scholarly journals Management of residents in difficulty in a Swiss general internal medicine outpatient clinic: Change is necessary!

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0254336
Author(s):  
Cédric Lanier ◽  
Virginie Muller-Juge ◽  
Melissa Dominicé Dao ◽  
Jean-Michel Gaspoz ◽  
Noëlle Junod Perron ◽  
...  
Keyword(s):  
Focus Groups ◽  
Close Contact ◽  
Hierarchical Level ◽  
List Type ◽  
University Hospitals ◽  
General Internal ◽  
Remediation Strategies ◽  
Hierarchical Levels ◽  
Chief Physician ◽  
Action Process

Aims of the study Residents in difficulty are a major cause for concern in medical education, with a prevalence of 7–15%. They are often detected late in their training and cannot make use of remediation plans. Nowadays, most training hospitals in Switzerland do not have a specific program to identify and manage residents in difficulty. The aim of the study was to explore the challenges perceived by physicians regarding the process of identifying, diagnosing, and supporting residents in difficulty in a structured and programmatic way. We explored perceptions of physicians at different hierarchical levels (residents (R), Chief residents (CR), attending physicians (A), Chief Physician (CP)) in order to better understand these challenges. Methods We conducted an exploratory qualitative study between December 2015 and July 2016. We asked volunteers from the Primary Care Division of the Geneva University Hospitals to partake to three focus groups (with CR, A, R) and one interview with the division’s CP. We transcribed, coded, and qualitatively analyzed the three focus groups and the interview, using a content thematic approach and Fishbein’s conceptual framework. Results We identified similarities and differences in the challenges of the management of residents in difficulty on a programmatic way amongst physicians of different hierarchical levels. Our main findings: Supervisors (CR, A, CP) have good identification skills of residents in difficulty, but they did not put in place systematic remediation strategies. Supervisors (CR, A) were concerned about managing residents in difficulty. They were aware of the possible adverse effects on patient care, but “feared to harm” resident’s career by documenting a poor institutional assessment. Residents “feared to share” their own difficulties with their supervisors. They thought that it would impact their career negatively. The four physician’s hierarchical level reported environmental constraints (lack of funding, time constraint, lack of time and resources…). Conclusion Our results add two perspectives to specialized recommendations regarding the implementation of remediation programs for residents in difficulty. The first revolves around the need to identify and fully understand not only the beliefs but also the implicit norms and the feeling of self-efficacy that are shared by teachers and that are likely to motivate them to engage in the management of residents in difficulty. The second emphasizes the importance of analyzing these elements that constitute the context for a change and of identifying, in close contact with the heads of the institutions, which factors may favor or hinder it. This research action process has fostered awareness and discussions at different levels. Since then, various actions and processes have been put in place at the Faculty of Medicine in Geneva.

Analyzing the Russian tool-making industry within the sustainable development concept

2020 ◽  
Vol 16 (4) ◽  
pp. 662-677 ◽  
Author(s):  
T.N. Ryzhikova ◽  
V.G. Borovskii
Keyword(s):  
Sustainable Development ◽  
Hierarchical Level ◽  
Economic Systems ◽  
Resource Use Efficiency ◽  
The Sustainable Development ◽  
Case Methods ◽  
Hierarchical Levels ◽  
Use Efficiency ◽  
Intensive Development

Subject. The article explores the economic component of sustainable development through the classification of industries from the perspective of assigning the output goods to fixed or current assets, using different types of resources and assessing their condition. It considers factors of production affecting the achievement of the result and determining the development of economic systems at the meso- and micro-hierarchical level. Objectives. The aim is to assess the function of economic systems of different hierarchical levels on the tool-making facilities case. Methods. We apply an approach using general and special methods of comparative and statistical analysis, synthesis and analogies. Results. The paper analyzes the development of the Russian tool-making industry on the basis of resource-oriented approach to assess the functioning of economic systems at various levels. We review interrelations between resource use efficiency, types of sustainable development of economic systems at various hierarchical levels and strategic security of the country. Conclusions. Any development can be considered sustainable, if there is an increment in the intensive development of economic systems at all three levels.

scholarly journals SARS-CoV-2 seroprevalence and asymptomatic viral carriage in healthcare workers: a cross-sectional study

Thorax ◽  
2020 ◽  
Vol 75 (12) ◽  
pp. 1089-1094 ◽  
Author(s):  
Adrian Shields ◽  
Sian E Faustini ◽  
Marisol Perez-Toledo ◽  
Sian Jossi ◽  
Erin Aldera ◽  
...  
Keyword(s):  
Intensive Care ◽  
Healthcare Workers ◽  
Venous Blood ◽  
Cross Sectional Study ◽  
Nasopharyngeal Swab ◽  
Sectional Study ◽  
University Hospitals ◽  
Cross Sectional ◽  
General Internal ◽  
Increased Risk

ObjectiveTo determine the rates of asymptomatic viral carriage and seroprevalence of SARS-CoV-2 antibodies in healthcare workers.DesignA cross-sectional study of asymptomatic healthcare workers undertaken on 24/25 April 2020.SettingUniversity Hospitals Birmingham NHS Foundation Trust (UHBFT), UK.Participants545 asymptomatic healthcare workers were recruited while at work. Participants were invited to participate via the UHBFT social media. Exclusion criteria included current symptoms consistent with COVID-19. No potential participants were excluded.InterventionParticipants volunteered a nasopharyngeal swab and a venous blood sample that were tested for SARS-CoV-2 RNA and anti-SARS-CoV-2 spike glycoprotein antibodies, respectively. Results were interpreted in the context of prior illnesses and the hospital departments in which participants worked.Main outcome measureProportion of participants demonstrating infection and positive SARS-CoV-2 serology.ResultsThe point prevalence of SARS-CoV-2 viral carriage was 2.4% (n=13/545). The overall seroprevalence of SARS-CoV-2 antibodies was 24.4% (n=126/516). Participants who reported prior symptomatic illness had higher seroprevalence (37.5% vs 17.1%, χ2=21.1034, p<0.0001) and quantitatively greater antibody responses than those who had remained asymptomatic. Seroprevalence was greatest among those working in housekeeping (34.5%), acute medicine (33.3%) and general internal medicine (30.3%), with lower rates observed in participants working in intensive care (14.8%). BAME (Black, Asian and minority ethnic) ethnicity was associated with a significantly increased risk of seropositivity (OR: 1.92, 95% CI 1.14 to 3.23, p=0.01). Working on the intensive care unit was associated with a significantly lower risk of seropositivity compared with working in other areas of the hospital (OR: 0.28, 95% CI 0.09 to 0.78, p=0.02).Conclusions and relevanceWe identify differences in the occupational risk of exposure to SARS-CoV-2 between hospital departments and confirm asymptomatic seroconversion occurs in healthcare workers. Further investigation of these observations is required to inform future infection control and occupational health practices.

Alternative Family Structures: A Career Advantage?

1997 ◽  
Vol 81 (3) ◽  
pp. 812-814 ◽  
Author(s):  
Ronald J. Burke
Keyword(s):  
Professional Services ◽  
Hierarchical Level ◽  
Family Structures ◽  
Men And Women ◽  
Hierarchical Levels ◽  
Professional Services Firm

This research examined the presence of homemakers among spouses of men and women at four hierarchical levels within a single large professional services firm. Men at the most senior level were significantly more likely to have spouses as homemakers than were men at lower levels and women at any hierarchical level. Men were generally more likely than women to have spouses as homemakers, thus family structures may create potential career disadvantages for women.

scholarly journals 4409 Indiana Clinical & Translational Science Monon Collaborative – Community Impact Hubs

2020 ◽  
Vol 4 (s1) ◽  
pp. 86-87
Author(s):  
Sarah Wiehe ◽  
David Craig ◽  
Matthew Wilcox ◽  
Emily Hardwick ◽  
Carrie Lawrence ◽  
...  
Keyword(s):  
Health Outcomes ◽  
Focus Groups ◽  
Research Team ◽  
Health Determinants ◽  
List Type ◽  
Community Impact ◽  
Marion County ◽  
Sustainable Solutions ◽  
Environmental Scan ◽  
Key Informant

OBJECTIVES/GOALS: Conduct an environmental scan of Marion County (Indianapolis) neighborhoods using electronic medical record data, state health data, and social and economic dataDevelop strong network of community collaboratorsConduct a thorough assessment for each targeted neighborhood by listening and understanding the pressing health issues in the community and working together to design and deliver solutionsMETHODS/STUDY POPULATION: Identify measures in the 3 domains of vulnerability, health and assets for the targeted neighborhoods and conduct bivariate descriptive statistics and multivariable regression analyses to investigate association between measures of vulnerability and health outcomes.Initiate relationships with leaders and residents in targeted neighborhoodsLocate organizations working in targeted neighborhoods through online mapping software and word-of-mouth at neighborhood events, and created a spreadsheet with contact information.Conduct multidisciplinary assessment (i.e. key informant interviews, focus groups, town hall meetings) of the targeted neighborhood.Iteratively synthesize assessments to develop areas of interest and relevance to the community.Develop a road map for solutions identified by the community.RESULTS/ANTICIPATED RESULTS: The results from the environmental scan conducted will be displayed in a report and visual “map” of health outcomes and health determinants, including assets and barriers for the targeted neighborhoods. The research team will use results from the environmental scan coupled with listening activities including attendance at community events, key informant interviews and focus groups to develop relationships and strong collaborations with the targeted neighborhood stakeholders. The relationship building between the research team and community will provide increased trust and engagement that will further enhance the effectiveness of the assessments completed with the targeted neighborhood. The assessments will help to empower communities to develop sustainable solutions and drive future work that will lead to future grant applications and larger-scale implementation in other community impact hub neighborhoods. DISCUSSION/SIGNIFICANCE OF IMPACT: Through the community impact hub work, we will develop collaborative efforts with targeted neighborhoods with the greatest health inequities in the Marion County area. In partnership with these neighborhoods, we will build a foundation – a network of community collaborators and a focused plan – upon which we will improve the health outcomes of residents while learning best practices on how to do so.

scholarly journals Hierarchical Structure of the Cocos nucifera (Coconut) Endocarp: Functional Morphology and its Influence on Fracture Toughness

Molecules ◽  
2020 ◽  
Vol 25 (1) ◽  
pp. 223 ◽  
Author(s):  
Stefanie Schmier ◽  
Naoe Hosoda ◽  
Thomas Speck
Keyword(s):  
Fracture Toughness ◽  
Functional Morphology ◽  
Role Models ◽  
Imaging Techniques ◽  
Cocos Nucifera ◽  
Hierarchical Level ◽  
Special Focus ◽  
Toughening Mechanisms ◽  
Hierarchical Levels ◽  
Organ Level

In recent years, the biomimetic potential of lignified or partially lignified fruit pericarps has moved into focus. For the transfer of functional principles into biomimetic applications, a profound understanding of the structural composition of the role models is important. The aim of this study was to qualitatively analyze and visualize the functional morphology of the coconut endocarp on several hierarchical levels, and to use these findings for a more precise evaluation of the toughening mechanisms in the endocarp. Eight hierarchical levels of the ripe coconut fruit were identified using different imaging techniques, including light and scanning electron microscopy as well as micro-computer-tomography. These range from the organ level of the fruit (H0) to the molecular composition (H7) of the endocarp components. A special focus was laid on the hierarchical levels of the endocarp (H3–H6). This investigation confirmed that all hierarchical levels influence the crack development in different ways and thus contribute to the pronounced fracture toughness of the coconut endocarp. By providing relevant morphological parameters at each hierarchical level with the associated toughening mechanisms, this lays the basis for transferring those properties into biomimetic technical applications.

scholarly journals The role of PhD-prepared, hospital-based nurses: an inter-Nordic study

2019 ◽  
Vol 24 (7) ◽  
pp. 470-485
Author(s):  
Erik Elgaard Sørensen ◽  
Kathrine Hoffmann Kusk ◽  
Asa Muntlin Athlin ◽  
Kirsten Lode ◽  
Tone Rustøen ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Close Contact ◽  
Cross Sectional Study ◽  
Nordic Countries ◽  
University Hospital ◽  
University Hospitals ◽  
Cross Sectional ◽  
Research Activities ◽  
Evidence Based Care

Background Little is known about PhD-prepared nurses employed at Nordic university hospitals, how they are organised, what their practices look like or what career pathway they have chosen. Aims The purpose was to investigate and compare the prevalence of PhD-prepared nurses employed at university hospitals in the Nordic countries, to investigate what functions they fulfil and what research activities they undertake and to document how they describe their ideal work life. Methods A descriptive cross-sectional study. An electronic questionnaire was sent to 245 PhD-prepared nurses working at a university hospital in one of six Nordic countries and 166 responses were achieved (response rate 67%). Descriptive analyses were performed using SPSS Statistics. Results The study found notable differences among PhD-prepared nurses employed at university hospitals with respect to work function; organisational structure; satisfaction about time split between research and practice; and the mean scores of time spend on research, clinical practice and teaching, supervision and administration. Conclusions In order to succeed with capacity building among the nursing workforce, collaboration and networking with other researchers and close contact to clinical practice is important. The role of the hospital-based, PhD-prepared nurse needs to be better described and defined to ensure that evidence-based care is provided.

scholarly journals Tension and relaxation (do not) exist in dodecaphonic music of Webern

2018 ◽  
Vol 44 (2) ◽  
pp. 423-436
Author(s):  
Gordana Grujić ◽  
Mladen Janković
Keyword(s):  
String Quartet ◽  
Research Field ◽  
Hierarchical Level ◽  
Fundamental Aspect ◽  
The Third ◽  
Hierarchical Levels ◽  
Similar Theme ◽  
Definition Of ◽  
Compositional System

Observing tension in music is generally a very sensitive research field. Authors like Wallace Berry and Joseph Swain believe that this is a principle which is the most fundamental aspect of music experience through its history, no matter which music language or compositional system it is. Starting from such general assumptions that it is possible to determine the parameters which affect the feeling of tension and relaxation in dodecaphonic music as well, the possibility of recording the closures that are the basis for the structural delineation of the sections and the determination of phrases and sentences in the musical flow is imposed. The system surely exists, the only question is whether we are able to perceive it in a new, dodecaphonic music flow? Is it possible in a dodecaphonically organized work to find dissonant and consonant harmonies, and thus demonstrate the elements of tension and resolution, or do some other musical components have the primacy in organizing and establishing hierarchical levels in the definition of closures in dodecaphonic music? Relying on the writings of authors who have dealt with this or similar theme (Babbitt 1949, Forte 1973, Lerdahl 1989, Boss 1994, Rothgeb 1997, Farbood 2006, Granot and Eithan 2011, Zatkalik 2016), this work will illustrate the systematization and ranking of closures at the hierarchical level at which they operate in the examples of Webern’s dodecaphonic music (op. 20, op. 21, op. 22, op. 24, op. 27, op. 28 i op. 30). Also, this work deals at a certain extent with the terminology of the cadence-closure. The parameters that are most important for the construction of the closures in Webern’s dodecaphony works are determined, and terminology is proposed: perfect closure – closure – semiclosure. The application of these ideas was demonstrated in the third movement of Webern’s String Quartet op. 28.

scholarly journals Neutrophil transit time and localization within the megakaryocyte define morphologically distinct forms of emperipolesis

2021 ◽  
Author(s):  
Frank Y. Huang ◽  
Pierre Cunin ◽  
Felix A. Radtke ◽  
Ricardo Grieshaber-Bouyer ◽  
Peter A. Nigrovic
Keyword(s):  
Endoplasmic Reticulum ◽  
Transit Time ◽  
Close Contact ◽  
Intracellular Localization ◽  
Membrane System ◽  
Cell Interaction ◽  
Single Type ◽  
List Type ◽  
Cell Cytoplasm

AbstractIn emperipolesis, neutrophils transit through megakaryocytes, but it is unknown whether this interaction represents a single type of cell-in-cell interaction or a set of distinct processes. Using an in vitro model of murine emperipolesis, we characterized neutrophils entering megakaryocytes using live-cell spinning disk microscopy and electron microscopy. Approximately half of neutrophils exited the megakaryocyte rapidly, typically in 10 minutes or less, displaying ameboid morphology as they passed through the host cell (fast emperipolesis). The remaining neutrophils assumed a sessile morphology, most remaining within the megakaryocyte for at least 60 minutes (slow emperipolesis). These neutrophils typically localized near the megakaryocyte nucleus. By ultrastructural assessment, all internalized neutrophils remained morphologically intact. Most neutrophils resided within emperisomes, but some could be visualized exiting the emperisome into the cell cytoplasm. Neutrophils in the cytoplasm assumed close contact with the platelet-forming demarcation membrane system or with the perinuclear endoplasmic reticulum, as confirmed by immunofluorescence microscopy. Together, these findings reveal that megakaryocyte emperipolesis reflects at least two processes, fast and slow emperipolesis, each with its own characteristic transit time, morphology, and intracellular localization, suggesting distinct functions.Key PointsNeutrophil passage through megakaryocytes, termed emperipolesis, diverges into fast and slow forms that differ in transit time, morphology, and intracellular localizationDuring emperipolesis, neutrophils can reside in vacuoles (emperisomes) or escape into the cell cytoplasm to assume positions near the megakaryocyte’s demarcation membrane system, endoplasmic reticulum, or nucleus.

scholarly journals Objects seen as scenes: neural circuitry for attending whole or parts

2019 ◽  
Author(s):  
Mitchell Valdés-Sosa ◽  
Marlis Ontivero-Ortega ◽  
Jorge Iglesias-Fuster ◽  
Agustin Lage-Castellanos ◽  
Jinnan Gong ◽  
...  
Keyword(s):  
Local Level ◽  
Temporal Cortex ◽  
Neural Circuitry ◽  
Cortical Network ◽  
Hierarchical Level ◽  
List Type ◽  
Shape Information ◽  
Illusory Conjunctions ◽  
Level Information ◽  
Cortical Regions

AbstractDepending on our goals, we pay attention to the global shape of an object or to the local shape of its parts, since it’s difficult to do both at once. This typically effortless process can be impaired in disease. However, it is not clear which cortical regions carry the information needed to constrain shape processing to a chosen global/local level. Here, novel stimuli were used to dissociate functional MRI responses to global and local shapes. This allowed identification of cortical regions containing information about level (independent from shape). Crucially, these regions overlapped part of the cortical network implicated in scene processing. As expected, shape information (independent of level) was mainly located in category-selective areas specialized for object- and face-processing. Regions with the same informational profile were strongly linked (as measured by functional connectivity), but were weak when the profiles diverged. Specifically, in the ventral-temporal-cortex (VTC) regions favoring level and shape were consistently separated by the mid-fusiform sulcus (MFS). These regions also had limited crosstalk despite their spatial proximity, thus defining two functional pathways within VTC. We hypothesize that object hierarchical level is processed by neural circuitry that also analyses spatial layout in scenes, contributing to the control of the spatial-scale used for shape recognition. Use of level information tolerant to shape changes could guide whole/part attentional selection but facilitate illusory shape/level conjunctions under impoverished vision.Significance statementOne daily engages hierarchically organized objects (e.g. face-eyes-eyelashes). Their perception is commonly studied with global shapes composed by of local shapes. Seeing shape at one level is easy, but difficult for both at once. How can the brain guide attention to one level? Here using novel stimuli that dissociate different levels over time and examining local patterns of brain-activity, we found that the level and shape of visual objects were represented into segregated sets of cortical regions, each connected into their own pathway. Level information was found in part of the cortical network known to process scenes. Coding of object-level independently from shape could participate in guiding sustained attention within objects, eliminating interference from irrelevant levels. It could also help produce “illusory conjunctions” (perceptual migration of a shape to the wrong level) when attention is limited.HighlightsModified Navon figures allow dissociation in time of fMRI responses for the global/local levels.Shape-invariant hierarchical level information was found in scenes selective areas, whereas level-invariant shape information was found in object- and faces- selective areas.Level and shape regions were divided by the mid-fusiform sulcus (MFS) in VTC cortex, and each type of region connected into its own pathway.Having separate level/shape pathways could facilitate selective-attention, but foster illusory conjunctions.

scholarly journals Delirium – are we doing enough prevention and basic management in acute settings?

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S112-S112
Author(s):  
Anna Watkins ◽  
Remy Flechais ◽  
Shah Tarfarosh
Keyword(s):  
Length Of Stay ◽  
Hearing Aids ◽  
Average Length ◽  
List Type ◽  
Electronic Patient Records ◽  
Visual Aids ◽  
University Hospitals ◽  
Management Options ◽  
Pharmacological Prevention ◽  
Dementia Patients

AimsTo identify the prevalence of delirium and/or dementia on complex medicine wards.To assess the use non-pharmacological prevention and management options in these patients.BackgroundDelirium, a common hospital syndrome, is often multi-factorial. So, the management needs not only treating a reversible cause but also minimising the factors that could increase the risk of developing delirium, or worsen its course.The Scottish-Intercollegiate-Guidelines-Network (SIGN) and National-Institute-for-Health-and-Care-Excellence (NICE) guidelines outline non-pharmacological factors to reduce the risk of developing delirium, and for its management once established.These factors include orientation, ensuring patients have their glasses and hearing aids, promoting sleep hygiene, maintaining optimal hydration and nutrition, early mobilisation, appropriate lighting and providing cognitively stimulating activities.MethodSIGN, NICE and local guidelines were used to develop a checklist of core non-pharmacological factors that minimise the risk of developing delirium and help in its management. Adherence to recommendations from these guidelines was thus evaluated in 4 Complex Medical Units of The John-Radcliffe Hospital (Oxford University Hospitals NHS Foundation Trust), cross sectionally. The data were collected by interviewing nursing staff on the wards, assessing the ward environment, reviewing nursing charts and electronic patient records.ResultThere were 57 patients aged >65 years across all four wards, with average percentages of delirium and dementia patients being 46% and 34%, respectively. Nurses were unsure about their patients having hearing or visual aids in 41% and 29%, respectively. On all four wards there was no clear signage, no digital clock, no calendar, and earplugs were not offered. Overall, the use of non-pharmacological recommendations was sub-optimal across a number of items. After a month, when the notes were reviewed, it was found that 18 out of those 57 patients had passed away (32%) and the average length of stay for delirium/dementia patients was way more than the other patients during that admission.ConclusionWe found high rates of delirium and dementia and a lack of consistent use of recommended non-pharmacological strategies for their management. Better adherence to these could help shorten length of stay and improve patient outcomes.Recommendations for patients with/at risk of delirium: –Bedside board for each patient with the name of the ward/hospital, picture of the named nurse.–Ensuring visible clock/calendar.–Non-pharmacological delirium management checklist to be added to the daily nursing notes.Emphasis on visual/hearing aids and daily reorientation. –Appropriate lighting in the bays.–Offer earplugs if not sleeping at night.

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