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Sample records for residence time based

  1. Conceptual framework for model-based analysis of residence time distribution in twin-screw granulation

    DEFF Research Database (Denmark)

    Kumar, Ashish; Vercruysse, Jurgen; Vanhoorne, Valerie

    2015-01-01

    Twin-screw granulation is a promising continuous alternative for traditional batchwise wet granulation processes. The twin-screw granulator (TSG) screws consist of transport and kneading element modules. Therefore, the granulation to a large extent is governed by the residence time distribution...... within each module where different granulation rate processes dominate over others. Currently, experimental data is used to determine the residence time distributions. In this study, a conceptual model based on classical chemical engineering methods is proposed to better understand and simulate...... the residence time distribution in a TSG. The experimental data were compared with the proposed most suitable conceptual model to estimate the parameters of the model and to analyse and predict the effects of changes in number of kneading discs and their stagger angle, screw speed and powder feed rate...

  2. Using reactor network for global identification based on residence time distribution theory

    Energy Technology Data Exchange (ETDEWEB)

    Hocine, S.; Pibouleau, L.; Azzaro-Pantel, C.; Domenech, S. [Laboratoire de Genie Chimique - UMR 5503 CNRS/ INPT ENSIACET, 31 - Toulouse (France)

    2006-07-01

    In the ventilation systems, the control of transfer contaminants is one of the principal problems during the design and control phases. The installation of a suitable ventilation system for the control of contaminant transfer is essential in industry, because it makes it possible to detect and to prevent chemical and radiological risks. Research on air distribution in ventilated rooms traditionally involves full-scale experiments, scale -model experiments and application of the computational fluid dynamics (C.F.D.) tools. Most of the time, particularly in our case of large and cluttered enclosures, the predictive approach based on C.F.D. codes can not be used. The solution retained here is the establishment of a model based on the well known residence time distribution. This model is widely used in chemical engineering to treat non-ideal flows. The proposed method is based on the experimental determination of the residence time distribution curve, generally obtained through the response of the system to tracer release. A superstructure involving the set of all the possible solutions corresponding to the physical reactor is then defined, and the model will be selected from this superstructure according to its simulated response. The superstructure is identified as a combination of elementary systems, representing ideal flow patterns, as perfect mixed flows, plug flows, continuous stirred tank reactors, etc. The selected model is derived from the comparison between the simulated response to a stimulus, and the experimental response. The structure and parameters of the model are simultaneously optimized in order to fit the experimental curve with a minimal number of elementary units, constituting a key point for future control purposes of the process. This problem is a dynamic M.I.N.L.P. (Mixed Integer Non Linear Programming) problem with bilinear equality constraints. Generally, these constraints lead to numerical difficulties for reaching an optimum solution (even a

  3. A residence-time-based transport approach for the groundwater pathway in performance assessment models

    Science.gov (United States)

    Robinson, Bruce A.; Chu, Shaoping

    2013-03-01

    This paper presents the theoretical development and numerical implementation of a new modeling approach for representing the groundwater pathway in risk assessment or performance assessment model of a contaminant transport system. The model developed in the present study, called the Residence Time Distribution (RTD) Mixing Model (RTDMM), allows for an arbitrary distribution of fluid travel times to be represented, to capture the effects on the breakthrough curve of flow processes such as channelized flow and fast pathways and complex three-dimensional dispersion. Mathematical methods for constructing the model for a given RTD are derived directly from the theory of residence time distributions in flowing systems. A simple mixing model is presented, along with the basic equations required to enable an arbitrary RTD to be reproduced using the model. The practical advantages of the RTDMM include easy incorporation into a multi-realization probabilistic simulation; computational burden no more onerous than a one-dimensional model with the same number of grid cells; and straightforward implementation into available flow and transport modeling codes, enabling one to then utilize advanced transport features of that code. For example, in this study we incorporated diffusion into the stagnant fluid in the rock matrix away from the flowing fractures, using a generalized dual porosity model formulation. A suite of example calculations presented herein showed the utility of the RTDMM for the case of a radioactive decay chain, dual porosity transport and sorption.

  4. 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 ...

  5. Impact of repository depth on residence times for leaking radionuclides in land-based surface water

    Science.gov (United States)

    Wörman, Anders; Marklund, Lars; Xu, Shulan; Dverstorp, Björn

    2007-03-01

    The multiple scales of landscape topography produce a wide distribution of groundwater circulation cells that control the hydro-geological environments surrounding geological repositories for nuclear waste. The largest circulation cells tend to discharge water into major river reaches, large freshwater systems or the nearby Baltic Sea. We investigated numerically the release of radionuclides from repositories placed in bedrock with depths between 100 to 2000 meters in a Swedish coastal area and found that leakage from the deeper positions emerges primarily in the major aquatic systems. In effect, radionuclides from the deeper repositories are more rapidly transported towards the Sea by the stream system compared to leakage from more shallow repositories. The release from the shallower repositories is significantly retained in the initial stage of the transport in the (superficial) landscape because the discharge occurs in or near low-order streams with high retention characteristics. This retention and residence time for radioactivity in the landscape control radiological doses to biota and can, thus, be expected to constitute an essential part of an associated risk evaluation.

  6. Highly efficient indoor air purification using adsorption-enhanced-photocatalysis-based microporous TiO2 at short residence time.

    Science.gov (United States)

    Lv, Jinze; Zhu, Lizhong

    2013-01-01

    A short residence time is a key design parameter for the removal of organic pollutants in catalyst-based indoor air purification systems. In this study, we synthesized a series of TiO2 with different micropore volumes and studied their removal efficiency of indoor carbonyl pollutants at a short residence time. Our results indicated that the superior adsorption capability of TiO2 with micropores improved its performance in the photocatalytic degradation of cyclohexanone, while the photocatalytic removal of the pollutant successfully kept porous TiO2 from becoming saturated. When treated with 1 mg m(-3) cyclohexanone at a relatively humidity of 18%, the adsorption amount on microporous TiO2 was 5.4-7.9 times higher than that on P25. Removal efficiency via photocatalysis followed'the same order as the adsorption amount: TiO2-5 > TiO2-20 > TiO2-60 > TiO2-180 > P25. The advantage of microporous TiO2 over P25 became more pronounced when the residence time declined from 0.072 to 0.036 s. Moreover, as the concentration of cyclohexanone deceased from 1000 ppb to 500 ppb, removal efficiency by microporous TiO2 increased more rapidly than P25.

  7. Development of Electronic Medical Record-Based "Rounds Report" Results in Improved Resident Efficiency, More Time for Direct Patient Care and Education, and Less Resident Duty Hour Violations.

    Science.gov (United States)

    Ham, Phillip B; Anderton, Toby; Gallaher, Ryan; Hyrman, Mike; Simmerman, Erika; Ramanathan, Annamalai; Fallaw, David; Holsten, Steven; Howell, Charles Gordon

    2016-09-01

    Surgeons frequently report frustration and loss of efficiency with electronic medical record (EMR) systems. Together, surgery residents and a programmer at Augusta University created a rounds report (RR) summarizing 24 hours of vitals, intake/output, labs, and other values for each inpatient that were previously transcribed by hand. The objective of this study was to evaluate the RR's effect on surgery residents. Surgery residents were queried to assess the RR's impact. Outcome measures were time spent preparing for rounds, direct patient care time, educational activity time, rates of incorrect/incomplete data on rounds, and rate of duty hour violations. Hospital wide, 17,200 RRs were generated in the 1-month study. Twenty-three surgery residents participated. Time spent preparing for rounds decreased per floor patient (15.6 ± 3.0 vs 6.0 ± 1.2, P care unit patient (19.9 ± 2.9 vs 7.5 ± 1.2 P care increased from 45.1 ± 5.6 to 54.0 ± 5.7 per cent (P = 0.0044). Educational activity time increased from 35.2 ± 5.4 to 54.7 ± 7.1 minutes per resident per day (P = 0.0004). Reported duty hour violations decreased 58 per cent (P care at academic medical centers.

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

    Science.gov (United States)

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

    2012-08-01

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

  9. A Time Study of Plastic Surgery Residents.

    Science.gov (United States)

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

    2016-05-01

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

  10. Atmospheric Residence Times of Continental Aerosols.

    Science.gov (United States)

    Balkanski, Yves Jacques

    The global atmospheric distributions of ^{222}Rn and ^{210 }Pb are simulated with a three-dimensional model of atmospheric transport based on the meteorology of the NASA GISS^1>=neral circulation model. The short-lived radioactive gas ^ {222}Rn (half-life = 3.8d) is emitted almost exclusively from land, at a relatively uniform rate; hence it is an excellent tracer of continental influences. Lead -210 is produced by decay of ^{222} Rn and immediately condenses to preexisting aerosol surfaces. It provides an excellent measure of aerosol residence times in the atmosphere because its source is accurately defined by the ^{222} Rn distribution. Results from the three-dimensional model are compared to measurements of ^ {222}Rn and ^{210 }Pb atmospheric concentrations to evaluate model's long-range transport over oceanic regions and to study the deposition mechanisms of atmospheric aerosols. Model results for ^{222} Rn are used to examine the long-range transport of continental air over two selected oceanic regions, the subantartic Indian Ocean and the North Pacific. It is shown that fast transport of air from southern Africa causes substantial continental pollution at southern mid-latitudes, a region usually regarded as pristine. Air over the North Pacific is heavily impacted by continental influences year round, but the altitude at which the transport occurs varies seasonally. Observations of aerosols at island sites, which are commonly used as diagnostics of continental influences, may be misleading because they do not account for influences at high altitude and because aerosols are efficiently scavenged by deposition during transport. The study of ^{210}Pb focuses on defining the residence times of submicron aerosols in the troposphere. Scavenging in wet convective updrafts is found to provide the dominant sink on a global scale. The globally averaged residence time for ^{210 }Pb-containing aerosols in the troposphere is 7 days. The average increase in residence time

  11. Teaching leadership in trauma resuscitation: Immediate feedback from a real-time, competency-based evaluation tool shows long-term improvement in resident performance.

    Science.gov (United States)

    Gregg, Shea C; Heffernan, Daithi S; Connolly, Michael D; Stephen, Andrew H; Leuckel, Stephanie N; Harrington, David T; Machan, Jason T; Adams, Charles A; Cioffi, William G

    2016-10-01

    Limited data exist on how to develop resident leadership and communication skills during actual trauma resuscitations. An evaluation tool was developed to grade senior resident performance as the team leader during full-trauma-team activations. Thirty actions that demonstrated the Accreditation Council for Graduate Medical Education core competencies were graded on a Likert scale of 1 (poor) to 5 (exceptional). These actions were grouped by their respective core competencies on 5 × 7-inch index cards. In Phase 1, baseline performance scores were obtained. In Phase 2, trauma-focused communication in-services were conducted early in the academic year, and immediate, personalized feedback sessions were performed after resuscitations based on the evaluation tool. In Phase 3, residents received only evaluation-based feedback following resuscitations. In Phase 1 (October 2009 to April 2010), 27 evaluations were performed on 10 residents. In Phase 2 (April 2010 to October 2010), 28 evaluations were performed on nine residents. In Phase 3 (October 2010 to January 2012), 44 evaluations were performed on 13 residents. Total scores improved significantly between Phases 1 and 2 (p = 0.003) and remained elevated throughout Phase 3. When analyzing performance by competency, significant improvement between Phases 1 and 2 (p competencies (patient care, knowledge, system-based practice, practice-based learning) with the exception of "communication and professionalism" (p = 0.56). Statistically similar scores were observed between Phases 2 and 3 in all competencies with the exception of "medical knowledge," which showed ongoing significant improvement (p = 0.003). Directed resident feedback sessions utilizing data from a real-time, competency-based evaluation tool have allowed us to improve our residents' abilities to lead trauma resuscitations over a 30-month period. Given pressures to maximize clinical educational opportunities among work-hour constraints, such a model may help

  12. 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.

  13. Characterization of the Gacka River basin karst aquifer (Croatia): Hydrochemistry, stable isotopes and tritium-based mean residence times

    Energy Technology Data Exchange (ETDEWEB)

    Ozyurt, Nur N. [Department of Geological Engineering, Hacettepe University, 06800 Ankara (Turkey); Lutz, Hans O. [Stable Isotope Laboratory, Medical Faculty, Rijeka University, 51000 Rijeka (Croatia); Faculty of Physics, Bielefeld University, 33615 Bielefeld (Germany); Hunjak, Tamara; Mance, Diana [Stable Isotope Laboratory, Medical Faculty, Rijeka University, 51000 Rijeka (Croatia); Roller-Lutz, Zvjezdana, E-mail: roller@medri.uniri.hr [Stable Isotope Laboratory, Medical Faculty, Rijeka University, 51000 Rijeka (Croatia)

    2014-07-01

    aquifer volumes. - Highlights: • The Gacka River karst aquifer is part of the strategic water resource of Croatia. • The discharge of springs indicates a long mean residence times of ground water. • Tritium-based models yield MRTs of ca. 12 years and a large reservoir volume. • Areal recharge mainly in the cold season; plug flow conditions are dominant.

  14. A time-efficient web-based teaching tool to improve medical knowledge and decrease ABIM failure rate in select residents.

    Science.gov (United States)

    Drake, Sean M; Qureshi, Waqas; Morse, William; Baker-Genaw, Kimberly

    2015-01-01

    The American Board of Internal Medicine (ABIM) exam's pass rate is considered a quality measure of a residency program, yet few interventions have shown benefit in reducing the failure rate. We developed a web-based Directed Reading (DR) program with an aim to increase medical knowledge and reduce ABIM exam failure rate. Internal medicine residents at our academic medical center with In-Training Examination (ITE) scores ≤ 35 th percentile from 2007 to 2013 were enrolled in DR. The program matches residents to reading assignments based on their own ITE-failed educational objectives and provides direct electronic feedback from their teaching physicians. ABIM exam pass rates were analyzed across various groups between 2002 and 2013 to examine the effect of the DR program on residents with ITE scores ≤ 35 percentile pre- (2002-2006) and post-intervention (2007-2013). A time commitment survey was also given to physicians and DR residents at the end of the study. Residents who never scored ≤ 35 percentile on ITE were the most likely to pass the ABIM exam on first attempt regardless of time period. For those who ever scored ≤ 35 percentile on ITE, 91.9% of residents who participated in DR passed the ABIM exam on first attempt vs 85.2% of their counterparts pre-intervention (p ITE were more likely to fail ABIM exam on first attempt, those who participated in the DR program were less likely to fail than the historical control counterparts. The web-based teaching method required little time commitment by faculty.

  15. 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.

  16. 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.

  17. Atmospheric residence times of continental aerosols

    International Nuclear Information System (INIS)

    Balkanski, Y.J.

    1991-01-01

    The global atmospheric distributions of Rn-222 are simulated with a three-dimensional model of atmospheric transport based on the meteorology of the NASA Goddard Institute for Space Studies (GISS) general circulation model. The short-lived radioactive gas Rn-222 (half-life = 3.8d) is emitted almost exclusively from land, at a relatively uniform rate; hence it is an excellent tracer of continental influences. Lead-210 is produced by decay of Rn-222 and immediately condenses to preexisting aerosol surfaces. It provides an excellent measure of aerosol residence times in the atmosphere because its source is accurately defined by the Rn-222 distribution. Results from the three-dimensional model are compared to measurements of Rn-222 and Pb-210 atmospheric concentrations to evaluate model's long-range transport over oceanic regions and to study the deposition mechanisms of atmospheric aerosols. Model results for Rn-222 are used to examine the long-range transport of continental air over two selected oceanic regions, the subantarctic Indian Ocean and the North Pacific. It is shown that the fast transport of air from southern Africa causes substantial continental pollution at southern mid-latitudes, a region usually regarded as pristine. Air over the North Pacific is heavily impacted by continental influences year round, but the altitude at which the transport occurs varies seasonally. Observations of aerosols at island sites, which are commonly used as diagnostics of continental influences, may be misleading because they do not account for influences at high altitude and because aerosols are efficiently scavenged by deposition during transport. The study of Pb-210 focuses on defining the residence times of submicron aerosols in the troposphere. Scavenging in wet convective updrafts is found to provide the dominant sink on a global scale

  18. Residence time and physical processes in lakes

    Directory of Open Access Journals (Sweden)

    Nicoletta SALA

    2003-09-01

    Full Text Available The residence time of a lake is highly dependent on internal physical processes in the water mass conditioning its hydrodynamics; early attempts to evaluate this physical parameter emphasize the complexity of the problem, which depends on very different natural phenomena with widespread synergies. The aim of this study is to analyse the agents involved in these processes and arrive at a more realistic definition of water residence time which takes account of these agents, and how they influence internal hydrodynamics. With particular reference to temperate lakes, the following characteristics are analysed: 1 the set of the lake's caloric components which, along with summer heating, determine the stabilizing effect of the surface layers, and the consequent thermal stratification, as well as the winter destabilizing effect; 2 the wind force, which transfers part of its momentum to the water mass, generating a complex of movements (turbulence, waves, currents with the production of active kinetic energy; 3 the water flowing into the lake from the tributaries, and flowing out through the outflow, from the standpoint of hydrology and of the kinetic effect generated by the introduction of these water masses into the lake. These factors were studied in the context of the general geographical properties of the lake basin and the watershed (latitude, longitude, morphology, also taking account of the local and regional climatic situation. Also analysed is the impact of ongoing climatic change on the renewal of the lake water, which is currently changing the equilibrium between lake and atmosphere, river and lake, and relationships

  19. Improving Timely Resident Follow-Up and Communication of Results in Ambulatory Clinics Utilizing a Web-Based Audit and Feedback Module.

    Science.gov (United States)

    Boggan, Joel C; Swaminathan, Aparna; Thomas, Samantha; Simel, David L; Zaas, Aimee K; Bae, Jonathan G

    2017-04-01

    Failure to follow up and communicate test results to patients in outpatient settings may lead to diagnostic and therapeutic delays. Residents are less likely than attending physicians to report results to patients, and may face additional barriers to reporting, given competing clinical responsibilities. This study aimed to improve the rates of communicating test results to patients in resident ambulatory clinics. We performed an internal medicine, residency-wide, pre- and postintervention, quality improvement project using audit and feedback. Residents performed audits of ambulatory patients requiring laboratory or radiologic testing by means of a shared online interface. The intervention consisted of an educational module viewed with initial audits, development of a personalized improvement plan after Phase 1, and repeated real-time feedback of individual relative performance compared at clinic and program levels. Outcomes included results communicated within 14 days and prespecified "significant" results communicated within 72 hours. A total of 76 of 86 eligible residents (88%) reviewed 1713 individual ambulatory patients' charts in Phase 1, and 73 residents (85%) reviewed 1509 charts in Phase 2. Follow-up rates were higher in Phase 2 than Phase 1 for communicating results within 14 days and significant results within 72 hours (85% versus 78%, P  Communication of "significant" results was more likely to occur via telephone, compared with communication of nonsignificant results. Participation in a shared audit and feedback quality improvement project can improve rates of resident follow-up and communication of results, although communication gaps remained.

  20. Real time curriculum map for internal medicine residency

    Directory of Open Access Journals (Sweden)

    Roberts J Mark

    2007-11-01

    Full Text Available Abstract Background To manage the voluminous formal curriculum content in a limited amount of structured teaching time, we describe the development and evaluation of a curriculum map for academic half days (AHD in a core internal medicine residency program. Methods We created a 3-year cyclical curriculum map (an educational tool combining the content, methodology and timetabling of structured teaching, comprising a matrix of topics under various specialties/themes and corresponding AHD hours. All topics were cross-matched against the ACP-ASIM in-training examination, and all hours were colour coded based on the categories of core competencies. Residents regularly updated the map on a real time basis. Results There were 208 topics covered in 283 AHD hours. All topics represented core competencies with minimal duplication (78% covered once in 3 years. Only 42 hours (15% involved non-didactic teaching, which increased after implementation of the map (18–19 hours/year versus baseline 5 hours/year. Most AHD hours (78% focused on medical expert competencies. Resident satisfaction (90% response was high throughout (range 3.64 ± 0.21, 3.84 ± 0.14 out of 4, which improved after 1 year but returned to baseline after 2 years. Conclusion We developed and implemented an internal medicine curriculum map based on real time resident input, with minimal topic duplication and high resident satisfaction. The map provided an opportunity to balance didactic versus non-didactic teaching, and teaching on medical versus non medical expert topics.

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

    Science.gov (United States)

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

    2017-07-05

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

  2. Residence time determination for adsorbent beds of different configurations

    Energy Technology Data Exchange (ETDEWEB)

    Otermat, J.E.; Wikoff, W.O.; Kovach, J.L.

    1995-02-01

    The residence time calculations of ASME AG-1 Code, Section FC, currently specify a screen surface area method, that is technically incorrect. Test data has been obtained on Type II adsorber trays of different configurations to establish residence time in the adsorber trays. These data indicate that the air volume/carbon volume ratio or the average screen area are more appropriate for the calculation of the residence time calculation than the currently used, smallest screen area basis.

  3. Long residence times - bad tracer tests?

    Science.gov (United States)

    Ghergut, Julia; Behrens, Horst; Sauter, Martin

    2015-04-01

    Tracer tests conducted at geothermal well doublets or triplets in the Upper Rhine Rift Valley [1] all face, with very few exceptions so far, one common issue: lack of conclusive tracer test results, or tracer signals still undetectable for longer than one or two years after tracer injection. While the reasons for this surely differ from site to site (Riehen, Landau, Insheim, Bruchsal, ...), its effects on how the usefulness of tracer tests is perceived by the non-tracer community are pretty much the same. The 'poor-signal' frustration keeps nourishing two major 'alternative' endeavours : (I) design and execute tracer tests in single-well injection-withdrawal (push-pull), 'instead of' inter-well flow-path tracing configurations; (II) use 'novel' tracer substances instead of the 'old' ones which have 'obviously failed'. Frustration experienced with most inter-well tracer tests in the Upper Rhine Rift Valley has also made them be regarded as 'maybe useful for EGS' ('enhanced', or 'engineered' geothermal systems, whose fluid RTD typically include a major share of values below one year), but 'no longer worthwhile a follow-up sampling' in natural, large-scale hydrothermal reservoirs. We illustrate some of these arguments with the ongoing Bruchsal case [2]. The inter-well tracer test conducted at Bruchsal was (and still is!) aimed at assessing inter-well connectivity, fluid residence times, and characterizing the reservoir structure [3]. Fluid samples taken at the geothermal production well after reaching a fluid turnover of about 700,000 m3 showed tracer concentrations in the range of 10-8 Minj per m3, in the liquid phase of each sample (Minj being the total quantity of tracer injected as a short pulse at the geothermal re-injection well). Tracer signals might actually be higher, owing to tracer amounts co-precipitated and/or adsorbed onto the solid phase whose accumulation in the samples was unavoidable (due to pressure relief and degassing during the very sampling

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

    Science.gov (United States)

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

    2013-06-01

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

  5. The role of topography on catchment‐scale water residence time

    Science.gov (United States)

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

    2005-01-01

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

  6. Residence time modeling of hot melt extrusion processes.

    Science.gov (United States)

    Reitz, Elena; Podhaisky, Helmut; Ely, David; Thommes, Markus

    2013-11-01

    The hot melt extrusion process is a widespread technique to mix viscous melts. The residence time of material in the process frequently determines the product properties. An experimental setup and a corresponding mathematical model were developed to evaluate residence time and residence time distribution in twin screw extrusion processes. The extrusion process was modeled as the convolution of a mass transport process described by a Gaussian probability function, and a mixing process represented by an exponential function. The residence time of the extrusion process was determined by introducing a tracer at the extruder inlet and measuring the tracer concentration at the die. These concentrations were fitted to the residence time model, and an adequate correlation was found. Different parameters were derived to characterize the extrusion process including the dead time, the apparent mixing volume, and a transport related axial mixing. A 2(3) design of experiments was performed to evaluate the effect of powder feed rate, screw speed, and melt viscosity of the material on the residence time. All three parameters affect the residence time of material in the extruder. In conclusion, a residence time model was developed to interpret experimental data and to get insights into the hot melt extrusion process. Copyright © 2013 Elsevier B.V. All rights reserved.

  7. Mean Residence Time and Emergency Drinking Water Supply.

    Science.gov (United States)

    Kralik, Martin; Humer, Franko

    2013-04-01

    Mean Residence Times (MRTs) of the raw water of drinking water supplies is the measurement of the water-isotopes (oxygen-18, hydrogen-2 and tritium (3H)). The traceability and the quality oft he lumped model calculation is based on the quality and the density of input (meteorological) stations in the region with monthly measurements. In addition, noble gas measurements in the groundwater (helium-3, krypton-85) and of industrial tracer gases (chlorofluorocarbon (CFC) and sulphurhexaflorid (SF6)) are important tools to estimate the MRTs of the raw water in the aquifers. To exclude the presence of small amounts of very recent waters, which are in cases of accidents some times heavily polluted, the raw water is tested for natural radionuclides (beryllium-7 or sulphur-35) with very short half-life or artificial fluorescence tracers. In addition, the estimate of the MRTs of groundwater is an essential part of the vulnerability assessment of drinking water supplies due to climate change impacts (frequency of droughts and floods in the recharge area) and offers a valuable tool to specify a sustainable water abstraction. The applicability of this approach was tested in several springs and groundwater monitoring wells used for raw water abstraction for drinking water supply in Austria.

  8. DNA residence time is a regulatory factor of transcription repression

    Science.gov (United States)

    Clauß, Karen; Popp, Achim P.; Schulze, Lena; Hettich, Johannes; Reisser, Matthias; Escoter Torres, Laura; Uhlenhaut, N. Henriette

    2017-01-01

    Abstract Transcription comprises a highly regulated sequence of intrinsically stochastic processes, resulting in bursts of transcription intermitted by quiescence. In transcription activation or repression, a transcription factor binds dynamically to DNA, with a residence time unique to each factor. Whether the DNA residence time is important in the transcription process is unclear. Here, we designed a series of transcription repressors differing in their DNA residence time by utilizing the modular DNA binding domain of transcription activator-like effectors (TALEs) and varying the number of nucleotide-recognizing repeat domains. We characterized the DNA residence times of our repressors in living cells using single molecule tracking. The residence times depended non-linearly on the number of repeat domains and differed by more than a factor of six. The factors provoked a residence time-dependent decrease in transcript level of the glucocorticoid receptor-activated gene SGK1. Down regulation of transcription was due to a lower burst frequency in the presence of long binding repressors and is in accordance with a model of competitive inhibition of endogenous activator binding. Our single molecule experiments reveal transcription factor DNA residence time as a regulatory factor controlling transcription repression and establish TALE-DNA binding domains as tools for the temporal dissection of transcription regulation. PMID:28977492

  9. Numerical simulation of onshore separation processes - residence time optimization

    Energy Technology Data Exchange (ETDEWEB)

    Fonte, Clarissa Bergman; Oliveira Junior, Joao Americo Aguirre [Engineering Simulation and Scientific Software (ESSS), Florianopolis, SC (Brazil)], E-mails: clarissa@esss.com.br, joao.aguirre@esss.com.br; Dutra, Eduardo Stein Soares [PETROBRAS E e P Engenharia de Producao, Rio de Janeiro, RJ (Brazil). Gerencia de Engenharia de Instalacoes de Superficie e Automacao], E-mail: eduardodutra@petrobras.com.br

    2011-04-15

    Cylindrical tanks are commonly used in onshore facilities to process and treat oil and water streams. These tanks generate a gravitational separation and, when sedimentation velocity is reached, the residence time inside the tank is crucial to guarantee proper separation. The ideal geometry for a tank maximizes the effective residence time by providing the largest possible fluid path, along which sedimentation of the denser phase occurs. Large volume tanks can be used for this purpose. However, internal devices, which increase the effective residence time and decrease undesirable hydrodynamic effects, are a commonly used alternative, allowing a reduction in tank size. This study focuses on the application of computational fluid dynamics as a tool to analyze four geometries found in gravitational separation tanks to identify that which offers the highest residence time values. (author)

  10. Children's postdivorce residence arrangements and parental experienced time pressure

    NARCIS (Netherlands)

    van der Heijden, Franciëlla; Poortman, Anne Rigt; van der Lippe, Tanja

    2016-01-01

    Although the rise in postdivorce joint physical custody has fueled scholarly interest in its impact on children, consequences for parents remain understudied. Because children's residence arrangements determine time and coordination demands associated with child care, this study investigated the

  11. Prediction of residence time distributions in food processing machinery

    DEFF Research Database (Denmark)

    Karlson, Torben; Friis, Alan; Szabo, Peter

    1996-01-01

    The velocity field in a co-rotating disc scraped surface heat exchanger (CDHE) is calculated using a finite element method. The residence time distribution for the CDHE is then obtained by tracing particles introduced in the inlet.......The velocity field in a co-rotating disc scraped surface heat exchanger (CDHE) is calculated using a finite element method. The residence time distribution for the CDHE is then obtained by tracing particles introduced in the inlet....

  12. Modelling travel and residence times in the eastern Irish Sea

    International Nuclear Information System (INIS)

    Dabrowski, T.; Hartnett, M.

    2008-01-01

    The Irish Sea, which lies between 51 deg. N-56 deg. N and 2 deg. 50'W-7 deg. W, provides a sheltered environment to exploit valuable fisheries resource. Anthropogenic activity is a real threat to its water quality. The majority of freshwater input down rivers flows into the eastern Irish Sea. The structure of the water circulation was not well understood during the planning of Sellafield nuclear plant outfall site in the eastern Irish Sea. A three-dimensional primitive equation numerical model was applied to the Irish Sea to simulate both barotropic and baroclinic circulation within the region. High accuracy was achieved with regard to the prediction of both tidal circulation and surface and nearbed water temperatures across the region. The model properly represented the Western Irish Sea Gyre, induced by thermal stratification and not known during planning Sellafield. Passive tracer simulations based on the developed hydrodynamic model were used to deliver residence times of the eastern Irish Sea region for various times of the year as well as travel times from the Sellafield outfall site to various locations within the Irish Sea. The results indicate a strong seasonal variability of travel times from Sellafield to the examined locations. Travel time to the Clyde Sea is the shortest for the autumnal tracer release (90 days); it takes almost a year for the tracer to arrive at the same location if it is released in January. Travel times from Sellafield to Dublin Bay fall within the range of 180-360 days. The average residence time of the entire eastern Irish Sea is around 7 months. The areas surrounding the Isle of Man are initially flushed due to a predominant northward flow; a backwater is formed in Liverpool Bay. Thus, elevated tracer concentrations are predicted in Liverpool Bay in the case of accidental spills at the Sellafield outfall site

  13. Land processes lead to surprising patterns in atmospheric residence time

    Science.gov (United States)

    van der Ent, R.; Tuinenburg, O.

    2017-12-01

    Our research using atmospheric moisture tracking methods shows that the global average atmospheric residence time of evaporation is 8-10 days. This residence time appears to be Gamma distributed with a higher probability of shorter than average residence times and a long tail. As a consequence the median of this residence time is around 5 days. In some places in the world the first few hours/days after evaporation there seems to be a little chance for a moisture particle to precipitate again, which is reflected by a Gamma distribution having a shape parameter below 1. In this study we present global maps of this parameter using different datasets (GLDAS and ERA-Interim). The shape parameter is as such also a measure for the land-atmospheric coupling strength along the path of the atmospheric water particle. We also find that different evaporation components: canopy interception, soil evaporation and transpiration appear to have different residence time distributions. We find a daily cycle in the residence time distribution over land, which is not present over the oceans. In this paper we will show which of the evaporation components is mainly responsible for this daily pattern and thus exhibits the largest daily cycle of land-atmosphere coupling strength.

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

    Science.gov (United States)

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

    2017-04-01

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

  15. Children's Perspectives on Everyday Experiences of Shared Residence: Time, Emotions and Agency Dilemmas

    Science.gov (United States)

    Haugen, Gry Mette D.

    2010-01-01

    Shared residence is often presented as an arrangement that is in the best interests of the child following the divorce of its parents. Based on in-depth interviews with Norwegian children who have experienced shared residence, this article seeks to explore some dilemmas concerning time, agency and the children's emotions. Three characteristics of…

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

    Science.gov (United States)

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

    2007-01-01

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

  17. RTDB: A memory resident real-time object database

    International Nuclear Information System (INIS)

    Nogiec, Jerzy M.; Desavouret, Eugene

    2003-01-01

    RTDB is a fast, memory-resident object database with built-in support for distribution. It constitutes an attractive alternative for architecting real-time solutions with multiple, possibly distributed, processes or agents sharing data. RTDB offers both direct and navigational access to stored objects, with local and remote random access by object identifiers, and immediate direct access via object indices. The database supports transparent access to objects stored in multiple collaborating dispersed databases and includes a built-in cache mechanism that allows for keeping local copies of remote objects, with specifiable invalidation deadlines. Additional features of RTDB include a trigger mechanism on objects that allows for issuing events or activating handlers when objects are accessed or modified and a very fast, attribute based search/query mechanism. The overall architecture and application of RTDB in a control and monitoring system is presented

  18. Measurement of the residence time distribution in industrial flotation equipment

    International Nuclear Information System (INIS)

    Yianatos, Juan; Diaz, F; Rodriguez, Jorge

    2003-01-01

    This work presents a determination of the effective liquid and solid residence time in mechanical cell banks of primary and sweep flotation, and in cleaning flotation columns, at Codelco-Chile's Salvador Division. The determination was carried out using the residence time distribution (RTD) measurement with radioactive tracers. Br-82 was used as the trace element for the liquid. Different kinds of minerals were used to trace the solid: a) activated global tailing (non floatable), b) tailing activated by size classifications (non floatable) and c) activated floatable mineral. The residence time measurement defined effective volumes of 50-80% of the total volume in flotation cell banks, and effective volumes of 77% of the total volume of large-size flotation solids. The effective residence time of the solid (23%+212 microns) in industrial flotation cell banks was 5% below that for the liquid. The residence time of the mineral decreased with increased particle size. Thick mineral (>150 microns) showed a residence time 8% below that for thin mineral (<45 microns). The RTD of industrial mechanical cell banks is adequately represented with a number of perfect mixers in series equivalent to the number of real bank cells. The RTD of the industrial columns equals less than two perfect mixers in series and adjusts better when considering a perfect mixers in series model, but in a different size. Common operating problems could also be observed and analyzed through the RTD measurement, such as embankment of the equipment and the deficient regulation of the outflow, used to control the pulp level (Cw)

  19. Relationships between removal processes and residence times for atmospheric pollutants

    International Nuclear Information System (INIS)

    Slinn, W.G.N.

    1978-01-01

    This report is concerned with improving estimates for the residence times of atmospheric trace constituents in various atmospheric reservoirs. Residence times are defined only for steady-state conditions; i.e., when the net growth rate vanishes. The most useful case of vanishing net growth rate is when the total growth rate is equal to the decay rate. It is demonstrated that the most important advance towards improving estimates of pollutant residence times is through proper choices of reservoirs. Chosen reservoirs should possess the following features: steady-state conditions, uniform mixing ratio throughout or throughout specified subreservoirs, and subreservoirs chosen in which removal rates can be treated as approximate constants. An example of a poorly mixed reservoir, the stratosphere, is discussed. In another example, it is suggested that commonly used reservoirs for atmospheric CO 2 have been chosen poorly and that a substantial portion of the anthropogenic CO 2 released during the past 50 years may still be mixing into the stratosphere. In another example, it is suggested that determination of the dry deposition velocity for accumulation-mode aerosol particles may not be so important as previously thought. To improve estimates for the atmospheric residence times of these particles, it is important to increase knowledge of what is called the ascension velocity

  20. Residence Time Distributions in a Cold, Confined Swirl Flow

    DEFF Research Database (Denmark)

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

    1997-01-01

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

  1. Studies on steps affecting tritium residence time in solid blanket

    International Nuclear Information System (INIS)

    Tanaka, Satoru

    1987-01-01

    For the self sustaining of CTR fuel cycle, the effective tritium recovery from blankets is essential. This means that not only tritium breeding ratio must be larger than 1.0, but also high recovering speed is required for the short residence time of tritium in blankets. Short residence time means that the tritium inventory in blankets is small. In this paper, the tritium residence time and tritium inventory in a solid blanket are modeled by considering the steps constituting tritium release. Some of these tritium migration processes were experimentally evaluated. The tritium migration steps in a solid blanket using sintered breeding materials consist of diffusion in grains, desorption at grain edges, diffusion and permeation through grain boundaries, desorption at particle edges, diffusion and percolation through interconnected pores to purging stream, and convective mass transfer to stream. Corresponding to these steps, diffusive, soluble, adsorbed and trapped tritium inventories and the tritium in gas phase are conceivable. The code named TTT was made for calculating these tritium inventories and the residence time of tritium. An example of the results of calculation is shown. The blanket is REPUTER-1, which is the conceptual design of a commercial reversed field pinch fusion reactor studied at the University of Tokyo. The experimental studies on the migration steps of tritium are reported. (Kako, I.)

  2. Financial and Time Burdens for Medical Students Interviewing for Residency.

    Science.gov (United States)

    Callaway, Paul; Melhado, Trisha; Walling, Anne; Groskurth, Jordan

    2017-02-01

    Interviewing for residency positions is increasingly stressful for students and challenging for programs. Little information is available about the costs and time invested by students in interviewing or about the key factors in decisions to accept interview offers. Our objective was to assess the time and financial costs of residency interviewing for an entire class at a regional campus and explore factors influencing student decisions to accept interviews. We used a 14-item survey administered electronically immediately following National Resident Matching Program results. The response rate was 75% (49 of 65 students). About half interviewed in primary care specialties. Thirty students (63%) applied to 20 or more programs, and 91% were offered multiple interviews out of state. Seventy percent limited interviews by time and cost. Other important factors included personal "fit," program reputation, and the quality of residents. About 50% of the students spent more than 20 days and $1,000-$5,000 interviewing; 29% reported spending over $5,000. Students used multiple funding sources, predominantly loans and savings. Primary care applicants applied to fewer out-of-state programs, reported fewer interview days and lower expenses, but received more financial support from programs. Students invested considerable time and resources in interviewing, and these factors significantly influenced their decisions about accepting interviews. The other major factors in interview decisions concerned personal comfort with the program, especially the residents. The costs and time reported in this study could be greater than other schools due to the regional campus location or lower due to the high proportion of students interviewing in primary care.

  3. Effect of viscosity on tear drainage and ocular residence time.

    Science.gov (United States)

    Zhu, Heng; Chauhan, Anuj

    2008-08-01

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

  4. How Entrustment Is Informed by Holistic Judgments Across Time in a Family Medicine Residency Program: An Ethnographic Nonparticipant Observational Study.

    Science.gov (United States)

    Sagasser, Margaretha H; Fluit, Cornelia R M G; van Weel, Chris; van der Vleuten, Cees P M; Kramer, Anneke W M

    2017-06-01

    Entrustment has mainly been conceptualized as delegating discrete professional tasks. Because residents provide most of their patient care independently, not all resident performance is visible to supervisors; the entrustment process involves more than granting discrete tasks. This study explored how supervisors made entrustment decisions based on residents' performance in a long-term family medicine training program. A qualitative nonparticipant observational study was conducted in 2014-2015 at competency-based family medicine residency programs in the Netherlands. Seven supervisor-resident pairs participated. During two days, one researcher observed first-year residents' patient encounters, debriefing sessions, and supervisor-resident educational meetings and interviewed them separately afterwards. Data were collected and analyzed using iterative, phenomenological inductive research methodology. The entrustment process developed over three phases. Supervisors based their initial entrustment on prior knowledge about the resident. In the ensuing two weeks, entrustment decisions regarding independent patient care were derived from residents' observed general competencies necessary for a range of health problems (clinical reasoning, decision making, relating to patients); medical knowledge and skills; and supervisors' intuition. Supervisors provided supervision during and after encounters. Once residents performed independently, supervisors kept reevaluating their decisions, informed by residents' overall growth in competencies rather than by adhering to a predefined set of tasks. Supervisors in family medicine residency training took a holistic approach to trust, based on general competencies, knowledge, skills, and intuition. Entrustment started before training and developed over time. Building trust is a mutual process between supervisor and resident, requiring a good working relationship.

  5. 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

  6. Allocation of Internal Medicine Resident Time in a Swiss Hospital: A Time and Motion Study of Day and Evening Shifts.

    Science.gov (United States)

    Wenger, Nathalie; Méan, Marie; Castioni, Julien; Marques-Vidal, Pedro; Waeber, Gérard; Garnier, Antoine

    2017-04-18

    Little current evidence documents how internal medicine residents spend their time at work, particularly with regard to the proportions of time spent in direct patient care versus using computers. To describe how residents allocate their time during day and evening hospital shifts. Time and motion study. Internal medicine residency at a university hospital in Switzerland, May to July 2015. 36 internal medicine residents with an average of 29 months of postgraduate training. Trained observers recorded the residents' activities using a tablet-based application. Twenty-two activities were categorized as directly related to patients, indirectly related to patients, communication, academic, nonmedical tasks, and transition. In addition, the presence of a patient or colleague and use of a computer or telephone during each activity was recorded. Residents were observed for a total of 696.7 hours. Day shifts lasted 11.6 hours (1.6 hours more than scheduled). During these shifts, activities indirectly related to patients accounted for 52.4% of the time, and activities directly related to patients accounted for 28.0%. Residents spent an average of 1.7 hours with patients, 5.2 hours using computers, and 13 minutes doing both. Time spent using a computer was scattered throughout the day, with the heaviest use after 6:00 p.m. The study involved a small sample from 1 institution. At this Swiss teaching hospital, internal medicine residents spent more time at work than scheduled. Activities indirectly related to patients predominated, and about half the workday was spent using a computer. Information Technology Department and Department of Internal Medicine of Lausanne University Hospital.

  7. 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.

  8. Competency Assessment in Family Medicine Residency: Observations, Knowledge-Based Examinations, and Advancement.

    Science.gov (United States)

    Mainous, Arch G; Fang, Bo; Peterson, Lars E

    2017-12-01

    The Family Medicine (FM) Milestones are competency-based assessments of residents in key dimensions relevant to practice in the specialty. Residency programs use the milestones in semiannual reviews of resident performance from the time of entry into the program to graduation. Using a national sample, we investigated the relationship of FM competency-based assessments to resident progress and the complementarity of milestones with knowledge-based assessments in FM residencies. We used midyear and end-of-year milestone ratings for all FM residents in Accreditation Council for Graduate Medical Education-accredited programs during academic years 2014-2015 and 2015-2016. The milestones contain 22 items across 6 competencies. We created a summative index across the milestones. The American Board of Family Medicine database provided resident demographics and in-training examination (ITE) scores. We linked information to the milestone data. The sample encompassed 6630 FM residents. The summative milestone index increased, on average, for each cohort (postgraduate year 1 [PGY-1] to PGY-2 and PGY-2 to PGY-3) at each assessment. The correlation between the milestone index that excluded the medical knowledge milestone and ITE scores was r  = .195 ( P  ITE scores and composite milestone assessments were higher for residents who advanced than for those who did not. Competency-based assessment using the milestones for FM residents seems to be a viable multidimensional tool to assess the successful progression of residents.

  9. Origin and residence time of water in the Lima Aquifer

    OpenAIRE

    Montoya, Modesto; Mamani, Enoc

    2014-01-01

    The 8 million inhabitants of the coastal city Lima are supplied with water from the Rimac and Chillon rivers and water wells in the Lima aquifer. The history of the Rimac River flow and static level of water in its wells have been correlated to calculate the residence time of water in the aquifer it is recharged by the Rimac River until it reaches a well located 12 km away in the Miraflores District near the sea. The relative abundance of H-2 and O-18 are used to identify the origins of the w...

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

    Science.gov (United States)

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

    2018-03-01

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

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

    Directory of Open Access Journals (Sweden)

    Jacob Arnold

    2018-02-01

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

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

    Science.gov (United States)

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

    2017-12-01

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

  13. Radiotracer investigation to study residence time distribution in an evaporator system

    Energy Technology Data Exchange (ETDEWEB)

    Pant, H J; Yelgaonkar, V N; Navada, S V [Isotope Division, Bhabha Atomic Research Centre, Mumbai (India)

    1994-06-01

    Determination of mean residence time, residence time distribution and evaluation of flow behavior in industrial process systems is of prime importance in order to control the process and to evaluate the performance of the process systems. This paper describes a case study carried out in an evaporator system in a sugar factory near Pune for determination of the mean residence time and residence time distribution using radiotracer technique. The mean residence time (MRT) was determined to be 4 seconds. The mathematical modelling of residence time distribution (RTD) data indicated the flow behaviour of the system to be a well mixed type. (author). 5 refs., 2 figs., 1 tab.

  14. Origin and residence time of water in the Lima aquifer

    Energy Technology Data Exchange (ETDEWEB)

    Montoya, Modesto [Instituto Peruano de Energia Nuclear, Av. Canada 1470, San Borja, Lima (Peru); Universidad Nacional de Ingenieria, Av. Tupac Amaru 210, Rimac, Lima (Peru); Mamani, Enoc [Direccion de Servicios, Instituto Peruano de Energia Nuclear, Av. Jose Saco km 12.5, Carabayllo, Lima (Peru)

    2013-07-01

    The 8 million inhabitants of the coastal city Lima are supplied with water from the Rimac and Chillon rivers and water wells in the Lima aquifer. The history of the Rimac River flow and static level of water in its wells have been correlated to calculate the residence time of water in the aquifer it is recharged by the Rimac River until it reaches a well located 12 km away in the Miraflores District near the sea. The relative abundance of {sup 2}H and {sup 18}O are used to identify the origins of the waters from those wells, and the {sup 3}H and {sup 14}C contents are used to estimate the time after they fall as rain. (authors).

  15. Origin and residence time of water in the Lima aquifer

    International Nuclear Information System (INIS)

    Montoya, Modesto; Mamani, Enoc

    2013-01-01

    The 8 million inhabitants of the coastal city Lima are supplied with water from the Rimac and Chillon rivers and water wells in the Lima aquifer. The history of the Rimac River flow and static level of water in its wells have been correlated to calculate the residence time of water in the aquifer it is recharged by the Rimac River until it reaches a well located 12 km away in the Miraflores District near the sea. The relative abundance of 2 H and 18 O are used to identify the origins of the waters from those wells, and the 3 H and 14 C contents are used to estimate the time after they fall as rain. (authors).

  16. Molecular Dynamics Simulations and Kinetic Measurements to Estimate and Predict Protein-Ligand Residence Times.

    Science.gov (United States)

    Mollica, Luca; Theret, Isabelle; Antoine, Mathias; Perron-Sierra, Françoise; Charton, Yves; Fourquez, Jean-Marie; Wierzbicki, Michel; Boutin, Jean A; Ferry, Gilles; Decherchi, Sergio; Bottegoni, Giovanni; Ducrot, Pierre; Cavalli, Andrea

    2016-08-11

    Ligand-target residence time is emerging as a key drug discovery parameter because it can reliably predict drug efficacy in vivo. Experimental approaches to binding and unbinding kinetics are nowadays available, but we still lack reliable computational tools for predicting kinetics and residence time. Most attempts have been based on brute-force molecular dynamics (MD) simulations, which are CPU-demanding and not yet particularly accurate. We recently reported a new scaled-MD-based protocol, which showed potential for residence time prediction in drug discovery. Here, we further challenged our procedure's predictive ability by applying our methodology to a series of glucokinase activators that could be useful for treating type 2 diabetes mellitus. We combined scaled MD with experimental kinetics measurements and X-ray crystallography, promptly checking the protocol's reliability by directly comparing computational predictions and experimental measures. The good agreement highlights the potential of our scaled-MD-based approach as an innovative method for computationally estimating and predicting drug residence times.

  17. Mean Transit Time and Mean Residence Time for Linear Diffusion–Convection–Reaction Transport System

    Directory of Open Access Journals (Sweden)

    Jacek Waniewski

    2007-01-01

    Full Text Available Characteristic times for transport processes in biological systems may be evaluated as mean transit times (MTTs (for transit states or mean residence times (MRT (for steady states. It is shown in a general framework of a (linear reaction–diffusion–convection equation that these two times are related. Analytical formulas are also derived to calculate moments of exit time distribution using solutions for a stationary state of the system.

  18. Residence Times in Central Valley Aquifers Recharged by Dammed Rivers

    Science.gov (United States)

    Loustale, M.; Paukert Vankeuren, A. N.; Visser, A.

    2017-12-01

    Groundwater is a vital resource for California, providing between 30-60% of the state's water supply. Recent emphasis on groundwater sustainability has induced a push to characterize recharge rates and residence times for high priority aquifers, including most aquifers in California's Central Valley. Flows in almost all rivers from the western Sierra to the Central Valley are controlled by dams, altering natural flow patterns and recharge to local aquifers. In eastern Sacramento, unconfined and confined shallow aquifers (depth recharged by a losing reach of the Lower American River, despite the presence of levees with slurry cut-off walls.1 Flow in the Lower American River is controlled through the operation of the Folsom and Nimbus Dams, with a minimum flow of 500 cfs. Water table elevation in wells in close proximity to the river are compared to river stage to determine the effect of river stage on groundwater recharge rates. Additionally, Tritium-3Helium dates and stable isotopes (∂18O and ∂2H) have been measured in monitoring wells 200- 2400 ft lateral distance from the river, and depths of 25 -225 feet BGS. Variation in groundwater age in the vertical and horizontal directions are used to determine groundwater flow path and velocity. These data are then used to calculate residence time of groundwater in the unconfined and confined aquifer systems for the Central Valley in eastern Sacramento. Applying groundwater age tracers can benefit future compliance metrics of the California Sustainable Groundwater Resources Act (SGMA), by quantifying river seepage rates and impacts of groundwater management on surface water resources. 1Moran et al., UCRL-TR-203258, 2004.

  19. Graduating med-peds residents' interest in part-time employment.

    Science.gov (United States)

    Fix, Amy L; Kaelber, David C; Melgar, Thomas A; Chamberlain, John; Cull, William; Robbins, Brett W

    2011-01-01

    As part-time work is becoming more popular among the primary care specialties, we examined the demographic descriptors of med-peds residents seeking and finding part-time employment upon completion of residency training. As part of the 2006 annual American Academy of Pediatrics (AAP) Graduating Med-Peds Residents Survey, we surveyed the graduating residents of all med-peds programs about their interest in and plans for part-time employment. A total of 199 (60%) of the residents responded. Of the resident respondents applying for nonfellowship jobs, 19% sought part-time positions and 10% actually accepted a part-time position. Female residents were significantly more likely than male residents to apply for part-time jobs (26% vs. 7%, P = .034). Sixty percent of female residents immediately seeking work and 58% of those going on to fellowship reported an interest in arranging a part-time or reduced-hours position at some point in the next 5 years. Part-time employment among med-peds residents applying for nonfellowship positions after graduation is similar to the current incidence of part-time employment in other fields of primary care. A much higher percentage of med-peds residents are interested in arranging part-time work within 5 years after graduation. This strong interest in part-time work has many implications for the primary care workforce. Copyright © 2011 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

  20. Residence-time framework for modeling multicomponent reactive transport in stream hyporheic zones

    Science.gov (United States)

    Painter, S. L.; Coon, E. T.; Brooks, S. C.

    2017-12-01

    Process-based models for transport and transformation of nutrients and contaminants in streams require tractable representations of solute exchange between the stream channel and biogeochemically active hyporheic zones. Residence-time based formulations provide an alternative to detailed three-dimensional simulations and have had good success in representing hyporheic exchange of non-reacting solutes. We extend the residence-time formulation for hyporheic transport to accommodate general multicomponent reactive transport. To that end, the integro-differential form of previous residence time models is replaced by an equivalent formulation based on a one-dimensional advection dispersion equation along the channel coupled at each channel location to a one-dimensional transport model in Lagrangian travel-time form. With the channel discretized for numerical solution, the associated Lagrangian model becomes a subgrid model representing an ensemble of streamlines that are diverted into the hyporheic zone before returning to the channel. In contrast to the previous integro-differential forms of the residence-time based models, the hyporheic flowpaths have semi-explicit spatial representation (parameterized by travel time), thus allowing coupling to general biogeochemical models. The approach has been implemented as a stream-corridor subgrid model in the open-source integrated surface/subsurface modeling software ATS. We use bedform-driven flow coupled to a biogeochemical model with explicit microbial biomass dynamics as an example to show that the subgrid representation is able to represent redox zonation in sediments and resulting effects on metal biogeochemical dynamics in a tractable manner that can be scaled to reach scales.

  1. Using just-in-time teaching and peer instruction in a residency program's core curriculum: enhancing satisfaction, engagement, and retention.

    Science.gov (United States)

    Schuller, Mary C; DaRosa, Debra A; Crandall, Marie L

    2015-03-01

    To assess use of the combined just-in-time teaching (JiTT) and peer instruction (PI) instructional strategy in a residency program's core curriculum. In 2010-2011, JiTT/PI was piloted in 31 core curriculum sessions taught by 22 faculty in the Northwestern University Feinberg School of Medicine's general surgery residency program. JiTT/PI required preliminary and categorical residents (n=31) to complete Web-based study questions before weekly specialty topic sessions. Responses were examined by faculty members "just in time" to tailor session content to residents' learning needs. In the sessions, residents answered multiple-choice questions (MCQs) using clickers and engaged in PI. Participants completed surveys assessing their perceptions of JiTT/PI. Videos were coded to assess resident engagement time in JiTT/PI sessions versus prior lecture-based sessions. Responses to topic session MCQs repeated in review sessions were evaluated to study retention. More than 70% of resident survey respondents indicated that JiTT/PI aided in the learning of key points. At least 90% of faculty survey respondents reported positive perceptions of aspects of the JiTT/PI strategy. Resident engagement time for JiTT/PI sessions was significantly greater than for prior lecture-based sessions (z=-2.4, P=.016). Significantly more review session MCQ responses were correct for residents who had attended corresponding JiTT/PI sessions than for residents who had not (chi-square=13.7; df=1; P<.001). JiTT/PI increased learner participation, learner retention, and the amount of learner-centered time. JiTT/PI represents an effective approach for meaningful and active learning in core curriculum sessions.

  2. Minimizing Barriers in Learning for On-Call Radiology Residents-End-to-End Web-Based Resident Feedback System.

    Science.gov (United States)

    Choi, Hailey H; Clark, Jennifer; Jay, Ann K; Filice, Ross W

    2018-02-01

    Feedback is an essential part of medical training, where trainees are provided with information regarding their performance and further directions for improvement. In diagnostic radiology, feedback entails a detailed review of the differences between the residents' preliminary interpretation and the attendings' final interpretation of imaging studies. While the on-call experience of independently interpreting complex cases is important to resident education, the more traditional synchronous "read-out" or joint review is impossible due to multiple constraints. Without an efficient method to compare reports, grade discrepancies, convey salient teaching points, and view images, valuable lessons in image interpretation and report construction are lost. We developed a streamlined web-based system, including report comparison and image viewing, to minimize barriers in asynchronous communication between attending radiologists and on-call residents. Our system provides real-time, end-to-end delivery of case-specific and user-specific feedback in a streamlined, easy-to-view format. We assessed quality improvement subjectively through surveys and objectively through participation metrics. Our web-based feedback system improved user satisfaction for both attending and resident radiologists, and increased attending participation, particularly with regards to cases where substantive discrepancies were identified.

  3. Classification of Animal Movement Behavior through Residence in Space and Time.

    Science.gov (United States)

    Torres, Leigh G; Orben, Rachael A; Tolkova, Irina; Thompson, David R

    2017-01-01

    Identification and classification of behavior states in animal movement data can be complex, temporally biased, time-intensive, scale-dependent, and unstandardized across studies and taxa. Large movement datasets are increasingly common and there is a need for efficient methods of data exploration that adjust to the individual variability of each track. We present the Residence in Space and Time (RST) method to classify behavior patterns in movement data based on the concept that behavior states can be partitioned by the amount of space and time occupied in an area of constant scale. Using normalized values of Residence Time and Residence Distance within a constant search radius, RST is able to differentiate behavior patterns that are time-intensive (e.g., rest), time & distance-intensive (e.g., area restricted search), and transit (short time and distance). We use grey-headed albatross (Thalassarche chrysostoma) GPS tracks to demonstrate RST's ability to classify behavior patterns and adjust to the inherent scale and individuality of each track. Next, we evaluate RST's ability to discriminate between behavior states relative to other classical movement metrics. We then temporally sub-sample albatross track data to illustrate RST's response to less resolved data. Finally, we evaluate RST's performance using datasets from four taxa with diverse ecology, functional scales, ecosystems, and data-types. We conclude that RST is a robust, rapid, and flexible method for detailed exploratory analysis and meta-analyses of behavioral states in animal movement data based on its ability to integrate distance and time measurements into one descriptive metric of behavior groupings. Given the increasing amount of animal movement data collected, it is timely and useful to implement a consistent metric of behavior classification to enable efficient and comparative analyses. Overall, the application of RST to objectively explore and compare behavior patterns in movement data can

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

    Directory of Open Access Journals (Sweden)

    Matteo Dainese

    2012-08-01

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

  5. Simulation-based interpersonal communication skills training for neurosurgical residents.

    Science.gov (United States)

    Harnof, Sagi; Hadani, Moshe; Ziv, Amitai; Berkenstadt, Haim

    2013-09-01

    Communication skills are an important component of the neurosurgery residency training program. We developed a simulation-based training module for neurosurgery residents in which medical, communication and ethical dilemmas are presented by role-playing actors. To assess the first national simulation-based communication skills training for neurosurgical residents. Eight scenarios covering different aspects of neurosurgery were developed by our team: (1) obtaining informed consent for an elective surgery, (2) discharge of a patient following elective surgery, (3) dealing with an unsatisfied patient, (4) delivering news of intraoperative complications, (5) delivering news of a brain tumor to parents of a 5 year old boy, (6) delivering news of brain death to a family member, (7) obtaining informed consent for urgent surgery from the grandfather of a 7 year old boy with an epidural hematoma, and (8) dealing with a case of child abuse. Fifteen neurosurgery residents from all major medical centers in Israel participated in the training. The session was recorded on video and was followed by videotaped debriefing by a senior neurosurgeon and communication expert and by feedback questionnaires. All trainees participated in two scenarios and observed another two. Participants largely agreed that the actors simulating patients represented real patients and family members and that the videotaped debriefing contributed to the teaching of professional skills. Simulation-based communication skill training is effective, and together with thorough debriefing is an excellent learning and practical method for imparting communication skills to neurosurgery residents. Such simulation-based training will ultimately be part of the national residency program.

  6. Interactive case-based learning improves resident knowledge and confidence in reproductive endocrinology and infertility.

    Science.gov (United States)

    Goldman, Kara N; Tiegs, Ashley W; Uquillas, Kristen; Nachtigall, Margaret; Fino, M Elizabeth; Winkel, Abigail F; Lerner, Veronica

    2017-06-01

    Resident physicians' scores on the REI section of the CREOG exam are traditionally low, and nearly 40% of house staff nation-wide perceive their REI knowledge to be poor. We aimed to assess whether an interactive case-based group-learning curriculum would narrow the REI knowledge gap by improving understanding and retention of core REI concepts under the time constraints affecting residents. A three-hour case-based workshop was developed to address four primary CREOG objectives. A multiple-choice test was administered immediately before and after the intervention and 7 weeks post-workshop, to evaluate both knowledge and confidence. Following the intervention, residents self-reported increased confidence with counseling and treatment of PCOS, ovulation induction cycle monitoring, counseling and treatment of POI, and breaking bad news related to infertility (p < 0.05). The multiple-choice exam was re-administered 7 weeks post-intervention, and scores remained significantly improved compared to pre-workshop scores (p < 0.05). At that time, all residents either strongly agreed (91.7%) or agreed (8.3%) that the case-based interactive format was preferable to traditional lecture-based teaching. In conclusion, a nontraditional curriculum aimed at teaching core REI concepts to residents through interactive case-based learning can be successfully integrated into a residency curriculum, and significantly improves knowledge and confidence of critical concepts in REI.

  7. Spatial distribution of residence time, microbe and storage volume of groundwater in headwater catchments

    Science.gov (United States)

    Tsujimura, Maki; Ogawa, Mahiro; Yamamoto, Chisato; Sakakibara, Koichi; Sugiyama, Ayumi; Kato, Kenji; Nagaosa, Kazuyo; Yano, Shinjiro

    2017-04-01

    Headwater catchments in mountainous region are the most important recharge area for surface and subsurface waters, and time and stock information of the water is principal to understand hydrological processes in the catchments. Also, a variety of microbes are included in the groundwater and spring water, and those varies in time and space, suggesting that information of microbe could be used as tracer for groundwater flow system. However, there have been few researches to evaluate the relationship among the residence time, microbe and storage volume of the groundwater in headwater catchments. We performed an investigation on age dating using SF6 and CFCs, microbe counting in the spring water, and evaluation of groundwater storage volume based on water budget analysis in 8 regions underlain by different lithology, those are granite, dacite, sedimentary rocks, serpentinite, basalt and volcanic lava all over Japan. We conducted hydrometric measurements and sampling of spring water in base flow conditions during the rainless periods 2015 and 2016 in those regions, and SF6, CFCs, stable isotopic ratios of oxygen-18 and deuterium, inorganic solute concentrations and total number of prokaryotes were determined on all water samples. Residence time of spring water ranged from 0 to 16 years in all regions, and storage volume of the groundwater within topographical watershed was estimated to be 0.1 m to 222 m in water height. The spring with the longer residence time tends to have larger storage volume in the watershed, and the spring underlain by dacite tends to have larger storage volume as compared with that underlain by sand stone and chert. Also, total number of prokaryotes in the spring water ranged from 103 to 105 cells/mL, and the spring tends to show clear increasing of total number of prokaryotes with decreasing of residence time. Thus, we observed a certain relationship among residence time, storage volume and total number of prokaryotes in the spring water, and

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

    Science.gov (United States)

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

    2012-01-01

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

  9. Effects of zebra mussels on food webs: Interactions with juvenile bluegill and water residence time

    Science.gov (United States)

    Richardson, W.B.; Bartsch, L.A.

    1997-01-01

    We evaluated how water residence time mediated the impact of zebra mussels Dreissena polymorpha and bluegill sunfish Lepomis macrochirus on experimental food webs established in 1100-1 outdoor mesocosms. Water residence time was manipulated as a surrogate for seston resupply - a critical variable affecting growth and survival of suspension-feeding invertebrates. We used a 2 x 2 x 2 factorial experimental design with eight treatment combinations (3 replicates/treatment) including the presence or absence of Dreissena (2000 per m2), juvenile bluegill (40 per mesocosm), and short (1100 1 per d) or long (220 1 per d) water residence time. Measures of seston concentration (chlorophyll a, turbidity and suspended solids) were greater in the short- compared to long water-residence mesocosms, but intermediate in short water-residence mesocosms containing Dreissena. Abundance of rotifers (Keratella and Polyarthra) was reduced in Dreissena mesocosms and elevated in short residence time mesocosms. Cladocera abundance, in general, was unaffected by the presence of Dreissena; densities were higher in short-residence time mesocosms, and reduced in the presence of Lepomis. The growth of juvenile Lepomis were unaffected by Dreissena because of abundant benthic food. The final total mass of Dreissena was significantly greater in short- than long-residence mesocosms. Impacts of Dreissena on planktonic food webs may not only depend on the density of zebra mussels but also on the residence time of the surrounding water and the resupply of seston. ?? 1997 Kluwer Academic Publishers.

  10. An estimate of hydrothermal fluid residence times and vent chimney growth rates based on 210Pb/Pb ratios and mineralogic studies of sulfides dredged from the Juan de Fuca Ridge

    International Nuclear Information System (INIS)

    Kadko, D.; Tatsumoto, Mitsunobu

    1985-01-01

    The 210 Pb/Pb ratios across two sulfide samples dredged from the Juan de Fuca Ridge are used to estimate the growth rate of the sulfide material and the residence time of the hydrothermal fluid within the oceanic crust from the onset of basalt alteration. 210 Pb is added to the hydrothermal fluid by two processes: 1) high-temperature alteration of basalt and 2) if the residence time of the fluid is on the order of the 22.3-year half-life of 210 Pb, by in-situ growth from 222 Rn (Krishnaswami and Turekian, 1982). Stable lead is derived only from the alteration of basalt. The 210 Pb/Pb ratio across one sample was proportional 0.5 dpm/10 -6 g Pb, and across the other is was proportional 0.4 dpm/10 -6 g Pb. These values are quite close to the 238 U/Pb ratios of basalts from the area, suggesting that the residence time of the hydrothermal fluid from the onset of basalt alteration is appreciably less than the mean life of 210 Pb, i.e., the time required for ingrowth from the radon. An apparent growth rate of 1.2 cm/yr is derived from the slope of the 210 Pb/Pb curve for one of the samples. This is consistent with its mineralogy and texture which suggest an accretionary pattern of development. There is no obvious sequential growth pattern, and virtually no gradient in 210 Pb/Pb across the second sample. This is consistent with alteration of the original 210 Pb/Pb distribution by extensive remobilization reactions which are inferred from the mineralogic and textural relationships of the sample. (orig.)

  11. Defining and measuring the mean residence time of lateral surface transient storage zones in small streams

    Science.gov (United States)

    T.R. Jackson; R. Haggerty; S.V. Apte; A. Coleman; K.J. Drost

    2012-01-01

    Surface transient storage (STS) has functional significance in stream ecosystems because it increases solute interaction with sediments. After volume, mean residence time is the most important metric of STS, but it is unclear how this can be measured accurately or related to other timescales and field-measureable parameters. We studied mean residence time of lateral...

  12. Factors that affect implementation of web-based faculty evaluation forms: residents' perspectives from a developing country.

    Science.gov (United States)

    Ibrahim, S H; Ali, S K; Sadaf, S

    2010-08-01

    A web-based evaluation system for residents to provide feedback on faculty was piloted in four training programs at the Aga Khan University prior to institution-wide implementation. Of the four programs, less than 50% of forms were submitted by residents of three programs while more than 70% of forms were submitted by the residents of one program. This study was conducted to identify reasons for the varying participation rates of the four programs with a view to improving the system. A qualitative approach was employed using focus group discussions (FGDs). Volunteers were invited and three groups of eight to ten residents each were formed. Participants for FGDs were selected from all residency years. FGDs were used to identify residents' perceptions regarding the web-based faculty evaluation system and to identify residents' problems and concerns with completing the web-based faculty evaluating forms. Technical issues in completing and submitting the forms online were identified to be the main deterrents to completing the evaluation forms. Non-accessibility of a resource person for resolving technical problems with the software and the burden of taking time out to complete the forms were considered as limiting factors by many residents. Residents recommended a focused orientation session to the new system within the departments. Residents' confidence and support are key to promoting adequate participation in web-based evaluations. Focused orientation sessions, reinforcement, reminders, assurances of confidentiality, and removal of technical glitches should help to improve resident participation.

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

    Data.gov (United States)

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

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

    Data.gov (United States)

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

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

    Data.gov (United States)

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

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

    Data.gov (United States)

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

  17. Residence-Based Fear of Crime: A Routine Activities Approach.

    Science.gov (United States)

    Lai, Yung-Lien; Ren, Ling; Greenleaf, Richard

    2017-07-01

    Most fear-of-crime research uses resident's neighborhood as a key reference location to measure fear, yet the location effects of one's own dwelling unit on crime-specific fear has not been explicitly studied theoretically in the literature. Drawing upon routine activities theory, this study undertakes an investigation into the levels and determinants of residence-based fear of crime across three racial/ethnic groups-Whites, African Americans, and non-White Hispanics. Data used in the analyses were collected from a random-sample telephone survey of 1,239 respondents in Houston, Texas. The results derived from factor analyses revealed that residents do distinguish between fear in the neighborhood and fear at home. Proximity to motivated offenders measured by perception of crime was found to be the most salient predictor of fear, followed by the measures of target vulnerability and capable guardianship. In addition, residence-based fear varies significantly across racial/ethnic groups. The significance of these findings and the policy implications are highlighted.

  18. Optimization of Occupancy Based Demand Controlled Ventilation in Residences

    DEFF Research Database (Denmark)

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

    2011-01-01

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

  19. Resident response to integration of simulation-based education into emergency medicine conference.

    Science.gov (United States)

    Wang, Ernest E; Beaumont, Jennifer; Kharasch, Morris; Vozenilek, John A

    2008-11-01

    Utilization of simulation-based training has become increasingly prevalent in residency training. The authors compared emergency medicine (EM) resident feedback for simulation sessions to traditional lectures from an EM residency didactic program. The authors performed a retrospective review of all written EM conference evaluations over a 29-month period. Evaluation questions were scored on a 1-9 Likert scale. Lectures and simulation accounted for 77.6 and 22.4% of the conferences, respectively. Scored means (+/-standard deviations [SDs]) were as follows: overall, lecture 7.97 +/- 0.74 versus simulation 8.373 +/- 0.44 (p higher than traditional lectures. The scores over time suggest that this preference for simulation can be sustainable long term. Residents perceive simulation as more desirable teaching method compared to the traditional lecture format.

  20. Effect of protected research time on ABSITE scores during general surgery residency.

    Science.gov (United States)

    Orkin, Bruce A; Poirier, Jennifer; Kowal-Vern, Areta; Chan, Edie; Ohara, Karen; Mendoza, Brian

    2018-02-01

    Objective - To determine whether residents with one or more years of dedicated research time (Research Residents, RR) improved their ABSITE scores compared to those without (Non-Research Residents, N-RR). A retrospective review of general surgery residents' ABSITE scores from 1995 to 2016 was performed. RR were compared to N-RR. Additional analysis of At Risk (AR) v Not At Risk residents (NAR) (35th percentile as PGY1-2) was also performed. Cohort - 147 residents (34 RR and 113 N-RR). There were no differences in initial ABSITE scores (p = 0.47). By definition, the AR group had lower scores than NAR. Overall, post-research RR v PGY-4 N-RR scores did not differ (p = 0.84). Only the AR residents improved their scores (p = 0.0009 v NAR p = 0.42), regardless of research group (p = 0.70). Protected research time did not improve residents' ABSITE scores, regardless of initial scores. At Risk residents improved regardless of research group status. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Residence times in a hypersaline lagoon: Using salinity as a tracer

    Science.gov (United States)

    Mudge, Stephen M.; Icely, John D.; Newton, Alice

    2008-04-01

    Generally the waters of the Ria Formosa Lagoon, Portugal have a short residence time, in the order of 0.5 days (Tett, P., Gilpin, L., Svendsen, H., Erlandsson, C.P., Larsson, U., Kratzer, S., Fouilland, E., Janzen, C., Lee, J., Grenz, C., Newton, A., Ferreira, J.G., Fernandes, T., Scory, S., 2003. Eutrophication and some European waters of restricted exchange. Continental Shelf Research 23, 1635-1671). This estimation is based on the measurements of currents and the modelling of water exchange at the outlets to the ocean. However, observations of the temperature and salinity in the inner channels imply that residence time is greater in these regions of the lagoon. To resolve this apparent contradiction, spatial measurements of the temperature and salinity were made with a meter for conductivity, temperature and depth along the principal channels of the western portion of the lagoon, with a sampling frequency of two per second. Evaporation rates of 5.4 mm day -1 were measured in a salt extraction pond adjacent to the lagoon and used to determine the residence time through salinity differences with the incoming seawater. In June 2004, the water flooding in from the ocean had an average salinity of 36.07 which contrasted with a maximum of 37.82 at mid ebb on a spring tide, corresponding to a residence time of >7 days; the mean residence time was 2.4 days. As the tide flooded into the channels, the existing water was advected back into the lagoon. Although there was a small amount of mixing with water from another inlet, the water body from the inner lagoon essentially remained distinct with respect to temperature and salinity characteristics. The residence time of the water was further prolonged at the junction between the main channels, where distinct boundaries were observed between the different water masses. As the water ebbed out, the shallow Western Channel was essentially isolated from the rest of the outer lagoon, and the water from this channel was forced

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

    Science.gov (United States)

    Messman, Anne M; Walker, Ian

    2018-01-01

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

  3. 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.

  4. Does Faculty Follow the Recommended Structure for a New Classroom-based, Daily Formal Teaching Session for Anesthesia Residents?

    DEFF Research Database (Denmark)

    Anwar, Anjum; Tanaka, Pedro; Madsen, Matias V

    2016-01-01

    BACKGROUND: A newly implemented 15-minute classroom-based, formal teaching session for anesthesia residents is given three times daily by the same faculty. The faculty member was provided a suggested template for the presentation. The template structure was developed by a group of residents......, and 31% used a clinical case vignette presentation to introduce the keyword. The most common visuals were the use of a picture (38%) and a chart or a graph (35%). We also saw that 65% of the sessions had active involvement of residents. With respect to time and slide limitations mentioned in the template...... of the residency curriculum more than two years after their implementation....

  5. Numerical and machine learning simulation of parametric distributions of groundwater residence time in streams and wells

    Science.gov (United States)

    Starn, J. J.; Belitz, K.; Carlson, C.

    2017-12-01

    Groundwater residence-time distributions (RTDs) are critical for assessing susceptibility of water resources to contamination. This novel approach for estimating regional RTDs was to first simulate groundwater flow using existing regional digital data sets in 13 intermediate size watersheds (each an average of 7,000 square kilometers) that are representative of a wide range of glacial systems. RTDs were simulated with particle tracking. We refer to these models as "general models" because they are based on regional, as opposed to site-specific, digital data. Parametric RTDs were created from particle RTDs by fitting 1- and 2-component Weibull, gamma, and inverse Gaussian distributions, thus reducing a large number of particle travel times to 3 to 7 parameters (shape, location, and scale for each component plus a mixing fraction) for each modeled area. The scale parameter of these distributions is related to the mean exponential age; the shape parameter controls departure from the ideal exponential distribution and is partly a function of interaction with bedrock and with drainage density. Given the flexible shape and mathematical similarity of these distributions, any of them are potentially a good fit to particle RTDs. The 1-component gamma distribution provided a good fit to basin-wide particle RTDs. RTDs at monitoring wells and streams often have more complicated shapes than basin-wide RTDs, caused in part by heterogeneity in the model, and generally require 2-component distributions. A machine learning model was trained on the RTD parameters using features derived from regionally available watershed characteristics such as recharge rate, material thickness, and stream density. RTDs appeared to vary systematically across the landscape in relation to watershed features. This relation was used to produce maps of useful metrics with respect to risk-based thresholds, such as the time to first exceedance, time to maximum concentration, time above the threshold

  6. Steady And Unsteady Lumped-Parameter Models For Determination of Groundwater Residence Time Distribution

    International Nuclear Information System (INIS)

    Oezyurt, N.N.

    2002-01-01

    Groundwater's residence time distribution is an important information to identify the transport mechanism in aquifer systems. In the absence or scarcity of geometric, hydraulic and geohydrologic data needed to describe a flow system, lumped parameter models, that handle the flow system as a whole, exist as an alternative to determine the residence time distribution. Lumped parametre models comprise of idealized models of piston and well-mixed flow and their combinations. Aquifer properties such as, dead volume and by-pass flow can also be included in these models. With the aid of these models, conceptual aquifer models can be tested and residence time distribution of groundwater can be determined

  7. Flow and Residence Times of Dynamic River Bank Storage and Sinuosity-Driven Hyporheic Exchange

    Science.gov (United States)

    Gomez-Velez, J. D.; Wilson, J. L.; Cardenas, M. B.; Harvey, J. W.

    2017-10-01

    Hydrologic exchange fluxes (HEFs) vary significantly along river corridors due to spatiotemporal changes in discharge and geomorphology. This variability results in the emergence of biogeochemical hot-spots and hot-moments that ultimately control solute and energy transport and ecosystem services from the local to the watershed scales. In this work, we use a reduced-order model to gain mechanistic understanding of river bank storage and sinuosity-driven hyporheic exchange induced by transient river discharge. This is the first time that a systematic analysis of both processes is presented and serves as an initial step to propose parsimonious, physics-based models for better predictions of water quality at the large watershed scale. The effects of channel sinuosity, alluvial valley slope, hydraulic conductivity, and river stage forcing intensity and duration are encapsulated in dimensionless variables that can be easily estimated or constrained. We find that the importance of perturbations in the hyporheic zone's flux, residence times, and geometry is mainly explained by two-dimensionless variables representing the ratio of the hydraulic time constant of the aquifer and the duration of the event (Γd) and the importance of the ambient groundwater flow (Δh∗). Our model additionally shows that even systems with small sensitivity, resulting in small changes in the hyporheic zone extent, are characterized by highly variable exchange fluxes and residence times. These findings highlight the importance of including dynamic changes in hyporheic zones for typical HEF models such as the transient storage model.

  8. Determination of the mean aerosol residence times in the atmosphere and additional 210Po input on the base of simultaneous determination of 7Be, 22Na, 210Pb, 210Bi and 210Po in urban air

    International Nuclear Information System (INIS)

    Magdalena Dlugosz-Lisiecka; Henryk Bem

    2012-01-01

    The significant differences in the activities of 210 Pb, 210 Bi, 210 Po and cosmogenic 7 Be and 22 Na radionuclides in the urban aerosol samples collected in the summers 2010 and 2011 in the Lodz city of Poland were observed. Simultaneous measurement of these radionuclides, after a simple modification of the one compartment model, allows us to calculate both: the corrected aerosol residence times in the troposphere (1 / 25 days) and in the lower stratosphere (103 / 205 days). The relative input of the additional sources (beside of the 222 Rn decay in the air) to the total activity concentrations of 210 Pb, 210 Bi and 210 Po radionuclides in the urban air, plays a substantial role (up to 97% of the total activity) only in the case of 210 Po. (author)

  9. Residents' surgical performance during the laboratory years: an analysis of rule-based errors.

    Science.gov (United States)

    Nathwani, Jay N; Wise, Brett J; Garren, Margaret E; Mohamadipanah, Hossein; Van Beek, Nicole; DiMarco, Shannon M; Pugh, Carla M

    2017-11-01

    Nearly one-third of surgical residents will enter into academic development during their surgical residency by dedicating time to a research fellowship for 1-3 y. Major interest lies in understanding how laboratory residents' surgical skills are affected by minimal clinical exposure during academic development. A widely held concern is that the time away from clinical exposure results in surgical skills decay. This study examines the impact of the academic development years on residents' operative performance. We hypothesize that the use of repeated, annual assessments may result in learning even without individual feedback on participants simulated performance. Surgical performance data were collected from laboratory residents (postgraduate years 2-5) during the summers of 2014, 2015, and 2016. Residents had 15 min to complete a shortened, simulated laparoscopic ventral hernia repair procedure. Final hernia repair skins from all participants were scored using a previously validated checklist. An analysis of variance test compared the mean performance scores of repeat participants to those of first time participants. Twenty-seven (37% female) laboratory residents provided 2-year assessment data over the 3-year span of the study. Second time performance revealed improvement from a mean score of 14 (standard error = 1.0) in the first year to 17.2 (SD = 0.9) in the second year, (F[1, 52] = 5.6, P = 0.022). Detailed analysis demonstrated improvement in performance for 3 grading criteria that were considered to be rule-based errors. There was no improvement in operative strategy errors. Analysis of longitudinal performance of laboratory residents shows higher scores for repeat participants in the category of rule-based errors. These findings suggest that laboratory residents can learn from rule-based mistakes when provided with annual performance-based assessments. This benefit was not seen with operative strategy errors and has important implications for

  10. MODELING HOW A HURRICANE BARRIER IN NEW BEDFORD HARBOR, MASSACHUSETTS, AFFECTS THE HYDRODYNAMICS AND RESIDENCE TIMES

    Science.gov (United States)

    Two-dimensional hydrodynamic and transport models were used to simulate tidal and subtidal circulation, residence times, and the longitudinal distributions of conservative constituents in New Bedford Harbor, Massachusetts, before and after a hurricane barrier was constructed. The...

  11. Residence times and nitrate transport in ground water discharging to streams in the Chesapeake Bay Watershed

    Science.gov (United States)

    Lindsey, Bruce D.; Phillips, Scott; Donnelly, Colleen A.; Speiran, Gary K.; Plummer, Niel; Bohlke, John Karl; Focazio, Michael J.; Burton, William C.; Busenberg, Eurybiades

    2003-01-01

    One of the major water-quality problems in the Chesapeake Bay is an overabundance of nutrients from the streams and rivers that discharge to the Bay. Some of these nutrients are from nonpoint sources such as atmospheric deposition, agricultural manure and fertilizer, and septic systems. The effects of efforts to control nonpoint sources, however, can be difficult to quantify because of the lag time between changes at the land surface and the response in the base-flow (ground water) component of streams. To help resource managers understand the lag time between implementation of management practices and subsequent response in the nutrient concentrations in the base-flow component of streamflow, a study of ground-water discharge, residence time, and nitrate transport in springs throughout the Chesapeake Bay Watershed and in four smaller watersheds in selected hydrogeomorphic regions (HGMRs) was conducted. The four watersheds were in the Coastal Plain Uplands, Piedmont crystalline, Valley and Ridge carbonate, and Valley and Ridge siliciclastic HGMRs.A study of springs to estimate an apparent age of the ground water was based on analyses for concentrations of chlorofluorocarbons in water samples collected from 48 springs in the Chesapeake Bay Watershed. Results of the analysis indicate that median age for all the samples was 10 years, with the 25th percentile having an age of 7 years and the 75th percentile having an age of 13 years. Although the number of samples collected in each HGMR was limited, there did not appear to be distinct differences in the ages between the HGMRs. The ranges were similar between the major HGMRs above the Fall Line (modern to about 50 years), with only two HGMRs of small geographic extent (Piedmont carbonate and Mesozoic Lowland) having ranges of modern to about 10 years. The median values of all the HGMRs ranged from 7 to 11 years. Not enough samples were collected in the Coastal Plain for comparison. Spring samples showed slightly younger

  12. Effect of oven residence time on mechanical properties in ...

    Indian Academy of Sciences (India)

    P L Ramkumar

    better choice from the manufacturing perspective. Several .... colour from natural to black. Based on the ... A lab scale electrically heated bi-axial rotational moulding machine was ..... internal air temperature assist in moulding multi-layer rota-.

  13. Mean residence times for tritium in some terrestrial plants

    International Nuclear Information System (INIS)

    Gogate, S.S.; Krishnamoorthy, T.M.; Soman, S.D.

    1975-01-01

    Uptake of tritiated water from a single or multiple exposure, its fixation and elimination from 3 terrestrial plants, Raphanus sativus L., Amaranthus viridis L. and Phyllanthus fraternus Webster under experimental field conditions are described. Tissue free water tritium (TFWT) attains peak concentration within 4 hr after a single exposure in R. sativus and then decreases with a single component from both leaves and root, with a biological half-time of 36.4 +- 4.2 and 48.5 +- 7.2 hr respectively. TFWT in leaves of A. viridis reaches its peak value within 0.5 hr of exposure and its decay exhibits 2 component fall, one having a very short half-life of 2.4 +- 0.7 hr and the other a long half-time of 86.1 +- 2.0 hr. The two component decay of tritium in TFWT is well represented in P. fraternus. The long-lived components are nearly 8 times of the short-lived ones, both in leaves and stems respectively. Generally, the long -lived component accounts for 15% of the peak TFWT. Tissue bound tritium (TBT) reaches to 4% of TFWT in Phyllanthus sp. TBT elimination time is many times longer than the experimental periods employed in the present study. (author)

  14. Residence time distribution in twin-screw extruders

    NARCIS (Netherlands)

    Jager, T.

    1992-01-01

    For the twin-screw extruders used in the food industry at short time high temperature processes the knowledge of their reactor properties is incomplete for mass- and heat flow. Therefore each process change such as: scale-up or product development requires a great number of measurements

  15. Effectiveness of a Core-Competency-based Program on Residents' Learning and Experience.

    Science.gov (United States)

    Charles, Lesley; Triscott, Jean; Dobbs, Bonnie; Tian, Peter George; Babenko, Oksana

    2016-06-01

    The Care of the Elderly (COE) Diploma Program is a six-to-twelve-month enhanced skills program taken after two years of core residency training in Family Medicine. In 2010, we developed and implemented a core-competency-based COE Diploma program (CC), in lieu of one based on learning objectives (LO). This study assessed the effectiveness of the core-competency-based program on residents' learning and their training experience as compared to residents trained using learning objectives. The data from the 2007-2013 COE residents were used in the study, with nine and eight residents trained in the LO and CC programs, respectively. Residents' learning was measured using preceptors' evaluations of residents' skills/abilities throughout the program (118 evaluations in total). Residents' rating of training experience was measured using the Graduate's Questionnaire which residents completed after graduation. For residents' learning, overall, there was no significant difference between the two programs. However, when examined as a function of the four CanMEDS roles, there were significant increases in the CC residents' scores for two of the CanMEDS roles: Communicator/Collaborator/Manager and Scholar compared to residents in the LO program. With respect to residents' training experience, seven out of ten program components were rated by the CC residents higher than by the LO residents. The implementation of a COE CC program appears to facilitate resident learning and training experience.

  16. The electronic residency application service application can predict accreditation council for graduate medical education competency-based surgical resident performance.

    Science.gov (United States)

    Tolan, Amy M; Kaji, Amy H; Quach, Chi; Hines, O Joe; de Virgilio, Christian

    2010-01-01

    Program directors often struggle to determine which factors in the Electronic Residency Application Service (ERAS) application are important in the residency selection process. With the establishment of the Accreditation Council for Graduate Medical Education (ACGME) competencies, it would be important to know whether information available in the ERAS application can predict subsequent competency-based performance of general surgery residents. This study is a retrospective correlation of data points found in the ERAS application with core competency-based clinical rotation evaluations. ACGME competency-based evaluations as well as technical skills assessment from all rotations during residency were collected. The overall competency score was defined as an average of all 6 competencies and technical skills. A total of77 residents from two (one university and one community based university-affiliate) general surgery residency programs were included in the analysis. Receiving honors for many of the third year clerkships and AOA membership were associated with a number of the individual competencies. USMLE scores were predictive only of Medical Knowledge (p = 0.004). Factors associated with higher overall competency were female gender (p = 0.02), AOA (p = 0.06), overall number of honors received (p = 0.04), and honors in Ob/Gyn (p = 0.03) and Pediatrics (p = 0.05). Multivariable analysis showed honors in Ob/Gyn, female gender, older age, and total number of honors to be predictive of a number of individual core competencies. USMLE scores were only predictive of Medical Knowledge. The ERAS application is useful for predicting subsequent competency based performance in surgical residents. Receiving honors in the surgery clerkship, which has traditionally carried weight when evaluating a potential surgery resident, may not be as strong a predictor of future success. Copyright © 2010 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights

  17. Meteorologic, oceanographic, and geomorphic controls on circulation and residence time in a coral reef-lined embayment: Faga'alu Bay, American Samoa

    Science.gov (United States)

    Storlazzi, C. D.; Cheriton, O. M.; Messina, A. M.; Biggs, T. W.

    2018-06-01

    Water circulation over coral reefs can determine the degree to which reef organisms are exposed to the overlying waters, so understanding circulation is necessary to interpret spatial patterns in coral health. Because coral reefs often have high geomorphic complexity, circulation patterns and the duration of exposure, or "local residence time" of a water parcel, can vary substantially over small distances. Different meteorologic and oceanographic forcings can further alter residence time patterns over reefs. Here, spatially dense Lagrangian surface current drifters and Eulerian current meters were used to characterize circulation patterns and resulting residence times over different regions of the reefs in Faga'alu Bay, American Samoa, during three distinct forcing periods: calm, strong winds, and large waves. Residence times varied among different geomorphic zones of the reef and were reflected in the spatially varying health of the corals across the embayment. The relatively healthy, seaward fringing reef consistently had the shortest residence times, as it was continually flushed by wave breaking at the reef crest, whereas the degraded, sheltered, leeward fringing reef consistently had the longest residence times, suggesting this area is more exposed to land-based sources of pollution. Strong wind forcing resulted in the longest residence times by pinning the water in the bay, whereas large wave forcing flushed the bay and resulted in the shortest residence times. The effect of these different forcings on residence times was fairly consistent across all reef geomorphic zones, with the shift from wind to wave forcing shortening mean residence times by approximately 50%. Although ecologically significant to the coral organisms in the nearshore reef zones, these shortened residence times were still 2-3 times longer than those associated with the seaward fringing reef across all forcing conditions, demonstrating how the geomorphology of a reef environment sets a

  18. A non-discrete method for computation of residence time in fluid mechanics simulations.

    Science.gov (United States)

    Esmaily-Moghadam, Mahdi; Hsia, Tain-Yen; Marsden, Alison L

    2013-11-01

    Cardiovascular simulations provide a promising means to predict risk of thrombosis in grafts, devices, and surgical anatomies in adult and pediatric patients. Although the pathways for platelet activation and clot formation are not yet fully understood, recent findings suggest that thrombosis risk is increased in regions of flow recirculation and high residence time (RT). Current approaches for calculating RT are typically based on releasing a finite number of Lagrangian particles into the flow field and calculating RT by tracking their positions. However, special care must be taken to achieve temporal and spatial convergence, often requiring repeated simulations. In this work, we introduce a non-discrete method in which RT is calculated in an Eulerian framework using the advection-diffusion equation. We first present the formulation for calculating residence time in a given region of interest using two alternate definitions. The physical significance and sensitivity of the two measures of RT are discussed and their mathematical relation is established. An extension to a point-wise value is also presented. The methods presented here are then applied in a 2D cavity and two representative clinical scenarios, involving shunt placement for single ventricle heart defects and Kawasaki disease. In the second case study, we explored the relationship between RT and wall shear stress, a parameter of particular importance in cardiovascular disease.

  19. Prevalence and cost of full-time research fellowships during general surgery residency: a national survey.

    Science.gov (United States)

    Robertson, Charles M; Klingensmith, Mary E; Coopersmith, Craig M

    2009-01-01

    To quantify the prevalence, outcomes, and cost of surgical resident research. General surgery is unique among graduate medical education programs because a large percentage of residents interrupt their clinical training to spend 1 to 3 years performing full-time research. No comprehensive data exists on the scope of this practice. Survey sent to all 239 program directors of general surgery residencies participating in the National Resident Matching Program. Response rate was 200 of 239 (84%). A total of 381 of 1052 trainees (36%) interrupt residency to pursue full-time research. The mean research fellowship length is 1.7 years, with 72% of trainees performing basic science research. A significant association was found between fellowship length and postresidency activity, with a 14.7% increase in clinical fellowship training and a 15.2% decrease in private practice positions for each year of full-time research (P < 0.0001). Program directors at 31% of programs reported increased clinical duties for research fellows as a result of Accreditation Council for Graduate Medical Education work hour regulations for clinical residents, whereas a further 10% of programs are currently considering such changes. It costs $41.5 million to pay the 634 trainees who perform research fellowships each year, the majority of which is paid for by departmental funds (40%) and institutional training grants (24%). Interrupting residency to perform a research fellowship is a common and costly practice among general surgery residents. Although performing a research fellowship is associated with clinical fellowship training after residency, it is unclear to what extent this practice leads to the development of surgical investigators after postgraduate training.

  20. 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

  1. Implementation and evaluation of a simulation curriculum for paediatric residency programs including just-in-time in situ mock codes.

    Science.gov (United States)

    Sam, Jonathan; Pierse, Michael; Al-Qahtani, Abdullah; Cheng, Adam

    2012-02-01

    To develop, implement and evaluate a simulation-based acute care curriculum in a paediatric residency program using an integrated and longitudinal approach. Curriculum framework consisting of three modular, year-specific courses and longitudinal just-in-time, in situ mock codes. Paediatric residency program at BC Children's Hospital, Vancouver, British Columbia. The three year-specific courses focused on the critical first 5 min, complex medical management and crisis resource management, respectively. The just-in-time in situ mock codes simulated the acute deterioration of an existing ward patient, prepared the actual multidisciplinary code team, and primed the surrounding crisis support systems. Each curriculum component was evaluated with surveys using a five-point Likert scale. A total of 40 resident surveys were completed after each of the modular courses, and an additional 28 surveys were completed for the overall simulation curriculum. The highest Likert scores were for hands-on skill stations, immersive simulation environment and crisis resource management teaching. Survey results also suggested that just-in-time mock codes were realistic, reinforced learning, and prepared ward teams for patient deterioration. A simulation-based acute care curriculum was successfully integrated into a paediatric residency program. It provides a model for integrating simulation-based learning into other training programs, as well as a model for any hospital that wishes to improve paediatric resuscitation outcomes using just-in-time in situ mock codes.

  2. Wairarapa Valley groundwater : residence time, flow pattern, and hydrochemistry trends

    International Nuclear Information System (INIS)

    Morgenstern, U.

    2005-01-01

    The Wairarapa groundwater system has a complicated hydrogeological setting as it evolved from sea level changes, tectonic activity, and geomorphic process. Due to increasing groundwater demand a better understanding of the groundwater resources is required to help achieve effective management and sustainable use. In addition to previous 'classical' hydrogeology studies, this report represents the first stage of a comprehensive approach using age dating and chemistry time trends for understanding the Wairarapa groundwater system. The methodology of groundwater age dating and mixing models is described in Appendix 1. Historic tritium data were evaluated, and combined with new tritium and CFC/SF 6 data to allow for robust age dating. (author). 14 refs., 30 figs

  3. Effect of Residence Time of Graphitisation on Thermal Conductivity of Molded Graphite

    Directory of Open Access Journals (Sweden)

    Pedy Artsanti

    2010-06-01

    Full Text Available The effect of residence time of graphitisation on thermal conductivity of molded graphite has been examined. The examination has been conducted by varying residence time of graphitisation of molded carbon with petroleum coke as raw material and coal tar pitch. Graphitisation has been conducted by heating molded graphite at 2500 °C in argon atmosphere with residention time of 10, 30 and 90 minutes. Graphitisation degree, density, shrinking mass and porosity of molded graphite were examined and so was its thermal conductivity. The result showed that the decrease of porosity and the increase of graphitisation degree due to the increasing of residention time of graphitisation will increase the thermal conductivity of graphite. Molded graphite graphitisized with residence time for 90 minutes residention time gave thermal conductivity of 2.134 Watt/mK and graphitization degree 0.718.

  4. Variability in benthic exchange rate, depth, and residence time beneath a shallow coastal estuary

    Science.gov (United States)

    Russoniello, C. J.; Michael, H. A.; Heiss, J.

    2017-12-01

    Hydrodynamically-driven exchange of water between the water column and shallow seabed aquifer, benthic exchange, is a significant and dynamic component of coastal and estuarine fluid budgets, but wave-induced benthic exchange has not been measured in the field. Mixing between surface water and groundwater solutes promotes ecologically important chemical reactions, so quantifying benthic exchange rates, depths, and residence times, constrains estimates of coastal chemical cycling. In this study, we present the first field-based direct measurements of wave-induced exchange and compare it to exchange induced by the other primary drivers of exchange - tides, and currents. We deployed instruments in a shallow estuary to measure benthic exchange and temporal variability over an 11-day period. Differential pressure sensors recorded pressure gradients across the seabed, and up-and down-looking ADCPs recorded currents and pressures from which wave parameters, surface-water currents, and water depth were determined. Wave-induced exchange was calculated directly from 1) differential pressure measurements, and indirectly with an analytical solution based on wave parameters from 2) ADCP and 3) weather station data. Groundwater flow models were used to assess the effects of aquifer properties on benthic exchange depth and residence time. Benthic exchange driven by tidal pumping or current-bedform interaction was calculated from tidal stage variation and from ADCP-measured currents at the bed, respectively. Waves were the primary benthic exchange driver (average = 20.0 cm/d, maximum = 92.3 cm/d) during the measurement period. Benthic exchange due to tides (average = 3.7 cm/d) and current-bedform interaction (average = 6.5x10-2 cm/d) was much lower. Wave-induced exchange calculated from pressure measurements and ADCP-measured wave parameters matched well, but wind-based rates underestimated wave energy and exchange. Groundwater models showed that residence time and depth increased

  5. Knowledge and Attitudes of Oman Medical Specialty Board Residents towards Evidence-Based Medicine

    Directory of Open Access Journals (Sweden)

    Aiman Al Wahaibi

    2014-05-01

    Full Text Available Objective: This study aims to evaluate the knowledge and attitudes of Oman Medical Specialty Board (OMSB residents towards Evidence-Based Medicine (EBM. Methods: This cross sectional study was conducted on all OMSB residents through a self-administered online questionnaire between October 2012 and March 2013. An electronic survey was designed to identify and determine residents' knowledge and attitudes toward the use of EBM. Results: The survey was completed by 93 (21% OMSB residents, 76 (82% of whom took part in continuing education courses and 50 (54% belonged to professional practice-oriented organizations. On average, the residents were reportedly involved in patient care for approximately 70% (Standard Deviation [SD] 17% of their time, while 14% (SD 12% participated in research activities. The results showed that 53 respondents (57% were competent users of medical search engines compared to 23 residents (25% who rated their skills as neutral. Sixteen percent of the respondents strongly agreed and 46% only agreed that the facility supports the use of current research in practice. Fourteen percent strongly agreed and fifty-three percent only agreed that the foundation of EBM is part of OMSB academic preparation. On the other hand, 17% of the respondents thought that insufficient time is always a barrier against EBM, while another 27% perceived insufficient time as a usual barrier. The lack of information resources was reported to always be a barrier in 11% of the respondents while 32% thought that it usually acts as a barrier. Conclusion: Time constraints and skills in EBM were found to be the two major obstacles. This study was, however, limited by the low response rate of the survey; thus larger studies with a previously validated questionnaire should be conducted in the future.

  6. Spectrum analysis of radiotracer residence time distribution for industrial and environmental applications

    International Nuclear Information System (INIS)

    Kasban, H.; Ashraf Hamid

    2014-01-01

    Radiotracer signal analysis and recognition still represents challenges in industrial and environmental applications specially in residence time distribution (RTD) measurement. This paper presents a development for the RTD signal recognition method that is based on power density spectrum (PDS). In this development, the features are extracted from the signals and/or from their higher-orders statistics (HOS) (Bispectrum and Trispectrum) instead of PDS. The HOS are estimated using direct, indirect and parametric estimations. The recognition results are analyzed and compared for different HOS estimation in order to select the best HOS estimation method for the purpose of RTD signal recognition. The artificial neural networks are used for training and testing of the proposed method. The proposed method is tested using RTD signals obtained from the measurements carried out using radiotracer technique. The simulation results show that the parametric estimation of the Trispectrum gives the higher recognition rate and is the most reliable for the RTD signal recognition. (author)

  7. Variability in Benthic Exchange Rate, Depth, and Residence Time Beneath a Shallow Coastal Estuary

    Science.gov (United States)

    Russoniello, Christopher J.; Heiss, James W.; Michael, Holly A.

    2018-03-01

    Hydrodynamically driven benthic exchange of water between the water column and shallow seabed aquifer is a significant and dynamic component of coastal and estuarine fluid budgets. Associated exchange of solutes promotes ecologically important chemical reactions, so quantifying benthic exchange rates, depths, and residence times constrains coastal chemical cycling estimates. We present the first combined field, numerical, and analytical modeling investigation of wave-induced exchange. Temporal variability of exchange was calculated with data collected by instruments deployed in a shallow estuary for 11 days. Differential pressure sensors recorded pressure gradients across the seabed, and up- and down-looking ADCPs recorded currents and pressures to determine wave parameters, surface-water currents, and water depth. Wave-induced exchange was calculated (1) directly from differential pressure measurements, and indirectly with an analytical model based on wave parameters from (2) ADCP and (3) wind data. Wave-induced exchange from pressure measurements and ADCP-measured wave parameters matched well, but both exceeded wind-based values. Exchange induced by tidal pumping and current-bed form interaction—the other primary drivers in shallow coastal waters were calculated from tidal stage variation and ADCP-measured currents. Exchange from waves (mean = 20.0 cm/d; range = 1.75-92.3 cm/d) greatly exceeded exchange due to tides (mean = 3.7 cm/d) and current-bed form interaction (mean = 6.5 × 10-2 cm/d). Groundwater flow models showed aquifer properties affect wave-driven benthic exchange: residence time and depth increased and exchange rates decreased with increasing hydraulic diffusivity (ratio of aquifer permeability to compressibility). This new understanding of benthic exchange will help managers assess its control over chemical fluxes to marine systems.

  8. Impact of the European Working Time Directive (EWTD) on the operative experience of surgery residents.

    Science.gov (United States)

    Hopmans, Cornelis J; den Hoed, Pieter T; van der Laan, Lijckle; van der Harst, Erwin; van der Elst, Maarten; Mannaerts, Guido H H; Dawson, Imro; Timman, Reinier; Wijnhoven, Bas P L; IJzermans, Jan N M

    2015-04-01

    In Europe and the United States, work hour restrictions are considered to be particularly burdensome for residents in surgery specialties. The aim of this study was to examine whether reduction of the work week to 48 hours resulting from the implementation of the European Working Time Directive has affected the operative experience of surgery residents. This study was conducted in a general surgery training region in the Netherlands, consisting of 1 university hospital and 6 district training hospitals. Operating records summarizing the surgical procedures performed as "primary surgeon" in the operating theater for different grades of surgeons were retrospectively analyzed for the period 2005-2012 by the use of linear regression models. Operative procedures performed by residents were considered the main outcome measure. In total, 235,357 operative procedures were performed, including 47,458 (20.2%) in the university hospital and 187,899 (79.8%) in the district training hospitals (n = 5). For residents in the university hospital, the mean number of operative procedures performed per 1.0 full-time equivalent increased from 128 operations in 2005 to 204 operations in 2012 (P = .001), whereas for residents in district training hospitals, no substantial differences were found over time. The mean (±SD) operative caseload of 64 residents who completed the 6-year training program between 2005 and 2012 was 1,391 ± 226 (range, 768-1856). A comparison of the operative caseload according to year of board-certification showed no difference. Implementation of the European Working Time Directive has not affected adversely the number of surgical procedures performed by residents within a general surgical training region in the Netherlands. Copyright © 2015 Elsevier Inc. All rights reserved.

  9. Lean principles optimize on-time vascular surgery operating room starts and decrease resident work hours.

    Science.gov (United States)

    Warner, Courtney J; Walsh, Daniel B; Horvath, Alexander J; Walsh, Teri R; Herrick, Daniel P; Prentiss, Steven J; Powell, Richard J

    2013-11-01

    Lean process improvement techniques are used in industry to improve efficiency and quality while controlling costs. These techniques are less commonly applied in health care. This study assessed the effectiveness of Lean principles on first case on-time operating room starts and quantified effects on resident work hours. Standard process improvement techniques (DMAIC methodology: define, measure, analyze, improve, control) were used to identify causes of delayed vascular surgery first case starts. Value stream maps and process flow diagrams were created. Process data were analyzed with Pareto and control charts. High-yield changes were identified and simulated in computer and live settings prior to implementation. The primary outcome measure was the proportion of on-time first case starts; secondary outcomes included hospital costs, resident rounding time, and work hours. Data were compared with existing benchmarks. Prior to implementation, 39% of first cases started on time. Process mapping identified late resident arrival in preoperative holding as a cause of delayed first case starts. Resident rounding process inefficiencies were identified and changed through the use of checklists, standardization, and elimination of nonvalue-added activity. Following implementation of process improvements, first case on-time starts improved to 71% at 6 weeks (P = .002). Improvement was sustained with an 86% on-time rate at 1 year (P < .001). Resident rounding time was reduced by 33% (from 70 to 47 minutes). At 9 weeks following implementation, these changes generated an opportunity cost potential of $12,582. Use of Lean principles allowed rapid identification and implementation of perioperative process changes that improved efficiency and resulted in significant cost savings. This improvement was sustained at 1 year. Downstream effects included improved resident efficiency with decreased work hours. Copyright © 2013 Society for Vascular Surgery. Published by Mosby, Inc. All

  10. Assessment of resident operative performance using a real-time mobile Web system: preparing for the milestone age.

    Science.gov (United States)

    Wagner, Justin P; Chen, David C; Donahue, Timothy R; Quach, Chi; Hines, O Joe; Hiatt, Jonathan R; Tillou, Areti

    2014-01-01

    To satisfy trainees' operative competency requirements while improving feedback validity and timeliness using a mobile Web-based platform. The Southern Illinois University Operative Performance Rating Scale (OPRS) was embedded into a website formatted for mobile devices. From March 2013 to February 2014, faculty members were instructed to complete the OPRS form while providing verbal feedback to the operating resident at the conclusion of each procedure. Submitted data were compiled automatically within a secure Web-based spreadsheet. Conventional end-of-rotation performance (CERP) evaluations filed 2006 to 2013 and OPRS performance scores were compared by year of training using serial and independent-samples t tests. The mean CERP scores and OPRS overall resident operative performance scores were directly compared using a linear regression model. OPRS mobile site analytics were reviewed using a Web-based reporting program. Large university-based general surgery residency program. General Surgery faculty used the mobile Web OPRS system to rate resident performance. Residents and the program director reviewed evaluations semiannually. Over the study period, 18 faculty members and 37 residents logged 176 operations using the mobile OPRS system. There were 334 total OPRS website visits. Median time to complete an evaluation was 45 minutes from the end of the operation, and faculty spent an average of 134 seconds on the site to enter 1 assessment. In the 38,506 CERP evaluations reviewed, mean performance scores showed a positive linear trend of 2% change per year of training (p = 0.001). OPRS overall resident operative performance scores showed a significant linear (p = 0.001), quadratic (p = 0.001), and cubic (p = 0.003) trend of change per year of clinical training, reflecting the resident operative experience in our training program. Differences between postgraduate year-1 and postgraduate year-5 overall performance scores were greater with the OPRS (mean = 0.96, CI

  11. Working time of neurosurgical residents in Europe--results of a multinational survey.

    Science.gov (United States)

    Stienen, Martin N; Netuka, David; Demetriades, Andreas K; Ringel, Florian; Gautschi, Oliver P; Gempt, Jens; Kuhlen, Dominique; Schaller, Karl

    2016-01-01

    The introduction of the European Working Time directive 2003/88/EC has led to a reduction of the working hours with distinct impact on the clinical and surgical activity of neurosurgical residents in training. A survey was performed among European neurosurgical residents between 06/2014 and 03/2015. Multiple logistic regression was used to assess the relationship between responder-specific variables (e.g., age, gender, country, postgraduate year (PGY)) and outcome (e.g., working time). A total of 652 responses were collected, of which n = 532 responses were taken into consideration. In total, 17.5, 22.1, 29.5, 19.5, 5.9, and 5.5 % of European residents indicated to work 80 h/week, respectively. Residents from France and Turkey (OR 4.72, 95 % CI 1.29-17.17, p = 0.019) and Germany (OR 2.06, 95 % CI 1.15-3.67, p = 0.014) were more likely to work >60 h/week than residents from other European countries. In total, 29 % of European residents were satisfied with their current working time, 11.3 % indicated to prefer reduced working time. More than half (55 %) would prefer to work more hours/week if this would improve their clinical education. Residents that rated their operative exposure as insufficient were 2.3 times as likely as others to be willing to work more hours (OR 2.32, 95 % CI 1.47-3.70, p 50 % of his/her working time in the operating room. By contrast, 77.4 % indicate to devote >25 % of their daily working time to administrative work. For every advanced PGY, the likelihood to spend >50 % of the working time in the OR increases by 19 % (OR 1.19, 95 % CI 1.02-1.40, p = 0.024) and the likelihood to spend >50 % of the working time with administrative work decreases by 18 % (OR 0.84, 95 % CI 0.76-0.94, p = 0.002). The results of this survey on >500 European neurosurgical residents clearly prove that less than 40 % conform with the 48-h week as claimed by the WTD2003/88/EC. Still, more than half of them would chose to work

  12. On the joint residence time of N independent two-dimensional Brownian motions

    International Nuclear Information System (INIS)

    Benichou, O; Coppey, M; Klafter, J; Moreau, M; Oshanin, G

    2003-01-01

    We study the behaviour of several joint residence times of N independent Brownian particles in a disc of radius R in two dimensions. We consider: (i) the time T N (t) spent by all N particles simultaneously in the disc within the time interval [0, t], (ii) the time T (m) N (t) which at least m out of N particles spend together in the disc within the time interval [0, t], and (iii) the time T-tilde (m) N (t) which exactly m out of N particles spend together in the disc within the time interval [0, t]. We obtain very simple exact expressions for the expectations of these three residence times in the limit t → ∞

  13. Hydraulic residence time and iron removal in a wetland receiving ferruginous mine water over a 4 year period from commissioning.

    Science.gov (United States)

    Kusin, F M; Jarvis, A P; Gandy, C J

    2010-01-01

    Analysis of residence time distribution (RTD) has been conducted for the UK Coal Authority's mine water treatment wetland at Lambley, Northumberland, to determine the hydraulic performance of the wetland over a period of approximately 4 years since site commissioning. The wetland RTD was evaluated in accordance with moment analysis and modelled based on a tanks-in-series (TIS) model to yield the hydraulic characteristics of system performance. Greater hydraulic performance was seen during the second site monitoring after 21 months of site operation i.e. longer hydraulic residence time to reflect overall system hydraulic efficiency, compared to wetland performance during its early operation. Further monitoring of residence time during the third year of wetland operation indicated a slight reduction in hydraulic residence time, thus a lower system hydraulic efficiency. In contrast, performance during the fourth year of wetland operation exhibited an improved overall system hydraulic efficiency, suggesting the influence of reed growth over the lifetime of such systems on hydraulic performance. Interestingly, the same pattern was found for iron (which is the primary pollutant of concern in ferruginous mine waters) removal efficiency of the wetland system from the second to fourth year of wetland operation. This may therefore, reflect the maturity of reeds for maintaining efficient flow distribution across the wetland to retain a longer residence time and significant fractions of water involved to enhance the extent of treatment received for iron attenuation. Further monitoring will be conducted to establish whether such performance is maintained, or whether efficiency decreases over time due to accumulation of dead plant material within the wetland cells.

  14. Spinning Disc Technology – Residence Time Distribution and Efficiency in Textile Wastewater Treatment Application

    Science.gov (United States)

    Iacob Tudose, E. T.; Zaharia, C.

    2018-06-01

    The spinning disc (SD) technology has received increased attention in the last years due to its enhanced fluid flow features resulting in improved property transfers. The actual study focuses on characterization of the flow within a spinning disc system based on experimental data used to establish the residence time distribution (RTD) and its dependence on the feeding liquid flowrate and the disc rotational speed. To obtain these data, an inert tracer (sodium chloride) was injected as a pulse input in the liquid stream entering the disc and the salt concentration of the liquid leaving the disc was continuously recorded. The obtained data indicate that an increase in the liquid flowrate from 10 L/h to 30 L/h determines a narrower RTD function. Also, at rotational speed of 200 rpm, the residence time distribution is broader than that for 500 rpm and 800 rpm. The RTD data suggest that depending on the needed flow characteristics, one can choose a certain flowrate and rotational speed domain for its application. Also, the SD technology was used to process textile wastewater treated with bentonite (as both coagulation and discoloration agent) in order to investigate whether the quality indicators such as the total suspended solid content, turbidity and discoloration, can be improved. The experimental results are promising since the discoloration and the removals of suspended solids attained values of over 40%, and respectively, 50 %, depending on the effluent flowrate (10 l/h and 30 L/h), and the disc rotational speed (200 rpm, 550 rpm and 850 rpm) without any other addition of chemicals, or initiation of other simultaneous treatment processes (e.g., advanced oxidative, or reductive, or biochemical processes). This recommends spinning disc technology as a suitable and promising tool to improve different wastewater characteristics.

  15. Single molecule diffusion and the solution of the spherically symmetric residence time equation.

    Science.gov (United States)

    Agmon, Noam

    2011-06-16

    The residence time of a single dye molecule diffusing within a laser spot is propotional to the total number of photons emitted by it. With this application in mind, we solve the spherically symmetric "residence time equation" (RTE) to obtain the solution for the Laplace transform of the mean residence time (MRT) within a d-dimensional ball, as a function of the initial location of the particle and the observation time. The solutions for initial conditions of potential experimental interest, starting in the center, on the surface or uniformly within the ball, are explicitly presented. Special cases for dimensions 1, 2, and 3 are obtained, which can be Laplace inverted analytically for d = 1 and 3. In addition, the analytic short- and long-time asymptotic behaviors of the MRT are derived and compared with the exact solutions for d = 1, 2, and 3. As a demonstration of the simplification afforded by the RTE, the Appendix obtains the residence time distribution by solving the Feynman-Kac equation, from which the MRT is obtained by differentiation. Single-molecule diffusion experiments could be devised to test the results for the MRT presented in this work. © 2011 American Chemical Society

  16. Mindfulness-based stress reduction for residents: A randomized controlled trial

    NARCIS (Netherlands)

    Verweij, H.; Ravesteijn, H.J. van; Hooff, M.L.M. van; Lagro-Janssen, A.L.M.; Speckens, A.E.M.

    2018-01-01

    Background: Burnout is highly prevalent in residents. No randomized controlled trials have been conducted measuring the effects of Mindfulness-Based Stress Reduction (MBSR) on burnout in residents. Objective: To determine the effectiveness of MBSR in reducing burnout in residents. Design: A

  17. Particle residence times in waters of the Yangtze and Amazon continental shelves

    International Nuclear Information System (INIS)

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

    1986-01-01

    Water column and seabed samples were analyzed for naturally occurring Th-234 to determine particle residence times in Yangtze and Amazon continental-shelf waters. On the Yangtze shelf, the water column was vertically well-mixed and suspended-sediment concentrations decreased offshore (from 230 mg/l near the river mouth to 2 mg/l in mid-shelf waters). Particle residence times increased offshore and ranged from 3.2 hours (12 m water depth) to 7.3 days (60 m water depth). Particle residence times ranged from 3 to 30 times shorter than values predicted by settling of discrete (4-8 micron) particles, suggesting that particles were settling in aggregate form. On the Amazon shelf, a two-layer estuarine flow dominated shelf circulation. Suspended-sediment concentrations on the inner shelf (10-12 m water depth) were much greater in bottom waters (range: 100-880 mg/l) than in surface waters (range 5-60 mg/l) as a result of resuspension. Particle residence times ranged from 1.1 days in surface waters to 2.5 days in bottom waters. Particles probably underwent several cycles of resuspension before permanent removal from the water column

  18. Effects of intergenerational Montessori-based activities programming on engagement of nursing home residents with dementia

    Directory of Open Access Journals (Sweden)

    Michelle M Lee

    2007-10-01

    Full Text Available Michelle M Lee1, Cameron J Camp2, Megan L Malone21Midwestern University, Department of Behavioral Medicine, Downers Grove, IL , USA; 2Myers Research Institute of Menorah Park Center for Senior Living, Beachwood, OH, USA Abstract: Fourteen nursing home residents on a dementia special care unit at a skilled nursing facility took part in one-to-one intergenerational programming (IGP with 15 preschool children from the facility’s on-site child care center. Montessori-based activities served as the interface for interactions between dyads. The amount of time residents demonstrated positive and negative forms of engagement during IGP and standard activities programming was assessed through direct observation using a tool developed for this purpose – the Myers Research Institute Engagement Scale (MRI-ES. These residents with dementia displayed the ability to successfully take part in IGP. Most successfully presented “lessons” to the children in their dyads, similar to the way that Montessori teachers present lessons to children, while persons with more severe cognitive impairment took part in IGP through other methods such as parallel play. Taking part in IGP was consistently related with higher levels of positive engagement and lower levels of negative forms of engagement in these residents with dementia than levels seen in standard activities programming on the unit. Implications of using this form of IGP, and directions for future research, are discussed.Keywords: Montessori-based activities, intergenerational programming, engagement, dementia

  19. "iBIM"--internet-based interactive modules: an easy and interesting learning tool for general surgery residents.

    Science.gov (United States)

    Azer, Nader; Shi, Xinzhe; de Gara, Chris; Karmali, Shahzeer; Birch, Daniel W

    2014-04-01

    The increased use of information technology supports a resident- centred educational approach that promotes autonomy, flexibility and time management and helps residents to assess their competence, promoting self-awareness. We established a web-based e-learning tool to introduce general surgery residents to bariatric surgery and evaluate them to determine the most appropriate implementation strategy for Internet-based interactive modules (iBIM) in surgical teaching. Usernames and passwords were assigned to general surgery residents at the University of Alberta. They were directed to the Obesity101 website and prompted to complete a multiple-choice precourse test. Afterwards, they were able to access the interactive modules. Residents could review the course material as often as they wanted before completing a multiple-choice postcourse test and exit survey. We used paired t tests to assess the difference between pre- and postcourse scores. Out of 34 residents who agreed to participate in the project, 12 completed the project (35.3%). For these 12 residents, the precourse mean score was 50 ± 17.3 and the postcourse mean score was 67 ± 14 (p = 0.020). Most residents who participated in this study recommended using the iBIMs as a study tool for bariatric surgery. Course evaluation scores suggest this novel approach was successful in transferring knowledge to surgical trainees. Further development of this tool and assessment of implementation strategies will determine how iBIM in bariatric surgery may be integrated into the curriculum.

  20. Uniting Evidence-Based Evaluation with the ACGME Plastic Surgery Milestones: A Simple and Reliable Assessment of Resident Operative Performance.

    Science.gov (United States)

    Kobraei, Edward M; Bohnen, Jordan D; George, Brian C; Mullen, John T; Lillemoe, Keith D; Austen, William G; Liao, Eric C

    2016-08-01

    Milestones evaluations in plastic surgery reflect a shift toward competency-based training but have created a number of challenges. The authors have incorporated the smartphone application evaluation tool, System for Improving and Measuring Procedural Learning (SIMPL), that was recently developed by a multi-institutional research collaborative. In this pilot study, the authors hypothesize that SIMPL can improve resident evaluation and also collect granular performance data to simplify compliance with the plastic surgery Milestones. SIMPL was prospectively piloted with a plastic surgery resident and faculty surgeon at Massachusetts General Hospital in this institutional review board-approved study. The study period was a 2-month interval corresponding to the resident's rotation. The resident-faculty combination performed 20 cases together. All cases were evaluated with SIMPL. SIMPL evaluations uniformly took under 1 minute to submit. The average time to completed evaluation from surgery completion was 5 hours (technology will support a shared vocabulary between residents and faculty to enhance intraoperative education.

  1. The role of librarians in teaching evidence-based medicine to pediatric residents: a survey of pediatric residency program directors.

    Science.gov (United States)

    Boykan, Rachel; Jacobson, Robert M

    2017-10-01

    The research sought to identify the general use of medical librarians in pediatric residency training, to define the role of medical librarians in teaching evidence-based medicine (EBM) to pediatric residents, and to describe strategies and curricula for teaching EBM used in pediatric residency training programs. We sent a 13-question web-based survey through the Association of Pediatric Program Directors to 200 pediatric residency program directors between August and December 2015. A total of 91 (46%) pediatric residency program directors responded. Most (76%) programs had formal EBM curricula, and more than 75% of curricula addressed question formation, searching, assessment of validity, generalizability, quantitative importance, statistical significance, and applicability. The venues for teaching EBM that program directors perceived to be most effective included journal clubs (84%), conferences (44%), and morning report (36%). While 80% of programs utilized medical librarians, most of these librarians assisted with scholarly or research projects (74%), addressed clinical questions (62%), and taught on any topic not necessarily EBM (58%). Only 17% of program directors stated that librarians were involved in teaching EBM on a regular basis. The use of a librarian was not associated with having an EBM curriculum but was significantly associated with the size of the program. Smaller programs were more likely to utilize librarians (100%) than were medium (71%) or large programs (75%). While most pediatric residency programs have an EBM curriculum and engage medical librarians in various ways, librarians' expertise in teaching EBM is underutilized. Programs should work to better integrate librarians' expertise, both in the didactic and clinical teaching of EBM.

  2. Conformational Network and Residence Time Estimation of Trypsin-Benzamidine Unbinding Pathways

    OpenAIRE

    Dickson, Alex; Lotz, Samuel D.

    2016-01-01

    In this poster we present results from molecular dynamics sampling of benzamidine unbinding from trypsin. We give background on the weighted ensemble technique used (WExplore) and the Markovian state model construction. Our network shows three unique unbinding pathways including a never before observed unbinding pathway. We also estimate residence time to within one order of magnitude to the experimental value.

  3. Dynamics of nitrate production and removal as a function of residence time in the hyporheic zone

    Science.gov (United States)

    Jay P. Zarnetske; Roy Haggerty; Steven M. Wondzell; Michelle A. Baker

    2011-01-01

    Biogeochemical reactions associated with stream nitrogen cycling, such as nitrification and denitrification, can be strongly controlled by water and solute residence times in the hyporheic zone (HZ). We used a whole-stream steady state 15N-Iabeled nitrate and conservative tracer addition to investigate the spatial and temporal physiochemical...

  4. Residence time of pollutants discharged in the Gulf of Kachchh, northwestern Arabian Sea

    Digital Repository Service at National Institute of Oceanography (India)

    Patgaonkar, R.S.; Vethamony, P.; Lokesh, K.S.; Babu, M.T.

    A 2D Hydrodynamic-Particle Analysis model was applied to the Gulf of Kachchh (GoK) to estimate the residence time of pollutants. The tidal currents in the Gulf have a strong E-W component, which prevents the material in the north being transported...

  5. Fertilizer residence time affects nitrogen uptake efficiency and growth of sweet corn

    NARCIS (Netherlands)

    Zotarelli, L.; Scholberg, J.M.S.; Dukes, M.D.; Munoz-Carpena, R.

    2008-01-01

    Understanding plant N uptake dynamics is critical for increasing fertilizer N uptake efficiency (FUE) and minimize the risk of N leaching. The objective of this research was to determine the effect of residence time of N fertilizer on N uptake and FUE of sweet corn. Plants were grown in 25 L columns

  6. Factors influencing the residence time of catchment waters : A virtual experiment approach

    NARCIS (Netherlands)

    Dunn, S.M.; McDonnell, J.J.; Vaché, K.B.

    Estimates of mean residence time (MRT) are increasingly used as simple summary descriptors of the hydrological processes involving storage and mixing of water within catchment systems. Current understanding of the physical controls on MRT remains limited, and various hypotheses have been proposed to

  7. Effect of Residence Time on Hydrothermal Carbonization of Corn Cob Residual

    Directory of Open Access Journals (Sweden)

    Lei Zhang

    2015-05-01

    Full Text Available Hydrothermal carbonization is a promising technique for conversion of industrial waste into valuable products. Producing hydrochar from corn cob residual (CCR in a cost-effective way is key, from an economic standpoint. For this purpose, the effect of residence time in the range of 0.5 to 6 h was studied under the optimal temperature of 250 °C. Results showed that the higher heating value (HHV of hydrochar increased approximately 40% in comparison to that of the raw material; however, prolonging the residence time beyond 0.5 h had a negligible effect on the HHV increase. Chemical compositions and H/C and O/C ratios of hydrochars revealed a minimal effect of longer residence time. Furthermore, thermogravimetric and derivative thermogravimetric analysis (TG/DTG, Fourier transform infrared spectroscopy (FTIR, and X-ray diffraction (XRD analysis of hydrochars also verified that the pyrolysis behavior and chemical structure of hydrochars with various residence times were similar.

  8. Timed Up And Go Risk Predictor Of Falls In Elderly People Residing In The Community?

    Directory of Open Access Journals (Sweden)

    Mayara Muniz Peixoto Rodrigues

    2017-04-01

    Full Text Available Objective: evaluate the risk of falls of elderly people residing in a community in northeastern Brazil using the “Timed up and go”. Method: descriptive study, with a quantitative approach, performed with elderly people residing in a community. The collected data related to the sociodemographic and economic characteristics of episodes of falls in the last two years, regular practice of physical exercise and complaint of pain at the time of the interview; and, at last, the application of the “Timed Up and Go” test. Result: Most of the elderly were classified as free and independent and independent. There is a direct relationship between advanced age and increased time to perform the test. Conclusion: the "Timed Up and Go" test was not effective in predicting risk of falls alone and should associate with other indicators. Descriptors: Elderly people; Accidents by fall; Walking; Postural balance.

  9. 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

  10. Burnout syndrome during residency in internal medicine and pediatrics in a country without working time directive.

    Science.gov (United States)

    Aksoy, Duygu Yazgan; Durusu Tanriover, Mine; Unal, Sule; Dizdar, Omer; Kalyoncu, Umut; Karakaya, Jale; Unal, Serhat; Kale, Gulsev

    2014-01-01

    The purpose of this paper is to demonstrate burnout syndrome among internal medicine and pediatrics residents in a country that does not have the working time directive (WTD) and also to determine the risk factors and consequent impact on efficient functioning in clinical areas. A 57-item questionnaire was given to internal medicine and pediatrics residents. Responses from 22 pediatrics and 33 internal medicine residents were evaluated. Demographic findings, burnout scores, having hobbies, social activities and reading books unrelated to medicine were similar between the two groups. Six pediatrics residents (27.3 per cent) and 11 (33.3 per cent) internal medicine residents met the criteria for clinically significant burnout. Personal accomplishment scores and reading books unrelated to medicine were found to be related to burnout. Burnout is a syndrome characterized by depersonalization, emotional exhaustion and a low sense of personal accomplishment. It is important to document burnout in countries where WTDs are not implemented. Further studies might demonstrate burnout's effect on patient safety, service quality and physician's performance.

  11. Life events during surgical residency have different effects on women and men over time.

    Science.gov (United States)

    Chen, Michelle M; Yeo, Heather L; Roman, Sanziana A; Bell, Richard H; Sosa, Julie A

    2013-08-01

    Women represent half of medical school graduates in the United States. Our aim was to characterize the effects of marriage and childbirth on the experiences of surgery residents. This was a prospective, longitudinal study of categorical general surgery residents between 2008 and 2010. Outcomes included changes in faculty and peer relationships, work-life balance, financial security, and career goals over time. We included 4,028 residents. Compared with men, women in postgraduate years (PGYs) 1 through 5 were less likely to be married (28.2% to 47.3% vs 49.6% to 67.6%) or have children (4.6% to 18.0% vs 19.0% to 45.8%) (P < .001). Women who married during PGY1 to PGY3 became worried about performing in front of senior residents (P = .005); men who married were more likely to be happy at work (P = .005). Women who had a first child during PGY1 to PGY3 were more likely to feel overwhelmed (P = .008) and worry about financial security (P = .03) than other women. Men who had a child were more likely to feel supported by faculty (P = .004), but they experienced more family strain (P = .008) compared to childless men. Marriage and childbirth are associated with divergent changes in career experiences for women and men. Women lag behind their male peers in these life events from start to finish of residency. Copyright © 2013 Mosby, Inc. All rights reserved.

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

    Science.gov (United States)

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

    2016-04-01

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

  13. Effect of Resident Involvement on Operative Time and Operating Room Staffing Costs.

    Science.gov (United States)

    Allen, Robert William; Pruitt, Mark; Taaffe, Kevin M

    The operating room (OR) is a major driver of hospital costs; therefore, operative time is an expensive resource. The training of surgical residents must include time spent in the OR, but that experience comes with a cost to the surgeon and hospital. The objective of this article is to determine the effect of surgical resident involvement in the OR on operative time and subsequent hospital labor costs. The Kruskal-Wallis statistical test is used to determine whether or not there is a difference in operative times between 2 groups of cases (with residents and without residents). This difference leads to an increased cost in associated hospital labor costs for the group with the longer operative time. Cases were performed at Greenville Memorial Hospital. Greenville Memorial Hospital is part of the larger healthcare system, Greenville Health System, located in Greenville, SC and is a level 1 trauma center with up to 33 staffed ORs. A total of 84,997 cases were performed at the partnering hospital between January 1st, 2011 and July 31st, 2015. Cases were only chosen for analysis if there was only one CPT code associated with the case and there were more than 5 observations for each group being studied. This article presents a comprehensive retrospective analysis of 29,134 cases covering 246 procedures. The analysis shows that 45 procedures took significantly longer with a resident present in the room. The average increase in operative time was 4.8 minutes and the cost per minute of extra operative time was determined to be $9.57 per minute. OR labor costs at the partnering hospital was found to be $2,257,433, or $492,889 per year. Knowing the affect on operative time and OR costs allows managers to make smart decisions when considering alternative educational and training techniques. In addition, knowing the connection between residents in the room and surgical duration could help provide better estimates of surgical time in the future and increase the predictability of

  14. Effects of intergenerational Montessori-based activities programming on engagement of nursing home residents with dementia.

    Science.gov (United States)

    Lee, Michelle M; Camp, Cameron J; Malone, Megan L

    2007-01-01

    Fourteen nursing home residents on a dementia special care unit at a skilled nursing facility took part in one-to-one intergenerational programming (IGP) with 15 preschool children from the facility's on-site child care center. Montessori-based activities served as the interface for interactions between dyads. The amount of time residents demonstrated positive and negative forms of engagement during IGP and standard activities programming was assessed through direct observation using a tool developed for this purpose--the Myers Research Institute Engagement Scale (MRI-ES). These residents with dementia displayed the ability to successfully take part in IGP. Most successfully presented "lessons" to the children in their dyads, similar to the way that Montessori teachers present lessons to children, while persons with more severe cognitive impairment took part in IGP through other methods such as parallel play. Taking part in IGP was consistently related with higher levels of positive engagement and lower levels of negative forms of engagement in these residents with dementia than levels seen in standard activities programming on the unit. Implications of using this form of IGP, and directions for future research, are discussed.

  15. Mean residence times of atmospheric aerosols in the boundary layer as determined from 210Bi/210Pb activity ratios

    International Nuclear Information System (INIS)

    Papastefanou, C.; Bondietti, E.A.

    1991-01-01

    Concentrations of radioactive 210 Pb and 210 Bi were measured in surface air after chemical separation and radiochemical analysis in an annual cycle and were used to determine aerosol residence times in the lower atmosphere. It was concluded that residence times of 8 days would apply to aerosols of 0.3 μm activity median aerodynamic diameter (AMAD). Cascade impactor data are also presented in relating the residence times and the AMAD of atmospheric aerosols. (author)

  16. Incidence of pneumonia in nursing home residents with dementia in the Netherlands: an estimation based on three differently designed studies.

    Science.gov (United States)

    Zomer, T P; VAN DER Maaden, T; VAN Gageldonk-Lafeber, A B; DE Greeff, S C; VAN DER Steen, J T; Verhoef, L

    2017-08-01

    Pneumonia leads to considerable morbidity and mortality in nursing home residents with dementia. We assessed pneumonia incidence based on data from three different studies: (1) real-time national surveillance of healthcare-associated infections in nursing home residents in 2009-2015; (2) a randomized controlled trial in 2012-2015 to assess effects of a practical guideline in nursing home residents with dementia and pneumonia; and (3) a study in 2007-2010 to assess quality of dying in newly admitted nursing home residents with dementia. In national surveillance data, pneumonia incidence was calculated separately for psychogeriatric and somatic beds, as a proxy for residents with and without dementia. Weekly pneumonia incidence was significantly lower per 1000 psychogeriatric beds (3·9; 95% confidence interval (CI) 3·2-4·6) compared with 1000 somatic beds (5·7; 95% CI 5·1-6·3). Annual incidence per 1000 psychogeriatric beds was similar in national surveillance (range 78·9-117·1) and the trial (range 71·0-94·3), and significantly higher in newly admitted dementia residents (range 267·3-363·2). The incidence was highest during the first months after admission when compared with residents with longer stay. In conclusion, follow-up of pneumonia in newly admitted dementia residents may result in higher incidence, possibly due to higher risk in this population.

  17. Measurement of residence time distribution of liquid phase in an industrial-scale continuous pulp digester using radiotracer technique.

    Science.gov (United States)

    Sheoran, Meenakshi; Goswami, Sunil; Pant, Harish J; Biswal, Jayashree; Sharma, Vijay K; Chandra, Avinash; Bhunia, Haripada; Bajpai, Pramod K; Rao, S Madhukar; Dash, A

    2016-05-01

    A series of radiotracer experiments was carried out to measure residence time distribution (RTD) of liquid phase (alkali) in an industrial-scale continuous pulp digester in a paper industry in India. Bromine-82 as ammonium bromide was used as a radiotracer. Experiments were carried out at different biomass and white liquor flow rates. The measured RTD data were treated and mean residence times in individual digester tubes as well in the whole digester were determined. The RTD was also analyzed to identify flow abnormalities and investigate flow dynamics of the liquid phase in the pulp digester. Flow channeling was observed in the first section (tube 1) of the digester. Both axial dispersion and tanks-in-series with backmixing models preceded with a plug flow component were used to simulate the measured RTD and quantify the degree of axial mixing. Based on the study, optimum conditions for operating the digester were proposed. Copyright © 2016 Elsevier Ltd. All rights reserved.

  18. Dedicated Shift Wrap-up Time Does Not Improve Resident Sign-out Volume or Efficiency.

    Science.gov (United States)

    Jeanmonod, Rebecca K; Brook, Christopher; Winther, Mark; Pathak, Soma; Boyd, Molly

    2010-02-01

    Sign-out (SO) is a challenge to the emergency physician. Some training programs have instituted overlapping 9-hour shifts. The residents see patients for eight hours, and have one hour of wrap-up time. This hour helps them complete patient care, leaving fewer patients to sign-out. We examined whether this strategy impacts SO burden. This is a retrospective review of patients evaluated by emergency medicine (EM) residents working 9-hour (eight hours of patient care, one hour wrap-up time) and 12-hour shifts (12 hours patient care, no reserved time for wrap-up). Data were collected by reviewing the clinical tracker. A patient was assigned to the resident who initiated care and dictated the chart. SO was defined as any patient in the ED without disposition at change of shift. Patient turn-around-time (TAT) was also recorded. One-hundred sixty-one postgraduate-year-one resident (PGY1), 264 postgraduate-year-two resident (PGY2), and 193 postgraduate-year-three resident (PGY3) shifts were included. PGY1s signed out 1.9 patients per 12-hour shift. PGY2s signed out 2.3 patients on 12-hour shifts and 1.8 patients on 9-hour shifts. PGY3s signed out 2.1 patients on 12-hour shifts and 2.0 patients on 9-hour shifts. When we controlled for patients seen per hour, SO burden was constant by class regardless of shift length, with PGY2s signing out 18% of patients seen compared to 15% for PGY3s. PGY1s signed out 18% of patients seen. TAT for patients seen by PGY1s and PGY2s was similar, at 189 and 187 minutes, respectively. TAT for patients seen by PGY3s was significantly less at 175 minutes. The additional hour devoted to wrapping up patients in the ED had no affect on SO burden. The SO burden represented a fixed percentage of the total number of patients seen by the residents. PGY3s sign-out a smaller percentage of patients seen compared to other classes, and have faster TATs.

  19. Dedicated Shift Wrap-up Time Does Not Improve Resident Sign-out Volume or Efficiency

    Directory of Open Access Journals (Sweden)

    Jeanmonod, Rebecca K

    2010-02-01

    Full Text Available Objectives: Sign-out (SO is a challenge to the emergency physician. Some training programs have instituted overlapping 9-hour shifts. The residents see patients for eight hours, and have one hour of wrap-up time. This hour helps them complete patient care, leaving fewer patients to sign-out. We examined whether this strategy impacts SO burden.Methods: This is a retrospective review of patients evaluated by emergency medicine (EM residents working 9-hour (eight hours of patient care, one hour wrap-up time and 12-hour shifts (12 hours patient care, no reserved time for wrap-up. Data were collected by reviewing the clinical tracker. A patient was assigned to the resident who initiated care and dictated the chart. SO was defined as any patient in the ED without disposition at change of shift. Patient turn-around-time (TAT was also recorded.Results: One-hundred sixty-one postgraduate-year-one resident (PGY1, 264 postgraduate-year-two resident (PGY2, and 193 postgraduate-year-three resident (PGY3 shifts were included. PGY1s signed out 1.9 patients per 12-hour shift. PGY2s signed out 2.3 patients on 12-hour shifts and 1.8 patients on 9-hour shifts. PGY3s signed out 2.1 patients on 12-hour shifts and 2.0 patients on 9-hour shifts. When we controlled for patients seen per hour, SO burden was constant by class regardless of shift length, with PGY2s signing out 18% of patients seen compared to 15% for PGY3s. PGY1s signed out 18% of patients seen. TAT for patients seen by PGY1s and PGY2s was similar, at 189 and 187 minutes, respectively. TAT for patients seen by PGY3s was significantly less at 175 minutes.Conclusion: The additional hour devoted to wrapping up patients in the ED had no affect on SO burden. The SO burden represented a fixed percentage of the total number of patients seen by the residents. PGY3s sign-out a smaller percentage of patients seen compared to other classes, and have faster TATs. [West J Emerg Med. 2010; 11(1:35-39].

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

    Directory of Open Access Journals (Sweden)

    Anne M. Messman

    2017-12-01

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

  1. 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.

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

    International Nuclear Information System (INIS)

    Pippel, W.

    1976-01-01

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

  3. Residence times of groundwater and nitrate transport in coastal aquifer systems: Daweijia area, northeastern China

    International Nuclear Information System (INIS)

    Han, Dongmei; Cao, Guoliang; McCallum, James; Song, Xianfang

    2015-01-01

    Groundwater within the coastal aquifer systems of the Daweijia area in northeastern China is characterized by a large of variations (33–521 mg/L) in NO_3"− concentrations. Elevated nitrate concentrations, in addition to seawater intrusion in the Daweijia well field, both attributable to anthropogenic activities, may impact future water-management practices. Chemical and stable isotopic (δ"1"8O, δ"2H) analysis, "3H and CFCs methods were applied to provide a better understanding of the relationship between the distribution of groundwater mean residence time (MRT) and nitrate transport, and to identify sources of nitrate concentrations in the complex coastal aquifer systems. There is a relatively narrow range of isotopic composition (ranging from − 8.5 to − 7.0‰) in most groundwater. Generally higher tritium contents observed in the wet season relative to the dry season may result from rapid groundwater circulation in response to the rainfall through the preferential flow paths. In the well field, the relatively increased nitrate concentrations of groundwater, accompanied by the higher tritium contents in the wet season, indicate the nitrate pollution can be attributed to domestic wastes. The binary exponential and piston-flow mixing model (BEP) yielded feasible age distributions based on the conceptual model. The good inverse relationship between groundwater MRTs (92–467 years) and the NO_3"− concentrations in the shallow Quaternary aquifers indicates that elevated nitrate concentrations are attributable to more recent recharge for shallow groundwater. However, there is no significant relationship between the MRTs (8–411 years) and the NO_3"− concentrations existing in the carbonate aquifer system, due to the complex hydrogeological conditions, groundwater age distributions and the range of contaminant source areas. Nitrate in the groundwater system without denitrification effects could accumulate and be transported for tens of years, through the

  4. Residence times of groundwater and nitrate transport in coastal aquifer systems: Daweijia area, northeastern China

    Energy Technology Data Exchange (ETDEWEB)

    Han, Dongmei [Key Laboratory of Water Cycle & Related Land Surface Processes, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing 100101 (China); National Centre for Groundwater Research and Training, Flinders University, GPO Box 2100, Adelaide, SA 5001 (Australia); Cao, Guoliang [National Centre for Groundwater Research and Training, Flinders University, GPO Box 2100, Adelaide, SA 5001 (Australia); Center for Water Research, College of Engineering, Peking University, Beijing 100871 (China); McCallum, James [National Centre for Groundwater Research and Training, Flinders University, GPO Box 2100, Adelaide, SA 5001 (Australia); School of the Environment, Flinders University, GPO Box 2100, Adelaide, SA 5001 (Australia); Song, Xianfang [Key Laboratory of Water Cycle & Related Land Surface Processes, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing 100101 (China)

    2015-12-15

    Groundwater within the coastal aquifer systems of the Daweijia area in northeastern China is characterized by a large of variations (33–521 mg/L) in NO{sub 3}{sup −} concentrations. Elevated nitrate concentrations, in addition to seawater intrusion in the Daweijia well field, both attributable to anthropogenic activities, may impact future water-management practices. Chemical and stable isotopic (δ{sup 18}O, δ{sup 2}H) analysis, {sup 3}H and CFCs methods were applied to provide a better understanding of the relationship between the distribution of groundwater mean residence time (MRT) and nitrate transport, and to identify sources of nitrate concentrations in the complex coastal aquifer systems. There is a relatively narrow range of isotopic composition (ranging from − 8.5 to − 7.0‰) in most groundwater. Generally higher tritium contents observed in the wet season relative to the dry season may result from rapid groundwater circulation in response to the rainfall through the preferential flow paths. In the well field, the relatively increased nitrate concentrations of groundwater, accompanied by the higher tritium contents in the wet season, indicate the nitrate pollution can be attributed to domestic wastes. The binary exponential and piston-flow mixing model (BEP) yielded feasible age distributions based on the conceptual model. The good inverse relationship between groundwater MRTs (92–467 years) and the NO{sub 3}{sup −} concentrations in the shallow Quaternary aquifers indicates that elevated nitrate concentrations are attributable to more recent recharge for shallow groundwater. However, there is no significant relationship between the MRTs (8–411 years) and the NO{sub 3}{sup −} concentrations existing in the carbonate aquifer system, due to the complex hydrogeological conditions, groundwater age distributions and the range of contaminant source areas. Nitrate in the groundwater system without denitrification effects could accumulate and be

  5. Using continuous underway isotope measurements to map water residence time in hydrodynamically complex tidal environments

    Science.gov (United States)

    Downing, Bryan D.; Bergamaschi, Brian; Kendall, Carol; Kraus, Tamara; Dennis, Kate J.; Carter, Jeffery A.; von Dessonneck, Travis

    2016-01-01

    Stable isotopes present in water (δ2H, δ18O) have been used extensively to evaluate hydrological processes on the basis of parameters such as evaporation, precipitation, mixing, and residence time. In estuarine aquatic habitats, residence time (τ) is a major driver of biogeochemical processes, affecting trophic subsidies and conditions in fish-spawning habitats. But τ is highly variable in estuaries, owing to constant changes in river inflows, tides, wind, and water height, all of which combine to affect τ in unpredictable ways. It recently became feasible to measure δ2H and δ18O continuously, at a high sampling frequency (1 Hz), using diffusion sample introduction into a cavity ring-down spectrometer. To better understand the relationship of τ to biogeochemical processes in a dynamic estuarine system, we continuously measured δ2H and δ18O, nitrate and water quality parameters, on board a small, high-speed boat (5 to >10 m s–1) fitted with a hull-mounted underwater intake. We then calculated τ as is classically done using the isotopic signals of evaporation. The result was high-resolution (∼10 m) maps of residence time, nitrate, and other parameters that showed strong spatial gradients corresponding to geomorphic attributes of the different channels in the area. The mean measured value of τ was 30.5 d, with a range of 0–50 d. We used the measured spatial gradients in both τ and nitrate to calculate whole-ecosystem uptake rates, and the values ranged from 0.006 to 0.039 d–1. The capability to measure residence time over single tidal cycles in estuaries will be useful for evaluating and further understanding drivers of phytoplankton abundance, resolving differences attributable to mixing and water sources, explicitly calculating biogeochemical rates, and exploring the complex linkages among time-dependent biogeochemical processes in hydrodynamically complex environments such as estuaries.

  6. Subunit Stabilization and Polyethylene Glycolation of Cocaine Esterase Improves In Vivo Residence Time

    Energy Technology Data Exchange (ETDEWEB)

    Narasimhan, Diwahar; Collins, Gregory T.; Nance, Mark R.; Nichols, Joseph; Edwald, Elin; Chan, Jimmy; Ko, Mei-Chuan; Woods, James H.; Tesmer, John J.G.; Sunahara, Roger K. (Michigan)

    2012-03-15

    No small-molecule therapeutic is available to treat cocaine addiction, but enzyme-based therapy to accelerate cocaine hydrolysis in serum has gained momentum. Bacterial cocaine esterase (CocE) is the fastest known native enzyme that hydrolyzes cocaine. However, its lability at 37 C has limited its therapeutic potential. Cross-linking subunits through disulfide bridging is commonly used to stabilize multimeric enzymes. Herein we use structural methods to guide the introduction of two cysteine residues within dimer interface of CocE to facilitate intermolecular disulfide bond formation. The disulfide-crosslinked enzyme displays improved thermostability, particularly when combined with previously described mutations that enhance stability (T172R-G173Q). The newly modified enzyme yielded an extremely stable form of CocE (CCRQ-CocE) that retained greater than 90% of its activity after 41 days at 37 C, representing an improvement of more than 4700-fold over the wild-type enzyme. CCRQ-CocE could also be modified by polyethylene glycol (PEG) polymers, which improved its in vivo residence time from 24 to 72 h, as measured by a cocaine lethality assay, by self-administration in rodents, and by measurement of inhibition of cocaine-induced cardiovascular effects in rhesus monkeys. PEG-CCRQ elicited negligible immune response in rodents. Subunit stabilization and PEGylation has thus produced a potential protein therapeutic with markedly higher stability both in vitro and in vivo.

  7. Relationship between fiber degradation and residence time distribution in the processing of long fiber reinforced thermoplastics

    Directory of Open Access Journals (Sweden)

    2008-08-01

    Full Text Available Long fiber reinforced thermoplastics (LFT were processed by in-line compounding equipment with a modified single screw extruder. A pulse stimulus response technique using PET spheres as the tracer was adopted to obtain residence time distribution (RTD of extrusion compounding. RTD curves were fitted by the model based on the supposition that extrusion compounding was the combination of plug flow and mixed flow. Characteristic parameters of RTD model including P the fraction of plug flow reactor (PFR and d the fraction of dead volume of continuous stirred tank reactor (CSTR were used to associate with fiber degradation presented by fiber length and dispersion. The effects of screw speed, mixing length and channel depth on RTD curves, and characteristic parameters of RTD models as well as their effects on the fiber degradation were investigated. The influence of shear force with different screw speeds and variable channel depth on fiber degradation was studied and the main impetus of fiber degradation was also presented. The optimal process for obtaining the balance of fiber length and dispersion was presented.

  8. Problem-based learning in laboratory medicine resident education: a satisfaction survey.

    Science.gov (United States)

    Lepiller, Quentin; Solis, Morgane; Velay, Aurélie; Gantner, Pierre; Sueur, Charlotte; Stoll-Keller, Françoise; Barth, Heidi; Fafi-Kremer, Samira

    2017-04-01

    Theoretical knowledge in biology and medicine plays a substantial role in laboratory medicine resident education. In this study, we assessed the contribution of problem-based learning (PBL) to improve the training of laboratory medicine residents during their internship in the department of virology, Strasbourg University Hospital, France. We compared the residents' satisfaction regarding an educational program based on PBL and a program based on lectures and presentations. PBL induced a high level of satisfaction (100%) among residents compared to lectures and presentations (53%). The main advantages of this technique were to create a situational interest regarding virological problems, to boost the residents' motivation and to help them identify the most relevant learning objectives in virology. However, it appears pertinent to educate the residents in appropriate bibliographic research techniques prior to PBL use and to monitor their learning by regular formative assessment sessions.

  9. Measurement of residence time distribution of liquid phase in an industrial-scale continuous pulp digester using radiotracer technique

    International Nuclear Information System (INIS)

    Sheoran, Meenakshi; Goswami, Sunil; Pant, Harish J.; Biswal, Jayashree; Sharma, Vijay K.; Chandra, Avinash; Bhunia, Haripada; Bajpai, Pramod K.; Rao, S. Madhukar; Dash, A.

    2016-01-01

    A series of radiotracer experiments was carried out to measure residence time distribution (RTD) of liquid phase (alkali) in an industrial-scale continuous pulp digester in a paper industry in India. Bromine-82 as ammonium bromide was used as a radiotracer. Experiments were carried out at different biomass and white liquor flow rates. The measured RTD data were treated and mean residence times in individual digester tubes as well in the whole digester were determined. The RTD was also analyzed to identify flow abnormalities and investigate flow dynamics of the liquid phase in the pulp digester. Flow channeling was observed in the first section (tube 1) of the digester. Both axial dispersion and tanks-in-series with backmixing models preceded with a plug flow component were used to simulate the measured RTD and quantify the degree of axial mixing. Based on the study, optimum conditions for operating the digester were proposed. - Highlights: • Radiotracer experiments were conducted to measure RTD of liquid phase in a pulp digester • Mean residence times of white liquor were measured • Axial dispersion and tanks-in-series models were used to investigate flow patterns • Parallel flow paths were observed in first section of the digester • Optimized flow rates of biomass and liquor were obtained

  10. Receptor residence time trumps drug-likeness and oral bioavailability in determining efficacy of complement C5a antagonists

    Science.gov (United States)

    Seow, Vernon; Lim, Junxian; Cotterell, Adam J.; Yau, Mei-Kwan; Xu, Weijun; Lohman, Rink-Jan; Kok, W. Mei; Stoermer, Martin J.; Sweet, Matthew J.; Reid, Robert C.; Suen, Jacky Y.; Fairlie, David P.

    2016-04-01

    Drug discovery and translation are normally based on optimizing efficacy by increasing receptor affinity, functional potency, drug-likeness (rule-of-five compliance) and oral bioavailability. Here we demonstrate that residence time of a compound on its receptor has an overriding influence on efficacy, exemplified for antagonists of inflammatory protein complement C5a that activates immune cells and promotes disease. Three equipotent antagonists (3D53, W54011, JJ47) of inflammatory responses to C5a (3nM) were compared for drug-likeness, receptor affinity and antagonist potency in human macrophages, and anti-inflammatory efficacy in rats. Only the least drug-like antagonist (3D53) maintained potency in cells against higher C5a concentrations and had a much longer duration of action (t1/2 ~ 20 h) than W54011 or JJ47 (t1/2 ~ 1-3 h) in inhibiting macrophage responses. The unusually long residence time of 3D53 on its receptor was mechanistically probed by molecular dynamics simulations, which revealed long-lasting interactions that trap the antagonist within the receptor. Despite negligible oral bioavailability, 3D53 was much more orally efficacious than W54011 or JJ47 in preventing repeated agonist insults to induce rat paw oedema over 24 h. Thus, residence time on a receptor can trump drug-likeness in determining efficacy, even oral efficacy, of pharmacological agents.

  11. Extra-regional residence time as a correlate of plant invasiveness: European archaeophytes in North America

    Czech Academy of Sciences Publication Activity Database

    La Sorte, F. A.; Pyšek, Petr

    2009-01-01

    Roč. 90, č. 9 (2009), s. 2589-2597 ISSN 0012-9658 R&D Projects: GA MŠk LC06073 Grant - others:Evropská komise(XE) GOCE-CT-2003-506675 Institutional research plan: CEZ:AV0Z60050516 Keywords : residence time * archaeophyte * North America Subject RIV: EF - Botanics Impact factor: 4.411, year: 2009

  12. New residence times of the Holocene reworked shells on the west coast of Bohai Bay, China

    Science.gov (United States)

    Shang, Zhiwen; Wang, Fu; Li, Jianfen; Marshall, William A.; Chen, Yongsheng; Jiang, Xingyu; Tian, Lizhu; Wang, Hong

    2016-01-01

    Shelly cheniers and shell-rich beds found intercalated in near-shore marine muds and sandy sediments can be used to indicate the location of ancient shorelines, and help to estimate the height of sea level. However, dating the deposition of material within cheniers and shell-rich beds is not straightforward because much of this material is transported and re-worked, creating an unknown temporal off-set, i.e., the residence time, between the death of a shell and its subsequent entombment. To quantify the residence time during the Holocene on a section of the northern Chinese coastline a total 47 shelly subsamples were taken from 17 discrete layers identified on the west coast of Bohai Bay. This material was AMS 14C dated and the calibrated ages were systematically compared. The subsamples were categorized by type as articulated and disarticulated bivalves, gastropod shells, and undifferentiated shell-hash. It was found that within most individual layers the calibrated ages of the subsamples got younger relative to the amount of apparent post-mortem re-working the material had been subject to. For examples, the 14C ages of the bivalve samples trended younger in this order: shell-hash → split shells → articulated shells. We propose that the younger subsample age determined within an individual layer will be the closest to the actual depositional age of the material dated. Using this approach at four Holocene sites we find residence times which range from 100 to 1260 cal yrs, with two average values of 600 cal yrs for the original 14C dates older than 1 ka cal BP and 100 cal yrs for the original 14C dates younger than 1 ka cal BP, respectively. Using this semi-empirical estimation of the shell residence times we have refined the existing chronology of the Holocene chenier ridges on the west coast of Bohai Bay.

  13. The use of 41Ar to investigate residence time distribution (RTD) in petrochemical industry

    International Nuclear Information System (INIS)

    Sirelkhatim, D. A.; Hassan, B. A.; ElTayeb, M. A. H.; Hills, A. E.

    2004-01-01

    Residence time measurements were carried out on a wax slurry bed reactor (SBR) and on a pilot FTDU reactor by means of radioisotope tracer technology using Ar-41 as tracer gas. Representative results were obtained as the behaviour of the gas in the SBR showed channeling downstream and in the FTDU, possible different mixing zones in the upper portion and the occurrence of air pockets was evident. ( Authors)

  14. Residence Time Distribution (RTD) Prediction in Mixing Vessel via CFD Simulation Using Fluent: An Overview

    International Nuclear Information System (INIS)

    Mohd Rizal Mamat; Azraf Azman; Noraishah Othman

    2011-01-01

    A prototype mixing vessel has been developed by Industrial Technology Division and installed at a multiphase testing facility in MINT Tech Park. A task to investigate the mixing vessel performance using Computational Fluid Dynamics (CFD) has been undertaken using the available FLUENT software in Malaysian Nuclear Agency. This paper discusses the modeling and simulation done in obtaining the Residence Time Distribution (RTD) for the mixing vessel using FLUENT. (author)

  15. A comparison of simulation-based education versus lecture-based instruction for toxicology training in emergency medicine residents.

    Science.gov (United States)

    Maddry, Joseph K; Varney, Shawn M; Sessions, Daniel; Heard, Kennon; Thaxton, Robert E; Ganem, Victoria J; Zarzabal, Lee A; Bebarta, Vikhyat S

    2014-12-01

    Simulation-based teaching (SIM) is a common method for medical education. SIM exposes residents to uncommon scenarios that require critical, timely actions. SIM may be a valuable training method for critically ill poisoned patients whose diagnosis and treatment depend on key clinical findings. Our objective was to compare medical simulation (SIM) to traditional lecture-based instruction (LEC) for training emergency medicine (EM) residents in the acute management of critically ill poisoned patients. EM residents completed two pre-intervention questionnaires: (1) a 24-item multiple-choice test of four toxicological emergencies and (2) a questionnaire using a five-point Likert scale to rate the residents' comfort level in diagnosing and treating patients with specific toxicological emergencies. After completing the pre-intervention questionnaires, residents were randomized to SIM or LEC instruction. Two toxicologists and three EM physicians presented four toxicology topics to both groups in four 20-min sessions. One group was in the simulation center, and the other in a lecture hall. Each group then repeated the multiple-choice test and questionnaire immediately after instruction and again at 3 months after training. Answers were not discussed. The primary outcome was comparison of immediate mean post-intervention test scores and final scores 3 months later between SIM and LEC groups. Test score outcomes between groups were compared at each time point (pre-test, post-instruction, 3-month follow-up) using Wilcoxon rank sum test. Data were summarized by descriptive statistics. Continuous variables were characterized by means (SD) and tested using t tests or Wilcoxon rank sum. Categorical variables were summarized by frequencies (%) and compared between training groups with chi-square or Fisher's exact test. Thirty-two EM residents completed pre- and post-intervention tests and comfort questionnaires on the study day. Both groups had higher post-intervention mean test

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

    International Nuclear Information System (INIS)

    Debien, Bruno R.

    2013-01-01

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

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

    Science.gov (United States)

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

    2017-11-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2013-07-01

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

  19. Developing a vision and strategic action plan for future community-based residency training.

    Science.gov (United States)

    Skelton, Jann B; Owen, James A

    2016-01-01

    The Community Pharmacy Residency Program (CPRP) Planning Committee convened to develop a vision and a strategic action plan for the advancement of community pharmacy residency training. Aligned with the profession's efforts to achieve provider status and expand access to care, the Future Vision and Action Plan for Community-based Residency Training will provide guidance, direction, and a strategic action plan for community-based residency training to ensure that the future needs of community-based pharmacist practitioners are met. National thought leaders, selected because of their leadership in pharmacy practice, academia, and residency training, served on the planning committee. The committee conducted a series of conference calls and an in-person strategic planning meeting held on January 13-14, 2015. Outcomes from the discussions were supplemented with related information from the literature. Results of a survey of CPRP directors and preceptors also informed the planning process. The vision and strategic action plan for community-based residency training is intended to advance training to meet the emerging needs of patients in communities that are served by the pharmacy profession. The group anticipated the advanced skills required of pharmacists serving as community-based pharmacist practitioners and the likely education, training and competencies required by future residency graduates in order to deliver these services. The vision reflects a transformation of community residency training, from CPRPs to community-based residency training, and embodies the concept that residency training should be primarily focused on training the individual pharmacist practitioner based on the needs of patients served within the community, and not on the physical location where pharmacy services are provided. The development of a vision statement, core values statements, and strategic action plan will provide support, guidance, and direction to the profession of pharmacy to

  20. Resident evaluation of clinical teachers based on teachers' certification.

    Science.gov (United States)

    Steiner, Ivan P; Yoon, Philip W; Kelly, Karen D; Diner, Barry M; Donoff, Michel G; Mackey, Duncan S; Rowe, Brian H

    2003-07-01

    To examine the influence of emergency medicine (EM) certification of clinical teaching faculty on evaluations provided by residents. A prospective cohort analysis was conducted of assessments between July 1994 and July 2000 on residents' evaluations of EM faculty at the University of Alberta, Edmonton, Canada. Resident- and faculty-related variables were entered anonymously using the validated evaluation tool (ER Scale). Credentialing and demographic information on EM faculty was supplemented by data obtained through a nine-question survey. Groups were compared using ANOVA. The 562 residents returned 705 (91%) valid evaluation sheets on 115 EM faculty members. The four domains of didactic teaching, clinical teaching, approachability, and helpfulness were assessed. The majority of ratings were in the very good or superb categories for each domain. Instructors with certification in EM had higher scores in didactic, clinical teaching compared with others, and teachers without national certification scored lower in the helpful and approachable categories (p certifications either through training or practice eligibility did not affect scores. Instructors under the age of 40 years had higher scores than the older age groups in three of four categories (p certification in EM, academic track, rotation year, and site are all correlated with better teaching performance.

  1. Objective classification of residents based on their psychomotor laparoscopic skills

    NARCIS (Netherlands)

    M.K. Chmarra (Magdalena); S. Klein (Stefan); J.C.F. van Winter (Joost); F-W. Jansen (Frank-Willem); J. Dankelman (Jenny)

    2010-01-01

    textabstractBackground From the clinical point of view, it is important to recognize residents' level of expertise with regard to basic psychomotor skills. For that reason, surgeons and surgical organizations (e.g., Acreditation Council for Graduate Medical Education, ACGME) are calling for

  2. Academic time at a level 1 trauma center: no resident, no problem?

    Science.gov (United States)

    Matsushima, Kazuhide; Dickinson, Rebecca M; Schaefer, Eric W; Armen, Scott B; Frankel, Heidi L

    2012-01-01

    Globally, the compliance of resident work-hour restrictions has no impact on trauma outcome. However, the effect of protected education time (PET), during which residents are unavailable to respond to trauma patients, has not been studied. We hypothesized that PET has no impact on the outcome of trauma patients. We conducted a retrospective review of relevant patients at an academic level I trauma center. During PET, a trauma attending and advanced practice providers (APPs) responded to trauma activations. PGY1, 3, and 4 residents were also available at all other times. The outcome of new trauma patient activations during Thursday morning 3-hours resident PET was compared with same time period on other weekdays (non-PET) using a univariate and multivariate analysis. From January 2005 to April 2010, a total of 5968 trauma patients were entered in the registry. Of these, 178 patients (2.98%) were included for study (37 PET and 141 non-PET). The mean injury severity score (ISS) was 16.2. Although no significant difference were identified in mortality, complications, or length of stay (LOS), we do see that length of emergency department stay (ED-LOS) tends to be longer during PET, although not significantly (314 vs 381 minutes, p = 0.74). On the multiple logistic regression model, PET was not a significant factor of complications, LOS, or ED-LOS. Few trauma activations occur during PET. New trauma activations can be staffed safely by trauma activations and APPs. However, there could be some delays in transferring patients to appropriate disposition. Additional study is required to determine the effect of PET on existing trauma inpatients. Copyright © 2012 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  3. A new time-space accounting scheme to predict stream water residence time and hydrograph source components at the watershed scale

    Science.gov (United States)

    Takahiro Sayama; Jeffrey J. McDonnell

    2009-01-01

    Hydrograph source components and stream water residence time are fundamental behavioral descriptors of watersheds but, as yet, are poorly represented in most rainfall-runoff models. We present a new time-space accounting scheme (T-SAS) to simulate the pre-event and event water fractions, mean residence time, and spatial source of streamflow at the watershed scale. We...

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

    Science.gov (United States)

    Flores, P.; Houser, C.

    2016-12-01

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

  5. Mineralogical Controls over Carbon Storage and Residence Times in Grassland Soils

    Science.gov (United States)

    Dwivedi, D.; Riley, W. J.; Torn, M. S.; Spycher, N.

    2014-12-01

    Globally, soil organic matter (SOM) contains approximately three times more carbon than the atmosphere and terrestrial vegetation contain combined. However, it is not well understood why some SOM persists for a long time while other SOM decomposes quickly. For future climate predictions, representing soil organic matter (SOM) dynamics accurately in Earth system models is essential. Soil minerals stabilize organic carbon in soil; however, there are gaps in our understanding of how soil mineralogy controls the quantity and turnover of long-residence-time organic carbon. To investigate the impact of soil mineralogy on SOM dynamics, we used a new model (Biotic and Abiotic Model of SOM—BAMS1 [Riley et al., 2014]) integrated with a three-dimensional, multiphase reactive transport solver (TOUGHREACT). The model represents bacterial and fungal activity, archetypal polymer and monomer carbon substrate groups, aqueous chemistry, gaseous diffusion, aqueous advection and diffusion, and adsorption and desorption processes. BAMS1 can predict bulk SOM and radiocarbon signatures without resorting to an arbitrary depth-dependent decline in SOM turnover rates. Results show a reasonable match between observed and simulated depth-resolved SOM and Δ14C in grassland ecosystems (soils formed on terraces south of Eureka, California, and the Central Chernozem Region of Russia) and were consistent with expectations of depth-resolved profiles of lignin content and fungi:aerobic bacteria ratios. Results also suggest that clay-mineral surface area and soil sorption coefficients constitute dominant controls over organic carbon stocks and residence times, respectively. Bibliography: Riley, W.J., F.M. Maggi, M. Kleber, M.S. Torn, J.Y. Tang, D. Dwivedi, and N. Guerry (2014), Long residence times of rapidly decomposable soil organic matter: application of a multi-phase, multi-component, and vertically resolved model (BAMS1) to soil carbon dynamics, Geoscientific Model Development, vol. 7, 1335

  6. Automated data mining: an innovative and efficient web-based approach to maintaining resident case logs.

    Science.gov (United States)

    Bhattacharya, Pratik; Van Stavern, Renee; Madhavan, Ramesh

    2010-12-01

    Use of resident case logs has been considered by the Residency Review Committee for Neurology of the Accreditation Council for Graduate Medical Education (ACGME). This study explores the effectiveness of a data-mining program for creating resident logs and compares the results to a manual data-entry system. Other potential applications of data mining to enhancing resident education are also explored. Patient notes dictated by residents were extracted from the Hospital Information System and analyzed using an unstructured mining program. History, examination and ICD codes were obtained and compared to the existing manual log. The automated data History, examination, and ICD codes were gathered for a 30-day period and compared to manual case logs. The automated method extracted all resident dictations with the dates of encounter and transcription. The automated data-miner processed information from all 19 residents, while only 4 residents logged manually. The manual method identified only broad categories of diseases; the major categories were stroke or vascular disorder 53 (27.6%), epilepsy 28 (14.7%), and pain syndromes 26 (13.5%). In the automated method, epilepsy 114 (21.1%), cerebral atherosclerosis 114 (21.1%), and headache 105 (19.4%) were the most frequent primary diagnoses, and headache 89 (16.5%), seizures 94 (17.4%), and low back pain 47 (9%) were the most common chief complaints. More detailed patient information such as tobacco use 227 (42%), alcohol use 205 (38%), and drug use 38 (7%) were extracted by the data-mining method. Manual case logs are time-consuming, provide limited information, and may be unpopular with residents. Data mining is a time-effective tool that may aid in the assessment of resident experience or the ACGME core competencies or in resident clinical research. More study of this method in larger numbers of residency programs is needed.

  7. Teaching and Assessing Systems-based Competency in Ophthalmology Residency Training Programs

    NARCIS (Netherlands)

    Lee, Andrew G.; Beaver, Hilary A.; Greenlee, Emily; Oetting, Thomas A.; Boldt, H. Culver; Olson, Richard; Abramoff, Michael; Carter, Keith

    2007-01-01

    The Accreditation Council for Graduate Medical Education (ACGME) has mandated that residency programs, including ophthalmology, teach and assess specific competencies, including systems-based learning. We review the pertinent literature on systems-based learning for ophthalmology and recommend

  8. Taste, choice and timing: Investigating resident and carer preferences for meals in aged care homes.

    Science.gov (United States)

    Milte, Rachel; Ratcliffe, Julie; Chen, Gang; Miller, Michelle; Crotty, Maria

    2018-03-01

    There has been little empirical investigation of the preferences of people living in aged care homes for food services. The aim of the present study was to elicit consumer preferences and their willingness to pay for food service in aged care homes. Current residents or their family members were invited to take part in the discrete choice experiment questionnaire administered via interview. Of the 109 eligible residents and 175 eligible family members approached for consent 121 (43%) participated, including 43 residents. Participant preferences were influenced by food taste, choice in relation to serving size, timing of meal selection, visual appeal, and additional cost. Participants indicated they would be willing to pay an additional $24 (US$18.42) per week for food which tasted excellent and $8 (US$6.14) per week to have choice in serving sizes. The study found that respondents were willing to pay a premium to receive food that met their expectations of taste, and for a high level of control over serving sizes, which has implications for the funding and provision of food and dining in long-term care in the future. © 2018 The Authors Nursing & Health Sciences Published by John Wiley & Sons Australia, Ltd.

  9. Geometrical effects on the electron residence time in semiconductor nano-particles.

    Science.gov (United States)

    Koochi, Hakimeh; Ebrahimi, Fatemeh

    2014-09-07

    We have used random walk (RW) numerical simulations to investigate the influence of the geometry on the statistics of the electron residence time τ(r) in a trap-limited diffusion process through semiconductor nano-particles. This is an important parameter in coarse-grained modeling of charge carrier transport in nano-structured semiconductor films. The traps have been distributed randomly on the surface (r(2) model) or through the whole particle (r(3) model) with a specified density. The trap energies have been taken from an exponential distribution and the traps release time is assumed to be a stochastic variable. We have carried out (RW) simulations to study the effect of coordination number, the spatial arrangement of the neighbors and the size of nano-particles on the statistics of τ(r). It has been observed that by increasing the coordination number n, the average value of electron residence time, τ̅(r) rapidly decreases to an asymptotic value. For a fixed coordination number n, the electron's mean residence time does not depend on the neighbors' spatial arrangement. In other words, τ̅(r) is a porosity-dependence, local parameter which generally varies remarkably from site to site, unless we are dealing with highly ordered structures. We have also examined the effect of nano-particle size d on the statistical behavior of τ̅(r). Our simulations indicate that for volume distribution of traps, τ̅(r) scales as d(2). For a surface distribution of traps τ(r) increases almost linearly with d. This leads to the prediction of a linear dependence of the diffusion coefficient D on the particle size d in ordered structures or random structures above the critical concentration which is in accordance with experimental observations.

  10. Radiotracer method for residence time distribution study in multiphase flow system

    International Nuclear Information System (INIS)

    Sugiharto, S.; Su'ud, Z.; Kurniadi, R.; Wibisono, W.; Abidin, Z.

    2009-01-01

    [ 131 I] isotope in different chemical compounds have been injected into 24 in hydrocarbon transmission pipeline containing approximately 95% water, 3% crude oil, 2% gas and negligible solid material, respectively. The system is operated at the temperature around 70 deg. C enabling fluids flow is easier in the pipeline. The segment of measurement was chosen far from the junction point of the pipeline, therefore, it was reasonably to assume that the fluids in such multiphase system were separated distinctively. Expandable tubing of injector was used to ensure that the isotopes were injected at the proper place in the sense that [ 131 I]Na isotope was injected into water layer and iodo-benzene, [131] IC 6 H 5, was injected into crude oil regime. The radiotracer selection was based on the compatibility of radiotracer with each of fluids under investigation. [ 131 I]Na was used for measuring flow of water while iodo-benzene, [131] IC 6 H 5, was used for measuring flow of crude oil. Two scintillation detectors were used and they are put at the distances 80 and 100 m, respectively, from injection point. The residence time distribution data were utilized for calculation water and crude oil flows. Several injections were conducted in the experiments. Although the crude oil density is lighter than the density of water, the result of measurement shows that the water flow is faster than the crude oil flow. As the system is water-dominated, water may act as carrier and the movement of crude oil is slowed due to friction between crude oil with water and crude oil with gas at top layer. Above of all, this result was able to give answer on the question why crude oil always arrives behind water as it is checked at gathering station. In addition, the flow patterns of the water in the pipeline calculated by Reynolds number and predicted by simple tank-in-series model is turbulence in character.

  11. Residence times of groundwater and nitrate transport in coastal aquifer systems: Daweijia area, northeastern China.

    Science.gov (United States)

    Han, Dongmei; Cao, Guoliang; McCallum, James; Song, Xianfang

    2015-12-15

    Groundwater within the coastal aquifer systems of the Daweijia area in northeastern China is characterized by a large of variations (33-521mg/L) in NO3(-) concentrations. Elevated nitrate concentrations, in addition to seawater intrusion in the Daweijia well field, both attributable to anthropogenic activities, may impact future water-management practices. Chemical and stable isotopic (δ(18)O, δ(2)H) analysis, (3)H and CFCs methods were applied to provide a better understanding of the relationship between the distribution of groundwater mean residence time (MRT) and nitrate transport, and to identify sources of nitrate concentrations in the complex coastal aquifer systems. There is a relatively narrow range of isotopic composition (ranging from -8.5 to -7.0‰) in most groundwater. Generally higher tritium contents observed in the wet season relative to the dry season may result from rapid groundwater circulation in response to the rainfall through the preferential flow paths. In the well field, the relatively increased nitrate concentrations of groundwater, accompanied by the higher tritium contents in the wet season, indicate the nitrate pollution can be attributed to domestic wastes. The binary exponential and piston-flow mixing model (BEP) yielded feasible age distributions based on the conceptual model. The good inverse relationship between groundwater MRTs (92-467years) and the NO3(-) concentrations in the shallow Quaternary aquifers indicates that elevated nitrate concentrations are attributable to more recent recharge for shallow groundwater. However, there is no significant relationship between the MRTs (8-411years) and the NO3(-) concentrations existing in the carbonate aquifer system, due to the complex hydrogeological conditions, groundwater age distributions and the range of contaminant source areas. Nitrate in the groundwater system without denitrification effects could accumulate and be transported for tens of years, through the complex carbonate

  12. Filling the Gap: Simulation-based Crisis Resource Management Training for Emergency Medicine Residents

    Directory of Open Access Journals (Sweden)

    Jessica R. Parsons

    2017-12-01

    Full Text Available Introduction In today’s team-oriented healthcare environment, high-quality patient care requires physicians to possess not only medical knowledge and technical skills but also crisis resource management (CRM skills. In emergency medicine (EM, the high acuity and dynamic environment makes CRM skills of physicians particularly critical to healthcare team success. The Accreditation Council of Graduate Medicine Education Core Competencies that guide residency program curriculums include CRM skills; however, EM residency programs are not given specific instructions as to how to teach these skills to their trainees. This article describes a simulation-based CRM course designed specifically for novice EM residents. Methods The CRM course includes an introductory didactic presentation followed by a series of simulation scenarios and structured debriefs. The course is designed to use observational learning within simulation education to decrease the time and resources required for implementation. To assess the effectiveness in improving team CRM skills, two independent raters use a validated CRM global rating scale to measure the CRM skills displayed by teams of EM interns in a pretest and posttest during the course. Results The CRM course improved leadership, problem solving, communication, situational awareness, teamwork, resource utilization and overall CRM skills displayed by teams of EM interns. While the improvement from pretest to posttest did not reach statistical significance for this pilot study, the large effect sizes suggest that statistical significance may be achieved with a larger sample size. Conclusion This course can feasibly be incorporated into existing EM residency curriculums to provide EM trainees with basic CRM skills required of successful emergency physicians. We believe integrating CRM training early into existing EM education encourages continued deliberate practice, discussion, and improvement of essential CRM skills.

  13. Spatial distribution of triazine residues in a shallow alluvial aquifer linked to groundwater residence time.

    Science.gov (United States)

    Sassine, Lara; Le Gal La Salle, Corinne; Khaska, Mahmoud; Verdoux, Patrick; Meffre, Patrick; Benfodda, Zohra; Roig, Benoît

    2017-03-01

    At present, some triazine herbicides occurrence in European groundwater, 13 years after their use ban in the European Union, remains of great concern and raises the question of their persistence in groundwater systems due to several factors such as storage and remobilization from soil and unsaturated zone, limited or absence of degradation, sorption in saturated zones, or to continuing illegal applications. In order to address this problem and to determine triazine distribution in the saturated zone, their occurrence is investigated in the light of the aquifer hydrodynamic on the basis of a geochemical approach using groundwater dating tracers ( 3 H/ 3 He). In this study, atrazine, simazine, terbuthylazine, deethylatrazine, deisopropylatrazine, and deethylterbuthylazine are measured in 66 samples collected between 2011 and 2013 from 21 sampling points, on the Vistrenque shallow alluvial aquifer (southern France), covered by a major agricultural land use. The frequencies of quantification range from 100 to 56 % for simazine and atrazine, respectively (LQ = 1 ng L -1 ). Total triazine concentrations vary between 15 and 350 ng L -1 and show three different patterns with depth below the water table: (1) low concentrations independent of depth but related to water origin, (2) an increase in concentrations with depth in the aquifer related to groundwater residence time and triazine use prior to their ban, and (3) relatively high concentrations at low depths in the saturated zone more likely related to a slow desorption of these compounds from the soil and unsaturated zone. The triazine attenuation rate varies between 0.3 for waters influenced by surface water infiltration and 4.8 for water showing longer residence times in the aquifer, suggesting an increase in these rates with water residence time in the saturated zone. Increasing triazine concentrations with depth is consistent with a significant decrease in the use of these pesticides for the last 10 years on

  14. Devolatilization kinetics of woody biomass at short residence times and high heating rates and peak temperatures

    DEFF Research Database (Denmark)

    Johansen, Joakim M.; Gadsbøll, Rasmus; Thomsen, Jesper

    2016-01-01

    This work combines experimental and computational fluid dynamics (CFD) results to derive global kinetics for biomass (pine wood) devolatilization during heating rates on the order of 105Ks-1, bulk flow peak temperatures between 1405 and 1667K, and particle residence times below 0.1s. Experiments......Jmol-1. The accuracy of the derived global kinetics was supported by comparing predictions to experimental results from a 15kW furnace. The work emphasizes the importance of characterizing the temperature history of the biomass particles when deriving pyrolysis kinetics. The present results indicate...

  15. Water Residence Time estimation by 1D deconvolution in the form of a l2 -regularized inverse problem with smoothness, positivity and causality constraints

    Science.gov (United States)

    Meresescu, Alina G.; Kowalski, Matthieu; Schmidt, Frédéric; Landais, François

    2018-06-01

    The Water Residence Time distribution is the equivalent of the impulse response of a linear system allowing the propagation of water through a medium, e.g. the propagation of rain water from the top of the mountain towards the aquifers. We consider the output aquifer levels as the convolution between the input rain levels and the Water Residence Time, starting with an initial aquifer base level. The estimation of Water Residence Time is important for a better understanding of hydro-bio-geochemical processes and mixing properties of wetlands used as filters in ecological applications, as well as protecting fresh water sources for wells from pollutants. Common methods of estimating the Water Residence Time focus on cross-correlation, parameter fitting and non-parametric deconvolution methods. Here we propose a 1D full-deconvolution, regularized, non-parametric inverse problem algorithm that enforces smoothness and uses constraints of causality and positivity to estimate the Water Residence Time curve. Compared to Bayesian non-parametric deconvolution approaches, it has a fast runtime per test case; compared to the popular and fast cross-correlation method, it produces a more precise Water Residence Time curve even in the case of noisy measurements. The algorithm needs only one regularization parameter to balance between smoothness of the Water Residence Time and accuracy of the reconstruction. We propose an approach on how to automatically find a suitable value of the regularization parameter from the input data only. Tests on real data illustrate the potential of this method to analyze hydrological datasets.

  16. Finite elements-based 2D theoretical analysis of the effect of IEX membrane thickness and salt solution residence time on the ion transport within a salinity gradient power reverse electrodialysis half cell pair

    OpenAIRE

    Etienne, Brauns

    2013-01-01

    Reverse electrodialysis electrical power generation is based on the transport of salt ions through ion conductive membranes. The ion flux, equivalent to an electric current, results from a salinity gradient, induced by two salt solutions at significantly different concentrations. Such equivalent electric current in combination with the corresponding electrochemical potential difference across the membrane, equivalent to an electric potential, results in a battery equivalency. While having a c...

  17. Spatio-Temporal Characteristics of Resident Trip Based on Poi and OD Data of Float CAR in Beijing

    Science.gov (United States)

    Mou, N.; Li, J.; Zhang, L.; Liu, W.; Xu, Y.

    2017-09-01

    Due to the influence of the urban inherent regional functional distribution, the daily activities of the residents presented some spatio-temporal patterns (periodic patterns, gathering patterns, etc.). In order to further understand the spatial and temporal characteristics of urban residents, this paper research takes the taxi trajectory data of Beijing as a sample data and studies the spatio-temporal characteristics of the residents' activities on the weekdays. At first, according to the characteristics of the taxi trajectory data distributed along the road network, it takes the Voronoi generated by the road nodes as the research unit. This paper proposes a hybrid clustering method - based on grid density, which is used to cluster the OD (origin and destination) data of taxi at different times. Then combining with the POI data of Beijing, this research calculated the density of the POI data in the clustering results, and analyzed the relationship between the activities of residents in different periods and the functional types of the region. The final results showed that the residents were mainly commuting on weekdays. And it found that the distribution of travel density showed a concentric circle of the characteristics, focusing on residential areas and work areas. The results of cluster analysis and POI analysis showed that the residents' travel had experienced the process of "spatial relative dispersion - spatial aggregation - spatial relative dispersion" in one day.

  18. SPATIO-TEMPORAL CHARACTERISTICS OF RESIDENT TRIP BASED ON POI AND OD DATA OF FLOAT CAR IN BEIJING

    Directory of Open Access Journals (Sweden)

    N. Mou

    2017-09-01

    Full Text Available Due to the influence of the urban inherent regional functional distribution, the daily activities of the residents presented some spatio-temporal patterns (periodic patterns, gathering patterns, etc.. In order to further understand the spatial and temporal characteristics of urban residents, this paper research takes the taxi trajectory data of Beijing as a sample data and studies the spatio-temporal characteristics of the residents' activities on the weekdays. At first, according to the characteristics of the taxi trajectory data distributed along the road network, it takes the Voronoi generated by the road nodes as the research unit. This paper proposes a hybrid clustering method – based on grid density, which is used to cluster the OD (origin and destination data of taxi at different times. Then,combining with the POI data of Beijing, this research calculated the density of the POI data in the clustering results, and analyzed the relationship between the activities of residents in different periods and the functional types of the region. The final results showed that the residents were mainly commuting on weekdays. And it found that the distribution of travel density showed a concentric circle of the characteristics, focusing on residential areas and work areas. The results of cluster analysis and POI analysis showed that the residents' travel had experienced the process of "spatial relative dispersion – spatial aggregation – spatial relative dispersion" in one day.

  19. Keeping up with the times: revising the dermatology residency curriculum in the era of molecular diagnostics and personalized medicine.

    Science.gov (United States)

    LaChance, Avery; Murphy, Michael J

    2014-11-01

    The clinical use of molecular diagnostics, genomics, and personalized medicine is increasing and improving rapidly over time. However, medical education incorporating the practical application of these techniques is lagging behind. Although instruction in these areas should be expanded upon and improved at all levels of training, residency provides a concentrated period of time in which to hone in on skills that are practically applicable to a trainee's specialty of choice. Although residencies in some fields, such as pathology, have begun to incorporate practical molecular diagnostics training, this area remains a relative gap in dermatology residency programs. Herein, we advocate for the incorporation of training in molecular diagnostics and personalized medicine into dermatology residency programs and propose a basic curriculum template for how to begin approaching these topics. By incorporating molecular diagnostics into dermatology residency training, dermatologists have the opportunity to lead the way and actively shape the specialty's transition into the era of personalized medicine. © 2014 The International Society of Dermatology.

  20. Simulation for Teaching Orthopaedic Residents in a Competency-based Curriculum: Do the Benefits Justify the Increased Costs?

    Science.gov (United States)

    Nousiainen, Markku T; McQueen, Sydney A; Ferguson, Peter; Alman, Benjamin; Kraemer, William; Safir, Oleg; Reznick, Richard; Sonnadara, Ranil

    2016-04-01

    Although simulation-based training is becoming widespread in surgical education and research supports its use, one major limitation is cost. Until now, little has been published on the costs of simulation in residency training. At the University of Toronto, a novel competency-based curriculum in orthopaedic surgery has been implemented for training selected residents, which makes extensive use of simulation. Despite the benefits of this intensive approach to simulation, there is a need to consider its financial implications and demands on faculty time. This study presents a cost and faculty work-hours analysis of implementing simulation as a teaching and evaluation tool in the University of Toronto's novel competency-based curriculum program compared with the historic costs of using simulation in the residency training program. All invoices for simulation training were reviewed to determine the financial costs before and after implementation of the competency-based curriculum. Invoice items included costs for cadavers, artificial models, skills laboratory labor, associated materials, and standardized patients. Costs related to the surgical skills laboratory rental fees and orthopaedic implants were waived as a result of special arrangements with the skills laboratory and implant vendors. Although faculty time was not reimbursed, faculty hours dedicated to simulation were also evaluated. The academic year of 2008 to 2009 was chosen to represent an academic year that preceded the introduction of the competency-based curriculum. During this year, 12 residents used simulation for teaching. The academic year of 2010 to 2011 was chosen to represent an academic year when the competency-based curriculum training program was functioning parallel but separate from the regular stream of training. In this year, six residents used simulation for teaching and assessment. The academic year of 2012 to 2013 was chosen to represent an academic year when simulation was used equally

  1. An instrument to characterize the environment for residents' evidence-based medicine learning and practice.

    Science.gov (United States)

    Mi, Misa; Moseley, James L; Green, Michael L

    2012-02-01

    Many residency programs offer training in evidence-based medicine (EBM). However, these curricula often fail to achieve optimal learning outcomes, perhaps because they neglect various contextual factors in the learning environment. We developed and validated an instrument to characterize the environment for EBM learning and practice in residency programs. An EBM Environment Scale was developed following scale development principles. A survey was administered to residents across six programs in primary care specialties at four medical centers. Internal consistency reliability was analyzed with Cronbach's coefficient alpha. Validity was assessed by comparing predetermined subscales with the survey's internal structure as assessed via factor analysis. Scores were also compared for subgroups based on residency program affiliation and residency characteristics. Out of 262 eligible residents, 124 completed the survey (response rate 47%). The overall mean score was 3.89 (standard deviation=0.56). The initial reliability analysis of the 48-item scale had a high reliability coefficient (Cronbach α=.94). Factor analysis and further item analysis resulted in a shorter 36-item scale with a satisfactory reliability coefficient (Cronbach α=.86). Scores were higher for residents with prior EBM training in medical school (4.14 versus 3.62) and in residency (4.25 versus 3.69). If further testing confirms its properties, the EBM Environment Scale may be used to understand the influence of the learning environment on the effectiveness of EBM training. Additionally, it may detect changes in the EBM learning environment in response to programmatic or institutional interventions.

  2. Shortening the Miles to the Milestones: Connecting EPA-Based Evaluations to ACGME Milestone Reports for Internal Medicine Residency Programs.

    Science.gov (United States)

    Choe, John H; Knight, Christopher L; Stiling, Rebekah; Corning, Kelli; Lock, Keli; Steinberg, Kenneth P

    2016-07-01

    The Next Accreditation System requires internal medicine training programs to provide the Accreditation Council for Graduate Medical Education (ACGME) with semiannual information about each resident's progress in 22 subcompetency domains. Evaluation of resident "trustworthiness" in performing entrustable professional activities (EPAs) may offer a more tangible assessment construct than evaluations based on expectations of usual progression toward competence. However, translating results from EPA-based evaluations into ACGME milestone progress reports has proven to be challenging because the constructs that underlay these two systems differ.The authors describe a process to bridge the gap between rotation-specific EPA-based evaluations and ACGME milestone reporting. Developed at the University of Washington in 2012 and 2013, this method involves mapping EPA-based evaluation responses to "milestone elements," the narrative descriptions within the columns of each of the 22 internal medicine subcompetencies. As faculty members complete EPA-based evaluations, the mapped milestone elements are automatically marked as "confirmed." Programs can maintain a database that tallies the number of times each milestone element is confirmed for a resident; these data can be used to produce graphical displays of resident progress along the internal medicine milestones.Using this count of milestone elements allows programs to bridge the gap between faculty assessments of residents based on rotation-specific observed activities and semiannual ACGME reports based on the internal medicine milestones. Although potentially useful for all programs, this method is especially beneficial to large programs where clinical competency committee members may not have the opportunity for direct observation of all residents.

  3. Determination of flow patterns in industrial gold leaching tank by radiotracer residence time distribution measurement

    International Nuclear Information System (INIS)

    Stegowski, Z.; Furman, L.; Dagadu, Ch.P.K.; Akaho, E.H.K.; Danso, K.A.; Mumuni, I.I.; Adu, P.S; Amoah, Ch.

    2010-01-01

    The carbon-in-leach (CIL) process is one the most efficient methods of gold recovery from gold bearing ores. The efficiency of the leaching process greatly depends on the flow structure created by mechanical agitation (in some cases air agitation) in the leaching tanks. Residence time distribution (RTD) measurement was conducted in the CIL section of a gold processing plant in order to determine the flow structure in the first tank using the 131 I radioactive tracer. The shape of the experimental data revealed that the flow behaviour in the tank was close to an ideal mixer. Modelling of the experimental data, however, revealed that the tank was not behaving as a single perfect mixer, but consisted of two mixing zones. The flow structure in the tank was best described by the '' perfect mixers with exchange '' model consisting of two mixing zones. The model allowed the determination of flow parameters including the mean residence time, flow rate and volumes of the mixing zones. (authors)

  4. Determination of the hydraulic residence time of trickling filters using radiotracer experiments

    International Nuclear Information System (INIS)

    Debien, Bruno R.; Ferreira, Ladislau M.; Barreto, Alberto A.; Pinto, Amenonia M.F.

    2013-01-01

    Trickling filters (TF) are bioreactors fulfilled with inert materials working as support for biofilm development, and have been used in a large scale in wastewater treatment for organic matter, ammonia nitrogen and nitrate removal. TF's can be widely used in Brazil, especially because of its simplicity and operational low cost. The efficiency of pollutants removal processes depends on the water flow dynamics inside the reactor. For this reason, in the present work the mean residence time of two TF's containing different support materials were determined by means of tracer testes. The radioisotope 82Br - a gamma radiation emitter, produced from soluble potassium bromide irradiated in the TRIGA reactor at the Centre for the Development of Nuclear Energy (CDTN) - was used as a pseudo-conservative tracer for the comparative study of aqueous phase flow dynamics in both TF's. Mean residence time for the first TF (containing a single support material) was 0,3 hours, much smaller than the value obtained for the second TF (containing two alternated support materials), around 2 hours. These results were already expected, once the alternated material is denser than the single one, and are very important for numerical modeling studies aiming to determine the kinetic constant for removal of the pollutants cited above. (author)

  5. Tritium activity concentrations and residence times of groundwater collected in Rokkasho, Japan

    International Nuclear Information System (INIS)

    Hasegawa, Hidenao; Ueda, Shinji; Kakiuchi, Hideki; Hisamatsu, Shun'ichi; Akata, Naofumi

    2015-01-01

    Tritium ( 3 H) concentrations were measured in groundwater samples from four surface wells (4-10 m deep), four shallow wells (24-26.5 m deep) and a 150-m-deep well in the Futamata River catchment area, which is adjacent to the large-scale commercial spent nuclear fuel reprocessing plant in Rokkasho, Japan. The 3 H concentrations in most of the surface- and shallow-well samples (<0.03-0.57 Bq l -1 ) were similar to those in precipitation (annual mean: 0.31-0.79 Bq l -1 ), suggesting that the residence time of the water in those wells was 0-15 y. The 3 H concentrations in the samples from a 26-m-deep well and the 150-m-deep well were lower than those in the other wells, indicating that groundwater with a long residence time exists in deep aquifers and the estuary area of the catchment. It is not clear whether 3 H released during test operation of the plant with actual spent nuclear fuel affected the 3 H concentrations observed in this study. (authors)

  6. Determination of the hydraulic residence time of trickling filters using radiotracer experiments

    Energy Technology Data Exchange (ETDEWEB)

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

    2013-07-01

    Trickling filters (TF) are bioreactors fulfilled with inert materials working as support for biofilm development, and have been used in a large scale in wastewater treatment for organic matter, ammonia nitrogen and nitrate removal. TF's can be widely used in Brazil, especially because of its simplicity and operational low cost. The efficiency of pollutants removal processes depends on the water flow dynamics inside the reactor. For this reason, in the present work the mean residence time of two TF's containing different support materials were determined by means of tracer testes. The radioisotope 82Br - a gamma radiation emitter, produced from soluble potassium bromide irradiated in the TRIGA reactor at the Centre for the Development of Nuclear Energy (CDTN) - was used as a pseudo-conservative tracer for the comparative study of aqueous phase flow dynamics in both TF's. Mean residence time for the first TF (containing a single support material) was 0,3 hours, much smaller than the value obtained for the second TF (containing two alternated support materials), around 2 hours. These results were already expected, once the alternated material is denser than the single one, and are very important for numerical modeling studies aiming to determine the kinetic constant for removal of the pollutants cited above. (author)

  7. A study of residence time distribution using radiotracer technique in the large scale plant facility

    Science.gov (United States)

    Wetchagarun, S.; Tippayakul, C.; Petchrak, A.; Sukrod, K.; Khoonkamjorn, P.

    2017-06-01

    As the demand for troubleshooting of large industrial plants increases, radiotracer techniques, which have capability to provide fast, online and effective detections to plant problems, have been continually developed. One of the good potential applications of the radiotracer for troubleshooting in a process plant is the analysis of Residence Time Distribution (RTD). In this paper, the study of RTD in a large scale plant facility using radiotracer technique was presented. The objective of this work is to gain experience on the RTD analysis using radiotracer technique in a “larger than laboratory” scale plant setup which can be comparable to the real industrial application. The experiment was carried out at the sedimentation tank in the water treatment facility of Thailand Institute of Nuclear Technology (Public Organization). Br-82 was selected to use in this work due to its chemical property, its suitable half-life and its on-site availability. NH4Br in the form of aqueous solution was injected into the system as the radiotracer. Six NaI detectors were placed along the pipelines and at the tank in order to determine the RTD of the system. The RTD and the Mean Residence Time (MRT) of the tank was analysed and calculated from the measured data. The experience and knowledge attained from this study is important for extending this technique to be applied to industrial facilities in the future.

  8. Investigation of liquid phase axial dispersion in Taylor bubble flow by radiotracer residence time distribution analysis

    Directory of Open Access Journals (Sweden)

    Jin J.H.

    2013-05-01

    Full Text Available A gas-liquid Taylor bubble flow occurs in small diameter channels in which gas bubbles are separated by slugs of pure liquid. This type of flow regime is well suited for solid catalyzed gas-liquid reactors in which the reaction efficiency is a strong function of axial dispersion in the regions of pure liquid. This paper presents an experimental study of liquid phase axial dispersion in a Taylor bubble flow developed in a horizontal tube using high speed photography and radiotracer residence time distribution (RTD analysis. A parametric dependence of axial dispersion on average volume fraction of gas phase was also investigated by varying the relative volumetric flow rates of the two phases. 137mBa produced from a 137Cs/137mBa radionuclide generator was used as radiotracer and measurements were made using the NaI(Tl scintillation detectors. Validation of 137mBa in the form of barium chloride as aqueous phase radiotracer was also carried out. Axial Dispersion Model (ADM was used to simulate the hydrodynamics of the system and the results of the experiment are presented. It was observed that the system is characterized by very high values of Peclet Number (Pe∼102 which reveals an approaching plug type flow. The experimental and model estimated values of mean residence times were observed in agreement with each other.

  9. Optimizing residence time, temperature and speed to improve TMP pulp properties and reduce energy

    Energy Technology Data Exchange (ETDEWEB)

    Sabourin, M.; Xu, E.; Cort, B.; Boileau, I.; Waller, A.

    1997-04-01

    The concept of reducing energy consumption in pulp mills by increasing the disc speed of refining has been established using single disc and double disc refiners in both pilot plant and mill applications. The RTS study evaluated in this paper reviews the effect of high-speed single disc refining coupled with shortdwell-high pressure retention conditions. Coupling these variables permitted evaluation of an optimum residence time, temperature and speed (RTS) operational window. The objective of the RTS conditions to sufficiently soften the wood chips through high temperature such that the fibre is more receptive to initial defiberization at high intensity. The improved pulp from the primary refiner at high intensity could potentially demonstrate improvements in physical pulp properties at a reduced specific energy requirement. The spruce/fir RTS-TMP described here required significantly less specific energy and produced TMP with slightly improved strength properties and equivalent optical properties compared to conventional TMP pulp. Studies on the radiate pine furnish indicated that the physical pulp property/specific energy relationships could be adjusted by manipulating the residence time. 4 refs., 10 tabs., 10 figs.

  10. Tritium activity concentrations and residence times of groundwater collected in Rokkasho, Japan.

    Science.gov (United States)

    Hasegawa, Hidenao; Ueda, Shinji; Akata, Naofumi; Kakiuchi, Hideki; Hisamatsu, Shun'ichi

    2015-11-01

    Tritium ((3)H) concentrations were measured in groundwater samples from four surface wells (4-10 m deep), four shallow wells (24-26.5 m deep) and a 150-m-deep well in the Futamata River catchment area, which is adjacent to the large-scale commercial spent nuclear fuel reprocessing plant in Rokkasho, Japan. The (3)H concentrations in most of the surface- and shallow-well samples (<0.03-0.57 Bq l(-1)) were similar to those in precipitation (annual mean: 0.31-0.79 Bq l(-1)), suggesting that the residence time of the water in those wells was 0-15 y. The (3)H concentrations in the samples from a 26-m-deep well and the 150-m-deep well were lower than those in the other wells, indicating that groundwater with a long residence time exists in deep aquifers and the estuary area of the catchment. It is not clear whether (3)H released during test operation of the plant with actual spent nuclear fuel affected the (3)H concentrations observed in this study. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  11. Groundwater residence time in basement aquifers of the Ochi-Narkwa Basin in the Central Region of Ghana

    Science.gov (United States)

    Ganyaglo, Samuel Y.; Osae, Shiloh; Akiti, Tetteh; Armah, Thomas; Gourcy, Laurence; Vitvar, Tomas; Ito, Mari; Otoo, Isaac

    2017-10-01

    Groundwaters from basement aquifers in the Ochi-Narkwa basin of the Central Region together with rain and surface waters have been analysed for stable isotopes (δ18O, δ2H and δ13C) and radioisotopes (3H and 14C) to determine sources of recharge, groundwater residence time and flow path. The mechanism of recharge to the groundwaters is by direct infiltration of past local rainfall of mean isotopic composition δ18O = -3.8‰ V-SMOW and δ2H = -18‰ V-SMOW. Tritium in the groundwaters ranged from 0.05 ± 0.07 to 4.75 ± 0.16 TU. Tritium data revealed that 85% of the groundwater samples were of modern recharge or young waters. The 14C content of the groundwaters ranged between 9.50 pMC in borehole CR2-50 at Ekumfi Asokwa to 113.56 pMC in borehole CR3-26 at Onyaadze. Evaluation of 3H and 14C data distinguished three groups of water namely (1) waters characterised by high 3H and high 14C depicting modern recharge, (2) waters showing a mixture of young and old water due to fractures and (3) waters showing low 3H and low 14C contents referred to as very old waters and include borehole CR2-50 at Ekumfi Asokwa. The estimated age or residence time of this older water is 19,459 years BP based on uncorrected age. The major flow direction is northwest-southeast. The dominant months contributing to recharge in the study area were February, March, April, May, June, August, September and October. Groundwater residence times in the basement aquifers of the Ochi-Narkwa basin showed that groundwater abstraction is sustainable and requires that the recharge areas are protected from contamination.

  12. Measurements of liquid phase residence time distributions in a pilot-scale continuous leaching reactor using radiotracer technique

    International Nuclear Information System (INIS)

    Pant, H.J.; Sharma, V.K.; Shenoy, K.T.; Sreenivas, T.

    2015-01-01

    An alkaline based continuous leaching process is commonly used for extraction of uranium from uranium ore. The reactor in which the leaching process is carried out is called a continuous leaching reactor (CLR) and is expected to behave as a continuously stirred tank reactor (CSTR) for the liquid phase. A pilot-scale CLR used in a Technology Demonstration Pilot Plant (TDPP) was designed, installed and operated; and thus needed to be tested for its hydrodynamic behavior. A radiotracer investigation was carried out in the CLR for measurement of residence time distribution (RTD) of liquid phase with specific objectives to characterize the flow behavior of the reactor and validate its design. Bromine-82 as ammonium bromide was used as a radiotracer and about 40–60 MBq activity was used in each run. The measured RTD curves were treated and mean residence times were determined and simulated using a tanks-in-series model. The result of simulation indicated no flow abnormality and the reactor behaved as an ideal CSTR for the range of the operating conditions used in the investigation. - Highlights: • Radiotracer technique was applied for evaluation of design of a pilot-scale continuous leaching reactor. • Mean residence time and dead volume were estimated. Dead volume was found to be ranging from 4% to 15% at different operating conditions. • Tank-in-series model was used to simulate the measured RTD data and was found suitable to describe the flow in the reactor. • No flow abnormality was found and the reactor behaved as a well-mixed system. The design of the reactor was validated

  13. Stress and burnout in residents: impact of mindfulness-based resilience training

    Directory of Open Access Journals (Sweden)

    Goldhagen BE

    2015-08-01

    Full Text Available Brian E Goldhagen,1 Karen Kingsolver,2 Sandra S Stinnett,1 Jullia A Rosdahl1 1Department of Ophthalmology, 2Department of Family and Community Medicine, Duke University Medical Center, Durham, NC, USABackground and objective: Stress and burnout impact resident physicians. This prospective study tests the hypothesis that a mindfulness-based resilience intervention would decrease stress and burnout in residents.Methods: Resident physicians from the Departments of Family Medicine, Psychiatry, and Anesthesia at Duke University, Durham, NC, USA, participated in two or three 1-hour sessions of mindfulness-based resilience activities, which introduced mindful-awareness and included practical exercises for nurturing resilience. Anonymous surveys were distributed before (completed by 47 residents and after the intervention (both completed by 30 residents; a follow-up survey was distributed 1 month later (seven residents completed all three surveys. The survey included the Depression Anxiety Stress Scale, 21-question version (DASS-21, the Oldenburg Burnout Inventory, the Mindful Attention Awareness Scale, and ten questions from the Cognitive Failures Questionnaire.Results: At baseline, most residents’ scores were in the normal range with respect to stress; however, female residents had higher DASS-21 scores than male residents (31.7, females vs 18.4, males; P=0.002. Most residents’ burnout scores were in the abnormal range, both with respect to exhaustion (38/47 residents, subscore ≥2.25 and disengagement (37/47 residents, subscore ≥2.1. Higher perceived levels of stress correlated with the instruments. Analysis of the surveys before and after the intervention showed no significant short-term change in stress, burnout, mindful-awareness, or cognitive failure. There was a trend for females and post-medical school graduate year 1 and 2 (PGY1 and PGY2 residents to have a reduction in DASS-21 scores after intervention. There was also a trend of

  14. Evidence-based practice for pain identification in cognitively impaired nursing home residents.

    Science.gov (United States)

    Sacoco, Christina; Ishikawa, Sally

    2014-09-01

    Pain identification of cognitively impaired elderly is very challenging. This project aimed to identify best practices for pain assessment in nursing home residents with cognitive impairment and to establish a standardized pain assessment guide to optimize nursing practice and resident outcomes. The Iowa Model of Evidence-Based Practice to Promote Quality of Care guided the project's process. Phase I of the project analyzed data gained from chart reviews on current practices of pain assessment, and Phase II used the results of Phase I to develop, implement, and evaluate an evidence-based practice standard for nursing assessment of pain for cognitively impaired residents. Copyright © 2014 Elsevier Inc. All rights reserved.

  15. The significance of oxygen as oxides and hydroxides in controlling the abundance and residence times of elements in seawater

    Digital Repository Service at National Institute of Oceanography (India)

    DileepKumar, M.

    A model is presented which signifies the role of oxygen (as oxides and hydroxides) in controlling the composition of seawater. respective concentration and residence times for the unknown elements can be estimated. Geometric and statistical indices...

  16. Prevalence and Cost of Full-Time Research Fellowships During General Surgery Residency – A National Survey

    Science.gov (United States)

    Robertson, Charles M.; Klingensmith, Mary E.; Coopersmith, Craig M.

    2009-01-01

    Structured Abstract Objective To quantify the prevalence, outcomes, and cost of surgical resident research. Summary Background Data General surgery is unique among graduate medical education programs because a large percentage of residents interrupt their clinical training to spend 1-3 years performing full-time research. No comprehensive data exists on the scope of this practice. Methods Survey sent to all 239 program directors of general surgery residencies participating in the National Resident Matching Program. Results Response rate was 200/239 (84%). A total of 381 out of 1052 trainees (36%) interrupt residency to pursue full-time research. The mean research fellowship length is 1.7 years, with 72% of trainees performing basic science research. A significant association was found between fellowship length and post-residency activity, with a 14.7% increase in clinical fellowship training and a 15.2% decrease in private practice positions for each year of full-time research (p<0.0001). Program directors at 31% of programs reported increased clinical duties for research fellows as a result of ACGME work hour regulations for clinical residents, while a further 10% of programs are currently considering such changes. It costs $41.5 million to pay the 634 trainees who perform research fellowships each year, the majority of which is paid for by departmental funds (40%) and institutional training grants (24%). Conclusions Interrupting residency to perform a research fellowship is a common and costly practice among general surgery residents. While performing a research fellowship is associated with clinical fellowship training after residency, it is unclear to what extent this practice leads to the development of surgical investigators after post-graduate training. PMID:19106692

  17. Associations of psychosocial working conditions and working time characteristics with somatic complaints in German resident physicians.

    Science.gov (United States)

    Fischer, Nina; Degen, Christiane; Li, Jian; Loerbroks, Adrian; Müller, Andreas; Angerer, Peter

    2016-05-01

    Somatic complaints (SC) are highly prevalent in working populations and cause suffering and extensive health-care utilization. Adverse psychosocial working conditions as conceptualized in the Job Demand-Control-Support Model (JDC-S) and adverse working time characteristics (WTC) are potential risk factors. This combination is particularly common in hospital physicians. This study examines associations of JDC-S and WTC with SC in resident physicians from Germany. A cross-sectional study was conducted among 405 physicians at the end of residency training. SC were measured using the Giessen Subjective Complaints List (GBB-24) containing the sub-categories exhaustion, gastrointestinal, musculoskeletal, and cardiovascular complaints. Data on working conditions were collected by a self-report method for work analysis in hospitals (TAA-KH-S) and by questions on WTC (i.e., working hours). Multivariable stepwise regression analyses were applied. Workload showed the most pronounced relationship with all sub-categories of SC except gastrointestinal complaints. Job autonomy was not significantly related to any SC sub-category. Social support at work was inversely associated with all SC sub-categories except for cardiovascular complaints. Free weekends were associated with reduced SC except for exhaustion. Shift work was related to an increased SC total score and musculoskeletal complaints. Working hours showed no association with SC. In resident physicians, high workload and shift work are associated with increased SC, while social support at work and free weekends are associated with decreased SC. These insights may inform the development of preventive measures to improve the health of this professional group. Prospective studies are needed though to corroborate our findings.

  18. 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.

  19. Orion: a web-based application designed to monitor resident and fellow performance on-call.

    Science.gov (United States)

    Itri, Jason N; Kim, Woojin; Scanlon, Mary H

    2011-10-01

    Radiology residency and fellowship training provides a unique opportunity to evaluate trainee performance and determine the impact of various educational interventions. We have developed a simple software application (Orion) using open-source tools to facilitate the identification and monitoring of resident and fellow discrepancies in on-call preliminary reports. Over a 6-month period, 19,200 on-call studies were interpreted by 20 radiology residents, and 13,953 on-call studies were interpreted by 25 board-certified radiology fellows representing eight subspecialties. Using standard review macros during faculty interpretation, each of these reports was classified as "agreement", "minor discrepancy", and "major discrepancy" based on the potential to impact patient management or outcome. Major discrepancy rates were used to establish benchmarks for resident and fellow performance by year of training, modality, and subspecialty, and to identify residents and fellows demonstrating a significantly higher major discrepancy rate compared with their classmates. Trends in discrepancies were used to identify subspecialty-specific areas of increased major discrepancy rates in an effort to tailor the didactic and case-based curriculum. A series of missed-case conferences were developed based on trends in discrepancies, and the impact of these conferences is currently being evaluated. Orion is a powerful information technology tool that can be used by residency program directors, fellowship programs directors, residents, and fellows to improve radiology education and training.

  20. Shadowing emergency medicine residents by medical education specialists to provide feedback on non-medical knowledge-based ACGME sub-competencies.

    Science.gov (United States)

    Waterbrook, Anna L; Spear Ellinwood, Karen C; Pritchard, T Gail; Bertels, Karen; Johnson, Ariel C; Min, Alice; Stoneking, Lisa R

    2018-01-01

    Non-medical knowledge-based sub-competencies (multitasking, professionalism, accountability, patient-centered communication, and team management) are challenging for a supervising emergency medicine (EM) physician to evaluate in real-time on shift while also managing a busy emergency department (ED). This study examines residents' perceptions of having a medical education specialist shadow and evaluate their nonmedical knowledge skills. Medical education specialists shadowed postgraduate year 1 and postgraduate year 2 EM residents during an ED shift once per academic year. In an attempt to increase meaningful feedback to the residents, these specialists evaluated resident performance in selected non-medical knowledge-based Accreditation Council of Graduate Medical Education (ACGME) sub-competencies and provided residents with direct, real-time feedback, followed by a written evaluation sent via email. Evaluations provided specific references to examples of behaviors observed during the shift and connected these back to ACGME competencies and milestones. Twelve residents participated in this shadow experience (six post graduate year 1 and six postgraduate year 2). Two residents emailed the medical education specialists ahead of the scheduled shadow shift requesting specific feedback. When queried, five residents voluntarily requested their feedback to be included in their formal biannual review. Residents received milestone scores and narrative feedback on the non-medical knowledge-based ACGME sub-competencies and indicated the shadow experience and subsequent feedback were valuable. Medical education specialists who observe residents over the course of an entire shift and evaluate non-medical knowledge-based skills are perceived by EM residents to provide meaningful feedback and add valuable information for the biannual review process.

  1. Factors Affecting Gender-based Experiences for Residents in Radiation Oncology

    International Nuclear Information System (INIS)

    Barry, Parul N.; Miller, Karen H.; Ziegler, Craig; Hertz, Rosanna; Hanna, Nevine; Dragun, Anthony E.

    2016-01-01

    Purpose: Although women constitute approximately half of medical school graduates, an uneven gender distribution exists among many specialties, including radiation oncology, where women fill only one third of residency positions. Although multiple social and societal factors have been theorized, a structured review of radiation oncology resident experiences has yet to be performed. Methods and Materials: An anonymous and voluntary survey was sent to 611 radiation oncology residents practicing in the United States. Residents were asked about their gender-based experiences in terms of mentorship, their professional and learning environment, and their partnerships and personal life. Results: A total of 203 participants submitted completed survey responses. Fifty-seven percent of respondents were men, and 43% were women, with a mean age of 31 years (standard deviation=3.7 years). Although residents in general value having a mentor, female residents prefer mentors of the same gender (P<.001), and noted having more difficulty finding a mentor (P=.042). Women were more likely to say that they have observed preferential treatment based on gender (P≤.001), and they were more likely to perceive gender-specific biases or obstacles in their professional and learning environment (P<.001). Women selected residency programs based on gender ratios (P<.001), and female residents preferred to see equal numbers of male and female faculty (P<.001). Women were also more likely to perceive work-related strain than their male counterparts (P<.001). Conclusions: Differences in experiences for male and female radiation oncology residents exist with regard to mentorship and in their professional and learning environment.

  2. Factors Affecting Gender-based Experiences for Residents in Radiation Oncology

    Energy Technology Data Exchange (ETDEWEB)

    Barry, Parul N., E-mail: pnbarr01@louisville.edu [Department of Radiation Oncology, University of Louisville, School of Medicine, Louisville, Kentucky (United States); Miller, Karen H.; Ziegler, Craig [Department of Graduate Medical Education, University of Louisville, School of Medicine, Louisville, Kentucky (United States); Hertz, Rosanna [Departments of Women' s and Gender Studies and Sociology, Wellesley College, Wellesley, Massachusetts (United States); Hanna, Nevine [Department of Radiation Oncology, University of Utah, School of Medicine, Salt Lake City, Utah (United States); Dragun, Anthony E. [Department of Radiation Oncology, University of Louisville, School of Medicine, Louisville, Kentucky (United States)

    2016-07-01

    Purpose: Although women constitute approximately half of medical school graduates, an uneven gender distribution exists among many specialties, including radiation oncology, where women fill only one third of residency positions. Although multiple social and societal factors have been theorized, a structured review of radiation oncology resident experiences has yet to be performed. Methods and Materials: An anonymous and voluntary survey was sent to 611 radiation oncology residents practicing in the United States. Residents were asked about their gender-based experiences in terms of mentorship, their professional and learning environment, and their partnerships and personal life. Results: A total of 203 participants submitted completed survey responses. Fifty-seven percent of respondents were men, and 43% were women, with a mean age of 31 years (standard deviation=3.7 years). Although residents in general value having a mentor, female residents prefer mentors of the same gender (P<.001), and noted having more difficulty finding a mentor (P=.042). Women were more likely to say that they have observed preferential treatment based on gender (P≤.001), and they were more likely to perceive gender-specific biases or obstacles in their professional and learning environment (P<.001). Women selected residency programs based on gender ratios (P<.001), and female residents preferred to see equal numbers of male and female faculty (P<.001). Women were also more likely to perceive work-related strain than their male counterparts (P<.001). Conclusions: Differences in experiences for male and female radiation oncology residents exist with regard to mentorship and in their professional and learning environment.

  3. Putting residents in the office: an effective method to teach the systems-based practice competency.

    Science.gov (United States)

    Pulcrano, Marisa; Chahine, A Alfred; Saratsis, Amanda; Divine-Cadavid, Jamie; Narra, Vinod; Evans, Stephen R T

    2015-01-01

    Systems-based practice (SBP) was 1 of 6 core competencies established by the Accreditation Council for Graduate Medical Education and has proven to be one of the most difficult to effectively implement. This pilot study presents an immersion workshop as an effective tool to teach the SBP competency in a way that could easily be integrated into a residency curriculum. In 2006, 16 surgical residents rotated through 3 stations for 30 minutes each: coding and billing, scheduling operations and return appointments, and patient check-in. Participants were administered a pretest and posttest questionnaire evaluating their knowledge of SBP, and were asked to evaluate the workshop. Outpatient clinic at MedStar Georgetown University Hospital, Washington, DC. Residents in the general surgery residency training program at MedStar Georgetown University Hospital. Most residents (62.5%) improved their score after the workshop, whereas 31.25% showed no change and 6.25% demonstrated a decrease in score. Overall within their training levels, all groups demonstrated an increase in mean test score. Postgraduate year-2 residents demonstrated the greatest change in mean score (20%), whereas postgraduate year-4 residents demonstrated the smallest change in mean score (3.3%). An immersion workshop where general surgery residents gained direct exposure to SBP concepts in situ was an effective and practical method of integrating this core competency into the residency curriculum. Such a workshop could complement more formal didactic teaching and be easily incorporated into the curriculum. For example, this workshop could be integrated into the ambulatory care requirement that each resident must fulfill as part of their clinical training. Copyright © 2014 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  4. Evaluation of clinical teaching quality in competency-based residency training in Lithuania.

    Science.gov (United States)

    Vaižgėlienė, Eglė; Padaiga, Žilvinas; Rastenytė, Daiva; Tamelis, Algimantas; Petrikonis, Kęstutis; Fluit, Cornelia

    2017-12-01

    In 2013, all residency programs at the Lithuanian University of Health Sciences were renewed into the competency-based medical education curriculum (CBME). In 2015, we implemented the validated EFFECT questionnaire together with the EFFECT-System for quality assessment of clinical teaching in residency training. The aim of this study was to investigate the influence of characteristics of the resident (year of training) and clinical teacher (gender, age, and type of academic position) on teaching quality, as well as to assess areas for teaching quality improvement. Residents from 7 different residency study programs filled out 333 EFFECT questionnaires evaluating 146 clinical teachers. We received 143 self-evaluations of clinical teachers using the same questionnaire. Items were scored on a 6-point Likert scale. Main outcome measures were residents' mean overall (MOS), mean subdomain (MSS) and clinical teachers' self-evaluation scores. The overall comparisons of MOS and MSS across study groups and subgroups were done using Student's t test and ANOVA for trend. The intraclass correlation coefficient (ICC) was calculated in order to see how residents' evaluations match with self-evaluations for every particular teacher. To indicate areas for quality improvement items were analyzed subtracting their mean score from the respective (sub)domain score. MOS for domains of "role modeling", "task allocation", "feedback", "teaching methodology" and "assessment" valued by residents were significantly higher than those valued by teachers (Pevaluation questionnaires were rated significantly higher by residents in role modeling subdomains (Phigher than the female teachers (Phigher (Pevaluations of clinical teachers are influenced by teachers' age, gender, year of residency training, type of teachers' academic position and whether or not a clinical teacher performed self-evaluation. Development of CBME should be focused on the continuous evaluation of quality, clinical teachers

  5. Trait differences between naturalized and invasive plant species independent of residence time and phylogeny.

    Science.gov (United States)

    Gallagher, R V; Randall, R P; Leishman, M R

    2015-04-01

    The ability to predict which alien plants will transition from naturalized to invasive prior to their introduction to novel regions is a key goal for conservation and has the potential to increase the efficacy of weed risk assessment (WRA). However, multiple factors contribute to plant invasion success (e.g., functional traits, range characteristics, residence time, phylogeny), and they all must be taken into account simultaneously in order to identify meaningful correlates of invasion success. We compiled 146 pairs of phylogenetically paired (congeneric) naturalized and invasive plant species in Australia with similar minimum residence times (i.e., time since introduction in years). These pairs were used to test for differences in 5 functional traits (flowering duration, leaf size, maximum height, specific leaf area [SLA], seed mass) and 3 characteristics of species' native ranges (biome occupancy, mean annual temperature, and rainfall breadth) between naturalized and invasive species. Invasive species, on average, had larger SLA, longer flowering periods, and were taller than their congeneric naturalized relatives. Invaders also exhibited greater tolerance for different environmental conditions in the native range, where they occupied more biomes and a wider breadth of rainfall and temperature conditions than naturalized congeners. However, neither seed mass nor leaf size differed between pairs of naturalized and invasive species. A key finding was the role of SLA in distinguishing between naturalized and invasive pairs. Species with high SLA values were typically associated with faster growth rates, more rapid turnover of leaf material, and shorter lifespans than those species with low SLA. This suite of characteristics may contribute to the ability of a species to transition from naturalized to invasive across a wide range of environmental contexts and disturbance regimes. Our findings will help in the refinement of WRA protocols, and we advocate the inclusion

  6. Calculation of residence times and radiation doses using the standard PC software Excel

    International Nuclear Information System (INIS)

    Herzog, H.; Zilken, H.; Niederbremer, A.; Friedrich, W.; Mueller-Gaertner, H.W.

    1997-01-01

    We developed a program which aims to facilitate the calculation of radiation doses to single organs and the whole body. IMEDOSE uses Excel to include calculations, graphical displays, and interactions with the user in a single general-purpose PC software tool. To start the procedure the input data are copied into a spreadsheet. They must represent percentage uptake values of several organs derived from measurements in animals or humans. To extrapolate these data up to seven half-lives of the radionuclide, fitting to one or two exponentional functions is included and can be checked by the user. By means of the approximate time-activity information the cumulated activity or residence times are calculated. Finally these data are combined with the absorbed fraction doses (S-values) given by MIRD pamphlet No. 11 to yield radiation doses, the effective dose equivalent and the effective dose. These results are presented in a final table. Interactions are realized with push-buttons and drop-down menus. Calculations use the Visual Basic tool of Excel. In order to test our program, biodistribution data of fluorine-18 fluorodeoxyglucose were taken from the literature (Meija et al., J Nucl Med 1991; 32:699-706). For a 70-kg adult the resulting radiation doses of all target organs listed in MIRD 11 were different from the ICRP 53 values by 1%±18% on the average. When the residence times were introduced into MIRDOSE3 (Stabin, J Nucl Med 1996; 37:538-546) the mean difference between our results and those of MIRDOSE3 was -3%±6%. Both outcomes indicate the validity of the present approach. (orig.)

  7. Calculation of residence times and radiation doses using the standard PC software Excel.

    Science.gov (United States)

    Herzog, H; Zilken, H; Niederbremer, A; Friedrich, W; Müller-Gärtner, H W

    1997-12-01

    We developed a program which aims to facilitate the calculation of radiation doses to single organs and the whole body. IMEDOSE uses Excel to include calculations, graphical displays, and interactions with the user in a single general-purpose PC software tool. To start the procedure the input data are copied into a spreadsheet. They must represent percentage uptake values of several organs derived from measurements in animals or humans. To extrapolate these data up to seven half-lives of the radionuclide, fitting to one or two exponentional functions is included and can be checked by the user. By means of the approximate time-activity information the cumulated activity or residence times are calculated. Finally these data are combined with the absorbed fraction doses (S-values) given by MIRD pamphlet No. 11 to yield radiation doses, the effective dose equivalent and the effective dose. These results are presented in a final table. Interactions are realized with push-buttons and drop-down menus. Calculations use the Visual Basic tool of Excel. In order to test our program, biodistribution data of fluorine-18 fluorodeoxyglucose were taken from the literature (Meija et al., J Nucl Med 1991; 32:699-706). For a 70-kg adult the resulting radiation doses of all target organs listed in MIRD 11 were different from the ICRP 53 values by 1%+/-18% on the average. When the residence times were introduced into MIRDOSE3 (Stabin, J Nucl Med 1996; 37:538-546) the mean difference between our results and those of MIRDOSE3 was -3%+/-6%. Both outcomes indicate the validity of the present approach.

  8. Calculation of residence times and radiation doses using the standard PC software Excel

    Energy Technology Data Exchange (ETDEWEB)

    Herzog, H.; Zilken, H.; Niederbremer, A.; Friedrich, W. [Institute of Medicine, Research Center Juelich, Juelich (Germany); Mueller-Gaertner, H.W. [Institute of Medicine, Research Center Juelich, Juelich (Germany)]|[Department of Nuclear Medicine, Heinrich-Heine University Hospital Duesseldorf (Germany)

    1997-12-01

    We developed a program which aims to facilitate the calculation of radiation doses to single organs and the whole body. IMEDOSE uses Excel to include calculations, graphical displays, and interactions with the user in a single general-purpose PC software tool. To start the procedure the input data are copied into a spreadsheet. They must represent percentage uptake values of several organs derived from measurements in animals or humans. To extrapolate these data up to seven half-lives of the radionuclide, fitting to one or two exponentional functions is included and can be checked by the user. By means of the approximate time-activity information the cumulated activity or residence times are calculated. Finally these data are combined with the absorbed fraction doses (S-values) given by MIRD pamphlet No. 11 to yield radiation doses, the effective dose equivalent and the effective dose. These results are presented in a final table. Interactions are realized with push-buttons and drop-down menus. Calculations use the Visual Basic tool of Excel. In order to test our program, biodistribution data of fluorine-18 fluorodeoxyglucose were taken from the literature (Meija et al., J Nucl Med 1991; 32:699-706). For a 70-kg adult the resulting radiation doses of all target organs listed in MIRD 11 were different from the ICRP 53 values by 1%{+-}18% on the average. When the residence times were introduced into MIRDOSE3 (Stabin, J Nucl Med 1996; 37:538-546) the mean difference between our results and those of MIRDOSE3 was -3%{+-}6%. Both outcomes indicate the validity of the present approach. (orig.) With 5 figs., 2 tabs., 18 refs.

  9. Residence time distribution measurements in a pilot-scale poison tank using radiotracer technique.

    Science.gov (United States)

    Pant, H J; Goswami, Sunil; Samantray, J S; Sharma, V K; Maheshwari, N K

    2015-09-01

    Various types of systems are used to control the reactivity and shutting down of a nuclear reactor during emergency and routine shutdown operations. Injection of boron solution (borated water) into the core of a reactor is one of the commonly used methods during emergency operation. A pilot-scale poison tank was designed and fabricated to simulate injection of boron poison into the core of a reactor along with coolant water. In order to design a full-scale poison tank, it was desired to characterize flow of liquid from the tank. Residence time distribution (RTD) measurement and analysis was adopted to characterize the flow dynamics. Radiotracer technique was applied to measure RTD of aqueous phase in the tank using Bromine-82 as a radiotracer. RTD measurements were carried out with two different modes of operation of the tank and at different flow rates. In Mode-1, the radiotracer was instantaneously injected at the inlet and monitored at the outlet, whereas in Mode-2, the tank was filled with radiotracer and its concentration was measured at the outlet. From the measured RTD curves, mean residence times (MRTs), dead volume and fraction of liquid pumped in with time were determined. The treated RTD curves were modeled using suitable mathematical models. An axial dispersion model with high degree of backmixing was found suitable to describe flow when operated in Mode-1, whereas a tanks-in-series model with backmixing was found suitable to describe flow of the poison in the tank when operated in Mode-2. The results were utilized to scale-up and design a full-scale poison tank for a nuclear reactor. Copyright © 2015 Elsevier Ltd. All rights reserved.

  10. Measurements of liquid phase residence time distributions in a pilot-scale continuous leaching reactor using radiotracer technique.

    Science.gov (United States)

    Pant, H J; Sharma, V K; Shenoy, K T; Sreenivas, T

    2015-03-01

    An alkaline based continuous leaching process is commonly used for extraction of uranium from uranium ore. The reactor in which the leaching process is carried out is called a continuous leaching reactor (CLR) and is expected to behave as a continuously stirred tank reactor (CSTR) for the liquid phase. A pilot-scale CLR used in a Technology Demonstration Pilot Plant (TDPP) was designed, installed and operated; and thus needed to be tested for its hydrodynamic behavior. A radiotracer investigation was carried out in the CLR for measurement of residence time distribution (RTD) of liquid phase with specific objectives to characterize the flow behavior of the reactor and validate its design. Bromine-82 as ammonium bromide was used as a radiotracer and about 40-60MBq activity was used in each run. The measured RTD curves were treated and mean residence times were determined and simulated using a tanks-in-series model. The result of simulation indicated no flow abnormality and the reactor behaved as an ideal CSTR for the range of the operating conditions used in the investigation. Copyright © 2014 Elsevier Ltd. All rights reserved.

  11. Determination of the resident time distribution (RTD) in copper concentrate drying plants using radioactive tracers

    International Nuclear Information System (INIS)

    Diaz V, Francisco J.; Duran P, Oscar U.; Hernandez A, Fernando A.

    1996-01-01

    This paper is a study on the drying process of copper concentrate, on two fluidized bed dryers at Fundicion Caletones, Division El Teniente, Codelco-Chile. The problem was investigated by experimental determination of the resident Time Distribution (RTD) for the material to be dry and by an analysis of the influence of the grain size in the drying process. The stimulus-response technique was used in the experiments, where the stimulation was a pulse of an adequate radioactive tracer injected at the dryer's input. Under these conditions, the response obtained at the dryer's outputs, i.e., the concentration variation curve as a function of time, represents directly the RTD of the system between the injection and measuring points. The tracer used was the same material to be dried, and it was irradiated with neutrons in the nuclear reactor at La Reina Nuclear Centre, thus producing a solid gamma radiation emitter tracer of identical behaviour as the material under study. The approximate activity of each sample was equivalent to 8 mCi of Cu-64 at the time of the injection and the measurement of the tracer was made on-line using NaI(Tl) gamma radiation detectors. The results obtained showed average times less than the estimated and would indicate a fast drying using minimum volume in the dryer. The drying of the fine particles was three times faster than the coarse ones. (author)

  12. Evaluation of Problem- and Simulator-Based Learning in Lumbar Puncture in Adult Neurology Residency Training.

    Science.gov (United States)

    Sun, Chenjing; Qi, Xiaokun

    2018-01-01

    Lumbar puncture (LP) is an essential part of adult neurology residency training. Technologic as well as nontechnologic training is needed. However, current assessment tools mostly focus on the technologic aspects of LP. We propose a training method-problem- and simulator-based learning (PSBL)-in LP residency training to develop overall skills of neurology residents. We enrolled 60 neurology postgraduate-year-1 residents from our standardized residents training center and randomly divided them into 2 groups: traditional teaching group and PSBL group. After training, we assessed the extent that the residents were ready to perform LP and tracked successful LPs performed by the residents. We then asked residents to complete questionnaires about the training models. Performance scores and the results of questionnaires were compared between the 2 groups. Students and faculty concluded that PSBL provided a more effective learning experience than the traditional teaching model. Although no statistical difference was found in the pretest, posttest, and improvement rate scores between the 2 groups, based on questionnaire scores and number of successful LPs after training, the PSBL group showed a statistically significant improvement compared with the traditional group. Findings indicated that nontechnical elements, such as planning before the procedure and controlling uncertainties during the procedure, are more crucial than technical elements. Compared with traditional teaching model, PSBL for LP training can develop overall surgical skills, including technical and nontechnical elements, improving performance. Residents in the PSBL group were more confident and effective in performing LP. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. Effects of mobile and digital support for a structured, competency-based curriculum in neurosurgery residency education.

    Science.gov (United States)

    Gonzalez, Nestor R; Dusick, Joshua R; Martin, Neil A

    2012-07-01

    Changes in neurosurgical practice and graduate medical education impose new challenges for training programs. We present our experience providing neurosurgical residents with digital and mobile educational resources in support of the departmental academic activities. A weekly mandatory conference program for all clinical residents based on the Accreditation Council for Graduate Medical Education competencies, held in protected time, was introduced. Topics were taught through didactic sessions and case discussions. Faculty and residents prepare high-quality presentations, equivalent to peer-review leading papers or case reports. Presentations are videorecorded, stored in a digital library, and broadcasted through our Website and iTunes U. Residents received mobile tablet devices with remote access to the digital library, applications for document/video management, and interactive teaching tools. Residents responded to an anonymous survey, and performances on the Self-Assessment in Neurological Surgery examination before and after the intervention were compared. Ninety-two percent reported increased time used to study outside the hospital and attributed the habit change to the introduction of mobile devices; 67% used the electronic tablets as the primary tool to access the digital library, followed by 17% hospital computers, 8% home computers, and 8% personal laptops. Forty-two percent have submitted operative videos, cases, and documents to the library. One year after introducing the program, results of the Congress of Neurological Surgeons-Self-Assessment in Neurological Surgery examination showed a statistically significant improvement in global scoring and improvement in 16 of the 18 individual areas evaluated, 6 of which reached statistical significance. A structured, competency-based neurosurgical education program supported with digital and mobile resources improved reading habits among residents and performance on the Congress of Neurological Surgeons

  14. Residence time of contaminants released in surface coal mines -- a wind-tunnel study

    Energy Technology Data Exchange (ETDEWEB)

    Thompson, R.S. [Environmental Protection Agency, Research Triangle Park, NC (United States)

    1994-12-31

    Surface coal mining operations (blasting, shoveling, loading, trucking, etc.) are sources of airborne particles. The 1990 Clean Air Act Amendments direct the EPA to analyze the accuracy of the Industrial Source Complex model and the AP-42 emission factors, and to make revisions as may be necessary to eliminate any significant over-prediction of air concentration of fugitive particles from surface coal mines. A wind-tunnel study was performed at the US EPA`s Fluid Modeling Facility to investigate dispersion from surface coal mines in support of the dispersion modeling activities. Described here is the portion of the study directed at determining the residence time that material released near the floor of a mine will stay within the mine.

  15. Hydrochemistry, origin and residence time of deep groundwater in the Yuseong area

    International Nuclear Information System (INIS)

    Koh, Yong Kwon; Kim, Geon Young; Bae, Dae Seok; Park, Kyung Woo

    2005-01-01

    As a part of the radioactive waste disposal research program in Korea, the geological, hydrogeological and hydrogeochemical investigations have been carried out in the Yuseong area (KAERI). The temperature or groundwater is measured up to 24 .deg. C and thermal gradient is obtained, to 0.26 .deg. C/100m. pH of groundwater at upper section shows about 7 and the pH of groundwater of 200m below surface reaches almost constant value as 9.9∼10.3. The redox potential of groundwater varied with depth and more negative values were recognized in deep groundwater. The redox potential of deep groundwater, main factor of U solubility, was measured up to -150 mV. These high pH and reduced conditions indicates that the maximum U concentration in groundwater would be limited by the equilibrium solubility of U minerals. The chemistry of shallow groundwater shows Ca-HCO 3 or Ca-Na-HCO 3 type, whereas the deep groundwater belongs to typical Na-HCO 3 type. The chemistry of groundwater below 250m from the surface is constant with depth, indicating that the extent of water-rock reaction is almost unique, which is controlled by the residence time of groundwater. The carbon isotope data (δ 13 C) of groundwater show the contribution of carbon from either that microbial oxidation of organic matter or carbon dioxide from plant respiration. The measurement and interpretation of C-14 indicate that the residence time of borehole deep groundwater ranges from about 2,000 to 6,000 yr BP. The high δ 34 S so4 value of groundwater indicate that the sulfate reduction might be occurred in the deep environment

  16. A theory-based curriculum design for remediation of residents' communication skills.

    Science.gov (United States)

    Leung, Fok-Han; Martin, Dawn; Batty, Helen

    2009-12-01

    Residents requiring remediation are often deficient in communication skills, namely clinical interviewing skills. Residents have to digest large amounts of knowledge, and then apply it in a clinical interview. The patient-centered approach, as demonstrated in the Calgary-Cambridge model and Martin's Map, can be difficult to teach. Before implementing a remediation curriculum, the theoretical educational underpinnings must be sound; curriculum evaluation is often expensive. Before establishing metrics for curriculum evaluation, a starting point is to perform a mental experiment to test theoretical adherence. This article describes an experiential remedial curriculum for communication skills. Educational theories of Kolb, Knowles, Bandura, and Bloom are used to design the curriculum into theory-based design components. Kolb's experiential cycle models the natural sequence of experiencing, teaching, and learning interviewing skills. A curriculum structured around this cycle has multiple intercalations with the above educational theories. The design is strengthened by appropriately timed use of education strategies such as learning contracts, taped interviews, simulations, structured reflection, and teacher role modeling. Importantly, it also models the form of the clinical interview format desired. Through understanding and application of contemporary educational theories, a program to remediate interviewing skills can increase its potential for success.

  17. Determining Nurse Aide Staffing Requirements to Provide Care Based on Resident Workload: A Discrete Event Simulation Model.

    Science.gov (United States)

    Schnelle, John F; Schroyer, L Dale; Saraf, Avantika A; Simmons, Sandra F

    2016-11-01

    Nursing aides provide most of the labor-intensive activities of daily living (ADL) care to nursing home (NH) residents. Currently, most NHs do not determine nurse aide staffing requirements based on the time to provide ADL care for their unique resident population. The lack of an objective method to determine nurse aide staffing requirements suggests that many NHs could be understaffed in their capacity to provide consistent ADL care to all residents in need. Discrete event simulation (DES) mathematically models key work parameters (eg, time to provide an episode of care and available staff) to predict the ability of the work setting to provide care over time and offers an objective method to determine nurse aide staffing needs in NHs. This study had 2 primary objectives: (1) to describe the relationship between ADL workload and the level of nurse aide staffing reported by NHs; and, (2) to use a DES model to determine the relationship between ADL workload and nurse aide staffing necessary for consistent, timely ADL care. Minimum Data Set data related to the level of dependency on staff for ADL care for residents in over 13,500 NHs nationwide were converted into 7 workload categories that captured 98% of all residents. In addition, data related to the time to provide care for the ADLs within each workload category was used to calculate a workload score for each facility. The correlation between workload and reported nurse aide staffing levels was calculated to determine the association between staffing reported by NHs and workload. Simulations to project staffing requirements necessary to provide ADL care were then conducted for 65 different workload scenarios, which included 13 different nurse aide staffing levels (ranging from 1.6 to 4.0 total hours per resident day) and 5 different workload percentiles (ranging from the 5th to the 95th percentile). The purpose of the simulation model was to determine the staffing necessary to provide care within each workload

  18. Resident Load Influence Analysis Method for Price Based on Non-intrusive Load Monitoring and Decomposition Data

    Science.gov (United States)

    Jiang, Wenqian; Zeng, Bo; Yang, Zhou; Li, Gang

    2018-01-01

    In the non-invasive load monitoring mode, the load decomposition can reflect the running state of each load, which will help the user reduce unnecessary energy costs. With the demand side management measures of time of using price, a resident load influence analysis method for time of using price (TOU) based on non-intrusive load monitoring data are proposed in the paper. Relying on the current signal of the resident load classification, the user equipment type, and different time series of self-elasticity and cross-elasticity of the situation could be obtained. Through the actual household load data test with the impact of TOU, part of the equipment will be transferred to the working hours, and users in the peak price of electricity has been reduced, and in the electricity at the time of the increase Electrical equipment, with a certain regularity.

  19. Groundwater residence times in Shenandoah National Park, Blue Ridge Mountains, Virginia, USA: A multi-tracer approach

    Science.gov (United States)

    Plummer, Niel; Busenberg, E.; Böhlke, J.K.; Nelms, D.L.; Michel, R.L.; Schlosser, P.

    2001-01-01

    Chemical and isotopic properties of water discharging from springs and wells in Shenandoah National Park (SNP), near the crest of the Blue Ridge Mountains, VA, USA were monitored to obtain information on groundwater residence times. Investigated time scales included seasonal (wet season, April, 1996; dry season, August–September, 1997), monthly (March through September, 1999) and hourly (30-min interval recording of specific conductance and temperature, March, 1999 through February, 2000). Multiple environmental tracers, including tritium/helium-3 (3H/3He), chlorofluorocarbons (CFCs), sulfur hexafluoride (SF6), sulfur-35 (35S), and stable isotopes (δ18O and δ2H) of water, were used to estimate the residence times of shallow groundwater discharging from 34 springs and 15 wells. The most reliable ages of water from springs appear to be based on SF6 and 3H/3He, with most ages in the range of 0–3 years. This range is consistent with apparent ages estimated from concentrations of CFCs; however, CFC-based ages have large uncertainties owing to the post-1995 leveling-off of the CFC atmospheric growth curves. Somewhat higher apparent ages are indicated by 35S (>1.5 years) and seasonal variation of δ18O (mean residence time of 5 years) for spring discharge. The higher ages indicated by the 35S and δ18O data reflect travel times through the unsaturated zone and, in the case of 35S, possible sorption and exchange of S with soils or biomass. In springs sampled in April, 1996, apparent ages derived from the 3H/3He data (median age of 0.2 years) are lower than those obtained from SF6 (median age of 4.3 years), and in contrast to median ages from 3H/3He (0.3 years) and SF6 (0.7 years) obtained during the late summer dry season of 1997. Monthly samples from 1999 at four springs in SNP had SF6apparent ages of only 1.2 to 2.5±0.8 years, and were consistent with the 1997 SF6 data. Water from springs has low excess air (0–1 cm3 kg−1) and N2–Ar temperatures that vary

  20. Geochemical modelling of groundwater evolution and residence time at the Kivetty site

    Energy Technology Data Exchange (ETDEWEB)

    Pitkaenen, P.; Luukkonen, A. [VTT Communities and Infrastructure, Espoo (Finland); Ruotsalainen, P. [Fintact Oy, Helsinki (Finland); Leino-Forsman, H.; Vuorinen, U. [VTT Chemical Technology, Espoo (Finland)

    1998-12-01

    groundwater are due to carbonate reactions: oxidising of organic carbon, and dissolution and precipitation of calcite. The carbonate reactions and slight hydrolysis of silicates stabilise the pH value at 8-9. In addition to aerobic oxidation of organic matter, oxidative dissolution of biotite seems to be an important oxygen consumer at shallow depth during recharge. The most important process controlling the redox state deeper in the bedrock was interpreted to be the microbially mediated sulphate reduction with simultaneous anaerobic respiration of organic carbon. This process buffers the redox level of about -200 - -300 mV depending on the pH. Even though the salinities of the groundwater samples and mass-transfer along flow paths remain low, the geochemical evolution was fully developed and has reached quite a stable thermodynamic state. The residence times of the groundwater samples cover the time span back to glaciation. Young ages seem to be limited to the upper part of bedrock, and any really dynamic natural flowpath with deep observed recently recharged water cannot be demonstrated. Deglacial or subglacial ages (over 9,700 years old at Kivetty) are typical below the 150-300m level in the bedrock. Subglacial waters are interpreted to derive from mixing of preglacial water and meltwater, the input of which is estimated to be about 20% at the most. Indications of elevated oxygen intrusion cannot be observed in groundwater having glacial signals. (orig.) 122 refs.

  1. Geochemical modelling of groundwater evolution and residence time at the Kivetty site

    International Nuclear Information System (INIS)

    Pitkaenen, P.; Luukkonen, A.; Ruotsalainen, P.; Leino-Forsman, H.; Vuorinen, U.

    1998-12-01

    groundwater are due to carbonate reactions: oxidising of organic carbon, and dissolution and precipitation of calcite. The carbonate reactions and slight hydrolysis of silicates stabilise the pH value at 8-9. In addition to aerobic oxidation of organic matter, oxidative dissolution of biotite seems to be an important oxygen consumer at shallow depth during recharge. The most important process controlling the redox state deeper in the bedrock was interpreted to be the microbially mediated sulphate reduction with simultaneous anaerobic respiration of organic carbon. This process buffers the redox level of about -200 - -300 mV depending on the pH. Even though the salinities of the groundwater samples and mass-transfer along flow paths remain low, the geochemical evolution was fully developed and has reached quite a stable thermodynamic state. The residence times of the groundwater samples cover the time span back to glaciation. Young ages seem to be limited to the upper part of bedrock, and any really dynamic natural flowpath with deep observed recently recharged water cannot be demonstrated. Deglacial or subglacial ages (over 9,700 years old at Kivetty) are typical below the 150-300m level in the bedrock. Subglacial waters are interpreted to derive from mixing of preglacial water and meltwater, the input of which is estimated to be about 20% at the most. Indications of elevated oxygen intrusion cannot be observed in groundwater having glacial signals. (orig.)

  2. "It's Not Just Time Off": A Framework for Understanding Factors Promoting Recovery From Burnout Among Internal Medicine Residents.

    Science.gov (United States)

    Abedini, Nauzley C; Stack, Shobha W; Goodman, Jessie L; Steinberg, Kenneth P

    2018-02-01

    Burnout rates for internal medicine residents are among the highest of all specialties, yet little is known about how residents recover from burnout. We identified factors promoting recovery from burnout and factors that assist with the subsequent avoidance of burnout among internal medicine residents. A purposive sample of postgraduate year 2 (PGY-2), PGY-3, and recent graduates who experienced and recovered from burnout during residency participated in semistructured, 60-minute interviews from June to August 2016. Using qualitative methods derived from grounded theory, saturation of themes occurred after 25 interviews. Coding was performed in an iterative fashion and consensus was reached on major themes. Coding revealed 2 different categories of resident burnout- circumstantial and existential -with differing recovery and avoidance methods. Circumstantial burnout stemmed from self-limited circumstances and environmental triggers. Recovery from, and subsequent avoidance of, circumstantial burnout arose from (1) resolving workplace challenges; (2) nurturing personal lives; and (3) taking time off. In contrast, existential burnout stemmed from a loss of meaning in medicine and an uncertain professional role. These themes were identified around recovery: (1) recognizing burnout and feeling validated; (2) connecting with patients and colleagues; (3) finding meaning in medicine; and (4) redefining a professional identity and role. Our study suggests that residents experience different types of burnout and have variable methods by which they recover from and avoid further burnout. Categorizing residents' burnout into circumstantial versus existential experiences may serve as a helpful framework for formulating interventions.

  3. Impact of a competency based curriculum on quality improvement among internal medicine residents.

    Science.gov (United States)

    Fok, Mark C; Wong, Roger Y

    2014-11-28

    Teaching quality improvement (QI) principles during residency is an important component of promoting patient safety and improving quality of care. The literature on QI curricula for internal medicine residents is limited. We sought to evaluate the impact of a competency based curriculum on QI among internal medicine residents. This was a prospective, cohort study over four years (2007-2011) using pre-post curriculum comparison design in an internal medicine residency program in Canada. Overall 175 post-graduate year one internal medicine residents participated. A two-phase, competency based curriculum on QI was developed with didactic workshops and longitudinal, team-based QI projects. The main outcome measures included self-assessment, objective assessment using the Quality Improvement Knowledge Assessment Tool (QIKAT) scores to assess QI knowledge, and performance-based assessment via presentation of longitudinal QI projects. Overall 175 residents participated, with a response rate of 160/175 (91%) post-curriculum and 114/175 (65%) after conducting their longitudinal QI project. Residents' self-reported confidence in making changes to improve health increased and was sustained at twelve months post-curriculum. Self-assessment scores of QI skills improved significantly from pre-curriculum (53.4 to 69.2 percent post-curriculum [p-value 0.002]) and scores were sustained at twelve months after conducting their longitudinal QI projects (53.4 to 72.2 percent [p-value 0.005]). Objective scores using the QIKAT increased post-curriculum from 8.3 to 10.1 out of 15 (p-value for difference value for difference from pre-curriculum based assessment occurred via presentation of all projects at the annual QI Project Podium Presentation Day. The competency based curriculum on QI improved residents' QI knowledge and skills during residency training. Importantly, residents perceived that their QI knowledge improved after the curriculum and this also correlated to improved QIKAT

  4. U Isotope Systematics on Groundwaters from Southwestern France : Mixing Processes and Residence Times

    Science.gov (United States)

    Innocent, C.; Malcuit, E.; Négrel, P.

    2011-12-01

    The Eocene Sands Aquifer of the Aquitanian Basin (Southwestern France) has been extensively studied for its hydrology, hydrogeochemistry and also for stable isotopes (André, 2002; André et al., 2005). 14C dates were also obtained in the southern part of the aquifer (André, 2002). Recently, in the framework of the CARISMEAU research project (Négrel et al., 2007), groundwaters have been analyzed for their U activity ratio in order to put some constraints on their residence time in the aquifer. A excellent correlation has been found between 234U/238U ratios (which can be as high as 13.5) and 14C dates, which allowed to propose residence times for the analyzed groundwaters at the scale of the whole aquifer (including the city of Bordeaux and its suburb) (Innocent and Négrel, 2008; submitted). The second step of the CARISMEAU research project (CARISMEAU 2) now focusses on the restricted "Entre-Deux-Mers" area. New groundwaters have been recovered and analyzed for their U isotopic composition. As for previous data, U activity ratios are typically very high, ranging from 2.9 to 8.6. Owing to additional 14C ages from the northern part of the aquifer, it is shown that most of the measured uranium activity ratios correlate with these 14C dates and fall on or close to the straight line defined previously (see above). As a consequence, residence times derived from U isotopic compositions fairly agree with 14C data, with only one exception from a groundwater which plots apart from the correlation line. Pumping tests have been done at a selected site (EMZM 7), involving pumping times of 1 hour, 8 hours and 16 hours. For each pumping time, waters have been recovered at different, increasing pumping rates of 80 m3 per hour, 120 m3 per hour, 160 m3 per hour, and 120 m3 per hour. The chemical composition of these twelve waters has not been found to vary significantly. Uranium activities are constant for ten of the twelve groundwaters (around 6.5, with a U concentration around

  5. Impact of Resident Surgeons on Procedure Length based on Common Pediatric Otolaryngology Cases

    Science.gov (United States)

    Puram, Sidharth V.; Kozin, Elliott D.; Sethi, Rosh; Alkire, Blake; Lee, Daniel J.; Gray, Stacey T.; Shrime, Mark G.; Cohen, Michael

    2015-01-01

    Background Surgical education remains an important mission of academic medical centers. Financial pressures, however, may favor improved operating room (OR) efficiency at the expense of surgical education. We aim to characterize resident impact on the duration of procedural time using common pediatric otolaryngologic cases which do not necessitate a surgical assistant and assess whether other factors modify the extent to which residents impact OR efficiency. Study Design We retrospectively reviewed resident and attending surgeon total OR and procedural times for isolated tonsillectomy, adenoidectomy, tonsillectomy with adenoidectomy (T&A) and bilateral myringotomy with tube insertion between 2009 and 2013. We included cases supervised or performed by one of four teaching surgeons in children with ASA otolaryngology procedures. While residents may increase operative times, addressing other system-wide issues may decrease impact of time needed for education and added efficiencies of resident participation may exist throughout the perioperative period. Our model is applicable to surgical education across specialties. Level of Evidence 4 PMID:25251257

  6. Measuring gas-residence times in large municipal incinerators, by means of a pseudo-random binary signal tracer technique

    International Nuclear Information System (INIS)

    Nasserzadeh, V.; Swithenbank, J.; Jones, B.

    1995-01-01

    The problem of measuring gas-residence time in large incinerators was studied by the pseudo-random binary sequence (PRBS) stimulus tracer response technique at the Sheffield municipal solid-waste incinerator (35 MW plant). The steady-state system was disturbed by the superimposition of small fluctuations in the form of a pseudo-random binary sequence of methane pulses, and the response of the incinerator was determined from the CO 2 concentration in flue gases at the boiler exit, measured with a specially developed optical gas analyser with a high-frequency response. For data acquisition, an on-line PC computer was used together with the LAB Windows software system; the output response was then cross-correlated with the perturbation signal to give the impulse response of the incinerator. There was very good agreement between the gas-residence time for the Sheffield MSW incinerator as calculated by computational fluid dynamics (FLUENT Model) and gas-residence time at the plant as measured by the PRBS tracer technique. The results obtained from this research programme clearly demonstrate that the PRBS stimulus tracer response technique can be successfully and economically used to measure gas-residence times in large incinerator plants. It also suggests that the common commercial practice of characterising the incinerator operation by a single-residence-time parameter may lead to a misrepresentation of the complexities involved in describing the operation of the incineration system. (author)

  7. Geochemical modelling of groundwater evolution and residence time at the Olkiluoto site

    International Nuclear Information System (INIS)

    Pitkaenen, P.; Luukkonen, A.; Ruotsalainen, P.; Leino-Forsman, H.; Vuorinen, U.

    1999-05-01

    external conditions such as glaciation, palaeo Baltic stages, land uplift and ancient hydrothermal events, have had a significant effect on local palaeohydrogeological conditions. They have caused great variability, which is observable in the chemical data notably in salinity (up to 70 g/l), water type and contents of conservative parameters, such as Cl, Br and stable isotopes of water. However, their influence is also significant on the water-rock interaction that principally controls the pH and redox conditions - varying 7.5 to 8 and -200 to -300 mV, respectively - in the groundwater, although the calculated mass transfer in the reactions is minor compared with conservative mixing at the site. Calcite in fractures is interpreted to principally control pH level in groundwater. Sulphidic redox conditions dominate in the upper 500 m in brackish and slightly saline groundwater. Deeper sulphur species are absent and methanic processes are obtained. The water types can be connected to certain palaeo stages. This enables to estimate mean residence time of groundwaters. Current meteoric recharge stage (< 2500 a) mainly dominates in the upper 150 m. Groundwater from Litorina stage (7500-2500 a ago) forms the bulk at 100 - 250 m. Glacial melt water (about 10 000 a old) is an important component of groundwater between 100 - 500 m. However, any remarks of oxygen intrusion cannot be interpreted neither from mineralogy nor from groundwater. Deeper, subglacial and older saline groundwater predominates. Despite the current locations of different groundwater bodies it seems according to hydrogeochemical interpretation that dynamic flow conditions has been limited to upper 150 - 200 m. (orig.)

  8. Geochemical modelling of groundwater evolution and residence time at the Olkiluoto site

    Energy Technology Data Exchange (ETDEWEB)

    Pitkaenen, P.; Luukkonen, A. [VTT Communities and Infrastructure, Espoo (Finland); Ruotsalainen, P. [Fintact Oy (Finland); Leino-Forsman, H.; Vuorinen, U. [VTT Chemical Technology, Espoo (Finland)

    1999-05-01

    external conditions such as glaciation, palaeo Baltic stages, land uplift and ancient hydrothermal events, have had a significant effect on local palaeohydrogeological conditions. They have caused great variability, which is observable in the chemical data notably in salinity (up to 70 g/l), water type and contents of conservative parameters, such as Cl, Br and stable isotopes of water. However, their influence is also significant on the water-rock interaction that principally controls the pH and redox conditions - varying 7.5 to 8 and -200 to -300 mV, respectively - in the groundwater, although the calculated mass transfer in the reactions is minor compared with conservative mixing at the site. Calcite in fractures is interpreted to principally control pH level in groundwater. Sulphidic redox conditions dominate in the upper 500 m in brackish and slightly saline groundwater. Deeper sulphur species are absent and methanic processes are obtained. The water types can be connected to certain palaeo stages. This enables to estimate mean residence time of groundwaters. Current meteoric recharge stage (< 2500 a) mainly dominates in the upper 150 m. Groundwater from Litorina stage (7500-2500 a ago) forms the bulk at 100 - 250 m. Glacial melt water (about 10 000 a old) is an important component of groundwater between 100 - 500 m. However, any remarks of oxygen intrusion cannot be interpreted neither from mineralogy nor from groundwater. Deeper, subglacial and older saline groundwater predominates. Despite the current locations of different groundwater bodies it seems according to hydrogeochemical interpretation that dynamic flow conditions has been limited to upper 150 - 200 m. (orig.) 82 refs.

  9. 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…

  10. Internal Medicine Residents' Perceptions of Team-Based Care and its Educational Value in the Continuity Clinic: A Qualitative Study.

    Science.gov (United States)

    Soones, Tacara N; O'Brien, Bridget C; Julian, Katherine A

    2015-09-01

    In order to teach residents how to work in interprofessional teams, educators in graduate medical education are implementing team-based care models in resident continuity clinics. However, little is known about the impact of interprofessional teams on residents' education in the ambulatory setting. To identify factors affecting residents' experience of team-based care within continuity clinics and the impact of these teams on residents' education. This was a qualitative study of focus groups with internal medicine residents. Seventy-seven internal medicine residents at the University of California San Francisco at three continuity clinic sites participated in the study. Qualitative interviews were audiotaped and transcribed. The authors used a general inductive approach with sensitizing concepts in four frames (structural, human resources, political and symbolic) to develop codes and identify themes. Residents believed that team-based care improves continuity and quality of care. Factors in four frames affected their ability to achieve these goals. Structural factors included communication through the electronic medical record, consistent schedules and regular team meetings. Human resources factors included the presence of stable teams and clear roles. Political and symbolic factors negatively impacted team-based care, and included low staffing ratios and a culture of ultimate resident responsibility, respectively. Regardless of the presence of these factors or resident perceptions of their teams, residents did not see the practice of interprofessional team-based care as intrinsically educational. Residents' experiences practicing team-based care are influenced by many principles described in the interprofessional teamwork literature, including understanding team members' roles, good communication and sufficient staffing. However, these attributes are not correlated with residents' perceptions of the educational value of team-based care. Including residents in

  11. Residence times and alluvial architecture of a sediment superslug in response to different flow regimes

    Science.gov (United States)

    Moody, John A.

    2017-01-01

    A superslug was deposited in a basin in the Colorado Front Range Mountains as a consequence of an extreme flood following a wildfire disturbance in 1996. The subsequent evolution of this superslug was measured by repeat topographic surveys (31 surveys from 1996 through 2014) of 18 cross sections approximately uniformly spaced over 1500 m immediately above the basin outlet. These surveys allowed the identification within the superslug of chronostratigraphic units deposited and eroded by different geomorphic processes in response to different flow regimes.Over the time period of the study, the superslug went through aggradation, incision, and stabilization phases that were controlled by a shift in geomorphic processes from generally short-duration, episodic, large-magnitude floods that deposited new chronostratigraphic units to long-duration processes that eroded units. These phases were not contemporaneous at each channel cross section, which resulted in a complex response that preserved different chronostratigraphic units at each channel cross section having, in general, two dominant types of alluvial architecture—laminar and fragmented. Age and transit-time distributions for these two alluvial architectures evolved with time since the extreme flood. Because of the complex shape of the distributions they were best modeled by two-parameter Weibull functions. The Weibull scale parameter approximated the median age of the distributions, and the Weibull shape parameter generally had a linear relation that increased with time since the extreme flood. Additional results indicated that deposition of new chronostratigraphic units can be represented by a power-law frequency distribution, and that the erosion of units decreases with depth of burial to a limiting depth. These relations can be used to model other situations with different flow regimes where vertical aggradation and incision are dominant processes, to predict the residence time of possible contaminated

  12. Residence times and alluvial architecture of a sediment superslug in response to different flow regimes

    Science.gov (United States)

    Moody, John A.

    2017-10-01

    A superslug was deposited in a basin in the Colorado Front Range Mountains as a consequence of an extreme flood following a wildfire disturbance in 1996. The subsequent evolution of this superslug was measured by repeat topographic surveys (31 surveys from 1996 through 2014) of 18 cross sections approximately uniformly spaced over 1500 m immediately above the basin outlet. These surveys allowed the identification within the superslug of chronostratigraphic units deposited and eroded by different geomorphic processes in response to different flow regimes. Over the time period of the study, the superslug went through aggradation, incision, and stabilization phases that were controlled by a shift in geomorphic processes from generally short-duration, episodic, large-magnitude floods that deposited new chronostratigraphic units to long-duration processes that eroded units. These phases were not contemporaneous at each channel cross section, which resulted in a complex response that preserved different chronostratigraphic units at each channel cross section having, in general, two dominant types of alluvial architecture-laminar and fragmented. Age and transit-time distributions for these two alluvial architectures evolved with time since the extreme flood. Because of the complex shape of the distributions they were best modeled by two-parameter Weibull functions. The Weibull scale parameter approximated the median age of the distributions, and the Weibull shape parameter generally had a linear relation that increased with time since the extreme flood. Additional results indicated that deposition of new chronostratigraphic units can be represented by a power-law frequency distribution, and that the erosion of units decreases with depth of burial to a limiting depth. These relations can be used to model other situations with different flow regimes where vertical aggradation and incision are dominant processes, to predict the residence time of possible contaminated

  13. Education research: a case-based bioethics curriculum for neurology residents.

    Science.gov (United States)

    Tolchin, Benjamin; Willey, Joshua Z; Prager, Kenneth

    2015-03-31

    In 2012, the American Academy of Neurology (AAN) updated and expanded its ethics curriculum into Practical Ethics in Clinical Neurology, a case-based ethics curriculum for neurologists. We piloted a case-based bioethics curriculum for neurology residents using the framework and topics recommended by the AAN, matched to clinical cases drawn from Columbia's neurologic services. Our primary outcome was residents' ability to analyze and manage ethically complex cases as measured on precurriculum and postcurriculum multiple-choice quizzes. Secondary outcomes included precurriculum and postcurriculum self-assessed comfort in discussing and managing ethically complex cases, as well as attendance at ethics discussion sessions as compared to attendance at other didactic sessions. Resident performance on quizzes improved from 75.8% to 86.7% (p = 0.02). Comfort in discussing ethically complex cases improved from 6.4 to 7.4 on a 10-point scale (p = 0.03). Comfort in managing such cases trended toward improvement but did not reach statistical significance. Attendance was significantly better at ethics discussions (73.5%) than at other didactic sessions (61.7%, p = 0.04). Our formal case-based ethics curriculum for neurology residents, based on core topics drawn from the AAN's published curricula, was successfully piloted. Our study showed a statistically significant improvement in residents' ability to analyze and manage ethically complex cases as measured by multiple-choice tests and self-assessments. © 2015 American Academy of Neurology.

  14. Assessment of the vaginal residence time of biomarkers of semen exposure.

    Science.gov (United States)

    Thurman, Andrea; Jacot, Terry; Melendez, Johan; Kimble, Thomas; Snead, Margaret; Jamshidi, Roxanne; Wheeless, Angie; Archer, David F; Doncel, Gustavo F; Mauck, Christine

    2016-11-01

    The primary objective of this pilot study is to determine and compare the residence time in the vagina of biomarkers of semen exposure for up to 15 days post exposure. The biomarkers are prostate-specific antigen (PSA), Y chromosome DNA, the sex determining region of the Y chromosome (SRY) and testis-specific protein Y-encoded 4 (TSPY4). The secondary objectives are to determine if biomarker concentrations differed between intercourse and inoculation groups, to establish whether the sampling frequency post exposure affected biomarker concentrations and decay profile and to determine if biomarker concentrations in vaginal swabs obtained by the participant at home were similar to swabs obtained by the nurse in the clinic. We randomized healthy women to unprotected intercourse (n=17) versus vaginal inoculation with the male partner's semen in the clinic (n=16). Women were then further randomized to have vaginal swabs obtained at either 7 or 4 time points after semen exposure, up to 15 days post exposure, either obtained at home by the participant or in the clinic by the research nurse. PSA and SRY were markers of recent semen exposure. TSPY4 was detectable in approximately 50% of participants at 15 days post exposure. Unprotected intercourse resulted in significantly higher concentrations of select biomarkers. Sampling frequency and home versus clinic sampling had no significant effect on biomarker concentrations. Objective biomarkers of recent or distant semen exposure may have great utility for verifying protocol compliance in a variety of clinical trials. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. Plan for radionuclide tracer studies of the residence time distribution in the Wilsonville dissolver and preheater

    International Nuclear Information System (INIS)

    Jolley, R.L.; Begovich, J.M.; Brashear, H.R.

    1983-12-01

    Stimulus-response measurements using radiotracers to measure residence time distribution (RTD) and hydrodynamic parameters for the preheaters and dissolvers at the Ft. Lewis Solvent Refined Coal (SRC) and the Exxon Donor Solvent (EDS) coal conversion pilot plants are reviewed. A plan is also presented for a series of radioactive tracer studies proposed for the Advanced Coal Liquefaction Facility at Wilsonville, Alabama, to measure the RTD for the preheater and dissolvers in the SRC-I mode. The tracer for the gas phase will be 133 Xe, and 198 Au (on carbonized resin or as an aqueous colloidal suspension) will be used as the slurry tracer. Four experimental phases are recommended for the RTD tracer studies: (1) preheater; (2) dissolver with 100% takeoff; (3) dissolver with 100% takeoff and solids withdrawal; and (4) dissolver with 50% takeoff. Eighteen gas-tracer and 22 liquid-tracer injections are projected to accomplish the four experimental phases. Two to four tracer injections are projected for preliminary tests to ensure the capability of safe injection of the radiotracers and the collection of statistically significant data. A complete projected cost and time schedule is provided, including procurement of necessary components, preparation of the radiotracers, assembly and testing of tracer injection apparatus and detection systems, onsite work and tracer injections, laboratory experimentation, data analysis, and report writing

  16. Improving resident's skills in the management of circulatory shock with a knowledge-based e-learning tool.

    Science.gov (United States)

    Riaño, David; Real, Francis; Alonso, Jose Ramon

    2018-05-01

    Correct clinical management of circulatory shock in emergency departments (ER) and intensive care units (ICU) is critical. In this context, the transmission of professional skills by means of the practical supervision of real cases at the point of care entails important issues that can be widely overcome with the use of computer knowledge-based e-learning tools. Shock-Instructor is a web-based e-learning tool implementing the already tested training program model (TPM) that uses a knowledge base about the evidence found in the clinical practice guidelines about seven types of shock. This tool is expected to reduce the learning times and to improve the skills of hospital residents with regard to both the correct application of the guidelines and patient recovery, suppressing the risks of direct interventions. Shock-Instructor has been used to train residents in the Emergency Department of the Hospital Clínic de Barcelona (Spain) in order to reduce the learning cycle without affecting quality. A case-base with the description of 51 cases with shock and a knowledge-base with 137 clinical rules about the treatment of shock were incorporated to the Shock-Instructor system. A group of 33 residents was involved in a randomized controlled trial to check whether the use of Shock-Instructor can significantly improve the skills of clinicians after one week of problem-based training. No significant differences were found in the skill levels of the intervention (IG) and control (CG) groups prior to learning. However, we observed an improvement of the IG clinicians capacity to stabilize patients with shock in better clinical conditions (5% improvement, p = 0.004), and to reduce the risk of death in 19.52% (p = 0.004), after training. First-year residents in IG enhanced 14.3% their sensitivity in the correct application of guidelines (p = 0.01), and 14.9% the mean survival rate of their patients (p = 0.01), after being trained with Shock-Instructor for a week

  17. Accessing doctors at times of need-measuring the distance tolerance of rural residents for health-related travel.

    Science.gov (United States)

    McGrail, Matthew Richard; Humphreys, John Stirling; Ward, Bernadette

    2015-05-29

    Poor access to doctors at times of need remains a significant impediment to achieving good health for many rural residents. The two-step floating catchment area (2SFCA) method has emerged as a key tool for measuring healthcare access in rural areas. However, the choice of catchment size, a key component of the 2SFCA method, is problematic because little is known about the distance tolerance of rural residents for health-related travel. Our study sought new evidence to test the hypothesis that residents of sparsely settled rural areas are prepared to travel further than residents of closely settled rural areas when accessing primary health care at times of need. A questionnaire survey of residents in five small rural communities of Victoria and New South Wales in Australia was used. The two outcome measures were current travel time to visit their usual doctor and maximum time prepared to travel to visit a doctor, both for non-emergency care. Kaplan-Meier charts were used to compare the association between increased distance and decreased travel propensity for closely-settled and sparsely-settled areas, and ordinal multivariate regression models tested significance after controlling for health-related travel moderating factors and town clustering. A total of 1079 questionnaires were completed with 363 from residents in closely-settled locations and 716 from residents in sparsely-settled areas. Residents of sparsely-settled communities travel, on average, 10 min further than residents of closely-settled communities (26.3 vs 16.9 min, p time prepared to travel (54.1 vs 31.9 min, p time remained significant after controlling for demographic and other constraints to access, such as transport availability or difficulties getting doctor appointments, as well as after controlling for town clustering and current travel times. Improved geographical access remains a key issue underpinning health policies designed to improve the provision of rural primary health care

  18. Burnout in Medical Residents: A Study Based on the Job Demands-Resources Model

    Directory of Open Access Journals (Sweden)

    Panagiotis Zis

    2014-01-01

    Full Text Available Purpose. Burnout is a prolonged response to chronic emotional and interpersonal stressors on the job. The purpose of our cross-sectional study was to estimate the burnout rates among medical residents in the largest Greek hospital in 2012 and identify factors associated with it, based on the job demands-resources model (JD-R. Method. Job demands were examined via a 17-item questionnaire assessing 4 characteristics (emotional demands, intellectual demands, workload, and home-work demands’ interface and job resources were measured via a 14-item questionnaire assessing 4 characteristics (autonomy, opportunities for professional development, support from colleagues, and supervisor’s support. The Maslach Burnout Inventory (MBI was used to measure burnout. Results. Of the 290 eligible residents, 90.7% responded. In total 14.4% of the residents were found to experience burnout. Multiple logistic regression analysis revealed that each increased point in the JD-R questionnaire score regarding home-work interface was associated with an increase in the odds of burnout by 25.5%. Conversely, each increased point for autonomy, opportunities in professional development, and each extra resident per specialist were associated with a decrease in the odds of burnout by 37.1%, 39.4%, and 59.0%, respectively. Conclusions. Burnout among medical residents is associated with home-work interface, autonomy, professional development, and resident to specialist ratio.

  19. Informatics in radiology: web-based preliminary reporting system for radiology residents with PACS integration.

    Science.gov (United States)

    O'Connell, Timothy; Chang, Debra

    2012-01-01

    While on call, radiology residents review imaging studies and issue preliminary reports to referring clinicians. In the absence of an integrated reporting system at the training sites of the authors' institution, residents were typing and faxing preliminary reports. To partially automate the on-call resident workflow, a Web-based system for resident reporting was developed by using the free open-source xAMP Web application framework and an open-source DICOM (Digital Imaging and Communications in Medicine) software toolkit, with the goals of reducing errors and lowering barriers to education. This reporting system integrates with the picture archiving and communication system to display a worklist of studies. Patient data are automatically entered in the preliminary report to prevent identification errors and simplify the report creation process. When the final report for a resident's on-call study is available, the reporting system queries the report broker for the final report, and then displays the preliminary report side by side with the final report, thus simplifying the review process and encouraging review of all of the resident's reports. The xAMP Web application framework should be considered for development of radiology department informatics projects owing to its zero cost, minimal hardware requirements, ease of programming, and large support community.

  20. A longitudinal simulation-based ethical-legal curriculum for otolaryngology residents.

    Science.gov (United States)

    Fanous, Amanda; Rappaport, Jamie; Young, Meredith; Park, Yoon Soo; Manoukian, John; Nguyen, Lily H P

    2017-11-01

    To develop, implement, and evaluate a longitudinal, simulation-based ethics and legal curriculum designed specifically for otolaryngology residents. Otolaryngology residents were recruited to participate in a yearly half-day ethical-legal module, the curriculum of which spanned 4 years. Each module included: three simulated scenarios, small-group multisource feedback, and large-group debriefings. Scenarios involved encounters with standardized patients. Residents' ethical-legal knowledge was assessed pre- and postmodule with multiple-choice questions, and ethical reasoning was assessed by a variety of evaluators during the simulated scenario using a locally developed assessment tool. Participants completed an exit survey at the end of each module. Eighteen residents completed four modules from the academic years of 2008 to 2009 to 2011 to 2012. The first year was considered a pilot module, and data were collected for the following 3 years. Knowledge of legal issues improved significantly among residents (mean at pre = 3.40 and post = 4.60, P otolaryngology-head and neck surgery residents. This educational program resulted in a both objective and subjective improvement in legal and ethics knowledge and skills. NA. Laryngoscope, 127:2501-2509, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

  1. Burnout in medical residents: a study based on the job demands-resources model.

    Science.gov (United States)

    Zis, Panagiotis; Anagnostopoulos, Fotios; Sykioti, Panagiota

    2014-01-01

    Burnout is a prolonged response to chronic emotional and interpersonal stressors on the job. The purpose of our cross-sectional study was to estimate the burnout rates among medical residents in the largest Greek hospital in 2012 and identify factors associated with it, based on the job demands-resources model (JD-R). Job demands were examined via a 17-item questionnaire assessing 4 characteristics (emotional demands, intellectual demands, workload, and home-work demands' interface) and job resources were measured via a 14-item questionnaire assessing 4 characteristics (autonomy, opportunities for professional development, support from colleagues, and supervisor's support). The Maslach Burnout Inventory (MBI) was used to measure burnout. Of the 290 eligible residents, 90.7% responded. In total 14.4% of the residents were found to experience burnout. Multiple logistic regression analysis revealed that each increased point in the JD-R questionnaire score regarding home-work interface was associated with an increase in the odds of burnout by 25.5%. Conversely, each increased point for autonomy, opportunities in professional development, and each extra resident per specialist were associated with a decrease in the odds of burnout by 37.1%, 39.4%, and 59.0%, respectively. Burnout among medical residents is associated with home-work interface, autonomy, professional development, and resident to specialist ratio.

  2. Videoconferencing of a national program for residents on evidence-based practice: early performance evaluation.

    LENUS (Irish Health Repository)

    O'Regan, Kevin

    2010-01-01

    The aim of this study was to evaluate the effectiveness of the medium of videoconferencing for the delivery of a course for radiology residents in practice-based learning (PBL), including evidence-based practice, at centers geographically separated from the principal teaching site.

  3. Teaching Evidence-Based Medicine Skills through a Residency-Developed Guideline.

    Science.gov (United States)

    Epling, John; Smucny, John; Patil, Anita; Tudiver, Fred

    2002-01-01

    Describes a curriculum intended to culminate in a resident-produced, evidence-based guideline for the care of patients with diabetes. Evaluation of the curriculum showed that learners appreciated the skills and knowledge gained in devising guidelines in an evidence-based manner but were uncertain that their searches were complete. Clinical…

  4. Are general surgery residents adequately prepared for hepatopancreatobiliary fellowships? A questionnaire-based study

    Science.gov (United States)

    Osman, Houssam; Parikh, Janak; Patel, Shirali; Jeyarajah, D Rohan

    2015-01-01

    Background The present study was conducted to assess the preparedness of hepatopancreatobiliary (HPB) fellows upon entering fellowship, identify challenges encountered by HPB fellows during the initial part of their HPB training, and identify potential solutions to these challenges that can be applied during residency training. Methods A questionnaire was distributed to all HPB fellows in accredited HPB fellowship programmes in two consecutive academic years (n = 42). Reponses were then analysed. Results A total of 19 (45%) fellows responded. Prior to their fellowship, 10 (53%) were in surgical residency and the rest were in other surgical fellowships or surgical practice. Thirteen (68%) were graduates of university-based residency programmes. All fellows felt comfortable in performing basic laparoscopic procedures independently at the completion of residency and less comfortable in performing advanced laparoscopy. Eight (42%) fellows cited a combination of inadequate case volume and lack of autonomy during residency as the reasons for this lack of comfort. Thirteen (68%) identified inadequate preoperative workup and management as their biggest fear upon entering practice after general surgery training. A total of 17 (89%) fellows felt they were adequately prepared to enter HPB fellowship. Extra rotations in transplant, vascular or minimally invasive surgery were believed to be most helpful in preparing general surgery residents pursing HPB fellowships. Conclusions Overall, HPB fellows felt themselves to be adequately prepared for fellowship. Advanced laparoscopic procedures and the perioperative management of complex patients are two of the challenges facing HPB fellows. General surgery residents who plan to pursue an HPB fellowship may benefit from spending extra rotations on certain subspecialties. Focus on perioperative workup and management should be an integral part of residency and fellowship training. PMID:25387852

  5. Watershed Influences on Residence Time and Oxygen Reduction Rates in an Agricultural Landscape

    Science.gov (United States)

    Shope, C. L.; Tesoriero, A. J.

    2015-12-01

    Agricultural use of synthetic fertilizers and animal manure has led to increased crop production, but also elevated nitrogen concentrations in groundwater, resulting in impaired water quality. Groundwater oxygen concentrations are a key indicator of potential biogeochemical processes, which control water/aquifer interactions and contaminant transport. The U.S. Geological Survey's National Water-Quality Assessment Program has a long-history of studying nutrient transport and processing across the United States and the Glacial Aquifer system in particular. A series of groundwater well networks in Eastern Wisconsin is being used to evaluate the distribution of redox reaction rates over a range of scales with a focus on dissolved O2 reduction rates. An analysis of these multi-scale networks elucidates the influence of explanatory variables (i.e.: soil type, land use classification) on reduction rates and redox reactions throughout the Fox-Wolf-Peshtigo watersheds. Multiple tracers including dissolved gasses, tritium, helium, chlorofluorocarbons, sulfur hexafluoride, and carbon-14 were used to estimate groundwater ages (0.8 to 61.2 yr) at over 300 locations. Our results indicate O2 reduction rates along a flowpath study area (1.2 km2) of 0.15 mg O2 L-1 yr-1 (0.12 to 0.18 mg O2 L-1 yr-1) up to 0.41 mg O2 L-1 yr-1 (0.23 to 0.89 mg O2 L-1 yr-1) for a larger scale land use study area (3,300 km2). Preliminary explanatory variables that can be used to describe the variability in reduction rates include soil type (hydrologic group, bulk density) and chemical concentrations (nitrite plus nitrate, silica). The median residence time expected to reach suboxic conditions (≤ 0.4 mg O2 L-1) for the flowpath and the land use study areas was 66 and 25 yr, respectively. These results can be used to elucidate and differentiate the impact of residence time on groundwater quality vulnerability and sustainability in agricultural regions without complex flow models.

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

    Science.gov (United States)

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

    2016-04-01

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

  7. Evaluation of a web-based portal to improve resident education by neonatology fellows

    Directory of Open Access Journals (Sweden)

    Ashwini Lakshmanan

    2014-07-01

    Full Text Available Background: Integration of web-based educational tools into medical training has been shown to increase accessibility of resources and optimize teaching. We developed a web-based educational portal (WBEP to support teaching of pediatric residents about newborn medicine by neonatology fellows. Objectives: 1 To compare residents’ attitudes about their fellow-led education in the NICU pre- and post-WBEP; including assessment of factors that impact their education and usefulness of teaching tools. 2 To compare fellow utilization of various teaching modalities pre- and post-WBEP. Design/methods: We queried residents about their attitudes regarding fellow-led education efforts and various teaching modalities in the NICU and logistics potentially impacting effectiveness. Based on these data, we introduced the WBEP – a repository of teaching tools (e.g., mock code cases, board review questions, journal articles, case-based discussion scenarios for use by fellows to supplement didactic sessions in a faculty-based curriculum. We surveyed residents about the effectiveness of fellow teaching pre- and post-WBEP implementation and the type of fellow-led teaching modalities that were used. Results: After analysis of survey responses, we identified that residents cited fellow level of interest as the most important factor impacting their education. Post-implementation, residents described greater utilization of various teaching modalities by fellows, including an increase in use of mock codes (14% to 76%, p<0.0001 and journal articles (33% to 59%, p=0.02. Conclusions: A web-based resource that supplements traditional curricula led to greater utilization of various teaching modalities by fellows and may encourage fellow involvement in resident teaching.

  8. Assessment of a Chief Complaint–Based Curriculum for Resident Education in Geriatric Emergency Medicine

    Directory of Open Access Journals (Sweden)

    Robert L Muelleman

    2011-05-01

    Full Text Available Introduction: We hypothesized that a geriatric chief complaint–based didactic curriculum would improve resident documentation of elderly patient care in the emergency department (ED. Methods: A geriatric chief complaint curriculum addressing the 3 most common chief complaints—abdominal pain, weakness, and falls—was developed and presented. A pre- and postcurriculum implementation chart review assessed resident documentation of the 5 components of geriatric ED care: 1 differential diagnosis/patient evaluation considering atypical presentations, 2 determination of baseline function, 3 chronic care facility/caregiver communication, 4 cognitive assessment, and 5 assessment of polypharmacy. A single reviewer assessed 5 pre- and 5 postimplementation charts for each of 18 residents included in the study. We calculated 95% confidence and determined that statistical significance was determined by a 2-tailed z test for 2 proportions, with statistical significance at 0.003 by Bonferroni correction. Results: For falls, resident documentation improved significantly for 1 of 5 measures. For abdominal pain, 2 of 5 components improved. For weakness, 3 of 5 components improved. Conclusion: A geriatric chief complaint–based curriculum improved emergency medicine resident documentation for the care of elderly patients in the ED compared with a non–age-specific chief complaint–based curriculum. [West J Emerg Med. 2011;12(4:484–488.

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

    Directory of Open Access Journals (Sweden)

    Yunliang Li

    2015-04-01

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

  10. [The European Working Time Directive and surgical residents' expertise: no effect on the number of operations].

    Science.gov (United States)

    Guicherit, Onno R

    2015-01-01

    Residents' working hours in the Netherlands were first capped in the early 1990 s. In 2003, European legislation consolidated restrictions to a 48-hour week. No adverse effects were seen on the number of surgical operations performed either in the first or the second decade following these measures. Either the effect on surgical training is minimal, or the number of operations carried out during a residency is not a meaningful indicator of its quality. Personalized modular rotations in both university and teaching hospitals are needed for residents with sub-specializations. Training activities, in combination with more supervision, have to focus on a broader set of competencies beyond simply mastering surgical procedures.

  11. Use of tritium for estimation of groundwater mean residence time, a case study of the Ain Al-Samak Karst springs (Central Syria)

    International Nuclear Information System (INIS)

    Kattan, Z.

    2003-01-01

    This work is an attempt to estimate the mean residence time of groundwater in the Ain Al-Tanour and Ain-Samak, which are the major karst springs in the Upper Orontes Basin (Central Syria). This estimate, which consists on the application of a mathematical modeling approach, was based on the use of tritium, as a natural radioisotope tracer and a tool for ground water age dating. By adopting a completely mixed reservoir model, linked with exponential time distribution function, the mean residence time (turnover time) of these two springs was evaluated to be about 50 years. This result is in good agreement with previous estimation obtained for the Figeh main spring, which belongs to the same aquifer (Cenomanian-Turonian complex) in the Damascus Basin. On the basis of this evaluation, a value of about 800 million m 3 was obtained for the maximum groundwater reservoir size

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

    Science.gov (United States)

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

    2016-04-01

    Groundwater residence-time or ages have been widely used in hydrogeology during the last decades. Following tritium measurements, anthropogenic gases (CFC, SF6, 35Kr) have been developed. They provide information at the aquifer scale on long residence times. They complement the more localized data obtained from sparse boreholes with hydraulic and geophysical methods. Anthropogenic tracer concentrations are most generally considered as "Groundwater ages" using a piston flow model providing an order of magnitude for the residence time. More advanced information can however be derived from the combined analysis of the tracer concentrations. For example, the residence time distribution over the last 50 years can be well approached by the concentration of two sufficient different anthropogenic tracers in the group (CFC, SF6, 35Kr), i.e. tracers whose anthropogenic chronicles are sufficiently different. And, with additional constrains on geological and hydraulic properties, groundwater ages contribute to characterize the aquifer structures and the groundwater resources. Complex geological environments also include old groundwater bodies in extremely confined aquifer sections. In such cases, various tracers are related to highly different processes. CFCs can be taken as a marker of modern contamination to track exchanges between shallower and deeper aquifers, leakage processes, and modification of circulations linked to recent anthropogenic changes. 14C or 36Cl can be used to evidence much older processes but have to be related to the history of the chemical element itself. Numerous field studies in fact demonstrate the broad-range extent of the residence time distribution spanning in some cases several orders of magnitude. Flow and transport models in heterogeneous structures confirm such wide residence times and help to characterize their distribution. Residence times also serve as a privileged interface to the fate of some contaminants in aquifers or to trace

  13. Google Glass for Residents Dealing With Pediatric Cardiopulmonary Arrest: A Randomized, Controlled, Simulation-Based Study.

    Science.gov (United States)

    Drummond, David; Arnaud, Cécile; Guedj, Romain; Duguet, Alexandre; de Suremain, Nathalie; Petit, Arnaud

    2017-02-01

    To determine whether real-time video communication between the first responder and a remote intensivist via Google Glass improves the management of a simulated in-hospital pediatric cardiopulmonary arrest before the arrival of the ICU team. Randomized controlled study. Children's hospital at a tertiary care academic medical center. Forty-two first-year pediatric residents. Pediatric residents were evaluated during two consecutive simulated pediatric cardiopulmonary arrests with a high-fidelity manikin. During the second evaluation, the residents in the Google Glass group were allowed to seek help from a remote intensivist at any time by activating real-time video communication. The residents in the control group were asked to provide usual care. The main outcome measures were the proportion of time for which the manikin received no ventilation (no-blow fraction) or no compression (no-flow fraction). In the first evaluation, overall no-blow and no-flow fractions were 74% and 95%, respectively. During the second evaluation, no-blow and no-flow fractions were similar between the two groups. Insufflations were more effective (p = 0.04), and the technique (p = 0.02) and rate (p Google Glass group than in the control group. Real-time video communication between the first responder and a remote intensivist through Google Glass did not decrease no-blow and no-flow fractions during the first 5 minutes of a simulated pediatric cardiopulmonary arrest but improved the quality of the insufflations and chest compressions provided.

  14. RESIDENCE TIMES OF PARTICLES IN DIFFUSIVE PROTOPLANETARY DISK ENVIRONMENTS. I. VERTICAL MOTIONS

    International Nuclear Information System (INIS)

    Ciesla, F. J.

    2010-01-01

    The chemical and physical evolution of primitive materials in protoplanetary disks are determined by the types of environments they are exposed to and their residence times within each environment. Here, a method for calculating representative paths of materials in diffusive protoplanetary disks is developed and applied to understanding how the vertical trajectories that particles take impact their overall evolution. The methods are general enough to be applied to disks with uniform diffusivity, the so-called constant-α cases, and disks with a spatially varying diffusivity, such as expected in 'layered-disks'. The average long-term dynamical evolution of small particles and gaseous molecules is independent of the specific form of the diffusivity in that they spend comparable fractions of their lifetimes at different heights in the disk. However, the paths that individual particles and molecules take depend strongly on the form of the diffusivity leading to a different range of behavior of particles in terms of deviations from the mean. As temperatures, gas densities, chemical abundances, and photon fluxes will vary with height in protoplanetary disks, the different paths taken by primitive materials will lead to differences in their chemical and physical evolution. Examples of differences in gas phase chemistry and photochemistry are explored here. The methods outlined here provide a powerful tool that can be integrated with chemical models to understand the formation and evolution of primitive materials in protoplanetary disks on timescales of 10 5 -10 6 years.

  15. Fluid flow profile in a packed bead column using residence time curves and radiotracer techniques

    Energy Technology Data Exchange (ETDEWEB)

    Almeida, Ana Paula F. de; Gonçalves, Eduardo Ramos; Brandão, Luis Eduardo B.; Salgado, Cesar M., E-mail: anacamiqui@gmail.com, E-mail: egoncalves@con.ufrj.br, E-mail: brandao@ien.gov.br, E-mail: otero@ien.gov.br [Instituto de Engenharia Nuclear (IEN/CNEN-RJ), Rio de Janeiro, RJ (Brazil)

    2017-07-01

    Filling columns are extremely important in the chemical industry and are used for purification, separation and treatment processes of gas or liquid mixtures. The objective of this work is to study the hydrodynamics of the fluid for a characterization of aqueous phase flow patterns in the filling column, associating with the methodology of the Curves of Residence Time Distribution (RTD) to analyze and associate theoretical models that put as conditions column operating. RTD can be obtained by using the pulse-stimulus response technique which is characterized by the instantaneous injection of a radiotracer into the system input. In this work, 68Ga was used as radiotracer. Five shielded and collimated NaI (Tl) 1 x 1″ scintillator detectors were suitably positioned to record the movement of the radiotracer's path in the conveying line and filling column. Making possible the analysis of the RTD curve in the regions of interest. With the data generated by the NaI (Tl) detectors with the passage of the radiotracer in the transport line and inside the column, it was possible to evaluate the flow profile of the aqueous phase and to identify operational failures, such as internal conduit and the existence of a retention zone in the inside the column. Theoretical models were used for different flow flows: the piston flow and perfect mixing. (author)

  16. Fluid flow profile in a packed bead column using residence time curves and radiotracer techniques

    International Nuclear Information System (INIS)

    Almeida, Ana Paula F. de; Gonçalves, Eduardo Ramos; Brandão, Luis Eduardo B.; Salgado, Cesar M.

    2017-01-01

    Filling columns are extremely important in the chemical industry and are used for purification, separation and treatment processes of gas or liquid mixtures. The objective of this work is to study the hydrodynamics of the fluid for a characterization of aqueous phase flow patterns in the filling column, associating with the methodology of the Curves of Residence Time Distribution (RTD) to analyze and associate theoretical models that put as conditions column operating. RTD can be obtained by using the pulse-stimulus response technique which is characterized by the instantaneous injection of a radiotracer into the system input. In this work, 68Ga was used as radiotracer. Five shielded and collimated NaI (Tl) 1 x 1″ scintillator detectors were suitably positioned to record the movement of the radiotracer's path in the conveying line and filling column. Making possible the analysis of the RTD curve in the regions of interest. With the data generated by the NaI (Tl) detectors with the passage of the radiotracer in the transport line and inside the column, it was possible to evaluate the flow profile of the aqueous phase and to identify operational failures, such as internal conduit and the existence of a retention zone in the inside the column. Theoretical models were used for different flow flows: the piston flow and perfect mixing. (author)

  17. Impacts of Streambed Heterogeneity and Anisotropy on Residence Time of Hyporheic Zone.

    Science.gov (United States)

    Liu, Suning; Chui, Ting Fong May

    2018-05-01

    The hyporheic zone (HZ), which is the region beneath or alongside a streambed, plays an important role in the stream's ecology. The duration that a water molecule or a solute remains within the HZ, or residence time (RT), is one of the most common metrics used to evaluate the function of the HZ. The RT is greatly influenced by the streambed's hydraulic conductivity (K), which is intrinsically difficult to characterize due to its heterogeneity and anisotropy. Many laboratory and numerical studies of the HZ have simplified the streambed K to a constant, thus producing RT values that may differ from those gathered from the field. Some studies have considered the heterogeneity of the HZ, but very few have accounted for anisotropy or the natural K distributions typically found in real streambeds. This study developed numerical models in MODFLOW to examine the influence of heterogeneity and anisotropy, and that of the natural K distribution in a streambed, on the RT of the HZ. Heterogeneity and anisotropy were both found to shorten the mean and median RTs while increasing the range of the RTs. Moreover, heterogeneous K fields arranged in a more orderly pattern had longer RTs than those with random K distributions. These results could facilitate the design of streambed K values and distributions to achieve the desired RT during river restoration. They could also assist the translation of results from the more commonly considered homogeneous and/or isotropic conditions into heterogeneous and anisotropic field situations. © 2017, National Ground Water Association.

  18. Investigation of residence time and groundwater flux in Venice Lagoon: comparing radium isotope and hydrodynamic models.

    Science.gov (United States)

    Rapaglia, John; Ferrarin, Christian; Zaggia, Luca; Moore, Willard S; Umgiesser, Georg; Garcia-Solsona, Ester; Garcia-Orellana, Jordi; Masqué, Pere

    2010-07-01

    The four naturally-occurring isotopes of radium were coupled with a previously evaluated hydrodynamic model to determine the apparent age of surface waters and to quantify submarine groundwater discharge (SGD) into the Venice Lagoon, Italy. Mean apparent age of water in the Venice Lagoon was calculated using the ratio of 224Ra to 228Ra determined from 30 monitoring stations and a mean pore water end member. Average apparent age was calculated to be 6.0 d using Ra ratios. This calculated age was very similar to average residence time calculated for the same period using a hydrodynamic model (5.8 d). A mass balance of Ra was accomplished by quantifying each of the sources and sinks of Ra in the lagoon, with the unknown variable being attributed to SGD. Total SGD were calculated to be 4.1 +/- 1.5, 3.8 +/- 0.7, 3.0 +/- 1.3, and 3.5 +/- 1.0 x 10(10) L d(-1) for (223,224,226, 228)Ra, respectively, which are an order of magnitude larger than total mean fluvial discharge into the Venice Lagoon (3.1 x 10(9) L d(-1)). The SGD as a source of nutrients in the Venice Lagoon is also discussed and, though significant to the nutrient budget, is likely to be less important as the dominant control on SGD is recirculated seawater rather than freshwater. 2009 Elsevier Ltd. All rights reserved.

  19. Investigation of residence time and groundwater flux in Venice Lagoon: comparing radium isotope and hydrodynamical models

    International Nuclear Information System (INIS)

    Rapaglia, John; Ferrarin, Christian; Zaggia, Luca; Moore, Willard S.; Umgiesser, Georg; Garcia-Solsona, Ester; Garcia-Orellana, Jordi; Masque, Pere

    2010-01-01

    The four naturally-occurring isotopes of radium were coupled with a previously evaluated hydrodynamic model to determine the apparent age of surface waters and to quantify submarine groundwater discharge (SGD) into the Venice Lagoon, Italy. Mean apparent age of water in the Venice Lagoon was calculated using the ratio of 224 Ra to 228 Ra determined from 30 monitoring stations and a mean pore water endmember. Average apparent age was calculated to be 6.0 d using Ra ratios. This calculated age was very similar to average residence time calculated for the same period using a hydrodynamic model (5.8 d). A mass balance of Ra was accomplished by quantifying each of the sources and sinks of Ra in the lagoon, with the unknown variable being attributed to SGD. Total SGD were calculated to be 4.1 ± 1.5, 3.8 ± 0.7, 3.0 ± 1.3, and 3.5 ± 1.0 x 10 10 L d -1 for 223,224,226,228 Ra, respectively, which are an order of magnitude larger than total mean fluvial discharge into the Venice Lagoon (3.1 x 10 9 L d -1 ). The SGD as a source of nutrients in the Venice Lagoon is also discussed and, though significant to the nutrient budget, is likely to be less important as the dominant control on SGD is recirculated seawater rather than freshwater.

  20. Relating hyporheic fluxes, residence times, and redox-sensitive biogeochemical processes upstream of beaver dams

    Science.gov (United States)

    Briggs, Martin A.; Lautz, Laura; Hare, Danielle K.

    2013-01-01

    Abstract. Small dams enhance the development of patchy microenvironments along stream corridors by trapping sediment and creating complex streambed morphologies. This patchiness drives intricate hyporheic flux patterns that govern the exchange of O2 and redox-sensitive solutes between the water column and the stream bed. We used multiple tracer techniques, naturally occurring and injected, to evaluate hyporheic flow dynamics and associated biogeochemical cycling and microbial reactivity around 2 beaver dams in Wyoming (USA). High-resolution fiber-optic distributed temperature sensing was used to collect temperature data over 9 vertical streambed profiles and to generate comprehensive vertical flux maps using 1-dimensional (1-D) heat-transport modeling. Coincident with these locations, vertical profiles of hyporheic water were collected every week and analyzed for dissolved O2, pH, dissolved organic C, and several conservative and redox-sensitive solutes. In addition, hyporheic and net stream aerobic microbial reactivity were analyzed with a constant-rate injection of the biologically sensitive resazurin (Raz) smart tracer. The combined results revealed a heterogeneous system with rates of downwelling hyporheic flow organized by morphologic unit and tightly coupled to the redox conditions of the subsurface. Principal component analysis was used to summarize the variability of all redox-sensitive species, and results indicated that hyporheic water varied from oxic-stream-like to anoxic-reduced in direct response to the hydrodynamic conditions and associated residence times. The anaerobic transition threshold predicted by the mean O2 Damko

  1. Drug-target residence time--a case for G protein-coupled receptors.

    Science.gov (United States)

    Guo, Dong; Hillger, Julia M; IJzerman, Adriaan P; Heitman, Laura H

    2014-07-01

    A vast number of marketed drugs act on G protein-coupled receptors (GPCRs), the most successful category of drug targets to date. These drugs usually possess high target affinity and selectivity, and such combined features have been the driving force in the early phases of drug discovery. However, attrition has also been high. Many investigational new drugs eventually fail in clinical trials due to a demonstrated lack of efficacy. A retrospective assessment of successfully launched drugs revealed that their beneficial effects in patients may be attributed to their long drug-target residence times (RTs). Likewise, for some other GPCR drugs short RT could be beneficial to reduce the potential for on-target side effects. Hence, the compounds' kinetics behavior might in fact be the guiding principle to obtain a desired and durable effect in vivo. We therefore propose that drug-target RT should be taken into account as an additional parameter in the lead selection and optimization process. This should ultimately lead to an increased number of candidate drugs moving to the preclinical development phase and on to the market. This review contains examples of the kinetics behavior of GPCR ligands with improved in vivo efficacy and summarizes methods for assessing drug-target RT. © 2014 Wiley Periodicals, Inc.

  2. The research rotation: competency-based structured and novel approach to research training of internal medicine residents

    Directory of Open Access Journals (Sweden)

    Dimitrov Vihren

    2006-10-01

    Full Text Available Abstract Background In the United States, the Accreditation Council of graduate medical education (ACGME requires all accredited Internal medicine residency training programs to facilitate resident scholarly activities. However, clinical experience and medical education still remain the main focus of graduate medical education in many Internal Medicine (IM residency-training programs. Left to design the structure, process and outcome evaluation of the ACGME research requirement, residency-training programs are faced with numerous barriers. Many residency programs report having been cited by the ACGME residency review committee in IM for lack of scholarly activity by residents. Methods We would like to share our experience at Lincoln Hospital, an affiliate of Weill Medical College Cornell University New York, in designing and implementing a successful structured research curriculum based on ACGME competencies taught during a dedicated "research rotation". Results Since the inception of the research rotation in 2004, participation of our residents among scholarly activities has substantially increased. Our residents increasingly believe and appreciate that research is an integral component of residency training and essential for practice of medicine. Conclusion Internal medicine residents' outlook in research can be significantly improved using a research curriculum offered through a structured and dedicated research rotation. This is exemplified by the improvement noted in resident satisfaction, their participation in scholarly activities and resident research outcomes since the inception of the research rotation in our internal medicine training program.

  3. Current situation and consideration of training base hospitals for residents of neurosurgical specialization in China

    Directory of Open Access Journals (Sweden)

    Feng-zeng JIAN

    2015-07-01

    Full Text Available Resident training of neurosurgical specialization will be tried and carried out in all over China. From the point of view of training base hospitals, a majority of 3A level hospitals have sufficient patients and good equipments which will ensure the success of training process; however, division of subspecialty, teaching motivation and teaching method still have a great potential to improve. In order to establish and improve training bases for residents of specialization, supervision from national administrative department should be strengthened; professional society also plays an important role in standardizing and controlling the training quality. Considering our nation's situation, integration of postgraduate education and resident training is worth of discussion. DOI: 10.3969/j.issn.1672-6731.2015.07.015

  4. Evidence-based practice in radiology: Knowledge, attitude and perceived barriers to practice among residents in radiology

    Energy Technology Data Exchange (ETDEWEB)

    Anuradha, Chandramohan, E-mail: anuradhachandramohan@gmail.com [Department of Radiology, Christian Medical College, Vellore, Tamil Nadu 632 004 (India); Jacob, K.S., E-mail: ksjacob@cmcvellore.ac.in [Department of Psychiatry, Christian Medical College, Vellore, Tamil Nadu 632 004 (India); Specialist Mental Health Service for Older People, Suite 106, 64–68 Derby Street, Kingswood, Penrith 2750 (Australia); Shyamkumar, N.K., E-mail: aparnashyam@gmail.com [Department of Radiology, Christian Medical College, Vellore, Tamil Nadu 632 004 (India); Sridhar, Gibikote, E-mail: gibikote@cmcvellore.ac.in [Department of Radiology, Christian Medical College, Vellore, Tamil Nadu 632 004 (India)

    2013-05-15

    Aim: We examinted the attitude, knowledge and perceived barriers to evidence-based practice of radiology (EBPR) among residents in radiology. Study design and setting: We used the McColl questionnaire (1) and the BARRIERS scale (2) to assess the issues among radiology trainees attending an annual refresher course. Ninety six residents from 32 medical colleges from Southern India attended the course. Results: Eighty (83.3%) residents, 55 male and 25 female of age range 24–34 years, consented and returned the questionnaire. The majority of the participants had a positive attitude towards EBPR. However, 45% were unaware of sources for evidence based literature although many had access to Medline (45%) and the internet (80%). The majority (70%) were aware of the common technical terms (e.g. odds ratio, absolute and relative risk) but other complex details (e.g. meta-analysis, clinical effectiveness, confidence interval, publication bias and number needed to treat) were poorly understood. Though majority of residents (59%) were currently following guidelines and protocols laid by colleagues within their departments, 70% of residents were interested in learning the skills of EBPR and were willing to appraise primary literature or systematic reviews by themselves. Insufficient time on the job to implement new ideas (70.1%); relevant literature is not being complied in one place (68.9%); not being able to understand statistical methods (68.5%) were considered to be the major barriers to EBPR. Training in critical appraisal significantly influence usage of bibliographic databases (p < 0.0001). Attitude of collegues (p = 0.006) influenced attitude of the trainees towards EBPR. Those with higher knowledge scores (p = 0.02) and a greater awareness of sources for seeking evidence based literature (p = 0.05) held stronger beliefs that EBPR significantly improved patient care. Conclusions: The large knowledge gap related to EBPR suggests the need to incorporate structured

  5. Evidence-based practice in radiology: Knowledge, attitude and perceived barriers to practice among residents in radiology

    International Nuclear Information System (INIS)

    Anuradha, Chandramohan; Jacob, K.S.; Shyamkumar, N.K.; Sridhar, Gibikote

    2013-01-01

    Aim: We examinted the attitude, knowledge and perceived barriers to evidence-based practice of radiology (EBPR) among residents in radiology. Study design and setting: We used the McColl questionnaire (1) and the BARRIERS scale (2) to assess the issues among radiology trainees attending an annual refresher course. Ninety six residents from 32 medical colleges from Southern India attended the course. Results: Eighty (83.3%) residents, 55 male and 25 female of age range 24–34 years, consented and returned the questionnaire. The majority of the participants had a positive attitude towards EBPR. However, 45% were unaware of sources for evidence based literature although many had access to Medline (45%) and the internet (80%). The majority (70%) were aware of the common technical terms (e.g. odds ratio, absolute and relative risk) but other complex details (e.g. meta-analysis, clinical effectiveness, confidence interval, publication bias and number needed to treat) were poorly understood. Though majority of residents (59%) were currently following guidelines and protocols laid by colleagues within their departments, 70% of residents were interested in learning the skills of EBPR and were willing to appraise primary literature or systematic reviews by themselves. Insufficient time on the job to implement new ideas (70.1%); relevant literature is not being complied in one place (68.9%); not being able to understand statistical methods (68.5%) were considered to be the major barriers to EBPR. Training in critical appraisal significantly influence usage of bibliographic databases (p < 0.0001). Attitude of collegues (p = 0.006) influenced attitude of the trainees towards EBPR. Those with higher knowledge scores (p = 0.02) and a greater awareness of sources for seeking evidence based literature (p = 0.05) held stronger beliefs that EBPR significantly improved patient care. Conclusions: The large knowledge gap related to EBPR suggests the need to incorporate structured

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

    Directory of Open Access Journals (Sweden)

    Emura Sei SE

    2011-09-01

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

  7. Developing an integrated evidence-based medicine curriculum for family medicine residency at the University of Alberta.

    Science.gov (United States)

    Allan, G Michael; Korownyk, Christina; Tan, Amy; Hindle, Hugh; Kung, Lina; Manca, Donna

    2008-06-01

    There is general consensus in the academic community that evidence-based medicine (EBM) teaching is essential. Unfortunately, many postgraduate programs have significant weakness in their EBM programs. The Family Medicine Residency committee at the University of Alberta felt their EBM curriculum would benefit from critical review and revision. An EBM Curriculum Committee was created to evaluate previous components and develop new strategies as needed. Input from stakeholders including faculty and residents was sought, and evidence regarding the teaching and practical application of EBM was gathered. The committee drafted goals and objectives, the primary of which were to assist residents to (1) become competent self-directed, lifelong learners with skills to effectively and efficiently keep up to date, and 2) develop EBM skills to solve problems encountered in daily practice. New curriculum components, each evidence based, were introduced in 2005 and include a family medicine EBM workshop to establish basic EBM knowledge; a Web-based Family Medicine Desktop promoting easier access to evidence-based Internet resources; a brief evidence-based assessment of the research project enhancing integration of EBM into daily practice; and a journal club to support peer learning and growth of rapid appraisal skills. Issues including time use, costs, and change management are discussed. Ongoing evaluation of the curriculum and its components is a principal factor of the design, allowing critical review and adaptation of the curriculum. The first two years of the curriculum have yielded positive feedback from faculty and statistically significant improvement in multiple areas of residents' opinions of the curriculum and comfort with evidence-based practice.

  8. Leveraging time and learning style, iPod vs. realtime attendance at a series of medicine residents conferences: a randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Michael Tempelhof

    2009-06-01

    Conclusions Residency training programmes can optimise time management strategies with the integration of innovative learning resources into educational curricula. This study suggests that iPod capture of conferences is a reasonable resource to help meet the educational goals of residents and residency programs.

  9. Groundwater residence time and movement in the Maltese islands - A geochemical approach

    Energy Technology Data Exchange (ETDEWEB)

    Stuart, M.E., E-mail: mest@bgs.ac.uk [British Geological Survey, Wallingford, Oxfordshire OX10 8BB (United Kingdom); Maurice, L. [British Geological Survey, Wallingford, Oxfordshire OX10 8BB (United Kingdom); Heaton, T.H.E. [British Geological Survey, NERC Isotope Geoscience Laboratory, Keyworth, Nottinghamshire NG12 5GG (United Kingdom); Sapiano, M.; Micallef Sultana, M. [Malta Resources Authority, Marsa MRS 9065 (Malta); Gooddy, D.C.; Chilton, P.J. [British Geological Survey, Wallingford, Oxfordshire OX10 8BB (United Kingdom)

    2010-05-15

    The Maltese islands are composed of two limestone aquifers, the Upper and Lower Coralline Limestone separated by an aquitard, the 'Blue Clay'. The Lower Coralline Limestone is overlain in part by the poorly permeable Globigerina Limestone. The upper perched aquifers are discontinuous and have very limited saturated thickness and a short water level response time to rainfall. Frequent detections of coliforms suggest a rapid route to groundwater. However, the unsaturated zone has a considerable thickness in places and the primary porosity of the Upper Coralline Limestone is high, so there is likely to be older recharge by slow matrix flow as well as rapid recharge from fractures. Measurement of SF{sub 6} from a pumping station in a deep part of one of the perched aquifers indicated a mean saturated zone age of about 15 a. The Main Sea Level aquifers (MSL) on both Malta and Gozo have a large unsaturated thickness as water levels are close to sea level. On Malta, parts of the aquifer are capped by the perched aquifers and more extensively by the Globigerina Limestone. The limited detection of coliform bacteria suggests only some rapid recharge from the surface via fractures or karst features. Transmissivity is low and {sup 3}H and CFC/SF{sub 6} data indicate that saturated zone travel times are in the range 15-40 a. On Gozo the aquifer is similar but is more-extensively capped by impermeable Blue Clay. CFC data show the saturated zone travel time is from 25 a to possibly more than 60 a. Groundwater age is clearly related to the extent of low-permeability cover. The {delta}{sup 13}C signature of groundwater is related to the geochemical processes which occur along the flowpath and is consistent with residence time ages in the sequence; perched aquifers < Malta MSL < Gozo MSL. The {sup 18}O and {sup 2}H enriched isotopic signature of post 1983 desalinated water can be seen in more-modern groundwater, particularly the urbanized areas of the perched and Malta MSL

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

    Science.gov (United States)

    Azevedo, Roger; And Others

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

  11. Development and Implementation of a Web-based Evaluation System for an Internal Medicine Residency Program.

    Science.gov (United States)

    Rosenberg, Mark E.; Watson, Kathleen; Paul, Jeevan; Miller, Wesley; Harris, Ilene; Valdivia, Tomas D.

    2001-01-01

    Describes the development and implementation of a World Wide Web-based electronic evaluation system for the internal medicine residency program at the University of Minnesota. Features include automatic entry of evaluations by faculty or students into a database, compliance tracking, reminders, extensive reporting capabilities, automatic…

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

    Directory of Open Access Journals (Sweden)

    Johanna Martinez

    2013-09-01

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

  13. Using acupressure and Montessori-based activities to decrease agitation for residents with dementia: a cross-over trial.

    Science.gov (United States)

    Lin, Li-Chan; Yang, Man-Hua; Kao, Chieh-Chun; Wu, Shiao-Chi; Tang, Sai-Hung; Lin, Jaung-Geng

    2009-06-01

    To explore the effectiveness of acupressure and Montessori-based activities in decreasing the agitated behaviors of residents with dementia. A double-blinded, randomized (two treatments and one control; three time periods) cross-over design was used. Six special care units for residents with dementia in long-term care facilities in Taiwan were the sites for the study. One hundred thirty-three institutionalized residents with dementia. Subjects were randomized into three treatment sequences: acupressure-presence-Montessori methods, Montessori methods-acupressure-presence and presence-Montessori methods-acupressure. All treatments were done once a day, 6 days per week, for a 4-week period. The Cohen-Mansfield Agitation Inventory, Ease-of-Care, and the Apparent Affect Rating Scale. After receiving the intervention, the acupressure and Montessori-based-activities groups saw a significant decrease in agitated behaviors, aggressive behaviors, and physically nonaggressive behaviors than the presence group. Additionally, the ease-of-care ratings for the acupressure and Montessori-based-activities groups were significantly better than for the presence group. In terms of apparent affect, positive affect in the Montessori-based-activities group was significantly better than in the presence group. This study confirms that a blending of traditional Chinese medicine and a Western activities program would be useful in elderly care and that in-service training for formal caregivers in the use of these interventions would be beneficial for patients

  14. Joint Residence-Workplace Location Choice Model Based on Household Decision Behavior

    Directory of Open Access Journals (Sweden)

    Pengpeng Jiao

    2015-01-01

    Full Text Available Residence location and workplace are the two most important urban land-use types, and there exist strong interdependences between them. Existing researches often assume that one choice dimension is correlated to the other. Using the mixed logit framework, three groups of choice models are developed to illustrate such choice dependencies. First, for all households, this paper presents a basic methodology of the residence location and workplace choice without decision sequence based on the assumption that the two choice behaviors are independent of each other. Second, the paper clusters all households into two groups, choosing residence or workplace first, and formulates the residence location and workplace choice models under the constraint of decision sequence. Third, this paper combines the residence location and workplace together as the choice alternative and puts forward the joint choice model. A questionnaire survey is implemented in Beijing city to collect the data of 1994 households. Estimation results indicate that the joint choice model fits the data significantly better, and the elasticity effects analyses show that the joint choice model reflects the influences of relevant factors to the choice probability well and leads to the job-housing balance.

  15. Fuzzy Analytic Hierarchy Process-based Chinese Resident Best Fitness Behavior Method Research.

    Science.gov (United States)

    Wang, Dapeng; Zhang, Lan

    2015-01-01

    With explosive development in Chinese economy and science and technology, people's pursuit of health becomes more and more intense, therefore Chinese resident sports fitness activities have been rapidly developed. However, different fitness events popularity degrees and effects on body energy consumption are different, so bases on this, the paper researches on fitness behaviors and gets Chinese residents sports fitness behaviors exercise guide, which provides guidance for propelling to national fitness plan's implementation and improving Chinese resident fitness scientization. The paper starts from the perspective of energy consumption, it mainly adopts experience method, determines Chinese resident favorite sports fitness event energy consumption through observing all kinds of fitness behaviors energy consumption, and applies fuzzy analytic hierarchy process to make evaluation on bicycle riding, shadowboxing practicing, swimming, rope skipping, jogging, running, aerobics these seven fitness events. By calculating fuzzy rate model's membership and comparing their sizes, it gets fitness behaviors that are more helpful for resident health, more effective and popular. Finally, it gets conclusions that swimming is a best exercise mode and its membership is the highest. Besides, the memberships of running, rope skipping and shadowboxing practicing are also relative higher. It should go in for bodybuilding by synthesizing above several kinds of fitness events according to different physical conditions; different living conditions so that can better achieve the purpose of fitness exercises.

  16. The decadal state of the terrestrial carbon cycle : Global retrievals of terrestrial carbon allocation, pools, and residence times

    NARCIS (Netherlands)

    Bloom, A Anthony; Exbrayat, Jean-François; van der Velde, Ivar R; Feng, Liang; Williams, Mathew

    2016-01-01

    The terrestrial carbon cycle is currently the least constrained component of the global carbon budget. Large uncertainties stem from a poor understanding of plant carbon allocation, stocks, residence times, and carbon use efficiency. Imposing observational constraints on the terrestrial carbon cycle

  17. Linking granulation performance with residence time and granulation liquid distributions in twin-screw granulation: An experimental investigation

    DEFF Research Database (Denmark)

    Kumar, Ashish; Alakarjula, Maija; Vanhoorne, Valérie

    2016-01-01

    Twin-screw granulation is a promising wet granulation technique for the continuous manufacturing of pharmaceutical solid dosage forms. A twin screw granulator displays a short residence time. Thus, the solid-liquid mixing must be achieved quickly by appropriate arrangement of transport and kneading...

  18. Comparison of the tritium residence times of various ceramic breeder materials irradiated in EXOTIC experiments 4 and 5

    International Nuclear Information System (INIS)

    Kwast, H.; Elen, J.D.; Conrad, R.; Casadio, S.; Werle, H.; Verstappen, G.

    1990-09-01

    Tritium residence times have been determined for various ceramic tritium breeding materials from in-situ release measurements. The irradiations, codenamed EXOTIC (EXtraction Of Tritium In Ceramics), were carried out in the High Flux Reactor (HFR) Petten. During the irradiation more than 450 transients were performed and the corresponding tritium release measured. Materials supplied by SCK/CEN (Li 2 ZrO 3 ), CEA (Li 2 ZrO 3 and LiAlO 2 ), ENEA (LiAlO 2 ), KfK (Li 4 SiO 4 ), NRL (Li 6 Zr 2 O 7 ) and ECN (Li 8 ZrO 6 ) were irradiated in EXOTIC-5 to compare the tritium residence times obtained under equal conditions. Apart from differences in density, grain size, pore size and OPV it appeared that the tritium residence times of the lithium zirconates (pellets) were shorter than those of the Li 4 SiO 4 pebbles. The tritium residence times of the Li 4 SiO 4 pebbles were shorter than those of the LiAlO 2 pellets. (author). 7 refs.; 5 figs.; 3 tabs

  19. Improving residents' handovers through just-in-time training for structured communication.

    Science.gov (United States)

    Rourke, Liam; Amin, Aditi; Boyington, Curtiss; Ao, Peter; Frolova, Natalia

    2016-01-01

    In a recent quality assurance project we learned that nearly half of the handovers we examined were characterized as unsatisfactory by our residents, who provided examples in which their anxiety had been piqued and patient care had been affected. These reports substantiated a growing body of literature on the relationship between the quality of handover and the quality of patient care, so we sought to improve the quality and consistency of the in-hosptial handovers undertaken by our internal medicine residents. Senior residents attended morning report for three consecutive month long blocks and evaluated the quality of the handovers using an observational protocol comprised of 16 aspects of effective handover. During the first block, the resident observed a median of eight of the 16 practices occurring across the 46 handovers, and a large amount of variability. At the beginning of the subsequent block we presented a concise introduction to a structured handover procedure (SBARR). The median quality of the subsequent 33 handovers rose to 11, and the variability decreased considerably. In the next block we refined the SBARR orientation to focus on the errors observed in the previous blocks, and the improvement in the quality and variability was sustained. The minor change, which requires few resources to sustain, had a favourable impact on the quality of our residents' in-hospital handovers.

  20. Innovative partnerships to advance public health training in community-based academic residency programs

    Directory of Open Access Journals (Sweden)

    Lo JC

    2017-10-01

    Full Text Available Joan C Lo,1–3 Thomas E Baudendistel,2,3 Abhay Dandekar,3,4 Phuoc V Le,5 Stanton Siu,2,3 Bruce Blumberg6 1Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA; 2Department of Medicine, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA; 3Graduate Medical Education, Kaiser Permanente East Bay, Oakland, CA, USA; 4Department of Pediatrics, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA; 5School of Public Health, University of California Berkeley, Berkeley, CA, USA; 6Graduate Medical Education, Kaiser Permanente Northern California, Oakland, CA, USA Abstract: Collaborative partnerships between community-based academic residency ­training programs and schools of public health, represent an innovative approach to training future physician leaders in population management and public health. In Kaiser Permanente Northern California, development of residency-Masters in Public Health (MPH tracks in the Internal Medicine Residency and the Pediatrics Residency programs, with MPH graduate studies completed at the University of California Berkeley School of Public Health, enables physicians to integrate clinical training with formal education in epidemiology, biostatistics, health policy, and disease prevention. These residency-MPH programs draw on more than 50 years of clinical education, public health training, and health services research – creating an environment that sparks inquiry and added value by developing skills in patient-centered care through the lens of population-based outcomes. Keywords: graduate medical education, public health, master’s degree, internal medicine, pediatrics, residency training

  1. Evaluation of an Evidence-Based Tobacco Treatment Curriculum for Psychiatry Residency Training Programs

    Science.gov (United States)

    Prochaska, Judith J.; Fromont, Sebastien C.; Leek, Desiree; Hudmon, Karen Suchanek; Louie, Alan K.; Jacobs, Marc H.; Hall, Sharon M.

    2009-01-01

    Objective Smokers with mental illness and addictive disorders account for nearly one in two cigarettes sold in the United States and are at high risk for smoking-related deaths and disability. Psychiatry residency programs provide a unique arena for disseminating tobacco treatment guidelines, influencing professional norms, and increasing access to tobacco cessation services among smokers with mental illness. The current study evaluated the Rx for Change in Psychiatry curriculum, developed for psychiatry residency programs and focused on identifying and treating tobacco dependence among individuals with mental illness. Methods The 4-hour curriculum emphasized evidence-based, patient-oriented cessation treatments relevant for all tobacco users, including those not yet ready to quit. The curriculum was informed by comprehensive literature review, consultation with an expert advisory group, faculty interviews, and a focus group with psychiatry residents. This study reports on evaluation of the curriculum in 2005–2006, using a quasi-experimental design, with 55 residents in three psychiatry residency training programs in Northern California. Results The curriculum was associated with improvements in psychiatry residents’ knowledge, attitudes, confidence, and counseling behaviors for treating tobacco use among their patients, with initial changes from pre- to posttraining sustained at 3-months’ follow-up. Residents’ self-reported changes in treating patients’ tobacco use were substantiated through systematic chart review. Conclusion The evidence-based Rx for Change in Psychiatry curriculum is offered as a model tobacco treatment curriculum that can be implemented in psychiatry residency training programs and disseminated widely, thereby effectively reaching a vulnerable and costly population of smokers. PMID:19190293

  2. Firing technology in practice - temperature, residence time, corrosion; Feuerungstechnik in der Praxis - Temperatur, Verweilzeit, Korrosion

    Energy Technology Data Exchange (ETDEWEB)

    Freimann, P.; Holl, D. [Muellheizkraftwerk Betriebsgesellschaft mbH, Burgkirchen/Alz (Germany)

    1998-09-01

    In a circular dated 1st Sept. 1994, i.e., after the issue of the pertinent planning decision, the Federal Environmental Ministry, BMU, laid down uniform standards on measurements and the parameterisation of the evaluation system for different operation states and loads. Subsequently, TUeV, the German Technical Control Board, prepared the parameterisation curves on the basis of these specifications. The implementation of the BMU paper of 1st Sept. 1994 did not result in any advantage, nor did it lead to a reduction of plant emissions, nor to advantages in the operation of the waste-fuelled cogeneration plant. On the contrary, elevated gas consumption and operating trouble due to frequent feed stops worsened the operating state of the plant. Elevated crude gas temperature in the boiler reduced the lifetime of the two boilers to a critical degree. An operating temperature of 850 C and a residence time of approx. 1 sec. in Burgkirchen waste-fuelled cogeneration plant have not worsened emission values while rendering the plant operable again. [Deutsch] Durch Rundschreiben d. BMU vom 01.09.1994 - also nach Erlass des Planfeststellungsbeschlusses - wurden einheitliche Vorgaben ueber Messungen und Parametrierung des Auswertesystems fuer die verschiedenen Betriebs- bzw. Lastzustaende erlassen. Unter Beruecksichtigung dieser Vorgaben wurden vom TUeV die Parametrierungskurven erstellt. Die Umsetzung des BMU-Papieres vom 01.09.1994 ergab keinerlei Vorteile, weder gab es eine Verringerung der anlagenbedingten Emissionen noch Vorteile fuer den Betrieb des MHKW`s. Im Gegenteil, erhoehte Gasverbraeuche und Betriebsstoerungen durch oftmalige Beschickungsstops verschlechterten den Betriebszustand. Erhoehte Rohgastemperatur im Kessel reduzierten die Lebensdauer der beiden Kessel kritisch. Der Betrieb mit 850 C und mit einer Verweilzeit von ca. 1 sec. fuehrt im MHKW Burgkirchen zu keiner Verschlechterung der Emissionswerte, macht aber die Anlagen wieder betreibbar. (orig./SR)

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

    International Nuclear Information System (INIS)

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

    2004-01-01

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

  4. Residence time distributions of artificially infiltrated groundwater used for drinking water production

    Science.gov (United States)

    Popp, A. L.; Marçais, J.; Moeck, C.; Brennwald, M. S.; Kipfer, R.

    2017-12-01

    Public drinking water supply in urban areas is often challenging due to exposure to potential contamination and high water demands. At our study site, a drinking water supply field in Switzerland, managed aquifer recharge (MAR) was implemented to overcome an increasing water demand and decreasing water quality. Water from the river Rhine is put on a system of channels and ponds to artificially infiltrate and hence, increase the natural groundwater availability. The groundwater system consists of two overlying aquifers, with hydraulic connections related to fractures and faults. The deeper aquifer contains contaminants, which possibly originate from nearby landfills and industrial areas. The operating water works aims to pump recently infiltrated water only. However, we suspect that the pumped water contains a fraction of old water due to the fractured zones which serve as hydraulic connection between the two aquifers. With this study, we aim to better understand the mixing patterns between recently infiltrated water and old groundwater to evaluate the risk for contamination of the system. To reach our objective, we used a set of gas tracers (222Rn, 3H/3He, 4He) from fifteen wells distributed throughout the area to estimate the residence time distribution (RTD) of each well. We calibrated the RTD with a Binary Mixing Model, where the fraction of young groundwater is assumed to follow a Piston Flow Model. The older groundwater fraction is calibrated with a Dispersion Model. Our results reflect the heterogeneity of the system with some abstraction wells containing young water only and others showing an admixture of old water which can only be explained by a connection to the deeper aquifer. We also show that our results on calibrated RTDs are in accordance with other geochemical data such as electrical conductivity, major ions and pH. Our results will contribute to a sound conceptual flow and transport understanding and will help to optimize the water supply system.

  5. Residence-Time Distributions in Laminar Flows and During the Passage of Granular Solids Through Rotary Kilns

    Energy Technology Data Exchange (ETDEWEB)

    Beek, W. J.; De Ridder, H. J. [Technische Hogeschool, Delft (Netherlands); Houtman, J. P.W.; Kuiper, D. [Reactor Instituut, Delft (Netherlands)

    1967-06-15

    Data on residence-time distributions are important in the design of apparatus for the chemical industry. Radioactive tracers can be useful in many cases, e.g. where a pulse technique is desired. Two examples are given in which a pulse of radioactive tracer is used. The first example deals with the residence-time distribution of a laminar, Newtonian flow in an annulus. This problem arises especially in the extrusion and injection moulding of polymers and in the coating of wires with plastics. In these cases the fractions of polymer with long residence times may have other properties than the polymer that flows fastest, because the polymerization reaction or the degradation reactions go on during the process. Two difficulties are to be considered: (a) the tracer pulse (a radioactive Au-sol suspended in the liquid used) cannot be distributed over the cross-section in proportion to the local flow velocity, and (b) the outflowing liquid must be sampled discontinuously. Both effects have been studied and corrections are indicated. When these corrections are applied to the measured distribution curve, the result is in fair agreement with the calculated residence-time distribution. The second example considers the residence-time distribution in a granular solid (sand) passing through a rotary kiln. The response was measured at the outlet to a pulse at the inlet of radioactive material (sand impregnated with a solution of radioactive AuCl{sub 3}). When calculating the residence-time distribution from the experimental data, difficulties were encountered because the duration of the pulse was of the same order of magnitude as the average residence time. Considering this, it was found that the axial dispersion of the flow of sand could be described by an effective dispersion coefficient. This dispersion coefficient proved to be very low (order of magnitude 10{sup -5} m{sup 2}/s); hence, in practical situations, the flow of granular material through a rotary kiln may often be

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

    Directory of Open Access Journals (Sweden)

    P. Rodgers

    2005-01-01

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

  7. Preliminary estimates of residence times and apparent ages of ground water in the Chesapeake Bay watershed, and water-quality data from a survey of springs

    Science.gov (United States)

    Focazio, Michael J.; Plummer, Niel; Bohlke, John K.; Busenberg, Eurybiades; Bachman, L. Joseph; Powars, David S.

    1998-01-01

    discharging from 30 of the 46 springs sampled were less than 20 years, including 5 that were 'modern' (0-4 years). Four samples had apparent ages of 22 to 34 years, and two others from thermal springs were 40 years or greater. The remaining ten samples were contaminated with local sources of CFC and could not be dated. Nitrate concentrations and nitrate delta 15 nitrogen (15N) values in water from many springs are similar to those in shallow ground water beneath fertilized fields, and some values are high enough to indicate a probable source from animal-waste components. The nitrogen data reported here highlight the significance of the springs sampled during this study as pathways for nutrient transport in the Chesapeake Bay watershed. Ground-water samples were collected from springs during an unusually high flow period and thus may not be representative of low base-flow conditions. Residence times estimated from plausible ranges of aquifer properties and results of previous age-dating analyses generally corroborate the apparent-age analysis made in the current study and suggests that some residence times could be much longer. The shortest residence times tend to be in the Blue Ridge and northern carbonate areas; however, the data are preliminary and not appropriate for statistical tests of significance or variance. Because the age distributions in the aquifer discharging to the springs are not known, and because the apparent ages of water from the springs are based on various com-binations of CFC criteria, the apparent ages and calculated residence times are compared for illustrative purposes but are considered preliminary until further work is accomplished.

  8. Residents' views of the role of classroom-based learning in graduate medical education through the lens of academic half days.

    Science.gov (United States)

    Chen, Luke Y C; McDonald, Julie A; Pratt, Daniel D; Wisener, Katherine M; Jarvis-Selinger, Sandra

    2015-04-01

    To examine the role of classroom-based learning in graduate medical education through the lens of academic half days (AHDs) by exploring residents' perceptions of AHDs' purpose and relevance and the effectiveness of teaching and learning in AHDs. The authors invited a total of 186 residents in three programs (internal medicine, orthopedic surgery, and hematology) at the University of British Columbia Faculty of Medicine to participate in semistructured focus groups from October 2010 to February 2011. Verbatim transcripts of the interviews underwent inductive analysis. Twenty-seven residents across the three programs volunteered to participate. Two major findings emerged. Purpose and relevance of AHDs: Residents believed that AHDs are primarily for knowledge acquisition and should complement clinical learning. Classroom learning facilitated consolidation of clinical experiences with expert clinical reasoning. Social aspects of AHDs were highly valued as an important secondary purpose. Perceived effectiveness of teaching and learning: Case-based teaching engaged residents in critical thinking; active learning was valued. Knowledge retention was considered suboptimal. Perspectives on the concept of AHDs as "protected time" varied in the three programs. Findings suggest that (1) engagement in classroom learning occurs through participation in clinically oriented discussions that highlight expert reasoning processes; (2) formal classroom teaching, which focuses on knowledge acquisition, can enhance informal learning occurring during clinical activity; and (3) social aspects of AHDs, including their role in creating communities of practice in residency programs and in professional identity formation, are an important, underappreciated asset for residency programs.

  9. Contrasting residence times and fluxes of water and sulfate in two small forested watersheds in Virginia, USA.

    Science.gov (United States)

    Böhlke, John Karl; Michel, Robert L

    2009-07-01

    Watershed mass balances for solutes of atmospheric origin may be complicated by the residence times of water and solutes at various time scales. In two small forested headwater catchments in the Appalachian Mountains of Virginia, USA, mean annual export rates of SO(4)(=) differ by a factor of 2, and seasonal variations in SO(4)(=) concentrations in atmospheric deposition and stream water are out of phase. These features were investigated by comparing (3)H, (35)S, delta(34)S, delta(2)H, delta(18)O, delta(3)He, CFC-12, SF(6), and chemical analyses of open deposition, throughfall, stream water, and spring water. The concentrations of SO(4)(=) and radioactive (35)S were about twice as high in throughfall as in open deposition, but the weighted composite values of (35)S/S (11.1 and 12.1x10(-15)) and delta(34)S (+3.8 and +4.1 per thousand) were similar. In both streams (Shelter Run, Mill Run), (3)H concentrations and delta(34)S values during high flow were similar to those of modern deposition, delta(2)H and delta(18)O values exhibited damped seasonal variations, and (35)S/S ratios (0-3x10(-15)) were low throughout the year, indicating inter-seasonal to inter-annual storage and release of atmospheric SO(4)(=) in both watersheds. In the Mill Run watershed, (3)H concentrations in stream base flow (10-13 TU) were consistent with relatively young groundwater discharge, most delta(34)S values were approximately the same as the modern atmospheric deposition values, and the annual export rate of SO(4)(=) was equal to or slightly greater than the modern deposition rate. In the Shelter Run watershed, (3)H concentrations in stream base flow (1-3 TU) indicate that much of the discharging ground water had been deposited prior to the onset of atmospheric nuclear bomb testing in the 1950s, base flow delta(34)S values (+1.6 per thousand) were significantly lower than the modern deposition values, and the annual export rate of SO(4)(=) was less than the modern deposition rate

  10. Impact of solids residence time on biological nutrient removal performance of membrane bioreactor.

    Science.gov (United States)

    Ersu, Cagatayhan Bekir; Ong, Say Kee; Arslankaya, Ertan; Lee, Yong-Woo

    2010-05-01

    Impact of long solids residence times (SRTs) on nutrient removal was investigated using a submerged plate-frame membrane bioreactor with anaerobic and anoxic tanks. The system was operated at 10, 25, 50 and 75 days SRTs with hydraulic retention times (HRTs) of 2 h each for the anaerobic and anoxic tanks and 8 h for the oxic tank. Recirculation of oxic tank mixed liquor into the anaerobic tank and permeate into the anoxic tank were fixed at 100% each of the influent flow. For all SRTs, percent removals of soluble chemical oxygen demand were more than 93% and nitrification was more than 98.5% but total nitrogen percent removal seemed to peak at 81% at 50 days SRT while total phosphorus (TP) percent removal showed a deterioration from approximately 80% at 50 days SRT to 60% at 75 days SRT. Before calibrating the Biowin((R)) model to the experimental data, a sensitivity analysis of the model was conducted which indicated that heterotrophic anoxic yield, anaerobic hydrolysis factors of heterotrophs, heterotrophic hydrolysis, oxic endogenous decay rate for heterotrophs and oxic endogenous decay rate of PAOs had the most impact on predicted effluent TP concentration. The final values of kinetic parameters obtained in the calibration seemed to imply that nitrogen and phosphorus removal increased with SRT due to an increase in anoxic and anaerobic hydrolysis factors up to 50 days SRT but beyond that removal of phosphorus deteriorated due to high oxic endogenous decay rates. This indirectly imply that the decrease in phosphorus removal at 75 days SRT may be due to an increase in lysis of microbial cells at high SRTs along with the low food/microorganisms ratio as a result of high suspended solids in the oxic tank. Several polynomial correlations relating the various calibrated kinetic parameters with SRTs were derived. The Biowin((R)) model and the kinetic parameters predicted by the polynomial correlations were verified and found to predict well the effluent water quality

  11. Estimation of gastric residence time of the Heidelberg capsule in humans: effect of varying food composition

    International Nuclear Information System (INIS)

    Mojaverian, P.; Ferguson, R.K.; Vlasses, P.H.; Rocci, M.L. Jr.; Oren, A.; Fix, J.A.; Caldwell, L.J.; Gardner, C.

    1985-01-01

    In animal and human studies, the gastric emptying of large (greater than 1 mm) indigestible solids is due to the activity of the interdigestive migrating myoelectric complex. The gastric residence time (GRT) of an orally administered, nondigestible, pH-sensitive, radiotelemetric device (Heidelberg capsule) was evaluated in three studies in healthy volunteers. In 6 subjects, the GRT of the Heidelberg capsule was compared with the half-emptying time (t1/2) of diethylenetriaminepentaacetic acid labeled with technetium 99m after a 4-ml/kg liquid fatty meal. The mean (+/-SD) GRT (4.3 +/- 1.4 h) was significantly (p less than 0.001) longer than the mean t1/2 (1.1 +/- 0.3 h); the GRT was prolonged compared with the t1/2 in each subject. In a randomized, crossover trial in 10 subjects, frequent feeding caused a dramatic prolongation in mean GRT of the capsule compared with the fasting state (greater than 14.5 vs. 0.5 h, p less than 0.005). In another crossover study in 6 subjects, the GRT of the capsule was evaluated after an overnight fast, a standard breakfast including solid food, and a liquid meal (i.e., 200 ml of diluted light cream). The mean GRT was 2.6 +/- 0.9 h after the liquid meal vs. 1.2 +/- 0.8 h after fasting (p less than 0.025). The mean GRT after the breakfast was 4.8 +/- 1.5 h, which was significantly greater than that after fasting (p less than 0.001) and after the liquid meal (p less than 0.01). These data suggest that the GRT of the Heidelberg capsule is a marker of the interdigestive migrating myoelectric complex in humans, the interdigestive migrating myoelectric complex can be markedly delayed by frequent feedings with solids, and the interdigestive migrating myoelectric complex is delayed by both liquid and solid meals

  12. Estimation of gastric residence time of the Heidelberg capsule in humans: effect of varying food composition

    Energy Technology Data Exchange (ETDEWEB)

    Mojaverian, P.; Ferguson, R.K.; Vlasses, P.H.; Rocci, M.L. Jr.; Oren, A.; Fix, J.A.; Caldwell, L.J.; Gardner, C.

    1985-08-01

    In animal and human studies, the gastric emptying of large (greater than 1 mm) indigestible solids is due to the activity of the interdigestive migrating myoelectric complex. The gastric residence time (GRT) of an orally administered, nondigestible, pH-sensitive, radiotelemetric device (Heidelberg capsule) was evaluated in three studies in healthy volunteers. In 6 subjects, the GRT of the Heidelberg capsule was compared with the half-emptying time (t1/2) of diethylenetriaminepentaacetic acid labeled with technetium 99m after a 4-ml/kg liquid fatty meal. The mean (+/-SD) GRT (4.3 +/- 1.4 h) was significantly (p less than 0.001) longer than the mean t1/2 (1.1 +/- 0.3 h); the GRT was prolonged compared with the t1/2 in each subject. In a randomized, crossover trial in 10 subjects, frequent feeding caused a dramatic prolongation in mean GRT of the capsule compared with the fasting state (greater than 14.5 vs. 0.5 h, p less than 0.005). In another crossover study in 6 subjects, the GRT of the capsule was evaluated after an overnight fast, a standard breakfast including solid food, and a liquid meal (i.e., 200 ml of diluted light cream). The mean GRT was 2.6 +/- 0.9 h after the liquid meal vs. 1.2 +/- 0.8 h after fasting (p less than 0.025). The mean GRT after the breakfast was 4.8 +/- 1.5 h, which was significantly greater than that after fasting (p less than 0.001) and after the liquid meal (p less than 0.01). These data suggest that the GRT of the Heidelberg capsule is a marker of the interdigestive migrating myoelectric complex in humans, the interdigestive migrating myoelectric complex can be markedly delayed by frequent feedings with solids, and the interdigestive migrating myoelectric complex is delayed by both liquid and solid meals.

  13. [Work satisfaction, quality of life and leisure time of residents at the Soroka University Medical Center, Beer Sheba, Israel].

    Science.gov (United States)

    Acker, Asaf; Perry, Zvi; Reuveni, Haim; Toker, Asaf

    2009-02-01

    Work dissatisfaction among physicians worldwide continues to rise over the last few decades, mainly due to declining professional prestige, tack of self fulfillment, time pressure and tack of leisure time. Physicians' burnout is a major result of dissatisfaction, causing doctors to leave the medical profession, and to provide lower quality of care. To examine the work satisfaction, quality of life and leisure time of residents in the Soroka University Medical Center. A validated questionnaire was delivered during the second half of 2004 to 252 residents in the Soroka University Medical Center The data was analyzed using the SPSS 12 for windows program. Descriptive analysis, parametric Students' T Test [where pleisure time. Further attention must be given to these matters--a step which will eventually improve patient care, and delay, to some extent, the burnout of physicians.

  14. Comment on "Scrutinizing the carbon cycle and CO2residence time in the atmosphere" by H. Harde

    Science.gov (United States)

    Köhler, Peter; Hauck, Judith; Völker, Christoph; Wolf-Gladrow, Dieter A.; Butzin, Martin; Halpern, Joshua B.; Rice, Ken; Zeebe, Richard E.

    2018-05-01

    Harde (2017) proposes an alternative accounting scheme for the modern carbon cycle and concludes that only 4.3% of today's atmospheric CO2 is a result of anthropogenic emissions. As we will show, this alternative scheme is too simple, is based on invalid assumptions, and does not address many of the key processes involved in the global carbon cycle that are important on the timescale of interest. Harde (2017) therefore reaches an incorrect conclusion about the role of anthropogenic CO2 emissions. Harde (2017) tries to explain changes in atmospheric CO2 concentration with a single equation, while the most simple model of the carbon cycle must at minimum contain equations of at least two reservoirs (the atmosphere and the surface ocean), which are solved simultaneously. A single equation is fundamentally at odds with basic theory and observations. In the following we will (i) clarify the difference between CO2 atmospheric residence time and adjustment time, (ii) present recently published information about anthropogenic carbon, (iii) present details about the processes that are missing in Harde (2017), (iv) briefly discuss shortcoming in Harde's generalization to paleo timescales, (v) and comment on deficiencies in some of the literature cited in Harde (2017).

  15. Competency-based residency training and the web log: modeling practice-based learning and enhancing medical knowledge

    Directory of Open Access Journals (Sweden)

    Matthew F. Hollon

    2015-12-01

    Full Text Available Background: By using web-based tools in medical education, there are opportunities to innovatively teach important principles from the general competencies of graduate medical education. Objectives: Postulating that faculty transparency in learning from uncertainties in clinical work could help residents to incorporate the principles of practice-based learning and improvement (PBLI in their professional development, faculty in this community-based residency program modeled the steps of PBLI on a weekly basis through the use of a web log. Method: The program confidentially surveyed residents before and after this project about actions consistent with PBLI and knowledge acquired through reading the web log. Results: The frequency that residents encountered clinical situations where they felt uncertain declined over the course of the 24 weeks of the project from a mean frequency of uncertainty of 36% to 28% (Wilcoxon signed rank test, p=0.008; however, the frequency with which residents sought answers when faced with uncertainty did not change (Wilcoxon signed rank test, p=0.39, remaining high at approximately 80%. Residents answered a mean of 52% of knowledge questions correct when tested prior to faculty posts to the blog, rising to a mean of 65% of questions correct when tested at the end of the project (paired t-test, p=0.001. Conclusions: Faculty role modeling of PBLI behaviors and posting clinical questions and answers to a web log led to modest improvements in medical knowledge but did not alter behavior that was already taking place frequently among residents.

  16. Web-Based Learning for Emergency Airway Management in Anesthesia Residency Training.

    Science.gov (United States)

    Hindle, Ada; Cheng, Ji; Thabane, Lehana; Wong, Anne

    2015-01-01

    Introduction. Web-based learning (WBL) is increasingly used in medical education; however, residency training programs often lack guidance on its implementation. We describe how the use of feasibility studies can guide the use of WBL in anesthesia residency training. Methods. Two case-based WBL emergency airway management modules were developed for self-directed use by anesthesia residents. The feasibility of using this educational modality was assessed using a single cohort pretest/posttest design. Outcome measures included user recruitment and retention rate, perceptions of educational value, and knowledge improvement. The differences between pre- and postmodule test scores and survey Likert scores were analysed using the paired t test. Results. Recruitment and retention rates were 90% and 65%, respectively. User-friendliness of the modules was rated highly. There was a significant improvement in perceptions of the value of WBL in the postsurvey. There was a significant knowledge improvement of 29% in the postmodule test. Conclusions. Feasibility studies can help guide appropriate use of WBL in curricula. While our study supported the potential feasibility of emergency airway management modules for training, collaboration with other anesthesia residency programs may enable more efficient development, implementation, and evaluation of this resource-intensive modality in anesthesia education and practice.

  17. Web-Based Learning for Emergency Airway Management in Anesthesia Residency Training

    Directory of Open Access Journals (Sweden)

    Ada Hindle

    2015-01-01

    Full Text Available Introduction. Web-based learning (WBL is increasingly used in medical education; however, residency training programs often lack guidance on its implementation. We describe how the use of feasibility studies can guide the use of WBL in anesthesia residency training. Methods. Two case-based WBL emergency airway management modules were developed for self-directed use by anesthesia residents. The feasibility of using this educational modality was assessed using a single cohort pretest/posttest design. Outcome measures included user recruitment and retention rate, perceptions of educational value, and knowledge improvement. The differences between pre- and postmodule test scores and survey Likert scores were analysed using the paired t test. Results. Recruitment and retention rates were 90% and 65%, respectively. User-friendliness of the modules was rated highly. There was a significant improvement in perceptions of the value of WBL in the postsurvey. There was a significant knowledge improvement of 29% in the postmodule test. Conclusions. Feasibility studies can help guide appropriate use of WBL in curricula. While our study supported the potential feasibility of emergency airway management modules for training, collaboration with other anesthesia residency programs may enable more efficient development, implementation, and evaluation of this resource-intensive modality in anesthesia education and practice.

  18. Human Emotion and Response in Surgery (HEARS): a simulation-based curriculum for communication skills, systems-based practice, and professionalism in surgical residency training.

    Science.gov (United States)

    Larkin, Anne C; Cahan, Mitchell A; Whalen, Giles; Hatem, David; Starr, Susan; Haley, Heather-Lyn; Litwin, Demetrius; Sullivan, Kate; Quirk, Mark

    2010-08-01

    This study examines the development and implementation of a pilot human factors curriculum during a 2-year period. It is one component of a comprehensive 5-year human factors curriculum spanning core competencies of interpersonal and communication skills, systems-based practice, and professionalism and using low-and high-fidelity simulation techniques. Members of the Department of Surgery and the Center for Clinical Communication and Performance Outcomes jointly constructed a curriculum for PGY1 and PGY2 residents on topics ranging from challenging communication to time and stress management. Video demonstrations, triggers, and simulated scenarios involving acting patients were created by surgeons and medical educators. Pre- and postintervention measures were obtained for communication skills, perceived stress level, and teamwork. Communication skills were evaluated using a series of video vignettes. The validated Perceived Stress Scale and Teamwork and Patient Safety Attitudes survey were used. Residents' perceptions of the program were also measured. Twenty-seven PGY1 residents and 15 PGY2 residents participated during 2 years. Analyses of video vignette tests indicated significant improvement in empathic communication for PGY1 (t = 3.62, p = 0.001) and PGY2 (t = 5.00, p = 0.004). There were no significant changes to teamwork attitudes. Perceived levels of stress became considerably higher. PGY1 residents reported trying 1 to 3 strategies taught in the time management session, with 60% to 75% reporting improvement post-training. This unique and comprehensive human factors curriculum is shown to be effective in building communication competency for junior-level residents in the human and emotional aspects of surgical training and practice. Continued refinement and ongoing data acquisition and analyses are underway. Copyright 2010 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  19. A web-based test of residents' skills in diagnostic radiology

    International Nuclear Information System (INIS)

    Finlay, K.; Norman, G.R.; Keane, D.R.; Stolberg, H.

    2006-01-01

    To develop an objective, Web-based tool for evaluating residents' knowledge of diagnostic radiology. We developed and tested a Web-based evaluation tool (the Diagnostic Radiology Skills Test) that consists of 3 tests, one in each of 3 domains of diagnostic radiology: chest, gastrointestinal, and musculoskeletal imaging. Each test comprises 30 cases representing a range of difficulty in the domain, including normal states, normal variants, typical cases of common diagnoses, and cases with more subtle findings. Cases are presented with a long menu of domain-specific possible diagnoses (response options), each coded for diagnostic appropriateness. Our subjects were 21 residents in postgraduate year (PGY) 2 to 5 and 11 experts in diagnostic radiology. Subjects accessed the tool via a Web site on our Web server. Residents test results were compared for reliability and validity across domain, case, and training level. In addition, results were correlated with commonly used established and objective evaluation tools. The tool demonstrated consistent monotonic improvement in performance with training level. It showed acceptable reliability in discriminating between residents at different performance levels, both within and across training levels (r = 0.53 within level and 0.69 across levels). Test results also had concurrent validity against the American College of Radiology In-Training Examination, a widely accepted objective assessment tool (r = 0.65, P < 0.01), and 2 Objective Structured Clinical Examinations (OSCEs) focusing on diagnostic skills (r = 0.78 and r 0.69, P < 0.01, respectively). Our study demonstrates the feasibility of a Web-based, standardized, objective assessment method for evaluating residents' performance. (author)

  20. Estimation of Transport Trajectory and Residence Time in Large River–Lake Systems: Application to Poyang Lake (China Using a Combined Model Approach

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    Yunliang Li

    2015-09-01

    Full Text Available The biochemical processes and associated water quality in many lakes mainly depend on their transport behaviors. Most existing methodologies for investigating transport behaviors are based on physically based numerical models. The pollutant transport trajectory and residence time of Poyang Lake are thought to have important implications for the steadily deteriorating water quality and the associated rapid environmental changes during the flood period. This study used a hydrodynamic model (MIKE 21 in conjunction with transport and particle-tracking sub-models to provide comprehensive investigation of transport behaviors in Poyang Lake. Model simulations reveal that the lake’s prevailing water flow patterns cause a unique transport trajectory that primarily develops from the catchment river mouths to the downstream area along the lake’s main flow channels, similar to a river-transport behavior. Particle tracking results show that the mean residence time of the lake is 89 days during July–September. The effect of the Yangtze River (the effluent of the lake on the residence time is stronger than that of the catchment river inflows. The current study represents a first attempt to use a combined model approach to provide insights into the transport behaviors for a large river–lake system, given proposals to manage the pollutant inputs both directly to the lake and catchment rivers.

  1. Using spaced retrieval and Montessori-based activities in improving eating ability for residents with dementia.

    Science.gov (United States)

    Lin, Li-Chan; Huang, Ya-Ju; Su, Su-Gen; Watson, Roger; Tsai, Belina W-J; Wu, Shiao-Chi

    2010-10-01

    To construct a training protocol for spaced retrieval (SR) and to investigate the effectiveness of SR and Montessori-based activities in decreasing eating difficulty in older residents with dementia. A single evaluator, blind, and randomized control trial was used. Eighty-five residents with dementia were chosen from three special care units for residents with dementia in long-term care facilities in Taiwan. To avoid any confounding of subjects, the three institutions were randomized into three groups: spaced retrieval, Montessori-based activities, and a control group. The invention consisted of three 30-40 min sessions per week, for 8 weeks. After receiving the intervention, the Edinburgh Feeding Evaluation in Dementia (EdFED) scores and assisted feeding scores for the SR and Montessori-based activity groups were significantly lower than that of the control group. However, the frequencies of physical assistance and verbal assistance for the Montessori-based activity group after intervention were significantly higher than that of the control group, which suggests that residents who received Montessori-based activity need more physical and verbal assistance during mealtimes. In terms of the effects of nutritional status after intervention, Mini-Nutritional Assessment (MNA) in the SR group was significantly higher than that of the control group. This study confirms the efficacy of SR and Montessori-based activities for eating difficulty and eating ability. A longitudinal study to follow the long-term effects of SR and Montessori-based activities on eating ability and nutritional status is recommended. Copyright © 2010 John Wiley & Sons, Ltd.

  2. Sediment residence times constrained by uranium-series isotopes: A critical appraisal of the comminution approach

    Science.gov (United States)

    Handley, Heather K.; Turner, Simon; Afonso, Juan C.; Dosseto, Anthony; Cohen, Tim

    2013-02-01

    Quantifying the rates of landscape evolution in response to climate change is inhibited by the difficulty of dating the formation of continental detrital sediments. We present uranium isotope data for Cooper Creek palaeochannel sediments from the Lake Eyre Basin in semi-arid South Australia in order to attempt to determine the formation ages and hence residence times of the sediments. To calculate the amount of recoil loss of 234U, a key input parameter used in the comminution approach, we use two suggested methods (weighted geometric and surface area measurement with an incorporated fractal correction) and typical assumed input parameter values found in the literature. The calculated recoil loss factors and comminution ages are highly dependent on the method of recoil loss factor determination used and the chosen assumptions. To appraise the ramifications of the assumptions inherent in the comminution age approach and determine individual and combined comminution age uncertainties associated to each variable, Monte Carlo simulations were conducted for a synthetic sediment sample. Using a reasonable associated uncertainty for each input factor and including variations in the source rock and measured (234U/238U) ratios, the total combined uncertainty on comminution age in our simulation (for both methods of recoil loss factor estimation) can amount to ±220-280 ka. The modelling shows that small changes in assumed input values translate into large effects on absolute comminution age. To improve the accuracy of the technique and provide meaningful absolute comminution ages, much tighter constraints are required on the assumptions for input factors such as the fraction of α-recoil lost 234Th and the initial (234U/238U) ratio of the source material. In order to be able to directly compare calculated comminution ages produced by different research groups, the standardisation of pre-treatment procedures, recoil loss factor estimation and assumed input parameter values

  3. Trait differences between naturalized and invasive plant species independent of residence time and phylogeny

    Science.gov (United States)

    Gallagher, R V; Randall, R P; Leishman, M R

    2015-01-01

    The ability to predict which alien plants will transition from naturalized to invasive prior to their introduction to novel regions is a key goal for conservation and has the potential to increase the efficacy of weed risk assessment (WRA). However, multiple factors contribute to plant invasion success (e.g., functional traits, range characteristics, residence time, phylogeny), and they all must be taken into account simultaneously in order to identify meaningful correlates of invasion success. We compiled 146 pairs of phylogenetically paired (congeneric) naturalized and invasive plant species in Australia with similar minimum residence times (i.e., time since introduction in years). These pairs were used to test for differences in 5 functional traits (flowering duration, leaf size, maximum height, specific leaf area [SLA], seed mass) and 3 characteristics of species’ native ranges (biome occupancy, mean annual temperature, and rainfall breadth) between naturalized and invasive species. Invasive species, on average, had larger SLA, longer flowering periods, and were taller than their congeneric naturalized relatives. Invaders also exhibited greater tolerance for different environmental conditions in the native range, where they occupied more biomes and a wider breadth of rainfall and temperature conditions than naturalized congeners. However, neither seed mass nor leaf size differed between pairs of naturalized and invasive species. A key finding was the role of SLA in distinguishing between naturalized and invasive pairs. Species with high SLA values were typically associated with faster growth rates, more rapid turnover of leaf material, and shorter lifespans than those species with low SLA. This suite of characteristics may contribute to the ability of a species to transition from naturalized to invasive across a wide range of environmental contexts and disturbance regimes. Our findings will help in the refinement of WRA protocols, and we advocate the

  4. Emergency medicine resident crisis resource management ability: a simulation-based longitudinal study

    Directory of Open Access Journals (Sweden)

    Samuel Clarke

    2014-12-01

    Full Text Available Background: Simulation has been identified as a means of assessing resident physicians’ mastery of technical skills, but there is a lack of evidence for its utility in longitudinal assessments of residents’ non-technical clinical abilities. We evaluated the growth of crisis resource management (CRM skills in the simulation setting using a validated tool, the Ottawa Crisis Resource Management Global Rating Scale (Ottawa GRS. We hypothesized that the Ottawa GRS would reflect progressive growth of CRM ability throughout residency. Methods: Forty-five emergency medicine residents were tracked with annual simulation assessments between 2006 and 2011. We used mixed-methods repeated-measures regression analyses to evaluate elements of the Ottawa GRS by level of training to predict performance growth throughout a 3-year residency. Results: Ottawa GRS scores increased over time, and the domains of leadership, problem solving, and resource utilization, in particular, were predictive of overall performance. There was a significant gain in all Ottawa GRS components between postgraduate years 1 and 2, but no significant difference in GRS performance between years 2 and 3. Conclusions: In summary, CRM skills are progressive abilities, and simulation is a useful modality for tracking their development. Modification of this tool may be needed to assess advanced learners’ gains in performance.

  5. Training at a faith-based institution matters for obstetrics and gynecology residents: results from a regional survey.

    Science.gov (United States)

    Guiahi, Maryam; Westhoff, Carolyn L; Summers, Sondra; Kenton, Kimberly

    2013-06-01

    Prior data suggest that opportunities in family planning training may be limited during obstetrics and gynecology (Ob-Gyn) residency training, particularly at faith-based institutions with moral and ethical constraints, although this aspect of the Ob-Gyn curriculum has not been formally studied to date. We compared Ob-Gyn residents' self-rated competency and intentions to provide family planning procedures at faith-based versus those of residents at non-faith-based programs. We surveyed residents at all 20 Ob-Gyn programs in Illinois, Indiana, Iowa, and Wisconsin from 2008 to 2009. Residents were queried about current skills and future plans to perform family planning procedures. We examined associations based on program and residents' personal characteristics and performed multivariable logistic regression analysis. A total of 232 of 340 residents (68%) from 17 programs (85%) returned surveys. Seven programs were faith-based. Residents from non-faith-based programs were more likely to be completely satisfied with family planning training (odds ratio [OR]  =  3.4, 95% confidence limit [CI], 1.9-6.2) and to report they "understand and can perform on own" most procedures. Most residents, regardless of program type, planned to provide all surveyed family planning services. Despite similar intentions to provide family planning procedures after graduation, residents at faith-based training programs were less satisfied with their family planning training and rate their ability to perform family planning services lower than residents at non-faith-based training programs.

  6. Mastery of Status Epilepticus Management via Simulation-Based Learning for Pediatrics Residents

    Science.gov (United States)

    Malakooti, Marcelo R.; McBride, Mary E.; Mobley, Bonnie; Goldstein, Joshua L.; Adler, Mark D.; McGaghie, William C.

    2015-01-01

    Background Management of status epilepticus (SE) in the pediatric population is highly time-sensitive. Failure to follow a standard management algorithm may be due to ineffective provider education, and can lead to unfavorable outcomes. Objective To design a learning module using high-fidelity simulation technology to teach mastery achievement of a hospital algorithm for managing SE. Methods Thirty pediatrics interns were enrolled. Using the Angoff method, an expert panel developed the minimal passing score, which defined mastery. Scoring of simulated performance was done by 2 observers. Sessions were digitally recorded. After the pretest, participants were debriefed on the algorithm and required to repeat the simulation. If mastery (minimal passing score) was not achieved, debriefing and the simulation were repeated until mastery was met. Once mastery was met, participants graded their comfort level in managing SE. Results No participants achieved mastery at pretest. After debriefing and deliberate simulator training, all (n = 30) achieved mastery of the algorithm: 30% achieved mastery after 1 posttest, 63% after a second, and 6.7% after a third. The Krippendorff α was 0.94, indicating strong interrater agreement. Participants reported more self-efficacy in managing SE, a preference for simulation-based education for learning practice-based algorithms of critical conditions, and highly rated the educational intervention. Conclusions A simulation-based mastery learning program using deliberate practice dramatically improves pediatrics residents' execution of a SE management protocol. Participants enjoyed and benefited from simulation education. Future applications include improving adherence to other hospital protocols. PMID:26221431

  7. Shadowing emergency medicine residents by medical education specialists to provide feedback on non-medical knowledge-based ACGME sub-competencies

    Directory of Open Access Journals (Sweden)

    Waterbrook AL

    2018-05-01

    Full Text Available Anna L Waterbrook,1 Karen C Spear Ellinwood,2 T Gail Pritchard,3 Karen Bertels,1 Ariel C Johnson,4 Alice Min,1 Lisa R Stoneking1 1Department of Emergency Medicine, The University of Arizona College of Medicine, Tucson, AZ, USA; 2Department of Obstetrics and Gynecology, The University of Arizona College of Medicine, Tucson, AZ, USA; 3Department of Pediatrics, The University of Arizona College of Medicine, Tucson, AZ, USA; 4College of Medicine, The University of Arizona College of Medicine, Tucson, AZ, USA Objective: Non-medical knowledge-based sub-competencies (multitasking, professionalism, accountability, patient-centered communication, and team management are challenging for a supervising emergency medicine (EM physician to evaluate in real-time on shift while also managing a busy emergency department (ED. This study examines residents’ perceptions of having a medical education specialist shadow and evaluate their nonmedical knowledge skills.Methods: Medical education specialists shadowed postgraduate year 1 and postgraduate year 2 EM residents during an ED shift once per academic year. In an attempt to increase meaningful feedback to the residents, these specialists evaluated resident performance in selected non-medical knowledge-based Accreditation Council of Graduate Medical Education (ACGME sub-competencies and provided residents with direct, real-time feedback, followed by a written evaluation sent via email. Evaluations provided specific references to examples of behaviors observed during the shift and connected these back to ACGME competencies and milestones.Results: Twelve residents participated in this shadow experience (six post graduate year 1 and six postgraduate year 2. Two residents emailed the medical education specialists ahead of the scheduled shadow shift requesting specific feedback. When queried, five residents voluntarily requested their feedback to be included in their formal biannual review. Residents received

  8. A Comparison Study of Communication Skills between General Surgery and General Practice Residents on First-time Patient Visits

    Directory of Open Access Journals (Sweden)

    Ahmed Al Ansari

    2012-04-01

    Full Text Available Background: There is little published research about differences in doctor-patient communication of different specialties. Accordingly, we compared doctor-patient communication skills in two different specialties, general surgery (GS and general practice (GP. Methods: Twenty residents training at the Bahrain Defence Force Hospital (10 men and 10 women; mean age 28 years; 10 GS and 10 GP participated in 200 patient first visit consultations. The consultations were video-recorded and analysed by four trained observers using the MAAS Global scale. Results: 1 Internal consistency reliability of the MAAS Global (> 0.91 and Ep2 = 0.84 for raters was high, 2 GP residents spent more time (12 minutes than GS residents (7 minutes, in the visits, 3 There were several differences on the MAAS Global items between GP and GS residents (GS > GP, p GS, p < 0.05 on information giving, and 4 The present participants performed well compared to normative samples as well as to criterion-referenced cut-off scores. The general level of communication skills in both specialties, however, was ‘unsatisfactory’ and ‘doubtful’, as it is for normative samples. Conclusion: Excellent doctor-patient communication is essential but does not appear to receive the amount of attention that it deserves in practice settings. There are some differences between specialties as well as unsatisfactory communication skills for both specialties, since residents from both programs spent less time than recommended on each consultation. Our findings emphasize the need to improve the communication skills of physicians in general and for surgeons in particular.

  9. Attitudes of surgical residents toward trauma care: a Canadian-based study.

    Science.gov (United States)

    Girotti, M J; Leslie, K; Chinnick, B; Butcher, C; Holliday, R L

    1994-01-01

    Surgical residents (n = 330) registered in training programs in the province of Ontario, Canada were surveyed about their attitudes toward trauma care related issues. Questionnaires were returned by 48%. Overall, 84% felt that their clinical exposure to trauma was adequate; 78% noted that the emphasis placed on trauma topics in their educational programs was appropriate; 50% spend > 10% of their current clinical time in trauma care. Orthopedic residents (n = 43) were different; 79% devoted > 10% and 29% > or = 30% of their time to trauma. Future clinical activity in trauma as practicing surgeons was expressed by 83% of the trainees: 31% intended 30% of their future practices to be related to trauma. The major positive factors of trauma were the scope and excitement of trauma care. The major negative factors were the night/weekend activity and the time away from family. We are encouraged by the results of this survey in that a significant number of residents perceive trauma as a clinical endeavor to be incorporated into their future surgical practices.

  10. Simulation-based Assessment to Reliably Identify Key Resident Performance Attributes.

    Science.gov (United States)

    Blum, Richard H; Muret-Wagstaff, Sharon L; Boulet, John R; Cooper, Jeffrey B; Petrusa, Emil R; Baker, Keith H; Davidyuk, Galina; Dearden, Jennifer L; Feinstein, David M; Jones, Stephanie B; Kimball, William R; Mitchell, John D; Nadelberg, Robert L; Wiser, Sarah H; Albrecht, Meredith A; Anastasi, Amanda K; Bose, Ruma R; Chang, Laura Y; Culley, Deborah J; Fisher, Lauren J; Grover, Meera; Klainer, Suzanne B; Kveraga, Rikante; Martel, Jeffrey P; McKenna, Shannon S; Minehart, Rebecca D; Mitchell, John D; Mountjoy, Jeremi R; Pawlowski, John B; Pilon, Robert N; Shook, Douglas C; Silver, David A; Warfield, Carol A; Zaleski, Katherine L

    2018-04-01

    Obtaining reliable and valid information on resident performance is critical to patient safety and training program improvement. The goals were to characterize important anesthesia resident performance gaps that are not typically evaluated, and to further validate scores from a multiscenario simulation-based assessment. Seven high-fidelity scenarios reflecting core anesthesiology skills were administered to 51 first-year residents (CA-1s) and 16 third-year residents (CA-3s) from three residency programs. Twenty trained attending anesthesiologists rated resident performances using a seven-point behaviorally anchored rating scale for five domains: (1) formulate a clear plan, (2) modify the plan under changing conditions, (3) communicate effectively, (4) identify performance improvement opportunities, and (5) recognize limits. A second rater assessed 10% of encounters. Scores and variances for each domain, each scenario, and the total were compared. Low domain ratings (1, 2) were examined in detail. Interrater agreement was 0.76; reliability of the seven-scenario assessment was r = 0.70. CA-3s had a significantly higher average total score (4.9 ± 1.1 vs. 4.6 ± 1.1, P = 0.01, effect size = 0.33). CA-3s significantly outscored CA-1s for five of seven scenarios and domains 1, 2, and 3. CA-1s had a significantly higher proportion of worrisome ratings than CA-3s (chi-square = 24.1, P < 0.01, effect size = 1.50). Ninety-eight percent of residents rated the simulations more educational than an average day in the operating room. Sensitivity of the assessment to CA-1 versus CA-3 performance differences for most scenarios and domains supports validity. No differences, by experience level, were detected for two domains associated with reflective practice. Smaller score variances for CA-3s likely reflect a training effect; however, worrisome performance scores for both CA-1s and CA-3s suggest room for improvement.

  11. Isotopic and geochemical tracers in the evaluation of groundwater residence time and salinization problems at Santiago Island, Cape Verde

    International Nuclear Information System (INIS)

    Carreira, Paula M.; Nunes, Dina; Marques, Jose M.; Monteiro Santos, Fernando A.; Goncalves, Rui; Pina, Antonio; Mota Gomes, Antonio

    2013-01-01

    Stable isotopes (δ 18 O, δ 2 H) and tritium ( 3 H), together with geochemistry and geophysical data, were used for evaluating groundwater recharge sources, flow paths, and residence times in a watershed on Santiago Island, Cape Verde, West Africa. Stable isotopes indicate the predominance of high-elevation precipitation that undergoes little evaporation prior to groundwater recharge. Low tritium concentrations at seven sampling sites indicate groundwater residence times greater than 50 years. Higher tritium values at other locations suggest more recent recharge. Young ages indicate local recharge and potential groundwater vulnerability to surface contamination and/or salt-water intrusion. Geochemical results indicate that water-rock interaction mechanisms are the major processes responsible for the groundwater quality (mainly calcium-bicarbonate type), reflecting the lithological composition of subsurface soil. (authors)

  12. Isotopic and geochemical tracers in the evaluation of groundwater residence time and salinization problems at Santiago Island, Cape Verde

    Energy Technology Data Exchange (ETDEWEB)

    Carreira, Paula M.; Nunes, Dina [Quimica Analitica e Ambiental, IST/ITN, Universidade Tecnica de Lisboa, Estrada Nacional no. 10, 2686-953 Sacavem (Portugal); Marques, Jose M. [Centro de Petrologia e Geoquimica. Instituto Superior Tecnico, UTL, Av. Rovisco Pais, 1049-001 Lisboa (Portugal); Monteiro Santos, Fernando A. [Universidade de Lisboa-IDL, 1749-016 Lisboa (Portugal); Goncalves, Rui [Inst. Politecnico de Tomar, Quinta do Contador, Estrada da Serra, 2300 Tomar (Portugal); Pina, Antonio; Mota Gomes, Antonio [Instituto Superior de Educacao, Praia, Santiago (Cape Verde)

    2013-07-01

    Stable isotopes (δ{sup 18}O, δ{sup 2}H) and tritium ({sup 3}H), together with geochemistry and geophysical data, were used for evaluating groundwater recharge sources, flow paths, and residence times in a watershed on Santiago Island, Cape Verde, West Africa. Stable isotopes indicate the predominance of high-elevation precipitation that undergoes little evaporation prior to groundwater recharge. Low tritium concentrations at seven sampling sites indicate groundwater residence times greater than 50 years. Higher tritium values at other locations suggest more recent recharge. Young ages indicate local recharge and potential groundwater vulnerability to surface contamination and/or salt-water intrusion. Geochemical results indicate that water-rock interaction mechanisms are the major processes responsible for the groundwater quality (mainly calcium-bicarbonate type), reflecting the lithological composition of subsurface soil. (authors)

  13. Design report for the residence time extension of KNK II/2 from 455 to 720 equivalent full-power days

    International Nuclear Information System (INIS)

    Schade, H.-J.; Steinmetz, B.; Wehmann, U.

    1985-05-01

    The report describes the performance of the whole reactor and of its assemblies and their components during the residence time extension of the second core of KNK II from the foreseen value of 455 equivalent full-power days (efpd) to 720 efpd. By this extension existing reactivity and design reserves can be utilized, and the burnup of the test zone assemblies can be increased towards the level aimed at for future sodium breeder reactors. The investigations about the static and the dynamic behavior of the core with its components and of the heat transfer systems under nominal and accidental conditions show, that the plant can be safely operated during the residence time extension [de

  14. Case based teaching at the bed side versus in classroom for undergraduates and residents of pediatrics

    Directory of Open Access Journals (Sweden)

    MAHDI SHAHRIARI

    2014-07-01

    Full Text Available Introduction: Bedside teaching is defined as teaching in the presence of a patient, it is a vital component of medical education. The aim of this study was to evaluate the effectiveness of two methods of case based teaching (at the bedside and in the classroom in the teaching hospitals (for both undergraduates and residents of pediatrics. Methods: Thirty undergraduates and twenty pediatric residents were asked to study a topic of their curriculum from their text then pretest was taken from learners in the two levels; then either lecture with power point or case presentation or bed side discussion were conducted. One week later posttest was taken, and then evaluation of these three methods was done by a questionnaire from learners. Results: The majority of under-graduates and all of pediatric residents had evaluated case based teaching superior to bedside teaching and these two methods superior to lecture method. Conclusion: They believed that in the case based teaching they are more relaxed and have more self-esteem than at the bedside of the patients. Clinician teacher must involve patients and learners in the process of bedside teaching, by preparing a comfortable situation and by using available technolgy.

  15. Using 50 years of soil radiocarbon data to identify optimal approaches for estimating soil carbon residence times

    Science.gov (United States)

    Baisden, W. T.; Canessa, S.

    2013-01-01

    In 1959, Athol Rafter began a substantial programme of systematically monitoring the flow of 14C produced by atmospheric thermonuclear tests through organic matter in New Zealand soils under stable land use. A database of ∼500 soil radiocarbon measurements spanning 50 years has now been compiled, and is used here to identify optimal approaches for soil C-cycle studies. Our results confirm the potential of 14C to determine residence times, by estimating the amount of ‘bomb 14C’ incorporated. High-resolution time series confirm this approach is appropriate, and emphasise that residence times can be calculated routinely with two or more time points as little as 10 years apart. This approach is generally robust to the key assumptions that can create large errors when single time-point 14C measurements are modelled. The three most critical assumptions relate to: (1) the distribution of turnover times, and particularly the proportion of old C (‘passive fraction’), (2) the lag time between photosynthesis and C entering the modelled pool, (3) changes in the rates of C input. When carrying out approaches using robust assumptions on time-series samples, multiple soil layers can be aggregated using a mixing equation. Where good archived samples are available, AMS measurements can develop useful understanding for calibrating models of the soil C cycle at regional to continental scales with sample numbers on the order of hundreds rather than thousands. Sample preparation laboratories and AMS facilities can play an important role in coordinating the efficient delivery of robust calculated residence times for soil carbon.

  16. Using 50 years of soil radiocarbon data to identify optimal approaches for estimating soil carbon residence times

    International Nuclear Information System (INIS)

    Baisden, W.T.; Canessa, S.

    2013-01-01

    In 1959, Athol Rafter began a substantial programme of systematically monitoring the flow of 14 C produced by atmospheric thermonuclear tests through organic matter in New Zealand soils under stable land use. A database of ∼500 soil radiocarbon measurements spanning 50 years has now been compiled, and is used here to identify optimal approaches for soil C-cycle studies. Our results confirm the potential of 14 C to determine residence times, by estimating the amount of ‘bomb 14 C’ incorporated. High-resolution time series confirm this approach is appropriate, and emphasise that residence times can be calculated routinely with two or more time points as little as 10 years apart. This approach is generally robust to the key assumptions that can create large errors when single time-point 14 C measurements are modelled. The three most critical assumptions relate to: (1) the distribution of turnover times, and particularly the proportion of old C (‘passive fraction’), (2) the lag time between photosynthesis and C entering the modelled pool, (3) changes in the rates of C input. When carrying out approaches using robust assumptions on time-series samples, multiple soil layers can be aggregated using a mixing equation. Where good archived samples are available, AMS measurements can develop useful understanding for calibrating models of the soil C cycle at regional to continental scales with sample numbers on the order of hundreds rather than thousands. Sample preparation laboratories and AMS facilities can play an important role in coordinating the efficient delivery of robust calculated residence times for soil carbon.

  17. Using 50 years of soil radiocarbon data to identify optimal approaches for estimating soil carbon residence times

    Energy Technology Data Exchange (ETDEWEB)

    Baisden, W.T., E-mail: t.baisden@gns.cri.nz [National Isotope Centre, GNS Science, P.O. Box 31312, Lower Hutt (New Zealand); Canessa, S. [National Isotope Centre, GNS Science, P.O. Box 31312, Lower Hutt (New Zealand)

    2013-01-15

    In 1959, Athol Rafter began a substantial programme of systematically monitoring the flow of {sup 14}C produced by atmospheric thermonuclear tests through organic matter in New Zealand soils under stable land use. A database of {approx}500 soil radiocarbon measurements spanning 50 years has now been compiled, and is used here to identify optimal approaches for soil C-cycle studies. Our results confirm the potential of {sup 14}C to determine residence times, by estimating the amount of 'bomb {sup 14}C' incorporated. High-resolution time series confirm this approach is appropriate, and emphasise that residence times can be calculated routinely with two or more time points as little as 10 years apart. This approach is generally robust to the key assumptions that can create large errors when single time-point {sup 14}C measurements are modelled. The three most critical assumptions relate to: (1) the distribution of turnover times, and particularly the proportion of old C ('passive fraction'), (2) the lag time between photosynthesis and C entering the modelled pool, (3) changes in the rates of C input. When carrying out approaches using robust assumptions on time-series samples, multiple soil layers can be aggregated using a mixing equation. Where good archived samples are available, AMS measurements can develop useful understanding for calibrating models of the soil C cycle at regional to continental scales with sample numbers on the order of hundreds rather than thousands. Sample preparation laboratories and AMS facilities can play an important role in coordinating the efficient delivery of robust calculated residence times for soil carbon.

  18. Comparison of Residence Time Distributions of Liquid for Different Types of Input Signal Using a Stimulus-Response Technique

    Czech Academy of Sciences Publication Activity Database

    Čermáková, Jiřina; Siyakatshana, N.; Šilar, F.; Kudrna, V.; Jahoda, M.; Machoň, V.

    2003-01-01

    Roč. 57, č. 6 (2003), s. 427-431 ISSN 0366-6352. [International Conference of Slovak Society of Chemical Engineering /30./. Tatranské Matliare, 26.05.2003-30.05.2003] Institutional research plan: CEZ:AV0Z4072921 Keywords : stirred tank * stimulus-response technique * residence time distribution Subject RIV: CF - Physical ; Theoretical Chemistry Impact factor: 0.226, year: 2003

  19. Successful invaders co-opt pollinators of native flora and accumulate insect pollinators with increasing residence time

    Czech Academy of Sciences Publication Activity Database

    Pyšek, Petr; Jarošík, Vojtěch; Chytrý, M.; Danihelka, Jiří; Kuhn, D.; Pergl, Jan; Tichý, L.; Biesmeijer, J. C.; Ellis, W. N.; Kunin, W. E.; Settele, J.

    2011-01-01

    Roč. 81, č. 2 (2011), s. 277-293 ISSN 0012-9615 R&D Projects: GA MŠk LC06073; GA ČR GA206/09/0563 Grant - others:European Comission(XE) GOCE-CT-2003-506675 Institutional research plan: CEZ:AV0Z60050516 Keywords : pollination * residence time * plant invasion Subject RIV: EF - Botanics Impact factor: 7.433, year: 2011

  20. Survey of some natural decay-series isotopes in the Wairakei geothermal area and possible residence-time applications

    International Nuclear Information System (INIS)

    Stewart, M.K.; Burnett, W.C.; Whitehead, N.E.

    1993-01-01

    Concentrations of selected isotopes in the uranium decay series were determined for samples collected from the Wairakei, Broadlands/Ohaaki and Waiotapu areas. /sup 226/Ra concentrations were found to be low (0.05-0.22 dpm/l), similar to values reported in neutral hot springs at Tatun geothermal area, Taiwan, but lower than other geothermal systems (Yellowstone, USA, and Latera, Central Italy) (up to 25 dpm/l). The potential of /sup 226/Ra//sup 228/Ra ratios for indicating water residence times could not be explored because /sup 228/Ra data was not available. /sup 222/Rn concentrations are higher and related to steam fractions and CO/sub 2/ concentrations. The short half-life (3.8 days) makes /sup 222/Rn suitable for estimating residence times of radon in steam, and therefore the distance of travel of steam from its source (e.g., wells WK9 and 52). /sup 210/Pb and /sup 210/Po concentrations were very low and less than detection limits in many of the Wairakei waters; no residence time applications are apparent for these isotopes. (author). 11 refs.; 5 figs.; 3 tabs

  1. Residence half-time of {sup 137}Cs in the top-soils of Japanese paddy and upland fields

    Energy Technology Data Exchange (ETDEWEB)

    Komamura, Misako [National Inst. of Agro-Environmental Sciences, Tsukuba, Ibaraki (Japan); Tsumura, Akito; Kodaira, Kiyoshi

    1999-03-01

    A series of top-soil samples of 14 paddy fields and 10 upland fields in Japan, were annually collected during more than 30 years, to be examined in the contents of {sup 137}Cs. The data, which were obtained by the use of a gamma spectrometric system, received some statistical treatments to distinguish the annual decline of {sup 137}Cs contents from deviations. Then the authors calculated `residence half-time of {sup 137}Cs` within top-soil, and `eluviation rate of {sup 137}Cs` from top to the sub-layer of the soil. The following nationwide results were obtained irrespective of paddy or upland field: (1) The `apparent residence half-time` was estimated as 16 - 17 years. This consists of both effects of eluviation and nuclear disintegration. (2) The true residence half-time` was reported as 41 - 42 years. This depends on the eluviation speed of {sup 137}Cs exclusively, because the influence of nuclear disintegration has been compensated. (3) The eluviation rate of {sup 137}Cs from top-soil down to the sub-soil was 1.6 - 1.7% per year. (4) The ratio of distribution of {sup 137}Cs between top-soil and the sub-soil was estimated to be 6:4 as average at the date of 1996. (author)

  2. Pathology resident and fellow education in a time of disruptive technologies.

    Science.gov (United States)

    Ziai, James M; Smith, Brian R

    2012-12-01

    The development of disruptive technologies is changing the practice of pathology. Their implementation challenges traditional educational paradigms. Training programs must adapt to these heuristic needs. The dual explosion of new medical knowledge and innovative methodologies adds new practice aspects to the pathologist's areas of expertise. This transformation potentially challenges the traditional core model of training. It raises questions as to how pathology should incorporate future expanding subspecialty needs into educational and practice models. This article examines the impact of these disruptive technologies on resident and fellow education and explores alternative educational and practice models that may better accommodate pathology's future. Copyright © 2012 Elsevier Inc. All rights reserved.

  3. 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.

  4. [Highlights of hospital-based internal medicine in 2010: chief residents' perspective].

    Science.gov (United States)

    Uhlmann, Marc; Burnard, Jérôme; Cosma Rochat, Monica; Gabus, Vincent; Micheloud, Valérie Geiser; Gobin, Niels; Laurent, Jean-Christophe; Marino, Laura; Méan, Marie; Merz, Laurent; Regamey, Julien; Stadelmann, Raphaël

    2011-02-02

    Applying knowledge acquired from recent medical studies to patient care poses a daily challenge to physicians. Chief residents from the Department of Internal Medicine at the University Hospital of Lausanne carried out a review of some of the issues they considered important. The conclusions of these various publications may have a significant impact on the daily practice of hospital-based internal medicine. Modern medicine based on scientific studies is a reminder that in spite of the essential importance of clinical experience, it is crucial to confront it with the results of relevant publications from the medical literature.

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

    Science.gov (United States)

    Borisenkov, Mikhail F

    2011-03-01

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

  6. The effectiveness of spaced retrieval combined with Montessori-based activities in improving the eating ability of residents with dementia.

    Science.gov (United States)

    Wu, Hua Shan; Lin, Li Chan; Wu, Shiao Chi; Lin, Ke Neng; Liu, Hsiu Chih

    2014-08-01

    To explore the long-term effects of standardized and individualized spaced retrieval combined with Montessori-based activities on the eating ability of residents with dementia. Eating difficulty is common in residents with dementia, resulting in low food intake, followed by eating dependence, weight loss and malnutrition. A single-blinded and quasi-experimental design with repeated measures. Ninety residents with dementia from four veterans' homes in Taiwan took part in this study. The intervention consisted of spaced retrieval combined with Montessori-based activities. Twenty-five participants in the standardized group received 24 intervention sessions over 8 weeks. Thirty-eight participants in the individualized group received tailored intervention sessions. The number of intervention sessions was adjusted according to the participant's recall responses in spaced retrieval. Twenty-seven participants in the control group received no treatment. The Chinese version of the Edinburgh Feeding Evaluation in Dementia was used, and eating amounts and body weight were measured pre-test, posttest and at 1-, 3- and 6-month follow-ups. Data were collected between July 2008-February 2010. Repeated measures of all dependent variables for the three groups were analysed by the linear mixed model. The standardized and individualized interventions could significantly decrease the scores for the Chinese version of the Edinburgh Feeding Evaluation in Dementia and increase the eating amount and body weight over time. Trained nurses in institutions can schedule the standardized or individualized intervention in usual activity time to ameliorate eating difficulty and its sequels. © 2014 John Wiley & Sons Ltd.

  7. Research on the Direct Carbon Emission Forecast of CHINA'S Provincial Residents Based on Neural Network

    Science.gov (United States)

    Zhang, T.; Zhou, B.; Zhou, S.; Yan, W.

    2018-04-01

    Global climate change, which mainly effected by human carbon emissions, would affect the regional economic, natural ecological environment, social development and food security in the near future. It's particularly important to make accurate predictions of carbon emissions based on current carbon emissions. This paper accounted out the direct consumption of carbon emissions data from 1995 to 2014 about 30 provinces (the data of Tibet, Hong Kong, Macao and Taiwan is missing) and the whole of China. And it selected the optimal models from BP, RBF and Elman neural network for direct carbon emission prediction, what aim was to select the optimal prediction method and explore the possibility of reaching the peak of residents direct carbon emissions of China in 2030. Research shows that: 1) Residents' direct carbon emissions per capita of all provinces showed an upward trend in 20 years. 2) The accuracy of the prediction results by Elman neural network model is higher than others and more suitable for carbon emission data projections. 3) With the situation of residents' direct carbon emissions free development, the direct carbon emissions will show a fast to slow upward trend in the next few years and began to flatten after 2020, and the direct carbon emissions of per capita will reach the peak in 2032. This is also confirmed that China is expected to reach its peak in carbon emissions by 2030 in theory.

  8. Enhancing pediatric safety: assessing and improving resident competency in life-threatening events with a computer-based interactive resuscitation tool

    International Nuclear Information System (INIS)

    Lerner, Catherine; Gaca, Ana M.; Frush, Donald P.; Ancarana, Anjanette; Hohenhaus, Sue; Seelinger, Terry A.; Frush, Karen

    2009-01-01

    Though rare, allergic reactions occur as a result of administration of low osmolality nonionic iodinated contrast material to pediatric patients. Currently available resuscitation aids are inadequate in guiding radiologists' initial management of such reactions. To compare radiology resident competency with and without a computer-based interactive resuscitation tool in the management of life-threatening events in pediatric patients. The study was approved by the IRB. Radiology residents (n=19; 14 male, 5 female; 19 certified in basic life support/advanced cardiac life support; 1 certified in pediatric advanced life support) were videotaped during two simulated 5-min anaphylaxis scenarios involving 18-month-old and 8-year-old mannequins (order randomized). No advance warning was given. In half of the scenarios, a computer-based interactive resuscitation tool with a response-driven decision tree was available to residents (order randomized). Competency measures included: calling a code, administering oxygen and epinephrine, and correctly dosing epinephrine. Residents performed significantly more essential interventions with the computer-based resuscitation tool than without (72/76 vs. 49/76, P<0.001). Significantly more residents appropriately dosed epinephrine with the tool than without (17/19 vs. 1/19; P<0.001). More residents called a code with the tool than without (17/19 vs. 14/19; P = 0.08). A learning effect was present: average times to call a code, request oxygen, and administer epinephrine were shorter in the second scenario (129 vs. 93 s, P=0.24; 52 vs. 30 s, P<0.001; 152 vs. 82 s, P=0.025, respectively). All the trainees found the resuscitation tool helpful and potentially useful in a true pediatric emergency. A computer-based interactive resuscitation tool significantly improved resident performance in managing pediatric emergencies in the radiology department. (orig.)

  9. Web-based objective structured clinical examination with remote standardized patients and Skype: resident experience.

    Science.gov (United States)

    Langenau, Erik; Kachur, Elizabeth; Horber, Dot

    2014-07-01

    Using Skype and remote standardized patients (RSPs), investigators sought to evaluate user acceptance of a web-based objective structured clinical examination (OSCE) among resident physicians. After participating in four web-based clinical encounters addressing pain with RSPs, 59 residents from different training programs, disciplines and geographic locations completed a 52-item questionnaire regarding their experience with Skype and RSPs. Open-ended responses were solicited as well. The majority of participants (97%) agreed or strongly agreed the web-based format was convenient and a practical learning exercise, and 90% agreed or strongly agreed the format was effective in teaching communication skills. Although 93% agreed or strongly agreed they could communicate easily with RSPs using Skype, 80% preferred traditional face-to-face clinical encounters, and 58% reported technical difficulties during the encounters. Open-ended written responses supported survey results. Findings from this study expose challenges with technology and human factors, but positive experiences support the continued investigation of web-based OSCEs as a synchronous e-learning initiative for teaching and assessing doctor-patient communication. Such educational programs are valuable but unlikely to replace face-to-face encounters with patients. This web-based OSCE program provides physician learners with additional opportunity to improve doctor-patient communication. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  10. Utility of Combining a Simulation-Based Method With a Lecture-Based Method for Fundoscopy Training in Neurology Residency.

    Science.gov (United States)

    Gupta, Deepak K; Khandker, Namir; Stacy, Kristin; Tatsuoka, Curtis M; Preston, David C

    2017-10-01

    Fundoscopic examination is an essential component of the neurologic examination. Competence in its performance is mandated as a required clinical skill for neurology residents by the American Council of Graduate Medical Education. Government and private insurance agencies require its performance and documentation for moderate- and high-level neurologic evaluations. Traditionally, assessment and teaching of this key clinical examination technique have been difficult in neurology residency training. To evaluate the utility of a simulation-based method and the traditional lecture-based method for assessment and teaching of fundoscopy to neurology residents. This study was a prospective, single-blinded, education research study of 48 neurology residents recruited from July 1, 2015, through June 30, 2016, at a large neurology residency training program. Participants were equally divided into control and intervention groups after stratification by training year. Baseline and postintervention assessments were performed using questionnaire, survey, and fundoscopy simulators. After baseline assessment, both groups initially received lecture-based training, which covered fundamental knowledge on the components of fundoscopy and key neurologic findings observed on fundoscopic examination. The intervention group additionally received simulation-based training, which consisted of an instructor-led, hands-on workshop that covered practical skills of performing fundoscopic examination and identifying neurologically relevant findings on another fundoscopy simulator. The primary outcome measures were the postintervention changes in fundoscopy knowledge, skills, and total scores. A total of 30 men and 18 women were equally distributed between the 2 groups. The intervention group had significantly higher mean (SD) increases in skills (2.5 [2.3] vs 0.8 [1.8], P = .01) and total (9.3 [4.3] vs 5.3 [5.8], P = .02) scores compared with the control group. Knowledge scores (6.8 [3

  11. A population-based study on health-related quality of life among urban community residents in Shenyang, Northeast of China.

    Science.gov (United States)

    Song, Tian; Ding, Yan-wei; Sun, Yan; He, Yi-Ni; Qi, Dian-Jun; Wu, Ying; Wu, Bin; Lang, Lang; Yu, Kai; Zhao, Xin; Zhu, Liang-liang; Wang, Shuang; Yu, Xiao-Song

    2015-09-19

    Due to the rising standard of living environment and advances in public health and medical care in China, it has been a tendency in recent years that health-related quality of life (HRQoL) has been increasingly acknowledged in community health management. However, large-scale population-based study on evaluating HQRoL in northeast of China was not conducted. This article aims to investigate the HRQoL in community residents in Northeast China and explore the associated factors. Stratified multiple-stage sampling method was used in the cross-sectional survey to investigate HRQoL of community residents in northeast of China. Univariate analysis and multiple linear regressions were used to analyze the factors associated to HRQoL of the community residents. The results were confirmed that HRQoL in general population was well performed for the first time in northeast of China in a large scale population. Community residents had better mental health than physical health. The factors influencing HRQoL included gender, age, educational level, marital status, ethnic group, chronic disease status, having breakfast frequency weekly and sleep quality. However, drinking and smoking habits did not affect residents' HRQoL. In this study, the result of the large-scale survey was satisfactory in northeast of China, providing HRQoL status of community residents. Policies on specific health management in community public health would emphasize on lifestyle behaviors especially eating habits in order to improving HRQoL.

  12. Maintaining social cohesion is a more important determinant of patch residence time than maximizing food intake rate in a group-living primate, Japanese macaque (Macaca fuscata).

    Science.gov (United States)

    Kazahari, Nobuko

    2014-04-01

    Animals have been assumed to employ an optimal foraging strategy (e.g., rate-maximizing strategy). In patchy food environments, intake rate within patches is positively correlated with patch quality, and declines as patches are depleted through consumption. This causes patch-leaving and determines patch residence time. In group-foraging situations, patch residence times are also affected by patch sharing. Optimal patch models for groups predict that patch residence times decrease as the number of co-feeding animals increases because of accelerated patch depletion. However, group members often depart patches without patch depletion, and their patch residence time deviates from patch models. It has been pointed out that patch residence time is also influenced by maintaining social proximity with others among group-living animals. In this study, the effects of maintaining social cohesion and that of rate-maximizing strategy on patch residence time were examined in Japanese macaques (Macaca fuscata). I hypothesized that foragers give up patches to remain in the proximity of their troop members. On the other hand, foragers may stay for a relatively long period when they do not have to abandon patches to follow the troop. In this study, intake rate and foraging effort (i.e., movement) did not change during patch residency. Macaques maintained their intake rate with only a little foraging effort. Therefore, the patches were assumed to be undepleted during patch residency. Further, patch residence time was affected by patch-leaving to maintain social proximity, but not by the intake rate. Macaques tended to stay in patches for short periods when they needed to give up patches for social proximity, and remained for long periods when they did not need to leave to keep social proximity. Patch-leaving and patch residence time that prioritize the maintenance of social cohesion may be a behavioral pattern in group-living primates.

  13. Competency-based evaluation tools for integrative medicine training in family medicine residency: a pilot study

    Directory of Open Access Journals (Sweden)

    Schneider Craig

    2007-04-01

    Full Text Available Abstract Background As more integrative medicine educational content is integrated into conventional family medicine teaching, the need for effective evaluation strategies grows. Through the Integrative Family Medicine program, a six site pilot program of a four year residency training model combining integrative medicine and family medicine training, we have developed and tested a set of competency-based evaluation tools to assess residents' skills in integrative medicine history-taking and treatment planning. This paper presents the results from the implementation of direct observation and treatment plan evaluation tools, as well as the results of two Objective Structured Clinical Examinations (OSCEs developed for the program. Methods The direct observation (DO and treatment plan (TP evaluation tools developed for the IFM program were implemented by faculty at each of the six sites during the PGY-4 year (n = 11 on DO and n = 8 on TP. The OSCE I was implemented first in 2005 (n = 6, revised and then implemented with a second class of IFM participants in 2006 (n = 7. OSCE II was implemented in fall 2005 with only one class of IFM participants (n = 6. Data from the initial implementation of these tools are described using descriptive statistics. Results Results from the implementation of these tools at the IFM sites suggest that we need more emphasis in our curriculum on incorporating spirituality into history-taking and treatment planning, and more training for IFM residents on effective assessment of readiness for change and strategies for delivering integrative medicine treatment recommendations. Focusing our OSCE assessment more narrowly on integrative medicine history-taking skills was much more effective in delineating strengths and weaknesses in our residents' performance than using the OSCE for both integrative and more basic communication competencies. Conclusion As these tools are refined further they will be of value both in improving

  14. The effect of electronic health record software design on resident documentation and compliance with evidence-based medicine.

    Science.gov (United States)

    Rodriguez Torres, Yasaira; Huang, Jordan; Mihlstin, Melanie; Juzych, Mark S; Kromrei, Heidi; Hwang, Frank S

    2017-01-01

    This study aimed to determine the role of electronic health record software in resident education by evaluating documentation of 30 elements extracted from the American Academy of Ophthalmology Dry Eye Syndrome Preferred Practice Pattern. The Kresge Eye Institute transitioned to using electronic health record software in June 2013. We evaluated the charts of 331 patients examined in the resident ophthalmology clinic between September 1, 2011, and March 31, 2014, for an initial evaluation for dry eye syndrome. We compared documentation rates for the 30 evidence-based elements between electronic health record chart note templates among the ophthalmology residents. Overall, significant changes in documentation occurred when transitioning to a new version of the electronic health record software with average compliance ranging from 67.4% to 73.6% (p Electronic Health Record A had high compliance (>90%) in 13 elements while Electronic Health Record B had high compliance (>90%) in 11 elements. The presence of dialog boxes was responsible for significant changes in documentation of adnexa, puncta, proptosis, skin examination, contact lens wear, and smoking exposure. Significant differences in documentation were correlated with electronic health record template design rather than individual resident or residents' year in training. Our results show that electronic health record template design influences documentation across all resident years. Decreased documentation likely results from "mouse click fatigue" as residents had to access multiple dialog boxes to complete documentation. These findings highlight the importance of EHR template design to improve resident documentation and integration of evidence-based medicine into their clinical notes.

  15. The effect of electronic health record software design on resident documentation and compliance with evidence-based medicine.

    Directory of Open Access Journals (Sweden)

    Yasaira Rodriguez Torres

    Full Text Available This study aimed to determine the role of electronic health record software in resident education by evaluating documentation of 30 elements extracted from the American Academy of Ophthalmology Dry Eye Syndrome Preferred Practice Pattern. The Kresge Eye Institute transitioned to using electronic health record software in June 2013. We evaluated the charts of 331 patients examined in the resident ophthalmology clinic between September 1, 2011, and March 31, 2014, for an initial evaluation for dry eye syndrome. We compared documentation rates for the 30 evidence-based elements between electronic health record chart note templates among the ophthalmology residents. Overall, significant changes in documentation occurred when transitioning to a new version of the electronic health record software with average compliance ranging from 67.4% to 73.6% (p 90% in 13 elements while Electronic Health Record B had high compliance (>90% in 11 elements. The presence of dialog boxes was responsible for significant changes in documentation of adnexa, puncta, proptosis, skin examination, contact lens wear, and smoking exposure. Significant differences in documentation were correlated with electronic health record template design rather than individual resident or residents' year in training. Our results show that electronic health record template design influences documentation across all resident years. Decreased documentation likely results from "mouse click fatigue" as residents had to access multiple dialog boxes to complete documentation. These findings highlight the importance of EHR template design to improve resident documentation and integration of evidence-based medicine into their clinical notes.

  16. Systematic Analysis of the Effect of Small Scale Permeability Heterogeneity on Hyporheic Exchange Flux and Residence Times

    Science.gov (United States)

    Laube, G.; Schmidt, C.; Fleckenstein, J. H.

    2014-12-01

    The hyporheic zone (HZ) contributes significantly to whole stream biogeochemical cycling. Biogeochemical reactions within the HZ are often transport limited, thus, understanding these reactions requires knowledge about the magnitude of hyporheic fluxes (HF) and the residence time (RT) of these fluxes within the HZ. While the hydraulics of HF are relatively well understood, studies addressing the influence of permeability heterogeneity lack systematic analysis and have even produced contradictory results (e.g. [1] vs. [2]). In order to close this gap, this study uses a statistical numerical approach to elucidate the influence of permeability heterogeneity on HF and RT. We simulated and evaluated 3750 2D-scenarios of sediment heterogeneity by means of Gaussian random fields with focus on total HF and RT distribution. The scenarios were based on ten realizations of each of all possible combinations of 15 different correlation lengths, 5 dipping angles and 5 permeability variances. Roughly 500 hyporheic stream traces were analyzed per simulation, for a total of almost two million stream traces analyzed for correlations between permeability heterogeneity, HF, and RT. Total HF and the RT variance positively correlated with permeability variance while the mean RT negatively correlated with permeability variance. In contrast, changes in correlation lengths and dipping angles had little effect on the examined properties RT and HF. These results provide a possible explanation of the seemingly contradictory conclusions of recent studies, given that the permeability variances in these studies differ by several orders of magnitude. [1] Bardini, L., Boano, F., Cardenas, M.B, Sawyer, A.H, Revelli, R. and Ridolfi, L. "Small-Scale Permeability Heterogeneity Has Negligible Effects on Nutrient Cycling in Streambeds." Geophysical Research Letters, 2013. doi:10.1002/grl.50224. [2] Zhou, Y., Ritzi, R. W., Soltanian, M. R. and Dominic, D. F. "The Influence of Streambed Heterogeneity on

  17. Effect of temperature, hydraulic residence time and elevated PCO2 on acid neutralization within a pulsed limestone bed reactor

    Science.gov (United States)

    Watten, B.J.; Lee, P.C.; Sibrell, P.L.; Timmons, M.B.

    2007-01-01

    Limestone has potential for reducing reagent costs and sludge volume associated with treatment of acid mine drainage, but its use is restricted by slow dissolution rates and the deposition of Fe, Al and Mn-based hydrolysis products on reactive surfaces. We evaluated a pulsed limestone bed (PLB) reactor (15 L/min capacity) that uses a CO2 pretreatment step to accelerate dissolution and hydraulic shearing forces provided by intermittent fluidization to abrade and carry away surface scales. We established the effects of hydraulic residence time (HRT, 5.1-15.9 min), temperature (T, 12-22 ??C) and CO2 tension (PCO2, 34.5-206.8 kPa) on effluent quality when inlet acidity (Acy) was fixed at 440 mg/L (pH=2.48) with H2SO4. The PLB reactor neutralized all H+ acidity (N=80) while concurrently providing unusually high levels of effluent alkalinity (247-1028 mg/L as CaCO3) that allow for side-stream treatment with blending. Alkalinity (Alk) yields rose with increases in PCO2, HRT and settled bed height (BH, cm) and decreased with T following the relationship (R2=0.926; p<0.001): (Alk)non-filtered=-548.726+33.571??(PCO2)0.5+33.671??(HRT)+7.734??(BH)-5.197??(T). Numerical modeling showed CO2 feed requirements for a target Alk yield decrease with increases in HRT, T and the efficiency of off-gas (CO2) recycling. ?? 2007 Elsevier Ltd. All rights reserved.

  18. Creating a Residency Application Personal Statement Writers Workshop: Fostering Narrative, Teamwork, and Insight at a Time of Stress.

    Science.gov (United States)

    Campbell, Bruce H; Havas, Nancy; Derse, Arthur R; Holloway, Richard L

    2016-03-01

    Every graduating medical student must write a personal statement for the Electronic Residency Application Service (ERAS), yet there are no widely available resources designed to aid the writing process, causing stress among applicants. The authors offered every Medical College of Wisconsin senior student in the Classes of 2014 and 2015 a voluntary self-contained two-hour Residency Application Personal Statement Writers Workshop. The session included the selection of writing prompts, speedwriting, and a peer-edit critique. Data were gathered before and after each workshop and at the time of ERAS submission. One hundred nine students elected to participate. Of the 96 participants completing a preworkshop questionnaire, only 28 (29%) were comfortable with creative and reflective writing. Fifty-four students completed a follow-up survey after submitting their ERAS application. Fifty-one (94%) found the session effective in getting their personal statement started, and 65 (70%) were surprised by the quality of their writing. Almost all could trace some of their final statement to the workshop. Forty-six (85%) found working with other students helpful, and 49 (91%) would recommend the session to future students; 47 (87%) agreed that the workshop was "fun." The full workshop will be repeated yearly. Workshops will also be offered to residents preparing fellowship applications. A shorter version (without the peer-edit critique) was used successfully with the entire Class of 2016 to help them reflect on their initial clinical encounters. The authors will seek further opportunities to enhance reflection for students, residents, and faculty with these techniques.

  19. Care staff training based on person-centered care and dementia care mapping, and its effects on the quality of life of nursing home residents with dementia.

    Science.gov (United States)

    Yasuda, Mami; Sakakibara, Hisataka

    2017-09-01

    To assess the effects of care staff training based on person-centered care (PCC) and dementia care mapping (DCM) on the quality of life (QOL) of residents with dementia in a nursing home. An intervention of staff training based on PCC and DCM was conducted with 40 care staff members at a geriatric nursing home. The effects of the staff training on the QOL of residents with dementia were evaluated by the DCM measurements of 40 residents with dementia three times at about one-month intervals (first, baseline; second, pre-intervention; third, post-intervention). The well-being and ill-being values (WIB values) of the residents with dementia measured by DCM were not different between the first and second rounds before the staff training (p = 0.211). Meanwhile, the WIB values increased from the first and second rounds to the third post-intervention round (p = 0.035 and p Staff training based on PCC and DCM could effectively improve the QOL of residents with dementia.

  20. Multimodal wireless sensor network-based ambient assisted living in real homes with multiple residents.

    Science.gov (United States)

    Tunca, Can; Alemdar, Hande; Ertan, Halil; Incel, Ozlem Durmaz; Ersoy, Cem

    2014-05-30

    Human activity recognition and behavior monitoring in a home setting using wireless sensor networks (WSNs) provide a great potential for ambient assisted living (AAL) applications, ranging from health and wellbeing monitoring to resource consumption monitoring. However, due to the limitations of the sensor devices, challenges in wireless communication and the challenges in processing large amounts of sensor data in order to recognize complex human activities, WSN-based AAL systems are not effectively integrated in the home environment. Additionally, given the variety of sensor types and activities, selecting the most suitable set of sensors in the deployment is an important task. In order to investigate and propose solutions to such challenges, we introduce a WSN-based multimodal AAL system compatible for homes with multiple residents. Particularly, we focus on the details of the system architecture, including the challenges of sensor selection, deployment, networking and data collection and provide guidelines for the design and deployment of an effective AAL system. We also present the details of the field study we conducted, using the systems deployed in two different real home environments with multiple residents. With these systems, we are able to collect ambient sensor data from multiple homes. This data can be used to assess the wellbeing of the residents and identify deviations from everyday routines, which may be indicators of health problems. Finally, in order to elaborate on the possible applications of the proposed AAL system and to exemplify directions for processing the collected data, we provide the results of several human activity inference experiments, along with examples on how such results could be interpreted. We believe that the experiences shared in this work will contribute towards accelerating the acceptance of WSN-based AAL systems in the home setting.

  1. Multimodal Wireless Sensor Network-Based Ambient Assisted Living in Real Homes with Multiple Residents

    Directory of Open Access Journals (Sweden)

    Can Tunca

    2014-05-01

    Full Text Available Human activity recognition and behavior monitoring in a home setting using wireless sensor networks (WSNs provide a great potential for ambient assisted living (AAL applications, ranging from health and wellbeing monitoring to resource consumption monitoring. However, due to the limitations of the sensor devices, challenges in wireless communication and the challenges in processing large amounts of sensor data in order to recognize complex human activities, WSN-based AAL systems are not effectively integrated in the home environment. Additionally, given the variety of sensor types and activities, selecting the most suitable set of sensors in the deployment is an important task. In order to investigate and propose solutions to such challenges, we introduce a WSN-based multimodal AAL system compatible for homes with multiple residents. Particularly, we focus on the details of the system architecture, including the challenges of sensor selection, deployment, networking and data collection and provide guidelines for the design and deployment of an effective AAL system. We also present the details of the field study we conducted, using the systems deployed in two different real home environments with multiple residents. With these systems, we are able to collect ambient sensor data from multiple homes. This data can be used to assess the wellbeing of the residents and identify deviations from everyday routines, which may be indicators of health problems. Finally, in order to elaborate on the possible applications of the proposed AAL system and to exemplify directions for processing the collected data, we provide the results of several human activity inference experiments, along with examples on how such results could be interpreted. We believe that the experiences shared in this work will contribute towards accelerating the acceptance of WSN-based AAL systems in the home setting.

  2. Effect of a Community-Based Service Learning Experience in Geriatrics on Internal Medicine Residents and Community Participants.

    Science.gov (United States)

    Miller, Rachel K; Michener, Jennifer; Yang, Phyllis; Goldstein, Karen; Groce-Martin, Jennine; True, Gala; Johnson, Jerry

    2017-09-01

    Community-based service learning (CBSL) provides an opportunity to teach internal medicine residents the social context of aging and clinical concepts. The objectives of the current study were to demonstrate the feasibility of a CBSL program targeting internal medicine residents and to assess its effect on medical residents and community participants. internal medicine residents participated in a CBSL experience for half a day during ambulatory blocks from 2011 to 2014. Residents attended a senior housing unit or center, delivered a presentation about a geriatric health topic, toured the facility, and received information about local older adult resources. Residents evaluated the experience. Postgraduate Year 3 internal medicine residents (n = 71) delivered 64 sessions. Residents felt that the experience increased their ability to communicate effectively with older adults (mean 3.91 ± 0.73 on a Likert scale with 5 = strongly agree), increased their knowledge of resources (4.09 ± 1.01), expanded their knowledge of a health topic pertinent to aging (3.48 ± 1.09), and contributed to their capacity to evaluate and care for older adults (3.84 ± 0.67). Free-text responses demonstrated that residents thought that this program would change their practice. Of 815 older adults surveyed from 36 discrete teaching sessions, 461 (56%) thought that the medical residents delivered health information clearly (4.55 ± 0.88) and that the health topics were relevant (4.26 ± 0.92). Free-text responses showed that the program helped them understand their health concerns. This CBSL program is a feasible and effective tool for teaching internal medicine residents and older adults. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

  3. The Use of a Social Media Based Curriculum for Newly Matched Interns Transitioning into Emergency Medicine Residency

    Directory of Open Access Journals (Sweden)

    Joel C Park, MD

    2018-04-01

    Full Text Available Audience: This is an online social media curriculum aimed at the incoming Emergency Department (ED intern. This curriculum is designed to foster collaborative learning in preparation for the upcoming intern year. Introduction: Graduating medical students tend to have few clinical experiences at the end of their fourth year. For many students, their last ED rotation is six months or more before the start of their internship. In addition, the transition from being a medical student to an intern can be quite abrupt and jarring, with little time to adjust to the rigorous new clinical demands of internship. To ease this transition, the Slack channels provide an easy medium to share thoughts and ideas regarding clinical cases provided by the Emergency Medicine (EM faculty. After performing a PubMed, Google Scholar, and Medline search, we found that no interventions have been described utilizing social media for helping rising interns to transition from medical school to emergency medicine residency. Medical school curriculum varies widely, and medical students often struggle with this transition.1,2 Multiple authors have evaluated the use of pre-graduation or early internship boot camps as preparation for emergency medicine residencies, but to our knowledge, there is no existing curriculum that is designed specifically for the transition between medical school and internship.3,4,5 We designed a social media based curriculum that addressed several of the competencies targeted by these boot camp programs4 and based on Accreditation Council for Graduate Medical Education (ACGME level 1 milestones in patient care. This curriculum provides an interactive, case-based learning platform for incoming residents prior to the start of residency. Using Slack, learners can post responses in real-time that can be seen by the entire group of incoming interns. The incoming interns will be able to interact with other users, either in a public or private forum, and

  4. Field-based generation and social validation managers and staff competencies for small community residences.

    Science.gov (United States)

    Thousand, J S; Burchard, S N; Hasazi, J E

    1986-01-01

    Characteristics and competencies for four staff positions in community residences for individuals with mental retardation were identified utilizing multiple empirical and deductive methods with field-based practitioners and field-based experts. The more commonly used competency generation methods of expert opinion and job performance analysis generated a high degree of knowledge and skill-based competencies similar to course curricula. Competencies generated by incumbent practitioners through open-ended methods of personal structured interview and critical incident analysis were ones which related to personal style, interpersonal interaction, and humanistic orientation. Although seldom included in staff, paraprofessional, or professional training curricula, these latter competencies include those identified by Carl Rogers as essential for developing an effective helping relationship in a therapeutic situation (i.e., showing liking, interest, and respect for the clients; being able to communicate positive regard to the client). Of 21 core competency statements selected as prerequisites to employment for all four staff positions, the majority (17 of 21) represented interpersonal skills important to working with others, including responsiveness to resident needs, personal valuation of persons with mental retardation, and normalization principles.

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

    Science.gov (United States)

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

    2017-04-01

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

  6. Fly Ash Formation during Suspension-Firing of Biomass. Effects of Residence Time and Fuel-Type

    DEFF Research Database (Denmark)

    Damø, Anne Juul; Jensen, Peter Arendt; Jappe Frandsen, Flemming

    2017-01-01

    particles were subjected to various analyses, including char burnout level, particle size distribution, elemental composition, and particle morphology and composition. Furthermore, the transient release, i.e. the vaporization of the flame-volatile inorganic elements K, Cl and S, from the burning fuel...... particles to the gas phase, has been quantified by using two different calculation methods. The ash formation mechanisms were found to be quite similar for straw and wood. The degree of conversion (char burn-out level) was generally good at residence times ≥ 1s. The size distribution of the residual fly ash...

  7. Disinfection of drinking water by ultraviolet light. Minimum dose and shortest time of residence are central criteria when choosing plant

    Energy Technology Data Exchange (ETDEWEB)

    1977-06-23

    It is no longer mandatory that a given residue of chlorine is present in drinking water and this has led to interest in the use of ultraviolet radiation for disinfection of water in large public waterworks. After a brief discussion of the effect of ultraviolet radiation related to wavelength, the most usual type of irradiation equipment is briefly described. Practioal considerations regarding the installation, such as attenuation of the radiation due to water quality and deposits are presented. The requirements as to dose and residence time are also discussed and finally it is pointed out that hydraulic imperfections can reduce the effectiveness drastically.

  8. Determination of the residence time of rain water in some hydrographic basins by means of stable isotopes

    International Nuclear Information System (INIS)

    Goncalves, A.R.L.

    1979-10-01

    Samples of rain-and river water, monthly collected during one year from ten stations of the Amazon basin analysed in their 18 O and D content. The residence time of rain water for each station was determined using the values of Δ 18 O(%o) and ΔD(%). The values of Δ 18 O(%o) were correlated with the precipitation ones (mm) in order to determine the occurence of 'amount effect' in the stations. An analysis of samples was done along the Amazon River for simple observation of the 'isotopic fractionation' phenomenon the values of Δ 18 O(%o). (Author) [pt

  9. Impact of meander geometry and stream flow events on residence times and solute transport in the intra-meander flow

    Science.gov (United States)

    Nasir Mahmood, Muhammad; Schmidt, Christian; Trauth, Nico

    2017-04-01

    Stream morphological features, in combination with hydrological variability play a key role in water and solute exchange across surface and subsurface waters. Meanders are prominent morphological features within stream systems which exhibit unique hydrodynamics. The water surface elevation difference across the inner bank of a meander induces lateral hyporheic exchange within the intra-meander region. This hyporheic flow is characterized by considerably prolonged flow paths and residence times (RT) compared to smaller scales of hyporheic exchange. In this study we examine the impact of different meander geometries on the intra-meander hyporheic flow field and solute mobilization under both steady state and transient flow conditions. We developed a number of artificial meander shape scenarios, representing various meander evolution stages, ranging from a typical initial to advanced stage (near cut off ) meander. Three dimensional steady state numerical groundwater flow simulations including the unsaturated zone were performed for the intra-meander region. The meandering stream was implemented in the model by adjusting the top layers of the modelling domain to the streambed elevation and assigning linearly decreasing head boundary conditions to the streambed cells. Residence times for the intra-meander region were computed by advective particle tracking across the inner bank of meander. Selected steady state cases were extended to transient flow simulations to evaluate the impact of stream discharge events on the temporal behavior of the water exchange and solute transport in the intra-meander region. The transient stream discharge was simulated for a number of discharge events of variable duration and peak height using the surface water model HEC-RAS. Transient hydraulic heads obtained from the surface water model were applied as transient head boundary conditions to the streambed cells of the groundwater model. A solute concentration source was added in the

  10. Intraoperative Noise Increases Perceived Task Load and Fatigue in Anesthesiology Residents: A Simulation-Based Study.

    Science.gov (United States)

    McNeer, Richard R; Bennett, Christopher L; Dudaryk, Roman

    2016-02-01

    Operating rooms are identified as being one of the noisiest of clinical environments, and intraoperative noise is associated with adverse effects on staff and patient safety. Simulation-based experiments would offer controllable and safe venues for investigating this noise problem. However, realistic simulation of the clinical auditory environment is rare in current simulators. Therefore, we retrofitted our operating room simulator to be able to produce immersive auditory simulations with the use of typical sound sources encountered during surgeries. Then, we tested the hypothesis that anesthesia residents would perceive greater task load and fatigue while being given simulated lunch breaks in noisy environments rather than in quiet ones. As a secondary objective, we proposed and tested the plausibility of a novel psychometric instrument for the assessment of stress. In this simulation-based, randomized, repeated-measures, crossover study, 2 validated psychometric survey instruments, the NASA Task Load Index (NASA-TLX), composed of 6 items, and the Swedish Occupational Fatigue Inventory (SOFI), composed of 5 items, were used to assess perceived task load and fatigue, respectively, in first-year anesthesia residents. Residents completed the psychometric instruments after being given lunch breaks in quiet and noisy intraoperative environments (soundscapes). The effects of soundscape grouping on the psychometric instruments and their comprising items were analyzed with a split-plot analysis. A model for a new psychometric instrument for measuring stress that combines the NASA-TLX and SOFI instruments was proposed, and a factor analysis was performed on the collected data to determine the model's plausibility. Twenty residents participated in this study. Multivariate analysis of variance showed an effect of soundscape grouping on the combined NASA-TLX and SOFI instrument items (P = 0.003) and the comparisons of univariate item reached significance for the NASA Temporal

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

    International Nuclear Information System (INIS)

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

    2009-01-01

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

  12. 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.

  13. Test determination with tritium as a radioactive tracer of the residence time distribution in the stability pool for Cabrero sewage

    International Nuclear Information System (INIS)

    Diaz, Francisco; Duran, Oscar; Henriquez, Pedro; Vega, Pedro; Padilla, Liliana; Gonzalez, David; Garcia Agudo, Edmundo

    2000-01-01

    This work was prepared by the Chilean and International Atomic Energy Agencies and covers the hydrodynamic functioning of sewage stability pools using tracers. The plant selected in the city of Cabrero, 500 km. south of Santiago, and is a rectangular facultative pool with a surface area of 7100 m 2 and a maximum volume of 12,327 m2 that receives an average flow of 20 l/s, serving a population of 7000 individuals. The work aims to characterize the runoff from the flow that enters the pool, using a radioactive tracer test, where the incoming water is marked, and its out-coming passage is determined, to establish the residence time distribution. Tritium was selected in the form of tritiated water as a tracer that is precisely emptied into the water flow from the distribution ravine at the lake entrance. Samples are taken at the outflow to determine the concentration of tritium after distillation, simultaneously measuring the flow, to be analyzed in a liquid flicker counter. An average test time of 5.3 days was obtained and an analysis of the residence time distribution for the tracer shows that it leaves quickly and indicates bad flow distribution in the lake with a major short circuit and probable dead zones

  14. Estimation of groundwater residence time and evaluation of geomorphological processes using cosmogenic and terrigenic radionuclides and isotopes of noble gases

    International Nuclear Information System (INIS)

    Mahara, Yasunori; Ohta, Tomoko; Igarashi, Toshifumi

    2013-01-01

    In this paper, the estimation of groundwater residence time and geomorphological changing processes are discussed by focusing on isotopes of noble gases and radionuclides with a long half-life as an environmental tracer. Noble gases and radionuclides are produced in the atmospheric air and terrestrial rocks by spallation and various muon reactions during cosmic rays irradiation. Groundwater dating and geomorphological changing are estimated from changes in the number of atoms of cosmogenic and terrigenic nuclides in groundwater and terrestrial rock. The main tools of groundwater dating are combination of the dissolved helium and tritium (half-life T 1/2 =12.3 y) for younger groundwater less than 60 years of residence time, and of the dissolved helium and 36 Cl (T 1/2 =3.01 x 10 5 y) for older groundwater over million years. On the other hand, the main tools on the geomorphological changes are the estimation of exposure time using cosmogenic radionuclides ( 10 Be(half-life T 1/2 =1.6 x 10 6 y), 14 C (T 1/2 =5730 y), 26 Al (T 1/2 =7.16 x 10 5 y) and 36 Cl) and cosmogenic stable noble gases ( 3 He and 21 Ne) produced in rock. (author)

  15. A model of environmental behaviour of contaminated dust and its application to determining dust fluxes and residence times

    International Nuclear Information System (INIS)

    Allott, R.W.; Kelly, M.; Hewitt, C.N.

    1994-01-01

    A model has been developed to describe the temporal behaviour of the concentrations of a pollutant tracer within the urban environment of Barrow-in-Furness, NW England. The tracer used was 137 Cs derived primarily from wet deposition of the radioactive cloud from the Chernobyl reactor accident. The 137 Cs activity deposited during this primary event was supplemented by a small secondary atmospheric deposition input of resuspended activity. The model was validated against the measured temporal behaviour of 137 Cs in urban dust for two outdoor reservoirs in which the only observed input of dust and activity was by atmospheric deposition. Further modelling studies on other reservoirs (both outdoors and indoors) confirmed the existence of additional input influxes of dust and activity. The model enabled estimates of the magnitudes of these additional fluxes to be made and mean dust mass residence times to be calculated. These residence times correspond to environment half-lives of 170 ± 70 d outdoors and 20 ± 1 d indoors, for reservoirs which only receive a single primary input of a contaminant. Where secondary inputs of pollutants occur, the mean environmental half-lives of the pollutants increase by 50% for outdoor dust reservoirs and over 18-times for indoor reservoirs. This re-contamination of indoor dusts has implications in that attention should be paid to reducing outdoor contamination levels to ensure that attempts to reduce the levels of a pollutant indoors by cleaning are effective. (Author)

  16. Resident Space Object Characterization and Behavior Understanding via Machine Learning and Ontology-based Bayesian Networks

    Science.gov (United States)

    Furfaro, R.; Linares, R.; Gaylor, D.; Jah, M.; Walls, R.

    2016-09-01

    In this paper, we present an end-to-end approach that employs machine learning techniques and Ontology-based Bayesian Networks (BN) to characterize the behavior of resident space objects. State-of-the-Art machine learning architectures (e.g. Extreme Learning Machines, Convolutional Deep Networks) are trained on physical models to learn the Resident Space Object (RSO) features in the vectorized energy and momentum states and parameters. The mapping from measurements to vectorized energy and momentum states and parameters enables behavior characterization via clustering in the features space and subsequent RSO classification. Additionally, Space Object Behavioral Ontologies (SOBO) are employed to define and capture the domain knowledge-base (KB) and BNs are constructed from the SOBO in a semi-automatic fashion to execute probabilistic reasoning over conclusions drawn from trained classifiers and/or directly from processed data. Such an approach enables integrating machine learning classifiers and probabilistic reasoning to support higher-level decision making for space domain awareness applications. The innovation here is to use these methods (which have enjoyed great success in other domains) in synergy so that it enables a "from data to discovery" paradigm by facilitating the linkage and fusion of large and disparate sources of information via a Big Data Science and Analytics framework.

  17. Residence times and mixing of water in river banks: implications for recharge and groundwater - surface water exchange

    Science.gov (United States)

    Unland, N. P.; Cartwright, I.; Cendón, D. I.; Chisari, R.

    2014-02-01

    The residence time of groundwater within 50 m of the Tambo River, South East Australia, has been estimated through the combined use of 3H and 14C. Groundwater residence times increase towards the Tambo River which implies a gaining river system and not increasing bank storage with proximity to the Tambo River. Major ion concentrations and δ2H and δ18O values of bank water also indicate that bank infiltration does not significantly impact groundwater chemistry under baseflow and post-flood conditions, suggesting that the gaining nature of the river may be driving the return of bank storage water back into the Tambo River within days of peak flood conditions. The covariance between 3H and 14C indicates the leakage and mixing between old (~17 200 yr) groundwater from a semi-confined aquifer and younger groundwater (bank storage, as rapid pressure propagation into the semi-confined aquifer during flooding will minimise bank infiltration. This study illustrates the complex nature of river groundwater interactions and the potential downfall in assuming simple or idealised conditions when conducting hydrogeological studies.

  18. Flow Characterization of Vapor Phase of Geothermal Fluid in Pipe Using Isotope 85Kr and Residence Time Distribution Modeling

    Directory of Open Access Journals (Sweden)

    S. Sugiharto

    2014-08-01

    Full Text Available Measurement of vapor flow in geothermal pipe faces great challenges due to fast fluids flow in high-temperature and high-pressure environment. In present study the flow rate measurement has been performed to characterization the geothermal vapor flow in a pipe. The experiment was carried out in a pipe which is connected to a geothermal production well, KMJ-14. The pipe has a 10” outside diameter and contains dry vapor at a pressure of 8 kg/cm2 and a temperature of 170 oC. Krypton-85 gas isotope (85Kr has been injected into the pipe. Three collimated radiation detectors positioned respectively at 127, 177 and 227m from injection point were used to obtain experimental data which represent radiotracer residence time distribution (RTD in the pipe. The last detector at the position of 227 m did not respond, which might be due to problems in cable connections. Flow properties calculated using mean residence time (MRT shows that the flow rate of the vapor in pipe is 10.98 m/s, much faster than fluid flow commonly found in various industrial process plants. Best fitting evaluated using dedicated software developed by IAEA expert obtained the Péclet number Pe as 223. This means that the flow of vapor of geothermal fluids in pipe is plug flow in character. The molecular diffusion coefficient is 0.45 m2/s, calculated from the axial dispersion model.

  19. Objective assessment in residency-based training for transoral robotic surgery.

    Science.gov (United States)

    Curry, Martin; Malpani, Anand; Li, Ryan; Tantillo, Thomas; Jog, Amod; Blanco, Ray; Ha, Patrick K; Califano, Joseph; Kumar, Rajesh; Richmon, Jeremy

    2012-10-01

    To develop a robotic surgery training regimen integrating objective skill assessment for otolaryngology and head and neck surgery trainees consisting of training modules of increasing complexity leading up to procedure-specific training. In particular, we investigated applications of such a training approach for surgical extirpation of oropharyngeal tumors via a transoral approach using the da Vinci robotic system. Prospective blinded data collection and objective evaluation (Objective Structured Assessment of Technical Skills [OSATS]) of three distinct phases using the da Vinci robotic surgical system in an academic university medical engineering/computer science laboratory setting. Between September 2010 and July 2011, eight otolaryngology-head and neck surgery residents and four staff experts from an academic hospital participated in three distinct phases of robotic surgery training involving 1) robotic platform operational skills, 2) set up of the patient side system, and 3) a complete ex vivo surgical extirpation of an oropharyngeal tumor located in the base of tongue. Trainees performed multiple (four) approximately equally spaced training sessions in each stage of the training. In addition to trainees, baseline performance data were obtained for the experts. Each surgical stage was documented with motion and event data captured from the application programming interfaces of the da Vinci system, as well as separate video cameras as appropriate. All data were assessed using automated skill measures of task efficiency and correlated with structured assessment (OSATS and similar Likert scale) from three experts to assess expert and trainee differences and compute automated and expert assessed learning curves. Our data show that such training results in an improved didactic robotic knowledge base and improved clinical efficiency with respect to the set up and console manipulation. Experts (e.g., average OSATS, 25; standard deviation [SD], 3.1; module 1, suturing

  20. How Entrustment Is Informed by Holistic Judgments Across Time in a Family Medicine Residency Program: An Ethnographic Nonparticipant Observational Study

    NARCIS (Netherlands)

    Sagasser, M.H.; Fluit, C.R.M.G.; Weel, C. van; Vleuten, C.P.M. van der; Kramer, A.W.M.

    2017-01-01

    PURPOSE: Entrustment has mainly been conceptualized as delegating discrete professional tasks. Because residents provide most of their patient care independently, not all resident performance is visible to supervisors; the entrustment process involves more than granting discrete tasks. This study

  1. Breaking Bad News Training Program Based on Video Reviews and SPIKES Strategy: What do Perinatology Residents Think about It?

    Science.gov (United States)

    Setubal, Maria Silvia Vellutini; Gonçalves, Andrea Vasconcelos; Rocha, Sheyla Ribeiro; Amaral, Eliana Martorano

    2017-10-01

    Objective  Resident doctors usually face the task to communicate bad news in perinatology without any formal training. The impact on parents can be disastrous. The objective of this paper is to analyze the perception of residents regarding a training program in communicating bad news in perinatology based on video reviews and setting, perception, invitation, knowledge, emotion, and summary (SPIKES) strategy. Methods  We performed the analysis of complementary data collected from participants in a randomized controlled intervention study to evaluate the efficacy of a training program on improving residents' skills to communicate bad news. Data were collected using a Likert scale. Through a thematic content analysis we tried to to apprehend the meanings, feelings and experiences expressed by resident doctors in their comments as a response to an open-ended question. Half of the group received training, consisting of discussions of video reviews of participants' simulated encounters communicating a perinatal loss to a "mother" based on the SPIKES strategy. We also offered training sessions to the control group after they completed participation. Twenty-eight residents who were randomized to intervention and 16 from the control group received training. Twenty written comments were analyzed. Results  The majority of the residents evaluated training highly as an education activity to help increase knowledge, ability and understanding about breaking bad news in perinatology. Three big categories emerged from residents' comments: SPIKES training effects; bad news communication in medical training; and doctors' feelings and relationship with patients. Conclusions  Residents took SPIKES training as a guide to systematize the communication of bad news and to amplify perceptions of the emotional needs of the patients. They suggested the insertion of a similar training in their residency programs curricula. Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil.

  2. Matrix diffusion: heavy-tailed residence time distributions and their influence on radionuclide retention

    International Nuclear Information System (INIS)

    Haggerty, R.

    2002-01-01

    Matrix diffusion in rocks is frequently assumed to be both Fickian and effectively homogeneous over space- and time-scales relevant to radionuclide retention. This paper discusses some cases of rocks where one or both of these assumptions may be invalid and what the consequences may be for modeling and performance assessment: a single pore diffusivity and matrix block size which is not representative of the diffusion process at all time- or space-scales, a scale-dependent diffusion rate coefficient which decreases with time- and space-scales, a retention capacity of host rocks that may be smaller than apparent in laboratory and field tests because all of the pore space is not accessible via diffusion over the performance assessment-scale transport time. (J.S.)

  3. Anesthesia preparation time is not affected by the experience level of the resident involved during his/her first month of adult cardiac surgery.

    Science.gov (United States)

    Broussard, David M; Couch, Michael C

    2011-10-01

    This study was designed to answer the question of whether the experience level of the resident on his/her first month of adult cardiothoracic anesthesiology has an impact on operating room efficiency in a large academic medical center. Traditionally, the resident's 1st month of cardiac anesthesia had been reserved for the clinical anesthesia (CA)-2 year of training. This study analyzed the impact on operating room efficiency of moving the 1st month of cardiac anesthesia into the CA-1 year. The authors hypothesized that there would be no difference in anesthesia preparation times (defined as the interval between "in-room" and "anesthesia-ready" times) between CA-1 and CA-2 residents on their 1st month of cardiac anesthesia. This study was retrospective and used an electronic anesthesia information management system database. This study was conducted on care provided at a single 450-bed academic medical center. This study included 12 residents in their 1st month of cardiac anesthesia. The anesthesia preparation time (defined as the interval between "in-room" and "anesthesia-ready" times) was measured for cases involving residents on their first month of cardiac anesthesia. Anesthesia preparation times for 6 CA-1 resident months and 6 CA-2 resident months (100 adult cardiac procedures in total) were analyzed (49 for the CA-1 residents and 51 for the CA-2s). There were no differences in preparation time between CA-1 and CA-2 residents as a group (p = 0.8169). The CA-1 residents had an unadjusted mean (±standard error) of 51.1 ± 3.18 minutes, whereas the CA-2 residents' unadjusted mean was 50.2 ± 2.41 minutes. Adjusting for case mix (valves v coronary artery bypass graft surgery), the CA-1 mean was 49.1 ± 5.22 minutes, whereas the CA-2 mean was 49.1 ± 4.54 minutes. These findings suggest that operating room efficiency as measured by the anesthesia preparation time may not be affected by the level of the resident on his/her 1st month of adult cardiac anesthesia

  4. Psychotherapy Training: Residents' Perceptions and Experiences.

    Science.gov (United States)

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

    2015-10-01

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

  5. Mean residence time of kaolinite and smectite-bound organic matter in mozambiquan soils

    NARCIS (Netherlands)

    Wattel-Koekkoek, E.J.W.; Buurman, P.

    2004-01-01

    To gain understanding about the process of global warming, it is essential to study the global C cycle. In the global C cycle, soil organic matter (SOM) is a major source and sink of atmospheric C. Turnover times of C in these soil organic compounds vary from hours to thousands of years. Clay

  6. Residence Time Distribution of Solid Particles in High-Aspect Ratio Multiple-Impeller Stirred Vessel

    Czech Academy of Sciences Publication Activity Database

    Scargiali, F.; Grisafi, F.; Čermáková, Jiřina; Machoň, V.; Brucato, A.

    2004-01-01

    Roč. 59, č. 17 (2004), s. 3601-3618 ISSN 0009-2509 Institutional research plan: CEZ:AV0Z4072921 Keywords : retention time distribution * twin systems approach * particle tracing Subject RIV: CF - Physical ; Theoretical Chemistry Impact factor: 1.655, year: 2004

  7. Cadaver-Based Simulation Increases Resident Confidence, Initial Exposure to Fundamental Techniques, and May Augment Operative Autonomy.

    Science.gov (United States)

    Kim, Steven C; Fisher, Jeremy G; Delman, Keith A; Hinman, Johanna M; Srinivasan, Jahnavi K

    Surgical simulation is an important adjunct in surgical education. The majority of operative procedures can be simplified to core components. This study aimed to quantify a cadaver-based simulation course utility in improving exposure to fundamental maneuvers, resident and attending confidence in trainee capability, and if this led to earlier operative independence. A list of fundamental surgical procedures was established by a faculty panel. Residents were assigned to a group led by a chief resident. Residents performed skills on cadavers appropriate for PGY level. A video-recorded examination where they narrated and demonstrated a task independently was then graded by attendings using standardized rubrics. Participants completed surveys regarding improvements in knowledge and confidence. The course was conducted at the Emory University School of Medicine and the T3 Laboratories in Atlanta, GA. A total of 133 residents and 41 attendings participated in the course. 133 (100%) participating residents and 32 (78%) attendings completed surveys. Resident confidence in completing the assigned skill independently increased from 3 (2-3) to 4 (3-4), p 80%), p < 0.04. Attendings were more likely to grant autonomy in the operating room after this exercise (4 [3-5]). A cadaveric skills course focused on fundamental maneuvers with objective confirmation of success is a viable adjunct to clinical operative experience. Residents were formally exposed to fundamental surgical maneuvers earlier as a result of this course. This activity improved both resident and attending confidence in trainee operative skill, resulting in increased attending willingness to grant a higher level of autonomy in the operating room. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  8. Batch leachate treatment using stirred electrocoagulation reactor with variation of residence time and stirring rate

    Science.gov (United States)

    Sitorus, I. S.; Astono, W.; Iswanto, B.

    2018-01-01

    This study aims to reduce pollutant levels of the leachate by electrocoagulation method using a stirred electrocoagulation reactor as the electrochemical water treatment. The release of active coagulants as metallic ions took place in the anode, while in the cathode, the electrolysis reaction in the form of hydrogen gas dischargeoccurred. The source of wastewater is Waste Water Treatment Plant inlet III of Bantar Gebang, Bekasi. Some parameters were analyzed in this research, i.e., Chemical Oxygen Demand (COD), Biochemical Oxygen Demand (BOD), NH3, NO3 -, NO2 -, N-total, and organic substances as well as the microorganism growth before and after electrocoagulation, with variations of detention time (seconds) of 10, 20, 120, 600 and rapid mixing conditions (rpm) of 60, 100 and 200. The results show that the greater the rapid mixing speed and the detention time of electrolysis, the higher the removal of contaminants in liquid waste. The optimum condition of electrocoagulation was encountered at 200 rpm rapid mixing with 600 seconds of processing time. The removal efficiencies of electrocoagulation method for each parameter are TSS of 46.80%, BOD5 of 71.33%, COD of 73.77%, Pb of 62.5%,and NH3-N of 57.92%,whereas the pH value has been increased from 8.03 to 8.95. The electrocoagulation method can reduce levels of pollutants, complying with the environmental standards.

  9. Use of multiple age tracers to estimate groundwater residence times and long-term recharge rates in arid southern Oman

    International Nuclear Information System (INIS)

    Müller, Th.; Osenbrück, K.; Strauch, G.; Pavetich, S.; Al-Mashaikhi, K.-S.; Herb, C.; Merchel, S.; Rugel, G.; Aeschbach, W.; Sanford, W.

    2016-01-01

    Multiple age tracers were measured to estimate groundwater residence times in the regional aquifer system underlying southwestern Oman. This area, known as the Najd, is one of the most arid areas in the world and is planned to be the main agricultural center of the Sultanate of Oman in the near future. The three isotopic age tracers "4He, "1"4C and "3"6Cl were measured in waters collected from wells along a line that extended roughly from the Dhofar Mountains near the Arabian Sea northward 400 km into the Empty Quarter of the Arabian Peninsula. The wells sampled were mostly open to the Umm Er Radhuma confined aquifer, although, some were completed in the mostly unconfined Rus aquifer. The combined results from the three tracers indicate the age of the confined groundwater is  100 ka in the central section north of the mountains, and up to and > one Ma in the Empty Quarter. The "1"4C data were used to help calibrate the "4He and "3"6Cl data. Mixing models suggest that long open boreholes north of the mountains compromise "1"4C-only interpretations there, in contrast to "4He and "3"6Cl calculations that are less sensitive to borehole mixing. Thus, only the latter two tracers from these more distant wells were considered reliable. In addition to the age tracers, δ"2H and δ"1"8O data suggest that seasonal monsoon and infrequent tropical cyclones are both substantial contributors to the recharge. The study highlights the advantages of using multiple chemical and isotopic data when estimating groundwater travel times and recharge rates, and differentiating recharge mechanisms. - Highlights: • Multiple age tracers are required for the interpretation of the groundwater system. • Different tracers are applicable along different sections of the flowpath. • Groundwater residence times >1 Ma have been determined for the northern Najd area.

  10. Innovative web-based multimedia curriculum improves cardiac examination competency of residents.

    Science.gov (United States)

    Criley, Jasminka M; Keiner, Jennifer; Boker, John R; Criley, Stuart R; Warde, Carole M

    2008-03-01

    Proper diagnosis of cardiac disorders is a core competency of internists. Yet numerous studies have documented that the cardiac examination (CE) skills of physicians have declined compared with those of previous generations of physicians, attributed variously to inadequate exposure to cardiac patients and lack of skilled bedside teaching. With growing concerns about ensuring patient safety and quality of care, public and professional organizations are calling for a renewed emphasis on the teaching and evaluation of clinical skills in residency training. The objective of the study was to determine whether Web training improves CE competency, whether residents retain what they learn, and whether a Web-based curriculum plus clinical training is better than clinical training alone. Journal of Hospital Medicine 2008;3:124-133. (c) 2008 Society of Hospital Medicine. This was a controlled intervention study. The intervention group (34 internal and family medicine interns) participated in self-directed use of a Web-based tutorial and three 1-hour teaching sessions taught by a hospitalist. Twenty-five interns from the prior year served as controls. We assessed overall CE competency and 4 subcategories of CE competency: knowledge, audio skills, visual skills, and audio-visual integration. The over mean score of the intervention group significantly improved, from 54 to 66 (P = .002). This improvement was retained (63.5, P = .05). When compared with end-of-year controls, the intervention group had significantly higher end-of-year CE scores (57 vs. 63.5, P = .05), knowledge (P = .04), and audio skills (P = .01). At the end of the academic year, all improvements were retained (P better than clinical training alone. (c) 2008 Society of Hospital Medicine.

  11. The price of 'free'. Quantifying the costs incurred by rural residents attending publically funded outpatient clinics in rural and base hospitals.

    Science.gov (United States)

    Fearnley, David; Kerse, Ngaire; Nixon, Garry

    2016-09-01

    INTRODUCTION Rural living is associated with increased costs in many areas, including health care. However, there is very little local data to quantify these costs, and their unknown quantity means that costs are not always taken into account in health service planning and delivery. AIM The aim of this study was to calculate the average time and travel costs of attending rural and base hospital outpatient clinics for rural Central Otago residents. METHODS A survey of 51 people attending rural hospital outpatient clinics. Individual costs in terms of travel and time were quantified and an average cost of both rural and base hospital attendance was calculated. RESULTS The average travel and lost time cost of attending a rural outpatient clinic was NZ$182 and 61% of respondents reported this cost had a significant effect on their weekly budget. The average cost incurred by residents associated with a base hospital attendance in Dunedin was NZ$732. DISCUSSION This study data show that costs are substantial and probably higher than most people might expect for both rural and base hospital attendances. It seems likely that these costs are a potential barrier to service access. However, the full implications of the personal costs incurred by rural residents in accessing health services are largely unstudied and therefore remain unknown in New Zealand.

  12. Recovery of Sleep or Recovery of Self? A Grounded Theory Study of Residents' Decision Making Regarding How to Spend Their Nonclinical Postcall Time.

    Science.gov (United States)

    Taylor, Taryn S; Nisker, Jeff; Teunissen, Pim W; Dornan, Tim; Lingard, Lorelei

    2016-03-01

    As resident work hours policies evolve, residents' off-duty time remains poorly understood. Despite assumptions about how residents should be using their postcall, off-duty time, there is little research on how residents actually use this time and the reasoning underpinning their activities. This study sought to understand residents' nonclinical postcall activities when they leave the hospital, their decision-making processes, and their perspectives on the relationship between these activities and their well-being or recovery. The study took place at a Liaison Committee on Medical Education-accredited Canadian medical school from 2012 to 2014. The authors recruited a purposive and convenience sample of postgraduate year 1-5 residents from six surgical and nonsurgical specialties at three hospitals affiliated with the medical school. Using a constructivist grounded theory approach, semistructured interviews were conducted, audio-taped, transcribed, anonymized, and combined with field notes. The authors analyzed interview transcripts using constant comparative analysis and performed post hoc member checking. Twenty-four residents participated. Residents characterized their predominant approach to postcall decision making as one of making trade-offs between multiple, competing, seemingly incompatible, but equally valuable, activities. Participants exhibited two different trade-off orientations: being oriented toward maintaining a normal life or toward mitigating fatigue. The authors' findings on residents' trade-off orientations suggest a dual recovery model with postcall trade-offs motivated by the recovery of sleep or of self. This model challenges the dominant viewpoint in the current duty hours literature and suggests that the duty hours discussion must be broadened to include other recovery processes.

  13. Comparison of groundwater residence time using isotope techniques and numerical groundwater flow model in Gneissic Terrain, Korea

    International Nuclear Information System (INIS)

    Bae, D.S.; Kim, C.S.; Koh, Y.K.; Kim, K.S.; Song, M.Y.

    1997-01-01

    The prediction of groundwater flow affecting the migration of radionuclides is an important component of the performance assessment of radioactive waste disposal. Groundwater flow in fractured rock mass is controlled by fracture networks, transmissivity and hydraulic gradient. Furthermore the scale-dependent and anisotropic properties of hydraulic parameters are resulted mainly from irregular patterns of fracture system, which are very complex to evaluate properly with the current techniques available. For the purpose of characterizing a groundwater flow in fractured rock mass, the discrete fracture network (DFN) concept is available on the basis of assumptions of groundwater flowing only along fractures and flowpaths in rock mass formed by interconnected fractures. To increase the reliability of assessment in groundwater flow phenomena, numerical groundwater flow model and isotopic techniques were applied. Fracture mapping, borehole acoustic scanning were performed to identify conductive fractures in gneissic terrane. Tracer techniques, using deuterium, oxygen-18 and tritium were applied to evaluate the recharge area and groundwater residence time

  14. Foraging strategy of a Neotropical primate: how intrinsic and extrinsic factors influence destination and residence time

    DEFF Research Database (Denmark)

    Plante, Sabrina; Colchero, Fernando; Calmé, Sophie

    2014-01-01

    accounting for intrinsic and extrinsic factors, which are often overlooked when modelling foraging behaviour. 2.We identified the decision rules for foraging in black howler monkeys (Alouatta pigra), according to food preferences, locations of high quality patches and previously eaten trees, phenology...... of food resources and hunger state. We depicted foraging in two stages: 1) the choice of the immediate next tree and 2) the time spent on this tree. We used a recently developed model for inference of movement processes, incorporating resource selection functions into a Markov Chain framework. 3.We found...... that monkeys tend to move to preferred tree species at each step. However, we did not find conclusively that, at each step, monkeys direct their movements to reach high-quality patches. In fact, they were using these patches intensively, thus limiting the possibility to move toward other high quality patches...

  15. How does warming affect carbon allocation, respiration and residence time in trees? An isotope tracer approach in a eucalypt

    Science.gov (United States)

    Pendall, E.; Drake, J. E.; Furze, M.; Barton, C. V.; Carillo, Y.; Richter, A.; Tjoelker, M. G.

    2017-12-01

    Climate warming has the potential to alter the balance between photosynthetic carbon assimilation and respiratory losses in forest trees, leading to uncertainty in predicting their future physiological functioning. In a previous experiment, warming decreased canopy CO2 assimilation (A) rates of Eucalyptus tereticornis trees, but respiration (R) rates were usually not significantly affected, due to physiological acclimation to temperature. This led to a slight increase in (R/A) and thus decrease in plant carbon use efficiency with climate warming. In contrast to carbon fluxes, the effect of warming on carbon allocation and residence time in trees has received less attention. We conducted a study to test the hypothesis that warming would decrease the allocation of C belowground owing to reduced cost of nutrient uptake. E. parramattensis trees were grown in the field in unique whole-tree chambers operated at ambient and ambient +3 °C temperature treatments (n=3 per treatment). We applied a 13CO2 pulse and followed the label in CO2 respired from leaves, roots, canopy and soil, in plant sugars, and in rhizosphere microbes over a 3-week period in conjunction with measurements of tree growth. The 9-m tall, 57 m3 whole-tree chambers were monitored for CO2 concentrations in independent canopy and below ground (root and soil) compartments; periodic monitoring of δ13C values in air in the compartments allowed us to quantify the amount of 13CO2 assimilated and respired by each tree. Warmed trees grew faster and assimilated more of the label than control trees, but the 13C allocation to canopy, root and soil respiration was not altered. However, warming appeared to reduce the residence time of carbon respired from leaves, and especially from roots and soil, indicating that autotrophic respiration has the potential to feedback to climate change. This experiment provides insights into how warming may affect the fate of assimilated carbon from the leaf to the ecosystem scale.

  16. Estimation of residence times of coastal basins in the Laxemar- Simpevarp area between 3000 BC and 9000 AD

    Energy Technology Data Exchange (ETDEWEB)

    Engqvist, Anders (AandI Engqvist Konsult HB, Vaxholm (Sweden))

    2010-09-15

    The assignment has consisted of computation of the morpho- and bathymetry of the coastal area of Laxemar-Simpevarp for the time period 3000 BC through 9000 AD, in order to estimate the residence times as yearly means of volume-averaged specific age (Average Age, AvA) for water in coastal basins. These basins have been selected as belonging to earlier defined biosphere objects, containing anticipated exit points from possible radionuclides leaking from a hypothetical underground repository for spent nuclear fuel. This endeavor starts with partitioning of the coast into appropriate sub-basins interconnected by straits in an as objective manner as possible. This has been performed in cooperation with Umeaa Univ. followed by the transformation of these hypsographical data to a form that can serve as input data to the employed numerical CouBa-model. This model has been developed to simulate the water exchange of straits between densimetrically stably stratified basins with a free sea level including advection and mixing of water-borne conservative scalar properties, e.g. salinity, heat and specific age. The forcing of the model consists of run-off, wind-induced stress, thermal surface dynamics (heating/cooling) and density fluctuations at the open boundary toward the coastal zone, relative by which the specific water age is calculated For these ambient forcing factors there do not exist sufficiently precise climate data other than for contemporary times. For all other time periods the measured and/or model-computed forcing data regarding 2004 have been used. Estimated AvA-values for the different time periods are thus an expression of sub-basin configuration and hypsographical differences. An overriding directive has been to rather overestimate than underestimate the residence times, as to avoid underestimation of the subsequent dose calculations. The results of these AvA computations, presented as volume averages of yearly means of the sixteen biosphere object

  17. Estimation of residence times of coastal basins in the Laxemar-Simpevarp area between 3000 BC and 9000 AD

    International Nuclear Information System (INIS)

    Engqvist, Anders

    2010-09-01

    The assignment has consisted of computation of the morpho- and bathymetry of the coastal area of Laxemar-Simpevarp for the time period 3000 BC through 9000 AD, in order to estimate the residence times as yearly means of volume-averaged specific age (Average Age, AvA) for water in coastal basins. These basins have been selected as belonging to earlier defined biosphere objects, containing anticipated exit points from possible radionuclides leaking from a hypothetical underground repository for spent nuclear fuel. This endeavor starts with partitioning of the coast into appropriate sub-basins interconnected by straits in an as objective manner as possible. This has been performed in cooperation with Umeaa Univ. followed by the transformation of these hypsographical data to a form that can serve as input data to the employed numerical CouBa-model. This model has been developed to simulate the water exchange of straits between densimetrically stably stratified basins with a free sea level including advection and mixing of water-borne conservative scalar properties, e.g. salinity, heat and specific age. The forcing of the model consists of run-off, wind-induced stress, thermal surface dynamics (heating/cooling) and density fluctuations at the open boundary toward the coastal zone, relative by which the specific water age is calculated For these ambient forcing factors there do not exist sufficiently precise climate data other than for contemporary times. For all other time periods the measured and/or model-computed forcing data regarding 2004 have been used. Estimated AvA-values for the different time periods are thus an expression of sub-basin configuration and hypsographical differences. An overriding directive has been to rather overestimate than underestimate the residence times, as to avoid underestimation of the subsequent dose calculations. The results of these AvA computations, presented as volume averages of yearly means of the sixteen biosphere object

  18. Time series linear regression of half-hourly radon levels in a residence

    International Nuclear Information System (INIS)

    Hull, D.A.

    1990-01-01

    This paper uses time series linear regression modelling to assess the impact of temperature and pressure differences on the radon measured in the basement and in the basement drain of a research house in the Princeton area of New Jersey. The models examine half-hour averages of several climate and house parameters for several periods of up to 11 days. The drain radon concentrations follow a strong diurnal pattern that shifts 12 hours in phase between the summer and the fall seasons. This shift can be linked both to the change in temperature differences between seasons and to an experiment which involved sealing the connection between the drain and the basement. We have found that both the basement and the drain radon concentrations are correlated to basement-outdoor and soil-outdoor temperature differences (the coefficient of determination varies between 0.6 and 0.8). The statistical models for the summer periods clearly describe a physical system where the basement drain pumps radon in during the night and sucks radon out during the day

  19. 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.

  20. 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.

  1. Randomized controlled resistance training based physical activity trial for central European nursing home residing older adults.

    Science.gov (United States)

    Barthalos, Istvan; Dorgo, Sandor; Kopkáné Plachy, Judit; Szakály, Zsolt; Ihász, Ferenc; Ráczné Németh, Teodóra; Bognár, József

    2016-10-01

    Nursing home residing older adults often experience fear of sickness or death, functional impairment and pain. It is difficult for these older adults to maintain a physically active lifestyle and to keep a positive outlook on life. This study evaluated the changes in quality of life, attitude to aging, assertiveness, physical fitness and body composition of nursing home residing elderly through a 15-week organized resistance training based physical activity program. Inactive older adults living in a state financed nursing home (N.=45) were randomly divided into two intervention groups and a control group. Both intervention groups were assigned to two physical activity sessions a week, but one of these groups also had weekly discussions on health and quality of life (Mental group). Data on anthropometric measures, fitness performance, as well as quality of life and attitudes to aging survey data were collected. Due to low attendance rate 12 subjects were excluded from the analyses. Statistical analysis included Paired Samples t-tests and Repeated Measures Analysis of Variance. Both intervention groups significantly improved their social participation, and their upper- and lower-body strength scores. Also, subjects in the Mental group showed improvement in agility fitness test and certain survey scales. No positive changes were detected in attitude towards aging and body composition measures in any groups. The post-hoc results suggest that Mental group improved significantly more than the Control group. Regular physical activity with discussions on health and quality of life made a more meaningful difference for the older adults living in nursing home than physical activity alone. Due to the fact that all participants were influenced by the program, it is suggested to further explore this area for better understanding of enhanced quality of life.

  2. Uncertainties in carbon residence time and NPP-driven carbon uptake in terrestrial ecosystems of the conterminous USA: a Bayesian approach

    Directory of Open Access Journals (Sweden)

    Xuhui Zhou

    2012-10-01

    Full Text Available Carbon (C residence time is one of the key factors that determine the capacity of ecosystem C storage. However, its uncertainties have not been well quantified, especially at regional scales. Assessing uncertainties of C residence time is thus crucial for an improved understanding of terrestrial C sequestration. In this study, the Bayesian inversion and Markov Chain Monte Carlo (MCMC technique were applied to a regional terrestrial ecosystem (TECO-R model to quantify C residence times and net primary productivity (NPP-driven ecosystem C uptake and assess their uncertainties in the conterminous USA. The uncertainty was represented by coefficient of variation (CV. The 13 spatially distributed data sets of C pools and fluxes have been used to constrain TECO-R model for each biome (totally eight biomes. Our results showed that estimated ecosystem C residence times ranged from 16.6±1.8 (cropland to 85.9±15.3 yr (evergreen needleleaf forest with an average of 56.8±8.8 yr in the conterminous USA. The ecosystem C residence times and their CV were spatially heterogeneous and varied with vegetation types and climate conditions. Large uncertainties appeared in the southern and eastern USA. Driven by NPP changes from 1982 to 1998, terrestrial ecosystems in the conterminous USA would absorb 0.20±0.06 Pg C yr−1. Their spatial pattern was closely related to the greenness map in the summer with larger uptake in central and southeast regions. The lack of data or timescale mismatching between the available data and the estimated parameters lead to uncertainties in the estimated C residence times, which together with initial NPP resulted in the uncertainties in the estimated NPP-driven C uptake. The Bayesian approach with MCMC inversion provides an effective tool to estimate spatially distributed C residence time and assess their uncertainties in the conterminous USA.

  3. Geochemical modelling of groundwater evolution and residence time at the Haestholmen site

    Energy Technology Data Exchange (ETDEWEB)

    Pitkaenen, P.; Luukkonen, A. [VTT Communities and Infrastructure, Espoo (Finland); Ruotsalainen, P. [Fintact Oy, Helsinki (Finland); Leino- Forsman, H.; Vuorinen, U. [VTT Chemical Technology, Espoo (Finland)

    2001-01-01

    An understanding of the geochemical evolution of groundwater is an essential part of the performance assessment and safety analysis of the geological final disposal of radioactive waste. The performance of technical barriers and migration of possibly released radionuclides depend on the geochemical conditions. A prerequisite for understanding these factors is the ability to specify the water-rock interactions that control chemical conditions in groundwater. The objective of this study is to interpret the processes and factors that control the hydrogeochemistry, such as pH and redox conditions. A model of the hydrogeochemical progress in different parts of the crystalline bedrock at Haestholmen has been created and the significance of geochemical reactions and groundwater mixing along different flow paths calculated. Long term hydrodynamics have also been evaluated. The interpretation and modelling are based on water samples (64 altogether) obtained from precipitation, the Baltic Sea, the soil layer, shallow wells in the bedrock, and 14 deep boreholes in the bedrock for which a comprehensive data set on dissolved chemical species and isotopes was available. Some analyses of dissolved gases and their isotopic measurements were also utilised. The data covers the bedrock at Haestholmen to a depth of 1000 m. The results from groundwater chemistry, isotopes, petrography, hydrogeology of the site, geomicrobial studies, and PCA and speciation calculations were used to evaluate evolutionary processes at the site. The geochemical interpretation of water-rock interaction, isotope-chemical evolution ({delta}{sup 13}C and {delta}{sup 34}S) and mixing of palaeo-water types were approached by mass-balance calculations (NETPATH). Reaction-path calculations (EQ3/6) were used to verify the thermodynamic feasibility of the reaction models obtained. The interpretation and calculation of hydrochemical data from Haestholmen suggest that changes in external conditions, such as glaciation

  4. Burden of Clostridium difficile-associated disease among patients residing in nursing homes: a population-based cohort study.

    Science.gov (United States)

    Yu, Holly; Baser, Onur; Wang, Li

    2016-11-25

    Clostridium difficile (C. difficile) infection (CDI) is the leading cause of nosocomial diarrhea in the United States. This study aimed to examine the incidence of CDI and evaluate mortality and economic burden of CDI in an elderly population who reside in nursing homes (NHs). This was a population-based retrospective cohort study focusing on US NHs by linking Medicare 5% sample, Medicaid, Minimum Data Set (MDS) (2008-10). NH residents aged ≥65 years with continuous enrollment in Medicare and/or Medicaid Fee-for-Service plan for ≥12 months and ≥2 quarterly MDS assessments were eligible for the study. The incidence rate was calculated as the number of CDI episodes by 100,000 person-years. A 1:4 propensity score matched sample of cohorts with and without CDI was generated to assess mortality and health care costs following the first CDI. Among 32,807 NH residents, 941 residents had ≥1 episode of CDI in 2009, with an incidence of 3359.9 per 100,000 person-years. About 30% CDI episodes occurred in the hospital setting. NH residents with CDI (vs without CDI) were more likely to have congestive heart failure, renal disease, cerebrovascular disease, hospitalizations, and outpatient antibiotic use. During the follow-up period, the 30-day (14.7% vs 4.3%, P CDI residents vs non-CDI residents. Total health care costs within 2 months following the first CDI episode were also significantly higher for CDI residents ($28,621 vs $13,644, P CDI presents a serious public health issue in NHs. Mortality, health care utilization, and associated costs were significant following incident CDI episodes.

  5. A retrospective review of required projects in systems-based practice in a single anesthesiology residency: a 10-year experience.

    Science.gov (United States)

    Sakai, Tetsuro; Emerick, Trent D; Patel, Rita M

    2015-09-01

    The Accreditation Council for Graduate Medical Education has emphasized in its core competencies and more recently, in its Milestones Project, that residents understand the importance of systems-based practice (SBP). The objectives of the study are to evaluate the quality of residents' SBP projects and to determine the degrees that were subsequently implemented. A retrospective educational observational study. A university-based anesthesiology training institution. One hundred forty-nine anesthesiology residents in their final (postgraduate year 4) year of training who completed SBP projects for the last 10 years (2004-2013). A structured SBP course was provided for postgraduate year 4 anesthesiology residents with deadlines set such as project identification, data collection, and proposal draft. Each resident's written SBP proposal received inputs by 2 members of the department executive steering committee. The SBP projects concluded with oral presentations by each resident to the department executive steering committee, who provided overall scores. All SBP projects were categorized into 7 categories: safety initiatives, economic analysis, process analysis, policy change recommendations, education initiatives, teamwork/communication, and operating room efficiency. Evaluation scores using a Likert scale (1-9, where 9 is the best) were analyzed. The rate of implementation of project ideas within the department based on the presentations to the executive committee was examined. Of 149 projects, policy change recommendations was the most frequently chosen category (46 projects; 30.9%), followed by process analysis (36 projects; 24.2%). The overall evaluation score was 7.6 ± 0.6 (mean ± SD). A total of 53 projects (35.6%) were implemented in the department. There was no statistical difference between SBPs with implementation vs SBPs without implementation in terms of evaluation scores, year of the presentation, or categories. This SBP project has given residents the

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

    Science.gov (United States)

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

    2018-01-01

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

  7. Local and national laparoscopic skill competitions: residents' opinions and impact on adoption of simulation-based training.

    Science.gov (United States)

    McCreery, Greig L; El-Beheiry, Mostafa; Schlachta, Christopher M

    2017-11-01

    Dedicated practice using laparoscopic simulators improves operative performance. Yet, voluntary utilization is minimal. We hypothesized that skill competition between peers, at the local and national level, positively influences residents' use of laparoscopic simulators. A web-based survey evaluated the relationship between Canadian General Surgery residents' use of laparoscopic simulation and participation in competition. Secondary outcomes assessed attitudes regarding simulation training, factors limiting use, and associations between competition level and usage. One hundred ninety (23%) of 826 potential participants responded. Eighty-three percent rated their laparoscopic abilities as novice or intermediate. More than 70% agreed that use of simulation practice improves intra-operative performance, and should be a mandatory component of training. However, 58% employed simulator practice less than once per month, and 18% never used a simulator. Sixty-five percent engaged in simulator training for 5 h or less over the preceding 6 months. Seventy-three percent had participated in laparoscopic skill competition. Of those, 51% agreed that competition was a motivation for simulation practice. No association was found between those with competition experience and simulator use. However, 83% of those who had competed nationally reported >5 h of simulator use in the previous 6 months compared to those with no competition experience (26%), local competition (40%), and local national-qualifying competition (23%) (p simulation-based training, with only the minority of individuals competing at the national level demonstrated significantly higher simulation use. However, simulation training was perceived as a valuable exercise. Lack of time and access to simulators, as opposed to lack of interest, were the most commonly reported to limited use.

  8. [Simulation-based intervention to improve anesthesiology residents communication with families of critically ill patients--preliminary prospective evaluation].

    Science.gov (United States)

    Berkenstadt, Haim; Perlson, Daria; Shalomson, Orit; Tuval, Atalia; Haviv-Yadid, Yael; Ziv, Amitai

    2013-08-01

    Although effective communication with families of critically ill patients is a vital component of quality care, training in this field is neglected. The article aims to validate communication skills training program for anesthesiology residents in the intensive care set up. Ten anesthesia residents, following 3 months of Intensive Care Unit (ICU) rotation, had 4 hours of lectures and one day simulation-based communication skills training with families of critically ill patients. Participants completed an attitude questionnaire over 3 time periods--before training [t1], immediately following training (t2) and three months following training (t3). The participants' communication skills were assessed by two blinded independent observers using the SEGUE framework while performing a simulation-based scenario at t1 and t3. Seven participants finished the study protocol. Participants ndicated communication importance as 3.68 +/- 0.58 (t1), 4.05 +/- 0.59 (t2), 4.13 +/- 0.64 (t3); their communication ability as 3.09 +/- 0.90 (t1), 3.70 +/- 0.80 (t2), 3.57 +/- 0.64 (t3); the contribution of lecture to communication 3.04 +/- 0.43 (t1), 3.83 +/- 0.39 (t2), 3.87 +/- 0.51 (t3), and contribution of simulation training to communication 3.00 +/- 0.71 (t1), 4.04 +/- 0.52 (t2), 3.84 +/- 0.31 (t3). The differences did not reach statistical significance. Objective assessment of the communication skills using the SEGUE framework indicated that 6/7 participants improved their communication skills, with communication ability before training at 2.66 +/- 0.83 and 1 month following training it was 3.38 +/- 0.78 (p = 0.09). This preliminary study demonstrates the value of communication skills training in the intensive care environment.

  9. More Learning in Less Time: Optimizing the Resident Educational Experience with Limited Clinical and Educational Work Hours.

    Science.gov (United States)

    Sedney, Cara L; Spirou, Eleni; Voelker, Joseph L; Rosen, Charles L

    2017-11-01

    Resident education in the United States and elsewhere has undergone significant changes in recent years owing to work hour restrictions, requiring didactics to fit within a limited schedule, while being increasingly effective at accomplishing educational goals. A single small program experience in improving the didactic experience of residents is described. Focused mentorship, curricula for intangibles, asynchronous education, and independent curricula all are useful tools in resident education. Residents can be exposed to both clinical material and specialty-specific mores using focused and intentional educational techniques. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. Evaluation of clinical teaching quality in competency-based residency training in Lithuania

    Directory of Open Access Journals (Sweden)

    Eglė Vaižgėlienė

    2017-12-01

    Conclusions: Resident evaluations of clinical teachers are influenced by teachers’ age, gender, year of residency training, type of teachers’ academic position and whether or not a clinical teacher performed self-evaluation. Development of CBME should be focused on the continuous evaluation of quality, clinical teachers educational support and the implementation of e-portfolio.

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

    Science.gov (United States)

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

    2016-01-01

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

  12. Redfield Ratios in Inland Waters: Higher Biological Control of C:N:P Ratios in Tropical Semi-arid High Water Residence Time Lakes

    Directory of Open Access Journals (Sweden)

    Ng H. They

    2017-08-01

    Full Text Available The canonical Redfield C:N:P ratio for algal biomass is often not achieved in inland waters due to higher C and N content and more variability when compared to the oceans. This has been attributed to much lower residence times and higher contributions of the watershed to the total organic matter pool of continental ecosystems. In this study we examined the effect of water residence times in low latitude lakes (in a gradient from humid to a semi-arid region on seston elemental ratios in different size fractions. We used lake water specific conductivity as a proxy for residence time in a region of Eastern Brazil where there is a strong precipitation gradient. The C:P ratios decreased in the seston and bacterial size-fractions and increased in the dissolved fraction with increasing water retention time, suggesting uptake of N and P from the dissolved pool. Bacterial abundance, production and respiration increased in response to increased residence time and intracellular nutrient availability in agreement with the growth rate hypothesis. Our results reinforce the role of microorganisms in shaping the chemical environment in aquatic systems particularly at long water residence times and highlights the importance of this factor in influencing ecological stoichiometry in all aquatic ecosystems.

  13. RESIDENCE TIMES OF PARTICLES IN DIFFUSIVE PROTOPLANETARY DISK ENVIRONMENTS. II. RADIAL MOTIONS AND APPLICATIONS TO DUST ANNEALING

    International Nuclear Information System (INIS)

    Ciesla, F. J.

    2011-01-01

    The origin of crystalline grains in comets and the outer regions of protoplanetary disks remains a mystery. It has been suggested that such grains form via annealing of amorphous precursors in the hot, inner region of a protoplanetary disk, where the temperatures needed for such transformations were found, and were then transported outward by some dynamical means. Here we develop a means of tracking the paths that dust grains would have taken through a diffusive protoplanetary disk and examine the types and ranges of environments that particles would have seen over a 10 6 yr time period in the dynamic disk. We then combine this model with three annealing laws to examine how the dynamic evolution of amorphous grains would have led to their physical restructuring and their delivery to various regions of the disk. It is found that 'sibling particles' - those particles that reside at the same location at a given period of time-take a wide range of unique and independent paths through the disk to arrive there. While high temperatures can persist in the disk for very long time periods, we find that those grains that are delivered to the cold outer regions of the disk are largely annealed in the first few x10 5 yr of disk history. This suggests that the crystallinity of grains in the outer disk would be determined early and remain unchanged for much of disk history, in agreement with recent astronomical observations.

  14. Comparative-Effectiveness of Simulation-Based Deliberate Practice Versus Self-Guided Practice on Resident Anesthesiologists' Acquisition of Ultrasound-Guided Regional Anesthesia Skills.

    Science.gov (United States)

    Udani, Ankeet Deepak; Harrison, T Kyle; Mariano, Edward R; Derby, Ryan; Kan, Jack; Ganaway, Toni; Shum, Cynthia; Gaba, David M; Tanaka, Pedro; Kou, Alex; Howard, Steven K

    2016-01-01

    Simulation-based education strategies to teach regional anesthesia have been described, but their efficacy largely has been assumed. We designed this study to determine whether residents trained using the simulation-based strategy of deliberate practice show greater improvement of ultrasound-guided regional anesthesia (UGRA) skills than residents trained using self-guided practice in simulation. Anesthesiology residents new to UGRA were randomized to participate in either simulation-based deliberate practice (intervention) or self-guided practice (control). Participants were recorded and assessed while performing simulated peripheral nerve blocks at baseline, immediately after the experimental condition, and 3 months after enrollment. Subject performance was scored from video by 2 blinded reviewers using a composite tool. The amount of time each participant spent in deliberate or self-guided practice was recorded. Twenty-eight participants completed the study. Both groups showed within-group improvement from baseline scores immediately after the curriculum and 3 months following study enrollment. There was no difference between groups in changed composite scores immediately after the curriculum (P = 0.461) and 3 months following study enrollment (P = 0.927) from baseline. The average time in minutes that subjects spent in simulation practice was 6.8 minutes for the control group compared with 48.5 minutes for the intervention group (P < 0.001). In this comparative effectiveness study, there was no difference in acquisition and retention of skills in UGRA for novice residents taught by either simulation-based deliberate practice or self-guided practice. Both methods increased skill from baseline; however, self-guided practice required less time and faculty resources.

  15. Determination of residence times of ions in a resistive glass selected ion flow-drift tube using the Hadamard transformation.

    Science.gov (United States)

    Spesyvyi, Anatolii; Španěl, Patrik

    2015-09-15

    Selected ion flow tube mass spectrometry, SIFT-MS, used for trace gas analyses has certain fundamental limitations that could be alleviated by adding a facility that allows reaction times and ion interaction energies to be varied. Thus, a selected ion flow-drift tube, SIFDT, has been created to explore the influence of an embedded electric field on these parameters and on reaction processes. The new SIFTD instrument was constructed using a miniature resistive glass drift tube. Arrival times of ions, t, analysed by a downstream quadrupole mass spectrometer over the m/z range 10-100 were studied by modulating the injected ion current using a gate lens. Single pulse modulation was compared with pseudorandom time multiplexing exploiting the Hadamard transformation. A simple model involving analysis of ethanol and water vapour mixture in air was used to explore the advantages of the SIFDT concept to SIFT-MS analysis. It is shown that the resistive glass drift tube is suitable for SIFDT experiments. The Hadamard transformation can be used to routinely determine reagent ion residence time in the flow-drift tube and also to observe differences in arrival times for different product ions. Two-dimensional data combining arrival time and mass spectra can be obtained rapidly. The calculated ion drift velocities vary with the reduced field strength, E/N, and the calculated ion mobilities agree with theoretical and previous literature values. This study has provided evidence that the SIFDT-MS technique can be implemented in a miniature and low-cost instrument and two- or three-dimensional data can be obtained (product ion count rates as functions of m/z, t and E/N) using the Hadamard transformation thus providing exciting possibilities for further analytical additions and extensions of the SIFT-MS technique. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

  16. Viability of a Web-Based Module for Teaching Electrocardiogram Reading Skills to Psychiatry Residents: Learning Outcomes and Trainee Interest.

    Science.gov (United States)

    DeBonis, Katrina; Blair, Thomas R; Payne, Samuel T; Wigan, Katherine; Kim, Sara

    2015-12-01

    Web-based instruction in post-graduate psychiatry training has shown comparable effectiveness to in-person instruction, but few topics have been addressed in this format. This study sought to evaluate the viability of a web-based curriculum in teaching electrocardiogram (EKG) reading skills to psychiatry residents. Interest in receiving educational materials in this format was also assessed. A web-based curriculum of 41 slides, including eight pre-test and eight post-test questions with emphasis on cardiac complications of psychotropic medications, was made available to all psychiatry residents via email. Out of 57 residents, 30 initiated and 22 completed the module. Mean improvement from pre-test to post-test was 25 %, and all 22 completing participants indicated interest in future web-based instruction. This pilot study suggests that web-based instruction is feasible and under-utilized as a means of teaching psychiatry residents. Potential uses of web-based instruction, such as tracking learning outcomes or patient care longitudinally, are also discussed.

  17. The impact of critical appraisal workshops on residents' evidence based medicine skills and knowledge

    Directory of Open Access Journals (Sweden)

    Nasr JA

    2018-04-01

    Full Text Available Justine A Nasr,1,2 John Falatko,1 Alexandra Halalau1,2 1Internal Medicine Department, Beaumont Hospital, Royal Oak, MI, USA; 2Internal Medicine Department, Oakland University William Beaumont School of Medicine, Rochester, MI, USA Objective: To assess the impact of four evidence based medicine (EBM critical appraisal education workshops in improving residents’ EBM knowledge and skills. Methods: The eligible participants in the workshops were 88 residents-in-training, postgraduate years one through four, rotating through the outpatient internal medicine clinic. Four EBM workshops, consisting of 3 days each (30 minutes daily, were taught by our faculty. Topics covered included critical appraisal of randomized controlled trials, case-control and cohort studies, diagnosis studies, and systematic reviews. Results: As a program evaluation, anonymous pre-workshop and post-workshop tests were administered. Each of the four sets of tests showed improvement in scores: therapy from 58% to 77% (42% response rate, harm from 65% to 73% (38% response rate, diagnosis from 49% to 68% (49% response rate, and systematic review from 57% to 72% (30% response rate. Conclusion: We found that teaching EBM in four short workshops improved EBM knowledge and critical appraisal skills related to the four topics. Keywords: evidence based medicine, medical education, assessment methods, graduate, instructional design, curriculum development, curriculum evaluation

  18. Perioperative self-reflection among surgical residents.

    Science.gov (United States)

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

    2017-09-01

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

  19. Groundwater flowpaths and residence times inferred by 14C, 36Cl and 4He isotopes in the Continental Intercalaire aquifer (North-Western Africa)

    Science.gov (United States)

    Petersen, J. O.; Deschamps, P.; Hamelin, B.; Fourré, E.; Gonçalvès, J.; Zouari, K.; Guendouz, A.; Michelot, J.-L.; Massault, M.; Dapoigny, A.; ASTER Team

    2018-05-01

    In a semi-arid to arid climate context, dependency on groundwater resources may lead to overexploitation and deterioration of water quality. The Continental Intercalaire (CI) aquifer is one such continental-scale aquifer (more than a million of km2), which is mainly confined, poorly recharged but intensely abstracted. To date, the management of this resource relies on hydrogeological modelling and key parameters such as recharge/discharge rate and groundwater dynamics. We use a combination of residence time indicators (14C, 36Cl, 4He) and stable isotopes of water (2H and 18O) to give greater constraint on the groundwater residence time in the CI. In previous studies, 14C measurements and steady state modelling indicate a residence time of less than 100 ka whereas in others, 36Cl measurements and transient scenarios modelling suggest a longer residence time (>500 ka). In this study, most of the 14C measurements are below the limit of detection, establishing residence times greater than 40 ka and confirming the necessity of strict sampling protocols to exclude all air and AMS measurements when low 14C concentrations are expected. In the Tunisian recharge area, detectable 14C indicate sporadic recharge episodes (3-7 ka and 29-43 ka), whereas 4He and 36Cl concentrations in central areas suggest very old (water quality in the whole system.

  20. Flow pattern and residence time of groundwater within the south-eastern Taoudeni sedimentary basin (Burkina Faso, Mali)

    Science.gov (United States)

    Huneau, F.; Dakoure, D.; Celle-Jeanton, H.; Vitvar, T.; Ito, M.; Traore, S.; Compaore, N. F.; Jirakova, H.; Le Coustumer, P.

    2011-10-01

    SummaryThe knowledge about groundwater flow conditions within the Southeastern Taoudeni Basin Aquifer shared by Burkina Faso and Mali is relatively limited with very little information on potentiometric heads, recharge processes, residence time and water quality. A better evaluation of groundwater resources in this area is a strategic point for water resources management in the entire Soudano-Sahelian region which endures since the beginning of the twentieth century a continuous decrease in precipitation amount. This paper provides a transboundary synthesis using water ( 18O, 2H and 3H) and carbon isotopes ( 13C and 14C) in conjunction with hydrogeological and hydrochemical data. The objectives are to improve the conceptual model of groundwater recharge and flow within this sandstone reservoir, and to assess the changes in the aquifer due to water abstraction and recent climate changes including an insight into Sahelian aquifers palaeorecharge processes. The local meteoric water line for the Bobo-Dioulasso station is proposed: δ 2H = 8.0 (±0.5)δ 18O + 10.2 (±2.1). Two main tendencies can be derived from groundwater chemistry. First, a slight evolution from the Ca-Mg-HCO 3 type towards a Na-K-HCO 3 type that indicates developed interactions between groundwater and clay minerals related to the residence time of groundwater. A second tendency towards Cl-NO 3-SO 4-HCO 3 water types indicates the anthropogenic influence on groundwater related to the poor sanitary conditions observed around wells. The carbon-14 activity measured on the TDIC varies between 0.3 and 122 pmC, so our record contains samples covering a wide period from Actual to Pleistocene suggesting a continuous recharge of the system through time even if the Sahel region has endured many different climate phases which have influenced the infiltration and recharge processes. All groundwater samples have stable isotope compositions in the range of the present day regional and global meteoric water line

  1. INFLUENCE OF RESIDENCE-TIME DISTRIBUTION ON A SURFACE-RENEWAL MODEL OF CONSTANT-PRESSURE CROSS-FLOW MICROFILTRATION

    Directory of Open Access Journals (Sweden)

    W. Zhang

    2015-03-01

    Full Text Available Abstract This work examines the influence of the residence-time distribution (RTD of surface elements on a model of cross-flow microfiltration that has been proposed recently (Hasan et al., 2013. Along with the RTD from the previous work (Case 1, two other RTD functions (Cases 2 and 3 are used to develop theoretical expressions for the permeate-flux decline and cake buildup in the filter as a function of process time. The three different RTDs correspond to three different startup conditions of the filtration process. The analytical expressions for the permeate flux, each of which contains three basic parameters (membrane resistance, specific cake resistance and rate of surface renewal, are fitted to experimental permeate flow rate data in the microfiltration of fermentation broths in laboratory- and pilot-scale units. All three expressions for the permeate flux fit the experimental data fairly well with average root-mean-square errors of 4.6% for Cases 1 and 2, and 4.2% for Case 3, respectively, which points towards the constructive nature of the model - a common feature of theoretical models used in science and engineering.

  2. Budget and residence time of {sup 210}Pb along the Gulf of Lion`s continental slope (Northwestern Mediterranean Sea)

    Energy Technology Data Exchange (ETDEWEB)

    Abassi, A.; Radakovitch, O.; Heussner, S.; Monaco, A. [Perpignan Univ., 66 (France). Lab. de Sedimentologie et Geochimie Marines

    1997-12-31

    Concentration of {sup 210}Pb has been measured in water and sediment trap samples collected on 7 experimental sites representative of the Gulf of Lion`s continental margin. This marine system is characterised by a major continental input through the Rhone river and a powerful along-slope cyclonic current (Northern Current). From the distribution of bulk {sup 210}Pb activities, it was intended to gain some information on the processes controlling the transport of trace metals at the ocean/continent boundary. Residence times of {sup 210}Pb relative to scavenging in surface waters (0-100 m) showed a constant along-slope (i.e., downstream) decrease that can be related to increasing concentrations in suspended particles. Annual time-series of {sup 210}Pb activities in settling particles were determined on samples collected by traps at 500 and 1000 m depth. From this data set, a budget for {sup 210}Pb on this margin was established which permitted to determine the flux of {sup 210}Pb theoretically adsorbed onto particles. This theoretical flux was compared, at each site, with fluxes effectively measured by traps and revealed that exchange processes - mainly in the form of large inputs of this nuclide (import of 47 to 93% of measured flux) - largely affect the {sup 210}Pb distribution on this continental margin. (author) 12 refs.

  3. Budget and residence time of 210Pb along the Gulf of Lion's continental slope (Northwestern Mediterranean Sea)

    International Nuclear Information System (INIS)

    Abassi, A.; Radakovitch, O.; Heussner, S.; Monaco, A.

    1997-01-01

    Concentration of 210 Pb has been measured in water and sediment trap samples collected on 7 experimental sites representative of the Gulf of Lion's continental margin. This marine system is characterised by a major continental input through the Rhone river and a powerful along-slope cyclonic current (Northern Current). From the distribution of bulk 210 Pb activities, it was intended to gain some information on the processes controlling the transport of trace metals at the ocean/continent boundary. Residence times of 210 Pb relative to scavenging in surface waters (0-100 m) showed a constant along-slope (i.e., downstream) decrease that can be related to increasing concentrations in suspended particles. Annual time-series of 210 Pb activities in settling particles were determined on samples collected by traps at 500 and 1000 m depth. From this data set, a budget for 210 Pb on this margin was established which permitted to determine the flux of 210 Pb theoretically adsorbed onto particles. This theoretical flux was compared, at each site, with fluxes effectively measured by traps and revealed that exchange processes - mainly in the form of large inputs of this nuclide (import of 47 to 93% of measured flux) - largely affect the 210 Pb distribution on this continental margin. (author)

  4. Role of WhatsApp-based discussions in improving residents' knowledge of post-operative pain management: a pilot study.

    Science.gov (United States)

    Bakshi, Sumitra G; Bhawalkar, Pranay

    2017-10-01

    To provide a platform for the dissemination of basic knowledge of pain management, a WhatsApp group was created by residents and consultants. Common clinical scenarios, resident queries, and important instructions to be followed by residents with respect to running the Acute Pain Service were discussed in the group. This study evaluates the benefits of this interaction. This study was approved by the hospital ethics board and was registered with the Clinical Trial Registry of India. Second- and third-year anesthesia residents were included in a WhatsApp group, along with consultants (board certified anesthesiologists with a special interest in pain). Pain knowledge assessment was performed pre- and post-discussion using a standard 22-point questionnaire. A feedback form, which included self-rated confidence scores (1-10, 10-most confident) and opinions about the 3-month WhatsApp discussion, was collected. Improvements in the documentation in clinical sheets post-discussion were also analyzed. A total of 38 residents were included in the WhatsApp group. An improvement in the percentage of correct answers from 69.1% (pre-discussion) to 73.6% (post-discussion) was observed (P = 0.031). Improvements in the self-rated residents' confidence levels were also noted (P WhatsApp-based discussion was useful. Documentation of the details of epidural blockade in clinical sheets improved from 30% to 100%. The WhatsApp discussion improved residents' knowledge and confidence levels, and also resulted in improved documentation of essential details in the clinical notes. This form of education is promising and should be explored in future studies.

  5. Possibility of retrospective follow up studies of mortality in the residents of Semipalatinsk region based on available archive data

    International Nuclear Information System (INIS)

    Bugembayeva, M.; Gaskov, A.; Valivach, M.; Musina, R.; Lipikhina, A.; Kurakina, N.; Kosatov, V.; Federbush, E.; Kusumi, S.

    2003-01-01

    Full text: Epidemiological follow up studies require the following basic data: exposure, people-years of observation, and registered events (incidence of diseases and/or deaths). Besides, it is important to register possible confounding factors such as sex, age, ethnicity, occupation, etc. Performing a joint Kazakhstan-Japanese project we are collecting such kind of data based on various archive documents. Retrospective radiation exposure reconstruction uses estimation methods with input data obtained from historic data, at present physical measurements and at present bio dosimetric measurements. Epidemiological studies is an important part of dose reconstruction, they provide the data on address history and occupation (for example, out-door or in-door job) in the period of atmospheric nuclear tests in 1949-1963. These data can be obtained from Household Books, which have been created and used by authorities for taxation purposes. Each Household Book cover a 2-3 year time band and contains lists of households (usually families), names, birth dates, occupation, ethnicity, and property. Unfortunately, Household Books have numerous mistakes in name spelling, birth dates, and handwriting is often bad. In addition, there are many cases when small children and old people are not mentioned in the lists. Correct data can be reconstructed by comparing the data of several subsequent Household Books and the data of ZAGSes (civilian registry offices). Such ZAGS document as birth certificate contains not only data on a newborn, but also correct names and birth dates of parents, place of birth. Marriage certificates include correct data on names and birth dates. If still there are any doubts, it is possible to collect additional information by interviewing old resident. Usually reconstruction of these data on a single person requires referral to 19 archive documents. A computer software designer A.Gaskov together with epidemiologists have developed a chain of technological

  6. Why wait until residency? Competency-based education in longitudinal integrated clerkships.

    Science.gov (United States)

    Gentles, John Quinn

    2017-02-01

    This essay was selected as the winner of the 2015 Canadian Undergraduate Surgical Education Committee student essay competition. It was written in response to the prompt: "How is your school preparing you for residency - be it surgical or medical?".

  7. RESEARCH ON THE DIRECT CARBON EMISSION FORECAST OF CHINA'S PROVINCIAL RESIDENTS BASED ON NEURAL NETWORK

    Directory of Open Access Journals (Sweden)

    T. Zhang

    2018-04-01

    Full Text Available Global climate change, which mainly effected by human carbon emissions, would affect the regional economic, natural ecological environment, social development and food security in the near future. It’s particularly important to make accurate predictions of carbon emissions based on current carbon emissions. This paper accounted out the direct consumption of carbon emissions data from 1995 to 2014 about 30 provinces (the data of Tibet, Hong Kong, Macao and Taiwan is missing and the whole of China. And it selected the optimal models from BP, RBF and Elman neural network for direct carbon emission prediction, what aim was to select the optimal prediction method and explore the possibility of reaching the peak of residents direct carbon emissions of China in 2030. Research shows that: 1 Residents’ direct carbon emissions per capita of all provinces showed an upward trend in 20 years. 2 The accuracy of the prediction results by Elman neural network model is higher than others and more suitable for carbon emission data projections. 3 With the situation of residents’ direct carbon emissions free development, the direct carbon emissions will show a fast to slow upward trend in the next few years and began to flatten after 2020, and the direct carbon emissions of per capita will reach the peak in 2032. This is also confirmed that China is expected to reach its peak in carbon emissions by 2030 in theory.

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

    International Nuclear Information System (INIS)

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

    1992-01-01

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

  9. A value- and expectancy-based approach to understanding residents' intended response to a wildfire threat

    DEFF Research Database (Denmark)

    McNeill, Ilona M.; Dunlop, Patrick D.; Skinner, Timothy C.

    2016-01-01

    To motivate residents to evacuate early in case of a wildfire threat, it is important to know what factors underlie their response-related decision-making. The current paper examines the role of the value and expectancy tied to potential outcomes of defending vs evacuating on awareness...... or wait and see. These findings have important implications for strategies to influence residents' response-related decision-making....

  10. 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.

  11. Prevalence and regional correlates of road traffic injury among Chinese urban residents: A 21-city population-based study.

    Science.gov (United States)

    Rockett, Ian R H; Jiang, Shuhan; Yang, Qian; Yang, Tingzhong; Yang, Xiaozhao Y; Peng, Sihui; Yu, Lingwei

    2017-08-18

    This study estimated the prevalence of road traffic injury among Chinese urban residents and examined individual and regional-level correlates. A cross-sectional multistage process was used to sample residents from 21 selected cities in China. Survey respondents reported their history of road traffic injury in the past 12 months through a community survey. Multilevel, multivariable logistic regression analysis was used to identify injury correlates. Based on a retrospective 12-month reporting window, road traffic injury prevalence among urban residents was 13.2%. Prevalence of road traffic injury, by type, was 8.7, 8.7, 8.5, and 7.7% in the automobile, bicycle, motorcycle, and pedestrian categories, respectively. Multilevel analysis showed that prevalence of road traffic injury was positively associated with minority status, income, and mental health disorder score at the individual level. Regionally, road traffic injury was associated with geographic location of residence and prevalence of mental health disorders. Both individual and regional-level variables were associated with road traffic injury among Chinese urban residents, a finding whose implications transcend wholesale imported generic solutions. This descriptive research demonstrates an urgent need for longitudinal studies across China on risk and protective factors, in order to inform injury etiology, surveillance, prevention, treatment, and evaluation.

  12. A core competency-based objective structured clinical examination (OSCE) can predict future resident performance.

    Science.gov (United States)

    Wallenstein, Joshua; Heron, Sheryl; Santen, Sally; Shayne, Philip; Ander, Douglas

    2010-10-01

    This study evaluated the ability of an objective structured clinical examination (OSCE) administered in the first month of residency to predict future resident performance in the Accreditation Council for Graduate Medical Education (ACGME) core competencies. Eighteen Postgraduate Year 1 (PGY-1) residents completed a five-station OSCE in the first month of postgraduate training. Performance was graded in each of the ACGME core competencies. At the end of 18 months of training, faculty evaluations of resident performance in the emergency department (ED) were used to calculate a cumulative clinical evaluation score for each core competency. The correlations between OSCE scores and clinical evaluation scores at 18 months were assessed on an overall level and in each core competency. There was a statistically significant correlation between overall OSCE scores and overall clinical evaluation scores (R = 0.48, p competencies of patient care (R = 0.49, p competencies. An early-residency OSCE has the ability to predict future postgraduate performance on a global level and in specific core competencies. Used appropriately, such information can be a valuable tool for program directors in monitoring residents' progress and providing more tailored guidance. © 2010 by the Society for Academic Emergency Medicine.

  13. Rational optimization of drug-target residence time: Insights from inhibitor binding to the S. aureus FabI enzyme-product complex

    Science.gov (United States)

    Chang, Andrew; Schiebel, Johannes; Yu, Weixuan; Bommineni, Gopal R.; Pan, Pan; Baxter, Michael V.; Khanna, Avinash; Sotriffer, Christoph A.; Kisker, Caroline; Tonge, Peter J.

    2013-01-01

    Drug-target kinetics has recently emerged as an especially important facet of the drug discovery process. In particular, prolonged drug-target residence times may confer enhanced efficacy and selectivity in the open in vivo system. However, the lack of accurate kinetic and structural data for series of congeneric compounds hinders the rational design of inhibitors with decreased off-rates. Therefore, we chose the Staphylococcus aureus enoyl-ACP reductase (saFabI) - an important target for the development of new anti-staphylococcal drugs - as a model system to rationalize and optimize the drug-target residence time on a structural basis. Using our new, efficient and widely applicable mechanistically informed kinetic approach, we obtained a full characterization of saFabI inhibition by a series of 20 diphenyl ethers complemented by a collection of 9 saFabI-inhibitor crystal structures. We identified a strong correlation between the affinities of the investigated saFabI diphenyl ether inhibitors and their corresponding residence times, which can be rationalized on a structural basis. Due to its favorable interactions with the enzyme, the residence time of our most potent compound exceeds 10 hours. In addition, we found that affinity and residence time in this system can be significantly enhanced by modifications predictable by a careful consideration of catalysis. Our study provides a blueprint for investigating and prolonging drug-target kinetics and may aid in the rational design of long-residence-time inhibitors targeting the essential saFabI enzyme. PMID:23697754

  14. Underwater Time Service and Synchronization Based on Time Reversal Technique

    Science.gov (United States)

    Lu, Hao; Wang, Hai-bin; Aissa-El-Bey, Abdeldjalil; Pyndiah, Ramesh

    2010-09-01

    Real time service and synchronization are very important to many underwater systems. But the time service and synchronization in existence cannot work well due to the multi-path propagation and random phase fluctuation of signals in the ocean channel. The time reversal mirror technique can realize energy concentration through self-matching of the ocean channel and has very good spatial and temporal focusing properties. Based on the TRM technique, we present the Time Reversal Mirror Real Time service and synchronization (TRMRT) method which can bypass the processing of multi-path on the server side and reduce multi-path contamination on the client side. So TRMRT can improve the accuracy of time service. Furthermore, as an efficient and precise method of time service, TRMRT could be widely used in underwater exploration activities and underwater navigation and positioning systems.

  15. Some Examples of Residence-Time Distribution Studies in Large-Scale Chemical Processes by Using Radiotracer Techniques

    Energy Technology Data Exchange (ETDEWEB)

    Bullock, R. M.; Johnson, P.; Whiston, J. [Imperial Chemical Industries Ltd., Billingham, Co., Durham (United Kingdom)

    1967-06-15

    The application of radiotracers to determine flow patterns in chemical processes is discussed with particular reference to the derivation of design data from model reactors for translation to large-scale units, the study of operating efficiency and design attainment in established plant and the rapid identification of various types of process malfunction. The requirements governing the selection of tracers for various types of media are considered and an example is given of the testing of the behaviour of a typical tracer before use in a particular large-scale process operating at 250 atm and 200 Degree-Sign C. Information which may be derived from flow patterns is discussed including the determination of mixing parameters, gas hold-up in gas/liquid reactions and the detection of channelling and stagnant regions. Practical results and their interpretation are given in relation to an define hydroformylation reaction system, a process for the conversion of propylene to isopropanol, a moving bed catalyst system for the isomerization of xylenes and a three-stage gas-liquid reaction system. The use of mean residence-time data for the detection of leakage between reaction vessels and a heat interchanger system is given as an example of the identification of process malfunction. (author)

  16. Residence times and mixing of water in river banks: implications for recharge and groundwater-surface water exchange

    Science.gov (United States)

    Unland, N. P.; Cartwright, I.; Cendón, D. I.; Chisari, R.

    2014-12-01

    Bank exchange processes within 50 m of the Tambo River, southeast Australia, have been investigated through the combined use of 3H and 14C. Groundwater residence times increase towards the Tambo River, which suggests the absence of significant bank storage. Major ion concentrations and δ2H and δ18O values of bank water also indicate that bank infiltration does not significantly impact groundwater chemistry under baseflow and post-flood conditions, suggesting that the gaining nature of the river may be driving the return of bank storage water back into the Tambo River within days of peak flood conditions. The covariance between 3H and 14C indicates the leakage and mixing between old (~17 200 years) groundwater from a semi-confined aquifer and younger groundwater (bank infiltration. Furthermore, the more saline deeper groundwater likely controls the geochemistry of water in the river bank, minimising the chemical impact that bank infiltration has in this setting. These processes, coupled with the strongly gaining nature of the Tambo River are likely to be the factors reducing the chemical impact of bank storage in this setting. This study illustrates the complex nature of river groundwater interactions and the potential downfall in assuming simple or idealised conditions when conducting hydrogeological studies.

  17. Charge and energy dependence of the residence time of cosmic ray nuclei below 15 GeV/nucleon

    International Nuclear Information System (INIS)

    Soutoul, A.; Engelmann, J.J.; Ferrando, P.; Koch-Miramond, L.; Masse, P.; Webber, W.R.

    1985-01-01

    The relative abundance of nuclear species measured in cosmic rays at Earth has often been interpreted with the simple leaky box model. For this model to be consistent an essential requirement is that the escape length does not depend on the nuclear species. The discrepancy between escape length values derived from iron secondaries and from the B/C ratio was identified by Garcia-Munoz and his co-workers using a large amount of experimental data. Ormes and Protheroe found a similar trend in the HEAO data although they questioned its significance against uncertainties. They also showed that the change in the B/C ratio values implies a decrease of the residence time of cosmic rays at low energies in conflict with the diffusive convective picture. These conclusions crucially depend on the partial cross section values and their uncertainties. Recently new accurate cross sections of key importance for propagation calculations have been measured. Their statistical uncertainties are often better than 4% and their values significantly different from those previously accepted. Here, these new cross sections are used to compare the observed B/C+O and (Sc to Cr)/Fe ratio to those predicted with the simple leaky box model

  18. Evaluating Residence Time for Cesium Removal from Simulated Hanford Tank Wastes Using SuperLig(R) 644 Resin

    International Nuclear Information System (INIS)

    Hassan, N.M.

    2003-01-01

    Batch contact and column experiments were performed to evaluate the effect of residence time on cesium (Cs) removal from two simulated Hanford tank wastes using SuperLig(R) 644 resin. The two waste simulants mimic the compositions of tanks 241-AZ-102 and 241-AN-107 at the U.S. Department of Energy (DOE) Hanford site. A single column made of glass tube (2.7-cm i.d.), which contained approximately 100 mL of H-form SuperLig(R) 644 resin was used in the column experiments. The experiments each consisted of loading, elution, and regeneration steps were performed at flow rates ranging from 0.64 to 8.2 BV/h for AZ-102 and from 1.5 to 18 BV/h for AN-107 simulant. The lowest flow rates of 0.64 and 1.5 BV/h were selected to evaluate less than optimal flow conditions in the plant. The range of the flow rates is consistent with the River Protection Project design for the waste treatment plant (WTP) columns, which will operate at a flow rate between 1.5 to 3 BV/h. Batch contact experiments were also performed for two batches of SuperLig(R) 644 to determine the equilibrium distribution coefficients (Kds) as a function of Cs concentration

  19. Hydraulic paths and estimation of the real residence time of the water in Lago Maggiore (N. Italy: application of massless markers transported in 3D motion fields

    Directory of Open Access Journals (Sweden)

    Nicoletta Sala

    2012-01-01

    Full Text Available This study, conducted using the TRIM_LM model, is a continuation of work on the movement of the water mass at different depths in Lago Maggiore, and thus on the estimation of the real residence time of the water in the lake. Three-dimensional CFD numerical simulations were extended to a 4-year period, focusing on the movements of 202 (two hundred and two massless markers inserted at different points in Lago Maggiore and at the mouths of 11 of its tributaries, enabling us to establish more realistic water renewal times for Lago Maggiore. By crossing the data of the horizontal trajectories of the environmental markers with those of their vertical variations, we reconstructed their movements over the four years of the simulation programme. An analysis of the results shows that the water mass in the layers of the upper 100 m has residence times between a minimum of 1 y and a maximum of 4-5 y. The water from the tributaries has residence times between 250 and 1000 days, depending on the distance of the tributaries from the closing section of the lake. The water in the layers below 100 m has residence times that still cannot be quantified with precision, but that can certainly be estimated at a number of years in two figures. These times are strongly conditioned by the depth of the late winter mixing, which in the last 40 y has not exceeded 200 m.

  20. Use of simulation-based education to improve resident learning and patient care in the medical intensive care unit: a randomized trial.

    Science.gov (United States)

    Schroedl, Clara J; Corbridge, Thomas C; Cohen, Elaine R; Fakhran, Sherene S; Schimmel, Daniel; McGaghie, William C; Wayne, Diane B

    2012-04-01

    The purpose of this study is to determine the effect of simulation-based education on the knowledge and skills of internal medicine residents in the medical intensive care unit (MICU). From January 2009 to January 2010, 60 first-year residents at a tertiary care teaching hospital were randomized by month of rotation to an intervention group (simulator-trained, n = 26) and a control group (traditionally trained, n = 34). Simulator-trained residents completed 4 hours of simulation-based education before their medical intensive care unit (MICU) rotation. Topics included circulatory shock, respiratory failure, and mechanical ventilation. After their rotation, residents completed a standardized bedside skills assessment using a 14-item checklist regarding respiratory mechanics, ventilator settings, and circulatory parameters. Performance of simulator-trained and traditionally trained residents was compared using a 2-tailed independent-samples t test. Simulator-trained residents scored significantly higher on the bedside skills assessment compared with traditionally trained residents (82.5% ± 10.6% vs 74.8% ± 14.1%, P = .027). Simulator-trained residents were highly satisfied with the simulation curriculum. Simulation-based education significantly improved resident knowledge and skill in the MICU. Knowledge acquired in the simulated environment was transferred to improved bedside skills caring for MICU patients. Simulation-based education is a valuable adjunct to standard clinical training for residents in the MICU. Copyright © 2012 Elsevier Inc. All rights reserved.

  1. Simulation-Based Training for Residents in the Management of Acute Agitation: A Cluster Randomized Controlled Trial.

    Science.gov (United States)

    Vestal, Heather S; Sowden, Gillian; Nejad, Shamim; Stoklosa, Joseph; Valcourt, Stephanie C; Keary, Christopher; Caminis, Argyro; Huffman, Jeff

    2017-02-01

    Simulations are used extensively in medicine to train clinicians to manage high-risk situations. However, to our knowledge, no studies have determined whether this is an effective means of teaching residents to manage acutely agitated patients. This study aimed to determine whether simulation-based training in the management of acute agitation improves resident knowledge and performance, as compared to didactic-based instruction. Following a standard lecture on the management of agitated patients, first-year psychiatry residents were randomized (in clusters of three to four residents) to either the intervention (n = 15) or control arm (n = 11). Residents in the intervention arm then received simulation-based training on the management of acute agitation using a scenario with an agitated standardized patient. Those in the control arm received simulation-based training on a clinical topic unrelated to the management of agitation using a scenario with a non-agitated standardized patient who had suffered a fall. Baseline confidence and knowledge were assessed using pre-intervention self-assessment questionnaires and open-ended clinical case vignettes. Efficacy of the intervention as a teaching tool was assessed with post-intervention open-ended clinical case vignettes and videotaped simulation-based assessment, using a different scenario of an agitated standardized patient. Residents who received the agitation simulation-based training showed significantly greater improvement in knowledge (intervention = 3.0 vs. control = 0.3, p = 0.007, Cohen's d = 1.2) and performance (intervention = 39.6 vs control = 32.5, p = 0.001, Cohen's d = 1.6). Change in self-perceived confidence did not differ significantly between groups. In this study, simulation-based training appeared to be more effective at teaching knowledge and skills necessary for the management of acutely agitated patients, as compared to didactic-based instruction alone

  2. Comparison of 2 resident learning tools-interactive screen-based simulated case scenarios versus problem-based learning discussions: a prospective quasi-crossover cohort study.

    Science.gov (United States)

    Rajan, Shobana; Khanna, Ashish; Argalious, Maged; Kimatian, Stephen J; Mascha, Edward J; Makarova, Natalya; Nada, Eman M; Elsharkawy, Hesham; Firoozbakhsh, Farhad; Avitsian, Rafi

    2016-02-01

    Simulation-based learning is emerging as an alternative educational tool in this era of a relative shortfall of teaching anesthesiologists. The objective of the study is to assess whether screen-based (interactive computer simulated) case scenarios are more effective than problem-based learning discussions (PBLDs) in improving test scores 4 and 8 weeks after these interventions in anesthesia residents during their first neuroanesthesia rotation. Prospective, nonblinded quasi-crossover study. Cleveland Clinic. Anesthesiology residents. Two case scenarios were delivered from the Anesoft software as screen-based sessions, and parallel scripts were developed for 2 PBLDs. Each resident underwent both types of training sessions, starting with the PBLD session, and the 2 cases were alternated each month (ie, in 1 month, the screen-based intervention used case 1 and the PBLD used case 2, and vice versa for the next month). Test scores before the rotation (baseline), immediately after the rotation (4 weeks after the start of the rotation), and 8 weeks after the start of rotation were collected on each topic from each resident. The effect of training method on improvement in test scores was assessed using a linear mixed-effects model. Compared to the departmental standard of PBLD, the simulation method did not improve either the 4- or 8-week mean test scores (P = .41 and P = .40 for training method effect on 4- and 8-week scores, respectively). Resident satisfaction with the simulation module on a 5-point Likert scale showed subjective evidence of a positive impact on resident education. Screen-based simulators were not more effective than PBLD for education during the neuroanesthesia rotation in anesthesia residency. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Use of multiple age tracers to estimate groundwater residence times and long-term recharge rates in arid southern Oman

    Science.gov (United States)

    Müller, Th.; Osenbrück, K.; Strauch, G.; Pavetich, S.; Al-Mashaikhi, K.-S.; Herb, C.; Merchel, S.; Rugel, G.; Aeschbach, W.; Sanford, Ward E.

    2016-01-01

    Multiple age tracers were measured to estimate groundwater residence times in the regional aquifer system underlying southwestern Oman. This area, known as the Najd, is one of the most arid areas in the world and is planned to be the main agricultural center of the Sultanate of Oman in the near future. The three isotopic age tracers 4He, 14C and 36Cl were measured in waters collected from wells along a line that extended roughly from the Dhofar Mountains near the Arabian Sea northward 400 km into the Empty Quarter of the Arabian Peninsula. The wells sampled were mostly open to the Umm Er Radhuma confined aquifer, although, some were completed in the mostly unconfined Rus aquifer. The combined results from the three tracers indicate the age of the confined groundwater is  100 ka in the central section north of the mountains, and up to and > one Ma in the Empty Quarter. The 14C data were used to help calibrate the 4He and 36Cl data. Mixing models suggest that long open boreholes north of the mountains compromise 14C-only interpretations there, in contrast to 4He and 36Cl calculations that are less sensitive to borehole mixing. Thus, only the latter two tracers from these more distant wells were considered reliable. In addition to the age tracers, δ2H and δ18O data suggest that seasonal monsoon and infrequent tropical cyclones are both substantial contributors to the recharge. The study highlights the advantages of using multiple chemical and isotopic data when estimating groundwater travel times and recharge rates, and differentiating recharge mechanisms.

  4. Using stable isotopes to estimate and compare mean residence times in contrasting geologic catchments (Attert River, NW Luxembourg)

    Science.gov (United States)

    Martínez-Carreras, N.; Fenicia, F.; Frentress, J.; Wrede, S.; Pfister, L.

    2012-04-01

    In recent years, stable isotopes have been increasingly used to characterize important aspects of catchment hydrological functioning, such as water storage dynamics, flow pathways and water sources. These characteristics are often synthesized by the Mean Residence Time (MRT), which is a simple catchment descriptor that employ the relation of distinct stable isotopic signatures in the rainfall input and streamflow output of a catchment that are significantly dampened through sub-surface propagation. In this preliminary study, MRT was estimated in the Attert River catchment (NW Luxembourg), where previous studies have shown that lithology exerts a major control on runoff generation. The Attert catchment lies at the transition zone of contrasting bedrock lithology: the Northern part is characterized by Devonian schist of the Ardennes massif, while sedimentary deposits of sandstone and marls dominate in the south of the catchment. As a consequence of differing lithologic characteristics, hydrological processes change across scales. The schistose catchments exhibit a delayed shallow groundwater component, sandstone catchments have slow-responding year-round groundwater component, whereas flashy runoff regimes prevails in the marly catchments. Under these circumstances, the MRTs are expected to vary significantly according to lithology, and provide additional understanding in internal catchment processes and their scale dependencies. In order to test this, bi-weekly monitoring of rainfall and discharge stable water isotope composition (oxygen-18 and deuterium) has been carried out since 2007 in 10 nested sub-catchments ranging in size from 0.4 to 247 km2 in the Attert catchment. MRT was estimated using different lumped convolution integral models and sine wave functions with varying transit times distributions (TTDs). TTDs were evaluated through calibration. Further research efforts will deal with the application of conceptual models to simulate and compare TTD, using

  5. Improved Safety and Cost Savings from Reductions in Cast-Saw Burns After Simulation-Based Education for Orthopaedic Surgery Residents.

    Science.gov (United States)

    Bae, Donald S; Lynch, Hayley; Jamieson, Katherine; Yu-Moe, C Winnie; Roussin, Christopher

    2017-09-06

    The purpose of this investigation was to characterize the clinical efficacy and cost-effectiveness of simulation training aimed at reducing cast-saw injuries. Third-year orthopaedic residents underwent simulation-based instruction on distal radial fracture reduction, casting, and cast removal using an oscillating saw. The analysis compared incidences of cast-saw injuries and associated costs before and after the implementation of the simulation curriculum. Actual and potential costs associated with cast-saw injuries included wound care, extra clinical visits, and potential total payment (indemnity and expense payments). Curriculum costs were calculated through time-derived, activity-based accounting methods. The researchers compared the costs of cast-saw injuries and the simulation curriculum to determine overall savings and return on investment. In the 2.5 years prior to simulation, cast-saw injuries occurred in approximately 4.3 per 100 casts cut by orthopaedic residents. For the 2.5-year period post-simulation, the injury rate decreased significantly to approximately 0.7 per 100 casts cut (p = 0.002). The total cost to implement the casting simulation was $2,465.31 per 6-month resident rotation. On the basis of historical data related to cast-saw burns (n = 6), total payments ranged from $2,995 to $25,000 per claim. The anticipated savings from averted cast-saw injuries and associated medicolegal payments in the 2.5 years post-simulation was $27,131, representing an 11-to-1 return on investment. Simulation-based training for orthopaedic surgical residents was effective in reducing cast-saw injuries and had a high theoretical return on investment. These results support further investment in simulation-based training as cost-effective means of improving patient safety and clinical outcomes. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

  6. Resident and proprietor perspectives on a recovery orientation in community-based housing.

    Science.gov (United States)

    Piat, Myra; Boyer, Richard; Fleury, Marie-Josée; Lesage, Alain; O'Connell, Maria; Sabetti, Judith

    2015-03-01

    Stable housing is a fundamental human right, and an important element for both mental health recovery and social inclusion among people with serious mental illness. This article reports findings from a study on the recovery orientation of structured congregate community housing services using the Recovery Self-Assessment Questionnaire (RSA) adapted for housing (O'Connell, Tondora, Croog, Evans, & Davidson, 2005). The RSA questionnaires were administered to 118 residents and housing providers from 112 congregate housing units located in Montreal, Canada. Residents rated their homes as significantly less recovery-oriented than did proprietors, which is contrary to previous studies of clinical services or Assertive Community Treatment where RSA scores for service users were significantly higher than service provider scores. Findings for both groups suggest the need for improvement on 5 of 6 RSA factors. While proprietors favored recovery training and education, and valued resident opinion and experience, vestiges of a traditional medical model governing this housing emerged in other findings, as in agreement between the 2 groups that residents have little choice in case management, or in the belief among proprietors that residents are unable to manage their symptoms. This study demonstrates that the RSA adapted for housing is a useful tool for creating recovery profiles of housing services. The findings provide practical guidance on how to promote a recovery orientation in structured community housing, as well as a novel approach for reaching a common understanding of what this entails among stakeholders. (PsycINFO Database Record (c) 2015 APA, all rights reserved).

  7. Resident and Proprietor Perspectives of a Recovery Orientation in Community-Based Housing

    Science.gov (United States)

    Piat, Myra; Boyer, Richard; Fleury, Marie-Josée; Lesage, Alain; O’Connell, Maria; Sabetti, Judith

    2016-01-01

    Objective Stable housing is a fundamental human right, and an important element for both mental health recovery and social inclusion among people with serious mental illness. This article reports findings from a study on the recovery orientation of structured congregate community housing services using the Recovery Self-Assessment Questionnaire (RSA) adapted for housing (O’Connell, Tondora, Croog, Evans, & Davidson, 2005). Methods The RSA questionnaires were administered to 118 residents and housing providers from 112 congregate housing units located in Montreal, Canada. Results Residents rated their homes as significantly less recovery-oriented than did proprietors, which is contrary to previous studies of clinical services or Assertive Community Treatment where RSA scores for service users were significantly higher than service provider scores. Findings for both groups suggest the need for improvement on 5 of 6 RSA factors. While proprietors favored recovery training and education, and valued resident opinion and experience, vestiges of a traditional medical model governing this housing emerged in other findings, as in agreement between the 2 groups that residents have little choice in case management, or in the belief among proprietors that residents are unable to manage their symptoms. Conclusions and Implications for Practice This study demonstrates that the RSA adapted for housing is a useful tool for creating recovery profiles of housing services. The findings provide practical guidance on how to promote a recovery orientation in structured community housing, as well as a novel approach for reaching a common understanding of what this entails among stakeholders. PMID:25559078

  8. Permanent health educati