WorldWideScience

Sample records for single family residence

  1. Attitudes of Family Medicine Program Directors Toward Osteopathic Residents Under the Single Accreditation System.

    Science.gov (United States)

    Hempstead, Laura K; Shaffer, Todd D; Williams, Karen B; Arnold, Lt Col James

    2017-04-01

    Between 2015 and 2020, residency programs accredited through the American Osteopathic Association (AOA) are preparing the single graduate medical education (GME) system through the Accreditation Council for Graduate Medical Education (ACGME). (1) To assess the attitudes of family medicine program directors in programs accredited dually by the AOA and ACGME (AOA/ACGME) or ACGME only toward the clinical and academic preparedness of osteopathic residency candidates and (2) to determine program director attitudes toward the perceived value of osteopathic-focused education, including osteopathic manipulative treatment (OMT) curricula. A survey was sent to program directors of AOA/ACGME and ACGME-only accredited family medicine residency programs. Items concerned program directors' perception of the academic and clinical strength of osteopathic residents at the onset of residency, the presence of osteopathic faculty and residents currently in the program, and the presence of formal curricula for teaching OMT. The perceived value of osteopathic focus was obtained through a composite score of 5 items. A total of 38 AOA/ACGME family medicine residency program directors (17%) and 211 ACGME family medicine residency program directors (45.6%) completed the survey (N=249). No difference was found in the ranking of the perceived clinical preparation of osteopathic residents vs allopathic residents in programs with and without OMT curricula (P=.054). Directors of programs with OMT curricula perceived the academic preparation of their osteopathic residents vs allopathic residents more highly than those without OMT curricula (P=.039). Directors of AOA/ACGME programs perceived both the academic preparation and clinical preparation of their osteopathic residents more highly than those at ACGME-only programs (P=.004 and P=.002, respectively). Directors of AOA/ACGME programs, as well as those whose programs have an osteopathic focus in curricular offerings, were more likely to rank the

  2. Financial methods applicable to energy-conserving retrofits for single-family residences

    Energy Technology Data Exchange (ETDEWEB)

    None

    1977-06-01

    The National Savings and Loan League (NSLL) has been researching techniques that may be used to finance energy-conservation measures in the residential sector. Twelve techniques developed and tested by NSLL are: future-advances clause under open-end mortgages; borrowing against existing savings accounts; home-improvement loans; variable-rate mortgages; second trusts or second mortgages; variable-payment mortgages; balloon-payment mortgages; deferred monthly payments for periods of excessive energy use; renegotiation of terms at set intervals; lower interest rates offered on mortgages in return for lender sharing in equity appreciation of the property; graduated payments; and deferred-interest loans. The testing took place in Pittsburgh, PA. The program consisted of 8 specific tasks, including several directed at different financial innovations for the financing of retrofits. Details are presented on findings; legal research; relationship of utilities to installation of retrofits; financing techniques applicable to retrofits; and national energy program for single-family residences. Some extensive attachments include information on: legal aspects, energy loan advertisements, and potential savings to be realized from various residential retrofit energy-conservation measures.

  3. Solar energy heating system design package for a single-family residence at New Castle, Pennsylvania

    Energy Technology Data Exchange (ETDEWEB)

    1977-08-01

    The design of a solar heating and hot water system for the New Castle Redevelopment Authority's single-family dwelling located at New Castle, Pennsylvania is described. Documentation submitted by the contractor for Government review of plans, specifications, cost trade studies and verification status for approval to commit the system to fabrication is presented. Also included are system integration drawings, major subsystems drawings, and architect's specifications and plans.

  4. Installation guidelines for solar heating system, single-family residence at New Castle, Pennsylvania

    Science.gov (United States)

    1980-01-01

    The solar heating system installer guidelines are presented for each subsystem. This single family residential heating system is a solar-assisted, hydronic-to-warm-air system with solar-assisted domestic water heating. It is composed of the following major components: (1) liquid cooled flat plate collectors; (2) water storage tank; (3) passive solar-fired domestic water preheater; (4) electric hot water heater; (5) heat pump with electric backup; (6) solar hot water coil unit; (7) tube-and-shell heat exchanger, three pumps, and associated pipes and valving in an energy transport module; (8) control system; and (9) air-cooled heat purge unit. Information is provided on the operating procedures, controls, caution requirements, and routine and schedule maintenance in the form of written descriptions, schematics, detail drawings, pictures, and manufacturer's component data.

  5. Waverly Homes, Inc. (lot 13) single family residence, Westminster, Colorado. Solar project description

    Science.gov (United States)

    1981-03-01

    The use of solar energy for space heating a single family home and preheating incoming city water is discussed. The system has an array of flat plate collectors with a gross area of 351 square feet. Air is used to deliver solar energy from the collector array to storage and to the space heating and hot water loads. Solar energy is stored in the basement in a 175 cubic foot concrete tin containing 17,500 pounds of rock. Solar energy preheated city water is stored in an 80 gallon preheat storage tank and supplied, to a conventional 40 gallon domestic hot water (DHW) tank. When solar energy is insufficient to satisfy the space heating load, a gas furnace provides auxiliary energy for space heating. Similarly, a gas heater in the DHW tank provides auxiliary energy for water heating.

  6. Solar heating system design package for a single-family residence at William O'Brien State Park, Minnesota

    Energy Technology Data Exchange (ETDEWEB)

    1977-07-01

    Honeywell, Inc. has undertaken the design, fabrication, installation, and monitoring of a prototype solar heating and hot water system for the Minnesota Department of Natural Resources' single-family dwelling located at O'Brien State Park, 30 miles east of Minneapolis, Minnesota. Documentation submitted by Honeywell for government review of plans, specifications, cost trade studies and verification status in order to provide the contractor with approval to commit the system to fabrication are included.

  7. Installation guidelines for solar heating system, single-family residence at William OBrien State Park, Stillwater, Minnesota

    Science.gov (United States)

    1980-01-01

    Installation procedures for the single family residential solar heating system at the William O'Brien State Park, Stillwater, Minnesota, are presented. The system is a solar-assisted, hydronic-to-warm-air system with solar-assisted domestic water heating. It is composed of the following major components: liquid cooled flat plate collectors; water storage tank; passive solar-fired domestic water preheater; electric hot water heater; heat pump with electric backup; solar hot water coil unit; tube-and-shell heat exchanger, three pumps, and associated pipes and valving in an energy transport module; control system; and air-cooled heat purge unit. Installer guidelines are provided for each subsystem and includes testing and filling the system. Information is also given on the operating procedures, controls, caution requirements and routine and schedule maintenance.

  8. Installation guidelines for solar heating system, single-family residence at William O'Brien State Park, Stillwater, Minnesota

    Energy Technology Data Exchange (ETDEWEB)

    1980-05-01

    The Solar Heating System installer guidelines are provided for each subsystem and testing and filling the system are included. This single-family residential heating system is a solar-assisted, hydronic-to-warm-air system with solar-assisted domestic water heating. It is composed of the following major components: liquid cooled flat plate collectors; water storage tank; passive solar-fired domestic water preheater; electric hot water heater; heat pump with electric backup; solar hot water coil unit; tube-and-shell heat exchanger, three pumps, and associated pipes and valving in an energy transport module; control system; and air-cooled heat purge unit. Information is also provided on the operating procedures, controls, caution requirements, and routine and schedule maintenance. Information consists of written procedures, schematics, detail drawings, pictures and manufacturer's component data.

  9. Teaching home care to family medicine residents.

    OpenAIRE

    Boillat, M.; Boulet, S.; Poulin de Courval, L.

    1996-01-01

    A growing elderly population suffering from chronic and debilitating diseases, the rising cost of institutional care, and increasing demand from patients for home visits indicate that home care will become a more important part of family physicians' practice in the future. We describe a model for teaching family medicine residents how to provide home services.

  10. Occurrence of Legionella in hot water systems of single-family residences in suburbs of two German cities with special reference to solar and district heating.

    Science.gov (United States)

    Mathys, Werner; Stanke, Juliane; Harmuth, Margarita; Junge-Mathys, Elisabeth

    2008-03-01

    A total of 452 samples from hot water systems of randomly selected single family residences in the suburbs of two German cities were analysed for the occurrence of Legionella. Technical data were documented using a standardized questionnaire to evaluate possible factors promoting the growth of the bacterium in these small plumbing systems. All houses were supplied with treated groundwater from public water works. Drinking water quality was within the limits specified in the German regulations for drinking water and the water was not chlorinated. The results showed that plumbing systems in private houses that provided hot water from instantaneous water heaters were free of Legionella compared with a prevalence of 12% in houses with storage tanks and recirculating hot water where maximum counts of Legionella reached 100,000 CFU/100ml. The presence of L. pneumophila accounted for 93.9% of all Legionella positive specimens of which 71.8% belonged to serogroup 1. The volume of the storage tank, interrupting circulation for several hours daily and intermittently raising hot water temperatures to >60 degrees C had no influence on Legionella counts. Plumbing systems with copper pipes were more frequently contaminated than those made of synthetic materials or galvanized steel. An inhibitory effect due to copper was not present. Newly constructed systems (district heating systems were colonized by Legionella. Their significantly lower hot water temperature is thought to be the key factor leading to intensified growth of Legionella. Although hot water systems using solar energy to supplement conventional hot water supplies operate at temperatures 3 degrees C lower than conventional systems, this technique does not seem to promote proliferation of the bacterium. Our data show convincingly that the temperature of the hot water is probably the most important or perhaps the only determinant factor for multiplication of Legionella. Water with a temperature below 46 degrees C was

  11. 75 FR 9247 - Single Family Mortgage Insurance Premium, Single Family

    Science.gov (United States)

    2010-03-01

    ... URBAN DEVELOPMENT Single Family Mortgage Insurance Premium, Single Family AGENCY: Office of the Chief... the Single Family Premium Collection Subsystem-Upfront (SFPCS-U) to remit the upfront premium to... manage and process upfront single family mortgage insurance premium collections and corrections to submit...

  12. Otolaryngology Training for Family Practice Residents.

    Science.gov (United States)

    And Others; Rood, Stewart R.

    1980-01-01

    The faculty of the Department of Otolaryngology, University of Pittsburgh School of Medicine, has designed a rotation in the otolaryngology service, that is a basic clinical orientation to ear, nose and throat medicine, to fit the one-month block committed by the local family practice residency training program. The program is described and its…

  13. Educational contracts in family medicine residency training.

    OpenAIRE

    Mahood, S.; Rojas, R.; Andres, D.; Zagozeski, C.; White, G.; Bradel, T.

    1994-01-01

    An educational contract for family medicine residency training and evaluation addresses many of the difficulties and challenges of current postgraduate medical education. This article identifies important principles for developing a contractual approach; describes the contract used in one program and its implementation; and discusses its theory, advantages, and limitations.

  14. An assessment of efficient water heating options for an all-electric single family residence in a mixed-humid climate

    Science.gov (United States)

    Balke, Elizabeth C.; Healy, William M.; Ullah, Tania

    2016-01-01

    An evaluation of a variety of efficient water heating strategies for an all-electric single family home located in a mixed-humid climate is conducted using numerical modeling. The strategies considered include various combinations of solar thermal, heat pump, and electric resistance water heaters. The numerical model used in the study is first validated against a year of field data obtained on a dual-tank system with a solar thermal preheat tank feeding a heat pump water heater that serves as a backup. Modeling results show that this configuration is the most efficient of the systems studied over the course of a year, with a system coefficient of performance (COPsys) of 2.87. The heat pump water heater alone results in a COPsys of 1.9, while the baseline resistance water heater has a COPsys of 0.95. Impacts on space conditioning are also investigated by considering the extra energy consumption required of the air source heat pump to remove or add heat from the conditioned space by the water heating system. A modified COPsys that incorporates the heat pump energy consumption shows a significant drop in efficiency for the dual tank configuration since the heat pump water heater draws the most heat from the space in the heating season while the high temperatures in the solar storage tank during the cooling season result in an added heat load to the space. Despite this degradation in the COPsys, the combination of the solar thermal preheat tank and the heat pump water heater is the most efficient option even when considering the impacts on space conditioning. PMID:27990058

  15. An assessment of efficient water heating options for an all-electric single family residence in a mixed-humid climate.

    Science.gov (United States)

    Balke, Elizabeth C; Healy, William M; Ullah, Tania

    2016-12-01

    An evaluation of a variety of efficient water heating strategies for an all-electric single family home located in a mixed-humid climate is conducted using numerical modeling. The strategies considered include various combinations of solar thermal, heat pump, and electric resistance water heaters. The numerical model used in the study is first validated against a year of field data obtained on a dual-tank system with a solar thermal preheat tank feeding a heat pump water heater that serves as a backup. Modeling results show that this configuration is the most efficient of the systems studied over the course of a year, with a system coefficient of performance (COPsys) of 2.87. The heat pump water heater alone results in a COPsys of 1.9, while the baseline resistance water heater has a COPsys of 0.95. Impacts on space conditioning are also investigated by considering the extra energy consumption required of the air source heat pump to remove or add heat from the conditioned space by the water heating system. A modified COPsys that incorporates the heat pump energy consumption shows a significant drop in efficiency for the dual tank configuration since the heat pump water heater draws the most heat from the space in the heating season while the high temperatures in the solar storage tank during the cooling season result in an added heat load to the space. Despite this degradation in the COPsys, the combination of the solar thermal preheat tank and the heat pump water heater is the most efficient option even when considering the impacts on space conditioning.

  16. Resident-as-teacher in family medicine: a CERA survey.

    Science.gov (United States)

    Al Achkar, Morhaf; Davies, M Kelly; Busha, Michael E; Oh, Robert C

    2015-06-01

    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.

  17. Morning Report in Family Medicine Residency Programs: A Descriptive Study.

    Science.gov (United States)

    Kuncharapu, Indumathi; Cass, Alvah R.; Carlson, Carol A.; Scott, Jack R.

    Morning Report (MR) is a frequently held case conference in most Family Medicine (FM) residency programs among medical learners who discuss recent inpatient admissions before the day's care of patients. This study conducted a national survey of FM residency program directors to describe the roles of faculty and residents in facilitating MR.…

  18. Family medicine residency training and burnout: a qualitative study

    Directory of Open Access Journals (Sweden)

    Kimberly Rutherford

    2014-12-01

    Conclusions: The high level of burnout in family medicine residents in BC is a multifactorial and complex phenomenon. Training programs and faculty should be aware of burnout risk factors and strive to implement changes to reduce burnout, including allowing residents increased control over scheduling, access to counseling services and training for resident mentors.

  19. Stress in Family Practice Residents: An Exploratory Study Using Art.

    Science.gov (United States)

    Julliard, Kell; Intilli, Nancy; Ryan, Jennifer; Vollmann, Sarah; Seshadri, Mahalakshmi

    2002-01-01

    Investigates the themes of 16 family practice residents' art work and their characteristics (age, gender, resident year, undergraduate training location) in relationship to stress. Residents' drawing were linked by common themes of psychological pressure, anxiety, a sense of being overwhelmed, and depression. Evidence of stress was more frequently…

  20. Normal versus Pathological Aging: Knowledge of Family Practice Residents.

    Science.gov (United States)

    Beall, S. Colleen; And Others

    1996-01-01

    Family physicians may lack discriminatory ability to differentiate normal aging form disease states. To assess such ability, 53 aging-related indicators or symptoms were presented to 65 physicians in 3 family practice residency programs. Respondents classified each symptom as normal aging or disease. On average, residents classified 73.4% of…

  1. Characteristics of Combined Family Practice-Psychiatry Residency Programs

    Science.gov (United States)

    Rachal, James; Lacy, Timothy J.; Warner, Christopher H.; Whelchel, Jennifer

    2005-01-01

    Objective: To evaluate how family practice-psychiatry residency programs meet the challenges of rigorous accreditation demands, clinical supervision, and boundaries of practice. Method: A 54-question survey of program directors of family practice-psychiatry residency programs outlining program demographic data, curricula, coordination, resident…

  2. Length and content of family practice residency training.

    Science.gov (United States)

    Duane, Marguerite; Green, Larry A; Dovey, Susan; Lai, Sandy; Graham, Robert; Fryer, George E

    2002-01-01

    Family practice residency programs are based largely on a model implemented more than 30 years ago. Substantial changes in medical practice, technology, and knowledge necessitate reassessment of how family physicians are prepared for practice. We simultaneously surveyed samples of family practice residency directors, first-year residents, and family physicians due for their first board recertification examination to determine, using both quantitative and qualitative methods, their opinions about the length and content of family practice residencies in the United States. Twenty-seven percent of residency directors, 32% of residents, and 28% of family physicians favored extending family practice residency to 4 years; very few favored 2- or 5-year programs. There was dispersion of opinions about possible changes within each group and among the three groups. Most in all three groups would be willing to extend residency for more training in office-based procedures and sports medicine, but many were unwilling to extend residency for more training in surgery or hospital-based care. Residents expressed more willingness than program directors or family physicians to change training. Barriers to change included disagreement about the need to change; program financing and opportunity costs, such as loss of income and delay in debt repayment; and potential negative impact on student recruitment. Most respondents support the current 3-year model of training. There is considerable interest in changing both the length and content of family practice training. Lack of consensus suggests that a period of elective experimentation might be needed to assure family physicians are prepared to meet the needs and expectations of their patients.

  3. The Residency Performance Index: An Effort at Residency Quality Assessment and Improvement in Family Medicine.

    Science.gov (United States)

    Hoekzema, Grant S; Maxwell, Lisa; Gravel, Joseph W; Mills, Walter W; Geiger, William

    2014-12-01

    Residency programs are increasingly being asked to defend their quality, and that of the residents they produce. Yet "residency quality" is a construct that has not been well defined, with no accepted standards other than meeting accreditation standards. In 2009, the Association of Family Medicine Residency Directors developed a strategic plan that included the goal of raising the quality of family medicine training. We describe the development of this quality improvement tool, which we called the residency performance index (RPI), and its first year of use by family medicine residency programs. We describe the use of the tool as a "dashboard" to facilitate program self-improvement. Using program metrics specific to family medicine training, and benchmark criteria for these metrics, the RPI was launched in 2012 to help programs identify strengths and areas for improvement in their educational activities and resident clinical experiences that could be tracked and reviewed as part of the annual program evaluation. Approximately 100 program directors began using the tool and 70 finished the process, and were provided aggregate data. Initial review of this experience revealed difficulties with collecting data, and lack of information on graduates' scope of practice. It also showed the potential usefulness of the tool as a program improvement mechanism. The RPI is a new quality improvement tool for family medicine residency programs. Although some initial challenges need to be addressed, it has the promise to aid family medicine residency in its internal improvement efforts.

  4. Geriatrics in family practice residency education: an unmet challenge.

    Science.gov (United States)

    Gazewood, John D; Vanderhoff, Bruce; Ackermann, Richard; Cefalu, Charles

    2003-01-01

    The aging of the US population poses one of the greatest future challenges for family practice residency graduates. At a time when our discipline should be strengthening geriatric education to address the needs of our aging population, the Group on Geriatric Education of the Society of Teachers of Family Medicine believes that recent guidelines from important family medicine organizations suggest that our discipline's interest in geriatric education may be waning. Barriers to improving geriatric education in family practice residencies include limited geriatric faculty, changes in geriatric fellowship training, competing curricular demands, and limited diversity of geriatric training sites. Improving geriatric education in family practice residencies will require greater emphasis on faculty development and integration of geriatric principles throughout family practice residency education. The Residency Review Committee for Family Practice should review the Program Requirements for Residency Education to ensure that geriatric training requirements are consistent with current educational needs. The leadership of family medicine organizations should collaboratively address the need for continued improvement in training our residents to care for older patients and the chronically ill.

  5. Incorporating Osteopathic Curriculum Into a Family Medicine Residency.

    Science.gov (United States)

    Hempstead, Laura K; Harper, Diane M

    2015-01-01

    Literature review reveals that doctors of osteopathic medicine (DO) physicians desire to maintain their osteopathic identity and enhance their osteopathic skills during residency training. An effective osteopathic curriculum has enhanced the University of Missouri-Kansas City (UMKC) Family Medicine Residency Program's recruitment of strong osteopathic residency candidates. UMKC has been a dually accredited family medicine residency since 2006. The study sought to determine resident attitudes toward osteopathic identity and principles and the perceived effectiveness of our osteopathic curriculum. An anonymous survey was sent to osteopathic residents and recent graduates still working within the Truman Medical Center (TMC) system. The survey questions assessed the perceived importance of osteopathic principles and the perceived effectiveness of the residency program's current osteopathic curriculum. The response rate of DO physicians representing seven colleges of osteopathic medicine (COM) was 29/30 (97%). Respondents agreed that the American Osteopathic Association (AOA) program is one of the strengths of our family medicine residency program. Respondents planned to utilize osteopathic manipulative therapy (OMT) in their own practice. Osteopathic principles stratified in order of importance were: OMT benefits our patients, maintaining hands-on OMT skills, and learning to integrate OMT into your office treatment regimen. Our residents value integrating OMT into their practices as a benefit to their patients, to maintain osteopathic skills, and to learn to integrate OMT into their office treatment regimen. They generally agreed that the AOA accredited program is one of the strengths of our residency program. They intend to utilize OMT when they are in practice.

  6. Hospitalist involvement in family medicine residency training: A CERA study.

    Science.gov (United States)

    Baldor, Robert; Savageau, Judith A; Shokar, Navkiran; Potts, Stacy; Gravel, Joseph; Eisenstock, Kimberly; Ledwith, James

    2014-02-01

    Little is known about the impact of hospitalists on family medicine residencies. We surveyed family medicine residency directors to assess attitudes about hospitalists and their involvement in residency teaching. Questions were included in the 2012 Council of Academic Family Medicine Educational Research Alliance (CERA) survey of family medicine residency directors. Univariate statistics were used to describe programs, directors, and our questions on the use of hospitalists. Bivariate statistics were used to examine relationships between the use of hospitalists to teach and program characteristics. Forty-one percent (n=175) of residency directors completed the hospitalist section of the CERA survey. Sixty-six percent of residency programs were community based/university affiliated. The majority of directors who have, or are planning to develop, a hospitalist service currently use an internal medicine service (92.5%), followed by family medicine (39.1%), pediatrics (35.4%), OB/laborists (18.0%), and combined services (8.7%). The majority of programs with a hospitalist training track (or plans to develop one) indicated that this was for a family medicine service. Sixty percent of programs that have a hospitalist service involve hospitalists in teaching. Twenty percent of directors reported that hospitalists serve as family medicine faculty, and 63% viewed them as "good educators." However, 85% reported no reduction in inpatient teaching by family medicine faculty despite using hospitalist teaching services. Hospitalists have a significant educational role in family medicine resident training. Further research is needed to explore how hospitalists and family medicine faculty can collaborate to promote enhanced efficiency and effectiveness as residency teachers.

  7. Family medicine residency training and burnout: a qualitative study

    Science.gov (United States)

    Rutherford, Kimberly; Oda, Joanna

    2014-01-01

    Background Almost three-quarters of family practice residents in British Columbia (BC) meet criteria for burnout. We sought to understand how burnout is perceived and experienced by family medicine residents, and to identify both contributory and protective factors for resident burnout. Method Two semi-structured focus groups were conducted with ten family practice residents from five distinct University of British Columbia training sites. Participants completed the Maslach Burnout Inventory (MBI). The data were analyzed using a thematic analysis approach. Results Seventy percent of the focus group participants met criteria for burnout using the MBI. The experience of burnout was described as physical and emotional exhaustion, loss of motivation, isolation from loved ones, and disillusionment with the medical profession. Contributory factors included high workload, burned-out colleagues, perceived undervaluing of family medicine, lack of autonomy, and inability to achieve work-life balance. Protective factors included strong role models in medicine, feeling that one’s work is valued and rotations in family medicine. Conclusions The high level of burnout in family medicine residents in BC is a multifactorial and complex phenomenon. Training programs and faculty should be aware of burnout risk factors and strive to implement changes to reduce burnout, including allowing residents increased control over scheduling, access to counseling services and training for resident mentors. PMID:26451218

  8. Family medicine residency training and burnout: a qualitative study.

    Science.gov (United States)

    Rutherford, Kimberly; Oda, Joanna

    2014-01-01

    Almost three-quarters of family practice residents in British Columbia (BC) meet criteria for burnout. We sought to understand how burnout is perceived and experienced by family medicine residents, and to identify both contributory and protective factors for resident burnout. Two semi-structured focus groups were conducted with ten family practice residents from five distinct University of British Columbia training sites. Participants completed the Maslach Burnout Inventory (MBI). The data were analyzed using a thematic analysis approach. Seventy percent of the focus group participants met criteria for burnout using the MBI. The experience of burnout was described as physical and emotional exhaustion, loss of motivation, isolation from loved ones, and disillusionment with the medical profession. Contributory factors included high workload, burned-out colleagues, perceived undervaluing of family medicine, lack of autonomy, and inability to achieve work-life balance. Protective factors included strong role models in medicine, feeling that one's work is valued and rotations in family medicine. The high level of burnout in family medicine residents in BC is a multifactorial and complex phenomenon. Training programs and faculty should be aware of burnout risk factors and strive to implement changes to reduce burnout, including allowing residents increased control over scheduling, access to counseling services and training for resident mentors.

  9. Correlates of Burnout Among Family Practice Residents.

    Science.gov (United States)

    Lemkau, Jeanne P.; And Others

    1988-01-01

    A study of burnout among 67 residents in four programs found little relationship between burnout scores and situational and background factors, but numerous relationships were found among personality measures, burnout scores, and measures of regret about career choice, indicating the importance of interpersonal skills and comfort in mitigating…

  10. Methodology and assumptions for evaluating heating and cooling energy requirements in new single-family residential buildings: Technical support document for the PEAR (Program for Energy Analysis of Residences) microcomputer program

    Energy Technology Data Exchange (ETDEWEB)

    Huang, Y.J.; Ritschard, R.; Bull, J.; Byrne, S.; Turiel, I.; Wilson, D.; Hsui, C.; Foley, D.

    1987-01-01

    This report provides technical documentation for a software package called PEAR (Program for Energy Analysis of Residences) developed by LBL. PEAR offers an easy-to-use and accurate method of estimating the energy savings associated with various energy conservation measures used in site-built, single-family homes. This program was designed for use by non-technical groups such as home builders, home buyers or others in the buildings industry, and developed as an integral part of a set of voluntary guidelines entitled Affordable Housing Through Energy Conservation: A Guide to Designing and Constructing Energy Efficient Homes. These guidelines provide a method for selecting and evaluating cost-effective energy conservation measures based on the energy savings estimated by PEAR. This work is part of a Department of Energy program aimed at conducting research that will improve the energy efficiency of the nation's stock of conventionally-built and manufactured homes, and presenting the results to the public in a simplified format.

  11. Training family medicine residents to practice collaboratively with psychology trainees.

    Science.gov (United States)

    Porcerelli, John H; Fowler, Shannon L; Murdoch, William; Markova, Tsveti; Kimbrough, Christina

    2013-01-01

    This article will describe a training curriculum for family medicine residents to practice collaboratively with psychology (doctoral) trainees at the Wayne State University/Crittenton Family Medicine Residency program. The collaborative care curriculum involves a series of patient care and educational activities that require collaboration between family medicine residents and psychology trainees. Activities include: (1) clinic huddle, (2) shadowing, (3) pull-ins and warm handoffs, (4) co-counseling, (5) shared precepting, (6) feedback from psychology trainees to family medicine residents regarding consults, brief interventions, and psychological testing, (7) lectures, (8) video-observation and feedback, (9) home visits, and (10) research. The activities were designed to teach the participants to work together as a team and to provide a reciprocal learning experience. In a brief three-item survey of residents at the end of their academic year, 83% indicated that they had learned new information or techniques from working with the psychology trainees for assessment and intervention purposes; 89% indicated that collaborating with psychology trainees enhanced their patient care; and 89% indicated that collaborating with psychology trainees enhanced their ability to work as part of a team. Informal interviews with the psychology trainees indicated that reciprocal learning had taken place. Family medicine residents can learn to work collaboratively with psychology trainees through a series of shared patient care and educational activities within a primary care clinic where an integrated approach to care is valued.

  12. Family medicine residents' practice intentions: Theory of planned behaviour evaluation.

    Science.gov (United States)

    Grierson, Lawrence E M; Fowler, Nancy; Kwan, Matthew Y W

    2015-11-01

    To assess residents' practice intentions since the introduction of the College of Family Physicians of Canada's Triple C curriculum, which focuses on graduating family physicians who will provide comprehensive care within traditional and newer models of family practice. A survey based on Ajzen's theory of planned behaviour was administered on 2 occasions. McMaster University in Hamilton, Ont. Residents (n = 135) who were enrolled in the Department of Family Medicine Postgraduate Residency Program at McMaster University in July 2012 and July 2013; 54 of the 60 first-year residents who completed the survey in 2012 completed it again in 2013. The survey was modeled so as to measure the respondents' intentions to practise with a comprehensive scope; determine the degree to which their attitudes, subjective norms, and perceptions of control about comprehensive practice influence those intentions; and investigate how these relationships change as residents progress through the curriculum. The survey also queried the respondents about their intentions with respect to particular medical services that underpin comprehensive practice. The responses indicate that the factors modeled by the theory of planned behaviour survey account for 60% of the variance in the residents' intentions to adopt a comprehensive scope of practice upon graduation, that there is room for curricular improvement with respect to encouraging residents to practise comprehensive care, and that targeting subjective norms about comprehensive practice might have the greatest influence on improving resident intentions. The theory of planned behaviour presents an effective approach to assessing curricular effects on resident practice intentions while also providing meaningful information for guiding further program evaluation efforts in the Department of Family Medicine at McMaster University.

  13. Residents' views about family medicine specialty education in Turkey

    Directory of Open Access Journals (Sweden)

    Uzuner Arzu

    2010-04-01

    Full Text Available Abstract Background Residents are one of the key stakeholders of specialty training. The Turkish Board of Family Medicine wanted to pursue a realistic and structured approach in the design of the specialty training programme. This approach required the development of a needs-based core curriculum built on evidence obtained from residents about their needs for specialty training and their needs in the current infrastructure. The aim of this study was to obtain evidence on residents' opinions and views about Family Medicine specialty training. Methods This is a descriptive, cross-sectional study. The board prepared a questionnaire to investigate residents' views about some aspects of the education programme such as duration and content, to assess the residents' learning needs as well as their need for a training infrastructure. The questionnaire was distributed to the Family Medicine Departments (n = 27 and to the coordinators of Family Medicine residency programmes in state hospitals (n = 11 by e-mail and by personal contact. Results A total of 191 questionnaires were returned. The female/male ratio was 58.6%/41.4%. Nine state hospitals and 10 university departments participated in the study. The response rate was 29%. Forty-five percent of the participants proposed over three years for the residency duration with either extensions of the standard rotation periods in pediatrics and internal medicine or reductions in general surgery. Residents expressed the need for extra rotations (dermatology 61.8%; otolaryngology 58.6%; radiology 52.4%. Fifty-nine percent of the residents deemed a rotation in a private primary care centre necessary, 62.8% in a state primary care centre with a proposed median duration of three months. Forty-seven percent of the participants advocated subspecialties for Family Medicine, especially geriatrics. The residents were open to new educational methods such as debates, training with models, workshops and e

  14. Residents' views about family medicine specialty education in Turkey.

    Science.gov (United States)

    Uzuner, Arzu; Topsever, Pinar; Unluoglu, Ilhami; Caylan, Ayse; Dagdeviren, Nezih; Uncu, Yesim; Mazicioğlu, Mumtaz; Ozçakir, Alis; Ozdemir, Hakan; Ersoy, Fusun

    2010-04-15

    Residents are one of the key stakeholders of specialty training. The Turkish Board of Family Medicine wanted to pursue a realistic and structured approach in the design of the specialty training programme. This approach required the development of a needs-based core curriculum built on evidence obtained from residents about their needs for specialty training and their needs in the current infrastructure. The aim of this study was to obtain evidence on residents' opinions and views about Family Medicine specialty training. This is a descriptive, cross-sectional study. The board prepared a questionnaire to investigate residents' views about some aspects of the education programme such as duration and content, to assess the residents' learning needs as well as their need for a training infrastructure. The questionnaire was distributed to the Family Medicine Departments (n = 27) and to the coordinators of Family Medicine residency programmes in state hospitals (n = 11) by e-mail and by personal contact. A total of 191 questionnaires were returned. The female/male ratio was 58.6%/41.4%. Nine state hospitals and 10 university departments participated in the study. The response rate was 29%. Forty-five percent of the participants proposed over three years for the residency duration with either extensions of the standard rotation periods in pediatrics and internal medicine or reductions in general surgery. Residents expressed the need for extra rotations (dermatology 61.8%; otolaryngology 58.6%; radiology 52.4%). Fifty-nine percent of the residents deemed a rotation in a private primary care centre necessary, 62.8% in a state primary care centre with a proposed median duration of three months. Forty-seven percent of the participants advocated subspecialties for Family Medicine, especially geriatrics. The residents were open to new educational methods such as debates, training with models, workshops and e-learning. Participation in courses and congresses was considered

  15. Observations on burnout in family medicine and psychiatry residents.

    Science.gov (United States)

    Woodside, Jack Richard; Miller, Merry Noel; Floyd, Michael R; McGowen, K Ramsey; Pfortmiller, Debi T

    2008-01-01

    To investigate the relationship between burnout, work environment, and a variety of personal variables, including age, gender, marital, parental and acculturation status within a population of family medicine and psychiatry resident physicians. Between 2002 and 2005, 155 residents in family medicine and psychiatry at East Tennessee State University College of Medicine were surveyed at intervals using the Maslach Burnout Inventory and Work Environment Scale, form R, to assess their current state of emotional health and job satisfaction. Female residents had lower scores on the Depersonalization scale of the Maslach Burnout Inventory (t=3.37, p=0.001). Parenting was associated with lower Depersonalization (t=3.98, pburnout than family medicine residents on the Depersonalization and Emotional Exhaustion scales (t=2.49, p=0.014: t=2.05, p=0.042) and higher Physical Comfort on the Work Environment Scale (t=-2.60, p=0.011); while family medicine residents reported higher Peer Cohesion, Supervisor Support, and Autonomy (t=3.41, p=0.001; t=2.38, p=0.019; t=2.27, p=0.025). This study design, using well established, standard, and valid measures, identified important issues for further exploration: the relationship between acculturation to burnout, the potential role of parenting as a protective factor from burnout, and the recognition that women residents may not be as vulnerable to burnout as previously reported.

  16. Generating developmentally appropriate competency assessment at a family medicine residency.

    Science.gov (United States)

    Baglia, Jay; Foster, Elissa; Dostal, Julie; Keister, Drew; Biery, Nyann; Larson, Daniel

    2011-02-01

    Ten years after the Accreditation Council for Graduate Medical Education's (ACGME) mandate that residency programs evaluate learners' competency, research is needed to guide efforts to meet this challenge. During an innovative residency redesign, the authors developed a process to effectively measure "competence." This particular family medicine residency admits six residents per class year and is sponsored by an academic community hospital. Our objective was to generate developmentally appropriate observable behaviors that assess competencies. Eight steps guided the development of this assessment system: (1) Generate residency-specific competencies, (2) Define residency-specific competencies, (3) Identify principles of assessment, (4) Compose and analyze narratives of excellence within each competency, (5) Distill standard statements from narratives and organize into Dreyfus levels of competence, (6) Derive observable behaviors from standard statements to directly correlate behaviors and competency levels, (7) Design assessment tools (based on observable behaviors) for six residency learning sites, and (8) Translate assessment tools for ACGME competencies. The results of this process include an assessment system that (1) features six tools used with strategic frequency throughout the academic year and (2) generates global assessment of residents' performance in both ACGME and residency-specific competencies. Narrative reflection was an effective method to tie observable behaviors to competencies. The process was time intensive; however, greater efficiency and enthusiasm is expected in the use of these assessment tools, with greater confidence in the program's capacity to assess training outcomes. Future research should include comparison of these tools with those of other programs.

  17. Teaching-skills training programs for family medicine residents

    Science.gov (United States)

    Lacasse, Miriam; Ratnapalan, Savithiri

    2009-01-01

    ABSTRACT OBJECTIVE To review the literature on teaching-skills training programs for family medicine residents and to identify formats and content of these programs and their effects. DATA SOURCES Ovid MEDLINE (1950 to mid-July 2008) and the Education Resources Information Center database (pre-1966 to mid-July 2008) were searched using and combining the MeSH terms teaching, internship and residency, and family practice; and teaching, graduate medical education, and family practice. STUDY SELECTION The initial MEDLINE and Education Resources Information Center database searches identified 362 and 33 references, respectively. Titles and abstracts were reviewed and studies were included if they described the format or content of a teaching-skills program or if they were primary studies of the effects of a teaching-skills program for family medicine residents or family medicine and other specialty trainees. The bibliographies of those articles were reviewed for unidentified studies. A total of 8 articles were identified for systematic review. Selection was limited to articles published in English. SYNTHESIS Teaching-skills training programs for family medicine residents vary from half-day curricula to a few months of training. Their content includes leadership skills, effective clinical teaching skills, technical teaching skills, as well as feedback and evaluation skills. Evaluations mainly assessed the programs’ effects on teaching behaviour, which was generally found to improve following participation in the programs. Evaluations of learner reactions and learning outcomes also suggested that the programs have positive effects. CONCLUSION Family medicine residency training programs differ from all other residency training programs in their shorter duration, usually 2 years, and the broader scope of learning within those 2 years. Few studies on teaching-skills training, however, were designed specifically for family medicine residents. Further studies assessing the

  18. Teaching colposcopy and androscopy in family practice residencies.

    Science.gov (United States)

    Newkirk, G R; Granath, B D

    1990-08-01

    Addressing the widespread human papillomavirus and genital epithelial dysplasia epidemic requires mastery of colposcopy, androscopy, and cryotherapy. Implementing a family medicine residency training program for these skills requires identifying a faculty facilitator to consider the issues of time, cost, caseload, reimbursement, specialist support, personal training, and office impact related to this training. Experience with teaching these skills in a community-based family practice residency indicates that startup costs range from $10,000 to $20,000. Residents will initially require from 30 to 60 minutes to provide a complete examination. All procedures require precepting by trained faculty and adherence to established protocol. The most frequent indications for these procedures include evaluating the abnormal Papanicolaou smear, visible cervical abnormalities, or evidence of clinical papillomavirus infection in either sex. Experience suggests that over 90% of cervical dysplasia can be managed entirely in the residency outpatient setting. These procedures have become the most common outpatient procedures performed, surpassing all others combined. Referrals to the residency for these procedures are readily available. Strategies for developing curriculum, literature review, learning materials, and training workshops are presented. Colposcopy, androscopy, and cryotherapy are appropriate additions to the training curriculum of family practice residencies.

  19. Teaching Chronic Pain in the Family Medicine Residency.

    Science.gov (United States)

    Zoberi, Kimberly; Everard, Kelly M

    2018-01-01

    Chronic pain is a significant condition affecting many Americans. Primary care physicians play an important role in chronic pain management, but many residents and physicians feel poorly prepared to manage it. Data were collected as part of the 2016 Council of Academic Family Medicine Educational Research Alliance (CERA) Program Director Survey, which was sent electronically to 484 program directors in the United States. The authors sought to determine whether residency directors' attitudes about treating chronic pain were associated with the amount of time devoted to teaching family medicine residents about chronic pain assessment, therapy (use of opioids, use adjuvant pain medications, use of other nonopioids, use of nonpharmacological treatments), and risk management (risk assessment, use of pain management contracts, informed consent when prescribing opioids, and urine drug monitoring). Attitudes were assessed by asking whether: (1) chronic pain is best managed by a primary care physician (PCP); (2) prescribing opioid medications is time consuming; (3) prescribing opioids is high-risk; (4) prescribing opioids contributes to opioid misuse; and (4) effective nonopioid treatments exist. An additional question assessed confidence in treating chronic pain. The response rate was 53%. The average family medicine residency devotes about 33 hours to education about pain management topics including 5.4 hours on chronic pain assessment, 16.2 hours on therapy, and 11.4 hours on risk assessment. Residency directors' belief that there are effective nonopioid treatments for chronic pain was the only attitude item that was associated with teaching about chronic pain. Residency directors' attitudes do not predict the time devoted to teaching chronic pain in family medicine residencies.

  20. Nursing home resident quality of life: testing for measurement equivalence across resident, family, and staff perspectives.

    Science.gov (United States)

    Godin, Judith; Keefe, Janice; Kelloway, E Kevin; Hirdes, John P

    2015-10-01

    This study explores the factor structure of the interRAI self-report nursing home quality of life survey and develops a measure that will allow researchers to compare predictors of quality of life (QOL) across resident, family, and staff perspectives. Nursing home residents (N = 319), family members (N = 397), and staff (N = 862) were surveyed about their perceptions of resident QOL. Exploratory factor analyses were conducted on a random half of the staff data. Subsequently, confirmatory factor analysis was used to test for measurement equivalence across the three perspectives. The final model had a four-factor structure (i.e., care and support, food, autonomy, and activities) across all three perspectives. Each factor had at least two items that were equivalent across all three perspectives, which suggests at least partial measurement equivalence. The finding of partial measurement equivalence acknowledges there are important differences between perspectives and provides a tool that researchers can use to compare predictors of QOL, but not levels of agreement across perspectives. Targeting these four aspects is likely to have the additional benefit of improving family and staff perceptions of resident QOL in addition to the resident's own QOL.

  1. Results of the 2011 National Resident Matching Program: family medicine.

    Science.gov (United States)

    Biggs, Wendy S; Bieck, Ashley D; Pugno, Perry A; Crosley, Philip W

    2011-10-01

    The results of the 2011 National Resident Matching Program (NRMP) reflect another small but promising increased level of student interest in family medicine residency training in the United States. Compared with the 2010 Match, family medicine residency programs filled 172 more positions (with 133 more US seniors) through the NRMP in 2011. In other primary care fields, 26 more primary care internal medicine positions filled (10 more US seniors), one more position in pediatrics-primary care (two fewer US seniors), and seven more positions in internal medicine-pediatrics programs (10 more US seniors). The 2011 NRMP results suggest a small increase in choosing primary care careers for the second year in a row; however, students continue to show an overall preference for subspecialty careers. Multiple forces continue to influence medical student career choices. Despite matching the highest number of US seniors into family medicine residencies since 2002, the production of family physicians remains insufficient to meet the current and anticipated need to support the nation's primary care infrastructure.

  2. Results of the 2010 national resident matching program: family medicine.

    Science.gov (United States)

    Pugno, Perry A; McGaha, Amy L; Schmittling, Gordon T; DeVilbiss Bieck, Ashley D; Crosley, Philip W; Ostergaard, Daniel J

    2010-09-01

    The results of the 2010 National Resident Matching Program (NRMP) reflect a small but promising increased level of student interest in family medicine residency training in the United States. Compared with the 2009 Match, 75 more positions (with 101 more US seniors) were filled in family medicine residency programs through the NRMP in 2010, at the same time that seven more positions were filled in primary care internal medicine (one more US senior), 14 fewer positions were filled in pediatrics-primary care (16 fewer US seniors), and 16 more positions were filled in internal medicine-pediatrics programs (58 more US seniors). Multiple forces including student perspectives of the demands, rewards, and prestige of the specialty; national dialogue about health care reform; turbulence in the economic environment; lifestyle issues; the advice of deans; and the impact of faculty role models continue to influence medical student career choices. Ninety-four more positions (90 more US seniors) were filled in categorical internal medicine. Fifty-seven more positions (29 more US seniors) were filled in categorical pediatrics programs. The 2010 NRMP results suggest that there is a small increase in primary care careers; however, students continue to show an overall preference for subspecialty careers. Despite matching the highest number of US seniors into family medicine residencies since 2004, in 2010 the production of family physicians remains insufficient to meet the current and anticipated need to support the nation's primary care infrastructure.

  3. Five Key Leadership Actions Needed to Redesign Family Medicine Residencies.

    Science.gov (United States)

    Kozakowski, Stanley M; Eiff, M Patrice; Green, Larry A; Pugno, Perry A; Waller, Elaine; Jones, Samuel M; Fetter, Gerald; Carney, Patricia A

    2015-06-01

    New skills are needed to properly prepare the next generation of physicians and health professionals to practice in medical homes. Transforming residency training to address these new skills requires strong leadership. We sought to increase the understanding of leadership skills useful in residency programs that plan to undertake meaningful change. The Preparing the Personal Physician for Practice (P4) project (2007-2014) was a comparative case study of 14 family medicine residencies that engaged in innovative training redesign, including altering the scope, content, sequence, length, and location of training to align resident education with requirements of the patient-centered medical home. In 2012, each P4 residency team submitted a final summary report of innovations implemented, overall insights, and dissemination activities during the study. Six investigators conducted independent narrative analyses of these reports. A consensus meeting held in September 2012 was used to identify key leadership actions associated with successful educational redesign. Five leadership actions were associated with successful implementation of innovations and residency transformation: (1) manage change; (2) develop financial acumen; (3) adapt best evidence educational strategies to the local environment; (4) create and sustain a vision that engages stakeholders; and (5) demonstrate courage and resilience. Residency programs are expected to change to better prepare their graduates for a changing delivery system. Insights about effective leadership skills can provide guidance for faculty to develop the skills needed to face practical realities while guiding transformation.

  4. The State of Communication Education in Family Medicine Residencies.

    Science.gov (United States)

    Jansen, Kate L; Rosenbaum, Marcy E

    2016-06-01

    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

  5. Examining Critical Thinking Skills in Family Medicine Residents.

    Science.gov (United States)

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

    2016-02-01

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

  6. [Professional motivation and family medicine residency: a national study].

    Science.gov (United States)

    Gaspar, Dina; Jesus, Saul Neves; Cruz, José Pestana

    2011-01-01

    Family medicine has some constraints, which may be considered critical for physicians' career choice, and motivation may be one of them. Motivation should be seen as a determinant of career success, particularly in educational context. The aim of this study was to develop an understanding about the family medicine residents' professional motivation, based on psychological and cognitive factors. The following objectives were set: (1) to characterize the residents, in terms of cognitive-motivational variables; (2) to evaluate their assertive skills during the vocational training. In 2005, we designed a mail survey applied to all graduates entering Family Medicine, in Portugal (N = 228), at the start of their specialty program. As part of a larger observational study, a 57 Likert scale items questionnaire was designed to collect descriptive data. In this cross sectional study we present data from professional project, professional commitment, intrinsic motivation, self-efficacy expectancies, results control expectancies, initial motivation to the specialty and assertiveness skills (cross sectional study). From the target population, 109 completed questionnaires (47.8%) were returned. Most of the participants indicated high levels of professional orientation (77.1%) for family medicine and 92.6% had been globally committed in practice. At the beginning of the residency, the participants had medium (59.6%) or high (33.9%) levels of motivation for choosing this specialty, 89% were intrinsically motivated and 60.5% proved to be quite assertive in their patient approach. These findings suggest that medical graduates, studied in this research, were globally motivated for practicing in a Family Medicine context, contradicting the overall perception of a physicians' declined interest for this specialty. These results may have implications in the design of real-life training programs for postgraduate education in Family Medicine, a time when physicians are forming expectations

  7. Results of the 2009 National Resident Matching Program: family medicine.

    Science.gov (United States)

    Pugno, Perry A; McGaha, Amy L; Schmittling, Gordon T; DeVilbiss, Ashley D; Ostergaard, Daniel J

    2009-09-01

    The results of the 2009 National Resident Matching Program (NRMP) reflect a persistently low level of student interest in family medicine residency training in the United States. Compared with the 2008 Match, 70 fewer positions (with 89 fewer US seniors) were filled in family medicine residency programs through the NRMP in 2009, at the same time that 18 fewer positions were filled in primary care internal medicine (11 fewer US seniors), one more position was filled in pediatrics-primary care (three more US seniors), and 13 more positions were filled in internal medicine-pediatrics programs (but with seven fewer US seniors). Multiple forces, including student perspectives of the demands, rewards and prestige of the specialty, the turbulence and uncertainty of the health care and economic environments, lifestyle issues, the advice of deans, and the impact of faculty role models, continue to influence medical student career choices. A total of 152 more positions (28 fewer US seniors) were filled in categorical internal medicine. Thirty-one more positions (72 more US seniors) were filled in categorical pediatrics programs. The 2009 NRMP results suggest that while interest in family medicine experienced a slight increase in the number of students choosing the specialty last year, overall interest in primary care careers continues to decline. With the nation continuing to call for the roles and services of family physicians, family medicine still matched too few graduates through the 2009 NRMP to effectively address the nation's needs for primary care physicians.

  8. Results of the 2008 National Resident Matching Program: family medicine.

    Science.gov (United States)

    Pugno, Perry A; McGaha, Amy L; Schmittling, Gordon T; DeVilbiss, Ashley D; Ostergaard, Daniel J

    2008-09-01

    The results of the 2008 National Resident Matching Program (NRMP) reflect a currently stable level of student interest in family medicine residency training in the United States. Compared with the 2007 Match, 91 more positions (with 65 more US seniors) were filled in family medicine residency programs through the NRMP in 2008, at the same time as 10 fewer (one fewer US senior) in primary care internal medicine, eight fewer positions were filled in pediatrics-primary care (10 fewer US seniors), and 19 fewer (27 fewer US seniors) in internal medicine-pediatrics programs. Multiple forces, including student perspectives of the demands, rewards, and prestige of the specialty, the turbulence and uncertainty of the health care environment, lifestyle issues, and the impact of faculty role models, continue to influence medical student career choices. Thirty-one more positions (20 fewer US seniors) were filled in categorical internal medicine. Thirty more positions (84 fewer US seniors) were filled in categorical pediatrics programs. The 2008 NRMP results suggest that while interest in family medicine experienced a slight increase in the number of students choosing the specialty, interest in other primary care careers continues to decline. With the needs of the nation calling for the roles and services of family physicians, family medicine still matched too few graduates through the 2008 NRMP to meet the nation's needs for primary care physicians.

  9. Communication skills of residents to families with Down syndrome babies.

    Science.gov (United States)

    Dogan, Derya G; Kutluturk, Yesim; Kivilcim, Meltem; Canaloglu, Sinem K

    2016-12-01

    Generally, pediatricians are the first health caregivers to deliver initial diagnosis of Down syndrome (DS) to the families. However, most of the parents are not satisfied with the contents and how they receive information when their child is born with DS. Pediatric residents should target educational interventions to help parents to overcome with these issues and to provide accurate information. The objective is to assess comfort levels and training requirements of pediatric residents to communicate with parents of babies born with Down syndrome. Diagnostic Situations Inventory (DSI) is a rating scale which included ten questions to assess discomfort level. A survey was sent via mobile, websites and all the social media which were available to all pediatrics residents in the country. Socio-demographic factors including information about training requirement were collected as well. From the 326 participants, total mean discomfort level was 30.22 in DSI out of 50 which was the highest score. Discomfort level was significantly increased in female participants (p= 0.033). Being female (p= 0.014), having less residency level (p= 0.028), examining less number of patients with Down syndrome (p= 0.025) and having higher discomfort levels (p= 0.001) were found to be related with increased training requirement. From the residents, 84% declared the need for additional training. This study showed that pediatric residents had a high level of discomfort when communicating with parentes of newborn with Down Syndrome. Female residentes had a discomfort level significantly higher than male residentes.

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

    Science.gov (United States)

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

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

  11. Introduction of handheld computing to a family practice residency program.

    Science.gov (United States)

    Rao, Goutham

    2002-01-01

    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.

  12. What do residents learn by meeting with families of children with disabilities?: A qualitative analysis of an experiential learning module.

    Science.gov (United States)

    Sharma, Niraj; Lalinde, Paula S; Brosco, Jeffrey P

    2006-01-01

    Attitudes of medical providers towards persons with disabilities can affect the quality of care their patients receive. The authors evaluated an experiential learning module to investigate what Paediatric and Medicine/Paediatric residents at the University of Miami/Jackson Memorial Hospital learn from visiting the homes of families with children who have disabilities. Families were recruited through a community-based parent organization. The families were instructed to discuss what it is like to have a child with a disability and to think about a primary message to give to residents during a 1-2 hour home visit. Since 1998, residents participated as part of the required Developmental Paediatrics rotation. They were instructed to write a one-page narrative description of their visit. The authors utilized the grounded theory of qualitative research and content analysis to count the key themes identified in the residents' descriptions. Twenty-four families and 63 residents participated in the learning module. The resident observations yielded four major themes. Twenty-four per cent stated families needed more information; 79% noted that families face various obstacles, including financial (33%), medical providers' pessimism (29%), inter-personal family conflicts (27%) and medical system problems (22%); 49% of residents commented that families adjust and cope with their child's disability; and 27% of residents stated that the experience changed their insight about children with disabilities. The authors' study suggests that a single home visit with the family of a child with a disability provides paediatrics and medicine/paediatrics residents with insights into the family's perspective on disability otherwise unattainable in a hospital-based training programme.

  13. Single incision laparoscopic proficiency correlates with residency training level.

    Science.gov (United States)

    Mora, Maria Carmen; Wong, Kaitlyn E; Fernandez, Gladys L; Tirabassi, Michael V

    2018-01-01

    With experience, certain psychomotor skills should translate from standard laparoscopy to single-incision laparoscopy (SIL). We proposed to compare all surgical postgraduate year (PGY) levels and determine if experience translated to improved SIL skills. Surgical residents of all PGY levels (1-5) at our institution were included. Baseline surveys were obtained to determine resident level of exposure to both SIL and standard laparoscopic cases. Participants performed the following tasks: running of the bowel, endoloop placement, extracorporeal suture tying, and intracorporeal suture tying. Tasks were performed on a commercially provided simulated inanimate organ model. Participants were given 5 min to complete each task. Data were collected and analyzed by an impartial-certified Fundamentals of Laparoscopic Surgery proctor. A total of 31 residents participated in the study. Overall, there was minimal SIL exposure among all residents. As expected, PGY level correlated with increased ability to complete assigned tasks within the allotted time. There was a statistically significant difference in the number of individuals able to complete a task based on PGY level for all given tasks (P = 0.005). With increased difficulty, the percentage of higher level residents able to complete the task decreased (100% PGY5 completed running of bowel versus 0% intracorporeal knot tying). Certain psychomotor skills did appear to translate to SIL skills. However, further dedicated SIL training may help to better develop certain laparoscopic skills devoted to SIL. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Developing an ethics curriculum for a family practice residency.

    Science.gov (United States)

    Levitt, C; Freedman, B; Kaczorowski, J; Adler, P; Wilson, R

    1994-11-01

    To develop a curriculum in ethics in family practice by studying which ethical issues physicians believe to be important based on frequency of encounter, difficulty in managing the problem, and helpfulness of discussion; to examine whether there are any important differences between faculty and residents and between genders; and to determine the preferred format(s) for teaching these issues. Between November 1991 and June 1992 a total of 475 questionnaires were mailed to all the family practice residents (first- and second-year), graduates in their first two years of practice, and the physician faculty of the Department of Family Medicine at the McGill University Faculty of Medicine. Overall, 319 usable questionnaires were returned, for a final response rate of 67%. The questionnaire asked respondents to evaluate 14 ethical dilemmas in order to determine the importance of teaching specific ethical issues as well as to determine the preferred format for teaching. Chi-square tests, analyses of variance, and Student's t-tests were used to test the significance of differences in responses. No consistent pattern of interrelationship was found among frequency of encounter and difficulty and helpfulness of discussion for most items. Overall, there was little difference in how faculty and residents, men and women, perceived the importance of these ethical issues. Women reported encountering ethical issues less frequently than men [F (14,285) = 1.82, p ethical dilemma. It is difficult to narrow down the content to be included in a curriculum in ethics in family practice. Frequency of encounter, difficulty in management, and helpfulness of discussion can all be argued to be important factors for consideration; they should all be considered separately or in combination for each teaching situation if time restrictions force a choice between topics.

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

    Science.gov (United States)

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

    2013-09-01

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

  16. Objective Evaluation of Otoscopy Skills Among Family and Community Medicine, Pediatric, and Otolaryngology Residents.

    Science.gov (United States)

    Oyewumi, Modupe; Brandt, Michael G; Carrillo, Brian; Atkinson, Adelle; Iglar, Karl; Forte, Vito; Campisi, Paolo

    2016-01-01

    The objective of this study is to evaluate and compare the perceived need for otolaryngology training and otoscopy diagnostic skills in primary care (Family and Community Medicine, Pediatric Medicine), and Otolaryngology Head and Neck Surgery (OTO-HNS) postgraduate trainees. Participant otoscopy skills were evaluated using the OtoSim simulator. Family and Community Medicine, Pediatric, and OTO-HNS residents were recruited. Each resident participated in 3 separate otoscopy training and assessment sessions. The ability to correctly identify middle ear pathology was objectively evaluated using OtoSim™. Pretest, posttest, and 3-month retention test results were compared among residents in a paired comparison paradigm. Survey data assessing exposure to OTO-HNS during undergraduate and postgraduate training were also collected. A total of 57 residents participated in the study. All residents reported limited exposure to OTO-HNS during undergraduate medical training. Primary care trainees performed poorly on pretest assessments (30% ± 7.8%; 95% CI). Significant improvement in diagnostic accuracy was demonstrated following a single 1-hour teaching session (30%-62%; p otoscopy simulator significantly improved diagnostic accuracy in primary care and OTO-HNS trainees. Improved performance is susceptible to deterioration at 3 months if acquired skills are not frequently used. Self-perceived comfort with otology may not be an accurate predictor of otoscopic diagnostic skill. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  17. The Effects of Abortion Training on Family Medicine Residents' Clinical Experience.

    Science.gov (United States)

    Summit, Aleza K; Gold, Marji

    2017-01-01

    RHEDI, Reproductive Health Education in Family Medicine, offers technical assistance and funding to family medicine residency programs to support integrated opt-out abortion and reproductive health training for residents. This study assessed the impact of this enhanced training on residents' reproductive health experience. Investigator-developed pre- and post-surveys were administered online to 214 residents at 12 family medicine residency programs before and after their RHEDI training experience. Surveys addressed experience in contraception and abortion, attitudes around abortion provision, and post-residency intentions. Descriptive statistics were generated, and statistical tests were performed to assess changes after training. Surveys had a 90% response rate. After the RHEDI enhanced reproductive health rotation, residents reported increased experience in contraception provision, early pregnancy ultrasound, aspiration and medication abortion, and miscarriage management. After training, residents with experience in IUD insertion increased from 85% to 99%, and contraceptive implant insertion experience rose from 60% to 85%. Residents who had performed any abortions increased from 15% to 79%, and self-rated competency in abortion increased. Finally, almost all residents agreed that early abortion was within the scope of family medicine, and training confirmed residents' intentions to provide reproductive health services after residency. Integrated training in reproductive health, with an emphasis on abortion, increases residents' experience and underscores their understanding of the role of these services in family medicine. Increasing the number of family medicine residency programs that offer this training could help prepare family physicians to meet their patients' needs for reproductive health services.

  18. Residency Training in Family Medicine: A History of Innovation and Program Support.

    Science.gov (United States)

    Carek, Peter J; Anim, Tanya; Conry, Colleen; Cullison, Sam; Kozakowski, Stan; Ostergaard, Dan; Potts, Stacy; Pugno, Perry A

    2017-04-01

    Residency programs have been integral to the development, expansion and progression of family medicine as a discipline. Three reports formed the foundation for graduate medical education in family medicine: Meeting the Challenge of Family Practice, The Graduate Education of Physicians, and Health is a Community Affair. In addition, the original core concepts of comprehensiveness, coordination, continuity, and patient centeredness continue to serve as the foundation for residency training in family medicine. While the Residency Review Committee for Family Medicine of the Accreditation Council for Graduate Medical Education has provided the requirements for training throughout the years, key organizations including the Society of Teachers of Family Medicine, the American Academy of Family Physicians, the Association of Family Medicine Residency Directors, and the American Board of Family Medicine have provided resources for and supported innovation in programs. Residency Program Solutions, National Institute for Program Director Development, and Family Medicine Residency Curriculum Resource are several of the resources developed by these organizations. The future of family medicine residency training should continue the emphasis on innovation and development of resources to enhance the training of residents. Areas for further development include leadership and health care systems training that allows residents to assume leadership of multidisciplinary health care teams and increase focus on the family medicine practice population as the main unit for resident education.

  19. Single Family Loan Sale Initiative - National Offering

    Data.gov (United States)

    Department of Housing and Urban Development — The FHA Office of Housing is conducting a series of mortgage loan sales under the Single Family Loan Sale (SFLS) Initiative. The current sales structure consists of...

  20. From crisis to success. Turning around a family practice residency program.

    Science.gov (United States)

    Mace, K C; Holm, C E; Lipsky, M S; Bartscht, K G

    1995-01-01

    On Match Day in 1991, Broadlawns Medical Center in Des Moines, Iowa, learned that no residents had matched for the family practice residency program. In the 1992 match, the medical center filled all its residency positions, and repeated the success in the 1993 and 1994 matches. Broadlawns affected this impressively rapid turnaround through a strong commitment to bring its program to a level competitive with leading family practice residency programs, substantive changes to the structure and curriculum of the program, and significant expenditures of time, resources and personal energy. The Broadlawns' case illustrates the need for family practice residency programs to position themselves as strong competitors in the residency market.

  1. Social media beliefs and usage among family medicine residents and practicing family physicians.

    Science.gov (United States)

    Klee, David; Covey, Carlton; Zhong, Laura

    2015-03-01

    Incorporation of social media (SM) use in medicine is gaining support. The Internet is now a popular medium for people to solicit medical information. Usage of social networks, such as Facebook and Twitter, is growing daily and provides physicians with nearly instantaneous access to large populations for both marketing and patient education. The benefits are myriad, but so are the inherent risks. We investigated the role providers' age and medical experience played in their beliefs and use of SM in medicine. Using multiple state-wide and national databases, we assessed social media use by family medicine residents, faculty, and practicing family physicians with a 24-question online survey. Descriptive data is compared by age and level of medical experience. A total of 61 family medicine residents and 192 practicing family physicians responded. There is a trend toward higher SM utilization in the younger cohort, with 90% of resident respondents reporting using SM, half of them daily. A total of 64% of family physician respondents over the age of 45 have a SM account. An equal percentage of senior physicians use SM daily or not at all. Practicing physicians, more than residents, agree that SM can be beneficial in patient care. The vast majority of residents and physicians polled believe that SM should be taught early in medical education. The high utilization of SM by younger providers, high prevalence of patient use of the Internet, and the countless beneficial opportunities SM offers should be catalysts to drive curriculum development and early implementation in medical education. This curriculum should focus around four pillars: professional standards for SM use, SM clinical practice integration, professional networking, and research.

  2. Scope of Practice Among Recent Family Medicine Residency Graduates.

    Science.gov (United States)

    Eiff, M Patrice; Hollander-Rodriguez, Joyce; Skariah, Joe; Young, Richard; Waller, Elaine; Dexter, Eve; O'Neill, Thomas R; Peabody, Michael R; Green, Larry A; Carney, Patricia A

    2017-09-01

    The scope of practice among primary care providers varies, and studies have shown that family physicians' scope may be shrinking. We studied the scope of practice among graduates of residencies associated with Preparing the Personal Physician for Practice (P4) and how length of training and individualized education innovations may influence scope. We surveyed graduates 18 months after residency between 2008 and 2014. The survey measured self-reported practice characteristics, scope of practice and career satisfaction. We assessed scope using individual practice components (25 clinical activities, 30 procedures) and a scaled score (P4-SOP) that measured breadth of practice scope. We conducted subgroup analyses according to exposure to innovations over the project period and exposure to specific innovations. No significant differences were found in mean P4-SOP scores between the Pre and Full P4 groups. Compared to national data, P4 graduates reported higher rates for vaginal deliveries (19.3% vs 9.2%), adult inpatient care (48.5% vs 33.7%) and nursing home care (25.4 vs 11.7%) in practice. Graduates exposed to innovations that lengthened training, compared to standard training length, were more likely to include adult hospital care (58.2% vs 38.5%, P=0.002), adult ICU care (30.6% vs 19.2%, P=0.047) and newborn resuscitation (25.6% vs 14%, P=0.028) in their practice and performed 19/30 procedures at higher rates. Graduates of programs with individualized training innovations reported no significant differences in scope compared to graduates without this innovation. Graduates of residencies engaged in significant educational redesign report a broad scope of practice. Innovations around the length of training may broaden scope and individualized education appears not to constrict scope.

  3. Family medicine residents' perceived level of comfort in treating common sports injuries across residency programs in the United States.

    Science.gov (United States)

    Amoako, Adae O; Amoako, Agyenim B; Pujalte, George Ga

    2015-01-01

    Family physicians are expected to be comfortable in treating common sports injuries. Evidence shows a limited level of comfort in treating these injuries in pediatric and internal medicine residents. Studies are lacking, however, in family medicine residents. The purpose of this study is to assess the comfort level of family medicine residents in treating common sports injuries in adults and children based on their perceived level of knowledge and attitudes. This is a cross-sectional study of family medicine residents in the United Sates. A written survey of 25 questions related to sports injury knowledge and factors affecting comfort level were collected. A chi-square test was implemented in calculating P-values. Five hundred and fifty-seven residents responded to the survey. A higher percentage of doctors of osteopathy (86.6%, 82.5%, 69.6%, and 68.7%) compared to doctors of medicine (78.5%, 71.6%, 53.4%, and 52.8%) respectively identified ankle sprain, concussion, plantar fasciitis, and lateral epicondylitis as common injuries, and felt comfortable in treating them (P-values =0.015, 0.004, 0.0001, and 0.0002, respectively). Residents with high interest in sports medicine correctly identified the injuries as common and felt comfortable treating them as well (knowledge, P=0.027, 0.0029, sports medicine contribute to residents' knowledge and comfort level in treatment of common sports injuries.

  4. Single-Parent Families: Myth and Reality

    Science.gov (United States)

    Verzaro, Marce; Hennon, Charles B.

    1980-01-01

    Examines the myths surrounding single-parent families. Discusses lifestyles, parental roles, parent-child relationships, psychological development of the child, and how these concerns affect home economics programs (knowledge, skills, coping patterns, teaching methods, the role of 4-H, stereotypes, and teachers' communication with parents). (CT)

  5. A descriptive analysis of abortion training in family medicine residency programs

    National Research Council Canada - National Science Library

    Brahmi, Dalia; Dehlendorf, Christine; Engel, David; Grumbach, Kevin; Joffe, Carole; Gold, Marji

    2007-01-01

    Access to abortion services in the United States is declining. While family physicians are well suited to provide this care, limited training in abortion occurs in family medicine residency programs...

  6. [Workload, burnout and need to recover among female residents in internal medicine and family medicine].

    Science.gov (United States)

    Barilan, Ayelet; Haimov, Tal; Doplet, Keren; Matnick, Stephen; Vinker, Shlomo; Kitai, Eliezer

    2011-08-01

    The Israeli medical residents' workload in hospitals is enormous, especially in the internaL wards, due to a severe lack of manpower and the demand to carry out many shifts. The workload of residents who practice in the community is rising as well: family physicians are required to achieve quality objectives in treating chronic diseases while the time dedicated to each patient is shortening. Creating a family usually parallels to this phase, causing home-work conflict among the residents. Consequently, the residents are Liable to develop burnout during their internship. Quantification and characterization of the need to recover from workload among internal ward resident mothers with young children, compared to family medicine resident mothers with young children, and to investigate the relation between workload and the development of burnout in those groups. A cross-sectional study was conducted comparing 30 female internal ward residents with young children to 38 female family medicine residents with young children, by using workload, burnout, sleep quality and need to recover questions. Although the workload reported by female internal ward residents was higher than that reported by family medicine residents [p burnout. Positive correlations were found between the workload and the burnout (p burnout and the need for recovery (p < 0.001, r = 0.67]. It seems that both groups are equally burned-out and need to recover after work. Our article calls for improvement of working conditions in both residencies.

  7. Motivations for learning of family medicine residents trained in competency-based education.

    Science.gov (United States)

    Babenko, Oksana; Szafran, Olga; Koppula, Sudha; Au, Lillian

    2017-08-16

    Family physicians regularly encounter clinical uncertainty and ambiguity and thus, are expected to engage in on-going learning to respond to changing needs of family practice. Using Achievement Goal Theory, the objective of this study was to examine motivations for learning of family medicine residents in a competency-based program. This was a cross-sectional study, employing a survey methodology with family medicine residents at the mid-point of training at a Canadian university. Multivariate analyses of variance and covariance were used to examine residents' goal orientations (performance approach, mastery approach, performance avoidance, mastery avoidance) for the group as a whole and to test for the effects of residents' gender and program stream (urban/rural), respectively. A total of 52 (67%) residents completed the survey. Overall, residents scored highest on mastery approach and lowest on performance avoidance, thus, exhibiting adaptive motivations for learning. Male residents demonstrated higher levels of performance approach, performance avoidance, and mastery avoidance than female residents. No significant differences in goal orientations were found between urban and rural residents. Family medicine residents trained in the culture of competency-based education appear to be mastery approach oriented. This motivation orientation is critical in the dynamic practice of family medicine and is consistent with the life-long learning mandate of the medical profession.

  8. ["Traffic lights" in pediatrics: what do residents beginning their family residency know about them?].

    Science.gov (United States)

    Launay, E; Canévet, J-P; Senand, R; Rozé, J-C; Gournay, V; Picherot, G; Vrignaud, B; Levieux, K; Hamel, A; Leclair, M-D; Gras le Guen, C

    2014-03-01

    Pediatric practice is a difficult task requiring physicians to discriminate potentially serious situations among a variety of benign situations. The goal of this study was to assess the knowledge of students beginning their residency in family medicine on these situations. One hundred and three students were evaluated on pediatric "traffic lights" using 103 true/false questions. Pediatric and family medicine teachers of the Nantes University Hospital defined "traffic lights" as the fundamentals of pediatrics, misleading situations, and diagnosis and treatment that should not to be missed. Emergency levels were defined by colors, with "red light" corresponding to life-threatening emergencies. Thirty-six percent of the questions (n=103) had a correct response rate below 75%. Thirty-two percent of the questions on emergency situations ("red lights") (n=37) had a response rate below 75%. Fifteen percent of the questions (n=103) had a correct response rate below 50%, half of which were "red light" (e.g., on meningitis, diabetic acidocytosis, or shock). Questions concerning infants (n=24) had significantly fewer correct answers (correct response rate below 50%: 29% versus 10%; P=0.047). All the students answered seven questions correctly. The students' mean score (percentage of good answers) was 76% (±6%). No student had 100% or less than 50% good answers. Some life-threatening situations or situations concerning infants had not been mastered by most of the students. It is therefore essential to optimize the teaching of pediatrics during the second cycle of medical studies. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  9. Teaching adaptive leadership to family medicine residents: what? why? how?

    Science.gov (United States)

    Eubank, Daniel; Geffken, Dominic; Orzano, John; Ricci, Rocco

    2012-09-01

    Health care reform calls for patient-centered medical homes built around whole person care and healing relationships. Efforts to transform primary care practices and deliver these qualities have been challenging. This study describes one Family Medicine residency's efforts to develop an adaptive leadership curriculum and use coaching as a teaching method to address this challenge. We review literature that describes a parallel between the skills underlying such care and those required for adaptive leadership. We address two questions: What is leadership? Why focus on adaptive leadership? We then present a synthesis of leadership theories as a set of process skills that lead to organization learning through effective work relationships and adaptive leadership. Four models of the learning process needed to acquire such skills are explored. Coaching is proposed as a teaching method useful for going beyond information transfer to create the experiential learning necessary to acquire the process skills. Evaluations of our efforts to date are summarized. We discuss key challenges to implementing such a curriculum and propose that teaching adaptive leadership is feasible but difficult in the current medical education and practice contexts.

  10. The Marshall Family Medicine Residency twINTERN Schedule: The Impact of an Innovative Hospital Coverage Scheme on Resident Fatigue.

    Science.gov (United States)

    Franks, Adam; Petrany, Stephen M; McElroy, Sydnee; Alley, Adam

    2017-06-01

    Work hour restriction has strained the balance between resident service and education. Night Float (NF) rotations are a popular answer to managing this balance but weakens continuity, an essential tenant of family medicine. An innovative short call system for Marshall University's Family Medicine Hospital Service (FMHS), the twINTERN call model, was created in response. We studied the impact of this approach on resident fatigue. Anonymous surveys assessed fatigue of the Marshall University's 2013-2014 Family Medicine intern resident class while on NF rotations (ICU, Pediatrics and Surgery) and the twINTERN call. Stanford Sleepiness Score (SSS) and Epworth Sleepiness Score (ESS) were administered trimonthly. RESULTS were categorized 'Alert' or 'Fatigued' and evaluated by Chi Square analysis. Also, outpatient office frequency was evaluated. 146 surveys were completed by eight residents. More even distribution of resident office experience was seen. The twINTERN call model didn't show worsening fatigue compared to NF systems in any parameter measured. It was superior mitigating fatigue by ESS for night shifts (P value 0.047). While fatigue was statistically worse for night float rotations by both parameters (ESS P value = 0.009; SSS P value = 0.008), the twINTERN call model only showed worsening fatigue in the SSS (P value = 0.038). Our study demonstrated that the twINTERN Call Model, which allows for improved continuity on the inpatient service, was at least as effective, and by some parameters superior to NF systems for mitigating resident fatigue.

  11. Grief among Family Members of Nursing Home Residents with Advanced Dementia

    Science.gov (United States)

    Givens, Jane L.; Prigerson, Holly G.; Kiely, Dan K.; Shaffer, Michele L.; Mitchell, Susan L.

    2011-01-01

    Objectives To describe pre-loss and post-loss grief symptoms among family members of nursing home (NH) residents with advanced dementia, and to identify predictors of greater post-loss grief symptoms. Design Prospective cohort study. Setting 22 NHs in the greater Boston area. Participants 123 family members of NH residents who died with advanced dementia. Measurements Pre-loss grief was measured at baseline, and post-loss grief was measured 2 and 7 months post-loss using the Prolonged Grief Disorder scale. Independent variables included resident and family member sociodemographic characteristics, resident comfort, acute illness, acute care prior to death, family member depression, and family member understanding of dementia and of resident’s prognosis. Results Levels of pre-loss and post-loss grief were relatively stable from baseline to 7 months post-loss. Feelings of separation and yearning were the most prominent grief symptoms. After multivariable adjustment, greater pre-loss grief and the family member having lived with the resident prior to NH admission were the only factors independently associated with greater post-loss grief 7 months after resident death. Conclusions The pattern of grieving for some family members of NH residents with advanced dementia is prolonged and begins before resident death. Identification of family members at risk for post-loss grief during the pre-loss period may help guide interventions aimed at lessening post-loss grief. PMID:21606897

  12. Development and Examination of a Family Triadic Measure to Examine Quality of Life Family Congruence in Nursing Home Residents and Two Family Members

    Science.gov (United States)

    Aalgaard Kelly, Gina

    2015-01-01

    Objective: The overall purpose of this study was to propose and test a conceptual model and apply family analyses methods to understand quality of life family congruence in the nursing home setting. Method: Secondary data for this study were from a larger study, titled Measurement, Indicators and Improvement of the Quality of Life (QOL) in Nursing Homes. Research literature, family systems theory and human ecological assumptions, fostered the conceptual model empirically testing quality of life family congruence. Results: The study results supported a model examining nursing home residents and two family members on quality of life family congruence. Specifically, family intergenerational dynamic factors, resident personal and social-psychological factors, and nursing home family input factors were examined to identify differences in quality of life family congruence among triad families. Discussion: Formal family involvement and resident cognitive functioning were found as the two most influential factors to quality of life family congruence (QOLFC). PMID:28138474

  13. Alternative families in recovery: fictive kin relationships among residents of sober living homes.

    Science.gov (United States)

    Heslin, Kevin C; Hamilton, Alison B; Singzon, Trudy K; Smith, James L; Anderson, Nancy Lois Ruth

    2011-04-01

    Sober living homes are group residences for people attempting to maintain abstinence from alcohol and drugs in a mutually supportive setting. Residents typically develop strong psychological and economic ties and have been referred to as "alternative families," thus evoking the anthropological concept of fictive kinship. We analyzed data from seven focus groups with sober living home residents to assess the prevalence and functions of fictive kinship in these settings. Results suggest that residents created kinship by exchanging various types of support, and by incorporating other residents into existing family relationships, particularly in homes where there were children. Residents perceived fictive kin as more supportive than actual kin, encouraging them toward greater individuation, in contrast with family backgrounds that were sometimes described as stifling. These accounts of the therapeutic qualities of fictive kin in sober living homes could inform the work of fair housing advocates and other community stakeholders.

  14. Implementing radical curriculum change in a family medicine residency: the majors and masteries program.

    Science.gov (United States)

    Mazzone, Michael; Krasovich, Susanne; Fay, David; Ginn, Patrick; Lopresti, Leigh; Nelson, Karen; Ambuel, Bruce

    2011-01-01

    There have been dramatic changes in the specialty of family medicine and the American health care system in the more than 40 years since the formation of the specialty. As a result, there is urgent need for experimentation and innovation in residency training to better prepare family physicians. Waukesha Family Medicine Residency used a strategic planning process to identify four guiding concepts for a new model of residency education: intentional diversification; options for advanced training in a fourth year of residency; longitudinal, competency-based training; and strong fundamental background in family medicine skills. These concepts guided radical restructuring of the curriculum. The new Majors and Masteries curriculum begins with 19 months of training in core family medicine skills. Residents then elect to pursue a Major or Mastery in an area of interest. Majors are completed within 3 years, while Masteries are completed in 4 years and include advanced training (MPH, MBA, advanced obstetrics). Since implementation, residents have selected a broad range of Majors, three residents have elected advanced training in three different mastery areas, and resident recruitment has not been disrupted. The Majors and Masteries curriculum and the process used to implement it may benefit other residencies considering radical curriculum change.

  15. A descriptive analysis of abortion training in family medicine residency programs.

    Science.gov (United States)

    Brahmi, Dalia; Dehlendorf, Christine; Engel, David; Grumbach, Kevin; Joffe, Carole; Gold, Marji

    2007-06-01

    Access to abortion services in the United States is declining. While family physicians are well suited to provide this care, limited training in abortion occurs in family medicine residency programs. This study was designed to describe the structure of currently available training and the experience of residents participating in these programs. E-mail questionnaires were sent to key faculty members and third-year residents in nine programs that have required abortion training. These faculty members and a sample of residents also completed semi-structured interviews. Residency programs varied in the amount of time dedicated to the procedural aspects of abortion training, ranging from 2 to 8 days, and also in non-procedural aspects of training such as values clarification and didactics. Themes that emerged from interviews with residents included the benefit of training with respect to technical skills and continuity of care. In addition, residents valued discussion of the emotional aspects of abortion care and issues relating to performing abortions after graduation from residency. While the details of the curricula vary, residents in programs with required abortion training generally felt positively about their experiences and felt that abortion was an appropriate procedure for family physicians to provide. Residents emphasized the importance of both non-procedural and technical aspects of training.

  16. A Model for Reintegrating Couples and Family Therapy Training in Psychiatric Residency Programs

    Science.gov (United States)

    Rait, Douglas; Glick, Ira

    2008-01-01

    Objective: The authors propose a family-systems training model for general residency training programs in psychiatry based on the couples and family therapy training program in Stanford's Department of Psychiatry and Behavioral Sciences. Methods: The authors review key elements in couples and family therapy training. Examples are drawn from the…

  17. Family Support in Nursing Homes Serving Residents with a Mental Health History

    Science.gov (United States)

    Frahm, Kathryn; Gammonley, Denise; Zhang, Ning Jackie; Paek, Seung Chun

    2010-01-01

    Using 2003 nursing home data from the Minimum Data Set (MDS) database, this study investigated the role of family support among nursing homes serving residents with a mental health history. Exploratory factor analysis was used to create and test a conceptual model of family support using indicators located within the MDS database. Families were…

  18. Preparing residents for family practice: role of an integrated “Triple C” curriculum

    Directory of Open Access Journals (Sweden)

    Joseph Lee

    2013-03-01

    Full Text Available Background: There is limited understanding of the impact of Triple C competency-based curriculums on the preparation of residents for family practice. This paper describes a competency-based curriculum within an integrated longitudinal block design and presents preliminary evaluation data on the impact of this curriculum on preparedness for family practice. Methods: First and second year family medicine residents were surveyed as a component of a year-end program evaluation to assess the extent to which the residency program is preparing them to engage in a variety of practice domains, the likelihood that they would engage in these domains, and the extent to which this residency program is comprehensive, relevant to their development as a family physician, and promotes interprofessional practice. Results: Residents perceived themselves as prepared to engage in most practice areas and their intentions to engage in various practice domains were positively correlated to their ratings of preparedness. Ratings reflected that residents perceived this program as comprehensive and relevant to their development as a family physician and they perceived a high degree of encouragement for interprofessional practice. Conclusions: This study provides some preliminary evidence that an integrated competency-based curriculum, with an emphasis on interprofessional practice has the potential to effectively prepare residents for practice in family medicine.

  19. A National CERA Study of the Use of Laborists in Family Medicine Residency Training.

    Science.gov (United States)

    Baldor, Robert A; Pecci, Christine Chang; Moreno, Gerardo; Van Duyne, Virginia; Potts, Stacy E

    2017-02-01

    Little is known about the impact of laborists (which we defined as "clinicians dedicated to providing L&D care services in the hospital environment for pregnant patients, regardless of who provided the prenatal care" for this survey) on family medicine residency training. We surveyed family medicine residency directors to assess characteristics about laborist services and their involvement in family medicine residency teaching. Questions were included in the 2015 Council of Academic Family Medicine Educational Research Alliance (CERA) survey of family medicine residency directors. Univariate statistics were used to describe programs, directors, and our questions on the use of laborists. Chi-square tests and Student's t tests were used to evaluate bivariate relationships using a P30% of their graduates included L&D care in their first practice.. Laborists have an important role in family medicine resident obstetrics training and education. More research is needed to explore how laborists and family medicine faculty can collaborate to promote enhanced efficiency and effectiveness as residency teachers.

  20. Reintegrating Family Therapy Training in Psychiatric Residency Programs: Making the Case

    Science.gov (United States)

    Rait, Douglas; Glick, Ira

    2008-01-01

    Objective: Given the marginalization of couples and family therapy in psychiatric residency programs over the past two decades, the authors propose a rationale for the reintegration of these important psychosocial treatments into the mainstream of general psychiatric residency education. Methods: After reviewing recent trends in the field that…

  1. Teaching Humanities in Medicine: The University of Massachusetts Family Medicine Residency Program Experience

    Science.gov (United States)

    Silk, Hugh; Shields, Sara

    2012-01-01

    Humanities in medicine (HIM) is an important aspect of medical education intended to help preserve humanism and a focus on patients. At the University of Massachusetts Family Medicine Residency Program, we have been expanding our HIM curriculum for our residents including orientation, home visit reflective writing, didactics and a department-wide…

  2. Acting as Standardized Patients Enhances Family Medicine Residents' Self-Reported Skills in Palliative Care

    Science.gov (United States)

    Sittikariyakul, Pat; Jaturapatporn, Darin; Kirshen, A. J.

    2015-01-01

    Recent publications have confirmed the use of standardized patients (SPs) in improving clinical skills and enhancing competency. Little research has studied the benefits residents may themselves gain in palliative care playing the role of SPs. Nineteen Family Medicine residents were recruited as standardized patients (FMR-SPs) for a mandatory…

  3. Multi-Source Evaluation of Interpersonal and Communication Skills of Family Medicine Residents

    Science.gov (United States)

    Leung, Kai-Kuen; Wang, Wei-Dan; Chen, Yen-Yuan

    2012-01-01

    There is a lack of information on the use of multi-source evaluation to assess trainees' interpersonal and communication skills in Oriental settings. This study is conducted to assess the reliability and applicability of assessing the interpersonal and communication skills of family medicine residents by patients, peer residents, nurses, and…

  4. Benefits of comprehensive reproductive health education in family medicine residency

    National Research Council Canada - National Science Library

    Nothnagle, Melissa; Prine, Linda; Goodman, Susan

    2008-01-01

    .... Comprehensive reproductive health education for family physicians could benefit patients by improving access to safe care for unintended pregnancy and early pregnancy loss and by improving continuity...

  5. Factors associated with research interest and activity during family practice residency.

    Science.gov (United States)

    Temte, J L; Hunter, P H; Beasley, J W

    1994-02-01

    Family medicine lacks a tradition of research training during residency. Previous studies of research during residency have surveyed faculty to assess residents' research interests. In contrast, we directly assessed research interest and activity during residency by surveying all 203 Wisconsin family practice residents. The survey instrument was a questionnaire that included questions about the appropriateness of research experience, interest in pursuing research during residency, involvement in research, and perceptions regarding program research support. The importance of factors that encourage research were evaluated. We then used stepwise discriminant analysis to assess whether residents with different levels of interest in research had different perceptions about program support and environmental factors that promote research. Of 143 respondents, most (85%) felt research experience was desirable, and 48% were interested in pursuing research during residency. Only 8% were active in research. Although faculty were perceived as having sufficient research skills and encouraging resident research, few residents responded that dedicated time, seminars on goals and methods of family practice research, or funding were available. Residents with research interests were more likely to respond that their faculty had sufficient research skills and knowledge. Active researchers rated time availability and access to resource personnel as highly important. Those interested, but not active, rated basic information, assistance in identifying topics, and a forum for presentation as highly important. Exposure to skilled and knowledgeable faculty researchers may stimulate interest in research. Teaching research goals and methods, assisting in identifying topics, and providing research forums, especially early in residency, may promote research activity. Dedicated time for research and availability of resource personnel will enhance this activity.

  6. Competency-based achievement system: using formative feedback to teach and assess family medicine residents' skills.

    Science.gov (United States)

    Ross, Shelley; Poth, Cheryl N; Donoff, Michel; Humphries, Paul; Steiner, Ivan; Schipper, Shirley; Janke, Fred; Nichols, Darren

    2011-09-01

    Family medicine residency programs require innovative means to assess residents' competence in "soft" skills (eg, patient-centred care, communication, and professionalism) and to identify residents who are having difficulty early enough in their residency to provide remedial training. To develop a method to assess residents' competence in various skills and to identify residents who are having difficulty. The Competency-Based Achievement System (CBAS) was designed to measure competence using 3 main principles: formative feedback, guided self-assessment, and regular face-to-face meetings. The CBAS is resident driven and provides a framework for meaningful interactions between residents and advisors. Residents use the CBAS to organize and review their feedback, to guide their own assessment of their progress, and to discern their future learning needs. Advisors use the CBAS to monitor, guide, and verify residents' knowledge of and competence in important skills. By focusing on specific skills and behaviour, the CBAS enables residents and advisors to make formative assessments and to communicate their findings. Feedback indicates that the CBAS is a user-friendly and helpful system to assess competence.

  7. Resident and family member perceptions of cultural diversity in aged care homes.

    Science.gov (United States)

    Xiao, Lily Dongxia; Willis, Eileen; Harrington, Ann; Gillham, David; De Bellis, Anita; Morey, Wendy; Jeffers, Lesley

    2017-03-01

    Similar to many developed nations, older people living in residential aged care homes in Australia and the staff who care for them have become increasingly multicultural. This cultural diversity adds challenges for residents in adapting to the care home. This study explores: (i) residents' and family members' perceptions about staff and cultural diversity, and (ii) culturally and linguistically diverse residents' and family members' experiences. An interpretive study design employing a thematic analysis was applied. Twenty-three residents and seven family members participated in interviews. Four themes were identified from interpreting residents and family members' perceptions of the impact of cultural diversity on their adaptation to aged care homes: (i) perceiving diversity as an attraction; (ii) adapting to cross-cultural communication; (iii) adjusting to diet in the residential care home; and (iv) anticipating individualized psychosocial interactions. The findings have implications for identifying strategies to support staff from all cultural backgrounds in order to create a caring environment that facilitates positive relationships with residents and supports residents to adjust to the care home. © 2016 John Wiley & Sons Australia, Ltd.

  8. Communication with Residents and Families in Nursing Homes at the End of Life.

    Science.gov (United States)

    Johnson, Samantha; Bott, Marjorie J

    2016-04-01

    Communication with residents and their families is important to ensure that the end-of-life experience is in accordance with resident's wishes. A secondary analysis was conducted to determine: (a) who should communicate with the resident/family about death and dying; (b) when communication should occur around death and dying, obtaining a "DNR" order, and obtaining a hospice referral; and (c) what differences exist in communication about death and dying between Registered Nurses (RNs), Licensed Practical Nurses (LPNs), and unlicensed staff. Greater than 90% of staff (N=2,191) reported that the physician or social worker should communicate about death and dying with residents/families, but only 53% thought that direct care staff should talk with them. Weighted scores for "When communication should occur about death and dying and obtaining a 'DNR' Order" revealed significantly (p care-planning meeting, or when the resident's family requested it. No differences were found between staff on communication about obtaining a hospice referral. The identified gaps in perception about who should be communicating can assist in developing appropriate interventions that need future testing. The potential for training regarding communication strategies and techniques could lead to higher satisfaction with end-of-life care for residents and their families.

  9. Cultural transition of international medical graduate residents into family practice in Canada.

    Science.gov (United States)

    Triscott, Jean A C; Szafran, Olga; Waugh, Earle H; Torti, Jacqueline M I; Barton, Martina

    2016-05-04

    To identify the perceived strengths that international medical graduate (IMG) family medicine residents possess and the challenges they are perceived to encounter in integrating into Canadian family practice. This was a qualitative, exploratory study employing focus groups and interviews with 27 participants - 10 family physicians, 13 health care professionals, and 4 family medicine residents. Focus group/interview questions addressed the strengths that IMGs possess and the challenges they face in becoming culturally competent within the Canadian medico-cultural context. Qualitative data were audiotaped, transcribed, and analyzed thematically. Participants identified that IMG residents brought multiple strengths to Canadian practice including strong clinical knowledge and experience, high education level, the richness of varied cultural perspectives, and positive personal strengths. At the same time, IMG residents appeared to experience challenges in the areas of: (1) communication skills (language nuances, unfamiliar accents, speech volume/tone, eye contact, directness of communication); (2) clinical practice (uncommon diagnoses, lack of familiarity with care of the opposite sex and mental health conditions); (3) learning challenges (limited knowledge of Canada's health care system, patient-centered care and ethical principles, unfamiliarity with self-directed learning, unease with receiving feedback); (4) cultural differences (gender roles, gender equality, personal space, boundary issues; and (5) personal struggles. Residency programs must recognize the challenges that can occur during the cultural transition to Canadian family practice and incorporate medico-cultural education into the curriculum. IMG residents also need to be aware of cultural differences and be open to different perspectives and new learning.

  10. Single parent families: diversity, myths and realities

    National Research Council Canada - National Science Library

    Hanson, Shirley M. H

    1995-01-01

    ...: * * * . * * * * * * * * * * * * * * * * * * * * Cults and the Family, edited by Florence Kaslow and Marvin B. Sussman Alternatives to Traditional Family Living, edited by Harriet Gross and Marvin B. Sussman...

  11. A comparison of surgery and family medicine residents' perceptions of cross-cultural care training.

    Science.gov (United States)

    Chun, Maria B J; Jackson, David S; Lin, Susan Y; Park, Elyse R

    2010-12-01

    The need for physicians formally trained to deliver care to diverse patient populations has been widely advocated. Utilizing a validated tool, Weissman and Betancourt's Cross-Cultural Care Survey, the aim of this current study was to compare surgery and family medicine residents' perceptions of their preparedness and skillfulness to provide high quality cross-cultural care. Past research has documented differences between the two groups' reported impressions of importance and level of instruction received in cross-cultural care. Twenty surgery and 15 family medicine residents participated in the study. Significant differences were found between surgery and family medicine residents on most ratings of the amount of training they received in cross-cultural skills. Specifically, family medicine residents reported having received more training on: 1) determining how patients want to be addressed, 2) taking a social history, 3) assessing their understanding of the cause of illness, 4) negotiating their treatment plan, 5) assessing whether they are mistrustful of the health care system and÷or doctor, 6) identifying cultural customs, 7) identifying how patients make decisions within the family, and 8) delivering services through a medical interpreter. One unexpected finding was that surgery residents, who reported not receiving much formal cultural training, reported higher mean scores on perceived skillfulness (i.e. ability) than family medicine residents. The disconnect may be linked to the family medicine residents' training in cultural humility - more knowledge and understanding of cross-cultural care can paradoxically lead to perceptions of being less prepared or skillful in this area. Hawaii Medical Journal Copyright 2010.

  12. Attitude Survey of Military Family Housing Residents, Hawaii 1987.

    Science.gov (United States)

    1987-09-01

    re- because decreases in satisfaction were found sponses, today’s military housing residents ap- between 1985 and 1987, an intervention should pear...length of time the renovations over an hour for the tire department to required was also a problem to some. answer a call ( smoke detector)." "At check...satisfied with the self-help program pp p Pp p I I PEARL HARBOR AREA Hale QUESTfONNAIRE TEMS - CURRENT CONDITIONS Moku Hokulan’ Haawa a kap ;3 (n=152) (n

  13. Single-family-residence solar heating--Carlsbad, New Mexico

    Science.gov (United States)

    1981-01-01

    Solar-heating and hot-water system includes 408 square feet of flat-plate air collectors, rock storage bin, energy transport system, air-to-water heat exchanger, controls, and hot-water preheat tank. Hot-air oil furnace supplies auxiliary space heating, and electricity powers air-handler blower and hot water preheat pump. For 12 month period, system provided 43 percent of space-heating and 53 percent of hot-water energy; net energy savings were 23.072 million Btu.

  14. 24 CFR 1710.10 - Single-family residence exemption.

    Science.gov (United States)

    2010-04-01

    ... potable water supply is available year-round and that the lot is approved for the installation of a septic...) Flooding. (vi) Water supply. (vii) Sewage disposal. (2) Each lot sold under the exemption must be either... concrete or pavement with a bituminous surface that is impervious to water, protects the base and is...

  15. [Opinions of Hungarian family physicians and residents on vocation and informal payment].

    Science.gov (United States)

    Torzsa, Péter; Csatlós, Dalma; Eőry, Ajándék; Hargittay, Csenge; Horváth, Ferenc; László, Andrea; Márkus, Bernadett; Mohos, András; Kalabay, László; Győrffy, Zsuzsa

    2016-09-01

    The changing of the family medicine can be observed in the New Millennium. Migration, the aging of the healers and informal payment are crucial to the human resource crisis of the health sector. The aim of this study was to investigate the family physicians' and residents' opinions about the vocation and informal payment. Exploratory, quantitative study was carried out among family physicians (n = 363) and family physician residents (n = 180). The central questions of the study were the vocation, the income and the informal payment. The most decisive factors of the carrier choice were altruism, service and responsibility. Residents were significantly rejective (19.7% vs. 38.3%, pvocation, but on the issue of informal payment, the two generations have different opinions. Orv. Hetil., 2016, 157(36), 1438-1444.

  16. Personality types of family practice residents as measured by the Myers-Briggs type indicator.

    Science.gov (United States)

    Harris, D L; Ebbert, P

    1985-01-01

    This study was initiated to test the hypothesis that individuals currently choosing family practice as a career are likely to have different personality types than those who previously pursued general practice. Incoming residents to the University of Utah Family Practice Residency Program were compared to a group of private primary care physicians serving rural areas. Personality types were determined by administering the Myers-Briggs Type Indicator to both groups. Results showed that the current resident group differed significantly from the primary care physician group and that the residents' personality types were similar to personality types of faculty in other studies. This raises the concern that many family practice residents may not choose to practice in underserved areas. Further studies need to follow personality types through medical school and residency training and into practice to help determine which prospective physicians are likely to choose a primary care career and a rural practice. This information may be useful in health manpower planning and in examining admissions policies of medical schools and residencies.

  17. NON-MUSCULOSKELETAL SPORTS MEDICINE LEARNING IN FAMILY MEDICINE RESIDENCY PROGRAMS

    Directory of Open Access Journals (Sweden)

    Pasqualino Caputo

    2008-06-01

    , descriptive statistics such as the means, standard deviations, and reliabilities of the scales were not equal across years. Therefore, we analyzed data separately by year, and then combined the results across years using meta-analysis. We first discuss the logic of analyzing the data for a single year, and then present the logic of combining the analyses.We expected that the residents in programs with sports medicine fellowships would show superior performance on the non-musculoskeletal sports medicine items. However, because assignment to fellowship was not random, we wanted to control for any possible differences in general family medicine knowledge that might exist between those residents who did and did not have a sports medicine fellowship at their residency program. Therefore, we treated scores on the family medicine scale as a covariate. We computed analysis of covariance (fellowship being a categorical independent variable with non-musculoskeletal sports medicine items as the dependent variable. The results allow for a statistical test of the effect of sports medicine fellowship while holding general family medicine knowledge constant. In other words, we applied a statistical control for self-selection into groups. We present results both with and without statistical control (i.e., both with and without the covariate because statistical control in the absence of random assignment to treatment, results in a very conservative test of the treatment effect when the treatment and covariate are correlated.To combine the studies, we used the method recommended by Hedges and colleagues (Hedges and Olkin, 1985; Hedges and Vevea, 1998. For each year, we first transformed the raw data to standardized scores by subtracting the variable's mean and dividing by the variable's standard deviation, so that all transformed variables had a mean of zero and a standard deviation of one. We then computed the analysis of covariance for each year and found the standardized regression weight

  18. A survey of formal training in the care of children in family practice residency programs.

    Science.gov (United States)

    Baldor, R A; Luckmann, R

    1992-08-01

    Declining hospitalization rates for children and an increased emphasis on ambulatory care may be affecting the way family practice residency programs train their residents in the care of children. We surveyed all US family practice residency program directors to determine the nature of the child care training that programs currently provide to residents. Responses were received from 78% of the programs. Residencies required a mean of 5.2 months of formal pediatric training (range: 1 to 11 months). Thirty percent of programs noted a declining inpatient census on inpatient pediatric teaching services, but since 1978, the mean duration of inpatient pediatric training increased by 0.4 months to a required mean of 2.7 months of general pediatric inpatient training (range: 0 to 6 months). The mean time devoted to structured outpatient pediatric training was only 1.6 months (range: 0 to 6 months). Nine percent of responding programs required no formal pediatric outpatient training other than family health center experience. Despite declining inpatient census and increased emphasis on comprehensive ambulatory care, family practice residencies require more formal inpatient pediatric training than formal outpatient training.

  19. Geriatric medicine training for family practice residents in the 21st century: a report from the Residency Assistance Program/Harfford Geriatrics Initiative.

    Science.gov (United States)

    Warshaw, Gregg; Murphy, John; Buehler, James; Singleton, Stacy

    2003-01-01

    Increasing the quality and quantity of geriatric medicine training for family practice residents is a particular challenge for community-based programs. With support from the John A. Hartford Foundation of New York City, the American Academy of Family Physicians (AAFP) implemented in 1995 a multi-part project to improve the amount and quality of geriatric medicine education received by family practice residents. This report summarizes the initial results of the regional geriatric medicine curriculum retreats for residency directors. The goals of the retreats were to build recognition among the residency directors of the skills that future family physicians will require to be successful providers of primary care to older adults and to allow the residency directors to identify and develop solutions to barriers to improving geriatric medicine training for residents. Forty-six program directors participated in the three retreats between February 2000 and February 2001. The participants represented 52 programs and rural tracks in all geographic regions, small and large programs, and urban and rural settings. The program directors developed a consensus on the geriatric medicine knowledge, skills, and attitudes that should be expected of all family practice residency graduates; developed a list of basic, required educational resources for each family practice residency program; and proposed solutions to common obstacles to successful curriculum development.

  20. What is Family-Centered Care for Nursing Home Residents With Advanced Dementia?

    Science.gov (United States)

    Lopez, Ruth Palan; Mazor, Kathleen M.; Mitchell, Susan L.; Givens, Jane L.

    2014-01-01

    To understand family members’ perspectives on person- and family-centered end-of-life care provided to nursing home (NH) residents with advanced dementia, we conducted a qualitative follow-up interview with 16 respondents who had participated in an earlier prospective study, Choices, Attitudes, and Strategies for Care of Advance Dementia at End of Life (CASCADE). Family members of NH residents (N = 16) with advanced dementia participated in semistructured qualitative interviews that inquired about overall NH experience, communication, surrogate decision making, emotional reaction, and recommendations for improvement. Analysis identified 5 areas considered important by family members: (1) providing basic care; (2) ensuring safety and security; (3) creating a sense of belonging and attachment; (4) fostering self-esteem and self-efficacy; and (5) coming to terms with the experience. These themes can provide a framework for creating and testing strategies to meet the goal of person- and family-centered care. PMID:24085250

  1. Comparison of Intended Scope of Practice for Family Medicine Residents With Reported Scope of Practice Among Practicing Family Physicians.

    Science.gov (United States)

    Coutinho, Anastasia J; Cochrane, Anneli; Stelter, Keith; Phillips, Robert L; Peterson, Lars E

    2015-12-08

    Narrowing of the scope of practice of US family physicians has been well documented. Proposed reasons include changing practice patterns as physicians age, employer restrictions, or generational choices. Determining components of care that remain integral to the practice of family medicine may be informed by assessing gaps between the intended scope of practice of residents and actual scope of practice of family physicians. To compare intended scope of practice for American Board of Family Medicine (ABFM) initial certifiers at residency completion with self-reported actual scope of practice of recertifying family physicians. Cross-sectional data were collected from a practice demographic questionnaire completed by all individuals applying to take the ABFM Maintenance of Certification for Family Physicians examination. Initial certifiers reported intentions and recertifiers reported actual provision of specific clinical activities. All physicians who registered for the 2014 ABFM Maintenance of Certification for Family Physicians examination were included: 3038 initial certifiers and 10,846 recertifiers. Initially certifying physicians vs recertifying physicians. The Scope of Practice for Primary Care score (scope score), a psychometric scale, was calculated for each physician and ranged from 0 to 30, with higher numbers equating to broader scope of practice. Recertifiers were categorized by decades in practice. The final sample included 13,884 family physicians and, because the questionnaire was a required component of the examination application, there was a 100% response rate. Mean scope score was significantly higher for initial certifier intended practice compared with recertifying physicians' reported actual practices (17.7 vs 15.5; difference, 2.2 [95% CI, 2.1-2.3]; P practice for only 1 to 10 years. In this study of family physicians taking ABFM examinations, graduating family medicine residents reported an intention to provide a broader scope of practice

  2. Family residency and psychosomatic problems among adolescents in Sweden: The impact of child-parent relations.

    Science.gov (United States)

    Hagquist, Curt

    2016-02-01

    Profound changes in family structure took place in many countries, during the second part of the previous century. The purpose of this paper is to analyse the association between the type of family residency and psychosomatic problems in younger and older adolescents, particularly focusing on alternate residency, and to examine the impact of child-parent relations. We used data collected in 2009 by Statistics Sweden among 172,298 Swedish students in Grade 6 and Grade 9 (approximate ages 12 and 15 years old); comprising 80% and 86%, respectively, of the entire population of students in those grades. We collected the data with a questionnaire, completed anonymously in school: We used the Psychosomatic Problems (PSP) scale as the outcome measure. The type of family residency showed a weaker association with psychosomatic problems than the child-parent relationships did. Living in non-intact families increased the probability of adolescent psychosomatic problems by 0-0.05, compared to intact families. In Grade 9, there were no differences in psychosomatic problems between the students in alternate residency and those living with their two parents; and in Grade 6, these differences were relatively small. In comparison, a worse relationship with parents increased the probability of psychosomatic problems by 0.11-0.17, depending on the school grade and type of family residency. The structure of the family, as well as the child-parent relationships needs to be taken into account, to properly estimate the magnitude of the family situation as a determinant of adolescent psychosomatic problems. Our results justify universal intervention at the policy level. © 2015 the Nordic Societies of Public Health.

  3. Starting and resourcing family and internal medicine residency programs as integral mission

    Directory of Open Access Journals (Sweden)

    Stephen P Merry

    2016-01-01

    Full Text Available Graduate medical education is an excellent means of building the capacity of health care systems in low and middle Income Countries (LMIC and a growing way for physicians in the U.S to get involved in integral mission – the proclamation and demonstration of the Gospel. This white paper purposes to provide a “best practices” recommendations on family and internal medicine (“medical” residency program development in majority world settings. An expert panel of residency educators convened in November 2015 at the Global Missions Health Conference (GMHC in Louisville, Kentucky and through an iterative process identified themes that were then further defined and clarified by medical residency faculty unable to be present. Participants largely agreed that integration and cooperation with the country’s Ministry of Health (MOH is essential for sustainable residency development. Recognition of family medicine as a specialty will enable graduates to succeed in the country’s physician job market and health systems leadership. Recognition by the national church of the unique needs of their mission hospitals’ educational programs to control their revenue in order to fund their programs’ growth and development exemplifies the common wisdom to provide authority and resources where responsibility for good outcomes is expected. Co-training of general surgeons and medical residents who can provide essential surgical call coverage may lead to on-going synergies. Teaching by medical and surgical subspecialists is essential in medical residencies to provide the depth of instruction residents need to develop as excellent clinicians. Dependable scheduling of their specialty instruction allows residency program directors to assure inclusion of their content in the residency curriculum. In summary, participants agreed that teaching in medical residency programs in LMIC present excellent opportunities for national and expat Christian physician educators

  4. Differential Experience With Men's and Women's Health Care Visits Between Male and Female Family Medicine Residents.

    Science.gov (United States)

    Garrison, Gregory M; Gentile, Natalie; Lai, Benjamin; Angstman, Kurt B; Bonacci, Robert

    2016-07-01

    Few studies have addressed whether male family medicine residents have more exposure to men's health issues than their female colleagues. Additionally, the association between panel demographics or continuity of care and the differential experience with gender-specific health care is unclear. Between July 1, 2011, and June 30, 2014, all residents in the family medicine program had their gender, the number of women's and men's health care visits, the total number of male and female visits, and the number of visits with patients assigned to their primary care panel recorded each academic year. To determine which visits pertained to men's or women's health care, Clinical Classification Software developed by the Agency for Healthcare Research and Quality (AHRQ) was used to map ICD9 billing codes into a useful ontology. Female residents had significantly more women's health visits (229 versus 123) while male residents had significantly more men's health visits (89 versus 49) than colleagues of the opposite gender. There were no significant differences in continuity, the gender distribution of panels, nor the mean age of panels. However, female residents saw a greater percentage of female visits overall (60.6% versus 53.3%). Both male and female resident physicians acquire more experience with same-gender health care visits during training. Panel demographics and continuity do not explain the differential experience. Patient preferences and/or biased scheduling selection may explain why residents accumulate same-gender health care visits at twice the rate of opposite-gender health care visits.

  5. A resident’s perspective on why global health work should be incorporated into family medicine residency training

    OpenAIRE

    Sarah Sweeney

    2016-01-01

    Family physicians are well prepared to address global health issues. In this perspective a family medicine resident reflects on her experience working on a global health project in Guatemala and why this type of experience should be incorporated into family medicine residency training.

  6. Family medicine residents' training in, knowledge about, and perceptions of digital rectal examination.

    Science.gov (United States)

    Bussières, Annick; Bouchard, Alexandre; Simonyan, David; Drolet, Sebastien

    2017-04-01

    To evaluate family medicine residents' training in, knowledge about, and perceptions of digital rectal examination (DRE). Descriptive study, using an online survey that was available in French and English. Quebec. A total of 217 residents enrolled in a family medicine program. Residents' demographic characteristics; the DRE teaching they received throughout their medical training; their reasons for omitting DRE; their recognition of DRE indications (strong vs weak) and application of DRE for 10 anorectal complaints; and their perceptions of the overall quality of the DRE training they received. Of the 879 residents contacted, 217 (25%) responded to the survey. Throughout their training, one-third of respondents did not receive any supervision for or feedback on DRE technique. Seventy-one percent of respondents expressed their inability to identify the nature of abnormal examination findings at least once during their training. The most frequently reported reasons to omit DRE were patient refusal, inadequate setting, and lack of time. Most of the residents in this study had omitted DRE at least once in their clinical work despite recognizing its importance. There was discordance between recognition of a complaint requiring DRE and execution of this technique in a clinical setting. Family medicine education programs and continuing medical education committees should consider including DRE training. Copyright© the College of Family Physicians of Canada.

  7. Family visits in shared-housing arrangements for residents with dementia--a cross-sectional study on the impact on residents' quality of life.

    Science.gov (United States)

    Gräske, Johannes; Meyer, Saskia; Worch, Andreas; Wolf-Ostermann, Karin

    2015-02-25

    Shared-housing arrangements (SHA) are a German type of small-scale living arrangements for people with dementia (PwD). The involvement of family members is one core domain of SHA. But it has not been investigated yet, what are factors associated with family visits and if family involvement within SHA contributes to better residents' quality of life (QoL). A cross-sectional study including all SHA in Berlin/Germany was performed. Main parameters of interest were residents' QoL (QUALIDEM) and frequencies of family visits within the SHA. Besides descriptive analyses we used logistic regression and ANCOVA to analyze the data. 58 SHA with 396 residents (78.4 years, 69.4% female) participated in the study. Older (OR: 1.034; 95% CI: 1.005; 1.064) and female residents (OR: 2.006; 95% CI: 1.018; 3.950) got more often visited by family members. An active participation of family members in SHA contributes on average to a better QoL in terms of social relationship and social isolation (all ANCOVA p family visits compared to those without family members. The involvement of family members in SHA is common but on a similar level compared to other care arrangements. Staff should convince available family members to visit PwD, in order to improve residents QoL. However, the response rate in the present study was about 13%, which may limit the results.

  8. Implementation and preliminary outcomes of the nation's first comprehensive 4-year residency in family medicine.

    Science.gov (United States)

    Douglass, Alan B; Rosener, Stephanie E; Stehney, Michael A

    2011-01-01

    Extending the residency curriculum to 4 years has been proposed as a logical innovation in response to the Future of Family Medicine Report given the increasing complexity of medical care and reduction in available training time due to duty hour restrictions. Middlesex Hospital, a participant in the P⁴ Initiative, is the first family medicine residency program to require a comprehensive 4-year curriculum for all residents. Over a 4-year time frame, the program transitioned from 8-8-8 to 6-6-6-6 staffing. The existing 3-year educational core of the program was left intact, and six additional core rotations and 7-month tracks of curricular enhancement were added. The residency practice transformed to a Patient-centered Medical Home (PCMH). Transition to a 4-year residency curriculum has proved smooth. Our funding model is sustainable, and practice income has increased. We have had no difficulty maintaining accreditation despite an innovative curriculum. A 4-year curriculum has resulted in substantially increased applicant interest and improved Match rates. The introduction of tracks has appealed to residents and has generated many positive spin-offs to the educational program as a whole. Transition to a PCMH has been of great value to both our patients and our learners. Transition to a comprehensive 4-year curriculum has been successful and has provided many benefits to our learners, practice, and educational program. Our graduates are substantially better prepared for practice.

  9. Impact of a family medicine resident wellness curriculum: a feasibility study

    Directory of Open Access Journals (Sweden)

    Christine Runyan

    2016-06-01

    Full Text Available Background: Up to 60% of practicing physicians report symptoms of burnout, which often peak during residency. Residency is also a relevant time for habits of self-care and resiliency to be emphasized. A growing literature underscores the importance of this; however, evidence about effective burnout prevention curriculum during residency remains limited. Objectives: The purpose of this project is to evaluate the impact of a new, 1-month wellness curriculum for 12 second-year family medicine residents on burnout, empathy, stress, and self-compassion. Methods: The pilot program, introduced during a new rotation emphasizing competencies around leadership, focused on teaching skills to cultivate mindfulness and self-compassion in order to enhance empathy and reduce stress. Pre-assessments and 3-month follow-up assessments on measures of burnout, empathy, self-compassion, and perceived stress were collected to evaluate the impact of the curriculum. It was hypothesized that this curriculum would enhance empathy and self-compassion as well as reduce stress and burnout among family medicine residents. Results: Descriptive statistics revealed positive trends on the mean scores of all the measures, particularly the Mindfulness Scale of the Self-Compassion Inventory and the Jefferson Empathy Scale. However, the small sample size and lack of sufficient power to detect meaningful differences limited the use of inferential statistics. Conclusions: This feasibility study demonstrates how a residency wellness curriculum can be developed, implemented, and evaluated with promising results, including high participant satisfaction.

  10. How Many Graduating Family Medicine Residents Have Chosen Financial Support for Service Commitments?

    Science.gov (United States)

    Phillips, Julie; Peterson, Lars E; Fang, Bo; Kovar-Gough, Iris; Phillips, Robert L

    2017-09-01

    New family physicians have opportunities to avoid accruing educational debt or have loans repaid by making a commitment to public service. Little information is available about the numbers of early career family physicians who have made service commitments to fund their education. The purpose of this study is to describe the proportion of graduating family medicine residents who have enrolled in US military and National Health Service Corps (NHSC) scholarship and loan repayment programs, thus obligating them to future public service. The study was a secondary analysis of de-identified data from the 2014 and 2015 American Board of Family Medicine examination registration questionnaire, which is required of all residents applying for board certification. Descriptive statistics were used to indicate the numbers and proportions of respondents who indicated military or NHSC financial support. Chi square analyses were used to analyze differences between groups. Of the 6,231 residents studied, 271 (4.4%) had either obtained military support (n=191, 3.1%) or enrolled in the NHSC (n=80, 1.3%). More men had enrolled in the military than women (4.2% vs 2.2%, P<0.01), but there was no significant NHSC gender difference. Underrepresented minorities (URM) were twice as likely to have enrolled in NHSC as non-URM residents (2.5% vs 1.0%, P<0.01). Only a small fraction of graduating family medicine residents have used either military enrollment or NHSC scholarships to fund their education. Family medicine should advocate strongly for expansion of the NHSC scholarship program, which receives many more applications than it can support.

  11. 7 CFR 1924.115 - Single Family Housing site evaluation.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 12 2010-01-01 2010-01-01 false Single Family Housing site evaluation. 1924.115 Section 1924.115 Agriculture Regulations of the Department of Agriculture (Continued) RURAL HOUSING... Work § 1924.115 Single Family Housing site evaluation. (a) Site review. The site approval official will...

  12. Lessons learned in developing family medicine residency training programs in Japan

    Directory of Open Access Journals (Sweden)

    Kitamura Kazuya

    2005-09-01

    Full Text Available Abstract Background While family medicine is not well established as a discipline in Japan, a growing number of Japanese medical schools and training hospitals have recently started sougoushinryoubu (general medicine departments. Some of these departments are incorporating a family medicine approach to residency training. We sought to learn from family medicine pioneers of these programs lessons for developing residency training. Methods This qualitative project utilized a long interview research design. Questions focused on four topics: 1 circumstances when becoming chair/faculty member; 2 approach to starting the program; 3 how Western ideas of family medicine were incorporated; and 4 future directions. We analyzed the data using immersion/crystallization to identify recurring themes. From the transcribed data, we selected representative quotations to illustrate them. We verified the findings by emailing the participants and obtaining feedback. Results Participants included: five chairpersons, two program directors, and three faculty members. We identified five lessons: 1 few people understand the basic concepts of family medicine; 2 developing a core curriculum is difficult; 3 start with undergraduates; 4 emphasize clinical skills; and 5 train in the community. Conclusion While organizational change is difficult, the identified lessons suggest issues that merit consideration when developing a family medicine training program. Lessons from complexity science could inform application of these insights in other countries and settings newly developing residency training.

  13. Impact of Catholic Hospital Affiliation During Obstetrics and Gynecology Residency on the Provision of Family Planning.

    Science.gov (United States)

    Guiahi, Maryam; Hoover, Jennifer; Swartz, Maryke; Teal, Stephanie

    2017-08-01

    Catholic hospitals operate under the Ethical and Religious Directives for Catholic Health Care Services, which for obstetrics and gynecology residents may create barriers to receiving adequate training in family planning. We evaluated how training at a Catholic hospital affects trainees' subsequent provision of reproductive health services at secular institutions. This qualitative study used semistructured interviews with recent obstetrics and gynecology graduates in generalist practice at secular institutions. We queried about their training experiences, perceived deficiencies, and current provision of family planning services. Three researchers independently coded transcripts, using grounded theory. We reached thematic saturation after 15 of 31 graduates (48%) from 7 Catholic hospital residencies participated in interviews between June 2014 and February 2015. Many participants reported a lack of awareness regarding limitations on this aspect of their training. All participants reported reproductive health care training deficiencies, and many explained that "elective" training required resident initiative to obtain. After graduation, participants reported dissatisfaction with training in family planning, delayed competency in this area, and a lack of ability to provide certain family planning procedures. All felt that Catholic programs should improve family planning training by providing routine, opt-out family planning opportunities. Obstetricians and gynecologists who trained at Catholic institutions felt that religion-based policies negatively affected their training experiences and the range of reproductive health services they subsequently provide in practice. Forming collaborations with off-site facilities, particularly for postpartum tubal ligation and uterine evacuation, may improve the reproductive care these physicians ultimately provide to women.

  14. Existing sustainable renovation concepts for single-family houses

    DEFF Research Database (Denmark)

    Tommerup, Henrik M.; Vanhoutteghem, Lies; Svendsen, Svend

    2010-01-01

    In the Nordic Innovation Centre Project, SuccessFamilies, the main objective is to change the business environment in order to speed up the implementation of sustainable renovation of single-family houses – proposing new service concepts that will combine both the technical solutions, financing...... concepts. The paper describes a few Nordic examples of full-service models for renovation of single-family houses which entered the market recently and the provisional success of these concepts. The existing Nordic single-family house renovation market is dominated by a craftsman based approach...... with individual solutions, traditional warehouses ”do-it-yourself-shops” and some actors marketing single products. To speed up the implementation of sustainable renovation of single-family houses there is a great need for full-service packages. Existing technical renovation concepts, typically focusing...

  15. Learning behaviour and preferences of family medicine residents under a flexible academic curriculum

    Science.gov (United States)

    Sy, Alice; Wong, Eric; Boisvert, Leslie

    2014-01-01

    Abstract Objective 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. Design Retrospective descriptive analysis of academic learning logs submitted by residents as part of their academic training requirements between 2008 and 2011. Setting London, Ont. Participants 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). Main outcome measures 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. Results 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. Conclusion 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

  16. Adolescent medicine: attitudes, training, and experience of pediatric, family medicine, and obstetric-gynecology residents.

    Science.gov (United States)

    Kershnar, Rebecca; Hooper, Charlene; Gold, Marji; Norwitz, Errol R; Illuzzi, Jessica L

    2009-12-01

    Several studies have documented a deficiency in the delivery of preventive services to adolescents during physician visits in the United States. This study sought to assess and compare pediatric, family medicine (FM), and obstetrics and gynecology (OB/GYN) resident perceptions of their responsibility, training, and experience with providing comprehensive health care services to adolescents. A 57-item, close-ended survey was designed and administered to assess resident perceptions of the scope of their practice, training, and experience with providing adolescent health care across a series of health care categories. Of the 87 respondents (31 OB/GYN, 29 FM, and 27 pediatric), most residents from all three fields felt that the full range of adolescent preventive and clinical services represented in the survey fell under their scope of practice. Residents from all three fields need more training and experience with mental health issues, referring teenagers to substance abuse treatment programs, and addressing physical and sexual abuse. In addition, OB-GYN residents reported deficiencies in training and experience regarding several preventive counseling and general health services, while pediatric residents reported deficiencies in training and experience regarding sexual health services. Our results indicate that at this time, residents from these three specialties are not optimally prepared to provide the full range of recommended preventive and clinical services to adolescents.

  17. Family medicine residents' beliefs, attitudes and performance with problem drinkers: a survey and simulated patient study.

    Science.gov (United States)

    Kahan, Meldon; Wilson, Lynn; Liu, Eleanor; Borsoi, Diane; Brewster, Joan M; Sobell, Linda C; Sobell, Mark B

    2004-03-01

    Fifty-six second-year family medicine residents completed a survey on their knowledge and beliefs about problem drinkers. Most residents felt responsible for screening and counseling, were confident in their clinical skills in these areas, and scored well on related knowledge questions. However, only 18% felt that problem drinkers would often respond to brief counseling sessions with physicians while 36% felt that moderate drinking was a reasonable goal for patients with severe alcohol dependence. Residents were then visited by unannounced simulated patients (SPs) presenting with alcohol-induced hypertension or insomnia. Residents detected the SP in 45 out of 104 visits. In the 59 undetected SP visits, residents asked about alcohol consumption in 47 visits (80%), discussed the relationship between alcohol use and the presenting complaint in 37 visits (63%), and recommended a specific weekly consumption in 35 visits (59%). Only 31% offered reduced drinking strategies, and most did not ask about features of alcohol dependence. These results suggest that residents have the fundamental clinical skills required to manage the problem drinker who gives a clear history and is receptive to advice. Educational efforts with residents should focus on the importance of systematic screening, taking an alcohol history under more challenging conditions, identifying the subtler presentations of alcohol problems, counselling the less receptive patient at an earlier stage of change, distinguishing the problem drinker from the alcohol-dependent patient, and offering specific behavioral strategies for the problem drinker.

  18. Adolescent Medicine: Attitudes, Training, and Experience Of Pediatric, Family Medicine, and Obstetric-Gynecology Residents

    Science.gov (United States)

    Kershnar, Rebecca; Hooper, Charlene; Gold, Marji; Norwitz, Errol R.; Illuzzi, Jessica L.

    2009-01-01

    Purpose: Several studies have documented a deficiency in the delivery of preventive services to adolescents during physician visits in the United States. This study sought to assess and compare pediatric, family medicine (FM), and obstetrics and gynecology (OB/GYN) resident perceptions of their responsibility, training, and experience with providing comprehensive health care services to adolescents. Methods: A 57-item, close-ended survey was designed and administered to assess resident perceptions of the scope of their practice, training, and experience with providing adolescent health care across a series of health care categories. Results: Of the 87 respondents (31 OB/GYN, 29 FM, and 27 pediatric), most residents from all three fields felt that the full range of adolescent preventive and clinical services represented in the survey fell under their scope of practice. Residents from all three fields need more training and experience with mental health issues, referring teenagers to substance abuse treatment programs, and addressing physical and sexual abuse. In addition, OB-GYN residents reported deficiencies in training and experience regarding several preventive counseling and general health services, while pediatric residents reported deficiencies in training and experience regarding sexual health services. Conclusions: Our results indicate that at this time, residents from these three specialties are not optimally prepared to provide the full range of recommended preventive and clinical services to adolescents. PMID:20027278

  19. Family medicine graduates' perceptions of intimidation, harassment, and discrimination during residency training

    Directory of Open Access Journals (Sweden)

    Crutcher Rodney A

    2011-10-01

    Full Text Available Abstract Background Despite there being considerable literature documenting learner distress and perceptions of mistreatment in medical education settings, these concerns have not been explored in-depth in Canadian family medicine residency programs. The purpose of the study was to examine intimidation, harassment and/or discrimination (IHD as reported by Alberta family medicine graduates during their two-year residency program. Methods A retrospective questionnaire survey was conducted of all (n = 377 family medicine graduates from the University of Alberta and University of Calgary who completed residency training during 2001-2005. The frequency, type, source, and perceived basis of IHD were examined by gender, age, and Canadian vs international medical graduate. Descriptive data analysis (frequency, crosstabs, Chi-square, Fisher's Exact test, analysis of variance, and logistic regression were used as appropriate. Results Of 377 graduates, 242 (64.2% responded to the survey, with 44.7% reporting they had experienced IHD while a resident. The most frequent type of IHD experienced was in the form of inappropriate verbal comments (94.3%, followed by work as punishment (27.6%. The main sources of IHD were specialist physicians (77.1%, hospital nurses (54.3%, specialty residents (45.7%, and patients (35.2%. The primary basis for IHD was perceived to be gender (26.7%, followed by ethnicity (16.2%, and culture (9.5%. A significantly greater proportion of males (38.6% than females (20.0% experienced IHD in the form of work as punishment. While a similar proportion of Canadian (46.1% and international medical graduates (IMGs (41.0% experienced IHD, a significantly greater proportion of IMGs perceived ethnicity, culture, or language to be the basis of IHD. Conclusions Perceptions of IHD are prevalent among family medicine graduates. Residency programs should explicitly recognize and robustly address all IHD concerns.

  20. Family Structure and Children's Success: A Comparison of Widowed and Divorced Single-Mother Families.

    Science.gov (United States)

    Biblarz, Timothy J.; Gottainer, Greg

    2000-01-01

    States that compared with children raised in single-mother families created by death of the father, children raised in divorced single-mother families have significantly lower levels of education, occupational status, and happiness as adults. Speculates that the contrasting positions in the social structure of different types of single-mother…

  1. Electrocardiography teaching in Canadian family medicine residency programs: a national survey.

    Science.gov (United States)

    Paul, Baldeep; Baranchuk, Adrian

    2011-04-01

    Electrocardiography (ECG) interpretation is an essential skill for a family physician. Teaching and learning electrocardiography is a difficult task, in part due to the erosion of knowledge when interpretation is not part of a daily activity. The objective of this study was to assess the current status of electrocardiography teaching in Canadian family medicine residency programs. A national survey was designed to specifically address the status of the ECG teaching curricula. This national survey was electronically sent to the family medicine program directors of all 17 Canadian accredited medical schools. Approximately 75% of the schools responded to the survey. There was a great variance among Canadian family medicine residency programs with respect to the time allotment, ECG training location, training faculty, and teaching methods utilized. The goals of each respective program are also quite wide-ranging. Family medicine residency programs across Canada are quite diverse regarding ECG training curricula and its goals. The need for a homogeneous way of teaching and evaluating has been identified.

  2. "Maintaining connections but wanting more": the continuity of familial relationships among assisted-living residents.

    Science.gov (United States)

    Tompkins, Catherine J; Ihara, Emily S; Cusick, Alison; Park, Nan Sook

    2012-01-01

    Social support is a key component of well-being for older adults, particularly for those who have moved from independent living to assisted living involving a transformation of roles, relationships, and responsibilities. Twenty-nine assisted-living facility residents were interviewed to understand the perceived continuity of relationships with family and friends. An inductive approach to thematic analysis revealed 1 main theme and 3 subthemes. The main theme that emerged was: maintaining connections but wanting more. Residents appreciated maintaining connections with family and friends, but often expressed feelings of discontentment with the continuity of former relationships. The subthemes included: appreciating family and friends, waiting for more, and losing control. Implications for research and practice are discussed.

  3. Does empowering resident families or nursing home employees in decision making improve service quality?

    Science.gov (United States)

    Hamann, Darla J

    2014-08-01

    This research examines how the empowerment of residents' family members and nursing home employees in managerial decision making is related to service quality. The study was conducted using data from 33 nursing homes in the United States. Surveys were administered to more than 1,000 employees on-site and mailed to the primary-contact family member of each resident. The resulting multilevel data were analyzed using hierarchical linear modeling. The empowerment of families in decision making was positively associated with their perceptions of service quality. The empowerment of nursing staff in decision making was more strongly related to service quality than the empowerment of nonnursing staff. Among nursing staff, the empowerment of nursing assistants improved service quality more than the empowerment of nurses. © The Author(s) 2013.

  4. Association between women's autonomy and family planning outcome in couples residing in Isfahan

    Science.gov (United States)

    Kohan, Shahnaz; Talebian, Ferdos; Ehsanpour, Soheila

    2014-01-01

    Background: One of the important factors in the prediction of family planning outcome is paying attention to women's role in decision making concerning fertility and household affairs. With the improvement of women's status and autonomy, their control over fertility is expected to increase. The present study aimed to investigate the association between women's autonomy and family planning outcome of the couples residing in Isfahan. Materials and Methods: This is cross-sectional study. Two hundred and seventy women of childbearing age, eligible for family planning and residing in Isfahan, were selected through random cluster sampling and they filled a researcher-made questionnaire. Women's autonomy was measured with the questions on their decision-making autonomy concerning household affairs and physical mobility autonomy. The association between women's autonomy and family planning outcome was analyzed through statistical methods. Results: The results showed that the mean of women's decision-making, physical mobility, and general autonomy was 50. Women's autonomy had a direct significant association with the type of contraception method (P = 0.01) and the length of usage of their present contraception method (P = 0.04) as well as where they received family planning services (P = 0.02). Conclusions: Analysis of data revealed women with higher autonomy used a more efficient contraception method and continued their contraception method for a longer time, which leads to improvement of couples’ family planning outcome. Therefore, family planning services should be planned and provided with women's autonomy under consideration. PMID:25400671

  5. Global Health in Family Medicine Summer Primer: Course for residents and faculty.

    Science.gov (United States)

    Rouleau, Katherine; Janakiram, Praseedha; Nicolle, Eileen; Godoy-Ruiz, Paula; Pakes, Barry N

    2015-07-01

    Despite the rapid emergence of global health training across North American universities, there remains a gap in educational programs focusing on the unique role of family medicine and primary care in global health. The objective of the Global Health in Family Medicine Summer Primer, developed in 2013 by the Department of Family and Community Medicine at the University of Toronto in Ontario, is to strengthen global health competencies among family medicine residents and faculty. The course covers the meaning of global health; global health ethics; the place of family medicine, primary care, and primary health care in the global health context; epidemiology; infectious diseases; the social determinants of health; and care of vulnerable populations locally and globally. The course is delivered in an intensive 5-day format with didactic lectures, group discussions, interactive workshops, and lived-experience panels. The Global Health in Family Medicine Summer Primer has proven to be a successful educational initiative and provides valuable lessons learned for other academic science centres in developing global health training programs for family medicine residents and faculty.

  6. Osteoporosis risk assessment by family practice faculty and residents: a chart review.

    Science.gov (United States)

    Schrager, S; Kausch, T; Bobula, J A

    1999-12-01

    To assess the frequency of osteoporosis risk assessment of postmenopausal women by family practice faculty and residents. Review of 263 charts of women over 50 from 3 residency clinics. Charts were evaluated for evidence of osteoporosis risk assessments or discussion of prevention strategies during the past 2 years. Overall, 35% of the charts contained documentation of some discussion of osteoporosis. Female physicians discussed osteoporosis more than their male colleagues (p osteoporosis discussions decreased as women aged (p osteoporosis discussions with high risk women was low in this sample. Strategies to improve osteoporosis screening are necessary.

  7. Duration of residence and disease occurrence among refugees and family reunited immigrants

    DEFF Research Database (Denmark)

    Nørredam, Marie Louise; Agyemang, Charles; Hoejbjerg Hansen, Oluf K

    2014-01-01

    Ratios (HRs) were modelled for disease incidence by residence duration since arrival (0-5 years; 0-10 years; 0-18 years) adjusting for age and sex. RESULTS: Compared with Danish-born individuals, refugees and family reunited immigrants had lower HRs of stroke and breast cancer within 5 years after...... of residence on disease occurrence among migrants imply that, when explaining migrants' advantageous health outcomes, the ruling theory of the HME should be used with caution, and other explanatory models should be included....

  8. A teaching unit in primary care sports medicine for family medicine residents.

    Science.gov (United States)

    Vernec, A; Shrier, I

    2001-03-01

    The authors describe their experience in setting up a sports medicine teaching unit within a family practice center of a teaching hospital. The unit's patient population more closely resembles that of a typical family practice than that of a traditional musculoskeletal teaching clinic (e.g., orthopedics, emergency room). The teaching program includes direct observation of residents performing history taking and physical examinations through one-way mirrors, close supervision for each case, and a sports therapist who educates patients and residents about home exercise programs when physiotherapy within private clinics is not necessary or affordable. At the end of each session 20-30 minutes are devoted to teaching specific physical examination skills. The authors describe how their clinic interacts with other services within the hospital and how certain obstacles they encountered when setting up the clinic might be avoided by others. They feel that this type of unit complements other existing programs in the family medicine department and provides an excellent learning experience for family medicine residents, who are likely to see a high proportion of patients with muskuloskeletal injuries in their practices.

  9. Graduate survey of the South Carolina Area Health Education Consortium family practice residency programs.

    Science.gov (United States)

    Carek, P J; Abercrombie, S; Baughman, O; Buehler, J; Goforth, G; Hester, W; Lammie, J; Snape, P

    2001-06-01

    The results of this study demonstrate several interesting characteristics of the graduates of the SC AHEC associated family medicine residency programs: 45 percent practice in South Carolina, 63 percent live further than 120 miles from their residency program, 96 percent are satisfied with their specialty choice, and 56 percent are involved in teaching medical students and residents. Furthermore, these graduates have the following tendencies: to practice in the traditional solo or group practice; to practice in a suburban community, town or rural community and a setting size less than a population of 100,000 persons; to care for the aging adult and geriatric population; to provide nursing home care; and to utilize house calls to provide patient care). As the current health care system continues to be redesigned, this information will be essential for assessment and planning purposes.

  10. Single Family Loan Sale Initiative - Neighborhood Stabilization Outcome Pool Offering

    Data.gov (United States)

    Department of Housing and Urban Development — The FHA Office of Housing is conducting a series of mortgage loan sales under the Single Family Loan Sale (SFLS) Initiative. The current sales structure consists of...

  11. The Demographic Shift From Single-Family to Multifamily Housing

    National Research Council Canada - National Science Library

    Jordan Rappaport

    2013-01-01

    .... The longer term outlook is especially positive for multifamily construction, reflecting the aging of the baby boomers and an associated shift in demand from single-family to multifamily housing...

  12. Single-Family Houses That Meet The Future Energy Demands

    DEFF Research Database (Denmark)

    Rose, Jørgen; Svendsen, Svend

    2002-01-01

    to examine these consequences thoroughly. The department is presently contributing to this end by participating in quite a few investigative projects, where single-family houses are designed to meet the proposed future energy demands. This paper describes the results obtained from one such project where...... the department, in co-operation with a major building entrepreneur, has developed a single-family house that shows that there are no evident problems in meeting the future energy demands....

  13. Aspects of indignity in nursing home residences as experienced by family caregivers

    DEFF Research Database (Denmark)

    Nåden, Dagfinn; Høy, Bente; Lohne, Vibeke

    2013-01-01

    , the sample consisted of 28 family caregivers of nursing home residents. The empirical material was interpreted using a hermeneutical approach. The overall theme that emerged was as follows: 'A feeling of being abandoned'. The sub-themes are designated as follows: deprived of the feeling of belonging...... or deprived from the perspective of family caregivers? In this article, we focus only on indignity in care. This study took place at six different nursing home residences in Sweden, Denmark and Norway. Data collection methods in this part of this study consisted of individual research interviews. Altogether......, deprived of dignity due to acts of omission, deprived of confirmation, deprived of dignity due to physical humiliation, deprived of dignity due to psychological humiliation and deprived of parts of life....

  14. Improving Family Medicine Residents' Written Communication Using a Self-assessment Process.

    Science.gov (United States)

    François, José

    2012-01-01

    Although competency in written communication is a core skill, written communication is seldom the focus of formal instruction in medical education. The objective of this intervention was to implement a self-assessment strategy to assist learners in improving their letter writing skills and then to evaluate its feasibility, reliability and potential educational value. Eight first-year family medicine residents from two teaching sites completing a six month family medicine rotation used a self-assessment process which included a self-study module and an assessment tool for letters. Each resident applied the self-assessment tool to eight to ten consecutive consult/referral request letters. Participants submitted initial and redrafted letters for independent rating. Analysis of the content, style and global ratings of the initial 77 draft letters showed multiple deficiencies in the content of their letters. It was confirmed that by using the self-assessment tool, residents were able to reliably assess the quality of their letters. Residents' assessments and those of the expert closely correlated (Pearson correlation 0.861, p written communication significantly improves the quality and completeness of routine consult/referral request letters.

  15. Family medicine residents' knowledge and attitudes about drug-nutrient interactions.

    Science.gov (United States)

    Lasswell, A B; DeForge, B R; Sobal, J; Muncie, H L; Michocki, R

    1995-04-01

    The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) requires that health professionals recognize the importance of drug-nutrient interactions and educate patients to prevent adverse effects. Drug-nutrient interactions are an important issue in medical practice, but it is not clear how or if physicians are trained in this issue. This investigation was a needs assessment that examined attitudes and knowledge about drug-nutrient interactions that was examined in a national sample of 834 family medicine residents in 56 residency programs. Most reported they had little or no formal training in drug-nutrient interactions in medical school (83%) or residency (80%). However, 79% believed it was the physician's responsibility to inform patients about drug-nutrient interactions, although many thought pharmacists (75%) and dietitians (66%) share this responsibility. Overall, residents correctly answered 61% +/- 19 of fourteen drug-nutrient interaction knowledge items. There was a slight increase in drug-nutrient knowledge as year of residency increased. Physicians' knowledge of drug-nutrient interactions may be improved by including nutrition education in the topics taught by physicians, nutritionists, and pharmacists using several educational strategies. Nutrition educators in particular can play a role in curriculum development about drug-nutrient interactions by developing, refining, and evaluating materials and educational tools. Nutrition educators need to provide this information in academic settings for the training of all health professionals as well as in patient education settings such as hospitals and public health clinics.

  16. Overcoming early barriers to PCMH practice improvement in family medicine residencies.

    Science.gov (United States)

    Fernald, Douglas H; Deaner, Nicole; O'Neill, Caitlin; Jortberg, Bonnie T; degruy, Frank Verloin; Dickinson, W Perry

    2011-01-01

    Residency programs face inevitable challenges as they redesign their practices for higher quality care and resident training. Identifying and addressing early barriers can help align priorities and thereby augment the capacity to change. Evaluation of the Colorado Family Medicine Residency PCMH Project included iterative qualitative analysis of field notes, interviews, and documents to identify early barriers to change and strategies to overcome them. Nine common but not universal barriers were identified: (1) a practice's history reflected some negative past experiences with quality improvement or routines incompatible with transformative change, (2) leadership gaps were evident in unprepared practice leaders or hierarchical leadership, (3) resistance and skepticism about change were expressed through cynicism aimed at change or ability to change, (4) unproductive team processes were reflected in patterns of canceled meetings, absentee leaders, or lack of accountability, (5) knowledge gaps about the Patient-centered Medical Home (PCMH) were apparent from incomplete dissemination about the project or planned changes, (6) EHR implementation distracted focus or stalled improvement activity, (7) sponsoring organizations' constraints emerged from staffing rules and differing priorities, (8) insufficient staff participation resulted from traditional role expectations and structures, and (9) communication was hampered by ineffective methods and part-time faculty and residents. Early barriers responded to varying degrees to specific interventions by practice coaches. Some barriers that interfere with practices getting started with cultural and structural transformation can be addressed with persistent attention and reflection from on-site coaches and by realigning the talents, leaders, and priorities already in these residency programs.

  17. Effectiveness of a Formal Mentorship Program in Family Medicine Residency: The Residents’ Perspective

    Directory of Open Access Journals (Sweden)

    Marie Andrades

    2013-01-01

    Full Text Available Introduction. Mentoring is a recognized form of teaching learning strategy in postgraduate medical education. This paper describes the effectiveness of a formal mentorship program from the residents’ perspective after a year of implementation. Methods. The Aga Khan University Family Medicine Residency Program is the first program in Pakistan to our knowledge to implement formal mentorship for all four years of residency. A mentorship program was developed, implemented, and evaluated a year later using a rating scale. The 10-point Likert scale consisted of questions on academics, clinical work, research, administrative issues, and personal/social issues. Results. The response rate was 95% (. Eighty percent ( were women. Satisfaction level in seeking help was the highest for academics (75%. Residents scored mentorship as low in helping to tackle their personal problems (20%. Barriers reported in rapport building with mentor were time constraints and gender difference. The most useful attributes of the mentor which helped rapport building were accessibility, active listening, support for emotional needs, and trustworthiness. Conclusion. Mentoring has a role in trainees’ personal and professional growth especially when their needs are addressed. The effectiveness of the mentorship program in residency can improve if the residents are allowed to choose their own mentors.

  18. Adolescents with mental health challenges residents of rural areas: perceptions about family, school and neighborhood context

    Directory of Open Access Journals (Sweden)

    Maria Fernanda Barboza Cid

    2016-07-01

    Full Text Available Objective: This study aimed to identify the perceptions of adolescents residents in a rural area, linked to a Family Health Unit due mental health challenges, about their relationships with family and friends, school, situations of stress and support experience, as well about the region where they live, and compare them with the perceptions of adolescents also residents in a rural area who don’t have mental health challenges. Method: The study included 10 adolescents residents in a rural area of a city in São Paulo state, divided in two groups, A e B (with and without mental health challenges. Data were collected from questionnaire identification and a semi-structured interview and analyzed using analysis of contents. Results: The results indicated that, in view of the participants, the family is considered the main source of support, and in the group of adolescents with mental health challenges it is indicated also as an important source of stress. The school is seen, generally, as a socialization space for teens. About neighborhood context, perceptions are predominantly positive, and one of the reported negative aspects refers to the lack of leisure facilities. Conclusion: We observed few differences in the perception of both groups on the issues addressed. The neighborhood context, although it is appointed as restricted in terms of activities possibilities, seems to guarantee membership in groups and environments, which may have a protective role in coping with psychological suffering.

  19. Teaching-skills training programs for family medicine residents: systematic review of formats, content, and effects of existing programs.

    Science.gov (United States)

    Lacasse, Miriam; Ratnapalan, Savithiri

    2009-09-01

    To review the literature on teaching-skills training programs for family medicine residents and to identify formats and content of these programs and their effects. Ovid MEDLINE (1950 to mid-July 2008) and the Education Resources Information Center database (pre-1966 to mid-July 2008) were searched using and combining the MeSH terms teaching, internship and residency, and family practice; and teaching, graduate medical education, and family practice. The initial MEDLINE and Education Resources Information Center database searches identified 362 and 33 references, respectively. Titles and abstracts were reviewed and studies were included if they described the format or content of a teaching-skills program or if they were primary studies of the effects of a teaching-skills program for family medicine residents or family medicine and other specialty trainees. The bibliographies of those articles were reviewed for unidentified studies. A total of 8 articles were identified for systematic review. Selection was limited to articles published in English. Teaching-skills training programs for family medicine residents vary from half-day curricula to a few months of training. Their content includes leadership skills, effective clinical teaching skills, technical teaching skills, as well as feedback and evaluation skills. Evaluations mainly assessed the programs' effects on teaching behaviour, which was generally found to improve following participation in the programs. Evaluations of learner reactions and learning outcomes also suggested that the programs have positive effects. Family medicine residency training programs differ from all other residency training programs in their shorter duration, usually 2 years, and the broader scope of learning within those 2 years. Few studies on teaching-skills training, however, were designed specifically for family medicine residents. Further studies assessing the effects of teaching-skills training in family medicine residents are

  20. [Children in single-parent families, yesterday and today].

    Science.gov (United States)

    Denis, H; Desjardins, B; Legare, J; Marcil-gratton, N

    1994-01-01

    "This study, conducted from the point of view of the children, compares cohorts from the time of New France [Quebec] with those of Canada today, showing that single parenthood is not a new phenomenon. The types of single parenthood, however, are quite different. The colonial model of the traditional family has given way to a variety of family situations. As well, while death was the only cause of single parenthood during the colonial era, separations today are essentially based on some sort of decision. The psychological repercussions of losing a parent are thus completely different." (SUMMARY IN ENG AND SPA) excerpt

  1. Systematic review of evidence-based medicine tests for family physician residents.

    Science.gov (United States)

    Thomas, Roger E; Kreptul, Dennis

    2015-02-01

    Evidence-based medicine (EBM) is increasingly important in resident education, and reliable and valid tests of competence for family medicine residents are needed. MEDLINE, PsycINFO, ERIC, ERC, and the Research & Development Resource Base (University of Toronto) were searched from inception to June 2014 to identify competence tests of family medicine and general practice residents in EBM. Two authors independently assessed all titles, abstracts, and full texts and abstracted data. Three EBM courses were evaluated by the Fresno test. Seven other authors designed EBM interventions and individual tests to evaluate them. Content validity was assessed by nine studies, construct validity by five, face validity by three, and concurrent validity by one. Internal reliability was reported by seven studies, inter-rater by four, item difficult and item discrimination by two, and intra-rater by one. Eight studies reported that knowledge scores increased significantly after the intervention. Content validity and internal reliability were the most frequently assessed measures. The basic EBM activities of identifying Population, Intervention, Comparison, Outcome, and Study Design (PICOS questions) and computing sensitivity, specificity, and number needed to treat (NNT) are unlikely to change. However, guidelines are often used in EBM courses, and they are updated regularly, which will involve new clinical scenarios, PICOS questions, and statistical computations. The Fresno test has been evaluated with three groups of family medicine residents, has the best documentation of validity and reliability, and is the best candidate for future development. Evaluation tools also need to be developed to measure if care received by patients is EBM.

  2. A Single Father's Shopping Bag: Purchasing Decisions in Single-Father Families

    Science.gov (United States)

    Ziol-Guest, Kathleen M.

    2009-01-01

    Using data from the 1980 to 2003 panels of the Consumer Expenditure Survey, this article examines purchasing decisions in father-headed single-parent families. Single-father expenditures are compared to both married-parent expenditures and single-mother expenditures on 17 broad categories of household-level goods and services. Multivariate…

  3. Competency-based evaluation tools for integrative medicine training in family medicine residency: a pilot study

    Directory of Open Access Journals (Sweden)

    Schneider Craig

    2007-04-01

    Full Text Available Abstract Background As more integrative medicine educational content is integrated into conventional family medicine teaching, the need for effective evaluation strategies grows. Through the Integrative Family Medicine program, a six site pilot program of a four year residency training model combining integrative medicine and family medicine training, we have developed and tested a set of competency-based evaluation tools to assess residents' skills in integrative medicine history-taking and treatment planning. This paper presents the results from the implementation of direct observation and treatment plan evaluation tools, as well as the results of two Objective Structured Clinical Examinations (OSCEs developed for the program. Methods The direct observation (DO and treatment plan (TP evaluation tools developed for the IFM program were implemented by faculty at each of the six sites during the PGY-4 year (n = 11 on DO and n = 8 on TP. The OSCE I was implemented first in 2005 (n = 6, revised and then implemented with a second class of IFM participants in 2006 (n = 7. OSCE II was implemented in fall 2005 with only one class of IFM participants (n = 6. Data from the initial implementation of these tools are described using descriptive statistics. Results Results from the implementation of these tools at the IFM sites suggest that we need more emphasis in our curriculum on incorporating spirituality into history-taking and treatment planning, and more training for IFM residents on effective assessment of readiness for change and strategies for delivering integrative medicine treatment recommendations. Focusing our OSCE assessment more narrowly on integrative medicine history-taking skills was much more effective in delineating strengths and weaknesses in our residents' performance than using the OSCE for both integrative and more basic communication competencies. Conclusion As these tools are refined further they will be of value both in improving

  4. Examination outcomes and work locations of international medical graduate family medicine residents in Canada.

    Science.gov (United States)

    Mathews, Maria; Kandar, Rima; Slade, Steve; Yi, Yanqing; Beardall, Sue; Bourgeault, Ivy

    2017-10-01

    To describe the postgraduate medical education (PGME) examination outcomes and work locations of international medical graduates (IMGs); and to identify differences between Canadians studying abroad (CSAs) and non-CSAs. Cohort study using data from the National IMG Database and Scott's Medical Database. Canada. All IMGs who had first entered a family medicine residency program between 2005 and 2009, with the exclusion of US graduates, visa trainees, and fellowship trainees. We examined 4 outcomes: passing the Medical Council of Canada Qualifying Examination Part 2 (MCCQE2), obtaining Certification in Family Medicine (CCFP), working in Canada within 2 years of completing PGME training, and working in Canada in 2015. Of the 876 residents in the study, 96.1% passed the MCCQE2, 78.1% obtained a specialty designation, 37.7% worked in Canada within 2 years after their PGME, and 91.2% worked in Canada in 2015. Older graduates were more likely (odds ratio [OR] = 3.45; 95% CI 1.52 to 7.69) than recent graduates were to pass the MCCQE2, and residents who participated in a skills assessment program before their PGME training were more likely (OR = 9.60; 95% CI 1.29 to 71.63) than those who had not were to pass the MCCQE2. Women were more likely (OR = 1.67; 95% CI 1.20 to 2.33) to obtain a specialty designation than men were. Recent graduates were more likely (OR = 1.36; 95% CI 1.03 to 1.79) than older graduates were to work in Canada following training. Residents who were eligible for a full licence were more likely (OR = 3.72; 95% CI 2.30 to 5.99) to work in Canada in 2015 than those who were not eligible for a full licence were. While most IMGs who entered the family medicine PGME program passed the MCCQE2, 1 in 5 did not obtain Certification. Most IMG residents remain in Canada. Canadians studying abroad and non-CSA IMGs share similar examination success rates and retention rates. Copyright© the College of Family Physicians of Canada.

  5. Attention without intention: explicit processing and implicit goal-setting in family medicine residents' written reflections.

    Science.gov (United States)

    Shaughnessy, Allen F; Allen, Lucas; Duggan, Ashley

    2017-05-01

    Reflection, a process of self-analysis to promote learning through better understanding of one's experiences, is often used to assess learners' metacognitive ability. However, writing reflective exercises, not submitted for assessment, may allow learners to explore their experiences and indicate learning and professional growth without explicitly connecting to intentional sense-making. To identify core components of learning about medicine or medical education from family medicine residents' written reflections. Family medicine residents' wrote reflections about their experiences throughout an academic year. Qualitative thematic analysis to identify core components in 767 reflections written by 33 residents. We identified four themes of learning: 'Elaborated reporting' and 'metacognitive monitoring' represent explicit, purposeful self-analysis that typically would be characterised as reflective learning about medicine. 'Simple reporting' and 'goal setting' signal an analysis of experience that indicates learning and professional growth but that is overlooked as a component of learning. Identified themes elucidate the explicit and implicit forms of written reflection as sense-making and learning. An expanded theoretical understanding of reflection as inclusive of conscious sense-making as well as implicit discovery better enables the art of physician self-development.

  6. Family Medicine Residents' Performance with Detected Versus Undetected Simulated Patients Posing as Problem Drinkers.

    Science.gov (United States)

    Kahan, Meldon; Liu, Eleanor; Borsoi, Diane; Wilson, Lynn; Brewster, Joan M; Sobell, Mark B; Sobell, Linda C

    2004-12-01

    Simulated patients are commonly used to evaluate medical trainees. Unannounced simulated patients provide an accurate measure of physician performance. To determine the effects of detection of SPs on physician performance, and identify factors leading to detection. Fixty-six family medicine residents were each visited by two unannounced simulated patients presenting with alcohol-induced hypertension or insomnia. Residents were then surveyed on their detection of SPs. SPs were detected on 45 out of 104 visits. Inner city clinics had higher detection rates than middle class clinics. Residents' checklist and global rating scores were substantially higher on detected than undetected visits, for both between-subject and within-subject comparisons. The most common reasons for detection concerned SP demographics and behaviour; the SP "did not act like a drinker" and was of a different social class than the typical clinic patient. Multi-clinic studies involving residents experienced with SPs should ensure that the SP role and behavior conform to physician expectations and the demographics of the clinic. SP station testing does not accurately reflect physicians' actual clinical behavior and should not be relied on as the primary method of evaluation. The study also suggests that physicians' poor performance in identifying and managing alcohol problems is not entirely due to lack of skill, as they demonstrated greater clinical skills when they became aware that they were being evaluated. Physicians' clinical priorities, sense of responsibility and other attitudinal determinants of their behavior should be addressed when training physicians on the management of alcohol problems.

  7. Teaching and evaluation of ethics and professionalism: in Canadian family medicine residency programs.

    Science.gov (United States)

    Pauls, Merril A

    2012-12-01

    To document the scope of the teaching and evaluation of ethics and professionalism in Canadian family medicine postgraduate training programs, and to identify barriers to the teaching and evaluation of ethics and professionalism. A survey was developed in collaboration with the Committee on Ethics of the College of Family Physicians of Canada. The data are reported descriptively and in aggregate. Canadian postgraduate family medicine training programs. Between June and December of 2008, all 17 Canadian postgraduate family medicine training programs were invited to participate. The first part of the survey explored the structure, resources, methods, scheduled hours, and barriers to teaching ethics and professionalism. The second section focused on end-of-rotation evaluations, other evaluation strategies, and barriers related to the evaluation of ethics and professionalism. Eighty-eight percent of programs completed the survey. Most respondents (87%) had learning objectives specifically for ethics and professionalism, and 87% had family doctors with training or interest in the area leading their efforts. Two-thirds of responding programs had less than 10 hours of scheduled instruction per year, and the most common barriers to effective teaching were the need for faculty development, competing learning needs, and lack of resident interest. Ninety-three percent of respondents assessed ethics and professionalism on their end-of-rotation evaluations, with 86% assessing specific domains. The most common barriers to evaluation were a lack of suitable tools and a lack of faculty comfort and interest. By far most Canadian family medicine postgraduate training programs had learning objectives and designated faculty leads in ethics and professionalism, yet there was little curricular time dedicated to these areas and a perceived lack of resident interest and faculty expertise. Most programs evaluated ethics and professionalism as part of their end-of-rotation evaluations, but

  8. Leadership training in a family medicine residency program: Cross-sectional quantitative survey to inform curriculum development.

    Science.gov (United States)

    Gallagher, Erin; Moore, Ainsley; Schabort, Inge

    2017-03-01

    To assess the current status of leadership training as perceived by family medicine residents to inform the development of a formal leadership curriculum. Cross-sectional quantitative survey. Department of Family Medicine at McMaster University in Hamilton, Ont, in December 2013. A total of 152 first- and second-year family medicine residents. Family medicine residents' attitudes toward leadership, perceived level of training in various leadership domains, and identified opportunities for leadership training. Overall, 80% (152 of 190) of residents completed the survey. On a Likert scale (1 = strongly disagree, 4 = neutral, 7 = strongly agree), residents rated the importance of physician leadership in the clinical setting as high (6.23 of 7), whereas agreement with the statement "I am a leader" received the lowest rating (5.28 of 7). At least 50% of residents desired more training in the leadership domains of personal mastery, mentorship and coaching, conflict resolution, teaching, effective teamwork, administration, ideals of a healthy workplace, coalitions, and system transformation. At least 50% of residents identified behavioural sciences seminars, a lecture and workshop series, and a retreat as opportunities to expand leadership training. The concept of family physicians as leaders resonated highly with residents. Residents desired more personal and system-level leadership training. They also identified ways that leadership training could be expanded in the current curriculum and developed in other areas. The information gained from this survey might facilitate leadership development among residents through application of its results in a formal leadership curriculum. Copyright© the College of Family Physicians of Canada.

  9. Providing competency-based family medicine residency training in substance abuse in the new millennium: a model curriculum

    Directory of Open Access Journals (Sweden)

    Shellenberger Sylvia

    2010-05-01

    Full Text Available Abstract Background This article, developed for the Betty Ford Institute Consensus Conference on Graduate Medical Education (December, 2008, presents a model curriculum for Family Medicine residency training in substance abuse. Methods The authors reviewed reports of past Family Medicine curriculum development efforts, previously-identified barriers to education in high risk substance use, approaches to overcoming these barriers, and current training guidelines of the Accreditation Council for Graduate Medical Education (ACGME and their Family Medicine Residency Review Committee. A proposed eight-module curriculum was developed, based on substance abuse competencies defined by Project MAINSTREAM and linked to core competencies defined by the ACGME. The curriculum provides basic training in high risk substance use to all residents, while also addressing current training challenges presented by U.S. work hour regulations, increasing international diversity of Family Medicine resident trainees, and emerging new primary care practice models. Results This paper offers a core curriculum, focused on screening, brief intervention and referral to treatment, which can be adapted by residency programs to meet their individual needs. The curriculum encourages direct observation of residents to ensure that core skills are learned and trains residents with several "new skills" that will expand the basket of substance abuse services they will be equipped to provide as they enter practice. Conclusions Broad-based implementation of a comprehensive Family Medicine residency curriculum should increase the ability of family physicians to provide basic substance abuse services in a primary care context. Such efforts should be coupled with faculty development initiatives which ensure that sufficient trained faculty are available to teach these concepts and with efforts by major Family Medicine organizations to implement and enforce residency requirements for

  10. La CLAve to increase psychosis literacy of Spanish-speaking community residents and family caregivers.

    Science.gov (United States)

    López, Steven R; Lara, Ma del Carmen; Kopelowicz, Alex; Solano, Susana; Foncerrada, Hector; Aguilera, Adrian

    2009-08-01

    The authors developed and tested a 35-min psychoeducational program with the goal of increasing Spanish-speaking persons' literacy of psychosis. The program uses popular cultural icons derived from music, art, and videos, as well as a mnemonic device--La CLAve (The Clue)--to increase (a) knowledge of psychosis, (b) efficacy beliefs that one can identify psychosis in others, (c) attributions to mental illness, and (d) professional help-seeking. Assessments were conducted before and after administering the program to both community residents (n = 57) and family caregivers of persons with schizophrenia (n = 38). For community residents, the authors observed increases across the 4 domains of symptom knowledge, efficacy beliefs, illness attributions, and recommended help-seeking. For caregivers, increases were observed in symptom knowledge and efficacy beliefs. La CLAve is a conceptually informed psychoeducational tool with a developing empirical base aimed at helping Spanish-speaking Latinos with serious mental illness obtain care in a timely manner.

  11. Vocal behavior of resident killer whale matrilines with newborn calves: the role of family signatures.

    Science.gov (United States)

    Weiss, Brigitte M; Ladich, Friedrich; Spong, Paul; Symonds, Helena

    2006-01-01

    Studies of the vocal behavior of resident killer whales or orcas, Orcinus orca, in British Columbia have shown that matrilines have unique call repertoires consisting of up to 17 different call types. These call types cannot be attributed exclusively to specific behaviors, and their function in social contexts is poorly understood. This study investigated the change in call patterns of three resident matrilines in a changed social environment, before and up to one year after the birth of a calf. Acoustic data were collected with a network of hydrophones and were supplemented by visual observations. Call use changed distinctly after the birth of a calf in all three observed matrilines. All call types that were recorded in control situations were also recorded in postbirth situations; however, aberrant versions of discrete calls and excitement calls made up a higher proportion of calls after birth. Most conspicuously, family-specific call types occurred significantly more frequently in the days following a birth in two of the three matrilines and gradually returned to prebirth values within 2 weeks. Their increased use after a calf's birth may facilitate the learning process of this "acoustic family badge" and thereby help to recognize and maintain cohesion with family members.

  12. The service-education linkage: implications for family practice residency programs and community and migrant health centers.

    Science.gov (United States)

    Gordon, P R; Hale, F

    1993-05-01

    Access to quality primary health care for our country's underserved populations is a challenge for both the government and physicians. The Division of Medicine, through funding priorities and other initiatives, is encouraging family practice educators to train residents and students for work in community and migrant health centers (C/MHCs) in underserved areas. The objective of this research was to study linkages between family practice residency programs and C/MHCs and determine the reasons for affiliation, disadvantages and advantages, predictors of successful linkages, and common errors in the linkage agreement. We conducted in-depth telephone interviews with the directors of 13 of the 19 family practice residency programs identified as having linkages with C/MHCs. All interviewees at residency programs indicated that their programs had a mission to serve underserved patients. The most commonly cited constraining factor cited by both residency programs and C/MHCs was financial support for residents, on-site faculty, and support staff. Many programs reported that residents training at the C/MHC were able to gain a community health perspective and practice community-oriented primary care. Finally, financing the relationship involved many different approaches, ranging from the residency paying all of the salaries, to a sharing of salaries by the residency, state, and/or hospital, to C/MHC paying the salaries either through its own funds or through grant support. These data provide an assessment of the current issues that family practice residencies must address to implement service-education linkages. They provide an empirical basis to outline the steps involved in forming a linkage between a residency and a C/MHC.

  13. Maternal Psychological Functioning, Family Processes, and Child Adjustment in Rural, Single-Parent, African American Families.

    Science.gov (United States)

    Brody, Gene H.; Flor, Douglas L.

    1997-01-01

    Tested a model linking family financial resources to adjustment among African American 6- to 9-year olds with single, rural, Southern mothers. Found that inadequate financial resources related to mothers' depression and low self-esteem. Self-esteem was linked with family routines and mother-child relationship quality. Child self-regulation…

  14. A Comparison of the Role of Grandparents in Single-Mother and Single-Father Families.

    Science.gov (United States)

    Hilton, Jeanne M.; Macari, Daniel P.

    There is little information available on the roles played by grandparents in the lives of their grandchildren following the divorce or separation of the grandchildren's parents. This study compared the specific activities shared by grandparents and grandchildren in single-mother and single-father families of children in grades 1 through 4. Data on…

  15. Economy Controls Energy Retrofits of Danish Single-family Houses

    DEFF Research Database (Denmark)

    Mortensen, Andrea; Heiselberg, Per; Knudstrup, Mary-Ann

    2014-01-01

    883 Danish single-family house owners completed a questionnaire about energy retrofit. The objective of this paper is, based on the survey results, to determine how Danish homeowners can be motivated to conduct energy retrofits. The conclusion is that the financial aspect of an energy retrofit...... situation and consumption is concluded as the optimal motivation strategy for the homeowners to conduct energy retrofits....

  16. 75 FR 27949 - Single Family Housing Guaranteed Loan Program

    Science.gov (United States)

    2010-05-19

    ... efficiency in managing the SFHGLP. The proposed changes are in accordance with the recommendations of the... Housing Service proposes two changes to its Single Family Housing Guaranteed Loan Program (SFHGLP...-quarter of 1 percent. The first proposed rule change would eliminate the lender's published VA rate for...

  17. Short-term heat load forecasting for single family houses

    DEFF Research Database (Denmark)

    Bacher, Peder; Madsen, Henrik; Nielsen, Henrik Aalborg

    2013-01-01

    This paper presents a method for forecasting the load for space heating in a single-family house. The forecasting model is built using data from sixteen houses located in Sønderborg, Denmark, combined with local climate measurements and weather forecasts. Every hour the hourly heat load for each...... and uncertainty of the weather forecasts for longer horizons, especially for solar radiation....

  18. Development of an air heating system for single Family housing

    DEFF Research Database (Denmark)

    Afshari, Alireza; Gunner, Amalie; Nikolaisen, Christian Grønborg

    2017-01-01

    The initial objective of the project was to break with common thinking about Space heating and to document that air heating can be used as the sole source of heating in a single Family house. The basic idea is that the ventilation must be installed in any case and it may equally well form the heat...

  19. Person-Directed Care Planning in Nursing Homes: Resident, Family, and Staff Perspectives.

    Science.gov (United States)

    Scales, Kezia; Lepore, Michael; Anderson, Ruth A; McConnell, Eleanor S; Song, Yuting; Kang, Bada; Porter, Kristie; Thach, Trini; Corazzini, Kirsten N

    2017-09-01

    Empowering individuals to direct their own care is central to person-centered care and health care policy. However, there is limited knowledge of how "person-directed care planning" (PDCP) can be achieved in particular settings. This study identifies key structures and processes for operationalizing and implementing PDCP in nursing homes. Using participatory inquiry, we convened "stakeholder engagement sessions" with residents, families, nursing staff, and managers/administrators in two North Carolina nursing homes ( N = 24 sessions; N = 67 unique participants). Stakeholders discussed current care-planning processes and provided feedback on an emergent conceptual framework of PDCP. Three themes emerged through directed-content analysis: strategies included providing formal and informal opportunities to engage in care planning and ensuring effective follow-through; different roles were required among leadership, staff, residents, and families to accomplish PDCP; and limits on achieving PDCP included competing priorities and perceived regulatory and resource constraints. Results are discussed in terms of the specific competencies required for accomplishing PDCP.

  20. Clinical Pharmacists as Educators in Family Medicine Residency Programs: A CERA Study of Program Directors.

    Science.gov (United States)

    Jarrett, Jennie B; Lounsbery, Jody L; D'Amico, Frank; Dickerson, Lori M; Franko, John; Nagle, John; Seehusen, Dean A; Wilson, Stephen A

    2016-03-01

    The clinical pharmacist's role within family medicine residency programs (FMRPs) is well established. However, there is limited information regarding perceptions of program directors (PDs) about clinical pharmacy educators. The study objectives were (1) to estimate the prevalence of clinical pharmacists within FMRPs and (2) to determine barriers and motivations for incorporation of clinical pharmacists as educators. The Council of Academic Family Medicine Educational Research Alliance (CERA) distributed an electronic survey to PDs. Questions addressed formalized pharmacotherapy education, clinical pharmacists in educator roles, and barriers and benefits of clinical pharmacists in FMRPs. The overall response rate was 50% (224/451). Seventy-six percent (170/224) of the responding PDs reported that clinical pharmacists provide pharmacotherapy education in their FMRPs, and 57% (97/170) consider clinical pharmacists as faculty members. In programs with clinical pharmacists, 72% (83/116) of PDs reported having a systematic approach for teaching pharmacotherapy versus 22% (21/95) in programs without. In programs without clinical pharmacists, the top barrier to incorporation was limited ability to bill for clinical services 48% (43/89) versus 29% (32/112) in programs with clinical pharmacists. In both programs with and without clinical pharmacists, the top benefit of having clinical pharmacists was providing a collaborative approach to pharmacotherapy education for residents (35% and 36%, respectively). Less than half of FMRPs incorporate clinical pharmacists as faculty members. Despite providing collaborative approaches to pharmacotherapy education, their limited ability to bill for services is a major barrier.

  1. [Patient safety culture in family and community medicine residents in Aragon].

    Science.gov (United States)

    Rodríguez-Cogollo, R; Paredes-Alvarado, I R; Galicia-Flores, T; Barrasa-Villar, J I; Castán-Ruiz, S

    2014-01-01

    having an appropriate patient safety culture is the first recommendation to improve it. The aim of this article is to determine the safety culture in family medicine residents and then to identify improvement strategies. an online cross-sectional survey of residents in family medicine teaching units of Aragon using the translated, validated and adapted to Spanish, Medical Office Survey on Patient Safety Culture (MOSPS) questionnaire. The results were grouped in 12-dimensional responses for analysis, and the mean value of each dimension was calculated. Perceptions were described by Percentages of Positive (PRP) and Negative Responses (PRN) to each dimension. positive results were seen in «the Patient Care Tracking/Follow-up». There were significant differences in the «Information Exchange With Other Settings», «Staff Training» and «Overall Perceptions of Patient Safety and Quality». Study participants viewed «Work Pressure and Pace» negatively. the institutions providing health services, as well as their staff, are increasingly aware of the importance of improving Patient Safety, and the results of this study allowed us to present information that helps identify weaknesses, and to design initiatives and strategies to improve care practices. Copyright © 2013 SECA. Published by Elsevier Espana. All rights reserved.

  2. Early Career Outcomes of Family Medicine Residency Graduates Exposed to Innovative Flexible Longitudinal Tracks.

    Science.gov (United States)

    Young, Richard A; Casey, Dan; Singer, Diana; Waller, Elaine; Carney, Patricia A

    2017-05-01

    The Preparing the Personal Physician for Practice (P4) project used a case series design to study innovations in the content, length, structure, and location of residency training in 14 geographically diverse family medicine programs between 2007 and 2012. We aimed to explore how offering flexible longitudinal tracks (FLT) affected graduates' scope of practice, particularly in maternal child health (MCH), which included at least 17 months of focused training that increased each year over 4 years. We administered a cross-sectional survey to graduates of P4 residencies approximately 18 months after they completed training (2011-2014) and compared graduates of the John Peter Smith (JPS) Family Medicine Residency MCH FLT to all other P4 graduates. The overall response rate was 81.8% (365/446). JPS graduates who completed the flexible MCH track (n=15) compared to all other P4 graduates (n=332) were more likely to deliver babies (13/15, 86.7% versus 48/324, 14.6%) and perform C-sections as the primary surgeon (12/15, 80.0% versus 15/322, 4.7%). Additional areas of expanded scope associated with the MCH track included endoscopy (4/15, 26.7% versus 10/323, 3.1%), the care of hospitalized adults and associated procedures (central lines, eg: 8/15, 53.3% versus 47/322, 14.6%), and the care of hospitalized children (13/15, 86.7% versus 111/323, 34.4%). Graduating from the JPS MCH FLT was associated with a higher provision of maternal, child, and ill adult patient care services, including associated procedures.

  3. Carbon isotopes in otolith amino acids identify residency of juvenile snapper (Family: Lutjanidae) in coastal nurseries

    Science.gov (United States)

    McMahon, K. W.; Berumen, M. L.; Mateo, I.; Elsdon, T. S.; Thorrold, S. R.

    2011-12-01

    This study explored the potential for otolith geochemistry in snapper (Family: Lutjanidae) to identify residency in juvenile nursery habitats with distinctive carbon isotope values. Conventional bulk otolith and muscle stable isotope analyses (SIA) and essential amino acid (AA) SIA were conducted on snapper collected from seagrass beds, mangroves, and coral reefs in the Red Sea, Caribbean Sea, and Pacific coast of Panama. While bulk stable isotope values in otoliths showed regional differences, they failed to distinguish nursery residence on local scales. Essential AA δ13C values in otoliths, on the other hand, varied as a function of habitat type and provided a better tracer of residence in different juvenile nursery habitats than conventional bulk otolith SIA alone. A strong linear relationship was found between paired otolith and muscle essential AA δ13C values regardless of species, geographic region, or habitat type, indicating that otolith AAs recorded the same dietary information as muscle AAs. Juvenile snapper in the Red Sea sheltered in mangroves but fed in seagrass beds, while snapper from the Caribbean Sea and Pacific coast of Panama showed greater reliance on mangrove-derived carbon. Furthermore, compound-specific SIA revealed that microbially recycled detrital carbon, not water-column-based new phytoplankton carbon, was the primary carbon source supporting snapper production on coastal reefs of the Red Sea. This study presented robust tracers of juvenile nursery residence that will be crucial for reconstructing ontogenetic migration patterns of fishes among coastal wetlands and coral reefs. This information is key to determining the importance of nursery habitats to coral reef fish populations and will provide valuable scientific support for the design of networked marine-protected areas.

  4. Carbon isotopes in otolith amino acids identify residency of juvenile snapper (Family: Lutjanidae) in coastal nurseries

    KAUST Repository

    McMahon, Kelton

    2011-08-26

    This study explored the potential for otolith geochemistry in snapper (Family: Lutjanidae) to identify residency in juvenile nursery habitats with distinctive carbon isotope values. Conventional bulk otolith and muscle stable isotope analyses (SIA) and essential amino acid (AA) SIA were conducted on snapper collected from seagrass beds, mangroves, and coral reefs in the Red Sea, Caribbean Sea, and Pacific coast of Panama. While bulk stable isotope values in otoliths showed regional differences, they failed to distinguish nursery residence on local scales. Essential AA δ13C values in otoliths, on the other hand, varied as a function of habitat type and provided a better tracer of residence in different juvenile nursery habitats than conventional bulk otolith SIA alone. A strong linear relationship was found between paired otolith and muscle essential AA δ13C values regardless of species, geographic region, or habitat type, indicating that otolith AAs recorded the same dietary information as muscle AAs. Juvenile snapper in the Red Sea sheltered in mangroves but fed in seagrass beds, while snapper from the Caribbean Sea and Pacific coast of Panama showed greater reliance on mangrove-derived carbon. Furthermore, compound-specific SIA revealed that microbially recycled detrital carbon, not water-column-based new phytoplankton carbon, was the primary carbon source supporting snapper production on coastal reefs of the Red Sea. This study presented robust tracers of juvenile nursery residence that will be crucial for reconstructing ontogenetic migration patterns of fishes among coastal wetlands and coral reefs. This information is key to determining the importance of nursery habitats to coral reef fish populations and will provide valuable scientific support for the design of networked marine-protected areas. © 2011 Springer-Verlag.

  5. A new paradigm for teaching behavior change: Implications for residency training in family medicine and psychiatry

    Directory of Open Access Journals (Sweden)

    Triana A

    2012-08-01

    Full Text Available Abstract Background Primary care physicians (PCPs provide ~50 % of all mental health services in the U.S. Given the widening gap between patient mental health needs and resources available to meet those needs, there is an increasing demand for family medicine and psychiatry trainees to master competencies in both behavioral medicine and primary care counseling during residency-if for no other reason than to accommodate the realities of medical practice given the oft present gap between the need for psychiatric services and the availability, quality, and/or affordability of specialized psychiatric care. To begin to address this gap, a skills-based, interactive curriculum based on motivational interviewing (MI as a teaching method is presented. Methods The curriculum described in this paper is a four-week block rotation taught in the second year of residency. Motivational interviewing (MI is used as a teaching approach toward the goal of clinical behavior change. Residents’ strengths, personal choice and autonomy are emphasized. Each week of the rotation, there is a clinical topic and a set of specific skills for mastery. Residents are offered a “menu” of skills, role modeling, role/real play, practice with standardized patients (SP, and direct supervision in clinic. Results Thirty-nine residents have completed the curriculum. Based on residents’ subjective reporting using pre-post scales (i.e., importance and confidence, all participants to date have reported substantial increases in confidence/self-efficacy using primary care counseling skills in their continuity clinic. Conclusions This paper presents an innovative, empirically based model for teaching the essential skills necessary for physicians providing care for patients with mental/emotional health needs as well as health-behavior change concerns. Implications for training in the broader context, particularly as it relates to multi-disciplinary and collaborative models of

  6. Experimental plan for the Single-Family Study

    Energy Technology Data Exchange (ETDEWEB)

    Berry, L.G.; Brown, M.A.; Wright, T.; White, D.L.

    1991-09-01

    The national evaluation of the Weatherization Assistance Program (WAP) consists of five separate studies. The Single-Family Study is one of three studies that will estimate program energy savings and cost effectiveness in principal WAP submarkets. This report presents the experimental plan for the Single-Family Study, which will be implemented over the next three years (1991--1993). The Single-Family Study will directly estimate energy savings for a nationally representative sample of single-family and small multifamily homes weatherized in the 1989 program year. Savings will be estimated from gas and electric utility billing records using the Princeton Scorekeeping Method (PRISM). The study will also assess nonenergy impacts (e.g., health, comfort, safety, and housing affordability), estimate cost effectiveness, and analyze factors influencing these outcomes. For homes using fuels such as wood, coal, fuel oil, kerosene, and propane as the primary source of space conditioning, energy savings will be studied indirectly. The study will assemble a large nationally representative data base. A cluster sampling approach will be used, in which about 400 subgrantees are selected in a first stage and weatherized homes are selected in a second range. To ensure that the Single-Family Study is able to identify promising opportunities for future program development, two purposively selected groups of subgrantees will be included: (1) subgrantees that install cooling measures (such as more efficient air conditioning equipment or radiant barriers), and (2) exemplary subgrantees that use state-of-the-art technologies and service delivery procedures (such as advanced audit techniques, blower door tests, infrared scanners, extensive client education, etc.). These two groups of subgrantees will be analyzed to identify the most effective program elements in specific circumstances. 14 refs., 4 figs., 3 tabs.

  7. 75 FR 9867 - Discontinuation of the Notice of Availability of Funding; Multi-Family Housing, Single Family...

    Science.gov (United States)

    2010-03-04

    ...; Multi- Family Housing, Single Family Housing AGENCY: Rural Housing Service, USDA. ACTION: Notice... notice of funds availability (NOFA) for some of its existing and continuing Multi-Family and Single-Family Housing programs for which it receives annual appropriations. For Fiscal Year 2010 and thereafter...

  8. Family medicine residents’ perceived level of comfort in treating common sports injuries across residency programs in the United States

    Science.gov (United States)

    Amoako, Adae O; Amoako, Agyenim B; Pujalte, George GA

    2015-01-01

    Background and objective Family physicians are expected to be comfortable in treating common sports injuries. Evidence shows a limited level of comfort in treating these injuries in pediatric and internal medicine residents. Studies are lacking, however, in family medicine residents. The purpose of this study is to assess the comfort level of family medicine residents in treating common sports injuries in adults and children based on their perceived level of knowledge and attitudes. Methods This is a cross-sectional study of family medicine residents in the United Sates. A written survey of 25 questions related to sports injury knowledge and factors affecting comfort level were collected. A chi-square test was implemented in calculating P-values. Results Five hundred and fifty-seven residents responded to the survey. A higher percentage of doctors of osteopathy (86.6%, 82.5%, 69.6%, and 68.7%) compared to doctors of medicine (78.5%, 71.6%, 53.4%, and 52.8%) respectively identified ankle sprain, concussion, plantar fasciitis, and lateral epicondylitis as common injuries, and felt comfortable in treating them (P-values =0.015, 0.004, 0.0001, and 0.0002, respectively). Residents with high interest in sports medicine correctly identified the injuries as common and felt comfortable treating them as well (knowledge, P=0.027, 0.0029, sports medicine contribute to residents’ knowledge and comfort level in treatment of common sports injuries. PMID:25848326

  9. Pharmacist-Physician Collaboration at a Family Medicine Residency Program: A Focus Group Study

    Directory of Open Access Journals (Sweden)

    Keri Hager

    2018-02-01

    Full Text Available Background: In response to transforming healthcare and pursuit of the Triple Aim, many health systems have added team members to expand the capabilities and effectiveness of the team to facilitate these aims. The objective of this study was to explore knowledge and perceptions of pharmacist-physician collaboration among family medicine residents (FMR, family medicine faculty (FMF, and pharmacist faculty and residents in a practice where clinical pharmacy services were relatively new. Understanding the nuances of pharmacist-physician interactions will provide insight into how to improve FMR education to prepare learners for patient-centered, team-based practice. Methods: An exploratory descriptive qualitative study design was used to articulate perceptions of professional roles and team-based care in an interprofessional family medicine community-based clinical practice. Five, 60-minute focus groups were conducted in a clinical training setting that focuses on preparing family medicine physicians for collaborative rural primary care practice. Results: Twenty-one FMRs, eight FMF, and six clinical pharmacists participated. Three themes emerged from the focus groups and were consistent across the groups: 1 roles of pharmacists recognized by physicians in different settings, 2 benefits to collaboration, and 3 keys to successful pharmacist-physician collaboration which include a developing the relationship, b optimizing communication, c creating beneficial clinical workflow, d clarifying roles and responsibilities, and e increasing opportunities for meaningful interactions. Conclusion: This study demonstrated that by co-locating physicians and pharmacists in the same environment, and providing a basic structure for collaboration, a collaborative working relationship can be initiated. Practices looking to have more effective collaborative working relationships should strive to increase the frequency of interactions of the professions, help the

  10. Energy Renovation of a Typical Danish Single-family House

    DEFF Research Database (Denmark)

    Tommerup, Henrik M.; Svendsen, Svend

    2007-01-01

    In 2006, new tighter energy performance requirements were introduced in Denmark for both new buildings and renovation, including a new classification system for low energy buildings. These demands are based on the directive on Energy Performance of Buildings, the EPBD (2002/91/EC). In general...... the effect of the new requirements for renovation is that existing buildings should be brought up to the energy performance level of new buildings in connection with larger renovations and other substantial changes in the buildings. To demonstrate how it could be done, a thorough energy efficient renovation...... of a typical Danish single-family house from the 1960/70’s with need of renovation has been initiated and the preliminary results are presented in this paper. It is worth noting that about 500,000 of a total of 1.1 million Danish detached single-family houses were erected in that time period. Specifically...

  11. Energy efficient demand controlled ventilation in single family houses

    DEFF Research Database (Denmark)

    Nielsen, Toke Rammer; Drivsholm, Christian

    2010-01-01

    in the Danish building regulations and the low flow rate is based on minimum requirements in indoor air quality standards. Measurements were performed on an existing single family house where the controls were installed on the existing mechanical ventilation system. The results showed that the ventilation can......This paper presents a strategy for a simple demand controlled ventilation system for single family houses where all sensors and controls are located in the air handling unit. The strategy is based on sensing CO2-concentration and moisture content in the outdoor air and exhaust air. The CO2......-concentration is used to ensure adequate ventilation during occupancy and the moisture content is used to ensure adequate removal of moisture produced in the house. The ventilation rate can be switched between two flow rates: a high rate and a low rate. The high flow rate is based on existing requirements...

  12. Family Medicine Residents' Performance with Detected Versus Undetected Simulated Patients Posing as Problem Drinkers

    Directory of Open Access Journals (Sweden)

    Mark B. Sobell, PhD

    2004-01-01

    Full Text Available Background: Simulated patients are commonly used to evaluate medical trainees. Unannounced simulated patients provide an accurate measure of physician performance. Purpose: To determine the effects of detection of SPs on physician performance, and identify factors leading to detection. Methods: Fixty-six family medicine residents were each visited by two unannounced simulated patients presenting with alcohol-induced hypertension or insomnia. Residents were then surveyed on their detection of SPs. Results: SPs were detected on 45 out of 104 visits. Inner city clinics had higher detection rates than middle class clinics. Residents’ checklist and global rating scores were substantially higher on detected than undetected visits, for both between-subject and within-subject comparisons. The most common reasons for detection concerned SP demographics and behaviour; the SP “did not act like a drinker” and was of a different social class than the typical clinic patient. Conclusions: Multi-clinic studies involving residents experienced with SPs should ensure that the SP role and behavior conform to physician expectations and the demographics of the clinic. SP station testing does not accurately reflect physicians’ actual clinical behavior and should not be relied on as the primary method of evaluation. The study also suggests that physicians’ poor performance in identifying and managing alcohol problems is not entirely due to lack of skill, as they demonstrated greater clinical skills when they became aware that they were being evaluated. Physicians’ clinical priorities, sense of responsibility and other attitudinal determinants of their behavior should be addressed when training physicians on the management of alcohol problems.

  13. Development of a diabetes care management curriculum in a family practice residency program.

    Science.gov (United States)

    Nuovo, Jim; Balsbaugh, Thomas; Barton, Sue; Davidson, Ellen; Fox-Garcia, Jane; Gandolfo, Angela; Levich, Bridget; Seibles, Joann

    2004-01-01

    Improving the quality of care for patients with chronic illness has become a high priority. Implementing training programs in disease management (DM) so the next generation of physicians can manage chronic illness more effectively is challenging. Residency training programs have no specific mandate to implement DM training. Additional barriers at the training facility include: 1) lack of a population-based perspective for service delivery; 2) weak support for self-management of illness; 3) incomplete implementation due to physician resistance or inertia; and 4) few incentives to change practices and behaviors. In order to overcome these barriers, training programs must take the initiative to implement DM training that addresses each of these issues. We report the implementation of a chronic illness management curriculum based on the Improving Chronic Illness Care (ICIC) Model. Features of this process included both patient care and learner objectives. These were: development of a multidisciplinary diabetes DM team; development of a patient registry; development of diabetes teaching clinics in the family practice center (nutrition, general management classes, and one-on-one teaching); development of a group visit model; and training the residents in the elements of the ICIC Model, ie, the community, the health system, self-management support, delivery system design, decision support, and clinical information systems. Barriers to implementing these curricular changes were: the development of a patient registry; buy-in from faculty, residents, clinic leadership, staff, and patients for the chronic care model; the ability to bill for services and maintain clinical productivity; and support from the health system key stakeholders for sustainability. Unique features of each training site will dictate differences in emphasis and structure; however, the core principles of the ICIC Model in enhancing self-management may be generalized to all sites.

  14. Utility of self-competency ratings during residency training in family medicine education-emerging countries: findings from Japan.

    Science.gov (United States)

    Fetters, Michael D; Motohara, Satoko; Ivey, Lauren; Narumoto, Keiichiro; Sano, Kiyoshi; Terada, Masahiko; Tsuda, Tsukasa; Inoue, Machiko

    2017-01-01

    Family medicine education-emerging countries face challenges in demonstrating a new program's ability to train residents in womb-to-tomb care and resident ability to provide such care competently. We illustrate the experience of a new Japanese family medicine program with resident self-competency assessments. In this longitudinal cross-sectional study, residents completed self-competency assessment surveys online during 2011-2015. Each year of training, residents self-ranked their competence using a 100-point visual analog scale for 142 conditions: acute (30 conditions), chronic (28 conditions) women's health (eight conditions), and geriatrics/home (12 conditions) care; procedures (38 types); health promotion (21 conditions). Twenty residents (11 women, 9 men) participated. Scores improved annually by training year from baseline to graduation; the mean composite score advanced from 31 to 65%. All subcategories showed improvement. Scores for care involving acute conditions rose from 49 to 75% (26% increase); emergency procedures, 46-65% (19% increase); chronic care, 33-73% (40% increase); women's health, 16-59% (43% increase); procedural care, 26-56% (30% increase); geriatrics care-procedures, 8-65% (57% increase); health promotion, 21-63% (42% increase). Acute care, chronic care, and health promotion achieved the highest levels. Women's health care, screenings, and geriatrics experienced the greatest increase. Health promotion gains occurred most dramatically in the final residency year. A resident self-competency assessment provides a simple and practical way to conduct an assessment of skills, to monitor skills over time, to use the data to inform residency program improvement, and to demonstrate the breadth of family medicine training to policymakers, and other stakeholders.

  15. Win/win: creating collaborative training opportunities for behavioral health providers within family medicine residency programs.

    Science.gov (United States)

    Ruddy, Nancy Breen; Borresen, Dorothy; Myerholtz, Linda

    2013-01-01

    Integrating behavioral health into primary healthcare offers multiple advantages for patients and health professionals. This model requires a new skill set for all healthcare professionals that is not emphasized in current educational models. The new skills include interprofessional team-based care competencies and expanded patient care competencies. Health professionals must learn new ways to efficiently and effectively address health behavior change, and manage behavioral health issues such as depression and anxiety. Learning environments that co-train mental health and primary care professionals facilitate acquisition of both teamwork and patient care competencies for mental health and primary care professional trainees. Family Medicine Residency programs provide an excellent opportunity for co-training. This article serves as a "how to" guide for residency programs interested in developing a co-training program. Necessary steps to establish and maintain a program are reviewed, as well as goals and objectives for a co-training curriculum and strategies to overcome barriers and challenges in co-training models.

  16. Patient safety principles in family medicine residency accreditation standards and curriculum objectives

    Science.gov (United States)

    Kassam, Aliya; Sharma, Nishan; Harvie, Margot; O’Beirne, Maeve; Topps, Maureen

    2016-01-01

    Abstract Objective To conduct a thematic analysis of the College of Family Physicians of Canada’s (CFPC’s) Red Book accreditation standards and the Triple C Competency-based Curriculum objectives with respect to patient safety principles. Design Thematic content analysis of the CFPC’s Red Book accreditation standards and the Triple C curriculum. Setting Canada. Main outcome measures Coding frequency of the patient safety principles (ie, patient engagement; respectful, transparent relationships; complex systems; a just and trusting culture; responsibility and accountability for actions; and continuous learning and improvement) found in the analyzed CFPC documents. Results Within the analyzed CFPC documents, the most commonly found patient safety principle was patient engagement (n = 51 coding references); the least commonly found patient safety principles were a just and trusting culture (n = 5 coding references) and complex systems (n = 5 coding references). Other patient safety principles that were uncommon included responsibility and accountability for actions (n = 7 coding references) and continuous learning and improvement (n = 12 coding references). Conclusion Explicit inclusion of patient safety content such as the use of patient safety principles is needed for residency training programs across Canada to ensure the full spectrum of care is addressed, from community-based care to acute hospital-based care. This will ensure a patient safety culture can be cultivated from residency and sustained into primary care practice. PMID:27965349

  17. Tobin's q for Danish single-family houses

    DEFF Research Database (Denmark)

    Haagerup, Christian Deichmann

    of land. This can be used as a guide as to how much prices are to fall, in order to bring them back to the fundamental value. It can also be seen as a warning or indication of a price bubble. This paper presents a calculation of the value of Tobin's q for single-family houses in Denmark from 1968 to 2008......The rising price of single-family houses in Denmark and it's relation to the activity in the construction sector has given renewed interest in the theory of Tobin's q. Prices for single-family houses in Denmark have risen by 153 percent from 1993 to 2007 in real terms, with a particular steep rise...... from 2003 to 2006. The activity in the construction sector has been increasing too, but with some time lag caused by what seems to be an inelastic supply. In the long run, house prices will be determined by the replacement cost of houses, e.g. the cost of constructing a similar house including the cost...

  18. Learning to See Beneath the Surface: A Qualitative Analysis of Family Medicine Residents' Reflections About Communication.

    Science.gov (United States)

    Duggan, Ashley P; Vicini, Andrea; Allen, Lucas; Shaughnessy, Allen F

    2015-01-01

    Patients share straightforward statements with physicians such as describing their fears about their diagnosis. Physicians need to also understanding implicit, indirect, subtle communication cues that give broader context to patients' illness experiences. This project examines physicians' written reflections that offer insight into their interpretation of both the stated and the tacit aspects of their observations about communication, their resulting responses, and their intended actions. Tufts University Family Medicine residents (N = 33) of the Tufts Family Medicine Cambridge Health Alliance completed three reflective exercises each week over the course of 1 year (756 reflective entries). An interdisciplinary research team identified communication-related concepts within the reflections. Identified themes include (a) physicians recognizing and discovering mutual interplay of their communication with and patient disclosure, (b) physicians paying attention to subtleties of patient behavior as indicative of a fuller picture of patients' lives and their coping with illness, and (c) physician images of growth and awareness about communication indicative of their potential for growth and improvement. The project extends the literature in communication and medical education by examining explicit and tacit points of reflection about communication. The project (a) allows for unpacking the multifaceted aspects of reflection and (b) bridges reflective theory and medical education with communication foundations.

  19. Training Family Medicine Residents in Effective Communication Skills While Utilizing Promotoras as Standardized Patients in OSCEs: A Health Literacy Curriculum.

    Science.gov (United States)

    Pagels, Patti; Kindratt, Tiffany; Arnold, Danielle; Brandt, Jeffrey; Woodfin, Grant; Gimpel, Nora

    2015-01-01

    Introduction. Future health care providers need to be trained in the knowledge and skills to effectively communicate with their patients with limited health literacy. The purpose of this study is to develop and evaluate a curriculum designed to increase residents' health literacy knowledge, improve communication skills, and work with an interpreter. Materials and Methods. Family Medicine residents (N = 25) participated in a health literacy training which included didactic lectures and an objective structured clinical examination (OSCE). Community promotoras acted as standardized patients and evaluated the residents' ability to measure their patients' health literacy, communicate effectively using the teach-back and Ask Me 3 methods, and appropriately use an interpreter. Pre- and postknowledge, attitudes, and postdidactic feedback were obtained. We compared OSCE scores from the group that received training (didactic group) and previous graduates. Residents reported the skills they used in practice three months later. Results. Family Medicine residents showed an increase in health literacy knowledge (p = 0.001) and scored in the adequately to expertly performed range in the OSCE. Residents reported using the teach-back method (77.8%) and a translator more effectively (77.8%) three months later. Conclusions. Our innovative health literacy OSCE can be replicated for medical learners at all levels of training.

  20. Impact of family and gender on career goals: results of a national survey of 4586 surgery residents.

    Science.gov (United States)

    Viola, Kate V; Bucholz, Emily; Yeo, Heather; Piper, Crystal L; Piper, Crystal; Bell, Richard H; Sosa, Julie Ann

    2010-05-01

    To determine how marriage, children, and gender influence US categorical general surgery residents' perceptions of their profession and motivations for specialty training. Cross-sectional national survey administered after the January 2008 American Board of Surgery In-service Training Examination. Two hundred forty-eight US general surgery residency programs. All US categorical general surgery residents. We evaluated demographic characteristics with respect to survey responses using the chi(2) test, analysis of variance, and multivariate logistic regression. Interaction terms between variables were assessed. Perceptions of respondents regarding the future of general surgery and the role of specialty training in relation to anticipated income and lifestyle. The survey response rate was 75.0% (4586 respondents). Mean age was 30.6 years; 31.7% were women, 51.3% were married, and 25.4% had children. Of the respondents, 28.7% believed general surgery is becoming obsolete (30.1% of men and 25.9% of women; P = .004), and 55.1% believed specialty training is necessary for success (56.4% of men and 52.7% of women; P = .02). Single residents and residents without children were more likely to plan for fellowship (59.1% single vs 51.9% married, P single or had no children tended to identify lifestyle rather than income as a motivator for specialty training. Marital status, children, and gender appear to have a powerful effect on general surgery residents' career planning.

  1. [What, how, and how much should a Family and Community Medicine resident do to become a good specialist?

    Science.gov (United States)

    Rodríguez Rodríguez, M; Aparcero Gallardo, M; Amodeo Arahal, M C; Romero Solís, P

    2017-10-23

    To determine the ideal volume of activity to be carried out by residents in Family and Community Medicine in order to acquire the competencies of their professional activity. The consensus opinion of a group of experts in the training of residents in Family and Community Medicine was collected from 152 tutors using an online Delphi-type questionnaire. The overall medians obtained in the different activities that should be developed by residents of Family and Community Medicine were: individual diagnostic/therapeutic interventions: retinography 60, spirometry 40, anticoagulation 45, cryo/electrocoagulation 35, infiltrations 45, tele-dermatology 60, and others 45; women's health: pregnancy 45, gynaecological ultrasound/IUD 41, cytology 32.5, family planning 19.5, and maternal education 17; lifestyle and care interventions: geriatrics 30, nursing 45, individual tobacco advice 30, group advice 15, health problems 15, and dietary advice 15; community intervention: sessions with youth 15, and social risk 15; training: sessions 40, continuing education 40. This information has defined the activity volumes that should be developed by the residents in order to acquire an adequate level of competence in the areas of individual diagnostic and therapeutic interventions, women's health, interventions to change lifestyles, community intervention, and clinical and training sessions. The consensus obtained could serve as a basis for the creation of a road map in the training of residents as a complementary tool to the Resident's Book, which is obligatory in all specialties. Copyright © 2017 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

  2. Development and evaluation of brochures for fall prevention education created to empower nursing home residents and family members.

    Science.gov (United States)

    Schoberer, Daniela; Eglseer, Doris; Halfens, Ruud J G; Lohrmann, Christa

    2018-01-25

    In this study, we describe the development of evidence- and theory-based fall prevention educational material and its evaluation from the users' perspectives. To reduce risk factors for falling in nursing homes, nursing staff must enact multifactorial fall prevention intervention programmes. A core component of these programmes is to educate residents and their family members, both verbally and in a written form. However, users can only benefit from educational material if it is based on current scientific evidence, easy to understand and process and customised. We followed a structured procedure during the development process, while considering various aspect of quality. To assess the understandability and usefulness of the resulting educational materials, we conducted a qualitative content analysis study. The educational materials development process incorporated several iterative steps including a systematic literature search and the application of frameworks for designing and writing the materials. To evaluate the material, we performed six focus group discussions separately with residents, family members and nursing staff from two nursing homes (total of 32 participants). Residents' brochures included clear information on avoiding external risks as well as coping strategies after a fall event. Family members' brochures were more comprehensive, including both concrete tips and outlining the advantages and disadvantages of interventions. Residents and family members had no difficulties understanding the material and tried to apply the content to their individual situations. Nursing staff commented on some ambiguities and incongruities relating to current nursing care practice. By involving users in the development of evidence-based educational materials, nursing staff can achieve a high acceptance rate for the materials and motivate users to address the topic. The involvement of users is essential for developing educational material that meets users' needs

  3. Associations Between Family Ratings on Experience With Care and Clinical Quality-of-Care Measures for Nursing Home Residents.

    Science.gov (United States)

    Li, Yue; Li, Qinghua; Tang, Yi

    2016-02-01

    Several states are currently collecting and publicly reporting nursing home resident and/or family member ratings of experience with care in an attempt to improve person-centered care in nursing homes. Using the 2008 Maryland nursing home family survey reports and other data, this study performed both facility- and resident-level analyses, and estimated the relationships between family ratings of care and several long-term care quality measures (pressure ulcers, overall and potentially avoidable hospitalizations, and mortality) after adjustment for resident characteristics. We found that better family evaluations of overall and specific aspects of care may be associated with reduced rates of risk-adjusted measures at the facility level (range of correlation coefficients: -.01 to -.31). Associations of overall experience ratings tended to persist after further adjustment for common nursing home characteristics such as nurse staffing levels. We conclude that family ratings of nursing home care complement other types of performance measures such as risk-adjusted outcomes. © The Author(s) 2015.

  4. A Structural Approach to Unresolved Mourning in Single Parent Family Systems.

    Science.gov (United States)

    Fulmer, Richard H.

    1983-01-01

    Considers the mother's depression as a special problem in therapy of single-parent families, resulting from unresolved mourning maintained by the family system. Offers reasons why the single-parent family's structure seems inherently vulnerable to unresolved mourning. Suggests techniques of Structural Family Therapy to facilitate mourning in such…

  5. Family medicine residents’ perceived level of comfort in treating common sports injuries across residency programs in the United States

    Directory of Open Access Journals (Sweden)

    Amoako AO

    2015-03-01

    Full Text Available Adae O Amoako,1 Agyenim B Amoako,2 George GA Pujalte3 1Department of Family and Community Medicine, Penn State Hershey Medical Center, Hershey, PA, USA; 2Department of Family Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA; 3Sports Medicine, Divisions of Primary Care, and Orthopedics, Mayo Clinic Health System, Waycross, GA, USA Background and objective: Family physicians are expected to be comfortable in treating common sports injuries. Evidence shows a limited level of comfort in treating these injuries in pediatric and internal medicine residents. Studies are lacking, however, in family medicine residents. The purpose of this study is to assess the comfort level of family medicine residents in treating common sports injuries in adults and children based on their perceived level of knowledge and attitudes. Methods: This is a cross-sectional study of family medicine residents in the United Sates. A written survey of 25 questions related to sports injury knowledge and factors affecting comfort level were collected. A chi-square test was implemented in calculating P-values. Results: Five hundred and fifty-seven residents responded to the survey. A higher percentage of doctors of osteopathy (86.6%, 82.5%, 69.6%, and 68.7% compared to doctors of medicine (78.5%, 71.6%, 53.4%, and 52.8% respectively identified ankle sprain, concussion, plantar fasciitis, and lateral epicondylitis as common injuries, and felt comfortable in treating them (P-values =0.015, 0.004, 0.0001, and 0.0002, respectively. Residents with high interest in sports medicine correctly identified the injuries as common and felt comfortable treating them as well (knowledge, P=0.027, 0.0029, <0.0001, and 0.0001, respectively; comfort level, P=0.0016, <0.0001, 0.0897, and 0.0010, respectively. Conclusion: Medical education background, factors that affect training, and an interest in sports medicine contribute to residents' knowledge and comfort

  6. Online short-term heat load forecasting for single family houses

    DEFF Research Database (Denmark)

    Bacher, Peder; Madsen, Henrik; Nielsen, Henrik Aalborg

    2013-01-01

    This paper presents a method for forecasting the load for heating in a single-family house. Both space and hot tap water heating are forecasted. The forecasting model is built using data from sixteen houses in Sønderborg, Denmark, combined with local climate measurements and weather forecasts...... variations in the heat load signal (predominant only for some houses), peaks presumably from showers, shifts in resident behavior, and uncertainty of the weather forecasts for longer horizons, especially for the solar radiation........ Every hour the hourly heat load for each house the following two days is forecasted. The forecast models are adaptive linear time-series models and the climate inputs used are: ambient temperature, global radiation, and wind speed. A computationally efficient recursive least squares scheme is used...

  7. [Small-scale, homelike care environments for people with dementia: effects on residents, family caregivers and nursing staff].

    Science.gov (United States)

    Verbeek, H; Zwakhalen, S M G; van Rossum, E; Kempen, G I J M; Hamers, J P H

    2013-12-01

    Institutional dementia care is increasingly directed towards small-scale and homelike care environments, in The Netherlands as well as abroad. In these facilities, a small number of residents, usually six to eight, live together, and normal daily household activities and social participation are emphasized. In a quasi-experimental study, we studied the effects of small-scale, homelike care environments on residents (n = 259), family caregivers (n = 206) and nursing staff (n = 305). We compared two types of institutional nursing care during a 1 year period (baseline assessment and follow-up measurements at 6 and 12 months): (28) small-scale, homelike care environments and (21) psychogeriatric wards in traditional nursing homes. A matching procedure was applied to increase comparability of residents at baseline regarding functional status and cognition. This study was unable to demonstrate convincing overall effects of small-scale, homelike care facilities. On our primary outcome measures, such as quality of life and behaviour of residents and job satisfaction and motivation of nursing staff, no differences were found with traditional nursing homes. We conclude that small-scale, homelike care environments are not necessarily a better care environment than regular nursing homes and other types of living arrangements should be considered carefully. This provides opportunities for residents and their family caregivers to make a choice which care facility suits their wishes and beliefs best.

  8. Developing the Family Involvement Questionnaire-Long-Term Care: A Measure of Familial Involvement in the Lives of Residents at Long-Term Care Facilities.

    Science.gov (United States)

    Fast, Christopher T; Houlihan, Daniel; Buchanan, Jeffrey A

    2018-01-03

    Existing measures designed to assess family involvement in the lives of older adults residing in long-term care facilities are basic, using visitation frequency as the prominent gauge of involvement in a situation specific fashion. The purpose of this study was to design and validate a measure of family involvement that could be used to gauge more aspects of family involvement than visitation alone and be useful in a variety of settings for both researchers and long-term care facility administrators. Long-term facility staff were asked to assist in creating a 40-item questionnaire that used 4-point Likert scales to measure various aspects of family involvement. The finalized Family Involvement Questionnaire-Long-Term Care (FIQ-LTC) was distributed to the family members of older adults residing in long-term care facilities around the country. A total of 410 participants responded. Researchers found that the FIQ-LTC was highly reliable (α = .965). Results also indicated that a significant correlation between distance and overall involvement (r = -.121, p = .015) was no longer significant (r = .17, p = .740) when the effect of a question asking the frequency of visitation was controlled for. These results indicate that existing measures that use visitation frequency as the sole measure of involvement are insufficient. The newly developed FIQ-LTC can serve as a more complete measure of family involvement.

  9. Perceived Importance of Pursuing Osteopathic Recognition in the Single Accreditation System: A Survey of Medical Students, Residents, and Faculty.

    Science.gov (United States)

    Hortos, Kari; Corser, William; Church, Brandy; Rohrer, Jonathan; Waarala, Kirsten

    2017-10-01

    As graduate medical education evolves under the single accreditation system, osteopathic residency programs and consortia strive for sustainable ways to achieve and support the Osteopathic Recognition (OR) designation. To determine whether differences existed in perceived importance of OR from 3 cohorts of osteopathic stakeholders: students, residents, and faculty. A nonexperimental quantitative cross-sectional online survey was administered during February and March 2016 to osteopathic medical students at Michigan State University College of Osteopathic Medicine and residents and faculty from the affiliated Statewide Campus System. After examining final working dataset patterns, a series of Kruskal-Wallis tests were conducted to identify statistically significant differences in perceived OR importance response categories across sample subgroups, including program specialty and primary vs non-primary care specialty. The final analytic sample comprised 278 osteopathic medical students, 359 residents, and 94 faculty members. Of 728 respondents, 497 (67.9%) indicated that OR was "somewhat important," "important," or "very important." The overall perceived importance category patterns varied significantly across students, residents, and faculty cohort respondents (, Posteopathic stakeholder groups, but significant differences may exist between different types of students, residents, and faculty. Pre- and postgraduate educational support structures designed to reduce barriers to OR implementation may help to sustain osteopathic principles and practice in the single accreditation system.

  10. Residents' and preceptors' perceptions of the use of the iPad for clinical teaching in a family medicine residency program.

    Science.gov (United States)

    Archibald, Douglas; Macdonald, Colla J; Plante, Judith; Hogue, Rebecca J; Fiallos, Javier

    2014-08-20

    As Family Medicine programs across Canada are transitioning into a competency-based curriculum, medical students and clinical teachers are increasingly incorporating tablet computers in their work and educational activities. The purpose of this pilot study was to identify how preceptors and residents use tablet computers to implement and adopt a new family medicine curriculum and to evaluate how they access applications (apps) through their tablet in an effort to support and enhance effective teaching and learning. Residents and preceptors (n = 25) from the Family Medicine program working at the Pembroke Regional Hospital in Ontario, Canada, were given iPads and training on how to use the device in clinical teaching and learning activities and how to access the online curriculum. Data regarding the use and perceived contribution of the iPads were collected through surveys and focus groups. This mixed methods research used analysis of survey responses to support the selection of questions for focus groups. Reported results were categorized into: curriculum and assessment; ease of use; portability; apps and resources; and perceptions about the use of the iPad in teaching/learning setting. Most participants agreed on the importance of accessing curriculum resources through the iPad but recognized that these required enhancements to facilitate use. The iPad was considered to be more useful for activities involving output of information than for input. Participants' responses regarding the ease of use of mobile technology were heterogeneous due to the diversity of computer proficiency across users. Residents had a slightly more favorable opinion regarding the iPad's contribution to teaching/learning compared to preceptors. iPad's interface should be fully enhanced to allow easy access to online curriculum and its built-in resources. The differences in computer proficiency level among users should be reduced by sharing knowledge through workshops led by more skillful i

  11. Intent to Build Hepatitis C Treatment Capacity Within Family Medicine Residencies: A Nationwide Survey of Program Directors: A CERA Study.

    Science.gov (United States)

    Camminati, Camille Webb; Simha, Aditya; Kolb, N Randall; Prasad, Ramakrishna

    2016-09-01

    In the current interferon-free era, family medicine is in a unique position to deliver hepatitis C (HCV) treatment with adequate training. Little is known about attitudes of family medicine program directors (PDs) toward capacity building within their residency programs. We report the results of a nationwide survey of family medicine PDs to examine these attitudes. This study was part of a CERA (Council of Academic Family Medicine Educational Research Alliance) omnibus survey administered to family medicine PDs between February 2015 and March 2015. Attitudes were assessed using a Likert scale ranging from 1=strongly disagree to 6=strongly agree. We surveyed 452 physicians, with 273 responses (response rate 61%). The majority of PDs (78%) believed that chronic HCV represented a significant problem for primary care, and 61.9% believed their program should take steps to build capacity in HCV treatment. There was no effect of regional HCV prevalence, residency program context, or PD characteristics on intent to build capacity. This is the first report to examine PDs intent to build capacity in HCV treatment in this interferon-free, direct antiviral era. Our findings highlight a historic opportunity to train family physicians and position them on the frontline as HCV treatment providers.

  12. Single-parent family forms and children's educational performance in a comparative perspective: Effects of school's share of single-parent families

    NARCIS (Netherlands)

    Lange, M. de; Dronkers, J.A.; Wolbers, M.H.J.

    2014-01-01

    Living in a single-parent family is negatively related with children's educational performance compared to living with 2 biological parents. In this article, we aim to find out to what extent the context of the school's share of single-parent families affects this negative relationship. We use

  13. Single-Parent Family Forms and Children's Educational Performance in a Comparative Perspective: Effects of School's Share of Single-Parent Families

    Science.gov (United States)

    de Lange, Marloes; Dronkers, Jaap; Wolbers, Maarten H. J.

    2014-01-01

    Living in a single-parent family is negatively related with children's educational performance compared to living with 2 biological parents. In this article, we aim to find out to what extent the context of the school's share of single-parent families affects this negative relationship. We use pooled data from the Organisation for Economic…

  14. Sustainable renovation concepts for single-family houses

    DEFF Research Database (Denmark)

    Vanhoutteghem, Lies; Tommerup, Henrik M.; Svendsen, Svend

    in order to reach the low primary energy level of new houses. The typical single-family houses identified to have large primary energy saving potential almost descend from the same time period in each Nordic country. The first segment is houses built in large numbers in the 1960 and 1970 before tightening...... is type houses from the post-war period in Finland. A complete energy efficient renovation of a typical house include post-insulation and sealing of the buildings envelope - roof/ceiling, façade, windows/doors and foundation and maybe slab on ground - installation of a mechanical ventilation system...... an economy in balance in the sense that the annual payment on a cheap loan, e.g. mortgage refinancing, to finance the investment is not fully offset by the expected annual energy savings. Since, the cost of energy measures today may not correspond to the increased market value of the house, it is important...

  15. Investigations of Intelligent Solar Heating Systems for Single Family House

    DEFF Research Database (Denmark)

    Andersen, Elsa; Chen, Ziqian; Fan, Jianhua

    2014-01-01

    Three differently designed intelligent solar heating systems are investigated experimentally in a test facility. The systems provide all the needed yearly heating demand in single family houses. The systems are based on highly stratified tanks with variable auxiliary heated volumes. The tank...... is a tank in tank heat storage with domestic hot water in the inner tank and space heating water in the outer tank. The total tank volume is 750 liters and the solar collector area is 9 m2. The auxiliary energy supply system is based on electrical heating element(s)/heat pump and is different for all three...... systems.The system will be equipped with an intelligent control system where the control of the electrical heating element(s)/heat pump is based on forecasts of the variable electricity price, the heating demand and the solar energy production.By means of numerical models of the systems made in Trnsys...

  16. Analysis of energy consumption in single family houses

    DEFF Research Database (Denmark)

    Nielsen, Henrik Aalborg; Mortensen, Stig Bousgaard; Bacher, Peder

    2010-01-01

    This article deals with estimation of the thermal characteristics of single family houses based on measurements of energy consumption and climate. The thermal characteristics includes the response of the building to changes in temperature (UA-value), solar radiation (gA-value), and wind (w...... to estimate the dynamic effects averages with a sample period around 4 hours are required. Also, it is beneficial to use measurements of the total energy consumption (heat and electricity). However, in most cases it results in adequate estimates if only the heat consumption is used as the response variable...... even for houses where a wood burning stove is being used. The article includes a short outline of how the methods could be integrated in an inter- active service such as “My E-Home” minbolig.elsparefonden.dk....

  17. Energy Renovation of Danish Single-Family Houses

    DEFF Research Database (Denmark)

    Mortensen, Andrea

    2015-01-01

    The PhD project is based on requirements from the European Union to reduce the energy consumption and on current renovation needs of and a huge energy saving potential in the Danish single-family houses from the 1960’s and 1970’s. The project focuses on the barriers for energy renovations....... Not one is overpowering, but numerous barriers have to be broken down simultaneously to achieve the desired effect. A questionnaire survey with nearly 900 responding homeowners examines the homeowners’ interest and willingness in performing energy renovations and their potential motivation factors....... The results show that despite the barriers the owners can in fact be motivated to perform private energy renovations. A sound project economy is all-important for this to happen and it should if possible be supported by improvements in both comfort, indoor environment and architecture to increase...

  18. Energy renovation of an old single-family house

    DEFF Research Database (Denmark)

    Overgaard, L.L.; Tommerup, Henrik M.; Svendsen, Svend

    2005-01-01

    After having identified a large potential for profitable energy renovation of the existing building stock, a demonstration project was carried out in practice. This paper deals with the methods and results from the demonstration project concerning a 161 m² poorly insulated single-family house bui......). If a conservative way of financing the building work of 157,000 DKK is assumed, the first year’s cost equals DKK 8,500 and the house owner will gain a net saving the first year of DKK 7,500....... cost of DKK 157,000. The project has shown that the energy renovation has reduced the gross energy consumption with around 50% from 53,400 to 28,100 kWh per year. This corresponds to a reduction of around 2,500 litre of fuel oil per year or 16,000 DKK per year (assuming a conservative energy price...

  19. Clinical Management of ADHD in a Family Medicine Residency Program: Comparison with AAP Guidelines.

    Science.gov (United States)

    Skelley, Jessica W; Carpenter, P Chase; Morehead, M Shawn; Murphy, Patrick L

    2016-06-01

    Attention-deficit/hyperactivity disorder (ADHD) is the most common neurobehavioral disorder. Research has shown that even with the growing incidence of children diagnosed as having ADHD, physicians may find providing optimal care to these patients challenging. Our objective was to contrast existing clinical management of ADHD in a family medicine setting with published American Academy of Pediatrics guidelines and review the literature pertinent to differences. A report was generated for all visits with "ADHD" or "ADD" (attention-deficit disorder) as a current or past medical problem that had been addressed at the family medicine clinic from July 2012 to June 2014. A total of 60 pediatric patients were identified. A retrospective chart review of clinical practice and management patterns for these patients was completed using a standardized data collection form based on the 2011 ADHD treatment guidelines set by the American Academy of Pediatrics. Fifty-seven (95%) patients had documentation of at least one core symptom of ADHD, and 27 (45%) patients had documentation of these symptoms in more than one setting (clinic/school/home). Only 30 (50%) patients were assessed at the initial ADHD visit for coexisting conditions. Coexisting conditions were found to be present in 20 (33.3%) patients. Of these 20 patients, coexisting conditions were not addressed during the visit in 12 (60%) patients before drug therapy for ADHD was initially prescribed. Behavioral therapy was initiated as first-line monotherapy in one of the nine preschool-age patients (4-5 years old). Fifty-two (86.7%) patients received a preferred initial medication as identified by guidelines, and 41 (78.8%) of those patients received an appropriate initial dose. Fifty-one (85%) patients were assessed for improvement of symptoms, and 39 (65%) were assessed for adverse events. Of 62 documented medication adjustments, 54 (87.1%) adjustments coincided with current practice guidelines. Sixteen (26.7%) patients

  20. Training Family Medicine Residents in Effective Communication Skills While Utilizing Promotoras as Standardized Patients in OSCEs: A Health Literacy Curriculum

    Directory of Open Access Journals (Sweden)

    Patti Pagels

    2015-01-01

    Full Text Available Introduction. Future health care providers need to be trained in the knowledge and skills to effectively communicate with their patients with limited health literacy. The purpose of this study is to develop and evaluate a curriculum designed to increase residents’ health literacy knowledge, improve communication skills, and work with an interpreter. Materials and Methods. Family Medicine residents N=25 participated in a health literacy training which included didactic lectures and an objective structured clinical examination (OSCE. Community promotoras acted as standardized patients and evaluated the residents’ ability to measure their patients’ health literacy, communicate effectively using the teach-back and Ask Me 3 methods, and appropriately use an interpreter. Pre- and postknowledge, attitudes, and postdidactic feedback were obtained. We compared OSCE scores from the group that received training (didactic group and previous graduates. Residents reported the skills they used in practice three months later. Results. Family Medicine residents showed an increase in health literacy knowledge p=0.001 and scored in the adequately to expertly performed range in the OSCE. Residents reported using the teach-back method (77.8% and a translator more effectively (77.8% three months later. Conclusions. Our innovative health literacy OSCE can be replicated for medical learners at all levels of training.

  1. Single Mothers, Social Capital, and Work--Family Conflict

    Science.gov (United States)

    Ciabattari, Teresa

    2007-01-01

    The purpose of this article is to examine work-family conflict among low-income, unmarried mothers. Analyzing the Fragile Families and Child Wellbeing Study, a national sample of nonmarital births, I examine how social capital affects work-family conflict and how both social capital and work-family conflict affect employment. Results show that…

  2. Methodological Caveats in the Assessment of Single-Parent Families of Handicapped Children.

    Science.gov (United States)

    Bristol, Marie M.

    1987-01-01

    Critical assumptions affecting the design of research and intervention for single-parent, mother-headed families of handicapped children involve: extent of father involvement; contribution to child-rearing of persons other than parents; socioeconomic differences between one-parent and two-parent families; heterogeneity of single-parent families;…

  3. Satisfaction with civilian family medicine residency training: Perspectives from serving general duty medical officers in the Canadian Armed Forces.

    Science.gov (United States)

    Wolfrom, Brent; Hodgetts, Geoff; Kotecha, Jyoti; Pollock, Emily; Martin, Mary; Han, Han; Morissette, Pierre

    2016-09-01

    To evaluate satisfaction with civilian residency training programs among serving general duty medical officers within the Canadian Armed Forces. A 23-item, cross-sectional survey face-validated by the office of the Surgeon General of the Canadian Armed Forces. Canada. General duty medical officers serving in the Canadian Armed Forces as of February 2014 identified through the Directorate of Health Services Personnel of the Canadian Forces Health Services Group Headquarters. Satisfaction with and time spent in 7 domains of training: trauma, critical care, emergency medicine, psychiatry, occupational health, sports medicine, and base clinic training. Overall preparedness for leading a health care team, caring for a military population, working in isolated and challenging environments, and being deployed were evaluated on a 5-point Likert scale. Among the survey respondents (n = 135, response rate 54%), 77% agreed or strongly agreed that their family medicine residency training was relevant to their role as a general duty medical officer. Most respondents were either satisfied or very satisfied with their emergency medicine training (77%) and psychiatry training (63%), while fewer were satisfied or very satisfied with their sports medicine (47%), base clinic (41%), and critical care (43%) training. Even fewer respondents were satisfied or very satisfied with their trauma (26%) and occupational health (12%) training. Regarding overall preparedness, 57% believed that they were adequately prepared to care for a military patient population, and 52% of respondents believed they were prepared for their first posting. Fewer respondents (38%) believed they were prepared to work in isolated, austere, or challenging environments, and even fewer (32%) believed that residency training prepared them to lead a health care team. General duty medical officers were satisfied with many aspects of their family medicine residency training; however, military-specific areas for improvement

  4. Parent-Child Relationships in Nondivorced, Divorced Single-Mother, and Remarried Families.

    Science.gov (United States)

    Hagan, Margaret Stanley; And Others

    1992-01-01

    Over time, mother-child relationships in families with remarried mothers grew increasingly similar to those in families whose parents had never divorced. Relationships in single-mother families remained different from those in the other two types of families. Stepfathers were less likely to be authoritative than were nondivorced fathers. (BC)

  5. Toward competency-based curricula in patient-centered spiritual care: recommended competencies for family medicine resident education.

    Science.gov (United States)

    Anandarajah, Gowri; Craigie, Frederic; Hatch, Robert; Kliewer, Stephen; Marchand, Lucille; King, Dana; Hobbs, Richard; Daaleman, Timothy P

    2010-12-01

    Spiritual care is increasingly recognized as an important component of medical care. Although many primary care residency programs incorporate spiritual care into their curricula, there are currently no consensus guidelines regarding core competencies necessary for primary care training. In 2006, the Society of Teachers of Family Medicine's Interest Group on Spirituality undertook a three-year initiative to address this need. The project leader assembled a diverse panel of eight educators with dual expertise in (1) spirituality and health and (2) family medicine. The multidisciplinary panel members represented different geographic regions and diverse faith traditions and were nationally recognized senior faculty. They underwent three rounds of a modified Delphi technique to achieve initial consensus regarding spiritual care competencies (SCCs) tailored for family medicine residency training, followed by an iterative process of external validation, feedback, and consensus modifications of the SCCs. Panel members identified six knowledge, nine skills, and four attitude core SCCs for use in training and linked these to competencies of the Accreditation Council for Graduate Medical Education. They identified three global competencies for use in promotion and graduation criteria. Defining core competencies in spiritual care clarifies training goals and provides the basis for robust curricula evaluation. Given the breadth of family medicine, these competencies may be adaptable to other primary care fields, to medical and surgical specialties, and to medical student education. Effective training in this area may enhance physicians' ability to attend to the physical, mental, and spiritual needs of patients and better maintain sustainable healing relationships.

  6. Irradiation-induced Deinococcus radiodurans genome fragmentation triggers transposition of a single resident insertion sequence.

    Directory of Open Access Journals (Sweden)

    Cécile Pasternak

    2010-01-01

    Full Text Available Stress-induced transposition is an attractive notion since it is potentially important in creating diversity to facilitate adaptation of the host to severe environmental conditions. One common major stress is radiation-induced DNA damage. Deinococcus radiodurans has an exceptional ability to withstand the lethal effects of DNA-damaging agents (ionizing radiation, UV light, and desiccation. High radiation levels result in genome fragmentation and reassembly in a process which generates significant amounts of single-stranded DNA. This capacity of D. radiodurans to withstand irradiation raises important questions concerning its response to radiation-induced mutagenic lesions. A recent study analyzed the mutational profile in the thyA gene following irradiation. The majority of thyA mutants resulted from transposition of one particular Insertion Sequence (IS, ISDra2, of the many different ISs in the D. radiodurans genome. ISDra2 is a member of a newly recognised class of ISs, the IS200/IS605 family of insertion sequences.

  7. Faculty and resident perspectives on ambulatory care education: A collective case study of family medicine, psychiatry, and surgery

    Science.gov (United States)

    Veinot, Paula; Lin, William; Woods, Nicole; Ng, Stella

    2017-01-01

    Background Ambulatory care (AC) experiences within medical education are garnering increasing attention. We sought to understand how faculty and residents’ describe their experiences of AC and ambulatory care education (ACEduc) within, between, and across disciplinary contexts. Methods We designed a Stakian collective case study, applying constructivist grounded theory analytic methods. Using purposive and snowball sampling, we interviewed 17 faculty and residents across three instrumental cases: family medicine, psychiatry, surgery. Through constant comparative analysis, we identified patterns within, between, and across cases. Results Family medicine and psychiatry saw AC as an inherent part of continuous, longitudinal care; surgery equated AC with episodic experiences in clinic, differentiating it from operating. Across cases, faculty and residents cautiously valued ACEduc, and in particular, considered it important to develop non-medical expert competencies (e.g., communication). However, surgery residents described AC and ACEduc as less interesting and a lower priority than operating. Educational structures mediated these views. Conclusion Differences between cases highlight a need for further study, as universal assumptions about ACEduc’s purposes and approaches may need to be tempered by situated, contextually-rich perspectives. How disciplinary culture, program structure, and systemic structure influence ACEduc warrant further consideration as does the educational potential for explicitly framing learners’ perspectives. PMID:29098047

  8. White Coat Ceremony as a Professional Identity Formation Activity in a United States Family Medicine Residency Program

    Directory of Open Access Journals (Sweden)

    Jacob Lee Bidwell

    2016-01-01

    Full Text Available Introduction White coat ceremonies (WCCs in medical school mark the transition of students to medicine, beginning their professional identity formation as a physician. However, a literature/web search revealed a paucity of residency-focused WCCs. Methods A 90-minute Family Medicine Residency (FM WCC was designed to support residents’ professional identity formation as a specialty physician. Through faculty narratives and brief histories of the white coat and the specialty, the WCC concludes with new residents donning their specialty embroidered white coats. A brief e-survey was sent to attendees, and WCC leaders were debriefed to determine the value and key elements of WCC. Results Seventy-nine percent of survey respondents (34/43 agreed that the WCC is an important transition event for residents’ identity while reaffirming FM values for faculty/staff. WCC leaders identified critical steps for initiating a WCC. Conclusion A resident WCC formally marks the transition to specialty physician identity. Lessons Learned Ceremony structure will evolve over time.

  9. Exploring the role of classroom-based learning in professional identity formation of family practice residents using the experiences, trajectories, and reifications framework.

    Science.gov (United States)

    Chen, Luke Y C; Hubinette, Maria M

    2017-08-01

    Classroom-based learning such as academic half day has undervalued social aspects. We sought to explore its role in the professional identity development of family medicine residents. In this case study, residents and faculty from four training sites in the University of British Columbia Department of Family Practice were interviewed. The "experiences, trajectories, and reifications (ETR) framework" was used as a sensitizing tool for modified inductive (thematic) analysis of the transcripts. Classroom-based learning provided a different context for residents' interpretation of their clinical experiences, characterized as a "home base" for rotating urban residents, and a connection to a larger academic community for residents in rural training sites. Both these aspects were important in creating a positive trajectory of professional identity formation. Teaching directed at the learning needs of family physicians, and participation of family practice faculty as teachers and role models was a precipitation of a curriculum "centered in family medicine." Interactions between family medicine residents and faculty in the classroom facilitated the necessary engagements to reify a shared understanding of the discipline of family practice. Classroom-based learning has substantial impact on professional identity formation at an individual and collective level.

  10. "Now I Don't Have to Guess": Using Pamphlets to Encourage Residents and Families/Friends to Engage in Advance Care Planning in Long-Term Care.

    Science.gov (United States)

    Sussman, Tamara; Kaasalainen, Sharon; Bui, Matthew; Akhtar-Danesh, Noori; Mintzberg, Susan; Strachan, Patricia

    2017-01-01

    Objective: This article explores whether access to illness trajectory pamphlets for five conditions with high prevalence in long-term care (LTC) can encourage residents and families/friends to openly engage in advance care planning (ACP) discussions with one another and with health providers. Method: In all, 57 residents and families/friends in LTC completed surveys and 56 participated in seven focus groups that explored whether the pamphlets supported ACP engagement. Results: Survey results suggested that access to pamphlets encouraged residents and families/friends to reflect on future care (48/57, 84%), clarified what questions to ask (40/57, 70%), and increased comfort in talking about end of life (EOL) care (36/57, 63%). Discussions between relatives and friends/families (32/57, 56%) or with health providers (21/57, 37%) were less common. Focus group deliberations illuminated that while reading illness-specific information was validating, a tendency to protect one another from an emotional topic, prevented residents and families/friends from conversing with one another about EOL issues. Discussion: Having access to pamphlets with information about EOL care provides important and welcome opportunities for reflection for both residents in LTC and their families/friends. Moving residents and families/friends from reflecting on issues to discussing them together could require staff support through planned care conferences or staff initiated conversations at the bedside.

  11. Microvascular Decompression for Familial Hemifacial Spasm : Single Institute Experience

    Science.gov (United States)

    Park, Jae-Han; Jo, Kyung-Il; Lee, Hyun-Seok; Lee, Jung-A

    2013-01-01

    Objective The purpose of this study was to evaluate the characteristics and surgical outcomes of familial hemifacial spasm (HFS) and to discuss the role of genetic susceptibility. Methods Between 2001 and 2011, 20 familial HFS patients with ten different pedigrees visited our hospital. The data from comprehensive evaluation of these patients, including clinical, radiological and electrophysiological data and surgical outcomes were reviewed to characterize familial HFS and to compare the characteristics between familial HFS and sporadic HFS. Results According to the family tree, the inheritance pattern was difficult to define clearly using these data. Radiologic findings suggested that the vertebral artery (VA) was a more frequent offender in familial HFS than in sporadic cases (35.0% vs. 10.0%, pspasm. Other features of familial HFS overlap with sporadic cases. These findings suggest that certain genetic susceptibilities rather than hypertension or diabetes may influence vascular tortuosity and HFS development. Conclusion In this study, familial HFS seems not so different from sporadic cases. Authors thought familial HFS could have heterogeneous etiology. Further study of familial HFS including clinical, anatomic, genetic, and molecular information may help identify a gene or trait that can provide insight into the mechanisms of sporadic and familial HFS. PMID:23440303

  12. Modification Effects of Family Economic Status and School Factors on Depression Risk of Single-Father Family Children in Mid-Taiwan Area

    Science.gov (United States)

    Lin, Jin-Ding; Hsieh, Yu-Hsin; Lin, Fu-Gong

    2013-01-01

    The incidence of single-parent families has increased significantly in Taiwan in recent years. Children born in single-parent families are predisposed to suffering from emotional problems. We aimed to determine if the children of single-parent families are more depressive than children from both-parent families, and to examine the individual and…

  13. Family caregiver perspectives on social relations of elderly residents with dementia in small-scale versus traditional long-term care settings in the Netherlands and Belgium.

    Science.gov (United States)

    de Rooij, Alida H P M; Luijkx, Katrien G; Spruytte, Nele; Emmerink, Peggy M J; Schols, Jos M G A; Declercq, Anja G

    2012-11-01

    To provide insight into family caregiver perspectives on social relations within the 'caregiving triangle' between family caregiver, professional caregiver and elderly resident with dementia. Results were compared between traditional versus small-scale long-term care settings in the Netherlands and Belgium. Residential dementia care is shifting towards a more holistic and person-centred approach. Until now, little is known about family caregiver perspectives. A quasi-experimental longitudinal design. This study was part of a larger research project focusing on the quality of life of residents with dementia in traditional and small-scale settings (n = 179). This study focused on family caregivers related to these residents (n = 64). They filled in a questionnaire containing 25 items (baseline and after 12 months) related to their perspectives on the interaction within the 'caregiving triangle'. Analyses were performed using mixed models and logistic regression. Compared to traditional settings, family caregivers of relatives with dementia living in small-scale settings had more contact with the professional caregivers, were more satisfied with this contact and felt that staff paid more attention to their feelings as family members. They also reported that staff showed better listening skills towards the residents. Furthermore, compared to those in Belgium, family caregivers in the Netherlands perceived staff to be less hurried and more accepting of help from family and felt that staff more often takes the resident seriously. In the move towards more person-centred care for residents with dementia, this study finds preliminary evidence for the importance of integrating the family perspective. Gaining more insight into the perspectives of family caregivers on the social relations within the 'caregiving triangle' may provide knowledge about the importance of the social system surrounding elderly residents with dementia and can provide pointers for future research.

  14. They are still the same - family members' stories about their relatives with dementia disorders as residents in a nursing home.

    Science.gov (United States)

    Cronfalk, Berit Seiger; Norberg, Astrid; Ternestedt, Britt-Marie

    2017-05-02

    In order to better understand the context of suffering from dementia disorders, greater efforts should be made to understand and identify what persons with such disorders experience when living in a nursing home. The aim of this qualitative study was to gain further understanding of how persons with dementia disorders experienced and coped with their changed life situation after being relocated to a nursing home as described by their family members' perceptions. Qualitative data were collected from ten interviews with family members and evaluated using content analysis. The main findings suggest that residents with dementia disorders largely maintained their personality intact throughout the trajectory of illness as they were able to keep their habits and interests. The local environment of the nursing home and the residents' relationships to staff were important in order to feel accepted. Four categories were discerned during the analysis: living in limbo; coming to peace; keeping old habits and relationships; and thoughts about impending death. It is reasonable to believe that old habits and interests may be preserved as the embodiment of such habits are deeply rooted and connected to a person's identity even when going through various changes and transitions in life. Therefore, to be accepted as the person you are requires care and services to specific needs, i.e. person-centeredness. Lack of understanding from staff may therefore have an adverse effect on a person's self-respect and identity. For that reason, staff needs to reflect on their attitudes and relationships as well as extending their knowledge about how to address sensitive topics such as the residents' impending death. To achieve this support from managers is pivotal. Future research should focus on support to nursing staff to further knowledge and understanding about the individual changes resident go through near the end of life. © 2017 Nordic College of Caring Science.

  15. Intern evaluation strategies in family medicine residency education: what is-and is not-being done.

    Science.gov (United States)

    Yates, Jennifer E

    2013-06-01

    Family medicine interns often have deficiencies that are not initially appreciated. By recognizing those growth opportunities early, programs may be able to better meet their interns' training needs. This study provides a needs assessment to ascertain what evaluation tools are being utilized by residency programs to assess their incoming interns. A questionnaire was sent to all US family medicine residency program coordinators (439 programs) via Survey Monkey© inquiring about whether intern evaluation is performed and, if so, what strategies are used. A mixed mode methodology was used: mailing with incentive, email prompts, and telephone calls. Of 439 programs, 220 (50%) responded to the survey. Most respondents (145, 66%) think intern evaluation is needed. However, only 79 (36%) programs are actually doing intern evaluations-only 14 (6.4%) extensively. Most programs are performing simulations (81, 45%) and assessing knowledge/comfort levels (79, 36%); less than one third are considering personality/learning styles, and almost no programs are evaluating skills such as typing (three, 1.4%) and math (one, 0.5%). Many programs use evaluations to guide future planning, help with early identification of challenging learners, and to match training to the residents' needs. Several programs expressed concern about how they would use the information once obtained. The majority of respondents agreed that a baseline intern evaluation is useful; few are actually doing it. This area is not well-described in the literature; residency programs could benefit from information sharing. The next step is to encourage interest in and implementation of such strategies.

  16. Developing Strategies to Improve Advance Care Planning in Long Term Care Homes: Giving Voice to Residents and Their Family Members

    Directory of Open Access Journals (Sweden)

    Kimberly Ramsbottom

    2014-01-01

    Full Text Available Long term care (LTC homes, also known as residential care homes, commonly care for residents until death, making palliative care and advance care planning (ACP important elements of care. However, limited research exists on ACP in LTC. In particular, research giving voice to family members and substitute decision makers is lacking. The objective of this research was to understand experiences, perspectives, and preferences to guide quality improvement of ACP in LTC. This qualitative descriptive study conducted 34 individual semistructured interviews in two LTC homes, located in Canada. The participants were 31 family members and three staff, consisting of a front line care worker, a registered nurse, and a nurse practitioner. All participants perceived ACP conversations as valuable to provide “resident-centred care”; however, none of the participants had a good understanding of ACP, limiting its effectiveness. Strategies generated through the research to improve ACP were as follows: educating families and staff on ACP and end-of-life care options; better preparing staff for ACP conversations; providing staff skills training and guidelines; and LTC staff initiating systematic, proactive conversations using careful timing. These strategies can guide quality improvement of palliative care and development of ACP tools and resources specific to the LTC home sector.

  17. Content and conceptual frameworks of psychology and social work preceptor feedback related to the educational requests of family medicine residents.

    Science.gov (United States)

    Côté, Luc; Rocque, Rhéa; Audétat, Marie-Claude

    2017-06-01

    Supervision of communication competency in clinical settings in medicine is an important component of professional training. The purpose of this study was to describe the content and rationale of psychology and social work preceptor feedback to family medicine residents who express educational needs during case-based written vignettes. We conducted a qualitative study with 25 psychology and social work preceptors from family medicine departments of the three French-speaking universities in the province of Quebec, Canada. During an individual interview, preceptors were asked to respond to three short case-based written vignettes depicting resident educational issues regarding communication and to explain their responses. Authors analyzed the content of responses and the conceptual frameworks reported. The three vignettes elicited 475 responses, including 58 distinct responses and 33 distinct conceptual frameworks. Therapeutic alliance and stages of grief were the two most reported conceptual frameworks. The vignettes stimulated a wealth of responses and conceptual frameworks among psychology and social work preceptors in family medicine. The complete list of responses could be useful for faculty development activities by stimulating preceptors' reflexive practice with regard to their responses, the educational goals of these responses and the conceptual frameworks underlying their feedback. Copyright © 2017 Elsevier B.V. All rights reserved.

  18. The impact of child hospitalization on the everyday lives of single parent families

    Directory of Open Access Journals (Sweden)

    Pamela Camila Fernandes Rumor

    2013-12-01

    Full Text Available This qualitative descriptive study was performed at a pediatric hospitalization unit with the objective to understand the impact of child hospitalization on the daily lives of single parent families. Interviews were conducted with twelve families, represented by the mothers, using a form divided into two parts: construction of the genogram and ecomap and semi-structured questions. Content analysis was used. The results point out that the major factors affecting the everyday lives of single parent families is the dependency on the family support network and the difficulty that both healthcare professionals and institutions have in developing an individualized look at the different family structures when providing their needs. In conclusion, there is a need for thinking and reviewing institutional practices and norms aiming at meeting the true particularities and needs of the everyday lives of today’s families. Descriptors: Single-Parent Family; Child, Hospitalized; Family Nursing.

  19. Developing a Cancer Survivorship Curriculum for Family Medicine Residents: A Needs Assessment

    Science.gov (United States)

    Schubart, Jane R.; Gusani, Niraj J.; Kass, Rena; Lewis, Peter

    2013-01-01

    With the increasing survival of cancer patients, primary care residents must be familiar with the late effects of cancer treatment and be able to offer appropriate survivorship care in partnership with cancer care specialists. To address these paired public health and educational needs, an interdisciplinary group at our institution is developing,…

  20. Adolescent Career Development in Urban-Residing Aboriginal Families in Canada

    Science.gov (United States)

    Marshall, Sheila K.; Young, Richard A.; Stevens, Alison; Spence, Wayne; Deyell, Stewart; Easterbrook, Adam; Brokenleg, Martin

    2011-01-01

    The purpose of this study was to understand how urban-residing Aboriginal adolescent-parent dyads (n = 11) jointly constructed and acted on goals and strategies with their social supports (n = 17) to facilitate the adolescents' career development. A modified protocol following the qualitative action-project method was used. A discrete joint…

  1. A Comparison of Single Freshmen Resident and Commuter Students Perceptions of the Junior College Environment.

    Science.gov (United States)

    Markee, David J.

    The environmental perceptions of 144 randomly selected freshman students at a southwestern junior college were measured using the College and University Environment Scales (CUES). The sample was equally divided between male and female students, and among three groups: city commuters, rural commuters, and campus residents. Differences between group…

  2. The surgical learning and instructional portfolio: what residents at a single institution are learning.

    Science.gov (United States)

    Webb, Travis P; Merkley, Taylor R

    2011-03-01

    The Accreditation Council for Graduate Medical Education (ACGME) Learning Portfolio is recommended as a tool to develop and document reflective, practice-based learning and improvement. There is no consensus regarding the appropriate content of a learning portfolio in medical education. Studying lessons selected for inclusion in their learning portfolios by surgical trainees could help identify useful subject matter for this purpose. Each month, all residents in our surgery residency program submit entries into their individual Surgical Learning and Instructional Portfolio (SLIP). The SLIP entries from July 2008 to 2009 (n = 420) were deidentified and randomized using a random number generator. We conducted a thematic content analysis of 50 random portfolio entries to identify lessons learned. Two independent raters analyzed the "3 lessons learned" portion of the portfolio entries and identified themes and subthemes using the constant comparative method used in grounded theory. The collaborative coding process resulted in theme saturation after the identification of 7 themes and their subthemes. Themes in decreasing order of frequency included complications, disease epidemiology, disease presentation, surgical management of disease, medical management of disease, operative techniques, and pathophysiology. Junior residents chose to focus on a broad array of foundational topics including disease presentation, epidemiology, and overall management of diseases, whereas postgraduate year-4 (PGY-4) and PGY-5 residents most frequently chose to focus on complications as learning points. Lessons learned reflect perceived needs of the trainees based on training year. When given a template to follow, junior and senior residents choose to reflect on different subject matter to meet their learning goals.

  3. Smart Growth and the Challenge of Nimby: Multifamily Dwellings and their Association with Single-Family House Selling Prices in Tallahasse, Florida, USA

    Directory of Open Access Journals (Sweden)

    Huston GIBSON

    2013-06-01

    Full Text Available Citizens protest development when they consider it undesirable. One type of development commonly perceived as undesirable by single-family home owners is proximate multifamily housing, often considered a cause of property devaluation. This study assesses multifamily housing, by typology, and its monetary association with proximate single-family housing prices. The research design is a cross-sectional study using multivariate regression. The unit of analysis is the detached single-family dwelling. The study population is a sample taken from all arms-length owner-occupied, primary residence, detached single-family property transactions recorded in Tallahassee-Leon County, Florida, USA, during 2008. The key findings show no statistically significant negative associations between multifamily housing and single-family property selling prices in the sample; in fact, the two were positively correlated. These findings address single-family homeowner concerns about proximate multifamily housing and should bolster the political feasibility of Smart Growth policy, which recommends denser urban infill.

  4. 76 FR 53851 - Federal Housing Administration (FHA): Suspension of Section 238(c) Single-Family Mortgage...

    Science.gov (United States)

    2011-08-30

    ... construction, repair, rehabilitation, or purchase of property located near any installation of the Armed Forces... Section 238(c) Single-Family Mortgage Insurance in Military Impacted Areas AGENCY: Office of the Assistant... National Housing Act (Act). This single-family mortgage insurance program, established by regulation in...

  5. 77 FR 9177 - Federal Housing Administration (FHA): Suspension of Section 238(c) Single-Family Mortgage...

    Science.gov (United States)

    2012-02-16

    ..., rehabilitation, or purchase of property located near any installation of the Armed Forces of the United States in... Section 238(c) Single-Family Mortgage Insurance in Military Impacted Areas AGENCY: Office of the Assistant... under section 238(c) of the National Housing Act. This single-family mortgage insurance program...

  6. 78 FR 75215 - Qualified Mortgage Definition for HUD Insured and Guaranteed Single Family Mortgages

    Science.gov (United States)

    2013-12-11

    ... CFR Parts 201, 203, 1005, and 1007 RIN 2502-AJ18 Qualified Mortgage Definition for HUD Insured and Guaranteed Single Family Mortgages AGENCY: Office of Secretary, HUD. ACTION: Final rule. SUMMARY: Through this final rule, HUD establishes a definition of ``qualified mortgage'' for the single family...

  7. The Effect of the Single-Parent Family on Academic Achievement. A Review of Related Literature.

    Science.gov (United States)

    Dawson, Patrice

    This is a literature review on the effect of the single-parent family on the academic achievement of children from such households. It is argued that, historically, society has discriminated against children from single-parent families, especially those of divorced parents. Research is cited which shows that: (1) children from one-parent…

  8. Growing Up with Single Parents and Stepparents: Long-Term Effects on Family Solidarity.

    Science.gov (United States)

    White, Lynn

    1994-01-01

    Used data on 3,625 respondents from National Survey of Families and Households to examine long-term consequences of childhood family structure for adult relationships with parents and siblings. Found that divorced single-parent families were associated with reduced solidarity between parents and children. Custodial mothers' remarriages were…

  9. Stress, coping, and adjustment in mothers and young adolescents in single- and two-parent families.

    Science.gov (United States)

    Compas, B E; Williams, R A

    1990-08-01

    Compared stress, coping, and psychological adjustment in single (divorced or separated) and married mothers and their young adolescent children. Single mothers reported more daily hassles related to economic, family, and personal health problems, and more symptoms of depression, anxiety, and psychoticism. Single mothers also reported using more coping strategies related to accepting responsibility and positive reappraisal. After controlling for level of family income, differences in family hassles and coping strategies remained significant. The two groups did not differ on subtypes of symptoms after controlling for income, but single mothers still reported more total psychological symptoms. No differences were found between children in these two family constellations on maternal reports of emotional/behavioral problems or on children's self-reported emotional/behavioral problems, stressful events, or coping. Implications of these findings for adjustment to life in single-parent families are discussed.

  10. Results of chart reviews conducted to evaluate primary care patients seen by second and third year family medicine residents for potential adverse polypharmacy

    Directory of Open Access Journals (Sweden)

    Chang LF

    2007-06-01

    Full Text Available Objective: To determine the prescribing patterns of family medicine residents for patients aged more than 60 years with 2 or more chronic diseases and seen at least twice in a 12 month timeframe.Methods: This is a descriptive analysis which was based on chart reviews. The setting was the University of Illinois-Rockford Family Practice Residency. Patients aged 60 years with 2 or more chronic diseases who were seen at least twice by second and third year residents.Results: Findings from this chart review include: 28.8% of the prescribed medications were not effective for the documented condition, 26.3% of the prescribed doses were incorrect, and 44.5% of the drugs prescribed were not the least expensive alternative.Discussion: This preliminary study suggests a need for a focused intervention with family medicine residents regarding inappropriate polypharmacy issues with older patients.

  11. A Comparison of Surgery and Family Medicine Residents' Perceptions of Cross-Cultural Care Training of Cross-Cultural Care Training

    Science.gov (United States)

    Jackson, David S; Lin, Susan Y; Park, Elyse R

    2010-01-01

    The need for physicians formally trained to deliver care to diverse patient populations has been widely advocated. Utilizing a validated tool, Weissman and Betancourt's Cross-Cultural Care Survey, the aim of this current study was to compare surgery and family medicine residents' perceptions of their preparedness and skillfulness to provide high quality cross-cultural care. Past research has documented differences between the two groups' reported impressions of importance and level of instruction received in cross-cultural care. Twenty surgery and 15 family medicine residents participated in the study. Significant differences were found between surgery and family medicine residents on most ratings of the amount of training they received in cross-cultural skills. Specifically, family medicine residents reported having received more training on: 1) determining how patients want to be addressed, 2) taking a social history, 3) assessing their understanding of the cause of illness, 4) negotiating their treatment plan, 5) assessing whether they are mistrustful of the health care system and/or doctor, 6) identifying cultural customs, 7) identifying how patients make decisions within the family, and 8) delivering services through a medical interpreter. One unexpected finding was that surgery residents, who reported not receiving much formal cultural training, reported higher mean scores on perceived skillfulness (i.e. ability) than family medicine residents. The disconnect may be linked to the family medicine residents' training in cultural humility — more knowledge and understanding of cross-cultural care can paradoxically lead to perceptions of being less prepared or skillful in this area. PMID:21225585

  12. Conservation of architectural paintings at Xiaonan Garden, former residence of Weng family in Changshu

    Directory of Open Access Journals (Sweden)

    Weijun He

    2016-03-01

    Full Text Available Xiaonan Garden is the back garden at the Weng family’s former residence, a famed mansion in Jiangnan. Various architectural colored paintings in the Jiangnan style, including a rare paster colored painting, are preserved in the garden. This study examines the wooden support, pigments, and structure of the painting and conducts a series of conservation experiments in situ and in the laboratory. Several conservation problems, such as the manually brushed lime, re-adherence of flaking painting layers, and consolidation of gold foil, were solved, and good results were obtained. Virtual recovery provided a solid foundation for protection and example of research on architectural colored paintings in Jiangnan.

  13. Perspectives and expectations for telemedicine opportunities from families of nursing home residents and caregivers in nursing homes.

    Science.gov (United States)

    Chang, Jun-Yih; Chen, Liang-Kung; Chang, Chia-Ching

    2009-07-01

    This study assessed current perspectives and expectations for telemedicine by nursing home caregivers and families of nursing home patients in Taipei, Taiwan. A total of 116 interviews were conducted with family members (n=37) and caregivers (n=79) using an original, four-part questionnaire devised to assess the expectations and concerns related to prospective telemedicine opportunities, including consumer attitude, knowledge of and interest in medicine, concerns and worries about telemedicine, and anticipated benefits of telemedicine. Statistical significance between the two groups was observed in sex, age, and educational level (all ppatients, notifications of health abnormalities, teleconferencing between physicians and family members, obtaining test/exam results and face-to-face consultation through telenetworks. Both groups hoped for information and education through telemedicine. More caregivers were concerned about increased costs (p=0.020), poor hardware quality (psecurity, confidentiality, and reliability (p=0.036), inconvenience to patients (p=0.006), associated moral and ethical issues (p=0.006), and uncertainty about responsibility (p=0.022). The two groups did not differ in expectations concerning benefits of telemedicine. More than 60% of family members or caregivers expected improved efficiency and quality of hospital and nursing home health care, greater rapport between nursing homes and either staff or patients, reduced overall medical costs of caregiving, and reduced staff/caregiver working hours. The acceptable cost was anything up to $15.30 USD per month. Nursing home caregivers and families of nursing home patients are highly interested in telemedicine; however, they are only willing to pay a slightly higher cost of nursing care for this service. The challenge for the future in this industry is to balance peoples' demands and telemedicine's associated costs. Results of this study suggest that caregivers and families of nursing home residents

  14. The Influence of Grandparents in Single-Mother Families

    Science.gov (United States)

    Dunifon, Rachel; Kowaleski-Jones, Lori

    2007-01-01

    This article examines whether children living with single mothers benefit when they also live with a grandparent, using data from the 1979 to 2002 waves of the National Longitudinal Survey of Youth merged mother-child file (N = 6,501). Results indicate that for White children, living with a single mother and a grandparent is associated with…

  15. African American Single Mothers Raising Sons: Implications for Family Therapy

    Science.gov (United States)

    Gantt, Ann L.; Greif, Geoffrey L.

    2009-01-01

    Being raised by a single mother is one factor that has been suggested as contributing to the plight of African American males. Yet few studies have focused specifically on African American single mothers' experiences with raising sons. This qualitative study explored the following questions: (1) What are the experiences of African American single…

  16. Perspectives about Family Meals from Single-Headed and Dual-Headed Households: A Qualitative Analysis

    Science.gov (United States)

    Berge, Jerica M.; Hoppmann, Caroline; Hanson, Carrie; Neumark-Sztainer, Dianne

    2013-01-01

    Cross-sectional and longitudinal research has shown that family meals are protective for adolescent healthful eating behaviors. However, little is known about what parents think of these findings and whether parents from single- versus dual-headed households have differing perspectives about the findings. Additionally, parents’ perspectives regarding barriers to applying the findings on family meals in their own homes and suggestions for more wide-spread adoption of the findings are unknown. The current study aimed to identify single- and dual-headed household parents’ perspectives regarding the research findings on family meals, barriers to applying the findings in their own homes and suggestions for helping families have more family meals. The current qualitative study included 59 parents who participated in sub-study of two linked multi-level studies—EAT 2010 (Eating and Activity in Teens) and Families and Eating and Activity in Teens (F-EAT). Parents (91.5% female) were racially/ethnically and socio-economically diverse. Data were analyzed using a grounded theory approach. Results from the current study suggest that parents from both single- and dual-headed households have similar perspectives regarding why family meals are protective for healthful eating habits for adolescents (e.g., provides structure/routine, opportunities for communication, connection), but provide similar and different reasons for barriers to family meals (e.g., single-headed=cost vs. dual-headed=lack of creativity) and ideas and suggestions for how to increase the frequency of family meals (e.g., single-headed=give fewer options vs. dual-headed=include children in the meal preparation). Findings may help inform public health intervention researchers and providers who work with adolescents and their families to understand how to approach discussions regarding reasons for having family meals, barriers to carrying out family meals and ways to increase family meals depending on family

  17. What Do Clinical Supervisors Require to Teach Residents in Family Medicine How to Care for Seniors?

    Science.gov (United States)

    Giguere, Anik M C; Lebel, Paule; Morin, Michèle; Proust, Françoise; Rodríguez, Charo; Carnovale, Valerie; Champagne, Louise; Légaré, France; Carmichael, Pierre-Hugues; Martineau, Bernard; Karazivan, Philippe; Durand, Pierre J

    2018-03-01

    We assessed clinicians' continuing professional development (CPD) needs at family practice teaching clinics in the province of Quebec. Our mixed methodology design comprised an environmental scan of training programs at four family medicine departments, an expert panel to determine priority clinical situations for senior care, a supervisors survey to assess their perceived CPD needs, and interviews to help understand the rationale behind their needs. From the environmental scan, the expert panel selected 13 priority situations. Key needs expressed by the 352 survey respondents (36% response rate) included behavioral and psychological symptoms of dementia, polypharmacy, depression, and cognitive disorders. Supervisors explained that these situations were sometimes complex to diagnose and manage because of psychosocial aspects, challenges of communicating with patients and families, and coordination of interprofessional teams. Supervisors also reported more CPD needs in long-term and home care, given the presence of caregivers and complexity of senior care in these settings.

  18. Depression and quality of life for women in single-parent and nuclear families.

    Science.gov (United States)

    Landero Hernández, René; Estrada Aranda, Benito; González Ramírez, Mónica Teresa

    2009-05-01

    This is a cross-sectional study which objectives are 1) to determine the predictors for perceived quality of life and 2) to analyze the differences between women from single-parent families and bi-parent families, about their quality of life, depression and familiar income. We worked with a non-probabilistic sample of 140 women from Monterrey, N.L, Mexico, 107 are from bi-parent families and 33 from single parent families. Some of the results show that women from single-parent families have lower quality of life (Z = -2.224, p = .026), lower income (Z = -2.727, p = .006) and greater depression (Z = -6.143, p = .001) than women from bi-parental families. The perceived quality of life's predictors, using a multiple regression model (n = 140) were depression, income and number of children, those variables explaining 25.4% of variance.

  19. Overcoming Stigma: Involving Families in Medical Student and Psychiatric Residency Education

    Science.gov (United States)

    Schmetzer, Alan D.; Lafuze, Joan E.

    2008-01-01

    Objective: The primary purpose of this article is to present a possible mechanism for increasing communication about psychiatric matters such as diagnoses, treatment, and stigma between the physicians, including psychiatrists, and the families of persons with mental illness through a NAMI presentation. Methods: Included are a description of a…

  20. An Exploration of Family Interaction with the Elderly by Race, Socioeconomic Status, and Residence.

    Science.gov (United States)

    Mitchell, Jim; Register, Jasper C.

    1984-01-01

    Questions the extended family hypothesis of Black aging. A survey of 334 elderly Blacks and 1,813 Whites indicates White elderly see their children and grandchildren more frequently, Blacks are more likely to receive help from children and grandchildren, and giving help is influenced more by socioeconomic factors than race. (JAC)

  1. Depression in Children from Single-Parent Families.

    Science.gov (United States)

    Huntley, Debra K.; And Others

    1986-01-01

    Examined depression in 53 eldest children between 6 and 10 years old who were living in mother-headed one-parent families. Only gender of the child was a significant predictor of depression, with boys reporting significantly greater depressive symptomatology. Contrary to expectation, neither time since separation nor depression in the mother was…

  2. Efficiency of single-family houses and harmonisation of their life cycle participants’ interests

    Directory of Open Access Journals (Sweden)

    Nerija Kvederyte

    2000-01-01

    Full Text Available An efficient single-family house is the main purpose of the life cycle. It determines the necessity to evaluate various decisions of the life cycle of single-family houses and possibilities to satisfy objectives and requirements of the participants of that process. To design and achieve an effective process of the life cycle of a single-family house, it is necessary to take care of its efficiency starting from the determination of needs and objectives and ending with the usage of a building.

  3. Solar project description for Moulder Corporation single family residence, Greenwood, Indiana

    Science.gov (United States)

    1980-07-01

    The system is designed to provide solar energy for space heating and domestic hot water heating. Solar energy is used for space heating the home and preheating domestic hot water (DHW). The solar energy system has an array of flat plate collectors with a gross area of 704 square feet. The array faces 5.5 degrees west of south at an angle of 45 degrees to the horizontal. Air is the transfer medium that delivers solar energy from the collector array to storage, space heating and hot water loads. Solar energy is stored underground in 945 cubic foot bin containing 81,000 pounds of crushed rock. The bin has 8 inch concrete block walls and the insulation on the exterior is sprayed urethane. Preheated city water is stored in an 80 gallon preheat tank, which is inside the storage bin and is supplied, on demand, to a conventional 52 gallon DHW tank. When solar energy is insufficient to satisfy the space heating load, a conventional electric furnace provides the auxiliary energy for space heating.

  4. 76 FR 41287 - Incidental Take Permits and Joint Environmental Assessment for Four Single Family Residences in...

    Science.gov (United States)

    2011-07-13

    ... identification of any other aspects of the human environment not already identified in the EA pursuant to... include a reduced design footprint, on-site land management to maintain use of the site by Perdido Key...

  5. Development and field verification of a model of house air infiltration for single family residences

    Energy Technology Data Exchange (ETDEWEB)

    Macriss, R.A.; Zawacki, T.S.; Cole, J.T.

    1981-07-01

    A computer program on house air infiltration was developed by including the effects of door openings and vent fans. The program was verified against data from actual dwellings. A simplified version of the program can now be used on a hand-held calculaor to estimate instantaneous, hourly, monthly, seasonal, and annual air-infiltration rates. To ensure the utility of this program by architects, engineers, and others, they prepared a user manual and program listing and developed a rigorous capable of being integrated into other programs for building energy calculations, such as E-Cube, NBS-LD, and DOE-2.

  6. Economic Evaluation of Single-Family-Residence Solar-Energy System

    Science.gov (United States)

    1982-01-01

    Report concludes that where solar-energy system investment costs are presently high, future promise of savings due to increased conventional energy costs is not optimistic. This is because cost of system tends to increase at a rate not significantly less than the cost of conventional energy.

  7. Economic Evaluation of Single-Family-Residence Solar-Energy Installation

    Science.gov (United States)

    1982-01-01

    Long-term economic performance of a commercial solar-energy system was analyzed and used to predict economic performance at four additional sites. Analysis described in report was done to demonstrate viability of design over a broad range of environmental/economic conditions. Report contains graphs and tables that present evaluation procedure and results. Also contains appendixes that aid in understanding methods used.

  8. The human PDI family: Versatility packed into a single fold

    DEFF Research Database (Denmark)

    Appenzeller-Herzog, Christian; Ellgaard, Lars

    2007-01-01

    in promoting oxidative protein folding in the ER has been extended in recent years to include roles in other processes such as ER-associated degradation (ERAD), trafficking, calcium homeostasis, antigen presentation and virus entry. Some of these functions are performed by non-catalytic members of the family...... that lack the active-site cysteines. Regardless of their function, all human PDIs contain at least one domain of approximately 100 amino acid residues with structural homology to thioredoxin. As we learn more about the individual proteins of the family, a complex picture is emerging that emphasizes as much...... their differences as their similarities, and underlines the versatility of the thioredoxin fold. Here, we primarily explore the diversity of cellular functions described for the human PDIs. Udgivelsesdato: 2007-Dec-3...

  9. The Family Education Rights and Privacy Act's impact on residency applicant behavior and recommendations: a pilot study.

    Science.gov (United States)

    Diab, Jessica; Riley, Stephanie; Overton, David T

    2011-01-01

    The Family Education Rights and Privacy Act (FERPA) provides residency applicants the right to view letters of recommendation. Applicants must indicate whether they waive this right. We determined how frequently applicants to an emergency medicine residency program waived the right to view letters of recommendation and whether such decisions impacted the letters' contents. A retrospective, observational review of all letters of recommendation submitted to an emergency medicine residency program in 2005-2006 determined applicants' FERPA declaration, use of the Standardized Letter of Recommendation (SLOR), and the SLOR Global Assessment ranking. The percentage of applicants waiving FERPA rights was determined. Chi-squared tests of independence assessed whether applicants' decisions influenced the SLOR Global Assessment. All statistical analysis used a 5% level of significance. There were 367 applications received; 1120 letters of recommendation accompanied 264 US medical school applications, 449 (40%) using the SLOR format. Of the SLORs, only 6% stated that the applicant did not waive his FERPA right; 426 SLORs included a Global Assessment. Of those waiving FERPA rights, 30% were ranked "Outstanding," 50% "Excellent," 17% "Very Good," and 3% "Good." For those not waiving FERPA rights, 35% were ranked as "Outstanding," 46% "Excellent," 15% "Very Good," and 4% "Good." There was no statistical difference in Global Assessment ranking between applicants who waived FERPA rights and those who did not (p = 0.934). In this pilot study, the vast majority of applicants waived FERPA rights to view letters of recommendation. The applicants' decisions did not influence their SLOR Global Assessment ranking. Copyright © 2011 Elsevier Inc. All rights reserved.

  10. Community-level characteristics associated with variation in rates of homelessness among families and single adults

    National Research Council Canada - National Science Library

    Fargo, Jamison D; Munley, Ellen A; Byrne, Thomas H; Montgomery, Ann Elizabeth; Culhane, Dennis P

    2013-01-01

    We modeled rates of family and single-adult homelessness in the United States in metropolitan and nonmetropolitan regions and as a function of community-level demographic, behavioral, health, economic...

  11. Analysis of Installed Measures and Energy Savings for Single-Family Residential Better Buildings Projects

    Energy Technology Data Exchange (ETDEWEB)

    Heaney, M. [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Polly, B. [National Renewable Energy Laboratory (NREL), Golden, CO (United States)

    2015-04-30

    This report presents an analysis of data for residential single-family projects reported by 37 organizations that were awarded federal financial assistance (cooperative agreements or grants) by the U.S. Department of Energy’s Better Buildings Neighborhood Program.1 The report characterizes the energy-efficiency measures installed for single-family residential projects and analyzes energy savings and savings prediction accuracy for measures installed in a subset of those projects.

  12. Market for Hawaii hardwood lumber in new single-family houses on Oahu, Hawaii

    Science.gov (United States)

    John D. Zinnikas; R. Sidney Boone

    1967-01-01

    The total potential market for flooring, siding, and cabinet and millwork in new single-family houses on Oahu was between 10½ and 11 million board feet of lumber in 1963. The total possible market for lumber in new single-family house construction from 1965 to 1970 is estimated at 18 to 23 million square feet of floor-ing, 28 to 36 million square feet of...

  13. The Links of Family Processes with Children's Academic and Psychosocial Competence in Rural Single-Parent African American Families.

    Science.gov (United States)

    Brody, Gene H.

    A study examined the links among mothers' endorsement of developmental goals, use of competence-promoting parenting practices, youth self-regulation, and academic and psychosocial outcomes. A sample of 175 single-mother-headed African American families with a 6- to 9-year-old child was recruited from nonmetropolitan counties in Georgia. Interviews…

  14. Improvements in staff quality of work life and family satisfaction following the move to single-family room NICU design.

    Science.gov (United States)

    Watson, Jo; DeLand, Marion; Gibbins, Sharyn; MacMillan York, Elizabeth; Robson, Kate

    2014-04-01

    The purpose of this study was to determine whether there were differences in staff quality of work life and parent satisfaction when a neonatal intensive care unit moved from an open-bay design to a single-room model of care. This descriptive study measured staff quality of work life and family satisfaction before and at 2 time periods after the relocation of a perinatal centre and the introduction of single-family room care. Differences in work life quality and satisfaction were determined using 2-sample t-tests. There were improvements in staff quality of work life and family satisfaction at both time periods following the move. Lessons learned may be of value to other units considering such a move. A neonatal intensive care unit designed to contribute to parental and staff well-being is a model to be considered for future neonatal designs.

  15. Adolescents’ Self-Esteem in Single and Two-Parent Families

    OpenAIRE

    Alami, Ali; Khosravan, Shahla; Sadegh Moghadam, Leila; Pakravan, Fateme; Hosseni, Fateme

    2014-01-01

    Background: Self-esteem is one of the basic needs for all individuals especially in adolescence. The aim of this study was to determine associations between adolescents’ self-esteem and perceived maternal parenting styles as well as its dimensions in terms of family type. Methods: In this analytic cross-sectional study, 356 high school students (250 two-parent nuclear family and 106 single-parent family) participated and filled out the Coppersmith self-esteem and the Robinson and colleagues (...

  16. Home visits by family physicians during the end-of-life: Does patient income or residence play a role?

    Directory of Open Access Journals (Sweden)

    Johnston Grace

    2005-01-01

    Full Text Available Abstract Background With a growing trend for those with advanced cancer to die at home, there is a corresponding increase in need for primary medical care in that setting. Yet those with lower incomes and in rural regions are often challenged to have their health care needs met. This study examined the association between patient income and residence and the receipt of Family Physician (FP home visits during the end-of-life among patients with cancer. Methods Data Sources/Study Setting. Secondary analysis of linked population-based data. Information pertaining to all patients who died due to lung, colorectal, breast or prostate cancer between 1992 and 1997 (N = 7,212 in the Canadian province of Nova Scotia (NS was extracted from three administrative health databases and from Statistics Canada census records. Study Design. An ecological measure of income ('neighbourhood' median household income was developed using census information. Multivariate logistic regression was then used to assess the association of income with the receipt of at least one home visit from a FP among all subjects and by region of residency during the end-of-life. Covariates in the initial multivariate model included patient demographics and alternative health services information such as total days spent as a hospital inpatient. Data Extraction Methods. Encrypted patient health card numbers were used to link all administrative health databases whereas the postal code was the link to Statistics Canada census information. Results Over 45% of all subjects received at least one home visit (n = 3265. Compared to those from low income areas, the log odds of receiving at least one home visit was significantly greater among subjects who reside in middle to high income neighbourhoods (for the highest income quintile, adjusted odds ratio [OR] = 1.37, 95% confidence interval [CI] = 1.15, 1.64; for upper-middle income, adjusted OR = 1.19, 95%CI = 1.02, 1.39; for middle income

  17. How do Ontario family medicine residents perform on global health competencies? A multi-institutional survey

    Directory of Open Access Journals (Sweden)

    Mirella Veras

    2013-09-01

    Results: The response rate ranged from 29% to 66% across the five universities. Self-perceived knowledge scores revealed that 34.3% of the respondents were very confident, 51.9% were somewhat confident, and 13.8% were not at all confident about their global health knowledge. Participants' confidence scores were lower in relation to knowledge of access to health care for low income nations (44.3%, and were better on their global health skills related to working in a team (70.9% and listening actively to patients' concerns (64.6%. Conclusions: The global health competency scale has identified key areas of strengths and weaknesses of family medicine programs in global health education. This can be used to evaluate and analyze progress over time.

  18. Religiosity of Muslim Adolescents from Single Parent Families Living in Government-Subsidised Settlement

    Directory of Open Access Journals (Sweden)

    Fariza, M. S.

    2015-12-01

    Full Text Available Adolescence is a phase of emotionl turmoil and stress. If not balanced with religious practice, it may cause adolescents to fall into moral and social problems such as breach of school discipline, delinquency, drug addiction and sexual permissiveness. Religiosity is one way for adolescents to deal with challenges in life thereby avoiding immoral activities. This is because religiosity may help to balance adolescent emotional, cognitive and social developments.The purpose of this study is to identify the behaviour and level of religiosity among 30 adolescents from single parents families who settle in government-subsidised area of residence, namely known as the Federal Land Development Authority (FELDA. The area is located in the state of Pahang, situated on the eastern part of Malaysia. These adolescents have been selected as research respondents. This research was conducted as a survey using questionnaire as the research instrument. It was constructed based on the guidelines of Islamic Practice Instrument (IPI (Fariza, 2012 and has already been verified in terms of its validity and reliability. The data analysis has adopted the method of descriptive statistics explained in table form. The research results have found that religiosity or religious behaviour that the adolescents most frequently abide by are staying away from gambling, having good thoughts and expectations of Allah, feeling awed and fear of Allah’s power (taqwa, staying away from fornication (zina and supplication (doa to Allah facing the direction of Qibla. The level of religiosity is medium for most adolescents. This factor explains why not many respondents are involved in moral and disciplinary problems at school. This research finds that generally, religiosity protects adolescents from being involved in immoral activities and other vices.

  19. Effectiveness of different memory training programs on improving hyperphagic behaviors of residents with dementia: a longitudinal single-blind study.

    Science.gov (United States)

    Kao, Chieh-Chun; Lin, Li-Chan; Wu, Shiao-Chi; Lin, Ker-Neng; Liu, Ching-Kuan

    2016-01-01

    Hyperphagia increases eating-associated risks for people with dementia and distress for caregivers. The purpose of this study was to compare the long-term effectiveness of spaced retrieval (SR) training and SR training combined with Montessori activities (SR + M) for improving hyperphagic behaviors of special care unit residents with dementia. The study enrolled patients with dementia suffering from hyperphagia resident in eight institutions and used a cluster-randomized single-blind design, with 46 participants in the SR group, 49 in the SR + M group, and 45 participants in the control group. For these three groups, trained research assistants collected baseline data on hyperphagic behavior, pica, changes in eating habits, short meal frequency, and distress to caregivers. The SR and SR + M groups underwent memory training over a 6-week training period (30 sessions), and a generalized estimating equation was used to compare data of all the three groups of subjects obtained immediately after the training period and at follow-ups 1 month, 3 months, and 6 months later. Results showed that the hyperphagic and pica behaviors of both the SR and SR + M groups were significantly improved (P<0.001) and that the effect lasted for 3 months after training. The improvement of fast eating was significantly superior in the SR + M group than in the SR group. The improvement in distress to caregivers in both intervention groups lasted only until the posttest. Improvement in changes in eating habits of the two groups was not significantly different from that of the control group. SR and SR + M training programs can improve hyperphagic behavior of patients with dementia. The SR + M training program is particularly beneficial for the improvement of rapid eating. Caregivers can choose a suitable memory training program according to the eating problems of their residents.

  20. Community-Level Characteristics Associated With Variation in Rates of Homelessness Among Families and Single Adults

    Science.gov (United States)

    Fargo, Jamison D.; Munley, Ellen A.; Byrne, Thomas H.; Montgomery, Ann Elizabeth; Culhane, Dennis P.

    2013-01-01

    Objectives. We modeled rates of family and single-adult homelessness in the United States in metropolitan and nonmetropolitan regions and as a function of community-level demographic, behavioral, health, economic, and safety net characteristics. Methods. We entered community-level characteristics and US Department of Housing and Urban Development point-in-time counts for a single night in January 2009 into separate mixed-effects statistical analyses that modeled homelessness rates for 4 subpopulations: families and single adults in metropolitan and nonmetropolitan regions. Results. Community-level factors accounted for 25% to 50% of the variance in homelessness rates across models. In metropolitan regions, alcohol consumption, social support, and several economic indicators were uniquely associated with family homelessness, and drug use and homicide were uniquely associated with single-adult homelessness. In nonmetropolitan regions, life expectancy, religious adherence, unemployment, and rent burden were uniquely associated with family homelessness, and health care access, crime, several economic indicators, and receipt of Supplemental Security Income were uniquely associated with single-adult homelessness. Conclusions. Considering homeless families and single adults separately enabled more precise modeling of associations between homelessness rates and community-level characteristics, indicating targets for interventions to reduce homelessness among these subpopulations. PMID:24148057

  1. Community-level characteristics associated with variation in rates of homelessness among families and single adults.

    Science.gov (United States)

    Fargo, Jamison D; Munley, Ellen A; Byrne, Thomas H; Montgomery, Ann Elizabeth; Culhane, Dennis P

    2013-12-01

    We modeled rates of family and single-adult homelessness in the United States in metropolitan and nonmetropolitan regions and as a function of community-level demographic, behavioral, health, economic, and safety net characteristics. We entered community-level characteristics and US Department of Housing and Urban Development point-in-time counts for a single night in January 2009 into separate mixed-effects statistical analyses that modeled homelessness rates for 4 subpopulations: families and single adults in metropolitan and nonmetropolitan regions. Community-level factors accounted for 25% to 50% of the variance in homelessness rates across models. In metropolitan regions, alcohol consumption, social support, and several economic indicators were uniquely associated with family homelessness, and drug use and homicide were uniquely associated with single-adult homelessness. In nonmetropolitan regions, life expectancy, religious adherence, unemployment, and rent burden were uniquely associated with family homelessness, and health care access, crime, several economic indicators, and receipt of Supplemental Security Income were uniquely associated with single-adult homelessness. Considering homeless families and single adults separately enabled more precise modeling of associations between homelessness rates and community-level characteristics, indicating targets for interventions to reduce homelessness among these subpopulations.

  2. The impact of single and shared rooms on family-centred care in children's hospitals.

    Science.gov (United States)

    Curtis, Penny; Northcott, Andy

    2017-06-01

    To explore whether and how spatial aspects of children's hospital wards (single and shared rooms) impact upon family-centred care. Family-centred care has been widely adopted in paediatric hospitals internationally. Recent hospital building programmes in many countries have prioritised the provision of single rooms over shared rooms. Limited attention has, however, been paid to the potential impact of spatial aspects of paediatric wards on family-centred care. Qualitative, ethnographic. Phase 1; observation within four wards of a specialist children's hospital. Phase 2; interviews with 17 children aged 5-16 years and 60 parents/carers. Sixty nursing and support staff also took part in interviews and focus group discussions. All data were subjected to thematic analysis. Two themes emerged from the data analysis: 'role expectations' and 'family-nurse interactions'. The latter theme comprised three subthemes: 'family support needs', 'monitoring children's well-being' and 'survey-assess-interact within spatial contexts'. Spatial configurations within hospital wards significantly impacted upon the relationships and interactions between children, parents and nurses, which played out differently in single and shared rooms. Increasing the provision of single rooms within wards is therefore likely to directly affect how family-centred care manifests in practice. Nurses need to be sensitive to the impact of spatial characteristics, and particularly of single and shared rooms, on families' experiences of children's hospital wards. Nurses' contribution to and experience of family-centred care can be expected to change significantly when spatial characteristics of wards change and, as is currently the vogue, hospitals maximise the provision of single rather than shared rooms. © 2016 John Wiley & Sons Ltd.

  3. Implementing Competency-Based Medical Education in a Postgraduate Family Medicine Residency Training Program: A Stepwise Approach, Facilitating Factors, and Processes or Steps That Would Have Been Helpful.

    Science.gov (United States)

    Schultz, Karen; Griffiths, Jane

    2016-05-01

    In 2009-2010, the postgraduate residency training program at the Department of Family Medicine, Queen's University, wrestled with the practicalities of competency-based medical education (CBME) implementation when its accrediting body, the College of Family Physicians of Canada, introduced the competency-based Triple C curriculum. The authors used a stepwise approach to implement CMBE; the steps were to (1) identify objectives, (2) identify competencies, (3) map objectives and competencies to learning experiences and assessment processes, (4) plan learning experiences, (5) develop an assessment system, (6) collect and interpret data, (7) adjust individual residents' training programs, and (8) distribute decisions to stakeholders. The authors also note overarching processes, costs, and facil itating factors and processes or steps that would have been helpful for CBME implementation. Early outcomes are encouraging. Residents are being directly observed more often with increased documented feedback about performance based on explicit competency standards (24,000 data points for 150 residents from 2013 to 2015). These multiple observations are being collated in a way that is allowing the identification of patterns of performance, red flags, and competency development trajectory. Outliers are being identified earlier, resulting in earlier individualized modification of their residency training program. The authors will continue to provide and refine faculty development, are developing an entrustable professional activity field note app for handheld devices, and are undertaking research to explore what facilitates learners' competency development, what increases assessors' confidence in making competence decisions, and whether residents are better trained as a result of CBME implementation.

  4. Lifestyle medicine course for family medicine residents: preliminary assessment of the impact on knowledge, attitudes, self-efficacy and personal health.

    Science.gov (United States)

    Malatskey, Lilach; Bar Zeev, Yael; Tzuk-Onn, Adva; Polak, Rani

    2017-09-01

    The WHO estimates that by 2020 two-thirds of the diseases worldwide will be the result of unhealthy lifestyle habits. Less than half of primary care physician graduates feel prepared to give lifestyle behaviour counselling. Our objective was to evaluate the impact of lifestyle medicine (LM) course on self-reported knowledge, attitudes, self-efficacy and health behaviour of family medicine residents. Based on the Israeli syllabus for the study of LM, we delivered five face to face 20 H courses. Pre/post data were collected by knowledge, attitudes, self-efficacy and personal health survey: RESULTS: A total of 112 family medicine residents participated in one of the five courses, of which 91 (81.3%) filled both pre and post surveys. Participates showed an improvement in self-reported knowledge and capacity to manage patients in regard to smoking, weight management and physical activity. An improvement was noted in personal health behaviour of overweight participant's in regard to self-reported physical activity. A comprehensive LM syllabus based course has a positive impact on family medicine residents LM counselling abilities. We suggest that LM course should be considered as a potential permanent addition to the family medicine residency programme. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  5. Provider Perspectives on the Influence of Family on Nursing Home Resident Transfers to the Emergency Department: Crises at the End of Life.

    Science.gov (United States)

    Stephens, Caroline; Halifax, Elizabeth; Bui, Nhat; Lee, Sei J; Harrington, Charlene; Shim, Janet; Ritchie, Christine

    2015-01-01

    Background. Nursing home (NH) residents often experience burdensome and unnecessary care transitions, especially towards the end of life. This paper explores provider perspectives on the role that families play in the decision to transfer NH residents to the emergency department (ED). Methods. Multiple stakeholder focus groups (n = 35 participants) were conducted with NH nurses, NH physicians, nurse practitioners, physician assistants, NH administrators, ED nurses, ED physicians, and a hospitalist. Stakeholders described experiences and challenges with NH resident transfers to the ED. Focus group interviews were recorded and transcribed verbatim. Transcripts and field notes were analyzed using a Grounded Theory approach. Findings. Providers perceive that families often play a significant role in ED transfer decisions as they frequently react to a resident change of condition as a crisis. This sense of crisis is driven by 4 main influences: insecurities with NH care; families being unprepared for end of life; absent/inadequate advance care planning; and lack of communication and agreement within families regarding goals of care. Conclusions. Suboptimal communication and lack of access to appropriate and timely palliative care support and expertise in the NH setting may contribute to frequent ED transfers.

  6. Provider Perspectives on the Influence of Family on Nursing Home Resident Transfers to the Emergency Department: Crises at the End of Life

    Directory of Open Access Journals (Sweden)

    Caroline Stephens

    2015-01-01

    Full Text Available Background. Nursing home (NH residents often experience burdensome and unnecessary care transitions, especially towards the end of life. This paper explores provider perspectives on the role that families play in the decision to transfer NH residents to the emergency department (ED. Methods. Multiple stakeholder focus groups (n=35 participants were conducted with NH nurses, NH physicians, nurse practitioners, physician assistants, NH administrators, ED nurses, ED physicians, and a hospitalist. Stakeholders described experiences and challenges with NH resident transfers to the ED. Focus group interviews were recorded and transcribed verbatim. Transcripts and field notes were analyzed using a Grounded Theory approach. Findings. Providers perceive that families often play a significant role in ED transfer decisions as they frequently react to a resident change of condition as a crisis. This sense of crisis is driven by 4 main influences: insecurities with NH care; families being unprepared for end of life; absent/inadequate advance care planning; and lack of communication and agreement within families regarding goals of care. Conclusions. Suboptimal communication and lack of access to appropriate and timely palliative care support and expertise in the NH setting may contribute to frequent ED transfers.

  7. Coparenting experiences in African American families: an examination of single mothers and their nonmarital coparents.

    Science.gov (United States)

    Gonzalez, Michelle; Jones, Deborah; Parent, Justin

    2014-03-01

    African American youth from single-mother homes continue to be overrepresented in statistics on risk behavior and delinquency, a trend that many be attributed to father-absence, socioeconomic disadvantage, and compromises in parenting more typical of single than two-parent families. Yet, this risk-focused perspective ignores a long-standing strength of the African American community, the involvement and potential protective impact of extended family members in childrearing. This study describes the experiences of 95 African American single mothers and their nonmarital coparents who participated in a study of African American single-mother families with an 11-16-year-old child. Specifically, the study examines: (a) the extent to which nonmarital coparents are involved in childrearing; (b) the relative levels of risk (i.e., depression, mother-coparent conflict) and protective (i.e., parenting) associated with maternal and coparent involvement; and (c) how similarly and/or differently coparent and mother variables operate with regard to youth externalizing problems. Findings reveal that a range of family members and other adults actively participate in childrearing in African American single-mother families, coparents do not differ from mothers on certain study variables (i.e., depression and mother-coparent conflict) but do for others (parenting), and coparent involvement is associated with youth adjustment in ways that are similar to our more established understanding of maternal involvement. The potential clinical implications of the findings are discussed and future research directions are highlighted. © 2014 FPI, Inc.

  8. THE RATE OF FAMILY PLANNING METHODS USAGE OF 15-49 YEARS OLD WOMEN LIVING IN DUZCE PERMANENT RESIDENCES AND THE CAUSES OF PREFERING METHODS

    OpenAIRE

    Atilla Senih MAYDA; Tugba ARSLAN; Hakan Bahadir BOZKURT; Ilker DEDELI; Meryem Ozlem OZKAN

    2005-01-01

    The aim of this cross-sectional and descriptive study is to learn the level of knowledge and source of knowledge about family planing, the rate of women using family planning methods and the causes of prefering the used methods of 15-49 years old women living in Duzce Permanent Residences. The population of the study ise 4394 women 15-49 years old. Cluster sampling is used and 280 women included to the study. A questionnaire containg 41 questions about family planning methods usage and the ca...

  9. The delivery of sexuality-related patient education to adolescent patients: A preliminary study of family practice resident physicians

    Directory of Open Access Journals (Sweden)

    Jeffrey K Clark

    2012-01-01

    Full Text Available Background: Risky sexual behavior among adolescents is one of the leading health behaviors most associated with mortality, morbidity, and social problems. Adolescents need reliable sources of information to help them promote healthy sexual behaviors. Physicians in the United States are often seen by adolescents as a reliable and trustworthy source of accurate sexual information. However, many physicians feel uncomfortable or ill-prepared to deal with sexuality issues among their adolescent patients. Purpose: This study examined the impact of family resident physicians′ sexual attitudes, knowledge, and comfort, on the delivery of sexuality-related patient education to their adolescent patients. Materials and Methods: Pre-post-test scales were administered to 21 physicians. Data were also collected for patient (n=644 charts. Factors that determined the delivery of sexuality-related patient education were analyzed. Results: Results indicate that sexuality-related patient education was rarely provided to adolescent patients. Conclusions: Adolescent sexuality education is not a high priority for physicians. Professional medical organizations should play a leadership role in training physicians on delivering sexuality education to adolescent patients.

  10. The Delivery of Sexuality-related Patient Education to Adolescent Patients: A Preliminary Study of Family Practice Resident Physicians.

    Science.gov (United States)

    Clark, Jeffrey K; Brey, Rebecca A; Banter, Amy E; Khubchandani, Jagdish

    2012-01-01

    Risky sexual behavior among adolescents is one of the leading health behaviors most associated with mortality, morbidity, and social problems. Adolescents need reliable sources of information to help them promote healthy sexual behaviors. Physicians in the United States are often seen by adolescents as a reliable and trustworthy source of accurate sexual information. However, many physicians feel uncomfortable or ill-prepared to deal with sexuality issues among their adolescent patients. This study examined the impact of family resident physicians' sexual attitudes, knowledge, and comfort, on the delivery of sexuality-related patient education to their adolescent patients. Pre-post-test scales were administered to 21 physicians. Data were also collected for patient (n=644) charts. Factors that determined the delivery of sexuality-related patient education were analyzed. Results indicate that sexuality-related patient education was rarely provided to adolescent patients. Adolescent sexuality education is not a high priority for physicians. Professional medical organizations should play a leadership role in training physicians on delivering sexuality education to adolescent patients.

  11. Effectiveness of different memory training programs on improving hyperphagic behaviors of residents with dementia: a longitudinal single-blind study

    Directory of Open Access Journals (Sweden)

    Kao CC

    2016-05-01

    Full Text Available Chieh-Chun Kao,1,2 Li-Chan Lin,3 Shiao-Chi Wu,4 Ker-Neng Lin,5,6 Ching-Kuan Liu7,8 1Department of Nursing, National Yang-Ming University, Taipei, 2Department of Nursing, Ching Kuo Institute of Management and Health, Keelung, 3Institute of Clinical Nursing, 4Institute of Health and Welfare Policy, National Yang-Ming University, 5Neurological Institute, Taipei Veterans General Hospital, Taipei, 6Department of Psychology, Soochow University, Taipei, Taiwan; 7Department of Neurology, Kaohsiung Medical University Hospital, 8Department of Neurology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan Background: Hyperphagia increases eating-associated risks for people with dementia and distress for caregivers. The purpose of this study was to compare the long-term effectiveness of spaced retrieval (SR training and SR training combined with Montessori activities (SR + M for improving hyperphagic behaviors of special care unit residents with dementia. Methods: The study enrolled patients with dementia suffering from hyperphagia resident in eight institutions and used a cluster-randomized single-blind design, with 46 participants in the SR group, 49 in the SR + M group, and 45 participants in the control group. For these three groups, trained research assistants collected baseline data on hyperphagic behavior, pica, changes in eating habits, short meal frequency, and distress to caregivers. The SR and SR + M groups underwent memory training over a 6-week training period (30 sessions, and a generalized estimating equation was used to compare data of all the three groups of subjects obtained immediately after the training period and at follow-ups 1 month, 3 months, and 6 months later. Results: Results showed that the hyperphagic and pica behaviors of both the SR and SR + M groups were significantly improved (P<0.001 and that the effect lasted for 3 months after training. The improvement of fast eating was

  12. Full-service concept for energy efficient renovation of single-family houses

    DEFF Research Database (Denmark)

    Vanhoutteghem, Lies; Tommerup, Henrik M.; Svendsen, Svend

    2011-01-01

    the business environment in order to speed up the implementation of sustainable renovation of single-family houses –a sustainable renovation concept suitable for different categories of single-family houses with regard to type and age has been proposed in this article. The sustainable renovation concept...... houses. A one-stop-shop in the form of a full-service concept could be seen as a possibility to make it easy for the homeowner to comply with possible future requirements to realize far-reaching energy savings in connection with extensive renovations, provided that the building sector offers...... includes an ideal full-service concept and technical renovation solutions targeted to different types of single-family houses....

  13. Motivational readiness of children to school in nuclear and single parent families

    Directory of Open Access Journals (Sweden)

    Kateryna Ostrovska

    2015-12-01

    Full Text Available The aim of the paper is a comparison of psychological readiness of the child to go to school in nuclear and single parent families. To obtain the objectives of the paper the following methods were used: 1 methods “Two schools” by L.A Venger to identify the level of formation of internal position of the student; 2 the method “Motivational research studies in older preschoolers” by M.R. Ginsburg; 3 method “Pattern” by L.I. Tsehanskaya to determine the degree of development of skills training activities; 4 method “Graphic dictation” by D. El’konin to study the ability to follow adult instructions. The investigated group consisted of 40 students from first grade secondary school - 20 students from nuclear families (12 girls and 8 boys and 20 students from single parent families (9 girls and 11 boys. As a result of qualitative, comparative and correlation analysis it was shown that readiness of children to go to school susbstantially depends on completness of their families. The children from families have a higher level of skill training and internal position than children from single parent families. This occurs because both parents pay more attention to the children in the forming of a willingness to learn in school. The studies have shown that in the group of children from nuclear families dominate the highest level of development of skills training activities, increased formation of internal positions and childrens social motivation. These indicators are the hallmarks of readiness to learn at school. Also, some recommendations to teachers are provided as for increase of motivation to learn in children from single parent families.

  14. Social Aspects Regarding the Single-Parent Families Vulnerability - The Case Of Arad County

    Directory of Open Access Journals (Sweden)

    Marţian Iovan

    2016-07-01

    single-parent families must rely on the complete knowledge of this social phenomenon, with the need to establish databases and map the dispersion of single-parent families within administrative-territorial units. The decrease in the number of families with a high social risk over time is the result of correlated and harmonized public policies, aimed at fighting poverty, discrimination, unemployment, lack of access to education, while ensuring the general background for economic development and prosperity. The study is determined by the fact that many times the parents and the children of single parent families find themselves in the situation of not being able to make ends meet, the lack of finances, education and proper housing making it impossible for them to live a decent life. By identifying, through specific scientific methods such as document analysis, interviews, case studies, the particular types of problems facing single parent families, we consider we will succeed in offering a strong basis to motivate decision makers to establish additional social protection measures that will contribute to the reduction of the causes that maintain this social category among vulnerable groups.

  15. Genetic screening for a single common LRRK2 mutation in familial Parkinson's disease.

    Science.gov (United States)

    Nichols, William C; Pankratz, Nathan; Hernandez, Dena; Paisán-Ruíz, Coro; Jain, Shushant; Halter, Cheryl A; Michaels, Veronika E; Reed, Terry; Rudolph, Alice; Shults, Clifford W; Singleton, Andrew; Foroud, Tatiana

    Mutations in the leucine-rich repeat kinase 2 (LRRK2) gene cause some forms of autosomal dominant Parkinson's disease. We measured the frequency of a novel mutation (Gly2019 ser) in familial Parkinson's disease by screening genomic DNA of patients and controls. Of 767 affected individuals from 358 multiplex families, 35 (5%) individuals were either heterozygous (34) or homozygous (one) for the mutation, and had typical clinical findings of idiopathic Parkinson's disease. Thus, our results suggest that a single LRRK2 mutation causes Parkinson's disease in 5% of individuals with familial disease. Screening for this mutation should be a component of genetic testing for Parkinson's disease.

  16. Child health care utilisation in families with young or single mothers in a Swedish county.

    Science.gov (United States)

    Wallby, Thomas; Modin, Bitte; Hjern, Anders

    2013-03-01

    Young age and lone parenthood are risk factors for impaired health among mothers and their children. Due to the higher risks of negative influences on physical and mental health, young and single mothers should be of special concern to the Child Health Services (CHS). In the present study, we investigated consumption patterns of child health care services among young and single mothers in Uppsala County, Sweden to study whether they are reached by the universal CHS program and if selective or indicative measures were administered in daily CHS practice. Register data on CHS contacts and socio-demographic indicators were collected for 10692 infants, born in 1998-2006. Results show small differences in contact pattern and immunization status, between children of young versus older, and single versus cohabiting mothers. However, both young (RR 0.64) and single (RR 0.80) mothers had significantly lower rates of participation in parental group. The CHS were consequently successful in implementing the universal preventive child health programme for all families, including families with young or single mothers. There was no indication, however, of an established selective preventive strategy aimed at these high risk families. Programs for strengthening the support provided to vulnerable families by the CHS are needed. © The Author(s) 2012.

  17. Children raised in fatherless families from infancy: family relationships and the socioemotional development of children of lesbian and single heterosexual mothers.

    Science.gov (United States)

    Golombok, S; Tasker, F; Murray, C

    1997-10-01

    The aim of the study was to investigate family functioning and the psychological development of children raised in fatherless families from their first year of life. Thirty lesbian mother families and 42 families headed by a single heterosexual mother were compared with 41 two-parent heterosexual families using standardised interview and questionnaire measures of the quality of parenting and the socioemotional development of the child. The results show that children raised in fatherless families from infancy experienced greater warmth and interaction with their mother, and were more securely attached to her, although they perceived themselves to be less cognitively and physically competent than their peers from father-present families. No differences were identified between families headed by lesbian and single heterosexual mothers, except for greater mother-child interaction in lesbian mother families.

  18. Forgotten Streams in the Family Life Course: Utilization of Qualitative Retrospective Interviews in the Analysis of Lifelong Single Women's Family Careers.

    Science.gov (United States)

    Allen, Katherine R.; Pickett, Robert S.

    1987-01-01

    Combined life course perspective with life history interviewing to compare 15 lifelong unmarried, childless women and 15 ever-married mothers from the 1910 birth cohort. Results suggest that linear progression from family of origin to family of procreation reveals one stream in family life course; experiences of lifelong single women revealed…

  19. Association Between Patient- Centered Medical Home Features and Satisfaction With Family Medicine Residency Training in the US.

    Science.gov (United States)

    Carney, Patricia A; Waller, Elaine; Dexter, Eve; Marino, Miguel; Rosener, Stephanie E; Green, Larry A; Jones, Geoffrey; M Keister, J Drew; Dostal, Julie A; Jones, Samuel M; Eiff, M Patrice

    2016-11-01

    Primary care residencies are undergoing dramatic changes because of changing health care systems and evolving demands for updated training models. We examined the relationships between residents' exposures to patient-centered medical home (PCMH) features in their assigned continuity clinics and their satisfaction with training. Longitudinal surveys were collected annually from residents evaluating satisfaction with training using a 5-point Likert-type scale (1=very unsatisfied to 5=very satisfied) from 2007 through 2011, and the presence or absence of PCMH features were collected from 24 continuity clinics during the same time period. Odds ratios on residents' overall satisfaction were compared according to whether they had no exposure to PCMH features, some exposure (1-2 years), or full exposure (all 3 or more years). Fourteen programs and 690 unique residents provided data to this study. Resident satisfaction with training was highest with full exposure for integrated case management compared to no exposure, which occurred in 2010 (OR=2.85, 95% CI=1.40, 5.80). Resident satisfaction was consistently statistically lower with any or full exposure (versus none) to expanded clinic hours in 2007 and 2009 (eg, OR for some exposure in 2009 was 0.31 95% CI=0.19, 0.51, and OR for full exposure 0.28 95% CI=0.16, 0.49). Resident satisfaction for many electronic health record (EHR)-based features tended to be significantly lower with any exposure (some or full) versus no exposure over the study period. For example, the odds ratio for resident satisfaction was significantly lower with any exposure to electronic health records in continuity practice in 2008, 2009, and 2010 (OR for some exposure in 2008 was 0.36; 95% CI=0.19, 0.70, with comparable results in 2009, 2010). Resident satisfaction with training was inconsistently correlated with exposure to features of PCMH. No correlation between PCMH exposure and resident satisfaction was sustained over time.

  20. 78 FR 59890 - Qualified Mortgage Definition for HUD Insured and Guaranteed Single Family Mortgages

    Science.gov (United States)

    2013-09-30

    ... URBAN DEVELOPMENT 24 CFR Parts 201, 203, 1005, and 1007 RIN 2502-AJ18 Qualified Mortgage Definition for HUD Insured and Guaranteed Single Family Mortgages AGENCY: Office of Secretary, HUD. ACTION: Proposed... mortgages, and generally prohibits a creditor from making a residential mortgage loan unless the creditor...

  1. Weatherization and Indoor Air Quality: Measured Impacts in Single Family Homes Under the Weatherization Assistance Program

    Energy Technology Data Exchange (ETDEWEB)

    Pigg, Scott [Energy Center of Wisconsin, Madison, WI (United States); Cautley, Dan [Energy Center of Wisconsin, Madison, WI (United States); Francisco, Paul [Univ. of Illinois, Urbana-Champaign, IL (United States); Hawkins, Beth A [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Brennan, Terry M [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States)

    2014-09-01

    This report summarizes findings from a national field study of indoor air quality parameters in homes treated under the Weatherization Assistance Program (WAP). The study involved testing and monitoring in 514 single-family homes (including mobile homes) located in 35 states and served by 88 local weatherization agencies.

  2. 75 FR 57052 - Notice of Single Family Loan Sale (SFLS 2010)

    Science.gov (United States)

    2010-09-17

    .... ] SUPPLEMENTARY INFORMATION: HUD announces its intention to sell in SFLS 2010 certain unsubsidized non-performing... URBAN DEVELOPMENT Notice of Single Family Loan Sale (SFLS 2010) AGENCY: Office of the Assistant Secretary for Housing--Federal Housing Commissioner, HUD. ACTION: Notice of sale of mortgage loans. SUMMARY...

  3. Midlife Education, Career, and Family Outcomes of Women Educated at Two Single-Sex Colleges.

    Science.gov (United States)

    Duncan, Lauren E.; Wentworth Phyllis A.; Owen-Smith, Ashli; LaFavor, Theresa

    2002-01-01

    Examined midlife educational, career, and family outcomes of women who attended women's colleges in the 1960s, one with a coed learning environment (CLE) and one with a single-sex environment (SLE). Overall, graduates of both colleges were very accomplished 30 years later. However, those who had experienced a CLE reported more sexism and active…

  4. Opportunities and Barriers related to Supply Chain Collaboration for Delivering Integrated Single-Family Home Renovations

    NARCIS (Netherlands)

    Mlecnik, E.; Kondratenko, I.; Haavik, T.

    2013-01-01

    Single-family home renovations often show deficiencies in project management. There might be a market addressing house owners who would prefer integrated renovation services and clear responsibilities. Companies that would respond to these client’s needs would have a clear market potential,

  5. Moisture supply in Danish single-family houses – the influence of building style

    DEFF Research Database (Denmark)

    Hansen, Ernst Jan de Place; Møller, Eva B.

    2017-01-01

    According to ISO 13788 internal moisture supply in dwellings can be described by humidity classes defined by outdoor temperature, occupancy and ventilation. Hygrothermal measurements in 500 Danish single-family houses were made to investigate if building style and geographical location are import...... by means of two-pin or capacitive moisture meter measurements to estimate indoor relative humidity....

  6. Processes Underlying Father Involvement in Dual-Earner and Single-Earner Families.

    Science.gov (United States)

    Crouter, Ann C.; And Others

    1987-01-01

    Correlates of father involvement were examined in 40 dual- and single-earner families with 1- to 25-month-old children. Fathers' work hours, sex role attitudes, perceived child care skill and perceived love for wives were assessed. On nine occasions, parents were asked to report on child care, leisure activities, and marital interactions during…

  7. Maternal Resources, Parenting Practices, and Child Competence in Rural, Single-Parent African American Families.

    Science.gov (United States)

    Brody, Gene H.; Flor, Douglas L.

    1998-01-01

    Tested a model linking maternal/family characteristics to child cognitive and psychosocial competence in African-American 6- to 9-year olds in rural single-mother-headed households. Found that maternal education, religiosity, and financial resources were linked with parenting style, mother-child relationship, and maternal school involvement.…

  8. 77 FR 19008 - Guidelines for Home Energy Professionals: Standard Work Specifications for Single Family Energy...

    Science.gov (United States)

    2012-03-29

    ...] [FR Doc No: 2012-7544] DEPARTMENT OF ENERGY Office of Energy Efficiency and Renewable Energy Guidelines for Home Energy Professionals: Standard Work Specifications for Single Family Energy Upgrades AGENCY: Office of Energy Efficiency and Renewable Energy, U.S. Department of Energy (DOE). ACTION: Notice...

  9. Central Control of Heat Pump for Smart Grid Purposes Tested on Single Family Houses

    DEFF Research Database (Denmark)

    Pedersen, Tom S.; Andersen, Palle; Nielsen, Kirsten M.

    2013-01-01

    A challenge in Denmark in the near future is to balance the electrical grid due to a large increase in the renewable energy production mainly from wind turbines. In this work a central control system using heat pumps in single family houses to help balancing the grid is investigated. The central...

  10. EFFECTS OF NATURAL AND FORCED BASEMENT VENTILATION ON RADON LEVELS IN SINGLE FAMILY DWELLINGS

    Science.gov (United States)

    The report gives, for the first time, results of an extensive study of the effect of ventilation on radon concentrations and radon entry rate in a single-family dwelling. Measurements of radon concentrations, building dynamics, and environmental parameters made in Princeton Unive...

  11. An Investigation of Energy Storage Possibilities in Single Family Houses for Smart Grid Purposes

    DEFF Research Database (Denmark)

    Andersen, Palle; Pedersen, Tom S.; Nielsen, Kirsten M.

    2014-01-01

    In Denmark it will be a challenge in near future to balance the electrical grid due to a large increase in the renewable energy production mainly from wind turbines. Smart grid solutions which exploit all storage capacities are essential to meet this challenge. In this work single family houses...

  12. Job-Family Role Strain among Employed Single Mothers of Preschoolers.

    Science.gov (United States)

    Campbell, Marian L.; Moen, Phyllis

    1992-01-01

    Examined correlates of job-family strain in 160 Canadian employed single mothers with preschoolers. Strain was positively related to hours worked, number of children, and child's age and negatively associated with more positive attitudes to work and higher work satisfaction. Child care variables were not associated with strain. (Author/NB)

  13. "Caring as if it were my family": health care aides' perspectives about expert care of the dying resident in a personal care home.

    Science.gov (United States)

    McClement, Susan; Wowchuk, Suzanne; Klaasen, Kathleen

    2009-12-01

    A qualitative pilot study was conducted to identify and describe expert behaviors in care of the dying resident in a personal care home setting from the perspective of health care aides (N = 5) nominated by their peers as demonstrating excellence in end-of-life care. Data was collected through audio-taped semi-structured interview, and transcribed verbatim using constant-comparative analysis procedures. The over-arching theme emerging from the data was "caring as if it were my family." Subsumed within this main theme included the sub-themes of: (1) care of the resident; (2) tending to the environment; (3) care of the family; (4) going to bat; and (5) processing loss. The findings from this pilot study provide preliminary empirical evidence that could inform educational programs for and performance evaluation of, health care aides providing end-of-life care in personal care home environments.

  14. Detail, Facture, and Colour in the Architecture of Polish Single-Family Houses after 1989

    Science.gov (United States)

    Sztafrowski, Marek

    2017-10-01

    The article presents single-family houses architecture transformations since 1989, with particularly close attention paid to the significance of detail, facture, and colour. The article presents the architecture as an art of designing and building facilities with both use and aesthetic value, an art of shaping space and building forms. Architectural work should correspond to the intended function, technique, economic and aesthetic requirements, thus shaping all elements of human immediate environment, both inside and outside of the building. Architecture of the building is perceived as form, structure, and function, as well as detail, facture, and colour. Facture and colour are created through materials used for external finishes. The solid of the building is noticed first while looking at the building, then the finishes detail such as colour, facture, and detail. Materials for external finishes are commonly selected for their aesthetic value equally with their technical characteristics. The detail was always a characteristic element of style. However, currently the fashion for details can be observed, the fashion for usage of materials for external finishes and inter-connected with that colour and facture. The architecture of Polish single-family houses underwent considerable metamorphosis after system change of 1989 – from destitute in form, devoid in detail and colour socmodernism, to architecture extremely varied in terms of form, utilised structures, materials, and detail. Hence, appearance of the phenomenon called fashion can be observed in the architecture, understood as constant changeability, seeking novelty, and creation based on opinion-forming centres. The architectural fashion consists of form, function, structure, building materials, detail, facture, and colour trends, e.g. after rejecting socmodernism, steep roofs characteristic for single-family houses trend started. After 1989, initially individual single-family house projects were created

  15. The Role of Artificial Intelligence in Diagnostic Radiology: A Survey at a Single Radiology Residency Training Program.

    Science.gov (United States)

    Collado-Mesa, Fernando; Alvarez, Edilberto; Arheart, Kris

    2018-02-21

    Advances in artificial intelligence applied to diagnostic radiology are predicted to have a major impact on this medical subspecialty. With the goal of establishing a baseline upon which to build educational activities on this topic, a survey was conducted among trainees and attending radiologists at a single residency program. An anonymous questionnaire was distributed. Comparisons of categorical data between groups (trainees and attending radiologists) were made using Pearson χ 2 analysis or an exact analysis when required. Comparisons were made using the Wilcoxon rank sum test when the data were not normally distributed. An α level of 0.05 was used. The overall response rate was 66% (69 of 104). Thirty-six percent of participants (n = 25) reported not having read a scientific medical article on the topic of artificial intelligence during the past 12 months. Twenty-nine percent of respondents (n = 12) reported using artificial intelligence tools during their daily work. Trainees were more likely to express doubts on whether they would have pursued diagnostic radiology as a career had they known of the potential impact artificial intelligence is predicted to have on the specialty (P = .0254) and were also more likely to plan to learn about the topic (P = .0401). Radiologists lack exposure to current scientific medical articles on artificial intelligence. Trainees are concerned by the implications artificial intelligence may have on their jobs and desire to learn about the topic. There is a need to develop educational resources to help radiologists assume an active role in guiding and facilitating the development and implementation of artificial intelligence tools in diagnostic radiology. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  16. Housing as a Social Determinant of Health: Exploring the Relationship between Rent Burden and Risk Behaviors for Single Room Occupancy Building Residents.

    Science.gov (United States)

    Bowen, Elizabeth A; Mitchell, Christopher G

    2016-01-01

    A growing body of health determinants research recognizes that housing and health are intimately linked. This study explores the relationship between rent burden (the ratio of rent to income) and health risk behaviors among a sample of single room occupancy (SRO) building residents. Cross-sectional data were gathered from a sample of 162 residents living in privately owned, for-profit SROs in Chicago. Findings indicated that participants who had full rental subsidies and thus were designated in a no-rent-burden category were more likely to engage in risk behaviors including illicit drug use, having multiple sexual partners, and having sex without a condom, in comparison to participants with moderate or high-rent burdens. These findings suggest that interventions to increase housing stability and affordability and bolster reliable income sources (in addition to rental subsidies) may be key in reducing risk behaviors and improving health for vulnerably housed populations such as SRO residents.

  17. Impact of a Neighborhood-Based Curriculum on the Helpfulness of Pediatric Residents' Anticipatory Guidance to Impoverished Families.

    Science.gov (United States)

    Real, Francis J; Beck, Andrew F; Spaulding, Jeanne R; Sucharew, Heidi; Klein, Melissa D

    2016-11-01

    Introduction Neighborhood location has been shown to impact childhood health and well-being. It follows that neighborhood context-the risks and assets present within a patient's neighborhood-may be an important consideration during provision of primary care. Pediatric residents often serve as the primary care physicians for high risk populations though are often unfamiliar with local neighborhoods. As such, education interventions that deepen residents' understanding of a patient's neighborhood context may allow for targeted care provision. A neighborhood-based curriculum was therefore created to improve residents' familiarity with local neighborhoods. Methods The neighborhood-based curriculum utilized a shared interactive presentation to address the topics of housing, nutrition, safe play, pharmacies, and transportation. Education modules included introduction to readily available on-line resources. A pre-post survey assessed resident self-perceived competence on the curricular topics of interest. Caregivers were interviewed in the post-curriculum period to rate the helpfulness of resident-administered advice. Results Following the curriculum, residents reported improved competence on the topics of safe play and transportation (p impoverished population.

  18. Cognitive Vulnerabilities to Depression for Adolescents in Single-Mother and Two-Parent Families.

    Science.gov (United States)

    Daryanani, Issar; Hamilton, Jessica L; McArthur, Brae Anne; Steinberg, Laurence; Abramson, Lyn Y; Alloy, Lauren B

    2017-01-01

    Although research consistently suggests that adolescents in single-mother families are at increased risk for depression, the mechanisms that explain this relationship are unclear. In a community sample of adolescents (N = 368; ages 12-16; 50 % female; 50 % White) and their mothers (42 % single), adolescents completed measures of depressive symptoms, rumination, and depressogenic inferential style at baseline and two yearly follow-ups. Mothers reported on stressful events that occurred in the child's life from birth until baseline. Adolescents raised by single mothers, relative to partnered mothers, experienced more childhood stressors and higher rumination levels at 1-year follow-up. Additionally, higher rumination mediated the relationship between single motherhood and greater youth depressive symptoms at the 2-year follow-up. Clinical implications and developmental considerations are discussed.

  19. Government Should Subsidize, Not Tax, Marriage: Social Policies Have Influenced the Rate of Growth in Single-Parent Families

    Science.gov (United States)

    Peterson, Paul E.

    2015-01-01

    Based upon reflections from the Moynihan report of 1965, this author notes that the root causes of the growth in single-parent families have yet to be well identified, making it difficult to figure out where to go next. However, from 1965 onward, social policies have influenced the rate of growth in single-parent families. What is needed is a…

  20. Determining stocks and flows of structural wood products in single family homes in the United States between 1950 and 2010

    DEFF Research Database (Denmark)

    Sianchuk, Robert A.; McFarlane, Paul N.; Ackom, Emmanuel

    2012-01-01

    The stocks and flows of six major structural wood products (SWPs)-lumber, plywood, oriented strand board [OSB], glue laminated timber, I-joists, and laminated veneer lumber (LVL)-in US single family homes were modeled from 1950 to 2010. The consumption of these products in US single family homes...

  1. Single-nucleotide polymorphism arrays and unexpected consanguinity: considerations for clinicians when returning results to families.

    Science.gov (United States)

    Delgado, Fernanda; Tabor, Holly K; Chow, Penny M; Conta, Jessie H; Feldman, Kenneth W; Tsuchiya, Karen D; Beck, Anita E

    2015-05-01

    The broad use of single-nucleotide polymorphism microarrays has increased identification of unexpected consanguinity. Therefore, guidelines to address reporting of consanguinity have been published for clinical laboratories. Because no such guidelines for clinicians exist, we describe a case and present recommendations for clinicians to disclose unexpected consanguinity to families. In a boy with multiple endocrine abnormalities and structural birth defects, single-nucleotide polymorphism array analysis revealed ~23% autosomal homozygosity suggestive of a first-degree parental relationship. We assembled an interdisciplinary health-care team, planned the most appropriate way to discuss results of the single-nucleotide polymorphism array with the adult mother, including the possibility of multiple autosomal recessive disorders in her child, and finally met with her as a team. From these discussions, we developed four major considerations for clinicians returning results of unexpected consanguinity, all guided by the child's best interests: (i) ethical and legal obligations for reporting possible abuse, (ii) preservation of the clinical relationship, (iii) attention to justice and psychosocial challenges, and (iv) utilization of the single-nucleotide polymorphism array results to guide further testing. As single-nucleotide polymorphism arrays become a common clinical diagnostic tool, clinicians can use this framework to return results of unexpected consanguinity to families in a supportive and productive manner.

  2. Attitudes towards family formation in cohabiting and single childless women in their mid- to late thirties

    DEFF Research Database (Denmark)

    Petersen, Kathrine Birch; Lykke-Sylvest, Randi; Andersen, Anders Nyboe

    2016-01-01

    This study aimed to explore attitudes towards family formation in single or cohabiting childless women of advanced age. The design comprised semi-structured qualitative interviews of 20 women aged 34–39 years attending the Fertility Assessment and Counselling Clinic, Rigshospitalet, Copenhagen....... A sample of 10 single women and 10 cohabiting women was chosen with equal distribution of postgraduate education length. Data were analysed using content analysis following the method of Graneheim and Lundman and consolidated criteria for reporting qualitative research (COREQ). The general attitude towards...

  3. Enhancing physical and social environments to reduce obesity among public housing residents: rationale, trial design, and baseline data for the Healthy Families study.

    Science.gov (United States)

    Quintiliani, Lisa M; DeBiasse, Michele A; Branco, Jamie M; Bhosrekar, Sarah Gees; Rorie, Jo-Anna L; Bowen, Deborah J

    2014-11-01

    Intervention programs that change environments have the potential for greater population impact on obesity compared to individual-level programs. We began a cluster randomized, multi-component multi-level intervention to improve weight, diet, and physical activity among low-socioeconomic status public housing residents. Here we describe the rationale, intervention design, and baseline survey data. After approaching 12 developments, ten were randomized to intervention (n=5) or assessment-only control (n=5). All residents in intervention developments are welcome to attend any intervention component: health screenings, mobile food bus, walking groups, cooking demonstrations, and a social media campaign; all of which are facilitated by community health workers who are residents trained in health outreach. To evaluate weight and behavioral outcomes, a subgroup of female residents and their daughters age 8-15 were recruited into an evaluation cohort. In total, 211 households completed the survey (RR=46.44%). Respondents were Latino (63%), Black (24%), and had ≤ high school education (64%). Respondents reported ≤2 servings of fruits & vegetables/day (62%), visiting fast food restaurants 1+ times/week (32%), and drinking soft drinks daily or more (27%). The only difference between randomized groups was race/ethnicity, with more Black residents in the intervention vs. control group (28% vs. 19%, p=0.0146). Among low-socioeconomic status urban public housing residents, we successfully recruited and randomized families into a multi-level intervention targeting obesity. If successful, this intervention model could be adopted in other public housing developments or entities that also employ community health workers, such as food assistance programs or hospitals. Copyright © 2014 Elsevier Inc. All rights reserved.

  4. Land cover in single-family housing areas and how it correlates with urban form

    DEFF Research Database (Denmark)

    Nielsen, Mette Boye; Jensen, Marina Bergen

    2015-01-01

    Land cover composition is a valuable indicator of the ecological performance of a city. Single-family housing areas constitute a substantial part of most cities and may as such play an important role for sustainable urban development. From aerial photos we performed detailed GIS-based mapping...... of land cover in three detached single-family housing areas in Denmark of different urban form but comparable housing densities (ranging from 10.0 to 11.3 houses per hectare). The findings were subjected to statistical analysis and landscape metrics. Land cover varied with urban form: A traditional...... to carports in all parcels, and number of trees to be positively correlated with garden size in rectangular parcels. Correlation analysis also showed that higher trees were located further from houses, and that rectangular parcels could support more trees than quadratic parcels. These results suggest...

  5. Experimental investigations on solar heating/heat pump systems for single family houses

    DEFF Research Database (Denmark)

    Andersen, Elsa; Perers, Bengt

    In the period 2013-2017 the project “Experimental investigations on solar heat pump systems for single family houses” is carried out at Department of Civil Engineering, Technical University of Denmark. The aim of this project is to increase the knowledge of the heat and mass transfer in the combi......In the period 2013-2017 the project “Experimental investigations on solar heat pump systems for single family houses” is carried out at Department of Civil Engineering, Technical University of Denmark. The aim of this project is to increase the knowledge of the heat and mass transfer...... in the combined solar heating/heat pump system type when the heat pump makes use of a horizontal ground source heat exchanger. The knowledge is gained by experimental investigations on a solar heating/heat pump system and forms the basis for improved marketed combined solar heating/heat pump systems....

  6. The earth-coupled heat pump: Utilizing innovative technology in single family rehabilitation strategies

    Energy Technology Data Exchange (ETDEWEB)

    1989-11-01

    The study examines the feasibility of incorporating the use of earth-coupled heat pump technology in single-family housing rehabilitation projects, based on energy conservation attributes and financial considerations. Following evaluation of a theoretical model which indicated that installations of the heat pumps were feasible, the heat pumps were tested under actual conditions in five single family housing units which were part of the Urban Homesteading Program, and were matched with comparable units which did not receive special treatment. Energy consumption information was collected for all units for twelve months. Variables were identified, and the data was analyzed for individual housing units and compared with the results predicted by the theoretical model to determine the practicality of incorporating such technology in large scale rehabilitation projects. 14 refs., 14 figs., 3 tabs.

  7. What is a family? Kinship, reproductive practices and single mothers by choice

    DEFF Research Database (Denmark)

    Ravn, Tine

    The proliferation of assisted reproductive technologies (ARTs) such as in vitro fertilization (IVF) has influenced and facilitated the rise of ‘new’ kinship practices and family formations. Furthermore, these technologies – in obscuring the relation between ‘biological facts of conception......, showing that the application of ARTs is also fashioned by more traditional notions of kinship (Levine 2008; Thompson 2005) and that the nuclear family ideal remains a strong notion within the realms of reproduction and parenting (Cutas & Chan 2012:5). By contributing to this continuing question of how...... to one emerging ‘new’ family form represented by single mothers by choice (SMC’s) who by means of donor insemination and/or IVF treatment, intentionally choose to conceive a child and act as the sole parent. Based on very initial findings from a larger Danish biographical narrative interview study...

  8. The NICU Environment: Infusing Single-Family Room Benefits into the Open-Bay Setting.

    Science.gov (United States)

    Meredith, Jenna L; Jnah, Amy; Newberry, Desi

    2017-03-01

    Two distinct architectural designs are found in today's NICUs-the open-bay (OPBY) and the single-family room (SFR) designs. When neonatology was recognized as a medical subspecialty in the 1970s, the OPBY design was the only platform offered to neonates and families. The OPBY design facilitated communication between staff, collegiality, and interprofessional collaboration among members of the neonatal team. Over time, pitfalls to the design were recognized, including increased transmission of sound and light. As a result, the SFR design emerged offering a family-centered, customizable environment. Through recognition and adoption of best practices, the neurodevelopmental benefits to SFRs can be infused within the OPBY unit. This article aims to identify best practices to infuse the benefits of SFR design (such as low light, low sound, and less overstimulation) into the OPBY NICU to reduce negative stimulation and optimize developmental outcomes for vulnerable neonates.

  9. Managing the Drivers of Air Flow and Water Vapor Transport in Existing Single-Family Homes

    Energy Technology Data Exchange (ETDEWEB)

    Cummings, James [Building America Partnership for Improved Residential Construction (BA-PIRC), Cocoa, FL (United States); Withers, Charles [Building America Partnership for Improved Residential Construction (BA-PIRC), Cocoa, FL (United States); Martin, Eric [Building America Partnership for Improved Residential Construction (BA-PIRC), Cocoa, FL (United States); Moyer, Neil [Building America Partnership for Improved Residential Construction (BA-PIRC), Cocoa, FL (United States)

    2012-10-01

    This report is a revision of an earlier report titled: Measure Guideline: Managing the Drivers of Air Flow and Water Vapor Transport in Existing Single-Family Homes. Revisions include: Information in the text box on page 1 was revised to reflect the most accurate information regarding classifications as referenced in the 2012 International Residential Code. “Measure Guideline” was dropped from the title of the report. An addition was made to the reference list.

  10. An econometric model of homeownership: single-family and multifamily housing option

    OpenAIRE

    Seong Woo Lee; Dowell Myers; Heon Soo Park

    2000-01-01

    The purpose of this study was to examine the utility of the multifamily housing sector through models of household tenure decision, by comparing the various individual and market characteristics. We utilized individual household-level census data in the United States to detect different responses between single-family housing occupiers and multifamily housing occupiers during the 1980s. We found that although the investment potential for multifamily housing was almost equivalent to that of si...

  11. Quality of Life of Families with Children Who Have Severe Developmental Disabilities: A Comparison Based on Child Residence

    Science.gov (United States)

    McFelea, Joni Taylor; Raver, Sharon

    2012-01-01

    This study measured the quality of life of two groups of families with children who had severe developmental disabilities-families whose child lived at home and families whose child lived in a residential facility. Participants were 54 primary caregivers of children who had severe intellectual disabilities and who lacked the ability to both…

  12. Staff Perceptions Before and After Adding Single-Family Rooms in the NICU.

    Science.gov (United States)

    Bosch, Sheila; Bledsoe, Tamara; Jenzarli, Ali

    2012-01-01

    The purpose of this study is to evaluate staff perceptions of environmental quality before and after the renovation of an existing open-bay neonatal intensive care unit (NICU) and the addition of 23 single-family NICU rooms in the Wasie Neonatal ICU at Joe DiMaggio Children's Hospital. In recent years there has been an increase in the design and construction of single-family rooms (SFRs) because they provide more privacy for families, offer better control over environmental stimuli such as lighting and noise, and possibly reduce infections. On the other hand, this model can cause staff members to feel isolated from one another, reduce their ability to respond quickly in a crisis situation, or impose additional demands on them. Few studies document the advantages and disadvantages of the SFR NICU model. This study utilized pre- and post-move surveys to investigate staff perceptions of the NICU. Overall, staff members perceive the quality of the work environment, and the safety and quality of the environment provided to patients and their families, as better in the renovated, combination NICU design (SFR and open bay) when compared to the open-bay, pre-move design. In spite of the potential drawbacks of having SFRs in the NICU, the study demonstrates that nurses may perceive associated benefits, such as a reduction of job stress and improvements in parental privacy, along with other positive outcomes.

  13. SBS symptoms in relation to dampness and ventilation in inspected single-family houses in Sweden.

    Science.gov (United States)

    Smedje, Greta; Wang, Juan; Norbäck, Dan; Nilsson, Håkan; Engvall, Karin

    2017-06-17

    To investigate the relationships between symptoms compatible with the sick building syndrome (SBS) in adults and building dampness and ventilation in single-family houses. Within the Swedish BETSI study, a national sample of single-family houses were inspected by professional building experts, and adults living in the houses answered a questionnaire on SBS. Relationships between building factors and SBS were analysed using logistic regression. Of the respondents, 23% reported having had weekly SBS symptoms during the last three months. A large proportion of houses exhibited building or construction problems. In total, 40% of houses had dampness problems in the foundation, and this was related to a higher prevalence of both mucous and dermal symptoms, and any SBS symptoms. Furthermore, high air humidity was related to more symptoms, with the relationship with absolute humidity being stronger than that with relative humidity or moisture load. Symptoms were also more prevalent in houses with a high U value, reflecting a poor thermal insulation. Compared to natural ventilation, living in a house with mechanical supply and exhaust ventilation was related to a lower prevalence of general symptoms and any SBS symptoms, but there were only weak associations between measured air exchange rate and symptoms. A large proportion of single-family houses have dampness problems in the foundation, and pollutants may enter the living space of the house and affect the health of the occupants. Furthermore, absolute air humidity should be measured more often in indoor air studies.

  14. A retrospective review of required projects in systems-based practice in a single anesthesiology residency: a 10-year experience.

    Science.gov (United States)

    Sakai, Tetsuro; Emerick, Trent D; Patel, Rita M

    2015-09-01

    The Accreditation Council for Graduate Medical Education has emphasized in its core competencies and more recently, in its Milestones Project, that residents understand the importance of systems-based practice (SBP). The objectives of the study are to evaluate the quality of residents' SBP projects and to determine the degrees that were subsequently implemented. A retrospective educational observational study. A university-based anesthesiology training institution. One hundred forty-nine anesthesiology residents in their final (postgraduate year 4) year of training who completed SBP projects for the last 10 years (2004-2013). A structured SBP course was provided for postgraduate year 4 anesthesiology residents with deadlines set such as project identification, data collection, and proposal draft. Each resident's written SBP proposal received inputs by 2 members of the department executive steering committee. The SBP projects concluded with oral presentations by each resident to the department executive steering committee, who provided overall scores. All SBP projects were categorized into 7 categories: safety initiatives, economic analysis, process analysis, policy change recommendations, education initiatives, teamwork/communication, and operating room efficiency. Evaluation scores using a Likert scale (1-9, where 9 is the best) were analyzed. The rate of implementation of project ideas within the department based on the presentations to the executive committee was examined. Of 149 projects, policy change recommendations was the most frequently chosen category (46 projects; 30.9%), followed by process analysis (36 projects; 24.2%). The overall evaluation score was 7.6 ± 0.6 (mean ± SD). A total of 53 projects (35.6%) were implemented in the department. There was no statistical difference between SBPs with implementation vs SBPs without implementation in terms of evaluation scores, year of the presentation, or categories. This SBP project has given residents the

  15. “Now I Don’t Have to Guess”: Using Pamphlets to Encourage Residents and Families/Friends to Engage in Advance Care Planning in Long-Term Care

    Science.gov (United States)

    Sussman, Tamara; Kaasalainen, Sharon; Bui, Matthew; Akhtar-Danesh, Noori; Mintzberg, Susan; Strachan, Patricia

    2017-01-01

    Objective: This article explores whether access to illness trajectory pamphlets for five conditions with high prevalence in long-term care (LTC) can encourage residents and families/friends to openly engage in advance care planning (ACP) discussions with one another and with health providers. Method: In all, 57 residents and families/friends in LTC completed surveys and 56 participated in seven focus groups that explored whether the pamphlets supported ACP engagement. Results: Survey results suggested that access to pamphlets encouraged residents and families/friends to reflect on future care (48/57, 84%), clarified what questions to ask (40/57, 70%), and increased comfort in talking about end of life (EOL) care (36/57, 63%). Discussions between relatives and friends/families (32/57, 56%) or with health providers (21/57, 37%) were less common. Focus group deliberations illuminated that while reading illness-specific information was validating, a tendency to protect one another from an emotional topic, prevented residents and families/friends from conversing with one another about EOL issues. Discussion: Having access to pamphlets with information about EOL care provides important and welcome opportunities for reflection for both residents in LTC and their families/friends. Moving residents and families/friends from reflecting on issues to discussing them together could require staff support through planned care conferences or staff initiated conversations at the bedside. PMID:29308424

  16. “Now I Don’t Have to Guess”: Using Pamphlets to Encourage Residents and Families/Friends to Engage in Advance Care Planning in Long-Term Care

    Directory of Open Access Journals (Sweden)

    Tamara Sussman MSW, PhD

    2017-12-01

    Full Text Available Objective: This article explores whether access to illness trajectory pamphlets for five conditions with high prevalence in long-term care (LTC can encourage residents and families/friends to openly engage in advance care planning (ACP discussions with one another and with health providers. Method: In all, 57 residents and families/friends in LTC completed surveys and 56 participated in seven focus groups that explored whether the pamphlets supported ACP engagement. Results: Survey results suggested that access to pamphlets encouraged residents and families/friends to reflect on future care (48/57, 84%, clarified what questions to ask (40/57, 70%, and increased comfort in talking about end of life (EOL care (36/57, 63%. Discussions between relatives and friends/families (32/57, 56% or with health providers (21/57, 37% were less common. Focus group deliberations illuminated that while reading illness-specific information was validating, a tendency to protect one another from an emotional topic, prevented residents and families/friends from conversing with one another about EOL issues. Discussion: Having access to pamphlets with information about EOL care provides important and welcome opportunities for reflection for both residents in LTC and their families/friends. Moving residents and families/friends from reflecting on issues to discussing them together could require staff support through planned care conferences or staff initiated conversations at the bedside.

  17. Multivariate family factors in lifetime and current marijuana use among American Indian and white adolescents residing on or near reservations.

    Science.gov (United States)

    Swaim, Randall C; Stanley, Linda R

    2016-12-01

    Rates of marijuana use are consistently high among reservation-based American Indian adolescents. The roles of family are unique in this ethnic group and can serve as sources of both risk and protection for substance use. To assess the relationships between distal and proximal family factors and lifetime and current marijuana use among American Indian and white middle and high school students who attend the same schools on or near reservations. In-school surveys were administered to 3380 American Indian and 1562 white students from 35 middle schools and 17 high schools regarding levels of marijuana use and family characteristics. Three logistic regression models (Control, Control+Distal; Control+Distral+Proximal) estimated effects of multiple family variables on lifetime and current marijuana use. Strong effects were found for family structure, parental monitoring, family conflict, and family sanctions against marijuana use. Weaker effects were found for family participation in school events, and no relationship was found for family communication about marijuana. Anumber of similar results were found across ethnicity and middle and high school students. Family variables exert strong and largely consistent effects across reservation-based American Indian and white youth on lifetime and current marijuana use. Interventions that include a broad range of targeted family components may serve to both limit uptake and forestall increases in adolescent marijuana use in these two groups. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  18. Trends in performance on the psychiatry resident-in-training examination (PRITE®): 10 years of data from a single institution.

    Science.gov (United States)

    Cooke, Brian K; Garvan, Cynthia; Hobbs, Jacqueline A

    2013-07-01

    The purpose of this study was to examine trends in the Psychiatry Resident-In-Training Examination (PRITE®) scores at one institution from 2001 to 2010. The authors hypothesized that two factors, the 2003 implementation of the Accreditation Council for Graduate Medical Education (ACGME) duty-hour restrictions and the residency program's 2008 restructuring of its curriculum to a half-day per week of didactics, would lead to improved scores. Residents in the general psychiatry program at the University of Florida College of Medicine from 2001 to 2010 were included in this study. To examine the effect of the 2003 ACGME duty-hours change, the authors compared test results from 2001-2002 and 2003-2010. To examine the effect of the 2008 didactic restructuring, they compared test results from 2001-2007 and 2008-2010. There were 288 PRITE test scores from 2001 to 2010. The authors did not find a statistical difference between test results before and after the 2003 implementation of ACGME duty-hour restrictions or between test results before and after the 2008 restructuring of residency didactics. The hypothesis was rejected. The results of the literature review propose that examination scores are affected by other elements of residency training.

  19. ILS Heuristics for the Single-Machine Scheduling Problem with Sequence-Dependent Family Setup Times to Minimize Total Tardiness

    OpenAIRE

    Vilar Jacob, Vinícius; Arroyo, José Elias C.

    2016-01-01

    This paper addresses a single-machine scheduling problem with sequence-dependent family setup times. In this problem the jobs are classified into families according to their similarity characteristics. Setup times are required on each occasion when the machine switches from processing jobs in one family to jobs in another family. The performance measure to be minimized is the total tardiness with respect to the given due dates of the jobs. The problem is classified as $\\mathcal{N}\\mathcal{P}$...

  20. National impacts of the Weatherization Assistance Program in single-family and small multifamily dwellings

    Energy Technology Data Exchange (ETDEWEB)

    Brown, M.A.; Berry, L.G.; Balzer, R.A.; Faby, E.

    1993-05-01

    Since 1976, the US Department of Energy (DOE) has operated one of the largest energy conservation programs in the nation -- the low-income Weatherization Assistance Program. The program strives to increase the energy efficiency of dwellings occupied by low-income persons in order to reduce their energy consumption, lower their fuel bills, increase the comfort of their homes, and safeguard their health. It targets vulnerable groups including the elderly, people with disabilities, and families with children. The most recent national evaluation of the impacts of the Program was completed in 1984 based on energy consumption data for households weatherized in 1981. DOE Program regulations and operations have changed substantially since then: new funding sources, management principles, diagnostic procedures, and weatherization technologies have been incorporated. Many of these new features have been studied in isolation or at a local level; however, no recent evaluation has assessed their combined, nationwide impacts to date or their potential for the future. In 1990, DOE initiated such an evaluation. This evaluation is comprised of three ``impact`` studies (the Single-Family Study, High-Density Multifamily Study, and Fuel-Oil Study) and two ``policy`` studies. Altogether, these five studies will provide a comprehensive national assessment of the Weatherization Assistance Program as it existed in the 1989 Program Year (PY 1989). This report presents the results of the first phase of the Single-Family Study. It evaluates the energy savings and cost effectiveness of the Program as it has been applied to the largest portion of its client base -- low-income households that occupy single-family dwellings, mobile homes, and small (2- to 4-unit) multifamily dwellings. It is based upon a representative national sample that covers the full range of conditions under which the program was implemented in PY 1989.

  1. Social support, stress and self-esteem in women from single-parent and bi-parent families

    Directory of Open Access Journals (Sweden)

    René Landero Hernández

    2011-07-01

    Full Text Available The objectives of the current study were to describe the characteristics of women from single-parent families and bi-parent families; and to compare their scores of social support, stress and self-esteem. We worked with a nonprobabilistic sample of 210 mothers, 105 from bi-parent families and 105 from single-parent families. Participants were interviewed in their houses. The mean age was 39.9 years old, and the children average was 2.1. Main results using Mann-Whitney U to compare differences between types of families showed that single woman score lower on scales of social support and self-esteem, and higher on scale of stress than women from bi-parent families.

  2. Quantification of protein copy number in single mitochondria: The Bcl-2 family proteins.

    Science.gov (United States)

    Chen, Chaoxiang; Zhang, Xiang; Zhang, Shuyue; Zhu, Shaobin; Xu, Jingyi; Zheng, Yan; Han, Jinyan; Zeng, Jin-Zhang; Yan, Xiaomei

    2015-12-15

    Bcl-2 family proteins, represented by antiapoptotic protein Bcl-2 and proapoptotic protein Bax, are key regulators of mitochondria-mediated apoptosis pathway. To build a quantitative model of how Bcl-2 family protein interactions control mitochondrial outer membrane permeabilization and subsequent cytochrome c release, it is essential to know the number of proteins in individual mitochondria. Here, we report an effective method to quantify the copy number and distribution of proteins in single mitochondria via immunofluorescent labeling and sensitive detection by a laboratory-built high sensitivity flow cytometer (HSFCM). Mitochondria isolated from HeLa cells were stained with Alexa Fluor 488 (AF488)-labeled monoclonal antibodies specifically targeting Bcl-2 or Bax and with nucleic acid dye. A series of fluorescent nanospheres with fluorescence intensity calibrated in the unit of molecules of equivalent soluble fluorochrome (MESF)-AF488 were used to construct a calibration curve for converting the immunofluorescence of a single mitochondrion to the number of antibodies bound to it and then to the number of proteins per mitochondrion. Under the normal condition, the measured mean copy numbers were 1300 and 220 per mitochondrion for Bcl-2 and Bax, respectively. A significant variation in protein copy number was identified, which ranged from 130 to 6000 (2.5-97.5%) for Bcl-2 and from 65 to 700 (2.5-97.5%) for Bax, respectively. We observed an approximately 4.4 fold increase of Bax copy number per mitochondrion upon 9h of apoptosis stimulation while the abundance of Bcl-2 remained almost unchanged. To the best of our knowledge, this is the first report of Bcl-2 family protein copy number and variance in single mitochondria. Collectively, we demonstrate that the HSFCM-based immunoassay provides a rapid and sensitive method for determining protein copy number distribution in single mitochondria. Copyright © 2015 Elsevier B.V. All rights reserved.

  3. Association between family factors and children's oral health behaviors--a cross-sectional comparative study of permanent resident and migrant children in large cities in China.

    Science.gov (United States)

    Ji, Ying; Zhang, Yan; Wang, Yanling; Chang, Chun

    2016-02-01

    To examine the association of family factors on oral health behaviors of children and compare them between permanent residents and migrant children. A total of 3015 children in grades 4, 5, and 6 from 16 elementary schools and their parents in Beijing and Guangzhou, China, were selected through multistage stratified cluster random sampling. Questionnaires constructed for this study were self-completed by children and parents to collect information on children's oral health behaviors (COHB), parents' modeling behaviors (PMB), parents' direct controlling behaviors (PDCB), parents' indirect controlling behaviors (PICB), parents' oral health knowledge and attitudes (POHKA), and children's oral health knowledge and attitudes (COHKA). Correlation analysis and path analysis were used to explore the correlation between COHB and PMB, as well as the effects of family factors [socioeconomic status (SES), PMB, PDCB, PICB, and POHKA on COHB]. Considering all participants, the rates of behavioral similarities of parents and children were 63.8-86.1%, all showing statistical significance. For family factors included, PMB, SES, PICB, and POHKA demonstrated positive relationships with COHB with standardized coefficients of 0.200, 0.122, 0.040, and 0.059 in residents and 0.160, 0.121, 0.090, and 0.041 in migrants, respectively. Family SES was associated with COHB directly and indirectly to a similar degree. In migrants, the relationship between COHKA and COHB was greater than that between PMB and COHB. COHB scores were higher in younger children. In residents, the relationship between PMB and COHB was greater than that between COHKA and COHB. COHB scores were slightly higher in older children indirectly influenced by increases in COHKA. Parents' behaviors shared relatively high similarities with COHB and family factors were associated with COHB greatly. The relationship between PMB and COHB was less than that between COHKA and COHB in migrants. The association between family factors

  4. Physical and Psychological Health of Family Carers Co-Residing with an Adult Relative with an Intellectual Disability

    Science.gov (United States)

    Grey, Jillian M.; Totsika, Vasiliki; Hastings, Richard P.

    2018-01-01

    Background: Providing long-term care to an adult relative with intellectual disability can impact negatively on caregivers' health and well-being. Methods: Data were collected via online and postal questionnaires on 110 family carers' physical and psychological health, family stress and perceived positive gains from caring. Psychological…

  5. Awareness of dementia by family carers of nursing home residents dying with dementia: A post-death study

    NARCIS (Netherlands)

    Penders, Y.W.H.; Albers, G.; Deliens, L.; van der Stichele, R.; Block, L.

    2015-01-01

    Background: High-quality palliative care for people with dementia should be patient-centered, family-focused, and include well-informed and shared decision-making, as affirmed in a recent white paper on dementia from the European Association for Palliative Care. Aim: To describe how often family

  6. Atopic Eczema and Stress among Single Parents and Families: An Empirical Study of 96 Mothers.

    Science.gov (United States)

    Gieler, Uwe; Schoof, Stefanie; Gieler, Tanja; Scheewe, Sibylle; Schut, Christina; Kupfer, Jörg

    2017-01-04

    This study investigated the extent to which single mothers of children with atopic eczema experience disease-related stress. A total of 96 mothers were divided into 4 groups: mothers living with a partner, who had or did not have a child with atopic eczema, and single mothers, who had or did not have a child with atopic eczema. The following questionnaires were used to assess psychological burden: Short Stress Questionnaire (Kurzer Fragebogen zur Erfassung von Belastung; KFB), Satisfaction with Life Questionnaire (Fragebogen zur Lebenszufriedenheit; FLZ), General Depression Scale (Allgemeine Depressions-Skala; ADS), and the Questionnaire for Parents of Children with Atopic Eczema (Fragebogen für Eltern von Neurodermitis kranken Kindern; FEN). Single mothers had higher levels of helplessness and aggression due to their child's scratching behaviour than did mothers living with a partner and a child with atopic eczema. Single mothers of children with atopic eczema had the highest scores regarding experienced stress in the family and the lowest scores concerning general life satisfaction. Special care should be provided for single mothers with higher stress, in order to teach them how to deal with the scratching behaviour of their children.

  7. Marginal Effects of a Gross Income Increase for a Single Parent Family in Six European Countries

    DEFF Research Database (Denmark)

    Willumsen, Marie

    High marginal tax rates constitute an issue in several countries because they are supposed to create barriers for increased labour supply. It is, however, often the case that relatively low income families with children face substantially higher combined marginal rates than even the highest...... marginal tax rates. High combined marginal rates are generated by increasing payment for care for children in childcare institutions and tapering of housing benefits in addition to taxation, when income rises. These effects are often simultaneous and add to the marginal tax rate. This paper explores...... the contributions to the combined marginal rate, the marginal effective tax rate, METR, using the OECD term, from taxation, payment for childcare, tapering of housing benefits and sometimes child benefits, when the income varies from a low level to a high level for a single parent family. Six countries are included...

  8. Family-Centered Management of Sensory Challenges of Children With Autism: Single-Case Experimental Design.

    Science.gov (United States)

    Bulkeley, Kim; Bundy, Anita; Roberts, Jacqueline; Einfeld, Stewart

    2016-01-01

    We explored the effectiveness of a sensory-based, family-centered coaching approach to changing problematic routines for young children with autism. Three mothers of young children with autism, atypical sensory processing, and global developmental delay each participated in a single-case experimental ABA design study. Mothers selected a problematic daily routine linked to sensory challenges as the focus of four intervention sessions provided in the home. Changes in mothers' perceptions of the children's behavior were the primary outcome, measured daily on a visual analog scale. Visual and descriptive analyses were undertaken. The sensory-based, family-centered coaching approach showed promise for changing sensory-related problem behaviors of young children with autism, but the degree and maintenance of the intervention effect varied among participants. Copyright © 2016 by the American Occupational Therapy Association, Inc.

  9. Effects of single-family rooms on nurse-parent and nurse-infant interaction in neonatal intensive care unit.

    Science.gov (United States)

    Toivonen, Mirka; Lehtonen, Liisa; Löyttyniemi, Eliisa; Axelin, Anna

    Single-family rooms in neonatal intensive care unit can provide longer interaction between family and staff. On the other hand, separation in private rooms has been shown detrimental to child development if parents are not present. To examine the effects of single-family rooms on nurse-family, nurse-parent and nurse-infant interaction time in neonatal intensive care unit. A quantitative, comparative, observational study was conducted before and after a move to a neonatal intensive care unit with single-family rooms. A total of 194 observation hours were conducted before the move and 194h after the move. The differences were analyzed using a hierarchical linear mixed model. Nurses working in one neonatal intensive care unit were recruited to study. The duration and number of nurse-parent and nurse-infant interaction episodes were recorded. The nurse-family and the nurse-parent interaction were longer in the unit with single-family rooms compared with the unit before the move (mean 261 vs. 138min per shift, pintensive care unit with single-family rooms supported an increase in nurse-parent interaction time. Importantly, nurse-infant interaction time did not decrease. Copyright © 2017 Elsevier B.V. All rights reserved.

  10. Implementation of a Resident-Led Osteopathic Manipulative Treatment Clinic in an Allopathic Residency.

    Science.gov (United States)

    Busey, Blake; Newsome, Jelaun; Raymond, Tyler; O'Mara, Heather

    2015-12-01

    With the growing number of osteopathic physicians practicing in the United States and the creation of a single graduate medical education system, a continued need exists for focused education in osteopathic principles, philosophy, and treatment modalities in primarily allopathic residency programs. To create and integrate a resident-led osteopathic manipulative treatment (OMT) clinic in an allopathic residency program. After an informal needs assessment on the basis of resident survey data, a resident-led OMT clinic was created within a military allopathic family medicine residency program. A standard operating procedure, resident survey, and scheduling system were created by the residents for approval by the departmental and hospital leadership. Resident survey data pertaining to the time available to perform OMT, education, and faculty supervision of OMT were obtained before the clinic implementation and 1 year after implementation. Nine osteopathic residents were surveyed before the OMT clinic implementation to illustrate a need for continued osteopathic medical education, faculty support, and skill maintenance. Sixteen osteopathic residents were surveyed after the OMT clinic implementation. More residents indicated that the establishment of an osteopathic curriculum was important (3 of 9 in the preclinic survey vs 9 of 16 in the postclinic survey) and that the program promoted the use of OMT (0 of 9 in the preclinic survey vs 13 of 16 in the postclinic survey). A resident-led OMT clinic can be successfully implemented, maintained, and expanded in an allopathic residency program by implementing an OMT curriculum, offering elective rotations, and encouraging regular use of OMT. The current project can be used as a framework for implementing an OMT clinic.

  11. Lead and other heavy metals in dust fall from single-family housing demolition.

    Science.gov (United States)

    Jacobs, David E; Cali, Salvatore; Welch, Alison; Catalin, Bogdan; Dixon, Sherry L; Evens, Anne; Mucha, Amy P; Vahl, Nicole; Erdal, Serap; Bartlett, John

    2013-01-01

    We measured lead and other heavy metals in dust during older housing demolition and effectiveness of dust suppression. We used American Public Housing Association Method 502 and U.S. Environmental Protection Agency Methods SW3050B and SW6020 at 97 single-family housing demolition events with intermittent (or no) use of water to suppress dust at perimeter, non-perimeter, and locations without demolition, with nested mixed modeling and tobit modeling with left censoring. The geometric mean (GM) lead dust fall during demolition was 6.01 micrograms of lead per square foot per hour (μg Pb/ft(2)/hour). GM lead dust fall was 14.18 μg Pb/ft(2)/hour without dust suppression, but declined to 5.48 μg Pb/ft(2)/hour (p=0.057) when buildings and debris were wetted. Significant predictors included distance, wind direction, and main street location. At 400 feet, lead dust fall was not significantly different from background. GM lead concentration at demolition (2,406 parts per million [ppm]) was significantly greater than background (GM=579 ppm, p=0.05). Arsenic, chromium, copper, iron, and manganese demolition dust fall was significantly higher than background (p<0.001). Demolition of approximately 400 old housing units elsewhere with more dust suppression was only 0.25 μg Pb/ft(2)/hour. Lead dust suppression is feasible and important in single-family housing demolition where distances between houses are smaller and community exposures are higher. Neighbor notification should be expanded to at least 400 feet away from single-family housing demolition, not just adjacent properties. Further research is needed on effects of distance, potential water contamination, occupational exposures, and water application.

  12. THE RATE OF FAMILY PLANNING METHODS USAGE OF 15-49 YEARS OLD WOMEN LIVING IN DUZCE PERMANENT RESIDENCES AND THE CAUSES OF PREFERING METHODS

    Directory of Open Access Journals (Sweden)

    Atilla Senih MAYDA

    2005-10-01

    Full Text Available The aim of this cross-sectional and descriptive study is to learn the level of knowledge and source of knowledge about family planing, the rate of women using family planning methods and the causes of prefering the used methods of 15-49 years old women living in Duzce Permanent Residences. The population of the study ise 4394 women 15-49 years old. Cluster sampling is used and 280 women included to the study. A questionnaire containg 41 questions about family planning methods usage and the causes of prefer them was applied to women with face to face interview. The rate of 232 married women using effective planning method is 53.4%, traditional methods 24.6%and not using any method 22%. The rate of effective method usage of all 280 women included to the study is 45.7%, traditional 21.1% and not using any method 33.2%. The causes to prefer the methods are 72 women (25.7% ?reliable?, 33 women (11.8% ?side effects are less?, and 19 women (6.4% ?cheap?. All the women who began to use family planing methot by consulting with Health Center has used effective methods. Considering ?cheap? as a cause of prefer the method make us to think that the family planning methods could not be supported to the population unpaid. Using effective methods of all the women who began to use family planing methods by consulting with Health Center puts forward that Health Centers have an effective role in family planning activities. [TAF Prev Med Bull 2005; 4(5.000: 265-279

  13. On the thermal inertia and time constant of single-family houses

    Energy Technology Data Exchange (ETDEWEB)

    Hedbrant, J.

    2001-08-01

    Since the 1970s, electricity has become a common heating source in Swedish single-family houses. About one million small houses can use electricity for heating, about 600.000 have electricity as the only heating source, A liberalised European electricity market would most likely raise the Swedish electricity prices during daytime on weekdays and lower it at other times. In the long run, electrical heating of houses would be replaced by fuels, but in the shorter perspective, other strategies may be considered. This report evaluates the use of electricity for heating a dwelling, or part of it, at night when both the demand and the price are low. The stored heat is utilised in the daytime some hours later, when the electricity price is high. Essential for heat storage is the thermal time constant. The report gives a simple theoretical framework for the calculation of the time constant for a single-family house with furniture. Furthermore the comfort time constant, that is, the time for a house to cool down from a maximum to a minimum acceptable temperature, is derived. Two theoretical model houses are calculated, and the results are compared to data from empirical studies in three inhabited test houses. The results show that it was possible to store about 8 kWh/K in a house from the seventies and about 5 kWh/K in a house from the eighties. The time constants were 34 h and 53 h, respectively. During winter conditions with 0 deg C outdoor, the 'comfort' time constants with maximum and minimum indoor temperatures of 23 and 20 deg C were 6 h and 10 h. The results indicate that the maximum load-shifting potential of an average single family house is about 1 kw during 16 daytime hours shifted into 2 kw during 8 night hours. Upscaled to the one million Swedish single-family houses that can use electricity as a heating source, the maximum potential is 1000 MW daytime time-shifted into 2000 MW at night.

  14. Renovation of a Detached Single-Family House into an Energy Efficient Low Energy House

    DEFF Research Database (Denmark)

    Larsen, Tine Steen; Maagaard, Steffen; Jensen, Rasmus Lund

    2011-01-01

    single-family house built in the early nineteen seventies. The old house was renovated in accordance to the best Danish low energy class (class 1). The project was followed by detailed measurements of the indoor environment (temperature, relative humidity and CO2 levels) and energy consumption for room...... heating and hot water supply. Measurements were carried out before and after the renovation in order to compare results and see whether the ambition for a 78% reduction in the energy consumption was reached. The paper will describe some of the most important factors regarding the energy renovation, which...

  15. Evaluation of the renovation of a Danish single-family house based on measurements

    DEFF Research Database (Denmark)

    Grøn Bjørneboe, Matilde; Svendsen, Svend; Heller, Alfred

    2017-01-01

    Building renovation is too often carried out with only one objective: necessary maintenance, updating design and functions, or reducing energy consumption. But, if a necessary maintenance is exploited as an opportunity for renovation, energy improvements can be implemented, house functions can...... be updated, and indoor climate improved with minimal nuisance and expense. This paper illustrates this approach by documenting the renovation of a single-family house in Denmark, and monitoring its energy consumption and indoor climate before and after the renovation. Building elements were replaced where...

  16. Moisture supply in Danish single-family houses – the influence of building style

    DEFF Research Database (Denmark)

    Hansen, Ernst Jan de Place; Møller, Eva B.

    2017-01-01

    are important as well. Further it was investigated whether snapshot measurements in materials could replace logging of relative humidity and temperature. Building type has only a limited effect on the moisture supply. Geographical location has an effect; however variations are not systematic. It is not possible......According to ISO 13788 internal moisture supply in dwellings can be described by humidity classes defined by outdoor temperature, occupancy and ventilation. Hygrothermal measurements in 500 Danish single-family houses were made to investigate if building style and geographical location...

  17. Single molecule tracking of Ace1p in Saccharomyces cerevisiae defines a characteristic residence time for non-specific interactions of transcription factors with chromatin.

    Science.gov (United States)

    Ball, David A; Mehta, Gunjan D; Salomon-Kent, Ronit; Mazza, Davide; Morisaki, Tatsuya; Mueller, Florian; McNally, James G; Karpova, Tatiana S

    2016-12-01

    In vivo single molecule tracking has recently developed into a powerful technique for measuring and understanding the transient interactions of transcription factors (TF) with their chromatin response elements. However, this method still lacks a solid foundation for distinguishing between specific and non-specific interactions. To address this issue, we took advantage of the power of molecular genetics of yeast. Yeast TF Ace1p has only five specific sites in the genome and thus serves as a benchmark to distinguish specific from non-specific binding. Here, we show that the estimated residence time of the short-residence molecules is essentially the same for Hht1p, Ace1p and Hsf1p, equaling 0.12-0.32 s. These three DNA-binding proteins are very different in their structure, function and intracellular concentration. This suggests that (i) short-residence molecules are bound to DNA non-specifically, and (ii) that non-specific binding shares common characteristics between vastly different DNA-bound proteins and thus may have a common underlying mechanism. We develop new and robust procedure for evaluation of adverse effects of labeling, and new quantitative analysis procedures that significantly improve residence time measurements by accounting for fluorophore blinking. Our results provide a framework for the reliable performance and analysis of single molecule TF experiments in yeast. Published by Oxford University Press on behalf of Nucleic Acids Research 2016. This work is written by (a) US Government employee(s) and is in the public domain in the US.

  18. Social support, stress and self-esteem in women from single-parent and bi-parent families

    National Research Council Canada - National Science Library

    René Landero Hernández; Mónica T. González Ramírez

    2011-01-01

    .... Main results using Mann-Whitney U to compare differences between types of families showed that single woman score lower on scales of social support and self-esteem, and higher on scale of stress...

  19. 76 FR 73653 - Notice of Withdrawal of Proposed Information Collection: Local Appeals to Single-Family Mortgage...

    Science.gov (United States)

    2011-11-29

    ...-Family Mortgage Limits AGENCY: Office of the Assistant Secretary for Housing, HUD. ACTION: Notice... to Single-Family Mortgage Limits. This notice announces the withdrawal of that proposed information collection. FOR FURTHER INFORMATION CONTACT: Program Contact, Arlene Nunes, Director, Home Mortgage Insurance...

  20. Familiarity with Long-acting Reversible Contraceptives among Obstetrics and Gynecology, Family Medicine, and Pediatrics Residents: Results of a 2015 National Survey and Implications for Contraceptive Provision for Adolescents.

    Science.gov (United States)

    Davis, Susan A; Braykov, Nikolay P; Lathrop, Eva; Haddad, Lisa B

    2017-09-21

    To assess familiarity with long-acting reversible contraceptives (LARC) among current obstetrics and gynecology (OB/GYN), family medicine (FM), and pediatrics senior residents in the United States. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: We selected 156 OB/GYN, FM, and pediatrics residency programs using the American Medical Association Freida database. Senior residents completed a survey addressing any training they had received on LARC, and rated their comfort level counseling about and inserting LARC. Residents rated their likelihood of recommending LARC to an adolescent, nulliparous patient, and indicated whether they would like additional training on LARC. Descriptive and analytic statistics were generated using R statistical software (The R Project for Statistical Computing; https://www.r-project.org). The survey was completed by 326 of 1,583 residents (20.6% response rate); at least 1 resident completed the survey at 105 (67.3%) of the residency programs contacted. Most programs (84.8%) provided some training on LARC. Residents in OB/GYN programs were comfortable counseling about and inserting contraceptive implants (97%, 83%), copper intrauterine devices (IUDs; 100%, 86%), and levonorgestrel (LNG) IUDs (100%, 86%). In FM programs, fewer residents were comfortable counseling about and inserting contraceptive implants (71%, 47%), copper IUDs (68%, 21%), and LNG IUDs (79%, 18%). Residents in pediatrics programs had low comfort levels counseling about contraceptive implants (14%), copper IUDs (14%), and LNG IUDs (25%); no pediatrics residents were comfortable inserting LARC. OB/GYN residents were significantly more likely to recommend a LARC to an adolescent, nulliparous patient (P = .019). Most pediatric and FM residents desired additional training on LARC (82.7% and 60.7%, respectively). This study shows that knowledge gaps exist regarding LARC among FM and pediatrics residents. Copyright © 2017 North American Society for

  1. Energy Efficiency Potential in the U.S. Single-Family Housing Stock

    Energy Technology Data Exchange (ETDEWEB)

    Wilson, Eric J. [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Christensen, Craig B. [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Horowitz, Scott G. [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Robertson, Joseph J. [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Maguire, Jeffrey B. [National Renewable Energy Laboratory (NREL), Golden, CO (United States)

    2017-12-19

    Typical approaches for assessing energy efficiency potential in buildings use a limited number of prototypes, and therefore suffer from inadequate resolution when pass-fail cost-effectiveness tests are applied, which can significantly underestimate or overestimate the economic potential of energy efficiency technologies. This analysis applies a new approach to large-scale residential energy analysis, combining the use of large public and private data sources, statistical sampling, detailed building simulations, and high-performance computing to achieve unprecedented granularity - and therefore accuracy - in modeling the diversity of the single-family housing stock. The result is a comprehensive set of maps, tables, and figures showing the technical and economic potential of 50 plus residential energy efficiency upgrades and packages for each state. Policymakers, program designers, and manufacturers can use these results to identify upgrades with the highest potential for cost-effective savings in a particular state or region, as well as help identify customer segments for targeted marketing and deployment. The primary finding of this analysis is that there is significant technical and economic potential to save electricity and on-site fuel use in the single-family housing stock. However, the economic potential is very sensitive to the cost-effectiveness criteria used for analysis. Additionally, the savings of particular energy efficiency upgrades is situation-specific within the housing stock (depending on climate, building vintage, heating fuel type, building physical characteristics, etc.).

  2. Residents’ and preceptors’ perceptions of the use of the iPad for clinical teaching in a family medicine residency program

    Science.gov (United States)

    2014-01-01

    Background As Family Medicine programs across Canada are transitioning into a competency-based curriculum, medical students and clinical teachers are increasingly incorporating tablet computers in their work and educational activities. The purpose of this pilot study was to identify how preceptors and residents use tablet computers to implement and adopt a new family medicine curriculum and to evaluate how they access applications (apps) through their tablet in an effort to support and enhance effective teaching and learning. Methods Residents and preceptors (n = 25) from the Family Medicine program working at the Pembroke Regional Hospital in Ontario, Canada, were given iPads and training on how to use the device in clinical teaching and learning activities and how to access the online curriculum. Data regarding the use and perceived contribution of the iPads were collected through surveys and focus groups. This mixed methods research used analysis of survey responses to support the selection of questions for focus groups. Results Reported results were categorized into: curriculum and assessment; ease of use; portability; apps and resources; and perceptions about the use of the iPad in teaching/learning setting. Most participants agreed on the importance of accessing curriculum resources through the iPad but recognized that these required enhancements to facilitate use. The iPad was considered to be more useful for activities involving output of information than for input. Participants’ responses regarding the ease of use of mobile technology were heterogeneous due to the diversity of computer proficiency across users. Residents had a slightly more favorable opinion regarding the iPad’s contribution to teaching/learning compared to preceptors. Conclusions iPad’s interface should be fully enhanced to allow easy access to online curriculum and its built-in resources. The differences in computer proficiency level among users should be reduced by sharing

  3. A Single-Case Study of Resiliency After Extreme Incest in an Old Order Amish Family.

    Science.gov (United States)

    McGuigan, William M; Stephenson, Sarah J

    2015-01-01

    This exploratory research brief presents a single case study of the resiliency of "Mary B." She grew up in an Old Order Amish family where isolation, secrecy, and patriarchy masked repeated sexual assaults by her older brothers that began at age 7. By the age of 20, Mary alleged she had been raped on more than 200 separate occasions by members of her Amish family. After years of pleading with her mother and church officials to intervene, she sought therapy outside the Amish community. This led to three of her brothers being incarcerated. Her family disowned her and she was banned from the Amish community, leaving with an 8th grade education and little more than the clothes she was wearing. In less than 2 years, Mary had moved to a new town, completed her GED, obtained a car and driving license, maintained a small home, and worked as a certified nursing assistant. She consented to tape recorded interviews and completed several quantitative diagnostic measures. Scores on the diagnostic measures placed her within the normal range on self-esteem, competency, depression, stress, social support, and life skills. Analysis of interviews revealed Mary rebounded from her past by reframing her experiences. Themes identified within the interviews supported 6 of the 7 types of resiliencies (insight, independence, initiative, relationships, humor, and morality) outlined in the therapeutic Challenge Model.

  4. Comparison of Parenting Style in Single Child and Multiple Children Families

    Directory of Open Access Journals (Sweden)

    Masoumeh Alidosti

    2016-06-01

    Full Text Available Background and Purpose: Family is the first and the most important structure in human civilization in which social lifestyles, mutual understanding, and compatibility is learned. Studies have shown that parenting style, is one the most important and fundamental factors in personality development. The purpose of this study was comparison of parenting style in single child and multiple children families. Materials and Methods: This study, in total, 152 mothers from Andimeshk city, Iran, were selected by random sampling. Data were collected from a health-care center was chosen randomly, mothers who had 5-7 years old children were enrolled in this study. The data collecting tool was the questionnaire which investigates permissive, authoritative, and authoritarian parenting styles in parents. After data entry in SPSS software, the collected data were analyzed by ANOVA, independent t-test, and Pearson correlation test. Results: The mean age of the participants was 32.71 ± 5.39 years old participated in this study. 69 mothers (45.4% had one child, 53 (34.9% had 2 children, and 30 mothers (19.7% had 3 and more children. The mean score of permissive parenting style was 19.97 ± 5.13 in single child families; the mean score of authoritative (19.56 ± 4.70 and authoritarian parenting style (34.50 ± 2.81 that difference was significantly (P < 0.050. Conclusion: According to the results of this study, it seems that having more children would make parents more logical and paves the way for upbringing children. Therefore, it is recommended to plan some educational programs about this issue for parents.

  5. [The young resident between work and family. Status quo and approaches to a solution in orthopedics and traumatology].

    Science.gov (United States)

    Depeweg, D; Achatz, G; Liebig, K; Lorenz, O

    2013-01-01

    The compatibility between the family and the medical profession requires a new challenge of leadership in hospitals, politics and medical societies. The generation change in the medical profession needs the implementation of modern framework conditions in the departments of orthopedics and traumatology. Topics such as work organisation, family support and programs to assist the return to work need to be discussed and should be used as a competitive advantage. Employees of generation y need a gender-independent role model in the field of modern management methods in employee leadership.

  6. Educational Challenges and Diminishing Family Safety Net Faced by High-School Girls in a Slum Residence, Nairobi, Kenya

    Science.gov (United States)

    Abuya, Benta A.; Onsomu, Elijah O.; Moore, Dakysha

    2012-01-01

    In 2010, there was a slight decrease in the number of out-of school adolescents from 75 million in 2009 (UNESCO, 2009) to 71 million in 2010, of which 55% are girls (UNESCO, 2010). In Kenya, only 17% of girls have secondary education (CBS, 2004). This paper analyzes the role of families in girls' secondary education in two schools within Nairobi…

  7. Nursing Staff Stress From Caregiving and Attitudes Toward Family Members of Nursing Home Residents With Dementia in Korea

    Directory of Open Access Journals (Sweden)

    Myonghwa Park, PhD, RN

    2010-09-01

    Conclusions: The findings in this study showed a need for systematic educational programs for staff to enhance their dementia care knowledge, alleviate their stress, and finally change positively their attitudes toward family. As the number of dementia patients in long-term care facilities increases, it will be important for staff members to develop individually satisfying and mutually acceptable caregiving roles.

  8. Supervisor continuity or co-location: Which matters in residency education? Findings from a qualitative study of remote supervisor family physicians in Australia and Canada

    DEFF Research Database (Denmark)

    Wearne, Susan M.; Wearne, Susan M.; Wearne, Susan M.

    2015-01-01

    required supervisors to articulate and pass on their expertise to residents but made monitoring difficult. Supervisory continuity encouraged residents to build on past experiences and confront deficiencies. Conclusions Remote supervision enabled residents to develop as clinicians and professionals...

  9. Embryo genome profiling by single-cell sequencing for preimplantation genetic diagnosis in a β-thalassemia family

    DEFF Research Database (Denmark)

    Xu, Yanwen; Chen, Shengpei; Yin, Xuyang

    2015-01-01

    for a β-thalassemia-carrier couple to have a healthy second baby. We carried out sequencing for single blastomere cells and the family trio and further developed the analysis pipeline, including recovery of the missing alleles, removal of the majority of errors, and phasing of the embryonic genome...... leukocyte antigen matching tests. CONCLUSIONS: This retrospective study in a β-thalassemia family demonstrates a method for embryo genome recovery through single-cell sequencing, which permits detection of genetic variations in preimplantation genetic diagnosis. It shows the potential of single...

  10. Perception of educational environment in the operating theatre by surgical residents, a single-centre prospective study.

    Science.gov (United States)

    Soomro, Shahzaib Habib; Ur Rehman, Syed Sheeraz; Hussain, Farhad

    2017-12-01

    To evaluate the perception of operation theatre educational environment using surgical theatre educational environmental measure. This cross-sectional study was conducted at Liaquat National Hospital, Karachi, from August 2015 to February 2016, and comprised surgical and allied trainees. The reliability of the surgical theatre educational environmental measure questionnaire was assessed by Cronbach's alpha. The minimum score on the questionnaire was 40 and possible maximum score was 200. A score of at least 120 out of 200 was considered favourable. SPSS 22 was used for data analysis. Of the 103 participants who completed the questionnaire, 52(50.4%) were males and 51(49.5%) females. The results showed favourable operating theatre educational environment with the total score of 129. The overall reliability was calculated to be 0.97. Male residents perceived the educational environment more adequate than females (ptheatre educational environment.

  11. Breaking bad news in the emergency department: a comparative analysis among residents, patients and family members' perceptions.

    Science.gov (United States)

    Toutin-Dias, Gabriela; Daglius-Dias, Roger; Scalabrini-Neto, Augusto

    2018-02-01

    Our main objective was to assess patient and family members' perception of bad news communication in the emergency department (ED) and compare these with physicians' perceptions. This is a cross-sectional study carried out at the ED of a tertiary teaching hospital. To compare physicians' and receivers' (patient and/or family member) perceptions, we created a survey based on the six attributes derived from the SPIKES protocol. The surveys were applied immediately after communication of bad news occurred in the ED. We analyzed agreement among participants using κ-statistics and the χ-test to compare proportions. A total of 73 bad news communication encounters were analyzed. The survey respondents were 73 physicians, 69 family members, and four patients. In general, there is a low level of agreement between physicians' and receivers' perceptions of how breaking bad news transpired. The satisfaction level of receivers, in terms of breaking bad news by doctors, presented a mean of 3.7±0.6 points. In contrast, the physicians' perception of the communication was worse (2.9±0.6 points), with P value less than 0.001. Doctors and receivers disagree in relation to what transpired throughout bad news communications. Discrepancies were more evident in issues involving emotion, invitation, and privacy. An important agreement between perceptions was found in technical and knowledge-related aspects of the communication.

  12. Seasonal variations of radon concentrations in single-family houses with different sub-structures

    DEFF Research Database (Denmark)

    Majborn, B.

    1992-01-01

    with track detectors on a quarterly basis throughout a year. For living rooms and bedrooms the seasonal variations range from being highly significant for the slab-on-grade houses to being insignificant for the crawl space houses. For basements and crawl spaces the geometric mean radon concentrations do......Seasonal variations of indoor radon concentrations have been studied in 70 single-family houses selected according to the type of sub-structure and the type of soil underneath the house. Five categories of sub-structure were included - slab-on-grade, crawl space, basement, and combinations...... of basement with slab-on-grade or crawl space. Half of the houses are located on clayey till and the other half on glaciofluvial gravel. In each house radon was measured in a living room and a bedroom, in the basement if present, and in the crawl space if present and accessible. The measurements were made...

  13. Developmental issues impacting military families with young children during single and multiple deployments.

    Science.gov (United States)

    Barker, Lisa Hains; Berry, Kathy D

    2009-10-01

    Recent years have seen a dramatic increase in war time deployments for military service members. How have young children been affected by single and multiple Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) deployments? We found young children with a deployed parent showed increased behavior problems during deployment and increased attachment behaviors at reunion compared with children whose parents had not experienced a recent deployment. Child behavior problems were related to many individual child and family characteristics, such as child age and temperament, length of the deployment, total time deployed parent was absent, number of moves, and number of stressors reported by parent. Child attachment behaviors were related to the length of the deployment, number of deployments, and the number of stressors faced by the parent. Soldiers and spouses of soldiers who chose not to re-enlist more often described themselves as depressed, and had children with many more behavior problems at reunion.

  14. Estimating household food waste in Denmark:case study of single family households

    DEFF Research Database (Denmark)

    Edjabou, Vincent Maklawe Essonanawe; Petersen, C.; Scheutz, Charlotte

    211 single-family houses in Denmark. The residual waste from each household was collected and sorted separately to obtain a representative variation of the quantity and composition of food waste among households. The main fractions contributing to the household food waste were avoidable vegetable food......Food waste prevention remains the first priority in the European Waste Framework Directive, which aimed to halve the amount of food wasted within the EU Member States by 2025. Thus, reliable data on food waste composition and quantity are crucial for assessing the current food waste situation...... and determine potential improvements. In Denmark, although many sorting campaigns involving household waste has been conducted, little attention has been placed on food waste. Comparison of recent studies made for examples in Austria, and the UK suggests that quantity and material composition of food waste vary...

  15. High concentration of basidiolichens in a single family of agaricoid mushrooms (Basidiomycota: Agaricales: Hygrophoraceae).

    Science.gov (United States)

    Lawrey, James D; Lücking, Robert; Sipman, Harrie J M; Chaves, José L; Redhead, Scott A; Bungartz, Frank; Sikaroodi, Masoumeh; Gillevet, Patrick M

    2009-10-01

    The Agaricales is the largest and most diverse order of mushroom-forming Basidiomycota, with over 100 natural groups recognized in recent Fungal Tree of Life studies. Most agarics are either saprotrophic or ectomycorrhizal fungi, but the family Hygrophoraceae is in part characterized by a unique and remarkable diversity of lichenized forms. The most familiar of these is the chlorolichen genus Lichenomphalia, whose phylogenetic position in the Agaricales has been established. Recent limited evidence suggested that Hygrophoraceae also contains cyanolichens in the genus Dictyonema, which indicates a remarkable concentration and diversity of lichen-formers in a single family of agarics. To demonstrate the relationships of lichen-formers to other fungi in the family, we assembled ribosomal sequences from 52 species representing recognized groups within the Hygrophoraceae, among them new sequences representing Acantholichen and most species and forms of Dictyonema. The molecular data were evaluated using parsimony, likelihood, Bayesian, and distance analyses, including coding of ambiguous regions by means of INAASE and ARC, all of which indicate that Dictyonema and Acantholichen form a monophyletic clade derived from the primarily bryophilous genus Arrhenia and sister to the enigmatic Athelia pyriformis, a species unrelated to the Atheliales for which we are proposing a new genus name Eonema. The chlorolichen genus Lichenomphalia may be polyphyletic. Fungi in the Dictyonema-Acantholichen clade are typically tropical, entirely lichenized, and associate with cyanobacterial photobionts. Our data indicate a transition from agaricoid-omphalinoid basidiomes observed in Arrhenia to stereoid-corticioid forms in Dictyonema, and also support a previous suggestion of a connection between loss of clamp connections and lichenization. The diverse basidiome and thallus morphologies and nutritional ecologies of these fungi indicate a remarkable evolutionary flexibility that appears to

  16. Segmental hair mercury evaluation of a single family along the Upper Madeira Basin, Brazilian Amazon

    Directory of Open Access Journals (Sweden)

    Boischio Ana Amélia Peixoto

    2000-01-01

    Full Text Available Mercury pollution (MeHg up the aquatic food chains in the Amazonian ecosystems has been a major concern in environmental health. Riverside people (ribeirinhos along the Upper Madeira river are heavy fish eaters. Hair is the best biomarker for MeHg exposure. By assuming a constant hair growth rate, it is possible to evaluate a temporal profile of Hg exposure over the recent defined past. In this paper we present the segmental total hair Hg concentrations from a single family from which some of the 10 persons investigated had high hair Hg concentrations (peak of 339 ppm. We also presented the hair MeHg content from 4 out of the 10 family members investigated. There was a wide variation in total hair Hg concentrations (8 to 339 ppm among these individuals, who were mostly sharing their meals; there was also a wide variation in total Hg concentrations in the same individual over time (136 to 274 ppm. Hg speciation showed a mean and standard deviation in the MeHg content of 62% and 6%, respectively. The wide variation in total hair Hg concentration strongly indicated that it is possible to mitigate critical Hg exposure levels by conducting a fish advisory.

  17. The study protocol of a cluster-randomised controlled trial of family-mediated personalised activities for nursing home residents with dementia

    Directory of Open Access Journals (Sweden)

    van der Ploeg Eva S

    2012-01-01

    Full Text Available Abstract Background Following admission to a nursing home, the feelings of depression and burden that family carers may experience do not necessarily diminish. Additionally, they may experience feelings of guilt and grief for the loss of a previously close relationship. At the same time, individuals with dementia may develop symptoms of depression and agitation (BPSD that may be related to changes in family relationships, social interaction and stimulation. Until now, interventions to alleviate carer stress and BPSD have treated carers and relatives separately rather than focusing on maintaining or enhancing their relationships. One-to-one structured activities have been shown to reduce BPSD and also improve the caring experience, but barriers such as a lack of resources impede the implementation of activities in aged care facilities. The current study will investigate the effect of individualised activities based on the Montessori methodology administered by family carers in residential care. Methods/Design We will conduct a cluster-randomised trial to train family carers in conducting personalised one-to-one activities based on the Montessori methodology with their relatives. Montessori activities derive from the principles espoused by Maria Montessori and subsequent educational theorists to promote engagement in learning, namely task breakdown, guided repetition, progression in difficulty from simple to complex, and the careful matching of demands to levels of competence. Persons with dementia living in aged care facilities and frequently visiting family carers will be included in the study. Consented, willing participants will be randomly assigned by facility to a treatment condition using the Montessori approach or a control waiting list condition. We hypothesise that family carers conducting Montessori-based activities will experience improvements in quality of visits and overall relationship with the resident as well as higher self

  18. The study protocol of a cluster-randomised controlled trial of family-mediated personalised activities for nursing home residents with dementia.

    Science.gov (United States)

    van der Ploeg, Eva S; Camp, Cameron J; Eppingstall, Barbara; Runci, Susannah J; O'Connor, Daniel W

    2012-01-12

    Following admission to a nursing home, the feelings of depression and burden that family carers may experience do not necessarily diminish. Additionally, they may experience feelings of guilt and grief for the loss of a previously close relationship. At the same time, individuals with dementia may develop symptoms of depression and agitation (BPSD) that may be related to changes in family relationships, social interaction and stimulation. Until now, interventions to alleviate carer stress and BPSD have treated carers and relatives separately rather than focusing on maintaining or enhancing their relationships. One-to-one structured activities have been shown to reduce BPSD and also improve the caring experience, but barriers such as a lack of resources impede the implementation of activities in aged care facilities. The current study will investigate the effect of individualised activities based on the Montessori methodology administered by family carers in residential care. We will conduct a cluster-randomised trial to train family carers in conducting personalised one-to-one activities based on the Montessori methodology with their relatives. Montessori activities derive from the principles espoused by Maria Montessori and subsequent educational theorists to promote engagement in learning, namely task breakdown, guided repetition, progression in difficulty from simple to complex, and the careful matching of demands to levels of competence. Persons with dementia living in aged care facilities and frequently visiting family carers will be included in the study. Consented, willing participants will be randomly assigned by facility to a treatment condition using the Montessori approach or a control waiting list condition. We hypothesise that family carers conducting Montessori-based activities will experience improvements in quality of visits and overall relationship with the resident as well as higher self-rated mastery, fewer depressive symptoms, and a better

  19. An Evaluation of a Family Counseling Intervention ("Tuko Pamoja") in Kenya: a Single Case Series Design

    Science.gov (United States)

    2017-11-27

    Mental Health; Family Relations; Family Conflict; Child Mental Disorder; Adolescent - Emotional Problem; Adolescent Problem Behavior; Child Behavior; Child Abuse; Marital Conflict; Domestic Violence; Parent-Child Relations; Parenting

  20. Single-parenthood by choice: Children’s socialization processes into a non-conventional family model

    Directory of Open Access Journals (Sweden)

    David Poveda

    2011-07-01

    Full Text Available In this article we present part of our findings from a research project focused on single-parent families by choice. The study collected data in three autonomous communities in Spain and includes interviews with mothers involved in single parent-projects (through adoption, foster parenting, assisted reproductive technologies or sexual fertilization through a known donor and their children about their family experiences, observations in different formative, associative and virtual spaces in which these families participate and a compilation of different documents on parenthood by choice. We focus on the way in which the children we have studied build their own non-conventional family model. We understand the construction of this model as a process of co-construction of the child's subjectivity in which mothers and other socializing agents play an active role.

  1. Pilot study comparing multi-family therapy to single family therapy for adults with anorexia nervosa in an intensive eating disorder program.

    Science.gov (United States)

    Dimitropoulos, Gina; Farquhar, Jamie C; Freeman, Victoria Emily; Colton, Patricia Anne; Olmsted, Marion Patricia

    2015-07-01

    Multi-family therapy (MFT) has yet to be evaluated in families of adults with anorexia nervosa (AN). The study aims were: (i) assess the feasibility of MFT for AN; and, (ii) assess whether MFT is associated with improved outcomes for families compared with single-family therapy (SFT). Adult patients with AN consecutively referred to an eating disorder treatment program were assigned (non-randomly) to receive eight sessions of SFT or MFT. Assessment occurred pre-therapy, immediately post-therapy, and at 3-month follow-up. A total of 37 female patients (13 SFT, 24 MFT) and 45 family members (16 SFT, 29 MFT) completed treatment. There were significant time effects for patients' BMI, eating disorder-related psychopathology and multiple family outcome measures. There were no differences between MFT and SFT on family outcome measures at end of treatment and 3 months post treatment. MFT is a feasible intervention that can be used in adult intensive treatment for those with AN. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.

  2. Results of a voter registration project at 2 family medicine residency clinics in the Bronx, New York.

    Science.gov (United States)

    Liggett, Alisha; Sharma, Manisha; Nakamura, Yumiko; Villar, Ryna; Selwyn, Peter

    2014-01-01

    Federally qualified health centers provide care to medically underserved populations, the same individuals often underrepresented in the electoral process. These centers are unique venues to access patients for voter registration services. We undertook a clinician-led, nonpartisan voter registration drive within 2 university-affiliated federally qualified health centers in the Bronx, New York. Patients were approached by voter registration volunteers in clinic waiting areas during a 12-week period. Volunteers directly engaged with 304 patients. Of the 128 patients who were eligible and not currently registered, 114 (89%) registered to vote through this project. This number corresponded to 38% of all patients engaged. Sixty-five percent of new registrants were aged younger than 40 years. This project was successful in registering clinic patients to vote. Clinics are not only health centers, but also powerful vehicles for bringing a voice to civically disenfranchised communities. © 2014 Annals of Family Medicine, Inc.

  3. Children Raised in Fatherless Families from Infancy: A Follow-Up of Children of Lesbian and Single Heterosexual Mothers at Early Adolescence

    Science.gov (United States)

    MacCallum, Fiona; Golombok, Susan

    2004-01-01

    Background: An increasing number of lesbian women and single heterosexual women are bringing up children with no male involvement. This study follows up to adolescence a sample of children raised in fatherless families from birth or early infancy. Methods: Twenty-five lesbian mother families and 38 families headed by a single heterosexual mother…

  4. Residents with mild cognitive decline and family members report health students 'enhance capacity of care' and bring 'a new breath of life' in two aged care facilities in Tasmania.

    Science.gov (United States)

    Elliott, Kate-Ellen J; Annear, Michael J; Bell, Erica J; Palmer, Andrew J; Robinson, Andrew L

    2015-12-01

    Care provided by student doctors and nurses is well received by patients in hospital and primary care settings. Whether the same is true for aged care residents of nursing homes with mild cognitive decline and their family members is unknown. To investigate the perspectives of aged care residents with mild cognitive decline and their family members on interdisciplinary student placements in two residential aged care facilities (RACF) in Tasmania. A mixed methods design was employed with both qualitative and quantitative data collected. All participants were interviewed and completed a questionnaire on residents' quality of life, during or after a period of student placements in each facility (October-November, 2012). Qualitative data were coded for themes following a grounded theory approach, and quantitative data were analysed using SPSS. Twenty-one participants (13 residents and 8 family members) were recruited. Four themes were identified from the qualitative data and included (i) increased social interaction and facility vibrancy; (ii) community service and personal development, (iii) vulnerability and sensitivity (learning to care) and (iv) increased capacity and the confidence of enhanced care. Residents' quality of life was reported to be mostly good in the presence of the students, despite their high care needs. Residents with mild cognitive decline and their family members perceive a wide array of benefits of student provided care in RACFs including increased social interaction. Future quantitative research should focus on whether changes in care occur for residents as a result of student involvement. © 2014 The Authors Health Expectations Published by John Wiley & Sons Ltd.

  5. Harnessing the hybrid power supply systems of utility grid and photovoltaic panels at retrofit residential single family building in Medan

    Science.gov (United States)

    Pangaribuan, A. B.; Rahmat, R. F.; Lidya, M. S.; Zálešák, M.

    2017-01-01

    The paper describes improvisation mode of energy supply source by collaboration between national utility grid as represented by fossil fuels and PV as independent renewable power resource in order to aim the energy consumptions efficiently in retrofit single family house. In this case, one existing single family house model in Medan, Indonesia was observed for the possibility of future refurbishment. The eco-design version of the house model and prediction analyses regarding nearby potential renewable energy resource (solar system) had been made using Autodesk Revit MEP 2015, Climate Consultant 6.0 and Green Building Studio Analysis. Economical evaluation of using hybrid power supply is discussed as well.

  6. Variable myopathic presentation in a single family with novel skeletal RYR1 mutation.

    Directory of Open Access Journals (Sweden)

    Ruben Attali

    Full Text Available We describe an autosomal recessive heterogeneous congenital myopathy in a large consanguineous family. The disease is characterized by variable severity, progressive course in 3 of 4 patients, myopathic face without ophthalmoplegia and proximal muscle weakness. Absence of cores was noted in all patients. Genome wide linkage analysis revealed a single locus on chromosome 19q13 with Zmax = 3.86 at θ = 0.0 and homozygosity of the polymorphic markers at this locus in patients. Direct sequencing of the main candidate gene within the candidate region, RYR1, was performed. A novel homozygous A to G nucleotide substitution (p.Y3016C within exon 60 of the RYR1 gene was found in patients. ARMS PCR was used to screen for the mutation in all available family members and in an additional 150 healthy individuals. This procedure confirmed sequence analysis and did not reveal the A to G mutation (p.Y3016C in 300 chromosomes from healthy individuals. Functional analysis on EBV immortalized cell lines showed no effect of the mutation on RyR1 pharmacological activation or the content of intracellular Ca(2+ stores. Western blot analysis demonstrated a significant reduction of the RyR1 protein in the patient's muscle concomitant with a reduction of the DHPRα1.1 protein. This novel mutation resulting in RyR1 protein decrease causes heterogeneous clinical presentation, including slow progression course and absence of centrally localized cores on muscle biopsy. We suggest that RYR1 related myopathy should be considered in a wide variety of clinical and pathological presentation in childhood myopathies.

  7. Variable myopathic presentation in a single family with novel skeletal RYR1 mutation.

    Science.gov (United States)

    Attali, Ruben; Aharoni, Sharon; Treves, Susan; Rokach, Ori; Becker Cohen, Michal; Fellig, Yakov; Straussberg, Rachel; Dor, Talya; Daana, Muhannad; Mitrani-Rosenbaum, Stella; Nevo, Yoram

    2013-01-01

    We describe an autosomal recessive heterogeneous congenital myopathy in a large consanguineous family. The disease is characterized by variable severity, progressive course in 3 of 4 patients, myopathic face without ophthalmoplegia and proximal muscle weakness. Absence of cores was noted in all patients. Genome wide linkage analysis revealed a single locus on chromosome 19q13 with Zmax = 3.86 at θ = 0.0 and homozygosity of the polymorphic markers at this locus in patients. Direct sequencing of the main candidate gene within the candidate region, RYR1, was performed. A novel homozygous A to G nucleotide substitution (p.Y3016C) within exon 60 of the RYR1 gene was found in patients. ARMS PCR was used to screen for the mutation in all available family members and in an additional 150 healthy individuals. This procedure confirmed sequence analysis and did not reveal the A to G mutation (p.Y3016C) in 300 chromosomes from healthy individuals. Functional analysis on EBV immortalized cell lines showed no effect of the mutation on RyR1 pharmacological activation or the content of intracellular Ca(2+) stores. Western blot analysis demonstrated a significant reduction of the RyR1 protein in the patient's muscle concomitant with a reduction of the DHPRα1.1 protein. This novel mutation resulting in RyR1 protein decrease causes heterogeneous clinical presentation, including slow progression course and absence of centrally localized cores on muscle biopsy. We suggest that RYR1 related myopathy should be considered in a wide variety of clinical and pathological presentation in childhood myopathies.

  8. Impact of caring for a child with cancer on single parents compared with parents from two-parent families.

    Science.gov (United States)

    Klassen, Anne F; Dix, David; Papsdorf, Michael; Klaassen, Robert J; Yanofsky, Rochelle; Sung, Lillian

    2012-01-01

    It is currently unknown how the intensive and often prolonged treatment of childhood cancer impacts on the lives of single parents. Our aims were to determine whether single parents differ from parents from two-parent families in terms of caregiver demand (the time and effort involved in caregiving), and health-related quality of life (HRQL). Forty single parents and 275 parents from two-parent families were recruited between November 2004 and February 2007 from five pediatric oncology centers in Canada. Parents were asked to complete a questionnaire booklet composed of items and scales to measure caregiver demand and HRQL (SF-36). The booklet also measured the following constructs: background and context factors, child factors, caregiving strain, intrapsychic factors, and coping factors. Single parents did not differ from parents from two-parent families in caregiving demand and physical and psychosocial HRQL. Compared with Canadian population norms for the SF-36, both groups reported clinically important differences (i.e., worse health) in psychosocial HRQL (effect size ≥ -2.00), while scores for physical HRQL were within one standard deviation of population norms. Our findings suggest that the impact of caregiving on single parents, in terms of caregiving demand and HRQL is similar to that of parents from two-parent families. Copyright © 2011 Wiley Periodicals, Inc.

  9. Family Adjustment of Single Parents in the U. S. Army: An Empirical Analysis of Work Stressors and Adaptive Resources

    Science.gov (United States)

    1993-08-01

    strategy should provide the Army with a better understanding of the adjustment of single parent families and, if warranted, help tailcr interventions ...military leadership has resisted efforts to fully assimilate women into military roles (Shields, 1988). Yet, sexism is but only one structural stress...differences have implications for policy and practice interventions . For single fathers, work suessors alone did not contribute a statistically significant

  10. Residents' and faculty's beliefs about the ideal clinical teacher.

    Science.gov (United States)

    Masunaga, Hiromi; Hitchcock, Maurice A

    2010-02-01

    The objective of this study was to examine how residents and faculty in family medicine compare in their beliefs about ideal clinical teaching. We studied 205 residents and 148 faculty in family medicine who completed the Clinical Teaching Perception Inventory (CTPI) online between April 2001 and July 2008. The participants ranked 28 single-word descriptors that characterized clinical teachers along a 7-point-scale ranging from "least like my ideal teacher" to "most like my ideal teacher." Both residents and faculty indicated that the ideal clinical teachers should be stimulating, encouraging, competent, and communicating and should not be conventional, cautious, or controlling. However, residents rated probing and innovative significantly lower than did faculty. Clinical faculty and residents in family medicine have a shared view of the ideal clinical teacher. However, residents and faculty differed in their ratings on the descriptors "Probing" and "Innovative." This difference might at least in part stem from where residents and faculty are located along a continuum from novice to mature expert.

  11. Mothers' and fathers' reports of stress in families of infants with and without single-suture craniosynostosis.

    Science.gov (United States)

    Rosenberg, Janine M; Kapp-Simon, Kathleen A; Starr, Jacqueline R; Cradock, Mary Michaeleen; Speltz, Matthew L

    2011-09-01

    To compare relative levels of stress reported by mothers and fathers in families containing infants with and without single-suture craniosynostosis. Case-control study. Mothers and fathers of 246 infants with recently diagnosed single-suture craniosynostosis and 253 frequency-matched control infants completed the Parenting Stress Index just prior to their infant's cranioplastic surgery. Family demographic information and mothers' ratings of the severity of their child's single-suture craniosynostosis were obtained. Average Parent Domain scores for parents of infants with single-suture craniosynostosis differed little from those reported by parents of control infants; however, Child Domain scores among parents of infants with single-suture craniosynostosis were higher on some subscales, primarily related to unexpected infant health and appearance issues. In both groups, fathers reported higher Child Domain stress than mothers, and mothers reported higher Parent Domain stress than fathers. Case mothers reported greater stress if they perceived their child's condition as more noticeable to others. Prior to cases' cranioplastic surgery, parents of children with and without single-suture craniosynostosis reported similar levels of stress in relation to their parenting roles and the behavioral characteristics of their infants. Visibility of condition should be considered a risk for increased stress for mothers of infants with single-suture craniosynostosis. Stress differences between mothers and fathers were far more discernible than those associated with the presence or absence of single-suture craniosynostosis.

  12. Research report 24 single-family dwellings from the fifties; Onderzoekrapport 24 eengezinswoningen jaren '50

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2011-05-15

    This analysis is part of a coordinated series of studies for different residential building complexes of different corporations. This research report concerns the quick scan to decide on investments for the improvement of three single-family houses complexes, which were built in 1959. Based on four financial scenarios a framework is set up by means of which an integrated investment assessment can be made. In the study, scores are given for improving energy efficiency, reducing emission, quality of the construction, technical quality, urban and architectural quality, indoor environment, social aspects, etc. [Dutch] Deze analyse is onderdeel van een gecoordineerde serie onderzoeken voor verschillende complexen van verschillende corporaties. Dit onderzoeksrapport betreft de quickscan voor de investeringsafweging voor de verbetering van een drietal complexen van het type eengezinswoningen eind jaren vijftig. Op basis van vier financieel onderbouwde scenario's wordt het kader geschetst waarmee een integrale investeringsafweging kan worden gemaakt. In het onderzoek worden waarderingen gegeven voor de verbetering van de aspecten energiezuinigheid, uitstoot), bouwtechnisch kwaliteit, markttechnische kwaliteit, stedenbouwkundige en architectonische kwaliteit, binnenklimaat, sociale aspecten, etc.

  13. Indirect Solar Water Heating in Single-Family, Zero Energy Ready Homes

    Energy Technology Data Exchange (ETDEWEB)

    Aldrich, Robb [Consortium for Advanced Residential Buildings, Norwalk, CT (United States)

    2016-02-17

    Solar water heating systems are not new, but they have not become prevalent in most of the U.S. Most of the country is cold enough that indirect solar thermal systems are required for freeze protection, and average installed cost of these systems is $9,000 to $10,000 for typical systems on single-family homes. These costs can vary significantly in different markets and with different contractors, and federal and regional incentives can reduce these up-front costs by 50% or more. In western Massachusetts, an affordable housing developer built a community of 20 homes with a goal of approaching zero net energy consumption. In addition to excellent thermal envelopes and PV systems, the developer installed a solar domestic water heating system (SDHW) on each home. The Consortium for Advanced Residential Buildings (CARB), a research consortium funded by the U.S. Department of Energy Building America program, commissioned some of the systems, and CARB was able to monitor detailed performance of one system for 28 months.

  14. Hypertrophic cardiomyopathy with midventricular obstruction and apical aneurysm formation in a single family: case report

    Directory of Open Access Journals (Sweden)

    Paraskevaidis Stylianos

    2009-06-01

    Full Text Available Abstract Background Hypertrophic cardiomyopathy (HCM is an extremely heterogeneous disease. An under recognized and very often missed subgroup within this broad spectrum concerns patients with left ventricular (LV apical aneurysms in the absence of coronary artery disease. Case presentation We describe a case of HCM with midventricular obstruction and apical aneurysm formation in 3 patients coming from a single family. This HCM pattern was detected by 2D-echocardiography and confirmed by cardiac magnetic resonance imaging. A cardioverter defibrillator was implanted in one of the patients because of non-sustained ventricular tachycardia detected in 24-h Holter monitoring and an abrupt drop in systolic blood pressure during maximal exercise test. The defibrillator activated 8 months after implantation by suppression of a ventricular tachycardia providing anti-tachycardia pacing. The patient died due to refractory heart failure 2 years after initial evaluation. The rest of the patients are stable after a 2.5-y follow-up period. Conclusion The detection of apical aneurysm by echocardiography in HCM patients may be complicated. Ventricular tachycardia arising from the scarred aneurysm wall may often occur predisposing to sudden death.

  15. Building America Case Study: Indirect Solar Water Heating Systems in Single-Family Homes, Greenfield, Massachusetts

    Energy Technology Data Exchange (ETDEWEB)

    2016-04-01

    Solar water heating systems are not new, but they have not become prevalent in most of the U.S. Most of the country is cold enough that indirect solar thermal systems are required for freeze protection, and average installed cost of these systems is $9,000 to $10,000 for typical systems on single-family homes. These costs can vary significantly in different markets and with different contractors, and federal and regional incentives can reduce these up-front costs by 50% or more. In western Massachusetts, an affordable housing developer built a community of 20 homes with a goal of approaching zero net energy consumption. In addition to excellent thermal envelopes and PV systems, the developer installed a solar domestic water heating system (SDHW) on each home. The Consortium for Advanced Residential Buildings (CARB), a research consortium funded by the U.S. Department of Energy Building America program, commissioned some of the systems, and CARB was able to monitor detailed performance of one system for 28 months.

  16. The financial viability of an SOFC cogeneration system in single-family dwellings

    Science.gov (United States)

    Alanne, Kari; Saari, Arto; Ugursal, V. Ismet; Good, Joel

    In the near future, fuel cell-based residential micro-CHP systems will compete with traditional methods of energy supply. A micro-CHP system may be considered viable if its incremental capital cost compared to its competitors equals to cumulated savings during a given period of time. A simplified model is developed in this study to estimate the operation of a residential solid oxide fuel cell (SOFC) system. A comparative assessment of the SOFC system vis-à-vis heating systems based on gas, oil and electricity is conducted using the simplified model for a single-family house located in Ottawa and Vancouver. The energy consumption of the house is estimated using the HOT2000 building simulation program. A financial analysis is carried out to evaluate the sensitivity of the maximum allowable capital cost with respect to system sizing, acceptable payback period, energy price and the electricity buyback strategy of an energy utility. Based on the financial analysis, small (1-2 kW e) SOFC systems seem to be feasible in the considered case. The present study shows also that an SOFC system is especially an alternative to heating systems based on oil and electrical furnaces.

  17. Privacy Control as a Function of Personal Space In Single-Family Homes in Jordan

    Directory of Open Access Journals (Sweden)

    Majd Al-Homoud

    2009-12-01

    Full Text Available Understanding the relationship between people and the built environment requires understanding of the relationship between human behavior and physical settings. To further verify this notion, this study attempts to investigate privacy control as an effect of personal space expressed by quality and quantity of bedroom space in single-family homes. Face-to-face structured interviews were conducted to elicit the data. The location of the study was Daheyat Al--Ferdous community, Fuhais, Jordan. Respondents were requested to record to the presence of certain physical components in their personal bedroom space that may potentially increase their feel of privacy control in general. Results indicated that some physical components such a kitchenette, a TV, and an audio station in the bedroom were important. Additional factors that affected privacy control feel included shape of the room, as square rooms provided more sense of control. In addition, smaller bedroom area increased feel of control, and a corridor before bedroom was seen as a predictor of privacy control.

  18. Energy renovation of single-family houses in Denmark utilising long-term financing based on equity

    DEFF Research Database (Denmark)

    Kragh, Jesper; Rose, Jørgen

    2011-01-01

    in long-term property mortgage loans and utilising it for extensive energy renovation improves both the economy and the extent of included measures. Approximately 30% of energy consumption in Denmark is used for space heating. The existing 1 million single-family houses account for approximately half...

  19. Disentangling an Invisible Trade : state interventions in Dutch and Dutch-Curaçaoan single-mother families

    NARCIS (Netherlands)

    Verhallen, T.L.

    2015-01-01

    The doctoral thesis sheds light on the interactional and institutional processes through which child welfare and child protection practices are delivered to fifteen Dutch and fifteen Dutch-Curaçaoan single-mother families with multiple problems in the Netherlands in order to reveal structures of

  20. Male Heads of Family in Single-Parent Households: Men Adaptations to the Needs of Their Children

    Directory of Open Access Journals (Sweden)

    Andrés Mauricio Cano Rodas

    2016-01-01

    The experience of the head of a single-parent home has led interviewed parents to modify the exercise of their masculinity regarding communication, relationships, the manner to express affection and the everyday performance with their children, accepting the new family role by associating it with the responsibility of raising and caring for the children

  1. Measured energy savings and economics of retrofitting existing single- family homes: An update of the BECA-B database

    Energy Technology Data Exchange (ETDEWEB)

    Cohen, S.D.; Goldman, C.A.; Harris, J.P.

    1991-02-01

    These appendices are the companion volume to report number LBL--28147 Vol.1, with the same title. The summary data tables include physical characteristics, energy consumption, savings, and the retrofit measures installed and their costs for each retrofit project. Each existing single family residential building'' retrofit project in the BECA-B database is described. 99 refs. (BM)

  2. Anomalous single production of fourth family up type quark associated with neutral gauge bosons at the LHC

    CERN Document Server

    Cakir, O; Senol, A; Tasci, A T

    2012-01-01

    From the present limits on the masses and mixings of fourth family quarks, they are expected to have mass larger than the top quark and allow a large range of mixing of the third family. They could also have different dynamics than the quarks of three families of the Standard Model. The single production of the fourth family up type quark t' has been studied via anomalous production process pp-> t'VX (where V=g,Z,\\gamma) at the LHC with the center of mass energy of 7 and 14 TeV. The signatures of such process are discussed within both the SM decay modes and anomalous decay modes of t' quarks. The sensitivity to anomalous coupling kappa/Lambda=0.004 TeV^(-1) can be reached at sqrt(s)=14 TeV and L_(int)=100 pb^(-1).

  3. Editing of misaligned 3'-termini by an intrinsic 3'-5' exonuclease activity residing in the PHP domain of a family X DNA polymerase.

    Science.gov (United States)

    Baños, Benito; Lázaro, José M; Villar, Laurentino; Salas, Margarita; de Vega, Miguel

    2008-10-01

    Bacillus subtilis gene yshC encodes a family X DNA polymerase (PolX(Bs)), whose biochemical features suggest that it plays a role during DNA repair processes. Here, we show that, in addition to the polymerization activity, PolX(Bs) possesses an intrinsic 3'-5' exonuclease activity specialized in resecting unannealed 3'-termini in a gapped DNA substrate. Biochemical analysis of a PolX(Bs) deletion mutant lacking the C-terminal polymerase histidinol phosphatase (PHP) domain, present in most of the bacterial/archaeal PolXs, as well as of this separately expressed protein region, allow us to state that the 3'-5' exonuclease activity of PolX(Bs) resides in its PHP domain. Furthermore, site-directed mutagenesis of PolX(Bs) His339 and His341 residues, evolutionary conserved in the PHP superfamily members, demonstrated that the predicted metal binding site is directly involved in catalysis of the exonucleolytic reaction. The implications of the unannealed 3'-termini resection by the 3'-5' exonuclease activity of PolX(Bs) in the DNA repair context are discussed.

  4. Energy performance analysis of a detached single-family house to be refurbished

    Science.gov (United States)

    Aleixo, Kevin; Curado, António

    2017-07-01

    This study was developed with the purpose of analyzing the reinforcement of the energy performance in a detached single-family house to be refurbished, using this building as a case-study for simulation and experimental analysis. The building is located in Viana do Castelo, a city in the northwest of Portugal nearby the Atlantic Ocean. The developed study was carried out in order to characterize the thermal performance of the house, using simulation analysis in a dynamic regime. The energy consumption study was developed in permanent regime analysis, using simulation tools. At the end, the study aimed to propose and define the best retrofitting solutions, both passive and active, and to improve the energy performance of the building. The outcomes of the study provided the importance of passive retrofitting solutions on thermal comfort and energy performance. The use of a set of thermal solutions, as the insulation of the roof, walls and the windows, it is possible to achieve a global gain of 0, 63 °C and to reduce energy consumption in 61, 46 [kWh/m2.year]. The study of the building in a simplified thermal regime, according to the Portuguese energy efficiency regulation, allowed the determination of the energy efficiency class of the house and retrofitting solutions proposed. The initial energy performance class of the building is C. With the application of a passive set of solutions, it's possible to improve the energy performance to a class B. With the implementation of some active solutions, it is possible to reach an energy class A +.

  5. The low-income single-family house and the effectiveness of architects in affecting affordability

    Directory of Open Access Journals (Sweden)

    Ron Dulaney Jr.

    2012-12-01

    Full Text Available Architects are increasingly engaged in efforts to provide affordable, owner-occupied housing in the United States. Yet architects’ roles in broadly addressing affordable housing remain marginal as was anecdotally evident by the absence of architects at a recent university-sponsored affordable housing workshop. Apparently, the potential contributions of architects in “the development of innovative approaches and best practices” related to affordable, owner-occupied housing is not always valued to housing policymakers and planners such as those who organized this workshop. This paper speculatively explores the gap between the potential value of architects and their actual effectiveness at realizing widespread relevancy, innovation, and change in improving the quality and attainability of affordable, owner occupied housing and how this gap may contribute to the undervaluation and marginalization of architects’ efforts to address affordable housing needs in the United States. Case studies of several recent U.S. house design competitions exemplify these gaps. Potential strategies for closing these gaps and thus appreciating the value of architects’ efforts in this endeavor are identified.To become central in providing much-needed affordable, owner-occupied housing, architects must make the value of their potential contributions evident. This requires a clear definition of design goals, a rigorous assessment of built projects, and the thorough dissemination of findings and methodologies. Architects must engage those fields to which they have, in the U.S., long relinquished affordable, single-family housing. Architects must demonstrate that qualitative design improvements are not just possible within the frameworks and agendas of those other fields but that good design will better enable the achievement of those extra-disciplinary goals.

  6. Training family physicians and residents in family medicine in shared decision making to improve clinical decisions regarding the use of antibiotics for acute respiratory infections: protocol for a clustered randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Frémont Pierre

    2011-01-01

    Full Text Available Abstract Background To explore ways to reduce the overuse of antibiotics for acute respiratory infections (ARIs, we conducted a pilot clustered randomized controlled trial (RCT to evaluate DECISION+, a training program in shared decision making (SDM for family physicians (FPs. This pilot project demonstrated the feasibility of conducting a large clustered RCT and showed that DECISION+ reduced the proportion of patients who decided to use antibiotics immediately after consulting their physician. Consequently, the objective of this study is to evaluate, in patients consulting for ARIs, if exposure of physicians to a modified version of DECISION+, DECISION+2, would reduce the proportion of patients who decide to use antibiotics immediately after consulting their physician. Methods/design The study is a multi-center, two-arm, parallel clustered RCT. The 12 family practice teaching units (FPTUs in the network of the Department of Family Medicine and Emergency Medicine of Université Laval will be randomized to a DECISION+2 intervention group (experimental group or to a no-intervention control group. These FPTUs will recruit patients consulting family physicians and residents in family medicine enrolled in the study. There will be two data collection periods: pre-intervention (baseline including 175 patients with ARIs in each study arm, and post-intervention including 175 patients with ARIs in each study arm (total n = 700. The primary outcome will be the proportion of patients reporting a decision to use antibiotics immediately after consulting their physician. Secondary outcome measures include: 1 physicians and patients' decisional conflict; 2 the agreement between the parties' decisional conflict scores; and 3 perception of patients and physicians that SDM occurred. Also in patients, at 2 weeks follow-up, adherence to the decision, consultation for the same reason, decisional regret, and quality of life will be assessed. Finally, in both patients

  7. Resident and Residency Characteristics Associated With Self-reported Preparedness for Population Health Management.

    Science.gov (United States)

    Schuster, Erica K; Peterson, Lars E

    2017-11-01

    Population health management (PHM) is an important function of primary care with potential to improve outcomes and decrease costs, but is also among the most difficult strategies to implement in both practices and residency training. Our objective was to determine resident and residency program characteristics associated with graduates' reported preparation to perform PHM. We used data from the American Board of Family Medicine (ABFM) Certification Examination registration questionnaire in 2014 and 2015 and ABFM administrative data. Resident PHM preparedness was assessed via a single, self-reported question. Bivariate analysis and logistic multilevel regression were performed to determine independent associations between characteristics and reported PHM preparedness. Odds ratios were converted to risk ratios given the high prevalence of the outcome. Our sample included 6,135 residents from 442 family medicine residencies. Sixty-nine percent (n=4,240) reported being extremely or moderately prepared to perform PHM. No residency program characteristics showed an association with reported PHM preparedness. Resident characteristics independently associated with reported preparedness included being an international medical graduate (IMG) (RR=1.21 [1.07-1.35]) and of Hispanic ethnicity. Reporting greater preparedness to use health information tools, to lead quality improvement projects, and to provide care in different settings were also associated with reported PHM preparedness. Similar to a study of practicing physicians, we found that IMGs are more likely to report preparedness to perform PHM. This suggests that elements of international medical education may better inculcate PHM principles, and that these elements could be used to produce physicians better prepared to manage population health.

  8. Canadian Children from Single-Parent Families: Are They an Overlooked Minority?

    Science.gov (United States)

    Hett, Geoffrey G.

    Although the divorce rate in Canada is growing, little Canadian research has studied the effects of family separation on children. To examine the effects of family separation on children in school-related areas, data were collected on 1241 students in kindergarten through seventh grade. Teachers completed an 11-item questionnaire for each student…

  9. Failing to Prepare Is Preparing to Fail: A Single-Blinded, Randomized Controlled Trial to Determine the Impact of a Preoperative Instructional Video on the Ability of Residents to Perform Laparoscopic Right Colectomy.

    Science.gov (United States)

    Crawshaw, Benjamin P; Steele, Scott R; Lee, Edward C; Delaney, Conor P; Mustain, W Conan; Russ, Andrew J; Shanmugan, Skandan; Champagne, Bradley J

    2016-01-01

    Laparoscopic colorectal resection is an index case for advanced skills training, yet many residents struggle to reach proficiency by graduation. Current methods to reduce the learning curve for residents remain expensive, time consuming, and poorly validated. The purpose of this study was to assess the impact of the addition of a preprocedural instructional video to improve the ability of a general surgery resident to perform laparoscopic right colectomy when compared with standard preparation. This was a single-blinded, randomized control study. Four university-affiliated teaching hospitals were included in the study. General surgery residents in postgraduation years 2 through 5 participated. Residents were randomly assigned to preparation with a narrated instructional video versus standard preparation. Resident performance, scored by a previously validated global assessment scale, was measured. Fifty-four residents were included. Half (n = 27) were randomly assigned to view the training video and half (n = 27) to standard preparation. There were no differences between groups in terms of training level or previous operative experience or in patient demographics (all p > 0.05). Groups were similar in the percentage of the case completed by residents (p = 0.39) and operative time (p = 0.74). Residents in the video group scored significantly higher in total score (mean: 46.8 vs 42.3; p = 0.002), as well as subsections directly measuring laparoscopic skill (vascular control mean: 11.3 vs 9.7, p instructional video before surgery may improve the learning curve of trainees and ultimately improve safety.

  10. Pragmatic cluster randomised controlled trial of facilitated family case conferencing compared with usual care for improving end of life care and outcomes in nursing home residents with advanced dementia and their families: the IDEAL study protocol.

    Science.gov (United States)

    Agar, Meera; Beattie, Elizabeth; Luckett, Tim; Phillips, Jane; Luscombe, Georgina; Goodall, Stephen; Mitchell, Geoffrey; Pond, Dimity; Davidson, Patricia M; Chenoweth, Lynnette

    2015-11-21

    Care for people with advanced dementia requires a palliative approach targeted to the illness trajectory and tailored to individual needs. However, care in nursing homes is often compromised by poor communication and limited staff expertise. This paper reports the protocol for the IDEAL Project, which aims to: 1) compare the efficacy of a facilitated approach to family case conferencing with usual care; 2) provide insights into nursing home- and staff-related processes influencing the implementation and sustainability of case conferencing; and 3) evaluate cost-effectiveness. A pragmatic parallel cluster randomised controlled trial design will be used. Twenty Australian nursing homes will be randomised to receive either facilitated family case conferencing or usual care. In the intervention arm, we will train registered nurses at each nursing home to work as Palliative Care Planning Coordinators (PCPCs) 16 h per week over 18 months. The PCPCs' role will be to: 1) use evidence-based 'triggers' to identify optimal time-points for case conferencing; 2) organise, facilitate and document case conferences with optimal involvement from family, multi-disciplinary nursing home staff and community health professionals; 3) develop and oversee implementation of palliative care plans; and 4) train other staff in person-centred palliative care. The primary endpoint will be symptom management, comfort and satisfaction with care at the end of life as rated by bereaved family members on the End of Life in Dementia (EOLD) Scales. Secondary outcomes will include resident quality of life (Quality of Life in Late-stage Dementia [QUALID]), whether a palliative approach is taken (e.g. hospitalisations, non-palliative medical treatments), staff attitudes and knowledge (Palliative Care for Advanced Dementia [qPAD]), and cost effectiveness. Processes and factors influencing implementation, outcomes and sustainability will be explored statistically via analysis of intervention 'dose' and

  11. Single Dirac Cone Topological Surface State and Unusual Thermoelectric Property of Compounds from a New Topological Insulator Family

    Energy Technology Data Exchange (ETDEWEB)

    Chen, Y

    2011-08-18

    Angle resolved photoemission spectroscopy (ARPES) study on TlBiTe2 and TlBiSe2 from a Thallium-based III-V-VI2 ternary chalcogenides family revealed a single surface Dirac cone at the center of the Brillouin zone for both compounds. For TlBiSe{sub 2}, the large bulk gap ({approx} 200meV) makes it a topological insulator with better mechanical properties than the previous binary 3D topological insualtor family. For TlBiTe{sub 2}, the observed negative bulk gap indicates it as a semi-metal, rather than a narrow gap semi-conductor as conventionally believed; this semi-metality naturally explains its mysteriously small thermoelectric figure of merit comparing to other compounds in the family. Finally, the unique band structures of TlBiTe{sub 2} also suggests it as a candidate for topological superconductors.

  12. The effect of urban trees on the rental price of single-family homes in Portland, Oregon

    Science.gov (United States)

    Geoffrey H. Donovan; David T. Butry

    2011-01-01

    Few studies have estimated the effect of environmental amenities on the rental price of houses. We address this gap in the literature by quantifying the effect of urban trees on the rental price of single-family homes in Portland, Oregon, USA. We found that an additional tree on a house's lot increased monthly rent by $5.62, and a tree in the public right of way...

  13. An Educational Interventional Study to Assess Awareness about Mosquito Breeding, Diseases Caused and Protective Measures Against them among Families Residing in an Urban Slum of Indore City

    Directory of Open Access Journals (Sweden)

    Deepa Raghunath

    2013-08-01

    Full Text Available Background: Community participation plays an important role in control of Mosquito borne diseases. This study tries to assess impact of educational intervention on various aspects of mosquito borne diseases in an urban slum. Methodology: An educational interventional study was done in 200 families residing in a slum (Badi Gwaltoli which is in field practice area of Urban Health Centre attached to Department of Community Medicine of M.G.M.Medical College, Indore. A pretested semi-structured questionnaire was administered to the Head of the family which studied their awareness and perception regarding breeding sites and biting habits of mosquitoes, diseases spread by them and personal protective measures used, followed by an educational intervention and post assessment. Data was entered into Microsoft excel spread sheet and analysed using SPSS version 20 software. Results: 46% of study population knew the correct breeding season of mosquitoes (monsoon season during pre-intervention and 68% of the population post- intervention (p- value 0.004. When asked at what time mosquitoes bite the most, maximum number (92% of people said that mosquitoes bite most in the evening and night, while only 6% and 2% were for morning and noon, respectively. Only 3.5% of the population who knew about breeding sites knew about artificial collections of water. Majority said mosquito breed in dirty stagnant water (78.5%. About 96%of the study population was aware that mosquitoes spread diseases. However, only 33.3%of respondents knew correctly about the diseases spread which improved to 68% in the post-intervention period (p-value=.000. 46% knew all the protection measures against mosquitoes in the pre-intervention which increased to 86% in the post intervention (p.value-.005. Conclusion: Awareness about Aedes mosquitoes and its habits is quite poor and many people still believe that only dirty water serves as a breeding place in mosquitoes. Regular IEC sessions

  14. Report on the regional and system type disaggregation of the single family dwelling space heat energy demand sector. [BESOM and dynamic programming model

    Energy Technology Data Exchange (ETDEWEB)

    Muench, T.J.; Wooders, M.H.; McLean, R.

    1976-08-01

    Two models are developed that can estimate derived fuel demands in single-family dwellings, given fixed final demand for space heat by states. One is an extension of a single-period linear programming model of the nation's energy system, the Brookhaven Energy System Optimization Model. In it the demand for single-family space heat is disaggregated by state and type of home-heating system. The other is a multiple-period dynamic programming model of single-family space heat demand, also disaggregated by state and type of system. Preliminary results for each model are presented and compared.

  15. Effectiveness of a strategy that uses educational games to implement clinical practice guidelines among Spanish residents of family and community medicine (e-EDUCAGUIA project): a clinical trial by clusters.

    Science.gov (United States)

    Del Cura-González, Isabel; López-Rodríguez, Juan A; Sanz-Cuesta, Teresa; Rodríguez-Barrientos, Ricardo; Martín-Fernández, Jesús; Ariza-Cardiel, Gloria; Polentinos-Castro, Elena; Román-Crespo, Begoña; Escortell-Mayor, Esperanza; Rico-Blázquez, Milagros; Hernández-Santiago, Virginia; Azcoaga-Lorenzo, Amaya; Ojeda-Ruiz, Elena; González-González, Ana I; Ávila-Tomas, José F; Barrio-Cortés, Jaime; Molero-García, José M; Ferrer-Peña, Raul; Tello-Bernabé, María Eugenia; Trujillo-Martín, Mar

    2016-05-17

    Clinical practice guidelines (CPGs) have been developed with the aim of helping health professionals, patients, and caregivers make decisions about their health care, using the best available evidence. In many cases, incorporation of these recommendations into clinical practice also implies a need for changes in routine clinical practice. Using educational games as a strategy for implementing recommendations among health professionals has been demonstrated to be effective in some studies; however, evidence is still scarce. The primary objective of this study is to assess the effectiveness of a teaching strategy for the implementation of CPGs using educational games (e-learning EDUCAGUIA) to improve knowledge and skills related to clinical decision-making by residents in family medicine. The primary objective will be evaluated at 1 and 6 months after the intervention. The secondary objectives are to identify barriers and facilitators for the use of guidelines by residents of family medicine and to describe the educational strategies used by Spanish teaching units of family and community medicine to encourage implementation of CPGs. We propose a multicenter clinical trial with randomized allocation by clusters of family and community medicine teaching units in Spain. The sample size will be 394 residents (197 in each group), with the teaching units as the randomization unit and the residents comprising the analysis unit. For the intervention, both groups will receive an initial 1-h session on clinical practice guideline use and the usual dissemination strategy by e-mail. The intervention group (e-learning EDUCAGUIA) strategy will consist of educational games with hypothetical clinical scenarios in a virtual environment. The primary outcome will be the score obtained by the residents on evaluation questionnaires for each clinical practice guideline. Other included variables will be the sociodemographic and training variables of the residents and the teaching unit

  16. Literacy, Parental Roles, and Support Systems among Single Latino Father Families

    Science.gov (United States)

    Santos, Rose A.; Alfred, Mary V.

    2016-01-01

    The purpose of this study was to investigate the roles of eight Latino single fathers as primary caregivers and their engagement with the literacy development of their children. The sample for this study consisted of eight single Latino fathers with children of elementary to middle school age. The primary method of data collection was…

  17. The effects on mood of adjunctive single-family and multi-family group therapy in the treatment of hospitalized patients with major depression. A 15-month follow-up study.

    Science.gov (United States)

    Lemmens, Gilbert M D; Eisler, Ivan; Buysse, Ann; Heene, Els; Demyttenaere, Koen

    2009-01-01

    Family-based interventions have been shown to be effective in the treatment of depression, but they have seldom been studied in hospitalized depressed patients. This study assesses the value of the additional use of single-family or multi-family group therapy within this patient population. Eighty-three patients were randomly assigned to: (1) the treatment programme as usual (n = 23), (2) treatment as usual combined with single-family therapy (n = 25) or (3) treatment as usual combined with multi-family group therapy (n = 35). Follow-up assessments were made at 3 months and 15 months. Multi-family group and single-family therapy conditions showed significantly higher rates of treatment responders than the group receiving the usual treatment (49, 24 and 9%, respectively), and higher rates of patients no longer using antidepressant medication (26, 16 and 0%, respectively) at 15 months. Partners taking part in the family treatments were significantly more likely to notice the improvements in the emotional health of the patient early on compared to those in the treatment as usual condition. This study suggests that single-family and multi-family therapy may benefit hospitalized patients with major depression, and may help the partners of the patients to become aware of the patient's improvement more quickly. 2009 S. Karger AG, Basel.

  18. Modelling the contribution of family history and variation in single nucleotide polymorphisms to risk of schizophrenia

    DEFF Research Database (Denmark)

    Agerbo, Esben; Mortensen, Preben Bo; Wiuf, Carsten

    2012-01-01

    Epidemiological studies indicate that having any family member with schizophrenia increases the risk of schizophrenia in the probands. However, genome-wide association studies (GWAS) have accounted for little of this variation. The aim of this study was to use a population-based sample to explore...

  19. ILS Heuristics for the Single-Machine Scheduling Problem with Sequence-Dependent Family Setup Times to Minimize Total Tardiness

    Directory of Open Access Journals (Sweden)

    Vinícius Vilar Jacob

    2016-01-01

    Full Text Available This paper addresses a single-machine scheduling problem with sequence-dependent family setup times. In this problem the jobs are classified into families according to their similarity characteristics. Setup times are required on each occasion when the machine switches from processing jobs in one family to jobs in another family. The performance measure to be minimized is the total tardiness with respect to the given due dates of the jobs. The problem is classified as NP-hard in the ordinary sense. Since the computational complexity associated with the mathematical formulation of the problem makes it difficult for optimization solvers to deal with large-sized instances in reasonable solution time, efficient heuristic algorithms are needed to obtain near-optimal solutions. In this work we propose three heuristics based on the Iterated Local Search (ILS metaheuristic. The first heuristic is a basic ILS, the second uses a dynamic perturbation size, and the third uses a Path Relinking (PR technique as an intensification strategy. We carry out comprehensive computational and statistical experiments in order to analyze the performance of the proposed heuristics. The computational experiments show that the ILS heuristics outperform a genetic algorithm proposed in the literature. The ILS heuristic with dynamic perturbation size and PR intensification has a superior performance compared to other heuristics.

  20. Evaluation of a family nursing intervention for distressed pregnant women and their partners: a single group before and after study.

    Science.gov (United States)

    Thome, Marga; Arnardottir, Stefanía B

    2013-04-01

    To report a study of the effects of an antenatal family nursing intervention for emotionally distressed women and their partners. High levels of depressive symptoms and anxiety are common in pregnant women, and their partners are likely to suffer from a higher degree of these symptoms than those of non-distressed women. Maternal anxiety and depressive symptoms influence the development of the foetus and child negatively. Distress-reducing interventions for couples are scarce. The design was a pre- and post-test single group quasi-experiment. All women distressed during the last two trimesters of pregnancy were referred by midwives to a family nursing home-visiting service in a primary care setting in Iceland. They were invited to participate in the study from November 2007-September 2009. The final sample was 39 couples. Assessment of distress was through self-reporting of depressive symptoms and anxiety, self-esteem, and dyadic adjustment. The couple received four home visits that were guided by the Calgary Family Nursing Model. Women experienced a higher degree of distress than men before the intervention. Couple's distress was interrelated, and improvement was significant on all indicators after the intervention. Healthcare professionals who care for distressed expectant women should attend to their partners' mental health status. The Calgary Family Nursing Model is an appropriate guide for nursing care of distressed prospective couples in a primary care setting. © 2012 Blackwell Publishing Ltd.

  1. A pragmatic randomised multi-centre trial of multifamily and single family therapy for adolescent anorexia nervosa.

    Science.gov (United States)

    Eisler, Ivan; Simic, Mima; Hodsoll, John; Asen, Eia; Berelowitz, Mark; Connan, Frances; Ellis, Gladys; Hugo, Pippa; Schmidt, Ulrike; Treasure, Janet; Yi, Irene; Landau, Sabine

    2016-11-24

    Considerable progress has been made in recent years in developing effective treatments for child and adolescent anorexia nervosa, with a general consensus in the field that eating disorders focussed family therapy (often referred to as Maudsley Family Therapy or Family Based Treatment) currently offers the most promising outcomes. Nevertheless, a significant number do not respond well and additional treatment developments are needed to improve outcomes. Multifamily therapy is a promising treatment that has attracted considerable interest and we report the results of the first randomised controlled trial of multifamily therapy for adolescent anorexia nervosa. The study was a pragmatic multicentre randomised controlled superiority trial comparing two outpatient eating disorder focussed family interventions - multifamily therapy (MFT-AN) and single family therapy (FT-AN). A total of 169 adolescents with a DSM-IV diagnosis of anorexia nervosa or eating disorder not otherwise specified (restricting type) were randomised to the two treatments using computer generated blocks of random sizes to ensure balanced numbers in the trial arms. Independent assessors, blind to the allocation, completed evaluations at baseline, 3 months, 12 months (end of treatment) and 18 months. Both treatment groups showed clinically significant improvements with just under 60% achieving a good or intermediate outcome (on the Morgan-Russell scales) at the end of treatment in the FT-AN group and more than 75% in the MFT-AN group - a statistically significant benefit in favour of the multifamily intervention (OR = 2.55 95%; CI 1.17, 5.52; p = 0.019). At follow-up (18 months post baseline) there was relatively little change compared to end of treatment although the difference in primary outcome between the treatments was no longer statistically significant. Clinically significant gains in weight were accompanied by improvements in mood and eating disorder psychopathology. Approximately

  2. Influence of air tightness of the building on its energy-efficiency in single-family buildings in Poland

    Directory of Open Access Journals (Sweden)

    Miszczuk Artur

    2017-01-01

    Full Text Available This publication focuses on assessing the impact of the tightness of single-family houses with a higher energy standard on their energy demand for heating. To formulate conclusions quantitative and qualitative research, including tightness test (blower door has been conducted in energy-efficient and passive houses. In the next step, energy demand for heating has been estimated. Based on the observation and results, the simulation of the impact of reducing the flow of infiltrated air through leaks in the buildings for energy demand for heating is calculated. The simulation results confirm the dependence between the tightness of the building and energy demand.

  3. Postdivorce Adjustment and Single Parenting: Exploring the Impact of Culture for Korean Families.

    Science.gov (United States)

    Song, Sunny Y.

    Formal mental health services offered in traditional Western settings may be neither appropriate for nor accessible to Korean Americans who are adjusting to divorce. This paper presents an overview of current research on postdivorce adjustment and single parenting in the United States, examines various cultural differences (e.g., African, Asian,…

  4. Contemporary Work and Family Issues Affecting Marriage and Cohabitation among Low-Income Single Mothers

    Science.gov (United States)

    Joshi, Pamela; Quane, James M.; Cherlin, Andrew J.

    2009-01-01

    In this paper, we advance and test an integrative model of the effects of employment status, nonstandard work schedules, male employment, and women's perceptions of economic instability on union formation among low-income single mothers. On the basis of the longitudinal data from 1,299 low-income mothers from the Three-City Welfare Study, results…

  5. The diurnal salivary cortisol pattern of adolescents from families with single, ill and healthy parents

    NARCIS (Netherlands)

    Sieh, D.S.; Visser-Meily, J.M.A.; Oort, F.J.; Meijer, A.M.

    2012-01-01

    Objective: Adolescents of single and/or chronically ill parents (target groups) reportedly have elevated psychological stress. However, their salivary cortisol pattern as part of the physiological stress system has not been compared to controls. The aim of this study is to examine differential

  6. A single gene target of an ETS-family transcription factor determines neuronal CO2-chemosensitivity

    DEFF Research Database (Denmark)

    Brandt, Julia P; Aziz-Zaman, Sonya; Juozaityte, Vaida

    2012-01-01

    . We report here a mechanism that endows C. elegans neurons with the ability to detect CO(2). The ETS-5 transcription factor is necessary for the specification of CO(2)-sensing BAG neurons. Expression of a single ETS-5 target gene, gcy-9, which encodes a receptor-type guanylate cyclase, is sufficient...

  7. Rural Mid-Life Single Adult Families: Male/Female Similarities and Differences.

    Science.gov (United States)

    Lingren, Herbert G.; And Others

    The study examined data from rural midlife singles concerning: (1) their socio-demographic characteristics; (2) their life satisfactions and happiness with their rural lifestyle; (3) their self-image and self-esteem; (4) their coping strategies; and (5) their social support systems. Subjects were 76 men and 149 women between the ages of 35 and 59…

  8. Permanent resident

    Directory of Open Access Journals (Sweden)

    John F. Fisher

    2016-05-01

    Full Text Available The training of physicians in the past century was based primarily on responsibility and the chain-of-command. Those with the bulk of that responsibility in the fields of pediatrics and internal medicine were residents. Residents trained the medical students and supervised them carefully in caring for patients. Most attending physicians supervised their teams at arm's length, primarily serving as teachers of the finer points of diagnosis and treatment during set periods of the day or week with a perfunctory signature on write-ups or progress notes. Residents endeavored to protect the attending physician from being heavily involved unless they were unsure about a clinical problem. Before contacting the attending physician, a more senior resident would be called. Responsibility was the ultimate teacher. The introduction of diagnosis-related groups by the federal government dramatically changed the health care delivery system, placing greater emphasis on attending physician visibility in the medical record, ultimately resulting in more attending physician involvement in day-to-day care of patients in academic institutions. Without specified content in attending notes, hospital revenues would decline. Although always in charge technically, attending physicians increasingly have assumed the role once dominated by the resident. Using biographical experiences of more than 40 years, the author acknowledges and praises the educational role of responsibility in his own training and laments its declining role in today's students and house staff.

  9. Single Nucleotide Polymorphism (SNP) Arrays and Unexpected Consanguinity: Considerations for Clinicians When Returning Results to Families

    Science.gov (United States)

    Delgado, Fernanda; Tabor, Holly K.; Chow, Penny M.; Conta, Jessie H.; Feldman, Kenneth W.; Tsuchiya, Karen D.; Beck, Anita E.

    2014-01-01

    Purpose The broad use of SNP microarrays has increased identification of unexpected consanguinity. Therefore, guidelines to address reporting of consanguinity have been published for clinical laboratories. Because no such guidelines exist for clinicians, we describe a case and present recommendations for clinicians to disclose unexpected consanguinity to families. Methods In a boy with multiple endocrine abnormalities and structural birth defects, SNP array analysis revealed ~23% autosomal homozygosity suggestive of a 1st-degree parental relationship. We assembled an interdisciplinary healthcare team, planned the most appropriate way to discuss results of the SNP array with the adult mother including the possibility of multiple autosomal recessive disorders in her child, and finally met with her as a team. Results From these discussions, we developed four major considerations for clinicians returning results of unexpected consanguinity, all guided by the child’s best interests: 1) ethical and legal obligations for reporting possible abuse, 2) preservation of the clinical relationship, 3) attention to justice and psychosocial challenges, and 4) utilization of the SNP array results to guide further testing. Conclusion As SNP arrays become a common clinical diagnostic tool, clinicians can use this framework to return results of unexpected consanguinity to families in a supportive and productive manner. PMID:25232848

  10. [Being raised by lesbian parents or in a single-parent family is no risk factor for problem behavior, however being raised as an adopted child is].

    Science.gov (United States)

    Verhulst, F C; Versluis-den Bieman, H O; Balmus, N C

    1997-03-01

    Modern reproductive techniques and alternative family structures (with single or homosexual parents and adoption situations) raise questions about the consequences for the growing children involved. Genetic links appear to be less important for the functioning of a family than a strong wish for parenthood; parents who have become parents only through great efforts display a better quality of parenthood than average natural parents. Characteristics of the parent/parents, such as paedagogic qualities, and the quality of the parent-child relationship appear more important than the type of family. Published results of research reveal no reason why lesbian families should be judged differently from heterosexual ones as family types for the raising of children. The main negative factor for the functioning of the child growing up in a single-parent family is the marriage conflicts that have led to the single-parent situation; being raised by a single parent in itself has no adverse effect. Raising adopted children from other countries makes far greater demands on the adoptive parents than parents of biological children have to meet. The raising of a foreign adopted child by a single parent entails additional risks for the child's development. Data on the development of children in alternative family structures frequently concern exceptionally competent parents, which may have biased the findings.

  11. Cigarette Smoking among African American Youth from Single Mother Homes: Examining the Roles of Maternal Smoking and Positive Parenting within an Extended Family Framework

    Science.gov (United States)

    Foster, Sarah E.; Zalot, Alecia A.; Jones, Deborah J.

    2007-01-01

    The current study examined the main and interactive effects of three family context variables, maternal smoking, positive parenting behavior, and the quality of the mother's relationship with another adult or family member who assists with parenting (i.e., coparent), and adolescent smoking among African American youth from single mother homes. The…

  12. The impact of changes in China's family patterns on family pension functions.

    Science.gov (United States)

    Su, Zhongxin; Hu, Z; Peng, Xizhe

    2017-07-01

    Using data from the Chinese census and the China Statistical Yearbook, this paper will analyze the historical changes and future trends of family households in China over the past 30 years and explore the changes of family pension functions and corresponding policies. Our analysis yielded 3 notable results. First, in family size miniaturization and structural simplification, 1- and 2-generation family households are the main body of contemporary China. Second, for family aging and changes in living patterns, which primarily manifest as an increase in; the proportion of elderly households and in middle-aged and elderly people in the family, the elderly model and the "multigenerational model" have become the 2 major residence models for the elderly in China. Third, nontraditional families have emerged in large numbers, such as the exclusively elderly family, empty nest family, grandparents family, Double Income, No Kids (DINK) family, older single family, and single-parent family. We argue that in the process of simplification, China's family structure is increasingly showing characteristics of networking. The change in family patterns entails the restoration of traditional functions and taking on new functions of the family by issuing relevant social policies. Only when these social policies are based on family functions and demands can they provide effective help to social members, particularly regarding the family's responsibilities to parent children and support the elderly. Copyright © 2017 John Wiley & Sons, Ltd.

  13. Benefit-cost analysis of commercially available activated carbon filters for indoor ozone removal in single-family homes.

    Science.gov (United States)

    Aldred, J R; Darling, E; Morrison, G; Siegel, J; Corsi, R L

    2016-06-01

    This study involved the development of a model for evaluating the potential costs and benefits of ozone control by activated carbon filtration in single-family homes. The modeling effort included the prediction of indoor ozone with and without activated carbon filtration in the HVAC system. As one application, the model was used to predict benefit-to-cost ratios for single-family homes in 12 American cities in five different climate zones. Health benefits were evaluated using disability-adjusted life-years and included city-specific age demographics for each simulation. Costs of commercially available activated carbon filters included capital cost differences when compared to conventional HVAC filters of similar particle removal efficiency, energy penalties due to additional pressure drop, and regional utility rates. The average indoor ozone removal effectiveness ranged from 4 to 20% across the 12 target cities and was largely limited by HVAC system operation time. For the parameters selected in this study, the mean predicted benefit-to-cost ratios for 1-inch filters were >1.0 in 10 of the 12 cities. The benefits of residential activated carbon filters were greatest in cities with high seasonal ozone and HVAC usage, suggesting the importance of targeting such conditions for activated carbon filter applications. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  14. Mother-child discrepancy in perceived parental control and adolescent filial piety in poor single-mother families.

    Science.gov (United States)

    Leung, Janet T Y; Shek, Daniel T L; Lin, Li

    2017-10-01

    Based on a sample of 432 poor Chinese single-mother families (mean age of adolescents = 13.7 years; 51.2% girls; mean age of mothers = 43.5 years) in Hong Kong, the interaction effect of mother-reported and adolescent-reported maternal control on filial piety of Chinese adolescents was examined. Results of polynomial multiple regression analyses showed that the interaction between mother-reported and adolescent-reported maternal control predicted perceived filial piety in adolescents. At high levels of mother-reported maternal control, high adolescent-perceived parental control was associated with higher filial piety. At low levels of mother-reported maternal control, filial piety increased initially and then decreased when adolescents reported higher levels of maternal control. Using multiple group analyses, these associations were found to be stable across gender and age. The present findings provide insights on how congruencies and discrepancies between mother-reported and adolescent-reported maternal control predict filial piety of Chinese adolescents growing up in poor single-mother families. Copyright © 2017 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.

  15. Family stressors and postdeployment mental health in single versus partnered parents deployed in support of the wars in Afghanistan and Iraq.

    Science.gov (United States)

    Vaughn-Coaxum, Rachel; Smith, Brian N; Iverson, Katherine M; Vogt, Dawne

    2015-08-01

    Little is known about the family-related stress and postdeployment adjustment of single versus partnered parents deployed in support of the wars in Iraq and Afghanistan. This study examined exposure to family-related stressors during and after deployment, as well as postdeployment psychological symptoms in a national sample of 318 single (n = 74) and partnered (n = 244) parent veterans of Operation Enduring Freedom and Operation Iraqi Freedom. Results demonstrated that single parents experienced higher levels of concern about life and family disruptions during deployment, lower levels of social support during and after deployment, and poorer postdeployment family functioning than partnered parents. Single parents also reported higher posttraumatic stress symptom severity, but not depression or anxiety symptom severity, compared with partnered parents. Family-related stressors demonstrated different associations with mental health for single and partnered parents, suggesting that some stressor-symptom relations may be more salient for single parents, and others may be more salient for partnered parents. Findings suggest that the deployment and postdeployment experiences of parents differ based on their partnered status, which has implications for the design and provision of services to single and partnered parents. (c) 2015 APA, all rights reserved).

  16. Familial Mediterranean fever with a single MEFV mutation: comparison of rare and common mutations in a Turkish paediatric cohort.

    Science.gov (United States)

    Soylemezoglu, Oguz; Kandur, Yasar; Duzova, Ali; Ozkaya, Ozan; Kasapcopur, Ozgür; Baskin, Esra; Fidan, Kibriya; Yalcinkaya, Fatos

    2015-01-01

    Presence of common MEFV gene mutations strengthened the diagnosis of FMF in addition to the typical clinical characteristics of FMF. However, there are also rare mutations. P369S, A744S, R761H, K695R, F479L are the main rare mutations in Turkish population. We aimed to evaluate FMF patients with a single allele MEFV mutation and to compare patients with common and rare mutations. We retrospectively reviewed the medical records of FMF patients with a single allele mutation who were followed up between 2008 and 2013 in six centres. We compared the patients with rare and common mutations for disease severity score, frequent exacerbations ( >1 attack per month), long attack period (>3 day), symptoms, age at the onset of symptoms, gender, consanguinity, and family history. Two hundred and seventeen patients (M/F=101/116) with the diagnosis of FMF and single mutation were included. Heterozygote mutations were defined as common (M694V, V726A, M68OI) and rare mutations (A744S, P369S, K695R, R761H, F479L). Sixty-seven patients (27 males, 40 females) had one single rare mutation and 150 (74 males, 76 females) had one single common mutation. No difference was found between the rare and common mutations with respect to the disease severity score. There was no significant difference between common and rare heterozygote form of mutations in terms of disease severity. Patients with typical characteristics of FMF, with some rare mutations (A744S, P369S) should be treated in the same manner as patients with a common mutation.

  17. Lampreys Have a Single Gene Cluster for the Fast Skeletal Myosin Heavy Chain Gene Family

    Science.gov (United States)

    Ikeda, Daisuke; Ono, Yosuke; Hirano, Shigeki; Kan-no, Nobuhiro; Watabe, Shugo

    2013-01-01

    Muscle tissues contain the most classic sarcomeric myosin, called myosin II, which consists of 2 heavy chains (MYHs) and 4 light chains. In the case of humans (tetrapod), a total of 6 fast skeletal-type MYH genes (MYHs) are clustered on a single chromosome. In contrast, torafugu (teleost) contains at least 13 fast skeletal MYHs, which are distributed in 5 genomic regions; the MYHs are clustered in 3 of these regions. In the present study, the evolutionary relationship among fast skeletal MYHs is elucidated by comparing the MYHs of teleosts and tetrapods with those of cyclostome lampreys, one of two groups of extant jawless vertebrates (agnathans). We found that lampreys contain at least 3 fast skeletal MYHs, which are clustered in a head-to-tail manner in a single genomic region. Although there was apparent synteny in the corresponding MYH cluster regions between lampreys and tetrapods, phylogenetic analysis indicated that lamprey and tetrapod MYHs have independently duplicated and diversified. Subsequent transgenic approaches showed that the 5′-flanking sequences of Japanese lamprey fast skeletal MYHs function as a regulatory sequence to drive specific reporter gene expression in the fast skeletal muscle of zebrafish embryos. Although zebrafish MYH promoters showed apparent activity to direct reporter gene expression in myogenic cells derived from mice, promoters from Japanese lamprey MYHs had no activity. These results suggest that the muscle-specific regulatory mechanisms are partially conserved between teleosts and tetrapods but not between cyclostomes and tetrapods, despite the conserved synteny. PMID:24376886

  18. Lampreys have a single gene cluster for the fast skeletal myosin heavy chain gene family.

    Directory of Open Access Journals (Sweden)

    Daisuke Ikeda

    Full Text Available Muscle tissues contain the most classic sarcomeric myosin, called myosin II, which consists of 2 heavy chains (MYHs and 4 light chains. In the case of humans (tetrapod, a total of 6 fast skeletal-type MYH genes (MYHs are clustered on a single chromosome. In contrast, torafugu (teleost contains at least 13 fast skeletal MYHs, which are distributed in 5 genomic regions; the MYHs are clustered in 3 of these regions. In the present study, the evolutionary relationship among fast skeletal MYHs is elucidated by comparing the MYHs of teleosts and tetrapods with those of cyclostome lampreys, one of two groups of extant jawless vertebrates (agnathans. We found that lampreys contain at least 3 fast skeletal MYHs, which are clustered in a head-to-tail manner in a single genomic region. Although there was apparent synteny in the corresponding MYH cluster regions between lampreys and tetrapods, phylogenetic analysis indicated that lamprey and tetrapod MYHs have independently duplicated and diversified. Subsequent transgenic approaches showed that the 5'-flanking sequences of Japanese lamprey fast skeletal MYHs function as a regulatory sequence to drive specific reporter gene expression in the fast skeletal muscle of zebrafish embryos. Although zebrafish MYH promoters showed apparent activity to direct reporter gene expression in myogenic cells derived from mice, promoters from Japanese lamprey MYHs had no activity. These results suggest that the muscle-specific regulatory mechanisms are partially conserved between teleosts and tetrapods but not between cyclostomes and tetrapods, despite the conserved synteny.

  19. Revisiting an era in Germany from the perspective of adolescents in mother-headed single-parent families.

    Science.gov (United States)

    Sharma, Deepali; Silbereisen, Rainer K

    2007-02-01

    Much of the documented work on families headed by single mothers is based on empirical evidence from North America and a few Anglo-Saxon countries. Many researchers consider single-mother families to be at a disadvantage because of nonsupportive family policies. This paper uses data from a social context that differed hugely in this respect-the German Democratic Republic (GDR). The GDR provided extensive state support to single-mother families and, thus, was vastly different from other countries. Based on a literature review and using Hill's family stress theory, this paper is based on the hypothesis that adolescents living in mother-headed single-parent families and those living with their biological parents would have near-similar social outcomes (display of psychosomatic symptoms, perception of stress, display of delinquent behaviour, life satisfaction, academic self-efficacy, and academic grades) and family-related outcomes (relationship with parents and perception of family environment). Further, it was hypothesized that adolescents from stepfather families would display more negative social and family-related outcomes when compared with respondents from the other two family types. The sample comprised 1302 adolescents (M  =  13.82 years, SD  =  1.88) who were recruited from the city of Leipzig in the year immediately following German unification, 1991. Respondents reported on measures of psychosomatic symptoms, stress, delinquency, life satisfaction, academic achievement, and family-related variables. ANCOVAs, with a control for income adjusted for household size, indicated adolescents from single-mother families to have very similar experiences to respondents living with their biological parents on all measures except for their assessment of family environment. Adolescents living in stepfather families reported the least favourable experiences. Results are indicative of a social context in Germany that, despite unification and the early hardships for

  20. Construction, characterization, and mutagenesis of an anti-fluorescein single chain antibody idiotype family.

    Science.gov (United States)

    Denzin, L K; Voss, E W

    1992-05-05

    In addition to crystallographic studies that determined antigen contact residues for monoclonal anti-fluorescein (Fl) antibody 4-4-20 (Ka = 2.5 x 10(10) M-1), primary structure comparisons revealed idiotypically cross-reactive monoclonal antibodies (mAbs) 9-40 (Ka = 4.4 x 10(7) M-1), 12-40 (Ka = 4.0 x 10(8) M-1), and 5-14 (Ka = 2.4 x 10(8) M-1) possessed identical Fl contact residues, with the exception of L34His for L34Arg. Site-specific mutagenesis of single chain antibody (SCA) 4-4-20 in which L34Arg was changed to L34His resulted in approximately 1000- and 3-fold decreases in binding affinity and Qmax (maximum quenching of bound Fl), respectively, which suggested that L34Arg was directly involved in increased binding affinity and fluorescence quenching. Therefore, substitution of Arg for His at residue L34 in mAbs 9-40, 12-40, and 5-14 should result in increased binding affinity and Qmax. To facilitate site-specific mutagenesis studies, single chain derivatives of mAbs 9-40, 12-40, and 5-14 were constructed. Following expression in Escherichia coli, characterization of the SCAs demonstrated that when compared with the respective parental mAb, the SCAs possessed identical binding affinities and similar Qmax and lambda max (absorption profiles of bound Fl) values. These results validated SCA 9-40, 12-40, and 5-14 for use in site-directed mutagenesis studies. Results of mutagenesis studies indicated that substitution of L34Arg into the active sites of 9-40, 12-40, and 5-14 was not enough to produce 4-4-20-like binding characteristics. Therefore, the following single chain mutants were constructed: 9-40L34Arg/L46Val, 12-40L34Arg/L46Val and 5-14L34Arg/L46Val, 9-40L34Arg/L46Val/H101Asp and 4-4-20H101Ala. Results demonstrated that these mutations were not able to render the mutant SCAs with increased binding affinity and fluorescence quenching values. Collectively, these results suggest that the combining sites of mAb 9-40, 12-40, and 5-14 may possess different active

  1. Do changes in regulatory requirements for energy efficiency in single-family houses result in the expected energy savings

    DEFF Research Database (Denmark)

    Kjærbye, Vibeke; Larsen, Anders; Togeby, Mikael

    2011-01-01

    This paper explores how changes in regulatory requirements for energy efficiency in buildings (in the US also known as building energy codes) affect household energy consumption. The focus in this paper is on natural gas consumption by Danish single-family owner-occupied houses. Unlike most other...... papers investigating household energy consumption this paper uses a unique panel data set constructed by merging several administrative data bases. The data set describes house and household characteristics, outdoor temperature and actual metered natural gas consumption over 6 years (1998-2003). Applying...... advanced econometric methods we examine differences in heating energy consumption due to different building regulation requirements at the time of house construction. As for the effect of the building regulation, we find that changes in Danish building regulations have led to significant reductions...

  2. Possible financing schemes for one-stop-shop service for sustainable renovation of single-family houses

    DEFF Research Database (Denmark)

    Mahapatra, Krushna; Gustavsson, Leif; Haavik, Trond

    available from mortgage financing (or base loan), national governments may consider to provide soft loans or subsidies. In countries where tax deduction on home renovation is available, amendments should be made to such programs to incorporate specific requirements regarding energy efficiency of implemented...... measures. Also, higher tax deduction could be offered for energy efficiency improvement than for other renovation. Moreover, a simple tool to inform the homeowners about the cost-efficiency of energy renovation investment would be that banks and utilities collaborate to send a joint invoice which contains......There are significant potentials to improve energy efficiency of single-family houses in the Nordic countries. Technical solutions exist, but there are market and financial barriers to implementation of such measures. The aim of this report is to identify financial barriers to implement energy...

  3. Residents' perspectives on urinary incontinence: a review of literature.

    Science.gov (United States)

    Ostaszkiewicz, Joan; O'Connell, Bev; Dunning, Trisha

    2012-12-01

    Individuals in residential aged care facilities experience urinary incontinence more than any other single population. Despite these factors, the impact of the condition on their quality of life, their perspectives of living with the condition, and their preferences for care have received little research attention. To provide a descriptive overview of research about; the impact of urinary incontinence on residents' quality of life; residents' perspectives of having urinary incontinence; and their preferences for continence care'. A descriptive review of literature. A broad search was undertaken for qualitative and quantitative research that evaluated residents' quality of life related to urinary incontinence; their perspectives on having urinary incontinence, and their preferences for managing it. Data were displayed in tabular format, summarized, and described. Ten studies were identified and reviewed (six qualitative and four quantitative). They reveal many residents' value having independent bowel and bladder function, but believe that incontinence in inevitable and intractable. Some adopt self management strategies, however considerable barriers hinder their ability to maintain continence and manage incontinence. Residents often have low expectations, and hence decline further evaluation and treatment. Some express satisfaction with continence care even if this care is not consistent with their preferences. Little is known about how cognitively impaired residents perceive their condition. However some individuals with cognitive impairment respond with acute anxiety when carers' attempt to provide continence care. Residents' perspectives on incontinence and preferences for continence care relate to low expectations for improvement. Such misconceptions should be addressed and residents and their family members should be given a range of options from which to choose. As urinary incontinence impacts on residents' quality of life, it is also important that

  4. Illegitimacy and sibship assignments in oil palm (Elaeis guineensis Jacq.) half-sib families using single locus DNA microsatellite markers.

    Science.gov (United States)

    Hama-Ali, Emad Omer; Alwee, Sharifah Shahrul Rabiah Syed; Tan, Soon Guan; Panandam, Jothi Malar; Ling, Ho Chai; Namasivayam, Parameswari; Peng, Hoh Boon

    2015-05-01

    Oil palm breeding has been progressing very well in Southeast Asia, especially in Malaysia and Indonesia. Despite this progress, there are still problems due to the difficulty of controlled crossing in oil palm. Contaminated/illegitimate progeny has appeared in some breeding programs; late and failure of detection by the traditional method causes a waste of time and labor. The use of molecular markers improves the integrity of breeding programs in perennial crops such as oil palm. Four half-sib families with a total of 200 progeny were used in this study. Thirty polymorphic single locus DNA microsatellites markers were typed to identify the illegitimate individuals and to obtain the correct parental and progeny assignments by using the CERVUS and COLONY programs. Three illegitimate palms (1.5%) were found, and 16 loci proved to be sufficient for sibship assignments without parental genotypes by using the COLONY program. The pairwise-likelihood score (PLS) method was better for half-sib family assignments than the full likelihood (FL) method.

  5. Cloning, characterization and phylogenetic analyses of members of three major venom families from a single specimen of Walterinnesia aegyptia.

    Science.gov (United States)

    Tsai, Hsin-Yu; Wang, Ying Ming; Tsai, Inn-Ho

    2008-06-01

    Walterinnesia aegyptia is a monotypic elapid snake inhabiting in Africa and Mideast. Although its envenoming is known to cause rapid deaths and paralysis, structural data of its venom proteins are rather limited. Using gel filtration and reverse-phase HPLC, phospholipases A(2) (PLAs), three-fingered toxins (3FTxs), and Kunitz-type protease inhibitors (KIns) were purified from the venom of a single specimen of this species caught in northern Egypt. In addition, specific primers were designed and PCR was carried out to amplify the cDNAs encoding members of the three venom families, respectively, using total cDNA prepared from its venom glands. Complete amino acid sequences of two acidic PLAs, three short chain 3FTxs, and four KIns of this venom species were thus deduced after their cDNAs were cloned and sequenced. They are all novel sequences and match the mass data of purified proteins. For members of each toxin family, protein sequences were aligned and subjected to molecular phylogenetic analyses. The results indicated that the PLAs and a Kunitz inhibitor of W. aegyptia are most similar to those of king cobra venom, and its 3FTxs belongs to either Type I alpha-neurotoxins or weak toxins of orphan-II subtype. It is remarkable that both king cobra and W. aegyptia cause rapid deaths of the victims, and a close evolutionary relationship between them is speculated.

  6. Evaluación de la competencia profesional de residentes de Medicina General Integral para la atención a la familia Evaluation of the professional competition of residents of Integral General Medicine for the attention to the family

    Directory of Open Access Journals (Sweden)

    M. Rocha-Vázquez

    2010-03-01

    Full Text Available Introducción. El proceso de evaluación de las competencias para diagnóstico de necesidades de aprendizaje es un elemento de vital importancia para el perfeccionamiento continuo del personal de salud; por ello, el presente trabajo pretendió evaluar la competencia de los residentes de Medicina General Integral en la atención a la familia, área de acción de estos profesionales de la salud. Sujetos y métodos. Para lograr el objetivo propuesto se ejecutó una investigación de evaluación, con diseño cuanticualitativo, en la Facultad de Ciencias Médicas de Cienfuegos, desde noviembre de 2005 a enero de 2007. De un total de 64 residentes de segundo año se seleccionaron 25 de manera aleatoria, que representan el 39% del total, a los cuales se les aplicó un examen de competencia, y cada uno de ellos efectuó dos visitas a la familia. Resultados. Sólo el 11,8% de los residentes aprobó el examen aplicado; las mayores dificultades se centraron en los temas de intervención familiar, evaluación del funcionamiento familiar y determinación de la salud familiar. De igual forma se constataron deficiencias en la ejecución de las visitas a la familia en cuanto a cumplimiento de sus principios, violación de etapas e intervenciones necesarias, fundamentalmente. Conclusiones. Con los instrumentos aplicados y los criterios asumidos para esta investigación se observa un muy bajo nivel de competencia de los residentes para la atención a la familia, lo que alerta de que deben diseñarse e implementarse estrategias inmediatas para revertir esta situación.Introduction. The process of evaluation of the competitions for diagnostic of learning necessities is an element of vital importance for the personnel's of health continuous improvement, it is for it that the present work sought to evaluate the competition of the residents of Integral General Medicine in the attention to the family, area of these professionals' of the health action. Subjects and

  7. Multiple hypotheses explain variation in extra-pair paternity at different levels in a single bird family.

    Science.gov (United States)

    Brouwer, Lyanne; van de Pol, Martijn; Aranzamendi, Nataly Hidalgo; Bain, Glen; Baldassarre, Daniel T; Brooker, Lesley C; Brooker, Michael G; Colombelli-Négrel, Diane; Enbody, Erik; Gielow, Kurt; Hall, Michelle L; Johnson, Allison E; Karubian, Jordan; Kingma, Sjouke A; Kleindorfer, Sonia; Louter, Marina; Mulder, Raoul A; Peters, Anne; Pruett-Jones, Stephen; Tarvin, Keith A; Thrasher, Derrick J; Varian-Ramos, Claire W; Webster, Michael S; Cockburn, Andrew

    2017-10-25

    Extra-pair paternity (EPP), where offspring are sired by a male other than the social male, varies enormously both within and among species. Trying to explain this variation has proved difficult because the majority of the interspecific variation is phylogenetically based. Ideally, variation in EPP should be investigated in closely related species, but clades with sufficient variation are rare. We present a comprehensive multifactorial test to explain variation in EPP among individuals in 20 populations of nine species over 89 years from a single bird family (Maluridae). Females had higher EPP in the presence of more helpers, more neighbours or if paired incestuously. Furthermore, higher EPP occurred in years with many incestuous pairs, populations with many helpers and species with high male density or in which males provide less care. Altogether, these variables accounted for 48% of the total and 89% of the interspecific and interpopulation variation in EPP. These findings indicate why consistent patterns in EPP have been so challenging to detect and suggest that a single predictor is unlikely to account for the enormous variation in EPP across levels of analysis. Nevertheless, it also shows that existing hypotheses can explain the variation in EPP well and that the density of males in particular is a good predictor to explain variation in EPP among species when a large part of the confounding effect of phylogeny is excluded. © 2017 John Wiley & Sons Ltd.

  8. Family Structure and Family Processes in Mexican American Families

    OpenAIRE

    Zeiders, Katharine H.; Roosa, Mark W.; Tein, Jenn-Yun

    2011-01-01

    Despite increases in single-parent families among Mexican Americans (MA), few studies have examined the association of family structure and family adjustment. Utilizing a diverse sample of 738 Mexican American families (21.7% single parent), the current study examined differences across family structure on early adolescent outcomes, family functioning, and parent-child relationship variables. Results revealed that early adolescents in single parent families reported greater school misconduct,...

  9. A multicenter study of the family educational rights and privacy act and the standardized letter of recommendation: impact on emergency medicine residency applicant and faculty behaviors.

    Science.gov (United States)

    Diab, Jessica; Riley, Stephanie; Downes, Andrew; Gaeta, Theodore; Hern, H Gene; Hwang, Eric; Kass, Lawrence; Kelly, Michael; Luber, Samuel D; Martel, Marc; Minns, Alicia; Patterson, Leigh; Pazderka, Philip; Sayan, Osman; Thurman, Jason; Vallee, Phyllis; Overton, David

    2014-06-01

    Residency applicants have the right to see letters of recommendation written on their behalf. It is not known whether applicants are affected by waiving this right. Our multicenter study assessed how frequently residency applicants waived their FERPA rights to view their letters of recommendation, and whether this affected the ratings they were given by faculty. We reviewed all ERAS-submitted letters of recommendation to 14 ACGME-accredited programs in 2006-2007. We collected ERAS ID, program name, FERPA declaration, standardized letter of recommendation (SLOR) use, and SLOR Global Assessment ranking. The percentage of applicants who waived their FERPA rights was determined. Chi-square tests of independence assessed whether applicants' decision to waive their FERPA rights was associated with their SLOR Global Assessment. We examined 1776 applications containing 6424 letters of recommendations. Of 2736 letters that specified a Global Assessment, 2550 (93%) applicants waived their FERPA rights, while 186 did not. Of the applicants who chose not to waive their rights, 45.6% received a ranking of Outstanding, 35.5% Excellent, 18.3% Very Good, and 1.6% Good. Of applicants who waived their FERPA rights, 35.1% received a ranking of Outstanding, 49.6% Excellent, 13.7% Very Good, and 1.6% Good. Applicants who did not waive their FERPA rights were more likely to receive an Outstanding Assessment (P  =  .003). The majority (93%) of residency applicants waived their FERPA rights. Those who did not waive their rights had a statistically higher chance of receiving an Outstanding Assessment than those who did.

  10. The effect of staff training on agitation and use of restraint in nursing home residents with dementia: a single-blind, randomized controlled trial.

    Science.gov (United States)

    Testad, Ingelin; Ballard, Clive; Brønnick, Kolbjørn; Aarsland, Dag

    2010-01-01

    Agitation is common in dementia and is associated with use of restraints and use of psychotropic drugs. The aim of this study was to determine whether an education and supervision intervention could reduce agitation and the use of restraints and antipsychotic drugs in nursing homes. Four Norwegian nursing homes were randomly allocated to receive either treatment as usual or an intervention consisting of a 2-day educational seminar and monthly group guidance for 6 months. One hundred forty-five residents with dementia (based on medical records and corroborated with a Functional Assessment Staging score >or= 4) completed baseline and 6-month intervention assessments and were included in the analyses. The co-primary outcome measures were the proportion of residents subject to interactional restraint and the severity of agitation using the Cohen-Mansfield Agitation Inventory (CMAI). Patients were assessed at baseline, immediately after completion of the intervention at 6 months, and 12 months after baseline. Comparison of change in the 2 groups was made using repeated-measures analysis of variance (CMAI) and Mann-Whitney test (restraints). The study was conducted from 2003 to 2004. The proportion of residents starting new restraint was lower in the intervention than in the control group at 6-month evaluation (P = .02), but no statistically significant differences were found at 12-month assessment (P = .57). The total CMAI score declined from baseline to 6 and 12 months' follow-up in the intervention homes compared to a small increase in the control homes (F2,176 = 3.46, P = .034). There were no statistically significant differences in use of antipsychotic drugs. A brief 2-day staff education program followed by continued monthly guidance was able both to improve quality of care by reducing the frequency of interactional restraints and to reduce severity of agitation. ©Copyright 2010 Physicians Postgraduate Press, Inc.

  11. Political violence and child adjustment in Northern Ireland: Testing pathways in a social ecological model including single and two-parent families

    Science.gov (United States)

    Cummings, E. Mark; Schermerhorn, Alice C.; Merrilees, Christine E.; Goeke-Morey, Marcie C.; Shirlow, Peter; Cairns, Ed

    2013-01-01

    Moving beyond simply documenting that political violence negatively impacts children, a social ecological hypothesis for relations between political violence and child outcomes was tested. Participants were 700 mother-child (M=12.1years, SD=1.8) dyads from 18 working class, socially deprived areas in Belfast, Northern Ireland, including single- and two-parent families. Sectarian community violence was associated with elevated family conflict and children’s reduced security about multiple aspects of their social environment (i.e., family, parent-child relations, and community), with links to child adjustment problems and reductions in prosocial behavior. By comparison, and consistent with expectations, links with negative family processes, child regulatory problems and child outcomes were less consistent for nonsectarian community violence. Support was found for a social ecological model for relations between political violence and child outcomes among both single and two parent families, with evidence that emotional security and adjustment problems were more negatively affected in single-parent families. The implications for understanding social ecologies of political violence and children’s functioning are discussed. PMID:20604605

  12. Financial Implications of Residency Programs for Sponsoring Organizations.

    Science.gov (United States)

    Heiberger, Michael H.

    1997-01-01

    Explores cost implications of residency programs within the Veterans Administration health care system, particularly the costs and benefits of residencies in family medicine, osteopathic medicine, and general dentistry, because they resemble optometric residencies most closely. Costs of an existing vision therapy residency are examined, and…

  13. Protein Interaction Screening for the Ankyrin Repeats and Suppressor of Cytokine Signaling (SOCS) Box (ASB) Family Identify Asb11 as a Novel Endoplasmic Reticulum Resident Ubiquitin Ligase

    DEFF Research Database (Denmark)

    Andresen, Christina Aaen; Smedegaard, Stine; Sylvestersen, Kathrine Beck

    2014-01-01

    The Ankyrin and SOCS (Suppressor of Cytokine Signaling) box (ASB) family of proteins function as the substrate recognition subunit in a subset of Elongin-Cullin-SOCS (ECS) E3 ubiquitin ligases. Despite counting with 18 members in humans, the identity of the physiological targets of the Asb protei...

  14. Prognostic significance of cancer family history for patients with gastric cancer: a single center experience from China.

    Science.gov (United States)

    Liu, Xiaowen; Cai, Hong; Yu, Lin; Huang, Hua; Long, Ziwen; Wang, Yanong

    2016-06-14

    Family history of cancer is a risk factor for gastric cancer. In this study, we investigated the prognoses of gastric cancer patients with family history of cancer. A total of 1805 gastric cancer patients who underwent curative gastrectomy from 2000 to 2008 were evaluated. The clinicopathologic parameters and prognoses of gastric cancer patients with a positive family history (PFH) of cancer were compared with those with a negative family history (NFH). Of 1805 patients, 382 (21.2%) patients had a positive family history of cancer. Positive family history of cancer correlated with younger age, more frequent alcohol and tobacco use, worse differentiation, smaller tumor size, and more frequent tumor location in the lower 1/3 of the stomach. The prognoses of patients with a positive family history of cancer were better than that of patients with a negative family history. Family history of cancer independently correlated with better prognosis after curative gastrectomy in gastric cancer patients.

  15. Mentoring in psychiatric residency programs: a survey of chief residents.

    Science.gov (United States)

    Lis, Lea DeFrancisci; Wood, William C; Petkova, Eva; Shatkin, Jess

    2009-01-01

    Mentorship is an important component of graduate education. This study assessed the perceptions of general psychiatry chief residents regarding the adequacy of mentorship provided during training. The authors surveyed 229 chief residents participating in the APA National Chief Residents Leadership Program in 2004 and 2005. The survey assessed domains such as work hours, didactics, home and family life, and mentorship. Of the chief psychiatric residents surveyed, 49% reported that they did not have a clearly defined career development mentor, and 39% reported that they did not feel adequately mentored. Gender, race/ethnicity, marital status, moonlighting, medical school (American versus international), and type of residency program (academic versus community based) did not show significant association with either "having a clearly defined mentor" or "feeling adequately mentored," based on chi-squared tests for independence. Chief residents who had authored peer-reviewed publications were significantly more likely to report having a clearly defined mentor and to feel adequately mentored than those who did not author publications. Logistic regression analysis showed that having a clearly defined mentor was associated with twice the odds for feeling well prepared to practice psychiatry upon graduation compared with those who did not have a clearly defined mentor, even after controlling for gender, race, medical school, and residency program type. Half of the psychiatric chief residents surveyed reported the lack of a clearly defined career development mentor. In addition, a chief resident's response of lacking a clear mentor was associated with the perception of being less prepared to practice psychiatry upon graduation. Psychiatric residency training programs may benefit from further clarification and implementation of effective mentorship programs.

  16. Family Satisfaction With Nursing Home Care.

    Science.gov (United States)

    Shippee, Tetyana P; Henning-Smith, Carrie; Gaugler, Joseph E; Held, Robert; Kane, Robert L

    2017-03-01

    This article explores the factor structure of a new family satisfaction with nursing home care instrument and determines the relationship of resident quality of life (QOL) and facility characteristics with family satisfaction. Data sources include (1) family satisfaction interviews ( n = 16,790 family members), (2) multidimensional survey of resident QOL ( n = 13,433 residents), and (3) facility characteristics ( n = 376 facilities). We used factor analysis to identify domains of family satisfaction and multivariate analyses to identify the role of facility-level characteristics and resident QOL on facility-mean values of family satisfaction. Four distinct domains were identified for family satisfaction: "care," "staff," "environment," and "food." Chain affiliation, higher resident acuity, more deficiencies, and large size were all associated with less family satisfaction, and resident QOL was a significant (albeit weak) predictor of family satisfaction. Results suggest that family member satisfaction is distinct from resident QOL but is associated with resident QOL and facility characteristics.

  17. Research report 24 single-family dwellings from the fifties. Annex; Onderzoekrapport 24 rijwoningen jaren '50. Bijlage

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2011-05-15

    This analysis is part of a coordinated series of studies for different residential building complexes of different corporations. This research report concerns the quick scan to decide on investments for the improvement of three single-family houses complexes, which were built in 1959. Based on four financial scenarios a framework is set up by means of which an integrated investment assessment can be made. In the study, scores are given for improving energy efficiency, reducing emission, quality of the construction, technical quality, urban and architectural quality, indoor environment, social aspects, etc. [Dutch] Deze analyse is onderdeel van een gecoordineerde serie onderzoeken voor verschillende complexen van verschillende corporaties. Dit onderzoeksrapport betreft de quickscan voor de investeringsafweging voor de verbetering van een drietal complexen van het type eengezinswoningen eind jaren vijftig. Op basis van vier financieel onderbouwde scenario's wordt het kader geschetst waarmee een integrale investeringsafweging kan worden gemaakt. In het onderzoek worden waarderingen gegeven voor de verbetering van de aspecten energiezuinigheid, uitstoot), bouwtechnisch kwaliteit, markttechnische kwaliteit, stedenbouwkundige en architectonische kwaliteit, binnenklimaat, sociale aspecten, etc.

  18. Neighborhood Landscape Spatial Patterns and Land Surface Temperature: An Empirical Study on Single-Family Residential Areas in Austin, Texas

    Science.gov (United States)

    Kim, Jun-Hyun; Gu, Donghwan; Sohn, Wonmin; Kil, Sung-Ho; Kim, Hwanyong; Lee, Dong-Kun

    2016-01-01

    Rapid urbanization has accelerated land use and land cover changes, and generated the urban heat island effect (UHI). Previous studies have reported positive effects of neighborhood landscapes on mitigating urban surface temperatures. However, the influence of neighborhood landscape spatial patterns on enhancing cooling effects has not yet been fully investigated. The main objective of this study was to assess the relationships between neighborhood landscape spatial patterns and land surface temperatures (LST) by using multi-regression models considering spatial autocorrelation issues. To measure the influence of neighborhood landscape spatial patterns on LST, this study analyzed neighborhood environments of 15,862 single-family houses in Austin, Texas, USA. Using aerial photos, geographic information systems (GIS), and remote sensing, FRAGSTATS was employed to calculate values of several landscape indices used to measure neighborhood landscape spatial patterns. After controlling for the spatial autocorrelation effect, results showed that larger and better-connected landscape spatial patterns were positively correlated with lower LST values in neighborhoods, while more fragmented and isolated neighborhood landscape patterns were negatively related to the reduction of LST. PMID:27598186

  19. The effect of building regulations on energy consumption in single-family houses in Denmark. Final version

    Energy Technology Data Exchange (ETDEWEB)

    Hansen Kjaerbye, V. (Roskilde Univ.. Dept. of Environmental, Social and Spatial Change, Roskilde (Denmark)); AKF (Danish Institute of Governmental Research, Copenhagen (Denmark)); Larsen, Anders E. (Roskilde Univ.. Dept. of Society and Globalisation, Roskilde (Denmark)); Togeby, M (Ea Energy Analyses, Copenhagen (Denmark))

    2010-04-15

    This paper explores how changes in regulatory requirements for energy efficiency in buildings (in the US also known as building energy codes) affect household energy consumption. The focus in this paper is on natural gas consumption by Danish single-family owner-occupied houses. Unlike most other papers investigating household energy consumption this paper uses a unique panel data set constructed by merging several administrative data bases. The data set describes house and household characteristics, outdoor temperature and actual metered natural gas consumption over 6 years (1998-2003). Applying advanced econometric methods we examine differences in heating energy consumption due to different building regulation requirements at the time of house construction. As for the effect of the building regulation, we find that changes in Danish building regulations have led to significant reductions in energy used for heating. The latest revision of the Danish building regulation covered by this paper is that of 1998. This revision has resulted in a 7 percent reduction in natural gas consumption. (Author)

  20. Neighborhood Landscape Spatial Patterns and Land Surface Temperature: An Empirical Study on Single-Family Residential Areas in Austin, Texas

    Directory of Open Access Journals (Sweden)

    Jun-Hyun Kim

    2016-09-01

    Full Text Available Rapid urbanization has accelerated land use and land cover changes, and generated the urban heat island effect (UHI. Previous studies have reported positive effects of neighborhood landscapes on mitigating urban surface temperatures. However, the influence of neighborhood landscape spatial patterns on enhancing cooling effects has not yet been fully investigated. The main objective of this study was to assess the relationships between neighborhood landscape spatial patterns and land surface temperatures (LST by using multi-regression models considering spatial autocorrelation issues. To measure the influence of neighborhood landscape spatial patterns on LST, this study analyzed neighborhood environments of 15,862 single-family houses in Austin, Texas, USA. Using aerial photos, geographic information systems (GIS, and remote sensing, FRAGSTATS was employed to calculate values of several landscape indices used to measure neighborhood landscape spatial patterns. After controlling for the spatial autocorrelation effect, results showed that larger and better-connected landscape spatial patterns were positively correlated with lower LST values in neighborhoods, while more fragmented and isolated neighborhood landscape patterns were negatively related to the reduction of LST.

  1. A single codon insertion in PICALM is associated with development of familial subvalvular aortic stenosis in Newfoundland dogs.

    Science.gov (United States)

    Stern, Joshua A; White, Stephen N; Lehmkuhl, Linda B; Reina-Doreste, Yamir; Ferguson, Jordan L; Nascone-Yoder, Nanette M; Meurs, Kathryn M

    2014-09-01

    Familial subvalvular aortic stenosis (SAS) is one of the most common congenital heart defects in dogs and is an inherited defect of Newfoundlands, golden retrievers and human children. Although SAS is known to be inherited, specific genes involved in Newfoundlands with SAS have not been defined. We hypothesized that SAS in Newfoundlands is inherited in an autosomal dominant pattern and caused by a single genetic variant. We studied 93 prospectively recruited Newfoundland dogs, and 180 control dogs of 30 breeds. By providing cardiac screening evaluations for Newfoundlands we conducted a pedigree evaluation, genome-wide association study and RNA sequence analysis to identify a proposed pattern of inheritance and genetic loci associated with the development of SAS. We identified a three-nucleotide exonic insertion in phosphatidylinositol-binding clathrin assembly protein (PICALM) that is associated with the development of SAS in Newfoundlands. Pedigree evaluation best supported an autosomal dominant pattern of inheritance and provided evidence that equivocally affected individuals may pass on SAS in their progeny. Immunohistochemistry demonstrated the presence of PICALM in the canine myocardium and area of the subvalvular ridge. Additionally, small molecule inhibition of clathrin-mediated endocytosis resulted in developmental abnormalities within the outflow tract (OFT) of Xenopus laevis embryos. The ability to test for presence of this PICALM insertion may impact dog-breeding decisions and facilitate reduction of SAS disease prevalence in Newfoundland dogs. Understanding the role of PICALM in OFT development may aid in future molecular and genetic investigations into other congenital heart defects of various species.

  2. Single chain variable fragment antibodies block aggregation and toxicity induced by familial ALS-linked mutant forms of SOD1.

    Science.gov (United States)

    Ghadge, Ghanashyam D; Pavlovic, John D; Koduvayur, Sujatha P; Kay, Brian K; Roos, Raymond P

    2013-08-01

    Approximately 10% of amyotrophic lateral sclerosis (ALS) cases are familial (known as FALS) with an autosomal dominant inheritance pattern, and ~25% of FALS cases are caused by mutations in Cu/Zn superoxide dismutase (SOD1). There is convincing evidence that mutant SOD1 (mtSOD1) kills motor neurons (MNs) because of a gain-of-function toxicity, most likely related to aggregation of mtSOD1. A number of recent reports have suggested that antibodies can be used to treat mtSOD1-induced FALS. To follow up on the use of antibodies as potential therapeutics, we generated single chain fragments of variable region antibodies (scFvs) against SOD1, and then expressed them as 'intrabodies' within a motor neuron cell line. In the present study, we describe isolation of human scFvs that interfere with mtSOD1 in vitro aggregation and toxicity. These scFvs may have therapeutic potential in sporadic ALS, as well as FALS, given that sporadic ALS may also involve abnormalities in the SOD1 protein or activity. Copyright © 2013 Elsevier Inc. All rights reserved.

  3. Inequalities in the psychological well-being of employed, single and partnered mothers: the role of psychosocial work quality and work-family conflict

    Directory of Open Access Journals (Sweden)

    Muhajarine Nazeem

    2010-02-01

    Full Text Available Abstract Background A large body of international research reveals that single mothers experience poorer mental health than their partnered counterparts, with socioeconomic disadvantage identified as an important contributory factor in understanding this health disparity. Much less research, however, has focused specifically on the psychological well-being of single mothers who are employed, despite their growing presence in the labor force. Of the research which has considered employment, the focus has been on employment status per se rather than on other important work-related factors which may impact psychological health, such as psychosocial work quality and work-family conflict. The aim of this study was to: (1 compare employed single mothers and employed partnered mothers on measures of psychological distress, psychosocial work quality and work-family conflict; and (2 explore the potential role of work-family conflict and psychosocial work quality as explanations for any observed differences in psychological distress based on partner status. Method Analysis of data obtained from a cross-sectional telephone survey of employed parents in a mid-sized Western Canadian city. Analyses were based on 674 employed mothers (438 partnered and 236 single, who were 25-50 years old, with at least one child in the household. Results Compared to employed single mothers, employed partnered mothers were older, had more education and reported fewer hours of paid work. Single mothers reported higher levels of psychological distress, financial hardship, work-family conflict and poor psychosocial work quality. Statistical adjustment for income adequacy, psychosocial work quality and work-family conflict each independently resulted in single motherhood no longer being associated with psychological distress. Conclusions While single employed mothers did experience higher levels of psychological distress than their partnered counterparts, differences between these

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

    Science.gov (United States)

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

    2015-01-01

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

  5. Gender Gap in Maths Test Scores in South Korea and Hong Kong: Role of Family Background and Single-Sex Schooling

    Science.gov (United States)

    Kim, Doo Hwan; Law, Helen

    2012-01-01

    In many industrialised societies, women remain underrepresented in the sciences, which can be predicted by the gender gap in math achievement at school. Using PISA 2006 data, we explore the role of family background and single-sex schooling in girls' disadvantage in maths in South Korea and Hong Kong. This disadvantage is found to be associated…

  6. A single nucleotide deletion of 293delT in SEDL gene causing spondyloepiphyseal dysplasia tarda in a four-generation Chinese family

    DEFF Research Database (Denmark)

    Xiao, Cuiying; Zhang, Sizhong; Wang, Jun

    2003-01-01

    . The distinctive radiological signs and the X-linked mode of inheritance make it easy to diagnose. Here a four-generation Chinese SEDT family has been analyzed and the disease-causing mutation has been found. After polymerase chain reaction (PCR)-single strand conformation polymorphism (SSCP) analysis and DNA...

  7. A family of 'windmill'-like {Cu6Ln12} complexes exhibiting single-molecule magnetism behavior and large magnetic entropy changes.

    Science.gov (United States)

    Alexandropoulos, Dimitris I; Poole, Katye M; Cunha-Silva, Luis; Ahmad Sheikh, Javeed; Wernsdorfer, Wolfgang; Christou, George; Stamatatos, Theocharis C

    2017-04-11

    A family of nanosized {Cu6Ln12} clusters with a 'windmill'-like topology was prepared from the employment of 2,6-diacetylpyridine dioxime, in conjunction with bridging N3-, in 3d/4f-metal chemistry; the octadecanuclear compounds exhibit single-molecule magnetism behavior and large magnetic entropy changes, depending on the 4f-metal ion present.

  8. Individual- and Family-Level Determinants of Risky Sexual Behavior Among Swedish- and Foreign-Born Young Adults 18-30 Years of Age, Residing in Skåne, Sweden.

    Science.gov (United States)

    Asamoah, Benedict Oppong; Agardh, Anette

    2017-05-30

    In Sweden, various public health interventions have been performed to reduce risky sexual behaviors among young people and promote safer and positive approaches to sexuality, while attempting to bridge the gap between the less privileged or more vulnerable young people and their more privileged peers. This study aimed to compare the individual- and familial-level determinants of risky sexual behavior among foreign-born and Swedish-born young adults 18-30 years of age residing in Skåne, the south of Sweden. This was a cross-sectional study that used a questionnaire to collect data from 2968 randomly selected respondents between 18 and 30 years between January and March 2013. The associations were analyzed using chi-square tests, and simple and multiple logistic regression analyses. Younger age, i.e., individual-level factor, and living with only one parent or another person while growing up, i.e., familial-level factor, increased the risk of engaging in sexual risk taking for both Swedish- and foreign-born youth. Male gender was related to a higher risk of engaging in sexual risk-taking behaviors among foreign-born youth but was not as important as influence on sexual risk taking among Swedish-born youth. Parental education level, on the other hand, was significantly associated with sexual intercourse on the "first night" and early sexual debut solely among Swedish-born youth. Condom use was not associated with any family-level factor among both Swedish-born and foreign-born youth. The design of sexual reproductive health and rights messages and interventions to target risky sexual behavior among Swedish youth should take into consideration immigration status (for example, being Swedish-born or foreign-born), individual- and family-level characteristics, as well as the type of behavioral change or outcome desired.

  9. A novel marker for terminal Schwann cells, homocysteine-responsive ER-resident protein, as isolated by a single cell PCR-differential display.

    Science.gov (United States)

    Oda, Ryo; Yaoi, Takeshi; Okajima, Seiichiro; Kobashi, Hiroaki; Kubo, Toshikazu; Fushiki, Shinji

    2003-09-05

    Terminal Schwann cells (TSCs) that cover motor neuron terminals are known to play important roles in maintaining neuromuscular junctions, as well as in the repair process after nerve injury. However, molecular characteristics of TSCs remain unknown, because of the difficulties in analyzing them due to their paucity. We have established a method of selectively and efficiently collecting TSCs so that cDNA analysis can be done properly. The expression of 1-2% of whole mRNAs was compared between myelinating Schwann cells (MSCs) and TSCs, and it turned out that approximately one-third of the bands could be categorized as cell-type-specific bands. TSCs thus constitute a distinct entity from the viewpoint of gene expression. As one of the cDNA clones belonging to TSC-specific bands was identified homocysteine-responsive ER-resident protein (Herp), and in situ hybridization confirmed that Herp mRNA is expressed in TSCs on motor nerve terminals but not in MSCs, both in developing and adult rats. In conclusion, we have been able to identify Herp as a novel molecular marker for TSCs.

  10. Investigation of single-strand conformational polymorphism of the TP53 gene in women with a family history of breast cancer

    Directory of Open Access Journals (Sweden)

    R.R. Burbano

    2000-11-01

    Full Text Available Breast cancer in families with germ line mutations in the TP53 gene has been described in the medical literature. Mutation screening for susceptibility genes should allow effective prophylactic and preventive measures. Using single-strand conformational polymorphism, we screened for mutations in exons 5, 6, 7 and 8 of gene TP53 in the peripheral blood of 8 young non-affected members (17 to 36 years old of families with a history of breast cancer. Studies of this type on young patients (mean age, 25 years are very rare in the literature. The identification of these mutations would contribute to genetic counseling of members of families with predisposition to breast cancer. The results obtained did not show any polymorphism indicating mutation. In our sample, the familial tumorigenesis is probably related to other gene etiologies.

  11. Family structure and family processes in Mexican-American families.

    Science.gov (United States)

    Zeiders, Katharine H; Roosa, Mark W; Tein, Jenn-Yun

    2011-03-01

    Despite increases in single-parent families among Mexican Americans, few studies have examined the association of family structure and family adjustment. Utilizing a diverse sample of 738 Mexican-American families (21.7% single parent), the current study examined differences across family structure on early adolescent outcomes, family functioning, and parent-child relationship variables. Results revealed that early adolescents in single-parent families reported greater school misconduct, conduct disorder/oppositional deviant disorder, and major depressive disorder symptoms, and greater parent-child conflict than their counterparts in 2-parent families. Single-parent mothers reported greater economic hardship, depression, and family stress. Family stress and parent-child conflict emerged as significant mediators of the association between family structure and early adolescent outcomes, suggesting important processes linking Mexican-American single-parent families and adolescent adjustment. 2011 © FPI, Inc.

  12. [Postgraduate education in family and community medicine. The importance of differences between health care activity of the tutor and the resident].

    Science.gov (United States)

    León Martínez, L P; Gómez Jara, P; Martínez González-Moro, N; Navarro Martínez, A; Guillén Montiel, C; Saura Llamas, J

    1994-01-01

    To find the health-care activity of Family and Community Medicine (FCM) Interns (I) during their third year of Primary Care duties, to check the existence of significant differences with the Tutor's (T) health-care activity, and to evaluate, using the requests for complementary tests and the referral rate, possible qualitative differences in the outcome of on-demand consultations. A descriptive and retrospective observation study, with two parts, each corresponding to one objective. Primary Health Care. The Carmen Health Centre in Murcia, used for teaching postgraduate FCM. A sample of 489 cases of those requesting health consultations between February 1st and December 21st, 1990 for the first part of the study; and all those consultations between April 8th and May 8th, 1991 for the second part. Covering five family practices. The variables studied were: gender, age, the first or second medical consultation, administrative consultations, reasons for the consultation, the number of inter-referrals and the number of complementary tests. The I had fewer consultations a day than the T (p < 0.001), with a greater proportion of young people between 26 and 35 (p < 0.001) and with first (p < 0.001) and administrative (p < 0.001) consultations predominating. However no differences were observed regarding requests for complementary tests and referral rates. 1. Significant differences exist between the health-care activity of the T and the I. 2. The population selects the doctor who is going to care for them. 3. There were no differences observed in requests for complementary tests and the referral rates. 4. It would be important to assess the teaching repercussion of these differences and to introduce corrective mechanisms if it is thought necessary.

  13. Las competencias profesionales adquiridas en medicina familiar y comunitaria: Una mirada desde tutores y residentes Professional competencies acquired in family and community medicine: An overwiew from tutors and residents

    Directory of Open Access Journals (Sweden)

    Eulalia Ros Martrat

    2004-12-01

    Full Text Available El estudio tenía como objetivo analizar y contrastar las percepciones de tutores y de sus respectivos residentes en la especialidad de Medicina Familiar y Comunitaria sobre las competencias profesionales adquiridas al finalizar la formación de postgrado. Para ello se combinó información cuantitativa y cualitativa. Primero se utilizó un cuestionario para recoger una primera opinión de dos poblaciones: los residentes (R3 de Cataluña de esta especialidad (N=240 y sus respectivos tutores (N=240. Después se organizaron grupos de discusión para analizar y clarificar los datos obtenidos en el cuestionario. Este proceso se realizó en paralelo con ambos colectivos. Los resultados mostraron que estadísticamente la percepción de los tutores sobre el grado de capacitación obtenido al finalizar el periodo de residencia es o muy similar o superior a la de los propios residentes y en general bastante positiva. Las áreas más valoradas son las habilidades clínicas básicas, habilidades de manejo, comunicación y preventiva; las menos valoradas, docencia, investigación y comunitaria quedando las otras áreas (técnicas instrumentales, aspectos organizativos y familia en una posición intermedia. Sin embargo, los datos narrativos ofrecen una visión más compleja de la realidad. Los resultados apuntan que la formación del especialista sigue poniendo más énfasis en la atención al individuo que en áreas vinculadas a un enfoque integral de la salud.This study analyses and contrasts the perceptions of tutors and their respective residents in the Family and Community Medicine speciality regarding the professional competencies acquired by the end of their postgraduate training. The study combined quantitative and qualitative data. Firstly, a questionnaire was used to collect a first opinion from two populations: residents (R3 in this speciality in Catalan hospitals (N=240 and their tutors (N=240. Discussion groups were then organised in order to

  14. Field Test Evaluation of Conservation Retrofits of Low-Income Single Family Buildings in Wisconsin: Summary Report

    Energy Technology Data Exchange (ETDEWEB)

    Ternes, M.P.

    2001-05-21

    During the winter of 1985-86, a retrofit field test was performed in 66 occupied, low-income, single-family homes in Madison, Wisconsin. The primary objectives of the field test were to (1) determine the measured energy savings and the relative benefits of a combination of envelope and mechanical equipment retrofits that were selected following a new audit-directed retrofit procedure, (2) determine the energy savings and benefits due to performing infiltration reduction work following a recently developed infiltration reduction procedure, and (3) study general occupant behavior and house thermal characteristics and their possible change following retrofit installation. This report provides an overview of the project and summarizes the findings which will be presented in detail in separate reports. Major findings from the field test include: (1) The audit-directed retrofit procedure produced an average savings of 207 therms/year/house. The procedure also more than doubled the overall cost-effectiveness of the low-income weatherization assistance program as compared with the priority system formerly used in Wisconsin. Wall insulation and condensing furnaces were the major retrofits (predicted annual energy savings greater than 100 therms/year) most often selected under the procedure. The respective average energy savings of the houses receiving wall insulation and condensing furnace. s was 14.6 and 14.3 therms/year for each $100 spent on them under the program. (2) The blower-door-guided infiltration reduction procedure reduced expenditures for infiltration reduction to about one-fourth of previous program costs (from $570/house to $106/house). The procedure also reduced the average air leakage rate in the treated houses by 16%, whereas, in a previous study, no significant reduction was found following the installation of typical infiltration reduction measures. (3) Twenty to 60% of the deviation between predicted and measured savings can be attributed to incorrect

  15. Residency Allocation Database

    Data.gov (United States)

    Department of Veterans Affairs — The Residency Allocation Database is used to determine allocation of funds for residency programs offered by Veterans Affairs Medical Centers (VAMCs). Information...

  16. Presymptomatic diagnosis using a deletion of a single codon in families with hereditary non-polyposis colorectal cancer

    DEFF Research Database (Denmark)

    Ripa, Rasmus S.; Katballe, Niels; Wikman, Friedrik P.

    2005-01-01

    , identified after mutation screening of MSH2 and MLH1. All patients in the families were haplotyped using markers flanking the MSH2 gene. The haplotypes revealed that the five families with high probability descended from only two founders. The N596del segregated with the HNPCC phenotype with lod scores of 3....... The results support the hypothesis that N596del is the disease causing mutation and not a clinically silent variation. On this basis, the application of the MSH2 N596del mutation, in presymptomatic screening of HNPCC families, is recommended....

  17. Anxiety and depression levels among multidisciplinary health residents

    Directory of Open Access Journals (Sweden)

    Daniela Salvagni Rotta

    2016-01-01

    Full Text Available Objective: to assess symptoms of anxiety and depression of professionals of Multidisciplinary Health Residence Programs. Methods: this is a cross-sectional study, performed with fifty professionals, using three instruments: one for socioeconomic and demographic data, and the Beck’s Anxiety and Depression Scale. Results: predominance of females (92.0%, average age 26 years old, single (88.0%, family income from two to five salaries (56.0% satisfied with the work (82.0% and thought about quitting the program (56.0% showed anxiety (50.0% and depression (28.0%. Conclusion: there was an association between anxiety and depression in multidisciplinary residents, which points to the need for rethinking strategies for identifying these symptoms and control of stress factors for the promotion of mental health.

  18. Retrofitting Domestic Hot Water Heaters for Solar Water Heating Systems in Single-Family Houses in a Cold Climate: A Theoretical Analysis

    OpenAIRE

    Björn Karlsson; Henrik Davidsson; Bernardo, Luis R.

    2012-01-01

    One of the biggest obstacles to economic profitability of solar water heating systems is the investment cost. Retrofitting existing domestic hot water heaters when a new solar hot water system is installed can reduce both the installation and material costs. In this study, retrofitting existing water heaters for solar water heating systems in Swedish single-family houses was theoretically investigated using the TRNSYS software. Four simulation models using forced circulation flow with differe...

  19. Retrofitting Conventional Electric Domestic Hot Water Heaters to Solar Water Heating Systems in Single-Family Houses—Model Validation and Optimization

    OpenAIRE

    Bernardo, Luis R.

    2013-01-01

    System cost reductions and development of standardised plug-and-function systems are some of the most important goals for solar heating technology development. Retrofitting hot water boilers in single-family houses when installing solar collectors has the potential to significantly reduce both material and installation costs. In this study, the TRNSYS simulation models of the retrofitting solar thermal system were validated against measurements. Results show that the validated models are in g...

  20. 7 CFR Exhibit E to Subpart K of... - Guide Letter to Delinquent FmHA or Its Successor Agency Under Public Law 103-354 Single Family...

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 13 2010-01-01 2009-01-01 true Guide Letter to Delinquent FmHA or Its Successor Agency Under Public Law 103-354 Single Family Housing Loan Borrowers E Exhibit E to Subpart K of Part..., Subpt. K, Exh. E Exhibit E to Subpart K of Part 1944—Guide Letter to Delinquent FmHA or Its Successor...

  1. Attempting to understand (and control) the relationship between structure and magnetism in an extended family of Mn(6) single-molecule magnets

    DEFF Research Database (Denmark)

    Inglis, Ross; Jones, Leigh F; Milios, Constantinos J

    2009-01-01

    The synthesis and characterisation of a large family of hexametallic [Mn(III)(6)] Single-Molecule Magnets of general formula [Mn(III)(6)O(2)(R-sao)(6)(X)(2)(sol)(4-6)] (where R = H, Me, Et; X = (-)O(2)CR' (R' = H, Me, Ph etc) or Hal(-); sol = EtOH, MeOH and/or H(2)O) are presented. We show how...

  2. Parenting During Residency: Providing Support for Dr Mom and Dr Dad.

    Science.gov (United States)

    Morris, Laura; Cronk, Nikole J; Washington, Karla T

    2016-02-01

    Parenting during family medicine residency is increasingly common. Relatively little is known about how the competing demands of work and family life affect residents. We conducted an exploratory qualitative study of parenting family medicine residents at one program in the Midwest utilizing focus groups to understand residents' perceptions of the positive and negative characteristics of their roles as physicians and parents. We used consensus coding to identify themes in the data and then developed a model to illustrate the relationships among the identified themes. Competing demands on their time require parenting family medicine residents to often make difficult choices, which result in both positive and negative outcomes for residents, their families, and their residency experience. Parenting family medicine residents experience numerous conflicts in their concurrent roles of learner, physician, and parent. Parenting-friendly residency training programs would likely offer valuable support for these individuals during this stressful life period.

  3. Primary Care Residents Improve Knowledge, Skills, Attitudes, and Practice After a Clinical Curriculum With a Hospice.

    Science.gov (United States)

    von Gunten, Charles F; Mullan, Patricia B; Nelesen, Richard; Garman, Karen; McNeal, Helen; Savoia, Maria; Muchmore, Elaine; Ikeda, Tyson; Amundson, Stan; McKennett, Marianne; Diamant, Joel; Pepper, Patricia; Gray, Cynthia; Weissman, David

    2017-09-01

    Effective approaches to teaching attitudes, knowledge, and skills to resident physicians in primary care that can be implemented in any residency program are needed. We examined the feasibility and impact of a single palliative care residency curriculum, including a clinical rotation with a hospice program, across 5 cohorts of residents in 7 divergent primary care residency programs (both family medicine and internal medicine). The didactic content was drawn from the national Education for Physicians on End-of-Life Care Project. A total of 448 residents completed the curriculum. A large effect size was seen in measures of knowledge change (*Cohen d = .89) when compared to a national sample of primary care residency programs. Additionally, measures of confidence to perform palliative care skills and ethical concerns also improved significantly ( P hospice setting. In a separate, ancillary evaluation, the average length of stay of patients enrolled in hospice care was 18.5 days longer for the alumni of this program when compared to physicians referring for hospice care who hadn't experienced the curriculum.

  4. EDUCATIONAL TACTICS OF MOTHERS AND THEIR RELATION TO THE PSYCHOLOGICAL CHARACTERISTICS OF ADOLESCENTS IN TWO-PARENT AND SINGLE-PARENT FAMILIES

    Directory of Open Access Journals (Sweden)

    Константин Борисович Зуев

    2013-04-01

    Full Text Available The paper presents the results of a study of the psychological characteristics of boys and girls from complete and incomplete families. In addition to the type of family, the authors consider the educational tactics of mothers. The combined effects of the type of family and educational tactics on psychological characteristics of the adolescent were investigated. Adolescence was chosen as a period, when on the one hand, a relatively stable personality structure is developed, and on the other hand, the importance of the immediate social environment is extremely high. For our study we selected the psychological characteristics, to the utmost revealing the reaction of children to their parents' divorce: the level of subjective control (degree of responsibility for their own lives, and the sovereignty of the psychological space (clearnesse of psychological boundaries. It is shown that the largest influence on the psychological characteristics of adolescents, regardless of the type of family, is rendered by hostility in maternal education. The dependence of psychological characteristics of maternal directiveness occurs only at high values of such educational tactics that highlights the consistency of the obtained results with the classical studies of single-parent families.DOI: http://dx.doi.org/10.12731/2218-7405-2013-3-6

  5. Burnout Comparison among Residents in Different Medical Specialties

    Science.gov (United States)

    Martini, Shahm; Arfken, Cynthia L.; Churchill, Amy; Balon, Richard

    2004-01-01

    Objective: To investigate resident burnout in relation to work and home-related factors. Method: Maslach Burnout Inventory was mailed to residents in eight different medical specialties, with a response rate of 35%. Results: Overall, 50% of residents met burnout criteria, ranging from 75% (obstetrics/gynecology) to 27% (family medicine). The first…

  6. [Structural, developmental and functional evaluation of the family of individuals with arterial hypertension].

    Science.gov (United States)

    Radovanovic, Cremilde Aparecida Trindade; Cecilio, Hellen Pollyanna Mantelo; Marcon, Sonia Silva

    2013-03-01

    The objective of the study was to evaluate the structure, development and functionality of the family that suffers from arterial hypertension. This is a qualitative study, developed with two families using the Calgary Model of Family Evaluation. It proposes the use of three categories of analysis: structural developmental and functional, and the use of a genogram and an ecomap. The two families are nuclear, however one is formed by the couple and their three sons who are married and reside in different homes. The other is a single-parent family established by the mother and children. The married son resides at another house in the same backyard with wife and daughter The application of the model of family evaluation allowed knowing the aspects related to the structure, operation and development of the two families that interfere impair or favor the development of the care in their quotidian.

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

    Directory of Open Access Journals (Sweden)

    Victor O. Kolade

    2014-07-01

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

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

    Science.gov (United States)

    Kolade, Victor O.; Staton, Lisa J.; Jayarajan, Ramesh; Bentley, Nanette K.; Huang, Xiangke

    2014-01-01

    Introduction The role of the internal medicine chief resident includes various administrative, academic, social, and educational responsibilities, fulfillment of which prepares residents for further leadership tasks. However, the chief resident position has historically only been held by a few residents. As fourth-year chief residents are becoming less common, we considered a new model for rotating third-year residents as the chief resident. Methods Online surveys were given to all 29 internal medicine residents in a single university-based program after implementation of a leadership curriculum and specific job description for the third-year chief resident. Chief residents evaluated themselves on various aspects of leadership. Participation was voluntary. Descriptive statistics were generated using SPSS version 21. Results Thirteen junior (first- or second-year) resident responses reported that the chief residents elicited input from others (mean rating 6.8), were committed to the team (6.8), resolved conflict (6.7), ensured efficiency, organization and productivity of the team (6.7), participated actively (7.0), and managed resources (6.6). Responses from senior residents averaged 1 point higher for each item; this pattern repeated itself in teaching evaluations. Chief resident self-evaluators were more comfortable running a morning report (8.4) than with being chief resident (5.8). Conclusion The feasibility of preparing internal medicine residents for leadership roles through a rotating PGY-3 (postgraduate year) chief residency curriculum was explored at a small internal medicine residency, and we suggest extending the study to include other programs. PMID:25147630

  9. Long-term effects of a 12 weeks high-intensity functional exercise program on physical function and mental health in nursing home residents with dementia: a single blinded randomized controlled trial.

    Science.gov (United States)

    Telenius, Elisabeth Wiken; Engedal, Knut; Bergland, Astrid

    2015-12-03

    Research indicates that exercise can have a positive effect on both physical and mental health in nursing home patients with dementia, however the lasting effect is rarely studied. In a previously published article we investigated the immediate effect of a 12 weeks functional exercise program on physical function and mental health in nursing home residents with dementia. In this paper we studied the long-term effect of this exercise program. We explored the differences between the exercise and control group from baseline to 6 months follow-up and during the detraining period from month 3 to 6. A single blind, randomized controlled trial was conducted and a total of 170 nursing home residents with dementia were included. The participants were randomly allocated to an intervention (n = 87) or a control group (n = 83). The intervention consisted of intensive strengthening and balance exercises in small groups twice a week for 12 weeks. The control condition was leisure activities. Thirty participants were lost between baseline and six-month follow-up. Linear mixed model analyses for repeated measurements were used to investigate the effect of exercise after detraining period. The exercise group improved their scores on Berg Balance Scale from baseline to 6 months follow-up by 2.7 points in average. The control group deteriorated in the same period and the difference between groups was statistically significant (p = 0.031). The exercise group also scored better on NPI agitation sub-score after 6 months (p = 0.045). The results demonstrate long-time positive effects of a high intensity functional exercise program on balance and indicate a positive effect on agitation, after an intervention period of 12 weeks followed by a detraining period of 12 weeks. Identifier at ClinicalTrials.gov: NCT02262104.

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

    Science.gov (United States)

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

    2012-08-01

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

  11. Editing of misaligned 3′-termini by an intrinsic 3′–5′ exonuclease activity residing in the PHP domain of a family X DNA polymerase

    Science.gov (United States)

    Baños, Benito; Lázaro, José M.; Villar, Laurentino; de Vega, Miguel

    2008-01-01

    Bacillus subtilis gene yshC encodes a family X DNA polymerase (PolXBs), whose biochemical features suggest that it plays a role during DNA repair processes. Here, we show that, in addition to the polymerization activity, PolXBs possesses an intrinsic 3′–5′ exonuclease activity specialized in resecting unannealed 3′-termini in a gapped DNA substrate. Biochemical analysis of a PolXBs deletion mutant lacking the C-terminal polymerase histidinol phosphatase (PHP) domain, present in most of the bacterial/archaeal PolXs, as well as of this separately expressed protein region, allow us to state that the 3′–5′ exonuclease activity of PolXBs resides in its PHP domain. Furthermore, site-directed mutagenesis of PolXBs His339 and His341 residues, evolutionary conserved in the PHP superfamily members, demonstrated that the predicted metal binding site is directly involved in catalysis of the exonucleolytic reaction. The implications of the unannealed 3′-termini resection by the 3′–5′ exonuclease activity of PolXBs in the DNA repair context are discussed. PMID:18776221

  12. Presymptomatic diagnosis using a deletion of a single codon in families with hereditary non-polyposis colorectal cancer

    DEFF Research Database (Denmark)

    Ripa, R S; Katballe, N; Wikman, F P

    2005-01-01

    The diagnosis of hereditary non-polyposis colorectal cancer (HNPCC) is often confirmed by a mutation in one of several mismatch-repair genes, in particular MLH1, MSH2 and MSH6. Presymptomatic diagnosis requires the identification of a mutation causing the disease. Three different deletions......, identified after mutation screening of MSH2 and MLH1. All patients in the families were haplotyped using markers flanking the MSH2 gene. The haplotypes revealed that the five families with high probability descended from only two founders. The N596del segregated with the HNPCC phenotype with lod scores of 3...

  13. A single codon insertion in PICALM is associated with development of familial subvalvular aortic stenosis in Newfoundland dogs

    Science.gov (United States)

    Familial subvalvular aortic stenosis (SAS) is one of the most common congenital heart defects in dogs and is an inherited defect of Newfoundlands, golden retrievers and human children. Although SAS is known to be inherited, specific genes involved in Newfoundlands with SAS have not been defined. We ...

  14. Amino acid based MOFs: synthesis, structure, single crystal to single crystal transformation, magnetic and related studies in a family of cobalt and nickel aminoisophthales.

    Science.gov (United States)

    Sarma, Debajit; Ramanujachary, K V; Lofland, S E; Magdaleno, Travis; Natarajan, Srinivasan

    2009-12-21

    Four new 5-aminoisophthalates of cobalt and nickel have been prepared employing hydro/solvothermal methods: [Co(2)(C(8)H(5)NO(4))(2)(C(4)H(4)N(2))(H(2)O)(2)].3H(2)O (I), [Ni(2)(C(8)H(5)NO(4))(2)(C(4)H(4)N(2))(H(2)O)(2)].3H(2)O (II), [Co(2)(H(2)O)(mu(3)-OH)(2)(C(8)H(5)NO(4))] (III), and [Ni(2)(H(2)O)(mu(3)-OH)(2)(C(8)H(5)NO(4))] (IV). Compounds I and II are isostructural, having anion-deficient CdCl(2) related layers bridged by a pyrazine ligand, giving rise to a bilayer arrangement. Compounds III and IV have one-dimensional M-O(H)-M chains connected by the 5-aminoisophthalate units forming a three-dimensional structure. The coordinated as well as the lattice water molecules of I and II could be removed and inserted by simple heating-cooling cycles under the atmospheric conditions. The removal of the coordinated water molecule is accompanied by changes in the coordination environment around the M(2+) (M = Co, Ni) and color of the samples (purple to blue, Co; green to dark yellow, Ni). This change has been examined by a variety of techniques that include in situ single crystal to single crystal transformation studies and in situ IR and UV-vis spectroscopic studies. Magnetic studies indicate antiferromagnetic behavior in I and II, a field-induced magnetism in III, and a canted antiferromagnetic behavior in IV.

  15. Adult bone strength of children from single-parent families: the Midlife in the United States Study.

    Science.gov (United States)

    Crandall, C J; Karlamangla, A S; Merkin, S S; Binkley, N; Carr, D; Greendale, G A; Seeman, T E

    2015-03-01

    Bone health may be negatively impacted by childhood socio-environmental circumstances. We examined the independent associations of single-parent childhood and parental death or divorce in childhood with adult bone strength indices. Longer exposure to a single-parent household in childhood was associated with lower bone strength in adulthood. Because peak bone mass is acquired during childhood, bone health may be negatively impacted by childhood socio-environmental disadvantage. The goal of this study was to determine whether being raised in a single-parent household is associated with lower bone strength in adulthood. Using dual-energy X-ray absorptiometry data from 708 participants (mean age 57 years) in the Midlife in the United States Biomarker Project, we examined the independent associations of composite indices of femoral neck bone strength relative to load (in three failure modes: compression, bending, and impact) in adulthood with the experience of single-parent childhood and parental death or divorce in childhood. After adjustment for gender, race, menopause transition stage, age, and body mass index, each additional year of single-parent childhood was associated with 0.02 to 0.03 SD lower indices of adult femoral neck strength. In those with 9-16 years of single-parent childhood, the compression strength index was 0.41 SD lower, bending strength index was 0.31 SD lower, and impact strength index was 0.25 SD lower (all p values divorce during childhood was not by itself independently associated with adult bone strength indices. The magnitudes of these associations were unaltered by additional adjustment for lifestyle factors and socioeconomic status in childhood and adulthood. Independent of parental death or divorce, growing up in a single-parent household is associated with lower femoral neck bone strength in adulthood, and this association is not entirely explained by childhood or adult socioeconomic conditions or lifestyle choices.

  16. Depression in family medicine faculty.

    Science.gov (United States)

    Costa, Anthony J; Labuda Schrop, Susan; McCord, Gary; Ritter, Christian

    2005-04-01

    Depression among family medicine faculty may contribute to decreased effectiveness in patient care, decreased effectiveness in teaching, and career changes. The present study determined the nationwide prevalence of depression and related risk factors among family medicine residency program faculty. All full-time US family medicine faculty, program directors, and behavioral scientists listed as members of the Society of Teachers of Family Medicine in October 2000 were surveyed. The survey included demographics, clinical practice characteristics, the Beck Depression Inventory II, the Social Readjustment Rating Scale (SRRS), and a scale to measure stress within the residency program. Surveys were completed by 1,418 faculty members. Seven percent of survey respondents scored mildly depressed, and 5% scored moderately to severely depressed. Seven percent of respondents scored highly stressed on the SRRS. Significant predictors of depression scores included being single, being a member of an underrepresented minority group, having increased stress scores, and having a greater amount of time devoted to teaching. Program directors and department chairs need to be aware of the prevalence of depression among faculty, since it may affect their performance of patient care and teaching responsibilities.

  17. Do teashirt family genes specify trunk identity? Insights from the single tiptop/teashirt homolog of Tribolium castaneum

    OpenAIRE

    Shippy, Teresa D.; Tomoyasu, Yoshinori; Nie, Wensheng; Brown, Susan J.; Denell, Robin E.

    2008-01-01

    The Drosophila teashirt gene acts in concert with the homeotic selector (Hox) genes to specify trunk (thorax and abdomen) identity. There has been speculation that this trunk-specifying function might be very ancient, dating back to the common ancestor of insects and vertebrates. However, other evidence suggests that the role of teashirt in trunk identity is not well conserved even within the Insecta. To address this issue, we have analyzed the function of Tc-tiotsh, the lone teashirt family ...

  18. A case of classical galactosemia: identification and characterization of 3 distinct mutations in galactose-1-phosphate uridyl transferase (GALT) gene in a single family.

    Science.gov (United States)

    Singh, Ramandeep; Kaur, Gurjit; Thapa, Babu R; Prasad, Rajendra; Kulkarni, Ketan

    2011-07-01

    Galactosemia is an autosomal recessive disorder of galactose metabolism. In the very first instance of its kind from India, the authors report the presence of three different galatose-1-phosphate uridyl transferase (GALT) gene mutations, associated with galactosemia, in a single Indian family. One of the three mutations, S307X, is a novel mutation (GenBank Accession number GQ355273) and is of nonsense nature causing the truncation of the GALT protein resulting in the decreased enzyme activity. The authors have also emphasized the importance of introduction of new born screening program for galactosemia and its genetic analysis in select settings across the country.

  19. Unlocking Solar for Low- and Moderate-Income Residents: A Matrix of Financing Options by Resident, Provider, and Housing Type

    Energy Technology Data Exchange (ETDEWEB)

    Cook, Jeffrey J. [National Renewable Energy Lab. (NREL), Golden, CO (United States); Bird, Lori A. [National Renewable Energy Lab. (NREL), Golden, CO (United States)

    2018-01-02

    Historically the low and moderate income (LMI) market has been underserved by solar photovoltaics (PV), in part due to the unique barriers LMI residents face to participation in the PV market. The intent of this report is to identify the most promising strategies state policymakers might consider to finance PV for LMI customers across three housing types: single family, multi-family, and manufactured housing. The result is a financing matrix that documents the first and second tier financing options states may consider for each housing type. The first tier options were selected based upon their potential impact on LMI PV deployment. Second tier financing approaches could also be used to achieve state policy goals, but may not have as much effect on the relevant LMI market segment. Nevertheless, each financing option comes with tradeoffs that state policymakers may wish to consider when they make decisions about which financing approaches are best suited to achieve their LMI PV deployment goals.

  20. Comparisons of Colorado women's cancer screening practices by residence: metropolitan, non-metropolitan, and farm.

    Science.gov (United States)

    Kakefuda, I; Stallones, L

    2006-02-01

    Combining farm residents and non-farm rural residents into a single category designated as rural may obscure differences in preventive care utilization, including cancer screening practices in each group, because of distinctive characteristics of farmers. This study compared three cancer screening practices (mammography, breast physical examination, and Pap smears) across three residence groups (metropolitan, non-metropolitan, and farms) of Colorado women and described demographic and socioeconomic characteristics of the groups. Females interviewed in the 1993 Colorado Behavioral Risk Factor Surveillance System (BRFSS) were divided into residence as metropolitan or non-metropolitan. Farm residents were female respondents interviewed as part of the Colorado Farm Family Health and Hazard Survey (CFFHHS) conducted in 1993-1997. Univariate and multivariate analyses were conducted to determine characteristics related to the screening practices. Farm women were more likely to be non-Hispanic white and older, to report their health as very good, and to have medical insurance and at least one source of primary care compared to non-metropolitan women. After controlling for related variables, residence was not associated with the screening practices, with the exception of breast physical examination; farm women were less likely to have a recent examination than metropolitan women (OR = 1.50, 95% CI = 1.07-2.10). When non-metropolitan and farm women were combined, there was no association between residence and having had a physical breast examination. There were important differences between non-metropolitan women and farm women in demographic and socioeconomic characteristics, which influenced screening practices. Further studies are needed to examine farm residents' cancer screening practices separately from other rural residents in order to fully understand the implications of these differences for health status in other geographic areas.

  1. The health status and well-being of low-resource, housing-unstable, single-parent families living in violent neighbourhoods in Philadelphia, Pennsylvania.

    Science.gov (United States)

    Jacoby, Sara F; Tach, Laura; Guerra, Terry; Wiebe, Douglas J; Richmond, Therese S

    2017-03-01

    The health and well-being of single-parent families living in violent neighbourhoods in US cities who participate in housing programmes is not well described. This two-phase, mixed-methods study explores the health status of families who were participants in a housing-plus programme in Philadelphia, Pennsylvania between 2011 and 2013 and the relationship between the characteristics of the neighbourhoods in which they lived and their perceptions of well-being and safety. In phase 1, data collected with standardised health status instruments were analysed using descriptive statistics and independent sample t-tests to describe the health of single parents and one randomly selected child from each parent's household in comparison to population norms. In a subset of survey respondents, focus groups were conducted to generate an in-depth understanding of the daily lives and stressors of these families. Focus group data were analysed using content analysis to identify key descriptive themes. In phase 2, daily activity path mapping, surveys and interviews of parent-child dyads were collected to assess how these families perceive their health, neighbourhood and the influence of neighbourhood characteristics on the families' day-to-day experience. Narratives and activity maps were combined with crime data from the Philadelphia Police Department to analyse the relationship between crime and perceptions of fear and safety. Phase 1 data demonstrated that parent participants met or exceeded the national average for self-reported physical health but fell below the national average across all mental health domains. Over 40% reported moderate to severe symptoms of depression. Parents described high levels of stress resulting from competing priorities, financial instability, and concern for their children's well-being and safety. Analysis of phase 2 data demonstrated that neighbourhood characteristics exert influence over parents' perceptions of their environment and how they permit

  2. Predicting the Use of Single Versus Multiple Types of Violence Towards Children in a Representative Sample of Quebec Families

    Science.gov (United States)

    Clement, Marie-Eve; Bouchard, Camil

    2005-01-01

    Objective: The purpose of this study is to determine which factors best predict parental use of single versus multiple types of violence. Methodology: The study uses data from a Quebec telephone survey conducted with a representative sample of 2,469 mothers of children aged 0-17 years. The interview covered topics such as mother's attitudes and…

  3. Effects of Stress and Social Supports on Mother-Child Interactions in Single and Two-Parent Families.

    Science.gov (United States)

    Weinraub, Marsha; Wolf, Barbara M.

    Twenty-eight mother-child pairs -- 14 single parent mothers and their preschool children and a matched group of married women and their children -- were observed in order to investigate four questions concerning potential differences in the mother-child interactions, life circumstances, and social supports. These questions are (1) Do mother-child…

  4. Burnout in nursing residents

    National Research Council Canada - National Science Library

    Franco, Gianfábio Pimentel; de Barros, Alba Lúcia Bottura Leite; Nogueira-Martins, Luiz Antônio; Zeitoun, Sandra Salloum

    2011-01-01

    .... 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...

  5. Resident Characteristics Report

    Data.gov (United States)

    Department of Housing and Urban Development — The Resident Characteristics Report summarizes general information about households who reside in Public Housing, or who receive Section 8 assistance. The report...

  6. Relevance of the Diversity among Members of the Trypanosoma Cruzi Trans-Sialidase Family Analyzed with Camelids Single-Domain Antibodies

    Science.gov (United States)

    Paris, Gastón; Zarebski, Laura; Frasch, Alberto C.; Goldbaum, Fernando A.

    2008-01-01

    The sialic acid present in the protective surface mucin coat of Trypanosoma cruzi is added by a membrane anchored trans-sialidase (TcTS), a modified sialidase that is expressed from a large gene family. In this work, we analyzed single domain camelid antibodies produced against trans-sialidase. Llamas were immunized with a recombinant trans-sialidase and inhibitory single-domain antibody fragments were obtained by phage display selection, taking advantage of a screening strategy using an inhibition test instead of the classic binding assay. Four single domain antibodies displaying strong trans-sialidase inhibition activity against the recombinant enzyme were identified. They share the same complementarity-determining region 3 length (17 residues) and have very similar sequences. This result indicates that they likely derived from a unique clone. Probably there is only one structural solution for tight binding inhibitory antibodies against the TcTS used for immunization. To our surprise, this single domain antibody that inhibits the recombinant TcTS, failed to inhibit the enzymatic activity present in parasite extracts. Analysis of individual recombinant trans-sialidases showed that enzymes expressed from different genes were inhibited to different extents (from 8 to 98%) by the llama antibodies. Amino acid changes at key positions are likely to be responsible for the differences in inhibition found among the recombinant enzymes. These results suggest that the presence of a large and diverse trans-sialidase family might be required to prevent the inhibitory response against this essential enzyme and might thus constitute a novel strategy of T. cruzi to evade the host immune system. PMID:18949046

  7. Relevance of the diversity among members of the Trypanosoma cruzi trans-sialidase family analyzed with camelids single-domain antibodies.

    Directory of Open Access Journals (Sweden)

    Laura Ratier

    Full Text Available The sialic acid present in the protective surface mucin coat of Trypanosoma cruzi is added by a membrane anchored trans-sialidase (TcTS, a modified sialidase that is expressed from a large gene family. In this work, we analyzed single domain camelid antibodies produced against trans-sialidase. Llamas were immunized with a recombinant trans-sialidase and inhibitory single-domain antibody fragments were obtained by phage display selection, taking advantage of a screening strategy using an inhibition test instead of the classic binding assay. Four single domain antibodies displaying strong trans-sialidase inhibition activity against the recombinant enzyme were identified. They share the same complementarity-determining region 3 length (17 residues and have very similar sequences. This result indicates that they likely derived from a unique clone. Probably there is only one structural solution for tight binding inhibitory antibodies against the TcTS used for immunization. To our surprise, this single domain antibody that inhibits the recombinant TcTS, failed to inhibit the enzymatic activity present in parasite extracts. Analysis of individual recombinant trans-sialidases showed that enzymes expressed from different genes were inhibited to different extents (from 8 to 98% by the llama antibodies. Amino acid changes at key positions are likely to be responsible for the differences in inhibition found among the recombinant enzymes. These results suggest that the presence of a large and diverse trans-sialidase family might be required to prevent the inhibitory response against this essential enzyme and might thus constitute a novel strategy of T. cruzi to evade the host immune system.

  8. The Impact of Coed Residence Halls on Self-Actualization

    Science.gov (United States)

    Schroeder, Charles C.; LeMay, Morris L.

    1973-01-01

    The purpose of the present study was to determine if there were initial differences on selected scales of the Personal Orientation Inventory (POI) between students who chose to live in coed residence halls and those who chose to live in traditional single-sex residence halls, and also if residing in coed living units affected the further…

  9. Changing family structure in a modernizing society: a study of marriage patterns in a single Muslim village in Israel.

    Science.gov (United States)

    Zlotogora, J; Habiballa, H; Odatalla, A; Barges, S

    2002-01-01

    Among 1,875 couples from one Muslim village, 374 (20%) marriages were between first cousins. Among women born after 1920, the highest rates of first-cousin marriages were observed among those born between 1940-1959 (26%) and this pattern declined in the last two decades. The majority of first-cousin marriages were between offspring of brothers. Analyzed by 20-year periods, the pattern of first-cousin marriages changed as the proportion of marriages between brothers' children decreased from 75% to 44%. Over the study period, more than 70% of marriages were between individuals born in the village and related to some degree. Examination of the marriages in which both spouses were born in the village demonstrated a preference to marry within the extended family; 68% of the women married a man with the same family name. Since the creation of the Israeli State, there have been significant changes among Israeli-Arab citizens. However, these data demonstrate that the tradition of marrying a relative remains central, although some changes in marriage preference have occurred. Copyright 2002 Wiley-Liss, Inc.

  10. Novel Family of Single-Phase Modified Impedance-Source Buck-Boost Multilevel Inverters with Reduced Switch Count

    DEFF Research Database (Denmark)

    Husev, Oleksandr; Strzelecki, Ryszard; Blaabjerg, Frede

    2016-01-01

    This paper describes novel single-phase solutions with increased inverter voltage levels derived by means of a nonstandard inverter configuration and impedance source networks. Operation principles based on special modulation techniques are presented. Detailed component design guidelines along wi...... with simulation and experimental verification are also provided. Possible application fields are discussed, as well as advantages and disadvantages. Finally, future studies are addressed for the new solutions....

  11. Family Complexity, Siblings, and Children's Aggressive Behavior at School Entry

    Science.gov (United States)

    Fomby, Paula; Goode, Joshua A.; Mollborn, Stefanie

    2016-01-01

    As family structure in the United States has become increasingly dynamic and complex, children have become more likely to reside with step- or half-siblings through a variety of pathways. When these pathways are accounted for, more than one in six children in the United States lives with a half- or step-sibling at age 4. We use data from the Early Childhood Longitudinal Study-Birth Cohort (N~6,550) to assess the independent and joint influences of residing with a single parent or stepparent and with step or half-siblings on children's aggressive behavior at school entry. The influences of parents’ union status and complex sibship status on aggressive behavior are independent. Family resources partially explain the association between residing with an unpartnered mother and aggressive behavior regardless of sibship status. However, the resource hypothesis does not explain the association of complex sibship with aggressive behavior. PMID:26608795

  12. Plagiarism in residency application essays.

    Science.gov (United States)

    Segal, Scott; Gelfand, Brian J; Hurwitz, Shelley; Berkowitz, Lori; Ashley, Stanley W; Nadel, Eric S; Katz, Joel T

    2010-07-20

    Anecdotal reports suggest that some residency application essays contain plagiarized content. To determine the prevalence of plagiarism in a large cohort of residency application essays. Retrospective cohort study. 4975 application essays submitted to residency programs at a single large academic medical center between 1 September 2005 and 22 March 2007. Specialized software was used to compare residency application essays with a database of Internet pages, published works, and previously submitted essays and the percentage of the submission matching another source was calculated. A match of more than 10% to an existing work was defined as evidence of plagiarism. Evidence of plagiarism was found in 5.2% (95% CI, 4.6% to 5.9%) of essays. The essays of non-U.S. citizens were more likely to demonstrate evidence of plagiarism. Other characteristics associated with the prevalence of plagiarism included medical school location outside the United States and Canada; previous residency or fellowship; lack of research experience, volunteer experience, or publications; a low United States Medical Licensing Examination Step 1 score; and non-membership in the Alpha Omega Alpha Honor Medical Society. The software database is probably incomplete, the 10%-match threshold for defining plagiarism has not been statistically validated, and the study was confined to applicants to 1 institution. Evidence of matching content in an essay cannot be used to infer the applicant's intent and is not sensitive to variations in the cultural context of copying in some societies. Evidence of plagiarism in residency application essays is more common in international applicants but was found in those by applicants to all specialty programs, from all medical school types, and even among applicants with significant academic honors. No external funding.

  13. Hearing impairment caused by mutations in two different genes responsible for nonsyndromic and syndromic hearing loss within a single family.

    Science.gov (United States)

    Niepokój, Katarzyna; Rygiel, Agnieszka M; Jurczak, Piotr; Kujko, Aleksandra A; Śniegórska, Dominika; Sawicka, Justyna; Grabarczyk, Alicja; Bal, Jerzy; Wertheim-Tysarowska, Katarzyna

    2017-11-18

    Usher syndrome is rare genetic disorder impairing two human senses, hearing and vision, with the characteristic late onset of vision loss. This syndrome is divided into three types. In all cases, the vision loss is postlingual, while loss of hearing is usually prelingual. The vestibular functions may also be disturbed in Usher type 1 and sometimes in type 3. Vestibular areflexia is helpful in making a proper diagnosis of the syndrome, but, often, the syndrome is misdiagnosed as a nonsyndromic hearing loss. Here, we present a Polish family with hearing loss, which was clinically classified as nonsyndromic. After excluding mutations in the DFNB1 locus, we implemented the next-generation sequencing method and revealed that hearing loss was syndromic and mutations in the USH2A gene indicate Usher syndrome. This research highlights the importance of molecular analysis in establishing a clinical diagnosis of congenital hearing loss.

  14. What Kids Get from Parents: Packages of Parental Involvement across Complex Family Forms.

    Science.gov (United States)

    Carlson, Marcia J; Berger, Lawrence M

    2013-06-01

    While demographers have continued to document the notable family changes that have occurred in recent decades, the nature of family functioning across diverse family forms is less well understood. In particular, we know little about the level and quality of parental investment that children receive across a range of contemporary family types. In this paper, we use data from a recent U.S. urban birth cohort to examine the 'package' of parental involvement that young children receive in two key domains across family types. We aggregate parent-child engagement across three potential parent(-figures)-biological mothers, biological fathers (resident or non-resident), and resident social fathers-and also assess the child's household income. We examine parental investments at child age 5 and changes in investments between child ages 1 and 5 by family structure categories. Overall, we find that children living with both of their married biological parents are advantaged with respect to both economic resources and parental engagement, while children living with single mothers-or their mother and a cohabiting social father-fare especially poorly in both domains; children in married social-father families receive higher overall levels of parental engagement than those in biological-father families but are much less economically advantaged. Our research sheds light on how changing family demography is related to parental investments in children, which may have implications for public policies designed to support disadvantaged families.

  15. Tuning anisotropy barriers in a family of tetrairon(III) single-molecule magnets with an S = 5 ground state.

    Science.gov (United States)

    Accorsi, Stefania; Barra, Anne-Laure; Caneschi, Andrea; Chastanet, Guillaume; Cornia, Andrea; Fabretti, Antonio C; Gatteschi, Dante; Mortalo, Cecilia; Olivieri, Emiliano; Parenti, Francesca; Rosa, Patrick; Sessoli, Roberta; Sorace, Lorenzo; Wernsdorfer, Wolfgang; Zobbi, Laura

    2006-04-12

    Tetrairon(III) Single-Molecule Magnets (SMMs) with a propeller-like structure exhibit tuneable magnetic anisotropy barriers in both height and shape. The clusters [Fe4(L1)2(dpm)6] (1), [Fe4(L2)2(dpm)6] (2), [Fe4(L3)2(dpm)6].Et2O (3.Et2O), and [Fe4(OEt)3(L4)(dpm)6] (4) have been prepared by reaction of [Fe4(OMe)6(dpm)6] (5) with tripodal ligands R-C(CH2OH)3 (H3L1, R = Me; H3L2, R = CH2Br; H3L3, R = Ph; H3L4, R = tBu; Hdpm = dipivaloylmethane). The iron(III) ions exhibit a centered-triangular topology and are linked by six alkoxo bridges, which propagate antiferromagnetic interactions resulting in an S = 5 ground spin state. Single crystals of 4 reproducibly contain at least two geometric isomers. From high-frequency EPR studies, the axial zero-field splitting parameter (D) is invariably negative, as found in 5 (D = -0.21 cm(-1)) and amounts to -0.445 cm(-1) in 1, -0.432 cm(-1) in 2, -0.42 cm(-1) in 3.Et2O, and -0.27 cm(-1) in 4 (dominant isomer). The anisotropy barrier Ueff determined by AC magnetic susceptibility measurements is Ueff/kB = 17.0 K in 1, 16.6 K in 2, 15.6 K in 3.Et2O, 5.95 K in 4, and 3.5 K in 5. Both |D| and U(eff) are found to increase with increasing helical pitch of the Fe(O2Fe)3 core. The fourth-order longitudinal anisotropy parameter B4(0), which affects the shape of the anisotropy barrier, concomitantly changes from positive in 1 ("compressed parabola") to negative in 5 ("stretched parabola"). With the aid of spin Hamiltonian calculations the observed trends have been attributed to fine modulation of single-ion anisotropies induced by a change of helical pitch.

  16. The production of Multiple Small Peptaibol Families by Single 14-Module Peptide Synthetases in Trichoderma/Hypocrea

    Energy Technology Data Exchange (ETDEWEB)

    Degenkolb, Thomas; Aghchehb, Razieh Karimi; Dieckmann, Ralf; Neuhof, Torsten; Baker, Scott E.; Druzhinina, Irina S.; Kubicek, Christian P.; Brückner, Hans; von Dohren, Hans

    2012-03-01

    The most common peptaibibiotic structures are 11-residue peptaibols found widely distributed in the genus Trichoderma/Hypocrea. Frequently associated are 14-residue peptaibols sharing partial sequence identity. Genome sequencing projects of 3 Trichoderma strains of the major clades reveal the presence of up to 3 types of nonribosomal peptide synthetases with 7, 14, or 18-20 amino acid adding modules. We here provide evidence that the 14-module NRPS type found in T. virens, T. reesei (teleomorph Hypocrea jecorina) and T. atroviride produces both 11- and 14- residue peptaibols based on the disruption of the respective NRPS gene of T. reesei, and bioinformatic analysis of their amino acid activating domains and modules. The structures of these peptides may be predicted from the gene structures and have been confirmed by analysis of families of 11- and 14-residue peptaibols from the strain 618, termed hypojecorins A (23 sequences determined, 4 new) and B (3 new sequences), and the recently established trichovirins A from T. virens. The distribution of 11- and 14-residue products is strain-specific and depends on growth conditions as well. Possible mechanisms of module skipping are discussed.

  17. Familial Mediterranean Fever Is Associated With Increased Mortality After Kidney Transplantation-A 19 Years' Single Center Experience.

    Science.gov (United States)

    Green, Hefziba; Lichtenberg, Shelly; Rahamimov, Ruth; Livneh, Avi; Chagnac, Avry; Mor, Eytan; Rozen-Zvi, Benaya

    2017-10-01

    Current data regarding the outcome of kidney transplantation in patients with familial Mediterranean fever (FMF) who reach end-stage renal disease (ESRD) due to reactive amyloidosis A (AA) are scarce and inconclusive. The outcomes of 20 patients with FMF and biopsy-proven AA amyloidosis that were transplanted between 1995 and 2014 were compared with 82 control patients (32 with diabetes mellitus and 50 with nondiabet