Implementation of a point-of-care ultrasound skills practicum for hospitalists

Introduction Point-of-care ultrasound is recognized as a safe and valuable diagnostic tool for patient evaluation. Hospitalists are prime candidates for advancing the point-of-care ultrasound field given their crucial role in inpatient medicine. Despite this, there is a notable lack of evidence-based ultrasound training for hospitalists. Most research focuses on diagnostic accuracy rather than the training required to achieve it. This study aims to improve hospitalists' point-of-care ultrasound knowledge and skills through a hands-on skills practicum. Methods Four skill practicums were conducted with pre-course, post-course, and six-month evaluations and knowledge assessments. Results The mean pre- vs. post-course knowledge assessment scores significantly improved, 41.7% vs. 75.9% (SD 16.1% and 12.7%, respectively, p < 0.0001). The mean ultrasound skills confidence ratings on a 10-point Likert scale significantly increased post-course (2.60 ± 1.66 vs. 6.33 ± 1.63, p < 0.0001), but decreased at six months (6.33 ± 1.63 vs. 4.10 ± 2.22, p < 0.0001). The greatest limitations to usage pre-course and at six months were knowledge/skills and lack of machine access. While knowledge/skills decreased from pre-course (82.0%) as compared to six-months (64.3%), lack of machine access increased from pre-course (15.8%) to six-months (28.6%) (p = 0.28). Conclusion Hospitalists agree that point-of-care ultrasound has utility in the diagnostic and therapeutic management of patients, though the lack of training is a significant limitation. Our study demonstrated that a brief skills practicum significantly improves hospitalists’ confidence and knowledge regarding ultrasound image acquisition and interpretation in the short term. Long-term confidence and usage wanes, which appears to be due to the lack of machine access

Efficiency of Nonpoint Source Pollution Instruments with Externality Among Polluters:An Experimental Study.

In nonpoint source pollution problems, the regulator does not observe each polluter’s individual emission, which prevents him from using the conventional policy instruments. Therefore new instruments have been designed to regulate this type of pollution. In an experiment, we compare the efficiency of some of these instruments: an input based tax, an ambient tax, and a group fine. We assume that the polluters themselves are affected by environmental damages. A control session without any regulation is also carried out in order to study the “status quo” situation. Our experimental data show that the input tax is almost perfectly efficient and very reliable, and the group fine is fairly efficient and reliable. Both instruments improve welfare with respect to the status quo. On the contrary, the ambient tax decreases social welfare with respect to the status quo, and its effect is very unreliable.Environmental Economics, Experimental Economics, Nonpoint source pollution, Regulation, Input Tax, Ambient Tax.

Prevention and Compensation of Muddy Flows: Some Economic Insights.

Recent surveys report the increasing number of muddy flows in many areas, and point out the fact that agricultural practices (among others) influence significantly the risk and severity of muddy flows. In this paper, we investigate the economic incentives that can be given to the farmer to adopt different practices. We propose an original economic instrument that entails an `ambient tax', voluntary revelations and a compensation fund. Because of the authorities' difficulties to be informed of each farmer's individual efforts, the tax cannot depend on the individual but on the collective level of efforts. However, each agent may lower his tax payment by revealing his individual efforts to the regulator so that high efforts may be rewarded compared to low ones. The tax revenue is used to supply a fund that is dedicated to the compensation of victims if a muddy flow occurs. hence it is possible to simultaneously increase the incentives for farmers to adopt more environmentally friendly practices and to improve the compensation of victims without mitigating their incentives to protect themselves against the risk of muddy flow.muddy flow, natural disasters, economic incentives, ambient tax, insurance, compensation fund.

Do Spouses Cooperate? And If Not: Why?

Models of household economics require an understanding of economic interactions in families. Social ties, repetition and reduced strategic uncertainty make social dilemmas in couples a very special case that needs to be empirically studied. In this paper we present results from a large economic experiment with 100 maritally living couples. Participants made decisions in a social dilemma with their partner and with a stranger. We predict behavior in this task with individual and couples' socio-demographic variables, efficiency preferences and couples' marital satisfaction. As opposed to models explaining behavior amongst strangers, the regressions on couples’ decisions highlight clear patterns concerning cooperation behavior which could inspire future household decision-making models.Noncooperative Games; Laboratory, Individual Behavior; Household Production and Intra-household Allocation

Perspectives 2007-2008. PECO : l'euro s'éloigne.

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