year after a hip fracture is substantial for specific activities. Recovery mainly takes place during the first three months after surgery. Change of residence mostly involved...

  18. What effects have resident work-hour changes had on education, quality of life, and safety? A systematic review.

    Science.gov (United States)

    Harris, Joshua D; Staheli, Greg; LeClere, Lance; Andersone, Diana; McCormick, Frank

    2015-05-01

    More than 15 years ago, the Institute of Medicine (IOM) identified medical error as a problem worthy of greater attention; in the wake of the IOM report, numerous changes were made to regulations to limit residents' duty hours. However, the effect of resident work-hour changes remains controversial within the field of orthopaedics. We performed a systematic review to determine whether work-hour restrictions have measurably influenced quality-of-life measures, operative and technical skill development, resident surgical education, patient care outcomes (including mortality, morbidity, adverse events, sentinel events, complications), and surgeon and resident attitudes (such as perceived effect on learning and training experiences, personal benefit, direct clinical experience, clinical preparedness). We performed a systematic review of PubMed, Scopus, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and Google Scholar using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Inclusion criteria were any English language peer-reviewed articles that analyzed the effect(s) of orthopaedic surgery resident work-hour restrictions on patient safety, resident education, resident/surgeon quality of life, resident technical operative skill development, and resident surgeon attitudes toward work-hour restrictions. Eleven studies met study inclusion criteria. One study was a prospective analysis, whereas 10 studies were of level IV evidence (review of surgical case logs) or survey results. Within our identified studies, there was some support for improved resident quality of life, improved resident sleep and less fatigue, a perceived negative impact on surgical operative and technical skill, and conflicting evidence on the topic of resident education, patient outcomes, and variable attitudes toward the work-hour changes. There is a paucity of high-level or clear evidence evaluating the effect of the changes to resident work

  19. Power plant construction contracting in a changing regulatory environment

    International Nuclear Information System (INIS)

    Person, J.C.

    1993-01-01

    The 1965 blackout in the Northeast provided the wake-up call that spawned in unprecedented program of power plant construction by electric utilities. This building program began in the late 1960s and continued unabated through the 1970s. Beginning in the late 1970s, state regulators began in era of 'prudence' reviews which disallowed as imprudent significant portions of the costs of certain nuclear units being brought on line at the time. This regulatory experience brought about a fundamental change in the way in which utilities evaluated the need for additional capacity. This paper explores construction contracting trends in light of recent developments in the relationship between the electric utility and the state regulator. It is within this context that the utility decides: (1) whether to build, buy, or save; and (2) if the decision is to build, which project planning and administration considerations will maximize the utility's ability to incorporate project costs into the ratebase. In order to put these issues into their proper perspective, this paper first presents a brief overview of the prudence decisions of the past, and the chilling effect of these decisions generally on new project planning. The paper next focuses on the recent changes to the post-construction prudence review model, including the introduction of pre-approval arrangements and rolling prudence reviews. Following that will be a survey of new construction spending decisions in light of these changes. After an analysis of the bases for the prudence disallowances of the past and the application of the lessons learned from these disallowances to contract planning and administration issues of today, the paper will close with a discussion of the relative advantages and disadvantages of the most commonly used contract delivery methods in today's regulatory environment

  20. Change in Residents' Experience in Continuity Clinic After Patient-Focused Primary Care Redesign.

    Science.gov (United States)

    Fogel, Benjamin N; Warrick, Stephen; Finkelstein, Jonathan A; Klein, Melissa

    2016-01-01

    Evaluation of efforts to redesign primary care has primarily focused on clinical services, with limited assessment of the effect on learners. This study evaluated the change in pediatric residents' perception of training, teamwork, and patient care in 2 different continuity clinic settings that were implementing patient-focused primary care redesign. Continuity clinic residents at 2 large urban pediatric training programs completed a survey, developed de novo, before and after primary care redesign. Differences in the proportion of positive (≥4 of 5) ratings before and after redesign were compared using chi-squared tests in 2 practice sites, each of which focused on improving specific aspects of their practice. The response rate was >70% in both sites and in both years. Residents in the site focused on teamwork and continuity were more likely to report improved teamwork training (64% vs 83%; P care in clinic also improved (47% vs 68%; P continuity clinic. Future redesign efforts deliberately involving residents might further enhance continuity clinic training. Copyright © 2016 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

  1. A buberian approach to the co-construction of relationships between professional caregivers and residents in nursing homes

    NARCIS (Netherlands)

    Westerhof, Gerben Johan; van Vuuren, Hubrecht A.; Brummans, Boris H.J.M.; Custers, Annette F.J.

    2014-01-01

    This article demonstrates the value of a Buberian approach to relationships between professional caregivers and residents in nursing homes. Extant research on relationships between professional caregivers and residents typically distinguishes between task-centered and person-centered communication

  2. Construction of climate change scenarios from transient climate change experiments for the IPCC impacts assessment

    International Nuclear Information System (INIS)

    Viner, D.; Hulme, M.; Raper, S.C.B.; Jones, P.D.

    1994-01-01

    This paper outlines the different methods which may be used for the construction of regional climate change scenarios. The main focus of the paper is the construction of global climate change scenarios from climate change experiments carried out using General Circulation Models (GCMS) An introduction to some GCM climate change experiments highlights the difference between model types and experiments (e.g., equilibrium or transient). The latest generation of climate change experiments has been performed using fully coupled ocean-atmosphere GCMS. These allow transient simulations of climate change to be performed with respect to a given greenhouse gas forcing scenario. There are, however, a number of problems with these simulations which pose difficulties for the construction of climate change scenarios for use in climate change impacts assessment. The characteristics of the transient climate change experiments which pose difficulties for the construction of climate change scenarios are discussed. Three examples of these problems are: different climate change experiments use different greenhouse gas concentration scenarios; the 'cold-start' problem makes it difficult to link future projections of climate change to a given calendar year; a drift of the climate is noticeable in the control simulations. In order to construct climate change scenarios for impacts assessment a method has therefore to be employed which addresses these problems. At present the climate modeling and climate change impacts communities are somewhat polarized in their approach to spatial scales. Current GCMs model the climate at resolutions larger than 2.5 x 3.75 degree, while the majority of impacts assessment studies are undertaken at scales below 50km (or 0.5 degree). This paper concludes by addressing the problems in bringing together these two different modeling perspectives by presenting a number of regional climate change scenarios. 35 refs., 8 figs., 2 tabs

  3. Effect of Process Changes in Surgical Training on Quantitative Outcomes From Surgery Residency Programs.

    Science.gov (United States)

    Dietl, Charles A; Russell, John C

    2016-01-01

    The purpose of this article is to review the literature on process changes in surgical training programs and to evaluate their effect on the Accreditation Council of Graduate Medical Education (ACGME) Core Competencies, American Board of Surgery In-Training Examination (ABSITE) scores, and American Board of Surgery (ABS) certification. A literature search was obtained from MEDLINE via PubMed.gov, ScienceDirect.com, Google Scholar on all peer-reviewed studies published since 2003 using the following search queries: surgery residency training, surgical education, competency-based surgical education, ACGME core competencies, ABSITE scores, and ABS pass rate. Our initial search list included 990 articles on surgery residency training models, 539 on competency-based surgical education, 78 on ABSITE scores, and 33 on ABS pass rate. Overall, 31 articles met inclusion criteria based on their effect on ACGME Core Competencies, ABSITE scores, and ABS certification. Systematic review showed that 5/31, 19/31, and 6/31 articles on process changes in surgical training programs had a positive effect on patient care, medical knowledge, and ABSITE scores, respectively. ABS certification was not analyzed. The other ACGME core competencies were addressed in only 6 studies. Several publications on process changes in surgical training programs have shown a positive effect on patient care, medical knowledge, and ABSITE scores. However, the effect on ABS certification, and other quantitative outcomes from residency programs, have not been addressed. Studies on education strategies showing evidence that residency program objectives are being achieved are still needed. This article addresses the 6 ACGME Core Competencies. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  4. While visitors conserve, residents splurge: Patterns and changes in energy consumption, 1997-2007

    International Nuclear Information System (INIS)

    Nasseri, Iman; Assané, Djeto; Konan, Denise Eby

    2015-01-01

    This study analyzes changes in energy consumption in Hawai‘i between 1997 and 2007 using input-output analysis. Residents increase their energy use by 33% in electricity and 18% in fuel, largely due to direct consumption. In contrast, visitors contract energy demand by 9% and 4% in electricity and fuel, respectively. The findings are robust at per-capita levels. Key drivers are the significant drops in energy intensity of primarily three industries: air transportation, hotels, and restaurants. Further analysis decomposes the change to evaluate the underlying factors. - Highlights: • Residents and visitors exhibit differences in their energy consumption profile. • Increase/decrease in energy consumption for residents/visitors from 1997 to 2007. • Visitor factor for fuel consumption dropped from 3.5 in 1997 to 2.3 in 2007. • Visitor factor for electricity consumption dropped from 2.4 in 1997 to 1.5 in 2007. • Decrease in energy intensity firmly establishes improvement in energy efficiency

  5. Predict Changes in Groundwater Systems Due to Construction of KURT

    International Nuclear Information System (INIS)

    Kim, Kyung Su; Koh, Young Kwon; Bae, Dae Seok; Kim, Geon Young; Park, Kyung Woo; Ji, Sung Hoon; Ryu, Ji Hoon

    2009-08-01

    Step 1 construction KURT facilities in connection with the entry of a 230m length of tunnel excavated by a tunnel and the research examined changes in groundwater systems. The continuum porous medium was assumed to be bedrock, Modflow model is used in the calculation. Input data from the KURT design phase consists of site surveys and existing YS series was based on data obtained from boreholes. This report has following contents: -Conceptual model and analysis presented area and the boundary conditions, Model calibration and calculation. This study evaluates the flow of groundwater and groundwater flow, impact, scope, and the underground water level derived drops

  6. The StrongWomen Change Clubs: Engaging Residents to Catalyze Positive Change in Food and Physical Activity Environments

    Directory of Open Access Journals (Sweden)

    Rebecca A. Seguin

    2014-01-01

    Full Text Available Introduction. The epidemic of obesity is a multifaceted public health issue. Positive policy and environmental changes are needed to support healthier eating and increased physical activity. Methods. StrongWomen Change Clubs (SWCCs were developed through an academic-community research partnership between researchers at Cornell University and Tufts University and community partners (cooperative extension educators in rural towns in seven U.S. states. Extension educators served as the local leader and each recruited 10–15 residents to undertake a project to improve some aspect of the nutrition or physical activity environment. Most residents had limited (or no experience in civic engagement. At 6 and 12 months after implementation, the research team conducted key informant interviews with SWCC leaders to capture their perceptions of program process, benchmark achievement, and self-efficacy. Results. At 12 months, each SWCC had accomplished one benchmark; the majority had completed three or more benchmarks. They described common processes for achieving benchmarks such as building relationships and leveraging stakeholder partnerships. Barriers to benchmark achievement included busy schedules and resistance to and slow pace of change. Conclusion. Findings suggest that community change initiatives that involve stakeholders, build upon existing activities and organizational resources, and establish feasible timelines and goals can successfully catalyze environmental change.

  7. COMPARATIVE ANALYSIS OF MOTIVATION METHODSAPPLIED TO HAVE THE KRASNOYARSK REGION RESIDENTS CHANGE THEIR LIFESTYLE

    Directory of Open Access Journals (Sweden)

    Olga Yurevna Kutumova

    2015-11-01

    Full Text Available The sociological research carried showed that provision of educational information is the main method of motivating people to change their lifestyle and break harmful habits. The mass media are in the first position in the rating as the most effective public awareness development means and healthcare professional advice goes second.A patient usually receives such advice when visiting a healthcare institution to be given diagnosis or treatment or in the course of health assessment or scheduled preventive medical examination. 45% of the Krasnoyarsk Region smokers considered changing their lifestyle and quitting smoking, 36,9% of the residents made such attempt and 8,4% broke the harmful habit after watching television features and under the influence of outdoor advertising. Information that was received from a doctor about risks of developing major no communicable diseases (cardiovascular, oncology, respiratory due to smoking motivated only 36, 9% of the population to change the lifestyle, which mostly included young people aged 18-24. For 63,6% of the region residents there was no positive effect of health professional advice received during a visit to a healthcare institution for a certain purpose. Thus, the received results testify to the bigger importance of educational promotion of mass media in motivation to change of a way of life and refusal of smoking, in comparison with information received from health workers.

  8. Resident resistance.

    Science.gov (United States)

    Price, J L; Cleary, B

    1999-01-01

    Clearly, faculty must work hard with residents to explore the nature of their resistance to a program's learning and growth opportunities. Initial steps to a deeper, more effective, and longer-lasting change process must be pursued. If resident resistance is mishandled or misunderstood, then learning and professional growth may be sidetracked and the purposes of residency training defeated. Listening to the whole person of the resident and avoiding the trap of getting caught up in merely responding to select resident behaviors that irritate us is critical. Every faculty member in the family practice residency program must recognize resistance as a form of defense that cannot immediately be torn down or taken away. Resident defenses have important purposes to play in stress reduction even if they are not always healthy. Residents, especially interns, use resistance to avoid a deeper and more truthful look at themselves as physicians. A family practice residency program that sees whole persons in their residents and that respects resident defenses will effectively manage the stress and disharmony inherent to the resistant resident.

  9. Integrating motivational interviewing and narrative therapy to teach behavior change to family medicine resident physicians.

    Science.gov (United States)

    Oshman, Lauren D; Combs, Gene N

    2016-05-01

    Motivational interviewing is a useful skill to address the common problem of patient ambivalence regarding behavior change by uncovering and strengthening a person's own motivation and commitment to change. The Family Medicine Milestones underline the need for clear teaching and monitoring of skills in communication and behavior change in Family Medicine postgraduate training settings. This article reports the integration of a motivational interviewing curriculum into an existing longitudinal narrative therapy-based curriculum on patient-centered communication. Observed structured clinical examination for six participants indicate that intern physicians are able to demonstrate moderate motivational interviewing skill after a brief 2-h workshop. Participant self-evaluations for 16 participants suggest a brief 2-h curriculum was helpful at increasing importance of learning motivational interviewing by participants, and that participants desire further training opportunities. A brief motivational interviewing curriculum can be integrated into existing communication training in a Family Medicine residency training program. © The Author(s) 2016.

  10. Changing trends in residents-as-teachers across graduate medical education

    Directory of Open Access Journals (Sweden)

    Al Achkar M

    2017-04-01

    Full Text Available Morhaf Al Achkar,1 Mathew Hanauer,1 Elizabeth H Morrison,2 M Kelly Davies,1 Robert C Oh3 1Department of Family Medicine-Indiana University, Indianapolis, IN, USA; 2Health Sciences, University of California, Riverside School of Medicine, Riverside, CA, USA; 3Family Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA Background: Teaching residents how to teach is a critical part of residents’ training in graduate medical education (GME. The purpose of this study was to assess the change in resident-as-teacher (RaT instruction in GME over the past 15 years in the US. Methods: We used a quantitative and qualitative survey of all program directors (PDs across specialties. We compared our findings with a previous work from 2000–2001 that studied the same matter. Finally, we qualitatively analyzed PDs’ responses regarding the reasons for implementing and not implementing RaT instruction. Results: Two hundred and twenty-one PDs completed the survey, which yields a response rate of 12.6%. Over 80% of PDs implement RaT, an increase of 26.34% compared to 2000–2001. RaT instruction uses multiple methods with didactic lectures reported as the most common, followed by role playing in simulated environments, then observing and giving feedback. Residents giving feedback, clinical supervision, and bedside teaching were the top three targeted skills. Through our qualitative analysis we identified five main reasons for implementing RaT: teaching is part of the residents’ role; learners desire formal RaT training; regulatory bodies require RaT training; RaT improves residents’ education; and RaT prepares residents for their current and future roles. Conclusion: The use of RaT instruction has increased significantly in GME. More and more PDs are realizing its importance in the residents’ formative training experience. Future studies should examine the effectiveness of each method for RaT instruction. Keywords: resident as

  11. Measuring change in activities of daily living in nursing home residents with moderate to severe cognitive impairment

    Directory of Open Access Journals (Sweden)

    Fries Brant E

    2006-04-01

    Full Text Available Abstract Background The objective of this study was to assess the responsiveness of the Minimum Data Set Activities of Daily Living (MDS-ADL Scale to change over time by examining the change in physical function in adults with moderate to severe dementia with no comorbid illness who had been resident in a nursing home for over 90 days. Methods Longitudinal data were collected on nursing home residents with moderate (n = 7001 or severe (n = 4616 dementia in one US state from the US national Minimum Data Set (MDS. Severity of dementia was determined by the MDS Cognitive Performance Scale (CPS. Physical function was assessed by summing the seven items (bed mobility, transfer, locomotion, dressing, eating, toilet use, personal hygiene on the MDS activities of daily living (ADL Long Form scale. Mean change over time of MDS-ADL scores were estimated at three and six months for residents with moderate (CPS score of 3 and severe (CPS score of 4 or 5 dementia. Results Physical function in residents with moderate cognitive impairment deteriorated over six months by an average of 1.78 points on the MDS-ADL Long Form scale, while those with severe cognitive impairment declined by an average of 1.70 points. Approximately one quarter of residents in both groups showed some improvement in physical function over the six month period. Residents with moderate cognitive impairment experienced the greatest deterioration in early-loss and mid-loss ADL items (personal hygiene, dressing, toilet use and residents with severe cognitive impairment showed the greatest deterioration in activities related to eating, a late loss ADL. Conclusion The MDS-ADL Long Form scale detected clinically meaningful change in physical function in a large cohort of long-stay nursing home residents with moderate to severe dementia, supporting its use as a research tool in future studies.

  12. Measuring change in activities of daily living in nursing home residents with moderate to severe cognitive impairment

    Science.gov (United States)

    Carpenter, G Iain; Hastie, Charlotte L; Morris, John N; Fries, Brant E; Ankri, Joel

    2006-01-01

    Background The objective of this study was to assess the responsiveness of the Minimum Data Set Activities of Daily Living (MDS-ADL) Scale to change over time by examining the change in physical function in adults with moderate to severe dementia with no comorbid illness who had been resident in a nursing home for over 90 days. Methods Longitudinal data were collected on nursing home residents with moderate (n = 7001) or severe (n = 4616) dementia in one US state from the US national Minimum Data Set (MDS). Severity of dementia was determined by the MDS Cognitive Performance Scale (CPS). Physical function was assessed by summing the seven items (bed mobility, transfer, locomotion, dressing, eating, toilet use, personal hygiene) on the MDS activities of daily living (ADL) Long Form scale. Mean change over time of MDS-ADL scores were estimated at three and six months for residents with moderate (CPS score of 3) and severe (CPS score of 4 or 5) dementia. Results Physical function in residents with moderate cognitive impairment deteriorated over six months by an average of 1.78 points on the MDS-ADL Long Form scale, while those with severe cognitive impairment declined by an average of 1.70 points. Approximately one quarter of residents in both groups showed some improvement in physical function over the six month period. Residents with moderate cognitive impairment experienced the greatest deterioration in early-loss and mid-loss ADL items (personal hygiene, dressing, toilet use) and residents with severe cognitive impairment showed the greatest deterioration in activities related to eating, a late loss ADL. Conclusion The MDS-ADL Long Form scale detected clinically meaningful change in physical function in a large cohort of long-stay nursing home residents with moderate to severe dementia, supporting its use as a research tool in future studies. PMID:16584565

  13. Identity construction and identity change: theories and competence building

    OpenAIRE

    Mihaela Boza

    2015-01-01

    Статья «Identity construction and identity change: theories and competence building» была опубликована в сборнике материалов III Всероссийской научно-практической конференции с международным участием «Проблемы формирования профессионализма специалистов социальной работы»

  14. Adapting to Climate Change: Lessons from Farmers and Peri-Urban Fringe Residents in South Australia

    Directory of Open Access Journals (Sweden)

    Guy M. Robinson

    2018-03-01

    Full Text Available This paper reports on results from two major research projects conducted in South Australia. The first investigates adaptation to climate change in two of the state’s major grain and sheep farming regions, using semi-structured interviews and focus groups. The second uses a postal questionnaire and an internet-based survey of residents in the peri-urban fringes of Adelaide, the state capital, to examine knowledge of and attitudes to climate change and resulting adaptations, especially in the context of increasing risk of wildfires. The research on adaptation to climate change in agriculture focused on formal institutions (e.g., government agencies and communities of practice (e.g., farm systems groups. Both groups noted that farmers autonomously adapt to various risks, including those induced by climate variability. The types and levels of adaptation varied among individuals partly because of barriers to adaptation, which included limited communication and engagement processes established between formal institutions and communities of practice. The paper discusses possibilities for more effective transfers of knowledge and information on climate change among formal institutions, communities of practice, trusted individual advisors and farmers. Research in the peri-urban fringe revealed that actions taken by individuals to mitigate and/or adapt to climate change were linked to the nature of environmental values held (or ecological worldview and place attachment. Individuals with a strong place attachment to the study area (the Adelaide Hills who possessed knowledge of and/or beliefs in climate change were most likely to take mitigating actions. This was also linked to previous experience of major risk from wildfires. The paper concludes by discussing prospects for developing co-management for reducing the impact of climate change across multiple groups in rural and peri-urban areas.

  15. 14 CFR Special Federal Aviation... - Construction or Alteration in the Vicinity of the Private Residence of the President of the...

    Science.gov (United States)

    2010-01-01

    ... of the Private Residence of the President of the United States Federal Special Federal Aviation Regulation No. 98 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) AIRSPACE OBJECTS AFFECTING NAVIGABLE AIRSPACE Pt. 77, SFAR No. 98 Special Federal Aviation...

  16. Understanding how residents’ preferences for supervisory methods change throughout residency training: a mixed-methods study

    OpenAIRE

    Olmos-Vega, Francisco; Dolmans, Diana; Donkers, Jeroen; Stalmeijer, Renée E.

    2015-01-01

    Background A major challenge for clinical supervisors is to encourage their residents to be independent without jeopardising patient safety. Residents’ preferences according to level of training on this regard have not been completely explored. This study has sought to investigate which teaching methods of the Cognitive Apprenticeship (CA) model junior, intermediate and senior residents preferred and why, and how these preferences differed between groups. Methods We invited 301 residents of a...

  17. Changes in the personal dignity of nursing home residents: a longitudinal qualitative interview study

    NARCIS (Netherlands)

    Oosterveld-Vlug, Mariska G.; Pasman, H. Roeline W.; van Gennip, Isis E.; Willems, Dick L.; Onwuteaka-Philipsen, Bregje D.

    2013-01-01

    Most nursing home residents spend the remainder of their life, until death, within a nursing home. As preserving dignity is an important aim of the care given here, insight into the way residents experience their dignity throughout their entire admission period is valuable. To investigate if and how

  18. Changes in the Personal Dignity of Nursing Home Residents: A Longitudinal Qualitative Interview Study

    NARCIS (Netherlands)

    Oosterveld-Vlug, M.G.; Pasman, H.R.W.; van Gennip, I.E.; Willems, D.L.; Onwuteaka-Philipsen, B.D.

    2013-01-01

    Background:Most nursing home residents spend the remainder of their life, until death, within a nursing home. As preserving dignity is an important aim of the care given here, insight into the way residents experience their dignity throughout their entire admission period is valuable.Aim:To

  19. The social construction of risk in a rural community: Responses of local residents to the 1990 Hagersville (Ontario) tire fire

    International Nuclear Information System (INIS)

    Eyles, J.; Taylor, S.M.; Baxter, J.; Sider, D.; Willms, D.

    1993-01-01

    This paper presents the findings of research relating to the 1990 Hagersville (Ontario) tire fire. After reviewing the literature on risk and risk perception, it begins by describing the event as well as the community in which it occurred. The reasons for adopting a qualitative research design are then established practical, conceptual, and methodological. The residents' accounts of the fire, evacuation, and aftermath in terms of concerns, anxieties, and responses are described. Five themes emerge: economic, community, health, environmental, and governance. The paper concludes by putting forward a case study-derived model of risk appraisal and management, and by relating the findings to policy issues. 48 refs., 1 fig

  20. Assessment of the living and workplace health and safety conditions of site-resident construction workers in Tehran, Iran.

    Science.gov (United States)

    Mohseni, Peyman Hossein; Farshad, Ali Asghar; Mirkazemi, Roksana; Orak, Rouhangiz Jamshidi

    2015-01-01

    The purpose of this study was to assess living and workplace safety conditions of construction workers in Tehran, Iran. This cross-sectional study was conducted among 410 construction sites in a municipal area of Tehran whose municipal building permits were issued in 2011. Data on ventilation, workplace safety and hygiene were collected by direct observation and interviews with site foremen. Noise levels were estimated from 10 sound-level-meter stations in the municipality area. Lack of ventilation in the workers' rooms was abundant. Bathrooms were unhygienic and minimum requirements such as lighting and ventilation did not exist in 80% of the cases. In nearly 50% of large construction sites, sewage and garbage disposal were inappropriate. Elevator safety was poor at all sites and no measures for fall prevention were present in over 88% of active construction sites. This study showed that the mean 24-h equivalent continuous sound level Leq was over 70 dB in 80% of the sites during weekdays. The results of this study revealed poor health and safety living and working conditions of construction workers in Tehran.

  1. Evaluation of risk in change orders report for AKDOT construction staff.

    Science.gov (United States)

    2009-06-01

    Work changes are common in construction contracts, especially for large projects. When contract changes must be made, how the owner : (the organization paying for the work) and the contractor (the firm performing the work) agree on a fair and reasona...

  2. ASSESSING THE EFFECT OF ANTIBIOTICS ON THE RESISTANCE OF RESIDENT MICROBES IN WETLANDS CONSTRUCTED FOR WASTEWATER TREATMENT

    Science.gov (United States)

    The use of constructed wetlands as a cost effective and environmentally friendly option for wastewater treatment is becoming more prevalent. These systems are championed as combining many of the benefits of tertiary treatment while also providing high quality wetland habitat as...

  3. Construction

    Science.gov (United States)

    2002-01-01

    Harbor Deepening Project, Jacksonville, FL Palm Valley Bridge Project, Jacksonville, FL Rotary Club of San Juan, San Juan, PR Tren Urbano Subway...David. What is nanotechnology? What are its implications for construction?, Foresight/CRISP Workshop on Nanotechnology, Royal Society of Arts

  4. Evaluation of a Cross Cultural Curriculum: Changing Knowledge, Attitudes and Skills in Pediatric Residents.

    Science.gov (United States)

    Horky, Susan; Andreola, Joseph; Black, Erik; Lossius, Michele

    2017-07-01

    Objectives The purpose of this study was to evaluate the effectiveness of six online modules, the Cross Cultural Case Stories, designed to teach healthcare professionals and trainees to provide culturally competent care to children with chronic respiratory conditions and their families. Modules increase provider awareness of the types of factors that may vary between cultures. This study assessed learner change in the three domains of knowledge, attitudes and self-reported skills. Improving on earlier studies, this evaluation included a control group for comparison. Methods Subjects comprised 66 first and second year pediatric residents at the University of Florida. Each module includes Objectives, Key Word definitions, Case Story, Lecture, Interactive Exercises and References. Intervention subjects completed an assessment tool before and after training. Control subjects completed the spaced assessments without completing the modules in-between. Results Within the intervention group there was a significant effect associated with the intervention. On average, participants within this group improved 1.67 points on the knowledge assessment (p < .01), 13.64 points on the attitudes self-assessment (p = .01) and 6.86 points on the skills assessment (p ≤ 0.01). When comparing between the intervention and control group significant differences were found in the post knowledge, post skills and post attitudes assessment, with the intervention group exceeding scores from the control group. Conclusions The Cross Cultural Cases provide an accessible, comprehensive and effective means for teaching healthcare and public health professionals and trainees. These cases can potentially provide training for students and practicing professionals from multiple medical and public health related disciplines.

  5. Climate change education and gender: constructing the role for the ...

    African Journals Online (AJOL)

    Although a state party and signatory to relevant instruments at that level, in addition to the scanty gender focus of South Africa in its national action on climate change, the role of education in addressing the climate change challenge is often overlooked. This is despite the fact that the 1996 Constitution of South Africa ...

  6. Resident iPad use: has it really changed the game?

    Science.gov (United States)

    Berkowitz, Seth J; Kung, Justin W; Eisenberg, Ronald L; Donohoe, Kevin; Tsai, Leo L; Slanetz, Priscilla J

    2014-02-01

    The purpose of this study was to assess residents' usage patterns and opinions of the iPad as a tool for radiology education and clinical practice at an academic medical center. All 38 radiology residents in our radiology program (postgraduate years 2 to 5) were provided with iPad 2 tablets and subscriptions to e-Anatomy and STATdx. After 6 months of device use, residents were surveyed to assess their opinions regarding the technology as a tool for education and clinical practice. A total of 36 residents (95%) completed the survey. Eighty-six percent reported daily iPad use. Radiology-specific applications, particularly e-Anatomy, were used weekly or daily by 88% of respondents. Most preferred to read journal articles on the iPad (70%), but the number of respondents preferring to read textbooks on the iPad (48.5%) compared with the traditional bound form (48.5%) was evenly divided. Residents were also divided on the clinical utility of the iPad. Most had not used the iPad to view radiologic examinations (75%). Fewer than half (47%) used their iPads during readout. Finally, only 12% had used the iPad to edit dictated reports. The iPad has generated excitement within the radiology community, particularly among resident educators, who are increasingly recognizing the unique needs of "millennial learners." This study showed that the majority of residents at the authors' institution have incorporated the iPad as an educational tool and use it as a learning aid. Incorporation of the iPad into clinical workflow has been less pronounced. Copyright © 2014 American College of Radiology. Published by Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

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

    2013-01-01

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

  8. Trainees as Agents of Change in the Opioid Epidemic: Optimizing the Opioid Prescription Practices of Surgical Residents.

    Science.gov (United States)

    Chiu, Alexander S; Healy, James M; DeWane, Michael P; Longo, Walter E; Yoo, Peter S

    are heavily influenced by their superiors, but are not receiving formal opioid-prescribing education, pointing to a great need for increased resident education on postoperative pain and opioid management to help change prescribing habits. Copyright © 2018 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  9. Negotiated risk and resident autonomy: Frontline care staff perspectives on culture change in long term care in Nova Scotia, Canada.

    Science.gov (United States)

    Roberts, Emily

    2016-08-12

    Regulating risk, freedom of action, and autonomy in decision making are problems shared by both caregivers and residents in long term care settings, and may become the subject of tension and constant negotiation. This study focuses on long term care staff and management perceptions of day to day life in a care community which has gone through a culture change transition, where small residentially scaled households replace large instutional models of care. In each household, the setting is considered to be home for the 8-12 residents, creating a major shift of roles for the caregivers; they are, in essence, coming into a home rather than institutional environment as a place of work. This potentially changes the dynamics of both patterns of work for caregivers and patterns of daily living for residents. Participant observations and care staff interviews. Several key themes emrged which include: teamwork; the culture of care; regulating risk; the physical environment and care staff empowerment. An unexpected outcome was the consensus among care staff that it is they who feel at home while working in the care households, leading to empowerment in their work roles and a deeper understanding of the importance of their role in the lives of the residents.

  10. Recognizing climate change in electricity network design and construction

    Energy Technology Data Exchange (ETDEWEB)

    Haenninen, S.; Pykaelae, M.-L.; Martikainen, A.; Farin, J. (VTT Technical Research Centre of Finland, Espoo (Finland))

    2009-07-01

    VTT has studied the impact of the climate change on the reliability of the medium voltage electricity network in Finland. The climate change concerning the planning and building of electric power networks was predicted using climate models and emission scenarios giving the mean value of the changes in 30 years. The Rossby Centre regional Atmosphere-Ocean model was the basis for the calculations. Two global climate models and two emission scenarios have been taken as boundary situations in order to take into account the uncertainty of the development in the future. The importance of the effects is shown as costs and failure durations for different line structures in different regions. On the basis of all these factors it will be judged how strong an effect the climate change has in the present electric power network and how one should be prepared for it. It is profitable to consider the final impacts in detail, because the weather causes faults in different ways depending on environmental conditions. Poor access to the fault locations increases the repairing time. Based on the calculations the influence of climate change is much lower at the roadside and even lower in the fields. Urban networks are already mostly underground cable networks having considerably lower climate effects than the overhead line network. The significance of the calculation results is estimated by comparing the calculated costs caused by the weather conditions to the total costs. Moreover, the influence of the climate change on the loading capacity of the power system components is presented. Impacts of the climate change on cables and transformers have been analyzed by TKK Power Systems and High Voltage Engineering. (orig.)

  11. A Systematic Review of Interventions to Change Staff Care Practices in Order to Improve Resident Outcomes in Nursing Homes.

    Directory of Open Access Journals (Sweden)

    Lee-Fay Low

    Full Text Available We systematically reviewed interventions that attempted to change staff practice to improve long-term care resident outcomes.Studies met criteria if they used a control group, included 6 or more nursing home units and quantitatively assessed staff behavior or resident outcomes. Intervention components were coded as including education material, training, audit and feedback, monitoring, champions, team meetings, policy or procedures and organizational restructure.Sixty-three unique studies were broadly grouped according to clinical domain-oral health (3 studies, hygiene and infection control (3 studies, nutrition (2 studies, nursing home acquired pneumonia (2 studies, depression (2 studies appropriate prescribing (7 studies, reduction of physical restraints (3 studies, management of behavioral and psychological symptoms of dementia (6 studies, falls reduction and prevention (11 studies, quality improvement (9 studies, philosophy of care (10 studies and other (5 studies. No single intervention component, combination of, or increased number of components was associated with greater likelihood of positive outcomes. Studies with positive outcomes for residents also tended to change staff behavior, however changing staff behavior did not necessarily improve resident outcomes. Studies targeting specific care tasks (e.g. oral care, physical restraints were more likely to produce positive outcomes than those requiring global practice changes (e.g. care philosophy. Studies using intervention theories were more likely to be successful. Program logic was rarely articulated, so it was often unclear whether there was a coherent connection between the intervention components and measured outcomes. Many studies reported barriers relating to staff (e.g. turnover, high workload, attitudes or organizational factors (e.g. funding, resources, logistics.Changing staff practice in nursing homes is possible but complex. Interventionists should consider barriers and

  12. A Systematic Review of Interventions to Change Staff Care Practices in Order to Improve Resident Outcomes in Nursing Homes

    Science.gov (United States)

    Low, Lee-Fay; Fletcher, Jennifer; Goodenough, Belinda; Jeon, Yun-Hee; Etherton-Beer, Christopher; MacAndrew, Margaret; Beattie, Elizabeth

    2015-01-01

    Background We systematically reviewed interventions that attempted to change staff practice to improve long-term care resident outcomes. Methods Studies met criteria if they used a control group, included 6 or more nursing home units and quantitatively assessed staff behavior or resident outcomes. Intervention components were coded as including education material, training, audit and feedback, monitoring, champions, team meetings, policy or procedures and organizational restructure. Results Sixty-three unique studies were broadly grouped according to clinical domain—oral health (3 studies), hygiene and infection control (3 studies), nutrition (2 studies), nursing home acquired pneumonia (2 studies), depression (2 studies) appropriate prescribing (7 studies), reduction of physical restraints (3 studies), management of behavioral and psychological symptoms of dementia (6 studies), falls reduction and prevention (11 studies), quality improvement (9 studies), philosophy of care (10 studies) and other (5 studies). No single intervention component, combination of, or increased number of components was associated with greater likelihood of positive outcomes. Studies with positive outcomes for residents also tended to change staff behavior, however changing staff behavior did not necessarily improve resident outcomes. Studies targeting specific care tasks (e.g. oral care, physical restraints) were more likely to produce positive outcomes than those requiring global practice changes (e.g. care philosophy). Studies using intervention theories were more likely to be successful. Program logic was rarely articulated, so it was often unclear whether there was a coherent connection between the intervention components and measured outcomes. Many studies reported barriers relating to staff (e.g. turnover, high workload, attitudes) or organizational factors (e.g. funding, resources, logistics). Conclusion Changing staff practice in nursing homes is possible but complex

  13. Ecological performance of construction materials subject to ocean climate change.

    Science.gov (United States)

    Davis, Kay L; Coleman, Melinda A; Connell, Sean D; Russell, Bayden D; Gillanders, Bronwyn M; Kelaher, Brendan P

    2017-10-01

    Artificial structures will be increasingly utilized to protect coastal infrastructure from sea-level rise and storms associated with climate change. Although it is well documented that the materials comprising artificial structures influence the composition of organisms that use them as habitat, little is known about how these materials may chemically react with changing seawater conditions, and what effects this will have on associated biota. We investigated the effects of ocean warming, acidification, and type of coastal infrastructure material on algal turfs. Seawater acidification resulted in greater covers of turf, though this effect was counteracted by elevated temperatures. Concrete supported a greater cover of turf than granite or high-density polyethylene (HDPE) under all temperature and pH treatments, with the greatest covers occurring under simulated ocean acidification. Furthermore, photosynthetic efficiency under acidification was greater on concrete substratum compared to all other materials and treatment combinations. These results demonstrate the capacity to maximise ecological benefits whilst still meeting local management objectives when engineering coastal defense structures by selecting materials that are appropriate in an ocean change context. Therefore, mitigation efforts to offset impacts from sea-level rise and storms can also be engineered to alter, or even reduce, the effects of climatic change on biological assemblages. Copyright © 2017 Elsevier Ltd. All rights reserved.

  14. Design and Construction of an Automatic Three-Phase Change ...

    African Journals Online (AJOL)

    The device can also amplify input voltage as low as 50V a.c to a constant 220V a.c. Furthermore, if no power is sensed, from the three live phases, that is if all the phases are in OFF STATE, the device auto-connect to a power generating plant. Keywords: Power Supply; stabilizer; phase Change-over Switch ...

  15. The use of potentially inappropriate medications and changes in quality of life among older nursing home residents.

    Science.gov (United States)

    Al Aqqad, Saná M H; Chen, Li Li; Shafie, Asrul Akmal; Hassali, Mohamed Azmi; Tangiisuran, Balamurugan

    2014-01-01

    Nursing home residents are mainly older people with multiple diseases and taking multiple medications. The quality use of medication and its association with health related quality of life (HRQoL) have not been reported in Malaysia. This study aims to investigate the association between the use of potentially inappropriate medications (PIMs) and the changes observed in the HRQoL among older nursing home residents. A prospective follow up study was conducted at four nongovernmental organization nursing homes in Penang, Malaysia. Older residents (≥65 years old) taking at least one prescribed medication were included. Residents with PIMs were identified by using Screening Tool of Older Person's potentially inappropriate Prescriptions (STOPP) criteria. HRQoL was assessed using EuroQol-5 dimension (EQ-5D) and EuroQol-visual analog scale (EQ-VAS) at baseline and after a 3-month follow up. The association of PIMs with HRQoL was analyzed using Mann-Whitney U test. The median age of the 211 participants was 77 years (interquartile range 72-82 years) and the median number of prescription medicines was four (interquartile range three to six). The prevalence of PIMs was 23.7% and 18.6% at baseline and 3 months later, respectively. The most commonly prescribed PIMs in decreasing order were first generation antihistamine, prescriptions of duplicate drug class, glibenclamide with type 2 diabetes mellitus, and anticholinergic to treat extrapyramidal side effects of neuroleptic medications. At baseline, there was no significant difference among residents with or without PIMs in each bracket of EQ-5D, EQ-5D index, or EQ-VAS scores. Comparison of the differences in the mean score index of EQ-5D between baseline and after 3 months also showed no statistically significant differences. PIMs were found to be relatively common among older nursing home residents. However, no significant changes were observed in HRQoL among these residents. Further studies with a bigger sample size and

  16. The use of potentially inappropriate medications and changes in quality of life among older nursing home residents

    Directory of Open Access Journals (Sweden)

    Al Aqqad S MH

    2014-01-01

    Full Text Available Sana’ MH Al Aqqad, Li Li Chen, Asrul Akmal Shafie, Mohamed Azmi Hassali, Balamurugan Tangiisuran Pharmacy Practice Research Group, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia Background: Nursing home residents are mainly older people with multiple diseases and taking multiple medications. The quality use of medication and its association with health related quality of life (HRQoL have not been reported in Malaysia. This study aims to investigate the association between the use of potentially inappropriate medications (PIMs and the changes observed in the HRQoL among older nursing home residents. Methods: A prospective follow up study was conducted at four nongovernmental organization nursing homes in Penang, Malaysia. Older residents (≥65 years old taking at least one prescribed medication were included. Residents with PIMs were identified by using Screening Tool of Older Person's potentially inappropriate Prescriptions (STOPP criteria. HRQoL was assessed using EuroQol-5 dimension (EQ-5D and EuroQol-visual analog scale (EQ-VAS at baseline and after a 3-month follow up. The association of PIMs with HRQoL was analyzed using Mann-Whitney U test. Results: The median age of the 211 participants was 77 years (interquartile range 72–82 years and the median number of prescription medicines was four (interquartile range three to six. The prevalence of PIMs was 23.7% and 18.6% at baseline and 3 months later, respectively. The most commonly prescribed PIMs in decreasing order were first generation antihistamine, prescriptions of duplicate drug class, glibenclamide with type 2 diabetes mellitus, and anticholinergic to treat extrapyramidal side effects of neuroleptic medications. At baseline, there was no significant difference among residents with or without PIMs in each bracket of EQ-5D, EQ-5D index, or EQ-VAS scores. Comparison of the differences in the mean score index of EQ-5D between baseline and after 3 months

  17. Can changes in the distributions of resident birds in China over the past 50 years be attributed to climate change?

    Science.gov (United States)

    Wu, Jianguo; Zhang, Guobin

    2015-01-01

    The distributions of bird species have changed over the past 50 years in China. To evaluate whether the changes can be attributed to the changing climate, we analyzed the distributions of 20 subspecies of resident birds in relation to climate change. Long-term records of bird distributions, gray relational analysis, fuzzy-set classification techniques, and attribution methods were used. Among the 20 subspecies of resident birds, the northern limits of over half of the subspecies have shifted northward since the 1960s, and most changes have been related to the thermal index. Driven by climate change over the past 50 years, the suitable range and latitude or longitude of the distribution centers of certain birds have exhibited increased fluctuations. The northern boundaries of over half of the subspecies have shifted northward compared with those in the 1960s. The consistency between the observed and predicted changes in the range limits was quite high for some subspecies. The changes in the northern boundaries or the latitudes of the centers of distribution of nearly half of the subspecies can be attributed to climate change. The results suggest that climate change has affected the distributions of particular birds. The method used to attribute changes in bird distributions to climate change may also be effective for other animals. PMID:26078858

  18. [Morphologic changes in ileoanal reservoirs 2 years after their construction].

    Science.gov (United States)

    Enríquez Navascues, J M; Capote, L; Devesa, J M; Morales, V; Carda, P; Vicente, E; Ferrero, E

    1989-01-01

    A study was made of the histologic changes in the mucosa of the ileoanal reservoirs of 10 patients who 2 years earlier had undergone ileoanal anastomosis with a J reservoir for ulcerative colitis (CU). In biopsies of the reservoirs were evaluated: 1) basic morphologic changes; 2) morphometric differences with respect to normal ileal mucosa; 3) the immunohistochemical pattern (IHQ) (IgA, IgG, IgM and CEA) of the reservoir mucosa as compared to normal ileum, active ulcerative colitis. Crohn's disease and celiaca; 4) the possible existence of atypias or dysplasias of the reservoir mucosa; and 5) the number of argentaffin cells per field. The basic morphologic alteration consisted of colonic metaplasia. Reservoir biopsies exhibited partial (8 cases) or subtotal atrophy (2 cases) of the mucosa. With respect to the normal ileum there was a decrease in villi height (p less than 0.05), an increase in crypt depth (p less than 0.05) and a higher index of mucosal regeneration, with a larger number of cells and mitoses per crypt (p less than 0.05). Fifty percent of the reservoirs presented a chronic inflammatory pattern with an acute component in 30% of them. The immunohistochemical pattern of the reservoirs not inflamed was similar to that of normal ileum (IgA much greater than IgM greater than IgG) and that of the inflamed reservoirs was similar to that of intestinal inflammatory disease (marked increase in the IgG. CEA (similar to what?) an alteration of local immune homeostasis could have of the genesis of pictures of "pouchitis". No alarming signs of atypia or dysplasia were found, nor changes in the population of argentaffin cells.

  19. Transit Use, Physical Activity, and Body Mass Index Changes: Objective Measures Associated With Complete Street Light-Rail Construction

    Science.gov (United States)

    Werner, Carol M.; Tribby, Calvin P.; Miller, Harvey J.; Smith, Ken R.

    2015-01-01

    Objectives. We assessed effects on physical activity (PA) and weight among participants in a complete street intervention that extended a light-rail line in Salt Lake City, Utah. Methods. Participants in the Moving Across Places Study resided within 2 kilometers of the new line. They wore accelerometers and global positioning system (GPS) loggers for 1 week before and after rail construction. Regression analyses compared change scores of participants who never rode transit with continuing, former, and new riders, after adjustment for control variables (total n = 537). Results. New riders had significantly more accelerometer-measured counts per minute than never-riders (P transit ridership in the complete street area, research should address how to encourage more sustained ridership. PMID:25973829

  20. Transit Use, Physical Activity, and Body Mass Index Changes: Objective Measures Associated With Complete Street Light-Rail Construction.

    Science.gov (United States)

    Brown, Barbara B; Werner, Carol M; Tribby, Calvin P; Miller, Harvey J; Smith, Ken R

    2015-07-01

    We assessed effects on physical activity (PA) and weight among participants in a complete street intervention that extended a light-rail line in Salt Lake City, Utah. Participants in the Moving Across Places Study resided within 2 kilometers of the new line. They wore accelerometers and global positioning system (GPS) loggers for 1 week before and after rail construction. Regression analyses compared change scores of participants who never rode transit with continuing, former, and new riders, after adjustment for control variables (total n = 537). New riders had significantly more accelerometer-measured counts per minute than never-riders (P complete street area, research should address how to encourage more sustained ridership.

  1. [Characteristics of smoking, nicotine dependence and motivation for change in specialists training in health sciences (residents) in Andalusia (Spain)].

    Science.gov (United States)

    Juárez-Jiménez, M V; Valverde-Bolívar, F J; Pérez-Milena, A; Moreno-Corredor, A

    2015-09-01

    As there are few studies on the smoking habits of specialists training in health sciences (residents), it is of interest to determine the prevalence of smoking, nicotine dependence and motivation for change, and their relationship with other variables (personal, work and consumption of other drugs). A multicentre, cross-sectional study using a questionnaire was conducted in 2012. All the residents who were studying in Teaching Health Centres in Andalusia (Spain) completed a questionnaire, which was sent by e-mail, collecting: age, sex, specialty, country of origin, qualitative-quantitative consumption of tobacco, age of onset/cessation, Fagerström test and stage of change (Proschaka). A total of 2667 residents (63% of total) completed the questionnaire. The mean age was 29.1 years (± 5.2), 69% female, 89% Spanish, and 86% physicians. Of the 17% who smoked (daily pattern-47%, intermittently-41%, related to leisure-3%), starting at 17.4 years (±3.5) and mean of 7.5 cigarettes per day (±7.1), higher medical specialties (P=.067 ANOVA), and in men (P=.074, Student-t). More than three-quarters (82%) had a low nicotine dependence, being higher in hospital medical specialties (P=.078 χ(2)). Of the total, 7% were former smokers, and 48% wanted to quit smoking (contemplation 38%, preparation 10%). In the multivariate analysis there was a link between smoking and alcohol consumption (OR 2.84) and illegal drugs (OR 3.57). There were no differences by age or country. The consumption of tobacco in residents is less than the general population, with a low dependence and better willingness to change. The period of specialised training is a good time to offer tobacco interventions. Copyright © 2014 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

  2. 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.

  3. Permanent resident.

    Science.gov (United States)

    Fisher, John F

    2016-01-01

    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.

  4. Middle school students' conceptual change in global climate change: Using argumentation to foster knowledge construction

    Science.gov (United States)

    Golden, Barry W.

    their explanations could be modified to better account for the data as pointed out by peers. As the students experienced the three lessons comprising the unit, data were taken of various modes, including pre-unit, mid-unit, post-unit, and delayed-post unit interviews, observer notes from the classroom, and artifacts created by the students as individuals and as members of a group. At the end of the unit, a written post-assessment was administered, and post-interviews were conducted with the selected students. These varied data sources were analyzed in order to develop themes corresponding to their frameworks of climate change. Negative cases were sought in order to test developing themes. Themes that emerged from the data were triangulated across the various data sources in order to ensure quality and rigor. These themes were then used to construct understandings of various students' frameworks of the content. Several findings emerged from this research. The first finding is that each student underwent some conceptual change regarding GCC, although of varying natures. The students' synthetic frameworks of GCC were more complex than their initial, or naive frameworks. Some characteristics of the naive frameworks included that the students tended to conflate climate change with a broader, generic category of environmental things. Examples of this conflation include the idea that climate change entails general pollution, litter, and needless killing of dolphins while fishing for tuna. This research suggests that students might benefit from explicit attention to this concept in terms of an ontological category, with the ideal synthetic view realizing that GCC is itself an example of an emergent process. Another characteristic of their naive frameworks includes some surprisingly accurate notions of GCC, including a general sense that temperatures and sea levels are rising. At the same time, none of the students were able to adequately invoke data to support their

  5. Occupational exposures and changes in pulmonary function over 13 years among residents of Cracow.

    OpenAIRE

    Krzyzanowski, M; Jedrychowski, W; Wysocki, M

    1988-01-01

    In a 13 year follow up study conducted among residents of Cracow the relation of annual rate of decline in FEV1 to occupational exposures was analysed. The study group consisted of 696 men and 983 women aged 19-60 at the start of the study in 1968. They were interviewed three times, in 1968, 1973, and 1981, and decline in FEV1 was estimated for each subject from spirometric measurements in 1968 and 1981. The interviews provided data on exposure at the workplace to dusts, variable temperature,...

  6. Are Stage of Change constructs relevant for subjective oral health in a vulnerable population?

    Science.gov (United States)

    Jamieson, L M; Parker, E J; Broughton, J; Lawrence, H P; Armfield, J M

    2015-06-01

    Stage of Change constructs may be proxy markers of psychosocial health which, in turn, are related to oral health. To determine if Stage of Change constructs were associated with subjective oral health in a population at heightened risk of dental disease. Stage of Change constructs were developed from a validated 18-item scale and categorised into 'Pre-contemplative', 'Contemplative' and 'Active'. A convenience sample of 446 Australian non-Aboriginal women pregnant by an Aboriginal male (age range 14-43 years) provided data to evaluate the outcome variables (self-rated oral health and oral health impairment), the Stage of Change constructs and socio-demographic, behavioural and access-related factors. Factors significant at the p health and 34% had oral health impairment. Around 12% were 'Pre-contemplative', 46% 'Contemplative' and 42% 'Active'. Being either 'pre-contemplative' or 'contemplative' was associated with poor self-rated oral health after adjusting for socio-demographic factors. 'Pre-contemplative' ceased being significant after adjusting for dentate status and dental behaviour. 'Pre-contemplative' remained significant when adjusting for dental cost, but not 'Contemplative'. The Stages of Change constructs ceased being associated with self-rated oral health after adjusting for all confounders. Only 'Contemplative' (reference: 'Active') was a risk indicator in the null model for oral health impairment which persisted after adding dentate status, dental behaviour and dental cost variables, but not socio-demographics. When adjusting for all confounders, 'Contemplative' was not a risk indicator for oral health impairment. Both the 'Pre-contemplative' and 'Contemplative' Stage of Change constructs were associated with poor self-rated oral health and oral health impairment after adjusting for some, but not all, covariates. When considered as a proxy marker of psychosocial health, Stage of Change constructs may have some relevance for subjective oral health.

  7. Improvements Needed in Managing Scope Changes and Oversight of Construction Projects at Camp Lemonnier, Djibouti

    Science.gov (United States)

    2016-09-30

    Improvements Needed in Managing Scope Changes and Oversight of Construction Projects at Camp Lemonnier, Djibouti S E P T E M B E R 3 0 , 2 0 1 6 Report...Improvements Needed in Managing Scope Changes and Oversight of Construction Projects at Camp Lemonnier, Djibouti Visit us at www.dodig.mil Objective We...Findings (cont’d) ii │ DODIG-2016-141 (Project No. D2014-D000RE-0157.000) Results in Brief Improvements Needed in Managing Scope Changes and Oversight

  8. Changes in malnutrition and quality of nutritional care among aged residents in all nursing homes and assisted living facilities in Helsinki 2003-2011.

    Science.gov (United States)

    Saarela, Riitta K T; Muurinen, Seija; Suominen, Merja H; Savikko, Niina N; Soini, Helena; Pitkälä, Kaisu H

    2017-09-01

    While nutritional problems have been recognized as common in institutional settings for several decades, less is known about how nutritional care and nutrition has changed in these settings over time. To describe and compare the nutritional problems and nutritional care of residents in all nursing homes (NH) in 2003 and 2011 and residents in all assisted living facilities (ALF) in 2007 and 2011, in Helsinki, Finland. We combined four cross-sectional datasets of (1) residents from all NHs in 2003 (N=1987), (2) residents from all ALFs in 2007 (N=1377), (3) residents from all NHs in 2011 (N=1576) and (4) residents from all ALFs in 2011 (N=1585). All participants at each time point were assessed using identical methods, including the Mini Nutritional Assessment (MNA). The mean age of both samples from 2011 was higher and a larger proportion suffered from dementia, compared to earlier collected samples. A larger proportion of the residents in 2011 were assessed either malnourished or at-risk for malnutrition, according to the MNA, than in 2003 (NH: 93.5% vs. 88.9%, psnacks between meals was significantly more common in the 2011 residents, compared to the respective earlier samples. In 2011, institutionalized residents were more disabled and more prone to malnourishment than in 2003 or 2007. Institutions do seem to be more aware of good nutritional care for vulnerable older people, although there is still room for improvement. Copyright © 2017 Elsevier B.V. All rights reserved.

  9. Technological change as a trade-off between social construction and technological paradigms

    OpenAIRE

    Engen, Ole Andreas; Olsen, Odd Einar

    2007-01-01

    Made available from Technology in Society, 29/4, Odd Einar Olsen, & Ole Andreas Engen, Technological change as a trade-off between social construction and technological paradigms, Pages No. 456-468, Copyright 2007, with permission from Elsevier. http://www.sciencedirect.com/science/journal/0160791X The theory of social construction of technology (SCOT) and the theory of technological paradigms (TTP) are normally regarded as competing or even incompatible perspectives on technological ch...

  10. A Policy Analysis of Missouri Community College Residence Hall Discipline Policies with an Analysis of Changes in the State Fair Community College Residence Hall Policy

    Science.gov (United States)

    Gilgour, Joseph G.

    2012-01-01

    Community colleges in the United States have long been known as institutions of equal opportunity and affordable education. One facet of student life appearing at more and more community colleges is the addition of residence halls. Still, the number of community colleges with on-campus living is relatively small, and for the campuses with…

  11. A quantitative experimental paradigm to optimize construction of rank order lists in the National Resident Matching Program: the ROSS-MOORE approach.

    Science.gov (United States)

    Ross, David A; Moore, Edward Z

    2013-09-01

    As part of the National Resident Matching Program, programs must submit a rank order list of desired applicants. Despite the importance of this process and the numerous manifest limitations with traditional approaches, minimal research has been conducted to examine the accuracy of different ranking strategies. The authors developed the Moore Optimized Ordinal Rank Estimator (MOORE), a novel algorithm for ranking applicants that is based on college sports ranking systems. Because it is not possible to study the Match in vivo, the authors then designed the Recruitment Outcomes Simulation System (ROSS). This program was used to simulate a series of interview seasons and to compare MOORE and traditional approaches under different conditions. The accuracy of traditional ranking and the MOORE approach are equally and adversely affected with higher levels of intrarater variability. However, compared with traditional ranking methods, MOORE produces a more accurate rank order list as interrater variability increases. The present data demonstrate three key findings. First, they provide proof of concept that it is possible to scientifically test the accuracy of different rank methods used in the Match. Second, they show that small amounts of variability can have a significant adverse impact on the accuracy of rank order lists. Finally, they demonstrate that an ordinal approach may lead to a more accurate rank order list in the presence of interviewer bias. The ROSS-MOORE approach offers programs a novel way to optimize the recruitment process and, potentially, to construct a more accurate rank order list.

  12. Changing trends in intestinal parasitic infections among long-term-residents and settled immigrants in Qatar

    Directory of Open Access Journals (Sweden)

    Doiphode Sanjay H

    2010-10-01

    Full Text Available Abstract Background The rapid socio-economic development in Qatar in the last two decades has encouraged a mass influx of immigrant workers, the majority of whom originate from countries with low socio-economic levels, inadequate medical care and many are known to carry patent intestinal helminth and protozoan infections on arrival in Qatar. Some eventually acquire residency status but little is known about whether they continue to harbour infections. Methods We examined 9208 hospital records of stool samples that had been analysed for the presence of intestinal helminth and protozoan ova/cysts, over the period 2005-2008, of subjects from 28 nationalities, but resident in Qatar and therefore not recent arrivals in the country. Results Overall 10.2% of subjects were infected with at least one species, 2.6% with helminths and 8.0% with protozoan species. Although hookworms, Ascaris lumbricoides, Trichuris trichiura and Hymenolepis nana were observed, the majority of helminth infections (69% were caused by hookworms, and these were largely aggregated among 20.0-39.9 year-old male subjects from Nepal. The remaining cases of helminth infection were mostly among Asian immigrants. Protozoan infections were more uniformly spread across immigrants from different regions when prevalence was calculated on combined data, but this disguised three quite contrasting underlying patterns for 3 taxa of intestinal protozoa. Blastocystis hominis, Giardia duodenalis and non-pathogenic amoebae were all acquired in childhood, but whereas prevalence of B. hominis rose to a plateau and then even further among the elderly, prevalence of G. duodenalis fell markedly in children aged 10 and older, and stayed low (Entamoeba coli, E. hartmanni, Endolimax nana and Iodamoeba buetschlii peaked in the 30.0-39.9 age group and only then dropped to very low values among the oldest subjects examined. A worrying trend in respect of both helminth and protozoan parasites was the

  13. Constructing changes in relational processes. Introducing a social constructionist approach to change work

    NARCIS (Netherlands)

    Hosking, D.M.; Bass, A.

    2001-01-01

    This article is constructed in the form of a dialogue between a mother - who has just returned from the conference "It's a relational world" - and her daughter, Sophie. Sophie asks her mother to explain what the conference was all about ... what is "relational constructionism", what is its

  14. Constructing Markov State Models to elucidate the functional conformational changes of complex biomolecules

    KAUST Repository

    Wang, Wei

    2017-10-06

    The function of complex biomolecular machines relies heavily on their conformational changes. Investigating these functional conformational changes is therefore essential for understanding the corresponding biological processes and promoting bioengineering applications and rational drug design. Constructing Markov State Models (MSMs) based on large-scale molecular dynamics simulations has emerged as a powerful approach to model functional conformational changes of the biomolecular system with sufficient resolution in both time and space. However, the rapid development of theory and algorithms for constructing MSMs has made it difficult for nonexperts to understand and apply the MSM framework, necessitating a comprehensive guidance toward its theory and practical usage. In this study, we introduce the MSM theory of conformational dynamics based on the projection operator scheme. We further propose a general protocol of constructing MSM to investigate functional conformational changes, which integrates the state-of-the-art techniques for building and optimizing initial pathways, performing adaptive sampling and constructing MSMs. We anticipate this protocol to be widely applied and useful in guiding nonexperts to study the functional conformational changes of large biomolecular systems via the MSM framework. We also discuss the current limitations of MSMs and some alternative methods to alleviate them.

  15. The influence of client brief and change order in construction project

    Science.gov (United States)

    Mahat, N. A. A.; Adnan, H.

    2018-02-01

    Construction briefing is a statement of needs about intentions and projects objectives. Briefing process is the preliminary stage in the design process and successful briefing can achieve project delivery right on target time, cost and quality of project confidently. Although there are many efforts to approach client’s requirement and needs for a project, it is still not collected adequately to make proper solutions in design. Thus, these may lead the client to include change orders during the construction phase. This paper is concerned toward the influence of client’s briefing of a construction project that impact on the change order on the construction works. The research objective is to identify the influence of client’s brief on change orders, therefore, the aims of the research is to reduce change orders in project delivery. This research adopted both qualitative and quantitative data collection methods which are content analysis and semi structure interview. The findings highlight factors contributing to change orders and the essential attributes of clients during the briefing stage that may help minimise them.

  16. Is there any change in the prevalence of intestinal and urinary parasitosis among "non-permanent resident" students in Tunisia ?

    Science.gov (United States)

    Trabelsi, Sonia; Bouchakoua, Myiram; Aouinet, Amira; Sellami, Amira; Khaled, Samira

    2012-07-01

    Intestinal parasitosis are cosmopolitan affections, often related to the fecal peril. However urinary bilharziosis is a disease eliminated in Tunisia. As part of monitoring the emergence and re-emergence of intestinal parasitosis and urinary bilharziasis, foreign students benefit from parasitological systematic monitoring stool and urine during their enrollment to the University. To study the prevalence of various intestinal parasitosis and urinary bilharziasis among non permanent resident students in Tunisia. A retrospective survey was carried at the Laboratory of Parasitology- Mycology of Charles Nicolle Hospital of Tunis during the inscription period of 6 university years 2005-2010. 328 students profited from a parasitological examination of stool and urine. 144 students (43.9%) harbored intestinal parasites. More than one parasite was detected in 69 students (47.9%). Intestinal protozoa were the majority of identified parasites (96.9%). 9.7% of identified parasites were pathogenic. Three cases (0.91%) of urinary bilharziasis were diagnosed. The prevalence of intestinal and urinary parasitism among the "non-permanent residents" students in Tunisia has not changed. This justifies a systematic parasitologic monitoring for students coming from areas of high endemicity of parasitosis in order to avoid the introduction of these.

  17. Wavelet analysis function of changing average work amounts in monolithic construction

    Directory of Open Access Journals (Sweden)

    Simankina Tatiana

    2016-01-01

    Full Text Available In work periodicity of impact of various external and internal factors on function of changing average work amounts and extent of various factors influence on the process of monolithic construction are defined by wavelet transform. Basic data are data on daily amount of the concreted structures (CBM in 4.5 months. Using the continuous wavelet transform wavelet spectrum was constructed, which showed the periods of impact of external and internal factors on the construction process. Using the discrete wavelet transform the algorithm of an exception of critical deviations from a function of changing average work amounts was developed. This algorithm allows to plan future works taking into account the revealed factors.

  18. Engaging Chicago residents in climate change action: Results from Rapid Ethnographic Inquiry

    Science.gov (United States)

    Lynne M. Westphal; Jennifer. Hirsch

    2010-01-01

    Addressing climate change requires action at all levels of society, from neighborhood to international levels. Using Rapid Ethnography rooted in Asset Based Community Development theory, we investigated climate-friendly attitudes and behaviors in two Chicago neighborhoods in order to assist the City with implementation of its Climate Action Plan. Our research suggests...

  19. Narrative change in emotion-focused therapy: how is change constructed through the lens of the innovative moments coding system?

    Science.gov (United States)

    Mendes, Inês; Ribeiro, António P; Angus, Lynne; Greenberg, Leslie S; Sousa, Inês; Gonçalves, Miguel M

    2010-11-01

    The aim of this study was to advance understanding of how clients construct their own process of change in effective therapy sessions. Toward this end, the authors applied a narrative methodological tool for the study of the change process in emotion-focused therapy (EFT), replicating a previous study done with narrative therapy (NT). The Innovative Moments Coding System (IMCS) was applied to three good-outcome and three poor-outcome cases in EFT for depression to track the innovative moments (IMs), or exceptions to the problematic self-narrative, in the therapeutic conversation. IMCS allows tracking of five types of IMs events: action, reflection, protest, reconceptualization, and performing change. The analysis revealed significant differences between the good-outcome and poor-outcome groups regarding reconceptualization and performing change IMs, replicating the findings from a previous study. Reconceptualization and performing change IMs seem to be vital in the change process.

  20. Ongoing changes in migration phenology and winter residency at Bracken Bat Cave.

    Science.gov (United States)

    Stepanian, Phillip M; Wainwright, Charlotte E

    2018-02-14

    Bats play an important role in agroecology and are effective bioindicators of environmental conditions, but little is known about their fundamental migration ecology, much less how these systems are responding to global change. Some of the world's largest bat populations occur during the summer in the south-central United States, when millions of pregnant females migrate from lower latitudes to give birth in communal maternity colonies. Despite a relatively large volume of research into these colonies, many fundamental questions regarding their abundance-including their intra- and interseasonal variability-remain unanswered, and even estimating the size of individual populations has been a long-running challenge. Overall, monitoring these bat populations at high temporal resolution (e.g., nightly) and across long time spans (e.g., decades) has been impossible. Here, we show 22 continuous years of nightly population counts at Bracken Cave, a large bat colony in south-central Texas, enabling the first climate-scale phenological analysis. Using quantitative radar monitoring, we found that spring migration and the summer reproductive cycle have advanced by approximately 2 weeks over the study period. Furthermore, we quantify the ongoing growth of a newly-established overwintering population that indicates a system-wide response to changing environmental conditions. Our observations reveal behavioral plasticity in bats' ability to adapt to changing resource availability, and provide the first long-term quantification of their response to a changing climate. As aerial insectivores, these changes in bat phenology and propensity for overwintering indicate probable shifts in prey availability, with clear implications for pest management across wider regional agrisystems. © 2018 John Wiley & Sons Ltd.

  1. Seismic effects on bedrock and underground constructions. A literature survey of damage on constructions; Changes in groundwater levels and flow; Changes in chemistry in groundwater and gases

    International Nuclear Information System (INIS)

    Roeshoff, Kennert.

    1989-06-01

    This report is a literature review of direct and indirect effects of earthquakes on underground constructions as tunnels, caverns and mines. The direct damage will cause vibrations, shaking and displacement, which may lead to partial or total destruction of the underground facility. Damage caused by shaking has been reported in several studies, and several hundreds of events have been reported both from mines and tunnels. These reports are mainly from active earthquake areas. There are very few reports of damage caused by displacements on an existing fault. The damage, which may be severe, is generally concentrated to the vicinity of the fault zone. The report also includes a review of the effects caused by earthquakes on groundwater level, flow, pressure, chemistry and constituents in the ground. Such changes are mainly reported from studies in wells near active faults. The interesting coupling of changes in groundwater characteristics around an underground construction is, unfortunately, very seldom reported. The groundwater level and pressure changes are discussed in Chapter 4. The bases for this part of the review is taken from the Alaska earthquake 1964. Other observations are reported from wells and reservoirs located near existing faults. Changes of the geochemistry in groundwater and soil gases are reviewed in Chapter 4. The mechanisms of seismochemical anomalies are discussed and examples of short and long term monitoring are given from USA, Soviet Union and China. Gases in ground water and soil is reported in Chapter 5. Radon is so far one of the most studied species and its variation in short, medium and long term with seismic activity is rather well understood. Other gases or isotopes that have been studied include helium, carbon dioxide, hydrogen, argon and methane, radium and uranium. The paper also includes same statements for repository design based on the result of the review. (81 refs.)

  2. Family involvement in timely detection of changes in health of nursing homes residents: A qualitative exploratory study.

    Science.gov (United States)

    Powell, Catherine; Blighe, Alan; Froggatt, Katherine; McCormack, Brendan; Woodward-Carlton, Barbara; Young, John; Robinson, Louise; Downs, Murna

    2018-01-01

    To explore family perspectives on their involvement in the timely detection of changes in their relatives' health in UK nursing homes. Increasingly, policy attention is being paid to the need to reduce hospitalisations for conditions that, if detected and treated in time, could be managed in the community. We know that family continue to be involved in the care of their family members once they have moved into a nursing home. Little is known, however, about family involvement in the timely detection of changes in health in nursing home residents. Qualitative exploratory study with thematic analysis. A purposive sampling strategy was applied. Fourteen semi-structured one-to-one interviews with family members of people living in 13 different UK nursing homes. Data were collected from November 2015-March 2016. Families were involved in the timely detection of changes in health in three key ways: noticing signs of changes in health, informing care staff about what they noticed and educating care staff about their family members' changes in health. Families suggested they could be supported to detect timely changes in health by developing effective working practices with care staff. Families can provide a special contribution to the process of timely detection in nursing homes. Their involvement needs to be negotiated, better supported, as well as given more legitimacy and structure within the nursing home. Families could provide much needed support to nursing home nurses, care assistants and managers in timely detection of changes in health. This may be achieved through communication about their preferred involvement on a case-by-case basis as well as providing appropriate support or services. © 2017 The Authors. Journal of Clinical Nursing Published by John Wiley & Sons Ltd.

  3. Change in Care Dependency and Nursing Care Problems in Nursing Home Residents with and without Dementia: A 2-Year Panel Study.

    Directory of Open Access Journals (Sweden)

    Sandra Schüssler

    Full Text Available Over time, chronic conditions like dementia can lead to care dependency and nursing care problems, often necessitating nursing home admission. This panel study (2012-2014 aims to explore changes in care dependency and nursing care problems (incontinence, malnutrition, decubitus, falls and restraints in residents with and without dementia over time. In total, nine Austrian nursing homes participated, including 258 residents (178 with, 80 without dementia who completed all five measurements. Data were collected with the International Prevalence Measurement of Care Problems questionnaire, the Care Dependency Scale and the Mini-Mental State Examination-2. Repeated measures ANOVA and crosstabs were used to analyse changes. The results showed that care dependency in dementia residents increased significantly for all 15 items of the Care Dependency Scale, with the highest increase being residents' day-/night pattern, contact with others, sense of rules/values and communication. In contrast, care dependency in residents without dementia increased for four of the 15 items, with the highest increase being for continence, followed by getting (undressed. With respect to the assessed nursing care problems, residents with dementia and those without only differed significantly in terms of an increase in urinary- (12.3% vs. 14.2%, fecal- (17.4% vs. 10%, and double incontinence (16.7% vs. 11.9%. The results indicated that residents with dementia experienced increased care dependency in different areas than residents without dementia. Furthermore, residents with dementia experienced a lower increase in urinary incontinence but a higher increase in fecal- and double incontinence. These results help professionals to identify areas for improvement in dementia care.

  4. Relationship Between Changes in Serum Thyrotropin and Total and Lipoprotein Cholesterol with Prolonged Antarctic Residence

    Science.gov (United States)

    1993-09-01

    winter-over Navy subjects for their melatonin , we can only speculate about its influences on participation and the National Science Foundation and Naval...variations is unlikely because daily thanks to Dr Louis Homer, Dr John Thomas, Dr Mohamed Shakir, cortisol circadian rhythm is unchanged with AR, and TSH Dr...cold air exposures change oral triiodothyronine kinetics in normal human melatonin rhythm during the Antarctic winter. Neurosci men. Am J Physiol 263:E85-E93, 1992 Lett 79:185-189, 1987

  5. On the interaction between constructional & lexical change: Copular, Passive and related Constructions in Old and Middle English.

    OpenAIRE

    Petré, Peter

    2010-01-01

    This is my thesis as submitted for my PhD degree. Meanwhile a greatly revised and expanded version of my PhD has appeared as the following monograph: (2014). Constructions and environments: Copular, Passive and related Constructions in Old and Middle English (Oxford Studies in the History of English 4). Oxford: Oxford University Press. https://global.oup.com/academic/product/constructions-and-environments-9780199373390 Please refer to the published monograph when citing.

  6. SEGMENTATION OF SERIAL MRI OF TBI PATIENTS USING PERSONALIZED ATLAS CONSTRUCTION AND TOPOLOGICAL CHANGE ESTIMATION.

    Science.gov (United States)

    Wang, Bo; Prastawa, Marcel; Awate, Suyash P; Irimia, Andrei; Chambers, Micah C; Vespa, Paul M; van Horn, John D; Gerig, Guido

    2012-01-01

    Traumatic brain injury (TBI) due to falls, car accidents, and warfare affects millions of people annually. Determining personalized therapy and assessment of treatment efficacy can substantially benefit from longitudinal (4D) magnetic resonance imaging (MRI). In this paper, we propose a method for segmenting longitudinal brain MR images with TBI using personalized atlas construction. Longitudinal images with TBI typically present topological changes over time due to the effect of the impact force on tissue, skull, and blood vessels and the recovery process. We address this issue by defining a novel atlas construction scheme that explicitly models the effect of topological changes. Our method automatically estimates the probability of topological changes jointly with the personalized atlas. We demonstrate the effectiveness of this approach on MR images with TBI that also have been segmented by human raters, where our method that integrates 4D information yields improved validation measures compared to temporally independent segmentations.

  7. An assessment of change in risk perception and optimistic bias for hurricanes among Gulf Coast residents.

    Science.gov (United States)

    Trumbo, Craig; Meyer, Michelle A; Marlatt, Holly; Peek, Lori; Morrissey, Bridget

    2014-06-01

    This study focuses on levels of concern for hurricanes among individuals living along the Gulf Coast during the quiescent two-year period following the exceptionally destructive 2005 hurricane season. A small study of risk perception and optimistic bias was conducted immediately following Hurricanes Katrina and Rita. Two years later, a follow-up was done in which respondents were recontacted. This provided an opportunity to examine changes, and potential causal ordering, in risk perception and optimistic bias. The analysis uses 201 panel respondents who were matched across the two mail surveys. Measures included hurricane risk perception, optimistic bias for hurricane evacuation, past hurricane experience, and a small set of demographic variables (age, sex, income, and education). Paired t-tests were used to compare scores across time. Hurricane risk perception declined and optimistic bias increased. Cross-lagged correlations were used to test the potential causal ordering between risk perception and optimistic bias, with a weak effect suggesting the former affects the latter. Additional cross-lagged analysis using structural equation modeling was used to look more closely at the components of optimistic bias (risk to self vs. risk to others). A significant and stronger potentially causal effect from risk perception to optimistic bias was found. Analysis of the experience and demographic variables' effects on risk perception and optimistic bias, and their change, provided mixed results. The lessening of risk perception and increase in optimistic bias over the period of quiescence suggest that risk communicators and emergency managers should direct attention toward reversing these trends to increase disaster preparedness. © 2013 Society for Risk Analysis.

  8. Assessing Heat Stress and Health among Construction Workers in a Changing Climate: A Review

    Directory of Open Access Journals (Sweden)

    Payel Acharya

    2018-02-01

    Full Text Available Construction workers are at an elevated risk of heat stress, due to the strenuous nature of the work, high temperature work condition, and a changing climate. An increasing number of workers are at risk, as the industry’s growth has been fueled by high demand and vast numbers of immigrant workers entering into the U.S., the Middle East and Asia to meet the demand. The risk of heat-related illnesses is increased by the fact that little to no regulations are present and/or enforced to protect these workers. This review recognizes the issues by summarizing epidemiological studies both in the U.S. and internationally. These studies have assessed the severity with which construction workers are affected by heat stress, risk factors and co-morbidities associated with heat-related illnesses in the construction industry, vulnerable populations, and efforts in implementing preventive measures.

  9. Bariatric surgery and the changing current scope of general surgery practice: implications for general surgery residency training.

    Science.gov (United States)

    Mostaedi, Rouzbeh; Ali, Mohamed R; Pierce, Jonathan L; Scherer, Lynette A; Galante, Joseph M

    2015-02-01

    The scope of general surgery practice has evolved tremendously in the last 20 years. However, clinical experience in general surgery residency training has undergone relatively little change. To evaluate the current scope of academic general surgery and its implications on surgical residency. The University HealthSystem Consortium and Association of American Medical Colleges established the Faculty Practice Solution Center (FPSC) to characterize physician productivity. The FPSC is a benchmarking tool for academic medical centers created from revenue data collected from more than 90,000 physicians who practice at 95 institutions across the United States. The FPSC database was queried to evaluate the annual mean procedure frequency per surgeon (PFS) in each calendar year from 2006 through 2011. The associated work relative value units (wRVUs) were also examined to measure physician effort and skill. During the 6-year period, 146 distinct Current Procedural Terminology codes were among the top 100 procedures, and 16 of these procedures ranked in the top 10 procedures in at least 1 year. The top 10 procedures accounted for more than half (range, 52.5%-57.2%) of the total 100 PFS evaluated for each year. Laparoscopic Roux-en-Y gastric bypass was consistently among the top 10 procedures in each year (PFS, 18.2-24.6). The other most frequently performed procedures included laparoscopic cholecystectomy (PFS, 30.3-43.5), upper gastrointestinal tract endoscopy (PFS, 26.5-34.3), mastectomy (PFS, 16.5-35.0), inguinal hernia repair (PFS, 15.5-22.1), and abdominal wall hernia repair (PFS, 21.6-26.1). In all years, laparoscopic Roux-en-Y gastric bypass generated the highest number of wRVUs (wRVUs, 491.0-618.2), and laparoscopic cholecystectomy was regularly the next highest (wRVUs, 335.8-498.7). A significant proportion of academic general surgery is composed of bariatric surgery, yet surgical training does not sufficiently emphasize the necessary exposure to technical expertise

  10. Changes in psychosocial conditions and eventual mortality in community-residing elderly people.

    Science.gov (United States)

    Nakanishi, Noriyuki; Fukuda, Hideki; Tatara, Kozo

    2003-03-01

    We evaluated the association between changes in psychosocial conditions (assessed In 1992 and 1998) and subsequent mortality through 2001 among 741 Japanese elderly people living in a city located on Osaka in 1992. After adjustment for potential predictors of mortality, the relative risk of mortality, compared with subjects who continued to participate in social activities, was 1.44 (95% confidence interval [CI]: 0.47-4.40), 4.03 (95% CI: 2.11-7.67), and 2.31 (95% CI: 1.28-4.17) for those who started, discontinued, and did not participate at any time, respectively. The multivariate-adjusted relative risk of mortality, compared with those who did not find human relationships difficult in either survey, was 0.88 (95% CI: 0.26-3.05) for those who did not find such relationships difficult in the second survey, 1.73 (95% CI: 1.03-2.88) for those who occasionally found them difficult, and 6.62 (95% CI: 2.43-18.03) for those who continuously did so. The multivariate-adjusted relative risk of mortality, relative to those who consistently considered life worth living (Ikigai), was 0.72 (95% CI: 0.28-1.87), 2.22 (95% CI: 1.44-3.42), and 1.46 (95% CI: 0.65-3.31) for those who found, lost, and did not find life worth living in either survey, respectively. Deterioration in psychosocial conditions as well as continuously poor psychosocial conditions may be an important determinant of mortality risk for elderly people.

  11. Linking climate change to water provision: greywater treatment by constructed wetlands

    Science.gov (United States)

    Qomariyah, S.; Ramelan, AH; Setyono, P.; Sobriyah

    2018-03-01

    Climate change has been felt to take place in Indonesia, causing the temperature to increase, additional drought with more moisture evaporates from rivers, lakes, and other bodies of water, and intense rainfall in a shorter rainy season. One of the major concerns is the risk of severe drought leading to water shortages. It will affect water supply and agriculture yields. As a country extremely vulnerable to the climate change, Indonesia must adapt to the serious environmental issues. This paper aims to offer an effort of water provision by recycling and reusing of greywater applying constructed wetland systems. The treated greywater is useful as water provision for non-consumptive uses. A recent experiment was conducted on a household yard using a single horizontal subsurface flow type of constructed wetland. The experiments demonstrated that the constructed wetland systems reduced effectively the pollutants of TSS, BOD, COD, and detergent to the level that are compliant with regulatory standards. The constructed wetland has been established for almost two years however the system still works properly.

  12. The Role of the Media in the Construction of Public Belief and Social Change

    Directory of Open Access Journals (Sweden)

    Catherine Happer

    2013-12-01

    Full Text Available The media play a central role in informing the public about what happens in the world, particularly in those areas in which audiences do not possess direct knowledge or experience. This article examines the impact the media has in the construction of public belief and attitudes and its relationship to social change. Drawing on findings from a range of empirical studies, we look at the impact of media coverage in areas such as disability, climate change and economic development. Findings across these areas show the way in which the media shape public debate in terms of setting agendas and focusing public interest on particular subjects. For example, in our work on disability we showed the relationship between negative media coverage of people on disability benefit and a hardening of attitudes towards them. Further, we found that the media also severely limit the information with which audiences understand these issues and that alternative solutions to political problems are effectively removed from public debate. We found other evidence of the way in which media coverage can operate to limit understanding of possibilities of social change. In our study of news reporting of climate change, we traced the way that the media have constructed uncertainty around the issue and how this has led to disengagement in relation to possible changes in personal behaviours. Finally, we discuss the implications for communications and policy and how both the traditional and new media might help in the development of better informed public debate.

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

    Science.gov (United States)

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

    2011-11-01

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

  14. Changes in the planktonic microbial community during residence in a surface flow constructed wetland used for tertiary wastewater treatment

    NARCIS (Netherlands)

    Mulling, B.T.M.; Soeter, A.M.; van der Geest, H.G.; Admiraal, W.

    2014-01-01

    Suspended particles are a major constituent of municipal wastewater and generally contain high levels of bacteria, including human pathogens. Discharge of these particles of anthropogenic nature can have profound effects on receiving aquatic ecosystems and mitigation of these effects requires

  15. ON FACTORS IN DOMAIN CHANGE FOR BUSINESS SUCCESION : A CONSIDERATION FROM A STUDY ON A CONSTRUCTION COMPANY IN KOCHI

    OpenAIRE

    SUEKANE, Atsuyoshi

    2012-01-01

    Business succession is crucial for an enterprise’s sustainability, for which domain change/expansion is sometimes required. The case explores how a construction company changed/expanded their business domain, and how it made possible to start a tea business, with analyses on factors as well as their business background. Kunitomo Shoji K.K., that has been doing a construction business since 1971, is located in a mountainous area, and started a tea business, under the recession of construction ...

  16. The Correlation Analysis of Subsidence Monitoring by D-Insar and the Change of Urban Construction Land

    Science.gov (United States)

    Yang, K. J.; Jiang, X. X.; Cao, L.; Lei, F.; Zeng, H.; Zhang, Z.

    2017-05-01

    The change of urban construction land affect the subsidence directly or indirectly, the method of D-InSAR has centimeter level or even millimeter accuracy that can provide a reliable and accurate data for the research of correlation analysis of subsidence monitoring by D-InSAR and the change of urban construction land. This article takes Guiyang, Nanning city as example, using 3m level TerraSAR data to construct the Subsidence model by interferometric measurement, then compared with the Chinese national land use change remote sensing survey database at the same measure time to have a correlation analysis GIS research between subsidence and the change of urban construction land. The results shows that the integral correlation coefficient achieved 0.78 between subsidence and the change of urban construction land, the major construction area and the high density construction area are with severe land subsidence. In addition, the correlation coefficient increased from the main city to the suburbs, indicates that some of the main city causes permanent settlement and is difficult to recover. It also shows that some area subsidence caused by long-term mining or other natural factors has no strong correlation with the change of urban construction land, therefore, the results of D-InSAR subsidence monitoring have a reaction on urban construction planning, guiding urban planning to high stability, low settlement area.

  17. THE CORRELATION ANALYSIS OF SUBSIDENCE MONITORING BY D-INSAR AND THE CHANGE OF URBAN CONSTRUCTION LAND

    Directory of Open Access Journals (Sweden)

    K. J. Yang

    2017-05-01

    Full Text Available The change of urban construction land affect the subsidence directly or indirectly, the method of D-InSAR has centimeter level or even millimeter accuracy that can provide a reliable and accurate data for the research of correlation analysis of subsidence monitoring by D-InSAR and the change of urban construction land. This article takes Guiyang, Nanning city as example, using 3m level TerraSAR data to construct the Subsidence model by interferometric measurement, then compared with the Chinese national land use change remote sensing survey database at the same measure time to have a correlation analysis GIS research between subsidence and the change of urban construction land. The results shows that the integral correlation coefficient achieved 0.78 between subsidence and the change of urban construction land, the major construction area and the high density construction area are with severe land subsidence. In addition, the correlation coefficient increased from the main city to the suburbs, indicates that some of the main city causes permanent settlement and is difficult to recover. It also shows that some area subsidence caused by long-term mining or other natural factors has no strong correlation with the change of urban construction land, therefore, the results of D-InSAR subsidence monitoring have a reaction on urban construction planning, guiding urban planning to high stability, low settlement area.

  18. Differential changes in production measures for an estuarine-resident sparid in deep and shallow waters following increases in hypoxia

    Science.gov (United States)

    Cottingham, Alan; Hall, Norman G.; Hesp, S. Alex; Potter, Ian C.

    2018-03-01

    This study determined how productivity measures for a fish species in different water depths of an estuary changed in response to the increase in hypoxia in deep waters, which had previously been shown to occur between 1993-95 and 2007-11. Annual data on length and age compositions, body mass, growth, abundance, biomass, production and production to biomass ratio (P/B) were thus determined for the estuarine-resident Acanthopagrus butcheri in nearshore shallow (fish typically reside. Annual densities, biomass and production in shallow waters of fish m-2, 2-4 g m-2 and ∼2 g m-2 y-1 in the earlier period were far lower than the 0.1-0.2 fish m-2, 8-15 g m-2 and 5-10 g m-2 y-1 in the later period, whereas the reverse trend occurred in deep waters, with values of 6-9 fish net-1, 2000-3900 g net-1, 900-1700 g net-1 y-1 in the earlier period vs fish net-1, ∼110 g net-1 and 27-45 g net-1 y-1 in the later period. Within the later period, and in contrast to the trends with annual abundance and biomass, the production in shallow waters was least during 2008/09, rather than greatest, reflecting the slow growth in that particularly cool year. The presence of substantial aggregations of both small and large fish in shallow waters accounts for the abundance, biomass and production in those waters increasing between those periods and thus, through a density-dependent effect, provide a basis for the overall reduction in growth. In marked contrast to the trends with the other three production measures, annual production to biomass ratios (P/B) in shallow waters in the two years in the earlier period, and in three of the four years of the later period, fell within the same range, i.e. 0.6-0.9 y-1, but was only 0.2 y-1 in 2008/09, reflecting the poor growth in that year. This emphasises the need to obtain data on P/B for a number of years when considering the implications of the typical P/B for a species in an estuary, in which environmental conditions and the growth of a species

  19. 26 CFR 1.871-13 - Taxation of individuals for taxable year of change of U.S. citizenship or residence.

    Science.gov (United States)

    2010-04-01

    ... 26 Internal Revenue 9 2010-04-01 2010-04-01 false Taxation of individuals for taxable year of... Foreign Corporations § 1.871-13 Taxation of individuals for taxable year of change of U.S. citizenship or...) Acquisition of U.S. citizenship or residence. Income from sources without the United States which is not...

  20. Vulnerability of climate change and its adaptation in the Mekong Delta: monitoring and resident's perception along the coast

    Science.gov (United States)

    Tamura, M.; Yasuhara, K.

    2014-12-01

    The Mekong Delta in Vietnam is expected to face challenges from various forms of climate-induced events. In addition, a growing population, which currently stands at 18.6 million people lives in the Mekong Delta, Vietnam. Therefore, the Mekong Delta is the focus of international action for adaptation. However, many climate sensitive regions and communities are unprepared for climate-induced natural disasters due to mismatch in perception with their respective risks. This study examines the vulnerability and appropriate adaptation in the Mekong Delta from both scientific and regional aspects. First, we show the change in coastal areas in Soc Trang province, comparing the past to the present images using Unmanned Aerial Vehicle (UAV) and satellite. We identify some vulnerable areas which derived from multiple factors due to coastal erosion, flooding, and sea level rise. Second, we present results of perception survey about climate change and the adaptation at community level in Ca Mau, Soc Trang, and An Giang Provinces, which were conducted in 2012 and 2014. While the findings suggest varying degrees of adaptation to seasonal flooding by raising the ground floors of their homes and repairing houses, their capacity to prepare for extreme flooding is limited in spite of the residents' awareness of the increasing frequency and intensity of natural disasters. Third, we propose an erosion-resistant dyke reinforcement technique by mixing natural palm tree fiber and cement, both of which are locally available materials in the Mekong Delta. It is expected that adaptation with multiple protections in accordance to regional feature can work well for such coastal disasters.

  1. Dynamic processes of conceptual change: Analysis of constructing mental models of chemical equilibrium

    Science.gov (United States)

    Chiu, Mei-Hung; Chou, Chin-Cheng; Liu, Chia-Ju

    2002-10-01

    The purpose of this study was to investigate students' mental models of chemical equilibrium using dynamic science assessments. Research in chemical education has shown that students at various levels have misconceptions about chemical equilibrium. According to Chi's theory of conceptual change, the concept of chemical equilibrium has constraint-based features (e.g., random, simultaneous, uniform activities) that might prevent students from deeply understanding the nature of the concept of chemical equilibrium. In this study, we examined how students learned and constructed their mental models of chemical equilibrium in a cognitive apprenticeship context. Thirty 10th-grade students participated in the study: 10 in a control group and 20 in a treatment group. Both groups were presented with a series of hands-on chemical experiments. The students in the treatment group were instructed based on the main features of cognitive apprenticeship (CA), such as coaching, modeling, scaffolding, articulation, reflection, and exploration. However, the students in the control group (non-CA group) learned from the tutor without explicit CA support. The results revealed that the CA group significantly outperformed the non-CA group. The students in the CA group were capable of constructing the mental models of chemical equilibrium - including dynamic, random activities of molecules and interactions between molecules in the microworld - whereas the students in the non-CA group failed to construct similar correct mental models of chemical equilibrium. The study focuses on the process of constructing mental models, on dynamic changes, and on the actions of students (such as self-monitoring/self-correction) who are learning the concept of chemical equilibrium. Also, we discuss the implications for science education.

  2. Strategic Change in a Construction Contractor's Purchasing Organisation and Supplier Relations

    DEFF Research Database (Denmark)

    Koch, Christian; Tambo, Torben

    2010-01-01

    ante studies with ex post elements. As the time frame is ten years a necessary combination of studies with different aims has been done. The case of a major contractor's efforts within supply chain and purchasing exhibits a number of change elements in interaction; new business concepts, processes...... and mixing of competences from engineering and purchasing. Even if the case represents some institutional mimicking of general trends within supply chain management and purchasing, it also exhibit strong adaption to construction project regimes and less ICT and e-business use than would be expected. Adopting......The paper adopts a combined supply chain management and purchasing theory approach to changes in a contractor's purchasing organization and suppliers relations. This is seen to be a complex prolonged change process emerging over long time. The method is qualitative and longitudinal combining ex...

  3. [Burnout in nursing residents].

    Science.gov (United States)

    Franco, Gianfábio Pimentel; de Barros, Alba Lúcia Bottura Leite; Nogueira-Martins, Luiz Antônio; Zeitoun, Sandra Salloum

    2011-03-01

    Nursing residents may experience physical and emotional exhaustion from the daily life of attending the Program. The aim of this study was to determine the Burnout incidence among Nursing Residents. An investigative, descriptive, analytical, longitudinal-prospective study was conducted with 16 Residents over two years. The Maslach Burnout Inventory was used, translated and validated for Brazil, as well as a sociodemographic/occupational data tool. Of all residents, 17.2% showed high rates in Emotional Exhaustion and Depersonalization; 18.8% showed impaired commitment in Personal Accomplishment, 75% of which belonged to specialty areas, such as Emergency Nursing, Adult and Pediatric Intensive Care. Age and specialty area were positively correlated with Personal Accomplishment. One of the Residents was identified with changes in three subscales of the Maslach Burnout Inventory, thus characterized as a Burnout Syndrome patient. Nursing Residents have profiles of disease. Knowing these factors can minimize health risks of these workers.

  4. Psychologic effects of residency.

    Science.gov (United States)

    Reuben, D B

    1983-03-01

    The intense situational and physiologic stresses that accompany postgraduate training may have serious psychosocial ramifications. Although only a small proportion of residents have overt psychiatric illness, virtually all display some psychologic impairment. Contributing factors include life-changes, stresses associated with providing patient care, loss of social support, long working hours, sleep deprivation, and underlying personality traits of residents. The manifestations of this impairment are variable and may be subtle. In response to these problems, residency programs have taken steps to provide psychosocial support. Unfortunately, most programs do not offer formal support groups or seminars to discuss difficulties that accompany residency. Further definition of the psychosocial effects of residency may prompt changes that make the training of physicians a more humane process.

  5. Curriculam change: construction of a new pedagogical training project in the field of Speech Therapy

    Directory of Open Access Journals (Sweden)

    Maria Cecília Bonini Trenche

    2008-01-01

    Full Text Available The first year of implementation of the new pedagogical project for the Speech Therapy course at the Catholic University of São Paulo (PUC-SP is analyzed. The aim was not only to analyze the changes in pedagogical concepts and practices, but also to construct collective work by the social body of the course. The results indicated that the new pedagogical activities (seminars, tutorials, workshops and instructive experiences were important tools for achieving the proposed changes in the new curricular model. Highlighted among other advances were: greater integration between basic disciplines and professionalizing activities; better comprehension by students of the importance of training based on the population's needs; greater linkage between teaching, research and extension activities; interaction among students at various levels of training, regarding health promotion and disease prevention actions; planning of supplementary pedagogical activities according to students' needs detected in educational assessments.

  6. The accommodation of science pedagogical knowledge: The application of conceptual change constructs to teacher education

    Science.gov (United States)

    Stofflett, René T.

    The purposes of this study were to (a) determine whether the conditions of the accommodation of a science conception (IPDF) could be applied to pedagogical conceptions of science, and (b) using this application, determine whether a group of elementary teacher candidates in a conceptual change methods course accommodated their didactic preconceptions of science teaching. This research was based on the assumption that, for teachers to learn to teach for conceptual change, they must undergo a process of pedagogical conceptual change themselves. The teacher candidates in this study were interviewed and observed teaching. Their lesson plans and reflective papers were analyzed. The course was also videotaped to provide contextual descriptions. The teacher candidates, as expected, held primarily didactic pedagogical conceptions and were resistant to the conceptual change strategies. However, at posttest they found the new strategies to be intelligible, plausible, and fruitful. They also expressed implicit dissatisfaction with their preexisting views. Cooperating teachers had significant influence in the development of both plausibility and fruitfulness. Recommendations for improving the use of the conceptual change constructs in future teacher education research are made.Received: 22 June 1993; Revised: 19 April 1994;

  7. A process evaluation of a Psychomotor Dance Therapy Intervention (DANCIN) for behavior change in dementia: attitudes and beliefs of participating residents and staff.

    Science.gov (United States)

    Guzmán, Azucena; Robinson, Lisa; Rochester, Lynn; James, Ian A; Hughes, Julian C

    2017-02-01

    In a previous paper, we presented results from a 12-week study of a Psychomotor DANCe Therapy INtervention (DANCIN) based on Danzón Latin Ballroom that involves motor, emotional-affective, and cognitive domains, using a multiple-baseline single-case design in three care homes. This paper reports the results of a complementary process evaluation to elicit the attitudes and beliefs of home care staff, participating residents, and family members with the aim of refining the content of DANCIN in dementia care. An external researcher collected bespoke questionnaires from ten participating residents, 32 care home staff, and three participants' family members who provided impromptu feedback in one of the care homes. The Behavior Change Technique Taxonomy v1 (BCTTv1) provided a methodological tool for identifying active components of the DANCIN approach warranting further exploration, development, and implementation. Ten residents found DANCIN beneficial in terms of mood and socialization in the care home. Overall, 78% of the staff thought DANCIN led to improvements in residents' mood; 75% agreed that there were improvements in behavior; 56% reported increased job satisfaction; 78% of staff were enthusiastic about receiving further training. Based on participants' responses, four BCTTv1 labels-Social support (emotional), Focus on past success and verbal persuasion to boost self-efficacy, Restructuring the social environment and Habit formation-were identified to describe the intervention. Residents and staff recommended including additional musical genres and extending the session length. Discussions of implementing a supervision system to sustain DANCIN regularly regardless of management or staff turnover were suggested. Care home residents with mild to moderate dementia wanted to continue DANCIN as part of their routine care and staff and family members were largely supportive of this approach. This study argues in favor of further dissemination of DANCIN in care homes

  8. Enhanced sensitivity of a mountain bog to climate change as a delayed effect of road construction

    Directory of Open Access Journals (Sweden)

    P. von Sengbusch

    2015-01-01

    Full Text Available Trees of Pinus rotundata (bog pine characterise many bogs in the mid-altitude mountains of central Europe (Switzerland, East and South Germany, Czech Republic. The research described here focuses on recent changes in the growth of bog pine on the Ennersbacher Moor, a mountain mire in the Black Forest (south-west Germany. An increase in the cover of bog pine is usually caused by drainage and subsequent drawdown of the water table. However, this bog has not been drained or directly disturbed in any other way. One possible explanation is that a road constructed in 1983 along one margin of the bog has diverted part of its water supply. Even though the road was designed to conduct potentially salt-contaminated drainage water away from the bog, its construction did not cause an immediate vegetation response in the 1980s and 1990s. Therefore, I hypothesise that it enhanced the sensitivity of the bog to climatic stress, predisposing it to a succession that was eventually triggered by a series of drought years in 2009–2011. Data collected near the centre of the bog over the period 1998–2014 indicate not only a distinct change in the relationship between height and trunk circumference of the trees, but also an increase of dwarf shrub cover and changes in the composition of Sphagnum communities. Although the pH of near-surface water may have increased slightly over this period, pH and EC values remain within typical ranges for raised bogs in the Black Forest. Examination of peat profiles reveals that the peat is more highly humified now than it was in 2002, and water table records from 2012–2014 show a greater amplitude of fluctuation than water table data collected in 1998–2001. Even though its mean level is only 105 mm below the ground surface, the water table is now observed to fall rapidly to depths of at least 350 mm during both wet and dry summers. Mapping surface (mesotopography and flow lines from the adjacent slope shows that the

  9. Stress and training satisfaction among resident doctors in Nigeria: Any justification for a change in training policy?

    Directory of Open Access Journals (Sweden)

    Oluseun Peter Ogunnubi

    2018-01-01

    Full Text Available Background: There are pointers in existing literature to the stressful nature of residency program, thereby placing training physicians at increased risk of psychological distress. Objectives: The study identified perceived stress, its sources, training satisfaction, and the associated sociodemographic characteristics among resident doctors. Materials and Methods: A total of 405 self-administered questionnaires were given to all attendees of the National Postgraduate Medical College Revision Course. The questionnaires sought information on sociodemographic variables, sources of stress, and training satisfaction. Only 20 questionnaires were not returned. Data were collated and analyzed. Results: A majority of the respondents were male (69.1%, mostly between 31 and 35 years of age. Most (80% of the respondents were married while 51.4% had over 4 dependents. All the respondents reported a significant level of stress, and different sources of stress were identified. Only 12 (3.1% of the respondents were satisfied with the quality of training being received in their institutions. Conclusion: Our study found residency training to be stressful for doctors and often compounded by identifiable variables as shown in this study. Such stressful experience can, in turn, have negative impacts on their physical along with mental well-being and the patient care. Thus, there is a need for relevant stakeholders to review the structure of residency program with the view of addressing “modifiable risks” of stress among would-be specialists.

  10. Alterations of temperature, sleepiness, mood, and performance in residents are not associated with changes in sulfatoxymelatonin excretion.

    Science.gov (United States)

    Sharp, K H; Vaughn, G M; Cosby, P W; Sewell, C E; Kennaway, D J

    1988-01-01

    Residency training may disrupt normal sleep/wake cycles, resulting in mood and performance deficits and alterations in biological rhythms. To characterize such disturbances and determine whether they are associated with an alteration in the day/night pattern of melatonin excretion, measurements were obtained around-the-clock in seven male subjects, each studied in two 48-h sessions. Session 1 was conducted during the week before beginning a residency, and session 2 at 6 months into a first-year surgical residency. The mean time of the end of nocturnal sleep and the timing of the temperature rhythm were both (P less than .01) approximately 2.3 h earlier in session 2 (vs. 1). The sleepiness rhythm and the overall mood score rhythm were also phase-advanced (P less than .05) in session 2. The mean value of mood around-the-clock was significantly worse due to increased anger, tension, confusion, depression, and fatigue in session 2. Vigilance, tested by simple reaction time, did not exhibit a 25-h rhythm and was worse in session 2 with an increase (P less than .05) in mean response latency less than 1 s and an increase (P less than .01) in lapse time (microsleep, greater than 1- s latency). The urinary cortisol rhythm exhibited a raised curve average value (mesor) in session 2 (vs. 1, P less than .05), but no difference was revealed in amplitude or acrophase. Urinary excretion of Na+, K+, and Cl- did not differ between sessions, though the Na+/K+ ratio peaked earlier in session 2 (P less than .05). The urinary 6-sulfatoxymelatonin rhythm did not differ in timing, amplitude, or mesor between sessions. A residency training schedule can be associated with altered timing in rhythms of sleep, sleepiness, temperature, and mood and with deterioration of mood and performance without detectable alteration of the endogenous melatonin pattern as exhibited by the excretion rate of the principal urinary metabolite.

  11. Comparison of Flood Vulnerability Assessments to Climate Change by Construction Frameworks for a Composite Indicator

    Directory of Open Access Journals (Sweden)

    Jong Seok Lee

    2018-03-01

    Full Text Available As extreme weather conditions due to climate change can cause deadly flood damages all around the world, a role of the flood vulnerability assessment has become recognized as one of the preemptive measures in nonstructural flood mitigation strategies. Although the flood vulnerability is most commonly assessed by a composite indicator compiled from multidimensional phenomena and multiple conflicting criteria associated with floods, directly or indirectly, it has been often overlooked that the construction frameworks and processes can have a significant influence on the flood vulnerability indicator outcomes. This study has, therefore, compared the flood vulnerability ranking orders for the 54 administrative districts in the Nakdong River Watershed of the Korean Peninsula, ranked from composite indicators by different frameworks and multi-attribute utility functions for combining the three assessment components, such as exposure, sensitivity, and coping, presented in the IPCC Third Assessment Report. The results show that the different aggregation components and utility functions under the same proxy variable system can lead to larger volatility of flood vulnerability rankings than expected. It is concluded that the vulnerability indicator needs to be derived from all three assessment components by a multiplicative utility function for a desirable flood vulnerability assessment to climate change.

  12. Constructal design of phase change material enclosures used for cooling electronic devices

    International Nuclear Information System (INIS)

    Kalbasi, Rasool; Salimpour, Mohammad Reza

    2015-01-01

    Recent developments in cooling methods for portable electronic devices have heightened the need for using the large latent heat capacity of phase change materials (PCM). The aim of the present study is to evaluate the thermal characteristics of a PCM-based heat sink with high conductive materials. The solution is acquired as a procession of optimization stages which starts with the elemental area and proceeds toward the first assembly. Every optimization stage is the result of maximizing the safe operation time without allowing the electronics to reach the critical temperature. Primarily, the degrees of freedom and constrains were defined and then by changing the geometrical parameters, the target function which is the maximization of operation time, was optimized. Results show that the melting process in rectangular enclosures with vertical fins attached to the heated bottom surface can be affected by the contact surface between the fin and PCM and the convection of the melted PCM. For a rectangular enclosure with a constant area, it is better to use wider enclosure than the square and thin one. Also results indicate that the ratio of the vertical fin thickness to the horizontal one does not have a considerable effect on performance. By increasing the number of enclosures, the contact surface is raised, but the performance is not necessarily improved. - Highlights: • Thermal characteristics of a finned PCM-based heat sink are studied. • Constructal theory was used to optimize the PCM enclosures. • By increasing the number of enclosures, the performance is not necessarily improved

  13. Use of a Night Float System to Comply With Resident Duty Hours Restrictions: Perceptions of Workplace Changes and Their Effects on Professionalism.

    Science.gov (United States)

    Sun, Ning-Zi; Gan, Runye; Snell, Linda; Dolmans, Diana

    2016-03-01

    Although some evidence suggests that resident duty hours reforms can lead to shift-worker mentality and loss of patient ownership, other evidence links long hours and fatigue to poor work performance and loss of empathy, suggesting the restrictions could positively affect professionalism. The authors explored perceived impacts of a 16-hour duty restriction, achieved using a night float (NF) system, on the workplace and professionalism. In 2013, the authors conducted semistructured interviews with 18 residents, 9 staff physicians, and 3 residency program directors in the McGill University core internal medicine residency program regarding their perceptions of the program's 12-hour shift-based NF system. Interviews were transcribed and coded for common themes. The authors used a descriptive qualitative methodology. Participants viewed implementation of the NF system as leading to decreased physical and mental exhaustion, more consistent interaction with patients, and more stable team structure within shifts compared with the previous 24-hour call system. These workplace changes were felt to improve teamwork and patient ownership within shifts, quality of work performed, and empathy. Across shifts, however, more frequent sign-overs, stricter application of shift time boundaries, and loose integration between daytime and NF teams were perceived as leading to emergence of shift-worker mentality around sign-over. Perceptions of optimal patient ownership changed from the traditional single-physician-24/7 model to team-based shared ownership. Duty hours restrictions, as exemplified by an NF system, have both positive and negative impacts on professionalism. Interventions and training toward effective team-based care are needed to curb emergence of shift-worker mentality.

  14. Validation of groundwater flow model using the change of groundwater flow caused by the construction of AESPOE hard rock laboratory

    International Nuclear Information System (INIS)

    Hasegawa, Takuma; Tanaka, Yasuharu

    2004-01-01

    A numerical model based on results during pre-investigation phases was applied to the groundwater flow change caused by the construction of AEspoe HRL. The drawdowns and chloride concentration during tunnel construction were simulated to validate the numerical model. The groundwater flow was induced by inflow from the Baltic Sea to the tunnel through the hydraulic conductor domain (HCD). The time series of tunnel progress and inflow, boundaries of the Baltic Sea, transmissivity and geometry of HCD are therefore important in representing the groundwater flow. The numerical model roughly represented the groundwater flow during tunnel construction. These simulations were effective in validating the numerical model for groundwater flow and solute transport. (author)

  15. Current halogenated flame retardant concentrations in serum from residents of Shandong Province, China, and temporal changes in the concentrations.

    Science.gov (United States)

    Ma, Yulong; Li, Peng; Jin, Jun; Wang, Ying; Wang, Qinghua

    2017-05-01

    The residents of Shandong Province, China, are exposed to high concentrations of halogenated flame retardants because large amounts of halogenated flame retardants are produced in the province. We determined the concentrations of eight polybrominated diphenyl ether congeners (PBDEs), seven novel brominated flame retardants (NBFRs), and the two dechlorane plus isomers (DPs) in serum from residents of Shandong Province. The aim was to identify temporal trends in the concentrations of these pollutants. The mean total concentrations of PBDEs, NBFRs and DPs were 41, 2.2 and 2.1ng/g lipid in pooled serum samples collected in 2014, and were 32, 3.5 and 3.1ng/g lipid in pooled serum samples collected in 2015, respectively. Decabromodiphenyl ether was the dominant PBDE congener in all of the samples. The novel brominated flame retardant and dechlorane plus concentrations were between one and two orders of magnitude lower than the PBDE concentrations. The PBDE concentrations in serum decreased significantly between 2007 and 2015, but the pentabromobenzene, pentabromotoluene, and dechlorane plus concentrations were relatively stable. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Constructing Perceptions of Climate Change: a case study of regional political decision makers

    Science.gov (United States)

    Bray, D.

    2012-12-01

    social construction of climate change, not scientific claims, that are shaping decisions. While certainty is the common demand of those charged with making decisions concerning climate change, certainty is the quality that seems to be given least value in taking action. Weather records are all but ignored. The direct voice of scientists was heeded but not fully accepted. In the transition, the truth-to-power model appears to be somewhat modified, whereby power states that the future will be different, but the difference is determined by other sources; shaping images of risk and danger. One could not deny that climate and sea level have always been forces shaping patterns of human settlement. And one could not deny that perhaps the time is nigh to reassess the human relationship with nature. However, any measure considered should be done so with a rational sense of objectivity. To do otherwise, there is the risk of misallocating scare resources.

  17. Changes in assimilation of C3 marsh plants by resident fishes in estuarine systems with distinct hydrogeomorphology features.

    Directory of Open Access Journals (Sweden)

    Adna Ferreira Garcia

    2015-11-01

    Full Text Available Although saltmarshes are widely recognized as important habitats providing shelter for estuarine organisms and protection against predators, there is still no consensus on the trophic value of marsh plants for estuarine food webs. We employed stable isotopes to evaluate differences in assimilation of nutrients derived from marsh plants with C3 (Juncus acutus, Scirpus maritimus, Scirpus olneyi and C4 (Spartina densiflora photosynthetic pathways by resident fishes in three estuaries with contrasting hydrogeomorphology characteristics. Carbon (δ13C and nitrogen (δ15N stable isotope ratios of basal food sources (C3 and C4 marsh plants, macroalgae, seagrass and seston and estuarine resident fishes (Achirus garmani, Atherinella brasiliensis, Genidens genidens, Ctenogobius shufeldti, Jenynsia multidentata, Odonthestes argentinensis were analyzed in two choked lagoons (Tramandai-29°S, Patos-30°S and a coastal river (Chui-33°S. Average δ13C values of consumers were statistically significant higher in the two choked-type estuaries (Tramandaí: -16.11; Patos: -15.82 than in the coastal river (Chui: -24.32 (p0.292. SIAR mixing models revealed that the most assimilated basal food sources by consumers in the choked-type lagoon estuaries were a pool of 13C enriched food sources (macroalgae, C4 marsh and seagrass and seston (95% credibility interval: 0.38 to 0.80 and 0.00 to 0.54, respectively. In contrast, nutrients derived from C3-marsh plants were the main basal food source assimilated by estuarine resident fishes at the coastal river (0.33 to 0.87. These findings could be explained by the absence of extensive shallow embayments and a steeper slope at the coastal river that could promote higher transport of C3-marsh detritus and, consequently, higher assimilation by estuarine fishes. In contrast, detritus derived from C3 marsh plants could be trapped in the upper intertidal zone of choked-typed estuaries and, consequently, be less available for aquatic

  18. Evaluating the impact of land use changes on the behaviour of shallow aquifers, by quantifying the groundwater mean residence times distribution

    Science.gov (United States)

    Vincent, Aude; Gillon, Marina; Marc, Vincent; Cognard-Plancq, Anne-Laure; Baillieux, Antoine; Babic, Milanka; Simler, Roland

    2017-04-01

    Residence time is one of the key factors of the groundwater resource management. The Crau aquifer (Mediterranean area, south of France) is a major resource for drinking water supply, threatened by climate change, changes in irrigation patterns, and urban expansion. Water residence time in the aquifer is expected to be highly dependent on these changes. We propose to determinate it using an isotopic approach, associated to numerical modelling. The Crau aquifer is a palaeo-alluvial fan of the Durance river, made of alluviums lying on a Miocene substratum, and recharged by rainwater and gravity irrigation water, diverted from the Durance river. The irrigation water being more depleted in 18O than the rain water, the contribution of irrigation to the aquifer recharge can be quantified (up to 80 to 85% of the total recharge), but is variable in space and time. The modelling approach uses two models, a lumped one and a discretised one. They are based on daily recharge data (rainfall, drainage rates under irrigated crops calculated from the STICS crop model, Olioso et al., 2013), and on monthly water sampling conducted from February 2012 to November 2016 for δ18O content in rainwater, surface water and groundwater. The lumped approach was carried out at a monthly time step, using a binary mixing model, including two exponentially draining reservoirs in parallel. It leads to a satisfying simulation of the δ18O variations in the monitored wells, and gives mean residence times between 3 and 20 months depending on the wells locations. The discretised model is a combination of MODFLOW and MODPATH, through the free user interface MODELMUSE, on a daily time-step. The permeability map used is the one calibrated by Baillieux et al. (2015). Recharge is applied with an increasing spatial complexity, in three successive steps: - a homogeneous recharge, provided by the intermediate output of the lumped model, in order to compare the two models results; - a recharge discretised in

  19. Changes in bacteria composition and efficiency of constructed wetlands under sustained overloads: A modeling experiment.

    Science.gov (United States)

    Boano, F; Rizzo, A; Samsó, R; García, J; Revelli, R; Ridolfi, L

    2018-01-15

    The average organic and hydraulic loads that Constructed Wetlands (CWs) receive are key parameters for their adequate long-term functioning. However, over their lifespan they will inevitably be subject to either episodic or sustained overloadings. Despite that the consequences of sustained overloading are well known (e.g., clogging), the threshold of overloads that these systems can tolerate is difficult to determine. Moreover, the mechanisms that might sustain the buffering capacity (i.e., the reduction of peaks in nutrient load) during overloads are not well understood. The aim of this work is to evaluate the effect of sudden but sustained organic and hydraulic overloads on the general functioning of CWs. To that end, the mathematical model BIO_PORE was used to simulate five different scenarios, based on the features and operation conditions of a pilot CW system: a control simulation representing the average loads; 2 simulations representing +10% and +30% sustained organic overloads; one simulation representing a sustained +30% hydraulic overload; and one simulation with sustained organic and hydraulic overloads of +15% each. Different model outputs (e.g., total bacterial biomass and its spatial distribution, effluent concentrations) were compared among different simulations to evaluate the effects of such operation changes. Results reveal that overloads determine a temporary decrease in removal efficiency before microbial biomass adapts to the new conditions and COD removal efficiency is recovered. Increasing organic overloads cause stronger temporary decreases in COD removal efficiency compared to increasing hydraulic loads. The pace at which clogging develops increases by 10% for each 10% increase on the organic load. Copyright © 2017 Elsevier B.V. All rights reserved.

  20. DIRECTIONS OF IMPROVING SELF-REGULATING SYSTEM IN CONSTRUCTION IN THE CONTEXT OF THE THEORY OF CHANGE

    Directory of Open Access Journals (Sweden)

    Uvarova Svetlana Sergeevna

    2016-08-01

    Full Text Available Self-regulation in construction is characterized by a number of essential disadvantages, which reduce its efficiency. The authors justify scientific and methodological base of self-regulation, which includes the elements of the theory of change and self-organization. Introduction of self-regulation is considered as organizational and economical change, the life cycle of which is an implementation process of the projects of change. According to the lifecycle, key problem zones of self-regulation process are determined and a number of required economical and institutional changes are offered.

  1. Changes in Prescribing Symptomatic and Preventive Medications in the Last Year of Life in Older Nursing Home Residents

    NARCIS (Netherlands)

    van der Meer, Helene G.; Taxis, Katja; Pont, Lisa G.

    2018-01-01

    Background At the end of life goals of care change from disease prevention to symptomatic control, however little is known about the patterns of medication prescribing at this stage. Objectives To explore changes in prescribing of symptomatic and preventive medication in the last year of life in

  2. Changing constructions of machismo for Latino men in therapy: "the devil never sleeps".

    Science.gov (United States)

    Falicov, Celia Jaes

    2010-09-01

    This paper presents current narratives about masculinity that question simplistic negative stereotypes of machismo for Latino heterosexual men. Various models of masculinity within Latino cultures are described using evidence from ethnographic studies, research data, and clinical observation. Therapeutic advantages of including positive cultural masculine traits such as respect and dignity are illustrated with an extensive case study. The case highlights contradictions in the coexistence of constructions of masculinity and traces progressive stages for transforming these constructions. In this strength-based approach, attention is directed to elements of cultural memory that reclaim a strong relational ethic present in the indigenous cultures. "Within the culture" definitions of masculinity contribute alternative constructions toward a more empowering cultural narrative for Latino men than the usual negative stereotypes. 2010 © FPI, Inc.

  3. BOHICA: bend over, here it comes again... construction and test of a Change Fatigue instrument

    NARCIS (Netherlands)

    Elving, W.J.L.; Hansma, L.D.; de Boer, M.G.

    2011-01-01

    Within change literature, pace and frequency of organizational change are reoccurring topics. The pace is experienced as high and the frequency of change within organizations appears to be growing exponentially. This lead to study to more extent ‘change fatigue’ that already received attention in

  4. Residency training program: Perceptions of residents

    African Journals Online (AJOL)

    Abstract. Background: There is a phobia among doctors for the residency training program, since the establishment of ... Materials and Methods: Structured questionnaires were administered to residents at 3 training institutions in Nigeria. Results: ... Keywords: Decentralization, motivation, perception, remuneration, residents.

  5. 1998 Construction Report.

    Science.gov (United States)

    Abramson, Paul

    1998-01-01

    Reports on the third annual survey of college and university construction in the United States. Finds that almost $5.8 billion worth of construction was completed in 1997, and $6.3 billion will be finished in 1998. Offers information on regional construction activity, profiles of new buildings on campuses, residence hall amenities, and other data.…

  6. New Inlet in Great South Bay: Changes in Circulation Dynamics, Residence Time, and Salt Balance in Response to Low Frequency Forcing from Observations and FCVOM Simulations

    Science.gov (United States)

    Hinrichs, C.; Flagg, C. N.; Wilson, R. E.; Flood, R. D.

    2016-02-01

    The Great South Bay is a shallow, multi-inlet estuary at the south shore of Long Island. It is sheltered from the Atlantic by its barrier island Fire Island. Sufficient freshwater input in form of river flow, runoff, and groundwater input combined with restricted ocean-bay-exchange through few narrow inlets produce significant horizontal salinity and temperature gradients. A new inlet was cut into Fire Island during Hurricane Sandy in October 2012, and thanks to the ongoing monitoring program observational data is available from before and after Sandy to investigate changes in the bay induced by this new inlet.The data show a persistent increase in salinity in the bay, and residents, fishermen and scientists report decreased turbidity, improved water quality and a healthier ecosystem in the eastern part of bay. Calculation of residence time based on the freshwater fraction method showed a decrease from 25 to ten days for Bellport Bay near the new breach. From tide gauge data we see, that while tidal range in the bay has not increased significantly with the new inlet, water level response to low frequency forcing did. In general, water levels within the bay responds to both coastal Ekman set-up/set-down and to local wind forcing over the bay itself. Data analysis shows that the relative importance of those two drivers did change with the new inlet. In concert with data analysis, the finite element model FVCOM is applied on a high-resolution Great South Bay grid to further investigate changes in salinity distribution, circulation, and bay-ocean volume-exchange induced by the new breach as well as to examine the degree of interaction between the existing inlets and the new breach.

  7. The Sexual Assault Teach In Program: Building Constructive Campus-Wide Discussions to Inspire Change

    Science.gov (United States)

    Katz, Jennifer; DuBois, Melinda

    2013-01-01

    To begin to address the problem of campus sexual assault, we conducted a Teach In, an educational forum used to explore complex social problems. All students, faculty, and staff at our small liberal arts college were invited to participate. This paper summarizes our Teach In program, goals, and methods. By engaging in constructive, informed…

  8. Communicating Organizational Change Reactions: Downsizing Survivors' Discursive Constructions of Flexible Identities

    Science.gov (United States)

    Aggerholm, Helle Kryger

    2014-01-01

    The aim of this article is to study employees' discursive construction of disparate survivor responses. The analysis reveals how employees position themselves simultaneously within different types of categories by use of discursive actions. Drawing on various discourses, the actors reject having one solid core of identity and instead signal the…

  9. The Construction of Academic Identity in the Changes of Finnish Higher Education

    Science.gov (United States)

    Ylijoki, Oili-Helena; Ursin, Jani

    2013-01-01

    This article sets out to explore how academics make sense of the current transformations of higher education and what kinds of academic identities are thereby constructed. Based on a narrative analysis of 42 interviews with Finnish academics, nine narratives are discerned, each providing a different answer as to what it means to be an academic in…

  10. Innovation and sectoral change in construction: The role of the industry paradigm and industry leaders

    NARCIS (Netherlands)

    Pries, F.; Vrijhoef, R.

    2004-01-01

    The construction industry appears to have serious problems to innovate effectively and incorporate innovative knowledge into firms’ businesses, despite the innovation potential and capacities of the industry. In the last decades several initiatives have been taken and many approaches have been

  11. Dynamic Processes of Conceptual Change: Analysis of Constructing Mental Models of Chemical Equilibrium.

    Science.gov (United States)

    Chiu, Mei-Hung; Chou, Chin-Cheng; Liu, Chia-Ju

    2002-01-01

    Investigates students' mental models of chemical equilibrium using dynamic science assessments. Reports that students at various levels have misconceptions about chemical equilibrium. Involves 10th grade students (n=30) in the study doing a series of hands-on chemical experiments. Focuses on the process of constructing mental models, dynamic…

  12. Physical and biological changes of suspended particles in a free surface flow constructed wetland

    NARCIS (Netherlands)

    Mulling, B.T.M.; van den Boomen, R.M.; Claassen, T.H.L.; van der Geest, H.G.; Kappelhof, J.W.N.M.; Admiraal, W.

    2013-01-01

    Suspended particles are considered as contaminants in treated wastewater and can have profound effects on the biological, physical and chemical properties of receiving aquatic ecosystems, depending on the concentration, type and nature of the suspended particles. Constructed wetlands are known to

  13. Chinese Business Students' Changes in Beliefs and Strategy Use in a Constructively Aligned PBL Course

    Science.gov (United States)

    Zhao, Ke; Zhang, Jie; Du, Xiangyun

    2017-01-01

    This study adopted a longitudinal retrospective case study approach to investigate Chinese business students' transitional learning experience in a problem-based learning (PBL) course with innovative assessment practices. The study focused on students' beliefs and strategy use in a constructively aligned PBL course for business communication.…

  14. Coastal Changes due to the Construction of Artificial Harbour Entrances and Practical Solutions, including Beach Replenishment

    NARCIS (Netherlands)

    Bijker, E.W.; Van der Leijé, J.P.; Pilon, J.J.; Svasek, J.N.; In 't Veld, J.K.; Verhagen, H.J.

    1981-01-01

    When longshore sediment transport is interrupted by a construction along a coast, e.g harbour moles or a dredged approach channel, the equilibrium of the coastline may be disturbed. When the disruption is caused by breakwaters, the longshore transport that is held back will cause accretion updrift

  15. Constructing Self as Leader: Case Studies of Women Who Are Change Agents in South Africa

    Science.gov (United States)

    Mogadime, Dolana; Mentz, P. J.; Armstrong, Denise E.; Holtam, Beryl

    2010-01-01

    The present article draws from the biographical narratives of three South African high school female principals which are part of a larger research study in which 26 aspiring and practicing women school leaders were interviewed. Narratives were constructed from in-depth interviews with each participant and analyzed for themes that provided…

  16. Teacher change in implementing a research-developed representation construction pedagogy

    Science.gov (United States)

    Hubber, Peter; Chittleborough, Gail

    2016-05-01

    The Representations in Learning Science (RiLS) project developed a representation construction approach to teaching and learning in science, which has successfully demonstrated enhanced student learning through sustained engagement with ideas, and enhancement of teachers' pedagogical knowledge and understandings of how knowledge in science is developed and communicated. The current Constructing Representations in Science Pedagogy (CRISP) project aims at wider scale implementation of the representation construction approach. This paper explores a range of issues that confronted four Year-8 teachers in implementing this research-developed approach, such as: preparedness of the teacher in terms of epistemological positioning and positioning as a learner, significant support for planning and modelling by the university expert, and a team ethos where teachers share ideas and plan jointly. The Year-8 teachers implemented a representation construction approach to the teaching of the topic of astronomy. The Interconnected Model of Teacher Growth (IMTG) (Clarke and Hollingworth, Teach. Educ., 18 (2001) 947) was used to analyse the teachers' experience in planning and delivering the teaching sequence. This model was found to be flexible in identifying the experiences of teachers in different situations and useful in identifying issues for implementation of a research-developed pedagogy.

  17. Rising Temperatures and Dwindling Water Supplies? Perception of Climate Change Among Residents of the Spanish Mediterranean Tourist Coastal Areas

    Science.gov (United States)

    March, Hug; Saurí, David; Olcina, Jorge

    2014-01-01

    In this article, we discuss the results of a survey on the perception of climate change in the 14 "tourist zones" (as defined by the Spanish Statistical Institute, INE) that stretch from the French border to Gibraltar alongside the Spanish Mediterranean coast, including the Balearic Islands. Our sample consisted of 1,014 telephone interviews stratified according to the number of tourists staying in each zone. Respondents showed concern for the likely impacts of climate change on jobs and thought that climate change would reduce the economic activity of their areas. Responses were also pessimistic regarding future water availability but agreed with the development of alternative sources such as desalination and water re-use. Household size, educational levels, and employment tended to be the most significant statistical explanatory factors regarding attitudes toward climate change. Respondents in larger households (a variable not tested in the literature as far as we know), respondents with higher education, and respondents working for a wage tended to express more concerns than the rest.

  18. Justification of directions of technological and price audit systems changes for the purpose of high-rise construction innovating

    Science.gov (United States)

    Rogacheva, Yana; Panenkov, Andrey; Petrikova, Zinaida; Nezhnikova, Ekaterina

    2018-03-01

    Improving the quality of high-rise buildings under modern conditions should be based not only on compliance with the norms of technical regulations, but also on ensuring energy efficiency, environmental friendliness, and intellectuality, which can be achieved only through the introduction of innovations at all stages of the life cycle of the investment project. Authors of this article justified the need for a mechanism of technological and price audit of projects. They also suggested the model of life cycle of organizational and economic changes, connected with implantation of the mechanism of projects audit. They showed innovation character of ecological high-rise construction for the whole life cycle. Authors also made proposals to change the audit system for high-rise construction projects in the focus of its environmental friendliness.

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

    Science.gov (United States)

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

    1993-01-01

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

  20. Awareness of and Attitudes towards Heat Waves within the Context of Climate Change among a Cohort of Residents in Adelaide, Australia

    Directory of Open Access Journals (Sweden)

    Iain A. Walker

    2012-12-01

    Full Text Available Heat waves are a public health concern in Australia and unprecedented heat waves have been recorded in Adelaide over recent years. The aim of this study was to examine the perception and attitudes towards heat waves in the context of climate change among a group of residents in Adelaide, an Australian city with a temperate climate. A cross-sectional study was conducted in the summer of 2012 among a sample of 267 residents. The results of the survey found that television (89.9%, radio (71.2%, newspapers (45.3% were the main sources from which respondents received information about heat waves. The majority of the respondents (73.0% followed news about heat waves very or somewhat closely. About 26.6% of the respondents were extremely or very concerned about the effects of heat waves on them personally. The main issues that were of personal concern for respondents during a heat wave were their personal comfort (60.7%, their garden (48.7%, and sleeping well (47.6%. Overall, respondents were more concerned about the impacts of heat waves to the society than on themselves. There was a significant association between gender (χ² = 21.2, df = 3, p = 0.000, gross annual household income (p = 0.03 and concern for the societal effects of heat waves. Less than half (43.2% of the respondents believed that heat waves will extremely or very likely increase in Adelaide according to climate projections. Nearly half (49.3% believed that the effects of heat waves were already being felt in Adelaide. These findings may inform the reframing and communication strategies for heat waves in Adelaide in the context of climate change.

  1. Awareness of and attitudes towards heat waves within the context of climate change among a cohort of residents in Adelaide, Australia.

    Science.gov (United States)

    Akompab, Derick A; Bi, Peng; Williams, Susan; Grant, Janet; Walker, Iain A; Augoustinos, Martha

    2012-12-20

    Heat waves are a public health concern in Australia and unprecedented heat waves have been recorded in Adelaide over recent years. The aim of this study was to examine the perception and attitudes towards heat waves in the context of climate change among a group of residents in Adelaide, an Australian city with a temperate climate. A cross-sectional study was conducted in the summer of 2012 among a sample of 267 residents. The results of the survey found that television (89.9%), radio (71.2%), newspapers (45.3%) were the main sources from which respondents received information about heat waves. The majority of the respondents (73.0%) followed news about heat waves very or somewhat closely. About 26.6% of the respondents were extremely or very concerned about the effects of heat waves on them personally. The main issues that were of personal concern for respondents during a heat wave were their personal comfort (60.7%), their garden (48.7%), and sleeping well (47.6%). Overall, respondents were more concerned about the impacts of heat waves to the society than on themselves. There was a significant association between gender (χ² = 21.2, df = 3, p = 0.000), gross annual household income (p = 0.03) and concern for the societal effects of heat waves. Less than half (43.2%) of the respondents believed that heat waves will extremely or very likely increase in Adelaide according to climate projections. Nearly half (49.3%) believed that the effects of heat waves were already being felt in Adelaide. These findings may inform the reframing and communication strategies for heat waves in Adelaide in the context of climate change.

  2. Awareness of and Attitudes towards Heat Waves within the Context of Climate Change among a Cohort of Residents in Adelaide, Australia

    Science.gov (United States)

    Akompab, Derick A.; Bi, Peng; Williams, Susan; Grant, Janet; Walker, Iain A.; Augoustinos, Martha

    2012-01-01

    Heat waves are a public health concern in Australia and unprecedented heat waves have been recorded in Adelaide over recent years. The aim of this study was to examine the perception and attitudes towards heat waves in the context of climate change among a group of residents in Adelaide, an Australian city with a temperate climate. A cross-sectional study was conducted in the summer of 2012 among a sample of 267 residents. The results of the survey found that television (89.9%), radio (71.2%), newspapers (45.3%) were the main sources from which respondents received information about heat waves. The majority of the respondents (73.0%) followed news about heat waves very or somewhat closely. About 26.6% of the respondents were extremely or very concerned about the effects of heat waves on them personally. The main issues that were of personal concern for respondents during a heat wave were their personal comfort (60.7%), their garden (48.7%), and sleeping well (47.6%). Overall, respondents were more concerned about the impacts of heat waves to the society than on themselves. There was a significant association between gender (χ² = 21.2, df = 3, p = 0.000), gross annual household income (p = 0.03) and concern for the societal effects of heat waves. Less than half (43.2%) of the respondents believed that heat waves will extremely or very likely increase in Adelaide according to climate projections. Nearly half (49.3%) believed that the effects of heat waves were already being felt in Adelaide. These findings may inform the reframing and communication strategies for heat waves in Adelaide in the context of climate change. PMID:23343978

  3. Modeling Hourly Resident Productivity in the Emergency Department.

    Science.gov (United States)

    Joseph, Joshua W; Henning, Daniel J; Strouse, Connie S; Chiu, David T; Nathanson, Larry A; Sanchez, Leon D

    2017-08-01

    Resident productivity, defined as new patients per hour, carries important implications for emergency department operations. In high-volume academic centers, essential staffing decisions can be made on the assumption that residents see patients at a static rate. However, it is unclear whether this model mirrors reality; previous studies have not rigorously examined whether productivity changes over time. We examine residents' productivity across shifts to determine whether it remained consistent. This was a retrospective cohort study conducted in an urban academic hospital with a 3-year emergency medicine training program in which residents acquire patients ad libitum throughout their shift. Time stamps of all patient encounters were automatically logged. A linear mixed model was constructed to predict productivity per shift hour. A total of 14,364 8- and 9-hour shifts were worked by 75 residents between July 1, 2010, and June 20, 2015. This comprised 6,127 (42.7%) postgraduate year (PGY) 1 shifts, 7,236 (50.4%) PGY-2 shifts, and 998 (6.9%) PGY-3 nonsupervisory shifts (Table 1). Overall, residents treated a mean of 10.1 patients per shift (SD 3.2), with most patients at Emergency Severity Index level 3 or more acute (93.8%). In the initial hour, residents treated a mean of 2.14 patients (SD 1.2), and every subsequent hour was associated with a significant decrease, with the largest in the second, third, and final hours. Emergency medicine resident productivity during a single shift follows a reliable pattern that decreases significantly hourly, a pattern preserved across PGY years and types of shifts. This suggests that resident productivity is a dynamic process, which should be considered in staffing decisions and studied further. Copyright © 2016 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

  4. Heritable Genetic Changes in Cells Recovered From Irradiated 3D Tissue Constructs

    Energy Technology Data Exchange (ETDEWEB)

    Michael Cornforth

    2012-03-26

    Combining contemporary cytogenetic methods with DNA CGH microarray technology and chromosome flow-sorting increases substantially the ability to resolve exchange breakpoints associated with interstitial deletions and translocations, allowing the consequences of radiation damage to be directly measured at low doses, while also providing valuable insights into molecular mechanisms of misrepair processes that, in turn, identify appropriate biophysical models of risk at low doses. Specific aims apply to cells recovered from 3D tissue constructs of human skin and, for the purpose of comparison, the same cells irradiated in traditional 2D cultures. The project includes research complementary to NASA/HRP space radiation project.

  5. Conceptual Change and Killer Whales: Constructing Ecological Values for Animals at the Vancouver Aquarium.

    Science.gov (United States)

    Kelsey, Elin

    1991-01-01

    Examines how the aquarium has attempted to move from a transfer view of knowledge to a constructivist approach in its most popular general public program--the killer whale presentation. The process of change that staff underwent is similar to conceptual change processes among learners of science. Describes constructivist strategies of conceptual…

  6. Education Research: Neurology resident education

    Science.gov (United States)

    Mayans, David; Schneider, Logan; Adams, Nellie; Khawaja, Ayaz M.; Engstrom, John

    2016-01-01

    Objective: To survey US-trained graduating neurology residents who are American Academy of Neurology members, in an effort to trend perceived quality and completeness of graduate neurology education. Methods: An electronic survey was sent to all American Academy of Neurology members graduating from US neurology residency programs in the Spring of 2014. Results: Of 805 eligible respondents, 24% completed the survey. Ninety-three percent of adult neurology residents and 56% of child neurology residents reported plans to pursue fellowship training after residency. Respondents reported a desire for additional training in neurocritical care, neuro-oncology, neuromuscular diseases, botulinum toxin injection, and nerve blocks. There remains a clear deficit in business training of neurology residents, although there was notable improvement in knowledge of coding and office management compared to previous surveys. Discussion: Although there are still areas of perceived weakness in neurology training, graduating neurology residents feel generally well prepared for their chosen careers. However, most still pursue fellowship training for reasons that are little understood. In addition to certain subspecialties and procedures, practice management remains deficient in neurology training and is a point of future insecurity for most residents. Future curriculum changes should consider resident-reported gaps in knowledge, with careful consideration of improving business training. PMID:26976522

  7. Seasonal and Spatial Changes of Microorganism Communities in Constructed Wetlands: A Community Level Physiological Profiling Analysis

    Directory of Open Access Journals (Sweden)

    Florent Chazarenc

    2010-01-01

    Full Text Available In constructed wetlands, microorganisms associated with plants are assumed to play a major role. A one-year survey was conducted in five vertical flow constructed wetland systems that had been operating from 2 months to 8 years in small French villages (100–500 People Equivalent to provide a better understanding of microbiological activity. The objective of our study was to highlight the most important factor generating variability between microorganisms communities compared to treatment performances. Results of community level physiological profiling using Biolog Ecoplates were analyzed using principal component analysis. The greatest microbial activity was observed in the oldest wetland during summer. Profiles of fed and rest bed were differentiated by the nature of the main carbon source metabolized. Whereas carbohydrates and carboxylic acids appeared to be better assimilated with fed beds, it seemed that phosphate compounds as well as amines allowed better growth in the plates inoculated with samples of rest beds. In all fed beds, the most important parameters affecting the diversity were the season and the age of the wetlands. There were only slight profile differences between surface and subsurface samples and between the first and second stage samples.

  8. Affairs of the heart: patients’ personal constructions of a cardiac event and their effect on lifestyle change

    Directory of Open Access Journals (Sweden)

    EC McKibbin

    2001-09-01

    Full Text Available The issue of why people do not always make appropriate lifestyle changes in response to a cardiac event has and continues to be of central importance to health practitioners. This paper addresses this issue from the perspective of the lived experience of persons who have suffered an acute myocardial infarction (AMI. The experiences of 10 persons admitted to the coronary care unit (CCU of a South African clinic were richly described, making use of the grounded theory methodology. These descriptions were then used as a basis for the development of a contextualist theory of the experience of heart attacks. A central feature of the results was that the disease was mainly attributed to stress by the participants. This was in contrast to the explanations offered by the medical profession, who attribute this more to other modifiable risk factors such as smoking, high blood cholesterol, high blood pressure, and lack of exercise. This tension between lay and professional constructions of the aetiology of the condition is deemed to be of import in the recovery process. The paper further alludes to the goodness of fit which exists between the proposed grounded theory and the personal construct theory of George Kelly. The importance of personal constructions of the event is then used as the basis for a proposed intervention process aimed at addressing the difficulties AMI patients’ experience in making and sustaining lifestyle changes.

  9. Tissues Use Resident Dendritic Cells and Macrophages to Maintain Homeostasis and to Regain Homeostasis upon Tissue Injury: The Immunoregulatory Role of Changing Tissue Environments

    Directory of Open Access Journals (Sweden)

    Maciej Lech

    2012-01-01

    Full Text Available Most tissues harbor resident mononuclear phagocytes, that is, dendritic cells and macrophages. A classification that sufficiently covers their phenotypic heterogeneity and plasticity during homeostasis and disease does not yet exist because cell culture-based phenotypes often do not match those found in vivo. The plasticity of mononuclear phagocytes becomes obvious during dynamic or complex disease processes. Different data interpretation also originates from different conceptual perspectives. An immune-centric view assumes that a particular priming of phagocytes then causes a particular type of pathology in target tissues, conceptually similar to antigen-specific T-cell priming. A tissue-centric view assumes that changing tissue microenvironments shape the phenotypes of their resident and infiltrating mononuclear phagocytes to fulfill the tissue's need to maintain or regain homeostasis. Here we discuss the latter concept, for example, why different organs host different types of mononuclear phagocytes during homeostasis. We further discuss how injuries alter tissue environments and how this primes mononuclear phagocytes to enforce this particular environment, for example, to support host defense and pathogen clearance, to support the resolution of inflammation, to support epithelial and mesenchymal healing, and to support the resolution of fibrosis to the smallest possible scar. Thus, organ- and disease phase-specific microenvironments determine macrophage and dendritic cell heterogeneity in a temporal and spatial manner, which assures their support to maintain and regain homeostasis in whatever condition. Mononuclear phagocytes contributions to tissue pathologies relate to their central roles in orchestrating all stages of host defense and wound healing, which often become maladaptive processes, especially in sterile and/or diffuse tissue injuries.

  10. Metropolitan social environments and pre-HAART/HAART era changes in mortality rates (per 10,000 adult residents among injection drug users living with AIDS.

    Directory of Open Access Journals (Sweden)

    Samuel R Friedman

    Full Text Available BACKGROUND: Among the largest US metropolitan areas, trends in mortality rates for injection drug users (IDUs with AIDS vary substantially. Ecosocial, risk environment and dialectical theories suggest many metropolitan areas characteristics that might drive this variation. We assess metropolitan area characteristics associated with decline in mortality rates among IDUs living with AIDS (per 10,000 adult MSA residents after highly active antiretroviral therapy (HAART was developed. METHODS: This is an ecological cohort study of 86 large US metropolitan areas from 1993-2006. The proportional rate of decline in mortality among IDUs diagnosed with AIDS (as a proportion of adult residents from 1993-1995 to 2004-2006 was the outcome of interest. This rate of decline was modeled as a function of MSA-level variables suggested by ecosocial, risk environment and dialectical theories. In multiple regression analyses, we used 1993-1995 mortality rates to (partially control for pre-HAART epidemic history and study how other independent variables affected the outcomes. RESULTS: In multivariable models, pre-HAART to HAART era increases in 'hard drug' arrest rates and higher pre-HAART income inequality were associated with lower relative declines in mortality rates. Pre-HAART per capita health expenditure and drug abuse treatment rates, and pre- to HAART-era increases in HIV counseling and testing rates, were weakly associated with greater decline in AIDS mortality. CONCLUSIONS: Mortality among IDUs living with AIDS might be decreased by reducing metropolitan income inequality, increasing public health expenditures, and perhaps increasing drug abuse treatment and HIV testing services. Given prior evidence that drug-related arrest rates are associated with higher HIV prevalence rates among IDUs and do not seem to decrease IDU population prevalence, changes in laws and policing practices to reduce such arrests while still protecting public order should be

  11. Assessment of exposure risk from hidden fungal growth by measurements of air change rates in construction cavities and living areas

    DEFF Research Database (Denmark)

    Knudsen, Sofie M; Møller, Eva B.; Gunnarsen, Lars Bo

    2017-01-01

    The transfer of particulate and gaseous pollution from hidden fungi growing on non-visible surfaces within the building envelope to occupied rooms is limited by the separating structure. Yet, growth, even in sealed construction cavities, is known to cause annoying smells and other more adverse...... health symptoms among the building occupants. This study analyses limitations of air change rate measurements in inaccessible construction cavities as well as analyses of the air exchange between living areas and accessible cavities such as crawl spaces and attics. It was necessary to invent a field...... study technique to use the tracer gas decay method in small and inaccessible cavities. This technique allowed further investigation on the exposure risk from hidden fungal growth. Assessment of the air transfer between crawl spaces and living areas indicate that the tightness of separating structure has...

  12. Chinese business students’ changes in beliefs and strategy use in a constructively aligned PBL course

    DEFF Research Database (Denmark)

    Zhao, Ke; Zhang, Jie; Du, Xiangyun

    2017-01-01

    This study adopted a longitudinal retrospective case study approach to investigate Chinese business students’ transitional learning experience in a problem-based learning (PBL) course with innovative assessment practices. The study focused on students’ beliefs and strategy use in a constructively...... aligned PBL course for business communication. Eight students who had made notable progress were chosen for retrospective analysis. The data included 48 journal entries, interviews, and writing samples collected at different stages of the course. This study identified taxonomies of participants’ beliefs...... that align social constructivist learning principles with students’ beliefs and strategies. The results also highlight the importance of developing appropriate assessment rubrics to enhance student engagement with PBL learning for improved outcomes....

  13. Construction of mathematical models the parachute jumper with change position acrobatic

    Science.gov (United States)

    Asmianto, Asmianto; Hariyanto, Hariyanto; Herisman, Iis

    2018-03-01

    Construction of mathematical models the movement of a parachutist during the air using newton’s II law is ΣF = ma. Position parachutist after exiting the plane immediately unfurled his body so as to create a large air resistance. The presence of air drag resulting movement indirectly parachutist moves down vertically downwards but also shifting toward horizontal and form a parabolic trajectory. Parachutist speed getting down increased until eventually the parachutist reaches terminal velocity it’s the position where the air drag is equal to the gravitational force (gravity) jumpers. In this paper is assumed to be parachutist with 91.6 kg mass (including equipment) jumping from a plane at an altitude of 3.000 meters and reach a height of parachutist ± 1000 meters with velocity ± 57 m/s. So the parachutist have to be clever in taking account of everything, because if just a little too late can dangerous the safety of the parachutist.

  14. Destinations unknown: the gender construction and changing nature of the sexual expressions of Thai youth.

    Science.gov (United States)

    Ford, N J; Kittisuksathit, S

    1994-01-01

    This paper discusses qualitative findings from a study of the sexual awareness, lifestyles and related health service needs of young, single factory workers in Thailand. The context of this study is Thailand's growing industrialization, the deepening intensity of the threats to sexual health (especially regarding HIV/AIDS transmission) and the vulnerability of young migrant women. Findings from 18 focus group discussions held with groups of young (15-24) male and female factory workers are outlined with principal reference to the gender construction of sexuality. Key themes explored include attitudes towards courtship, marriage, sexual feelings and arousal, expressions of involvement in pre-marital sexual activities and the consequences of such activity. In conclusion there is some discussion of the implication for young women's sexual health, of the interplay of a measure of pre-marital intercourse and the continuing emotional barriers to effective use of contraception.

  15. European Climate Change Programme. Working Group II. Impacts and Adaptation. Urban Planning and Construction. Sectoral Report

    International Nuclear Information System (INIS)

    2007-03-01

    Adaptation is a new policy area for the European Climate Change Policy. The Impacts and Adaptation Workgroup has been set up as part of European Climate Change Programme (ECCP II). The main objective of the workgroup is to explore options to improve Europe's resilience to climate change impacts, to encourage the integration of climate change adaptation into other policy areas at the European, national, regional and local level and to define the role of EU-wide policies complementing action by Member States. The aim of this initial programme of work is to identify good practice in the development of adaptation policy and foster learning from different sectoral experiences and explore a possible EU role in adaptation policies. The Commission has led a series of 10 sectoral meetings looking at adaptation issues for different sectors. One of these meetings looked at the impacts on urban planning and infrastructure in particular. This report summarises the state of play in the urban planning sector in relation to adaptation to climate change on the basis of the information gathered at the stakeholder meeting. Some of the other stakeholder meetings, such as the meeting on human health, have a strong connection with the urban planning agenda. Therefore, some actions in the sector report on adaptation and human health relate to urban planning and infrastructure considerations

  16. The central role of the construction sector for climate change adaptions in the built environment

    NARCIS (Netherlands)

    Roders, M.J.; Straub, A.; Visscher, H.J.

    2013-01-01

    Over the past years, research has clearly enunciated the necessity of adaptation to climate change in the built environment. Policy is being developed on national and municipal levels to have adaptations implemented. However, for the actual application of the measures, property owners are the actors

  17. Adaptation to Climate Change in France and Quebec: Convergent Institutional Constructions, Divergent Diffusion

    International Nuclear Information System (INIS)

    Marquet, Vincent; Salles, Denis

    2014-01-01

    In the space of a few decades, climate change has established itself as a central object of research for the scientific community and a high profile social and political question. Closely associated with the work of the IPCC, two dominant modes of action have supplied the institutional response: these are, respectively, attenuation and adaptation. The latter has established itself as a potential path for policy by appealing to the imperative of human survival and adopting the form of a vast normative program. By drawing upon a comparative approach, I propose to examine climate change adaptation policies as an emerging framework structuring global, transversal and multi-level public action. To this end, I examine the convergent process by which climate change adaptation policies have been institutionalized in France and Quebec. I then consider the issues involved in the spread of climate change adaptation via territorial risk management policies and water resource governance. Ultimately, the result is that the new requirements imposed by adaptation are in contradiction with the interests and shorter temporalities still prevailing within local management activities

  18. Pathology Informatics Essentials for Residents

    Science.gov (United States)

    Karcher, Donald S.; Harrison, James H.; Sinard, John H.; Riben, Michael W.; Boyer, Philip J.; Plath, Sue; Thompson, Arlene; Pantanowitz, Liron

    2016-01-01

    Context: Recognition of the importance of informatics to the practice of pathology has surged. Training residents in pathology informatics has been a daunting task for most residency programs in the United States because faculty often lacks experience and training resources. Nevertheless, developing resident competence in informatics is essential for the future of pathology as a specialty. Objective: To develop and deliver a pathology informatics curriculum and instructional framework that guides pathology residency programs in training residents in critical pathology informatics knowledge and skills, and meets Accreditation Council for Graduate Medical Education Informatics Milestones. Design: The College of American Pathologists, Association of Pathology Chairs, and Association for Pathology Informatics formed a partnership and expert work group to identify critical pathology informatics training outcomes and to create a highly adaptable curriculum and instructional approach, supported by a multiyear change management strategy. Results: Pathology Informatics Essentials for Residents (PIER) is a rigorous approach for educating all pathology residents in important pathology informatics knowledge and skills. PIER includes an instructional resource guide and toolkit for incorporating informatics training into residency programs that vary in needs, size, settings, and resources. PIER is available at http://www.apcprods.org/PIER (accessed April 6, 2016). Conclusions: PIER is an important contribution to informatics training in pathology residency programs. PIER introduces pathology trainees to broadly useful informatics concepts and tools that are relevant to practice. PIER provides residency program directors with a means to implement a standardized informatics training curriculum, to adapt the approach to local program needs, and to evaluate resident performance and progress over time. PMID:28725772

  19. Pathology Informatics Essentials for Residents

    Directory of Open Access Journals (Sweden)

    Walter H. Henricks MD

    2016-07-01

    Full Text Available Context: Recognition of the importance of informatics to the practice of pathology has surged. Training residents in pathology informatics has been a daunting task for most residency programs in the United States because faculty often lacks experience and training resources. Nevertheless, developing resident competence in informatics is essential for the future of pathology as a specialty. Objective: To develop and deliver a pathology informatics curriculum and instructional framework that guides pathology residency programs in training residents in critical pathology informatics knowledge and skills, and meets Accreditation Council for Graduate Medical Education Informatics Milestones. Design: The College of American Pathologists, Association of Pathology Chairs, and Association for Pathology Informatics formed a partnership and expert work group to identify critical pathology informatics training outcomes and to create a highly adaptable curriculum and instructional approach, supported by a multiyear change management strategy. Results: Pathology Informatics Essentials for Residents (PIER is a rigorous approach for educating all pathology residents in important pathology informatics knowledge and skills. PIER includes an instructional resource guide and toolkit for incorporating informatics training into residency programs that vary in needs, size, settings, and resources. PIER is available at http://www.apcprods.org/PIER (accessed April 6, 2016. Conclusions: PIER is an important contribution to informatics training in pathology residency programs. PIER introduces pathology trainees to broadly useful informatics concepts and tools that are relevant to practice. PIER provides residency program directors with a means to implement a standardized informatics training curriculum, to adapt the approach to local program needs, and to evaluate resident performance and progress over time.

  20. Climatic change, cientific consensus and mediatic construction. The paradigm of the communication for the sustainable development

    OpenAIRE

    Dr. Bernando Díaz Nosty,

    2009-01-01

    The climatic change, the global warming and the sustainable development are concepts integrated in the agenda setting of the media that reveal preoccupations and alert in the scientific consensus. Nevertheless, the reflections of the information about these aspects reveal deficiency in the constructivist techniques of journalism, moreover things that have to do with politics, economic and cultural interest. This article has to do with the evolution and tendencies of the informative flow in re...

  1. Change with age in regression construction of fat percentage for BMI in school-age children.

    Science.gov (United States)

    Fujii, Katsunori; Mishima, Takaaki; Watanabe, Eiji; Seki, Kazuyoshi

    2011-01-01

    In this study, curvilinear regression was applied to the relationship between BMI and body fat percentage, and an analysis was done to see whether there are characteristic changes in that curvilinear regression from elementary to middle school. Then, by simultaneously investigating the changes with age in BMI and body fat percentage, the essential differences in BMI and body fat percentage were demonstrated. The subjects were 789 boys and girls (469 boys, 320 girls) aged 7.5 to 14.5 years from all parts of Japan who participated in regular sports activities. Body weight, total body water (TBW), soft lean mass (SLM), body fat percentage, and fat mass were measured with a body composition analyzer (Tanita BC-521 Inner Scan), using segmental bioelectrical impedance analysis & multi-frequency bioelectrical impedance analysis. Height was measured with a digital height measurer. Body mass index (BMI) was calculated as body weight (km) divided by the square of height (m). The results for the validity of regression polynomials of body fat percentage against BMI showed that, for both boys and girls, first-order polynomials were valid in all school years. With regard to changes with age in BMI and body fat percentage, the results showed a temporary drop at 9 years in the aging distance curve in boys, followed by an increasing trend. Peaks were seen in the velocity curve at 9.7 and 11.9 years, but the MPV was presumed to be at 11.9 years. Among girls, a decreasing trend was seen in the aging distance curve, which was opposite to the changes in the aging distance curve for body fat percentage.

  2. Changes in breastfeeding and nutritional status of Nigerian children between 1990 and 2008, and variations by region, area of residence and maternal education and occupation.

    Science.gov (United States)

    Onubogu, Chinyere U; Onyeka, Ifeoma N; Esangbedo, Dorothy O; Ndiokwelu, Chika; Okolo, Selina N; Ngwu, Elizabeth K; Nwaru, Bright I

    2016-11-01

    Inadequate breastfeeding practices contribute to malnutrition in young children. This study examined changes in breastfeeding practices and the nutritional status of children (0-35 months, n = 37154) using data from the nationally-representative Nigerian Demographic and Health Surveys for 1990-2008. The study estimated the relative changes in the proportion of children meeting recommended breastfeeding practices and the anthropometric indices of the children during the study period, by region, place of residence, maternal education and maternal occupation. In each study year, over 97% of the children were ever breastfed. The proportion of infants breastfed within 1 hour and 1 day of birth increased from 34% to 45.8%, and from 63.8% to 82.3%, respectively. Overall, breastfeeding for ≥ 12 months changed from 88.9% to 95.2%, an increase of 7%; however, an increase of 14% was observed in the northern region (from 86.1% to 97.8%) while a decline of 7% was observed in the southern region (from 97.1% to 89.9%). Over the study period, the prevalence of all the assessed indicators of malnutrition (stunting, wasting and underweight) increased in the northern region while the southern region experienced a decline in all except severe wasting. In both urban and rural areas, stunting and wasting increased, while underweight declined. Children of non-formally educated and unemployed mothers were more malnourished in all the study years. Improvement in some breastfeeding practices did not result in improvement in the nutritional status of Nigerian children during 1990-2008, particularly in northern Nigeria and among socially disadvantaged mothers. Improving maternal education and employment, and integrating messages on techniques and benefits of optimal infant feeding with other maternal and child healthcare services could be beneficial.

  3. A Stitch in Time: Changing Cultural Constructions of Craft and Mending

    Directory of Open Access Journals (Sweden)

    Anna König

    2013-12-01

    Full Text Available Over the course of the twentieth century, the availability of cheap, mass-produced fashion has contributed to a decline in everyday domestic mending skills. Indeed, as mass-manufactured goods have become cheaper for the global population it has become normative consumer behaviour to dispose of any item that is less than per-fect, even when the damage is entirely superficial, leading Clark to claim that: ‘mending has died out’ (2008: 435. However, in recent years there has been an apparent revival in domestic mending, aided and evidenced by the emergence of sewing and mending groups in the UK, mainland Europe and North America. This has coincided with a growing interest in more sustainable material goods (McDonough & Braungart 2002; Fletcher 2008, and a small body of academic work around the notion of craftsmanship (e.g. Sennett 2008; Crawford 2009. Of particular interest here is the history of mending of clothing and household goods, as well as recent incarnations of mending as both an individual and group activity. In the past year, researchers from diverse theoretical backgrounds have also highlighted the role of mending in everyday material goods providing further insights into the subject (Laitala & Boks 2012; Middleton 2012; Portwood-Stacer 2012. An examination of mending reveals a complex picture in which gender, class, aesthetics and social motivations interweave with the imperatives of consumer culture. Whilst historically it is generally constructed as a feminine activity, and carried connotations of material deprivation, contemporary mending is often motivated by environmental concerns and a desire to reduce consumption. Ultimately, mending is demonstrated to be an under-researched subject loaded with cultural meaning, and ultimately, is shown to be anything but a trivial activity.

  4. Changes in the Vegetation Cover in a Constructed Wetland at Argonne National Laboratory, Illinois

    Energy Technology Data Exchange (ETDEWEB)

    Bergman, C.L.; LaGory, K.

    2004-01-01

    Wetlands are valuable resources that are disappearing at an alarming rate. Land development has resulted in the destruction of wetlands for approximately 200 years. To combat this destruction, the federal government passed legislation that requires no net loss of wetlands. The United States Army Corps of Engineers (USACE) is responsible for regulating wetland disturbances. In 1991, the USACE determined that the construction of the Advanced Photon Source at Argonne National Laboratory would damage three wetlands that had a total area of one acre. Argonne was required to create a wetland of equal acreage to replace the damaged wetlands. For the first five years after this wetland was created (1992-1996), the frequency of plant species, relative cover, and water depth was closely monitored. The wetland was not monitored again until 2002. In 2003, the vegetation cover data were again collected with a similar methodology to previous years. The plant species were sampled using quadrats at randomly selected locations along transects throughout the wetland. The fifty sampling locations were monitored once in June and percent cover of each of the plant species was determined for each plot. Furthermore, the extent of standing water in the wetland was measured. In 2003, 21 species of plants were found and identified. Eleven species dominated the wetland, among which were reed canary grass (Phalaris arundinacea), crown vetch (Coronilla varia), and Canada thistle (Cirsium arvense). These species are all non-native, invasive species. In the previous year, 30 species were found in the same wetland. The common species varied from the 2002 study but still had these non-native species in common. Reed canary grass and Canada thistle both increased by more than 100% from 2002. Unfortunately, the non-native species may be contributing to the loss of biodiversity in the wetland. In the future, control measures should be taken to ensure the establishment of more desired native species.

  5. 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

  6. Constructing Consistent Multiscale Scenarios by Transdisciplinary Processes: the Case of Mountain Regions Facing Global Change

    Directory of Open Access Journals (Sweden)

    Fridolin Simon. Brand

    2013-06-01

    Full Text Available Alpine regions in Europe, in particular, face demanding local challenges, e.g., the decline in the agriculture and timber industries, and are also prone to global changes, such as in climate, with potentially severe impacts on tourism. We focus on the Visp region in the Upper Valais, Switzerland, and ask how the process of stakeholder involvement in research practice can contribute to a better understanding of the specific challenges and future development of mountainous regions under global change. Based on a coupled human-environment system (HES perspective, we carried out a formative scenario analysis to develop a set of scenarios for the future directions of the Visp region. In addition, we linked these regional scenarios to context scenarios developed at the global and Swiss levels via an external consistency analysis. This method allows the coupling of both the scenario building process and the scenarios as such. We used a functional-dynamic approach to theory-practice cooperation, i.e., the involvement of key stakeholders from, for example, tourism, forestry, and administration, differed in type and intensity during the steps of the research process. In our study, we experienced strong problem awareness among the stakeholders concerning the impacts of global change and local challenges. The guiding research question was commonly defined and problem ownership was more or less balanced. We arrived at six multiscale scenarios that open up future trajectories for the Visp region, and present generic strategies to cope with global and local challenges. The results show that local identity, spatial planning, community budget, and demographic development are important steering elements in the region's future development. We suggest that method-guided transdisciplinary processes result in a richer picture and a more systemic understanding, which enable a discussion of critical and surprising issues.

  7. Impact on house staff evaluation scores when changing from a Dreyfus- to a Milestone-based evaluation model: one internal medicine residency program's findings.

    Science.gov (United States)

    Friedman, Karen A; Balwan, Sandy; Cacace, Frank; Katona, Kyle; Sunday, Suzanne; Chaudhry, Saima

    2014-01-01

    As graduate medical education (GME) moves into the Next Accreditation System (NAS), programs must take a critical look at their current models of evaluation and assess how well they align with reporting outcomes. Our objective was to assess the impact on house staff evaluation scores when transitioning from a Dreyfus-based model of evaluation to a Milestone-based model of evaluation. Milestones are a key component of the NAS. We analyzed all end of rotation evaluations of house staff completed by faculty for academic years 2010-2011 (pre-Dreyfus model) and 2011-2012 (post-Milestone model) in one large university-based internal medicine residency training program. Main measures included change in PGY-level average score; slope, range, and separation of average scores across all six Accreditation Council for Graduate Medical Education (ACGME) competencies. Transitioning from a Dreyfus-based model to a Milestone-based model resulted in a larger separation in the scores between our three post-graduate year classes, a steeper progression of scores in the PGY-1 class, a wider use of the 5-point scale on our global end of rotation evaluation form, and a downward shift in the PGY-1 scores and an upward shift in the PGY-3 scores. For faculty trained in both models of assessment, the Milestone-based model had greater discriminatory ability as evidenced by the larger separation in the scores for all the classes, in particular the PGY-1 class.

  8. Coping with floods after the severe event in 2002: Recent changes in preparedness, response and recovery of flood-affected residents in Germany

    Science.gov (United States)

    Kienzler, Sarah; Pech, Ina; Kreibich, Heidi; Müller, Meike; Thieken, Annegret

    2014-05-01

    In the aftermath of the severe flood in August 2002, a number of political changes on flood policies in Germany and Europe were launched aiming at an improved risk communication and management. The question arises, whether flood-affected private households are now better prepared than in 2002. Therefore, computer-aided telephone interviews with private households that suffered property damage due to flooding in 2005, 2006, 2010 or 2011 were performed. The obtained data were also compared to results from a similar investigation carried out by Thieken et al. (2007 - Hydrol. Sci. J. 52(5): 1016-1037) after the flood in 2002. After 2002, a larger part of people knew that they are at risk of flooding and the level of private precaution increased considerably. Yet this knowledge did not necessarily result in actual building retrofitting or flood proofing measures. Accordingly, the benefits and cost savings of these actions still have to be communicated in a better way. Best precaution before the flood event in 2011 and 2006 might be explained by more flood experience and overall greater awareness of the residents. Early warning and emergency response were substantially influenced by the floods' characteristics. In contrast to flood-affected people in 2006 or 2011, people affected by floods in 2005 or 2010 had to deal with shorter lead times, less time to take emergency measures and consequently suffered higher losses. Therefore, it is important to further improve early warning systems and communication channels, particularly in hilly areas with fast onset flooding.

  9. Study of improving the thermal response of a construction material containing a phase change material

    Science.gov (United States)

    Laaouatni, A.; Martaj, N.; Bennacer, R.; Elomari, M.; El Ganaoui, M.

    2016-09-01

    The use of phase change materials (PCMs) for improving the thermal comfort in buildings has become an attractive application. This solution contributes to increasing the thermal inertia of the building envelope and reducing power consumption. A building element filled with a PCM and equipped with ventilation tubes is proposed, both for increasing inertia and contributing to refreshing building envelope. A numerical simulation is conducted by the finite element method in COMSOL Multiphysics, which aims to test the thermal behaviour of the developed solution. An experimental study is carried out on a concrete block containing a PCM with ventilation tubes. The objective is to see the effect of PCM coupled with ventilation on increasing the inertia of the block. The results show the ability of this new solution to ensure an important thermal inertia of a building.

  10. Climatic change, cientific consensus and mediatic construction. The paradigm of the communication for the sustainable development

    Directory of Open Access Journals (Sweden)

    Dr. Bernando Díaz Nosty, nosty@infoamerica.org

    2009-01-01

    Full Text Available The climatic change, the global warming and the sustainable development are concepts integrated in the agenda setting of the media that reveal preoccupations and alert in the scientific consensus. Nevertheless, the reflections of the information about these aspects reveal deficiency in the constructivist techniques of journalism, moreover things that have to do with politics, economic and cultural interest. This article has to do with the evolution and tendencies of the informative flow in relation to climatic change as well as dissonances between scientific and media messages. It also has to do with the growing interest of the communication studies, especially in the Anglo-Saxon world about the environmental crisis up to the point to suggest the development of a flowing oriented to journalistic communication and sustainable innovation.El cambio climático, el calentamiento global y la sostenibilidad son conceptos integrados en la agenda de los medios, que reflejan preocupaciones y alertas amparadas en un amplio consenso científico. No obstante, el reflejo de la información sobre estos aspectos revela carencias en las técnicas constructivas del periodismo, además de aquellas que responden a cruces de intereses políticos, económicos y culturales. En este artículo se refiere la evolución y tendencias de los flujos informativos relativos al cambio climático, así como a las disonancias entre los mensajes científico y el mediático. También, se hace hincapié en el creciente interés de los estudios de comunicación, especialmente en el mundo anglosajón, sobre la crisis medioambiental, hasta el punto de sugerir el desarrollo de una corriente orientada a la comunicación periodística y la innovación sostenible.

  11. Residency Allocation Database

    Data.gov (United States)

    Department of Veterans Affairs — The Residency Allocation Database is used to determine allocation of funds for residency programs offered by Veterans Affairs Medical Centers (VAMCs). Information...

  12. American College of Radiology In-Training Examination for Residents in Radiation Oncology (2004-2007)

    International Nuclear Information System (INIS)

    Paulino, Arnold C.; Kurtz, Elizabeth

    2008-01-01

    Purpose: To review the results of the recent American College of Radiology (ACR) in-training examinations in radiation oncology and to provide information regarding the examination changes in recent years. Methods and Materials: A retrospective review of the 2004 to 2007 ACR in-training examination was undertaken. Results: The number of residents taking the in-training examination increased from 2004 to 2007, compatible with the increase in the number of radiation oncology residents in the United States and Canada. The number of questions decreased from approximately 510 in 2004 and 2005, to 405 in 2006 and 360 in 2007, most of these changes were in the clinical oncology section. Although the in-training examination showed construct validity with resident performance improving with each year of additional clinical oncology training, it did so only until Level 3 for biology and physics. Several changes have been made to the examination process, including allowing residents to keep the examination booklet for self-study, posting of the answer key and rationales to questions on the ACR Website, and providing hard copies to residency training directors. In addition, all questions are now A type or multiple choice questions with one best answer, similar to the American Board of Radiology written examination for radiation oncology. Conclusion: Several efforts by the ACR have been made in recent years to make the examination an educational tool for radiation oncology residents and residency directors

  13. Changes in water quality of a small urban river triggered by deep drainage of a construction site

    Directory of Open Access Journals (Sweden)

    Bartnik Adam

    2016-12-01

    Full Text Available The paper presents the results of the monitoring of the selected physicochemical properties of the Jasień River waters (in Łódź, the third biggest city of Poland and their changes under the influence of drainage of a railway station Łódź Fabryczna construction site. Even 25 years ago the Jasień River was a receiver for the sewage from the Łódź textile factories. The drainage of the excavations and disposal of the water into the Jasień River was started on January 2014 and changed stable hydrological, physical and chemical regime of the river once again. In a consequence, average monthly flows exceeded the Jasień River flow in its upper section by six times, and at the beginning by even ten times. Chloride concentration was systematically growing over the study period. This growth and higher water pH were probably associated with increasing level of contaminants in the discharged water and its gradually decreasing uptake. Average annual water temperature increased and a decrease in its amplitude was observed. The annual conductivity and pH patterns became more uniform and the changes in pH followed a clear trend of monthly changes. Water turbidity increased by two times and during summer floods this parameter was often even a few times higher than before the drainage commenced. Chlorides improved water conductance and sodium and potassium increased basicity.

  14. Is your graduating general surgery resident qualified to take trauma call? A 15-year appraisal of the changes in general surgery education for trauma.

    Science.gov (United States)

    Strumwasser, Aaron; Grabo, Daniel; Inaba, Kenji; Matsushima, Kazuhide; Clark, Damon; Benjamin, Elizabeth; Lam, Lydia; Demetriades, Demetrios

    2017-03-01

    Trauma training in general surgery residency is undergoing an evolution. Hour restrictions, the growth of subspecialty care, and the trend toward nonoperative management have altered resident exposure to operative trauma. We sought to identify trends in resident trauma training since the inception of the 80-hour workweek. The Accreditation Council for General Medical Education Case Log Statistical Reports for Surgery was abstracted for general surgery resident trauma operative volume for the years 1999-2014. Resident trauma experience (operative caseload [OC]) was compared before inception of the 80-hour workweek (1999-2002) to after the 80-hour workweek began (2003 to current). A trend toward decreased operative trauma for general surgery residents was observed (mean OC [before 80-hour workweek vs. 80-hour workweek], 39,252 ± 1,065.2 cases vs. 36,065 ± 1,291.8; p = 0.06). Trauma laparotomies increased (range, 5,446-9,364 cases) with corresponding decreases in vascular trauma (4,704 to 799 cases), neck explorations (1,876 to 1,370 cases), and thoracotomies (2,507 to 2,284 cases). By comparison, an increase in vascular/integrated cases was noted (mean OC [before 80-hour workweek vs. 80-hour workweek], 845 ± 44.2 vs. 1,465 ± 88.4 cases; p surgery (p surgery.

  15. Retrospective evaluation of residents' American Board of Surgery In-Service Training Examination (ABSITE) scores as a tool to evaluate changes made in a basic science curriculum.

    Science.gov (United States)

    Lube, Matthew W; Borman, Karen R; Fulbright, Ava E; Friedell, Mark L

    2010-01-01

    To evaluate the effectiveness of a new basic science curriculum at a university-affiliated general surgery residency program. A retrospective evaluation of general surgery residents' American Board of Surgery (ABS) In-Training Examination (ABSITE) scores before and after the implementation of a new basic science curriculum. Not-for-profit tertiary referral center with a university-affiliated Accreditation Council for Graduate Medical Education (ACGME) accredited community general surgery residency program. Postgraduate year (PGY) 1 through 5 general surgical residents. The total questions answered correctly (percent correct) in the main 3 categories improved after implementation of the new curriculum for PGY 1 (total test: 70 +/- 7 vs 60 +/- 9, p science: 71 +/- 10 vs 59 +/- 9, p science: 69 +/- 7 vs 60 +/- 10, p = 0.0003) and for PGY 2 residents (total test: 74 +/- 5 vs 66 +/- 7, p science: 74 +/- 7 vs 66 +/- 8, p = 0.003; and basic science: 74 +/- 5 vs 66 +/- 8, p science curriculum organized and directed by the faculty, there were statistically significant improvements of PGY 1 and 2 residents' ABSITE scores. Copyright (c) 2010 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  16. Impact on house staff evaluation scores when changing from a Dreyfus- to a Milestone-based evaluation model: one internal medicine residency program's findings

    Directory of Open Access Journals (Sweden)

    Karen A. Friedman

    2014-11-01

    Full Text Available Purpose: As graduate medical education (GME moves into the Next Accreditation System (NAS, programs must take a critical look at their current models of evaluation and assess how well they align with reporting outcomes. Our objective was to assess the impact on house staff evaluation scores when transitioning from a Dreyfus-based model of evaluation to a Milestone-based model of evaluation. Milestones are a key component of the NAS. Method: We analyzed all end of rotation evaluations of house staff completed by faculty for academic years 2010–2011 (pre-Dreyfus model and 2011–2012 (post-Milestone model in one large university-based internal medicine residency training program. Main measures included change in PGY-level average score; slope, range, and separation of average scores across all six Accreditation Council for Graduate Medical Education (ACGME competencies. Results: Transitioning from a Dreyfus-based model to a Milestone-based model resulted in a larger separation in the scores between our three post-graduate year classes, a steeper progression of scores in the PGY-1 class, a wider use of the 5-point scale on our global end of rotation evaluation form, and a downward shift in the PGY-1 scores and an upward shift in the PGY-3 scores. Conclusions: For faculty trained in both models of assessment, the Milestone-based model had greater discriminatory ability as evidenced by the larger separation in the scores for all the classes, in particular the PGY-1 class.

  17. Relations Of Peer -Victimization Exposure In Adolescents With The Perceived Social Support, Parental Attitude, School Success, School Change And Area Of Residence

    Directory of Open Access Journals (Sweden)

    Gülşah Tura

    2017-01-01

    Full Text Available This study is made to determine the predictive powers of the perceived social support, parental attitude, school success, school change and living in different area of residences variables in the students of 8.grade who are exposed to peer-victimization. T he data of the research has been procured from 550 students who are the eighth-grader in Diyarbakır and Kocaeli. The data related to the predicted variable has been collected by using Peer-victimization Scale (Mynard & Joseph, 2000 and the data related to the predictor variables has been gathered by using the Perceived Social Support Scale – Revised Form (Yıldırım, 2004, the Parental Attitude Scale (Lamborn, Mounts, Steinberg & Dornbush, 1991 and the Personal Information Form prepared by the researcher. The statistical analysis of the gathered data has been performed in computer by using SPSS 11.5 packaged software. Multiple Regression Analysis is used in determining the variables predicting peer-victimization exposure which is the purpose of the study. On the other hand, the Stepwise Regression Analysis is implemented in order to determine the explanatory variables having high correlation coefficient and the predicted variable. The findings obtained by the research can be summarized as the following: School success, perceived social support and authoritarian parental attitude are the variables predicting the peer-victimization exposure. It has been found out that the other variables in the analysis do not predict the exposure of the students to the peer-victimization. The findings obtained in the research are discussed and commented and suggestions have been made based on the facts.

  18. Is the Front Line Prepared for the Changing Faces of Patients? Predictors of Cross-Cultural Preparedness Among Clinical Nurses and Resident Physicians in Lausanne, Switzerland.

    Science.gov (United States)

    Casillas, Alejandra; Paroz, Sophie; Green, Alexander R; Wolff, Hans; Weber, Orest; Faucherre, Florence; Ninane, Françoise; Bodenmann, Patrick

    2015-01-01

    PHENOMENON: Assuring quality medical care for all persons requires that healthcare providers understand how sociocultural factors affect a patient's health beliefs/behaviors. Switzerland's changing demographics highlight the importance of provider cross-cultural preparedness for all patients-especially those at risk for social/health precarity. We evaluated healthcare provider cross-cultural preparedness for commonly encountered vulnerable patient profiles. A survey on cross-cultural care was mailed to Lausanne University hospital's "front-line healthcare providers": clinical nurses and resident physicians at our institution. Preparedness items asked "How prepared do you feel to care for … ?" (referring to example patient profiles) on an ascending 5-point Likert scale. We examined proportions of "4 - well/5 - very well prepared" and the mean composite score for preparedness. We used linear regression to examine the adjusted effect of demographics, work context, cultural-competence training, and cross-cultural care problem awareness, on preparedness. Of 885 questionnaires, 368 (41.2%) were returned: 124 (33.6%) physicians and 244 (66.4%) nurses. Mean preparedness composite was 3.30 (SD = 0.70), with the lowest proportion of healthcare providers feeling prepared for patients "whose religious beliefs affect treatment" (22%). After adjustment, working in a sensitized department (β = 0.21, p = .01), training on the history/culture of a specific group (β = 0.25, p = .03), and awareness regarding (a) a lack of practical experience caring for diverse populations (β = 0.25, p = .004) and (b) inadequate cross-cultural training (β = 0.18, p = .04) were associated with higher preparedness. Speaking French as a dominant language and physician role (vs. nurse) were negatively associated with preparedness (β = -0.26, p = .01; β = -0.22, p = .01). INSIGHTS: The state of cross-cultural care preparedness among Lausanne's front-line healthcare providers leaves room for

  19. Construction history and construction management

    International Nuclear Information System (INIS)

    Agh, S.

    1999-01-01

    The process of pre-design and design preparation of the Mochovce NPP as well as the construction history of the plant is highlighted, including the financing aspect and problems arising from changes in the technological and other conditions of start-up of the reactor units. The results of international audits performed to improve the level of nuclear safety and implementation of the measures suggested are also described. The milestones of the whole construction process and start-up process, the control and quality system, and the methods of control and management of the complex construction project are outlined. (author)

  20. Construction of three-dimensional liver tissue models by cell accumulation technique and maintaining their metabolic functions for long-term culture without medium change.

    Science.gov (United States)

    Matsuzawa, Atsushi; Matsusaki, Michiya; Akashi, Mitsuru

    2015-04-01

    Three-dimensional (3D) hepatocyte cultures have attracted much attention to obtain high biological functions of hepatocyte for pharmaceutical drug assessment. However, maintaining the high functions for over one month is still a key challenge although many approaches have been reported. In this study, we demonstrate for the first time simple and rapid construction of 3D-hepatocyte constructs by our cell accumulation technique and their high biological functions for one month, without any medium change. The human hepatocyte carcinoma (HepG2) cells were coated with ∼ 7 nm-sized extracellular matrix (ECM) films consisting of fibronectin (FN) and gelatin (G), and then incubated in cell culture insert to construct 3D-tissue constructs for 24 h. The thickness of obtained 3D-HepG2 constructs was easily controlled by altering seeding cell number and the maximum is over 100 μm. When a large volume of culture media was employed, the 3D-constructs showed higher mRNA expression of albumin and some cytochrome P450 (CYP) enzymes as compared to general two-dimensional (2D) culture. Surprisingly, their high cell viabilities (over 80%) and high mRNA expressions were successfully maintained without medium change for at least 27 days. These results demonstrate novel easy and rapid technique to construct 3D-human liver tissue models which can maintain their high functions and viability for 1 month without medium change. © 2014 Wiley Periodicals, Inc.

  1. Modeling of constructed wetland performance in BOD5removal for domestic wastewater under changes in relative humidity using genetic programming.

    Science.gov (United States)

    Sankararajan, Vanitha; Neelakandhan, Nampoothiri; Chandrasekaran, Sivapragasam

    2017-04-01

    Despite the extensive use of constructed wetland (CW) as an effective method for domestic wastewater treatment, there is lack of clarity in arriving at well-defined design guidelines. This is particularly due to the fact that the design of CW is dependent on many inter-connected parameters which interact in a complex manner. Consequently, different researchers in the past have tried to address different aspects of this complexity. In this study, an attempt is made to model the influence of relative humidity (RH) in the effectiveness of BOD 5 removal. Since it is an accepted fact that plants respond to change in humidity, it is necessary to take this parameter into consideration particularly when the CW is to be designed involving changes in relative humidity over a shorter time horizon (say a couple of months). This study reveals that BOD 5out depends on the ratio of BOD 5in and relative humidity. An attempt is also made to model the outlet BOD 5 using genetic programming with inlet BOD 5 and relative humidity as input parameters.

  2. Impact of changes in welfare legislation on the incidence of disability pension. A cohort study of construction workers.

    Science.gov (United States)

    Söderberg, Mia; Mannelqvist, Ruth; Järvholm, Bengt; Schiöler, Linus; Stattin, Mikael

    2018-01-01

    Study objectives were to investigate how changes in social insurance legislation influenced the incidence of disability pension. The study included 295,636 male construction workers who attended health examinations between 1971 and 1993, aged 20-60 years and without previous disability pension. Via the Swedish National Insurance Agency national register we identified 66,046 subjects who were granted disability pension up until 2010. The incidence rates were calculated and stratified according to age and diagnosis. The incidence rate of disability pension was fairly stable until the 1990s when large variations occurred, followed by a strong decreasing trend from the early 2000s to 2010. Trends in incidence rates, stratified by age and diagnosis, showed a consistent decrease in cardiovascular disease for all age groups. In subjects aged 30-49 years there was a high peak around 2003 for musculoskeletal diseases and psychiatric diseases. For the age group 50-59 years, musculoskeletal diagnosis, the most common cause of disability pension, had a sharp peak around 1993 and then a decreasing trend. In the 60-64 age group, the incidence rate for psychiatric diagnosis was stable, while incidence rates for musculoskeletal diagnosis varied during the 1990s. There are considerable variations in the incidence rate of disability pension over time, with different patterns depending on age and diagnosis. Changes in social insurance legislation, as well as in administration processes, seem to influence the variation.

  3. Changes in soil hydraulic properties caused by construction of a simulated waste trench at the Idaho National Engineering Laboratory, Idaho

    International Nuclear Information System (INIS)

    Shakofsky, S.

    1995-03-01

    In order to assess the effect of filled waste disposal trenches on transport-governing soil properties, comparisons were made between profiles of undisturbed soil and disturbed soil in a simulated waste trench. The changes in soil properties induced by the construction of a simulated waste trench were measured near the Radioactive Waste Management Complex at the Idaho National Engineering Laboratory (INEL) in the semiarid southeast region of Idaho. The soil samples were collected, using a hydraulically-driven sampler to minimize sample disruption, from both a simulated waste trench and an undisturbed area nearby. Results show that the undisturbed profile has distinct layers whose properties differ significantly, whereas the soil profile in the simulated waste trench is, by comparison, homogeneous. Porosity was increased in the disturbed cores, and, correspondingly, saturated hydraulic conductivities were on average three times higher. With higher soil-moisture contents (greater than 0.32), unsaturated hydraulic conductivities for the undisturbed cores were typically greater than those for the disturbed cores. With lower moisture contents, most of the disturbed cores had greater hydraulic conductivities. The observed differences in hydraulic conductivities are interpreted and discussed as changes in the soil pore geometry

  4. The development of the Ganges-Brahmaputra tidal delta plain: construction to maintenance phase changes in platform and channel morphology

    Science.gov (United States)

    Wilson, C.; Goodbred, S. L., Jr.; Hale, R. P.; Bain, R. L.

    2016-12-01

    The lower Ganges-Brahmaputra (G-B) delta can be divided into the fluvial-tidal river mouth and distributaries under active construction by the G-B rivers, and the distal tidally maintained deltaplain. In the active river-mouth, distributaries have constructed 5,000 km2 of large, coalescing islands that define the prograding coastline and subaerial-delta front. Although seasonal riverbank erosion is common, the area as a whole has gained land, primarily via horizontal and vertical accretion of intertidal mudflats and seaward progradation of emergent, tidally-elongated sandy channel-mouth bars. An analysis of historical imagery within the active river mouth shows larger and higher order channels form as merging bars and shoal-islands constrict distributary channels, while lower order creeks emerge secondarily, presumably as flow on shoaling intertidal mudflats becomes channelized and mangrove vegetation takes hold. With waning fluvial input (occurring from major distributary migration or avulsion), tidal and marine processes exhibit a stronger control on sediment transport and distribution, as is happening in the downdrift areas of the G-B tidal delta plain. The relatively pristine Sundarbans mangrove forest covers 4,100 km2 along the coast, while 11,200 km2 of the lower tidal delta plain is densely inhabited (population density up to 1,000/km2) and embanked for agricultural purposes. Although considered moribund or abandoned from direct fluvial sediment input, distal portions of the tidal delta are connected to the sediment transport system by its dense network of tidal channels. The subaerial landscape that was initially constructed by the point-sourced input of coarser-grained fluvial sediment from the mainstem rivers is thereafter maintained predominantly by onshore tidal sediment transport of finer-grained silt, and we observe accretion rates as high as 2-4 cm/y supported on the mangrove platform during the monsoon season. The tidal channels show evidence of

  5. The Other "Real World": Gentrification and the Social Construction of Place in Chicago.

    Science.gov (United States)

    Perez, Gina M.

    2002-01-01

    Explores competing constructions and understandings of the gentrifying neighborhoods on Chicago's near northwest side, noting how Puerto Rican youth are implicated in these changes. Explores contradictory images of neighborhoods, residents' responses to these changes, and various linguistic attempts to refashion new ethno-racial designations in…

  6. Residency training program: Perceptions of residents

    African Journals Online (AJOL)

    This study was carried out to ascertain the perception of the residency ... the time of the study. Analysis of the respondents showed similar findings for both senior and junior levels of training. Discussion. The introduction of the residency training program .... Overseas training/ attachment should be re-introduced. 12. (10.1).

  7. Holocene Dunefield Construction, Wind Climate and North Atlantic Climate Change: Data From The West Coast of Jutland, Denmark

    Science.gov (United States)

    Clemmensen, L. B.

    Holocene dunefield construction on the west coast of Jutland (56 N) was episodic (Clemmensen et al., 2001a; 2001b). Evidence from optically stimulated luminescence dating and radiocarbon dating supplemented by archaeological data and historical ob- servations places the onset of these phases of increased aeolian activity to about 4000 BC, 2200 BC, 700 BC, AD 500, AD 1100, and AD 1625. Most of these aeolian events record increased storminess and were simultaneous with climatic cooling phases in the North Atlantic (Bond et al., 1997; Bianchi &McCave, 1999). During these events cool, ice-bearing waters were advected far southward in the North Atlantic Ocean and the atmospheric circulation changed (Bond et al., 1997). Climate model experiments suggest that during periods of increased sea-ice cover and cold waters in the North Atlantic Ocean the jet stream over the North Atlantic was strengthened, causing an enhanced cyclonic activity over large parts of Europe (Renssen et al., 1997; Lopez et al., 2000). These climatic events can probably be explained by a change in solar activity (van Geel et al., 1999). Thus geological data and climate experiments agree well and suggest millennial-scale variability in storminess in Jutland in concert with climatic change in the North Atlantic. References: Bianchi, G. G. &McCave, I. N., 1999: Holocene periodicity in North Atlantic climate and deep-ocean flow south of Iceland. Nature, 397, 515-517. Bond et al., 1997: A pervasive millennial-scale cycle in North Atlantic Holocene and glacial climates. Science, 278, 1257-1266. Clemmensen et al., 2001a: Sedimentology, stratigraphy and landscape evolution of a Holocene coastal dune system, Lodbjerg, NW Jutland, Denmark. Sedimentology,48, 3-27. Clemmensen et al., 2001b: A Holocene coastal aeolian system, Vejers, Denmark: land- scape evolution and sequence stratigraphy. Terra Nova, 13, 129-134.

  8. Significant change in the construction of a door to a room with slowed down neutron field by means of commonly used inexpensive protective materials

    International Nuclear Information System (INIS)

    Konefal, Adam; Laciak, Marcin; Dawidowska, Anna; Osewski, Wojciech

    2014-01-01

    The detailed analysis of nuclear reactions occurring in materials of the door is presented for the typical construction of an entrance door to a room with a slowed down neutron field. The changes in the construction of the door were determined to reduce effectively the level of neutron and gamma radiation in the vicinity of the door in a room adjoining the neutron field room. Optimisation of the door construction was performed with the use of Monte Carlo calculations (GEANT4). The construction proposed in this paper bases on the commonly used inexpensive protective materials such as borax (13.4 cm), lead (4 cm) and stainless steel (0.1 and 0.5 cm on the side of the neutron field room and of the adjoining room, respectively). The improved construction of the door, worked out in the presented studies, can be an effective protection against neutrons with energies up to 1 MeV (authors)

  9. Relative abundance, habitat use, and long-term population changes of wintering and resident landbirds on St. John, U.S. Virgin Islands

    Science.gov (United States)

    David Steadman; Jensen Montambault; Scott Robinson; Sonja Oswalt; Thomas Brandeis; Agustavo Londono; Matthew Reetz; Wendy Schelsky; Natalie Wright; Jeffrey Hoover; Jill Jankowski; Andrew Kratter; Arie Martínez; Jordan. Smith

    2009-01-01

    St. John, U.S. Virgin Islands, is one of the most forested islands in the West Indies and provides an opportunity to conserve both resident birds and wintering neotropical migrants.We conducted double-observer point counts of landbirds in December 2005 and 2006 in Forest Inventory and Analysis (FIA) plots and National Park Service (NPS) trails in Virgin Islands...

  10. Thermal Inertia Performance Evaluation of Light-Weighted Construction Space Envelopes Using Phase Change Materials in Mexico City’s Climate

    OpenAIRE

    Adriana Lira-Oliver; S. Rodolfo S. Vilchis-Martínez

    2017-01-01

    The present study’s main objective was to determine the applicability of organic phase change materials (PCMs) in a building’s envelope construction system for the passive provision of comfortable indoor thermal conditions over one year based on thermal inertia in Mexico City. Research on PCMs relate mainly to their use in building envelope construction systems to reduce energy consumption for mechanical indoor thermal conditioning—not in passive systems. Computer simulation results of mean i...

  11. Resident Characteristics Report

    Data.gov (United States)

    Department of Housing and Urban Development — The Resident Characteristics Report summarizes general information about households who reside in Public Housing, or who receive Section 8 assistance. The report...

  12. A Time Study of Plastic Surgery Residents.

    Science.gov (United States)

    Lau, Frank H; Sinha, Indranil; Jiang, Wei; Lipsitz, Stuart R; Eriksson, Elof

    2016-05-01

    Resident work hours are under scrutiny and have been subject to multiple restrictions. The studies supporting these changes have not included data on surgical residents. We studied the workday of a team of plastic surgery residents to establish prospective time-study data of plastic surgery (PRS) residents at a single tertiary-care academic medical center. Five trained research assistants observed all residents (n = 8) on a PRS service for 10 weeks and produced minute-by-minute activity logs. Data collection began when the team first met in the morning and continued until the resident being followed completed all non-call activities. We analyzed our data from 3 perspectives: 1) time spent in direct patient care (DPC), indirect patient care, and didactic activities; 2) time spent in high education-value activities (HEAs) versus low education-value activities; and 3) resident efficiency. We defined HEAs as activities that surgeons must master; other activities were LEAs. We quantified resident efficiency in terms of time fragmentation and time spent waiting. A total of 642.4 hours of data across 50 workdays were collected. Excluding call, residents worked an average of 64.2 hours per week. Approximately 50.7% of surgical resident time was allotted to DPC, with surgery accounting for the largest segment of this time (34.8%). Time spent on HEAs demonstrated trended upward with higher resident level (P = 0.086). Time in spent in surgery was significantly associated with higher resident levels (P time study of PRS residents, we found that compared with medicine trainees, surgical residents spent 3.23 times more time on DPC. High education-value activities comprised most of our residents' workdays. Surgery was the leading component of both DPC and HEAs. Our residents were highly efficient and fragmented, with the majority of all activities requiring 4 minutes or less. Residents spent a large portion of their time waiting for other services. In light of these data, we

  13. The influence of social niche on cultural niche construction: modelling changes in belief about marriage form in Taiwan.

    Science.gov (United States)

    Lipatov, Mikhail; Brown, Melissa J; Feldman, Marcus W

    2011-03-27

    With introduction of social niche effects into a model of cultural change, the frequency of a practice cannot predict the frequency of its underlying belief. The combination of a general model with empirical data from a specific case illustrates the importance of collaboration between modellers and field researchers, and identifies the type of quantitative data necessary for analysing case studies. Demographic data from colonial-period household registers in Taiwan document a shift in marriage form within 40 years, from a mixture of uxorilocal marriages and virilocal marriages to the latter's dominance. Ethnographic data indicate marriage-related beliefs, costs, ethnic effects and colonial policies as well as the importance of horizontal cultural transmission. We present a formal model for the effects of moral beliefs about marriage and a population economic index on the decline of uxorilocal marriage. We integrate empirical marriage rates and an estimated economic index to produce five projections of the historical frequencies of one belief. These projections demonstrate how economic development may affect a cultural niche. They also indicate the need for future research on the relationship between wealth and cultural variability, the motivational force of cultural versus social factors, and the process of cultural niche construction.

  14. The influence of social niche on cultural niche construction: modelling changes in belief about marriage form in Taiwan

    Science.gov (United States)

    Lipatov, Mikhail; Brown, Melissa J.; Feldman, Marcus W.

    2011-01-01

    With introduction of social niche effects into a model of cultural change, the frequency of a practice cannot predict the frequency of its underlying belief. The combination of a general model with empirical data from a specific case illustrates the importance of collaboration between modellers and field researchers, and identifies the type of quantitative data necessary for analysing case studies. Demographic data from colonial-period household registers in Taiwan document a shift in marriage form within 40 years, from a mixture of uxorilocal marriages and virilocal marriages to the latter's dominance. Ethnographic data indicate marriage-related beliefs, costs, ethnic effects and colonial policies as well as the importance of horizontal cultural transmission. We present a formal model for the effects of moral beliefs about marriage and a population economic index on the decline of uxorilocal marriage. We integrate empirical marriage rates and an estimated economic index to produce five projections of the historical frequencies of one belief. These projections demonstrate how economic development may affect a cultural niche. They also indicate the need for future research on the relationship between wealth and cultural variability, the motivational force of cultural versus social factors, and the process of cultural niche construction. PMID:21320903

  15. USE OF STABILISED EARTH IN THE CONSTRUCTION OF LOW COST SUSTAINABLE HOUSING IN AFRICA – AN ENERGY SOLUTION IN THE ERA OF CLIMATE CHANGE

    Directory of Open Access Journals (Sweden)

    Mohammad Sharif Zami

    2009-07-01

    Full Text Available Stabilised earth is an alternative building material which is significantly cheaper than using conventional brick and concrete, and is also environmentally sustainable. Earth has been used as a construction material in every continent and in every age. It is one of the oldest building materials. The use of earth on site as a building material saves manufacturing cost, time, energy, environmental pollution and transportation cost. Most African countries do not have any well-structured and effective program to address the global agenda of sustainability through the use of appropriate construction materials. In order to demonstrate stabilized earth as a sustainable appropriate construction material, the experiences and practices of using earth construction can be studied and harnessed from other subcontinents to demonstrate the dynamism of this material suitable for low cost house construction in the African subcontinent. This paper aims to identify and highlight potentiality of stabilized earth construction in the solution of low cost housing crisis in Africa and justify the use of this appropriate construction material is an energy solution in the era of climate change.

  16. Evolution of the Pathology Residency Curriculum

    Science.gov (United States)

    Powell, Suzanne Z.; Black-Schaffer, W. Stephen

    2016-01-01

    The required medical knowledge and skill set for the pathologist of 2020 are different than in 2005. Pathology residency training curriculum must accordingly change to fulfill the needs of these ever-changing requirements. In order to make rational curricular adjustments, it is important for us to know the current trajectory of resident training in pathology—where we have been, what our actual current training curriculum is now—to understand how that might change in anticipation of meeting the needs of a changing patient and provider population and to fit within the evolving future biomedical and socioeconomic health-care setting. In 2013, there were 143 Accreditation Council for Graduate Medical Education-accredited pathology residency training programs in the United States, with approximately 2400 residents. There is diversity among residency training programs not only with respect to the number of residents but also in training venue(s). To characterize this diversity among pathology residency training programs, a curriculum survey was conducted of pathology residency program directors in 2013 and compared with a similar survey taken almost 9 years previously in 2005 to identify trends in pathology residency curriculum. Clinical pathology has not changed significantly in the number of rotations over 9 years; however, anatomic pathology has changed dramatically, with an increase in the number of surgical pathology rotations coupled with a decline in stand-alone autopsy rotations. With ever-expanding medical knowledge that the graduating pathology resident must know, it is necessary to (1) reflect upon what are the critical need subjects, (2) identify areas that have become of lesser importance, and then (3) prioritize training accordingly. PMID:28725779

  17. Investigating the Impact of Temperature Changes, Material Aging, and Service Load on the Strain of a Reinforced Concrete Construction

    Science.gov (United States)

    Kanciruk, Adam

    2014-12-01

    Intensive exploitation of coal beds in the Upper Silesia Coal Basin led to the degradation of the Katowice-Muchowiec civilian/military airport. As a result, it became necessary to adapt the Pyrzowice military airport for use as a public transport facility. This involved reconstruction of a hangar located at the airport. As part of this process, a new hangar slab was constructed, designed in such a way as to bear the load of passenger aircraft. In the area of the greatest wheel load to the slab, three strain rosettes were installed for the purpose of monitoring the slab strain. The mointoring process - which has been automatically conducted for almost three years now - revealed deformations resulting from service load, the aging of reinforced concrete, and changes of its temperature. Intensywna eksploatacja górnośląskich złóż węgla doprowadziła do degradacji cywilno-wojskowego lotniska Katowice-Muchowiec. W związku z tym, wynikła konieczność przystosowania do celów komunikacyjnych lotniska wojskowego w Pyrzowicach, w tym przebudowy znajdującego się na jego terenie hangaru. W ramach przebudowy wykonano nową posadzkę, zdolną przenosić ciężar samolotów pasażerskich. W posadzce tej, w rejonie występowania największych nacisków zainstalowano 3 rozety tensometryczne w celu monitorowania jej odkształceń. Monitorowanie to, prowadzone w sposób automatyczny już niemal 3 lata, wykazało występowanie odkształceń będących skutkiem obciążeń eksploatacyjnych, starzenia się żelbetu oraz zmian jego temperatury.

  18. Enhancing teamwork between chief residents and residency program directors: description and outcomes of an experiential workshop.

    Science.gov (United States)

    McPhillips, Heather A; Frohna, John G; Murad, M Hassan; Batra, Maneesh; Panda, Mukta; Miller, Marsha A; Brigham, Timothy P; Doughty, Robert A

    2011-12-01

    An effective working relationship between chief residents and residency program directors is critical to a residency program's success. Despite the importance of this relationship, few studies have explored the characteristics of an effective program director-chief resident partnership or how to facilitate collaboration between the 2 roles, which collectively are important to program quality and resident satisfaction. We describe the development and impact of a novel workshop that paired program directors with their incoming chief residents to facilitate improved partnerships. The Accreditation Council for Graduate Medical Education sponsored a full-day workshop for residency program directors and their incoming chief residents. Sessions focused on increased understanding of personality styles, using experiential learning, and open communication between chief residents and program directors, related to feedback and expectations of each other. Participants completed an anonymous survey immediately after the workshop and again 8 months later to assess its long-term impact. Participants found the workshop to be a valuable experience, with comments revealing common themes. Program directors and chief residents expect each other to act as a role model for the residents, be approachable and available, and to be transparent and fair in their decision-making processes; both groups wanted feedback on performance and clear expectations from each other for roles and responsibilities; and both groups identified the need to be innovative and supportive of changes in the program. Respondents to the follow-up survey reported that workshop participation improved their relationships with their co-chiefs and program directors. Participation in this experiential workshop improved the working relationships between chief residents and program directors. The themes that were identified can be used to foster communication between incoming chief residents and residency directors and to

  19. Internal medicine residency training in Turkey.

    Science.gov (United States)

    Sahin, Hatice; Akcicek, Fehmi

    2005-12-01

    Medical school entrance depends on passing a central examination that is given annually by the National Selection and Placement Center. Undergraduate medical education takes 6 years. About 5000 students graduate from medical faculties annually. The central exam necessary for residency training is given by the National Selection and Placement Center. A Specialist Training Regulation regulates residency training. Internal medicine residency training takes 4 years and includes inpatient and outpatient care in wards and rotations. Residents prepare a dissertation that is used in the evaluation of residency competency. At the end of the residency period, residents who have been successful in previous evaluations take an oral exam followed by a written exam, which lead to their certification in internal medicine. Residents' scientific knowledge and skills are assessed by a jury consisting of five people, four from the same department and one from the equivalent department in another training institution. The title of specialist is granted after a certification exam given by training institutions and approved by the Ministry of Health. Internists are mainly employed in state hospitals, which are under the Ministry of Health. Subspecialty areas in internal medicine include gastroenterology, geriatrics, endocrinology, nephrology, hematology, rheumatology, immunology, allergology, and oncology. The training period for a subspecialty is 2 years. A substantial effort is being made all over the country to improve regulations and health care service delivery. These changes will also affect the residency training and manpower planning and employment of internists.

  20. A Retrospective Mid- and Long-term Follow-up Study on the Changes in Hematologic Parameters in the Highly Exposed Residents of the Hebei Spirit Oil Spill in Taean, South Korea.

    Science.gov (United States)

    Choi, Young-Hyun; Hong, Jee-Young; Lee, Moo-Sik

    2017-10-01

    This study aimed to analyze changes in hematologic parameters in the residents of the areas highly contaminated by the Hebei Spirit Oil Spill in 2007 and those who participated in the clean-up activities. According to demographic characteristics, health status and behavior, and level of exposure to oil, we compared the hematologic results in 2009 and 2012 among 701 residents. The hematologic parameters were composed of white blood cell (WBC) count, and levels of hemoglobin, hematocrit (Hct), aspartate aminotransferase (AST), alanine aminotransferase (ALT), glucose, glycosylated hemoglobin (HbA1c), blood urea nitrogen (BUN), creatinine (Cr), total cholesterol (T-chol), high-density lipoprotein (HDL), and triglyceride (TG). Paired t -test revealed that the WBC count and levels of Hct, AST, ALT, glucose, and HbA1c significantly increased, whereas the BUN, Cr, HDL, and TG levels significantly decreased. Multiple linear regression modelling showed a relationship between the level of exposure to oil and temporal changes in Hct, glucose, HbA1c, and BUN levels. Our results suggest a relationship between level of exposure to oil and changes in hematologic parameters over 3 years. Further studies should be conducted to determine the impact of oil spill on health such as the occurrence of diseases.

  1. A Retrospective Mid- and Long-term Follow-up Study on the Changes in Hematologic Parameters in the Highly Exposed Residents of the Hebei Spirit Oil Spill in Taean, South Korea

    Science.gov (United States)

    Choi, Young-Hyun; Hong, Jee-Young; Lee, Moo-Sik

    2017-01-01

    Objectives This study aimed to analyze changes in hematologic parameters in the residents of the areas highly contaminated by the Hebei Spirit Oil Spill in 2007 and those who participated in the clean-up activities. Methods According to demographic characteristics, health status and behavior, and level of exposure to oil, we compared the hematologic results in 2009 and 2012 among 701 residents. The hematologic parameters were composed of white blood cell (WBC) count, and levels of hemoglobin, hematocrit (Hct), aspartate aminotransferase (AST), alanine aminotransferase (ALT), glucose, glycosylated hemoglobin (HbA1c), blood urea nitrogen (BUN), creatinine (Cr), total cholesterol (T-chol), high-density lipoprotein (HDL), and triglyceride (TG). Results Paired t-test revealed that the WBC count and levels of Hct, AST, ALT, glucose, and HbA1c significantly increased, whereas the BUN, Cr, HDL, and TG levels significantly decreased. Multiple linear regression modelling showed a relationship between the level of exposure to oil and temporal changes in Hct, glucose, HbA1c, and BUN levels. Conclusion Our results suggest a relationship between level of exposure to oil and changes in hematologic parameters over 3 years. Further studies should be conducted to determine the impact of oil spill on health such as the occurrence of diseases. PMID:29164048

  2. Development and implementation of a residency project advisory board.

    Science.gov (United States)

    Dagam, Julie K; Iglar, Arlene; Kindsfater, Julie; Loeb, Al; Smith, Chad; Spexarth, Frank; Brierton, Dennis; Woller, Thomas

    2017-06-15

    The development and implementation of a residency project advisory board (RPAB) to manage multiple pharmacy residents' yearlong projects across several residency programs are described. Preceptor and resident feedback during our annual residency program review and strategic planning sessions suggested the implementation of a more-coordinated approach to the identification, selection, and oversight of all components of the residency project process. A panel of 7 department leaders actively engaged in residency training and performance improvement was formed to evaluate the residency project process and provide recommendations for change. These 7 individuals would eventually constitute the RPAB. The primary objective of the RPAB at Aurora Health Care is to provide oversight and a structured framework for the selection and execution of multiple residents' yearlong projects across all residency programs within our organization. Key roles of the RPAB include developing expectations, coordinating residency project ideas, and providing oversight and feedback. The development and implementation of the RPAB resulted in a significant overhaul of our entire yearlong resident project process. Trends toward success were realized after the first year of implementation, including consistent expectations, increased clarity and engagement in resident project ideas, and more projects meeting anticipated endpoints. The development and implementation of an RPAB have provided a framework to optimize the organization, progression, and outcomes of multiple pharmacy resident yearlong projects in all residency programs across our pharmacy enterprise. Copyright © 2017 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

  3. Personal Therapy in Psychiatry Residency Training: A National Survey of Canadian Psychiatry Residents.

    Science.gov (United States)

    Hadjipavlou, George; Halli, Priyanka; Hernandez, Carlos A Sierra; Ogrodniczuk, John S

    2016-02-01

    The authors collected nationally representative data on Canadian residents' experiences with and perspectives on personal psychotherapy in their psychiatric training. A 43-item questionnaire was distributed electronically to all current psychiatry residents in Canada (N = 839). Four hundred residents from every program across Canada returned the survey (response rate 47.7%). The prevalence of personal therapy at any time was 55.3%, with 42.8% receiving personal therapy during residency. Of residents who undertook personal psychotherapy, 59.3% engaged in weekly therapy, 74.1% received psychodynamic psychotherapy, and 81.5% participated in long-term therapy (>1 year). Personal growth, self-understanding, and professional development were the most common reasons for engaging in personal therapy; however, one-third of residents did so to alleviate symptoms of depression, anxiety, or other mental health concerns. Time was the most important factor impeding residents from personal therapy; only 8.8% found stigma to act as a barrier. The vast majority of residents rated their experience with personal therapy as having a positive or very positive impact on their personal life (84.8%) and overall development as psychiatrists (81.8%). For 64% of respondents, personal therapy had an important or very important role in psychiatry residency training. Residents who received personal therapy rated themselves as better able to understand what happens moment by moment during therapy sessions, detect and deal with patients' emotional reactions, and constructively use their personal reactions to patients. Interest in personal therapy remains strong among psychiatry trainees in Canada. Residents who engaged in psychotherapy endorsed greater confidence in psychotherapy and rated their psychotherapy skills more favorably than those who had never been in the patient role, supporting the view of personal therapy as an important adjunct to psychotherapy training during residency.

  4. Flexibility in PPP contracts : Dealing with potential change in the pre-contract phase of a construction project

    NARCIS (Netherlands)

    Demirel, H.C.; Leendertse, W.L.; Volker, L.; Hertogh, M.J.C.M.

    2016-01-01

    Public Private Partnerships (PPPs) cover a range of possible relationships between public and private parties. PPP contracts are typically used in contexts of great uncertainty, such as large construction and infrastructure projects that are realized over a longer period of time. Hence, a major

  5. Spatiotemporal Changes of Built-Up Land Expansion and Carbon Emissions Caused by the Chinese Construction Industry.

    Science.gov (United States)

    Chuai, Xiaowei; Huang, Xianjin; Lu, Qinli; Zhang, Mei; Zhao, Rongqin; Lu, Junyu

    2015-11-03

    China is undergoing rapid urbanization, enlarging the construction industry, greatly expanding built-up land, and generating substantial carbon emissions. We calculated both the direct and indirect carbon emissions from energy consumption (anthropogenic emissions) in the construction sector and analyzed built-up land expansion and carbon storage losses from the terrestrial ecosystem. According to our study, the total anthropogenic carbon emissions from the construction sector increased from 3,905×10(4) to 103,721.17×10(4) t from 1995 to 2010, representing 27.87%-34.31% of the total carbon emissions from energy consumption in China. Indirect carbon emissions from other industrial sectors induced by the construction sector represented approximately 97% of the total anthropogenic carbon emissions of the sector. These emissions were mainly concentrated in seven upstream industry sectors. Based on our assumptions, built-up land expansion caused 3704.84×10(4) t of carbon storage loss from vegetation between 1995 and 2010. Cropland was the main built-up land expansion type across all regions. The study shows great regional differences. Coastal regions showed dramatic built-up land expansion, greater carbon storage losses from vegetation, and greater anthropogenic carbon emissions. These regional differences were the most obvious in East China followed by Midsouth China. These regions are under pressure for strong carbon emissions reduction.

  6. Facility Focus: Residence Halls.

    Science.gov (United States)

    College Planning & Management, 2003

    2003-01-01

    Describes four examples of residence hall design, one renovation and three new residence halls, that exemplify design principles that meet student and institutional requirements. The examples are at (1) the University of Illinois at Chicago; (2) Bowdoin College; (3) Muhlenberg College; and (4) Spring Arbor University. (SLD)

  7. Rain Forest Dance Residency.

    Science.gov (United States)

    Watson, Dawn

    1997-01-01

    Outlines the author's experience as a dancer and choreographer artist-in-residence with third graders at a public elementary school, providing a cultural arts experience to tie in with a theme study of the rain forest. Details the residency and the insights she gained working with students, teachers, and theme. (SR)

  8. Systematic Review of Methods in Low-Consensus Fields: Supporting Commensuration through `Construct-Centered Methods Aggregation' in the Case of Climate Change Vulnerability Research.

    Science.gov (United States)

    Delaney, Aogán; Tamás, Peter A; Crane, Todd A; Chesterman, Sabrina

    2016-01-01

    There is increasing interest in using systematic review to synthesize evidence on the social and environmental effects of and adaptations to climate change. Use of systematic review for evidence in this field is complicated by the heterogeneity of methods used and by uneven reporting. In order to facilitate synthesis of results and design of subsequent research a method, construct-centered methods aggregation, was designed to 1) provide a transparent, valid and reliable description of research methods, 2) support comparability of primary studies and 3) contribute to a shared empirical basis for improving research practice. Rather than taking research reports at face value, research designs are reviewed through inductive analysis. This involves bottom-up identification of constructs, definitions and operationalizations; assessment of concepts' commensurability through comparison of definitions; identification of theoretical frameworks through patterns of construct use; and integration of transparently reported and valid operationalizations into ideal-type research frameworks. Through the integration of reliable bottom-up inductive coding from operationalizations and top-down coding driven from stated theory with expert interpretation, construct-centered methods aggregation enabled both resolution of heterogeneity within identically named constructs and merging of differently labeled but identical constructs. These two processes allowed transparent, rigorous and contextually sensitive synthesis of the research presented in an uneven set of reports undertaken in a heterogenous field. If adopted more broadly, construct-centered methods aggregation may contribute to the emergence of a valid, empirically-grounded description of methods used in primary research. These descriptions may function as a set of expectations that improves the transparency of reporting and as an evolving comprehensive framework that supports both interpretation of existing and design of future

  9. Systematic Review of Methods in Low-Consensus Fields: Supporting Commensuration through `Construct-Centered Methods Aggregation’ in the Case of Climate Change Vulnerability Research

    Science.gov (United States)

    Crane, Todd A.; Chesterman, Sabrina

    2016-01-01

    There is increasing interest in using systematic review to synthesize evidence on the social and environmental effects of and adaptations to climate change. Use of systematic review for evidence in this field is complicated by the heterogeneity of methods used and by uneven reporting. In order to facilitate synthesis of results and design of subsequent research a method, construct-centered methods aggregation, was designed to 1) provide a transparent, valid and reliable description of research methods, 2) support comparability of primary studies and 3) contribute to a shared empirical basis for improving research practice. Rather than taking research reports at face value, research designs are reviewed through inductive analysis. This involves bottom-up identification of constructs, definitions and operationalizations; assessment of concepts’ commensurability through comparison of definitions; identification of theoretical frameworks through patterns of construct use; and integration of transparently reported and valid operationalizations into ideal-type research frameworks. Through the integration of reliable bottom-up inductive coding from operationalizations and top-down coding driven from stated theory with expert interpretation, construct-centered methods aggregation enabled both resolution of heterogeneity within identically named constructs and merging of differently labeled but identical constructs. These two processes allowed transparent, rigorous and contextually sensitive synthesis of the research presented in an uneven set of reports undertaken in a heterogenous field. If adopted more broadly, construct-centered methods aggregation may contribute to the emergence of a valid, empirically-grounded description of methods used in primary research. These descriptions may function as a set of expectations that improves the transparency of reporting and as an evolving comprehensive framework that supports both interpretation of existing and design of future

  10. Effectiveness of resident as teacher curriculum in preparing emergency medicine residents for their teaching role.

    Science.gov (United States)

    Hosein Nejad, Hooman; Bagherabadi, Mehdi; Sistani, Alireza; Dargahi, Helen

    2017-01-01

    Over the past 30 years, recognizing the need and importance of training residents in teaching skills has resulted in several resident-as-teacher programs. The purpose of this study was to explore the impact of this teaching initiative and investigate the improvement in residents' teaching skills through evaluating their satisfaction and perceived effectiveness as well as assessing medical students' perception of the residents' teaching quality. This research is a quasi-experimental study with pre- and post-tests, continuing from Dec 2010 to May 2011 in Imam Hospital, Tehran University of Medical Sciences. In this survey, Emergency Medicine Residents (n=32) participated in an 8-hour workshop. The program evaluation was performed based on Kirkpatrick's model by evaluation of residents in two aspects: self-assessment and evaluation by interns who were trained by these residents. Content validity of the questionnaires was judged by experts and reliability was carried out by test re-test. The questionnaires were completed before and after the intervention. Paired sample t-test was applied to analyze the effect of RAT curriculum and workshop on the improvement of residents' teaching skills based on their self-evaluation and Mann-Whitney U test was used to identify significant differences between the two evaluator groups before and after the workshop. The results indicated that residents' attitude towards their teaching ability was improved significantly after participating in the workshop (pTeacher for emergency medicine residents resulted in favorable outcomes in the second evaluated level of Kirkpatrick's model, i.e. it showed measurable positive changes in the self-assessments of medical residents about different aspects of teaching ability and performance. However, implementing training sessions for resident physicians, although effective in improving their confidence and self-assessment of their teaching skills, seems to cause no positive change in the third

  11. Significant change in the construction of a door to a room with slowed down neutron field by means of commonly used inexpensive protective materials.

    Science.gov (United States)

    Konefał, Adam; Łaciak, Marcin; Dawidowska, Anna; Osewski, Wojciech

    2014-12-01

    The detailed analysis of nuclear reactions occurring in materials of the door is presented for the typical construction of an entrance door to a room with a slowed down neutron field. The changes in the construction of the door were determined to reduce effectively the level of neutron and gamma radiation in the vicinity of the door in a room adjoining the neutron field room. Optimisation of the door construction was performed with the use of Monte Carlo calculations (GEANT4). The construction proposed in this paper bases on the commonly used inexpensive protective materials such as borax (13.4 cm), lead (4 cm) and stainless steel (0.1 and 0.5 cm on the side of the neutron field room and of the adjoining room, respectively). The improved construction of the door, worked out in the presented studies, can be an effective protection against neutrons with energies up to 1 MeV. © The Author 2013. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

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

    Science.gov (United States)

    Smalley, Hannah K; Keskinocak, Pinar

    2016-03-01

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

  13. Climate Change, a Case Study of Media Construction of Environmental Problems; El Cambio Climatico como Casuistica de la Construccion Mediatica de los Problemas Medioambientales

    Energy Technology Data Exchange (ETDEWEB)

    Lopera, E.

    2009-07-21

    Nowadays climate change is one of the environmental problems in the global policy agenda. However, in countries like United States and United Kingdom the media started to report regularly on this issue in 1988. Since then many researches have been carrying out focused on how the media influence, along with other factors, public understanding of climate change through the media construction of the problem in several countries. Given the implications of social acceptance for design and implementation of public policies on mitigation and adaptation to climate change, the overall aim of this report is to review the status of the issue from a qualitative and quantitative approach. Qualitatively, media construction of climate change is described as the result of different processes taking place at macro and micro scales. Interactions among scientists, politicians, industry, the media themselves and the social context are considered macro-scale influences, while journalistic values and norms shape the media coverage of this environmental problem at micro-scale when media professionals report on climate change. From a quantitative point of view this paper also includes the evolution of newspaper coverage on climate change in Spain from 1996 to 2006 and these figures are compared to the results obtained in the United States and United Kingdom during the same period. (Author) 23 refs.

  14. Health changes of refugees from Afghanistan, Iran and Somalia: role of residence status and experienced living difficulties in the resettlement process.

    NARCIS (Netherlands)

    Lamkaddem, M.; Essink-Bot, M.; Gerritsen, A.A.M.; Devillé, W.; Stronks, K.

    2013-01-01

    Introduction: Refugees and asylum seekers are an important group of new immigrants in today’s Europe. Despite recent research efforts information on changes in health upon resettlement is scarce. We analyzed the mechanisms underlying changes in mental and physical health after arrival in The

  15. Residents in difficulty

    DEFF Research Database (Denmark)

    Christensen, Mette Krogh; O'Neill, Lotte; Hansen, Dorthe Høgh

    2016-01-01

    Background The majority of studies on prevalence and characteristics of residents in difficulty have been conducted in English-speaking countries and the existing literature may not reflect the prevalence and characteristics of residents in difficulty in other parts of the world such as the Scand......Background The majority of studies on prevalence and characteristics of residents in difficulty have been conducted in English-speaking countries and the existing literature may not reflect the prevalence and characteristics of residents in difficulty in other parts of the world...... such as the Scandinavian countries, where healthcare systems are slightly different. The aim of this study was to examine prevalence and characteristics of residents in difficulty in one out of three postgraduate medical training regions in Denmark, and to produce both a quantifiable overview and in-depth understanding...... of the topic. Methods We performed a mixed methods study. All regional residency program directors (N = 157) were invited to participate in an e-survey about residents in difficulty. Survey data were combined with database data on demographical characteristics of the background population (N = 2399...

  16. Medication Refusal: Resident Rights, Administration Dilemma.

    Science.gov (United States)

    Haskins, Danielle R; Wick, Jeannette Y

    2017-12-01

    Occasionally, residents actively or passively refuse to take medications. Residents may refuse medication for a number of reasons, including religious beliefs, dietary restrictions, misunderstandings, cognitive impairment, desire to self-harm, or simple inconvenience. This action creates a unique situation for pharmacists and long-term facility staff, especially if patients have dementia. Residents have the legal right to refuse medications, and long-term care facilities need to employ a process to resolve disagreement between the health care team that recommends the medication and the resident who refuses it. In some cases, simple interventions like selecting a different medication or scheduling medications in a different time can address and resolve the resident's objection. If the medical team and the resident cannot resolve their disagreement, often an ethics consultation is helpful. Documenting the resident's refusal to take any or all medications, the health care team's actions and any other outcomes are important. Residents' beliefs may change over time, and the health care team needs to be prepared to revisit the issue as necessary.

  17. Social cost in construction projects

    International Nuclear Information System (INIS)

    Çelik, Tolga; Kamali, Saeed; Arayici, Yusuf

    2017-01-01

    Despite the fact that completion of construction projects has a direct positive impact on the growth of national and local economies as well as humans' wellbeing, construction projects, especially in the urban areas, generate serious environmental nuisances for the adjacent residents and have unintentional adverse impacts on their surrounding environment. Construction causative adverse impacts on the neighbouring communities are known as the social costs. This study aims to present a state-of-the-art overview of social costs in construction industry in terms of definition, consideration, classification and quantification. Furthermore, it is aimed to bring the construction social cost phenomenon for the agenda of Environmental Impact Assessors.

  18. Improving applicant selection: identifying qualities of the unsuccessful otolaryngology resident.

    Science.gov (United States)

    Badran, Karam W; Kelley, Kanwar; Conderman, Christian; Mahboubi, Hossein; Armstrong, William B; Bhandarkar, Naveen D

    2015-04-01

    To identify the prevalence and management of problematic residents. Additionally, we hope to identify the factors associated with successful remediation of unsuccessful otolaryngology residents. Self-reported Internet and paper-based survey. An anonymous survey was distributed to 152 current and former program directors (PDs) in 2012. The factors associated with unsuccessful otolaryngology residents and those associated with the successful remediation of problematic residents were investigated. An unsuccessful resident is defined as one who quit or was removed from the program for any reason, or one whose actions resulted in criminal action or citation against their medical license after graduation from residency. Remediation is defined as an individualized program implemented to correct documented weaknesses. The overall response rate was 26% (40 PDs). Seventy-three unsuccessful or problematic residents were identified. Sixty-six problematic or unsuccessful residents were identified during residency, with 58 of 66 (88%) undergoing remediation. Thirty-one (47%) residents did not graduate. The most commonly identified factors of an unsuccessful resident were: change in specialty (21.5%), interpersonal and communication skills with health professionals (13.9%), and clinical judgment (10.1%). Characteristics of those residents who underwent successful remediation include: poor performance on in-training examination (17%, P otolaryngology PDs in this sample identified at least one unsuccessful resident. Improved methods of applicant screening may assist in optimizing otolaryngology resident selection. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

  19. Government, Anti-Reflexivity, and the Construction of Public Ignorance about Climate Change: Australia and Canada Compared

    OpenAIRE

    Nathan Young; Aline Coutinho

    2013-01-01

    This article compares the political strategies used by conservative governments in Australia (John Howard) and Canada (Stephen Harper) to manage public impressions of climate change and climate change policy. These cases are significant in part because both governments acted against the weight of domestic public opinion. While many studies of political resistance to climate change mitigation focus on the role of denial, skepticism, and counter-claims, our comparison finds a significant role f...

  20. Technology in Residence.

    Science.gov (United States)

    Fox, Jordan

    1999-01-01

    Discusses the necessity for incorporating current technology in today's college residence halls to meet the more diverse and continued activities of its students. Technology addressed covers data networking and telecommunications, heating and cooling systems, and fire-safety systems. (GR)

  1. Thermal Inertia Performance Evaluation of Light-Weighted Construction Space Envelopes Using Phase Change Materials in Mexico City’s Climate

    Directory of Open Access Journals (Sweden)

    Adriana Lira-Oliver

    2017-10-01

    Full Text Available The present study’s main objective was to determine the applicability of organic phase change materials (PCMs in a building’s envelope construction system for the passive provision of comfortable indoor thermal conditions over one year based on thermal inertia in Mexico City. Research on PCMs relate mainly to their use in building envelope construction systems to reduce energy consumption for mechanical indoor thermal conditioning—not in passive systems. Computer simulation results of mean indoor temperature variations are presented with the objective of evaluating these construction systems’ thermal inertia properties. In the present study, dynamic thermal simulations (DTS, using EnergyPlus software, of ten 1 m3 test units with envelope construction systems combining organic PCMs of different fusion temperatures with conventional materials were performed. Based on the results, it is concluded that the implementation of organic PCMs with a fusion temperature around 25 °C in combination with aerated concrete in a space envelope results in the highest number of hours the indoor temperatures remain within the comfort range throughout a typical year, due to the decrement of indoor temperature oscillations and, to a large extent, to thermal lag.

  2. Assessing working memory in children with ADHD: Minor administration and scoring changes may improve digit span backward's construct validity.

    Science.gov (United States)

    Wells, Erica L; Kofler, Michael J; Soto, Elia F; Schaefer, Hillary S; Sarver, Dustin E

    2018-01-01

    Pediatric ADHD is associated with impairments in working memory, but these deficits often go undetected when using clinic-based tests such as digit span backward. The current study pilot-tested minor administration/scoring modifications to improve digit span backward's construct and predictive validities in a well-characterized sample of children with ADHD. WISC-IV digit span was modified to administer all trials (i.e., ignore discontinue rule) and count digits rather than trials correct. Traditional and modified scores were compared to a battery of criterion working memory (construct validity) and academic achievement tests (predictive validity) for 34 children with ADHD ages 8-13 (M=10.41; 11 girls). Traditional digit span backward scores failed to predict working memory or KTEA-2 achievement (allns). Alternate administration/scoring of digit span backward significantly improved its associations with working memory reordering (r=.58), working memory dual-processing (r=.53), working memory updating (r=.28), and KTEA-2 achievement (r=.49). Consistent with prior work, these findings urge caution when interpreting digit span performance. Minor test modifications may address test validity concerns, and should be considered in future test revisions. Digit span backward becomes a valid measure of working memory at exactly the point that testing is traditionally discontinued. Copyright © 2017 Elsevier Ltd. All rights reserved.

  3. The organizational transformative power of nurse residency programs.

    Science.gov (United States)

    Kramer, Marlene; Maguire, Pat; Halfer, Diana; Budin, Wendy C; Hall, Debra S; Goodloe, Lauren; Klaristenfeld, Jessica; Teasley, Susan; Forsey, Lynn; Lemke, Johanna

    2012-01-01

    Residency programs for newly licensed registered nurses (NLRNs) have been strongly advocated by the Institute of Medicine, American Organization of Nurse Executives, and other professional organizations. Their cost-effectiveness as well as their impact on NLRN retention, job and practice satisfaction, improved performance, and reduction in environmental reality shock has been demonstrated. This qualitative study sought answers to the question: what people, components, processes and activities of Nurse Residency Programs (NRPs), and the work environment are instrumental in the transition and integration of NLRNs into the professional practice role and into professional communities? In the course of interviewing 907 nurses-NLRNs, experienced nurses, managers, and educators-practicing on clinical units with confirmed "very healthy work environments" in 20 Magnet hospitals, it became evident that not only did NRPs positively impact the professional socialization of NLRNs, they led to transformative changes in the organization and in the practice of other health care professionals. The organizational transformative changes described by the interviewees are presented for each of the 7 major challenges identified by NLRNs-delegation, prioritization, managing patient care delivery, autonomous decision-making, collaboration with other disciplines, constructive conflict resolution, and utilizing feedback to restore self-confidence. If it can be demonstrated that these transformative changes stimulated by NRPs also lead to improved patient outcomes, NRPs may be the most significant organization transformation instituted by nurse leaders in recent years.

  4. Do dam constructions in a Vietnamese river basin result in change points in hydrologic regime and how reliable are different methods?

    Science.gov (United States)

    Vu, Tinh Thi; Kiesel, Jens; Guse, Bjoern; Fohrer, Nicola

    2017-04-01

    The damming of rivers causes one of the most considerable impacts of our society on the riverine environment. More than 50% of the world's streams and rivers are currently impounded by dams before reaching the oceans. The construction of dams is of high importance in developing and emerging countries, i.e. for power generation and water storage. In the Vietnamese Vu Gia - Thu Bon Catchment (10,350 km2), about 23 dams were built during the last decades and store approximately 2,156 billion m3 of water. The water impoundment in 10 dams in upstream regions amounts to 17 % of the annual discharge volume. It is expected that impacts from these dams have altered the natural flow regime. However, up to now it is unclear how the flow regime was altered. For this, it needs to be investigated at what point in time these changes became significant and detectable. Many approaches exist to detect changes in stationary or consistency of hydrological records using statistical analysis of time series for the pre- and post-dam period. The objective of this study is to reliably detect and assess hydrologic shifts occurring in the discharge regime of an anthropogenically influenced river basin, mainly affected by the construction of dams. To achieve this, we applied nine available change-point tests to detect change in mean, variance and median on the daily and annual discharge records at two main gauges of the basin. The tests yield conflicting results: The majority of tests found abrupt changes that coincide with the damming-period, while others did not. To interpret how significant the changes in discharge regime are, and to which different properties of the time series each test responded, we calculated Indicators of Hydrologic Alteration (IHAs) for the time period before and after the detected change points. From the results, we can deduce, that the change point tests are influenced in different levels by different indicator groups (magnitude, duration, frequency, etc) and that

  5. Satisfaction among residents in ASHP-accredited pharmacy residency programs.

    Science.gov (United States)

    VanDenBerg, C; Murphy, J E

    1997-07-01

    The level of work satisfaction among pharmacists in ASHP-accredited residencies was studied. In March 1996 a questionnaire designed to measure residency satisfaction was mailed to 697 individuals in ASHP-accredited pharmacy practice and specialty practice residencies. Subjects responded to 16 statements relating to intrinsic and extrinsic determinants of work satisfaction on a scale of 1 to 5, where 1 = strongly disagree and 5 = strongly agree. Questionnaires were returned by 413 (59%) of the residents. The respondents were predominantly women (76%), and most (86%) had at least a Pharm. D. degree. Hospitals were the primary work setting (88%). Of the 413 residents, 305 were in pharmacy practice residencies and 108 were in specialized residencies. None of the mean scores indicated disagreement (scores 3) with the negatively worded statements. The median and mode were equal to 2 (disagree) for the three negatively worded items and 4 (agree) for all but three positively worded items. Only 8% of the residents indicated that they would not accept the residency again if given the chance. Specialized residents tended to rate positively worded statements higher and negatively worded statements lower than pharmacy practice residents. Female residents indicated greater satisfaction than male residents. Pay and benefits were rated slightly better than neutral. Pharmacy residents appeared generally satisfied with their residencies. Specialized pharmacy residents were more satisfied than pharmacy practice residents, and women were more satisfied than men.

  6. Results of the 2005-2008 Association of Residents in Radiation Oncology Survey of Chief Residents in the United States: Clinical Training and Resident Working Conditions

    International Nuclear Information System (INIS)

    Gondi, Vinai; Bernard, Johnny Ray; Jabbari, Siavash; Keam, Jennifer; Amorim Bernstein, Karen L. de; Dad, Luqman K.; Li, Linna; Poppe, Matthew M.; Strauss, Jonathan B.; Chollet, Casey T.

    2011-01-01

    Purpose: To document clinical training and resident working conditions reported by chief residents during their residency. Methods and Materials: During the academic years 2005 to 2006, 2006 to 2007, and 2007 to 2008, the Association of Residents in Radiation Oncology conducted a nationwide survey of all radiation oncology chief residents in the United States. Chi-square statistics were used to assess changes in clinical training and resident working conditions over time. Results: Surveys were completed by representatives from 55 programs (response rate, 71.4%) in 2005 to 2006, 60 programs (75.9%) in 2006 to 2007, and 74 programs (93.7%) in 2007 to 2008. Nearly all chief residents reported receiving adequate clinical experience in commonly treated disease sites, such as breast and genitourinary malignancies; and commonly performed procedures, such as three-dimensional conformal radiotherapy and intensity-modulated radiotherapy. Clinical experience in extracranial stereotactic radiotherapy increased over time (p < 0.001), whereas clinical experience in endovascular brachytherapy (p <0.001) decreased over time. The distribution of gynecologic and prostate brachytherapy cases remained stable, while clinical case load in breast brachytherapy increased (p = 0.006). A small but significant percentage of residents reported receiving inadequate clinical experience in pediatrics, seeing 10 or fewer pediatric cases during the course of residency. Procedures involving higher capital costs, such as particle beam therapy and intraoperative radiotherapy, and infrequent clinical use, such as head and neck brachytherapy, were limited to a minority of institutions. Most residency programs associated with at least one satellite facility have incorporated resident rotations into their clinical training, and the majority of residents at these programs find them valuable experiences. The majority of residents reported working 60 or fewer hours per week on required clinical duties

  7. Mapping human vulnerability to climate change in the Brazilian Amazon: The construction of a municipal vulnerability index.

    Science.gov (United States)

    Menezes, Júlia Alves; Confalonieri, Ulisses; Madureira, Ana Paula; Duval, Isabela de Brito; Santos, Rhavena Barbosa Dos; Margonari, Carina

    2018-01-01

    Vulnerability, understood as the propensity to be adversely affected, has attained importance in the context of climate change by helping to understand what makes populations and territories predisposed to its impacts. Conditions of vulnerability may vary depending on the characteristics of each territory studied-social, environmental, infrastructural, public policies, among others. Thus, the present study aimed to evaluate what makes the municipalities of the state of Amazonas, Brazil, vulnerable to climate change in the context of the largest tropical forest in the world, and which regions of the State are the most susceptible. A Municipal Vulnerability Index was developed, which was used to associate current socio-environmental characteristics of municipalities with climate change scenarios in order to identify those that may be most affected by climate change. The results showed that poor adaptive capacity and poverty had the most influence on current vulnerability of the municipalities of Amazonas with the most vulnerable areas being the southern, northern, and eastern regions of the state. When current vulnerability was related to future climate change projections, the most vulnerable areas were the northern, northeastern, extreme southern, and southwestern regions. From a socio-environmental and climatic point of view, these regions should be a priority for public policy efforts to reduce their vulnerability and prepare them to cope with the adverse aspects of climate change.

  8. Mapping human vulnerability to climate change in the Brazilian Amazon: The construction of a municipal vulnerability index

    Science.gov (United States)

    Confalonieri, Ulisses; Madureira, Ana Paula; Duval, Isabela de Brito; dos Santos, Rhavena Barbosa; Margonari, Carina

    2018-01-01

    Vulnerability, understood as the propensity to be adversely affected, has attained importance in the context of climate change by helping to understand what makes populations and territories predisposed to its impacts. Conditions of vulnerability may vary depending on the characteristics of each territory studied—social, environmental, infrastructural, public policies, among others. Thus, the present study aimed to evaluate what makes the municipalities of the state of Amazonas, Brazil, vulnerable to climate change in the context of the largest tropical forest in the world, and which regions of the State are the most susceptible. A Municipal Vulnerability Index was developed, which was used to associate current socio-environmental characteristics of municipalities with climate change scenarios in order to identify those that may be most affected by climate change. The results showed that poor adaptive capacity and poverty had the most influence on current vulnerability of the municipalities of Amazonas with the most vulnerable areas being the southern, northern, and eastern regions of the state. When current vulnerability was related to future climate change projections, the most vulnerable areas were the northern, northeastern, extreme southern, and southwestern regions. From a socio-environmental and climatic point of view, these regions should be a priority for public policy efforts to reduce their vulnerability and prepare them to cope with the adverse aspects of climate change. PMID:29444086

  9. Constructed Wetlands

    Science.gov (United States)

    these systems can improve water quality, engineers and scientists construct systems that replicate the functions of natural wetlands. Constructed wetlands are treatment systems that use natural processes

  10. Simulation of permafrost changes due to technogenic influences of different ingeneering constructions used in nothern oil and gas fields

    Science.gov (United States)

    Filimonov, M. Yu; Vaganova, N. A.

    2016-10-01

    Significant amount of oil and gas is producted in Russian Federation on the territories with permafrost soils. Ice-saturated rocks thawing due to global warming or effects of various human activity will be accompanied by termocarst and others dangerous geological processes in permafrost. Design and construction of well pads in permafrost zones have some special features. The main objective is to minimize the influence of different heat sources (engineering objects) inserted into permafrost and accounting long-term forecast of development of permafrost degradation due to different factors in particular generated by human activity. In this work on the basis a mathematical model and numerical algorithms approved on 11 northern oil and gas fields some effects obtained by carrying out numerical simulations for various engineering systems are discussed.

  11. Assessment of hydrological changes in the Nile River due to the construction of Renaissance Dam in Ethiopia

    Directory of Open Access Journals (Sweden)

    Mohammed El Bastawesy

    2015-06-01

    Full Text Available This paper assesses impact of the Renaissance Dam on Ethiopia; on the Nile discharge ultimately reaches Egypt downstream. The Landsat-8 satellite images of 2013 were obtained and interpreted to identify locations for the construction sites for the Renaissance Dam. Then the Shuttle Radar Topography Mission (SRTM data were obtained and processed to create a digital elevation model (DEM for the Blue Nile upstream areas that will be submerged. Different scenarios for the dams’ heights and resulting storages were simulated to estimate the resulting abstraction of the Blue Nile flows until completion of the project and the annual losses due to evaporation thereafter. The current site (506 m asl for the Renaissance Dam allows the creation of a 100 m deep reservoir with a total storage of 17.5 km3; overflows will occur at that lake’s level (606 m asl from the north western part of the developed lake into Rosaires downstream. Construction of the spillway dam to control the overflow area can allow the creation of a 180 m deep lake that store up to 173 km3 in a lake that will cover 3130 km2. The analysis of Tropical Rainfall Monitoring Mission (TRMM suggests that the variation of total annual rainfall could reach 20%, thus the resulting hydrological fluctuations could affect the estimated filling time, the operational functions and discharge downstream. The negative hydrological impacts of the Renaissance Dam will increase by increasing the height of its spillway dam, as increasing the storage capacity could affect the strategic storage for the reservoirs in Egypt and Sudan. It is strongly recommended that an agreement should be reached to compromise the storage capacities and water supplies for all dams on the Nile to thoroughly satisfy the necessary needs.

  12. Adverse Event Reporting: Harnessing Residents to Improve Patient Safety.

    Science.gov (United States)

    Tevis, Sarah E; Schmocker, Ryan K; Wetterneck, Tosha B

    2017-10-13

    Reporting of adverse and near miss events are essential to identify system level targets to improve patient safety. Resident physicians historically report few events despite their role as front-line patient care providers. We sought to evaluate barriers to adverse event reporting in an effort to improve reporting. Our main outcomes were as follows: resident attitudes about event reporting and the frequency of event reporting before and after interventions to address reporting barriers. We surveyed first year residents regarding barriers to adverse event reporting and used this input to construct a fishbone diagram listing barriers to reporting. Barriers were addressed, and resident event reporting was compared before and after efforts were made to reduce obstacles to reporting. First year residents (97%) recognized the importance of submitting event reports; however, the majority (85%) had not submitted an event report in the first 6 months of residency. Only 7% of residents specified that they had not witnessed an adverse event in 6 months, whereas one third had witnessed 10 or more events. The main barriers were as follows: lack of knowledge about how to submit events (38%) and lack of time to submit reports (35%). After improving resident education around event reporting and simplifying the reporting process, resident event reporting increased 230% (68 to 154 annual reports, P = 0.025). We were able to significantly increase resident event reporting by educating residents about adverse events and near misses and addressing the primary barriers to event reporting. Moving forward, we will continue annual resident education about patient safety, focus on improving feedback to residents who submit reports, and empower senior residents to act as role models to junior residents in patient safety initiatives.

  13. Burnout Syndrome During Residency.

    Science.gov (United States)

    Turgut, Namigar; Karacalar, Serap; Polat, Cengiz; Kıran, Özlem; Gültop, Fethi; Kalyon, Seray Türkmen; Sinoğlu, Betül; Zincirci, Mehmet; Kaya, Ender

    2016-10-01

    The aim of this study is identified the degree of Burnout Syndrome (BOS) and find out its correlation with years of recidency and sociodemograpfic chareacteristics, training, sleeping habits, such as smoking and alcohol consumption. After approval from the Hospital Ethics Committee and obtaining informed consent, First, second, third, fourth and fifth year of recidency staff (n=127) working in our hospital were involved in this study. The standardized Maslach Burnout Inventory (MBI) was used in this study. Fifty six male (44.1%) and seventy one female (55.9%) residents were enroled in this study (Coranbach Alfa(α)=0.873). 57% of the first year residents smokes cigaret and 54% of them use alcohol. 2% of them gets one day off after hospital night shift, 61% of them suffers from disturbed sleep. 60% of them had been stated that they willingly selected their profession. 61% of them prefers talking to friends and 32% of them prefers shopping to overcome stress. There were statistical difference acording to years of recidency in MBI, Emotional Burnout (EB) and desensitisation scale (DS) points. EB scale points of the second year of residency group was statisticaly higher than fourth year of residency group. DS points of second year of residency group was also statisticaly higher than the third and fourth year of residency group. There was no statistical difference between any groups in Personal Success. BOS is a frequent problem during residency in anaesthesia. Appropriate definition and awareness are the first important steps to prevent this syndrome. Further administrative approaches should be evaluated with regard to their effects.

  14. Evaluating residents in the nuclear medicine residency training program: an educational perspective

    International Nuclear Information System (INIS)

    Pascual, T.N.; San Luis, T.O.L.; Leus, M.

    2007-01-01

    Full text: The comprehensive evaluation of medical residents in a residency-training program includes the use of educational tools to measure the attainment of competencies in the cognitive, psychomotor and affective domains as prescribed in the training curriculum. Attention is almost always focused on the testing of cognitive domain of the learners with limited attention given on the psychomotor and affective parameters, which are in fact, together with the cognitive domain, integral to the students' learning behaviour. This paper aims to review the principles of test construction, including the perspectives on the roles, types and purpose of tests in the domains of learning (cognitive, psychomotor and affective) as well as the use of Non-Test materials for measuring affective learning outcomes and the construction of Performance Tests and Portfolio Assessment tools which are all essential for the effective and efficient evaluation of residents in a Nuclear Medicine Training Program. (author)

  15. Analysis of Resident Case Logs in an Anesthesiology Residency Program

    DEFF Research Database (Denmark)

    Yamamoto, Satoshi; Tanaka, Pedro; Madsen, Matias Vested

    2016-01-01

    Our goal in this study was to examine Accreditation Council for Graduate Medical Education case logs for Stanford anesthesia residents graduating in 2013 (25 residents) and 2014 (26 residents). The resident with the fewest recorded patients in 2013 had 43% the number of patients compared with the...

  16. Residents as teachers: survey of Canadian family medicine residents.

    Science.gov (United States)

    Ng, Victor K; Burke, Clarissa A; Narula, Archna

    2013-09-01

    To examine Canadian family medicine residents' perspectives surrounding teaching opportunities and mentorship in teaching. A 16-question online survey. Canadian family medicine residency programs. Between May and June 2011, all first- and second-year family medicine residents registered in 1 of the 17 Canadian residency programs as of September 2010 were invited to participate. A total of 568 of 2266 residents responded. Demographic characteristics, teaching opportunities during residency, and resident perceptions about teaching. A total of 77.7% of family medicine residents indicated that they were either interested or highly interested in teaching as part of their future careers, and 78.9% of family medicine residents had had opportunities to teach in various settings. However, only 60.1% of respondents were aware of programs within residency intended to support residents as teachers, and 33.0% of residents had been observed during teaching encounters. It appears that most Canadian family medicine residents have the opportunity to teach during their residency training. Many are interested in integrating teaching as part of their future career goals. Family medicine residencies should strongly consider programs to support and further develop resident teaching skills.

  17. Bereavement-related depression: Did the changes induced by DSM-V make a difference? Results from a large population-based survey of French residents.

    Science.gov (United States)

    Clesse, Florence; Leray, Emmanuelle; Bodeau-Livinec, Florence; Husky, Mathilde; Kovess-Masfety, Viviane

    2015-08-15

    DSM-V has been criticized for excessively expanding criteria for bereavement-related depression. The aim of this study was to quantify a potential increase in depression prevalence due to changes in diagnostic criteria and to assess the severity, clinical profile and healthcare use of new cases. A cross-sectional telephone survey was performed in 2005-2006 in four French regions. Twelve-month prevalence of psychiatric disorders was measured by CIDI-SF. Bereavement was assessed in those who endorsed the gate question to the depression module. Persons with bereavement-related depression according to DSM-IV and DSM-V diagnosis criteria were compared. Of the 22,138 respondents, 692 were bereaved. The prevalence of depression among those bereaved was 49.9% (95% CI ¼=43.7−56.0) according to DSM-IV and 59.6% (53.1−66.1) according to DSM-V [corrected]. The overall prevalence of major depression increased from 8.6% (8.1–9.1) with DSM-IV to 8.8% (8.3−9.3) with DSM-V . Cases diagnosed using DSM-IV presented more symptoms than cases diagnosed using DSM-V but clinical features were similar except regarding criterion E׳s symptoms. Healthcare use was similar between the two groups regarding consultations and psychotropic drug prescription. Some DSM-IV and DSM-V criteria were difficult to operationalize in the survey. The observed difference in prevalence according to DSM-IV and DSM-V may be reduced when clinical judgment is taken into account. The overall prevalence of major depression is only marginally increased by the new criteria. However, diagnostic changes increase the prevalence by 10 points among those bereaved. Diagnostic changes do not appear to modify service use. Copyright © 2015 Elsevier B.V. All rights reserved.

  18. Circadian Levels of Serum Melatonin and Cortisol in relation to Changes in Mood, Sleep, and Neurocognitive Performance, Spanning a Year of Residence in Antarctica

    OpenAIRE

    Premkumar, Madhumita; Sable, Tarulata; Dhanwal, Dinesh; Dewan, Richa

    2013-01-01

    Background. Altered circadian cortisol and melatonin rhythms in healthy subjects exposed to an extreme polar photoperiod results in changes in mood and sleep, which can influence cognitive performance. Materials and Methods. We assessed the circadian rhythm of 20 subjects who wintered over at Maitri (70°S, 11°E), India’s permanent Antarctic station, from November 2010 to December 2011. Serum cortisol and melatonin levels were measured by radioimmunoassay at 8 am, 3 pm, 8 pm, and 2 am in...

  19. Changes in the bacterial community structure in two-stage constructed wetlands with different plants for industrial wastewater treatment.

    Science.gov (United States)

    Calheiros, Cristina S C; Duque, Anouk F; Moura, Alexandra; Henriques, Isabel S; Correia, António; Rangel, António O S S; Castro, Paula M L

    2009-07-01

    This study focused on the diversity of bacterial communities from two series of two-stage constructed wetlands (CWs) treating tannery wastewater, under different hydraulic conditions. Series were separately planted with Typha latifolia and Phragmites australis in expanded clay aggregates and operated for 31 months. The effect of plant species, hydraulic loading and unit stage on bacterial communities was addressed through bacterial enumeration and denaturating gradient gel electrophoresis (DGGE). Diverse and distinct bacterial communities were found in each system unit, which was related in part to the type of plant and stage position (first or second unit in the series). Numerical analysis of DGGE profiles showed high diversity in each unit with an even distribution of species. No clear relation was established between the sample collection time, hydraulic loading applied and the bacterial diversity. Isolates retrieved from plant roots and substrates of CWs were affiliated with gamma-Proteobacteria, Firmicutes, alpha-Proteobacteria, Sphingobacteria, Actinobacteria and Bacteroidetes. Both series were effective in removing organic matter from the inlet wastewater, however, based on batch degradation experiments it seems that biodegradation was limited by the recalcitrant properties of the wastewater.

  20. Climate change impact assessment on Veneto and Friuli plain groundwater. Part I: An integrated modeling approach for hazard scenario construction

    International Nuclear Information System (INIS)

    Baruffi, F.; Cisotto, A.; Cimolino, A.; Ferri, M.; Monego, M.; Norbiato, D.; Cappelletto, M.; Bisaglia, M.; Pretner, A.; Galli, A.; Scarinci, A.; Marsala, V.; Panelli, C.; Gualdi, S.; Bucchignani, E.; Torresan, S.; Pasini, S.; Critto, A.

    2012-01-01

    Climate change impacts on water resources, particularly groundwater, is a highly debated topic worldwide, triggering international attention and interest from both researchers and policy makers due to its relevant link with European water policy directives (e.g. 2000/60/EC and 2007/118/EC) and related environmental objectives. The understanding of long-term impacts of climate variability and change is therefore a key challenge in order to address effective protection measures and to implement sustainable management of water resources. This paper presents the modeling approach adopted within the Life + project TRUST (Tool for Regional-scale assessment of groUndwater Storage improvement in adaptation to climaTe change) in order to provide climate change hazard scenarios for the shallow groundwater of high Veneto and Friuli Plain, Northern Italy. Given the aim to evaluate potential impacts on water quantity and quality (e.g. groundwater level variation, decrease of water availability for irrigation, variations of nitrate infiltration processes), the modeling approach integrated an ensemble of climate, hydrologic and hydrogeologic models running from the global to the regional scale. Global and regional climate models and downscaling techniques were used to make climate simulations for the reference period 1961–1990 and the projection period 2010–2100. The simulation of the recent climate was performed using observed radiative forcings, whereas the projections have been done prescribing the radiative forcings according to the IPCC A1B emission scenario. The climate simulations and the downscaling, then, provided the precipitation, temperatures and evapo-transpiration fields used for the impact analysis. Based on downscaled climate projections, 3 reference scenarios for the period 2071–2100 (i.e. the driest, the wettest and the mild year) were selected and used to run a regional geomorphoclimatic and hydrogeological model. The final output of the model ensemble

  1. Dietary Changes over 25 Years in Tianjin Residents: Findings from the 1986–1988, 2000–2004, and 2008–2011 Nutrition Surveys

    Directory of Open Access Journals (Sweden)

    Xuan Wang

    2016-01-01

    Full Text Available In China, the rates of chronic diseases characteristic of countries in nutritional transition have been increasing. However, few studies have examined diet changes in recent decades. We analyzed dietary changes in Tianjin, China. The data in this descriptive, population-based study in ≥18-year-old adults were collected from three surveys from 1986 to 2011. Food consumption and nutrient intake were compared among the three surveys separately for urban and rural areas. Differences in food consumption between urban and rural areas in different periods were also shown. The consumption of cereals, vegetables, and oils decreased, and that of fruits and beans increased in both urban and rural areas. Moreover, the total consumption of animal foods, especially milk, increased (0.01% in 1986–1988; 1.72% in 2008–2011 in rural areas. Although milk consumption also increased in urban areas, consumption of other animal foods decreased (19.33% in 1986–1988; 13.74% in 2008–2011. Meanwhile, cereals consumption rebounded from 22.63% in 2000–2004 to 29.75% in 2008–2011. Moreover, the lack of dairy products and some nutrients, e.g., retinol, calcium, and dietary fiber (<80% of recommended nutrient intake, in the diet persisted in both urban and rural areas. In conclusion, differences in diet between urban and rural areas decreased over time.

  2. Construction management

    CERN Document Server

    Pellicer, Eugenio; Teixeira, José C; Moura, Helder P; Catalá, Joaquín

    2014-01-01

    The management of construction projects is a wide ranging and challenging discipline in an increasingly international industry, facing continual challenges and demands for improvements in safety, in quality and cost control, and in the avoidance of contractual disputes. Construction Management grew out of a Leonardo da Vinci project to develop a series of Common Learning Outcomes for European Managers in Construction. Financed by the European Union, the project aimed to develop a library of basic materials for developing construction management skills for use in a pan-European context. Focused exclusively on the management of the construction phase of a building project from the contractor's point of view, Construction Management covers the complete range of topics of which mastery is required by the construction management professional for the effective delivery of new construction projects. With the continued internationalisation of the construction industry, Construction Management will be required rea...

  3. Energy Efficiency Indicators for Assessing Construction Systems Storing Renewable Energy: Application to Phase Change Material-Bearing Façades

    Directory of Open Access Journals (Sweden)

    José A. Tenorio

    2015-08-01

    Full Text Available Assessing the performance or energy efficiency of a single construction element by itself is often a futile exercise. That is not the case, however, when an element is designed, among others, to improve building energy performance by harnessing renewable energy in a process that requires a source of external energy. Harnessing renewable energy is acquiring growing interest in Mediterranean climates as a strategy for reducing the energy consumed by buildings. When such reduction is oriented to lowering demand, the strategy consists in reducing the building’s energy needs with the use of construction elements able to passively absorb, dissipate, or accumulate energy. When reduction is pursued through M&E services, renewable energy enhances building performance. The efficiency of construction systems that use renewable energy but require a supplementary power supply to operate can be assessed by likening these systems to regenerative heat exchangers built into the building. The indicators needed for this purpose are particularly useful for designers, for they can be used to compare the efficiency or performance to deliver an optimal design for each building. This article proposes a series of indicators developed to that end and describes their application to façades bearing phase change materials (PCMs.

  4. Changes to United States Navy Submarine Design and Construction during World War I, as Determined by the General Board.

    Science.gov (United States)

    2017-06-09

    multiple torpedoes at intervals to increase the likelihood of achieving a hit. Pierce explained that he felt it would help and with multiple bow tubes it... increasing their submerged depth at periscope depth to achieve higher speeds. The ability of a submarine to operate at higher speed at a...understand the changes implemented. Much academic work has been devoted to the development of submarines during the interwar period, however, very little is

  5. Assessing forest products usage and local residents' perception of environmental changes in peri-urban and rural mangroves of Cameroon, Central Africa

    Directory of Open Access Journals (Sweden)

    Nfotabong-Atheull Adolphe

    2011-12-01

    Full Text Available Abstract Background Deforestation is one of the most ubiquitous forms of land degradation worldwide. Although remote sensing and aerial photographs can supply valuable information on land/use cover changes, they may not regularly be available for some tropical coasts (e.g., Cameroon estuary where cloud cover is frequent. With respect to mangroves, researchers are now employing local knowledge as an alternative means of understanding forest disturbances. This paper was primarily aimed at assessing the mangrove forest products usage, along with the local people's perceptions on environmental changes, between Littoral (Cameroon estuary and Southern (mouth of the Nyong River and Mpalla village regions of Cameroon. Methods The data from both locations were obtained through conducting household interviews and field observations. Results In the Cameroon estuary (Littoral region, 69.23% of respondents (mostly elders could distinguish two to four mangrove plants, whereas the informants (65.45% in the mouth of the Nyong River and Mpalla village (mostly young people interviewed from the Southern region are familiar with only one or two commonly found mangroves. Also, more respondents from the Cameroon estuary are depending on mangroves for fuelwood (Rhizophora spp. and housing (Rhizophora spp., Avicennia germinans (L. Stearn and Nypa fruticans (Thumb. Wurmb. purposes, in contrast to Nyong River mouth and Mpalla village. Although local people perceived wood extraction as a greater disruptive factor, there are several causes for mangrove depletion in the Cameroon estuary. Among others, over-harvesting, clear-felled corridors, sand extraction and housing were found important. Furthermore, a decline in mangrove fauna composition (in terms of fishery products was recorded in the Littoral as well as Southern regions. However, the causes of such perceived negative changes were not similar in both cases. Conclusions Findings of this study highlight the need to

  6. Examining Theory-Based Behavior-Change Constructs, Social Interaction, and Sociability Features of the Weight Watchers' Online Community.

    Science.gov (United States)

    Wang, Ye; Willis, Erin

    2016-12-01

    Objective To examine whether and to what extent relevant and meaningful discussions of weight loss occurred in the Weight Watchers' online community, and whether and to what extent the online community is designed for fostering such discussions. A multimethod approach was used here. First, a quantitative content analysis was conducted on 320 posts from 64 threads sampled from WeightWatchers.com's message boards between December 1, 2011, and January 31, 2012. The coding categories included constructs from the health belief model, the planned behavior theory, and the theory of self-efficacy. An acceptable level of intercoder reliability was reached; frequencies, cluster analysis, and t test were reported. Second, a conventional content analysis of the posts was conducted. The posts were examined for themes and patterns within the discussion. Finally, the researchers examined the sociability features of the message boards. The qualitative review followed established procedures and was conducted independently by four researchers. Mastery experience occurred in 46% of the posts. Threads focusing on physical activities contained more perceived barriers, mastery experiences, and verbal persuasion than other types of threads. Posts focusing on diet included unanswered questions about dieting practices with certain medical conditions. Posts focusing on mastery experience celebrated any small step toward success. Posts irrelevant to weight loss mostly contained events and happenings in members' lives. The sociability review revealed a lack of moderation. The Weight Watchers' online community included much discussion about weight loss. Findings suggest that physical activities require more encouragement than dieting. Health educators have an opportunity to interject and moderate meaningful discussions. For example, dieting with certain medical conditions, opinions on various diets, and the relationship between dieting and being healthy are opportunities to facilitate learning

  7. Process-oriented dynamic group psychotherapy for depression as a teaching modality in a family medicine residency program- A pilot study.

    Science.gov (United States)

    Simon, Eric P; McClaflin, Richard; Zonca, Rachel; Mikuni, Karen; Chung, Willard; Etnyre, Ethan; Faucette, Lindsey; Oates, David; Merrill, Chuck

    2017-01-01

    Background and Objectives This pilot study provides a description and evaluation of process-oriented dynamic group psychotherapy for depression as a teaching modality for family medicine residents. The main purpose of using this modality was to teach family medicine residents a variety of psychological clinical skills. A secondary benefit of this modality was to provide in-house, primary care treatment to depressed patients, although the efficacy of this was not evaluated in the present study. Methods A 10-item, self-report, Likert-type questionnaire was administered to a convenience sample of family medicine residents who had participated in the program. Results Completed questionnaires were received from 100% of the family medicine resident participants. Responses to the questionnaires indicate that the residents felt they acquired a variety of clinical skills from the training modality, to include developing active listening and interviewing skills; methods to improve the doctor-patient relationship; increased skills in empathy, intuitive processes, and emotional support; a depth understanding of how intra-psychic conflicts and interpersonal problems contribute to depression; how to give effective feedback that promotes behavioral change; and how to place interventions at the appropriate level of change. Eighty-eight percent of residents indicated they would recommend this learning modality to a family medicine physician colleague. Conclusions The family medicine residents' responses to the questionnaires indicate that they perceived process-oriented dynamic group psychotherapy for depression as a constructive and beneficial modality for both patient care and learning a variety of clinical skills.

  8. Are the French neurology residents satisfied with their training?

    Science.gov (United States)

    Codron, P; Roux, T; Le Guennec, L; Zuber, M

    2015-11-01

    There have been dramatic changes in neurology over the past decade; these advances require a constant adaptation of residents' theoretical and practical training. The French Association of Neurology Residents and the College of Neurology Teachers conducted a national survey to assess the French neurology residents' satisfaction about their training. A 16-item questionnaire was sent via e-mail to French neurology residents completing training in 2014. Data were collected and processed anonymously. Of eligible respondents, 126 returned the survey, representing approximately 40% of all the French neurology residents. Most residents (78%) rated their clinical training favorably. Seventy-two percent reported good to excellent quality teaching of neurology courses from their faculty. However, many residents (40%) felt insufficient their doctoral thesis supervision. All residents intended to enter fellowship training after their residency, and most of them (68%) planned to practice in a medical center. French neurology residents seemed satisfied with the structure and quality of their training program. However, efforts are required to improve management of the doctoral thesis and make private practice more attractive and accessible during the residency. In the future, similar surveys should be scheduled to regularly assess neurology residents' satisfaction and the impact of the forthcoming national and European reforms. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  9. Measuring the intensity of resident supervision in the department of veterans affairs: the resident supervision index.

    Science.gov (United States)

    Byrne, John M; Kashner, Michael; Gilman, Stuart C; Aron, David C; Cannon, Grant W; Chang, Barbara K; Godleski, Linda; Golden, Richard M; Henley, Steven S; Holland, Gloria J; Kaminetzky, Catherine P; Keitz, Sheri A; Kirsh, Susan; Muchmore, Elaine A; Wicker, Annie B

    2010-07-01

    To develop a survey instrument designed to quantify supervision by attending physicians in nonprocedural care and to assess the instrument's feasibility and reliability. In 2008, the Department of Veterans Affairs (VA) Office of Academic Affiliations convened an expert panel to adopt a working definition of attending supervision in nonprocedural patient care and to construct a survey to quantify it. Feasibility was field-tested on residents and their supervising attending physicians at primary care internal medicine clinics at the VA Loma Linda Healthcare System in their encounters with randomly selected outpatients diagnosed with either major depressive disorder or diabetes. The authors assessed both interrater concurrent reliability and test-retest reliability. The expert panel adopted the VA's definition of resident supervision and developed the Resident Supervision Index (RSI) to measure supervision in terms of residents' case understanding, attending physicians' contributions to patient care through feedback to the resident, and attending physicians' time (minutes). The RSI was field-tested on 60 residents and 37 attending physicians for 148 supervision episodes from 143 patient encounters. Consent rates were 94% for residents and 97% for attending physicians; test-retest reliability intraclass correlations (ICCs) were 0.93 and 0.88, respectively. Concurrent reliability between residents' and attending physicians' reported time was an ICC of 0.69. The RSI is a feasible and reliable measure of resident supervision that is intended for research studies in graduate medical education focusing on education outcomes, as well as studies assessing quality of care, patient health outcomes, care costs, and clinical workload.

  10. Circadian Levels of Serum Melatonin and Cortisol in relation to Changes in Mood, Sleep, and Neurocognitive Performance, Spanning a Year of Residence in Antarctica

    Directory of Open Access Journals (Sweden)

    Madhumita Premkumar

    2013-01-01

    Full Text Available Background. Altered circadian cortisol and melatonin rhythms in healthy subjects exposed to an extreme polar photoperiod results in changes in mood and sleep, which can influence cognitive performance. Materials and Methods. We assessed the circadian rhythm of 20 subjects who wintered over at Maitri (70°S, 11°E, India’s permanent Antarctic station, from November 2010 to December 2011. Serum cortisol and melatonin levels were measured by radioimmunoassay at 8 am, 3 pm, 8 pm, and 2 am in a single day, once each during the polar summer and winter photoperiods. Conventional psychological tests, Depression, Anxiety, and Stress Scale (DASS-42, Epworth Sleepiness Scale (ESS, and a computerized neurocognitive test battery were used to measure mood, sleep, and cognitive performance. Results. The mean scores for DASS42 were higher during midwinter suggesting the presence of “overwintering.” Mean diurnal cortisol levels during summer and winter were comparable, but the levels of melatonin were markedly higher during winter. Higher 8 am melatonin levels were associated with better sleep quality, lower depression scores, and better performance in tasks like attention, visual memory, and arithmetic. Conclusion. Timing of artificial light exposure and usage of melatonin supplements in improving sleep and cognitive performance in expedition teams are of future research interest.

  11. Circadian Levels of Serum Melatonin and Cortisol in relation to Changes in Mood, Sleep, and Neurocognitive Performance, Spanning a Year of Residence in Antarctica.

    Science.gov (United States)

    Premkumar, Madhumita; Sable, Tarulata; Dhanwal, Dinesh; Dewan, Richa

    2013-01-01

    Background. Altered circadian cortisol and melatonin rhythms in healthy subjects exposed to an extreme polar photoperiod results in changes in mood and sleep, which can influence cognitive performance. Materials and Methods. We assessed the circadian rhythm of 20 subjects who wintered over at Maitri (70°S, 11°E), India's permanent Antarctic station, from November 2010 to December 2011. Serum cortisol and melatonin levels were measured by radioimmunoassay at 8 am, 3 pm, 8 pm, and 2 am in a single day, once each during the polar summer and winter photoperiods. Conventional psychological tests, Depression, Anxiety, and Stress Scale (DASS-42), Epworth Sleepiness Scale (ESS), and a computerized neurocognitive test battery were used to measure mood, sleep, and cognitive performance. Results. The mean scores for DASS42 were higher during midwinter suggesting the presence of "overwintering." Mean diurnal cortisol levels during summer and winter were comparable, but the levels of melatonin were markedly higher during winter. Higher 8 am melatonin levels were associated with better sleep quality, lower depression scores, and better performance in tasks like attention, visual memory, and arithmetic. Conclusion. Timing of artificial light exposure and usage of melatonin supplements in improving sleep and cognitive performance in expedition teams are of future research interest.

  12. Construction and use of special drawdown scales for use in prediction of water-level changes throughout heavily pumped areas

    Science.gov (United States)

    Conover, C.S.; Reeder, H.O.

    1957-01-01

    Problem and Proposed Method of Solution Frequently the Theis nonequilibrium formula is use din the quantitative analyses that are part of many-ground-water investigations. The computations associated therewith may become quite involved and tedious, especially when dealing with predictions of the decline of water levels throughout large areas in which there are many discharging wells. The process of predicting future water-level declines can be greatly simplified and shortened by preparing a special draw-down scale for given conditions. Through use of such a scale much of the computation can be reduced to scaling the values sought from a map, on which the pumped wells have been spotted. The net drawdown effect, which is the sum of the water-level declines caused by the many individual pumped wells, can be determined readily for any desired point in the area. If the net drawdown effect is desired, a summation of the effects of all the pumped wells can be repeated for each point. By determining the water-level change at a number of points, for a given period of time, a contour map of predicted water-level changes for the multiple-well system can be drawn.

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

    Science.gov (United States)

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

    2016-01-01

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

  14. Efficacy of neurosurgery resident education in the new millennium: the 2008 Council of State Neurosurgical Societies post-residency survey results.

    Science.gov (United States)

    Mazzola, Catherine A; Lobel, Darlene A; Krishnamurthy, Satish; Bloomgarden, Gary M; Benzil, Deborah L

    2010-08-01

    Neurosurgical residency training paradigms have changed in response to Accreditation Council for Graduate Medical Education mandates and demands for quality patient care. Little has been done to assess resident education from the perspective of readiness to practice. To assess the efficacy of resident training in preparing young neurosurgeons for practice. In response to Resolution V-2007F of the Council of State Neurosurgical Societies, a survey was developed for neurosurgeons who applied for oral examination, Part II of the American Board of Neurological Surgery boards, in 2002 through 2007 (N = 800). The survey was constructed in "survey monkey" format and sent to 775 of 800 (97%) neurosurgeons for whom e-mail addresses were available. The response rate was 30% (233/775). Most neurosurgeons were board certified (n = 226, 97%). General neurosurgical training was judged as adequate by a large majority (n = 188, 80%). Sixty-percent chose to pursue at least 1 additional year of fellowship training (n = 138, 60%). Surgical skills training was acceptable, but 6 skill-technique areas were reported to be inadequate (endovascular techniques, neurosurgical treatment of pain, stereotactic radiosurgery, epilepsy surgery, cranial base surgery, and stereotactic neurosurgery). Respondents also noted inadequate education in contract negotiation, practice evaluation, and management. The study suggests that neurosurgeons believed that they were well trained in their surgical skills except for some areas of subspecialization. However, there is a significant need for improvement of resident training in the areas of socioeconomic and medicolegal education. Continued evaluation of the efficacy of neurosurgical education is important.

  15. Construction of a remote radiotherapy planning system

    International Nuclear Information System (INIS)

    Ogawa, Yoshihiro; Nemoto, Kenji; Takahashi, Chiaki; Takai, Yoshihiro; Yamada, Shogo; Seiji, Hiromasa; Sasaki, Kazuya

    2005-01-01

    We constructed a remote radiotherapy planning system, and we examined the usefulness of and faults in our system in this study. Two identical radiotherapy planning systems, one installed at our institution and the other installed at an affiliated hospital, were used for radiotherapy planning. The two systems were connected by a wide area network (WAN), using a leased line. Beam data for the linear accelerator at the affiliated hospital were installed in the two systems. During the period from December 2001 to December 2002, 43 remote radiotherapy plans were made using this system. Data were transmitted using a file transfer protocol (FTP) software program. The 43 radiotherapy plans examined in this study consisted of 13 ordinary radiotherapy plans, 28 radiotherapy plans sent to provide assistance for medical residents, and 2 radiotherapy plans for emergency cases. There were ten minor planning changes made in radiotherapy plans sent to provide assistance for medical residents. Our remote radiotherapy planning system based on WAN using a leased line is useful for remote radiotherapy, with advantages for both radiation oncologists and medical residents. (author)

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

    Science.gov (United States)

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

    2003-01-01

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

  17. The disabilities of the arm, shoulder and hand (DASH outcome questionnaire: longitudinal construct validity and measuring self-rated health change after surgery

    Directory of Open Access Journals (Sweden)

    Atroshi Isam

    2003-06-01

    Full Text Available Abstract Background The disabilities of the arm, shoulder and hand (DASH questionnaire is a self-administered region-specific outcome instrument developed as a measure of self-rated upper-extremity disability and symptoms. The DASH consists mainly of a 30-item disability/symptom scale, scored 0 (no disability to 100. The main purpose of this study was to assess the longitudinal construct validity of the DASH among patients undergoing surgery. The second purpose was to quantify self-rated treatment effectiveness after surgery. Methods The longitudinal construct validity of the DASH was evaluated in 109 patients having surgical treatment for a variety of upper-extremity conditions, by assessing preoperative-to-postoperative (6–21 months change in DASH score and calculating the effect size and standardized response mean. The magnitude of score change was also analyzed in relation to patients' responses to an item regarding self-perceived change in the status of the arm after surgery. Performance of the DASH as a measure of treatment effectiveness was assessed after surgery for subacromial impingement and carpal tunnel syndrome by calculating the effect size and standardized response mean. Results Among the 109 patients, the mean (SD DASH score preoperatively was 35 (22 and postoperatively 24 (23 and the mean score change was 15 (13. The effect size was 0.7 and the standardized response mean 1.2. The mean change (95% confidence interval in DASH score for the patients reporting the status of the arm as "much better" or "much worse" after surgery was 19 (15–23 and for those reporting it as "somewhat better" or "somewhat worse" was 10 (7–14 (p = 0.01. In measuring effectiveness of arthroscopic acromioplasty the effect size was 0.9 and standardized response mean 0.5; for carpal tunnel surgery the effect size was 0.7 and standardized response mean 1.0. Conclusion The DASH can detect and differentiate small and large changes of disability over time

  18. Scholar Quest: A Residency Research Program Aligned With Faculty Goals

    Directory of Open Access Journals (Sweden)

    Ashish R. Panchal

    2014-05-01

    Full Text Available Introduction: The ACGME requires that residents perform scholarly activities prior to graduation, but this is difficult to complete and challenging to support. We describe a residency research program, taking advantage of environmental change aligning resident and faculty goals, to become a contributor to departmental cultural change and research development. Methods: A research program, Scholar Quest (SQ, was developed as a part of an Information Mastery program. The goal of SQ is for residents to gain understanding of scholarly activity through a mentor-directed experience in original research. This curriculum is facilitated by providing residents protected time for didactics, seed grants and statistical/staff support. We evaluated total scholarly activity and resident/faculty involvement before and after implementation (PRE-SQ; 2003-2005 and POST-SQ; 2007-2009. Results: Scholarly activity was greater POST-SQ versus PRE-SQ (123 versus 27 (p<0.05 with an incidence rate ratio (IRR=2.35. Resident and faculty involvement in scholarly activity also increased PRE-SQ to POST-SQ (22 to 98 residents; 10 to 39 faculty, p<0.05 with an IRR=2.87 and 2.69, respectively. Conclusion: Implementation of a program using department environmental change promoting a resident longitudinal research curriculum yielded increased resident and faculty scholarly involvement, as well as an increase in total scholarly activity.

  19. A method for the assessment of long-term changes in carbon stock by construction of a hydropower reservoir.

    Science.gov (United States)

    Bernardo, Julio Werner Yoshioka; Mannich, Michael; Hilgert, Stephan; Fernandes, Cristovão Vicente Scapulatempo; Bleninger, Tobias

    2017-09-01

    Sustainability of hydropower reservoirs has been questioned since the detection of their greenhouse gas (GHG) emissions which are mainly composed of carbon dioxide and methane. A method to assess the impact on the carbon cycle caused by the transition from a natural river system into a reservoir is presented and discussed. The method evaluates the long term changes in carbon stock instead of the current approach of monitoring and integrating continuous short term fluxes. A case study was conducted in a subtropical reservoir in Brazil, showing that the carbon content within the reservoir exceeds that of the previous landuse. The average carbon sequestration over 43 years since damming was 895 mg C m[Formula: see text] and found to be mainly due to storage of carbon in sediments. These results demonstrate that reservoirs have two opposite effects on the balance of GHGs. By storing organic C in sediments, reservoirs are an important carbon sink. On the other hand, reservoirs increase the flux of methane into the atmosphere. If the sediments of reservoirs could be used for long term C storage, reservoirs might have a positive effect on the balance of GHGs.

  20. Towards green construction

    International Nuclear Information System (INIS)

    Bajracharya, Bijaya B.; Shrestha, Prasanna M.

    2000-01-01

    Sustainability is the key to any development works. In the operation phase, hydro power is the most sustainable form of energy. However construction activities for the same power station are usually far from being green. The popular myth is that construction activity converts green into grey. Despite this popular myth, construction of a hydro power project in Nepal has made the project area greener than earlier during the construction phase itself. Choice of construction technology, appropriate level of environmental impact assessment, monitoring of environmental parameters along side the construction progress followed by mitigation at the right time; launching community development programmes side by side, having environmental specification in contractual documents and self-reliance to fulfill environmental obligations by contractors itself are the key factors in the environmental management within the construction activities. The main conclusions in the paper is the need to change the way to think about the project constraints

  1. How Useful are Orthopedic Surgery Residency Web Pages?

    Science.gov (United States)

    Oladeji, Lasun O; Yu, Jonathan C; Oladeji, Afolayan K; Ponce, Brent A

    2015-01-01

    Medical students interested in orthopedic surgery residency positions frequently use the Internet as a modality to gather information about individual residency programs. Students often invest a painstaking amount of time and effort in determining programs that they are interested in, and the Internet is central to this process. Numerous studies have concluded that program websites are a valuable resource for residency and fellowship applicants. The purpose of the present study was to provide an update on the web pages of academic orthopedic surgery departments in the United States and to rate their utility in providing information on quality of education, faculty and resident information, environment, and applicant information. We reviewed existing websites for the 156 departments or divisions of orthopedic surgery that are currently accredited for resident education by the Accreditation Council for Graduate Medical Education. Each website was assessed for quality of information regarding quality of education, faculty and resident information, environment, and applicant information. We noted that 152 of the 156 departments (97%) had functioning websites that could be accessed. There was high variability regarding the comprehensiveness of orthopedic residency websites. Most of the orthopedic websites provided information on conference, didactics, and resident rotations. Less than 50% of programs provided information on resident call schedules, resident or faculty research and publications, resident hometowns, or resident salary. There is a lack of consistency regarding the content presented on orthopedic residency websites. As the competition for orthopedic websites continues to increase, applicants flock to the Internet to learn more about orthopedic websites in greater number. A well-constructed website has the potential to increase the caliber of students applying to a said program. Copyright © 2015 Association of Program Directors in Surgery. Published by

  2. Leadership Training in Otolaryngology Residency.

    Science.gov (United States)

    Bent, John P; Fried, Marvin P; Smith, Richard V; Hsueh, Wayne; Choi, Karen

    2017-06-01

    Although residency training offers numerous leadership opportunities, most residents are not exposed to scripted leadership instruction. To explore one program's attitudes about leadership training, a group of otolaryngology faculty (n = 14) and residents (n = 17) was polled about their attitudes. In terms of self-perception, more faculty (10 of 14, 71.4%) than residents (9 of 17, 52.9%; P = .461) considered themselves good leaders. The majority of faculty and residents (27 of 31) thought that adults could be taught leadership ability. Given attitudes about leadership ability and the potential for improvement through instruction, consideration should be given to including such training in otolaryngology residency.

  3. Evaluating a novel resident role-modelling programme.

    Science.gov (United States)

    Sternszus, Robert; Steinert, Yvonne; Bhanji, Farhan; Andonian, Sero; Snell, Linda S

    2017-05-09

    Role modelling is a fundamental method by which students learn from residents. To our knowledge, however, resident-as-teacher curricula have not explicitly addressed resident role modelling. The purpose of this project was to design, implement and evaluate an innovative programme to teach residents about role modelling. The authors designed a resident role-modelling programme and incorporated it into the 2015 and 2016 McGill University resident-as-teacher curriculum. Influenced by experiential and social learning theories, the programme incorporated flipped-classroom and simulation approaches to teach residents to be aware and deliberate role models. Outcomes were assessed through a pre- and immediate post-programme questionnaire evaluating reaction and learning, a delayed post-programme questionnaire evaluating learning, and a retrospective pre-post questionnaire (1 month following the programme) evaluating self-reported behaviour changes. Thirty-three of 38 (87%) residents who participated in the programme completed the evaluation, with 25 residents (66%) completing all questionnaires. Participants rated the programme highly on a five-point Likert scale (where 1 = not helpful and 5 = very helpful; mean score, M = 4.57; standard deviation, SD = 0.50), and showed significant improvement in their perceptions of their importance as role models and their knowledge of deliberate role modelling. Residents also reported an increased use of deliberate role-modelling strategies 1 month after completing the programme. Resident-as-teacher curricula have not explicitly addressed resident role modelling DISCUSSION: The incorporation of resident role modelling into our resident-as-teacher curriculum positively influenced the participants' perceptions of their role-modelling abilities. This programme responds to a gap in resident training and has the potential to guide further programme development in this important and often overlooked area. © 2017 John Wiley & Sons

  4. 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

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

    Science.gov (United States)

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

    2017-10-01

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

  6. Construction practice

    International Nuclear Information System (INIS)

    Winters, J.; Clelland, J.; Rumble, E.; Sandell, L.

    2007-01-01

    One has elaborated a virtual computer model (VRC) of construction of the AP1000 project reactor to demonstrate its viability, to improve the NPP project making it more easy for construction with simultaneous reduction of time, costs and risk of construction. The approach ensured time sequence of the 3-D visualization of NPP at the construction stages. The VRC ensures optimization of scheme implementation time period and specifies the basic costs. The VRC application offers essential advantages when planning construction of a nuclear power facility [ru

  7. Changes of Dietary Pattern, Food Choice, Food Consumption, Nutrient Intake and Body Mass Index of Korean American College Students with Different Length of Residence in the Los Angeles Areas

    Science.gov (United States)

    Kim, Nam; Tam, Chick F.; Poon, George; Lew, Polong; Kim, Samuel Saychang; Kim, James C.; Kim, Rachel Byungsook

    2010-01-01

    This study was to investigate how dietary pattern, food choice, food consumption, nutrient intake and body mass index (BMI) vary with length of residence for Korean American college students. The respondents were 60 Korean American residents living in the Los Angeles Area. They were divided into two groups based on the length of stay in the U.S.:…

  8. Tailoring Morning Reports to an Internal Medicine Residency in Qatar.

    Science.gov (United States)

    Dousa, Khalid Mohamed Ali; Muneer, Mohammed; Rahil, Ali; Al-Mohammed, Ahmed; AlMohanadi, Dabia; Elhiday, Abdelhaleem; Hamad, Abdelrahman; Albizreh, Bassim; Suliman, Noor; Muhsin, Saif

    2014-12-01

    Morning report, a case-based conference that allows learners and teachers to interact and discuss patient care, is a standard educational feature of internal residency programs, as well as some other specialties. Our intervention was aimed at enhancing the format for morning report in our internal medicine residency program in Doha, Qatar. In July 2011, we performed a needs assessment of the 115 residents in our internal medicine residency program, using a questionnaire. Resident input was analyzed and prioritized using the percentage of residents who agreed with a given recommendation for improving morning report. We translated the input into interventions that enhanced the format and content, and improved environmental factors surrounding morning report. We resurveyed residents using the questionnaire that was used for the needs assessment. Key changes to the format for morning report included improving organization, adding variety to the content, enhancing case selection and the quality of presentations, and introducing patient safety and quality improvement topics into discussions. This led to a morning report format that is resident-driven, and resident-led, and that produces resident-focused learning and quality improvement activities. Our revised morning report format is a dynamic tool, and we will continue to tailor and modify it on an ongoing basis in response to participant feedback. We recommend a process of assessing and reassessing morning report for other programs that want to enhance resident interest and participation in clinical and safety-focused discussions.

  9. Cosmetic Surgery Training in Plastic Surgery Residency Programs.

    Science.gov (United States)

    McNichols, Colton H L; Diaconu, Silviu; Alfadil, Sara; Woodall, Jhade; Grant, Michael; Lifchez, Scott; Nam, Arthur; Rasko, Yvonne

    2017-09-01

    Over the past decade, plastic surgery programs have continued to evolve with the addition of 1 year of training, increase in the minimum number of required aesthetic cases, and the gradual replacement of independent positions with integrated ones. To evaluate the impact of these changes on aesthetic training, a survey was sent to residents and program directors. A 37 question survey was sent to plastic surgery residents at all Accreditation Council for Graduate Medical Education-approved plastic surgery training programs in the United States. A 13 question survey was sent to the program directors at the same institutions. Both surveys were analyzed to determine the duration of training and comfort level with cosmetic procedures. Eighty-three residents (10%) and 11 program directors (11%) completed the survey. Ninety-four percentage of residents had a dedicated cosmetic surgery rotation (an increase from 68% in 2015) in addition to a resident cosmetic clinic. Twenty percentage of senior residents felt they would need an aesthetic surgery fellowship to practice cosmetic surgery compared with 31% in 2015. Integrated chief residents were more comfortable performing cosmetic surgery cases compared with independent chief residents. Senior residents continue to have poor confidence with facial aesthetic and body contouring procedures. There is an increase in dedicated cosmetic surgery rotations and fewer residents believe they need a fellowship to practice cosmetic surgery. However, the comfort level of performing facial aesthetic and body contouring procedures remains low particularly among independent residents.

  10. Training Pediatric Residents to Provide Smoking Cessation Counseling to Parents

    Directory of Open Access Journals (Sweden)

    Rebecca L. Collins

    2005-01-01

    Full Text Available The objective was to assess the effectiveness of a smoking cessation educational program on pediatric residents' counseling. Residents were randomly selected to receive the intervention. Residents who were trained were compared to untrained residents. Self-reported surveys and patient chart reviews were used. Measures included changes in self-reported knowledge, attitudes and behaviors of residents, and differences in chart documentation and caretaker-reported physician counseling behaviors. The intervention was multidimensional including a didactic presentation, a problem-solving session, clinic reminders, and provision of patient education materials. Results showed that residents who were trained were more likely to ask about tobacco use in their patients' households. They were also more likely to advise caretakers to cut down on or to quit smoking, to help set a quit date, and to follow up on the advice given at a subsequent visit. Trained residents were more likely to record a history of passive tobacco exposure in the medical record. These residents also reported improved confidence in their counseling skills and documented that they had done such counseling more often than did untrained residents. Caretakers of pediatric patients who smoke seen by intervention residents were more likely to report that they had received tobacco counseling. Following this intervention, pediatric residents significantly improved their behaviors, attitudes, and confidence in providing smoking cessation counseling to parents of their pediatric patients.

  11. A comparative between CRISP-DM and SEMMA through the construction of a MODIS repository for studies of land use and cover change

    Directory of Open Access Journals (Sweden)

    Herman Jair Gómez Palacios

    2017-06-01

    Full Text Available Among the most popular methodologies for development of data mining projects are CRISP-DM and SEMMA, This research paper explains the reason why it was decided to compare them from a specific case study. Therefore, this document describes in detail each phase, task and activity proposed by each methodology, applying it in the construction of a MODIS repository for studies of land use and cover change. In addition to the obvious differences between the methodologies, there were found other differences in the activities proposed by each model that are crucial in non-typical studies of data mining. At the same time, this research determines safely the advantages and disadvantages of each model for this type of case studies. When the MODIS product repository construction process was completed, it was found that the additional time used by CRISP-DM in the first phase was composed in the following phases, since the planning, definition of mining goals, and generation of contingency plans, allow developing the proposed phases without inconvenience. It was also demonstrated that CRISP-DM is presented as a true methodology in comparison with SEMMA, because it describes in detail each phase and task through its official documentation and concrete examples of its application.

  12. 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.

  13. 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

  14. Lawful Permanent Residents - Annual Report

    Data.gov (United States)

    Department of Homeland Security — A lawful permanent resident (LPR) or 'green card' recipient is defined by immigration law as a person who has been granted lawful permanent residence in the United...

  15. Construction aggregates

    Science.gov (United States)

    Tepordei, V.V.

    1994-01-01

    Part of a special section on industrial minerals in 1993. The 1993 production of construction aggregates increased 6.3 percent over the 1992 figure, to reach 2.01 Gt. This represents the highest estimated annual production of combined crushed stone and construction sand and gravel ever recorded in the U.S. The outlook for construction aggregates and the issues facing the industry are discussed.

  16. FFTF constructibility

    International Nuclear Information System (INIS)

    Weber, S.A.; Hulbert, D.I.

    1975-01-01

    The influence of the design criteria on the constructibility of the Fast Flux Test Facility is described. Specifically, the effects of requirements due to maintenance accessibility, inerting of cells, seismicity, codes, and standards are addressed. The design and construction techniques developed to minimize the impact of the design criteria on cost and schedule are presented with particular emphasis on the cleanliness and humidity controls imposed during construction of the sodium systems. (U.S.)

  17. Functional unit, technological dynamics, and scaling properties for the life cycle energy of residences.

    Science.gov (United States)

    Frijia, Stephane; Guhathakurta, Subhrajit; Williams, Eric

    2012-02-07

    Prior LCA studies take the operational phase to include all energy use within a residence, implying a functional unit of all household activities, but then exclude related supply chains such as production of food, appliances, and household chemicals. We argue that bounding the functional unit to provision of a climate controlled space better focuses the LCA on the building, rather than activities that occur within a building. The second issue explored in this article is how technological change in the operational phase affects life cycle energy. Heating and cooling equipment is replaced at least several times over the lifetime of a residence; improved efficiency of newer equipment affects life cycle energy use. The third objective is to construct parametric models to describe LCA results for a family of related products. We explore these three issues through a case study of energy use of residences: one-story and two-story detached homes, 1,500-3,500 square feet in area, located in Phoenix, Arizona, built in 2002 and retired in 2051. With a restricted functional unit and accounting for technological progress, approximately 30% of a building's life cycle energy can be attributed to materials and construction, compared to 0.4-11% in previous studies.

  18. Coping and Protective Behavior of Residents of Radioactive Contaminated Territories Depending on Age and Gender

    Directory of Open Access Journals (Sweden)

    Ирина Вадимовна Борисова

    2018-12-01

    Full Text Available The article examines the results of an empirical study of the coping and protective behavior of the residents of radioactive contaminated territories, depending on age and gender. The specifics of coping and protection are revealed depending on age and gender. It is shown that young men and women more often use non-constructive ways of coping behavior to cope with difficult life situations, in comparison with adult men and women. Men are worse than women at relieving stress and maintaining self-esteem in difficult life situations through the use of coping strategies. It was established that the residents of radioactive territories do not want to take responsibility for their lives, but passively expect assistance without any independent actions aimed at resolving their problems. It was revealed that substitution as a mechanism of psychological defense is more pronounced in adolescent and mature men than in girls and women, respectively. The relationship between defensive and coping behavior in adolescence and adulthood was described. It was established that in adolescence, confrontational coping, manifested through aggressive efforts aimed at actively asserting one’s opinion and desires in relations with others and trying to have one’s own way, through chaotic activities that do not change the situation, is closely related to the mechanisms of psychological defense. Substitution does not allow the use of constructive ways of coping both in adolescence and in adulthood. The results of the study can be used to provide psychological assistance to residents of radioactive contaminated areas.

  19. VARIANT FOR CONSTRUCTION, REPAIR OR RECONSTRUCTION OF BUILDING

    Directory of Open Access Journals (Sweden)

    S. N. Osipov

    2016-01-01

    Full Text Available In the XXI century moral depreciation concept comprises not only deterioration of outside appearance of construction elements in the course of time but accelerated fashion changes in respect of interior design and rapid increase in technical level for residence buildings. For this reason if average rate of building dilapidation in the buildings of series 1–335, 1–335А and 1–464А constructed in Minsk within the period of 1957–1975 and being operated till 2005–2006 has constituted 25–29 % and their moral depreciation has been equal to more than 40 % then rate of the moral depreciation has significantly increased in the XXI century. Such situation requires execution of special investigations. High operating rates of refinancing have led to the necessity for record keeping of initial expenses and repairability levels because selection of building construction, repair or reconstruction variant depends on these parameters. Repairability classification of main elements of residence buildings and premises has been proposed for regulation of such selection procedure. In this case it is recommended to take into account technological effectiveness of repair and technical service, verifiability, accessibility, easy dismountability, substitutability and interchangeability of construction elements and technical devices. The paper presents nomograms that permit to make easier practical calculations on determination of cost-efficient time period for operation of the element prior to its substitution at various refinancing rates and also for comparison of relative initial expenses according to time service. 

  20. Quantitative Identification of Construction Risk

    OpenAIRE

    Kasprowicz T.

    2017-01-01

    Risks pertaining to construction work relate to situations in which various events may randomly change the duration and cost of the project or worsen its quality. Because of possible significant changes of random events, favorable, moderate, and difficult conditions of construction work are considered. It is the first stage of the construction risk analysis. The probabilistic parameters of construction are identified and described by using the design characteristics model of the structure and...

  1. [Assessment of a residency training program in endocrinology and nutrition: results of a resident survey].

    Science.gov (United States)

    Gutiérrez-Alcántara, Carmen; Moreno-Fernández, Jesús; Palomares-Ortega, Rafael; García-Manzanares, Alvaro; Benito-López, Pedro

    2011-12-01

    In 2006, a new training program was approved for resident physicians in endocrinology and nutrition (EN). A survey was conducted to EN residents to assess their training, their depth of knowledge, and compliance with the new program, as well as potential changes in training, and the results obtained were compared to those from previous surveys. A survey previously conducted in 2000 and 2005 was used for this study. The survey included demographic factors, questions about the different rotations, scientific and practical training, assessment of their training departments and other aspects. Results of the current survey were compared to those of the 2005 survey. The survey was completed by 40 residents. Mandatory rotations are mainly fulfilled, except for neurology. Some rotations removed from the program, such as radiology and nuclear medicine, still are frequently performed and popular among residents, who would include them back into the program. There was a low compliance with practical training in the endocrinology area. Forty percent of residents were not aware of the new program, but 60% thought that it was fulfilled. A total of 82.5% of residents thought that their departments fulfilled the training objectives. Few differences were found in rotations as compared to the data collected in 2005 despite changes in the training program, and there was still a lack of practical training. By contrast, rating of training received from departments and senior physicians was improved as compared to prior surveys. Copyright © 2011 SEEN. Published by Elsevier Espana. All rights reserved.

  2. Blended Learning in Obstetrics and Gynecology Resident Education: Impact on Resident Clinical Performance.

    Science.gov (United States)

    Ghareeb, Allen; Han, Heeyoung; Delfino, Kristin; Taylor, Funminiyi

    2016-01-01

    Effects of residents' blended learning on their clinical performance have rarely been reported. A blended learning pilot program was instituted at Southern Illinois University School of Medicine's Obstetrics and Gynecology program. One of the modules was chronic hypertension in pregnancy. We sought to evaluate if the resident blended learning was transferred to their clinical performance six months after the module. A review of patient charts demonstrated inadequate documentation of history, evaluation, and counseling of patients with chronic hypertension at the first prenatal visit by Obstetrics and Gynecology (OB/GYN) residents. A blended learning module on chronic hypertension in pregnancy was then provided to the residents. A retrospective chart review was then performed to assess behavioral changes in the OB/GYN residents. This intervention was carried out at the Department of Obstetrics and Gynecology, Southern Illinois University. All 16 OB/GYN residents were enrolled in this module as part of their educational curriculum. A query of all prenatal patients diagnosed with chronic hypertension presenting to the OB/GYN resident clinics four months prior to the implementation of the blended learning module (March 2015-June 2015) and six months after (July 20, 2015-February 2016) was performed. Data were collected from outpatient charts utilizing the electronic medical record. Data were abstracted from resident documentation at the first prenatal visit. The residents thought that the blended learning module was applicable to performance improvement in the real-world setting. Patients evaluated before ( n = 10) and after ( n = 7) the intervention were compared. After the intervention, there was an increase in assessment of baseline liver enzymes, referral for electrocardiogram, and early assessment for diabetes in the obese patients. More patients were provided a blood pressure cuff after the module (71.4% vs. 20%). Data were provided to the residents in an

  3. The Role of Regional Conferences in Research Resident Career Development: The California Psychiatry Research Resident Retreat.

    Science.gov (United States)

    Besterman, Aaron D; Williams, Jody K; Reus, Victor I; Pato, Michele T; Voglmaier, Susan M; Mathews, Carol A

    2017-04-01

    For psychiatry research resident career development, there is a recognized need for improved cross-institutional mentoring and networking opportunities. One method to address this need is via regional conferences, open to current and recently graduated research residents and their mentors. With this in mind, we developed the biennial California Psychiatry Research Resident Retreat (CPRRR) and collected feedback from participants to 1) Assess resident satisfaction, 2) Determine the utility of the retreat as a networking and mentorship tool, and 3) Identify areas for improvement. We gathered survey data from resident attendees at the two first CPRRRs. We analyzed the data to look for trends in satisfaction as well as areas that need improvement. Thirty-two residents from five California training programs attended the CPRRR in 2013 while 33 attended from six programs in 2015. The residents were from all years of training, but concentrated in their second and third years. Approximately 41% and 49% of the attendees were female and 53% and 39% had an MD/PhD in 2013 and 2015, respectively. Twenty-four and 32 residents provided anonymous feedback in 2013 and 2015, respectively. Mean feedback scores were very high (> 4/5) for overall satisfaction, peer- and faculty-networking, the keynote speaker and the flash talks for both years. Mean feedback scores for the ethics debates and mentoring sessions were somewhat lower (≤ 4/5), however, both showed significant improvement from 2013 to 2015. The CPRRRs appear to be an effective mechanism for providing psychiatry research residents with a meaningful cross-institutional opportunity for networking and mentorship. Feedback-driven changes to the CPRRRs improved participant satisfaction for several components of the conference. Future efforts will be aimed at broadening mentorship and networking opportunities, optimizing teaching approaches for research ethics, and considering different feedback-gathering approaches to allow for

  4. 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

  5. Ten-year trends in family medicine residency productivity and staffing: impact of electronic health records, resident duty hours, and the medical home.

    Science.gov (United States)

    Lesko, Sarah; Hughes, Lauren; Fitch, Wes; Pauwels, Judith

    2012-02-01

    Electronic health records (EHRs), resident duty hour restrictions, and Patient-centered Medical Home (PCMH) innovations have all impacted the clinical practices of residency programs over the past decade. The University of Washington Family Medicine Network (UWFMN) residencies have collaborated for 10 years in collecting and comparing data regarding the productivity and operations of their training programs to identify the program-level effects of such changes. Based on five survey results from 2000 to 2010, this study examines changes in faculty and resident productivity and staffing models of UWFMN residency training clinics using a standardized methodology, specifically describing the productivity impact of EHR changes and duty hour restrictions and the implementation of the PCMH by residencies. Data were systematically collected via standardized questionnaire, evaluated for quality, clarified, and then analyzed. Resident productivity decreased over the 10-year interval, with resident total yearly patient visits down 17.2%. Core family medicine faculty productivity was highly variable among programs, and nonphysician provider visits increased. Faculty part-time status increased. Front office, medical assistant, and nursing staffing grew significantly, but other administrative staff decreased, resulting in minimal change in total non-provider staffing. A majority of programs engaged in PCMH initiatives in 2010 and had implemented an EHR. Physician productivity in UWFMN residency programs decreased for all resident physicians from 2000 to 2010, likely due to a combination of decreased resident duty hours and other clinical practice changes. Productivity trends have implications for the structure and training requirements for family medicine residency programs.

  6. Research on construction quality and improvement of assembly construction

    Science.gov (United States)

    Cheng, Fei

    2017-11-01

    Based on the acceleration of the urbanization process and the improvement of the quality of life of our residents, the demand for building construction has been increasing. In this context, the construction industry in order to promote the construction efficiency, quality improvement, to meet the needs of the development of the times to strengthen the new technology, the use of new technologies. At present, China’s engineering construction units in the process of carrying out the project to strengthen the use of assembly-type construction technology, which thus achieved for the traditional construction work low-level, high time-consuming issues, and promote the steady improvement of production efficiency. Based on this, this paper focuses on the analysis of the connotation of the assembly structure and analyzes the quality problems in the construction process of the construction projects and puts forward the improvement measures to promote the improvement of the building quality and the construction of the building Construction speed. Based on this, this paper analyzes the structural system and design of prefabricated building.

  7. Assessment of dam construction impact on hydrological regime changes in lowland river – A case of study: the Stare Miasto reservoir located on the Powa River

    Directory of Open Access Journals (Sweden)

    Sojka Mariusz

    2016-09-01

    Full Text Available The purpose of the presented research is analysis and assessment of the Stare Miasto reservoir impact on the hydrological regime changes of the Powa River. The reservoir was built in 2006 and is located in the central part of Poland. The total area of inundation in normal conditions is 90.68 ha and its capacity is 2.159 mln m3. Hydrological regime alteration of the Powa River is analysed on the basis of daily flows from the Posoka gauge station observed during period 1974–2014. Assessment of hydrological regime changes is carried out on the basis of Range of Variability Approach (RVA method. All calculations are made by means of Indicators of Hydrologic Alteration (IHA software version 7.1.0.10. The analysis shows that the Stare Miasto reservoir has a moderate impact on hydrological regime of the Powa River. Construction of the reservoir has positive effect on stability of minimal flows, which are important for protection of river ecosystems. The results obtained indicate that the Stare Miasto reservoir reduces a spring peak flow and enables to moderate control of floods.

  8. 42 CFR 413.343 - Resident assessment data.

    Science.gov (United States)

    2010-10-01

    ...; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES Prospective Payment for Skilled Nursing Facilities § 413.343 Resident assessment data. (a) Submission of resident assessment data... such other assessments that are necessary to account for changes in patient care needs. (c...

  9. Residency and small-scale movement behaviour of three endemic ...

    African Journals Online (AJOL)

    Juvenile zebra displayed the highest degree of residency followed by white musselcracker and blacktail, with re-sightings recorded on 53%, 40% and 10% of observation days, respectively. The high degree of residency by early juvenile sparids renders them vulnerable to localized coastal perturbations and climate change.

  10. Policies and attitudes toward the pregnant radiology resident

    International Nuclear Information System (INIS)

    Sheth, S.; Freedman, M.T.; Arak, G.

    1985-01-01

    To evaluate attitudes and policies toward pregnant radiology residents, a questionnaire was sent to the chiefs of radiology residency programs across the country. A return rate of 76.4% and a response rate of 75.4% were achieved. A large majority of the respondents indicated that schedule changes would be made to avoid excessive exposure of a pregnant resident to radiation. The accommodations they suggest are reviewed, and suggestions are made that would help alleviate some of the stress and conflicts that invariably arise when a resident becomes pregnant

  11. Therapeutic kitchens for residents with dementia.

    Science.gov (United States)

    Marsden, J P; Meehan, R A; Calkins, M P

    2001-01-01

    Long-term care facilities are increasingly incorporating some sort of kitchen, often referred to as a therapeutic kitchen, for resident, staff, and family use through remodeling efforts or new construction. A study, consisting of five site visits and a questionnaire mailed to 631 facilities providing dementia care, was conducted to identify physical features that are typically included in therapeutic kitchen design and to explore how these features support daily use in relation to activities programming and food service systems. Findings indicate that universal design features should be incorporated to a greater extent and certain features are more common, reinforce homelike imagery, or enhance safety. Results also suggest that a higher number of residents participate in more recreational activities, such as baking, than they do in household chores, such as meal set-up, and therapeutic kitchens are not always linked to food service systems.

  12. Modelling the impact of land-use change and farm dam construction on hillslope sediment delivery to rivers at the regional scale

    Science.gov (United States)

    Verstraeten, Gert; Prosser, Ian P.

    2008-06-01

    Landscapes in southeastern Australia have changed dramatically since the spread of European colonisation in the 19th century. Due to widespread forest clearance for cultivation and grazing, erosion and sediment yields have increased by a factor of more than 150. In the 20th century, erosion and sediment yield were reduced again due to an increasing vegetative cover. Furthermore, during the last decades, thousands of small farm dams were constructed to provide drinking water for cattle. These dams trap a lot of sediment, thereby further reducing sediment delivery from hillslopes to river channels. Changes in sediment delivery since European colonisation are documented in sediment archives. Within this study, these changing rates in hillslope erosion and sediment delivery were modelled using a spatially distributed erosion and sediment delivery model (WATEM/SEDEM) that was calibrated for Australian ecosystems using sediment yield data derived from sedimentation rates in 26 small farm dams. The model was applied to the Murrumbidgee river basin (30,000 km 2) under different land-use scenarios. First, the erosion and sediment yield under pre-European land-use was modelled. Secondly, recent land-use patterns were used in the model. Finally, recent land-use including the impact of farm dams and large reservoirs was simulated. The results show that the WATEM/SEDEM model is capable of predicting the intensity of the geomorphic response to changes in land-use through time. Changes in hillslope erosion and hillslope sediment delivery rates are not equal, illustrating the non-linear response of the catchment. Current hillslope sediment supply to the river channel network is predicted to be 370% higher compared to the pre-European settlement period, yet farm dams have reduced this back to 2.5 times the pre-19th century values. The role of larger reservoirs is even more important as they have reduced the current sediment supply downstream to their pre-European values, thus

  13. Construction fraud

    NARCIS (Netherlands)

    Graafland, J.J.; Liedekerke, L.; Dubbink, W.; van Liedekerke, L.; van Luijk, H.

    2011-01-01

    Due to the actions of a whistleblower The Netherlands was confronted with a massive case of construction fraud involving almost the entire construction sector. Price fixing, prior consulting, duplicate accounts, fictitious invoices and active corruption of civil servants were rampant practices. This

  14. Superstring construction

    CERN Document Server

    1989-01-01

    The book includes a selection of papers on the construction of superstring theories, mainly written during the years 1984-1987. It covers ten-dimensional supersymmetric and non-supersymmetric strings, four-dimensional heterotic strings and four-dimensional type-II strings. An introduction to more recent developments in conformal field theory in relation to string construction is provided.

  15. Usability Constructs

    DEFF Research Database (Denmark)

    Hertzum, Morten; Clemmesen, Torkil; Hornbæk, Kasper Anders Søren

    2007-01-01

    frustrating systems are experienced similarly to easy-to-use systems. Looking at the most characteristic construct for each participant we find that Chinese participants use constructs related to security, task types, training, and system issues, whereas Danish and to some extent Indian participants make more...

  16. Length and content of family practice residency training.

    Science.gov (United States)

    Duane, Marguerite; Green, Larry A; Dovey, Susan; Lai, Sandy; Graham, Robert; Fryer, George E

    2002-01-01

    Family practice residency programs are based largely on a model implemented more than 30 years ago. Substantial changes in medical practice, technology, and knowledge necessitate reassessment of how family physicians are prepared for practice. We simultaneously surveyed samples of family practice residency directors, first-year residents, and family physicians due for their first board recertification examination to determine, using both quantitative and qualitative methods, their opinions about the length and content of family practice residencies in the United States. Twenty-seven percent of residency directors, 32% of residents, and 28% of family physicians favored extending family practice residency to 4 years; very few favored 2- or 5-year programs. There was dispersion of opinions about possible changes within each group and among the three groups. Most in all three groups would be willing to extend residency for more training in office-based procedures and sports medicine, but many were unwilling to extend residency for more training in surgery or hospital-based care. Residents expressed more willingness than program directors or family physicians to change training. Barriers to change included disagreement about the need to change; program financing and opportunity costs, such as loss of income and delay in debt repayment; and potential negative impact on student recruitment. Most respondents support the current 3-year model of training. There is considerable interest in changing both the length and content of family practice training. Lack of consensus suggests that a period of elective experimentation might be needed to assure family physicians are prepared to meet the needs and expectations of their patients.

  17. The Impact of the 80-Hour Resident Workweek on Surgical Residents and Attending Surgeons

    Science.gov (United States)

    Hutter, Matthew M.; Kellogg, Katherine C.; Ferguson, Charles M.; Abbott, William M.; Warshaw, Andrew L.

    2006-01-01

    Objective: To assess the impact of the 80-hour resident workweek restrictions on surgical residents and attending surgeons. Summary Background Data: The ACGME mandated resident duty hour restrictions have required a major workforce restructuring. The impact of these changes needs to be critically evaluated for both the resident and attending surgeons, specifically with regards to the impact on motivation, job satisfaction, the quality of surgeon training, the quality of the surgeon's life, and the quality of patient care. Methods: Four prospective studies were performed at a single academic surgical program with data collected both before the necessary workforce restructuring and 1 year after, including: 1) time cards to assess changes in components of daily activity; 2) Web-based surveys using validated instruments to assess burnout and motivation to work; 3) structured, taped, one-on-one interviews with an external PhD investigator; and 4) statistical analyses of objective, quantitative data. Results: After the work-hour changes, surgical residents have decreased “burnout” scores, with significantly less “emotional exhaustion” (Maslach Burnout Inventory: 29.1 “high” vs. 23.1 “medium,” P = 0.02). Residents have better quality of life both in and out of the hospital. They felt they got more sleep, have a lighter workload, and have increased motivation to work (Herzberg Motivation Dimensions). We found no measurable, statistically significant difference in the quality of patient care (NSQIP data). Resident training and education objectively were not statistically diminished (ACGME case logs, ABSITE scores). Attending surgeons perceived that their quality of their life inside and outside of the hospital was “somewhat worse” because of the work-hour changes, as they had anticipated. Many concerns were identified with regards to the professional development of future surgeons, including a change toward a shift-worker mentality that is not patient

  18. Attitudes toward the use of gender-inclusive language among residency trainees. The McMaster Residency Training Program Directors.

    Science.gov (United States)

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

    1997-05-01

    To explore postgraduate medical trainees' attitudes toward the use of gender-inclusive language. Self-administered questionnaire. Seven residency training programs at McMaster University, Hamilton, Ont., from July 1993 to June 1994. Of 225 residents in the programs, 186 responded to the survey, for a response rate of 82.7%. Men and women were equally represented among the respondents. Categorization of attitudes about the use of language as gender-inclusive or gender-exclusive; characteristics predicting a gender-inclusive attitude. Factor analysis and Cronbach's alpha (0.90) supported the existence of a construct related to attitudes about language use, the poles of which were categorized as gender-inclusive and gender-exclusive. The authors classified residents with respect to their attitudes to language use from their responses to the questionnaire. In univariate analyses, sex, residency program and country of graduation significantly predicted a gender-inclusive attitude (p < 0.01). Only the first 2 variables were significant in a multivariate model; residency program explained 18% of the variance and sex 3%. Residents in obstetrics and gynecology and psychiatry had the most gender-inclusive attitudes, whereas residents in surgery and anesthesia had the most gender-exclusive attitudes. Residents' values are reflected in the language they choose to use. Language use may provide an index of underlying attitudes that may create hostile environments for female trainees.

  19. Blended Learning in Obstetrics and Gynecology Resident Education: Impact on Resident Clinical Performance

    Directory of Open Access Journals (Sweden)

    Allen Ghareeb

    2016-01-01

    Full Text Available Problem Effects of residents’ blended learning on their clinical performance have rarely been reported. A blended learning pilot program was instituted at Southern Illinois University School of Medicine's Obstetrics and Gynecology program. One of the modules was chronic hypertension in pregnancy. We sought to evaluate if the resident blended learning was transferred to their clinical performance six months after the module. Intervention A review of patient charts demonstrated inadequate documentation of history, evaluation, and counseling of patients with chronic hypertension at the first prenatal visit by Obstetrics and Gynecology (OB/GYN residents. A blended learning module on chronic hypertension in pregnancy was then provided to the residents. A retrospective chart review was then performed to assess behavioral changes in the OB/GYN residents. Context This intervention was carried out at the Department of Obstetrics and Gynecology, Southern Illinois University. All 16 OB/GYN residents were enrolled in this module as part of their educational curriculum. A query of all prenatal patients diagnosed with chronic hypertension presenting to the OB/GYN resident clinics four months prior to the implementation of the blended learning module (March 2015–June 2015 and six months after (July 20, 2015–February 2016 was performed. Data were collected from outpatient charts utilizing the electronic medical record. Data were abstracted from resident documentation at the first prenatal visit. Outcome The residents thought that the blended learning module was applicable to performance improvement in the real-world setting. Patients evaluated before ( n = 10 and after ( n = 7 the intervention were compared. After the intervention, there was an increase in assessment of baseline liver enzymes, referral for electrocardiogram, and early assessment for diabetes in the obese patients. More patients were provided a blood pressure cuff after the module (71

  20. Education research: neurology training reassessed. The 2011 American Academy of Neurology Resident Survey results.

    Science.gov (United States)

    Johnson, Nicholas E; Maas, Matthew B; Coleman, Mary; Jozefowicz, Ralph; Engstrom, John

    2012-10-23

    To assess the strengths and weaknesses of neurology resident education using survey methodology. A 27-question survey was sent to all neurology residents completing residency training in the United States in 2011. Of eligible respondents, 49.8% of residents returned the survey. Most residents believed previously instituted duty hour restrictions had a positive impact on resident quality of life without impacting patient care. Most residents rated their faculty and clinical didactics favorably. However, many residents reported suboptimal preparation in basic neuroscience and practice management issues. Most residents (71%) noted that the Residency In-service Training Examination (RITE) assisted in self-study. A minority of residents (14%) reported that the RITE scores were used for reasons other than self-study. The vast majority (86%) of residents will enter fellowship training following residency and were satisfied with the fellowship offers they received. Graduating residents had largely favorable neurology training experiences. Several common deficiencies include education in basic neuroscience and clinical practice management. Importantly, prior changes to duty hours did not negatively affect the resident perception of neurology residency training.

  1. Operations management for construction

    CERN Document Server

    March, Chris

    2009-01-01

    Students studying construction management and related subjects need to have a broad understanding of the major aspects of controlling the building processes. Operations Management for Construction is one of three textbooks (Business Organisation, Operations Management and Finance Control) written to systematically cover the field. Focusing on construction sites and operations which are challenging to run, Chris March explores issues such as the setting up of the site, the deciding of the methodology of construction, and the sequence of work and resourcing. As changing and increasing regulations affect the way sites are managed, he also considers the issues and methods of successful administering, safety, quality and environment. Finally, the contractor's responsibility to the environment, including relationships with third parties, selection of materials, waste management and sustainability is discussed. Chris March has a wealth of practical experience in the construction industry, as well as considerable exp...

  2. Worldwide construction

    International Nuclear Information System (INIS)

    Williamson, M.

    1994-01-01

    The paper lists major construction projects in worldwide processing and pipelining, showing capacities, contractors, estimated costs, and time of construction. The lists are divided into refineries, petrochemical plants, sulfur recovery units, gas processing plants, pipelines, and related fuel facilities. This last classification includes cogeneration plants, coal liquefaction and gasification plants, biomass power plants, geothermal power plants, integrated coal gasification combined-cycle power plants, and a coal briquetting plant

  3. Impacts of residence time during storage on potential of water saving for grey water recycling system.

    Science.gov (United States)

    Liu, S; Butler, D; Memon, F A; Makropoulos, C; Avery, L; Jefferson, B

    2010-01-01

    Grey water recycling has been generally accepted and is about to move into practice in terms of sustainable development. Previous research has revealed the bacteria re-growth in grey water and reclaimed municipal water during storage. However, in most present grey water recycling practices, impacts of water quality changes during storage on the system's performance and design regulation have not been addressed. In this paper, performance of a constructed wetland based grey water recycling system was analysed by taking the constraint of residence time during storage into account using an object based household water cycle model. Two indicators, water saving efficiency (WSE) and residence time index (RTI), are employed to reflect the system's performance and residence time during storage respectively. Results show that WSE and RTI change with storage tank volumes oppositely. As both high WSE and RTI cannot be achieved simultaneously, it is concluded that in order to achieve the most cost-effective and safe solution, systems with both small grey and green tanks are needed, whilst accepting that only relatively modest water saving efficiency targets can be achieved. Higher efficiencies will only be practicable if water quality deterioration in the green water tank can be prevented by some means (e.g. disinfection).

  4. Constructive Consumer Choice Processes.

    OpenAIRE

    Bettman, James R; Luce, Mary Frances; Payne, John W

    1998-01-01

    Consumer decision making has been a focal interest in consumer research, and consideration of current marketplace trends ( e.g., technological change, an information explosion) indicates that this topic will continue to be critically important. We argue that consumer choice is inherently constructive. Due to limited processing capacity, consumers often do not have well-defined existing preferences, but construct them using a variety of strategies contingent on task demands. After describing c...

  5. Five Key Leadership Actions Needed to Redesign Family Medicine Residencies.

    Science.gov (United States)

    Kozakowski, Stanley M; Eiff, M Patrice; Green, Larry A; Pugno, Perry A; Waller, Elaine; Jones, Samuel M; Fetter, Gerald; Carney, Patricia A

    2015-06-01

    New skills are needed to properly prepare the next generation of physicians and health professionals to practice in medical homes. Transforming residency training to address these new skills requires strong leadership. We sought to increase the understanding of leadership skills useful in residency programs that plan to undertake meaningful change. The Preparing the Personal Physician for Practice (P4) project (2007-2014) was a comparative case study of 14 family medicine residencies that engaged in innovative training redesign, including altering the scope, content, sequence, length, and location of training to align resident education with requirements of the patient-centered medical home. In 2012, each P4 residency team submitted a final summary report of innovations implemented, overall insights, and dissemination activities during the study. Six investigators conducted independent narrative analyses of these reports. A consensus meeting held in September 2012 was used to identify key leadership actions associated with successful educational redesign. Five leadership actions were associated with successful implementation of innovations and residency transformation: (1) manage change; (2) develop financial acumen; (3) adapt best evidence educational strategies to the local environment; (4) create and sustain a vision that engages stakeholders; and (5) demonstrate courage and resilience. Residency programs are expected to change to better prepare their graduates for a changing delivery system. Insights about effective leadership skills can provide guidance for faculty to develop the skills needed to face practical realities while guiding transformation.

  6. Factors Influencing Resident Choice of Prosthodontic Residency Program.

    Science.gov (United States)

    Wojnarwsky, Pandora Keala Lee; Wang, Yan; Shah, Kumar; Koka, Sreenivas

    2017-06-01

    The decision by prosthodontic residency program directors to employ the Match process highlights the need to understand applicant priorities that influence their choice of which programs to rank highly. The purpose of this study is to determine the factors that were most important to residents when choosing from among nonmilitary based prosthodontics dental residency programs in the United States. Following completion of a pilot study, all currently enrolled prosthodontic residents at nonmilitary residency programs were invited to participate via the internet. The study consisted of a survey instrument asking residents to rank 26 possible factors that might impact an applicant's choice of residency program. In addition, the instrument collected other possible influencing variables including gender and debt load. Mean rank scores were compared to determine the most and least important factors. Kruskal-Wallis test was used to compare specific factors between the possible influencing variables. Two hundred and thirty residents completed the survey instrument, representing a 54.1% response rate of possible participants. With regard to factors influencing program choice, reputation of the residency program was the factor ranked the highest by participants, followed in descending order by the program director's personality, curriculum content, access to use of the latest digital technology, and opportunities for dental implant placement. Quality of schools for children, community outreach opportunities, and the ability to moonlight were ranked as the least important factors. Male and female residents ranked factors such as tuition/stipend, curriculum content, and community outreach opportunities significantly differently. Depending on debt load, residents ranked the factors tuition/stipend, ability to moonlight, curriculum content, and safety of the area where the program is differently. Current prosthodontic residents valued the reputation of the program as the most

  7. Training Psychiatry Residents in Professionalism in the Digital World.

    Science.gov (United States)

    John, Nadyah Janine; Shelton, P G; Lang, Michael C; Ingersoll, Jennifer

    2017-06-01

    Professionalism is an abstract concept which makes it difficult to define, assess and teach. An additional layer of complexity is added when discussing professionalism in the context of digital technology, the internet and social media - the digital world. Current physicians-in-training (residents and fellows) are digital natives having been raised in a digital, media saturated world. Consequently, their use of digital technology and social media has been unconstrained - a reflection of it being integral to their social construct and identity. Cultivating the professional identity and therefore professionalism is the charge of residency training programs. Residents have shown negative and hostile attitudes to formalized professionalism curricula in training. Approaches to these curricula need to consider the learning style of Millennials and incorporate more active learning techniques that utilize technology. Reviewing landmark position papers, guidelines and scholarly work can therefore be augmented with use of vignettes and technology that are available to residency training programs for use with their Millennial learners.

  8. Factors associated with the satisfaction of millennial generation dental residents.

    Science.gov (United States)

    Lam, Hwai-Tai C; O'Toole, Terry G; Arola, Patricia E; Kashner, T Michael; Chang, Barbara K

    2012-11-01

    Data from the 2010 Learners' Perceptions Survey (LPS) administered through the Office of Academic Affiliations, Department of Veterans Affairs (VA) were analyzed to identify factors associated with dental residents' satisfaction with the VA as a clinical training environment. Satisfaction scores were linked to clinic workloads, dental procedure complexity levels, staffing patterns, and facility infrastructure data to explore conditions that may improve residents' satisfaction. Findings supported the construct validity of the LPS survey data and underscored the importance of maintaining optimal ratios of attending dentists, dental assistants, and administrative staff to residents so that each trainee will have opportunities to perform an adequate level of dental workload. As programs strive to improve the quality of graduate dental education, findings from this study are vital for setting curriculum design guidelines and for providing infrastructure support for dental resident education.

  9. Construction safety

    CERN Document Server

    Li, Rita Yi Man

    2013-01-01

    A close-to-ideal blend of suburb and city, speedy construction of towers of Babylon, the sparkling proportion of glass and steel buildings’ facade at night showcase the wisdom of humans. They also witness the footsteps, sweats and tears of architects and engineers. Unfortunately, these signatures of human civilizations are swathed in towering figures of construction accidents. Fretting about these on sites, different countries adopt different measures on sites. This book firstly sketches the construction accidents on sites, followed by a review on safety measures in some of the developing countries such as Bermuda, Egypt, Kuwait and China; as well as developed countries, for example, the United States, France and Singapore. It also highlights the enormous compensation costs with the courts’ experiences in the United Kingdom and Hong Kong.

  10. Opportunities to Create New General Surgery Residency Programs to Alleviate the Shortage of General Surgeons.

    Science.gov (United States)

    Meagher, Ashley D; Beadles, Christopher A; Sheldon, George F; Charles, Anthony G

    2016-06-01

    To estimate the capacity for supporting new general surgery residency programs among U.S. hospitals that currently do not have such programs. The authors compiled 2011 American Hospital Association data regarding the characteristics of hospitals with and without a general surgery residency program and 2012 Accreditation Council for Graduate Medical Education data regarding existing general surgery residencies. They performed an ordinary least squares regression to model the number of residents who could be trained at existing programs on the basis of residency program-level variables. They identified candidate hospitals on the basis of a priori defined criteria for new general surgery residency programs and an out-of-sample prediction of resident capacity among the candidate hospitals. The authors found that 153 hospitals in 39 states could support a general surgery residency program. The characteristics of these hospitals closely resembled the characteristics of hospitals with existing programs. They identified 435 new residency positions: 40 hospitals could support 2 residents per year, 99 hospitals could support 3 residents, 12 hospitals could support 4 residents, and 2 hospitals could support 5 residents. Accounting for progressive specialization, new residency programs could add 287 additional general surgeons to the workforce annually (after an initial five- to seven-year lead time). By creating new general surgery residency programs, hospitals could increase the number of general surgeons entering the workforce each year by 25%. A challenge to achieving this growth remains finding new funding mechanisms within and outside Medicare. Such changes are needed to mitigate projected workforce shortages.

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

    Science.gov (United States)

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

    2011-12-01

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

  12. Burnout among Dutch medical residents

    NARCIS (Netherlands)

    Prins, J.T.; Hoekstra-Weebers, J.E.; Van De Wiel, H.B.; Gazendam-Donofrio, S.M.; Sprangers, F.; Jaspers, F.C.; van der Heijden, F.M.

    2007-01-01

    We examined levels of burnout and relationships between burnout, gender, age, years in training, and medical specialty in 158 medical residents working at the University Medical Center Groningen, the Netherlands. Thirteen percent of the residents met the criteria for burnout, with the highest

  13. Surgical residency: A tenant's view

    African Journals Online (AJOL)

    'To sleep: perchance to dream', is the frequent mantra of the surgical resident. However, unlike. Hamlet, there is no ensuing speculation as to what dreams may come as there are seldom any!! Surgical residency has been both vilified and immortalized, but the fact remains that it is one of the most challenging, provocative ...

  14. Evidence-based selection of theories for designing behaviour change interventions: using methods based on theoretical construct domains to understand clinicians' blood transfusion behaviour.

    Science.gov (United States)

    Francis, Jill J; Stockton, Charlotte; Eccles, Martin P; Johnston, Marie; Cuthbertson, Brian H; Grimshaw, Jeremy M; Hyde, Chris; Tinmouth, Alan; Stanworth, Simon J

    2009-11-01

    Many theories of behaviour are potentially relevant to predictive and intervention studies but most studies investigate a narrow range of theories. Michie et al. (2005) agreed 12 'theoretical domains' from 33 theories that explain behaviour change. They developed a 'Theoretical Domains Interview' (TDI) for identifying relevant domains for specific clinical behaviours, but the framework has not been used for selecting theories for predictive studies. It was used here to investigate clinicians' transfusion behaviour in intensive care units (ICU). Evidence suggests that red blood cells transfusion could be reduced for some patients without reducing quality of care. (1) To identify the domains relevant to transfusion practice in ICUs and neonatal intensive care units (NICUs), using the TDI. (2) To use the identified domains to select appropriate theories for a study predicting transfusion behaviour. An adapted TDI about managing a patient with borderline haemoglobin by watching and waiting instead of transfusing red blood cells was used to conduct semi-structured, one-to-one interviews with 18 intensive care consultants and neonatologists across the UK. Relevant theoretical domains were: knowledge, beliefs about capabilities, beliefs about consequences, social influences, behavioural regulation. Further analysis at the construct level resulted in selection of seven theoretical approaches relevant to this context: Knowledge-Attitude-Behaviour Model, Theory of Planned Behaviour, Social Cognitive Theory, Operant Learning Theory, Control Theory, Normative Model of Work Team Effectiveness and Action Planning Approaches. This study illustrated, the use of the TDI to identify relevant domains in a complex area of inpatient care. This approach is potentially valuable for selecting theories relevant to predictive studies and resulted in greater breadth of potential explanations than would be achieved if a single theoretical model had been adopted.

  15. 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.

  16. 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.

  17. Construction work

    CERN Multimedia

    2004-01-01

    Construction work on building 179 will start on the 16th February 2004 and continue until November 2004. The road between buildings 179 and 158 will temporarily become a one way street from Route Democrite towards building 7. The parking places between buildings 179 and 7 will become obsolete. The ISOLDE collaboration would like to apologize for any inconveniences.

  18. Scale Construction.

    Science.gov (United States)

    Dawis, Rene V.

    1987-01-01

    Discusses design, development, and evaluation of scales used in counseling psychology research. Describes methods of scale construction including the Thurstone, Q-sort, rank-order methods, Likert, semantic differential, Guttman, Rasch, and external criterion methods. Presents ways of evaluating newly developed scales. Discusses measurement versus…

  19. 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.

  20. 22 CFR 19.5-3 - Residence of spouse during service at unhealthful post.

    Science.gov (United States)

    2010-04-01

    ... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Residence of spouse during service at... Residence of spouse during service at unhealthful post. (a) The calculation of the pro rata share of... assignment. Both the participant and spouse shall sign the completed form. If there is a change in residence...

  1. [Career plans of French residents in Psychiatry: results of a National Survey].

    Science.gov (United States)

    Berger-Vergiat, A; Chauvelin, L; Van Effenterre, A

    2015-02-01

    For many years, the numerus clausus limiting the number of medical students has increased in France. The government wants to reform the residency process to homogenize medical studies. However, the suggested residency program changes would imply changes in the length of residency, in the mobility of residents after residency, their access to unconventional sectors, and more generally, the responsibility of the resident and his/her status in the hospital. In this context, we have investigated the future plans of all psychiatry residents in France. To study the desires of psychiatry residents in France, regarding their training, their short and long-term career plans, and to analyze the evolution of those desires over the last 40 years. A survey was carried out among residents in psychiatry from November 2011 to January 2012. An anonymous questionnaire including four parts (resident's description, residency training and trainees choice, orientation immediately after residency, professional orientation in 5-10 years) was sent by the French Federative Association of Psychiatrists Trainees (AFFEP) to all French psychiatrist trainees, through their local trainee associations (n=26) and through an on line questionnaire. The questionnaire was answered by 853 of the 1615 psychiatry residents (53%), of which 71% were women. At the end of the residency, 76% of residents reported that they would like to pursue a post-residency position (chief resident, senior physician assistant university hospitals); 22% reported wanting to work in another city. Between 5 to 10 years after completion of the residency, 71% reported wanting to work in a hospital, and 40% preferred to have their own private practice. Almost a third of the trainees wished to work in the child and adolescent psychiatry field, for some of them in an exclusive way, for others, combined with a practice in adult psychiatry. Copyright © 2013 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.

  2. The combination of environmental quality with increasingly rural residence and associations with adverse birth outcomes

    Science.gov (United States)

    Environmental quality differs across levels of urbanicity, and both urban and rural residence having been previously associated with better health. To explore these relationships, we constructed an environmental quality index (EQI) with data representing five domains (air, water,...

  3. MODELING HOW A HURRICANE BARRIER IN NEW BEDFORD HARBOR, MASSACHUSETTS, AFFECTS THE HYDRODYNAMICS AND RESIDENCE TIMES

    Science.gov (United States)

    Two-dimensional hydrodynamic and transport models were used to simulate tidal and subtidal circulation, residence times, and the longitudinal distributions of conservative constituents in New Bedford Harbor, Massachusetts, before and after a hurricane barrier was constructed. The...

  4. Practical Interventions to Enhance Resident Ownership of Patient Care.

    Science.gov (United States)

    Soeprono, Thomas; Markman, Jesse; Grodesky, Michael; Cowley, Deborah

    2017-06-19

    In the modern training environment, some question whether trainees have the opportunity to develop ownership of patient care, which includes concepts such as advocacy, autonomy, commitment, communication, follow-through, knowledge about the patient, responsibility, and teamwork. Despite descriptions of what ownership is, there is little discussion of how to foster ownership during residency. The objective of this study was to solicit psychiatry resident and faculty perspectives on ways to enhance resident ownership in training. Twenty-nine of 74 (39.2%) residents and 31 of 68 (45.6%) faculty members surveyed provided narrative responses to a voluntary, anonymous, electronic survey asking two structured, open-ended questions about what factors make it more or less likely that a resident will take "ownership" of patient care. The coding process produced four overarching categories of themes (attending, resident, educational program, and environment) that reflect domains for possible interventions to increase ownership, with conceptual guidance from the Theory of Planned Behavior. From these factors, the authors propose a number of practical yet theory-based interventions which include setting expectations, modeling, promoting autonomy, countertransference supervision, changing residency culture, and longer rotations. These interventions address subjective norms, attitudes, perceived ability and control, environment, and actual resident abilities, all of which, according to the Theory of Planned Behavior, would be likely to influence patient care ownership. Future studies could develop curricula and examine the effectiveness of the interventions proposed here in reinforcing or developing ownership in physicians.

  5. Modelling Constructs

    DEFF Research Database (Denmark)

    Kindler, Ekkart

    2009-01-01

    , these notations have been extended in order to increase expressiveness and to be more competitive. This resulted in an increasing number of notations and formalisms for modelling business processes and in an increase of the different modelling constructs provided by modelling notations, which makes it difficult......There are many different notations and formalisms for modelling business processes and workflows. These notations and formalisms have been introduced with different purposes and objectives. Later, influenced by other notations, comparisons with other tools, or by standardization efforts...... to compare modelling notations and to make transformations between them. One of the reasons is that, in each notation, the new concepts are introduced in a different way by extending the already existing constructs. In this chapter, we go the opposite direction: We show that it is possible to add most...

  6. Airship construction

    Science.gov (United States)

    Roda, J.

    1975-01-01

    Forty-four years ago the first successful metal airship was completed and delivered to the United States Navy, the ZMC-2. Between those years and the present, very little effort or serious consideration has been given to the manufacture, design, construction, or economic impact of airships. It is important to retain and exploit the small but continually diminishing pool of airship talent that will expedite the success of the United States in what is now a pioneering venture. The relative simplicity of airship construction, utilizing the tremendous technical advances of the last 44 years, leads to the conclusion that this form of transportation holds great promise for reducing costs of military missions and improving the international competitive position of the United States in commercial applications.

  7. The Effects of Abortion Training on Family Medicine Residents' Clinical Experience.

    Science.gov (United States)

    Summit, Aleza K; Gold, Marji

    2017-01-01

    RHEDI, Reproductive Health Education in Family Medicine, offers technical assistance and funding to family medicine residency programs to support integrated opt-out abortion and reproductive health training for residents. This study assessed the impact of this enhanced training on residents' reproductive health experience. Investigator-developed pre- and post-surveys were administered online to 214 residents at 12 family medicine residency programs before and after their RHEDI training experience. Surveys addressed experience in contraception and abortion, attitudes around abortion provision, and post-residency intentions. Descriptive statistics were generated, and statistical tests were performed to assess changes after training. Surveys had a 90% response rate. After the RHEDI enhanced reproductive health rotation, residents reported increased experience in contraception provision, early pregnancy ultrasound, aspiration and medication abortion, and miscarriage management. After training, residents with experience in IUD insertion increased from 85% to 99%, and contraceptive implant insertion experience rose from 60% to 85%. Residents who had performed any abortions increased from 15% to 79%, and self-rated competency in abortion increased. Finally, almost all residents agreed that early abortion was within the scope of family medicine, and training confirmed residents' intentions to provide reproductive health services after residency. Integrated training in reproductive health, with an emphasis on abortion, increases residents' experience and underscores their understanding of the role of these services in family medicine. Increasing the number of family medicine residency programs that offer this training could help prepare family physicians to meet their patients' needs for reproductive health services.

  8. Construction traditions and Restoration

    Directory of Open Access Journals (Sweden)

    B. Paolo Torsello

    2010-12-01

    Full Text Available In view of the physical and material incompatibility of many restoration works performed in the past, in recent years there has arisen a debate about the wisdom of retrieving old building traditions for the restoration process with a simple mechanical interpretation. Professor Torsello dissects the concept of tradition as regards its relationship with experience, science, history and production to discover an order of problems that affect the structure of our knowledge and whose origin resides in the radical changes that characterise modernity.

  9. Construct ability Improvement for Nuclear Power Plants

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Dae Soo; Lee, Jong Rim; Kim, Jong Ku [Korea Electric Power Research Institute, Taejon (Korea, Republic of)

    1997-12-31

    The purpose of this study was to identify methods for improving the construct ability of nuclear power plants. This study reviewed several references of current construction practices of domestic and overseas nuclear plants in order to identify potential methods for improving construct ability. The identified methods for improving construct ability were then evaluated based on the applicability to domestic nuclear plant construction. The selected methods are expected to reduce the construction period, improve the quality of construction, cost, safety, and productivity. Selection of which methods should be implemented will require further evaluation of construction modifications, design changes, contract revisions. Among construction methods studied, platform construction methods can be applied through construction sequence modification without significant design changes, and Over the Top construction method of the NSSS, automatic welding of RCL pipes, CLP modularization, etc., are considered to be applied after design modification and adjustment of material lead time. (author). 49 refs., figs., tabs.

  10. The Preferred Learning Styles of Neurosurgeons, Neurosurgery Residents, and Neurology Residents: Implications in the Neurosurgical Field.

    Science.gov (United States)

    Lai, Hung-Yi; Lee, Ching-Yi; Chiu, Angela; Lee, Shih-Tseng

    2014-01-01

    To delineate the learning style that best defines a successful practitioner in the field of neurosurgery by using a validated learning style inventory. The Kolb Learning Style Inventory, a validated assessment tool, was administered to all practicing neurosurgeons, neurosurgical residents, and neurology residents employed at Chang Gung Memorial Hospital, an institution that provides primary and tertiary clinical care in 3 locations, Linkou, Kaohsiung, and Chiayi. There were 81 participants who entered the study, and all completed the study. Neurosurgeons preferred the assimilating learning style (52%), followed by the diverging learning style (39%). Neurosurgery residents were slightly more evenly distributed across the learning styles; however, they still favored assimilating (32%) and diverging (41%). Neurology residents had the most clearly defined preferred learning style with assimilating (76%) obtaining the large majority and diverging (12%) being a distant second. The assimilating and diverging learning styles are the preferred learning styles among neurosurgeons, neurosurgery residents, and neurology residents. The assimilating learning style typically is the primary learning style for neurosurgeons and neurology residents. Neurosurgical residents start off with a diverging learning style and progress toward an assimilating learning style as they work toward becoming practicing neurosurgeons. The field of neurosurgery has limited opportunities for active experimentation, which may explain why individuals who prefer reflective observation are more likely to succeed in this field. Copyright © 2014 Elsevier Inc. All rights reserved.

  11. A basic residency curriculum concerning the chronically mentally ill.

    Science.gov (United States)

    Faulkner, L R; Cutler, D L; Krohn, D D; Factor, R M; Goldfinger, S M; Goldman, C R; Lamb, H R; Lefley, H; Minkoff, K; Schwartz, S R

    1989-10-01

    In this paper a group of knowledgeable individuals with expertise in psychiatric education present their recommendations for a basic psychiatric residency curriculum concerning the chronically mentally ill. The proposed curriculum consists of knowledge, skill, and attitude educational objectives, as well as clinical experiences, faculty supervision, didactics and seminars, and evaluation mechanisms. Recommendations are also made concerning changes in the Accreditation Council for Graduate Medical Education's Special Requirements for Residency Training in Psychiatry, which would require residency programs to place more emphasis on training to meet the needs of the chronically mentally ill. Obstacles to the implementation of the proposed recommendations are presented and possible solutions are discussed.

  12. Helping Residents Protect Water Sources

    Science.gov (United States)

    Building on the successful early engagement of the Plain Sect agricultural community, the Eastern Lancaster County Source Water Protection Collaborative is expanding its efforts to involve local residents in the work of protecting drinking water sources.

  13. Challenges to neurology residency education in today's health care environment.

    Science.gov (United States)

    Bega, Danny; Krainc, Dimitri

    2016-09-01

    Residency training has had to adapt to higher patient volumes, increased complexity of medical care, and the commercialized system of health care. These changes have led to a concerning culture shift in neurology. We review the relationship between the emerging health care delivery system and residency training, highlighting issues related to duty hours and work-life balance, the changing technological landscape, high patient volumes, and complex service obligations. We propose that the current challenges in health care delivery offer the opportunity to improve neurology residency through faculty development programs, bringing teaching back to the bedside, increasing resident autonomy, utilizing near-peer teaching, and rewarding educators who facilitate an environment of inquiry and scholarship, with the ultimate goal of better alignment between education and patient care. Ann Neurol 2016;80:315-320. © 2016 American Neurological Association.

  14. the contribution of resident physicians

    OpenAIRE

    Trusch, Klaus

    2011-01-01

    A telephone survey of resident physicians to the basic conditions in which they work has been conducted in 14 of the 16 federal states. In the center of the survey stood the general medicine within the prisons. This limitation was necessary in order to achieve comparability to primary medical care outside of correctional services. There are 140 salaried and tenured resident pysicians and 97 contract doctors in the general medical care of approx. 70000 prisoners in 185 independent prisons ...

  15. Resident physicians' attitudes and confidence in communicating with patients: a pilot study at a Japanese university hospital.

    Science.gov (United States)

    Ishikawa, Hirono; Eto, Masato; Kitamura, Kiyoshi; Kiuchi, Takahiro

    2014-09-01

    This study aimed to explore the relationships among physicians' confidence in conducting medical interviews, their attitudes toward the patient-physician relationship, and undergraduate training in communication skills among resident physicians in Japan. Participants were 63 first-year resident physicians at a university hospital in Tokyo. The Physician Confidence in the Medical Interview scale (PCMI) was constructed based on the framework of the Calgary-Cambridge Guide. Additionally, participants' attitudes toward the patient-physician relationship (Patient-Practitioner Orientation Scale; PPOS), undergraduate experience of communication skills training, and demographic characteristics were assessed through a self-reported questionnaire. The internal consistency of the PCMI and PPOS scales were adequate. As expected from the undergraduate curriculum for medical interviews in Japan, residents had relatively higher confidence in their communication skills with respect to gathering information and building the relationship, whereas less confident about sharing information and planning treatment. The PCMI was associated with a more patient-centered attitude as measured by the PPOS. These scales could be useful tools to measure physicians' confidence and attitudes in communicating with patients and to explore their changes through medical education. Residency programs should consider including systematic training and assessment in communication skills related to sharing information and planning treatment. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

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

    Science.gov (United States)

    Druce, Maralyn; Howden, Stella

    2017-07-01

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

  17. Minimum Data Set Active Resident Information Report

    Data.gov (United States)

    U.S. Department of Health & Human Services — The MDS Active Resident Report summarizes information for residents currently in nursing homes. The source of these counts is the residents MDS assessment record....

  18. Sleep Quality Among Psychiatry Residents.

    Science.gov (United States)

    Carvalho Aguiar Melo, Matias; das Chagas Medeiros, Francisco; Meireles Sales de Bruin, Veralice; Pinheiro Santana, José Abraão; Bastos Lima, Alexandre; De Francesco Daher, Elizabeth

    2016-01-01

    Medical residency programs are traditionally known for long working hours, which can be associated with a poor quality of sleep and daytime sleepiness. However, few studies have focused on this theme. Our objective was to investigate sleep quality, daytime sleepiness, and their relation with anxiety, social phobia, and depressive symptoms. This cross-sectional observational study involved 59 psychiatry residents. The Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS) were used to measure the quality of sleep and excessive daytime sleepiness ([EDS] and ESS > 10), respectively. Among the 59 psychiatry residents, 59.3% had poor sleep quality (PSQI > 5) and 28.8% had EDS. Poor sleep quality was associated with higher EDS (P = 0.03) and the year of residency program (P = 0.03). Only 20% of residents with poor sleep had consulted at least once for sleep problems; 54.2% had used medications for sleep; and 16.9% were using medications at the time of interview. Only 30% obtained medication during medical consultations. Poor sleep was associated with irregular sleep hours (P = 0.001) and long periods lying down without sleep (P = 0.03). Poor sleep quality was also associated with high scores of anxiety symptoms (P Psychiatry residents frequently have poor sleep quality and EDS. Considering that sleep disorders can affect quality of life, predispose to metabolic syndrome, and be associated with worse performance at work, attention to this clinical problem is needed. © The Author(s) 2016.

  19. 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.

  20. Constructing Catalonia

    Directory of Open Access Journals (Sweden)

    Bill Philips

    2009-07-01

    Full Text Available Catalonia, in common with other nations, has long been concerned with the question of identity and difference. Its problematic relationship with Spain has led to an emphasis on differentiating itself from its larger neighbour (if we are to accept, as most Spaniards do not, that Catalonia is not Spain, a situation complicated by the loss of the Spanish colonies of Cuba and The Philippines in 1898, and the Spanish Civil War and subsequent dictatorship from 1936 to 1976. Beginning in the late nineteenth century, the construction of a Catalan identity followed a similar route to that taken by other European nations such as England, Ireland and, indeed, Spain, including an emphasis on rural values, activities and the countryside, and the conversion of specifically local traditions into national past times. It is only in the last ten years or so that this model of Catalan identity has been recognised for what it is – a model constructed and encouraged for and by specific nationalist political interests. Ironically, Catalonia’s identity abroad has also been constructed and manipulated for political purposes, but from quite a different perspective. Orwell’s /Homage to Catalonia/ (1938 narrates an extremely blinkered version of the Spanish Civil War which has achieved iconic status as a result of cold war politics. Subsequent portrayals of the Spanish Civil War – Valentine Cunningham’s /The Penguin Book of Spanish Civil War Verse/ (ed., Penguin, 1980, or Ken Loach’s 1995 film /Land and Freedom/ base their arguments unquestioningly on /Homage to Catalonia/, perpetuating a view of the nation’s recent history that is both reductive and inaccurate

  1. The effect of transitioning from residency to pharmacy practice on learning style.

    Science.gov (United States)

    Loewen, Peter S; Jelescu-Bodos, Anca; Yeung, Janice; Lau, Torey

    2014-10-15

    To describe the evolution of learning styles of pharmacy residents as they transition from residency to practice. Cross-sectional survey and interview-based study. A complete provincial cohort of former pharmacy residents (N=28), who had their learning styles characterized with the Pharmacists' Inventory of Learning Styles (PILS) at the beginning of their residency and, 1 year post-residency, were invited to repeat the PILS. Interviews were administered to consenting participants to gain additional insight. Twenty-seven of the former residents (96%) completed the PILS survey and 16 (59%) completed the post-PILS interview. Thirteen (48%) changed their dominant learning style and 20 (74%) changed their secondary learning style. Six (22%) participants did not change either learning style. The overall proportion of dominant assimilators (59%) and convergers (26%) remained similar to baseline (52% and 26%, respectively), meaning participants had adopted and abandoned different learning style in similar numbers. Change in learning style was associated with being a preceptor (pteaching practices based on knowledge of their learning styles gained during their residency. Changing learning style is common for former residents after 1 year in postresidency practice. There is no overall direction to the change; former residents transition into and out of various learning styles with similar frequency and retain preferences for passive/abstract learning approaches over active/concrete ones. The early-career lability in learning style the study demonstrated may reveal an opportunity to guide pharmacists toward more active learning preferences through residency curricula, preceptorship, and mentorship.

  2. Layout Construction

    DEFF Research Database (Denmark)

    Frandsen, Gudmund Skovbjerg; Palsberg, Jens; Schmidt, Erik Meineche

    We design a system for generating newspaper layout proposals. The input to the system consists of editorial information (text, pictures, etc) and style information (non-editorial information that specifies the aesthetic appearance of a layout). We consider the automation of layout construction...... to pose two main problems. One problem consists in optimizing the layout with respect to the constraints and preferences specified in the style information. Another problem consists in finding a representation of the style information that both supports its use in the combinatorial optimization...

  3. Prefabrication in building construction: a perspective of pakistan construction industry

    International Nuclear Information System (INIS)

    Memon, N.A.; Memon, F.A.; Khehro, S.H.

    2014-01-01

    Construction industry is facing many problems in terms of construction waste, quality, environment, durability, safety and higher construction cost. Adoption of prefabrication is a possible solution to such problems. Accordingly, there is a need to study the prospects that would stimulate the appropriate discussion of the suitability of prefabrication and other construction methods for concrete buildings. Therefore, this study investigates the significance of advantages in adopting prefabrication along with hindrances through questionnaire survey. The data has been analyzed using RIW (Relative Importance Weight) method as a MCDM approach. The results depict that main advantages of prefabrication are Shorter construction time and Less construction site waste. The top hindrances in adopting prefabrication as identified in this study are: Higher initial construction cost and Inflexible for design changes. Based on the survey results and apparent progress in the adoption of prefabrication around the world, it is concluded that the use of prefabrication is likely to increase in developing countries like Pakistan. (author)

  4. 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

  5. Does the Dietary Pattern of Shanghai Residents  Change across Seasons and Area of Residence:  Assessing Dietary Quality Using the Chinese Diet  Balance Index (DBI).

    Science.gov (United States)

    Zang, Jiajie; Yu, Huiting; Zhu, Zhenni; Lu, Ye; Liu, Changhe; Yao, Chunxia; Bai, Pinqing; Guo, Changyi; Jia, Xiaodong; Zou, Shurong; Wu, Fan

    2017-03-08

    Few studies have applied the Chinese Diet Balance Index (DBI) in evaluating dietary quality across seasons. The Shanghai Diet and Health Survey (SDHS) included 1680 participants from all districts of Shanghai from 2012 to 2013. Dietary data were obtained using three-day 24-h recall in spring, summer, fall, and winter. Higher bound score (HBS), lower bound score (LBS) and diet quality distance (DQD) were calculated according to compliance with the dietary guidelines and based on the recommendations for consumption within the main food groups. HBS, LBS, and DQD represent over-intake, under-intake, and overall imbalance of the diet, respectively. 836 males and 844 females were included. The HBS indicated that 10.08%, 11.84%, 10.31%, and 12.73% people have moderate or high levels of over-intake of food in spring, summer, fall, and winter, respectively; and 74.04%, 37.61%, 53.09%, and 42.72% people have moderate or high levels of deficit food intake for each of the four seasons. The mean HBS and LBS among the four seasons were statistically significant difference (p < 0.001). The mean (SD) DQD was 43.27 (10.21), 35.67 (9.71), 39.19 (9.36), and 36.84 (9.45) in each season. A multivariable model showed statistically significant differences in DQD according to age, gender, occupational status, education, smoking, drinking status, season, and residency (p < 0.001). An unbalanced diet is common among people living in Shanghai. Seasonality and area of residence were found to be two significant predictors. Strengthening the accessibility and the supply of food across seasons and regions should be considered.

  6. Does the Dietary Pattern of Shanghai Residents  Change across Seasons and Area of Residence:  Assessing Dietary Quality Using the Chinese Diet  Balance Index (DBI

    Directory of Open Access Journals (Sweden)

    Jiajie Zang

    2017-03-01

    Full Text Available Background: Few studies have applied the Chinese Diet Balance Index (DBI in evaluating dietary quality across seasons. Method: The Shanghai Diet and Health Survey (SDHS included 1680 participants from all districts of Shanghai from 2012 to 2013. Dietary data were obtained using three‐day 24‐h recall in spring, summer, fall, and winter. Higher bound score (HBS, lower bound score (LBS and diet quality distance (DQD were calculated according to compliance with the dietary guidelines and based on the recommendations for consumption within the main food groups. HBS, LBS, and DQD represent over‐intake, under‐intake, and overall imbalance of the diet, respectively. Results: 836 males and 844 females were included. The HBS indicated that 10.08%, 11.84%, 10.31%, and 12.73% people have moderate or high levels of over‐intake of food in spring, summer, fall, and winter, respectively; and 74.04%, 37.61%, 53.09%, and 42.72% people have moderate or high levels of deficit food intake for each of the four seasons. The mean HBS and LBS among the four seasons were statistically significant difference (p < 0.001. The mean (SD DQD was 43.27 (10.21, 35.67 (9.71, 39.19 (9.36, and 36.84 (9.45 in each season. A multivariable model showed statistically significant differences in DQD according to age, gender, occupational status, education, smoking, drinking status, season, and residency (p < 0.001. Conclusion: An unbalanced diet is common among people living in Shanghai. Seasonality and area of residence were found to be two significant predictors. Strengthening the accessibility and the supply of food across seasons and regions should be considered.

  7. Climate Responsive Design and the Milam Residence

    Directory of Open Access Journals (Sweden)

    Mohammad Shahadat

    2011-11-01

    Full Text Available Energy conservation and efficiency is an essential area of focus in contemporary building design. The perception that the designers of buildings during the Modernist period of architecture ignored these principles is a false one. The present study, an examination of Paul Rudolph’s Milam Residence, a masterpiece of American residential architecture, is part of a larger project endeavoring to create a knowledge base of the environmental performance of iconic modernist homes. A critical examination of the Milam House allows insight into specific design characteristics that impact energy efficiency and conservation. Located in Ponte Vedra Beach, Florida, the Milam Residence was constructed in 1962. It was the last of a series of Florida residences designed by Rudolph, Chairman of the Department of Architecture at Yale University (1958–1965. The structure’s form is strongly related to its location on a subtropical beachfront. This paper presents a detailed analysis of the building’s solar responsiveness. Specifically, we examine design strategies such as orientation and sunscreening and their effect on daylighting, shading, and heat gain. The analysis is based on parametric energy modeling studies using Autodesk’s Ecotect, an environmental analysis tool that allows simulation of building performance. While the initial target of the program was early design, the program allows the input of complex geometries and detailed programming of zones, materials, schedules, etc. The program's excellent analyses of desired parameters are augmented by visualizations that make it especially valuable in communicating results. Our findings suggest that the building, as built and situated on the site, does take advantage of daylighting and solar shading and does so in both expected and unexpected ways.

  8. "It's not our ass": medical resident sense-making regarding lawsuits.

    Science.gov (United States)

    Noland, Carey; Carl, Walter J

    2006-01-01

    This study examined the accounts of 27 medical residents regarding how they make sense of their feelings about medical malpractice lawsuits and communication strategies to deal with mistakes. The study uncovered 4 distinct ways residents discursively constructed lawsuits--as inevitable, as recourse, as the result of unrealistic expectations, and as a gamble--and the implications of each construction. Further, the analysis suggests that it is essential to understand the role of the medical hierarchy and the resident-attending physician relationship to understand how residents make sense of their feelings toward lawsuits and strategies used to handle mistakes and the threat of lawsuits. The article concludes with implications for people supervising medical residents and for risk managers.

  9. Contribution of promoting the green residence assessment scheme to energy saving

    International Nuclear Information System (INIS)

    Huang, Zhiyu; Yuan, Hongping; Shen, Liyin

    2012-01-01

    Green residence development has been one of the important strategies for promoting sustainable urban development. Governments throughout the world have been encouraging property developers to deliver green properties. In line with this development, governments have been implementing various assessment programs to certify green residential buildings with the aim of contributing to sustainable urban development. With reference to the Chinese construction practice, this paper examines the effectiveness of the green residence assessment scheme toward its defined aim through investigating the contents and procedures of the green residence assessment scheme by referring to the practices of Chongqing city in western China. Based on the results of five case studies and five semi-structured interviews, this study reveals the significant contribution from implementing the green residence assessment scheme particularly to energy saving in residential buildings. Further, the green residence assessment scheme promotes the application of green building materials and green construction technologies in the entire process of delivering and operating residential buildings. The findings provide valuable references for further investigating alternative methods to achieve better energy saving in developing residential buildings. - Highlights: ► Energy saving in residence development is important for sustainable urban development. ► Green residence assessment scheme contributes significantly to energy saving in residences. ► Green residence assessment promotes application of environmentally friendly building materials and technologies

  10. Personal characteristics of residents may predict competency improvement.

    Science.gov (United States)

    Park, EunMi; Ha, Patrick K; Eisele, David W; Francis, Howard W; Kim, Young J

    2016-08-01

    We hypothesized that personal characteristics of residents may affect how well competency is attained in a surgical residency. To this end, we examined two concepts of global trait emotional intelligence and learner autonomy profile and their factor relationship with competency outcomes in a residency program in otolaryngology-head and neck surgery. A cohort study prospectively gathered competency change scores for 1 year and retrospectively analyzed the factor associations. We measured two personal characteristics using the Trait Emotional Intelligence Questionnaire-Short Form and Learner Autonomy Profile-Short Form between 2013 and 2014 in a tertiary otolaryngology-head and neck residency program. We prospectively examined faculty-rated resident competency scores monitored in the same time period and correlated the personal attributes with cumulative competency improvement scores. Statistical analyses included factor correlations and univariate regression. With a response rate of 64% (N = 16/25), we identified two statically significant predictors of competency improvement outcome attained by the end of the year. Regression analyses showed that emotionality factor of global trait emotional intelligence (P = .04) and learner autonomy profile (P < .01) were significant predictors for the higher improvement of aggregate competency outcome. Personal factors of individual residents can affect their improvement of overall competency. Practicing competency-based education should, therefore, include assessing individual resident factors as well as teaching clinical knowledge and technical skills. NA Laryngoscope, 126:1746-1752, 2016. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

  11. ACGME proposes dropping the 16 hour resident shift limit

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2016-11-01

    Full Text Available No abstract available. Article truncated after 150 words. The Accreditation Council for Graduate Medical Education (ACGME is proposing that first-year residents would no longer be limited to 16-hour shifts during the 2017-2018 academic year under a controversial proposal released today (1. Instead, individual residency programs could assign first-year trainees to shifts as long as 28 hours, the current limit for all other residents. The 28-hour maximum includes 4 transitional hours that's designed in part to help residents improve continuity of care. The plan to revise training requirements does not change other rules designed to protect all residents from overwork. including the maximum80 hours per week. The ACGME capped the shifts of first-year residents at 16 hours in 2011 as a part of an ongoing effort to make trainee schedules more humane and avoid clinical errors caused by sleep deprivation. ACGME CEO Thomas Nasca, MD, told Medscape Medical News that the problem arises largely from first-year residents not being ...

  12. 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

  13. Improving Otolaryngology Residency Selection Using Principles from Personnel Psychology.

    Science.gov (United States)

    Bowe, Sarah N; Laury, Adrienne M; Gray, Stacey T

    2017-06-01

    There has been a heightened focus on improving the resident selection process, particularly within highly competitive specialties. Previous research, however, has generally lacked a theoretical background, leading to inconsistent and biased results. Our recently published systematic review examining applicant characteristics and performance in residency can provide historical insight into the predictors (ie, constructs) and outcomes (ie, criteria) previously deemed pertinent by the otolaryngology community. Personnel psychology uses evidence-based practices to identify the most qualified candidates for employment using a variety of selection methods. Extensive research in this discipline has shown that integrity tests, structured interviews, work samples, and conscientiousness offer the greatest increase in validity when combined with general cognitive ability. Blending past research knowledge with the principles of personnel selection can provide the necessary foundation with which to engage in theory-driven, longitudinal studies on otolaryngology resident selection moving forward.

  14. Synchronicity of social change and the construct of gender roles: Traditionalism and modernity as contents of mainstream model of female gender roles in women's magazines during the last quarter of 20

    Directory of Open Access Journals (Sweden)

    Jarić Isidora N.

    2002-01-01

    Full Text Available The main intention of the research is to retrospectively decode changes in mainstream construct of female gender roles within the period of ''developed self-management socialism'' (1970s, period of structural crisis of socialism (1980s and post-socialist period of Serbian/Yugoslav society. The mainstream construct of female gender roles will be reconstruct from Serbian women's magazine 'Bazar''. Through the basic presumptions of theoretical framework the research will try to conceptualize theoretical approach which will correspond with co called 'new communicative research model' which will be capable to incorporate contemporary changes within the process of communication among the emitter and recipients in order to better understand the content of the message.

  15. Injection safety practices among resident doctors in a tertiary health ...

    African Journals Online (AJOL)

    Conclusion: The prevalence of needle stick injury was high, awareness of reporting was high but the level of reporting was low. Behavior change communication models are required to bring about a positive change in the practice of reporting. Key words: Injection safety, resident doctors, University of Benin Teaching ...

  16. Changes in river channel pattern as a result of the construction, operation and decommissioning of watermills – the case of the middle reach of the River Liswarta near Krzepice, Poland

    OpenAIRE

    Fajer Maria

    2018-01-01

    Changes in river channel pattern in the middle reach of the River Liswarta and in the lower reaches of its tributaries near Krzepice were analysed, and were related to the construction, operation and decommissioning of watermills. For this purpose, old maps which covered the period from the beginning of the 18th century until the 20th century were used alongside written historical sources. Maps from the first half of the 19th century provided valuable source material. Traces of old mill water...

  17. Prevalence of mental disorders in migrants compared with original residents and local residents in Ningxia, China

    Directory of Open Access Journals (Sweden)

    Zhizhong Wang

    2016-10-01

    Full Text Available Abstract Background Ecological migrants has a special background compared with other types of migrant. However, the mental health status of ecological migrants who were expected to benefit from a massive “ecological migration project” initiated by the Chinese government is unknown. This study aims to explore the influence of environmental change on individuals’ mental health and to improve current understanding of the mechanisms that mental disorders occurred. Methods The data were extracted from a cross-sectional study. Anxiety disorders, mood disorders and substance use disorders were assessed using the Chinese version WHO-CIDI. The prevalence of mental disorders was stratified by migration status into ecological migrant, local resident and original resident groups. Unconditional logistic regression models were used to calculate the risk of prevalence among these three groups. Results After controlling for gender, ethnicity, age, marriage, and education, the migrants had lower risk of mental disorders than original residents [OR = 0.70 (95 % CI: 0.57–0.86], p < 0.001, but had a higher risk of mental disorders than local residents [OR = 1.29 (95 % CI: 1.06–1.55], p = 0.007. Conclusion The ecological migration project may be beneficial to people’s mental health by improving their living environment and social economy.

  18. Urban residents' priorities for neighborhood features. A survey of New Orleans residents after Hurricane Katrina.

    Science.gov (United States)

    Hong, Traci; Farley, Thomas A

    2008-04-01

    Efforts to promote physical activity through environmental changes in low-income, urban, and minority areas should be informed by an understanding of the value that residents place on different neighborhood features and characteristics. Neighborhood rebuilding preferences among 442 New Orleans residents after the damage from Hurricane Katrina were assessed by a random-digit-dialed telephone survey conducted between April 25, 2006 and May 2, 2006. The survey instrument assessed the importance (on a 5-point Likert-type scale on which 1=not at all important and 5=extremely important) for 24 neighborhood features and characteristics. Ratings of neighborhood features were compared by race and income. Overall, residents rated most highly the features that reflected low levels of neighborhood crime and disorder. There was moderate support for features that promote physical activity, specifically sidewalks and crosswalks, neighborhood grocery stores, and parks or playgrounds. Blacks rated more highly than whites 13 neighborhood features such as good schools, lack of noise, a park or playground, affordable housing, health clinics, and the absence of liquor stores. The low-income group rated the following features as being more important than the high-income group: affordable housing, a bus or streetcar line, and the presence of a corner store. New Orleans residents' top neighborhood priority is reducing crime and disorder, but all groups otherwise support neighborhood features that promote physical activity.

  19. Simvastatin and atorvastatin reduce the mechanical properties of tendon constructs in vitro and introduce catabolic changes in the gene expression pattern

    DEFF Research Database (Denmark)

    Eliasson, Pernilla; Svensson, Rene B; Giannopoulos, Antonis

    2017-01-01

    simvastatin or atorvastatin, low or high dose, respectively, for up to seven days. After seven days of treatment, mechanical testing of the constructs was performed. Collagen content and cell proliferation were also determined. mRNA levels of several target genes were measured after one or seven days....... The maximum force and stiffness were reduced by both statins after 7 days (patorvastatin (p = 0.01) and the cell proliferation rate was decreased by both types of statins (p

  20. The General Surgery Chief Resident Operative Experience

    Science.gov (United States)

    Drake, Frederick Thurston; Horvath, Karen D.; Goldin, Adam B.; Gow, Kenneth W.

    2014-01-01

    IMPORTANCE The chief resident (CR) year is a pivotal experience in surgical training. Changes in case volume and diversity may impact the educational quality of this important year. OBJECTIVE To evaluate changes in operative experience for general surgery CRs. DESIGN, SETTING, AND PARTICIPANTS Review of Accreditation Council for Graduate Medical Education case logs from 1989–1990 through 2011–2012 divided into 5 periods. Graduates in period 3 were the last to train with unrestricted work hours; those in period 4 were part of a transition period and trained under both systems; and those in period 5 trained fully under the 80-hour work week. Diversity of cases was assessed based on Accreditation Council for Graduate Medical Education defined categories. MAIN OUTCOMES AND MEASURES Total cases and defined categories were evaluated for changes over time. RESULTS The average total CR case numbers have fallen (271 in period 1 vs 242 in period 5, P general surgery training may be jeopardized by reduced case diversity. Chief resident cases are crucial in surgical training and educators should consider these findings as surgical training evolves. PMID:23864049

  1. THE IMPACT OF CONSTRUCTION AND GENTRIFICATION ON AN OUTDOOR TRANS SEX WORK ENVIRONMENT: VIOLENCE, DISPLACEMENT AND POLICING.

    Science.gov (United States)

    Lyons, Tara; Krüsi, Andrea; Pierre, Leslie; Small, Will; Shannon, Kate

    2017-12-01

    The objective of this study was to investigate how environmental and structural changes to a trans outdoor work environment impacted sex workers in Vancouver, Canada. The issue of changes to the work area arose during qualitative interviews with 33 trans sex workers. In response, ethnographic walks that incorporated photography were undertaken with trans sex workers. Changes to the work environment were found to increase vulnerabilities to client violence, displace trans sex workers, and affect policing practices. Within a criminalized context, construction and gentrification enhanced vulnerabilities to violence and harassment from police and residents.

  2. Cooperative learning as applied to resident instruction in radiology reporting.

    Science.gov (United States)

    Mueller, Donald; Georges, Alexandra; Vaslow, Dale

    2007-12-01

    The study is designed to evaluate the effectiveness of an active form of resident instruction, cooperative learning, and the residents' response to that form of instruction. The residents dictated three sets of reports both before and after instruction in radiology reporting using the cooperative learning method. The reports were evaluated for word count, Flesch-Kincaid grade level, advancement on clinical spectrum, clarity, and comparison to prior reports. The reports were evaluated for changes in performance characteristics between the pre- and postinstruction dictations. The residents' response to this form of instruction was evaluated by means of a questionnaire. The instruction was effective in changing the resident dictations. The results became shorter (Pcooperative learning activities. The least positive responses related to the amount of time devoted to the project. Sixty-three percent of respondents stated that the time devoted to the project was appropriate. Cooperative learning can be an effective tool in the setting of the radiology residency. Instructional time requirements must be strongly considered in designing a cooperative learning program.

  3. Trends in violence education in family medicine residency curricula.

    Science.gov (United States)

    Cronholm, Peter F; Singh, Vijay; Fogarty, Colleen T; Ambuel, Bruce

    2014-09-01

    Violence is a significant public health issue with far-reaching implications for the health of individuals and their communities. Our objective was to describe trends in violence-related training in family medicine residency programs since the last national survey was conducted in 1997. Surveys were sent to 337 US family medicine residency programs with the program director having active Society of Teachers of Family Medicine (STFM) membership. Measures included residency setting and characteristics, violence-related curricular content, teaching techniques and personnel, timing of content, and impact of changes in Residency Review Committee (RRC) and Accreditation Council for Graduate Medical Education (ACGME) requirements. Descriptive statistics and bivariate analyses comparing measures across time were used. A total of 201 (60%) surveys were completed. The most common violence curricula was child (83%) and elder abuse (76%), and the most common teachers of violence-related content were family physicians, psychologists, and social workers. The most common teaching methods were clinical precepting (94%), lectures (90%), case vignettes (71%), and intimate partner violence (IPV) shelter experiences (67%). ACGME and RRC changes were not reflected in self-reported measures of curricular emphasis or time. Violence curricular content and number of hours has been constant in family medicine residencies over time. An increase in the reported use of active learning strategies was identified as a trend across surveys. Next steps for violence curricula involve assessment of residents' competency to identify and intervene in violence.

  4. 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.

  5. Plagiarism in residency application essays.

    Science.gov (United States)

    Segal, Scott; Gelfand, Brian J; Hurwitz, Shelley; Berkowitz, Lori; Ashley, Stanley W; Nadel, Eric S; Katz, Joel T

    2010-07-20

    Anecdotal reports suggest that some residency application essays contain plagiarized content. To determine the prevalence of plagiarism in a large cohort of residency application essays. Retrospective cohort study. 4975 application essays submitted to residency programs at a single large academic medical center between 1 September 2005 and 22 March 2007. Specialized software was used to compare residency application essays with a database of Internet pages, published works, and previously submitted essays and the percentage of the submission matching another source was calculated. A match of more than 10% to an existing work was defined as evidence of plagiarism. Evidence of plagiarism was found in 5.2% (95% CI, 4.6% to 5.9%) of essays. The essays of non-U.S. citizens were more likely to demonstrate evidence of plagiarism. Other characteristics associated with the prevalence of plagiarism included medical school location outside the United States and Canada; previous residency or fellowship; lack of research experience, volunteer experience, or publications; a low United States Medical Licensing Examination Step 1 score; and non-membership in the Alpha Omega Alpha Honor Medical Society. The software database is probably incomplete, the 10%-match threshold for defining plagiarism has not been statistically validated, and the study was confined to applicants to 1 institution. Evidence of matching content in an essay cannot be used to infer the applicant's intent and is not sensitive to variations in the cultural context of copying in some societies. Evidence of plagiarism in residency application essays is more common in international applicants but was found in those by applicants to all specialty programs, from all medical school types, and even among applicants with significant academic honors. No external funding.

  6. Resident training in a new robotic thoracic surgery program.

    Science.gov (United States)

    White, Yasmine N; Dedhia, Priya; Bergeron, Edward J; Lin, Jules; Chang, Andrew A; Reddy, Rishindra M

    2016-03-01

    The volume of robot-assisted operations has drastically increased over the past decade. New programs have focused on training surgeons, whereas resident training has lagged behind. The objective of this study was to evaluate our institutional experience with resident participation in thoracic robotic surgery cases since the initiation of our program. The first 100 robotic thoracic surgery cases at our institution were retrospectively reviewed and categorized into three sequential cohorts. Procedure type, patient and operative characteristics, level of resident participation (primary surgeon [PS] or assistant), and postoperative variables were evaluated. Of the first 100 cases, 38% were lung resections, 23% were esophageal operations, and 20% were sympathectomies. The distribution of cases changed over time with the proportion of pulmonary resections significantly increasing. Patient age (P robotics program. Operative time, estimated blood loss, and length of stay were similar regardless of level of resident participation. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. 38 CFR 51.70 - Resident rights.

    Science.gov (United States)

    2010-07-01

    ... FOR NURSING HOME CARE OF VETERANS IN STATE HOMES Standards § 51.70 Resident rights. The resident has a... legal representative. (5) Conveyance upon death. Upon the death of a resident with a personal fund...; (iii) Physicians of the resident's choice (to provide care in the nursing home, physicians must meet...

  8. Mentorship in orthopaedic and trauma residency training ...

    African Journals Online (AJOL)

    Background: Mentorship is important in residency training as it is necessary for personal and professional development of the resident trainees. Objectives: This study documents mentorship in orthopaedic residency training programme in Nigeria by assessing the awareness of orthopaedic residents on the role of a mentor, ...

  9. Surgery resident learning styles and academic achievement.

    Science.gov (United States)

    Contessa, Jack; Ciardiello, Kenneth A; Perlman, Stacie

    2005-01-01

    To determine if surgical residents share a preferred learning style as measured by Kolb's Learning Style Inventory (LSI) and if a relationship exists between resident learning style and achievement as measured by a standardized examination (AME). Also, core faculty learning styles were assessed to determine if faculty and residents share a preferred learning style. Kolb's LSI, Version 3, was administered to 16 surgical residents and the residency program's core faculty of 6 attending physicians. To measure academic achievement, the American Medical Education (AME) examination was administered to residents. The Hospital of Saint Raphael, General Surgery Residency Program, New Haven, Connecticut. Both instruments were administered to residents during protected core curriculum time. Core faculty were administered the LSI on an individual basis. Surgical residents of the Hospital of Saint Raphael's General Surgery Residency Program and 6 core faculty members Analysis of resident learning style preference revealed Converging as the most commonly occurring style for residents (7) followed by Accommodating (5), Assimilating (3), and Diverging (1). The predominant learning style for core faculty was also Converging (4) with 2 Divergers. The average score for the Convergers on the AME was 62.6 compared with 42 for the next most frequently occurring learning style, Accommodators. In this surgical residency program, a preferred learning style for residents seems to exist (Converging), which confirms what previous studies have found. Additionally, residents with this learning style attained a higher average achievement score as measured by the AME. Also, core faculty share the same preferential learning style as this subset of residents.

  10. 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.

  11. Family medicine residents' practice intentions: Theory of planned behaviour evaluation.

    Science.gov (United States)

    Grierson, Lawrence E M; Fowler, Nancy; Kwan, Matthew Y W

    2015-11-01

    To assess residents' practice intentions since the introduction of the College of Family Physicians of Canada's Triple C curriculum, which focuses on graduating family physicians who will provide comprehensive care within traditional and newer models of family practice. A survey based on Ajzen's theory of planned behaviour was administered on 2 occasions. McMaster University in Hamilton, Ont. Residents (n = 135) who were enrolled in the Department of Family Medicine Postgraduate Residency Program at McMaster University in July 2012 and July 2013; 54 of the 60 first-year residents who completed the survey in 2012 completed it again in 2013. The survey was modeled so as to measure the respondents' intentions to practise with a comprehensive scope; determine the degree to which their attitudes, subjective norms, and perceptions of control about comprehensive practice influence those intentions; and investigate how these relationships change as residents progress through the curriculum. The survey also queried the respondents about their intentions with respect to particular medical services that underpin comprehensive practice. The responses indicate that the factors modeled by the theory of planned behaviour survey account for 60% of the variance in the residents' intentions to adopt a comprehensive scope of practice upon graduation, that there is room for curricular improvement with respect to encouraging residents to practise comprehensive care, and that targeting subjective norms about comprehensive practice might have the greatest influence on improving resident intentions. The theory of planned behaviour presents an effective approach to assessing curricular effects on resident practice intentions while also providing meaningful information for guiding further program evaluation efforts in the Department of Family Medicine at McMaster University.

  12. Conversations with Holocaust survivor residents.

    Science.gov (United States)

    Hirst, Sandra P; LeNavenec, Carole Lynne; Aldiabat, Khaldoun

    2011-03-01

    Traumatic events in one's younger years can have an impact on how an individual copes with later life. One traumatic experience for Jewish individuals was the Holocaust. Some of these people are moving into long-term care facilities. It was within this context that the research question emerged: What are Holocaust survivor residents' perceptions of a life lived as they move into a long-term care facility? For this qualitative study, Holocaust survivors were individually interviewed. Findings emphasize that nursing care needs to ensure that Holocaust survivor residents participate in activities, receive timely health care, and receive recognition of their life experiences. Copyright 2011, SLACK Incorporated.

  13. Constructing a modern city machine

    DEFF Research Database (Denmark)

    Lindegaard, Hanne; Jørgensen, Ulrik

    1998-01-01

    Based on the Copenhagen sewers debates and constructions the role of changing perceptions of water, hygiene and environment is discussed in relation to the modernisation of cities by machinating flows and infrastructures.......Based on the Copenhagen sewers debates and constructions the role of changing perceptions of water, hygiene and environment is discussed in relation to the modernisation of cities by machinating flows and infrastructures....

  14. Improving construction performance

    International Nuclear Information System (INIS)

    1990-03-01

    Design for Constructability's overall purpose was to identify and address changes in the nuclear industry to restore nuclear energy as an attractive option for new generating capacity. As the centerpiece of project control, a comprehensive, stable schedule should organize the project logically to accomplish the project's objectives. A good schedule will: integrate the project team; serve as a communications tool to all members of the project team; and provide a means to monitor and measure project performance

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

    Science.gov (United States)

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

    2014-12-10

    In 2011, the Accreditation Council for Graduate Medical Education (ACGME) restricted resident duty hour requirements beyond those established in 2003, leading to concerns about the effects on patient care and resident training. To determine if the 2011 ACGME duty hour reform was associated with a change in general surgery patient outcomes or in resident examination performance. Quasi-experimental study of general surgery patient outcomes 2 years before (academic years 2009-2010) and after (academic years 2012-2013) the 2011 duty hour reform. Teaching and nonteaching hospitals were compared using a difference-in-differences approach adjusted for procedural mix, patient comorbidities, and time trends. Teaching hospitals were defined based on the proportion of cases at which residents were present intraoperatively. Patients were those undergoing surgery at hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP). General surgery resident performance on the annual in-training, written board, and oral board examinations was assessed for this same period. National implementation of revised resident duty hour requirements on July 1, 2011, in all ACGME accredited residency programs. Primary outcome was a composite of death or serious morbidity; secondary outcomes were other postoperative complications and resident examination performance. In the main analysis, 204,641 patients were identified from 23 teaching (n = 102,525) and 31 nonteaching (n = 102,116) hospitals. The unadjusted rate of death or serious morbidity improved during the study period in both teaching (11.6% [95% CI, 11.3%-12.0%] to 9.4% [95% CI, 9.1%-9.8%], P general surgery patient outcomes or differences in resident examination performance. The implications of these findings should be considered when evaluating the merit of the 2011 ACGME duty hour reform and revising related policies in the future.

  16. Understanding the exercise habits of residents and attending physicians: a mixed methodology study.

    Science.gov (United States)

    Williams, Amy S; Williams, Casey D; Cronk, Nikole J; Kruse, Robin L; Ringdahl, Erika N; Koopman, Richelle J

    2015-02-01

    Although the benefits of exercise are well known, rates of exercise among residents are much lower than those of attendings or medical students. Little is known about the barriers that prevent residents from exercising regularly. This mixed methodology study identifies and compares these barriers for resident and attending physicians practicing in the same setting. We conducted three focus groups with first-year and senior residents and attending physicians in the University of Missouri Department of Family and Community Medicine from April to August 2013. We also administered a survey inquiring about exercise rates and habits to 110 resident and attending physicians in the same department using both paper and electronic versions. During both inpatient and non-inpatient rotations, residents reported exercising less than attending physicians. No residents exercised more than 150 minutes/week during inpatient rotations compared to 18.42% of attendings. Only 6.9% of residents exercised more than 150 minutes/week during non-inpatient rotations, compared to 25% of attendings. Residents and attendings reported different barriers to regular exercise. Residents reported lack of time for a traditional structured workout as a major barrier, which leads to an adversarial relationship between work and exercise. Residency programs can help residents overcome exercise barriers by reframing exercise expectations to include more frequent but brief periods of exercise during the workday and by developing a supportive exercise culture. Changing worksite environments to support physician exercise may improve physician wellness.

  17. Loss aversion and duration of residence

    Directory of Open Access Journals (Sweden)

    Philip S. Morrison

    2016-10-01

    Full Text Available Background: Studies of internal migration ask who moves, why they move, and what are the consequences - to themselves, their origin, and their destination. By contrast, studies of those who stay for very long durations are less common, despite the fact that most people move relatively infrequently. Objective: We argue that staying is the dominant, preferred state and that moving is simply an adjustment toward a desired state of stability (or equilibrium. The core of our argument, already recognized in the literature, is that migration is risky. However, we extend the argument to loss aversion as developed within prospect theory. Prospect theory posits that existing possessions, including the dwelling and existing commodities, are attributed a value well beyond their purchase price and that this extends the average period of staying among the loss-averse. Methods: Applying prospect theory has several challenges, including measurement of the reference point and potential degrees of gain and loss households face in deciding to change residence, as well as their own degree of loss aversion. The growing number of large panel sets should make it possible to estimate the degree to which endowment effects are likely to extend durations of residence as predicted by prospect theory. Conclusions: Rational expectations models of mobility focus on the changes in the level of consumption of residential services. By contrast, prospect theory focuses on potential gains and losses relative to the existing dwelling - the reference point. As we confront increasing durations of residence in contemporary society, an application of prospect theory is likely to yield important advantages over existing models of mobility and staying.

  18. Residents' Perceived Social-Economic Impact of the 2008 Beijing Olympic Games

    Science.gov (United States)

    Zhang, Mark; Chen, Li; Lei, Ouyang; Malone, Christopher

    2013-01-01

    This study was designed to examine whether the Olympic Games was a catalyst for changes to Beijing residents' quality of life based on social-economic perspectives and how these changes affected their continuous support for the Games. Residents who lived in Beijing 18 months or longer were invited to participate in this survey research (N = 412)…

  19. Increasing faculty participation in resident education and providing cost-effective self-assessment module credit to faculty through resident-generated didactics.

    Science.gov (United States)

    Kim, Hyun; Malatesta, Theresa M; Anné, Pramila R; McAna, John; Bar-Ad, Voichita; Dicker, Adam P; Den, Robert B

    Board certified radiation oncologists and medical physicists are required to earn self-assessment module (SAM) continuing medical education (CME) credit, which may require travel costs or usage fees. Data indicate that faculty participation in resident teaching activities is beneficial to resident education. Our hypothesis was that providing the opportunity to earn SAM credit in resident didactics would increase faculty participation in and improve resident education. SAM applications, comprising CME certified category 1 resident didactic lectures and faculty-generated questions with respective answers, rationales, and references, were submitted to the American Board of Radiology for formal review. Surveys were distributed to assess main academic campus physician, affiliate campus physician, physicist, and radiation oncology resident impressions regarding the quality of the lectures. Survey responses were designed in Likert-scale format. Sign-test was performed with P < .05 considered statistically different from neutral. First submission SAM approval was obtained for 9 of 9 lectures to date. A total of 52 SAM credits have been awarded to 4 physicists and 7 attending physicians. Main academic campus physician and affiliate campus physician attendance increased from 20% and 0%, respectively, over the 12 months preceding CME/SAM lectures, to 55.6% and 20%, respectively. Survey results indicated that the change to SAM lectures increased the quality of resident lectures (P = .001), attending physician participation in resident education (P < .0001), physicist involvement in medical resident education (P = .0006), and faculty motivation to attend resident didactics (P = .004). Residents reported an increased amount of time required to prepare lectures (P = .008). We are the first department, to our knowledge, to offer SAM credit to clinical faculty for participation in resident-generated didactics. Offering SAM credit at resident lectures is a cost-effective alternative

  20. Model Legislation on Student Residency.

    Science.gov (United States)

    Higher Education in the States, 1971

    1971-01-01

    Because of the radical variance in residency requirements from state to state and sometimes from institution to institution, and because of several court cases involving this issue, the Education Commission of the States appointed a Committee to develop (1) a statement of principles for consideration in drafting legislation in connection with…

  1. From Residency to Lifelong Learning.

    Science.gov (United States)

    Brandt, Keith

    2015-11-01

    The residency training experience is the perfect environment for learning. The university/institution patient population provides a never-ending supply of patients with unique management challenges. Resources abound that allow the discovery of knowledge about similar situations. Senior teachers provide counseling and help direct appropriate care. Periodic testing and evaluations identify deficiencies, which can be corrected with future study. What happens, however, when the resident graduates? Do they possess all the knowledge they'll need for the rest of their career? Will medical discovery stand still limiting the need for future study? If initial certification establishes that the physician has the skills and knowledge to function as an independent physician and surgeon, how do we assure the public that plastic surgeons will practice lifelong learning and remain safe throughout their career? Enter Maintenance of Certification (MOC). In an ideal world, MOC would provide many of the same tools as residency training: identification of gaps in knowledge, resources to correct those deficiencies, overall assessment of knowledge, feedback about communication skills and professionalism, and methods to evaluate and improve one's practice. This article discusses the need; for education and self-assessment that extends beyond residency training and a commitment to lifelong learning. The American Board of Plastic Surgery MOC program is described to demonstrate how it helps the diplomate reach the goal of continuous practice improvement.

  2. Evolving Perceptions of the Plastic Surgery Integrated Residency Training Program.

    Science.gov (United States)

    Pace, Elizabeth; Mast, Bruce; Pierson, Justine M; Leavitt, Adam; Reintgen, Christian

    2016-01-01

    In recent years, there has been a transition in plastic surgery residency training. Many programs across the country are now using integrated training modalities vs. independent training programs. This change in residency training has brought into question the effectiveness of integrated residency programs, in which medical students immediately enter the plastic surgery specialty upon graduation. This study assessed plastic surgery residency program directors and faculty members׳ viewpoints on the transition to integrated training programs and the effect this transition has had on the training of plastic surgery residents. An anonymous 13-question survey was formulated using a pilot survey sent to members of the plastic surgery department at the University of Florida. The final survey was then electronically sent via SurveyMonkey.com to 92 current plastic surgery residency program directors. Program directors were identified via program lists provided by the American Council of Academic Surgeons. Program directors were then asked to forward the survey to faculty members of their respective institutions. Responses collected were analyzed via SurveyMonkey.com and Microsoft Excel. University of Florida College of Medicine, Department of Plastic Surgery. Plastic surgery residency program directors as identified by the American Council of Academic Surgeons. A response rate of 40.2% was achieved via 37 of the 92 plastic surgery program directors responding to the electronic survey. An additional 6 anonymous faculty members also responded to the survey, 13.9% of all responses. Institutions indicated that the majority was using integrated residency programs, with some institutions using both integrated and independent training programs simultaneously. Most respondents indicated that they supported the transition to the integrated residency program at their respective institutions. Respondents indicated several reasons as to why or why not programs have transitioned to the

  3. Budget performance reporting and construction work packaging

    International Nuclear Information System (INIS)

    Strong, M.G.; Weyers, L.L.

    1976-01-01

    A changing financial, technological, and regulatory environment has increased the complexity, costliness, and risk involved in constructing new generating facilities. A primary challenge facing utility executives is to hold down costs on these construction projects. New construction management techniques are required to accomplish this. Commonwealth Edison has responded by implementing a new Budget Performance Reporting System and a Construction Work Packaging System. The new systems are being used successfully on four major construction projects with budgets totaling over $4 billion

  4. Student Expenses in Residency Interviewing.

    Science.gov (United States)

    Walling, Anne; Nilsen, Kari; Callaway, Paul; Grothusen, Jill; Gillenwater, Cole; King, Samantha; Unruh, Gregory

    2017-08-01

    The student costs of residency interviewing are of increasing concern but limited current information is available. Updated, more detailed information would assist students and residency programs in decisions about residency selection. The study objective was to measure the expenses and time spent in residency interviewing by the 2016 graduating class of the University of Kansas School of Medicine and assess the impact of gender, regional campus location, and primary care application. All 195 students who participated in the 2016 National Residency Matching Program (NRMP) received a 33 item questionnaire addressing interviewing activity, expenses incurred, time invested and related factors. Main measures were self-reported estimates of expenses and time spent interviewing. Descriptive analyses were applied to participant characteristics and responses. Multivariate analysis of variance (MANOVA) and chi-square tests compared students by gender, campus (main/regional), and primary care/other specialties. Analyses of variance (ANOVA) on the dependent variables provided follow-up tests on significant MANOVA results. A total of 163 students (84%) completed the survey. The average student reported 38 (1-124) applications, 16 (1-54) invitations, 11 (1-28) completed interviews, and spent $3,500 ($20-$12,000) and 26 (1-90) days interviewing. No significant differences were found by gender. After MANOVA and ANOVA analyses, non-primary care applicants reported significantly more applications, interviews, and expenditures, but less program financial support. Regional campus students reported significantly fewer invitations, interviews, and days interviewing, but equivalent costs when controlled for primary care application. Cost was a limiting factor in accepting interviews for 63% and time for 53% of study respondents. Students reported investing significant time and money in interviewing. After controlling for other variables, primary care was associated with significantly

  5. Residence time and physical processes in lakes

    Directory of Open Access Journals (Sweden)

    Nicoletta SALA

    2003-09-01

    Full Text Available The residence time of a lake is highly dependent on internal physical processes in the water mass conditioning its hydrodynamics; early attempts to evaluate this physical parameter emphasize the complexity of the problem, which depends on very different natural phenomena with widespread synergies. The aim of this study is to analyse the agents involved in these processes and arrive at a more realistic definition of water residence time which takes account of these agents, and how they influence internal hydrodynamics. With particular reference to temperate lakes, the following characteristics are analysed: 1 the set of the lake's caloric components which, along with summer heating, determine the stabilizing effect of the surface layers, and the consequent thermal stratification, as well as the winter destabilizing effect; 2 the wind force, which transfers part of its momentum to the water mass, generating a complex of movements (turbulence, waves, currents with the production of active kinetic energy; 3 the water flowing into the lake from the tributaries, and flowing out through the outflow, from the standpoint of hydrology and of the kinetic effect generated by the introduction of these water masses into the lake. These factors were studied in the context of the general geographical properties of the lake basin and the watershed (latitude, longitude, morphology, also taking account of the local and regional climatic situation. Also analysed is the impact of ongoing climatic change on the renewal of the lake water, which is currently changing the equilibrium between lake and atmosphere, river and lake, and relationships

  6. Second Life™: a novel simulation platform for the training of surgical residents.

    Science.gov (United States)

    Flowers, Michael G; Aggarwal, Rajesh

    2014-03-01

    A virtual world is a three-dimensional, computer-generated, simulated environment. Human users create "avatars," or virtual projections of themselves, in order to explore this virtual environment and interact with the objects and structures inside it. Second Life™ is one such virtual world accessible freely via the internet, which has been used to construct a virtual hospital complete with reception areas, changing rooms, offices, and hospital wards. Early pioneering studies have demonstrated the advantages of using virtual worlds in the education of surgical residents in a number of ways, from introductions to the clinical environment, initial patient assessment, and managing adverse outcomes, to gaining informed consent, hospital-wide training, and medical device development.

  7. Living in commodified history: constructing class identities in neotraditional neighbourhoods

    NARCIS (Netherlands)

    Meier, S.; Karsten, L.

    2012-01-01

    This paper examines how residents of neotraditional neighbourhoods in the Netherlands socially construct a ‘classed’ place identity and what role the historicised architecture plays within that process. Given that place identity is constructed through social and cultural practices, the paper argues

  8. Visions of Education: How Education Is Constructed in Editorial Cartoons

    Science.gov (United States)

    Carpenter, Dick M., II

    2004-01-01

    At the center of the social construction and interpretation of education sits the fourth estate. Through ideological media "voices," in part, education's meaning and the social reality in which schools reside are constructed for and with the community. This study looks at one vehicle of popular and influential communication overlooked by…

  9. Teaching residents to write a research paper.

    Science.gov (United States)

    Coleridge, S T

    1993-09-01

    Medical writing and publications are important in developing a scholarly basis for residency programs and in providing a learning experience for both resident and faculty mentors. Residency directors must provide the stimulus and support for both faculty and residents' varied creative activities. This support manifests itself in a commitment to scholarly activity (including a dedicated research person), the procurement of available research materials, the establishment of a process or plan for beginning a research project, and the development of a method for rewarding or recognizing faculty and residents who produce scholarly works. Some osteopathic residency programs may need to train faculty in research skills at the same time that residents are learning to write. Trained faculty are better models and coaches for residents engaged in research. Beginning with a fundamental, but disciplined, writing program, both faculty and residents may learn methods for sharing new knowledge or acquiring those skills necessary to critically analyze the medical literature.

  10. Survival prediction among nursing home residents: A longitudinal study.

    Science.gov (United States)

    Lai, Claudia Kam Yuk; Ho, Lily Yuen Wah; Chin, Kenny Chi Wing; Kwong, Enid Wai Yung

    2018-03-01

    To determine the survival time and predictors of survival of residents in a nursing home. Nursing home residents admitted from June 2008 (when the nursing home started operating) to December 2012 (n = 230) to a new nursing home in Hong Kong were prospectively followed. The predictors of survival in the residents were assessed annually, with the exception of those who did not want to continue with the study, or were hospitalized, discharged from the nursing home or died, to compare changes occurring from 2008 to 2012. Cox's regression analysis was used to examine the predictors of survival. A total of 66 of the nursing home residents (28.7%) died during the study period. The median length of survival was 20.46 months. Sex, the number of diseases, depressive symptoms, cognitive status and nutritional status were found to be significant predictors of survival. It is crucial for healthcare providers to offer quality care to residents in long-term care to enhance their well-being in the final sojourn of their lives. Although there are no consistent reports of predictors in the international literature, it is important to address the modifiable predictors, as this might lead to improvements in the quality of life of the residents. Geriatr Gerontol Int 2018; 18: 428-433. © 2017 Japan Geriatrics Society.

  11. Internal Medicine Residents' Perceptions of Cross-Cultural Training

    Science.gov (United States)

    Park, Elyse R; Betancourt, Joseph R; Miller, Elizabeth; Nathan, Michael; MacDonald, Ellie; Ananeh-Firempong, Owusu; Stone, Valerie E

    2006-01-01

    BACKGROUND Physicians increasingly face the challenge of managing clinical encounters with patients from a range of cultural backgrounds. Despite widespread interest in cross-cultural care, little is known about resident physicians' perceptions of what will best enable them to provide quality care to diverse patient populations. OBJECTIVES To assess medicine residents' (1) perceptions of cross-cultural care, (2) barriers to care, and (3) training experiences and recommendations. DESIGN, SETTING, AND PATIENTS Qualitative individual interviews were conducted with 26 third-year medicine residents at Massachusetts General Hospital in Boston (response rate = 87%). Interviews were recorded, transcribed, and analyzed. RESULTS Despite significant interest in cross-cultural care, almost all of the residents reported very little training during residency. Most had gained cross-cultural skills through informal learning. A few were skeptical about formal training, and some expressed concern that it is impossible to understand every culture. Challenges to the delivery of cross-cultural care included managing patients with limited English proficiency, who involve family in critical decision making, and who have beliefs about disease that vary from the biomedical model. Residents cited many implications to these barriers, ranging from negatively impacting the patient-physician relationship to compromised care. Training recommendations included making changes to the educational climate and informal and formal training mechanisms. CONCLUSIONS If cross-cultural education is to be successful, it must take into account residents' perspectives and be focused on overcoming residents' cited barriers. It is important to convey that cross-cultural education is a set of skills that can be taught and applied, in a time-efficient manner, rather than requiring an insurmountable knowledge base. PMID:16704391

  12. A patient safety curriculum for medical residents based on the perspectives of residents and supervisors

    NARCIS (Netherlands)

    Jansma, J.D.; Wagner, C.; Bijnen, A.B.

    2011-01-01

    Objectives: To develop a patient safety course for medical residents based on the views of medical residents and their supervisors. Methods: In 2007, questionnaires were distributed to investigate residents' and supervisors' perspectives on the current patient safety performance and educational

  13. Construction cost forecast model : model documentation and technical notes.

    Science.gov (United States)

    2013-05-01

    Construction cost indices are generally estimated with Laspeyres, Paasche, or Fisher indices that allow changes : in the quantities of construction bid items, as well as changes in price to change the cost indices of those items. : These cost indices...

  14. Women’s Role in the Social Construction of Popular Houses

    Directory of Open Access Journals (Sweden)

    Rebeca Buzzo Fertrin

    2010-01-01

    Full Text Available This article aimed at investigating the role of relevant social groups and their interaction in the shaping of a technological artefact, namely, a social housing project in which the future residents are themselves responsible for the construction work. In particular, it focuses on the role of the women in the group of future residents. The close observation of the development of the process together with information from documents and interviews revealed that not only the final artefact is shaped by the social groups but also that the interaction between and within such groups are considerably modified during the process. In particular, the social role of women was significantly changed: they steadly and firmly took ever the leading roles; they assumed all sorts of “heavy” and “dangerous” work and, they built, together with the houses, a new female identity.

  15. Providing rapid feedback to residents on their teaching skills: an educational strategy for contemporary trainees.

    Science.gov (United States)

    Katz-Sidlow, Rachel J; Baer, Tamar G; Gershel, Jeffrey C

    2016-03-20

    The objective of this study was to assess the attitudes of contemporary residents toward receiving rapid feedback on their teaching skills from their medical student learners. Participants consisted of 20 residents in their second post-graduate training year. These residents facilitated 44 teaching sessions with medical students within our Resident-as-Teacher program. Structured, written feedback from students was returned to the resident within 3 days following each session. Residents completed a short survey about the utility of the feedback, whether they would make a change to future teaching sessions based on the feedback, and what specifically they might change. The survey utilized a 4-point scale ("Not helpful/likely=1" to "Very helpful/likely=4"), and allowed for one free-text response. Free-text responses were hand-coded and underwent qualitative analysis to identify themes. There were 182 student feedback encounters resulting from 44 teaching sessions. The survey response rate was 73% (32/44). Ninety-four percent of residents rated the rapid feedback as "very helpful," and 91% would "very likely" make a change to subsequent sessions based on student feedback. Residents' proposed changes included modifications to session content and/or their personal teaching style. Residents found that rapid feedback received from medical student learners was highly valuable to them in their roles as teachers. A rapid feedback strategy may facilitate an optimal educational environment for contemporary trainees.

  16. Assessing Resident Performance in Screening Mammography: Development of a Quantitative Algorithm.

    Science.gov (United States)

    Lewis, Petra J; Rooney, Timothy B; Frazee, Tracy E; Poplack, Steven P

    2018-01-20

    This study aims to provide objective performance data and feedback, including examination volumes, recall rates, and concordance with faculty interpretations, for residents performing independent interpretation of screening mammography examinations. Residents (r) and faculty (f) interpret screening mammograms separately and identify non-callbacks (NCBs) and callbacks (CBs). Residents review all discordant results. The number of concordant interpretations (fCB-rCB and fNCB-rNCB) and discordant interpretations (fCB-rNCB and fNCB-rCB) are entered into a macro-driven spreadsheet. These macros weigh the data dependent on the perceived clinical impact of the resident's decision. Weighted outcomes are combined with volumes to generate a weighted mammography performance score. Rotation-specific goals are assigned for the weighted score, screening volumes, recall rate relative to faculty, and concordance rates. Residents receive one point for achieving each goal. Between July 2013 and May 2017, 18,747 mammography examinations were reviewed by 31 residents, in 71 resident rotations, over 246 resident weeks. Mean resident recall rate was 9.9% and significantly decreased with resident level (R), R2 = 11.3% vs R3 = 9.4%, R4 = 9.2%. Mean resident-faculty discordance rate was 10% and significantly decreased from R2 = 12% to R4 = 9.6%. Weighted performance scores ranged from 1.1 to 2.0 (mean 1.6, standard deviation 0.17), but did not change with rotation experience. Residents had a mean goal achievement score of 2.6 (standard deviation 0.47). This method provides residents with easily accessible case-by-case individualized screening outcome data over the longitudinal period of their residency, and provides an objective method of assessing resident screening mammography performance. Copyright © 2017 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

  17. Residence Hall Student Satisfaction with Interim Alcohol Policy. Office for Student Affairs Research Bulletin; v15 n4 Jul74.

    Science.gov (United States)

    Seabourg, Deborah; And Others

    At the beginning of the 1973-74 academic year alcohol usage was officially permitted for the first time in residence halls at the Twin Cities Campus of the University of Minnesota. To determine residents' perceptions of the effects of the change in drinking policy, interviews were conducted with 49 current dormitory residents, who had also lived…

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

    Science.gov (United States)

    Kolade, Victor O; Staton, Lisa J; Jayarajan, Ramesh; Bentley, Nanette K; Huang, Xiangke

    2014-01-01

    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. 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. 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). 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.

  19. Constructs of Childhood: Enduring or Open to Change? Early Years Students' Reflections on First Hand Experiences of Childhood and Early Years Education in a Different Country and Culture

    Science.gov (United States)

    McGillivray, Gill

    2009-01-01

    It can be argued that globalisation brings change for children and their families in the guise of increased poverty and inequality; for example, for the world's poorest populations and communities. Students undertaking Early Childhood Studies degrees in the United Kingdom are likely to encounter modules with a focus on childhood in a variety of…

  20. Exploration of the Mechanisms of Change in Constructs From Self-Determination Theory and Quality of Life During a Multidisciplinary Family-Based Intervention for Overweight Adolescents.

    Science.gov (United States)

    Fenner, Ashley A; Howie, Erin K; Straker, Leon M; Hagger, Martin S

    2016-02-01

    The current study explored whether a multidisciplinary family-based intervention underpinned by self-determination theory could enhance perceptions of parent need support, autonomous motivation, and quality of life in overweight and obese adolescents. Using a staggered-entry waitlist-period control design, adolescents (n = 56) were assessed at baseline and preintervention (within-participant control), immediately following intervention, and at 3, 6, and 12 month follow-ups. Parents were trained in need-supportive behaviors within the broader context of an 8-week multidisciplinary intervention attended jointly with adolescents. Following intervention, significant improvements were demonstrated in adolescent perceptions of parent need support, autonomous motivation, and quality of life, and changes were maintained at the 1-year follow-up. Mediation analyses revealed changes in perceptions of parent need support predicted changes in quality of life indirectly via changes in autonomous motivation. Findings suggest overweight and obese adolescents are likely to benefit from multidisciplinary family-based interventions that aim to train parents in need-supportive behaviors.

  1. Continuity of Care in Resident Outpatient Clinics: A Scoping Review of the Literature.

    Science.gov (United States)

    Walker, Jeremey; Payne, Brittany; Clemans-Taylor, B Lee; Snyder, Erin Dunn

    2018-02-01

    Continuity between patients and physicians is a core principle of primary care and an accreditation requirement. Resident continuity clinics face challenges in nurturing continuity for their patients and trainees. We undertook a scoping review of the literature to better understand published benchmarks for resident continuity; the effectiveness of interventions to improve continuity; and the impact of continuity on resident and patient satisfaction, patient outcomes, and resident career choice. We developed a MEDLINE search strategy to identify articles that defined continuity in residency programs in internal medicine, family medicine, and pediatrics published prior to December 31, 2015, and used a quality evaluation tool to assess included studies. The review includes 34 articles describing 12 different measures of continuity. The usual provider of care and continuity for physician formulas were most commonly utilized, and mean baseline continuity was 56 and 55, respectively (out of a total possible score of 100). Clinic and residency program redesign innovations (eg, advanced access scheduling, team-based care, and block scheduling) were studied and had mixed impact on continuity. Continuity in resident clinics is lower than published continuity rates for independently practicing physicians. Interventions to enhance continuity in resident clinics have mixed effects. More research is needed to understand how changes in continuity affect resident and patient satisfaction, patient outcomes, and resident career choice. A major challenge to research in this area is the lack of empanelment of residents' patients, creating difficulties in scheduling and measuring continuity visits.

  2. Cooperation in Construction:

    DEFF Research Database (Denmark)

    Vogelius, Peter; Storgaard, Kresten

    2016-01-01

    . The management logic of the main contractor is interpreted as based on a sociology-inspired understanding focusing on norms and social values rather than on contractual (law) and functional (engineering) logic, which had hitherto been prevalent in Danish construction management.......The study presents a building project executed by a major Danish construction company, where cooperation and its staging were essential for achieving high productivity and competitiveness. The form of this cooperation is the main theme for the article. The contractor actively changed...... the companies in the case can be understood as possessing a social capital which is enforced and united by initiatives of the main contractor. The social capital was built up and maintained through the actual constitution of cooperation already in the initial phase of bidding before the building process...

  3. Multi-Mission Cross-Calibration of Satellite Altimeters: Constructing a Long-Term Data Record for Global and Regional Sea Level Change Studies

    Directory of Open Access Journals (Sweden)

    Wolfgang Bosch

    2014-03-01

    Full Text Available Climate studies require long data records extending the lifetime of a single remote sensing satellite mission. Precise satellite altimetry exploring global and regional evolution of the sea level has now completed a two decade data record. A consistent long-term data record has to be constructed from a sequence of different, partly overlapping altimeter systems which have to be carefully cross-calibrated. This cross-calibration is realized globally by adjusting an extremely large set of single- and dual-satellite crossover differences performed between all contemporaneous altimeter systems. The total set of crossover differences creates a highly redundant network and enables a robust estimate of radial errors with a dense and rather complete sampling for all altimeter systems analyzed. An iterative variance component estimation is applied to obtain an objective relative weighting between altimeter systems with different performance. The final time series of radial errors is taken to estimate (for each of the altimeter systems an empirical auto-covariance function. Moreover, the radial errors capture relative range biases and indicate systematic variations in the geo-centering of altimeter satellite orbits. The procedure has the potential to estimate for all altimeter systems the geographically correlated mean errors which is not at all visible in single-satellite crossover differences but maps directly to estimates of the mean sea surface.

  4. An investigation of developmental changes in interpretation and construction of graphic AAC symbol sequences through systematic combination of input and output modalities.

    Science.gov (United States)

    Trudeau, Natacha; Sutton, Ann; Morford, Jill P

    2014-09-01

    While research on spoken language has a long tradition of studying and contrasting language production and comprehension, the study of graphic symbol communication has focused more on production than comprehension. As a result, the relationships between the ability to construct and to interpret graphic symbol sequences are not well understood. This study explored the use of graphic symbol sequences in children without disabilities aged 3;0 to 6;11 (years; months) (n=111). Children took part in nine tasks that systematically varied input and output modalities (speech, action, and graphic symbols). Results show that in 3- and 4-year-olds, attributing meaning to a sequence of symbols was particularly difficult even when the children knew the meaning of each symbol in the sequence. Similarly, while even 3- and 4-year-olds could produce a graphic symbol sequence following a model, transposing a spoken sentence into a graphic sequence was more difficult for them. Representing an action with graphic symbols was difficult even for 5-year-olds. Finally, the ability to comprehend graphic-symbol sequences preceded the ability to produce them. These developmental patterns, as well as memory-related variables, should be taken into account in choosing intervention strategies with young children who use AAC.

  5. [Changes in the energy indices of Escherichia coli during exhaustion and renewal of glucose and ammonia supply as a factor responsible for the coupling of energy and constructive types of metabolism].

    Science.gov (United States)

    Tkachenko, A G

    1990-01-01

    The shift down of glucose in the growth medium lowered the energetic status of cells whereas that of ammonium elevated it, which was indicative of their specific effect on metabolism. The shift up of glucose within the first four seconds promptly increased the intracellular ATP pool, the energy charge and the ATP/ADP ratio up to values characteristic of growth, while the addition of ammonium after its exhaustion resulted in the opposite effect. The described changes are typical of an incomplete coupling between energetic and constructive metabolic types in E. coli.

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

    Science.gov (United States)

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

    2013-03-01

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

  7. Lawful Permanent Residents Fiscal Year 2011 Country

    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...

  8. Lawful Permanent Residents Fiscal Year 2014 Country

    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...

  9. Lawful Permanent Residents Fiscal Year 2015 State

    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...

  10. Lawful Permanent Residents Fiscal Year 2014 State

    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...

  11. Lawful Permanent Residents Fiscal Year 2011 State

    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...

  12. Lawful Permanent Residents Fiscal Year 2016 State

    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...

  13. Lawful Permanent Residents Fiscal Year 2015 Country

    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...

  14. Citizens' views about the proposed Hartsville Nuclear Power Plant: a survey of residents' perceptions in August 1975

    International Nuclear Information System (INIS)

    Sundstrom, E.D.; Costomiris, L.J.; DeVault, R.C.; Dowell, D.A.; Lounsbury, J.W.; Mattingly, T.J. Jr.; Passino, E.M.; Peelle, E.

    1977-05-01

    This report describes the results of a survey conducted in August 1975 among a group of residents of Hartsville and Trousdale County, Tennessee, regarding their views about the nuclear power plant the Tennessee Valley Authority is constructing five miles outside of Hartsville. As part of a longitudinal study of the social impacts of the nuclear facility, the survey was conducted during the planning and pre-licensing phase of the project to address two questions: (1) What factors are related to favorable or unfavorable attitudes toward the nuclear plant. (2) How do residents of Hartsville perceive their quality of life, and how have their perceptions changed since an earlier survey in January 1975. A panel of 288 residents interviewed in January 1975 was reinterviewed in August 1975. Questions concerned perceptions of the quality of life in Hartsville, knowledge and sources of information about the proposed nuclear plant, expectations regarding its effects on the community, and attitudes toward the plant and related issues. Responses are presented

  15. Citizens' views about the proposed Hartsville Nuclear Power Plant: a survey of residents' perceptions in August 1975

    Energy Technology Data Exchange (ETDEWEB)

    Sundstrom, E. D.; Costomiris, L. J.; DeVault, R. C.; Dowell, D. A.; Lounsbury, J. W.; Mattingly, Jr., T. J.; Passino, E. M.; Peelle, E.

    1977-05-01

    This report describes the results of a survey conducted in August 1975 among a group of residents of Hartsville and Trousdale County, Tennessee, regarding their views about the nuclear power plant the Tennessee Valley Authority is constructing five miles outside of Hartsville. As part of a longitudinal study of the social impacts of the nuclear facility, the survey was conducted during the planning and pre-licensing phase of the project to address two questions: (1) What factors are related to favorable or unfavorable attitudes toward the nuclear plant. (2) How do residents of Hartsville perceive their quality of life, and how have their perceptions changed since an earlier survey in January 1975. A panel of 288 residents interviewed in January 1975 was reinterviewed in August 1975. Questions concerned perceptions of the quality of life in Hartsville, knowledge and sources of information about the proposed nuclear plant, expectations regarding its effects on the community, and attitudes toward the plant and related issues. Responses are presented.

  16. Effect of oven residence time on mechanical properties in ...

    Indian Academy of Sciences (India)

    Simulation studies were conducted using ROTOSIM software to analyze thermal transitions and phase changes during the process. Degree of curing of the polymers was also assessed and correlated with mechanical properties. Experiments were further conducted to obtain favourable oven residence time to obtain highest ...

  17. Surgical resident working hours in South Africa | Kong | South ...

    African Journals Online (AJOL)

    Background: Surgical training has undergone major changes worldwide, especially with regard to work hour regulations. Very little is known regarding the situation in South Africa, and how it compares with other countries. Method: We conducted a retrospective review of the hours worked by surgical residents in a major ...

  18. Psychiatry Residency Education in Canada: Past, Present and Future

    Science.gov (United States)

    Saperson, Karen

    2013-01-01

    Objective: This article provides a brief overview of the history of psychiatry residency training in Canada,and outlines the rationale for the current training requirements, changes to the final certification examination,and factors influencing future trends in psychiatry education and training. Method: The author compiled findings and reports on…

  19. The Chief Resident Role in Emergency Medicine Residency Programs

    Directory of Open Access Journals (Sweden)

    Hafner, John W. Jr., MD, MPH

    2010-05-01

    Full Text Available Study Objectives: Although other specialties have examined the role of the chief resident (CR, the role and training of the emergency medicine (EM CR has largely been undefined.Methods: A survey was mailed to all EM CRs and their respective program directors (PD in 124 EM residency programs. The survey consisted of questions defining demographics, duties of the typical CR, and opinions regarding the level of support and training received. Multiple choice, Likert scale (1 strong agreement, 5 strong disagreement and short-answer responses were used. We analyzed associations between CR and PD responses using Chi-square, Student’s T and Mann-Whitney U tests.Results: Seventy-six percent of CRs and 65% of PDs responded and were similar except for age (31 vs. 42 years; p<0.001. CR respondents were most often male, in year 3 of training and held the position for 12 months. CRs and PDs agreed that the assigned level of responsibility is appropriate (2.63 vs. 2.73, p=0.15; but CRs underestimate their influence in the residency program (1.94 vs. 2.34, p=0.002 and the emergency department (2.61 vs. 3.03, p=0.002. The majority of CRs (70% and PDs (77% report participating in an extramural training program, and those CRs who participated in training felt more prepared for their job duties (2.26 vs. 2.73; p=0.03.Conclusion: EM CRs feel they have appropriate job responsibility but believe they are less influential in program and department administration than PD respondents. Extramural training programs for incoming CRs are widely used and felt to be helpful. [West J Emerg Med. 2010; 11(2:120-125.

  20. Triple-loop learning as foundation for profound change, individual cultivation, and radical innovation. Construction processes beyond scientific and rational knowledge.

    OpenAIRE

    Peschl, Markus F.

    2007-01-01

    Purpose: Ernst von Glasersfeld’s question concerning the relationship between scientific/ rational knowledge and the domain of wisdom and how these forms of knowledge come about is the starting point. This article aims at developing an epistemological as well as methodological framework that is capable of explaining how profound change can be brought about in various contexts, such as in individual cultivation, in organizations, in processes of radical innovation, etc. This fra...

  1. Pediatric Program Leadership's Contribution Toward Resident Wellness.

    Science.gov (United States)

    Carson, Savanna L; Perkins, Kate; Reilly, Maura R; Sim, Myung-Shin; Li, Su-Ting T

    2018-02-27

    Residency program leaders are required to support resident well-being, but often do not receive training in how to do so. Determine frequency in which program leadership provides support for resident well-being, comfort in supporting resident well-being, and factors associated with need for additional training in supporting resident well-being. National cross-sectional web-based survey of pediatric program directors, associate program directors, and coordinators in June 2015, on their experience supporting resident well-being. Univariate and bivariate descriptive statistics compared responses between groups. Generalized linear modeling, adjusting for program region, size, program leadership role, and number of years in role determined factors associated with need for additional training. 39.3% (322/820) of participants responded. Most respondents strongly agreed that supporting resident well-being is an important part of their role, but few reported supporting resident well-being as part of their job description. Most reported supporting residents' clinical, personal, and health issues at least annually, and in some cases weekly, with 72% spending >10% of their time on resident well-being. Most program leaders desired more training. After adjusting for level of comfort in dealing with resident well-being issues, program leaders more frequently exposed to resident well-being issues were more likely to desire additional training (pProgram leaders spend a significant amount of time supporting resident well-being. While they feel that supporting resident well-being is an important part of their job, opportunities exist for developing program leaders through including resident wellness on job descriptions and training program leaders how to support resident well-being. Copyright © 2018 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

  2. 45 CFR 233.40 - Residence.

    Science.gov (United States)

    2010-10-01

    .... For purposes of this section: (1) A resident of a State is one: (i) Who is living in the State... resident of the State in which he or she is living other than on a temporary basis. Residence may not depend upon the reason for which the individual entered the State, except insofar as it may bear upon...

  3. Breaking Bad News - Perceptions of Pediatric Residents.

    Science.gov (United States)

    Geeta, M G; Krishnakumar, P

    2017-08-15

    The present study evaluated the perceptions and practice of 92 final year pediatric residents with regard to breaking bad news. Only 16% of residents had received any training in communication skills. Majority (65%) of the residents were not comfortable while breaking bad news.

  4. 8 CFR 325.3 - Residence.

    Science.gov (United States)

    2010-01-01

    ... 8 Aliens and Nationality 1 2010-01-01 2010-01-01 false Residence. 325.3 Section 325.3 Aliens and Nationality DEPARTMENT OF HOMELAND SECURITY NATIONALITY REGULATIONS NATIONALS BUT NOT CITIZENS OF THE UNITED STATES; RESIDENCE WITHIN OUTLYING POSSESSIONS § 325.3 Residence. (a) For purposes of applying the...

  5. 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…

  6. Pioneering partnerships: Resident involvement from multiple perspectives

    NARCIS (Netherlands)

    Baur, V.E.; Abma, T.A.; Boelsma, F.; Woelders, S.

    2013-01-01

    Resident involvement in residential care homes is a challenge due to shortcomings of consumerist and formal approaches such as resident councils. The PARTNER approach aims to involve residents through collective action to improve their community life and wellbeing. The purpose of this article is to

  7. 24 CFR 206.39 - Principal residence.

    Science.gov (United States)

    2010-04-01

    ... 24 Housing and Urban Development 2 2010-04-01 2010-04-01 false Principal residence. 206.39 Section... CONVERSION MORTGAGE INSURANCE Eligibility; Endorsement Eligible Mortgagors § 206.39 Principal residence. The property must be the principal residence of each mortgagor at closing. For purposes of this section, the...

  8. 25 CFR 700.97 - Residence.

    Science.gov (United States)

    2010-04-01

    ... 25 Indians 2 2010-04-01 2010-04-01 false Residence. 700.97 Section 700.97 Indians THE OFFICE OF NAVAJO AND HOPI INDIAN RELOCATION COMMISSION OPERATIONS AND RELOCATION PROCEDURES General Policies and Instructions Definitions § 700.97 Residence. (a) Residence is established by proving that the head of household...

  9. Suicidal Thoughts Among Medical Residents with Burnout

    NARCIS (Netherlands)

    van der Heijden, Frank; Dillingh, Gea; Bakker, Arnold; Prins, Jelle

    2008-01-01

    Objectives: Recent research showed that medical residents have a high risk for developing burnout. The present study investigates the prevalence of burnout and its relationship with suicidal thoughts among medical residents. Methods: All Dutch medical residents (n = 5126) received a self-report

  10. Does Targeted Training Improve Residents' Teaching Skills?

    Science.gov (United States)

    Polreis, Sean; D'Eon, Marcel F.; Premkumar, Kalyani; Trinder, Krista; Bonnycastle, Deirdre

    2015-01-01

    Resident doctors have an important and integral responsibility of teaching a number of individuals. The purpose of this study was to measure the effectiveness of the University of Saskatchewan's resident-as-teacher training course--Teaching Improvement Project Systems (TIPS). Residents who attended the TIPS course from January, 2010 through June,…

  11. Negotiations of Acknowledgement among Middle Class Residents

    DEFF Research Database (Denmark)

    Andersen, Nina Blom

    2013-01-01

    The article presents an analysis of communication processes between residents, between residents and people in the broader societal context as well as of media coverage of a fireworks disaster in a Danish suburb. It demonstrates how residents (all members of the Danish middle class) were able...

  12. 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.

  13. Strangers and friends: residents' social careers in assisted living.

    Science.gov (United States)

    Kemp, Candace L; Ball, Mary M; Hollingsworth, Carole; Perkins, Molly M

    2012-07-01

    This study examines coresident relationships in assisted living (AL) and identifies factors influencing relationships. We draw on qualitative data collected from 2008 to 2009 from three AL communities varying in size, location, and resident characteristics. Data collection methods included participant observation, and informal and formal, in-depth interviews with residents, administrators, and AL staff. Data analysis was guided by principles of grounded theory method, an iterative approach that seeks to discover core categories, processes, and patterns and link these together to construct theory. The dynamic, evolutionary nature of relationships and the individual patterns that comprise residents' overall experiences with coresidents are captured by our core category, "negotiating social careers in AL." Across facilities, relationships ranged from stranger to friend. Neighboring was a common way of relating and often involved social support, but was not universal. We offer a conceptual model explaining the multilevel factors influencing residents' relationships and social careers. Our explanatory framework reveals the dynamic and variable nature of coresident relationships and raises additional questions about social career variability, trajectories, and transitions. We discuss implications for practice including the need for useable spaces, thoughtful activity programming, and the promotion of neighboring through staff and family involvement.

  14. Exploring residents' communication learning process in the workplace: a five-phase model.

    Directory of Open Access Journals (Sweden)

    Valerie van den Eertwegh

    Full Text Available Competency-based education is a resurgent paradigm in professional medical education. However, more specific knowledge is needed about the learning process of such competencies, since they consist of complex skills. We chose to focus on the competency of skilled communication and want to further explore its learning process, since it is regarded as a main competency in medical education.This study aims to explore in more detail the learning process that residents in general practice go through during workplace-based learning in order to become skilled communicators.A qualitative study was conducted in which twelve GP residents were observed during their regular consultations, and were interviewed in-depth afterwards.Analysis of the data resulted in the construction of five phases and two overall conditions to describe the development towards becoming a skilled communicator: Confrontation with (undesired behaviour or clinical outcomes was the first phase. Becoming conscious of one's own behaviour and changing the underlying frame of reference formed the second phase. The third phase consisted of the search for alternative behaviour. In the fourth phase, personalization of the alternative behaviour had to occur, this was perceived as difficult and required much time. Finally, the fifth phase concerned full internalization of the new behaviour, which by then had become an integrated part of the residents' clinical repertoire. Safety and cognitive & emotional space were labelled as overall conditions influencing this learning process.Knowledge and awareness of these five phases can be used to adjust medical working and learning environments in such a way that development of skilled medical communication can come to full fruition and its benefits are more fully reaped.

  15. Exploring residents' communication learning process in the workplace: a five-phase model.

    Science.gov (United States)

    van den Eertwegh, Valerie; van der Vleuten, Cees; Stalmeijer, Renée; van Dalen, Jan; Scherpbier, Albert; van Dulmen, Sandra

    2015-01-01

    Competency-based education is a resurgent paradigm in professional medical education. However, more specific knowledge is needed about the learning process of such competencies, since they consist of complex skills. We chose to focus on the competency of skilled communication and want to further explore its learning process, since it is regarded as a main competency in medical education. This study aims to explore in more detail the learning process that residents in general practice go through during workplace-based learning in order to become skilled communicators. A qualitative study was conducted in which twelve GP residents were observed during their regular consultations, and were interviewed in-depth afterwards. Analysis of the data resulted in the construction of five phases and two overall conditions to describe the development towards becoming a skilled communicator: Confrontation with (un)desired behaviour or clinical outcomes was the first phase. Becoming conscious of one's own behaviour and changing the underlying frame of reference formed the second phase. The third phase consisted of the search for alternative behaviour. In the fourth phase, personalization of the alternative behaviour had to occur, this was perceived as difficult and required much time. Finally, the fifth phase concerned full internalization of the new behaviour, which by then had become an integrated part of the residents' clinical repertoire. Safety and cognitive & emotional space were labelled as overall conditions influencing this learning process. Knowledge and awareness of these five phases can be used to adjust medical working and learning environments in such a way that development of skilled medical communication can come to full fruition and its benefits are more fully reaped.

  16. Financial Contribution of Residents When Billing as "Junior Associates" in the "Surgical Firm".

    Science.gov (United States)

    Stoller, Jeremy; Pratt, Sarah; Stanek, Stephen; Zelenock, Gerald; Nazzal, Munier

    2016-01-01

    There is an increasing number of proposals to change the way Graduate Medical Education is funded. This study attempts to estimate the potential financial contribution of surgical residents using an alternative funding mechanism similar to that used by law firms, which would allow surgery departments to bill for resident activity as "junior associates." Following 24 residents over a period of 12 weeks, we were able to estimate the annual revenue that they generated from operating room procedures, independent consultations, patient management, and minor procedures using Medicare reimbursement rates. The appropriate first assistant modifier was used to calculate the operating room procedure fees, but full price was used to calculate the revenue for minor procedures, patient management, and consultations done independently. We adjusted for vacation time and academic activities. Including postgraduate year 1 residents, the estimated yearly revenue generated per resident in first assistant operative services was $33,305.67. For minor procedures, patient management, and independent consultations, the estimated yearly revenue per resident was $37,350.66. The total estimated financial contribution per resident per year was $70,656.33. Excluding postgraduate year 1 residents, as most states require completion of the intern year before full licensure, the estimated yearly revenue generated per resident in first assistant operative services was $38,914.56. For minor procedures, patient management, and independent consultations, the estimated yearly revenue per resident was $55,957.33. The total estimated financial contribution per resident per year was $94,871.89. Residents provide a significant service to hospitals. If resident activity was compensated at the level of supervised "junior associates" of a surgery department, more than 75% of the direct educational costs of training could be offset. Furthermore, we believe this value is underestimated. Given the foreseeable

  17. Interactions between medical residents and drug companies: a national survey after the Mediator® affair.

    Directory of Open Access Journals (Sweden)

    François Montastruc

    Full Text Available BACKGROUND: The present study aimed to describe exposure and attitudes of French medical residents towards pharmaceutical industry. The study was performed shortly after the Mediator affair which revealed several serious conflicts of interest inside the French health system. METHODS AND FINDINGS: A cross-sectional study was implemented among residents from 6 French medical faculties. Independent education in pharmacology, attitudes towards the practices of pharmaceutical sales representatives, opinions concerning the pharmaceutical industry, quality of information provided by the pharmaceutical industry, and opinions about pharmaceutical company sponsorship were investigated through a web-based questionnaire. We also assessed potential changes in resident attitudes following the Mediator affair. The mean value of exposure to drug companies was 1.9 times per month. Global opinions towards drug company information were negative for 42.7% of the residents and positive for only 8.2%. Surprisingly, 81.6% of residents claimed that they had not changed their practices regarding drug information since the Mediator affair. Multivariate analyses found that residents in anesthesiology were less likely to be exposed than others (OR = 0.17 CI95% [0.05-0.61], exposure was significantly higher at the beginning of residence (p<0.001 and residents who had a more positive opinion were more frequently exposed to drug companies (OR = 2.12 CI95% [1.07-4.22]. CONCLUSIONS: Resident exposure to drug companies is around 1 contact every 2 weeks. Global opinion towards drug information provided by pharmaceutical companies was negative for around 1 out of 2 residents. In contrast, residents tend to consider the influences of the Mediator affair on their practice as relatively low. This survey enabled us to identify profiles of residents who are obviously less exposed to pharmaceutical industry. Current regulatory provisions are not sufficient, indicating that

  18. Specific features of modern multifunctional high-rise building construction

    Science.gov (United States)

    Manukhina, Lyubov; Samosudova, Natal'ja

    2018-03-01

    The article analyzes the main reasons for the development of high-rise building construction the most important of which-is a limitation of the urban areas and, consequently, the high price of land reserved for construction. New engineering and compositional solutions for the creation of new types of buildings are considered - complex technical designs of a large number of storeys completely meet the new requirements for safety and comfort. Some peculiarities of designing high-rise buildings and searching for optimal architectural and planning solutions are revealed since, with external architectural simplicity, high-rise buildings have complex structural and technological and space-planning solutions. We consider the specific features of a high-rise housing in various countries around the world, including Russia, such as the layout of the multi-storey residential buildings, depending on the climatic characteristics of the regions, assessment of the geological risk of the construction site, the choice of parameters and functional purpose of the sections of the territory of high-rise construction, location of the town-planning object for substantiating the overall dimensions of the building, assessment of changes aeration and engineering and hydrological conditions of the site. A special place in the article on the problems of improvement of the territory, the device of courtyards, landscaping, the device of playing and sports grounds. The main conclusion in the article is the following problem - when developing high-rise housing construction, the development of high-rise housing, and an increase in the population density in the territory of large cities of Russia, necessary to create a comfortable and safe level of residents living and not a decrease, but an improvement in the quality of the urban environment.

  19. One's Colonies: a virtual reality environment of oriental residences

    Science.gov (United States)

    Chi, Catherine

    2013-03-01

    This paper is a statement about my virtual reality environment project, One's Colonies, and a description of the creative process of the project. I was inspired by the buildings in my hometown-Taiwan, which is really different from the architectural style in the United States. By analyzing the unique style of dwellings in Taiwan, I want to demonstrate how the difference between geography, weather and culture change the appearance of the living space. Through this project I want to express the relationship between architectural style and cultural difference, and how the emotional condition or characteristics of the residents are affected by their residencies.

  20. Meaning construction in remembering

    DEFF Research Database (Denmark)

    Wagoner, Brady

    2011-01-01

    F.C. Bartlett and L.S.Vygotsky were two seminal figures in the psychological study of remembering. Both emphasized the role of meaning and imagination in this process. Bartlett did this by showing the systematic and holistic changes that ensue when cultural material is repeatedly reproduced outside...... of the group to which it belongs. Vygotsky, on the other hand, attended to the ways in which we construct meaningful ―signs‖ as artificial memory aids to solve memory problems that go beyond our natural capacities. These two approaches are brought together to show how we utilize various cultural resources...

  1. Green Construction in Building Renovation

    Directory of Open Access Journals (Sweden)

    Ksit Barbara

    2016-06-01

    Full Text Available Modern materials and construction solutions draw more and more attention to ecology and building certification. Among the criteria appearing in revitalization, an important element is bringing plants back into heavily urbanized areas. In its natural form, this is not possible to carry out everywhere, often requiring large amounts of space. Nowadays, however, there are a number of green roofs and green wall systems, allowing “greener” construction without making significant changes in the urban environment.

  2. [The Computer Book of the Internal Medicine resident: validity and reliability of a questionnaire for self-assessment of competences in internal medicine residents].

    Science.gov (United States)

    Oristrell, J; Casanovas, A; Jordana, R; Comet, R; Gil, M; Oliva, J C

    2012-12-01

    There are no simple and validated instruments for evaluating the training of specialists. To analyze the reliability and validity of a computerized self-assessment method to quantify the acquisition of medical competences during the Internal Medicine residency program. All residents of our department participated in the study during a period of 28 months. Twenty-two questionnaires specific for each rotation (the Computer-Book of the Internal Medicine Resident) were constructed with items (questions) corresponding to three competence domains: clinical skills competence, communication skills and teamwork. Reliability was analyzed by measuring the internal consistency of items in each competence domain using Cronbach's alpha index. Validation was performed by comparing mean scores in each competence domain between senior and junior residents. Cut-off levels of competence scores were established in order to identify the strengths and weaknesses of our training program. Finally, self-assessment values were correlated with the evaluations of the medical staff. There was a high internal consistency of the items of clinical skills competences, communication skills and teamwork. Higher scores of clinical skills competence and communication skills, but not in those of teamwork were observed in senior residents than in junior residents. The Computer-Book of the Internal Medicine Resident identified the strengths and weaknesses of our training program. We did not observe any correlation between the results of the self- evaluations and the evaluations made by staff physicians. The items of Computer-Book of the Internal Medicine Resident showed high internal consistency and made it possible to measure the acquisition of medical competences in a team of Internal Medicine residents. This self-assessment method should be complemented with other evaluation methods in order to assess the acquisition of medical competences by an individual resident. Copyright © 2012 Elsevier Espa

  3. Constructing leadership identities through stories

    DEFF Research Database (Denmark)

    Frimann, Søren; Hersted, Lone

    2016-01-01

    This article analyzes the construction of leadership identities through stories found in four narrative interviews from a qualitative study and leadership development project based on social constructionism and action learning. We argue that leadership development and the construction of leadership...... that the concept of coauthoring is useful in developing leadership and leadership identities through reflexive dialogs and emerging stories....... narrative interviews about their challenges as leaders? In addition, how do these discursive constructions restrict or enable new perspectives, other voices, and the possibilities for learning and change? Our analysis identified traces of both modern and postmodern leadership discourses. We suggest...

  4. A set of principles, developed by residents, to guide Canadian residency education.

    Science.gov (United States)

    Maniate, Jerry M; Karimuddin, Ahmer

    2009-11-01

    With so much invested in the clinical competency of physicians, adequate and appropriate mechanisms are needed to ensure that educational systems provide the highest-quality training possible and are responsive both to the changing demands of the patient population and to changing technologies and research. After a literature review, the authors concluded that there are no established criteria or principles, from a learners' perspective, that set out goals for the delivery and evaluation in Canada of quality postgraduate medical education. The authors initiated the process of developing a set of principles of medical education based on residents' perspectives by compiling a list of issues and concepts that were felt to be important to creating the "ideal" postgraduate medical education system. This list of issues was divided into broad categories before presentation by the authors for Canada-wide discussion, reflection, and further refinement of concepts and issues across a nine-month period. The process eventually resulted in the final consensus-driven and iterative development of the main categories and the final principles that were adopted by the Canadian Association of Internes and Residents (CAIR). The authors present this set of principles and propose that they be used as a template to guide postgraduate medical education and against which changes to the system can be evaluated. CAIR will use these principles in a number of ways, including evaluation, education, and quality assurance.

  5. Improving Patient Safety Event Reporting Among Residents and Teaching Faculty.

    Science.gov (United States)

    Louis, Michelle Y; Hussain, Lala R; Dhanraj, David N; Khan, Bilal S; Jung, Steven R; Quiles, Wendy R; Stephens, Lorraine A; Broering, Mark J; Schrand, Kevin V; Klarquist, Lori J

    2016-01-01

    sustainability include (1) developing patient safety faculty and resident experts in each training program to teach patient safety and to be role models, (2) working toward decreasing the barriers to reporting, and (3) providing timely feedback and system changes.

  6. THE REVIEW ON LEAN CONSTRUCTION AN EFFECTIVE APPROACH IN CONSTRUCTION INDUSTRY

    OpenAIRE

    S. Dinesh; R. Sethuraman; Shruthi Sivaprakasam

    2017-01-01

    Lean construction is a new management involved in making a theory which has the capacity to develop advanced and original changes in the construction industry. The principle of lean construction focuses on material and waste minimization which is contributing to sustainable construction. Lean construction enhances the productivity. The main objective of this paper is to draw a special attention to review on literature. Researchers have used pertaining methods for examining reimbursement of le...

  7. Long-Term Care Resident Outcomes Following a Natural Disaster

    Science.gov (United States)

    Cacchione, Pamela Z.; Willoughby, Lisa M.; Langan, Joanne C.; Culp, Kennith

    2015-01-01

    This report describes the outcomes of 17 long-term care residents who were participating in a nursing intervention study. The residents were evacuated for 5 days due to a severe summer storm that caused widespread power outages. These residents were seen the day of the storm and three times per week for 2 weeks following their return to the nursing home. More than half of the participants had significant changes in their NEECHAM Confusion Scale scores (n = 11) and modified Confusion Assessment Method scores (n = 9) scores, suggesting the onset of delirium. Two participants were hospitalized within the 2 weeks of the evacuation. One participant died unexpectedly. This report provides a rare look into the negative effects of a short-term evacuation due to a natural disaster. PMID:21634311

  8. Nursing Home Resident Symptomatology Triggering Transfer: Avoiding Unnecessary Hospitalizations

    Directory of Open Access Journals (Sweden)

    Alyce S. Ashcraft

    2012-01-01

    Full Text Available The purpose of this study was to describe nursing home resident symptomatology and medical diagnoses associated with nursing home to hospital transfers. A retrospective chart review of documented transfers was conducted at a 120-bed, nonprofit urban Continuing Care Retirement Center nursing home facility located in the southwestern United States. The transferred residents (n=101 had seventy different medical diagnoses prior to hospital transfer with hypertension, coronary artery disease, and congestive heart failure most frequently reported. Most frequently reported symptomatology included fatigue, lethargy or weakness, shortness of breath, and change in level of consciousness. Multiple symptomatology was indicative of a wide variety of medical diagnoses. The diagnoses and symptomatology recorded in this paper identify the importance of strategic planning concerning assessment and communication of common nursing home resident symptomatology and the importance of basic nursing and diagnostic procedures for prevention of potentially avoidable hospitalizations.

  9. Construction completion report

    International Nuclear Information System (INIS)

    1990-01-01

    This Construction Completion Report documents the major construction projects at the Waste Isolation Pilot Plant (WIPP) site and related information on contracts, schedules, and other areas which affected construction. This report is not intended to be an exhaustive detailed analysis of construction, but is a general overview and summary of the WIPP construction. 10 refs., 29 figs

  10. 2003 survey of Canadian radiation oncology residents

    International Nuclear Information System (INIS)

    Yee, Don; Fairchild, Alysa; Keyes, Mira; Butler, Jim; Dundas, George

    2005-01-01

    Purpose: Radiation oncology's popularity as a career in Canada has surged in the past 5 years. Consequently, resident numbers in Canadian radiation oncology residencies are at all-time highs. This study aimed to survey Canadian radiation oncology residents about their opinions of their specialty and training experiences. Methods and Materials: Residents of Canadian radiation oncology residencies that enroll trainees through the Canadian Resident Matching Service were identified from a national database. Residents were mailed an anonymous survey. Results: Eight of 101 (7.9%) potential respondents were foreign funded. Fifty-two of 101 (51.5%) residents responded. A strong record of graduating its residents was the most important factor residents considered when choosing programs. Satisfaction with their program was expressed by 92.3% of respondents, and 94.3% expressed satisfaction with their specialty. Respondents planning to practice in Canada totaled 80.8%, and 76.9% plan to have academic careers. Respondents identified job availability and receiving adequate teaching from preceptors during residency as their most important concerns. Conclusions: Though most respondents are satisfied with their programs and specialty, job availability and adequate teaching are concerns. In the future, limited time and resources and the continued popularity of radiation oncology as a career will magnify the challenge of training competent radiation oncologists in Canada

  11. Operative Landscape at Canadian Neurosurgery Residency Programs.

    Science.gov (United States)

    Tso, Michael K; Dakson, Ayoub; Ahmed, Syed Uzair; Bigder, Mark; Elliott, Cameron; Guha, Daipayan; Iorio-Morin, Christian; Kameda-Smith, Michelle; Lavergne, Pascal; Makarenko, Serge; Taccone, Michael S; Wang, Bill; Winkler-Schwartz, Alexander; Sankar, Tejas; Christie, Sean D

    2017-07-01

    Background Currently, the literature lacks reliable data regarding operative case volumes at Canadian neurosurgery residency programs. Our objective was to provide a snapshot of the operative landscape in Canadian neurosurgical training using the trainee-led Canadian Neurosurgery Research Collaborative. Anonymized administrative operative data were gathered from each neurosurgery residency program from January 1, 2014, to December 31, 2014. Procedures were broadly classified into cranial, spine, peripheral nerve, and miscellaneous procedures. A number of prespecified subspecialty procedures were recorded. We defined the resident case index as the ratio of the total number of operations to the total number of neurosurgery residents in that program. Resident number included both Canadian medical and international medical graduates, and included residents on the neurosurgery service, off-service, or on leave for research or other personal reasons. Overall, there was an average of 1845 operative cases per neurosurgery residency program. The mean numbers of cranial, spine, peripheral nerve, and miscellaneous procedures were 725, 466, 48, and 193, respectively. The nationwide mean resident case indices for cranial, spine, peripheral nerve, and total procedures were 90, 58, 5, and 196, respectively. There was some variation in the resident case indices for specific subspecialty procedures, with some training programs not performing carotid endarterectomy or endoscopic transsphenoidal procedures. This study presents the breadth of neurosurgical training within Canadian neurosurgery residency programs. These results may help inform the implementation of neurosurgery training as the Royal College of Physicians and Surgeons residency training transitions to a competence-by-design curriculum.

  12. 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.

  13. Advancing resident assessment in graduate medical education.

    Science.gov (United States)

    Swing, Susan R; Clyman, Stephen G; Holmboe, Eric S; Williams, Reed G

    2009-12-01

    The Outcome Project requires high-quality assessment approaches to provide reliable and valid judgments of the attainment of competencies deemed important for physician practice. The Accreditation Council for Graduate Medical Education (ACGME) convened the Advisory Committee on Educational Outcome Assessment in 2007-2008 to identify high-quality assessment methods. The assessments selected by this body would form a core set that could be used by all programs in a specialty to assess resident performance and enable initial steps toward establishing national specialty databases of program performance. The committee identified a small set of methods for provisional use and further evaluation. It also developed frameworks and processes to support the ongoing evaluation of methods and the longer-term enhancement of assessment in graduate medical education. The committee constructed a set of standards, a methodology for applying the standards, and grading rules for their review of assessment method quality. It developed a simple report card for displaying grades on each standard and an overall grade for each method reviewed. It also described an assessment system of factors that influence assessment quality. The committee proposed a coordinated, national-level infrastructure to support enhancements to assessment, including method development and assessor training. It recommended the establishment of a new assessment review group to continue its work of evaluating assessment methods. The committee delivered a report summarizing its activities and 5 related recommendations for implementation to the ACGME Board in September 2008.

  14. Resident-Led Palliative Care Education Project.

    Science.gov (United States)

    Karlen, Naomi; Cruz, Brian; Leigh, A E

    2016-04-01

    Despite the growth of palliative medicine, 39% of hospitals do not have palliative care teams for consultation or to provide resident education. We examined the impact of resident-led education in palliative care principles on attitudes toward and comfort with palliative medicine and end-of-life care among internal medicine residents. An educational module designed by the authors was presented to other internal medicine residents in the program. Pre- and post-intervention survey data measuring residents' agreement with various statements regarding palliative medicine and end-of-life care were analyzed. Residents' agreement with various statements regarding palliative medicine and end-of-life care on a 5-point Likert scale was analyzed. Following the intervention, participants reported improved comfort with general knowledge of palliative medicine (p palliative care and end-of-life care (p curriculum in palliative medicine can improve resident comfort within this still-under-represented area of medicine.

  15. A Qualitative Analysis of Attending Physicians' Use of Shared Decision-Making: Implications for Resident Education.

    Science.gov (United States)

    Schoenfeld, Elizabeth M; Goff, Sarah L; Elia, Tala R; Khordipour, Errel R; Poronsky, Kye E; Nault, Kelly A; Lindenauer, Peter K; Mazor, Kathleen M

    2018-02-01

    Physicians need to rapidly and effectively facilitate patient-centered, shared decision-making (SDM) conversations, but little is known about how residents or attending physicians acquire this skill. We explored emergency medicine (EM) attending physicians' use of SDM in the context of their experience as former residents and current educators and assessed the implications of these findings on learning opportunities for residents. We used semistructured interviews with a purposeful sample of EM physicians. Interviews were transcribed verbatim, and 3 research team members performed iterative, open coding of transcripts, building a provisional codebook as work progressed. We analyzed the data with a focus on participants' acquisition and use of skills required for SDM and their use of SDM in the context of resident education. Fifteen EM physicians from academic and community practices were interviewed. All reported using SDM techniques to some degree. Multiple themes noted had negative implications for resident acquisition of this skill: (1) the complex relationships among patients, residents, and attending physicians; (2) residents' skill levels; (3) the setting of busy emergency departments; and (4) individual attending factors. One theme was noted to facilitate resident education: the changing culture-with a cultural shift toward patient-centered care. A constellation of factors may diminish opportunities for residents to acquire and practice SDM skills. Further research should explore residents' perspectives, address the modifiable obstacles identified, and examine whether these issues generalize to other specialties.

  16. Serum levels of RBP4 and adipose tissue levels of PTP1B are increased in obese men resident in northeast Scotland without associated changes in ER stress response genes

    Directory of Open Access Journals (Sweden)

    Hoggard N

    2012-05-01

    Full Text Available Nigel Hoggard1, Abdelali Agouni2, Nimesh Mody2, Mirela Delibegovic21Rowett Institute of Nutrition and Health, 2Integrative Physiology, University of Aberdeen, Aberdeen, UKBackground: Retinol-binding protein 4 (RBP4 is an adipokine identified as a marker of insulin resistance in mice and humans. Protein tyrosine phosphatase 1B (PTP1B expression levels as well as other genes involved in the endoplasmic reticulum (ER stress response are increased in adipose tissue of obese, high-fat-diet-fed mice. In this study we investigated if serum and/or adipose tissue RBP4 protein levels and expression levels of PTP1B and other ER stress-response genes are altered in obese and obese/diabetic men resident in northeast Scotland.Methods: We studied three groups of male volunteers: (1 normal/overweight (body mass index [BMI] < 30, (2 obese (BMI > 30, and (3 obese/diabetic (BMI > 30 controlling their diabetes either by diet or the antidiabetic drug metformin. We analyzed their serum and adipose tissue RBP4 protein levels as well as adipose tissue mRNA expression of PTP1B, binding immunoglobulin protein (BIP, activated transcription factor 4 (ATF4, and glucose-regulated protein 94 (GRP94 alongside other markers of adiposity (percentage body fat, leptin, cholesterol, triglycerides and insulin resistance (oral glucose tolerance tests, insulin, homeostatic model assessment–insulin resistance, C-reactive protein, and adiponectin.Results: We found that obese Scottish subjects had significantly higher serum RBP4 protein levels in comparison to the normal/overweight subjects (P < 0.01. Serum RBP4 levels were normalized in obese/diabetic subjects treated with diet or metformin (P < 0.05. Adipose tissue RBP4 protein levels were comparable between all three groups of subjects as were serum and adipose transthyretin levels. Adipose tissue PTP1B mRNA levels were increased in obese subjects in comparison to normal/overweight subjects (P < 0.05; however diet and/or metformin

  17. Paleoreconstruction of organic carbon inputs to an oxbow lake in the Mississippi River watershed: Effects of dam construction and land use change on regional inputs

    Science.gov (United States)

    Bianchi, Thomas S.; Galy, Valier; Rosenheim, Brad E.; Shields, Michael; Cui, Xingqian; Van Metre, Peter

    2015-10-01

    We use a dated sediment core from Lake Whittington (USA) in the lower Mississippi River to reconstruct linkages in the carbon cycling and fluvial sediment dynamics over the past 80 years. Organic carbon (OC) sources were characterized using bulk (δ13C, ramped pyrolysis-oxidation (PyrOx) 14C, δ15N, and TN:OC ratios) and compound-specific (lignin phenols and fatty acids, including δ13C and 14C of the fatty acids) analyses. Damming of the Missouri River in the 1950s, other hydrological modifications to the river, and soil conservation measures resulted in reduced net OC export, in spite of increasing OC concentrations. Decreasing δ13C values coincided with increases in δ15N, TN:OC ratios, long-chain fatty acids, and lignin-phenol concentrations, suggesting increased inputs of soil-derived OC dominated by C3 vegetation, mainly resulting from changes in farming practices and crop distribution. However, ramped PyrOx 14C showed no discernible differences downcore in thermochemical stability, indicating a limited impact on soil OC turnover.

  18. Paleoreconstruction of organic carbon inputs to an oxbow lake in the Mississippi River watershed: Effects of dam construction and land use change on regional inputs

    Science.gov (United States)

    Bianchi, Thomas S.; Galy, Valier; Rosenheim, Brad E.; Shields, Michael; Cui, Xingquan; Van Metre, Peter C.

    2015-01-01

    We use a dated sediment core from Lake Whittington (USA) in the lower Mississippi River to reconstruct linkages in the carbon cycling and fluvial sediment dynamics over the past 80 years. Organic carbon (OC) sources were characterized using bulk (δ13C, ramped pyrolysis-oxidation (PyrOx) 14C, δ15N, and TN:OC ratios) and compound-specific (lignin phenols and fatty acids, including δ13C and 14C of the fatty acids) analyses. Damming of the Missouri River in the 1950s, other hydrological modifications to the river, and soil conservation measures resulted in reduced net OC export, in spite of increasing OC concentrations. Decreasing δ13C values coincided with increases in δ15N, TN:OC ratios, long-chain fatty acids, and lignin-phenol concentrations, suggesting increased inputs of soil-derived OC dominated by C3 vegetation, mainly resulting from changes in farming practices and crop distribution. However, ramped PyrOx 14C showed no discernible differences downcore in thermochemical stability, indicating a limited impact on soil OC turnover.

  19. The effect of limiting residents' work hours on their surgical training: a Canadian perspective.

    Science.gov (United States)

    Romanchuk, Ken

    2004-05-01

    Restrictions in residents' work hours have been in place in Canada for roughly a decade, having been negotiated rather than imposed. The changes in residents' schedules that resulted are roughly equivalent to the limitation of 80 duty hours per week in the United States. When work-hours restrictions began, surgery faculty were worried that residents' experience would be compromised. But these fears have not materialized. Why? The author maintains there are many reasons. (1) Most surgical procedures are now faster, and lengthy inpatient care has diminished, all of which saves time. (2) Formerly difficult or risky procedures are now performed more frequently and safely, which increases residents' education about difficult conditions. (3) A variety of resources (e.g., skills-transfer courses, surgical simulators, etc.) are now available for residents to learn and evolve surgical techniques, and residents take advantage of these resources, being highly motivated to learn the best in the time available to them. (4) There have been positive changes in residents' education that have helped them become more efficient learners than before, with improved resources and skills for faster access to information. The author maintains that in his present surgery residency program, the residents still work extremely hard but are more protected from the unending demands for patient care. They have more time for orderly study and greater opportunities to develop skills other than technical ones. They are in a happier work setting, which the author strongly believes facilitates improved patient care.

  20. Construct Validity of Medical Clinical Competence Measures: A Multitrait-Multimethod Matrix Study Using Confirmatory Factor Analysis.

    Science.gov (United States)

    Forsythe, George B.; And Others

    1986-01-01

    Construct validity was investigated for three tests of clinical competence in medicine: National Board of Medical Examiners examination (NBME), California Psychological Inventory (CPI), and Resident Evaluation Form (REF). Scores from 166 residents were analyzed. Results suggested low construct validity for CPI and REF scales, and moderate…