Teaching the Emergency Department Patient Experience: Needs Assessment from the CORD-EM Task Force.

INTRODUCTION: Since the creation of Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient satisfaction (PS) scores, patient experience (PE) has become a metric that can profoundly affect the fiscal balance of hospital systems, reputation of entire departments and welfare of individual physicians. While government and hospital mandates demonstrate the prominence of PE as a quality measure, no such mandate exists for its education. The objective of this study was to determine the education and evaluation landscape for PE in categorical emergency medicine (EM) residencies. METHODS: This was a prospective survey analysis of the Council of Emergency Medicine Residency Directors (CORD) membership. Program directors (PDs), assistant PDs and core faculty who are part of the CORD listserv were sent an email link to a brief, anonymous electronic survey. Respondents were asked their position in the residency, the name of their department, and questions regarding the presence and types of PS evaluative data and PE education they provide. RESULTS: We obtained 168 responses from 139 individual residencies, representing 72% of all categorical EM residencies. This survey found that only 27% of responding residencies provide PS data to their residents. Of those programs, 61% offer simulation scores, 39% provide third-party attending data on cases with resident participation, 37% provide third-party acquired data specifically about residents and 37% provide internally acquired quantitative data. Only 35% of residencies reported having any organized PE curricula. Of the programs that provide an organized PE curriculum, most offer multiple modalities; 96% provide didactic lectures, 49% small group sessions, 47% simulation sessions and 27% specifically use standardized patient encounters in their simulation sessions. CONCLUSION: The majority of categorical EM residencies do not provide either PS data or any organized PE curriculum. Those that do use a heterogeneous set of data collection modalities and educational techniques. American Osteopathic Association and Accreditation Council for Graduate Medical Education residencies show no significant differences in their resident PS data provision or formal curricula. Further work is needed to improve education given the high stakes of PS scores in the emergency physician\u27s career

A Note on Commuting Diffeomorphisms on Surfaces

Let S be a closed surface with nonzero Euler characteristic. We prove the existence of an open neighborhood V of the identity map of S in the C^1-topology with the following property: if G is an abelian subgroup of Diff^1(S) generated by any family of elements in V then the elements of G have common fixed points. This result generalizes a similar result due to Bonatti and announced in his paper "Diffeomorphismes commutants des surfaces et stabilite des fibrations en tores".Comment: 16 page

Reduction in squamous cell carcinomas in mouse skin by dietary zinc supplementation.

Inadequate dietary Zn consumption increases susceptibility to esophageal and other cancers in humans and model organisms. Since Zn supplementation can prevent cancers in rodent squamous cell carcinoma (SCC) models, we were interested in determining if it could have a preventive effect in a rodent skin cancer model, as a preclinical basis for considering a role for Zn in prevention of human nonmelanoma skin cancers, the most frequent cancers in humans. We used the 7,12-dimethyl benzanthracene carcinogen/phorbol myristate acetate tumor promoter treatment method to induce skin tumors in Zn-sufficient wild-type and Fhit (human or mouse protein) knockout mice. Fhit protein expression is lost in \u3e50% of human cancers, including skin SCCs, and Fhit-deficient mice show increased sensitivity to carcinogen induction of tumors. We hypothesized that: (1) the skin cancer burdens would be reduced by Zn supplementation; (2) Fhit(-/-) (Fhit, murine fragile histidine triad gene) mice would show increased susceptibility to skin tumor induction versus wild-type mice. 30 weeks after initiating treatment, the tumor burden was increased ~2-fold in Fhit(-/-) versus wild-type mice (16.2 versus 7.6 tumors, P \u3c 0.001); Zn supplementation significantly reduced tumor burdens in Fhit(-/-) mice (males and females combined, 16.2 unsupplemented versus 10.3 supplemented, P = 0.001). Most importantly, the SCC burden was reduced after Zn supplementation in both strains and genders of mice, most significantly in the wild-type males (P = 0.035). Although the mechanism(s) of action of Zn supplementation in skin tumor prevention is not known in detail, the Zn-supplemented tumors showed evidence of reduced DNA damage and some cohorts showed reduced inflammation scores. The results suggest that mild Zn supplementation should be tested for prevention of skin cancer in high-risk human cohorts

Mapeamento de termiteiros em pastagem da região do cerrado por krigagem indicatriz.

Este trabalho tem por objetivo mapear a incidência de termiteiros ativos em uma pastagem de Andropogon sp. utilizando krigagem indicatriz para estimar isolinhas de probabilidades de existirem termiteiros ativos, dada a informação obtida.Na publicação: Suzana Druck Fuks

Análise do movimento do herbicida tebutiuron, por simulação, na cultura da cana-de-açúcar em área de recarga do aquífero Botucatu, Ribeirão Preto/SP.

Com o objetivo de conhecer o comportamento do herbicida Tebutiuron, em área de agricultura intensiva de cana-de-açúcar, localizada na região de Ribeirão Preto, SP, utilizou-se o simulador CMLS-94 - "Chemical Movement in Layered Soils" (Nofziger & Hornsby, 1994). O cenário das simulações foi baseado na data de plantio de cana, 20 de setembro, com aplicação inicial do produto um mês após o plantio, na dose de 1,1 Kg/ha, para um período de simulação de quatro anos. Os resultados mostraram que o Tebutiuron, simulado em solos LR, Transição LR para LE, LE e AQ chega a atingir 30 metros de profundidade no solo AQ, fornecendo indícios de contaminação do lençol freático

Detection of inconsistencies in geospatial data with geostatistics

Almost every researcher has come through observations that “drift” from the rest of the sample, suggesting some inconsistency. The aim of this paper is to propose a new inconsistent data detection method for continuous geospatial data based in Geostatistics, independently from the generative cause (measuring and execution errors and inherent variability data). The choice of Geostatistics is based in its ideal characteristics, as avoiding systematic errors, for example. The importance of a new inconsistent detection method proposal is in the fact that some existing methods used in geospatial data consider theoretical assumptions hardly attended. Equally, the choice of the data set is related to the importance of the LiDAR technology (Light Detection and Ranging) in the production of Digital Elevation Models (DEM). Thus, with the new methodology it was possible to detect and map discrepant data. Comparing it to a much utilized detections method, BoxPlot, the importance and functionality of the new method was verified, since the BoxPlot did not detect any data classified as discrepant. The proposed method pointed that, in average, 1,2% of the data of possible regionalized inferior outliers and, in average, 1,4% of possible regionalized superior outliers, in relation to the set of data used in the study