Zhang, Zi; Krauthamer, Alan V; Rosenkrantz, Andrew B
In March 2017, the ACGME relaxed resident duty-hour restrictions to allow first-year residents to work 24-hour shifts, affecting the internship experience of incoming radiology residents. The aim of this study was to assess the media response to this duty-hour change, comparing news articles with favorable and unfavorable views. Google News was used to identify 36 relevant unique news articles published over a 4-week period after the announcement. Articles' stance was categorized as favorable, unfavorable, or neutral. Additional article characteristics were explored. Article sources were 58% national, 22% local, and 20% medical news. Article stance was most commonly unfavorable for national news sources (48%), compared with neutral for local (62%) and medical (72%) news sources. Most common reasons for unfavorable stance were sleep deprivation (n = 11), medical errors (n = 11), residents' health (n = 9), risk for car accidents (n = 9), a patriarchal hazing system (n = 6), and work-life balance (n = 5). Most common reasons for favorable stance were impact on resident education (n = 7) and continuity of care (n = 7). Supporting data were cited by 38% of unfavorable and 100% of favorable articles. Unfavorable articles most commonly quoted physicians affiliated with resident advocacy groups; favorable articles most commonly quoted physicians affiliated with the ACGME. The relaxed duty-hour restrictions received an overall unfavorable media response, particularly in nonmedical news sources, driven by concerns regarding sleep-deprived doctors. Favorable articles ubiquitously cited data supporting the safety of relaxed duty hour restrictions. Further research is warranted to better understand the impact of relaxed resident duty-hour limits on sleep deprivation, residents' health and education, and the quality of patient care. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.
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
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
Rajaram, Ravi; Chung, Jeanette W; Jones, Andrew T; Cohen, Mark E; Dahlke, Allison R; Ko, Clifford Y; Tarpley, John L; Lewis, Frank R; Hoyt, David B; Bilimoria, Karl Y
In 2011, the Accreditation Council for Graduate Medical Education (ACGME) restricted resident duty hour requirements beyond those established in 2003, leading to concerns about the effects on patient care and resident training. To determine if the 2011 ACGME duty hour reform was associated with a change in general surgery patient outcomes or in resident examination performance. Quasi-experimental study of general surgery patient outcomes 2 years before (academic years 2009-2010) and after (academic years 2012-2013) the 2011 duty hour reform. Teaching and nonteaching hospitals were compared using a difference-in-differences approach adjusted for procedural mix, patient comorbidities, and time trends. Teaching hospitals were defined based on the proportion of cases at which residents were present intraoperatively. Patients were those undergoing surgery at hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP). General surgery resident performance on the annual in-training, written board, and oral board examinations was assessed for this same period. National implementation of revised resident duty hour requirements on July 1, 2011, in all ACGME accredited residency programs. Primary outcome was a composite of death or serious morbidity; secondary outcomes were other postoperative complications and resident examination performance. In the main analysis, 204,641 patients were identified from 23 teaching (n = 102,525) and 31 nonteaching (n = 102,116) hospitals. The unadjusted rate of death or serious morbidity improved during the study period in both teaching (11.6% [95% CI, 11.3%-12.0%] to 9.4% [95% CI, 9.1%-9.8%], P general surgery patient outcomes or differences in resident examination performance. The implications of these findings should be considered when evaluating the merit of the 2011 ACGME duty hour reform and revising related policies in the future.
Borman, Karen R; Jones, Andrew T; Shea, Judy A
The balance between patient treatment risks and training residents to proficiency is confounded by duty-hour limits. Stricter limits have been recommended to enhance quality and safety, although supporting data are scarce. A previously piloted survey was delivered with the 2010 American Board of Surgery In-Training Examination (ABSITE). First postgraduate year (PGY1) and PGY2 trainees took the Junior examination (IJE); PGY3 and above took the Senior examination (ISE). Residency type, size, and location were linked to examinees using program codes. Five survey items queried all residents about the impact of further hour limits on care quality; online test residents answered 7 more items probing medical error sources. Data were analyzed using factorial ANOVA for association with sex, PGY level, and program demographics. There were 6,161 categorical surgery residents who took the ABSITE: 60% men, 60% ISE, and two-thirds in university programs. Paper (n = 5,079) and online (n = 1,082) examinees were similar. Item response rates ranged from 91% to 98%. Few (surgery residents do not perceive that reduced duty hours will noticeably improve quality of care. Resident perceptions of causes of medical errors suggest that system changes are more likely to enhance patient safety than further hour limits. Copyright © 2012 American College of Surgeons. Published by Elsevier Inc. All rights reserved.
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.
Romano, Patrick S.; Itani, Kamal M.F.; Rosen, Amy K.; Small, Dylan; Lipner, Rebecca S.; Bosk, Charles L.; Wang, Yanli; Halenar, Michael J.; Korovaichuk, Sophia; Even-Shoshan, Orit; Volpp, Kevin G.
Purpose To determine whether the 2003 Accreditation Council for Graduate Medical Education (ACGME) duty hours reform affected medical knowledge as reflected by written board scores for internal medicine (IM) residents. Method The authors conducted a retrospective cohort analysis of postgraduate year 1 (PGY-1) Internal Medicine residents who started training before and after the 2003 duty hour reform using a merged data set of American Board of Internal Medicine (ABIM) Board examination and the National Board of Medical Examiners (NMBE) United States Medical Licensing Examination (USMLE) Step 2 Clinical Knowledge test scores. Specifically, using four regression models, the authors compared IM residents beginning PGY-1 training in 2000 and completing training unexposed to the 2003 duty hours reform (PGY-1 2000 cohort, n = 5,475) to PGY-1 cohorts starting in 2001 through 2005 (n = 28,008), all with some exposure to the reform. Results The mean ABIM board score for the unexposed PGY-1 2000 cohort (n = 5,475) was 491, SD = 85. Adjusting for demographics, program, and USMLE Step 2 exam score, the mean differences (95% CI) in ABIM board scores between the PGY-1 2001, 2002, 2003, 2004 and 2005 cohorts minus the PGY-1 2000 cohort were −5.43 (−7.63, −3.23), −3.44 (−5.65, −1.24), 2.58 (0.36, 4.79), 11.10 (8.88, 13.33) and 11.28 (8.98, 13.58) points respectively. None of these differences exceeded one-fifth of an SD in ABIM board scores. Conclusions The duty hours reforms of 2003 did not meaningfully affect medical knowledge as measured by scores on the ABIM board examinations. PMID:24556772
Nomura, Osamu; Mishina, Hiroki; Kobayashi, Yoshinori; Ishiguro, Akira; Sakai, Hirokazu; Kato, Hiroyuki
Duty hour regulations have been placed in residency programs to address mental health concerns and to improve wellness. Here, we elucidate the prevalence of depressive symptoms after implementing an overnight call shift system and the factors associated with burnout or depression among residents.A sequential exploratory mixed methods study was conducted in a tertiary care pediatric and perinatal hospital in Tokyo, Japan. A total of 41 pediatric residents participated in the cross-sectional survey. We determined and compared the prevalence of depressive symptoms and the number of actual working hours before and after implementing the shift system. A follow-up focus-group interview with 4 residents was conducted to explore the factors that may trigger or prevent depression and burnout.Mean working hours significantly decreased from 75.2 hours to 64.9 hours per week. Prevalence of depressive symptoms remained similar before and after implementation of the shift system. Emotional exhaustion and depersonalization from the burnout scale were markedly associated with depression. High workload, stress intolerance, interpersonal difficulties, and generation gaps regarding work-life balance could cause burnout. Stress tolerance, workload monitoring and balancing, appropriate supervision, and peer support could prevent burnout.Although the overnight call shift system was effective in reducing working hours, its effectiveness in managing mental health issues among pediatric residents remains unclear. Resident wellness programs represent an additional strategy and they should be aimed at fostering peer support and improvement of resident-faculty interactions. Such an approach could be beneficial to the relationship between physicians of different generations with conflicting belief structures.
Moeller, Andrew; Webber, Jordan; Epstein, Ian
Resident duty hours have recently been under criticism, with concerns for resident and patient well-being. Historically, call shifts have been long, and some residency training programs have now restricted shift lengths. Data and opinions about the effects of such restrictions are conflicting. The Internal Medicine Residency Program at Dalhousie University recently moved from a traditional call structure to a day float/night float system. This study evaluated how this change in duty hours affected resident perceptions in several key domains. Senior residents from an internal medicine training program in Canada responded to an anonymous online survey immediately before and 6 months after the implementation of duty hour reform. The survey contained questions relating to three major domains: resident wellness, ability to deliver quality health care, and medical education experience. Mean pre- and post-intervention scores were compared using the t-test for paired samples. Twenty-three of 27 (85 %) senior residents completed both pre- and post-reform surveys. Residents perceived significant changes in many domains with duty hour reform. These included improved general wellness, less exposure to personal harm, fewer feelings of isolation, less potential for error, improvement in clinical skills expertise, increased work efficiency, more successful teaching, increased proficiency in medical skills, more successful learning, and fewer rotation disruptions. Senior residents in a Canadian internal medicine training program perceived significant benefits in medical education experience, ability to deliver healthcare, and resident wellness after implementation of duty hour reform.
Simien, Christopher; Holt, Kathleen D; Richter, Thomas H; Whalen, Thomas V; Coburn, Michael; Havlik, Robert J; Miller, Rebecca S
Resident duty hour restrictions were implemented in 2002-2003. This study examines changes in resident surgical experience since these restrictions were put into place. Operative log data for 3 specialties were examined: general surgery, urology, and plastic surgery. The academic year immediately preceding the duty hour restrictions, 2002-2003, was used as a baseline for comparison to subsequent academic years. Operative log data for graduating residents through 2007-2008 were the primary focus of the analysis. Examination of associated variables that may moderate the relationship between fewer duty hours and surgical volume was also included. Plastic surgery showed no changes in operative volume following duty hour restrictions. Operative volume increased in urology programs. General surgery showed a decrease in volume in some operative categories but an increase in others. Specifically the procedures in vascular, plastic, and thoracic areas showed a consistent decrease. There was no increase in the percentage of programs' graduates falling below minimum requirements. Procedures in pancreas, endocrine, and laparoscopic areas demonstrated an increase in volume. Graduates in larger surgical programs performed fewer procedures than graduates in smaller programs; this was not the case for urology or plastic surgery programs. The reduction of duty hours has not resulted in an across the board decrease in operative volume. Factors other than duty hour reforms may be responsible for some of the observed findings.
Sandefur, Benjamin J; Shewmaker, Diana M; Lohse, Christine M; Rose, Steven H; Colletti, James E
The Accreditation Council for Graduate Medical Education (ACGME) implemented revisions to resident duty hour requirements (DHRs) in 2011 to improve patient safety and resident well-being. Perceptions of DHRs have been reported to vary by training stage and specialty among internal medicine and general surgery residents. The authors explored perceptions of DHRs among all residents at a large academic medical center. The authors administered an anonymous cross-sectional survey about DHRs to residents enrolled in all ACGME-accredited core residency programs at their institution. Residents were categorized as medical and pediatric, surgery, or other. In total, 736 residents representing 24 core specialty residency programs were surveyed. The authors received responses from 495 residents (67%). A majority reported satisfaction (78%) with DHRs and believed DHRs positively affect their training (73%). Residents in surgical specialties and in advanced stages of training were significantly less likely to view DHRs favorably. Most respondents believed fatigue contributes to errors (89%) and DHRs reduce both fatigue (80%) and performance of clinical duties while fatigued (74%). A minority of respondents (37%) believed that DHRs decrease medical errors. This finding may reflect beliefs that handovers contribute more to errors than fatigue (41%). Negative perceived effects included diminished patient familiarity and continuity of care (62%) and diminished clinical educational experiences for residents (41%). A majority of residents reported satisfaction with the 2011 DHRs, although satisfaction was significantly less among residents in surgical specialties and those in advanced stages of training.
Leafloor, Cameron W; Lochnan, Heather A; Code, Catherine; Keely, Erin J; Rothwell, Deanna M; Forster, Alan J; Huang, Allen R
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. 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. 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. 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/other activities from 21.5% to 17.1%. There was a paucity of time-motion data. There was great variability in the operational definitions of task categories reported in the studies. Implementation of the ACGME duty hour standards did not have a significant effect on the percentage of time spent in particular tasks. There are conflicting reports on how duty hour changes have affected patient safety. A low proportion of time spent in educational activities deserves further study and may point to a review of the
Lesko, Sarah; Hughes, Lauren; Fitch, Wes; Pauwels, Judith
Electronic health records (EHRs), resident duty hour restrictions, and Patient-centered Medical Home (PCMH) innovations have all impacted the clinical practices of residency programs over the past decade. The University of Washington Family Medicine Network (UWFMN) residencies have collaborated for 10 years in collecting and comparing data regarding the productivity and operations of their training programs to identify the program-level effects of such changes. Based on five survey results from 2000 to 2010, this study examines changes in faculty and resident productivity and staffing models of UWFMN residency training clinics using a standardized methodology, specifically describing the productivity impact of EHR changes and duty hour restrictions and the implementation of the PCMH by residencies. Data were systematically collected via standardized questionnaire, evaluated for quality, clarified, and then analyzed. Resident productivity decreased over the 10-year interval, with resident total yearly patient visits down 17.2%. Core family medicine faculty productivity was highly variable among programs, and nonphysician provider visits increased. Faculty part-time status increased. Front office, medical assistant, and nursing staffing grew significantly, but other administrative staff decreased, resulting in minimal change in total non-provider staffing. A majority of programs engaged in PCMH initiatives in 2010 and had implemented an EHR. Physician productivity in UWFMN residency programs decreased for all resident physicians from 2000 to 2010, likely due to a combination of decreased resident duty hours and other clinical practice changes. Productivity trends have implications for the structure and training requirements for family medicine residency programs.
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
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
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.
Pastores, Stephen M; O'Connor, Michael F; Kleinpell, Ruth M; Napolitano, Lena; Ward, Nicholas; Bailey, Heatherlee; Mollenkopf, Fred P; Coopersmith, Craig M
The Accreditation Council for Graduate Medical Education recently released new standards for supervision and duty hours for residency programs. These new standards, which will affect over 100,000 residents, take effect in July 2011. In response to these new guidelines, the Society of Critical Care Medicine convened a task force to develop a white paper on the impact of changes in resident duty hours on the critical care workforce and staffing of intensive care units. A multidisciplinary group of professionals with expertise in critical care education and clinical practice. Relevant medical literature was accessed through a systematic MEDLINE search and by requesting references from all task force members. Material published by the Accreditation Council for Graduate Medical Education and other specialty organizations was also reviewed. Collaboratively and iteratively, the task force corresponded by electronic mail and held several conference calls to finalize this report. The new rules mandate that all first-year residents work no more than 16 hrs continuously, preserving the 80-hr limit on the resident workweek and 10-hr period between duty periods. More senior trainees may work a maximum of 24 hrs continuously, with an additional 4 hrs permitted for handoffs. Strategic napping is strongly suggested for trainees working longer shifts. Compliance with the new Accreditation Council for Graduate Medical Education duty-hour standards will compel workflow restructuring in intensive care units, which depend on residents to provide a substantial portion of care. Potential solutions include expanded utilization of nurse practitioners and physician assistants, telemedicine, offering critical care training positions to emergency medicine residents, and partnerships with hospitalists. Additional research will be necessary to evaluate the impact of the new standards on patient safety, continuity of care, resident learning, and staffing in the intensive care unit.
Gender-Based Differences in Surgical Residents' Perceptions of Patient Safety, Continuity of Care, and Well-Being: An Analysis from the Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST) Trial.
Ban, Kristen A; Chung, Jeanette W; Matulewicz, Richard S; Kelz, Rachel R; Shea, Judy A; Dahlke, Allison R; Quinn, Christopher M; Yang, Anthony D; Bilimoria, Karl Y
Little is known about gender differences in residency training experiences and whether duty hour policies affect these differences. Using data from the Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST) trial, we examined gender differences in surgical resident perceptions of patient safety, education, health and well-being, and job satisfaction, and assessed whether duty hour policies affected gender differences. We compared proportions of male and female residents expressing dissatisfaction or perceiving a negative effect of duty hours on aspects of residency training (ie patient safety, resident education, well-being, job satisfaction) overall and by PGY. Logistic regression models with robust clustered SEs were used to test for significant gender differences and interaction effects of duty hour policies on gender differences. Female PGY2 to 3 residents were more likely than males to be dissatisfied with patient safety (odds ratio [OR] = 2.50; 95% CI, 1.29-4.84) and to perceive a negative effect of duty hours on most health and well-being outcomes (OR = 1.51-2.10; all p gender differences in career dissatisfaction among interns (p = 0.028), but widened gender differences in negative perceptions of duty hours on patient safety (p job satisfaction (p Gender differences exist in perceptions of surgical residency. These differences vary across cohorts and can be influenced by duty hour policies. Copyright © 2016 American College of Surgeons. Published by Elsevier Inc. All rights reserved.
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.
Lawrence, Rachel; Kantrowitz-Gordon, Ira; Landis, Andrea
A growing body of literature has emerged describing the risks of extended-duty shifts and sleep deprivation. Worldwide, midwifery organizations have not adopted standards for practitioner or student duty shifts. This project reviews the literature related to extended-duty shifts in an effort to develop evidence-based recommendations for student nurse-midwives/student midwives (SNMs/SMs). A comprehensive literature search was conducted through electronic databases, major journals, and reference lists published in English since January 2001. Primary research studies evaluating sleep deprivation and shift duration were included. Studies that did not include the target population (shift workers) and those that formed conclusions related to extended-duty shifts greater than 30 hours were excluded. In addition, an extensive worldwide review of duty-hour recommendations from more than 300 health care organizations was conducted. A total of 40 studies met the inclusion criteria. Extended-duty shifts (those greater than 12 hours) increased the risk for cognitive and physical functional errors, safety concerns, and decreased quality of life from sleep deprivation. Cognitive function errors included attention lapses, visual tracking errors, decreased mentation and immediate recall, and decreased learning capacity. Physical errors included decreased motor skills and slowed reaction times in clinical simulations. These deficits led to an increased risk of motor vehicle accidents, needle sticks, and performance equivalent to unsafe blood alcohol concentrations. An overall decrease in quality of life and job satisfaction was linked to extended-duty shifts. Seven organizations for medical residents or advanced practice nurses have developed policy statements on duty shifts, with extended-duty shift limitations between 12 and 24 hours. The risks associated with extended-duty shifts may inhibit the development of SNMs/SMs into competent practitioners and place patients at risk. It
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.
Full Text Available Residents’ work overload is a rising issue in Taiwan. Duty hours of the residents in the United States have been limited by the Accreditation Council for Graduate Medical Education Common Program Requirements since 2003; similar standards were not implemented in Taiwan until 2013. Taiwanese duty hour standards are the work hour limits adopted as part of the required teaching hospital accreditation status. In January 2015, the Ministry of Health and Welfare conducted a national survey for all house officers in Taiwan. We collected data including those on demographics and perceptions of residents regarding duty hour limits. Most respondents reported positive perceptions of the duty hour standards. They felt that these limits will improve resident education, quality of life, and patient safety. The strong incentive to follow the regulations (through teaching hospital accreditation could help protect residents (and patients from unsafe working conditions. However, further studies on the influence of shortened duty hour on professional development are necessary for future improvement.
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
McInnes, Colin W; Vorstenbosch, Joshua; Chard, Ryan; Logsetty, Sarvesh; Buchel, Edward W; Islur, Avinash
The impact of resident work hour restrictions on training and patient care remains a highly controversial topic, and to date, there lacks a formal assessment as it pertains to Canadian plastic surgery residents. To characterize the work hour profile of Canadian plastic surgery residents and assess the perspectives of residents and program directors regarding work hour restrictions related to surgical competency, resident wellness, and patient safety. An anonymous online survey developed by the authors was sent to all Canadian plastic surgery residents and program directors. Basic summary statistics were calculated. Eighty (53%) residents and 10 (77%) program directors responded. Residents reported working an average of 73 hours in hospital per week with 8 call shifts per month and sleep 4.7 hours/night while on call. Most residents (88%) reported averaging 0 post-call days off per month and 61% will work post-call without any sleep. The majority want the option of working post-call (63%) and oppose an 80-hour weekly maximum (77%). Surgical and medical errors attributed to post-call fatigue were self-reported by 26% and 49% of residents, respectively. Residents and program directors expressed concern about the ability to master surgical skills without working post-call. The majority of respondents oppose duty hour restrictions. The reason is likely multifactorial, including the desire of residents to meet perceived expectations and to master their surgical skills while supervised. If duty hour restrictions are aggressively implemented, many respondents feel that an increased duration of training may be necessary.
Arora, Vineet M; Prochaska, Micah T; Farnan, Jeanne M; Meltzer, David O
Although direct patient care is necessary for experiential learning during residency, inpatient perceptions of the roles of resident and attending physicians in their care may have changed with residency duty hours. We aimed to assess if patients' perceptions of who is most involved in their care changed with residency duty hours. This was a prospective observational study over 12 years at a single institution. Participants were 22,408 inpatients admitted to the general medicine teaching service from 2001 to 2013, who completed a 1-month follow-up phone interview. Percentage of inpatients who reported an attending, resident, or intern as most involved in their care by duty hour period (pre-2003, post-2003-pre-2011, post-2011). With successive duty hour limits, the percentage of patients who reported the attending as most involved in their care increased (pre-2003 20 %, post-2003-pre-2011 29 %, post-2011 37 %, p importance of experiential learning to the formation of clinical judgment for independent practice, further study on the implications of these trends for resident education and patient safety is warranted.
Bilimoria, Karl Y; Chung, Jeanette W; Hedges, Larry V; Dahlke, Allison R; Love, Remi; Cohen, Mark E; Hoyt, David B; Yang, Anthony D; Tarpley, John L; Mellinger, John D; Mahvi, David M; Kelz, Rachel R; Ko, Clifford Y; Odell, David D; Stulberg, Jonah J; Lewis, Frank R
Concerns persist regarding the effect of current surgical resident duty-hour policies on patient outcomes, resident education, and resident well-being. We conducted a national, cluster-randomized, pragmatic, noninferiority trial involving 117 general surgery residency programs in the United States (2014-2015 academic year). Programs were randomly assigned to current Accreditation Council for Graduate Medical Education (ACGME) duty-hour policies (standard-policy group) or more flexible policies that waived rules on maximum shift lengths and time off between shifts (flexible-policy group). Outcomes included the 30-day rate of postoperative death or serious complications (primary outcome), other postoperative complications, and resident perceptions and satisfaction regarding their well-being, education, and patient care. In an analysis of data from 138,691 patients, flexible, less-restrictive duty-hour policies were not associated with an increased rate of death or serious complications (9.1% in the flexible-policy group and 9.0% in the standard-policy group, P=0.92; unadjusted odds ratio for the flexible-policy group, 0.96; 92% confidence interval, 0.87 to 1.06; P=0.44; noninferiority criteria satisfied) or of any secondary postoperative outcomes studied. Among 4330 residents, those in programs assigned to flexible policies did not report significantly greater dissatisfaction with overall education quality (11.0% in the flexible-policy group and 10.7% in the standard-policy group, P=0.86) or well-being (14.9% and 12.0%, respectively; P=0.10). Residents under flexible policies were less likely than those under standard policies to perceive negative effects of duty-hour policies on multiple aspects of patient safety, continuity of care, professionalism, and resident education but were more likely to perceive negative effects on personal activities. There were no significant differences between study groups in resident-reported perception of the effect of fatigue on
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 …
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.
Hutter, Matthew M.; Kellogg, Katherine C.; Ferguson, Charles M.; Abbott, William M.; Warshaw, Andrew L.
Objective: To assess the impact of the 80-hour resident workweek restrictions on surgical residents and attending surgeons. Summary Background Data: The ACGME mandated resident duty hour restrictions have required a major workforce restructuring. The impact of these changes needs to be critically evaluated for both the resident and attending surgeons, specifically with regards to the impact on motivation, job satisfaction, the quality of surgeon training, the quality of the surgeon's life, and the quality of patient care. Methods: Four prospective studies were performed at a single academic surgical program with data collected both before the necessary workforce restructuring and 1 year after, including: 1) time cards to assess changes in components of daily activity; 2) Web-based surveys using validated instruments to assess burnout and motivation to work; 3) structured, taped, one-on-one interviews with an external PhD investigator; and 4) statistical analyses of objective, quantitative data. Results: After the work-hour changes, surgical residents have decreased “burnout” scores, with significantly less “emotional exhaustion” (Maslach Burnout Inventory: 29.1 “high” vs. 23.1 “medium,” P = 0.02). Residents have better quality of life both in and out of the hospital. They felt they got more sleep, have a lighter workload, and have increased motivation to work (Herzberg Motivation Dimensions). We found no measurable, statistically significant difference in the quality of patient care (NSQIP data). Resident training and education objectively were not statistically diminished (ACGME case logs, ABSITE scores). Attending surgeons perceived that their quality of their life inside and outside of the hospital was “somewhat worse” because of the work-hour changes, as they had anticipated. Many concerns were identified with regards to the professional development of future surgeons, including a change toward a shift-worker mentality that is not patient
Mackowiak, Philip A; Billings, Frederic T; Wasserman, Steven S
Confederate general "Stonewall" Jackson has been called "one of the greatest military geniuses the world ever saw." However, on critical review of his command decisions during the course of 12 of the 20 battles he fought during the American Civil War, historians have rated his performance as poor. In this investigation, the authors examined the effect of sleep deprivation on Jackson's battle decisions in light of experimental data driving current calls for limiting the duty hours of physicians.
Day, T Eugene; Napoli, Joseph T; Kuo, Paul C
The resident 80-hour work week requires that programs now schedule duty hours. Typically, scheduling is performed in an empirical "trial-and-error" fashion. However, this is a classic "scheduling" problem from the field of operations research (OR). It is similar to scheduling issues that airlines must face with pilots and planes routing through various airports at various times. The authors hypothesized that an OR approach using iterative computer algorithms could provide a rational scheduling solution. Institution-specific constraints of the residency problem were formulated. A total of 56 residents are rotating through 4 hospitals. Additional constraints were dictated by the Residency Review Committee (RRC) rules or the specific surgical service. For example, at Hospital 1, during the weekday hours between 6 am and 6 pm, there will be a PGY4 or PGY5 and a PGY2 or PGY3 on-duty to cover Service "A." A series of equations and logic statements was generated to satisfy all constraints and requirements. These were restated in the Optimization Programming Language used by the ILOG software suite for solving mixed integer programming problems. An integer programming solution was generated to this resource-constrained assignment problem. A total of 30,900 variables and 12,443 constraints were required. A total of man-hours of programming were used; computer run-time was 25.9 hours. A weekly schedule was generated for each resident that satisfied the RRC regulations while fulfilling all stated surgical service requirements. Each required between 64 and 80 weekly resident duty hours. The authors conclude that OR is a viable approach to schedule resident work hours. This technique is sufficiently robust to accommodate changes in resident numbers, service requirements, and service and hospital rotations.
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.
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 ...
Choi, Dongseok; Dickey, Jamie; Wessel, Kristen; Girard, Donald E
To assess the impact of work hours' limitations required by the Accreditation Council for Graduate Medical Education (ACGME) on residents' career satisfaction, emotions and attitudes. A validated survey instrument was used to assess residents' levels of career satisfaction, emotions and attitudes before and after the ACGME duty hour requirements were implemented. The "pre" implementation survey was distributed in December 2002 and the "post" implementation one in December 2004. Only the latter included work-hour related questions. The response rates were 56% for the 2002 and 72% for the 2004 surveys respectively. Although career satisfaction remained unchanged, numerous changes occurred in both emotions and attitudes. Compared to those residents who did not violate work-hour requirements, those who did were significantly more negative in attitudes and emotions. With the implementation of the ACGME work hour limitations, the training experience became more negative for those residents who violated the work hour limits and had a small positive impact on those who did not violate them. Graduate medical education leaders must innovate to make the experiences for selected residents improved and still maintain compliance with the work hour requirements.
Restrictions in residents' work hours have been in place in Canada for roughly a decade, having been negotiated rather than imposed. The changes in residents' schedules that resulted are roughly equivalent to the limitation of 80 duty hours per week in the United States. When work-hours restrictions began, surgery faculty were worried that residents' experience would be compromised. But these fears have not materialized. Why? The author maintains there are many reasons. (1) Most surgical procedures are now faster, and lengthy inpatient care has diminished, all of which saves time. (2) Formerly difficult or risky procedures are now performed more frequently and safely, which increases residents' education about difficult conditions. (3) A variety of resources (e.g., skills-transfer courses, surgical simulators, etc.) are now available for residents to learn and evolve surgical techniques, and residents take advantage of these resources, being highly motivated to learn the best in the time available to them. (4) There have been positive changes in residents' education that have helped them become more efficient learners than before, with improved resources and skills for faster access to information. The author maintains that in his present surgery residency program, the residents still work extremely hard but are more protected from the unending demands for patient care. They have more time for orderly study and greater opportunities to develop skills other than technical ones. They are in a happier work setting, which the author strongly believes facilitates improved patient care.
Joseph, Joshua W; Henning, Daniel J; Strouse, Connie S; Chiu, David T; Nathanson, Larry A; Sanchez, Leon D
Resident productivity, defined as new patients per hour, carries important implications for emergency department operations. In high-volume academic centers, essential staffing decisions can be made on the assumption that residents see patients at a static rate. However, it is unclear whether this model mirrors reality; previous studies have not rigorously examined whether productivity changes over time. We examine residents' productivity across shifts to determine whether it remained consistent. This was a retrospective cohort study conducted in an urban academic hospital with a 3-year emergency medicine training program in which residents acquire patients ad libitum throughout their shift. Time stamps of all patient encounters were automatically logged. A linear mixed model was constructed to predict productivity per shift hour. A total of 14,364 8- and 9-hour shifts were worked by 75 residents between July 1, 2010, and June 20, 2015. This comprised 6,127 (42.7%) postgraduate year (PGY) 1 shifts, 7,236 (50.4%) PGY-2 shifts, and 998 (6.9%) PGY-3 nonsupervisory shifts (Table 1). Overall, residents treated a mean of 10.1 patients per shift (SD 3.2), with most patients at Emergency Severity Index level 3 or more acute (93.8%). In the initial hour, residents treated a mean of 2.14 patients (SD 1.2), and every subsequent hour was associated with a significant decrease, with the largest in the second, third, and final hours. Emergency medicine resident productivity during a single shift follows a reliable pattern that decreases significantly hourly, a pattern preserved across PGY years and types of shifts. This suggests that resident productivity is a dynamic process, which should be considered in staffing decisions and studied further. Copyright © 2016 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.
Background: Surgical training has undergone major changes worldwide, especially with regard to work hour regulations. Very little is known regarding the situation in South Africa, and how it compares with other countries. Method: We conducted a retrospective review of the hours worked by surgical residents in a major ...
Freiburg, Carter; James, Ted; Ashikaga, Takamura; Moalem, Jacob; Cherr, Greg
The introduction of duty-hour restrictions has impacted surgical training. Several strategies were introduced by training programs in response to these restrictions. The purpose of this study was to assess the various strategies employed by residency programs to comply with work-hour restrictions with respect to the impact on the quality of surgical education. A national survey was developed and distributed to resident members of the Resident and Associate Society of the American College of Surgeons in all accredited residency programs across North America. Questions in the survey addressed 10 separate accommodation strategies used by training programs to adhere to resident work-hour restrictions. Resident respondents completed a 5-point Likert scale rating each strategy according to its impact on surgical education (detrimental, not very helpful, neutral, somewhat helpful, and very helpful). A total of 599 (9.7%) responses were received from 6186 members of the Resident Associate Society. The use of health information technology (IT), nurse practitioners, and physician assistants were most highly rated. Hiring clinical fellows, establishing nonteaching services, and shift-work scheduling were the three most poorly rated accommodations to work-hour restrictions with respect to resident education. Hospital IT and nonphysician care providers were rated by residents to optimize surgical education in the current work-hour limitation environment. We infer that strategies which lead to increased efficiency and redistribution of resident workload allow surgical trainees to spend more time on activities perceived to have higher educational value. Copyright © 2011 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.
Dumont, Travis M; Tranmer, Bruce I; Horgan, Michael A; Rughani, Anand I
In 2003 the Accreditation Council for Graduate Medical Education implemented duty-hour restrictions for residents, with an unclear impact on patient care. The authors hypothesize that implementation of duty-hour restrictions is not associated with decreased morbidity for neurosurgical patients. This hypothesis was tested with the Nationwide Inpatient Sample to examine inpatient complications associated with a common elective procedure, craniotomy for meningioma. The Nationwide Inpatient Sample was queried for all patients admitted for elective craniotomy for meningioma from 1998 to 2008, excluding the year 2003. Each case was queried for common in-hospital postoperative complications. The complication rate was compared for 5-year epochs at teaching and nonteaching hospitals before (1998-2002) and after (2004-2008) the adoption of the Accreditation Council for Graduate Medical Education work-hour restriction. Multivariate analysis was performed to control for the effects of age and medical comorbidities. We identified 21177 patients who met inclusion criteria. We identified an effect of age, preexisting medical comorbidity, and timing of surgery on postoperative complication rates. At teaching hospitals, the complication rate increased from 14% to 16% (P < .001). In contrast, this increase was not mirrored at nonteaching hospitals, which saw a nearly constant postoperative complication rate of 15% from 1998 to 2002 and 15% for the years 2004 to 2008 (P = .979). This effect remained significant in a multivariate analysis including age and existing comorbidities as covariates (P = .016). In patients undergoing craniotomy for meningioma, postoperative complication rates increased at teaching hospitals, but not at nonteaching hospitals over the 5-year epochs before and after 2003.
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
In July 2003, the Accreditation Council for Graduate Medical Education (ACGME) instituted new resident work hour mandates, which are being shown to improve resident well-being and patient safety. However, there are limited data on the impact these new mandates may have on educational activities. To assess the impact on educational activities of a day float system created to meet ACGME work hour mandates. The inpatient ward coverage was changed by adding a day float team responsible for new patient admissions in the morning, with the on-call teams starting later and being responsible for new patient admissions thereafter. I surveyed the residents to assess the impact of this new system on educational activities-resident autonomy, attending teaching, conference attendance, resident teaching, self-directed learning, and ability to complete patient care responsibilities. There was no adverse effect of the day float system on educational activities. House staff reported increased autonomy, enhanced teaching from attending physicians, and improved ability to complete patient care responsibilities. Additionally, house staff demonstrated improved compliance with the ACGME mandates. The implementation of a novel day float system for the inpatient medicine ward service improved compliance with ACGME work duty requirements and did not adversely impact educational activities of the residency training program.
Vadera, Sumeet; Griffith, Sandra D; Rosenbaum, Benjamin P; Chan, Alvin Y; Thompson, Nicolas R; Kshettry, Varun R; Kelly, Michael L; Weil, Robert J; Bingaman, William; Jehi, Lara
The Accreditation Council for Graduate Medical Education (ACGME) established duty-hour regulations for accredited residency programs on July 1, 2003. It is unclear what changes occurred in the national incidence of medication errors in surgical patients before and after ACGME regulations. Patient and hospital characteristics for pre- and post-duty-hour reform were evaluated, comparing teaching and nonteaching hospitals. A difference-in-differences study design was used to assess the association between duty-hour reform and medication errors in teaching hospitals. We used the Nationwide Inpatient Sample database, which consists of approximately annual 20% stratified sample of all the United States nonfederal hospital inpatient admissions. A query of the database, including 4 years before (2000-2003) and 8 years after (2003-2011) the ACGME duty-hour reform of July 2003, was performed to extract surgical inpatient hospitalizations (N = 13,933,326). The years 2003 and 2004 were discarded in the analysis to allow for a wash-out period during duty-hour reform (though we still provide medication error rates). The Nationwide Inpatient Sample estimated the total national surgical inpatients (N = 135,092,013) in nonfederal hospitals during these time periods with 68,736,863 patients in teaching hospitals and 66,355,150 in nonteaching hospitals. Shortly after duty-hour reform (2004 and 2006), teaching hospitals had a statistically significant increase in rate of medication error (p = 0.019 and 0.006, respectively) when compared with nonteaching hospitals even after accounting for trends across all hospitals during this period. After 2007, no further statistically significant difference was noted. After ACGME duty-hour reform, medication error rates increased in teaching hospitals, which diminished over time. This decrease in errors may be related to changes in training program structure to accommodate duty-hour reform. Copyright © 2015 Association of Program Directors in
Volpp, Kevin G.; Shea, Judy A.; Small, Dylan S.; Basner, Mathias; Zhu, Jingsan; Norton, Laurie; Ecker, Adrian; Novak, Cristina; Bellini, Lisa M.; Dine, C. Jessica; Mollicone, Daniel J.; Dinges, David F.
Context A 2009 Institute of Medicine report recommended protected sleep periods for medicine trainees on extended overnight shifts, a position reinforced by new Accreditation Council for Graduate Medical Education requirements. Objective To evaluate the feasibility and consequences of protected sleep periods during extended duty. Design, Setting, and Participants Randomized controlled trial conducted at the Philadelphia VA Medical Center medical service and Oncology Unit of the Hospital of the University of Pennsylvania (2009–2010). Of the 106 interns and senior medical students who consented, 3 were not scheduled on any study rotations. Among the others, 44 worked at the VA center, 16 at the university hospital, and 43 at both. Intervention Twelve 4-week blocks were randomly assigned to either a standard intern schedule (extended duty overnight shifts of up to 30 hours; equivalent to 1200 overnight intern shifts at each site), or a protected sleep period (protected time from 12:30 AM to 5:30 AM with handover of work cell phone; equivalent to 1200 overnight intern shifts at each site). Participants were asked to wear wrist actigraphs and complete sleep diaries. Main Outcome Measures Primary outcome was hours slept during the protected period on extended duty overnight shifts. Secondary outcome measures included hours slept during a 24-hour period (noon to noon) by day of call cycle and Karolinska sleepiness scale. Results For 98.3% of on-call nights, cell phones were signed out as designed. At the VA center, participants with protected sleep had a mean 2.86 hours (95% CI, 2.57–3.10 hours) of sleep vs 1.98 hours (95% CI, 1.68–2.28 hours) among those who did not have protected hours of sleep (P < .001). At the university hospital, participants with protected sleep had a mean 3.04 hours (95% CI, 2.77–3.45 hours) of sleep vs 2.04 hours (95% CI, 1.79–2.24) among those who did not have protected sleep (P <.001). Participants with protected sleep were
Langelotz, C; Koplin, G; Pascher, A; Lohmann, R; Köhler, A; Pratschke, J; Haase, O
Background Between the conflicting requirements of clinic organisation, the European Working Time Directive, patient safety, an increasing lack of junior staff, and competitiveness, the development of ideal duty hour models is vital to ensure maximum quality of care within the legal requirements. To achieve this, it is useful to evaluate the actual effects of duty hour models on staff satisfaction. Materials and Methods After the traditional 24-hour duty shift was given up in a surgical maximum care centre in 2007, an 18-hour duty shift was implemented, followed by a 12-hour shift in 2008, to improve handovers and reduce loss of information. The effects on work organisation, quality of life and salary were analysed in an anonymous survey in 2008. The staff survey was repeated in 2014. Results With a response rate of 95% of questionnaires in 2008 and a 93% response rate in 2014, the 12-hour duty model received negative ratings due to its high duty frequency and subsequent social strain. Also the physical strain and chronic tiredness were rated as most severe in the 12-hour rota. The 18-hour duty shift was the model of choice amongst staff. The 24-hour duty model was rated as the best compromise between the requirements of work organisation and staff satisfaction, and therefore this duty model was adapted accordingly in 2015. Conclusion The essential basis of a surgical department is a duty hour model suited to the requirements of work organisation, the Working Time Directive and the needs of the surgical staff. A 12-hour duty model can be ideal for work organisation, but only if augmented with an adequate number of staff members, the implementation of this model is possible without the frequency of 12-hour shifts being too high associated with strain on surgical staff and a perceived deterioration of quality of life. A staff survey should be performed on a regular basis to assess the actual effects of duty hour models and enable further optimisation. The much
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.
Defense Language Inst., Washington, DC.
This military intelligence unit refresher course in Japanese is designed for 210 hours of audiolingual instruction. The materials, prepared by the Defense Language Institute, are intended for students with considerable intensive training in spoken and written Japanese who are preparing for a military language assignment. [Not available in hard…
Wang, Man-Ling; Lin, Pei-Lin; Huang, Chi-Hsiang; Huang, Hui-Hsun
In residency programs, it is well known that autonomic regulation is influenced by night duty due to workload stress and sleep deprivation. A less investigated question is the impact on the autonomic nervous system of residents before or when anticipating a night duty shift. In this study, heart rate variability (HRV) was evaluated as a measure of autonomic nervous system regulation. Eight residents in the Department of Anesthesiology were recruited, and 5 minutes of electrocardiography were recorded under 3 different conditions: (1) the morning of a regular work day (baseline); (2) the morning before a night duty shift (anticipating the night duty); and (3) the morning after a night duty shift. HRV parameters in the time and frequency domains were calculated. Repeated measures analysis of variance was performed to compare the HRV parameters among the 3 conditions. There was a significant decrease of parasympathetic-related HRV measurements (high-frequency power and root mean square of the standard deviation of R-R intervals) in the morning before night duty compared with the regular work day. The mean difference of high-frequency power between the 2 groups was 80.2 ms (95% confidence interval, 14.5-146) and that of root mean square of the standard deviation of R-R intervals was 26 milliseconds (95% confidence interval, 7.2-44.8), with P = .016 and .007, respectively. These results suggest that the decrease of parasympathetic activity is associated with stress related to the condition of anticipating the night duty work. On the other hand, the HRV parameters in the morning after duty were not different from the regular workday. The stress of anticipating the night duty work may affect regulation of the autonomic nervous system, mainly manifested as a decrease in parasympathetic activity. The effect of this change on the health of medical personnel deserves our concern.
Blum, Alexander B; Raiszadeh, Farbod; Shea, Sandra; Mermin, David; Lurie, Peter; Landrigan, Christopher P; Czeisler, Charles A
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. 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. 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 > or =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. 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.
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.
Volpp, Kevin G; Shea, Judy A; Small, Dylan S; Basner, Mathias; Zhu, Jingsan; Norton, Laurie; Ecker, Adrian; Novak, Cristina; Bellini, Lisa M; Dine, C Jessica; Mollicone, Daniel J; Dinges, David F
A 2009 Institute of Medicine report recommended protected sleep periods for medicine trainees on extended overnight shifts, a position reinforced by new Accreditation Council for Graduate Medical Education requirements. To evaluate the feasibility and consequences of protected sleep periods during extended duty. Randomized controlled trial conducted at the Philadelphia VA Medical Center medical service and Oncology Unit of the Hospital of the University of Pennsylvania (2009-2010). Of the 106 interns and senior medical students who consented, 3 were not scheduled on any study rotations. Among the others, 44 worked at the VA center, 16 at the university hospital, and 43 at both. Twelve 4-week blocks were randomly assigned to either a standard intern schedule (extended duty overnight shifts of up to 30 hours; equivalent to 1200 overnight intern shifts at each site), or a protected sleep period (protected time from 12:30 AM to 5:30 AM with handover of work cell phone; equivalent to 1200 overnight intern shifts at each site). Participants were asked to wear wrist actigraphs and complete sleep diaries. Primary outcome was hours slept during the protected period on extended duty overnight shifts. Secondary outcome measures included hours slept during a 24-hour period (noon to noon) by day of call cycle and Karolinska sleepiness scale. For 98.3% of on-call nights, cell phones were signed out as designed. At the VA center, participants with protected sleep had a mean 2.86 hours (95% CI, 2.57-3.10 hours) of sleep vs 1.98 hours (95% CI, 1.68-2.28 hours) among those who did not have protected hours of sleep (P < .001). At the university hospital, participants with protected sleep had a mean 3.04 hours (95% CI, 2.77-3.45 hours) of sleep vs 2.04 hours (95% CI, 1.79-2.24) among those who did not have protected sleep (P < .001). Participants with protected sleep were significantly less likely to have call nights with no sleep: 5.8% (95% CI, 3.0%-8.5%) vs 18.6% (95% CI, 13
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.
... of sleeping time and lunch periods constitute hours worked. (Armour v. Wantock, 323 U.S. 126 (1944... v. Day & Zimmerman, 157 F. 2d 736 (C.A. 8, 1946); McLaughlin v. Todd & Brown, Inc., 7 W.H. Cases...
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.
Mansukhani, Meghna P; Kolla, Bhanu Prakash; Surani, Salim; Varon, Joseph; Ramar, Kannan
Extended work hours, interrupted sleep, and shift work are integral parts of medical training among all specialties. The need for 24-hour patient care coverage and economic factors have resulted in prolonged work hours for resident physicians. This has traditionally been thought to enhance medical educational experience. These long and erratic work hours lead to acute and chronic sleep deprivation and poor sleep quality, resulting in numerous adverse consequences. Impairments may occur in several domains, including attention, cognition, motor skills, and mood. Resident performance, professionalism, safety, and well-being are affected by sleep deprivation, causing potentially adverse implications for patient care. Studies have shown adverse health consequences, motor vehicle accidents, increased alcohol and medication use, and serious medical errors to occur in association with both sleep deprivation and shift work. Resident work hour limitations have been mandated by the Accreditation Council for Graduate Medical Education in response to patient safety concerns. Studies evaluating the impact of these regulations on resident physicians have generated conflicting reports on patient outcomes, demonstrating only a modest increase in sleep duration for resident physicians, along with negative perceptions regarding their education. This literature review summarizes research on the effects of sleep deprivation and shift work, and examines current literature on the impact of recent work hour limitations on resident physicians and patient-related outcomes.
Marwaha, Jayson S; Drolet, Brian C; Maddox, Suma S; Adams, Charles A
In 2011, the ACGME limited duty hours for residents. Although studies evaluating the 2011 policy have not shown improvements in general measures of morbidity or mortality, these outcomes might not reflect changes in specialty-specific practice patterns and secondary quality measures. All trauma admissions from July 2009 through June 2013 at an academic Level I trauma center were evaluated for 5 primary outcomes (eg, mortality and length of stay), and 10 secondary quality measures and practice patterns (eg, operating room [OR] visits). All variables were compared before and after the reform (July 1, 2011). Piecewise regression was used to study temporal trends in quality. There were 11,740 admissions studied. The reform was not strongly associated with changes in any primary outcomes except length of stay (7.98 to 7.36 days; p = 0.01). However, many secondary quality metrics changed. The total number of OR and bedside procedures per admission (6.72 to 7.34; p oversight, might have insulated major outcomes from change. Our findings show that some less-commonly studied quality metrics related to costs of care changed after the 2011 reform at our institution. Copyright © 2016 American College of Surgeons. Published by Elsevier Inc. All rights reserved.
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
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...
... motor vehicle (CMV) driver to record meal and other routine stops made during a work shift as off-duty... Commercial Motor Vehicle (CMV) driver to record meal and other routine stops made during a tour of duty as... Commercial Motor Vehicle Drivers Regulatory Guidance for 49 CFR 395.2, Definitions Question 2: What...
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
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
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
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 dementiacaregivers. This book describes a study in which six intervention wards received a training program ‘snoezelen for caregivers’. They were compared with six control wards providing 'usual care'...
Taylor, Taryn S; Teunissen, Pim W; Dornan, Tim; Lingard, Lorelei
Although one proposed solution to the problem of fatigued medical trainees is the implementation of work hours regulations, concerns about the effectiveness of these regulations are growing. Canada remains one of the few Western jurisdictions without legislated regulation. Recent research suggests that fatigue is a complex social construct, rather than simply a lack of sleep; thus, the authors explored how regulations and fatigue are understood in countries with established work hours frameworks to better inform other jurisdictions looking to address trainee fatigue. Using constructivist grounded theory methodology, the authors conducted individual, semistructured interviews in 2015-2016 with 13 postgraduate medical trainees from four European countries with established work hours regulations. Data collection and analysis proceeded iteratively, and the authors used a constant comparative approach to analysis. Trainees reported that they were commonly fatigued and that they violated the work hours restrictions for various reasons, including educational pursuits. Although they understood the regulations were legislated specifically to ensure safe patient care and optimize trainee well-being, they also described implicit meanings (e.g., monitoring for trainee efficiency) and unintended consequences (e.g., losing a sense of vocation). Work hours regulations carry multiple, conflicting meanings for trainees that are captured by three predominant rhetorics: the rhetoric of patient safety, of well-being, and of efficiency. Tensions within each of those rhetorics reveal that managing fatigue within clinical training environments is complex. These findings suggest that straightforward solutions are unlikely to solve the problem of fatigue, assure patient safety, and improve trainee well-being.
Businger, Adrian P; Laffer, Urban; Kaderli, Reto
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 restrict...
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.
Bellini, Lisa M; Shea, Judy A
Nurse practitioners (NPs) are assuming larger roles in many residency programs as a result of work hour reform, which is creating the potential for collaboration with interns and residents. To assess housestaff perceptions of NPs. We used a 17-item survey before and after the implementation of a collaborative care model in a university-based medicine residency. The majority of residents held favorable attitudes about NPs before the introduction of the collaborative care model. After 1 year, more interns and residents appreciated NPs' clinical judgment (effect size [ES] = .26, p =.02), thought they should be able to order laboratory tests (ES = .23, p = .05) and perform basic procedures (ES = .67, p collaborative care can be an unintended consequence of work hour reform. Educators are encouraged to think about how changes in the curriculum structure can provide opportunities for positive collaborative care experiences.
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…
Smalley, Hannah K; Keskinocak, Pinar
At academic teaching hospitals around the country, the majority of clinical care is provided by resident physicians. During their training, medical residents often rotate through various hospitals and/or medical services to maximize their education. Depending on the size of the training program, manually constructing such a rotation schedule can be cumbersome and time consuming. Further, rules governing allowable duty hours for residents have grown more restrictive in recent years (ACGME 2011), making day-to-day shift scheduling of residents more difficult (Connors et al., J Thorac Cardiovasc Surg 137:710-713, 2009; McCoy et al., May Clin Proc 86(3):192, 2011; Willis et al., J Surg Edu 66(4):216-221, 2009). These rules limit lengths of duty periods, allowable duty hours in a week, and rest periods, to name a few. In this paper, we present two integer programming models (IPs) with the goals of (1) creating feasible assignments of residents to rotations over a one-year period, and (2) constructing night and weekend call-shift schedules for the individual rotations. These models capture various duty-hour rules and constraints, provide the ability to test multiple what-if scenarios, and largely automate the process of schedule generation, solving these scheduling problems more effectively and efficiently compared to manual methods. Applying our models on data from a surgical residency program, we highlight the infeasibilities created by increased duty-hour restrictions placed on residents in conjunction with current scheduling paradigms.
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
Ferrera, Marisa H; Beaman, Shawn T; Metro, David G; Handley, Linda J; Walker, James E
To determine the cost of replacing an anesthesiology resident with a certified registered nurse anesthetist (CRNA) for equal operating room (OR) work. Retrospective financial analysis. Academic anesthesiology department. Clinical anesthesia (CA)-1 through CA-3 residents. Cost of replacing anesthesiology residents with CRNAs for equal OR work was determined. The cost of replacing one anesthesiology resident with a CRNA for the same number of OR hours ranged from $9,940.32 to $43,300 per month ($106,241.68 to $432,937.50 per yr). Numbers varied depending on the CRNA pay scale and whether the calculations were based on the number of OR hours worked at our residency program or OR hours worked in a maximum duty hour model. A CRNA is paid substantially more per OR hour worked, at all pay levels, than an anesthesiology resident.
Talmon, Geoffrey A; Czarnecki, Donna K; Sayles, Harlan R
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 ex...
Arzalier-Daret, Ségolène; Buléon, Clément; Bocca, Marie-Laure; Denise, Pierre; Gérard, Jean-Louis; Hanouz, Jean-Luc
Sleep deprivation has been associated with an increased incidence of medical errors and can jeopardise patients' safety during medical crisis management. The aim of the study was to assess the effect of sleep deprivation on the management of simulated anaesthesia crisis by residents in anaesthesiology. A randomised, comparative, monocentric crossover study involving 48 residents in anaesthesia was performed on a high fidelity patient simulator. Each resident was evaluated in a sleep-deprived state (deprived group, after a night shift duty) and control state (control group, after a night of sleep). Performance was assessed through points obtained during crisis scenario 1 (oesophageal intubation followed by anaphylactic shock) and scenario 2 (anaesthesia-related bronchospasm followed by ventricular tachycardia). Sleep periods were recorded by actigraphy. Two independent observers assessed the performances. The primary endpoint of the study was the score obtained for each scenario. Resident's crisis management performance is associated with sleep deprivation (scenario 1: control=39 [33-42] points vs. deprived=26 [19-40] points, P=0.02; scenario 2: control=21 [17-24] vs. deprived=14 [12-19], P=0.01). The main errors observed were: error in drug administration and dose, delay in identification of hypotension, and missing communication with the surgical team about situation. The present study showed that sleep deprivation is associated with impairment of performance to manage crisis situations by residents in anaesthesia. Copyright © 2017 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.
Sterling, Lynn; McCaffrey, Carmen; Secter, Michael; Rich, Rebecca; Green, Jessica; Shirreff, Lindsay; Steele, Donna
The 2013 pan-Canadian consensus Report on Resident Duty Hours identified that traditional 24-hour duty periods pose risks to the well-being of residents and should be avoided. In anticipation of duty-hour restrictions, the Obstetrics and Gynaecology Residency Program at the University of Toronto developed and implemented a night float (NF) call model over a three-year span. Quarterly resident surveys have consistently shown that the NF system is preferred to traditional 24-hour call and has resulted in reduced fatigue and improved continuity of patient care. Through many iterations, the NF model achieved levels of resident morale, surgical experience, and impact on family relationships that are comparable to the 24-hour call system. We review here our process for developing an NF call model and the perceptions and experiences of residents, with the goal of providing insight for other residency programs that are considering or instituting NF call systems. Copyright © 2016 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.
Caldicott, Catherine V; Holsapple, James W
The medical literature is replete with articles about the Accreditation Council for Graduate Medical Education's 2003 resident duty hour restrictions. Most of these papers describe creative and thoughtful responses to the new system. However, others express concern that the "80-hour work week" could hamper continuity of care and educational activities. Nevertheless, if fatigue impairs resident learning and medical care quality, then work hour restrictions seem worthwhile. We add our voices to the critics' for additional reasons. Data support that fatigue occurs even with reasonable work schedules, and residents do not reliably use time off from work to rest. Regulated work schedules can interfere with adequate rehearsal of the physical and mental stamina required in certain specialties, yet patients have a right to expect their physicians to be trained in the particular demands of those specialties. Similarly, residents have a right to a realistic understanding of authentic clinical practice. Further, while self-sacrifice need not be routine, trainees should feel that occasional self-sacrifice is appropriate and acceptable for a physician. We reject uniform, arbitrary duty hour limits for all specialties. Rather, we propose that a subspecialty-based system can foster the development of the endurance, skills, and reasoning that patients and colleagues expect.
Lee, Soo-Hoon; Desai, Sanjay V; Phan, Phillip H
Although JCAHO requires a standardised approach to handoffs, and while many standardised protocols have been tested, sign-out practices continue to vary. We believe this is due to the variability in workflow during inpatient duty cycle. We investigate the impact of such workflows on intern sign-out practices. We employed a prospective, grounded theory mixed-method design. The study was conducted at a residency programme in the mid-Atlantic USA. Two observers randomly evaluated three types of daily sign-outs for 1 week every 3 months from September 2013 to March 2014. The compliance of each observed behaviour to JCAHO's Handoff Communication Checklist was recorded. Thirty one interns conducting 134 patient sign-outs were observed randomly among the 52 in the programme. In the 06:00 to 07:00 sign-back, the night-cover focused on providing information on overnight events to the day interns. In the 11:00 to 12:00 sign-out, the night-cover focused on transferring task accountability to a day-cover intern before departure. In the 20:00 to 21:00 sign-out, the day interns focused on transferring responsibility of their patients to a night-cover. Different sign-out periods had different emphases regarding information exchange, personal responsibility and task accountability. Sign-outs are context-specific, implying that across-the-board standardised sign-out protocols are likely to have limited efficacy and compliance. Standardisation may need to be relative to the specific type and purpose of each sign-out to be supported by interns. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
Full Text Available Abstract Background The Accreditation Council for Graduate Medical Education's (ACGME new requirements raise multiple challenges for academic medical centers. We sought to evaluate career satisfaction, emotional states, positive and negative experiences, work hours and sleep among residents and faculty simultaneously in one academic medical center after implementation of the ACGME duty hour requirements. Methods Residents and faculty (1330 in the academic health center were asked to participate in a confidential survey; 72% of the residents and 66% of the faculty completed the survey. Results Compared to residents, faculty had higher levels of satisfaction with career choice, competence, importance and usefulness; lower levels of anxiousness and depression. The most positive experiences for both groups corresponded to strong interpersonal relationships and educational value; most negative experiences to poor interpersonal relationships and issues perceived outside of the physician's control. Approximately 13% of the residents and 14% of the faculty were out of compliance with duty hour requirements. Nearly 5% of faculty reported working more than 100 hours per week. For faculty who worked 24 hour shifts, nearly 60% were out of compliance with the duty-hour requirements. Conclusion Reasons for increased satisfaction with career choice, positive emotional states and experiences for faculty compared to residents are unexplained. Earlier studies from this institution identified similar positive findings among advanced residents compared to more junior residents. Faculty are more frequently at risk for duty-hour violations. If patient safety is of prime importance, faculty, in particular, should be compliant with the duty hour requirements. Perhaps the ACGME should contain faculty work hours as part of its regulatory function.
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 (pReport, with diverse attendance including surgical attendings and residents in various training years, is the ideal venue for real-time teaching and evaluation of sign-outs and reinforcing good communication 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
...-consecutive-hour off-duty period long enough to provide restorative sleep regardless of the number of hours... short rest periods during the work day improve driver alertness in the operation of a CMV? How long should these rest periods be? At what point in the duty cycle or drive-time would short rest periods...
Fabreau, Gabriel; Elliott, Meghan; Khanna, Suneil; Minty, Evan; Wallace, Jean E; de Grood, Jill; Lewin, Adriane; Brown, Garielle; Bharwani, Aleem; Gilmour, Janet; Lemaire, Jane B
Extended duty hours for residents are associated with negative consequences. Strategies to accommodate duty hour restrictions may also have unintended impacts. To eliminate extended duty hours and potentially lessen these impacts, we developed a senior resident rotation bundle that integrates a night float system, educational sessions on sleep hygiene, an electronic handover tool, and a simulation-based medical education curriculum. The aim of this study was to assess internal medicine residents' perceptions of the impact of the bundle on three domains: the senior residents' wellness, ability to deliver quality health care, and medical education experience. This prospective study compared eligible residents' experiences (N = 67) before and after a six-month trial of the bundle at a training program in western Canada. Data was collected using an on-line survey. Pre- and post-intervention scores for the final sample (N = 50) were presented as means and compared using the t-test for paired samples. Participants felt that most aspects of the three domains were unaffected by the introduction of the bundle. Four improved and two worsened perception shifts emerged post-intervention: less exposure to personal harm, reduced potential for medical error, more successful teaching, fewer disruptions to other rotations, increased conflicting role demands and less staff physician supervision. The rotation bundle integrates components that potentially ease some of the perceived negative consequences of night float rotations and duty hour restrictions. Future areas of study should include objective measures of the three domains to validate our study participants' perceptions.
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.
Gupta, Raghav; Moore, Justin M; Adeeb, Nimer; Griessenauer, Christoph J; Schneider, Anna M; Gandhi, Chirag D; Harsh, Griffith R; Thomas, Ajith J; Ogilvy, Christopher S
Efforts to address resident errors and to enhance patient safety have included systemic reforms, such as the Accreditation Council for Graduate Medical Education's (ACGME's) mandated duty-hour restrictions, and specialty-specific initiatives such as the neurosurgery Milestone Project. However, there is currently little data describing the basis for these errors or outlining trends in neurosurgical resident error. An online questionnaire was distributed to program directors of 108 U.S. neurosurgery residency training programs to assess the frequency, most common forms and causes of resident error, the resulting patient outcomes, and the steps taken by residency programs to address these errors. Thirty-one (28.7%) responses were received. Procedural/surgical error was the most commonly observed type of error. Transient injury and no injury to the patient were perceived to be the 2 most frequent outcomes. Inexperience or resident mistake despite adequate training were cited as the most common causes of error. Twenty-three (74.2%) respondents stated that a lower post graduate year level correlated with an increased incidence of errors. There was a trend toward an association between an increased number of residents within a program and the number of errors attributable to a lack of supervision (r = 0.36; P = 0.06). Most (93.5%) program directors do not believe that mandated duty-hour restrictions reduce error frequency. Program directors believe that procedural error is the most commonly observed form of error, with post graduate year level believed to be an important predictor of error frequency. The perceived utility of systemic reforms that aim to reduce the incidence of resident error remains unclear. Copyright © 2017. Published by Elsevier Inc.
Di Stasi, Leandro L; McCamy, Michael B; Macknik, Stephen L; Mankin, James A; Hooft, Nicole; Catena, Andrés; Martinez-Conde, Susana
Little is known about the effects of surgical residents' fatigue on patient safety. We monitored surgical residents' fatigue levels during their call day using (1) eye movement metrics, (2) objective measures of laparoscopic surgical performance, and (3) subjective reports based on standardized questionnaires. Prior attempts to investigate the effects of fatigue on surgical performance have suffered from methodological limitations, including inconsistent definitions and lack of objective measures of fatigue, and nonstandardized measures of surgical performance. Recent research has shown that fatigue can affect the characteristics of saccadic (fast ballistic) eye movements in nonsurgical scenarios. Here we asked whether fatigue induced by time-on-duty (~24 hours) might affect saccadic metrics in surgical residents. Because saccadic velocity is not under voluntary control, a fatigue index based on saccadic velocity has the potential to provide an accurate and unbiased measure of the resident's fatigue level. We measured the eye movements of members of the general surgery resident team at St. Joseph's Hospital and Medical Center (Phoenix, AZ) (6 males and 6 females), using a head-mounted video eye tracker (similar configuration to a surgical headlight), during the performance of 3 tasks: 2 simulated laparoscopic surgery tasks (peg transfer and precision cutting) and a guided saccade task, before and after their call day. Residents rated their perceived fatigue level every 3 hours throughout their 24-hour shift, using a standardized scale. Time-on-duty decreased saccadic velocity and increased subjective fatigue but did not affect laparoscopic performance. These results support the hypothesis that saccadic indices reflect graded changes in fatigue. They also indicate that fatigue due to prolonged time-on-duty does not result necessarily in medical error, highlighting the complicated relationship among continuity of care, patient safety, and fatigued providers. Our data
... is the minimum time in each period necessary to provide restorative sleep? 2. Could the 14-hour on... FMCSA. A. Rest and On-Duty Time 1. Would mandatory short rest periods during the work day improve driver alertness in the operation of a CMV? How long should these rest periods be? At what point in the duty cycle...
Brooks, Joanna Veazey; Bosk, Charles L.
We examine how a policy aimed at improving patient safety by limiting residents’ work hours brought with it an unintended and unexamined consequence: altered socialization due to modified rites of passage during residency that endangered the stereotypical “Surgical Personality” and created a potential rift between the occupational identities of surgical residents who train under duty hour regulations and those who trained before they were imposed. Through participant observation occurring between June 2008 and June 2010, in-depth interviews (n=13), and focus groups (n=2), we explore how surgical residents training in four U.S. hospitals think about the threats that the shift from unrestricted to restricted duty hours creates for their claims of competence and professionalism. We identify three types of resident responses: (1) neutralizing statements that deny any significant change to occupational identity has occurred; (2) embracing statements that express the belief that a changed and more balanced occupational identity is needed; and (3) apprehensive statements that expressed fear of an altered occupational identity and an anxiety about readiness for individual practice. PMID:22863331
Gondi, Vinai; Bernard, Johnny Ray; Jabbari, Siavash; Keam, Jennifer; Amorim Bernstein, Karen L. de; Dad, Luqman K.; Li, Linna; Poppe, Matthew M.; Strauss, Jonathan B.; Chollet, Casey T.
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
Nomura, Osamu; Mishina, Hiroki; Jasti, Harish; Sakai, Hirokazu; Ishiguro, Akira
Although the long working hours of physicians are considered to be a social issue, no effective policies such as duty hour regulations have so far been proposed in Japan. We implemented an overnight call shift (OCS) system for ward rotations to improve the working environment for residents in a pediatric residency program. We later conducted a cross-sectional questionnaire asking the residents to compare this system with the traditional overnight call system. Forty-one pediatric residents participated in this survey. The residents felt that the quality of patient care improved (80.4% agreed). Most felt that there was less emphasis on education (26.8%) and more emphasis on service (31.7%). Overall, the residents reported that the OCS was beneficial (90.2%). In conclusion, the pediatric residents considered the OCS system during ward rotations as beneficial. Alternative solutions are vital to balance improvements in resident work conditions with the requirement for a high quality of education. © 2017 Japan Pediatric Society.
Bega, Danny; Krainc, Dimitri
Residency training has had to adapt to higher patient volumes, increased complexity of medical care, and the commercialized system of health care. These changes have led to a concerning culture shift in neurology. We review the relationship between the emerging health care delivery system and residency training, highlighting issues related to duty hours and work-life balance, the changing technological landscape, high patient volumes, and complex service obligations. We propose that the current challenges in health care delivery offer the opportunity to improve neurology residency through faculty development programs, bringing teaching back to the bedside, increasing resident autonomy, utilizing near-peer teaching, and rewarding educators who facilitate an environment of inquiry and scholarship, with the ultimate goal of better alignment between education and patient care. Ann Neurol 2016;80:315-320. © 2016 American Neurological Association.
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.
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.
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
Lukish, Jeffrey; Cruess, David
The specific aim of this study was to summarize the viewpoints of the Resident and Associate Society of the American College of Surgeons (RAS-ACS) membership regarding current training and quality of life-related issues prior to implementation of the new duty-hour guidelines. The goal was to gain insight of the members that may be useful to recruit and guide the future training of surgical residents. An Internet-based survey was developed to evaluate the viewpoints of RAS-ACS. The survey was administered by Esurveymaker.com via the ACS Web page from 2000 to 2003. RAS-ACS member participation was voluntary and anonymous. Analyses were performed to determine the frequency of response for each survey item. Two hundred thirty-five members completed the survey representing 5 per cent of RAS-ACS. Eighty-four per cent were general surgery residents. Personal satisfaction (64%) and mentorship (49%) were top factors for respondents to pursue surgical training; discussion with colleagues and future income was less important. Forty-five per cent reported that job performance was their most important concern during residency. A rewarding surgical career and family life were ranked as the most important expectations. Eighty-six per cent reported that they were satisfied with their residency, and 66 per cent reported that work hours should be limited. Personal satisfaction and mentorship were critical factors for members of the RAS-ACS to seek surgical training. Although most of the members report that work hours should be limited, an overwhelming majority reports satisfaction with surgical training prior to institution of the new duty-hour guidelines. Further emphasis on mentorship and work-hour reform may be beneficial in recruiting medical students into surgical residencies.
Hamui-Sutton, Liz; Barragán-Pérez, Virginia; Fuentes-García, Ruth; Monsalvo-Obregón, Erika Cristina; Fouilloux-Morales, Claudia
In countries such as United States and European Nations changes have been proposed regarding to duty and academic structure of specialists in training, this implies adjustments in the norms concerning the number of hours a week that residents work. The main argument which has underpinned such transformations is based on the assumption that excessive working hours (more than 16 hours uninterrupted) cause cognitive and psychomotor disorders in residents. To evaluate the association between sleep deprivation and cognitive and psychomotor skills of a sample of residents of different specialties of Medicine. Longitudinal study with measurements pre and post shifts, in 31 residents of Medicine. The measured variables were: cognitive and psychomotor skills, demographic data and conditions of the shift, quality of sleep and psychopathology. 81% residents showed detriment in at least one of the tests, however, in psychomotor skills significant different results were found in CPR maneuvers between pre and post shift with an improvement in scores. Sleep deprivation causes detriment of cognitive and psychomotor skills. While our results can't be generalized, they may constitute a precedent for possible changes in the working hours of medical residencies.
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 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...
... REQUIREMENTS Motors § 111.25-15 Duty cycle. Each motor must be rated for continuous duty, except a motor for an... table. Table 111.25-15 Application of motor Minimum short-time rating of motor, in hours Deck winch and... idle pump operation, followed by 1/4 hr. full load operation. Steering gear, direct acting One...
Greene, James G
Neurology residency training programs have been profoundly impacted by recent changes in resident duty hours, workloads, and supervisory requirements. In response, many programs have adopted a night float coverage system to minimize the requirements for overnight call. The majority involves residents working a block of night shifts in what is typically a service-oriented rotation. Recently, concerns have arisen regarding the impact of this design on resident education and patient care. We have developed a novel on-site nighttime neurohospitalist model for the explicit purpose of steepening the initial learning curve for neurology residents in an effort to rapidly improve their neurological skills and, in conjunction, overnight patient care. We surveyed residents after the initiation of this system to assess their perception of the impact of direct overnight supervision on education and patient care. As part of ongoing quality improvement efforts, surveys were administered to neurology house staff at a tertiary academic medical center after they had completed service on the night float rotation both with and without an attending in the hospital using a retrospective pre/postdesign. There was a robust positive impact on resident's perception of overall quality, educational value, and clinical quality on the night float rotation with an attending on-site. Despite an overall perception that their autonomy was maintained, residents believed barriers to contact the attending were lower, and attending interaction during critical decision making was more frequent. Direct overnight supervision by a neurohospitalist enhances the educational value and care quality on overnight resident rotations.
Basner, Mathias; Dinges, David F; Shea, Judy A; Small, Dylan S; Zhu, Jingsan; Norton, Laurie; Ecker, Adrian J; Novak, Cristina; Bellini, Lisa M; Volpp, Kevin G
Fatigue from sleep loss is a risk to physician and patient safety, but objective data on physician sleep and alertness on different duty hour schedules is scarce. This study objectively quantified differences in sleep duration and alertness between medical interns working extended overnight shifts and residents not or rarely working extended overnight shifts. Sleep-wake activity of 137 interns and 87 PGY-2/3 residents on 2-week Internal Medicine and Oncology rotations was assessed with wrist-actigraphy. Alertness was assessed daily with a brief Psychomotor Vigilance Test (PVT) and the Karolinska Sleepiness Scale. Interns averaged 6.93 hours (95% confidence interval [CI] 6.84-7.03 hours) sleep per 24 hours across shifts, significantly less than residents not working overnight shifts (7.18 hours, 95% CI 7.06-7.30 hours, p = .007). Interns obtained on average 2.19 hours (95% CI 2.02-2.36 hours) sleep during on-call nights (17.5% obtained no sleep). Alertness was significantly lower on mornings after on-call nights compared to regular shifts (p Sleep inertia significantly affected alertness in the 60 minutes after waking on-call. Extended overnight shifts increase the likelihood of chronic sleep restriction in interns. Reduced levels of alertness after on-call nights need to be mitigated. A systematic comparison of sleep, alertness, and safety outcomes under current and past duty hour rules is encouraged. © Sleep Research Society 2017. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e-mail email@example.com.
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
Oklahoma State Dept. of Vocational and Technical Education, Stillwater. Curriculum and Instructional Materials Center.
This document contains the occupational duty/task lists for three occupations in the cosmetology series. Each occupation is divided into a number of duties. A separate page for each duty in the occupation lists the tasks in that duty along with its code number and columns to indicate whether that particular duty has been taught and to provide…
Chelsea R. Mehr MD
Full Text Available Changes in the field of pathology and resident education necessitate ongoing evaluation of residency training. Evolutionary change is particularly important for surgical pathology rotations, which form the core of anatomic pathology training programs. In the past, we organized this rotation based on subjective insight. When faced with the recent need to restructure the rotation, we strove for a more evidence-based process. Our approach involved 2 primary sources of data. We quantified the number of cases and blocks submitted per case type to estimate workload and surveyed residents about the time required to gross specimens in all organ systems. A multidisciplinary committee including faculty, residents, and staff evaluated the results and used the data to model how various changes to the rotation would affect resident workload, turnaround time, and other variables. Finally, we identified rotation structures that equally distributed work and created a point-based system that capped grossing time for residents of different experience. Following implementation, we retrospectively compared turnaround time and duty hour violations before and after these changes and surveyed residents about their experiences with both systems. We evaluated the accuracy of the point-based system by examining grossing times and comparing them to the assigned point values. We found overall improvement in the rotation following the implementation. As there is essentially no literature on the subject of surgical pathology rotation organization, we hope that our experience will provide a road map to improve pathology resident education at other institutions.
Alston, Meredith J.; Metz, Torri D.; Fothergill, Russell; (Meg) Autry, Amy; Wagner, Sarah A.; Allshouse, Amanda A.; Stephenson-Famy, Alyssa
Background Little is known about the factors that influence medical student selection of obstetrics and gynecology (ob-gyn) residency programs. Objective We assessed the factors influencing residency program selection by fourth-year medical students pursuing ob-gyn training. Methods 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. Results 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). Conclusions 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. PMID:28261407
... aircraft are not required; (3) Include provisions to add one flight attendant to the minimum flight... in that duty period at least one flight attendant in addition to the minimum flight attendant... hours, but no more than 20 hours, if the scheduled duty period includes one or more flights that land or...
Reuben, D B
The intense situational and physiologic stresses that accompany postgraduate training may have serious psychosocial ramifications. Although only a small proportion of residents have overt psychiatric illness, virtually all display some psychologic impairment. Contributing factors include life-changes, stresses associated with providing patient care, loss of social support, long working hours, sleep deprivation, and underlying personality traits of residents. The manifestations of this impairment are variable and may be subtle. In response to these problems, residency programs have taken steps to provide psychosocial support. Unfortunately, most programs do not offer formal support groups or seminars to discuss difficulties that accompany residency. Further definition of the psychosocial effects of residency may prompt changes that make the training of physicians a more humane process.
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...
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.
... 19 Customs Duties 2 2010-04-01 2010-04-01 false Residence status of arriving persons. 148.2... Residence status of arriving persons. (a) General. Persons arriving from foreign countries shall be divided... established a home elsewhere. For this purpose, the residence of a wife shall be deemed to be that of her...
Savita Rani Singhal
Full Text Available To find shortest and reliable time period of urine collection for determination of proteinuria.It is a prospective study carried out on 125 pregnant women with preeclampsia after 20 weeks of gestation having urine albumin >1 using dipstick test. Urine was collected in five different time intervals in colors labeled containers with the assistance of nursing staff; the total collection time was 24 hours. Total urine protein of two-hour, four-hour, eight-hour, 12-hour and 24-hour urine was measured and compared with 24-hour collection. Data was analyzed using the Pearson correlation coefficient.There was significant correlation (p value < 0.01 in two, four, eight and 12-hour urine protein with 24-urine protein, with correlation coefficient of 0.97, 0.97, 0.96 and 0.97, respectively. When a cut off value of 25 mg, 50 mg. 100 mg, and 150 mg for urine protein were used for 2-hour, 4-hours, 8-hour and 12-hour urine collection, a sensitivity of 92.45%, 95.28%, 91.51%, and 96.23% and a specificity of 68.42%, 94.74%, 84.21% and 84.21% were obtained, respectively.Two-hour urine proteins can be used for assessment of proteinuria in preeclampsia instead of gold standard 24-hour urine collection for early diagnosis and better patient compliance.
Amin, Mohammad M; Graber, Mark; Ahmad, Khalid; Manta, Dragos; Hossain, Sayeed; Belisova, Zuzana; Cheney, William; Gold, Morris S; Gold, Avram R
Despite shorter duty hours, fatigue remains a problem among medical residents. The authors tested the effect of a short, mid-day nap on the cognitive functioning and alertness of first-year internal medicine (IM) residents during normal duty hours. This was a controlled, interventional study performed between July 2008 and April 2010. The authors recruited a nap group of 18 residents and a rest (control) group of 11 residents. Investigators connected all participants to an ambulatory sleep monitor before the beginning of their shifts in order to monitor rolling eye movements, a proxy for attention failures. At mid-day, both groups took Conner's Continuous Performance Test (CPT II) to evaluate their cognitive functioning and then were placed in a reclining chair designed for napping. The authors instructed nap group residents to nap for up to 20 minutes and chatted with control group residents to prevent them from napping. All residents took the CPT II again immediately after the intervention. Residents' attention failures were recorded until the end of the workday. The authors compared the mean outcome parameters of the two groups through analysis of variance, using effect-of-treatment and baseline covariates. Nap group participants slept a mean of 8.4±3.0 minutes. Compared with controls whose cognitive functioning and number of attention failures did not change from morning to afternoon, the nap group's cognitive functioning improved and their number of attention failures decreased. A short, mid-day nap can improve cognitive functioning and alertness among first-year IM residents.
Death and taxes are unavoidable. In terms of the current legislation both estate duty and capital gains tax (hereinafter referred to as 'CGT') are levied upon death. The South African National Treasury is reconsidering taxes on death as estate duty contributes minuscule revenue, and its administration is cumbersome. Worldwide taxation is based on either source or residence. Because of the R3 500 000 exemption from estate duty, only wealthy individuals are generally subject to e...
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.
The basic currency of higher education--the credit hour--represents the root of many problems plaguing America's higher education system: the practice of measuring time rather than learning. "Cracking the Credit Hour" traces the history of this time-based unit, from the days of Andrew Carnegie to recent federal efforts to define a credit…
Chand, David V
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. 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. 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. 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.
Nielsen, Morten Ebbe Juul
On Taylor and Honneth's theories of recognition and whether one can derive a "duty to recognize Culture" from these......On Taylor and Honneth's theories of recognition and whether one can derive a "duty to recognize Culture" from these...
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
This issue's discussion has two goals. First, we shall examine the reasons clinical personnel gravitate to the Kantian concept of duty. Second, we shall examine a technique used within Kantian theory that will help you decide when an ethical dilemma obligates you to act regardless of the consequences.
... driver can reset this ``on-duty clock'' to zero by obtaining a period of at least 34-consecutive hours...-0047] Hours of Service of Drivers: Application for Exemption; David Muresan AGENCY: Federal Motor... comments. SUMMARY: FMCSA announces that David Muresan has applied for an exemption from the Agency's hours...
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.
Nauta, Russell J
Despite a quarter century of discourse since a sentinel event in New York City raised the question of appropriate oversight for graduate medical education, many questions remain unanswered. Even with the Accreditation Council for Graduate Medical Education rules in place, some opportunity remains to examine handoff methodology, the relationship of duty hours to education, and the impact of fatigue on resident performance. Neurophysiologic adjuncts applied concomitantly to evaluation of didactic performance offer promise for data-driven definition of the optimal shift. Concurrently, the merits of specialty-specific oversight of graduate medical education remain under active consideration. Copyright © 2012 Elsevier Inc. All rights reserved.
Urine protein - 24 hour; Chronic kidney disease - urine protein; Kidney failure - urine protein ... Heart failure High blood pressure during pregnancy ( preeclampsia ) Kidney disease caused by diabetes, high blood pressure, autoimmune disorders, ...
Yamamoto, Satoshi; Tanaka, Pedro; Madsen, Matias V
, for example, the duration of post-medical school training and national requirements for certain rotations, a number of cases, faculty supervision, national in-training written exams, and duty hour limits. These data were augmented by review of each country's publicly available residency training documents...... as available on the internet. Post-medical school anesthesia residency duration varied: three years (Brazil), four years (USA), five years (Canada and Switzerland), six years (Japan and Denmark) to nine years (UK), as did the number of explicitly required clinical rotations of a defined duration: zero (Denmark......), one (Switzerland and UK), four (Brazil), six (Canada), and 12 (USA). Minimum case requirements exist in the USA, Japan, and Brazil, but not in the other countries. National written exams taken during training exist for all countries studied except Japan and Denmark. The countries studied increasingly...
Robertson, Charles M; Klingensmith, Mary E; Coopersmith, Craig M
To quantify the prevalence, outcomes, and cost of surgical resident research. General surgery is unique among graduate medical education programs because a large percentage of residents interrupt their clinical training to spend 1 to 3 years performing full-time research. No comprehensive data exists on the scope of this practice. Survey sent to all 239 program directors of general surgery residencies participating in the National Resident Matching Program. Response rate was 200 of 239 (84%). A total of 381 of 1052 trainees (36%) interrupt residency to pursue full-time research. The mean research fellowship length is 1.7 years, with 72% of trainees performing basic science research. A significant association was found between fellowship length and postresidency activity, with a 14.7% increase in clinical fellowship training and a 15.2% decrease in private practice positions for each year of full-time research (P < 0.0001). Program directors at 31% of programs reported increased clinical duties for research fellows as a result of Accreditation Council for Graduate Medical Education work hour regulations for clinical residents, whereas a further 10% of programs are currently considering such changes. It costs $41.5 million to pay the 634 trainees who perform research fellowships each year, the majority of which is paid for by departmental funds (40%) and institutional training grants (24%). Interrupting residency to perform a research fellowship is a common and costly practice among general surgery residents. Although performing a research fellowship is associated with clinical fellowship training after residency, it is unclear to what extent this practice leads to the development of surgical investigators after postgraduate training.
An hour-by-hour account is given of the progression of events leading up to and during the accident at the Three Mile Island Unit 2 reactor. The emergency procedures followed, the evacuation of local residents and the decisions taken as the possibility of a meltdown became apparent are recorded in detail together with aspects of the media coverage and the problems of communication. (U.K.)
Bakhai, A; Goodman, F; Juchniewichz, H; Martin, A; Porter, G; White, C; Williams, L; Hopkins, A
To ascertain ease or difficulty of contacting duty junior doctors responsible for acute medical admissions by telephone. Telephone survey of hospitals in six health regions in England and Wales. 70 Randomly selected hospitals, 15 of which were excluded because of non-acceptance of acute medical admissions. 71 Duty doctors (duty house physicians, senior house officers, or registrars responsible for acute medical admissions) in 48 hospitals; seven duty doctors in seven hospitals were excluded (four declined to participate and three required a written explanation of the survey). 67 Doctors gave full information to all questions. Time taken for hospital switchboards and duty doctors to reply to telephone call, diagnoses of patients recently admitted, and on call rotas and hours of sleep of duty doctors. Hospital switchboards responded within 30 seconds in 87 (74%) calls, and in 76 calls (64%) the duty doctor requested was contacted within a further two minutes. Chest pain, possibly due to myocardial infarction, was the most common reason for acute medical admissions. Nearly half (48%) of the duty doctors in larger hospitals reported having 4-5 hours sleep or less on their nights on call. Most (30) were on a one in three rota; two were on a one in two rota. Despite impressions to the contrary contacting the duty medical team by telephone seemed fairly easy. Although most junior doctors were on a rota of one in three or better, insufficient recognition may be given to their deprivation of sleep during nights on duty.
VOLU TARY AFTER-DUTY FOLWW-UP CARE OF MALNOURISHED CHILDREN IN. THE ... the good work. Home visiting in off-duty hours commen- ced in earnest in January 1969. The group called themselves the·Phila Nutritional Advisory Team, and have a Bantu ... them how to feed their babies in order to prevent malnu-.
Ilsøe, Anna; Larsen, Trine Pernille; Felbo-Kolding, Jonas
Purpose The purpose of this paper is to investigate the effect of part-time work on absolute wages. The empirical focus is wages and working hours in three selected sectors within private services in the Danish labour market – industrial cleaning, retail, hotels and restaurants – and their agreem......Purpose The purpose of this paper is to investigate the effect of part-time work on absolute wages. The empirical focus is wages and working hours in three selected sectors within private services in the Danish labour market – industrial cleaning, retail, hotels and restaurants...... in industrial cleaning includes a minimum floor of 15 weekly working hours – this is not the case in retail, hotels and restaurants. This creates a loophole in the latter two sectors that can be exploited by employers to gain wage flexibility through part-time work. Originality/value The living wage literature...
... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) PIPELINE SAFETY DRUG AND ALCOHOL TESTING Alcohol Misuse Prevention Program § 199.219 Pre-duty use. Each operator shall prohibit a covered employee from using alcohol... operator having actual knowledge that a covered employee has used alcohol within four hours prior to...
Hsieh, Cindy M; Nolan, Norris J
To document the pathology learning experiences of pathology residents prior to residency and to determine how confident they were in their knowledge and technical skills. An online survey was distributed to all pathology residency program directors in the United States, who were requested to forward the survey link to their residents. Data were obtained on pathology electives, grossing experience, and frozen section experience. Likert scale questions assessed confidence level in knowledge and skills. In total, 201 pathology residents responded (8% of residents in the United States). Prior to starting residency, most respondents had exposure to anatomic pathology through elective rotations. Few respondents had work-related experience. Most did not feel confident in their pathology-related knowledge or skills, and many did not understand what pathology resident duties entail. Respondents gained exposure to pathology primarily through elective rotations, and most felt the elective experience prepared them for pathology residency. However, elective time may be enhanced by providing opportunities for students to increase hands-on experience and understanding of resident duties. Copyright© by the American Society for Clinical Pathology.
Tackling climate change has often been considered the responsibility of national governments. But do individuals also have a duty to act in the face of this problem? In particular do they have a duty to adopt a greener lifestyle or to press their government to act? This review critically examines the arguments provided for and against such duties in the relevant philosophic literature. It first discusses the problem of causal inefficacy—namely the fact that individual greenhouse gas emissions...
Robertson, Charles M.; Klingensmith, Mary E.; Coopersmith, Craig M.
Structured Abstract Objective To quantify the prevalence, outcomes, and cost of surgical resident research. Summary Background Data General surgery is unique among graduate medical education programs because a large percentage of residents interrupt their clinical training to spend 1-3 years performing full-time research. No comprehensive data exists on the scope of this practice. Methods Survey sent to all 239 program directors of general surgery residencies participating in the National Resident Matching Program. Results Response rate was 200/239 (84%). A total of 381 out of 1052 trainees (36%) interrupt residency to pursue full-time research. The mean research fellowship length is 1.7 years, with 72% of trainees performing basic science research. A significant association was found between fellowship length and post-residency activity, with a 14.7% increase in clinical fellowship training and a 15.2% decrease in private practice positions for each year of full-time research (p<0.0001). Program directors at 31% of programs reported increased clinical duties for research fellows as a result of ACGME work hour regulations for clinical residents, while a further 10% of programs are currently considering such changes. It costs $41.5 million to pay the 634 trainees who perform research fellowships each year, the majority of which is paid for by departmental funds (40%) and institutional training grants (24%). Conclusions Interrupting residency to perform a research fellowship is a common and costly practice among general surgery residents. While performing a research fellowship is associated with clinical fellowship training after residency, it is unclear to what extent this practice leads to the development of surgical investigators after post-graduate training. PMID:19106692
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....
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
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.
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
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.
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.
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
Temporomandibular Dysfunction 14,000 10,000 8, (Advanced C l 12,000 8,000 6,000 12 creditable service”36 or have completed their active duty obligated...NAVAL POSTGRADUATE SCHOOL MONTEREY, CALIFORNIA MBA PROFESSIONAL REPORT Influences on the Retention of Residency-Trained and...SUBTITLE: Influences on the Retention of Residency-Trained and Non-Residency Trained Navy Dental Corps Officers 6. AUTHOR(S) Alan B. Christian 5
Johnson, William R.
Hours constraints are typically identified by worker responses to questions asking whether they would prefer a job with more hours and more pay or fewer hours and less pay. Because jobs with different hours but the same rate of pay may be infeasible when there are fixed costs of employment or mandatory overtime premia, the constraint in those…
In certain situations, soldiers must continue to perform their duties over an extended period of time, knowing that their regular sleep period will be missed and their time awake will extend well past 24 hours...
Social Security Administration — SSA provides a web service and downloadable file for SSA Resident Station locations, telephone numbers, and hours of operation. (Note: If you think an office might...
Carvalho Aguiar Melo, Matias; das Chagas Medeiros, Francisco; Meireles Sales de Bruin, Veralice; Pinheiro Santana, José Abraão; Bastos Lima, Alexandre; De Francesco Daher, Elizabeth
Medical residency programs are traditionally known for long working hours, which can be associated with a poor quality of sleep and daytime sleepiness. However, few studies have focused on this theme. Our objective was to investigate sleep quality, daytime sleepiness, and their relation with anxiety, social phobia, and depressive symptoms. This cross-sectional observational study involved 59 psychiatry residents. The Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS) were used to measure the quality of sleep and excessive daytime sleepiness ([EDS] and ESS > 10), respectively. Among the 59 psychiatry residents, 59.3% had poor sleep quality (PSQI > 5) and 28.8% had EDS. Poor sleep quality was associated with higher EDS (P = 0.03) and the year of residency program (P = 0.03). Only 20% of residents with poor sleep had consulted at least once for sleep problems; 54.2% had used medications for sleep; and 16.9% were using medications at the time of interview. Only 30% obtained medication during medical consultations. Poor sleep was associated with irregular sleep hours (P = 0.001) and long periods lying down without sleep (P = 0.03). Poor sleep quality was also associated with high scores of anxiety symptoms (P Psychiatry residents frequently have poor sleep quality and EDS. Considering that sleep disorders can affect quality of life, predispose to metabolic syndrome, and be associated with worse performance at work, attention to this clinical problem is needed. © The Author(s) 2016.
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. Copyright © 2014 American College of Radiology. Published by Elsevier Inc. All rights reserved.
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...
Abstract. Background: There is a phobia among doctors for the residency training program, since the establishment of ... Materials and Methods: Structured questionnaires were administered to residents at 3 training institutions in Nigeria. Results: ... Keywords: Decentralization, motivation, perception, remuneration, residents.
... 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 aircraft...
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.
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.
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
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.
Lau, Frank H; Sinha, Indranil; Jiang, Wei; Lipsitz, Stuart R; Eriksson, Elof
Resident work hours are under scrutiny and have been subject to multiple restrictions. The studies supporting these changes have not included data on surgical residents. We studied the workday of a team of plastic surgery residents to establish prospective time-study data of plastic surgery (PRS) residents at a single tertiary-care academic medical center. Five trained research assistants observed all residents (n = 8) on a PRS service for 10 weeks and produced minute-by-minute activity logs. Data collection began when the team first met in the morning and continued until the resident being followed completed all non-call activities. We analyzed our data from 3 perspectives: 1) time spent in direct patient care (DPC), indirect patient care, and didactic activities; 2) time spent in high education-value activities (HEAs) versus low education-value activities; and 3) resident efficiency. We defined HEAs as activities that surgeons must master; other activities were LEAs. We quantified resident efficiency in terms of time fragmentation and time spent waiting. A total of 642.4 hours of data across 50 workdays were collected. Excluding call, residents worked an average of 64.2 hours per week. Approximately 50.7% of surgical resident time was allotted to DPC, with surgery accounting for the largest segment of this time (34.8%). Time spent on HEAs demonstrated trended upward with higher resident level (P = 0.086). Time in spent in surgery was significantly associated with higher resident levels (P time study of PRS residents, we found that compared with medicine trainees, surgical residents spent 3.23 times more time on DPC. High education-value activities comprised most of our residents' workdays. Surgery was the leading component of both DPC and HEAs. Our residents were highly efficient and fragmented, with the majority of all activities requiring 4 minutes or less. Residents spent a large portion of their time waiting for other services. In light of these data, we
Le, Hung M; Young, Shardae D
Results of a study of stress and negative affect levels in postgraduate year 1 (PGY1) and postgraduate year 2 (PGY2) pharmacy residents are presented. A cross-sectional approach was used. Pharmacy residency program directors received e-mailed invitation letters requesting that they ask their residents to participate in an online survey in 2011. The main study outcomes included evaluation of resident scores on the 10-item Perceived Stress Scale (PSS10) and the Multiple Affect Adjective Checklist-Revised (MAACL-R) anxiety, depression, hostility, and dysphoria subscales. Of the 524 pharmacy residents included in the study, 75.4% were female, 41.2% were under 26 years of age, and 41% reported working more than 60 hours per week. There were no significant differences between PGY1 and PGY2 residents in stress levels, as assessed with the PSS10 (mean ± S.D. score, 19.05 ± 5.96 versus 19.09 ± 5.77). MAACL-R scores for hostility were, on average, higher among PGY2 residents (mean ± S.D., 50.83 ± 10.02) than among PGY1 residents (48.62 ± 8.96), while there were no significant differences in anxiety, depression, and dysphoria levels. Relative to residents who worked 60 or fewer hours per week, those who worked more than 60 hours had higher perceived stress levels as well as higher depression, hostility, and dysphoria scores. Pharmacy residents exhibited high levels of perceived stress, especially those who worked more than 60 hours per week. Perceived stress was highly correlated to negative affect levels. Copyright © 2017 by the American Society of Health-System Pharmacists, Inc. All rights reserved.
Wittich, Christopher M; Agrawal, Anoop; Cook, David A; Halvorsen, Andrew J; Mandrekar, Jayawant N; Chaudhry, Saima; Dupras, Denise M; Oxentenko, Amy S; Beckman, Thomas J
E-learning-the use of Internet technologies to enhance knowledge and performance-has become a widely accepted instructional approach. Little is known about the current use of e-learning in postgraduate medical education. To determine utilization of e-learning by United States internal medicine residency programs, program director (PD) perceptions of e-learning, and associations between e-learning use and residency program characteristics. We conducted a national survey in collaboration with the Association of Program Directors in Internal Medicine of all United States internal medicine residency programs. Of the 368 PDs, 214 (58.2%) completed the e-learning survey. Use of synchronous e-learning at least sometimes, somewhat often, or very often was reported by 85 (39.7%); 153 programs (71.5%) use asynchronous e-learning at least sometimes, somewhat often, or very often. Most programs (168; 79%) do not have a budget to integrate e-learning. Mean (SD) scores for the PD perceptions of e-learning ranged from 3.01 (0.94) to 3.86 (0.72) on a 5-point scale. The odds of synchronous e-learning use were higher in programs with a budget for its implementation (odds ratio, 3.0 [95% CI, 1.04-8.7]; P = .04). Residency programs could be better resourced to integrate e-learning technologies. Asynchronous e-learning was used more than synchronous, which may be to accommodate busy resident schedules and duty-hour restrictions. PD perceptions of e-learning are relatively moderate and future research should determine whether PD reluctance to adopt e-learning is based on unawareness of the evidence, perceptions that e-learning is expensive, or judgments about value versus effectiveness.
A colleague can't make a coffee date at a time the author proposes because it would conflict with his office hour. No student has actually made an appointment with him during the hour, but he is committed to being in his office as promised in case someone drops by. The author's reaction to her colleague's faithfulness to his posted office hour…
Full Text Available Introduction: Medical professionalism is a core competency for emergency medicine (EM trainees; but defining professionalism remains challenging, leading to difficulties creating objectives and performing assessment. Because professionalism is dynamic, culture-specific, and often taught by modeling, an exploration of trainees’ perceptions can highlight their educational baseline and elucidate the importance they place on general conventional professionalism domains. To this end, our objective was to assess the relative value EM residents place on traditional components of professionalism. Methods: We performed a cross-sectional, multi-institutional survey of incoming and graduating EM residents at four programs. The survey was developed using the American Board of Internal Medicine’s “Project Professionalism” and the Accreditation Council of Graduate Medical Education definition of professionalism competency. We identified 27 attributes within seven domains: clinical excellence, humanism, accountability, altruism, duty and service, honor and integrity, and respect for others. Residents were asked to rate each attribute on a 10-point scale. We analyzed data to assess variance across attributes as well as differences between residents at different training levels or different institutions. Results: Of the 114 residents eligible, 100 (88% completed the survey. The relative value assigned to different professional attributes varied considerably, with those in the altruism domain valued significantly lower and those in the “respect for others” and “honor and integrity” valued significantly higher (p<0.001. Significant differences were found between interns and seniors for five attributes primarily in the “duty and service” domain (p<0.05. Among different residencies, significant differences were found with attributes within the “altruism” and “duty and service” domains (p<0.05. Conclusion: Residents perceive differences in
... Association (APA) from FMCSA's regulation prohibiting drivers of commercial motor vehicles (CMVs) from driving after the 14th hour after coming on duty. The FMCSA renews the exemption for 45 APA member-companies and... carrier is being denied. Additionally, the APA advised FMCSA of the removal from the original renewal...
Liao, Q. Q.; Wang, B.
Fine hourly forecast in single station weather forecast is required in many human production and life application situations. Most previous MOS (Model Output Statistics) which used a linear regression model are hard to solve nonlinear natures of the weather prediction and forecast accuracy has not been sufficient at high temporal resolution. This study is to predict the future meteorological elements including temperature, precipitation, relative humidity and wind speed in a local region over a relatively short period of time at hourly level. By means of hour-to-hour NWP (Numeral Weather Prediction)meteorological field from Forcastio (https://darksky.net/dev/docs/forecast) and real-time instrumental observation including 29 stations in Yunnan and 3 stations in Tianjin of China from June to October 2016, predictions are made of the 24-hour hour-by-hour ahead. This study presents an ensemble approach to combine the information of instrumental observation itself and NWP. Use autoregressive-moving-average (ARMA) model to predict future values of the observation time series. Put newest NWP products into the equations derived from the multiple linear regression MOS technique. Handle residual series of MOS outputs with autoregressive (AR) model for the linear property presented in time series. Due to the complexity of non-linear property of atmospheric flow, support vector machine (SVM) is also introduced . Therefore basic data quality control and cross validation makes it able to optimize the model function parameters , and do 24 hours ahead residual reduction with AR/SVM model. Results show that AR model technique is better than corresponding multi-variant MOS regression method especially at the early 4 hours when the predictor is temperature. MOS-AR combined model which is comparable to MOS-SVM model outperform than MOS. Both of their root mean square error and correlation coefficients for 2 m temperature are reduced to 1.6 degree Celsius and 0.91 respectively. The
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...
Dozois, Eric J; Holubar, Stefan D; Tsikitis, Vassiliki L; Malireddy, Kishore; Cima, Robert R; Farley, David R; Larson, David W
We aimed to assess perceptions of the effects of the 80-hour workweek (80hWW) restriction on patient care, education, and resident quality of life. In April 2007, attending surgeons and residents in nine surgical specialties at our institution were surveyed. Respondents were categorized into three groups: (1) attending surgeons; (2) residents beginning their training before the 80hWW implementation (ResBefore); and (3) residents beginning training after the 80hWW implementation (ResAfter). Differences between groups were assessed with univariate analysis. The overall response rate was 57%. A minority in all three groups ( or =84%) agreed that midlevel providers were now critical to successfully deliver health care (P = 0.40). Fewer attending surgeons (21%) and ResBefore (29%) perceived improvements in education compared with ResAfter (68%; P work-life balance for residents (attending surgeons [85%], ResBefore [71%], and ResAfter [92%]; P = 0.008), but 76% of attending surgeons reported decreased job satisfaction. We showed a discrepancy between perceptions of attending surgeons and residents regarding the effect of the 80hWW on patient care and surgical education. Quality of life was improved for residents but not for attending surgeons. The impact of the 80hWW on patient care and surgical education needs to be quantified.
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.
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...
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
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
Nur Ubaidah Saidin; Muhamad Daud; Siti Radiah Mohd Kamarudin
This report explained the test conducted in salt fog chamber to evaluate the effectiveness of mild steel, coated with rust converter, for 168 hours in artificial seawater exposure. The samples were compared with mild steel coated with commercial primer. The tests were conducted followed ASTM B117. Individual pictures were taken of each sample before the tests began, at 24, 48, 72, 96, 120, 144 and 168 hours to see the progression of the corrosion. Results showed that the samples coated with rust converter provide a good significant protection against corrosion phenomenon than the samples coated with commercial primer that available in the market. (author)
... board the aircraft are not required; and (iii) Include provisions to add one flight attendant to the... least one flight attendant in addition to the minimum flight attendant complement required for the... than 20 hours, if the scheduled duty period includes one or more flights that land or take off outside...
..., that are alleged to be sold in the United States at less than fair value. Unless the Department of... duties will each be collectively allocated one hour within which to make an oral presentation at the... investigation. Parties may file written testimony in connection with their presentation at the conference no...
... than fair value and alleged to be subsidized by the Governments of China and Indonesia. Unless the... duties will each be collectively allocated one hour within which to make an oral presentation at the... investigations. Parties may file written testimony in connection with their presentation at the conference no...
... at a truck stop that offers the scanning service. The image would then be electronically transmitted... Preparation of Drivers' Record of Duty Status To Document Compliance With the Hours-of-Service Requirements... original handwritten record, and subsequent electronic submission to the motor carrier of a scanned image...
Szumacher, Ewa; Warner, Eiran; Zhang Liying; Kane, Gabrielle; Ackerman, Ida; Nyhof-Young, Joyce; Agboola, Olusegun; Metz, Catherine de; Rodrigues, George; Voruganti, Sachi; Rappolt, Susan
Purpose: To assess radiation oncology residents' needs and satisfaction in their first postgraduate year (PGY-1) in the province of Ontario. Methods and Materials: Of 62 radiation oncology residents, 58 who had completed their PGY-1 and were either enrolled or had graduated in 2006 were invited to participate in a 31-item survey. The questionnaire explored PGY-1 residents' needs and satisfaction in four domains: clinical workload, faculty/learning environment, stress level, and discrimination/harassment. The Fisher's exact and Wilcoxon nonparametric tests were used to determine relationships between covariate items and summary scores. Results: Of 58 eligible residents, 44 (75%) responded. Eighty-four percent of residents felt that their ward and call duties were appropriate. More than 50% of respondents indicated that they often felt isolated from their radiation oncology program. Only 77% agreed that they received adequate feedback, and 40% received sufficient counseling regarding career planning. More than 93% of respondents thought that faculty members had contributed significantly to their learning experience. Approximately 50% of residents experienced excessive stress and inadequate time for leisure or for reading the medical literature. Less than 10% of residents indicated that they had been harassed or experienced discrimination. Eighty-three percent agreed or strongly agreed that their PGY-1 experience had been outstanding. Conclusions: Most Ontario residents were satisfied with their PGY-1 training program. More counseling by radiation oncology faculty members should be offered to help residents with career planning. The residents might also benefit from more exposure to 'radiation oncology' and an introduction to stress management strategies
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.
Walsh, Allyn; Gold, Michelle; Jensen, Phyllis; Jedrzkiewicz, Michelle
To determine what factors enable or impede women in a Canadian family medicine residency program from combining motherhood with residency training. To determine how policies can support these women, given that in recent decades the number of female family medicine residents has increased. Qualitative study using in-person interviews. McMaster University Family Medicine Residency Program. Twenty-one of 27 family medicine residents taking maternity leave between 1994 and 1999. Semistructured interviews. The research team reviewed transcripts of audiotaped interviews for emerging themes; consensus was reached on content and meaning. NVIVO software was used for data analysis. Long hours, unpredictable work demands, guilt because absences from work increase workload for colleagues, and residents' high expectations of themselves cause pregnant residents severe stress. This stress continues upon return to work; finding adequate child care is an added stress. Residents report receiving less support from colleagues and supervisors upon return to work; they associate this with no longer being visibly pregnant. Physically demanding training rotations put additional strain on pregnant residents and those newly returned to work. Flexibility in scheduling rotations can help accommodate needs at home. Providing breaks, privacy, and refrigerators at work can help maintain breastfeeding. Allowing residents to remain involved in academic and clinical work during maternity leave helps maintain clinical skills, build new knowledge, and promote peer support. Pregnancy during residency training is common and becoming more common. Training programs can successfully enhance the experience of motherhood during residency by providing flexibility at work to facilitate a healthy balance among the competing demands of family, work, and student life.
Fisch, Jay; McNamara, Sara E; Lansing, Bonnie J; Mody, Lona
Twenty-four-hour reports are filled out by nurses daily to monitor nursing home residents and document any changes in resident status. Semistructured interviews conducted with ICPs from 12 southeast Michigan nursing homes showed that although 24-hour reports were used, they were not standardized for infection prevention activities. Our results indicate 24-hour reports can be an effective communication tool and potentially aid in early recognition of infections and outbreaks. Published by Elsevier Inc.
Twenty males aged 25-40 years, many with extensive shiftwork and/or power plant operations experience, volunteered for a laboratory study to compare 8-hour and 12-hour shift schedules. Experiments were conducted in workplace simulation laboratories of the Human Alertness Research Center (HARC) at the Institute for Circadian Physiology in Boston, MA. This unique facility includes a simulated control room with process control simulator, control panels, and self-contained residential apartments where subjects sleep and spend off-duty hours. The design of the study is described. Subjects learn the operation of the process control simulator in multiple practice sessions prior to the experiment. They also practice computer-based performance tests, learn work shift protocols and assignments, and procedures for keeping subjective rating scales for alertness, mood and performance. By the time the first experimental shift begins, all subjects are prepared to perform their simulated work shift duties. These duties include monitoring of four video display terminals for silent (visual cues only) and auditory (visual and auditory) alarms, acknowledging the alarms with computer controls, and keeping log records of alarm activity. The process control simulator simultaneously keeps records of subject performance of these tasks by recording storing all times of alarm activity and alarm acknowledgement by the subject
This study was carried out to ascertain the perception of the residency ... the time of the study. Analysis of the respondents showed similar findings for both senior and junior levels of training. Discussion. The introduction of the residency training program .... Overseas training/ attachment should be re-introduced. 12. (10.1).
Stefano Bartolini; Ennio Bilancini
We investigate the relationship between social participation and the hours worked in the market. Social participation is the component of social capital that measures individuals? engagement in groups, associations and non-governmental organizations. We provide a model of consumer choice where social participation may be either a substitute or a complement to material consumption ? depending on whether participation is instrumentally or non-instrumentally motivated ? and where a local environ...
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.
Kalmbach, David A; Arnedt, J Todd; Song, Peter X; Guille, Constance; Sen, Srijan
While short and poor quality sleep among training physicians has long been recognized as problematic, the longitudinal relationships among sleep, work hours, mood, and work performance are not well understood. Here, we prospectively characterize the risk of depression and medical errors based on preinternship sleep disturbance, internship-related sleep duration, and duty hours. Survey data from 1215 nondepressed interns were collected at preinternship baseline, then 3 and 6 months into internship. We examined how preinternship sleep quality and internship sleep and work hours affected risk of depression at 3 months, per the Patient Health Questionnaire 9. We then examined the impact of sleep loss and work hours on depression persistence from 3 to 6 months. Finally, we compared self-reported errors among interns based on nightly sleep duration (≤6 hr vs. >6 hr), weekly work hours (sleeping trainees obtained less sleep and were at elevated risk of depression in the first months of internship. Short sleep (≤6 hr nightly) during internship mediated the relationship between sleep disturbance and depression risk, and sleep loss led to a chronic course for depression. Depression rates were highest among interns with both sleep disturbance and short sleep. Elevated medical error rates were reported by physicians sleeping ≤6 hr per night, working ≥ 70 weekly hours, and who were acutely or chronically depressed. Sleep disturbance and internship-enforced short sleep increase risk of depression development and chronicity and medical errors. Interventions targeting sleep problems prior to and during residency hold promise for curbing depression rates and improving patient care. © Sleep Research Society 2017. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e-mail firstname.lastname@example.org.
Proposed Rule for Modification of Federal On Board Diagnostic Regulations for: Light Duty Vehicles, Light Duty Trucks, Medium Duty Passenger Vehicles, Complete Heavy Duty Vehicles and Engines Intended for Use in Heavy Duty Vehicles Weighing 14,000 Pounds
Following is information for the proposed rule for the Modification of Federal On Board Diagnostic Regulations for Light-Duty Vehicles, Light-Duty Trucks, etc. Includes links to Federal Register and final rule.
Department of Housing and Urban Development — The Resident Characteristics Report summarizes general information about households who reside in Public Housing, or who receive Section 8 assistance. The report...
Can 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
... foreign air carrier from liability for violations of the statute, nor shall the filing of a tariff, or... 14 Aeronautics and Space 4 2010-01-01 2010-01-01 false Carrier's duty. 221.2 Section 221.2... REGULATIONS TARIFFS General § 221.2 Carrier's duty. (a) Must file tariffs. (1) Except as provided in paragraph...
... EMISSIONS FROM MARINE COMPRESSION-IGNITION ENGINES Test Procedures § 94.105 Duty cycles. (a) Overview. For...) General cycle. Propulsion engines that are used with (or intended to be used with) fixed-pitch propellers, propeller-law auxiliary engines, and any other engines for which the other duty cycles of this section do...
... 34 Education 1 2010-07-01 2010-07-01 false IRB duties. 97.403 Section 97.403 Education Office of the Secretary, Department of Education PROTECTION OF HUMAN SUBJECTS Additional ED Protections for Children Who Are Subjects in Research § 97.403 IRB duties. In addition to other responsibilities assigned...
... Administrative Body § 930.31 Duties. The Board shall have, among others, the following duties: (a) To select such...) To adopt bylaws and to adopt such rules for the conduct of its business as it may deem advisable; (e... assessments for such period; (f) To keep minutes, books, and records which will reflect all of the acts and...
... committee may deem necessary or as the Secretary may request. The report of such audit shall show the... Handling Committee § 966.35 Duties. It shall be, among other things, the duty of the committee: (a) At the... be necessary, to select subcommittees of committee members, and to adopt such rules and regulations...
... committee may deem necessary or as the Secretary may request. The report of such audit shall show the... COUNTIES IN IDAHO, AND MALHEUR COUNTY, OREGON Order Regulating Handling Administrative Committee § 945.33 Duties. It shall be the duty of the committee: (a) To act as intermediary between the Secretary and any...
... committee may deem necessary or as the Secretary may request (the report of each such audit shall show the... GRANDE VALLEY IN TEXAS Order Regulating Handling Committee § 906.31 Duties. It shall be, among other things, the duty of the committee: (a) At the beginning of each term of office, to meet and organize, to...
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
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
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
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. Copyright © 2011 Elsevier Ltd. All rights reserved.
Feng, Xiaoxin (Inventor); Roper, Weston (Inventor); Seefeldt, James D. (Inventor)
In general, this disclosure is directed to a duty cycle correction (DCC) circuit that adjusts a falling edge of a clock signal to achieve a desired duty cycle. In some examples, the DCC circuit may generate a pulse in response to a falling edge of an input clock signal, delay the pulse based on a control voltage, adjust the falling edge of the input clock signal based on the delayed pulse to produce an output clock signal, and adjust the control voltage based on the difference between a duty cycle of the output clock signal and a desired duty cycle. Since the DCC circuit adjusts the falling edge of the clock cycle to achieve a desired duty cycle, the DCC may be incorporated into existing PLL control loops that adjust the rising edge of a clock signal without interfering with the operation of such PLL control loops.
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. © 2012 American Physical Society
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.
Nabavizadeh, Nima; Burt, Lindsay M; Mancini, Brandon R; Morris, Zachary S; Walker, Amanda J; Miller, Seth M; Bhavsar, Shripal; Mohindra, Pranshu; Kim, Miranda B; Kharofa, Jordan
The purpose of this project was to survey radiation oncology chief residents to define their residency experience and readiness for independent practice. During the academic years 2013 to 2014 and 2014 to 2015, the Association of Residents in Radiation Oncology (ARRO) conducted an electronic survey of post-graduate year-5 radiation oncology residents in the United States during the final 3 months of training. Descriptive statistics are reported. Sixty-six chief residents completed the survey in 2013 to 2014 (53% response rate), and 69 completed the survey in 2014 to 2015 (64% response rate). Forty to 85% percent of residents reported inadequate exposure to high-dose rate and low-dose rate brachytherapy. Nearly all residents in both years (>90%) reported adequate clinical experience for the following disease sites: breast, central nervous system, gastrointestinal, genitourinary, head and neck, and lung. However, as few as 56% reported adequate experience in lymphoma or pediatric malignancies. More than 90% of residents had participated in retrospective research projects, with 20% conducting resident-led prospective clinical trials and 50% conducting basic science or translational projects. Most chief residents reported working 60 or fewer hours per week in the clinical/hospital setting and performing fewer than 15 hours per week tasks that were considered to have little or no educational value. There was more than 80% compliance with Accreditation Council for Graduate Medical Education (ACGME) work hour limits. Fifty-five percent of graduating residents intended to join an established private practice group, compared to 25% who headed for academia. Residents perceive the job market to be more competitive than previous years. This first update of the ARRO chief resident survey since the 2007 to 2008 academic year documents US radiation oncology residents' experiences and conditions over a 2-year period. This analysis may serve as a valuable tool for those seeking to
In light of recent events that have raised ethical and legal dilemmas in the health care field, the author explains that nurses now have a duty to participate in the debate over these issues and to educate the public. The author, a staff nurse in the Abbott-Northwestern Hospital in Minneapolis, explains that the city has recently witnessed a series of events with ethical overtones that have captured national attention. In one case, the hospital sought judicial guidance on whether an 87-year-old comatose women--dependent on a ventilator for over a year--should continue to receive the costly and labor-intensive care simply because the family desired it. Although the hospital argued that continuing to provide care would only prolong a futile life, the court ruled that only the family could make the decision of whether or not to continue care. Coincidentally, around the same time as the court case, Minneapolis hosted the International Special Olympics, and event that brought together individuals with mental and physical disabilities for athletic competition. The event illustrated that there is no consensus on the definition of a futile life. In one other event that captured national headlines, 2 physicians admitted that they had continued to practice medicine despite knowing that they were infected with the AIDS virus. These disclosures heightened the debate over mandatory HIV testing for health care workers--especially for health care workers who perform invasive procedures. This debate has raised a number of issues: confidentiality, the safety of patients, as well as the safety of health care workers. The author explains that such issues of life and death are often drowned in emotionalism and public hysteria. Nurses have a duty to see that the public is educated.
Hosein Nejad, Hooman; Bagherabadi, Mehdi; Sistani, Alireza; Dargahi, Helen
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. 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. The results indicated that residents' attitude towards their teaching ability was improved significantly after participating in the workshop (pTeacher for emergency medicine residents resulted in favorable outcomes in the second evaluated level of Kirkpatrick'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
Wong, Roger Y; Roberts, J Mark
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. 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. 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. 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.
Bensimon, Cécile M; Smith, Maxwell J; Pisartchik, Dmitri; Sahni, Sachin; Upshur, Ross E G
Ever since the emergence of SARS, when we were reminded that the nature of health care practitioners' duty to care is greatly contested, it has remained a polarizing issue. Discussions on the nature and limits of health care practitioners' duty to care during disasters and public health emergencies abounds the literature, ripe with arguments seeking to ground its foundations. However, to date there has been little public engagement on this issue. This study involved three Townhall meetings held between February 2008 and May 2010 in three urban settings in Canada in order to probe lay citizens' views about ethical issues related to pandemic influenza, including issues surrounding the duty to care. Participants included Canadian residents aged 18 and over who were fluent in English. Data were collected through day-long facilitated group discussions using case scenarios and focus group guides. Participant's views were organized according to several themes, including the following main themes (and respective sub-themes): 1. Legitimate limits; a) competing obligations; and b) appeal to personal choice; and 2. Legitimate expectations; a) reciprocity; and b) enforcement and planning. Our findings show that participants moved away from categorical notions of the duty to care towards more equivocal and often normative views throughout deliberations. Our analysis contributes a better understanding of the constitutive nature of the duty to care, defined in part by taking account of public views. This broadened understanding can further inform the articulation of acceptable norms of duty to care and policy development efforts. What is more, it illustrates the urgent need for policy-makers and regulators to get clarity on obligations, responsibilities, and accountability in the execution of HCPs' duty to care during times of universal vulnerability. Copyright © 2012 Elsevier Ltd. All rights reserved.
Girgis, Fady; Miller, Jonathan P
Engaging residents across a multiyear training spectrum is challenging given the heterogeneity of experience and limited time available for educational activities. A "flipped classroom" model, in which residents prepare ahead of time for mentored topic discussions, has potential advantages. We implemented a curriculum consisting of topics distributed across the specialty. Weekly, each resident was randomly assigned to research a specific aspect of an assigned topic appropriate to his or her level of experience: junior residents about what characterizes each clinical entity, midlevel residents about when to intervene, and chief residents about how to administer treatment. Residents completed an anonymous survey 6 months after implementation. Board examination performance was assessed before and after implementation. A total of 12 residents participated in the program. Weekly, 1.75±0.40 hours were spent in preparation, with senior residents reporting less time than junior residents. All residents indicated that the accumulation of experience across 7 years of residency was a major advantage of this program, and all preferred it to lectures. Performance on the board examination significantly increased after implementation (from 316±36 to 468±45, pflipped classroom is a viable approach to resident education and is associated with increased engagement and improved performance using validated knowledge-assessment tools.
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...
Pettit, Jeffrey E; Dahdaleh, Nader S; Albert, Gregory W; Greenlee, Jeremy D
A great deal of time and resources go into the development and training of neurosurgeons. One area that has minimal literature and assessment is leadership development. Under the core competency of interpersonal and communication skills, the Accreditation Council for Graduate Medical Education has indicated that residents are expected to work effectively as a member or leader of a healthcare team. This article reveals how a structured leadership program was developed so that residents are better prepared for the role of chief resident and future leadership roles. Beginning in October 2006, residents attended a series of 1-hour workshops conducted monthly. Topics included leadership style, conflict management, effective feedback, team building, team leadership, motivation, and moving from peer to leader. A retrospective pretest was conducted at the end of the program. Residents reported a significant knowledge gain for the majority of topics. Resident comments indicated a greater awareness of the impact of leading and ways to improve their personal leadership. Quantitatively and qualitatively, residents and faculty reported that the leadership program made a significant impact on the development of future neurosurgical leaders.
2002; Min 2009b); and attitudes (Douglas & Swartz 2009). Thus, HOS may have different results than other safety regulations because it is not...Morrow 2002; Min 2009b); and attitudes (Douglas & Swartz 2009). This dissertation research incorporates this previous research and builds upon it by...of driving or duty hours in a given period. Unlike the permanent obsolescence of milk , which the U.S. Federal Drug Administration (FDA) prohibits
Jurisdiction turned out well to create a basic ruling for due diligence duties. These due diligence duties are high standards for the law of torts (outside of contracts) within the Austrian civil law and represent a liability-extension for the holder of the source of danger. They establish an action for injunction in particular for preventing (further) damages. Therewith due diligence duties get a general sense in the range of a civil law for environmental liability. The responsible holder of a danger zone will therefore influence his way of acting to protect potential victims and the environment. The burden of proof is on the plaintiff (victims) under the Civil Code. Victims have specific sources of danger including high endangering special facilities in their argumentation with the so-called prima-facie-proof or first-appearance-proof. A turning back of the presentation of evidence to the polluter is wrong. The polluter himself has a continuing liability for dangerous activities and his clerks in the case of an extremely high danger of damage. All due diligence duties can be arranged in three areas: in information-, danger-avoidance- and danger-prevention-duties. The determination of range and essence of the duties has to be adjusted to each individual case. The range of the specific danger area is the essential link. The intensity of due diligence duties is increasing with the size of danger in the way of a movable system depending on the protected interest. Due diligence duties have to be kept within reasonable limits with two criterions: necessarity and demand. Proportionality of actions is a third criterion to avoid exaggeration of due diligence duties to obtain an effective protection for victims including the environment. (author)
... revisited the HOS rules. The Commission considered testimony from oilfield equipment suppliers and operators... and oil industry, any period of 8 consecutive days may end with the beginning of any off-duty period... supporting the need to limit excessive hours of driving and work, which can lead to fatigued driving. The...
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
Leff, Daniel R; Aggarwal, Rajesh; Rana, Mariam; Nakhjavani, Batool; Purkayastha, Sanjay; Khullar, Vik; Darzi, Ara W
Research evaluating fatigue-induced skills decline has focused on acute sleep deprivation rather than the effects of circadian desynchronization associated with multiple shifts. As a result, the number of consecutive night shifts that residents can safely be on duty without detrimental effects to their technical skills remains unknown. A prospective observational cohort study was conducted to assess the impact of 7 successive night shifts on the technical surgical performance of junior residents. The interventional strategy included training 21 residents from surgery and allied disciplines on a virtual reality surgical simulator, towards the achievement of preset benchmark scores, followed by 294 technical skills assessments conducted over 1764 manpower night shift hours. Primary outcomes comprised serial technical skills assessments on 2 tasks of a virtual reality surgical simulator. Secondary outcomes included assessments of introspective fatigue, duration of sleep, and prospective recordings of activity (number of "calls" received, steps walked, and patients evaluated). Maximal deterioration in performance was observed following the first night shift. Residents took significantly longer to complete the first (P = 0.002) and second tasks (P = 0.005) compared with baseline. They also committed significantly greater numbers of errors (P = 0.025) on the first task assessed. Improved performance was observed across subsequent shifts towards baseline levels. Newly acquired technical surgical skills deteriorate maximally after the first night shift, emphasizing the importance of adequate preparation for night rotas. Performance improvements across successive shifts may be due to ongoing learning or adaptation to chronic fatigue. Further research should focus on assessments of both technical procedural skills and cognitive abilities to determine the rotas that best minimize errors and maximize patient safety.
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.
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.
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
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... Customs by the broker. (c) Claim against estate of importer. The claim of the Government for unpaid duties... 19 Customs Duties 2 2010-04-01 2010-04-01 false Liability of importer for duties. 141.1 Section 141.1 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND SECURITY; DEPARTMENT...
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... 19 Customs Duties 1 2010-04-01 2010-04-01 false Refunds of excess customs duties. 10.625 Section 10.625 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND SECURITY; DEPARTMENT... and Apparel Goods § 10.625 Refunds of excess customs duties. (a) Applicability. Section 205 of the...
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.
Al Achkar, Morhaf; Davies, M Kelly; Busha, Michael E; Oh, Robert C
Teaching has been increasingly recognized as a primary responsibility of residents. Residents enjoy teaching, and their majority report interest in the continuation of teaching activities after graduation. Resident-as-teacher programs have emerged nationally as a means of enhancing teaching skills. This study examined the current use of residents-as-teachers programs in family medicine residencies through a national survey of family medicine residency program directors. This survey project was part of the Council of Academic Family Medicine Education Research Alliance (CERA) 2014 survey to family medicine program directors that was conducted between February 2014 and May 2014. The response rate of the survey was 49.6% (224/451). The majority (85.8%) of residency programs offer residents formal instruction in teaching skills. The vast majority (95.6%) of programs mandated the training. The average total hours of teaching instruction residents receive while in residency training was 7.72. The residents are asked to formally evaluate the teaching instruction in 68.1% of the programs. Less than a quarter (22.6%) of residency programs offer the teaching instruction in collaboration with other programs. "Retreat, workshop, and seminars" were identified as the main form of instruction by 33.7% of programs. In 83.3% of programs not offering instruction, lack of resources was identified as the primary barrier. The majority of family medicine residency programs provide resident-as-teacher instructions, which reflects increasing recognition of importance of the teaching role of residents. Further research is needed to assess the effectiveness of such instruction on residents' teaching skills and their attitudes toward teaching.
Ishak, Waguih William; Lederer, Sara; Mandili, Carla; Nikravesh, Rose; Seligman, Laurie; Vasa, Monisha; Ogunyemi, Dotun; Bernstein, Carol A
Burnout is a state of mental and physical exhaustion related to work or care giving activities. Burnout during residency training has gained significant attention secondary to concerns regarding job performance and patient care. This article reviews the relevant literature on burnout in order to provide information to educators about its prevalence, features, impact, and potential interventions. Studies were identified through a Medline and PsychInfo search from 1974 to 2009. Fifty-one studies were identified. Definition and description of burnout and measurement methods are presented followed by a thorough review of the studies. An examination of the burnout literature reveals that it is prevalent in medical students (28%-45%), residents (27%-75%, depending on specialty), as well as practicing physicians. Psychological distress and physical symptoms can impact work performance and patient safety. Distress during medical school can lead to burnout, which in turn can result in negative consequences as a working physician. Burnout also poses significant challenges during early training years in residency. Time demands, lack of control, work planning, work organization, inherently difficult job situations, and interpersonal relationships, are considered factors contributing to residents' burnout. Potential interventions include workplace-driven and individual-driven measures. Workplace interventions include education about burnout, workload modifications, increasing the diversity of work duties, stress management training, mentoring, emotional intelligence training, and wellness workshops. Individual-driven behavioral, social, and physical activities include promoting interpersonal professional relations, meditation, counseling, and exercise. Educators need to develop an active awareness of burnout and ought to consider incorporating relevant instruction and interventions during the process of training resident physicians.
College Planning & Management, 2003
Describes four examples of residence hall design, one renovation and three new residence halls, that exemplify design principles that meet student and institutional requirements. The examples are at (1) the University of Illinois at Chicago; (2) Bowdoin College; (3) Muhlenberg College; and (4) Spring Arbor University. (SLD)
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)
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
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...... 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...
The in-training examination is a national and yearly exam administered by the American Board of Emergency Medicine to all emergency medicine residents in the USA. The purpose of the examination is to evaluate a resident's progress toward obtaining the fundamental knowledge to practice independent emergency medicine. The purpose of this study was to determine the effects of a 40 hour board review lecture course on the resident in-training examination in emergency medicine. A 40 hour board review lecture course was designed and implemented during the weekly 5 hour long resident conferences during the 8 weeks preceding the in-training examination date in 2006. Attendance was mandatory at the Accreditation Council for Graduate Medical Education (ACGME) standard of 70% or greater. A positive result was considered to be a 10% increase or greater in the resident's individual national class percentile ranking among their national peers for their class year for the emergency medicine in-training examination. A resident was excluded from the study if there was no 2005 in-training examination score for self-comparison. The 95% confidence intervals (CI) were used to analyze the results. Of 16 residents, 1 (6.25%; 95% CI: 0-18%) showed a positive result of increasing their national class percentile ranking by 10% or greater. For the PGY2, one of the eight had a positive result (12.5%; 95% CI: 0-35.4%). For PGY3, no resident (0%; 95% CI: 0-35.4%) had a positive result. A 40 hour board review lecture course has no positive effect on improving a resident's in-training examination score.
Johnson, E.H.; Hall, R.E.
Fitness for duty is a legal, moral, emotional, and political issue. It is therefore that type of issue that one would expect industry to run from, opting instead for government intervention and prescriptive regulations. This would allow the industry to hide behind the shield of doing what is necessary to comply. But fitness for duty is also a rational business issue. It involves getting a reasonable return on the investment in the people who are necessary to run the nuclear industry. It is within this context that the US Nuclear Regulatory Commission (NRC) has exercised its discretion to not undertake new rule making, instead giving the industry the mandate of pursuing this issue. The NRC has deferred rule making as long as the industry programs are effective in producing the desired results. The NRC has also retained the right to follow up on operational events and to evaluate the effectiveness of the programs in place. The industry, under the leadership of NUMARC, has risen to this challenge and has adopted the August 1985 Edison Electric Institute (EEI) fitness-for-duty program guidelines for implementation by all utilities. In evaluating the effectiveness of programs, the NRC is conducting inspections at some utilities. These inspections have confirmed that the EEI guidelines are being used as the basis for fitness-for-duty programs. Even though the nuclear industry has taken a generally strong stand on fitness for duty and has adopted reasonable guidelines for its assurance, there still remain several challenges
... AND IN-USE HIGHWAY VEHICLES AND ENGINES (CONTINUED) General Compliance Provisions for Control of Air Pollution From New and In-Use Light-Duty Vehicles, Light-Duty Trucks, and Complete Otto-Cycle Heavy-Duty.... Additionally, this section applies to hybrid electric vehicles (HEVs) and zero emission vehicles (ZEVs). Unless...
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.
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
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.
Discusses the necessity for incorporating current technology in today's college residence halls to meet the more diverse and continued activities of its students. Technology addressed covers data networking and telecommunications, heating and cooling systems, and fire-safety systems. (GR)
Illing, R.O.; Ingham Clark, C.L.; Allum, C.
Aim: To review the provision of out-of-hours interventional radiology (IR) services in the London Strategic Health Authority (SHA). Materials and methods: All 29 acute hospitals in the London SHA were contacted between November 2008 and January 2009. A questionnaire based on the Royal College of Radiologists (RCR) guidelines assessed the provision of out-of-hours IR services. An 'ad-hoc' service was defined as on-call provision where not all the radiologists could perform intervention: If IR was required out of hours, an interventionalist came in when off-duty or the patient was transferred. Results: Seventeen out of the 29 (59%) hospitals provided ad-hoc out-of-hours services, eight (28%) provided a 24-hour rota, and four (14%) provide no out-of-hours cover. No ad-hoc service had formal transfer arrangements to a centre providing a 24 h service. Only two hospitals providing a 24 h service had six radiologists on the rota. Conclusion: Strategic planning for out-of-hours IR across London is recommended. This is likely to be welcomed by the hospitals involved, allowing informal arrangements to be formalized, and collaboration to provide comprehensive regional networks, provided appropriate funding is made available. A national audit is recommended; it is unlikely these findings are unique to London.
Illing, R.O., E-mail: email@example.com [University College London Hospitals NHS Foundation Trust, 235 Euston Road, London NW1 2BU (United Kingdom); Ingham Clark, C.L.; Allum, C. [Whittington Hospital NHS Trust, London (United Kingdom)
Aim: To review the provision of out-of-hours interventional radiology (IR) services in the London Strategic Health Authority (SHA). Materials and methods: All 29 acute hospitals in the London SHA were contacted between November 2008 and January 2009. A questionnaire based on the Royal College of Radiologists (RCR) guidelines assessed the provision of out-of-hours IR services. An 'ad-hoc' service was defined as on-call provision where not all the radiologists could perform intervention: If IR was required out of hours, an interventionalist came in when off-duty or the patient was transferred. Results: Seventeen out of the 29 (59%) hospitals provided ad-hoc out-of-hours services, eight (28%) provided a 24-hour rota, and four (14%) provide no out-of-hours cover. No ad-hoc service had formal transfer arrangements to a centre providing a 24 h service. Only two hospitals providing a 24 h service had six radiologists on the rota. Conclusion: Strategic planning for out-of-hours IR across London is recommended. This is likely to be welcomed by the hospitals involved, allowing informal arrangements to be formalized, and collaboration to provide comprehensive regional networks, provided appropriate funding is made available. A national audit is recommended; it is unlikely these findings are unique to London.
Liu, Wenjin; Ye, Hong; Tang, Bing; Sun, Zhiping; Wen, Ping; Wu, Wenhui; Bian, Xueqing; Shen, Xia; Yang, Junwei
The two most commonly used strategies to evaluate dialysis patients' blood pressure (BP) level are 44-hour and 24-hour ambulatory blood pressure monitoring (ABPM). The objective of this study was to find an appropriate 24-hour period that correlated well with the 44-hour BP level and determine the differences between these strategies. In a group of 51 dialysis patients, the authors performed 44-hour ABPM and extracted data for a fixed 24-hour ABPM. The fixed 24-hour ABPM started at 6 am on the nondialysis day. A strong correlation was found between all parameters of 44-hour and the fixed 24-hour ABPM, with paired sample t test showing only small magnitude changes in a few parameters. Both 24-hour ABPM and 44-hour ABPM were superior to clinic BP in predicting left ventricular mass index (LVMI) by multiple regression analysis. It was found that 44-hour ambulatory arterial stiffness index (AASI), but not 24-hour AASI, had a positive association with LVMI (r=0.328, P=.021). However, after adjustment for 44-hour systolic blood pressure, this association disappeared. Fixed 24-hour ABPM is a good surrogate of 44-hour ABPM to some extent, while 44-hour ABPM can provide more accurate and detailed information. ©2013 Wiley Periodicals, Inc.
Rosen, Ilene M; Bellini, Lisa M; Shea, Judy A
Physicians-in-training are susceptible to fatigue given their prolonged duty hours. Sleep deprivation has been shown to alter perceptions of sleepiness and performance. This study examined the state of sleepiness and attitudes about sleep and performance of work- and non-work-related tasks among incoming and current housestaff; and how rotation, call cycle, and call status are related to acute and chronic sleep deprivation and perceptions of sleepiness. A survey instrument was administered in June 2001 to 53 incoming interns and 79 current housestaff at the University Pennsylvania School of Medicine, a university-based internal medicine residency program. All 132 participants (100%) completed the instrument. Acute sleep deprivation was experienced by 34% of the current housestaff and 64% of current housestaff were chronically sleep deprived. Current housestaff admitted to the possibility of dozing while performing various work-related tasks such as writing notes in charts (69%), reviewing medication lists (61%), interpreting labs (51%), and writing orders (46%). At least half of all respondents felt their patients received good care despite residents' sleepiness and as many believed sleep deprivation was a necessary part of training. Nearly half (48%) of current housestaff rotating on a ward service reported acute sleep deprivation, as did 81% of those who were postcall. Over two-thirds of the housestaff on wards and in the ICU reported chronic sleep deprivation. Subjective sleepiness did not vary much across rotations, call cycle, and call status. Chronic and acute sleep deprivation contribute to residents' fatigue. Education could be targeted at attitudes. Further investigation of factors contributing to chronic sleep deprivation in this population is warranted.
VanDenBerg, C; Murphy, J E
The level of work satisfaction among pharmacists in ASHP-accredited residencies was studied. In March 1996 a questionnaire designed to measure residency satisfaction was mailed to 697 individuals in ASHP-accredited pharmacy practice and specialty practice residencies. Subjects responded to 16 statements relating to intrinsic and extrinsic determinants of work satisfaction on a scale of 1 to 5, where 1 = strongly disagree and 5 = strongly agree. Questionnaires were returned by 413 (59%) of the residents. The respondents were predominantly women (76%), and most (86%) had at least a Pharm. D. degree. Hospitals were the primary work setting (88%). Of the 413 residents, 305 were in pharmacy practice residencies and 108 were in specialized residencies. None of the mean scores indicated disagreement (scores 3) with the negatively worded statements. The median and mode were equal to 2 (disagree) for the three negatively worded items and 4 (agree) for all but three positively worded items. Only 8% of the residents indicated that they would not accept the residency again if given the chance. Specialized residents tended to rate positively worded statements higher and negatively worded statements lower than pharmacy practice residents. Female residents indicated greater satisfaction than male residents. Pay and benefits were rated slightly better than neutral. Pharmacy residents appeared generally satisfied with their residencies. Specialized pharmacy residents were more satisfied than pharmacy practice residents, and women were more satisfied than men.
Khan, A B M S; Clark, Nigel N; Gautam, Mridul; Wayne, W Scott; Thompson, Gregory J; Lyons, Donald W
Idle emissions data from 19 medium heavy-duty diesel and gasoline trucks are presented in this paper. Emissions from these trucks were characterized using full-flow exhaust dilution as part of the Coordinating Research Council (CRC) Project E-55/59. Idle emissions data were not available from dedicated measurements, but were extracted from the continuous emissions data on the low-speed transient mode of the medium heavy-duty truck (MHDTLO) cycle. The four gasoline trucks produced very low oxides of nitrogen (NOx) and negligible particulate matter (PM) during idle. However, carbon monoxide (CO) and hydrocarbons (HCs) from these four trucks were approximately 285 and 153 g/hr on average, respectively. The gasoline trucks consumed substantially more fuel at an hourly rate (0.84 gal/hr) than their diesel counterparts (0.44 gal/hr) during idling. The diesel trucks, on the other hand, emitted higher NOx (79 g/hr) and comparatively higher PM (4.1 g/hr), on average, than the gasoline trucks (3.8 g/hr of NOx and 0.9 g/hr of PM, on average). Idle NOx emissions from diesel trucks were high for post-1992 model year engines, but no trends were observed for fuel consumption. Idle emissions and fuel consumption from the medium heavy-duty diesel trucks (MHDDTs) were marginally lower than those from the heavy heavy-duty diesel trucks (HHDDTs), previously reported in the literature.
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. Reprint & Copyright © 2015 Association of Military Surgeons of the U.S.
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...
Ng, Victor K; Burke, Clarissa A; Narula, Archna
To examine Canadian family medicine residents' perspectives surrounding teaching opportunities and mentorship in teaching. A 16-question online survey. Canadian family medicine residency programs. Between May and June 2011, all first- and second-year family medicine residents registered in 1 of the 17 Canadian residency programs as of September 2010 were invited to participate. A total of 568 of 2266 residents responded. Demographic characteristics, teaching opportunities during residency, and resident perceptions about teaching. A total of 77.7% of family medicine residents indicated that they were either interested or highly interested in teaching as part of their future careers, and 78.9% of family medicine residents had had opportunities to teach in various settings. However, only 60.1% of respondents were aware of programs within residency intended to support residents as teachers, and 33.0% of residents had been observed during teaching encounters. It appears that most Canadian family medicine residents have the opportunity to teach during their residency training. Many are interested in integrating teaching as part of their future career goals. Family medicine residencies should strongly consider programs to support and further develop resident teaching skills.
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.
This document defines the software requirements for the integrated control and data acquisition system of the Light Duty Utility Arm (LDUA) System. It is intended to be used to guide the design of the application software, to be a basis for assessing the application software design, and to establish what is to be tested in the finished application software product
... 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...
... AND ORDERS; MISCELLANEOUS COMMODITIES), DEPARTMENT OF AGRICULTURE WATERMELON RESEARCH AND PROMOTION PLAN Watermelon Research and Promotion Plan National Watermelon Promotion Board § 1210.328 Duties. The... Secretary may request; (m) To notify watermelon producers, handlers, and importers of all Board meetings...
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 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
... 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 shall...
The report is a collection of data concerning physical, operating, performance, and market characteristics of light duty trucks for the model years 1972 and 1975 thru 1977. The data is stored on tape in DOT/TSC DEC System 10 computer system. Informat...
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
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
... of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Marketing Agreements and... NEW MEXICO Administrative Committee § 983.45 Duties. The committee shall have, among others, the... of this part; (i) To investigate and assemble data on the growing, handling, shipping and marketing...
..., which are necessary in connection with the performance of its official duties; (d) To select, from among... of its anticipated expenditures and the recommended rate of assessment for the ensuing crop year, and... submit to the Secretary quarterly statements of the financial operations of the committee, exclusive of...
Awad, Samir S; Hayley, Barbara; Fagan, Shawn P; Berger, David H; Brunicardi, F Charles
Today's complex health care environment coupled with the 80-hour workweek mandate has required that surgical resident team interactions evolve from a military command-and-control style to a collaborative leadership style. A novel educational curriculum was implemented with objectives of training the residents to have the capacity/ability to create and manage powerful teams through alignment, communication, and integrity integral tools to practicing a collaborative leadership style while working 80 hours per week. Specific strategies were as follows: (1) to focus on quality of patient care and service while receiving a high education-to-service ratio, and (2) to maximize efficiency through time management. This article shows that leadership training as part of a resident curriculum can significantly increase a resident's view of leadership in the areas of alignment, communication, and integrity; tools previously shown in business models to be vital for effective and efficient teams. This curriculum, over the course of the surgical residency, can provide residents with the necessary tools to deliver efficient quality of care while working within the 80-hour workweek mandate in a more collaborative style environment.
Hourly meteorological data of both dry bulb temperature and relative humidity for 18 locations in Nigeria for the period 1995 to 2009 were analysed to obtain the mean monthly average and monthly hourly average of each of the two meteorological variables for each month for each location. The difference between the ...
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…
In the past surgical registrars were expected to work unusual- ly long hours. This was thought to provide better patient care, and to result in better registrar training. Junior doctors in the USA worked between 95 and 136 hours per week.1. The paradigm changed in 1984 after the death of Libby Zion in a New York hospital ...
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
... 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...
... 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...
Esposito, V.J.; Gutierrez, J.E.
One of the goals of the nuclear industry is to achieve economic performance such that nuclear power plants are competitive in a de-regulated market. The manner in which nuclear fuel is designed and operated lies at the heart of economic viability. In this sense reliability, operating flexibility and low costs are the three major requirements of the NPP today. The translation of these three requirements to the design is part of our work. The challenge today is to produce a fuel design which will operate with long operating cycles, high discharge burnup, power up-rating and while still maintaining all design and safety margins. European Fuel Group (EFG) understands that to achieve the required performance high duty/energy fuel designs are needed. The concerns for high duty design includes, among other items, core design methods, advanced Safety Analysis methodologies, performance models, advanced material and operational strategies. The operational aspects require the trade-off and evaluation of various parameters including coolant chemistry control, material corrosion, boiling duty, boron level impacts, etc. In this environment MAEF is the design that EFG is now offering based on ZIRLO alloy and a robust skeleton. This new design is able to achieve 70 GWd/tU and Lead Test Programs are being executed to demonstrate this capability. A number of performance issues which have been a concern with current designs have been resolved such as cladding corrosion and incomplete RCCA insertion (IRI). As the core duty becomes more aggressive other new issues need to be addressed such as Axial Offset Anomaly. These new issues are being addressed by combination of the new design in concert with advanced methodologies to meet the demanding needs of NPP. The ability and strategy to meet high duty core requirements, flexibility of operation and maintain acceptable balance of all technical issues is the discussion in this paper. (authors)
... Secretary, for Antidumping and Countervailing Duty Operations, through Melissa Skinner, Director, Office III... Duty Operations, through Melissa Skinner, Director, Office III Antidumping and Countervailing Duty..., Deputy Assistant Secretary, for Antidumping and Countervailing Duty Operations, through Melissa Skinner...
Gass, J. Ric
Discussed are concepts involved in legal liability for laboratory accidents. The focus of this article is on negligence, duty, and responsibility issues. Highlighted are the basis of a lawsuit, negligent tort, duty and breech of duty, and cause and harm. Thirty-one cases are cited. (CW)
... 7 Agriculture 3 2010-01-01 2010-01-01 false Heavy duty vacuum cleaners. 58.230 Section 58.230....230 Heavy duty vacuum cleaners. Each plant handling dry milk products shall be equipped with a heavy duty industrial vacuum cleaner. The vacuum cleaner shall be of a type that has a collector or...
Walker, Linda; Minchin, Anne; Pickard, Jane
The off duty or rostering system is an important part of managing any ward or department. This article looks at the issues that need to be considered when drawing up and managing off duty. It recommends standards for off-duty planning and shares the results of an audit carried out against some of these standards in one NHS trust.
... 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 ...
... International Trade Administration Antidumping Duty Order: Polyvinyl Alcohol From Taiwan AGENCY: Import... Department is issuing an antidumping duty order on polyvinyl alcohol (PVA) from Taiwan. DATES: Effective Date... value in the antidumping duty investigation of PVA from Taiwan. See Polyvinyl Alcohol From Taiwan: Final...
... 10 Energy 1 2010-01-01 2010-01-01 false Fitness-for-duty program. 26.21 Section 26.21 Energy NUCLEAR REGULATORY COMMISSION FITNESS FOR DUTY PROGRAMS Program Elements § 26.21 Fitness-for-duty program. The licensees and other entities specified in § 26.3(a) through (c) shall establish, implement, and...
... 29 Labor 3 2010-07-01 2010-07-01 false Fitness-for-duty certification. 825.312 Section 825.312... § 825.312 Fitness-for-duty certification. (a) As a condition of restoring an employee whose FMLA leave... provider to provide the information directly to the employer) in the fitness-for-duty certification process...
Cole, Stephanie; Arnold, Michelle; Sanderson, Alicia; Cupp, Craig
Pregnancy during graduate medical training became a pertinent issue in the United States during the 10-year interval between 1992 and 2002 as the number of female residents trended steadily upward to over 25 per cent. Surgical training programs characteristically present unique challenges and stressors for all trainees, and pregnancy introduces additional physical, professional, and emotional demands for the pregnant woman and her coworkers. A qualitative study was performed using in-person interviews of female otolaryngology residents who had given birth within the previous 12 months. Items addressed included the pregnancy course and its complications, specific stressors during and after pregnancy, and solutions implemented by the resident and her program director. Reactions and level of support from coworkers were also discussed. Five pregnancies were reported among three residents interviewed. One resident experienced preterm delivery, which necessitated a week-long stay in the neonatal intensive care unit for her infant. Another had chorioamnionitis during delivery of two infants. One child had low birth weight. The third resident had a miscarriage during the first trimester of her first pregnancy and sustained a minor head injury after fainting in the operating room during her second pregnancy. Overall, long hours, unpredictable work demands, and guilt over colleagues' increased workloads and altered schedules were noted as significant sources of stress among these residents; the women also described high expectations of themselves, along with misgivings over their ability to balance pregnancy and parenthood with career demands. The most significant postpartum stress indicator was the matter of child care, especially as it related to finding adequate coverage for on-call periods ranging from 3 to 14 days per month. Maintaining breastfeeding was an additional concern in the postpartum period. Pregnancy during surgical residency is a significant source of
Singh-Manoux, Archana; Ferrie, Jane E.; Gimeno, David; Marmot, Michael G.; Elovainio, Marko; Jokela, Markus; Vahtera, Jussi; Kivimäki, Mika
This study examined the association between long working hours and cognitive function in middle age. Data were collected in 1997–1999 (baseline) and 2002–2004 (follow-up) from a prospective study of 2,214 British civil servants who were in full-time employment at baseline and had data on cognitive tests and covariates. A battery of cognitive tests (short-term memory, Alice Heim 4-I, Mill Hill vocabulary, phonemic fluency, and semantic fluency) were measured at baseline and at follow-up. Compared with working 40 hours per week at most, working more than 55 hours per week was associated with lower scores in the vocabulary test at both baseline and follow-up. Long working hours also predicted decline in performance on the reasoning test (Alice Heim 4-I). Similar results were obtained by using working hours as a continuous variable; the associations between working hours and cognitive function were robust to adjustments for several potential confounding factors including age, sex, marital status, education, occupation, income, physical diseases, psychosocial factors, sleep disturbances, and health risk behaviors. This study shows that long working hours may have a negative effect on cognitive performance in middle age. PMID:19126590
In recent years, teachers' increased workloads have become an issue for policy, and have been multiply pointed out, deriving as they do from peripheral duties such as paperwork, in academic research as well. However, these mentions have not been based on sufficiently solid proof. Here, this paper compares teacher working hours surveys extant from…
Trinkoff, Alison M; Storr, Carla L; Lerner, Nancy B; Yang, Bo Kyum; Han, Kihye
To examine the relationship between certified nursing assistant (CNA) training requirements and resident outcomes in U.S. nursing homes (NHs). The number and type of training hours vary by state since many U.S. states have chosen to require additional hours over the federal minimums, presumably to keep pace with the increasing complexity of care. Yet little is known about the impact of the type and amount of training CNAs are required to have on resident outcomes. Compiled data on 2010 state regulatory requirements for CNA training (clinical, total initial training, in-service, ratio of clinical to didactic hours) were linked to 2010 resident outcomes data from 15,508 NHs. Outcomes included the following NH Compare Quality Indicators (QIs) (Minimum Data Set 3.0): pain, antipsychotic use, falls with injury, depression, weight loss and pressure ulcers. Facility-level QIs were regressed on training indicators using generalized linear models with the Huber-White correction, to account for clustering of NHs within states. Models were stratified by facility size and adjusted for case-mix, ownership status, percentage of Medicaid-certified beds and urban-rural status. A higher ratio of clinical to didactic hours was related to better resident outcomes. NHs in states requiring clinical training hours above federal minimums (i.e., >16hr) had significantly lower odds of adverse outcomes, particularly pain falls with injury, and depression. Total and in-service training hours also were related to outcomes. Additional training providing clinical experiences may aid in identifying residents at risk. This study provides empirical evidence supporting the importance of increased requirements for CNA training to improve quality of care. © The Author 2016. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: firstname.lastname@example.org.
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.
... 40 Protection of Environment 19 2010-07-01 2010-07-01 false Tables for Production Compliance Auditing of Heavy-Duty Engines and Heavy-Duty Vehicles, Including Light-Duty Trucks XII Appendix XII to... Appendix XII to Part 86—Tables for Production Compliance Auditing of Heavy-Duty Engines and Heavy-Duty...
Heikkila, Katriina; Nyberg, Solja T.; Madsen, Ida E. H.
per week was associated with 1.60-fold (95% confidence interval 1.12–2.29) increase in female breast cancer risk independently of age, socioeconomic position, shift- and night-time work and lifestyle factors, but this observation may have been influenced by residual confounding from parity......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...
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...
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...
Brodsky, C M
The above examples illustrate the complex of biologic, psychological, and social factors that result in a fitness for duty referral. Workplace needs set the tolerance limits within which the worker must operate. They are different for a police officer, for a correctional officer, for a schoolteacher, and for a school custodian. Tolerance limits are affected by factors out of the employer's control, e.g., civil service rules, union contracts, and by the culture of the workplace, the latter being a set of unwritten rules. Ideally, the psychiatrist who performs the fitness for duty examination would have all of the information described above, but in most cases does not. The psychiatrist who has this information can begin to put in place one part of the mosaic that is the ethnography of work.
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.
Rodriguez Lien, Elizabeth; Shattuck, Karen
Breastfeeding education is known to be insufficient in pediatric (PEDS) training and is, in part, responsible for suboptimal rates of breastfeeding. No recent studies about the level of education provided to family medicine (FM) and obstetrics-gynecology (OB) residency trainees are available. This study was conducted to investigate breastfeeding education and support services provided to FM and OB residents in the United States. The results were compared with a 2011 study of PEDS residents. A cross-sectional study was conducted using a web-based survey emailed to program directors (PDs) of FM and OB residency programs in the United States. Eighteen percent of PDs (95 of 515) completed the survey. Of these, 88% answered questions regarding education and support services provided. A median of 23 hours of breastfeeding education is provided to OB residents (4-year program) and 8 hours provided to FM residents (3-year program). In comparison, PEDS programs reported a median of 9 hours. The most commonly used settings included lectures with faculty and lactation consultants, similar to the PEDS study. Approximately 75% of respondents cited barriers to educating residents, with limited resident time being the most common. Eighty-one percent of respondents identified breastfeeding rooms as the service most frequently provided to residents who breastfeed. FM and PEDS residents are provided similar amounts of breastfeeding education, while OB programs provide more education, but in different settings. Reported barriers to this education are similar in all specialties. Support services are more commonly provided in PEDS programs.
Song, S.; Xue, J.
With the development of the performance of GNSS, the hourly updated orbit and clock of GNSS are paid much more attention and used by more and more users because of the timeliness and high accuracy. The hourly GNSS orbit and clock are produced routinely in Shanghai Analysis Center(AC) of the International GNSS Monitoring and Assessment Service (iGMAS).In this article, the accuracy of hourly and 6-hourly updated ultra-rapid GPS,GLONASS,GALILEO,BDS orbit and clock (SHU1 and SHU6) are analyzed relative to the final production in detail. The analysis show that, in calculation session, there's no much difference between the mean SHU1 and SHU6 RMS and STD for GNSS orbit and clock. However, for BDS clock in prediction session, the RMS and STD of BDS SHU1 are 2.6ns and 0.5ns respectively, the RMS of BDS SHU6 increase from 2.7ns to 4.5ns from the 1st to the 6th hour prediction session, but there's no much changes of STD. For GPS clock in prediction session, the RMS and STD of GPS SHU1 is quite stable with 0.5ns and 0.2ns.The RMS of GPS SHU6 clock increase from 0.6ns to 1.0ns from the 1st to the 6th hour, but STD is stable at about 0.2ns.For the orbit in calculate session, the RMS of BDS SHU1 is a little less than that of SHU6,the RMS of GPS SHU1 and SHU6 orbit are approximately at the same level. In prediction session, the RMS of IGSO/MEO for BDS SHU1 is relative stable, but the RMS of SHU6 1st-6th hour prediction session increase from about 26.5cm to 32.7cm. The RMS of GPS SHU1 orbit's prediction session is about 3.4cm,but which increase from 3.3cm to 4.3cm for GPS SHU6 1st-6th hour prediction session.The comparison of GLONASS and GALILEO orbit and clock also will be described.The results show that the hourly update is more important for BDS at this stage.Moreover,some problems appearing in satellites and stations can be found earlier by 1 hourly updated frequency.
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
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.
van Vendeloo, Stefan N; Godderis, Lode; Brand, Paul L P; Verheyen, Kees C P M; Rowell, Suria A; Hoekstra, Harm
Although burnout is viewed as a syndrome rooted in the working environment and organizational culture, the role of the learning environment in the development of resident burnout remains unclear. We aimed to evaluate the association between burnout and the learning environment in a cohort of Belgian residents. We conducted a cross-sectional online survey among residents in a large university hospital in Belgium. We used the Dutch version of the Maslach Burnout Inventory (UBOS-C) to assess burnout and the Dutch Residency Educational Climate Test (D-RECT) to assess the learning environment. A total of 236 residents (29 specialties) completed the survey (response rate 34.6%), of which 98 (41.5%) met standard criteria for burnout. After multivariate regression analysis adjusting for hours worked per week, quality of life and satisfaction with work-life balance, we found an inverse association between D-RECT scores and the risk of burnout (adjusted odds ratio; 0.47 for each point increase in D-RECT score; 95% CI, 0.23 - 0.95; p = 0.01). Resident burnout is highly prevalent in our cohort of Belgian residents. Our results suggest that the learning environment plays an important role in reducing the risk of burnout among residents.
Kaderli, R; Businger, A; Oesch, A; Stefenelli, U; Laffer, U
Work-hour regulations for residency programmes in Switzerland, including a 50-hour weekly limit, were set in on 1 January 2005. Patient safety was one of the major arguments for the implementation. As the effect of the restriction of residency work hours on patient care in Switzerland has not yet been evaluated on objective data, the aim of the present study was to assess its impact by comparing the patients' morbidity and mortality before (2001-2004) and after (2005-2008) the implementation. Retrospective analysis of records of the Spitalzentrum Biel AG, a large referral center classified according to the Swiss Medical Association, collected in the database of the Association for Quality Assurance in Surgery (AQC), a prospective database of consecutive patients undergoing surgical procedures in Switzerland. A selection of 2,686 patients with common surgeries, operated on by residents, was performed. There were 1,259 (46.9%) patients meeting our inclusion criteria who were admitted during the period before introduction of work-hour limitation and 1,427 (53.1%) patients after introduction. The in-hospital mortality and postoperative surgical complication rate were significantly higher after the reform (p limitation implemented in Switzerland was not associated with surgical patient safety measure improvement for common surgeries (i.e., morbidity and mortality rate). Further research on a nationwide basis is needed to assess the value of the higher surgical complication and mortality rate.
Flarup, Lone; Moth, Grete; Christensen, Morten Bondo
little is known about the reasons for encounter, the performed clinical work and the patient perspectives. MATERIAL AND METHODS: During a one-year period (2010- 2011), data on patient contacts were collected using pop-up questionnaires integrated into the existing IT system. The questions explored......INTRODUCTION: The primary care out-of-hours (OOH) service is of considerable importance; it is the main provider of freely accessible medical advice outside daytime hours, and it covers 75% of the active time in the healthcare system. Although the OOH handles three million contacts annually, only...... the contents and characteristics of patient contacts. A paper-based questionnaire was sent to the included patients. RESULTS: Of all 700 general practitioners (GP) on duty, 383 (54.7%) participated at least once, and the participating GPs were representative of all GPs. In total, 21,457 contacts were...
Chou, D C; Rosen, D M; Cario, G M; Carlton, M A; Lam, A M; Chapman, M; Johns, C
We assessed the feasibility of safe discharge home within 24 hours following laparoscopic hysterectomy in 30 patients who met the inclusion criteria and consented to be enrolled in the study group. Patients were admitted on the day of their surgery with the expectation of discharge within 24 hours. Appropriate home nursing follow-up and phone contact by the surgical team were organized preoperatively. Inclusion criteria were: age 30-65 years, absence of any major medical history that would require prolonged hospitalization, availability of home support for the first 48 hours after discharge and presence of a working telephone line and an address within the area of the Community Home Nursing service. All 30 operative procedures were completed without incident. Six patients underwent total laparoscopic hysterectomy (TLH) (all the procedures of hysterectomy being performed laparoscopically including the suturing of uterine arteries, colpotomy and closure of the vaginal vault. The uterus was removed vaginally) and 24 patients underwent laparoscopic hysterectomy (LH) (this techniques differs from TLH in that the colpotomy was performed laparoscopically but the uterosacral ligaments were divided vaginally and the vault also was closed vaginally after the uterus was removed vaginally). The average operating time was 115 minutes (range 85-150 minutes) and the average blood loss was 97 mL (20-250 mL). There were no intraoperative complications, no requirement for transfusion and no readmission to hospital for any of the patients in the study. Postoperative complications were minor (umbilical cellulitis (1), intestinal colic (1)) and both were treated with resolution of the symptoms. Ninety per cent of patients in the study were discharged within 24 hours of their surgery, the average duration of stay being 22.9 hours (20-24 hours). Three patients were not fit for discharge at 24 hours postoperatively due to general lethargy, migraine and nausea; their average discharge time
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.
Kasi, Pashtoon Murtaza; Khawar, Talha; Khan, Farooq Hasan; Kiani, Jawad Ghazanfar; Khan, Umber Zaheer; Khan, Hadi Mohammad; Khuwaja, Urooj Bakht; Rahim, Musa
The growing debate regarding long working hours of postgraduate trainees has been receiving considerable attention recently. This greater workload contributes to increasing stress. Our objective was to specifically study the association between long working hours, stress and the greater use of 'maladaptive' coping strategies. A cross-sectional descriptive study was carried out on all interns and residents at the Aga Khan University Hospital during February to May, 2005. Level of stress was measured by use of General Health Questionnaire (GHQ-12) and the use of maladaptive coping mechanisms through Brief Cope-28. 55.1% scored over the threshold for mild stress i.e. GHQ > 3, while more than 46% of the trainees scored over the threshold of more than 4 for morbid stress. Trainees under stress reported more working hours on average as compared to those not under stress, 83.8 and 74.7 hours respectively. At the same time, those working for longer hours were more likely to have used these negative coping mechanisms, which would further contribute to more stress rather than relieving it. Significant levels of stress have been identified. Along with this, those working for longer hours were more likely to have used these negative coping mechanisms. Reduction of working hours is important. Simultaneously, interventions need to be planned at imparting knowledge, awareness and skills to cope with various kinds of stressors encountered by a trainee during his/her training. Additionally, limits need to be devised for the working hours of the trainees.
Full Text Available Is the civic duty to report crime and corruption a genuine moral duty? After clarifying the nature of the duty, I consider a couple of negative answers to the question, and turn to an attractive and commonly held view, according to which this civic duty is a genuine moral duty. On this view, crime and corruption threaten political stability, and citizens have a moral duty to report crime and corruption to the government in order to help the government’s law enforcement efforts. The resulting duty is triply general in that it applies to everyone, everywhere, and covers all criminal and corrupt activity. In this paper, I challenge the general scope of this argument. I argue that that the civic duty to report crime and corruption to the authorities is much narrower than the government claims and people might think, for it only arises when the state (i condemns genuine wrongdoing and serious ethical offenses as “crime” and “corruption,” and (ii constitutes a dependable “disclosure recipient,” showing the will and power to hold wrongdoers accountable. I further defend a robust duty to directly report to the public—one that is weightier and wider than people usually assume. When condition (ii fails to obtain, I submit, citizens are released of the duty to report crime and corruption to the authorities, but are bound to report to the public, even when the denunciation targets the government and is risky or illegal.
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...
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.
... Provisions for Control of Air Pollution From New and In-Use Light-Duty Vehicles, Light-Duty Trucks, and..., including multi-fuel vehicles, vehicles fueled with alternative fuels, hybrid electric vehicles, plug-in hybrid electric vehicles, electric vehicles, and fuel cell vehicles. Unless otherwise specified, multi...
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...
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.
Cabrera, Alvin R; Lee, W Robert; Madden, Richard; Sims, Ershela; Hoang, Jenny K; White, Leonard E; Marks, Lawrence B; Chino, Junzo P
Radiation oncologists require a thorough understanding of anatomy, but gross anatomy is not part of the standard residency curriculum. "Oncoanatomy" is an educational program for radiation oncology residents at Duke University that integrates cadaver dissection into the instruction of oncologic anatomy, imaging, and treatment planning. In this report, the authors document their experience with a 2-year curriculum. Nineteen radiation oncology residents from Duke University and the University of North Carolina participated during academic years 2008-2009 and 2009-2010. Monthly modules, based on anatomic site, consisted of one or two clinically oriented hour-long lectures, followed by a 1-hour gross anatomy session. Clinical lectures were case based and focused on radiographic anatomy, image segmentation, and field design. Gross anatomy sessions centered on cadaver prosections, with small groups rotating through stations at which anatomists led cadaver exploration. Adjacent monitors featured radiologic imaging to facilitate synthesis of gross anatomy with imaging anatomy. Satisfaction was assessed on a 10-point scale via anonymous survey. Twenty modules were held over the 2-year period. Participants gave the course a median rating of 8 (interquartile range, 7-9), with 1 signifying "as effective as the worst educational activities" and 10 "as effective as the best educational activities." High resident satisfaction was seen with all module components. Incorporating a structured, 2-year gross anatomy-based curriculum into radiation oncology residency is feasible and associated with high resident satisfaction. Copyright © 2011 American College of Radiology. Published by Elsevier Inc. All rights reserved.
Guglielmo Maria Caporale; Luis A. Gil-Alana
This paper analyses monthly hours worked in the US over the sample period 1939m1 – 2011m10 using a cyclical long memory model; this is based on Gegenbauer processes and characterised by autocorrelations decaying to zero cyclically and at a hyperbolic rate along with a spectral density that is unbounded at a non-zero frequency. The reason for choosing this specification is that the periodogram of the hours worked series has a peak at a frequency away from zero. The empirical results confirm th...
Bivona, S.; Leone, C. [Palermo Univ., Dip di Fisica e Technologie Relative, Palermo (Italy); Burlon, R. [Palermo Univ., Dip. di Ingegnaria Nucleare, Palermo (Italy)
The hourly average wind speed data recorded by CNMCA (Centro Nazionale di Meteorologia e Climatologia Aeronautica) have been used to study the statistical properties of the wind speed at nine locations on Sicily. By grouping the observations month by month, we show that the hourly average wind speed, with calms omitted, is represented by a Weibull function. The suitability of the distribution is judged by the discrepancies between the observed and calculated values of the monthly average wind speed and of the standard deviation. (Author)
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.
Graham, Lisa A.; Belisle, Sheri L.; Rieger, Paul
Nitrous oxide (N 2O) emissions measurements were made on light duty gasoline and light duty diesel vehicles during chassis dynamometer testing conducted at the Environment Canada and California Air Resources Board vehicle emissions laboratories between 2001 and 2007. Per phase and composite FTP emission rates were measured. A subset of vehicles was also tested using other driving cycles to characterize emissions as a function of different driving conditions. Vehicles were both new (automobile and light duty truck is not significant for any of the emission standards represented by the test fleet and the distinction between new and aged catalyst is significant for vehicles meeting all emission standards but Tier 2. This is likely due to the relatively low mileage accumulated by the Tier 2 vehicles in this study as compared to the durability requirement of the standard. The FTP composite N 2O emission factors for gasoline vehicles meeting emission standards more stringent than Tier 1 are substantially lower than those currently used by both Canada and the US for the 2005 inventories. N 2O emission factors from test cycles other than the FTP illustrate the variability of emission factors as a function of driving conditions. N 2O emission factors are shown to strongly correlate with NMHC/NMOG emission standards and less strongly with NO X and CO emission standards. A review of several published reports on the effect of gasoline sulfur content on N 2O emissions suggests that additional research is needed to adequately quantify the increase in N 2O emissions as a function of fuel sulfur.
Almajwal, Ali M
To investigate the association between stress, shift work, and eating behavior among non-Saudi female nurses working in Central Saudi Arabia. A sample of 395 non-Saudi female nurses from 2 major hospitals in Riyadh, Kingdom of Saudi Arabia participated in this cross-sectional study. The nurses completed a questionnaire from November 2013 to January 2014 that included items relating to stress and eating behavior using the Dutch Eating Behavior Questionnaire (DEBQ). The questionnaire also contained items pertaining to socio-demographic data, body mass index, shift work, and hours worked per week. For all eating styles, stress, and shift duty influenced the amount of food nurses consumed, but was more significant under a restrained eating style. Under this eating style, a significantly higher percentage of nurses reported eating more fast food, snacks, and binging, while fruits and vegetables were the least likely to be eaten under stress. High stressed nurses were more likely to present with abnormal restrained eating (odds ratio [OR]=1.52, p=0.004), emotional (OR=1.24; p=0.001), and external (OR=1.21; p=0.001) DEBQ scores. Working nighttime shift duty was positively associated with restrained eating (OR=1.53; p=0.029) and emotional eating (OR=1.24; p=0.001), but negatively associated with external eating (OR=0.45; p=0.001). Our findings suggest that stress and shift duty were associated with eating habits.
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 general 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
Shedd, Jessica M.
Traces the history of the student credit hour, designed at the end of the 19th century to translate high school work to college admissions officers. It was expanded to higher education to record elective course work and became widespread in response to calls to document workload and institutional productivity. (SLD)
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.
... period long enough to provide restorative sleep regardless of the number of hours worked prior to the... split into two periods, what is the minimum time in each period necessary to provide restorative sleep... periods during the work day improve driver alertness in the operation of a CMV? How long should these rest...
..., training, or pre-shift briefings for special evolutions; and holdovers for interviews needed for event... of this subpart, a break is defined as an interval of time that falls between successive work periods... shall— (1) Review the actual work hours and performance of individuals who are subject to this section...
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
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…
To demonstrate the effect of ethics education on a resident's ability to answer questions that relate to moral dilemmas and on the clinical evaluations of residents by faculty. The curriculum for the ethics education that was used for this study was designed by the author and consisted of 10 lectures of 1.5 hours each. Five residencies were included in the project. One residency received one lecture, two residencies received three lectures, and two residencies received 10 lectures. To evaluate the moral skills of the residents at the beginning of the course and at the end, the residents were given the Defining Issues Test (DIT-2) developed by James Rest, which involves answering standardized questions about four moral dilemmas. Faculty evaluations were completed before and after the ethics lectures were given. At the beginning of the ethics course, each resident was given a social survey that was designed to assess participation in community, religious, political, and societal activities as well as attitudes about these activities. All residents were also asked demographic information, including their age, gender, and year of residency. The results of the DIT-2 taken before and after the ethics lectures were compared. No correlations were found in faculty evaluations of clinical performance of the residents before and after the course (P = .052). Associations between DIT-2 scores and questions on community and religion in the social survey were noted. The finding that the effect of an ethics course on residents' ability to answer moral dilemmas did not achieve statistical significance should be accepted with the understanding that this was a first attempt at standardization of many variables, especially the format of the curriculum and materials used. The use of faculty evaluations to assess clinical performance needs to be standardized, and the faculty members need additional training to ensure validity of the results. The social survey was also the first attempt
Davidoff, Ian; Leigh, Andrew
Land transfer taxes are a substantial portion of the cost of moving house in many developed countries. Since stamp duties are endogenous with respect to the house price, we create an instrumental variable that is the stamp duty on a property, given that postcode's starting house price and the national house price trend. In a specification with postcode and year fixed effects, this instrument effectively captures policy changes and nonlinearities in the stamp duty schedule. We find that the im...
... 29 Labor 9 2010-07-01 2010-07-01 false Investment duties. 2550.404a-1 Section 2550.404a-1 Labor... FIDUCIARY RESPONSIBILITY § 2550.404a-1 Investment duties. (a) In general. Section 404(a)(1)(B) of the... use in the conduct of an enterprise of a like character and with like aims. (b) Investment duties. (1...
... 48 Federal Acquisition Regulations System 3 2010-10-01 2010-10-01 false Duty-free entry. 252.225... Clauses 252.225-7013 Duty-free entry. As prescribed in 225.1101(4), use the following clause: Duty-Free Entry (DEC 2009) (a) Definitions. As used in this clause— (1) “Component” means any item supplied to the...
Gulseth, Oeystein Arff; Fjeld-Nielsen, Siri
The regulatory framework concerning the new excise duty appears as complex and unfinished, raising more questions than providing answers. The duty will entail a significant expense item for the businesses liable to register and it is therefore important to have an overview of how the regulatory framework should be understood. Errors made since 1 January 2007 may lead to future reassessments of duties, with interest (author) (ml)
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
Cohen, Elaine R.; Caprio, Timothy; McGaghie, William C.; Simuni, Tanya; Wayne, Diane B.
Objective: To evaluate the effect of simulation-based mastery learning (SBML) on internal medicine residents' lumbar puncture (LP) skills, assess neurology residents' acquired LP skills from traditional clinical education, and compare the results of SBML to traditional clinical education. Methods: This study was a pretest-posttest design with a comparison group. Fifty-eight postgraduate year (PGY) 1 internal medicine residents received an SBML intervention in LP. Residents completed a baseline skill assessment (pretest) using a 21-item LP checklist. After a 3-hour session featuring deliberate practice and feedback, residents completed a posttest and were expected to meet or exceed a minimum passing score (MPS) set by an expert panel. Simulator-trained residents' pretest and posttest scores were compared to assess the impact of the intervention. Thirty-six PGY2, 3, and 4 neurology residents from 3 medical centers completed the same simulated LP assessment without SBML. SBML posttest scores were compared to neurology residents' baseline scores. Results: PGY1 internal medicine residents improved from a mean of 46.3% to 95.7% after SBML (p < 0.001) and all met the MPS at final posttest. The performance of traditionally trained neurology residents was significantly lower than simulator-trained residents (mean 65.4%, p < 0.001) and only 6% met the MPS. Conclusions: Residents who completed SBML showed significant improvement in LP procedural skills. Few neurology residents were competent to perform a simulated LP despite clinical experience with the procedure. PMID:22675080
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.
Full Text Available http://dx.doi.org/10.5007/1808-1711.2012v16n1p147 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.
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. Copyright © 2013 Elsevier Ltd. All rights reserved.
Hilditch, Cassie J; Short, Michelle; Van Dongen, Hans P A; Centofanti, Stephanie A; Dorrian, Jillian; Kohler, Mark; Banks, Siobhan
Sleep inertia is a safety concern for shift workers returning to work soon after waking up. Split duty schedules offer an alternative to longer shift periods, but introduce additional wake-ups and may therefore increase risk of sleep inertia. This study investigated sleep inertia across a split duty schedule. Sixteen participants (age range 21-36 years; 10 females) participated in a 9-day laboratory study with two baseline nights (10 h time in bed, [TIB]), four 24-h periods of a 6-h on/6-h off split duty schedule (5-h TIB in off period; 10-h TIB per 24 h) and two recovery nights. Two complementary rosters were evaluated, with the timing of sleep and wake alternating between the two rosters (2 am/2 pm wake-up roster versus 8 am/8 pm wake-up roster). At 2, 17, 32 and 47 min after scheduled awakening, participants completed an 8-min inertia test bout, which included a 3-min psychomotor vigilance test (PVT-B), a 3-min Digit-Symbol Substitution Task (DSST), the Karolinska Sleepiness Scale (KSS), and the Samn-Perelli Fatigue Scale (SP-Fatigue). Further testing occurred every 2 h during scheduled wakefulness. Performance was consistently degraded and subjective sleepiness/fatigue was consistently increased during the inertia testing period as compared to other testing times. Morning wake-ups (2 am and 8 am) were associated with higher levels of sleep inertia than later wake-ups (2 pm and 8 pm). These results suggest that split duty workers should recognise the potential for sleep inertia after waking, especially during the morning hours.
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...... 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...
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...... 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...
Planned Parenthood of Houston and southeast Texas is currently implementing a reproductive health care clinic with night-time hours. The clinic provides for the reproductive health care needs of college students with after-class jobs, women with two jobs or with night-shift employment, and all other women who do not have time to go to a daytime clinic. The clinic operates twice a month on Fridays and was initially open 10:30 p.m. - 7 a.m., but now it has changed its hours to 7:30 p.m. - 3:30 a.m. The clinic is staffed by one clinician and two clinic assistants, which attend to an average of 17-22 patients per night's schedule. Women who use the clinic keep their appointments better and do not have to wait so long for care.
Alofisan, Tariq; Al-Alaiyan, Saleh; Al-Abdulsalam, Moath; Siddiqui, Khawar; Hussain, Ibrahim Bin; Al-Qahtani, Mohammad H
Good communication skills and rapport building are considered the cardinal tools for developing a patient-doctor relationship. A positive, healthy competition among different health care organizations in Saudi Arabia underlines an ever increasing emphasis on effective patient-doctor relationship. Despite the numerous guidelines provided and programs available, there is a significant variation in the acceptance and approach to the use of this important tool among pediatric residents in this part of the world. To determine pediatric residents' attitude toward communication skills, their perception of important communication skills, and their confidence in the use of their communication skills in the performance of their primary duties. A cross-sectional study was conducted among all pediatrics trainee residents working in 13 different hospitals in Saudi Arabia. A standardized self-administered questionnaire developed by the Harvard Medical School was used. A total of 297 residents out of all trainees in these centers participated in the data collection. The 283 (95%) residents considered learning communication skills a priority in establishing a good patient-doctor relationship. Thirty four percent reported being very confident with regard to their communication skills. Few residents had the skills, and the confidence to communicate with children with serious diseases, discuss end-of-life issues, and deal with difficult patients and parents. Pediatric residents perceive the importance of communication skills and competencies as crucial components in their training. A proper comprehensive communication skills training should be incorporated into the pediatric resident training curriculum.
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...
Robbins, Riann; Sullivan, Sarah; Smith, Brigitte
The Accreditation Council for Graduate Medical Education mandates scheduled didactics for residency programs but allows flexibility in implementation. Work-hour restrictions, patient care duties, and operative schedules create barriers to attendance for surgical trainees. We explored vascular surgery trainees and faculty perceptions on trainees operative preparation and participation, and overall fund of knowledge after implementing an academic half day conference (AHD) schedule. The vascular surgery conference at a single academic institution was changed from three 1-hour conferences weekly, to a single protected, 3-hour conference once weekly. Faculty and trainees were surveyed before and 5 months after implementing the new AHD schedule. Overall satisfaction improved after initiating the AHD (4 of 4 trainees, 3 of 4 faculty). All trainees (n = 4) and faculty (n = 4) believed the AHD conference format was worthwhile. Most trainees believed the AHD format improved their Vascular Surgery in Service Training Exam preparation (3 of 4), fund of knowledge (4 of 4), and operative preparation (3 of 4). More trainees than faculty tended to feel that the AHD interfered with operative participation (3 of 4 trainees vs 1 of 4 faculty). Neither group agreed that the conference was optimally scheduled. This single-institution, pilot study suggests a positive association in the attitudes of most vascular surgery trainees and faculty regarding preparation for the Vascular Surgery In-Training Exam and overall fund of knowledge after implementing a protected AHD schedule. Further research is needed to understand the impact of the AHD conference on operative experience and training exam scores. Copyright © 2018 Elsevier Inc. All rights reserved.
... 40 Protection of Environment 19 2010-07-01 2010-07-01 false Sampling Plans for Selective Enforcement Auditing of Heavy-Duty Engines and Light-Duty Trucks X Appendix X to Part 86 Protection of... Plans for Selective Enforcement Auditing of Heavy-Duty Engines and Light-Duty Trucks Table 1—Sampling...
Baker, T.L.; Campbell, S.S.; Dawson, D.; Moore-Ede, M.
Recently, much attention has been paid to the alertness and performance problems of rotational shiftworkers in the nuclear power industry. Growing awareness of higher rates of human errors and accidents on night shifts and reports of operations personnel falling asleep on the job have contributed to the heightened interest in this subject. The industry is now considering the effects of different shift rotation systems, including evaluation of the most recent of industry trends in shift scheduling-schedules that include 12 hour work shifts. Surveys show that within the past 5 years about 20% of commercially operational nuclear power plants have instituted schedules that use only 12 hour shifts, or schedules using a combination of 8-hour and 12-hour shifts. Many more plants routinely use 12-hour work shifts during plant outages and refueling operations. In response to this growing trend, the NRC has funded research which is a first attempt to compare alertness, operator performance, and sleep-wake patterns in subjects working simulated 8-hour and 12-hour shifts at the Human Alertness Research Center (HARC), located at the Institute of Circadian Physiology in Boston, MA. This paper will describe in greater detail the design of the study, measurement techniques for alertness and sleep, work routine, work task performance measures, and cognitive performance test protocols. It will review the role of circadian factors in human alertness and performance, and discuss previous research findings in this area. It will discuss other variables that are known to influence human alertness in the workplace, such as caffeine, alcohol, and working environment. The physiological basis for shift worker sleep problems will be explained in the context of the ongoing research project at HARC. Finally, the paper presents previous research on shift work and fatigue which may be relevant to a comparison of 8-hour and 12-hour shifts
... duties upon appeals. 1333.212 Section 1333.212 Federal Acquisition Regulations System DEPARTMENT OF... Contracting officer's duties upon appeals. Only Procurement Counsel will communicate with the Civilian Board of Contract Appeals or the Department of Justice regarding appeals of contracting officer decisions...
Kamminga, Menno R.
Philosophers interested in John Rawls’s international political theorizing have paid considerable attention to the duty of assistance as a key notion of his Law of Peoples. However, in focusing on contentious-theoretical and practical implications of this duty, they have not thoroughly examined the
... Duties of the Finance Board. (a) Bank System. The Finance Board supervises and regulates the Banks and... 12 Banks and Banking 7 2010-01-01 2010-01-01 false Duties of the Finance Board. 905.4 Section 905.4 Banks and Banking FEDERAL HOUSING FINANCE BOARD FEDERAL HOUSING FINANCE BOARD ORGANIZATION AND...
... 40 Protection of Environment 32 2010-07-01 2010-07-01 false Duty cycle generation. 1065.610 Section 1065.610 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR POLLUTION CONTROLS ENGINE-TESTING PROCEDURES Calculations and Data Requirements § 1065.610 Duty cycle generation...
... fails to perform any specification or duty, express or implied, is in violation of the Act and may be... or duty, express or implied, arising out of any undertaking in connection with transactions subject... statement describing the terms and conditions under which he will handle the produce of the grower during...
... 45 Public Welfare 4 2010-10-01 2010-10-01 false Council purpose and duties. 1603.5 Section 1603.5 Public Welfare Regulations Relating to Public Welfare (Continued) LEGAL SERVICES CORPORATION STATE ADVISORY COUNCILS § 1603.5 Council purpose and duties. (a) The purpose of the council shall be to notify...
Alm, James; Annez, Patricia; Modi, Arbind
The authors review the options for reform of stamp duties on immovable property transfers collected by Indian state governments. After briefly reviewing some of the many administrative difficulties experienced with the tax, they turn to an examination of its economic impacts. A review of stamp duties internationally indicates that Indian rates are exceptionally high, at rates often above 1...
... 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 programming...
... 25 Indians 1 2010-04-01 2010-04-01 false Appointment and duties of appraiser. 11.706 Section 11... OFFENSES AND LAW AND ORDER CODE Probate Proceedings § 11.706 Appointment and duties of appraiser. (a) Upon ordering an estate to be probated, the court shall appoint a disinterested and competent person as an...
... 21 Food and Drugs 8 2010-04-01 2010-04-01 false IRB composition, duties, and functions. 812.60 Section 812.60 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... composition, duties, and functions. An IRB reviewing and approving investigations under this part shall comply...
... 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 Lead...
... 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, the...
... 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 administrative...
... 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 nursing...
football , and soccer. The authors conducted searches of computerized databases of published literature regarding disability and exercise as it relates to...and 5% of servicewomen aged 40 to 65 years have osteoarthritis . Adjustment reaction affects 4% of active-duty women and 2% of active-duty men, and
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…
This study was aimed at articulating principals' leadership styles and teachers' motivation to duty in Cross River State, Nigeria. Discussions have been focused on motivation of teachers to duty, and how leadership styles can enhance goal achievement and performance on the part of the teacher. Two research hypotheses ...
... of brown charging system, book reservation, keeping of reserved collection, circulation of reserved books, treatment of overdue, lost of books on loan and library statistics among other as duties perform in circulation department of libraries. Keywords: Library Service, Circulation Duties, Challenges, Academic Libraries ...
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
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.
The Australian Anti-Dumping Authority (ADA0) has imposed dumping duties on imports of polyvinyl chloride (PVC) resin from seven countries and on certain expanded polystyrene (EPS) beads from Korea and Singapore. The decisions come at the end of two separate investigations begun earlier this year. In its first finding, the ADA concluded that there has been dumping of PVC resin from Canada, China, France, Japan, Norway, Saudi Arabia, and Thailand, which has caused and threatens to cause material injury to the domestic PVC industry. An eighth country, Romania, was found not to have been exporting PVC to Australia. The case is the second of its kind in Australia focusing on PVC. In December 1991 the ADA found in favor of local producer sin a dumping complaint against Argentina, Brazil, Hungary, Israel, Korea, Mexico, Poland, Singapore, Taiwan, and the US
Lee, Michael A; McGlinch, Erin B; McGlinch, Maria C; Capacchione, John F
Malignant hyperthermia (MH) is an inherited hypermetabolic condition characterized by uncontrolled calcium release from the sarcoplasmic reticulum of skeletal muscle, usually from exposure to inhaled general anesthetics and/or the depolarizing neuromuscular blocking agent succinylcholine. Multiple case reports now reveal that crises may be precipitated by environmental factors such as exercise or high ambient temperatures. Common signs of an MH crisis include life-threatening hyperthermia, metabolic acidosis, muscle rigidity, and tachycardia. Treatment consists of stopping triggering agents, administering dantrolene, and actively cooling the patient. MH is a medically disqualifying condition for service in the U.S. Armed Forces. However, patients with MH-causative mutations may never have experienced an MH episode. If they previously have had an event concerning for MH, details are often sparse and a formal evaluation is absent. We present 2 case reports with military service implications, one as a formal applicant to the service academies and the other as the father of an active duty Navy chief. Both patients experienced prior MH-like reactions to anesthesia but had not undergone testing with a caffeine-halothane contracture test (CHCT) or genetic analysis. Both patients underwent skeletal muscle biopsies of the left vastus lateralis with nontriggering anesthetics at Children's National Medical Center in Washington, DC, and MH diagnostic CHCT at the Uniformed Services University of the Health Sciences (USUHS) in Bethesda, Maryland. The CHCT was performed according to the North American MH Registry Protocol. With USUHS Institutional Review Board approval, ryanodine receptor type 1 gene (RYR1) and L-type calcium channel α-1 subunit gene (CACNA1S) sequencing was performed on the remaining muscle at USUHS. Each subject was CHCT positive, confirming a diagnosis of MH. One was found to have a known MH-causative gene mutation. The applicant to the service academy was
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".
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.
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.
Wojnarwsky, Pandora Keala Lee; Wang, Yan; Shah, Kumar; Koka, Sreenivas
The decision by prosthodontic residency program directors to employ the Match process highlights the need to understand applicant priorities that influence their choice of which programs to rank highly. The purpose of this study is to determine the factors that were most important to residents when choosing from among nonmilitary based prosthodontics dental residency programs in the United States. Following completion of a pilot study, all currently enrolled prosthodontic residents at nonmilitary residency programs were invited to participate via the internet. The study consisted of a survey instrument asking residents to rank 26 possible factors that might impact an applicant's choice of residency program. In addition, the instrument collected other possible influencing variables including gender and debt load. Mean rank scores were compared to determine the most and least important factors. Kruskal-Wallis test was used to compare specific factors between the possible influencing variables. Two hundred and thirty residents completed the survey instrument, representing a 54.1% response rate of possible participants. With regard to factors influencing program choice, reputation of the residency program was the factor ranked the highest by participants, followed in descending order by the program director's personality, curriculum content, access to use of the latest digital technology, and opportunities for dental implant placement. Quality of schools for children, community outreach opportunities, and the ability to moonlight were ranked as the least important factors. Male and female residents ranked factors such as tuition/stipend, curriculum content, and community outreach opportunities significantly differently. Depending on debt load, residents ranked the factors tuition/stipend, ability to moonlight, curriculum content, and safety of the area where the program is differently. Current prosthodontic residents valued the reputation of the program as the most
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
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
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 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
Coban, Onder; Hacifazlioglu, Oguzhan; Ciray, H Nadir; Ulug, Ulun; Tekin, H Ibrahim; Bahceci, Mustafa
To assess cycle outcome after oocyte refrigeration. Case report. Private IVF center. One couple in a donor oocyte program. Intracytoplasmic sperm injection and blastocyst culture after refrigeration of oocytes for 12 hours. Birth. Fourteen two-pronuclei zygotes from 17 metaphase II refrigerated oocytes resulted in transfer of two blastocysts at day 5 and cryopreservation of six excess embryos at day 6. The patient delivered one healthy male baby after 38 weeks' gestation. The successful outcome of oocyte refrigeration indicates that this protocol could be useful in circumstances in which a delay in obtaining spermatozoa arises. Copyright © 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.
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... 2060-AI23; 2060-AQ12 Tier 2 Light-Duty Vehicle and Light-Duty Truck Emission Standards and Gasoline.... The rulemaking also required oil refiners to limit the sulfur content of the gasoline they produce. Sulfur in gasoline has a detrimental impact on catalyst performance and the sulfur requirements have...
Christianson, Mindy S; Washington, Chantel I; Stewart, Katherine I; Shen, Wen
Previous work has shown American obstetrics and gynecology (OB/GYN) residents are lacking in menopause training. Our objective was to assess the effectiveness of a 2-year menopause medicine curriculum in improving OB/GYN residents' knowledge and self-assessed competency in menopause topics. We developed a menopause medicine-teaching curriculum for OB/GYN residents at our academic hospital-based residency program. The 2-year curriculum was composed of year 1: four 1-hour lectures and one 2-hour lab with cases presentations, and year 2: three 1-hour lectures and one 2-hour lab. Core topics included menopause physiology, hormone therapy, breast health, bone health, cardiovascular disease, and autoimmune disease. Pre- and posttests assessed resident knowledge and comfort in core topics, and a pre- and postcurriculum survey assessed utility and learning satisfaction. From July 2011 to June 2013, 34 OB/GYN residents completed the menopause curriculum annually with an average attendance at each module of 23 residents. Pre-/posttest scores improved from a mean pretest score of 57.3% to a mean posttest score of 78.7% (P menopause patients with 75.8% reporting feeling "barely comfortable" and 8.4% feeling "not at all comfortable." After the 2-year curriculum, 85.7% reported feeling "comfortable/very comfortable" taking care of menopause patients. The majority of residents (95.2%) reported the menopause curriculum was "extremely useful." A 2-year menopause medicine curriculum for OB/GYN residents utilizing lectures and a lab with case studies is an effective modality to improve resident knowledge required to manage menopause patients.
Nirfalini Aulia, Dwira; Aritonang, Cindy
An official residence is a housing provided by the state and used as a residence occupied by the official duties of officials and civil servants during their service in the city. The property rights of the official residence have limit, only valid while the residents serve in the city. The process of adaptation becomes indispensable because, in the early days of occupying the housing, residents will face a new social environment, which may be different from their previous environment. Furthermore, backgrounds such as economic, cultural, and social factors of each occupant will also determine the adaptation process that occurs. This research aims to find out and analyze adaptation process of the official residence’s dwellers to its environment. This study used the descriptive-qualitative method by interviewing ten occupants who selected by purposive sampling method. Results of research indicated that the most adaptation process occurs adaptation by the reaction such as adding the number of room and service area.
Karcher, Donald S.; Harrison, James H.; Sinard, John H.; Riben, Michael W.; Boyer, Philip J.; Plath, Sue; Thompson, Arlene; Pantanowitz, Liron
Context: Recognition of the importance of informatics to the practice of pathology has surged. Training residents in pathology informatics has been a daunting task for most residency programs in the United States because faculty often lacks experience and training resources. Nevertheless, developing resident competence in informatics is essential for the future of pathology as a specialty. Objective: To develop and deliver a pathology informatics curriculum and instructional framework that guides pathology residency programs in training residents in critical pathology informatics knowledge and skills, and meets Accreditation Council for Graduate Medical Education Informatics Milestones. Design: The College of American Pathologists, Association of Pathology Chairs, and Association for Pathology Informatics formed a partnership and expert work group to identify critical pathology informatics training outcomes and to create a highly adaptable curriculum and instructional approach, supported by a multiyear change management strategy. Results: Pathology Informatics Essentials for Residents (PIER) is a rigorous approach for educating all pathology residents in important pathology informatics knowledge and skills. PIER includes an instructional resource guide and toolkit for incorporating informatics training into residency programs that vary in needs, size, settings, and resources. PIER is available at http://www.apcprods.org/PIER (accessed April 6, 2016). Conclusions: PIER is an important contribution to informatics training in pathology residency programs. PIER introduces pathology trainees to broadly useful informatics concepts and tools that are relevant to practice. PIER provides residency program directors with a means to implement a standardized informatics training curriculum, to adapt the approach to local program needs, and to evaluate resident performance and progress over time. PMID:28725772
Walter H. Henricks MD
Full Text Available Context: Recognition of the importance of informatics to the practice of pathology has surged. Training residents in pathology informatics has been a daunting task for most residency programs in the United States because faculty often lacks experience and training resources. Nevertheless, developing resident competence in informatics is essential for the future of pathology as a specialty. Objective: To develop and deliver a pathology informatics curriculum and instructional framework that guides pathology residency programs in training residents in critical pathology informatics knowledge and skills, and meets Accreditation Council for Graduate Medical Education Informatics Milestones. Design: The College of American Pathologists, Association of Pathology Chairs, and Association for Pathology Informatics formed a partnership and expert work group to identify critical pathology informatics training outcomes and to create a highly adaptable curriculum and instructional approach, supported by a multiyear change management strategy. Results: Pathology Informatics Essentials for Residents (PIER is a rigorous approach for educating all pathology residents in important pathology informatics knowledge and skills. PIER includes an instructional resource guide and toolkit for incorporating informatics training into residency programs that vary in needs, size, settings, and resources. PIER is available at http://www.apcprods.org/PIER (accessed April 6, 2016. Conclusions: PIER is an important contribution to informatics training in pathology residency programs. PIER introduces pathology trainees to broadly useful informatics concepts and tools that are relevant to practice. PIER provides residency program directors with a means to implement a standardized informatics training curriculum, to adapt the approach to local program needs, and to evaluate resident performance and progress over time.
Wagner, Richard F; Raimer, Sharon S; Kelly, Brent C
Programmatic changes for the dermatology residency program at The University of Texas Medical Branch were first introduced in 2005, with the faculty goal incorporating formal dermatology research projects into the 3-year postgraduate training period. This curriculum initially developed as a recommendation for voluntary scholarly project activity by residents, but it evolved into a program requirement for all residents in 2009. Departmental support for this activity includes assignment of a faculty mentor with similar interest about the research topic, financial support from the department for needed supplies, materials, and statistical consultation with the Office of Biostatistics for study design and data analysis, a 2-week elective that provides protected time from clinical activities for the purpose of preparing research for publication and submission to a peer-reviewed medical journal, and a departmental award in recognition for the best resident scholarly project each year. Since the inception of this program, five classes have graduated a total of 16 residents. Ten residents submitted their research studies for peer review and published their scholarly projects in seven dermatology journals through the current academic year. These articles included three prospective investigations, three surveys, one article related to dermatology education, one retrospective chart review, one case series, and one article about dermatopathology. An additional article from a 2012 graduate about dermatology education has also been submitted to a journal. This new program for residents was adapted from our historically successful Dermatology Honors Research Program for medical students at The University of Texas Medical Branch. Our experience with this academic initiative to promote dermatology research by residents is outlined. It is recommended that additional residency programs should consider adopting similar research programs to enrich resident education. PMID:23901305
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
Gerngross, Heinz; Kahle, Wilhelm
Today, the six-hours-rule is a delicate item for military logistics and it is a great challenge for medical services to provide an adequate treatment during the first hours after wounding. DEFINITION: Six-hour-rule...
Cronholm, Peter F; Singh, Vijay; Fogarty, Colleen T; Ambuel, Bruce
Violence is a significant public health issue with far-reaching implications for the health of individuals and their communities. Our objective was to describe trends in violence-related training in family medicine residency programs since the last national survey was conducted in 1997. Surveys were sent to 337 US family medicine residency programs with the program director having active Society of Teachers of Family Medicine (STFM) membership. Measures included residency setting and characteristics, violence-related curricular content, teaching techniques and personnel, timing of content, and impact of changes in Residency Review Committee (RRC) and Accreditation Council for Graduate Medical Education (ACGME) requirements. Descriptive statistics and bivariate analyses comparing measures across time were used. A total of 201 (60%) surveys were completed. The most common violence curricula was child (83%) and elder abuse (76%), and the most common teachers of violence-related content were family physicians, psychologists, and social workers. The most common teaching methods were clinical precepting (94%), lectures (90%), case vignettes (71%), and intimate partner violence (IPV) shelter experiences (67%). ACGME and RRC changes were not reflected in self-reported measures of curricular emphasis or time. Violence curricular content and number of hours has been constant in family medicine residencies over time. An increase in the reported use of active learning strategies was identified as a trend across surveys. Next steps for violence curricula involve assessment of residents' competency to identify and intervene in violence.
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...
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
'To sleep: perchance to dream', is the frequent mantra of the surgical resident. However, unlike. Hamlet, there is no ensuing speculation as to what dreams may come as there are seldom any!! Surgical residency has been both vilified and immortalized, but the fact remains that it is one of the most challenging, provocative ...
Stone, Patricia W; Du, Yunling; Cowell, Rhabia; Amsterdam, Norma; Helfrich, Thomas A; Linn, Robert W; Gladstein, Amy; Walsh, Mary; Mojica, Lorraine A
Many nurses desire 12-hour shifts. However, there are concerns about implementation. We sought to compare the effects of 8- and 12-hour shifts on nurse, system, and quality patient care outcomes. We used a cross-sectional design with data collected from multiple sources in 2003-2004, including a nurse survey and administrative and patient records. We studied hospital nurses and patients in general adult wards, with outcomes including burnout, job satisfaction, scheduling satisfaction, preferences, intention to stay, and employee safety. System outcomes included recruitment and turnover, staffing, absenteeism, and related costs. A variety of quality patient care outcomes were measured from the 3 different types of data. Thirteen New York City hospitals participated; 805 surveys were examined from 99 nursing units (response rate 42%). Compared with nurses working 8-hour shifts, those working 12-hour shifts were on average more satisfied with their jobs, experienced less emotional exhaustion, 10 times more likely to be satisfied with schedules, 2 times as likely to perceive 12-hour schedules as important, and 58% less likely to report missing shifts; units with 12-hour shifts had lower vacancy rates and weeks to fill the position (all P values < or =0.05). There were no differences in patient outcomes. Nurses working 12-hour shifts were more satisfied. There were no differences in quality outcomes. Flexibility and choice in shift length are important elements in a positive nurse work environment. This study represents an innovative attempt by a labor-management bargaining group to make an evidence-based decision. We encourage others to conduct similar studies.
Full Text Available The paper analyzes the legal provisions of the Criminal Code of the Republic of Macedonia relating to crimes against official duty. Crimes against official duty represent a group of criminal offenses that occupy a special place in criminal law. This kind of crimes is also called civil servants crimes, that is, they are defined as a violation of duty made by an official in performing his/her official duty. In this paper we will analyze all articles of the Criminal Code that regulate the group of criminal offenses against official duty. Most frequent cases of misuse of official duty are cases of misuse of official position and authorization, unprincipled operation within the service, defraud in the service, receiving a bribe, giving a bribe, unlawful mediation, disclosing an official secret, falsifying an official document and other. The paper will define the terms official and responsible person. In the context of the paper we will show the research referring to the number of registered and accused of crimes against official duty in the Republic of Macedonia in the period from 2004 to 2013.
Brandman, David M; Haji, Faizal A; Matte, Marie C; Clarke, David B
Residents must develop a diverse range of skills in order to practice neurosurgery safely and effectively. The purpose of this study was to identify the foundational skills required for neurosurgical trainees as they transition from medical school to residency. Based on the CanMEDS competency framework, a web-based survey was distributed to all Canadian academic neurosurgical centers, targeting incoming and current PGY-1 neurosurgical residents as well as program directors. Using Likert scale and free-text responses, respondents rated the importance of various cognitive (e.g. management of raised intracranial pressure), technical (e.g. performing a lumbar puncture) and behavioral skills (e.g. obtaining informed consent) required for a PGY-1 neurosurgical resident. Of 52 individuals contacted, 38 responses were received. Of these, 10 were from program directors (71%), 11 from current PGY-1 residents (58%) and 17 from incoming PGY-1 residents (89%). Respondents emphasized operative skills such as proper sterile technique and patient positioning; clinical skills such as lesion localization and interpreting neuro-imaging; management skills for common scenarios such as raised intracranial pressure and status epilepticus; and technical skills such as lumbar puncture and external ventricular drain placement. Free text answers were concordant with the Likert scale results. We surveyed Canadian neurosurgical program directors and PGY-1 residents to identify areas perceived as foundational to neurosurgical residency education and training. This information is valuable for evaluating the appropriateness of a training program's goals and objectives, as well as for generating a national educational curriculum for incoming PGY-1 residents.
Agazio, Janice G; Ephraim, Paula M; Flaherty, Norma B; Gurney, Cynthia A
The purpose of this study was to determine the extent to which selected demographic characteristics, definition of health, perceived health status, perceived self-efficacy, and resources are related to the health promoting behaviors of active-duty women with children and to describe qualitatively the experience of being an active-duty mother. Grounded in Pender's (1996) Health Promotion Model, this study used methodological triangulation to test a hypothesized model. A sample of 141 active-duty women with children using military health services participated. Resource availability and commitment were key components of being successful at balancing home and work demands.
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...
Jansen, Kate L; Rosenbaum, Marcy E
Communication skills are essential to medical training and have lasting effects on patient satisfaction and adherence rates. However, relatively little is reported in the literature identifying how communication is taught in the context of residency education. Our goal was to determine current practices in communication curricula across family medicine residency programs. Behavioral scientists and program directors in US family medicine residencies were surveyed via email and professional organization listservs. Questions included whether programs use a standardized communication model, methods used for teaching communication, hours devoted to teaching communication, as well as strengths and areas for improvement in their program. Analysis identified response frequencies and ranges complemented by analysis of narrative comments. A total of 204 programs out of 458 family medicine residency training sites responded (45%), with 48 out of 50 US states represented. The majority of respondents were behavioral scientists. Seventy-five percent of programs identified using a standard communication model; Mauksch's patient-centered observation model (34%) was most often used. Training programs generally dedicated more time to experiential teaching methods (video review, work with simulated patients, role plays, small groups, and direct observation of patient encounters) than to lectures (62% of time and 24% of time, respectively). The amount of time dedicated to communication education varied across programs (average of 25 hours per year). Respondent comments suggest that time dedicated to communication education and having a formal curriculum in place are most valued by educators. This study provides a picture of how communication skills teaching is conducted in US family medicine residency programs. These findings can provide a comparative reference and rationale for residency programs seeking to evaluate their current approaches to communication skills teaching and
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
What happens on the last day of a massive stars life? In the hours before the star collapses and explodes as a supernova, the rapid evolution of material in its core creates swarms of neutrinos. Observing these neutrinos may help us understand the final stages of a massive stars life but theyve never been detected.A view of some of the 1,520 phototubes within the MiniBooNE neutrino detector. Observations from this and other detectors are helping to illuminate the nature of the mysterious neutrino. [Fred Ullrich/FNAL]Silent Signposts of Stellar EvolutionThe nuclear fusion that powers stars generates tremendous amounts of energy. Much of this energy is emitted as photons, but a curious and elusive particle the neutrino carries away most of the energy in the late stages of stellar evolution.Stellar neutrinos can be created through two processes: thermal processesand beta processes. Thermal processes e.g.,pair production, in which a particle/antiparticle pair are created depend on the temperature and pressure of the stellar core. Beta processes i.e.,when a proton converts to a neutron, or vice versa are instead linked to the isotopic makeup of the stars core. This means that, if we can observe them, beta-process neutrinos may be able to tell us about the last steps of stellar nucleosynthesis in a dying star.But observing these neutrinos is not so easilydone. Neutrinos arenearly massless, neutral particles that interact only feebly with matter; out of the whopping 1060neutrinos released in a supernova explosion, even the most sensitive detectors only record the passage of just a few. Do we have a chance of detectingthe beta-process neutrinos that are released in the final few hours of a stars life, beforethe collapse?Neutrino luminosities leading up to core collapse. Shortly before collapse, the luminosity of beta-process neutrinos outshines that of any other neutrino flavor or origin. [Adapted from Patton et al. 2017]Modeling Stellar CoresTo answer this question, Kelly
The effect of daylight hours on growing grasscutters was determined using sixteen 8-months old femalegrasscutters. The grasscutters were separated into four groups and allotted to four treatments of varying daylight hours. The treatments included; zero (0) hours of daylight and twenty four (24) hours (6.00 am-6.00 am) of ...
A continuous duty cryopump system was designed and developed that comprises a self-contained cryopump for installation into a vacuum chamber, and a microprocessor controller for automatic operation. This deuterium pump has two units in a single housing, arranged so that one is pumping while the other is being regenerated. Liquid helium-cooled, finned sections in each unit pump deuterium by condensation, and a third pump integral within the cryopump housing collects the regenerated gas. A microprocessor unit controls distribution of liquid and gaseous helium, used for conditioning the pumping units, and operates remote actuators for the regeneration. Software provides fully automatic, timed sequencing of the repetitive cryopump events which include: cooldown of the pumping units, opening of the louvers isolating the unit from the vacuum chamber, closing of the louvers, and warming up of the unit for regeneration. Default values in the software can be reprogrammed by the operator through the keyboard in response to prompts displayed on the computer. An override allows the operator to control the cryopump manually by activating switches on a control panel. Interlocks to prevent cryogen lockup are included in the software
Ho, Ying-Yi; Fang, Yin-Ping; Chou, Cheng-Han; Cheng, Hsi-Chi; Chang, Hsueh-Wen
Laryngeally echolocating bats avoid self-deafening (forward masking) by separating pulse and echo either in time using low duty cycle (LDC) echolocation, or in frequency using high duty cycle (HDC) echolocation. HDC echolocators are specialized to detect fluttering targets in cluttered environments. HDC echolocation is found only in the families Rhinolophidae and Hipposideridae in the Old World and in the New World mormoopid, Pteronotus parnellii. Here we report that the hipposiderid Coelops frithii, ostensibly an HDC bat, consistently uses an LDC echolocation strategy whether roosting, flying, or approaching a fluttering target rotating at 50 to 80 Hz. We recorded the echolocation calls of free-flying C. frithii in the field in various situations, including presenting bats with a mechanical fluttering target. The echolocation calls of C. frithii consisted of an initial narrowband component (0.5±0.3 ms, 90.6±2.0 kHz) followed immediately by a frequency modulated (FM) sweep (194 to 113 kHz). This species emitted echolocation calls at duty cycles averaging 7.7±2.8% (n = 87 sequences). Coelops frithii approached fluttering targets more frequently than did LDC bats (C.frithii, approach frequency = 40.4%, n = 80; Myotis spp., approach frequency = 0%, n = 13), and at the same frequency as sympatrically feeding HDC species (Hipposideros armiger, approach rate = 53.3%, n = 15; Rhinolophus monoceros, approach rate = 56.7%, n = 97). We propose that the LDC echolocation strategy used by C. frithii is derived from HDC ancestors, that this species adjusts the harmonic contents of its echolocation calls, and that it may use both the narrowband component and the FM sweep of echolocations calls to detect fluttering targets.
Full Text Available Laryngeally echolocating bats avoid self-deafening (forward masking by separating pulse and echo either in time using low duty cycle (LDC echolocation, or in frequency using high duty cycle (HDC echolocation. HDC echolocators are specialized to detect fluttering targets in cluttered environments. HDC echolocation is found only in the families Rhinolophidae and Hipposideridae in the Old World and in the New World mormoopid, Pteronotus parnellii. Here we report that the hipposiderid Coelops frithii, ostensibly an HDC bat, consistently uses an LDC echolocation strategy whether roosting, flying, or approaching a fluttering target rotating at 50 to 80 Hz. We recorded the echolocation calls of free-flying C. frithii in the field in various situations, including presenting bats with a mechanical fluttering target. The echolocation calls of C. frithii consisted of an initial narrowband component (0.5±0.3 ms, 90.6±2.0 kHz followed immediately by a frequency modulated (FM sweep (194 to 113 kHz. This species emitted echolocation calls at duty cycles averaging 7.7±2.8% (n = 87 sequences. Coelops frithii approached fluttering targets more frequently than did LDC bats (C.frithii, approach frequency = 40.4%, n = 80; Myotis spp., approach frequency = 0%, n = 13, and at the same frequency as sympatrically feeding HDC species (Hipposideros armiger, approach rate = 53.3%, n = 15; Rhinolophus monoceros, approach rate = 56.7%, n = 97. We propose that the LDC echolocation strategy used by C. frithii is derived from HDC ancestors, that this species adjusts the harmonic contents of its echolocation calls, and that it may use both the narrowband component and the FM sweep of echolocations calls to detect fluttering targets.
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.
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...
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...
This report provides data on the fuel economy, carbon dioxide (CO2) emissions, and technology trends of new light-duty vehicles (cars, minivans, sport utility vehicles, and pickup trucks) for model years 1975 to present in the United States.
... 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 apportionment...
Crabtree, Mark S; Eddy, Douglas R
An exhaustive search of archives, reports, databases and publications was performed to locate research data that describe the activities of off-duty pilots as they prepare for night or long duration missions...
Various methods were evaluated for decontaminating the Light Duty Utility Arm (LDUA). Physical capabilities of each method were compared with the constraints and requirements for the LDUA Decontamination System. Costs were compared and a referred alternative was chosen
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…
Shaughnessy, Allen F; Duggan, Ashley P
Teaching residents how to reflect and providing ongoing experience in reflection may aid their development into adaptable, life-long learning professionals. We introduced an ongoing reflective exercise into the curriculum of a family medicine residency program. Residents were provided 15 minutes, three times a week, to complete these reflective exercises. We termed these reflective exercises "clinical blogs" since they were entered into a web-based computer portfolio, though they were not publicly available. The aim of this study is to explore family medicine residents' responses to the introduction of an ongoing reflective exercise and examine strengths and challenges of the reflective process. We invited a cohort of family medicine residents (8 residents) who had all participated in the reflective exercises as part of their residency to participate in one of two offered focus groups to share their experience with the reflective exercise. An investigator not connected to the training program led each focus group using minimal structure in order to allow for the breadth of residents' experiences to be revealed. The focus groups were audio recorded, and the recordings were transcribed verbatim without identifying participants. We used a grounded theory approach, using open coding to analyze the focus group transcripts and to identify themes. Four residents participated in each focus group. We identified four main themes regarding family medicine residents' responses of the reflective practice exercises: (1) Residents viewed blogging (reflecting) as a method of enhanced personal and professional self-development; (2) Despite the reflective exercises being valued as self-development, residents see an inherent conflict between self-development and professional duties; (3) Residents recognize their emotional responses, but writing about emotional issues is difficult for some residents; and (4) Clinical blogging in our residency has not reached its potential due to the
The Illinois Department of Transportation (IDOT) has requested a waiver from the Federal Highway Administration (FHWA) to : allow IDOT to implement a 24-hour traffic-count program on the non-state HPMS routes, as opposed to the current Highway : Perf...
Building on the successful early engagement of the Plain Sect agricultural community, the Eastern Lancaster County Source Water Protection Collaborative is expanding its efforts to involve local residents in the work of protecting drinking water sources.
This project was designed to test and demonstrate the use of a high- percentage ethanol-blended fuel in a fleet of heavy-duty, over-the- road trucks, paying particular attention to emissions, performance, and repair and maintenance costs. This project also represents the first public demonstration of the use of ethanol fuels as a viable alternative to conventional diesel fuel in heavy-duty engines.
This article evaluates the legal nature of the duty of care and skill of directors. In terms of the Companies Act 71 of 2008 this duty is essentially delictual in nature. This article evaluates whether the duty is in fact delictual in nature. Case law, which considered the duty of care and skill and where it had been sought to establish ...
... Bags From Malaysia: Preliminary Results of Antidumping Duty Administrative Review AGENCY: Import... antidumping duty order on polyethylene retail carrier bags (PRCBs) from Malaysia. The review covers one... published in the Federal Register the antidumping duty order on PRCBs from Malaysia. See Antidumping Duty...
... 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 Argentina...
... 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 for...
... 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 Argentina...
Ali M. Almajwal
Full Text Available Objectives: To investigate the association between stress, shift work, and eating behavior among non-Saudi female nurses working in Central Saudi Arabia. Methods: A sample of 395 non-Saudi female nurses from 2 major hospitals in Riyadh, Kingdom of Saudi Arabia participated in this cross-sectional study. The nurses completed a questionnaire from November 2013 to January 2014 that included items relating to stress and eating behavior using the Dutch Eating Behavior Questionnaire (DEBQ. The questionnaire also contained items pertaining to socio-demographic data, body mass index, shift work, and hours worked per week. Results: For all eating styles, stress, and shift duty influenced the amount of food nurses consumed, but was more significant under a restrained eating style. Under this eating style, a significantly higher percentage of nurses reported eating more fast food, snacks, and binging, while fruits and vegetables were the least likely to be eaten under stress. High stressed nurses were more likely to present with abnormal restrained eating (odds ratio [OR]=1.52, p=0.004, emotional (OR=1.24; p=0.001, and external (OR=1.21; p=0.001 DEBQ scores. Working nighttime shift duty was positively associated with restrained eating (OR=1.53; p=0.029 and emotional eating (OR=1.24; p=0.001, but negatively associated with external eating (OR=0.45; p=0.001. Conclusion: Our findings suggest that stress and shift duty were associated with eating habits.
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.
A telephone survey of resident physicians to the basic conditions in which they work has been conducted in 14 of the 16 federal states. In the center of the survey stood the general medicine within the prisons. This limitation was necessary in order to achieve comparability to primary medical care outside of correctional services. There are 140 salaried and tenured resident pysicians and 97 contract doctors in the general medical care of approx. 70000 prisoners in 185 independent prisons ...
Shetty, Anup; Hammer, Mark; Gould, Jennifer; Evens, Ronald
The American Alliance of Academic Chief Residents in Radiology (A³CR²) conducts an annual survey of chief residents in accredited radiology programs in North America. The survey serves as a tool for observing trends and disseminating ideas among radiology programs. An online survey conducted through the SurveyMonkey Web site was distributed to chief residents from 187 Accreditation Council on Graduate Medical Education (ACGME)-accredited radiology training programs. A variety of multiple-choice and free-response questions were designed to gather information about residency program details, benefits, chief resident responsibilities, call, preparations for the recent American Board of Radiology Core Examination, implementation of selectives (mini-fellowships), fellowships, health care economics and the job market, and ACGME milestones. Among those surveyed, 212 unique responses from 136 programs were provided, yielding a 73% response rate. Data were compared to historical data from prior surveys dating back through 2002. Programs are increasingly providing 24-hour sonographer coverage, full day routine services on weekends, and 24-hour attending radiologist coverage. The new American Board of Radiology examination format and schedule has driven many changes, including when chief residents serve, board preparation and review, and how the final year of residency training is structured. Despite facing many changes, there is slightly more optimism among chief residents regarding their future job prospects. Copyright © 2014 AUR. Published by Elsevier Inc. All rights reserved.
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....
Dew, S.M.; Hill, A.O.
In formulating the fitness-for-duty program at Houston Lighting and Power (HL and P), the project and plant staffs followed program guidelines developed by the Edison Electric Institute and considered the performance criteria for the fitness-for-duty programs developed by the Institute of Nuclear Power Operations. The staff visited utilities involved in fitness-for-duty implementation to review the problems and successes experienced by those utilities. On November 1, 1985, the nuclear group vice-president instituted the South Texas Project Fitness-for-Duty Policy to become effective on January 1, 1986. It was important to implement the program at that time, as the project moved to the final stages of construction and preparation for plant operations. The South Texas Project has made a firm commitment to the industry with our fitness-for-duty program. The no-nonsense approach to illegal drug and alcohol use enables to assure a high level of employee health, productivity, and safety in a drug- and alcohol-free environment. The cost of the fitness-for-duty program is minimal when compared to the increase in productivity and the heightened confidence in workers by the US Nuclear Regulatory Commission since implementation of this program
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.
Marwan, Yousef; Ayed, Adel
In Kuwait, 21 residency training programs were offered in the year 2011; however, no data is available regarding the criteria of selecting residents for these programs. This study aims to provide information about the importance of these criteria. A self-administered questionnaire was used to collect data from members (e.g. chairmen, directors, assistants …etc.) of residency programs in Kuwait. A total of 108 members were invited to participate. They were asked to rate the importance level (scale from 1 to 5) of criteria that may affect the acceptance of an applicant to their residency programs. Average scores were calculated for each criterion. Of the 108 members invited to participate, only 12 (11.1%) declined to participate. Interview performance was ranked as the most important criteria for selecting residents (average score: 4.63/5.00), followed by grade point average (average score: 3.78/5.00) and honors during medical school (average score: 3.67/5.00). On the other hand, receiving disciplinary action during medical school and failure in a required clerkship were considered as the most concerning among other criteria used to reject applicants (average scores: 3.83/5.00 and 3.54/5.00 respectively). Minor differences regarding the importance level of each criterion were noted across different programs. This study provided general information about the criteria that are used to accept/reject applicants to residency programs in Kuwait. Future studies should be conducted to investigate each criterion individually, and to assess if these criteria are related to residents' success during their training.
Handheld computers are valuable practice tools. It is important for residency programs to introduce their trainees and faculty to this technology. This article describes a formal strategy to introduce handheld computing to a family practice residency program. Objectives were selected for the handheld computer training program that reflected skills physicians would find useful in practice. TRGpro handheld computers preloaded with a suite of medical reference programs, a medical calculator, and a database program were supplied to participants. Training consisted of four 1-hour modules each with a written evaluation quiz. Participants completed a self-assessment questionnaire after the program to determine their ability to meet each objective. Sixty of the 62 participants successfully completed the training program. The mean composite score on quizzes was 36 of 40 (90%), with no significant differences by level of residency training. The mean self-ratings of participants across all objectives was 3.31 of 4.00. Third-year residents had higher mean self-ratings than others (mean of group, 3.62). Participants were very comfortable with practical skills, such as using drug reference software, and less comfortable with theory, such as knowing the different types of handheld computers available. Structured training is a successful strategy for introducing handheld computing to a residency program.
Chappell, Alyssa; Dervay, Katelyn
Purpose: To describe an innovative strategy for incorporating leadership training and development across multiple postgraduate year 2 (PGY2) pharmacy residency programs at a single institution. Background: Tampa General Hospital has 7 pharmacy residency positions: 4 postgraduate year 1 (PGY1) residents and a single resident for each of the 3 PGY2 programs (critical care, emergency medicine, and solid organ transplant). Administrative topics are incorporated across the PGY1 and PGY2 residency programs, with each PGY2 program having additional administrative topics specific to their specialty area. Summary: What began as an elective administrative topic discussion for the PGY2 emergency medicine resident has evolved over time into a longitudinal leadership book club. The leadership book club is utilized to meet the residency goals and objectives related to leadership development for all 3 PGY2 programs. Each year a single book is identified through the American Society of Health-System Pharmacists (ASHP) Leadership Academy book list or by participant suggestion. The book is then divided into 4 sections with corresponding hour-long discussions that occur quarterly throughout the residency year. The residency program directors (RPDs) and co-RPDs lead the initial discussion, and each PGY2 resident leads 1 of the subsequent 3 discussions. Based on resident feedback, the leadership book club is an innovative and effective strategy to incorporate leadership training and development into residency training. Conclusion: It is imperative to foster the development of leadership skills in pharmacy residency programs to prevent a future leadership gap in health system pharmacy. Leadership book club is a unique strategy to incorporate leadership training longitudinally across multiple PGY2 residency programs at a single institution.
Tamuz, Michal; Giardina, Traber Davis; Thomas, Eric J.; Menon, Shailaja; Singh, Hardeep
Background Inadequate supervision is a significant contributing factor to medical errors involving trainees but supervision in high-risk settings such as the Intensive Care Unit (ICU) is not well studied. Objective We explored how residents in the ICU experienced supervision related to medication safety not only from supervising physicians but also from other professionals. Design, Setting, Measurements Using qualitative methods, we examined in-depth interviews with 17 residents working in ICUs of three tertiary-care hospitals. We analyzed residents' perspectives on receiving and initiating supervision from physicians within the traditional medical hierarchy and from other professionals, including nurses, staff pharmacists and clinical pharmacists (“interprofessional supervision”). Results While initiating their own supervision within the traditional hierarchy, residents believed in seeking assistance from fellows and attendings and articulated rules of thumb for doing so; however, they also experienced difficulties. Some residents were concerned that their questions would reflect poorly on them; others were embarrassed by their mistaken decisions. Conversely, residents described receiving interprofessional supervision from nurses and pharmacists, who proactively monitored, intervened in, and guided residents' decisions. Residents relied on nurses and pharmacists for non-judgmental answers to their queries, especially after-hours. To enhance both types of supervision, residents emphasized the importance of improving interpersonal communication skills. Conclusions Residents depended on interprofessional supervision when making decisions regarding medications in the ICU. Improving interprofessional supervision, which thus far has been under-recognized and underemphasized in graduate medical education, can potentially improve medication safety in high-risk settings. PMID:21990173
Musculus, Mark P. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)
Regulatory drivers and market demands for lower pollutant emissions, lower carbon dioxide emissions, and lower fuel consumption motivate the development of clean and fuel-efficient engine operating strategies. Most current production engines use a combination of both in-cylinder and exhaust emissions-control strategies to achieve these goals. The emissions and efficiency performance of in-cylinder strategies depend strongly on flow and mixing processes associated with fuel injection. Various diesel engine manufacturers have adopted close-coupled post-injection combustion strategies to both reduce pollutant emissions and to increase engine efficiency for heavy-duty applications, as well as for light- and medium-duty applications. Close-coupled post-injections are typically short injections that follow a larger main injection in the same cycle after a short dwell, such that the energy conversion efficiency of the post-injection is typical of diesel combustion. Of the various post-injection schedules that have been reported in the literature, effects on exhaust soot vary by roughly an order of magnitude in either direction of increasing or decreasing emissions relative to single injections (O’Connor et al., 2015). While several hypotheses have been offered in the literature to help explain these observations, no clear consensus has been established. For new engines to take full advantage of the benefits that post-injections can offer, the in-cylinder mechanisms that affect emissions and efficiency must be identified and described to provide guidance for engine design.
Mhaske, Shubhangi Ashok; Ahmad, Malik Ajaz; Yuwanati, Monal B.; Prabhu, Shweta; Pardhe, Nilesh
Background Prolonged use of conventional microscope develops musculo-skeletal injuries like chronic pain syndrome, including shoulder, neck, back aches & fatigue. Since the problems go unnoticed, the injuries can lead to some serious permanent damages. This further leads to a compromise in the health and welfare of the person and the institute. Hence, an understanding about the ergonomics is the need of the hour in this postmodern era. Inspite of few studies and surveys about ergonomics, there is still a steep rise in the musculoskeletal disorders. Aim of the Study The aim of our study was to gauge the general awareness of pathologists, microbiologists and oral pathologists towards ergonomics in their profession. Materials and Methods A cross-sectional survey based study was designed, which included a questionnaire. The questionnaire included multiple choice questions with four alternatives. Professionals (pathologists, microbiologists and oral pathologists) were included in the survey. Teaching faculty (Professors, Associate Professors and Lecturers) and Post graduate students formed the study group. Results and Observations The response to the questionnaire was 100%. Less than 50% of oral pathologists were aware of the importance of ergonomics in their profession. The most common site affected was neck and back. One of the drastic observations was that, Oral Pathologists suffered from a combination of problems affecting neck, back, eyes, headache, shoulders, arms and wrists. Conclusion Increase in our understanding regarding ergonomically designed microscopes can increase our efficiency and in turn improve our general well-being. With improvements in ergonomics, professionals would be able to modify and optimize their working conditions. Certain guidelines need to be followed by the professionals to reduce chances of musculoskeletal disorders. PMID:26155565
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.
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
Wood, Gavin A.
The purchaser of housing incurs stamp duty liabilities in all Australian States. These stamp duties are levied on the conveyance of residential property and mortgage sums secured. In general, stamp duties were a growing financial burden on home buyers during the period 1985-1991. This paper examines the role of house price inflation in causing increases in average rates of stamp duty, the responsiveness of average rates of stamp duty to future changes in the nominal tax base and the effective...
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
Abuhamad, Alfred; Minton, Katherine K; Benson, Carol B
Ultrasound imaging has become integral to the practice of obstetrics and gynecology. With increasing educational demands and limited hours in residency programs, dedicated time for training and achieving competency in ultrasound has diminished substantially. The American Institute of Ultrasound...... in Medicine assembled a multisociety task force to develop a consensus-based, standardized curriculum and competency assessment tools for obstetric and gynecologic ultrasound training in residency programs. The curriculum and competency assessment tools were developed based on existing national...
Abuhamad, Alfred; Minton, Katherine K; Benson, Carol B
Ultrasound imaging has become integral to the practice of obstetrics and gynecology. With increasing educational demands and limited hours in residency programs, dedicated time for training and achieving competency in ultrasound has diminished substantially. The American Institute of Ultrasound...... in Medicine assembled a multisociety task force to develop a consensus-based, standardized curriculum and competency assessment tools for obstetric and gynecologic ultrasound training in residency programs. The curriculum and competency assessment tools were developed based on existing national...
Salles, Arghavan; Liebert, Cara A; Esquivel, Micaela; Greco, Ralph S; Henry, Rebecca; Mueller, Claudia
The demands of surgical residency are intense and threaten not only trainees' physical wellness, but also risk depression, burnout, and suicide. Our residency program implemented a multifaceted Balance in Life program that is designed to improve residents' well-being. The purpose of this study was to evaluate the program utilization and perceived value by residents. Residents (n = 56, 76% response rate) were invited to participate in a voluntary survey from December 2013 to February 2014 regarding utilization, barriers to use, and perceived value of 6 program components (refrigerator, After Hours Guide, psychological counseling sessions, Resident Mentorship Program, Class Representative System, and social events). They were also asked questions about psychological well-being, burnout, grit, and sleep and exercise habits before and after implementation of the program. The most valued components of the program were the refrigerator (mean = 4.61) and the psychological counseling sessions (mean = 3.58), followed by social events (mean = 3.48), the Resident Mentorship Program (mean = 2.79), the Class Representative System (mean = 2.62), and the After Hours Guide (mean = 2.10). When residents were asked how they would allocate $100 among the different programs, the majority was allocated to the refrigerator ($54.31), social events ($26.43), and counseling sessions ($24.06). There was no change in psychological well-being or burnout after the program. Residents had higher levels of grit (β = 0.26, p valued, and positively perceived by the residents. Further research is needed to quantify the effectiveness and longitudinal impact such a program has on resident depression, burnout, and other psychological factors. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.
Gohar, Ashraf; Adams, Alexander; Gertner, Elie; Sackett-Lundeen, Linda; Heitz, Richard; Engle, Randall; Haus, Erhard; Bijwadia, Jagdeep
Concerns about medical errors due to sleep deprivation during residency training led the Accreditation Council for Graduate Medical Education to mandate reductions in work schedules. Although call rotations with extended shifts continue, effects on resident sleep-wake times and working memory capacity (WMC) have not been investigated. The objective of this study was to measure effects of call rotations on sleep-wake times and WMC in internal medicine residents. During 2 months of an internal medicine training program adhering to ACGME work-hour restrictions (between April 2006 and June 2007), residents completed daily WMC tests, wore actigraphy watches, and logged their sleep hours. This observational study was conducted during a call month requiring 30-hour call rotations every fourth night, whereas the noncall month, which allowed sleep/wake cycle freedom, was used as the control. Sleep hours per night and WMC testing. Thirty-nine residents completing the study had less sleep per night during their call month (6.4 vs 7.3 h per night noncall, p errors occurred when on call (+1.07/test, p error rates were not evaluated.
Ashack, Kurt A; Burton, Kyle A; Soh, Jonathan M; Lanoue, Julien; Boyd, Anne H; Milford, Emily E; Dunnick, Cory; Dellavalle, Robert P
Internet resources play an important role in how medical students access information related to residency programs.Evaluating program websites is necessary in order to provide accurate information for applicants and provide information regarding areas of website improvement for programs. To date, dermatology residency websites (D WS) have not been evaluated.This paper evaluates dermatology residency websites based on availability of predefined measures. Using the FREIDA (Fellowship and Residency Electronic Interactive Database) Online database, authors searched forall accredited dermatology program websites. Eligible programs were identified through the FREIDA Online database and had a functioning website. Two authors independently extracted data with consensus or third researcher resolution of differences. This data was accessed and archived from July 15th to July 17th, 2015.Primary outcomes measured were presence of content on education, resident and faculty information, program environment, applicant recruitment, schedule, salary, and website quality evaluated using an online tool (WooRank.com). Out of 117 accredited dermatology residencies, 115 had functioning webpages. Of these, 76.5% (75) had direct links found on the FRIEDA Online database. Most programs contained information on education, faculty, program environment, and applicant recruitment. However, website quality and marketing effectiveness were highly variable; most programs were deemed to need improvements in the functioning of their webpages. Also, additional information on current residents and about potential away rotations were lacking from most websites with only 52.2% (60) and 41.7% (48) of programs providing this content, respectively. A majority of dermatology residency websites contained adequate information on many of the factors we evaluated. However, many were lacking in areas that matter to applicants. We hope this report will encourage dermatology residencyprograms
Strumwasser, Aaron; Grabo, Daniel; Inaba, Kenji; Matsushima, Kazuhide; Clark, Damon; Benjamin, Elizabeth; Lam, Lydia; Demetriades, Demetrios
Trauma training in general surgery residency is undergoing an evolution. Hour restrictions, the growth of subspecialty care, and the trend toward nonoperative management have altered resident exposure to operative trauma. We sought to identify trends in resident trauma training since the inception of the 80-hour workweek. The Accreditation Council for General Medical Education Case Log Statistical Reports for Surgery was abstracted for general surgery resident trauma operative volume for the years 1999-2014. Resident trauma experience (operative caseload [OC]) was compared before inception of the 80-hour workweek (1999-2002) to after the 80-hour workweek began (2003 to current). A trend toward decreased operative trauma for general surgery residents was observed (mean OC [before 80-hour workweek vs. 80-hour workweek], 39,252 ± 1,065.2 cases vs. 36,065 ± 1,291.8; p = 0.06). Trauma laparotomies increased (range, 5,446-9,364 cases) with corresponding decreases in vascular trauma (4,704 to 799 cases), neck explorations (1,876 to 1,370 cases), and thoracotomies (2,507 to 2,284 cases). By comparison, an increase in vascular/integrated cases was noted (mean OC [before 80-hour workweek vs. 80-hour workweek], 845 ± 44.2 vs. 1,465 ± 88.4 cases; p surgery (p surgery.
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...
... ANALYSIS SYSTEM § 360.107 Hours of operation. The automatic licensing system will generally be accessible... Commerce directly via fax during regular business hours. Should the system be inaccessible for an extended...
Jaffar, S.; Tayyab, A.; Shah, S.S.; Naseem, S.; Ghazanfar, H.
Background: Ophthalmological conditions are frequently encountered in almost all clinical specialties. Assessing the adequacy of ophthalmology teaching in undergraduate medical education is important in order to diagnose and manage different ophthalmological conditions. The objective of this study was to determine the comfort level of post graduate residents working in different clinical domains in managing common ophthalmic conditions. Methods: A cross sectional survey involving 277 post graduate residents was carried out over a period of six months in both private and public tertiary care hospital. A questionnaire containing two sections and 17 variables in total were distributed among Medical Residents of different specialties except ophthalmology residents. Participants of the study were selected through consecutive non probability sampling. Results: Mean hours of classroom based ophthalmology instruction during during undergraduate program was 59.38 hours (55.9) and mean hours of clinical based ophthalmology instruction during undergraduate program was 62.73 hours (60.8) 54 percentage were either not comfortable or somewhat comfortable in managing common ophthalmic condition. Conclusion: Teaching hours in under graduate program meet or exceed requisite criteria. However graduating doctors generally feel that the time spent does not provide them with the comfort and skill level required to care for patients with ocular presentations. (author)
A survey of physics and related teaching to radiation oncology residents in 21 Canadian cancer centres was undertaken in December 1987 and January 1988. This survey illustrates a very considerable variation in the formal teaching of physics to aspiring radiation oncologists with, for example, the number of hours offered ranging from 40 to 160 in those 10 centres that have a training program. It would appear to be of benefit to radiation oncology residents, those charged with teaching them, and the radiation oncology community as a whole, to develop specific guidelines for this aspect of resident education. (8 refs., tab.)
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
Frankenhauser-Mannuß, J; Goetz, K; Scheuer, M; Szescenyi, J; Leutgeb, R
The aim of this study was to explore views, experiences und perspectives of German GPs related to current out-of-hours service provision covering both urban and rural settings. In the context of the international project EurOOHnet (European Research Network for Out-of-Hours Primary Health Care) the German members (of EurOOHnet) developed a questionnaire about organisational structures, infrastructure requirements and the procedures of information flow between regular care and out-of-hours care in 2011. This questionnaire was adopted in every participating country. A comprehensive postal questionnaire was sent to 410 feneral practice cooperatives in Germany. Qualitative content analysis and an inductive reasoning process, supported by the use of Atlas.ti, were used to identify key themes from responses to open-ended questions in the survey. Results were grouped into 3 overarching categories and each of these were grouped into 3 sub-categories. The questionnaire response rate was 44% (181/410). The analysis identified organisational issues (e. g., financing) and infrastructure barriers (e. g., lack of motivated GPs for out-of-hours care) as key themes. Significantly, different priorities between rural and urban GPs were identified. In particular, rural GPs highlighted shortages of GPs and distance between the GP practice and patients' residence as concerning factors impacting on out-of-hours care. Based on reported views from survey respondents, urban and rural primary care service needs vary significantly and, therefore, different solutions are needed to improve out-of-hours primary care and optimise service quality. © Georg Thieme Verlag KG Stuttgart · New York.
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.
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.
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.
... FOR NURSING HOME CARE OF VETERANS IN STATE HOMES Standards § 51.70 Resident rights. The resident has a... legal representative. (5) Conveyance upon death. Upon the death of a resident with a personal fund...; (iii) Physicians of the resident's choice (to provide care in the nursing home, physicians must meet...
Background: Mentorship is important in residency training as it is necessary for personal and professional development of the resident trainees. Objectives: This study documents mentorship in orthopaedic residency training programme in Nigeria by assessing the awareness of orthopaedic residents on the role of a mentor, ...
Contessa, Jack; Ciardiello, Kenneth A; Perlman, Stacie
To determine if surgical residents share a preferred learning style as measured by Kolb's Learning Style Inventory (LSI) and if a relationship exists between resident learning style and achievement as measured by a standardized examination (AME). Also, core faculty learning styles were assessed to determine if faculty and residents share a preferred learning style. Kolb's LSI, Version 3, was administered to 16 surgical residents and the residency program's core faculty of 6 attending physicians. To measure academic achievement, the American Medical Education (AME) examination was administered to residents. The Hospital of Saint Raphael, General Surgery Residency Program, New Haven, Connecticut. Both instruments were administered to residents during protected core curriculum time. Core faculty were administered the LSI on an individual basis. Surgical residents of the Hospital of Saint Raphael's General Surgery Residency Program and 6 core faculty members Analysis of resident learning style preference revealed Converging as the most commonly occurring style for residents (7) followed by Accommodating (5), Assimilating (3), and Diverging (1). The predominant learning style for core faculty was also Converging (4) with 2 Divergers. The average score for the Convergers on the AME was 62.6 compared with 42 for the next most frequently occurring learning style, Accommodators. In this surgical residency program, a preferred learning style for residents seems to exist (Converging), which confirms what previous studies have found. Additionally, residents with this learning style attained a higher average achievement score as measured by the AME. Also, core faculty share the same preferential learning style as this subset of residents.
Fish, D G
In the view of residents in their last year of specialty training, the Fellowship is now becoming the operative standard for obtaining hospital privileges in urban centres and they felt that this implied that the two standards, the Certificate and the Fellowship of the Royal College, were not achieving the purpose for which they were designed. Although 80% of the residents intended to write the Fellowship, few viewed a year in a basic science department or in research as of intrinsic value in terms of their future practice.The examinations of the Royal College were the subject of criticism, most residents feeling that the examinations did not test the knowledge and ability gained in training. Most expressed a desire for ongoing evaluation during the training period.Service responsibilities were generally regarded as too heavy.Despite the criticism of both training and examination, most residents felt that their training had provided them with the experience and background they needed to practise as specialists.
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.
Full Text Available The duty of care, which sets the standard of conduct of a „good director” is currently governed by the Romanian Companies Act and the Civil Code. The corroboration of the two legal acts is challenging, the paper in hand aims at a comparative view of the legal norms and at the appraisal of the content of this fiduciary duty in the modern context of the competitive economy. The nature of this fiduciary duty and the cases when it can be defied according to the Romanian Law are discussed in terms of the literature and the case law that inspired the legislator. By creating parallels between the content of the agency and the traditional characters of the director's office, mainly tagged with legal prerogatives, the study will reveal the importance of the fiduciary characters of the director’s function. The conclusions will catch the effects of standardizing the substantive exercise of the duty of care and the importance of defining the fiduciary character of directors’ duties, both with respect to case law and as well for healthy business relationships.
Hirst, Sandra P; LeNavenec, Carole Lynne; Aldiabat, Khaldoun
Traumatic events in one's younger years can have an impact on how an individual copes with later life. One traumatic experience for Jewish individuals was the Holocaust. Some of these people are moving into long-term care facilities. It was within this context that the research question emerged: What are Holocaust survivor residents' perceptions of a life lived as they move into a long-term care facility? For this qualitative study, Holocaust survivors were individually interviewed. Findings emphasize that nursing care needs to ensure that Holocaust survivor residents participate in activities, receive timely health care, and receive recognition of their life experiences. Copyright 2011, SLACK Incorporated.
Zebende, G. F.; Brito, A. A.; Silva Filho, A. M.; Castro, A. P.
In this paper we propose to study the cross-correlation between the air temperature and the air relative humidity using the DCCA cross-correlation coefficient ρDCCA. We choose four cities (meteorological stations) located in the State of Bahia (Brazil), as our case study. Our data were available hourly from the Brazilian Institute of Meteorology. Accordingly, in addition to showing that the variables have a negative cross-correlation, we present a new vision about these variables, producing the detrended cross-correlation contour map. As a result, we can see (or not) islands of cross-correlations, that depend on the local time and also the time scale involved.
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 flipped 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.
This study centers on a statistical analysis of the preliminary construction time, main construction time, and total construction man hours of nuclear power plants. The use of these econometric techniques allows the major man hour driving variables to be identified through multivariate analysis of time-series data on over 80 United States nuclear power plants. The analysis made in this study provides a clearer picture of the dynamic changes that have occurred in the man hours of these plants when compared to engineering estimates of man hours, and produces a tool that can be used to project nuclear power plant man hours
Seabott, Heather; Smith, Ryan K; Alseidi, Adnan; Thirlby, Richard C
The interview process is a pivotal, differentiating component of the residency match. Our bias is toward a working interview, producing better fulfillment of the needs of both parties, and a more informed match selection for the candidates and program. We describe a "candidate-centered" approach for integrating applicant interviews into our daily work schedule. Applicants are informed upon accepting the interview of the working interview model. Our program offers 33 interview days over a 12-week period. A maximum of 5 applicants are hosted per day. Applicants are assigned to 1 of our general, thoracic, vascular, or plastic surgery teams. The interview day begins with the applicant changing into scrubs, attending a morning conference, and taking part in a program overview by a Chief Resident. Applicants join their host team where 4-8 hours are spent observing the operative team, on rounds and sharing lunch. The faculty and senior residents are responsible for interviewing and evaluating applicants though the Electronic Residency Application Service. A total of 13 surgeons are involved in the interview process resulting in broad-based evaluations. Each surgeon interviewed between 3 and 12 applicants. Faculty rate this interview approach highly because it allows them to maintain a rigorous operative schedule while interacting with applicants. Current residents are engaged in welcoming applicants to view the program. Faculty and residents believe cooperating in a real world manner aids their assessment of the applicant. Applicants routinely provide positive feedback, relaying this approach is informative, transparent, and should be the "standard." Applicants believe they are presented a realistic view of the program. Ultimately, this candidate-centered process may be attributable to our resident cohort who exhibit high satisfaction, excellent resident morale, and very low dropout rate. We present a candidate-centered, working interview approach used in the selection of
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
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
Sy, Alice; Wong, Eric; Boisvert, Leslie
To determine family medicine residents' learning behaviour and preferences outside of clinical settings in order to help guide the development of an effective academic program that can maximize their learning. Retrospective descriptive analysis of academic learning logs submitted by residents as part of their academic training requirements between 2008 and 2011. London, Ont. All family medicine residents at Western University who had completed their academic program requirements (N = 72) by submitting 300 or more credits (1 credit = 1 hour). Amount of time spent on various learning modalities, location where the learning took place, resources used for self-study, and the objective of the learning activity. A total of 72 residents completed their academic requirements during the study period and logged a total of 25 068 hours of academic learning. Residents chose to spend most of their academic time engaging in self-study (44%), attending staff physicians' teaching sessions (20%),and participating in conferences, courses, or workshops (12%) and in postgraduate medical education sessions (12%). Textbooks (26%), medical journals (20%), and point-of-care resources (12%) were the 3 most common resources used for self-study. The hospital (32%), residents' homes (32%),and family medicine clinics (14%) were the most frequently cited locations where academic learning occurred. While all physicians used a variety of educational activities, most residents (67%) chose self-study as their primary method of learning. The topic for academic learning appeared to have some influence on the learning modalities used by residents. Residents used a variety of learning modalities and chose self-study over other more traditional modalities (eg, lectures) for most of their academic learning. A successful academic program must take into account residents' various learning preferences and habits while providing guidance and training in the use of more effective learning methods and
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...... on the speed of the human, the cameras setup etc. and hence a robust descriptor for gait classification. The dutyfactor is basically a matter of measuring the ground support of the feet with respect to the stride. We estimate this by comparing the incoming silhouettes to a database of silhouettes with known...... ground support. Silhouettes are extracted using the Codebook method and represented using Shape Contexts. The matching with database silhouettes is done using the Hungarian method. While manually estimated duty-factors show a clear classification the presented system contains misclassifications due...
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.
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.
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.
Kwah, Jason; Weintraub, Jennifer; Fallar, Robert; Ripp, Jonathan
Burnout is a common issue in internal medicine residents, and its impact on medical errors and professionalism is an important subject of investigation. To evaluate differences in medical errors and professionalism in internal medicine residents with and without burnout. A single institution observational cohort study was conducted between June 2011 and July 2012. Burnout was measured using the Maslach Burnout Inventory to generate subscores for the following 3 domains: emotional exhaustion, depersonalization, and sense of personal accomplishment. By convention, burnout was defined as a high emotional exhaustion or depersonalization subscore. Medication prescription error rate was the chosen measure of medical errors. Professionalism was measured cumulatively through examining discharge summaries completed within 48 hours, outpatient charts completed within 72 hours, and the average time to review outpatient laboratory tests. Of a total of 54 eligible first-year residents, 53 (98%) and 32 (59%) completed the initial and follow-up surveys, respectively. Residents with year-end burnout had a lower rate of medication prescription errors (0.553 versus 0.780, P = .007). Discharge summaries completed within 48 hours of discharge (83.8% versus 84.0%, P = .93), outpatient charts completed within 72 hours of encounter (93.7% versus 94.3%, P = .31), and time (minutes) to review outpatient laboratory test results (72.3 versus 26.9, P = .28) were similar between residents with and without year-end burnout. This study found a small decrease in medical errors in residents with year-end burnout compared to burnout-free residents and no difference in selected measures of professionalism.
Higher Education in the States, 1971
Because of the radical variance in residency requirements from state to state and sometimes from institution to institution, and because of several court cases involving this issue, the Education Commission of the States appointed a Committee to develop (1) a statement of principles for consideration in drafting legislation in connection with…
The residency training experience is the perfect environment for learning. The university/institution patient population provides a never-ending supply of patients with unique management challenges. Resources abound that allow the discovery of knowledge about similar situations. Senior teachers provide counseling and help direct appropriate care. Periodic testing and evaluations identify deficiencies, which can be corrected with future study. What happens, however, when the resident graduates? Do they possess all the knowledge they'll need for the rest of their career? Will medical discovery stand still limiting the need for future study? If initial certification establishes that the physician has the skills and knowledge to function as an independent physician and surgeon, how do we assure the public that plastic surgeons will practice lifelong learning and remain safe throughout their career? Enter Maintenance of Certification (MOC). In an ideal world, MOC would provide many of the same tools as residency training: identification of gaps in knowledge, resources to correct those deficiencies, overall assessment of knowledge, feedback about communication skills and professionalism, and methods to evaluate and improve one's practice. This article discusses the need; for education and self-assessment that extends beyond residency training and a commitment to lifelong learning. The American Board of Plastic Surgery MOC program is described to demonstrate how it helps the diplomate reach the goal of continuous practice improvement.
Walling, Anne; Nilsen, Kari; Callaway, Paul; Grothusen, Jill; Gillenwater, Cole; King, Samantha; Unruh, Gregory
The student costs of residency interviewing are of increasing concern but limited current information is available. Updated, more detailed information would assist students and residency programs in decisions about residency selection. The study objective was to measure the expenses and time spent in residency interviewing by the 2016 graduating class of the University of Kansas School of Medicine and assess the impact of gender, regional campus location, and primary care application. All 195 students who participated in the 2016 National Residency Matching Program (NRMP) received a 33 item questionnaire addressing interviewing activity, expenses incurred, time invested and related factors. Main measures were self-reported estimates of expenses and time spent interviewing. Descriptive analyses were applied to participant characteristics and responses. Multivariate analysis of variance (MANOVA) and chi-square tests compared students by gender, campus (main/regional), and primary care/other specialties. Analyses of variance (ANOVA) on the dependent variables provided follow-up tests on significant MANOVA results. A total of 163 students (84%) completed the survey. The average student reported 38 (1-124) applications, 16 (1-54) invitations, 11 (1-28) completed interviews, and spent $3,500 ($20-$12,000) and 26 (1-90) days interviewing. No significant differences were found by gender. After MANOVA and ANOVA analyses, non-primary care applicants reported significantly more applications, interviews, and expenditures, but less program financial support. Regional campus students reported significantly fewer invitations, interviews, and days interviewing, but equivalent costs when controlled for primary care application. Cost was a limiting factor in accepting interviews for 63% and time for 53% of study respondents. Students reported investing significant time and money in interviewing. After controlling for other variables, primary care was associated with significantly
Siti Hapsah Isfardiyana
Full Text Available Abstrak Direksi merupakan organ perseroan terbatas yang bertanggungjawab terhadap pengurusan dan perwakilan perseroan, sesuai maksud dan tujuan perseroan berdasarkan Anggaran Dasar Rumah Tangga perseroan terbatas. Pengurusan dan perwakilan oleh direksi harus dijalankan sesuai prinsip fiduciary duty. Tulisan ini menekankan pada persoalan kecerobohan direksi sehingga melakukan pelanggaran fiduciary duty, yang berakibat pada penerapan piercing the corporate vielpada direksi. Dasar hukum utama yang digunakan di penelitian ini termasuk Kitab Undang-Undang Hukum Perdata (KUHP dan Undang-Undang Nomor 40 Tahun 2007 tentang Perseroan Terbatas. Direksi dalam menjalankan kepengurusannya harus didasarkan dengan itikad baik dan penuh tanggung jawab karena direksi memegang fiduciary duty dari perseroan. Apabila direksi lalai dalam tugasnya,direksi dapat dikenakan piercing the corporate viel yaitu pertanggungjawaban pribadi sampai kepada harta pribadi direksi atas kerugian yang diterima oleh perseroan, pemegang saham, atau pihak ketiga. Hal ini digunakan untuk melindungi kepentingan pemegang saham atau pihak ketiga yang dirugikan atas tindakan direksi yang sewenang-wenang atau tidak layak yang dilakukan atas nama perseroan. Abstract The company's directors is the organ responsible for the maintenance and as a representative of the company based on the purpose and objectives of the articles of association. Management and representationby the directors must be executed according to the principle of fiduciary duty. This study emphasized the issue of directors’negligence that leads to the breach of fiduciary duty, whichresultsto the application of piercing the coporate viel by the directors. Primary legal materials used in this study including the Code of Civil Law (Civil Code and Law No. 40 of 2007 on Limited Company. The directors should be implemented in good faith and full responsibility in carrying out its duty, because the directors hold fiduciary duty of
This plan describes the configuration management for the Light Duty Utility Arm robotic manipulation arm control software. It identifies the requirement, associated documents, and the software control methodology. The Light Duty Utility Ann (LDUA) System is a multi-axis robotic manipulator arm and deployment vehicle, used to perform surveillance and characterization operations in support of remediation of defense nuclear wastes currently stored in the Hanford Underground Storage Tanks (USTs) through the available 30.5 cm (12 in.) risers. This plan describes the configuration management of the LDUA software
Dickens, B M
This article provides an overview of some major areas of legal concern in which the AIDS epidemic is having an impact. The rights of infected individuals to testing, treatment, and confidentiality are reviewed, and emphasis is given to their claims to nondiscrimination regarding access to health care, employment, housing, education, insurance, and related interests. Infected persons' duties to contain transmission of AIDS are outlined under principles of criminal and civil law, including liability for provision of contaminated blood products. Uninfected people's general rights to protection are considered, and health professionals' and authorities' rights and duties are given more detailed attention. In conclusion, some legal developments outside the United States are reviewed.
Brooks, Graham; Sparrow, Paul
This paper focuses on customers' views on the extent that bookmakers and individuals are responsible for a duty of care. 72 participants from seven bookmakers in one city in England were interviewed that illustrates customers expect bookmakers to take 'reasonable steps' to avoid exploiting all customers. However, the customers' views recorded in this paper illustrate a range of views on what a duty of care should actually comprise with differences of opinion on the level of bookmakers and individuals level of responsibility, dealing with intoxicated customers, illegal gambling, prevention of excessive and problem gambling and self-exclusion.
This report reviews, assesses, and summarizes the research and development status of diesel engine technology applicable to light-duty vehicles. In addition, it identifies specific basic and applied research and development needs in light-duty diesel technology and related health areas where initial or increased participation by the US Government would be desirable. The material presented in this report updates information provided in the first diesel engine status report prepared by the Aerospace Corporation for the Department of Energy in September, 1978.
Boumans, Nicolle P G; Dorant, Elisabeth
This study compared the work-related experiences and personal health status of double-duty caregivers with those of caregivers who do not provide informal care to a family member or close friend in need. The interest in providing informal care alongside employment is growing. However, little attention has been paid to the dual role of the healthcare professional who also has caregiving responsibilities for a needy person in his/her private situation. It is important to study the negative and positive consequences of this combination of professional and family care giving. A cross-sectional study. In 2011, we distributed a digital questionnaire to employees with a professional care function working at a healthcare organization in the Netherlands. Descriptive statistics, analyses of covariance and tests of linearity were performed. Analyses of variance demonstrated that as professional healthcare workers provide more hours of informal care in their private lives, their mental and physical health significantly worsens, while their need for recovery increases. Also, statistical significant increases were seen for emotional exhaustion, presenteeism and negative experiences with Work-Home and Home-Work Interferences. Remarkably, positive Home-Work Interference increased significantly with increasing hours of informal care. Double-duty caregivers appeared to be equally motivated and satisfied with their work as their co-workers. No differences were seen with respect to absenteeism. Double-duty caregivers prove to be employees who are at risk of developing symptoms of overload. This finding calls for special attention, with long-term solutions at both legislative and organizational level. © 2013 John Wiley & Sons Ltd.
Desselle, Bonnie C; English, Robin; Hescock, George; Hauser, Andrea; Roy, Melissa; Yang, Tong; Chauvin, Sheila W
Active engagement in the learning process is important to enhance learners' knowledge acquisition and retention and the development of their thinking skills. This study evaluated whether a 1-hour faculty development workshop increased the use of active teaching strategies and enhanced residents' active learning and thinking. Faculty teaching in a pediatrics residency participated in a 1-hour workshop (intervention) approximately 1 month before a scheduled lecture. Participants' responses to a preworkshop/postworkshop questionnaire targeted self-efficacy (confidence) for facilitating active learning and thinking and providing feedback about workshop quality. Trained observers assessed each lecture (3-month baseline phase and 3-month intervention phase) using an 8-item scale for use of active learning strategies and a 7-item scale for residents' engagement in active learning. Observers also assessed lecturer-resident interactions and the extent to which residents were asked to justify their answers. Responses to the workshop questionnaire (n = 32/34; 94%) demonstrated effectiveness and increased confidence. Faculty in the intervention phase demonstrated increased use of interactive teaching strategies for 6 items, with 5 reaching statistical significance (P ≤ .01). Residents' active learning behaviors in lectures were higher in the intervention arm for all 7 items, with 5 reaching statistical significance. Faculty in the intervention group demonstrated increased use of higher-order questioning (P = .02) and solicited justifications for answers (P = .01). A 1-hour faculty development program increased faculty use of active learning strategies and residents' engagement in active learning during resident core curriculum lectures.
Adams, Barbara J; Margaron, Franklin; Kaplan, Brian J
The video game industry has become increasingly popular over recent years, offering photorealistic simulations of various scenarios while requiring motor, visual, and cognitive coordination. Video game players outperform nonplayers on different visual tasks and are faster and more accurate on laparoscopic simulators. The same qualities found in video game players are highly desired in surgeons. Our investigation aims to evaluate the effect of video game play on the development of fine motor and visual skills. Specifically, we plan to examine if handheld video devices offer the same improvement in laparoscopic skill as traditional simulators, with less cost and more accessibility. We performed an Institutional Review Board-approved study, including categorical surgical residents and preliminary interns at our institution. The residents were randomly assigned to 1 of 3 study arms, including a traditional laparoscopic simulator, XBOX 360 gaming console, or Nintendo DS handheld gaming system. After an introduction survey and baseline timed test using a laparoscopic surgery box trainer, residents were given 6 weeks to practice on their respective consoles. At the conclusion of the study, the residents were tested again on the simulator and completed a final survey. A total of 31 residents were included in the study, representing equal distribution of each class level. The XBOX 360 group spent more time on their console weekly (6 hours per week) compared with the simulator (2 hours per week), and Nintendo groups (3 hours per week). There was a significant difference in the improvement of the tested time among the 3 groups, with the XBOX 360 group showing the greatest improvement (p = 0.052). The residents in the laparoscopic simulator arm (n = 11) improved 4.6 seconds, the XBOX group (n = 10) improved 17.7 seconds, and the Nintendo DS group (n = 10) improved 11.8 seconds. Residents who played more than 10 hours of video games weekly had the fastest times on the simulator
Coleridge, S T
Medical writing and publications are important in developing a scholarly basis for residency programs and in providing a learning experience for both resident and faculty mentors. Residency directors must provide the stimulus and support for both faculty and residents' varied creative activities. This support manifests itself in a commitment to scholarly activity (including a dedicated research person), the procurement of available research materials, the establishment of a process or plan for beginning a research project, and the development of a method for rewarding or recognizing faculty and residents who produce scholarly works. Some osteopathic residency programs may need to train faculty in research skills at the same time that residents are learning to write. Trained faculty are better models and coaches for residents engaged in research. Beginning with a fundamental, but disciplined, writing program, both faculty and residents may learn methods for sharing new knowledge or acquiring those skills necessary to critically analyze the medical literature.
Full Text Available Dongseok Choi,1,2 Andrea Cedfeldt,3,4 Christine Flores,5 Kimberly Irish,3 Patrick Brunett,3,6 Donald Girard3,4 1OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, OR, USA; 2School of Dentistry, Kyung Hee University, Seoul, Korea; 3Division of Graduate Medical Education, 4Department of Medicine, 5Division of Continuing Professional Development, 6Department of Emergency Medicine, Oregon Health & Science University, Portland, OR, USA Background: The surveys in this study were carried out at the Graduate Medical Education Division at Oregon Health & Science University (OHSU. OHSU implemented two significant wellness initiatives: a wellness program in 2004, and a policy allowing 4 half-days off each academic year to pursue personal or family health care needs in 2010. This study provides a secondary data analysis of five cross-sectional surveys of career satisfaction of resident and fellow trainees. Methods: All trainees were surveyed five times over a 10-year period using anonymous, cross-sectional web-based survey instruments. Surveys included questions about career satisfaction, perceived stress, sleep hours, burnout, and related factors.Results: This represents 10 years of accumulated responses from over 2,200 residents with results showing continual improvement in their career satisfaction. Response rates ranged from 56% to 72%. During the study period, there was a significant positive change in overall resident career satisfaction, with little change in factors traditionally considered to be predictive of overall career satisfaction such as sleep hours or perceived stress level. In addition, our data support that availability of time for personal tasks could positively impact the overall training experience.Conclusion: We postulate that the improvements in satisfaction relate to two major institutional innovations designed to promote resident wellness. Keywords: satisfaction, burnout, graduate medical education
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
Lande, R Gregory; Gragnani, Cynthia
Military service members have unique experiences that may contribute to sleep problems in this patient population. To gather sleep habits and chronic sleep complaints among active-duty service members to identify common characteristics. The investigators administered a detailed sleep log, the Pittsburgh Insomnia Rating Scale, the Zung Self-Rating Depression Scale, the Epworth Sleepiness Scale, and the Pre-Sleep Arousal Scale to consenting service members referred to a military psychiatric partial hospitalization program. A total of 57 service members participated in this study. Participants reported a mean of less than 5 total hours of sleep and sleep latencies of 30 minutes or more. Tobacco users (n=22) reported nearly a full hour less of total time slept. Service members with combat experience (n=26) reported qualitatively poorer sleep with less total sleep time (P=.05), greater presleep arousal (P=.01), and a substantially greater number of troubling dreams (P=.06) compared with service members without combat experience. Chronic sleep issues are common complaints among military personnel, an anecdotal finding confirmed by the results of this study. These results lend support for more detailed sleep assessments, particularly among combat veterans.
This report summarized the regulatory requirements related to nitrous oxide (NO x ) fleet averaging for light-duty vehicles, light-duty trucks, and medium-duty passenger vehicles under the On-Road Vehicle and Engine Emission Regulations. The regulations introduced more stringent national emission standards for on-road vehicles and engines and include technical standards that establish maximum limits on vehicle exhaust emissions. The fleet average NO x emission performance of individual companies and the overall Canadian fleet for 2007 was summarized, and the effectiveness of the Canadian fleet average NO x emission program was evaluated in relation to its environmental performance objectives. A total of 22 companies submitted reports for 294 test groups comprising 1,599,051 vehicles of the 2007 model year. The average NO x value for the entire LDV/LLDT fleet was 0.06897630 grams per mile. The average value for the HLDT/MDPV fleet was 0.160668 grams per mile. NO x values for both overall fleets remained better than the corresponding fleet average NO x standards, and were consistent with the environmental performance objectives of the regulations. 9 tabs., 3 figs.
The On-Road Vehicle and Engine Emission Regulations came into effect on January 1, 2004. The regulations introduced more stringent national emission standards for on-road vehicles and engines, and also required that companies submit reports containing information concerning the company's fleets. This report presented a summary of the regulatory requirements relating to nitric oxide (NO x ) fleet average emissions for light-duty vehicles, light-duty trucks, and medium-duty passenger vehicles under the new regulations. The effectiveness of the Canadian fleet average NO x emission program at achieving environmental performance objectives was also evaluated. A summary of the fleet average NO x emission performance of individual companies was presented, as well as the overall Canadian fleet average of the 2004 model year based on data submitted by companies in their end of model year reports. A total of 21 companies submitted reports covering 2004 model year vehicles in 10 test groups, comprising 1,350,719 vehicles of the 2004 model year manufactured or imported for the purpose of sale in Canada. The average NO x value for the entire Canadian LDV/LDT fleet was 0.2016463 grams per mile. The average NO x values for the entire Canadian HLDT/MDPV fleet was 0.321976 grams per mile. It was concluded that the NO x values for both fleets were consistent with the environmental performance objectives of the regulations for the 2004 model year. 9 tabs
Deffenbacher, Brandy; Langner, Shannon; Khodaee, Morteza
A family medicine residency is a unique training environment where residents are exposed to care in multiple settings, across all ages. Procedures are an integral part of family medicine practice. Family medicine residency (FMR) programs are tasked with the job of teaching these skills at a level of intensity and frequency that allows a resident to achieve competency of such skills. In an environment that is limited by work hour restrictions, self-study teaching methods are one way to ensure all residents receive the fundamental knowledge of how to perform procedures. We developed and evaluated the efficacy of a self-study procedure teaching method and procedure evaluation checklist. A self-study procedure teaching intervention was created, consisting of instructional articles and videos on three procedures. To assess the efficacy of the intervention, and the competency of the residents, pre- and postintervention procedure performance sessions were completed. These sessions were reviewed and scored using a standardized procedure performance checklist. All 24 residents participated in the study. Overall, the resident procedure knowledge increased on two of the three procedures studied, and ability to perform procedure according to expert-validated checklist improved significantly on all procedures. A self-study intervention is a simple but effective way to increase and improve procedure training in a way that fits the complex scheduling needs of a residency training program. In addition, this study demonstrates that the procedure performance checklists are a simple and reliable way to increase assessment of resident procedure performance skills in a residency setting.
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
Raviv, Eran; Bouwman, Kees E.; van Dijk, Dick
This discussion paper led to a publication in 'Energy Economics' , 2015, 50, 227-239. The daily average price of electricity represents the price of electricity to be delivered over the full next day and serves as a key reference price in the electricity market. It is an aggregate that equals the average of hourly prices for delivery during each of the 24 individual hours. This paper demonstrates that the disaggregated hourly prices contain useful predictive information for the daily average ...
Smiley, A.; Moray, N.P.
This project reviewed the practice of 12-hour shift work schedules at nuclear power plants, and its relationship to safety. The current literature was examined for information on accidents, fatigue and personal preferences. Interviews with operators and maintainers showed that these groups had attitude and preference differences related to both 12 hour shift schedules and overtime work opportunities. Several factors related to 12-hour schedules were identified which could affect safety, but which have not been adequately considered. (24 refs.)
... 1930, as amended (the Act), the Department preliminarily determined that the use of facts available for...: Offset of Countervailing Duty Duties Comment 5: Levels of Trade Comment 6: Treatment of Merchandising...
... Shrimp From Malaysia: Preliminary Countervailing Duty Determination AGENCY: Import Administration... the Countervailing Duty Investigation of Certain Frozen Warmwater Shrimp from Malaysia,'' dated... frozen warmwater shrimp (frozen shrimp) from Malaysia. The period of investigation (POI) is January 1...
... Bags From Thailand: Rescission of Antidumping Duty Administrative Review AGENCY: Import Administration... duty order on polyethylene retail carrier bags from Thailand. The period of review is August 1, 2010... 25685
... DEPARTMENT OF COMMERCE INTERNATIONAL TRADE ADMINISTRATION [A-201-831] Prestressed Concrete Steel Wire Strand from Mexico: Rescission of Antidumping Duty Administrative Review AGENCY: Import... request an administrative review of the antidumping duty order on prestressed concrete steel wire strand...
L.T. Visscher (Louis)
textabstractAbstract: In many jurisdictions, potential injurers are under a legal duty to incorporate possible mistakes of the potential victim. I distinguish three types of mistakes. First, victims might make mistakes because it is too costly to avoid them (e.g. little children in traffic). Second,
In its reaching its decision, the German Federal Constitutional Court is responsible for preserving the political discretion of the legislature in protecting interests and remembering the structural distinction between "hard" defensive rights and "soft" protective duties in order to prevent the erosion of the directly binding nature of ...
... highways for any purpose other than: (i) Transportation to and from a franchised dealership of the vehicle... SAFETY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) REGISTERED IMPORTERS OF VEHICLES NOT ORIGINALLY MANUFACTURED TO CONFORM TO THE FEDERAL MOTOR VEHICLE SAFETY STANDARDS § 592.6 Duties of a...
... at least 5 Hz. Use these recorded values to calculate cycle-validation statistics and total work. (d... sequence of paired values for speed and torque or for speed and power. (b) Transform normalized values of... describes how to transform these normalized values into a sequence of reference speeds, f nref. Running duty...
Daily physical activity ist a predictive factor for cardio-vascular disease and for obesity. In military, police and firefighter service duty sport is used to increase and to keep a work specifical physical fitness. Till today no study data with direct data acquisition exists for a risk assessment of the injury rates in duty sport. In this one-year study in a German Armed Forces armoured brigade with 22 companies, every sport-related injury on duty and the following sick days were recorded. Apart from the sport type, the duration of the athletic activity and the number of soldiers that took part in it were monitored. 275 sport injuries were recorded. Soccer was the sport with the highest risk of injuries. Team sports proved to be more dangerous than individual physical activity. The author has demonstrated a reduction of the total injury rate by 39 %, of sick days by 50 %, and of the days with partial unfitness for duty by 42 % when team sports are reduced in favour to other physical activities. © Georg Thieme Verlag KG Stuttgart · New York.
... 2590-AA27 Enterprise Duty To Serve Underserved Markets AGENCY: Federal Housing Finance Agency. ACTION... Recovery Act of 2008 (HERA) amended section 1335 of the Federal Housing Enterprises Financial Safety and... Enterprises) to serve three specified underserved markets--manufactured housing, affordable housing...
The paper discusses measurements of ammonia (NH3) emissions from EPA's light duty test vehicle while operated on a dynamometer. The vehicle's (1993 Chevrolet equipped with a three-way catalyst) emissions were measured for three transient (urban driving, highway fuel economy, and ...
... 21 Food and Drugs 9 2010-04-01 2010-04-01 false Custody and other duties. 1316.73 Section 1316.73 Food and Drugs DRUG ENFORCEMENT ADMINISTRATION, DEPARTMENT OF JUSTICE ADMINISTRATIVE FUNCTIONS, PRACTICES, AND PROCEDURES Seizure, Forfeiture, and Disposition of Property § 1316.73 Custody and other...
De Silva, Muthu
This study investigates the influence of academic entrepreneurship on traditional academic duties carried out in a resource-constrained environment, particularly focusing on whether there is synergy or rivalry between these two activities. Using qualitative evidence, we discover that there are funding, resource, knowledge and skill and networking…
Genderen, M. van; Aken, M.G. van
In a NOx adsorber programme the feasibility for applying this technology to heavy duty diesel engines was investigated. After modelling and simulations for realising best λ < 1 engine conditions a platform was build which was used to obtain good NOx adsorber regeneration settings in a number of
... Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (MARKETING AGREEMENTS AND ORDERS; MISCELLANEOUS COMMODITIES), DEPARTMENT OF AGRICULTURE BEEF PROMOTION AND RESEARCH Beef Promotion and Research Order Cattlemen's Beef Promotion and Research Board § 1260.150 Duties of the Board...