Effects of 2- vs 4- Week Attending Physician Inpatient Rotations on Unplanned Patient Revisits, Evaluations by Trainees, and Attending Physician Burnout: A Randomized Trial

Colin West and the Mayo team recently published a meta-analysis of Interventions to Prevent and Reduce Physician Burnout (Lancet 2016; 388: 2272-81) and found that only three randomized studies of structural or organizational interventions have been reported in the literature. Brian Lucas et al. examined the Effects of 2- vs 4- Week Attending Physician Inpatient Rotations on Unplanned Patient Revisits, Evaluations by Trainees, and Attending Physician Burnout (JAMA 2012). The second organizational intervention was the Healthy Work Place (HWP) study by Mark Linzer et al: Interventions to Improve Work Conditions and Clinician Burnout in Primary Care (J Gen Intern Med 2015). Third, Christopher Parshuram et al studied Patient Safety, Resident Well-Being and Continuity of Care with Different Residents Duty Schedules in the Intensive Care Unit (CMAJ 2015). The panel will discuss the findings of these four studies and what further research is needed to determine the most effective interventions for preventing and reducing physician burnout.https://openworks.mdanderson.org/hrc_burnout_presentations/1008/thumbnail.jp

A neuropsychological study of prefrontal lobe function in the positive and negative subtypes of schizophrenia.

The symptoms of schizophrenia are frequently divided into positive and negative subtypes. It has been suggested that the negative symptoms are similar to those seen with prefrontal lobe cortical dysfunction. Several neuropsychological investigations of that hypothesis have been carried out, but none have directly compared a negative symptom group with a positive symptom group on the same test battery. In the present study, the Positive and Negative Syndrome Scale (PANSS; Kay, Fiszbein, & Opler, 1987) was used to distinguish two groups of 20 patients with schizophrenia with predominant positive or negative symptoms. A battery of 7 neuropsychological tests considered capable of isolating prefrontal lobe dysfunction was administered. A significant group difference was noted on 6 of the tests; the negative symptom group performed much worse than the positive symptom group. The results of this study support the hypothesis that a relationship exists between the negative symptoms of schizophrenia and prefrontal lobe dysfunction

Energy Storage in Madeira, Portugal: Co-optimizing for Arbitrage, Self-Sufficiency, Peak Shaving and Energy Backup

International audienceEnergy storage applications are explored from a prosumer (consumers with generation) perspective for the island of Madeira in Portugal. These applications could also be relevant to other power networks. We formulate a convex co-optimization problem for performing arbitrage under zero feed-in tariff, increasing self-sufficiency by increasing self-consumption of locally generated renewable energy, provide peak shaving and act as a backup power source during anticipated and scheduled power outages. Using real data from Madeira we perform short and long timescale simulations in order to select end-user contract which maximizes their gains considering storage degradation based on operational cycles. We observe energy storage ramping capability decides peak shaving potential, fast ramping batteries can significantly reduce peak demand charge. The numerical experiment indicates that storage providing backup does not significantly reduce gains performing arbitrage and peak demand shaving. Furthermore, we also use AutoRegressive Moving Average (ARMA) forecasting along with Model Predic-tive Control (MPC) for real-time implementation of the proposed optimization problem in the presence of uncertainty

A Case Control Study of Nutrient Intake Deficiencies in Patients Taking Warfarin

Introduction We previously published the case of a woman taking warfarin who was found to have scurvy, a disease caused by a deficiency of vitamin C. This led us to hypothesize that patients taking warfarin who consume a diet limited in vitamin K rich foods may be at risk for other nutrient deficiencies. To test our hypothesis, we studied dietary nutrient intake in patients taking warfarin compared to patients with heart disease not taking warfarin. Methods The warfarin (n=59) and control groups (n=24) comprised convenience samples of patients with heart disease over age 60 years. Patients completed a three-day food diary and reported use of supplements. Results Based on diet history, the most common deficiencies were vitamin D (100% both groups), vitamin E (93% warfarin, 92% control), vitamin A (71% warfarin, 71% control), vitamin K (66% warfarin, 58% control), vitamin C (58 % warfarin, 46% control) and pantothenic acid (69% warfarin, 71% control) with no significant differences in intake deficiencies between warfarin and control groups. Conclusion All of our patients had nutritional intake deficiencies. This may be due to Appalachian dietary habits and not the low vitamin K diet. It seems prudent to recommend multivitamins, however, universal multivitamin supplementation has not been supported by randomized controlled trials. More study is needed to determine the reason for poor nutritional intake in our Appalachian population and to determine whether similar results are evident in a larger sample

Arbitrage with Power Factor Correction using Energy Storage

The importance of reactive power compensation for power factor (PF) correction will significantly increase with the large-scale integration of distributed generation interfaced via inverters producing only active power. In this work, we focus on co-optimizing energy storage for performing energy arbitrage as well as local power factor correction. The joint optimization problem is non-convex, but can be solved efficiently using a McCormick relaxation along with penalty-based schemes. Using numerical simulations on real data and realistic storage profiles, we show that energy storage can correct PF locally without reducing arbitrage profit. It is observed that active and reactive power control is largely decoupled in nature for performing arbitrage and PF correction (PFC). Furthermore, we consider a real-time implementation of the problem with uncertain load, renewable and pricing profiles. We develop a model predictive control based storage control policy using auto-regressive forecast for the uncertainty. We observe that PFC is primarily governed by the size of the converter and therefore, look-ahead in time in the online setting does not affect PFC noticeably. However, arbitrage profit are more sensitive to uncertainty for batteries with faster ramp rates compared to slow ramping batteries.Comment: 10 pages, 8 figure

Role of Dietary Components in Modulating Hypertension

Hypertension is a major health issue, particularly in medically underserved populations that may suffer from poor health literacy, poverty, and limited access to healthcare resources. Management of the disease reduces the risk of adverse outcomes, such as cardiovascular or cerebrovascular events, vision impairment due to retinal damage, and renal failure. In addition to pharmacological therapy, lifestyle modifications such as diet and exercise are effective in managing hypertension. Current diet guidelines include the DASH diet, a low-fat and low-sodium diet that encourages high consumption of fruits and vegetables. While the diet is effective in controlling hypertension, adherence to the diet is poor and there are few applicable dietary alternatives, which is an issue that can arise from poor health literacy in at-risk populations. The purpose of this review is to outline the effect of specific dietary components, both positive and negative, when formulating a dietary approach to hypertension management that ultimately aims to improve patient adherence to the treatment, and achieve better control of hypertension