Evaluating Emergency Medicine Faculty at End-of-Shift

Introduction: Faculty often evaluate learners in the emergency department (ED) at the end of each shift. In contrast, learners usually evaluate faculty only at the end of a rotation. In December 2007 [X] School of Medicine changed its evaluation process, requiring ED trainees to complete end-of-shift evaluations of faculty.Objective: Determine the feasibility and acceptance of end-of-shift evaluations for emergency medicine faculty.Methods: We conducted this one-year observational study at two hospitals with 120,000 combined annual ED visits. Trainees (residents and students) anonymously completed seven-item shift evaluations and placed them in a locked box. Trainees and faculty completed a survey about the new process.Results: During the study, trainees were assigned 699 shifts, and 633 end-of-shift evaluations were collected for a completion rate of 91%. The median number of ratings per faculty was 31, and the median number of comments was 11 for each faculty. The survey was completed by 16/22 (73%) faculty and 41/69 (59%) trainees. A majority of faculty (86%) and trainees (76%) felt comfortable being evaluated at end-of-shift. No trainees felt it was a time burden.Conclusion: Evaluating faculty following an ED shift is feasible. End-of-shift faculty evaluations are accepted by trainees and faculty. [West J Emerg Med. 2010; 11(5):486-490.

MEMS 411 Morphing Wing RC Glider Senior Design Project

The problem we spent a semester working on was building a remote controlled glider which used morphing wings rather than traditional control surfaces. After interviewing our customer, we discovered a few metrics guiding the size of our project as well as the requirements of gliding and control. After brainstorming several ideas, we settled on a bat wing design keying in on the flexible wing material. The wing skin material we used ended up being made from one layer of plastic sandwiched by two layers of elastic fabric. The elastic skin was stretched over airfoil cross sections which rotated over a controlling torsion bar. The result were controllable, morphing surfaces for the main wings of our RC glider. The report contains several photos of the construction and videos of the operation of the wings. During testing we ran in to problems with weather which limited the results we could obtain. This meant we fell short on some of our design metrics such as flight time and glide ratio. However, we were able to successfully demonstrate control in the air by using the morphing wings. In the future, we would like to build upon our success by cutting down on weight in the parts used for construction, the addition of pitch control through controllable rear elevator surfaces, the addition of landing gear, and finally by ensuring proper weather conditions before flying

Recent Decisions

Comments on recent decisions by Sidney Baker, Arthur L. Beaudette, Mark Harry Berens, Francis W. Collopy, Patrick F. Coughlin, Benedict R. Danko, Joseph M. Gaydos, William T. Huston, Francis J. Keating, John E. Lindberg, James D. Matthews, Lawrence S. May, Jr., Maurice J. Moriarty, George J. Murphy, Jr., William J. O\u27Connor, Charles James Perrin, Albert R. Ritcher, Henry Martin Shine, Jr., Cyril C. Vidra, and Dale A. Winnie

Radiation risk predictions for Space Station Freedom orbits

Risk assessment calculations are presented for the preliminary proposed solar minimum and solar maximum orbits for Space Station Freedom (SSF). Integral linear energy transfer (LET) fluence spectra are calculated for the trapped proton and GCR environments. Organ dose calculations are discussed using the computerized anatomical man model. The cellular track model of Katz is applied to calculate cell survival, transformation, and mutation rates for various aluminum shields. Comparisons between relative biological effectiveness (RBE) and quality factor (QF) values for SSF orbits are made

Pain Coping Skills Training for Patients Who Catastrophize About Pain Prior to Knee Arthroplasty: A Multisite Randomized Clinical Trial

BACKGROUND: Pain catastrophizing has been identified as a prognostic indicator of poor outcome following knee arthroplasty. Interventions to address pain catastrophizing, to our knowledge, have not been tested in patients undergoing knee arthroplasty. The purpose of this study was to determine whether pain coping skills training in persons with moderate to high pain catastrophizing undergoing knee arthroplasty improves outcomes 12 months postoperatively compared with usual care or arthritis education. METHODS: A multicenter, 3-arm, single-blinded, randomized comparative effectiveness trial was performed involving 5 university-based medical centers in the United States. There were 402 randomized participants. The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain Scale, measured at baseline, 2 months, 6 months, and 12 months following the surgical procedure. RESULTS: Participants were recruited from January 2013 to June 2016. In 402 participants, 66% were women and the mean age of the participants (and standard deviation) was 63.2 ± 8.0 years. Three hundred and forty-six participants (90% of those who underwent a surgical procedure) completed a 12-month follow-up. All 3 treatment groups had large improvements in 12-month WOMAC pain scores with no significant differences (p > 0.05) among the 3 treatment arms. No differences were found between WOMAC pain scores at 12 months for the pain coping skills and arthritis education groups (adjusted mean difference, 0.3 [95% confidence interval (CI), -0.9 to 1.5]) or between the pain coping and usual-care groups (adjusted mean difference, 0.4 [95% CI, -0.7 to 1.5]). Secondary outcomes also showed no significant differences (p > 0.05) among the 3 groups. CONCLUSIONS: Among adults with pain catastrophizing undergoing knee arthroplasty, cognitive behaviorally based pain coping skills training did not confer pain or functional benefit beyond the large improvements achieved with usual surgical and postoperative care. Future research should develop interventions for the approximately 20% of patients undergoing knee arthroplasty who experience persistent function-limiting pain. LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence

Usefulness of electrophysiologic study to determine the clinical tolerance of arrhythmia recurrences during amiodarone therapy

The relation of clinical and electrophysiologic variables to outcome was evaluated in 121 patients treated with amiodarone for sustained ventricular tachyarrhythmias. Electrophysiologic study was performed in all patients a mean of 14 days after beginning amiodarone therapy. Forty-six patients who were given oral amiodarone therapy experienced arrhythmia recurrence. Multivariate analysis was performed using 16 clinical and electrophysiologic variables to determine which factors were associated with 1) arrhythmia recurrence and 2) a poorly tolerated arrhythmia recurrence (that is, cardiac arrest or sudden cardiac death) during oral amiodarone therapy. No variable predicted arrhythmia recurrence. Five variables correlated significantly with a poorly tolerated arrhythmia recurrence. Hemodynamic stability of the arrhythmia induced on electrophysiologic testing during amiodarone therapy had the best predictive value (p < 0.001). Younger age, lower ejection fraction, a poorly tolerated rhythm at clinical presentation and absence of left ventricular aneurysm were also associated with a poorly tolerated arrhythmia recurrence.Only 3 of 57 patients who had a well tolerated arrhythmia induced on electrophysiologic testing during amiodarone therapy had recurrence of a poorly tolerated arrhythmia versus 19 of 47 who had hemodynamically unstable arrhythmias induced during amiodarone therapy (p < 0.001). Thus, electrophysiologic testing during amiodarone therapy appears useful in identifying patients who are prone to have catastrophic arrhythmia recurrences and could allow for the institution of additional or alternative modes of therapy

The Reddest Quasars

In a survey of quasar candidates selected by matching the FIRST and 2MASS catalogs, we have found two extraordinarily red quasars. FIRST J013435.7-093102 is a 1 Jy source at z=2.216 and has B-K > 10, while FIRST J073820.1+275045 is a 2.5 mJy source at z=1.985 with B-K = 8.4. FIRST J073820.1+275045 has strong absorption lines of MgII and CIV in the rest frame of the quasar and is highly polarized in the rest frame ultraviolet, strongly favoring the interpretation that its red spectral energy distribution is caused by dust reddening local to the quasar. FIRST J073820.1+275045 is thus one of the few low radio-luminosity, highly dust-reddened quasars known. The available observational evidence for FIRST J013435.7-093102 leads us to conclude that it too is reddened by dust. We show that FIRST J013435.7-093102 is gravitationally lensed, increasing the number of known lensed, extremely dust-reddened quasars to at least three, including MG0414-0534 and PKS1830-211. We discuss the implications of whether these objects are reddened by dust in the host or lensing galaxies. If reddened by their local environment, then we estimate that between 10 and 20% of the radio-loud quasar population is reddened by dust in the host galaxy. The discovery of FIRST J073820.1+275045 and objects now emerging from X-ray surveys suggests the existence of an analogous radio-quiet red quasar population. Such objects will be entirely missed by standard radio or optical quasar surveys. If dust in the lensing galaxies is primarily responsible for the extreme redness of the lensed quasars, then an untold number of gravitationally lensed quasars are being overlooked.Comment: AASTEX 24 pp., 7 figs; accepted by ApJ. See also the preprint astro-ph/0107435 by Winn et al., who independently discovered that J013435.7-093102 is gravitationally lense

Physics-Based Damage Predictions for Simulating Testing and Evaluation (T and E) Experiments

This is the final report of a two-year, Laboratory-Directed Research and Development (LDRD) project at the Los Alamos National Laboratory (LANL). This report addresses the need to develop computational techniques and physics-based material models for simulating damage to weapons systems resulting from ballistic threats. Modern weapons systems, such as fighter aircraft, are becoming more dependent upon composite materials to reduce weight, to increase strength and stiffness, and to resist adverse conditions resulting from high temperatures and corrosion. Unfortunately, damaged components can have severe and detrimental effects, as evidenced by statistics from Desert Storm indicating that 75% of aircraft losses were attributable to fuel system vulnerability with hydrodynamic ram being the primary kill mechanism. Therefore, this project addresses damage predictions for composite systems that are subjected to ballistic threats involving hydrodynamic ram. A computational technique for simulating fluid-solid interaction phenomena and physics-based material models have been developed for this purpose

Environmental controls on the distribution and diversity of lentic Chironomidae (Insecta: Diptera) across an altitudinal gradient in tropical South America

To predict the response of aquatic ecosystems to future global climate change, data on the ecology and distribution of keystone groups in freshwater ecosystems are needed. In contrast to mid- and high-latitude zones, such data are scarce across tropical South America (Neotropics). We present the distribution and diversity of chironomid species using surface sediments of 59 lakes from the Andes to the Amazon (0.1–17°S and 64–78°W) within the Neotropics. We assess the spatial variation in community assemblages and identify the key variables influencing the distributional patterns. The relationships between environmental variables (pH, conductivity, depth, and sediment organic content), climatic data, and chironomid assemblages were assessed using multivariate statistics (detrended correspondence analysis and canonical correspondence analysis). Climatic parameters (temperature and precipitation) were most significant in describing the variance in chironomid assemblages. Temperature and precipitation are both predicted to change under future climate change scenarios in the tropical Andes. Our findings suggest taxa of Orthocladiinae, which show a preference to cold high-elevation oligotrophic lakes, will likely see range contraction under future anthropogenic-induced climate change. Taxa abundant in areas of high precipitation, such as Micropsectra and Phaenopsectra, will likely become restricted to the inner tropical Andes, as the outer tropical Andes become drier. The sensitivity of chironomids to climate parameters makes them important bio-indicators of regional climate change in the Neotropics. Furthermore, the distribution of chironomid taxa presented here is a vital first step toward providing urgently needed autecological data for interpreting fossil chironomid records of past ecological and climate change from the tropical Andes