Physician Executive Leadership: Assessing a Student-Led Approach to Healthcare Leadership Education in Medical School

Poster presented at: 14th Annual AMA Research Symposium in Orlando, Fl Objective: To investigate the effectiveness of Physican Leadership, an open access, student-led healthcare leadership program at Sidney Kimmel Medical College, in preparing to face five key emerging topics in medical practice: healthcare economics, health policy, care and quality and safety, law and medicine, and patient experience. The Problem: Gaps in Medical Education Healthcare in the US continues to evolve, and topics such as health policy, health finance, and patient experience are not central to the practice of medicine. However, the sheer volume of material students are required to learn in the preclinical years makes it challenging to introduce new subjects into traditional medical school curricula. As a result, these topics in healthcare leadership are often left out. Indeed, only 40-50% of medical student report appropriate training in the practice of medicine, including subjects as medical economics, healthcare systems, and managed care.https://jdc.jefferson.edu/pel/1002/thumbnail.jp

The Forensics Aspects of Event Data Recorders

The proper generation and preservation of digital data from Event Data Recorders (EDRs) can provide invaluable evidence to automobile crash reconstruction investigations. However, data collected from the EDR can be difficult to use and authenticate, complicating the presentation of such information as evidence in legal proceedings. Indeed, current techniques for removing and preserving such data do not meet the court’s standards for electronic evidence. Experimentation with an EDR unit from a 2001 GMC Sierra pickup truck highlighted particular issues with repeatability of results. Fortunately, advances in the digital forensics field and memory technology can be applied to EDR analysis in order to provide more complete and usable data. The presented issues should assist in the identification and development of a model for forensically sound collection and investigation techniques for EDRs

High Availability Instrumentation Packaging Standards for the ILC and Detectors

ILC designers are exploring new packaging standards for Accelerator Controls and Instrumentation, particularly high-speed serial interconnect systems for intelligent instruments versus the existing parallel backplanes of VME, VXI and CAMAC. The High Availability Advanced Telecom Computing Architecture (ATCA) system is a new industrial open standard designed to withstand single-point hardware or software failures. The standard crate, controller, applications module and sub-modules are being investigated. All modules and sub-modules are hot-swappable. A single crate is designed for a data throughput in communications applications of 2 Tb/s and an Availability of 0.99999, which translates into a downtime of five minutes per year. The ILC is planning to develop HA architectures for controls, beam instrumentation and detector systems

Unsupervised machine learning of integrated health and social care data from the Macmillan Improving the Cancer Journey service in Glasgow

Background: Improving the Cancer Journey (ICJ) was launched in 2014 by Glasgow City Council and Macmillan Cancer Support. As part of routine service, data is collected on ICJ users including demographic and health information, results from holistic needs assessments and quality of life scores as measured by EQ-5D health status. There is also data on the number and type of referrals made and feedback from users on the overall service. By applying artificial intelligence and interactive visualization technologies to this data, we seek to improve service provision and optimize resource allocation.Method: An unsupervised machine-learning algorithm was deployed to cluster the data. The classical k-means algorithm was extended with the k-modes technique for categorical data, and the gap heuristic automatically identified the number of clusters. The resulting clusters are used to summarize complex data sets and produce three-dimensional visualizations of the data landscape. Furthermore, the traits of new ICJ clients are predicted by approximately matching their details to the nearest existing cluster center.Results: Cross-validation showed the model’s effectiveness over a wide range of traits. For example, the model can predict marital status, employment status and housing type with an accuracy between 2.4 to 4.8 times greater than random selection. One of the most interesting preliminary findings is that area deprivation (measured through Scottish Index of Multiple Deprivation-SIMD) is a better predictor of an ICJ client’s needs than primary diagnosis (cancer type).Conclusion: A key strength of this system is its ability to rapidly ingest new data on its own and derive new predictions from those data. This means the model can guide service provision by forecasting demand based on actual or hypothesized data. The aim is to provide intelligent person-centered recommendations. The machine-learning model described here is part of a prototype software tool currently under development for use by the cancer support community.Disclosure: Funded by Macmillan Cancer Support</p

Learning from generations of sustainability concepts

Background: For decades, scientists have attempted to provide a sustainable development framework that integrates goals of environmental protection and human development. The Planetary Boundaries concept (PBc)—a framework to guide sustainable development—juxtaposes a 'safe operating space for humanity' and 'planetary boundaries', to achieve a goal that decades of research have yet to meet. We here investigate if PBc is sufficiently different to previous sustainability concepts to have the intended impact, and map how future sustainability concept developments might make a difference. Design: We build a genealogy of the research that is cited in and informs PBc. We analyze this genealogy with the support of two seminal and a new consumer-resource models, that provide simple and analytically tractable analogies to human-environment relationships. These models bring together environmental limits, minimum requirements for populations and relationships between resource-limited and waste-limited environments. Results: PBc is based on coherent knowledge about sustainability that has been in place in scientific and policy contexts since the 1980s. PBc represents the ultimate framing of limits to the use of the environment, as limits not to single resources, but to Holocene-like Earth system dynamics. Though seldom emphasized, the crux of the limits to sustainable environmental dynamics lies in waste (mis-)management, which sets where boundary values might be. Minimum requirements for populations are under-defined: it is the distribution of resources, opportunities and waste that shape what is a safe space and for whom. Discussion: We suggest that PBc is not different or innovative enough to break 'Cassandra's dilemma' and ensure scientific research effectively guides humanity towards sustainable development. For this, key issues of equality must be addressed, un-sustainability must be framed as a problem of today, rather than projected into the future, and scientific foundations of frameworks such as PBc must be broadened and diversified

Physical characteristics underpinning repetitive lunging in fencing

Given the repetitive demand to execute lunging and changes in direction within fencing, the ability to sustain these at maximal capacity is fundamental to performance. The aim of this study was threefold. Firstly to provide normative values for this variable referred to as repeat lunge ability (RLA) and secondly to identify the physical characteristics that underpin it. Thirdly, was to establish if a cause and effect relationship existed by training the associated characteristics. Assessment of lower body power, reactive strength, speed, change of direction speed (CODS) and a sport specific RLA were conducted on senior and junior elite male fencers (n = 36). Fencers were on average (± SD) 18.9 ± 3.2 years of age, 174.35 ± 10.42 cm tall, 70.67 ± 7.35 kg in mass, and 8.5 ± 4.2 years fencing experience. The RLA test had average work times of 16.03 s ± 1.40 and demonstrated "large" to "very large" associations with all tested variables, but in particular CODS (r = .70) and standing broad jump (SBJ; r = -68). Through linear regression analysis, these also provided a two-predictor model accounting for 61% of the common variance associated with RLA. A cause and effect relationship with SBJ and CODS was confirmed by the training group, where RLA performance in these fencers improved from 15.80 ± 1.07 s to 14.90 ± 0.86 s, with the magnitude of change reported as "moderate" (ES = 0.93). Concurrent improvements were also noted in both SBJ (216.86 cm ± 17.15 vs. 221.71 ± 17.59 cm) and CODS (4.44 ± 0.29 s s. 4.31 ± 0.09 s) and while differences were only significant in SBJ, magnitudes of change were classed as "small" (ES = 0.28) and "moderate" (ES = 0.61)respectively. In conclusion, to improve RLA strength and conditioning coaches should focus on improving lower-body power and reactive strength, noting that jump training and plyometrics designed to enhance horizontal propulsion may be most effective, and translate to improvement in CODS also

Report of the Committee on Resolutions- Declaration

Pamphlet concerning a declaration made by the National Educational Association at the forty-third annual convention

Production of Heparin-Binding Epidermal Growth Factor–like Growth Factor (HB-EGF) at Sites of Thermal Injury in Pediatric Patients

Fluids that accumulate at wound sites may be an important reservoir of growth factors that promote the normal wound healing response. The presence of heparin-binding growth factors was studied in burn wound fluid (BWF) from 45 pediatric patients who had sustained partial thickness burns. One of the growth factors present was similar to platelet-derived growth factor (PDGF) based on its heparin affinity, inhibition of bioactivity by a PDGF antiserum, and detection in a PDGF-AB enzyme-linked iminunosorbent assay. A second growth factor was identified as heparin-binding epidermal growth factor–like growth factor (HB-EGF) based on its heparin affinity, competition with 125I-labeled epidermal growth factor (EGF) for EGF receptor binding, and recognition in biological assays and Western blots by two HB-EGF antisera. Amino acid sequence analysis of one form of this second growth factor verified its identity as an N-terminally truncated form of HB-EGF. Immunohistochemical analysis of partial thickness burns demonstrated the presence of HB-EGF in the advancing epithelial margin, islands of regenerating epithelium within the burn wound, and in the duct and proximal tubules of eccrine sweat glands. HB-EGF in the surface epithelium of burn wounds was uniformally distributed, whereas it was restricted to the basal epithelium in nonburned skin. These data support a role for PDGF and HB-EGF in burn wound healing and suggest that the response to injury includes deposition of HB-EGF and PDGF into blister fluid and a redistribution of HB-EGF in the surface epithelium near the wound site