A MEPS is a MEPS is a MEPS. Comparing Ecodesign and Top Runner schemes for setting product efficiency standards

Energy Technology Data Exchange (ETDEWEB)

Siderius, P.J.S. [NL Agency, Croeselaan 15, P.O. Box 8242, 3503 RE Utrecht (Netherlands); Nakagami, H. [Jyukankyo Research Institute, 3-29, Kioi-cho, Chiyoda-ku Tokyo, 102-0094 (Japan)

2013-02-15

Both Top Runner in Japan and Ecodesign in the European Union are schemes to set requirements on the energy efficiency (minimum efficiency performance standards, MEPS) of a variety of products. This article provides an overview of the main characteristics and results of both schemes and gives recommendations for improving them. Both schemes contribute significantly to the energy efficiency targets set by the European Commission and the Japanese government. Although it is difficult to compare the absolute levels of the requirements, comparison of the relative improvements and of the savings on household electricity consumption (11 % in Japan, 16 % in the EU) suggest they are in the same range. Furthermore, the time needed to set or review requirements is in both schemes considerable (between 5 and 6 years on average) and the manageability increasingly will become a challenge. The appeal of the Top Runner approach is that the most efficient product (Top Runner) sets the standard for all products at the next target year. Although the Ecodesign scheme includes the elements for a Top Runner approach, it could exploit this principle more explicitly. On the other hand, the Top Runner scheme could benefit by using a real minimum efficiency performance standard instead of a fleet average. This would make the monitoring and enforcement more simple and transparent, and would open the scheme for products where the market situation is less clear.

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

Science.gov (United States)

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

2014-07-01

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

Preoperative learning goals set by surgical residents and faculty.

Science.gov (United States)

Pernar, Luise I M; Breen, Elizabeth; Ashley, Stanley W; Peyre, Sarah E

2011-09-01

The operating room (OR) remains the main teaching venue for surgical trainees. The OR is considered a pure-discovery learning environment; the downsides of this can be putatively overcome when faculty and trainee arrive at a shared understanding of learning. This study aimed to better understand preoperative learning goals to identify areas of commonalities and potential barrier to intraoperative teaching. Brief, structured preoperative interviews were conducted outside the OR with the resident and faculty member who were scheduled to operate together. Answers were analyzed and grouped using grounded theory. Twenty-seven resident-faculty pairs were interviewed. Nine residents (33.3%) were junior (PGY 1 and 2) and 18 (66.7%) were senior (PGY 3 through 5). Learning goal categories that emerged from the response analysis were anatomy, basic and advanced surgical skills, general and specific procedural tasks, technical autonomy, and pre-, intra-, and postoperative considerations. Residents articulated fewer learning goals than faculty (1.5 versus 2.4; P = 0.024). The most frequently identified learning goal by both groups was one classifiable under general procedural tasks; the greatest divergence was seen regarding perioperative considerations, which were identified frequently by faculty members but rarely by residents. Faculty articulate significantly more learning goals for the residents they will operate with than residents articulate for themselves. Our data suggest that residents and faculty align on some learning goals for the OR but residents tend to be more limited, focusing predominantly on technical aspects of the operation. Faculty members tend to hold a broader view of the learning potential of the OR. These discrepancies may present barriers to effective intraoperative teaching. Copyright © 2011 Elsevier Inc. All rights reserved.

Resident and Facility Factors Associated With the Incidence of Urinary Tract Infections Identified in the Nursing Home Minimum Data Set.

Science.gov (United States)

Castle, Nicholas; Engberg, John B; Wagner, Laura M; Handler, Steven

2017-02-01

This research examined resident and facility-specific factors associated with a diagnosis of a urinary tract infection (UTI) in the nursing home setting. Minimum Data Set and Online Survey, Certification and Reporting system data were used to identify all nursing home residents in the United States on April 1, 2006, who did not have a UTI ( n = 1,138,418). Residents were followed until they contracted a UTI (9.5%), died (8.3%), left the nursing home (33.2%), or the year ended (49.0%). A Cox proportional hazards model was estimated, controlling for resident and facility characteristics and for the state of residence. The presence of an indwelling catheter was the primary predictor of whether a resident contracted a UTI (adjusted incidence ratio = 3.35, p factors such as percentage of Medicaid residents, for-profit, and chain status was less significant. Estimates regarding staffing levels indicate that increased contact hours with more highly educated nursing staff are associated with less catheter use. Several facility-specific risk factors are of significance. Of significance, UTIs may be reduced by modifying factors such as staffing levels.

Voltage protection scheme for MG sets used to drive inductive energy storage systems

International Nuclear Information System (INIS)

Campen, G.L.; Easter, R.B.

1977-01-01

A recent tokamak proposal at ORNL called for MG (motor-generator) sets to drive the ohmic heating (OH] coil, which was to be subjected to 20 kV immediately after coil charge-up to initiate the experiment. Since most rotating machinery is inherently low voltage, including the machines available at ORNL, a mechanism was necessary to isolate the generators from the high voltage portions of the circuit before the appearance of this voltage. It is not the expected 20 kV at the coil that causes difficulty, because the main interrupting switch handles this. The voltage induced in the armature due to di/dt and the possibility of faults are the greatest causes for concern and are responsible for the complexity of the voltage protection scheme, which must accommodate any possible combination of fault time and location. Such a protection scheme is presented in this paper

Secondhand Smoke Exposure and Smoke-Free Policy Support Among Public Housing Authority Residents in Rural and Tribal Settings.

Science.gov (United States)

Schmidt, Lisa M; Reidmohr, Alison A; Helgerson, Steven D; Harwell, Todd S

2016-12-01

Previous research has shown that multi-unit housing (MUH) residents are at risk of secondhand smoke (SHS) exposure, which can transfer between units. The purpose of this study was to determine SHS exposure and examine attitudes towards smoking policies among public housing authority (PHA) residents in rural and tribal settings. A self-administered questionnaire was completed by 895 adult tenants (41 % response rate) living in PHA multiunit buildings in Montana in 2013. Our primary outcome was tenant support of smoke-free policies; our secondary outcome was exacerbation of child asthma symptoms due to SHS exposure. In 2014, we used multiple logistic regression models to test associations between independent variables and outcomes of interest. The majority (80.6 %) of respondents supported having a smoke-free policy in their building, with support being significantly higher among nonsmokers [adjusted odds ratio (aOR) 4.2, 95 % confidence interval (CI) 1.5-11.6] and among residents living with children (aOR 2.9, 95 % CI 1.3-6.2). Tribal residents were as likely to support smoke-free policies as non-tribal residents (aOR 1.4; 95 % CI 0.5-4.0). Over half (56.5 %) of respondents reported SHS exposure in their home; residents in a building with no smoke-free policy in place were significantly more likely to report exposure (aOR 3.5, 95 % CI 2.2-5.5). SHS exposure was not significantly associated with asthma symptoms. There is a significant reduction in exposure to SHS in facilities with smoke-free policies and there is strong support for such policies by both tribal and non-tribal MUH residents. Opportunities exist for smoke-free policy initiatives in rural and tribal settings.

Constructing an Urban Population Model for Medical Insurance Scheme Using Microsimulation Techniques

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Linping Xiong

2012-01-01

Full Text Available China launched a pilot project of medical insurance reform in 79 cities in 2007 to cover urban nonworking residents. An urban population model was created in this paper for China’s medical insurance scheme using microsimulation model techniques. The model made it clear for the policy makers the population distributions of different groups of people, the potential urban residents entering the medical insurance scheme. The income trends of units of individuals and families were also obtained. These factors are essential in making the challenging policy decisions when considering to balance the long-term financial sustainability of the medical insurance scheme.

How medical residents perceive the quality of supervision provided by attending doctors in the clinical setting

NARCIS (Netherlands)

Busari, Jamiu O.; Weggelaar, Nielske M.; Knottnerus, Andrieke C.; Greidanus, Petra-Marie; Scherpbier, Albert J. J. A.

2005-01-01

The supervision of medical residents is a key responsibility of attending doctors in the clinical setting. Most attending doctors, however, are unfamiliar with the principles of effective supervision. Although inconsistent, supervision has been shown to be both important and effective for the

Healthy incentive scheme in the Irish full-day-care pre-school setting.

LENUS (Irish Health Repository)

Molloy, C Johnston

2013-12-16

A pre-school offering a full-day-care service provides for children aged 0-5 years for more than 4 h\\/d. Researchers have called for studies that will provide an understanding of nutrition and physical activity practices in this setting. Obesity prevention in pre-schools, through the development of healthy associations with food and health-related practices, has been advocated. While guidelines for the promotion of best nutrition and health-related practice in the early years\\' setting exist in a number of jurisdictions, associated regulations have been noted to be poor, with the environment of the child-care facility mainly evaluated for safety. Much cross-sectional research outlines poor nutrition and physical activity practice in this setting. However, there are few published environmental and policy-level interventions targeting the child-care provider with, to our knowledge, no evidence of such interventions in Ireland. The aim of the present paper is to review international guidelines and recommendations relating to health promotion best practice in the pre-school setting: service and resource provision; food service and food availability; and the role and involvement of parents in pre-schools. Intervention programmes and assessment tools available to measure such practice are outlined; and insight is provided into an intervention scheme, formulated from available best practice, that was introduced into the Irish full-day-care pre-school setting.

Abolition of set-aside schemes and its impacts on habitat styructure in Denmark from 2007-2008

DEFF Research Database (Denmark)

Levin, Gregor

2010-01-01

Agriculture accounts for 65% of the Danish land area. Habitats for wild species are characterized by small patches, surrounded by intensive agriculture. Due to extensive management, set-aside land can if located close to habitats, improve habitat structure in terms of patch size and connectivity....... In 2008 set-aside schemes were abolished, leading to a decline in the area of set-aside land from 6% of all agricultural land in 2007 to 3% in 2008. We developed an indicator aiming to measure the effect of the reduced area of set-aside land on habitat structure. The indicator combines distance...... to habitats, potential corridors between habitats and area percentage of set-aside land. Analyses show that the halving of the area of set-aside land has led to a 55% reduction of the effect of set-aside land on habitat structure....

Set of difference spitting schemes for solving the Navier-Stokes incompressible equations in natural variables

International Nuclear Information System (INIS)

Koleshko, S.B.

1989-01-01

A three-parametric set of difference schemes is suggested to solve Navier-Stokes equations with the use of the relaxation form of the continuity equation. The initial equations are stated for time increments. Use is made of splitting the operator into one-dimensional forms that reduce calculations to scalar factorizations. Calculated results for steady- and unsteady-state flows in a cavity are presented

Abolition of set-aside schemes and its impact on habitat connectivity in Denmark from 2007 - 2008

DEFF Research Database (Denmark)

Levin, Gregor

In Denmark, agriculture occupies 28,000 km² or 65% of the land. As a consequence, habitats for wild species are mainly characterized by small patches, surrounded by intensive agriculture. Due to extensive agricultural management, set-aside land can spatially connect habitats and thus positively...... affect habitat connectivity, which is of importance to the survival of wild species. In 2008 set-aside schemes were abolished, leading to a considerable re-cultivation of former set-aside land and consequently to a decline in the area of set-aside land from 6% of all agricultural land in 2007 to 3......% in 2008. The main argument against regulations of the re-cultivation of set-aside land with the aim to minimize declines in habitat-connectivity was that re-cultivation would primarily occur on highly productive land at a long distance from habitats, while set-aside land located on marginal land, close...

Geminal embedding scheme for optimal atomic basis set construction in correlated calculations

Energy Technology Data Exchange (ETDEWEB)

Sorella, S., E-mail: sorella@sissa.it [International School for Advanced Studies (SISSA), Via Beirut 2-4, 34014 Trieste, Italy and INFM Democritos National Simulation Center, Trieste (Italy); Devaux, N.; Dagrada, M., E-mail: mario.dagrada@impmc.upmc.fr [Institut de Minéralogie, de Physique des Matériaux et de Cosmochimie, Université Pierre et Marie Curie, Case 115, 4 Place Jussieu, 75252 Paris Cedex 05 (France); Mazzola, G., E-mail: gmazzola@phys.ethz.ch [Theoretische Physik, ETH Zurich, 8093 Zurich (Switzerland); Casula, M., E-mail: michele.casula@impmc.upmc.fr [CNRS and Institut de Minéralogie, de Physique des Matériaux et de Cosmochimie, Université Pierre et Marie Curie, Case 115, 4 Place Jussieu, 75252 Paris Cedex 05 (France)

2015-12-28

We introduce an efficient method to construct optimal and system adaptive basis sets for use in electronic structure and quantum Monte Carlo calculations. The method is based on an embedding scheme in which a reference atom is singled out from its environment, while the entire system (atom and environment) is described by a Slater determinant or its antisymmetrized geminal power (AGP) extension. The embedding procedure described here allows for the systematic and consistent contraction of the primitive basis set into geminal embedded orbitals (GEOs), with a dramatic reduction of the number of variational parameters necessary to represent the many-body wave function, for a chosen target accuracy. Within the variational Monte Carlo method, the Slater or AGP part is determined by a variational minimization of the energy of the whole system in presence of a flexible and accurate Jastrow factor, representing most of the dynamical electronic correlation. The resulting GEO basis set opens the way for a fully controlled optimization of many-body wave functions in electronic structure calculation of bulk materials, namely, containing a large number of electrons and atoms. We present applications on the water molecule, the volume collapse transition in cerium, and the high-pressure liquid hydrogen.

Elder abuse and neglect in institutional settings: the resident's perspective.

Science.gov (United States)

Charpentier, Michèle; Soulières, Maryse

2013-01-01

This article strives to share research findings concerning the rights and empowerment of the elderly living in various long-term care (LTC) or residential care facilities (public and private sectors) in Quebec, Canada. Inspired by the theories of constructivism, the research aims to understand the residents' perception of abuse, as well as the strategies they are developing to exercise their rights and liberties. Data from semistructured interviews with 20 residents, mostly very old women aged 80 to 98, are presented. Results show that residents' perception of abuse: (1) is conditioned by sensationalistic media coverage; (2) is limited to physical mistreatment; and (3) tends to legitimize day-to-day infringements of their rights, as these "minor" violations seem inoffensive when compared to the "real" acts of violence reported in the media. Tensions that can build up among residents, sometimes resulting in intimidation or even bullying, were addressed.

Reflective Practice in the Clinical Setting: A Multi-Institutional Qualitative Study of Pediatric Faculty and Residents.

Science.gov (United States)

Plant, Jennifer; Li, Su-Ting T; Blankenburg, Rebecca; Bogetz, Alyssa L; Long, Michele; Butani, Lavjay

2017-11-01

To explore when and in what form pediatric faculty and residents practice reflection. From February to June 2015, the authors conducted focus groups of pediatric faculty and residents at the University of California, Davis; Stanford University; and the University of California, San Francisco, until thematic saturation occurred. Transcripts were analyzed based on Mezirow's and Schon's models of reflection, using the constant comparative method associated with grounded theory. Two investigators independently coded transcripts and reconciled codes to develop themes. All investigators reviewed the codes and developed a final list of themes through consensus. Through iterative discussions, investigators developed a conceptual model of reflection in the clinical setting. Seventeen faculty and 20 residents from three institutions participated in six focus groups. Five themes emerged: triggers of reflection, intrinsic factors, extrinsic factors, timing, and outcome of reflection. Various triggers led to reflection; whether a specific trigger led to reflection depended on intrinsic and extrinsic factors. When reflection occurred, it happened in action or on action. Under optimal conditions, this reflection was goal and action directed and became critical reflection. In other instances, this process resulted in unproductive rumination or acted as an emotional release or supportive therapy. Participants reflected in clinical settings, but did not always explicitly identify it as reflection or reflect in growth-promoting ways. Strategies to enhance critical reflection include developing knowledge and skills in reflection, providing performance data to inform reflection, creating time and space for safe reflection, and providing mentorship to guide the process.

Challenges of interprofessional team training: a qualitative analysis of residents' perceptions.

Science.gov (United States)

van Schaik, Sandrijn; Plant, Jennifer; O'Brien, Bridget

2015-01-01

Simulation-based interprofessional team training is thought to improve patient care. Participating teams often consist of both experienced providers and trainees, which likely impacts team dynamics, particularly when a resident leads the team. Although similar team composition is found in real-life, debriefing after simulations puts a spotlight on team interactions and in particular on residents in the role of team leader. The goal of the current study was to explore residents' perceptions of simulation-based interprofessional team training. This was a secondary analysis of a study of residents in the pediatric residency training program at the University of California, San Francisco (United States) leading interprofessional teams in simulated resuscitations, followed by facilitated debriefing. Residents participated in individual, semi-structured, audio-recorded interviews within one month of the simulation. The original study aimed to examine residents' self-assessment of leadership skills, and during analysis we encountered numerous comments regarding the interprofessional nature of the simulation training. We therefore performed a secondary analysis of the interview transcripts. We followed an iterative process to create a coding scheme, and used interprofessional learning and practice as sensitizing concepts to extract relevant themes. 16 residents participated in the study. Residents felt that simulated resuscitations were helpful but anxiety provoking, largely due to interprofessional dynamics. They embraced the interprofessional training opportunity and appreciated hearing other healthcare providers' perspectives, but questioned the value of interprofessional debriefing. They identified the need to maintain positive relationships with colleagues in light of the teams' complex hierarchy as a barrier to candid feedback. Pediatric residents in our study appreciated the opportunity to participate in interprofessional team training but were conflicted about the

Knowledge and uptake of community-based health insurance scheme among residents of Olowora, Lagos

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O A Ibukun

2013-01-01

Full Text Available Background and Objective: The informal sector population in developing nations has low health coverage from Community Based Health Insurance (CBHI and problems such as limited awareness about the potential impact of prepayment health financing and the limited resources to finance health care can impede success. This study assessed the community based health insurance scheme uptake and determinants in Olowora, Lagos State. Methods: This was a descriptive cross sectional study carried out in July 2010 in all households of 12 out of 41 streets in Olowora,by multistage sampling. Four hundred and sixteen interviewer-administered questionnaires were completed and returned. Analysis was by Epi- info version 3.5.1 software. Results: Although 75.5% of respondents were aware of the Community Health Insurance scheme at Olowora, just about half (49.5% of them had good knowledge of the scheme. A substantial proportion (44.2% of respondents did not believe in contributing money for illness yet to come, and majority (72.3% of such respondents prefers payment for health care when ill. While about half (53% of respondentshad enrolled into the community health insurance scheme, 45.6% of those who had not enrolled were not aware of the scheme. Lack of money was the main reason (51.5% why some enrollees had defaulted. Conclusion: The study identified information gaps and poor understanding of the scheme as well as poverty as factors that have negatively affected uptake. The scheme management has to re-evaluate its sensitization programmes, and also strengthen marketing strategies with special emphasis on the poor.

An intelligent hybrid scheme for optimizing parking space: A Tabu metaphor and rough set based approach

Directory of Open Access Journals (Sweden)

Soumya Banerjee

2011-03-01

Full Text Available Congested roads, high traffic, and parking problems are major concerns for any modern city planning. Congestion of on-street spaces in official neighborhoods may give rise to inappropriate parking areas in office and shopping mall complex during the peak time of official transactions. This paper proposes an intelligent and optimized scheme to solve parking space problem for a small city (e.g., Mauritius using a reactive search technique (named as Tabu Search assisted by rough set. Rough set is being used for the extraction of uncertain rules that exist in the databases of parking situations. The inclusion of rough set theory depicts the accuracy and roughness, which are used to characterize uncertainty of the parking lot. Approximation accuracy is employed to depict accuracy of a rough classification [1] according to different dynamic parking scenarios. And as such, the hybrid metaphor proposed comprising of Tabu Search and rough set could provide substantial research directions for other similar hard optimization problems.

The role of residence time in diagnostic models of global carbon storage capacity: model decomposition based on a traceable scheme.

Science.gov (United States)

Yizhao, Chen; Jianyang, Xia; Zhengguo, Sun; Jianlong, Li; Yiqi, Luo; Chengcheng, Gang; Zhaoqi, Wang

2015-11-06

As a key factor that determines carbon storage capacity, residence time (τE) is not well constrained in terrestrial biosphere models. This factor is recognized as an important source of model uncertainty. In this study, to understand how τE influences terrestrial carbon storage prediction in diagnostic models, we introduced a model decomposition scheme in the Boreal Ecosystem Productivity Simulator (BEPS) and then compared it with a prognostic model. The result showed that τE ranged from 32.7 to 158.2 years. The baseline residence time (τ'E) was stable for each biome, ranging from 12 to 53.7 years for forest biomes and 4.2 to 5.3 years for non-forest biomes. The spatiotemporal variations in τE were mainly determined by the environmental scalar (ξ). By comparing models, we found that the BEPS uses a more detailed pool construction but rougher parameterization for carbon allocation and decomposition. With respect to ξ comparison, the global difference in the temperature scalar (ξt) averaged 0.045, whereas the moisture scalar (ξw) had a much larger variation, with an average of 0.312. We propose that further evaluations and improvements in τ'E and ξw predictions are essential to reduce the uncertainties in predicting carbon storage by the BEPS and similar diagnostic models.

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

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.)

Performance of internal medicine residents in the primary interpretation of musculoskeletal radiographs in an ambulatory care setting

International Nuclear Information System (INIS)

Mann, F.A.; Stewart, N.R.; Terrell, C.B.

1990-01-01

This paper determines the characteristics of misinterpretations of musculoskeletal radiographs by internal medicine residents (IMRs) in an ambulatory care setting. Discordances between IMRs and staff radiologists were prospectively identified and retrospectively reviewed to assess type of error and patient outcome. The setting was an acute ambulatory care clinic at a large university hospital staffed by board-certified emergency medicine faculty and IMRs. Of 541 patients radiographed, 321 (59%) had adequate follow-up to establish outcome. Error characteristics examined included nature and site, type (false negative ([F-] or false positive [F+]), clinical significance, interpreter responsible, and level of interpreter training

The socio-economic impact of the Lake Chad resettlement scheme ...

African Journals Online (AJOL)

AJL

will change the lives of current and future residents of a ... community's fiscal balance sheet or local natural ... resettlement scheme deserves environmental impact assessment ..... work and others (especially the returnees) could not even.

Setting aside Transactions from Pyramid Schemes as Impeachable Dispositions under South African Insolvency Legislation

Directory of Open Access Journals (Sweden)

Zingapi Mabe

2016-10-01

Full Text Available South African courts have experienced a rise in the number of cases involving schemes that promise a return on investment with interest rates which are considerably above the maximum amount allowed by law, or schemes which promise compensation from the active recruitment of participants. These schemes, which are often referred to as pyramid or Ponzi schemes, are unsustainable operations and give rise to problems in the law of insolvency. Investors in these schemes are often left empty-handed upon the scheme’s eventual collapse and insolvency. Investors who received pay-outs from the scheme find themselves in the defence against the trustee’s claims for the return of the pay-outs to the insolvent estate. As the schemes are illegal and the pay-outs are often in terms of void agreements, the question arises whether they can be returned to the insolvent estate. A similar situation arose in Griffiths v Janse van Rensburg 2015 ZASCA 158 (26 October 2015. The point of contention in this case was whether the illegality of the business of the scheme was a relevant consideration in determining whether the pay-outs were made in the ordinary course of business of the scheme. This paper discusses pyramid schemes in the context of impeachable dispositions in terms of the Insolvency Act 24 of 1936.

Bodily pain intensity in nursing home residents with pressure ulcers: analysis of national minimum data set 3.0.

Science.gov (United States)

Ahn, Hyochol; Stechmiller, Joyce; Fillingim, Roger; Lyon, Debra; Garvan, Cynthia

2015-06-01

Clinical reports suggest that superficial pressure ulcers produce pain, but that pain decreases as the wound advances in stage. This study of the relationship between pressure ulcer stage and bodily pain intensity in nursing home residents was a secondary analysis of the national Minimum Data Set 3.0 assessment data in long-term care facilities, collected from nursing home residents at least 65 years of age. Data were examined from residents with pressure ulcers who completed a bodily pain intensity interview between January and March 2012 (N = 41,680) as part of the MDS comprehensive assessment. After adjusting for other variables (e.g., cognition, functional impairment, presence of comorbidities, use of scheduled pain medication, and sociodemographic variables), bodily pain intensity for those with more severe pressure ulcers in comparison to those with Stage I ulcers was higher by 11% (Stage II), 14% (Stage III), 24% (Stage IV), and 22% (suspected deep tissue injury). Because multivariate analysis showed that greater bodily pain intensity was associated with an advanced stage of pressure ulcer, health care providers should assess bodily pain intensity and order appropriate pain management for nursing home residents with pressure ulcers, particularly for those with advanced pressure ulcers who are vulnerable to greater bodily pain intensity. © 2015 Wiley Periodicals, Inc.

Caregiver person-centeredness and behavioral symptoms during mealtime interactions: development and feasibility of a coding scheme.

Science.gov (United States)

Gilmore-Bykovskyi, Andrea L

2015-01-01

Mealtime behavioral symptoms are distressing and frequently interrupt eating for the individual experiencing them and others in the environment. A computer-assisted coding scheme was developed to measure caregiver person-centeredness and behavioral symptoms for nursing home residents with dementia during mealtime interactions. The purpose of this pilot study was to determine the feasibility, ease of use, and inter-observer reliability of the coding scheme, and to explore the clinical utility of the coding scheme. Trained observers coded 22 observations. Data collection procedures were acceptable to participants. Overall, the coding scheme proved to be feasible, easy to execute and yielded good to very good inter-observer agreement following observer re-training. The coding scheme captured clinically relevant, modifiable antecedents to mealtime behavioral symptoms, but would be enhanced by the inclusion of measures for resident engagement and consolidation of items for measuring caregiver person-centeredness that co-occurred and were difficult for observers to distinguish. Published by Elsevier Inc.

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.

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.

Delivering energy efficiency and carbon reduction schemes in England: Lessons from Green Deal Pioneer Places

International Nuclear Information System (INIS)

Marchand, Robert D.; Koh, S.C. Lenny; Morris, Jonathan C.

2015-01-01

Against a background of growing international and national carbon reduction legislation, the UK government introduced the “Green Deal” to deliver a significant increase in housing energy efficiency and reduction in carbon emissions. This paper reflects on one English local authority's experience delivering a programme intended to foster local interest in the Green Deal. Drawing on social surveys and pre and post Green Deal intervention interviews with five demonstrator homes (households that applied to receive a Green Deal package fully funded by the scheme, providing a test bed for the Green Deal recruitment and installation process), this paper shows that awareness and understanding of the Green Deal scheme is low. There is opposition to the cost of finance offered but a strong interest in improving household warmth and for funding improvements through payments added to the electricity bill. Demonstrator home residents perceived Green Deals had improved the warmth and quality of their home, but saving money was the primary motivator for their involvement, not increasing warmth. Whilst Green Deal has not delivered the level of success that was hoped, much can be learned from the scheme to improve future energy efficiency schemes that will be necessary to deliver emission reduction commitments. -- Highlights: •Resident awareness and understanding of the Green Deal is low. •Green Deal assessment costs and loan interest rates are biggest barriers to uptake. •Funding energy improvements via a charge on electricity bill welcomed by residents. •Saving money rather than increasing warmth main motivator for scheme involvement. •Insights from this work should be used to inform future emission reduction schemes

Implementation of a web-based, interactive polytrauma tutorial in computed tomography for radiology residents: How we do it

International Nuclear Information System (INIS)

Schlorhaufer, C.; Behrends, M.; Diekhaus, G.; Keberle, M.; Weidemann, J.

2012-01-01

Purpose: Due to the time factor in polytraumatized patients all relevant pathologies in a polytrauma computed tomography (CT) scan have to be read and communicated very quickly. During radiology residency acquisition of effective reading schemes based on typical polytrauma pathologies is very important. Thus, an online tutorial for the structured diagnosis of polytrauma CT was developed. Materials and methods: Based on current multimedia theories like the cognitive load theory a didactic concept was developed. As a web-environment the learning management system ILIAS was chosen. CT data sets were converted into online scrollable QuickTime movies. Audiovisual tutorial movies with guided image analyses by a consultant radiologist were recorded. Results: The polytrauma tutorial consists of chapterized text content and embedded interactive scrollable CT data sets. Selected trauma pathologies are demonstrated to the user by guiding tutor movies. Basic reading schemes are communicated with the help of detailed commented movies of normal data sets. Common and important pathologies could be explored in a self-directed manner. Conclusions: Ambitious didactic concepts can be supported by a web based application on the basis of cognitive load theory and currently available software tools.

Implementation of a web-based, interactive polytrauma tutorial in computed tomography for radiology residents: How we do it

Energy Technology Data Exchange (ETDEWEB)

Schlorhaufer, C., E-mail: Schlorhaufer.Celia@mh-hannover.de [Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover (Germany); Behrends, M., E-mail: behrends.marianne@mh-hannover.de [Peter L. Reichertz Department of Medical Informatics, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover (Germany); Diekhaus, G., E-mail: Diekhaus.Gesche@mh-hannover.de [Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover (Germany); Keberle, M., E-mail: m.keberle@bk-paderborn.de [Department of Diagnostic and Interventional Radiology, Brüderkrankenhaus St. Josef Paderborn, Husener Str. 46, 33098 Paderborn (Germany); Weidemann, J., E-mail: Weidemann.Juergen@mh-hannover.de [Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover (Germany)

2012-12-15

Purpose: Due to the time factor in polytraumatized patients all relevant pathologies in a polytrauma computed tomography (CT) scan have to be read and communicated very quickly. During radiology residency acquisition of effective reading schemes based on typical polytrauma pathologies is very important. Thus, an online tutorial for the structured diagnosis of polytrauma CT was developed. Materials and methods: Based on current multimedia theories like the cognitive load theory a didactic concept was developed. As a web-environment the learning management system ILIAS was chosen. CT data sets were converted into online scrollable QuickTime movies. Audiovisual tutorial movies with guided image analyses by a consultant radiologist were recorded. Results: The polytrauma tutorial consists of chapterized text content and embedded interactive scrollable CT data sets. Selected trauma pathologies are demonstrated to the user by guiding tutor movies. Basic reading schemes are communicated with the help of detailed commented movies of normal data sets. Common and important pathologies could be explored in a self-directed manner. Conclusions: Ambitious didactic concepts can be supported by a web based application on the basis of cognitive load theory and currently available software tools.

Use of the International Classification of Functioning, Disability and Health Generic-30 Set for the characterization of outpatients: Italian Society of Physical and Rehabilitative Medicine Residents Section Project.

Science.gov (United States)

Gimigliano, Francesca; De Sire, Alessandro; Gastaldo, Marco; Maghini, Irene; Paoletta, Marco; Pasquini, Andrea; Boldrini, Paolo; Selb, Melissa; Prodinger, Birgit

2018-06-11

The International Classification of Functioning, Disability and Health (ICF) Generic- 30 Set (previously referred to as Rehabilitation Set) is a minimal set of ICF categories for reporting and assessing functioning and disability in clinical populations with different health conditions along the continuum of care. Recently, the Italian Society of Physical and Rehabilitation Medicine (SIMFER) developed an Italian modification of the simple and intuitive descriptions (SID) of these categories. This study was the first one to implement the use of the SID in practice. 1) To implement the use of the ICF in clinical practice and research among Italian Residents in PRM. 2) To verify if the SID made the application of ICF Generic 30 Set more user-friendly than the original descriptions. 3) To examine the prevalence of functioning problems of patients accessing Rehabilitation Services to serve as reference for the development of an ICF-based clinical data collection tool. Multicenter cross-sectional study. Italian Physical Medicine and Rehabilitation (PRM) outpatient rehabilitation services. Patients referring to Italian PRM outpatient rehabilitation services and Italian Residents in PRM. Each School of Specialization involved, randomly, received the ICF Generic-30 Set with the original descriptions or with the SID. Residents collected over a 4-month period (April-July 2016) patients data related to the ICF Generic-30 Set categories. Moreover, the residents self- assessed their difficulty in using the ICF Generic-30 Set with the original descriptions or with the SID, through a Numeric Rating Scale (NRS). Ninety-three residents collected functioning data of 864 patients (mean aged 57.7±19.3) with ICF Generic-30 Set: 304 with the original descriptions and 560 with SID. The difficulty in using the ICF Generic-30 Set with SID was rated as lower than using the original descriptions (NRS = 2.8±2.5 vs 3.5±3.1; p<0.001). The most common disease was the back pain (9.6%) and

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...

Emergency ultrasound usage among recent emergency medicine residency graduates of a convenience sample of 14 residencies.

Science.gov (United States)

Dean, Anthony J; Breyer, Michael J; Ku, Bon S; Mills, Angela M; Pines, Jesse M

2010-02-01

Emergency Medicine (EM) residency graduates are trained to perform Emergency Medicine bedside ultrasound (EMBU). However, the degree to which they use this skill in their practice after graduation is unknown. We sought to test the amount and type of usage of EMBU among recent residency graduates, and how usage and barriers vary among various types of EM practice settings. Graduates from 14 EM residency programs in 2003-2005 were surveyed on their current practice setting and use of EMBU. There were 252 (73%) graduates who completed the survey. Of the 73% of respondents reporting access to EMBU, 98% had used it within the past 3 months. Access to EMBU was higher in academic (97%) vs. community teaching (79%) vs. community non-teaching settings (62%) (p < 0.001), and in Emergency Departments (EDs) where yearly census exceeded 60,000 visits (87% vs. 65%, p < 0.001). Physicians in academic settings reported "high use" of EMBU more frequently than those in community settings for most modalities. FAST (focused assessment by sonography in trauma) was the most common high-use application and the most useful in practice. The greatest impediment to EMBU use was "not enough time" (61%). Ultrasound usage among recent EM residency graduates is significantly higher in teaching than in community settings and in high-volume EDs. Its use is more widespread than in previous reports in all types of practice. There is a wide range of utilization of ultrasound in the various applications in emergency practice, with the evaluation of trauma being the most common. Copyright (c) 2010 Elsevier Inc. All rights reserved.

A progressive diagonalization scheme for the Rabi Hamiltonian

International Nuclear Information System (INIS)

Pan, Feng; Guan, Xin; Wang, Yin; Draayer, J P

2010-01-01

A diagonalization scheme for the Rabi Hamiltonian, which describes a qubit interacting with a single-mode radiation field via a dipole interaction, is proposed. It is shown that the Rabi Hamiltonian can be solved almost exactly using a progressive scheme that involves a finite set of one variable polynomial equations. The scheme is especially efficient for the lower part of the spectrum. Some low-lying energy levels of the model with several sets of parameters are calculated and compared to those provided by the recently proposed generalized rotating-wave approximation and a full matrix diagonalization.

Privacy Preserving Mapping Schemes Supporting Comparison

NARCIS (Netherlands)

Tang, Qiang

2010-01-01

To cater to the privacy requirements in cloud computing, we introduce a new primitive, namely Privacy Preserving Mapping (PPM) schemes supporting comparison. An PPM scheme enables a user to map data items into images in such a way that, with a set of images, any entity can determine the <, =, >

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

Residents in difficulty

DEFF Research Database (Denmark)

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

2016-01-01

Background The majority of studies on prevalence and characteristics of residents in difficulty have been conducted in English-speaking countries and the existing literature may not reflect the prevalence and characteristics of residents in difficulty in other parts of the world such as the Scand...... in a healthcare system. From our perspective, further sociological and pedagogical investigations in educational cultures across settings and specialties could inform our understanding of and knowledge about pitfalls in residents’ and doctors’ socialization into the healthcare system....

Nutritional status and mortality of refugee and resident children in a non-camp setting during conflict: follow up study in Guinea-Bissau.

Science.gov (United States)

Aaby, P; Gomes, J; Fernandes, M; Djana, Q; Lisse, I; Jensen, H

1999-10-02

To study the effects on children of humanitarian aid agencies restricting help to refugee families (internally displaced people). Follow up study of 3 months. Prabis peninsular outside Bissau, the capital of Guinea-Bissau, which has functioned as a refugee area for internally displaced people in the ongoing war, and the study area of the Bandim health project in Bissau. 422 children aged 9-23 months in 30 clusters. Mid-upper arm circumference and survival in relation to residence status. During the refugee situation all children deteriorated nutritionally, and mortality was high (3.0% in a 6 week period). Rice consumption was higher in families resident in Prabis than in refugees from Bissau but there was no difference in food expenditure. Nutritional status, measured by mid- upper arm circumference, was not associated with rice consumption levels in the family, and the decline in circumference was significantly worse for resident than for refugee children; the mid-upper arm circumference of refugee children increased faster than that of resident children. For resident children, mortality was 4.5 times higher (95% confidence interval 1.1 to 30.0) than for refugee children. Mortality for both resident and refugee children was 7.2 times higher (1.3 to 133.9) during the refugee's stay in Prabis compared with the period after the departure of the refugees. In a non-camp setting, residents may be more malnourished and have higher mortality than refugees. Major improvements in nutritional status and a reduction in mortality occurred in resident and refugee children as soon as refugees returned home despite the fact that there was no improvement in food availability.

LevelScheme: A level scheme drawing and scientific figure preparation system for Mathematica

Science.gov (United States)

Caprio, M. A.

2005-09-01

LevelScheme is a scientific figure preparation system for Mathematica. The main emphasis is upon the construction of level schemes, or level energy diagrams, as used in nuclear, atomic, molecular, and hadronic physics. LevelScheme also provides a general infrastructure for the preparation of publication-quality figures, including support for multipanel and inset plotting, customizable tick mark generation, and various drawing and labeling tasks. Coupled with Mathematica's plotting functions and powerful programming language, LevelScheme provides a flexible system for the creation of figures combining diagrams, mathematical plots, and data plots. Program summaryTitle of program:LevelScheme Catalogue identifier:ADVZ Program obtainable from: CPC Program Library, Queen's University of Belfast, N. Ireland Program summary URL:http://cpc.cs.qub.ac.uk/summaries/ADVZ Operating systems:Any which supports Mathematica; tested under Microsoft Windows XP, Macintosh OS X, and Linux Programming language used:Mathematica 4 Number of bytes in distributed program, including test and documentation:3 051 807 Distribution format:tar.gz Nature of problem:Creation of level scheme diagrams. Creation of publication-quality multipart figures incorporating diagrams and plots. Method of solution:A set of Mathematica packages has been developed, providing a library of level scheme drawing objects, tools for figure construction and labeling, and control code for producing the graphics.

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.

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.

Tabled Execution in Scheme

Energy Technology Data Exchange (ETDEWEB)

Willcock, J J; Lumsdaine, A; Quinlan, D J

2008-08-19

Tabled execution is a generalization of memorization developed by the logic programming community. It not only saves results from tabled predicates, but also stores the set of currently active calls to them; tabled execution can thus provide meaningful semantics for programs that seemingly contain infinite recursions with the same arguments. In logic programming, tabled execution is used for many purposes, both for improving the efficiency of programs, and making tasks simpler and more direct to express than with normal logic programs. However, tabled execution is only infrequently applied in mainstream functional languages such as Scheme. We demonstrate an elegant implementation of tabled execution in Scheme, using a mix of continuation-passing style and mutable data. We also show the use of tabled execution in Scheme for a problem in formal language and automata theory, demonstrating that tabled execution can be a valuable tool for Scheme users.

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

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.

Differences exist across insurance schemes in China post-consolidation.

Directory of Open Access Journals (Sweden)

Yang Li

Full Text Available In China, the basic insurance system consists of three schemes: the UEBMI (Urban Employee Basic Medical Insurance, URBMI (Urban Resident Basic Medical Insurance, and NCMS (New Cooperative Medical Scheme, across which significant differences have been observed. Since 2009, the central government has been experimenting with consolidating these schemes in selected areas. This study examines whether differences still exist across schemes after the consolidation.A survey was conducted in the city of Suzhou, collecting data on subjects 45 years old and above with at least one inpatient or outpatient treatment during a period of twelve months. Analysis on 583 subjects was performed comparing subjects' characteristics across insurance schemes. A resampling-based method was applied to compute the predicted gross medical cost, OOP (out-of-pocket cost, and insurance reimbursement rate.Subjects under different insurance schemes differ in multiple aspects. For inpatient treatments, subjects under the URBMI have the highest observed and predicted gross and OOP costs, while those under the UEBMI have the lowest. For outpatient treatments, subjects under the UEBMI and URBMI have comparable costs, while those under the NCMS have much lower costs. Subjects under the NCMS also have a much lower reimbursement rate.Differences still exist across schemes in medical costs and insurance reimbursement rate post-consolidation. Further investigations are needed to identify the causes, and interventions are needed to eliminate such differences.

Interpolation-free scanning and sampling scheme for tomographic reconstructions

International Nuclear Information System (INIS)

Donohue, K.D.; Saniie, J.

1987-01-01

In this paper a sampling scheme is developed for computer tomography (CT) systems that eliminates the need for interpolation. A set of projection angles along with their corresponding sampling rates are derived from the geometry of the Cartesian grid such that no interpolation is required to calculate the final image points for the display grid. A discussion is presented on the choice of an optimal set of projection angles that will maintain a resolution comparable to a sampling scheme of regular measurement geometry, while minimizing the computational load. The interpolation-free scanning and sampling (IFSS) scheme developed here is compared to a typical sampling scheme of regular measurement geometry through a computer simulation

Hilbert schemes of points on some classes surface singularities

OpenAIRE

Gyenge, Ádám

2016-01-01

We study the geometry and topology of Hilbert schemes of points on the orbifold surface [C^2/G], respectively the singular quotient surface C^2/G, where G is a finite subgroup of SL(2,C) of type A or D. We give a decomposition of the (equivariant) Hilbert scheme of the orbifold into affine space strata indexed by a certain combinatorial set, the set of Young walls. The generating series of Euler characteristics of Hilbert schemes of points of the singular surface of type A or D is computed in...

Demand for voluntary basic medical insurance in urban China: panel evidence from the Urban Resident Basic Medical Insurance scheme.

Science.gov (United States)

Chen, Gang; Yan, Xiao

2012-12-01

This paper investigates the key factors associated with the demand for Urban Resident Basic Medical Insurance (URBMI), which was established in 2007 and aims to cover all Chinese urban residents. Two waves of longitudinal household survey data are used, and a three-level random-intercept logit model is used for the analysis. Two different sets of explanatory variables were identified for adults and children, separately. Results suggest for both the adult and the child samples that income, health status, age and health risk behaviours are key influencing factors for basic medical insurance demand. The household head's characteristics are also significantly related to other household members' medical insurance demands. Specifically, household heads who are more educated or retired are more likely to purchase medical insurance for their children. These findings suggest that an expansion of the special subsidy to the poor or, probably more important, a risk-adjusted benefit package may be needed for voluntary basic medical insurance in China. In addition, adverse selection consistently exists and is a major challenge for the sustainability of medical insurance financing. To expand insurance coverage for children, especially those under school age, special efforts (possibly through health education or health promotion) should be focused on the household head, particularly those engaging in risky health behaviours.

Comparison of caregivers', residents', and community-dwelling spouses' opinions about expressing sexuality in an institutional setting.

Science.gov (United States)

Gibson, M C; Bol, N; Woodbury, M G; Beaton, C; Janke, C

1999-04-01

Opinions regarding the appropriateness of elderly residents' sexual behaviors in a chronic care hospital and how to respond to inappropriate behaviors were surveyed. Study participation was open to all staff (N = 1,205), eligible residents (N = 182) and community-dwelling spouses (N = 103). Participation rates were 40% (residents), 42% (spouses), 34% (nursing staff), 50% (allied health staff), and 22% (support staff). Staff completed the questionnaire independently, while residents and spouses were offered self-completion or a structured interview. Almost all selected the interview. Residents and spouses were less tolerant than staff of residents' masturbating, engaging in sexual relationships, viewing sexual materials, and making sexual approaches to staff. Privacy was the primary determinant of appropriateness for behaviors for all groups. Staff and spouses were more likely to endorse counseling when behaviors were perceived as inappropriate than residents. Nurses endorsed counseling less frequently than allied health professionals and support staff. Nurses were more likely to have been approached sexually by a resident. Differences of opinion are interpreted in terms of cohort influences on values and contextual influences on behavior.

Chinese Gini Coefficient from 2005 to 2012, Based on 20 Grouped Income Data Sets of Urban and Rural Residents

Directory of Open Access Journals (Sweden)

Jiandong Chen

2015-01-01

Full Text Available Data insufficiency has become the primary factor affecting research on income disparity in China. To resolve this issue, this paper explores Chinese income distribution and income inequality using distribution functions. First, it examines 20 sets of grouped data on family income between 2005 and 2012 by the China Yearbook of Household Surveys, 2013, and compares the fitting effects of eight distribution functions. The results show that the generalized beta distribution of the second kind has a high fitting to the income distribution of urban and rural residents in China. Next, these results are used to calculate the Chinese Gini ratio, which is then compared with the findings of relevant studies. Finally, this paper discusses the influence of urbanization on income inequality in China and suggests that accelerating urbanization can play an important role in narrowing the income gap of Chinese residents.

Understanding the challenges to facilitating active learning in the resident conferences: a qualitative study of internal medicine faculty and resident perspectives.

Science.gov (United States)

Sawatsky, Adam P; Zickmund, Susan L; Berlacher, Kathryn; Lesky, Dan; Granieri, Rosanne

2015-01-01

In the Next Accreditation System, the Accreditation Council for Graduate Medical Education outlines milestones for medical knowledge and requires regular didactic sessions in residency training. There are many challenges to facilitating active learning in resident conferences, and we need to better understand resident learning preferences and faculty perspectives on facilitating active learning. The goal of this study was to identify challenges to facilitating active learning in resident conferences, both through identifying specific implementation barriers and identifying differences in perspective between faculty and residents on effective teaching and learning strategies. The investigators invited core residency faculty to participate in focus groups. The investigators used a semistructured guide to facilitate discussion about learning preferences and teaching perspectives in the conference setting and used an 'editing approach' within a grounded theory framework to qualitative analysis to code the transcripts and analyze the results. Data were compared to previously collected data from seven resident focus groups. Three focus groups with 20 core faculty were conducted. We identified three domains pertaining to facilitating active learning in resident conferences: barriers to facilitating active learning formats, similarities and differences in faculty and resident learning preferences, and divergence between faculty and resident opinions about effective teaching strategies. Faculty identified several setting, faculty, and resident barriers to facilitating active learning in resident conferences. When compared to residents, faculty expressed similar learning preferences; the main differences were in motivations for conference attendance and type of content. Resident preferences and faculty perspectives differed on the amount of information appropriate for lecture and the role of active participation in resident conferences. This study highlights several

A repeat-until-success quantum computing scheme

Energy Technology Data Exchange (ETDEWEB)

Beige, A [School of Physics and Astronomy, University of Leeds, Leeds LS2 9JT (United Kingdom); Lim, Y L [DSO National Laboratories, 20 Science Park Drive, Singapore 118230, Singapore (Singapore); Kwek, L C [Department of Physics, National University of Singapore, 2 Science Drive 3, Singapore 117542, Singapore (Singapore)

2007-06-15

Recently we proposed a hybrid architecture for quantum computing based on stationary and flying qubits: the repeat-until-success (RUS) quantum computing scheme. The scheme is largely implementation independent. Despite the incompleteness theorem for optical Bell-state measurements in any linear optics set-up, it allows for the implementation of a deterministic entangling gate between distant qubits. Here we review this distributed quantum computation scheme, which is ideally suited for integrated quantum computation and communication purposes.

A repeat-until-success quantum computing scheme

International Nuclear Information System (INIS)

Beige, A; Lim, Y L; Kwek, L C

2007-01-01

Recently we proposed a hybrid architecture for quantum computing based on stationary and flying qubits: the repeat-until-success (RUS) quantum computing scheme. The scheme is largely implementation independent. Despite the incompleteness theorem for optical Bell-state measurements in any linear optics set-up, it allows for the implementation of a deterministic entangling gate between distant qubits. Here we review this distributed quantum computation scheme, which is ideally suited for integrated quantum computation and communication purposes

Generalized quantization scheme for two-person non-zero sum games

International Nuclear Information System (INIS)

Nawaz, Ahmad; Toor, A H

2004-01-01

We proposed a generalized quantization scheme for non-zero sum games which can be reduced to the two existing quantization schemes under an appropriate set of parameters. Some other important situations are identified which are not apparent in the two existing quantization schemes

Risk Factors for Pressure Ulcers Including Suspected Deep Tissue Injury in Nursing Home Facility Residents: Analysis of National Minimum Data Set 3.0.

Science.gov (United States)

Ahn, Hyochol; Cowan, Linda; Garvan, Cynthia; Lyon, Debra; Stechmiller, Joyce

2016-04-01

To provide information on risk factors associated with pressure ulcers (PrUs), including suspected deep tissue injury (sDTI), in nursing home residents in the United States. This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. After participating in this educational activity, the participant should be better able to:1. Examine the literature related to risk factors for the development of PrUs.2. Compare risk factors associated with the prevalence of PrUs and sDTI from the revised Minimum Data Set 3.0 2012 using a modified Defloor's conceptual model of PrUs as a theoretical framework. This study aims to characterize and compare risk factors associated with pressure ulcers (PrUs), including suspected deep tissue injury (sDTI), in nursing home (NH) residents in the United States. Secondary analysis of the 2012 Minimum Data Set (MDS 3.0). Medicare- or Medicaid-certified NHs in the United States. Nursing home residents (n = 2,936,146) 18 years or older with complete PrU data, who received comprehensive assessments from January to December 2012. Pressure ulcer by stage was the outcome variable. Explanatory variables (age, gender, race and ethnicity, body mass index, skin integrity, system failure, disease, infection, mobility, and cognition) from the MDS 3.0 were aligned with the 4 elements of Defloor's conceptual model: compressive forces, shearing forces, tissue tolerance for pressure, and tissue tolerance for oxygen. Of 2,936,146 NH residents who had complete data for PrU, 89.9% had no PrU; 8.4% had a Stage 2, 3, or 4 or unstagable PrU; and 1.7% had an sDTI. The MDS variables corresponding to the 4 elements of Defloor's model were significantly predictive of both PrU and sDTI. Black residents had the highest risk of any-stage PrU, and Hispanic residents had the highest risk of sDTI. Skin integrity, system failure, infection, and disease risk factors had larger effect sizes for sDTI than for other PrU stages

Re-thinking clinical research training in residency

Directory of Open Access Journals (Sweden)

Jennifer O'Brien

2014-12-01

Conclusions: We conclude that medical educators should critically re-think our programs to develop resident researchers. If it is worthwhile to require original research projects during residency, then we must consider the priorities of local settings to best serve the public interest.

42 CFR 435.403 - State residence.

Science.gov (United States)

2010-10-01

... set forth in § 431.52 of this chapter. (b) Definition. For purposes of this section—Institution has... intent, the State of residence is the State where the individual is living with the intention to remain...), the State of residence is the State where the individual is— (i) Living with the intention to remain...

Use of fall risk increasing drugs in residents of retirement villages: a pilot study of long term care and retirement home residents in Ontario, Canada.

Science.gov (United States)

Rojas-Fernandez, Carlos; Dadfar, Farzan; Wong, Andrea; Brown, Susan G

2015-10-14

Falls continue to be a problem for older people in long-term care (LTC) and retirement home (RH) settings and are associated with significant morbidity and health care use. Fall-risk increasing drugs (FRIDs) are known to increase fall risk and represent modifiable risk factors. There are limited data regarding the use of FRIDs in contemporary LTC and RH settings, and it has not been well documented to what extent medication regimens are reviewed and modified for those who have sustained falls. The objective of this study is to characterize medication related fall risk factors in LTC and RH residents and on-going use of medications known to increase fall risk. Retrospective chart review of residents aged >65 who sustained one or more falls living in LTC or RH settings. 105 residents who fell one or more times during 2009-2010 were identified with a mean age of 89 years, a mean of nine scheduled medications and seven diagnoses, and 83% were women. Residents in LTC were ostensibly at higher risk for falls relative to those in RH settings as suggested by higher proportion of residents with multiple falls, multiple comorbidities, comorbidities that increase fall risk and visual impairment. Post fall injuries were sustained by 42% of residents, and residents in RH sustained more injuries relative to LTC residents (47 vs 34%). Use of FRIDs such as benzodiazepines, antipsychotic, antidepressant and various antihypertensive drugs was common in the present sample. No medication regimen changes were noted in the 6-month post fall period. The present study documented common use FRIDs by LTC and RH residents with multiple falls. These potentially modifiable falls risk factors are not being adequately addressed in contemporary practice, demonstrating that there is much room for improvement with regards to the safe and appropriate use of medications in LTC and RH residents.

Vector domain decomposition schemes for parabolic equations

Science.gov (United States)

Vabishchevich, P. N.

2017-09-01

A new class of domain decomposition schemes for finding approximate solutions of timedependent problems for partial differential equations is proposed and studied. A boundary value problem for a second-order parabolic equation is used as a model problem. The general approach to the construction of domain decomposition schemes is based on partition of unity. Specifically, a vector problem is set up for solving problems in individual subdomains. Stability conditions for vector regionally additive schemes of first- and second-order accuracy are obtained.

REFERQUAL: a pilot study of a new service quality assessment instrument in the GP exercise referral scheme setting

Science.gov (United States)

Cock, Don; Adams, Iain C; Ibbetson, Adrian B; Baugh, Phil

2006-01-01

Background The development of an instrument accurately assessing service quality in the GP Exercise Referral Scheme (ERS) industry could potentially inform scheme organisers of the factors that affect adherence rates leading to the implementation of strategic interventions aimed at reducing client drop-out. Methods A modified version of the SERVQUAL instrument was designed for use in the ERS setting and subsequently piloted amongst 27 ERS clients. Results Test re-test correlations were calculated via Pearson's 'r' or Spearman's 'rho', depending on whether the variables were Normally Distributed, to show a significant (mean r = 0.957, SD = 0.02, p < 0.05; mean rho = 0.934, SD = 0.03, p < 0.05) relationship between all items within the questionnaire. In addition, satisfactory internal consistency was demonstrated via Cronbach's 'α'. Furthermore, clients responded favourably towards the usability, wording and applicability of the instrument's items. Conclusion REFERQUAL is considered to represent promise as a suitable tool for future evaluation of service quality within the ERS community. Future research should further assess the validity and reliability of this instrument through the use of a confirmatory factor analysis to scrutinise the proposed dimensional structure. PMID:16725021

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

A hybrid Lagrangian Voronoi-SPH scheme

Science.gov (United States)

Fernandez-Gutierrez, D.; Souto-Iglesias, A.; Zohdi, T. I.

2017-11-01

A hybrid Lagrangian Voronoi-SPH scheme, with an explicit weakly compressible formulation for both the Voronoi and SPH sub-domains, has been developed. The SPH discretization is substituted by Voronoi elements close to solid boundaries, where SPH consistency and boundary conditions implementation become problematic. A buffer zone to couple the dynamics of both sub-domains is used. This zone is formed by a set of particles where fields are interpolated taking into account SPH particles and Voronoi elements. A particle may move in or out of the buffer zone depending on its proximity to a solid boundary. The accuracy of the coupled scheme is discussed by means of a set of well-known verification benchmarks.

The effects of China's urban basic medical insurance schemes on the equity of health service utilisation: evidence from Shaanxi Province.

Science.gov (United States)

Zhou, Zhongliang; Zhu, Liang; Zhou, Zhiying; Li, Zhengya; Gao, Jianmin; Chen, Gang

2014-03-09

In order to alleviate the problem of "Kan Bing Nan, Kan Bing Gui" (medical treatment is difficult to access and expensive) and improve the equity of health service utilisation for urban residents in China, the Urban Employee Basic Medical Insurance scheme (UEBMI) and Urban Resident Basic Medical Insurance scheme (URBMI) were established in 1999 and 2007, respectively. This study aims to analyse the effects of UEBMI and URBMI on the equity of outpatient and inpatient utilisation in Shaanxi Province, China. Using the data from the fourth National Health Services Survey in Shaanxi Province, the method of Propensity Score Matching was employed to generate comparable samples between the insured and uninsured residents, through a one-to-one match algorithm. Next, based on the matched data, the method of decomposition of the concentration index was employed to compare the horizontal inequity indexes of health service utilisation between the UEBMI/URBMI insured and the matched uninsured residents. For the UEBMI insured and matched uninsured residents, the horizontal inequity indexes of outpatient visits are 0.1256 and -0.0511 respectively, and the horizontal inequity indexes of inpatient visits are 0.1222 and 0.2746 respectively. Meanwhile, the horizontal inequity indexes of outpatient visits are -0.1593 and 0.0967 for the URBMI insured and matched uninsured residents, and the horizontal inequity indexes of inpatient visits are 0.1931 and 0.3199 respectively. The implementation of UEBMI increased the pro-rich inequity of outpatient utilisation (rich people utilise outpatient facilities more than the poor people) and the implementation of URBMI increased the pro-poor inequity of outpatient utilisation. Both of these two health insurance schemes reduced the pro-rich inequity of inpatient utilisation.

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.

Resident career planning needs in internal medicine: a qualitative assessment.

Science.gov (United States)

Garcia, Rina L; Windish, Donna M; Rosenbaum, Julie R

2010-12-01

Few residency programs have centralized resources for career planning. As a consequence, little is known about residents' informational needs regarding career planning. To examine career preparation stressors, practical needs, and information that residents wished they were privy to when applying. In 2007 and 2008, we surveyed 163 recent graduates or graduating residents from 10 Yale-based and Yale-affiliated hospitals' internal medicine programs regarding their experiences with applying for positions after residency. We included questions about demographics, mentorship, stress of finding a job or fellowship, and open-ended questions to assess barriers and frustrations. Qualitative data were coded independently and a classification scheme was negotiated by consensus. A total of 89 residents or recent graduates responded, and 75% of them found career planning during residency training at least somewhat stressful. Themes regarding the application process included (1) knowledge about the process, (2) knowledge about career paths and opportunities, (3) time factors, (4) importance of adequate personal guidance and mentorship, and (5) self-knowledge regarding priorities and the desired outcome. Residents identified the following advice as most important: (1) start the process as early as possible and with a clear knowledge of the process timeline, (2) be clear about personal goals and priorities, and (3) be well-informed about a prospective employer and what that employer is looking for. Most residents felt career planning should be structured into the curriculum and should occur in the first year or throughout residency. This study highlights residents' desire for structured dissemination of information and counseling with regard to career planning during residency. Our data suggest that exposure to such resources may be beneficial as early as the first year of training.

Mobile Application Use Among Obstetrics and Gynecology Residents.

Science.gov (United States)

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

2017-10-01

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

Resident transitions to assisted living: a role for social workers.

Science.gov (United States)

Fields, Noelle LeCrone; Koenig, Terry; Dabelko-Schoeny, Holly

2012-08-01

This study explored key aspects of resident transitions to assisted living (AL), including the frequency and importance of preadmission resident education and the potential role of social workers in this setting. To examine the factors that may help or hinder resident transitions to AL, a written survey was administered to a statewide, geographically representative purposive sample of Medicaid Assisted Living Waiver providers (N = 28). Findings suggest a positive relationship between the availability of a social worker and the frequency and importance of resident preadmission education in several areas. Results also suggest a gap between what AL providers believe is important for resident transitions and what is actually happening in their facilities. Social workers may play a significant role in providing preadmission education and are well positioned to address the unmet psychosocial needs of residents and family members during the transition to AL. Future studies should specifically examine the contributing role of social workers during the period of adjustment to AL and the effect of social work services on the well-being of AL residents and families in AL settings.

Additive operator-difference schemes splitting schemes

CERN Document Server

Vabishchevich, Petr N

2013-01-01

Applied mathematical modeling isconcerned with solving unsteady problems. This bookshows how toconstruct additive difference schemes to solve approximately unsteady multi-dimensional problems for PDEs. Two classes of schemes are highlighted: methods of splitting with respect to spatial variables (alternating direction methods) and schemes of splitting into physical processes. Also regionally additive schemes (domain decomposition methods)and unconditionally stable additive schemes of multi-component splitting are considered for evolutionary equations of first and second order as well as for sy

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

NARCIS (Netherlands)

Trompetter, H.R.; Trompetter, Hester; Scholte, Ron; Westerhof, Gerben Johan

2011-01-01

Purpose: 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

The Political Economy of International Emissions Trading Scheme Choice

DEFF Research Database (Denmark)

Boom, Jan-Tjeerd; Svendsen, Jan Tinggard

2000-01-01

The Kyoto Protocol allows emission trade between the Annex B countries. We consider three schemes of emissions trading: government trading, permit trading and credit trading. The schemes are compared in a public choice setting focusing on group size and rent-seeking from interest groups. We find ...

Certificateless Key-Insulated Generalized Signcryption Scheme without Bilinear Pairings

Directory of Open Access Journals (Sweden)

Caixue Zhou

2017-01-01

Full Text Available Generalized signcryption (GSC can be applied as an encryption scheme, a signature scheme, or a signcryption scheme with only one algorithm and one key pair. A key-insulated mechanism can resolve the private key exposure problem. To ensure the security of cloud storage, we introduce the key-insulated mechanism into GSC and propose a concrete scheme without bilinear pairings in the certificateless cryptosystem setting. We provide a formal definition and a security model of certificateless key-insulated GSC. Then, we prove that our scheme is confidential under the computational Diffie-Hellman (CDH assumption and unforgeable under the elliptic curve discrete logarithm (EC-DL assumption. Our scheme also supports both random-access key update and secure key update. Finally, we evaluate the efficiency of our scheme and demonstrate that it is highly efficient. Thus, our scheme is more suitable for users who communicate with the cloud using mobile devices.

Scheme-Independent Predictions in QCD: Commensurate Scale Relations and Physical Renormalization Schemes

International Nuclear Information System (INIS)

Brodsky, Stanley J.

1998-01-01

Commensurate scale relations are perturbative QCD predictions which relate observable to observable at fixed relative scale, such as the ''generalized Crewther relation'', which connects the Bjorken and Gross-Llewellyn Smith deep inelastic scattering sum rules to measurements of the e + e - annihilation cross section. All non-conformal effects are absorbed by fixing the ratio of the respective momentum transfer and energy scales. In the case of fixed-point theories, commensurate scale relations relate both the ratio of couplings and the ratio of scales as the fixed point is approached. The relations between the observables are independent of the choice of intermediate renormalization scheme or other theoretical conventions. Commensurate scale relations also provide an extension of the standard minimal subtraction scheme, which is analytic in the quark masses, has non-ambiguous scale-setting properties, and inherits the physical properties of the effective charge α V (Q 2 ) defined from the heavy quark potential. The application of the analytic scheme to the calculation of quark-mass-dependent QCD corrections to the Z width is also reviewed

A numerical scheme for the generalized Burgers–Huxley equation

Directory of Open Access Journals (Sweden)

Brajesh K. Singh

2016-10-01

Full Text Available In this article, a numerical solution of generalized Burgers–Huxley (gBH equation is approximated by using a new scheme: modified cubic B-spline differential quadrature method (MCB-DQM. The scheme is based on differential quadrature method in which the weighting coefficients are obtained by using modified cubic B-splines as a set of basis functions. This scheme reduces the equation into a system of first-order ordinary differential equation (ODE which is solved by adopting SSP-RK43 scheme. Further, it is shown that the proposed scheme is stable. The efficiency of the proposed method is illustrated by four numerical experiments, which confirm that obtained results are in good agreement with earlier studies. This scheme is an easy, economical and efficient technique for finding numerical solutions for various kinds of (nonlinear physical models as compared to the earlier schemes.

Resident partnerships: an effective strategy for training in primary care.

Science.gov (United States)

Adam, P; Williamson, H A; Zweig, S C; Delzell, J E

1997-06-01

To facilitate resident training in the ambulatory setting, a few family practice residency programs use a partnership system to train residents. Partnerships are pairs of residents from the same year that rotate together on inpatient services. We identified and characterized the advantages and disadvantages of partnership programs in family practice residencies. We conducted a national survey of family practice residencies, followed by phone interviews with residency directors of programs with partnerships. A total of 305 of 407 (75%) residencies responded; 10 programs fit our definition of partnership. Program directors were positive about resident partnerships. Benefits included improved outpatient continuity, enhanced medical communication skills, and emotional and intellectual support. Disadvantages were decreased inpatient exposure and difficulty coordinating residents' schedules. Directors were favorable about partnerships, which seem to be an underutilized technique to improve residency training.

Resident Transitions to Assisted Living: A Role for Social Workers

Science.gov (United States)

Fields, Noelle LeCrone; Koenig, Terry; Dabelko-Schoeny, Holly

2012-01-01

This study explored key aspects of resident transitions to assisted living (AL), including the frequency and importance of preadmission resident education and the potential role of social workers in this setting. To examine the factors that may help or hinder resident transitions to AL, a written survey was administered to a statewide,…

Modifiable factors related to abusive behaviors in nursing home residents with dementia

NARCIS (Netherlands)

Volicer, L.; Kampen, van J.T.; Frijters, D.H.M.

2009-01-01

OBJECTIVES: To determine modifiable factors related to abusive behaviors in nursing home residents with dementia. DESIGN: Analysis of Minimum Data Set (MDS) of the Resident Assessment Instrument (RAI) information. SETTING: We used MDS-RAI data from 8 Dutch nursing homes and 10 residential homes that

The effects of China’s urban basic medical insurance schemes on the equity of health service utilisation: evidence from Shaanxi Province

Science.gov (United States)

2014-01-01

Introduction In order to alleviate the problem of “Kan Bing Nan, Kan Bing Gui” (medical treatment is difficult to access and expensive) and improve the equity of health service utilisation for urban residents in China, the Urban Employee Basic Medical Insurance scheme (UEBMI) and Urban Resident Basic Medical Insurance scheme (URBMI) were established in 1999 and 2007, respectively. This study aims to analyse the effects of UEBMI and URBMI on the equity of outpatient and inpatient utilisation in Shaanxi Province, China. Methods Using the data from the fourth National Health Services Survey in Shaanxi Province, the method of Propensity Score Matching was employed to generate comparable samples between the insured and uninsured residents, through a one-to-one match algorithm. Next, based on the matched data, the method of decomposition of the concentration index was employed to compare the horizontal inequity indexes of health service utilisation between the UEBMI/URBMI insured and the matched uninsured residents. Results For the UEBMI insured and matched uninsured residents, the horizontal inequity indexes of outpatient visits are 0.1256 and -0.0511 respectively, and the horizontal inequity indexes of inpatient visits are 0.1222 and 0.2746 respectively. Meanwhile, the horizontal inequity indexes of outpatient visits are -0.1593 and 0.0967 for the URBMI insured and matched uninsured residents, and the horizontal inequity indexes of inpatient visits are 0.1931 and 0.3199 respectively. Conclusions The implementation of UEBMI increased the pro-rich inequity of outpatient utilisation (rich people utilise outpatient facilities more than the poor people) and the implementation of URBMI increased the pro-poor inequity of outpatient utilisation. Both of these two health insurance schemes reduced the pro-rich inequity of inpatient utilisation. PMID:24606592

Joint multiuser switched diversity and adaptive modulation schemes for spectrum sharing systems

KAUST Repository

Qaraqe, Marwa

2012-12-01

In this paper, we develop multiuser access schemes for spectrum sharing systems whereby secondary users are allowed to share the spectrum with primary users under the condition that the interference observed at the primary receiver is below a predetermined threshold. In particular, we devise two schemes for selecting a user among those that satisfy the interference constraint and achieve an acceptable signal-to-noise ratio level. The first scheme selects the user that reports the best channel quality. In order to alleviate the high feedback load associated with the first scheme, we develop a second scheme based on the concept of switched diversity where the base station scans the users in a sequential manner until an acceptable user is found. In addition to these two selection schemes, we consider two power adaptive settings at the secondary users based on the amount of interference available at the secondary transmitter. In the On/Off power setting, users are allowed to transmit based on whether the interference constraint is met or not, while in the full power adaptive setting, the users are allowed to vary their transmission power to satisfy the interference constraint. Finally, we present numerical results for our proposed algorithms where we show the trade-off between the average spectral efficiency and average feedback load for both schemes. © 2012 IEEE.

Joint multiuser switched diversity and adaptive modulation schemes for spectrum sharing systems

KAUST Repository

Qaraqe, Marwa; Abdallah, Mohamed M.; Serpedin, Erchin; Alouini, Mohamed-Slim; Alnuweiri, Hussein M.

2012-01-01

In this paper, we develop multiuser access schemes for spectrum sharing systems whereby secondary users are allowed to share the spectrum with primary users under the condition that the interference observed at the primary receiver is below a predetermined threshold. In particular, we devise two schemes for selecting a user among those that satisfy the interference constraint and achieve an acceptable signal-to-noise ratio level. The first scheme selects the user that reports the best channel quality. In order to alleviate the high feedback load associated with the first scheme, we develop a second scheme based on the concept of switched diversity where the base station scans the users in a sequential manner until an acceptable user is found. In addition to these two selection schemes, we consider two power adaptive settings at the secondary users based on the amount of interference available at the secondary transmitter. In the On/Off power setting, users are allowed to transmit based on whether the interference constraint is met or not, while in the full power adaptive setting, the users are allowed to vary their transmission power to satisfy the interference constraint. Finally, we present numerical results for our proposed algorithms where we show the trade-off between the average spectral efficiency and average feedback load for both schemes. © 2012 IEEE.

Newborn well-child visits in the home setting: a pilot study in a family medicine residency.

Science.gov (United States)

Lakin, Ashley; Sutter, Mary Beth; Magee, Susanna

2015-03-01

The purpose of our study was to pilot a home visit program targeting neonates conducted by family medicine residents. While the literature shows that home visit programs are successful at preventing adverse outcomes for young children, such as improving parenting practices and promoting breastfeeding, no data exist about newborn home visits conducted by resident physicians. Residents conducted newborn home visits precepted by a family medicine faculty member from June 2012--May 2013. Subjects were recruited from the residency continuity practice and randomized to receive two home visits (which replaced two office visits) or routine office-based newborn care. All participants were surveyed using the validated WHOQOL-BREF quality of life scale and a patient satisfaction instrument. Metrics were also obtained from the electronic medical record. Mothers and resident physicians completed an open-ended questionnaire about their experience. All patients, whether receiving office-based or home-based care, rated their care highly. Significant differences were seen in usage of acute care in the first 6 months of life, and mothers in the home visit group trended toward initiating breastfeeding at a higher rate. The home visit group ranked their quality of life higher across all domains when compared to the control group, approaching statistical significance in two domains. Residents providing home visits reported increased connectedness to patients and improved confidence in anticipatory guidance delivery. Home visits are valuable for families with newborns, in terms of minimizing acute care service usage, breastfeeding promotion, and perhaps increasing maternal perceptions of well-being. A home visit program has the potential to enhance resident education and the doctor-patient relationship.

Cooperative learning as applied to resident instruction in radiology reporting.

Science.gov (United States)

Mueller, Donald; Georges, Alexandra; Vaslow, Dale

2007-12-01

The study is designed to evaluate the effectiveness of an active form of resident instruction, cooperative learning, and the residents' response to that form of instruction. The residents dictated three sets of reports both before and after instruction in radiology reporting using the cooperative learning method. The reports were evaluated for word count, Flesch-Kincaid grade level, advancement on clinical spectrum, clarity, and comparison to prior reports. The reports were evaluated for changes in performance characteristics between the pre- and postinstruction dictations. The residents' response to this form of instruction was evaluated by means of a questionnaire. The instruction was effective in changing the resident dictations. The results became shorter (Pcooperative learning activities. The least positive responses related to the amount of time devoted to the project. Sixty-three percent of respondents stated that the time devoted to the project was appropriate. Cooperative learning can be an effective tool in the setting of the radiology residency. Instructional time requirements must be strongly considered in designing a cooperative learning program.

Adaptive PCA based fault diagnosis scheme in imperial smelting process.

Science.gov (United States)

Hu, Zhikun; Chen, Zhiwen; Gui, Weihua; Jiang, Bin

2014-09-01

In this paper, an adaptive fault detection scheme based on a recursive principal component analysis (PCA) is proposed to deal with the problem of false alarm due to normal process changes in real process. Our further study is also dedicated to develop a fault isolation approach based on Generalized Likelihood Ratio (GLR) test and Singular Value Decomposition (SVD) which is one of general techniques of PCA, on which the off-set and scaling fault can be easily isolated with explicit off-set fault direction and scaling fault classification. The identification of off-set and scaling fault is also applied. The complete scheme of PCA-based fault diagnosis procedure is proposed. The proposed scheme is first applied to Imperial Smelting Process, and the results show that the proposed strategies can be able to mitigate false alarms and isolate faults efficiently. Copyright © 2013 ISA. Published by Elsevier Ltd. All rights reserved.

Reflections in a time of transition: orthopaedic faculty and resident understanding of accreditation schemes and opinions on surgical skills feedback

Directory of Open Access Journals (Sweden)

Kenneth R. Gundle

2016-04-01

Full Text Available Introduction: Orthopaedic surgery is one of the first seven specialties that began collecting Milestone data as part of the Accreditation Council for Graduate Medical Education's Next Accreditation System (NAS rollout. This transition from process-based advancement to outcome-based education is an opportunity to assess resident and faculty understanding of changing paradigms, and opinions about technical skill evaluation. Methods: In a large academic orthopaedic surgery residency program, residents and faculty were anonymously surveyed. A total of 31/32 (97% residents and 29/53 (55% faculty responded to Likert scale assessments and provided open-ended responses. An internal end-of-rotation audit was conducted to assess timeliness of evaluations. A mixed-method analysis was utilized, with nonparametric statistical testing and a constant-comparative qualitative method. Results: There was greater familiarity with the six core competencies than with Milestones or the NAS (p<0.05. A majority of faculty and residents felt that end-of-rotation evaluations were not adequate for surgical skills feedback. Fifty-eight per cent of residents reported that end-of-rotation evaluations were rarely or never filled out in a timely fashion. An internal audit demonstrated that more than 30% of evaluations were completed over a month after rotation end. Qualitative analysis included themes of resident desire for more face-to-face feedback on technical skills after operative cases, and several barriers to more frequent feedback. Discussion: The NAS and outcome-based education have arrived. Residents and faculty need to be educated on this changing paradigm. This transition period is also a window of opportunity to address methods of evaluation and feedback. In our orthopaedic residency, trainees were significantly less satisfied than faculty with the amount of technical and surgical skills feedback being provided to trainees. The quantitative and qualitative analyses

New Imaging Operation Scheme at VLTI

Science.gov (United States)

Haubois, Xavier

2018-04-01

After PIONIER and GRAVITY, MATISSE will soon complete the set of 4 telescope beam combiners at VLTI. Together with recent developments in the image reconstruction algorithms, the VLTI aims to develop its operation scheme to allow optimized and adaptive UV plane coverage. The combination of spectro-imaging instruments, optimized operation framework and image reconstruction algorithms should lead to an increase of the reliability and quantity of the interferometric images. In this contribution, I will present the status of this new scheme as well as possible synergies with other instruments.

Internal Medicine Residents' Perceptions of Cross-Cultural Training

Science.gov (United States)

Park, Elyse R; Betancourt, Joseph R; Miller, Elizabeth; Nathan, Michael; MacDonald, Ellie; Ananeh-Firempong, Owusu; Stone, Valerie E

2006-01-01

BACKGROUND Physicians increasingly face the challenge of managing clinical encounters with patients from a range of cultural backgrounds. Despite widespread interest in cross-cultural care, little is known about resident physicians' perceptions of what will best enable them to provide quality care to diverse patient populations. OBJECTIVES To assess medicine residents' (1) perceptions of cross-cultural care, (2) barriers to care, and (3) training experiences and recommendations. DESIGN, SETTING, AND PATIENTS Qualitative individual interviews were conducted with 26 third-year medicine residents at Massachusetts General Hospital in Boston (response rate = 87%). Interviews were recorded, transcribed, and analyzed. RESULTS Despite significant interest in cross-cultural care, almost all of the residents reported very little training during residency. Most had gained cross-cultural skills through informal learning. A few were skeptical about formal training, and some expressed concern that it is impossible to understand every culture. Challenges to the delivery of cross-cultural care included managing patients with limited English proficiency, who involve family in critical decision making, and who have beliefs about disease that vary from the biomedical model. Residents cited many implications to these barriers, ranging from negatively impacting the patient-physician relationship to compromised care. Training recommendations included making changes to the educational climate and informal and formal training mechanisms. CONCLUSIONS If cross-cultural education is to be successful, it must take into account residents' perspectives and be focused on overcoming residents' cited barriers. It is important to convey that cross-cultural education is a set of skills that can be taught and applied, in a time-efficient manner, rather than requiring an insurmountable knowledge base. PMID:16704391

The "zing factor"-how do faculty describe the best pediatrics residents?

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Rosenbluth, Glenn; O'Brien, Bridget; Asher, Emily M; Cho, Christine S

2014-03-01

Faculty in graduate medical education programs may not have uniform approaches to differentiating the quality of residents, and reviews of evaluations suggest that faculty use different standards when assessing residents. Standards for assessing residents also do not consistently map to items on evaluation forms. One way to improve assessment is to reach consensus on the traits and behaviors that are (or should be) present in the best residents. A trained interviewer conducted semistructured interviews with faculty affiliated with 2 pediatrics residency programs until content saturation was achieved. Interviewees were asked to describe specific traits present in residents they identify as the best. Interviews were recorded and transcribed. We used an iterative, inductive approach to generate a coding scheme and identify common themes. From 23 interviews, we identified 7 thematic categories of traits and behaviors: personality, energy, professionalism, team behaviors, self-improvement behaviors, patient-interaction behaviors, and medical knowledge and clinical skills (including a subcategory, knowledge integration). Most faculty interviewees focused on traits like passion, enthusiasm, maturity, and reliability. Examination score or intelligence was mentioned less frequently than traits and behaviors categorized under personality and professionalism. Faculty identified many traits and behaviors in the residents they define as the best. The thematic categories had incomplete overlap with Accreditation Council for Graduate Medical Education (ACGME) and CanMEDS competencies. This research highlights the ongoing need to review our assessment strategies, and may have implications for the ACGME Milestone Project.

Accuracy of spectral and finite difference schemes in 2D advection problems

DEFF Research Database (Denmark)

Naulin, V.; Nielsen, A.H.

2003-01-01

In this paper we investigate the accuracy of two numerical procedures commonly used to solve 2D advection problems: spectral and finite difference (FD) schemes. These schemes are widely used, simulating, e.g., neutral and plasma flows. FD schemes have long been considered fast, relatively easy...... that the accuracy of FD schemes can be significantly improved if one is careful in choosing an appropriate FD scheme that reflects conservation properties of the nonlinear terms and in setting up the grid in accordance with the problem....

A national review of the frequency of minimally invasive surgery among general surgery residents: assessment of ACGME case logs during 2 decades of general surgery resident training.

Science.gov (United States)

Richards, Morgan K; McAteer, Jarod P; Drake, F Thurston; Goldin, Adam B; Khandelwal, Saurabh; Gow, Kenneth W

2015-02-01

Minimally invasive surgery (MIS) has created a shift in how many surgical diseases are treated. Examining the effect on resident operative experience provides valuable insight into trends that may be useful for restructuring the requirements of resident training. To evaluate changes in general surgery resident operative experience regarding MIS. Retrospective review of the frequency of MIS relative to open operations among general surgery residents using the Accreditation Council for Graduate Medical Education case logs for academic years 1993-1994 through 2011-2012. General surgery residency training among accredited programs in the United States. We analyzed the difference in the mean number of MIS techniques and corresponding open procedures across training periods using 2-tailed t tests with statistical significance set at P surgery has an increasingly prominent role in contemporary surgical therapy for many common diseases. The open approach, however, still predominates in all but 5 procedures. Residents today must become efficient at performing multiple techniques for a single procedure, which demands a broader skill set than in the past.

Accuracy of electrocardiogram reading by family practice residents.

Science.gov (United States)

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

2000-05-01

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

First UHF Implementation of the Incremental Scheme for Open-Shell Systems.

Science.gov (United States)

Anacker, Tony; Tew, David P; Friedrich, Joachim

2016-01-12

The incremental scheme makes it possible to compute CCSD(T) correlation energies to high accuracy for large systems. We present the first extension of this fully automated black-box approach to open-shell systems using an Unrestricted Hartree-Fock (UHF) wave function, extending the efficient domain-specific basis set approach to handle open-shell references. We test our approach on a set of organic and metal organic structures and molecular clusters and demonstrate standard deviations from canonical CCSD(T) values of only 1.35 kJ/mol using a triple ζ basis set. We find that the incremental scheme is significantly more cost-effective than the canonical implementation even for relatively small systems and that the ease of parallelization makes it possible to perform high-level calculations on large systems in a few hours on inexpensive computers. We show that the approximations that make our approach widely applicable are significantly smaller than both the basis set incompleteness error and the intrinsic error of the CCSD(T) method, and we further demonstrate that incremental energies can be reliably used in extrapolation schemes to obtain near complete basis set limit CCSD(T) reaction energies for large systems.

Analysis of PGY-1 Pharmacy Resident Candidate Letters of Recommendation at an Academically Affiliated Residency Program.

Science.gov (United States)

McLaughlin, Milena M; Masic, Dalila; Gettig, Jacob P

2018-04-01

Letters of recommendation (LORs) are a critical component for differentiating among similarly qualified pharmacy residency candidates. These letters contain information that is difficult to ascertain from curricula vitae and pharmacy school transcripts. LOR writers may use any words or phrases appropriate for each candidate as there is no set framework for LORs. The objective of this study was to characterize descriptive themes in postgraduate year 1 (PGY-1) pharmacy residency candidates' LORs and to examine which themes of PGY-1 pharmacy residency candidates' LORs are predictive of an interview invitation at an academically affiliated residency program. LORs for candidates from the Pharmacy Online Residency Centralized Application System (PhORCAS) from 2013 and 2014 for the Midwestern University PGY-1 Pharmacy Residency were analyzed. LOR characteristics and descriptive themes were collected. All scores for candidate characteristics and overall PhORCAS recommendation were also recorded. A total of 351 LORs for 111 candidates from 2013 (n = 47 candidates) and 2014 (n = 64 candidates) were analyzed; 36 (32.4%) total candidates were offered an interview. Themes that were identified as predictors of an interview included a higher median (interquartile range) number of standout words (3 words [1.3-4] vs 3.8 words [2.5-5.5], P < .01) and teaching references (3.7 words [2.7-6] vs 5.7 words [3.7-7.8], P = .01). For this residency program, standout words and teaching references were important when offering interviews.

Resident duty hours in Canada: a survey and national statement.

Science.gov (United States)

Masterson, Mark F; Shrichand, Pankaj; Maniate, Jerry M

2014-01-01

Physicians in general, and residents in particular, are adapting to duty schedules in which they have fewer continuous work hours; however, there are no Canadian guidelines on duty hours restrictions. To better inform resident duty hour policy in Canada, we set out to prepare a set of recommendations that would draw upon evidence reported in the literature and reflect the experiences of resident members of the Canadian Association of Internes and Residents (CAIR). A survey was prepared and distributed electronically to all resident members of CAIR. A total of 1796 eligible residents participated in the survey. Of those who responded, 38% (601) reported that they felt they could safely provide care for up to 16 continuous hours, and 20% (315) said that 12 continuous hours was the maximum period during which they could safely provide care (n=1592). Eighty-two percent (1316) reported their perception that the quality of care they had provided suffered because of the number of consecutive hours worked (n=1598). Only 52% (830) had received training in handover (n=1594); those who had received such training reported that it was commonly provided through informal modelling. On the basis of these data and the existing literature, CAIR recommends that resident duty hours be managed in a way that does not endanger the health of residents or patients; does not impair education; is flexible; and does not violate ethical or legal standards. Further, residents should be formally trained in handover skills and alternative duty hour models.

An efficient numerical progressive diagonalization scheme for the quantum Rabi model revisited

International Nuclear Information System (INIS)

Pan, Feng; Bao, Lina; Dai, Lianrong; Draayer, Jerry P

2017-01-01

An efficient numerical progressive diagonalization scheme for the quantum Rabi model is revisited. The advantage of the scheme lies in the fact that the quantum Rabi model can be solved almost exactly by using the scheme that only involves a finite set of one variable polynomial equations. The scheme is especially efficient for a specified eigenstate of the model, for example, the ground state. Some low-lying level energies of the model for several sets of parameters are calculated, of which one set of the results is compared to that obtained from the Braak’s exact solution proposed recently. It is shown that the derivative of the entanglement measure defined in terms of the reduced von Neumann entropy with respect to the coupling parameter does reach the maximum near the critical point deduced from the classical limit of the Dicke model, which may provide a probe of the critical point of the crossover in finite quantum many-body systems, such as that in the quantum Rabi model. (paper)

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

Science.gov (United States)

Schwartz, C; Rabinovitz, S

2003-02-01

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

Mammography image assessment; validity and reliability of current scheme

International Nuclear Information System (INIS)

Hill, C.; Robinson, L.

2015-01-01

Mammographers currently score their own images according to criteria set out by Regional Quality Assurance. The criteria used are based on the ‘Perfect, Good, Moderate, Inadequate’ (PGMI) marking criteria established by the National Health Service Breast Screening Programme (NHSBSP) in their Quality Assurance Guidelines of 2006 1 . This document discusses the validity and reliability of the current mammography image assessment scheme. Commencing with a critical review of the literature this document sets out to highlight problems with the national approach to the use of marking schemes. The findings suggest that ‘PGMI’ scheme is flawed in terms of reliability and validity and is not universally applied across the UK. There also appear to be differences in schemes used by trainees and qualified mammographers. Initial recommendations are to be made in collaboration with colleagues within the National Health Service Breast Screening Programme (NHSBSP), Higher Education Centres, College of Radiographers and the Royal College of Radiologists in order to identify a mammography image appraisal scheme that is fit for purpose. - Highlights: • Currently no robust evidence based marking tools in use for the assessment of images in mammography. • Is current system valid, reliable and robust? • How can the current image assessment tool be improved? • Should students and qualified mammographers use the same tool? • What marking criteria are available for image assessment?

Decentralized Economic Dispatch Scheme With Online Power Reserve for Microgrids

DEFF Research Database (Denmark)

Nutkani, I. U.; Loh, Poh Chiang; Wang, P.

2017-01-01

Decentralized economic operation schemes have several advantages when compared with the traditional centralized management system for microgrids. Specifically, decentralized schemes are more flexible, less computationally intensive, and easier to implement without relying on communication...... costs, their power ratings, and other necessary constraints, before deciding the DG dispatch priorities and droop characteristics. The proposed scheme also allows online power reserve to be set and regulated within the microgrid. This, together with the generation cost saved, has been verified...... infrastructure. Economic operation of existing decentralized schemes is also usually achieved by either tuning the droop characteristics of distributed generators (DGs) or prioritizing their dispatch order. For the latter, an earlier scheme has tried to prioritize the DG dispatch based on their no...

Identification of facilitators and barriers to residents' use of a clinical reasoning tool.

Science.gov (United States)

DiNardo, Deborah; Tilstra, Sarah; McNeil, Melissa; Follansbee, William; Zimmer, Shanta; Farris, Coreen; Barnato, Amber E

2018-03-28

While there is some experimental evidence to support the use of cognitive forcing strategies to reduce diagnostic error in residents, the potential usability of such strategies in the clinical setting has not been explored. We sought to test the effect of a clinical reasoning tool on diagnostic accuracy and to obtain feedback on its usability and acceptability. We conducted a randomized behavioral experiment testing the effect of this tool on diagnostic accuracy on written cases among post-graduate 3 (PGY-3) residents at a single internal medical residency program in 2014. Residents completed written clinical cases in a proctored setting with and without prompts to use the tool. The tool encouraged reflection on concordant and discordant aspects of each case. We used random effects regression to assess the effect of the tool on diagnostic accuracy of the independent case sets, controlling for case complexity. We then conducted audiotaped structured focus group debriefing sessions and reviewed the tapes for facilitators and barriers to use of the tool. Of 51 eligible PGY-3 residents, 34 (67%) participated in the study. The average diagnostic accuracy increased from 52% to 60% with the tool, a difference that just met the test for statistical significance in adjusted analyses (p=0.05). Residents reported that the tool was generally acceptable and understandable but did not recognize its utility for use with simple cases, suggesting the presence of overconfidence bias. A clinical reasoning tool improved residents' diagnostic accuracy on written cases. Overconfidence bias is a potential barrier to its use in the clinical setting.

Analysis of multi drug resistant tuberculosis (MDR-TB) financial protection policy: MDR-TB health insurance schemes, in Chhattisgarh state, India.

Science.gov (United States)

Kundu, Debashish; Sharma, Nandini; Chadha, Sarabjit; Laokri, Samia; Awungafac, George; Jiang, Lai; Asaria, Miqdad

2018-01-27

There are significant financial barriers to access treatment for multi drug resistant tuberculosis (MDR-TB) in India. To address these challenges, Chhattisgarh state in India has established a MDR-TB financial protection policy by creating MDR-TB benefit packages as part of the universal health insurance scheme that the state has rolled out in their effort towards attaining Universal Health Coverage for all its residents. In these schemes the state purchases health insurance against set packages of services from third party health insurance agencies on behalf of all its residents. Provider payment reform by strategic purchasing through output based payments (lump sum fee is reimbursed as per the MDR-TB benefit package rates) to the providers - both public and private health facilities empanelled under the insurance scheme was the key intervention. To understand the implementation gap between policy and practice of the benefit packages with respect to equity in utilization of package claims by the poor patients in public and private sector. Data from primary health insurance claims from January 2013 to December 2015, were analysed using an extension of 'Kingdon's multiple streams for policy implementation framework' to explain the implementation gap between policy and practice of the MDR-TB benefit packages. The total number of claims for MDR-TB benefit packages increased over the study period mainly from poor patients treated in public facilities, particularly for the pre-treatment evaluation and hospital stay packages. Variations and inequities in utilizing the packages were observed between poor and non-poor beneficiaries in public and private sector. Private providers participation in the new MDR-TB financial protection mechanism through the universal health insurance scheme was observed to be much lower than might be expected given their share of healthcare provision overall in India. Our findings suggest that there may be an implementation gap due to weak

A Layered Searchable Encryption Scheme with Functional Components Independent of Encryption Methods

Science.gov (United States)

Luo, Guangchun; Qin, Ke

2014-01-01

Searchable encryption technique enables the users to securely store and search their documents over the remote semitrusted server, which is especially suitable for protecting sensitive data in the cloud. However, various settings (based on symmetric or asymmetric encryption) and functionalities (ranked keyword query, range query, phrase query, etc.) are often realized by different methods with different searchable structures that are generally not compatible with each other, which limits the scope of application and hinders the functional extensions. We prove that asymmetric searchable structure could be converted to symmetric structure, and functions could be modeled separately apart from the core searchable structure. Based on this observation, we propose a layered searchable encryption (LSE) scheme, which provides compatibility, flexibility, and security for various settings and functionalities. In this scheme, the outputs of the core searchable component based on either symmetric or asymmetric setting are converted to some uniform mappings, which are then transmitted to loosely coupled functional components to further filter the results. In such a way, all functional components could directly support both symmetric and asymmetric settings. Based on LSE, we propose two representative and novel constructions for ranked keyword query (previously only available in symmetric scheme) and range query (previously only available in asymmetric scheme). PMID:24719565

Machiavelli and the Chief Resident.

Science.gov (United States)

Raviglione, Mario C.

1990-01-01

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

Preparing Emergency Medicine Residents to Disclose Medical Error Using Standardized Patients

Directory of Open Access Journals (Sweden)

Carmen N. Spalding

2017-12-01

Full Text Available Introduction Emergency Medicine (EM is a unique clinical learning environment. The American College of Graduate Medical Education Clinical Learning Environment Review Pathways to Excellence calls for “hands-on training” of disclosure of medical error (DME during residency. Training and practicing key elements of DME using standardized patients (SP may enhance preparedness among EM residents in performing this crucial skill in a clinical setting. Methods This training was developed to improve resident preparedness in DME in the clinical setting. Objectives included the following: the residents will be able to define a medical error; discuss ethical and professional standards of DME; recognize common barriers to DME; describe key elements in effective DME to patients and families; and apply key elements during a SP encounter. The four-hour course included didactic and experiential learning methods, and was created collaboratively by core EM faculty and subject matter experts in conflict resolution and healthcare simulation. Educational media included lecture, video exemplars of DME communication with discussion, small group case-study discussion, and SP encounters. We administered a survey assessing for preparedness in DME pre-and post-training. A critical action checklist was administered to assess individual performance of key elements of DME during the evaluated SP case. A total of 15 postgraduate-year 1 and 2 EM residents completed the training. Results After the course, residents reported increased comfort with and preparedness in performing several key elements in DME. They were able to demonstrate these elements in a simulated setting using SP. Residents valued the training, rating the didactic, SP sessions, and overall educational experience very high. Conclusion Experiential learning using SP is effective in improving resident knowledge of and preparedness in performing medical error disclosure. This educational module can be adapted

Building Secure Public Key Encryption Scheme from Hidden Field Equations

Directory of Open Access Journals (Sweden)

Yuan Ping

2017-01-01

Full Text Available Multivariate public key cryptography is a set of cryptographic schemes built from the NP-hardness of solving quadratic equations over finite fields, amongst which the hidden field equations (HFE family of schemes remain the most famous. However, the original HFE scheme was insecure, and the follow-up modifications were shown to be still vulnerable to attacks. In this paper, we propose a new variant of the HFE scheme by considering the special equation x2=x defined over the finite field F3 when x=0,1. We observe that the equation can be used to further destroy the special structure of the underlying central map of the HFE scheme. It is shown that the proposed public key encryption scheme is secure against known attacks including the MinRank attack, the algebraic attacks, and the linearization equations attacks. The proposal gains some advantages over the original HFE scheme with respect to the encryption speed and public key size.

A New Quantum Secure Direct Communication Scheme with Authentication

International Nuclear Information System (INIS)

Dan, Liu; Chang-Xing, Pei; Dong-Xiao, Quan; Nan, Zhao

2010-01-01

A new quantum secure direct communication (QSDC) scheme with authentication is proposed based on polarized photons and EPR pairs. EPR pairs are used to transmit information, while polarized photons are used to detect Eve and their encoding bases are used to transmit authentication information. Alice and Bob have their own identity number which is shared by legal users only. The identity number is encoded on the bases of polarized photons and distilled if there is no Eve. Compared with other QSDC schemes with authentication, this new scheme is considerably easier and less expensive to implement in a practical setting

AUS - the Australian modular scheme for reactor neutronics computations

International Nuclear Information System (INIS)

Robinson, G.S.

1975-12-01

A general description is given of the AUS modular scheme for reactor neutronics calculations. The scheme currently includes modules which provide the capacity for lattice calculations, 1D transport calculations, 1 and 2D diffusion calculations (with feedback-free kinetics), and burnup calculations. Details are provided of all system aspects of AUS, but individual modules are only outlined. A complete specification is given of that part of user input which controls the calculation sequence. The report also provides sufficient details of the supervisor program and of the interface data sets to enable additional modules to be incorporated in the scheme. (author)

Everyday ethics issues in the outpatient clinical practice of pediatric residents.

Science.gov (United States)

Moon, Margaret; Taylor, Holly A; McDonald, Erin L; Hughes, Mark T; Carrese, Joseph A

2009-09-01

To describe the ethics issues that pediatric residents encounter during routine care in an outpatient teaching clinic. Qualitative study including in-depth interviews with pediatric residents and direct observation of interactions between preceptors and residents in a pediatric teaching clinic. The Johns Hopkins Harriet Lane Pediatric Primary Care Clinic, March 20 through April 11, 2006. A convenience sample including all pediatric faculty preceptors supervising at the clinic during the 19 half-day sessions that occurred during the observation period (N = 15) and the pediatric residents seeing patients during these clinic sessions (N = 50). Main Outcome Measure Field notes of preceptor-resident discussions about patient care were made and transcribed for qualitative analysis. Qualitative analysis of the ethics content of cases presented by residents in this pediatric teaching clinic identified 5 themes for categorizing ethics challenges: (1) promoting the child's best interests in complex and resource-poor home and social settings; (2) managing the therapeutic alliance with parents and caregivers; (3) protecting patient privacy and confidentiality; (4) balancing the dual roles of learner and health care provider; and (5) using professional authority appropriately. Qualitative analysis of the ethics content of directly observed preceptor-resident case discussions yielded a set of themes describing the ethics challenges facing pediatric residents. The themes are somewhat different from the lists of residents' ethics experiences developed using recall or survey methods and may be very different from the ideas usually included in hospital-based ethics discussions. This may have implications for improving ethics education during residency training.

Burnout, engagement and resident physicians' self-reported errors.

Science.gov (United States)

Prins, J T; van der Heijden, F M M A; Hoekstra-Weebers, J E H M; Bakker, A B; van de Wiel, H B M; Jacobs, B; Gazendam-Donofrio, S M

2009-12-01

Burnout is a work-related syndrome that may negatively affect more than just the resident physician. On the other hand, engagement has been shown to protect employees; it may also positively affect the patient care that the residents provide. Little is known about the relationship between residents' self-reported errors and burnout and engagement. In our national study that included all residents and physicians in The Netherlands, 2115 questionnaires were returned (response rate 41.1%). The residents reported on burnout (Maslach Burnout Inventory-Health and Social Services), engagement (Utrecht Work Engagement Scale) and self-assessed patient care practices (six items, two factors: errors in action/judgment, errors due to lack of time). Ninety-four percent of the residents reported making one or more mistake without negative consequences for the patient during their training. Seventy-one percent reported performing procedures for which they did not feel properly trained. More than half (56%) of the residents stated they had made a mistake with a negative consequence. Seventy-six percent felt they had fallen short in the quality of care they provided on at least one occasion. Men reported more errors in action/judgment than women. Significant effects of specialty and clinical setting were found on both types of errors. Residents with burnout reported significantly more errors (p engaged residents reported fewer errors (p burnout and to keep residents engaged in their work.

The prison setting as a place of enforced residence, its mental health effects, and the mental healthcare implications.

Science.gov (United States)

Jordan, Melanie

2011-09-01

The subject of place is salient certainly when deliberating the health of prisoners as a social group. This paper provides an overview and assessment of health and place in relation to mental health and the prison locale. Particular attention is devoted to prison culture, both staff and inmate. The incarceration experience (i.e. the nature of enforced residence in the prison environment) can affect negatively prisoners' mental health. The mental health of the prison population is poor, and mental health services in the prison setting have need of further improvement. However, the provision of mental healthcare and the pursuit of good mental health in the prison milieu are challenging. The prison-based-exceedingly complex-three-way relationship between culture-mental and health-mental healthcare is debated. Copyright © 2011 Elsevier Ltd. All rights reserved.

Comparative Evaluation of Cash Benefit Scheme of Janani Suraksha Yojana for Beneficiary Mothers from Different Health Care Settings of Rewa District, Madhya Pradesh, India.

Directory of Open Access Journals (Sweden)

Trivedi R

2014-05-01

Full Text Available Introduction: For better outcomes in mother and child health, Government of India launched the National Rural Health Mission (NRHM in 2005 with a major objective of providing accessible, affordable and quality health care to the rural population; especially the vulnerable. Reduction in MMR to 100/100,000 is one of its goals and the Janani Suraksha Yojana (JSY is the key strategy of NRHM to achieve this reduction. The JSY, as a safe motherhood intervention and modified alternative of the National Maternity Benefit Scheme (NMBS, has been implemented in all states and Union territories with special focus on low performing states. The main objective and vision of JSY is to reduce maternal, neo-natal mortality and promote institutional delivery among the poor pregnant women of rural and urban areas. This scheme is 100% centrally sponsored and has an integrated delivery and post delivery care with the help of a key person i.e. ASHA (Accredited Social Health Activist, followed by cash monetary help to the women. Objectives: 1To evaluate cash benefit service provided under JSY at different health care settings. 2 To know the perception and elicit suggestions of beneficiaries on quality of cash benefit scheme of JSY. Methodology: This is a health care institute based observational cross sectional study including randomly selected 200 JSY beneficiary mothers from the different health care settings i.e., Primary Health Centres, Community Health Centres, District Hospital and Medical College Hospital of Rewa District of Madhya Pradesh state. Data was collected with the help of set pro forma and then analysed with Epi Info 2000. Chi square test was applied appropriately. Results: 60% and 80% beneficiaries from PHC and CHC received cash within 1 week after discharge whereas 100% beneficiaries of District Hospital and Medical College Hospital received cash at the time of discharge; the overall distribution of time of cash disbursement among beneficiaries of

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.

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

Science.gov (United States)

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

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

Social deterministic factors to participation in the National Health Insurance Scheme in the context of rural Ghanaian setting

Directory of Open Access Journals (Sweden)

Stephen Manortey

2014-04-01

Full Text Available The primary purpose of this study is to identify predictors of complete household enrollment into the National Health Insurance Scheme (NHIS among inhabitants of the Barekese sub-district in the Ashanti Region of Ghana. Heads of households in 20 communities from the Barekuma Collaborative Community Project site were interviewed to gather data on demographic, socioeconomic status (SES indicators and complete household subscription in the NHIS. Logistic regression model was used to predict enrollment in the NHIS. Of the 3228 heads of households interviewed, 60 percent reported having all members of their respective households enrolled in the NHIS. Residents in the classified Middle and High SES brackets had 1.47 (95% CI: 1.21-1.77 and 1.66 (95% CI: 1.27- 2.16 times higher odds, respectively, of complete household enrollment compared to their counterparts in the Low SES category. The odds of enrolling in the program tend to increase progressively with the highest level of education attained by the head of the family unit. Eight years after the introduction of the national health insurance policy in Ghana, the reported subscription rate for complete households was about 60 percent in the 20 rural communities that participated in the study. This finding calls for the need to step up further national strategies that will help increase enrollment coverage, especially among the poor and less educated in the rural communities.

Value of a regional family practice residency training program site

Science.gov (United States)

Fletcher, Sarah; Mullett, Jennifer; Beerman, Steve

2014-01-01

Abstract Objective To examine the perceptions of residents, nurses, and physicians about the effect of a regional family practice residency site on the delivery of health services in the community, as well as on the community health care providers. Design Interviews and focus groups were conducted. Setting Nanaimo, BC. Participants A total of 16 residents, 15 nurses, and 20 physicians involved with the family practice residency training program at the Nanaimo site. Methods A series of semistructured interviews and focus groups was conducted. Transcripts of interviews and focus groups were analyzed thematically by the research team. Main findings Overall, participants agreed that having a family practice residency training site in the community contributed to community life and to the delivery of health services in the following ways: increased community capacity and social capital; motivated positive relationships and attitudes in the hospital and community settings; improved communication and teamwork, as well as accessibility and understanding of the health care system; increased the standard of care; and facilitated the recruitment and retention of family physicians. Conclusion This family practice residency training site was beneficial for the community it served. Future planning for distributed medical education sites should take into account the effects of these sites on the health care community and ensure that they continue to be positive influences. Further research in this area could focus on patients’ perceptions of how residency programs affect their care, as well as on the effect of residency programs on wait times and workload for physicians and nurses. PMID:25217693

Numerical schemes for explosion hazards

International Nuclear Information System (INIS)

Therme, Nicolas

2015-01-01

In nuclear facilities, internal or external explosions can cause confinement breaches and radioactive materials release in the environment. Hence, modeling such phenomena is crucial for safety matters. Blast waves resulting from explosions are modeled by the system of Euler equations for compressible flows, whereas Navier-Stokes equations with reactive source terms and level set techniques are used to simulate the propagation of flame front during the deflagration phase. The purpose of this thesis is to contribute to the creation of efficient numerical schemes to solve these complex models. The work presented here focuses on two major aspects: first, the development of consistent schemes for the Euler equations, then the buildup of reliable schemes for the front propagation. In both cases, explicit in time schemes are used, but we also introduce a pressure correction scheme for the Euler equations. Staggered discretization is used in space. It is based on the internal energy formulation of the Euler system, which insures its positivity and avoids tedious discretization of the total energy over staggered grids. A discrete kinetic energy balance is derived from the scheme and a source term is added in the discrete internal energy balance equation to preserve the exact total energy balance at the limit. High order methods of MUSCL type are used in the discrete convective operators, based solely on material velocity. They lead to positivity of density and internal energy under CFL conditions. This ensures that the total energy cannot grow and we can furthermore derive a discrete entropy inequality. Under stability assumptions of the discrete L8 and BV norms of the scheme's solutions one can prove that a sequence of converging discrete solutions necessarily converges towards the weak solution of the Euler system. Besides it satisfies a weak entropy inequality at the limit. Concerning the front propagation, we transform the flame front evolution equation (the so called

Reinforcement Learning Based Data Self-Destruction Scheme for Secured Data Management

Directory of Open Access Journals (Sweden)

Young Ki Kim

2018-04-01

Full Text Available As technologies and services that leverage cloud computing have evolved, the number of businesses and individuals who use them are increasing rapidly. In the course of using cloud services, as users store and use data that include personal information, research on privacy protection models to protect sensitive information in the cloud environment is becoming more important. As a solution to this problem, a self-destructing scheme has been proposed that prevents the decryption of encrypted user data after a certain period of time using a Distributed Hash Table (DHT network. However, the existing self-destructing scheme does not mention how to set the number of key shares and the threshold value considering the environment of the dynamic DHT network. This paper proposes a method to set the parameters to generate the key shares needed for the self-destructing scheme considering the availability and security of data. The proposed method defines state, action, and reward of the reinforcement learning model based on the similarity of the graph, and applies the self-destructing scheme process by updating the parameter based on the reinforcement learning model. Through the proposed technique, key sharing parameters can be set in consideration of data availability and security in dynamic DHT network environments.

On Converting Secret Sharing Scheme to Visual Secret Sharing Scheme

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Wang Daoshun

2010-01-01

Full Text Available Abstract Traditional Secret Sharing (SS schemes reconstruct secret exactly the same as the original one but involve complex computation. Visual Secret Sharing (VSS schemes decode the secret without computation, but each share is m times as big as the original and the quality of the reconstructed secret image is reduced. Probabilistic visual secret sharing (Prob.VSS schemes for a binary image use only one subpixel to share the secret image; however the probability of white pixels in a white area is higher than that in a black area in the reconstructed secret image. SS schemes, VSS schemes, and Prob. VSS schemes have various construction methods and advantages. This paper first presents an approach to convert (transform a -SS scheme to a -VSS scheme for greyscale images. The generation of the shadow images (shares is based on Boolean XOR operation. The secret image can be reconstructed directly by performing Boolean OR operation, as in most conventional VSS schemes. Its pixel expansion is significantly smaller than that of VSS schemes. The quality of the reconstructed images, measured by average contrast, is the same as VSS schemes. Then a novel matrix-concatenation approach is used to extend the greyscale -SS scheme to a more general case of greyscale -VSS scheme.

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

African Journals Online (AJOL)

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

Intercomparison between BATS and LSPM surface schemes, using point micrometeorological data set

Energy Technology Data Exchange (ETDEWEB)

Ruti, P.M.; Cacciamani, C.; Paccagnella, T. [Servizio Meteorologico Regionale, Bologna (Italy); Cassardo, C. [Turin Univ., Alessandria (Italy). Dipt. di Scienze e Technologie Avanzate; Longhetto, A. [Turin Univ. (Italy). Ist. di Fisica Generale; Bargagli, A. [ENEA, Roma (Italy). Gruppo di Dinamica dell`Atmosfera e dell`Oceano

1997-08-01

This work has been developed with the aim to create an archive of climatological values of sensible, latent and ground-atmosphere heat fluxes in the Po valley (CLIPS experiment); due to the unavailability of climatological archives of turbulent fluxes at synoptic scale, we have used the outputs of ``stand-alone`` runnings of biospheric models; this archive could be used to check the parametrizations of large- and mesoscale models in the surface layer. We started to check the reliability of our proposal by testing the model outputs by a comparison with observed data. We selected a flat, rural area in the middle-east Po valley (San Pietro Capofiume, Italy) and used the data gathered in the experimental campaign SPCFLUX93 carried out there. The models adopted for the intercomparison have been the biosphere-atmosphere transfer scheme (BATS) of Dickinson et al. (1986 version) and the land surface process model (LSPM) of Cassardo et al. (1996 version). An improved version of BATS has been implemented by us changing in a substantial way the soil thermal and hydrological subroutines. The upper boundary conditions used for all models were taken by interpolating the synoptic observations carried out at San Pietro Capofiume (Italy) station; the algorithm used for the interpolations was tested with the data achieved in a fortnight campaign (SPCFLUX93) carried out at the same location during June 1993, showing a good agreement between interpolated and observed variables. Two experiments have been carried out; in the first one, the vegetation parameter set used by BATS has been used to force all models, while in the second one a vegetation cover value closest to the observations in the site has been used. 30 refs.

Canonical, stable, general mapping using context schemes.

Science.gov (United States)

Novak, Adam M; Rosen, Yohei; Haussler, David; Paten, Benedict

2015-11-15

Sequence mapping is the cornerstone of modern genomics. However, most existing sequence mapping algorithms are insufficiently general. We introduce context schemes: a method that allows the unambiguous recognition of a reference base in a query sequence by testing the query for substrings from an algorithmically defined set. Context schemes only map when there is a unique best mapping, and define this criterion uniformly for all reference bases. Mappings under context schemes can also be made stable, so that extension of the query string (e.g. by increasing read length) will not alter the mapping of previously mapped positions. Context schemes are general in several senses. They natively support the detection of arbitrary complex, novel rearrangements relative to the reference. They can scale over orders of magnitude in query sequence length. Finally, they are trivially extensible to more complex reference structures, such as graphs, that incorporate additional variation. We demonstrate empirically the existence of high-performance context schemes, and present efficient context scheme mapping algorithms. The software test framework created for this study is available from https://registry.hub.docker.com/u/adamnovak/sequence-graphs/. anovak@soe.ucsc.edu Supplementary data are available at Bioinformatics online. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Age-of-Air, Tape Recorder, and Vertical Transport Schemes

Science.gov (United States)

Lin, S.-J.; Einaudi, Franco (Technical Monitor)

2000-01-01

A numerical-analytic investigation of the impacts of vertical transport schemes on the model simulated age-of-air and the so-called 'tape recorder' will be presented using an idealized 1-D column transport model as well as a more realistic 3-D dynamical model. By comparing to the 'exact' solutions of 'age-of-air' and the 'tape recorder' obtainable in the 1-D setting, useful insight is gained on the impacts of numerical diffusion and dispersion of numerical schemes used in global models. Advantages and disadvantages of Eulerian, semi-Lagrangian, and Lagrangian transport schemes will be discussed. Vertical resolution requirement for numerical schemes as well as observing systems for capturing the fine details of the 'tape recorder' or any upward propagating wave-like structures can potentially be derived from the 1-D analytic model.

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

Science.gov (United States)

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

2018-04-14

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

Results of the 2013-2015 Association of Residents in Radiation Oncology Survey of Chief Residents in the United States

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Nabavizadeh, Nima, E-mail: nabaviza@ohsu.edu [Department of Radiation Medicine, Oregon Health and Science University, Portland, Oregon (United States); Burt, Lindsay M. [Department of Radiation Oncology, University of Utah, Salt Lake City, Utah (United States); Mancini, Brandon R. [Department of Therapeutic Radiology, Yale University, New Haven, Connecticut (United States); Morris, Zachary S. [Department of Human Oncology, University of Wisconsin, Madison, Wisconsin (United States); Walker, Amanda J. [Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland (United States); Miller, Seth M. [Department of Radiation Oncology, University of North Carolina Chapel Hill, Chapel Hill, North Carolina (United States); Bhavsar, Shripal [Department of Radiation Oncology, Integris Cancer Institute, Oklahoma City, Oklahoma (United States); Mohindra, Pranshu [Department of Radiation Oncology, University of Maryland, Baltimore, Maryland (United States); Kim, Miranda B. [Harvard Radiation Oncology Program, Boston, Massachusetts (United States); Kharofa, Jordan [Department of Radiation Oncology, University of Cincinnati, Cincinnati, Ohio (United States)

2016-02-01

Purpose: The purpose of this project was to survey radiation oncology chief residents to define their residency experience and readiness for independent practice. Methods and Materials: During the academic years 2013 to 2014 and 2014 to 2015, the Association of Residents in Radiation Oncology (ARRO) conducted an electronic survey of post-graduate year-5 radiation oncology residents in the United States during the final 3 months of training. Descriptive statistics are reported. Results: Sixty-six chief residents completed the survey in 2013 to 2014 (53% response rate), and 69 completed the survey in 2014 to 2015 (64% response rate). Forty to 85% percent of residents reported inadequate exposure to high-dose rate and low-dose rate brachytherapy. Nearly all residents in both years (>90%) reported adequate clinical experience for the following disease sites: breast, central nervous system, gastrointestinal, genitourinary, head and neck, and lung. However, as few as 56% reported adequate experience in lymphoma or pediatric malignancies. More than 90% of residents had participated in retrospective research projects, with 20% conducting resident-led prospective clinical trials and 50% conducting basic science or translational projects. Most chief residents reported working 60 or fewer hours per week in the clinical/hospital setting and performing fewer than 15 hours per week tasks that were considered to have little or no educational value. There was more than 80% compliance with Accreditation Council for Graduate Medical Education (ACGME) work hour limits. Fifty-five percent of graduating residents intended to join an established private practice group, compared to 25% who headed for academia. Residents perceive the job market to be more competitive than previous years. Conclusions: This first update of the ARRO chief resident survey since the 2007 to 2008 academic year documents US radiation oncology residents' experiences and conditions over a 2-year period

Results of the 2013-2015 Association of Residents in Radiation Oncology Survey of Chief Residents in the United States.

Science.gov (United States)

Nabavizadeh, Nima; Burt, Lindsay M; Mancini, Brandon R; Morris, Zachary S; Walker, Amanda J; Miller, Seth M; Bhavsar, Shripal; Mohindra, Pranshu; Kim, Miranda B; Kharofa, Jordan

2016-02-01

The purpose of this project was to survey radiation oncology chief residents to define their residency experience and readiness for independent practice. During the academic years 2013 to 2014 and 2014 to 2015, the Association of Residents in Radiation Oncology (ARRO) conducted an electronic survey of post-graduate year-5 radiation oncology residents in the United States during the final 3 months of training. Descriptive statistics are reported. Sixty-six chief residents completed the survey in 2013 to 2014 (53% response rate), and 69 completed the survey in 2014 to 2015 (64% response rate). Forty to 85% percent of residents reported inadequate exposure to high-dose rate and low-dose rate brachytherapy. Nearly all residents in both years (>90%) reported adequate clinical experience for the following disease sites: breast, central nervous system, gastrointestinal, genitourinary, head and neck, and lung. However, as few as 56% reported adequate experience in lymphoma or pediatric malignancies. More than 90% of residents had participated in retrospective research projects, with 20% conducting resident-led prospective clinical trials and 50% conducting basic science or translational projects. Most chief residents reported working 60 or fewer hours per week in the clinical/hospital setting and performing fewer than 15 hours per week tasks that were considered to have little or no educational value. There was more than 80% compliance with Accreditation Council for Graduate Medical Education (ACGME) work hour limits. Fifty-five percent of graduating residents intended to join an established private practice group, compared to 25% who headed for academia. Residents perceive the job market to be more competitive than previous years. This first update of the ARRO chief resident survey since the 2007 to 2008 academic year documents US radiation oncology residents' experiences and conditions over a 2-year period. This analysis may serve as a valuable tool for those seeking to

Results of the 2013-2015 Association of Residents in Radiation Oncology Survey of Chief Residents in the United States

International Nuclear Information System (INIS)

Nabavizadeh, Nima; Burt, Lindsay M.; Mancini, Brandon R.; Morris, Zachary S.; Walker, Amanda J.; Miller, Seth M.; Bhavsar, Shripal; Mohindra, Pranshu; Kim, Miranda B.; Kharofa, Jordan

2016-01-01

Purpose: The purpose of this project was to survey radiation oncology chief residents to define their residency experience and readiness for independent practice. Methods and Materials: During the academic years 2013 to 2014 and 2014 to 2015, the Association of Residents in Radiation Oncology (ARRO) conducted an electronic survey of post-graduate year-5 radiation oncology residents in the United States during the final 3 months of training. Descriptive statistics are reported. Results: Sixty-six chief residents completed the survey in 2013 to 2014 (53% response rate), and 69 completed the survey in 2014 to 2015 (64% response rate). Forty to 85% percent of residents reported inadequate exposure to high-dose rate and low-dose rate brachytherapy. Nearly all residents in both years (>90%) reported adequate clinical experience for the following disease sites: breast, central nervous system, gastrointestinal, genitourinary, head and neck, and lung. However, as few as 56% reported adequate experience in lymphoma or pediatric malignancies. More than 90% of residents had participated in retrospective research projects, with 20% conducting resident-led prospective clinical trials and 50% conducting basic science or translational projects. Most chief residents reported working 60 or fewer hours per week in the clinical/hospital setting and performing fewer than 15 hours per week tasks that were considered to have little or no educational value. There was more than 80% compliance with Accreditation Council for Graduate Medical Education (ACGME) work hour limits. Fifty-five percent of graduating residents intended to join an established private practice group, compared to 25% who headed for academia. Residents perceive the job market to be more competitive than previous years. Conclusions: This first update of the ARRO chief resident survey since the 2007 to 2008 academic year documents US radiation oncology residents' experiences and conditions over a 2-year period. This

Texting preferences in a Paediatric residency.

Science.gov (United States)

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

2017-12-01

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

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

Energy Efficient MAC Scheme for Wireless Sensor Networks with High-Dimensional Data Aggregate

Directory of Open Access Journals (Sweden)

Seokhoon Kim

2015-01-01

Full Text Available This paper presents a novel and sustainable medium access control (MAC scheme for wireless sensor network (WSN systems that process high-dimensional aggregated data. Based on a preamble signal and buffer threshold analysis, it maximizes the energy efficiency of the wireless sensor devices which have limited energy resources. The proposed group management MAC (GM-MAC approach not only sets the buffer threshold value of a sensor device to be reciprocal to the preamble signal but also sets a transmittable group value to each sensor device by using the preamble signal of the sink node. The primary difference between the previous and the proposed approach is that existing state-of-the-art schemes use duty cycle and sleep mode to save energy consumption of individual sensor devices, whereas the proposed scheme employs the group management MAC scheme for sensor devices to maximize the overall energy efficiency of the whole WSN systems by minimizing the energy consumption of sensor devices located near the sink node. Performance evaluations show that the proposed scheme outperforms the previous schemes in terms of active time of sensor devices, transmission delay, control overhead, and energy consumption. Therefore, the proposed scheme is suitable for sensor devices in a variety of wireless sensor networking environments with high-dimensional data aggregate.

Resident and user support for urban natural areas restoration practices

Science.gov (United States)

Paul H. Gobster; Kristin Floress; Lynne M. Westphal; Cristy A. Watkins; Joanne Vining; Alaka Wali

2016-01-01

Public support is important to the success of natural areas restoration programs. Support can be especially critical in urban settings where stakeholders recreate in or reside near natural areas but may lack familiarity with practices for managing ecological processes. Surveys of on-site recreationists and nearby residents (N= 888) of 11 Chicago metropolitan natural...

Living in institutional care: residents' experiences and coping strategies.

Science.gov (United States)

Timonen, Virpi; O'Dwyer, Ciara

2009-01-01

Insights into daily living in residential care settings are rare. This article draws on a qualitative dataset (semi-structured interviews and recordings of residents' council meetings) that gives a glimpse of the experiences and coping strategies of (older) people living in residential care. The data highlight the range of unmet needs of the residents, similar to the categories of physiological, safety, love, esteem, and self-actualization needs in Maslow's hierarchy of needs theory. Our analysis indicates that "higher" and "lower" needs are closely intertwined and mutually reinforcing and should therefore be accorded equal emphasis by professionals (including social workers) employed within residential care settings.

Challenges of pediatric residency training in Taiwan.

Science.gov (United States)

Tsai, Tsuen-Chiuan; Harasym, Peter H

2006-01-01

A crisis in pediatric residency training today has raised serious concerns about the healthcare quality for children in Taiwan. The purpose of this study was to document the problems and to propose possible solutions for improvement. The problems include: 1) manpower shortage due to the difficulty of recruiting pediatric residents; 2) heavy workload that hinders learning; 3) lack of assessment and poor program planning; and 4) inadequate institutional and financial support. As a result, physicians' competencies are not guaranteed at the end of residency training, even with the pediatric board certification. Possible solutions may include: 1) conducting research on physician manpower statistics, work hours and environment; 2) establishing a Residency Program Review Committee and provision of standards for accreditation; 3) defining the competencies mandated as a general pediatrician and developing a set of measurable qualitative standards; 4) encouraging new programs with flexibility (e.g., primary care); and 5) pursuing adequate institutional and financial supports.

Axisymmetric pumping scheme for the thermal barrier in a tandem mirror

International Nuclear Information System (INIS)

Li, X.Z.

1985-09-01

An axisymmetric pumping scheme is proposed to pump the particles that trap in a thermal barrier without invoking the neutral beam or geodesic curvature. In this scheme a magnetic scraper is moved uni-directionally on the barrier peak to push the barely trapped particles into the central cell. We utilize a potential jump that forms at the peak field for sufficiently strong pumping. The non-collisional catching effect has to be limited by setting an upper limit on the scraping frequency of the magnetic bump. On the other hand, the dynamic stability of the pumping scheme sets a lower limit on the scraping frequency. Using the variational method, we are able to estimate the window between these two limits, which seems feasible for the Tara reactor parameter set. A primary calculation shows that the magnetic bump, ΔB/B is about 10 -4 and the scraping frequency, nu/sub sc/, is about 10 +5 sec -1 , which are similar to the parameters required for those for drift pumping

Literature Review of Residents as Teachers from an Adult Learning Perspective

Science.gov (United States)

Blanchard, Rebecca D.; Hinchey, Kevin T.; Bennett, Elisabeth E.

2011-01-01

Academic medical centers represent the intersection of higher education and workforce development. However residents often utilize traditional pedagogical approaches learned from higher education settings that fail to translate with adult learners. The purpose of this study is to synthesize literature on resident teachers from the perspective of…

Setting-related influences on physical inactivity of older adults in residential care settings : a review

NARCIS (Netherlands)

Douma, Johanna G.; Volkers, Karin M.; Engels, Gwenda; Sonneveld, Marieke H.; Goossens, Richard H. M.; Scherder, Erik J. A.

2017-01-01

Background: Despite the detrimental effects of physical inactivity for older adults, especially aged residents of residential care settings may spend much time in inactive behavior. This may be partly due to their poorer physical condition; however, there may also be other, setting-related factors

Recommended integrative medicine competencies for family medicine residents.

Science.gov (United States)

Locke, Amy B; Gordon, Andrea; Guerrera, Mary P; Gardiner, Paula; Lebensohn, Patricia

2013-01-01

The use of complementary and alternative medicine (CAM) and Integrative Medicine (IM) has grown steadily over the past decade. Patients seek physician guidance, yet physicians typically have limited knowledge and training. There is some coverage of IM/CAM topics in medical schools and residencies but with little coordination or consistency. In 2008, the Society of Teachers of Family Medicine (STFM) group on Integrative Medicine began the process of designing a set of competencies to educate Family Medicine residents in core concepts of IM. The goal was creation of a set of nationally recognized competencies tied to the Accreditation Council for Graduate Medical Education (ACGME) domains. These competencies were to be achievable by diverse programs, including those without significant internal resources. The group compiled existing curricula from programs around the country and distilled these competencies through multiple reviews and discussions. Simultaneously, the Integrative Medicine in Residency program run by the University of Arizona underwent a similar process. In 2009, these competencies were combined and further developed at the STFM annual meeting by a group of experts. In 2010, the STFM Board approved 19 measurable competencies, each categorized by ACGME domain, as recommended for Family Medicine residencies. Programs have implemented these competencies in various ways given individual needs and resources. This paper reviews the development of IM competencies for residency education in Family Medicine and presents those endorsed by STFM. By educating physicians in training about IM/CAM via competency-based curricula, we aim to promote comprehensive patient-centered care. © 2013 Elsevier Inc. 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.

Functional Status After Colon Cancer Surgery In Elder Nursing Home Residents

Science.gov (United States)

Finlayson, Emily; Zhao, Shoujun; Boscardin, W. John; Fries, Brant E.; Landefeld, C. Seth; Dudley, R. Adams

2015-01-01

Objectives To determine functional status and mortality rates after colon cancer surgery in older nursing home residents. Design Retrospective cohort study. Setting and Participants 6822 nursing home residents age 65 and older who underwent surgery for colon cancer in the United States between 1999 and 2005. Measurements Changes in functional status were assessed before and after surgery using the Minimum Data Set-Activities of Daily Living (MDS-ADL) summary scale, a 28-point scale in which score increases as functional dependence increases. Methods Using the Medicare Inpatient File and the Minimum Data Set for Nursing Homes, we identified the 6822 nursing home residents age 65 and older who underwent surgery for colon cancer. We used regression techniques to identify patient characteristics associated with mortality and functional decline at 1 year after surgery. Results On average, residents who underwent colectomy experienced a 3.9 point worsening in MDS-ADL score at one year. One year after surgery, the rates of mortality and sustained functional decline were 53% and 24%, respectively. In multivariate analysis, older age (age 80+ v. age 65–69, adjusted relative risk (ARR 1.53), 95%CI 1.15–2.04, pppp<0.0001) were associated with functional decline at one year. Conclusion Mortality and sustained functional decline are very common after colon cancer surgery in nursing home residents. Initiatives aimed at improving surgical outcomes are needed in this vulnerable population. PMID:22428583

Performance goals on simulators boost resident motivation and skills laboratory attendance.

Science.gov (United States)

Stefanidis, Dimitrios; Acker, Christina E; Greene, Frederick L

2010-01-01

To assess the impact of setting simulator training goals on resident motivation and skills laboratory attendance. Residents followed a proficiency-based laparoscopic curriculum on the 5 Fundamentals of Laparoscopic Surgery and 9 virtual reality tasks. Training goals consisted of the average expert performance on each task + 2 SD (mandatory) and best expert performance (optional). Residents rated the impact of the training goals on their motivation on a 20-point visual analog scale. Performance and attendance data were analyzed and correlated (Spearman's). Data are reported as medians (range). General Surgery residency program at a regional referral Academic Medical Center. General surgery residents (n = 15). During the first 5 months of the curriculum, weekly attendance rate was 51% (range, 8-96). After 153 (range, 21-412) repetitions, resident speed improved by 97% (range, 18-230), errors improved by 17% (range, 0-24), and motion efficiency by 59% (range, 26-114) compared with their baseline. Nine (60%) residents achieved proficiency in 7 (range, 3-14) and the best goals in 3.5 (range, 1-9) tasks; the other 6 residents had attendance rates motivation as 15 (range, 1-18) and setting a best goal as 13 (range, 1-18). Motivation ratings correlated positively with attendance rates, number of repetitions, performance improvement, and achievement of proficiency and best goals (r = 0.59-0.75; p motivation to participate in a simulator curriculum. While more stringent goals may potentiate this effect, they have a limited impact on senior residents. Further research is needed to investigate ways to improve skills laboratory attendance. Copyright 2010 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

A novel grain cluster-based homogenization scheme

International Nuclear Information System (INIS)

Tjahjanto, D D; Eisenlohr, P; Roters, F

2010-01-01

An efficient homogenization scheme, termed the relaxed grain cluster (RGC), for elasto-plastic deformations of polycrystals is presented. The scheme is based on a generalization of the grain cluster concept. A volume element consisting of eight (= 2 × 2 × 2) hexahedral grains is considered. The kinematics of the RGC scheme is formulated within a finite deformation framework, where the relaxation of the local deformation gradient of each individual grain is connected to the overall deformation gradient by the, so-called, interface relaxation vectors. The set of relaxation vectors is determined by the minimization of the constitutive energy (or work) density of the overall cluster. An additional energy density associated with the mismatch at the grain boundaries due to relaxations is incorporated as a penalty term into the energy minimization formulation. Effectively, this penalty term represents the kinematical condition of deformation compatibility at the grain boundaries. Simulations have been performed for a dual-phase grain cluster loaded in uniaxial tension. The results of the simulations are presented and discussed in terms of the effective stress–strain response and the overall deformation anisotropy as functions of the penalty energy parameters. In addition, the prediction of the RGC scheme is compared with predictions using other averaging schemes, as well as to the result of direct finite element (FE) simulation. The comparison indicates that the present RGC scheme is able to approximate FE simulation results of relatively fine discretization at about three orders of magnitude lower computational cost

PDF fit in the fixed-flavour-number scheme

International Nuclear Information System (INIS)

Alekhin, S.; Bluemlein, J.; Moch, S.

2012-02-01

We discuss the heavy-quark contribution to deep inelastic scattering in the scheme with n f =3;4;5 fixed flavors. Based on the recent ABM11 PDF analysis of world data for deep-inelastic scattering and fixed-target data for the Drell-Yan process with the running-mass definition for heavy quarks we show that fixed flavor number scheme is sufficient for describing the deep-inelastic-scattering data in the entire kinematic range. We compare with other PDF sets and comment on the implications for measuring the strong coupling constant α s (M Z ).

Fourier analysis of finite element preconditioned collocation schemes

Science.gov (United States)

Deville, Michel O.; Mund, Ernest H.

1990-01-01

The spectrum of the iteration operator of some finite element preconditioned Fourier collocation schemes is investigated. The first part of the paper analyses one-dimensional elliptic and hyperbolic model problems and the advection-diffusion equation. Analytical expressions of the eigenvalues are obtained with use of symbolic computation. The second part of the paper considers the set of one-dimensional differential equations resulting from Fourier analysis (in the tranverse direction) of the 2-D Stokes problem. All results agree with previous conclusions on the numerical efficiency of finite element preconditioning schemes.

Multiobjective hyper heuristic scheme for system design and optimization

Science.gov (United States)

Rafique, Amer Farhan

2012-11-01

As system design is becoming more and more multifaceted, integrated, and complex, the traditional single objective optimization trends of optimal design are becoming less and less efficient and effective. Single objective optimization methods present a unique optimal solution whereas multiobjective methods present pareto front. The foremost intent is to predict a reasonable distributed pareto-optimal solution set independent of the problem instance through multiobjective scheme. Other objective of application of intended approach is to improve the worthiness of outputs of the complex engineering system design process at the conceptual design phase. The process is automated in order to provide the system designer with the leverage of the possibility of studying and analyzing a large multiple of possible solutions in a short time. This article presents Multiobjective Hyper Heuristic Optimization Scheme based on low level meta-heuristics developed for the application in engineering system design. Herein, we present a stochastic function to manage meta-heuristics (low-level) to augment surety of global optimum solution. Generic Algorithm, Simulated Annealing and Swarm Intelligence are used as low-level meta-heuristics in this study. Performance of the proposed scheme is investigated through a comprehensive empirical analysis yielding acceptable results. One of the primary motives for performing multiobjective optimization is that the current engineering systems require simultaneous optimization of conflicting and multiple. Random decision making makes the implementation of this scheme attractive and easy. Injecting feasible solutions significantly alters the search direction and also adds diversity of population resulting in accomplishment of pre-defined goals set in the proposed scheme.

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

Science.gov (United States)

Park, Elyse R; Betancourt, Joseph R; Kim, Minah K; Maina, Angela W; Blumenthal, David; Weissman, Joel S

2005-09-01

An Institute of Medicine report issued in 2002 cited cross-cultural training as a mechanism to address racial and ethnic disparities in health care, but little is known about residents' training and capabilities to provide quality care to diverse populations. This article explores a select group of residents' perceptions of their preparedness to deliver quality care to diverse populations. Seven focus groups and ten individual interviews were conducted with 68 residents in locations nationwide. Qualitative analysis of focus-group and individual interview transcripts was performed to assess residents' perceptions of (1) preparedness to deliver care to diverse patients; (2) educational climate; and (3) training experiences. Most residents in this study noted the importance of cross-cultural care yet reported little formal training in this area. Residents wanted more formal training yet expressed concern that culture-specific training could lead to stereotyping. Most residents had developed ad hoc, informal skills to care for diverse patients. Although residents perceived institutional endorsement, they sensed it was a low priority due to lack of time and resources. Residents in this study reported receiving mixed messages about cross-cultural care. They were told it is important, yet they received little formal training and did not have time to treat diverse patients in a culturally sensitive manner. As a result, many developed coping behaviors rather than skills based on formally taught best practices. Training environments need to increase training to enhance residents' preparedness to deliver high-quality cross-cultural care if the medical profession is to achieve the goals set by the Institute of Medicine.

On usage of CABARET scheme for tracer transport in INM ocean model

International Nuclear Information System (INIS)

Diansky, Nikolay; Kostrykin, Sergey; Gusev, Anatoly; Salnikov, Nikolay

2010-01-01

The contemporary state of ocean numerical modelling sets some requirements for the numerical advection schemes used in ocean general circulation models (OGCMs). The most important requirements are conservation, monotonicity and numerical efficiency including good parallelization properties. Investigation of some advection schemes shows that one of the best schemes satisfying the criteria is CABARET scheme. 3D-modification of the CABARET scheme was used to develop a new transport module (for temperature and salinity) for the Institute of Numerical Mathematics ocean model (INMOM). Testing of this module on some common benchmarks shows a high accuracy in comparison with the second-order advection scheme used in the INMOM. This new module was incorporated in the INMOM and experiments with the modified model showed a better simulation of oceanic circulation than its previous version.

Comorbidity and 1-year mortality risks in nursing home residents

NARCIS (Netherlands)

van Dijk, P.T.; Mehr, D.R.; Ooms, M.E.; Madsen, R.W.; Petroski, G.; Frijters, D.H.M.; Pot, A.M.; Ribbe, M.W.

2005-01-01

OBJECTIVES: To investigate the effect of chronic diseases and disease combinations on 1-year mortality in nursing home residents. DESIGN: Retrospective cohort study using electronically submitted Minimum Data Set (MDS) information and Missouri death certificate data. SETTING: Five hundred twenty-two

Adaptive protection coordination scheme for distribution network with distributed generation using ABC

Directory of Open Access Journals (Sweden)

A.M. Ibrahim

2016-09-01

Full Text Available This paper presents an adaptive protection coordination scheme for optimal coordination of DOCRs in interconnected power networks with the impact of DG, the used coordination technique is the Artificial Bee Colony (ABC. The scheme adapts to system changes; new relays settings are obtained as generation-level or system-topology changes. The developed adaptive scheme is applied on the IEEE 30-bus test system for both single- and multi-DG existence where results are shown and discussed.

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

Science.gov (United States)

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

2016-09-01

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

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

Science.gov (United States)

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

2007-01-01

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

Nonlinear Differential Equations and Feedback Control Design for the Urban-Rural Resident Pension Insurance in China

Science.gov (United States)

Wang, Lijian

2015-12-01

Facing many problems of the urban-rural resident pension insurance system in China, one should firstly make sure that this system can be optimized. This paper, based on the modern control theory, sets up differential equations as models to describe the urban-rural resident pension insurance system, and discusses the globally asymptotic stability in the sense of Liapunov for the urban-rural resident pension insurance system in the new equilibrium point. This research sets the stage for our further discussion, and it is theoretically important and convenient for optimizing the urban-rural resident pension insurance system.

Market-based support schemes for renewable energy sources

NARCIS (Netherlands)

Fagiani, R.

2014-01-01

The European Union set ambitious goals regarding the production of electricity from renewable energy sources and the majority of European governments have implemented policies stimulating investments in such technologies. Support schemes differ in many aspects, not only in their effectivity and

Ulam's scheme revisited digital modeling of chaotic attractors via micro-perturbations

CERN Document Server

Domokos, Gabor K

2002-01-01

We consider discretizations $f_N$ of expanding maps $f:I \\to I$ in the strict sense: i.e. we assume that the only information available on the map is a finite set of integers. Using this definition for computability, we show that by adding a random perturbation of order $1/N$, the invariant measure corresponding to $f$ can be approximated and we can also give estimates of the error term. We prove that the randomized discrete scheme is equivalent to Ulam's scheme applied to the polygonal approximation of $f$, thus providing a new interpretation of Ulam's scheme. We also compare the efficiency of the randomized iterative scheme to the direct solution of the $N \\times N$ linear system.

Depression and cognitive impairment among newly admitted nursing home residents in the USA.

Science.gov (United States)

Ulbricht, Christine M; Rothschild, Anthony J; Hunnicutt, Jacob N; Lapane, Kate L

2017-11-01

The objective of this study is to describe the prevalence of depression and cognitive impairment among newly admitted nursing home residents in the USA and to describe the treatment of depression by level of cognitive impairment. We identified 1,088,619 newly admitted older residents between 2011 and 2013 with an active diagnosis of depression documented on the Minimum Data Set 3.0. The prevalence of receiving psychiatric treatment was estimated by cognitive impairment status and depression symptoms. Binary logistic regression using generalized estimating equations provided adjusted odds ratios and 95% confidence intervals for the association between level of cognitive impairment and receipt of psychiatric treatment, adjusted for clustering of residents within nursing homes and resident characteristics. Twenty-six percent of newly admitted residents had depression; 47% of these residents also had cognitive impairment. Of those who had staff assessments of depression, anhedonia, impaired concentration, psychomotor disturbances, and irritability were more commonly experienced by residents with cognitive impairment than residents without cognitive impairment. Forty-eight percent of all residents with depression did not receive any psychiatric treatment. Approximately one-fifth of residents received a combination of treatment. Residents with severe cognitive impairment were less likely than those with intact cognition to receive psychiatric treatment (adjusted odds ratio = 0.95; 95% confidence interval: 0.93-0.98). Many newly admitted residents with an active diagnosis of depression are untreated, potentially missing an important window to improve symptoms. The extent of comorbid cognitive impairment and depression and lack of treatment suggest opportunities for improved quality of care in this increasingly important healthcare setting. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

'It depends': medical residents' perspectives on working with nurses.

Science.gov (United States)

Weinberg, Dana B; Miner, Dianne Cooney; Rivlin, Leetal

2009-07-01

Using the theory of relational coordination, which holds that in high-pressure settings such as hospitals, high-quality communication and strong relationships are necessary for coordinated action, we sought to determine the quality of the nurse-physician relationship by examining the communication and interaction between nurses and residents from the residents' perspective. A sample of 20 medical and surgical residents, selected by a snowball sampling technique, were interviewed about the quality of their communication and relationships with nurses in the workplace. Residents' responses were influenced by their perceptions of nurses' cooperativeness and competence, and their impressions of nurses' professional preparation and demeanor varied widely. Although 19 of 20 residents reported instances of poor communication or problematic relationships with nurses, most believed that this posed no significant threat to patient care because the nurses' role, as they saw it, was one of simply following orders. Given the strong doubts some residents expressed about nurses' cooperativeness and competence, the nursing profession should consider strengthening nursing education and clearly delineating nurses' roles and competencies.

The QKD network: model and routing scheme

Science.gov (United States)

Yang, Chao; Zhang, Hongqi; Su, Jinhai

2017-11-01

Quantum key distribution (QKD) technology can establish unconditional secure keys between two communicating parties. Although this technology has some inherent constraints, such as the distance and point-to-point mode limits, building a QKD network with multiple point-to-point QKD devices can overcome these constraints. Considering the development level of current technology, the trust relaying QKD network is the first choice to build a practical QKD network. However, the previous research didn't address a routing method on the trust relaying QKD network in detail. This paper focuses on the routing issues, builds a model of the trust relaying QKD network for easily analysing and understanding this network, and proposes a dynamical routing scheme for this network. From the viewpoint of designing a dynamical routing scheme in classical network, the proposed scheme consists of three components: a Hello protocol helping share the network topology information, a routing algorithm to select a set of suitable paths and establish the routing table and a link state update mechanism helping keep the routing table newly. Experiments and evaluation demonstrates the validity and effectiveness of the proposed routing scheme.

The role of simulation training in anesthesiology resident education.

Science.gov (United States)

Yunoki, Kazuma; Sakai, Tetsuro

2018-03-09

An increasing number of reports indicate the efficacy of simulation training in anesthesiology resident education. Simulation education helps learners to acquire clinical skills in a safe learning environment without putting real patients at risk. This useful tool allows anesthesiology residents to obtain medical knowledge and both technical and non-technical skills. For faculty members, simulation-based settings provide the valuable opportunity to evaluate residents' performance in scenarios including airway management and regional, cardiac, and obstetric anesthesiology. However, it is still unclear what types of simulators should be used or how to incorporate simulation education effectively into education curriculums. Whether simulation training improves patient outcomes has not been fully determined. The goal of this review is to provide an overview of the status of simulation in anesthesiology resident education, encourage more anesthesiologists to get involved in simulation education to propagate its influence, and stimulate future research directed toward improving resident education and patient outcomes.

A pharmacogenetics service experience for pharmacy students, residents, and fellows.

Science.gov (United States)

Drozda, Katarzyna; Labinov, Yana; Jiang, Ruixuan; Thomas, Margaret R; Wong, Shan S; Patel, Shitalben; Nutescu, Edith A; Cavallari, Larisa H

2013-10-14

To utilize a comprehensive, pharmacist-led warfarin pharmacogenetics service to provide pharmacy students, residents, and fellows with clinical and research experiences involving genotype-guided therapy. First-year (P1) through fourth-year (P4) pharmacy students, pharmacy residents, and pharmacy fellows participated in a newly implemented warfarin pharmacogenetics service in a hospital setting. Students, residents, and fellows provided genotype-guided dosing recommendations as part of clinical care, or analyzed samples and data collected from patients on the service for research purposes. Students', residents', and fellows' achievement of learning objectives was assessed using a checklist based on established core competencies in pharmacogenetics. The mean competency score of the students, residents, and fellows who completed a clinical and/or research experience with the service was 97% ±3%. A comprehensive warfarin pharmacogenetics service provided unique experiential and research opportunities for pharmacy students, residents, and fellows and sufficiently addressed a number of core competencies in pharmacogenetics.

Training Pediatric Residents to Provide Smoking Cessation Counseling to Parents

Directory of Open Access Journals (Sweden)

Rebecca L. Collins

2005-01-01

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

Pain and pharmacologic pain management in long-stay nursing home residents.

Science.gov (United States)

Hunnicutt, Jacob N; Ulbricht, Christine M; Tjia, Jennifer; Lapane, Kate L

2017-06-01

Previous studies estimate that >40% of long-stay nursing home (NH) residents experience persistent pain, with 20% of residents in pain receiving no analgesics. Strengthened NH surveyor guidance and improved pain measures on the Minimum Data Set 3.0 were introduced in March 2009 and October 2010, respectively. This study aimed to provide estimates after the important initiatives of (1) prevalence and correlates of persistent pain; and (2) prevalence and correlates of untreated or undertreated persistent pain. We identified 1,387,405 long-stay residents in U.S. NHs between 2011 and 2012 with 2 Minimum Data Set assessments 90 days apart. Pain was categorized as persistent (pain on both assessments), intermittent (pain on either assessment), or none. Pharmacologic pain management was classified as untreated pain (no scheduled or as needed medications received) or potentially undertreated (no scheduled received). Modified Poisson models adjusting for resident clustering within NHs provided adjusted prevalence ratios (APRs) estimates and 95% confidence intervals (CIs). The prevalence of persistent and intermittent pain was 19.5% and 19.2%, respectively, but varied substantially by age, sex, race and ethnicity, cognitive impairment, and cancer. Of residents in persistent pain, 6.4% and 32.0% were untreated and undertreated, respectively. Racial and ethnic minorities (non-Hispanic blacks vs whites, APR = 1.19, 95% CI: 1.13-1.25) and severely cognitively impaired residents (severe vs no/mild APR = 1.51, 95% CI: 1.44-1.57) had an increased prevalence of untreated and undertreated pain. One in 5 NH residents has persistent pain. Although this estimate is greatly improved, many residents may be undertreated. The disturbing disparities in untreated and undertreated pain need to be addressed.

Outcomes of a New Residential Scheme for Adults with Intellectual Disabilities in Taiwan: A 2-Year Follow-Up

Science.gov (United States)

Chou, Y-C.; Pu, C.; Kroger, T.; Lee, W.; Chang, S.

2011-01-01

Background: The Taiwanese government launched a new programme in November 2004 to support adults with intellectual disabilities living in smaller facilities. This paper aims to evaluate the service outcomes of this new residential scheme over 2 years including those residents who moved from an institution and those who moved from their family.…

Antidepressant treatment of depression in rural nursing home residents.

Science.gov (United States)

Kerber, Cindy Sullivan; Dyck, Mary J; Culp, Kennith R; Buckwalter, Kathleen

2008-09-01

Under-diagnosis and under-treatment of depression are major problems in nursing home residents. The purpose of this study was to determine antidepressant use among nursing home residents who were diagnosed with depression using three different methods: (1) the Geriatric Depression Scale, (2) Minimum Data Set, and (3) primary care provider assessments. As one would expect, the odds of being treated with an antidepressant were about eight times higher for those diagnosed as depressed by the primary care provider compared to the Geriatric Depression Scale or the Minimum Data Set. Men were less likely to be diagnosed and treated with antidepressants by their primary care provider than women. Depression detected by nurses through the Minimum Data Set was treated at a lower rate with antidepressants, which generates issues related to interprofessional communication, nursing staff communication, and the need for geropsychiatric role models in nursing homes.

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.

Predicting currency fluctuations and crises - do resident firms have an informational advantage?

OpenAIRE

Kaufmann, Daniel; Mehrez, Gil; Schmukler, Sergio

1999-01-01

The authors investigate whether resident enterprise managers have an informational advantage about the countries in which they work. They propose a method for extracting information available to resident managers but unknown to investors and forecasters. They rest their hypothesis of informational advantage using a unique data set, the Global Competitiveness Survey. The survey asks local managers about their outlook for the country in which they reside. They find that local managers do have u...

PDF fit in the fixed-flavour-number scheme

Energy Technology Data Exchange (ETDEWEB)

Alekhin, S. [Deutsches Elektronen-Synchrotron (DESY), Zeuthen (Germany); Institute for High Energy Physics, Moscow (Russian Federation); Bluemlein, J.; Moch, S. [Deutsches Elektronen-Synchrotron (DESY), Zeuthen (Germany)

2012-02-15

We discuss the heavy-quark contribution to deep inelastic scattering in the scheme with n{sub f}=3;4;5 fixed flavors. Based on the recent ABM11 PDF analysis of world data for deep-inelastic scattering and fixed-target data for the Drell-Yan process with the running-mass definition for heavy quarks we show that fixed flavor number scheme is sufficient for describing the deep-inelastic-scattering data in the entire kinematic range. We compare with other PDF sets and comment on the implications for measuring the strong coupling constant {alpha}{sub s}(M{sub Z}).

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.

How does it feel to be a pathology resident? Results of a survey on experiences and job satisfaction during pathology residency.

Science.gov (United States)

Pehlivanoglu, Burcin; Hassoy, Hur; Calle, Catarina; Dendooven, Amelie; Nalbantoglu, ILKe; Reshchikova, Lidiya; Gul, Gulen; Doganavsargil, Basak

2017-09-01

Residents' career choices and professional motivation can be affected from perception of their role and recognition within a medical team as well as their educational and workplace experiences. To evaluate pathology trainees' perceptions of their pathology residency, we conducted a 42-item survey via a web-based link questioning respondents' personal and institutional background, workplace, training conditions, and job satisfaction level. For the 208 residents from different European countries who responded, personal expectations in terms of quality of life (53%) and scientific excitement (52%) were the most common reasons why they chose and enjoy pathology. Sixty-six percent were satisfied about their relationship with other people working in their department, although excessive time spent on gross examination appeared less satisfactory. A set residency training program (core curriculum), a set annual scientific curriculum, and a residency program director existed in the program of 58, 60, and 69% respondents, respectively. Most respondents (76%) considered that pathologists have a direct and high impact on patient management, but only 32% agreed that pathologists cooperate with clinicians/surgeons adequately. Most (95%) found that patients barely know what pathologists do. Only 22% considered pathology and pathologists to be adequately positioned in their country's health care system. Almost 84% were happy to have chosen pathology, describing it as "puzzle solving," "a different fascinating world," and "challenging while being crucial for patient management." More than two thirds (72%) considered pathology and pathologists to face a bright future. However, a noticeable number of respondents commented on the need for better physical working conditions, a better organized training program, more interaction with experienced pathologists, and deeper knowledge on molecular pathology.

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.

Setting-related influences on physical inactivity of older adults in residential care settings: a review.

Science.gov (United States)

Douma, Johanna G; Volkers, Karin M; Engels, Gwenda; Sonneveld, Marieke H; Goossens, Richard H M; Scherder, Erik J A

2017-04-28

Despite the detrimental effects of physical inactivity for older adults, especially aged residents of residential care settings may spend much time in inactive behavior. This may be partly due to their poorer physical condition; however, there may also be other, setting-related factors that influence the amount of inactivity. The aim of this review was to review setting-related factors (including the social and physical environment) that may contribute to the amount of older adults' physical inactivity in a wide range of residential care settings (e.g., nursing homes, assisted care facilities). Five databases were systematically searched for eligible studies, using the key words 'inactivity', 'care facilities', and 'older adults', including their synonyms and MeSH terms. Additional studies were selected from references used in articles included from the search. Based on specific eligibility criteria, a total of 12 studies were included. Quality of the included studies was assessed using the Mixed Methods Appraisal Tool (MMAT). Based on studies using different methodologies (e.g., interviews and observations), and of different quality (assessed quality range: 25-100%), we report several aspects related to the physical environment and caregivers. Factors of the physical environment that may be related to physical inactivity included, among others, the environment's compatibility with the abilities of a resident, the presence of equipment, the accessibility, security, comfort, and aesthetics of the environment/corridors, and possibly the presence of some specific areas. Caregiver-related factors included staffing levels, the available time, and the amount and type of care being provided. Inactivity levels in residential care settings may be reduced by improving several features of the physical environment and with the help of caregivers. Intervention studies could be performed in order to gain more insight into causal effects of improving setting-related factors on

Use of 360-degree assessment of residents in internal medicine in a Danish setting

DEFF Research Database (Denmark)

Allerup, Peter

2007-01-01

objectives to be assessed. We considered 22 of these suitable for assessment by 360-degrees assessment. METHODS: Medical departments of six hospitals contributed 42 interns to the study. Each resident was assessed by ten persons of whom one was a secretary, four were nurses and five senior doctors...

Structural and parameteric uncertainty quantification in cloud microphysics parameterization schemes

Science.gov (United States)

van Lier-Walqui, M.; Morrison, H.; Kumjian, M. R.; Prat, O. P.; Martinkus, C.

2017-12-01

Atmospheric model parameterization schemes employ approximations to represent the effects of unresolved processes. These approximations are a source of error in forecasts, caused in part by considerable uncertainty about the optimal value of parameters within each scheme -- parameteric uncertainty. Furthermore, there is uncertainty regarding the best choice of the overarching structure of the parameterization scheme -- structrual uncertainty. Parameter estimation can constrain the first, but may struggle with the second because structural choices are typically discrete. We address this problem in the context of cloud microphysics parameterization schemes by creating a flexible framework wherein structural and parametric uncertainties can be simultaneously constrained. Our scheme makes no assuptions about drop size distribution shape or the functional form of parametrized process rate terms. Instead, these uncertainties are constrained by observations using a Markov Chain Monte Carlo sampler within a Bayesian inference framework. Our scheme, the Bayesian Observationally-constrained Statistical-physical Scheme (BOSS), has flexibility to predict various sets of prognostic drop size distribution moments as well as varying complexity of process rate formulations. We compare idealized probabilistic forecasts from versions of BOSS with varying levels of structural complexity. This work has applications in ensemble forecasts with model physics uncertainty, data assimilation, and cloud microphysics process studies.

Electrocardiographic interpretation skills of cardiology residents: are they competent?

Science.gov (United States)

Sibbald, Matthew; Davies, Edward G; Dorian, Paul; Yu, Eric H C

2014-12-01

Achieving competency at electrocardiogram (ECG) interpretation among cardiology subspecialty residents has traditionally focused on interpreting a target number of ECGs during training. However, there is little evidence to support this approach. Further, there are no data documenting the competency of ECG interpretation skills among cardiology residents, who become de facto the gold standard in their practice communities. We tested 29 Cardiology residents from all 3 years in a large training program using a set of 20 ECGs collected from a community cardiology practice over a 1-month period. Residents interpreted half of the ECGs using a standard analytic framework, and half using their own approach. Residents were scored on the number of correct and incorrect diagnoses listed. Overall diagnostic accuracy was 58%. Of 6 potentially life-threatening diagnoses, residents missed 36% (123 of 348) including hyperkalemia (81%), long QT (52%), complete heart block (35%), and ventricular tachycardia (19%). Residents provided additional inappropriate diagnoses on 238 ECGs (41%). Diagnostic accuracy was similar between ECGs interpreted using an analytic framework vs ECGs interpreted without an analytic framework (59% vs 58%; F(1,1333) = 0.26; P = 0.61). Cardiology resident proficiency at ECG interpretation is suboptimal. Despite the use of an analytic framework, there remain significant deficiencies in ECG interpretation among Cardiology residents. A more systematic method of addressing these important learning gaps is urgently needed. Copyright © 2014 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

COMMENTS OF THE OCDE 2008MODEL CONVENTION ON ESTABLISHING THE TAX RESIDENCE

OpenAIRE

Lect. Mihail Antonescu Ph. D; Ligia Antonescu Ph. D

2010-01-01

In the fiscal field, the competition between countries develops as a growing phenomenon, and results in the permanent improvement of the legislation to attract the investments and implicitly, the incomes to be taxed. Most developed countries set the limits of their tax jurisdiction, by defining the concept of resident. In the Romanian legislation, there are transposed the provisions of the OECD Model Convention on defining the residence, both in terms of residence and period of actual presenc...

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.

Transmission of MRSA to Healthcare Personnel Gowns and Gloves during Care of Nursing Home Residents

Science.gov (United States)

Roghmann, Mary-Claire; Johnson, J. Kristie; Sorkin, John D.; Langenberg, Patricia; Lydecker, Alison; Sorace, Brian; Levy, Lauren; Mody, Lona

2016-01-01

Objective To estimate the frequency of MRSA transmission to gowns and gloves worn by healthcare personnel (HCP) interacting with nursing home residents in order to inform infection prevention policies in this setting Design Observational study Setting and Participants Residents and HCP from 13 community-based nursing homes in Maryland and Michigan Methods Residents were cultured for MRSA at the anterior nares and perianal or perineal skin. HCP wore gowns and gloves during usual care activities. At the end of each activity, a research coordinator swabbed the HCP’s gown and gloves. Results 403 residents were enrolled; 113 were MRSA colonized. Glove contamination was higher than gown contamination (24% vs. 14% of 954 interactions, pgloves. We identified high risk activities (OR >1.0, pglove contamination. Conclusions MRSA transmission from MRSA positive residents to HCP gown and gloves is substantial with high contact activities of daily living conferring the highest risk. These activities do not involve overt contact with body fluids, skin breakdown or mucous membranes suggesting the need to modify current standards of care involving the use of gowns and gloves in this setting. PMID:26008727

Mentor-guided self-directed learning affects resident practice.

Science.gov (United States)

Aho, Johnathon M; Ruparel, Raaj K; Graham, Elaina; Zendejas-Mummert, Benjamin; Heller, Stephanie F; Farley, David R; Bingener, Juliane

2015-01-01

Self-directed learning (SDL) can be as effective as instructor-led training. It employs less instructional resources and is potentially a more efficient educational approach. Although SDL is encouraged among residents in our surgical training program via 24-hour access to surgical task trainers and online modules, residents report that they seldom practice. We hypothesized that a mentor-guided SDL approach would improve practice habits among our residents. From 2011 to 2013, 12 postgraduate year (PGY)-2 general surgery residents participated in a 6-week minimally invasive surgery (MIS) rotation. At the start of the rotation, residents were asked to practice laparoscopic skills until they reached peak performance in at least 3 consecutive attempts at a task (individual proficiency). Trainees met with the staff surgeon at weeks 3 and 6 to evaluate progress and review a graph of their individual learning curve. All trainees subsequently completed a survey addressing their practice habits and suggestions for improvement of the curriculum. By the end of the rotation, 100% of participants improved in all practiced tasks (p mentor-guided SDL. Additionally, 6 (50%) residents reported that their skill level had improved relative to their peers. Some residents (n = 3) felt that the curriculum could be improved by including task-specific goals and additional practice sessions with the staff surgeon. Mentor-guided SDL stimulated surgical residents to practice with greater frequency. This repeated deliberate practice led to significantly improved MIS skills without significantly increasing the need for faculty-led instruction. Some residents preferred more discrete goal setting and increased mentor guidance. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

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.

Clinimetric testing in Mexican elders: associations with age, gender and place of residence

Directory of Open Access Journals (Sweden)

Lorena eTavano-Colaizzi

2014-10-01

Full Text Available Aim. To evaluate the ability of five clinimetric instruments to discriminate between subjects >60 years of age living at home versus those living in a residency.Methods. Trained nutritionists applied five instruments (Cognition/ Depression/ Functionality/ Nutrition/ Appetite to 285 subjects with majorities of women (64%, aged <80y (61% and home residents (54%.Results. Multivariable regression models were generated for each instrument using age, gender and residency as independent variables. Age was associated with worsening scores in the five instruments whereas residency showed association in three instruments, and gender in two. Score-age regressions by place of residency showed differences suggesting that Mundet residents had increasingly worse scores with increasing age, than home dwellers for Cognition, Depression and Nutrition. Also, living at home prevented the worsening of Depression with increasing age. In contrast, Functionality and Appetite deteriorated at a similar rate for home and Mundet residents suggesting an inhability of these two instruments to dicriminate between settings. Score-age regressions by gender suggested males have less cognitive problems at 60 and 80 years of age but not at 100, and better appetite than women at all ages.Conclusions. Increasing age proved to be associated to worsening scores in the five instruments but only three were able to detect differences according to setting. An interesting observation was that living at home appeared to prevent the Depression increase with increasing age seen in Mundet residents.

A Temporal Domain Decomposition Algorithmic Scheme for Large-Scale Dynamic Traffic Assignment

Directory of Open Access Journals (Sweden)

Eric J. Nava

2012-03-01

This paper presents a temporal decomposition scheme for large spatial- and temporal-scale dynamic traffic assignment, in which the entire analysis period is divided into Epochs. Vehicle assignment is performed sequentially in each Epoch, thus improving the model scalability and confining the peak run-time memory requirement regardless of the total analysis period. A proposed self-turning scheme adaptively searches for the run-time-optimal Epoch setting during iterations regardless of the characteristics of the modeled network. Extensive numerical experiments confirm the promising performance of the proposed algorithmic schemes.

The same number of optimized parameters scheme for determining intermolecular interaction energies

DEFF Research Database (Denmark)

Kristensen, Kasper; Ettenhuber, Patrick; Eriksen, Janus Juul

2015-01-01

We propose the Same Number Of Optimized Parameters (SNOOP) scheme as an alternative to the counterpoise method for treating basis set superposition errors in calculations of intermolecular interaction energies. The key point of the SNOOP scheme is to enforce that the number of optimized wave...... as numerically. Numerical results for second-order Møller-Plesset perturbation theory (MP2) and coupled-cluster with single, double, and approximate triple excitations (CCSD(T)) show that the SNOOP scheme in general outperforms the uncorrected and counterpoise approaches. Furthermore, we show that SNOOP...

An Employer of Last Resort Scheme which Resembles a Free Labour Market

OpenAIRE

MUSGRAVE, Ralph S.

2017-01-01

Abstract. The idea that government should act as employer of last resort (ELR) is an old one. That idea is often referred to nowadays as “job guarantee”. Many ELR schemes to date have been confined to the public sector. There is no good reason for that limitation: i.e. the private sector should use ELR labour as well.  A second common characteristic of ELR schemes has been that (like the WPA in the US in the 1930s) they involve specially set up projects or schemes as distinct from subsidising...

[Life project of residents and institutional approach in nursing homes].

Science.gov (United States)

Chanut, Corinne

The life project in a nursing home involves all the players concerned: first of all, the resident, then the caregivers, the families and the institution. This unifying tool, organised around the elderly, helps to develop collective competencies, favours the integration of new residents and reassures families. This article presents a nursing home's experience of setting up a life project. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

The renormalization scale-setting problem in QCD

Energy Technology Data Exchange (ETDEWEB)

Wu, Xing-Gang [Chongqing Univ. (China); Brodsky, Stanley J. [SLAC National Accelerator Lab., Menlo Park, CA (United States); Mojaza, Matin [SLAC National Accelerator Lab., Menlo Park, CA (United States); Univ. of Southern Denmark, Odense (Denmark)

2013-09-01

A key problem in making precise perturbative QCD predictions is to set the proper renormalization scale of the running coupling. The conventional scale-setting procedure assigns an arbitrary range and an arbitrary systematic error to fixed-order pQCD predictions. In fact, this ad hoc procedure gives results which depend on the choice of the renormalization scheme, and it is in conflict with the standard scale-setting procedure used in QED. Predictions for physical results should be independent of the choice of the scheme or other theoretical conventions. We review current ideas and points of view on how to deal with the renormalization scale ambiguity and show how to obtain renormalization scheme- and scale-independent estimates. We begin by introducing the renormalization group (RG) equation and an extended version, which expresses the invariance of physical observables under both the renormalization scheme and scale-parameter transformations. The RG equation provides a convenient way for estimating the scheme- and scale-dependence of a physical process. We then discuss self-consistency requirements of the RG equations, such as reflexivity, symmetry, and transitivity, which must be satisfied by a scale-setting method. Four typical scale setting methods suggested in the literature, i.e., the Fastest Apparent Convergence (FAC) criterion, the Principle of Minimum Sensitivity (PMS), the Brodsky–Lepage–Mackenzie method (BLM), and the Principle of Maximum Conformality (PMC), are introduced. Basic properties and their applications are discussed. We pay particular attention to the PMC, which satisfies all of the requirements of RG invariance. Using the PMC, all non-conformal terms associated with the β-function in the perturbative series are summed into the running coupling, and one obtains a unique, scale-fixed, scheme-independent prediction at any finite order. The PMC provides the principle underlying the BLM method, since it gives the general rule for extending

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

Pharmacologic management of non-cancer pain among nursing home residents.

Science.gov (United States)

Lapane, Kate L; Quilliam, Brian J; Chow, Wing; Kim, Myoung S

2013-01-01

Pain is common in nursing home settings. To describe scheduled analgesic use among nursing home (NH) residents experiencing non-cancer pain and evaluate factors associated with scheduled analgesic use. We identified 2508 residents living in one of 185 NHs predominantly from one for-profit chain, with pain recorded on two consecutive Minimum Data Set assessments. Pharmacy transaction files provided detailed medication information. Logistic regression models adjusted for clustering of residents in NHs identified factors related to scheduled prescription analgesics. Twenty-three percent had no scheduled analgesics prescribed. Those with scheduled analgesics were more likely to have excruciating pain (5.5% vs. 1.2%) and moderate pain documented (64.7% vs. 47.5%) than residents without scheduled analgesics. Hydrocodone (41.7%), short-acting oxycodone (16.6%), and long-acting fentanyl (9.4%) were common, and 13.8% reported any nonsteroidal anti-inflammatory agent use. Factors associated with decreased odds of scheduled analgesics included severe cognitive impairment (adjusted odds ratio [AOR] 0.56; 95% confidence interval [CI] 0.36 to 0.88), age more than 85 years (AOR 0.57; 95% CI 0.41 to 0.80), and Parkinson's disease (AOR 0.55; 95% CI 0.30 to 0.99). Factors associated with increased odds of scheduled analgesic use included history of fracture (AOR 1.79; 95% CI 1.16 to 2.76), diabetes (AOR 1.30; 95% CI 1.02 to 1.66), and higher Minimum Data Set mood scores (AOR 1.11; 95% CI 1.04 to 1.19). Some improvements in pharmacologic management of pain in NHs have been realized. Yet, presence of pain without scheduled analgesics prescribed was still common. Evidence-based procedures to assure adherence to clinical practice guidelines for pain management in this setting are warranted. Copyright © 2013 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

[Occlusal schemes of complete dentures--a review of the literature].

Science.gov (United States)

Tarazi, E; Ticotsky-Zadok, N

2007-01-01

Occlusal scheme is defined as the form and the arrangement of the occlusal contacts in natural and artificial dentition. The choice of an occlusal scheme will determine the pattern of occlusal contacts between opposing teeth during centric relation and functional movement of the mandible. With dentures, the quantity and the intensity of these contacts determine the amount and the direction of the forces that are transmitted through the bases of the denture to the residual ridges. That is why the occlusal scheme is an important factor in the design of complete dentures. Three occlusal schemes are viewed in this review: bilateral balanced occlusion, monplane occlusion, and linear occlusion scheme. Each scheme represents a different concept of occlusion. Comparisons between these schemes are also reviewed and analyzed. The reasoning underlying the bilateral balanced occlusion scheme is that stability of the dentures is attained when bilateral contacts exist throughout all dynamic and static states of the denture during function. Anatomic teeth are used: the upper anterior teeth are set to satisfy aesthetics, and the posterior teeth are arranged in a compensatory curve and a medial curve. This scheme is adequate for well developed residual ridges, with skeletal class I relation. With highly resorbed residual ridges, the vectors of force that are transmitted through anatomic cusps will dislodge the lower denture and thus impair the comfort and efficiency of mastication experienced by the patient. In order to accommodate to the special needs posed by highly resorbed residual ridges and skeletal relations that are not class I, the monoplane scheme of occlusion was designed. This scheme consists of non anatomic (cuspless) teeth, which are set so that the anterior teeth provide the aesthetics, the premolars and the first molars are used for chewing, and the second molars do not occlude (although sometimes they are specifically used to establish bilateral contacts in lateral

Numerical simulation of interface movement in gas-liquid two-phase flows with Level Set method

International Nuclear Information System (INIS)

Li Huixiong; Chinese Academy of Sciences, Beijing; Deng Sheng; Chen Tingkuan; Zhao Jianfu; Wang Fei

2005-01-01

Numerical simulation of gas-liquid two-phase flow and heat transfer has been an attractive work for a quite long time, but still remains as a knotty difficulty due to the inherent complexities of the gas-liquid two-phase flow resulted from the existence of moving interfaces with topology changes. This paper reports the effort and the latest advances that have been made by the authors, with special emphasis on the methods for computing solutions to the advection equation of the Level set function, which is utilized to capture the moving interfaces in gas-liquid two-phase flows. Three different schemes, i.e. the simple finite difference scheme, the Superbee-TVD scheme and the 5-order WENO scheme in combination with the Runge-Kutta method are respectively applied to solve the advection equation of the Level Set. A numerical procedure based on the well-verified SIMPLER method is employed to numerically calculate the momentum equations of the two-phase flow. The above-mentioned three schemes are employed to simulate the movement of four typical interfaces under 5 typical flowing conditions. Analysis of the numerical results shows that the 5-order WENO scheme and the Superbee-TVD scheme are much better than the simple finite difference scheme, and the 5-order WENO scheme is the best to compute solutions to the advection equation of the Level Set. The 5-order WENO scheme will be employed as the main scheme to get solutions to the advection equations of the Level Set when gas-liquid two-phase flows are numerically studied in the future. (authors)

A novel adjuvant to the resident selection process: the hartman value profile.

Science.gov (United States)

Cone, Jeffrey D; Byrum, C Stephen; Payne, Wyatt G; Smith, David J

2012-01-01

The goal of resident selection is twofold: (1) select candidates who will be successful residents and eventually successful practitioners and (2) avoid selecting candidates who will be unsuccessful residents and/or eventually unsuccessful practitioners. Traditional tools used to select residents have well-known limitations. The Hartman Value Profile (HVP) is a proven adjuvant tool to predicting future performance in candidates for advanced positions in the corporate setting. No literature exists to indicate use of the HVP for resident selection. The HVP evaluates the structure and the dynamics of an individual value system. Given the potential impact, we implemented its use beginning in 2007 as an adjuvant tool to the traditional selection process. Experience gained from incorporating the HVP into the residency selection process suggests that it may add objectivity and refinement in predicting resident performance. Further evaluation is warranted with longer follow-up times.

Riemann-problem and level-set approaches for two-fluid flow computations I. Linearized Godunov scheme

NARCIS (Netherlands)

B. Koren (Barry); M.R. Lewis; E.H. van Brummelen (Harald); B. van Leer

2001-01-01

textabstractA finite-volume method is presented for the computation of compressible flows of two immiscible fluids at very different densities. The novel ingredient in the method is a two-fluid linearized Godunov scheme, allowing for flux computations in case of different fluids (e.g., water and

Inter-generational co-residence and women's work and leisure time in Egypt

Directory of Open Access Journals (Sweden)

Nadia Diamond-Smith

2015-10-01

Full Text Available Background: Labor force participation among women in Egypt remains low, and due to falling fertility and increases life expectancy, women in Egypt in the future may spend more time co-residing with aging in-laws. Past literature has suggested that co-residence in some settings allows women to enter the labor force more, as mother-in-laws help care for their grandchildren, or inhibits labor force participation when mother-in-laws reinforce traditional values. There is little research on co-residence and labor supply, or leisure time, in Egypt. Objective: This paper examines the role of intergenerational co-residence in women's work, work time, and leisure time using data on time allocation in Egypt. Methods: Data were collected from 548 women with a living mother-in-law: 291 co-residing their mother-in-law and 257 not. Survey data included work status, a 24-hour time diary, and a health assessment of the mother-in-law. Multivariate regression models predicted work, work time, and leisure time use using standard models. Results: Co-residing with a disabled mother-in-law was associated with decreased odds of women working and fewer minutes spent working a day. Leisure time was not associated with the co-residence and disability status of a mother-in-law. Factors related to couples' relationships and the woman's views on gender norms were also associated with women working. Conclusions: Co-residence appears to be associated with women's work, depending on the disability status of the co-residing mother-in-law. If increased life expectancy is associated with more time spent in a disabled state for mothers-in-law, this could put downward pressure on women's work in this setting.

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

Science.gov (United States)

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

2012-01-01

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

Use of a Self-Reflection Tool to Enhance Resident Learning on an Adolescent Medicine Rotation.

Science.gov (United States)

Greenberg, Katherine Blumoff; Baldwin, Constance

2016-08-01

Adolescent Medicine (AM) educators in pediatric residency programs are seeking new ways to engage learners in adolescent health. This mixed-methods study presents a novel self-reflection tool and addresses whether self-reflection enhanced residents' perception of the value of an adolescent rotation, in particular, its relevance to their future practice. The self-reflection tool included 17 Likert scale items on residents' comfort with the essential tasks of adolescent care and open-ended questions that promoted self-reflection and goal setting. Semi-structured, postrotation interviews encouraged residents to discuss their experiences. Likert scale data were analyzed using descriptive statistics, and interview notes and written comments on the self-reflection tool were combined for qualitative data analysis. Residents' pre-to post-self-evaluations showed statistically significant increases in comfort with most of the adolescent health care tasks. Four major themes emerged from our qualitative analysis: (1) the value of observing skilled attendings as role models; (2) the comfort gained through broad and frequent adolescent care experiences; (3) the career relevance of AM; and (4) the ability to set personally meaningful goals for the rotation. Residents used the self-reflection tool to mindfully set goals and found their AM education valuable and relevant to their future careers. Our tool helped make explicit to residents the norms, values, and beliefs of the hidden curriculum applied to the care of adolescents and helped them to improve the self-assessed quality of their rapport and communications with adolescents. We conclude that a structured self-reflection exercise can enhance residents' experiences on an AM rotation. Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

MDS 2.0 Public Quality Indicator and Resident Reports

Data.gov (United States)

U.S. Department of Health & Human Services — The Minimum Data Set (MDS) is part of the federally mandated process for clinical assessment of all residents in Medicare or Medicaid certified nursing homes. This...

Use of dialectical behavior therapy in borderline personality disorder: a view from residency.

Science.gov (United States)

Sharma, Binali; Dunlop, Boadie W; Ninan, Philip T; Bradley, Rebekah

2007-01-01

The authors describe the use of dialectical behavior therapy (DBT) in treating borderline personality disorder during psychiatry residency, and assess the status of DBT education within psychiatry residencies in the United States. The authors present a patient with borderline personality disorder treated by a resident using DBT, along with perspectives from the resident's supervisors. Additionally, self-report surveys inquiring about the attitudes and experiences of residency directors and PGY-4 residents regarding DBT were sent to program directors with available e-mail addresses on FREIDA online. The DBT method employed by the resident had to be modified to fit the constraints of a residency program. The patient in therapy had a tumultuous course, ultimately resulting in the discontinuation of treatment. Survey results suggested an underemphasis on the education and use of DBT during residency, though the strength of this conclusion is limited by the small proportion of surveys returned. Achieving the efficacy of DBT-based treatment of borderline personality disorder reported in the literature in the setting of a residency program is challenging. Greater exposure to DBT during residency may increase residents' skills in using the technique and the likelihood that they will use it after residency.

A light weight secure image encryption scheme based on chaos & DNA computing

Directory of Open Access Journals (Sweden)

Bhaskar Mondal

2017-10-01

Full Text Available This paper proposed a new light weight secure cryptographic scheme for secure image communication. In this scheme the plain image is permuted first using a sequence of pseudo random number (PRN and encrypted by DeoxyriboNucleic Acid (DNA computation. Two PRN sequences are generated by a Pseudo Random Number Generator (PRNG based on cross coupled chaotic logistic map using two sets of keys. The first PRN sequence is used for permuting the plain image whereas the second PRN sequence is used for generating random DNA sequence. The number of rounds of permutation and encryption may be variable to increase security. The scheme is proposed for gray label images but the scheme may be extended for color images and text data. Simulation results exhibit that the proposed scheme can defy any kind of attack.

Gradual and Cumulative Improvements to the Classical Differential Evolution Scheme through Experiments

Directory of Open Access Journals (Sweden)

Anescu George

2016-12-01

Full Text Available The paper presents the experimental results of some tests conducted with the purpose to gradually and cumulatively improve the classical DE scheme in both efficiency and success rate. The modifications consisted in the randomization of the scaling factor (a simple jitter scheme, a more efficient Random Greedy Selection scheme, an adaptive scheme for the crossover probability and a resetting mechanism for the agents. After each modification step, experiments have been conducted on a set of 11 scalable, multimodal, continuous optimization functions in order to analyze the improvements and decide the new improvement direction. Finally, only the initial classical scheme and the constructed Fast Self-Adaptive DE (FSA-DE variant were compared with the purpose of testing their performance degradation with the increase of the search space dimension. The experimental results demonstrated the superiority of the proposed FSA-DE variant.

Resident involvement in civilian tactical emergency medicine.

Science.gov (United States)

Ramirez, Mario Luis; Slovis, Corey M

2010-07-01

Tactical emergency medicine services (TEMS) has emerged as a specialized niche within the field of emergency medicine. With increasing demand for physician participation in civilian tactical teams, there will be efforts by residents to become involved at earlier points in their clinical training. This article discusses resident involvement with a civilian TEMS unit and provides five maxims for emergency physicians to better understand the difference between working in the emergency department or with emergency medical services vs. in a TEMS environment. Differences between TEMS and other trauma life support models, institutional and political barriers likely to be encountered by the resident, the value of preventive medicine and the role of the physician in long-term tactical operations, opportunities for subspecialty growth, and the role of operational security are all discussed in detail. Tactical emergency medicine is a specialty that utilizes the full array of the emergency physician's skill set. It is also a field that is ripe for continued expansion, but the resident looking to become involved with a team should be aware of the requirements necessary to do so and the obstacles likely to be encountered along the way. Copyright 2010 Elsevier Inc. All rights reserved.

Balancing Urban Biodiversity Needs and Resident Preferences for Vacant Lot Management

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Christine C. Rega-Brodsky

2018-05-01

Full Text Available Urban vacant lots are often a contentious feature in cities, seen as overgrown, messy eyesores that plague neighborhoods. We propose a shift in this perception to locations of urban potential, because vacant lots may serve as informal greenspaces that maximize urban biodiversity while satisfying residents’ preferences for their design and use. Our goal was to assess what kind of vacant lots are ecologically valuable by assessing their biotic contents and residents’ preferences within a variety of settings. We surveyed 150 vacant lots throughout Baltimore, Maryland for their plant and bird communities, classified the lot’s setting within the urban matrix, and surveyed residents. Remnant vacant lots had greater vegetative structure and bird species richness as compared to other lot origins, while vacant lot settings had limited effects on their contents. Residents preferred well-maintained lots with more trees and less artificial cover, support of which may increase local biodiversity in vacant lots. Collectively, we propose that vacant lots with a mixture of remnant and planted vegetation can act as sustainable urban greenspaces with the potential for some locations to enhance urban tree cover and bird habitat, while balancing the needs and preferences of city residents.

Role of Pharmacy Residency Training in Career Planning: A Student's Perspective.

Science.gov (United States)

McElhaney, Ashley; Weber, Robert J

2014-12-01

Pharmacy students typically become more focused on career planning and assessment in the final year of their PharmD training. Weighing career options in the advanced pharmacy practice experience year can be both exciting and stressful. The goal of this article is to provide a primer on how pharmacy students can assess how a residency can fit into career planning. This article will describe the various career paths available to graduating students, highlight ways in which a residency can complement career choices, review the current state of the job market for pharmacists, discuss the current and future plans for residency programs, and present thoughts from some current and former residents on why they chose to complete a residency. Most career paths require some additional training, and a residency provides appropriate experience very quickly compared to on-the-job training. Alternative plans to residency training must also be considered, as there are not enough residency positions for candidates. Directors of pharmacy must consider several factors when giving career advice on pharmacy residency training to pharmacy students; they should provide the students with an honest assessment of their work skills and their abilities to successfully complete a residency. This assessment will help the students to set a plan for improvement and give them a better chance at being matched to a pharmacy residency.

Implementation and analysis of trajectory schemes for informate: a serial link robot manipulator

International Nuclear Information System (INIS)

Rauf, A.; Ahmed, S.M.; Asif, M.; Ahmad, M.

1997-01-01

Trajectory planning schemes generally interpolate or approximate the desired path by a class of polynomial functions and generate a sequence of time based control set points for the control of the manipulator movement from certain initial configuration to final configuration. Schemes for trajectory generation can be implemented in Joint space and in Cartesian space. This paper describes Joint Space trajectory schemes and Cartesian Space trajectory schemes and their implementation for Infomate, a six degrees of freedom serial link robot manipulator. LSPBs and cubic Spline are chosen as interpolating functions of time for each type of schemes. Modules developed have been incorporated in an OLP system for Infomate. Trajectory planning Schemes discussed in this paper incorporate the constraints of velocities and accelerations of the actuators. comparison with respect to computation and motion time is presented for above mentioned trajectory schemes. Algorithms have been developed that enable the end effector to follow a straight line; other paths like circle, ellipse, etc. can be approximated by straight line segments. (author)

Teaching ethics to paediatrics residents: the centrality of the therapeutic alliance.

Science.gov (United States)

Taylor, Holly A; McDonald, Erin L; Moon, Margaret; Hughes, Mark T; Carrese, Joseph A

2009-10-01

of this project to better target and enhance their ethics education efforts directed at residents in the out-patient setting. Future research could further examine and test these findings in other clinical settings (e.g. adult general medicine).

A Stereo Music Preprocessing Scheme for Cochlear Implant Users.

Science.gov (United States)

Buyens, Wim; van Dijk, Bas; Wouters, Jan; Moonen, Marc

2015-10-01

Listening to music is still one of the more challenging aspects of using a cochlear implant (CI) for most users. Simple musical structures, a clear rhythm/beat, and lyrics that are easy to follow are among the top factors contributing to music appreciation for CI users. Modifying the audio mix of complex music potentially improves music enjoyment in CI users. A stereo music preprocessing scheme is described in which vocals, drums, and bass are emphasized based on the representation of the harmonic and the percussive components in the input spectrogram, combined with the spatial allocation of instruments in typical stereo recordings. The scheme is assessed with postlingually deafened CI subjects (N = 7) using pop/rock music excerpts with different complexity levels. The scheme is capable of modifying relative instrument level settings, with the aim of improving music appreciation in CI users, and allows individual preference adjustments. The assessment with CI subjects confirms the preference for more emphasis on vocals, drums, and bass as offered by the preprocessing scheme, especially for songs with higher complexity. The stereo music preprocessing scheme has the potential to improve music enjoyment in CI users by modifying the audio mix in widespread (stereo) music recordings. Since music enjoyment in CI users is generally poor, this scheme can assist the music listening experience of CI users as a training or rehabilitation tool.

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.

Exact analysis of Packet Reversed Packet Combining Scheme and Modified Packet Combining Scheme; and a combined scheme

International Nuclear Information System (INIS)

Bhunia, C.T.

2007-07-01

Packet combining scheme is a well defined simple error correction scheme for the detection and correction of errors at the receiver. Although it permits a higher throughput when compared to other basic ARQ protocols, packet combining (PC) scheme fails to correct errors when errors occur in the same bit locations of copies. In a previous work, a scheme known as Packet Reversed Packet Combining (PRPC) Scheme that will correct errors which occur at the same bit location of erroneous copies, was studied however PRPC does not handle a situation where a packet has more than 1 error bit. The Modified Packet Combining (MPC) Scheme that can correct double or higher bit errors was studied elsewhere. Both PRPC and MPC schemes are believed to offer higher throughput in previous studies, however neither adequate investigation nor exact analysis was done to substantiate this claim of higher throughput. In this work, an exact analysis of both PRPC and MPC is carried out and the results reported. A combined protocol (PRPC and MPC) is proposed and the analysis shows that it is capable of offering even higher throughput and better error correction capability at high bit error rate (BER) and larger packet size. (author)

Identifying nursing home residents at risk for falling.

Science.gov (United States)

Kiely, D K; Kiel, D P; Burrows, A B; Lipsitz, L A

1998-05-01

To develop a fall risk model that can be used to identify prospectively nursing home residents at risk for falling. The secondary objective was to determine whether the nursing home environment independently influenced the development of falls. A prospective study involving 1 year of follow-up. Two hundred seventy-two nursing homes in the state of Washington. A total of 18,855 residents who had a baseline assessment in 1991 and a follow-up assessment within the subsequent year. Baseline Minimum Data Set items that could be potential risk factors for falling were considered as independent variables. The dependent variable was whether the resident fell as reported at the follow-up assessment. We estimated the extrinsic risk attributable to particular nursing home environments by calculating the annual fall rate in each nursing home and grouping them into tertiles of fall risk according to these rates. Factors associated independently with falling were fall history, wandering behavior, use of a cane or walker, deterioration of activities of daily living performance, age greater than 87 years, unsteady gait, transfer independence, wheelchair independence, and male gender. Nursing home residents with a fall history were more than three times as likely to fall during the follow-up period than residents without a fall history. Residents in homes with the highest tertile of fall rates were more than twice as likely to fall compared with residents of homes in the lowest tertile, independent of resident-specific risk factors. Fall history was identified as the strongest risk factor associated with subsequent falls and accounted for the vast majority of the predictive strength of the model. We recommend that fall history be used as an initial screener for determining eligibility for fall intervention efforts. Studies are needed to determine the facility characteristics that contribute to fall risk, independent of resident-specific risk factors.

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.

Simplification of a dust emission scheme and comparison with data

Science.gov (United States)

Shao, Yaping

2004-05-01

A simplification of a dust emission scheme is proposed, which takes into account of saltation bombardment and aggregates disintegration. The statement of the scheme is that dust emission is proportional to streamwise saltation flux, but the proportionality depends on soil texture and soil plastic pressure p. For small p values (loose soils), dust emission rate is proportional to u*4 (u* is friction velocity) but not necessarily so in general. The dust emission predictions using the scheme are compared with several data sets published in the literature. The comparison enables the estimate of a model parameter and soil plastic pressure for various soils. While more data are needed for further verification, a general guideline for choosing model parameters is recommended.

Energy Design Advice Scheme (EDAS): operations and achievements 1992-1998

Energy Technology Data Exchange (ETDEWEB)

NONE

1998-09-01

The Energy Design Advice Scheme (EDAS) was launched in 1992 under the DTI's Passive Solar Programme to help improve the energy performance of the UK's building stock. It aimed to do this through direct advice and guidance on passive solar design and energy efficient technologies and processes given to the designers of real building projects. Furthermore, the scheme aimed to raise the awareness and take-up of definitive guidance produced under government programmes such as the Passive Solar programme and the Energy Efficiency Best Practice programme. A target energy saving worth Pound 19.3m was set to be achieved by the end of the scheme. This energy saving is equivalent to a reduction in carbon dioxide emission of 220,000 tonnes per year. (author)

Why Do Emergency Medicine Residents Experience Burn Out? A qualitative study

Directory of Open Access Journals (Sweden)

Atefe Kamaloo

2017-06-01

Full Text Available Objective: Emergency medicine residents are a high–risk group for burnout syndrome. This was a qualitative study with content analysis on emergency medical residents with 2 aims: evaluating the incidence of occupational burnout syndrome and identifying the points of view and attitudes of emergency medical residents about factors related to occupational burnout syndrome.Method: For this study, 2 sessions of focus group discussions were set up at Imam Khomeini hospital affiliated to Tehran University of Medical Sciences. Each session took 90 minutes, and 20 emergency medicine residents in their first or second year of emergency medicine residency participated in the sessions. Data were coded   by MAXQDA10 software.Results: Data were categorized in 4 themes as follow: (1 the characteristics of emergency medicine; (2 ambiguity in residents’ duties; (3 educational planning; and (4 careers.Data on the proposed solutions by residents were analyzed and coded in 3 groups including (1 changes in personal life; (2 arrangement in shifts; and  (3 educational issues.Conclusion: According to findings of this qualitative study, most of emergency medicine residents have experienced exhaustion sometime during the course of their residency. Psychological supports may help the residents to cope with their career difficulties and probable burn out.

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).

Fully discrete Galerkin schemes for the nonlinear and nonlocal Hartree equation

Directory of Open Access Journals (Sweden)

Walter H. Aschbacher

2009-01-01

Full Text Available We study the time dependent Hartree equation in the continuum, the semidiscrete, and the fully discrete setting. We prove existence-uniqueness, regularity, and approximation properties for the respective schemes, and set the stage for a controlled numerical computation of delicate nonlinear and nonlocal features of the Hartree dynamics in various physical applications.

Supervisor leadership in relation to resident job satisfaction

NARCIS (Netherlands)

Wal, van der Martha; Schonrock-Adema, Johanna; Scheele, Fedde; Schripsema, Nienke R.; Jaarsma, A. Debbie C.; Cohen-Schotanus, Janke

2016-01-01

Background: Research from outside the medical field shows that leadership behaviours influence job satisfaction. Whether the same is true for the medical training setting needs to be explored. The aim of this study was to investigate the influence of residents' overall appreciation of their

Practice management education during surgical residency.

Science.gov (United States)

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

2008-12-01

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

A strategic approach to quality improvement and patient safety education and resident integration in a general surgery residency.

Science.gov (United States)

O'Heron, Colette T; Jarman, Benjamin T

2014-01-01

To outline a structured approach for general surgery resident integration into institutional quality improvement and patient safety education and development. A strategic plan to address Accreditation Council for Graduate Medical Education (ACGME) Clinical Learning Environment Review assessments for resident integration into Quality Improvement and Patient Safety initiatives is described. Gundersen Lutheran Medical Foundation is an independent academic medical center graduating three categorical residents per year within an integrated multi-specialty health system serving 19 counties over 3 states. The quality improvement and patient safety education program includes a formal lecture series, online didactic sessions, mandatory quality improvement or patient safety projects, institutional committee membership, an opportunity to serve as a designated American College of Surgeons National Surgical Quality Improvement Project and Quality in Training representative, mandatory morbidity and mortality conference attendance and clinical electives in rural surgery and international settings. Structured education regarding and participation in quality improvement and patient safety programs are able to be accomplished during general surgery residency. The long-term outcomes and benefits of these strategies are unknown at this time and will be difficult to measure with objective data. © 2013 Published by Association of Program Directors in Surgery on behalf of Association of Program Directors in Surgery.

Renormalization in self-consistent approximation schemes at finite temperature I: theory

International Nuclear Information System (INIS)

Hees, H. van; Knoll, J.

2001-07-01

Within finite temperature field theory, we show that truncated non-perturbative self-consistent Dyson resummation schemes can be renormalized with local counter-terms defined at the vacuum level. The requirements are that the underlying theory is renormalizable and that the self-consistent scheme follows Baym's Φ-derivable concept. The scheme generates both, the renormalized self-consistent equations of motion and the closed equations for the infinite set of counter terms. At the same time the corresponding 2PI-generating functional and the thermodynamic potential can be renormalized, in consistency with the equations of motion. This guarantees the standard Φ-derivable properties like thermodynamic consistency and exact conservation laws also for the renormalized approximation scheme to hold. The proof uses the techniques of BPHZ-renormalization to cope with the explicit and the hidden overlapping vacuum divergences. (orig.)

Otolaryngology Residency Program Research Resources and Scholarly Productivity.

Science.gov (United States)

Villwock, Jennifer A; Hamill, Chelsea S; Nicholas, Brian D; Ryan, Jesse T

2017-06-01

Objective To delineate research resources available to otolaryngology residents and their impact on scholarly productivity. Study Design Survey of current otolaryngology program directors. Setting Otolaryngology residency programs. Subjects and Methods An anonymous web-based survey was sent to 98 allopathic otolaryngology training program directors. Fisher exact tests and nonparametric correlations were used to determine statistically significant differences among various strata of programs. Results Thirty-nine percent (n = 38) of queried programs responded. Fourteen (37%) programs had 11 to 15 full-time, academic faculty associated with the residency program. Twenty (53%) programs have a dedicated research coordinator. Basic science lab space and financial resources for statistical work were present at 22 programs (58%). Funding is uniformly provided for presentation of research at conferences; a minority of programs (13%) only funded podium presentations. Twenty-four (63%) have resident research requirements beyond the Accreditation Council for Graduate Medical Education (ACGME) mandate of preparing a "manuscript suitable for publication" prior to graduation. Twenty-five (67%) programs have residents with 2 to 3 active research projects at any given time. None of the investigated resources were significantly associated with increased scholarly output. There was no uniformity to research curricula. Conclusions Otolaryngology residency programs value research, evidenced by financial support provided and requirements beyond the ACGME minimum. Additional resources were not statistically related to an increase in resident research productivity, although they may contribute positively to the overall research experience during training. Potential future areas to examine include research curricula best practices, how to develop meaningful mentorship and resource allocation that inspires continued research interest, and intellectual stimulation.

Neuroscience and humanistic psychiatry: a residency curriculum.

Science.gov (United States)

Griffith, James L

2014-04-01

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

Involvement in Activities and Wandering in Nursing Home Residents With Cognitive Impairment

NARCIS (Netherlands)

Volicer, L.; van der Steen, J.T.; Frijters, D.H.M.

2013-01-01

Objectives: Analysis of a relationship between wandering and involvement in meaningful activities in nursing home residents with cognitive impairment. DESIGN:: Cross-sectional analysis of the Minimum Data Set information. SETTING:: The analyses were conducted on 8 nursing homes in the Netherlands.

A generalized form of the Bernoulli Trial collision scheme in DSMC: Derivation and evaluation

Science.gov (United States)

Roohi, Ehsan; Stefanov, Stefan; Shoja-Sani, Ahmad; Ejraei, Hossein

2018-02-01

The impetus of this research is to present a generalized Bernoulli Trial collision scheme in the context of the direct simulation Monte Carlo (DSMC) method. Previously, a subsequent of several collision schemes have been put forward, which were mathematically based on the Kac stochastic model. These include Bernoulli Trial (BT), Ballot Box (BB), Simplified Bernoulli Trial (SBT) and Intelligent Simplified Bernoulli Trial (ISBT) schemes. The number of considered pairs for a possible collision in the above-mentioned schemes varies between N (l) (N (l) - 1) / 2 in BT, 1 in BB, and (N (l) - 1) in SBT or ISBT, where N (l) is the instantaneous number of particles in the lth cell. Here, we derive a generalized form of the Bernoulli Trial collision scheme (GBT) where the number of selected pairs is any desired value smaller than (N (l) - 1), i.e., Nsel < (N (l) - 1), keeping the same the collision frequency and accuracy of the solution as the original SBT and BT models. We derive two distinct formulas for the GBT scheme, where both formula recover BB and SBT limits if Nsel is set as 1 and N (l) - 1, respectively, and provide accurate solutions for a wide set of test cases. The present generalization further improves the computational efficiency of the BT-based collision models compared to the standard no time counter (NTC) and nearest neighbor (NN) collision models.

Health outcomes and quality of life of residents of shared-housing arrangements compared to residents of special care units - results of the Berlin DeWeGE-study.

Science.gov (United States)

Wolf-Ostermann, Karin; Worch, Andreas; Fischer, Thomas; Wulff, Ines; Gräske, Johannes

2012-11-01

To compare different health outcomes as well as quality of life (QoL) between people with dementia living in shared-housing arrangements (SHA) and special care units (SCU) in nursing homes. Often situated in large apartments in mostly urban settings, SHA are a specific German kind of small-scale living facilities for older care-dependent persons, predominantly suffering from dementia. SHA are completely disconnected from traditional nursing homes. In a longitudinal design, all new residents of SHA and SCU suffering with dementia in Berlin were surveyed for one year. They were assessed when they moved into the SHA or SCU and again 6 and 12 months later. We surveyed physical and psychological health outcomes including ADL-functioning (Barthel), neuropsychiatric symptoms of dementia (NPI) and challenging behaviour (Cohen-Mansfield agitation inventory) as well as QoL (Qualidem). Fifty-six persons (43 women, 13 men) were recruited into the longitudinal study. The average age was 82·5 years at admission, participants mostly had a moderate level of cognitive impairment (mean Mini Mental State Examination = 13·3), prevalence of neuropsychiatric symptoms was high. During the one-year follow-up, analyses show a significant decrease in cognitive abilities but also of neuropsychiatric symptoms in both groups. In SHA, QoL increases on average during the one-year study period. Both types of facilities attract slightly different populations according to our data. Comparison of SHA residents to SCU residents documented no significant beneficial effects of settings in terms of health outcomes. As no clear advantage of either SHA or SCU in nursing homes can be demonstrated for residents with dementia who move in newly, it is impossible to give a clear evidence-based recommendation and the decision for one setting or the other can be made according solely to personal preference of the resident. © 2012 Blackwell Publishing Ltd.

Third Order Reconstruction of the KP Scheme for Model of River Tinnelva

Directory of Open Access Journals (Sweden)

Susantha Dissanayake

2017-01-01

Full Text Available The Saint-Venant equation/Shallow Water Equation is used to simulate flow of river, flow of liquid in an open channel, tsunami etc. The Kurganov-Petrova (KP scheme which was developed based on the local speed of discontinuity propagation, can be used to solve hyperbolic type partial differential equations (PDEs, hence can be used to solve the Saint-Venant equation. The KP scheme is semi discrete: PDEs are discretized in the spatial domain, resulting in a set of Ordinary Differential Equations (ODEs. In this study, the common 2nd order KP scheme is extended into 3rd order scheme while following the Weighted Essentially Non-Oscillatory (WENO and Central WENO (CWENO reconstruction steps. Both the 2nd order and 3rd order schemes have been used in simulation in order to check the suitability of the KP schemes to solve hyperbolic type PDEs. The simulation results indicated that the 3rd order KP scheme shows some better stability compared to the 2nd order scheme. Computational time for the 3rd order KP scheme for variable step-length ode solvers in MATLAB is less compared to the computational time of the 2nd order KP scheme. In addition, it was confirmed that the order of the time integrators essentially should be lower compared to the order of the spatial discretization. However, for computation of abrupt step changes, the 2nd order KP scheme shows a more accurate solution.

Finite Boltzmann schemes

NARCIS (Netherlands)

Sman, van der R.G.M.

2006-01-01

In the special case of relaxation parameter = 1 lattice Boltzmann schemes for (convection) diffusion and fluid flow are equivalent to finite difference/volume (FD) schemes, and are thus coined finite Boltzmann (FB) schemes. We show that the equivalence is inherent to the homology of the

A Professionalism Curricular Model to Promote Transformative Learning Among Residents.

Science.gov (United States)

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

2017-06-01

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

Emissions trading to combat climate change: The impact of scheme design on transaction costs

OpenAIRE

Betz, Regina

2006-01-01

This paper explores the likely impact of emissions trading design on transaction costs. Transaction costs include both the costs for the private sector to comply with the scheme rules and the costs of scheme administration. In economic theory transaction costs are often assumed to be zero. But transaction costs are real costs and there is no reason for treating them differently to other costs. Thus, in setting up an emissions trading scheme, transaction costs have to be taken into account in ...

RADPED: an approach to teaching communication skills to radiology residents

International Nuclear Information System (INIS)

Goske, Marilyn J.; Reid, Janet R.; Yaldoo-Poltorak, Dunya; Hewson, Mariana

2005-01-01

The Accreditation Council for Graduate Medical Education mandates that radiology residency programs teach communication skills to residents. The purpose of this paper is to present a mnemonic, RADPED, that can be used to enhance communication in the radiology setting. It reminds the resident of the salient points to address during an imaging encounter with pediatric patients and their families for the purpose of enhancing communication. Recent history and research in medical communication are reviewed. Various communication guides used by primary care physicians, such as SEGUE, and the Kalamazoo consensus statement are discussed. This methodology was adapted into a format that could be used to teach communication skills to radiology residents in the context of an imaging encounter. RADPED reminds the resident to establish rapportwith the patient, ask questionsas to why the patient and family are presenting for the study, discuss the exam, perform the procedure, use exam distractions, and discussthe results with the referring physician and family when appropriate. This guide is available with movie clips as part of an on-line pediatric radiology curriculum. This simple memory aid promotes the key points necessary to optimize the radiology resident's encounter with pediatric patients and their families. (orig.)

Development of a Post-Graduate Year 2 Pharmacy Residency in Clinical Pharmacogenetics

Science.gov (United States)

Hoffman, James M.; Gammal, Roseann S.; Relling, Mary V.; Crews, Kristine R.

2017-01-01

Purpose The structure and development of an innovative clinical pharmacogenetics post-graduate year 2 (PGY2) ASHP-accredited residency program is described. Summary The advent of the era of genomics has left practitioners wondering how to interpret the data obtained from sequencing and genotyping patients. In order to train the next leaders in the area of implementing pharmacogenetics, St. Jude Children’s Research Hospital established the first accredited residency program in clinical pharmacogenetics. The 12-month long PGY2 residency was created in accordance with the ASHP standards for advanced practice residencies. The resident learns to optimize patient outcomes through the expert provision of evidence-based, patient-centered precision medicine as an integral part of an interdisciplinary team. The resident gains hands-on experience in a dynamic environment regarding all aspects of running a clinical pharmacogenetics service. Since the first resident graduated in 2012, the program has graduated one resident each year. Conclusion To fill a need for pharmacists trained in pharmacogenetics, an innovative PGY2 residency in clinical pharmacogenetics was successfully developed. Upon completion of the program, residents are equipped with the clinical skills and necessary experience to drive precision medicine forward and lead the implementation of pharmacogenetics in various healthcare settings. PMID:28274984

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.

Obesity and intensive staffing needs of nursing home residents.

Science.gov (United States)

Harris, John Alexander; Engberg, John; Castle, Nicholas George

2018-06-05

The objective of this study is to examine how increasing body mass index (BMI) among nursing home residents affects the amount of staffing assistance needed for activities of daily living (ADL). We analyzed 1,627,141 US nursing home residents reported in the 2013 Minimum Data Set in seven BMI categories, from underweight (BMI < 18.5 kg/m 2 ) to obesity Class IIIB (≥50 kg/m 2 ). Logistic regression models estimated the odds of nursing home-reported need for extensive (≥2 staff member) assistance needed for ADLs. The adjusted odds increased from 1.07 (95% Confidence Interval (95%CI) 1.06-1.08) for Class I, 1.16 (95%CI 1.14-1.17) for Class II, 1.33 (95%CI 1.31-1.35) for Class IIIA, and 1.90 (95%CI 1.86-1.95) for Class IIIB obesity residents compared to residents of normal weight. As a nursing home resident's BMI increases, especially for BMI ≥40 kg/m 2 , the need for extensive staffing assistance with ADLs also increases substantially. Copyright © 2018 Elsevier Inc. All rights reserved.

Specific Physician Orders Improve Pain Detection and Pain Reports in Nursing Home Residents: Preliminary Data.

Science.gov (United States)

Monroe, Todd B; Misra, Sumathi; Habermann, Ralf C; Dietrich, Mary S; Bruehl, Stephen P; Cowan, Ronald L; Newhouse, Paul A; Simmons, Sandra F

2015-10-01

Despite evidence that many nursing home residents' pain is poorly managed, reasons for this poor management remain unanswered. The aim of this study was to determine if specific order sets related to pain assessment would improve pain management in nursing home (NH) residents. Outcomes included observed nurse pain assessment queries and resident reports of pain. The pretest/post-test study was performed in a 240-bed for-profit nursing home in the mid-southern region of the United States and participants were 43 nursing home residents capable of self-consent. Medical chart abstraction was performed during a 2-week (14-day) period before the implementation of specific order sets for pain assessment (intervention) and a 2-week (14-day) period after the intervention. Trained research assistants observed medication administration passes and performed participant interviews after each medication pass. One month after intervention implementation, 1 additional day of observations was conducted to determine data reliability. Nurses were observed to ask residents about pain more frequently, and nurses continued to ask about pain at higher rates 1 month after the intervention was discontinued. The proportion of residents who reported pain also significantly increased in response to increased nurse queries (e.g., "Do you have any pain right now?"), which underscores the importance of nurses directly asking residents about pain. Notably 70% of this long-stay NH population only told the nurses about their pain symptoms when asked directly. Findings uncover that using specific pain order sets seems to improve the detection of pain, which should be a routine part of nursing assessment. Copyright © 2015 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

The Canadian general surgery resident: defining current challenges for surgical leadership.

Science.gov (United States)

Tomlinson, Corey; Labossière, Joseph; Rommens, Kenton; Birch, Daniel W

2012-08-01

Surgery training programs in Canada and the United States have recognized the need to modify current models of training and education. The shifting demographic of surgery trainees, lifestyle issues and an increased trend toward subspecialization are the major influences. To guide these important educational initiatives, a contemporary profile of Canadian general surgery residents and their impressions of training in Canada is required. We developed and distributed a questionnaire to residents in each Canadian general surgery training program, and residents responded during dedicated teaching time. In all, 186 surveys were returned for analysis (62% response rate). The average age of Canadian general surgery residents is 30 years, 38% are women, 41% are married, 18% have dependants younger than 18 years and 41% plan to add to or start a family during residency. Most (87%) residents plan to pursue postgraduate education. On completion of training, 74% of residents plan to stay in Canada and 49% want to practice in an academic setting. Almost half (42%) of residents identify a poor balance between work and personal life during residency. Forty-seven percent of respondents have appropriate access to mentorship, whereas 37% describe suitable access to career guidance and 40% identify the availability of appropriate social supports. Just over half (54%) believe the stress level during residency is manageable. This survey provides a profile of contemporary Canadian general surgery residents. Important challenges within the residency system are identified. Program directors and chairs of surgery are encouraged to recognize these challenges and intervene where appropriate.

Meeting stroke survivors' perceived needs: a qualitative study of a community-based exercise and education scheme.

Science.gov (United States)

Reed, Mary; Harrington, Rachel; Duggan, Aine; Wood, Victorine A

2010-01-01

A qualitative study using a phenomenological approach, to explore stroke survivors' needs and their perceptions of whether a community stroke scheme met these needs. Semi-structured in-depth interviews of 12 stroke survivors, purposively selected from participants attending a new community stroke scheme. Interpretative phenomenological analysis of interviews by two researchers independently. Participants attending the community stroke scheme sought to reconstruct their lives in the aftermath of their stroke. To enable this they needed internal resources of confidence and sense of purpose to 'create their social self', and external resources of 'responsive services' and an 'informal support network', to provide direction and encouragement. Participants felt the community stroke scheme met some of these needs through exercise, goal setting and peer group interaction, which included social support and knowledge acquisition. Stroke survivors need a variety of internal and external resources so that they can rebuild their lives positively post stroke. A stroke-specific community scheme, based on exercise, life-centred goal setting, peer support and knowledge acquisition, is an external resource that can help with meeting some of the stroke survivor's needs.

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

Energy Design Advice Scheme (EDAS): operations and achievements 1992-1998

Energy Technology Data Exchange (ETDEWEB)

NONE

1998-09-01

The Energy Design Advice Scheme (EDAS) was launched in 1992 under the DTI's Passive Solar Programme to help improve the energy performance of the UK's building stock. It aimed to do this through direct advice and guidance on passive solar design and energy efficient technologies and processes given to the designers of real building projects. Furthermore, the scheme aimed to raise the awareness and take-up of definitive guidance produced under government programmes such as the Passive Solar programme and the Energy Efficiency Best Practice programme. A target energy saving worth Pound 19.3m was set to be achieved by the end of the scheme. This energy saving is equivalent to a reduction in carbon dioxide emission of 220,000 tonnes per year. (author)

[The specialty program as a training tool: an individual training plan for each resident].

Science.gov (United States)

Rodríguez González, R; Capilla Cabezuelo, E

2010-01-01

The official training program for the specialty "Diagnostic Imaging" establishes minimum learning objectives that must be fulfilled. Each accredited teaching unit is responsible for designing and carrying out a curriculum to ensure that these objectives are met, and this approach permits a degree of flexibility. Various aspects must be considered in the individual training plans for each resident: the rotation scheme according to the way the department is organized, plans for recovering missed material or reinforcing weak points, optional rotations, increasing degrees of responsibility as skills are acquired during training, and accommodating special needs of handicapped persons. Nevertheless, the individual plan must be fitted to the established curriculum and guarantee that the content of the official program is covered and that the objectives stipulated therein are met. Furthermore, the methods of teaching must be adapted to the individual characteristics of the residents, and this is the most important aspect of the individualization of training. To this end, it is fundamental for residents to take on an active role in their training, guided by their tutor and with the participation of all the radiologists in the department including the other residents, all of whom should act as teachers. Copyright © 2010 SERAM. Published by Elsevier Espana. All rights reserved.

Are Self-study Procedural Teaching Methods Effective? A Pilot Study of a Family Medicine Residency Program.

Science.gov (United States)

Deffenbacher, Brandy; Langner, Shannon; Khodaee, Morteza

2017-11-01

A family medicine residency is a unique training environment where residents are exposed to care in multiple settings, across all ages. Procedures are an integral part of family medicine practice. Family medicine residency (FMR) programs are tasked with the job of teaching these skills at a level of intensity and frequency that allows a resident to achieve competency of such skills. In an environment that is limited by work hour restrictions, self-study teaching methods are one way to ensure all residents receive the fundamental knowledge of how to perform procedures. We developed and evaluated the efficacy of a self-study procedure teaching method and procedure evaluation checklist. A self-study procedure teaching intervention was created, consisting of instructional articles and videos on three procedures. To assess the efficacy of the intervention, and the competency of the residents, pre- and postintervention procedure performance sessions were completed. These sessions were reviewed and scored using a standardized procedure performance checklist. All 24 residents participated in the study. Overall, the resident procedure knowledge increased on two of the three procedures studied, and ability to perform procedure according to expert-validated checklist improved significantly on all procedures. A self-study intervention is a simple but effective way to increase and improve procedure training in a way that fits the complex scheduling needs of a residency training program. In addition, this study demonstrates that the procedure performance checklists are a simple and reliable way to increase assessment of resident procedure performance skills in a residency setting.

Efficient and Provable Secure Pairing-Free Security-Mediated Identity-Based Identification Schemes

Directory of Open Access Journals (Sweden)

Ji-Jian Chin

2014-01-01

Full Text Available Security-mediated cryptography was first introduced by Boneh et al. in 2001. The main motivation behind security-mediated cryptography was the capability to allow instant revocation of a user’s secret key by necessitating the cooperation of a security mediator in any given transaction. Subsequently in 2003, Boneh et al. showed how to convert a RSA-based security-mediated encryption scheme from a traditional public key setting to an identity-based one, where certificates would no longer be required. Following these two pioneering papers, other cryptographic primitives that utilize a security-mediated approach began to surface. However, the security-mediated identity-based identification scheme (SM-IBI was not introduced until Chin et al. in 2013 with a scheme built on bilinear pairings. In this paper, we improve on the efficiency results for SM-IBI schemes by proposing two schemes that are pairing-free and are based on well-studied complexity assumptions: the RSA and discrete logarithm assumptions.

Efficient and provable secure pairing-free security-mediated identity-based identification schemes.

Science.gov (United States)

Chin, Ji-Jian; Tan, Syh-Yuan; Heng, Swee-Huay; Phan, Raphael C-W

2014-01-01

Security-mediated cryptography was first introduced by Boneh et al. in 2001. The main motivation behind security-mediated cryptography was the capability to allow instant revocation of a user's secret key by necessitating the cooperation of a security mediator in any given transaction. Subsequently in 2003, Boneh et al. showed how to convert a RSA-based security-mediated encryption scheme from a traditional public key setting to an identity-based one, where certificates would no longer be required. Following these two pioneering papers, other cryptographic primitives that utilize a security-mediated approach began to surface. However, the security-mediated identity-based identification scheme (SM-IBI) was not introduced until Chin et al. in 2013 with a scheme built on bilinear pairings. In this paper, we improve on the efficiency results for SM-IBI schemes by proposing two schemes that are pairing-free and are based on well-studied complexity assumptions: the RSA and discrete logarithm assumptions.

Senior residents' perceived need of and preferences for "smart home" sensor technologies.

Science.gov (United States)

Demiris, George; Hensel, Brian K; Skubic, Marjorie; Rantz, Marilyn

2008-01-01

The goal of meeting the desire of older adults to remain independent in their home setting while controlling healthcare costs has led to the conceptualization of "smart homes." A smart home is a residence equipped with technology that enhances safety of residents and monitors their health conditions. The study aim is to assess older adults' perceptions of specific smart home technologies (i.e., a bed sensor, gait monitor, stove sensor, motion sensor, and video sensor). The study setting is TigerPlace, a retirement community designed according to the Aging in Place model. Focus group sessions with fourteen residents were conducted to assess perceived advantages and concerns associated with specific applications, and preferences for recipients of sensor-generated information pertaining to residents' activity levels, sleep patterns and potential emergencies. Sessions were audio-taped; tapes were transcribed, and a content analysis was performed. A total of fourteen older adults over the age of 65 participated in three focus group sessions Most applications were perceived as useful, and participants would agree to their installation in their own home. Preference for specific sensors related to sensors' appearance and residents' own level of frailty and perceived need. Specific concerns about privacy were raised. The findings indicate an overall positive attitude toward sensor technologies for nonobtrusive monitoring. Researchers and practitioners are called upon to address ethical and technical challenges in this emerging domain.

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.

Impact of the Primary Care Exception on Family Medicine Resident Coding.

Science.gov (United States)

Cawse-Lucas, Jeanne; Evans, David V; Ruiz, David R; Allcut, Elizabeth A; Andrilla, C Holly A; Thompson, Matthew; Norris, Thomas E

2016-03-01

The Medicare Primary Care Exception (PCE) allows residents to see and bill for less-complex patients independently in the primary care setting, requiring attending physicians only to see patients for higher-level visits and complete physical exams in order to bill for them as such. Primary care residencies apply the PCE in various ways. We investigated the impact of the PCE on resident coding practices. Family medicine residency directors in a five-state region completed a survey regarding interpretation and application of the PCE, including the number of established patient evaluation and management codes entered by residents and attending faculty at their institution. The percentage of high-level codes was compared between residencies using chi-square tests. We analyzed coding data for 125,016 visits from 337 residents and 172 faculty physicians in 15 of 18 eligible family medicine residencies. Among programs applying the PCE criteria to all patients, residents billed 86.7% low-mid complexity and 13.3% high-complexity visits. In programs that only applied the PCE to Medicare patients, residents billed 74.9% low-mid complexity visits and 25.2% high-complexity visits. Attending physicians coded more high-complexity visits at both types of programs. The estimated revenue loss over the 1,650 RRC-required outpatient visits was $2,558.66 per resident and $57,569.85 per year for the average residency in our sample. Residents at family medicine programs that apply the PCE to all patients bill significantly fewer high-complexity visits. This finding leads to compliance and regulatory concerns and suggests significant revenue loss. Further study is required to determine whether this discrepancy also reflects inaccuracy in coding.

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

ESCAP mobile training scheme.

Science.gov (United States)

Yasas, F M

1977-01-01

In response to a United Nations resolution, the Mobile Training Scheme (MTS) was set up to provide training to the trainers of national cadres engaged in frontline and supervisory tasks in social welfare and rural development. The training is innovative in its being based on an analysis of field realities. The MTS team consisted of a leader, an expert on teaching methods and materials, and an expert on action research and evaluation. The country's trainers from different departments were sent to villages to work for a short period and to report their problems in fulfilling their roles. From these grass roots experiences, they made an analysis of the job, determining what knowledge, attitude and skills it required. Analysis of daily incidents and problems were used to produce indigenous teaching materials drawn from actual field practice. How to consider the problems encountered through government structures for policy making and decisions was also learned. Tasks of the students were to identify the skills needed for role performance by job analysis, daily diaries and project histories; to analyze the particular community by village profiles; to produce indigenous teaching materials; and to practice the role skills by actual role performance. The MTS scheme was tried in Nepal in 1974-75; 3 training programs trained 25 trainers and 51 frontline workers; indigenous teaching materials were created; technical papers written; and consultations were provided. In Afghanistan the scheme was used in 1975-76; 45 participants completed the training; seminars were held; and an ongoing Council was created. It is hoped that the training program will be expanded to other countries.

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

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

Science.gov (United States)

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

2015-12-01

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

Precision Radiology Residency Training: Special Distinction Tracks for Noninterpretative Professional Development.

Science.gov (United States)

Snyder, Elizabeth; Solnes, Lilja; Horton, Karen M; Johnson, Pamela T

2018-06-01

The role of a radiologist has expanded beyond the tripartite mission of patient care, education, and research to include cross-specialty consultation for patient management, innovative solutions to improve health-care quality and safety, device design, and policy advocacy. As such, radiology residency programs should incorporate formalized training to prepare residents for these various professional roles. Since the 2015-2016 academic year, five training tracks focused on noninterpretative skills have been integrated into our residency training program: Clinician Educator, Quality Improvement, Entrepreneurship/Innovation, Health Policy Advocacy, and High-Value Care. Each track is longitudinal, with a set of requirements throughout the residents' training necessary to achieve certification at graduation. To date nine residents have participated in the programs, including two who received distinction in two separate tracks. Residents in each of the tracks have implemented successful initiatives related to the focus area. As such, these tracks enrich training by ensuring that residents make meaningful contributions to the department and institution during their training and disseminate successful initiatives through presentation at national meetings and publications. The duration of a radiology residency and resources available in an academic center provide opportunities for residency program directors to advance residents' skills in important noninterpretative components of radiology practice. Regardless of whether residents pursue academic medicine or private practice, these skills are necessary for graduates to become valuable members of a radiology practice and serve as national leaders in the field of radiology. Copyright © 2018 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

PPM-based relay communication schemes for wireless body area networks

NARCIS (Netherlands)

Zhang, P.; Willems, F.M.J.; Huang, Li

2012-01-01

This paper investigates cooperative communication schemes based on a single relay with pulse-position modulation (PPM) signaling, for enhancing energy efficiency of wireless body area networks (WBANs) in noncoherent channel settings. We explore cooperation between the source and the relay such that

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.

Living in cold homes after heating improvements: Evidence from Warm-Front, England's Home Energy Efficiency Scheme

International Nuclear Information System (INIS)

Critchley, Roger; Gilbertson, Jan; Grimsley, Michael; Green, Geoff

2007-01-01

Objective: To investigate explanatory factors for persistent cold temperatures in homes which have received heating improvements. Design: Analysis of data from a national survey of dwellings and households (in England occupied by low-income residents) that had received heating improvements or repairs under the Warm Front Scheme. Methods: Over the winters of 2001-02 and 2002-03, householders recorded living room and main bedroom temperatures in a diary. Entries were examined for 888 households, which had received high level heating interventions. Two hundred and twenty-two households were identified as occupying cold homes, with mean bedroom temperature below 16 deg. C or mean living room temperatures below 18 deg. C. Binary logistic regression was used to model dwelling and household features and then occupants' behaviour and attitudes in the 'cold homes' sub-set compared with the remainder of the high intervention group. Seventy-nine supplementary, structured telephone interviews explored reasons given for lower temperatures. Using graphical and tabular methods, householders preferring cooler homes were distinguished from those who felt constrained in some way. Results: Cold homes predominate in pre-1930 properties where the householder remains dissatisfied with the heating system despite major improvements funded by Warm Front. Residents of cold homes are less likely to have long-standing illness or disability, but more likely to experience anxiety or depression. A small sample of telephone interviews reveals those preferring lower temperatures for health or other reasons, report less anxiety and depression than those with limited control over their home environment. Their 'thermal resistance' to higher temperatures challenges orthodox definitions of comfort and fuel poverty

Therapeutic kitchens for residents with dementia.

Science.gov (United States)

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

2001-01-01

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

Evaluation and decision of products conceptual design schemes based on customer requirements

Energy Technology Data Exchange (ETDEWEB)

Huang, Hong Zhong; Li, Yan Feng; Liu, Yu; Wang, Zhonglai [University of Electronic Science and Technology of China, Sichuan (China); Liu, Wenhai [2China Science Patent Trademark Agents Ltd., Beijing (China)

2011-09-15

Within the competitive market environment, understanding customer requirements is crucial for all corporations to obtain market share and survive competition. Only the products exactly meeting customer requirements can win in the market place. Therefore, customer requirements play a very important role in the evaluation and decision process of conceptual design schemes of products. In this paper, an evaluation and decision method based on customer requirements is presented. It utilizes the importance of customer requirements, the satisfaction degree of each evaluation metric to the specification, and an evaluation metric which models customer requirements to evaluate the satisfaction degree of each design scheme to specific customer requirements via the proposed BP neural networks. In the evaluation and decision process, fuzzy sets are used to describe the importance of customer requirements, the relationship between customer requirements and evaluation metrics, the satisfaction degree of each scheme to customer requirements, and the crisp set is used to describe the satisfaction degree of each metric to specifications. The effectiveness of the proposed method is demonstrated by an example of front suspension fork design of mountain bikes.

Evaluation and decision of products conceptual design schemes based on customer requirements

International Nuclear Information System (INIS)

Huang, Hong Zhong; Li, Yan Feng; Liu, Yu; Wang, Zhonglai; Liu, Wenhai

2011-01-01

Within the competitive market environment, understanding customer requirements is crucial for all corporations to obtain market share and survive competition. Only the products exactly meeting customer requirements can win in the market place. Therefore, customer requirements play a very important role in the evaluation and decision process of conceptual design schemes of products. In this paper, an evaluation and decision method based on customer requirements is presented. It utilizes the importance of customer requirements, the satisfaction degree of each evaluation metric to the specification, and an evaluation metric which models customer requirements to evaluate the satisfaction degree of each design scheme to specific customer requirements via the proposed BP neural networks. In the evaluation and decision process, fuzzy sets are used to describe the importance of customer requirements, the relationship between customer requirements and evaluation metrics, the satisfaction degree of each scheme to customer requirements, and the crisp set is used to describe the satisfaction degree of each metric to specifications. The effectiveness of the proposed method is demonstrated by an example of front suspension fork design of mountain bikes

Carrier-based modulation schemes for various three-level matrix converters

DEFF Research Database (Denmark)

Blaabjerg, Frede; Loh, P.C.; Rong, R.C.

2008-01-01

different performance merits. To avoid confusion and hence fasten the converter applications in the industry, it would surely be better for modulation schemes to be developed from a common set of modulation principles that unfortunately has not yet been thoroughly defined. Contributing to that area...... a limited set of switching vectors because of its lower semiconductor count. Through simulation and experimental testing, all the evaluated matrix converters are shown to produce satisfactory sinusoidal input and output quantities using the same set of generic modulation principles, which can conveniently...

SU-F-E-12: Elective International Rotations in Medical Physics Residency Programs

Energy Technology Data Exchange (ETDEWEB)

Brown, D; Mundt, A; Einck, J; Pawlicki, T [University of California, San Diego, La Jolla, CA (United States)

2016-06-15

Purpose: The purpose of this educational program is to motivate talented, intelligent individuals to become stakeholders in the global effort to improve access to radiotherapy. Methods: The need to improve global access to radiotherapy has been clearly established and several organizations are making substantial progress in securing funding and developing plans to achieve this worthwhile goal. The incorporation of elective international rotations in residency programs may provide one possible mechanism to promote and support this future investment. We recently incorporated an elective 1-month international rotation into our CAMPEP accredited Medical Physics residency program, with our first rotation taking place in Vietnam. A unique aspect of this rotation was that it was scheduled collaboratively with our Radiation Oncology residency program such that Radiation Oncology and Medical Physics residents traveled to the same clinic at the same time. Results: We believe the international rotation substantially enhances the educational experience, providing additional benefits to residents by increasing cross-disciplinary learning and offering a shared learning experience. The combined international rotation may also increase benefit to the host institution by modeling positive multidisciplinary working relationships between Radiation Oncologists and Medical Physicists. Our first resident returned with several ideas designed to improve radiotherapy in resource-limited settings – one of which is currently being pursued in collaboration with a vendor. Conclusion: The elective international rotation provides a unique learning experience that has the potential to motivate residents to become stakeholders in the global effort to improve access to radiotherapy. What better way to prepare the next generation of Medical Physicists to meet the challenges of improving global access to radiotherapy than to provide them with training experiences that motivate them to be socially

SU-F-E-12: Elective International Rotations in Medical Physics Residency Programs

International Nuclear Information System (INIS)

Brown, D; Mundt, A; Einck, J; Pawlicki, T

2016-01-01

Purpose: The purpose of this educational program is to motivate talented, intelligent individuals to become stakeholders in the global effort to improve access to radiotherapy. Methods: The need to improve global access to radiotherapy has been clearly established and several organizations are making substantial progress in securing funding and developing plans to achieve this worthwhile goal. The incorporation of elective international rotations in residency programs may provide one possible mechanism to promote and support this future investment. We recently incorporated an elective 1-month international rotation into our CAMPEP accredited Medical Physics residency program, with our first rotation taking place in Vietnam. A unique aspect of this rotation was that it was scheduled collaboratively with our Radiation Oncology residency program such that Radiation Oncology and Medical Physics residents traveled to the same clinic at the same time. Results: We believe the international rotation substantially enhances the educational experience, providing additional benefits to residents by increasing cross-disciplinary learning and offering a shared learning experience. The combined international rotation may also increase benefit to the host institution by modeling positive multidisciplinary working relationships between Radiation Oncologists and Medical Physicists. Our first resident returned with several ideas designed to improve radiotherapy in resource-limited settings – one of which is currently being pursued in collaboration with a vendor. Conclusion: The elective international rotation provides a unique learning experience that has the potential to motivate residents to become stakeholders in the global effort to improve access to radiotherapy. What better way to prepare the next generation of Medical Physicists to meet the challenges of improving global access to radiotherapy than to provide them with training experiences that motivate them to be socially

Examining Critical Thinking Skills in Family Medicine Residents.

Science.gov (United States)

Ross, David; Schipper, Shirley; Westbury, Chris; Linh Banh, Hoan; Loeffler, Kim; Allan, G Michael; Ross, Shelley

2016-02-01

Our objective was to determine the relationship between critical thinking skills and objective measures of academic success in a family medicine residency program. This prospective observational cohort study was set in a large Canadian family medicine residency program. Intervention was the California Critical Thinking Skills Test (CCTST), administered at three points in residency: upon entry, at mid-point, and at graduation. Results from the CCTST, Canadian Residency Matching Service file, and interview scores were compared to other measures of academic performance (Medical Colleges Admission Test [MCAT] and College of Family Physicians of Canada [CCFP] certification examination results). For participants (n=60), significant positive correlations were found between critical thinking skills and performance on tests of knowledge. For the MCAT, CCTST scores correlated positively with full scores (n=24, r=0.57) as well as with each section score (verbal reasoning: r=0.59; physical sciences: r=0.64; biological sciences: r=0.54). For CCFP examination, CCTST correlated reliably with both sections (n=49, orals: r=0.34; short answer: r=0.47). Additionally, CCTST was a better predictor of performance on the CCFP exam than was the interview score at selection into the residency program (Fisher's r-to-z test, z=2.25). Success on a critical thinking skills exam was found to predict success on family medicine certification examinations. Given that critical thinking skills appear to be stable throughout residency training, including an assessment of critical thinking in the selection process may help identify applicants more likely to be successful on final certification exam.

Discontinuous nodal schemes applied to the bidimensional neutron transport equation

International Nuclear Information System (INIS)

Delfin L, A.; Valle G, E. Del; Hennart B, J.P.

1996-01-01

In this paper several strong discontinuous nodal schemes are described, starting from the one that has only two interpolation parameters per cell to the one having ten. Their application to the spatial discretization of the neutron transport equation in X-Y geometry is also described, giving, for each one of the nodal schemes, the approximation for the angular neutron flux that includes the set of interpolation parameters and the corresponding polynomial space. Numerical results were obtained for several test problems presenting here the problem with the highest degree of difficulty and their comparison with published results 1,2 . (Author)

Organizational and Individual Conditions Associated with Depressive Symptoms among Nursing Home Residents over Time

Science.gov (United States)

Cassie, Kimberly M.; Cassie, William E.

2012-01-01

Purpose: To examine the effect of organizational culture and climate on depressive symptoms among nursing home residents. Design and Methods: Using a pooled cross-sectional design, this study examines a sample of 23 nursing homes, 1,114 employees, and 5,497 residents. Depressive symptoms were measured using the Minimum Data Set, Depression Rating…

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

Science.gov (United States)

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

1980-12-01

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

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.

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

Adaptive protection scheme

Directory of Open Access Journals (Sweden)

R. Sitharthan

2016-09-01

Full Text Available This paper aims at modelling an electronically coupled distributed energy resource with an adaptive protection scheme. The electronically coupled distributed energy resource is a microgrid framework formed by coupling the renewable energy source electronically. Further, the proposed adaptive protection scheme provides a suitable protection to the microgrid for various fault conditions irrespective of the operating mode of the microgrid: namely, grid connected mode and islanded mode. The outstanding aspect of the developed adaptive protection scheme is that it monitors the microgrid and instantly updates relay fault current according to the variations that occur in the system. The proposed adaptive protection scheme also employs auto reclosures, through which the proposed adaptive protection scheme recovers faster from the fault and thereby increases the consistency of the microgrid. The effectiveness of the proposed adaptive protection is studied through the time domain simulations carried out in the PSCAD⧹EMTDC software environment.

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

Science.gov (United States)

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

2011-01-01

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

Assessing and counseling the obese patient: Improving resident obesity counseling competence.

Science.gov (United States)

Iyer, Shwetha; Jay, Melanie; Southern, William; Schlair, Sheira

To evaluate obesity counseling competence among residents in a primary care training program METHODS: We delivered a 3h obesity curriculum to 28 Primary Care residents and administered a pre-curriculum and post curriculum survey looking specifically at self-assessed obesity counseling competence. Nineteen residents completed both the pre curriculum survey and the post curriculum survey. The curriculum had a positive impact on residents' ability to ascertain patient's stage of change, use different methods to obtain diet history (including 24h recall, food record or food frequency questionnaire), respond to patient's questions regarding treatment options, assist patients in setting realistic goals for weight loss based on making permanent lifestyle changes, and use of motivational interviewing to change behavior. When looking at the 5As domains, there was a significant improvement in the domains of Assess, Advise, and Assist. The proportion of residents with a lower level of self-assessed obesity counseling competence reduced from 75% before the curriculum to 37.5% (p=0.04) after the curriculum. Our curriculum addressing weight loss counseling using the 5As model increased obesity counseling competence among residents in a primary care internal medicine residency program. Copyright © 2018 Asia Oceania Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.

Using television shows to teach communication skills in internal medicine residency.

Science.gov (United States)

Wong, Roger Y; Saber, Sadra S; Ma, Irene; Roberts, J Mark

2009-02-03

To address evidence-based effective communication skills in the formal academic half day curriculum of our core internal medicine residency program, we designed and delivered an interactive session using excerpts taken from medically-themed television shows. We selected two excerpts from the television show House, and one from Gray's Anatomy and featured them in conjunction with a brief didactic presentation of the Kalamazoo consensus statement on doctor-patient communication. To assess the efficacy of this approach a set of standardized questions were given to our residents once at the beginning and once at the completion of the session. Our residents indicated that their understanding of an evidence-based model of effective communication such as the Kalamazoo model, and their comfort levels in applying such model in clinical practice increased significantly. Furthermore, residents' understanding levels of the seven essential competencies listed in the Kalamazoo model also improved significantly. Finally, the residents reported that their comfort levels in three challenging clinical scenarios presented to them improved significantly. We used popular television shows to teach residents in our core internal medicine residency program about effective communication skills with a focus on the Kalamazoo's model. The results of the subjective assessment of this approach indicated that it was successful in accomplishing our objectives.

Enhancing of chemical compound and drug name recognition using representative tag scheme and fine-grained tokenization.

Science.gov (United States)

Dai, Hong-Jie; Lai, Po-Ting; Chang, Yung-Chun; Tsai, Richard Tzong-Han

2015-01-01

The functions of chemical compounds and drugs that affect biological processes and their particular effect on the onset and treatment of diseases have attracted increasing interest with the advancement of research in the life sciences. To extract knowledge from the extensive literatures on such compounds and drugs, the organizers of BioCreative IV administered the CHEMical Compound and Drug Named Entity Recognition (CHEMDNER) task to establish a standard dataset for evaluating state-of-the-art chemical entity recognition methods. This study introduces the approach of our CHEMDNER system. Instead of emphasizing the development of novel feature sets for machine learning, this study investigates the effect of various tag schemes on the recognition of the names of chemicals and drugs by using conditional random fields. Experiments were conducted using combinations of different tokenization strategies and tag schemes to investigate the effects of tag set selection and tokenization method on the CHEMDNER task. This study presents the performance of CHEMDNER of three more representative tag schemes-IOBE, IOBES, and IOB12E-when applied to a widely utilized IOB tag set and combined with the coarse-/fine-grained tokenization methods. The experimental results thus reveal that the fine-grained tokenization strategy performance best in terms of precision, recall and F-scores when the IOBES tag set was utilized. The IOBES model with fine-grained tokenization yielded the best-F-scores in the six chemical entity categories other than the "Multiple" entity category. Nonetheless, no significant improvement was observed when a more representative tag schemes was used with the coarse or fine-grained tokenization rules. The best F-scores that were achieved using the developed system on the test dataset of the CHEMDNER task were 0.833 and 0.815 for the chemical documents indexing and the chemical entity mention recognition tasks, respectively. The results herein highlight the importance

Comparative study of numerical schemes of TVD3, UNO3-ACM and optimized compact scheme

Science.gov (United States)

Lee, Duck-Joo; Hwang, Chang-Jeon; Ko, Duck-Kon; Kim, Jae-Wook

1995-01-01

Three different schemes are employed to solve the benchmark problem. The first one is a conventional TVD-MUSCL (Monotone Upwind Schemes for Conservation Laws) scheme. The second scheme is a UNO3-ACM (Uniformly Non-Oscillatory Artificial Compression Method) scheme. The third scheme is an optimized compact finite difference scheme modified by us: the 4th order Runge Kutta time stepping, the 4th order pentadiagonal compact spatial discretization with the maximum resolution characteristics. The problems of category 1 are solved by using the second (UNO3-ACM) and third (Optimized Compact) schemes. The problems of category 2 are solved by using the first (TVD3) and second (UNO3-ACM) schemes. The problem of category 5 is solved by using the first (TVD3) scheme. It can be concluded from the present calculations that the Optimized Compact scheme and the UN03-ACM show good resolutions for category 1 and category 2 respectively.

Scheme (in?) dependence in perturbative Lagrangian quantum field theory

International Nuclear Information System (INIS)

Slavnov, D.A.

1995-01-01

A problem of renormalization - scheme ambiguity in perturbation quantum field theory is investigated. A procedure is described that makes it possible to express uniquely all observable quantities in terms of a set base observables. Renormalization group equations for the base observable are constructed. The case of mass theory is treated. 9 refs

Remediation plans in family medicine residency

Science.gov (United States)

Audétat, Marie-Claude; Voirol, Christian; Béland, Normand; Fernandez, Nicolas; Sanche, Gilbert

2015-01-01

Abstract Objective To assess use of the remediation instrument that has been implemented in training sites at the University of Montreal in Quebec to support faculty in diagnosing and remediating resident academic difficulties, to examine whether and how this particular remediation instrument improves the remediation process, and to determine its effects on the residents’ subsequent rotation assessments. Design A multimethods approach in which data were collected from different sources: remediation plans developed by faculty, program statistics for the corresponding academic years, and students’ academic records and rotation assessment results. Setting Family medicine residency program at the University of Montreal. Participants Family medicine residents in academic difficulty. Main outcome measures Assessment of the content, process, and quality of remediation plans, and students’ academic and rotation assessment results (successful, below expectations, or failure) both before and after the remediation period. Results The framework that was developed for assessing remediation plans was used to analyze 23 plans produced by 10 teaching sites for 21 residents. All plans documented cognitive problems and implemented numerous remediation measures. Although only 48% of the plans were of good quality, implementation of a remediation plan was positively associated with the resident’s success in rotations following the remediation period. Conclusion The use of remediation plans is well embedded in training sites at the University of Montreal. The residents’ difficulties were mainly cognitive in nature, but this generally related to deficits in clinical reasoning rather than knowledge gaps. The reflection and analysis required to produce a remediation plan helps to correct many academic difficulties and normalize the academic career of most residents in difficulty. Further effort is still needed to improve the quality of plans and to support teachers.

[Patient safety culture in Family practice residents of Galicia].

Science.gov (United States)

Portela Romero, Manuel; Bugarín González, Rosendo; Rodríguez Calvo, María Sol

To determine the views held by Family practice (FP) residents on the different dimensions of patient safety, in order to identify potential areas for improvement. A cross-sectional study. Seven FP of Galicia teaching units. 182 FP residents who completed the Medical Office Survey on Patient Safety Culture questionnaire. The Medical Office Survey on Patient Safety Culture questionnaire was chosen because it is translated, validated, and adapted to the Spanish model of Primary Care. The results were grouped into 12 composites assessed by the mentioned questionnaire. The study variables were the socio-demographic dimensions of the questionnaire, as well as occupational/professional variables: age, gender, year of residence, and teaching unit of FP of Galicia. The "Organisational learning" and "Teamwork" items were considered strong areas. However, the "Patient safety and quality issues", "Information exchange with other settings", and "Work pressure and pace" items were considered areas with significant potential for improvement. First-year residents obtained the best results and the fourth-year ones the worst. The results may indicate the need to include basic knowledge on patient safety in the teaching process of FP residents in order to increase and consolidate the fragile patient safety culture described in this study. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

Analytical reconstruction schemes for coarse-mesh spectral nodal solution of slab-geometry SN transport problems

International Nuclear Information System (INIS)

Barros, R. C.; Filho, H. A.; Platt, G. M.; Oliveira, F. B. S.; Militao, D. S.

2009-01-01

Coarse-mesh numerical methods are very efficient in the sense that they generate accurate results in short computational time, as the number of floating point operations generally decrease, as a result of the reduced number of mesh points. On the other hand, they generate numerical solutions that do not give detailed information on the problem solution profile, as the grid points can be located considerably away from each other. In this paper we describe two analytical reconstruction schemes for the coarse-mesh solution generated by the spectral nodal method for neutral particle discrete ordinates (S N ) transport model in slab geometry. The first scheme we describe is based on the analytical reconstruction of the coarse-mesh solution within each discretization cell of the spatial grid set up on the slab. The second scheme is based on the angular reconstruction of the discrete ordinates solution between two contiguous ordinates of the angular quadrature set used in the S N model. Numerical results are given so we can illustrate the accuracy of the two reconstruction schemes, as described in this paper. (authors)

Comparative Study on Feature Selection and Fusion Schemes for Emotion Recognition from Speech

Directory of Open Access Journals (Sweden)

Santiago Planet

2012-09-01

Full Text Available The automatic analysis of speech to detect affective states may improve the way users interact with electronic devices. However, the analysis only at the acoustic level could be not enough to determine the emotion of a user in a realistic scenario. In this paper we analyzed the spontaneous speech recordings of the FAU Aibo Corpus at the acoustic and linguistic levels to extract two sets of features. The acoustic set was reduced by a greedy procedure selecting the most relevant features to optimize the learning stage. We compared two versions of this greedy selection algorithm by performing the search of the relevant features forwards and backwards. We experimented with three classification approaches: Naïve-Bayes, a support vector machine and a logistic model tree, and two fusion schemes: decision-level fusion, merging the hard-decisions of the acoustic and linguistic classifiers by means of a decision tree; and feature-level fusion, concatenating both sets of features before the learning stage. Despite the low performance achieved by the linguistic data, a dramatic improvement was achieved after its combination with the acoustic information, improving the results achieved by this second modality on its own. The results achieved by the classifiers using the parameters merged at feature level outperformed the classification results of the decision-level fusion scheme, despite the simplicity of the scheme. Moreover, the extremely reduced set of acoustic features obtained by the greedy forward search selection algorithm improved the results provided by the full set.

The clinician-educator track: training internal medicine residents as clinician-educators.

Science.gov (United States)

Smith, C Christopher; McCormick, Ian; Huang, Grace C

2014-06-01

Although resident-as-teacher programs bring postgraduate trainees' teaching skills to a minimum threshold, intensive, longitudinal training is lacking for residents who wish to pursue careers in medical education. The authors describe the development, implementation, and preliminary assessment of the novel track for future clinician-educators that they introduced in the internal medicine residency program at Beth Israel Deaconess Medical Center in 2010. Categorical medical interns with a career interest in medical education apply to participate in the clinician-educator track (CET) at the midpoint of their first postgraduate year. CET residents complete a 2.5-year curriculum in which they review foundations of medical education, design and assess new curricula, and evaluate learners and programs. They apply these skills in a variety of clinical settings and receive frequent feedback from faculty and peers. All CET residents design and implement at least one medical education research project. A comprehensive evaluation plan to assess the impact of the CET on resident teaching skills, scholarly productivity, career selection, and advancement is under way. A preliminary evaluation demonstrates high satisfaction with the track among the first cohort of CET residents, who graduated in 2012. Compared with residents in the traditional resident-as-teacher program, CET residents reported higher gains in their confidence in core medical education skills. Although these preliminary data are promising, data will be collected over the next several years to explore whether the additional curricular time, faculty time, and costs and potential expansion to other institutions are justified.

Angular quadrature sets for the streaming ray method in x-y geometry

International Nuclear Information System (INIS)

England, R.; Filippone, W.L.

1983-01-01

Steaming ray (SR) computations normally employ a set of specially selected ray directions. For x-y geometry, these directions are not uniformly spaced in the azimuthal angle, nor do they conform to any of the standard quadrature sets in current use. For simplicity in all previous SR computations, uniform angular weights were used. This note investigates two methods--a bisection scheme and a Fourier scheme--for selecting more appropriate azimuthal angular weights. In the bisection scheme, the azimuthal weight assigned to an SR direction is half the angular spread (in the x-y plane) between its two adjacent ray directions. In the Fourier method, the weights are chosen such that the number of terms in a Fourier series exactly integrable on the interval (0, 2π) is maximized. Several sample calculations have been performed. While both the Fourier and bisection weights showed significant advantage over the uniform weights used previously, the Fourier scheme appears to be the best method. Lists of bisection and Fourier weights are given for quadrature sets containing 4, 8, 12, ..., 60 azimuthal SR directions

Specific features of two diffraction schemes for a widely divergent X-ray beam

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Avetyan, K. T.; Levonyan, L. V.; Semerjian, H. S.; Arakelyan, M. M., E-mail: marakelyan@ysu.am; Badalyan, O. M. [Yerevan State University (Armenia)

2015-03-15

We investigated the specific features of two diffraction schemes for a widely divergent X-ray beam that use a circular diaphragm 30–50 μm in diameter as a point source of characteristic radiation. In one of the schemes, the diaphragm was set in front of the crystal (the diaphragm-crystal (d-c) scheme); in the other, it was installed behind the crystal (the crystal-diaphragm (c-d) scheme). It was established that the diffraction image in the c-d scheme is a topographic map of the investigated crystal area. In the d-c scheme at L = 2l (l and L are the distances between the crystal and the diaphragm and between the photographic plate and the diaphragm, respectively), the branches of hyperbolas formed in this family of planes (hkl) by the characteristic K{sub α} and K{sub β} radiations, including higher order reflections, converge into one straight line. It is experimentally demonstrated that this convergence is very sensitive to structural inhomogeneities in the crystal under study.

Evaluating Labour Market Effects of Wage Subsidies for the Disabled -The Danish Flexjobs Scheme

DEFF Research Database (Denmark)

Datta Gupta, Nabanita; Larsen, Mona

2010-01-01

We evaluate the employment and disability exit effects of a wage subsidy program for the disabled in a setting characterized by universal health insurance and little employment protection. We focus on the Danish Flexjob scheme that was introduced in 1998 and targeted towards improving the employm......We evaluate the employment and disability exit effects of a wage subsidy program for the disabled in a setting characterized by universal health insurance and little employment protection. We focus on the Danish Flexjob scheme that was introduced in 1998 and targeted towards improving...... the employment prospects of the long-term disabled with partial working capacity. We find a substantial, positive employment effect of the scheme in the 1994-2001 period within the target group compared to a control group of closely matched ineligibles, but no discernable effects on the probability of disability...... exit. For the target group employment probability is raised by 33 pct. points after the scheme is introduced relative to a mean employment rate at baseline of 44%. One explanation for a strong employment entry effect concomitant with a non-existent disability exit effect could be that subsidized jobs...

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.

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.

Health status of UK care home residents: a cohort study.

Science.gov (United States)

Gordon, Adam Lee; Franklin, Matthew; Bradshaw, Lucy; Logan, Pip; Elliott, Rachel; Gladman, John R F

2014-01-01

UK care home residents are often poorly served by existing healthcare arrangements. Published descriptions of residents' health status have been limited by lack of detail and use of data derived from surveys drawn from social, rather than health, care records. to describe in detail the health status and healthcare resource use of UK care home residents a 180-day longitudinal cohort study of 227 residents across 11 UK care homes, 5 nursing and 6 residential, selected to be representative for nursing/residential status and dementia registration. Barthel index (BI), Mini-mental state examination (MMSE), Neuropsychiatric index (NPI), Mini-nutritional index (MNA), EuroQoL-5D (EQ-5D), 12-item General Health Questionnaire (GHQ-12), diagnoses and medications were recorded at baseline and BI, NPI, GHQ-12 and EQ-5D at follow-up after 180 days. National Health Service (NHS) resource use data were collected from databases of local healthcare providers. out of a total of 323, 227 residents were recruited. The median BI was 9 (IQR: 2.5-15.5), MMSE 13 (4-22) and number of medications 8 (5.5-10.5). The mean number of diagnoses per resident was 6.2 (SD: 4). Thirty per cent were malnourished, 66% had evidence of behavioural disturbance. Residents had contact with the NHS on average once per month. residents from both residential and nursing settings are dependent, cognitively impaired, have mild frequent behavioural symptoms, multimorbidity, polypharmacy and frequently use NHS resources. Effective care for such a cohort requires broad expertise from multiple disciplines delivered in a co-ordinated and managed way.

Outbreak of epidemic keratoconjunctivitis caused by adenovirus in medical residents.

Science.gov (United States)

Melendez, Carlos Pantoja; Florentino, Margarita Matias; Martinez, Irma Lopez; Lopez, Herlinda Mejia

2009-01-01

The present work documents an outbreak of epidemic keratoconjunctivitis among ophthalmology residents, its influence in the presentation of the community cases, the use of molecular techniques for its diagnosis, and the implementation of successful control measures for its containment. Isolation of the etiologic agent was achieved using cultured African green monkey kidney epithelial cells (VERO). Through molecular tests, such as polymerase chain reaction (PCR) and DNA sequencing, the genotype of the isolated virus was identified. The sequences obtained were aligned with data reported in the NCBI GenBank. A scheme of outbreak control measures was designed to enforce correct sanitary measures in the clinic. The statistical program, Epi info 2002, and openepi were used to determine the attack rate. The Excel Microsoft program was used to elaborate the endemic channel. Nine of the ten samples studied were isolated from the culture and identified by Adenovirus-specifc PCR. Sequencing allowed identification of Ad8 as the agent responsible for the outbreak. The attack rate was 24.39 cases per 100. The epidemic curve allowed identification of a disseminated source in the Institute of Ophthalmology "Conde de Valenciana." It was not possible to calculate the incubation periods among the cases. The endemic channel showed the presence of an epidemic keratoconjunctivitis among the patients that had been cared for at the out-patient services of the institute. One outbreak of a disseminated source caused by Ad8 was detected in the institute among its medical residents, probably associated with relaxation of the habitual sanitary measures during an epidemic of hemorrhagic conjunctivitis among the patients cared for at the institute. The proposed scheme to control the outbreak allowed for its containment and controlled the epidemic of associated cases.

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.

Trends in violence education in family medicine residency curricula.

Science.gov (United States)

Cronholm, Peter F; Singh, Vijay; Fogarty, Colleen T; Ambuel, Bruce

2014-09-01

Violence is a significant public health issue with far-reaching implications for the health of individuals and their communities. Our objective was to describe trends in violence-related training in family medicine residency programs since the last national survey was conducted in 1997. Surveys were sent to 337 US family medicine residency programs with the program director having active Society of Teachers of Family Medicine (STFM) membership. Measures included residency setting and characteristics, violence-related curricular content, teaching techniques and personnel, timing of content, and impact of changes in Residency Review Committee (RRC) and Accreditation Council for Graduate Medical Education (ACGME) requirements. Descriptive statistics and bivariate analyses comparing measures across time were used. A total of 201 (60%) surveys were completed. The most common violence curricula was child (83%) and elder abuse (76%), and the most common teachers of violence-related content were family physicians, psychologists, and social workers. The most common teaching methods were clinical precepting (94%), lectures (90%), case vignettes (71%), and intimate partner violence (IPV) shelter experiences (67%). ACGME and RRC changes were not reflected in self-reported measures of curricular emphasis or time. Violence curricular content and number of hours has been constant in family medicine residencies over time. An increase in the reported use of active learning strategies was identified as a trend across surveys. Next steps for violence curricula involve assessment of residents' competency to identify and intervene in violence.

Multi-phase flow monitoring with electrical impedance tomography using level set based method

International Nuclear Information System (INIS)

Liu, Dong; Khambampati, Anil Kumar; Kim, Sin; Kim, Kyung Youn

2015-01-01

Highlights: • LSM has been used for shape reconstruction to monitor multi-phase flow using EIT. • Multi-phase level set model for conductivity is represented by two level set functions. • LSM handles topological merging and breaking naturally during evolution process. • To reduce the computational time, a narrowband technique was applied. • Use of narrowband and optimization approach results in efficient and fast method. - Abstract: In this paper, a level set-based reconstruction scheme is applied to multi-phase flow monitoring using electrical impedance tomography (EIT). The proposed scheme involves applying a narrowband level set method to solve the inverse problem of finding the interface between the regions having different conductivity values. The multi-phase level set model for the conductivity distribution inside the domain is represented by two level set functions. The key principle of the level set-based method is to implicitly represent the shape of interface as the zero level set of higher dimensional function and then solve a set of partial differential equations. The level set-based scheme handles topological merging and breaking naturally during the evolution process. It also offers several advantages compared to traditional pixel-based approach. Level set-based method for multi-phase flow is tested with numerical and experimental data. It is found that level set-based method has better reconstruction performance when compared to pixel-based method

Integration of Fault Detection and Isolation with Control Using Neuro-fuzzy Scheme

Directory of Open Access Journals (Sweden)

A. Asokan

2009-10-01

Full Text Available In this paper an algorithms is developed for fault diagnosis and fault tolerant control strategy for nonlinear systems subjected to an unknown time-varying fault. At first, the design of fault diagnosis scheme is performed using model based fault detection technique. The neuro-fuzzy chi-square scheme is applied for fault detection and isolation. The fault magnitude and time of occurrence of fault is obtained through neuro-fuzzy chi-square scheme. The estimated magnitude of the fault magnitude is normalized and used by the feed-forward control algorithm to make appropriate changes in the manipulated variable to keep the controlled variable near its set value. The feed-forward controller acts along with feed-back controller to control the multivariable system. The performance of the proposed scheme is applied to a three- tank process for various types of fault inputs to show the effectiveness of the proposed approach.

The generalized scheme-independent Crewther relation in QCD

Science.gov (United States)

Shen, Jian-Ming; Wu, Xing-Gang; Ma, Yang; Brodsky, Stanley J.

2017-07-01

The Principle of Maximal Conformality (PMC) provides a systematic way to set the renormalization scales order-by-order for any perturbative QCD calculable processes. The resulting predictions are independent of the choice of renormalization scheme, a requirement of renormalization group invariance. The Crewther relation, which was originally derived as a consequence of conformally invariant field theory, provides a remarkable connection between two observables when the β function vanishes: one can show that the product of the Bjorken sum rule for spin-dependent deep inelastic lepton-nucleon scattering times the Adler function, defined from the cross section for electron-positron annihilation into hadrons, has no pQCD radiative corrections. The ;Generalized Crewther Relation; relates these two observables for physical QCD with nonzero β function; specifically, it connects the non-singlet Adler function (Dns) to the Bjorken sum rule coefficient for polarized deep-inelastic electron scattering (CBjp) at leading twist. A scheme-dependent ΔCSB-term appears in the analysis in order to compensate for the conformal symmetry breaking (CSB) terms from perturbative QCD. In conventional analyses, this normally leads to unphysical dependence in both the choice of the renormalization scheme and the choice of the initial scale at any finite order. However, by applying PMC scale-setting, we can fix the scales of the QCD coupling unambiguously at every order of pQCD. The result is that both Dns and the inverse coefficient CBjp-1 have identical pQCD coefficients, which also exactly match the coefficients of the corresponding conformal theory. Thus one obtains a new generalized Crewther relation for QCD which connects two effective charges, αˆd (Q) =∑i≥1 αˆg1 i (Qi), at their respective physical scales. This identity is independent of the choice of the renormalization scheme at any finite order, and the dependence on the choice of the initial scale is negligible. Similar

Patterns of serum PCDD/Fs affected by vegetarian regime, consumption of locally produced food, and resident places of residents living near incinerators

Energy Technology Data Exchange (ETDEWEB)

Chen Hsiu-Ling; Lee Chang-Ching; Su Hue-Jen; Liao Pao-Chi [Inst. of Basic Medical Science, Medical Coll., National Cheng Kung Univ., Tainan (Taiwan)

2004-09-15

Previous reports have been estimated that more than 90% of serum PCDD/Fs can be accounted for by the consumption of various food groups. Nouwen et al. suggested residents living near incinerators with the elevated dioxin exposure while they ate locally produced food compared to the general population from other areas. PCDD/Fs usually abound in fatty meats and marine foods, and consumption of which is the major pathway of human expose to PCDD/Fs. However, no distinct association was shown between vegetarian regime of human and their corresponding serum PCDD/Fs concentration. In addition, the resident region is associated to their corresponding dietary consumption and ambient exposure of PCDD/Fs, especially for subjects consumed the local foods with special dioxin-like contamination. The current study, therefore, was set to examine how dietary habits, including vegetarian regime and consumption of local food original for residents living near the incinerators are associated to serum PCDD/F concentrations. In addition, the further aim is to assess the influence on the serum PCDD/Fs levels resulting from subjects living in the alternative resident regions, even all of them exposed to PCDD/Fs emission from incinerators.

Thoughts of Quitting General Surgery Residency: Factors in Canada.

Science.gov (United States)

Ginther, David Nathan; Dattani, Sheev; Miller, Sarah; Hayes, Paul

2016-01-01

Attrition rates in general surgery training are higher than other surgical disciplines. We sought to determine the prevalence with which Canadian general surgery residents consider leaving their training and the contributing factors. An anonymous survey was administered to all general surgery residents in Canada. Responses from residents who considered leaving their training were assessed for importance of contributing factors. The study was conducted at the Royal University Hospital, University of Saskatchewan, Saskatoon, Saskatchewan, Canada, a tertiary academic center. The response rate was approximately 34.0%. A minority (32.0%) reported very seriously or somewhat seriously considering leaving their training, whereas 35.2% casually considered doing so. Poor work-life balance in residency (38.9%) was the single-most important factor, whereas concern about future unemployment (16.7%) and poor future quality of life (15.7%) were next. Enjoyment of work (41.7%) was the most frequent mitigating factor. Harassment and intimidation were reported factors in 16.7%. On analysis, only intention to practice in a nonacademic setting approached significant association with thoughts of leaving (odds ratio = 1.92, CI = 0.99-3.74, p = 0.052). There was no association with sex, program, postgraduate year, relationship status, or subspecialty interest. There was a nonsignificant trend toward more thoughts of leaving with older age. Canadian general surgery residents appear less likely to seriously consider quitting than their American counterparts. Poor work-life balance in residency, fear of future unemployment, and anticipated poor future quality of life are significant contributors to thoughts of quitting. Efforts to educate prospective residents about the reality of the surgical lifestyle, and to assist residents in securing employment, may improve completion rates. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Impact of Intervention to Improve Nursing Home Resident-Staff Interactions and Engagement.

Science.gov (United States)

Hartmann, Christine W; Mills, Whitney L; Pimentel, Camilla B; Palmer, Jennifer A; Allen, Rebecca S; Zhao, Shibei; Wewiorski, Nancy J; Sullivan, Jennifer L; Dillon, Kristen; Clark, Valerie; Berlowitz, Dan R; Snow, Andrea Lynn

2018-04-30

For nursing home residents, positive interactions with staff and engagement in daily life contribute meaningfully to quality of life. We sought to improve these aspects of person-centered care in an opportunistic snowball sample of six Veterans Health Administration nursing homes (e.g., Community Living Centers-CLCs) using an intervention that targeted staff behavior change, focusing on improving interactions between residents and staff and thereby ultimately aiming to improve resident engagement. We grounded this mixed-methods study in the Capability, Opportunity, Motivation, Behavior (COM-B) model of behavior change. We implemented the intervention by (a) using a set of evidence-based practices for implementing quality improvement and (b) combining primarily CLC-based staff facilitation with some researcher-led facilitation. Validated resident and staff surveys and structured observations collected pre and post intervention, as well as semi-structured staff interviews conducted post intervention, helped assess intervention success. Sixty-two CLC residents and 308 staff members responded to the surveys. Researchers conducted 1,490 discrete observations. Intervention implementation was associated with increased staff communication with residents during the provision of direct care and decreased negative staff interactions with residents. In the 66 interviews, staff consistently credited the intervention with helping them (a) develop awareness of the importance of identifying opportunities for engagement and (b) act to improve the quality of interactions between residents and staff. The intervention proved feasible and influenced staff to make simple enhancements to their behaviors that improved resident-staff interactions and staff-assessed resident engagement.

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

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.

Does undernutrition still prevail among nursing home residents?

Science.gov (United States)

Törmä, Johanna; Winblad, Ulrika; Cederholm, Tommy; Saletti, Anja

2013-08-01

During recent years public awareness about malnutrition has increased and collective initiatives have been undertaken. Simultaneously, the number of older adults is increasing, and the elderly care has been placed under pressure. The aim was to assess the nutritional situation and one-year mortality among nursing home (NH) residents, and compare with historical data. Mini Nutritional Assessment-Short Form (MNA-SF), ADL Barthel Index (BI), Short Portable Mental Status Questionnaire (SPMSQ), EQ-5D, Charlson Comorbidity Index (CCI), and blood samples were collected from 172 NH residents (86.3 ± 8 years, 70% women). Mortality data was taken from NH records. Nutritional data from 166 NH residents (83.8 ± 8 years, 61% women) examined in 1996 was retrieved for historical comparison. The prevalence of malnutrition was 30%, as compared to 71% in the historical data set, corresponding to a present average body mass index of 23.7 ± 5.1 compared with 22.3 ± 4.2 kg/m(2) (p prevails and is associated with deteriorated cognition, function and increased mortality. A possible improvement in nutritional status in NH residents over time was observed. Copyright © 2012 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

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.

Factors Affecting Resident Satisfaction in Continuity Clinic-a Systematic Review.

Science.gov (United States)

Stepczynski, J; Holt, S R; Ellman, M S; Tobin, D; Doolittle, Benjamin R

2018-05-07

In recent years, with an increasing emphasis on time spent in ambulatory training, educators have focused attention on improving the residents' experience in continuity clinic. The authors sought to review the factors associated with physician trainee satisfaction with outpatient ambulatory training. A systematic literature review was conducted for all English language articles published between January 1980 and December 2016 in relevant databases, including Medline (medicine), CINAHL (nursing), PSYCHinfo (psychology), and the Cochrane Central Register of Controlled Clinical Trials. Search terms included internship and residency, satisfaction, quality of life, continuity of care, ambulatory care, and medical education. We included studies that directly addressed resident satisfaction in the ambulatory setting through interventions that we considered reproducible. Three hundred fifty-seven studies were reviewed; 346 studies were removed based on exclusion criteria with 11 papers included in the final review. Seven studies emphasized aspects of organizational structure such as block schedules, working in teams, and impact on resident-patient continuity (continuity between resident provider and patient as viewed from the provider's perspective). Four studies emphasized the importance of a dedicated faculty for satisfaction. The heterogeneity of the studies precluded aggregate analysis. Clinic structures that limit inpatient and outpatient conflict and enhance continuity, along with a dedicated outpatient faculty, are associated with greater resident satisfaction. Implications for further research are discussed.

Using television shows to teach communication skills in internal medicine residency

Directory of Open Access Journals (Sweden)

Ma Irene

2009-02-01

Full Text Available Abstract Background To address evidence-based effective communication skills in the formal academic half day curriculum of our core internal medicine residency program, we designed and delivered an interactive session using excerpts taken from medically-themed television shows. Methods We selected two excerpts from the television show House, and one from Gray's Anatomy and featured them in conjunction with a brief didactic presentation of the Kalamazoo consensus statement on doctor-patient communication. To assess the efficacy of this approach a set of standardized questions were given to our residents once at the beginning and once at the completion of the session. Results Our residents indicated that their understanding of an evidence-based model of effective communication such as the Kalamazoo model, and their comfort levels in applying such model in clinical practice increased significantly. Furthermore, residents' understanding levels of the seven essential competencies listed in the Kalamazoo model also improved significantly. Finally, the residents reported that their comfort levels in three challenging clinical scenarios presented to them improved significantly. Conclusion We used popular television shows to teach residents in our core internal medicine residency program about effective communication skills with a focus on the Kalamazoo's model. The results of the subjective assessment of this approach indicated that it was successful in accomplishing our objectives.

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.

Noticeable Variations in the Educational Exposure During Residency in Danish Orthopedic Departments

DEFF Research Database (Denmark)

Brand, Eske; Fridberg, Marie; Knudsen, Ulrik Kragegaard

2016-01-01

. CONCLUSIONS: A large variation in the educational exposure was found among the Danish orthopedic departments. Numbers indicate that Danish residents, compared with their US counterparts, operate considerably less during residency. Most residents work overtime and many of them work for free to participate......OBJECTIVE: The objective of the study was to examine the educational exposure during residency in Danish orthopedic departments. DESIGN: Questionnaire-based cross-sectional study. SETTING: Data were gathered from January 1, 2014 to April 30, 2014 through a nationwide web-based questionnaire...... procedures as primary surgeon was 16 (range: 8-35) per month. In all, 18 of 22 (81%) departments offered the possibility to participate in research facilitated by the department and 38 of 96 (40%) worked for free (an average of 10h a month [range: 3-60]) to increase the amount of surgical procedures...

Tilling the soil while sowing the seeds: combining resident education with medical home transformation.

Science.gov (United States)

Muench, John; Jarvis, Kelly; Boverman, Josh; Hardman, Joseph; Hayes, Meg; Winkle, Jim

2012-01-01

In order to successfully integrate screening, brief intervention, and referral to treatment (SBIRT) into primary care, education of clinicians must be paired with sustainable transformation of the clinical settings in which they practice. The SBIRT Oregon project adopted this strategy in an effort to fully integrate SBIRT into 7 primary care residency clinics. Residents were trained to assess and intervene in their patients' unhealthy substance use, whereas clinic staff personnel were trained to carry out a multistep screening process. Electronic medical record tools were created to further integrate and track SBIRT processes. This article describes how a resident training curriculum complemented and was informed by the transformation of workflow processes within the residents' home clinics.

A classification scheme for risk assessment methods.

Energy Technology Data Exchange (ETDEWEB)

Stamp, Jason Edwin; Campbell, Philip LaRoche

2004-08-01

This report presents a classification scheme for risk assessment methods. This scheme, like all classification schemes, provides meaning by imposing a structure that identifies relationships. Our scheme is based on two orthogonal aspects--level of detail, and approach. The resulting structure is shown in Table 1 and is explained in the body of the report. Each cell in the Table represent a different arrangement of strengths and weaknesses. Those arrangements shift gradually as one moves through the table, each cell optimal for a particular situation. The intention of this report is to enable informed use of the methods so that a method chosen is optimal for a situation given. This report imposes structure on the set of risk assessment methods in order to reveal their relationships and thus optimize their usage.We present a two-dimensional structure in the form of a matrix, using three abstraction levels for the rows and three approaches for the columns. For each of the nine cells in the matrix we identify the method type by name and example. The matrix helps the user understand: (1) what to expect from a given method, (2) how it relates to other methods, and (3) how best to use it. Each cell in the matrix represent a different arrangement of strengths and weaknesses. Those arrangements shift gradually as one moves through the table, each cell optimal for a particular situation. The intention of this report is to enable informed use of the methods so that a method chosen is optimal for a situation given. The matrix, with type names in the cells, is introduced in Table 2 on page 13 below. Unless otherwise stated we use the word 'method' in this report to refer to a 'risk assessment method', though often times we use the full phrase. The use of the terms 'risk assessment' and 'risk management' are close enough that we do not attempt to distinguish them in this report. The remainder of this report is organized as follows. In

Training future surgeons for management roles: the resident-surgeon-manager conference.

Science.gov (United States)

Hanna, Waël C; Mulder, David S; Fried, Gerald M; Elhilali, Mostafa; Khwaja, Kosar A

2012-10-01

OBJECTIVE To demonstrate that senior surgical residents would benefit from focused training by professionals with management expertise. Although managerial skills are recognized as necessary for the successful establishment of a surgical practice, they are not often emphasized in traditional surgical residency curricula. DESIGN Senior residents from all surgical subspecialties at McGill University were invited to participate in a 1-day management seminar. Precourse questionnaires aimed at evaluating the residents' perceptions of their own managerial knowledge and preparedness were circulated. The seminar was then given in the form of interactive lectures and case-based discussions. The questionnaires were readministered at the end of the course, along with an evaluation form. Precourse and postcourse data were compared using the Freeman-Halton extension of the Fisher exact test to determine statistical significance (P < .05). SETTING McGill University Health Centre in Montreal, Quebec, Canada. PARTICIPANTS A total of 43 senior residents. RESULTS Before the course, the majority of residents (27 of 43 [63%]) thought that management instruction only happened "from time to time" in their respective programs. After the course, 15 residents (35%) felt that management topics were "well addressed," and 19 (44%) felt that management topics have been "very well addressed" (P < .01). Residents noted a significant improvement in their ability to perform the following skills after the course: giving feedback, delegating duties, coping with stress, effective learning, and effective teaching. On the ensemble of all managerial skills combined, 26 residents (60%) rated their performance as "good" or "excellent" after the course vs only 21 (49%) before the course (P = .02). Residents also noted a statistically significant improvement in their ability to perform the managerial duties necessary for the establishment of a surgical practice. CONCLUSIONS Surgical residency programs

Evaluation of a mock interview session on residency interview skills.

Science.gov (United States)

Buckley, Kelsey; Karr, Samantha; Nisly, Sarah A; Kelley, Kristi

2018-04-01

To evaluate the impact of student pharmacist participation in a mock interview session on confidence level and preparation regarding residency interview skills. The study setting was a mock interview session, held in conjunction with student programming at the American College of Clinical Pharmacy (ACCP) Annual Meeting. Prior to the mock interview session, final year student pharmacists seeking residency program placement were asked to complete a pre-session survey assessing confidence level for residency interviews. Each student pharmacist participated in up to three mock interviews. A post-session survey evaluating confidence level was then administered to consenting participants. Following the American Society for Health-System Pharmacists (ASHP) Pharmacy Resident Matching Program (RMP), a post-match electronic survey was sent to study participants to determine their perception of the influence of the mock interview session on achieving successful interactions during residency interviews. A total of 59 student pharmacists participated in the mock interview session and completed the pre-session survey. Participants completing the post-session survey (88%, n = 52) unanimously reported an enhanced confidence in interviewing skills following the session. Thirty responders reported a program match rate of 83%. Approximately 97% (n = 29) of the respondents agreed or strongly agreed that the questions asked during the mock interview session were reflective of questions asked during residency interviews. Lessons learned from this mock interview session can be applied to PGY1 residency mock interview sessions held locally, regionally, and nationally. Students participating in the ACCP Mock Interview Session recognized the importance of the interview component in obtaining a postgraduate year 1 (PGY1) pharmacy residency. Copyright © 2017 Elsevier Inc. All rights reserved.

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.

Application of Central Upwind Scheme for Solving Special Relativistic Hydrodynamic Equations

Science.gov (United States)

Yousaf, Muhammad; Ghaffar, Tayabia; Qamar, Shamsul

2015-01-01

The accurate modeling of various features in high energy astrophysical scenarios requires the solution of the Einstein equations together with those of special relativistic hydrodynamics (SRHD). Such models are more complicated than the non-relativistic ones due to the nonlinear relations between the conserved and state variables. A high-resolution shock-capturing central upwind scheme is implemented to solve the given set of equations. The proposed technique uses the precise information of local propagation speeds to avoid the excessive numerical diffusion. The second order accuracy of the scheme is obtained with the use of MUSCL-type initial reconstruction and Runge-Kutta time stepping method. After a discussion of the equations solved and of the techniques employed, a series of one and two-dimensional test problems are carried out. To validate the method and assess its accuracy, the staggered central and the kinetic flux-vector splitting schemes are also applied to the same model. The scheme is robust and efficient. Its results are comparable to those obtained from the sophisticated algorithms, even in the case of highly relativistic two-dimensional test problems. PMID:26070067

Attitudes of Nursing Facilities' Staff Toward Pharmacy Students' Interaction with its Residents.

Science.gov (United States)

Adkins, Donna; Gavaza, Paul; Deel, Sharon

2017-06-01

All Appalachian College of Pharmacy second-year students undertake the longitudinal geriatric early pharmacy practice experiences (EPPE) 2 course, which involves interacting with geriatric residents in two nursing facilities over two semesters. The study investigated the nursing staff's perceptions about the rotation and the pharmacy students' interaction with nursing facility residents. Cross-sectional study. Academic setting. 63 nursing facility staff. A 10-item attitude survey administered to nursing staff. Nursing staff attitude toward pharmacy students' interaction with geriatric residents during the course. Sixty-three responses were received (84% response rate). Most respondents were female (95.2%), who occasionally interacted with pharmacy students (54.8%) and had worked at the facilities for an average of 6.8 years (standard deviation [SD] = 6.7) years. Staff reported that pharmacy students practiced interacting with geriatric residents and nursing facility staff, learned about different medications taken by residents as well as their life as a nursing facility resident. In addition, the student visits improved the mood of residents and staff's understanding of medicines, among others. Staff suggested that students spend more time with their residents in the facility as well as ask more questions of staff. The nursing facility staff generally had favorable attitudes about pharmacy students' visits in their nursing facility. Nursing facility staff noted that the geriatric rotation was a great learning experience for the pharmacy students.

Colour schemes

DEFF Research Database (Denmark)

van Leeuwen, Theo

2013-01-01

This chapter presents a framework for analysing colour schemes based on a parametric approach that includes not only hue, value and saturation, but also purity, transparency, luminosity, luminescence, lustre, modulation and differentiation.......This chapter presents a framework for analysing colour schemes based on a parametric approach that includes not only hue, value and saturation, but also purity, transparency, luminosity, luminescence, lustre, modulation and differentiation....

Cross-cultural psychiatric residency training: the Oregon experience.

Science.gov (United States)

Boehnlein, James K; Leung, Paul K; Kinzie, John David

2008-01-01

The purpose of this article is to describe the goals and structure of cross-cultural psychiatric training at Oregon Health and Science University (OHSU). This training in core knowledge, skills, and attitudes of cultural psychiatry over the past three decades has included medical students, residents, and fellows, along with allied mental health personnel. The curriculum includes both didactic sessions devoted to core topics in the field and varied clinical experiences in community settings and the Intercultural Psychiatric Program under the supervision of experienced academic faculty. The authors review the central elements of the training experiences and include a detailed description of the core clinical settings and experiences. At the conclusion of their clinical experiences, trainees have specialized cross-cultural psychiatric knowledge and skills, including treatment of refugees and immigrants, sociocultural variables that influence the assessment and treatment of a wide range of psychiatric conditions, and comfort with cultural dynamics that influence both the doctor/patient relationship and collaboration with a wide range of mental health professionals. Because of rapid demographic changes in the U.S. population, providing cross-cultural training for students, residents, and fellows is an essential foundation for the education of the next generation of clinicians and health care leaders. OHSU has provided a long-term model for this training in a busy clinical and academic setting that places an emphasis on multidisciplinary and multicultural collaboration.

Evaluating Labour Market Effects of Wage Subsidies for the Disabled – the Danish Flexjob Scheme

DEFF Research Database (Denmark)

Datta Gupta, Nabanita; Larsen, Mona

We evaluate the employment and disability exit effects of a wage subsidy program for the disabled in a setting characterized by universal health insurance and little employment protection. We focus on the Danish Flexjob scheme that was introduced in 1998 and targeted towards improving the employm......We evaluate the employment and disability exit effects of a wage subsidy program for the disabled in a setting characterized by universal health insurance and little employment protection. We focus on the Danish Flexjob scheme that was introduced in 1998 and targeted towards improving...... the employment prospects of the long-term disabled with partial working capacity. We find a substantial, positive employment effect of the scheme in the 1994-2001 period within the target group compared to a control group of closely matched ineligibles, but no discernable effects on the probability of disability...... exit. For the target group employment probability is raised by 33 pct. points after the scheme is introduced relative to a mean employment rate at baseline of 44%. One explanation for a strong employment entry effect concomitant with a non-existent disability exit effect could be that subsidized jobs...

Building fast well-balanced two-stage numerical schemes for a model of two-phase flows

Science.gov (United States)

Thanh, Mai Duc

2014-06-01

We present a set of well-balanced two-stage schemes for an isentropic model of two-phase flows arisen from the modeling of deflagration-to-detonation transition in granular materials. The first stage is to absorb the source term in nonconservative form into equilibria. Then in the second stage, these equilibria will be composed into a numerical flux formed by using a convex combination of the numerical flux of a stable Lax-Friedrichs-type scheme and the one of a higher-order Richtmyer-type scheme. Numerical schemes constructed in such a way are expected to get the interesting property: they are fast and stable. Tests show that the method works out until the parameter takes on the value CFL, and so any value of the parameter between zero and this value is expected to work as well. All the schemes in this family are shown to capture stationary waves and preserves the positivity of the volume fractions. The special values of the parameter 0,1/2,1/(1+CFL), and CFL in this family define the Lax-Friedrichs-type, FAST1, FAST2, and FAST3 schemes, respectively. These schemes are shown to give a desirable accuracy. The errors and the CPU time of these schemes and the Roe-type scheme are calculated and compared. The constructed schemes are shown to be well-balanced and faster than the Roe-type scheme.

A Transactional Asynchronous Replication Scheme for Mobile Database Systems

Institute of Scientific and Technical Information of China (English)

丁治明; 孟小峰; 王珊

2002-01-01

In mobile database systems, mobility of users has a significant impact on data replication. As a result, the various replica control protocols that exist today in traditional distributed and multidatabase environments are no longer suitable. To solve this problem, a new mobile database replication scheme, the Transaction-Level Result-Set Propagation (TLRSP)model, is put forward in this paper. The conflict detection and resolution strategy based on TLRSP is discussed in detail, and the implementation algorithm is proposed. In order to compare the performance of the TLRSP model with that of other mobile replication schemes, we have developed a detailed simulation model. Experimental results show that the TLRSP model provides an efficient support for replicated mobile database systems by reducing reprocessing overhead and maintaining database consistency.

Tag-KEM from Set Partial Domain One-Way Permutations

Science.gov (United States)

Abe, Masayuki; Cui, Yang; Imai, Hideki; Kurosawa, Kaoru

Recently a framework called Tag-KEM/DEM was introduced to construct efficient hybrid encryption schemes. Although it is known that generic encode-then-encrypt construction of chosen ciphertext secure public-key encryption also applies to secure Tag-KEM construction and some known encoding method like OAEP can be used for this purpose, it is worth pursuing more efficient encoding method dedicated for Tag-KEM construction. This paper proposes an encoding method that yields efficient Tag-KEM schemes when combined with set partial one-way permutations such as RSA and Rabin's encryption scheme. To our knowledge, this leads to the most practical hybrid encryption scheme of this type. We also present an efficient Tag-KEM which is CCA-secure under general factoring assumption rather than Blum factoring assumption.

Economic Droop Scheme for Decentralized Power Management in DC Microgrids

Directory of Open Access Journals (Sweden)

E. Alizadeh

2016-12-01

Full Text Available This paper proposes an autonomous and economic droop control scheme for DC microgrid application. In this method, a cost-effective power sharing technique among various types of DG units is properly adopted. The droop settings are determined based on an algorithm to individually manage the power management without any complicated optimization methods commonly applied in the centralized control method. In the proposed scheme, the system retains all the advantages of the traditional droop method while minimizes the generation costs of the DC microgrid. In the proposed method, all DGs are classified in a sorting rule based on their total generation cost and the reference voltage of their droop equations is then determined. The proposed scheme is applied to a typical DC microgrid consisting of four different types of DGs and a controllable load. The simulation results are presented to verify the effectiveness of the proposed method using MATLAB/SIMULINK software.

Utilizing Maximal Independent Sets as Dominating Sets in Scale-Free Networks

Science.gov (United States)

Derzsy, N.; Molnar, F., Jr.; Szymanski, B. K.; Korniss, G.

Dominating sets provide key solution to various critical problems in networked systems, such as detecting, monitoring, or controlling the behavior of nodes. Motivated by graph theory literature [Erdos, Israel J. Math. 4, 233 (1966)], we studied maximal independent sets (MIS) as dominating sets in scale-free networks. We investigated the scaling behavior of the size of MIS in artificial scale-free networks with respect to multiple topological properties (size, average degree, power-law exponent, assortativity), evaluated its resilience to network damage resulting from random failure or targeted attack [Molnar et al., Sci. Rep. 5, 8321 (2015)], and compared its efficiency to previously proposed dominating set selection strategies. We showed that, despite its small set size, MIS provides very high resilience against network damage. Using extensive numerical analysis on both synthetic and real-world (social, biological, technological) network samples, we demonstrate that our method effectively satisfies four essential requirements of dominating sets for their practical applicability on large-scale real-world systems: 1.) small set size, 2.) minimal network information required for their construction scheme, 3.) fast and easy computational implementation, and 4.) resiliency to network damage. Supported by DARPA, DTRA, and NSF.

Measuring general surgery residents' communication skills from the patient's perspective using the Communication Assessment Tool (CAT).

Science.gov (United States)

Stausmire, Julie M; Cashen, Constance P; Myerholtz, Linda; Buderer, Nancy

2015-01-01

The Communication Assessment Tool (CAT) has been used and validated to assess Family and Emergency Medicine resident communication skills from the patient's perspective. However, it has not been previously reported as an outcome measure for general surgery residents. The purpose of this study is to establish initial benchmarking data for the use of the CAT as an evaluation tool in an osteopathic general surgery residency program. Results are analyzed quarterly and used by the program director to provide meaningful feedback and targeted goal setting for residents to demonstrate progressive achievement of interpersonal and communication skills with patients. The 14-item paper version of the CAT (developed by Makoul et al. for residency programs) asks patients to anonymously rate surgery residents on discrete communication skills using a 5-point rating scale immediately after the clinical encounter. Results are reported as the percentage of items rated as "excellent" (5) by the patient. The setting is a hospital-affiliated ambulatory urban surgery office staffed by the residency program. Participants are representative of adult patients of both sexes across all ages with diverse ethnic backgrounds. They include preoperative and postoperative patients, as well as those needing diagnostic testing and follow-up. Data have been collected on 17 general surgery residents from a single residency program representing 5 postgraduate year levels and 448 patient encounters since March 2012. The reliability (Cronbach α) of the tool for surgery residents was 0.98. The overall mean percentage of items rated as excellent was 70% (standard deviations = 42%), with a median of 100%. The CAT is a useful tool for measuring 1 facet of resident communication skills-the patient's perception of the physician-patient encounter. The tool provides a unique and personalized outcome measure for identifying communication strengths and improvement opportunities, allowing residents to receive

Stress and coping among orthopaedic surgery residents and faculty.

Science.gov (United States)

Sargent, M Catherine; Sotile, Wayne; Sotile, Mary O; Rubash, Harry; Barrack, Robert L

2004-07-01

Evaluations of physicians and residents have revealed concerning levels of psychosocial dysfunction. The purposes of this study were to determine the quality of life of orthopaedic residents and faculty and to identify the risk factors for decompensation. Twenty-one orthopaedic residents and twenty-five full-time orthopaedic faculty completed a 102-question voluntary, anonymous survey. The survey consisted of three validated instruments, i.e., the Maslach Burnout Inventory, the General Health Questionnaire-12, and the Revised Dyadic Adjustment Scale; and three novel question sets addressing background and demographic information, stress reaction and management, and the balance between work and home life. Descriptive statistics, pairwise correlations, simple t tests, and Pearson and nonparametric Spearman correlations were calculated. The simple correlation coefficient was used to assess bivariate relationships. The mean overall quality-of-life score, on a scale of 0 to 4 points, was 2.5 points for residents compared with 3.6 points for faculty members. Residents reported considerable burnout, showing a high level of emotional exhaustion and depersonalization and an average level of personal achievement, whereas faculty reported minimal burnout, showing a low level of emotional exhaustion (p burnout and psychiatric morbidity correlated with weekly work hours; conflict between the commitments of work and home life; discord with faculty, nursing staff, and senior residents; debt load; and work-related stress. Protective factors included being a parent, spending time with a spouse, having a physician father, and deriving satisfaction from discussing concerns with colleagues, friends, and family. In pursuit of our goal of determining the quality of life of orthopaedic residents and faculty, we identified a large disparity between the two groups. The resident group reported much greater levels of dysfunction particularly with regard to burnout and psychiatric morbidity

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.

Scheme for Quantum Computing Immune to Decoherence

Science.gov (United States)

Williams, Colin; Vatan, Farrokh

2008-01-01

that the derivation provides explicit constructions for finding the exchange couplings in the physical basis needed to implement any arbitrary 1-qubit gate. These constructions lead to spintronic encodings of quantum logic that are more efficient than those of a previously published scheme that utilizes a universal but fixed set of gates.

A numerical relativity scheme for cosmological simulations

Science.gov (United States)

Daverio, David; Dirian, Yves; Mitsou, Ermis

2017-12-01

Cosmological simulations involving the fully covariant gravitational dynamics may prove relevant in understanding relativistic/non-linear features and, therefore, in taking better advantage of the upcoming large scale structure survey data. We propose a new 3  +  1 integration scheme for general relativity in the case where the matter sector contains a minimally-coupled perfect fluid field. The original feature is that we completely eliminate the fluid components through the constraint equations, thus remaining with a set of unconstrained evolution equations for the rest of the fields. This procedure does not constrain the lapse function and shift vector, so it holds in arbitrary gauge and also works for arbitrary equation of state. An important advantage of this scheme is that it allows one to define and pass an adaptation of the robustness test to the cosmological context, at least in the case of pressureless perfect fluid matter, which is the relevant one for late-time cosmology.

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.

Choosing academia versus private practice: factors affecting oral maxillofacial surgery residents' career choices.

Science.gov (United States)

Lanzon, Jesse; Edwards, Sean P; Inglehart, Marita R

2012-07-01

This study explored how residents who intend to enter private practice versus academic careers differ in their background and educational characteristics, engagement in different professional activities, professional values, and satisfaction. Survey data were collected from 257 residents in oral and maxillofacial surgery programs in the United States. The responses of the respondents who planned a career in private practice (65%) and who considered academia (35%) were compared with χ(2) and independent-sample t tests. Residents who considered academia were more likely to be women (29% vs 8%; P career compared with residents interested in private practice. Future clinicians placed a higher value on having manageable hours and more time performing outpatient procedures than future educators. These findings showed, first, that the characteristics at the beginning of residency programs that are likely to indicate an increased interest in academic careers are being a woman, from a non-European American background, and having an interest in research. Second, once residents are admitted, different types of surgeries and different types of professional activities tend to appeal to residents who want to practice in private practice settings versus work in academia. Third, residents interested in academia have a relatively lower level of satisfaction compared with residents interested in practicing outside of academia. Copyright © 2012 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Interference Cancellation Schemes for Single-Carrier Block Transmission with Insufficient Cyclic Prefix

Directory of Open Access Journals (Sweden)

Hayashi Kazunori

2008-01-01

Full Text Available Abstract This paper proposes intersymbol interference (ISI and interblock interference (IBI cancellation schemes at the transmitter and the receiver for the single-carrier block transmission with insufficient cyclic prefix (CP. The proposed scheme at the transmitter can exterminate the interferences by only setting some signals in the transmitted signal block to be the same as those of the previous transmitted signal block. On the other hand, the proposed schemes at the receiver can cancel the interferences without any change in the transmitted signals compared to the conventional method. The IBI components are reduced by using previously detected data signals, while for the ISI cancellation, we firstly change the defective channel matrix into a circulant matrix by using the tentative decisions, which are obtained by our newly derived frequency domain equalization (FDE, and then the conventional FDE is performed to compensate the ISI. Moreover, we propose a pilot signal configuration, which enables us to estimate a channel impulse response whose order is greater than the guard interval (GI. Computer simulations show that the proposed interference cancellation schemes can significantly improve bit error rate (BER performance, and the validity of the proposed channel estimation scheme is also demonstrated.

An Improved Overloading Scheme for Downlink CDMA

Directory of Open Access Journals (Sweden)

Marc Moeneclaey

2005-04-01

Full Text Available An improved overloading scheme is presented for single-user detection in the downlink of multiple-access systems based on OCDMA/OCDMA (O/O. By displacing in time the orthogonal signatures of the two user sets that make up the overloaded system, the cross-correlation between the users of the two sets is reduced. For random O/O with square-root cosine rolloff chip pulses, the multiuser interference can be decreased by up to 50% (depending on the chip pulse bandwidth as compared to quasiorthogonal sequences (QOS that are presently part of the downlink standard of Cdma2000. This reduction of the multiuser interference gives rise to an increase of the achievable signal-to-interference-plus-noise ratio for a particular channel load.

A Study to Assess Knowledge and Attitude Regarding Hand Hygiene amongst Residents and Nursing Staff in a Tertiary Health Care Setting of Bhopal City.

Science.gov (United States)

Maheshwari, Veena; Kaore, Navin Chandra M; Ramnani, Vijay Kumar; Gupta, Sanjay Kumar; Borle, Amod; Kaushal, Rituja

2014-08-01

Infection due to hospital-acquired microbes is an evolving problem worldwide, and horizontal transmission of bacterial organism continues to cause a high nosocomial infection rate in health care settings. Most nosocomial infections are thought to be transmitted by the hands of health care workers.The application of hand hygiene is effective in reducing infection rates. To assess the level of knowledge and attitude regarding hand hygiene practices amongst the health care professionals and to identify areas of gaps in their knowledge and attitude. A cross-sectional study. A total 160 respondents were studied about their knowledge and attitude towards hand hygiene practices and significant difference with a p-value of 0.0025 was observed regarding most frequent source of germs responsible for health care associated infections among resident and nurses. A significant difference with p-value of 0.0001 & 0.04 was observed in colonization due to jewellery and artificial nail among the study groups. The attitude regarding correct hand hygiene practices to be followed at all times was found to be better among nurses (62.5%) as compared to residents (21.3%) which was found to be highly significant with p-value hand hygiene practices among the health care workers to provide the current knowledge in the area with a behavioral change in attitudes and practices leading to reduction of nosocomial infections.

Upwind differencing scheme for the equations of ideal magnetohydrodynamics

International Nuclear Information System (INIS)

Brio, M.; Wu, C.C.

1988-01-01

Recently, upwind differencing schemes have become very popular for solving hyperbolic partial differential equations, especially when discontinuities exist in the solutions. Among many upwind schemes successfully applied to the problems in gas dynamics, Roe's method stands out for its relative simplicity and clarity of the underlying physical model. In this paper, an upwind differencing scheme of Roe-type for the MHD equations is constructed. In each computational cell, the problem is first linearized around some averaged state which preserves the flux differences. Then the solution is advanced in time by computing the wave contributions to the flux at the cell interfaces. One crucial task of the linearization procedure is the construction of a Roe matrix. For the special case γ = 2, a Roe matrix in the form of a mean value Jacobian is found, and for the general case, a simple averaging procedure is introduced. All other necessary ingredients of the construction, which include eigenvalues, and a complete set of right eigenvectors of the Roe matrix and decomposition coefficients are presented. As a numerical example, we chose a coplanar MHD Riemann problem. The problem is solved by the newly constructed second-order upwind scheme as well as by the Lax-Friedrichs, the Lax-Wendroff, and the flux-corrected transport schemes. The results demonstrate several advantages of the upwind scheme. In this paper, we also show that the MHD equations are nonconvex. This is a contrast to the general belief that the fast and slow waves are like sound waves in the Euler equations. As a consequence, the wave structure becomes more complicated; for example, compound waves consisting of a shock and attached to it a rarefaction wave of the same family can exist in MHD. copyright 1988 Academic Press, Inc

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

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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.

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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.

Time-dependent internal density functional theory formalism and Kohn-Sham scheme for self-bound systems

International Nuclear Information System (INIS)

Messud, Jeremie

2009-01-01

The stationary internal density functional theory (DFT) formalism and Kohn-Sham scheme are generalized to the time-dependent case. It is proven that, in the time-dependent case, the internal properties of a self-bound system (such as an atomic nuclei or a helium droplet) are all defined by the internal one-body density and the initial state. A time-dependent internal Kohn-Sham scheme is set up as a practical way to compute the internal density. The main difference from the traditional DFT formalism and Kohn-Sham scheme is the inclusion of the center-of-mass correlations in the functional.

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

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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.

An Efficient and Privacy-Preserving Multiuser Cloud-Based LBS Query Scheme

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Lu Ou

2018-01-01

Full Text Available Location-based services (LBSs are increasingly popular in today’s society. People reveal their location information to LBS providers to obtain personalized services such as map directions, restaurant recommendations, and taxi reservations. Usually, LBS providers offer user privacy protection statement to assure users that their private location information would not be given away. However, many LBSs run on third-party cloud infrastructures. It is challenging to guarantee user location privacy against curious cloud operators while still permitting users to query their own location information data. In this paper, we propose an efficient privacy-preserving cloud-based LBS query scheme for the multiuser setting. We encrypt LBS data and LBS queries with a hybrid encryption mechanism, which can efficiently implement privacy-preserving search over encrypted LBS data and is very suitable for the multiuser setting with secure and effective user enrollment and user revocation. This paper contains security analysis and performance experiments to demonstrate the privacy-preserving properties and efficiency of our proposed scheme.

Proposed criteria for the evaluation of an address assignment scheme in Botswana

CSIR Research Space (South Africa)

Ditsela, J

2011-06-01

Full Text Available propose criteria for an address assignment scheme in Botswana: a single set of place or area names; different addresses types for urban, rural and farm areas; principles for address numbering assignment; integration of different referencing systems; and a...

Adaptive nonseparable vector lifting scheme for digital holographic data compression.

Science.gov (United States)

Xing, Yafei; Kaaniche, Mounir; Pesquet-Popescu, Béatrice; Dufaux, Frédéric

2015-01-01

Holographic data play a crucial role in recent three-dimensional imaging as well as microscopic applications. As a result, huge amounts of storage capacity will be involved for this kind of data. Therefore, it becomes necessary to develop efficient hologram compression schemes for storage and transmission purposes. In this paper, we focus on the shifted distance information, obtained by the phase-shifting algorithm, where two sets of difference data need to be encoded. More precisely, a nonseparable vector lifting scheme is investigated in order to exploit the two-dimensional characteristics of the holographic contents. Simulations performed on different digital holograms have shown the effectiveness of the proposed method in terms of bitrate saving and quality of object reconstruction.

Resource Allocation and Resident Outcomes In Nursing Homes: Comparisons between the Best and Worst1

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Anderson, Ruth A.; Hsieh, Pi-Ching; Su, Hui-Fang

2005-01-01

The purpose of this study was to identify patterns of resource allocation that related to resident outcomes in nursing homes. Data on structure, staffing levels, salaries, cost, casemix, and resident outcomes were obtained from state-level, administrative databases on 494 nursing homes. We identified two sets of comparison groups and showed that the group of homes with the greatest percentage of improvement in resident outcomes had higher levels of RN staffing and higher costs. However, comparison groups based on best/worst average outcomes did not differ in resource allocation patterns. Additional analysis demonstrated that when controlling for RN staffing, resident outcomes in high and low cost homes did not differ. The results suggest that, although RN staffing is more expensive, it is key to improving resident outcomes. PMID:9679807

Numerical simulations of natural or mixed convection in vertical channels: comparisons of level-set numerical schemes for the modeling of immiscible incompressible fluid flows

International Nuclear Information System (INIS)

Li, R.

2012-01-01

The aim of this research dissertation is at studying natural and mixed convections of fluid flows, and to develop and validate numerical schemes for interface tracking in order to treat incompressible and immiscible fluid flows, later. In a first step, an original numerical method, based on Finite Volume discretizations, is developed for modeling low Mach number flows with large temperature gaps. Three physical applications on air flowing through vertical heated parallel plates were investigated. We showed that the optimum spacing corresponding to the peak heat flux transferred from an array of isothermal parallel plates cooled by mixed convection is smaller than those for natural or forced convections when the pressure drop at the outlet keeps constant. We also proved that mixed convection flows resulting from an imposed flow rate may exhibit unexpected physical solutions; alternative model based on prescribed total pressure at inlet and fixed pressure at outlet sections gives more realistic results. For channels heated by heat flux on one wall only, surface radiation tends to suppress the onset of re-circulations at the outlet and to unify the walls temperature. In a second step, the mathematical model coupling the incompressible Navier-Stokes equations and the Level-Set method for interface tracking is derived. Improvements in fluid volume conservation by using high order discretization (ENO-WENO) schemes for the transport equation and variants of the signed distance equation are discussed. (author)

Comparison in Schemes for Simulating Depositional Growth of Ice Crystal between Theoretical and Laboratory Data

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Zhai, Guoqing; Li, Xiaofan

2015-04-01

The Bergeron-Findeisen process has been simulated using the parameterization scheme for the depositional growth of ice crystal with the temperature-dependent theoretically predicted parameters in the past decades. Recently, Westbrook and Heymsfield (2011) calculated these parameters using the laboratory data from Takahashi and Fukuta (1988) and Takahashi et al. (1991) and found significant differences between the two parameter sets. There are two schemes that parameterize the depositional growth of ice crystal: Hsie et al. (1980), Krueger et al. (1995) and Zeng et al. (2008). In this study, we conducted three pairs of sensitivity experiments using three parameterization schemes and the two parameter sets. The pre-summer torrential rainfall event is chosen as the simulated rainfall case in this study. The analysis of root-mean-squared difference and correlation coefficient between the simulation and observation of surface rain rate shows that the experiment with the Krueger scheme and the Takahashi laboratory-derived parameters produces the best rain-rate simulation. The mean simulated rain rates are higher than the mean observational rain rate. The calculations of 5-day and model domain mean rain rates reveal that the three schemes with Takahashi laboratory-derived parameters tend to reduce the mean rain rate. The Krueger scheme together with the Takahashi laboratory-derived parameters generate the closest mean rain rate to the mean observational rain rate. The decrease in the mean rain rate caused by the Takahashi laboratory-derived parameters in the experiment with the Krueger scheme is associated with the reductions in the mean net condensation and the mean hydrometeor loss. These reductions correspond to the suppressed mean infrared radiative cooling due to the enhanced cloud ice and snow in the upper troposphere.

Which factors engage women in deprived neighbourhoods to participate in exercise referral schemes?

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Nierkens Vera

2008-10-01

Full Text Available Abstract Background Exercise referral schemes (ERS have become a popular way of promoting physical activity. The aim of these schemes is to encourage high risk patients to exercise. In evaluating these schemes, little attention has been paid to lower socio-economic groups in a multi-ethnic urban setting. This study aimed to explore the socio-demographic and psychosocial characteristics of female participants in ERS located in deprived neighbourhoods. The second aim was to determine which elements of the intervention make it appealing to participate in the scheme. Methods A mixed method approach was utilized, combining a cross-sectional descriptive study and a qualitative component. In the quantitative part of the study, all female participants (n = 523 filled out a registration form containing questions about socio-demographic and psychosocial characteristics. Height and weight were also measured. In the qualitative part of the study, 38 of these 523 participants were interviewed. Results The majority of the participants had a migrant background, a low level of education, no paid job and a high body mass index. Although most participants were living sedentary lives, at intake they were quite motivated to start exercising. The ERS appealed to them because of its specific elements: facilitating role of the health professional, supportive environment, financial incentive, supervision and neighbourhood setting. Conclusion This study supports the idea that ERS interventions appeal to women from lower socio-economic groups, including ethnic minorities. The ERS seems to meet their contextual, economic and cultural needs. Since the elements that enabled the women to start exercising are specific to this ERS, we should become aware of whether this population continues to exercise after the end of the scheme.

Does Mindfulness Training Enhance the Professional Development of Residents? A Qualitative Study.

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Verweij, Hanne; van Ravesteijn, Hiske; van Hooff, Madelon L M; Lagro-Janssen, Antoine L M; Speckens, Anne E M

2018-04-24

In addition to developing diagnostic and clinical skills, postgraduate medical education should stimulate residents' professional development. Teaching medical professionalism is challenging and is often left largely to the informal and hidden curricula. An intervention that might be beneficial for medical residents is Mindfulness-Based Stress Reduction (MBSR). The authors implemented MBSR as an optional course for residents and qualitatively explored how it influenced residents professionally. Between 2014 and 2016, the authors conducted 19 in-depth, face-to-face interviews with residents who had participated in an MBSR course at Radboud university medical center, the Netherlands. Medical and surgical residents, across a range of disciplines, participated. The authors used the constant comparison method to analyze the data. The analysis of the data resulted in five themes: awareness of thoughts, emotions, bodily sensations, and behavior; increased self-reflection; acceptance and nonjudgment; increased resilience; and relating to others. Residents indicated that the MBSR training increased their awareness and self-reflection at work, and they were more accepting toward themselves and toward their limitations. Furthermore, they mentioned being more resilient and better at setting priorities and limits. They improved their self-care and work-life balance. In addition, residents indicated that the training made them more aware of how they communicated. They asked for help more often and seemed to be more open toward feedback. Lastly, they indicated an increased sense of compassion for others. This study indicated that mindfulness training can serve as a tool to cultivate important professional competencies for residents.

Packet reversed packet combining scheme

International Nuclear Information System (INIS)

Bhunia, C.T.

2006-07-01

The packet combining scheme is a well defined simple error correction scheme with erroneous copies at the receiver. It offers higher throughput combined with ARQ protocols in networks than that of basic ARQ protocols. But packet combining scheme fails to correct errors when the errors occur in the same bit locations of two erroneous copies. In the present work, we propose a scheme that will correct error if the errors occur at the same bit location of the erroneous copies. The proposed scheme when combined with ARQ protocol will offer higher throughput. (author)

Comparison of nutrient profiling schemes for restricting the marketing of food and drink to children.

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Brinsden, H; Lobstein, T

2013-08-01

The food and beverage industry have made voluntary pledges to reduce children's exposure to the marketing of energy-dense foods and beverages, and in 2012 announced the replacement of company-specific nutrient profiling schemes with uniform sets of criteria from 2013 (in the USA) and 2014 (in the European Union [EU]). To compare the proposed USA and EU nutrient profiling schemes and three government-led schemes, paying particular attention to the differences in sugar criteria. Food and beverage products permitted to be advertised in the USA under pre-2013 criteria were examined using five nutrient profiling schemes: the forthcoming USA and EU schemes and three government-approved schemes: the US Interagency Working Group (IWG) proposals, the United Kingdom Office of Communications (OfCom) regulations and the Danish Forum co-regulatory Code. Under the new USA and EU nutrient profiling schemes, 88 (49%) and 73 (41%) of a total of 178 products would be permitted to be advertised, respectively. The US IWG permitted 25 (14%) products; the Ofcom regulations permitted 65 (37%) and the Danish Code permitted 13 (7%). Government-led schemes are significantly more restrictive than industry-led schemes, primarily due to their tougher sugar criteria. The Danish Forum (93%) and USA IWG scheme (86%) are the most restrictive of the five examined. Further harmonization of nutrient profiling schemes is needed to reduce children's exposure to the promotion of energy-dense foods. © 2013 The Authors. Pediatric Obesity © 2013 International Association for the Study of Obesity.

Core components of clinical education: a qualitative study with attending physicians and their residents

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ALIREZA ESTEGHAMATI

2016-04-01

Full Text Available Introduction: In medical education, particularly in residency courses, most of the training occurs in real clinical environments. Workplace-based learning profoundly affects students’ knowledge, attitudes, and practice; therefore, it should be properly planned. Due to the extensiveness of the clinical environment and its importance in training residents, investigating how residents learn in these environments and detecting factors that influence effectiveness will help curriculum designers to promote residents’ learning by improving their learning environment. Therefore, our qualitative content analysis study, aimed to examine the experiences and perspectives of internal and surgical residents and their attending physicians about learning in clinical settings. Methods: This qualitative content analysis study was conducted through purposeful sampling. Semi-structured interviews were conducted with 15 internal and surgical residents and 15 of their attending physicians at educational hospitals of Tehran University of Medical Sciences. Results: The main categories explored in this study were hidden curriculum, learning resources, and learning conditions. In the context of clinical environment and under its individual culture, residents learn professionalism and learn to improve their communication skills with patients and colleagues. Because of clinical obligations such as priority of treating the patients for education or workload of the attending physicians, residents acquire most of their practical knowledge from colleagues, fellows, or follow-up patients in different learning conditions (such as: educational rounds, morning reports and outpatient clinics. They see some of their attending physicians as role models. Conclusion: Changing cultural and contextual factors is of prime importance to promote a learning-oriented environment in a clinical setting. The present findings will help curriculum planners and attending physicians to improve

Use of a policy debate to teach residents about health care reform.

Science.gov (United States)

Nguyen, Vu Q C; Hirsch, Mark A

2011-09-01

Resident education involves didactics and pedagogic strategies using a variety of tools and technologies in order to improve critical thinking skills. Debating is used in educational settings to improve critical thinking skills, but there have been no reports of its use in residency education. The present paper describes the use of debate to teach resident physicians about health care reform. We aimed to describe the method of using a debate in graduate medical education. Second-year through fourth-year physical medicine and rehabilitation residents participated in a moderated policy debate in which they deliberated whether the United States has one of the "best health care system(s) in the world." Following the debate, the participants completed an unvalidated open-ended questionnaire about health care reform. Although residents expressed initial concerns about participating in a public debate on health care reform, all faculty and residents expressed that the debate was robust, animated, and enjoyed by all. Components of holding a successful debate on health care reform were noted to be: (1) getting "buy-in" from the resident physicians; (2) preparing the debate; and (3) follow-up. The debate facilitated the study of a large, complex topic like health care reform. It created an active learning process. It encouraged learners to keenly attend to an opposing perspective while enthusiastically defending their position. We conclude that the use of debates as a teaching tool in resident education is valuable and should be explored further.

Admonitory Behavioral Norms of Campus Housing and Residence Life Professionals

Science.gov (United States)

Wilson, Maureen E.; Hirschy, Amy S.; Braxton, John M.

2016-01-01

To protect the welfare of students, staff, and other clients in housing and residence life (HRL), administrators must understand what behaviors are unacceptable. Professionals might make idiosyncratic and unconstrained decisions when there is no conduct code or set of informal rules. Informal rules may become norms comprising normative structures…

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

The current and ideal state of mental health training: pediatric resident perspectives.

Science.gov (United States)

Hampton, Elisa; Richardson, Joshua E; Bostwick, Susan; Ward, Mary J; Green, Cori

2015-01-01

PHENOMENON: Mental health (MH) problems are prevalent in the pediatric population, and in a setting of limited resources, pediatricians need to provide MH care in the primary medical home yet are uncomfortable doing so citing a lack of training during residency as one barrier. The purpose of this study is to describe pediatric residents' experiences and perspectives on the current and ideal states of MH training and ideas for curriculum development to bridge this gap. A qualitative study using focus groups of pediatric residents from an urban academic medical center was performed. Audio recordings were transcribed and analyzed using a grounded theory approach. Twenty-six residents participated in three focus groups, which is when thematic saturation was achieved. The team generated five major themes: capabilities, comfort, organizational capacity, coping, and education. Residents expressed uncertainty at every step of an MH visit. Internal barriers identified included low levels of comfort and negative emotional responses. External barriers included a lack of MH resources and mentorship in MH care, or an inadequate organizational capacity. These internal and external barriers resulted in a lack of perceived capability in handling MH issues. In response, residents reported inadequate coping strategies, such as ignoring MH concerns. To build knowledge and skills, residents prefer educational modalities including didactics, experiential learning through collaborations with MH specialists, and tools built into patient care flow. Insights: Pediatric residency programs need to evolve in order to improve resident training in MH care. The skills and knowledge requested by residents parallel the American Academy of Pediatrics statement on MH competencies. Models of collaborative care provide similar modalities of learning requested by residents. These national efforts have not been operationalized in training programs yet may be useful for curriculum development and

Enhancing Community Detection By Affinity-based Edge Weighting Scheme

Energy Technology Data Exchange (ETDEWEB)

Yoo, Andy [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Sanders, Geoffrey [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Henson, Van [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Vassilevski, Panayot [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States)

2015-10-05

Community detection refers to an important graph analytics problem of finding a set of densely-connected subgraphs in a graph and has gained a great deal of interest recently. The performance of current community detection algorithms is limited by an inherent constraint of unweighted graphs that offer very little information on their internal community structures. In this paper, we propose a new scheme to address this issue that weights the edges in a given graph based on recently proposed vertex affinity. The vertex affinity quantifies the proximity between two vertices in terms of their clustering strength, and therefore, it is ideal for graph analytics applications such as community detection. We also demonstrate that the affinity-based edge weighting scheme can improve the performance of community detection algorithms significantly.

National Disability Insurance Scheme, health, hospitals and adults with intellectual disability.

Science.gov (United States)

Wallace, Robyn A

2018-03-01

Preventable poor health outcomes for adults with intellectual disability in health settings have been known about for years. Subsequent analysis and the sorts of reasonable adjustments required in health and disability support settings to address these health gaps are well described, but have not really been embedded in practice in any significant way in either setting. As far as health is concerned, implementation of the National Disability Insurance Scheme (NDIS, the Scheme) affords an opportunity to recognise individual needs of people with intellectual disability to provide reasonable and necessary functional support for access to mainstream health services, to build capacity of mainstream health providers to supply services and to increase individual capacity to access services. Together these strands have potential to transform health outcomes. Success of the Scheme, however, rests on as yet incompletely defined operational interaction between NDIS and mainstream health services and inherently involves the disability sector. This interaction is especially relevant for adults with intellectual disability, known high users of hospitals and for whom hospital outcomes are particularly poor and preventable. Keys to better hospital outcomes are first, the receiving of quality person-centred healthcare from physicians and hospitals taking into account significance of intellectual disability and second, formulation of organised quality functional supports during hospitalisation. Achieving these require sophisticated engagement between consumers, the National Disability Insurance Agency, Commonwealth, State and Territory government leaders, senior hospital and disability administrators, NDIS service providers and clinicians and involves cross fertilisation of values, sharing of operational policies and procedures, determination of boundaries of fiscal responsibility for functional supports in hospital. © 2018 Royal Australasian College of Physicians.

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

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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...

Risk aversion and willingness to pay for water quality: The case of non-farm rural residents.

Science.gov (United States)

Larue, Bruno; West, Gale E; Singbo, Alphonse; Tamini, Lota Dabio

2017-07-15

Stated choice experiments are used to investigate the economic valuation of rural residents living in the province of Quebec for water quality improvements. In Quebec, rural residents played an important role in the setting of stricter environmental regulations. Unlike most stated choice experiments about the valuation of improvements in water quality, this study explicitly accounts for risk in the design and analysis of choice experiments. Risk in phosphorus and coliform reductions is introduced through a three-point uniform distribution in the choice sets. The results show greater support for constant absolute risk aversion preferences than for constant relative risk aversion. Rural residents value coliform and phosphorus reductions and the more educated ones are particularly willing to see the government tax farmers and taxpayers to secure such reductions. As the science improves and risk in water quality outcomes decrease and as the political weight of non-farm rural residents increase, it should be easier for governments to replace voluntary cost-share programs by polluter-payer programs. Copyright © 2017 Elsevier Ltd. All rights reserved.

Interrelationships between romance, life quality, and medical training of female residents

Directory of Open Access Journals (Sweden)

Yu-Jung Wang

2012-08-01

Conclusion: Romance and quality of life were significantly influenced by the pattern of medical training in female residents. Setting duty-hour limits and initiating a new hobby were determined to be potentially beneficial to their quality of life and attitudes toward romance.

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

Science.gov (United States)

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

2016-12-01

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

Application of a robust and efficient Lagrangian particle scheme to soot transport in turbulent flames

KAUST Repository

Attili, Antonio

2013-09-01

A Lagrangian particle scheme is applied to the solution of soot dynamics in turbulent nonpremixed flames. Soot particulate is described using a method of moments and the resulting set of continuum advection-reaction equations is solved using the Lagrangian particle scheme. The key property of the approach is the independence between advection, described by the movement of Lagrangian notional particles along pathlines, and internal aerosol processes, evolving on each notional particle via source terms. Consequently, the method overcomes the issues in Eulerian grid-based schemes for the advection of moments: errors in the advective fluxes pollute the moments compromising their realizability and the stiffness of source terms weakens the stability of the method. The proposed scheme exhibits superior properties with respect to conventional Eulerian schemes in terms of stability, accuracy, and grid convergence. Taking into account the quality of the solution, the Lagrangian approach can be computationally more economical than commonly used Eulerian schemes as it allows the resolution requirements dictated by the different physical phenomena to be independently optimized. Finally, the scheme posseses excellent scalability on massively parallel computers. © 2013 Elsevier Ltd.

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

Science.gov (United States)

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

2017-12-01

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

Equity of the premium of the Ghanaian National Health Insurance Scheme and the implications for achieving universal coverage.

Science.gov (United States)

Amporfu, Eugenia

2013-01-07

The Ghanaian National Health Insurance Scheme (NHIS) was introduced to provide access to adequate health care regardless of ability to pay. By law the NHIS is mandatory but because the informal sector has to make premium payment before they are enrolled, the authorities are unable to enforce mandatory nature of the scheme. The ultimate goal of the Scheme then is to provide all residents with access to adequate health care at affordable cost. In other words, the Scheme intends to achieve universal coverage. An important factor for the achievement of universal coverage is that revenue collection be equitable. The purpose of this study is to examine the vertical and horizontal equity of the premium collection of the Scheme. The Kakwani index method as well as graphical analysis was used to study the vertical equity. Horizontal inequity was measured through the effect of the premium on redistribution of ability to pay of members. The extent to which the premium could cause catastrophic expenditure was also examined. The results showed that revenue collection was both vertically and horizontally inequitable. The horizontal inequity had a greater effect on redistribution of ability to pay than vertical inequity. The computation of catastrophic expenditure showed that a small minority of the poor were likely to incur catastrophic expenditure from paying the premium a situation that could impede the achievement of universal coverage. The study provides recommendations to improve the inequitable system of premium payment to help achieve universal coverage.

Equity of the premium of the Ghanaian national health insurance scheme and the implications for achieving universal coverage

Directory of Open Access Journals (Sweden)

Amporfu Eugenia

2013-01-01

Full Text Available Abstract The Ghanaian National Health Insurance Scheme (NHIS was introduced to provide access to adequate health care regardless of ability to pay. By law the NHIS is mandatory but because the informal sector has to make premium payment before they are enrolled, the authorities are unable to enforce mandatory nature of the scheme. The ultimate goal of the Scheme then is to provide all residents with access to adequate health care at affordable cost. In other words, the Scheme intends to achieve universal coverage. An important factor for the achievement of universal coverage is that revenue collection be equitable. The purpose of this study is to examine the vertical and horizontal equity of the premium collection of the Scheme. The Kakwani index method as well as graphical analysis was used to study the vertical equity. Horizontal inequity was measured through the effect of the premium on redistribution of ability to pay of members. The extent to which the premium could cause catastrophic expenditure was also examined. The results showed that revenue collection was both vertically and horizontally inequitable. The horizontal inequity had a greater effect on redistribution of ability to pay than vertical inequity. The computation of catastrophic expenditure showed that a small minority of the poor were likely to incur catastrophic expenditure from paying the premium a situation that could impede the achievement of universal coverage. The study provides recommendations to improve the inequitable system of premium payment to help achieve universal coverage.

A full quantum network scheme

International Nuclear Information System (INIS)

Ma Hai-Qiang; Wei Ke-Jin; Yang Jian-Hui; Li Rui-Xue; Zhu Wu

2014-01-01

We present a full quantum network scheme using a modified BB84 protocol. Unlike other quantum network schemes, it allows quantum keys to be distributed between two arbitrary users with the help of an intermediary detecting user. Moreover, it has good expansibility and prevents all potential attacks using loopholes in a detector, so it is more practical to apply. Because the fiber birefringence effects are automatically compensated, the scheme is distinctly stable in principle and in experiment. The simple components for every user make our scheme easier for many applications. The experimental results demonstrate the stability and feasibility of this scheme. (general)

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...

Transmission usage cost allocation schemes

International Nuclear Information System (INIS)

Abou El Ela, A.A.; El-Sehiemy, R.A.

2009-01-01

This paper presents different suggested transmission usage cost allocation (TCA) schemes to the system individuals. Different independent system operator (ISO) visions are presented using the proportional rata and flow-based TCA methods. There are two proposed flow-based TCA schemes (FTCA). The first FTCA scheme generalizes the equivalent bilateral exchanges (EBE) concepts for lossy networks through two-stage procedure. The second FTCA scheme is based on the modified sensitivity factors (MSF). These factors are developed from the actual measurements of power flows in transmission lines and the power injections at different buses. The proposed schemes exhibit desirable apportioning properties and are easy to implement and understand. Case studies for different loading conditions are carried out to show the capability of the proposed schemes for solving the TCA problem. (author)

Research on the supercapacitor support schemes for LVRT of variable-frequency drive in the thermal power plant

Science.gov (United States)

Han, Qiguo; Zhu, Kai; Shi, Wenming; Wu, Kuayu; Chen, Kai

2018-02-01

In order to solve the problem of low voltage ride through(LVRT) of the major auxiliary equipment’s variable-frequency drive (VFD) in thermal power plant, the scheme of supercapacitor paralleled in the DC link of VFD is put forward, furthermore, two solutions of direct parallel support and voltage boost parallel support of supercapacitor are proposed. The capacitor values for the relevant motor loads are calculated according to the law of energy conservation, and they are verified by Matlab simulation. At last, a set of test prototype is set up, and the test results prove the feasibility of the proposed schemes.

Declining Otolaryngology Resident Training Experience in Tracheostomies: Case Log Trends from 2005 to 2015.

Science.gov (United States)

Lesko, David; Showmaker, Jason; Ukatu, Ceisha; Wu, Qiwei; Chang, C W David

2017-06-01

Objective To evaluate recent tracheostomy surgical experience among otolaryngology residents and general surgery residents. Study Design Retrospective database review. Setting Accreditation Council for Graduate Medical Education otolaryngology and general surgery programs. Subjects and Methods Accreditation Council for Graduate Medical Education case log data from 2005 to 2015 for resident graduates in otolaryngology and general surgery were used to obtain mean graduate tracheostomy numbers, mean graduate composite case numbers, and number of graduating residents. Market share for each specialty was estimated through the derived metric of nationwide total tracheostomy graduate experience, calculated by multiplying the number of graduating residents by the mean number of graduate tracheostomies. Linear regression analysis was used to calculate trends. Multiple linear regression analysis was used for pairwise comparison of trends. Results From 2005 to 2015, mean graduate tracheostomy numbers for otolaryngology residents declined 2.3% per year, while those for general surgery residents increased 1.8% per year. Accounting for changes in number of resident graduates, market share of tracheostomy decreased 1.0% per year for otolaryngology and increased 3.0% per year for general surgery. Mean graduate composite case numbers increased significantly by 1.8% and 1.0% per year for otolaryngology and general surgery residents, respectively. Conclusion Tracheostomy case volume in otolaryngology residency has decreased steadily in comparison with general surgery residency. However, current otolaryngology graduates have more experience in tracheostomy when compared with general surgery graduates. While otolaryngology residents have excellent exposure to tracheostomy, otolaryngology programs should be made aware of this declining trend as well as changing procedural trends, which may affect training needs.

Family medicine residency program directors attitudes and knowledge of family medicine CAM competencies.

Science.gov (United States)

Gardiner, Paula; Filippelli, Amanda C; Lebensohn, Patricia; Bonakdar, Robert

2013-01-01

Little is known about the incorporation of integrative medicine (IM) and complementary and alternative medicine (CAM) into family medicine residency programs. The Society for Teachers of Family Medicine (STFM) approved a set of CAM/IM competencies for family medicine residencies. We hope to evaluate whether residency programs are implementing such competencies into their curriculum using an online survey tool. We also hope to assess the knowledge and attitudes of Residency Directors (RDs) on the CAM/IM competencies. A survey was distributed by the Council of Academic Family Medicine (CAFM) Educational Research Alliance to RDs via e-mail. The survey was distributed to 431 RDs. Of those who received it, 212 responded, giving a response rate of 49.1%. Questions assessed the knowledge and attitudes of CAM/IM competencies and incorporation of CAM/IM into the residency curriculum. Forty-five percent of RDs were aware of the competencies. In terms of RD attitudes, 58% reported that CAM/IM is an important component of residents' curriculum; yet, 60% report not having specific learning objectives for CAM/IM in their residency curriculum. Among all programs, barriers to CAM/IM implementation included time in residents' schedules (77%); faculty training (75%); access to CAM experts (43%); lack of reimbursement (43%); and financial resources (29%). While many RDs are aware of the STFM CAM/IM competencies and acknowledge their role in residence education, there are many barriers that prevent residencies from implementing the STFM CAM/IM competencies. © 2013 Elsevier Inc. All rights reserved.

Matroids and quantum-secret-sharing schemes

International Nuclear Information System (INIS)

Sarvepalli, Pradeep; Raussendorf, Robert

2010-01-01

A secret-sharing scheme is a cryptographic protocol to distribute a secret state in an encoded form among a group of players such that only authorized subsets of the players can reconstruct the secret. Classically, efficient secret-sharing schemes have been shown to be induced by matroids. Furthermore, access structures of such schemes can be characterized by an excluded minor relation. No such relations are known for quantum secret-sharing schemes. In this paper we take the first steps toward a matroidal characterization of quantum-secret-sharing schemes. In addition to providing a new perspective on quantum-secret-sharing schemes, this characterization has important benefits. While previous work has shown how to construct quantum-secret-sharing schemes for general access structures, these schemes are not claimed to be efficient. In this context the present results prove to be useful; they enable us to construct efficient quantum-secret-sharing schemes for many general access structures. More precisely, we show that an identically self-dual matroid that is representable over a finite field induces a pure-state quantum-secret-sharing scheme with information rate 1.

Reassessment of MLST schemes for Leptospira spp. typing worldwide.

Science.gov (United States)

Varni, Vanina; Ruybal, Paula; Lauthier, Juan José; Tomasini, Nicolás; Brihuega, Bibiana; Koval, Ariel; Caimi, Karina

2014-03-01

Leptospirosis is a neglected zoonosis of global importance. Several multilocus sequence typing (MLST) methods have been developed for Leptospira spp., the causative agent of leptospirosis. In this study we reassessed the most commonly used MLST schemes in a set of worldwide isolates, in order to select the loci that achieve the maximum power of discrimination for typing Leptospira spp. Global eBURST algorithm was used to detect clonal complexes among STs and phylogenetic relationships among concatenated and individual sequences were inferred through maximum likelihood (ML) analysis. The evaluation of 12 loci combined to type a subset of strains rendered 57 different STs. Seven of these loci were selected into a final scheme upon studying the number of alleles and polymorphisms, the typing efficiency, the discriminatory power and the ratio dN/dS per nucleotide site for each locus. This new 7-locus scheme was applied to a wider collection of worldwide strains. The ML tree constructed from concatenated sequences of the 7 loci identified 6 major clusters corresponding to 6 Leptospira species. Global eBURST established 8 CCs, which showed that genotypes were clearly related by geographic origin and host. ST52 and ST47, represented mostly by Argentinian isolates, grouped the higher number of isolates. These isolates were serotyped as serogroups Pomona and Icterohaemorrhagiae, showing a unidirectional correlation in which the isolates with the same ST belong to the same serogroup. In summary, this scheme combines the best loci from the most widely used MLST schemes for Leptospira spp. and supports worldwide strains classification. The Argentinian isolates exhibited congruence between allelic profile and serogroup, providing an alternative to serological methods. Published by Elsevier B.V.

Modeling and Analysis of Hybrid Cellular/WLAN Systems with Integrated Service-Based Vertical Handoff Schemes

Science.gov (United States)

Xia, Weiwei; Shen, Lianfeng

We propose two vertical handoff schemes for cellular network and wireless local area network (WLAN) integration: integrated service-based handoff (ISH) and integrated service-based handoff with queue capabilities (ISHQ). Compared with existing handoff schemes in integrated cellular/WLAN networks, the proposed schemes consider a more comprehensive set of system characteristics such as different features of voice and data services, dynamic information about the admitted calls, user mobility and vertical handoffs in two directions. The code division multiple access (CDMA) cellular network and IEEE 802.11e WLAN are taken into account in the proposed schemes. We model the integrated networks by using multi-dimensional Markov chains and the major performance measures are derived for voice and data services. The important system parameters such as thresholds to prioritize handoff voice calls and queue sizes are optimized. Numerical results demonstrate that the proposed ISHQ scheme can maximize the utilization of overall bandwidth resources with the best quality of service (QoS) provisioning for voice and data services.

[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.

Optimum Electrode Configurations for Two-Probe, Four-Probe and Multi-Probe Schemes in Electrical Resistance Tomography for Delamination Identification in Carbon Fiber Reinforced Composites

Directory of Open Access Journals (Sweden)

Luis Waldo Escalona-Galvis

2018-04-01

Full Text Available Internal damage in Carbon Fiber Reinforced Polymer (CFRP composites modifies the internal electrical conductivity of the composite material. Electrical Resistance Tomography (ERT is a non-destructive evaluation (NDE technique that determines the extent of damage based on electrical conductivity changes. Implementation of ERT for damage identification in CFRP composites requires the optimal selection of the sensing sites for accurate results. This selection depends on the measuring scheme used. The present work uses an effective independence (EI measure for selecting the minimum set of measurements for ERT damage identification using three measuring schemes: two-probe, four-probe and multi-probe. The electrical potential field in two CFRP laminate layups with 14 electrodes is calculated using finite element analyses (FEA for a set of specified delamination damage cases. The measuring schemes consider the cases of 14 electrodes distributed on both sides and seven electrodes on only one side of the laminate for each layup. The effectiveness of EI reduction is demonstrated by comparing the inverse identification results of delamination cases for the full and the reduced sets using the measuring schemes and electrode sets. This work shows that the EI measure optimally reduces electrode and electrode combinations in ERT based damage identification for different measuring schemes.

An international comparison of the Ohio department of aging-resident satisfaction survey: applicability in a U.S. and Canadian sample.

Science.gov (United States)

Cooke, Heather A; Yamashita, Takashi; Brown, J Scott; Straker, Jane K; Baiton Wilkinson, Susan

2013-12-01

The majority of resident satisfaction surveys available for use in assisted living settings have been developed in the United States; however, empirical assessment of their measurement properties remains limited and sporadic, as does knowledge regarding their applicability for use in settings outside of the United States. This study further examines the psychometric properties of the Ohio Department of Aging-Resident Satisfaction Survey (ODA-RSS) and explores its applicability within a sample of Canadian assisted living facilities. Data were collected from 9,739 residential care facility (RCF) residents in Ohio, United States and 938 assisted-living residents in British Columbia, Canada. Confirmatory factor analysis was used to assess the instrument's psychometric properties within the 2 samples. Although the ODA-RSS appears well suited for assessing resident satisfaction in Ohio RCFs, it is less so in British Columbia assisted living settings. Adequate reliability and validity were observed for all 8 measurable instrument domains in the Ohio sample, but only 4 (Care and Services, Employee Relations, Employee Responsiveness, and Communications) in the British Columbia sample. The ODA-RSS performs best in an environment that encompasses a wide range of RCF types. In settings where greater uniformity and standardization exist, more nuanced questions may be required to detect variation between facilities. It is not sufficient to assume that rigorous development and empirical testing of a tool ensures its applicability in states or countries other than that in which it was initially developed.

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.

Comparison of actinides and fission products recycling scheme with the normal plutonium recycling scheme in fast reactors

Directory of Open Access Journals (Sweden)

Salahuddin Asif

2013-01-01

Full Text Available Multiple recycling of actinides and non-volatile fission products in fast reactors through the dry re-fabrication/reprocessing atomics international reduction oxidation process has been studied as a possible way to reduce the long-term potential hazard of nuclear waste compared to that resulting from reprocessing in a wet PUREX process. Calculations have been made to compare the actinides and fission products recycling scheme with the normal plutonium recycling scheme in a fast reactor. For this purpose, the Karlsruhe version of isotope generation and depletion code, KORIGEN, has been modified accordingly. An entirely novel fission product yields library for fast reactors has been created which has replaced the old KORIGEN fission products library. For the purposes of this study, the standard 26 groups data set, KFKINR, developed at Forschungszentrum Karlsruhe, Germany, has been extended by the addition of the cross-sections of 13 important actinides and 68 most important fission products. It has been confirmed that these 68 fission products constitute about 95% of the total fission products yield and about 99.5% of the total absorption due to fission products in fast reactors. The amount of fissile material required to guarantee the criticality of the reactor during recycling schemes has also been investigated. Cumulative high active waste per ton of initial heavy metal is also calculated. Results show that the recycling of actinides and fission products in fast reactors through the atomics international reduction oxidation process results in a reduction of the potential hazard of radioactive waste.

Hitting emissions targets with (statistical) confidence in multi-instrument Emissions Trading Schemes

International Nuclear Information System (INIS)

Shipworth, David

2003-12-01

A means of assessing, monitoring and controlling aggregate emissions from multi-instrument Emissions Trading Schemes is proposed. The approach allows contributions from different instruments with different forms of emissions targets to be integrated. Where Emissions Trading Schemes are helping to meet specific national targets, the approach allows the entry requirements of new participants to be calculated and set at a level that will achieve these targets. The approach is multi-levelled, and may be extended downwards to support pooling of participants within instruments, or upwards to embed Emissions Trading Schemes within a wider suite of policies and measures with hard and soft targets. Aggregate emissions from each instrument are treated stochastically. Emissions from the scheme as a whole are then the joint probability distribution formed by integrating the emissions from its instruments. Because a Bayesian approach is adopted, qualitative and semi-qualitative data from expert opinion can be used where quantitative data is not currently available, or is incomplete. This approach helps government retain sufficient control over emissions trading scheme targets to allow them to meet their emissions reduction obligations, while minimising the need for retrospectively adjusting existing participants' conditions of entry. This maintains participant confidence, while providing the necessary policy levers for good governance

Insights on different participation schemes to meet climate goals

International Nuclear Information System (INIS)

Russ, Peter; Ierland, Tom van

2009-01-01

Models and scenarios to assess greenhouse gas mitigation action have become more diversified and detailed, allowing the simulation of more realistic global climate policy set-ups. In this paper, different participation schemes to meet different levels of radiative forcing are analysed. The focus is on scenarios that are in line with the 2 deg. C target. Typical stylised participation schemes are based either on a perfect global carbon market or delayed participation with targets only for developed countries, no actions by developing countries and no access to credits from offsetting mechanisms in developing countries. This paper adds an intermediate policy scenario assuming a gradual incorporation of all countries, including a gradually developing carbon market, and taking into account the ability to contribute of different parties. Perfect participation by all parties would be optimal, but it is shown that participation schemes involving a gradual and differentiated participation by all parties can substantially decrease global costs and still meet the 2 deg. C target. Carbon markets can compensate in part for those costs incurred by developing countries' own, autonomous mitigation actions that do not generate tradable emission credits.

TRACER: an ‘eye-opener’ to the patient experience across the transition of care in an internal medicine resident program

Directory of Open Access Journals (Sweden)

Lauren B. Meade

2015-04-01

Full Text Available Background: A safe patient transition requires a complex set of physician skills within the interprofessional practice. Objective: To evaluate a rotation which applies self-reflection and workplace learning in a TRAnsition of CarE Rotation (TRACER for internal medicine (IM residents. TRACER is a 2-week required IM resident rotation where trainees join a ward team as a quality officer and follow patients into postacute care. Methods: In 2010, residents participated in semistructured, one-on-one interviews as part of ongoing program evaluation. They were asked what they had learned on TRACER, the year prior, and how they used those skills in their practice. Using transcripts, the authors reviewed and coded each transcript to develop themes. Results: Five themes emerged from a qualitative, grounded theory analysis: seeing things from the other side, the ‘ah ha’ moment of fragmented care, team collaboration including understanding nursing scope of practice in different settings, patient understanding, and passing the learning on. TRACER gives residents a moment to breathe and open their eyes to the interprofessional practice setting and the patient's experience of care in transition. Conclusions: Residents learn about transitions of care through self-reflection. This learning is sustained over time and is valued enough to teach to their junior colleagues.

Geriatric workforce capacity: a pending crisis for nursing home residents.

Science.gov (United States)

Lee, Wei-Chen; Sumaya, Ciro V

2013-07-29

The nursing home (NH) population in the US has grown to 1.6 million people and is expected to double by 2030. While 88.3% of NH residents are over 65, the elders aged 85 and more have become the principal group. This demographic change has increased the already high rates of chronic diseases and functional disabilities in NH residents. This study reviewed the supply of geriatricians in addressing the growing healthcare needs of NH residents. English-written articles between 1989 and 2012 were reviewed. Trend data demonstrate that the geriatrician workforce has decreased from 10,270 in 2000 to 8,502 in 2010. Further, the pipeline analysis of physicians projected to receive board certification in geriatrics (and maintain this certification) indicates a worsening of the already insufficient supply of geriatricians for this vulnerable population. Strategies to attract and maintain a geriatrician workforce are imperative to avert a mounting crisis in the geriatric care in NH and, by extension, other living settings.

Effect of length of dental resident clinical rotations on patient behavior.

Science.gov (United States)

Lau, Agnes

2018-01-01

The purpose of this retrospective chart review study was to determine if the length of residents' comprehensive dental care rotations in a general practice residency affected late cancellations, broken appointments, completion of treatment, timeliness of recall visits, emergency visits, and the need for redo of restorations and prostheses. Patients who presented for comprehensive care from 2010 to 2013, during which residents had 3- to 4-month dental clinic rotations, comprised Group 1, and patients who presented for comprehensive care from 2013 to 2016, during which residents had 11-month dental clinic rotations, comprised Group 2. Subjects were excluded if they only presented for emergency care, they had only one visit, or their care was delivered in both time periods. There were 105 patients in Group 1 and 55 patients in Group 2. The statistically significant results were that Group 1 patients had more late cancellations and broken appointments and failed to reach recall status more often than Group 2 patients, and that Group 1 patients had fewer emergency visits. Within the limitations of this retrospective study, the results suggest that short block rotations have an adverse effect on resident experience and outcomes of patient care in a hospital outpatient setting. © 2018 Special Care Dentistry Association and Wiley Periodicals, Inc.

Psychiatric education in the correctional setting: challenges and opportunities.

Science.gov (United States)

Holoyda, Brian J; Scott, Charles L

2017-02-01

As the need for mental healthcare services within correctional settings in the US increases, so does the need for a mental health workforce that is motivated to work within such systems. One potentially effective method by which to increase the number of psychiatrists working in jails, prisons, and parole clinics is to provide exposure to these environments during their training. Correctional settings can serve as unique training sites for medical students and psychiatric residents and fellows. Such training experiences can provide a host of benefits to both trainees and staff within the correctional mental health system. Alongside many potential benefits exist substantial potential barriers to coordinating correctional training experiences, including both programme directors' and residents' concerns regarding safety and enjoyment and negative perceptions of inmate and prisoner patients. The establishment of academic affiliations with correctional institutions and didactic instruction on commonly encountered clinical issues with inmate populations may be methods of diffusing these concerns. Improving residents' and fellows' training experiences offers a hope for increasing the attractiveness of a career in correctional psychiatry.

Hierarchical Markov Model in Life Insurance and Social Benefit Schemes

Directory of Open Access Journals (Sweden)

Jiwook Jang

2018-06-01

Full Text Available We explored the effect of the jump-diffusion process on a social benefit scheme consisting of life insurance, unemployment/disability benefits, and retirement benefits. To do so, we used a four-state Markov chain with multiple decrements. Assuming independent state-wise intensities taking the form of a jump-diffusion process and deterministic interest rates, we evaluated the prospective reserves for this scheme in which the individual is employed at inception. We then numerically demonstrated the state of the reserves for the scheme under jump-diffusion and non-jump-diffusion settings. By decomposing the reserve equation into five components, our numerical illustration indicated that an extension of the retirement age has a spillover effect that would increase government expenses for other social insurance programs. We also conducted sensitivity analyses and examined the total-reserves components by changing the relevant parameters of the transition intensities, which are the average jump-size parameter, average jump frequency, and diffusion parameters of the chosen states, with figures provided. Our computation revealed that the total reserve is most sensitive to changes in average jump frequency.

Efficient JPEG 2000 Image Compression Scheme for Multihop Wireless Networks

Directory of Open Access Journals (Sweden)

Halim Sghaier

2011-08-01

Full Text Available When using wireless sensor networks for real-time data transmission, some critical points should be considered. Restricted computational power, reduced memory, narrow bandwidth and energy supplied present strong limits in sensor nodes. Therefore, maximizing network lifetime and minimizing energy consumption are always optimization goals. To overcome the computation and energy limitation of individual sensor nodes during image transmission, an energy efficient image transport scheme is proposed, taking advantage of JPEG2000 still image compression standard using MATLAB and C from Jasper. JPEG2000 provides a practical set of features, not necessarily available in the previous standards. These features were achieved using techniques: the discrete wavelet transform (DWT, and embedded block coding with optimized truncation (EBCOT. Performance of the proposed image transport scheme is investigated with respect to image quality and energy consumption. Simulation results are presented and show that the proposed scheme optimizes network lifetime and reduces significantly the amount of required memory by analyzing the functional influence of each parameter of this distributed image compression algorithm.

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.

Scheme Program Documentation Tools

DEFF Research Database (Denmark)

Nørmark, Kurt

2004-01-01

are separate and intended for different documentation purposes they are related to each other in several ways. Both tools are based on XML languages for tool setup and for documentation authoring. In addition, both tools rely on the LAML framework which---in a systematic way---makes an XML language available...... as named functions in Scheme. Finally, the Scheme Elucidator is able to integrate SchemeDoc resources as part of an internal documentation resource....

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

Heterogeneity in Wage Setting Behavior in a New-Keynesian Model

NARCIS (Netherlands)

Eijffinger, S.C.W.; Grajales Olarte, A.; Uras, R.B.

2015-01-01

In this paper we estimate a New-Keynesian DSGE model with heterogeneity in price and wage setting behavior. In a recent study, Coibion and Gorodnichenko (2011) develop a DSGE model, in which firms follow four different types of price setting schemes: sticky prices, sticky information, rule of thumb,

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.

A Memory Efficient Network Encryption Scheme

Science.gov (United States)

El-Fotouh, Mohamed Abo; Diepold, Klaus

In this paper, we studied the two widely used encryption schemes in network applications. Shortcomings have been found in both schemes, as these schemes consume either more memory to gain high throughput or low memory with low throughput. The need has aroused for a scheme that has low memory requirements and in the same time possesses high speed, as the number of the internet users increases each day. We used the SSM model [1], to construct an encryption scheme based on the AES. The proposed scheme possesses high throughput together with low memory requirements.

Schemes of detecting nuclear spin correlations by dynamical decoupling based quantum sensing

Science.gov (United States)

Ma, Wen-Long Ma; Liu, Ren-Bao

Single-molecule sensitivity of nuclear magnetic resonance (NMR) and angstrom resolution of magnetic resonance imaging (MRI) are the highest challenges in magnetic microscopy. Recent development in dynamical decoupling (DD) enhanced diamond quantum sensing has enabled NMR of single nuclear spins and nanoscale NMR. Similar to conventional NMR and MRI, current DD-based quantum sensing utilizes the frequency fingerprints of target nuclear spins. Such schemes, however, cannot resolve different nuclear spins that have the same noise frequency or differentiate different types of correlations in nuclear spin clusters. Here we show that the first limitation can be overcome by using wavefunction fingerprints of target nuclear spins, which is much more sensitive than the ''frequency fingerprints'' to weak hyperfine interaction between the targets and a sensor, while the second one can be overcome by a new design of two-dimensional DD sequences composed of two sets of periodic DD sequences with different periods, which can be independently set to match two different transition frequencies. Our schemes not only offer an approach to breaking the resolution limit set by ''frequency gradients'' in conventional MRI, but also provide a standard approach to correlation spectroscopy for single-molecule NMR.

A scheme to promote the world's economic development with migration.

Science.gov (United States)

Simon, J L

1982-01-01

housing and amenities for the migrants and the kind of occupational training they would receive. Such a contract could be a profitable means of earning foreign currency for a country. Another side benefit of the scheme is its possible use as an anticyclical device. A difficult question is the lenght (or permanence) of migratory residents. Clearly, a migration scheme will be adopted in the near future, and if it can be implemented it might work wonders for the economic development of the world.

Knowledge-Based Trajectory Error Pattern Method Applied to an Active Force Control Scheme

Directory of Open Access Journals (Sweden)

Endra Pitowarno, Musa Mailah, Hishamuddin Jamaluddin

2012-08-01

Full Text Available The active force control (AFC method is known as a robust control scheme that dramatically enhances the performance of a robot arm particularly in compensating the disturbance effects. The main task of the AFC method is to estimate the inertia matrix in the feedback loop to provide the correct (motor torque required to cancel out these disturbances. Several intelligent control schemes have already been introduced to enhance the estimation methods of acquiring the inertia matrix such as those using neural network, iterative learning and fuzzy logic. In this paper, we propose an alternative scheme called Knowledge-Based Trajectory Error Pattern Method (KBTEPM to suppress the trajectory track error of the AFC scheme. The knowledge is developed from the trajectory track error characteristic based on the previous experimental results of the crude approximation method. It produces a unique, new and desirable error pattern when a trajectory command is forced. An experimental study was performed using simulation work on the AFC scheme with KBTEPM applied to a two-planar manipulator in which a set of rule-based algorithm is derived. A number of previous AFC schemes are also reviewed as benchmark. The simulation results show that the AFC-KBTEPM scheme successfully reduces the trajectory track error significantly even in the presence of the introduced disturbances.Key Words:  Active force control, estimated inertia matrix, robot arm, trajectory error pattern, knowledge-based.

Modified Aggressive Packet Combining Scheme

International Nuclear Information System (INIS)

Bhunia, C.T.

2010-06-01

In this letter, a few schemes are presented to improve the performance of aggressive packet combining scheme (APC). To combat error in computer/data communication networks, ARQ (Automatic Repeat Request) techniques are used. Several modifications to improve the performance of ARQ are suggested by recent research and are found in literature. The important modifications are majority packet combining scheme (MjPC proposed by Wicker), packet combining scheme (PC proposed by Chakraborty), modified packet combining scheme (MPC proposed by Bhunia), and packet reversed packet combining (PRPC proposed by Bhunia) scheme. These modifications are appropriate for improving throughput of conventional ARQ protocols. Leung proposed an idea of APC for error control in wireless networks with the basic objective of error control in uplink wireless data network. We suggest a few modifications of APC to improve its performance in terms of higher throughput, lower delay and higher error correction capability. (author)

Higher Rate of Tuberculosis in Second Generation Migrants Compared to Native Residents in a Metropolitan Setting in Western Europe

Science.gov (United States)

Marx, Florian M.; Fiebig, Lena; Hauer, Barbara; Brodhun, Bonita; Glaser-Paschke, Gisela; Haas, Walter

2015-01-01