Procedural Skills Training During Emergency Medicine Residency: Are We Teaching the Right Things?

Objectives: The Residency Review Committee training requirements for emergency medicine residents (EM) are defined by consensus panels, with specific topics abstracted from lists of patient complaints and diagnostic codes. The relevance of specific curricular topics to actual practice has not been studied. We compared residency graduates’ self-assessed preparation during training to importance in practice for a variety of EM procedural skills.Methods: We distributed a web-based survey to all graduates of the Denver Health Residency Program in EM over the past 10 years. The survey addressed: practice type and patient census; years of experience; additional procedural training beyond residency; and confidence, preparation, and importance in practice for 12 procedures (extensor tendon repair, transvenous pacing, lumbar puncture, applanation tonometry, arterial line placement, anoscopy, CT scan interpretation, diagnostic peritoneal lavage, slit lamp usage, ultrasonography, compartment pressure measurement and procedural sedation). For each skill, preparation and importance were measured on four-point Likert scales. We compared mean preparation and importance scores using paired sample t-tests, to identify areas of under- or over-preparation.Results: Seventy-four residency graduates (59% of those eligible) completed the survey. There were significant discrepancies between importance in practice and preparation during residency for eight of the 12 skills. Under-preparation was significant for transvenous pacing, CT scan interpretation, slit lamp examinations and procedural sedation. Over-preparation was significant for extensor tendon repair, arterial line placement, peritoneal lavage and ultrasonography. There were strong correlations (r>0.3) between preparation during residency and confidence for 10 of the 12 procedural skills, suggesting a high degree of internal consistency for the survey.Conclusions: Practicing emergency physicians may be uniquely qualified to identify areas of under- and over-preparation during residency training. There were significant discrepancies between importance in practice and preparation during residency for eight of 12 procedures. There was a strong correlation between confidence and preparation during residency for almost all procedural skills, re-enforcing the tenet that residency training is the primary locus of instruction for clinical procedures.[WestJEM. 2009;10:152-156.

Retention of radiation damage in zircon xenocrysts from kimberlites, Northern Yakutia

We have studied zircon xenocrysts from Mesozoic kimberlites from the Kuoika and Ary–Mastakh fields in Northern Yakutia. Zircon xenocrysts are assumed to originate from crustal rocks. Our SHRIMP (Sensitive High mass Resolution Ion MicroProbe) analyses yielded predominantly concordant U–Th–Pb ages (up to ~ 3570 Ma; Paleoarchean) that clearly predate kimberlite formation. The general U–Th–Pb concordance observed excludes notable disturbance of the zircon xenocrysts U–Th–Pb isotope system during kimberlite ascent and emplacement. In addition, zircon xenocrysts were found to be significantly more radiation-damaged than would correspond to damage accumulation only since the time of kimberlite formation. This observation first indicates that zircon crystals were sampled by the kimberlite magma at comparably shallow depths not exceeding 10–12 km. If, in contrast, zircon crystals originated from deeper levels of the Earth's crust, they would have been exposed to temperatures of 250–300 °C or more. This in turn would have caused long-term thermal annealing of the radiation damage, which was however not observed in our study. Second, our observation contradicts the hypothesis that high temperatures experienced by zircon xenocrysts during kimberlite ascent will cause notable structural reconstitution by short-term thermal annealing. Consequently, zircon crystals cannot have spent more than a few hours at temperatures exceeding ca. 700–800 °C, or more than a few days at temperatures exceeding ca. 500–600 °C. This in turn suggests that (i) temperatures of the ascending kimberlite magmas were rather moderate, and (ii) kimberlite ascent is a comparably short process followed by rapid cooling

2017 Research & Innovation Day Program

A one day showcase of applied research, social innovation, scholarship projects and activities.https://first.fanshawec.ca/cri_cripublications/1004/thumbnail.jp

The History, Relevance, and Applications of the Periodic System in Geochemistry

Geochemistry is a discipline in the earth sciences concerned with understanding the chemistry of the Earth and what that chemistry tells us about the processes that control the formation and evolution of Earth materials and the planet itself. The periodic table and the periodic system, as developed by Mendeleev and others in the nineteenth century, are as important in geochemistry as in other areas of chemistry. In fact, systemisation of the myriad of observations that geochemists make is perhaps even more important in this branch of chemistry, given the huge variability in the nature of Earth materials – from the Fe-rich core, through the silicate-dominated mantle and crust, to the volatile-rich ocean and atmosphere. This systemisation started in the eighteenth century, when geochemistry did not yet exist as a separate pursuit in itself. Mineralogy, one of the disciplines that eventually became geochemistry, was central to the discovery of the elements, and nineteenth-century mineralogists played a key role in this endeavour. Early “geochemists” continued this systemisation effort into the twentieth century, particularly highlighted in the career of V.M. Goldschmidt. The focus of the modern discipline of geochemistry has moved well beyond classification, in order to invert the information held in the properties of elements across the periodic table and their distribution across Earth and planetary materials, to learn about the physicochemical processes that shaped the Earth and other planets, on all scales. We illustrate this approach with key examples, those rooted in the patterns inherent in the periodic law as well as those that exploit concepts that only became familiar after Mendeleev, such as stable and radiogenic isotopes

Genetic effects on gene expression across human tissues

Characterization of the molecular function of the human genome and its variation across individuals is essential for identifying the cellular mechanisms that underlie human genetic traits and diseases. The Genotype-Tissue Expression (GTEx) project aims to characterize variation in gene expression levels across individuals and diverse tissues of the human body, many of which are not easily accessible. Here we describe genetic effects on gene expression levels across 44 human tissues. We find that local genetic variation affects gene expression levels for the majority of genes, and we further identify inter-chromosomal genetic effects for 93 genes and 112 loci. On the basis of the identified genetic effects, we characterize patterns of tissue specificity, compare local and distal effects, and evaluate the functional properties of the genetic effects. We also demonstrate that multi-tissue, multi-individual data can be used to identify genes and pathways affected by human disease-associated variation, enabling a mechanistic interpretation of gene regulation and the genetic basis of diseas

Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic

This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic

Versailles Project on Advanced Materials and Standards interlaboratory study on intensity calibration for x-ray photoelectron spectroscopy instruments using low-density polyethylene

We report the results of a Versailles Project on Advanced Materials and Standards interlaboratory study on the intensity scale calibration of x-ray photoelectron spectrometers using low-density polyethylene (LDPE) as an alternative material to gold, silver, and copper. An improved set of LDPE reference spectra, corrected for different instrument geometries using a quartz-monochromated Al Kα x-ray source, was developed using data provided by participants in this study. Using these new reference spectra, a transmission function was calculated for each dataset that participants provided. When compared to a similar calibration procedure using the NPL reference spectra for gold, the LDPE intensity calibration method achieves an absolute offset of ∼3.0% and a systematic deviation of ±6.5% on average across all participants. For spectra recorded at high pass energies (≥90 eV), values of absolute offset and systematic deviation are ∼5.8% and ±5.7%, respectively, whereas for spectra collected at lower pass energies (<90 eV), values of absolute offset and systematic deviation are ∼4.9% and ±8.8%, respectively; low pass energy spectra perform worse than the global average, in terms of systematic deviations, due to diminished count rates and signal-to-noise ratio. Differences in absolute offset are attributed to the surface roughness of the LDPE induced by sample preparation. We further assess the usability of LDPE as a secondary reference material and comment on its performance in the presence of issues such as variable dark noise, x-ray warm up times, inaccuracy at low count rates, and underlying spectrometer problems. In response to participant feedback and the results of the study, we provide an updated LDPE intensity calibration protocol to address the issues highlighted in the interlaboratory study. We also comment on the lack of implementation of a consistent and traceable intensity calibration method across the community of x-ray photoelectron spectroscopy (XPS) users and, therefore, propose a route to achieving this with the assistance of instrument manufacturers, metrology laboratories, and experts leading to an international standard for XPS intensity scale calibration

Genetic effects on gene expression across human tissues

Characterization of the molecular function of the human genome and its variation across individuals is essential for identifying the cellular mechanisms that underlie human genetic traits and diseases. The Genotype-Tissue Expression (GTEx) project aims to characterize variation in gene expression levels across individuals and diverse tissues of the human body, many of which are not easily accessible. Here we describe genetic effects on gene expression levels across 44 human tissues. We find that local genetic variation affects gene expression levels for the majority of genes, and we further identify inter-chromosomal genetic effects for 93 genes and 112 loci. On the basis of the identified genetic effects, we characterize patterns of tissue specificity, compare local and distal effects, and evaluate the functional properties of the genetic effects. We also demonstrate that multi-tissue, multi-individual data can be used to identify genes and pathways affected by human disease-associated variation, enabling a mechanistic interpretation of gene regulation and the genetic basis of disease

Feasibility of a mindfulness-based stress reduction intervention on health care safety

Includes bibliographical references.2016 Summer.Occupational injuries represent a significant and costly social and public health problem, especially among health care workers, whose well-being impacts patient safety and quality of care. Mindfulness training, which teaches individuals to bring awareness and acceptance to the present moment, could decrease occupational injury rates while improving worker well-being. Mindfulness training has been proven effective in improving the health and well-being of clinical and healthy populations, but it has not yet been tested as an intervention to improve worker safety. Using a randomized waitlist controlled trial design with a mixed methods approach, the current study sought to: 1) conceptualize hospital health care workers’ experiences in adopting mindfulness practices within the context of an established health behavior theory; and 2) assess the impact of mindfulness training on safety outcomes among hospital health care workers. Hospital health care workers involved in direct patient care at two hospitals in Colorado were recruited to participate in the study.  Participants were randomly assigned to a group that participated in an 8-week Mindfulness-Based Stress Reduction (MBSR) course first or to a waitlist control group, which completed the MBSR training after the first group completed the course.  The MBSR intervention included eight 2.5-hour group sessions of meditation, yoga, and group discussion and one 7-hour silent session to train participants to incorporate the skills in their daily lives. All participants completed questionnaires measuring covariates and safety outcomes at baseline, post-intervention, and six months after they completed the training. Participants also answered open-ended questions about their experiences when adopting mindfulness practices taught in the course. In the qualitative portion of the study, a theory-driven thematic analysis approach was used to analyze the qualitative data with the key constructs of the Health Belief Model acting as the framework for the analysis. In the quantitative portion of the study, mean scores were calculated for each participant on the study variables at each time point. Univariate repeated measures analyses of variance (RM ANOVA) time X group interaction effects with alpha level .05 were used to compare the baseline and post-intervention scores on the outcome variables between groups.  Paired-samples t-tests were used to examine the stability of the intervention effects from both groups’ post-intervention time point to the 6-month follow-up data collection on the significant outcomes for all participants. Hospital health care workers from a university hospital system in Colorado volunteered to participate and were randomized to the immediate MBSR intervention (n=11) or waitlist control group (n=12).  The majority of participants were female and nurses. Qualitative results highlighted the benefits of mindfulness practice among health care workers, which included enhanced awareness and improvements in social relationships and interactions with patients and colleagues. Participants described the lack of healthcare-specific recommendations for incorporating mindfulness practices at work and minimal discussion of evidence supporting mindfulness training as barriers to adopting and adhering to mindfulness practices. Viewed within the context of the Health Belief Model, these qualitative findings may help practitioners design and tailor workplace mindfulness programs to fit the needs of health care workers. Quantitative results of the study indicated that mindfulness training can decrease workplace cognitive failures and increase safety compliance behaviors among hospital health care workers. The qualitative and quantitative results contribute to the novel understanding of the role mindfulness practice plays in health care worker occupational safety and health and can support future larger-scale studies testing the longer-term impacts of mindfulness on health care safety