Ulmer, Cheryl, Ed.; Wolman, Dianne Miller, Ed.; Johns, Michael M. E., Ed.
Medical residents in hospitals are often required to be on duty for long hours. In 2003 the organization overseeing graduate medical education adopted common program requirements to restrict resident workweeks, including limits to an average of 80 hours over 4 weeks and the longest consecutive period of work to 30 hours in order to protect…
Devitt, Katharine S.; Keshet, Itay; Spicer, Jonathan; Imrie, Kevin; Feldman, Liane; Cools-Lartigue, Jonathan; Kayssi, Ahmed; Lipsman, Nir; Elmi, Maryam; Kulkarni, Abhaya V.; Parshuram, Chris; Mainprize, Todd; Warren, Richard J.; Fata, Paola; Gorman, M. Sean; Feinberg, Stan; Rutka, James
Background: In 2003, the Accreditation Council for Graduate Medical Education (ACGME) mandated 80-hour resident duty limits. In 2011 the ACGME mandated 16-hour duty maximums for PGY1 (post graduate year) residents. The stated goals were to improve patient safety, resident well-being, and education. A systematic review and meta-analysis were performed to evaluate the impact of resident duty hours (RDH) on clinical and educational outcomes in surgery. Methods: A systematic review (1980–2013) was executed on CINAHL, Cochrane Database, Embase, Medline, and Scopus. Quality of articles was assessed using the GRADE guidelines. Sixteen-hour shifts and night float systems were analyzed separately. Articles that examined mortality data were combined in a random-effects meta-analysis to evaluate the impact of RDH on patient mortality. Results: A total of 135 articles met the inclusion criteria. Among these, 42% (N = 57) were considered moderate-high quality. There was no overall improvement in patient outcomes as a result of RDH; however, some studies suggest increased complication rates in high-acuity patients. There was no improvement in education related to RDH restrictions, and performance on certification examinations has declined in some specialties. Survey studies revealed a perception of worsened education and patient safety. There were improvements in resident wellness after the 80-hour workweek, but there was little improvement or negative effects on wellness after 16-hour duty maximums were implemented. Conclusions: Recent RDH changes are not consistently associated with improvements in resident well-being, and have negative impacts on patient outcomes and performance on certification examinations. Greater flexibility to accommodate resident training needs is required. Further erosion of training time should be considered with great caution. PMID:24662409
Albergo, J I; Fernández, M C; Zaifrani, L; Giunta, D H; Albergo, L
Sleep deprivation is usually present in residents during their training program. The purpose of our study was to analyze the cognitive performance of a group of orthopaedic residents before and after 24 hours on call duty. We include orthopaedic residents and their cognitive functions were evaluated by the following tests: Continuous Performance Test (CPT 2), Digit Spam (Versión 5), 1 letter Fonologic Fluence y Pasat Test. All the tests were done after a sleeping period at home of at least 6 hours and after being on call (sleeping less than 3 hours). Nineteen residents were included in the study. The median age was 27 ± 1.89 and 15 were male. The mean hours of sleeping at home was 6.5 (range 6-8) and after on call duty was 1.5 (range 0.5-3). Statistical difference were found in CPT 2 test en terms of correct answers (p=0.007), omissions (p=0.004) and perseverations (p=0.036). No significant differences were found in the other tests. Sleep deprivation after 24 hours on call duty affects cognitive performance of orthopaedic residents, increasing the number of errors and omissions. Copyright © 2015 SECOT. Published by Elsevier Espana. All rights reserved.
Blay, Eddie; Hewitt, D Brock; Chung, Jeanette W; Biester, Thomas; Fiore, James F; Dahlke, Allison R; Quinn, Christopher M; Lewis, Frank R; Bilimoria, Karl Y
Concerns persist about the effect of current duty hour reforms on resident educational outcomes. We investigated whether a flexible, less-restrictive duty hour policy (Flexible Policy) was associated with differential general surgery examination performance compared with current ACGME duty hour policy (Standard Policy). We obtained examination scores on the American Board of Surgery In-Training Examination, Qualifying Examination (written boards), and Certifying Examination (oral boards) for residents in 117 general surgery residency programs that participated in the Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST) Trial. Using bivariate analyses and regression models, we compared resident examination performance across study arms (Flexible Policy vs Standard Policy) for 2015 and 2016, and 1 year of the Qualifying Examination and Certifying Examination. Adjusted analyses accounted for program-level factors, including the stratification variable for randomization. In 2016, FIRST trial participants were 4,363 general surgery residents. Mean American Board of Surgery In-Training Examination scores for residents were not significantly different between study groups (Flexible Policy vs Standard Policy) overall (Flexible Policy: mean [SD] 502.6 [100.9] vs Standard Policy: 502.7 [98.6]; p = 0.98) or for any individual postgraduate year level. There was no difference in pass rates between study arms for either the Qualifying Examination (Flexible Policy: 90.4% vs Standard Policy: 90.5%; p = 0.99) or Certifying Examination (Flexible Policy: 86.3% vs Standard Policy: 88.6%; p = 0.24). Results from adjusted analyses were consistent with these findings. Flexible, less-restrictive duty hour policies were not associated with differences in general surgery resident performance on examinations during the FIRST Trial. However, more years under flexible duty hour policies might be needed to observe an effect. Copyright © 2016 American College of Surgeons
Curtis, Stuart H; Miller, Robert H; Weng, Cindy; Gurgel, Richard K
Evaluate the effect of duty hour regulation on graduating otolaryngology resident surgical case volume and analyze trends in surgical case volume for Accreditation Council for Graduate Medical Education (ACGME) key indicator cases from 1996 to 2011. Time-trend analysis of surgical case volume. Nationwide sample of otolaryngology residency programs. Operative logs from the American Board of Otolaryngology and ACGME for otolaryngology residents graduating in the years 1996 to 2011. Key indicator volumes and grouped domain volumes before and after resident duty hour regulations (2003) were calculated and compared. Independent t test was performed to evaluate overall difference in operative volume. Wilcoxon rank sum test evaluated differences between procedures per time period. Linear regression evaluated trend. The average total number of key indicator cases per graduating resident was 440.8 in 1996-2003 compared to 500.4 cases in 2004-2011, and overall average per number of key indicators was 31.5 and 36.2, respectively (P = .067). Four key indicator cases showed statistically significant (P otolaryngology residents. The overall trend in operative volume is increasing for several specific key indicators. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2014.
Tierney, William S; Elkin, Rachel L; Nielsen, Craig D
July 2011 saw the implementation of the newest duty hour restrictions, further limiting the working hours of first year residents and necessitating a variety of adaptations on the part of residency programs. The present study sought to characterize the perceived impact of these restrictions on residency program personnel using a multi-specialty and multi-site approach. We developed and administered a survey to internal medicine and general surgery residency programs at three academic medical centers within an urban region. The survey combined quantitative and qualitative components to gain a broader understanding of the impact of the newest regulations. Quantitative responses were compared between Internal Medicine and General Surgery programs with Student t-tests. Other comparisons were performed using ANOVA or Kruskal-Wallis testing as appropriate. For all comparisons, the threshold for significance was set at 0.01. Two independent reviewers coded all qualitative data and assigned one or more themes based on content. Descriptive statistics were calculated and the diversity of themes identified. No between-group comparisons were conducted with the qualitative data. We found significant differences in the overall perceptions of duty hour restrictions across specialty (internal medicine more positive than general surgery) and across position (first year residents more positive than senior residents and faculty). Notably, individuals who trained at osteopathic medical schools reported significantly more negative views of the duty hour restrictions than those who had trained at allopathic or international medical schools, suggesting an influence of undergraduate medical training. The complementary qualitative data offered insights into the perceived strengths and weaknesses of the duty hour restrictions, as well as actionable suggestions that could help to improve residency program function. This study characterizes responses to the new duty hour restrictions from a
Vucicevic, Darko; Mookadam, Farouk; Webb, Brandon J.; Labonte, Helene R.; Cha, Stephen S.; Blair, Janis E.
The Accreditation Council for Graduate Medical Education (ACGME) implemented work hour restrictions for physicians in training in 2003 that were revised July 1, 2011. Current published data are insufficient to assess whether such work hour restrictions will have long-term impact on residents' education. We searched computer-generated reports…
Full Text Available Cameron W Leafloor,1 Heather A Lochnan,2,3,6 Catherine Code,2,4 Erin J Keely,2,3,6 Deanna M Rothwell,5,6 Alan J Forster,2,4–6 Allen R Huang2,6,7 1Faculty of Medicine, 2Department of Medicine, 3Division of Endocrinology and Metabolism, 4Division of General Internal Medicine, 5Performance Measurement and Innovation, 6Ottawa Hospital Research Institute, 7Division of Geriatric Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, ON, Canada Background: Since the mid-1980s, medical residents' long duty hours have been under scrutiny as a factor affecting patient safety and the work environment for the residents. After several mandated changes in duty hours, it is important to understand how residents spend their time before proposing and implementing future changes. Time-motion methodology may provide reliable information on what residents do while on duty.Purpose: The purpose of this study is to review all available literature pertaining to time-motion studies of internal medicine residents while on a medicine service and to understand how much of their time is apportioned to various categories of tasks, and also to determine the effects of the Accreditation Council for Graduate Medical Education (ACGME-mandated duty hour changes on resident workflow in North America.Methods: Electronic bibliographic databases were searched for articles in English between 1941 and April 2013 reporting time-motion studies of internal medicine residents rotating through a general medicine service.Results: Eight articles were included. Residents spent 41.8% of time in patient care activities, 18.1% communicating, 13.8% in educational activities, 19.7% in personal/other, and 6.6% in transit. North American data showed the following changes after the implementation of the ACGME 2003 duty hours standard: patient care activities from 41.8% to 40.8%, communication activities from 19.0% to 22.3%, educational activities from 17.7% to 11.6%, and personal
Thorp, Jonathon; Dattalo, Melissa; Ghanem, Khalil G; Christmas, Colleen
Training programs have implemented the 2011 ACGME duty hour regulations (DHR) using "workload compression" (WLC) strategies, attempting to fit similar clinical responsibilities into fewer working hours, or workload reduction (WLR) approaches, reducing the number of patient encounters per trainee. Many have expressed concern that these strategies could negatively impact patient care and learner outcomes. This study evaluates the medical knowledge and clinical impact of a WLR intervention in a single institution. Nonrandomized intervention study with comparison to a historical control study among 58 PGY-1 internal medicine trainees in the 2 years after duty hour implementation [exposure cohort (EC), 7/1/2011-6/30/2013], compared to 2 years before implementation [comparison cohort (CC), 7/1/2009-6/30/2011]. Process outcomes were average inpatient encounters, average new inpatient admissions, and average scheduled outpatient encounters per PGY-1 year. Performance outcomes included trainee inpatient and outpatient days on service, In-Training Examination (ITE) scores as an objective surrogate of medical knowledge, Case-Mix Index (CMI), and quality of care measures (30-day readmission rate, 30-day mortality rate, and average length of stay). Baseline characteristics and average numbers of inpatient encounters per PGY-1 class were similar between the EC and CC. However, the EC experienced fewer new inpatient admissions (157.47 ± 40.47 vs. 181.72 ± 25.45; p theoretical concern that reducing PGY-1 inpatient admissions volumes may negatively impact education and clinical care measures, this study found no evidence of such a trade-off.
Smith, Aaron; Braden, Lauren; Wan, Jim; Sebelik, Merry
Graduate medical education has undergone a transformation from traditional long work hours to a restricted plan to allow adequate rest for residents. The initial goal of this restriction is to improve patient outcomes. To determine whether duty hour restrictions had any impact on surgery-specific outcomes by analyzing complications following thyroid and parathyroid procedures performed before and after duty hour reform. Retrospective cross-sectional analysis of the National Inpatient Sample (NIS).The NIS was queried for procedure codes associated with thyroid and parathyroid procedures for the years 2000 to 2002 and 2006 to 2008. Hospitals were divided based on teaching status into 3 groups: nonteaching hospitals (NTHs), teaching hospitals without otolaryngology programs (THs), and teaching hospitals with otolaryngology programs (THs-OTO). Procedure-specific complication rates, length of stay, and mortality rates were collected. SAS statistical software (version 9.4) was used for analysis with adjustment using Charlson comorbidity index. Total numbers of head and neck endocrine procedures were 34 685 and 39 770 (a 14.7% increase), for 2000 to 2002 and 2006 to 2008, respectively. THs-OTO contributed a greater share of procedures in 2006 to 2008 (from 18% to 25%). With the earlier period serving as the reference, length of stay remained constant (2.1 days); however, total hospital charges increased (from $12 978 to $23 708; P otolaryngology programs.
Sun, Ning-Zi; Gan, Runye; Snell, Linda; Dolmans, Diana
Although some evidence suggests that resident duty hours reforms can lead to shift-worker mentality and loss of patient ownership, other evidence links long hours and fatigue to poor work performance and loss of empathy, suggesting the restrictions could positively affect professionalism. The authors explored perceived impacts of a 16-hour duty restriction, achieved using a night float (NF) system, on the workplace and professionalism. In 2013, the authors conducted semistructured interviews with 18 residents, 9 staff physicians, and 3 residency program directors in the McGill University core internal medicine residency program regarding their perceptions of the program's 12-hour shift-based NF system. Interviews were transcribed and coded for common themes. The authors used a descriptive qualitative methodology. Participants viewed implementation of the NF system as leading to decreased physical and mental exhaustion, more consistent interaction with patients, and more stable team structure within shifts compared with the previous 24-hour call system. These workplace changes were felt to improve teamwork and patient ownership within shifts, quality of work performed, and empathy. Across shifts, however, more frequent sign-overs, stricter application of shift time boundaries, and loose integration between daytime and NF teams were perceived as leading to emergence of shift-worker mentality around sign-over. Perceptions of optimal patient ownership changed from the traditional single-physician-24/7 model to team-based shared ownership. Duty hours restrictions, as exemplified by an NF system, have both positive and negative impacts on professionalism. Interventions and training toward effective team-based care are needed to curb emergence of shift-worker mentality.
Full Text Available Abstract Background Work-hour limitations have been implemented by the Accreditation Council for Graduate Medical Education (ACGME in July 2003 in order to minimize fatigue related medical adverse events. The effects of this regulation are still under intense debate. In this literature review, data of effects of limited work-hours on the quality of life, surgical education, and patient care was summarized, focusing on surgical subspecialities. Methods Studies that assessed the effects of the work-hour regulation published following the implementation of ACGME guidelines (2003 were searched using PubMed database. The following search modules were selected: work-hours, 80-hour work week, quality of life, work satisfaction, surgical education, residency training, patient care, continuity of care. Publications were included if they were completed in the United States and covered the subject of our review. Manuscrips were analysed to identify authors, year of publication, type of study, number of participants, and the main outcomes. Review Findings Twenty-one articles met the inclusion criteria. Studies demonstrate that the residents quality of life has improved. The effects on surgical education are still unclear due to inconsistency in studies. Furthermore, according to several objective studies there were no changes in mortality and morbidity following the implementation. Conclusion Further studies are necessary addressing the effects of surgical education and studying the objective methods to assess the technical skill and procedural competence of surgeons. In addition, patient surveys analysing their satisfaction and concerns can contribute to recent discussion, as well.
Hamadani, Fadi T; Deckelbaum, Dan; Sauve, Alexandre; Khwaja, Kosar; Razek, Tarek; Fata, Paola
The implementation of work hour restrictions across North America have resulted in decreased levels of self injury and medical errors for Residents. An arbitration ruling in Quebec has led to further curtailment of work hours beyond that proposed by the ACGME. This may threaten Resident quality of life and in turn decrease the educational quality of surgical residency training. We administered a quality of life questionnaire with an integrated education quality assessment tool to all General Surgery residents training at McGill 6 months after the work hour restrictions. Across several strata respondents reveal a decreased sense of educational quality and quality of life. The arbitration argued that work- hour restrictions would be necessary to improve quality of life for trainees and hence improve patient safety. Results from this study demonstrate the exact opposite in a large majority of respondents, who report a poorer quality of life and a self-reported inability on their part to provide continuous and safe patient care. Copyright © 2013 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.
Wada, Koji; Sakata, Yumi; Theriault, Gilles; Narai, Rie; Yoshino, Yae; Tanaka, Katsutoshi; Aizawa, Yoshiharu
Despite long-standing concerns regarding the effects of working hours on the performance and health of medical residents, and the patients' safety, prior studies have not shown an association of excessive sleepiness with the number of sleeping hours and days of overnight work among medical residents. In August 2005, a questionnaire was mailed to 227 eligible participants at 16 teaching hospitals. The total number of sleeping hours in the last 30 d was estimated from the average number of sleeping hours during regular days and during days with overnight work, and the number of days of overnight work. Multiple logistic regression analysis was used to adjust for potentially associated variables. A total of 149 men and 47 women participated in this study. The participation rate was 86.3%. Among the participants, 55 (28.1%) suffered from excessive sleepiness. Excessive sleepiness was associated with sleeping for less than 150 h in the last 30 d (corrected odds ratio [cOR]=1.57; 95% confidence interval [CI], 1.02-2.16). The number of days of overnight work in the last 30 d showed no association with excessive sleepiness. Excessive sleepiness was also associated with smoking (cOR, 1.65; 95%CI, 1.01-2.32). Medical residents who slept for less than 150 h in the last 30 d and smoked had a significantly higher risk of excessive sleepiness on duty.
Rosen, Amy K; Loveland, Susan A; Romano, Patrick S; Itani, Kamal M F; Silber, Jeffrey H; Even-Shoshan, Orit O; Halenar, Michael J; Teng, Yun; Zhu, Jingsan; Volpp, Kevin G
Improving patient safety was a strong motivation behind duty hour regulations implemented by Accreditation Council for Graduate Medical Education on July 1, 2003. We investigated whether rates of patient safety indicators (PSIs) changed after these reforms. Observational study of patients admitted to Veterans Health Administration (VA) (N = 826,047) and Medicare (N = 13,367,273) acute-care hospitals from July 1, 2000 to June 30, 2005. We examined changes in patient safety events in more versus less teaching-intensive hospitals before (2000-2003) and after (2003-2005) duty hour reform, using conditional logistic regression, adjusting for patient age, gender, comorbidities, secular trends, baseline severity, and hospital site. Ten PSIs were aggregated into 3 composite measures based on factor analyses: "Continuity of Care," "Technical Care," and "Other" composites. Continuity of Care composite rates showed no significant changes postreform in hospitals of different teaching intensity in either VA or Medicare. In the VA, there were no significant changes postreform for the technical care composite. In Medicare, the odds of a Technical Care PSI event in more versus less teaching-intensive hospitals in postreform year 1 were 1.12 (95% CI; 1.01-1.25); there were no significant relative changes in postreform year 2. Other composite rates increased in VA in postreform year 2 in more versus less teaching-intensive hospitals (odds ratio, 1.63; 95% CI; 1.10-2.41), but not in Medicare in either postreform year. Duty hour reform had no systematic impact on PSI rates. In the few cases where there were statistically significant increases in the relative odds of developing a PSI, the magnitude of the absolute increases were too small to be clinically meaningful.
Understanding medical professionalism and its evaluation is essential to ensuring that physicians graduate with the requisite knowledge and skills in this domain. It is important to consider the context in which behaviours occur, along with tensions between competing values and the individual’s approach to resolving such conflicts. However, too much emphasis on behaviours can be misleading, as they may not reflect underlying attitudes or professionalism in general. The same behaviour can be viewed and evaluated quite differently, depending on the situation. These concepts are explored and illustrated in this paper in the context of duty hour regulations. The regulation of duty hours creates many conflicts that must be resolved, and yet their resolution is often hidden, especially when compliance with or violation of regulations carries significant consequences. This article challenges attending physicians and the medical education community to reflect on what we value in our trainees and the attributions we make regarding their behaviours. To fully support our trainees’ development as professionals, we must create opportunities to teach them the valuable skills they will need to achieve balance in their lives. [P]rofessionalism has no meaningful existence independent of the interactions that give it form and meaning. There is great folly in thinking otherwise. Hafferty and Levinson (2008) Understanding and evaluating professionalism is essential to excellence in medical education and is mandated by organizations that oversee medical training . Historically, attention has been focused largely on the professionalism of individual students or residents, at least for the purposes of evaluation. Yet there is now a growing appreciation that professionalism can be defined, understood, and evaluated from multiple perspectives . Importantly, context has been recognized as critical to shaping trainees’ behaviours, and hence as important to our understanding of
Bhavsar, Jignesh; Montgomery, Daniel; Li, Jin; Kline-Rogers, Eva; Saab, Fadi; Motivala, Apurva; Froehlich, James B; Parekh, Vikas; Del Valle, John; Eagle, Kim A
In July 2003, the Accreditation Council for Graduate Medical Education instituted residency duty-hours requirements in response to growing concerns regarding clinician fatigue and the incidence of medical errors. These changes, which limited maximum continuous hours worked and total hours per week, often resulted in increased discontinuity of care. The objective of this study was to assess the impact of the duty-hours restrictions on quality of care and outcomes of patients with acute coronary syndrome. We performed a retrospective analysis of 1003 consecutive patients with acute coronary syndrome admitted to the University of Michigan Hospital between July 2002 and June 2004. Patients were stratified by hospital admission during academic year 2002-2003 (pre-duty-hours changes, n=572) and academic year 2003-2004 (post-duty-hours changes, n=431). Main outcome measures included differences in adherence to quality indicators, length of stay, and in-hospital and 6-month adverse events. Post-duty-hours changes, there was an increase in the usage of beta-blockers (85.8% vs 93.8%, P Accreditation Council for Graduate Medical Education residency duty-hours restrictions on an academic inpatient cardiology service was associated with improved quality of care and efficiency in patients admitted with acute coronary syndrome. In addition, improved efficiency did not adversely impact patient outcomes, including mortality.
Allen-Dicker, Joshua; Herzig, Shoshana J; Mukamal, Kenneth J; Tess, Anjala
The Accreditation Council for Graduate Medical Education duty hour standards restrict continuous duty for postgraduate year (PGY)-1 residents to 16 hours. We aimed to assess the relationship between a duty hour-compliant schedule and resident sleep. To comply with 2011 duty hour limits, Beth Israel Deaconess Medical Center restructured its intensive care unit call model for internal medicine PGY-1 residents from a traditional shift model to an overlapping shorter-duration shift model with preserved educational periods. Before and after schedule changes, we used daily surveys of PGY-1 residents to collect self-reported data on quantity and quality of sleep and quality of education. A total of 1162 surveys were sent to 43 interns before scheduling changes, and 1305 were sent to 41 interns after the changes. Response rate was 31.2% (362 of 1161) before and 22.2% (290 of 1305) after. Before changes, 57.7% (209 of 362) reported receiving 6 hours or more of sleep in a 24-hour period compared to 72.4% (210 of 290) after the changes (adjusted relative risk, 1.33; 95% CI, 1.15-1.53), with an adjusted difference of 0.83 hours of sleep per 24 hours (95% CI, 0.28-1.38). After the intervention, on a 5-point Likert scale, residents reported higher quality of sleep (odds ratio [OR], 1.62; 95% CI, 1.01-2.60) and greater satisfaction with their education (OR, 2.59; 95% CI, 1.40-4.81). Following conversion to a duty hour-compliant model with preserved didactic time, PGY-1 residents reported minor increases in quantity and quality of sleep per 24-hour period, and increased satisfaction with the educational experience.
Bandiera, Glen; Hynes, Melissa Kennedy; Spadafora, Salvatore M
The potential impact of resident duty hour restrictions on faculty is likely significant; however, the extent of this impact has still not been well documented. We undertook a narrative review of the literature to determine the magnitude of that potential impact and the nature of the evolving discourse related to faculty members as individuals. The literature provides an inconsistent picture of the impact of duty hour restrictions on faculty. While some studies have reported a significant increase in faculty workload, others suggest that the impact of duty hour restrictions has been minimal. Some papers suggest that duty hour restrictions may fundamentally change the nature of resident-teacher interactions and, as a result, will necessitate significant changes to the way education is delivered. Overall, the majority of issues of concern relate to one of the following: volume and composition of work, impact on faculty career choice, evolving perceptions of residents as learners, and the need to find an appropriate balance between learning and the quality and quantity of patient care. In describing these themes we identify some potential solutions and future directions for reconciling duty hour restrictions with faculty perceptions, anxieties, and desired outcomes.
Levine, Rachel B.; Miller, Redonda G.; Ashar, Bimal H.; Bass, Eric B.; Rice, Tasha; Cofrancesco, Joseph
BACKGROUND Teaching faculty have valuable perspectives on the impact of residency duty hour regulations on medical students. OBJECTIVE The objective of this study was to elicit faculty views on the impact of residency duty hour regulations on medical students’ educational experience on inpatient medicine rotations. DESIGN AND PARTICIPANTS We conducted a National Survey of Key Clinical Faculty (KCF) at 40 internal medicine residency programs affiliated with U.S. medical schools using a random sample stratified by National Institutes of Health funding and program size. MEASUREMENTS This study measures KCF opinions on the effect of duty hour regulations on students’ education. RESULTS Of 154 KCF targeted, 111 responded (72%). Fifty-two percent of KCF reported worsening in the overall quality of students’ education compared to just 2.7% reporting improvement (p < 0.001). In multivariate analysis adjusted for gender, academic rank, specialty, and years of teaching experience, faculty who spent ≥15 hours per week teaching were more likely to report worsening in medical students’ level of responsibility on inpatient teams [odds ratio (OR) 3.1; 95% confidence interval (CI) 1.3–7.6], ability to follow patients throughout hospitalization (OR 3.2; 95% CI 1.3–7.9), ability to develop working relationships with residents (OR 2.3; 95% CI 1.0–5.2), and the overall quality of students’ education (OR 3.3; 95% CI 1.4–8.1) compared to faculty who spent less time teaching. CONCLUSION Key clincal faculty report concerns about the impact of duty hour regulations on aspects of medical students’ education in internal medicine. Medical schools and residency programs should identify ways to ensure optimal educational experiences for students within duty hour requirements. PMID:18612749
Full Text Available No abstract available. Article truncated after 150 words. On March 10, 2017, the Accreditation Council for Graduate Medical Education (ACGME announced revisions to its common program requirements related to duty hours (1. Effective on July 1, 2017, the most important change will be an increase in the maximum consecutive hours that an intern may work. Interns will now be able to continuously perform patient care work up to a maximum of 24 hours with an additional 4 hours for managing care transitions. This reverses the controversial reduction to 16 hours that occurred in 2011 (2. The regulation of house staff duty hours formally began in the late 1980s. It was precipitated largely because of the publicity resulting from the 1984 death of Libby Zion in a New York teaching hospital that was attributed partly to poor decisions made by fatigued and overworked house staff (3. Consequently, the state of New York in 1989 passed laws restricting the …
D'Sa, Viren A; High, Pamela C
This study assessed the structure of pediatric resident developmental behavioral pediatrics (DBP) rotations in the context of the Accreditation Council for Graduate Medical Education duty hour mandates. : We distributed an online survey addressing rotation structure, call schedule, and impact of the duty hour policy to resident DBP rotation directors in 114 of 204 pediatric residency programs in the United States and Canada and received responses from 81 programs (71% response rate). Seventy-five percent of respondents reported an average of 16% reduction in their DBP rotation after implementation of the Duty Hours rule in 2003. More programs having overnight calls during the rotation reported decreases versus those without overnight calls (91% vs 52%, p rotations. Attention may need to be given to the consequences for resident education in DBP.
O'Hagan, Anna Donnla; Issartel, Johann; Fletcher, Richard; Warrington, Giles
Working long duty hours has often been associated with increased risk of incidents and accidents in transport industries. Despite this, information regarding the intermediate relationship between duty hours and incident risk is limited. This study aimed to test a work hours/incident model to identify the interplay of factors contributing to incidents within the aviation industry. Nine hundred and fifty-four European-registered commercial airline pilots completed a 30-item survey investigating self-report attitudes and experiences of fatigue. Path analysis was used to test the proposed model. The fit indices indicated this to be a good fit model (χ(2) = 11.066, df = 5, p = 0.05; Comparative Fit Index = 0.991; Normed Fit Index = 0.984; Tucker-Lewis Index = 0.962; Root Mean Square of Approximation = 0.036). Highly significant relationships were identified between duty hours and sleep disturbance (r = 0.18, p < 0.001), sleep disturbance and fatigue in the cockpit (r = 0.40, p < 0.001), and fatigue in the cockpit and microsleeps in the cockpit (r = 0.43, p < 0.001). A critical pathway from duty hours through to self-reported incidents in flight was identified. Further investigation employing both objective and subjective measures of sleep and fatigue is needed.
Bush, Roger W; Philibert, Ingrid
Parsimony, and not industry, is the immediate cause of the increase of capital. Industry, indeed, provides the subject which parsimony accumulates. But whatever industry might acquire, if parsimony did not save and store up, the capital would never be the greater.Adam Smith, The Wealth of Nations, book 2, chapter 31In 2003, the Accreditation Council for Graduate Medical Education implemented resident duty hour limits that included a weekly limit and limits on continuous hours. Recent recommendations for added reductions in resident duty hours have produced concern about concomitant reductions in future graduates' preparedness for independent practice. The current debate about resident hours largely does not consider whether all hours residents spend in the educational and clinical-care environment contribute meaningfully either to residents' learning or to effective patient care. This may distract the community from waste in the current clinical-education model. We propose that use of "lean production" and quality improvement methods may assist teaching institutions in attaining a deeper understanding of work flow and waste. These methods can be used to assign value to patient- and learner-centered activities and outputs and to optimize the competing and synergistic aspects of all desired outcomes to produce the care the Institute of Medicine recommends: safe, effective, efficient, patient-centered, timely, and equitable. Finally, engagement of senior clinical faculty in determining the culture of the care and education system will contribute to an advanced social-learning and care network.
Jones, Arden M; Jones, Kevin B
The restriction of the resident physician work week to 80 hours has had dramatic affects on resident education and life-style. While effects on mood, psychological distress, and burn-out have been studied, the resultant changes in tangible quality of life have received little attention. Birth rate was considered a measurable, relevant outcome. The resident marital and parental status by duty month was collected from a single orthopaedic surgical residency program for the four academic years preceding and following the implementation of the 80-hour work week. The number of births to residents during these periods were also tallied. The relative prevalence of positive marital status changed very little between residents in the two time durations from 66 to 71 percent, but parental status increased from 27 to 43 percent. The number of births per married resident duty year also increased from 0.23 pre-restrictions to 0.32 post-restrictions. While the individual decisions involved in generating these observed changes are complex and difficult to entirely decipher, it is thought that an increased perception of life-control within the work-hour restrictions may have prompted the dramatic changes in birth rate among resident families.
Mirmehdi, Issa; O'Neal, Cindy-Marie; Moon, Davis; MacNew, Heather; Senkowski, Christopher
With the implementation of strict 80-hour work week in general surgery training, serious questions have been raised concerning the quality of surgical education and the ability of newly trained general surgeons to independently operate. Programs that were randomized to the interventional arm of the Flexibility In duty-hour Requirements for Surgical Trainees (FIRST) Trial were able to decrease transitions and allow for better continuity by virtue of less constraints on duty-hour rules. Using National Surgical Quality Improvement Program Quality In-Training Initiative data along with duty-hour violations compared with old rules, it was hypothesized that quality of care would be improved and outcomes would be equivalent or better than the traditional duty-hour rules. It was also hypothesized that resident perception of compliance with duty hour would not change with implementation of new regulations based on FIRST trial. Flexible work hours were implemented on July 1, 2014. National Surgical Quality Improvement Program Quality In-Training Initiative information was reviewed from July 2014 to January 2015. Patient risk factors and outcomes were compared between institutional resident cases and the national cohort for comparison. Residents' duty-hour logs and violations during this period were compared to the 6-month period before the implementation of the FIRST trial. The annual Accreditation Council for Graduate Medical Education resident survey was used to assess the residents' perception of compliance with duty hours. With respect to the postoperative complications, the only statistically significant measures were higher prevalence of pneumonia (3.4% vs. 1.5%, p < 0.05) and lower prevalence of sepsis (0% vs. 1.5%, p < 0.05) among cases covered by residents with flexible duty hours. All other measures of postoperative surgical complications showed no difference. The total number of duty-hour violations decreased from 54 to 16. Had the institution not been part of the
Friedlaender, Gary E
There is considerable concern and much evidence resident fatigue results in medical errors, some of which have serious consequences. Similarly, fatigue causes poor health in house-staff and places these individuals at greater risk for personal injuries, including motor vehicle accidents. These circumstances led the Accreditation Council on Graduate Medical Education to develop and, on July 1, 2003, to implement guidelines for all residency training programs limiting the time of in-house duty to 80 hours per week. Surveys of orthopaedic residents by the American Academy of Orthopaedic Surgeons, before and right after implementation of these new duty rules, confirm housestaff were working longer than 80 hours before July 2003 and are largely in compliance since that date. Residents generally approve of these changes and are personally happier, but also express concern for a loss of continuity of care and reduced exposure to operative cases. It remains to be demonstrated whether these new rules will improve patient care, enhance housestaff well-being, or influence education.
Chua, Kao-Ping; Gordon, Mary Beth; Sectish, Theodore; Landrigan, Christopher P
In 2009, Children's Hospital Boston implemented a night-team system on general pediatric wards to reduce extended work shifts. Residents worked 5 consecutive nights for 1 week and worked day shifts for the remainder of the rotation. Of note, resident staffing at night decreased under this system. The objective of this study was to assess the effects of this system on resident sleep and work hours. We conducted a prospective cohort study in which residents on the night-team system logged their sleep and work hours on work days. These data were compared with similar data collected in 2004, when there was a traditional call system. In 2004 and 2009, mean shift length was 15.22 ± 6.86 and 12.92 ± 5.70 hours, respectively (P = .161). Daily work hours were 10.49 ± 6.85 and 8.79 ± 6.42 hours, respectively (P = .08). Nightly sleep time decreased from 6.72 ± 2.60 to 4.77 ± 2.46 hours (P team system was unexpectedly associated with decreased sleep hours. As residency programs create work schedules that are compliant with the 2011 Accreditation Council for Graduate Medical Education duty-hour standards, resident sleep should be monitored carefully.
Fang, Z Amy; Hudson, Darren
Residents are a significant part of coverage in many hospitals. Resident associations are negotiating work hour limits to prevent fatigue-induced medical errors. Our intensive care unit experienced an unexpected resident shortage and used the opportunity to trial a shift schedule for one month. Post-surveys were sent to nurses, attending physicians and residents to evaluate the effects on staff interactions, patient safety and education quality. The trial was clearly a failure on all fronts. Work hour restrictions are a reality in medical education, and administrators need to start considering alternative staffing models and discussing alternative schedules with their medicine faculty.
Full Text Available No abstract available. Article truncated after 150 words. The Accreditation Council for Graduate Medical Education (ACGME is proposing that first-year residents would no longer be limited to 16-hour shifts during the 2017-2018 academic year under a controversial proposal released today (1. Instead, individual residency programs could assign first-year trainees to shifts as long as 28 hours, the current limit for all other residents. The 28-hour maximum includes 4 transitional hours that's designed in part to help residents improve continuity of care. The plan to revise training requirements does not change other rules designed to protect all residents from overwork. including the maximum80 hours per week. The ACGME capped the shifts of first-year residents at 16 hours in 2011 as a part of an ongoing effort to make trainee schedules more humane and avoid clinical errors caused by sleep deprivation. ACGME CEO Thomas Nasca, MD, told Medscape Medical News that the problem arises largely from first-year residents not being ...
Maloney, Christopher G; Antommaria, Armand H Matheny; Bale, James F; Ying, Jian; Greene, Tom; Srivastava, Rajendu
In 2003 the Accreditation Council for Graduate Medical Education mandated work hour restrictions. Violations can results in a residency program being cited or placed on probation. Recurrent violations could results in loss of accreditation. We wanted to determine specific intern and workload factors associated with violation of a specific mandate, the 30-hour duty period requirement. Retrospective review of interns' performance against the 30-hour duty period requirement during inpatient ward rotations at a pediatric residency program between June 24, 2008 and June 23, 2009. The analytical plan included both univariate and multivariable logistic regression analyses. Twenty of the 26 (77%) interns had 80 self-reported episodes of continuous work hours greater than 30 hours. In multivariable analysis, noncompliance was inversely associated with the number of prior inpatient rotations (odds ratio: 0.49, 95% confidence interval (0.38, 0.64) per rotation) but directly associated with the total number of patients (odds ratio: 1.30 (1.10, 1.53) per additional patient). The number of admissions on-call, number of admissions after midnight and number of discharges post-call were not significantly associated with noncompliance. The level of noncompliance also varied significantly between interns after accounting for intern experience and workload factors. Subject to limitations in statistical power, we were unable to identify specific intern characteristics, such as demographic variables or examination scores, which account for the variation in noncompliance between interns. Both intern and workload factors were associated with pediatric intern noncompliance with the 30-hour duty period requirement during inpatient ward rotations. Residency programs must develop information systems to understand the individual and experience factors associated with noncompliance and implement appropriate interventions to ensure compliance with the duty hour regulations.
Kocolas, Irene; Day, Kristen; King, Marta; Stevenson, Adam; Sheng, Xiaoming; Hobson, Wendy; Bruse, Jaime; Bale, James
The effects of 2011 Accreditation Council on Graduate Medical Education (ACGME) duty hour standards on intern work hours, patient load, conference attendance, and sleep have not been fully determined. We prospectively compared intern work hours, patient numbers, conference attendance, sleep duration, pattern, and quality in a 2011 ACGME duty hour-compliant shift schedule with a 2003 ACGME duty hour-compliant call schedule at a single pediatric residency program. Interns were assigned to shift or call schedules during 4 alternate months in the winter of 2010-2011. Work hours, patient numbers, conference attendance, sleep duration, pattern, and quality were tracked. Interns worked significantly fewer hours per week on day (73.2 hours) or night (71.6 hours) shifts than during q4 call (79.6 hours; P interns cared for significantly more patients/day (8.1/day shift vs 6.2/call; P interns. Night shift interns slept more hours per 24-hour period than call schedule interns (7.2 ± 0.5 vs 6.3 ± 0.9 hours; P intern work hours and improved sleep duration and pattern. Although intern didactic conference attendance declined significantly during high census months, opportunities for experiential learning remained robust with unchanged or increased intern patient numbers. Copyright © 2016 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.
Harris, Joshua D; Staheli, Greg; LeClere, Lance; Andersone, Diana; McCormick, Frank
More than 15 years ago, the Institute of Medicine (IOM) identified medical error as a problem worthy of greater attention; in the wake of the IOM report, numerous changes were made to regulations to limit residents' duty hours. However, the effect of resident work-hour changes remains controversial within the field of orthopaedics. We performed a systematic review to determine whether work-hour restrictions have measurably influenced quality-of-life measures, operative and technical skill development, resident surgical education, patient care outcomes (including mortality, morbidity, adverse events, sentinel events, complications), and surgeon and resident attitudes (such as perceived effect on learning and training experiences, personal benefit, direct clinical experience, clinical preparedness). We performed a systematic review of PubMed, Scopus, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and Google Scholar using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Inclusion criteria were any English language peer-reviewed articles that analyzed the effect(s) of orthopaedic surgery resident work-hour restrictions on patient safety, resident education, resident/surgeon quality of life, resident technical operative skill development, and resident surgeon attitudes toward work-hour restrictions. Eleven studies met study inclusion criteria. One study was a prospective analysis, whereas 10 studies were of level IV evidence (review of surgical case logs) or survey results. Within our identified studies, there was some support for improved resident quality of life, improved resident sleep and less fatigue, a perceived negative impact on surgical operative and technical skill, and conflicting evidence on the topic of resident education, patient outcomes, and variable attitudes toward the work-hour changes. There is a paucity of high-level or clear evidence evaluating the effect of the changes to resident work
Kellogg, Katherine C; Breen, Elizabeth; Ferzoco, Stephen J; Zinner, Michael J; Ashley, Stanley W
Although the practical challenges to work hour restrictions have been the focus of much discussion, cultural resistance to such change has received less attention. Surgical residency has its own unique social structure, and we hypothesized that challenges to this would provide impediments to successful implementation of duty hours reform. We used ethnographic research methods to study the efforts at work hour restriction over a 15-month period before the introduction of the Accreditation Council for Graduate Medical Education regulations. These methods, validated for studying institutional change, build on intense periods of observation. Records of observations are then analyzed and coded to uncover cultural and political challenges. The frequency of successful hand-offs in sign-out situations between day and night float residents was measured as an objective index of success. Practical issues were addressed initially by scheduling adjustments including creating a night float system. The hand-offs that this system required, however, were successful only 14% of the time. Subsequent steps to address the challenge to resident identity by top-down support of a new definition of professionalism increased the number of successful hand-offs to 39%. Finally, a reduction in a noted hierarchy violation led to successful hand-offs 79% of the time. These results demonstrate that practical solutions alone may not be a sufficient basis for change in surgical residency. While we face other challenges to the traditional surgical culture, attention to social and political issues may enhance the success of our efforts.
Blum, Alexander B; Shea, Sandra; Czeisler, Charles A; Landrigan, Christopher P; Leape, Lucian
Long working hours and sleep deprivation have been a facet of physician training in the US since the advent of the modern residency system. However, the scientific evidence linking fatigue with deficits in human performance, accidents and errors in industries from aeronautics to medicine, nuclear power, and transportation has mounted over the last 40 years. This evidence has also spawned regulations to help ensure public safety across safety-sensitive industries, with the notable exception of medicine. In late 2007, at the behest of the US Congress, the Institute of Medicine embarked on a year-long examination of the scientific evidence linking resident physician sleep deprivation with clinical performance deficits and medical errors. The Institute of Medicine's report, entitled "Resident duty hours: Enhancing sleep, supervision and safety", published in January 2009, recommended new limits on resident physician work hours and workload, increased supervision, a heightened focus on resident physician safety, training in structured handovers and quality improvement, more rigorous external oversight of work hours and other aspects of residency training, and the identification of expanded funding sources necessary to implement the recommended reforms successfully and protect the public and resident physicians themselves from preventable harm. Given that resident physicians comprise almost a quarter of all physicians who work in hospitals, and that taxpayers, through Medicare and Medicaid, fund graduate medical education, the public has a deep investment in physician training. Patients expect to receive safe, high-quality care in the nation's teaching hospitals. Because it is their safety that is at issue, their voices should be central in policy decisions affecting patient safety. It is likewise important to integrate the perspectives of resident physicians, policy makers, and other constituencies in designing new policies. However, since its release, discussion of the
Dennis, Bradley M; Long, Eric L; Zamperini, Katherine M; Nakayama, Don K
To observe the effects of the 2011 Accreditation Council on Graduate Medical Education 16-hour intern workday restrictions on surgical residents' clinical and educational activities. All the residents recorded the following weekly in-hospital activities during February and March 2011 (year before intern work restrictions) and 2012 (first year under new requirements): operating room (OR) and clinic; bedside procedures; rounds and ward work; on-call duties in hospital; communication (e.g., checkouts and family and patient discussions); education (conferences and study); and personal (rest and meals). Descriptive statistics were calculated in 3 resident groups (interns, first postgraduate year [PGY1]; junior, PGY2 and 3; and senior, PGY4 and 5). The unpaired t test was used to compare data between 2011 and 2012; significance was set at pintern did not change (all results in h/wk, mean±standard deviation: 68.5±13.8 to 72.8±15.8, respectively) but the time devoted to specific activities changed significantly. In-hospital personal time decreased by 50% (5.3±4.6 to 2.6±2.0, p = 0.004). Interns spent less time placing central lines (2.1±2.2 to 0.9±1.2, p = 0.006) and more on rounds (8.8±8.8 to 14.2±9.8, p = 0.027), which included supervision with upper level residents. There was no change in the total time spent in the OR, the clinic, performing bedside procedures, and educational activities. Changes in intern work did not affect the time junior and senior residents spent on bedside procedures, time spent in the clinic, and total time spent in the hospital. In 2012, junior residents spent less time in educational activities (11.4±8.5 to 7.0±4.5, p = 0.0007) and the seniors spent more time in the OR (13.7±7.5 to 20.6±10.7, p = 0.0002). The 16-hour restriction preserved interns' educational activities and time spent in the OR and clinic, but changed resident work activities at all levels. The time spent on rounds increased, time spent by the juniors on
... 25 Indians 2 2010-04-01 2010-04-01 false Consuming intoxicants on Government premises or during duty hours. 700.547 Section 700.547 Indians THE OFFICE OF NAVAJO AND HOPI INDIAN RELOCATION COMMISSION OPERATIONS AND RELOCATION PROCEDURES Employee Responsibility and Conduct § 700.547 Consuming intoxicants on...
Background In 2003 the Accreditation Council for Graduate Medical Education mandated work hour restrictions. Violations can results in a residency program being cited or placed on probation. Recurrent violations could results in loss of accreditation. We wanted to determine specific intern and workload factors associated with violation of a specific mandate, the 30-hour duty period requirement. Methods Retrospective review of interns’ performance against the 30-hour duty period requirement during inpatient ward rotations at a pediatric residency program between June 24, 2008 and June 23, 2009. The analytical plan included both univariate and multivariable logistic regression analyses. Results Twenty of the 26 (77%) interns had 80 self-reported episodes of continuous work hours greater than 30 hours. In multivariable analysis, noncompliance was inversely associated with the number of prior inpatient rotations (odds ratio: 0.49, 95% confidence interval (0.38, 0.64) per rotation) but directly associated with the total number of patients (odds ratio: 1.30 (1.10, 1.53) per additional patient). The number of admissions on-call, number of admissions after midnight and number of discharges post-call were not significantly associated with noncompliance. The level of noncompliance also varied significantly between interns after accounting for intern experience and workload factors. Subject to limitations in statistical power, we were unable to identify specific intern characteristics, such as demographic variables or examination scores, which account for the variation in noncompliance between interns. Conclusions Both intern and workload factors were associated with pediatric intern noncompliance with the 30-hour duty period requirement during inpatient ward rotations. Residency programs must develop information systems to understand the individual and experience factors associated with noncompliance and implement appropriate interventions to ensure compliance with the
Blum, Alexander B; Shea, Sandra; Czeisler, Charles A; Landrigan, Christopher P; Leape, Lucian
Long working hours and sleep deprivation have been a facet of physician training in the US since the advent of the modern residency system. However, the scientific evidence linking fatigue with deficits in human performance, accidents and errors in industries from aeronautics to medicine, nuclear power, and transportation has mounted over the last 40 years. This evidence has also spawned regulations to help ensure public safety across safety-sensitive industries, with the notable exception of medicine. In late 2007, at the behest of the US Congress, the Institute of Medicine embarked on a year-long examination of the scientific evidence linking resident physician sleep deprivation with clinical performance deficits and medical errors. The Institute of Medicine’s report, entitled “Resident duty hours: Enhancing sleep, supervision and safety”, published in January 2009, recommended new limits on resident physician work hours and workload, increased supervision, a heightened focus on resident physician safety, training in structured handovers and quality improvement, more rigorous external oversight of work hours and other aspects of residency training, and the identification of expanded funding sources necessary to implement the recommended reforms successfully and protect the public and resident physicians themselves from preventable harm. Given that resident physicians comprise almost a quarter of all physicians who work in hospitals, and that taxpayers, through Medicare and Medicaid, fund graduate medical education, the public has a deep investment in physician training. Patients expect to receive safe, high-quality care in the nation’s teaching hospitals. Because it is their safety that is at issue, their voices should be central in policy decisions affecting patient safety. It is likewise important to integrate the perspectives of resident physicians, policy makers, and other constituencies in designing new policies. However, since its release
Quillin, Ralph C; Cortez, Alexander R; Pritts, Timothy A; Hanseman, Dennis J; Edwards, Michael J; Davis, Bradley R
The Accreditation Council for Graduate Medical Education instituted the 80-h workweek for residency programs in 2003. This presented a unique challenge for surgery residents who must acquire a medical and technical knowledge base during training. Therefore, learning should be delivered in an environment congruent with an individual's learning style. In this study, we evaluated the learning styles of general surgery residents to determine how learning styles changed after the implementation to the 80-h workweek. Kolb learning style inventory was taken by general surgery residents at the University of Cincinnati's Department of Surgery, and results from 1999-2012 were analyzed. Statistical analysis was performed using the chi-squared, logistic regression and Wilcoxon rank-sum test. Significance was defined as a P value of learning styles after the institution of the 80-h workweek to converging (43.9%) and accommodating (40.4%, P learning. This change paralleled the transition to a more team-based approach to patient care with the implementation of the 80-h workweek. These findings are important for surgical educators to consider in the development of surgical resident curriculum. Copyright © 2016 Elsevier Inc. All rights reserved.
Martini, Shahm; Arfken, Cynthia L.; Balon, Richard
Objective: The authors assess whether implementation of work hour limits is associated with a lower prevalence of medical resident burnout. Method: A survey was mailed to medical residents in different medical specialties at one university. Results: Somewhat lower burnout prevalence was reported among residents after implementation of work hour…
Martini, Shahm; Arfken, Cynthia L.; Balon, Richard
Objective: The authors assess whether implementation of work hour limits is associated with a lower prevalence of medical resident burnout. Method: A survey was mailed to medical residents in different medical specialties at one university. Results: Somewhat lower burnout prevalence was reported among residents after implementation of work hour…
Kiernan, Michael; Civetta, Joseph; Bartus, Christine; Walsh, Stephen
Studies in on-call residents have shown that mood is worsened by fatigue as indicated by increased scores on measures of depression, anxiety, confusion, and anger using the Profile of Mood States (POMS). In prior sleep deprivation studies, mood has been shown to be more affected than either cognitive or motor performances. The purpose of this study was to examine the effect of the 80-hour work week regulations on resident mood in general and in a post-call period (PC). Institutional Review Board approval was obtained to survey the residents and publish the results. POMS is a 65-item adjective questionnaire that includes subscales for measuring tension-anxiety, anger-hostility, depression-dejection, vigor-activity, fatigue-inertia, and confusion-bewilderment, with the summation of the scales forming a total mood disturbance score. Surgical residents were tested at a 9 am didactic curriculum session (9 am has been shown to correlate with the nadir of performance). Residents were tested after nights off call (NOC) or after PC. Time asleep in the preceding 24 hours and other demographic data were also collected. Acute fatigue (AF) was defined as mood questionnaires were administered on 4 occasions to 51 surgical residents, 35 men and 16 women at levels PGY-1 through PGY-5. Overall, 33 tests (27%) were taken after PC and 90 (73%) were taken after NOC. Acute fatigue residents had a mean sleep time of 2.2 (+/-1.5) hours, whereas rested (R) residents had a mean sleep time of 6.7 (+/-2.2) hours (whether PC or NOC). No statistical differences in mean values of vigor, anger, depression, concentration, fatigue, tension, or total score were observed between PC and NOC or between AF and R residents. There was no significant relationship between acute sleep deprivation and total mood disturbance, whether PC or NOC. In linear relationships, NOC total score and hours slept had r2 = 0.01 (p = 0.44), whereas PC total score and hours slept had r2 = 0.07 (p = 0.14). Although POMS was
Full Text Available Abstract Background In both Europe and the US, resident physician work hour reduction has been a source of controversy within academic medicine. In 2008, the Institute of Medicine (IOM recommended a reduction in resident physician work hours. We sought to assess the American public perspective on this issue. Methods We conducted a national survey of 1,200 representative members of the public via random digit telephone dialing in order to describe US public opinion on resident physician work hour regulation, particularly with reference to the IOM recommendations. Results Respondents estimated that resident physicians currently work 12.9-h shifts (95% CI 12.5 to 13.3 h and 58.3-h work weeks (95% CI 57.3 to 59.3 h. They believed the maximum shift duration should be 10.9 h (95% CI 10.6 to 11.3 h and the maximum work week should be 50 h (95% CI 49.4 to 50.8 h, with 1% approving of shifts lasting >24 h (95% CI 0.6% to 2%. A total of 81% (95% CI 79% to 84% believed reducing resident physician work hours would be very or somewhat effective in reducing medical errors, and 68% (95% CI 65% to 71% favored the IOM proposal that resident physicians not work more than 16 h over an alternative IOM proposal permitting 30-h shifts with ≥5 h protected sleep time. In all, 81% believed patients should be informed if a treating resident physician had been working for >24 h and 80% (95% CI 78% to 83% would then want a different doctor. Conclusions The American public overwhelmingly favors discontinuation of the 30-h shifts without protected sleep routinely worked by US resident physicians and strongly supports implementation of restrictions on resident physician work hours that are as strict, or stricter, than those proposed by the IOM. Strong support exists to restrict resident physicians' work to 16 or fewer consecutive hours, similar to current limits in New Zealand, the UK and the rest of Europe.
Landesman, Linda Young; Markowitz, Forest; Conde, Nelson
The limitation of medical intern and resident work hours, known as the Bell 405 regulations, was initiated in New York State in 1989 with a modification to the state hospital code. The Bell 405 regulations were strengthened in 2000, and facilities would now be fined for noncompliance. Monitoring systems in place at that time were insufficient to provide an adequate level of review for the New York City Health and Hospitals Corporation (HHC) with more than 7,000 medical residents whose training is based at or who rotate through these public hospitals. A "simple to use," yet comprehensive, method of monitoring compliance needed to be developed to ensure that residents and interns complied with laws regulating working hours. The subsequent development of national accreditation standards increased the stakes for reliable scrutiny. HHC developed and implemented a Web-based Structured Query Language (SQL) application that facilitated easy access to work hour surveys captured through electronic time sheets. The time sheet data automatically entered a database that provided instant analysis of conformance to state law. The development of an electronic on-line application accessible from anywhere allowed HHC to efficiently identify nonconformance and pinpoint corrective action. Since the inception of the application and its expansion allowing access through the intranet, 26,000 individual time sheets have been submitted for evaluation. With the national movement regulating work hours, other hospitals still at the pencil and manual computation stage would greatly benefit by developing a similar application.
DeBlasio, Dominick; Kerrey, M Kathleen; Sucharew, Heidi; Klein, Melissa
To determine if implementing an educationally minded schedule utilizing consecutive night shifts can moderate the impact of the 2011 duty hour standards on education and patient continuity of care in longitudinal primary care experience (continuity clinic). A 14-month pre-post study was performed in continuity clinic with one supervising physician group and two intern groups. Surveys to assess attitudes and education were distributed to the supervising physicians and interns before and after the changes in duty hour standards. Intern groups' schedules were reviewed for the number of regular and alternative day clinic (i.e. primary care experience on a different weekday) sessions and patient continuity of care. Fifteen supervising physicians and 51 interns participated (25 in 2011, 26 in 2012). Intern groups' comfort when discussing patient issues, educational needs and teamwork perception did not differ. Supervising physicians' understanding of learning needs and provision of feedback did not differ between groups. Supervising physicians indicated a greater ability to provide feedback and understand learning needs during regular continuity clinic sessions compared with alternative day clinics (all p intern groups in the number of regularly scheduled continuity clinics, alternative day clinics or patient continuity of care. The 2011 duty hour standards required significant alterations to intern schedules, but educationally minded scheduling limited impact on education and patient continuity in care.
Implementation of an intern boot camp curriculum to address clinical competencies under the new Accreditation Council for Graduate Medical Education supervision requirements and duty hour restrictions.
Krajewski, Aleksandra; Filippa, Dawn; Staff, Ilene; Singh, Rekha; Kirton, Orlando C
Today's general surgery interns are faced with increased duty hour restrictions and stringent competency-based supervision milestone requirements (ie, from direct to indirect supervision). Working within these constraints, we instituted a unique 2-month intern curriculum (boot camp) incorporating knowledge-based, experiential, and practical components. To describe our curriculum and the effect on resident performance and teaching faculty and nursing staff perceptions. All interns underwent a 2-month (July and August 2011) boot camp curriculum consisting of two 2½-hour knowledge-based and procedural skills (SimMan) didactic sessions per week and completion of 25 core intensive introductory American College of Surgeons Fundamentals of Surgery web-based self-study modules, followed by a standardized patient clinical skills assessment. Integrated general surgery residency program at the University of Connecticut School of Medicine, Farmington. Postgraduate year 1 general surgery categorical and preliminary residents. We used several assessment tools, including an intern boot camp survey, clinical skills assessment scores, intern American Board of Surgeons In-Training Examination scores, and nursing staff and teaching faculty surveys of intern performance and aptitudes compared with the previous year's interns. Data were analyzed by independent group t test, χ2 tests of proportions, and Fisher exact test for small sample cross tables. In total, 84% (91 of 108) of intern respondents agreed or strongly agreed with the usefulness, relevance, and execution of the boot camp. Compared with the previous year's interns, the nursing staff agreed or strongly agreed that the cohort interns were better at patient assessment, collaboration, and effective communication and provided compassionate and respectful patient care. More than 40% (7 of 17) of surveyed teaching faculty agreed or strongly agreed that the cohort interns demonstrated better patient care and procedural skills
Blum AB; Shea S; Czeisler CA; Landrigan CP; Leape L
Long working hours and sleep deprivation have been a facet of physician training in the US since the advent of the modern residency system. However, the scientific evidence linking fatigue with deficits in human performance, accidents and errors in industries from aeronautics to medicine, nuclear power, and transportation has mounted over the last 40 years. This evidence has also spawned regulations to help ensure public safety across safety-sensitive industries, with the notable exception of...
McElearney, Shannon Tierney; Saalwachter, Alison R; Hedrick, Traci L; Pruett, Timothy L; Sanfey, Hilary A; Sawyer, Robert G
The Accreditation Council for Graduate Medical Education (ACGME) implemented mandatory work week hours restrictions in 2003. Due to the traditionally long hours in general surgery, the effect of restrictions on surgical training and case numbers was a matter of concern. Data was compiled retrospectively from ACGME logs and operating room (OR) records at a university hospital for 2002 and 2003. Work week restrictions began in January 2003. This data was reviewed to determine resident case numbers, both in whole and by postgraduate year (PGY). Mean case numbers per resident-month in 2002 were 8.8 +/- 8.2 for PGY1s, 16.2 +/- 15.7 for PGY2s, 31.4 +/- 12.9 for PGY3s, 31.5 +/- 17.6 for PGY4s, and 31.5 +/- 17.6 for PGY5s. In 2003, they were 8.8 +/- 5.2 for PGY1s, 16.6 +/- 13.9 for PGY2s, 27.8 +/- 12.5 for PGY3s, 38.2 +/- 18.8 for PGY4s, and 26.1 +/- 9.6 for PGY5s. PGY1s, PGY2s, PGY3s, PGY4s, or all classes were not statistically different. PGY5s did have statistically fewer cases in 2003 (P = 0.03). PGY5s did have statistically fewer cases after the work-hours restriction, which likely represented shifting of postcall afternoon cases to other residents. Comparing other classes and all PGYs, case numbers were not statistically different. Operative training experience does not appear to be hindered by the 80-hour work week.
Full Text Available Alexander B Blum1, Sandra Shea2, Charles A Czeisler3,4, Christopher P Landrigan3-5, Lucian Leape61Department of Health and Evidence Policy, Mount Sinai School of Medicine, New York, NY, USA; 2Committee of Interns and Residents, SEIU Healthcare Division, Service Employees International Union, New York, NY, USA; 3Harvard Work Hours, Health and Safety Group, Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA; 4Division of Sleep Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; 5Division of General Pediatrics, Department of Medicine, Children's Hospital Boston, Harvard Medical School, Boston, MA, USA; 6Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, USAAbstract: Long working hours and sleep deprivation have been a facet of physician training in the US since the advent of the modern residency system. However, the scientific evidence linking fatigue with deficits in human performance, accidents and errors in industries from aeronautics to medicine, nuclear power, and transportation has mounted over the last 40 years. This evidence has also spawned regulations to help ensure public safety across safety-sensitive industries, with the notable exception of medicine.
Ruutiainen, Alexander T; Durand, Daniel J; Scanlon, Mary H; Itri, Jason N
To determine if the rate of major discrepancies between resident preliminary reports and faculty final reports increases during the final hours of consecutive 12-hour overnight call shifts. Institutional review board exemption status was obtained for this study. All overnight radiology reports interpreted by residents on-call between January 2010 and June 2010 were reviewed by board-certified faculty and categorized as major discrepancies if they contained a change in interpretation with the potential to impact patient management or outcome. Initial determination of a major discrepancy was at the discretion of individual faculty radiologists based on this general definition. Studies categorized as major discrepancies were secondarily reviewed by the residency program director (M.H.S.) to ensure consistent application of the major discrepancy designation. Multiple variables associated with each report were collected and analyzed, including the time of preliminary interpretation, time into shift study was interpreted, volume of studies interpreted during each shift, day of the week, patient location (inpatient or emergency department), block of shift (2-hour blocks for 12-hour shifts), imaging modality, patient age and gender, resident identification, and faculty identification. Univariate risk factor analysis was performed to determine the optimal data format of each variable (ie, continuous versus categorical). A multivariate logistic regression model was then constructed to account for confounding between variables and identify independent risk factors for major discrepancies. We analyzed 8062 preliminary resident reports with 79 major discrepancies (1.0%). There was a statistically significant increase in major discrepancy rate during the final 2 hours of consecutive 12-hour call shifts. Multivariate analysis confirmed that interpretation during the last 2 hours of 12-hour call shifts (odds ratio (OR) 1.94, 95% confidence interval (CI) 1.18-3.21), cross
Sedney, Cara L; Spirou, Eleni; Voelker, Joseph L; Rosen, Charles L
Resident education in the United States and elsewhere has required significant changes in recent years due to work hour restrictions, requiring didactics to fit within a limited schedule while being increasingly effective at accomplishing educational goals. Compounding these changes are an altered clinical milieu and generational changes among learners. Residents can be exposed to both clinical material and specialty-specific mores utilizing focused mentorship, curricula for intangibles, asynchronous education, and independent curricula. Copyright © 2017. Published by Elsevier Inc.
Wong, Jeffrey G.; Holmboe, Eric S; Huot, Stephen J.
The 80-hour workweek limit for residents provides an opportunity for residency directors to creatively innovate their programs. Our novel day-float rotation augmented both the educational structure within the inpatient team setting and the ability for house staff to complete their work within the mandated limits. Descriptive evaluation of the rotation was performed through an end-of-rotation questionnaire. The average length of the ward residents’ work week was quantified before and after the...
DeStigter, Kristen K; Mainiero, Martha B; Janower, Murray L; Resnik, Charles S
Historically, diagnostic radiology residents have been allowed time off from clinical duties to study for the ABR oral board examination. This practice has resulted in a disruptive "board frenzy" at many programs. The new ABR examination structure gives programs an opportunity to evaluate this practice. This position statement of the Association of Program Directors in Radiology describes the rationale behind a recommendation of no time off from clinical service before the ABR core examination.
This paper uses a two-year panel dataset on hospitals from the American Hospital Association (AHA) to evaluate the effect a policy change has on the marginal product of medical residents. A weighted 2SLS approach is used to estimate a semi-parametric production function. A policy restricting medical residents to work no more than 80 hours a week is found to result in a net loss of 14 inpatient days per resident annually, which is not statistically different from zero. In addition, the mode...
This paper uses a two-year panel dataset on hospitals from the American Hospital Association (AHA) to evaluate the effect a policy change has on the marginal product of medical residents. A weighted 2SLS approach is used to estimate a semi-parametric production function. A policy restricting medical residents to work no more than 80 hours a week is found to result in a net loss of 14 inpatient days per resident annually, which is not statistically different from zero. In addition, the model p...
Wolfrom, Brent; Hodgetts, Geoff; Kotecha, Jyoti; Pollock, Emily; Martin, Mary; Han, Han; Morissette, Pierre
To evaluate satisfaction with civilian residency training programs among serving general duty medical officers within the Canadian Armed Forces. A 23-item, cross-sectional survey face-validated by the office of the Surgeon General of the Canadian Armed Forces. Canada. General duty medical officers serving in the Canadian Armed Forces as of February 2014 identified through the Directorate of Health Services Personnel of the Canadian Forces Health Services Group Headquarters. Satisfaction with and time spent in 7 domains of training: trauma, critical care, emergency medicine, psychiatry, occupational health, sports medicine, and base clinic training. Overall preparedness for leading a health care team, caring for a military population, working in isolated and challenging environments, and being deployed were evaluated on a 5-point Likert scale. Among the survey respondents (n = 135, response rate 54%), 77% agreed or strongly agreed that their family medicine residency training was relevant to their role as a general duty medical officer. Most respondents were either satisfied or very satisfied with their emergency medicine training (77%) and psychiatry training (63%), while fewer were satisfied or very satisfied with their sports medicine (47%), base clinic (41%), and critical care (43%) training. Even fewer respondents were satisfied or very satisfied with their trauma (26%) and occupational health (12%) training. Regarding overall preparedness, 57% believed that they were adequately prepared to care for a military patient population, and 52% of respondents believed they were prepared for their first posting. Fewer respondents (38%) believed they were prepared to work in isolated, austere, or challenging environments, and even fewer (32%) believed that residency training prepared them to lead a health care team. General duty medical officers were satisfied with many aspects of their family medicine residency training; however, military-specific areas for improvement
Jack, Megan C; Kenkare, Sonya B; Saville, Benjamin R; Beidler, Stephanie K; Saba, Sam C; West, Alisha N; Hanemann, Michael S; van Aalst, John A
Faced with work-hour restrictions, educators are mandated to improve the efficiency of resident and medical student education. Few studies have assessed learning styles in medicine; none have compared teaching and learning preferences. Validated tools exist to study these deficiencies. Kolb describes 4 learning styles: converging (practical), diverging (imaginative), assimilating (inductive), and accommodating (active). Grasha Teaching Styles are categorized into "clusters": 1 (teacher-centered, knowledge acquisition), 2 (teacher-centered, role modeling), 3 (student-centered, problem-solving), and 4 (student-centered, facilitative). Kolb's Learning Style Inventory (HayGroup, Philadelphia, Pennsylvania) and Grasha-Riechmann's TSS were administered to surgical faculty (n = 61), residents (n = 96), and medical students (n = 183) at a tertiary academic medical center, after informed consent was obtained (IRB # 06-0612). Statistical analysis was performed using χ(2) and Fisher exact tests. Surgical residents preferred active learning (p = 0.053), whereas faculty preferred reflective learning (p teaching preferences, although both groups preferred student-centered, facilitative teaching, faculty preferred teacher-centered, role-modeling instruction (p = 0.02) more often. Residents had no dominant teaching style more often than surgical faculty (p = 0.01). Medical students preferred converging learning (42%) and cluster 4 teaching (35%). Statistical significance was unchanged when corrected for gender, resident training level, and subspecialization. Significant differences exist between faculty and residents in both learning and teaching preferences; this finding suggests inefficiency in resident education, as previous research suggests that learning styles parallel teaching styles. Absence of a predominant teaching style in residents suggests these individuals are learning to be teachers. The adaptation of faculty teaching methods to account for variations in resident
Schroeppel, Thomas J; Sharpe, John P; Magnotti, Louis J; Weinberg, Jordan A; Croce, Martin A; Fabian, Timothy C
Work-hour restrictions were amended in 2011 to limit interns to 16 continuous duty hours, essentially requiring a night float system of 12-hour shifts. We hypothesize that there has been no improvement in outcomes after implementation of the amended work-hour restrictions. Outcomes from trauma admissions were queried from the trauma registry from 2009 to 2011 (PRE) and 2011 to 2013 (POST). The primary outcome was mortality with secondary outcomes intensive care unit length of stay (LOS)and LOS. Patients were stratified based on age, mechanism, gender, blood pressure, heart rate, and injury severity (Injury Severity Score, Glasgow Coma Scale, Base Deficit). Outcomes were then compared from admissions PRE to POST. A total of 9178 patients were included in the study population. The mean age was 42 with most being male (72%) and blunt mechanism (81%). Patient populations were well matched except patients in the POST period were slightly older (43 vs 42 years; P = 0.01). Intensive care unit LOS and LOS were higher in the POST period. After adjusted analysis, admission in the POST period was not a predictor of mortality (odds ratio 0.857; confidence interval 0.655-1.12). The POST period was an independent predictor for LOS (β = 0.74; P = 0.002). This study adds to the mounting evidence that the implementation of the amended limits on work hours leads to furthermore decreased efficiency of care.
were asked to log the timing of significant daily activities. Significant entries included bedtimes, wake-up times, mealtimes , exercise periods, and...strategies to cope with the rapid transition from daytime to nighttime duty hours. In the case of IPs, social and family situations were expected to...comparisons were of less interest because IPs were expected to experience different family conditions, possibly helping night shift adaptations in some
van Weert, J.; van Dulmen, S.; Bensing, J.
Dementia among nursing home residents is oftenaccompanied by behavioural disturbances and high caredependency. Multi-Sensory Stimulation or snoezelen,integrated in 24-h dementia care, is an approach thatmight improve mood and behaviour of demented elderlyas well as the quality of working life of dem
Weert, J. van; Dulmen, S. van; Bensing, J.
Dementia among nursing home residents is oftenaccompanied by behavioural disturbances and high caredependency. Multi-Sensory Stimulation or snoezelen,integrated in 24-h dementia care, is an approach thatmight improve mood and behaviour of demented elderlyas well as the quality of working life of dem
... commercial motor vehicle programs and safety regulation. Background On April 4, 1997 (62 FR 16370), the... FR 16422): Question 2: What conditions must be met for a Commercial Motor Vehicle (CMV) driver to... Drivers; Regulatory Guidance Concerning Off-Duty Time AGENCY: Federal Motor Carrier Safety...
Obi, Andrea; Chung, Jennifer; Chen, Ryan; Lin, Wandi; Sun, Siyuan; Pozehl, William; Cohn, Amy M; Daskin, Mark S; Seagull, F Jacob; Reddy, Rishindra M
Certain operative cases occur unpredictably and/or have long operative times, creating a conflict between Accreditation Council for Graduate Medical Education (ACGME) rules and adequate training experience. A ProModel-based simulation was developed based on historical data. Probabilistic distributions of operative time calculated and combined with an ACGME compliant call schedule. For the advanced surgical cases modeled (cardiothoracic transplants), 80-hour violations were 6.07% and the minimum number of days off was violated 22.50%. There was a 36% chance of failure to fulfill any (either heart or lung) minimum case requirement despite adequate volume. The variable nature of emergency cases inevitably leads to work hour violations under ACGME regulations. Unpredictable cases mandate higher operative volume to ensure achievement of adequate caseloads. Publically available simulation technology provides a valuable avenue to identify adequacy of case volumes for trainees in both the elective and emergency setting. Copyright © 2015 Elsevier Inc. All rights reserved.
Businger Adrian P
Full Text Available Abstract In 2005 the Swiss government implemented new work-hour limitations for all residency programs in Switzerland, including a 50-hour weekly limit. The reduction in the working hours of doctors in training implicate an increase in their rest time and suggest an amelioration of doctors' clinical performance and consequently in patients' outcomes and safety - which was not detectable in a preliminary study at a large referral center in Switzerland. It remains elusive why work-hour restrictions did not improve patient safety. We are well advised to thoroughly examine and eliminate the known adverse effects of reduced work-hours to improve our patients' safety.
Segerman, Jill; Crable, Elaine; Brodzinski, James
Medical education helps ensure doctors acquire skills and knowledge needed to care for patients. However, resident duty hour restrictions have impacted the time residents have available for medical education, leaving resident educators searching for alternate options for effective medical education. Classroom situated e-learning, a blended…
Full Text Available Geoffrey A Talmon,1 Donna K Czarnecki,2 Harlan R Sayles3 1Department of Pathology and Microbiology, 2Educational Support Office, 3Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, USA Background: While others have studied the effects of resident teaching on medical student performance, few have examined the benefits to the resident educator. Our study compared the quantity of pathology residents’ didactic teaching with their performance on in-service examinations. Methods: The academic records of anatomic/clinical pathology residents over 10 years were reviewed. Scores on step I of the United States Medical Licensing Examination (USMLE®, the annual percentile on the in-service examination, and preclinical teaching hours for each resident were obtained. Results: Average annual teaching hours showed a weak positive correlation with mean in-service examination performance. Those below the 50th percentile had a lower number of teaching hours (average 7.8 than above the 50th percentile (mean 10.4, P=0.01. The incremental positive association between the two metrics increased by year in training and was strongest among senior residents, even controlling for USMLE performance (P<0.01. Conclusion: There is an association between the amount of pathology residents’ preclinical educational activity and their mean performance on in-service examinations. Keywords: residency, medical student, USMLE
Smrtka, Michael P.; Gunatilake, Ravindu P.; Harris, Benjamin; Yu, Miao; Lan, Lan; Brancazio, Leo R.; Valea, Fidel A.; Grotegut, Chad A.; Brown, Haywood L.
Background In 2003, the Accreditation Council for Graduate Medical Education limited resident duty hours to 80 hours per week. More than a decade later, the effect of the limits on resident clinical competence is not fully understood. Objective We sought to assess the effect of duty hour restrictions on resident performance of an uncomplicated cesarean delivery. Methods We reviewed unlabored primary cesarean deliveries at Duke University Hospital after 34 weeks gestation, between 2003 and 2011. Descriptive statistics and linear regression were used to compare total operative time with incision to delivery time as a function of years since institution of the 80-hour workweek. Resident training level, subject body mass index, estimated blood loss, and skin closure method were controlled for in the regression model. Results We identified 444 deliveries that met study criteria. The mean (SD) total operative time in 2003–2004 was 43.3 (14.3) minutes and 59.6 (10.7) minutes in 2010–2011 (P delivery time (P = .05). The magnitude of increased operative time was seen among junior residents (2.0 min/y, P < .001) compared to that of senior residents (1.2 min/y, P = .06). Conclusions Since introduction of the 2003 duty hour limits, there has been an increase of nearly 20 minutes in the time required for a routine cesarean delivery. It is unclear if the findings are due to a change in residency duty hours or to another aspect of residency training. PMID:26457141
Talmon, Geoffrey A; Czarnecki, Donna K; Sayles, Harlan R
Background While others have studied the effects of resident teaching on medical student performance, few have examined the benefits to the resident educator. Our study compared the quantity of pathology residents’ didactic teaching with their performance on in-service examinations. Methods The academic records of anatomic/clinical pathology residents over 10 years were reviewed. Scores on step I of the United States Medical Licensing Examination (USMLE®), the annual percentile on the in-service examination, and preclinical teaching hours for each resident were obtained. Results Average annual teaching hours showed a weak positive correlation with mean in-service examination performance. Those below the 50th percentile had a lower number of teaching hours (average 7.8) than above the 50th percentile (mean 10.4, P=0.01). The incremental positive association between the two metrics increased by year in training and was strongest among senior residents, even controlling for USMLE performance (P<0.01). Conclusion There is an association between the amount of pathology residents’ preclinical educational activity and their mean performance on in-service examinations. PMID:25945073
Medical education helps ensure doctors acquire skills and knowledge needed to care for patients. However, resident duty hour restrictions have impacted time residents have for medical education, leaving resident educators searching for innovative options for effective medical education. Classroom situated e-learning, a blended learning delivery…
Full Text Available Abstract Background Physicians' mental health may be adversely affected by the number of days of work and time spent on-call, and improved by sleep and days-off. The aim of this study was to determine the associations of depressive symptoms with taking days of off duty, hours of sleep, and the number of days of on-call and overnight work among physicians working in Japanese hospitals. Methods A cross-sectional study as a national survey was conducted by mail. The study population was 10,000 randomly selected physicians working in hospitals who were also members of the Japan Medical Association (response rate 40.5%. Self-reported anonymous questionnaire was sent to assess the number of days off-duty, overnight work, and on-calls, and the average number of sleep hours on days not working overnight in the previous one month. Depressive state was determined by the Japanese version of the Quick Inventory of Depressive Symptomatology. Logistic regression analysis was used to explore the associations between depressive symptoms and the studied variables. Results Among the respondents, 8.3% of men and 10.5% of women were determined to be depressed. For both men and women, depressive state was associated with having no off-duty days and averaging less than 5 hours of sleep on days not doing overnight work. Depressive state was positively associated with being on-call more than 5 days per month for men, and more than 8 days per month for women, and was negatively associated with being off-duty more than 8 days per month for men. Conclusion Some physicians need some support to maintain their mental health. Physicians who do not take enough days-off, who reduced sleep hours, and who have certain number of days on-calls may develop depressive symptoms.
Johnson, Nicholas E; Maas, Matthew B; Coleman, Mary; Jozefowicz, Ralph; Engstrom, John
To assess the strengths and weaknesses of neurology resident education using survey methodology. A 27-question survey was sent to all neurology residents completing residency training in the United States in 2011. Of eligible respondents, 49.8% of residents returned the survey. Most residents believed previously instituted duty hour restrictions had a positive impact on resident quality of life without impacting patient care. Most residents rated their faculty and clinical didactics favorably. However, many residents reported suboptimal preparation in basic neuroscience and practice management issues. Most residents (71%) noted that the Residency In-service Training Examination (RITE) assisted in self-study. A minority of residents (14%) reported that the RITE scores were used for reasons other than self-study. The vast majority (86%) of residents will enter fellowship training following residency and were satisfied with the fellowship offers they received. Graduating residents had largely favorable neurology training experiences. Several common deficiencies include education in basic neuroscience and clinical practice management. Importantly, prior changes to duty hours did not negatively affect the resident perception of neurology residency training.
Ottinger, Mary E; Monaghan, Sean F; Gregg, Shea C; Stephen, Andrew H; Connolly, Michael D; Harrington, David T; Adams, Charles A; Cioffi, William G; Heffernan, Daithi S
The 80h work week has raised concerns that complications may increase due to multiple sign-outs or poor communication. Trauma Surgery manages complex trauma and acute care surgical patients with rapidly changing physiology, clinical demands and a large volume of data that must be communicated to render safe, effective patient care. Trauma Morning Report format may offer the ideal situation to study and teach sign-outs and resident communication. Surgery Residents were assessed on a 1-5 scale for their ability to communicate to their fellow residents. This consisted of 10 critical points of the presentation, treatment and workup from the previous night's trauma admissions. Scores were grouped into three areas. Each area was scored out of 15. Area 1 consisted of Initial patient presentation. Area 2 consisted of events in the trauma bay. Area 3 assessed clarity of language and ability to communicate to their fellow residents. The residents were assessed for inclusion of pertinent positive and negative findings, as well as overall clarity of communication. In phase 1, residents were unaware of the evaluation process. Phase 2 followed a series of resident education session about effective communication, sign-out techniques and delineation of evaluation criteria. Phase 3 was a resident-blinded phase which evaluated the sustainability of the improvements in resident communication. 50 patient presentations in phase 1, 200 in phase 2, and 50 presentations in phase 3 were evaluated. Comparisons were made between the Phase 1 and Phase 2 evaluations. Area 1 (initial events) improved from 6.18 to 12.4 out of 15 (pcommunication and language) improved from 8.36 to 12.22 out of 15 (Pcommunication skills in residents. Copyright © 2017 Elsevier Ltd. All rights reserved.
Lígia Andrade da Silva Telles Mathias
ñana, después 24 horas de trabajo, sin dormir, sin plantón en los 3 días anteriores (M2; a las 13 horas de la tarde, después de 30 horas de trabajo, sin dormir, sin plantón en los 3 días anteriores (M3. En todas esas situaciones fue realizado electroencefalograma (EEG continuo, en sala apropiada para registro de los señales de sueño, evaluándose la latencia del sueño (LS. RESULTADOS: Se Verificó reducción significativa de la LS entre los residentes, después de 24 ó 30 horas de plantón sin dormir. Entre los praticantes que tuvieron noche de sueño normal en la víspera del examen, 36,4% presentaron LS en nivel considerado patológico. CONCLUSIONES: La jornada de plantón de 24 ó 30 horas lleva a valores de LS menores que 5 minutos, considerados patológicos, reflejando la fatiga extrema de residentes de Anestesiologia. Pode ser importante la reglamentación del número de horas de descanso pos-plantón.BACKGROUND AND OBJECTIVES: Physicians in general, and anesthesiologists in particular, have long working hours. Residents of Anesthesiology may present significant fatigue and stress. This study aimed at investigating first and second year residents’ sleep latency after a period on duty. METHODS: Participated in this study 11 residents in different situations: at 7:00 am, after a normal night sleep (> 7 h, without on duty period in the last 3 days (M1; at 7:00 am, after 24h of night work, without on duty period in the last 3 days (M2; and at 1:00 pm after 30h of work without on duty period in the last 3 days (M3. Continuous EEG was performed for all situations in adequate room to record sleep signals. Sleep latency (SL was evaluated. RESULTS: There has been significant shorter SL among residents after 24 or 30 hours without sleep. From residents after a normal night sleep the day before the evaluation, 36.4% presented pathological SL levels. CONCLUSIONS: Periods on duty for 24 or 30 hours lead to SL values below 5 minutes, which are considered pathologic and
Freeman, W D; Nolte, C M; Matthews, B R; Coleman, M; Corboy, J R
To assess the effect of neurology residency education as trainees advance into independent practice, the American Academy of Neurology (AAN) elected to survey all graduating neurology residents at time of graduation and in 3-year cycles thereafter. A 22-question survey was sent to all neurology residents completing residency training in the United States in 2007. Of 523 eligible residents, 285 (54.5%) responded. Of these, 92% reported good to excellent quality teaching of basic neurology from their faculty; however, 47% noted less than ideal training in basic neuroscience. Two-thirds indicated that the Residency In-service Training Examination was used only as a self-assessment tool, but reports of misuse were made by some residents. After residency, 78% entered fellowships (with 61% choosing a fellowship based on interactions with a mentor at their institution), whereas 20% entered practice directly. After adjustment for the proportion of residents who worked before the duty hour rules were implemented and after their implementation, more than half reported improvement in quality of life (87%), education (60%), and patient care (62%). The majority of international medical graduates reported wanting to stay in the United States to practice rather than return to their country of residence. Neurology residents are generally satisfied with training, and most entered a fellowship. Duty hour implementation may have improved resident quality of life, but reciprocal concerns were raised about impact on patient care and education. Despite the majority of international trainees wishing to stay in the United States, stricter immigration laws may limit their entry into the future neurology workforce.
Gondi, Vinai, E-mail: email@example.com [Department of Radiation Oncology, University of Wisconsin Comprehensive Cancer Center, Madison, Wisconsin (United States); Bernard, Johnny Ray [Mayo Clinic Jacksonville, Jacksonville, Florida (United States); Jabbari, Siavash [University of California San Francisco, San Francisco, California (United States); Keam, Jennifer [Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Amorim Bernstein, Karen L. de [Albert Einstein College of Medicine, Bronx, New York (United States); Dad, Luqman K. [SUNY Roswell Park Cancer Institute, Buffalo, New York (United States); Li, Linna [Fox Chase Cancer Center, Philadelphia, Pennsylvania (United States); Poppe, Matthew M. [University of Utah Huntsman Cancer Hospital (United States); Strauss, Jonathan B. [Northwestern University Feinberg School of Medicine, Chicago, Illinois (United States); Chollet, Casey T. [Loyola University Medical Center, Maywood, Illinois (United States)
Purpose: To document clinical training and resident working conditions reported by chief residents during their residency. Methods and Materials: During the academic years 2005 to 2006, 2006 to 2007, and 2007 to 2008, the Association of Residents in Radiation Oncology conducted a nationwide survey of all radiation oncology chief residents in the United States. Chi-square statistics were used to assess changes in clinical training and resident working conditions over time. Results: Surveys were completed by representatives from 55 programs (response rate, 71.4%) in 2005 to 2006, 60 programs (75.9%) in 2006 to 2007, and 74 programs (93.7%) in 2007 to 2008. Nearly all chief residents reported receiving adequate clinical experience in commonly treated disease sites, such as breast and genitourinary malignancies; and commonly performed procedures, such as three-dimensional conformal radiotherapy and intensity-modulated radiotherapy. Clinical experience in extracranial stereotactic radiotherapy increased over time (p < 0.001), whereas clinical experience in endovascular brachytherapy (p <0.001) decreased over time. The distribution of gynecologic and prostate brachytherapy cases remained stable, while clinical case load in breast brachytherapy increased (p = 0.006). A small but significant percentage of residents reported receiving inadequate clinical experience in pediatrics, seeing 10 or fewer pediatric cases during the course of residency. Procedures involving higher capital costs, such as particle beam therapy and intraoperative radiotherapy, and infrequent clinical use, such as head and neck brachytherapy, were limited to a minority of institutions. Most residency programs associated with at least one satellite facility have incorporated resident rotations into their clinical training, and the majority of residents at these programs find them valuable experiences. The majority of residents reported working 60 or fewer hours per week on required clinical duties
Full Text Available Introduction: Medical resident workload has been shown to be associated with learning efficiency and patient satisfaction. However, there is limited evidence about it in developing countries. This study aimed to evaluate the medical resident workload in a multidisciplinary teaching hospital in Tehran, Iran.Methods: All medical residents at Shariati Hospital, a teaching hospital affiliated with Tehran University of Medical Science, who were working between November and December 2011 were enrolled in this cross-sectional study. A self–reported questionnaire was used to gather information about their duty hours (including daily activities and shifts and financial issues.Results:135 (52.5% out of 257 residents responded to the questionnaire. 72 (53.3% residents were in surgical departments and 63 (46.7% were in non-surgical departments. Mean duty hours per month were significantly higher in surgical (350.8 ±76.7 than non-surgical (300.6±74.2 departments (p=0.001. Three cardiology (a non-surgical group residents (5.7% and 30 residents (41% in surgical groups (p<0.001 declared a number of “on-calls in the hospital” more than the approved number in the curriculum. The majority of residents (97.8% declared that their salary was not sufficient to manage their lives and they needed other financial resources. Conclusion: Medical residents at teaching hospitals in Iran suffer from high workloads and low income. There is a need to reduce medical resident workload and increase salary to improve worklife balance and finances.
高松林; 刘宇; 师索
2012年刑诉法修订，立法机关保留了监视居住，并对其功能重新定位，衍生出了指定居所监视居住。在具体适用中必须把握好保障人权、严格程序与审慎适用三个原则。准确理解指定居所监视居住异于一般监视居住的立法精神以及其分化出的程序性侦查功能，将有助于职务犯罪侦查机关正确比较适用强制措施。在具体操作中应着力构筑审批、执行、变更三个环节规范运行、全程监督的刚性程序。同时，指定居所监视居住作为制度创新仍有较大的完善空间，需要更多的理论反思和实践尝试。%In the Criminal Procedure Law revised in 2012 ,the legislature retains residential surveillance ,repositions its function ,and develops residential surveillance of assigned residence .In the specific application , we must grasp the principle of protection of human rights ,strict procedures ,and careful application .To make clear the spirit of the legislation accurately that the residential surveillance of assigned residence is different from general residential sur -veillance and its differential procedural investigative function will be helpful for the investigating authorities of duty crimes to correctly compare and apply compulsory measures .In the specific operation , we should make efforts to build rigid procedures of standardized operation nd full supervision of approval , execution , and change a .Mean-while,as system innovation,there is still much space for improvement in residential surveillance of assigned resi-dence ,and it needs more theoretical reflection and practical attempts .
... 19 Customs Duties 1 2010-04-01 2010-04-01 false Observation of official hours. 132.3 Section 132.3 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND SECURITY; DEPARTMENT OF THE TREASURY QUOTAS General Provisions § 132.3 Observation of official hours. An entry summary for consumption...
Taylor, Taryn S; Nisker, Jeff; Teunissen, Pim W; Dornan, Tim; Lingard, Lorelei
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.
Advanced Petroleum-Based Fuels - Diesel Emissions Project (APBF-DEC): 2,000-Hour Performance of a NOx Adsorber Catalyst and Diesel Particle Filter System for a Medium-Duty, Pick-Up Diesel Engine Platform; Final Report
Presents the results of a 2,000-hour test of an emissions control system consisting of a nitrogen oxides adsorber catalyst in combination with a diesel particle filter, advanced fuels, and advanced engine controls in an SUV/pick-up truck vehicle platform.
Advanced Petroleum-Based Fuels - Diesel Emissions Project (APBF-DEC): 2,000-Hour Performance of a NOx Adsorber Catalyst and Diesel Particle Filter System for a Medium-Duty, Pick-Up Diesel Engine Platform; Final Report
Presents the results of a 2,000-hour test of an emissions control system consisting of a nitrogen oxides adsorber catalyst in combination with a diesel particle filter, advanced fuels, and advanced engine controls in an SUV/pick-up truck vehicle platform.
Kim, Roger H; Gilbert, Timothy; Ristig, Kyle; Chu, Quyen D
As a consequence of surgical resident duty hour restrictions, there is a need for faculty to utilize novel teaching methods to convey information in a more efficient manner. The current paradigm of surgical training, which has not changed significantly since the time of Halsted, assumes that all residents assimilate information in a similar fashion. However, recent data has shown that learners have preferences for the ways in which they receive and process information. The VARK model categorizes learners as visual (V), aural (A), read/write (R), and kinesthetic (K). The VARK learning style preferences of surgical residents have not been previously evaluated. In this study, the preferred learning styles of general surgery residents were determined, along with faculty and resident perception of resident learning styles. In addition, we hypothesized that American Board of Surgery In-Training Exam (ABSITE) scores are associated with preference for a read/write (R) learning style. The Fleming VARK learning styles inventory was administered to all general surgery residents at a university hospital-based program. Responses on the inventory were scored to determine the preferred learning style for each resident. Faculty members were surveyed to determine their accuracy in identifying the preferred learning style of each resident. All residents were also surveyed to determine their accuracy in identifying their peers' VARK preferences. Resident ABSITE scores were examined for association with preferred learning styles. Twenty-nine residents completed the inventory. Most (18 of 29, 62%) had a multimodal preference, although more than a third (11 of 29, 38%) demonstrated a single-modality preference. Seventy-six percent of all residents (22 of 29) had some degree of kinesthetic (K) learning, while under 50% (14 of 29) were aural (A) learners. Although not significant, dominant (R) learners had the highest mean ABSITE scores. Faculty identified residents' learning styles
Nida, Andrew M; Googe, Benjamin J; Lewis, Andrea F; May, Warren L
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.
... 19 Customs Duties 2 2010-04-01 2010-04-01 false Resident corporations. 141.38 Section 141.38... TREASURY (CONTINUED) ENTRY OF MERCHANDISE Powers of Attorney § 141.38 Resident corporations. A power of attorney shall not be required if the person signing Customs documents on behalf of a resident...
... 19 Customs Duties 1 2010-04-01 2010-04-01 false Hours of business. 101.6 Section 101.6 Customs... GENERAL PROVISIONS § 101.6 Hours of business. Except as specified in paragraphs (a) through (g) of this section, each CBP office shall be open for the transactions of general CBP business between the hours of 8...
... long a railroad may require or allow an employee in a certain category to remain on duty and how long the railroad must give the employee off duty before the employee may go on duty again. In issuing this... Employees and Requirement of 48 or 72 Hours Off Duty at the Home Terminal 1. What constitutes a ``Day'' for...
... the maximum on-duty periods and minimum off-duty periods for railroad employees performing certain... Employee Has Initiated an On-duty Period on Six Consecutive Days (Section III.D of the Second Interim... Limitation for Freight Train Employees and the Requirement of at Least 48 or 72 Hours Off Duty at the Home...
Turner, Jonathan; Kim, Kibaek; Mehrotra, Sanjay; DaRosa, Debra A; Daskin, Mark S; Rodriguez, Heron E
The primary goal of a residency program is to prepare trainees for unsupervised care. Duty hour restrictions imposed throughout the prior decade require that residents work significantly fewer hours. Moreover, various stakeholders (e.g. the hospital, mentors, other residents, educators, and patients) require them to prioritize very different activities, often conflicting with their learning goals. Surgical residents' learning goals include providing continuity throughout a patient's pre-, peri-, and post-operative care as well as achieving sufficient surgical experience levels in various procedure types and participating in various formal educational activities, among other things. To complicate matters, senior residents often compete with other residents for surgical experience. This paper features experiments using an optimization model and a real dataset. The experiments test the viability of achieving the above goals at a major academic center using existing models of delivering medical education and training to surgical residents. It develops a detailed multi-objective, two-stage stochastic optimization model with anticipatory capabilities solved over a rolling time horizon. A novel feature of the models is the incorporation of learning curve theory in the objection function. Using a deterministic version of the model, we identify bounds on the achievement of learning goals under existing training paradigms. The computational results highlight the structural problems in the current surgical resident educational system. These results further corroborate earlier findings and suggest an educational system redesign is necessary for surgical medical residents.
Somsila, Nattamon; Chaiear, Naesinee; Boonjaraspinyo, Sirintip; Tiamkao, Somsak
1) To assess work-related quality of life (WRQOL) among medical residents at a university hospital in northeast Thailand. 2) To determine the strength of the association between personal and working condition components and WRQOL among medical residents. A descriptive study was used to describe the WRQOL among medical residents. The study population comprised of all 375 residents affiliated with the university hospital. The Thai version of a self-administered work-related quality of life scale-2 was used for data collection. Testing the reliability revealed a Cronbach's alpha of 0.908. Questionnaires were completed by 259 of 375 (68.3%). The study found that the mean rating by residents for overall WRQOL was 113.8 out of 170 (SD 14.8). Most rated WRQOL as moderate (76.6%). The seven sub-factors were rated as moderate to high for employee engagement and control at work, moderate for home/work interface, general well-being and working conditions, high-moderate for job career satisfaction, and low-moderate for stress at work. Relationships between the personal and working condition components and WRQOL were analyzed using binary logistic regression. Residents in minor specialties had a higher WRQOL than those in major specialties (OR 2.522, 95% CI: 1.37, 4.63). Residents who had less than eight duty shifts/week had a higher WRQOL than those with more than eight duty shifts/week (OR 2.263, 95% CI: 1.16, 4.41). Similarly, residents working with less than 80 hours/week had a higher WRQOL than those working more than 80 hours/week (OR 2.344, 95% CI: 1.17, 4.72). A subgroup analyzes of those working in minor specialties showed the trend that working less than eight shifts/month and working less than 80 hours/week had the potential association with good quality of work-life (QWL). This phenomenon is presented in the subgroup analyses of those working in major specialties. Therefore, working hours and number of shifts might have played important role in contributing good QWL
... ``hurry back'' within 8 hours. As a result of the mandatory 10 hours off-duty requirement, RockTenn... drug testing, medical certification, and other driver-qualification requirements. RockTenn,...
Alston, Meredith J; Metz, Torri D; Fothergill, Russell; Meg Autry, Amy; Wagner, Sarah A; Allshouse, Amanda A; Stephenson-Famy, Alyssa
Little is known about the factors that influence medical student selection of obstetrics and gynecology (ob-gyn) residency programs. We assessed the factors influencing residency program selection by fourth-year medical students pursuing ob-gyn training. A voluntary, anonymous, 19-question survey of residency selection factors was distributed to all fourth-year medical students interviewing at 1 of 5 academic ob-gyn departments for a residency position during the 2013-2014 interview season. Participants were surveyed about the relative importance (not important, somewhat important, important) of various residency selection factors, including operative experience, exposure to subspecialties, curricular experience, access to fellowships, and administrative aspects of residency, including adherence to duty hour restrictions. Of 322 potential respondents, 262 (81%) completed the survey. Surgical training and training in laparoscopic surgery were deemed "important" by nearly all respondents (98%, 258 of 262, and 97%, 253 of 262, respectively). Factors that were considered "not important" by a significant group of respondents included maternity/paternity leave policies (22%, 58 of 259); opportunity for international rotations/electives (20%, 51 of 259); exposure to quality and safety initiatives (13%, 34 of 259); and training in abortion (13%, 34 of 262). Fourth-year medical students identified surgical training as the most important factor in selecting an ob-gyn residency, a finding that is particularly relevant as decreasing and changing surgical volumes affect residency training in this specialty.
... given duty period. It has three 8-hour shifts up to 7 days a week, and there are two shipping employees... minimum of at least 8 hours off duty. If exempt from the normal HOS requirements, these employees can... (FMCSRs). This limited exemption is for RockTenn's shipping department employees and occasional substitute...
C. Binder (C.); C. Heilmann (Conrad)
markdownabstractEver since the publication of Peter Singer’s article ‘‘Famine, Affluence, and Morality’’ has the question of whether the (geographical) distance to people in need affects our moral duties towards them been a hotly debated issue. Does geographical distance affect our moral duties?
Burrows, Jason; Coolen, Jillian
The practice patterns of Obstetricians and Gynaecologists continue to evolve with each new generation of physicians. Diversifying subspecialties, changes in resident duty hours, job market saturation, and desire for work-life balance are playing stronger roles. Professional practice direction and needs assessment may be aided by awareness of future Obstetrics and Gynaecology physician career plans and expectations. The objective of this study was to determine the expected career plans and practice patterns of Canadian Obstetrics and Gynaecology residents following residency. The SOGC Junior Member Committee administered its third career planning survey to Canadian Obstetrics and Gynaecology residents electronically in December 2011. The data collected was statistically analyzed and compared to previous surveys. There were 183 responses giving a response rate of 43%. More than one half of all residents were considering postgraduate training (58%). Projected practice patterns included: 84% maintaining obstetrical practice, 60% locuming, and 50% job-sharing. The majority of residents expected to work in a 6 to 10 person call group (48%), work 3 to 5 call shifts per month (72%), work 41 to 60 hours weekly (69%), and practise in a city with a population greater than 500 000 (45%). Only 18% of residents surveyed were in favour of streaming residency programs in Obstetrics and Gynaecology. Canadian resident career plan and expected practice pattern assessment remains an important tool for aiding in resource allocation and strategic development of care and training in Obstetrics and Gynaecology in Canada. Copyright © 2016 Society of Obstetricians and Gynaecologists of Canada. Published by Elsevier Inc. All rights reserved.
National Oceanic and Atmospheric Administration, Department of Commerce — Standard hourly observations taken at Weather Bureau/National Weather Service offices and airports throughout the United States. Hourly observations began during the...
... Preparation of Drivers' Record of Duty Status To Document Compliance With the Hours-of-Service Requirements... motor vehicle (CMV) drivers to prepare, in duplicate, a record of duty status for each 24-hour period...: MCPSD@dot.gov . Phone (202) 366-4325. SUPPLEMENTARY INFORMATION: Legal Basis The Motor Carrier...
Esraa M. Al-Maddah
Full Text Available Objectives: Sleep deprivation is common among medical residents of all specialties. This study aimed to determine the prevalence of sleep deprivation and depressive symptoms among medical residents in King Fahd University Hospital (KFUH in Al Khobar, Saudi Arabia. Furthermore, the association between sleep deprivation, sleepiness and depressive symptoms was examined. Methods: This cross-sectional study took place between February and April 2012 and involved 171 KFUH medical residents of different specialties. Data were collected using a specifically designed questionnaire eliciting demographic information, working hours and number of hours of sleep. In addition, validated Arabic versions of the Epworth Sleepiness Scale and the Beck Depression Inventory-2 (BDI-2 were used. Results: The prevalence of acute sleep deprivation and chronic sleep deprivation among residents in KFUH was 85.9% and 63.2%, respectively. The prevalence of overall sleepiness was 52%; 43.3% reported being excessively sleepy in certain situations while 8.8% reported being excessively sleepy regardless of the situation. Based on the BDI-2, the prevalence of mild, moderate and severe depressive symptoms was 43.3%, 15.2% and 4.7%, respectively. Significant associations were found between sleep deprivation and depressive symptoms; depressive symptoms and sleepiness, and depressive symptoms and being a female resident. Conclusion: The vast majority of medical residents had acute sleep deprivation, with more than half suffering from chronic sleep deprivation. The number of hours and quality of sleep among the residents were strongly associated with depressive symptoms. New regulations are recommended regarding the number of working hours and night duties for medical residents. Further studies should assess these new regulations on a regular basis.
Price, J L; Cleary, B
Clearly, faculty must work hard with residents to explore the nature of their resistance to a program's learning and growth opportunities. Initial steps to a deeper, more effective, and longer-lasting change process must be pursued. If resident resistance is mishandled or misunderstood, then learning and professional growth may be sidetracked and the purposes of residency training defeated. Listening to the whole person of the resident and avoiding the trap of getting caught up in merely responding to select resident behaviors that irritate us is critical. Every faculty member in the family practice residency program must recognize resistance as a form of defense that cannot immediately be torn down or taken away. Resident defenses have important purposes to play in stress reduction even if they are not always healthy. Residents, especially interns, use resistance to avoid a deeper and more truthful look at themselves as physicians. A family practice residency program that sees whole persons in their residents and that respects resident defenses will effectively manage the stress and disharmony inherent to the resistant resident.
Havrda, Dawn E; Engle, Janet P; Anderson, Keri C; Ray, Shaunta' M; Haines, Seena L; Kane-Gill, Sandra L; Ballard, Stephanie L; Crannage, Andrew J; Rochester, Charmaine D; Parman, Malinda G
Postgraduate year one (PGY1) and postgraduate year two (PGY2) residencies serve to develop pharmacists into skillful clinicians who provide advanced patient-centered care in various general and specialized areas of pharmacy practice. Pharmacy residencies are a minimum requirement for many clinical pharmacy positions, as well as for positions in academia. The role of clinical pharmacists typically includes teaching, regardless of whether they pursue an academic appointment. Common teaching duties of pharmacist-clinicians include giving continuing education or other invited presentations, providing education to colleagues regarding clinical initiatives, precepting pharmacy students (early and advanced experiences) and residents, and educating other health care professionals. Although ASHP provides accreditation standards for PGY1 and PGY2 residencies, the standards pertaining to teaching or education training are vague. Through the years, teaching certificate programs that develop residents' teaching skills and better prepare residents for a diverse pharmacy job market have increased in popularity; moreover, teaching certificate programs serve as an attractive recruitment tool. However, the consistency of requirements for teaching certificate programs is lacking, and standardization is needed. The Task Force on Residencies developed two sets of guidelines to define teaching experiences within residencies. The first guideline defines the minimum standards for teaching experiences in any residency-training program. The second guideline is for programs offering a teaching certificate program to provide standardization, ensuring similar outcomes and quality on program completion. One of the main differences between the guidelines is the recommendation that residency programs offering a teaching certificate program be affiliated with an academic institution to provide the pedagogy and variety of teaching experiences for the resident. Residency program directors should
Chand, David V.
Background Recent focus on resident work hours has challenged residency programs to modify their curricula to meet established duty hour restrictions and fulfill their mission to develop the next generation of clinicians. Simultaneously, health care systems strive to deliver efficient, high-quality care to patients and families. The primary goal of this observational study was to use a data-driven approach to eliminate examples of waste and variation identified in resident rounding using Lean Six Sigma methodology. A secondary goal was to improve the efficiency of the rounding process, as measured by the reduction in nonvalue-added time. Methods We used the “DMAIC” methodology: define, measure, analyze, improve, and control. Pediatric and family medicine residents rotating on the pediatric hospitalist team participated in the observation phase. Residents, nurses, hospitalists, and parents of patients completed surveys to gauge their attitudes toward rounds. The Mann-Whitney test was used to test for differences in the median times measured during the preimprovement and postimprovement phases, and the Student t test was used for comparison of survey data. Results and Discussion Collaborative, family-centered rounding with elimination of the “prerounding” process, as well as standard work instructions and pacing the process to meet customer demand (takt time), were implemented. Nonvalue-added time per patient was reduced by 64% (P = .005). Survey data suggested that team members preferred the collaborative, family-centered approach to the traditional model of rounding. Conclusions Lean Six Sigma provides tools, a philosophy, and a structured, data-driven approach to address a problem. In our case this facilitated an effort to adhere to duty hour restrictions while promoting education and quality care. Such approaches will become increasingly useful as health care delivery and education continue to transform. PMID:22655134
Wang, Yu-Jung; Hsu, Kan-Lin; Chang, Chin-Sung; Wu, Chih-Hsing
For the past 30 years, there has been a steady increase in the number of female physicians, but the relationship between their romantic lives and their pattern of training has been inadequately reported. This study was designed to investigate the interrelationships between medical training, quality of life, and the attitudes that female residents have toward romance. Of the 106 female medical residents at our medical center in 2009, a total of 78 residents (73.6%) were enrolled for the study. Structured questionnaires (Cronbach α = 0.878), which included questions about female resident quality of life, attitude toward spousal choice, and the impact of programmed professional medical training, were self-administered through an anonymous process. Female residents, especially ward-care specialists, were determined to have excessively long working hours (84.6% > 88 work hours/week), insufficient and irregular sleep (44.9%), and inadequate personal time (73.1% romances, 87.5% (n = 40) of romantic partners were physicians and 58.3% (n = 28) initiated their relationships when they were medical students, but exhibited no preferential dating of senior medical students or physicians. Factors affecting the choice of spouses included time limitations, a limited circle of friends, differences in values, and work-related stress. Those presumptive factors influencing romance between the assumed partner being a doctor or a "nondoctor" were significantly different with regard to lack of time (p = 0.002), values (p Romance and quality of life were significantly influenced by the pattern of medical training in female residents. Setting duty-hour limits and initiating a new hobby were determined to be potentially beneficial to their quality of life and attitudes toward romance. Copyright © 2012. Published by Elsevier B.V.
Nursing care is a humane action which bears with it an ethical dimension which is revealed by the focus of the care provided. Among the different options for action, a nurse will choose that which contributes to the care of a patient without harming that patient. The care choice made is the result of a conscientious, deliberate decision-making process which presupposes a recognition of what one plans to do, what one is capable of doing and what can accomplish. Freedom to choose which care option is applied imposes on a nurse the duty to act according to principles and duties which rule the profession; a nurse's power to act transforms to a power of the duty to provide treatment.
... following: (a) Personal and household effects taken abroad by a resident of the United States and brought..., instruments, and tools of trade, occupation, or employment taken abroad by an individual and brought back on... for repairs or alterations, which may be returned upon the payment of duty on the value of repairs...
Defense Language Inst., Washington, DC.
The materials presented in this intermediate-advanced refresher course in Korean are intended for those who have already had considerable intensive training in spoken and written Korean. Lessons 1-70 (the first seven weeks of the course) aim to "maintain and develop habitual responses in the use of words and sentences dealing with high…
C. Binder (C.); C. Heilmann (Conrad)
markdownabstractEver since the publication of Peter Singer’s article ‘‘Famine, Affluence, and Morality’’ has the question of whether the (geographical) distance to people in need affects our moral duties towards them been a hotly debated issue. Does geographical distance affect our moral
Laby, Arthur B
While duties of loyalty generally do not conflict with other duties of loyalty, and while conflicting duties of care typically only raise issues of competing resources, the fiduciary's duty of loyalty...
Cappi, R; Steinbach, C
In the framework of antiproton physics at CERN, a new Low Energy Antiproton Ring (LEAR) is being designed. In the basic mode, it will serve as a beam stretcher giving spill times in the region of an hour. The spill phi (t) must, of course, have a good duty factor ( phi )/sup 2//( phi /sup 2/). A method employing 'stochastic extraction' has been studied theoretically and tried out at the CERN PS ( approximately 9 s flat top) where an extremely good duty factor has been achieved, showing that much longer spill times will be practicable. The pulse length can be varied within wide limits given by the ripple, the momentum acceptance and the intermodulation distortion of the amplifier chain for the noise power. In addition, another method has been found effective which uses empty buckets. These methods need no servo system and both can easily be applied to other synchrotrons. (6 refs).
... revenue will be properly protected. Liquidated duties shall be based upon the port director's final... 19 Customs Duties 2 2010-04-01 2010-04-01 false Duties. 151.65 Section 151.65 Customs Duties U.S...) EXAMINATION, SAMPLING, AND TESTING OF MERCHANDISE Wool and Hair § 151.65 Duties. Duties on wool or...
Opponents of euthanasia sometimes argue that it is incompatible with the purpose of medicine, since physicians have an unconditional duty never to intentionally cause death. But it is not clear how such a duty could ever actually be unconditional, if due consideration is given to the moral weight of countervailing duties equally fundamental to medicine. Whether physicians' moral duties are understood as correlative with patients' moral rights or construed noncorrelatively, a doctor's obligation to abstain from intentional killing cannot be more than a defeasible duty.
Kjærgaard, Jane; Sillesen, Martin; Beier-Holgersen, Randi
OBJECTIVE: Since 2003, United States residents have been limited to an 80-hour workweek. This has prompted concerns of reduced educational quality, especially inadequate operating exposure. In contrast, the Danish surgical specialty-training program mandates a cap on working hours of 37 per week....
Waterbrook, Anna L; Pritchard, T Gail; Lane, Allison D; Stoneking, Lisa R; Koch, Bryna; McAtee, Robert; Grall, Kristi H; Min, Alice A; Prior, Jessica; Farrell, Isaac; McNulty, Holly G; Stolz, Uwe
experience when compared to the traditional orthopedics rotation. All SC residents successfully completed their sports medicine rotation, had completed postrotation evaluations by attending physicians, and had no duty hour violations while on sports medicine. In our experience, a sports medicine rotation is an effective alternative to the traditional orthopedics rotation for EM residents.
total number of dislocation reductions performed by each graduating resident at both programs over the last 5 years. While all residents in both programs exceeded the ten dislocation reductions required for graduation, residents on the sports medicine rotation had a statistically significant higher rate of satisfaction of their educational experience when compared to the traditional orthopedics rotation. All SC residents successfully completed their sports medicine rotation, had completed postrotation evaluations by attending physicians, and had no duty hour violations while on sports medicine. In our experience, a sports medicine rotation is an effective alternative to the traditional orthopedics rotation for EM residents. Keywords: musculoskeletal medicine, musculoskeletal education, medical education, orthopedics
Fisher, John F
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.
John F. Fisher
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.
Please note the new opening hours of the gates as well as the intersites tunnel from the 19 May 2009: GATE A 7h - 19h GATE B 24h/24 GATE C 7h - 9h\t17h - 19h GATE D 8h - 12h\t13h - 16h GATE E 7h - 9h\t17h - 19h Prévessin 24h/24 The intersites tunnel will be opened from 7h30 to 18h non stop. GS-SEM Group Infrastructure and General Services Department
This book will focus on just the essentials needed to pass the Security+ certification exam. It will be filled with critical information in a way that will be easy to remember and use for your quickly approaching exam. It will focus on the main objectives of the exam and include the following pedagogy for ease of use in those final hours. The book will include:. •Exam Objectives – Fast Track Review. •Key words/definitions. •Five Toughest questions and their answers. •Exam Warnings – What to pay attention to
Speake, Graham; Happel, Chris; Lillard, Terrence V
The 11th Hour Linux+ Study Guide is keyed to the XK0-003 revision of the CompTIA Linux+exam. This book is streamlined to include only core certification information and is presented for ease of last-minute studying. Main objectives of the exam are covered with key concepts highlighted. ..: ..; Fast Facts quickly review fundamentals ..; Exam Warnings highlight particularly tough sections of the exam ..; Crunch Time sidebars point out key concepts to remember ..; Did You Know? sidebars cover sometimes forgotten details ..; Top Five Toughest Questions and answers help you to prepare .. The 11th H
Waterbrook, Anna L; Pritchard, T Gail; Lane, Allison D; Stoneking, Lisa R; Koch, Bryna; McAtee, Robert; Grall, Kristi H; Min, Alice A; Prior, Jessica; Farrell, Isaac; McNulty, Holly G; Stolz, Uwe
educational experience when compared to the traditional orthopedics rotation. All SC residents successfully completed their sports medicine rotation, had completed postrotation evaluations by attending physicians, and had no duty hour violations while on sports medicine. In our experience, a sports medicine rotation is an effective alternative to the traditional orthopedics rotation for EM residents. PMID:27186151
The 18th edition of the Geneva 24 hours swim competition will take place at the Vernets Swimming Pool on the 4th and 5th of October. More information and the results of previous years are given at: http://www.carouge-natation.com/24_heures/home_24_heures.htm Last year, CERN obtained first position in the inter-company category with a total of 152.3 kms swam by 45 participants. We are counting on your support to repeat this excellent performance this year. For those who would like to train, the Livron swimming pool in Meyrin is open as from Monday the 8th September. For further information please do not hesitate to contact us. Gino de Bilio and Catherine Delamare
The 18th edition of the Geneva 24 hours swim competition will take place at the Vernets Swimming Pool on the 4th and 5th of October. More information and the results of previous years are given at: http://www.carouge-natation.com/24_heures/home_24_heures.htm Last year, CERN obtained first position in the inter-company category with a total of 152.3 kms swam by 45 participants. We are counting on your support to repeat this excellent performance this year. For those who would like to train, the Livron swimming pool in Meyrin is open as from Monday the 8th September. For further information please do not hesitate to contact us. Gino de Bilio and Catherine Delamare
The goal of this study is to improve instructional classes for “Extensive Reading”. We compare two approaches. The traditional method is based on the original procedure; the method we try is a “task-placemented” one. inspired by the method we try is a “task-placemented” one. inspired by the theory of “Tasks of Ascending Difficulty”.This paper provides a comparative evaluation of our experiments on Extensive Reading. Our aim is to resolve the logistical problem of heavy teaching loads and limited class hours, which often prevents English learners from fulfilling their study targets and our intended learning outcomes. In view of the experimental data,we have managed to establish a “feedback” to test the two hypotheses, and demonstrate that the new approach contributes to efficient acquisition of the information in the presented reading materials. Our study concludes with an interpretation of the function and merits of this approach.
Full Text Available Naila Nadeem,1,* Ranish Deedar Ali Khawaja,2,3,* Madiha Beg,1 Muhammad Naeem,4 Zain Majid41Department of Radiology, 2Aga Khan University Hospital, Karachi, Pakistan; 3Massachusetts General Hospital, Harvard Medical School, Boston, USA; 4Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan*These authors contributed equally to this workBackground: In an integrated method of education, medical students are introduced to radiology in their preclinical years. However, no study has been conducted in Pakistan to demonstrate an academic framework of medical radiology education at an undergraduate level. Therefore, we aimed to document and compare the current level of teaching duties, teaching methodologies, and teaching rewards among radiologists and residents in private and public teaching hospitals in Karachi, Pakistan.Methods: A survey was conducted among 121 radiologists and residents in two private and two public teaching hospitals in Karachi, Pakistan. Radiologists who were nationally registered with the Pakistan Medical and Dental Council either part-time or full-time were included. Radiology residents and fellows who were nationally registered with the Pakistan Medical and Dental Council were also included. Self-administered questionnaires addressing teaching duties, methods, and rewards were collected from 95 participants.Results: The overall response rate was 78.51% (95/121. All of the radiologists were involved in teaching residents and medical students, but only 36% reported formal training in teaching skills. Although most of the respondents (76% agreed that medical students appeared enthusiastic about learning radiology, the time spent on teaching medical students was less than five hours per week annually (82%. Only 37% of the respondents preferred dedicated clerkships over distributed clerkships (41%. The most common preferred teaching methodology overall was one-on-one interaction. Tutorials, teaching rounds, and
Monday 23 June 2008 at 14:00, Council Chamber (503/1-001) At the June 2008 Finance Committee and Council meetings, the Management will submit proposals to modify Chapter III, Section 1 of the Staff Rules and Regulations on Working Hours. These provisions will touch upon areas including compensation during the annual closure, periods of stand-by duty, plus compensation and eligibility for special working hours. A general information meeting, at which E. Chiaveri, Head of HR Department, will present the new policy, will be held on Monday 23 June at 14:00 in the Council Chamber. HR Department
Kansagra, Akash P
The revised ABR board certification process has updated the method by which diagnostic radiology residents are evaluated for competency in clinical radiologic physics. In this work, the author reports the successful design and implementation of a resident-taught physics course consisting of 5 weekly, hour-long lectures intended for incoming first-year radiology residents in their first month of training. To the author's knowledge, this is the first description of a course designed to provide a very early framework for ongoing physics education throughout residency without increasing the didactic burden on faculty members. Twenty-six first-year residents spanning 2 academic years took the course and reported subjective improvement in their knowledge (90%) and interest (75%) in imaging physics and a high level of satisfaction with the use of senior residents as physics educators. Based on the success of this course and the minimal resources required for implementation, this work may serve as a blueprint for other radiology residency programs seeking to develop revised physics curricula.
... 19 Customs Duties 1 2010-04-01 2010-04-01 false Private aircraft taken abroad by U.S. residents. 122.28 Section 122.28 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND SECURITY; DEPARTMENT OF THE TREASURY AIR COMMERCE REGULATIONS Private Aircraft § 122.28 Private...
National Oceanic and Atmospheric Administration, Department of Commerce — Hourly Precipitation Data (HPD) Publication is archived and available from the National Climatic Data Center (NCDC). This publication contains hourly precipitation...
National Oceanic and Atmospheric Administration, Department of Commerce — Hourly observations journal from the National Observatory in Washington DC. The observatory is the first station in the United States to produce hourly observations...
Hafner, John W. Jr., MD, MPH
Full Text Available Study Objectives: Although other specialties have examined the role of the chief resident (CR, the role and training of the emergency medicine (EM CR has largely been undefined.Methods: A survey was mailed to all EM CRs and their respective program directors (PD in 124 EM residency programs. The survey consisted of questions defining demographics, duties of the typical CR, and opinions regarding the level of support and training received. Multiple choice, Likert scale (1 strong agreement, 5 strong disagreement and short-answer responses were used. We analyzed associations between CR and PD responses using Chi-square, Student’s T and Mann-Whitney U tests.Results: Seventy-six percent of CRs and 65% of PDs responded and were similar except for age (31 vs. 42 years; p<0.001. CR respondents were most often male, in year 3 of training and held the position for 12 months. CRs and PDs agreed that the assigned level of responsibility is appropriate (2.63 vs. 2.73, p=0.15; but CRs underestimate their influence in the residency program (1.94 vs. 2.34, p=0.002 and the emergency department (2.61 vs. 3.03, p=0.002. The majority of CRs (70% and PDs (77% report participating in an extramural training program, and those CRs who participated in training felt more prepared for their job duties (2.26 vs. 2.73; p=0.03.Conclusion: EM CRs feel they have appropriate job responsibility but believe they are less influential in program and department administration than PD respondents. Extramural training programs for incoming CRs are widely used and felt to be helpful. [West J Emerg Med. 2010; 11(2:120-125.
...-call status. 551.431 Section 551.431 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL... § 551.431 Time spent on standby duty or in an on-call status. (a)(1) An employee is on duty, and time... in an on-call status shall not be considered hours of work if: (1) The employee is allowed to leave...
Soteriades, Elpidoforos S
Workplace modified duty programs may provide reasonable accommodations to employees who have partial temporary job disability and could work on duty accommodations until they fully recover. However, little is known about the implementation barriers and effectiveness of such programs. This study is aimed at evaluating the implementation of a modified duty program for employees in an oncology center. A modified duty program for employees working at the Bank of Cyprus Oncology Center, a non profit organization with 200 employees located in the Republic of Cyprus was evaluated based on the health records of the occupational medicine department. Employees' participation in the program was 3%. A total of 12 employees participated (6 each year). The participants were all women and the mean participation period was 21.6 days (range 10 - 65 days). The two most frequent reasons for a modified duty assignment were pregnancy and back pain. Employees were assigned either on limited duties or on a combination of limited duties and reduced work hours. Employees reported being very satisfied with their participation based on a follow-up narrative oral assessment. The small participation rate does not allow for advanced statistical analyses. Further studies from larger organizations are urgently needed to evaluate the effectiveness of modified duty programs. The development of a legal framework for such modified duty programs in Cyprus as well as internationally may promote their implementation in order to facilitate the effective management of temporary partial job disability for the benefit of both employees and businesses.
Gow, Kenneth W; Drake, F Thurston; Aarabi, Shahram; Waldhausen, John H
General surgery (GS) residents in ACGME programs log cases performed during their residency. We reviewed designated pediatric surgery (PS) cases to assess for changes in performed cases over time. The ACGME case logs for graduating GS residents were reviewed from academic year (AY) 1989-1990 to 2010-2011 for designated pediatric cases. Overall and designated PS cases were analyzed. Data were combined into five blocks: Period I (AY1989-90 to AY1993-94), Period II (AY1994-95 to AY1998-99), Period III (AY1999-00 to AY2002-03), Period IV (AY2003-04 to AY2006-07), and Period V (AY2007-08 to AY2010-11). Periods IV and V were delineated by implementation of duty hour restrictions. Student t-tests compared averages among the time periods with significance at P pediatric cases declined for each period from an average of 47.7 in Period I to 33.8 in Period V. These changes are due to a decline in hernia repairs, which account for half of cases. All other cases contributed only minimally to the pediatric cases. The only laparoscopic cases in the database were anti-reflux procedures, which increased over time. GS residents perform a diminishing number of designated PS cases. This decline occurred before the onset of work-hour restrictions. These changes have implications on the capabilities of the current graduating workforce. However, the case log does not reflect all cases trainees may be exposed to, so revision of this list is recommended. Copyright © 2013 Elsevier Inc. All rights reserved.
Gow, Kenneth W.; Drake, F. Thurston; Aarabi, Shahram; Waldhausen, John H.
Background General surgery (GS) residents in ACGME programs log cases performed during their residency. We reviewed designated pediatric surgery (PS) cases to assess for changes in performed cases over time. Methods The ACGME case logs for graduating GS residents were reviewed from academic year (AY) 1989–1990 to 2010–2011 for designated pediatric cases. Overall and designated PS cases were analyzed. Data were combined into five blocks: Period I (AY1989–90 to AY1993–94), Period II (AY1994–95 to AY1998–99), Period III (AY1999–00 to AY2002–03), Period IV (AY2003–04 to AY2006–07), and Period V (AY2007–08 to AY2010–11). Periods IV and V were delineated by implementation of duty hour restrictions. Student t-tests compared averages among the time periods with significance at P < .05. Results Overall GS case load remained relatively stable. Of total cases, PS cases accounted for 5.4% in Period I and 3.7% in Period V. Designated pediatric cases declined for each period from an average of 47.7 in Period I to 33.8 in Period V. These changes are due to a decline in hernia repairs, which account for half of cases. All other cases contributed only minimally to the pediatric cases. The only laparoscopic cases in the database were anti-reflux procedures, which increased over time. Conclusions GS residents perform a diminishing number of designated PS cases. This decline occurred before the onset of work-hour restrictions. These changes have implications on the capabilities of the current graduating workforce. However, the case log does not reflect all cases trainees may be exposed to, so revision of this list is recommended. PMID:23932601
... light-duty vehicles, light-duty trucks, and medium-duty passenger vehicles. 86.1818-12 Section 86.1818... vehicles, light-duty trucks, and medium-duty passenger vehicles. (a) Applicability. This section contains... vehicles, light-duty trucks, and medium-duty passenger vehicles. Manufacturers that qualify as a small...
Ana Paula Solans
Full Text Available The aim of this presentation is to present the results of three qualitative research on the exercise of rights and duties on Parenting Practices (PP, held in Buenos Aires, Argentina. They included interviews with mothers of children with Unsatisfied Basic Needs concretized between 2009 and 2013. Their analysis revealed that in this set of households were carried out three types of PP: imposition, guide and free will, the latter was the most used. As part of this practice, children managed their hours of sleep, wakefulness and leisure, without the intervention of their parents. It was noted, for example, that children over 10 years decided on matters concerning their schooling, absenting progressively to school, to abandonment. These practices were respected by their parents. By default, the postponement of pleasure (tolerance to frustration will not be exercised: they let children do at will. A trend of teenage pregnancy and the formation of pairs of children between 14-16 years with parental consent was also noted. In this sense, even when children lived in a house in contact with their parents, with a supply of food and available school, the indiscriminate exercise of free will put children's health at risk and full development, curtailing their rights. We recommend further studies such timely interventions to promote programs and projects designed to guide parents on issues related to the development of children as subjects of Rights and Duties.
Ray, Wilson Z; Ganju, Aruna; Harrop, James S; Hoh, Daniel J
Surgical simulators are useful in many surgical disciplines to augment residency training. Duty hour restrictions and increasing emphasis on patient safety and attending oversight have changed neurosurgical education from the traditional apprenticeship model. The Congress of Neurological Surgeons Simulation Committee has been developing neurosurgical simulators for the purpose of enhancing resident education and assessing proficiency. To review the initial experience with an anterior cervical diskectomy and fusion (ACDF) simulator. The first ACDF training module was implemented at the 2012 Congress of Neurological Surgeons Annual Meeting. The 90-minute curriculum included a written pretest, didactics, a practical pretest on the simulator, hands-on training, a written posttest, a practical posttest, and postcourse feedback. Didactic material covered clinical indications for ACDF, comparison with other cervical procedures, surgical anatomy and approach, principles of arthrodesis and spinal fixation, and complication management. Written pretests and posttests were administered to assess baseline knowledge and evidence of improvement after the module. Qualitative evaluation of individual performance on the practical (simulator) portion was included. Three neurosurgery residents, 2 senior medical students, and 1 attending neurosurgeon participated in the course. The pretest scores were an average 9.2 (range, 6-13). Posttest scores improved to 11.0 (range, 9-13; P = .03). Initial experience with the ACDF simulator suggests that it may represent a meaningful training module for residents. Simulation will be an important training modality for residents to practice surgical technique and for teachers to assess competency. Further development of an ACDF simulator and didactic curriculum will require additional verification of simulator validity and reliability.
Smith, Caitlin; Galante, Joseph M; Pierce, Jonathan L; Scherer, Lynette A
Birthrates during surgical residency appear to be rising. One assumption is that this is due to changes in the structure of surgical residencies. The purpose of our study was to explore whether an increase in birthrates has occurred and the reasons for this. We conducted an anonymous survey of current residents and alumni from 1976 to 2009 at a single university-based surgery training program. Alumni (46 of 116) and current residents (38 of 51) were surveyed, and our response rate was approximately 50% (84 of 167). Respondents were grouped into cohorts based on their residency start year. The early cohort consisted of residents starting residency between 1976 and 1999, and the late cohort consisted of residents starting residency between 2000 and 2009. The percentage of male residents with children during residency training was similar for the early and late cohorts (34% [10 of 29] versus 41% [9 of 22]). For female residents, there was a substantial increase in childbearing for the late cohort (7% [1 of 15] versus 35% [6 of 18]). Fifty-two percent (44 of 84) of the respondents who had children during residency reported that work hours and schedule had a negative effect on their decision to have children. Most respondents reported that availability or cost of child care, impact on residency, support from the program, increased length of training, or availability of family leave did not factor as concerns. Childbearing during residency has increased in female residents in our study. Surgical residency programs may need to accommodate this change if they want to continue to recruit and retain talented residents.
Full Text Available Supervision by school administrators is becoming more and more important. The change in the roles ofschool administrators has a great effect on that increase. At present, school administrators are consideredmore than as technical directors, but as instructional leaders. This increased the importance of schooladministrators’ expected supervision acts. In this respect, the aim of this study is to make a conceptualanalysis about school administrators’ supervision duties. For this reason, a literature review related withsupervision and contemporary supervision approaches was done, and the official documents concerningsupervision were examined. As a result, it can be said that school administrators’ supervision duties havebecome very important. And these duties must certainly be carried out by school administrators.
Department of Veterans Affairs — The Residency Allocation Database is used to determine allocation of funds for residency programs offered by Veterans Affairs Medical Centers (VAMCs). Information...
U.S. Environmental Protection Agency — This data layer identifies areas in the U.S. where air pollution levels have not met the National Ambient Air Quality Standards (NAAQS) for Ozone - 1hour (Legacy...
Teaching is considered an essential competency for residents to achieve during their training. Instruction in teaching skills may assist radiology residents in becoming more effective teachers and increase their overall satisfaction with teaching. The purposes of this study were to survey radiology residents' teaching experiences during residency and to assess perceived benefits following participation in a teaching skills development course. Study participants were radiology residents with membership in the American Alliance of Academic Chief Residents in Radiology or the Siemens AUR Radiology Resident Academic Development Program who participated in a 1.5-hour workshop on teaching skills development at the 2010 Association of University Radiologists meeting. Participants completed a self-administered, precourse questionnaire that addressed their current teaching strategies, as well as the prevalence and structure of teaching skills training opportunities at their institutions. A second postcourse questionnaire enabled residents to evaluate the seminar and assessed new knowledge and skill acquisition. Seventy-eight residents completed the precourse and postcourse questionnaires. The vast majority of respondents indicated that they taught medical students (72 of 78 [92.3%]). Approximately 20% of residency programs (17 of 78) provided residents with formal didactic programs on teaching skills. Fewer than half (46.8%) of the resident respondents indicated that they received feedback on their teaching from attending physicians (36 of 77), and only 18% (13 of 78) routinely gave feedback to their own learners. All of the course participants agreed or strongly agreed that this workshop was helpful to them as teachers. Few residency programs had instituted resident teacher training curricula. A resident teacher training workshop was perceived as beneficial by the residents, and they reported improvement in their teaching skills. Copyright © 2011 AUR. Published by
Neal Devins; Saikrishna Prakash
.... First, the duties to enforce and defend lack any sound basis in the Constitution. Hence, while President Obama is right to refuse to defend the Defense of Marriage Act, he is wrong to continue to enforce a law he believes is unconstitutional...
Cook, David A; Beckman, Thomas J; Thomas, Kris G; Thompson, Warren G
Increased clinical demands and decreased available time accentuate the need for efficient learning in postgraduate medical training. Adapting Web-based learning (WBL) to learners' prior knowledge may improve efficiency. We hypothesized that time spent learning would be shorter and test scores not adversely affected for residents who used a WBL intervention that adapted to prior knowledge. Randomized, crossover trial. Academic internal medicine residency program continuity clinic. 122 internal medicine residents. Four WBL modules on ambulatory medicine were developed in standard and adaptive formats. The adaptive format allowed learners who correctly answered case-based questions to skip the corresponding content. The measurements were knowledge posttest, time spent on modules, and format preference. One hundred twenty-two residents completed at least 1 module, and 111 completed all 4. Knowledge scores were similar between the adaptive format (mean +/- standard error of the mean, 76.2 +/- 0.9) and standard (77.2 +/- 0.9, 95% confidence interval [CI] for difference -3.0 to 1.0, P = .34). However, time spent was lower for the adaptive format (29.3 minutes [CI 26.0 to 33.0] per module) than for the standard (35.6 [31.6 to 40.3]), an 18% decrease in time (CI 9 to 26%, P = .0003). Seventy-two of 96 respondents (75%) preferred the adaptive format. Adapting WBL to learners' prior knowledge can reduce learning time without adversely affecting knowledge scores, suggesting greater learning efficiency. In an era where reduced duty hours and growing clinical demands on trainees and faculty limit the time available for learning, such efficiencies will be increasingly important. For clinical trial registration, see http://www.clinicaltrials.gov NCT00466453 ( http://www.clinicaltrials.gov/ct/show/NCT00466453?order=1 ).
Presents activities in which students are asked to (1) identify sources of duties affecting individual behavior; (2) define and give examples of legal, as well as social, religious and moral duties; (3) and compare social, religious, moral, and legal duties and discuss their relationships. (DB)
...); Skidmore v. Swift, 323 U.S. 134 (1944); General Electric Co. v. Porter, 208 F. 2d 805 (C.A. 9, 1953), cert.... 2d 114 (C.A. 7, 1946) cert. denied 330 U.S. 843 (1947); Bell v. Porter, 159 F. 2d 117 (C.A. 7, 1946...
Master VBA automation quickly and easily to get more out of Excel Excel VBA 24-Hour Trainer, 2nd Edition is the quick-start guide to getting more out of Excel, using Visual Basic for Applications. This unique book/video package has been updated with fifteen new advanced video lessons, providing a total of eleven hours of video training and 45 total lessons to teach you the basics and beyond. This self-paced tutorial explains Excel VBA from the ground up, demonstrating with each advancing lesson how you can increase your productivity. Clear, concise, step-by-step instructions are combined wit
... 19 Customs Duties 2 2010-04-01 2010-04-01 false Liability of importer for duties. 141.1 Section... Merchandise § 141.1 Liability of importer for duties. (a) Time duties accrue. Duties and the liability for... for by law. (b) Payment of duties—(1) Personal debt of importer. The liability for duties,...
Askin, Amanda Christine; Barter, Garrett.; West, Todd H.; Manley, Dawn Kataoka
This report describes work performed for an Early Career Research and Development project. This project developed a heavy-duty vehicle (HDV) sector model to assess the factors influencing alternative fuel and efficiency technology adoption. This model builds on a Sandia light duty vehicle sector model and provides a platform for assessing potential impacts of technological advancements developed at the Combustion Research Facility. Alternative fuel and technology adoption modeling is typically developed around a small set of scenarios. This HDV sector model segments the HDV sector and parameterizes input values, such as fuel prices, efficiencies, and vehicle costs. This parameterization enables sensitivity and trade space analyses to identify the inputs that are most associated with outputs of interest, such as diesel consumption and greenhouse gas emissions. Thus this analysis tool enables identification of the most significant HDV sector drivers that can be used to support energy security and climate change goals.
Kal'nysh, V V; Shvets', A V; Ieshchenko, O I
Psychophysiological peculiarities of influence of a 24-hour shift work on the efficiency of operators have been discussed. It was shown that servicemen operators develop significant fatigue as a result of 24 hrs duty services. The informative psychophysiological characteristics which can be reliable indicators of fatigue level are highlighted. Individual psychophysiological indicators of fatigue level, according to different mechanisms of its development, have been proposed. The hypothesis about the existence of several compensatory mechanisms for maintenance of long duty operators' working capacity has been formulated.
Deligiannis, Ilias; Dimitriadis, Panayiotis; Koutsoyiannis, Demetris
The wind process is essential for hydrometeorology and additionally, is one of the basic renewable energy resources. Most stochastic forecast models are limited up to daily scales disregarding the hourly scale which is significant for renewable energy management. Here, we analyze hourly wind timeseries giving emphasis on the temporal distribution of wind within the day. We finally present a periodic model based on statistical as well as hydrometeorological reasoning that shows good agreement with data. Acknowledgement: This research is conducted within the frame of the undergraduate course "Stochastic Methods in Water Resources" of the National Technical University of Athens (NTUA). The School of Civil Engineering of NTUA provided moral support for the participation of the students in the Assembly.
Human Resources Division
Due to the extra workload generated by the global renewal of French cards and in order to preserve the level of service offered by the cards office, please note that this office will in future be open every morning from 8.30 a.m. to 12.30 p.m. until further notice. The service can be contacted by telephone during the same hours. Thank you for your understanding.
Department of Housing and Urban Development — The Resident Characteristics Report summarizes general information about households who reside in Public Housing, or who receive Section 8 assistance. The report...
Damewood, Richard B; Blair, Patrice Gabler; Park, Yoon Soo; Lupi, Linda K; Newman, Rachel Williams; Sachdeva, Ajit K
The American College of Surgeons (ACS) appointed a committee of leaders from the ACS, Association of Program Directors in Surgery, Accreditation Council for Graduate Medical Education, and American Board of Surgery to define key challenges facing surgery resident training programs and to explore solutions. The committee wanted to solicit the perspectives of surgery resident program directors (PDs) given their pivotal role in residency training. Two surveys were developed, pilot tested, and administered to PDs following Institutional Review Board approval. PDs from 247 Accreditation Council for Graduate Medical Education-accredited general surgery programs were randomized to receive 1 of the 2 surveys. Bias analyses were conducted, and adjusted Pearson χ(2) tests were used to test for differences in response patterns by program type and size. All accredited general surgery programs in the United States were included in the sampling frame of the survey; 10 programs with initial or withdrawn accreditation were excluded from the sampling frame. A total of 135 PDs responded, resulting in a 54.7% response rate (Survey A: n = 67 and Survey B: n = 68). The respondent sample was determined to be representative of program type and size. Nearly 52% of PD responses were from university-based programs, and 41% had over 6 residents per graduating cohort. More than 61% of PDs reported that, compared to 10 years ago, both entering and graduating residents are less prepared in technical skills. PDs expressed significant concerns regarding the effect of duty-hour restrictions on the overall preparation of graduating residents (61%) and quality of patient care (57%). The current 5-year training structure was viewed as needing a significant or extensive increase in opportunities for resident autonomy (63%), and the greatest barriers to resident autonomy were viewed to be patient preferences not to be cared for by residents (68%), liability concerns (68%), and Centers for Medicare and
trainer relationship can only then be imagined. ... like these lend themselves to personal and cultural ... An ideal resident's clinical options .... of humanistic and professional values, the lack of .... graduate medical education should do more in mak-.
Lichstein, P R; Turner, R C; O'Brien, K
To survey internal medicine residency program directors regarding interactions between their residents and pharmaceutical company (PC) representatives (PCRs) a questionnaire was sent to the directors of all Accreditation Council for Graduate Medical Education-approved internal medicine residency programs. The survey included 444 program directors, of whom 272 (61.16%) responded. The majority of program directors, 228 (83.8%), allowed PCRs to meet with residents during working hours and 241 (88.6%) permitted PC sponsorship of conferences. About half of the program directors were "moderately" or "very" concerned about the potential adverse effects of PC marketing on resident attitudes and prescribing practices. Seventy percent "agreed" or "strongly agreed" that the benefits of PC sponsorship outweigh the adverse effects and 41.5% believed that refusal to allow PCRs to meet with residents would jeopardize PC funding of other departmental activities. Most program directors reported that alternate funds for conferences were available if PC support was withdrawn. "Unethical" marketing activities were observed by 14.3% of program directors and 37.5% reported that residents had participated in PC-sponsored trips during the 3 years prior to the survey. At the time of this survey, only 35.3% of programs had developed formal policies regulating PCR activities and 25.7% provided residents with formal instruction on marketing issues. Knowledge of the current extent of PCR interactions with residents may be helpful to program directors in developing policies regulating PC-marketing activities.
Palesa; Temaswati; Mthethwa
VEGETARIAN for a week! That was the plan.But it’s funny how side effects start kicking in so early when trying to let go of an everyday habit.The first morning of my experiment,I felt like I hadn’t eaten poultry in months(I had devoured a bucket of KFC the night before).Lunch was a disaster.I didn’t know whether to cook or spend an hour searching for a restaurant. That afternoon I received the worst phone call a first-time vegetarian can get:
Lowery, Joseph W
Comprehensive written and interactive instruction for learning HTML5 HTML is the core technology for building websites. Today, with HTML5 opening the Internet to new levels of rich content and dynamic interactivity, developers are looking for information to learn and utilize HTML5. HTML5 24-Hour Trainer provides that information, giving new and aspiring web developers the knowledge they need to achieve early success when building websites. Covers the most basic aspects of a web page, including a brief introduction to Cascading Style Sheets (CSS) Provides lessons that are backed up by prof
Quick and painless Java programming with expert multimedia instruction Java Programming 24-Hour Trainer, 2nd Edition is your complete beginner's guide to the Java programming language, with easy-to-follow lessons and supplemental exercises that help you get up and running quickly. Step-by-step instruction walks you through the basics of object-oriented programming, syntax, interfaces, and more, before building upon your skills to develop games, web apps, networks, and automations. This second edition has been updated to align with Java SE 8 and Java EE 7, and includes new information on GUI b
In 'bioethics', the rights to self-determination and to informed consent of the patient are prerequisites to every medical decision: paternalism is no longer a justifiable attitude. Hence, it seems that compulsory vaccination is an unacceptable praxis. Even John Stuart Mill. however, took into account other values: e.g. the duty not to harm others. This article is dedicated to the analysis of the historical development of these values and to their relevance for the ethics of vaccination. The acceptability of coercion is upheld, but no clear-cut answers are given in general: in every case the pros and cons of coercion are to be weighed carefully against each other.
MacKay, Douglas; Rulli, Tina
We examine current applications of the moral duty to rescue to justify clinical investigators' duties of ancillary care and standard of care to subjects in resource-poor settings. These applications fail to explain why investigators possess obligations to research participants, in particular, and not to people in need, in general. Further, these applications fail to recognize the normative significance of the institutional role of the investigators. We offer a positive account of the duty to rescue for investigators as institutional agents, with duties to populations rather than merely individuals.
Full Text Available 7 positions in 2 hours (2013 is a drawing that documents the process of making the short film Role Reversal Rehearsal. It became quickly apparent that the process of making the work was more dynamic and interesting than the finished piece itself. Relationships between the childcare arrangements of the participants and the collective working process brought about the necessity of collaboration for parent artists. Each participant gave their time, energy and creative insight towards filming a series of birthing positions with roles reversed. The male performer became the central figure in an attempt to prompt empathy, humour, and to embody the importance of the male role in childbirth. There were two hours to choreograph, rehearse, and film the sequence. The drawing by Ackerman encapsulates the 'rhizomatic' approach to producing creative work under the constraints of parenthood. The 'arborescent' structure of hierarchy encouraged in industrial filmmaking is subsumed in favour of a horizontal structure. This new structure allows for the creative input, and flow of collaboration between all people involved - including the 3 and 5 year olds, who contributed ideas for camera and soundtrack in situ.
... duties. For purposes of calculating estimated duties, the port director shall use the rate or rates... 19 Customs Duties 2 2010-04-01 2010-04-01 false Rates for estimated duties. 159.38 Section 159.38 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND SECURITY; DEPARTMENT OF...
Côté, Valérie; Kus, Lukas H; Zhang, Xun; Richardson, Keith; Nguyen, Lily H
We conducted a study to assess residents' levels of comfort with advanced airway management in Canadian otolaryngology residency programs. In October 2008, an electronic questionnaire was sent to all otolaryngology residents in Canada. Responses were voluntary and anonymous. The response rate was 64.8% (94 of 145 residents). Residents were asked about the amount of teaching they received and the amount they would like to receive each year in four areas: emergency surgical airway, pediatric airway, airway trauma, and management of complications during laryngoscopy/bronchoscopy. They were also asked how comfortable they were with their current level of knowledge in these areas. Overall, residents were not comfortable with difficult airway situations, scoring a mean of 3.08 on a 5-point Likert scale. Residents were most comfortable with the emergency airway and least comfortable with the pediatric airway. Overall, residents indicated that they had not received adequate teaching on advanced airway management, and they consistently desired more. With respect to the type of instruction, most residents requested more teaching via simulations, mannequins, and cadaver or animal models. Linear regression models revealed a positive relationship between their overall comfort with airway management and the number of airway teaching hours they received. Their consensus was that formal airway training should occur during postgraduate year (PGY) 2, with refresher courses offered every 2 years. This is the first wide-scale assessment of the status of airway teaching in otolaryngology residency programs in Canada. Overall, our findings suggest that otolaryngology residents in these programs are not comfortable with advanced airway management early in their training and feel they would benefit from a significant increase in airway teaching time. Comfort levels improved with increasing levels of training such that PGY5 residents indicated they were indeed comfortable with advanced
Carré, Françoise; Tilly, Chris
In settings where most workers have full-time schedules, hourly wages are appropriate primary indicators of job quality and worker outcomes. However, in sectors where full-time schedules do not dominate - primarily service-producing activities - total hours matter, in addition to hourly wages, for job quality and worker outcomes. In this paper we employ a sector-focused, comparative framework to further examine hours levels - measured as average weekly hours - and trends in Canada, the United...
Franco, Gianfábio Pimentel; de Barros, Alba Lúcia Bottura Leite; Nogueira-Martins, Luiz Antônio; Zeitoun, Sandra Salloum
Nursing residents may experience physical and emotional exhaustion from the daily life of attending the Program. The aim of this study was to determine the Burnout incidence among Nursing Residents. An investigative, descriptive, analytical, longitudinal-prospective study was conducted with 16 Residents over two years. The Maslach Burnout Inventory was used, translated and validated for Brazil, as well as a sociodemographic/occupational data tool. Of all residents, 17.2% showed high rates in Emotional Exhaustion and Depersonalization; 18.8% showed impaired commitment in Personal Accomplishment, 75% of which belonged to specialty areas, such as Emergency Nursing, Adult and Pediatric Intensive Care. Age and specialty area were positively correlated with Personal Accomplishment. One of the Residents was identified with changes in three subscales of the Maslach Burnout Inventory, thus characterized as a Burnout Syndrome patient. Nursing Residents have profiles of disease. Knowing these factors can minimize health risks of these workers.
Christensen, Mette K.; O'Neill, Lotte Dyhrberg; Hansen, Dorthe H.;
Background The majority of studies on prevalence and characteristics of residents in difficulty have been conducted in English-speaking countries and the existing literature may not reflect the prevalence and characteristics of residents in difficulty in other parts of the world such as the Scand......Background The majority of studies on prevalence and characteristics of residents in difficulty have been conducted in English-speaking countries and the existing literature may not reflect the prevalence and characteristics of residents in difficulty in other parts of the world...... of the topic. Methods We performed a mixed methods study. All regional residency program directors (N = 157) were invited to participate in an e-survey about residents in difficulty. Survey data were combined with database data on demographical characteristics of the background population (N = 2399...
Roach, Gregory D; Sargent, Charli; Darwent, David; Dawson, Drew
Most of the research related to human fatigue in the aviation industry has focussed on long-haul pilots, but short-haul pilots also experience elevated levels of fatigue. The aim of this study was to examine the impact of early start times on the amount of sleep obtained prior to duty and on fatigue levels at the start of duty. Seventy short-haul pilots collected data regarding their duty schedule and sleep/wake behaviour for at least two weeks. Data were collected using self-report duty/sleep diaries and wrist activity monitors. Mixed-effects regression analyses were used to examine the effects of duty start time (04:00-10:00 h) on (i) the total amount of sleep obtained in the 12h prior to the start of duty and (ii) self-rated fatigue level at the start of duty. Both analyses indicated significant main effects of duty start time. In particular, the amount of sleep obtained in the 12h prior to duty was lowest for duty periods that commenced between 04:00 and 05:00 h (i.e. 5.4h), and greatest for duty periods that commenced between 09:00 and 10:00 h (i.e. 6.6h). These data indicate that approximately 15 min of sleep is lost for every hour that the start of duty is advanced prior to 09:00 h. In addition, self-rated fatigue at the start of duty was highest for duty periods that commenced between 04:00 and 05:00 h, and lowest for duty periods that commenced between 09:00 and 10:00 h. Airlines should implement a fatigue risk management system (FRMS) for short-haul pilots required to work early-morning shifts. One component of the FRMS should be focussed on the production of 'fatigue-friendly' rosters. A second component of the FRMS should be focussed on training pilots to optimise sleep opportunities, to identify circumstances where the likelihood of fatigue is elevated, and to manage the risks associated with fatigue-related impairment.
Can there be a duty to forgive those who have wronged us? According to a popular view amongst philosophers working on forgiveness the answer is no. Forgiveness, it is claimed, is always elective. This view is rejected by Gamlund (2010a; 2010b) who argues that duties to forgive do exist and then
Garcia, J L A
This essay rebuts Gary Seay's efforts to show that committing euthanasia need not conflict with a physician's professional duties. First, I try to show how his misunderstanding of the correlativity of rights and duties and his discussion of the foundation of moral rights undermine his case. Second, I show aspects of physicians' professional duties that clash with euthanasia, and that attempts to avoid this clash lead to absurdities. For professional duties are best understood as deriving from professional virtues and the commitments and purposes with which the professional as such ought to act, and there is no plausible way in which her death can be seen as advancing the patient's medical welfare. Third, I argue against Prof. Seay's assumption that apparent conflicts among professional duties must be resolved through "balancing" and argue that, while the physician's duty to extend life is continuous with her duty to protect health, any duty to relieve pain is subordinate to these. Finally, I show that what is morally determinative here, as throughout the moral life, is the agent's intention and that Prof. Seay's implicitly preferred consequentialism threatens not only to distort moral thinking but would altogether undermine the medical (and any other) profession and its internal ethics.
... 45 Public Welfare 1 2010-10-01 2010-10-01 false IRB duties. 46.403 Section 46.403 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION PROTECTION OF HUMAN SUBJECTS Additional Protections for Children Involved as Subjects in Research § 46.403 IRB duties. In addition to...
Lenard, Patti Tamara
.... I argue that receiving states are duty-bound to act in ways that enable migrants to exercise their right to exit. In particular, I argue that receiving states have a perfect duty to collectivize the process by which needy migrants can exercise the right to exit.
Can there be a duty to forgive those who have wronged us? According to a popular view amongst philosophers working on forgiveness the answer is no. Forgiveness, it is claimed, is always elective. This view is rejected by Gamlund (2010a; 2010b) who argues that duties to forgive do exist and then prov
Figone, Albert J.
This article identifies seven legal duties of coaches and discusses the practical application of each. These duties relate to supervision, planning, warning of risks, providing a safe environment, evaluating players for injuries and incapacities, fairly matching players, and first aid and emergency procedures. (IAH)
... the Secretary, a program of research, advertising, and sales promotion projects, together with a... AND ORDERS; MISCELLANEOUS COMMODITIES), DEPARTMENT OF AGRICULTURE COTTON RESEARCH AND PROMOTION Cotton Research and Promotion Order Cotton Board § 1205.332 Duties. The Board shall have the following duties:...
Tian, Zhao; Jia, Li-Min; Dong, Hong-Hui; Zhang, Zun-Dong; Ye, Yang-Dong
Traffic congestion is now nearly ubiquitous in many urban areas and frequently occurs during rush hour periods. Rush hour avoidance is an effective way to ease traffic congestion. It is significant to calculate the rush hour for alleviating traffic congestion. This paper provides a method to calculate the fuzzy peak hour of the urban traffic network considering the flow, speed and occupancy. The process of calculation is based on betweenness centrality of network theory, optimal separation method, time period weighting, probability-possibility transformations and trapezoidal approximations of fuzzy numbers. The fuzzy peak hour of the urban road traffic network (URTN) is a trapezoidal fuzzy number [m1, m2, m3, m4]. It helps us (i) to confirm a more detailed traffic condition at each moment, (ii) to distinguish the five traffic states of the traffic network in one day, (iii) to analyze the characteristic of appearance and disappearance processes of the each traffic state and (iv) to find out the time pattern of residents travel in one city.
Dharan, Nadiv; Farago, Oded
Molecular motors are found throughout the cells of the human body and have many different and important roles. These micromachines move along filament tracks and have the ability to convert chemical energy into mechanical work that powers cellular motility. Different types of motors are characterized by different duty ratios, which is the fraction of time that a motor is attached to its filament. In the case of myosin II (a nonprocessive molecular machine with a low duty ratio), cooperativity between several motors is essential to induce motion along its actin filament track. In this work we use statistical mechanical tools to calculate the duty ratio of cooperative molecular motors. The model suggests that the effective duty ratio of nonprocessive motors that work in cooperation is lower than the duty ratio of the individual motors. The origin of this effect is the elastic tension that develops in the filament which is relieved when motors detach from the track.
Verbanis, Ephanielle; Martin, Anthony; Houlmann, Raphaël; Boso, Gianluca; Bussières, Félix; Zbinden, Hugo
Bit commitment is a fundamental cryptographic primitive in which a party wishes to commit a secret bit to another party. Perfect security between mistrustful parties is unfortunately impossible to achieve through the asynchronous exchange of classical and quantum messages. Perfect security can nonetheless be achieved if each party splits into two agents exchanging classical information at times and locations satisfying strict relativistic constraints. A relativistic multiround protocol to achieve this was previously proposed and used to implement a 2-millisecond commitment time. Much longer durations were initially thought to be insecure, but recent theoretical progress showed that this is not so. In this Letter, we report on the implementation of a 24-hour bit commitment solely based on timed high-speed optical communication and fast data processing, with all agents located within the city of Geneva. This duration is more than 6 orders of magnitude longer than before, and we argue that it could be extended to one year and allow much more flexibility on the locations of the agents. Our implementation offers a practical and viable solution for use in applications such as digital signatures, secure voting and honesty-preserving auctions.
Kinoshita, Kensuke; Tsugawa, Yusuke; Shimizu, Taro; Tanoue, Yusuke; Konishi, Ryota; Nishizaki, Yuji; Shiojiri, Toshiaki; Tokuda, Yasuharu
Both clinical workload and access to learning resource are important components of educational environment and may have effects on clinical knowledge of residents. We conducted a survey with a clinical knowledge evaluation involving postgraduate year (PGY)-1 and -2 resident physicians at teaching hospitals offering 2-year postgraduate training programs required for residents in Japan, using the General Medicine In-Training Examination (GM-ITE). An individual-level analysis was conducted to examine the impact of the number of assigned patients and emergency department (ED) duty on the residents' GM-ITE scores by fitting a multivariable generalized estimating equations. In hospital-level analysis, we evaluated the relationship between for the number of UpToDate reviews for each hospital and for the hospitals' mean GM-ITE score. A total of 431 PGY-1 and 618 PGY-2 residents participated. Residents with four or five times per month of the ED duties exhibited the highest mean scores compared to those with greater or fewer ED duties. Those with largest number of inpatients in charge exhibited the highest mean scores compared to the residents with fewer inpatients in charge. Hospitals with the greater UpToDate topic viewing showed significantly greater mean score. Appropriate ED workload and inpatient caseload, as well as use of evidence-based electronic resources, were associated with greater clinical knowledge of residents.
Outlines the author's experience as a dancer and choreographer artist-in-residence with third graders at a public elementary school, providing a cultural arts experience to tie in with a theme study of the rain forest. Details the residency and the insights she gained working with students, teachers, and theme. (SR)
Ryu, Won Hyung A; Chan, Sonny; Sutherland, Garnette R
The proposed implementation of work hour restrictions has presented a significant challenge of maintaining the quality of resident education and ensuring adequate hands-on experience that is essential for novice surgeons. To maintain the level of resident surgical competency, revision of the apprentice model of surgical education to include supplementary educational methods, such as laboratory and virtual reality (VR) simulations, have become frequent topics of discussion. We aimed to better understand the role of supplementary educational methods in Canadian neurosurgery residency training. An online survey was sent to program directors of all 14 Canadian neurosurgical residency programs and active resident members of the Canadian Neurosurgical Society (N=85). We asked 16 questions focusing on topics of surgeon perception, current implementation and barriers to supplementary educational models. Of the 99 surveys sent, 8 out of 14 (57%) program directors and 37 out of 85 (44%) residents completed the survey. Of the 14 neurosurgery residency programs across Canada, 7 reported utilizing laboratory-based teaching within their educational plan, while only 3 programs reported using VR simulation as a supplementary teaching method. The biggest barriers to implementing supplementary educational methods were resident availability, lack of resources, and cost. Work-hour restrictions threaten to compromise the traditional apprentice model of surgical training. The potential value of supplementary educational methods for surgical education is evident, as reported by both program directors and residents across Canada. However, availability and utilization of laboratory and VR simulations are limited by numerous factors such as time constrains and lack of resources.
Christensen, Mette Krogh; O'Neill, Lotte; Hansen, Dorthe Høgh;
Background The majority of studies on prevalence and characteristics of residents in difficulty have been conducted in English-speaking countries and the existing literature may not reflect the prevalence and characteristics of residents in difficulty in other parts of the world such as the Scand......Background The majority of studies on prevalence and characteristics of residents in difficulty have been conducted in English-speaking countries and the existing literature may not reflect the prevalence and characteristics of residents in difficulty in other parts of the world...... such as the Scandinavian countries, where healthcare systems are slightly different. The aim of this study was to examine prevalence and characteristics of residents in difficulty in one out of three postgraduate medical training regions in Denmark, and to produce both a quantifiable overview and in-depth understanding...
Luks, Andrew M; Smith, C Scott; Robins, Lynne; Wipf, Joyce E
Night float rotations are being increasingly used in the era of resident physician work-hour regulations, but their impact on resident education is not clear. Our objective was to clarify resident perceptions of the educational aspects of night float rotations. An anonymous survey of internal medicine residents at a university-based residency program was completed. Responses were received from 116 of 163 surveyed residents (71%). Residents attended less residents' report (0.10 +/- .43 vs. 2.70 + 0.93 sessions/week, pvalue of night float, sleep cycle adjustment issues, and impact on their personal lives, which correlated with resident evaluations from the regular program evaluation process. In free responses, residents commented that they liked the autonomy and opportunity to improve triage skills on these rotations and confirmed their negative opinions about the sleep-wake cycle and interference with personal lives. Internal medicine residents at a university-based program have negative opinions regarding the educational value of night float rotations. Further work is necessary to determine whether problems exist across programs and specialties.
Jaeger, L; Bertram, E; Grate, S; Mischkowsky, T; Paul, D; Probst, J; Scala, E; Wbllenweber, H D
On 26 February 2013 the new "Law on Patients' Rights" (hereinafter also the "Law") became effective. This Law strengthens patients' rights vis-à-vis the insurdnce company and also regulates patients' rights regarding their relation to the doctor. This has consequences for the laws on medical liability all doctors must consider. The doctor's performance is and remains a service and such service does not hold any guarantee of success. Nevertheless, this Law primarily reads as a "law on the duties of physicians". To duly take into account these duties and to avoid mistakes and misinterpretation of the Law, the Ethics Committee of the Consortium of Osteosynthesis Trauma Germany (AOTRAUMA-D) has drafted comments on the Law. Brief summaries of its effects are to be found at the end of the respective comment under the heading "Consequences for Practice". The text of the law was influenced particularly by case law, as continuously developed by the German Federal Court of Justice ("BGH"). The implementation of the Law on Patients' Rights was effected by the newly inserted sections 630a to 630h of the German Civil Code (the "BGB"), which are analysed below. The following comments are addressed to physicians only and do not deal with the specific requirements and particularities of the other medical professions such as physiotherapy, midwifery and others so on. Special attention should be paid to the comments on the newly inserted Duty to inform, which has to be fullfilled prior to any diagnostic or therapeutic procedure (sec. 630c para 2 sentence 1 BGB). Under certain conditions the doctor also has to inform the patient about the circumstances that lead to the presumed occurance of a therapeutic or diagnostic malpractice (sec. 630c para. 2 sentence 2 BGB), based on the manifestation of an undesired event or an undesired outcome. As before, the patient's valid consent to any procedure (sec. 630d BGB) is directly linked to the comprehensive and timely provision of information
Full Text Available Abstract Background A Night Float (NF system has been implemented by many institutions to address increasing concerns about residents' work hours. The purpose of our study was to examine the perceptions of residents towards a NF system. Methods A 115-item questionnaire was developed to assess residents' perceptions of the NF rotation as compared with a regular call month. The categories included patient care, education, medical errors, and overall satisfaction. Internal Medicine housestaff (post-graduate years 1–3 from three hospital settings at the University of Pittsburgh completed the questionnaire. Results The response rate was 90% (n = 149. Of these, 74 had completed the NF rotation. The housestaff felt that the quality of patient care was improved because of NF (41% agreed and 18% disagreed. A majority also felt that better care was provided by a rested physician in spite of being less familiar with the patient (46% agreed and 21% disagreed. Most felt that there was less emphasis on education (65% and more emphasis on service (52% during NF. Overall, the residents felt more rested during their call months (83% and strongly supported the 80-hour workweek requirement (77%. Conclusion Housestaff felt that the overall quality of patient care was improved by a NF system. The perceived improved quality of care by a rested physician coupled with a perceived decrease in the emphasis on education may have significant implications in housestaff training.
In most managerial, management-related, sales, production, and transportation occupations, workers with longer hours earned a high hourly rate. The reverse was true for some jobs, including computer specialists, engineers, schoolteachers, and construction workers. (JOW)
In the summer, the three CERN restaurants remain open during their usual hours. On Monday 1st August and Thursday 8 September, the Restaurant 1 will be open from 7:00 a.m. to 10:00 p.m. The satellites will be open as follows: Building 6: normal hours Building 13: normal hours Building 30: normal hours Building 40: closing at 4:30 p.m. instead of 5:00 pm Building 54: normal hours in July, closed in August Building 864: normal hours Building 865: normal hours Building 774: normal hours
Tiffany Michele Hébert MD
Full Text Available Onboarding is a system frequently used in the corporate world as a means of orienting incoming employees to their duties and inculcating the workplace values. The program aims to facilitate transition into new work roles and improve employee retention rates. At Montefiore, we have instituted an onboarding curriculum that is given to new anatomic and clinical pathology residents about a month prior to the start of residency. The program includes an introductory video series of basic histology and a series of anatomic and clinical case studies illustrating basic laboratory principles. This didactic content is tagged to learning objectives and short self-assessment modules. In addition, content related to the work ethos at Montefiore and the role of the core competencies and milestones in residency education are included. Finally, a broader component of the onboarding gives the incoming residents a social welcome to our area, including key information about living in the area surrounding Montefiore. The program has been well received by our residents for whom the content has helped to boost confidence when starting. We feel that the program is helpful in ensuring that all incoming residents start having received the same baseline didactic content. Transmitting this didactic content via onboarding allows our residents to begin the work of learning pathology immediately, rather than spending the first weeks of residency covering remedial content such as basic histology. Such a program may be useful to other pathology residencies, most of whom have residents from a range of backgrounds and whose prior exposure to pathology may be limited.
Constant, Amelie F.; Otterbach, Steffen
If individuals reveal their preference as consumers, then they are taken seriously. What happens if individuals, as employees, reveal their preferences in working hours? And what happens if there is a misalignment between actual hours worked and preferred hours, the so-called work hours constraints? How does this affect the productivity of workers, their health, and overall life satisfaction? Labor supply and corresponding demand are fundamental to production. Labor economists know for long t...
Bueno, José Ignacio; Vázquez, Javier
The selection from available commercial market of a set of slides to be used in an habitable pressurised module in space, to draw a 660 mm box out of a rack, up to a completely extracted position in a safely supported configuration, seems in principle not to be a complicated task. That was the first approach taken in the design process of the telescopic guides of the Crew Work Bench (CWB) included in the Fluid Science Laboratory (FSL), part of "ESA Microgravity Facilities for Columbus" within the Columbus Orbital Facility (COF) of the International Space Station (ISS). Nevertheless, common space compatible requirements such as materials, specific environmental loads, available envelope, total weight, etc., can make the selection of telescopic slides from commercial market unfeasible. A specific development to design space compatible telescopic slides for the CWB was undertaken. A set of heavy duty space compatible telescopic slides were designed, manufactured and tested. They should be operative in both, 1-g environment and in orbit, and additionally should withstand an inadvertent astronaut kick or bump of 556 N in any direction.
... Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (MARKETING AGREEMENTS AND ORDERS; MISCELLANEOUS COMMODITIES), DEPARTMENT OF AGRICULTURE WATERMELON RESEARCH AND PROMOTION PLAN Watermelon Research and Promotion Plan National Watermelon Promotion Board § 1210.328 Duties....
... Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (MARKETING AGREEMENTS AND ORDERS; MISCELLANEOUS COMMODITIES), DEPARTMENT OF AGRICULTURE POTATO RESEARCH AND PROMOTION PLAN Potato Research and Promotion Plan National Potato Promotion Board § 1207.328 Duties. The Board...
Malm, Heidi; May, Thomas; Francis, Leslie P; Omer, Saad B; Salmon, Daniel A; Hood, Robert
Numerous grounds have been offered for the view that healthcare workers have a duty to treat, including expressed consent, implied consent, special training, reciprocity (also called the social contract view), and professional oaths and codes. Quite often, however, these grounds are simply asserted without being adequately defended or without the defenses being critically evaluated. This essay aims to help remedy that problem by providing a critical examination of the strengths and weaknesses of each of these five grounds for asserting that healthcare workers have a duty to treat, especially as that duty would arise in the context of an infectious disease pandemic. Ultimately, it argues that none of the defenses is currently sufficient to ground the kind of duty that would be needed in a pandemic. It concludes by sketching some practical recommendations in that regard.
Full Text Available Duties of protection are duties of the state to protect certain legal interests of its citizens. They cover the interests of life, health, freedom and property and also protect some other interests and certain constitutionally recognised institutions. State duties of protection must be considered in connection with fundamental rights. The foundations of modern constitutionalism and attendant procedures are essential to develop guidelines for a constructive critique of the jurisprudence of the Constitutional Court. This is done with reference to the recent history of France, Germany and England. The historical excursus reveals that a single theory underlies the variety of constitutional states. The development of the constitutional state gave rise to the significance of the preservation of freedom through the maintenance of law and the separation of powers. This has given rise to various legal devices, based also in part on experience with moderate rule and earlier theories of the imperium limitatum.A textual analysis of the German Basic Law is undertaken to determine whether and how the duties of protection are expressly created. Furthermore, the duties that have been discovered in the Basic Law by the Federal Constitutional Court are considered. These duties include the protection of human life and health, personal freedom, the right to autonomous development of one's personality, freedom of science, research and teaching, marriage and the family, children, mothers, professional freedom, property and the protection of German nationals against foreign states. Finally the justification of such duties and the constitutional control of the manner of protection are considered.In a final section a critique of relevant constitutional jurisprudence is undertaken. It is argued that claims to protection cannot be directly binding law. They presuppose legislation. If statutory protection is connected with infringements of third-party fundamental rights
... § 10.43 Duty-free status. (a) The port director may, at his discretion, require appropriate proof of... 19 Customs Duties 1 2010-04-01 2010-04-01 false Duty-free status. 10.43 Section 10.43 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND SECURITY; DEPARTMENT OF THE...
... 19 Customs Duties 2 2010-04-01 2010-04-01 false Estimated duties on raw sugar. 151.22 Section 151... THE TREASURY (CONTINUED) EXAMINATION, SAMPLING, AND TESTING OF MERCHANDISE Sugars, Sirups, and Molasses § 151.22 Estimated duties on raw sugar. Estimated duties shall be taken on raw sugar, as defined...
... 19 Customs Duties 1 2010-04-01 2010-04-01 false Enforcement; duties of Customs officers. 12.62 Section 12.62 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND SECURITY...; duties of Customs officers. (a) In accordance with the authority contained in sections 10 and 12 of...
Earl, G.; Curtis, A.; Allan, C.
The decline in biodiversity is a worldwide phenomenon, with current rates of species extinction more dramatic than any previously recorded. Habitat loss has been identified as the major cause of biodiversity decline. In this article we suggest that a statutory duty of care would complement the current mix of policy options for biodiversity conservation. Obstacles hindering the introduction of a statutory duty of care include linguistic ambiguity about the terms ‘duty of care’ and ‘stewardship’ and how they are applied in a natural resource management context, and the absence of a mechanism to guide its implementation. Drawing on international literature and key informant interviews we have articulated characteristics of duty of care to reduce linguistic ambiguity, and developed a framework for implementing a duty of care for biodiversity at the regional scale. The framework draws on key elements of the common law ‘duty of care’, the concepts of ‘taking reasonable care’ and ‘avoiding foreseeable harm’, in its logic. Core elements of the framework include desired outcomes for biodiversity, supported by current recommended practices. The focus on outcomes provides opportunities for the development of innovative management practices. The framework incorporates multiple pathways for the redress of non-compliance including tiered negative sanctions, and positive measures to encourage compliance. Importantly, the framework addresses the need for change and adaptation that is a necessary part of biodiversity management.
Drake, Frederick Thurston; Aarabi, Shahram; Garland, Brandon T; Huntington, Ciara R; McAteer, Jarod P; Richards, Morgan K; Zern, Nicole Kansier; Gow, Kenneth W
To describe secular trends in operative experience for surgical trainees across an extended period using the most comprehensive data available, the Accreditation Council for Graduate Medical Education (ACGME) case logs. Some experts have expressed concern that current trainees are inadequately prepared for independent practice. One frequently mentioned factor is whether duty hours' restrictions (DHR) implemented in 2003 and 2004 contributed by reducing time spent in the operating room. A dataset was generated from annual ACGME reports. Operative volume for total major cases (TMC), defined categories, and four index laparoscopic procedures was evaluated. TMC dropped after implementation of DHR but rebounded after a transition period (949 vs 946 cases, P = nonsignificance). Abdominal cases increased from 22% of overall cases to 31%. Alimentary cases increased from 21% to 26%. Trauma and vascular surgery substantially decreased. For trauma, this drop took place well before DHR. The decrease in vascular surgery also began before DHR but continued afterward as well: 148 cases/resident in the late 1990s to 107 currently. Although total operative volume rebounded after implementation of DHR, diversity of operative experienced narrowed. The combined increase in alimentary and abdominal cases is nearly 13%, over a half-year's worth of operating in 5-year training programs. Bedrock general surgery cases-trauma, vascular, pediatrics, and breast-decreased. Laparoscopic operations have steadily increased. If the competence of current graduates has, in fact, diminished. Our analysis suggests that operative volume is not the problem. Rather, changing disease processes, subspecialization, reductions in resident autonomy, and technical innovation challenge how today's general surgeons are trained.
Nakhla, Jonathan; Kobets, Andrew; De la Garza Ramos, Rafeal; Haranhalli, Neil; Gelfand, Yaroslav; Ammar, Adam; Echt, Murray; Scoco, Aleka; Kinon, Merritt; Yassari, Reza
The relatively decreased time spent in the operating room and overall reduction in cases performed by neurosurgical trainees as a result of duty-hour restrictions demands that the pedagogical content within each surgical encounter be maximized and crafted toward the specific talents and shortcomings of the individual. It is imperative to future generations that the quality of training adapts to the changing administrative infrastructures and compensates for anything that may compromise the technical abilities of trainees. Neurosurgeons in teaching hospitals continue to experiment with various emerging technologies-such as simulators and virtual presence-to supplement and improve surgical training. The authors participated in the Google Glass Explorer Program in order to assess the applicability of Google Glass as a tool to enhance the operative education of neurosurgical residents. Google Glass is a type of wearable technology in the form of eyeglasses that employs a high-definition camera and allows the user to interact using voice commands. Google Glass was able to effectively capture video segments of various lengths for residents to review in a variety of clinical settings within a large, tertiary care university hospital, as well as during a surgical mission to a developing country. The resolution and quality of the video were adequate to review and use as a teaching tool. While Google Glass harbors the potential to dramatically improve both neurosurgical education and practice in a variety of ways, certain technical drawbacks of the current model limit its effectiveness as a teaching tool. Copyright © 2016 Elsevier Inc. All rights reserved.
Fang, Michele; Linson, Eric; Suneja, Manish; Kuperman, Ethan F
Excellence in Graduate Medical Education requires the right clinical environment with an appropriate workload where residents have enough patients to gain proficiency in medicine with optimal time for reflection. The Accreditation Council for Graduate Medical Education (ACGME) has focused more on work hours rather than workload; however, high resident workload has been associated with lower resident participation in education and fatigue-related errors. Recognizing the potential risks associated with high resident workload and being mindful of the costs of reducing resident workload, we sought to reduce residents' workload by adding an advanced practice provider (APP) to the surgical comanagement service (SCM) and study its effect on resident satisfaction and perceived educational value of the rotation. In Fiscal Year (FY) 2014 and 2015, an additional faculty member was added to the SCM rotation. In FY 2014, the faculty member was a staff physician, and in FY 2015, the faculty member was an APP.. Resident workload was assessed using billing data. We measured residents' perceptions of the rotation using an anonymous electronic survey tool. We compared FY2014-2015 data to the baseline FY2013. The number of patients seen per resident per day decreased from 8.0(SD 3.3) in FY2013 to 5.0(SD 1.9) in FY2014 (p rotation (40.0%, 72.2%, 72.6% in FY2013, 2014, 2015 respectively, p rotation.
Full Text Available Medical residents, as part of their job to balance the demands of their work with caring for themselves so as to be mentally, emotionally, and physically sound to stay clinically competent. While regulatory and legislative attempts at limiting medical resident work hours have materialized but have yet to attain passage, there are fairly little data looking into how residents cope up with their demands and yet attend to their own personal health.Anonymous mailed survey.Three hundred and thirty-seven residents from all internal medicine residency programs within United States.We conducted a survey in the form of a questionnaire that was sent by e-mail to the program directors of various internal medicine residency programs within the United States, and responses were collected between May 19 and June 21, 2009. Response was well appreciated with total number of participants of 337 with even demographical distribution in gender, residency year, AMG/IMG, age group. Seventy-one percent of the residents felt that they would prefer getting admitted to their own hospital for any acute medical or surgical condition. Of the 216 residents who have had received health care in the past, almost half of them chose their own hospital because of the proximity, while 45% did not choose their own hospital despite proximity. Two out of three residents missed their doctors appointments or cancelled them due to demands of medical training. Only half of the residents have a primary care physician and almost 80% of them did not have their yearly health checkup. Close to 30% held back information regarding their social and sexual history from their provider because of privacy and confidentiality concerns. Eighty percent of residents never received information about barriers that physicians may face in obtaining care for their socially embarrassing conditions. Seventy percent felt that their performance then was suboptimal because of that health condition and also felt
Turgut, Namigar; Karacalar, Serap; Polat, Cengiz; Kıran, Özlem; Gültop, Fethi; Kalyon, Seray Türkmen; Sinoğlu, Betül; Zincirci, Mehmet; Kaya, Ender
The aim of this study is identified the degree of Burnout Syndrome (BOS) and find out its correlation with years of recidency and sociodemograpfic chareacteristics, training, sleeping habits, such as smoking and alcohol consumption. After approval from the Hospital Ethics Committee and obtaining informed consent, First, second, third, fourth and fifth year of recidency staff (n=127) working in our hospital were involved in this study. The standardized Maslach Burnout Inventory (MBI) was used in this study. Fifty six male (44.1%) and seventy one female (55.9%) residents were enroled in this study (Coranbach Alfa(α)=0.873). 57% of the first year residents smokes cigaret and 54% of them use alcohol. 2% of them gets one day off after hospital night shift, 61% of them suffers from disturbed sleep. 60% of them had been stated that they willingly selected their profession. 61% of them prefers talking to friends and 32% of them prefers shopping to overcome stress. There were statistical difference acording to years of recidency in MBI, Emotional Burnout (EB) and desensitisation scale (DS) points. EB scale points of the second year of residency group was statisticaly higher than fourth year of residency group. DS points of second year of residency group was also statisticaly higher than the third and fourth year of residency group. There was no statistical difference between any groups in Personal Success. BOS is a frequent problem during residency in anaesthesia. Appropriate definition and awareness are the first important steps to prevent this syndrome. Further administrative approaches should be evaluated with regard to their effects.
Yamamoto, Satoshi; Tanaka, Pedro; Madsen, Matias Vested;
Our goal in this study was to examine Accreditation Council for Graduate Medical Education case logs for Stanford anesthesia residents graduating in 2013 (25 residents) and 2014 (26 residents). The resident with the fewest recorded patients in 2013 had 43% the number of patients compared with the...
Roberts J Mark
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.
Baker, T.L. [Institute for Circadian Physiology, Boston, MA (United States)
A growing number of nuclear power plants in the United States have adopted routine 12-hr shift schedules. Because of the potential impact that extended work shifts could have on safe and efficient power plant operation, the U.S. Nuclear Regulatory Commission funded research on 8-hr and 12-hr shifts at the Human Alertness Research Center (HARC) in Boston, Massachusetts. This report describes the research undertaken: a study of simulated 8-hr and 12-hr work shifts that compares alertness, speed, and accuracy at responding to simulator alarms, and relative cognitive performance, self-rated mood and vigor, and sleep-wake patterns of 8-hr versus 12-hr shift workers.
Heikkila, Katriina; Nyberg, Solja T.; Madsen, Ida E. H.
Background: Working longer than the maximum recommended hours is associated with an increased risk of cardiovascular disease, but the relationship of excess working hours with incident cancer is unclear. Methods: This multi-cohort study examined the association between working hours and cancer risk...... in 116 462 men and women who were free of cancer at baseline. Incident cancers were ascertained from national cancer, hospitalisation and death registers; weekly working hours were self-reported. Results: During median follow-up of 10.8 years, 4371 participants developed cancer (n colorectal cancer: 393......; n lung cancer: 247; n breast cancer: 833; and n prostate cancer: 534). We found no clear evidence for an association between working hours and the overall cancer risk. Working hours were also unrelated the risk of incident colorectal, lung or prostate cancers. Working greater than or equal to55 h...
Klein, Eileen J; Jackson, J Craig; Kratz, Lyn; Marcuse, Edgar K; McPhillips, Heather A; Shugerman, Richard P; Watkins, Sandra; Stapleton, F Bruder
The need to teach professionalism during residency has been affirmed by the Accreditation Council for Graduate Medical Education, which will require documentation of education and evaluation of professionalism by 2007. Recently the American Academy of Pediatrics has proposed the following components of professionalism be taught and measured: honesty/integrity, reliability/responsibility, respect for others, compassion/empathy, self-improvement, self-awareness/knowledge of limits, communication/collaboration, and altruism/advocacy. The authors describe a curriculum for introducing the above principles of professionalism into a pediatrics residency that could serve as a model for other programs. The curriculum is taught at an annual five-day retreat for interns, with 11 mandatory sessions devoted to addressing key professionalism issues. The authors also explain how the retreat is evaluated and how the retreat's topics are revisited during the residency, and discuss general issues of teaching and evaluating professionalism.
.... tour. ] Limitations on Consecutive Duty Tours May not be on duty as a None If employee initiates or Total Duty Tours in Set Period. train employee after an on-duty period each initiating an on-duty day... time service for any on duty between 8 p.m. railroad carrier at and 4 a.m.) employee the employee's...
Molecular motors are found throughout the cells of the human body, and have many different and important roles. These micro-machines move along filament tracks, and have the ability to convert chemical energy into mechanical work that powers cellular motility. Different types of motors are characterized by different duty-ratios, which is the fraction of time that a motor is attached to its filament. In the case of myosin II - a non-processive molecular machine with a low duty ratio - cooperativity between several motors is essential to induce motion along its actin filament track. In this work we use statistical mechanical tools to calculate the duty ratio of cooperative molecular motors. The model suggests that the effective duty ratio of non-processive motors that work in cooperation is lower than the duty ratio of the individual motors. The origin of this effect is the elastic tension that develops in the filament which is relieved when motors detach from the track.
Chiaramonte, Delia R; D'Adamo, Christopher; Amr, Sania
The University of Maryland Department of Epidemiology and Public Health collaborated with the Center for Integrative Medicine at the same institution to develop and implement a unique integrative medicine curriculum within a preventive medicine residency program. Between October 2012 and July 2014, Center for Integrative Medicine faculty provided preventive medicine residents and faculty, and occasionally other Department of Epidemiology and Public Health faculty, with comprehensive exposure to the field of integrative medicine, including topics such as mind-body medicine, nutrition and nutritional supplements, Traditional Chinese Medicine, massage, biofield therapies, manual medicine, stress management, creative arts, and the use of integrative medicine in the inpatient setting. Preventive medicine residents, under the supervision of Department of Epidemiology and Public Health faculty, led integrative medicine-themed journal clubs. Resident assessments included a case-based knowledge evaluation, the Integrative Medicine Attitudes Questionnaire, and a qualitative evaluation of the program. Residents received more than 60 hours of integrative medicine instruction, including didactic sessions, experiential workshops, and wellness retreats in addition to clinical experiences and individual wellness mentoring. Residents rated the program positively and recommended that integrative medicine be included in preventive medicine residency curricula. The inclusion of a wellness-focused didactic, experiential, and skill-based integrative medicine program within a preventive medicine residency was feasible and well received by all six preventive medicine residents.
Prohaska, R.; Duran, A.; Ragatz, A.; Kelly, K.
In an effort to help commercialize technologies for electric vehicles (EVs) through deployment and demonstration projects, the U.S. Department of Energy’s (DOE's) American Recovery and Reinvestment Act (ARRA) provided funding to participating U.S. companies to cover part of the cost of purchasing new EVs. Within the medium- and heavy-duty commercial vehicle segment, both Smith Electric Newton and and Navistar eStar vehicles qualified for such funding opportunities. In an effort to evaluate the performance characteristics of the new technologies deployed in these vehicles operating under real world conditions, data from Smith Electric and Navistar medium-duty EVs were collected, compiled, and analyzed by the National Renewable Energy Laboratory's (NREL) Fleet Test and Evaluation team over a period of 3 years. More than 430 Smith Newton EVs have provided data representing more than 150,000 days of operation. Similarly, data have been collected from more than 100 Navistar eStar EVs, resulting in a comparative total of more than 16,000 operating days. Combined, NREL has analyzed more than 6 million kilometers of driving and 4 million hours of charging data collected from commercially operating medium-duty electric vehicles in various configurations. In this paper, extensive duty-cycle statistical analyses are performed to examine and characterize common vehicle dynamics trends and relationships based on in-use field data. The results of these analyses statistically define the vehicle dynamic and kinematic requirements for each vehicle, aiding in the selection of representative chassis dynamometer test cycles and the development of custom drive cycles that emulate daily operation. In this paper, the methodology and accompanying results of the duty-cycle statistical analysis are presented and discussed. Results are presented in both graphical and tabular formats illustrating a number of key relationships between parameters observed within the data set that
Full Text Available Adam EM Eltorai Warren Alpert Medical School of Brown University, RI, USA Abstract: Obesity is a major public health concern. Given its lasting efficacy for improving obesity and obesity-related diseases, bariatric surgery is an increasingly common treatment option. As the implementation of the Affordable Care Act progresses, the impending physician shortage will become more severe. Thus there will be an even greater need for doctors specialized in the management and treatment of obese patients. The development of integrated bariatric surgery residency programs could be considered and is discussed herein. Keywords: obesity, bariatric surgery, integrated residency, surgery education
HOSEIN NEJAD, HOOMAN; BAGHERABADI, MEHDI; SISTANI, ALIREZA; DARGAHI, HELEN
Introduction: Over the past 30 years, recognizing the need and importance of training residents in teaching skills has resulted in several resident-as-teacher programs. The purpose of this study was to explore the impact of this teaching initiative and investigate the improvement in residents’ teaching skills through evaluating their satisfaction and perceived effectiveness as well as assessing medical students’ perception of the residents’ teaching quality. Methods: This research is a quasi-experimental study with pre- and post-tests, continuing from Dec 2010 to May 2011 in Imam Hospital, Tehran University of Medical Sciences. In this survey, Emergency Medicine Residents (n=32) participated in an 8-hour workshop. The program evaluation was performed based on Kirkpatrick’s model by evaluation of residents in two aspects: self-assessment and evaluation by interns who were trained by these residents. Content validity of the questionnaires was judged by experts and reliability was carried out by test re-test. The questionnaires were completed before and after the intervention. Paired sample t-test was applied to analyze the effect of RAT curriculum and workshop on the improvement of residents’ teaching skills based on their self-evaluation and Mann-Whitney U test was used to identify significant differences between the two evaluator groups before and after the workshop. Results: The results indicated that residents’ attitude towards their teaching ability was improved significantly after participating in the workshop (pKirkpatrick’s model, i.e. it showed measurable positive changes in the self-assessments of medical residents about different aspects of teaching ability and performance. However, implementing training sessions for resident physicians, although effective in improving their confidence and self-assessment of their teaching skills, seems to cause no positive change in the third evaluated level of Kirkpatrick’s model, i.e. the residents
Bowman, Adam C.
The purpose of this study was to explore the adaptive measures that academic libraries perform when implementing and operating a 24-hour schedule. Five in-depth interviews were conducted with current managerial-level librarians at 24-hour academic libraries. The exploratory interviews revealed similar measures for security, budgeting, employee…
... 17 Commodity and Securities Exchanges 2 2010-04-01 2010-04-01 false Business hours. 201.104 Section 201.104 Commodity and Securities Exchanges SECURITIES AND EXCHANGE COMMISSION RULES OF PRACTICE Rules of Practice General Rules § 201.104 Business hours. The Headquarters office of the Commission, at...
... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Business hours. 801.304 Section 801.304 Employees' Benefits BENEFITS REVIEW BOARD, DEPARTMENT OF LABOR ESTABLISHMENT AND OPERATION OF THE BOARD Action by the Board § 801.304 Business hours. The office of the Clerk of the Board at Washington, DC...
van der Veen, Egbert; Hans, Elias W.; Veltman, Bart; Berrevoets, Leo M.; Berden, Hubert J.J.M.
We study how flexibility in workforce capacity can be used to efficiently match capacity and demand. Flexibility in workforce capacity is introduced by the annualized hours regime. Annualized hours allow organizations to measure working time per year, instead of per month or per week. An additional
Hwang, John S; Beebe, Kathleen S; Benevenia, Joseph; Karanfilian, Briette; Berberian, Wayne S
Many orthopedic residents accrue considerable debt by residency graduation. These debts for graduating medical students continue to increase due to the yearly increase of medical school tuition. The purpose of this study was to examine the causes of financial debt, as well the effects of debt on orthopedic residents.Orthopedic residents from postgraduate years 1 to 5 (N=27) completed an anonymous, optional financial survey. The survey asked questions regarding the characteristics of the residents' debt and their concern caused by their debt. All residents from our institute (N=27) voluntarily participated in the survey. The residents consisted of 4 (15%) women and 23 (85%) men, with 14 (56%) single residents and 12 (44%) married residents. No statistically significant difference existed in total debt >$100,000 between single and married residents or men and women. Forty-eight percent (n=13) of the residents had medical educational debt >$100,000, whereas 45% (n=12) had total debt >$200,000. Residents with total debt >$100,000 were concerned about their debt, whereas 1 of 4 residents with orthopedic residents financially and may cause stress and hinder their medical training. Appropriate measures should be taken to help residents properly manage their debt and to provide supplemental assistance with their financial struggles.
Riggs, Patricia L.
A four-week writer-in-residence program designed to stimulate the creativity of K-5 students was held in the Briar Glen Library Media Center, Wheaton, Illinois, with poet Joan Colby. This description of the program includes information on planning, funding, and future plans. (CHC)
Baker, J. David, III; And Others
Selection data for all Medical University of South Carolina anesthesiology residency applicants (about 200 per year) and the 8 selected per year were compared for 4 years. Results showed standardized test scores, grades, and class ranks of those selected were not higher than of others, but interview and recommendation scores were higher.…
The summer lodge residency was based in Nottingham from June 29th to July 10th Each of the artists was given a studio space and technical facilities. There were discussion points and meals, a seminar day, open presentations and reflection time.
Fischer, Josef E
The controversy concerning the limit of residents' work time to 80 hours a week has generated unprecedented dismay for many involved in graduate medical education, particularly surgeons. The author maintains that 80 hours a week is too short a time for surgery residents to provide excellent care and that this new rule undercuts the importance of continuity of care, a principle highly valued by surgeons. General surgeons and those specialty surgeons most closely associated with them think of themselves as the last "compleat physicians," who should and can take care of the entire patient, and that when difficulties arise, they should not transfer the patient to another physician but instead ask someone else to help them continue to care for the patient. The author traces the arbitrary choice of an 80-hour work week (instead of a 92-hour one) to several sources, including the leadership of internal medicine, which he feels has largely de-emphasized patient contact for many years and has become focused on research and/or administration. He also maintains that the issue of moonlighting has also driven the push for an 80-hour work week, and that the view of moonlighting by surgical residencies (i.e., that it is almost always counterproductive) is different from that of other residencies. He concludes by acknowledging that the 80-hour work week and the abandonment of the principle of continuity of care are societal decisions, and have occurred because surgeons and other physicians did not make their case strongly enough or in time.
Neimann, Johannes; Knabl, Julia; Puppe, Julian; Bayer, Christian Michael; Gass, Paul; Gabriel, Lena; Seelbach-Goebel, Birgit; Lermann, Johannes; Schott, Sarah
Compiling a daily hospital roster which complies with existing laws and tariff regulations and meets the requirements for ongoing professional training while also taking the legal regulations on the health of employees into account makes planning the duty roster a challenge. The aim of this study was to obtain a realistic picture of existing duty roster systems and of the current workloads of obstetricians in Germany. This online survey was sent to 2770 physicians training to become obstetricians or specializing in specific areas of obstetric care. The survey consisted of an anonymized 95-item questionnaire which collected data on different types of duty roster systems and the workload of obstetricians in Germany for the period from 17.02.2015 to 16.05.2015. Out of a total of 2770 physicians who were contacted, 437 (16%) completed the questionnaire. Across all forms of care, the care provided outside normal working hours usually (75%) consisted of a combination of regular working times and on-call duty or even consisted entirely of standby duty. Level I perinatal centers were most likely 20% (n = 88) to have a shift system in place. Working a shift system was significantly more common in care facilities which had previously carried out a job analysis. The number of physicians in hospitals who are present during the night shift was higher in facilities with higher numbers of births and in facilities which offered higher levels of care. In addition to regularly working overtime and the fact that often not all the hours worked were recorded, it was notable that the systems used to compile duty rosters often did not comply with legal regulations or with collectively agreed working hours nor were they compatible with the staff planning requirements. The results of this study show that the conditions of work, the working times, and the organization of working times in obstetric departments are in need of improvement. Recording the actual times worked together with an
Rintala, Harri; Häkkinen, Arja; Siitonen, Simo; Kyröläinen, Heikki
Although the mechanisms of G-induced stresses on the spinal structure of military pilots are well understood, less is known about relationships between the intensity of physical activity, fitness, occupational musculoskeletal symptoms, and the degree of resulting disabilities. During an aeromedical examination, Finnish military pilots answered a questionnaire on their flying experience, the occurrence of flight duty-related pain, the degree of resulting disabilities, and the intensity of physical activity they conducted. 195 males were selected for further analysis. They were divided into three groups, designated high G, low G, and HQ, according to their current flight duty profile. 93% of pilots who had passed fighter lead-in training reported flight duty-induced musculoskeletal disorders. The high-G group exhibited the highest aerobic capacity (p fitness scores (p fit counterparts (p = 0.005). Flight hour accumulation among the subjects in the high-G group was associated (p = 0.010) with the occurrence of flight duty-induced disabilities. The fittest pilots flew aircraft that induce the heaviest accelerations. They also reported more musculoskeletal pain than the other pilots. Yet they seemed to experience fewer disabilities, which highlights the importance of physical training in the maintenance of operational readiness.
Jane R. Rosenman MD
Full Text Available Resident participation in international health electives (IHEs has been shown to be beneficial, yet not all residents have the opportunity to participate. We sought to determine whether participating in simulated global health cases, via the standardized Simulation Use for Global Away Rotations (SUGAR curriculum, was useful for all pediatric residents, not merely those planning to go on an IHE. Pediatric residents in our program took part in 2 SUGAR cases and provided feedback via an online survey. Thirty-six of 40 residents participated (90%; 72% responded to the survey. Three of 10 residents not previously planning to work in resource-limited settings indicated participation in SUGAR made them more likely to do so. Nearly all residents (88% felt SUGAR should be part of the residency curriculum. All felt better prepared for working cross-culturally. While designed to prepare trainees for work in resource-limited settings, SUGAR may be beneficial for all residents.
Diego Restuccia; Guillaume Vandenbroucke
An average person born in the United States in the second half of the nineteenth century completed 7 years of schooling and spent 58 hours a week working in the market. By contrast, an average person born at the end of the twentieth century completed 14 years of schooling and spent 40 hours a week working. In the span of 100 years, completed years of schooling doubled and working hours decreased by 30 percent. What explains these trends? We consider a model of human capital and labor supply t...
Garde, Anne Helene; Albertsen, Karen; Nabe Nielsen, Kirsten
group. Intervention A encompassed the possibility to specify preferences for starting time and length of shift down to 15 minutes intervals. Interventions B and C included the opportunity to choose between a number of predefined duties. Questionnaires (N=840) on recovery and health and objective......, age, family type, degree of employment, or working hour arrangements. Conclusions After implementation of self-rostering, employees changed shift length and timing but did not compromise most recommendations for acceptable shift work schedules. Positive consequences of self-rostering for recovery...
Bent, John P; Fried, Marvin P; Smith, Richard V; Hsueh, Wayne; Choi, Karen
Although residency training offers numerous leadership opportunities, most residents are not exposed to scripted leadership instruction. To explore one program's attitudes about leadership training, a group of otolaryngology faculty (n = 14) and residents (n = 17) was polled about their attitudes. In terms of self-perception, more faculty (10 of 14, 71.4%) than residents (9 of 17, 52.9%; P = .461) considered themselves good leaders. The majority of faculty and residents (27 of 31) thought that adults could be taught leadership ability. Given attitudes about leadership ability and the potential for improvement through instruction, consideration should be given to including such training in otolaryngology residency.
Snellgrove, Susan; Beck, Cornelia; Green, Angela; McSweeney, Jean C
Certified nurses' assistants (CNAs) employed by a rural nursing home in Northeast Arkansas described their perceptions of resident-to-resident violence in order to provide insight on factors, including unmet needs, that may trigger the phenomenon. Semistructured interviews were conducted with 11 CNAs. Data were analyzed using content analysis and constant comparison. Two categories of triggers emerged from the data-active and passive. Active triggers involved the actions of other residents that were intrusive in nature, such as wandering into a residents' personal space, taking a resident's belongings, and so forth. Passive triggers did not involve the actions of residents but related to the internal and external environment of the residents. Examples were factors such as boredom, competition for attention and communication difficulties. Results indicate that there are factors, including unmet needs within the nursing home environment that may be identified and altered to prevent violence between residents.
It is a long-standing tradition in medicine that doctors have an ethical duty to care for all patients who fall within the scope of their skill base. This duty reflects the value system of many doctors and the type of typical dedication to their craft that has long been expected and given. The modern doctor, however, may have other additional roles -- such as those of parent, researcher, business person and many others. What about the duties that accompany these other activities and what if these duties come into conflict with the duty to care for patients? How does a doctor decide how far the duty to care for patients extends? This article explores this question of duty and discusses how the notion of the traditional doctor's duty to care may need to be amended in light of the kinds of lives that doctors now lead.
C.J. Hopmans (Niels)
textabstractWithin the past decade, the structure and format of surgical residency training has changed radically by the introduction of competency-based training programs, the progressive fragmentation of general surgery into subspecialties, and the implementation of stringent work hour restriction
... Orders; Fruits, Vegetables, Nuts), DEPARTMENT OF AGRICULTURE HAZELNUTS GROWN IN OREGON AND WASHINGTON Order Regulating Handling Hazelnut Control Board § 982.39 Duties. The Board shall have among others the... investigate the growing, shipping and marketing conditions with respect to hazelnuts, and assemble data...
van Eijk, N.; van Engers, T.; Wiersma, C.; Jasserand, C.; Abel, W.
Internet Service Providers currently find themselves in the spotlight, both in a national and international context, with regard to their relationship both with governments and other private parties, on for example questions of (civil) liability. The paper focuses on duties of care as concerns the r
... from an injury incurred or aggravated in line of duty or from an acute myocardial infarction, a cardiac... manner in which the travel was performed; and the immediate cause of disability or death. Whenever any... means any of the following: (i) An acute myocardial infarction. (ii) A cardiac arrest. (iii)...
... NAMI to 741741 Find Help Living with a Mental Health Condition Family Members and Caregivers Teens and Young Adults Veterans & Active Duty Diverse Communities LGBTQ NAMI Programs Discussion Groups NAMI HelpLine Get Involved stigma free Learn how you can help replace stigma ...
This paper investigates the moral duties that human rights NGOs, such as Amnesty International, and development NGOs, such as Oxfam, have in relation to human rights – especially in relation to the human right to a decent standard of living. The mentioned NGOs are powerful new agents on the global
Oklahoma State Dept. of Vocational and Technical Education, Stillwater. Curriculum and Instructional Materials Center.
This task list is intended for use in planning and/or evaluating a competency-based course to prepare machine tool, drill press, grinding machine, lathe, mill, and/or power saw operators. The listing is divided into six sections, with each one outlining the tasks required to perform the duties that have been identified for the given occupation.…
van Eijk, N.; van Engers, T.; Wiersma, C.; Jasserand, C.; Abel, W.
Internet Service Providers currently find themselves in the spotlight, both in a national and international context, with regard to their relationship both with governments and other private parties, on for example questions of (civil) liability. The paper focuses on duties of care as concerns the
In order to adapt to market development, the General Administration of Customs recently has revised the “Classification Table for Imported Articles of the People＇s Republic of China” and “Duty-Paid Price List for Imported Articles of the People＇s Republic of China”, and the new standard was put into practice on April 15th, 2012. According to the Announcement No.15, 2012, of the General Administration of Customs, the rate of duty on imports of clothing, accessories, home textiles, and others whose duty paragraph is 04000000 is adjusted to 20%, and the leather clothing and its accessories （including all kinds of leather garments and leather accessories） of duty paragraph 05000000 see the adjustment to 10%. As for the former one, the clothing includes coat, trousers, underwear, shirt/T-shirt, and other clothing; accessories include hats, scarves, headcloth, neckerchief, ties, belts, gloves, socks, handkerchiefs and so on; home textiles refer to blankets, quilts, pillows, bedspreads, sleeping bags, screens, etc.; the others are towels, bath towels, tablecloths, curtains, and carpets.
This paper investigates the moral duties that human rights NGOs, such as Amnesty International, and development NGOs, such as Oxfam, have in relation to human rights – especially in relation to the human right to a decent standard of living. The mentioned NGOs are powerful new agents on the global s
... 7 Agriculture 10 2010-01-01 2010-01-01 false Duties. 1215.30 Section 1215.30 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (MARKETING AGREEMENTS... statements to be prepared in conformity with generally accepted accounting principles and to be audited by an...
... 7 Agriculture 10 2010-01-01 2010-01-01 false Duties. 1209.39 Section 1209.39 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (MARKETING AGREEMENTS... statements to be prepared in conformity with generally accepted accounting principles and to be audited by an...
... growing, shipping, and marketing conditions with respect to almonds and to assemble data in connection... 7 Agriculture 8 2010-01-01 2010-01-01 false Duties. 981.39 Section 981.39 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Marketing Agreements...
... of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Marketing Agreements and... duties of each such person; (e) To investigate, from time to time, and to assemble data on the growing, harvesting, shipping, and marketing conditions with respect to potatoes; (f) To keep minutes, books,...
... of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Marketing Agreements and... and define the duties of each such person; (e) To investigate from time to time and to assemble data on the growing, harvesting, shipping and marketing conditions with respect to onions and to engage...
..., and assemble data on the producing, handling, shipping, and marketing conditions relative to prunes... of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Marketing Agreements and... Regulating Handling Prune Marketing Committee § 993.36 Duties. The committee shall have, among others,...
... investigate and assemble data on the growing, handling, and marketing conditions with respect to grapes; (i... 7 Agriculture 8 2010-01-01 2010-01-01 false Duties. 925.29 Section 925.29 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Marketing Agreements...
This plan details the methods and procedures necessary to ensure a safe transition in the operation of the Light Duty Utility Arm (LDUA) System. The steps identified here outline the work scope and identify responsibilities to complete startup, and turnover of the LDUA to Characterization Project Operations (CPO).
This study concerns the definition and implementation of the precautionary principle under general, or customary, international law. A search for patterns and common denominators in state practice resulted in the following definitions of a right and a duty which states are deemed to have under
Schenarts, Paul J; Langenfeld, Sean
Residents have the rights and responsibilities of both students and employees. Dismissal of a resident from a training program is traumatic and has lasting repercussions for the program director, the faculty, the dismissed resident, and the residency. A review of English language literature was performed using PUBMED and OVID databases, using the search terms, resident dismissal, resident termination, student dismissal, student and resident evaluation, legal aspects of education, and remediation. The references of each publication were also reviewed to identify additional appropriate citations. If the Just Cause threshold has been met, educators have the absolute discretion to evaluate academic and clinical performance. Legal opinion has stated that it is not necessary to wait until a patient is harmed to dismiss a resident. Evaluations should be standard and robust. Negative evaluations are not defamatory as the resident gave consent to be evaluated. Provided departmental and institutional polices have been followed, a resident can be dismissed without a formal hearing. Residencies are entitled to modify academic requirements and dismissal is not considered a breach of contract. Although there is anxiety regarding resident dismissal, the courts have uniformly supported faculty having this role. When indicated, failure to dismiss a resident also places the program director and the faculty at risk for educational malpractice.
U.S. Environmental Protection Agency — This data layer identifies areas in the U.S. where air pollution levels have not met the National Ambient Air Quality Standards (NAAQS) for ozone over 8 hours and...
National Oceanic and Atmospheric Administration, Department of Commerce — This publication contains hourly precipitation amounts obtained from recording rain gages located at National Weather Service, Federal Aviation Administration, and...
National Oceanic and Atmospheric Administration, Department of Commerce — Hourly Precipitation Data (HPD) is digital data set DSI-3240, archived at the National Climatic Data Center (NCDC). The primary source of data for this file is...
U.S. Environmental Protection Agency — This data layer identifies areas in the U.S. where air pollution levels have not met the National Ambient Air Quality Standards (NAAQS) for Sulfur dioxide 8 hour...
J Gordon Millichap
Full Text Available The incidence and risk factors of acute recurrence of unprovoked seizures within 24 hours of admission to an Emergency Department (ED were analyzed by a retrospective chart review at Schneider Children’s Hospital, New York.
Virtanen, Marianna; Jokela, Markus; Nyberg, Solja T
OBJECTIVE: To quantify the association between long working hours and alcohol use. DESIGN: Systematic review and meta-analysis of published studies and unpublished individual participant data. DATA SOURCES: A systematic search of PubMed and Embase databases in April 2014 for published studies......, supplemented with manual searches. Unpublished individual participant data were obtained from 27 additional studies. REVIEW METHODS: The search strategy was designed to retrieve cross sectional and prospective studies of the association between long working hours and alcohol use. Summary estimates were.......20) in the analysis of prospective published and unpublished data. In the 18 studies with individual participant data it was possible to assess the European Union Working Time Directive, which recommends an upper limit of 48 hours a week. Odds ratios of new onset risky alcohol use for those working 49-54 hours...
Green, Colin Peter; Hollingsworth, Bruce Philip; Navarro Paniagua, Maria
Two related issues in public policy with respect to alcohol are how increased availability influences consumption and what effect excess consumption has on individual health outcomes. This paper examines one particular source of variation in availability, bar opening hours, and how this influences alcohol consumption, physical and mental health. We focus on the extension of opening hours in England and Wales that occurred in 2005. We demonstrate a marked increase in consumption, which appears...
Moreno-Fernández, Jesús; Gutiérrez-Alcántara, Carmen; Palomares-Ortega, Rafael; García-Manzanares, Alvaro; Benito-López, Pedro
The current training program for resident physicians in endocrinology and nutrition (EN) organizes their medical learning. Program evaluation by physicians was assessed using a survey. The survey asked about demographic variables, EN training methods, working time and center, and opinion on training program contents. Fifty-one members of Sociedad Castellano-Manchega de Endocrinología, Nutrición y Diabetes, and Sociedad Andaluza de Endocrinología y Nutrición completed the survey. Forty-percent of them disagreed with the compulsory nature of internal medicine, cardiology, nephrology and, especially, neurology rotations (60%); a majority (>50%) were against several recommended rotations included in the program. The fourth year of residence was considered by 37.8% of respondents as the optimum time for outpatient and inpatient control and monitoring without direct supervision. The recommended monthly number of on-call duties was 3.8±1.2. We detected a positive opinion about extension of residence duration to 4.4±0.5 years. Doctoral thesis development during the residence period was not considered convenient by 66.7% of physicians. Finally, 97.8% of resident physicians would recommend residency in EN to other colleagues. Endocrinologists surveyed disagreed with different training program aspects such as the rotation system, skill acquisition timing, and on-call duties. Therefore, an adaptation of the current training program in EN would be required. Copyright © 2011 SEEN. Published by Elsevier Espana. All rights reserved.
Boiselle, Phillip M; Donohoe, Kevin; Graham, David; Siewert, Bettina; Jennette, Richard; Hatabu, Hiroto; Kressel, Herbert Y
The authors describe their initial 5-year experience with a new model of residency directorship: a triumvirate of shared leadership consisting of a director and 2 associate directors with specific areas of expertise and assigned responsibility. The major appeal of this model is its potential to draw on the diverse talents of 3 individuals with responsibilities matched to their specific areas of strength. A major benefit of the model is that each director has more time and energy to devote to specific duties, resulting in a greater opportunity for innovation and creativity. In this article, the authors describe the roles, responsibilities, and accomplishments of each of the 3 directors. They also discuss potential benefits of the triumvirate model in comparison with a traditional residency directorship and potential pitfalls to avoid when implementing this model.
... 18 Conservation of Power and Water Resources 2 2010-04-01 2010-04-01 false Director-duties and... ORGANIZATION Headquarters Organization § 701.77 Director—duties and responsibilities. The Director shall serve... their authorities; and facilitate the work of the Council and the Chairman. His duties...
... Federal Aviation Administration 14 CFR Parts 117 and 121 Clarification of Flight, Duty, and Rest... published a final rule on January 4, 2012, that amends the existing flight, duty and rest regulations... questions about the new flight, duty, and rest rule. This is a response to those questions. FOR FURTHER...
... 7 Agriculture 9 2010-01-01 2009-01-01 true Duties of the referendum agent. 1160.604 Section 1160... Procedure for Conduct of Referenda in Connection with a Fluid Milk Promotion Order § 1160.604 Duties of the referendum agent. The referendum agent, in addition to any other duties imposed by this subpart, shall: (a...
... 46 Shipping 9 2010-10-01 2010-10-01 false Duty to file. 531.5 Section 531.5 Shipping FEDERAL... General Provisions § 531.5 Duty to file. (a) The duty under this part to file NSAs, amendments and notices.... (d) Registration—(1) Application. Authority to file or delegate the authority to file must...
... 46 Shipping 9 2010-10-01 2010-10-01 false Duty to file. 530.5 Section 530.5 Shipping FEDERAL... Provisions § 530.5 Duty to file. (a) The duty under this part to file service contracts, amendments and... conditions as the parties may agree. (c) Registration—(1) Application. Authority to file or delegate...
... Definitions and Active Duty § 17.31 Duty periods defined. Full-time duty as a member of the Women's Army Auxiliary Corps, Women's Reserve of the Navy and Marine Corps and Women's Reserve of the Coast Guard... Patient Rights...
Department of Homeland Security — A lawful permanent resident (LPR) or 'green card' recipient is defined by immigration law as a person who has been granted lawful permanent residence in the United...
Abrahamson, Kathleen; Lewis, Teresa; Perkins, Anthony; Clark, Daniel; Nazir, Arif; Arling, Greg
We examined the (a) influence of nursing facility characteristics on resident quality of life and (b) the impact of cognitive impairment and residence on a dementia special care unit(SCU) on QOL after controlling for resident and facility characteristics. Multilevel models (resident and facility) were estimated for residents with and without cognitive impairment on conventional units and dementia SCU. Data came from the 2007 Minnesota Nursing Home Resident Quality of Life and Consumer Satisfaction Survey (N = 13,983). Level of resident CI was negatively related to QOL, although residing on a dementia SCU was positively related to QOL. Certified Nursing Assistant and activity personnel hours per resident day had a positive relationship with resident QOL. Our results highlight the need to ensure adequate levels of paraprofessional direct care staff and the availability of dementia-focused (SCU)s despite current constraints on long-term care funding.
Méan, Marie; Garnier, Antoine; Wenger, Nathalie; Castioni, Julien; Waeber, Gérard; Marques-Vidal, Pedro
Recent implementation of electronic health records (EHR) has dramatically changed medical ward organization. While residents in general internal medicine use EHR systems half of their working time, whether computer usage impacts residents' workflow remains uncertain. We aimed to observe the frequency of task-switches occurring during resident's work and to assess whether computer usage was associated with task-switching. In a large Swiss academic university hospital, we conducted, between May 26 and July 24, 2015 a time-motion study to assess how residents in general internal medicine organize their working day. We observed 49 day and 17 evening shifts of 36 residents, amounting to 697 working hours. During day shifts, residents spent 5.4 hours using a computer (mean total working time: 11.6 hours per day). On average, residents switched 15 times per hour from a task to another. Task-switching peaked between 8:00-9:00 and 16:00-17:00. Task-switching was not associated with resident's characteristics and no association was found between task-switching and extra hours (Spearman r = 0.220, p = 0.137 for day and r = 0.483, p = 0.058 for evening shifts). Computer usage occurred more frequently at the beginning or ends of day shifts and was associated with decreased overall task-switching. Task-switching occurs very frequently during resident's working day. Despite the fact that residents used a computer half of their working time, computer usage was associated with decreased task-switching. Whether frequent task-switches and computer usage impact the quality of patient care and resident's work must be evaluated in further studies.
Full Text Available Objective: Emergency medicine residents are a high–risk group for burnout syndrome. This was a qualitative study with content analysis on emergency medical residents with 2 aims: evaluating the incidence of occupational burnout syndrome and identifying the points of view and attitudes of emergency medical residents about factors related to occupational burnout syndrome.Method: For this study, 2 sessions of focus group discussions were set up at Imam Khomeini hospital affiliated to Tehran University of Medical Sciences. Each session took 90 minutes, and 20 emergency medicine residents in their first or second year of emergency medicine residency participated in the sessions. Data were coded by MAXQDA10 software.Results: Data were categorized in 4 themes as follow: (1 the characteristics of emergency medicine; (2 ambiguity in residents’ duties; (3 educational planning; and (4 careers.Data on the proposed solutions by residents were analyzed and coded in 3 groups including (1 changes in personal life; (2 arrangement in shifts; and (3 educational issues.Conclusion: According to findings of this qualitative study, most of emergency medicine residents have experienced exhaustion sometime during the course of their residency. Psychological supports may help the residents to cope with their career difficulties and probable burn out.
Yamamoto, Satoshi; Tanaka, Pedro; Madsen, Matias Vested; Macario, Alex
Our goal in this study was to examine Accreditation Council for Graduate Medical Education case logs for Stanford anesthesia residents graduating in 2013 (25 residents) and 2014 (26 residents). The resident with the fewest recorded patients in 2013 had 43% the number of patients compared with the resident with the most patients, and in 2014, this equaled 48%. There were residents who had 75% more than the class average number of cases for several of the 12 case types and 3 procedure types required by the Accreditation Council for Graduate Medical Education. Also, there were residents with fewer than half as many for some of the required cases or procedure types. Some of the variability may have been because of the hazards of self-reporting.
Jeanmonod, Rebecca K
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].
Papalexiou, Simon Michael; Dialynas, Yannis G.; Pappas, Christoforos
The importance of accurate representation of precipitation at fine time scales (e.g., hourly), directly associated with flash flood events, is crucial in hydrological design and prediction. The upper part of a probability distribution, known as the distribution tail, determines the behavior of extreme events. In general, and loosely speaking, tails can be categorized in two families: the subexponential and the hyperexponential family, with the first generating more intense and more frequent extremes compared to the latter. In past studies, the focus has been mainly on daily precipitation, with the Gamma distribution being the most popular model. Here, we investigate the behaviour of tails of hourly precipitation by comparing the upper part of empirical distributions of thousands of records with three general types of tails corresponding to the Pareto, Lognormal, and Weibull distributions. Specifically, we use thousands of hourly rainfall records from all over the USA. The analysis indicates that heavier-tailed distributions describe better the observed hourly rainfall extremes in comparison to lighter tails. Traditional representations of the marginal distribution of hourly rainfall may significantly deviate from observed behaviours of extremes, with direct implications on hydroclimatic variables modelling and engineering design.
Drawing on the life course paradigm, I assess how the effect of fatherhood on employment hours varies by age of becoming a parent and time elapsed since the birth. Using the National Longitudinal Survey of Youth - 1979 Cohort from 1979 to 2002 (N = 28,514 observations), separate effects are estimated based on fathers' marital status and co-residence with own children. Only unmarried men who became fathers before 24 work longer hours immediately after a first birth, but in the long run, most early fathers work fewer hours as a result of parenthood. Over time, unmarried but coresident men who became fathers between 24 and 29 increase their hours, as do married, coresident men who delayed fatherhood until 30 or older. However, the latter increase is moderated by support for egalitarian gender roles. The findings shed light on the contemporary transition to adulthood and on men's work-family balance.
Solana, A M; Pascual De Sans, A
The authors review trends in the size of the resident foreign population in Spain over time since the 1940s. A continuing growth over time, with temporal fluctuations, is noted, with a rapid rise in immigration in the 1980s, leading to new legislation designed to control immigration in 1985-1986 and 1991. The authors note that Europeans, particularly from countries of the European Union, make up a large percentage of the foreign population, but that the number of immigrants from developing countries has increased significantly in the last 10 years.
Drake, Frederick Thurston; Horvath, Karen D.; Goldin, Adam B.; Gow, Kenneth W.
IMPORTANCE The chief resident (CR) year is a pivotal experience in surgical training. Changes in case volume and diversity may impact the educational quality of this important year. OBJECTIVE To evaluate changes in operative experience for general surgery CRs. DESIGN, SETTING, AND PARTICIPANTS Review of Accreditation Council for Graduate Medical Education case logs from 1989–1990 through 2011–2012 divided into 5 periods. Graduates in period 3 were the last to train with unrestricted work hours; those in period 4 were part of a transition period and trained under both systems; and those in period 5 trained fully under the 80-hour work week. Diversity of cases was assessed based on Accreditation Council for Graduate Medical Education defined categories. MAIN OUTCOMES AND MEASURES Total cases and defined categories were evaluated for changes over time. RESULTS The average total CR case numbers have fallen (271 in period 1 vs 242 in period 5, P surgery training may be jeopardized by reduced case diversity. Chief resident cases are crucial in surgical training and educators should consider these findings as surgical training evolves. PMID:23864049
Miranda, L.E.; Dolan, C.R.
Under controlled laboratory conditions we measured the electrical peak power required to immobilize (i.e., narcotize or tetanize) fish of various species and sizes with duty cycles (i.e., percentage of time a field is energized) ranging from 1.5% to 100%. Electrofishing effectiveness was closely associated with duty cycle. Duty cycles of 10-50% required the least peak power to immobilize fish; peak power requirements increased gradually above 50% duty cycle and sharply below 10%. Small duty cycles can increase field strength by making possible higher instantaneous peak voltages that allow the threshold power needed to immobilize fish to radiate farther away from the electrodes. Therefore, operating within the 10-50% range of duty cycles would allow a larger radius of immobilization action than operating with higher duty cycles. This 10-50% range of duty cycles also coincided with some of the highest margins of difference between the electrical power required to narcotize and that required to tetanize fish. This observation is worthy of note because proper use of duty cycle could help reduce the mortality associated with tetany documented by some authors. Although electrofishing with intermediate duty cycles can potentially increase effectiveness of electrofishing, our results suggest that immobilization response is not fully accounted for by duty cycle because of a potential interaction between pulse frequency and duration that requires further investigation.
Virtanen, Marianna; Jokela, Markus; Nyberg, Solja T
OBJECTIVE: To quantify the association between long working hours and alcohol use. DESIGN: Systematic review and meta-analysis of published studies and unpublished individual participant data. DATA SOURCES: A systematic search of PubMed and Embase databases in April 2014 for published studies......, supplemented with manual searches. Unpublished individual participant data were obtained from 27 additional studies. REVIEW METHODS: The search strategy was designed to retrieve cross sectional and prospective studies of the association between long working hours and alcohol use. Summary estimates were...... countries. The pooled maximum adjusted odds ratio for the association between long working hours and alcohol use was 1.11 (95% confidence interval 1.05 to 1.18) in the cross sectional analysis of published and unpublished data. Odds ratio of new onset risky alcohol use was 1.12 (1.04 to 1...
The scientific information service. The CERN library is open 24 hours a day, 365 days a year. So how, you might be wondering, can they improve on that? The answer is in the detail. Although you can already use the library whenever you want, items can only be checked out when the front desk is staffed. A decision taken last week by the Scientific Information Policy Board now means that there will someone at the desk through out CERN's official working hours, with an extra 90 minutes at the end of the day so that people can check out material on their way home. In other words, the library will be open from 8:30 to 19:00, Monday to Friday. The library continues, of course, to be open 24 hours a day, all year round, and services provided via the digital library remain at your disposal day and night: http://library.cern.ch
Air temperature is the main climatological element, with major impact on the earth-atmosphere energy balance. The characteristics of the surface air temperature in locations without meteorological measurements are obtained using spatio-temporal interpolation techniques. Gridded surface meteorological data are essential for evaluating the performance of regional climate models (RCMs), for applying Statistical Downscaling (SD) methods and as input data for hydrological models. In this study we proposed a methodolgy for interpolating hourly surface temperatures. Three gridding methods are compared. A two-step multivariate gridding approach was used. First we interpolated the hourly normal maps, considered as multiannual average (1961-2010), of air temperature for each hour (4 meteorological terms) of a standard year (366 days). In this step, the Residual Kriging method was used with potential predictors derived from DEM and Landcover Corinne. For interpolating the residuals of the regression model we tested 3 gridding methods: Multiquadratic (MQ), Ordinary Kriging (OK) and 3D Kriging (using time as a third dimension). In the second step, we calculated the anomalies of each hour, day, year for the period 1961-2010. The anomalies were interpolated using the same methods applied for gridding regression residuals. The final hourly surface air temperature maps were obtained by summing the maps from first step with the anomlies map. The main data used in this work were the hourly air temperatures of the 4 observation terms (01, 07, 13, 19), measured between 1961-2010 at the weather stations of the Romanian Meteorological Administration. The predictors were derived from SRTM (Shuttle Radar Topography Mission) DEM and from CORINE Land Cover 2000 product. The gridding was performed in a Romanian National Grid (Stereo 70), at 1 km2 spatial resolution, using R language. The study has been financed by the research project Changes in climate extremes and associated impact in
Full Text Available Emergency medicine is a relatively new specialty in Iran. Therefore, the general public and the medical community do not have enough information on its duties, capabilities, its nature, and its work schedule or its degree of occupational difficulty compared to other specialties. Hence, an insight from the early group of residents who selected this specialty can help identify the strengths and weaknesses of this field in order to promote the scientific quality of this field, and attract medical students. It can also help to alleviate deficiencies and strengthen positive aspects of emergency medicine. The aim of this study was to identify the reasons behind choosing emergency medicine as a specialty. A qualitative study was conducted using semi-structured interviews. Maximum variation opportunistic sampling was done, and face-to-face interviews were held with 23 emergency medicine residents and fellows (4 faculty members and 19 residents. Data were analyzed through thematic analysis, and categories and themes were extracted. The main levels extracted were: 1 Individual priorities, 2 the nature of work and the field of study, and 3 professional future. The themes of each main level were extracted and encoded. This study showed that the majority of residents choose emergency medicine specialty to achieve a better social and professional status in one of the most challenging fields of medicine.
Turunen, J; Loula, P; Soininen, H
In this paper we present a computer-based system that is designed to reduce the number of patient calls in physicians' phone-in hours. Simultaneously it will offer a parallel alternative channel for the patients to listen to their laboratory results. The system requirements were reliability, security and the low costs. The results showed after a two-month test period that the tailored system proved extremely successful. The average time that the physician saved by using this system was over 4 minutes and doctors can leave the messages to the server also outside the phone-in hours.
Silberman, Cherie L
Due to the highly technical language in the wage and hour laws and regulations, employers often find that they have unknowingly violated the Fair Labor Standards Act (FLSA). This can occur because employers have improperly classified an employee as exempt or because employers do not realize that certain time should be paid in full. Improperly classifying employees as exempt or failing to compensate nonexempt employees for all time worked can lead to costly lawsuits, audits, or enforcement actions by the Wage and Hour Division of the Department of Labor. This article discusses the most common FLSA exemptions and provides best practices to avoid liability under the FLSA.
Wolfsthal, Susan D; Beasley, Brent W; Kopelman, Richard; Stickley, William; Gabryel, Timothy; Kahn, Marc J
To identify benchmarks of financial and staff support in internal medicine residency training programs and their correlation with indicators of quality. A survey instrument to determine characteristics of support of residency training programs was mailed to each member program of the Association of Program Directors of Internal Medicine. Results were correlated with the three-year running average of the pass rates on the American Board of Internal Medicine certifying examination using bivariate and multivariate analyses. Of 394 surveys, 287 (73%) were completed: 74% of respondents were program directors and 20% were both chair and program director. The mean duration as program director was 7.5 years (median = 5), but it was significantly lower for women than for men (4.9 versus 8.1; p =.001). Respondents spent 62% of their time in educational and administrative duties, 30% in clinical activities, 5% in research, and 2% in other activities. Most chief residents were PGY4s, with 72% receiving compensation additional to base salary. On average, there was one associate program director for every 33 residents, one chief resident for every 27 residents, and one staff person for every 21 residents. Most programs provided trainees with incremental educational stipends, meals while oncall, travel and meeting expenses, and parking. Support from pharmaceutical companies was used for meals, books, and meeting expenses. Almost all programs provided meals for applicants, with 15% providing travel allowances and 37% providing lodging. The programs' board pass rates significantly correlated with the numbers of faculty fulltime equivalents (FTEs), the numbers of resident FTEs per office staff FTEs, and the numbers of categorical and preliminary applications received and ranked by the programs in 1998 and 1999. Regression analyses demonstrated three independent predictors of the programs' board pass rates: number of faculty (a positive predictor), percentage of clinical work
Patti Tamara Lenard
Full Text Available Conventionally, it is presumed that while citizens have the right to exit the state in which they are located, no particular state (except a citizen's home state is required to admit them. Yet, this convention has produced, and continues to produce, injustice; to understand why, I focus on defining and protecting a right to exit, as distinct from the right to move in general. This analysis leads me to propose that whereas the political theoretic literature appears to have converged on a commitment to decisive asymmetry (in favor of accepting a state's right to exclude, I propose that only a weak asymmetry is justified. I argue that receiving states are duty-bound to act in ways that enable migrants to exercise their right to exit. In particular, I argue that receiving states have a perfect duty to collectivize the process by which needy migrants can exercise the right to exit.
Bartling, Samantha J; Rivard, Shayna C; Meyerle, Jon H
Given that the majority of active duty service members are young and healthy, potentially malignant diagnoses such as skin cancer may be overlooked. Although melanoma accounts for only approximately 1% of skin cancers, it causes the greatest majority of skin cancer deaths. We present the case of a 27-year-old active duty Marine who presented with a hyperpigmented macule at his lateral neck that was a malignant melanoma in situ. This article reviews risk factors for the development of melanoma, offers guidelines for primary care providers, reviews resources for providers in a deployed or austere environment, offers recommendations for prevention and early diagnosis, and discusses follow up. Reprint & Copyright © 2017 Association of Military Surgeons of the U.S.
Zubairi, Akbar Jaleel; Noordin, Shahryar
Introduction Recent literature has focused on burnout as a specific job related distress syndrome among physicians and residents having adverse effects on patient care. Local data on burnout is lacking. Materials & methods An online self-administered questionnaire was sent via email to all residents (325) at our institute with and a response rate of 110 (34%) was achieved. Out of these 82 residents consented and completely filled the questionnaires and were included in the analysis. The questionnaire comprised of demographic variables, the Maslach burnout inventory and occupational risk factors. Results High levels of burnout on at least one subscale were reported by 61(74.4%) residents, in 2 components by 34(41.5%) whereas an alarming 10(12.2%) residents scored high on all three subscales. Among the individual subscales emotional exhaustion was most frequent in 49(59.8%). Among the departments Radiology reported the highest levels (100%) of burnout and low levels were reported by Pediatrics (45%). There was no difference between burnout levels among junior and senior residents. Dissatisfaction with workload, length of work hours, relationship with co-workers and lack of autonomy were significantly associated with high level of burnout. Conclusion High levels of burnout are prevalent among trainee doctors in our part of the world which are comparable with international literature. Efforts to improve the work environment of residents may significantly reduce levels of burnout. PMID:26955475
Carlos FERNANDES MAIA
Full Text Available The author starts from some considerations about Froebel's and the New School pedagogy and tries to oppose to that orientation of rights the need of a perspective of the duty. This is the best ethical way to manifest the human fulfilment in the present and the possibility of future perfection. With the story "Natal" (Christmas, from Miguel Torga, the value of an ethic of initiative and sharing as the best way to achieve liberty is exemplified.
... number of hours worked in excess of 40 in the week. Thus a $6 hourly rate will bring, for an employee who....80 for 46 hours (46 hours at $6.20 plus 6 hours at $3.10, or 40 hours at $6.20 plus 6 hours at $9.30). ... Regulations Relating to Labor (Continued) WAGE AND HOUR DIVISION, DEPARTMENT OF LABOR STATEMENTS OF...
Shekar, Vinita; Singh, Mark; Shekar, Kishore; Brennan, Peter
The Department of Health is considering imposing a legal duty of candour on health care providers to ensure that an apology and explanation are given to patients when errors occur during medical treatment. This aims to improve quality of care and reduce adverse events during medical treatment. We present the current system of clinical negligence and the future of medical ethics. We discuss relevant cases with regard to duty of candour, and highlight the existence of serious imbalances in which patients' rights and corresponding ethical duties of professionals predominate over the responsibilities of patients themselves. It is known that most adverse events arise because of multiple factors for which no individual should be blamed. To improve healthcare services there is a need for a system in which lessons can be learnt from mistakes, and services can be improved in the interest of patient safety, and for transparency in the broad principles on which the decisions are based within which clinical performance is supervised and monitored. Copyright © 2010 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
The second questionnaire for scientists and engineers was carried out in 2007, and status of Japanese scientists and engineers were analyzed and reported. A part of the data was reanalyzed from the viewpoint of work life balance. In particular, office/laboratory staying hour and home working hour were analyzed and dependences on various factors were investigated. It was found that these hours depend on gender, marital status, number of child, employment status and age. In addition, the total hours tend to be kept constant regardless of various factors.
For organizational matters, please note that, as from 15 March 2010, the Installation Service will have wen opening hours. The new schedule will be from 14:00 to 17:00 (Monday to Friday). Contact persons are: Martine Briant, Karine Robert and Claudia Bruggmann. The office address remains 73-3-014. Installation Service
Weijs, Joost; Lohse, Detlef
We present a theoretical model for the experimentally found but counterintuitive exceptionally long lifetime of surface nanobubbles. We can explain why, under normal experimental conditions, surface nanobubbles are stable for many hours or even up to days rather than the expected microseconds. The
..., training, or pre-shift briefings for special evolutions; and holdovers for interviews needed for event... waivers under which work was performed to evaluate staffing adequacy for all jobs subject to the work hour...; and (4) Record, trend, and correct, under the licensee's corrective action program, any problems...
Butler, Graham; Hunt, Brian; Doyle, Andrew
Private Members' Bill (legislation) introduced in Dáil Éireann (House of Deputies), Houses of the Oireachtas (Parliament of Ireland). An Act to set voting hours for Dáil Elections, Dáil Bye-Elections, Presidential Elections, European Parliament Elections, Local Government Elections and Referenda...
Galluzzo, Benjamin J.; Wendt, Theodore J.
Across the mathematics curriculum there is a renewed emphasis on applications of mathematics and on mathematical modeling. Providing students with modeling experiences beyond the ordinary classroom setting remains a challenge, however. In this article, we describe the 24-hour Mathematical Modeling Challenge, an extracurricular event that exposes…
By reading the short story The Story of An Hour written by Kate Chopin, we tried to probe the story better by analyz-ing five characters, plots of the story and rhetorical devices, such as irony and symbolism. With originality and profound mean-ings, the novel about the small theme of family life had a wide variety of social significance.
Page, John S
This manual's latest edition continues to be the best source available for making accurate, reliable man-hour estimates for electrical installation. This new edition is revised and expanded to include installation of electrical instrumentation, which is used in monitoring various process systems.
Shattuck, Nita L; Matsangas, Panagiotis
Sailors in the U.S. Navy are habitual shiftworkers, often experiencing circadian misalignment due to their irregular work/rest schedules. This study assessed the effect of sunlight exposure, work hours, and caffeinated beverage consumption on the daily sleep duration of crewmembers of a U.S. Navy ship during a 2-wk underway period. Working in an artificially lit area with no access to sunlight during work hours, U.S. Navy crew members (N = 91) used daily logs to report their daily activity, caffeinated beverage consumption, and exposure to sunlight while off-duty; sleep was assessed by wrist-worn actigraphy. Hours of sunlight exposure, work duration, and the amount of coffee/tea/soft drinks were statistically significant predictors of sleep duration. On average, crewmembers who reported more than one half-hour of sunlight each day slept on average ∼40 min (10%) less than their peers working the same shifts who received less than one half-hour of sunlight (on average 6.05 ± 0.90 h vs. 6.71 ± 0.91 h, respectively). Exposure to sunlight, work hours, and consumption of caffeinated beverages are important factors when planning watchstanding schedules at sea. Even though further research is needed, our results suggest that even brief exposure to sunlight may contribute to circadian misalignment that negatively affects sleep in the operational environment. Educating crewmembers about sleep hygiene, especially the important roles played by sunlight and caffeine, could potentially improve the sleep and fatigue levels of this population of maritime shiftworkers.Shattuck NL, Matsangas P. Sunlight exposure, work hours, caffeine consumption, and sleep duration in the naval environment. Aerosp Med Hum Perform. 2017; 88(6):579-585.
Rialon, Kristy L; Barfield, Michael E; Elfenbein, Dawn M; Lunsford, Keri E; Tracy, Elisabeth T; Migaly, John
To design an orientation for surgical interns to meet the new Accreditation Council for Graduate Medical Education Common Program Requirements regarding supervision, to test patient-management competencies, and to assess confidence on skills and tasks pre-orientation and post-orientation. Twenty-seven incoming surgical interns participated in a two-day orientation to clinical duties. Activities included a pre-test, lectures, simulation, oral examination, intern shadowing, and a post-test. Incoming interns were surveyed before and after orientation and two months later for confidence in patient-management and surgical intern skills. Paired t-tests were used to determine if confidence improved pre-orientation and post-orientation, and two months following orientation. The study took place at an academic training hospital. All (n = 27) postgraduate year-1 (PGY-1) surgical residents at our institution, which included the categorical and nondesignated preliminary general surgery, urology, orthopedic surgery, otolaryngology, and neurosurgery programs. All interns passed the oral and written examinations, and were deemed able to be indirectly supervised, with direct supervision immediately available. They reported increased confidence in all areas of patient management addressed during orientation, and this confidence was retained after two months. In surgical and floor-related tasks and skills, interns reported no increase in confidence directly following orientation. However, after two months, they reported a significant increase in confidence, particularly in those tasks that are performed often. New requirements for resident supervision require creative ways of verifying resident competency in basic skills. This type of orientation is an effective way to address the new requirements of supervision and teach interns the tasks and skills that are necessary for internship. Copyright © 2013 Association of Program Directors in Surgery. Published by Elsevier Inc. All
The response speed of ambulance calls is very crucial to rescue patients suffering immediately life threatening conditions. The serious health outcomes might be caused by exposing to extreme heat only several hours before. However, limited evidence is available on this topic. This study aims to examine the hourly association between heat and ambulance calls, to improve the ambulance services and to better protect health. Hourly data on ambulance calls for non-accidental causes, temperature and air pollutants (PM10, NO2, and O3) were collected from Brisbane, Australia, during 2001 and 2007. A time-stratified case-crossover design was used to examine the associations between hourly ambulance calls and temperature during warm season (Nov, Dec, Jan, Feb, and Mar), while adjusting for potential confounders. Stratified analyses were performed for sex and age groups. Ambulance calls peaked at 10am for all groups, except those aged heat-ambulance calls relationships were non-linear for all groups, with thresholds between 27 °C and 31 °C. The associations appeared immediately, and lasted for about 24 h. There were no significant modification effect by sex and age. The findings suggest that hot hourly temperatures (>27 °C) increase the demands of ambulance. This information is helpful to increase the efficiency of ambulance service then save lives, for example, preparing more ambulance before appearance of extremely hot temperature in combination with weather forecast. Also, people should better arrange their time for outdoor activities to avoid exposing to extreme hot temperatures. Copyright Â© 2016 Elsevier Ltd. All rights reserved.
Chessare, J B
The growth of managed care has brought a new focus on physician competency in the appropriate use of resources to help patients. The community of pediatric educators must improve residency curricula and teaching methodologies to ensure that graduates of their programs can effectively and efficiently meet the needs of children and their families. The educational approach in many pediatric residency programs is an implicit apprenticeship model, with which the residents follow the actions of attending physicians with little attention to scrutiny of the clinical evidence for and against diagnostic and treatment strategies. Evidence-based medicine stresses to the trainee the importance of the evaluation of evidence from clinical research and cautions against the use of intuition, unsystematic clinical experience, and untested pathophysiologic reasoning as sufficient for medical decision-making. Managed care also has helped to create a heightened awareness of the need to educate residents to incorporate the preferences of patients and families into diagnostic and treatment decisions. Trainees must know how to balance their duty to maximize the health of populations at the lowest resource use with their duty to each individual patient and family. Changes in the residency curriculum will bring change in educational settings and the structure of rotations. Potential barriers to implementation will include the need for faculty development and financial resources for information technology.
Kelly, Kenneth; Bennion, Kevin; Miller, Eric; Prohaska, Bob
NREL's Fleet Test and Evaluation group has extensive in-use vehicle data demonstrating the importance of understanding the vocational duty cycle for appropriate sizing of electric vehicle (EV) and power electronics components for medium- and heavy-duty EV applications. This presentation includes an overview of recent EV fleet evaluation projects that have valuable in-use data that can be leveraged for sub-system research, analysis, and validation. Peak power and power distribution data from in-field EVs are presented for four different vocations, including class 3 delivery vans, class 6 delivery trucks, class 8 transit buses, and class 8 port drayage trucks, demonstrating the impacts of duty cycle on performance requirements.
Full Text Available Although scarce, the literature addressing the effects of the economy on voter turnout and political attitudes has yielded mixed results. By using individual, longitudinal data from Spain—a country devastated by the Great Recession—our study illuminates how the latest economic crisis has impacted citizens’ perceptions of voting. We analyze how economic conditions and perceptions of the economy have transformed the belief that voting is a civic duty, which is one of the strongest attitudinal predictors of turnout. Our results suggest that hard times slightly weaken citizens’ sense of civic duty, particularly among the youngest. However, the adverse effects of the economic crisis are compensated by the positive effects of the electoral context, and as a consequence there is no aggregate decline in civic duty during the period examined (2010–2012.
Full Text Available Laparoscopic trainers have been proved to be effective to improve skills of laparoscopic surgery; they are usually installed at hospital in the surgical department with limited access hours, usually inconvenient to the schedule of the resident. Simple trainer boxes are necessary for residents who desire developing their skills at home independently to the venue and hours of surgical departments. Our goal is to bring the laparoscopic trainer to the desktop of the surgical resident by making it very cheap, small, light, secure and easy to construct. We describe a model of laparoscopic trainer using steel basket which, we believe, meets all of the above-mentioned requirements. It is accessible to any personal budget and can be constructed with a minimum of hand skill. It is small and light enough to permit its daily use on the desktop of the resident for a couple of hours, then after it can be stocked in any locker.
Wagner RF Jr
Full Text Available Richard F Wagner Jr, Sharon S Raimer, Brent C Kelly Department of Dermatology, The University of Texas Medical Branch, Galveston, Texas, USA Abstract: Programmatic changes for the dermatology residency program at The University of Texas Medical Branch were first introduced in 2005, with the faculty goal incorporating formal dermatology research projects into the 3-year postgraduate training period. This curriculum initially developed as a recommendation for voluntary scholarly project activity by residents, but it evolved into a program requirement for all residents in 2009. Departmental support for this activity includes assignment of a faculty mentor with similar interest about the research topic, financial support from the department for needed supplies, materials, and statistical consultation with the Office of Biostatistics for study design and data analysis, a 2-week elective that provides protected time from clinical activities for the purpose of preparing research for publication and submission to a peer-reviewed medical journal, and a departmental award in recognition for the best resident scholarly project each year. Since the inception of this program, five classes have graduated a total of 16 residents. Ten residents submitted their research studies for peer review and published their scholarly projects in seven dermatology journals through the current academic year. These articles included three prospective investigations, three surveys, one article related to dermatology education, one retrospective chart review, one case series, and one article about dermatopathology. An additional article from a 2012 graduate about dermatology education has also been submitted to a journal. This new program for residents was adapted from our historically successful Dermatology Honors Research Program for medical students at The University of Texas Medical Branch. Our experience with this academic initiative to promote dermatology research by
Hanna, Waël C; Mulder, David S; Fried, Gerald M; Elhilali, Mostafa; Khwaja, Kosar A
OBJECTIVE To demonstrate that senior surgical residents would benefit from focused training by professionals with management expertise. Although managerial skills are recognized as necessary for the successful establishment of a surgical practice, they are not often emphasized in traditional surgical residency curricula. DESIGN Senior residents from all surgical subspecialties at McGill University were invited to participate in a 1-day management seminar. Precourse questionnaires aimed at evaluating the residents' perceptions of their own managerial knowledge and preparedness were circulated. The seminar was then given in the form of interactive lectures and case-based discussions. The questionnaires were readministered at the end of the course, along with an evaluation form. Precourse and postcourse data were compared using the Freeman-Halton extension of the Fisher exact test to determine statistical significance (P < .05). SETTING McGill University Health Centre in Montreal, Quebec, Canada. PARTICIPANTS A total of 43 senior residents. RESULTS Before the course, the majority of residents (27 of 43 [63%]) thought that management instruction only happened "from time to time" in their respective programs. After the course, 15 residents (35%) felt that management topics were "well addressed," and 19 (44%) felt that management topics have been "very well addressed" (P < .01). Residents noted a significant improvement in their ability to perform the following skills after the course: giving feedback, delegating duties, coping with stress, effective learning, and effective teaching. On the ensemble of all managerial skills combined, 26 residents (60%) rated their performance as "good" or "excellent" after the course vs only 21 (49%) before the course (P = .02). Residents also noted a statistically significant improvement in their ability to perform the managerial duties necessary for the establishment of a surgical practice. CONCLUSIONS Surgical residency programs
Yorkgitis, Brian K; Bryant, Elizabeth; Raygor, Desiree; Brat, Gabriel; Smink, Douglas S; Crandall, Marie
Opioid abuse and misuse is a public health crisis. A national effort to reduce this phenomenon is ongoing. Residents represent a large pool of opioid prescribers but, are often not the target for opioid prescribing education (OPE). We developed a survey to assess current opioid prescribing practices and education among surgical residents. An Institutional Review Board and Association of Program Directors in Surgery approved survey was electronically mailed to surgical program directors (PDs). The survey included questions regarding residency type, location, number of graduates per year, perceived value of OPE, residency policy on prescribing outpatients controlled substances, presence of OPE, and preferred method of OPE. A total of 248 PDs were e-mailed the survey with 110 complete responses (44.4%). Of all 104 (94.5%) allow residents to prescribe outpatient opioids with 24 (23.1%) limiting the opioid class prescribed. A total of 29 (27.9%) programs require residents to obtain their own Drug Enforcement Administration registration. Only 22 (20.0%) programs had in place mandatory OPE, 7 (6.4%) PDs were unsure if OPE was a mandatory educational requirement. Furthermore, 70 (79.5%) of programs currently without OPE are considering adding it. Didactic lecture (18, 81.8%) is the most common modality for OPE. The mode time dedicated to OPE was 1 hour. When PDs were asked about which method would be best to deliver OPE, the most common response was case-based scenarios (39, 35.5%). Bivariate statistics were performed and no association was found between OPE and program characteristics'. Most surgical residency programs allow residents to prescribe outpatient opioids, very few require OPE. The most common method of OPE was didactic lectures. To enhance a resident's knowledge in prescribing opioids, programs should incorporate OPE into their curriculum. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.
Cedfeldt, Andrea S; Bower, Elizabeth A; English, Clea; Grady-Weliky, Tana A; Girard, Donald E; Choi, Dongseok
Doctors who are satisfied with their careers have less stress and burnout and are less likely to make medical errors and more likely to provide a higher quality of patient care. In response to reports that residents experienced barriers to taking time off, Oregon Health and Science University designed a survey to evaluate residents' awareness of their programmes' policies for time off, their ability to find time for personal needs, and associations of both with career satisfaction, emotions and training experience. All 675 residents in a large, urban, tertiary care academic medical centre located in the USA were invited to participate in a confidential, web-based, cross-sectional survey in 2008; 66% completed the survey. The survey instrument consisted of a variety of items including yes/no, multiple choice, Likert scale and narrative response types. Only 41% of respondents were aware of their programmes' policies regarding time off. Residents who reported awareness of a policy were more able to find time to take care of personal needs (odds ratio=1.553, p=0.026). These respondents reported more positive experiences and emotions, fewer negative experiences and emotions, higher levels of career satisfaction and relatively less perceived stress than those who were unaware of a time-off policy. In addition, these respondents reported, on average, fewer work and more sleep hours. Our results highlight the importance of ensuring mechanisms for residents to find time to fulfil personal needs in order to enhance resident well-being and career satisfaction. Ensuring resident awareness of time-off policies is one way to do this. Our study demonstrates that ensuring residents are able to find time for personal needs has significant consequences with respect to resident perceptions of well-being and may be an effective strategy to promote career satisfaction and prevent burnout. © Blackwell Publishing Ltd 2010.
Aho, Johnathon M; Ruparel, Raaj K; Graham, Elaina; Zendejas-Mummert, Benjamin; Heller, Stephanie F; Farley, David R; Bingener, Juliane
Self-directed learning (SDL) can be as effective as instructor-led training. It employs less instructional resources and is potentially a more efficient educational approach. Although SDL is encouraged among residents in our surgical training program via 24-hour access to surgical task trainers and online modules, residents report that they seldom practice. We hypothesized that a mentor-guided SDL approach would improve practice habits among our residents. From 2011 to 2013, 12 postgraduate year (PGY)-2 general surgery residents participated in a 6-week minimally invasive surgery (MIS) rotation. At the start of the rotation, residents were asked to practice laparoscopic skills until they reached peak performance in at least 3 consecutive attempts at a task (individual proficiency). Trainees met with the staff surgeon at weeks 3 and 6 to evaluate progress and review a graph of their individual learning curve. All trainees subsequently completed a survey addressing their practice habits and suggestions for improvement of the curriculum. By the end of the rotation, 100% of participants improved in all practiced tasks (p < 0.05), and each reported that they practiced more in this rotation than during rotations without mentor-guided SDL. Additionally, 6 (50%) residents reported that their skill level had improved relative to their peers. Some residents (n = 3) felt that the curriculum could be improved by including task-specific goals and additional practice sessions with the staff surgeon. Mentor-guided SDL stimulated surgical residents to practice with greater frequency. This repeated deliberate practice led to significantly improved MIS skills without significantly increasing the need for faculty-led instruction. Some residents preferred more discrete goal setting and increased mentor guidance. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.
Lepetit, Alexis; Lavigne, Benjamin; Legros, Emilie; Herrmann, Mathieu; Sebbane, Déborah
Aging of the population is a growing concern in developed countries. Therefore, geriatric psychiatry has gradually emerged from general psychiatry. Many names have been proposed to term this sub-specialty: old age psychiatry (OAP), psychogeriatrics, geropsychiatry. A working group of the French federation of psychiatric trainees (AFFEP) set up an inventory of the theoretical instruction and clinical practice of OAP during the training of psychiatrists in France. Methods. A survey of both academic teaching and practical training for OAP was carried out in the 28 local AFFEP representatives of every French medical residency district, including overseas. We assessed the supply of general courses and seminars devoted to OAP during the training of French residents in psychiatry, and the offer of university or inter-university degrees as well as the possibility of specialized internship in every residency district. Results. 96% of French medical residency districts offered general courses of OAP with a mean volume of 11.5 hours along the four years of psychiatric training in France. Fifty percent of medical residency districts proposed at least one seminar devoted to OAP. Half of medical residency districts also offer a specialized university or inter-university degree. Concerning clinical practice, 86% of medical residency districts had one internship dedicated to OAP, in 39% of cases in teaching hospitals. Conclusion. Nationwide, there is an overall effort to make OAP available to French psychiatric residents by general courses and internship, but some disparity appeared in academic teaching (i.e. offering seminars and university/inter-university degrees) according to various residency districts.
Mayans, David; Schneider, Logan; Adams, Nellie; Khawaja, Ayaz M.; Engstrom, John
Objective: To survey US-trained graduating neurology residents who are American Academy of Neurology members, in an effort to trend perceived quality and completeness of graduate neurology education. Methods: An electronic survey was sent to all American Academy of Neurology members graduating from US neurology residency programs in the Spring of 2014. Results: Of 805 eligible respondents, 24% completed the survey. Ninety-three percent of adult neurology residents and 56% of child neurology residents reported plans to pursue fellowship training after residency. Respondents reported a desire for additional training in neurocritical care, neuro-oncology, neuromuscular diseases, botulinum toxin injection, and nerve blocks. There remains a clear deficit in business training of neurology residents, although there was notable improvement in knowledge of coding and office management compared to previous surveys. Discussion: Although there are still areas of perceived weakness in neurology training, graduating neurology residents feel generally well prepared for their chosen careers. However, most still pursue fellowship training for reasons that are little understood. In addition to certain subspecialties and procedures, practice management remains deficient in neurology training and is a point of future insecurity for most residents. Future curriculum changes should consider resident-reported gaps in knowledge, with careful consideration of improving business training. PMID:26976522
Virtanen, Marianna; Jokela, Markus; Nyberg, Solja T
, supplemented with manual searches. Unpublished individual participant data were obtained from 27 additional studies. REVIEW METHODS: The search strategy was designed to retrieve cross sectional and prospective studies of the association between long working hours and alcohol use. Summary estimates were...... obtained with random effects meta-analysis. Sources of heterogeneity were examined with meta-regression. RESULTS: Cross sectional analysis was based on 61 studies representing 333,693 participants from 14 countries. Prospective analysis was based on 20 studies representing 100,602 participants from nine...... countries. The pooled maximum adjusted odds ratio for the association between long working hours and alcohol use was 1.11 (95% confidence interval 1.05 to 1.18) in the cross sectional analysis of published and unpublished data. Odds ratio of new onset risky alcohol use was 1.12 (1.04 to 1...
Weijs, Joost H
We present a theoretical model for the experimentally found but counter-intuitive exceptionally long lifetime of surface nanobubbles. We can explain why, under normal experimental conditions, surface nanobubbles are stable for many hours or even up to days rather than the expected microseconds. The limited gas diffusion through the water in the far field, the cooperative effect of nanobubble clusters, and the pinned contact line of the nanobubbles lead to the slow dissolution rate.
Part 2: Knowledge Discovery and Sharing; International audience; We propose optimum arrangement of taxi drivers’ working hours. In Japan, income of taxi vehicle is decreasing about 11 thousand yen in the past 15 years. Then some taxi companies are investing to gain more customers. But there are many small taxi companies that are difficult to invest with much money. Therefore we have been researching the other method to gain more customers by little investment for small companies. In this pape...
Krennrich, F; Boyle, P J; Bradbury, S M; Buckley, J H
Mrk 421 is the first TeV blazar found to exhibit significant spectral variability during strong flaring activity, showing hardening of the TeV spectrum in high emission states. Mrk 421 is also known to exhibit flux variability on time scales as short as 15 minutes. In this paper we present studies of hourly spectral variability of Mrk 421 in 2001 using data from the Whipple Observatory 10m gamma-ray telescope.
Full Text Available The hourly values of the geomagnetic field from 1911 to 1931 derived from measurements made at Eskdalemuir observatory in the UK, and available online from the World Data Centre for Geomagnetism at http://www.wdc.bgs.ac.uk/, have now been corrected. Previously they were 2-point averaged and transformed from the original north, east and vertical down values in the tables in the observatory yearbooks. This paper documents the course of events from discovering the post-processing done to the data to the final resolution of the problem. As it was through the development of a new index, the Inter-Hour Variability index, that this post-processing came to light, we provide a revised series of this index for Eskdalemuir and compare it with that from another European observatory. Conclusions of studies concerning long-term magnetic field variability and inferred solar variability, whilst not necessarily consistent with one another, are not obviously invalidated by the incorrect hourly values from Eskdalemuir. This series of events illustrates the challenges that lie ahead in removing any remaining errors and inconsistencies in the data holdings of different World Data Centres.
From 8.30 to 9.30 p.m. on Saturday, 26 March 2011, the Globe of Science and Innovation will be plunged into darkness to mark CERN's participation in Earth Hour. A growing number of countries and cities across the planet are involved in this global initiative against climate change, which was launched by the WWF in 2007. The lights on the Globe were switched off for the 2009 Earth Hour event. Along with individuals, companies and tourist attractions in thousands of towns and cities all over the world participating in the fourth annual Earth Hour event, CERN will turn off the lights of the Globe for 60 minutes at 8.30 p.m. on Saturday 26 March. CERN's participation in the initiative is one of several examples of its commitment to respect the environment and keep its ecological footprint to the minimum. A recent example under the green transport heading was the replacement of part of CERN's petrol vehicle fleet with cars running on natural gas with a view to reducing air pollution. Other examples...
Full Text Available In many recent studies in the literature have described and commented on “competency based resident training” in pathology. According to this model, competencies are subclassified in 6 main categories: Patient care, medical knowledge, practice based learning and improvement, interpersonal and communication skills, professionalism, and systems based practice. Assessment of competency forms the main component of this model.Under the framework of Ankara Society of Pathology, a working group, composed of 11 residents, 6 of which representing the Training and Research Hospitals of Ministry of Health and the rest representing the university hospitals in Ankara, was established in order to participate in the think-tank about resident training in pathology. A questionnaire, composed of 12 questions, was prepared. According to this questionnaire, the number of trainers in the university hospitals is much higher than in the commercial hospitals. While the total number of cases and cases per resident do not differ between the university and commercial hospitals, microscopes used for the educational purposes are significantly less in the commercial hospitals, that is due to less number of binocular microscopes. The amount of resident training program, which consists of intra and intersectional meetings, are similar in the university and commercial hospitals, however, theoretic lectures are given only in 3 departments. Residents working in the university hospitals have obviously heavier burden than in the commercial hospitals. Lastly, residents generally exclaimed that the time dedicated to the macroscopy training is less sufficient than time used for the microscopy training.The factors affecting the training of resident in pathology are divided into two main groups: 1 Factors directly affecting training (quality of trainer, time dedicated for education, feed back, eg. and 2 Conditions which waste residents' time. For instant, workload which does need
Bellolio, M. Fernanda; Cabrera, Daniel; Sadosty, Annie T.; Hess, Erik P.; Campbell, Ronna L.; Lohse, Christine M.; Sunga, Karmen L.
Introduction Compassion fatigue (CF) is the emotional and physical burden felt by those helping others in distress, leading to a reduced capacity and interest in being empathetic towards future suffering. Emergency care providers are at an increased risk of CF secondary to their first responder roles and exposure to traumatic events. We aimed to investigate the current state of compassion fatigue among emergency medicine (EM) resident physicians, including an assessment of contributing factors. Methods We distributed a validated electronic questionnaire consisting of the Professional Quality of Life Scale with subscales for the three components of CF (compassion satisfaction, burnout and secondary traumatic stress), with each category scored independently. We collected data pertaining to day- versus night-shift distribution, hourly workload and child dependents. We included residents in EM, neurology, orthopedics, family medicine, pediatrics, obstetrics, and general surgery. Results We surveyed 255 residents, with a response rate of 75%. Of the 188 resident respondents, 18% worked a majority of their clinical shifts overnight, and 32% had child dependents. Burnout scores for residents who worked greater than 80 hours per week, or primarily worked overnight shifts, were higher than residents who worked less than 80 hours (mean score 25.0 vs 21.5; p=0.013), or did not work overnight (mean score 23.5 vs 21.3; p=0.022). EM residents had similar scores in all three components of CF when compared to other specialties. Secondary traumatic stress scores for residents who worked greater than 80 hours were higher than residents who worked less than 80 hours (mean score 22.2 vs 19.5; p=0.048), and those with child dependents had higher secondary traumatic stress than those without children (mean score 21.0 vs 19.1; p=0.012). Conclusion CF scores in EM residents are similar to residents in other surgical and medical specialties. Residents working primarily night shifts and
M. Fernanda Bellolio
Full Text Available Introduction: Compassion fatigue (CF is the emotional and physical burden felt by those helping others in distress, leading to a reduced capacity and interest in being empathetic towards future suffering. Emergency care providers are at an increased risk of CF secondary to their first responder roles and exposure to traumatic events. We aimed to investigate the current state of compassion fatigue among emergency medicine (EM resident physicians, including an assessment of contributing factors. Methods: We distributed a validated electronic questionnaire consisting of the Professional Quality of Life Scale with subscales for the three components of CF (compassion satisfaction, burnout and secondary traumatic stress, with each category scored independently. We collected data pertaining to day- versus night-shift distribution, hourly workload and child dependents. We included residents in EM, neurology, orthopedics, family medicine, pediatrics, obstetrics, and general surgery. Results: We surveyed 255 residents, with a response rate of 75%. Of the 188 resident respondents, 18% worked a majority of their clinical shifts overnight, and 32% had child dependents. Burnout scores for residents who worked greater than 80 hours per week, or primarily worked overnight shifts, were higher than residents who worked less than 80 hours (mean score 25.0 vs 21.5; p=0.013, or did not work overnight (mean score 23.5 vs 21.3; p=0.022. EM residents had similar scores in all three components of CF when compared to other specialties. Secondary traumatic stress scores for residents who worked greater than 80 hours were higher than residents who worked less than 80 hours (mean score 22.2 vs 19.5; p=0.048, and those with child dependents had higher secondary traumatic stress than those without children (mean score 21.0 vs 19.1; p=0.012. Conclusion: CF scores in EM residents are similar to residents in other surgical and medical specialties. Residents working primarily
Daniels, Michael N; Maynard, Sharon; Porter, Ivan; Kincaid, Hope; Jain, Deepika; Aslam, Nabeel
Interest in nephrology careers among internal medicine residents in the United States is declining. Our objective was to assess the impact of the presence of a nephrology fellowship training program on perceptions and career interest in nephrology among internal medicine residents. A secondary objective was to identify commonly endorsed negative perceptions of nephrology among internal medicine residents. This was a repeated cross-sectional survey of internal medicine residents before (Group 1) and 3 years after (Group 2) the establishment of nephrology fellowship programs at two institutions. The primary outcome was the percentage of residents indicating nephrology as a career interest in Group 1 vs. Group 2. Secondary outcomes included the frequency that residents agreed with negative statements about nephrology. 131 (80.9%) of 162 residents completed the survey. 19 (14.8%) residents indicated interest in a nephrology career, with 8 (6.3%) indicating nephrology as their first choice. There was no difference in career interest in nephrology between residents who were exposed to nephrology fellows during residency training (Group 2) and residents who were not (Group 1). The most commonly endorsed negative perceptions of nephrology were: nephrology fellows have long hours/burdensome call (36 [28.1%] of residents agreed or strongly agreed), practicing nephrologists must take frequent/difficult call (35 [27.6%] agreed or strongly agreed), and nephrology has few opportunities for procedures (35 [27.3%] agreed or strongly agreed). More residents in Group 2 agreed that nephrology is poorly paid (8.9% in Group 1 vs. 20.8% in Group 2, P = 0.04), whereas more residents in Group 1 agreed that nephrologists must take frequent/difficult call (40.0% in Group 1 vs. 18.1% in Group 2, P = 0.02). The initiation of a nephrology fellowship program was not associated with an increase in internal medicine residents' interest in nephrology careers. Residents endorsed several negative
McCay, M. H.; McCay, T. D.; Dahotre, N. B.; Sharp, C. M.; Sedghinasab, A.; Gopinathan, S.
Crack sensitive Inconel 718 was laser pulse welded using a 3.0 kW CO2 laser. Weld shape, structure, and porosity were recorded as a function of the pulse duty cycle. Within the matrix studied, the welds were found to be optimized at a high (17 ms on, 7 ms off) duty cycle. These welds were superior in appearance and lack of porosity to both low duty cycle and CW welds.
We study the effects of EU antidumping policy when foreign firms can ‘jump’ antidumping duties through foreign direct investment (FDI) in the EU. We show that duty jumping or duty pre-empting FDI occurs if the EU administration has broader objectives than protecting EU industry's profitability and if cost advantages of foreign firms are transferable abroad. The (expectation of) price undertakings reduces the incentives to engage in FDI and may even discourage FDI as long as products are not t...
Hall, Jacqulyn Kay
Increasingly, clinicians are under a moral duty to report errors to the patients who are injured by such errors. The sources of this duty are identified, and its probable impact on malpractice litigation and criminal law is discussed. The potential consequences of enforcing this new moral duty as a minimum in law are noted. One predicted consequence is that the trend will be accelerated toward government payment of compensation for errors. The effect of truth-telling on individuals is discussed.
TANASOIU Georgiana Lavinia; Enea, Constanta
Social responsibility is not charity, it’s a duty. Today we see all major companies following social responsibility. Social duty is not only attention allotted consumers, customers and contractors, communions and environment, as well employees and implicit their family. In concept triple bottom line, social duty presume achievements of social level, financial plane and environment level and follow a positive impact on society and, in same time, financial achievements. Education is an area...
Cristina M. Elizondo
organizational data. Academic data were collected in a sample of 24 residencies using questionnaires. We also gathered data using qualitative measurements, in a subsample of 15 residencies, by means of direct observation and in-depth interviews. We identified 162 ongoing residencies and a total of 2012 residents. The majority of them (87% were located in big cities, with a preponderance of public residencies (66%; 13% of these didn't have a residency instructor or coordinator. Most of these didn't have Institutional Internet available. The residents median age was 29 years old (Intercuartil range 2.7, with a 64.5% of women; 24% were under the regimen called "concurrente". From the sample, 230 residents were interviewed; 13% of them (CI95% 9-18.7 dide not receive any remuneration. The rest received a monthly payment (in Arg $ ranging from US$ 140 to 552. A 58% (13/22 was involved in Specialist courses. Medians for weekly working hours and for "on duty" were respectively 50 and 8 per month, with no difference between public or private institutions. These findings evidence the need to certify the formative and academic process of IMR.
An observational study describes on-duty nurses' informative behaviors from the perspective of library and information science, rather than patient care,. It reveals their information sources, the kinds of information they seek, and their barriers to information acquisition. Participant observation and in-context interviews were used to record in detail fifty hours of the information behavior of a purposive sample of on-duty critical care nurses on twenty-bed critical care unit in a community hospital. The investigator used rigorous ethnographic methods-including open, in vivo, and axial coding--to analyze the resulting rich textual data. The nurses' information behavior centered on the patient, seeking information from people, the patient record, and other systems. The nurses mostly used patient-specific information, but they also used some social and logistic information. They occasionally sought knowledge-based information. Barriers to information acquisition included illegible handwriting, difficult navigation of online systems, equipment failure, unavailable people, social protocols, and mistakes caused by people multitasking while working with multiple complex systems. Although the participating nurses understood and respected evidence-based practice, many believed that taking time to read published information on duty was not only difficult, but perhaps also ethically wrong. They said that a personal information service available to them at all hours of the day or night would be very useful. On-duty critical care nursing is a patient-centric information activity. A major implication of this study for librarians is that immediate professional reference service--including quality and quantity filtering-may be more useful to on-duty nurses than do-it-yourself searching and traditional document delivery are.
Objectives: An observational study describes on-duty nurses' informative behaviors from the perspective of library and information science, rather than patient care,. It reveals their information sources, the kinds of information they seek, and their barriers to information acquisition. Methods: Participant observation and in-context interviews were used to record in detail fifty hours of the information behavior of a purposive sample of on-duty critical care nurses on twenty-bed critical care unit in a community hospital. The investigator used rigorous ethnographic methods—including open, in vivo, and axial coding—to analyze the resulting rich textual data. Results: The nurses' information behavior centered on the patient, seeking information from people, the patient record, and other systems. The nurses mostly used patient-specific information, but they also used some social and logistic information. They occasionally sought knowledge-based information. Barriers to information acquisition included illegible handwriting, difficult navigation of online systems, equipment failure, unavailable people, social protocols, and mistakes caused by people multitasking while working with multiple complex systems. Although the participating nurses understood and respected evidence-based practice, many believed that taking time to read published information on duty was not only difficult, but perhaps also ethically wrong. They said that a personal information service available to them at all hours of the day or night would be very useful. Conclusions: On-duty critical care nursing is a patient-centric information activity. A major implication of this study for librarians is that immediate professional reference service—including quality and quantity filtering—may be more useful to on-duty nurses than do-it-yourself searching and traditional document delivery are. PMID:16636706
Filippo eSantoni de Sio
Full Text Available This theoretical paper draws the scientific community’s attention to how pharmacological cognitive enhancement may impact on society and law. Namely, if safe, reliable, and effective techniques to enhance mental performance are eventually developed, then this may under some circumstances impose new duties onto people in high-responsibility professions – e.g. surgeons or pilots – to use such substances to minimize risks of adverse outcomes or to increase the likelihood of good outcomes. By discussing this topic, we also hope to encourage scientists to bring their expertise to bear on this current public debate.
Carpenter, A.W. [Lawson Lundell Lawson and MacIntosh, Calgary, AB (Canada)
Aboriginal law in Canada has been evolving and industry is beginning to engage in the change. This presentation describes the legal aspects regarding Aboriginal rights and the duty to consult First Nations regarding treaty rights. The implications for First Nations and industry are described. Aboriginal peoples of Canada include the Indian, Inuit and Metis populations. Aboriginal titles exist, therefore they are constitutionally protected. The paper describes recent decisions regarding the Mikisew Cree First Nation versus Canada, the Taku River Tlinget versus Ringstad, and the Haida Nation versus British Columbia and Weyerhaeuser.
Max Maureira Pacheco
Full Text Available For Kant, the moral duty is determined universally, that is, on account of its form, in the moral norm. However the moral norm is opposed to particularity, determined by what is not the norm itself, hence being the origin of singularity. The singularized norm is opposed, from experience, by its negation in individual cases. To assume Kant demands the reconciliation of the singular, manifested incases, with the universal. This article deals with this question, demonstrating, above all, the practical difficulties linked to the moral experience in its totality.
Lakshminarayanan, P A
The critical parts of a heavy duty engine are theoretically designed for infinite life without mechanical fatigue failure. Yet the life of an engine is in reality determined by wear of the critical parts. Even if an engine is designed and built to have normal wear life, abnormal wear takes place either due to special working conditions or increased loading. Understanding abnormal and normal wear enables the engineer to control the external conditions leading to premature wear, or to design the critical parts that have longer wear life and hence lower costs. The literature on wear phenomenon r
Peets, Adam D; Stelfox, Henry T
Learning in the clinical environment is believed to be a crucial component of residency training. However, it remains unclear whether recent changes to postgraduate medical education, including the implementation of work hour limitations, have significantly impacted opportunities for experiential learning. Therefore, we sought to quantify opportunities to gain clinical experience within medical-surgical intensive care units (ICUs) over time. Data on the numbers of patients admitted and invasive procedures performed per day between 1 July 2001 and 30 June 2010 within three academic medical-surgical ICUs in Calgary, Alberta, Canada were obtained from electronic medical records. These data were matched to resident doctor on-call schedules and residents' opportunities to admit patients and participate in procedures were calculated and compared over time using Spearman's rho. We found that over a 9-year period, the opportunities afforded to residents (n = 1156) to admit patients (n = 17 189) and perform procedures (n = 52 827) during ICU rotations decreased by 32% (p < 0.001) and 34% (p < 0.001), respectively. Our results suggest that there has been a significant decrease in residents' clinical experiences in the ICU over time. Further investigations to better understand these changes and how they may impact on performance as residents become independent practising doctors are warranted. © Blackwell Publishing Ltd 2012.
Full Text Available The paper defends the thesis that our epistemic duty is the duty to proportion our beliefs to the evidence we possess. An inclusive view of evidenced possessed is put forward on the grounds that it makes sense of our intuitions about when it is right to say that a person ought to believe some proposition P. A second thesis is that we have no epistemic duty to adopt any particular doxastic attitudes. The apparent tension between the two theses is resolved by applying the concept of duty to belief indirectly.
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Prins, J.T.; Hoekstra-Weebers, J.E.; Van De Wiel, H.B.; Gazendam-Donofrio, S.M.; Sprangers, F.; Jaspers, F.C.; van der Heijden, F.M.
We examined levels of burnout and relationships between burnout, gender, age, years in training, and medical specialty in 158 medical residents working at the University Medical Center Groningen, the Netherlands. Thirteen percent of the residents met the criteria for burnout, with the highest percen
Prins, J.T.; Hoekstra-Weebers, J.E.; Van De Wiel, H.B.; Gazendam-Donofrio, S.M.; Sprangers, F.; Jaspers, F.C.; van der Heijden, F.M.
We examined levels of burnout and relationships between burnout, gender, age, years in training, and medical specialty in 158 medical residents working at the University Medical Center Groningen, the Netherlands. Thirteen percent of the residents met the criteria for burnout, with the highest percen
Levine, Stephen B.; Scott, David L.
Objective: The authors seek to promote sexuality curriculum development in departments of psychiatry. Methods: The authors first focus on educational philosophy about what residents can be taught about sexual topics and then provide numerical and narrative resident evaluation data following a 6-month, half day per week rotation in a sexuality…
Lagwinski, Nikolaj; Hunt, Jennifer L
Recent changes in pathology residency education have included a decrease in the program length (from 5 years to 4 years for combined anatomic and clinical pathology training) and a national mandate for programs to assess 6 general competencies of trainees. These have undoubtedly led to changes in program curricula and in residents' desires to seek fellowship training. This study was designed to gather information about what residents are seeking from fellowship training programs. This study used an online survey to assess attitudes of residents in training programs toward fellowship training. The survey instrument had 26 questions pertaining to fellowship choices, motivations for pursuing fellowships, expectations of the fellowships, and postresidency concerns. There were 213 respondents from a mix of program types and representing each postgraduate year. Most residents will seek at least 1 or 2 fellowships after residency training. The most popular first-choice fellowship was surgical pathology (26%), followed by cytopathology (16%), hematopathology (15%), gastrointestinal pathology (10%), dermatopathology (8%), and forensic pathology (5%). The most common reasons for pursuing fellowship training were to "increase marketability" (43%) or to "become an expert in a particular area" (33%). Most trainees got their information about fellowship training programs from Internet sources. Fellowship programs will benefit from an optimally designed Web site because residents seek information predominantly from the Internet. Residents seeking fellowships are particularly concerned with selecting programs that provide job connections, an increase in their marketability, and the opportunity to develop diagnostic expertise.
Lutsky, Irving; And Others
The analysis of 183 responses to a survey of former anesthesiology residents of the Medical College of Wisconsin found that 29 had been self-administered problematic substance abusers during their residencies, 23 had been alcohol dependent, and 6 had been drug dependent. More than 85 percent of respondents considered the drug policy information…
Hall, James W.
Institutions are bringing the professional artist into their instructional and cultural environments through five approaches: concert performances, extended performances, master classes, part-time residencies, and full-time residencies. The effect of each program on the artist and the college or university is examined. (Author/LBH)
Prins, J.T.; Hoekstra-Weebers, J.E.; Van De Wiel, H.B.; Gazendam-Donofrio, S.M.; Sprangers, F.; Jaspers, F.C.; van der Heijden, F.M.
We examined levels of burnout and relationships between burnout, gender, age, years in training, and medical specialty in 158 medical residents working at the University Medical Center Groningen, the Netherlands. Thirteen percent of the residents met the criteria for burnout, with the highest
From November 1993 to October 1996, Hennepin County, which includes Minneapolis, field-tested two heavy-duty snowplow/road maintenance trucks fueled by ethanol. The overall objective of this program was to collect data from original equipment manufacturer alternative fuel heavy-duty trucks, along with comparable data from a similarly configured diesel-powered vehicle, to establish economic, emissions, performance, and durability data for the alternative fuel technology. These ethanol trucks, along with an identical third truck equipped with a diesel engine, were operated year round to maintain the Hennepin county roads. In winter, the trucks were run in 8-hour shifts plowing and hauling snow from urban and suburban roads. For the rest of the year, the three trucks were used to repair and maintain these same roads. As a result of this project, a considerable amount of data was collected on E95 fuel use, as well as maintenance, repair, emissions, and operational characteristics. Maintenance and repair costs of the E95 trucks were considerably higher primarily due to fuel filter and fuel pump issues. From an emissions standpoint, the E95 trucks emitted less particulate matter and fewer oxides of nitrogen but more carbon monoxide and hydrocarbons. Overall, the E95 trucks operated as well as the diesel, as long as the fuel filters were changed frequently. This project was a success in that E95, a domestically produced fuel from a renewable energy source, was used in a heavy-duty truck application and performed the same rigorous tasks as the diesel counterparts. The drawbacks to E95 as a heavy-duty fuel take the form of higher operational costs, higher fuel costs, shorter range, and the lack of over-the-road infrastructure.
... U.S. heavy-duty vehicle sales of complete heavy-duty Otto-cycle motor vehicles for model year 2008... complete heavy-duty Otto-cycle motor vehicles for model year 2008. (2)(i) Manufacturers certifying vehicles... Vehicles, Light-Duty Trucks, and Complete Otto-Cycle Heavy-Duty Vehicles § 86.1816-08 Emission...
William M. Snellings
Full Text Available Ethylene oxide was tested on groups of rats for either 4-hour or 1-hour inhalation exposure, followed by 14 days of observation. Groups of five Sprague-Dawley rats/sex were exposed, and clinical signs and mortality were recorded. Clinical signs noted included irregular breathing, absence of certain reflexes, and tremors. Rats that died had moderate to severe pulmonary congestion. The calculated LC50 values, reported as ppm by volume (with 95% confidence limits, were as follows. 4-hour LC50 values were 1972 (1887 to 2061 ppm for males; 1537 (1391 to 1698 ppm for females; 1741 (1655 to 1831 ppm for the combined sexes. The 1-hour LC50 values were 5748 (5276 to 6262 ppm for males; 4439 (4034 to 4884 ppm for females; 5029 (4634 to 5459 ppm for the combined sexes.
Please note the new opening hours of the gates as well as the intersites tunnel from the 19 May 2009: GATE A 7h - 19h GATE B 24h/24 GATE C 7h - 9h\t17h - 19h GATE D 8h - 12h\t13h - 16h GATE E 7h - 9h\t17h - 19h Prévessin 24h/24 The intersites tunnel will be opened from 7h30 to 18h non stop. GS-SEM Group Infrastructure and General Services Department
Due to maintenance work, the opening hours of Gate A (near Reception) will be modified between Monday, 13 and Friday, 17 April 2015. During this period, the gate will be open to vehicles between 7 a.m. and 9.30 a.m., then between 4.30 p.m. and 7 p.m. It will be completely closed to traffic between 9.30 a.m. and 4.30 p.m. Pedestrians and cyclists may continue to use the gate. We apologise for any inconvenience and thank you for your understanding.
Please note the new temporary opening hours for the gate C as from 22 September 2010 until 29 October 2010 (working days): Morning: between 7:00 a.m. and 9:00 a.m. Lunch: between 12:00 and 2:00 p.m. Evening: between 5:00 pm and 7:00 p.m. Traffic flow will be permitted in both directions during this period. Please minimize your speed accordingly and respect all road signs. GS-SEM Group General Infrastructure Services Department
Butler, Graham; Hunt, Brian; Doyle, Andrew
Private Members' Bill (legislation) introduced in Dáil Éireann (House of Deputies), Houses of the Oireachtas (Parliament of Ireland). An Act to set voting hours for Dáil Elections, Dáil Bye-Elections, Presidential Elections, European Parliament Elections, Local Government Elections and Referenda...... as being 7.00 a.m. to 10.00 p.m. and for that purpose to amend the Electoral Act 1992, Presidential Elections Act 1993, Referendum Act 1994, European Parliament Elections Act 1997, the Local Government Act 2001 and to provide for related matters....
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Cooley, Dennis R
Standard arguments for a duty to die or to commit suicide generally rely upon contractarian or other form of justice or the Principle of Beneficence. Even though some of these arguments might appear deontological, there is an explicit or implicit consequentialist common thread in all of them in which utility of some sort is maximized only through the taking of one's own life. Hence, most arguments for a suicide duty are consequentialist in nature. There are a number of relatively unexplored deontological arguments that make plausible cases for the mandatory taking of one's own life. For example, although Kant is widely thought to prohibit all suicides, a careful reading of his work can show a plausible case based on the Categorical Imperative. If it is necessary to preserve the individual's moral life, then everyone could will the generalized maxim governing the situation as a law of nature. Unfortunately, Kant's argument is weakened by his poor understanding of moral psychology. To strengthen Kant's case, care-relationship ethics can be combined with the argument to produce a plausible case that people are obligated to kill themselves if a number of criteria are satisfied.
Morrisey, F G
The new Code of Canon Law outlines a number of duties of those who have responsibility for administering the Church's temporal goods. Before assuming office, administrators must pledge to be efficient and faithful, and they must prepare an inventory of goods belonging to the juridic person they serve. Among their duties, administrators must: Ensure that adequate insurance is provided; Use civilly valid methods to protect canonical ownership of the goods; Observe civil and canon law prescriptions as well as donors' intentions; Collect and safeguard revenues, repay debts, and invest funds securely; Maintain accurate records, keep documents secure, and prepare an annual budget; Prepare an annual report and present it to the Ordinary where prescribed; Observe civil law concerning labor and social policy, and pay employees a just and decent wage. Administrators who carry out acts that are invalid canonically are liable for such acts. The juridic person is not liable, unless it derived benefit from the transaction. Liability is especially high when the sale of property is involved or when a contract is entered into without proper cannonical consent. Although Church law is relatively powerless to punish those who have been negligent, stewards, administrators, and trustees must do all they can to be truthful to the responsibility with which they have been entrusted.
Romano, P; Segreto, A; Ducci, L; Vercellone, S
The duty cycle (DC) of astrophysical sources is generally defined as the fraction of time during which the sources are active. However, DCs are generally not provided with statistical uncertainties, since the standard approach is to perform Monte Carlo bootstrap simulations to evaluate them, which can be quite time consuming for a large sample of sources. As an alternative, considerably less time-consuming approach, we derived the theoretical expectation value for the DC and its error for sources whose state is one of two possible, mutually exclusive states, inactive (off) or flaring (on), as based on a finite set of independent observational data points. Following a Bayesian approach, we derived the analytical expression for the posterior, the conjugated distribution adopted as prior, and the expectation value and variance. We applied our method to the specific case of the inactivity duty cycle (IDC) for supergiant fast X-ray transients. We also studied IDC as a function of the number of observations in the ...
Nakrem, Sigrid; Vinsnes, Anne G; Harkless, Gene E; Paulsen, Bård; Seim, Arnfinn
Residential care in nursing homes continues to be necessary for those individuals who are no longer able to live at home. Uncovering what nursing home residents' view as quality of care in nursing homes will help further understanding of how best to provide high quality, person-centred care. To describe residents' experiences of living in a nursing home related to quality of care. The study utilises a descriptive exploratory design. In-depth interviews were undertaken with 15 residents who were not cognitively impaired, aged 65 and over and living in one of four nursing homes. The interviews were transcribed verbatim and analysed by categorising of meaning. Residents perceived the nursing home as their home, but at the same time not 'a home'. This essential ambiguity created the tension from which the categories of perceptions of quality emerged. Four main categories of quality of care experience were identified: 'Being at home in a nursing home', 'Paying the price for 24-hour care', 'Personal habits and institutional routines', and 'Meaningful activities for a meaningful day'. Ambiguities concerning the nursing home as a home and place to live, a social environment in which the residents experience most of their social life and the institution where professional health service is provided were uncovered. High-quality care was when ambiguities were managed well and a home could be created within the institution. Implication for practice. Achieving quality care in nursing homes requires reconciling the ambiguities of the nursing home as a home. This implies helping residents to create a private home distinct from the professional home, allowing residents' personal habits to guide institutional routines and supporting meaningful activities. Using these resident developed quality indicators is an important step in improving nursing home services. © 2012 Blackwell Publishing Ltd.
This year, the 48-hour film project (48hfp) returns to Geneva after a one-year hiatus. Organized by Neal Hartman and the CERN film-making club, Open Your Eyes Films, the 48hfp challenges teams of film-makers to write, shoot, soundtrack and edit a 4 to 7 minute film in 48 hours from 4 to 6 November. At the start of the festival, contestants picked their film genre from a hat. The films will be screened on 8 and 9 November, with the awards presentation on the 9th. The winner will receive a trip to the US to compete in the international version of the competition. “There are so many short films being made now," says Hartman, “I think, however, that the 48hfp allows a critical creative mass to form. The result is that these 20 teams make 20 better films than if each participant were making their own." Each team draws a genre from a hat and is given a character, a prop and a line of dialogue that must appear in their film. The genres run the gamut from &am...
Shweiki, Ehyal; Martin, Niels D; Beekley, Alec C; Jenoff, Jay S; Koenig, George J; Kaulback, Kris R; Lindenbaum, Gary A; Patel, Pankaj H; Rosen, Matthew M; Weinstein, Michael S; Zubair, Muhammad H; Cohen, Murray J
Medical resident education in the United States has been a matter of national priority for decades, exemplified initially through the Liaison Committee for Graduate Medical Education and then superseded by the Accreditation Council for Graduate Medical Education. A recent Special Report in the New England Journal of Medicine, however, has described resident educational programs to date as prescriptive, noting an absence of innovation in education. Current aims of contemporary medical resident education are thus being directed at ensuring quality in learning as well as in patient care. Achievement and work-motivation theories attempt to explain people's choice, performance, and persistence in tasks. Expectancy Theory as one such theory was reviewed in detail, appearing particularly applicable to surgical residency training. Correlations between Expectancy Theory as a work-motivation theory and residency education were explored. Understanding achievement and work-motivation theories affords an opportunity to gain insight into resident motivation in training. The application of Expectancy Theory in particular provides an innovative perspective into residency education. Afforded are opportunities to promote the development of programmatic methods facilitating surgical resident motivation in education.
Shweiki, Ehyal; Martin, Niels D; Beekley, Alec C; Jenoff, Jay S; Koenig, George J; Kaulback, Kris R; Lindenbaum, Gary A; Patel, Pankaj H; Rosen, Matthew M; Weinstein, Michael S; Zubair, Muhammad H; Cohen, Murray J
Medical resident education in the United States has been a matter of national priority for decades, exemplified initially through the Liaison Committee for Graduate Medical Education and then superseded by the Accreditation Council for Graduate Medical Education. A recent Special Report in the New England Journal of Medicine, however, has described resident educational programs to date as prescriptive, noting an absence of innovation in education. Current aims of contemporary medical resident education are thus being directed at ensuring quality in learning as well as in patient care. Achievement and work-motivation theories attempt to explain people’s choice, performance, and persistence in tasks. Expectancy Theory as one such theory was reviewed in detail, appearing particularly applicable to surgical residency training. Correlations between Expectancy Theory as a work-motivation theory and residency education were explored. Understanding achievement and work-motivation theories affords an opportunity to gain insight into resident motivation in training. The application of Expectancy Theory in particular provides an innovative perspective into residency education. Afforded are opportunities to promote the development of programmatic methods facilitating surgical resident motivation in education. PMID:25995656
Schwartz, Samuel I; Galante, Joseph; Kaji, Amy; Dolich, Matthew; Easter, David; Melcher, Marc L; Patel, Kevin; Reeves, Mark E; Salim, Ali; Senagore, Anthony J; Takanishi, Danny M; de Virgilio, Christian
The 80-hour work-week limit for all residents was instituted in 2003 and studies looking at its effect have been mixed. Since the advent of the 16-hour mandate for postgraduate year 1 residents in July 2011, no data have been published regarding the effect of this additional work-hour restriction. To determine whether the 16-hour intern work limit, implemented in July 2011, has adversely affected operative experience. A retrospective review of categorical postgraduate year 1 Accreditation Council for Graduate Medical Education case logs from the intern class (N = 52) (with 16-hour work limit) compared with the 4 preceding years (2007-2010; N = 197) (without 16-hour work limit). A total of 249 categorical general surgery interns from 10 general surgery residency programs in the western United States were included. Total, major, first-assistant, and defined-category case totals. As compared with the preceding 4 years, the 2011-2012 interns recorded a 25.8% decrease in total operative cases (65.9 vs 88.8, P = .005), a 31.8% decrease in major cases (54.9 vs 80.5, P intern era, whereas there was no decrease in trauma, vascular, alimentary, endoscopy, liver, and pancreas cases. The 16-hour work limit for interns, implemented in July 2011, is associated with a significant decrease in categorical intern operative experience. If the 16-hour shift were to be extended to all postgraduate year levels, one can anticipate that additional years of training will be needed to maintain the same operative volume.
... 33 Navigation and Navigable Waters 1 2010-07-01 2010-07-01 false Assignment to specific duties. 5.27 Section 5.27 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY GENERAL COAST GUARD AUXILIARY § 5.27 Assignment to specific duties. Members of the Auxiliary shall not be...
Fihl, Preben; Moeslund, Thomas B.
This paper deals with classification of human gait types based on the notion that different gait types are in fact different types of locomotion, i.e., running is not simply walking done faster. We present the duty-factor, which is a descriptor based on this notion. The duty-factor is independent...
... 7 Agriculture 1 2010-01-01 2010-01-01 false County executive director duties. 7.25 Section 7.25... CONSERVATION STATE, COUNTY AND COMMUNITY COMMITTEES § 7.25 County executive director duties. (a) The county executive director shall execute the policies established by the county committee and be responsible for...
... and Rest Requirements AGENCY: Federal Aviation Administration (FAA), DOT. ACTION: Availability of... Regulatory Impact Analysis of its final rule amending its existing flight, duty and rest regulations... Register as Flight Crew Member Duty and Rest Requirements on January 4, 2012. 77 FR 330. The regulations...
... Federal Aviation Administration 14 CFR Parts 117 and 121 RIN 2120-AJ58 Flightcrew Member Duty and Rest..., to amend its existing flight, duty and rest regulations applicable to certificate holders and their... and Rest Requirements.'' The proposed regulation recognizes the growing similarities between the types...
... Federal Aviation Administration 14 CFR Parts 117 and 121 RIN 2120-AJ58 Flightcrew Member Duty and Rest... flight, duty and rest regulations applicable to certificate holders and their flightcrew members. The FAA... and Rest Requirements'' (75 FR 55852). The proposed regulation recognizes the growing similarities...
... misconduct. 3.301 Section 3.301 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS... Entitlement Considerations § 3.301 Line of duty and misconduct. (a) Line of duty. Direct service connection..., and not the result of the veteran's own willful misconduct or, for claims filed after October 31,...
... 15 Commerce and Foreign Trade 1 2010-01-01 2010-01-01 false Duties of a Team. 270.105 Section 270... OF STANDARDS AND TECHNOLOGY, DEPARTMENT OF COMMERCE NATIONAL CONSTRUCTION SAFETY TEAMS NATIONAL CONSTRUCTION SAFETY TEAMS Establishment and Deployment of Teams § 270.105 Duties of a Team. (a) A Team's...
... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Uncommon tours of duty. 630.210 Section 630.210 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS ABSENCE AND LEAVE Definitions and General Provisions for Annual and Sick Leave § 630.210 Uncommon tours of duty. (a...
... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Duties of custodian. 49.2 Section 49.2 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) ANTITRUST CIVIL PROCESS ACT § 49.2 Duties of custodian. (a) Upon taking physical possession of documentary material, answers to interrogatories,...
... 40 Protection of Environment 32 2010-07-01 2010-07-01 false Duty cycle generation. 1065.512... cycle generation. (a) Generate duty cycles according to this section if the standard-setting part... sequence of paired values for speed and torque or for speed and power. (b) Transform normalized values...
... OF THE TREASURY ARTICLES CONDITIONALLY FREE, SUBJECT TO A REDUCED RATE, ETC. Dominican Republic... last CAFTA-DR country will be liquidated or reliquidated at the applicable rate of duty for that good... excess customs duties paid with respect to such entry, with interest accrued from the date of entry...
... 7 Agriculture 1 2010-01-01 2010-01-01 false Community committee duties. 7.22 Section 7.22... CONSERVATION STATE, COUNTY AND COMMUNITY COMMITTEES § 7.22 Community committee duties. (a) The community... community committee shall: (1) Serve as an advisor and consultant to the county committee; (2)...
This study surveys 107 foreign language departments in secondary schools in western New York and identifies duties and practices of those responsible for the departmental leadership. The report also determines the amount of released time granted to perform departmental duties. The educational preparation and work experience of supervisory staff…
... 31 Money and Finance: Treasury 2 2010-07-01 2010-07-01 false Duties of Bureau of Customs. 401.4... TRANSPORT COUNTERFEIT COINS, OBLIGATIONS, SECURITIES, AND PARAPHERNALIA § 401.4 Duties of Bureau of Customs... director of customs pursuant to the said act of August 9, 1939, and the regulations in this part,...
... 31 Money and Finance: Treasury 2 2010-07-01 2010-07-01 false Duties of customs officers. 406.4... 1934 AND GOLD REGULATIONS § 406.4 Duties of customs officers. The appropriate officials of the Bureau of Customs are hereby authorized and designated as the officers who shall perform such...
Last month's article considered the scope of a district nurse's duty to maintain the confidentiality of patient information under the Nursing and Midwifery Council (NMC) Code, their contract of employment, and the law. This month, Richard Griffith considers the exceptions to these duties and sets out when a district nurse would be justified in disclosing patient information.
... 46 Shipping 9 2010-10-01 2010-10-01 false Freight forwarder duties. 515.32 Section 515.32 Shipping... Commission § 515.32 Freight forwarder duties. (a) Notice of shipper affiliation. When a licensed freight... licensed freight forwarder shall have the option of: (1) Identifying itself as such and/or, where...
... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Programming, duty, and housing... INSTITUTIONAL MANAGEMENT MEDICAL SERVICES Infectious Disease Management § 549.13 Programming, duty, and housing restrictions. (a) The CD will assess any inmate with an infectious disease for appropriateness for...
... 42 Public Health 4 2010-10-01 2010-10-01 false Private duty nursing services. 440.80 Section 440... nursing services. Private duty nursing services means nursing services for recipients who require more individual and continuous care than is available from a visiting nurse or routinely provided by the...
This article explores the situation when a nurse receives a report from a patient that a colleague is stealing from the patient. It looks at the duty of the nurse and the issues which may arise when she tries to put her duty into action. It also considers the legal situation of the colleague who is the subject of the allegations.
Ferracioli, L.; de Lora, P.
In this essay, we focus on the moral justification of a highly controversial measure to redress medical brain drain: the duty to stay. We argue that the moral justification for this duty lies primarily in the fact that medical students impose high risks on their fellow citizens while receiving their
... 45 Public Welfare 4 2010-10-01 2010-10-01 false Duties of the Corporation. 1618.5 Section 1618.5 Public Welfare Regulations Relating to Public Welfare (Continued) LEGAL SERVICES CORPORATION ENFORCEMENT PROCEDURES § 1618.5 Duties of the Corporation. (a) Whenever there is reason to believe that a recipient or...
... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Employee's duty to report... PROVISIONS Referrals of Information Regarding Criminal Violations § 1.201 Employee's duty to report. All VA employees with knowledge or information about actual or possible violations of criminal law related to VA...
Donlevy, James Kent; Gereluk, Dianne; Brandon, Jim; Patterson, Peggy
Following "E.D.G. v. Hammer", Canadian law has held that school boards, although they have a fiduciary duty to their students, do not guarantee the safety of their students from the acts of their employees. The scope of that fiduciary duty is narrow, restricted to a board acting with disloyalty, in bad faith, or in a conflict of interest…
... 25 Indians 1 2010-04-01 2010-04-01 false Law enforcement officer's duties. 11.1003 Section 11.1003 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR LAW AND ORDER COURTS OF INDIAN OFFENSES AND LAW AND ORDER CODE Juvenile Offender Procedure § 11.1003 Law enforcement officer's duties. A law...
... 25 Indians 1 2010-04-01 2010-04-01 false Law enforcement officer's duties. 11.1103 Section 11.1103 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR LAW AND ORDER COURTS OF INDIAN OFFENSES AND LAW AND ORDER CODE Minor-in-Need-of-Care Procedure § 11.1103 Law enforcement officer's duties. Upon...
Klein, Eric E; Gerbi, Bruce J; Price, Robert A; Balter, James M; Paliwal, Bhudatt; Hughes, Lesley; Huang, Eugene
In 2004, the American Society for Therapeutic Radiology and Oncology (ASTRO) published a curriculum for physics education. The document described a 54-hour course. In 2006, the committee reconvened to update the curriculum. The committee is composed of physicists and physicians from various residency program teaching institutions. Simultaneously, members have associations with the American Association of Physicists in Medicine, ASTRO, Association of Residents in Radiation Oncology, American Board of Radiology, and American College of Radiology. Representatives from the latter two organizations are key to provide feedback between the examining organizations and ASTRO. Subjects are based on Accreditation Council for Graduate Medical Education requirements (particles and hyperthermia), whereas the majority of subjects and appropriated hours/subject were developed by consensus. The new curriculum is 55 hours, containing new subjects, redistribution of subjects with updates, and reorganization of core topics. For each subject, learning objectives are provided, and for each lecture hour, a detailed outline of material to be covered is provided. Some changes include a decrease in basic radiologic physics, addition of informatics as a subject, increase in intensity-modulated radiotherapy, and migration of some brachytherapy hours to radiopharmaceuticals. The new curriculum was approved by the ASTRO board in late 2006. It is hoped that physicists will adopt the curriculum for structuring their didactic teaching program, and simultaneously, the American Board of Radiology, for its written examination. The American College of Radiology uses the ASTRO curriculum for their training examination topics. In addition to the curriculum, the committee added suggested references, a glossary, and a condensed version of lectures for a Postgraduate Year 2 resident physics orientation. To ensure continued commitment to a current and relevant curriculum, subject matter will be updated
... International Trade Administration Honey from Argentina: Rescission of Countervailing Duty Administrative Review... the countervailing duty order on honey from Argentina. See Antidumping or Countervailing Duty Order..., 2009). On December 31, 2009, the American Honey Producers Association and the Sioux Honey...
... bank loan benchmark. Subsequently, on September 14, 2010, the DP Master Group filed rebuttal comments... China: Preliminary Affirmative Countervailing Duty Determination, 75 FR 33245 (June 11, 2010...: Alignment of Final Countervailing Duty Determination with Final Antidumping Duty Determination, 75 FR...
Visnja Vojvodić Rosenzweig
Full Text Available Maintenance of the training aircraft causes downtime of operations and thereby reduces the operational availability, which is crucial for flight planning in a training organisation. Manual daily planning within the fleet delivers suboptimal results and often causes discontinued flight of several aircraft that have to be maintained at the same time. Optimal maintenance schedule of training aircraft can be obtained by a sliding scale method. This paper presents a mathematical model of the sliding scale formulated by a mixed integer linear problem. Allocation of flight hours is optimised by using AMPL programming language, assuring that a sufficient number of aircraft are always available for training. The model can be used by a flight dispatch department in a training organisation as a basis for optimised planning and reduction of maintenance downtime.
Cole, Bonnie; Clark, Denice Crowe; Seale, J. Paul; Shellenberger, Sylvia; Lyme, Alan; Johnson, J. Aaron; Chhabria, Aruna
To enhance the skills of primary care residents in addressing substance misuse, residency screening, brief intervention, and referral to treatment (SBIRT) programs increasingly offer motivational interviewing (MI) training, but seldom include feedback and coaching. This innovative 2-round "Virginia Reel" approach, supplementing 3 hours of basic MI…
Dickens, Bernard M
This paper addresses legal protection of individual choices to obtain abortion services, to decline to perform abortions on grounds of religious objection, and to participate in these procedures. It considers legal duties to respect women as decision-makers in their own lives, including when they decide to continue pregnancy. The choice to decline participation in abortions is an aspect of religious freedom available to physicians, nurses, and, for instance, pharmacists, but not artificial legal persons such as hospital and clinic corporations. Refusal does not extend to ancillary functions such as serving meals, routine pre-operative and post-operative care of abortion patients or typing abortion referral letters. Physicians practising in proximate care must be trained in appropriate medical management of incomplete and threatened abortion even when they would refuse to apply such techniques to induce abortion.
Refolo, P; González-Melado, F J; Di Pietro, M L
People had contradictory opinions on using vaccinations over time: an initial opposition, later large favour and then doubts and perplexities. In recent times, some movements, blogs and associations stigmatize the use of vaccinations and they are increasingly asking to remove mandatory vaccinations in countries where they are active. The impact of the antivaccination campaigns should not be underestimated, considering that, for example, in Italy, due to these campaigns, adhesions to vaccinations are decreasing by 1% per year, and in reference to rubella and measles, adhesions decreased by 25% in some regions of the country. Overcoming the choice between mandatory and recommended vaccinations, the paper deals with the topic of using preventive immunization starting from the concept of "moral dutifulness".
Pruez, Jacky; Shoukry, Samir; Williams, Gergis; Shoukry, Mark
The main objective of this project is to develop, analyze and validate data, methodologies and tools that support widespread applications of automotive lightweighting technologies. Two underlying principles are guiding the research efforts towards this objective: • Seamless integration between the lightweight materials selected for certain vehicle systems, cost-effective methods for their design and manufacturing, and practical means to enhance their durability while reducing their Life-Cycle-Costs (LCC). • Smooth migration of the experience and findings accumulated so far at WVU in the areas of designing with lightweight materials, innovative joining concepts and durability predictions, from applications to the area of weight savings for heavy vehicle systems and hydrogen storage tanks, to lightweighting applications of selected systems or assemblies in light–duty vehicles.
Takala, T; Häyry, M
In a contribution to The Journal of Medicine and Philosophy, Professor Rosamond Rhodes argues that individuals sometimes have an obligation to know about their genetic disorders, because this is required by their status as autonomous persons. Her analysis, which is based on Kant's concept of autonomy and Aristotle's notion of friendship, is extended here to consequentialist concerns. These are of paramount importance if, as we believe and Professor Rhodes herself implies, the Kantian and Aristotelian doctrines can be helpful only in the sphere of private morality, not in the public realm. Better tools for assessing the right to genetic ignorance as an issue of public policy can, we contend, be found in Mill's ideas concerning liberty and the prevention of harm. Our own conclusion, based on the Millian way of thinking, is that individuals probably do have the right to remain in ignorance in the cases Professor Rhodes presents as examples of a duty to know.
Mackie, Robin J. D. [Smith Electric Vehicles Corporation, Kansas City, MO (United States)
The Smith Electric Vehicle Demonstration Project (SDP) was integral to the Smith business plan to establish a manufacturing base in the United States (US) and produce a portfolio of All Electric Vehicles (AEV’s) for the medium duty commercial truck market. Smith focused on the commercial depot based logistics market, as it represented the market that was most ready for the early adoption of AEV technology. The SDP enabled Smith to accelerate its introduction of vehicles and increase the size of its US supply chain to support early market adoption of AEV’s that were cost competitive, fully met the needs of a diverse set of end users and were compliant with Federal safety and emissions requirements. The SDP accelerated the development and production of various electric drive vehicle systems to substantially reduce petroleum consumption, reduce vehicular emissions of greenhouse gases (GHG), and increase US jobs.
Gordon, Chad R; Axelrad, Alex; Alexander, James B; Dellinger, R Phillip; Ross, Steven E
As a result of the recently mandated work-hour restrictions, it has become more difficult to provide 24-hour intensive care unit (ICU) in-house coverage by the general surgical residents. To assess the current state of providing appropriate continuous care to surgical critical care patients during the era of resident work-hour constraints, a national survey was conducted by the Association of Program Directors of Surgery. The results revealed that 37 per cent of programs surveyed have residents other than general surgery housestaff providing cross-coverage and writing orders for surgical ICU patients. Residents in emergency medicine, anesthesia, family medicine, otorhinolaryngology, obstetrics/gynecology, internal medicine, urology, and orthopedic surgery have provided this cross-coverage. Some found it necessary to use physician extenders (i.e., nurse practitioners or physician assistants), thereby decreasing the burden of surgical housestaff coverage. The results indicated that 30 per cent use physician extenders to help cover the ICU during daytime hours and 11 per cent used them during nighttime hours. In addition, 24 per cent used a "night-float" system in an attempt to maintain continuous care, yet still adhere to the mandated guidelines. In conclusion, our survey found multiple strategies, including the use of physician extenders, a "night-float" system, and the use of nongeneral surgical residents in an attempt to provide continuous coverage for surgical ICU patients. The overall outcome of these new strategies still needs to be assessed before any beneficial results can be demonstrated.
Full Text Available Taking the duty of loyalty as a starting point, which we consider to be the director’s core fiduciary duty, this paper aims at identifying the contours of good faith in corporate law and the interpretations of this institution in corporate governance. The objective of the paper is to demonstrate the autonomy of good faith, along with the duty of care and the duty of loyalty. The paper displays the traditional legal approaches of this institution, both in continental civil law and in common law literature and jurisprudence and exhaustively describes the obligations that compose or even define this concept. Due to its amplitude, the duty of good faith enabled courts to articulate subsidiary fiduciary duties that meet social changes and transformation within business law. By means of cited case law, the conclusion will show that due to the nature, content and effects of situations where specific obligations are met, these may not be incorporated as elements of the traditional duty of care or duty of loyalty.
U.S. Department of Health & Human Services — The MDS Active Resident Report summarizes information for residents currently in nursing homes. The source of these counts is the residents MDS assessment record....
Lobato, R D; Fernandez Alen, J; Alday, R; Gómez, P A; Lagares, A
A new Residency Program in Neurological Surgery has been recently elaborated by the "Comisión Nacional de Neurocirugía" following the requirement of the National Council of Specialities. This new Program, which will replace the one proposed in 1992, has been designed in a similar way as those applied in countries providing the best neurosurgical training. Changes included deal with the definition of the speciality, and the introduction of new rotations,a resident Log Book, a Tutor with a well defined profil and commitments, a structured planning of academic and clinical objectives, a rotation or training in research, and a planning for continuous evaluation of the progress of the resident. It is likely that an appropriate application of the new Program in Spanish neurosurgical units with accreditation for training will result in formation of highly competent neurosurgeons. However, there are new challenges for improving neurosurgical training and the development of our speciality in Spain, as those related with new legislation regulating resident working hours, or some political decisions changing the mechanisms for controlling the number of resident positions per year.
Full Text Available Ehyal Shweiki,1 Niels D Martin,2 Alec C Beekley,1 Jay S Jenoff,1 George J Koenig,1 Kris R Kaulback,1 Gary A Lindenbaum,1 Pankaj H Patel,1 Matthew M Rosen,1 Michael S Weinstein,1 Muhammad H Zubair,2 Murray J Cohen1 1Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA; 2Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA Abstract: Medical resident education in the United States has been a matter of national priority for decades, exemplified initially through the Liaison Committee for Graduate Medical Education and then superseded by the Accreditation Council for Graduate Medical Education. A recent Special Report in the New England Journal of Medicine, however, has described resident educational programs to date as prescriptive, noting an absence of innovation in education. Current aims of contemporary medical resident education are thus being directed at ensuring quality in learning as well as in patient care. Achievement and work-motivation theories attempt to explain people's choice, performance, and persistence in tasks. Expectancy Theory as one such theory was reviewed in detail, appearing particularly applicable to surgical residency training. Correlations between Expectancy Theory as a work-motivation theory and residency education were explored. Understanding achievement and work-motivation theories affords an opportunity to gain insight into resident motivation in training. The application of Expectancy Theory in particular provides an innovative perspective into residency education. Afforded are opportunities to promote the development of programmatic methods facilitating surgical resident motivation in education. Keywords: learning, education, achievement
Alves, Hayda Josiane; Boog,Maria Cristina Faber
Objective: To qualitatively describe food practices of students living in a residence hall. Methods: A quantitative and qualitative study was carried out in a drawn sample of 100 university students living in a residence hall in the city of Campinas, Southeastern Brazil, in 2004. Students were interviewed using a questionnaire to collect 24-hour food recall information including open questions on shopping and intake practices. Criteria were established for the analysis of meal quality. The Ch...
Andrea Mechanick Braverman PhD; Elisabeth J. Kunkel MD; Leo Katz MD; Austin Katona BS; Teresa Heavens BA, CLSS; Andrew Miller MD, MPH; Jennifer Jasmine Arfaa PhD
Objectives: Acquiring communication and interpersonal skills is an important part of providing patient-centered care and improving patient satisfaction. This study explores whether residents' own values about patient communication can be influenced by training. Methods: As part of service excellence, a three-hour communication skills training in AIDET™ (Acknowledge, Introduce, Duration, Explanation, Thank You) was delivered to first and second Post-Graduate Year (PGY) residents (n = 123). A s...
Teresita M. Hogan
Full Text Available Introduction: Emergency care of older adults requires specialized knowledge of their unique physiology, atypical presentations, and care transitions. Older adults often require distinctive assessment, treatment and disposition. Emergency medicine (EM residents should develop expertise and efficiency in geriatric care. Older adults represent over 25% of most emergency department (ED volumes. Yet many EM residencies lack curricula or assessment tools for competent geriatric care. Fully educating residents in emergency geriatric care can demand large amounts of limited conference time. The Geriatric Emergency Medicine Competencies (GEMC are high-impact geriatric topics developed to help residencies efficiently and effectively meet this training demand. This study examines if a 2-hour didactic intervention can significantly improve resident knowledge in 7 key domains as identified by the GEMC across multiple programs. Methods: A validated 29-question didactic test was administered at six EM residencies before and after a GEMC-focused lecture delivered in summer and fall of 2009. We analyzed scores as individual questions and in defined topic domains using a paired student t test. Results: A total of 301 exams were administered; 86 to PGY1, 88 to PGY2, 86 to PGY3, and 41 to PGY4 residents. The testing of didactic knowledge before and after the GEMC educational intervention had high internal reliability (87.9%. The intervention significantly improved scores in all 7 GEMC domains (improvement 13.5% to 34.6%; p<0.001. For all questions, the improvement was 23% (37.8% pre, 60.8% post; P<0.001 Graded increase in geriatric knowledge occurred by PGY year with the greatest improvement post intervention seen at the PGY 3 level (PGY1 19.1% versus PGY3 27.1%. Conclusion: A brief GEMC intervention had a significant impact on EM resident knowledge of critical geriatric topics. Lectures based on the GEMC can be a high-yield tool to enhance resident knowledge of
Mirela - Anca Postole
Full Text Available Accession to the European Union, starting price and trade exchange liberalization, alongside a strong exchange rate reform, required a depth rethinking of the customs duty system and also influenced the role of this category of tax in establishing budgetary resources.This study reviews the impact of customs duties on changing levels of revenues collected at the state budget. The analysis used is the econometric modeling based on a single- factor regression model.But in Romania, customs duties do not have any major impact on budget revenues and the effects of their collection on the state budget revenues are felt within two months of collection.
Ibragimov Abdulla; Fatimah Mohamed Arshad; B. K. Bala; Kusairi Mohd Noh; Muhammad Tasrif
In January 2013, Malaysia reduced the export duty structure to be in line with the Indonesia’s duty structure. Both countries export crude and processed palm oil. Since Malaysia and Indonesia are close competitors and they compete in the same market, a change in export duty rate in one country will affect the other. Indonesia, as the world’s biggest palm oil producer, has drastically widened the values between the crude palm oil and refined palm oil export taxes since October 2011...
Brandl, Julia; Madsen, Mona Toft; Madsen, Henning
of particular HR duties and how the importance assigned to HR duties varies across managers. Based on a survey of 1,500 Danish managers, we find that 'motivating others' is considered the most important HR duty whereas 'team building', 'handling conflicts' and 'coaching' are considered the least important HR......Today, HR scholars widely acknowledge that realising HRM requires the involvement of all managers and that the personal motivation of line managers plays an important role in their successful involvement. Yet, previous research has neglected to study how line managers rate the importance...
Full Text Available Kensuke Kinoshita,1 Yusuke Tsugawa,2 Taro Shimizu,3 Yusuke Tanoue,4 Ryota Konishi,5 Yuji Nishizaki,6 Toshiaki Shiojiri,7 Yasuharu Tokuda8 1Department of Medicine, Mito Kyodo General Hospital, University of Tsukuba, Mito City, Ibaraki, Japan; 2Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA; 3Tokyo Joto Hospital, Koto-ku, Tokyo, 4Good Medicine Japan, Miyagi, 5Department of General Internal Medicine, Kanto Rosai Hospital, Kawasaki, Kanagawa, 6Department of Cardiology, Juntendo University Graduate School of Medicine, Tokyo, 7Department of General Internal Medicine, Asahi General Hospital, Asahi, Chiba, 8Japan Community Healthcare Organization, Minato-ku, Tokyo, Japan Background: Both clinical workload and access to learning resource are important components of educational environment and may have effects on clinical knowledge of residents. Methods: We conducted a survey with a clinical knowledge evaluation involving postgraduate year (PGY-1 and -2 resident physicians at teaching hospitals offering 2-year postgraduate training programs required for residents in Japan, using the General Medicine In-Training Examination (GM-ITE. An individual-level analysis was conducted to examine the impact of the number of assigned patients and emergency department (ED duty on the residents' GM-ITE scores by fitting a multivariable generalized estimating equations. In hospital-level analysis, we evaluated the relationship between for the number of UpToDate reviews for each hospital and for the hospitals' mean GM-ITE score. Results: A total of 431 PGY-1 and 618 PGY-2 residents participated. Residents with four or five times per month of the ED duties exhibited the highest mean scores compared to those with greater or fewer ED duties. Those with largest number of inpatients in charge exhibited the highest mean scores compared to the residents with fewer inpatients in charge. Hospitals with the greater Up
Safak, I.; Wiberg, P. L.; Richardson, D. L.; Kurum, M. O.
Patterns of transport and residence time influence the morphology, ecology and biogeochemistry of shallow coastal bay systems in important ways. To better understand the factors controlling residence time and exchange in coastal bays, a three-dimensional finite-volume coastal ocean model was set up and validated with field observations of circulation in a system of 14 shallow coastal bays on the Atlantic coast of the USA (Virginia Coast Reserve). Residence times of neutrally buoyant particles as well as exchange among the bays in the system and between the bays and the ocean were examined with Lagrangian particle tracking. There was orders of magnitude variation in the calculated residence time within most of the bays, ranging from hours in the tidally refreshed (repletion) water near the inlets to days-weeks in the remaining (residual) water away from the inlets. Residence time in the repletion waters was most sensitive to the tidal phase (low vs. high) when particles were released whereas residence time in the residual waters was more sensitive to wind forcing. Wind forcing was found to act as a diffuser that shortens particle residence within the bays; its effect was higher away from the inlets and in relatively confined bays. Median residence time in the bays significantly decreased with an increase in the ratio between open water area and total area (open water plus marsh). Exchange among the bays and capture areas of inlets (i.e., exchange between the bays and the ocean) varied considerably but were insensitive to tidal phase of release, wind, and forcing conditions in different years, in contrast to the sensitivity of residence time to these factors. We defined a new quantity, termed shortest-path residence time, calculated as distance from the closest inlet divided by root-mean-square velocity at each point in model domain. A relationship between shortest-path residence time and particle-tracking residence time provides a means of estimating residence time
A survey of physics and related teaching to radiation oncology residents in 21 Canadian cancer centres was undertaken in December 1987 and January 1988. This survey illustrates a very considerable variation in the formal teaching of physics to aspiring radiation oncologists with, for example, the number of hours offered ranging from 40 to 160 in those 10 centres which have a training program. It would appear to be of benefit to radiation oncology residents, those charged with teaching them, and the radiation oncology community as a whole, to develop specific guidelines for this aspect of resident education.
Dappen, Alan; And Others
The American Academy of Family Practice requires that nutrition be taught to residents throughout their three-year residencies, although it does not specify a block of nutrition instruction. The nutrition knowledge of residents in eight family practice residencies in California were examined. (MLW)
Warrick, Shirley S.; Crumrine, Robert S.
Factors that contributed to successful residency performance by anesthesiology residents were examined in order to assist the program's selection committee in developing selection criteria. The best predictor of a resident's academic average in the anethesiology program was the number of years the resident had spent in other specialities.…
Mercurio, Mark R; Peterec, Steven M
Based at least in part on concerns for patient safety and evidence that long shifts are associated with an increased risk of physician error, residents' and fellows' work hours have been strictly limited for the past several years. Little attention has been paid, however, to excessive attending physician shift duration, although there seems to be no reason to assume that this common practice poses any less risk to patients. Potential justifications for allowing attending physicians to work without hourly limits include physician autonomy, workforce shortages in certain communities or subspecialties, continuity of care, and financial considerations. None of these clearly justify the apparent increased risk to patients, with the exception in some settings of workforce shortage. In many hospital settings, the practice of allowing attending physicians to work with no limit on shift duration could pose an unnecessary risk to patients.
Segal, Scott; Gelfand, Brian J; Hurwitz, Shelley; Berkowitz, Lori; Ashley, Stanley W; Nadel, Eric S; Katz, Joel T
Anecdotal reports suggest that some residency application essays contain plagiarized content. To determine the prevalence of plagiarism in a large cohort of residency application essays. Retrospective cohort study. 4975 application essays submitted to residency programs at a single large academic medical center between 1 September 2005 and 22 March 2007. Specialized software was used to compare residency application essays with a database of Internet pages, published works, and previously submitted essays and the percentage of the submission matching another source was calculated. A match of more than 10% to an existing work was defined as evidence of plagiarism. Evidence of plagiarism was found in 5.2% (95% CI, 4.6% to 5.9%) of essays. The essays of non-U.S. citizens were more likely to demonstrate evidence of plagiarism. Other characteristics associated with the prevalence of plagiarism included medical school location outside the United States and Canada; previous residency or fellowship; lack of research experience, volunteer experience, or publications; a low United States Medical Licensing Examination Step 1 score; and non-membership in the Alpha Omega Alpha Honor Medical Society. The software database is probably incomplete, the 10%-match threshold for defining plagiarism has not been statistically validated, and the study was confined to applicants to 1 institution. Evidence of matching content in an essay cannot be used to infer the applicant's intent and is not sensitive to variations in the cultural context of copying in some societies. Evidence of plagiarism in residency application essays is more common in international applicants but was found in those by applicants to all specialty programs, from all medical school types, and even among applicants with significant academic honors. No external funding.
Deutsch, Ellen S; Wiet, Gregory J; Seidman, Michael; Hussey, Heather M; Malekzadeh, Sonya; Fried, Marvin P
Simulation has become a valuable tool in medical education, and several specialties accept or require simulation as a resource for resident training or assessment as well as for board certification or maintenance of certification. This study investigates current simulation resources and activities in US otolaryngology residency programs and examines interest in advancing simulation training and assessment within the specialty. Web-based survey. US otolaryngology residency training programs. An electronic web-based survey was disseminated to all US otolaryngology program directors to determine their respective institutional and departmental simulation resources, existing simulation activities, and interest in further simulation initiatives. Descriptive results are reported. Responses were received from 43 of 104 (43%) residency programs. Simulation capabilities and resources are available in most respondents' institutions (78.6% report onsite resources; 73.8% report availability of models, manikins, and devices). Most respondents (61%) report limited simulation activity within otolaryngology. Areas of simulation are broad, addressing technical and nontechnical skills related to clinical training (94%). Simulation is infrequently used for research, credentialing, or systems improvement. The majority of respondents (83.8%) expressed interest in participating in multicenter trials of simulation initiatives. Most respondents from otolaryngology residency programs have incorporated some simulation into their curriculum. Interest among program directors to participate in future multicenter trials appears high. Future research efforts in this area should aim to determine optimal simulators and simulation activities for training and assessment as well as how to best incorporate simulation into otolaryngology residency training programs. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.
McCaffrey, Ruth G; Hayes, Rosemarie; Stuart, Wendy; Cassell, Asenath; Farrell, Cheryl; Miller-Reyes, Charmin; Donaldson, Audeanne
A program was implemented for nurses and medical residents to improve communication and collaboration. It has been noted that communication and collaboration between members of the health care team improve patient outcomes and job satisfaction among nurses. Nurses on the unit where medical residents trained attended a 2-hour educational program that reviewed effective communication styles and positive aspects of collaboration, including role-playing examples. Medical residents received a self-learning packet with a posttest that was returned to researchers when completed. Focus groups, including both nurses and medical residents, were held twice a month for 6 months after the educational program. Overall improvements in communication, collaboration, patient outcomes, and job satisfaction were noted from the focus group data. The educational program proved to be successful in improving collaboration and communication between nurses and medical residents, which in turn improved patient care.
Heiselman, Terry; Noelker, Linda S.
Interviewed nursing assistants (n=40) and nursing facility residents (n=37) regarding ways they experienced respect, disrespect, attachment, and distancing in their relationships with each other. As a result of finding evidence of disrespect, an inservice session on gaining respect as a nursing assistant was presented. (ABL)
Background Surgical education is evolving under the dual pressures of an enlarging body of knowledge required during residency and mounting work-hour restrictions. Changes in surgical residency training need to be based on available educational models and research to ensure successful training of surgeons. Experiential learning theory, developed by David Kolb, demonstrates the importance of individual learning styles in improving learning. This study helps elucidate the way in which medical students, surgical residents, and surgical faculty learn. Methods The Kolb Learning Style Inventory, which divides individual learning styles into Accommodating, Diverging, Converging, and Assimilating categories, was administered to the second year undergraduate medical students, general surgery resident body, and general surgery faculty at the University of Alberta. Results A total of 241 faculty, residents, and students were surveyed with an overall response rate of 73%. The predominant learning style of the medical students was assimilating and this was statistically significant (p < 0.03) from the converging learning style found in the residents and faculty. The predominant learning styles of the residents and faculty were convergent and accommodative, with no statistically significant differences between the residents and the faculty. Conclusions We conclude that medical students have a significantly different learning style from general surgical trainees and general surgeons. This has important implications in the education of general surgery residents. PMID:20591159
Landmann, Alessandra; Mahnken, Heidi; Antonoff, Mara B; White, SuAnn; Patel, Arpit; Scifres, Aaron M; Lees, Jason S
To qualify and characterize resident overnight activity. A prospective 3-phase study was conducted of surgical residents with attention to activities performed on the overnight rotation: needs assessment, direct observation of activities, and feedback. This study was conducted at the University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma. This is both a tertiary referral center and the only American College of Surgeons (ACS) verified level 1 trauma center in the state. This study included current surgical residents within the residency program. During the study period, 270 pages were individually recorded, with 60% of these pages defined as time-sensitive activities. In addition, most of the pages involved pressing patient-care issues irrespective of postgraduate year level. Analyses revealed that residents spend most of their time performing educational activities (62%). On feedback, residents reported overall satisfaction with the learning opportunities during night-shift (6.4/7.0) and indicated their perceptions of an adequate balance of service and education on night float (6.6/7.0). This correlates with our annual rotation assessment where residents identify night-float as an overall positive experience which provides educational benefit. Work-hour restrictions induce residency programs to adapt to new training models. Our results report a breakdown of resident activities while on night-float and demonstrate that overnight shifts continue to provide important educational opportunities during training. Copyright © 2017 Association of Program Directors in Surgery. All rights reserved.
Engels, Paul T; de Gara, Chris
Surgical education is evolving under the dual pressures of an enlarging body of knowledge required during residency and mounting work-hour restrictions. Changes in surgical residency training need to be based on available educational models and research to ensure successful training of surgeons. Experiential learning theory, developed by David Kolb, demonstrates the importance of individual learning styles in improving learning. This study helps elucidate the way in which medical students, surgical residents, and surgical faculty learn. The Kolb Learning Style Inventory, which divides individual learning styles into Accommodating, Diverging, Converging, and Assimilating categories, was administered to the second year undergraduate medical students, general surgery resident body, and general surgery faculty at the University of Alberta. A total of 241 faculty, residents, and students were surveyed with an overall response rate of 73%. The predominant learning style of the medical students was assimilating and this was statistically significant (p learning style found in the residents and faculty. The predominant learning styles of the residents and faculty were convergent and accommodative, with no statistically significant differences between the residents and the faculty. We conclude that medical students have a significantly different learning style from general surgical trainees and general surgeons. This has important implications in the education of general surgery residents.
Brandl, Julia; Madsen, Mona Toft; Madsen, Henning
Today, HR scholars widely acknowledge that realising HRM requires the involvement of all managers and that the personal motivation of line managers plays an important role in their successful involvement. Yet, previous research has neglected to study how line managers rate the importance...... of particular HR duties and how the importance assigned to HR duties varies across managers. Based on a survey of 1,500 Danish managers, we find that 'motivating others' is considered the most important HR duty whereas 'team building', 'handling conflicts' and 'coaching' are considered the least important HR...... duties. Female top managers in the public sector exhibit the greatest interest in HR whereas men at lower managerial levels in the private sector give lowest priority to HR work. We conclude with possible explanations for the observed differences in a Danish context and beyond and provide suggestions...
Fenton, M. B.; Faure, P. A.; Ratcliffe, J. M.
Duty cycle describes the relative 'on time' of a periodic signal. In bats, we argue that high duty cycle (HDC) echolocation was selected for and evolved from low duty cycle (LDC) echolocation because increasing call duty cycle enhanced the ability of echolocating bats to detect, lock onto and track...... fluttering insects. Most echolocators (most bats and all birds and odontocete cetaceans) use LDC echolocation, separating pulse and echo in time to avoid forward masking. They emit short duration, broadband, downward frequency modulated (FM) signals separated by relatively long periods of silence....... In contrast, bats using HDC echolocation emit long duration, narrowband calls dominated by a single constant frequency (CF) separated by relatively short periods of silence. HDC bats separate pulse and echo in frequency by exploiting information contained in Doppler-shifted echoes arising from their movements...
Full Text Available A clock with 50% duty cycle is very significant in many applications such as DDR-SDRAMs and double sampling analog-to-digital converters. This crisp presents a Modified Successive Approximation Register (MSAR controlled duty cycle corrector (DCC, to attain 50% duty cycle correction. Here MSAR adopts a binary search method to compress lock time while maintaining tight synchronization between effort and production clocks. The MSAR-DCC circuit has been implemented in a 0.18- µm CMOS process which corrects the duty rate within 5 cycles which has a closed loop characteristics. The measured power dissipation and area occupation are 5581nW and 0.033mm2 respectively.
... Regulations of the Department of Agriculture AGRICULTURAL MARKETING SERVICE (Standards, Inspections, Marketing Practices), DEPARTMENT OF AGRICULTURE MARKETING OF PERISHABLE AGRICULTURAL COMMODITIES REGULATIONS (OTHER THAN RULES OF PRACTICE) UNDER THE PERISHABLE AGRICULTURAL COMMODITIES ACT, 1930 Duties of...
This paper is a discussion of the duty of doctors to do what is best for their patients. What is required by this duty is shown to depend on the circumstances, including any financial constraints on the doctor. The duty to do the best is a duty of benevolence, and this virtue itself has to be understood as bounded by other virtues, including justice and professional responsibility. An Aristotelian account of medical benevolence is developed, and the issues of supererogation and individual judgement are discussed within this framework. The paper ends with the claim that the patient-centred conception of benevolence defended in the paper is in line with consequentialist and deontological ethical traditions. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
... CALIFORNIA Order Regulating Handling Administrative Bodies § 917.34 Duties of Control Committee. The Control... develop and provide the commodity committees data on shared expenses to facilitate equitable...
Duran, A.; Ragatz, A.; Prohaska, R.; Kelly, K.; Walkowicz, K.
The U.S. Department of Energy's American Recovery and Reinvestment Act (ARRA) deployment and demonstration projects are helping to commercialize technologies for all-electric vehicles (EVs). Under the ARRA program, data from Smith Electric and Navistar medium duty EVs have been collected, compiled, and analyzed in an effort to quantify the impacts of these new technologies. Over a period of three years, the National Renewable Energy Laboratory (NREL) has compiled data from over 250 Smith Newton EVs for a total of over 100,000 days of in-use operation. Similarly, data have been collected from over 100 Navistar eStar vehicles, with over 15,000 operating days having been analyzed. NREL has analyzed a combined total of over 4 million kilometers of driving and 1 million hours of charging data for commercial operating medium duty EVs. In this paper, the authors present an overview of medium duty EV operating and charging behavior based on in-use data collected from both Smith and Navistar vehicles operating in the United States. Specifically, this paper provides an introduction to the specifications and configurations of the vehicles examined; discusses the approach and methodology of data collection and analysis, and presents detailed results regarding daily driving and charging behavior. In addition, trends observed over the course of multiple years of data collection are examined, and conclusions are drawn about early deployment behavior and ongoing adjustments due to new and improving technology. Results and metrics such as average daily driving distance, route aggressiveness, charging frequency, and liter per kilometer diesel equivalent fuel consumption are documented and discussed.
Yunus, Fakir M; Khan, Safayet; Akter, Tahera; Jhohura, Fatema T; Reja, Saifur; Islam, Akramul; Rahman, Mahfuzar
This study investigated total sleep time in the Bangladeshi population and identified the proportion of the population at greater risk of developing chronic diseases due to inadequate sleep. Using a cross-sectional survey, total sleep time was captured and analysed in 3968 respondents aged between 6 and 106 years in 24 (of 64) districts in Bangladesh. Total sleep time was defined as the hours of total sleep in the previous 24 h. We used National Sleep Foundation (2015) guidelines to determine the recommended sleep hours in different age categories. Less or more than the recommended total sleep time (in hours) was considered 'shorter' and 'longer' sleep time, respectively. Linear and multinomial logistic regression models were used to determine the relationship between demographic variables and estimated risk of shorter and longer total sleep time. The mean (±standard deviation) total sleep time of children (6-13 years), teenagers (14-17 years), young adults and adults (18-64 years) and older adults (≥65 years) were 8.6 (±1.1), 8.1 (±1.0), 7.7 (±0.9) and 7.8 (±1.4) h, respectively, which were significantly different (P < 0.01). More than half of school-age children (55%) slept less than, and 28.2% of older adults slept longer than, recommended. Residents in all divisions (except Chittagong) in Bangladesh were less likely to sleep longer than in the Dhaka division. Rural populations had a 3.96× greater chance of sleeping for a shorter time than urban residents. The Bangladeshi population tends to sleep for longer and/or shorter times than their respective recommended sleep hours, which is detrimental to health.
... MANAGEMENT § 917.2 General authorities and duties of Bank boards of directors. (a) Management of a Bank. The...'s board of directors for that Bank's management is non-delegable. (b) Duties of Bank directors. Each Bank director shall have the duty to: (1) Carry out his or her duties as director in good faith, in...
... 19 Customs Duties 2 2010-04-01 2010-04-01 false Dumping and countervailing duties; action by port director. 159.58 Section 159.58 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND... Dumping and countervailing duties; action by port director. (a) Antidumping matters. Upon receipt...
... § 152.2 Notification to importer of increased duties. If the port director believes that the entered... 19 Customs Duties 2 2010-04-01 2010-04-01 false Notification to importer of increased duties. 152.2 Section 152.2 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND...
..., Customs Form 7501, shall show the value, classification, and rate of duty as approved by the port director... 19 Customs Duties 2 2010-04-01 2010-04-01 false Contents of entry summary; estimated duties. 144.12 Section 144.12 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND...
... reasonable assurance to the port director that conditionally duty-free merchandise purchased therein will be... 19 Customs Duties 1 2010-04-01 2010-04-01 false Requirements for duty-free store operations. 19.36 Section 19.36 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND...
... International Trade Administration Honey From Argentina: Notice of Initiation of Antidumping Duty New Shipper... ] antidumping duty order on honey from Argentina. See Notice of Antidumping Duty Order: Honey From Argentina, 66...: Background On December 10, 2001, the Department published the antidumping duty order on honey from...
... International Trade Administration Honey From Argentina: Rescission of Countervailing Duty Administrative Review... countervailing duty order on honey ] from Argentina. See Notice of Countervailing Duty Order: Honey From... opportunity to request an administrative review of the countervailing duty order on honey from Argentina...
... International Trade Administration Honey From Argentina: Notice of Initiation of Antidumping Duty New Shipper... antidumping duty order on honey from Argentina. See Notice of Antidumping Duty Order: Honey From Argentina, 66...: Background On December 10, 2001, the Department published the antidumping duty order on honey from...
...-Exemption and 7113 Jewelry Duty-Refund Program AGENCY: International Trade Administration, Commerce. ACTION... watch duty- exemptions and watch and jewelry duty-refunds to program producers in the U.S. insular... the duty-refund program for the watch and jewelry producers. Form ITA-360P requires no...
... following duty cycles apply for variable-speed engines with maximum engine power below 19 kW: (1) The... variable-speed engines with maximum engine power at or above 19 kW: (1) The following duty cycle applies... Appendix II to Part 1039—Steady-State Duty Cycles (a) The following duty cycles apply for constant-speed...
... International Trade Administration Certain Tin Mill Products From Japan: Rescission of Antidumping Duty...) initiated an administrative review of the antidumping duty order covering certain tin mill products from... antidumping duty order on certain tin mill products from Japan. See Antidumping or Countervailing Duty...
Chokshi, Binny D; Schumacher, Heidi K; Reese, Kristen; Bhansali, Priti; Kern, Jeremy R; Simmens, Samuel J; Blatt, Benjamin; Greenberg, Larrie W
The Accreditation Council for Graduate Medical Education requires training that enhances resident teaching skills. Despite this requirement, many residency training programs struggle to implement effective resident-as-teacher (RAT) curricula, particularly within the context of the 80-hour resident workweek. In 2013, the authors developed and evaluated an intensive one-day RAT curriculum using a flipped classroom approach. Twenty-nine second-year residents participated in daylong RAT sessions. The curriculum included four 1-hour workshops focusing on adult learning principles, giving feedback, teaching a skill, and orienting a learner. Each workshop, preceded by independent reading, featured peer co-teaching, application, and feedback. The authors evaluated the curriculum using pre- and postworkshop objective structured teaching examinations (OSTEs) and attitudinal and self-efficacy teaching questionnaires. Residents demonstrated statistically significant improvements in performance between pre- and postworkshop OSTEs on each of three core skills: giving feedback (P = .005), orienting a learner (P classroom approach is an efficient and effective method for training residents to improve teaching skills, especially in an era of work hour restrictions. They have committed to the continuation of this curriculum and are planning to include assessment of its long-term effects on resident behavior change and educational outcomes.
Anona Armstrong; Ronald D. Francis
The current emergence, once again, of corporate collapses due in no small way to unethical behaviour raises questions about the duties and responsibilities of boards of major organisations for building an ethical organisation. This paper argues that the legal duty of care to employees extends to creating an ethical work environment. It describes different types of ethical climates, how they are recognised and the consequences of their impact on the behaviours of their members. It illustrates ...
Full Text Available In January 2013, Malaysia reduced the export duty structure to be in line with the Indonesia’s duty structure. Both countries export crude and processed palm oil. Since Malaysia and Indonesia are close competitors and they compete in the same market, a change in export duty rate in one country will affect the other. Indonesia, as the world’s biggest palm oil producer, has drastically widened the values between the crude palm oil and refined palm oil export taxes since October 2011, to encourage more downstream investments and production of refined palm oil products. Under the revised export duty structure, crude palm oil and crude palm kernel oil are cheaper for downstream activities in Indonesia. The new structure is expected to reduce Malaysia’s competitiveness in the world market as its export duty is relatively higher. A high export duty results in high price of crude palm oil which is the raw material for processed palm oil. The research questions are: (i What are the likely future trends of crude palm oil exports under the new crude palm oil export duties? Will it increase, reduce or stabilize? (ii What are the likely future trends of processed palm oil exports? Will it increase exponentially, stabilize or reduce? To answer these questions, a system dynamics model was developed for the Malaysian palm oil. Application of the system dynamics model provides a framework to understand the feedback structure and how changes in variables impact the behavior of the palm oil industry. This research suggests that with low crude palm oil export duties crude palm oil domestic price, profitability of plantation owners, immature crop, mature crop, total planted area, production and exports of crude palm oil increase, however exports of processed palm oil decrease.
U.S. Environmental Protection Agency — Monthly AQS hourly site compare output files for the CMAQv502 Base simulation. Monthly files contain hourly paired model/ob data for the AQS network. These data were...
... medlineplus.gov/news/fullstory_167478.html Rush Hour Pollution May Be Worse Than Thought Higher measurements seen ... in rush-hour traffic? New research finds air pollution levels in cars are much higher than previously ...
Klein, Katherine P; Hannum, Wallace M; Koroluk, Lorne D; Proffit, William R
Sharing resources through distance education has been proposed as 1 way to deal with a lack of full-time faculty in orthodontic residency programs. To keep distance education for orthodontic residents as cost-effective as possible while retaining interaction, we developed a "blended" interactive distance learning approach that combines observation of Web-based seminars with live postseminar discussions. For the 2009-2010 academic year, a grant from the American Association of Orthodontists opened access to the blended learning experience to all orthodontic programs in the United States and Canada. The specific aims of this project were to (1) measure programmatic interest in using blended distance learning, (2) determine resident and faculty interest, (3) determine the seminars' perceived usefulness, and (4) elicit feedback regarding future use. Participants in this project were expected to (1) read all assigned articles before viewing a recorded seminar, (2) watch a 1 to 1.5 hour recording of an actual interactive seminar on a Web site, and (3) participate in a 30-minute follow-up discussion immediately after watching the recorded seminar either with a faculty member at the participating institution or via a videoconference with the leader of the Web-based seminar. The residents and faculty then completed surveys about the experience. Half (52%) of the 63 orthodontic programs in the United States fully participated in this project. The blended approach to distance learning was judged to be effective and enjoyable; faculty members were somewhat more enthusiastic about the experience than were residents. Most residents were not adequately prepared for the seminars (only 14% read all preparatory articles in depth); this impacted their perception of the effectiveness and enjoyability of the experience (P = 0.0016). Prepared residents reported a greater ability to learn from the seminars (P = 0.0035) than those who did not read, and also indicated that they were more
Yaghoubian, Arezou; De Virgilio, Christian; Destro, Laura; Kaji, Amy H; Putnam, Brant; Neville, Angela L
In the 80-hour work week era, optimal distribution of the residency workforce is critical. Little data exist as to whether current hours of hospital staffing parallel trends in trauma activity. The purpose of this study was to determine peak periods of trauma volume, severity, need for operative intervention, and mortality and determine if there are differences in mortality based on time period of arrival. We performed a retrospective analysis of the 17,167 patients admitted to our academic Level I trauma center between 2000 and 2007. Each admission was plotted against time of arrival and trends noted. A significant increase in activity occurred between 1700 and 0100 hours. Compared with other shifts, this shift had a disproportionately higher number of patients with penetrating injuries, need for operative intervention, Injury Severity Score (ISS) greater than 15, and death (P hours. In an era of optimizing resident training within the constraints of an 80-hour work week, strong consideration should be made for deploying personnel to match these findings.
Elmore, Leisha C; Jeffe, Donna B; Jin, Linda; Awad, Michael M; Turnbull, Isaiah R
Background Burnout is a complex syndrome of emotional distress that can disproportionately affect individuals who work in healthcare professions. Study Design For a national survey of burnout in US general surgery residents, we asked all Accreditation Council for Graduate Medical Education-accredited general surgery program directors to email their general surgery residents an invitation to complete an anonymous, online survey. Burnout was assessed with the Maslach Burnout Inventory; total scores for Emotional Exhaustion (EE), Depersonalization (DP), and Personal Accomplishment (PA) subscales were calculated. Burnout was defined as having a score in the highest tertile for EE or DP or lowest tertile for PA. Chi-square tests and one-way analyses of variance were used to test associations between burnout tertiles for each subscale and various resident and training-program characteristics as appropriate. Results From April–December, 2014, 665 residents actively engaged in clinical training had data for analysis; 69% met the criterion for burnout on at least one subscale. Higher burnout on each subscale was reported by residents planning private practice compared with academic careers. A greater proportion of women than men reported burnout on EE and PA. Higher burnout on EE and DP was associated with greater work hours per week. Having a structured mentoring program was associated with lower burnout on each subscale. Conclusions The high rates of burnout among general surgery residents are concerning given the potential impact of burnout on the quality of patient care. Efforts to identify at-risk populations and to design targeted interventions to mitigate burnout in surgical trainees are warranted. PMID:27238875
Full Text Available Coexistence of Wi-Fi and LTE-Unlicensed (LTE-U technologies has drawn significant concern in industry. In this paper, we investigate the Wi-Fi performance in the presence of duty cycle based LTE-U transmission on the same channel. More specifically, one LTE-U cell and one Wi-Fi basic service set (BSS coexist by allowing LTE-U devices to transmit their signals only in predetermined duty cycles. Wi-Fi stations, on the other hand, simply contend the shared channel using the distributed coordination function (DCF protocol without cooperation with the LTE-U system or prior knowledge about the duty cycle period or duty cycle of LTE-U transmission. We define the fairness of the above scheme as the difference between Wi-Fi performance loss ratio (considering a defined reference performance and the LTE-U duty cycle (or function of LTE-U duty cycle. Depending on the interference to noise ratio (INR being above or below −62 dbm, we classify the LTE-U interference as strong or weak and establish mathematical models accordingly. The average throughput and average service time of Wi-Fi are both formulated as functions of Wi-Fi and LTE-U system parameters using probability theory. Lastly, we use the Monte Carlo analysis to demonstrate the fairness of Wi-Fi and LTE-U air time sharing.
Ronai, Christina; Lang, Peter
In 2003, work-hour regulations were implemented by the Accreditation Council for Graduate Medical Education. Much has been published regarding resident rest and quality of life as well as patient safety. There has been no examination on the effect of work-hour restrictions on academic productivity of fellows in training. Paediatric subspecialty fellows have a scholarly requirement mandated by the American Board of Pediatrics. We have examined the impact of work-hour restrictions on the scholarly productivity of paediatric cardiology fellows during their fellowship. We conducted a literature search for all paediatric cardiology fellows between 1998 and 2007 at a single academic institution as first or senior authors on papers published during their 3-year fellowship and 3 years after completion of their categorical fellowship (n=63, 30 fellows before 2003 and 33 fellows after 2003). The numbers of first- or senior-author fellow publications before and after 2003 were compared. We also collected data on final paediatric cardiology subspecialty career choice. There was no difference in the number of fellow first-author publications before and after 2003. Before work-hour restrictions, the mean number of publications per fellow was 2.1 (±2.2), and after work-hour restrictions it was 2.0 (±1.8), (p=0.89). By subspecialty career choice, fellows who select electrophysiology, preventative cardiology, and heart failure always published within the 6-year time period. Since the implementation of work-hour regulations, total number of fellow first-authored publications has not changed. The role of subspecialty choice may play a role in academic productivity of fellows in training.
Cameron, Claire; Statham, June
Reception and initial contact arrangements and practices in social services play a key role in safeguarding children and providing an avenue for the public and professionals to report concerns about a child's welfare. This paper reports on findings from a small-scale study, commissioned in the wake of the Laming Inquiry into the circumstances surrounding the death of Victoria Climbié. The aim of the study was an exploration of the arrangements local authorities had in place in early 2004 to receive referrals from the public and professional sources, and to report on duty team managers' levels of satisfaction with these arrangements. It drew on interviews with 70 social work managers responsible for daytime and out-of-hours duty services in 28 English local authorities. The authors argue that, while the Inquiry recommendations to improve the organisation of initial contact with social services in the event of concerns about a child's welfare remain important, wide variations exist in practice. The paper concludes with a discussion of possible contributory factors for such variation, and policy and practice measures that could address the variation.
Hotel and Catering Industry Training Board, Wembley (England).
This syllabus is intended for the use of training personnel in drawing up training programs for cleaners in halls of residence. Its main objective is to produce fully trained cleaners, thereby maintaining and raising standards. The syllabus is divided into three sections: Introduction to Housekeeping Employees, and Tasks Performed by the Majority…
Bezemer, R.A.; Bos, E.W.
Medical residents are in a vulnerable position. While still in training, they are responsible for patient care. They have a dependent relation with their supervisor and low decision latitude. An intervention was developed to increase individual and system resilience, addressing burnout, patient safe
Du, Jie; Wimmer, Hayden; Rada, Roy
The Hour of Code is a one-hour introduction to computer science organized by Code.org, a non-profit dedicated to expanding participation in computer science. This study investigated the impact of the Hour of Code on students' attitudes towards computer programming and their knowledge of programming. A sample of undergraduate students from two…
R. Huisman (Ronald); C. Huurman; R.J. Mahieu (Ronald)
textabstractThis paper focuses on the characteristics of hourly electricity prices in day-ahead markets. In these markets, quotes for day-ahead delivery of electricity are submitted simultaneously for all hours in the next day. The same information set is used for quoting all hours of the day. The d
... METHODS AND CONTRACT TYPES TYPES OF CONTRACTS Time-and-Materials, Labor-Hour, and Letter Contracts 16.602 Labor-hour contracts. Description. A labor-hour contract is a variation of the time-and-materials contract, differing only in that materials are not supplied by the contractor. See 12.207(b),...
This document is a report of the Light Duty Utility Arm (LDUA) drawing walkdown. The purpose of this walkdown was to validate the essential configuration of the LDUA in preparation of deploying the equipment in a Hanford waste tank. The LDUA system has, over the course of its development, caused the generation of a considerable number of design drawings. The number of drawings is estimated to be well over 1,000. A large number consist of vendor type drawings, furnished by both Pacific Northwest National Laboratory (PNNL) and SPAR Aerospace Limited (SPAR). A smaller number, approximately 200, are H-6 type drawing sheets in the Project Hanford Management Contract (PHMC) document control system. A preliminary inspection of the drawings showed that the physical configuration of the LDUA did not match the documented configuration. As a result of these findings, a scoping walkdown of 20 critical drawing sheets was performed to determine if a problem existed in configuration management of the LDUA system. The results of this activity showed that 18 of the 20 drawing sheets were found to contain errors or omissions of varying concern. Given this, Characterization Engineering determined that a walkdown of the drawings necessary and sufficient to enable safe operation and maintenance of the LDUA should be performed. A review team was assembled to perform a review of all of the drawings and determine the set which would need to be verified through an engineering walkdown. The team determined that approximately 150 H-6 type drawing sheets would need to be verified, 12 SPAR/PNNL drawing sheets would need to be verified and converted to H-6 drawings, and three to six new drawings would be created (see Appendix A). This report documents the results of that walkdown.
Ogundipe, O A; Olagunju, A T; Lasebikan, V O; Coker, A O
The mental health of doctors is an issue of growing concern all over the world as it frequently interplays with their professional trainings and responsibilities. This study was done to determine the pattern and correlates of burnout among 204 doctors undergoing residency training. Eligible participants were interviewed using designed questionnaire, General Health Questionnaire (GHQ-12) and Maslach Burnout Inventory (MBI). The mean age of participants was 33.44±4.50. Ninety-three (45.6%) respondents reported burnout in the dimension of emotional exhaustion (EE), 118 (57.8%) in the dimension of depersonalization (D), and 126 (61.8%) in the dimension of reduced personal accomplishment (RPA). Factors that were significantly associated with all the dimensions of burnout were perceived heavy workload and presence of emotional distress (based on GHQ score of ≥3). The perception of call duty as being not stressful was negatively predictive of burnout in the emotional exhaustion subscale (odds ratio [OR]=0.52; 95%confidence interval [CI]=0.29-0.97; p=0.03), while emotional distress was a positive predictor (OR=6.97; 95%CI=3.28-14.81; pburnout in the depersonalization subscale (OR=0.36; 95%CI=0.17-0.76); pburnout in the reduced personal accomplishment subscale. Burnout is highly prevalent among resident doctors. Evolvement of comprehensive mental health services, training supports, conflict de-escalation/resolution mechanisms, and periodic assessment are indicated to mitigate work related distress with burn out among resident doctors, while improving their productivity.
Ashker, Sumer; Burkiewicz, Jill S
The attitudes of pharmacy residents toward pharmaceutical industry promotion and the perceived effects of such promotion on the knowledge and professional practice of the residents were studied. A questionnaire study of current postgraduate year 1 and postgraduate year 2 pharmacy residents was conducted. Questions were adapted from instruments used in studies of medical student or physician attitudes regarding the pharmaceutical industry. The questionnaire requested demographic information about the resident, information regarding the resident's exposure to specific types of pharmaceutical company-related activities, and the resident's perception of whether the residency program or department had policies or guidelines regarding interactions with the pharmaceutical industry. Questions investigated the attitudes toward pharmaceutical industry promotion and the perceived influence of pharmaceutical industry promotion on the professional knowledge and behavior of the residents. Responses were received from 496 pharmacy residents. Nearly all (89%) residents agreed that pharmaceutical company-sponsored educational events enhance knowledge. Almost half (43%) of the respondents reported that information from educational events influences therapeutic recommendations. One quarter (26%) of the pharmacy residents indicated prior training regarding pharmacist-industry interactions, and most (60%) residents indicated that their institution's residencies or departments have policies regarding interactions with the pharmaceutical industry. Most surveyed pharmacy residents believed that educational events sponsored by pharmaceutical companies enhance knowledge. Respondents whose institutions had policies or who had received training about such events were less likely than other respondents to perceive an influence of the events on their knowledge and behavior.
Aimee M. Rolston
Full Text Available Introduction: Choosing a residency program is a stressful and important decision. Doximity released residency program rankings by specialty in September 2014. This study sought to investigate the impact of those rankings on residency application choices made by fourth year medical students. Methods: A 12-item survey was administered in October 2014 to fourth year medical students at three schools. Students indicated their specialty, awareness of and perceived accuracy of the rankings, and the rankings’ impact on the programs to which they chose to apply. Descriptive statistics were reported for all students and those applying to Emergency Medicine (EM. Results: A total of 461 (75.8% students responded, with 425 applying in one of the 20 Doximity ranked specialties. Of the 425, 247 (58% were aware of the rankings and 177 looked at them. On a 1-100 scale (100=very accurate, students reported a mean ranking accuracy rating of 56.7 (SD 20.3. Forty-five percent of students who looked at the rankings modified the number of programs to which they applied. The majority added programs. Of the 47 students applying to EM, 18 looked at the rankings and 33% changed their application list with most adding programs. Conclusion: The Doximity rankings had real effects on students applying to residencies as almost half of students who looked at the rankings modified their program list. Additionally, students found the rankings to be moderately accurate. Graduating students might benefit from emphasis on more objective characterization of programs to assess in light of their own interests and personal/career goals
This article describes a school librarian's experience with initiating an Hour of Code event for her school's student body. Hadi Partovi of Code.org conceived the Hour of Code "to get ten million students to try one hour of computer science" (Partovi, 2013a), which is implemented during Computer Science Education Week with a goal of…
... May not be on duty as a None No more than six ``Type Tours. train employee after 2'' assignments... off any service for any duty at the employee's railroad carrier at the home terminal. No more employee... Type 2) without 2 seventh consecutive day consecutive calendar when the employee ends days off duty at...
Full Text Available This review begins with the history of the events starting with the death of Libby Zion that lead to the Bell Commission, that the studied her death and made recommendations for improvement that were codified into law in New York state as the 405 law that the ACGME essentially adopted in putting a cap on work hours and establishing the level of staff supervision that must be available to residents in clinical situations particularly the emergency room and acute care units. A summary is then provided of the findings of the laboratory effects of total sleep deprivation including acute total sleep loss and the consequent widespread physiologic alterations, and of the effects of selective and chronic sleep loss. Generally the sequence of responses to increasing sleep loss goes from mood changes to cognitive effects to performance deficits. In the laboratory situation, deficits resulting from sleep deprivation are clearly and definitively demonstrable. Sleep loss in the clinical situation is usually sleep deprivation superimposed on chronic sleep loss. An examination of questionnaire studies, the literature on reports of sleep loss, studies of the reduction of work hours on performance as well as observational and a few interventional studies have yielded contradictory and often equivocal results. The residents generally find they feel better working fewer hours but improvements in patient care are often not reported or do not occur. A change in the attitude of the resident toward his role and his patient has not been salutary. Decreasing sleep loss should have had a positive effect on patient care in reducing medical error, but this remains to be unequivocally demonstrated.
Jansma, J.D.; Wagner, C.; Bijnen, A.B.
Objectives: To develop a patient safety course for medical residents based on the views of medical residents and their supervisors. Methods: In 2007, questionnaires were distributed to investigate residents' and supervisors' perspectives on the current patient safety performance and educational
T. D. Gordon
Full Text Available The effects of photochemical aging on emissions from 15 light-duty gasoline vehicles were investigated using a smog chamber to probe the critical link between the tailpipe and ambient atmosphere. The vehicles were recruited from the California in-use fleet; they represent a wide range of model years (1987 to 2011, vehicle types and emission control technologies. Each vehicle was tested on a chassis dynamometer using the unified cycle. Dilute emissions were sampled into a portable smog chamber and then photochemically aged under urban-like conditions. For every vehicle, substantial secondary organic aerosol (SOA formation occurred during cold-start tests, with the emissions from some vehicles generating as much as 6 times the amount of SOA as primary particulate matter after three hours of oxidation inside the chamber at typical atmospheric oxidant levels. Therefore, the contribution of light duty gasoline vehicle exhaust to ambient PM levels is likely dominated by secondary PM production (SOA and nitrate. Emissions from hot-start tests formed about a factor of 3–7 less SOA than cold-start tests. Therefore, catalyst warm-up appears to be an important factor in controlling SOA precursor emissions. The mass of SOA generated by photo-oxidizing exhaust from newer (LEV1 and LEV2 vehicles was only modestly lower (38% than that formed from exhaust emitted by older (pre-LEV vehicles, despite much larger reductions in non-methane organic gas emissions. These data suggest that a complex and non-linear relationship exists between organic gas emissions and SOA formation, which is not surprising since SOA precursors are only one component of the exhaust. Except for the oldest (pre-LEV vehicles, the SOA production could not be fully explained by the measured oxidation of speciated (traditional SOA precursors. Over the time scale of these experiments, the mixture of organic vapors emitted by newer vehicles appear to be more efficient (higher yielding in
Raknes, Guttorm; Morken, Tone; Hunskår, Steinar
Geographical factors have an impact on the utilisation of out-of-hours services. In this study we have investigated the travel distance to out-of-hours casualty clinics in Norwegian municipalities in 2011 and the number of municipalities covered by the proposed recommendations for secondary on-call arrangements due to long distances. We estimated the average maximum travel times and distances in Norwegian municipalities using a postcode-based method. Separate analyses were performed for municipalities with a single, permanently located casualty clinic. Altogether 417 out of 430 municipalities were included. We present the median value of the maximum travel times and distances for the included municipalities. The median maximum average travel distance for the municipalities was 19 km. The median maximum average travel time was 22 minutes. In 40 of the municipalities (10 %) the median maximum average travel time exceeded 60 minutes, and in 97 municipalities (23 %) the median maximum average travel time exceeded 40 minutes. The population of these groups comprised 2 % and 5 % of the country's total population respectively. For municipalities with permanent emergency facilities(N = 316), the median average flight time 16 minutes and median average distance 13 km.. In many municipalities, the inhabitants have a long average journey to out-of-hours emergency health services, but seen as a whole, the inhabitants of these municipalities account for a very small proportion of the Norwegian population. The results indicate that the proposed recommendations for secondary on-call duty based on long distances apply to only a small number of inhabitants. The recommendations should therefore be adjusted and reformulated to become more relevant.
Zabar, Sondra; Hanley, Kathleen; Stevens, David L; Kalet, Adina; Schwartz, Mark D; Pearlman, Ellen; Brenner, Judy; Kachur, Elizabeth K; Lipkin, Mack
Medical residents, frontline clinical educators, must be competent teachers. Typically, resident teaching competence is not assessed through any other means than gleaning learner's comments. We developed, evaluated, and integrated into our annual objective structured clinical examination a resident teaching skills assessment using "standardized" students. Faculty observers rated residents using a customized 19-item rating instrument developed to assess teaching competencies that were identified and defined as part of our project. This was feasible, acceptable, and valuable to all 65 residents, 8 students, and 16 faculty who participated. Teaching scenarios have potential as reliable, valid, and practical measures of resident teaching skills.
Byrne, John; Straub, Heather; DiGiovanni, Laura; Chor, Julie
The objective of the study was to assess the current status of ethics education in obstetrics-gynecology residency programs. A cross-sectional, web-based survey was designed in conjunction with a professional survey laboratory at the University of Chicago. The survey was piloted with a convenience sample of clinical medical ethics fellows to assess question content and clarity. The survey was deployed by e-mail to all obstetrics-gynecology residency program directors. Descriptive statistics were used to analyze participant responses. The University of Chicago's Institutional Review Board deemed this study exempt from institutional review board formal review. Of 242 eligible obstetrics-gynecology residency program directors, 118 (49%) completed the survey. Most respondents were from university-based programs (n = 78, 66%) that were not religiously affiliated (n = 98, 83%) and trained 4-6 residents per postgraduate year (n = 64, 70%). Although 50% of program directors (n = 60) reported having ethics as part of their core curriculum, most programs teach ethics in an unstructured manner. Fifty-seven percent of respondents (n = 66) stated their program dedicated 5 or fewer hours per year to ethics. The majority of program directors (n = 80, 73%) responded they would like more to a lot more ethics education and believed that ethics education should be required (n = 93, 85%) for residents to complete their training. Respondents identified that crowding in the curriculum was a significant barrier to increased ethics training (n = 50, 45%) and two-thirds (n = 74, 67%) reported a lack of faculty expertise as a moderate barrier to providing ethics education in the residency curriculum. This study found that a lack of structured curricula, inadequate faculty expertise, and limited time were important barriers for ethics education in obstetrics-gynecology programs across the nation. Despite these existing challenges, program directors have a strong interest in increasing ethics
Rouzi, Abdulrahim A; Alsahly, Nora; Alamoudi, Rana; Almansouri, Nisma; Alsinani, Nawal; Alkafy, Souzan; Rozzah, Rayyan; Abduljabbar, Hassan
Misoprostol is an effective agent for the induction of labor. Existing guidelines recommend oral misoprostol solution 25 μg every 2 hours. However, more research is required to optimize the use of oral misoprostol solution for the induction of labor. The purpose of this study was to compare efficacy and safety of hourly titrated-dose oral misoprostol solution with static-dose oral misoprostol solution every 2 hours for labor induction. In this randomized controlled study, oral misoprostol solution was administered as (1) 20 μg hourly (≤4 doses) that was increased in the absence of regular uterine contractions to 40 μg hourly (≤4 doses) and then to 60 μg hourly (≤16 doses) or (2) 25 μg every 2 hours until active labor began (≤12 doses). A sample size of 146 women was planned with the use of a projected 95% rate for the primary endpoint (vaginal delivery within 24 hours) for hourly titrated-dose misoprostol and 80% rate for static-dose misoprostol every 2 hours. Safety outcomes included maternal morbidity and adverse neonatal outcomes. From December 2013 to July 2015, 146 women were assigned randomly to treatment. Demographic and clinical factors were similar between groups, except for age. Vaginal delivery was achieved within 24 hours in 47 women (64.4%) who received hourly titrated-doses of misoprostol solution and 48 women (65.8%) who received 2-hourly static-dose misoprostol solution (P=1.00). Rates of vaginal delivery within 24 hours did not differ significantly between treatment groups for women who were nulliparous (P=1.00) or who had postterm pregnancies (P=.66), a Bishop score of ≤3 (P=.84), or oxytocin augmentation (P=.83). Cesarean deliveries were performed within 24 hours in 9 women who received hourly titrated-dose misoprostol solution and 2 women who received 2-hourly static-dose misoprostol solution (P=.056). Pyrexia and meconium-stained liquor occurred more frequently with the hourly titrated-dose regimen. The static-dose oral
Background Evidence-based medicine (EBM) has been widely integrated into residency curricula, although results of randomized controlled trials and long term outcomes of EBM educational interventions are lacking. We sought to determine if an EBM workshop improved internal medicine residents' EBM knowledge and skills and use of secondary evidence resources. Methods This randomized controlled trial included 48 internal medicine residents at an academic medical center. Twenty-three residents were randomized to attend a 4-hour interactive workshop in their PGY-2 year. All residents completed a 25-item EBM knowledge and skills test and a self-reported survey of literature searching and resource usage in their PGY-1, PGY-2, and PGY-3 years. Results There was no difference in mean EBM test scores between the workshop and control groups at PGY-2 or PGY-3. However, mean EBM test scores significantly increased over time for both groups in PGY-2 and PGY-3. Literature searches, and resource usage also increased significantly in both groups after the PGY-1 year. Conclusions We were unable to detect a difference in EBM knowledge between residents who did and did not participate in our workshop. Significant improvement over time in EBM scores, however, suggests EBM skills were learned during residency. Future rigorous studies should determine the best methods for improving residents' EBM skills as well as their ability to apply evidence during clinical practice. PMID:20807453
Jürgens, C; Antal, S; Henrici, K; Grossjohann, R; Tost, F H
Elevated intraocular pressure (IOP) is a clinically relevant factor in glaucoma progression. As a dynamic parameter the IOP depends on various internal and exogenic influencing factors. Therefore, we analysed intraindividual IOD variations between ambulant care and 24-h home-monitoring using self-tonometry. This study is based on paper-based glaucoma cards of 25 patients with primary open angle glaucoma. Additionally, all patients participated in a telemedical home-monitoring study with self-measurements of IOP and blood pressure stored in an electronic patient record. The glaucoma cards contained a total number of 409 IOP values with documentation periods from 0.5 to 10 years. In the teletonometry project all 25 patients were observed for 6 months with 1490 recorded IOP values. Statistical analysis was performed with SPSS software. Average IOP values for all 25 glaucoma patients were 16.3 +/- 2.9 mmHg for both eyes in glaucoma card documentation, whereas the electronic patient records showed IOP averages of 18.9 +/- 4.7 mmHg for right eyes and 18.2 +/- 4.4 mmHg for left eyes. Corresponding to the practice opening hours the glaucoma cards contained no IOP records from 12:00 pm to 01:30 pm as well as between 06:00 pm and 07:15 am. In these time periods 17 % of all IOP values recorded in 24-hour teletonometry were higher than 20 mmHg. However, statistical analysis and clinical evaluation of device parameters and measurement characteristics revealed sporadic measuring errors. The additional involvement of self-tonometry in telemedical 24-h home-monitoring is a feasible method to record and detect intraday IOP fluctuations. Compared to single IOP measurements documented in common paper-based glaucoma cards, the 24-h electronic patient record showed more frequent circadian IOP variations. As a result, self-tonometry and home-monitoring can be a useful link to fill the gap between singular ambulant IOP measurement and hospitalisation with 24-hour IOP profiles.
Two residents, wearing white coats with their names and "Department of Orthopaedics" conspicuously embroidered on them, boarded a hospital elevator crowded with physicians, employees, and visitors. In a clearly audible voice, one resident began a story: "You should have seen the patient I saw in my clinic the other day. She was beautiful. I should send her to see Dr. W. He would love to see her!" This comment drew the undivided attention of everyone in the elevator and cast a ghastly silence over the rest of the ride. In recent years, interest has expanded regarding professionalism and its importance in medicine and surgery. Orthopaedic surgery is no exception, as the topic has recently reached prominence in our literature and policies. It is unlikely that professionalism is a universal and innate characteristic of college students entering medical school, yet it becomes a necessary value in medical practice. Somewhere in the ongoing process of medical education, the issue must be addressed.
Civetta, J M; Morejón, O V; Kirton, O C; Reilly, P J; Serebriakov, I I; Dobkin, E D; D'Angelica, M; Antonetti, M
An Internet application could collect information to satisfy documentation required by the Residency Review Committee. Beyond replacing a difficult and inefficient paper system, it would collect, process, and distribute information to administration, faculty, and residents. Descriptive study. An integrated residency of 18 services at a university teaching hospital with 4 affiliated institutions. Residency administrators, faculty, and residents. The application included a procedure recorder, resident evaluation of faculty and rotations, goals and objectives (stratified by service and resident level), and matching faculty evaluation of residents with these goals as competencies. Policies, schedules, research opportunities, clinical site information, and curriculum support were created. Degree of compliance with Residency Review Committee standards, number of deficiencies corrected, and quantity and quality of information available to administration, faculty, and residents. The Internet system increased resident compliance for faculty and rotation evaluations from 20% and 34%, respectively, to 100%, which was maintained for 22 months. These evaluations can be displayed individually, in summary grids, and as postgraduate year-specific averages. Faculty evaluations of residents can be reviewed throughout the system. The defined category report for procedures, which had deficiencies in the preceding 6 years, had none for the last 2 years. The Internet application provides Accreditation Council for Graduate Medical Education-validated operative logs to regulatory agencies. A Web-based system can satisfy requirements and provide processed data that are of better quality and more complete than our paper system. We are now able to use scarce time and personnel to nurture developing surgical residents instead of shuffling paper.
Wenger, Nathalie; Méan, Marie; Castioni, Julien; Marques-Vidal, Pedro; Waeber, Gérard; Garnier, Antoine
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.
Asamoah, Osei Kwame; Weiss, Steven J; Ernst, Amy A; Richards, Michael; Sklar, David P
Ambulance diversion is a problem in many communities. When patients are diverted prompt and appropriate medical care may be delayed. Compare diversion hours and drop-off times before and after a dramatic change in diversion policy restricting each hospital to 1 hour out of every 8. This study was a retrospective study in a county of 600,000 people and 10 hospitals from September 2004 to February 2006. A countywide diversion protocol was implemented in March 2005 that limited diversion hours to 1 hour out of every 8 (maximum of 90 h/mo). No other changes were implemented during the study period. Pretrial (9/04-2/05), interim (3/05-8/05), and posttrial (9/05-2/06) periods were compared. The main outcome measures were ambulance diversion hours and emergency medical service (EMS) drop-off times. Results were compared using analysis of variance and a Tukey post hoc analysis. P ambulance diversion hours (difference, 251 hours; 95% CI, 136-368) and significant increase in additional time that EMS crews required to transport patients (drop-off times) (difference, 178 hours; 95% CI, 74-283) were observed. Posttrial diversion hours decreased to 18% of the pretrial values (from 305 to 54). This novel ambulance diversion protocol dramatically reduced diversion hours at the cost of increasing EMS drop-off times in a large community.
Civaner, Murat; Sarikaya, Ozlem; Balcioğlu, Harun
Medical ethics education in residency training is one of the hot topics of continuous medical education debates. Its importance and necessity is constantly stressed in declarations and statements on national and international level. Parallel to the major structural changes in the organization and the finance model of health care system, patient-physician relationship, identity of physicianship, social perception and status of profession are changing. Besides, scientific developments and technological advancements create possibilities that never exists before, and bring new ethical dilemmas along with. To be able to transplant human organs has created two major problems for instance; procurement of organs in sufficient numbers, and allocating them to the patients in need by using some prioritizing criteria. All those new and challenging questions force the health care workers to find authentic and justifiable solutions while keeping the basic professional values. In that sense, proper medical ethics education in undergraduate and postgraduate term that would make physician-to-be's and student-physicians acquire the core professional values and skill to notice, analyze and develop justifiable solutions to ethical problems is paramount. This article aims to express the importance of medical ethics education in residency training, and to propose major topics and educational methods to be implemented into. To this aim, first, undergraduate medical education, physician's working conditions, the exam of selection for residency training, and educational environment were revised, and then, some topics and educational methods, which are oriented to educate physicians regarding the professional values that they should have, were proposed.
Gerard, James M; Thomas, Scott M; Germino, Kevin W; Street, Megan H; Burch, Wesley; Scalzo, Anthony J
The Accreditation Council for Graduate Medical Education requires that family medicine residents receive structured skills training on pediatric advanced life support (PALS) and should learn procedures for medical emergencies in patients of all ages. Traditional methods of training family medicine residents in PALS is challenging given their limited clinical exposure to critically ill patients. The primary objective of this study was to assess the effect of a 2-hour PALS training session utilizing high-fidelity mannequins on residents' psychomotor skills performances. Between February and June 2009, residents from two urban family medicine residency programs received training on four PALS procedures (bag-mask ventilation, tracheal intubation, intraosseous line placement, and cardiac rhythm assessment/defibrillation) at a university simulation center. Residents completed questionnaires to provide data on previous resuscitation training and experience. We collected self-confidence data and video recordings of residents performing the procedures before and after training. To assess retention at 6 months, we collected self-confidence data and video recordings of PGY-1 and PGY-2 residents performing the procedures. A blinded reviewer scored the video recordings. Forty-seven residents completed the study. The majority of residents (53.2%) had never performed any of the procedures on a real patient. Immediately following skills training, mean overall performance improved from 39.5% (± 11.5%) to 76.5% (± 10.4%), difference 37.0% (95% CI, 33.5%--40.6%). Bag-mask ventilation and intraosseous insertion skills remained above baseline at 6-month follow-up. Simulation training is beneficial for teaching PALS procedures to family medicine residents.
Cullen, Edward J; Lawless, Stephen T; Hertzog, James H; Penfil, Scott; Bradford, Kathleen K; Nadkarni, Vinay M; Corddry, David H; Costarino, Andrew T
Centers for Medicare & Medicaid Services (CMS) Health Resources and Services Administration Children's Hospitals Graduate Medical Education (GME) Payment Program now supports freestanding children's teaching hospitals. To analyze the fair market value impact of GME payment on resident teaching efforts in our pediatric intensive care unit (PICU). Cost-accounting model, developed from a 1-year retrospective, descriptive, single-institution, longitudinal study, applied to physician teachers, residents, and CMS. Sixteen-bed PICU in a freestanding, university-affiliated children's teaching hospital. Pediatric critical care physicians, second-year residents. Cost of physician opportunity time; CMS investment return; the teaching physicians' investment return; residents' investment return; service balance between CMS and teaching service investment margins; economic balance points; fair market value. GME payments to our hospital increased 4.8-fold from 577 886 dollars to 2 772 606 dollars during a 1-year period. Critical care physicians' teaching opportunity cost rose from 250 097 dollars to 262 215 dollars to provide 1523 educational hours (6853 relative value units). Residents' net financial value for service provided to the PICU rose from 245 964 dollars to 317 299 dollars. There is an uneven return on investment in resident education for CMS, critical care physicians, and residents. Economic balance points are achievable for the present educational efforts of the CMS, critical care physicians, and residents if the present direct medical education payment increases from 29.38% to 36%. The current CMS Health Resources and Services Administration Children's Hospitals GME Payment Program produces uneven investment returns for CMS, critical care physicians, and residents. We propose a cost-accounting model, based on perceived production capability measured in relative value units and available GME funds, that would allow a clinical service to balance and obtain a fair
Full Text Available The clock distribution and generation circuitry forms a critical component of current synchronous digital systems. A digital system’s clocks must have not only low jitter, low skew, but also well-controlled duty cycle in order to facilitate versatile clocking techniques. In high-speed CMOS clock buffer design, the duty cycle of a clock is liable to be changed when the clock passes through a multistage buffer because the circuit is not pure digital . In this paper, we propose a pulse width control loop referred as MPWCL (modified pulse width control loop that adopts the same architecture as the conventional PWCL, but with a new pulse generator and new charge pump circuit as a constituent of the duty cycle detector. Thanks to using new building blocks the proposed pulse width control loop can control the duty cycle in a wide range, and what is more important it becomes operative in saturation region too, what provides conditional for fast locking time. For 1.2 µm double-metal double-poly CMOS process with Vdd = 5 V and operating frequency of 133 MHz, results of SPICE simulation show that the duty cycle can be well controlled in the range from 20 % up to 80 % if the loop parameters are properly chosen.
Fenton, M Brock; Faure, Paul A; Ratcliffe, John M
Duty cycle describes the relative 'on time' of a periodic signal. In bats, we argue that high duty cycle (HDC) echolocation was selected for and evolved from low duty cycle (LDC) echolocation because increasing call duty cycle enhanced the ability of echolocating bats to detect, lock onto and track fluttering insects. Most echolocators (most bats and all birds and odontocete cetaceans) use LDC echolocation, separating pulse and echo in time to avoid forward masking. They emit short duration, broadband, downward frequency modulated (FM) signals separated by relatively long periods of silence. In contrast, bats using HDC echolocation emit long duration, narrowband calls dominated by a single constant frequency (CF) separated by relatively short periods of silence. HDC bats separate pulse and echo in frequency by exploiting information contained in Doppler-shifted echoes arising from their movements relative to background objects and their prey. HDC echolocators are particularly sensitive to amplitude and frequency glints generated by the wings of fluttering insects. We hypothesize that narrowband/CF calls produced at high duty cycle, and combined with neurobiological specializations for processing Doppler-shifted echoes, were essential to the evolution of HDC echolocation because they allowed bats to detect, lock onto and track fluttering targets. This advantage was especially important in habitats with dense vegetation that produce overlapping, time-smeared echoes (i.e. background acoustic clutter). We make four specific, testable predictions arising from this hypothesis.
DeForge, B R; Sobal, J
The art of clinical medicine involves learning to deal with varying levels of ambiguity and uncertainty. Tolerance of ambiguity was examined by giving Budner's Intolerance of Ambiguity Scale to a sample of 37 family practice residents from a university hospital residency and 22 from a community hospital residency. Residents in both the community and university programs had similar scores. No differences existed between men and women. Compared to studies of medical students, first-year family practice residents were slightly more intolerant of ambiguity. However, intolerance of ambiguity was lower among third-year residents, suggesting that as training advances, residents may become more tolerant of ambiguity. The residency training process may lead to a reduction in intolerance of ambiguity, which produces physicians who can deal with the ambiguity and uncertainty of clinical practice.
This paper presents the initial theoretical framework adopted for a study into resident acceptance of sustainable renovation. Seven expert interviews and two retrospective case studies revealed that the relationship between social housing residents and the renovation process requires careful attenti
Ayala-Morillas, L E; Fuentes-Ferrer, M E; Sánchez-Díaz, J; Rumayor-Zarzuelo, M; Fernández-Pérez, C; Marco-Martínez, F
We do not know what factors influence residents' perceived satisfaction during their training. The aim of this study was to analyze the satisfaction of specialists with their training and its associated factors. This was a cross-sectional study using self-completion surveys of residents in training at the Clinic Hospital San Carlos for the courses conducted in 2006, 2009, 2010 and 2012. The study's dependent variable was overall satisfaction with the training; the independent factors were demographic and occupational characteristics, variables related to healthcare, teaching and research activity. The total participation percentage was 83.7% (1,424/1,701), and the mean age was 28.4 years (SD, 3.2 years). The overall satisfaction percentage was 75.2%. The factors statistically associated with overall satisfaction in the multivariate analysis were the involvement of the teaching staff (tutors and assistants) in the training, greater satisfaction in medical versus surgical specialties, the year of residence, the facilities for completing the thesis, working less than 40 h a week, adequate time to perform daily tasks, appropriate number of department meetings and not having a previous specialty. the activities related to research and teaching are associated with the overall satisfaction of residents. The routine activity factors most closely associated with satisfaction were the time available and the work hours. More studies are necessary to understand the impact of resident satisfaction on care quality and in their activity as future specialists. Copyright © 2013 Elsevier España, S.L. All rights reserved.
Genin, Emilie; Haines, Victor Y; Pelletier, David; Rousseau, Vincent; Marchand, Alain
This study investigates the determinants of long working hours from the perspectives of the demand-control model [Karasek, 1979] and social exchange theory [Blau, 1964; Goulder, 1960]. These two theoretical perspectives are tested to understand why individuals work longer (or shorter) hours. The hypotheses are tested with a representative sample of 1,604 employed Canadians. In line with Karasek's model, the results support that high job demands are positively associated with longer work hours. The social exchange perspective would predict a positive association between skill discretion and work hours. This hypothesis was supported for individuals with a higher education degree. Finally, the results support a positive association between active jobs and longer work hours. Our research suggests that job demands and social exchange dynamics need to be considered together in the explanation of longer (or shorter) work hours.
... Greenhouse Gas Emissions Standards and Fuel Efficiency Standards for Medium- and Heavy-Duty Engines and...--Proposed Vocational Diesel Engine Standards Over the Heavy-Duty FTP Cycle Medium Model year Standard Light... Light heavy-duty Medium heavy-duty Heavy heavy-duty Fuel Consumption Baseline (gallon/1,000 ton-mile...
With the increasing trend of heavy crudes supply with deteriorated quality and demand for clean fuels, deep processing of residuum, in particular the processing of low-grade resid, has become the main source for enhancing economic benefits of oil refiners. This article has discussed the technology for processing of different resids and the advantages and disadvantages of the combination processes for resid processing, while pinpointing the directions for development and application of technologies for resid processing in China.
Jack Rossiter; Hugh O.'Flynn; Michael Kalush; Giorgos Kallis; Nicholas Ashford
This article explores the pros and cons for reducing working hours in Europe. To arrive to an informed judgment we review critically the theoretical and empirical literature, mostly from economics, concerning the relation between working hours on the one hand, and productivity, employment, quality of life, and the environment, on the other. We adopt a binary economics distinction between capital and labor productiveness, and are concerned with how working hours may be reduced without harming ...
Huebener, Mathias; Kuger, Susanne; Marcus, Jan
Do increased instruction hours improve the performance of all students? Using PISA scores of students in ninth grade, we analyse the effect of a German education reform that increased weekly instruction hours by two hours (6.5 percent) overalmost five years. In the additional time, students are taught new learning content. On average, the reform improves student performance. However, treatment effects are small and differ across the student performance distribution. While low-performing stude...
Goad, Jeffery A; Taitel, Michael S; Fensterheim, Leonard E; Cannon, Adam E
Approximately 50,000 adults die annually from vaccine-preventable diseases in the United States. Most traditional vaccine providers (eg, physician offices) administer vaccinations during standard clinic hours, but community pharmacies offer expanded hours that allow patients to be vaccinated at convenient times. We analyzed the types of vaccines administered and patient populations vaccinated during off-clinic hours in a national community pharmacy, and their implications for vaccination access and convenience. We retrospectively reviewed data for all vaccinations given at the Walgreens pharmacy chain between August 2011 and July 2012. The time of vaccination was categorized as occurring during traditional hours (9:00 am-6:00 pm weekdays) or off-clinic hours, consisting of weekday evenings, weekends, and federal holidays. We compared demographic characteristics and types of vaccine. We used a logistic regression model to identify predictors of being vaccinated during off-clinic hours. During the study period, pharmacists administered 6,250,402 vaccinations, of which 30.5% were provided during off-clinic hours: 17.4% were provided on weekends, 10.2% on evenings, and 2.9% on holidays. Patients had significantly higher odds of off-clinic vaccination if they were younger than 65 years of age, were male, resided in an urban area, and did not have any chronic conditions. A large proportion of adults being vaccinated receive their vaccines during evening, weekend, and holiday hours at the pharmacy, when traditional vaccine providers are likely unavailable. Younger, working-aged, healthy adults, in particular, a variety of immunizations during off-clinic hours. With the low rates of adult and adolescent vaccination in the United States, community pharmacies are creating new opportunities for vaccination that expand access and convenience.
Waineo, Eva; Arfken, Cynthia L.; Morreale, Mary K.
Objective: This report discusses psychiatric residents' perceptions of sexual health education and their opinions regarding curricular improvements. Methods: An anonymous, web-based survey was sent to residents in one general psychiatry program (N = 33). The response rate was 69.7%. Results: Residents reported inadequate experience in multiple…
van der Heijden, Frank; Dillingh, Gea; Bakker, Arnold; Prins, Jelle
Objectives: Recent research showed that medical residents have a high risk for developing burnout. The present study investigates the prevalence of burnout and its relationship with suicidal thoughts among medical residents. Methods: All Dutch medical residents (n = 5126) received a self-report ques
Stern, David T.; And Others
A study of 28 medical residents' skills in evaluating research compared student evaluations of a journal article with 1 developed by means of a Delphi technique utilizing 5 experts. Residents' scores were not significantly associated with residency year or self-assessed critical appraisal skill. The method is proposed as an objective means of…
... 38 Pensions, Bonuses, and Veterans' Relief 2 2010-07-01 2010-07-01 false Resident assessment. 51...) PER DIEM FOR NURSING HOME CARE OF VETERANS IN STATE HOMES Standards § 51.110 Resident assessment. The... condition a comprehensive, accurate, standardized, reproducible assessment of each resident's functional...
... United States. (2) The resident has the right to be free of interference, coercion, discrimination, and... resident has the right to— (1) Voice grievances without discrimination or reprisal. Residents may voice... has documented the need or desire for work in the plan of care; (ii) The plan specifies the nature...
... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false Resident compensation. 964.340 Section 964.340 Housing and Urban Development Regulations Relating to Housing and Urban Development...) Program § 964.340 Resident compensation. Residents employed to provide services or renovation...
van der Heijden, Frank; Dillingh, Gea; Bakker, Arnold; Prins, Jelle
Objectives: Recent research showed that medical residents have a high risk for developing burnout. The present study investigates the prevalence of burnout and its relationship with suicidal thoughts among medical residents. Methods: All Dutch medical residents (n = 5126) received a self-report
Waineo, Eva; Arfken, Cynthia L.; Morreale, Mary K.
Objective: This report discusses psychiatric residents' perceptions of sexual health education and their opinions regarding curricular improvements. Methods: An anonymous, web-based survey was sent to residents in one general psychiatry program (N = 33). The response rate was 69.7%. Results: Residents reported inadequate experience in multiple…
Juliana da Costa Fernandes
Full Text Available OBJECTIVE: to analyse the differences between genders in the description in the professional, domestic and total work hours and assess its association with health-related behaviour among nurses. METHODS: this is a transversal study carried out in 18 different public hospitals in the municipality of Rio de Janeiro. The data collection procedure was based on questionnaires. All nurses working with assistance were considered eligible (n=2,279. RESULTS: men and women showed significant differences in relation to working hours. The female group showed longer domestic and total work hours when compared to the group of men. In contrast, the number of hours spent on professional work was higher among men. For the women, both the professional hours and total work hours were often associated with excessive consumption of fried food and also coffee, lack of physical exercise and also the greater occurrence of overweight and obesity. CONCLUSION: both the professional hours and the domestic work hours need to be taken into account in studies about health, self-care and also the care provided within the context of nursing workers, particularly among women. The results add weight to the need for actions for health promotion in this occupational group and the importance of assessing the impact of long working hours on the health of workers.
This presentation discusses field evaluations of medium- and heavy-duty vehicles performed by NREL. The project provides medium-duty (MD) and heavy-duty (HD) test results, aggregated data, and detailed analysis, including 3rd party unbiased data (data that would not normally be shared by industry in an aggregated and detailed manner). Over 5.6 million miles of advanced technology MD and HD truck data have been collected, documented, and analyzed on over 240 different vehicles since 2002. Data, analysis, and reports are shared within DOE, national laboratory partners, and industry for R&D planning and strategy. The results help guide R&D for new technology development, help define intelligent usage of newly developed technology, and help fleets/users understand all aspects of advanced technology.
Teresa H. Young
Full Text Available Child advocacy centers across the United States intervened in more than 250,000 child abuse cases in 2011(National Children's Alliance, 2012. Understanding the work of family victim advocates is imperative to helping children and families in child abuse cases. In this exploratory study, we surveyed advocates and program directors from child advocacy centers (CACs across the United States to compare their perceptions of the critical job duties of family victim advocates. Data analysis revealed that CAC directors rated the importance of these duties significantly higher than family victim advocates. Results suggest the need for additional training to ensure that family victim advocates understand the importance of critical job duties to meet the needs of children and families in child abuse cases.
Colello, R. G.; Boghani, A. B.; Gardella, N. C.; Gott, P. G.; Lee, W. D.; Pollak, E. C.; Teagan, W. P.; Thomas, R. G.; Snyder, C. M.; Wilson, R. P., Jr.
A catalog of energy management models for heavy duty transport systems powered by diesel engines is presented. The catalog results from a literature survey, supplemented by telephone interviews and mailed questionnaires to discover the major computer models currently used in the transportation industry in the following categories: heavy duty transport systems, which consist of highway (vehicle simulation), marine (ship simulation), rail (locomotive simulation), and pipeline (pumping station simulation); and heavy duty diesel engines, which involve models that match the intake/exhaust system to the engine, fuel efficiency, emissions, combustion chamber shape, fuel injection system, heat transfer, intake/exhaust system, operating performance, and waste heat utilization devices, i.e., turbocharger, bottoming cycle.