An Experimental Analysis of Embankment on Stone Columns

When embankment is constructed on very soft soil, special construction methods are adopted. One of the techniques is a piled embankment. Piled (stone columns) embankments provide an economic and effective solution to the problem of constructing embankments over soft soils. This method can reduce settlements, construction time and cost. Stone columns provide an effective improvement method for soft soils under light structures such as rail or road embankments. The present work investigates the behavior of the embankment models resting on soft soil reinforced with stone columns. Model tests were performed with different spacing distances between stone columns and two lengths to diameter ratios of the stone columns, in addition to different embankment heights. A total number of 21 model tests were carried out on a soil with undrianed shear strength ≈ 10 kPa. The models consist of stone columns embankment at spacing to diameter ratio equal to 2.5, 3 and 4. Three embankment heights; 200 mm, 250 mm and 300 mm were conducted. Three earth pressure cells were used to measure directly the vertical effective stress on column at the top of the middle stone column under the center line of embankment and on the edge stone column for all models while the third cell was placed at the base of embankment between two columns to measure the vertical effective stress in reinforced soft soil directly. The embankment models constructed on soft clay treated with ordinary stone columns at spacing ratio equal 2.5 revealed maximum bearing improvement ratio equals (1.21, 1.44 and 1.7) for 200 mm, 250 mm and 300 embankment heights, respectively and maximum settlement improvement ratio equals (0.78, 0.67 and 0.56) for 200 mm, 250 mm and 300 embankment heights, respectively

A simulated “Night-onCall” to assess and address the readiness-for-internship of transitioning medical students

Transitioning medical students are anxious about their readiness-for-internship, as are their residency program directors and teaching hospital leadership responsible for care quality and patient safety. A readiness-for-internship assessment program could contribute to ensuring optimal quality and safety and be a key element in implementing competency-based, time-variable medical education. In this paper, we describe the development of the Night-onCall program (NOC), a 4-h readiness-for-internship multi-instructional method simulation event. NOC was designed and implemented over the course of 3 years to provide an authentic “night on call” experience for near graduating students and build measurements of students’ readiness for this transition framed by the Association of American Medical College’s Core Entrustable Professional Activities for Entering Residency. The NOC is a product of a program of research focused on questions related to enabling individualized pathways through medical training. The lessons learned and modifications made to create a feasible, acceptable, flexible, and educationally rich NOC are shared to inform the discussion about transition to residency curriculum and best practices regarding educational handoffs from undergraduate to graduate education

Are Good Intentions Good Enough?: Informed Consent Without Trained Interpreters

OBJECTIVE: To examine the informed consent process when trained language interpreters are unavailable. BACKGROUND: Ensuring sufficient patient understanding for informed consent is especially challenging for patients with Limited English Proficiency (LEP). While US law requires provision of competent translation for LEP patients, such services are commonly unavailable. DESIGN AND PARTICIPANTS: Qualitative data was collected in 8 prenatal genetics clinics in Texas, including interviews and observations with 16 clinicians, and 30 Latina patients. Using content analysis techniques, we examined whether the basic criteria for informed consent (voluntariness, discussion of alternatives, adequate information, and competence) were evident for each of these patients, contrasting LEP patients with patients not needing an interpreter. We present case examples of difficulties related to each of these criteria, and compare informed consent scores for consultations requiring interpretation and those which did not. RESULTS: We describe multiple communication problems related to the use of untrained interpreters, or reliance on clinicians’ own limited Spanish. These LEP patients appear to be consistently disadvantaged in each of the criteria we examined, and informed consent scores were notably lower for consultations which occurred across a language barrier. CONCLUSIONS: In the absence of adequate Spanish interpretation, it was uncertain whether these LEP patients were provided the quality and content of information needed to assure that they are genuinely informed. We offer some low-cost practice suggestions that might mitigate these problems, and improve the quality of language interpretation, which is essential to assuring informed choice in health care for LEP patients

Physicians' attitudes about obesity and their associations with competency and specialty: A cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Physicians frequently report negative attitudes about obesity which is thought to affect patient care. However, little is known about how attitudes toward treating obese patients are formed. We conducted a cross-sectional survey of physicians in order to better characterize their attitudes and explore the relationships among attitudes, perceived competency in obesity care, including report of weight loss in patients, and other key physician, training, and practice characteristics.</p> <p>Methods</p> <p>We surveyed all 399 physicians from internal medicine, pediatrics, and psychiatry specialties at one institution regarding obesity care attitudes, competency, including physician report of percent of their patients who lose weight. We performed a factor analysis on the attitude items and used hierarchical regression analysis to explore the degree to which competency, reported weight loss, physician, training and practice characteristics explained the variance in each attitude factor.</p> <p>Results</p> <p>The overall response rate was 63%. More than 40% of physicians had a negative reaction towards obese patients, 56% felt qualified to treat obesity, and 46% felt successful in this realm. The factor analysis revealed 4 factors–<it>Physician Discomfort/Bias, Physician Success/Self Efficacy, Positive Outcome Expectancy</it>, and <it>Negative Outcome Expectancy</it>. Competency and reported percent of patients who lose weight were most strongly associated with the <it>Physician Success/Self Efficacy </it>attitude factor. Greater skill in patient assessment was associated with less <it>Physician Discomfort/Bias</it>. Training characteristics were associated with outcome expectancies with newer physicians reporting more positive treatment expectancies. Pediatric faculty was more positive and psychiatry faculty less negative in their treatment expectancies than internal medicine faculty.</p> <p>Conclusion</p> <p>Physician attitudes towards obesity are associated with competency, specialty, and years since postgraduate training. Further study is necessary to determine the direction of influence and to explore the impact of these attitudes on patient care.</p

Harmonic content in the variable-frequency ac power line of TFTR

Studies were made of the harmonic content of the current and voltage at the generator bus of the Tokamak Fusion Test Reactor. Out of numerous load scenarios, one case was considered in detail. The harmonics were found acceptable for the generator; however, control problems and substantial telecommunications interference may result, requiring appropriate control measures and shielded telecommunication lines