RESISTING RESISTANCE TO CHANGE: A CRITICAL ANALYSIS OF THE STRUCTURE OF SURGICAL RESIDENCY TRAINING PROGRAMS

In 2003, the Accreditation Council for Graduate Medical Education (ACGME) issued regulations affecting the structure of surgical residency training programs. These regulations placed work hour restrictions on residents. There has been significant resistance by the surgical leadership, including program directors and officers in academic organizations, to the adoption of the changes required by these regulations. The need for these changes to the structure of the resident’s work environment, and the resistance to the incorporation of these changes, provide an opportunity to examine the ethos and culture of surgical residency for a potential source of this conflict. This thesis claims that a significant element of this resistance is the recognition that the required changes will not only affect the structure of surgical residency training, but also the culture of residency training and the adoption of a traditional surgical identity by the trainees immersed in that culture. There is increasing evidence of significant ethical problems resulting from the traditional structure of surgical residency training. The norms perpetuated by the traditional approach to surgical training are antithetical to the current ethical norms expected regarding patient care and the surgeon’s personal and professional development. Critical ethical issues addressed in this thesis include those raised by both the apparent generational break between surgeons trained before and after work hour reform, and the conflict in balancing visions of surgical identity and concerns of patient and personal safety. The thesis argues that there is no well grounded reason for the resistance to incorporating the changes required by the ACGME. Instead, the development of the structure and culture of the surgical residency may have evolved in response to dysfunctional influences, rather than being built on sound pedagogical theory. The resulting surgical identity molded by this culture may then be appreciated as a potentially flawed, dysfunctional social construct. Changes prompted by the ACGME may result in both a healthier surgical work force and the ability to attract a greater diversity of applicants to the field of surgery. The reframing of what is essential to the surgical identity may allow the creation of new models of surgical training

Structure–activity relationships of aminoglycoside-arginine conjugates that bind HIV-1 RNAs as determined by fluorescence and NMR spectroscopy

AbstractWe present here a new set of aminoglycoside-arginine conjugates (AACs) that are either site-specific or per-arginine conjugates of paromomycin, neamine, and neomycin B as well as their structure–activity relationships. Their binding constants (KD) for TAR and RRE RNAs, measured by fluorescence anisotropy, revealed dependence on the number and location of arginines in the different aminoglycoside conjugates. The binding affinity of the per-arginine aminoglycosides to TAR is higher than to RRE, and hexa-arginine neomycin B is the most potent binder (KD=5 and 23 nM, respectively). The 2D TOCSY NMR spectrum of the TAR monoarginine-neomycin complex reveals binding at the bulge region of TAR

Environmental sustainability of food environments: Development and application of a framework in four cities in South Asia

BackgroundFood environments, where people directly engage with broader food systems, may be an important contributor to the environmental sustainability of food systems. The primary objectives of this paper were to establish a new food environment framework that considers environmental indicators and to assess data availability and gaps using data previously collected as part of a food systems survey in four South Asian cities.MethodsThe framework was developed by conducting a structured literature review of previous food environment frameworks and in-depth interviews with content experts (n = 6). The framework and indicators were then mapped to data collected by consumer and vendor surveys using the Urban Food Systems Assessment Tool (UFSAT) in Ahmedabad (India), Pune (India), Kathmandu (Nepal), and Pokhara (Nepal).ResultsWe have expanded the sustainability domain within food environments to include consumer travel to food vendors, the presence of food delivery services, policies related to sustainability, vendor food waste, vendor plastic use, vendor utility usage, vendor recycling & waste management practices, and food packaging. Mapping the framework to existing data from four cities in South Asia, we found variations in food environment sustainability indicators, particularly regarding consumer transportation to food vendors, the presence of delivery services, and food waste.ConclusionWhile the majority of food environment research focuses on the availability and affordability of healthy foods, there is an urgent need to understand better how aspects of food environments contribute to our environmental goals. When mapping the framework to existing food systems data, we found gaps in data on environmental sustainability in food environments and variation in indicators across settings

Associations of Bone Mineral Density with Lean Mass, Fat Mass, and Physical Activity in Young Overweight and Obese Women - A Feasibility Study

International Journal of Exercise Science 15(7): 585-598, 2022. To examine the associations between bone mineral density (BMD), body composition and habitual physical activity in women who are overweight/obese. We measured whole-body bone, and body composition (lean mass, fat mass, and total fat percent) via dual-energy x-ray absorptiometry (model General Electric Lunar whole-body scanner) in a diverse group of women (N=48, age 26.6+/-4.7 years, 63% Black) living in an urban setting. The relations between BMD with total fat percent [%]), lean mass (kg), fat mass (kg), and physical activity were examined using Pearson correlations and multiple linear regression models, adjusted for race, age, and dietary calcium. BMD was positively correlated with lean mass (r=0.43, p=0.002) and negatively correlated with total fat percentage (r=-0.31, p=0.03). Multiple linear regression models indicated BMD was positively associated with lean mass (β: 0.007, p\u3c0.001), and negatively associated with fat mass (kg) and total fat percentage (β: -0.003, p=0.03; β: -0.004, p=0.03, respectively). When stratified by race, these relations were maintained in white women but only lean mass in Black women. When stratified by age, the positive correlation between BMD and lean mass was significant in younger women (\u3c30y) only. There were no significant relationships between BMD and any physical activity measures. Our results indicate that in young women who are overweight/obese BMD is significantly associated with body composition, both lean mass and total fat percentage, but not habitual physical activity. An emphasis on lean mass accrual may be valuable for young women, particularly Black women, to improve bone health

Effect of Laparoscopic Adjustable Gastric Banding on Metabolic Syndrome and Its Risk Factors in Morbidly Obese Adolescents

We examined the effect of laparoscopic adjustable gastric banding (LAGB) on weight loss, inflammatory markers, and components of the Metabolic Syndrome (MeS) in morbidly obese adolescents and determined if those with MeS lose less weight post-LAGB than those without. Data from 14–18 yr adolescents were obtained at baseline, 6 and 12 months following LAGB. Significant weight loss and improvements in MeS components were observed 6 months and one year following LAGB. The incidence of MeS declined 56.8% after 6 months and 69.6% after 12 months. There was no significant difference in amount of weight lost post-LAGB between those with and without MeS at either timepoint. Correlations between change in weight parameters and components of MeS in those with and without MeS at baseline were examined and found to vary by diagnostic category. LAGB is effective for short-term improvement in weight, inflammatory markers, and components of MeS in morbidly obese adolescents

Social and Economic Consequences of Overweight in Adolescence and Young Adulthood

Izrada web-sjedišta predstavlja izazov za svakog web-dizajnerskog pojedinca. Kako bi olakšali izradu samih sjedišta , mnogi web-dizajneri se odlučuju za sustave koji omogućavaju upravljanje sadržajem na internetu(CMS-Content Management System) koje u svakom pogledu olakšavaju samu izradu. Kroz ovaj rad proći ćemo kroz nekoliko segmenata u izradi web-sjedišta za turističku agenciju Lanterna, od same instalacije CMS sustava, korištenje istog, do kompletne izrade i dizajniranja teme . Detaljno će biti prikazani svi koraci pri izradi kako bi pobliže mogli objasniti svaki segment

C-reactive protein is essential for innate resistance to pneumococcal infection

Summary: No deficiency of human C-reactive protein (CRP), or even structural polymorphism of the protein, has yet been reported so its physiological role is not known. Here we show for the first time that CRP-deficient mice are remarkably susceptible to Streptococcus pneumoniae infection and are protected by reconstitution with isolated pure human CRP, or by anti-pneumococcal antibodies. Autologous mouse CRP is evidently essential for innate resistance to pneumococcal infection before antibodies are produced. Our findings are consistent with the significant association between clinical pneumococcal infection and non-coding human CRP gene polymorphisms which affect CRP expression. Deficiency or loss of function variation in CRP may therefore be lethal at the first early-life encounter with this ubiquitous virulent pathogen, explaining the invariant presence and structure of CRP in human adults