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 Yet studies of such topics as community, home, migration, and tourism remain infused with outdated assumptions of a geographically rooted subject.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. Changes in medicine: residency

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2011-07-01

    Full Text Available No abstract available. Article truncated at 150 words. The most important time in a physician’s educational development is residency, especially the first year. However, residency work and responsibility have come under the scrutiny of a host of agencies and bureaucracies, and therefore, is rapidly changing. Most important in the alphabet soup of regulatory agencies is the Accreditation Council for Graduate Medical Education (ACGME which accredits residencies and ultimately makes the governing rules.Resident work hours have received much attention and are clearly decreasing. However, the decline in work hours began in the 1970’s before the present political push to decrease work hours. The residency I entered in 1976 had every third night call during the first year resident’s 6-9 months on general medicine or wards. It had changed from every other night the year before. On wards, we normally were in the hospital for our 24 hours of call and followed this with a 10-12 hour day before …

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

    OpenAIRE

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

    2017-01-01

    Purpose 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. Method The authors used a constructivist grounded theory approach. In 2012–2014, they conducted semistructured interviews with a purposive and theoretical sample of 1...

  4. 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.

  5. 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.

  6. 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,

  7. [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.

  8. Changes in communication skills of clinical residents through psychiatric training.

    Science.gov (United States)

    Yutani, Motoki; Takahashi, Megumi; Miyaoka, Hitoshi

    2011-10-01

    The objective of this study was to clarify whether the communication skills (CS) of clinical residents change before and after psychiatric training and, if so, what factors are related to the change. The 44 clinical residents who agreed to participate in this study were provided with an originally developed self-accomplished questionnaire survey on CS (communication skills questionnaire [CSQ]) and a generally used questionnaire on self-esteem, anxiety, and depressive mood considered to be related to CS at the start and end of a 2-month psychiatric training session. Statistical analysis was conducted for the 34 residents who completed both questionnaires. The CSQ score (t[32]: -2.17, P self-esteem and negatively with anxiety and depressive tendency. The amount of change in assertive CS score showed a weakly positive correlation with self-esteem. The results suggested that CS, including assertive CS and cooperative CS, were improved by the psychiatric training. Increasing self-esteem and reducing the tendency toward depression and anxiety are considered to be useful for further improving CS. © 2011 The Authors. Psychiatry and Clinical Neurosciences © 2011 Japanese Society of Psychiatry and Neurology.

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

    Directory of Open Access Journals (Sweden)

    Iliashenko Oksana

    2018-01-01

    Full Text Available 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.

  10. 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.

  11. Change and predictors of change in social skills of nursing home residents with dementia.

    Science.gov (United States)

    Chappell, Neena L; Kadlec, Helena; Reid, Colin

    2014-02-01

    Social skills are of primary importance for those with dementia and their care providers, yet we know little about the extent to which basic social skills can be maintained over time and the predictors of change. A total of 18 nursing homes with 149 newly admitted residents with moderate to severe dementia, 195 direct care staff, and 135 family members, in British Columbia, Canada, contributed data on change in social skills from admission to 6 months and 1 year later. Three-quarters of residents maintained or improved their basic social skills during both the time periods. Decline was explained primarily by cognitive status at the time of admission, notably present orientation. However, staff-to-resident communication becomes more important over time. Social skills appear to present an opportunity to maintain interaction with these residents. The findings also suggest that a focus on the present orientation before and following admission and on staff-to-resident communication may be beneficial.

  12. 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...... for mobility inducing policies are especially found through the housing market parameters....

  13. 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...

  14. [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.

  15. 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)

  16. 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)

  17. 31 CFR 215.9 - Change of legal residence by members of the Armed Forces.

    Science.gov (United States)

    2010-07-01

    ... legal residence. The notification shall include the name, social security number, current mailing... 31 Money and Finance: Treasury 2 2010-07-01 2010-07-01 false Change of legal residence by members... Withholding Agreement § 215.9 Change of legal residence by members of the Armed Forces. (a) In determining the...

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

    International Nuclear Information System (INIS)

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

    1992-01-01

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

  19. [The possibility of provision of hygienically safe residing for the population in residential construction located closely to air transport enterprises].

    Science.gov (United States)

    Gildenskiold, R S; Tatyanyuk, T K; Savelyev, S I; Rekis, V K

    Operation of the modern heavy aircraft on the surrounding vast territory is associated with the appearance of high levels of sound pressure generated by the powerful engines, especially during takeoff and landing operations. Currently, the elimination or significant reduction of noise pollution on the environment technically does not yet have a radical solution and the possible reduction of the impact ofnoise pollution on the residents ofnearby settlements is achievedfor residents of building by the optimal location of the runway, changing in conditions for the takeoff and landing of aircrafts, the ordering of the regimen of the airport, the introduction of the package sufficiently effective anti-noise diverse - engineering, planning activities, in some cases, the creation ofprotective noise shield on the border of the residential area and the construction ofprotective awnings over the children’s and sports fields with fencing shields converted in the direction of the runway. An example of a positive decision, taking into account the complexity and variety of aspects of the problem, it is possible to consider the development of the project plan of the new microdistrict «Eletsky» in the Soviet district of the city of Lipetsk, falling under the impact of aircraft noise of plying aircrafts of the military airfield.

  20. Changes in the number of resident publications after inception of the 80-hour work week.

    Science.gov (United States)

    Namdari, Surena; Baldwin, Keith D; Weinraub, Barbara; Mehta, Samir

    2010-08-01

    Since the inception of resident work-hour regulations, there has been considerable concern regarding the influence of decreased work hours on graduate medical education. In particular, it is unclear whether implementation of work-hour restrictions has influenced resident academic performance as defined by quantity of peer-reviewed publications while participating in graduate medical education. We determined the impact of work-hour changes on resident involvement in the number of published clinical studies, laboratory research, case reports, and review articles. We conducted a PubMed literature search of 139 consecutive orthopaedic surgery residents (789 total resident-years) at one institution from academic years 1995-1996 to 2008-2009. This represented a continuous timeline before and after implementation of work-hour restrictions. The number of resident publications before and after implementation of work-hour changes was compared. There was a greater probability of peer review authorship in any given resident-year after work-hour changes than before. Average publications per resident-year increased for total articles, clinical articles, case reports, and reviews. There was an increased rate of publications in which the resident was the first author. Since implementation of work-hour changes, total resident publications and publications per resident-year have increased.

  1. 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.

  2. Changes in the construction of reactors

    International Nuclear Information System (INIS)

    Le Ngoc, B.

    2016-01-01

    In order to better manage the design and construction phases of the new reactors, nuclear companies like AREVA are changing the way they work. They want more flexibility in contractual relationships and a better integration of all the enterprises involved in the same project. New tools like virtual and enhanced reality, 3-dimensional simulations are entering design offices to favor creativity, to spare time and to win efficiency. The integration of the enterprises will be made through a better communication between them and the common share of digital tools and databases, and the replacement of paper documents by electronic records. The share of the information between all the players will be made real-time. The work in the offices will be organized and managed differently, short meetings will be favored to detect any problem looming and to make any people more concerned by the project. This kind of project management has been applied to the Astrid (a 4. generation reactor) project successfully since the milestones of the project have been respected so far. It is currently applied to the EPR-NM project which is the simplification and optimisation of the design of future EPR reactors. (A.C.)

  3. Intrinsic Changes: Energy Saving Behaviour among Resident University Students

    Science.gov (United States)

    Black, Rosemary; Davidson, Penny; Retra, Karen

    2010-01-01

    This paper presents the results of a study that explored the effectiveness of three intervention strategies in facilitating energy saving behaviour among resident undergraduate university students. In contrast to a dominant practice of motivating with rewards or competition this study sought to appeal to students' intrinsic motivations. An…

  4. 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…

  5. 78 FR 49782 - Interim Staff Guidance on Changes During Construction

    Science.gov (United States)

    2013-08-15

    ... Construction AGENCY: Nuclear Regulatory Commission. ACTION: Draft interim staff guidance; request for comment... During Construction.'' This ISG provides guidance to the NRC staff on the Preliminary Amendment Request...-ISG-025 ``Interim Staff Guidance on Changes during Construction under 10 CFR Part 52'' is available...

  6. Empathy, Sense of Power, and Personality: Do They Change During Pediatric Residency?

    Science.gov (United States)

    Greenberg, Larrie; Agrawal, Dewesh; Toto, Regina; Blatt, Benjamin

    2015-08-01

    Empathy is a critical competency in medicine. Prior studies demonstrate a longitudinal decrease in empathy during residency; however, they have not included pediatric residents. The relations among the expression of empathy, sense of power (ability to influence other's behavior), and personality traits in residents also have not been addressed. Lastly, there are no data on how residents compare with the general nonmedical population in their expression of empathy. The purposes of our study were to assess whether empathy, sense of power, and personality type were statistically correlated; if resident empathy declines over time; and how resident empathy compares with that of nonmedical peers. In 2010, a cohort of individuals entering pediatric residency were given three validated survey instruments at the beginning of their first and third years of training to explore longitudinal changes in empathy, sense of power, and major personality traits. We found no decrease in resident empathy in 2 years of pediatric training, no changes in their sense of power, and no statistically significant correlation between empathetic tendencies and sense of power. When compared with the general nonmedical population, pediatric residents rated themselves higher in empathy. As expected, the two components of empathy (empathic concern and perspective taking) were moderately correlated. Of the major personality traits, only agreeableness showed significant correlation with empathy. Pediatric resident empathy did not decrease longitudinally, unlike studies in other residents. There was no inverse relation between self-perceptions of sense of power and empathy as is present in the business literature. Finally, pediatric resident empathy was significantly higher when compared with a general nonmedical population.

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

    Science.gov (United States)

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

    2018-04-14

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

  8. Staging constructions of authenticity in organizational change

    DEFF Research Database (Denmark)

    Dupret, Katia

    2018-01-01

    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...... 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...

  9. The role of leaders' paradigm in construction industry change

    NARCIS (Netherlands)

    Pries, Frens; Doree, Andries G.; van der Veen, Bas; van der Veen, Bas; Vrijhoef, Ruben

    2004-01-01

    As in other industries, firms in the construction industry need to become more client- and market-oriented. In the last decade, several initiatives have been taken to change the construction industry in that direction. The changes, however, seem to be slower than other industries and less

  10. 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

  11. Seasonal change of residence time in spring water and groundwater at a mountainous headwater catchment

    Science.gov (United States)

    Nagano, Kosuke; Tsujimura, Maki; Onda, Yuichi; Iwagami, Sho; Sakakibara, Koichi; Sato, Yutaro

    2017-04-01

    Determination of water age in headwater is important to consider water pathway, source and storage in the catchment. Previous studies showed that groundwater residence time changes seasonally. These studies reported that mean residence time of water in dry season tends to be longer than that in rainy season, and it becomes shorter as precipitation and discharge amount increases. However, there are few studies to clarify factors causing seasonal change in mean residence time in spring water and groundwater based on observed data. Therefore, this study aims to reveal the relationship between mean residence time and groundwater flow system using SFconcentration in spring and 10 minutes interval hydrological data such as discharge volume, groundwater level and precipitation amount in a headwater catchment in Fukushima, Japan. The SF6 concentration data in spring water observed from April 2015 to November 2016 shows the mean residence time of springs ranged from zero to 14 years. We also observed a clear negative correlation between discharge rate and residence time in the spring. The residence time in shallow groundwater in rainy season was younger as compared with that in low rainfall period. Therefore, the shallow groundwater with young residence time seems to contribute to the spring in rainy season, causing shorter residence time. Additionally, the residence time of groundwater ranged from 3 to 5 years even in low rainfall period. The residence time in high groundwater table level in ridge was older as compared with that in low groundwater table level. These suggest that the contribution of groundwater with older age in the ridge becomes dominant in the low discharge.

  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. Constructing Legitimacy for Climate Change Planning

    DEFF Research Database (Denmark)

    Cashmore, Matthew Asa; Wejs, Anja

    2014-01-01

    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......Within the literature, climate change mitigation and adaptation at the local level is in- creasingly portrayed as a new, discrete field of spatial planning research and practice. This article examines in detail the situated institutionalisation of this emerging field in local government...... 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...

  15. 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.

  16. 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.

  17. 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

    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 nursing home residents' personal dignity changes over the course of time, and what contributes to this. A longitudinal qualitative study. 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. 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. 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.

  18. 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.

  19. 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...

  20. [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.

  1. "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.

  2. 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)

  3. 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...

  4. Soil Carbon Residence Time in the Arctic - Potential Drivers of Past and Future Change

    Science.gov (United States)

    Huntzinger, D. N.; Fisher, J.; Schwalm, C. R.; Hayes, D. J.; Stofferahn, E.; Hantson, W.; Schaefer, K. M.; Fang, Y.; Michalak, A. M.; Wei, Y.

    2017-12-01

    Carbon residence time is one of the most important factors controlling carbon cycling in ecosystems. Residence time depends on carbon allocation and conversion among various carbon pools and the rate of organic matter decomposition; all of which rely on environmental conditions, primarily temperature and soil moisture. As a result, residence time is an emergent property of models and a strong determinant of terrestrial carbon storage capacity. However, residence time is poorly constrained in process-based models due, in part, to the lack of data with which to benchmark global-scale models in order to guide model improvements and, ultimately, reduce uncertainty in model projections. Here we focus on improving the understanding of the drivers to observed and simulated carbon residence time in the Arctic-Boreal region (ABR). Carbon-cycling in the ABR represents one of the largest sources of uncertainty in historical and future projections of land-atmosphere carbon dynamics. This uncertainty is depicted in the large spread of terrestrial biospheric model (TBM) estimates of carbon flux and ecosystem carbon pool size in this region. Recent efforts, such as the Arctic-Boreal Vulnerability Experiment (ABoVE), have increased the availability of spatially explicit in-situ and remotely sensed carbon and ecosystem focused data products in the ABR. Together with simulations from Multi-scale Synthesis and Terrestrial Model Intercomparison Project (MsTMIP), we use these observations to evaluate the ability of models to capture soil carbon stocks and changes in the ABR. Specifically, we compare simulated versus observed soil carbon residence times in order to evaluate the functional response and sensitivity of modeled soil carbon stocks to changes in key environmental drivers. Understanding how simulated carbon residence time compares with observations and what drives these differences is critical for improving projections of changing carbon dynamics in the ABR and globally.

  5. Changes in nutrition among residents and refugees in Sarajevo during the war.

    Science.gov (United States)

    Smaijkic, A; Zec, S; Telebak, B; Filipovic-Hadziomeragic, A

    1995-10-01

    To assess how food shortage has been reflected in changes in nutritional status and dietary intake of resident and refugee populations in wartime Sarajevo. Longitudinal observations were carried out on residents (who stayed in their homes) and refugees (living in collective centres). Three out of four municipal areas of Sarajevo were covered in the sample and households and collective centres in close proximity to the homes of fieldworkers were selected. The same households were visited in October 1992-March 1993 and November 1993-January 1994. The study took place in besieged Sarajevo. In the first round 362 households (170 resident and 192 refugee) were visited and in the second round 324 households (146 resident and 178 refugee) were visited. Nutritional information was gathered through anthropometric measurements, medical examination and questionnaires which included a seven day dietary recall. Nutritional status was assessed by calculating body mass index (BMI) (weight/height2) in adults and weight for age percentiles in children (2-18 years of age). Undernutrition in adults was defined as BMI war which is deficient both in quantity and quality. Nevertheless the nutritional status of the resident and refugee populations has been maintained. Dietary intake was found to be low but this may have been partly due to under-reporting. The accuracy of data obtained through dietary intake surveys in emergency conditions may be questionable.

  6. Building for a Changing Climate - Adaptation through planning and construction

    Energy Technology Data Exchange (ETDEWEB)

    2009-08-15

    Adaptation through planning and construction can help to reduce the negative effects of climate change, such as flooding, landslides, landslips, and erosion. The National Board of Housing, Building and Planning (Boverket) has conducted an analysis of how the Planning and Building Act can assist in the work towards climate change adaptation. This brochure provides guidance and support to for example property owners, developers, officials and decision makers in municipalities and the state

  7. 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 ...

  8. 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.)

  9. [Preference Changes Regarding Future Work Area and Intended Position Among German Residents after Four Years of Residency].

    Science.gov (United States)

    Ziegler, Stine; van den Bussche, Hendrik; Römer, Farina; Krause-Solberg, Lea; Scherer, Martin

    2017-06-01

    Introduction  We investigated the preferences of medical residents in Germany with regard to future working place (hospital or private practice) and position (employment/self-employment in private practice; resp. specialist/senior or chief physician in the hospital). This is analysed in a gender comparative perspective, including the influence of parenthood. Methods  Annual postal surveys among graduates of seven medical faculties in Germany from their last year ("Practical Year") until after four years of postgraduate training. The return rate at baseline was 48 % and the four surveys after reached rates from 85 % up. In all samples about two thirds were women, which corresponds to the actual gender differentiation in under- and postgraduate training. Descriptive statistics and regression analyses were performed. Results  Compared to private practice the hospital is clearly preferred, although the attraction of hospital jobs decreased over the years. The decision for or against the hospital is connected to the discipline. Working in private practice is seen as possibility for part time work. Men prefer self-employment whereas women prefer to work under an employment contract. In the hospital, male doctors prefer to work in leading positions. Those positions are associated with full-time work. Leadership training especially takes place in university hospitals. Discussion  Three trends are recognized: Reluctance against leading positions, growing interest for part time work and rising popularity of work as an employee in private practice. Those trends can be understood as a rejection of traditional professional role models. The realization of these preferences is easily feasible because of the current labour market situation. Therefore, emerging problems have to be faced in another way. A change of gender-typical role models was rarely detected. © Georg Thieme Verlag KG Stuttgart · New York.

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

    Directory of Open Access Journals (Sweden)

    Johanna Martinez

    2013-09-01

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

  11. 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.

  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. 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

  14. 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.

  15. 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.

  16. 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

  17. 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

  18. 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

  19. 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

  20. 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.

  1. Changes in Resident Well-Being at One Institution Across a Decade of Progressive Work Hours Limitations.

    Science.gov (United States)

    Krug, Michael F; Golob, Anna L; Wander, Pandora L; Wipf, Joyce E

    2017-10-01

    To measure changes in markers of resident well-being over time as progressive work hours limitations (WHLs) were enforced, and to investigate resident perceptions of the 2011 WHLs. A survey study of internal medicine residents was conducted at the University of Washington's multihospital residency program in 2012. The survey included validated well-being questions: the Maslach Burnout Inventory, the two-question PRIME-MD depression screen, and career satisfaction questions. Chi-square tests were used to compare 2012 well-being questionnaire responses against nearly identical surveys conducted in 2001 and 2004 at the same institution. In addition, residents were asked to rate the impact of WHLs on resident well-being and education as well as patient care, and to state preferences for future WHLs. Significantly different proportions of residents met burnout criteria across time, with fewer meeting criteria in 2012 than in 2001 (2001: 76% [87/115]; 2004: 64% [75/118]; 2012: 61% [68/112]; P = .039). Depression screening results also differed across time, with fewer screening positive in 2012 than in 2004 (2001: 45% [52/115]; 2004: 55% [65/118]; 2012 [35/112]: 31%; P = .001). Residents, especially seniors, reported perceived negative impacts of WHLs on their well-being, education, and patient care. Most senior residents favored reverting to the pre-July 2011 system of WHLs. Interns were more divided. Validated measures of resident well-being changed across the three time points measured. Residents had the lowest rates of burnout and depression in 2012. Resident perceptions of the 2011 WHLs, however, were generally negative.

  2. 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.

  3. Construction of a Urologic Robotic Surgery Training Curriculum: How Many Simulator Sessions Are Required for Residents to Achieve Proficiency?

    Science.gov (United States)

    Wiener, Scott; Haddock, Peter; Shichman, Steven; Dorin, Ryan

    2015-11-01

    To define the time needed by urology residents to attain proficiency in computer-aided robotic surgery to aid in the refinement of a robotic surgery simulation curriculum. We undertook a retrospective review of robotic skills training data acquired during January 2012 to December 2014 from junior (postgraduate year [PGY] 2-3) and senior (PGY4-5) urology residents using the da Vinci Skills Simulator. We determined the number of training sessions attended and the level of proficiency achieved by junior and senior residents in attempting 11 basic or 6 advanced tasks, respectively. Junior residents successfully completed 9.9 ± 1.8 tasks, with 62.5% completing all 11 basic tasks. The maximal cumulative success rate of junior residents completing basic tasks was 89.8%, which was achieved within 7.0 ± 1.5 hours of training. Of senior residents, 75% successfully completed all six advanced tasks. Senior residents attended 6.3 ± 3.5 hours of training during which 5.1 ± 1.6 tasks were completed. The maximal cumulative success rate of senior residents completing advanced tasks was 85.4%. When designing and implementing an effective robotic surgical training curriculum, an allocation of 10 hours of training may be optimal to allow junior and senior residents to achieve an acceptable level of surgical proficiency in basic and advanced robotic surgical skills, respectively. These data help guide the design and scheduling of a residents training curriculum within the time constraints of a resident's workload.

  4. Changing stream of power. Hydropower and local residents along the Kemi River; Valtavirta muutoksessa. Vesivoima ja paikalliset asukkaat Kemijoella

    Energy Technology Data Exchange (ETDEWEB)

    Autti, O.

    2013-11-01

    The construction of human-controlled watercourses to meet the need for hydroelectric power has substantially changed freshwater ecosystems, as well as the cultural dynamics of local communities along the Kemi River. At the moment there are 21 hydropower plants in the Kemi River basin, and further building is still topical. The construction of hydropower plants gave benefits but it also caused damages to the people living along the Kemi River. It was a deathblow to salmon migration. The alteration of the river has radically changed the water environment, the landscape and the usage of the river environment. The processed conflicts and paid compensations are always connected to economic losses, but the river has also many other aspects and meanings from the viewpoint of a riverman. The planning and building of hydroelectric plants took place at the same time with other significant events in northern Finland. The rise of the forestry industry, the Second World War, post-war reconstruction and structural changes in society framed the electrification of northern rivers. The transformation from an agrarian society to a service and information society happened unusually fast in Finland. It involved every aspect of local people's lives, as the physical environment, local culture, social relations, means of income and the surrounding society changed in a short period of time. In my research I examine the changes caused by the electrification of the Kemi River in their temporal and spatial context. The focus is on the perspectives of local people and their personal relationships with the environment, but on the other hand also on the power relations within various actor groups. From my interview data I have identified four different adaptation strategies: compliant builders, those in denial, resigned bystanders and opposing resisters. These strategies may be found overlapping in the stories of the interviewees. Local residents have had an opportunity to realign

  5. 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.

  6. 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

  7. 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

    those patients who lived alone in their own home at pre-fracture. Implications for Rehabilitation One year after fracture, patients did not recover their previous function, and the activities most affected at the one-year follow-up were: dressing lower body, bathing/showering, transfer bathtub....../shower and walking up/down stairs. After a hip fracture, most recovery of the function happens within the first three months, though some functional activities continue recovering over the first year. Rehabilitation programs cannot be based only on mobility activities, the recovery of other daily living activities......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...

  8. 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.

  9. Innovativeness in housing construction and the role of the Housing Fund: From residence to an integral living environment

    Directory of Open Access Journals (Sweden)

    Zdravko Mlinar

    2008-01-01

    Full Text Available This article attempts to contribute to clarification of the conditions and actors impacting innovativeness in housing construction and the management of space. It concentrates on the role of the Slovenian national Housing Fund, which is too restricted and lacks appropriate legal bases and means, and also – according to some evaluations – the aspiration to assert its innovative and developmental role. The Fund is focussed on the financial-economic aspects of providing non-profit housing and housing for the market. Currently attention is primarily directed towards its legal-organizational structure and its transformation into an independent company. This neglects broader consideration of socio-spatial change, developmental directions and values in the context of the information age (Lisbon Strategy, which call for innovative sociological, architectural and urbanistic solutions. Mindsets, legal norms and institutions in Slovenia are lagging behind these changes. Thus, housing is still mainly treated as a discrete segment. In order to perform their task in this new framework, which demands more integral treatment of the everyday living environment and reintegration of living, work and recreation, the mandate of the housing funds must no longer be confined merely to housing. Several examples of innovative design as well as their limitations are presented, together with examples of good international practice.

  10. Changes in utilization of health services among poor and rural residents in Uganda: are reforms benefitting the poor?

    Science.gov (United States)

    Pariyo, George W; Ekirapa-Kiracho, Elizabeth; Okui, Olico; Rahman, Mohammed Hafizur; Peterson, Stefan; Bishai, David M; Lucas, Henry; Peters, David H

    2009-11-12

    Uganda implemented health sector reforms to make services more accessible to the population. An assessment of the likely impact of these reforms is important for informing policy. This paper describes the changes in utilization of health services that occurred among the poor and those in rural areas between 2002/3 and 2005/6 and associated factors. Secondary data analysis was done using the socio-economic component of the Uganda National Household Surveys 2002/03 and 2005/06. The poor were identified from wealth quintiles constructed using an asset based index derived from Principal Components Analysis (PCA). The probability of choice of health care provider was assessed using multinomial logistic regression and multi-level statistical models. The odds of not seeking care in 2005/6 were 1.79 times higher than in 2002/3 (OR = 1.79; 95% CI 1.65 - 1.94). The rural population experienced a 43% reduction in the risk of not seeking care because of poor geographical access (OR = 0.57; 95% CI 0.48 - 0.67). The risk of not seeking care due to high costs did not change significantly. Private for profit providers (PFP) were the major providers of services in 2002/3 and 2005/6. Using PFP as base category, respondents were more likely to have used private not for profit (PNFP) in 2005/6 than in 2002/3 (OR = 2.15; 95% CI 1.58 - 2.92), and also more likely to use public facilities in 2005/6 than 2002/3 (OR = 1.31; 95% CI 1.15 - 1.48). The most poor, females, rural residents, and those from elderly headed households were more likely to use public facilities relative to PFP. Although overall utilization of public and PNFP services by rural and poor populations had increased, PFP remained the major source of care. The odds of not seeking care due to distance decreased in rural areas but cost continued to be an important barrier to seeking health services for residents from poor, rural, and elderly headed households. Policy makers should consider targeting subsidies to the poor and

  11. Changes in utilization of health services among poor and rural residents in Uganda: are reforms benefitting the poor?

    Directory of Open Access Journals (Sweden)

    Bishai David M

    2009-11-01

    Full Text Available Abstract Background Uganda implemented health sector reforms to make services more accessible to the population. An assessment of the likely impact of these reforms is important for informing policy. This paper describes the changes in utilization of health services that occurred among the poor and those in rural areas between 2002/3 and 2005/6 and associated factors. Methods Secondary data analysis was done using the socio-economic component of the Uganda National Household Surveys 2002/03 and 2005/06. The poor were identified from wealth quintiles constructed using an asset based index derived from Principal Components Analysis (PCA. The probability of choice of health care provider was assessed using multinomial logistic regression and multi-level statistical models. Results The odds of not seeking care in 2005/6 were 1.79 times higher than in 2002/3 (OR = 1.79; 95% CI 1.65 - 1.94. The rural population experienced a 43% reduction in the risk of not seeking care because of poor geographical access (OR = 0.57; 95% CI 0.48 - 0.67. The risk of not seeking care due to high costs did not change significantly. Private for profit providers (PFP were the major providers of services in 2002/3 and 2005/6. Using PFP as base category, respondents were more likely to have used private not for profit (PNFP in 2005/6 than in 2002/3 (OR = 2.15; 95% CI 1.58 - 2.92, and also more likely to use public facilities in 2005/6 than 2002/3 (OR = 1.31; 95% CI 1.15 - 1.48. The most poor, females, rural residents, and those from elderly headed households were more likely to use public facilities relative to PFP. Conclusion Although overall utilization of public and PNFP services by rural and poor populations had increased, PFP remained the major source of care. The odds of not seeking care due to distance decreased in rural areas but cost continued to be an important barrier to seeking health services for residents from poor, rural, and elderly headed households. Policy

  12. 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

  13. 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

  14. 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...... content of constructions is organised to a great extent in paradigmatic oppositions, similar to those found in classical morphology (Nørgård-Sørensen, Heltoft & Schøsler 2011). This organisation principle implies that the semantic description must uncover the boundaries of the construction’s content...

  15. Cohort differences in dementia recognition and treatment indicators among assisted living residents in Maryland: did a change in the resident assessment tool make a difference?

    Science.gov (United States)

    Samus, Quincy M; Vavilikolanu, Amrita; Mayer, Lawrence; McNabney, Matthew; Brandt, Jason; Lyketsos, Constantine G; Rosenblatt, Adam

    2013-12-01

    There is a lack of empirical evidence about the impact of regulations on dementia care quality in assisted living (AL). We examined cohort differences in dementia recognition and treatment indicators between two cohorts of AL residents with dementia, evaluated prior to and following a dementia-related policy modification to more adequately assess memory and behavioral problems. Cross-sectional comparison of two AL resident cohorts was done (Cohort 1 [evaluated 2001-2003] and Cohort 2 [evaluated 2004-2006]) from the Maryland Assisted Living studies. Initial in-person evaluations of residents with dementia (n = 248) were performed from a random sample of 28 AL facilities in Maryland (physician examination, clinical characteristics, and staff and family recognition of dementia included). Adequacy of dementia workup and treatment was rated by an expert consensus panel. Staff recognition of dementia was better in Cohort 1 than in Cohort 2 (77% vs. 63%, p = 0.011), with no significant differences in family recognition (86% vs. 85%, p = 0.680), or complete treatment ratings (52% vs. 64%, p = 0.060). In adjusted logistic regression, cognitive impairment and neuropsychiatric symptoms correlated with staff recognition; and cognitive impairment correlated with family recognition. Increased age and cognitive impairment reduced odds of having a complete dementia workup. Odds of having complete dementia treatment was reduced by age and having more depressive symptoms. Cohort was not predictive of dementia recognition or treatment indicators in adjusted models. We noted few cohort differences in dementia care indicators after accounting for covariates, and concluded that rates of dementia recognition and treatment did not appear to change much organically following the policy modifications.

  16. Changing residents' beliefs and concerns about treating chronic noncancer pain with opioids: evaluation of a pilot workshop.

    Science.gov (United States)

    Roth, Craig S; Burgess, Diana J

    2008-10-01

    To determine if a pilot phase workshop influenced residents' beliefs and concerns about using opioids for chronic noncancer pain. Pre- and post-survey questionnaire. University residency program. Seventy-two Medicine and Medicine-Pediatrics residents. Participation in a 4-hour workshop based on adult learning theory. Residents' pre- and post-workshop concerns, feelings, and beliefs about the efficacy and safety of opioids for chronic noncancer pain (low back pain), and barriers to prescribing them (paired t-tests). On a scale of 1 = least to 10 = most, residents' concerns about addiction risk from opioids in patients with chronic noncancer pain dropped significantly (P changes were observed regarding concerns about abuse (5.61 to 3.92), side effects (4.88 to 2.88), limiting use of other treatments (5.41 to 3.60), sanctioning (State Board; 4.27 to 3.71; Legal 4.22 to 3.43), and drawing criticism from attending staff (4.50 to 2.77), with P beliefs about efficacy and safety of opioids for chronic noncancer pain increased (Pre 4.96 to Post 7.40), and they were more comfortable prescribing them (4.30 to 6.82), with P beliefs and concerns about using opioids for chronic noncancer pain changed after participating in a 4-hour interactive workshop.

  17. Duty hours for post-graduate resident doctors need for change

    Directory of Open Access Journals (Sweden)

    Sushil Kumar

    2013-01-01

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

  18. 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

  19. Changing Patterns of Glucose-Lowering Medication Use in VA Nursing Home Residents With Diabetes, 2005 to 2011.

    Science.gov (United States)

    Lee, Sei J; Stijacic-Cenzer, Irena; Barnhart, Caroline; McClymont, Keelan; Steinman, Michael A

    2015-10-01

    Although nursing home (NH) residents make up a large and growing proportion of Americans with diabetes mellitus, little is known about how glucose-lowering medications are used in this population. We sought to examine glucose-lowering medication use in Veterans Affairs (VA) NH residents with diabetes between 2005 and 2011. Retrospective cohort study, using linked laboratory, pharmacy, administrative, and NH Minimum Dataset (MDS) 2.0 databases in 123 VA NHs. A total of 9431 long-stay (>90 days) VA NH residents older than 65 followed for 52,313 person-quarters. We identified receipt of glucose-lowering medications, including insulin, metformin, sulfonylureas, thiazolidinediones, and others (alpha-glucosidase inhibitors, meglitinides, glucagonlike peptide-1 analogs, dipeptidyl peptidase-4 inhibitors and amylin analogs) per quarter. The rates of sulfonylurea use in long-stay NH residents dropped dramatically from 24% in 2005 to 12% in 2011 (P use (10% to 2%, P use in 2007 (4% to Metformin use was stable, ranging between 7% and 9% (P = .24). Insulin use increased slightly from 30% to 32% (P Use of other classes of glucose-lowering medications was stable (P = .22) and low, remaining below 1.3%. Between 2005 and 2011, there were dramatic declines in use of sulfonylureas and thiazolidinediones in VA NH residents, suggesting that prescribing practices can be quickly changed in this setting. Published by Elsevier Inc.

  20. Formalization, Conflict, and Change: Constructive and Destructive Consequences in Schools.

    Science.gov (United States)

    DiPaola, Michael F.; Hoy, Wayne K.

    2001-01-01

    Describes a typology of change drawn from conceptualizing conflict as cognitive or affective, and organizational formalization in terms of enabling or coercive procedures. The framework can predict the impact of change, from situations that catalyze and facilitate change to those that frustrate and inhibit it. Summarizes key factors for school…

  1. What Health and Aged Care Culture Change Models Mean for Residents and Their Families: A Systematic Review.

    Science.gov (United States)

    Petriwskyj, Andrea; Parker, Deborah; Brown Wilson, Christine; Gibson, Alexandra

    2016-04-01

    A range of commercialized programs are increasingly being adopted which involve broad culture change within care organizations to implement person-centered care. These claim a range of benefits for clients; however, the published evidence for client and family outcomes from culture change is inconclusive and the evidence for these specific models is difficult to identify. The purpose of this review was to identify and evaluate the peer-reviewed evidence regarding consumer outcomes for these subscription-based models. The review followed the Joanna Briggs Institute procedure. The review considered peer-reviewed literature that reported on studies conducted with health and aged care services, their staff, and consumers, addressed subscription-based person-centered culture change models, and were published in English up to and including 2015. The review identified 19 articles of sufficient quality that reported evidence relating to consumer outcomes and experience. Resident outcomes and family and resident satisfaction and experiences were mixed. Findings suggest potential benefits for some outcomes, particularly related to quality of life and psychiatric symptoms, staff engagement, and functional ability. Although residents and families identified some improvements in residents' lives, both also identified problematic aspects of the change related to staff adjustment and staff time. Outcomes for these models are at best comparable with traditional care with limited suggestions that they result in poorer outcomes and sufficient potential for benefits to warrant further investigation. Although these models may have the potential to benefit residents, the implementation of person-centered principles may affect the outcomes. © The Author 2015. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  2. 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.

  3. 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.

  4. Constructing a Shared Mental Model for Faculty Development for the Core Entrustable Professional Activities for Entering Residency.

    Science.gov (United States)

    Favreau, Michele A; Tewksbury, Linda; Lupi, Carla; Cutrer, William B; Jokela, Janet A; Yarris, Lalena M

    2017-06-01

    In 2014, the Association of American Medical Colleges identified 13 Core Entrustable Professional Activities for Entering Residency (Core EPAs), which are activities that entering residents might be expected to perform without direct supervision. This work included the creation of an interinstitutional concept group focused on faculty development efforts, as the processes and tools for teaching and assessing entrustability in undergraduate medical education (UME) are still evolving. In this article, the authors describe a conceptual framework for entrustment that they developed to better prepare all educators involved in entrustment decision making in UME. This framework applies to faculty with limited or longitudinal contact with medical students and to those who contribute to entrustment development or render summative entrustment decisions.The authors describe a shared mental model for entrustment that they developed, based on a critical synthesis of the EPA literature, to serve as a guide for UME faculty development efforts. This model includes four dimensions for Core EPA faculty development: (1) observation skills in authentic settings (workplace-based assessments), (2) coaching and feedback skills, (3) self-assessment and reflection skills, and (4) peer guidance skills developed through a community of practice. These dimensions form a conceptual foundation for meaningful faculty participation in entrustment decision making.The authors also differentiate between the UME learning environment and the graduate medical education learning environment to highlight distinct challenges and opportunities for faculty development in UME settings. They conclude with recommendations and research questions for future Core EPA faculty development efforts.

  5. 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

  6. 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.

  7. Constructing Madness. Discourse analysis of changes in the DSM

    OpenAIRE

    Böröndi, Anita

    2014-01-01

    Understandings of mental disorders have changed over time and related concepts are often contested and definitions. This project used discourse analysis to analyse how the official definition of substance related disorders have changed in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders in comparison with the previous fourth edition (APA, 2000, 2013a). In particular, the analysis focused on how the changes are presented as justified in academic discourse. Three r...

  8. 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...

  9. 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...

  10. 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

  11. 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

  12. 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

  13. A Perspective on the Effect of the 80-Hour Work Week: Has It Changed the Graduating Orthopaedic Resident?

    Science.gov (United States)

    Pellegrini, Vincent D

    2017-06-01

    Orthopaedic residency education has changed substantially in recent decades because of the imposition of the 80-hour work week, a decrease in quality and quantity of general surgical education, regulations mandating closer trainee supervision, and an expansion of orthopaedic subspecialty rotations. These factors pose a challenge in efforts to prepare competent, confident, cautious, caring, and communicative orthopaedic residents within the traditional 5-year program. Evidence suggests that contemporary graduates are more intelligent, better balanced in life and work, and more in touch with humanistic aspects of medicine than were earlier graduates. Yet insufficient competence and confidence in surgical skills after residency and a lack of "ownership" of patient care have become an increasing concern of educators and trainees. The concept of 10,000 hours of deliberate practice to achieve mastery of a technical skill applies to orthopaedic residency education. A different approach to graduate medical education must address the critical minimum training time required to achieve the necessary skills to support independent medical and surgical practice.

  14. 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

    2015-06-01

    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.

  15. 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

  16. 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.

  17. [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.

  18. 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 ...

  19. Curriculum reform for residency training: competence, change, and opportunities for leadership.

    Science.gov (United States)

    Fraser, Amy B; Stodel, Emma J; Chaput, Alan J

    2016-07-01

    Certain pressures stemming from within the medical community and from society in general, such as the need for increased accountability in resident training and restricted resident duty hours, have prompted a re-examination of methods for training physicians. Leaders in medical education in North America and around the world champion competency-based medical education (CBME) as a solution. The Department of Anesthesiology at the University of Ottawa launched Canada's first CBME program for anesthesiology residents on July 1, 2015. In this paper, we discuss the opportunities and challenges associated with CBME and delineate the elements of the new CBME program at the University of Ottawa. Review of the current literature. Competency-based medical education addresses some of the challenges associated with physician training, such as ensuring that specialists are competent in all key areas and reducing training costs. In principle, competency-based medical education can better meet the needs of patients, providers, and other stakeholders in the healthcare system, but its success will depend on support from all involved. As CBME is implemented, anesthesiologists have the opportunity to become leaders in innovation and medical education. The University of Ottawa has implemented a CBME program with a twofold purpose, namely, to focus learning opportunities on the development of the specific competencies required of practicing anesthesiologists and to test the effectiveness of a reduction in the length of training. Canadian anesthesia residency programs will soon transition to CBME in order to promote better transparency, accountability, fairness, fiscal responsibility, and patient safety. Competency-based medical education offers significant potential advantages for healthcare stakeholders.

  20. 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.

  1. 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

  2. Drivers of Change in Construction Training: How Significant Is the Sustainability Agenda?

    Science.gov (United States)

    Fien, John; Winfree, Tomi

    2014-01-01

    The construction industry is contributing to the sustainability agenda through numerous strategies to improve energy efficiency in the design, materials, and operating conditions of buildings. However, this is only one driver of change in the construction sector. This article, which takes Australia as a case study, shows that many other drivers…

  3. A Proactive Approach for Change Management and Control on Construction Projects

    OpenAIRE

    CHEN, CHAO

    2015-01-01

    Changes on construction projects present tough and controversial issues. Change is one of the primary reasons for schedule delay and cost overrun, which create negative impact on project performance and profitability. The liability of change and its consequences are major sources of disagreements between project participants, which often lead to disputes or claims.To answer the challenge of change, both industry and academia have developed change management techniques. Many studies have touch...

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

    KAUST Repository

    Wang, Wei; Cao, Siqin; Zhu, Lizhe; Huang, Xuhui

    2017-01-01

    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

  5. 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

  6. Decrease Risk Behavior HIV Infected on Construction Laborers with Behavior Change Communication (BCC Approach

    Directory of Open Access Journals (Sweden)

    Purwaningsih Purwaningsih

    2016-09-01

    The purpose of this study was to determine the effectiveness of BCC approach to the reduction of contracting HIV risk behavior in the construction laborers. Method: This study used operational research design. In this study measures the effectiveness of behavior change of construction workers on the prevention of HIV transmission by comparing the behavior of the construction workers before and after the intervention. The subjects of this study were 150 people risk group of construction workers who work and are spread throughout the city of Surabaya. This research was carried out into three phases, namely, phase preintervention research, intervention research, and post-intervention phase of the study. Implemented in the first year and second year praintervensi stage implemented intervention and post-intervention phases. Result: The results of this study showed that 72% of construction workers is productive (18–35 years and visit his family more than once a month (38%. There is 20% of construction workers had sex with commercial sex workers and no one was using drugs. By 50% of construction workers never get information about HIV/AIDS and as many as 48% never use the services of HIV/AIDS. Discussion: External motivation construction workers associated with the utilization of behavioral HIV/AIDS services with sufficient correlation. Strong external motivation is influenced by risk behaviors of HIV/AIDS were conducted and the desire to get help. Weak external motivation is influenced by a lack of exposure to information related to HIV/AIDS services. The results of the FGD stakeholders have the perception is the same if a construction worker is a high risk group of contracting HIV. Most of the construction workers not have enough knowledge for the prevention of HIV transmission because they do not have access to HIV care and behavior are at risk of contracting HIV by construction workers. Keywords: construction workers, behavior change communication, behavior

  7. 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

  8. Evaluation of knowledge change of internal medicine residents following a training program in smoking cessation

    International Nuclear Information System (INIS)

    Labib, N.A.; Radwan, G.N.; Salma, R.A.A.; Horeesh, N.A.

    2012-01-01

    One of the major barriers to smoking cessation practice is that many health professionals do not have the knowledge and skills on how to intervene. Objectives: To assess the effect of a training program on physicians' knowledge about tobacco dependence and cessation interventions. Subjects and Methods: A comprehensive training program was given to internal medicine residents in Cairo University Hospitals, Egypt during 2008-2009. An anonymous, 11- item questionnaire was administered before and after the training program. The training process was evaluated by participants' satisfaction using a 13- item checklist. The objective of the study was adequately explained to participants and their consensus was obtained with assured confidentiality. Results: A total of 163 internists entered the training program. Improvement in overall knowledge was evidenced by higher mean score in the post-test than pre-test (6.2 vs. 4.7; p<0.001). Significant improvement were seen in the participants' knowledge related to assessment of tobacco dependence (61% vs. 27%;p<0.001), interventions for smokers willing to quit (51.6 vs. 28.2%; p<0.001), interventions for smokers unwilling to quit (40.8 vs. 19.6%; p<0.001) and coping skills to handle withdrawal symptoms (52.9 vs. 30.7;p<0.001). Almost all participants reported that the training was very useful (96%) and applicable (85.6%) in their medical practices. Conclusions: Targeted training of health professionals has a potential to translate into improved smoking cessation counseling and to increase their inclination to intervene. Policy message: Continued medical education and regular/targeted training of health providers should be done. (author)

  9. 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.

  10. Assessing changes to in-stream turbidity following construction of a forest road in West Virginia

    Science.gov (United States)

    Jingxin Wang; Pamela J. Edwards; William A. Goff

    2011-01-01

    Two forested headwater watersheds were monitored to examine changes to in-stream turbidity following the construction of a forest haul road. One watershed was used as an undisturbed reference, while the other had a 0.92-km (0.57-mi) haul road constructed in it. The channels in both are intermittent tributaries of the Left Fork of Clover Run in the Cheat River watershed...

  11. Mobile Computing Changing the Traditional Ways of Organizing the Construction Company

    OpenAIRE

    Nataa uman; Mirko Punder

    2008-01-01

    The focus of this paper is to represent some important mobile computing potential which help tackle project collaboration and information dissemination problems. Especially in the construction industry where workers have no steady working places mobile computing is shown as a chance for optimising the traditional ways of organizing Construction Company. Special attention is given to the description of changing the current information system as well as to the hierarchical organization structur...

  12. 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.

  13. 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...

  14. Middle School Students' Conceptual Change in Global Climate Change: Using Argumentation to Foster Knowledge Construction

    Science.gov (United States)

    Golden, Barry W.

    2011-01-01

    This research examined middle school student conceptions about global climate change (GCC) and the change these conceptions undergo during an argument driven instructional unit. The theoretical framework invoked for this study is the "framework theory" of conceptual change (Vosniadou, 2007a). This theory posits that students do not…

  15. 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.

  16. 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.

  17. 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.

  18. 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.

  19. 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%, pimprovement. Copyright © 2017 Elsevier B.V. All rights reserved.

  20. 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.

  1. Modeling and simulation of a phase change material system for improving summer comfort in domestic residence

    International Nuclear Information System (INIS)

    Borderon, Julien; Virgone, Joseph; Cantin, Richard

    2015-01-01

    Highlights: • Modeling of a PCM/air ventilation system. • Sizing of PCM system units. • Simulation in TRNSYS of the system connected to a house and enhancement of the summer comfort. - Abstract: In the current context of thermal improvement in the building sector, research of new solutions to integrate to the retrofitting process is an essential step in the way of saving energy. With the purpose of maintaining or improving the summer comfort after a retrofitting in a residential building, Phase Change Materials (PCM) could be used to bring enough inertia to use the freshness of night for cooling during the warmest hour in the day. Passive solutions of PCM integration have demonstrated their limited benefits. Using PCM in the way proposed in this article goes through the design of a PCM/air system able to store latent heat. This unit is coupled to the ventilation system to ensure that the heat transfers between the ventilated air and the PCM stock are forced convection and then higher than the ones with natural convection. The fusion and solidification temperature for the PCM needs to be carefully chosen to allow the latent heat storage. To analyze the behavior of such a system in a retrofitted house with the climate of 4 different French cities, simulations in different configurations have been carried out. According to these climates, we analyze the necessary conditions for the improvement of efficiency of PCM use. Also, the appropriate PCM melting temperature range is defined with corresponding existing PCM characteristics. After, optimal thickness is obtained considering the diurnal temperature evolutions. The TRNSYS software runs the modeled house, coupled with Matlab for the PCM/air system model. The number of units of such a system can be changed and adapted to the different climates. Results are expressed in terms of percentage of the time when the indoor operative temperature reaches a certain level. Comparisons are made with classical systems without

  2. A Co-Construction Perspective on Organizational Change and Educational Reform

    Science.gov (United States)

    Mehan, Hugh; Hubbard, Lea; Datnow, Amanda

    2010-01-01

    In their earlier work, the authors explained how the co-construction perspective has been heuristic in the study of organizational change and educational reform, often providing more nuanced analyses and findings than "technical-rational" models that dominated the field previously (Datnow, Hubbard, & Mehan, 2002). In framing organizational change…

  3. 2007 Effect of Changes in Layout Shape on Unit Construction Cost

    African Journals Online (AJOL)

    ezra

    The shape of a building layout is the spatial attribute that defines the outline of the building. ... The results of this study indicate that perimeter-to-floor ratio, unit construction ... Design variables have been defined as the .... The objective of this paper is to explore the effect ... preparation of cost estimate, changing of design.

  4. Risk perception: The social construction of spatial knowledge around climate change-related scenarios in Lima

    NARCIS (Netherlands)

    Miranda Sara, L.; Jameson, S.; Pfeffer, K.; Baud, I.

    2016-01-01

    Lima's environmental sustainability is threatened by increasing water scarcity, heavy rain events and limited attention for water vulnerability and climate change scenarios. In this paper we examine how knowledge construction and risk perception on water-related disaster risks and vulnerabilities

  5. Mental model construction, not just memory, is a central component of cognitive change in psychotherapy.

    Science.gov (United States)

    von Hecker, Ulrich; McIntosh, Daniel N; Sedek, Grzegorz

    2015-01-01

    We challenge the idea that a cognitive perspective on therapeutic change concerns only memory processes. We argue that inclusion of impairments in more generative cognitive processes is necessary for complete understanding of cases such as depression. In such cases what is identified in the target article as an "integrative memory structure" is crucially supported by processes of mental model construction.

  6. 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 change of U.S. citizenship or residence. 1.871-13 Section 1.871-13 Internal Revenue INTERNAL REVENUE... Foreign Corporations § 1.871-13 Taxation of individuals for taxable year of change of U.S. citizenship or...

  7. 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.)

  8. 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

  9. A retrospective study on changes in residents' physical activities, social interactions, and neighborhood cohesion after moving to a walkable community.

    Science.gov (United States)

    Zhu, Xuemei; Yu, Chia-Yuan; Lee, Chanam; Lu, Zhipeng; Mann, George

    2014-12-01

    This study is to examine changes in residents' physical activities, social interactions, and neighborhood cohesion after they moved to a walkable community in Austin, Texas. Retrospective surveys (N=449) were administered in 2013-2014 to collect pre- and post-move data about the outcome variables and relevant personal, social, and physical environmental factors. Walkability of each resident's pre-move community was measured using the Walk Score. T tests were used to examine the pre-post move differences in the outcomes in the whole sample and across sub-groups with different physical activity levels, neighborhood conditions, and neighborhood preferences before the move. After the move, total physical activity increased significantly in the whole sample and all sub-groups except those who were previously sufficiently active; lived in communities with high walkability, social interactions, or neighborhood cohesion; or had moderate preference for walkable neighborhoods. Walking in the community increased in the whole sample and all subgroups except those who were previously sufficiently active, moved from high-walkability communities, or had little to no preference for walkable neighborhoods. Social interactions and neighborhood cohesion increased significantly after the move in the whole sample and all sub-groups. This study explored potential health benefits of a walkable community in promoting physically and socially active lifestyles, especially for populations at higher risk of obesity. The initial result is promising, suggesting the need for more work to further examine the relationships between health and community design using pre-post assessments. Copyright © 2014 Elsevier Inc. All rights reserved.

  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. Numerical and Experimental Analysis on Inorganic Phase Change Material Usage in Construction

    Science.gov (United States)

    Muthuvel, S.; Saravanasankar, S.; Sudhakarapandian, R.; Muthukannan, M.

    2014-12-01

    This work demonstrates the significance of Phase Change Material (PCM) in the construction of working sheds and product storage magazines in fireworks industries to maintain less temperature variation by passive cooling. The inorganic PCM, namely Calcium Chloride Hexahydrate (CCH) is selected in this study. First, the performance of two models with inbuilt CCH was analysed, using computational fluid dynamics. A significant change in the variation of inner wall temperature was observed, particularly during the working hours. This is mainly due to passive cooling, where the heat transfer from the surroundings to the room is partially used for the phase change from solid to liquid. The experiment was carried out by constructing two models, one with PCM packed in hollow brick walls and roof, and the other one as a conventional construction. The experimental results show that the temperature of the room got significantly reduced up to 7 °C. The experimental analysis results had good agreement with the numerical analysis results, and this reveals the advantage of the PCM in the fireworks industry construction.

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

    Science.gov (United States)

    Mansi, Ishak A

    2011-03-01

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

  13. 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.

  14. 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 (compositions imply that the increase in hypoxia was accompanied by the distribution of the majority of the older and larger A. butcheri changing from deep to shallow waters, where the small 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

  15. 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.

  16. Changing priorities of codes and standards -- quality engineering: Experiences in plant construction, maintenance, and operation

    International Nuclear Information System (INIS)

    Antony, D.D.; Suleski, P.F.; Meier, J.C.

    1994-01-01

    Application of the ASME Code across various fossil and nuclear plants necessitates a Company approach adapted by unique status of each plant. This arises from State Statutes, Federal Regulations and consideration of each plant's as-built history over a broad time frame of design, construction and operation. Additionally, the National Board Inspection Code accompanies Minnesota Statutes for plants owned by Northern States Power Company. This paper addresses some key points on NSP's use of ASME Code as a principal mechanical standard in plant design, construction and operation. A primary resource facilitating review of Code provisions is accurate status on current plant configuration. As plant design changes arise, the Code Edition/Addenda of original construction and installed upgrades or replacements are considered against available options allowed by current standards and dialog with the Jurisdictional Authority. Consistent with the overall goal of safe and reliable plant operation, there are numerous Code details and future needs to be addressed in concert with expected plant economics and planned outages for implementation. The discussion begins in the late 60's with new construction of Monticello and Prairie Island (both nuclear), through Sherburne County Units 1 through 3 (fossil), and their changes, replacements or repairs as operating plants

  17. 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.

  18. 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

  19. Estimate at the nucleotide resolution level of genetic changes in the humans residing in the ecologically unfavourable regions of the Techa river

    International Nuclear Information System (INIS)

    Sojfer, V.N.; Petrova, N.V.; Timofeeva, O.A.; Filipenko, M.L.; Solov'eva, N.A.; Popovskij, A.V.; Vlasko, V.V.

    1998-01-01

    To study DNA at the nucleotide level of resolution in residents of settlements located along the Techa river, studies are performed by direct sequencing of gene sequences preliminary amplified and selected by means of analysis of changes of the conformation of DNA unifilament fragments (SSCP-method). Results are presented in details [ru

  20. 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.

  1. Morphological changes in paraurethral area after introduction of tissue engineering construct on the basis of adipose tissue stromal cells.

    Science.gov (United States)

    Makarov, A V; Arutyunyan, I V; Bol'shakova, G B; Volkov, A V; Gol'dshtein, D V

    2009-10-01

    We studied morphological changes in the paraurethral area of Wistar rats after introduction of tissue engineering constructs on the basis of multipotent mesenchymal stem cells and gelatin sponge. The tissue engineering construct containing autologous culture of the stromal fraction of the adipose tissue was most effective. After introduction of this construct we observed more rapid degradation of the construct matrix and more intensive formation of collagen fibers.

  2. Monitoring of Building Construction by 4D Change Detection Using Multi-temporal SAR Images

    Science.gov (United States)

    Yang, C. H.; Pang, Y.; Soergel, U.

    2017-05-01

    Monitoring urban changes is important for city management, urban planning, updating of cadastral map, etc. In contrast to conventional field surveys, which are usually expensive and slow, remote sensing techniques are fast and cost-effective alternatives. Spaceborne synthetic aperture radar (SAR) sensors provide radar images captured rapidly over vast areas at fine spatiotemporal resolution. In addition, the active microwave sensors are capable of day-and-night vision and independent of weather conditions. These advantages make multi-temporal SAR images suitable for scene monitoring. Persistent scatterer interferometry (PSI) detects and analyses PS points, which are characterized by strong, stable, and coherent radar signals throughout a SAR image sequence and can be regarded as substructures of buildings in built-up cities. Attributes of PS points, for example, deformation velocities, are derived and used for further analysis. Based on PSI, a 4D change detection technique has been developed to detect disappearance and emergence of PS points (3D) at specific times (1D). In this paper, we apply this 4D technique to the centre of Berlin, Germany, to investigate its feasibility and application for construction monitoring. The aims of the three case studies are to monitor construction progress, business districts, and single buildings, respectively. The disappearing and emerging substructures of the buildings are successfully recognized along with their occurrence times. The changed substructures are then clustered into single construction segments based on DBSCAN clustering and α-shape outlining for object-based analysis. Compared with the ground truth, these spatiotemporal results have proven able to provide more detailed information for construction monitoring.

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

    OpenAIRE

    Akompab, Derick; Bi, Peng; Williams, Susan; Grant, Janet; Walker, Iain; 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%)...

  5. 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.

  6. Can changes in psychosocial factors and residency explain the decrease in physical activity during the transition from high school to college or university?

    Science.gov (United States)

    Van Dyck, Delfien; De Bourdeaudhuij, Ilse; Deliens, Tom; Deforche, Benedicte

    2015-04-01

    When students make the transition from high school to college or university, their physical activity (PA) levels decrease strongly. Consequently, it is of crucial importance to identify the determinants of this decline in PA. The study aims were to (1) examine changes in psychosocial factors in students during the transition from high school to college/university, (2) examine if changes in psychosocial factors and residency can predict changes in PA, and (3) investigate the moderating effects of residency on the relationship between changes in psychosocial factors and changes in PA. Between March 2008 and October 2010, 291 Flemish students participated in a longitudinal study, with baseline measurements during the final year of high school and follow-up measurements at the start of second year of college/university. At both time points, participants completed a questionnaire assessing demographics, active transportation, leisure-time sports, psychosocial variables, and residency. Repeated measures MANOVA analyses and multiple moderated hierarchic regression analyses were conducted. Modeling, self-efficacy, competition-related benefits, and health-related, external and social barriers decreased, while health-related benefits and time-related barriers increased from baseline to follow-up. Decreases in modeling and time-related barriers were associated with a decrease in active transportation (adjusted R(2) = 3.2%); residency, decreases in self-efficacy, competition-related benefits, and increases in health- and time-related barriers predicted a decrease in leisure-time sports (adjusted R(2) = 29.3%). Residency only moderated two associations between psychosocial factors and changes in PA. Residency and changes in psychosocial factors were mainly important to explain the decrease in leisure-time sports. Other factors such as distance to college/university are likely more important to explain the decrease in active transportation; these are worth exploring in

  7. Dynamic testing in schizophrenia: does training change the construct validity of a test?

    Science.gov (United States)

    Wiedl, Karl H; Schöttke, Henning; Green, Michael F; Nuechterlein, Keith H

    2004-01-01

    Dynamic testing typically involves specific interventions for a test to assess the extent to which test performance can be modified, beyond level of baseline (static) performance. This study used a dynamic version of the Wisconsin Card Sorting Test (WCST) that is based on cognitive remediation techniques within a test-training-test procedure. From results of previous studies with schizophrenia patients, we concluded that the dynamic and static versions of the WCST should have different construct validity. This hypothesis was tested by examining the patterns of correlations with measures of executive functioning, secondary verbal memory, and verbal intelligence. Results demonstrated a specific construct validity of WCST dynamic (i.e., posttest) scores as an index of problem solving (Tower of Hanoi) and secondary verbal memory and learning (Auditory Verbal Learning Test), whereas the impact of general verbal capacity and selective attention (Verbal IQ, Stroop Test) was reduced. It is concluded that the construct validity of the test changes with dynamic administration and that this difference helps to explain why the dynamic version of the WCST predicts functional outcome better than the static version.

  8. 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.

  9. Assisted living: a place to manage uncertainty. The ambiguity of assisted living is unavoidable because residents' needs are always changing. The Wheat Valley example is used to examine this concept.

    Science.gov (United States)

    Ekerdt, David J

    2005-01-01

    The assisted living environment lacks the satisfying clarity of the consumer model (a stay at the Holiday Inn) or the medical model (the hospital or nursing home). Yet the ambiguity of assisted living is unavoidable because it shelters individuals whose needs are changing, the model of care requires extensive negotiation with residents, and staff members must continually compromise as they implement the principles. Assisted living is a place where uncertainty is managed, not resolved. This indicates a need for the further pursuit of qualitative research, such as reported by these articles and others (e.g., Carder, 2002), to explore how participants construct, make sense of, and interpret their daily experience in assisted living.

  10. 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

  11. Scanning of speechless comics changes spatial biases in mental model construction.

    Science.gov (United States)

    Román, Antonio; Flumini, Andrea; Santiago, Julio

    2018-08-05

    The mental representation of both time and number shows lateral spatial biases, which can be affected by habitual reading and writing direction. However, this effect is in place before children begin to read. One potential early cause is the experiences of looking at picture books together with a carer, as those images also follow the directionality of the script. What is the underlying mechanism for this effect? In the present study, we test the possibility that such experiences induce spatial biases in mental model construction, a mechanism which is a good candidate to induce the biases observed with numbers and times. We presented a speechless comic in either standard (left-to-right) or mirror-reversed (right-to-left) form to adult Spanish participants. We then asked them to draw the scene depicted by sentences like 'the square is between the cross and the circle'. The position of the lateral objects in these drawings reveals the spatial biases at work when building mental models in working memory. Under conditions of highly consistent directionality, the mirror comic changed pre-existing lateral biases. Processes of mental model construction in working memory stand as a potential mechanism for the generation of spatial biases for time and number.This article is part of the theme issue 'Varieties of abstract concepts: development, use and representation in the brain'. © 2018 The Author(s).

  12. Analysing Changes in Discursive Constructions of Rural Areas in the Context of Demographic Change. Towards Counterpoints in the Dominant Discourse on “Dying Villages”

    Directory of Open Access Journals (Sweden)

    Gabriela B. Christmann

    2016-01-01

    For the conceptualisation of the empirical observations, the article is based on the assumption that it is in communications and in public discourses – in particular specific recurrent contents on rural areas and demographic change – that specific knowledge elements and reality constructions of rural areas emerge and stabilise within society. This assumption includes the idea that when the content of public discourses on rural areas change, for example through small-scale discursive counterpoints, it is possible for new knowledge elements and new constructions of reality to develop. Against this background, the approach of a (new discursive construction of spaces is selected as theoretical starting point for the analysis. By referring to the communicative-constructivism approach and by integrating the sociology of knowledge approach to discourse, it is perfectly suited for theoretically spelling out changing discursive constructions of rural areas in the context of demographic change.

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

    Science.gov (United States)

    Lamkaddem, Majda; Essink-Bot, Marie-Louise; Devillé, Walter; Gerritsen, Annette; Stronks, Karien

    2015-12-01

    Worldwide, refugees show a poorer mental and physical health than the populations among which they resettle. Little is known about the factors influencing health after resettlement. We examined the development of mental and physical health of refugees. As experienced living difficulties might decrease with obtaining a residence permit, we expected this to play a central role in health improvement after resettlement. A two-wave study conducted in the Netherlands among a cohort of 172 recent (n = 68) and longstanding (n = 104) permit holders from Afghanistan, Iran and Somalia between 2003 and 2011. Multivariate mediation analyses were conducted for the effect of changes in living difficulties on the association between change in status and changes in health. Health outcomes were self-reported general health, number of chronic conditions, PTSD and anxiety/depression. Recent permit holders had larger decreases in PTSD score (-0.402, CI -0.612; -0.192) and anxiety/depression score (-0.298, CI -0.464; -0.132), and larger improvements in self-rated general health between T1 and T2 (0.566, CI 0.183; 0.949) than longstanding permit holders. This association was not significant for changes in number of chronic conditions. Mediation analyses showed that the effect of getting a residence permit on health improvements transited through an improvement in living conditions, in particular employment and the presence of family/social support. These results suggest that change in residence permit is beneficial for health mainly because of the change in living difficulties. These results add up to the evidence on the role of social circumstances for refugees upon resettlement, and point at labour participation and social support as key mechanisms for health improvements. © The Author 2015. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

  14. 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.

  15. 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

  16. Psychosocial constructs and postintervention changes in physical activity and dietary outcomes in a lifestyle intervention, HUB City Steps, 2010

    Science.gov (United States)

    Purpose: To examine relationships among psychosocial constructs (PSC) of behavior change and post-intervention changes in physical activity (PA) and dietary outcomes. Design: Non-controlled, pre- post-experimental intervention. Setting: Midsized, southern United States city. Subjects: 269 prima...

  17. Changes in Perceived Supervision Quality After Introduction of Competency-Based Orthopedic Residency Training: A National 6-Year Follow-Up Study.

    Science.gov (United States)

    van Vendeloo, Stefan N; Brand, Paul L P; Kollen, Boudewijn J; Verheyen, Cees C P M

    2018-04-27

    To evaluate the perceived quality of the learning environment, before and after introduction of competency-based postgraduate orthopedic education. From 2009 to 2014, we conducted annual surveys among Dutch orthopedic residents. The validated Dutch Residency Educational Climate Test (D-RECT, 50 items on 11 subscales) was used to assess the quality of the learning environment. Scores range from 1 (poor) to 5 (excellent). Dynamic cohort follow-up study. All Dutch orthopedic residents were surveyed during annual compulsory courses. Over the 6-year period, 641 responses were obtained (response rate 92%). Scores for "supervision" (95% CI for difference 0.06-0.28, p = 0.002) and "coaching and assessment" (95% CI 0.11-0.35, p < 0.001) improved significantly after introduction of competency-based training. There was no significant change in score on the other subscales of the D-RECT. After the introduction of some of the core components of competency-based postgraduate orthopedic education the perceived quality of "supervision" and "coaching and assessment" improved significantly. Copyright © 2018 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  18. 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

  19. 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)

  20. 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

  1. 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.

  2. Priority and construction sites of water storage in a watershed in response to climate change

    Science.gov (United States)

    Lin, Cheng-Yu; Zhang, Wen-Yan; Lin, Chao-Yuan

    2014-05-01

    Taiwan is located at the Eastern Asia Monsoon climate zone. Typhoons and/or convectional rains occur frequently and result in high intensity storms in the summer season. Once the detention facilities are shortage or soil infiltration rate become worse in a watershed due to land use, surface runoff is easily to concentrate and threaten the protected areas. Therefore, it is very important to examine the functionality of water storage for a watershed. The purpose of this study is to solve the issue of flooding in the Puzi Creek. A case study of Yizen Bridge Watershed, in which the SCS curve number was used as an index to extract the spatial distribution of the strength of water storage, and the value of watershed mean CN along the main channel was calculated using area-weighting method. Therefore, the hotspot management sites were then derived and the priority method was applied to screen the depression sites for the reference of management authorities in detention ponds placement. The results show that the areas of subzone A with the characteristics of bad condition in topography and soil, which results in poor infiltration. However, the areas are mostly covered with forest and are difficult to create the artificial water storage facilities. Detention dams are strongly recommended at the site of depression in the river channel to decrease discharge velocity and reduce impact from flood disaster. The areas of subzone B are mainly located at the agriculture slope land. The topographic depressions in the farmland are the suitable places to construct the farm ponds for the use of flood detention and sediment deposition in the rainy seasons and irrigation in the dry seasons. Areas of subzone C are mainly occupied the gentle slope land with a better ability in water storage due to low CN value. Farm ponds constructed in the riparian to bypass the nearby river channel can create multifunctional wetland to effectively decrease the peak discharge in the downstream during

  3. Residence time as a key for comprehensive assessment of the relationship between changing land use and nitrates in regional groundwater systems.

    Science.gov (United States)

    Cao, Yingjie; Tang, Changyuan; Song, Xianfang; Liu, Changming; Zhang, Yinghua

    2013-04-01

    In this study, an approach is put forward to study the relationship between changing land use and groundwater nitrate contamination in the Sanjiang Plain. This approach emphasizes the importance of groundwater residence time when relating the nitrates to the changing land use. The principles underlying the approach involve the assessment of groundwater residence time by CFCs and the Vogel age model and the reconstruction of the land use at the groundwater recharge time by interpolation. Nitrate trend analysis shows that nitrates have begun to leach into the aquifers since agricultural activities boomed after the 1950s. Hydrochemical analysis implies that the possible process relating to the nitrate reduction in the groundwater is the oxidation of Fe(ii)-silicates. However, the chemical kinetics of the oxidation of Fe(ii)-silicates is slow, so this denitrification process contributes little to the nitrate variations. Stepwise regression shows that the nitrate concentrations of samples had no direct relationship with the land use at the groundwater sampling time, but had a relatively strong relationship with the land use at the groundwater recharge time. Dry land is recognized as the dominant factor contributing to the elevated concentration of nitrates. The nitrogen isotope for nitrate (δ(15)N-NO3) gives a more direct result of the identification of nitrate sources: the use of manure in agricultural activities. Principle component (PC) regression shows that the process of the dry land exploitation is the major process that controls the nitrate contamination in the Sanjiang Plain.

  4. Moisture transfer and change in strength during the construction of earthen buildings

    Directory of Open Access Journals (Sweden)

    Schroeder, H.

    2011-09-01

    Full Text Available A number of rammed earth projects constructed in recent years in Germany and abroad testify to the high level of architectural interest in this material, not only in our country. Rammed earth has been “rediscovered”, in particular by young architects, due to its unique materiality and fascinating and individual surface aesthetics. In connection with the realisation of two rammed earth projects realised in Thuringia, Germany, in 2003/2004 some questions arose concerning the process of moisture transfer and changes in strength properties during construction. The earthen building standards detail only very rough estimates of drying times for rammed earth walls. The idea arose to develop a test programme for investigating the aspect of drying time with regard to the change in material strength in rammed earth walls, as well as for elaborating general aspects of testing procedures for rammed earth in standards. The paper presents results of a laboratory programme that attempts to approach this very complex problem. A series of test specimens were produced and the unconfined compressive strength was determined after different drying times varying from 7 to 90 days. The moisture content of the test specimens also was varied: at OMC (Proctor test and above and below the OMC.

    Una serie de proyectos de tierra apisonada construidos en los últimos años en Alemania y en el extranjero dan testimonio del alto nivel de interés arquitectónico en este material, no solo en nuestro país. La tierra apisonada ha sido “redescubierta”, en particular por los arquitectos jóvenes, debido a su materialidad única y fascinante y la estética singular de su superficie. En relación con la realización de dos proyectos de tierra apisonada realizados en Turingia, Alemania, en el período 2003/2004 surgieron algunas preguntas sobre el proceso de transferencia de la humedad y los cambios en las propiedades de resistencia durante la construcción. Las

  5. 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.

  6. Is the apparent decrease in injury and illness rates in construction the result of changes in reporting?

    Science.gov (United States)

    Welch, Laura S; Dong, Xiuwen; Carre, Francoise; Ringen, Knut

    2007-01-01

    Injury rates in all industries and in construction in particular have been declining. Inconsistencies in the information suggest some of the apparent decrease may be due to changes in the ways injuries are treated, misclassification of employees, or underreporting. Lost-time injury rates for the largest construction employers declined by as much as 92% between 1988 and 1999. Yet the rate for cases with restricted work activity actually increased from 0.7 to 1.2 per 100 full-time workers between 1990 and 2000, and fatalities among construction workers remain high. In Massachusetts, at least 14% of construction employers misclassified workers as independent contractors, with the effect that injuries to these workers are not recordable. Studies that compare OSHA logs with other data sources find that the OSHA logs do not include a significant proportion of injuries and illnesses identified elsewhere.

  7. 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

  8. Impact of Residency Training Redesign on Residents' Clinical Knowledge.

    Science.gov (United States)

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

    2017-10-01

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

  9. 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.

  10. [Remote sensing analysis of ecological change caused by construction of the new island city: Pingtan Comprehensive Experimental Zone, Fujian Province].

    Science.gov (United States)

    Wen, Xiao-le; Lin, Zheng-feng; Tang, Fei

    2015-02-01

    Pingtan Island was officially established as the 'Pingtan Comprehensive Experimental Zone of Fujian' in 2010, and it led to a surge of construction in the island city. Based on the Landsat-5 images for 2007 and the latest Landsat-8 images for 2013, this paper studied the ecological status, the temporal trends of the ecological changes and the reasons for those changes in Pingtan Comprehensive Experimental Zone at its early stage of construction, by using the remote sensing of ecological index (RSEI). The results showed that as an ecologically fragile area, Pingtan Island had a moderate level of overall ecological status. In the early construction period (from 2007 to 2013), the ecological status of the island showed a downward trend, with a 14% drop of RSEI from 0.511 in 2007 down to 0.450 in 2013, and approximately 36.5% of the area of the island faced the degradation of ecological status, which mainly occurred in the central and southwestern parts of the island. The reason for the degradation was mainly due to the large-scale construction which further damaged the scarce vegetation on the island. Therefore, in order to curb the downward trend of the ecological quality of Pingtan Comprehensive Experimental Zone, some effective ecological protection measures must be developed and implemented during the construction.

  11. Should We Play Games Where Energy Is Concerned? Perceptions of Serious Gaming as a Technology to Motivate Energy Behaviour Change among Social Housing Residents

    Directory of Open Access Journals (Sweden)

    Christine Boomsma

    2018-05-01

    Full Text Available The invisibility and intangibility of energy are key challenges faced by communicators looking to reduce household energy demand. ‘Serious games’—defined as formalized, goal-oriented games designed to educate, or promote health and well-being—are one potential strategy that may help to alleviate these challenges. This paper discusses the suitability of serious gaming as an educational and behavioural change tool within the context of social housing—a faction often overlooked when it comes to household energy research. The paper takes a two-part approach. First, we review current literature on serious energy games, and second, we discuss perceptions of serious energy games amongst social housing residents using data from two surveys (Survey A, n = 536; Survey B, n = 78. Perceptions of serious energy games were found to be mixed. Some residents liked the idea of a game for energy, particularly if clear, actionable solutions for reducing energy bills were provided. However, others were disinterested, due to existing time pressures, negative perceptions of gaming, and limited confidence using computers or tablets. As such, uptake may be met with challenges. The findings highlight the need for interdisciplinary collaborations and user-led approaches for the design of successful and engaging serious energy games.

  12. 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.

  13. 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...

  14. Use of cost-effective construction technologies in India to mitigate climate change

    Energy Technology Data Exchange (ETDEWEB)

    Sengupta, N. [Forum of Scientists, Engineers and Technologists, Kolkata (India)

    2008-01-10

    Concentration of greenhouse gases plays a major role in raising the earth's temperature. Carbon dioxide, produced from burning of fossil fuels, is the principle greenhouse gas and efforts are being made at international level to reduce its emission through adoption of energy-efficient technologies. The UN Conference on Environment and Development, 1992 made a significant development in this field by initiating the discussion on sustainable development under the Agenda 21. Cost-effective construction technologies can bring down the embodied energy level associated with production of building materials by lowering use of energy-consuming materials. This embodied energy is a crucial factor for sustainable construction practices and effective reduction of the same would contribute in mitigating global warming. The cost-effective construction technologies would emerge as the most acceptable case of sustainable technologies in India both in terms of cost and environment.

  15. 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.

  16. BOHICA; bend over, here it comes again… construction and test of a change fatigue instrument

    NARCIS (Netherlands)

    Elving, Wim; Hansma, Lindy; de Boer, Merel

    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

  17. Phytosociological studies on vegetation change caused by road construction in natural park. III

    Energy Technology Data Exchange (ETDEWEB)

    Kameyama, A

    1975-06-01

    An attempt has been made to explain how forests have been destroyed by road construction in a natural park in Japan. The author discussed the methods of analyzing the problem, as well as the impact of the construction on various developmental stages in plants. A survey of the plant community was taken and a vegetation map on a scale of 1:3,000 was made. According to the map, vegetation was affected in an area 10-20m from the road, sometimes 50 m, by exhaust fumes from the traffic.

  18. Change in numbers of resident and migratory shorebirds at the Cabo Rojo Salt Flats, Puerto Rico, USA (1985–2014)

    Science.gov (United States)

    Parks, Morgan A.; Collazo, Jaime A.; Colon, Jose A.; Ramos Alvarez, Katsi R.; Diaz, Oscar

    2016-01-01

    North American migratory shorebirds have declined markedly since the 1980s, underscoring the importance of population surveys to conduct status and trend assessments. Shorebird surveys were conducted during three multi-year periods between 1985 and 2014 and used to assess changes in numbers and species composition at the Cabo Rojo Salt Flats, Puerto Rico, USA, a site of regional importance in the eastern Caribbean. Eight fewer species (total = 21) were recorded in 2013–2014 as compared to the 29 from 1985–1992; all eight species were Nearctic migrants. Small calidrids had the highest population counts; however, this suite of species and all others experienced a ≥ 70% decline. Combined counts from the salt flats and neighboring wetlands in 2013–2014 were lower than counts only from the Cabo Rojo Salt Flats in two previous multi-year survey periods, which indicated a real change in numbers not just a shift in wetland use. Invertebrate prey density was lower in 2013–2014 than in 1994. Body fat condition of Semipalmated Sandpipers (Calidris pusilla), an index of habitat quality, did not differ between 1985–1992 and 2013–2014. These findings do not exclude the possibility that other species might be affected by lower prey density, or that local declines in numbers reflect changes at hemispheric, not local, scales. The magnitude of change between local and hemispheric scales closely matched for some species. Continued monitoring at the salt flats is warranted to help gauge the status of shorebirds in Puerto Rico and discern the probable cause of declines. Monitoring other sites in the Caribbean is needed for stronger inferences about regional status and trends.

  19. 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.

  20. 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

  1. 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.

  2. Positive Deviance during Organization Change: Researchers' Social Construction of Expanded University Goals

    Science.gov (United States)

    Sutherland, Claire Euline

    2013-01-01

    Many universities have expanded from teaching only to include research goals, requiring shifts in organization behavior. An exploratory case study method was used to examine these dynamics among positive deviant researchers at the University of Technology, Jamaica (UTech), the single case examined, from a social construction perspective. As a…

  3. 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…

  4. 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

  5. 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…

  6. 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.

  7. Natural versus anthropogenic climate change: Swedish farmers' joint construction of climate perceptions.

    Science.gov (United States)

    Asplund, Therese

    2016-07-01

    While previous research into understandings of climate change has usually examined general public perceptions, this study offers an audience-specific departure point. This article analyses how Swedish farmers perceive climate change and how they jointly shape their understandings. The agricultural sector is of special interest because it both contributes to and is directly affected by climate change. Through focus group discussions with Swedish farmers, this study finds that (1) farmers relate to and understand climate change through their own experiences, (2) climate change is understood either as a natural process subject to little or no human influence or as anthropogenic and (3) various communication tools contribute to the formation of natural and anthropogenic climate change frames. The article ends by discussing frame resonance and frame clash in public understanding of climate change and by comparing potential similarities and differences in how various segments of the public make sense of climate change. © The Author(s) 2014.

  8. 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.

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

    Directory of Open Access Journals (Sweden)

    Rogacheva Yana

    2018-01-01

    Full Text Available 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.

  10. 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.

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

    Science.gov (United States)

    2016-09-30

    efficiency; advises the Secretary of Defense and Congress; and informs the public. Vision Our vision is to be a model oversight organization in the...Bachelor Enlisted Quarters and P220, Ammunition Supply Point, with combined estimated costs of $65.2 million, for audit . This is one in a series of...The Director stated that maintaining contract files was secondary to construction completion. As a result, there is an increased risk that

  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...... 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. 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

  14. 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 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.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.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.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 considered.

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

    Science.gov (United States)

    Lech, Maciej; Gröbmayr, Regina; Weidenbusch, Marc; Anders, Hans-Joachim

    2012-01-01

    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. PMID:23251037

  16. Adaptation of the Recent Life Changes Questionnaire (RLCQ) to measure stressful life events in adults residing in an urban megapolis in Pakistan.

    Science.gov (United States)

    Artani, Azmina; Bhamani, Shireen Shehzad; Azam, Iqbal; AbdulSultan, Moiz; Khoja, Adeel; Kamal, Ayeesha K

    2017-05-05

    Contextually relevant stressful life events are integral to the quantification of stress. None such measures have been adapted for the Pakistani population. The RLCQ developed by Richard Rahe measures stress of an individual through recording the experience of life changing events. We used qualitative methodology in order to identify contextually relevant stressors in an open ended format, using serial in-depth interviews until thematic saturation of reported stressful life events was achieved. In our next phase of adaptation, our objective was to scale each item on the questionnaire, so as to weigh each of these identified events, in terms of severity of stress. This scaling exercise was performed on 200 random participants residing in the four communities of Karachi namely Kharadar, Dhorajee, Gulshan and Garden. For analysis of the scaled tool, exploratory factor analysis was used to inform structuring. Finally, to complete the process of adaption, content and face validity exercises were performed. Content validity by subject expert review and face validity was performed by translation and back translation of the adapted RLCQ. This yielded our final adapted tool. Stressful life events emerging from the qualitative phase of the study reflect daily life stressors arising from the unstable socio-political environment. Some such events were public harassment, robbery/theft, missed life opportunities due to nepotism, extortion and threats, being a victim of state sponsored brutality, lack of electricity, water, sanitation, fuel, destruction due to natural disasters and direct or media based exposure to suicide bombing in the city. Personal or societal based relevant stressors included male child preference, having an unmarried middle aged daughter, lack of empowerment and respect reported by females. The finally adapted RLCQ incorporated "Environmental Stress" as a new category. The processes of qualitative methodology, in depth interview, community based scaling and

  17. Natural versus anthropogenic climate change: Swedish farmers joint construction of climate perceptions

    OpenAIRE

    Asplund, Therese

    2016-01-01

    While previous research into understandings of climate change has usually examined general public perceptions, this study offers an audience-specific departure point. This article analyses how Swedish farmers perceive climate change and how they jointly shape their understandings. The agricultural sector is of special interest because it both contributes to and is directly affected by climate change. Through focus group discussions with Swedish farmers, this study finds that (1) farmers relat...

  18. Higher Education Institution Leaders' Identity Constructions in Times of Changing Structures and Legislation

    Science.gov (United States)

    Tigerstedt, Christa

    2016-01-01

    The focus in this paper is on the leadership of higher education institutions (HEI) in Finland and more specifically on the rector's leadership. The higher education sector is undergoing many changes and has been so for a long time. How, then, do the current changes become visible from a leadership perspective? The leadership discourse is here…

  19. 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.

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

    DEFF Research Database (Denmark)

    Koch, Christian; Tambo, Torben

    2010-01-01

    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...... 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...

  1. The Construction of a Sustainable Development in Times of Climate Change

    OpenAIRE

    Brandstedt, Eric

    2013-01-01

    This dissertation is a contribution to the debate about ‘climate justice’, i.e. a call for a just and feasible distribution of responsibility for addressing climate change. The main argument is a proposal for a cautious, practicable, and necessary step in the right direction: given the set of theoretical and practical obstacles to climate justice, we must begin by making contemporary development practices sustainable. In times of climate change, this is done by recognising and responding to t...

  2. Evaluating the Effects of Dam Construction on the Morphological Changes of Downstream Meandering Rivers (Case Study: Karkheh River

    Directory of Open Access Journals (Sweden)

    A. Liaghat

    2017-04-01

    Full Text Available The establishment of stability in rivers is dependent on a variety of factors, and yet the established stability can be interrupted at any moment or time. One factor that can strongly disrupt the stability of rivers is the construction of dams. For this study, the identification and evaluation of morphological changes occurring to the Karkheh River, before and after the construction of the Karkheh Dam, along with determining the degree of changes to the width and length of the downstream meanders of the river, have been performed with the assistance of satellite images and by applying the CCHE2D hydrodynamic model. Results show that under natural circumstances the width of the riverbed increases downstream parallel to the decrease in the slope angle of the river. The average width of the river was reduced from 273 meters to 60 meters after dam construction. This 78% decrease in river width has made available 21 hectares of land across the river bank per kilometer length of the river. In the studied area, the average thalweg migration of the river is approximately 340 meters, while the minimum and maximum of river migration measured 53 and 768 meters, respectively. Evaluations reveal that nearly 56% of the migrations pertain to the western side of the river, while over 59% of these migrations take place outside the previous riverbed. By average, each year, the lateral migration rate of the river is 34 meters in the studied area which signifies the relevant instability of the region.

  3. 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.

  4. 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.

  5. 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

  6. 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.

  7. A Constructive-Critical Approach to the Changing Workplace and its Technologies

    DEFF Research Database (Denmark)

    Møller, Naja Holten; Shklovski, Irina; Silberman, Six

    2017-01-01

    Implementation of technical systems into work practices can result in shifting the balance of power in terms of what is visible and what is hidden (Suchman 1994; Star & Strauss 1999) and in fundamentally changing the nature of work itself (Bannon 1994). Sometimes these changes can have...... unpredictable and even adverse effects on the stakeholders involved (Clement & Wagner 1995). ECSCW as a venue has not shied away from pointing out that there is politics to sociomaterial processes we observe and study (Bannon & Bødker 1997; Bjørn and Balka 2007). As work computerization begins to involve...... the digitization of work practices, however, more thorny political questions emerge. The workplace changes when the spheres of private life and work are blurred as sensors are attached to the employee in the workplace for tracking movement (Gorm & Shklovski 2016; Møller et al. 2017), when the workplace as a fixed...

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

    Science.gov (United States)

    Mansi, Ishak A

    2011-01-01

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

  9. Changes in soil bulk density resulting from construction and conventional cable skidding using preplanned skid trails

    Science.gov (United States)

    Jingxin Wang; Chris B. LeDoux; Pam Edwards

    2007-01-01

    A harvesting system consisting of chainsaw felling and cable skidder extraction was studied to determine soil bulk density changes in a central Appalachian hardwood forest site. Soil bulk density was measured using a nuclear gauge preharvest and postharvest systematically across the harvest site, on transects across skid trails, and for a subset of skid trail transects...

  10. 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

  11. 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

  12. 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.

  13. 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.

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

    OpenAIRE

    Fridolin Simon. Brand; Roman Seidl; Quang Bao. Le; Julia Maria. Brändle; Roland Werner. Scholz

    2013-01-01

    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 ...

  15. 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.

  16. 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.

  17. 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.

  18. 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...

  19. Hospitalist career decisions among internal medicine residents.

    Science.gov (United States)

    Ratelle, John T; Dupras, Denise M; Alguire, Patrick; Masters, Philip; Weissman, Arlene; West, Colin P

    2014-07-01

    Hospital medicine is a rapidly growing field of internal medicine. However, little is known about internal medicine residents' decisions to pursue careers in hospital medicine (HM). To identify which internal medicine residents choose a career in HM, and describe changes in this career choice over the course of their residency education. Observational cohort using data collected from the annual Internal Medicine In-Training Examination (IM-ITE) survey. 16,781 postgraduate year 3 (PGY-3) North American internal medicine residents who completed the annual IM-ITE survey in 2009-2011, 9,501 of whom completed the survey in all 3 years of residency. Self-reported career plans for individual residents during their postgraduate year 1 (PGY-1), postgraduate year 2 (PGY-2) and PGY-3. Of the 16,781 graduating PGY-3 residents, 1,552 (9.3 %) reported HM as their ultimate career choice. Of the 951 PGY-3 residents planning a HM career among the 9,501 residents responding in all 3 years, 128 (13.5 %) originally made this decision in PGY-1, 192 (20.2 %) in PGY-2, and 631 (66.4 %) in PGY-3. Only 87 (9.1 %) of these 951 residents maintained a career decision of HM during all three years of residency education. Hospital medicine is a reported career choice for an important proportion of graduating internal medicine residents. However, the majority of residents do not finalize this decision until their final year.

  20. 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

  1. Nuclear Power and Climate Change: Construction and Consequences of a Geopolitical Rhetoric in France and Sweden

    International Nuclear Information System (INIS)

    Meyer, Teva

    2017-01-01

    The political awakening to the climate- change issue in the 1980's has durably de-structured the antinuclear movements. Previously held as the highest global threat, atomic energy became a potential solution to the contemporary environmental challenges thanks to its low emissions of greenhouse gases. However, it appears that these upheavals have not identically impacted every country, as evidenced by the diversity of reactions after the Fukushima accident. Relying on the study of two highly nuclearized countries, France and Sweden, this article intends to analyze the consequences of the climate argument on the balance of power between actors of the conflict over atomic energy's future. While in France, this new issue triggered an internal crisis within the antinuclear movement which did not structurally influence the conflict, it led in Sweden to a complete reorganization of the debate, thus facilitating the return of nuclear power in 2011 in the country

  2. 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.

  3. 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.

  4. Creating a Culture of Wellness in Residency.

    Science.gov (United States)

    Edmondson, Emma K; Kumar, Anupam A; Smith, Stephanie M

    2018-04-17

    Despite increased awareness and recognition of the prevalence of physician burnout and the associated risks of depression and suicide, there is a paucity of actionable guidelines for residency programs to mitigate these risks for their residents. In this Invited Commentary, the authors acknowledge that, although there are inherent barriers to resident wellness, there are numerous modifiable barriers that present opportunities for programs to enable culture change and improve resident wellbeing. The authors frame the discussion with a personal narrative written by a resident in their internal medicine program who experienced burnout, depression, and suicidality during his intern year. They aim to inspire residency programs and hospital leadership to identify and intervene upon the modifiable barriers to wellness for residents in their programs in order to shape meaningful cultural change.

  5. 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.

  6. 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.

  7. 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.

  8. Floodplain construction of the Rio Grande at El Paso, Texas, USA: response to Holocene climate change

    Science.gov (United States)

    Hall, Stephen A.; Peterson, John A.

    2013-04-01

    The Rio Grande is one of the larger rivers in North America, and the development of its floodplain is related to Holocene climate and climate change. The late Pleistocene through early Holocene channel is characterized by a meander or braided system with lateral cutting and backfilling, resulting in the valley-wide deposition of massive to cross-bedded, fine-to-medium textured sand. The late Pleistocene-early Holocene floodplain is also the sand source for the adjacent Bolson sand sheet. The sand sheet stopped accumulating new sand 5000 yrs ago, an event directly related to the shutting off of the sand supply caused by the deposition of overbank muds that covered and sealed the floodplain surface. During the middle Holocene, the river may have dried intermittently with the floodplain becoming deflated and local sand dunes forming on the floodplain. After 5000 yrs the climate was less arid and the river shifted to a regime of increased flooding and overbank deposition of silt and clay. By 2500 yrs, a late Holocene period of wet climate resulted in further overbank deposition and the formation of a cumulic Mollisol across the floodplain, the Socorro paleosol. The period of wet climate corresponds to the Audubon Neoglacial and active rock glaciers in the southern Rocky Mountains, speleothem growth in nearby caves, and other evidence for wet-cool conditions in the region. After 1000 yrs, the climate became drier, and the deposition and accumulation of overbank muds by the flooding Rio Grande came to a halt. Even though the river has flooded often in historic times, and presumably during late prehistoric times as well, there is little evidence for deposition of overbank sediments on the floodplain since A.D. 1000. Accordingly, the present-day surface of the Lower Valley is ten centuries old. Three channels occur on the US side of the Lower Valley floodplain, and during the past 2500 yrs stream flow has shifted from one to the other by the avulsion process of channel

  9. 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

  10. A review of the effect of oral nutritional interventions on both weight change and functional outcomes in older nursing home residents

    NARCIS (Netherlands)

    Beck, A.M.; Wijnhoven, H.A.H.; Lassen, K.O.

    2011-01-01

    Background & Aims: The prevalence of undernutrition among older nursing home residents is high and has been associated with impaired muscle strength, functional limitations, reduced quality of life and increased health care costs.However, the causality of these associations is difficult to

  11. Does Concern Motivate Behavior Change?: Exploring the Relationship between Physical Activity and Body Mass Index among Low-Income Housing Residents

    Science.gov (United States)

    Tamers, Sara L.; Allen, Jennifer; Yang, May; Stoddard, Anne; Harley, Amy; Sorensen, Glorian

    2014-01-01

    Objective: To explore relationships between concerns and physical activity and body mass index (BMI) among a racially/ethnically diverse low-income population. Method: A cross-sectional survey documented behavioral risks among racially/ethnically diverse low-income residents in the Boston area (2005-2009). Multivariable logistic regressions were…

  12. [Part-time residency training in Israel].

    Science.gov (United States)

    Fishbain, Dana; Levi, Baruch; Borow, Malke; Ashkenazi, Shai; Lindner, Arie

    2012-08-01

    Full-time work has long been perceived as a cornerstone of medical residency, the consensus being that a resident must apply the bulk of his time and attention to his professional training. Demographic and cultural changes that have taken place over the last several years, specifically the rise in the number of female doctors and the importance of leisure time to the younger generation, have intensified the need to find new and innovative ways to deal with the plight of the resident population. One idea, already in effect in many Western countries, is the institution of part-time residency programs. The possibility of fulfilling residency requirements on a part-time basis is intended to assist medical residents in integrating their professional development with their personal and family life, without compromising the quality of their training. A number of research studies conducted over the last several years in countries that allow part-time residency, among them the United States, England and Switzerland, aimed to examine the quality of part-time training. The various studies evinced a high level of satisfaction from the program both by the residents themselves and their supervisors, and in many aspects those doing residency part-time received higher appraisals than their full-time colleagues. Some of the residents polled noted that they would have totally foregone the practice of medicine had there not been an option to complete residency part-time. In light of the experience throughout the world and the changing landscape in Israel, the Scientific Council of the Israeli Medical Association decided to examine the issue and its various aspects, and weighed all the considerations in favor and against part-time residency. Recently, the Scientific Council approved the launch of a pilot program to allow part-time residency in several fields that were carefully selected according to specific criteria. Once the Ministry of Health completes the LegisLation process, part

  13. Peer observation and feedback of resident teaching.

    Science.gov (United States)

    Snydman, Laura; Chandler, Daniel; Rencic, Joseph; Sung, Yung-Chi

    2013-02-01

    Resident doctors (residents) play a significant role in the education of medical students. Morning work rounds provide an optimal venue to assess resident teaching. The purpose of this study was to assess the feasibility of peer observation of resident work rounds, to evaluate resident perceptions of peer observation and to evaluate resident perceptions of peer feedback.   Twenty-four internal medicine residents were simultaneously observed by an attending physician and a peer while teaching during work rounds (between August2008 and May 2009). At year-end, residents received a survey to characterise their attitudes towards peer observation and feedback. Twenty-one residents (87.5%) completed the survey. Half (52.4%) felt that participating in the peer observation study stimulated their interest in teaching during work rounds. Prior to participation in the study, fewer than half (42.9%) felt comfortable being observed by their peers, compared with 71.4 percent after participation (p=0.02). The proportion of residents who felt comfortable giving feedback to peers increased from 26.3 to 65.0percent (p=0.004), and the proportion of residents who felt comfortable receiving feedback from peers increased from 76.2 to 95.2 percent (p=0.02). Peer observation and feedback of resident teaching during work rounds is feasible and rewarding for the residents involved. Comfort with regards to being observed by peers, with receiving feedback from peers and with giving feedback to peers significantly increased after the study. Most residents reported changes in their teaching behaviour resulting from feedback. Residents felt that observing a peer teach on work rounds was one of the most useful activities to improve their own teaching on work rounds. © Blackwell Publishing Ltd 2013.

  14. 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.

  15. 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

  16. Constructing a Measure of Private-pay Nursing Home Days.

    Science.gov (United States)

    Thomas, Kali S; Silver, Benjamin; Gozalo, Pedro L; Dosa, David; Grabowski, David C; Makineni, Rajesh; Mor, Vincent

    2018-05-01

    Nursing home (NH) care is financed through multiple sources. Although Medicaid is the predominant payer for NH care, over 20% of residents pay out-of-pocket for their care. Despite this large percentage, an accepted measure of private-pay NH occupancy has not been established and little is known about the types of facilities and the long-term care markets that cater to this population. To describe 2 novel measures of private-pay utilization in the NH setting, including the proportion of privately financed residents and resident days, and examine their construct validity. Retrospective descriptive analysis of US NHs in 2007-2009. We used Medicare claims, Medicare Enrollment records, and the Minimum Data Set to create measures of private-pay resident prevalence and proportion of privately financed NH days. We compared our estimates of private-pay utilization to payer data collected in the NH annual certification survey and evaluated the relationships of our measures with facility characteristics. Our measures of private-pay resident prevalence and private-pay days are highly correlated (r=0.83, Ppay residents and days in higher quality facilities. This new methodology provides estimates of private-pay resident prevalence and resident days. These measures were correlated with estimates using other data sources and validated against measures of facility quality. These data set the stage for additional work to examine questions related to NH payment, quality of care, and responses to changes in the long-term care market.

  17. 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)

  18. 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...

  19. 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

  20. 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…

  1. Machiavelli and the Chief Resident.

    Science.gov (United States)

    Raviglione, Mario C.

    1990-01-01

    Precepts from Machiavelli's "The Prince" are used in giving advice to chief residents on how to balance their responsibilities in working for the welfare of both the housestaff and the institution. Subject discussions include the difficulties of introducing change, setting good examples, and supervising former colleagues and peers. (GLR)

  2. 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)

  3. Looking at Organizational Change Through the Construction and Reconstruction of the Underpinning Values of the Organization Through Interactions Among Stakeholders

    Directory of Open Access Journals (Sweden)

    Sueli dos Santos Leitão

    2015-09-01

    Full Text Available Objective – This paper attempts to understand how the stakeholders in an organization - which strives to achieve goals that are sometimes in conflict - construct and reconstruct (through their interactions their beliefs (values related to organizational competition and habits of action (practices. Design/methodology/approach – A qualitative single case study was conducted at a tax consulting firm in the service sector in Brazil, with ongoing organizational change. The firm seeks to find an even balance between fostering human and social development and financial earnings. Semi-structured and in-depth interviews were conducted with the founder, employees, customers and suppliers, in addition to nonparticipant observation, naturally occurring discussions, and documents. Findings – The analysis of the discursive materials showed that organizational practices reflect values formed over several years through the paradoxical tension between the world views of the founder on how the business world actually is and how it should be. The value of “coherence between what is said and what is done” permeated several reflexivity practices, when decisions were taken and the reasons underpinning them were discussed by management and employees, in pursuit of the goals initially proposed. Practical implications – This research contributes to wider-ranging reflections on the competitive world of organizations dealing with the challenges that face them, extending beyond social responsibility. It also illustrates that reflexivity may be particularly helpful in other forprofit organizations, particularly those focused on social innovation. Originality/value – This study promotes a discussion of change as a continuous process, grounded on a differentiated approach to organizational values, highlighting the emerging characteristics of organizational becoming.

  4. ‘Daring Leaps’ Construction of Meaning and Individual Agency in Career Change Narratives in the Media

    Directory of Open Access Journals (Sweden)

    Kirsi LaPointe

    2014-05-01

    Full Text Available The role of individual agency in crafting meaningful work has attracted increasing interest in recent studies of careers and working life. The purpose of this paper is to make visible the role of the media in reproducing and shaping understandings of careers and agency. By analyzing narratives of career change in the Finnish media, we identify three types of narrative and show how they construct meaningful careers by juxtaposing the past and present work in terms of setting, status, meaning, pace, and workload. Overall, these narratives depict a shift from traditional careers toward work that is concrete, meaningful, of lower status, and less hectic. Moreover, the narratives represent career changers as self-reliant heroes taking “daring leaps.” Hence, we argue that the media reproduces individualistic assumptions of careers and reinforces the dominant, neoliberal ideal of self-responsible, autonomous subjects. We conclude by calling for alternative narratives that recognize the need for more meaningful careers but help strengthen agency in a less individualistic fashion.

  5. 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

  6. design and construction of design and construction of pilot scale

    African Journals Online (AJOL)

    eobe

    construction of the extractor, evaporator, condensate receiver and the the extractor, evaporator ... The concept of overall heat transfer coefficient was adopted for calculating the heat ..... Evaporator. Residence time for evaporation = 14070.25s.

  7. Evolution of the Pathology Residency Curriculum

    Directory of Open Access Journals (Sweden)

    Wesley Y. Naritoku MD, PhD

    2016-10-01

    Full Text Available 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.

  8. 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

  9. Women residents, women physicians and medicine's future.

    Science.gov (United States)

    Serrano, Karen

    2007-08-01

    The number of women in medicine has increased dramatically in the last few decades, and women now represent half of all incoming medical students. Yet residency training still resembles the historical model when there were few women in medicine. This article reviews the issues facing women in residency today. Data suggest that the experience of female residents is more negative than that of males. Unique challenges facing female residents include the existence of gender bias and sexual harassment, a scarcity of female mentors in leadership positions, and work/family conflicts. Further research is needed to understand the experience of female residents and to identify barriers that hinder their optimal professional and personal development. Structural and cultural changes to residency programs are needed to better accommodate the needs of female trainees.

  10. 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

  11. 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

  12. 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.

  13. 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.

  14. 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.

  15. Family medicine residency training and burnout: a qualitative study

    Directory of Open Access Journals (Sweden)

    Kimberly Rutherford

    2014-12-01

    Conclusions: The high level of burnout in family medicine residents in BC is a multifactorial and complex phenomenon. Training programs and faculty should be aware of burnout risk factors and strive to implement changes to reduce burnout, including allowing residents increased control over scheduling, access to counseling services and training for resident mentors.

  16. Tracking Emotional and Behavioral Changes in Childhood: Does the Strength and Difficulties Questionnaire Measure the Same Constructs across Time?

    Science.gov (United States)

    Sosu, Edward M.; Schmidt, Peter

    2017-01-01

    R. Goodman's Strength and Difficulties Questionnaire (SDQ) is widely used to measure emotional and behavioral difficulties in childhood and adolescence. In the present study, we examined whether the SDQ measures the same construct across time, when used for longitudinal research. A nationally representative sample of parents (N = 3,375) provided…

  17. 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.

  18. 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

  19. 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

  20. 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.

  1. 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

  2. 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

  3. 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.

  4. 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.

  5. [Medical ethics in residency training].

    Science.gov (United States)

    Civaner, Murat; Sarikaya, Ozlem; Balcioğlu, Harun

    2009-04-01

    Medical ethics education in residency training is one of the hot topics of continuous medical education debates. Its importance and necessity is constantly stressed in declarations and statements on national and international level. Parallel to the major structural changes in the organization and the finance model of health care system, patient-physician relationship, identity of physicianship, social perception and status of profession are changing. Besides, scientific developments and technological advancements create possibilities that never exists before, and bring new ethical dilemmas along with. To be able to transplant human organs has created two major problems for instance; procurement of organs in sufficient numbers, and allocating them to the patients in need by using some prioritizing criteria. All those new and challenging questions force the health care workers to find authentic and justifiable solutions while keeping the basic professional values. In that sense, proper medical ethics education in undergraduate and postgraduate term that would make physician-to-be's and student-physicians acquire the core professional values and skill to notice, analyze and develop justifiable solutions to ethical problems is paramount. This article aims to express the importance of medical ethics education in residency training, and to propose major topics and educational methods to be implemented into. To this aim, first, undergraduate medical education, physician's working conditions, the exam of selection for residency training, and educational environment were revised, and then, some topics and educational methods, which are oriented to educate physicians regarding the professional values that they should have, were proposed.

  6. Factors influencing selection of internal medicine residency--a prospective study.

    Science.gov (United States)

    Pereg, David; Gronich, Naomi; Lishner, Michael

    2006-08-01

    Recently, the popularity of internal medicine residency has been decreasing. We studied the effect of an improved working environment and a decrease in residents' workload on the selection of internal medicine residency. An organizational diagnosis team joined our department and identified several causes for residents' heavy workload. These findings were subsequently discussed in a workshop and led to a modification of the daily routine and a parallel decrease in workload and rise in residents' satisfaction. Following these changes, the demand for residency in our department rose. We conclude that an improvement in the working environment and workload during residency increases the residents' satisfaction and the demand for residency in internal medicine.

  7. Impact of new duty-hour rules on residency training.

    Science.gov (United States)

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

    2010-11-01

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

  8. 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.

  9. Diversity in Dermatology Residency Programs.

    Science.gov (United States)

    Van Voorhees, Abby S; Enos, Clinton W

    2017-10-01

    Given the change in our population to one that is more racially and ethnically diverse, the topic of diversity in dermatology residency programs has gained attention. In a field that has become highly competitive, diversity is lagging behind. What are the reasons for this? The existing diversity among medical school matriculants is reflective of the applicant pool, and although modest, there has been an increase in applications and acceptances from minority populations. However, these proportions do not carry through to the population applying to dermatology residency. Making sense of this and planning how to recruit a more diverse applicant pool will improve the quality and cultural competency of future dermatologists. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  10. How the Social Construction of “Child Abuse” Affect Immigrant Parents: Policy Changes That Protect Children and Families

    OpenAIRE

    REISIG, Jennifer A.; MILLER, Monica K.

    2009-01-01

    Immigrants who move to the United States often face the challenge of interpreting new laws and social norms (e.g., parenting norms), which may vary greatly from their native culture. Acceptable parenting practices are socially constructed beliefs, rooted in cultural context. What is acceptable in one culture may be labeled as child abuse in another. Thus, immigrant parents are at risk for having their parenting practices defined as child abuse by mainstream culture. Defining child abuse in a ...

  11. 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...... in a healthcare system. From our perspective, further sociological and pedagogical investigations in educational cultures across settings and specialties could inform our understanding of and knowledge about pitfalls in residents’ and doctors’ socialization into the healthcare system....

  12. 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

  13. Change of radiation conditions at the ''Ukryttya' object after pitching of arch construction

    International Nuclear Information System (INIS)

    Jegorov, V.V.; Morozov, Yu.V.; Pavlovs'kij, L.Yi.; Kholodyuk, A.O.

    2017-01-01

    Individual measurements of dose rate (DR) capacity values were performed on the outer surfaces (roof) of object ''Ukryttya'', in local zone both before and after pitching of Arch construction (Arch) as well as study the characteristics of angular distribution of gamma radiation intensity at those areas. A comparative analysis of results obtained was performed. At all measuring points after Arch pitching a reduction of DR value, depending on area of research, was observed.Measurements were being performed during the period from 16.11.2016 till 18.01.2017

  14. 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.

  15. Social cost in construction projects

    Energy Technology Data Exchange (ETDEWEB)

    Çelik, Tolga, E-mail: tolga.celik@emu.edu.tr [Department of Civil Engineering, Eastern Mediterranean University, Famagusta, T.R. North Cyprus, Via Mersin 10 (Turkey); Kamali, Saeed, E-mail: saeedkamali2002@gmail.com [Civil Engineering Department, Middle East Technical University, 06800 Ankara (Turkey); Arayici, Yusuf, E-mail: yusuf.arayici@hku.edu.tr [Department of Civil Engineering, Hasan Kalyoncu University, Gaziantep (Turkey)

    2017-05-15

    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.

  16. 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.

  17. 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.

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

    Science.gov (United States)

    Messman, Anne M; Walker, Ian

    2018-01-01

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

  19. 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.

  20. Construction of cell model of silenced Ku80 and the radiobiology change of HeLa cell

    International Nuclear Information System (INIS)

    Zhuang Liang; Yu Shiying; Huang Xiaoyuan; Xiong Huihua; Xiong Hua; Li Xiaolan; Leng Yan

    2007-01-01

    Objective: To construct the cell model of Ku80 with expression inhibited by siRNA and to explore the role of Ku80 in radiobiology. Methods: Ku80-siRNA expression plasmids were constructed and HeLa cells were transfected with these plasmids by lipofectamine. Western blotting was used to measure the expression of Ku80. After irradiation with 6 MV X ray, cells were collected and analyzed by flow cytometry for apoptosis and cell cycle at 24, 48 and 72 h; The radiobiology parameters of four cell lines were acquired by clone formation array. Results: Three stable transfected cell clones were obtained, and the inhibition rates of Ku80 protein expression of two positive clones were 89.3% and 96.4%; The apoptosis rates of HeLa cells Ku80 inhibited were higher than control cells at 48 and 72 after X ray irradiation (P 0.05). HeLa cells of silenced Ku80 had lower SF 2 and D 0 than control cells, and their SER (sensitization enhancement ratio) based on D 10 were 1.315 and 1.365, respectively. Conclusions: The HeLa cell models with Ku80 expression suppressed were successfully established; the inhibition of Ku80 by siRNA could enhance the radiosensitivity of HeLa cells. (authors)

  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. Learning strategies used by cardiology residents: assessment of learning styles and their correlations.

    Science.gov (United States)

    de Lima, Alberto Alves; Bettati, María Ines; Baratta, Sergio; Falconi, Mariano; Sokn, Fernando; Galli, Amanda; Barrero, Carlos; Cagide, Arturo; Iglesias, Ricardo

    2006-11-01

    To identify the learning styles of a group of cardiology residents (R) undergoing a training program at the University of Buenos Aires and to identify correlations of these styles. Statistical data were obtained through a 120-question survey developed by Vermunt and colleagues, which identified four different learning styles: construction-directed; reproduction-directed; application-directed; and undirected. Four variables were identified [gender, previous experience as a teaching assistant (TA) in medical school, university final average (FA) and the public or private institution/centre of origin] in order to analyse level of correlation with learning styles (LS). Between April 2001 and April 2002, 149 residents (R) completed the survey. Average age was 29 (+/-2.7) years old; with 63% being men. The predominant LS were oriented toward knowledge application. In terms of variables, no differences regarding gender were detected; the R with TA showed undirected LS characteristics; those with a low FA registered a tendency towards reproduction-directed LS; and those residents at public/state medical centres indicated construction-directed LS tendencies. An application-directed learning style predominates in this group of residents. Information regarding learning styles can provide foundations upon which arguments can be made for changes in education that are traditionally not evidence-based.

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

    Directory of Open Access Journals (Sweden)

    Júlia Alves Menezes

    Full Text Available 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.

  4. 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.

  5. 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.

  6. 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)

  7. 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.

  8. 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.

  9. 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.

  10. Up and down or down and up? The process of change in constructive couple behavior during Traditional and Integrative Behavioral Couple Therapy.

    Science.gov (United States)

    Sevier, Mia; Atkins, David C; Doss, Brian D; Christensen, Andrew

    2015-01-01

    Observed positive and negative spouse behavior during sessions of Traditional (TBCT) and Integrative Behavioral Couples Therapy (IBCT) were compared for couples with successful outcomes and their unsuccessful counterparts. One hundred and thirty-four married chronically and seriously distressed couples (on average in their forties and 80% Caucasian) were randomly assigned to TBCT or IBCT. Trained observers made ratings of 1224 segments from approximately 956 sessions sampled from the course of up to 26 sessions. Multilevel modeling was used to examine change over time. TBCT treatment responders demonstrated a boost-drop pattern, increasing in constructive behaviors early (more positive behaviors and less negative behaviors) but decreasing later. IBCT responders demonstrated an opposite, drop-boost pattern, decreasing in constructive behaviors early and increasing later. Patterns were significant for positive behaviors (p behaviors (p = .05). In both treatments, nonresponders showed a significant pattern of decline in positive and increase in negative behaviors over time, although a trend (p = .05) indicates that TBCT nonresponders initially declined in negative behaviors. This study helps clarify the different process of change in two behavioral couple therapies, which may assist in treatment development and provide a guide for therapists in considering behavioral markers of change during treatment. © 2013 American Association for Marriage and Family Therapy.

  11. 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

  12. 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

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

    Energy Technology Data Exchange (ETDEWEB)

    Baruffi, F. [Autorita di Bacino dei Fiumi dell' Alto Adriatico, Cannaregio 4314, 30121 Venice (Italy); Cisotto, A., E-mail: segreteria@adbve.it [Autorita di Bacino dei Fiumi dell' Alto Adriatico, Cannaregio 4314, 30121 Venice (Italy); Cimolino, A.; Ferri, M.; Monego, M.; Norbiato, D.; Cappelletto, M.; Bisaglia, M. [Autorita di Bacino dei Fiumi dell' Alto Adriatico, Cannaregio 4314, 30121 Venice (Italy); Pretner, A.; Galli, A. [SGI Studio Galli Ingegneria, via della Provvidenza 13, 35030 Sarmeola di Rubano (PD) (Italy); Scarinci, A., E-mail: andrea.scarinci@sgi-spa.it [SGI Studio Galli Ingegneria, via della Provvidenza 13, 35030 Sarmeola di Rubano (PD) (Italy); Marsala, V.; Panelli, C. [SGI Studio Galli Ingegneria, via della Provvidenza 13, 35030 Sarmeola di Rubano (PD) (Italy); Gualdi, S., E-mail: silvio.gualdi@bo.ingv.it [Centro Euro-Mediterraneo per i Cambiamenti Climatici (CMCC), via Augusto Imperatore 16, 73100 Lecce (Italy); Bucchignani, E., E-mail: e.bucchignani@cira.it [Centro Euro-Mediterraneo per i Cambiamenti Climatici (CMCC), via Augusto Imperatore 16, 73100 Lecce (Italy); Torresan, S., E-mail: torresan@cmcc.it [Centro Euro-Mediterraneo per i Cambiamenti Climatici (CMCC), via Augusto Imperatore 16, 73100 Lecce (Italy); Pasini, S., E-mail: sara.pasini@stud.unive.it [Centro Euro-Mediterraneo per i Cambiamenti Climatici (CMCC), via Augusto Imperatore 16, 73100 Lecce (Italy); Department of Environmental Sciences, Informatics and Statistics, University Ca' Foscari Venice, Calle Larga S. Marta 2137, 30123 Venice (Italy); Critto, A., E-mail: critto@unive.it [Centro Euro-Mediterraneo per i Cambiamenti Climatici (CMCC), via Augusto Imperatore 16, 73100 Lecce (Italy); Department of Environmental Sciences, Informatics and Statistics, University Ca' Foscari Venice, Calle Larga S. Marta 2137, 30123 Venice (Italy); and others

    2012-12-01

    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 produced

  14. 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.

  15. 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.

  16. 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.

  17. Protocol for the residents in action pilot cluster randomised controlled trial (RiAT): evaluating a behaviour change intervention to promote walking, reduce sitting and improve mental health in physically inactive older adults in retirement villages.

    Science.gov (United States)

    Thøgersen-Ntoumani, Cecilie; Wright, Ashlene; Quested, Eleanor; Burton, Elissa; Hill, Keith D; Cerin, Ester; Biddle, Stuart J H; Ntoumanis, Nikos

    2017-06-23

    Ageing is accompanied by increased risks of chronic disease, declined functioning and increased dependency. Physical activity is critical to retaining health and independence, but the majority of older people are insufficiently physically active to achieve these benefits and have high levels of sedentary (sitting) time. Activity programmes are often offered in retirement villages; however, their uptake is limited. Furthermore, although the physical environment in and around these villages can play an important role in decisions to be physically active, its role is often overlooked by research in these settings. We aim to develop, implement and evaluate a proof-of-concept motivationally embellished intervention designed to increase walking, reduce sitting and improve mental health in residents in retirement villages. This will be a 16-week pilot intervention using a cluster randomised design with retirement villages as the unit of randomisation and residents as the unit of assessment. Fourteen retirement villages around Perth, Western Australia, will be recruited for the intervention. Objective audits of neighbourhood environments around each village will be completed using the Pathway Environmental Audit Tool. Seven villages will be randomised to the experimental arm and seven to the control arm. Only participants in the experimental arm will receive motivational training. All outcomes will be assessed at baseline, end of intervention and 6-month follow-up. Changes in physical activity levels, sitting time and mental health will be examined. Multilevel modelling will be used to analyse the data. A mixed methods process evaluation will also be conducted. Ethics approval was granted by Curtin University's Human Research Ethics Committee (HREC2016-0187). The results of the study will be disseminated via peer-reviewed publications, conference presentations and reports to, and seminars with, stakeholders. The trial is registered with the Australian New Zealand Clinical

  18. 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

  19. 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.

  20. 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.

  1. Cognitive learning during surgical residency. A model for curriculum evaluation.

    Science.gov (United States)

    Rhodes, R S; Wile, M Z; Persons, M L; Shuck, J M

    1987-02-01

    The program summary of the American Board of Surgery In-Service Training Exam (ABSITE) can be used to quantitate cognitive learning during a surgical residency and to identify areas of curricular weakness in a residency program. Knowledge on each question is categorized as high (known) or low (unknown) depending on the percentage of residents who answered correctly. Knowledge of Level 1 (entry) residents is then compared with Level 5 (exit) residents. Each ABSITE question can thus be categorized on entry versus exit as known-known, unknown-unknown, unknown-known, and known-unknown. Only about half of unknown knowledge on entry appears to become known on exit. Very little knowledge known on entry becomes unknown on exit. Weaknesses in specific subject areas can be readily identified by ranking questions according to the number of exiting residents who answer incorrectly. Use of this technique to quantitate cognitive learning in a residency program may allow objective assessment of changes in curriculum.

  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. 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

  4. The urology residency matching program in practice.

    Science.gov (United States)

    Teichman, J M; Anderson, K D; Dorough, M M; Stein, C R; Optenberg, S A; Thompson, I M

    2000-06-01

    We evaluate behaviors and attitudes among resident applicants and program directors related to the American Urological Association (AUA) residency matching program and recommend changes to improve the match. Written questionnaires were mailed to 519 resident applicants and 112 program directors after the 1999 American Urological Association match. Subjects were asked about their observations, behaviors and opinions towards the match. Questionnaires were returned by 230 resident applicants and 94 program directors (44% and 83% response rates, respectively.) Of the resident applicants 75% spent $1,001 to $5,000 for interviewing. Of the program directors 47% recalled that applicants asked how programs would rank the applicant and 61% of applicants recalled that program directors asked applicants how they would rank programs. Dishonesty was acknowledged by 31% of program directors and 44% of resident applicants. Of program directors 82% thought applicants "lied", while 67% of applicants thought that programs "lied" (quotations indicate questionnaire language). Participants characterized their own dishonesty as "just playing the game" or they "did not feel badly." Of program directors 81% and of applicants 61% were "skeptical" or "did not believe" when informed they were a "high" or "number 1" selection. Being asked about marital status was recalled by 91% of male and 100% of female (p = 0. 02), if they had children by 53% of male and 67% of female, (p = 0. 03), and intent to have children by 25% of male and 62% of female (p match code rules frequently. Program directors and resident applicants are skeptical of each other. Patterns of faculty behavior differ based on applicant gender. Interviews are costly for applicants. We recommend that 1) programs adopt policies to enhance fairness, 2) applications be filed electronically, 3) programs assist resident applicants with interview accommodation to reduce financial burden and 4) a post-interview code of limited or

  5. 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.

  6. 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

  7. 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)

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

    Science.gov (United States)

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

    2017-10-01

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

  9. 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.:…

  10. Texting preferences in a Paediatric residency.

    Science.gov (United States)

    Draper, Lauren; Kuklinski, Cadence; Ladley, Amy; Adamson, Greg; Broom, Matthew

    2017-12-01

    Text messaging is ubiquitous among residents, but remains an underused educational tool. Though feasibility has been demonstrated, evidence of its ability to improve standardised test scores and provide insight on resident texting preferences is lacking. The authors set out to evaluate: (1) satisfaction with a hybrid question-and-answer (Q&A) texting format; and (2) pre-/post-paediatric in-training exam (ITE) performance. A prospective study with paediatrics and internal medicine-paediatrics residents. Residents were divided into subgroups: adolescent medicine (AM) and developmental medicine (DM). Messages were derived from ITE questions and sent Monday-Friday with a 20 per cent variance in messages specific to the sub-group. Residents completed surveys gauging perceptions of the programme, and pre- and post-programme ITE scores were analysed. Forty-one residents enrolled and 32 (78%) completed a post-programme survey. Of those, 21 (66%) preferred a Q&A format with an immediate text response versus information-only texts. The percentage change in ITE scores between 2013 and 2014 was significant. Comparing subgroups, there was no significant difference between the percentage change in ITE scores. Neither group performed significantly better on either the adolescent or developmental sections of the ITE. Text messaging… remains an underused educational tool CONCLUSIONS: Overall, participants improved their ITE scores, but no improvement was seen in the targeted subgroups on the exam. Although Q&A texts are preferred by residents, further assessment is required to assess the effect on educational outcomes. © 2017 John Wiley & Sons Ltd and The Association for the Study of Medical Education.

  11. Eugenics, sexual pedagogy and social change: constructing the responsible subject of governmentality in the Spanish Second Republic.

    Science.gov (United States)

    Jiménez-Alonso, Belén

    2008-06-01

    This study focuses on eugenics in Spain, and more specifically on the 'official' eugenics whose platform was the Primeras Jornadas Eugénicas Españolas (First Spanish Eugenic Days, FSED). The aim of this paper is to relate eugenics to 'governmentality' rather than to State politics alone and to 'Latin eugenics' rather than to 'mainline eugenics'. On the one hand, the FSED were largely centred on the development of a new sexual code which would set Catholic sexual morality aside. For this reason, sexual pedagogy was one of the most relevant topics during the FSED, personal responsibility becoming the first step to social change. The concern about making people play an active role in their own self-regulation is typical of governmentality. The latter refers to societies where power is decentered and where the objective is to structure the field of action of others (the conduct of conduct). On the other hand, the FSED emphasised preventive eugenics such as welfare programmes and health campaigns rather than negative eugenics such as the sterilisation of the unfit. The situation in Spain was mirrored in countries such as Brazil, Argentina and Mexico, which allows us to think about them in terms of 'Latin eugenics' rather than 'mainline eugenics' from countries such as Great Britain, Germany and the USA.

  12. 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.

  13. 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.

  14. 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.

  15. 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

  16. 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...

  17. The Impossible Sustainability of the Bay of Brest? Fifty Years of Ecosystem Changes, Interdisciplinary Knowledge Construction and Key Questions at the Science-Policy-Community Interface

    Directory of Open Access Journals (Sweden)

    Olivier Ragueneau

    2018-04-01

    Full Text Available In this contribution, the study of the Bay of Brest ecosystem changes over the past 50 years is used to explore the construction of interdisciplinary knowledge and raise key questions that now need to be tackled at the science-policy-communities interface. The Bay of Brest is subject to a combination of several aspects of global change, including excessive nutrient inputs from watersheds and the proliferation of invasive species. These perturbations strongly interact, affecting positively or negatively the ecosystem functioning, with important impacts on human activities. We first relate a cascade of events over these five decades, linking farming activities, nitrogen, and silicon biogeochemical cycles, hydrodynamics of the Bay, the proliferation of an exotic benthic suspension feeder, the development of the Great scallop fisheries and the high biodiversity in maerl beds. The cascade leads to today's situation where toxic phytoplankton blooms become recurrent in the Bay, preventing the fishery of the great scallop and forcing the fishermen community to switch pray and alter the maerl habitat and the benthic biodiversity it hosts, despite the many scientific alerts and the protection of this habitat. In the second section, we relate the construction of the interdisciplinary knowledge without which scientists would never have been able to describe these changes in the Bay. Interdisciplinarity construction is described, first among natural sciences (NS and then, between natural sciences and human and social sciences (HSS. We finally ask key questions at the science-policy interface regarding this unsustainable trend of the Bay: How is this possible, despite decades of joint work between scientists and fishermen? Is adaptive co-management a sufficient condition for a sustainable management of an ecosystem? How do the different groups (i.e., farmers, fishermen, scientists, environmentalists, with their diverse interests, take charge of this situation

  18. 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

  19. How engineering facilitates construction

    International Nuclear Information System (INIS)

    Bailey, D.T.

    1976-01-01

    During a recent survey, construction personnel at jobsites were asked, ''what are the ten most unwanted construction problems.'' One reoccurring answer was design/construction incompatibility. In fact, many designs were impractical from a construction point of view. The reasons for this problem can be identified: Once construction begins, engineering is under intense pressure to issue new drawings to allow work to progress according to schedule. Other reasons may be the relative inexperience of the design personnel in construction, changes in design criteria and delays in receipt of supplier or client information. A description is presented of ways to solve this problem by obtaining construction expertise and input into the various phases and products of the engineering work

  20. Electrochemical construction

    Science.gov (United States)

    Einstein, Harry; Grimes, Patrick G.

    1983-08-23

    An electrochemical cell construction features a novel co-extruded plastic electrode in an interleaved construction with a novel integral separator-spacer. Also featured is a leak and impact resistant construction for preventing the spill of corrosive materials in the event of rupture.

  1. Usability Constructs

    DEFF Research Database (Denmark)

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

    2007-01-01

    Whereas research on usability predominantly employs universal definitions of the aspects that comprise usability, people experience their use of information systems through personal constructs. Based on 48 repertory-grid interviews, this study investigates how such personal constructs are affected...... use of constructs traditionally associated with usability (e.g., easy-to-use, intuitive, and liked). Further analysis of the data is ongoing...

  2. 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.

  3. Resident away rotations allow adaptive neurosurgical training.

    Science.gov (United States)

    Gephart, Melanie Hayden; Derstine, Pamela; Oyesiku, Nelson M; Grady, M Sean; Burchiel, Kim; Batjer, H Hunt; Popp, A John; Barbaro, Nicholas M

    2015-04-01

    Subspecialization of physicians and regional centers concentrate the volume of certain rare cases into fewer hospitals. Consequently, the primary institution of a neurological surgery training program may not have sufficient case volume to meet the current Residency Review Committee case minimum requirements in some areas. To ensure the competency of graduating residents through a comprehensive neurosurgical education, programs may need for residents to travel to outside institutions for exposure to cases that are either less common or more regionally focused. We sought to evaluate off-site rotations to better understand the changing demographics and needs of resident education. This would also allow prospective monitoring of modifications to the neurosurgery training landscape. We completed a survey of neurosurgery program directors and query of data from the Accreditation Council of Graduate Medical Education to characterize the current use of away rotations in neurosurgical education of residents. We found that 20% of programs have mandatory away rotations, most commonly for exposure to pediatric, functional, peripheral nerve, or trauma cases. Most of these rotations are done during postgraduate year 3 to 6, lasting 1 to 15 months. Twenty-six programs have 2 to 3 participating sites and 41 have 4 to 6 sites distinct from the host program. Programs frequently offset potential financial harm to residents rotating at a distant site by support of housing and transportation costs. As medical systems experience fluctuating treatment paradigms and demographics, over time, more residency programs may adapt to meet the Accreditation Council of Graduate Medical Education case minimum requirements through the implementation of away rotations.

  4. 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

  5. Governing through time: management of radioactive waste in France, organizational changes and the construction of irreversible technical solutions (1950-2014)

    International Nuclear Information System (INIS)

    Blanck, Julie

    2017-01-01

    In France, the problem of radioactive waste has been subjected to different solutions. In 1979, the storage of radioactive waste was entrusted to a specialized operator, the National Agency for Radioactive Waste Management (Andra). Yet, through the course of its history, the Agency has faced many difficulties to implement its projects, which often came under strong public criticism. Still today, while its project of geological disposal is about to move into its industrial phase, the Andra is still widely criticized and serves as a crystallization point for power relationships in the nuclear sector. In order to retrace the evolution of French radioactive waste management since the 1950's, the archival and ethnographic study of the Andra's organizational work provides an insider perspective on how its agents have defined problems, as well as conceived and implemented solutions. Indeed, through this strategic and political work, they have frequently transformed the Agency to fit the progress of its projects. From an industrial subsidiary of the French Atomic Energy Commission (CEA), the Agency was transformed into a finalized research agency, then again into an industrial operator in order to undertake to construction the geological disposal site. Through to these changes, actors have been able to revived criticized projects, without necessarily modifying their contents. In fact, it is not stability but organizational and institutional flexibility, which can account for the preservation of these controversial solutions. Lastly, the problem of radioactive waste crystallizes a multiplicity of temporal logics. The analysis of this work of temporalization, which can be seen as a particular kind of organization, questions the articulation between change and permanency of public action. As such, this study sheds light on the relation between dynamics of problem definition, the construction of irreversible technical solutions, and organizational and temporal work

  6. 48 CFR 852.236-88 - Contract changes-supplement.

    Science.gov (United States)

    2010-10-01

    ... small tools, incidental job burdens, and general home office expenses and no separate allowance will be... contractor shall submit proposals for changes in work to the resident engineer. Proposals, to be submitted as..., labor costs (separated into trades), construction equipment, etc. (Labor costs are to be identified with...

  7. 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.

  8. 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.

  9. 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

  10. Have the 'black clouds' cleared with new residency programme regulations?

    Science.gov (United States)

    Schissler, A J; Einstein, A J

    2016-06-01

    For decades, residents believed to work harder have been referred to as having a 'black cloud'. Residency training programmes recently instituted changes to improve physician wellness and achieve comparable clinical workload. All Internal Medicine residents in the internship class of 2014 at Columbia were surveyed to assess for the ongoing presence of 'black cloud' trainees. While some residents are still thought to have this designation, they did not have a greater workload when compared to their peers. © 2016 Royal Australasian College of Physicians.

  11. 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

  12. 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...

  13. A Professionalism Curricular Model to Promote Transformative Learning Among Residents.

    Science.gov (United States)

    Foshee, Cecile M; Mehdi, Ali; Bierer, S Beth; Traboulsi, Elias I; Isaacson, J Harry; Spencer, Abby; Calabrese, Cassandra; Burkey, Brian B

    2017-06-01

    Using the frameworks of transformational learning and situated learning theory, we developed a technology-enhanced professionalism curricular model to build a learning community aimed at promoting residents' self-reflection and self-awareness. The RAPR model had 4 components: (1) R ecognize : elicit awareness; (2) A ppreciate : question assumptions and take multiple perspectives; (3) P ractice : try new/changed perspectives; and (4) R eflect : articulate implications of transformed views on future actions. The authors explored the acceptability and practicality of the RAPR model in teaching professionalism in a residency setting, including how residents and faculty perceive the model, how well residents carry out the curricular activities, and whether these activities support transformational learning. A convenience sample of 52 postgraduate years 1 through 3 internal medicine residents participated in the 10-hour curriculum over 4 weeks. A constructivist approach guided the thematic analysis of residents' written reflections, which were a required curricular task. A total of 94% (49 of 52) of residents participated in 2 implementation periods (January and March 2015). Findings suggested that RAPR has the potential to foster professionalism transformation in 3 domains: (1) attitudinal, with participants reporting they viewed professionalism in a more positive light and felt more empathetic toward patients; (2) behavioral, with residents indicating their ability to listen to patients increased; and (3) cognitive, with residents indicating the discussions improved their ability to reflect, and this helped them create meaning from experiences. Our findings suggest that RAPR offers an acceptable and practical strategy to teach professionalism to residents.

  14. Accuracy of electrocardiogram reading by family practice residents.

    Science.gov (United States)

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

    2000-05-01

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

  15. Resident Peritoneal NK cells

    Science.gov (United States)

    Gonzaga, Rosemary; Matzinger, Polly; Perez-Diez, Ainhoa

    2011-01-01

    Here we describe a new population of NK cells that reside in the normal, un-inflamed peritoneal cavity. Phenotypically, they share some similarities with the small population of CD49b negative, CD27 positive immature splenic NK cells, and liver NK cells but differ in their expression of CD62L, TRAIL and EOMES. Functionally, the peritoneal NK cells resemble the immature splenic NK cells in their production of IFN-γ, GM-CSF and TNF-α and in the killing of YAC-1 target cells. We also found that the peritoneum induces different behavior in mature and immature splenic NK cells. When transferred intravenously into RAGγcKO mice, both populations undergo homeostatic proliferation in the spleen, but only the immature splenic NK cells, are able to reach the peritoneum. When transferred directly into the peritoneum, the mature NK cells survive but do not divide, while the immature NK cells proliferate profusely. These data suggest that the peritoneum is not only home to a new subset of tissue resident NK cells but that it differentially regulates the migration and homeostatic proliferation of immature versus mature NK cells. PMID:22079985

  16. 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.

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

    Science.gov (United States)

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

    2013-01-01

    findings suggest that structured residency research programs are associated with higher resident research productivity. The program duration and the fraction of faculty in resident research education did not significantly increase research productivity. Research training is an integral component of resident education, but the mandatory enhancement of resident research education will require a significant change in the culture of academic anesthesiology leadership and faculty.

  18. About Politeness, Face, and Feedback: Exploring Resident and Faculty Perceptions of How Institutional Feedback Culture Influences Feedback Practices.

    Science.gov (United States)

    Ramani, Subha; Könings, Karen D; Mann, Karen V; Pisarski, Emily E; van der Vleuten, Cees P M

    2018-03-06

    To explore resident and faculty perspectives on what constitutes feedback culture, their perceptions of how institutional feedback culture (including politeness concepts) might influence the quality and impact of feedback, feedback seeking, receptivity, and readiness to engage in bidirectional feedback. Using a constructivist grounded theory approach, five focus group discussions with internal medicine residents, three focus group discussions with general medicine faculty, and eight individual interviews with subspecialist faculty were conducted at Brigham and Women's Hospital between April and December 2016. Discussions and interviews were audiotaped and transcribed verbatim; concurrent data collection and analysis were performed using the constant comparative approach. Analysis was considered through the lens of politeness theory and organizational culture. Twenty-nine residents and twenty-two general medicine faculty participated in focus group discussions, and eight subspecialty faculty participated in interviews. The institutional feedback culture was described by participants as: (1) a culture of politeness, in which language potentially damaging to residents' self-esteem was discouraged, and (2) a culture of excellence, in which the institution's outstanding reputation and pedigree of trainees inhibited constructive feedback. Three key themes situated within this broader cultural context were discovered: normalizing constructive feedback to promote a culture of growth, overcoming the mental block to feedback seeking, and hierarchical culture impeding bidirectional feedback. An institutional feedback culture of excellence and politeness may impede honest, meaningful feedback and may impact feedback seeking, receptivity, and bidirectional feedback exchanges. It is essential to understand the institutional feedback culture before it can be successfully changed.

  19. 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.

  20. 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. 

  1. Construction mathematics

    CERN Document Server

    Virdi, Surinder; Virdi, Narinder Kaur

    2014-01-01

    Construction Mathematics is an introductory level mathematics text, written specifically for students of construction and related disciplines. Learn by tackling exercises based on real-life construction maths. Examples include: costing calculations, labour costs, cost of materials and setting out of building components. Suitable for beginners and easy to follow throughout. Learn the essential basic theory along with the practical necessities. The second edition of this popular textbook is fully updated to match new curricula, and expanded to include even more learning exercises. End of chapter exercises cover a range of theoretical as well as practical problems commonly found in construction practice, and three detailed assignments based on practical tasks give students the opportunity to apply all the knowledge they have gained. Construction Mathematics addresses all the mathematical requirements of Level 2 construction NVQs from City & Guilds/CITB and Edexcel courses, including the BTEC First Diploma in...

  2. 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.)

  3. The pregnant female surgical resident

    Directory of Open Access Journals (Sweden)

    Shifflette V

    2018-05-01

    Full Text Available Vanessa Shifflette,1 Susannah Hambright,2 Joseph Darryl Amos,1 Ernest Dunn,3 Maria Allo4 1Associates in Surgical Acute Care, Methodist Dallas Medical Center, Dallas, TX, USA; 2Methodist Surgical Associates, Methodist Dallas Medical Center, Dallas, TX, USA; 3Graduate Medical Education - General Surgery, Methodist Dallas Medical Center, Dallas, TX, USA; 4Santa Clara Valley Medical Center, San Jose, CA, USA Background: Surgery continues to be an intense, time-consuming residency. Many medical students decide against surgery as a profession due to the long work hours and family strain. The pregnant female surgical resident has an added stress factor compared to her male counterpart. Methods: We distributed an electronic, online 26-question survey to 32 general surgery programs in the southwestern region of the United States. Each program distributed our survey to the female surgical residents who had been pregnant during residency in the last 5 years. Each program was re-contacted 6 weeks after the initial contact. Most questions were in a 5-point Likert scale format. The responses were collected and analyzed using the Survey Monkey website. Results: An unvalidated survey was sent to 32 general surgery programs and 26 programs responded (81%. Each program was asked for the total number of possible responses from female residents that met our criteria (60 female residents. Seven of the programs (27% stated that they have had zero residents pregnant. We had 22 residents respond (37%. Over half of the residents (55% were pregnant during their 2nd or 3rd year of residency, with only 18% pregnant during a research year. Thirty-one percent had a lower American Board of Surgery In-Training Exam (ABSITE score. Ninety percent of the residents were able to take 4 weeks or more for maternity leave. Most of the residents (95% stated that they would do this again during residency given the opportunity, but many of the residents felt that returning back to work

  4. 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.

  5. 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...

  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. Construction Management.

    Science.gov (United States)

    Abbott, James F.

    This article provides a detailed discussion of a team approach to building that involves a construction manager, an architect, and a contractor. Bidding methods are outlined; the major components in construction management -- value engineering and fast track scheduling -- and the use of performance specifications are discussed. The construction…

  8. 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

  9. 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.

  10. 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.

  11. Practice management education during surgical residency.

    Science.gov (United States)

    Jones, Kory; Lebron, Ricardo A; Mangram, Alicia; Dunn, Ernest

    2008-12-01

    Surgical education has undergone radical changes in the past decade. The introductions of laparoscopic surgery and endovascular techniques have required program directors to alter surgical training. The 6 competencies are now in place. One issue that still needs to be addressed is the business aspect of surgical practice. Often residents complete their training with minimal or no knowledge on coding of charges or basic aspects on how to set up a practice. We present our program, which has been in place over the past 2 years and is designed to teach the residents practice management. The program begins with a series of 10 lectures given monthly beginning in August. Topics include an introduction to types of practices available, negotiating a contract, managed care, and marketing the practice. Both medical and surgical residents attend these conferences. In addition, the surgical residents meet monthly with the business office to discuss billing and coding issues. These are didactic sessions combined with in-house chart reviews of surgical coding. The third phase of the practice management plan has the coding team along with the program director attend the outpatient clinic to review in real time the evaluation and management coding of clinic visits. Resident evaluations were completed for each of the practice management lectures. The responses were recorded on a Likert scale. The scores ranged from 4.1 to 4.8 (average, 4.3). Highest scores were given to lectures concerning negotiating employee agreements, recruiting contracts, malpractice insurance, and risk management. The medical education department has tracked resident coding compliance over the past 2 years. Surgical coding compliance increased from 36% to 88% over a 12-month period. The program director who participated in the educational process increased his accuracy from 50% to 90% over the same time period. When residents finish their surgical training they need to be ready to enter the world of business

  12. 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.

  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. 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

  15. [Resident evaluation of general surgery training programs].

    Science.gov (United States)

    Espinoza G, Ricardo; Danilla E, Stefan; Valdés G, Fabio; San Francisco R, Ignacio; Llanos L, Osvaldo

    2009-07-01

    The profile of the general surgeon has changed, aiming to incorporate new skills and to develop new specialties. To assess the quality of postgraduate General Surgery training programs given by Chilean universities, the satisfaction of students and their preferences after finishing the training period. A survey with multiple choice and Likert type questions was designed and applied to 77 surgery residents, corresponding to 59% of all residents of general surgery specialization programs of Chilean universities. Fifty five per cent of residents financed with their own resources the specialization program. Thirty nine percent disagreed partially or totally with the objectives and rotations of programs. The opportunity to perform surgical interventions and the support by teachers was well evaluated. However, 23% revealed teacher maltreatment. Fifty six percent performed research activities, 73% expected to continue training in a derived specialty and 69% was satisfied with the training program. Residents considered that the quality and dedication of professors and financing of programs are issues that must be improved. The opportunity to perform surgical interventions, obtaining a salary for their work and teacher support is considered of utmost importance.

  16. [Motivation and satisfaction of residents in urology].

    Science.gov (United States)

    Enzmann, T; Buxel, H; Benzing, F

    2010-08-01

    To address the increasing shortage of qualified residents, which leads to further discontent and additional on-call rotations for the remaining physicians, an analysis of the current situation was performed. Stress in the daily working routine, not enough free time, too little pay, or too little compensatory time off for overtime as well as inadequate options for continuing education were reported to be the main elements of dissatisfaction. The economic pressure of day-to-day work continues to define the physician's role and places demands on the medical staff by burdening them with nonmedical and administrative tasks.The major causes mentioned were staff shortage and lack of support provided by supervisors and the administration. For this reason, human resource development should be considered a strategic and central goal. This requires a normative, cross-functional approach at all levels of management and inclusion of personnel departments in the strategic processes of the hospital. The most important aspects for resident satisfaction were the work environment, acceptable work-life balance and remuneration, compensation for overtime, and quality of available continuing education, which is often rated as being insufficient.Effective strategies to improve the motivation of residents comprise offering opportunities for structured continuing education, optimizing the everyday work processes, and involving employees in social networks. The establishment of feedback strategies, including recognition of residents' achievements, will help to ensure their loyalty and identification with their clinic. This can serve as a preventive measure to offset any potential willingness to change jobs.

  17. The Effect of Thermal Mass on Annual Heat Load and Thermal Comfort in Cold Climate Construction

    DEFF Research Database (Denmark)

    Stevens, Vanessa; Kotol, Martin; Grunau, Bruno

    2016-01-01

    been shown to reduce the annual heating demand. However, few studies exist regarding the effects of thermal mass in cold climates. The purpose of this research is to determine the effect of high thermal mass on the annual heat demand and thermal comfort in a typical Alaskan residence using energy......Thermal mass in building construction refers to a building material's ability to absorb and release heat based on changing environmental conditions. In building design, materials with high thermal mass used in climates with a diurnal temperature swing around the interior set-point temperature have...... modeling software. The model simulations show that increased thermal mass can decrease the risk of summer overheating in Alaskan residences. They also show that increased thermal mass does not significantly decrease the annual heat load in residences located in cold climates. These results indicate...

  18. 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

  19. 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.

  20. 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...

  1. 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.

  2. How much guidance is given in the operating room? Factors influencing faculty self-reports, resident perceptions, and faculty/resident agreement.

    Science.gov (United States)

    Torbeck, Laura; Williams, Reed G; Choi, Jennifer; Schmitz, Connie C; Chipman, Jeffrey G; Dunnington, Gary L

    2014-10-01

    Guidance in the operating room impacts resident confidence and ability to function independently. The purpose of this study was to explore attending surgeon guidance practices in the operating room as reported by faculty members themselves and by junior and senior residents. This was an exploratory, cross-sectional survey research study involving 91 categorical residents and 82 clinical faculty members at two academic general surgery training programs. A series of analyses of variance along with descriptive statistics were performed to understand the impact of resident training year, program, and surgeon characteristics (sex and type of surgery performed routinely) on guidance practices. Resident level (junior versus senior) significantly impacted the amount of guidance given as reported by faculty and as perceived by residents. Within each program, junior residents perceived less guidance than faculty reported giving. For senior guidance practices, however, the differences between faculty and resident practices varied by program. In terms of the effects of surgeon practice type (mostly general versus mostly complex cases), residents at both institutions felt they were more supervised closely by the faculty who perform mostly complex cases. More autonomy is given to senior than to junior residents. Additionally, faculty report a greater amount of change in their guidance practices over the training period than residents perceive. Faculty and resident agreement about the need for guidance and for autonomy are important for achieving the goals of residency training. Copyright © 2014 Elsevier Inc. All rights reserved.

  3. Psychiatry residents in a milieu participatory democracy: a resident's view.

    Science.gov (United States)

    Gersten, D

    1978-11-01

    Psychiatry residents respond with a variety of coping mechanisms to the lack of traditional structure in a milieu participatory democracy. To incorporate themselves into the system they must accept such democratic ideals as equality among staff and patients, group decision making, and free self-expression and give up some of their traditional ideas about staff and patient roles, treatment modalities, and the therapeutic environment. The author was a first-year resident in psychiatry on a university hospital inpatient therapeutic community; he discusses the conflicts between residents, who often adopt a "we-they" attitude, and the permanent staff, whose protectiveness of the ward community reflects their personal commitment to its ideals.

  4. Does Residency Selection Criteria Predict Performance in Orthopaedic Surgery Residency?

    Science.gov (United States)

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

    2016-04-01

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

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

    Science.gov (United States)

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

    2006-12-01

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

  6. Attrition from surgical residency training: perspectives from those who left.

    Science.gov (United States)

    Bongiovanni, Tasce; Yeo, Heather; Sosa, Julie A; Yoo, Peter S; Long, Theodore; Rosenthal, Marjorie; Berg, David; Curry, Leslie; Nunez-Smith, Marcella

    2015-10-01

    High rates of attrition from general surgery residency may threaten the surgical workforce. We sought to gain further insight regarding resident motivations for leaving general surgery residency. We conducted in-depth interviews to generate rich narrative data that explored individual experiences. An interdisciplinary team used the constant comparative method to analyze the data. Four themes characterized experiences of our 19 interviewees who left their residency program. Participants (1) felt an informal contract was breached when clinical duties were prioritized over education, (2) characterized a culture in which there was no safe space to share personal and programmatic concerns, (3) expressed a scarcity of role models who demonstrated better work-life balance, and (4) reported negative interactions with authority resulting in a profound loss of commitment. As general surgery graduate education continues to evolve, our findings may inform interventions and policies regarding programmatic changes to boost retention in surgical residency. Copyright © 2015 Elsevier Inc. All rights reserved.

  7. 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.

  8. 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...

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

    Science.gov (United States)

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

    2015-01-01

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

  10. [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.

  11. 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.

  12. Personal finances of urology residents in Canada.

    Science.gov (United States)

    Teichman, J M; Tongco, W; MacNeily, A E; Smart, M

    2000-12-01

    We examined how Urology residents in Canada manage their personal finances. A survey instrument was designed to elicit information on demographics, expenses, savings and incomes. The questionnaire was completed by 40 Urology residents attending the 2000 Queen's Urology Exam Skills Training (QUEST) program. Twenty-eight residents (70%) had educational debt (median debt $50 000). Seventeen residents (45%) paid credit card interest charges within the last year. Four residents (10%) maintained an unpaid credit card balance > $7500 at 17% annual interest rate. Twenty-six residents (67%) contributed to Registered Retirement Savings Program (RRSP) accounts. Seventeen residents (44%) contributed to non-RRSP retirement accounts. Nineteen residents (50%) budgeted expenses. Median resident income was $45 000. Thirteen residents (34%) had cash reserves < $250. Many residents save little, and incur substantial debt over and above educational loans. Many residents would benefit from instruction concerning prudent financial management. Residents should be informed of the consequences of low saving and high debt.

  13. 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.

  14. 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,...

  15. 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...

  16. Constructing sanctions

    DEFF Research Database (Denmark)

    Jaeger, Mark Daniel

    2016-01-01

    such an effect. This paper explores sanctions conflicts as social constructs. It purports that rally-around-the-flag is all but one part of the discursive dimension of sanctions conflicts. Sanctions are intricately connected with the conflict setting they occur in. The study suggests a dialectical relation...... between how opponents perceive conflicts and the meaning of sanctions therein. This nexus of different constructions of sanctions moreover extends to “targeted” sanctions as well: As restrictive measures against Zimbabwe demonstrate, they are not the kind of minimally-invasive operations with clinical...

  17. Estimating the distribution of lifetime cumulative radon exposures for California residents: a brief summary

    International Nuclear Information System (INIS)

    Liu, K.-S.; Chang, Y.-L.; Hayward, S.B.; Gadgil, A.J.; Nero, A.V.

    1992-01-01

    Data on residential radon concentrations in California, together with information on California residents' moving houses and time-activity patterns, have been used to estimate the distribution of lifetime cumulative exposures to 222 Rn. This distribution was constructed using Monte Carlo techniques to simulate the lifetime occupancy histories and associated radon exposures of 10,000 California residents. For standard male and female lifespans, the simulation sampled from transition probability matrices representing changes of residence within and between six regions of California, as well as into and out of the other United States, and then sampled from the appropriate regional (or national) distribution of indoor concentrations. The resulting distribution of lifetime cumulative exposures has a significantly narrower relative width than the distribution of California indoor concentrations, with only a small fraction (less than 0.2%) of the population having lifetime exposures equivalent to living their lifetimes in a single home with a radon concentration of 148 Bq.m -3 or more. (author)

  18. Designing and implementing a resiliency program for family medicine residents.

    Science.gov (United States)

    Brennan, Julie; McGrady, Angele

    2015-01-01

    Family medicine residents are at risk for burnout due to extended work hours, lack of control over their work schedule, and challenging work situations and environments. Building resiliency can prevent burnout and may improve a resident's quality of life and health behavior. This report describes a program designed to build resiliency, the ability to bounce back from stress, in family medicine residents in a medium sized U.S. residency training program. Interactive sessions emphasized building self-awareness, coping skills, strengths and meaning in work, time management, self-care, and connections in and outside of medicine to support resident well-being. System changes which fostered wellness were also implemented. These changes included increasing the availability of fresh fruits in the conference and call room, purchasing an elliptical exercise machine for the on call room, and offering a few minutes of mindfulness meditation daily to the inpatient residents. Results to date show excellent acceptance of the program by trainees, increased consumption of nutritious foods, more personal exercise, and self-reported decreased overreactions to stress. Resiliency programs can effectively serve to meet accreditation requirements while fostering residents' abilities to balance personal and professional demands. © The Author(s) 2015.

  19. 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

    Background 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. Methods 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. Results 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. Conclusions 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. PMID:27306995

  20. Combining clinical microsystems and an experiential quality improvement curriculum to improve residency education in internal medicine.

    Science.gov (United States)

    Tess, Anjala V; Yang, Julius J; Smith, C Christopher; Fawcett, Caitlin M; Bates, Carol K; Reynolds, Eileen E

    2009-03-01

    Beth Israel Deaconess Medical Center's internal medicine residency program was admitted to the new Education Innovation Project accreditation pathway of the Accreditation Council of Graduate Medical Education to begin in July 2006. The authors restructured the inpatient medical service to create clinical microsystems in which residents practice throughout residency. Program leadership then mandated an active curriculum in quality improvement based in those microsystems. To provide the experience to every graduating resident, a core faculty in patient safety was trained in the basics of quality improvement. The authors hypothesized that such changes would increase the number of residents participating in quality improvement projects, improve house officer engagement in quality improvement work, enhance the culture of safety the residents perceive in their training environment, improve work flow on the general medicine ward rotations, and improve the overall educational experience for the residents on ward rotations.The authors describe the first 18 months of the intervention (July 2006 to January 2008). The authors assessed attitudes and the educational experience with surveys and evaluation forms. After the intervention, the authors documented residents' participation in projects that overlapped with hospital priorities. More residents reported roles in designing and implementing quality improvement changes. Residents also noted greater satisfaction with the quality of care they deliver. Fewer residents agreed or strongly agreed that the new admitting system interfered with communication. Ongoing residency program assessment showed an improved perception of workload, and educational ratings of rotations improved. The changes required few resources and can be transported to other settings.

  1. 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.

  2. 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.

  3. 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.

  4. 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....

  5. 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.

  6. City Size, Housing Price and Resident Income Gap

    Institute of Scientific and Technical Information of China (English)

    FAN Hong-zhong; ZHANG Ting; LI Ming-liang

    2014-01-01

    Taking the urban population size and urban housing price as the proxy variable of city size,this paper conducts an empirical analysis with the data of CHIPS 2002 and 2008.It is found that the rising of city size and housing prices has important promotion effects on income inequality of city residents.The main reason is that the wage of migrant workers is separated from the housing price of the cities in which they reside;while their wage level can balance the wage level of the ordinary workers of city residents,making it separate from the urban housing price.But the wage of high quality worker of city residents is closely connected with the housing price.The combined action of the multy sizes in China's urban labor market leads to such a result that the greater the size of cities,the higher the urban housing prices,and the larger the income gap between urban residents.This means that in the construction of the new urbanization,to limit the over-expansion of such mega-cities as Beijing,Shanghai and so on and to develop the middle and small cities is an effective way to narrow the income gap between urban residents in China.

  7. 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.

  8. 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.

  9. 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.

  10. 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.

  11. 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 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.

  12. 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

  13. 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...

  14. Program Characteristics Influencing Allopathic Students' Residency Selection.

    Science.gov (United States)

    Stillman, Michael D; Miller, Karen Hughes; Ziegler, Craig H; Upadhyay, Ashish; Mitchell, Charlene K

    2016-04-01

    Medical students must consider many overt variables when entering the National Resident Matching Program. However, changes with the single graduate medical education accreditation system have caused a gap in knowledge about more subtle considerations, including what, if any, influence the presence of osteopathic physician (ie, DO) and international medical graduate (IMG) house officers has on allopathic students' residency program preferences. Program directors and selection committee members may assume students' implicit bias without substantiating evidence. To reexamine which program characteristics affect US-trained allopathic medical students' residency selection, and to determine whether the presence of DO and IMG house officers affects the program choices of allopathic medical students. Fourth-year medical students from 4 allopathic medical schools completed an online survey. The Pearson χ(2) statistic was used to compare demographic and program-specific traits that influence ranking decisions and to determine whether school type (private vs public), valuing a residency program's prestige, or interest in a competitive specialty dictated results. Qualitative data were analyzed using the Pandit variation of the Glaser and Strauss constant comparison. Surveys were completed by 323 of 577 students (56%). Students from private vs public institutions were more likely to value a program's prestige (160 [93%] vs 99 [72%]; P<.001) and research opportunities (114 [66%] vs 57 [42%]; P<.001), and they were less likely to consider their prospects of being accepted (98 [57%] vs 111 [81%]; P<.001). A total of 33 (10%) and 52 (16%) students reported that the presence of DO or IMG trainees, respectively, would influence their final residency selection, and these percentages were largely unchanged among students interested in programs' prestige or in entering a competitive specialty. Open-ended comments were generally optimistic about diversification of the physician

  15. How Prospective Physical Medicine and Rehabilitation Trainees Rank Residency Training Programs.

    Science.gov (United States)

    Auriemma, Michael J; Whitehair, Curtis L

    2018-03-01

    Since the inception of the National Resident Matching Program, multiple studies have investigated the factors applicants consider important to ranking prospective residency programs. However, only 2 previous studies focused on prospective physical medicine and rehabilitation (PM&R) trainees, and the most recent of these studies was published in 1993. It is unknown whether these previous studies are reflective of current prospective PM&R residents. To assess various factors that contribute to prospective PM&R residents' decision making in choosing a residency program and compare these findings with previous studies. An anonymous, voluntary questionnaire. A single PM&R residency program. All applicants to a single PM&R residency program. All applicants to our PM&R residency program were invited to participate in a 44-item, 5-point Likert-based questionnaire. Applicants were asked to rate the importance of various factors as they related to constructing their residency rank list. Means and standard deviations were calculated for items included in the survey. A response rate of 26% was obtained, with the responses of 98 applicants (20%) ultimately analyzed. The highest rated factors included "perceived happiness of current residents," "opportunities for hands-on procedure training," "perceived camaraderie among current residents," "perceived camaraderie among faculty and current residents," "perceived quality of current residents," and "perceived work/life balance among current residents." Although male and female respondents demonstrated similar ranking preferences, an apparent difference was detected between how genders rated the importance of "whether the program projects a favorable environment for women" and "whether the program projects a favorable environment for minorities." As compared with previous PM&R applicants, current prospective trainees seem to place greater importance on skill acquisition over didactic teaching. Prospective PM&R residents highly value

  16. 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.

  17. 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

  18. Family medicine residency training and burnout: a qualitative study

    Science.gov (United States)

    Rutherford, Kimberly; Oda, Joanna

    2014-01-01

    Background Almost three-quarters of family practice residents in British Columbia (BC) meet criteria for burnout. We sought to understand how burnout is perceived and experienced by family medicine residents, and to identify both contributory and protective factors for resident burnout. Method Two semi-structured focus groups were conducted with ten family practice residents from five distinct University of British Columbia training sites. Participants completed the Maslach Burnout Inventory (MBI). The data were analyzed using a thematic analysis approach. Results Seventy percent of the focus group participants met criteria for burnout using the MBI. The experience of burnout was described as physical and emotional exhaustion, loss of motivation, isolation from loved ones, and disillusionment with the medical profession. Contributory factors included high workload, burned-out colleagues, perceived undervaluing of family medicine, lack of autonomy, and inability to achieve work-life balance. Protective factors included strong role models in medicine, feeling that one’s work is valued and rotations in family medicine. Conclusions The high level of burnout in family medicine residents in BC is a multifactorial and complex phenomenon. Training programs and faculty should be aware of burnout risk factors and strive to implement changes to reduce burnout, including allowing residents increased control over scheduling, access to counseling services and training for resident mentors. PMID:26451218

  19. 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 ...

  20. Family medicine residency training and burnout: a qualitative study.

    Science.gov (United States)

    Rutherford, Kimberly; Oda, Joanna

    2014-01-01

    Almost three-quarters of family practice residents in British Columbia (BC) meet criteria for burnout. We sought to understand how burnout is perceived and experienced by family medicine residents, and to identify both contributory and protective factors for resident burnout. Two semi-structured focus groups were conducted with ten family practice residents from five distinct University of British Columbia training sites. Participants completed the Maslach Burnout Inventory (MBI). The data were analyzed using a thematic analysis approach. Seventy percent of the focus group participants met criteria for burnout using the MBI. The experience of burnout was described as physical and emotional exhaustion, loss of motivation, isolation from loved ones, and disillusionment with the medical profession. Contributory factors included high workload, burned-out colleagues, perceived undervaluing of family medicine, lack of autonomy, and inability to achieve work-life balance. Protective factors included strong role models in medicine, feeling that one's work is valued and rotations in family medicine. The high level of burnout in family medicine residents in BC is a multifactorial and complex phenomenon. Training programs and faculty should be aware of burnout risk factors and strive to implement changes to reduce burnout, including allowing residents increased control over scheduling, access to counseling services and training for resident mentors.

  1. 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.

  2. 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

  3. 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.

  4. 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.

  5. 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

  6. Theoretical Aspects of Design and Construction of “Alive” House in Conditions of Changes of the Environment of the Life-sustaining Activity

    Directory of Open Access Journals (Sweden)

    Larionov Arkady

    2017-01-01

    Full Text Available Arguments in support of the thesis of the necessity of acceleration of the creation of harmonious human environment in connection with development of the freelance on the West and in the Russian Federation are presented in the present work. Disclosed the contents of the spatial-property modeling of the apartment house, not only as point of residence of the human, but also as a place of work. Justified the importance and availability of ensure by the comfortable housing for those groups of citizens who engage in freelance and have a certain capital. Special place is given to the formation of the theory of the “alive” house in consideration of the peculiarities of the eco-friendly, investment and luxury housing.

  7. Perception of Climate Change of the Residents at Various Elevations in the Zayu River Valley in Southeast Tibet%藏东南察隅河流域不同海拔居民对气候变化的感知

    Institute of Scientific and Technical Information of China (English)

    侯磊; 周尧治; 任毅华

    2017-01-01

    在藏东南察隅河流域选取海拔分别为3 3135、2 8911和2 4764 m的3个村庄,对268位居民进行问卷调查,研究不同海拔居民对气候变化的感知状况,并对居民的感知状况与海拔进行相关性分析.结果表明,海拔为3 3135、2 8911和2 4764 m的村庄中,分别有917%、889%和977%的居民认为当地气候发生了变化,其中又有917%、955%和977%的居民认为气候变化明显.不同海拔居民对温度的感知强烈,分别有750%、100%和483%的居民认为夏季变暖,417%、100%和494%的居民认为冬季变冷,但大部分居民对湿度的感知不强烈.随着海拔降低,认为以前气候比现在好的居民比例增大(分别为500%、565%和614%),认为冰川面积增加(分别为83%、136%和455%)、河流水量增加(分别为467%、560%和791%)、农作物病虫害增加(分别为333%、583%和727%)的居民比例增大,认为以前气候比现在好的居民比例与海拔呈显著负相关(P<005).分别有750%、741%和727%的居民认为气候变化对生产生活造成了影响.在感知气候变化的途径中,自身经历是最主要的途径(分别为833%、100%和909%).当地政府应当进行相应的宣传指导,帮助当地居民适应气候变化带来的不利影响.%A survey was performed on perception of climate change of residents living in three villages situated at various elevations, 3 3135, 2 8911 and 2 4764 m, separately in the Zayu River Valley, Southeast Tibet by means of questionnaires.Based on the returned questionnaires from 268 residents analysis was done of relationship between the perception of the residents and the elevation they live at.Results show that about 917%, 889% and 977% of the residents, respectively, living in the villages at 3 3135, 2 8911 and 2 4764 m in elevation hold that the local climate has changed; about 750%, 100% and 483% think that summer is getting warmer; and 417%, 100% and 494% believe that winter is becoming colder.However, still a number of

  8. 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...

  9. 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.

  10. 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.

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

    Directory of Open Access Journals (Sweden)

    Roshan Razik

    2013-09-01

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

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

    Directory of Open Access Journals (Sweden)

    Anne M. Messman

    2017-12-01

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

  13. 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.

  14. 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.

  15. I feel disconnected: learning technologies in resident education.

    Science.gov (United States)

    Armstrong, April D; Jarvis-Selinger, Sandra

    2013-01-01

    With the rapid development of technology in medical education, orthopaedic educators are recognizing that the way residents learn and access information is profoundly changing. Residency programs are faced with the challenging problem that current educational methods are not designed to take full advantage of the information explosion and rapid technologic changes. This disconnection is often seen in the potentially separate approaches to education preferred by residents and orthopaedic educators. Becoming connected with residents requires understanding the possible learning technologies available and the learners' abilities, needs, and expectations. It is often assumed that approaches to strategic lifelong learning are developed by residents during their training; however, without the incorporation of technology into the learning environment, residents will not be taught the digital literacy and information management strategies that will be needed in the future. To improve learning, it is important to highlight and discuss current technologic trends in education, the possible technologic disconnection between educators and learners, the types of learning technologies available, and the potential opportunities for getting connected.

  16. 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, ...

  17. 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.

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

    Science.gov (United States)

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

    2018-05-30

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

  19. 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.

  20. 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.

  1. Prefabrication in Building Construction: A Perspective of Pakistan Construction Industry

    Directory of Open Access Journals (Sweden)

    Nafees Ahmed Memon

    2014-07-01

    Full Text Available 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

  2. 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)

  3. 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.

  4. Energy efficiency indicators for assessing construction systems storing renewable energy: Application to phase change material-bearing Façades

    OpenAIRE

    Tenorio Ríos, José Antonio; Sánchez-Ramos, José; Ruiz-Pardo, Álvaro; Álvarez, Servando; Cabeza, Luisa F.

    2015-01-01

    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...

  5. 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

  6. 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 adverse outcome. Mean (SD) in-training examination scores did not significantly change from 2010 to 2013 for first-year residents (499.7 [ 85.2] to 500.5 [84.2], P = .99), for residents from other postgraduate years, or for first-time examinees taking the written or oral board

  7. Climate Change and Conceptual Change

    OpenAIRE

    Clark, David Joseph

    2013-01-01

    Global Warming (“GW”) is easily one of the most pressing concerns of our time,and its solution will come about only through a change in human behavior.Compared to the residents of most other nations worldwide, Americans reportlower acceptance of the realities of GW. In order to address this concern in afree society, U.S. residents must be convinced or coerced to take the necessaryactions. In spite of the democratic appeal of education, however, many climatecommunicators appear t...

  8. 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...

  9. 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.

  10. Burnout, coping, and spirituality among internal medicine resident physicians.

    Science.gov (United States)

    Doolittle, Benjamin R; Windish, Donna M; Seelig, Charles B

    2013-06-01

    Burnout in physicians is common, and studies show a prevalence of 30% to 78%. Identifying constructive coping strategies and personal characteristics that protect residents against burnout may be helpful for reducing errors and improving physician satisfaction. We explored the complex relationships between burnout, behaviors, emotional coping, and spirituality among internal medicine and internal medicine-pediatrics residents. We anonymously surveyed 173 internal medicine and medicine-pediatrics residents to explore burnout, coping, and spiritual attitudes. We used 3 validated survey instruments: the Maslach Burnout Inventory, the Carver Coping Orientation to Problems Experienced (COPE) Inventory, and the Hatch Spiritual Involvement and Beliefs Scale (SIBS). A total of 108 (63%) residents participated, with 31 (28%) reporting burnout. Residents who employed strategies of acceptance, active coping, and positive reframing had lower emotional exhaustion and depersonalization (all, P < .03). Residents who reported denial or disengagement had higher emotional exhaustion and depersonalization scores. Personal accomplishment was positively correlated with the SIBS total score (r  =  +.28, P  =  .003), as well as the internal/fluid domain (r  =  +.32, P  =  .001), existential axes (r  =  +.32, P  =  .001), and humility/personal application domain (r  =  +.23, P  =  .02). The humility/personal application domain also was negatively correlated with emotional exhaustion (r  =  -.20, P  =  .04) and depersonalization (r  =  -.25, P  =  .009). No activity or demographic factor affected any burnout domain. Burnout is a heterogeneous syndrome that affects many residents. We identified a range of emotional and spiritual coping strategies that may have protective benefit.

  11. 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)…

  12. 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.

  13. 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.

  14. 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

  15. Getting Explicit Memory off the Ground: Steps toward Construction of a Neuro-Developmental Account of Changes in the First Two Years of Life

    Science.gov (United States)

    Bauer, Patricia J.

    2004-01-01

    Historically, infants and very young children were thought incapable of explicit memory. As a result of changes in theoretical perspective and methodological developments, this assumption was challenged in the latter part of the 20th century. Substantial progress was made in describing age-related changes in explicit memory in the first two years…

  16. Construction labor productivity during nuclear power plant construction

    International Nuclear Information System (INIS)

    Murray, W.B.

    1980-01-01

    There is no single satisfactory way to measure productivity in the construction industry. The industry is too varied, too specialized and too dependent upon vast numbers of interrelations between trades, contractors, designers and owners. Hence, no universally reliable indices for measuring construction productivity has been developed. There are problems that are generic to all large union-built nuclear power plants. The actions of any one owner cannot rectify the shortcomings of the construction industry. The generic problems are being identified, and many national organizations are attempting to make the construction industry more productive by recommending various changes

  17. Understanding nurses' decisions to treat pain in nursing home residents with dementia.

    Science.gov (United States)

    Gilmore-Bykovskyi, Andrea L; Bowers, Barbara J

    2013-04-01

    Nursing home (NH) residents with dementia continue to receive inadequate pain treatment. The purpose of this qualitative study was to examine how nurses make decisions to pharmacologically treat pain in NH residents with dementia. Using Grounded Dimensional Analysis, 15 in-depth interviews were conducted with 13 nurses from four skilled nursing facilities in Wisconsin. Nurses experienced varying levels of certainty regarding suspected pain in response to particular resident characteristics and whether pain was perceived as visible/obvious or nonvisible/not obvious. Nurses felt highly uncertain about pain in residents with dementia. Suspected pain in residents with dementia was nearly always conceptualized as a change in behavior to which nurses responded by trialing multiple interventions in attempts to return the resident to baseline, which despite current recommendations, did not include pain relief trials. Residents with dementia were described as being at greatest risk for experiencing underassessment, undertreatment, and delayed treatment for pain Copyright 2013, SLACK Incorporated.

  18. Comprehensive Health Care Economics Curriculum and Training in Radiology Residency.

    Science.gov (United States)

    Keiper, Mark; Donovan, Timothy; DeVries, Matthew

    2018-06-01

    To investigate the ability to successfully develop and institute a comprehensive health care economics skills curriculum in radiology residency training utilizing didactic lectures, case scenario exercises, and residency miniretreats. A comprehensive health care economics skills curriculum was developed to significantly expand upon the basic ACGME radiology residency milestone System-Based Practice, SBP2: Health Care Economics requirements and include additional education in business and contract negotiation, radiology sales and marketing, and governmental and private payers' influence in the practice of radiology. A health care economics curriculum for radiology residents incorporating three phases of education was developed and implemented. Phase 1 of the curriculum constituted basic education through didactic lectures covering System-Based Practice, SBP2: Health Care Economics requirements. Phase 2 constituted further, more advanced didactic lectures on radiology sales and marketing techniques as well as government and private insurers' role in the business of radiology. Phase 3 applied knowledge attained from the initial two phases to real-life case scenario exercises and radiology department business miniretreats with the remainder of the radiology department. A health care economics skills curriculum in radiology residency is attainable and essential in the education of future radiology residents in the ever-changing climate of health care economics. Institution of more comprehensive programs will likely maximize the long-term success of radiology as a specialty by identifying and educating future leaders in the field of radiology. Copyright © 2018 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  19. General surgery training and robotics: Are residents improving their skills?

    Science.gov (United States)

    Finnerty, Brendan M; Afaneh, Cheguevara; Aronova, Anna; Fahey, Thomas J; Zarnegar, Rasa

    2016-02-01

    While robotic-assisted operations have become more prevalent, many general surgery residencies do not have a formal robotic training curriculum. We sought to ascertain how well current general surgery training permits acquisition of robotic skills by comparing robotic simulation performance across various training levels. Thirty-six participants were categorized by level of surgical training: eight medical students (MS), ten junior residents (JR), ten mid-level residents (MLR), and eight senior residents (SR). Participants performed three simulation tasks on the da Vinci (®) Skills Simulator (MatchBoard, EnergyDissection, SutureSponge). Each task's scores (0-100) and cumulative scores (0-300) were compared between groups. There were no differences in sex, hand dominance, video gaming history, or prior robotic experience between groups; however, SR was the oldest (p Robotic skillsets acquired during general surgery residency show minimal improvement during the course of training, although laparoscopic experience is correlated with advanced robotic task performance. Changes in residency curricula or pursuit of fellowship training may be warranted for surgeons seeking proficiency.

  20. Early tracking would improve the operative experience of general surgery residents.

    Science.gov (United States)

    Stain, Steven C; Biester, Thomas W; Hanks, John B; Ashley, Stanley W; Valentine, R James; Bass, Barbara L; Buyske, Jo

    2010-09-01

    High surgical complexity and individual career goals has led most general surgery (GS) residents to pursue fellowship training, resulting in a shortage of surgeons who practice broad-based general surgery. We hypothesize that early tracking of residents would improve operative experience of residents planning to be general surgeons, and could foster greater interest and confidence in this career path. Surgical Operative Log data from GS and fellowship bound residents (FB) applying for the 2008 American Board of Surgery Qualifying Examination (QE) were used to construct a hypothetical training model with 6 months of early specialization (ESP) for FB residents in 4 specialties (cardiac, vascular, colorectal, pediatric); and presumed these cases would be available to GS residents within the same program. A total of 142 training programs had both FB residents (n = 237) and GS residents (n = 402), and represented 70% of all 2008 QE applicants. The mean numbers of operations by FB and GS residents were 1131 and 1091, respectively. There were a mean of 252 cases by FB residents in the chief year, theoretically making 126 cases available for each GS resident. In 9 defined categories, the hypothetical model would result in an increase in the 5-year operative experience of GS residents (mastectomy 6.5%; colectomy 22.8%; gastrectomy 23.4%; antireflux procedures 23.4%; pancreatic resection 37.4%; liver resection 29.3%; endocrine procedures 19.6%; trauma operations 13.3%; GI endoscopy 6.5%). The ESP model improves operative experience of GS residents, particularly for complex gastrointestinal procedures. The expansion of subspecialty ESP should be considered.

  1. 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

  2. A resident's rotation in consultation psychiatry. A maturational experience.

    Science.gov (United States)

    Granet, R B; Perry, S W; Talbott, J A

    1980-12-01

    The authors emphasize the importance of a consultation psychiatry experience in the maturation of the young psychiatrist by examining some of the processes operational in both community and hospital consultation work, performed by the senior author during his fourth year of residency. Such experiences can provide opportunities for developing psychiatric skills not emphasized elsewhere, including the adoption of an active therapeutic stance, the application of the psychodynamic theory to the consultation system itself, and teaching without the use of jargon. In addition the experience as consultant facilitates the transition from residency to the outside world, not only through attitudinal changes achieved by exposure to less structured settings, a change in the supervisory model, and a solidification of identity as a physician and psychiatrist, but also by providing the resident the opportunity to begin de-cathecting from the training program.

  3. 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

  4. Closing the door on pharma? A national survey of family medicine residencies regarding industry interactions.

    Science.gov (United States)

    Fugh-Berman, Adriane; Brown, Steven R; Trippett, Rachel; Bell, Alicia M; Clark, Paige; Fleg, Anthony; Siwek, Jay

    2011-05-01

    To assess the extent and type of interactions U.S. family medicine residencies permit industry to have with medical students and residents. In 2008, the authors e-mailed a four-question survey to residency directors or coordinators at all 460 accredited U.S. family medicine residencies concerning the types of industry support and interaction permitted. The authors conducted quantitative and qualitative analyses of survey responses and written comments. Residencies that did not permit any industry food, gifts, samples, or support of residency activities were designated "pharma-free." The survey response rate was 62.2% (286/460). Among responding family medicine residencies, 52.1% refused drug samples, 48.6% disallowed industry gifts or food, 68.5% forbade industry-sponsored residency activities, and 44.1% denied industry access to students and residents at the family medicine center. Seventy-five residencies (26.2%) were designated as "pharma-free." Medical-school-based and medical-school-administered residencies were no more likely than community-based residencies to be pharma-free. Among the 211 programs that permitted interaction, 68.7% allowed gifts or food, 61.1% accepted drug samples, 71.1% allowed industry representatives access to trainees in the family medicine center, and 37.9% allowed industry-sponsored residency activities. Respondents commented on challenges inherent to limiting industry interactions. Many programs noted recent changes in plans or practices. Most family medicine residencies limit industry interaction with trainees. Because industry interactions can have adverse effects on rational prescribing, residency programs should assess the benefits and harms of these relationships. Copyright © by the Association of American medical Colleges.

  5. 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....

  6. 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…

  7. Redesigning journal club in residency.

    Science.gov (United States)

    Al Achkar, Morhaf

    2016-01-01

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

  8. Redesigning journal club in residency

    Directory of Open Access Journals (Sweden)

    Al Achkar M

    2016-05-01

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

  9. SU-E-E-03: Shared Space Fosters Didactic and Professional Learning Across Professions for Medical and Physics Residents

    International Nuclear Information System (INIS)

    Dieterich, S; Perks, J; Fragoso, R

    2015-01-01

    Purpose: Medical Physicists and Radiation Oncologists are two professions who should be working as a team for optimal patient care, yet lack of mutual understanding about each others respective role and work environment creates barriers To improve collaboration and learning, we designed a shared didactic and work space for physics and radiation oncology residents to maximize interaction throughout their professional training. Methods: Physician and Physics residents are required to take the same didactic classes, including journal clubs and respective seminars. The residents also share an office environment among the seven physician and two physic residents. Results: By maximizing didactic overlap and sharing office space, the two resident groups have developed a close professional relationship and supportive work environment. Several joint research projects have been initiated by the residents. Awareness of physics tasks in the clinic has led to a request by the physician residents to change physics didactics, converting the physics short course into a lab-oriented course for the medical residents which is in part taught by the physics residents. The physics seminar is given by both residency groups; increased motivation and interest in learning about physics has led to several medical resident-initiated topic selections which generated lively discussion. The physics long course has changed toward including more discussion among residents to delve deeper into topics and study beyond what passing the boards would require. A supportive work environment has developed, embedding the two physics residents into a larger residents group, allowing them to find mentor and peers more easily. Conclusion: By creating a shared work and didactic environment, physician and physics residents have improved their understanding of respective professional practice. Resident-initiated changes in didactic practice have led to improved learning and joint research. A strong social

  10. SU-E-E-03: Shared Space Fosters Didactic and Professional Learning Across Professions for Medical and Physics Residents

    Energy Technology Data Exchange (ETDEWEB)

    Dieterich, S; Perks, J; Fragoso, R [UC Davis Medical Center, Sacramento, CA (United States)

    2015-06-15

    Purpose: Medical Physicists and Radiation Oncologists are two professions who should be working as a team for optimal patient care, yet lack of mutual understanding about each others respective role and work environment creates barriers To improve collaboration and learning, we designed a shared didactic and work space for physics and radiation oncology residents to maximize interaction throughout their professional training. Methods: Physician and Physics residents are required to take the same didactic classes, including journal clubs and respective seminars. The residents also share an office environment among the seven physician and two physic residents. Results: By maximizing didactic overlap and sharing office space, the two resident groups have developed a close professional relationship and supportive work environment. Several joint research projects have been initiated by the residents. Awareness of physics tasks in the clinic has led to a request by the physician residents to change physics didactics, converting the physics short course into a lab-oriented course for the medical residents which is in part taught by the physics residents. The physics seminar is given by both residency groups; increased motivation and interest in learning about physics has led to several medical resident-initiated topic selections which generated lively discussion. The physics long course has changed toward including more discussion among residents to delve deeper into topics and study beyond what passing the boards would require. A supportive work environment has developed, embedding the two physics residents into a larger residents group, allowing them to find mentor and peers more easily. Conclusion: By creating a shared work and didactic environment, physician and physics residents have improved their understanding of respective professional practice. Resident-initiated changes in didactic practice have led to improved learning and joint research. A strong social

  11. 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

  12. Environmental standards and project construction: A review

    International Nuclear Information System (INIS)

    Mason, P.F.; Thornberry, H.L.

    1991-01-01

    In the past decade, changes have occurred in the area of environmental regulation. This paper identifies the typical environmental standards applicable to project construction, recent environmental regulatory issues and trends, and identifies new environmental issues which must be considered in project construction. These include (1) handling hazardous chemicals in the workplace, (2) construction at formerly utilized sites, (3) disposal of debris, construction materials and hazardous waste, and (4) training and experience of construction personnel in environmental issues

  13. 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…

  14. 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

  15. 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...

  16. 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...

  17. 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...

  18. 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...

  19. 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...

  20. 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...

  1. 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...

  2. Predictors of Sunburn Risk Among Florida Residents.

    Science.gov (United States)

    Arutyunyan, Sergey; Alfonso, Sarah V; Hernandez, Nilda; Favreau, Tracy; Fernández, M Isabel

    2017-03-01

    The incidence of skin cancer, the most common type of cancer in the United States, is increasing. Sunburn is a major modifiable risk factor for skin cancer, and its prevalence among the US population is high. To identify predictors of having had a red or painful sunburn in the past 12 months among people living in Florida. Florida residents were recruited from public places and online. They were asked to complete an anonymous cross-sectional survey that assessed demographic information, dermatologic history, as well as knowledge, attitude, and behavior factors associated with sunburn. A total of 437 participants whose data were complete for all variables were included in the multivariate analysis. In multivariate logistic regression, younger age (18-29 years) was the most significant predictor of sunburn (OR, 15.26; 95% CI, 5.97-38.98; PSunburn prevention programs that osteopathic physicians can readily implement in clinical practice are urgently needed, particularly for young adult patients. This study identified 7 predictors of sunburn in Florida residents. With additional research findings, promoting attitude change toward sun protection may be a viable strategy.

  3. West Nile Virus in Resident Birds from Yucatan, Mexico.

    Science.gov (United States)

    Chaves, Andrea; Sotomayor-Bonilla, Jesus; Monge, Otto; Ramírez, Abigaíl; Galindo, Francisco; Sarmiento-Silva, Rosa Elena; Gutiérrez-Espeleta, Gustavo A; Suzán, Gerardo

    2016-01-01

    West Nile virus (WNV) in the Americas is thought to be transported at large spatial scales by migratory birds and locally spread and amplified by resident birds. Local processes, including interspecific interactions and dominance of passerine species recognized as competent reservoirs, may boost infection and maintain endemic cycles. Change in species composition has been recognized as an important driver for infection dynamics. Due to migration and changes in species diversity and composition in wintering grounds, changes in infection prevalence are expected. To these changes, we used PCR to estimate the prevalence of WNV in wild resident birds during the dry and rainy seasons of 2012 in Yucatan, Mexico. Serum samples were obtained from 104 wild birds, belonging to six orders and 35 species. We detected WNV in 14 resident birds, representing 11 species and three orders. Prevalences by order was Passeriformes (27%), Columbiformes (6%), and Piciformes (33%). Resident birds positive to WNV from Yucatan may be indicative of local virus circulation and evidence of past virus transmission activity.

  4. 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…

  5. 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

  6. 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.

  7. 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

  8. 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

  9. 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

  10. 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...

  11. 24 CFR 964.140 - Resident training.

    Science.gov (United States)

    2010-04-01

    ... TENANT PARTICIPATION AND TENANT OPPORTUNITIES IN PUBLIC HOUSING Tenant Participation § 964.140 Resident... Resident Management Corporations and duly elected Resident Councils; (3) Public housing policies, programs... colleges, vocational schools; and (4) HUD and other Federal agencies and other local public, private and...

  12. 38 CFR 51.110 - Resident assessment.

    Science.gov (United States)

    2010-07-01

    ...) PER DIEM FOR NURSING HOME CARE OF VETERANS IN STATE HOMES Standards § 51.110 Resident assessment. The... physician orders for the resident's immediate care and a medical assessment, including a medical history and...) Review of assessments. The nursing facility management must examine each resident no less than once every...

  13. 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…

  14. A Study on Evaluation of Living Environment by Students' Preferences in Residences

    OpenAIRE

    鶴崎, 直樹; 坂井, 猛; 上野, 武; 有馬, 隆文; Tsurusaki, Naoki; Sakai, Takeru; Ueno, Takeshi; Arima, Takafumi

    2006-01-01

    The purpose of this paper was to construct a living quarters environment evaluation method by surveying students' preferences in residences and to apply the evaluation method to the Kyushu University Hakozaki campus so as to inspect the method's efficacy and applicability to a new campus. The obtained results included: 1)information about preferences in residence selection by students attending Kyushu University. 2)proof of efficacy from the viewpoint of students in the Kyushu University Hako...

  15. Cultivating social learning spaces at an urban Johannesburg university student residence

    OpenAIRE

    Agherdien, Najma

    2015-01-01

    Ph.D. (Education) This case study investigated the conceptualisation and implementation of social learning spaces (SLS) in a University of Johannesburg student residence. The literature base I drew on included ideas, concepts and constructs associated with learning communities [where the terms ‘SLS’ and ‘learning communities’ (LCs) are often used interchangeably], Wenger’s communities of practice, the First Year Experience (FYE), university student residence life and transformation in high...

  16. Explaining Direct Care Resource Use of Nursing Home Residents: Findings from Time Studies in Four States

    Science.gov (United States)

    Arling, Greg; Kane, Robert L; Mueller, Christine; Lewis, Teresa

    2007-01-01

    Objective To explain variation in direct care resource use (RU) of nursing home residents based on the Resource Utilization Groups III (RUG-III) classification system and other resident- and unit-level explanatory variables. Data Sources/Study Setting Primary data were collected on 5,314 nursing home residents in 156 nursing units in 105 facilities from four states (CO, IN, MN, MS) from 1998 to 2004. Study Design Nurses and other direct care staff recorded resident-specific and other time caring for all residents on sampled nursing units. Care time was linked to resident data from the Minimum Data Set assessment instrument. Major variables were: RUG-III group (34-group), other health and functional conditions, licensed and other professional minutes per day, unlicensed minutes per day, and direct care RU (wage-weighted minutes). Resident- and unit-level relationships were examined through hierarchical linear modeling. Data Collection/Extraction Methods Time study data were recorded with hand-held computers, verified for accuracy by project staff at the data collection sites and then merged into resident and unit-level data sets. Principal Findings Resident care time and RU varied between and within nursing units. RUG-III group was related to RU; variables such as length of stay and unit percentage of high acuity residents also were significantly related. Case-mix indices (CMIs) constructed from study data displayed much less variation across RUG-III groups than CMIs from earlier time studies. Conclusions Results from earlier time studies may not be representative of care patterns of Medicaid and private pay residents. New RUG-III CMIs should be developed to better reflect the relative costs of caring for these residents. PMID:17362220

  17. 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.

  18. 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

  19. 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...

  20. Altering workplace attitudes for resident education (A.W.A.R.E.): discovering solutions for medical resident bullying through literature review.

    Science.gov (United States)

    Leisy, Heather B; Ahmad, Meleha

    2016-04-27

    Physicians-in-training are challenged every day with grueling academic requirements, job strain, and patient safety concerns. Residency shapes the skills and values that will percolate to patient care and professional character. Unfortunately, impediments to the educational process due to medical resident mistreatment by bullying remain highly prevalent in training today. A PubMed literature review was undertaken using key terms to help define resident mistreatment by bullying, determine its prevalence, identify its potential causes and sequelae, and find suggestions for changing this detrimental culture of medical training. We identified 62 relevant articles. The most frequently noted form of mistreatment was verbal abuse, with the most common perpetrators being fellow physicians of higher hierarchical power. Mistreatment exists due to its cyclical nature and the existing culture of medical training. These disruptive behaviors affect the wellbeing of both medical residents and patients. This article highlights the importance of creating systems that educate physicians-in-training about professional mistreatment by bullying and the imperative in recognizing and correcting these abuses. Resident bullying leads to increased resident stress, decreased resident wellbeing as well as risks to patient safety and increased healthcare costs. Solutions include education of healthcare team members, committee creation, regulation of feedback, and creation of a zero-tolerance policy focused on the health of both patients and residents. Altering workplace attitudes will diminish the detrimental effects that bullying has on resident training.

  1. [Structured residency training program for otolaryngology: a trendsetting principle].

    Science.gov (United States)

    Meyer, J E; Wollenberg, B; Schmidt, C

    2008-09-01

    A concept for an ORL residency training program is necessary because of personnel bottlenecks, quality assurance and benchmarkings. We have created a 2.5 years' program, which is based on 6 pillars: 1. Acquisition of the necessary specialist knowledge by the resident in self-study. 2. Weekly attendance of training lectures according to a study timetable, a monthly specialist seminar to discuss case examples. 3. Weekly presentation by the resident on an article from the current literature, alternating with a presentation on cases and a morbidity and mortality conference. 4. Annual 60 min learning target test. 5. Definition of a surgical training calendar oriented to the new national ORL training regulations. 6. Internal operation course with preparative exercises in anatomy and visit to an operations course at a renowned otolaryngology clinic each year. After 2.5 years of the training time a revision course is introduced. In this way a basic training will be guaranteed for all residents, which can be assessed by the annual test. Finally, the construction of a further training curriculum should lead to an improved transparent training, a higher standard of quality and improved staff satisfaction.

  2. 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.

  3. 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.

  4. Sustainable Construction Risk Perceptions in the Kuwaiti Construction Industry

    Directory of Open Access Journals (Sweden)

    Dalya Ismael

    2018-06-01

    Full Text Available Sustainable construction is fundamentally different than traditional construction because it requires whole systems thinking, early collaboration across stakeholders, and core principles like reducing resource consumption, eliminating toxins, and applying life cycle costing. Construction professionals unfamiliar with this mindset and approach may perceive sustainable construction as risky. One of the global regions in need of more sustainable construction is the Middle Eastern and North African (MENA region. The MENA region is one of the fastest developing in the world. However, it is the slowest one in implementing sustainable construction practices. Kuwait, in particular, contributes 53% more carbon emissions per capita than the United States. To understand how the Kuwaiti construction industry perceives risks associated with more sustainable construction, a survey was developed with 52 risk elements in which 131 industry professionals responded. The results indicate that industry professionals perceive a lack of public awareness as the risk element with the highest probability of occurrence. The risk element with the highest possible negative impact on future projects is designers’ and contractors’ inexperience with sustainable construction. Other risks were found to include a high initial cost for materials and overall project costs. Educational interventions, changes in risk allocation, and behavioral science to reframe upfront costs as long-term savings are offered as possible solutions.

  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. Cooperation in Construction:

    DEFF Research Database (Denmark)

    Vogelius, Peter; Storgaard, Kresten

    2016-01-01

    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 communic......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....... 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....

  7. 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...

  8. Psychotherapy Training: Residents' Perceptions and Experiences.

    Science.gov (United States)

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

    2015-10-01

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

  9. How do urology residents manage personal finances?

    Science.gov (United States)

    Teichman, J M; Bernheim, B D; Espinosa, E A; Cecconi, P P; Meyer, J; Pearle, M S; Preminger, G M; Leveillee, R J

    2001-05-01

    To examine personal financial management among residents to answer three research questions: do residents make reasonable financial choices; why do some residents not save; and what steps can be taken to improve residents' personal financial decisions. Portions of the Federal Reserve Board's Survey of Consumer Finances were modified and piloted to elicit demographic, expense, saving, and income data. The final questionnaire was completed by 151 urology residents at 20 programs. Comparing residents with the general population in the same age and income categories, the median debt/household income ratio was 2.38 versus 0.64. Residents had greater educational debt, greater noneducational debt, and lower savings. Resident participation in retirement accounts was 100% at institutions with employer-matching 401k or 403b plans, 63% at institutions with nonmatching 401k or 403b plans, and 48% at institutions without retirement plans for residents (P = 0.002). Fifty-nine percent of residents budgeted expenses, 27% had cash balances below $1000, 51% had paid interest charges on credit cards within the previous year, and 12% maintained unpaid credit card balances greater than $10,000. The median resident income was $38,400. A significant minority of residents appear not to make reasonable financial choices. Some residents save little because of a failure to budget, indebtedness, high projected income growth, or insufficient attention to personal financial management. Residents save more when they are eligible for tax-deferred retirement plans, particularly when their institution matches their contributions. Many residents would benefit from instruction concerning prudent financial management.

  10. 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.

  11. 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.

  12. A construction process model for implementing constructability in construction

    NARCIS (Netherlands)

    Langkemper, J.; Al-Jibouri, S.; Reymen, I.M.M.J.; Maas, G.J.; Gassel, van F.

    2003-01-01

    In construction, failure of design professionals to consider how a builder will implement the design can result in scheduling problems, cost escalation, delays and disputes during the construction process. The integration of construction knowledge and experience during planning and design is termed

  13. [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 s