Peer assisted learning (PAL) project for intern development

Description of How the Problem was Identified and Explored: A common complaint among our intern and upper level house staff is the lack of training interns receive regarding efficiency of the pre-rounding process and training with the EMR. Additionally, the ward teams are often burdened with work and find it difficlut to provide extra support to struggling team members. Description of the Innovation: A collaborative effort between the chief residents and senior residents identified as having scored high marks in efficiency and familiarity with the EMR resulted in a series of documents highlighting efficient pre-rounding techniques. Also, senior residents on electives were paired with interns starting an inpatient ward or critical care service for the first time and pre-rounded with those interns for two days at the start of their rotation, allowing a supportive environment in which to implement the efficient techniques. Results to date: Collection data is via a questionnaire, and results are still being acquired. We currently have two additional months in which we plan to observe this project. Initial data returned shows a signifant improvement in 1) Efficiency of the pre-rounding process, 2) Comfort with the pre-rounding process, 3) Quality of the pre-rounding process and 4) Familiarity with the EMR. Respondents have recommended that the project continue next year beginning at the start of intern year, and current interns who were included in the project have identified themselves as hoping to serve as future mentors in the PAL program. Discussion/Reflection/Lessons Learned: Though efficiency and the use of EMR are topics addressed in our intern orientation, it is difficult to retain this information without being able to immediately utilize or implement information. The busy nature of the inpatient ward teams can make it difficult for a particular ward team to provide additional support to struggling team members regarding ways to improve efficiency. By utilizing our house staff currently on elective rotations, the PAL project is able to provide this support prophylactically to all interns starting an unfamiliar rotation, resulting in improved performance for the intern and a more active educator experience for the senior resident

Imaging and burst location with the EXIST high-energy telescope

The primary instrument of the proposed EXIST mission is a coded mask high energy telescope (the HET), that must have a wide field of view and extremely good sensitivity. It will be crucial to minimize systematic errors so that even for very long total integration times the imaging performance is close to the statistical photon limit. There is also a requirement to be able to reconstruct images on-board in near real time in order to detect and localize gamma-ray bursts. This must be done while the spacecraft is scanning the sky. The scanning provides all-sky coverage and is key to reducing systematic errors. The on-board computational problem is made even more challenging for EXIST by the very large number of detector pixels. Numerous alternative designs for the HET have been evaluated. The baseline concept adopted depends on a unique coded mask with two spatial scales. Monte Carlo simulations and analytic analysis techniques have been used to demonstrate the capabilities of the design and of the proposed two-step burst localization procedure

The Potential Trajectory of Carbapenem-Resistant Enterobacteriaceae, an Emerging Threat to Health-Care Facilities, and the Impact of the Centers for Disease Control and Prevention Toolkit.

Carbapenem-resistant Enterobacteriaceae (CRE), a group of pathogens resistant to most antibiotics and associated with high mortality, are a rising emerging public health threat. Current approaches to infection control and prevention have not been adequate to prevent spread. An important but unproven approach is to have hospitals in a region coordinate surveillance and infection control measures. Using our Regional Healthcare Ecosystem Analyst (RHEA) simulation model and detailed Orange County, California, patient-level data on adult inpatient hospital and nursing home admissions (2011-2012), we simulated the spread of CRE throughout Orange County health-care facilities under 3 scenarios: no specific control measures, facility-level infection control efforts (uncoordinated control measures), and a coordinated regional effort. Aggressive uncoordinated and coordinated approaches were highly similar, averting 2,976 and 2,789 CRE transmission events, respectively (72.2% and 77.0% of transmission events), by year 5. With moderate control measures, coordinated regional control resulted in 21.3% more averted cases (n = 408) than did uncoordinated control at year 5. Our model suggests that without increased infection control approaches, CRE would become endemic in nearly all Orange County health-care facilities within 10 years. While implementing the interventions in the Centers for Disease Control and Prevention's CRE toolkit would not completely stop the spread of CRE, it would cut its spread substantially, by half

The politics of alcohol policy in Nigeria: a critical analysis of how and why brewers use strategic ambiguity to supplant policy initiatives

The global call by the World Health Assembly (WHA) to control the rising alcohol-related problems caused by harmful consumption through policy became necessary in 2005 due to the recognition of the fact that many countries did not have alcohol policies. This gave rise to the adoption of a ten-point policy strategy by the World Health Organization (WHO) Member States in 2010. Against this backdrop, many countries adopted alcohol policies to reduce harmful alcohol consumption. Nigeria was one of the WHO Member Countries that adopted the resolution. Nigeria is among the 30 countries with the highest per capita consumption and alcohol-related problems, yet has not formulated alcohol policy to date. This paper draws on Eisenberg’s Strategic Ambiguity Model to explore the role of brewers in supplanting alcohol policy initiatives in Nigeria. It argues that the leading alcohol producers in Nigeria have been the main reason alcohol policies have not been formulated. The article focuses on why their campaigns for responsible drinking, promotions, sponsorships and ‘strategic social responsibilities’ may have increased since the WHA made the call and the WHO adopted the resolution in 2010. It concludes by arguing that there is an urgent need to formulate policies drawing from the WHO resolution to curtail the activities of these brewers and reduce harmful consumption