Quantifying the Opportunity Cost of Resident Involvement in Academic Orthopedic Shoulder Arthroplasty: A Matched – Pair Analysis

Background There is minimal work defining the economic impact of resident participation in shoulder arthroplasty. Thus, this study quantified the opportunity cost of resident participation in total shoulder arthroplasty (TSA) and hemiarthroplasty (HA) by determining differences in operative time, relative value units (RVUs)/hour, and RVUs/case. Methods A retrospective analysis of shoulder arthroplasty procedures were identified from the ACS-NSQIP database from 2006 to 2014 using CPT codes. Demographic, comorbidity, preoperative laboratory data and surgical procedure were used to develop matched cohorts. Mean differences in operative time, RVUs/case and RVUs/hour between attending-only (AO) cases and cases with resident involvement (RI) were examined. Cost analysis was performed to identify differences in RVUs generated per hour in dollars/case. Results A total of 1786 AO and 1102 RI cases were identified. With the exception of PGY-3 and PGY-4 cases, RI cases had lower mean operative times compared to AO cases. The cost of RI was highest for PGY-3 ($199.87 per case) and PGY-4 ($9 .2 9) residents with all other postgraduate years providing a cost reduction. Discussion Involvement of residents was associated with shorter operative times leading to a savings of $29.64 per case. Involvement of intermediate-level (PGY-3) residents were associated with increased costs that ultimately decreased as residents became more senior.

Evaluation of a Structure Providing Cultural Ecosystem Services in Forest Recreation: Quantitative Text Analysis of Essays by Participants

Cultural ecosystem services are nonmaterial benefits that individuals acquire from the ecosystem, such as recreation, aesthetic enjoyment, and tourism. The quantification of cultural services is considered difficult to accurately make compared to other forest ecosystem services. Although some studies evaluate cultural services from forest recreation, “simple quantification” based on easy-to-obtain data is criticized for disregarding the local context and missing essential details. Therefore, this study evaluates a structure providing cultural services, and the local or detailed factors missed by simple quantification, while illustrating objective and statistical evidence with careful observations and a comprehension of local society. This study focuses on urban resident participation in natural resource management through recreational activities in Japanese mountain villages, using Fujiwara District, Minakami Town, Japan, as a case study, and by conducting a quantitative text analysis of 424 essays containing participants’ experiences and impressions. Using the software KH Coder, the Jaccard index is used to calculate co-occurrence relationships between frequently used words, visualizing the results in a network diagram. Additionally, several codes are added to keywords that characterize this case, and correlations between each code are examined. From the analysis, we discovered that social factors, such as interaction with comrades and locals, considerably influence participants’ positive emotions.

DengueChat: A Social and Software Platform for Community-based Arbovirus Vector Control

The mosquito Aedes aegypti transmits arboviral diseases at extraordinary rates. Dengue alone afflicts 50 to 100 million people each year, with more than 3 billion at risk globally. This indicates that current approaches to prevention and control are inadequate, and that a paradigm shift from one that largely promotes vertical chemical-based control and vaccine development to one that also concentrates on eliminating the mosquito through actions by the communities it plagues is necessary. We have developed a new social and software platform, DengueChat (denguechat.org), to advance community interventions in arbovirus vector control. It is an interactive platform combining open-source digital communication technologies with face-to-face assemblies. It promotes resident participation in evidence collection, reporting, and analysis, and it incorporates pedagogic information, key messaging, and game concepts to motivate communities to implement vector reduction strategies. Using DengueChat, we conducted a 19-month pilot study in five neighborhoods of Managua, Nicaragua. The results strongly suggest that using the software produced value-added features that enhance community engagement. We measured the entomological and behavioral impacts at different time points and relative risk reduction of entomological indices at the end of the study. The entomological results showed significant risk reductions in disease transmission: Ae. aegypti larvae and pupae indices were reduced by approximately 44% in neighborhoods using DengueChat during one epidemic year, whereas control neighborhoods experienced an increase of more than 500%. A cluster permutation test determined that the probability of household positivity was significantly reduced in neighborhoods that participated in DengueChat compared with the reference neighborhoods (P = 0.0265). Therefore, DengueChat is a promising resource for vector control.

The Implementation of Character Building to Improve Resident Participation in Waste Management

Household waste commonly dominates the municipal waste composition, indicating a vital role of residents' participation in solving waste problems. Various efforts have been made to encourage resident's participation. However, many approaches implemented cannot keep participation sustainable. Previous studies showed that educating residents through nurturing moral values is influential in improving waste management behaviour. Meanwhile, the moral value becomes the core of character building, implying that character building could have a role in resident-based education to enhance waste management behaviour. In fact, character building can change individual behaviour sustainably. Thus, this study aimed to figure out the possibility of implementing character building to nurture sustainable waste management behaviour and investigate how character-building was implemented. Using a case study approach, we explored a resident-based education in Neglasari, Bandung, Indonesia, that implemented moral value as the educational strategy. This study found that some primary activities were conducted to transfer moral value. The learning activities were focused on nurturing moral knowing, moral feeling, and moral action as central components of character building. However, implementing character building seemed to take time and required iteration to get a sustainable change in the behaviour. Nevertheless, it is worth to continue to gain significant benefits.

Total elbow arthroplasty cases involving orthopedic residents do not affect short-term postoperative complications

Background Impact of resident participation on short-term postoperative outcomes after total elbow arthroplasty has not been studied. The aim was to investigate whether resident participation affects postoperative complication rates, operative time, and length of stay. Methods The American College of Surgeons National Surgical Quality Improvement Program registry was queried from 2006 to 2012 for patients undergoing total elbow arthroplasty. A 1:1 propensity score match was performed to match resident cases to attending-only cases. Comorbidities, surgical time, and short-term (30-day) postoperative complications were compared between groups. Multivariate Poisson regression was used to compare the rates of postoperative adverse events between groups. Results After propensity score match, 124 cases (50% with resident participation) were included. Adverse event rate after surgery was 18.5%. On multivariate analysis, there were no significant differences between attending-only cases and resident involved cases, with regards to short-term major complications, minor complications, or any complications (all p > 0.071). Total operative time was similar between cohorts (149.16 vs. 165.66 min; p = 0.157). No difference was observed in the length of hospital stay (2.95 vs. 2.6 days), p = 0.399. Discussion Resident participation during total elbow arthroplasty is not associated with increased risk for short-term medical or surgical postoperative complications or operative efficiency.

Enhancing the Teaching Environment: 3-Year Follow-Up of a Resident-Led Residents-as-Teachers Program

ABSTRACT Background Previous faculty-driven residents-as-teachers (RAT) models have had limited efficacy and sustainability. Objective To evaluate the acceptability and effects of a resident-led RAT program on resident teaching. Methods In October 2016, obstetrics and gynecology (OB/GYN) residents at a large academic institution implemented a resident-led RAT program, consisting of a steering committee of peer-selected residents with 2 faculty mentors who planned education-focused resident didactics and journal clubs, organized resident involvement in clerkship activities, and recognized residents who excelled in teaching as Distinguished Educators (DEs). From July 2016 through June 2019, using the Kirkpatrick Model, we evaluated the program with annual resident surveys assessing self-perception of 13 teaching skills (5-point Likert scale) and value of RAT program, institutional end-of-clerkship student evaluations of resident teaching, and resident participation in DE award. Results Annual resident survey response rates ranged from 63% to 88%. Residents' self-reported teaching skills improved significantly in 11 of 13 domains from 2016 to 2018 (improvements ranging from 0.87–1.42; 5-point Likert scale; P < .05). Of the 2018 respondents, 80% agreed that the resident-led RAT program added value to the residency. For 2017–2018 and 2018–2019 academic years, 47% and 48% of medical students (100% response rate) strongly agreed that residents provided effective teaching compared to 30% in 2016–2017 (P < .05). Ten residents have graduated as DEs during this time period. Conclusions A resident-led RAT program increased residents' self-reported teaching skills, improved medical student perceptions of teaching quality, and was sustainable and acceptable over a 3-year period.

The Role of Public-Private Partnerships in Housing as a Potential Contributor to Sustainable Cities and Communities: A Systematic Review

Today cities face the increasing negative consequences of the unsustainable course society is set on. Climate change, biodiversity loss and increasing spatial segregation are testament to this. The effects of these issues often exceed the coping capacity of individual urban housing developers. Thus, an antidote to the current neoliberal trend must be found in collaborations such as public-private partnerships (PPP). Here the shortcomings and limitations of PPP and its potential ability to solve the problem of unsustainable urban development are investigated. Using the Doughnut Economics (DE) model as a general guide, a systematic literature review is conducted. The results reveal evidence that PPPs are unjust and exclude local actors from collaborations. Hence, resident participation and inclusion is considered the best strategy for PPP to evolve as a future guarantor of the sustainable city. First, however, major differences in the character of issues that connect the global model of sustainability to the harsh reality of the local context need to be addressed. This gap concerns the city’s social foundation and ecological ceiling. The DE model applied herein is an excellent tool to test the scope and depth of local collaborations such as PPPs and reflect on international treaties such as SDGs.