The Relative Financial Cost and Benefit of an Ophthalmology Resident Compared to an Advanced Practice Provider, Optometrist, or Faculty Ophthalmologist

Objective The main objective of the article is to determine the relative direct financial cost and benefit of an advanced practice provider (APP), optometrist, and faculty ophthalmologist compared with an ophthalmology resident. Design Single center cost–benefit financial analysis. Methods The direct total expenses, including mean salary and benefits; the cost/week, based upon calculated hours worked; and net revenue, based upon technical collections subtracted from total expenses were collected for all APPs, optometrists, faculty ophthalmologists, and ophthalmology residents at the University of Kentucky for the 2016 to 2017 academic year. Optometry and ophthalmology faculty collections were adjusted for clinical full-time equivalents. Results Total annual mean salary and benefits for 242 APPs, 4 optometrists, 17 faculty ophthalmologists, and 9 ophthalmology residents were $126,797,$117,021, $338,233, and$71,210, respectively. Assuming a 50-hour-work week, the calculated hourly costs were $48.77,$45.01, $130.09, and$27.39, respectively. Ophthalmology residents do not directly generate work relative value units or collections. On this basis, the net annual revenues were −$62,729,$122,757, $566,119, and −$71,210, respectively. Conclusions Ophthalmology residents are relatively inexpensive compared with potential substitute health care providers, although they are unable to generate direct revenue. Indirect costs and benefits are likely substantial, but currently incalculable. More candid analyses of the role and financial impact of trainees in health care are needed

Explicit connection between conformal field theory and 2+1 Chern-Simons theory

We give explicit field theoretical representations for the observables of 2+1 dimensional Chern-Simons theory in terms of gauge invariant composites of 2D WZW fields. To test our identification we compute some basic Wilson loop correlators reobtaining known results.Comment: 13 pages, Latex file. To appear in Mod.Phys.Lett.

An Objective Assessment of the Variability in Number of Drops per Bottle of Glaucoma Medication

Background: The purpose of this study is to evaluate the number of eyedrops available per bottle of a variety of commonly prescribed glaucoma medications. Methods: Six bottles of each glaucoma medication were tested: three each in the vertical and horizontal orientations. Bottles were housed in a customized force gauge apparatus designed to mimic ballpoint fingertip contact with a bottle. At a standard rate, all drops were expressed from each bottle and counted with an automated drop counter. Simultaneously, bottle volume was measured and drop size and number were also estimated. The main outcome measures were: total number of drops, volume per bottle and drops per milliliter (mL) of glaucoma medication. Results: A total of 192 bottles from 32 bottle designs and manufacturers were tested. Twenty-two of the 32 bottle designs had a significantly different mean number of drops in the vertical and horizontal positions, with 10 designs have more drops dispensed in the horizontal orientation and 12 in the vertical orientation. Six of the 32 bottle designs had a significantly different mean total bottle volume in the vertical and horizontal positions, with all designs having greater volume in the vertical position. An adjusted ratio of mean number of drops/mean bottle volume demonstrated a range from 20.9 drops/mL to 40.8 drops/mL. Conclusions: There is significant variability in drops and volume available per bottle of glaucoma medication depending on both the bottle position and manufacturer. These data point to the need for circumspection in prescribing glaucoma medications and caution in evaluating therapeutic outcomes

A physical model for efficient ranking in networks

We present a physically inspired model and an efficient algorithm to infer hierarchical rankings of nodes in directed networks. It assigns real-valued ranks to nodes rather than simply ordinal ranks, and it formalizes the assumption that interactions are more likely to occur between individuals with similar ranks. It provides a natural statistical significance test for the inferred hierarchy, and it can be used to perform inference tasks such as predicting the existence or direction of edges. The ranking is obtained by solving a linear system of equations, which is sparse if the network is; thus, the resulting algorithm is extremely efficient and scalable. We illustrate these findings by analyzing real and synthetic data, including data sets from animal behavior, faculty hiring, social support networks, and sports tournaments. We show that our method often outperforms a variety of others, in both speed and accuracy, in recovering the underlying ranks and predicting edge directions

Wall Crossing from Dirac Zeromodes

We explore the physics of two-body decay of BPS states using semiclassical analysis to construct explicit solutions that illustrate the main features of wall crossing, for both ordinary and framed BPS states. In particular we recover the primitive wall-crossing formula from an asymptotic analysis of certain Dirac-type operators on monopole moduli spaces. Along the way we give an asymptotic metric for the moduli space of singular monopoles, analogous to the Gibbons-Manton and Lee-Weinberg-Yi metrics for the moduli space of smooth monopoles, and we find evidence for the existence of stable non-BPS boundstates. Our discussion applies to four-dimensional N = 2 super-Yang-Mills theories with general gauge group and general 't Hooft defects.Comment: 32 pages plus appendices; 1 figure. v2: references added, typos fixed. v3: references added, published versio

Student Builders of Online Curriculum Content. What Are Their Perceptions and Motivations?

Objective/Purpose: 1. Describe the benefits and challenges of establishing a campus-wide student-centered program to create online curricular content. 2. Gain insight about student perceptions and motivations for becoming curriculum content developers. Need for Innovation: Faculty receive constant encouragement to discover methods for transforming health science instructional materials using active learning. Faculty identify lack of time as the most significant barrier to developing blended and online materials. In 2014, our academic medical center issued a student-centered call for proposals to create online materials for the Interactive E-Learning Program as a means to include students in the curricular change process. By pairing student creators, many of whom are fluent consumers of technology and digital education, with content expert faculty, the program uniquely capitalized on the students desire to contribute with the identified need of faculty for production time. Instructional Methods/Materials Used: The first call for student proposals was conducted in the fall of 2014, with the second in the fall of 2015. The competitive application required the following information: project members, faculty advisors, learning objectives, budget worksheet, description of the proposed module, and implementation plans for the curriculum. Awardees received $1000 per project for project expenses or student stipends. Students developed modules in six months with guidance from faculty advisors using resources available in the campus e-learning studio. Program completion was recognized by a letter of commendation. During the summer of 2016, students from both cohorts took part in a survey to assess their motivations and perceived benefits of participating in the Interactive E-Learning Program. Educational Outcomes: The two calls for proposals resulted in 30 funded student projects covering curricular topics for medicine, nursing, pharmacy, dentistry, allied health, and public health. A total of 58 students were involved and worked solo or in groups of 2-4 people. Survey results indicated students were motivated to participate by the desire to contribute to or enhance the curriculum and to develop their own e-learning skills. Students perceived an enhanced relationship with their faculty advisors and increased e-learning skills to be benefits of the program. Students also perceived participation in the program as a positive addition to their CV. Strengths/Areas for Improvement: The energy and creativity with which students approached the modules they designed resulted in many novel projects. The centralized e-learning studio and instructional design staff are strengths of the program, ensuring the modules meet instructional design principles, university branding requirements, copyright guidelines, and accessibility rules. An internal rubric and project checklist provided a guide for development and served as a tool for evaluation and feedback. Areas for improvement include the development of more interprofessional student teams that can lead to content applicable in more than one curriculum (eg professionalism skills, vital signs, medical history, etc). Approaches for identifying opportunities to implement the student-developed materials into courses on campus is also under consideration. Feasibility of Program Maintenance/Transferability: Many health sciences programs are facing curriculum redesign to meet the learning needs of current and future students or are seeking ways to engage students in the learning process. Based on our findings, extending the opportunity to students to become creators in partnership with faculty content experts was highly successful. Students are now more than just learners, but are also demonstrating altruistic behaviors to contribute and enhance curriculum for future students. After initial expenditures are made to acquire the proper software and hardware needed to support a formal e-learning program, the cost of maintaining such equipment is of small consequence when considering the impact of this program for the student developers, their faculty mentors, and the entire campus community

Survival Rates Indicate that Correlations Between Community-Weighted Mean Traits and Environments can be Unreliable Estimates of the Adaptive Value of Traits

Correlations between community-weighted mean (CWM) traits and environmental gradients are often assumed to quantify the adaptive value of traits. We tested this assumption by comparing these correlations with models of survival probability using 46 perennial species from long-term permanent plots in pine forests of Arizona. Survival was modeled as a function of trait-by-environment interactions, plant size, climatic variation, and neighborhood competition. The effect of traits on survival depended on the environmental conditions, but the two statistical approaches were inconsistent. For example, CWM specific leaf area (SLA) and soil fertility were uncorrelated. However, survival was highest for species with low SLA in infertile soil, a result which agreed with expectations derived from the physiological tradeoff underpinning leaf economic theory. CWM trait-environment relationships were unreliable estimates of how traits affected survival, and should only be used in predictive models when there is empirical support for an evolutionary tradeoff that affects vital rates

Treatment preferences among problem drinkers in primary care.

OBJECTIVE: Alcohol misuse is common among primary care patients, yet many do not receive treatment because doctors believe problem drinkers are in denial, or are unwilling to change their drinking habits. The real problem, however, may be that patients are being offered treatment modalities that do not meet their needs. This study was designed to measure the acceptability of various treatment options among drinkers who were currently not receiving treatment. METHOD: Patients in a primary care clinic were given a self-report questionnaire that included: (1) the Alcohol Use Disorders Questionnaire, (2) a measure of readiness to change drinking behavior, and (3) a list of treatment modalities to be rated based on level of interest. RESULTS: Within a random sample of 402 patients, 40.2% reported high risk drinking and 16.3% reported problem drinking. Among the latter group, 89.3% were either considering change, or had begun to take steps to make changes in their drinking behaviors. When asked about treatment preferences, the modalities most frequently recommended by physicians-group therapy and Alcoholics Anonymous-were among the least acceptable. The most popular options were getting help from a primary care doctor and taking a medication that would make it easier to avoid drinking without making them sick if they drank. CONCLUSIONS: The belief that problem drinkers are unwilling to change was not supported by this study. Treatment for problem drinking should involve a collaborative evaluation of options with an emphasis on patient preference and treatment within the primary care setting