Training Program Plan for the Sales Department of Great Western Manufacturing

This field project for the Masters of Science in Engineering Management at the University of Kansas was designed to provide a layout for a training program for the Sales Department of Great Western Manufacturing. It began with a literature review on how adults learn, the types of training programs available, and information on designing training programs. Through the literature review, it was determined that adults learn best through repetition and scenario based training. A questionnaire was distributed to the Sales staff and production managers at Great Western Manufacturing. The questionnaire was focused on the opinions of both veteran employees and new staff within the Sales department. Based on the idea that the production staff would know better where sales lacked at delivering the necessary information for production, a second questionnaire was created for production supervisors to get a sense of what the supervisors thought should be included in the sales training program. The questionnaire focused on what training employees felt was needed in a training program for the Sales department. It also asked employees what they felt would be the best method of training for the training program The Sales staff found five areas to focus training: internal systems, technical aspects of Great Western equipment, sieves and flows, customer/industry information, and competitor information. Overwhelmingly, production managers found the area in greatest need of training attention concerned documentation and order descriptions. Both groups found formal structured training with some hands on training to be the best methods of delivery. Based on the information provided by the literature review and questionnaire, a training plan was developed for the Sales department of Great Western Manufacturing. The plan includes the content of the program, mode of delivery, roles and responsibilities, and the preliminary schedule

The effect of emphasis on the position of the attributive

Thesis (M.A.)--University of Kansas, Latin and Greek, 1932

The Effectiveness of a Volume-Based Enteral Feeding Protocol to Provide Energy Intake in Hospitalized Critically Ill Adults

Background: Patients determined to be at high nutrition risk are most likely to benefit from early enteral nutrition (EN) therapy. The use of enteral feeding protocols has been associated with significant improvements in nutrition practice and overall nutrition adequacy. The effect of a combined-approach volume-based enteral feeding protocol on the percent of calories received by patients is unknown. Objective: The aim of this study was to determine if a newly implemented combined-approach volume-based enteral feeding (VBF) protocol is more effective in the delivery of EN volume and calories in intensive care unit (ICU) patients compared with the previous rate-based protocol where 88% of patients achieved 85% of their caloric requirements. Participants/setting: Eighteen critically ill adults hospitalized in either the burn or neurological ICU at a large urban hospital. Main outcome measure: The percentage of calories delivered for each patient after a minimum of 7 days of protocol compliance. Results: Ten patients (50% male, 70% Caucasian) received VBF in compliance with protocol for a median of 5.5 days (Interquartile Range; 4.8, 14.0). The percent of goal volume delivered for those who received at least 7 days of treatment (n = 4) was 104.2 ± 7.9. Conclusions: The delivery of goal EN volume using VBF exceeded the average volume provided by the previous rate-based approach in a small sample of critically ill adults. This study supports the use of feeding protocols in order to increase overall percentage of volume delivered. Additional research in a larger patient population is needed to determine the impact of this increase in volume delivery on patient outcomes

Exploring Dietary Patterns with the Rapid Eating and Activity Assessment for Patients (REAP) Tool in a Dental School Clinic

Background: Dietary pattern assessment by healthcare providers leads to a better understanding of usual intake and evaluation of nutritional status, systemic health, and disease. Interprofessional team members can use such information to provide interventions leading to improved health outcomes. Objective: The aim was to explore the dietary patterns of adults seen in a dental clinic using the Rapid Eating and Activity Assessment for Patients (REAP) tool. Methods: This was a cross-sectional study of data from 220 adult patients (aged 18-89 years) who had a diet evaluation completed in a dental school clinic. Demographic information and REAP responses were obtained from the electronic health record and reported using frequency distributions. Results: The study sample (N=220) was 50.0% male (n= 110). The median (IQR) age and BMI were 56.0 years (IQR=48.2, 66.0) and 28.0 kg/m2 (IQR= 24.3, 32.8 kg/m2), respectively; 73.5% had a BMI considered overweight or obese. Approximately one-third reported usually/sometimes eating sweets more than twice/day (n=74, 35.9%) and drinking more than 16 ounces of SSBs (n=74, 34.1%). Most reported usually/sometimes eating less than 3 servings of whole grains (n=165, 75.0%), 2-3 servings of fruit (n=155, 71.1%), or 3-4 servings of vegetables (n=121, 70.8%) daily. Seventy-two percent (n=156) indicated they were willing to make dietary changes. Conclusion: This study revealed that the dietary patterns of adults seen in a dental school clinic did not align with the Dietary Guidelines for Americans recommendations. Diet assessment is feasible in this setting and may be an important part of interprofessional education

Rehabilitative Interventions to Improve Biomechanical or Functional Outcomes for Children with Obstetric Brachial Plexus Palsy

Background: Obstetric brachial plexus palsy (OBPP) affects children worldwide, with incidence rates ranging from 0.5 to 3 per 1000 live births (Foad, Mehlman & Ying, 2008). Injury characteristics vary greatly and therefore, discrepancies exist regarding the most effective rehabilitation interventions. These children receive conservative management (through occupational and physical therapy), Botulinum toxin, surgery, or a combination of treatments (Benjamin, 2005). Objective: To present the results of a systematic review of the literature to identify rehabilitative interventions that demonstrate statistically significant functional/biomechanical outcomes in children with OBPP. Methods: A systematic search of the databases PubMed, CINAHL, and MEDLINE (2003-2013) yielded 256 results. Authors agreed on 16 articles for qualitative review based on strict inclusion/exclusion criteria pertaining to age of subjects, interventions, quality of study, and date of publication. Two authors independently critiqued (using Law, M. & McDermid, J. (2003). Appendix M and N) and subsequently synthesized each article for identification of common themes. Findings: Overall, there is intermediate to low quality evidence to support the effectiveness of rehabilitative interventions for OBPP. Statistically significant gains in strength and ROM were associated with mCIMT, electrical stimulation, DVD home program, and serial casting/splinting. Statistically significant gains in functional task performance were measured using standardized and non-standardized instruments and associated with casting, mCIMT, conventional OT/PT and kinesiotaping. However, several studies used co-interventions (including botox-A and surgery), and positive results may not be attributable to the experimental condition alone. Results suggest the following patient factors may affect outcomes: age, surgical history, level and severity of OBPP injury, presence/severity of contracture, and caregivers’ proficiency and/or program compliance. Conclusion: Results suggest that rehabilitative interventions produce significant biomechanical and functional improvements among children with OBPP whether performed alone or after surgery and/or Botox-A. To support these interventions in clinical practice, further studies with larger sample sizes and more rigorous validity standards will help determine isolated effects of the interventions, the generalizability of the interventions, and the optimal time to initiate treatment. References: Benjamin, K. (2005). Part 1. Injuries to the brachial plexus: Mechanisms of injury and identification of risk factors. Advances in Neonatal Care, 5 (4), 181-189. doi:10.1016/j.adnc.2005.03.004 Foad, S. I., Mehlman, C. T., & Ying, J. (2008). The epidemiology of neonatal brachial plexus palsy in the united states. Journal of bone and joint surgery, 90, 1258-64. doi:10.2106/JBJS.G.0085

Does prior acute exercise affect postexercise substrate oxidation in response to a high carbohydrate meal?

<p>Abstract</p> <p>Background</p> <p>Consumption of a mixed meal increases postprandial carbohydrate utilization and decreases fat oxidation. On the other hand, acute endurance exercise increases fat oxidation and decreases carbohydrate utilization during the post-exercise recovery period. It is possible that the resulting post-exercise increase in circulating nonesterified fatty acids could attenuate the ability of ingested carbohydrate to inhibit lipid oxidation. The purpose of this study was to determine whether prior exercise attenuates the usual meal-induced decline in lipid oxidation.</p> <p>Methods</p> <p>Six healthy, physically active young subjects (x age = 26.3 years, 4 males, 2 females) completed three treatments in random order after a ~10 h fast: (a) Exercise/Carbohydrate (Ex/CHO) – subjects completed a bout of exercise at 70% VO_2peak(targeted net energy cost of 400 kcals), followed by consumption of a carbohydrate-rich meal; (b) Exercise/Placebo (Ex/Placebo) – subjects completed an identical bout of exercise followed by consumption of a placebo; and (c) No Exercise/Carbohydrate (NoEx/CHO) – subjects sat quietly rather than exercising and then consumed the carbohydrate-rich meal. Blood samples were obtained before and during the postprandial period to determine plasma glucose, insulin, and non-esterified fatty acids (NEFA). Respiratory gas exchange measures were used to estimate rates of fat and carbohydrate oxidation.</p> <p>Results</p> <p>Plasma NEFA were approximately two-fold higher immediately following the two exercise conditions compared to the no-exercise condition, while meal consumption significantly increased insulin and glucose in both Ex/CHO and NoEx/CHO. NEFA concentrations fell rapidly during the 2-h postprandial period, but remained higher compared to the NoEx/CHO treatment. Carbohydrate oxidation increased rapidly and fat oxidation decreased in response to the meal, with no differences in the rates of carbohydrate and fat oxidation during recovery between the Ex/CHO and NoEx/CHO conditions.</p> <p>Conclusion</p> <p>The plasma NEFA concentration is increased during the post exercise period, which is associated with elevated fat oxidation when no meal is consumed. However, when a mixed meal is consumed immediately following exercise, the initially elevated plasma NEFA concentration decreases rapidly, and postexercise fat oxidation during this 2-h postexercise, postprandial period is no higher than that of the 2-h postprandial period without prior exercise.</p

Fellowship training:a qualitative study of scope and purpose across one department of medicine

BACKGROUND: Fellowship training follows certification in a primary specialty or subspecialty and focusses on distinct and advanced clinical and/or academic skills. This phase of medical education is growing in prevalence, but has been an &quot;invisible phase of postgraduate training&quot; lacking standards for education and accreditation, as well as funding. We aimed to explore fellowship programs and examine the reasons to host and participate in fellowship training, seeking to inform the future development of fellowship education. METHODS: During the 2013-14 academic year, we conducted interviews and focus groups to examine the current status of fellowship training from the perspectives of division heads, fellowship directors and current fellows at the Department of Medicine, University of Ottawa, Canada. Descriptive statistics were used to depict the prevailing status of fellowship training. A process of data reduction, data analysis and conclusions/verifications was performed to analyse the quantitative data. RESULTS: We interviewed 16 division heads (94%), 15 fellowship directors (63%) and 8 fellows (21%). We identified three distinct types of fellowships. Individualized fellowships focus on the career goals of the trainee and/or the recruitment goals of the division. Clinical fellowships focus on the attainment of clinical expertise over and above the competencies of residency. Research fellowships focus on research productivity. Participants identified a variety of reasons to offer fellowships: improve academic productivity; improve clinical productivity; share/develop enhanced clinical expertise; recruit future faculty members/attain an academic position; enhance the reputation of the division/department/trainee; and enhance the scholarly environment. CONCLUSIONS: Fellowships serve a variety of purposes which benefit both individual trainees as well as the academic enterprise. Fellowships can be categorized within a distinct taxonomy: individualized; clinical; and research. Each type of fellowship may serve a variety of purposes, and each may need distinct support and resources. Further research is needed to catalogue the operational requirements for hosting and undertaking fellowship training, and establish recommendations for educational and administrative policy and processes in this new phase of postgraduate education

Molecular and Antigenic Characterization of Reassortant H3N2 Viruses from Turkeys with a Unique Constellation of Pandemic H1N1 Internal Genes

Triple reassortant (TR) H3N2 influenza viruses cause varying degrees of loss in egg production in breeder turkeys. In this study we characterized TR H3N2 viruses isolated from three breeder turkey farms diagnosed with a drop in egg production. The eight gene segments of the virus isolated from the first case submission (FAV-003) were all of TR H3N2 lineage. However, viruses from the two subsequent case submissions (FAV-009 and FAV-010) were unique reassortants with PB2, PA, nucleoprotein (NP) and matrix (M) gene segments from 2009 pandemic H1N1 and the remaining gene segments from TR H3N2. Phylogenetic analysis of the HA and NA genes placed the 3 virus isolates in 2 separate clades within cluster IV of TR H3N2 viruses. Birds from the latter two affected farms had been vaccinated with a H3N4 oil emulsion vaccine prior to the outbreak. The HAl subunit of the H3N4 vaccine strain had only a predicted amino acid identity of 79% with the isolate from FAV-003 and 80% for the isolates from FAV-009 and FAV-0010. By comparison, the predicted amino acid sequence identity between a prototype TR H3N2 cluster IV virus A/Sw/ON/33853/2005 and the three turkey isolates from this study was 95% while the identity between FAV-003 and FAV-009/10 isolates was 91%. When the previously identified antigenic sites A, B, C, D and E of HA1 were examined, isolates from FAV-003 and FAV-009/10 had a total of 19 and 16 amino acid substitutions respectively when compared with the H3N4 vaccine strain. These changes corresponded with the failure of the sera collected from turkeys that received this vaccine to neutralize any of the above three isolates in vitro