Seasonal variation of residence time in spring and groundwater evaluated by CFCs and numerical simulation in mountainous headwater catchment

Science.gov (United States)

Tsujimura, Maki; Watanabe, Yasuto; Ikeda, Koichi; Yano, Shinjiro; Abe, Yutaka

2016-04-01

Headwater catchments in mountainous region are the most important recharge area for surface and subsurface waters, additionally time information of the water is principal to understand hydrological processes in the catchments. However, there have been few researches to evaluate variation of residence time of subsurface water in time and space at the mountainous headwaters especially with steep slope. We investigated the temporal variation of the residence time of the spring and groundwater with tracing of hydrological flow processes in mountainous catchments underlain by granite, Yamanashi Prefecture, central Japan. We conducted intensive hydrological monitoring and water sampling of spring, stream and ground waters in high-flow and low-flow seasons from 2008 through 2013 in River Jingu Watershed underlain by granite, with an area of approximately 15 km2 and elevation ranging from 950 m to 2000 m. The CFCs, stable isotopic ratios of oxygen-18 and deuterium, inorganic solute constituent concentrations were determined on all water samples. Also, a numerical simulation was conducted to reproduce of the average residence times of the spring and groundwater. The residence time of the spring water estimated by the CFCs concentration ranged from 10 years to 60 years in space within the watershed, and it was higher (older) during the low flow season and lower (younger) during the high flow season. We tried to reproduce the seasonal change of the residence time in the spring water by numerical simulation, and the calculated residence time of the spring water and discharge of the stream agreed well with the observed values. The groundwater level was higher during the high flow season and the groundwater dominantly flowed through the weathered granite with higher permeability, whereas that was lower during the low flow season and that flowed dominantly through the fresh granite with lower permeability. This caused the seasonal variation of the residence time of the spring

Factors driving spatial and temporal variation in production and production/biomass ratio of stream-resident brown trout (Salmo trutta) in Cantabrian streams

Science.gov (United States)

Lobon-Cervia, J.; Gonzalez, G.; Budy, P.

2011-01-01

1.The objective was to identify the factors driving spatial and temporal variation in annual production (PA) and turnover (production/biomass) ratio (P/BA) of resident brown trout Salmo trutta in tributaries of the Rio Esva (Cantabrian Mountains, Asturias, north-western Spain). We examined annual production (total production of all age-classes over a year) (PA) and turnover (P/BA) ratios, in relation to year-class production (production over the entire life time of a year-class) (PT) and turnover (P/BT) ratio, over 14years at a total of 12 sites along the length of four contrasting tributaries. In addition, we explored whether the importance of recruitment and site depth for spatial and temporal variations in year-class production (PT), elucidated in previous studies, extends to annual production. 2.Large spatial (among sites) and temporal (among years) variation in annual production (range 1.9-40.3gm-2 per year) and P/BA ratio (range 0.76-2.4per year) typified these populations, values reported here including all the variation reported globally for salmonids streams inhabited by one or several species. 3.Despite substantial differences among streams and sites in all production attributes, when all data were pooled, annual (PA) and year-class production (PT) and annual (P/BA) and year-class P/BT ratios were tightly linked. Annual (PA) and year-class production (PT) were similar but not identical, i.e. PT=0.94 PA, whereas the P/BT ratios were 4+P/BA ratios. 4.Recruitment (Rc) and mean annual density (NA) were major density-dependent drivers of production and their relationships were described by simple mathematical models. While year-class production (PT) was determined (R2=70.1%) by recruitment (Rc), annual production (PA) was determined (R2=60.3%) by mean annual density (NA). In turn, variation in recruitment explained R2=55.2% of variation in year-class P/BT ratios, the latter attaining an asymptote at P/BT=6 at progressively higher levels of recruitment

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

Explaining variation in the uptake of HPV vaccination in England

Directory of Open Access Journals (Sweden)

Whynes David K

2011-03-01

Full Text Available Abstract Background In England, two national programmes of HPV vaccination for girls have been instituted, a routine programme for 12- and 13-year-olds and a catch-up programme for 17- and 18-year-olds. Uptake rates across the country have been far from uniform, and this research sought to identify factors explaining the variation in uptake by locality. Methods An association between uptake, deprivation and ethnic background had been established in pilot research. The present analysis was conducted at an aggregate, Primary Care Trust (PCT, level for the first year of the programmes. Published measures of HPV vaccination uptake, material deprivation, ethnic composition of PCT populations, primary care quality, and uptake of cervical screening and of other childhood immunisations were collated. Strong evidence of collinearity amongst the explanatory variables required a factor analysis to be undertaken. This provided four independent factors, used thereafter in regression models to explain uptake by PCT. Results The factor analysis revealed that ethnic composition was associated with attitudes towards cervical screening and other childhood vaccinations, whilst material deprivation and quality of primary care were orthogonal. Ethnic composition, early childhood vaccination, cervical screening and primary care quality were found to be influential in predicting uptake in both the routine and the catch-up cohorts, although with a lower degree of confidence in the case of the last two independent variables. Lower primary care quality was significant in explaining a greater fall in vaccination uptake between the first two doses in the catch-up cohort. Greater deprivation was a significant explanatory factor for both uptake and the fall in uptake between doses for the catch-up cohort but not for uptake in the routine cohort. Conclusion These results for uptake of the first year of the national programme using aggregate data corroborate findings from

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

Science.gov (United States)

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

1997-01-01

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

Individual quality explains variation in reproductive success better than territory quality in a long-lived territorial raptor.

Directory of Open Access Journals (Sweden)

Jabi Zabala

Full Text Available Evolution by natural selection depends on the relationship between individual traits and fitness. Variation in individual fitness can result from habitat (territory quality and individual variation. Individual quality and specialization can have a deep impact on fitness, yet in most studies on territorial species the quality of territory and individuals are confused. We aimed to determine if variation in breeding success is better explained by territories, individual quality or a combination of both. We analysed the number of fledglings and the breeding quality index (the difference between the number of fledglings of an individual/breeding pair and the average number of fledglings of the monitored territories in the same year as part of a long term (16 years peregrine falcon (Falco peregrinus monitoring program with identification of individuals. Using individual and territory identities as correlates of quality, we built Generalised Linear Models with Mixed effects, in which random factors depicted different hypotheses for sources of variation (territory/individual quality in the reproductive success of unique breeding pairs, males and females, and assessed their performance. Most evidence supported the hypothesis that variation in breeding success is explained by individual identity, particularly male identity, rather than territory. There is also some evidence for inter year variations in the breeding success of females and a territory effect in the case of males. We argue that, in territorial species, individual quality is a major source of variation in breeding success, often masked by territory. Future ecological and conservation studies on habitat use should consider and include the effect of individuals, in order to avoid misleading results.

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.

The role of staff in health promotion in community residences for people with intellectual disabilities: variation in views among managers and caregivers.

Science.gov (United States)

Bergström, Helena; Wihlman, Ulla

2011-09-01

Managers and caregivers in community residences for people with intellectual disabilities are expected both to promote residents' health and to support their autonomy. The aim of this article was to explore variation in views among managers and caregivers on the role of staff in health promotion. A qualitative study was conducted using semi-structured interviews with six managers and six caregivers. The analysis used a phenomenographic approach to categorize variation in views. We identified five qualitatively different main categories of roles staff play in health promotion: the parent, the manipulator, the coach, the educator and the libertarian. In addition lifestyle-related risk factors for ill-health and barriers to a healthy lifestyle were analysed and described using qualitative content analysis. The results highlight the ethical conflict that faces staff trying to support a healthy lifestyle as well as the autonomy of the residents.

Modeling per capita state health expenditure variation: state-level characteristics matter.

Science.gov (United States)

Cuckler, Gigi; Sisko, Andrea

2013-01-01

In this paper, we describe the methods underlying the econometric model developed by the Office of the Actuary in the Centers for Medicare & Medicaid Services, to explain differences in per capita total personal health care spending by state, as described in Cuckler, et al. (2011). Additionally, we discuss many alternative model specifications to provide additional insights for valid interpretation of the model. We study per capita personal health care spending as measured by the State Health Expenditures, by State of Residence for 1991-2009, produced by the Centers for Medicare & Medicaid Services' Office of the Actuary. State-level demographic, health status, economic, and health economy characteristics were gathered from a variety of U.S. government sources, such as the Census Bureau, Bureau of Economic Analysis, the Centers for Disease Control, the American Hospital Association, and HealthLeaders-InterStudy. State-specific factors, such as income, health care capacity, and the share of elderly residents, are important factors in explaining the level of per capita personal health care spending variation among states over time. However, the slow-moving nature of health spending per capita and close relationships among state-level factors create inefficiencies in modeling this variation, likely resulting in incorrectly estimated standard errors. In addition, we find that both pooled and fixed effects models primarily capture cross-sectional variation rather than period-specific variation.

Can variation in risk of nest predation explain altitudinal migration in tropical birds?

Science.gov (United States)

Boyle, W Alice

2008-03-01

Migration is among the best studied of animal behaviors, yet few empirical studies have tested hypotheses explaining the ultimate causes of these cyclical annual movements. Fretwell's (1980) hypothesis predicts that if nest predation explains why many tropical birds migrate uphill to breed, then predation risk must be negatively associated with elevation. Data from 385 artificial nests spanning 2,740 m of elevation on the Atlantic slope of Costa Rica show an overall decline in predation with increasing elevation. However, nest predation risk was highest at intermediate elevations (500-650 m), not at lowest elevations. The proportion of nests depredated by different types of predators differed among elevations. These results imply that over half of the altitudinal migrant bird species in this region migrate to safer breeding areas than their non-breeding areas, suggesting that variation in nest predation risk could be an important benefit of uphill migrations of many species.

Influence of temperature on patch residence time in parasitoids: physiological and behavioural mechanisms

Science.gov (United States)

Moiroux, Joffrey; Abram, Paul K.; Louâpre, Philippe; Barrette, Maryse; Brodeur, Jacques; Boivin, Guy

2016-04-01

Patch time allocation has received much attention in the context of optimal foraging theory, including the effect of environmental variables. We investigated the direct role of temperature on patch time allocation by parasitoids through physiological and behavioural mechanisms and its indirect role via changes in sex allocation and behavioural defences of the hosts. We compared the influence of foraging temperature on patch residence time between an egg parasitoid, Trichogramma euproctidis, and an aphid parasitoid, Aphidius ervi. The latter attacks hosts that are able to actively defend themselves, and may thus indirectly influence patch time allocation of the parasitoid. Patch residence time decreased with an increase in temperature in both species. The increased activity levels with warming, as evidenced by the increase in walking speed, partially explained these variations, but other mechanisms were involved. In T. euproctidis, the ability to externally discriminate parasitised hosts decreased at low temperature, resulting in a longer patch residence time. Changes in sex allocation with temperature did not explain changes in patch time allocation in this species. For A. ervi, we observed that aphids frequently escaped at intermediate temperature and defended themselves aggressively at high temperature, but displayed few defence mechanisms at low temperature. These defensive behaviours resulted in a decreased patch residence time for the parasitoid and partly explained the fact that A. ervi remained for a shorter time at the intermediate and high temperatures than at the lowest temperature. Our results suggest that global warming may affect host-parasitoid interactions through complex mechanisms including both direct and indirect effects on parasitoid patch time allocation.

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

Science.gov (United States)

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

2017-12-01

program, and 18 (21.2%) exited graduate medical education altogether. Each program had an annual attrition rate ranging from 0.73% to 6.0% (median [IQR], 2.5% [1.5%-3.4%]). Low-attrition programs were more likely than high-attrition programs to use resident remediation (21.0% vs 6.8%; P < .001). Median (IQR) Qualifying Examination pass rates (93% [90%-98%] vs 92% [86%-100%]; P = .92) and Certifying Examination pass rates (83% [68%-84%] vs 81% [71%-86%]; P = .47) were similar. Program directors at high-attrition programs were more likely than their counterparts at low-attrition programs to agree with this statement: "I feel that it is my responsibility as a program director to redirect residents who should not be surgeons." The overall 5-year attrition rate of 8.8% was significantly lower than previously reported. Program directors at low-attrition programs were more likely to use resident remediation. Variations in attrition may be explained by program director attitudes, although larger studies are needed to further define program factors affecting attrition.

Does residence time affect responses of alien species richness to environmental and spatial processes?

Directory of Open Access Journals (Sweden)

Matteo Dainese

2012-08-01

Full Text Available One of the most robust emerging generalisations in invasion biology is that the probability of invasion increases with the time since introduction (residence time. We analysed the spatial distribution of alien vascular plant species in a region of north-eastern Italy to understand the influence of residence time on patterns of alien species richness. Neophytes were grouped according to three periods of arrival in the study region (1500–1800, 1800–1900, and > 1900. We applied multiple regression (spatial and non-spatial with hierarchical partitioning to determine the influence of climate and human pressure on species richness within the groups. We also applied variation partitioning to evaluate the relative importance of environmental and spatial processes. Temperature mainly influenced groups with speciesa longer residence time, while human pressure influenced the more recently introduced species, although its influence remained significant in all groups. Partial regression analyses showed that most of the variation explained by the models is attributable to spatially structured environmental variation, while environment and space had small independent effects. However, effects independent of environment decreased, and spatially independent effects increased, from older to the more recent neophytes. Our data illustrate that the distribution of alien species richness for species that arrived recently is related to propagule pressure, availability of novel niches created by human activity, and neutral-based (dispersal limitation processes, while climate filtering plays a key role in the distribution of species that arrived earlier. This study highlights the importance of residence time, spatial structure, and environmental conditions in the patterns of alien species richness and for a better understanding of its geographical variation.

Explaining variation in work ethic in Europe. Religious heritage rather than modernisation, the welfare state and communism

NARCIS (Netherlands)

Stam, K.; Verbakel, C.M.C.; Graaf, P.M. de

2013-01-01

This paper presents unique descriptive and explanatory analyses of cross-national variation in work ethic in 44 European countries (European Values Study 2008). A strong work ethic is the conviction that people have a moral duty to work. To explain differences in the adherence of the work ethic

Explaining variation in work ethic in Europe : Religious heritage rather than modernization, the welfare state and communism

NARCIS (Netherlands)

Stam, K.; Verbakel, C.M.C.; de Graaf, P.M.

2013-01-01

This paper presents unique descriptive and explanatory analyses of cross-national variation in work ethic in 44 European countries (European Values Study 2008). A strong work ethic is the conviction that people have a moral duty to work. To explain differences in the adherence of the work ethic

Geographic variation in sexual behavior can explain geospatial heterogeneity in the severity of the HIV epidemic in Malawi.

Science.gov (United States)

Palk, Laurence; Blower, Sally

2018-02-09

In sub-Saharan Africa, where ~ 25 million individuals are infected with HIV and transmission is predominantly heterosexual, there is substantial geographic variation in the severity of epidemics. This variation has yet to be explained. Here, we propose that it is due to geographic variation in the size of the high-risk group (HRG): the group with a high number of sex partners. We test our hypothesis by conducting a geospatial analysis of data from Malawi, where ~ 13% of women and ~ 8% of men are infected with HIV. We used georeferenced HIV testing and behavioral data from ~ 14,000 participants of a nationally representative population-level survey: the 2010 Malawi Demographic and Health Survey (MDHS). We constructed gender-stratified epidemic surface prevalence (ESP) maps by spatially smoothing and interpolating the HIV testing data. We used the behavioral data to construct gender-stratified risk maps that reveal geographic variation in the size of the HRG. We tested our hypothesis by fitting gender-stratified spatial error regression (SER) models to the MDHS data. The ESP maps show considerable geographic variation in prevalence: 1-29% (women), 1-20% (men). Risk maps reveal substantial geographic variation in the size of the HRG: 0-40% (women), 16-58% (men). Prevalence and the size of the HRG are highest in urban centers. However, the majority of HIV-infected individuals (~75% of women, ~ 80% of men) live in rural areas, as does most of the HRG (~ 80% of women, ~ 85% of men). We identify a significant (P national average in districts where > 20% of women are in the HRG. Most importantly, the SER models show that geographic variation in the size of the HRG can explain a substantial proportion (73% for women, 67% for men) of the geographic variation in epidemic severity. Taken together, our results provide substantial support for our hypothesis. They provide a potential mechanistic explanation for the geographic variation in the severity

Reform-based science teaching: A mixed-methods approach to explaining variation in secondary science teacher practice

Science.gov (United States)

Jetty, Lauren E.

The purpose of this two-phase, sequential explanatory mixed-methods study was to understand and explain the variation seen in secondary science teachers' enactment of reform-based instructional practices. Utilizing teacher socialization theory, this mixed-methods analysis was conducted to determine the relative influence of secondary science teachers' characteristics, backgrounds and experiences across their teacher development to explain the range of teaching practices exhibited by graduates from three reform-oriented teacher preparation programs. Data for this study were obtained from the Investigating the Meaningfulness of Preservice Programs Across the Continuum of Teaching (IMPPACT) Project, a multi-university, longitudinal study funded by NSF. In the first quantitative phase of the study, data for the sample (N=120) were collected from three surveys from the IMPPACT Project database. Hierarchical multiple regression analysis was used to examine the separate as well as the combined influence of factors such as teachers' personal and professional background characteristics, beliefs about reform-based science teaching, feelings of preparedness to teach science, school context, school culture and climate of professional learning, and influences of the policy environment on the teachers' use of reform-based instructional practices. Findings indicate three blocks of variables, professional background, beliefs/efficacy, and local school context added significant contribution to explaining nearly 38% of the variation in secondary science teachers' use of reform-based instructional practices. The five variables that significantly contributed to explaining variation in teachers' use of reform-based instructional practices in the full model were, university of teacher preparation, sense of preparation for teaching science, the quality of professional development, science content focused professional, and the perceived level of professional autonomy. Using the results

Explaining quantitative variation in the rate of Optional Infinitive errors across languages: a comparison of MOSAIC and the Variational Learning Model.

Science.gov (United States)

Freudenthal, Daniel; Pine, Julian; Gobet, Fernand

2010-06-01

In this study, we use corpus analysis and computational modelling techniques to compare two recent accounts of the OI stage: Legate & Yang's (2007) Variational Learning Model and Freudenthal, Pine & Gobet's (2006) Model of Syntax Acquisition in Children. We first assess the extent to which each of these accounts can explain the level of OI errors across five different languages (English, Dutch, German, French and Spanish). We then differentiate between the two accounts by testing their predictions about the relation between children's OI errors and the distribution of infinitival verb forms in the input language. We conclude that, although both accounts fit the cross-linguistic patterning of OI errors reasonably well, only MOSAIC is able to explain why verbs that occur more frequently as infinitives than as finite verb forms in the input also occur more frequently as OI errors than as correct finite verb forms in the children's output.

Variations in body morphology explain sex differences in thermoeffector function during compensable heat stress.

Science.gov (United States)

Notley, Sean R; Park, Joonhee; Tagami, Kyoko; Ohnishi, Norikazu; Taylor, Nigel A S

2017-05-01

What is the central question of this study? Can sex-related differences in cutaneous vascular and sudomotor responses be explained primarily by variations in the ratio between body surface area and mass during compensable exercise that elicits equivalent heat-loss requirements and mean body temperature changes across participants? What is the main finding and its importance? Mass-specific surface area was a significant determinant of vasomotor and sudomotor responses in men and women, explaining 10-48% of the individual thermoeffector variance. Nonetheless, after accounting for changes in mean body temperature and morphological differences, sex explained only 5% of that inter-individual variability. It was concluded that sex differences in thermoeffector function are morphologically dependent, but not sex dependent. Sex is sometimes thought to be an independent modulator of cutaneous vasomotor and sudomotor function during heat exposure. Nevertheless, it was hypothesized that, when assessed during compensable exercise that evoked equal heat-loss requirements across participants, sex differences in those thermoeffectors would be explained by variations in the ratio between body surface area and mass (specific surface area). To evaluate that possibility, vasomotor and sudomotor functions were assessed in 60 individuals (36 men and 24 women) with widely varying (overlapping) specific surface areas (range, 232.3-292.7 and 241.2-303.1 cm 2  kg -1 , respectively). Subjects completed two trials in compensable conditions (28°C, 36% relative humidity) involving rest (20 min) and steady-state cycling (45 min) at fixed, area-specific metabolic heat-production rates (light, ∼135 W m -2 ; moderate, ∼200 W m -2 ). Equivalent heat-loss requirements and mean body temperature changes were evoked across participants. Forearm blood flow and vascular conductance were positively related to specific surface area during light work in men (r = 0.67 and r = 0

Geographic variation in fee-for-service medicare beneficiaries' medical costs is largely explained by disease burden.

Science.gov (United States)

Reschovsky, James D; Hadley, Jack; Romano, Patrick S

2013-10-01

Control for area differences in population health (casemix adjustment) is necessary to measure geographic variations in medical spending. Studies use various casemix adjustment methods, resulting in very different geographic variation estimates. We study casemix adjustment methodological issues and evaluate alternative approaches using claims from 1.6 million Medicare beneficiaries in 60 representative communities. Two key casemix adjustment methods-controlling for patient conditions obtained from diagnoses on claims and expenditures of those at the end of life-were evaluated. We failed to find evidence of bias in the former approach attributable to area differences in physician diagnostic patterns, as others have found, and found that the assumption underpinning the latter approach-that persons close to death are equally sick across areas-cannot be supported. Diagnosis-based approaches are more appropriate when current rather than prior year diagnoses are used. Population health likely explains more than 75% to 85% of cost variations across fixed sets of areas.

Factors associated with physiotherapy provision in a population of elderly nursing home residents; a cross sectional study

Directory of Open Access Journals (Sweden)

Ribbe Miel W

2007-04-01

Full Text Available Abstract Background Although physiotherapy (PT plays an important role in improving activities of daily living (ADL functioning and discharge rates, it is unclear how many nursing home residents receive treatment. Furthermore, there is a lack of insight into the determinants that influence the decision for treatment. In this study, we investigated how many nursing home residents receive PT. In addition, we analysed the factors that contribute to the variation in the provision of PT both between nursing homes and between residents. Methods A random sample of 600 elderly residents was taken from a random sample of 15 nursing homes. Residents had to be admitted for rehabilitation or for long-term care. Data were collected through interviews with the nursing home physician and the physiotherapist. Multilevel analysis was used to define the variation in the provision of PT and the factors that are associated with the question whether a resident receives PT or not. Furthermore the amount of PT provided was analysed and the factors that are associated with this. Results On average 69% of the residents received PT. The percentage of patients receiving treatment differed significantly across nursing homes, and especially the number of physiotherapists available, explained this difference between nursing homes. Residents admitted to a somatic ward for rehabilitation, and male residents in general, were most likely to receive PT. Residents who were treated by a physiotherapist received on average 55 minutes (sd 41 treatment a week. Residents admitted for rehabilitation received more PT a week, as were residents with a status after a total hip replacement. Conclusion PT is most likely to be provided to residents on a somatic ward, recently admitted for rehabilitation to a nursing home, which has a relatively large number of physiotherapists. This suggests a potential under-use of PT for long-term residents with cognitive problems. It is recommended that

Factors associated with physiotherapy provision in a population of elderly nursing home residents; a cross sectional study.

Science.gov (United States)

Leemrijse, Chantal J; de Boer, Marike E; van den Ende, Cornelia H M; Ribbe, Miel W; Dekker, Joost

2007-04-04

Although physiotherapy (PT) plays an important role in improving activities of daily living (ADL functioning) and discharge rates, it is unclear how many nursing home residents receive treatment. Furthermore, there is a lack of insight into the determinants that influence the decision for treatment. In this study, we investigated how many nursing home residents receive PT. In addition, we analysed the factors that contribute to the variation in the provision of PT both between nursing homes and between residents. A random sample of 600 elderly residents was taken from a random sample of 15 nursing homes. Residents had to be admitted for rehabilitation or for long-term care. Data were collected through interviews with the nursing home physician and the physiotherapist. Multilevel analysis was used to define the variation in the provision of PT and the factors that are associated with the question whether a resident receives PT or not. Furthermore the amount of PT provided was analysed and the factors that are associated with this. On average 69% of the residents received PT. The percentage of patients receiving treatment differed significantly across nursing homes, and especially the number of physiotherapists available, explained this difference between nursing homes. Residents admitted to a somatic ward for rehabilitation, and male residents in general, were most likely to receive PT. Residents who were treated by a physiotherapist received on average 55 minutes (sd 41) treatment a week. Residents admitted for rehabilitation received more PT a week, as were residents with a status after a total hip replacement. PT is most likely to be provided to residents on a somatic ward, recently admitted for rehabilitation to a nursing home, which has a relatively large number of physiotherapists. This suggests a potential under-use of PT for long-term residents with cognitive problems. It is recommended that physiotherapists reconsider which residents may benefit from

Explained variation and predictive accuracy in general parametric statistical models: the role of model misspecification

DEFF Research Database (Denmark)

Rosthøj, Susanne; Keiding, Niels

2004-01-01

When studying a regression model measures of explained variation are used to assess the degree to which the covariates determine the outcome of interest. Measures of predictive accuracy are used to assess the accuracy of the predictions based on the covariates and the regression model. We give a ...... a detailed and general introduction to the two measures and the estimation procedures. The framework we set up allows for a study of the effect of misspecification on the quantities estimated. We also introduce a generalization to survival analysis....

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

Science.gov (United States)

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

2018-01-01

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

A passive heat tracer experiment to determine the seasonal variation in residence times in a managed aquifer recharge system with DTS

NARCIS (Netherlands)

des Tombe, B.F.; Bakker, M.; Schaars, F; van der Made, KJ; Calje, R; Borst, L.

2016-01-01

Targeted provisional session N°8.01 The seasonal variation in residence times is determined in a managed aquifer recharge system using a passive heat tracer test. The managed aquifer recharge system consists of a sequence of alternating elongated recharge basins and rows of recovery wells. The

Genetic variation may explain why females are less susceptible to dental erosion.

Science.gov (United States)

Uhlen, Marte-Mari; Stenhagen, Kjersti R; Dizak, Piper M; Holme, Børge; Mulic, Aida; Tveit, Anne B; Vieira, Alexandre R

2016-10-01

Not all individuals at risk for dental erosion (DE) display erosive lesions. The prevalence of DE is higher among male subjects. The occurrence of DE may depend on more than just acidic challenge, with genetics possibly playing a role. The aim of this study was to investigate the association of enamel-formation genes with DE. One premolar and a saliva sample were collected from 90 individuals. Prepared teeth were immersed in 0.01 M HCl (pH 2.2), and enamel loss (μm) was measured using white light interferometry. DNA was extracted from saliva, and 15 single-nucleotide polymorphisms were analysed. Allele and genotype frequencies were related to the enamel loss of the specimens. Single-marker and haplotype analyses were performed using sex as a covariate. Mean enamel loss was higher for male donors than for female donors (P = 0.047). Significant associations were found between enamel loss and amelogenin, X-linked (AMELX), tuftelin 1 (TUFT1), and tuftelin-interacting protein 11 (TFIP11). Analyses showed significant associations between variation in enamel-formation genes and a lower susceptibility to DE in female subjects. The results indicate that susceptibility to DE is influenced by genetic variation, and may, in part, explain why some individuals are more susceptible than others to DE, including differences between female subjects and male subjects. © 2016 Eur J Oral Sci.

Can Research Design Explain Variation in Head Start Research Results? A Meta-Analysis of Cognitive and Achievement Outcomes

Science.gov (United States)

Shager, Hilary M.; Schindler, Holly S.; Magnuson, Katherine A.; Duncan, Greg J.; Yoshikawa, Hirokazu; Hart, Cassandra M. D.

2013-01-01

This study explores the extent to which differences in research design explain variation in Head Start program impacts. We employ meta-analytic techniques to predict effect sizes for cognitive and achievement outcomes as a function of the type and rigor of research design, quality and type of outcome measure, activity level of control group, and…

Variations in automatically recorded rumination time as explained by variations in intake of dietary fractions and milk production, and between-cow variation.

Science.gov (United States)

Byskov, M V; Nadeau, E; Johansson, B E O; Nørgaard, P

2015-06-01

Individual recording of rumination time (RT) is now possible in commercial dairy herds, through development of a microphone-based sensor, which is able to record RT by the sound of rumination activity. The objectives of this study were to examine the relationship between daily RT and intakes of different dietary fractions, the relationship between RT in minutes per kilogram of dry matter intake (DMI) and milk production, and to examine the variation in RT within and between mid-lactating dairy cows. Data from 3 production trials were used in which a total of 27 different diets were fed. The data contained 761, 290, and 203 daily recordings of RT, milk yield, milk components, DMI, and intake of dietary fractions recorded on 29, 26, and 24 Holstein and Swedish Red cows from trials 1, 2, and 3, respectively. The dietary fractions included forage neutral detergent fiber (NDF), concentrate NDF, crude protein, sugar, starch, and the remaining fraction represented by organic matter--(forage NDF+concentrate NDF+crude protein+sugar+starch). The relationship between the dietary fractions and RT was analyzed in 2 steps. In step 1, the dietary fractions, which were significantly related to RT, were selected and simultaneously checked for multicollinearity between the dietary components; in step 2, a multivariate model, including the effect of repeated measurements, the main effect of the selected dietary fractions from step 1, random effects of cow(trial) and trial, and information on breed, days in milk, and parity was used to analyze the relationship between RT and the selected dietary fractions. Relationships between RT in minutes per kilogram of DMI and milk yield and milk components were analyzed, using the same multivariate model as in step 2. Approximately 32% of the variation in daily RT could be explained by variations in intakes of the dietary fractions, whereas 48% of the total variation in RT was accounted for by individual variations between cows. Intakes of

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

Swallowing disorders in nursing home residents: how can the problem be explained?

Directory of Open Access Journals (Sweden)

Nogueira D

2013-02-01

Full Text Available Dália Nogueira,1 Elizabeth Reis21Speech Therapy Department, Escola Superior de Saúde de Alcoitão, Estoril, Portugal; 2Department of Quantitative Methods, Lisbon University Institute ISCTE/IUL, Lisbon, PortugalBackground: The swallowing mechanism changes significantly as people age, even in the absence of chronic diseases. Presbyphagia, a term that refers to aging-related changes in the swallowing mechanism, may be linked to many health conditions and presents itself in distinct ways. Swallowing disorders are also identified as a major problem amongst the elderly population living in nursing homes.Methods: The study sought to determine the prevalence of swallowing disorders in nursing home residents, to identify the relationship between self-perceived swallowing disorders, cognitive functions, autonomy, and depression, and also to analyze which variables explain the score of the Dysphagia Self-Test (DST. For this purpose, the researchers chose to apply a survey conveying questions on demographic aspects, general health, eating and feeding, as well as instruments to assess functional performance and the 3 ounce Water Swallow Test.Results: The sample consisted of 272 elderly people living in eight nursing homes in Portugal. Six did not sign the informed consent form. Of the total, 29% were totally dependent, 33% were depressed, 45% had cognitive impairment, and 38% needed help with feeding. About 43% of the individuals reported having problems related to eating. Regarding the DST, 40% showed signs of dysphagia. With respect to the 3 ounce Water Swallow Test, 38% revealed at least one of the symptoms, wet voice being the most prevalent. Correlation measures showed that age had no linear association with the DST score although correlation with the Barthel Index and Mini Mental State Examination was found to be significant. A linear regression model was estimated with the DST score as the dependent variable and the MMSE and BI scores, gender, age

Canopy area of large trees explains aboveground biomass variations across neotropical forest landscapes

Science.gov (United States)

Meyer, Victoria; Saatchi, Sassan; Clark, David B.; Keller, Michael; Vincent, Grégoire; Ferraz, António; Espírito-Santo, Fernando; d'Oliveira, Marcus V. N.; Kaki, Dahlia; Chave, Jérôme

2018-06-01

Large tropical trees store significant amounts of carbon in woody components and their distribution plays an important role in forest carbon stocks and dynamics. Here, we explore the properties of a new lidar-derived index, the large tree canopy area (LCA) defined as the area occupied by canopy above a reference height. We hypothesize that this simple measure of forest structure representing the crown area of large canopy trees could consistently explain the landscape variations in forest volume and aboveground biomass (AGB) across a range of climate and edaphic conditions. To test this hypothesis, we assembled a unique dataset of high-resolution airborne light detection and ranging (lidar) and ground inventory data in nine undisturbed old-growth Neotropical forests, of which four had plots large enough (1 ha) to calibrate our model. We found that the LCA for trees greater than 27 m (˜ 25-30 m) in height and at least 100 m2 crown size in a unit area (1 ha), explains more than 75 % of total forest volume variations, irrespective of the forest biogeographic conditions. When weighted by average wood density of the stand, LCA can be used as an unbiased estimator of AGB across sites (R2 = 0.78, RMSE = 46.02 Mg ha-1, bias = -0.63 Mg ha-1). Unlike other lidar-derived metrics with complex nonlinear relations to biomass, the relationship between LCA and AGB is linear and remains unique across forest types. A comparison with tree inventories across the study sites indicates that LCA correlates best with the crown area (or basal area) of trees with diameter greater than 50 cm. The spatial invariance of the LCA-AGB relationship across the Neotropics suggests a remarkable regularity of forest structure across the landscape and a new technique for systematic monitoring of large trees for their contribution to AGB and changes associated with selective logging, tree mortality and other types of tropical forest disturbance and dynamics.

Climate variables explain neutral and adaptive variation within salmonid metapopulations: The importance of replication in landscape genetics

Science.gov (United States)

Hand, Brian K.; Muhlfeld, Clint C.; Wade, Alisa A.; Kovach, Ryan; Whited, Diane C.; Narum, Shawn R.; Matala, Andrew P.; Ackerman, Michael W.; Garner, B. A.; Kimball, John S; Stanford, Jack A.; Luikart, Gordon

2016-01-01

Understanding how environmental variation influences population genetic structure is important for conservation management because it can reveal how human stressors influence population connectivity, genetic diversity and persistence. We used riverscape genetics modelling to assess whether climatic and habitat variables were related to neutral and adaptive patterns of genetic differentiation (population-specific and pairwise FST) within five metapopulations (79 populations, 4583 individuals) of steelhead trout (Oncorhynchus mykiss) in the Columbia River Basin, USA. Using 151 putatively neutral and 29 candidate adaptive SNP loci, we found that climate-related variables (winter precipitation, summer maximum temperature, winter highest 5% flow events and summer mean flow) best explained neutral and adaptive patterns of genetic differentiation within metapopulations, suggesting that climatic variation likely influences both demography (neutral variation) and local adaptation (adaptive variation). However, we did not observe consistent relationships between climate variables and FST across all metapopulations, underscoring the need for replication when extrapolating results from one scale to another (e.g. basin-wide to the metapopulation scale). Sensitivity analysis (leave-one-population-out) revealed consistent relationships between climate variables and FST within three metapopulations; however, these patterns were not consistent in two metapopulations likely due to small sample sizes (N = 10). These results provide correlative evidence that climatic variation has shaped the genetic structure of steelhead populations and highlight the need for replication and sensitivity analyses in land and riverscape genetics.

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

Directory of Open Access Journals (Sweden)

Brita Roy

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

Does mobility explain variation in colonisation and population recovery among stream fishes?

Science.gov (United States)

Angermeier, Paul L.; Albanese, Brett; Peterson, James T.

2009-01-01

1. Colonisation and population recovery are crucial to species persistence in environmentally variable ecosystems, but are poorly understood processes. After documenting movement rates for several species of stream fish, we predicted that this variable would influence colonisation rates more strongly than local abundance, per cent occupancy, body size and taxonomic family. We also predicted that populations of species with higher movement rates would recover more rapidly than species with lower movement rates and that assemblage structure would change accordingly. 2. To test these predictions, we removed fishes from a headwater and a mainstem creek in southwest Virginia and monitored colonisation over a 2-year period. Using an information–theoretic approach, we evaluated the relative plausibility of 15 alternative models containing different combinations of our predictor variables. Our best-supported model contained movement rate and abundance and was 41 times more likely to account for observed patterns in colonisation rates than the next-best model. Movement rate and abundance were both positively related to colonisation rates and explained 88% of the variation in colonisation rates among species. 3. Population recovery, measured as the per cent of initial abundance restored, was also positively associated with movement rate. One species recovered within 3 months, most recovered within 2 years, but two species still had not recovered after 2 years. Despite high variation in recovery, the removal had only a slight impact on assemblage structure because species that were abundant in pre-removal samples were also abundant in post-removal samples. 4. The significance of interspecific variation in colonisation and recovery rates has been underappreciated because of the widely documented recovery of stream fish assemblages following fish kills and small-scale experimental defaunations. Our results indicate that recovery of the overall assemblage does not imply

A marker of biological age explains individual variation in the strength of the adult stress response.

Science.gov (United States)

Andrews, Clare; Nettle, Daniel; Larriva, Maria; Gillespie, Robert; Reichert, Sophie; Brilot, Ben O; Bedford, Thomas; Monaghan, Pat; Spencer, Karen A; Bateson, Melissa

2017-09-01

The acute stress response functions to prioritize behavioural and physiological processes that maximize survival in the face of immediate threat. There is variation between individuals in the strength of the adult stress response that is of interest in both evolutionary biology and medicine. Age is an established source of this variation-stress responsiveness diminishes with increasing age in a range of species-but unexplained variation remains. Since individuals of the same chronological age may differ markedly in their pace of biological ageing, we asked whether biological age-measured here via erythrocyte telomere length-predicts variation in stress responsiveness in adult animals of the same chronological age. We studied two cohorts of European starlings in which we had previously manipulated the rate of biological ageing by experimentally altering the competition experienced by chicks in the fortnight following hatching. We predicted that individuals with greater developmental telomere attrition, and hence greater biological age, would show an attenuated corticosterone (CORT) response to an acute stressor when tested as adults. In both cohorts, we found that birds with greater developmental telomere attrition had lower peak CORT levels and a more negative change in CORT levels between 15 and 30 min following stress exposure. Our results, therefore, provide strong evidence that a measure of biological age explains individual variation in stress responsiveness: birds that were biologically older were less stress responsive. Our results provide a novel explanation for the phenomenon of developmental programming of the stress response: observed changes in stress physiology as a result of exposure to early-life adversity may reflect changes in ageing.

Explaining the variation in the shear force of lamb meat using sarcomere length, the rate of rigor onset and pH.

Science.gov (United States)

Hopkins, D L; Toohey, E S; Lamb, T A; Kerr, M J; van de Ven, R; Refshauge, G

2011-08-01

The temperature when the pH=6.0 (temp@pH6) impacts on the tenderness and eating quality of sheep meat. Due to the expense, sarcomere length is not routinely measured as a variable to explain variation in shear force, but whether measures such as temp@pH6 are as useful a parameter needs to be established. Measures of rigor onset in 261 carcases, including the temp@pH6, were evaluated in this study for their ability to explain some of the variation in shear force. The results show that for 1 day aged product combinations of the temp@pH6, the pH at 18 °C and the pH at 24 h provided a larger reduction (almost double) in total shear force variation than sarcomere length alone, with pH at 24 h being the single best measure. For 5 day aged product, pH at 18 °C was the single best measure. Inclusion of sarcomere length did represent some improvement, but the marginal increase would not be cost effective. Crown Copyright © 2011. Published by Elsevier Ltd. All rights reserved.

Seasonal variations of aerosol residence time in the lower atmospheric boundary layer

International Nuclear Information System (INIS)

Ahmed, A.A.; Mohamed, A.; Ali, A.E.; Barakat, A.; Abd El-Hady, M.; El-Hussein, A.

2004-01-01

During a one year period, from Jan. 2002 up to Dec. 2002, approximately 130 air samples were analyzed to determine the atmospheric air activity concentrations of short- and long-lived ( 222 Rn) decay products 214 Pb and 210 Pb. The samples were taken by using a single-filter technique and γ-spectrometry was applied to determine the activity concentrations. A seasonal fluctuation in the concentration of 214 Pb and 210 Pb in surface air was observed. The activity concentrations of both radionuclides were observed to be relatively higher during the winter/autumn season than in spring/summer season. The mean activity concentration of 214 Pb and 210 Pb within the whole year was found to be 1.4±0.27 Bq m -3 and 1.2±0.15 mBq m -3 , respectively. Different 210 Pb: 214 Pb activity ratios during the year varied between 1.78x10 -4 and 1.6x10 -3 with a mean value of 8.9x10 -4 ±7.6x10 -5 . From the ratio between the activity concentrations of the radon decay products 214 Pb and 210 Pb a mean residence time (MRT) of aerosol particles in the atmosphere of about 10.5±0.91 d could be estimated. The seasonal variation pattern shows relatively higher values of MRT in spring/summer season than in winter/autumn season. The MRT data together with relative humidity (RH), air temperature (T) and wind speed (WS), were used for a comprehensive regression analysis of its seasonal variation in the atmospheric air

Variations in levels of care between nursing home patients in a public health care system.

Science.gov (United States)

Døhl, Øystein; Garåsen, Helge; Kalseth, Jorid; Magnussen, Jon

2014-03-05

Within the setting of a public health service we analyse the distribution of resources between individuals in nursing homes funded by global budgets. Three questions are pursued. Firstly, whether there are systematic variations between nursing homes in the level of care given to patients. Secondly, whether such variations can be explained by nursing home characteristics. And thirdly, how individual need-related variables are associated with differences in the level of care given. The study included 1204 residents in 35 nursing homes and extra care sheltered housing facilities. Direct time spent with patients was recorded. In average each patient received 14.8 hours direct care each week. Multilevel regression analysis is used to analyse the relationship between individual characteristics, nursing home characteristics and time spent with patients in nursing homes. The study setting is the city of Trondheim, with a population of approximately 180 000. There are large variations between nursing homes in the total amount of individual care given to patients. As much as 24 percent of the variation of individual care between patients could be explained by variation between nursing homes. Adjusting for structural nursing home characteristics did not substantially reduce the variation between nursing homes. As expected a negative association was found between individual care and case-mix, implying that at nursing home level a more resource demanding case-mix is compensated by lowering the average amount of care. At individual level ADL-disability is the strongest predictor for use of resources in nursing homes. For the average user one point increase in ADL-disability increases the use of resources with 27 percent. In a financial reimbursement model for nursing homes with no adjustment for case-mix, the amount of care patients receive does not solely depend on the patients' own needs, but also on the needs of all the other residents.

Variability in Resident Operative Hand Experience by Specialty.

Science.gov (United States)

Silvestre, Jason; Lin, Ines C; Levin, L Scott; Chang, Benjamin

2018-01-01

Recent attention has sought to standardize hand surgery training in the United States. This study analyzes the variability in operative hand experience for orthopedic and general surgery residents. Case logs for orthopedic and general surgery residency graduates were obtained from the American Council of Graduate Medical Education (2006-2007 to 2014-2015). Plastic surgery case logs were not available for comparison. Hand surgery case volumes were compared between specialties with parametric tests. Intraspecialty variation in orthopedic surgery was assessed between the bottom and top 10th percentiles in procedure categories. Case logs for 9605 general surgery residents and 5911 orthopedic surgery residents were analyzed. Orthopedic surgery residents performed a greater number of hand surgery cases than general surgery residents ( P < .001). Mean total hand experience ranged from 2.5 ± 4 to 2.8 ± 5 procedures for general surgery residents with no reported cases of soft tissue repairs, vascular repairs, and replants. Significant intraspecialty variation existed in orthopedic surgery for all hand procedure categories (range, 3.3-15.0). As the model for hand surgery training evolves, general surgeons may represent an underutilized talent pool to meet the critical demand for hand surgeon specialists. Future research is needed to determine acceptable levels of training variability in hand surgery.

Representation in the Care Planning Process for Nursing Home Residents With Dementia.

Science.gov (United States)

McCreedy, Ellen; Loomer, Lacey; Palmer, Jennifer A; Mitchell, Susan L; Volandes, Angelo; Mor, Vincent

2018-05-01

Federally mandated assessments of nursing home (NH) residents drive individualized care planning. Residents with cognitive impairment may not be able to meaningfully communicate their care needs and preferences during this process-a gap that may be partially addressed by involving surrogates. We describe the prevalence of family participation in the care planning process for long-stay NH residents with varying degrees of cognitive impairment. Retrospective study using administrative data made available as part of an ongoing pragmatic cluster randomized controlled trial. A total of 292 NHs from 1 large for-profit NH system. Long-stay NH residents in 2016. We identified all care planning assessments conducted in 2016 for long-stay NH residents. Cognitive functioning was defined using the Cognitive Function Scale. The Minimum Data Set was used to determine whether a resident, family member, and/or legal guardian participated in the assessment process. Certification and Survey Provider Enhance Reporting system data was used to identify facility-level correlates of family participation. Bivariate and multivariable hierarchical regression results are presented. The analytic sample included 18,552 long-stay NH residents. Family member/representative participation varied by degree of resident cognitive impairment; 8% of residents with no cognitive impairment had family or representative participation in care planning during 2016, compared with 26% of residents with severe impairment. NHs with more social workers had greater family participation in care planning. Available NH characteristics do not explain most of the variation in family participation between NHs (residual intraclass correlation = .57). Only a minority of family members and surrogates participate in NH care planning, even for residents with severe cognitive impairment. The association between social work staffing and participation suggests family involvement may be a measure of quality improvement

Rib Geometry Explains Variation in Dynamic Structural Response: Potential Implications for Frontal Impact Fracture Risk.

Science.gov (United States)

Murach, Michelle M; Kang, Yun-Seok; Goldman, Samuel D; Schafman, Michelle A; Schlecht, Stephen H; Moorhouse, Kevin; Bolte, John H; Agnew, Amanda M

2017-09-01

The human thorax is commonly injured in motor vehicle crashes, and despite advancements in occupant safety rib fractures are highly prevalent. The objective of this study was to quantify the ability of gross and cross-sectional geometry, separately and in combination, to explain variation of human rib structural properties. One hundred and twenty-two whole mid-level ribs from 76 fresh post-mortem human subjects were tested in a dynamic frontal impact scenario. Structural properties (peak force and stiffness) were successfully predicted (p rib cross-sectional geometry obtained via direct histological imaging (total area, cortical area, and section modulus) and were improved further when utilizing a combination of cross-sectional and gross geometry (robusticity, whole bone strength index). Additionally, preliminary application of a novel, adaptive thresholding technique, allowed for total area and robusticity to be measured on a subsample of standard clinical CT scans with varied success. These results can be used to understand variation in individual rib response to frontal loading as well as identify important geometric parameters, which could ultimately improve injury criteria as well as the biofidelity of anthropomorphic test devices (ATDs) and finite element (FE) models of the human thorax.

Body size and geographic range do not explain long term variation in fish populations: a Bayesian phylogenetic approach to testing assembly processes in stream fish assemblages.

Directory of Open Access Journals (Sweden)

Stephen J Jacquemin

Full Text Available We combine evolutionary biology and community ecology to test whether two species traits, body size and geographic range, explain long term variation in local scale freshwater stream fish assemblages. Body size and geographic range are expected to influence several aspects of fish ecology, via relationships with niche breadth, dispersal, and abundance. These traits are expected to scale inversely with niche breadth or current abundance, and to scale directly with dispersal potential. However, their utility to explain long term temporal patterns in local scale abundance is not known. Comparative methods employing an existing molecular phylogeny were used to incorporate evolutionary relatedness in a test for covariation of body size and geographic range with long term (1983 - 2010 local scale population variation of fishes in West Fork White River (Indiana, USA. The Bayesian model incorporating phylogenetic uncertainty and correlated predictors indicated that neither body size nor geographic range explained significant variation in population fluctuations over a 28 year period. Phylogenetic signal data indicated that body size and geographic range were less similar among taxa than expected if trait evolution followed a purely random walk. We interpret this as evidence that local scale population variation may be influenced less by species-level traits such as body size or geographic range, and instead may be influenced more strongly by a taxon's local scale habitat and biotic assemblages.

Muscle characteristics only partially explain color variations in fresh hams.

Science.gov (United States)

Stufft, K; Elgin, J; Patterson, B; Matarneh, S K; Preisser, R; Shi, H; England, E M; Scheffler, T L; Mills, E W; Gerrard, D E

2017-06-01

Fresh hams display significant lean color variation that persists through further processing and contributes to a less desirable cured product. In an attempt to understand the underlying cause of this color disparity, we evaluated the differences in muscle characteristics and energy metabolites across semimembranosus (SM) muscles differing in color variation. The L* (lightness) and a* (redness) values were highest and lowest (Pham color variation but suggest other factors may mitigate or exacerbate these variances. Copyright © 2016 Elsevier Ltd. All rights reserved.

Evaluation of quantitative imaging methods for organ activity and residence time estimation using a population of phantoms having realistic variations in anatomy and uptake

International Nuclear Information System (INIS)

He Bin; Du Yong; Segars, W. Paul; Wahl, Richard L.; Sgouros, George; Jacene, Heather; Frey, Eric C.

2009-01-01

Estimating organ residence times is an essential part of patient-specific dosimetry for radioimmunotherapy (RIT). Quantitative imaging methods for RIT are often evaluated using a single physical or simulated phantom but are intended to be applied clinically where there is variability in patient anatomy, biodistribution, and biokinetics. To provide a more relevant evaluation, the authors have thus developed a population of phantoms with realistic variations in these factors and applied it to the evaluation of quantitative imaging methods both to find the best method and to demonstrate the effects of these variations. Using whole body scans and SPECT/CT images, organ shapes and time-activity curves of 111In ibritumomab tiuxetan were measured in dosimetrically important organs in seven patients undergoing a high dose therapy regimen. Based on these measurements, we created a 3D NURBS-based cardiac-torso (NCAT)-based phantom population. SPECT and planar data at realistic count levels were then simulated using previously validated Monte Carlo simulation tools. The projections from the population were used to evaluate the accuracy and variation in accuracy of residence time estimation methods that used a time series of SPECT and planar scans. Quantitative SPECT (QSPECT) reconstruction methods were used that compensated for attenuation, scatter, and the collimator-detector response. Planar images were processed with a conventional (CPlanar) method that used geometric mean attenuation and triple-energy window scatter compensation and a quantitative planar (QPlanar) processing method that used model-based compensation for image degrading effects. Residence times were estimated from activity estimates made at each of five time points. The authors also evaluated hybrid methods that used CPlanar or QPlanar time-activity curves rescaled to the activity estimated from a single QSPECT image. The methods were evaluated in terms of mean relative error and standard deviation of the

Extremes in Otolaryngology Resident Surgical Case Numbers: An Update.

Science.gov (United States)

Baugh, Tiffany P; Franzese, Christine B

2017-06-01

Objectives The purpose of this study is to examine the effect of minimum case numbers on otolaryngology resident case log data and understand differences in minimum, mean, and maximum among certain procedures as a follow-up to a prior study. Study Design Cross-sectional survey using a national database. Setting Academic otolaryngology residency programs. Subjects and Methods Review of otolaryngology resident national data reports from the Accreditation Council for Graduate Medical Education (ACGME) resident case log system performed from 2004 to 2015. Minimum, mean, standard deviation, and maximum values for total number of supervisor and resident surgeon cases and for specific surgical procedures were compared. Results The mean total number of resident surgeon cases for residents graduating from 2011 to 2015 ranged from 1833.3 ± 484 in 2011 to 2072.3 ± 548 in 2014. The minimum total number of cases ranged from 826 in 2014 to 1004 in 2015. The maximum total number of cases increased from 3545 in 2011 to 4580 in 2015. Multiple key indicator procedures had less than the required minimum reported in 2015. Conclusion Despite the ACGME instituting required minimum numbers for key indicator procedures, residents have graduated without meeting these minimums. Furthermore, there continues to be large variations in the minimum, mean, and maximum numbers for many procedures. Variation among resident case numbers is likely multifactorial. Ensuring proper instruction on coding and case role as well as emphasizing frequent logging by residents will ensure programs have the most accurate data to evaluate their case volume.

Can Simple Soil Parameters Explain Field-Scale Variations in Glyphosate-, Bromoxyniloctanoate-, Diflufenican-, and Bentazone Mineralization?

DEFF Research Database (Denmark)

Norgaard, Trine; de Jonge, Lis Wollesen; Møldrup, Per

2015-01-01

The large spatial heterogeneity in soil physico-chemical and microbial parameters challenges our ability to predict and model pesticide leaching from agricultural land. Microbial mineralization of pesticides is an important process with respect to pesticide leaching since mineralization...... is the major process for the complete degradation of pesticides without generation of metabolites. The aim of our study was to determine field-scale variation in the potential for mineralization of the herbicides glyphosate, bromoxyniloctanoate, diflufenican, and bentazone and to investigate whether....... The mineralization potentials for glyphosate and bentazone were compared with 9-years leaching data from two horizontal wells 3.5 m below the field. The field-scale leaching patterns, however, could not be explained by the pesticide mineralization data. Instead, field-scale pesticide leaching may have been governed...

Does Social Capital Explain Community-Level Differences in Organ Donor Designation?

Science.gov (United States)

Ladin, Keren; Wang, Rui; Fleishman, Aaron; Boger, Matthew; Rodrigue, James R

2015-09-01

mobility, violent-death rate), and religious characteristics. We used spatial modeling, including lagged variables to account for the effect of adjacent block groups, and multivariate regression analysis to examine the relationship of social capital and community-level characteristics with organ donor designation rates. Block groups with higher levels of social capital, racial homogeneity, income, workforce participation, owner-occupied housing, native-born residents, and white residents had higher rates of organ donor designation (p < 0.001). These factors remained significant in the multivariate model, which explained more than half the geographic variance in organ donor designation (R(2) = 0.52). The findings suggest that community-level factors, including social capital, predict more than half the variation in donor designation. Future interventions should target the community as the unit of intervention and should tailor messaging for areas with low social capital. © 2015 Milbank Memorial Fund.

Inequality in healthcare costs between residing and non-residing patients: evidence from Vietnam.

Science.gov (United States)

Nguyen, Hieu M

2017-05-12

Place of residence has been shown to impact health. To date, however, previous studies have only focused on the variability in health outcomes and healthcare costs between urban and rural patients. This study takes a different approach and investigates cost inequality facing non-residing patients - patients who do not reside in the regions in which the hospitals are located. Understanding the sources for this inequality is important, as they are directly related to healthcare accessibility in developing countries. The causal impact of residency status on individual healthcare spending is documented with a quasi-experimental design. The propensity score matching method is applied to a unique patient-level dataset (n = 900) collected at public general and specialist hospitals across North Vietnam. Propensity score matching shows that Vietnamese patients who do not reside in the regions in which the hospitals are located are expected to pay about 15 million Vietnamese dongs (approximately 750 USD) more than those who do, a sizable gap, given the distribution of total healthcare costs for the overall sample. This estimate is robust to alternative matching specifications. The obtained discrepancy is empirically attributable to the differences in three potential contributors, namely spending on accompanying relatives, "courtesy funds," and days of hospitalization. The present study finds that there is significant inequality in healthcare spending between residing and non-residing patients at Vietnamese hospitals and that this discrepancy can be partially explained by both institutional and non-institutional factors. These factors signal practical channels through which policymakers can improve healthcare accessibility.

Explaining nascent entrepreneurship across countries

NARCIS (Netherlands)

A.R. Thurik (Roy); A.J. van Stel (André); A.R.M. Wennekers (Sander); P. Reynolds (Paul)

2003-01-01

textabstractThis paper aims at explaining cross-country variation in nascent entrepreneurship. Regression analysis is applied using various explanatory variables derived from three different approaches. We make use of the Global Entrepreneurship Monitor database, including nascent entrepreneurship

Stress Redistribution Explains Anti-correlated Subglacial Pressure Variations

Directory of Open Access Journals (Sweden)

Pierre-Marie Lefeuvre

2018-01-01

Full Text Available We used a finite element model to interpret anti-correlated pressure variations at the base of a glacier to demonstrate the importance of stress redistribution in the basal ice. We first investigated two pairs of load cells installed 20 m apart at the base of the 210 m thick Engabreen glacier in Northern Norway. The load cell data for July 2003 showed that pressurisation of a subglacial channel located over one load cell pair led to anti-correlation in pressure between the two pairs. To investigate the cause of this anti-correlation, we used a full Stokes 3D model of a 210 m thick and 25–200 m wide glacier with a pressurised subglacial channel represented as a pressure boundary condition. The model reproduced the anti-correlated pressure response at the glacier bed and variations in pressure of the same order of magnitude as the load cell observations. The anti-correlation pattern was shown to depend on the bed/surface slope. On a flat bed with laterally constrained cross-section, the resulting bridging effect diverted some of the normal forces acting on the bed to the sides. The anti-correlated pressure variations were then reproduced at a distance >10–20 m from the channel. In contrast, when the bed was inclined, the channel support of the overlying ice was vertical only, causing a reduction of the normal stress on the bed. With a bed slope of 5 degrees, the anti-correlation occurred within 10 m of the channel. The model thus showed that the effect of stress redistribution can lead to an opposite response in pressure at the same distance from the channel and that anti-correlation in pressure is reproduced without invoking cavity expansion caused by sliding.

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.

Teacher in Residence: Bringing Science to Students

CERN Multimedia

Daisy Yuhas

CERN welcomes its first Teacher in Residence, Terrence Baine of the University of Oslo. Baine, who originally hails from Canada, will be concurrently completing his PhD in Physics Education during his time at CERN. Like CERN’s High School Teacher Programme (HST), of which Baine is an alumnus, the Teacher in Residence position is designed to help educators spread the science of CERN in a form that is accessible to students and can encourage them to pursue physics throughout their education.   Terrence Baine, first 'teacher in residence' at CERN Baine explains, “It’s very important to have a teacher present who can be that middle person between the young peoplecoming here, whom we are trying to enlighten, and the physicists who work at CERN. The Teacher in Residence can act as an on-site educational consultant.” As Teacher in Residence, Baine’s primary project will be to develop teaching modules, or a series of lesson plans, that can help high schoo...

Regional variation in post-stroke multidisciplinary rehabilitation care among veteran residents in community nursing homes

Directory of Open Access Journals (Sweden)

Jia H

2017-03-01

Full Text Available Huanguang Jia,1 Qinglin Pei,1 Charles T Sullivan,1 Diane C Cowper Ripley,1 Samuel S Wu,1 W Bruce Vogel,1 Xinping Wang,1 Douglas E Bidelspach,2 Jennifer L Hale-Gallardo,1 Barbara E Bates3 1Center of Innovation on Disability and Rehabilitation Research, North Florida/South Georgia Veterans Health System, Gainesville, FL, 2Physical Medicine and Rehabilitation Service, Department of Veterans Affairs, Washington, DC, 3Aleda E. Lutz VA Medical Center, Saginaw, MI, USA Introduction: Effective post-acute multidisciplinary rehabilitation therapy improves stroke survivors’ functional recovery and daily living activities. The US Department of Veterans Affairs (VA places veterans needing post-acute institutional care in private community nursing homes (CNHs. These placements are made under the same rules and regulations across the VA health care system and through individual per diem contracts between local VA facilities and CNHs. However, there is limited information about utilization of these veterans’ health services as well as the geographic variation of the service utilization. Aim: The aims of this study were to determine rehabilitation therapy and restorative nursing care utilization by veterans with stroke in VA-contracted CNHs and to assess risk-adjusted regional variations in the utilization of rehabilitation therapy and restorative nursing care. Methods: This retrospective study included all veterans diagnosed with stroke residing in VA-contracted CNHs between 2006 and 2009. Minimum Dataset (a health status assessment tool for CNH residents for the study CNHs was linked with veterans’ inpatient and outpatient data within the VA health care system. CNHs were grouped into five VA-defined geographic regions: the North Atlantic, Southeast, Midwest, Continental, and Pacific regions. A two-part model was applied estimating risk-adjusted utilization probability and average weekly utilization days. Two dependent variables were rehabilitation

Spatial and temporal variation of residence time and storage volume of subsurface water evaluated by multi-tracers approach in mountainous headwater catchments

Science.gov (United States)

Tsujimura, Maki; Yano, Shinjiro; Abe, Yutaka; Matsumoto, Takehiro; Yoshizawa, Ayumi; Watanabe, Ysuhito; Ikeda, Koichi

2015-04-01

Headwater catchments in mountainous region are the most important recharge area for surface and subsurface waters, additionally time and stock information of the water is principal to understand hydrological processes in the catchments. However, there have been few researches to evaluate variation of residence time and storage volume of subsurface water in time and space at the mountainous headwaters especially with steep slope. We performed an investigation on age dating and estimation of storage volume using simple water budget model in subsurface water with tracing of hydrological flow processes in mountainous catchments underlain by granite, Paleozoic and Tertiary, Yamanashi and Tsukuba, central Japan. We conducted hydrometric measurements and sampling of spring, stream and ground waters in high-flow and low-flow seasons from 2008 through 2012 in the catchments, and CFCs, stable isotopic ratios of oxygen-18 and deuterium, inorganic solute constituent concentrations were determined on all water samples. Residence time of subsurface water ranged from 11 to 60 years in the granite catchments, from 17 to 32 years in the Paleozoic catchments, from 13 to 26 years in the Tertiary catchments, and showed a younger age during the high-flow season, whereas it showed an older age in the low-flow season. Storage volume of subsurface water was estimated to be ranging from 10 ^ 4 to 10 ^ 6 m3 in the granite catchments, from 10 ^ 5 to 10 ^ 7 m3 in the Paleozoic catchments, from 10 ^ 4 to 10 ^ 6 m3 in the Tertiary catchments. In addition, seasonal change of storage volume in the granite catchments was the highest as compared with those of the Paleozoic and the Tertiary catchments. The results suggest that dynamic change of hydrological process seems to cause a larger variation of the residence time and storage volume of subsurface water in time and space in the granite catchments, whereas higher groundwater recharge rate due to frequent fissures or cracks seems to cause larger

A model explaining genotypic and ontogenetic variation of leaf photosynthetic rate in rice (Oryza sativa) based on leaf nitrogen content and stomatal conductance.

Science.gov (United States)

Ohsumi, Akihiro; Hamasaki, Akihiro; Nakagawa, Hiroshi; Yoshida, Hiroe; Shiraiwa, Tatsuhiko; Horie, Takeshi

2007-02-01

Identification of physiological traits associated with leaf photosynthetic rate (Pn) is important for improving potential productivity of rice (Oryza sativa). The objectives of this study were to develop a model which can explain genotypic variation and ontogenetic change of Pn in rice under optimal conditions as a function of leaf nitrogen content per unit area (N) and stomatal conductance (g(s)), and to quantify the effects of interaction between N and g(s) on the variation of Pn. Pn, N and g(s) were measured at different developmental stages for the topmost fully expanded leaves in ten rice genotypes with diverse backgrounds grown in pots (2002) and in the field (2001 and 2002). A model of Pn that accounts for carboxylation and CO diffusion processes, and assumes that the ratio of internal conductance to g(s) is constant, was constructed, and its goodness of fit was examined. Considerable genotypic differences in Pn were evident for rice throughout development in both the pot and field experiments. The genotypic variation of Pn was correlated with that of g(s) at a given stage, and the change of Pn with plant development was closely related to the change of N. The variation of g(s) among genotypes was independent of that of N. The model explained well the variation in Pn of the ten genotypes grown under different conditions at different developmental stages. Conclusions The response of Pn to increased N differs with g(s), and the increase in Pn of genotypes with low g(s) is smaller than that of genotypes with high g(s). Therefore, simultaneous improvements of these two traits are essential for an effective breeding of rice genotypes with increased Pn.

The role of organizational context and individual nurse characteristics in explaining variation in use of information technologies in evidence based practice

Directory of Open Access Journals (Sweden)

Doran Diane

2012-12-01

Full Text Available Abstract Background There is growing awareness of the role of information technology in evidence-based practice. The purpose of this study was to investigate the role of organizational context and nurse characteristics in explaining variation in nurses’ use of personal digital assistants (PDAs and mobile Tablet PCs for accessing evidence-based information. The Promoting Action on Research Implementation in Health Services (PARIHS model provided the framework for studying the impact of providing nurses with PDA-supported, evidence-based practice resources, and for studying the organizational, technological, and human resource variables that impact nurses’ use patterns. Methods A survey design was used, involving baseline and follow-up questionnaires. The setting included 24 organizations representing three sectors: hospitals, long-term care (LTC facilities, and community organizations (home care and public health. The sample consisted of 710 participants (response rate 58% at Time 1, and 469 for whom both Time 1 and Time 2 follow-up data were obtained (response rate 66%. A hierarchical regression model (HLM was used to evaluate the effect of predictors from all levels simultaneously. Results The Chi square result indicated PDA users reported using their device more frequently than Tablet PC users (p = 0.001. Frequency of device use was explained by ‘breadth of device functions’ and PDA versus Tablet PC. Frequency of Best Practice Guideline use was explained by ‘willingness to implement research,’ ‘structural and electronic resources,’ ‘organizational slack time,’ ‘breadth of device functions’ (positive effects, and ‘slack staff’ (negative effect. Frequency of Nursing Plus database use was explained by ‘culture,’ ‘structural and electronic resources,’ and ‘breadth of device functions’ (positive effects, and ‘slack staff’ (negative. ‘Organizational culture’ (positive, ‘breadth of device functions�

Do diagnosis-related groups appropriately explain variations in costs and length of stay of hip replacement? A comparative assessment of DRG systems across 10 European countries.

Science.gov (United States)

Geissler, Alexander; Scheller-Kreinsen, David; Quentin, Wilm

2012-08-01

This paper assesses the variations in costs and length of stay for hip replacement cases in Austria, England, Estonia, Finland, France, Germany, Ireland, Poland, Spain and Sweden and examines the ability of national diagnosis-related group (DRG) systems to explain the variation in resource use against a set of patient characteristic and treatment specific variables. In total, 195,810 cases clustered in 712 hospitals were analyzed using OLS fixed effects models for cost data (n=125,698) and negative binominal models for length-of-stay data (n=70,112). The number of DRGs differs widely across the 10 European countries (range: 2-14). Underlying this wide range is a different use of classification variables, especially secondary diagnoses and treatment options are considered to a different extent. In six countries, a standard set of patient characteristics and treatment variables explain the variation in costs or length of stay better than the DRG variables. This raises questions about the adequacy of the countries' DRG system or the lack of specific criteria, which could be used as classification variables. Copyright © 2012 John Wiley & Sons, Ltd.

Regional variation in short distance homogamy

OpenAIRE

Haandrikman, Karen; van Wissen, Leo

2011-01-01

A third of all Dutch cohabiters choose a partner from the same municipality, so-called short distance homogamy. This article analyses the regional variation in this phenomenon, and it explains this variation in terms of geographical, socioeconomic, demographic and cultural determinants. Population register data on all new cohabiters in 2004 were used. Regression methods were employed to explain spatial patterns. Regional variation in short distance homogamy is largely explained by geographica...

Variation in family physicians' recording of auscultation abnormalities in patients with acute cough is not explained by case mix. A study from 12 European networks.

Science.gov (United States)

Francis, Nick A; Melbye, Hasse; Kelly, Mark J; Cals, Jochen W L; Hopstaken, Rogier M; Coenen, Samuel; Butler, Christopher C

2013-06-01

Conflicting data on the diagnostic and prognostic value of auscultation abnormalities may be partly explained by inconsistent use of terminology. To describe general practitioners use of chest auscultation abnormality terms for patients presenting with acute cough across Europe, and to explore the influence of geographic location and case mix on use of these terms. Clinicians recorded whether 'diminished vesicular breathing', 'wheezes', 'crackles' and 'rhonchi' were present in an observational study of adults with acute cough in 13 networks in 12 European countries. We describe the use of these terms overall and by network, and used multilevel logistic regression to explore variation by network, controlling for patients' gender, age, comorbidities, smoking status and symptoms. 2345 patients were included. Wheeze was the auscultation abnormality most frequently recorded (20.6% overall) with wide variation by network (range: 8.3-30.8%). There was similar variation for other auscultation abnormalities. After controlling for patient characteristics, network was a significant predictor of auscultation abnormalities with odds ratios for location effects ranging from 0.37 to 4.46 for any recorded auscultation abnormality, and from 0.25 to 3.14 for rhonchi. There is important variation in recording chest auscultation abnormalities by general practitioners across Europe, which cannot be explained by differences in patient characteristics. There is a need and opportunity for standardization in the detection and classification of lung sounds.

Do countries matter? Explaining the variation in the use of numerical flexibility arrangements across European companies using a Multi-level model

OpenAIRE

Chung, Heejung

2007-01-01

Do countries matter, especially compared to other aspects that affect the flexibility behaviours of companies? Many studies on the labour market assume that there are country differences, cross-national variances, and that it is a crucial factor in explaining the actual practices of the labour market by individuals and companies. The supposition is that although there are variations across countries, the behaviour of actors within the country is rather homogeneous. Thus, due to country level ...

An assessment of emergency medicine residents' ability to perform in a multitasking environment.

Science.gov (United States)

Ledrick, David; Fisher, Susan; Thompson, Justin; Sniadanko, Mark

2009-09-01

Multitasking (MT) is a term often applied to emergency medicine (EM), but it is still poorly understood. In an effort to facilitate MT research in EM, the authors conducted this pilot study to describe EM residents' scores on a Multi-Tasking Assessment Tool (MTAT) and compare these scores with the residents' work efficiency in the emergency department. The authors administered a previously developed test of MT ability to EM residents. They performed a multiple regression analysis to determine the effect of MT ability on resident work efficiency, defining efficiency as the number of relative value units billed per hour. They controlled the analysis for year of training and medical knowledge using as a standard the in-service exam administered by the American Board of Emergency Medicine. Complete data for 35 residents were available for analysis. Work efficiency was multivariately correlated with MTAT scores and year of training (P training explained the majority of the variance, a resident's MT ability accounted for a smaller but still significant portion. This pilot study further validates the MTAT and lays the groundwork for further research in MT in EM. Resident year of training and MTAT scores explain the variability in resident work efficiency significantly more than medical knowledge. Understanding MT ability may ultimately help in resident selection, education, and remediation as well as career counseling and improvement of practice systems in EM.

Journalism and Explaining News Content

NARCIS (Netherlands)

Albæk, E.; Skovsgaard, M.; de Vreese, C.H.; Nussbaum, J.F.

Three models are presented to explain variation in news content. In the first model the explanation is based on the individual journalist, in the second model on the professional journalist, and in the third model on the organized journalist. The individual journalist model focuses on how the

Explaining individual- and country-level variations in unregistered employment using a multi-level model: evidence from 35 Eurasian countries

Directory of Open Access Journals (Sweden)

Krasniqi Besnik A.

2017-12-01

Full Text Available The aim of this paper is to evaluate the individual- and country-level variations in unregistered employment. To analyse whether it is marginalised groups who are more likely to engage in unregistered employment and explain the country-level variations, a 2010 Life in Transition Survey (LiTS involving 38,864 interviews in 35 Eurasian countries is reported. Multilevel logistic regression analysis reveals that younger age groups, the divorced, and those with fewer years in education, are more likely to be unregistered employed. On a country-level, meanwhile, the prevalence of unregistered employment is strongly associated with tax morale; the greater the asymmetry between informal and formal institutions, the greater is the prevalence of unregistered employment. It is also higher when GDP per capita as well as social distribution and state intervention (subsidies and transfers, social contribution expenditure, health expenditure are lower. The paper concludes by discussing the theoretical and policy implications.

Which plant trait explains the variations in relative growth rate and its response to elevated carbon dioxide concentration among Arabidopsis thaliana ecotypes derived from a variety of habitats?

Science.gov (United States)

Oguchi, Riichi; Ozaki, Hiroshi; Hanada, Kousuke; Hikosaka, Kouki

2016-03-01

Elevated atmospheric carbon dioxide (CO2) concentration ([CO2]) enhances plant growth, but this enhancement varies considerably. It is still uncertain which plant traits are quantitatively related to the variation in plant growth. To identify the traits responsible, we developed a growth analysis model that included primary parameters associated with morphology, nitrogen (N) use, and leaf and root activities. We analysed the vegetative growth of 44 ecotypes of Arabidopsis thaliana L. grown at ambient and elevated [CO2] (800 μmol mol(-1)). The 44 ecotypes were selected such that they were derived from various altitudes and latitudes. Relative growth rate (RGR; growth rate per unit plant mass) and its response to [CO2] varied by 1.5- and 1.7-fold among ecotypes, respectively. The variation in RGR at both [CO2]s was mainly explained by the variation in leaf N productivity (LNP; growth rate per leaf N),which was strongly related to photosynthetic N use efficiency (PNUE). The variation in the response of RGR to [CO2] was also explained by the variation in the response of LNP to [CO2]. Genomic analyses indicated that there was no phylogenetic constraint on inter-ecotype variation in the CO2 response of RGR or LNP. We conclude that the significant variation in plant growth and its response to [CO2] among ecotypes reflects the variation in N use for photosynthesis among ecotypes, and that the response of PNUE to CO2 is an important target for predicting and/or breeding plants that have high growth rates at elevated [CO2].

Quantitative Social Dialectology : Explaining Linguistic Variation Geographically and Socially

NARCIS (Netherlands)

Wieling, Martijn; Nerbonne, John; Baayen, R. Harald

2011-01-01

In this study we examine linguistic variation and its dependence on both social and geographic factors. We follow dialectometry in applying a quantitative methodology and focusing on dialect distances, and social dialectology in the choice of factors we examine in building a model to predict word

The resident-intruder paradigm : a standardized test for aggression, violence and social stress

NARCIS (Netherlands)

Koolhaas, Jacob; Coppens, Caroline M.; de Boer, Sietse F.; Buwalda, Bauke; Meerlo, Peter; Timmermans, Paul J. A.

2013-01-01

This video publication explains in detail the experimental protocol of the resident-intruder paradigm in rats. This test is a standardized method to measure offensive aggression and defensive behavior in a semi natural setting. The most important behavioral elements performed by the resident and the

What Explains Patterns of Diversification and Richness among Animal Phyla?

Science.gov (United States)

Jezkova, Tereza; Wiens, John J

2017-03-01

Animal phyla vary dramatically in species richness (from one species to >1.2 million), but the causes of this variation remain largely unknown. Animals have also evolved striking variation in morphology and ecology, including sessile marine taxa lacking heads, eyes, limbs, and complex organs (e.g., sponges), parasitic worms (e.g., nematodes, platyhelminths), and taxa with eyes, skeletons, limbs, and complex organs that dominate terrestrial ecosystems (arthropods, chordates). Relating this remarkable variation in traits to the diversification and richness of animal phyla is a fundamental yet unresolved problem in biology. Here, we test the impacts of 18 traits (including morphology, ecology, reproduction, and development) on diversification and richness of extant animal phyla. Using phylogenetic multiple regression, the best-fitting model includes five traits that explain ∼74% of the variation in diversification rates (dioecy, parasitism, eyes/photoreceptors, a skeleton, nonmarine habitat). However, a model including just three (skeleton, parasitism, habitat) explains nearly as much variation (∼67%). Diversification rates then largely explain richness patterns. Our results also identify many striking traits that have surprisingly little impact on diversification (e.g., head, limbs, and complex circulatory and digestive systems). Overall, our results reveal the key factors that shape large-scale patterns of diversification and richness across >80% of all extant, described species.

Operative Landscape at Canadian Neurosurgery Residency Programs.

Science.gov (United States)

Tso, Michael K; Dakson, Ayoub; Ahmed, Syed Uzair; Bigder, Mark; Elliott, Cameron; Guha, Daipayan; Iorio-Morin, Christian; Kameda-Smith, Michelle; Lavergne, Pascal; Makarenko, Serge; Taccone, Michael S; Wang, Bill; Winkler-Schwartz, Alexander; Sankar, Tejas; Christie, Sean D

2017-07-01

Background Currently, the literature lacks reliable data regarding operative case volumes at Canadian neurosurgery residency programs. Our objective was to provide a snapshot of the operative landscape in Canadian neurosurgical training using the trainee-led Canadian Neurosurgery Research Collaborative. Anonymized administrative operative data were gathered from each neurosurgery residency program from January 1, 2014, to December 31, 2014. Procedures were broadly classified into cranial, spine, peripheral nerve, and miscellaneous procedures. A number of prespecified subspecialty procedures were recorded. We defined the resident case index as the ratio of the total number of operations to the total number of neurosurgery residents in that program. Resident number included both Canadian medical and international medical graduates, and included residents on the neurosurgery service, off-service, or on leave for research or other personal reasons. Overall, there was an average of 1845 operative cases per neurosurgery residency program. The mean numbers of cranial, spine, peripheral nerve, and miscellaneous procedures were 725, 466, 48, and 193, respectively. The nationwide mean resident case indices for cranial, spine, peripheral nerve, and total procedures were 90, 58, 5, and 196, respectively. There was some variation in the resident case indices for specific subspecialty procedures, with some training programs not performing carotid endarterectomy or endoscopic transsphenoidal procedures. This study presents the breadth of neurosurgical training within Canadian neurosurgery residency programs. These results may help inform the implementation of neurosurgery training as the Royal College of Physicians and Surgeons residency training transitions to a competence-by-design curriculum.

Validation of the visitor and resident framework in an e-book setting

DEFF Research Database (Denmark)

Engelsmann, Hazel C.; Greifeneder, Elke Susanne; Lauridsen, Nikoline D.

2014-01-01

Introduction. By applying the visitor and resident framework on e-book usage, the article explores whether the concepts of a resident and a visitor can help to explain e-book use, and can help to gain a better insight into users' motivations for e-book use. Method. A questionnaire and semi-struct...

Ambulatory Care Skills: Do Residents Feel Prepared?

Directory of Open Access Journals (Sweden)

Denise Bonds

2002-10-01

Full Text Available Objective: To determine resident comfort and skill in performing ambulatory care skills. Methods: Descriptive survey of common ambulatory care skills administered to internal medicine faculty and residents at one academic medical center. Respondents were asked to rate their ability to perform 12 physical exam skills and 6 procedures, and their comfort in performing 7 types of counseling, and obtaining 6 types of patient history (4 point Likert scale for each. Self-rated ability or comfort was compared by gender, status (year of residency, faculty, and future predicted frequency of use of the skill. Results: Residents reported high ability levels for physical exam skills common to both the ambulatory and hospital setting. Fewer felt able to perform musculoskeletal, neurologic or eye exams easily alone. Procedures generally received low ability ratings. Similarly, residents’ comfort in performing common outpatient counseling was also low. More residents reported feeling very comfortable in obtaining history from patients. We found little variation by gender, year of training, or predicted frequency of use. Conclusion: Self-reported ability and comfort for many common ambulatory care skills is low. Further evaluation of this finding in other training programs is warranted.

ENSO, nest predation risk, food abundance, and male status fail to explain annual variations in the apparent survival rate of a migratory songbird.

Directory of Open Access Journals (Sweden)

Alizée Vernouillet

Full Text Available Adult mortality can be a major driver of population decline in species whose productivity is relatively low. Yet, little is known about the factors influencing adult survival rates in migratory bird species, nor do we know much about the longer-term effects of habitat disturbance on the fitness of individuals. The Ovenbird (Seiurus aurocapilla is one of the vertebrate species most sensitive to forest management, yet it is still common and widespread. We monitored the fate of 330 colour-banded Ovenbird males in four pairs of 25-ha plots during 9 successive breeding seasons. One plot of each pair was treated through selection harvesting (30-40% basal area removed during the first winter. We tested the following hypotheses: (1 higher physiological costs in harvested plots as a result of lower food abundance will reduce apparent survival rate (ASR relative to controls; (2 lower ASR following years with low nest survival and higher probability of renesting; (3 fluctuations in ASR reflecting El Niño Southern Oscillation (ENSO; and (4 higher ASR in returning males than in recruits (unbanded immigrants owing to greater site familiarity in the former. We tested the relative importance of these hypotheses, or combinations thereof, by generating 23 models explaining variation in ASR. The year-dependent model received the most support, showing a 41% decrease in ASR from 2007 to 2014. The important year-to-year variation we observed in ASR (Σw(i = 0.99 was not explained by variation in nest predation risk nor by ENSO. There was also little evidence for an effect of selection harvesting on ASR of Ovenbird males, despite a slight reduction in lifespan relative to males from control plots (2.7 vs 2.9 years. An avenue worth exploring to explain this intriguing pattern would be to determine whether conditions at migratory stopover sites or in the wintering area of our focal population have gradually worsened over the past decade.

Geographic Variations of Colorectal and Breast Cancer Late-Stage Diagnosis and the Effects of Neighborhood-Level Factors.

Science.gov (United States)

Lin, Yan; Wimberly, Michael C

2017-04-01

The purpose of this study was to examine the geographic variations of late-stage diagnosis in colorectal cancer (CRC) and breast cancer as well as to investigate the effects of 3 neighborhood-level factors-socioeconomic deprivation, urban/rural residence, and spatial accessibility to health care-on the late-stage risks. This study used population-based South Dakota cancer registry data from 2001 to 2012. A total of 4,878 CRC cases and 6,418 breast cancer cases were included in the analyses. Two-level logistic regression models were used to analyze the risk of late-stage CRC and breast cancer. For CRC, there was a small geographic variation across census tracts in late-stage diagnosis, and residing in isolated small rural areas was significantly associated with late-stage risk. However, this association became nonsignificant after adjusting for census-tract level socioeconomic deprivation. Socioeconomic deprivation was an independent predictor of CRC late-stage risk, and it explained the elevated risk among American Indians. No relationship was found between spatial accessibility and CRC late-stage risk. For breast cancer, no geographic variation in the late-stage diagnosis was observed across census tracts, and none of the 3 neighborhood-level factors was significantly associated with late-stage risk. Results suggested that socioeconomic deprivation, rather than spatial accessibility, contributed to CRC late-stage risks in South Dakota as a rural state. CRC intervention programs could be developed to target isolated small rural areas, socioeconomically disadvantaged areas, as well as American Indians residing in these areas. © 2016 National Rural Health Association.

Environmental proxies of antigen exposure explain variation in immune investment better than indices of pace of life.

Science.gov (United States)

Horrocks, Nicholas P C; Hegemann, Arne; Ostrowski, Stéphane; Ndithia, Henry; Shobrak, Mohammed; Williams, Joseph B; Matson, Kevin D; Tieleman, B I

2015-01-01

Investment in immune defences is predicted to covary with a variety of ecologically and evolutionarily relevant axes, with pace of life and environmental antigen exposure being two examples. These axes may themselves covary directly or inversely, and such relationships can lead to conflicting predictions regarding immune investment. If pace of life shapes immune investment then, following life history theory, slow-living, arid zone and tropical species should invest more in immunity than fast-living temperate species. Alternatively, if antigen exposure drives immune investment, then species in antigen-rich tropical and temperate environments are predicted to exhibit higher immune indices than species from antigen-poor arid locations. To test these contrasting predictions we investigated how variation in pace of life and antigen exposure influence immune investment in related lark species (Alaudidae) with differing life histories and predicted risks of exposure to environmental microbes and parasites. We used clutch size and total number of eggs laid per year as indicators of pace of life, and aridity, and the climatic variables that influence aridity, as correlates of antigen abundance. We quantified immune investment by measuring four indices of innate immunity. Pace of life explained little of the variation in immune investment, and only one immune measure correlated significantly with pace of life, but not in the predicted direction. Conversely, aridity, our proxy for environmental antigen exposure, was predictive of immune investment, and larks in more mesic environments had higher immune indices than those living in arid, low-risk locations. Our study suggests that abiotic environmental variables with strong ties to environmental antigen exposure can be important correlates of immunological variation.

Which factors explain variation in intention to disclose a diagnosis of dementia? A theory-based survey of mental health professionals

Directory of Open Access Journals (Sweden)

Eccles Martin

2007-09-01

Full Text Available Abstract Background For people with dementia, patient-centred care should involve timely explanation of the diagnosis and its implications. However, this is not routine. Theoretical models of behaviour change offer a generalisable framework for understanding professional practice and identifying modifiable factors to target with an intervention. Theoretical models and empirical work indicate that behavioural intention represents a modifiable predictor of actual professional behaviour. We identified factors that predict the intentions of members of older people's mental health teams (MHTs to perform key behaviours involved in the disclosure of dementia. Design Postal questionnaire survey. Participants Professionals from MHTs in the English National Health Service. Methods We selected three behaviours: Determining what patients already know or suspect about their diagnosis; using explicit terminology when talking to patients; and exploring what the diagnosis means to patients. The questionnaire was based upon the Theory of Planned Behaviour (TPB, Social Cognitive Theory (SCT, and exploratory team variables. Main outcomes Behavioural intentions. Results Out of 1,269 professionals working in 85 MHTs, 399 (31.4% returned completed questionnaires. Overall, the TPB best explained behavioural intention. For determining what patients already know, the TPB variables of subjective norm, perceived behavioural control and attitude explained 29.4% of the variance in intention. For the use of explicit terminology, the same variables explained 53.7% of intention. For exploring what the diagnosis means to patients, subjective norm and perceived behavioural control explained 48.6% of intention. Conclusion These psychological models can explain up to half of the variation in intention to perform key disclosure behaviours. This provides an empirically-supported, theoretical basis for the design of interventions to improve disclosure practice by targeting relevant

Can variation in hypothalamic-pituitary-adrenal (HPA-axis activity explain the relationship between depression and cognition in bipolar patients?

Directory of Open Access Journals (Sweden)

Marieke J van der Werf-Eldering

Full Text Available Dysregulation of the hypothalamic-pituitary-adrenal (HPA axis is thought to be associated with more mood symptoms and worse cognitive functioning. This study examined whether variation in HPA axis activity underlies the association between mood symptoms and cognitive functioning.In 65 bipolar patients cognitive functioning was measured in domains of psychomotor speed, speed of information processing, attentional switching, verbal memory, visual memory, executive functioning and an overall mean score. Severity of depression was assessed by the Inventory of Depressive Symptomatology-self rating version. Saliva cortisol measurements were performed to calculate HPA axis indicators: cortisol awakening response, diurnal slope, the evening cortisol level and the cortisol suppression on the dexamethasone suppression test. Regression analyses of depressive symptoms and cognitive functioning on each HPA axis indicator were performed. In addition we calculated percentages explanation of the association between depressive symptoms and cognition by HPA axis indicators. Depressive symptoms were associated with dysfunction in psychomotor speed, attentional switching and the mean score, as well as with attenuation in diurnal slope value. No association was found between HPA axis activity and cognitive functioning and HPA axis activity did not explain the associations between depressive symptoms and cognition.As our study is the first one in this field specific for bipolar patients and changes in HPA-axis activity did not seem to explain the association between severity of depressive symptoms and cognitive functioning in bipolar patients, future studies are needed to evaluate other factors that might explain this relationship.

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.

Alongshore Variation in the Depth of Activation: Implications of Oil Residence Time

Science.gov (United States)

Flores, P.; Houser, C.

2016-12-01

In 2010 the Deepwater Horizon Oil Spill released approximately 5 million barrels of oil into the Gulf of Mexico just as the nearshore and beach profile were recovering from winter storms. As a consequence, oil mats and tar balls were trapped at depth within the beach and nearshore profile. Excavation of this buried oil during subsequent storms creates the potential for the contamination of adjacent beaches and the degradation of marine ecosystems, which can in turn negatively impact local economies that depend on fisheries and tourism. The potential for oil burial and persistence is dependent on four things: the physio-chemical nature of the oil as it reaches the nearshore environment, the pre-existing morphology of the beach and nearshore, and the evolution of that morphology after the oil is deposited. The depth at which the oil is buried is also dependent on the beach profile during the time of the spill. The purpose of this study is to characterize the alongshore variation in depth of activation on a Deepwater Horizon impacted section of Pensacola Beach, Florida with regards to the implications of oil residence time. Ground- Penetrating Radar (GPR) surveys were conducted along two parallel 1-km transects adjacent to the swash zone and the dune. Additional cross- shore transects were completed every 150 m from the base of the dune to the top of the swash zone. Sediments cores were taken at the crossing points of the alongshore and cross-shore transects, to calibrate the GPR surveys and complete an elemental analysis for the identification of storm layers. The cores were also analyzed for the presence of buried oil.

Disparities between resident and attending surgeon perceptions of intraoperative teaching.

Science.gov (United States)

Butvidas, Lynn D; Anderson, Cheryl I; Balogh, Daniel; Basson, Marc D

2011-03-01

This study aimed to assess attending surgeon and resident recall of good and poor intraoperative teaching experiences and how often these experiences occur at present. By web-based survey, we asked US surgeons and residents to describe their best and worst intraoperative teaching experiences during training and how often 26 common intraoperative teaching behaviors occur in their current environment. A total of 346 residents and 196 surgeons responded (51 programs; 26 states). Surgeons and residents consistently identified trainee autonomy, teacher confidence, and communication as positive, while recalling negatively contemptuous, arrogant, accusatory, or uncommunicative teachers. Residents described intraoperative teaching behaviors by faculty as substantially less frequent than faculty self-reports. Neither sex nor seniority explained these results, although women reported communicative behaviors more frequently than men. Although veteran surgeons and current trainees agree on what constitutes effective and ineffective teaching in the operating room, they disagree on how often these behaviors occur, leaving substantial room for improvement. Published by Elsevier Inc.

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

Science.gov (United States)

Thibault, Alexis

2015-01-01

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

Explaining reported puma-related behaviors and behavioral intentions among northern Arizona residents

Science.gov (United States)

Mattson, David J.; Ruther, Elizabeth J.

2012-01-01

Management of pumas in the American West is typified by conflict among stakeholders plausibly rooted in life experiences and worldviews. We used a mail questionnaire to assess demographics, nature-views, puma-related life experiences and behaviors, and support for puma-related policies among residents of northern Arizona. Data from the questionnaire (n = 693 respondents) were used to model behaviors and support for policies. Compared to models based on nature-views and life experiences, those based on demographics had virtually no support from the data. The Utilitarian/Dominionistic nature-view had the strongest effect of any variable in six of seven models, and was associated with firearms and opposition to policies that would limit killing pumas. The Humanistic/Moralistic nature-view was positively associated with non-lethal behaviors and policies in five models. Gender had the strongest effect of any demographic variable. Compared to demographics alone, our results suggest that worldviews provide a more meaningful explanation of reported human behaviors and behavioral intentions regarding pumas.

Geographic variation and effect of area-level poverty rate on colorectal cancer screening

Directory of Open Access Journals (Sweden)

Schootman Mario

2008-10-01

Full Text Available Abstract Background With a secular trend of increasing colorectal cancer (CRC screening, concerns about disparities in CRC screening also have been rising. It is unclear if CRC screening varies geographically, if area-level poverty rate affects CRC screening, and if individual-level characteristics mediate the area-level effects on CRC screening. Methods Using 2006 Missouri Behavioral Risk Factor Surveillance System (BRFSS data, a multilevel study was conducted to examine geographic variation and the effect of area-level poverty rate on CRC screening use among persons age 50 or older. Individuals were nested within ZIP codes (ZIP5 areas, which in turn, were nested within aggregations of ZIP codes (ZIP3 areas. Six groups of individual-level covariates were considered as potential mediators. Results An estimated 51.8% of Missourians aged 50 or older adhered to CRC screening recommendations. Nearly 15% of the total variation in CRC screening lay between ZIP5 areas. Persons residing in ZIP5 areas with ≥ 10% of poverty rate had lower odds of CRC screening use than those residing in ZIP5 areas with Conclusion Large geographic variation of CRC screening exists in Missouri. Area-level poverty rate, independent of individual-level characteristics, is a significant predictor of CRC screening, but it only explains a small portion of the geographic heterogeneity of CRC screening. Individual-level factors we examined do not mediate the effect of the area-level poverty rate on CRC screening. Future studies should identify other area- and individual-level characteristics associated with CRC screening in Missouri.

Geographic variation and effect of area-level poverty rate on colorectal cancer screening.

Science.gov (United States)

Lian, Min; Schootman, Mario; Yun, Shumei

2008-10-16

With a secular trend of increasing colorectal cancer (CRC) screening, concerns about disparities in CRC screening also have been rising. It is unclear if CRC screening varies geographically, if area-level poverty rate affects CRC screening, and if individual-level characteristics mediate the area-level effects on CRC screening. Using 2006 Missouri Behavioral Risk Factor Surveillance System (BRFSS) data, a multilevel study was conducted to examine geographic variation and the effect of area-level poverty rate on CRC screening use among persons age 50 or older. Individuals were nested within ZIP codes (ZIP5 areas), which in turn, were nested within aggregations of ZIP codes (ZIP3 areas). Six groups of individual-level covariates were considered as potential mediators. An estimated 51.8% of Missourians aged 50 or older adhered to CRC screening recommendations. Nearly 15% of the total variation in CRC screening lay between ZIP5 areas. Persons residing in ZIP5 areas with > or = 10% of poverty rate had lower odds of CRC screening use than those residing in ZIP5 areas with poverty rate (unadjusted odds ratio [OR], 0.69; 95% confidence interval [95% CI], 0.58-0.81; adjusted OR, 0.81; 95% CI, 0.67-0.98). Persons who resided in ZIP3 areas with > or = 20% poverty rate also had lower odds of following CRC screening guidelines than those residing in ZIP3 areas with poverty rate (unadjusted OR, 0.66; 95% CI, 0.52-0.83; adjusted OR, 0.64; 95% CI, 0.50-0.83). Obesity, history of depression/anxiety and access to care were associated with CRC screening, but did not mediate the effect of area-level poverty on CRC screening. Large geographic variation of CRC screening exists in Missouri. Area-level poverty rate, independent of individual-level characteristics, is a significant predictor of CRC screening, but it only explains a small portion of the geographic heterogeneity of CRC screening. Individual-level factors we examined do not mediate the effect of the area-level poverty rate on

Natural selection in a population of Drosophila melanogaster explained by changes in gene expression caused by sequence variation in core promoter regions.

Science.gov (United States)

Sato, Mitsuhiko P; Makino, Takashi; Kawata, Masakado

2016-02-09

Understanding the evolutionary forces that influence variation in gene regulatory regions in natural populations is an important challenge for evolutionary biology because natural selection for such variations could promote adaptive phenotypic evolution. Recently, whole-genome sequence analyses have identified regulatory regions subject to natural selection. However, these studies could not identify the relationship between sequence variation in the detected regions and change in gene expression levels. We analyzed sequence variations in core promoter regions, which are critical regions for gene regulation in higher eukaryotes, in a natural population of Drosophila melanogaster, and identified core promoter sequence variations associated with differences in gene expression levels subjected to natural selection. Among the core promoter regions whose sequence variation could change transcription factor binding sites and explain differences in expression levels, three core promoter regions were detected as candidates associated with purifying selection or selective sweep and seven as candidates associated with balancing selection, excluding the possibility of linkage between these regions and core promoter regions. CHKov1, which confers resistance to the sigma virus and related insecticides, was identified as core promoter regions that has been subject to selective sweep, although it could not be denied that selection for variation in core promoter regions was due to linked single nucleotide polymorphisms in the regulatory region outside core promoter regions. Nucleotide changes in core promoter regions of CHKov1 caused the loss of two basal transcription factor binding sites and acquisition of one transcription factor binding site, resulting in decreased gene expression levels. Of nine core promoter regions regions associated with balancing selection, brat, and CG9044 are associated with neuromuscular junction development, and Nmda1 are associated with learning

Deterministic rather than stochastic factors explain most of the variation in the expression of skin telangiectasia after radiotherapy

International Nuclear Information System (INIS)

Safwat, Akmal; Bentzen, Soeren M.; Turesson, Ingela; Hendry, Jolyon H.

2002-01-01

90% (with 95% confidence limits 65% and 100%) of the variance in radioresponsiveness in the right-sided field was explained by the radioresponsiveness on the left-sided field. Through the linear regression analysis between the AUC and the ID2, it was estimated that patients with a reaction that is 1 SD from the population mean would require a dose modification of approximately 23 Gy (from the group mean of 56 Gy) to give them a level of reaction similar to the group average. Similarly, the WAUC was significantly correlated with the ID2, and 81% (with 95% confidence limits 49% and 100%) of the variance in radioresponsiveness in the right-sided field was explained by the radioresponsiveness on the left-sided field. Patients with a reaction that is 1 SD from the population mean would require a dose modification of approximately 21 Gy (from the group mean of 56 Gy) to give them a level of reaction similar to the group average. Conclusion: For a given fractionation schedule, patient-related factors explain 81-90% of the patient-to-patient variation in telangiectasia level seen after radiotherapy. The remaining 10-19% are explained by stochastic effects. This observation encourages further research into genetic or phenotypic assays of normal tissue radioresponsiveness

Large Variations in HIV-1 Viral Load Explained by Shifting-Mosaic Metapopulation Dynamics

Science.gov (United States)

Lythgoe, Katrina A.; Blanquart, François

2016-01-01

The viral population of HIV-1, like many pathogens that cause systemic infection, is structured and differentiated within the body. The dynamics of cellular immune trafficking through the blood and within compartments of the body has also received wide attention. Despite these advances, mathematical models, which are widely used to interpret and predict viral and immune dynamics in infection, typically treat the infected host as a well-mixed homogeneous environment. Here, we present mathematical, analytical, and computational results that demonstrate that consideration of the spatial structure of the viral population within the host radically alters predictions of previous models. We study the dynamics of virus replication and cytotoxic T lymphocytes (CTLs) within a metapopulation of spatially segregated patches, representing T cell areas connected by circulating blood and lymph. The dynamics of the system depend critically on the interaction between CTLs and infected cells at the within-patch level. We show that for a wide range of parameters, the system admits an unexpected outcome called the shifting-mosaic steady state. In this state, the whole body’s viral population is stable over time, but the equilibrium results from an underlying, highly dynamic process of local infection and clearance within T-cell centers. Notably, and in contrast to previous models, this new model can explain the large differences in set-point viral load (SPVL) observed between patients and their distribution, as well as the relatively low proportion of cells infected at any one time, and alters the predicted determinants of viral load variation. PMID:27706164

Urinary 1-hydroxypyrene in children living in city and rural residences in Denmark

DEFF Research Database (Denmark)

Hansen, Åse Marie; Raaschou-Nielsen, Ole; Knudsen, Lisbeth E.

2006-01-01

AIMS: The present study aims to assess the biological uptake in children of polycyclic aromatic hydrocarbons measured as 1-hydroxypyrene in urine from children living in city and rural residences. METHODS: 103 children living in Copenhagen and 101 children living in rural residences of Denmark......, the children excreted on average 0.07 [95% CI: 0.01-0.41] micromol urinary 1-hydroxypyrene per mol creatinine. Children living in urban residences excreted 0.02 [95% CI: 0.01-0.05] micromol more 1-hydroxypyrene than children living in rural residences. This was confirmed in the multiple regression analysis...... living in urban residences are more exposed to PAH than children living in rural residences. Time spent outdoors increased the excretion of 1-hydroxypyrene, which was most evident among urban children. Higher concentrations of ambient air pollution in urban areas may explain this finding. No influence...

Selective Pressures Explain Differences in Flower Color among Gentiana lutea Populations.

Science.gov (United States)

Sobral, Mar; Veiga, Tania; Domínguez, Paula; Guitián, Javier A; Guitián, Pablo; Guitián, José M

2015-01-01

Flower color variation among plant populations might reflect adaptation to local conditions such as the interacting animal community. In the northwest Iberian Peninsula, flower color of Gentiana lutea varies longitudinally among populations, ranging from orange to yellow. We explored whether flower color is locally adapted and the role of pollinators and seed predators as agents of selection by analyzing the influence of flower color on (i) pollinator visitation rate and (ii) escape from seed predation and (iii) by testing whether differences in pollinator communities correlate with flower color variation across populations. Finally, (iv) we investigated whether variation in selective pressures explains flower color variation among 12 G. lutea populations. Flower color influenced pollinator visits and differences in flower color among populations were related to variation in pollinator communities. Selective pressures on flower color vary among populations and explain part of flower color differences among populations of G. lutea. We conclude that flower color in G. lutea is locally adapted and that pollinators play a role in this adaptation.

Selective Pressures Explain Differences in Flower Color among Gentiana lutea Populations.

Directory of Open Access Journals (Sweden)

Mar Sobral

Full Text Available Flower color variation among plant populations might reflect adaptation to local conditions such as the interacting animal community. In the northwest Iberian Peninsula, flower color of Gentiana lutea varies longitudinally among populations, ranging from orange to yellow. We explored whether flower color is locally adapted and the role of pollinators and seed predators as agents of selection by analyzing the influence of flower color on (i pollinator visitation rate and (ii escape from seed predation and (iii by testing whether differences in pollinator communities correlate with flower color variation across populations. Finally, (iv we investigated whether variation in selective pressures explains flower color variation among 12 G. lutea populations. Flower color influenced pollinator visits and differences in flower color among populations were related to variation in pollinator communities. Selective pressures on flower color vary among populations and explain part of flower color differences among populations of G. lutea. We conclude that flower color in G. lutea is locally adapted and that pollinators play a role in this adaptation.

Explaining mastitis incidence in Dutch dairy farming: the influence of farmers' attitudes and behaviour.

Science.gov (United States)

Jansen, J; van den Borne, B H P; Renes, R J; van Schaik, G; Lam, T J G M; Leeuwis, C

2009-11-15

When mastitis incidence increases, either infection pressure has increased or cows' resistance has decreased. This usually indicates that farm management is not optimal. Numerous quantitative studies have demonstrated the effect of management practices on mastitis. In most of these studies, the identified risk factors could explain only part of the variance in mastitis incidence on farms. Several studies suggest that the unexplained variance is caused by farmers' attitudes towards different aspects of mastitis treatment and preventive behaviour. This study aims to determine, to quantify and to specify the extent to which farmers' attitudes, over and above farmers' behaviour, are factors that explain the variation in mastitis incidence, measured in terms of the quantifiable effect of management factors. An extensive survey on self-reported attitudes, behaviour and mastitis incidence was conducted on 336 Dutch dairy farms. Results of multiple linear regression analyses show that farmers' self-reported behaviour and attitudes together explain 48%, 31% and 23% of the variation within, respectively, the average farm bulk milk somatic cell count (BMSCC), the clinical mastitis incidence and the combined clinical and subclinical mastitis incidence. Both behaviour and attitudes explain part of the variance. However, most of the variance in all three dependant measures is explained solely by the attitude variables. The variation in BMSCC value is best explained by (1) farmers' normative frame of reference about mastitis, (2) farmers' perceptions about the control of mastitis and (3) the perceived effect of a BMSCC penalty level. The variation in clinical mastitis is best explained by farmers' perceptions about mastitis control. The variation in the combined clinical and subclinical mastitis incidence rate is best explained by the perceived effect of a BMSCC penalty level and the frequency of contact with others. The results of this study show that farmers' attitudes are a

Evaluation of residents in professionalism and communication skills in south China

International Nuclear Information System (INIS)

Bo Qu; Yuhong Zhao; Baozhi Sun

2010-01-01

To evaluate the resident doctors' competency in professionalism and communication skills in south China.We conducted this cross-sectional study in 8 hospitals, in 4 provinces of southern China from October to December 2007. The evaluation included 148 resident doctors. A 360-degree instrument from Education Outcomes Service Group (EOS group) of the Arizona Medical Education Consortium was developed and used by the attending physicians, residents, and their peers, nurses, patients, and office staff in this study. All data were entered into a computerized database and analyzed using the Statistical Package for Social Sciences version 13.0( SPSS Inc., Chicago, IL, USA) for Windows. Our results indicated that the instruments are internally consistent (Cronbach's alpha >0.90). The principal components analysis with varimax rotation for the attending-, resident self-evaluation, nurse-, patient-, office staff- and resident peer-rated questionnaires explained 70.68%, 76.13%, 77.02%, 76.37%, 75.51%, and 72.05% of the total variance. Significant differences (p<0.05) were found among different evaluators. The 360-degree instrument appears to be reliable in evaluating a residents' competency in professionalism and communication skills. Information from the assessment may provide feedback to residents (Author).

Defense styles explain psychiatric symptoms: an empirical study.

Science.gov (United States)

Holi, M M; Sammallahti, P R; Aalberg, V A

1999-11-01

To examine the relation between psychiatric symptoms and defense mechanisms, we administered two questionnaires, the Symptom Check-list 90 (SCL-90) and the Defense Style Questionnaire (DSQ) to 122 psychiatric out-patients and to a community sample of 337 subjects. Using regression analysis, we found that 51.8% of the variation in subject's Global Severity Index value could be explained by his defense style. Of the three defense styles, the immature style explained most of the variation in the symptoms. We found little overall evidence for specific connections between particular defenses and symptoms. Projection and dissociation were central in most of the symptom dimensions. We compared patients and controls with the same level of general symptom severity and found that patients used significantly more devaluation and splitting, and controls used significantly more altruism and idealization. Whether defenses predispose to certain symptomatology or are one of its aspects is discussed.

Partitioning sources of variation in vertebrate species richness

Science.gov (United States)

Boone, R.B.; Krohn, W.B.

2000-01-01

Aim: To explore biogeographic patterns of terrestrial vertebrates in Maine, USA using techniques that would describe local and spatial correlations with the environment. Location: Maine, USA. Methods: We delineated the ranges within Maine (86,156 km2) of 275 species using literature and expert review. Ranges were combined into species richness maps, and compared to geomorphology, climate, and woody plant distributions. Methods were adapted that compared richness of all vertebrate classes to each environmental correlate, rather than assessing a single explanatory theory. We partitioned variation in species richness into components using tree and multiple linear regression. Methods were used that allowed for useful comparisons between tree and linear regression results. For both methods we partitioned variation into broad-scale (spatially autocorrelated) and fine-scale (spatially uncorrelated) explained and unexplained components. By partitioning variance, and using both tree and linear regression in analyses, we explored the degree of variation in species richness for each vertebrate group that Could be explained by the relative contribution of each environmental variable. Results: In tree regression, climate variation explained richness better (92% of mean deviance explained for all species) than woody plant variation (87%) and geomorphology (86%). Reptiles were highly correlated with environmental variation (93%), followed by mammals, amphibians, and birds (each with 84-82% deviance explained). In multiple linear regression, climate was most closely associated with total vertebrate richness (78%), followed by woody plants (67%) and geomorphology (56%). Again, reptiles were closely correlated with the environment (95%), followed by mammals (73%), amphibians (63%) and birds (57%). Main conclusions: Comparing variation explained using tree and multiple linear regression quantified the importance of nonlinear relationships and local interactions between species

Explaining life history variation in a changing climate across a species' range

DEFF Research Database (Denmark)

Neuheimer, Anna B.; MacKenzie, Brian R.

2014-01-01

Timing of reproduction greatly influences offspring success and resulting population production. Explaining and predicting species' dynamics necessitates disentangling the intrinsic (genotypic) and extrinsic (climatic) factors controlling reproductive timing. Here we explore temporal and spatial...... changes in spawning time for 21 populations of Atlantic cod (Gadus morhua) across the species' range (40 degrees to 80 degrees N). We estimate spawning time using a physiologically relevant metric that includes information on fish thermal history (degree-days, DD). First, we estimate spawning DD among...... years (within populations) to show how recent changes in spawning time can be explained by local changes in temperature. Second, we employ spawning DD to identify temperature-independent trends in spawning time among populations that are consistent with parallel adaptive evolution and the evolutionary...

Effects of variations in cadmium and lead levels in river sediments on local foods and body burden of local residents in non-polluted areas in Japan.

Science.gov (United States)

Ikeda, Masayuki; Watanabe, Takao; Ohashi, Fumiko; Shimbo, Shinichiro

2010-03-01

This study was initiated to examine if variations in the concentrations of cadmium (Cd) and lead (Pb) in water environment may affect metal levels in local foods and body burden of local residents in non-polluted areas in Japan. Two nationwide databases have been made available on concentrations of Cd in locally harvested brown rice and of Cd and Pb in sediments in local river beds. These data were combined with published data on metal concentrations in polished rice, food duplicates, and blood and urine from the residents. Cd in river sediments correlated significantly with those in brown rice, food duplicates, blood, and urine. Cd in food duplicates correlated with Cd in rice. In contrast, Pb concentrations in the river sediments either did not correlate or correlated only weakly with Pb in biological materials or food duplicates. Possible implication of the different behavior between Cd and Pb regarding the intensity of correlation was discussed with reference to the different routes of exposure to the elements. In conclusions, the Cd body burden on local residents in Japan is significantly influenced by Cd levels in water in the general environment, whereas water-borne Pb did not show clear correlation with the Pb body burden.

The "Nursing Home Compare" measure of urinary/fecal incontinence: cross-sectional variation, stability over time, and the impact of case mix.

Science.gov (United States)

Li, Yue; Schnelle, John; Spector, William D; Glance, Laurent G; Mukamel, Dana B

2010-02-01

To assess the impact of facility case mix on cross-sectional variations and short-term stability of the "Nursing Home Compare" incontinence quality measure (QM) and to determine whether multivariate risk adjustment can minimize such impacts. Retrospective analyses of the 2005 national minimum data set (MDS) that included approximately 600,000 long-term care residents in over 10,000 facilities in each quarterly sample. Mixed logistic regression was used to construct the risk-adjusted QM (nonshrinkage estimator). Facility-level ordinary least-squares models and adjusted R(2) were used to estimate the impact of case mix on cross-sectional and short-term longitudinal variations of currently published and risk-adjusted QMs. At least 50 percent of the cross-sectional variation and 25 percent of the short-term longitudinal variation of the published QM are explained by facility case mix. In contrast, the cross-sectional and short-term longitudinal variations of the risk-adjusted QM are much less susceptible to case-mix variations (adjusted R(2)case-mix variations across facilities and over time, and therefore it may be biased. This issue can be largely addressed by multivariate risk adjustment using risk factors available in the MDS.

Stress and burnout among Swiss dental residents.

Science.gov (United States)

Divaris, Kimon; Lai, Caroline S; Polychronopoulou, Argy; Eliades, Theodore; Katsaros, Christos

2012-01-01

Stress and burnout have been well-documented in graduate medical and undergraduate dental education, but studies among dental graduate students and residents are sparse. The purpose of this investigation was to examine perceived stressors and three dimensions of burnout among dental residents enrolled in the University of Bern, Switzerland. Thirty-six residents enrolled in five specialty programmes were administered the Graduate Dental Environment Stress (GDES30) questionnaire and the Maslach Burnout Inventory (MBI). Individual stress items and overall GDES30 scores were used to quantify perceived stress. To measure burnout, proportions of burnout "cases" and MBI subscale scores were computed in the domains of emotional exhaustion (EE), depersonalization (DP) and reduced personal accomplishment (PA). Analyses relied on descriptive and bi-variate methods. The mean GDES30 score was 2.1 (SD = 0.4). "Lack of leisure time", "meeting the research requirement of the programme" and "completing graduation requirements" emerged as the top three stressors. Thirty-six percent of respondents were burnout "cases" on the PA scale, while this proportion was 17% for EE and 8% for DP. Both stress and burnout levels increased according to year of study, whereas younger residents and females had consistently higher stress and burnout scores compared to older ones and males. Overall, low levels of perceived stress and burnout were found among this group of Swiss dental residents.

Continuity of care in dermatology residency programs in the United States.

Science.gov (United States)

Loh, Tiffany; Vazirnia, Aria; Afshar, Maryam; Dorschner, Robert; Paravar, Taraneh

2017-05-15

As established by the AccreditationCouncil for Graduate Medical Education (ACGME),dermatology residents in the United States must participate in continuity clinic. This requirement may be achieved through multiple means, allowing for program variation. To better assess continuity clinic's role in resident learning, more data on this component of graduate medical education is needed. An anonymous online survey was distributed via the American Board of Dermatology list serv to all U.S. dermatology residents. Continuity clinic organization, setting, frequency, and patient and preceptor characteristics were assessed; resident satisfaction and learning were compared. Of 231 responses, 7.8% reported continuity clinic daily, 77.1% weekly, 9.1% every other week, 3.0%monthly, 0.4% once every several months, and 2.2%only during certain blocks. Of the clinics reported,80.1% were "resident-run with attending" and 11.3%were attending-run. The rest were "resident-run with no attending" (0.9%), both resident and attending run(3.0%), or "other" (4.8%). Trainees in resident-run clinics (with attendings) reported greater continuity of care than those in attending-run clinics (p<0.001).Residents reported better teaching with attending presence during patient encounters than when attendings were present only if concerns were raised(p<0.01).

Diversity of fields and farmers : explaining yield variations in northern Cameroon

NARCIS (Netherlands)

Steenhuijsen Piters, de B.

1995-01-01

This research was inspired by the inability of agricultural research to deal adequately with phenomena of variation, diversity and heterogeneity in agriculture. Although these phenomena were observed as long ago as the beginning of this century, they are still causing concern. Until

The teaching of physics and related courses to residents in radiation oncology

International Nuclear Information System (INIS)

Dunscombe, P.

1989-01-01

A survey of physics and related teaching to radiation oncology residents in 21 Canadian cancer centres was undertaken in December 1987 and January 1988. This survey illustrates a very considerable variation in the formal teaching of physics to aspiring radiation oncologists with, for example, the number of hours offered ranging from 40 to 160 in those 10 centres that have a training program. It would appear to be of benefit to radiation oncology residents, those charged with teaching them, and the radiation oncology community as a whole, to develop specific guidelines for this aspect of resident education. (8 refs., tab.)

Improving Reliability of a Residency Interview Process

Science.gov (United States)

Serres, Michelle L.; Gundrum, Todd E.

2013-01-01

Objective. To improve the reliability and discrimination of a pharmacy resident interview evaluation form, and thereby improve the reliability of the interview process. Methods. In phase 1 of the study, authors used a Many-Facet Rasch Measurement model to optimize an existing evaluation form for reliability and discrimination. In phase 2, interviewer pairs used the modified evaluation form within 4 separate interview stations. In phase 3, 8 interviewers individually-evaluated each candidate in one-on-one interviews. Results. In phase 1, the evaluation form had a reliability of 0.98 with person separation of 6.56; reproducibly, the form separated applicants into 6 distinct groups. Using that form in phase 2 and 3, our largest variation source was candidates, while content specificity was the next largest variation source. The phase 2 g-coefficient was 0.787, while confirmatory phase 3 was 0.922. Process reliability improved with more stations despite fewer interviewers per station—impact of content specificity was greatly reduced with more interview stations. Conclusion. A more reliable, discriminating evaluation form was developed to evaluate candidates during resident interviews, and a process was designed that reduced the impact from content specificity. PMID:24159209

Improving reliability of a residency interview process.

Science.gov (United States)

Peeters, Michael J; Serres, Michelle L; Gundrum, Todd E

2013-10-14

To improve the reliability and discrimination of a pharmacy resident interview evaluation form, and thereby improve the reliability of the interview process. In phase 1 of the study, authors used a Many-Facet Rasch Measurement model to optimize an existing evaluation form for reliability and discrimination. In phase 2, interviewer pairs used the modified evaluation form within 4 separate interview stations. In phase 3, 8 interviewers individually-evaluated each candidate in one-on-one interviews. In phase 1, the evaluation form had a reliability of 0.98 with person separation of 6.56; reproducibly, the form separated applicants into 6 distinct groups. Using that form in phase 2 and 3, our largest variation source was candidates, while content specificity was the next largest variation source. The phase 2 g-coefficient was 0.787, while confirmatory phase 3 was 0.922. Process reliability improved with more stations despite fewer interviewers per station-impact of content specificity was greatly reduced with more interview stations. A more reliable, discriminating evaluation form was developed to evaluate candidates during resident interviews, and a process was designed that reduced the impact from content specificity.

Juvenile Delinquency Explained? A Test of Containment Theory.

Science.gov (United States)

Thompson, William E.; Dodder, Richard A.

1983-01-01

Examines the extent to which variation in self-reported delinquency is explained by the seven containment variables (favorable self-concept, goal orientation, frustration tolerance, retention of norms, internalization of rules, availability of meaningful roles, and group reinforcement), and focuses on racial and sex differences in self-reported…

Co-residence patterns in hunter-gatherer societies show unique human social structure.

Science.gov (United States)

Hill, Kim R; Walker, Robert S; Bozicević, Miran; Eder, James; Headland, Thomas; Hewlett, Barry; Hurtado, A Magdalena; Marlowe, Frank; Wiessner, Polly; Wood, Brian

2011-03-11

Contemporary humans exhibit spectacular biological success derived from cumulative culture and cooperation. The origins of these traits may be related to our ancestral group structure. Because humans lived as foragers for 95% of our species' history, we analyzed co-residence patterns among 32 present-day foraging societies (total n = 5067 individuals, mean experienced band size = 28.2 adults). We found that hunter-gatherers display a unique social structure where (i) either sex may disperse or remain in their natal group, (ii) adult brothers and sisters often co-reside, and (iii) most individuals in residential groups are genetically unrelated. These patterns produce large interaction networks of unrelated adults and suggest that inclusive fitness cannot explain extensive cooperation in hunter-gatherer bands. However, large social networks may help to explain why humans evolved capacities for social learning that resulted in cumulative culture.

Factors influencing variation in dentist service rates.

Science.gov (United States)

Grembowski, D; Milgrom, P; Fiset, L

1990-01-01

In the previous article, we calculated dentist service rates for 200 general dentists based on a homogeneous, well-educated, upper-middle-class population of patients. Wide variations in the rates were detected. In this analysis, factors influencing variation in the rates were identified. Variation in rates for categories of dental services was explained by practice characteristics, patient exposure to fluoridated water supplies, and non-price competition in the dental market. Rates were greatest in large, busy practices in markets with high fees. Older practices consistently had lower rates across services. As a whole, these variables explained between 5 and 30 percent of the variation in the rates.

Attitudes toward the use of gender-inclusive language among residency trainees

Science.gov (United States)

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

1997-01-01

OBJECTIVE: To explore postgraduate medical trainees' attitudes toward the use of gender-inclusive language. DESIGN: Self-administered questionnaire. SETTING: Seven residency training programs at McMaster University, Hamilton, Ont., from July 1993 to June 1994. PARTICIPANTS: 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. OUTCOME MEASURES: Categorization of attitudes about the use of language as gender-inclusive or gender-exclusive; characteristics predicting a gender-inclusive attitude. RESULTS: Factor analysis and Cronbach's alpha (0.90) supported the existence of a construct related to attitudes about language use, the poles of which were categorized as gender-inclusive and gender-exclusive. The authors classified residents with respect to their attitudes to language use from their responses to the questionnaire. In univariate analyses, sex, residency program and country of graduation significantly predicted a gender-inclusive attitude (p < 0.01). Only the first 2 variables were significant in a multivariate model; residency program explained 18% of the variance and sex 3%. Residents in obstetrics and gynecology and psychiatry had the most gender-inclusive attitudes, whereas residents in surgery and anesthesia had the most gender-exclusive attitudes. CONCLUSIONS: 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. PMID:9145055

Interannual variability of net ecosystem productivity in forests is explained by carbon flux phenology in autumn

DEFF Research Database (Denmark)

Wu, Chaoyang; Chen, Xi Jing; Black, T. Andrew

2013-01-01

To investigate the importance of autumn phenology in controlling interannual variability of forest net ecosystem productivity (NEP) and to derive new phenological metrics to explain the interannual variability of NEP. North America and Europe. Flux data from nine deciduous broadleaf forests (DBF......, soil water content and precipitation, were also used to explain the phenological variations. We found that interannual variability of NEP can be largely explained by autumn phenology, i.e. the autumn lag. While variation in neither annual gross primary productivity (GPP) nor in annual ecosystem...

Do Slow and Steady Residents Win the Race? Modeling the Effects of Peak and Overall Resident Productivity in the Emergency Department.

Science.gov (United States)

Joseph, Joshua W; Novack, Victor; Wong, Matthew L; Nathanson, Larry A; Sanchez, Leon D

2017-08-01

Emergency medicine residents need to be staffed in a way that balances operational needs with their educational experience. Key to developing an optimal schedule is knowing a resident's expected productivity, a poorly understood metric. We sought to measure how a resident's busiest (peak) workload affects their overall productivity for the shift. We conducted a retrospective, observational study of resident productivity at an urban, tertiary care center with a 3-year Accreditation Council for Graduate Medical Education-approved emergency medicine training program, with 55,000 visits annually. We abstracted resident productivity data from a database of patient assignments from July 1, 2010 to June 20, 2015, utilizing a generalized estimation equation method to evaluate physician shifts. Our primary outcome measure was the total number of patients seen by a resident over a shift. The secondary outcome was the number of patients seen excluding those in the peak hour. A total of 14,361 shifts were evaluated. Multivariate analysis showed that the total number of patients seen was significantly associated with the number of patients seen during the peak hour, level of training, the timing of the shift, but most prominently, lower variance in patients seen per hour (coefficient of variation productivity can be a strong predictor of their overall productivity, but the substantial negative effect of variability favors a steadier pace. This suggests that resident staffing and patient assignments should generally be oriented toward a more consistent workload, an effect that should be further investigated with attending physicians. Copyright © 2017 Elsevier Inc. All rights reserved.

Explaining regional variations in health care utilization between Swiss cantons using panel econometric models.

Science.gov (United States)

Camenzind, Paul A

2012-03-13

In spite of a detailed and nation-wide legislation frame, there exist large cantonal disparities in consumed quantities of health care services in Switzerland. In this study, the most important factors of influence causing these regional disparities are determined. The findings can also be productive for discussing the containment of health care consumption in other countries. Based on the literature, relevant factors that cause geographic disparities of quantities and costs in western health care systems are identified. Using a selected set of these factors, individual panel econometric models are calculated to explain the variation of the utilization in each of the six largest health care service groups (general practitioners, specialist doctors, hospital inpatient, hospital outpatient, medication, and nursing homes) in Swiss mandatory health insurance (MHI). The main data source is 'Datenpool santésuisse', a database of Swiss health insurers. For all six health care service groups, significant factors influencing the utilization frequency over time and across cantons are found. A greater supply of service providers tends to have strong interrelations with per capita consumption of MHI services. On the demand side, older populations and higher population densities represent the clearest driving factors. Strategies to contain consumption and costs in health care should include several elements. In the federalist Swiss system, the structure of regional health care supply seems to generate significant effects. However, the extent of driving factors on the demand side (e.g., social deprivation) or financing instruments (e.g., high deductibles) should also be considered.

Residence Time Distributions in a Cold, Confined Swirl Flow

DEFF Research Database (Denmark)

Lans, Robert Pieter Van Der; Glarborg, Peter; Dam-Johansen, Kim

1997-01-01

Residence time distributions (RTD) in a confined, cold swirling flow have been measured with a fast-response probe and helium as a tracer. The test-rig represented a scaled down version of a burner. The effect of variation of flow velocities and swirl angle on the flow pattern in the near...

Climate and terrain factors explaining streamflow response and recession in Australian catchments

Directory of Open Access Journals (Sweden)

A. I. J. M. van Dijk

2010-01-01

Full Text Available Daily streamflow data were analysed to assess which climate and terrain factors best explain streamflow response in 183 Australian catchments. Assessed descriptors of catchment response included the parameters of fitted baseflow models, and baseflow index (BFI, average quick flow and average baseflow derived by baseflow separation. The variation in response between catchments was compared with indicators of catchment climate, morphology, geology, soils and land use. Spatial coherence in the residual unexplained variation was investigated using semi-variogram techniques. A linear reservoir model (one parameter; recession coefficient produced baseflow estimates as good as those obtained using a non-linear reservoir (two parameters and for practical purposes was therefore considered an appropriate balance between simplicity and explanatory performance. About a third (27–34% of the spatial variation in recession coefficients and BFI was explained by catchment climate indicators, with another 53% of variation being spatially correlated over distances of 100–150 km, probably indicative of substrate characteristics not captured by the available soil and geology data. The shortest recession half-times occurred in the driest catchments and were attributed to intermittent occurrence of fast-draining (possibly perched groundwater. Most (70–84% of the variation in average baseflow and quick flow was explained by rainfall and climate characteristics; another 20% of variation was spatially correlated over distances of 300–700 km, possibly reflecting a combination of terrain and climate factors. It is concluded that catchment streamflow response can be predicted quite well on the basis of catchment climate alone. The prediction of baseflow recession response should be improved further if relevant substrate properties were identified and measured.

Does dispersal from landlocked trout explain the coexistence of resident and migratory trout females in a small stream?

DEFF Research Database (Denmark)

Pettersson, J.C.E.; Hansen, Michael Møller; Bohlin, T.

2001-01-01

The hypothesis that stream-resident females of brown trout Salmo trutta occurring in sympatry with sea-migrant females in a small stream were immigrants from an up-stream allopatric landlocked population was rejected. Genetic differentiation was not detected between the sympatric forms whereas...

Explaining brain size variation: from social to cultural brain.

Science.gov (United States)

van Schaik, Carel P; Isler, Karin; Burkart, Judith M

2012-05-01

Although the social brain hypothesis has found near-universal acceptance as the best explanation for the evolution of extensive variation in brain size among mammals, it faces two problems. First, it cannot account for grade shifts, where species or complete lineages have a very different brain size than expected based on their social organization. Second, it cannot account for the observation that species with high socio-cognitive abilities also excel in general cognition. These problems may be related. For birds and mammals, we propose to integrate the social brain hypothesis into a broader framework we call cultural intelligence, which stresses the importance of the high costs of brain tissue, general behavioral flexibility and the role of social learning in acquiring cognitive skills. Copyright © 2012 Elsevier Ltd. All rights reserved.

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.

Racial differences in dementia care among nursing home residents.

Science.gov (United States)

Sengupta, Manisha; Decker, Sandra L; Harris-Kojetin, Lauren; Jones, Adrienne

2012-06-01

This article aims to describe potential racial differences in dementia care among nursing home residents with dementia. Using data from the 2004 National Nursing Home Survey (NNHS) in regression models, the authors examine whether non-Whites are less likely than Whites to receive special dementia care--defined as receiving special dementia care services or being in a dementia special care unit (SCU)--and whether this difference derives from differences in resident or facility characteristics. The authors find that non-Whites are 4.3 percentage points less likely than Whites to receive special dementia care. The fact that non-Whites are more likely to rely on Medicaid and less likely to pay out of pocket for nursing home care explains part but not all of the difference. Most of the difference is due to the fact that non-Whites reside in facilities that are less likely to have special dementia care services or dementia care units, particularly for-profit facilities and those in the South.

To what extent does climate explain variations in reported malaria cases in early 20th century Uganda?

Directory of Open Access Journals (Sweden)

Adrian M. Tompkins

2016-03-01

Full Text Available Malaria case statistics were analysed for the period 1926 to 1960 to identify inter-annual variations in malaria cases for the Uganda Protectorate. The analysis shows the mid-to-late 1930s to be a period of increased reported cases. After World War II, malaria cases trend down to a relative minimum in the early 1950s, before increasing rapidly after 1953 to the end of the decade. Data for the Western Province confirm these national trends, which at the time were attributed to a wide range of causes, including land development and management schemes, population mobility, interventions and misdiagnosis. Climate was occasionally proposed as a contributor to enhanced case numbers, and unusual precipitation patterns were held responsible; temperature was rarely, if ever, considered. In this study, a dynamical malaria model was driven with available precipitation and temperature data from the period for five stations located across a range of environments in Uganda. In line with the historical data, the simulations produced relatively enhanced transmission in the 1930s, although there is considerable variability between locations. In all locations, malaria transmission was low in the late 1940s and early 1950s, steeply increasing after 1954. Results indicate that past climate variability explains some of the variations in numbers of reported malaria cases. The impact of multiannual variability in temperature, while only on the order of 0.5°C, was sufficient to drive some of the trends observed in the statistics and thus the role of climate was likely underestimated in the contemporary reports. As the elimination campaigns of the 1960s followed this partly climate-driven increase in malaria, this emphasises the need to account for climate when planning and evaluating intervention strategies.

Partial migration and transient coexistence of migrants and residents in animal populations.

Science.gov (United States)

Singh, Navinder J; Leonardsson, Kjell

2014-01-01

Partial migration, whereby a proportion of the population migrates, is common across the animal kingdom. Much of the focus in the literature has been on trying to explain the underlying mechanisms for the coexistence of migrants and residents. In addition, there has been an increasing number of reports on the prevalence and frequency of partially migratory populations. One possible explanation for the occurrence of partial migration, which has received no attention in the literature, is that of 'transient coexistence' during the invasion phase of a superior behaviour. In this study we develop a theoretical basis for explaining partial migration as a transient coexistence and derive a method to predict the frequency of residents and migrants in partially migrating populations. This method is useful to predict the frequencies of migrants and residents in a small set of populations as a complementing hypothesis to 'an Evolutionary Stable Strategy (ESS)'. We use the logistic growth equation to derive a formula for predicting the frequencies of residents and migrants. We also use simulations and empirical data from white perch (Morone americana), moose (Alces alces) and red deer (Cervus elaphus) to demonstrate our approach. We show that the probability of detecting partial migration due to transient coexistence depends upon a minimum number of tracked or marked individuals for a given number of populations. Our approach provides a starting point in searching for explanations to the observed frequencies, by contrasting the observed pattern with both the predicted transient and the uniform random pattern. Aggregating such information on observed patterns (proportions of migrants and residents) may eventually lead to the development of a quantitative theory for the equilibrium (ESS) populations as well.

Partial migration and transient coexistence of migrants and residents in animal populations.

Directory of Open Access Journals (Sweden)

Navinder J Singh

Full Text Available Partial migration, whereby a proportion of the population migrates, is common across the animal kingdom. Much of the focus in the literature has been on trying to explain the underlying mechanisms for the coexistence of migrants and residents. In addition, there has been an increasing number of reports on the prevalence and frequency of partially migratory populations. One possible explanation for the occurrence of partial migration, which has received no attention in the literature, is that of 'transient coexistence' during the invasion phase of a superior behaviour. In this study we develop a theoretical basis for explaining partial migration as a transient coexistence and derive a method to predict the frequency of residents and migrants in partially migrating populations. This method is useful to predict the frequencies of migrants and residents in a small set of populations as a complementing hypothesis to 'an Evolutionary Stable Strategy (ESS'. We use the logistic growth equation to derive a formula for predicting the frequencies of residents and migrants. We also use simulations and empirical data from white perch (Morone americana, moose (Alces alces and red deer (Cervus elaphus to demonstrate our approach. We show that the probability of detecting partial migration due to transient coexistence depends upon a minimum number of tracked or marked individuals for a given number of populations. Our approach provides a starting point in searching for explanations to the observed frequencies, by contrasting the observed pattern with both the predicted transient and the uniform random pattern. Aggregating such information on observed patterns (proportions of migrants and residents may eventually lead to the development of a quantitative theory for the equilibrium (ESS populations as well.

Spatial variation in tuber depletion by swans explained by differences in net intake rates

NARCIS (Netherlands)

Nolet, BA; Langevoord, O; Bevan, RM; Engelaar, KR; Klaassen, M; Mulder, RJW

We tested whether the spatial variation in resource depletion by Tundra Swans (Cygnus columbianus) foraging on belowground tubers of sage pondweed (Potnmogeton pectinatus) was caused by differences in net energy intake rates. The variation in giving up densities within the confines of one lake was

Assessment and Management of Professionalism Issues in Pathology Residency Training

Directory of Open Access Journals (Sweden)

Ronald E. Domen MD

2015-07-01

Full Text Available Professionalism issues are common in residency training and can be very difficult to recognize and manage. Almost one-third of the milestones for pathology recently instituted by the Accreditation Council for Graduate Medical Education encompass aspects of professionalism. Program directors are often unsure of how and when to remediate residents for unprofessional behavior. We used a case-based educational approach in a workshop setting to assist program directors in the management of unprofessional behavior in residents. Eight case scenarios highlighting various aspects of unprofessional behavior by pathology residents were developed and presented in an open workshop forum at the annual pathology program director’s meeting. Prior to the workshop, 2 surveys were conducted: (1 to collect data on program directors’ experience with identifying, assessing, and managing unprofessional behavior in their residents and (2 to get feedback from workshop registrants on how they would manage each of the 8 case scenarios. A wide range of unprofessional behaviors have been observed by pathology program directors. Although there is occasionally general agreement on how to manage specific behaviors, there remains wide variation in how to manage many of the presented unprofessional behaviors. Remediation for unprofessional behavior in pathology residents remains a difficult and challenging process. Additional education and research in this area are warranted.

Decomposing Racial Disparities in Obesity Prevalence: Variations in Retail Food Environment.

Science.gov (United States)

Singleton, Chelsea R; Affuso, Olivia; Sen, Bisakha

2016-03-01

Racial disparities in obesity exist at the individual and community levels. Retail food environment has been hypothesized to be associated with racial disparities in obesity prevalence. This study aimed to quantify how much food environment measures explain racial disparities in obesity at the county level. Data from 2009 to 2010 on 3,135 U.S. counties were extracted from the U.S. Department of Agriculture Food Environment Atlas and the Behavioral Risk Factor Surveillance System and analyzed in 2013. Oaxaca-Blinder decomposition was used to quantify the portion of the gap in adult obesity prevalence observed between counties with a high and low proportion of African-American residents is explained by food environment measures (e.g., proximity to grocery stores, per capita fast-food restaurants). Counties were considered to have a high African-American population if the percentage of African-American residents was >13.1%, which represents the 2010 U.S. Census national estimate of percentage African-American citizens. There were 665 counties (21%) classified as a high African-American county. The total gap in mean adult obesity prevalence between high and low African-American counties was found to be 3.35 percentage points (32.98% vs 29.63%). Retail food environment measures explained 13.81% of the gap in mean age-adjusted adult obesity prevalence. Retail food environment explains a proportion of the gap in adult obesity prevalence observed between counties with a high proportion of African-American residents and counties with a low proportion of African-American residents. Copyright © 2016 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Do sleep, stress, and illness explain daily variations in fatigue? A prospective study.

Science.gov (United States)

Akerstedt, Torbjörn; Axelsson, John; Lekander, Mats; Orsini, Nicola; Kecklund, Göran

2014-04-01

Fatigue is related to a number of serious diseases, as well as to general well-being. It is also a major cause of sickness absence and use of health facilities. Still, the determinants of variations in fatigue are little investigated. The purpose of present study was to investigate the relationships between the daily variations of fatigue with sleep during the previous night, stress or disease symptoms during the same day - across 42 consecutive days of normal life. 50 individuals participated and gave diary reports and used an actigraph across the 42days. The data was analyzed using a multilevel approach with mixed model regression. The analyses showed that the day-to-day variation in fatigue was related to (poor) sleep quality (pstress (pfatigue rating. Fatigue was also strongly related to poorer subjective health (pstress and illness are consistently connected to how fatigue is experienced during normal living conditions. Copyright © 2014 Elsevier Inc. All rights reserved.

Population-genetic nature of copy number variations in the human genome.

Science.gov (United States)

Kato, Mamoru; Kawaguchi, Takahisa; Ishikawa, Shumpei; Umeda, Takayoshi; Nakamichi, Reiichiro; Shapero, Michael H; Jones, Keith W; Nakamura, Yusuke; Aburatani, Hiroyuki; Tsunoda, Tatsuhiko

2010-03-01

Copy number variations (CNVs) are universal genetic variations, and their association with disease has been increasingly recognized. We designed high-density microarrays for CNVs, and detected 3000-4000 CNVs (4-6% of the genomic sequence) per population that included CNVs previously missed because of smaller sizes and residing in segmental duplications. The patterns of CNVs across individuals were surprisingly simple at the kilo-base scale, suggesting the applicability of a simple genetic analysis for these genetic loci. We utilized the probabilistic theory to determine integer copy numbers of CNVs and employed a recently developed phasing tool to estimate the population frequencies of integer copy number alleles and CNV-SNP haplotypes. The results showed a tendency toward a lower frequency of CNV alleles and that most of our CNVs were explained only by zero-, one- and two-copy alleles. Using the estimated population frequencies, we found several CNV regions with exceptionally high population differentiation. Investigation of CNV-SNP linkage disequilibrium (LD) for 500-900 bi- and multi-allelic CNVs per population revealed that previous conflicting reports on bi-allelic LD were unexpectedly consistent and explained by an LD increase correlated with deletion-allele frequencies. Typically, the bi-allelic LD was lower than SNP-SNP LD, whereas the multi-allelic LD was somewhat stronger than the bi-allelic LD. After further investigation of tag SNPs for CNVs, we conclude that the customary tagging strategy for disease association studies can be applicable for common deletion CNVs, but direct interrogation is needed for other types of CNVs.

[Premorbid personality and aggressive behavior in residents of psychogeriatic nursing homes].

Science.gov (United States)

Cahn, C; Allewijn, M; Diesfeldt, H F A

2005-11-01

In the present study, the correlation was examined between pre-morbid personality traits and the occurrence of aggressive behaviour in residents of a psychogeriatric nursing home. The participants in the study were the close relatives of 39 residents of a psychogeriatric nursing home. These residents were selected on the basis of two subscales of the BOP assessment scale for elderly patients: Aggressive and annoying behaviour, and mental disability. Residents were divided into two groups: one group did not display aggressive behaviour, the other group displayed a great deal of such behaviour. The groups were comparable with regard to the degree of mental disability. To ascertain pre-morbid personality traits, use was made of the hetero-anamnestic personality questionnaire (HAP) and the Quick Big Five (QBF). We found no significant differences in any of the premorbid personality traits between the two groups. We could not confirm the conclusion of other authors that emotional lability (neuroticism) is a personality trait which makes people susceptible to developing aggressive behaviour. In conclusion, our study did not confirm the hypothesis that pre-morbid personality traits are useful to explain the occurrence of aggressive behaviour in residents of a psychogeriatric nursing home.

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.

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.

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

Science.gov (United States)

Azevedo, Roger; And Others

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

Incorporating resident research into the dermatology residency program

Science.gov (United States)

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

2013-01-01

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

Incorporating resident research into the dermatology residency program.

Science.gov (United States)

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

2013-01-01

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

A case-mix classification system for explaining healthcare costs using administrative data in Italy.

Science.gov (United States)

Corti, Maria Chiara; Avossa, Francesco; Schievano, Elena; Gallina, Pietro; Ferroni, Eliana; Alba, Natalia; Dotto, Matilde; Basso, Cristina; Netti, Silvia Tiozzo; Fedeli, Ugo; Mantoan, Domenico

2018-03-04

The Italian National Health Service (NHS) provides universal coverage to all citizens, granting primary and hospital care with a copayment system for outpatient and drug services. Financing of Local Health Trusts (LHTs) is based on a capitation system adjusted only for age, gender and area of residence. We applied a risk-adjustment system (Johns Hopkins Adjusted Clinical Groups System, ACG® System) in order to explain health care costs using routinely collected administrative data in the Veneto Region (North-eastern Italy). All residents in the Veneto Region were included in the study. The ACG system was applied to classify the regional population based on the following information sources for the year 2015: Hospital Discharges, Emergency Room visits, Chronic disease registry for copayment exemptions, ambulatory visits, medications, the Home care database, and drug prescriptions. Simple linear regressions were used to contrast an age-gender model to models incorporating more comprehensive risk measures aimed at predicting health care costs. A simple age-gender model explained only 8% of the variance of 2015 total costs. Adding diagnoses-related variables provided a 23% increase, while pharmacy based variables provided an additional 17% increase in explained variance. The adjusted R-squared of the comprehensive model was 6 times that of the simple age-gender model. ACG System provides substantial improvement in predicting health care costs when compared to simple age-gender adjustments. Aging itself is not the main determinant of the increase of health care costs, which is better explained by the accumulation of chronic conditions and the resulting multimorbidity. Copyright © 2018. Published by Elsevier B.V.

Regional variation in short distance homogamy

NARCIS (Netherlands)

Haandrikman, K.; van Wissen, L.J.G.

2011-01-01

A third of all Dutch cohabiters choose a partner from the same municipality, so-called short distance homogamy. This article analyses the regional variation in this phenomenon, and it explains this variation in terms of geographical, socioeconomic, demographic and cultural determinants. Population

Does a hostel's managing agency determine the access to psychiatric services of its residents?

Science.gov (United States)

Lucas, B; Audini, B; Chisholm, D; Knapp, M; Lelliott, P

1998-10-01

This study examines the effect of managing agency (local authority, private or voluntary) on the use of other health and social care services by residents in mental health hostels and group homes with different levels of staffing in England and Wales. The sample comprised 1323 residents in 275 facilities in eight districts. The measures of service use were number of days in hospital and number of other service contacts. There were highly significant differences between facilities with similar levels of staffing managed by different agencies. Residents in the voluntary sector used fewer community services overall; residents in low-staffed local authority facilities used more services than those in similar facilities managed by other agencies. These differences were not easily explained by differences in the social or clinical characteristics of residents. This suggests that there may be organisational factors, e.g. hostel staff, knowledge of services, which influence access to and use of community services.

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.

Explaining the judicial independence of international courts: a comparative analysis

DEFF Research Database (Denmark)

Beach, Derek

What factors allow some international courts (ICs) to rule against the express preferences of powerful member states, whereas others routinely defer to governments? While judicial independence is not the only factor explaining the strength of a given international institution, it is a necessary...... condition. The paper first develops three sets of competing explanatory variables that potentially can explain variations in the judicial independence of ICs. The causal effects of these explanatory variables upon variance in judicial independence are investigated in a comparative analysis of the ACJ, ECJ...

Hip Fractures in Long-Term Care: Is the Excess Explained by the Age and Gender Distribution of the Residents?

Directory of Open Access Journals (Sweden)

Richard G. Crilly

2010-01-01

Full Text Available Introduction. This study compares hip fracture rates in Long Term Care (LTC residents with those in the community to determine if their high rate of fracturing reflects the extreme age and predominantly female nature of that population. Methods. Hospital discharge data in London Ontario (population 350,000 and Statistics Canada data were used to correct the hip fracture rate in the LTC setting for age and gender. Results. The risk of hip fracture is 1.8 times greater in LTC than in the community for people of similar age and gender. The rate in women is 1.5 times higher whereas in men it is 4.3 times higher. In the oldest residents, the risk in men exceeds that of women in LTC. Conclusion. The high hip fracture rate in LTC is not just a reflection of the age and predominantly female nature of this population. The oldest men in LTC are a particularly high risk group, deserving more attention.

Climate and foraging mode explain interspecific variation in snake metabolic rates.

Science.gov (United States)

Dupoué, Andréaz; Brischoux, François; Lourdais, Olivier

2017-11-29

The energy cost of self-maintenance is a critical facet of life-history strategies. Clarifying the determinant of interspecific variation in metabolic rate (MR) at rest is important to understand and predict ecological patterns such as species distributions or responses to climatic changes. We examined variation of MR in snakes, a group characterized by a remarkable diversity of activity rates and a wide distribution. We collated previously published MR data ( n = 491 observations) measured in 90 snake species at different trial temperatures. We tested for the effects of metabolic state (standard MR (SMR) versus resting MR (RMR)), foraging mode (active versus ambush foragers) and climate (temperature and precipitation) while accounting for non-independence owing to phylogeny, body mass and thermal dependence. We found that RMR was 40% higher than SMR, and that active foragers have higher MR than species that ambush their prey. We found that MR was higher in cold environments, supporting the metabolic cold adaptation hypothesis. We also found an additive and positive effect of precipitation on MR suggesting that lower MR in arid environments may decrease dehydration and energetic costs. Altogether, our findings underline the complex influences of climate and foraging mode on MR and emphasize the relevance of these facets to understand the physiological impact of climate change. © 2017 The Author(s).

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.

A father effect explains sex-ratio bias.

Science.gov (United States)

Malo, Aurelio F; Martinez-Pastor, Felipe; Garcia-Gonzalez, Francisco; Garde, Julián; Ballou, Jonathan D; Lacy, Robert C

2017-08-30

Sex ratio allocation has important fitness consequences, and theory predicts that parents should adjust offspring sex ratio in cases where the fitness returns of producing male and female offspring vary. The ability of fathers to bias offspring sex ratios has traditionally been dismissed given the expectation of an equal proportion of X- and Y-chromosome-bearing sperm (CBS) in ejaculates due to segregation of sex chromosomes at meiosis. This expectation has been recently refuted. Here we used Peromyscus leucopus to demonstrate that sex ratio is explained by an exclusive effect of the father, and suggest a likely mechanism by which male-driven sex-ratio bias is attained. We identified a male sperm morphological marker that is associated with the mechanism leading to sex ratio bias; differences among males in the sperm nucleus area (a proxy for the sex chromosome that the sperm contains) explain 22% variation in litter sex ratio. We further show the role played by the sperm nucleus area as a mediator in the relationship between individual genetic variation and sex-ratio bias. Fathers with high levels of genetic variation had ejaculates with a higher proportion of sperm with small nuclei area. This, in turn, led to siring a higher proportion of sons (25% increase in sons per 0.1 decrease in the inbreeding coefficient). Our results reveal a plausible mechanism underlying unexplored male-driven sex-ratio biases. We also discuss why this pattern of paternal bias can be adaptive. This research puts to rest the idea that father contribution to sex ratio variation should be disregarded in vertebrates, and will stimulate research on evolutionary constraints to sex ratios-for example, whether fathers and mothers have divergent, coinciding, or neutral sex allocation interests. Finally, these results offer a potential explanation for those intriguing cases in which there are sex ratio biases, such as in humans. © 2017 The Author(s).

Causes and significance of variation in mammalian basal metabolism.

Science.gov (United States)

Raichlen, David A; Gordon, Adam D; Muchlinski, Magdalena N; Snodgrass, J Josh

2010-02-01

Mammalian basal metabolic rates (BMR) increase with body mass, whichs explains approximately 95% of the variation in BMR. However, at a given mass, there remains a large amount of variation in BMR. While many researchers suggest that the overall scaling of BMR with body mass is due to physiological constraints, variation at a given body mass may provide clues as to how selection acts on BMR. Here, we examine this variation in BMR in a broad sample of mammals and we test the hypothesis that, across mammals, body composition explains differences in BMR at a given body mass. Variation in BMR is strongly correlated with variation in muscle mass, and both of these variables are correlated with latitude and ambient temperature. These results suggest that selection alters BMR in response to thermoregulatory pressures, and that selection uses muscle mass as a means to generate this variation.

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

Science.gov (United States)

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

2010-10-01

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

Why do some, but not all, tropical birds migrate? A comparative study of diet breadth and fruit preference

Science.gov (United States)

Boyle, W.A.; Conway, C.J.; Bronstein, Judith L.

2011-01-01

Annual migrations of birds profoundly influence terrestrial communities. However, few empirical studies examine why birds migrate, in part due to the difficulty of testing causal hypotheses in long-distance migration systems. Short-distance altitudinal migrations provide relatively tractable systems in which to test explanations for migration. Many past studies explain tropical altitudinal migration as a response to spatial and temporal variation in fruit availability. Yet this hypothesis fails to explain why some coexisting, closely-related frugivorous birds remain resident year-round. We take a mechanistic approach by proposing and evaluating two hypotheses (one based on competitive exclusion and the other based on differences in dietary specialization) to explain why some, but not all, tropical frugivores migrate. We tested predictions of these hypotheses by comparing diets, fruit preferences, and the relationships between diet and preference in closely-related pairs of migrant and resident species. Fecal samples and experimental choice trials revealed that sympatric migrants and residents differed in both their diets and fruit preferences. Migrants consumed a greater diversity of fruits and fewer arthropods than did their resident counterparts. Migrants also tended to have slightly stronger fruit preferences than residents. Most critically, diets of migrants more closely matched their preferences than did the diets of residents. These results suggest that migrants may be competitively superior foragers for fruit compared to residents (rather than vice versa), implying that current competitive interactions are unlikely to explain variation in migratory behavior among coexisting frugivores. We found some support for the dietary specialization hypothesis, propose refinements to the mechanism underlying this hypothesis, and discuss how dietary specialization might ultimately reflect past interspecific competition. We recommend that future studies quantify variation

Tourist Activity of Senior Citizens (60+ Residing in Urban and Rural Areas

Directory of Open Access Journals (Sweden)

Omelan Aneta

2016-12-01

Full Text Available The objective of this study was to analyze the influence of place of permanent residence (urban or rural on the tourist activity of senior citizens (60+ of different socioeconomic statuses. The study involved 380 senior citizens (305 female and 75 male aged 60 years and older who were permanent residents of the region of Warmia and Mazury, Poland. In this group, 244 subjects resided in urban areas and 136 participants were rural dwellers. The respondents were asked to complete a questionnaire regarding their socioeconomic status (place of permanent residence, age, gender, educational attainment, financial status, membership in senior organizations, marital status, and professional activity and tourist activity. A significance test of two structure coefficients (α=0.05 was applied. Factors such as gender, professional activity, and marital status were not related with the travel propensity of seniors from different groups (urban and rural, but were significant when rural residents were compared with urban dwellers. Seniors residing in urban areas of Warmia and Mazury, Poland, were significantly more likely to travel for leisure than those residing in rural areas. The tourist activity of seniors decreased significantly (p<0.05 with the age (60-74 years and financial status of rural residents. The travel propensity of elderly people increased significantly (p<0.05 with educational attainment and membership in senior organizations. The study revealed considerable differences in the socioeconomic status and social characteristics of seniors residing in rural and urban areas, and those variations significantly influenced their propensity for travel: urban residents traveled more frequently than rural residents. It can be concluded that place of residence was a crucial factor determining the tourist behavior of senior citizens, and urban dwellers were more likely to travel.

Microhabitat and Climatic Niche Change Explain Patterns of Diversification among Frog Families.

Science.gov (United States)

Moen, Daniel S; Wiens, John J

2017-07-01

A major goal of ecology and evolutionary biology is to explain patterns of species richness among clades. Differences in rates of net diversification (speciation minus extinction over time) may often explain these patterns, but the factors that drive variation in diversification rates remain uncertain. Three important candidates are climatic niche position (e.g., whether clades are primarily temperate or tropical), rates of climatic niche change among species within clades, and microhabitat (e.g., aquatic, terrestrial, arboreal). The first two factors have been tested separately in several studies, but the relative importance of all three is largely unknown. Here we explore the correlates of diversification among families of frogs, which collectively represent ∼88% of amphibian species. We assemble and analyze data on phylogeny, climate, and microhabitat for thousands of species. We find that the best-fitting phylogenetic multiple regression model includes all three types of variables: microhabitat, rates of climatic niche change, and climatic niche position. This model explains 67% of the variation in diversification rates among frog families, with arboreal microhabitat explaining ∼31%, niche rates ∼25%, and climatic niche position ∼11%. Surprisingly, we show that microhabitat can have a much stronger influence on diversification than climatic niche position or rates of climatic niche change.

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

Does place explain racial health disparities? Quantifying the contribution of residential context to the Black/white health gap in the United States.

Science.gov (United States)

Do, D Phuong; Finch, Brian Karl; Basurto-Davila, Ricardo; Bird, Chloe; Escarce, Jose; Lurie, Nicole

2008-10-01

The persistence of the black health disadvantage has been a puzzling component of health in the United States in spite of general declines in rates of morbidity and mortality over the past century. Studies that have focused on well-established individual-level determinants of health such as socio-economic status and health behaviors have been unable to fully explain these disparities. Recent research has begun to focus on other factors such as racism, discrimination, and segregation. Variation in neighborhood context-socio-demographic composition, social aspects, and built environment-has been postulated as an additional explanation for racial disparities, but few attempts have been made to quantify its overall contribution to the black/white health gap. This analysis is an attempt to generate an estimate of place effects on explaining health disparities by utilizing data from the U.S. National Health Interview Survey (NHIS) (1989-1994), combined with a methodology for identifying residents of the same blocks both within and across NHIS survey cross-sections. Our results indicate that controlling for a single point-in-time measure of residential context results in a roughly 15-76% reduction of the black/white disparities in self-rated health that were previously unaccounted for by individual-level controls. The contribution of residential context toward explaining the black/white self-rated health gap varies by both age and gender such that contextual explanations of disparities decline with age and appear to be smaller among females.

Comparison of radiology residency programs in ten countries

International Nuclear Information System (INIS)

Willatt, J.M.G.; Mason, A.C.

2006-01-01

The purpose of our study was to compare various aspects of radiology training schemes in ten countries. A questionnaire was sent to senior residents in the UK, USA, Canada, Australia, New Zealand, Italy, Egypt, India, Malaysia and Greece. The questions concerned length of training, required pre-training experience, the organization of the training scheme, teaching, resources, stages at which residents can independently perform and report examinations, fellowships, and progression to jobs. A wide variety of training, ranging from highly scheduled programs with detailed aims and objectives, to self-learning occurs across the world. Examinations and assessments are also variable. There are lessons to be learned from varying practices; more exchanges of ideas should be encouraged. In view of the ''internationalization'' of radiology services and the variation in training styles an international qualification for quality assurance purposes may be desirable. (orig.)

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

Science.gov (United States)

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

2018-04-17

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

Dynamics of postmarital residence among the Hadza: a kin investment model.

Science.gov (United States)

Wood, Brian M; Marlowe, Frank W

2011-07-01

When we have asked Hadza whether married couples should live with the family of the wife (uxorilocally) or the family of the husband (virilocally), we are often told that young couples should spend the first years of a marriage living with the wife's family, and then later, after a few children have been born, the couple has more freedom--they can continue to reside with the wife's kin, or else they could join the husband's kin, or perhaps live in a camp where there are no close kin. In this paper, we address why shifts in kin coresidence patterns may arise in the later years of a marriage, after the birth of children. To do so, we model the inclusive fitness costs that wives might experience from leaving their own kin and joining their husband's kin as a function of the number of children in their nuclear family. Our model suggests that such shifts should become less costly to wives as their families grow. This simple model may help explain some of the dynamics of postmarital residence among the Hadza and offer insight into the dynamics of multilocal residence, the most prevalent form of postmarital residence among foragers.

Regional variation in smoking among African Americans.

Science.gov (United States)

King, G; Polednak, A P; Bendel, R

1999-08-01

The impact of geographic region and metropolitan residence on smoking prevalence among African Americans has not been adequately examined. This study analyzed 5 years of data from the National Health Interview Survey (1990-1994) on current smoking and regional variation among 16,738 African Americans. Results. Respondents in the West had the lowest unadjusted smoking prevalence rates and Midwest residents had the highest. Current smoking was lower among African Americans living in non-central cities than in central cities even after adjusting for several sociodemographic covariates. Multivariate logistic regression analysis revealed that black women in the South were significantly less likely to be smokers compared with any other gender/region group. These findings suggest the significance of gender and regional factors such as the social history of migration, social stress and racism, exposure to tobacco advertisement, variations in cultural influences, community structures, and coping strategies in under standing African American smoking behavior. Copyright 1999 American Health Foundation and Academic Press.

Leveraging new information technology to monitor medicine use in 71 residential aged care facilities: variation in polypharmacy and antipsychotic use.

Science.gov (United States)

Pont, Lisa G; Raban, Magda Z; Jorgensen, Mikaela L; Georgiou, Andrew; Westbrook, Johanna I

2018-06-08

The aim of this study was to use routinely collected electronic medicines administration (eMAR) data in residential aged care (RAC) to investigate the quality use of medicines. A cross-sectional analysis of eMAR data. 71 RAC facilities in New South Wales and the Australian Capital Territory, Australia. Permanent residents living in a participating facility on 1 October 2015. None. Variation in polypharmacy (≥5 medications), hyper-polypharmacy (≥10 medications) and antipsychotic use across facilities was examined using funnel plot analysis. The study dataset included 4775 long-term residents. The mean resident age was 85.3 years and 70.6% of residents were female. The median facility size was 60 residents and 74.3% were in metropolitan locations. 84.3% of residents had polypharmacy, 41.2% hyper-polypharmacy and 21.0% were using an antipsychotic. The extent of polypharmacy (69.75-100% of residents), hyper-polypharmacy (38.81-76.19%) and use of antipsychotic medicines (0-75.6%) varied considerably across the 71 facilities. Using eMAR data we found substantial variation in polypharmacy, hyper-polypharmacy and antipsychotic medicine use across 71 RAC facilities. Further investigation into the policies and practices of facilities performing above or below expected levels is warranted to understand variation and drive quality improvement.

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

Directory of Open Access Journals (Sweden)

Heidi H. Ewen

2017-03-01

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

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

Science.gov (United States)

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

2017-01-01

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

Foliar pH as a new plant trait: can it explain variation in foliar chemistry and carbon cycling processes among subarctic plant species and types?

Science.gov (United States)

Cornelissen, J H C; Quested, H M; van Logtestijn, R S P; Pérez-Harguindeguy, N; Gwynn-Jones, D; Díaz, S; Callaghan, T V; Press, M C; Aerts, R

2006-03-01

Plant traits have become popular as predictors of interspecific variation in important ecosystem properties and processes. Here we introduce foliar pH as a possible new plant trait, and tested whether (1) green leaf pH or leaf litter pH correlates with biochemical and structural foliar traits that are linked to biogeochemical cycling; (2) there is consistent variation in green leaf pH or leaf litter pH among plant types as defined by nutrient uptake mode and higher taxonomy; (3) green leaf pH can predict a significant proportion of variation in leaf digestibility among plant species and types; (4) leaf litter pH can predict a significant proportion of variation in leaf litter decomposability among plant species and types. We found some evidence in support of all four hypotheses for a wide range of species in a subarctic flora, although cryptogams (fern allies and a moss) tended to weaken the patterns by showing relatively poor leaf digestibility or litter decomposability at a given pH. Among seed plant species, green leaf pH itself explained only up to a third of the interspecific variation in leaf digestibility and leaf litter up to a quarter of the interspecific variation in leaf litter decomposability. However, foliar pH substantially improved the power of foliar lignin and/or cellulose concentrations as predictors of these processes when added to regression models as a second variable. When species were aggregated into plant types as defined by higher taxonomy and nutrient uptake mode, green-specific leaf area was a more powerful predictor of digestibility or decomposability than any of the biochemical traits including pH. The usefulness of foliar pH as a new predictive trait, whether or not in combination with other traits, remains to be tested across more plant species, types and biomes, and also in relation to other plant or ecosystem traits and processes.

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

Science.gov (United States)

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

1996-06-01

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

Psychosocial Training in U.S. Internal Medicine and Family Practice Residency Programs.

Science.gov (United States)

Gaufberg, Elizabeth H.; Joseph, Robert C.; Pels, Richard J.; Wyshak, Grace; Wieman, Dow; Nadelson, Carol C.

2001-01-01

Surveyed directors of internal medicine (IM) and family practice (FP) residency programs regarding the format, content, and quantity of psychosocial training in their programs, their opinions on topics related to such training, and program demographics. Found considerable variation in content and time devoted to psychosocial training within and…

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

Science.gov (United States)

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

2012-11-01

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

seasonal variation and prevalence of tuberculosis among health

African Journals Online (AJOL)

Damary

2006-11-11

Nov 11, 2006 ... effects of seasonal variation on the incidence of TB in the study area and to use sentinel analysis to predict areas of ... One third of the world's population is exposed to TB ... residence and ethnic origin) were collected from all.

Fluctuating survival selection explains variation in avian group size.

Science.gov (United States)

Brown, Charles R; Brown, Mary Bomberger; Roche, Erin A; O'Brien, Valerie A; Page, Catherine E

2016-05-03

Most animal groups vary extensively in size. Because individuals in certain sizes of groups often have higher apparent fitness than those in other groups, why wide group size variation persists in most populations remains unexplained. We used a 30-y mark-recapture study of colonially breeding cliff swallows (Petrochelidon pyrrhonota) to show that the survival advantages of different colony sizes fluctuated among years. Colony size was under both stabilizing and directional selection in different years, and reversals in the sign of directional selection regularly occurred. Directional selection was predicted in part by drought conditions: birds in larger colonies tended to be favored in cooler and wetter years, and birds in smaller colonies in hotter and drier years. Oscillating selection on colony size likely reflected annual differences in food availability and the consequent importance of information transfer, and/or the level of ectoparasitism, with the net benefit of sociality varying under these different conditions. Averaged across years, there was no net directional change in selection on colony size. The wide range in cliff swallow group size is probably maintained by fluctuating survival selection and represents the first case, to our knowledge, in which fitness advantages of different group sizes regularly oscillate over time in a natural vertebrate population.

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

Science.gov (United States)

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

2008-07-01

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

Explaining inequalities in women's mortality between U.S. States

Directory of Open Access Journals (Sweden)

Jennifer Karas Montez

2016-12-01

Full Text Available Inequalities in women's mortality between U.S. states are large and growing. It is unknown whether they reflect differences between states in their population characteristics, contextual characteristics, or both. This study systematically examines the large inequalities in women's mortality between U.S. states using a multilevel approach. It focuses on “fundamental” social determinants of mortality at the individual and state levels as potential explanations. We analyze data from the 2013 public-use National Longitudinal Mortality Study on women aged 45–89 years and estimate multilevel logistic regression models. The models include women's personal characteristics (age, race/ethnicity, education, employment, income, and marriage and states’ contextual characteristics (economic environment, social cohesion, sociopolitical orientation, physical infrastructure, and tobacco environment. We found that variation in women's mortality across states was significant (p<0.001. Adjusting for women's personal characteristics explained 30% of the variation. Additionally adjusting for states’ contextual characteristics explained 62% of the variation; the most important characteristics were social cohesion and economic conditions. No significant mortality differences between any two states remained after accounting for individual and contextual characteristics. Supplementary analyses of men indicate that state contexts have stronger and more pernicious consequences for women than men. Taken together, the findings underscore the importance of ‘bringing context back in’ and taking a multilevel approach when investigating geographic inequalities in U.S. mortality. Keywords: Mortality, Gender, Inequality, Social determinants, U.S. states, Multilevel

Monitoring and reactive-transport modeling of the spatial and temporal variations of the Strengbach spring hydrochemistry

Science.gov (United States)

Ackerer, J.; Chabaux, F.; Lucas, Y.; Clément, A.; Fritz, B.; Beaulieu, E.; Viville, D.; Pierret, M. C.; Gangloff, S.; Négrel, Ph.

2018-03-01

This study focuses on 20 years of hydrochemical monitoring of the small springs that emerge in the experimental granitic catchment of Strengbach (OHGE, France) and the simulation of these data using the KIRMAT code. The data indicate that the Strengbach springs display chemostatic behavior; that is, limited temporal variations were noted in the concentrations of dissolved silica (H4SiO4) and most of the basic cations during the studied period (1987-2010), resulting in relative stability of the global weathering fluxes exported by the springs. Only the Ca2+ concentrations reflect a significant decrease in all the Strengbach springs since 1987, and the variations differ from one spring to another. The modeling results show that the decrease in Ca2+ in the Strengbach springs is due to the response of the water-rock interactions within the bedrock to the variations in the chemical composition of the soil solutions, which were characterized by a significant increase in pH and a decrease in Ca2+ concentrations between 1987 and 2010. The decrease in Ca2+ concentrations seen in the Strengbach springs is controlled by changes in the apatite dissolution rate and the compositions of clay minerals induced by the soil solution changes. The differences observed between the Ca2+ trends of the springs are related to changes in the residence time of the water supplying the different springs. The weak impact of the soil solution modifications on the dissolution rates of other primary minerals and on the bulk precipitation rates of the clay minerals explains the relative stability over time of the concentrations of the other cations and dissolved silica in the water derived from the Strengbach springs. Further, the hydrochemical simulations suggest that the chemostatic behavior of the Strengbach springs cannot be explained by the mobilization of waters that are close to chemical equilibrium, but rather by a hydrological control of the spring water residence times. Finally, a

Pass rates on the American Board of Family Medicine Certification Exam by residency location and size.

Science.gov (United States)

Falcone, John L; Middleton, Donald B

2013-01-01

The Accreditation Council for Graduate Medical Education (ACGME) sets residency performance standards for the American Board of Family Medicine Certification Examination. This study aims are to describe the compliance of residency programs with ACGME standards and to determine whether residency pass rates depend on program size and location. In this retrospective cohort study, residency performance from 2007 to 2011 was compared with the ACGME performance standards. Simple linear regression was performed to see whether program pass rates were dependent on program size. Regional differences in performance were compared with χ(2) tests, using an α level of 0.05. Of 429 total residency programs, there were 205 (47.8%) that violate ACGME performance standards. Linear regression showed that program pass rates were positively correlated and dependent on program size (P family medicine training programs do not meet the ACGME examination performance standards. Pass rates are associated with residency program size, and regional variation occurs. These findings have the potential to affect ACGME policy and residency program application patterns.

Can neighborhoods explain racial/ethnic differences in adolescent inactivity?

Science.gov (United States)

Richmond, Tracy K; Field, Alison E; Rich, Michael

2007-01-01

To determine if neighborhoods and their attributes contribute to racial/ethnic disparities in adolescent inactivity. We undertook a cross-sectional analysis of the National Longitudinal Study of Adolescent Health (n = 17,007), a nationally representative school-based study in the United States. Stratifying by gender, we used multivariate linear regression and multi-level modeling to determine whether neighborhood of residence may partially explain racial/ethnic disparities in adolescent physical inactivity, defined as hours viewing television or videos/DVDs and/or playing computer/video games each week. Participants lived in largely segregated communities. Black and Hispanic adolescent girls reported higher levels of inactivity than White adolescent girls (21 vs. 15 vs. 13 hours/week, respectively, p violent crime in the neighborhood was associated with inactivity, despite the individual's perception of his/her neighborhood as safe not being predictive. Although inactivity varies by race/ethnicity and gender, only in Hispanic adolescent girls does neighborhood fully explain the differential use. Our findings suggest that approaches other than changing neighborhood characteristics are needed to eliminate racial/ethnic disparities in adolescent inactivity.

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

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.

What does remediation and probation status mean? A survey of emergency medicine residency program directors.

Science.gov (United States)

Weizberg, Moshe; Smith, Jessica L; Murano, Tiffany; Silverberg, Mark; Santen, Sally A

2015-01-01

Emergency medicine (EM) residency program directors (PDs) nationwide place residents on remediation and probation. However, the Accreditation Council for Graduate Medical Education and the EM PDs have not defined these terms, and individual institutions must set guidelines defining a change in resident status from good standing to remediation or probation. The primary objective of this study was to determine if EM PDs follow a common process to guide actions when residents are placed on remediation and probation. An anonymous electronic survey was distributed to EM PDs via e-mail using SurveyMonkey to determine the current practice followed after residents are placed on remediation or probation. The survey queried four designations: informal remediation, formal remediation, informal probation, and formal probation. These designations were compared for deficits in the domains of medical knowledge (MK) and non-MK remediation. The survey asked what process for designation exists and what actions are triggered, specifically if documentation is placed in a resident's file, if the graduate medical education (GME) office is notified, if faculty are informed, or if resident privileges are limited. Descriptive data are reported. Eighty-one of 160 PDs responded. An official policy on remediation and/or probation was reported by 41 (50.6%) programs. The status of informal remediation is used by 73 (90.1%), 80 (98.8%) have formal remediation, 40 (49.4%) have informal probation, and 79 (97.5%) have formal probation. There was great variation among PDs in the management and definition of remediation and probation. Between 81 and 86% of programs place an official letter into the resident's file regarding formal remediation and probation. However, only about 50% notify the GME office when a resident is placed on formal remediation. There were no statistical differences between MK and non-MK remediation practices. There is significant variation among EM programs regarding the

Attitudes and behaviour of residents within the framework of energy efficiency

Energy Technology Data Exchange (ETDEWEB)

Valkila, N.

2013-11-01

The goal of this study was to determine how Finnish energy policies are realised and the attitudes of consumers regarding energy issues. Further research was done to study if the attitudes of residents and their behaviour regarding energy issues are inter-related. A goal was also to study if place of residence affects attitudes and behaviour. Are residents willing to improve their efficiency in terms of energy consumption? The range of applied research methods was diverse. A literature review was performed and experts operating in the energy industry were interviewed. Ordinary energy consumers, i.e. residents, were studied using interviews and measurements and by forming consumer panels. Content analysis and statistical methods were used for analysing the results. Based on this study, Finland should strive to utilise more diverse energy sources and engage in closer co-operation with different stakeholders. Resident attitudes on energy matters must be influenced. The most effective influencing methods are peer groups, communication, media, training and education, perceptions and visions. Age and the location of residence influence people's attitudes and behaviour with respect to energy issues, whereas their life satisfaction level does not. For example, research subjects that reside in a more densely populated suburban area are more concerned with climate change and more willing to give up driving than research subjects that live in more scarcely populated residential areas. Residents are willing to improve their energy behaviour, although young and elderly people are more willing to make environmentally friendly choices than the middle-aged demographic. There is a gap that needs to be bridged between attitudes and behaviour. If the attitudes of residents were to become more active and positive towards energy, they could lead to the desired energy-efficient behaviour. This study does not aim to make generalisations regarding Finns. Instead, it wishes to explain

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

Science.gov (United States)

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

2017-12-15

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

Residents' response to bleeding during a simulated robotic surgery task.

Science.gov (United States)

Walker, Jessica L; Nathwani, Jay N; Mohamadipanah, Hossein; Laufer, Shlomi; Jocewicz, Frank F; Gwillim, Eran; Pugh, Carla M

2017-12-01

The aim of this study was to assess performance measurement validity of our newly developed robotic surgery task trainer. We hypothesized that residents would exhibit wide variations in their intercohort performance as well as a measurable difference compared to surgeons in fellowship training. Our laboratory synthesized a model of a pelvic tumor that simulates unexpected bleeding. Surgical residents and fellows of varying specialties completed a demographic survey and were allowed 20 minutes to resect the tumor using the da Vinci robot and achieve hemostasis. At a standardized event in the simulation, venous bleeding began, and participants attempted hemostasis using suture ligation. A motion tracking system, using electromagnetic sensors, recorded participants' hand movements. A postparticipation Likert scale survey evaluated participants' assessment of the model's realism and usefulness. Three of the seven residents (postgraduate year 2-5), and the fellow successfully resected the tumor in the allotted time. Residents showed high variability in performance and blood loss (125-700 mL) both within their cohort and compared to the fellow (150 mL blood). All participants rated the model as having high realism and utility for trainees. The results support that our bleeding pelvic tumor simulator has the ability to discriminate resident performance in robotic surgery. The combination of motion, decision-making, and blood loss metrics offers a multilevel performance assessment, analyzing both technical and decision-making abilities. Copyright © 2017 Elsevier Inc. All rights reserved.

Optimization of Occupancy Based Demand Controlled Ventilation in Residences

DEFF Research Database (Denmark)

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

2011-01-01

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

Determinants of Medical and Health Care Expenditure Growth for Urban Residents in China: A Systematic Review Article.

Science.gov (United States)

Zhu, Xiaolong; Cai, Qiong; Wang, Jin; Liu, Yun

2014-12-01

In recent years, medical and health care consumption has risen, making health risk an important determinant of household spending and welfare. We aimed to examine the determinants of medical and health care expenditure to help policy-makers in the improvement of China's health care system, benefiting the country, society and every household. This paper employs panel data from China's provinces from 2001 to 2011 with all possible economic variations and studies the determinants of medical and healthcare expenditure for urban residents. CPI (consumer price index) of medical services and the resident consumption level of urban residents have positive influence on medical and health care expenditures for urban residents, while the local medical budget, the number of health institutions, the incidence of infectious diseases, the year-end population and the savings of urban residents will not have effect on medical and health care expenditure for urban residents. This paper proposed three relevant policy suggestions for Chinese governments based on the findings of the research.

Beyond dichotomous explanations: Explaining constitutional control of the executieve with fuzzy-sets.

NARCIS (Netherlands)

Pennings, P.J.M.

2003-01-01

What are the main variations in the constitutional control of the executive in 45 parliamentary democracies and how can these differences be accounted for? Four competing hypotheses, based on dichotomies, explain the degree of this control by means of contrasting institutional settings: consensus

Beyond dichotomous explanations: explaining constitutional control of the executive with fuzzy-sets

NARCIS (Netherlands)

Pennings, P.J.M.

2003-01-01

What are the main variations in the constitutional control of the executive in 45 parliamentary democracies and how can these differences be accounted for? Four competing hypotheses, based on dichotomies, explain the degree of this control by means of contrasting institutional settings: consensus

Reproducibility of blood pressure variation in older ambulatory and bedridden subjects.

Science.gov (United States)

Tsuchihashi, Takuya; Kawakami, Yasunobu; Imamura, Tsuyoshi; Abe, Isao

2002-06-01

We investigated the influence of ambulation on the reproducibility of circadian blood pressure variation in older nursing home residents. Ambulatory blood pressure monitoring was performed twice in 37 older nursing home residents. Nursing home in Japan. Subjects included 18 ambulatory nursing home residents who had no limitation on physical activity and 19 bedridden residents who did not participate in physical activity. Twenty-four-hour, daytime, and nighttime blood pressure levels and their variability. The 24-hour and daytime variability of systolic blood pressure (SBP) was significantly greater in ambulatory than in bedridden subjects, whereas nighttime variability was similar. Significant correlations in SBP averaged for the whole day, daytime, and nighttime were observed between the two examinations in ambulatory (r =.80-.83) and bedridden (r =.83-.91) subjects, but the variabilities of SBP for the whole day and during the daytime of the first measurement were correlated with those of the second measurement in bedridden (r =.67 and r =.47, respectively) but not in ambulatory (r =.39 and r =.28, respectively) subjects. Significant correlations were found between the nocturnal SBP changes at two occasions in both ambulatory (r =.50) and bedridden (r =.51) subjects, but the dipper versus nondipper profiles, defined as reduction in SBP of greater than 10% versus not, showed low reproducibility in ambulatory subjects; five ambulatory (28%) and one bedridden (5%) subjects showed divergent profiles between the two examinations. The reproducibility of blood pressure variation in nursing home residents is influenced by ambulation.

Lunar nitrogen: Secular variation or mixing?

International Nuclear Information System (INIS)

Norris, S.J.; Wright, I.P.; Pillinger, C.T.

1986-01-01

The two current models to explain the nearly 40% variation of the lunar nitrogen isotopic composition are: (1) secular variation of solar wind nitrogen; and (2) a two component mixing model having a constant, heavy solar wind admixed with varying amounts of indigenous light lunar N (LLN). Both models are needed to explain the step pyrolysis extraction profile. The secular variation model proposes that the low temperature release is modern day solar wind implanted into grain surfaces, the 900 C to 1100 C release is from grain surfaces which were once exposed to the ancient solar wind but which are now trapped inside agglutinates, and the >1100 C release as spallogenic N produced by cosmic rays. The mixing model ascribes the components to solar wind, indigenous lunar N and spallogenic N respectively. An extension of either interpretation is that the light N seen in lunar breccias or deep drill cores represent conditions when more N-14 was available to the lunar surface

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

Science.gov (United States)

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

2015-01-01

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

Killer whale morphology - Variation in morphology of killer whale ecotypes

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — We are using elliptic Fourier analysis to determine the patterns of variation in morphology of dorsal fin shape, saddle patch shape, and eye patch shape of resident,...

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.

Ethnolinguistic Study of Local Wisdom in Ex-Residency of Surakarta

Directory of Open Access Journals (Sweden)

Wakit Abdullah

2017-02-01

Full Text Available This study discusses “the local wisdom summarized in the proverbs of the Javanese community in Ex-residency of Surakarta”. The purposes of this study are to describe (1 the background of the local wisdom as summarize in the proverbs of the Javanese community in Ex-residency of Surakarta, (2 to elaborate further reasons and specific times the people in Ex-residency of Surakarta employ the Javanese proverbs that summarize the local wisdom, and (3 explain the cultural meanings resided in the Javanese proverbs. This study employed ethnographic methods framed by the ethnolinguistic study to find the cultural meanings. Data and the data sources are categorized into primary and secondary data; the data collection method is done through the observation-participation and in-depth interview techniques; data analysis employed the ethnoscience model which underwent 12-phases of advanced research stages (of taxonomic, componential and domain analyses to find the cultural themes; validity of the data is attested with the triangulation techniques (the triangulation of data, methods, researcher, and theory. The results encompassed (1 background of the local wisdom summarized in the Javanese proverbs  expressed by the Javanese community in Ex-residency of Surakarta influenced by the cultural factors, the Javanese language, aesthetical, ethical, social, economical, political, and geographical factors; (2 the community in Ex-Surakarta expressed the Javanese proverb that summarizes local wisdom, the demands of fidelity to the culture is inevitable, media that facilitates the growth of the Javanese language, aesthetical and ethical motivations, social conditions, economical motivation, political media which show the geographical background; and (3 the cultural meaning of the Javanese proverbs which summarize the local wisdom of the community in Ex-residency of Surakarta, all of which are to show the courtesy, avoid direct confrontation, the proverbs also

Splines and variational methods

CERN Document Server

Prenter, P M

2008-01-01

One of the clearest available introductions to variational methods, this text requires only a minimal background in calculus and linear algebra. Its self-contained treatment explains the application of theoretic notions to the kinds of physical problems that engineers regularly encounter. The text's first half concerns approximation theoretic notions, exploring the theory and computation of one- and two-dimensional polynomial and other spline functions. Later chapters examine variational methods in the solution of operator equations, focusing on boundary value problems in one and two dimension

Small-scale density variations in the lunar crust revealed by GRAIL

Science.gov (United States)

Jansen, J. C.; Andrews-Hanna, J. C.; Li, Y.; Lucey, P. G.; Taylor, G. J.; Goossens, S.; Lemoine, F. G.; Mazarico, E.; Head, J. W.; Milbury, C.; Kiefer, W. S.; Soderblom, J. M.; Zuber, M. T.

2017-07-01

Data from the Gravity Recovery and Interior Laboratory (GRAIL) mission have revealed that ∼98% of the power of the gravity signal of the Moon at high spherical harmonic degrees correlates with the topography. The remaining 2% of the signal, which cannot be explained by topography, contains information about density variations within the crust. These high-degree Bouguer gravity anomalies are likely caused by small-scale (10‧s of km) shallow density variations. Here we use gravity inversions to model the small-scale three-dimensional variations in the density of the lunar crust. Inversion results from three non-descript areas yield shallow density variations in the range of 100-200 kg/m3. Three end-member scenarios of variations in porosity, intrusions into the crust, and variations in bulk crustal composition were tested as possible sources of the density variations. We find that the density anomalies can be caused entirely by changes in porosity. Characteristics of density anomalies in the South Pole-Aitken basin also support porosity as a primary source of these variations. Mafic intrusions into the crust could explain many, but not all of the anomalies. Additionally, variations in crustal composition revealed by spectral data could only explain a small fraction of the density anomalies. Nevertheless, all three sources of density variations likely contribute. Collectively, results from this study of GRAIL gravity data, combined with other studies of remote sensing data and lunar samples, show that the lunar crust exhibits variations in density by ± 10% over scales ranging from centimeters to 100‧s of kilometers.

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

Science.gov (United States)

Shamsudin, Zarina; Shamsudin, Shafiza; Zainal, Rozlin

2017-10-01

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

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

Consequences for established design practice from geographical variation of historical rainfall data

DEFF Research Database (Denmark)

Mikkelsen, P.S.; Arnbjerg-Nielsen, K.; Harremoës, P.

1997-01-01

variation and variation due to (correlated) sampling errors. Further analyses indicate that the observed variation can be explained only partially by correlation with regional climatological variables and that a significant residual variation remains, especially for large return periods. The new perceptions...

Why do some women refuse to allow male residents to perform pelvic exams?

Science.gov (United States)

Rifkin, Julie I; Shapiro, Howard; Regensteiner, Judith G; Stotler, Jeanne K; Schmidt, Betty

2002-10-01

Many women who receive medical care in residency training clinics refuse to allow male residents to perform their pelvic exams. This study was conducted to identify which women were most likely to refuse and to learn their reasons for refusing. From January to March 1997, a questionnaire was given to all women entering a Tri-County Health office and a Planned Parenthood clinic, both in the Denver, Colorado, metropolitan area, who consented to participate in the study. Data from the questionnaire were analyzed using a statistical software package. A total of 1,437 women entered the clinics during the study period. Of these patients, 1,078 consented to complete the questionnaire. Seven of these 1,078 women did not complete the questionnaire. Women who did not know the training level of the resident performing the pelvic exam were more likely to refuse than were women who knew the training level of the resident (p =.001), but many women preferred a female physician regardless of the physician's training level. Fifty-eight percent said they would allow a male resident to observe a female attending physician perform the exam, compared with 36% who said they would allow a male resident to observe if the attending physician was a man. Common statements from those who would refuse were: "I am just more comfortable with a female," "Women do not want men to examine their private body parts," and "Women explain things better." A woman's knowledge of the resident's training level correlates with her willingness to have a pelvic exam performed by a male resident. Women who said they would refuse a pelvic exam performed by a male resident gave specific reasons for their decision.

Documentation and billing for services provided by midwives teaching obstetrics and gynecology residents and medical students.

Science.gov (United States)

Wilson-Liverman, Angela; Slager, Joan; Wage, Deborah

2009-01-01

Certified nurse-midwives are teaching obstetrics and gynecology residents and medical students in major academic institutions across the United States. In these instances, the ability to appropriately document services rendered to support a billable service is paramount. This article explains the difference in requirements for midwives' documentation when working with residents compared with documentation required of an attending obstetrician-gynecologist. It also reviews the teaching physician guidelines developed by the Centers for Medicare and Medicaid Services (CMS) as well as current evaluation and management documentation requirements. Several examples of documentation are provided, as are suggestions for enhancement and simplification of the guidelines to include midwives. An important point to remember is that the CMS rules do not prohibit a certified nurse-midwife from teaching a resident.

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.

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

Science.gov (United States)

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

2018-03-01

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

Seasonality in cholera dynamics: A rainfall-driven model explains the wide range of patterns in endemic areas

Science.gov (United States)

Baracchini, Theo; King, Aaron A.; Bouma, Menno J.; Rodó, Xavier; Bertuzzo, Enrico; Pascual, Mercedes

2017-10-01

Seasonal patterns in cholera dynamics exhibit pronounced variability across geographical regions, showing single or multiple peaks at different times of the year. Although multiple hypotheses related to local climate variables have been proposed, an understanding of this seasonal variation remains incomplete. The historical Bengal region, which encompasses the full range of cholera's seasonality observed worldwide, provides a unique opportunity to gain insights on underlying environmental drivers. Here, we propose a mechanistic, rainfall-temperature driven, stochastic epidemiological model which explicitly accounts for the fluctuations of the aquatic reservoir, and analyze with this model the historical dataset of cholera mortality in the Bengal region. Parameters are inferred with a recently developed sequential Monte Carlo method for likelihood maximization in partially observed Markov processes. Results indicate that the hydrological regime is a major driver of the seasonal dynamics of cholera. Rainfall tends to buffer the propagation of the disease in wet regions due to the longer residence times of water in the environment and an associated dilution effect, whereas it enhances cholera resurgence in dry regions. Moreover, the dynamics of the environmental water reservoir determine whether the seasonality is unimodal or bimodal, as well as its phase relative to the monsoon. Thus, the full range of seasonal patterns can be explained based solely on the local variation of rainfall and temperature. Given the close connection between cholera seasonality and environmental conditions, a deeper understanding of the underlying mechanisms would allow the better management and planning of public health policies with respect to climate variability and climate change.

Is the diurnal pattern sufficient to explain the intraday variation in volatility? A nonparametric assessment

DEFF Research Database (Denmark)

Christensen, Kim; Hounyo, Ulrich; Podolskij, Mark

In this paper, we propose a nonparametric way to test the hypothesis that time-variation in intraday volatility is caused solely by a deterministic and recurrent diurnal pattern. We assume that noisy high-frequency data from a discretely sampled jump-diffusion process are available. The test...... inference, we propose a new bootstrap approach, which leads to almost correctly sized tests of the null hypothesis. We apply the developed framework to a large cross-section of equity high-frequency data and find that the diurnal pattern accounts for a rather significant fraction of intraday variation...

"They Have to Adapt to Learn": Surgeons' Perspectives on the Role of Procedural Variation in Surgical Education.

Science.gov (United States)

Apramian, Tavis; Cristancho, Sayra; Watling, Chris; Ott, Michael; Lingard, Lorelei

2016-01-01

Clinical research increasingly acknowledges the existence of significant procedural variation in surgical practice. This study explored surgeons' perspectives regarding the influence of intersurgeon procedural variation on the teaching and learning of surgical residents. This qualitative study used a grounded theory-based analysis of observational and interview data. Observational data were collected in 3 tertiary care teaching hospitals in Ontario, Canada. Semistructured interviews explored potential procedural variations arising during the observations and prompts from an iteratively refined guide. Ongoing data analysis refined the theoretical framework and informed data collection strategies, as prescribed by the iterative nature of grounded theory research. Our sample included 99 hours of observation across 45 cases with 14 surgeons. Semistructured, audio-recorded interviews (n = 14) occurred immediately following observational periods. Surgeons endorsed the use of intersurgeon procedural variations to teach residents about adapting to the complexity of surgical practice and the norms of surgical culture. Surgeons suggested that residents' efforts to identify thresholds of principle and preference are crucial to professional development. Principles that emerged from the study included the following: (1) knowing what comes next, (2) choosing the right plane, (3) handling tissue appropriately, (4) recognizing the abnormal, and (5) making safe progress. Surgeons suggested that learning to follow these principles while maintaining key aspects of surgical culture, like autonomy and individuality, are important social processes in surgical education. Acknowledging intersurgeon variation has important implications for curriculum development and workplace-based assessment in surgical education. Adapting to intersurgeon procedural variations may foster versatility in surgical residents. However, the existence of procedural variations and their active use in surgeons

Explaining biomass growth of tropical canopy trees: the importance of sapwood.

Science.gov (United States)

van der Sande, Masha T; Zuidema, Pieter A; Sterck, Frank

2015-04-01

Tropical forests are important in worldwide carbon (C) storage and sequestration. C sequestration of these forests may especially be determined by the growth of canopy trees. However, the factors driving variation in growth among such large individuals remain largely unclear. We evaluate how crown traits [total leaf area, specific leaf area and leaf nitrogen (N) concentration] and stem traits [sapwood area (SA) and sapwood N concentration] measured for individual trees affect absolute biomass growth for 43 tropical canopy trees belonging to four species, in a moist forest in Bolivia. Biomass growth varied strongly among trees, between 17.3 and 367.3 kg year(-1), with an average of 105.4 kg year(-1). We found that variation in biomass growth was chiefly explained by a positive effect of SA, and not by tree size or other traits examined. SA itself was positively associated with sapwood growth, sapwood lifespan and basal area. We speculate that SA positively affects the growth of individual trees mainly by increasing water storage, thus securing water supply to the crown. These positive roles of sapwood on growth apparently offset the increased respiration costs incurred by more sapwood. This is one of the first individual-based studies to show that variation in sapwood traits-and not crown traits-explains variation in growth among tropical canopy trees. Accurate predictions of C dynamics in tropical forests require similar studies on biomass growth of individual trees as well as studies evaluating the dual effect of sapwood (water provision vs. respiratory costs) on tropical tree growth.

Explaining variations in state foster care maintenance rates and the implications for implementing new evidence-based programs

Science.gov (United States)

Goldhaber-Fiebert, Jeremy D.; Babiarz, Kimberly S.; Garfield, Rachel L.; Wulczyn, Fred; Landsverk, John; Horwitz, Sarah M.

2013-01-01

declined $40 if a state's governorship and legislature became Republican, though significance was marginal. In analyses also examining state revenue, federal funding, and legal challenges, maintenance rates increased as the federal share of maximum TANF payments increased. However, >50% of variation in foster care maintenance rates was explained by unobserved state-level factors as measured by state fixed effects. These factors did not appear to be strongly related to 2008 Child Welfare outcomes like foster care placement stability and maltreatment which were also not correlated with foster care maintenance rates. Conclusions Despite being part of a social safety net, foster care maintenance rates have declined in real terms since 1991 in many states, and there is no strong evidence that they increase in response to harsher economic climates or to federal programs or legal reviews. State variation in maintenance rates was not related to Child Welfare outcomes, though further analysis of this important relationship is needed. Variability in state foster care maintenance rates appears highly idiosyncratic, an important contextual factor to consider when designing and disseminating evidence-based services. PMID:24659842

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

Directory of Open Access Journals (Sweden)

Lee Ann Riesenberg

2014-11-01

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

On the Total Variation Distance of Semi-Markov Chains

DEFF Research Database (Denmark)

Bacci, Giorgio; Bacci, Giovanni; Larsen, Kim Guldstrand

2015-01-01

Semi-Markov chains (SMCs) are continuous-time probabilistic transition systems where the residence time on states is governed by generic distributions on the positive real line. This paper shows the tight relation between the total variation distance on SMCs and their model checking problem over...

Moderation of Genetic Influences on Alcohol Involvement by Rural Residency among Adolescents: Results from the 1962 National Merit Twin Study.

Science.gov (United States)

Davis, Christal N; Natta, Shanaliz S; Slutske, Wendy S

2017-11-01

Adolescents in rural and urban areas may experience different levels of environmental restrictions on alcohol use, with those in rural areas experiencing greater monitoring and less access to alcohol. Such restrictions may limit expression of genetic vulnerability for alcohol use, resulting in a gene-environment interaction (G × E). This phenomenon has previously been reported in Finnish and Minnesota adolescents. The current study used data from 839 same-sex twin pairs from the 1962 National Merit Scholarship Qualifying Test to determine whether the G × E interaction would be evident in this earlier time period. We also assessed whether the G × E interaction would be moderated by sex, and whether family socioeconomic status (SES; income and parental education) may mediate the G × E interaction. Findings showed the expected interaction among females, with a weaker contribution of genes (2 vs. 44%) and greater contribution of shared environment (62 vs. 29%) to variation in alcohol involvement among rural as compared to urban residents. The G × E interaction was not observed among males, and operated independently from differences in family SES among rural and urban adolescents. This study represents a partial replication in a novel setting of the moderation of the genetic contribution to alcohol use by rural/urban residency, and suggests that SES differences may not explain this effect.

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

Directory of Open Access Journals (Sweden)

Nicole Battaglioli

2018-02-01

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

Delegation of medical tasks in French radiation oncology departments: current situation and impact on residents' training.

Science.gov (United States)

Thureau, S; Challand, T; Bibault, J-E; Biau, J; Cervellera, M; Diaz, O; Faivre, J-C; Fumagalli, I; Leroy, T; Lescut, N; Martin, V; Pichon, B; Riou, O; Dubray, B; Giraud, P; Hennequin, C

2013-10-01

A national survey was conducted among the radiation oncology residents about their clinical activities and responsibilities. The aim was to evaluate the clinical workload and to assess how medical tasks are delegated and supervised. A first questionnaire was administered to radiation oncology residents during a national course. A second questionnaire was mailed to 59 heads of departments. The response rate was 62% for radiation oncology residents (99 questionnaires) and 51% for heads of department (30). Eighteen heads of department (64%) declared having written specifications describing the residents' clinical tasks and roles, while only 31 radiation oncology residents (34%) knew about such a document (P=0.009). A majority of residents were satisfied with the amount of medical tasks that were delegated to them. Older residents complained about insufficient exposure to new patient's consultation, treatment planning and portal images validation. The variations observed between departments may induce heterogeneous trainings and should be addressed specifically. National specifications are necessary to reduce heterogeneities in training, and to insure that the residents' training covers all the professional skills required to practice radiation oncology. A frame endorsed by academic and professional societies would also clarify the responsibilities of both residents and seniors. Copyright © 2013 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.

Case-Logging Practices in Otolaryngology Residency Training: National Survey of Residents and Program Directors.

Science.gov (United States)

Dermody, Sarah M; Gao, William; McGinn, Johnathan D; Malekzadeh, Sonya

2017-06-01

Objective (1) Evaluate the consistency and manner in which otolaryngology residents log surgical cases. (2) Assess the extent of instruction and guidance provided by program directors on case-logging practices. Study Design Cross-sectional national survey. Setting Accreditation Council for Graduate Medical Education otolaryngology residency programs in the United States. Subjects and Methods US otolaryngology residents, postgraduate year 2 through graduating chiefs as of July 2016, were recruited to respond to an anonymous questionnaire designed to characterize surgical case-logging practices. Program directors of US otolaryngology residency programs were recruited to respond to an anonymous questionnaire to elucidate how residents are instructed to log cases. Results A total of 272 residents and 53 program directors completed the survey, yielding response rates of 40.6% and 49.5%, respectively. Perceived accuracy of case logs is low among residents and program directors. Nearly 40% of residents purposely choose not to log certain cases, and 65.1% of residents underreport cases performed. More than 80% of program directors advise residents to log procedures performed outside the operating room, yet only 16% of residents consistently log such cases. Conclusion Variability in surgical case-logging behaviors and differences in provided instruction highlight the need for methods to improve consistency of logging practices. It is imperative to standardize practices across otolaryngology residency programs for case logs to serve as an accurate measure of surgical competency. This study provides a foundation for reform efforts within residency programs and for the Resident Case Log System.

Variations in the perception of trauma-related complications between attending surgeons, surgery residents, critical care nurses, and medical students.

Science.gov (United States)

Dissanaike, Sharmila; Berry, Matthew; Ginos, Jason; Paige, Robert; McNabb, Wendi; Griswold, John

2009-06-01

The morbidity and mortality conference (M&M) is a key component of the performance improvement process. The audience response system (ARS) has been shown to improve audience participation and promote more truthful responses in various settings. We implemented the ARS in our trauma M&M and evaluated the responses we received from different categories of participants. This was a prospective observational study undertaken between November 2006 and July 2007. Cases were graded based on the American College of Surgeons scoring system. We evaluated the responses of attending surgeons, residents, critical care nurses, and medical students using the ARS. We had 695 responses for complications and 936 responses for deaths. Residents consistently scored complications as more severe than other groups (P = .03). There was no difference in the scoring of deaths. Surgical residents assign higher severity to trauma-related complications than other groups when using an anonymous automated scoring system.

Small-Scale Density Variations in the Lunar Crust Revealed by GRAIL

Science.gov (United States)

Jansen, J. C.; Andrews-Hanna, J. C.; Li, Y.; Lucey, P. G.; Taylor, G. J.; Goossens, S.; Lemoine, F. G.; Mazarico, E.; Head, J. W., III; Milbury, C.;

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

Directory of Open Access Journals (Sweden)

Victor O. Kolade

2014-07-01

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

Living environment matters: relationships between neighborhood characteristics and health of the residents in a Dutch municipality

NARCIS (Netherlands)

Putrik, Polina; de Vries, Nanne K.; Mujakovic, Suhreta; van Amelsvoort, Ludovic; Kant, Ijmert; Kunst, Anton E.; van Oers, Hans; Jansen, Maria

2015-01-01

Characteristics of an individual alone cannot exhaustively explain all the causes of poor health, and neighborhood of residence have been suggested to be one of the factors that contribute to health. However, knowledge about aspects of the neighborhood that are most important to health is limited.

Living environment matters : Relationships between neighborhood characteristics and health of the residents in a Dutch municipality

NARCIS (Netherlands)

Putrik, P.; de Vries, N.K.; Mujakovic, S.; van Amelsvoort, L.; Kant, IJ.; Kunst, A.E.; van Oers, J.A.M.; Jansen, M.

2015-01-01

Characteristics of an individual alone cannot exhaustively explain all the causes of poor health, and neighborhood of residence have been suggested to be one of the factors that contribute to health. However, knowledge about aspects of the neighborhood that are most important to health is limited.

Intracultural variation of knowledge about wild plant uses in the Biosphere Reserve Grosses Walsertal (Austria

Directory of Open Access Journals (Sweden)

Schunko Christoph

2012-07-01

Full Text Available Abstract Background Leading scholars in ethnobiology and ethnomedicine continuously stress the need for moving beyond the bare description of local knowledge and to additionally analyse and theorise about the characteristics and dynamics of human interactions with plants and related local knowledge. Analyses of the variation of local knowledge are thereby perceived as minimal standard. In this study we investigate the distribution and variation of wild plant knowledge in five domains: food, drinks, human medicine, veterinary medicine and customs. We assess relations between the wild plant knowledge of informants and their socio-demographic as well as geographic background. Method Research was conducted in the Biosphere Reserve Grosses Walsertal, Austria. Structured questionnaires were used to inquire wild plant knowledge from 433 informants with varying socio-demographic and geographic background. Children assisted in the data collection. Data was analysed using descriptive statistics and generalized linear models. Results and discussion A majority of respondents is familiar with wild plant uses, however to varying degrees. Knowledge variations depend on the socio-demographic and geographic background of the informants as well as on the domains of knowledge under investigation: women, older informants and homegardeners report more human medicinal applications and applications in drinks than men, younger informants and non-homegardeners; farmers know a greater variety of veterinary medicinal applications than non-farmers; the place of residence relates significantly to food and veterinary uses. Customs are difficult to investigate in standardized matrices. The household-related distribution of work and the general socio-cultural context are especially helpful in order to explain intracultural variation of knowledge in the Grosses Walsertal. Conclusions Research on the intracultural variation of local knowledge exposes cultural characteristics and

Brand Name Statin Prescribing in a Resident Ambulatory Practice: Implications for Teaching Cost-Conscious Medicine.

Science.gov (United States)

Ryskina, Kira L; Pesko, Michael F; Gossey, J Travis; Caesar, Erica Phillips; Bishop, Tara F

2014-09-01

Several national initiatives aim to teach high-value care to residents. While there is a growing body of literature on cost impact of physicians' therapeutic decisions, few studies have assessed factors that influence residents' prescribing practices. We studied factors associated with intensive health care utilization among internal medicine residents, using brand name statin prescribing as a proxy for higher-cost care. We conducted a retrospective, cross-sectional analysis of statin prescriptions by residents at an urban academic internal medicine program, using electronic health record data between July 1, 2010, and June 30, 2011. For 319 encounters by 90 residents, patients were given a brand name statin in 50% of cases. When categorized into quintiles, the bottom quintile of residents prescribed brand name statins in 2% of encounters, while the top quintile prescribed brand name statins in 98% of encounters. After adjusting for potential confounders, including patient characteristics and supervising attending, being in the primary care track was associated with lower odds (odds ratio [OR], 0.38; P  =  .02; 95% confidence interval [CI], 0.16-0.86), and graduating from a medical school with an above-average hospital care intensity index was associated with higher odds of prescribing brand name statins (OR, 1.70; P  =  .049; 95% CI, 1.003-2.88). We found considerable variation in brand name statin prescribing by residents. Medical school attended and residency program type were associated with resident prescribing behavior. Future interventions should raise awareness of these patterns in an effort to teach high-value, cost-conscious care to all residents.

What explains between-school differences in rates of sexual experience?

Directory of Open Access Journals (Sweden)

Williamson Lisa

2008-02-01

Full Text Available Abstract Background Schools have the potential to influence their pupils' behaviour through the school's social organisation and culture, as well as through the formal curriculum. This paper provides the first attempt to explain the differences between schools in rates of reported heterosexual sexual experience amongst 15 and 16 year olds. It first examined whether variations in rates of sexual experience remained after controlling for the known predictors of sexual activity. It then examined whether these residuals, or 'school effects', were attributable to processes within the school, or were more likely to reflect characteristics of the neighbourhood. Methods Longitudinal survey data from 4,926 pupils in 24 Scottish schools were linked to qualitative and quantitative data on school processes including quality of relationships (staff-pupil, etc, classroom discipline, organisation of Personal and Social Education, school appearance and pupil morale. Multi-level modelling was used to test a range of models and the resulting 'school effects' were then interpreted using the process data. Results Overall, 42% of girls and 33% of boys reported experience of sexual intercourse, with rates by school ranging from 23% to 61%. When individual socio-economic and socio-cultural factors were taken into account the school variation dropped sharply, though pupils' attitudes and aspirations had little effect. There was very little correlation between boys' and girls' rates of sexual experience by school, after controlling for known predictors of sexual activity. Girls were more influenced by individual socio-economic factors than boys. School-level socio-economic factors were predictive even after taking account of individual socio-cultural factors, suggesting that the wider socio-economic environment further influenced young people's sexual experience. Conclusion Importantly, school processes did not explain the variation between schools in sexual experience

Predictors of psychosocial adaptation among elderly residents in long-term care settings.

Science.gov (United States)

Chao, Shu-Yuan; Lan, Yii-Hwei; Tso, Hsiu-Ching; Chung, Chao-Ming; Neim, Yum-Mei; Clark, Mary Jo

2008-06-01

This cross-sectional descriptive study explored psychosocial adaptation and its determinants among elderly residents of long-term care facilities. A convenience sample of 165 elderly residents was recruited from two nursing homes and two assisted living institutions in the Taichung area. All residents who met the criteria for this study were interviewed individually from April through June 2006. A structured questionnaire was used to collect data on participant demographic characteristics, admission conditions, functional status, perceived family support, life attitudes, and psychosocial adaptation. The adaptation inventory incorporated three aspects of adaptation, including (1) sense of self-value, (2) sense of belonging and (3) sense of continuity. Findings, in general, did not indicate participants had achieved a high level of overall adaptation or significant adaptation in any of the three aspects targeted. Most participants were female. More than half were widowed and unable to fully finance their own institutional care. Nearly one-third was not admitted voluntarily. Having adequate funding for admission, voluntary admission, and number of roommates were the three most influential factors affecting overall adaptation, explaining 54% of variance. Study findings reflect the importance to residents' adaptation of self-determination, autonomy, and pre-institutionalization preparation and are intended to provide guidance for nursing intervention and social welfare policy making.

Explaining labor wedge trends: An equilibrium search approach

Directory of Open Access Journals (Sweden)

Coralia A. Quintero Rojas

2016-06-01

Full Text Available In this paper, we present a search and matching model of the labor market and use this as a device to explain the long-run variation in the aggregate hours worked in several OECD countries over the period 1980-2013. The model distinguishes between hours worked per employee (intensive margin and the employment rate (extensive margin and includes a tax/benefit system. This allows us to assess the impact of the observed time-varying heterogeneity of taxes, unemployment benefits, and workers’ bargaining power on the two margins. Our method is based on an accounting procedure. Once it has been calibrated, we find that, for the ten countries of the sample, our search economy is able to explain the patterns of the two margins of aggregate hours worked over the 1980-2013 period, when it includes the cross-country heterogeneity of the labor market institutions.

Does Research Training During Residency Promote Scholarship and Influence Career Choice? A Cross-Sectional Analysis of a 10-Year Cohort of the UCSF-PRIME Internal Medicine Residency Program.

Science.gov (United States)

Kohlwes, Jeffrey; O'Brien, Bridget; Stanley, Marion; Grant, Ross; Shunk, Rebecca; Connor, Denise; Cornett, Patricia; Hollander, Harry

2016-01-01

The Association of Program Directors in Internal Medicine, the Accreditation Council for Graduate Medical Education, the Alliance for Academic Internal Medicine, and the Carnegie Foundation report on medical education recommend creating individualized learning pathways during medical training so that learners can experience broader professional roles beyond patient care. Little data exist to support the success of these specialized pathways in graduate medical education. We present the 10-year experience of the Primary Care Medicine Education (PRIME) track, a clinical-outcomes research pathway for internal medicine residents at the University of California San Francisco (UCSF). We hypothesized that participation in an individualized learning track, PRIME, would lead to a greater likelihood of publishing research from residency and accessing adequate career mentorship and would be influential on subsequent alumni careers. We performed a cross-sectional survey of internal medicine residency alumni from UCSF who graduated in 2001 through 2010. We compared responses of PRIME and non-PRIME categorical alumni. We used Pearson's chi-square and Student's t test to compare PRIME and non-PRIME alumni on categorical and continuous variables. Sixty-six percent (211/319) of alumni responded to the survey. A higher percentage of PRIME alumni published residency research projects compared to non-PRIME alumni (64% vs. 40%; p = .002). The number of PRIME alumni identifying research as their primary career role was not significantly different from non-PRIME internal medicine residency graduates (35% of PRIME vs. 29% non-PRIME). Process measures that could explain these findings include adequate access to mentors (M 4.4 for PRIME vs. 3.6 for non-PRIME alumni, p medicine residency programs.

Current integrated cardiothoracic surgery residents: a Thoracic Surgery Residents Association survey.

Science.gov (United States)

Tchantchaleishvili, Vakhtang; LaPar, Damien J; Stephens, Elizabeth H; Berfield, Kathleen S; Odell, David D; DeNino, Walter F

2015-03-01

After approval by the Thoracic Surgery Residency Review Committee in 2007, 6-year integrated cardiothoracic surgery (I-6) residency programs have gained in popularity. We sought to assess and objectively quantify the level of satisfaction I-6 residents have with their training and to identify areas of improvement for future curriculum development. A completely anonymous, electronic survey was created by the Thoracic Surgery Residents Association that asked the responders to provide demographic information, specialty interest, and lifestyle priorities, and to rate their experience and satisfaction with I-6 residency. The survey was distributed nationwide to all residents in I-6 programs approved by the Accreditation Council for Graduate Medical Education. Of a total of 88 eligible I-6 residents, 49 completed the survey (55.7%). Career choice satisfaction was high (75.5%), as was overall satisfaction with integrated training (83.7%). The majority (77.6%) were interested in cardiac surgery. Overall, the responders reported sufficient time for life outside of the hospital (57.1%), but experienced conflicts between work obligations and personal life at least sometimes (75.5%). Early exposure to cardiothoracic surgery was reported as the dominant advantage of the I-6 model, whereas variable curriculum structure and unclear expectations along with poor integration with general surgery training ranked highest among perceived disadvantages. Current I-6 residents are largely satisfied with the integrated training model and report a reasonable work/life balance. The focused nature of training is the primary perceived advantage of the integrated pathway. Curriculum variability and poor integration with general surgery training are identified by residents as primary areas of concern. Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Self-Esteem among Jamaican Children: Exploring the Impact of Skin Color and Rural/Urban Residence

Science.gov (United States)

Ferguson, Gail M. (Anderson); Cramer, Phebe

2007-01-01

This study investigates the extent to which two different models predict the relation of self-esteem to skin color and rural/urban residence among Jamaican children. To explain this relation, Crocker and Major's Self-protective hypothesis and Harter's Additive model were examined among 200 African-Caribbean children from rural (n=85) and urban…

Confidence, knowledge, and skills at the beginning of residency. A survey of pathology residents.

Science.gov (United States)

Hsieh, Cindy M; Nolan, Norris J

2015-01-01

To document the pathology learning experiences of pathology residents prior to residency and to determine how confident they were in their knowledge and technical skills. An online survey was distributed to all pathology residency program directors in the United States, who were requested to forward the survey link to their residents. Data were obtained on pathology electives, grossing experience, and frozen section experience. Likert scale questions assessed confidence level in knowledge and skills. In total, 201 pathology residents responded (8% of residents in the United States). Prior to starting residency, most respondents had exposure to anatomic pathology through elective rotations. Few respondents had work-related experience. Most did not feel confident in their pathology-related knowledge or skills, and many did not understand what pathology resident duties entail. Respondents gained exposure to pathology primarily through elective rotations, and most felt the elective experience prepared them for pathology residency. However, elective time may be enhanced by providing opportunities for students to increase hands-on experience and understanding of resident duties. Copyright© by the American Society for Clinical Pathology.

Variations in pollen counts largely explained by climate and weather

Science.gov (United States)

Jung, Stephan; Damialis, Athanasios; Estrella, Nicole; Jochner, Susanne; Menzel, Annette

2017-04-01

The interaction between climate and vegetation is well studied within phenology. Climatic / weather conditions affect e.g. flowering date, length of vegetation period, start and end of the season and the plant growth. Besides phenological stages also pollen counts can be used to investigate the interaction between climate and vegetation. Pollen emission and distribution is directly influenced by temperature, wind speed, wind direction and humidity/precipitation. The objective of this project is to study daily/sub daily variations in pollen counts of woody and herbaceous plant species along an altitudinal gradient with different climatic conditions during the vegetation period. Measurements of pollen were carried out with three volumetric pollen traps installed at the altitudes 450 m a.s.l (Freising), 700 m a.s.l (Garmisch-Partenkirchen), and 2700 m a.s.l (Schneefernerhaus near Zugspitze) representing gradient from north of Munich towards the highest mountain of Germany. Airborne pollen concentrations were recorded during the years 2014-2015. The altitudinal range of these three stations accompanied by different microclimates ("space for time approach") can be used as proxy for climate change and to assess its impact on pollen counts and thus allergenic risk for human health. For example the pollen season is shortened and pollen amount is reduced at higher sites. For detailed investigations pollen of the species Plantago, Quercus, Poaceae, Cupressaceae, Cyperacea, Betula and Platanus were chosen, because those are found in appropriate quantities. In general, pollen captured in the pollen traps to a certain extent has its origin from the immediate surrounding. Thus, it mirrors local species distribution. But furthermore the distance of pollen transport is also based on (micro-) climatic conditions, land cover and topography. The pollen trap shortly below the summit of Zugspitze (Schneefernerhaus) has an alpine environment without vegetation nearby. Therefore, this

Seasonal Variation in Epidemiology

Science.gov (United States)

Marrero, Osvaldo

2013-01-01

Seasonality analyses are important in medical research. If the incidence of a disease shows a seasonal pattern, then an environmental factor must be considered in its etiology. We discuss a method for the simultaneous analysis of seasonal variation in multiple groups. The nuts and bolts are explained using simple trigonometry, an elementary…

Variational principles in physics

CERN Document Server

Basdevant, Jean-Louis

2007-01-01

Optimization under constraints is an essential part of everyday life. Indeed, we routinely solve problems by striking a balance between contradictory interests, individual desires and material contingencies. This notion of equilibrium was dear to thinkers of the enlightenment, as illustrated by Montesquieu’s famous formulation: "In all magistracies, the greatness of the power must be compensated by the brevity of the duration." Astonishingly, natural laws are guided by a similar principle. Variational principles have proven to be surprisingly fertile. For example, Fermat used variational methods to demonstrate that light follows the fastest route from one point to another, an idea which came to be known as Fermat’s principle, a cornerstone of geometrical optics. Variational Principles in Physics explains variational principles and charts their use throughout modern physics. The heart of the book is devoted to the analytical mechanics of Lagrange and Hamilton, the basic tools of any physicist. Prof. Basdev...

Mapping and explaining the use of the left-right divide

Directory of Open Access Journals (Sweden)

André Freire

2013-12-01

Full Text Available This study is about mapping and explaining the use of the Left-Right divide across 14 countries from 5 Continents and relies on the richness of the post electoral mass surveys from the Comparative National Election Project: 14 countries and 18 elections spread over 5 continents. The paper shows not only how extensively the LR divide is used in these 14 countries, but also explains variation across both individuals and countries in terms of the factors determining LR recognition and use. Overall, it is shown that, although seen world-wide, the LR divide (both for self-placement and party placement is more present in long consolidated and middle-aged democracies and countries with freer media systems than in new democracies and societies with less free media systems. In the case of parties LR placement, party size also counts: larger parties are more easily placed. Additionally, we also show that LR recognition is more socially and politically determined in long consolidated and middle-aged democracies and in countries with more freedom of the press than in new democracies and in systems with less free media system. These findings add to the existing knowledge about these topics because previous studies were either country/Continent specific, or, if global in nature, never invested in explaining individual and system variation across 14 from 5 Continents. Besides, these findings mean that in the long term probably the new democracies will converge with the long consolidated or middle-aged ones, but this is an empirical question to be researched in future studies.

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

Science.gov (United States)

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

2012-01-01

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

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.

Well-being in residency training: a survey examining resident physician satisfaction both within and outside of residency training and mental health in Alberta

Directory of Open Access Journals (Sweden)

Patten Scott

2005-06-01

Full Text Available Abstract Background Despite the critical importance of well-being during residency training, only a few Canadian studies have examined stress in residency and none have examined well-being resources. No recent studies have reported any significant concerns with respect to perceived stress levels in residency. We investigated the level of perceived stress, mental health and understanding and need for well-being resources among resident physicians in training programs in Alberta, Canada. Methods A mail questionnaire was distributed to the entire resident membership of PARA during 2003 academic year. PARA represents each of the two medical schools in the province of Alberta. Results In total 415 (51 % residents participated in the study. Thirty-four percent of residents who responded to the survey reported their life as being stressful. Females reported stress more frequently than males (40% vs. 27%, p Residents highly valued their colleagues (67%, program directors (60% and external psychiatrist/psychologist (49% as well-being resources. Over one third of residents wished to have a career counselor (39% and financial counselor (38%. Conclusion Many Albertan residents experience significant stressors and emotional and mental health problems. Some of which differ among genders. This study can serve as a basis for future resource application, research and advocacy for overall improvements to well-being during residency training.

Tracer concentration curves and residence time analysis in technological flow systems. 2

International Nuclear Information System (INIS)

Pippel, W.

1976-01-01

Tracer concentration curves measured in flow systems by means of radioactive isotopes are treated as a two dimensional random process. Comparing them with the family distribution functions described in part I, it follows that only in case of ergodic behaviour of the system tracer curves can be considered as age distribution functions. The conception of ergodicity in residence time systems has been explained with the aid of a time function measurable by a special method of radioactive tracer technique and by the mean value of the residence time obtainable from this function. Furthermore, technological consequences in evaluating tracer concentration curves of real flow systems are discussed with respect to supposed ergodic or nonergodic behaviour. These considerations are of special importance for flow systems with temporary fluctuations in structure. (author)

Explaining Away Intuitions

Directory of Open Access Journals (Sweden)

Jonathan Ichikawa

2009-12-01

Full Text Available What is it to explain away an intuition? Philosophers regularly attempt to explain intuitions away, but it is often unclear what the success conditions for their project consist in. I attempt to articulate some of these conditions, taking philosophical case studies as guides, and arguing that many attempts to explain away intuitions underestimate the challenge the project of explaining away involves. I will conclude, therefore, that explaining away intuitions is a more difficult task than has sometimes been appreciated; I also suggest, however, that the importance of explaining away intuitions has often been exaggerated.

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

Science.gov (United States)

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

2016-01-01

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

Regional variations in cancer survival: Impact of tumour stage, socioeconomic status, comorbidity and type of treatment in Norway.

Science.gov (United States)

Skyrud, Katrine Damgaard; Bray, Freddie; Eriksen, Morten Tandberg; Nilssen, Yngvar; Møller, Bjørn

2016-05-01

Cancer survival varies by place of residence, but it remains uncertain whether this reflects differences in tumour, patient and treatment characteristics (including tumour stage, indicators of socioeconomic status (SES), comorbidity and information on received surgery and radiotherapy) or possibly regional differences in the quality of delivered health care. National population-based data from the Cancer Registry of Norway were used to identify cancer patients diagnosed in 2002-2011 (n = 258,675). We investigated survival from any type of cancer (all cancer sites combined), as well as for the six most common cancers. The effect of adjusting for prognostic factors on regional variations in cancer survival was examined by calculating the mean deviation, defined by the mean absolute deviation of the relative excess risks across health services regions. For prostate cancer, the mean deviation across regions was 1.78 when adjusting for age and sex only, but decreased to 1.27 after further adjustment for tumour stage. For breast cancer, the corresponding mean deviations were 1.34 and 1.27. Additional adjustment for other prognostic factors did not materially change the regional variation in any of the other sites. Adjustment for tumour stage explained most of the regional variations in prostate cancer survival, but had little impact for other sites. Unexplained regional variations after adjusting for tumour stage, SES indicators, comorbidity and type of treatment in Norway may be related to regional inequalities in the quality of cancer care. © 2015 UICC.

Host-related factors explaining interindividual variability of carotenoid bioavailability and tissue concentrations in humans

DEFF Research Database (Denmark)

Bohn, Torsten; Desmarchelier, Charles; Dragsted, Lars Ove

2017-01-01

.g. smoking), gender and age, as well as genetic variations including single nucleotide polymorphisms that govern carotenoid metabolism. These are expected to explain interindividual differences that contribute to carotenoid uptake, distribution, metabolism and excretion, and therefore possibly also...

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.

Investigation of Residence and Travel Times in a Large Floodplain Lake with Complex Lake-River Interactions: Poyang Lake (China

Directory of Open Access Journals (Sweden)

Yunliang Li

2015-04-01

Full Text Available Most biochemical processes and associated water quality in lakes depends on their flushing abilities. The main objective of this study was to investigate the transport time scale in a large floodplain lake, Poyang Lake (China. A 2D hydrodynamic model (MIKE 21 was combined with dye tracer simulations to determine residence and travel times of the lake for various water level variation periods. The results indicate that Poyang Lake exhibits strong but spatially heterogeneous residence times that vary with its highly seasonal water level dynamics. Generally, the average residence times are less than 10 days along the lake’s main flow channels due to the prevailing northward flow pattern; whereas approximately 30 days were estimated during high water level conditions in the summer. The local topographically controlled flow patterns substantially increase the residence time in some bays with high spatial values of six months to one year during all water level variation periods. Depending on changes in the water level regime, the travel times from the pollution sources to the lake outlet during the high and falling water level periods (up to 32 days are four times greater than those under the rising and low water level periods (approximately seven days.

Assessment of medical resident's attention to the health literacy level of newly admitted patients

Directory of Open Access Journals (Sweden)

Cecile Karsenty

2013-12-01

Full Text Available Objectives: The objective of this study was to assess communication at the bedside in the emergency room between residents and their patients in order to identify common communication gaps. We also intended to evaluate whether residents for whom English is a second language (ESL residents communicate less effectively. Methods: A scorable checklist was developed in order to assess and identify communication gaps between the residents and their patients. Medical students observed the internal medicine and family medicine residents while they admitted patients to the medical service in the Emergency Room. Before this, medical students were trained for two weeks with a senior internist. The role of the medical student was not revealed; rather they were self-described as observers of the admission process. Results: Over an 8 week period, 71 observations were made of 27 medicine residents. 71 patient intakes were observed, evaluating 27 residents. In 52.1% of these interactions, the residents used medical acronyms when communicating with the patients. During 66.2% of interactions, technical medical terms or expressions were used during the history taking and in only 27.6% of those cases were the terms explained at least partially. Teach back technique was not observed in any of the interactions evaluated. Data was also analyzed based on whether the doctors were ESL residents or native English speakers. ESL residents tended to use significantly more technical language than the native English speakers, but the native English speakers tended to use more acronyms. Conclusions: How much patients understand of what their doctor says is called “health literacy.” Resident physicians often overestimate their patients’ health literacy, and this leads to communication gaps which have the potential to result in poorer health outcomes for the patients. The checklist developed for this pilot study assessed how well residents tailor their communication to

Attending Surgeons' Leadership Style in the Operating Room: Comparing Junior Residents' Experiences and Preferences.

Science.gov (United States)

Kissane-Lee, Nicole A; Yule, Steven; Pozner, Charles N; Smink, Douglas S

2016-01-01

Recent studies have focused on surgeons' nontechnical skills in the operating room (OR), especially leadership. In an attempt to identify trainee preferences, we explored junior residents' opinions about the OR leadership style of teaching faculty. Overall, 20 interns and 20 mid-level residents completed a previously validated survey on the style of leadership they encountered, the style they preferred to receive, and the style they personally employed in the OR. In all, 4 styles were explored; authoritative: leader makes decisions and communicates them firmly; explanatory: leader makes decisions promptly, but explains them fully; consultative: leader consults with trainees when important decisions are made, and delegative: leader puts the problem before the group and makes decisions by majority opinion. Comparisons were completed using chi-square analysis. Junior resident preference for leadership style of attending surgeons in the OR differed from what they encountered. Overall, 62% of residents encountered an authoritative leadership style; however, only 9% preferred this (p styles (41%). Preferences differed by postgraduate year. Although 40% of interns preferred a consultative style, 50% of mid-level residents preferred explanatory leadership. Junior resident preference of leadership style in the OR differs from what they actually encounter. This has the potential to create unwanted tension and may erode team performance. Awareness of this difference provides an opportunity for an educational intervention directed at both attendings and trainees. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Career Interests of Canadian Psychiatry Residents: What Makes Residents Choose a Research Career?

Science.gov (United States)

Laliberté, Vincent; Rapoport, Mark J.; Andrew, Melissa; Davidson, Marla

2016-01-01

Objectives: Training future clinician-researchers remains a challenge faced by Canadian psychiatry departments. Our objectives were to determine the prevalence of residents interested in pursuing research and other career options as part of their practice, and to identify the factors associated with interest in research. Method: Data from a national online survey of 207 Canadian psychiatry residents from a total of 853 (24.3% response rate) were examined. The main outcome was interest in research as part of residents’ future psychiatrist practice. Bivariate and multivariate analyses were performed to identify demographic and vocational variables associated with research interest. Results: Interest in research decreases by 76% between the first and fifth year of psychiatry residency (OR 0.76 per year, 95% CI 0.60 to 0.97). Training in a department with a residency research track did not correlate with increased research interest (χ2 = 0.007, df = 1, P = 0.93). Conclusions: Exposing and engaging psychiatry residents in research as early as possible in residency training appears key to promoting future research interest. Psychiatry residency programs and research tracks could consider emphasizing research training initiatives and protected research time early in residency. PMID:27253699

Diversity in plant hydraulic traits explains seasonal and inter-annual variations of vegetation dynamics in seasonally dry tropical forests.

Science.gov (United States)

Xu, Xiangtao; Medvigy, David; Powers, Jennifer S; Becknell, Justin M; Guan, Kaiyu

2016-10-01

We assessed whether diversity in plant hydraulic traits can explain the observed diversity in plant responses to water stress in seasonally dry tropical forests (SDTFs). The Ecosystem Demography model 2 (ED2) was updated with a trait-driven mechanistic plant hydraulic module, as well as novel drought-phenology and plant water stress schemes. Four plant functional types were parameterized on the basis of meta-analysis of plant hydraulic traits. Simulations from both the original and the updated ED2 were evaluated against 5 yr of field data from a Costa Rican SDTF site and remote-sensing data over Central America. The updated model generated realistic plant hydraulic dynamics, such as leaf water potential and stem sap flow. Compared with the original ED2, predictions from our novel trait-driven model matched better with observed growth, phenology and their variations among functional groups. Most notably, the original ED2 produced unrealistically small leaf area index (LAI) and underestimated cumulative leaf litter. Both of these biases were corrected by the updated model. The updated model was also better able to simulate spatial patterns of LAI dynamics in Central America. Plant hydraulic traits are intercorrelated in SDTFs. Mechanistic incorporation of plant hydraulic traits is necessary for the simulation of spatiotemporal patterns of vegetation dynamics in SDTFs in vegetation models. © 2016 The Authors. New Phytologist © 2016 New Phytologist Trust.

Effect of viscosity on tear drainage and ocular residence time.

Science.gov (United States)

Zhu, Heng; Chauhan, Anuj

2008-08-01

An increase in residence time of dry eye medications including artificial tears will likely enhance therapeutic benefits. The drainage rates and the residence time of eye drops depend on the viscosity of the instilled fluids. However, a quantitative understanding of the dependence of drainage rates and the residence time on viscosity is lacking. The current study aims to develop a mathematical model for the drainage of Newtonian fluids and also for power-law non-Newtonian fluids of different viscosities. This study is an extension of our previous study on the mathematical model of tear drainage. The tear drainage model is modified to describe the drainage of Newtonian fluids with viscosities higher than the tear viscosity and power-law non-Newtonian fluids with rheological parameters obtained from fitting experimental data in literature. The drainage rate through canaliculi was derived from the modified drainage model and was incorporated into a tear mass balance to calculate the transients of total solute quantity in ocular fluids and the bioavailability of instilled drugs. For Newtonian fluids, increasing the viscosity does not affect the drainage rate unless the viscosity exceeds a critical value of about 4.4 cp. The viscosity has a maximum impact on drainage rate around a value of about 100 cp. The trends are similar for shear thinning power law fluids. The transients of total solute quantity, and the residence time agrees at least qualitatively with experimental studies. A mathematical model has been developed for the drainage of Newtonian fluids and power-law fluids through canaliculi. The model can quantitatively explain different experimental observations on the effect of viscosity on the residence of instilled fluids on the ocular surface. The current study is helpful for understanding the mechanism of fluid drainage from the ocular surface and for improving the design of dry eye treatments.

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

Ontario Radiation Oncology Residents' Needs in the First Postgraduate Year-Residents' Perspective Survey

International Nuclear Information System (INIS)

Szumacher, Ewa; Warner, Eiran; Zhang Liying; Kane, Gabrielle; Ackerman, Ida; Nyhof-Young, Joyce; Agboola, Olusegun; Metz, Catherine de; Rodrigues, George; Voruganti, Sachi; Rappolt, Susan

2007-01-01

Purpose: To assess radiation oncology residents' needs and satisfaction in their first postgraduate year (PGY-1) in the province of Ontario. Methods and Materials: Of 62 radiation oncology residents, 58 who had completed their PGY-1 and were either enrolled or had graduated in 2006 were invited to participate in a 31-item survey. The questionnaire explored PGY-1 residents' needs and satisfaction in four domains: clinical workload, faculty/learning environment, stress level, and discrimination/harassment. The Fisher's exact and Wilcoxon nonparametric tests were used to determine relationships between covariate items and summary scores. Results: Of 58 eligible residents, 44 (75%) responded. Eighty-four percent of residents felt that their ward and call duties were appropriate. More than 50% of respondents indicated that they often felt isolated from their radiation oncology program. Only 77% agreed that they received adequate feedback, and 40% received sufficient counseling regarding career planning. More than 93% of respondents thought that faculty members had contributed significantly to their learning experience. Approximately 50% of residents experienced excessive stress and inadequate time for leisure or for reading the medical literature. Less than 10% of residents indicated that they had been harassed or experienced discrimination. Eighty-three percent agreed or strongly agreed that their PGY-1 experience had been outstanding. Conclusions: Most Ontario residents were satisfied with their PGY-1 training program. More counseling by radiation oncology faculty members should be offered to help residents with career planning. The residents might also benefit from more exposure to 'radiation oncology' and an introduction to stress management strategies

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...

Variation in the prevalence of chronic bronchitis among smokers: a cross-sectional study.

Science.gov (United States)

Mahesh, P A; Jayaraj, B S; Chaya, S K; Lokesh, K S; McKay, A J; Prabhakar, A K; Pape, U J

2014-07-01

Given the wide variations in prevalence of chronic obstructive pulmonary disease observed between populations with similar levels of exposure to tobacco smoke, we aimed to investigate the possibility of variations in prevalence of chronic bronchitis (CB) between two geographically distinct smoking populations in rural Karnataka, India. The Burden of Obstructive Lung Disease (BOLD) questionnaire was administered to all men aged >30 years in a cross-sectional survey. The χ(2) and Fisher's exact tests were used to compare CB prevalence in the two populations. Logistic regression was used to analyse the impact of multiple variables on the occurrence of CB. Two samples of 2322 and 2182 subjects were included in the study. In non-smokers, CB prevalence did not differ between the populations. However, it was significantly different between smoking populations (44.79% vs. 2.13%, P < 0.0001). Logistic regression indicated that, in addition to smoking, region, age, occupational dust exposure and type of house were associated with higher likelihood of CB. An interaction between smoking and area of residence was found (P < 0.001) and appeared to explain the effect of region (without interaction). A significant difference in CB prevalence was observed between male populations from two areas of Karnataka state, including when stratified by smoking status. No significant difference was observed between non-smokers.

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...

Can we explain the observed methane variability after the Mount Pinatubo eruption?

NARCIS (Netherlands)

Banda, Narcisa; Krol, M.; Van Weele, M.; Van Noije, T.; Le Sager, P.; Röckmann, T.

2016-01-01

The CH4 growth rate in the atmosphere showed large variations after the Pinatubo eruption in June 1991. A decrease of more than 10 ppb yr-1 in the growth rate over the course of 1992 was reported, and a partial recovery in the following year. Although several reasons have been proposed to explain

Consequences of contextual factors on clinical reasoning in resident physicians.

Science.gov (United States)

McBee, Elexis; Ratcliffe, Temple; Picho, Katherine; Artino, Anthony R; Schuwirth, Lambert; Kelly, William; Masel, Jennifer; van der Vleuten, Cees; Durning, Steven J

2015-12-01

Context specificity and the impact that contextual factors have on the complex process of clinical reasoning is poorly understood. Using situated cognition as the theoretical framework, our aim was to evaluate the verbalized clinical reasoning processes of resident physicians in order to describe what impact the presence of contextual factors have on their clinical reasoning. Participants viewed three video recorded clinical encounters portraying straightforward diagnoses in internal medicine with select patient contextual factors modified. After watching each video recording, participants completed a think-aloud protocol. Transcripts from the think-aloud protocols were analyzed using a constant comparative approach. After iterative coding, utterances were analyzed for emergent themes with utterances grouped into categories, themes and subthemes. Ten residents participated in the study with saturation reached during analysis. Participants universally acknowledged the presence of contextual factors in the video recordings. Four categories emerged as a consequence of the contextual factors: (1) emotional reactions (2) behavioral inferences (3) optimizing the doctor patient relationship and (4) difficulty with closure of the clinical encounter. The presence of contextual factors may impact clinical reasoning performance in resident physicians. When confronted with the presence of contextual factors in a clinical scenario, residents experienced difficulty with closure of the encounter, exhibited as diagnostic uncertainty. This finding raises important questions about the relationship between contextual factors and clinical reasoning activities and how this relationship might influence the cost effectiveness of care. This study also provides insight into how the phenomena of context specificity may be explained using situated cognition theory.

Generic Skills Development and Satisfaction with Groupwork among Business Students: Effect of Country of Permanent Residency

Science.gov (United States)

Teo, Stephen T. T.; Segal, Naomi; Morgan, Adam C.; Kandlbinder, Peter; Wang, Karen Y.; Hingorani, Anurag

2012-01-01

Purpose: The purpose of this study is to examine variables explaining students' positive and negative experiences of groupwork and connect country of residence with the perception of generic skills development and self-reported satisfaction with groupwork. It also aims to examine the effect of prior training in groups from the perspective of…

Life history dependent morphometric variation in stream-dwelling Atlantic salmon

Science.gov (United States)

Letcher, B.H.

2003-01-01

The time course of morphometric variation among life histories for stream-dwelling Atlantic salmon (Salmo salar L.) parr (age-0+ to age-2+) was analyzed. Possible life histories were combinations of parr maturity status in the autumn (mature or immature) and age at outmigration (smolt at age-2+ or later age). Actual life histories expressed with enough fish for analysis in the 1997 cohort were immature/age-2+ smolt, mature/age-2 +smolt, and mature/age-2+ non-smolt. Tagged fish were assigned to one of the three life histories and digital pictures from the field were analyzed using landmark-based geometric morphometrics. Results indicated that successful grouping of fish according to life history varied with fish age, but that fish could be grouped before the actual expression of the life histories. By March (age-1+), fish were successfully grouped using a descriptive discriminant function and successful assignment ranged from 84 to 97% for the remainder of stream residence. A jackknife of the discriminant function revealed an average life history prediction success of 67% from age-1+ summer to smolting. Low sample numbers for one of the life histories may have limited prediction success. A MANOVA on the shape descriptors (relative warps) also indicated significant differences in shape among life histories from age-1+ summer through to smolting. Across all samples, shape varied significantly with size. Within samples, shape did not vary significantly with size for samples from December (age-0+) to May (age-1+). During the age-1+ summer however, shape varied significantly with size, but the relationship between shape and size was not different among life histories. In the autumn (age-1+) and winter (age-2+), life history differences explained a significant portion of the change in shape with size. Life history dependent morphometric variation may be useful to indicate the timing of early expressions of life history variation and as a tool to explore temporal and

Primary care resident perceived preparedness to deliver cross-cultural care: an examination of training and specialty differences.

Science.gov (United States)

Greer, Joseph A; Park, Elyse R; Green, Alexander R; Betancourt, Joseph R; Weissman, Joel S

2007-08-01

Previous research has shown that resident physicians report differences in training across primary care specialties, although limited data exist on education in delivering cross-cultural care. The goals of this study were to identify factors that relate to primary care residents' perceived preparedness to provide cross-cultural care and to explore the extent to which these perceptions vary across primary care specialties. Cross-sectional, national mail survey of resident physicians in their last year of training. Eleven hundred fifty primary care residents specializing in family medicine (27%), internal medicine (23%), pediatrics (26%), and obstetrics/gynecology (OB/GYN) (24%). Male residents as well as those who reported having graduated from U.S. medical schools, access to role models, and a greater cross-cultural case mix during residency felt more prepared to deliver cross-cultural care. Adjusting for these demographic and clinical factors, family practice residents were significantly more likely to feel prepared to deliver cross-cultural care compared to internal medicine, pediatric, and OB/GYN residents. Yet, when the quantity of instruction residents reported receiving to deliver cross-cultural care was added as a predictor, specialty differences became nonsignificant, suggesting that training opportunities better account for the variability in perceived preparedness than specialty. Across primary care specialties, residents reported different perceptions of preparedness to deliver cross-cultural care. However, this variation was more strongly related to training factors, such as the amount of instruction physicians received to deliver such care, rather than specialty affiliation. These findings underscore the importance of formal education to enhance residents' preparedness to provide cross-cultural care.

The relative importance of water temperature and residence time in predicting cyanobacteria abundance in regulated rivers.

Science.gov (United States)

Cha, YoonKyung; Cho, Kyung Hwa; Lee, Hyuk; Kang, Taegu; Kim, Joon Ha

2017-11-01

Despite a growing awareness of the problems associated with cyanobacterial blooms in rivers, and particularly in regulated rivers, the drivers of bloom formation and abundance in rivers are not well understood. We developed a Bayesian hierarchical model to assess the relative importance of predictors of summer cyanobacteria abundance, and to test whether the relative importance of each predictor varies by site, using monitoring data from 16 sites in the four major rivers of South Korea. The results suggested that temperature and residence time, but not nutrient levels, are important predictors of summer cyanobacteria abundance in rivers. Although the two predictors were of similar significance across the sites, the residence time was marginally better in accounting for the variation in cyanobacteria abundance. The model with spatial hierarchy demonstrated that temperature played a consistently significant role at all sites, and showed no effect from site-specific factors. In contrast, the importance of residence time varied significantly from site to site. This variation was shown to depend on the trophic state, indicated by the chlorophyll-a and total phosphorus levels. Our results also suggested that the magnitude of weir inflow is a key factor determining the cyanobacteria abundance under baseline conditions. Copyright © 2017 Elsevier Ltd. All rights reserved.

[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.

Variation in transnationalism among Eastern European migrants in Italy: the role of duration of residence and integration

NARCIS (Netherlands)

Cela, E.; Fokkema, T.; Ambrosetti, E.; King, Russell; Povrzanović Frykman, Maya; Vullnetari, Julie

2017-01-01

Transnationalism of first-generation migrants, usually considered as a core element of their migratory projects, is nowadays taken somewhat for granted. Our aim in this paper is to examine empirically the relations of transnationalism with duration of residence and integration of Eastern European

Advance care planning for nursing home residents with dementia: policy vs. practice.

Science.gov (United States)

Ampe, Sophie; Sevenants, Aline; Smets, Tinne; Declercq, Anja; Van Audenhove, Chantal

2016-03-01

The aims of this study were: to evaluate the advance care planning policy for people with dementia in nursing homes; to gain insight in the involvement of residents with dementia and their families in advance care planning, and in the relationship between the policy and the actual practice of advance care planning. Through advance care planning, nursing home residents with dementia are involved in care decisions, anticipating their reduced decision-making capacity. However, advance care planning is rarely realized for this group. Prevalence and outcomes have been researched, but hardly any research has focused on the involvement of residents/families in advance care planning. Observational cross-sectional study in 20 nursing homes. The ACP audit assessed the views of the nursing homes' staff on the advance care planning policy. In addition, individual conversations were analysed with 'ACP criteria' (realization of advance care planning) and the 'OPTION' instrument (involvement of residents/families). June 2013-September 2013. Nursing homes generally met three quarters of the pre-defined criteria for advance care planning policy. In almost half of the conversations, advance care planning was explained and discussed substantively. Generally, healthcare professionals only managed to involve residents/families on a baseline skill level. There were no statistically significant correlations between policy and practice. The evaluations of the policy were promising, but the actual practice needs improvement. Future assessment of both policy and practice is recommended. Further research should focus on communication interventions for implementing advance care planning in the daily practice. © 2015 John Wiley & Sons Ltd.

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

Science.gov (United States)

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

2018-04-01

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

Seasonal variation of infestation by ectoparasitic chigger mite larvae (Acarina: Trombiculidae) on resident and migratory birds in coffee agroecosystems of Chiapas, Mexico.

Science.gov (United States)

Dietsch, Thomas V

2005-12-01

Parasitism is not well documented for birds found in tropical habitats. Long-distance migratory birds may face additional risks to an already hazardous journey when infected. This study explores the ecology of an ectoparasite infestation in Chiapas, Mexico. During a mist-netting project in 2 different coffee management systems, chigger mites (Acarina: Trombiculidae), ectoparasitic during the larval stage, were found on both resident and migratory birds. Using a rapid assessment protocol, it was observed that 17 of 26 species of long-distance migrants and 33 of 71 resident species had at least 1 infested individual. Infestation prevalences were unexpectedly high on some long-distance migrants, as high as 0.73 for Swainson's thrush (Catharus ustulatus), a value on par with heavily infested resident species. Prevalence was highest during winter sampling: 0.18 overall, 0.16 of migrants, and 0.23 of residents. Prevalence was 0.14 for resident birds during the summer breeding season. Mean abundance and mean intensity of infestation are reported for 97 species captured and inspected during the course of this study. In this region, chigger mite larvae are relatively common on birds and their abundance varies seasonally. High prevalence for some migratory birds suggests that more research and monitoring of ectoparasites are needed, especially in light of emerging diseases.

Women in leadership positions within obstetrics and gynecology: does the past explain the present?

Science.gov (United States)

Baecher-Lind, Laura

2012-12-01

To determine whether the proportion of leadership positions in obstetrics and gynecology held by women is consistent with expectations based on the proportion of women entering residency at the time of current leaders. Leadership positions were considered as department chairs affiliated with the Council of University Chairs of Obstetrics and Gynecology, editors of the 20 obstetrics and gynecology journals with the highest impact factors [corrected],and presidents of influential professional societies. Publically available data were accessed to determine sex and the year of medical school graduation for each individual holding each leadership position, as well as to determine the number of men and women entering residency in obstetrics and gynecology per year. Actual and expected proportions of leadership positions held by women were compared using χ² tests. Women should hold 71 of the total 194 leadership positions based on the proportion of women entering residency during the mean graduation year among leaders. Women actually hold 41 of these leadership positions (21.1%; Pwomen should hold 28 of these 74 leadership positions. Women actually hold 20 of the leadership positions from this subset (27.0%; P=.05). Women are underrepresented in leadership positions in obstetrics and gynecology, and this cannot be explained by historical sex imbalances among physicians entering our specialty.

Explaining Physics – What Skills does a good Explainer Need?

CERN Multimedia

CERN. Geneva; Bartels, Hauke

2018-01-01

Explaining physics in a way that it is both scientifically correct and comprehensible is a highly demanding practice. But are explanations an effective way to teach physics? Under which circumstances should a physics teacher explain – and is there such a thing as a guideline for effective instructional explanations? Of course, explaining is more than just presenting content knowledge in clear language – but what more? In our talk, we want to discuss empirical studies on instructional explanations from science education and psychology to address these questions. Among other things, we will refer to results from a large study aiming to research whether teacher education contributes to the development of explaining skills. Besides, we will give insights into a project that seeks to measure explaining skills with an interactive online test instrument.

How Residents Learn From Patient Feedback: A Multi-Institutional Qualitative Study of Pediatrics Residents' Perspectives.

Science.gov (United States)

Bogetz, Alyssa L; Orlov, Nicola; Blankenburg, Rebecca; Bhavaraju, Vasudha; McQueen, Alisa; Rassbach, Caroline

2018-04-01

Residents may view feedback from patients and their families with greater skepticism than feedback from supervisors and peers. While discussing patient and family feedback with faculty may improve residents' acceptance of feedback and learning, specific strategies have not been identified. We explored pediatrics residents' perspectives of patient feedback and identified strategies that promote residents' reflection on and learning from feedback. In this multi-institutional, qualitative study conducted in June and July 2016, we conducted focus groups with a purposive sample of pediatrics residents after their participation in a randomized controlled trial in which they received written patient feedback and either discussed it with faculty or reviewed it independently. Focus group transcripts were audiorecorded, transcribed, and analyzed for themes using the constant comparative approach associated with grounded theory. Thirty-six of 92 (39%) residents participated in 7 focus groups. Four themes emerged: (1) residents valued patient feedback but felt it may lack the specificity they desire; (2) discussing feedback with a trusted faculty member was helpful for self-reflection; (3) residents identified 5 strategies faculty used to facilitate their openness to and acceptance of patient feedback (eg, help resident overcome emotional responses to feedback and situate feedback in the context of lifelong learning); and (4) residents' perceptions of feedback credibility improved when faculty observed patient encounters and solicited feedback on the resident's behalf prior to discussions. Discussing patient feedback with faculty provided important scaffolding to enhance residents' openness to and reflection on patient feedback.

Explaining Cross-Country Differences in Attitudes Towards Immigration in the EU-15

DEFF Research Database (Denmark)

Malchow-Møller, Nikolaj; Munch, Jakob Roland; Schroll, Sanne

2009-01-01

In this paper, we use data from the first two rounds of the European Social Survey to analyze the extent to which differences in average attitudes towards immigration across the EU-15 countries may be explained by differences in socioeconomic characteristics and individually perceived consequences...... of immigration, using an extension of a decomposition technique developed by Fairlie (2005). We find that despite the significant effects of socioeconomic characteristics on attitudes, differences in the distributions of these characteristics can only explain a modest share of the cross-country variation...... in average attitudes. A larger part can be explained by differences in perceived consequences of immigration, but the main part is still left unexplained. Apart from providing useful input for policy makers working in the area of immigration policy, this raises a number of questions for further research...

Explaining Cross-Country Differences in Attitudes towards Immigration in the EU-15

DEFF Research Database (Denmark)

Malchow-Møller, Nikolaj; Munch, Jakob Roland; Schroll, Sanne

2007-01-01

In this paper, we use data from the first two rounds of the European Social Survey to analyze the extent to which differences in average attitudes towards immigration across the EU-15 countries may be explained by differences in socioeconomic characteristics and individually perceived consequences...... of immigration, using an extension of a decomposition technique developed by Fairlie (2005). We find that despite the significant effects of socioeconomic characteristics on attitudes, differences in the distributions of these characteristics can only explain a modest share of the cross-country variation...... in average attitudes. A larger part can be explained by differences in perceived consequences of immigration, but the main part is still left unexplained. Apart from providing useful input for policy makers working in the area of immigration policy, this raises a number of questions for further research...

Explaining Cross-Country Differences in Attitudes Towards Immigration in the EU-15

DEFF Research Database (Denmark)

Malchow-Møller, Nikolaj; Munch, Jakob Roland; Skaksen, Jan Rose

In this paper, we use data from the first two rounds of the European Social Survey to analyse the extent to which differences in average attitudes towards immigration across the EU-15 countries may be explained by differences in socioeconomic characteristics and individually perceived consequences...... of immigration, using an extension of a decomposition technique developed by Fairlie (2005). We find that despite the significant effects of socioeconomic characteristics on attitudes, differences in the distributions of these characteristics can only explain a modest share of the cross-country variation...... in average attitudes. A larger part can be explained by differences in perceived consequences of immigration, but the main part is still left unexplained. Apart from providing useful input for policy makers working in the area of immigration policy, this raises a number of questions for further research...

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

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

Toward a Resident Personal Finance Curriculum: Quantifying Resident Financial Circumstances, Needs, and Interests.

Science.gov (United States)

McKillip, Ryan; Ernst, Michael; Ahn, James; Tekian, Ara; Shappell, Eric

2018-04-26

Introduction Resident financial health has been linked to wellness and resiliency, yet financial literacy among residents is highly variable. While some medical school curricula include budgeting and student loan education, content on managing finances as a resident is usually lacking. We sought to quantitatively assess residents' financial circumstances, needs, and interests to inform the design of a resident personal finance curriculum. Methods Surveys were sent to residents in eight specialties at an academic medical center. Likert-type responses allowed respondents to rate their level of comfort (1 = Very Uncomfortable, 7 = Very Comfortable) and interest (1 = Very Uninterested, 7 = Very Interested) in various personal finance topics including budgeting, loan repayment, disability insurance, life insurance, home buying, and retirement planning. Details regarding financial circumstances, including assets, liabilities, and insurance, were also collected. Results of questions that utilized a Likert-type scale are reported as median (interquartile range). Results Of 346 residents surveyed, 144 (41.6%) responded. Residents were from Internal Medicine (56, 38.9%), Pediatrics (34, 23.6%), Emergency Medicine (18, 12.5%), and other specialties (36, 25.0%). Ninety-one (63.2%) reported educational loans, with an average balance of $191,730. Credit card balances exceeding $3,000 were reported by 11 (7.6%) respondents. One-hundred-two (70.1%) reported emergency savings, but only 65 (45.1%) reported having a retirement account (average balance $27,608). Respondents rated highest comfort levels with budgeting (5[4-6]), and lowest level of comfort with disability insurance (2[2-4]) and home buying (2[2-5]). Interest in learning each topic was high (6[5-7]), with retirement planning (6[5-7]), investing (6[5-7]), and home buying (6[5-7]) the topics of highest interest. Conclusion These results highlight the deficits in personal finance literacy among residents. Future work should

Perspectives of Residents of Mashhad School of Dentistry about the Curriculum of Residency Program

Directory of Open Access Journals (Sweden)

Javad Sarabadani

2015-09-01

Full Text Available Introduction: This study was carried out to analyze the viewpoint of the residents of school of dentistry about the curriculum presented in the residency program to students of Mashhad School of Dentistry. Methods: To evaluate the perspectives of residents of dental school about the curriculum and regulations of residency program, a questionnaire was designed whose validity and reliability were confirmed by the authorities of School of Dentistry and test-retest reliability, respectively. The questionnaire was distributed among 100 residents and 80 of them completed the questionnaires. The data were analyzed by SPSS software (version 11.5. Results: A total of 43% of residents were informed of the curriculum (e.g. academic leave, transfer, removal of semester, etc.. As for the ability to write research proposal, 42.7% of residents were reported to have a favorable status, i.e. they were able to write more than 80% of their proposal. From among the residents, 30.4% had specialized English language certificate. Most of them (77% were satisfied with the professional staff, faculty members, of the faculty. Many students liked to participate in the teaching method courses of the residency program. Conclusion: Residents maintained that the curriculum in such domains as educational and research issues and special capabilities had some weak points. Thus, appropriate strategies are recommended to be applied to revise the curriculum using the residents’ views on these programs.

Facebook Use between College Resident Advisors' and Their Residents: A Mixed Methods Approach.

Science.gov (United States)

Kacvinsky, Lauren E; Moreno, Megan A

2014-01-01

Facebook use is nearly ubiquitous among college students. Studies have shown links between Facebook displays of depression or problem drinking and risk of these problems. This project aimed to determine whether Facebook could be used to help Resident Advisors (RAs) identify college students at risk for depression or problem drinking. Interviews were conducted with college freshmen to investigate whether they were Facebook "friends" with their RA. Focus groups were conducted with RAs to determine their views on Facebook friending their dormitory residents and using Facebook to help identify at-risk students. 72 freshmen were interviewed and 25 RAs participated in focus groups; both agreed it is common for RAs and residents to be Facebook friends. RAs commonly noted references to depression and problem drinking on residents' Facebook pages, which often led to in-person discussions with the resident. This study provides support that RAs use Facebook to identify issues that may impact their student residents. RAs emphasized benefits of in-person interactions in order to provide support and obtain additional details about the situation. Universities could consider whether providing RA education about Facebook interactions with residents merits encouragement within their existing RA training programs.

CYP1B1 Mutations in Individuals With Primary Congenital Glaucoma and Residing in Denmark

DEFF Research Database (Denmark)

Grønskov, Karen; Redó-Riveiro, Alba; Sandfeld, Lisbeth

2016-01-01

Primary congenital glaucoma (PCG OMIM 231300) can be caused by pathogenic sequence variations in cytochrome P450, subfamily 1, polypeptide 1 (CYP1B1). The purpose of this study was to investigate the contribution of sequence variations in CYP1B1 in a cohort of individuals with PCG residing...... mutations, 5 of which were novel. The frequency of CYP1B1 mutations in this cohort was comparable with other populations. We also detected an individual heterozygous for p.(Tyr81Asn) mutation, previously suggested to cause autosomal dominant primary open-angle glaucoma....

Residents as teachers: psychiatry and family medicine residents' self-assessment of teaching knowledge, skills, and attitudes.

Science.gov (United States)

Brand, Michael W; Ekambaram, Vijayabharathi; Tucker, Phebe; Aggarwal, Ruchi

2013-09-01

Residents are one of the prime sources of information and education for medical students. As an initial step in supporting residents as teachers, a baseline self-assessment of residents' knowledge, skills, attitudes, and values related to teaching was conducted among psychiatry and family medicine residents to compare and improve their confidence and skills as teachers. Psychiatry residents (N=12) and family medicine residents (N=23) completed self-assessments of their knowledge, skills, attitudes, and values related to teaching. Residents also were asked to list steps used in the One-Minute Preceptor process and estimate the time each spent in teaching. Descriptive summary statistics were used for four main areas related to teaching; t-test and chi-square analyses were conducted to ascertain whether there was a significant difference in resident groups. In the current study, the perceived amount of time spent for teaching patients was significantly higher among family practice residents, whereas no group differences were found for time teaching medical students, peers, community members, non-physicians, or others. However, family medicine residents rated themselves higher than psychiatry residents in their understanding of their roles in teaching medical students and teaching patients. Also, family medicine residents' self-reported teaching skills were more advanced (82.4%) than psychiatry residents' (54.2%). They most likely applied at least two different teaching methods in inpatient and outpatient settings, as compared with psychiatry residents. No significant group differences were found in the other 15 items assessing teaching knowledge, skills, attitudes, and values. Results indicate that residents' knowledge, skills, attitudes, and values regarding teaching varies across institutions and training programs. The psychiatry residents in this study do not clearly understand their role as educators with patients and medical students; they have a less clear

Presence of sequence and SNP variation in the IRF6 gene in healthy residents of Guangdong Province

Directory of Open Access Journals (Sweden)

Wu Wenli

2016-01-01

Full Text Available This study was to investigate the single nucleotide polymorphism (SNP in the interferon regulatory factor 6 (IRF6 gene in healthy residents of Guangdong Province, China, for further analysis of their associations with the development of cleft lip with or without palate (CL/P.

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.

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.

Do organisational constraints explain the use of restraint? A comparative ethnographic study from three nursing homes in Norway.

Science.gov (United States)

Øye, Christine; Jacobsen, Frode Fadnes; Mekki, Tone Elin

2017-07-01

To investigate (1) what kind of restraint is used in three nursing homes in Norway and (2) how staff use restraint under what organisational conditions. Restraint use in residents living with dementia in nursing homes is controversial, and at odds with fundamental human rights. Restraint is a matter of hindering residents' free movement and will by applying either interactional, physical, medical, surveillance or environmental restraint. Previous research has identified use of restraint related to individual resident characteristics such as agitation, aggressiveness and wandering. This model is embedded in an overall mixed-method education intervention design study called Modelling and evaluating evidence-based continuing education program in dementia care (MEDCED), applying ethnography postintervention to examine the use of restraint in 24 nursing homes in Norway. Based on restraint diversity measured in the trial, ethnographic investigation was carried out in three different nursing homes in Norway over a 10-month period to examine restraint use in relation to organisational constraints. Several forms of restraint were observed; among them, interactional restraint was used most frequently. We identified that use of restraint relates to the characteristics of individual residents, such as agitation, aggressiveness and wandering. However, restraint use should also be explained in relation to organisational conditions such as resident mix, staff culture and available human resources. A fluctuating and dynamic interplay between different individual and contextual factors determines whether restraint is used - or not in particular situations with residents living with dementia. Educational initiatives targeting staff to reduce restraint must be sensitive towards fluctuating organisational constraints. © 2016 John Wiley & Sons Ltd.

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

Protected Time for Research During Orthopaedic Residency Correlates with an Increased Number of Resident Publications.

Science.gov (United States)

Williams, Benjamin R; Agel, Julie A; Van Heest, Ann E

2017-07-05

The Accreditation Council for Graduate Medical Education (ACGME) requires orthopaedic residency programs to promote scholarship and research, which manifest differently among programs. We assess the impact of protected research time during orthopaedic residency on the number of resident publications. Rotation schedules and resident names were collected from 125 ACGME-accredited U.S. orthopaedic residency programs. Protected research time was classified as 1 of 3 types: (1) block time, (2) longitudinal time, or (3) no dedicated time. In April 2016, we searched residents in postgraduate year (PGY)-3 to PGY-5 on pubmed.gov to generate all orthopaedic publications with a PubMed identifier published during residency. Each publication's 2015 Thomson Reuters Journal Citation Reports 5-Year Journal Impact Factor and resident first authorship were noted. The number of PubMed identifiers for each program was summed and was divided by the number of residents in PGY-3 to PGY-5, giving a mean number of publications per resident. The relationship between output and program research time was compared using t tests and analysis of variance (ANOVA). A total of 1,690 residents were included, with an overall mean number (and standard deviation) of 1.2 ± 2.4 publications per resident. Eighty-seven programs reported block time, 14 programs reported longitudinal time, and 24 programs reported no time. There was a significant difference (p = 0.02) in the mean number of publications per resident when compared between programs with protected time (1.1 ± 1.2 publications) and programs with no protected time (0.6 ± 0.5 publication). One-way ANOVA demonstrated a significant mean difference across the 3 groups (p publications than block time at 1.0 ± 1.0 publication or no time at 0.6 ± 0.5 publication, a difference that persisted when adjusted to include only impact factors of >0 and exclude case reports (p = 0.0015). Both the presence of and the type of dedicated research time correlate

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.

Living in a continuous traumatic reality: Impact on elderly persons residing in urban and rural communities.

Science.gov (United States)

Regev, Irit; Nuttman-Shwartz, Orit

2016-01-01

This study is an exploration of the contribution of exposure to the continuous threat of Qassam rocket attacks to PTSD among elderly residents of urban and rural communities. Specifically, we examined the contribution of sociodemographic variables, psychological resources, and perceived social support to PTSD, and whether this relationship is mediated by cognitive appraisals. The sample consisted of 298 residents of 2 different communities: urban (n = 190), and rural (n = 108). We examined the main research question by calculating the correlations of the sociodemographic variables, the psychological resource (self-esteem), social support, and cognitive appraisals with the dependent variable (PTSD). Our model explained the variance in PTSD (53% for urban residents, and 56% for rural residents). Higher levels of PTSD were found among the urban residents. Most of the predictors contributed to PTSD, but differences were found between each type of community with regard to the combination of components. Results indicated that the type of community is related degree of protection against stress-related triggers such as Qassam rockets. The psychological resource (self-esteem) and cognitive appraisal variables were found to be important for older people facing a continuous threat, and can serve as a basis for professional intervention. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

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

Genetic factors explain half of all variance in serum eosinophil cationic protein

DEFF Research Database (Denmark)

Elmose, Camilla; Sverrild, Asger; van der Sluis, Sophie

2014-01-01

with variation in serum ECP and to determine the relative proportion of the variation in ECP due to genetic and non-genetic factors, in an adult twin sample. METHODS: A sample of 575 twins, selected through a proband with self-reported asthma, had serum ECP, lung function, airway responsiveness to methacholine......, exhaled nitric oxide, and skin test reactivity, measured. Linear regression analysis and variance component models were used to study factors associated with variation in ECP and the relative genetic influence on ECP levels. RESULTS: Sex (regression coefficient = -0.107, P ... was statistically non-significant (r = -0.11, P = 0.50). CONCLUSION: Around half of all variance in serum ECP is explained by genetic factors. Serum ECP is influenced by sex, BMI, and airway responsiveness. Serum ECP and airway responsiveness seem not to share genetic variance....

Ensembl variation resources

Directory of Open Access Journals (Sweden)

Marin-Garcia Pablo

2010-05-01

Full Text Available Abstract Background The maturing field of genomics is rapidly increasing the number of sequenced genomes and producing more information from those previously sequenced. Much of this additional information is variation data derived from sampling multiple individuals of a given species with the goal of discovering new variants and characterising the population frequencies of the variants that are already known. These data have immense value for many studies, including those designed to understand evolution and connect genotype to phenotype. Maximising the utility of the data requires that it be stored in an accessible manner that facilitates the integration of variation data with other genome resources such as gene annotation and comparative genomics. Description The Ensembl project provides comprehensive and integrated variation resources for a wide variety of chordate genomes. This paper provides a detailed description of the sources of data and the methods for creating the Ensembl variation databases. It also explores the utility of the information by explaining the range of query options available, from using interactive web displays, to online data mining tools and connecting directly to the data servers programmatically. It gives a good overview of the variation resources and future plans for expanding the variation data within Ensembl. Conclusions Variation data is an important key to understanding the functional and phenotypic differences between individuals. The development of new sequencing and genotyping technologies is greatly increasing the amount of variation data known for almost all genomes. The Ensembl variation resources are integrated into the Ensembl genome browser and provide a comprehensive way to access this data in the context of a widely used genome bioinformatics system. All Ensembl data is freely available at http://www.ensembl.org and from the public MySQL database server at ensembldb.ensembl.org.

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

Variational principle in quantum mechanics

International Nuclear Information System (INIS)

Popiez, L.

1986-01-01

The variational principle in a standard, path integral formulation of quantum mechanics (as proposed by Dirac and Feynman) appears only in the context of a classical limit n to 0 and manifests itself through the method of abstract stationary phase. Symbolically it means that a probability amplitude averaged over trajectories denotes a classical evolution operator for points in a configuration space. There exists, however, the formulation of quantum dynamics in which variational priniple is one of basic postulates. It is explained that the translation between stochastic and quantum mechanics in this case can be understood as in Nelson's stochastic mechanics

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

Science.gov (United States)

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

2014-01-01

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

Body size and pubertal development explain ethnic differences in structural geometry at the femur in Asian, Hispanic and white early adolescent girls living in the US

Science.gov (United States)

Variation in structural geometry is present in adulthood, but when this variation arises and what influences this variation prior to adulthood remains poorly understood. Ethnicity is commonly the focus of research of skeletal integrity and appears to explain some of the variation in quantification o...

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.

Associated factors of different nutrition indicators in German nursing home residents: comparative results of a multicenter cross-sectional study.

Science.gov (United States)

Palm, R; Reuther, S; Bartholomeyczik, S

2012-10-01

Malnutrition is one of the most important care problems in the nursing home care sector. The subject of this analysis is the investigation of associative factors for different indicators of malnutrition of residents in nursing homes in Germany. A secondary data analysis was conducted using data from 4,478 nursing home residents. Unintended weight loss or reduced intake and BMI ≤ 20 were analysed as indicators for malnutrition. The influence of age, sex, co-morbidities and care dependency were investigated in logistic regression models. Residents with a high care dependency had a higher risk of suffering weight loss/reduced intake. With regard to BMI ≤ 20, residents aged > 85 years, female gender, cancer, musculoskeletal disease as well as high care dependency had a higher risk. In both models, care dependency plays a major role in explaining malnutrition. Associative factors for malnutrition must be interpreted according to the indicators used to define malnutrition.

Perioperative self-reflection among surgical residents.

Science.gov (United States)

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

2017-09-01

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

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

Science.gov (United States)

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

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

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

Science.gov (United States)

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

2013-01-01

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

Are Multilingualism, Tolerance of Ambiguity, and Attitudes toward Linguistic Variation Related?

Science.gov (United States)

van Compernolle, Rémi A.

2016-01-01

This article explores the links between multilingualism, the personality trait Tolerance of Ambiguity (TA), and attitudes toward linguistic variation among 379 mono-, bi-, and multilingual adults who completed an online questionnaire. A self-reported high level of proficiency in multiple languages, short- and long-term residence abroad, and high…

Temporal and spatial variation of nitrogen transformations in a coniferous soil.

NARCIS (Netherlands)

Laverman, A.M.; Zoomer, H.R.; van Verseveld, H.W.; Verhoef, H.A.

2000-01-01

Forest soils show a great degree of temporal and spatial variation of nitrogen mineralization. The aim of the present study was to explain temporal variation in nitrate leaching from a nitrogen-saturated coniferous forest soil by potential nitrification, mineralization rates and nitrate uptake by

Impact of rural residence and health system structure on quality of liver care.

Directory of Open Access Journals (Sweden)

Catherine Rongey

Full Text Available Specialist physician concentration in urban areas can affect access and quality of care for rural patients. As effective drug treatment for hepatitis C (HCV becomes increasingly available, the extent to which rural patients needing HCV specialists face access or quality deficits is unknown. We sought to determine the influence of rural residency on access to HCV specialists and quality of liver care.The study used a national cohort of 151,965 Veterans Health Administration (VHA patients with HCV starting in 2005 and followed to 2009. The VHA's constant national benefit structure reduces the impact of insurance as an explanation for observed disparities. Multivariate cox proportion regression models for each quality indicator were performed.Thirty percent of VHA patients with HCV reside in rural and highly rural areas. Compared to urban residents, highly rural (HR 0.70, CI 0.65-0.75 and rural (HR 0.96, CI 0.94-0.97 residents were significantly less likely to access HCV specialty care. The quality indicators were more mixed. While rural residents were less likely to receive HIV screening, there were no significant differences in hepatitis vaccinations, endoscopic variceal and hepatocellular carcinoma screening between the geographic subgroups. Of note, highly rural (HR 1.31, CI 1.14-1.50 and rural residents (HR 1.06, CI 1.02-1.10 were more likely to receive HCV therapy. Of those treated for HCV, a third received therapy from a non-specialist provider.Rural patients have less access to HCV specialists, but this does not necessarily translate to quality deficits. The VHA's efforts to improve specialty care access, rural patient behavior and decentralization of HCV therapy beyond specialty providers may explain this contradiction. Lessons learned within the VHA are critical for US healthcare systems restructuring into accountable care organizations that acquire features of integrated systems.

Multivariate benthic ecosystem functioning in the Arctic – benthic fluxes explained by environmental parameters in the southeastern Beaufort Sea

Directory of Open Access Journals (Sweden)

H. Link

2013-09-01

Full Text Available The effects of climate change on Arctic marine ecosystems and their biogeochemical cycles are difficult to predict given the complex physical, biological and chemical interactions among the ecosystem components. We studied benthic biogeochemical fluxes in the Arctic and the influence of short-term (seasonal to annual, long-term (annual to decadal and other environmental variability on their spatial distribution to provide a baseline for estimates of the impact of future changes. In summer 2009, we measured fluxes of dissolved oxygen, nitrate, nitrite, ammonia, soluble reactive phosphate and silicic acid at the sediment–water interface at eight sites in the southeastern Beaufort Sea at water depths from 45 to 580 m. The spatial pattern of the measured benthic boundary fluxes was heterogeneous. Multivariate analysis of flux data showed that no single or reduced combination of fluxes could explain the majority of spatial variation, indicating that oxygen flux is not representative of other nutrient sink–source dynamics. We tested the influence of eight environmental parameters on single benthic fluxes. Short-term environmental parameters (sinking flux of particulate organic carbon above the bottom, sediment surface Chl a were most important for explaining oxygen, ammonium and nitrate fluxes. Long-term parameters (porosity, surface manganese and iron concentration, bottom water oxygen concentrations together with δ13Corg signature explained most of the spatial variation in phosphate, nitrate and nitrite fluxes. Variation in pigments at the sediment surface was most important to explain variation in fluxes of silicic acid. In a model including all fluxes synchronously, the overall spatial distribution could be best explained (57% by the combination of sediment Chl a, phaeopigments, δ13Corg, surficial manganese and bottom water oxygen concentration. We conclude that it is necessary to consider long-term environmental variability along with

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

Science.gov (United States)

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

2017-07-18

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

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

Slum residence and child health in developing countries.

Science.gov (United States)

Fink, Günther; Günther, Isabel; Hill, Kenneth

2014-08-01

Continued population growth and increasing urbanization have led to the formation of large informal urban settlements in many developing countries in recent decades. The high prevalence of poverty, overcrowding, and poor sanitation observed in these settlements-commonly referred to as "slums"-suggests that slum residence constitutes a major health risk for children. In this article, we use data from 191 Demographic and Health Surveys (DHS) across 73 developing countries to investigate this concern empirically. Our results indicate that children in slums have better health outcomes than children living in rural areas yet fare worse than children in better-off neighborhoods of the same urban settlements. A large fraction of the observed health differences appears to be explained by pronounced differences in maternal education, household wealth, and access to health services across residential areas. After we control for these characteristics, children growing up in the slums and better-off neighborhoods of towns show levels of morbidity and mortality that are not statistically different from those of children living in rural areas. Compared with rural children, children living in cities (irrespective of slum or formal residence) fare better with respect to mortality and stunting but not with respect to recent illness episodes.

Operative time and cost of resident surgical experience: effect of instituting an otolaryngology residency program.

Science.gov (United States)

Pollei, Taylor R; Barrs, David M; Hinni, Michael L; Bansberg, Stephen F; Walter, Logan C

2013-06-01

Describe the procedure length difference between surgeries performed by an attending surgeon alone compared with the resident surgeon supervised by the same attending surgeon. Case series with chart review. Tertiary care center and residency program. Six common otolaryngologic procedures performed between August 1994 and May 2012 were divided into 2 cohorts: attending surgeon alone or resident surgeon. This division coincided with our July 2006 initiation of an otolaryngology-head and neck surgery residency program. Operative duration was compared between cohorts with confounding factors controlled. In addition, the direct result of increased surgical length on operating room cost was calculated and applied to departmental and published resident case log report data. Five of the 6 procedures evaluated showed a statistically significant increase in surgery length with resident involvement. Operative time increased 6.8 minutes for a cricopharyngeal myotomy (P = .0097), 11.3 minutes for a tonsillectomy (P operative time difference. Cost of increased surgical time was calculated per surgery and ranged from $286 (cricopharyngeal myotomy) to $2142 (mastoidectomy). When applied to reported national case log averages for graduating residents, this resulted in a significant increase of direct training-related costs. Resident participation in the operating room results in increased surgical length and additional system cost. Although residency is a necessary part of surgical training, associated costs need to be acknowledged.

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

Science.gov (United States)

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

2012-01-01

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

Note: Dynamic Conjectural Variations in a Lanchester Oligopoly

OpenAIRE

Gary M. Erickson

1997-01-01

An approach based on dynamic conjectural variations is advanced for developing dynamic advertising strategies in a Lanchester oligopoly differential game. The approach allows competitors to anticipate rival reactions to market-share state variables, and maintains the computational advantage of open-loop Nash equilibrium strategies. In an empirical application to the ready-to-eat cereal industry, it is shown that advertising strategies based on dynamic conjectural variations can better explain...

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

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.

Regional Variation of Cost of Care in the Last 12 Months of Life in Switzerland: Small-area Analysis Using Insurance Claims Data.

Science.gov (United States)

Panczak, Radoslaw; Luta, Xhyljeta; Maessen, Maud; Stuck, Andreas E; Berlin, Claudia; Schmidlin, Kurt; Reich, Oliver; von Wyl, Viktor; Goodman, David C; Egger, Matthias; Zwahlen, Marcel; Clough-Gorr, Kerri M

2017-02-01

Health care spending increases sharply at the end of life. Little is known about variation of cost of end of life care between regions and the drivers of such variation. We studied small-area patterns of cost of care in the last year of life in Switzerland. We used mandatory health insurance claims data of individuals who died between 2008 and 2010 to derive cost of care. We used multilevel regression models to estimate differences in costs across 564 regions of place of residence, nested within 71 hospital service areas. We examined to what extent variation was explained by characteristics of individuals and regions, including measures of health care supply. The study population consisted of 113,277 individuals. The mean cost of care during last year of life was 32.5k (thousand) Swiss Francs per person (SD=33.2k). Cost differed substantially between regions after adjustment for patient age, sex, and cause of death. Variance was reduced by 52%-95% when we added individual and regional characteristics, with a strong effect of language region. Measures of supply of care did not show associations with costs. Remaining between and within hospital service area variations were most pronounced for older females and least for younger individuals. In Switzerland, small-area analysis revealed variation of cost of care during the last year of life according to linguistic regions and unexplained regional differences for older women. Cultural factors contribute to the delivery and utilization of health care during the last months of life and should be considered by policy makers.

Resident satisfaction on their residence and environment (case study of Srondol Bumi Indah Housing of Semarang City)

Science.gov (United States)

Hariyono, Paulus

2017-12-01

A piece of an architecture work will be meaningful if it meets the needs of the residents. Likewise, the design and natural environment of a residence will surely be meaningful if it is able to satisfy the residents. The degree of satisfaction can be referred to the theory of human need hierarchy proposed by Abraham Maslow. Although his theory is an old one, it is still a good one for a reference. Socio economic status (SES)also affects someone in understanding the comfort of his resident. This research has some purpose: 1) to know the satisfaction level of the residents, 2) to know the effects of socio economic status towards the residents, and 3) to know the natural environment aspect to resident satisfaction. The methode analysis used is qualitative analysis. The major finding are: 1)security factor is the main aspect of the human need residents; 2) upper and lowerclass residents have different knowledge and understanding regarding the natural environment satisfaction on the house they live.

Active parenting or Solomon’s justice?
Alternating residence in Sweden for children with separated parents

Directory of Open Access Journals (Sweden)

Anna Singer

2008-06-01

Full Text Available Alternating residence for children with separated parents has become increasingly popular in Sweden over the last few decades. In this article, a brief background to the use of alternating residence in Sweden will be provided. Relevant legislation will be described and some of the apparent problems in connection to this kind of living arrangement will also be discussed. It is estimated that approximately one out of every five children with separated parents today are living alternately with both parents. The high frequency of alternating residence can probably be explained, to a great extent, by determined legislative work to ensure that joint custody is the main rule for separated parents. Joint custody after separation encourages parents to take a more active part in the child’s life. Alternating residence can be seen as the optimal way to ensure that a child is provided natural and stress-free contact with both parents in the different events of everyday life that is not possible when the child lives with one parent. However, there are also problems related to alternating residence that need to be addressed. The possibility for the courts to decide on alternating residence against the will of one of the parents appears to have little justification considering that one of the prerequisites for this form of living arrangement is that it is beneficial for children if their parents can co-operate. There are also other aspects of the regulation of alternating residence that need to be improved, in particular questions concerning the child maintenance. Different aspects of the public social security system for children with separated parents also need to be adjusted to provide just and fair solutions for children with alternating residence. Finally, since alternating residence is motivated by a desire to protect the best interests of the child, further research clarifying the experiences of children with alternating residence needs to be carried

Geographic Variation in Maternal Smoking during Pregnancy in the Missouri Adolescent Female Twin Study (MOAFTS)

Science.gov (United States)

Lian, Min; Madden, Pamela A.; Lynskey, Michael T.; Colditz, Graham A.; Lessov-Schlaggar, Christina N.; Schootman, Mario; Heath, Andrew C.

2016-01-01

Objective Despite well-known adverse health effects of maternal smoking during pregnancy (MSP), it is still unclear if MSP varies geographically and if neighborhood socioeconomic deprivation (SED) plays an important role in MSP. This study aims to investigate small-area geographic variation in MSP and examine the association of SED with MSP. Methods The Missouri Adolescent Female Twin Study (MOAFTS) is a cohort study of female like-sex twins born in Missouri to Missouri-resident parents during 1975–1985. Biological mothers completed a baseline interview in 1995–1998 and reported MSP with the twins. Residential address of the mother at birth was geocoded. We developed a census tract-level SED index using a common factor approach based on 21 area-level socioeconomic variables from the 1980 Census data. Multilevel logistic regressions estimated geographic heterogeneity (random effect) in MSP and the odds ratios (ORs, fixed effects) of neighborhood SED associated with MSP. Results Of 1658 MOAFTS mothers, 35.2% reported any MSP and 21.9% reported MSP beyond the first trimester. Neighborhood SED was associated with any MSP (the highest vs. the lowest quartile: OR = 1.90, 95% confidence interval [CI] = 1.40–2.57, Ptrendalcohol use, and parents’ cohabitation), neighborhood SED was not associated with MSP, but geographic variation still persisted in MSP (variance = 0.41, P = 0.003) and in MSP beyond the first trimester (variance = 0.82, P<0.001). Conclusions Neighborhood SED was associated with MSP in unadjusted analyses but this association could be explained by individual socioeconomic conditions. Nonetheless, significant geographic variation in MSP persisted and was not accounted for by differences in neighborhood SED. To develop effective interventions to reduce MSP, further studies are necessary to explore underlying reasons for its geographic variation. PMID:27100091

Variation across mitochondrial gene trees provides evidence for systematic error: How much gene tree variation is biological?

Science.gov (United States)

Richards, Emilie J; Brown, Jeremy M; Barley, Anthony J; Chong, Rebecca A; Thomson, Robert C

2018-02-19

The use of large genomic datasets in phylogenetics has highlighted extensive topological variation across genes. Much of this discordance is assumed to result from biological processes. However, variation among gene trees can also be a consequence of systematic error driven by poor model fit, and the relative importance of biological versus methodological factors in explaining gene tree variation is a major unresolved question. Using mitochondrial genomes to control for biological causes of gene tree variation, we estimate the extent of gene tree discordance driven by systematic error and employ posterior prediction to highlight the role of model fit in producing this discordance. We find that the amount of discordance among mitochondrial gene trees is similar to the amount of discordance found in other studies that assume only biological causes of variation. This similarity suggests that the role of systematic error in generating gene tree variation is underappreciated and critical evaluation of fit between assumed models and the data used for inference is important for the resolution of unresolved phylogenetic questions.

Hospital Variation in Cesarean Delivery: A Multilevel Analysis.

Science.gov (United States)

Vecino-Ortiz, Andres I; Bardey, David; Castano-Yepes, Ramon

2015-12-01

To assess the issue of hospital variations in Colombia and to contribute to the methodology on health care variations by using a model that clusters the variance between hospitals while accounting for individual-level reimbursement rates and objective health-status variables. We used data on all births (N = 11,954) taking place in a contributory-regimen insurer network in Colombia during 2007. A multilevel logistic regression model was used to account for the share of unexplained variance between hospitals. In addition, an alternative variance decomposition specification was further carried out to measure the proportion of such unexplained variance due to the region effect. Hospitals account for 20% of the variation in performing cesarean sections, whereas region explains only one-third of such variance. Variables accounting for preferences on the demand side as well as reimbursement rates are found to predict the probability of performing cesarean sections. Hospital variations explain large variances within a single-payer's network. Because this insurer company is highly regarded in terms of performance and finance, these results might provide a lower bound for the scale of hospital variation in the Colombian health care market. Such lower bound provides guidance on the relevance of this issue for Colombia. Some factors such as demand-side preferences and physician reimbursement rates increase variations in health care even within a single-payer network. This is a source of inefficiencies, threatening the quality of health care and financial sustainability. The proposed methodology should be considered in further research on health care variations. Copyright © 2015 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Managing Cultural Variation in Software Process Improvement

DEFF Research Database (Denmark)

Müller, Sune Dueholm; Kræmmergaard, Pernille; Mathiassen, Lars

The scale and complexity of change in software process improvement (SPI) are considerable and managerial attention to organizational culture during SPI can therefore potentially contribute to successful outcomes. However, we know little about the impact of variations in organizational subculture...... CMMI level 2 as planned, ASY struggled to implement even modest improvements. To explain these differences, we analyzed the underlying organizational culture within ISY and ASY using two different methods for subculture assessment. The study demonstrates how variations in culture across software...

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

Science.gov (United States)

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

2018-03-01

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

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

Directory of Open Access Journals (Sweden)

Jacob Arnold

2018-02-01

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

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.

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

Science.gov (United States)

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

2006-01-01

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

Text messaging among residents and faculty in a university general surgery residency program: prevalence, purpose, and patient care.

Science.gov (United States)

Shah, Dhruvil R; Galante, Joseph M; Bold, Richard J; Canter, Robert J; Martinez, Steve R

2013-01-01

There is little information about the use of text messaging (texting) devices among resident and faculty physicians for patient-related care (PRC). To determine the prevalence, frequency, purpose, and concerns regarding texting among resident and attending surgeons and to identify factors associated with PRC texting. E-mail survey. University medical center and its affiliated hospitals. Surgery resident and attending staff. Prevalence, frequency, purpose, and concerns regarding patient-related care text messaging. Overall, 73 (65%) surveyed physicians responded, including 45 resident (66%) and 28 attending surgeons (62%). All respondents owned a texting device. Majority of surgery residents (88%) and attendings (71%) texted residents, whereas only 59% of residents and 65% of attendings texted other faculty. Most resident to resident text occurred at a frequency of 3-5 times/d (43%) compared with most attending to resident texts, which occurred 1-2 times/d (33%). Most resident to attending (25%) and attending to attending (30%) texts occurred 1-2 times/d. Among those that texted, PRC was the most frequently reported purpose for resident to resident (46%), resident to attending (64%), attending to resident (82%), and attending to other attending staff (60%) texting. Texting was the most preferred method to communicate about routine PRC (47% of residents vs 44% of attendings). Age (OR: 0.86, 95% CI: 0.79-0.95; p = 0.003), but not sex, specialty/clinical rotation, academic rank, or postgraduate year (PGY) level predicted PRC texting. Most resident and attending staff surveyed utilize texting, mostly for PRC. Texting was preferred for communicating routine PRC information. Our data may facilitate the development of guidelines for the appropriate use of PRC texting. Copyright © 2013 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Milk fat depression in dairy ewes fed fish oil: Might differences in rumen biohydrogenation, fermentation, or bacterial community explain the individual variation?

Science.gov (United States)

Frutos, P; Toral, P G; Belenguer, A; Hervás, G

2018-07-01

more abundant in RESPON+. Overall, the results suggest that individual variation in MFD severity in dairy ewes fed fish oil cannot be fully explained by differences in the processes of rumen biohydrogenation and fermentation or in the bacterial community, and further research would be necessary to elucidate the large variability in the responsiveness to MFD-inducing marine lipids. Copyright © 2018 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Can Medical School Performance Predict Residency Performance? Resident Selection and Predictors of Successful Performance in Obstetrics and Gynecology

Science.gov (United States)

Stohl, Hindi E.; Hueppchen, Nancy A.; Bienstock, Jessica L.

2010-01-01

Background During the evaluation process, Residency Admissions Committees typically gather data on objective and subjective measures of a medical student's performance through the Electronic Residency Application Service, including medical school grades, standardized test scores, research achievements, nonacademic accomplishments, letters of recommendation, the dean's letter, and personal statements. Using these data to identify which medical students are likely to become successful residents in an academic residency program in obstetrics and gynecology is difficult and to date, not well studied. Objective To determine whether objective information in medical students' applications can help predict resident success. Method We performed a retrospective cohort study of all residents who matched into the Johns Hopkins University residency program in obstetrics and gynecology between 1994 and 2004 and entered the program through the National Resident Matching Program as a postgraduate year-1 resident. Residents were independently evaluated by faculty and ranked in 4 groups according to perceived level of success. Applications from residents in the highest and lowest group were abstracted. Groups were compared using the Fisher exact test and the Student t test. Results Seventy-five residents met inclusion criteria and 29 residents were ranked in the highest and lowest quartiles (15 in highest, 14 in lowest). Univariate analysis identified no variables as consistent predictors of resident success. Conclusion In a program designed to train academic obstetrician-gynecologists, objective data from medical students' applications did not correlate with successful resident performance in our obstetrics-gynecology residency program. We need to continue our search for evaluation criteria that can accurately and reliably select the medical students that are best fit for our specialty. PMID:21976076

Improving education under work-hour restrictions: comparing learning and teaching preferences of faculty, residents, and students.

Science.gov (United States)

Jack, Megan C; Kenkare, Sonya B; Saville, Benjamin R; Beidler, Stephanie K; Saba, Sam C; West, Alisha N; Hanemann, Michael S; van Aalst, John A

2010-01-01

Faced with work-hour restrictions, educators are mandated to improve the efficiency of resident and medical student education. Few studies have assessed learning styles in medicine; none have compared teaching and learning preferences. Validated tools exist to study these deficiencies. Kolb describes 4 learning styles: converging (practical), diverging (imaginative), assimilating (inductive), and accommodating (active). Grasha Teaching Styles are categorized into "clusters": 1 (teacher-centered, knowledge acquisition), 2 (teacher-centered, role modeling), 3 (student-centered, problem-solving), and 4 (student-centered, facilitative). Kolb's Learning Style Inventory (HayGroup, Philadelphia, Pennsylvania) and Grasha-Riechmann's TSS were administered to surgical faculty (n = 61), residents (n = 96), and medical students (n = 183) at a tertiary academic medical center, after informed consent was obtained (IRB # 06-0612). Statistical analysis was performed using χ(2) and Fisher exact tests. Surgical residents preferred active learning (p = 0.053), whereas faculty preferred reflective learning (p style more often than surgical faculty (p = 0.01). Medical students preferred converging learning (42%) and cluster 4 teaching (35%). Statistical significance was unchanged when corrected for gender, resident training level, and subspecialization. Significant differences exist between faculty and residents in both learning and teaching preferences; this finding suggests inefficiency in resident education, as previous research suggests that learning styles parallel teaching styles. Absence of a predominant teaching style in residents suggests these individuals are learning to be teachers. The adaptation of faculty teaching methods to account for variations in resident learning styles may promote a better learning environment and more efficient faculty-resident interaction. Additional, multi-institutional studies using these tools are needed to elucidate these findings fully

Association of Group Prenatal Care in US Family Medicine Residencies With Maternity Care Practice: A CERA Secondary Data Analysis.

Science.gov (United States)

Barr, Wendy B; Tong, Sebastian T; LeFevre, Nicholas M

2017-03-01

Group prenatal care has been shown to improve both maternal and neonatal outcomes. With increasing adaption of group prenatal care by family medicine residencies, this model may serve as a potential method to increase exposure to and interest in maternity care among trainees. This study aims to describe the penetration, regional and program variations, and potential impacts on future maternity care practice of group prenatal care in US family medicine residencies. The CAFM Educational Research Alliance (CERA) conducted a survey of all US family medicine residency program directors in 2013 containing questions about maternity care training. A secondary data analysis was completed to examine relevant data on group prenatal care in US family medicine residencies and maternity care practice patterns. 23.1% of family medicine residency programs report provision of group prenatal care. Programs with group prenatal care reported increased number of vaginal deliveries per resident. Controlling for average number of vaginal deliveries per resident, programs with group prenatal care had a 2.35 higher odds of having more than 10% of graduates practice obstetrics and a 2.93 higher odds of having at least one graduate in the past 5 years enter an obstetrics fellowship. Residency programs with group prenatal care models report more graduates entering OB fellowships and practicing maternity care. Implementing group prenatal care in residency training can be one method in a multifaceted approach to increasing maternity care practice among US family physicians.

Neodymium isotopic variations in seawater

Science.gov (United States)

Piepgras, D. J.; Wasserburg, G. J.

1980-01-01

Direct measurement of the isotopic composition of Nd in the Atlantic agree with the Nd content in ferromanganese sediments and differ from the observed amounts in the Pacific samples. These data indicate the existence of distinctive differences in the isotopic composition of Nd in the waters of major oceans; the average values determined from seawater and ferromanganese sediments are considerably lower than in sources with oceanic mantle affinities showing that the REE in the oceans is dominated by continental sources. The Nd isotopic variations in seawater are applied to relate the residence time of Nd and mixing rates between the oceans.

Primary Care Resident Perceived Preparedness to Deliver Cross-cultural Care: An Examination of Training and Specialty Differences

Science.gov (United States)

Park, Elyse R.; Green, Alexander R.; Betancourt, Joseph R.; Weissman, Joel S.

2007-01-01

Objective Previous research has shown that resident physicians report differences in training across primary care specialties, although limited data exist on education in delivering cross-cultural care. The goals of this study were to identify factors that relate to primary care residents’ perceived preparedness to provide cross-cultural care and to explore the extent to which these perceptions vary across primary care specialties. Design Cross-sectional, national mail survey of resident physicians in their last year of training. Participants Eleven hundred fifty primary care residents specializing in family medicine (27%), internal medicine (23%), pediatrics (26%), and obstetrics/gynecology (OB/GYN) (24%). Results Male residents as well as those who reported having graduated from U.S. medical schools, access to role models, and a greater cross-cultural case mix during residency felt more prepared to deliver cross-cultural care. Adjusting for these demographic and clinical factors, family practice residents were significantly more likely to feel prepared to deliver cross-cultural care compared to internal medicine, pediatric, and OB/GYN residents. Yet, when the quantity of instruction residents reported receiving to deliver cross-cultural care was added as a predictor, specialty differences became nonsignificant, suggesting that training opportunities better account for the variability in perceived preparedness than specialty. Conclusions Across primary care specialties, residents reported different perceptions of preparedness to deliver cross-cultural care. However, this variation was more strongly related to training factors, such as the amount of instruction physicians received to deliver such care, rather than specialty affiliation. These findings underscore the importance of formal education to enhance residents’ preparedness to provide cross-cultural care. PMID:17516107

Effects of local and large-scale climate patterns on estuarine resident fishes: The example of Pomatoschistus microps and Pomatoschistus minutus

Science.gov (United States)

Nyitrai, Daniel; Martinho, Filipe; Dolbeth, Marina; Rito, João; Pardal, Miguel A.

2013-12-01

Large-scale and local climate patterns are known to influence several aspects of the life cycle of marine fish. In this paper, we used a 9-year database (2003-2011) to analyse the populations of two estuarine resident fishes, Pomatoschistus microps and Pomatoschistus minutus, in order to determine their relationships with varying environmental stressors operating over local and large scales. This study was performed in the Mondego estuary, Portugal. Firstly, the variations in abundance, growth, population structure and secondary production were evaluated. These species appeared in high densities in the beginning of the study period, with subsequent occasional high annual density peaks, while their secondary production was lower in dry years. The relationships between yearly fish abundance and the environmental variables were evaluated separately for both species using Spearman correlation analysis, considering the yearly abundance peaks for the whole population, juveniles and adults. Among the local climate patterns, precipitation, river runoff, salinity and temperature were used in the analyses, and North Atlantic Oscillation (NAO) index and sea surface temperature (SST) were tested as large-scale factors. For P. microps, precipitation and NAO were the significant factors explaining abundance of the whole population, the adults and the juveniles as well. Regarding P. minutus, for the whole population, juveniles and adults river runoff was the significant predictor. The results for both species suggest a differential influence of climate patterns on the various life cycle stages, confirming also the importance of estuarine resident fishes as indicators of changes in local and large-scale climate patterns, related to global climate change.

TAXATION AND INTERNAL MIGRATION - EVIDENCE FROM THE SWISS CENSUS USING COMMUNITY-LEVEL VARIATION IN INCOME TAX RATES

OpenAIRE

Liebig, Thomas; Puhani, Patrick A.; Sousa-Poza, Alfonso

2006-01-01

We investigate the relationship between income tax rate variation and internal migration for the unique case of Switzerland, whose system of determining tax rates primarily at the community level results in enough variation to permit analysis of their influence on migration. Specifically, using Swiss census data, we analyze migratory responses to tax rate variations for various groups defined by age, education, and nationality/residence permit. The results suggest that young Swiss college gra...

A model of self-directed learning in internal medicine residency: a qualitative study using grounded theory.

Science.gov (United States)

Sawatsky, Adam P; Ratelle, John T; Bonnes, Sara L; Egginton, Jason S; Beckman, Thomas J

2017-02-02

Existing theories of self-directed learning (SDL) have emphasized the importance of process, personal, and contextual factors. Previous medical education research has largely focused on the process of SDL. We explored the experience with and perception of SDL among internal medicine residents to gain understanding of the personal and contextual factors of SDL in graduate medical education. Using a constructivist grounded theory approach, we conducted 7 focus group interviews with 46 internal medicine residents at an academic medical center. We processed the data by using open coding and writing analytic memos. Team members organized open codes to create axial codes, which were applied to all transcripts. Guided by a previous model of SDL, we developed a theoretical model that was revised through constant comparison with new data as they were collected, and we refined the theory until it had adequate explanatory power and was appropriately grounded in the experiences of residents. We developed a theoretical model of SDL to explain the process, personal, and contextual factors affecting SDL during residency training. The process of SDL began with a trigger that uncovered a knowledge gap. Residents progressed to formulating learning objectives, using resources, applying knowledge, and evaluating learning. Personal factors included motivations, individual characteristics, and the change in approach to SDL over time. Contextual factors included the need for external guidance, the influence of residency program structure and culture, and the presence of contextual barriers. We developed a theoretical model of SDL in medical education that can be used to promote and assess resident SDL through understanding the process, person, and context of SDL.

Resident Wellness and Social Support: Development and Cognitive Validation of a Resident Social Capital Assessment Tool.

Science.gov (United States)

Kaplan, Stephen J; Seabott, Heather M; Cunningham, Erika B; Helman, James D; Calderon, Alvin; Thirlby, Richard C; Schenarts, Kimberly D

The purpose of this study is to develop and generate validity evidence for an instrument to measure social capital in residents. Mixed-methods, phased approach utilizing a modified Delphi technique, focus groups, and cognitive interviews. Four residency training institutions in Washington state between February 2016 and March 2017. General surgery, anesthesia, and internal medicine residents ranging from PGY-1 to PGY-6. The initial resident-focused instrument underwent revision via Delphi process with 6 experts; 100% expert consensus was achieved after 4 cycles. Three focus groups were conducted with 19 total residents. Focus groups identified 6 of 11 instrument items with mean quality ratings ≤4.0 on a 1-5 scale. The composite instrument rating of the draft version was 4.1 ± 0.5. After refining the instrument, cognitive interviews with the final version were completed with 22 residents. All items in the final version had quality ratings >4.0; the composite instrument rating was 4.8 ± 0.1. Social capital may be an important factor in resident wellness as residents rely upon each other and external social support to withstand fatigue, burnout, and other negative sequelae of rigorous training. This instrument for assessment of social capital in residents may provide an avenue for data collection and potentially, identification of residents at-risk for wellness degradation. Copyright © 2018 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Invasibility of a nutrient-poor pasture through resident and non-resident herbs is controlled by litter, gap size and propagule pressure.

Directory of Open Access Journals (Sweden)

R Lutz Eckstein

Full Text Available Since inference concerning the relative effects of propagule pressure, biotic interactions, site conditions and species traits on the invasibility of plant communities is limited, we carried out a field experiment to study the role of these factors for absolute and relative seedling emergence in three resident and three non-resident confamilial herb species on a nutrient-poor temperate pasture. We set up a factorial field experiment with two levels each of the factors litter cover (0 and 400 g m(-2, gap size (0.01 and 0.1 m(2 and propagule pressure (5 and 50 seeds and documented soil temperature, soil water content and relative light availability. Recruitment was recorded in spring and autumn 2010 and in spring 2011 to cover initial seedling emergence, establishment after summer drought and final establishment after the first winter. Litter alleviated temperature and moisture conditions and had positive effects on proportional and absolute seedling emergence during all phases of recruitment. Large gaps presented competition-free space with high light availability but showed higher temperature amplitudes and lower soil moisture. Proportional and absolute seedling recruitment was significantly higher in large than in small gaps. In contrast, propagule pressure facilitated absolute seedling emergence but had no effects on proportional emergence or the chance for successful colonisation. Despite significantly higher initial seedling emergence of resident than non-resident species, seed mass and other species-specific traits may be better predictors for idiosyncratic variation in seedling establishment than status. Our data support the fluctuating resource hypothesis and demonstrate that the reserve effect of seeds may facilitate seedling emergence. The direct comparison of propagule pressure with other environmental factors showed that propagule pressure affects absolute seedling abundance, which may be crucial for species that depend on other

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 …

Ecological effects of aphid abundance, genotypic variation, and contemporary evolution on plants.

Science.gov (United States)

Turley, Nash E; Johnson, Marc T J

2015-07-01

Genetic variation and contemporary evolution within populations can shape the strength and nature of species interactions, but the relative importance of these forces compared to other ecological factors is unclear. We conducted a field experiment testing the effects of genotypic variation, abundance, and presence/absence of green peach aphids (Myzus persicae) on the growth, leaf nitrogen, and carbon of two plant species (Brassica napus and Solanum nigrum). Aphid genotype affected B. napus but not S. nigrum biomass explaining 20 and 7% of the total variation, respectively. Averaging across both plant species, the presence/absence of aphids had a 1.6× larger effect size (Cohen's d) than aphid genotype, and aphid abundance had the strongest negative effects on plant biomass explaining 29% of the total variation. On B. napus, aphid genotypes had different effects on leaf nitrogen depending on their abundance. Aphids did not influence leaf nitrogen in S. nigrum nor leaf carbon in either species. We conducted a second experiment in the field to test whether contemporary evolution could affect plant performance. Aphid populations evolved in as little as five generations, but the rate and direction of this evolution did not consistently vary between plant species. On one host species (B. napus), faster evolving populations had greater negative effects on host plant biomass, with aphid evolutionary rate explaining 23% of the variation in host plant biomass. Together, these results show that genetic variation and evolution in an insect herbivore can play important roles in shaping host plant ecology.

The Heterogeneous Non-Resident Student Body: Measuring the Effect of Out-of-State Students' Home-State Wealth on Tuition and Fee Price Variations

Science.gov (United States)

González Canché, Manuel S.

2017-01-01

More than 40 years of research has found a positive relationship between increases in the proportion of non-resident students enrolling in an institution and increases in the tuition prices this institution charges to these same students. Notably, this line of research has consistently treated this non-resident student body as if they constitute a…

[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

Current perspectives on chief residents in psychiatry.

Science.gov (United States)

Warner, Christopher H; Rachal, James; Breitbach, Jill; Higgins, Michael; Warner, Carolynn; Bobo, William

2007-01-01

The authors examine qualitative data from outgoing chief residents in psychiatry from the 2004-2005 academic year to 1) determine common characteristics between programs, 2) examine the residents' perspectives on their experiences, and 3) determine their common leadership qualities. The authors sent out self-report surveys via e-mail to 89 outgoing chief residents who attended the APA/Lilly Chief Resident Executive Leadership Program. Fifty-three (60%) chief residents responded. Although most chief residents are senior residents, over 20% are in their third postgraduate year. Two-thirds of programs have more than one chief resident each year. Most chief residents believe that their "participating" leadership style, existing leadership skills, and interpersonal skills contributed to their overall positive experiences. Successfully performing duties as a chief resident entails functioning in a variety of roles and demands attention to leadership qualities of the individual. Developing existing leadership skills, clarifying expectations, and providing mentorship to chief residents will ensure successful transition into practice, and the advancement of the field of psychiatry.

Temporal and spatial variation of nitrogen transformations in a coniferous forest soils.

NARCIS (Netherlands)

Laverman, A.M.; Zoomer, H.R.; van Verseveld, H.W.; Verhoef, H.A.

2000-01-01

Forest soils show a great degree of temporal and spatial variation of nitrogen mineralization. The aim of the present study was to explain temporal variation in nitrate leaching from a nitrogen-saturated coniferous forest soil by potential nitrification, mineralization rates and nitrate uptake by

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

Data.gov (United States)

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

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

Data.gov (United States)

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

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

Data.gov (United States)

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

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

Data.gov (United States)

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

A statistical light use efficiency model explains 85% variations in global GPP

Science.gov (United States)

Jiang, C.; Ryu, Y.

2016-12-01

Photosynthesis is a complicated process whose modeling requires different levels of assumptions, simplification, and parameterization. Among models, light use efficiency (LUE) model is highly compact but powerful in monitoring gross primary production (GPP) from satellite data. Most of LUE models adopt a multiplicative from of maximum LUE, absorbed photosynthetically active radiation (APAR), and temperature and water stress functions. However, maximum LUE is a fitting parameter with large spatial variations, but most studies only use several biome dependent constants. In addition, stress functions are empirical and arbitrary in literatures. Moreover, meteorological data used are usually coarse-resolution, e.g., 1°, which could cause large errors. Finally, sunlit and shade canopy have completely different light responses but little considered. Targeting these issues, we derived a new statistical LUE model from a process-based and satellite-driven model, the Breathing Earth System Simulator (BESS). We have already derived a set of global radiation (5-km resolution), carbon and water fluxes (1-km resolution) products from 2000 to 2015 from BESS. By exploring these datasets, we found strong correlation between APAR and GPP for sunlit (R2=0.84) and shade (R2=0.96) canopy, respectively. A simple model, only driven by sunlit and shade APAR, was thus built based on linear relationships. The slopes of the linear function act as effective LUE of global ecosystem, with values of 0.0232 and 0.0128 umol C/umol quanta for sunlit and shade canopy, respectively. When compared with MPI-BGC GPP products, a global proxy of FLUXNET data, BESS-LUE achieved an overall accuracy of R2 = 0.85, whereas original BESS was R2 = 0.83 and MODIS GPP product was R2 = 0.76. We investigated spatiotemporal variations of the effective LUE. Spatially, the ratio of sunlit to shade values ranged from 0.1 (wet tropic) to 4.5 (dry inland). By using maps of sunlit and shade effective LUE the accuracy of

Explaining topic prevalence in answers to open-ended survey questions about climate change

Science.gov (United States)

Tvinnereim, Endre; Fløttum, Kjersti

2015-08-01

Citizens’ opinions are crucial for action on climate change, but are, owing to the complexity of the issue, diverse and potentially unformed. We contribute to the understanding of public views on climate change and to knowledge needed by decision-makers by using a new approach to analyse answers to the open survey question `what comes to mind when you hear the words `climate change’?’. We apply automated text analysis, specifically structural topic modelling, which induces distinct topics based on the relative frequencies of the words used in 2,115 responses. From these data, originating from the new, nationally representative Norwegian Citizen Panel, four distinct topics emerge: Weather/Ice, Future/Impact, Money/Consumption and Attribution. We find that Norwegians emphasize societal aspects of climate change more than do respondents in previous US and UK studies. Furthermore, variables that explain variation in closed questions, such as gender and education, yield different and surprising results when employed to explain variation in what respondents emphasize. Finally, the sharp distinction between scepticism and acceptance of conventional climate science, often seen in previous studies, blurs in many textual responses as scepticism frequently turns into ambivalence.

Resident-to-resident relational aggression and subjective well-being in assisted living facilities.

Science.gov (United States)

Trompetter, Hester; Scholte, Ron; Westerhof, Gerben

2011-01-01

Research in settings similar to assisted living facilities suggests that relational aggression, an indirect and mature form of aggression, might occur in assisted living facilities. This empirical study investigates the existence of relational aggression in a sample of residents and the relationship between relational aggression and resident's subjective well-being. 121 residents from six assisted living facilities completed questionnaires assessing personal experiences as victims of relational aggression and subjective well-being. Also nurses reported on victimization of relational aggression for every participant. Linear regression models were used to examine the association between both reports of relational aggression and subjective well-being. Relational aggression was shown to exist in assisted living facilities according to both residents (prevalence: 19%) and nurses (prevalence: 41%). Chi-square testing revealed no association between ratings by nurses and residents. Self-reports of victimization of relational aggression were related to depression, anxiety, satisfaction with life and social loneliness, but not to emotional loneliness. Nurse-reports of victimization of relational aggression were not related to subjective well-being. Self-reports of relational aggression seem to be better predictors of resident's well-being than nurse-reports of relational aggression. Awareness of these findings and the discrepancy between nurse-reports and self-reports are important for practice and for future research regarding social dynamics and living arrangements in elderly care settings.

Phenotypic Characterization and Multivariate Analysis to Explain Body Conformation in Lesser Known Buffalo (Bubalus bubalis) from North India

Science.gov (United States)

Vohra, V.; Niranjan, S. K.; Mishra, A. K.; Jamuna, V.; Chopra, A.; Sharma, Neelesh; Jeong, Dong Kee

2015-01-01

Phenotypic characterization and body biometric in 13 traits (height at withers, body length, chest girth, paunch girth, ear length, tail length, length of tail up to switch, face length, face width, horn length, circumference of horn at base, distances between pin bone and hip bone) were recorded in 233 adult Gojri buffaloes from Punjab and Himachal Pradesh states of India. Traits were analysed by using varimax rotated principal component analysis (PCA) with Kaiser Normalization to explain body conformation. PCA revealed four components which explained about 70.9% of the total variation. First component described the general body conformation and explained 31.5% of total variation. It was represented by significant positive high loading of height at wither, body length, heart girth, face length and face width. The communality ranged from 0.83 (hip bone distance) to 0.45 (horn length) and unique factors ranged from 0.16 to 0.55 for all these 13 different biometric traits. Present study suggests that first principal component can be used in the evaluation and comparison of body conformation in buffaloes and thus provides an opportunity to distinguish between early and late maturing to adult, based on a small group of biometric traits to explain body conformation in adult buffaloes. PMID:25656215

Problematizing the multidisciplinary residency in oncology: a practical teaching protocol from the perspective of nurse residents

Directory of Open Access Journals (Sweden)

Myllena Cândida de Melo

2014-08-01

Full Text Available Objective: To investigate practical teaching of nurse residents in a multidisciplinary residency in oncology. Method: A qualitative descriptive study grounded in the problematization methodology and its steps, represented by the Maguerez Arch. Data were analyzed using content analysis. Results: Potentiating and limiting elements of the residency guided the design of a practical teaching protocol from the perspective of residents, structured in three stages: Welcoming and ambience; Nursing care for problem situations; and, Evaluation process. Conclusion: Systematization of practical teaching promoted the autonomy of individuals and the approximation of teaching to reality, making residency less strenuous, stressful and distressing.

The Surgical Personality: Does Surgery Resident Motivation Predict Attrition?

Science.gov (United States)

Symer, Matthew M; Abelson, Jonathan S; Yeo, Heather L; Sosa, Julie A; Rosenthal, M Zachary

2018-05-01

There is limited understanding of the wide variation in attrition rates among general surgery residencies. We used the validated Behavior Inhibitory System/Behavior Approach System (BIS/BAS) instrument to compare motivational traits among residents who did and not complete surgical training. All US general surgery categorical interns in the class of 2007-2008 were surveyed with a validated motivational trait assessment tool. American Board of Surgery records from 2008-2016 were used to determine who completed training. Motivation, an aspect of personality, was assessed with the BIS/BAS, which correlates with an individual's tendency to approach pleasant stimuli (BAS) or avoid negative stimuli (BIS). Subscale mean scores were compared with regard to the primary end point, attrition. Eight hundred and one (76.5%) interns completed the survey and had matching records. Six hundred and forty-five (80.5%) completed training. Men had lower scores than women in the BAS Drive subscale (12.0 vs 12.5; p scale (19.3 vs 20.9; p academic 17.3 vs community 17.6 vs military 16.6; p motivational personality traits. Copyright © 2018 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Using stable isotope tracers to assess hydrological flow paths, residence times and landscape influences in a nested mesoscale catchment

Directory of Open Access Journals (Sweden)

P. Rodgers

2005-01-01

Full Text Available δ18O measurements in precipitation and stream waters were used to investigate hydrological flow paths and residence times at nested spatial scales in the mesoscale (233 km2 River Feugh catchment in the northeast of Scotland over the 2001-2002 hydrological year. Precipitation δ18O exhibited strong seasonal variation, which although significantly damped within the catchment, was reflected in stream water at six sampling sites. This allowed δ18O variations to be used to infer the relative influence of soil-derived storm flows with a seasonally variable isotopic signature, and groundwater of apparently more constant isotopic composition. Periodic regression analysis was then used to examine the sub-catchment difference using an exponential flow model to provide indicative estimates of mean stream water residence times, which varied between approximately 3 and 14 months. This showed that the effects of increasing scale on estimated mean stream water residence time was minimal beyond that of the smallest (ca. 1 km2 headwater catchment scale. Instead, the interaction of catchment soil cover and topography appeared to be the dominant controlling influence. Where sub-catchments had extensive peat coverage, responsive hydrological pathways produced seasonally variable δ18O signatures in runoff with short mean residence times (ca. 3 months. In contrast, areas dominated by steeper slopes, more freely draining soils and larger groundwater storage in shallow valley-bottom aquifers, deeper flow paths allow for more effective mixing and damping of δ18O indicating longer residence times (>12 months. These insights from δ18O measurements extend the hydrological understanding of the Feugh catchment gained from previous geochemical tracer studies, and demonstrate the utility of isotope tracers in investigating the interaction of hydrological processes and catchment characteristics at larger spatial scales.

Explaining the Variation in Adoption Rates of the Information Content of Environmental Disclosure

DEFF Research Database (Denmark)

Fallan, Even

2015-01-01

of content, and whether innovation adoption theory might represent important factors of this decision-making process. Design/methodology/approach: - Actual adoption rates of 13 information content categories are computed using content analysis of annual reports for 62 listed companies. Each content category......Purpose: - Corporate management decides what types of environmental information content to disclose/adopt. It is explored whether internal context - decision-makers’ perception of characteristics of the information content - might predict the variation in adoption rates of different types...... is seen as an innovation the company decides to adopt or not. Interviews with management in several companies illustrate the decision process of disclosure, and help predict adoption rates. Predicted and actual adoption rates are compared. Findings: - Adoption rates vary considerably among the 13 types...

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.

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.

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

Variability in working memory performance explained by epistasis vs polygenic scores in the ZNF804A pathway

NARCIS (Netherlands)

Nicodemus, Kristin K.; Hargreaves, April; Morris, Derek; Anney, Richard; Gill, Michael; Corvin, Aiden; Donohoe, Gary; Ripke, Stephan; Sanders, Alan R.; Kendler, Kenneth S.; Levinson, Douglas F.; Sklar, Pamela; Holmans, Peter A.; Lin, Dan-Yu; Duan, Jubao; Ophoff, Roel A.; Andreassen, Ole A.; Scolnick, Edward; Cichon, Sven; St Clair, David; Gurling, Hugh; Werge, Thomas; Rujescu, Dan; Blackwood, Douglas H. R.; Pato, Carlos N.; Malhotra, Anil K.; Purcell, Shaun; Dudbridge, Frank; Neale, Benjamin M.; Rossin, Lizzy; Visscher, Peter M.; Posthuma, Danielle; Ruderfer, Douglas M.; Fanous, Ayman; Stefansson, Hreinn; Steinberg, Stacy; Mowry, Bryan J.; Golimbet, Vera; de Hert, Marc; Jönsson, Erik G.; Bitter, István; Pietiläinen, Olli P. H.; Collier, David A.; Tosato, Sarah; Agartz, Ingrid; Albus, Margot; Alexander, Madeline; Amdur, Richard L.; de Haan, Lieuwe; Linszen, Don H.

2014-01-01

We investigated the variation in neuropsychological function explained by risk alleles at the psychosis susceptibility gene ZNF804A and its interacting partners using single nucleotide polymorphisms (SNPs), polygenic scores, and epistatic analyses. Of particular importance was the relative

Variability in working memory performance explained by epistasis vs polygenic scores in the ZNF804A pathway.

NARCIS (Netherlands)

Nicodemus, K.K.; Hargreaves, A.; Morris, D.; Anney, R.; Gill, M.; Corvin, A.; Posthuma, D.; Donohoe, G.

2014-01-01

IMPORTANCE We investigated the variation in neuropsychological function explained by risk alleles at the psychosis susceptibility gene ZNF804A and its interacting partners using single nucleotide polymorphisms (SNPs), polygenic scores, and epistatic analyses. Of particular importance was the

Latitude of residence and position in time zone are predictors of cancer incidence, cancer mortality, and life expectancy at birth.

Science.gov (United States)

Borisenkov, Mikhail F

2011-03-01

According to the hypothesis of circadian disruption, external factors that disturb the function of the circadian system can raise the risk of malignant neoplasm and reduce life span. Recent work has shown that the functionality of the circadian system is dependent not only on latitude of residence but also on the region's position in the time zone. The purpose of the present research was to examine the influence of latitude and time zone on cancer incidence, cancer mortality, and life expectancy at birth. A stepwise multiple regression analysis was carried out on residents of 59 regions of the European part of the Russian Federation (EPRF) using age-standardized parameters (per 100,000) of cancer incidence (CI), cancer mortality (CM), and life expectancy at birth (LE, yrs) as dependent variables. The geographical coordinates (latitude and position in the time zone) of the regions were used as independent variables, controlling for the level of economic development in the regions. The same analysis was carried out for LE in 31 regions in China. Latitude was the strongest predictor of LE in the EPRF population; it explained 48% and 45% of the variability in LE of women and men, respectively. Position within the time zone accounted for an additional 4% and 3% variability of LE in women and men, respectively. The highest values for LE were observed in the southeast of the EPRF. In China, latitude was not a predictor of LE, whereas position in the time zone explained 15% and 18% of the LE variability in women and men, respectively. The highest values of LE were observed in the eastern regions of China. Both latitude and position within the time zone were predictors for CI and CM of the EPRF population. Latitude was the best predictor of stomach CI and CM; this predictor explained 46% and 50% of the variability, respectively. Position within the time zone was the best predictor of female breast CM; it explained 15% of the variability. In most cases, CI and CM increased

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

Identifying areas of weakness in thoracic surgery residency training: a comparison of the perceptions of residents and program directors.

Science.gov (United States)

Edwards, Janet P; Schofield, Adam; Paolucci, Elizabeth Oddone; Schieman, Colin; Kelly, Elizabeth; Servatyari, Ramin; Dixon, Elijah; Ball, Chad G; Grondin, Sean C

2014-01-01

To identify core thoracic surgery procedures that require increased emphasis during thoracic surgery residency for residents to achieve operative independence and to compare the perspectives of residents and program directors in this regard. A modified Delphi process was used to create a survey that was distributed electronically to all Canadian thoracic surgery residents (12) and program directors (8) addressing the residents' ability to perform 19 core thoracic surgery procedures independently after the completion of residency. Residents were also questioned about the adequacy of their operative exposure to these 19 procedures during their residency training. A descriptive summary including calculations of frequencies and proportions was conducted. The perceptions of the 2 groups were then compared using the Fisher exact test employing a Bonferroni correction. The relationship between residents' operative exposure and their perceived operative ability was explored in the same fashion. The response rate was 100% for residents and program directors. No statistical differences were found between residents' and program directors' perceptions of residents' ability to perform the 19 core procedures independently. Both groups identified lung transplantation, first rib resection, and extrapleural pneumonectomy as procedures for which residents were not adequately prepared to perform independently. Residents' subjective ratings of operative exposure were in good agreement with their reported operative ability for 13 of 19 procedures. This study provides new insight into the perceptions of thoracic surgery residents and their program directors regarding operative ability. This study points to good agreement between residents and program directors regarding residents' surgical capabilities. This study provides information regarding potential weaknesses in thoracic surgery training, which may warrant an examination of the curricula of existing programs as well as a

DETERMINANTS OF SPECIALTY CHOICE OF RESIDENT DOCTORS; CASE STUDY--AMONG RESIDENT DOCTORS IN NIGERIA.

Science.gov (United States)

Osuoji, Roland I; Adebanji, Atinuke; Abdulsalam, Moruf A; Oludara, Mobolaji A; Abolarinwa, Abimbola A

2015-01-01

This study examined medical specialty selection by Nigerian resident doctors using a marketing research approach to determine the selection criteria and the role of perceptions, expected remuneration, and job placement prospects of various specialties in the selection process. Data were from the Community of residents from April 2014 to July 2014. The cohort included 200 residents, but only 171 had complete information. Data were obtained from a cross section of resident doctors in the Lagos State University Teaching Hospital and at the 2014 Ordinary General Meeting of the National Association of Resident Doctors(NARD) where representatives from over 50 Teaching hospitals in Nigeria attended. Using a client behaviour model as a framework, a tripartite questionnaire was designed and administered to residents to deduce information on their knowledge about and interests in various specialties, their opinions of sixteen specialties, and the criteria they used in specialty selection. A total of 171 (85.5%) questionnaires were returned. ln many instances, consistency between selection criteria and perceptions of a specialty were accompanied by interest in pursuing the specialty. Job security, job availability on completion of programme, duration of training and qualifying examinations were highly correlated with p value marketing research concepts for medical specialty selection (Weissmanet al 2012) stipulates that choice of speciality is influenced by criteria and perception. This study shows that job security expected financial remuneration, and examination requirements for qualification are major determinants of the choice of speciality for residents.

Radiology residents' experience with intussusception reduction

International Nuclear Information System (INIS)

Bateni, Cyrus; Stein-Wexler, Rebecca; Wootton-Gorges, Sandra L.; Li, Chin-Shang

2011-01-01

Residents should be exposed to adequate procedural volume to act independently upon completion of training. Informal inquiry led us to question whether residents encounter enough intussusception reductions to become comfortable with the procedure. We sought to determine radiology residents' exposure to intussusception reductions, and whether their experiences vary by region or institution. U.S. radiology residency program directors were asked to encourage their residents to complete a 12-question online survey describing characteristics of their pediatric radiology department, experiences with intussusception reduction, and confidence in their own ability to perform the procedure. Six hundred sixty-four residents responded during the study period. Of those, 308 (46.4%) had not experienced an intussusception reduction, and 228 (34%) had experienced only one or two. Twenty-two percent of fourth-year residents had never experienced an intussusception reduction, and 21% had experienced only one. Among second- through fourth-year residents, only 99 (18.3%) felt confident that they could competently reduce an intussusception (P < 0.0001), and 336 (62.2%) thought they would benefit from a computer-assisted training model simulating intussusception reduction (P < 0.0001). Radiology residents have limited opportunity to learn intussusception reduction and therefore lack confidence. Most think they would benefit from additional training with a computer-simulation model. (orig.)

Neurocritical care education during neurology residency

Science.gov (United States)

Drogan, O.; Manno, E.; Geocadin, R.G.; Ziai, W.

2012-01-01

Objective: Limited information is available regarding the current state of neurocritical care education for neurology residents. The goal of our survey was to assess the need and current state of neurocritical care training for neurology residents. Methods: A survey instrument was developed and, with the support of the American Academy of Neurology, distributed to residency program directors of 132 accredited neurology programs in the United States in 2011. Results: A response rate of 74% (98 of 132) was achieved. A dedicated neuroscience intensive care unit (neuro-ICU) existed in 64%. Fifty-six percent of residency programs offer a dedicated rotation in the neuro-ICU, lasting 4 weeks on average. Where available, the neuro-ICU rotation was required in the vast majority (91%) of programs. Neurology residents' exposure to the fundamental principles of neurocritical care was obtained through a variety of mechanisms. Of program directors, 37% indicated that residents would be interested in performing away rotations in a neuro-ICU. From 2005 to 2010, the number of programs sending at least one resident into a neuro-ICU fellowship increased from 14% to 35%. Conclusions: Despite the expansion of neurocritical care, large proportions of US neurology residents have limited exposure to a neuro-ICU and neurointensivists. Formal training in the principles of neurocritical care may be highly variable. The results of this survey suggest a charge to address the variability of resident education and to develop standardized curricula in neurocritical care for neurology residents. PMID:22573636

The Relationship Between Academic Motivation and Lifelong Learning During Residency: A Study of Psychiatry Residents.

Science.gov (United States)

Sockalingam, Sanjeev; Wiljer, David; Yufe, Shira; Knox, Matthew K; Fefergrad, Mark; Silver, Ivan; Harris, Ilene; Tekian, Ara

2016-10-01

To examine the relationship between lifelong learning (LLL) and academic motivation for residents in a psychiatry residency program, trainee factors that influence LLL, and psychiatry residents' LLL practices. Between December 2014 and February 2015, 105 of 173 (61%) eligible psychiatry residents from the Department of Psychiatry, University of Toronto, completed a questionnaire with three study instruments: an LLL needs assessment survey, the Jefferson Scale of Physician Lifelong Learning (JeffSPLL), and the Academic Motivation Scale (AMS). The AMS included a relative autonomy motivation score (AMS-RAM) measuring the overall level of intrinsic motivation (IM). A significant correlation was observed between JeffSPLL and AMS-RAM scores (r = 0.39, P motivation identification domain (mean difference [M] = 0.38; 95% confidence interval [CI] [0.01, 0.75]; P = .045; d = 0.44) compared with senior residents. Clinician scientist stream (CSS) residents had significantly higher JeffSPLL scores compared with non-CSS residents (M = 3.15; 95% CI [0.52, 5.78]; P = .020; d = 0.57). The use of rigorous measures to study LLL and academic motivation confirmed prior research documenting the positive association between IM and LLL. The results suggest that postgraduate curricula aimed at enhancing IM, for example, through support for learning autonomously, could be beneficial to cultivating LLL in learners.

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...

Single-nucleotide polymorphisms in LPA explain most of the ancestry-specific variation in Lp(a levels in African Americans.

Directory of Open Access Journals (Sweden)

Rahul C Deo

2011-01-01

Full Text Available Lipoprotein(a (Lp(a is an important causal cardiovascular risk factor, with serum Lp(a levels predicting atherosclerotic heart disease and genetic determinants of Lp(a levels showing association with myocardial infarction. Lp(a levels vary widely between populations, with African-derived populations having nearly 2-fold higher Lp(a levels than European Americans. We investigated the genetic basis of this difference in 4464 African Americans from the Jackson Heart Study (JHS using a panel of up to 1447 ancestry informative markers, allowing us to accurately estimate the African ancestry proportion of each individual at each position in the genome. In an unbiased genome-wide admixture scan for frequency-differentiated genetic determinants of Lp(a level, we found a convincing peak (LOD = 13.6 at 6q25.3, which spans the LPA locus. Dense fine-mapping of the LPA locus identified a number of strongly associated, common biallelic SNPs, a subset of which can account for up to 7% of the variation in Lp(a level, as well as >70% of the African-European population differences in Lp(a level. We replicated the association of the most strongly associated SNP, rs9457951 (p = 6 × 10(-22, 27% change in Lp(a per allele, ∼5% of Lp(a variance explained in JHS, in 1,726 African Americans from the Dallas Heart Study and found an even stronger association after adjustment for the kringle(IV repeat copy number. Despite the strong association with Lp(a levels, we find no association of any LPA SNP with incident coronary heart disease in 3,225 African Americans from the Atherosclerosis Risk in Communities Study.

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

Science.gov (United States)

Merchant, Shaila; Hameed, Morad; Melck, Adrienne

2011-12-01

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

A 15-year review of the Stanford Internal Medicine Residency Program: predictors of resident satisfaction and dissatisfaction

Directory of Open Access Journals (Sweden)

Kahn JS

2017-08-01

Full Text Available James S Kahn,1–3 Ronald M Witteles,3,4 Kenneth W Mahaffey,3–5 Sumbul A Desai,2,3 Errol Ozdalga,2,3 Paul A Heidenreich1,3 1Veterans Affairs Palo Alto Health Care System, Palo Alto, 2Division of Primary Care and Population Health, 3Department of Medicine, 4Division of Cardiovascular Medicine, 5Stanford Center for Clinical Research, Stanford University School of Medicine, Stanford, CA, USA Introduction: Satisfaction with training and with educational experiences represents important internal medicine (IM programmatic goals. Graduates from IM residency programs are uniquely poised to provide insights into their educational and training experiences and to assess whether these experiences were satisfactory and relevant to their current employment. Methods: We surveyed former IM residents from the training program held during the years 2000–2015 at the Department of Medicine, Stanford University. The first part of the survey reviewed the IM residency program and the second part sought identifying data regarding gender, race, ethnicity, work, relationships, and financial matters. The primary outcome was satisfaction with the residency experience. Results: Of the 405 individuals who completed the Stanford IM residency program in the study period, we identified 384 (95% former residents with a known email address. Two hundred and one (52% former residents responded to the first part and 185 (48% answered both the parts of the survey. The mean age of the respondents was 36.9 years; 44% were female and the mean time from IM residency was 6.1 (±4.3 years. Fifty-eight percent reported extreme satisfaction with their IM residency experience. Predictors associated with being less than extremely satisfied included insufficient outpatient experience, insufficient international experience, insufficient clinical research experience, and insufficient time spent with family and peers. Conclusion: The residents expressed an overall high satisfaction rate with

Age and Sex Variation In Prevalence Of Chronic Medical Conditions In Older Residents of U.S. Nursing Homes

Science.gov (United States)

Moore, Kelly L.; Boscardin, W. John; Steinman, Michael A.; Schwartz, Janice B.

2012-01-01

OBJECTIVES To investigate patterns in prevalences of chronic medical conditions over the agespan of long-term stay nursing home residents and between the sexes with data from the 2004 National Nursing Home Survey (NNHS). DESIGN Retrospective, cross-sectional study. SETTING U.S. nursing homes. PARTICIPANTS Nationally representative sample comprising 11,788 long-term stay residents (3003 (25%) men and 8785 women) aged 65 years or older. MEASUREMENTS Clinical Classifications Software (CCS) was used to group ICD-9 codes to identify the 20 most prevalent chronic medical conditions. SAS survey procedures were used to account for design effects of stratification and clustering to generate nationally representative estimates of prevalences of medical conditions. RESULTS Average age was 84 y, with women older than men (85 vs. 81, p=0.02) with 67% of women ages 80–95. Women required more ADL assistance. The most frequent chronic medical conditions were hypertension (53, 56%: men, women), dementia (45, 52%), depression (31, 37%), arthritis (26, 35%), diabetes mellitus (26, 23%), gastrointestinal reflux -GERD (23, 23%), atherosclerosis (24, 20%), congestive heart failure -CHF (18, 21%), cerebrovascular disease (24, 19%) and anemia (17, 20%). Sex differences in prevalences existed for all but constipation, GERD, and hypertension. Diabetes, cerebrovascular disease, and lipid disorders decreased with age in men and women. Atrial fibrillation, anemia, arthritis, CHF, and dementia, and thyroid disease increased with age in both men and women. Age-related patterns differed between the sexes for diabetes, hypertension, and Parkinson’s disease. CONCLUSION The profile of chronic medical conditions varies over the agespan of nursing home residents and differs between men and women. This knowledge should guide educational and care efforts in long-term care. PMID:22463062

The energy consumption of households - technical and social explanations of variations; Boligers energiforbrug - sociale og tekniske forklaringer pae forskelle

Energy Technology Data Exchange (ETDEWEB)

Gram-Hansen, K

2003-07-01

It is well known that the amount of energy consumed in different households varies greatly with respect to both heat and electricity. Previous research has focused on either technical or social explanations for this and the social explanations have focused on the big variations between social groups. In contrast to this, the aim of this project has been to explain differences in energy consumption between quite similar households and to seek social and technical explanations. Seven high-dense, low-rise neighbourhoods in the municipality of Albertslund have been investigated. The eco-account of the municipality shows large variations in the level of energy consumption both between households in the same neighbourhood and between the neighbourhoods. Noticeably larger heat consumption was found in neighbourhoods with rented apartments rather than with owner-occupied apartments. On this background the aim of this project has been: To explore technical and social explanations for large variations in energy consumption in similar neighbourhoods; To investigate connections between technical and social explanations; To point to relevant strategies concerning behaviour and lifestyle to reduce energy consumption. To answer these questions several investigations were carried out in the seven neighbourhoods including computer calculations of the buildings' heat loss, a survey among 500 residents, qualitative interviews with ten families and detailed measures of the indoor climate in thirty households. Based on the results the following strategies to reduce energy consumption are formulated: Emphasising positive aspect of a modest life to promote families with a saving attitude to stick to this in spite of societal pressure for increased consumption; Continuing information strategies towards a more environmentally sound behaviour, bur with greater emphasis on reducing consumption than on the attitude towards environment; Concerning new information technologies, technology

The energy consumption of households - technical and social explanations of variations; Boligers energiforbrug - sociale og tekniske forklaringer pae forskelle

Energy Technology Data Exchange (ETDEWEB)

Gram-Hansen, K.

2003-07-01

It is well known that the amount of energy consumed in different households varies greatly with respect to both heat and electricity. Previous research has focused on either technical or social explanations for this and the social explanations have focused on the big variations between social groups. In contrast to this, the aim of this project has been to explain differences in energy consumption between quite similar households and to seek social and technical explanations. Seven high-dense, low-rise neighbourhoods in the municipality of Albertslund have been investigated. The eco-account of the municipality shows large variations in the level of energy consumption both between households in the same neighbourhood and between the neighbourhoods. Noticeably larger heat consumption was found in neighbourhoods with rented apartments rather than with owner-occupied apartments. On this background the aim of this project has been: To explore technical and social explanations for large variations in energy consumption in similar neighbourhoods; To investigate connections between technical and social explanations; To point to relevant strategies concerning behaviour and lifestyle to reduce energy consumption. To answer these questions several investigations were carried out in the seven neighbourhoods including computer calculations of the buildings' heat loss, a survey among 500 residents, qualitative interviews with ten families and detailed measures of the indoor climate in thirty households. Based on the results the following strategies to reduce energy consumption are formulated: Emphasising positive aspect of a modest life to promote families with a saving attitude to stick to this in spite of societal pressure for increased consumption; Continuing information strategies towards a more environmentally sound behaviour, bur with greater emphasis on reducing consumption than on the attitude towards environment; Concerning new information technologies, technology

Costs and clinical quality among Medicare beneficiaries: associations with health center penetration of low-income residents.

Science.gov (United States)

Sharma, Ravi; Lebrun-Harris, Lydie A; Ngo-Metzger, Quyen

2014-01-01

Determine the association between access to primary care by the underserved and Medicare spending and clinical quality across hospital referral regions (HRRs). Data on elderly fee-for-service beneficiaries across 306 HRRs came from CMS' Geographic Variation in Medicare Spending and Utilization database (2010). We merged data on number of health center patients (HRSA's Uniform Data System) and number of low-income residents (American Community Survey). We estimated access to primary care in each HRR by "health center penetration" (health center patients as a proportion of low-income residents). We calculated total Medicare spending (adjusted for population size, local input prices, and health risk). We assessed clinical quality by preventable hospital admissions, hospital readmissions, and emergency department visits. We sorted HRRs by health center penetration rate and compared spending and quality measures between the high- and low-penetration deciles. We also employed linear regressions to estimate spending and quality measures as a function of health center penetration. The high-penetration decile had 9.7% lower Medicare spending ($926 per capita, p=0.01) than the low-penetration decile, and no different clinical quality outcomes. Compared with elderly fee-for-service beneficiaries residing in areas with low-penetration of health center patients among low-income residents, those residing in high-penetration areas may accrue Medicare cost savings. Limited evidence suggests that these savings do not compromise clinical quality.

Impact of adding additional providers to resident workload and the resident experience on a medical consultation rotation.

Science.gov (United States)

Fang, Michele; Linson, Eric; Suneja, Manish; Kuperman, Ethan F

2017-02-22

Excellence in Graduate Medical Education requires the right clinical environment with an appropriate workload where residents have enough patients to gain proficiency in medicine with optimal time for reflection. The Accreditation Council for Graduate Medical Education (ACGME) has focused more on work hours rather than workload; however, high resident workload has been associated with lower resident participation in education and fatigue-related errors. Recognizing the potential risks associated with high resident workload and being mindful of the costs of reducing resident workload, we sought to reduce residents' workload by adding an advanced practice provider (APP) to the surgical comanagement service (SCM) and study its effect on resident satisfaction and perceived educational value of the rotation. In Fiscal Year (FY) 2014 and 2015, an additional faculty member was added to the SCM rotation. In FY 2014, the faculty member was a staff physician, and in FY 2015, the faculty member was an APP.. Resident workload was assessed using billing data. We measured residents' perceptions of the rotation using an anonymous electronic survey tool. We compared FY2014-2015 data to the baseline FY2013. The number of patients seen per resident per day decreased from 8.0(SD 3.3) in FY2013 to 5.0(SD 1.9) in FY2014 (p value of the rotation (40.0%, 72.2%, 72.6% in FY2013, 2014, 2015 respectively, p perceived educational value and clinical experience of a medical consultation rotation.

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.

Using Reflections of Recent Resident Graduates and their Pediatric Colleagues to Evaluate a Residency Program

Directory of Open Access Journals (Sweden)

Robert K. Kamei, M.D.

2003-01-01

Full Text Available Background and Purposes: In response to the new Accreditation Council for Graduate Medical Education (ACGME mandate for residency programs to use feedback to improve its educational program, we piloted a novel evaluation strategy of a residency program using structured interviews of resident graduates working in a primary care practice and their physician associates. Methods: A research assistant performed a structured telephone interview. Quantitative data assessing the graduate’s self-assessment and the graduate’s clinical practice by the associate were analyzed. In addition, we performed a qualitative analysis of the interviews. Results: Thirteen resident graduates in primary care practice and seven physician practice associates participated in the study. Graduate self-assessment revealed high satisfaction with their residency training and competency. The associates judged our graduates as highly competent and mentioned independent decision-making and strong interpersonal skills (such as teamwork and communication as important. They specifically cited the graduate’s skills in intensive care medicine and adolescent medicine as well as communication and teamwork skills as important contributions to their practice. Conclusions: The ACGME Outcomes Project, which increases the emphasis on educational outcomes in the accreditation of residency education programs, requires programs to provide evidence of its effectiveness in preparing residents for practice. Direct assessment of the competency of our physician graduates in practice using structured interviews of graduates and their practice associates provide useful feedback information to a residency program as part of a comprehensive evaluation plan of our program’s curriculum and can be used to direct future educational initiatives of our training program

Perceptions, training experiences, and preferences of surgical residents toward laparoscopic simulation training: a resident survey.

Science.gov (United States)

Shetty, Shohan; Zevin, Boris; Grantcharov, Teodor P; Roberts, Kurt E; Duffy, Andrew J

2014-01-01

Simulation training for surgical residents can shorten learning curves, improve technical skills, and expedite competency. Several studies have shown that skills learned in the simulated environment are transferable to the operating room. Residency programs are trying to incorporate simulation into the resident training curriculum to supplement the hands-on experience gained in the operating room. Despite the availability and proven utility of surgical simulators and simulation laboratories, they are still widely underutilized by surgical trainees. Studies have shown that voluntary use leads to minimal participation in a training curriculum. Although there are several simulation tools, there is no clear evidence of the superiority of one tool over the other in skill acquisition. The purpose of this study was to explore resident perceptions, training experiences, and preferences regarding laparoscopic simulation training. Our goal was to profile resident participation in surgical skills simulation, recognize potential barriers to voluntary simulator use, and identify simulation tools and tasks preferred by residents. Furthermore, this study may help to inform whether mandatory/protected training time, as part of the residents' curriculum is essential to enhance participation in the simulation laboratory. A cross-sectional study on general surgery residents (postgraduate years 1-5) at Yale University School of Medicine and the University of Toronto via an online questionnaire was conducted. Overall, 67 residents completed the survey. The institutional review board approved the methods of the study. Overall, 95.5% of the participants believed that simulation training improved their laparoscopic skills. Most respondents (92.5%) perceived that skills learned during simulation training were transferrable to the operating room. Overall, 56.7% of participants agreed that proficiency in a simulation curriculum should be mandatory before operating room experience. The

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

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.

Pregnancy and the Plastic Surgery Resident.

Science.gov (United States)

Garza, Rebecca M; Weston, Jane S; Furnas, Heather J

2017-01-01

Combining pregnancy with plastic surgery residency has historically been difficult. Two decades ago, 36 percent of plastic surgery program directors surveyed actively discouraged pregnancy among residents, and 33 percent of women plastic surgeons suffered from infertility. Most alarmingly, 26 percent of plastic surgery trainees had had an elective abortion during residency. With increasing numbers of women training in plastic surgery, this historical lack of support for pregnancy deserves further attention. To explore the current accommodations made for the pregnant plastic surgery resident, an electronic survey was sent to 88 plastic surgery program directors in the United States. Fifty-four responded, for a response rate of 61.36 percent. On average, a director trained a total of 7.91 women among 17.28 residents trained over 8.19 years. Of the women residents, 1.43 were pregnant during a director's tenure, with 1.35 of those residents taking maternity leave. An average 1.75 male residents took paternity leave. Approximately one-third of programs had a formal maternity/paternity leave policy (36.54 percent) which, in most cases, was limited to defining allowed weeks of leave, time required to fulfill program requirements, and remuneration during leave. This survey of plastic surgery directors is a first step in defining the challenges training programs face in supporting the pregnant resident. Directors provided comments describing their challenges accommodating an absent resident in a small program and complying with the American Board of Plastic Surgery's required weeks of training per year. A discussion of these challenges is followed by suggested solutions.

A national survey of residents in combined Internal Medicine and Dermatology residency programs: educational experience and future plans.

Science.gov (United States)

Mostaghimi, Arash; Wanat, Karolyn; Crotty, Bradley H; Rosenbach, Misha

2015-10-16

In response to a perceived erosion of medical dermatology, combined internal medicine and dermatology programs (med/derm) programs have been developed that aim to train dermatologists who take care of medically complex patients. Despite the investment in these programs, there is currently no data with regards to the potential impact of these trainees on the dermatology workforce. To determine the experiences, motivations, and future plans of residents in combined med/derm residency programs. We surveyed residents at all United States institutions with both categorical and combined training programs in spring of 2012. Respondents used visual analog scales to rate clinical interests, self-assessed competency, career plans, and challenges. The primary study outcomes were comfort in taking care of patients with complex disease, future practice plans, and experience during residency. Twenty-eight of 31 med/derm residents (87.5%) and 28 of 91 (31%) categorical residents responded (overall response rate 46%). No significant differences were seen in self-assessed dermatology competency, or comfort in performing inpatient consultations, cosmetic procedures, or prescribing systemic agents. A trend toward less comfort in general dermatology was seen among med/derm residents. Med/derm residents were more likely to indicate career preferences for performing inpatient consultation and taking care of medically complex patients. Categorical residents rated their programs and experiences more highly. Med/derm residents have stronger interests in serving medically complex patients. Categorical residents are more likely to have a positive experience during residency. Future work will be needed to ascertain career choices among graduates once data are available.

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.

Pediatric resident perceptions of family-friendly benefits.

Science.gov (United States)

Berkowitz, Carol D; Frintner, Mary Pat; Cull, William L

2010-01-01

The aim of this study was to examine the importance of family-friendly features in residency program selection, benefits offered to and used by residents, and importance of benefits in future job selection. A survey of a random, national sample of 1000 graduating pediatric residents in 2008 was mailed and e-mailed. Survey response rate for graduating resident respondents was 59%. Among the respondents, 76% were women. Thirty-seven percent of men and 32% of women were parents. Residents with children were more likely than residents without children to rate family-friendly characteristics as very important in their residency selection (P maternity leave (88%), paternity leave (59%), individual flexibility with schedule (63%), and lactation rooms (55%), but fewer reported on-site child care (24%), care for ill children (19%), and part-time residency positions (12%). Among residents reporting availability, 77% of women with children used maternity leave and lactation rooms. Few held part-time residency positions (2%), but many expressed interest (23% of women with children). The majority of residents with and without children reported that flexibility with schedule was important in their future job selection. Most women with children (71%) and many women without children (52%) considered part-time work to be very important in their job selection. Family-friendly benefits are important to residents, particularly those with children. The data provides a benchmark for the availability and use of family-friendly features at pediatric training programs. The data also shows that many residents are unaware if benefits are offered, which suggests a need to make available benefits more transparent to residents. Copyright 2010 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Own-wage labor supply elasticities: variation across time and estimation methods

Directory of Open Access Journals (Sweden)

Olivier Bargain

2016-10-01

Full Text Available Abstract There is a huge variation in the size of labor supply elasticities in the literature, which hampers policy analysis. While recent studies show that preference heterogeneity across countries explains little of this variation, we focus on two other important features: observation period and estimation method. We start with a thorough survey of existing evidence for both Western Europe and the USA, over a long period and from different empirical approaches. Then, our meta-analysis attempts to disentangle the role of time changes and estimation methods. We highlight the key role of time changes, documenting the incredible fall in labor supply elasticities since the 1980s not only for the USA but also in the EU. In contrast, we find no compelling evidence that the choice of estimation method explains variation in elasticity estimates. From our analysis, we derive important guidelines for policy simulations.

AN ANALYSIS OF HATCHLING RESTING METABOLISM - IN SEARCH OF ECOLOGICAL CORRELATES THAT EXPLAIN DEVIATIONS FROM ALLOMETRIC RELATIONS

NARCIS (Netherlands)

KLAASSEN, M; DRENT, R

From data in the literature, an allometric equation is compiled for hatchling resting metabolic rate and an attempt is made to explain residual variation in terms of hatchling type, yolk and water content, embryonic and postnatal growth rate, and environmental circumstances (latitudinal

2003 survey of Canadian radiation oncology residents

International Nuclear Information System (INIS)

Yee, Don; Fairchild, Alysa; Keyes, Mira; Butler, Jim; Dundas, George

2005-01-01

Purpose: Radiation oncology's popularity as a career in Canada has surged in the past 5 years. Consequently, resident numbers in Canadian radiation oncology residencies are at all-time highs. This study aimed to survey Canadian radiation oncology residents about their opinions of their specialty and training experiences. Methods and Materials: Residents of Canadian radiation oncology residencies that enroll trainees through the Canadian Resident Matching Service were identified from a national database. Residents were mailed an anonymous survey. Results: Eight of 101 (7.9%) potential respondents were foreign funded. Fifty-two of 101 (51.5%) residents responded. A strong record of graduating its residents was the most important factor residents considered when choosing programs. Satisfaction with their program was expressed by 92.3% of respondents, and 94.3% expressed satisfaction with their specialty. Respondents planning to practice in Canada totaled 80.8%, and 76.9% plan to have academic careers. Respondents identified job availability and receiving adequate teaching from preceptors during residency as their most important concerns. Conclusions: Though most respondents are satisfied with their programs and specialty, job availability and adequate teaching are concerns. In the future, limited time and resources and the continued popularity of radiation oncology as a career will magnify the challenge of training competent radiation oncologists in Canada

Personality matters: individual variation in reactions of naive bird predators to aposematic prey

NARCIS (Netherlands)

Exnerová, A.; Hotova Svadova, K.; Fucikova, E.; Drent, P.; Stys, P.

2010-01-01

Variation in reactions to aposematic prey is common among conspecific individuals of bird predators. It may result from different individual experience but it also exists among naive birds. This variation may possibly be explained by the effect of personality—a complex of correlated, heritable

Parents or predators: Examining intraseasonal variation in nest survival for migratory passerine

Science.gov (United States)

Robin Hirsch-Jacobson; W. Andrew Cox; Emily E. Tewes; Frank R., III Thompson; John. Faaborg

2012-01-01

For birds, risk of nest predation can vary within a breeding season, but few data exist that explain why such variation occurs. We investigated intraseasonal variation of nest survival of the Acadian Flycatcher (Empidonax virescens) in Midwestern forests and tested whether four of the adults' reproductive strategies (clutch size, nest...

Partitioning of genetic variation between regulatory and coding gene segments: the predominance of software variation in genes encoding introvert proteins.

Science.gov (United States)

Mitchison, A

1997-01-01

In considering genetic variation in eukaryotes, a fundamental distinction can be made between variation in regulatory (software) and coding (hardware) gene segments. For quantitative traits the bulk of variation, particularly that near the population mean, appears to reside in regulatory segments. The main exceptions to this rule concern proteins which handle extrinsic substances, here termed extrovert proteins. The immune system includes an unusually large proportion of this exceptional category, but even so its chief source of variation may well be polymorphism in regulatory gene segments. The main evidence for this view emerges from genome scanning for quantitative trait loci (QTL), which in the case of the immune system points to a major contribution of pro-inflammatory cytokine genes. Further support comes from sequencing of major histocompatibility complex (Mhc) class II promoters, where a high level of polymorphism has been detected. These Mhc promoters appear to act, in part at least, by gating the back-signal from T cells into antigen-presenting cells. Both these forms of polymorphism are likely to be sustained by the need for flexibility in the immune response. Future work on promoter polymorphism is likely to benefit from the input from genome informatics.

Regional variations in breast cancer among california teachers.

Science.gov (United States)

Reynolds, Peggy; Hurley, Susan; Goldberg, Debbie E; Anton-Culver, Hoda; Bernstein, Leslie; Deapen, Dennis; Horn-Ross, Pamela L; Peel, David; Pinder, Richard; Ross, Ronald K; West, Dee; Wright, William E; Ziogas, Argyrios

2004-11-01

Observed regional differences in breast cancer incidence could provide valuable clues to the etiology of this disease. The pattern of historically higher breast cancer rates among residents of California's San Francisco Bay and Southern Coastal areas is evident in the disease experience among members of the California Teachers Study. This large cohort study has followed female professional school employees for cancer incidence since 1995 and has collected extensive information on breast cancer risk factors. Between 1996 and 1999, invasive breast cancer was diagnosed in 1562 of the 115,611 cohort members who could be geocoded to a California address in 1995 and who had no previous breast cancer diagnosis. Adjusted hazard rate ratios (HRs) were estimated through multivariate Cox proportional hazards modeling. Rates were higher for cohort members in the San Francisco Bay area (HR = 1.22; 95% confidence interval = 1.06-1.40) and Southern Coastal area (1.16; 1.04-1.30) compared with those in the rest of California. The distributions of variables representing socioeconomic status, urbanization, and personal risk factors were consistent with higher risks for cohort members residing in the San Francisco Bay and Southern Coastal areas. Adjustment for these factors, however, did not explain regional differences in incidence, resulting in HRs that remained elevated for these 2 areas. Regional differences in breast cancer incidence in this large, well-defined cohort are not easily explained by known risk factors.

Variation in Women's Preferences Regarding Male Facial Masculinity Is Better Explained by Genetic Differences Than by Previously Identified Context-Dependent Effects.

Science.gov (United States)

Zietsch, Brendan P; Lee, Anthony J; Sherlock, James M; Jern, Patrick

2015-09-01

Women's preferences for masculine versus feminine male faces are highly variable. According to a dominant theory in evolutionary psychology, this variability results from adaptations that optimize preferences by calibrating them to certain contextual factors, including women's self-perceived attractiveness, short- versus long-term relationship orientation, pathogen disgust sensitivity, and stage of the menstrual cycle. The theory does not account for the possible contribution of genetic variation on women's facial masculinity preference. Using a large sample (N = 2,160) of identical and nonidentical female Finnish twins and their siblings, we showed that the proportion of variation in women's preferences regarding male facial masculinity that was attributable to genetic variation (38%) dwarfed the variation due to the combined effect of contextual factors (< 1%). These findings cast doubt on the importance of these context-dependent effects and may suggest a need for refocusing in the field toward understanding the wide genetic variation in these preferences and how this variation relates to the evolution of sexual dimorphism in faces. © The Author(s) 2015.

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.

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

Preparing Residents for Teaching Careers: The Faculty for Tomorrow Resident Workshop.

Science.gov (United States)

Lin, Steven; Gordon, Paul

2017-03-01

Progress toward growing the primary care workforce is at risk of being derailed by an emerging crisis: a critical shortage of family medicine faculty. In response to the faculty shortage, the Society of Teachers of Family Medicine (STFM) launched a 2-year initiative called "Faculty for Tomorrow" (F4T). The F4T Task Force created a workshop designed to increase residents' interest in, and prepare them for, careers in academic family medicine. We aimed to evaluate the effectiveness of this workshop. Participants were family medicine residents who preregistered for and attended the F4T Resident Workshop at the 2016 STFM Annual Spring Conference. The intervention was a full-day, 9-hour preconference workshop delivered by a multi-institutional faculty team. Participants were asked to complete a questionnaire before and immediately after the workshop. Data collected included demographics, residency program characteristics, future career plans, self-reported confidence in skills, and general knowledge relevant to becoming faculty. A total of 75 participants attended the workshop. The proportion of those who were "extremely likely" to pursue a career in academic family medicine increased from 58% to 72%. Participants reported statistically significant improvements in their confidence in clinical teaching, providing feedback to learners, writing an effective CV, knowledge about the structure of academic family medicine, and knowledge about applying for a faculty position. The STFM F4T Resident Workshop was effective at increasing participants' interest in academic careers, as well as self-reported confidence in skills and knowledge relevant to becoming faculty. The data collected from participants regarding their career plans may inform future interventions.

Ophthalmology resident surgical competency: a national survey.

Science.gov (United States)

Binenbaum, Gil; Volpe, Nicholas J

2006-07-01

To describe the prevalence, management, and career outcomes of ophthalmology residents who struggle with surgical competency and to explore related educational issues. Fourteen-question written survey. Fifty-eight program directors at Accreditation Council on Graduate Medical Education-accredited, United States ophthalmology residency programs, representing a total of 2179 resident graduates, between 1991 and 2000. Study participants completed a mailed, anonymous survey whose format combined multiple choice and free comment questions. Number of surgically challenged residents, types of problems identified, types of remediation, final departmental decision at the end of residency, known career outcomes, and residency program use of microsurgical skills laboratories and applicant screening tests. One hundred ninety-nine residents (9% overall; 10% mean per program) were labeled as having trouble mastering surgical skills. All of the programs except 2 had encountered such residents. The most frequently cited problems were poor hand-eye coordination (24%) and poor intraoperative judgment (22%). Most programs were supportive and used educational rather than punitive measures, the most common being extra practice-laboratory time (32%), scheduling cases with the best teaching surgeon (23%), and counseling (21%). Nearly one third (31%) of residents were believed to have overcome their difficulties before graduation. Other residents were encouraged to pursue medical ophthalmology (22%) or to obtain further surgical training through a fellowship (21%) or a supervised practice setting (12%); these residents were granted a departmental statement of satisfactory completion of residency for Board eligibility. Twelve percent were asked to leave residency. Of reported career outcomes, 92% of residents were practicing ophthalmology, 65% as surgical and 27% as medical ophthalmologists. Ninety-eight percent of residency programs had microsurgical practice facilities, 64% had a formal

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.

Emergency oil stocks in Southeastern and Eastern Europe: What explains variation in convergence towards the EU model?

International Nuclear Information System (INIS)

Tosun, Jale

2012-01-01

The accumulation and maintenance of emergency oil stocks in accordance with the requirements of the European Union involve changes in legislation, the strengthening of national stockholding institutions and the attraction of investment. Despite these challenges, almost all Southeastern and Eastern European countries have begun to align their oil stockholding arrangements with the European model, albeit there is variation in the actual degree of convergence. The greatest convergence is observed for Croatia and the Former Yugoslav Republic of Macedonia. In marked contrast, the oil stockholding system of Moldova continues to be different from the European model. This study provides an overview of the Southeastern and Eastern European countries’ progress in approximating the European requirements for emergency oil stocks and identifies the factors responsible for the cross-country variation. The differences observed stem from the extent to which the countries are legally obliged to comply with the European provisions, their membership aspirations, levels of energy-related investment from the European Union, and dependence on oil imports. - Highlights: ► Southeastern and Eastern European countries are approaching the European stockholding model. ► Croatia and Macedonia demonstrate the highest degree of convergence. ► Moldova displays the greatest distance to the European model. ► Variation in convergence is determined by legal obligation, membership aspiration, investment and dependence on oil.

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

Science.gov (United States)

Swary, Jillian Havey; Stratman, Erik J

2014-07-01

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

Feasibility and Benefit of Incorporating a Multimedia Cadaver Laboratory Training Program into a Didactics Curriculum for Junior and Senior Surgical Residents.

Science.gov (United States)

Simmerman, Erika; Simmerman, Andrew; Lassiter, Randi; King, Ray; Ham, Ben; Adam, Bao-Ling; Ferdinand, Colville; Holsten, Steven

2018-04-17

As operative experience in general surgery decreases and work hour limitations increase there is less exposure of surgical residents to advanced vascular and trauma exposures. Many institutions have demonstrated benefits of cadaver laboratory courses. We have incorporated a multimedia cadaver laboratory course into our general surgery residency didactics curriculum with the objective to demonstrate a benefit of the program as well as the feasibility of incorporation. This is a prospective study at a tertiary care institution including general surgery residents within our residency program. A curriculum was designed, requiring residents to complete multimedia learning modules before both a trauma cadaver laboratory and vascular exposure cadaver laboratory. Outcome measures included self-efficacy/confidence (precourse and postcourse 5-point Likert surveys), knowledge (net performance on precourse and postcourse multiple choice examinations), and resident perception of the curriculum (postcourse 5-point Likert survey). Data were analyzed using ANOVA paired t-tests. For the vascular cadaver laboratory, resident knowledge improved overall from an average of 41.2% to 50.0% of questions correct (p = 0.032) and self-efficacy/confidence improved by 0.59 from 1.52 to 2.11 out of 5 (p = 0.009). Median confidence is 1.37 out of 5 and 2.32 out of 5, before and after course, respectively. Wilcoxon nonparametric test reveals a p = 0.011. Resident's perception of the usefulness of the laboratory evaluation was 3.85 out 5. There were 85.71% agreed that the laboratory is useful and 14.29% were disagree. The Z-score is -0.1579 (means 0.1579 standard deviations a score of 3.85 below the benchmark). The percentile rank is 56.27%. The coefficient of variation is 24.68%. For the trauma cadaver laboratory, resident knowledge improved overall from an average of 55.89% to 66.17% of questions correct (p = 0.001) and self-efficacy/confidence improved by 0.75 from 1.68 out of 5 to 2.43 out of

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...

Motherhood during residency training: challenges and strategies.

Science.gov (United States)

Walsh, Allyn; Gold, Michelle; Jensen, Phyllis; Jedrzkiewicz, Michelle

2005-07-01

To determine what factors enable or impede women in a Canadian family medicine residency program from combining motherhood with residency training. To determine how policies can support these women, given that in recent decades the number of female family medicine residents has increased. Qualitative study using in-person interviews. McMaster University Family Medicine Residency Program. Twenty-one of 27 family medicine residents taking maternity leave between 1994 and 1999. Semistructured interviews. The research team reviewed transcripts of audiotaped interviews for emerging themes; consensus was reached on content and meaning. NVIVO software was used for data analysis. Long hours, unpredictable work demands, guilt because absences from work increase workload for colleagues, and residents' high expectations of themselves cause pregnant residents severe stress. This stress continues upon return to work; finding adequate child care is an added stress. Residents report receiving less support from colleagues and supervisors upon return to work; they associate this with no longer being visibly pregnant. Physically demanding training rotations put additional strain on pregnant residents and those newly returned to work. Flexibility in scheduling rotations can help accommodate needs at home. Providing breaks, privacy, and refrigerators at work can help maintain breastfeeding. Allowing residents to remain involved in academic and clinical work during maternity leave helps maintain clinical skills, build new knowledge, and promote peer support. Pregnancy during residency training is common and becoming more common. Training programs can successfully enhance the experience of motherhood during residency by providing flexibility at work to facilitate a healthy balance among the competing demands of family, work, and student life.

Remediation of problematic residents--A national survey.

Science.gov (United States)

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

2016-04-01

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

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

Directory of Open Access Journals (Sweden)

Emura Sei SE

2011-09-01

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

Personal finances of residents at three Canadian universities.

Science.gov (United States)

Teichman, Joel M H; Matsumoto, Edward; Smart, Michael; Smith, Aspen E; Tongco, Wayne; Hosking, Denis E; MacNeily, Andrew E; Jewett, Michael A S

2005-02-01

To address 3 research questions (What financial choices do residents make? Are the financial choices of residents similar to those of the general public? Are the financial choices of surgical residents reasonable?), we examined financial data from Canadian residents. A written survey was administered to 338 residents (103 of them surgical residents) at 3 Canadian training institutions (University of Toronto, Queen's University and University of Manitoba). Resident household cash flows, assets and liabilities were characterized. Finances for residents were compared with those of the general public, by means of the Survey of Household Spending and Survey of Financial Security. Median resident income was 45,000 dollars annually (Can dollars throughout). With a working spouse, median household income was 87,500 dollars. Among residents, 62% had educational debt (median 37,500 dollars), 39% maintained unpaid credit-card balances (median 1750 dollars), 36% did not budget expenses, 25% maintained cash reserves card debts (39% v. 50%, respectively). Surgical residents had income expectations after graduation higher than current billings justified. Fewer surgical (69%) than anesthesiology residents (88%, p card debts. Surgical residents' expectations of future income may be unrealistic. Further study is warranted.

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...

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

Science.gov (United States)

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

2015-01-01

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

Preparedness of Entering Pediatric Dentistry Residents: Advanced Pediatric Program Directors' and First-Year Residents' Perspectives.

Science.gov (United States)

Rutkauskas, John; Seale, N Sue; Casamassimo, Paul; Rutkauskas, John S

2015-11-01

For children to receive needed oral health care, adequate training at both the predoctoral and postdoctoral levels of dental education is required, but previous studies have found inadequacies in predoctoral education that lead to general dentists' unwillingness to treat certain young populations. As another way of assessing predoctoral preparation, the aim of this study was to determine the perspectives of first-year residents and pediatric program directors about residents' preparedness to enter advanced education programs in pediatric dentistry. Surveys were sent to all 74 U.S. program directors and 360 first-year residents. The survey focused on procedures related to prevention, behavior management, restorative procedures, pulp therapy, sedation, and surgery, as well as treating patients funded by Medicaid and with special health care needs. Among the first-year residents, 173 surveys were returned for a 48% response rate; 61 directors returned surveys for an 82% response rate. Only half of the residents (55%) reported feeling adequately prepared for their first year in residency; less than half cited adequate preparation to place stainless steel crowns (SSCs) (42%) and perform pulpotomies (45%). Far fewer felt adequately prepared to provide treatment for children six months to three years of age, including examinations (29%), infant oral exams (27%), and children with severe caries (37%). The program directors were even less positive about the adequacy of residents' preparation. Only 17% deemed them adequately prepared to place SSCs and 13% to perform pulpotomies. Approximately half reported their first-year residents were inadequately prepared to treat very young children and children with severe caries (55% each). This study found that the perceived inadequacy of predoctoral education in pediatric dentistry was consistent at both the learner and educator levels, supporting previous studies identifying inadequacies in this area.

Resident cross-cultural training, satisfaction, and preparedness.

Science.gov (United States)

Frintner, Mary Pat; Mendoza, Fernando S; Dreyer, Benard P; Cull, William L; Laraque, Danielle

2013-01-01

To describe the diversity of pediatric residents and examine relationships of cross-cultural training experiences with training satisfaction, perceived preparedness for providing culturally effective care, and attitudes surrounding care for underserved populations. A cross-sectional survey was conducted of a national random sample of graduating pediatric residents and an additional sample of minority residents. Using weighted analysis, we used multivariate regression to test for differences in satisfaction, preparedness, and attitudes between residents with more and less cross-cultural experiences during residency, controlling for residents' characteristics and experiences before training. The survey response rate was 57%. Eleven percent were Hispanic, 61% white, 21% Asian, 9% African American, 9% other racial/ethnic groups; 34% grew up in a bi- or multilingual family. Ninety-three percent of residents were satisfied with their residency training, 81% with the instruction they received on health and health care disparities, and 54% on global health issues. Ninety-six percent of residents felt they were prepared to care for patients from diverse backgrounds, but fewer felt prepared to care for families with beliefs at odds with Western medicine (49%) and families who receive alternative or complementary care (37%). Residents with more cross-cultural experiences during residency reported being better prepared than those with less experience to care for families with limited English proficiency (adjusted odds ratio [aOR] 2.11; 95% confidence interval [CI] 1.40-3.17), new immigrants (aOR 1.91; 95% CI 1.32-2.75), and with religious beliefs that might affect clinical care (aOR 1.62; 95% CI 1.13-2.32). Pediatric residents begin their training with diverse cross-cultural backgrounds and experiences. Residency experiences in cross-cultural care contribute to feelings of preparedness to care for diverse US children. Copyright © 2013 Academic Pediatric Association. Published

Tracking Residents Through Multiple Residency Programs: A Different Approach for Measuring Residents' Rates of Continuing Graduate Medical Education in ACGME-Accredited Programs.

Science.gov (United States)

Byrne, Lauren M; Holt, Kathleen D; Richter, Thomas; Miller, Rebecca S; Nasca, Thomas J

2010-12-01

Increased focus on the number and type of physicians delivering health care in the United States necessitates a better understanding of changes in graduate medical education (GME). Data collected by the Accreditation Council for Graduate Medical Education (ACGME) allow longitudinal tracking of residents, revealing the number and type of residents who continue GME following completion of an initial residency. We examined trends in the percent of graduates pursuing additional clinical education following graduation from ACGME-accredited pipeline specialty programs (specialties leading to initial board certification). Using data collected annually by the ACGME, we tracked residents graduating from ACGME-accredited pipeline specialty programs between academic year (AY) 2002-2003 and AY 2006-2007 and those pursuing additional ACGME-accredited training within 2 years. We examined changes in the number of graduates and the percent of graduates continuing GME by specialty, by type of medical school, and overall. The number of pipeline specialty graduates increased by 1171 (5.3%) between AY 2002-2003 and AY 2006-2007. During the same period, the number of graduates pursuing additional GME increased by 1059 (16.7%). The overall rate of continuing GME increased each year, from 28.5% (6331/22229) in AY 2002-2003 to 31.6% (7390/23400) in AY 2006-2007. Rates differed by specialty and for US medical school graduates (26.4% [3896/14752] in AY 2002-2003 to 31.6% [4718/14941] in AY 2006-2007) versus international medical graduates (35.2% [2118/6023] to 33.8% [2246/6647]). The number of graduates and the rate of continuing GME increased from AY 2002-2003 to AY 2006-2007. Our findings show a recent increase in the rate of continued training for US medical school graduates compared to international medical graduates. Our results differ from previously reported rates of subspecialization in the literature. Tracking individual residents through residency and fellowship programs provides

Leaf density explains variation in leaf mass per area in rice between cultivars and nitrogen treatments.

Science.gov (United States)

Xiong, Dongliang; Wang, Dan; Liu, Xi; Peng, Shaobing; Huang, Jianliang; Li, Yong

2016-05-01

Leaf mass per area (LMA) is an important leaf trait; however, correlations between LMA and leaf anatomical features and photosynthesis have not been fully investigated, especially in cereal crops. The objectives of this study were (a) to investigate the correlations between LMA and leaf anatomical traits; and (b) to clarify the response of LMA to nitrogen supply and its effect on photosynthetic nitrogen use efficiency (PNUE). In the present study, 11 rice varieties were pot grown under sufficient nitrogen (SN) conditions, and four selected rice cultivars were grown under low nitrogen (LN) conditions. Leaf anatomical traits, gas exchange and leaf N content were measured. There was large variation in LMA across selected rice varieties. Regression analysis showed that the variation in LMA was more closely related to leaf density (LD) than to leaf thickness (LT). LMA was positively related to the percentage of mesophyll tissue area (%mesophyll), negatively related to the percentage of epidermis tissue area (%epidermis) and unrelated to the percentage of vascular tissue area (%vascular). The response of LMA to N supplementation was dependent on the variety and was also mainly determined by the response of LD to N. Compared with SN, photosynthesis was significantly decreased under LN, while PNUE was increased. The increase in PNUE was more critical in rice cultivars with a higher LMA under SN supply. Leaf density is the major cause of the variation in LMA across rice varieties and N treatments, and an increase in LMA under high N conditions would aggravate the decrease in PNUE. © The Author 2016. Published by Oxford University Press on behalf of the Annals of Botany Company. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

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, ...

Temporal variation of 228Ra in the near-surface Gulf of Mexico

International Nuclear Information System (INIS)

Reid, F.D.; Moore, W.S.; Sackett, W.M.

1979-01-01

The Mn-fiber technique for extracting radium from seawater has proved useful for studying the marine geochemistry of 228 Ra. In the Gulf of Mexico, this technique was used to measure the surface and near-surface distribution of 226 Ra and 228 Ra. The observed surface distribution of 228 Ra, and particularly the radium activity ratio (228/226) can be explained by known circulation patterns, or, when local surface currents are not well understood, may provide insight into their general characteristics. The radium activity ratio has increased from 0.5 in 1968 to 0.7 in 1973 in the surface Gulf of Mexico. This observed increase cannot be attributed to known anthropogenic or natural source perturbations within the Caribbean Sea-Gulf of Mexico system. Possible causes include a change in the residence time for near-surface water, or variations in the relative dominance of the two eastern Caribbean; the North Equatorial Current and the Guiana Current. The temporal distribution of 228 Ra is unstable and naturally variable over a time period less than or equal to five years in the Gulf of Mexico and by extrapolation, the Caribbean Sea. Therefore, its usefulness in calculations of eddy diffusion coefficients for these regions is greatly diminished. (Auth.)

Screening mammography among nursing home residents in the United States: Current guidelines and practice.

Science.gov (United States)

Mack, Deborah S; Epstein, Mara M; Dubé, Catherine; Clark, Robin E; Lapane, Kate L

2018-06-04

United States (US) guidelines regarding when to stop routine breast cancer screening remain unclear. No national studies to-date have evaluated the use of screening mammography among US long-stay nursing home residents. This cross-sectional study was designed to identify prevalence, predictors, and geographic variation of screening mammography among that population in the context of current US guidelines. Screening mammography prevalence, identified with Physician/Supplier Part B claims and stratified by guideline age classification (65-74, ≥75 years), was estimated for all women aged ≥65 years residing in US Medicare- and Medicaid- certified nursing homes (≥1 year) with an annual Minimum Data Set (MDS) 3.0 assessment, continuous Medicare Part B enrollment, and no clinical indication for screening mammography as of 2011 (n = 389,821). The associations between resident- and regional- level factors, and screening mammography, were estimated by crude and adjusted prevalence ratios from robust Poisson regressions clustered by facility. Women on average were 85.4 (standard deviation ±8.1) years old, 77.9% were disabled, and 76.3% cognitively impaired. Screening mammography prevalence was 7.1% among those aged 65-74 years (95% Confidence Interval (CI): 6.8%-7.3%) and 1.7% among those ≥75 years (95% CI, 1.7%-1.8%), with geographic variation observed. Predictors of screening in both age groups included race, cognitive impairment, frailty, hospice, and some comorbidities. These results shed light on the current screening mammography practices in US nursing homes. Thoughtful consideration about individual screening recommendations and the implementation of more clear guidelines for this special population are warranted to prevent overscreening. Copyright © 2018 Elsevier Inc. All rights reserved.

Somatic mutation in peripheral blood lymphocytes among Metro Manila residents: indicator of exposure to environmental pollution

International Nuclear Information System (INIS)

Yulo-Nazarea, Teresa; Cobar, Ma. Lucia C.; Nato, Alejandro Q.; Nazarea, Apolinario D.

2001-01-01

Results of a four-year study on somatic mutation in peripheral blood lymphocytes among Metro Manila residents as an indicator of exposure to environmental pollution conducted by the Philippine Nuclear Research Institute (PNRI) is presented. The study which involves mutation indexing of 200 blood donors demonstrated very strong correlation between high levels of ambient air pollution and increase incidence of mutation at the specific gene locus in peripheral blood lymphocytes among residents of specific areas in Metro Manila. Using the PNRI adapted protocol to determine incidence of mutation at a specific gene marker, hypoxanthine guanine phosphoribosyl transferase (HGPRT), our database analysis indicated a statistically significant difference between mean mutation index of blood donors residing in an area with lower level of pollution (Las Pinas) compared to those residents living in areas with the highest estimated pollution level (Valenzuela). The results of the statistical analyses should provide regulators the direction in incorporating the data into their pollution abatement program to maximize health impact. Biomarker analysis should play a greater role in the future in the formulation of national environment policies. The temporal variation of these ''aseline data'' as the Philippine moves forward through the next several years in its industrialization program should in itself be a very valuable source of environmental policy instruments. (Author)

The characteristics of a good clinical teacher as perceived by resident physicians in Japan: a qualitative study.

Science.gov (United States)

Kikukawa, Makoto; Nabeta, Hiromi; Ono, Maiko; Emura, Sei; Oda, Yasutomo; Koizumi, Shunzo; Sakemi, Takanobu

2013-07-25

It is not known whether the characteristics of a good clinical teacher as perceived by resident physicians are the same in Western countries as in non-Western countries including Japan. The objective of this study was to identify the characteristics of a good clinical teacher as perceived by resident physicians in Japan, a non-Western country, and to compare the results with those obtained in Western countries. Data for this qualitative research were collected using semi-structured focus group interviews. Focus group transcripts were independently analyzed and coded by three authors. Residents were recruited by maximum variation sampling until thematic saturation was achieved. Twenty-three residents participated in five focus group interviews regarding the perceived characteristics of a good clinical teacher in Japan. The 197 descriptions of characteristics that were identified were grouped into 30 themes. The most commonly identified theme was "provided sufficient support", followed by "presented residents with chances to think", "provided feedback", and "provided specific indications of areas needing improvement". Using Sutkin's main categories (teacher, physician, and human characteristics), 24 of the 30 themes were categorized as teacher characteristics, 6 as physician characteristics, and none as human characteristics. "Medical knowledge" of teachers was not identified as a concern of residents, and "clinical competence of teachers" was not emphasized, whereas these were the two most commonly recorded themes in Sutkin's study. Our results suggest that Japanese and Western resident physicians place emphasis on different characteristics of their teachers. We speculate that such perceptions are influenced by educational systems, educational settings, and culture. Globalization of medical education is important, but it is also important to consider differences in educational systems, local settings, and culture when evaluating clinical teachers.

The association of neuropsychiatric symptoms and environment with quality of life in assisted living residents with dementia.

Science.gov (United States)

Samus, Quincy M; Rosenblatt, Adam; Steele, Cynthia; Baker, Alva; Harper, Michael; Brandt, Jason; Mayer, Lawrence; Rabins, Peter V; Lyketsos, Constantine G

2005-10-01

We conducted this study to determine whether neuropsychiatric symptoms and environmental characteristics are associated with quality of life in assisted living residents with dementia. We used a cross-sectional study of 134 residents from 22 facilities and employed the Alzheimer's Disease-Related Quality of Life Scale and the Neuropsychiatric Inventory. A scale was developed to capture the homelike climate of each facility. Linear regression analyses were used to estimate the relationship of neuropsychiatric symptoms and homelike climate with quality of life, controlling for sociodemographics, cognition, functional dependence, and physical health. Exploratory analyses and graphical techniques were employed to test for environmental-level moderating effects. Agitation, depression, apathy, and irritability were significant predictors of quality of life, explaining 29% of the variance. Neither facility size nor homelike environment was significantly associated with quality of life in univariate analyses. Size of facility moderated the relationship between agitation and quality of life. Neuropsychiatric symptoms impair quality of life in residents with dementia. Further research should investigate the role of other environmental aspects.

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.