Enhancing the Collection and Analysis of General Aviation Insurance Data in Australasia Through the Use of HFACS

This paper provides an overview of a 5-stage program of work conducted over a three-year period that aims to develop a General Aviation (GA) safety database in Australia using data collected by aviation insurers. The need to standardize and enhance insurance data was recognized to support meaningful safety-based countermeasure development. Incorporating the Human Factors Analysis and Classification Scheme into the insurance assessment process is a major feature of the data enhancement process. Data collection by GA insurance assessors in Australia, using standardized and enhanced data collection methods, will begin in late 2007. Establishment of this database will allow for meaningful safety-based analyses of GA insurance incident data in the future

Program Director Opinion on the Ideal Length of Residency Training in Emergency Medicine

ObjectiveThis study sought to define expert opinion on the ideal length of training (LoT) for Accreditation Council of Graduate Medical Education (ACGME)‐accredited emergency medicine (EM) residency programs.MethodsA cross‐sectional Web‐based survey was sent to program directors (PDs) at all ACGME‐accredited EM residency programs during a study period of August to October 2014. The primary outcome of ideal LoT was determined in two ways: 1) subjects provided the ideal total LoT in months and 2) then separately selected the type and number of rotations for an ideal EM residency curriculum by month, the sum of which provided an alternative measurement of their ideal LoT. We did not include vacation time. Descriptive statistics and an analysis of variance are reported.ResultsResponse rate was 68.0% (108/159) with 72% of respondents (78/108) directing programs in the PGY 1–3 (36‐month) format and 28% directing PGY 1–4 (48‐month) programs. More than half of subjects (51.9%) have direct personal experience with both formats. When asked about ideal total LoT, PDs averaged 41.5 months (n = 107; SD = 5.5 months, range = 36–60 months). When asked to provide durations of individual clinical experiences for their ideal EM program, the sum total (n = 104) averaged 45.0 months. Results from a factorial analysis of variance revealed statistically significant effects of PDs’ past training experiences: participants who trained in a 36‐month program had statistically significantly lower LoT (mean = 39.2 months) than participants who trained in a 48‐month program (mean = 44.5 months). There was also a statistically significant effect of current program format on ideal LoT: participants who directed a 36‐month program had statistically significantly lower LoT (mean = 39.8 months) than participants who directed a 48‐month program (mean = 45.8 months).ConclusionsPD opinion on ideal LoT averages between 36 and 48 months, but is longer when the sum of desired clinical rotations is considered. While half of the respondents reported direct experience with both PGY 1–3 and PGY 1–4 training programs, opinions on ideal LoT through both methods corresponded strongly with the length of the program the PDs trained in and the format of the program they currently direct. PD opinions may be too biased by their own experiences to provide objective input on the ideal LoT for EM residency programs.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/133574/1/acem12968-sup-0001-DataSupplementS1.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/133574/2/acem12968.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/133574/3/acem12968_am.pd

Risk factors for COPD exacerbations in inhaled medication users: the COPDGene study biannual longitudinal follow-up prospective cohort.

BackgroundDespite inhaled medications that decrease exacerbation risk, some COPD patients experience frequent exacerbations. We determined prospective risk factors for exacerbations among subjects in the COPDGene Study taking inhaled medications.Methods2113 COPD subjects were categorized into four medication use patterns: triple therapy with tiotropium (TIO) plus long-acting beta-agonist/inhaled-corticosteroid (ICS ± LABA), tiotropium alone, ICS ± LABA, and short-acting bronchodilators. Self-reported exacerbations were recorded in telephone and web-based longitudinal follow-up surveys. Associations with exacerbations were determined within each medication group using four separate logistic regression models. A head-to-head analysis compared exacerbation risk among subjects using tiotropium vs. ICS ± LABA.ResultsIn separate logistic regression models, the presence of gastroesophageal reflux, female gender, and higher scores on the St. George's Respiratory Questionnaire were significant predictors of exacerbator status within multiple medication groups (reflux: OR 1.62-2.75; female gender: OR 1.53 - OR 1.90; SGRQ: OR 1.02-1.03). Subjects taking either ICS ± LABA or tiotropium had similar baseline characteristics, allowing comparison between these two groups. In the head-to-head comparison, tiotropium users showed a trend towards lower rates of exacerbations (OR = 0.69 [95 % CI 0.45, 1.06], p = 0.09) compared with ICS ± LABA users, especially in subjects without comorbid asthma (OR = 0.56 [95% CI 0.31, 1.00], p = 0.05).ConclusionsEach common COPD medication usage group showed unique risk factor patterns associated with increased risk of exacerbations, which may help clinicians identify subjects at risk. Compared to similar subjects using ICS ± LABA, those taking tiotropium showed a trend towards reduced exacerbation risk, especially in subjects without asthma.Trial registrationClinicalTrials.gov NCT00608764, first received 1/28/2008

Using Hubble Space Telescope Imaging of Nuclear Dust Morphology to Rule Out Bars Fueling Seyfert Nuclei

If AGN are powered by the accretion of matter onto massive black holes, how does the gas in the host galaxy lose the required angular momentum to approach the black hole? Gas easily transfers angular momentum to stars in strong bars, making them likely candidates. Although ground-based searches for bars in active galaxies using both optical and near infrared surface brightness have not found any excess of bars relative to quiescent galaxies, the searches have not been able to rule out small-scale nuclear bars. To look for these nuclear bars we use HST WFPC2-NICMOS color maps to search for the straight dust lane signature of strong bars. Of the twelve Seyfert galaxies in our sample, only three have dust lanes consistent with a strong nuclear bar. Therefore, strong nuclear bars cannot be the primary fueling mechanism for Seyfert nuclei. We do find that a majority of the galaxies show an spiral morphology in their dust lanes. These spiral arms may be a possible fueling mechanism.Comment: To be published in the Astronomical Journal, June 1999. 25 pages and 14 figures. Full resolution figures are available at ftp://www.ciw.edu/pub/mregan/fullfigs.tar.g

The PdBI Arcsecond Whirlpool Survey (PAWS). I. A Cloud-Scale/Multi-Wavelength View of the Interstellar Medium in a Grand-Design Spiral Galaxy

The PdBI (Plateau de Bure Interferometer) Arcsecond Whirlpool Survey (PAWS) has mapped the molecular gas in the central ~9kpc of M51 in its 12CO(1-0) line emission at cloud-scale resolution of ~40pc using both IRAM telescopes. We utilize this dataset to quantitatively characterize the relation of molecular gas (or CO emission) to other tracers of the interstellar medium (ISM), star formation and stellar populations of varying ages. Using 2-dimensional maps, a polar cross-correlation technique and pixel-by-pixel diagrams, we find: (a) that (as expected) the distribution of the molecular gas can be linked to different components of the gravitational potential, (b) evidence for a physical link between CO line emission and radio continuum that seems not to be caused by massive stars, but rather depend on the gas density, (c) a close spatial relation between the PAH and molecular gas emission, but no predictive power of PAH emission for the molecular gas mass,(d) that the I-H color map is an excellent predictor of the distribution (and to a lesser degree the brightness) of CO emission, and (e) that the impact of massive (UV-intense) young star-forming regions on the bulk of the molecular gas in central ~9kpc can not be significant due to a complex spatial relation between molecular gas and star-forming regions that ranges from co-spatial to spatially offset to absent. The last point, in particular, highlights the importance of galactic environment -- and thus the underlying gravitational potential -- for the distribution of molecular gas and star formation.Comment: 52 pages, 14 figures, 2 tables, (several minor typos corrected) accepted by ApJ, high resolution version available, see http://www.mpia.de/PAWS/pub/paws_schinnerer.pdf ; for more information on PAWS, further papers and the data, see http://www.mpia.de/PAW

Disaster Exposure and Mental Health Among Puerto Rican Youths After Hurricane Maria

Importance: Quantifying the magnitude of disaster exposure and trauma-related symptoms among youths is critical for deployment of psychological services in underresourced settings. Hurricane Maria made landfall in Puerto Rico on September 20, 2017, resulting in massive destruction and unprecedented mortality. Objective: To determine the magnitude of disaster exposure and mental health outcomes among Puerto Rican youths after Hurricane Maria. Design, Setting, and Participants: Survey study in which a school-based survey was administered to each public school student at all schools in Puerto Rico between February 1 and June 29, 2018 (5-9 months after Hurricane Maria). Of the 226 808 students eligible to participate, 96 108 students completed the survey. Main Outcomes and Measures: Participants were assessed for exposure to hurricane-related stressors, posttraumatic stress disorder (PTSD), and depressive symptoms, using standardized self-report measures administered in Spanish. Descriptive statistics were compiled for all outcome variables, as was the frequency of individuals reporting clinically elevated symptoms of PTSD or depression. Differences in these statistics across sexes were also examined via t tests. Correlations between demographic, geographic, and main outcome variables were also calculated, and regressions were conducted to examine their association with symptoms of PTSD. Results: A total of 96 108 students participated in the study (42.4% response rate; 50.3% female), representative of grades 3 to 12 across all 7 educational regions of Puerto Rico. As a result of the hurricane, 83.9% of youths saw houses damaged, 57.8% had a friend or family member leave the island, 45.7% reported damage to their own homes, 32.3% experienced shortages of food or water, 29.9% perceived their lives to be at risk, and 16.7% still had no electricity 5 to 9 months after the hurricane. Overall, 7.2% of youths (n = 6900) reported clinically significant symptoms of PTSD; comparison of the frequency of reporting clinically elevated symptoms of PTSD across sex yielded a significant difference (t = 12.77; 95% CI of the difference, 0.018-0.025; P \u3c .001), with girls (8.2%) exceeding the clinical cutoff score more often than boys (6.1%). Finally, similar analysis of differences in depression between sexes was also significant (t = 17.56; 95% CI of the difference, 0.31-0.39; P \u3c .001), with girls displaying higher mean (SD) scores (2.72 [3.14]) than boys (2.37 [2.93]). Demographic and risk variables accounted for approximately 20% of variance in symptoms of PTSD (r2 = 0.195; 95% CI, 0.190-0.200). Conclusions and Relevance: Survey results indicate that Hurricane Maria exposed Puerto Rican youths to high levels of disaster-related stressors, and youths reported high levels of PTSD and depressive symptoms. Results are currently being used by the Puerto Rico Department of Education to inform targeted and sustainable evidence-based practices aimed at improving mental health outcomes for Puerto Rico\u27s youths

Scholarly Tracks in Emergency Medicine

Over the past decade, some residency programs in emergency medicine (EM) have implemented scholarly tracks into their curricula. The goal of the scholarly track is to identify a niche in which each trainee focuses his or her scholarly work during residency. The object of this paper is to discuss the current use, structure, and success of resident scholarly tracks. A working group of residency program leaders who had implemented scholarly tracks into their residency programs collated their approaches, implementation, and early outcomes through a survey disseminated through the Council of Emergency Medicine Residency Directors (CORD) list-serve. At the 2009 CORD Academic Assembly, a session was held and attended by approximately 80 CORD members where the results were disseminated and discussed. The group examined the literature, discussed the successes and challenges faced during implementation and maintenance of the tracks, and developed a list of recommendations for successful incorporation of the scholarly track structure into a residency program. Our information comes from the experience at eight training programs (five 3-year and three 4-year programs), ranging from 8 to 14 residents per year. Two programs have been working with academic tracks for 8 years. Recommendations included creating clear goals and objectives for each track, matching track topics with faculty expertise, protecting time for both faculty and residents, and providing adequate mentorship for the residents. In summary, scholarly tracks encourage the trainee to develop an academic or clinical niche within EM during residency training. The benefits include increased overall resident satisfaction, increased success at obtaining faculty and fellowship positions after residency, and increased production of scholarly work. We believe that this model will also encourage increased numbers of trainees to choose careers in academic medicine.ACADEMIC EMERGENCY MEDICINE 2010; 17:S87–S94 © 2010 by the Society for Academic Emergency MedicinePeer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/79229/1/j.1553-2712.2010.00890.x.pd

Feasibility and effectiveness of a telehealth service delivery model for treating childhood posttraumatic stress: A community-based, open pilot trial of trauma-focused cognitive-behavioral therapy

© 2020 American Psychological Association. Telepsychotherapy (also referred to as telehealth or telemental health), the use of videoconferencing to deliver psychotherapy services, offers an innovative way to address significant gaps in access to care and is being used to deliver a variety of treatments for youth. Although recent research has supported the effectiveness of telehealth delivery of a variety of interventions for children, the literature has focused very little on childhood posttraumatic stress disorder. This pilot study examined the feasibility and potential effectiveness of trauma-focused cognitive- behavioral therapy (TF-CBT) delivered via telepsychotherapy in community-based locations of either schools or patient homes. Telepsychotherapy treatment was delivered to 70 traumaexposed youth in 7 underserved communities. Of these, 88.6% completed a full course of TF-CBT and 96.8% of these treatment completers no longer met diagnostic criteria for a trauma-related disorder at posttreatment. Results demonstrated clinically meaningful symptom change posttreatment, with large effect sizes evident for both youthand caregiver-reported reduction in posttraumatic stress disorder symptoms. The results observed in this pilot evaluation are promising and provide preliminary evidence of the feasibility and effectiveness of this novel treatment format. The COVID-19 global pandemic has resulted in an unprecedented need to rethink how mental health services are delivered, which is particularly applicable to high base rate conditions related to posttraumatic stress. Given the existing network of nationally certified TF-CBT therapists, and many international TF-CBT therapists, these findings suggest the potential for providing effective and accessible telepsychotherapy intervention during this public health crisis (as well as those that will occur in the future)