The Evolving Educational Challenge: Balancing Patient Numbers, Conference Attendance, Sleep, and Resident Wellness

The Accreditation Council on Graduate Medical Education (ACMGE) 2011 guidelines for resident physicians specifically limited interns to 16-hour shifts and forced a paradigm switch from traditional overnight call.1 In “Shift Schedules and Intern Work Hours, Patient Numbers, Conference Attendance, and Sleep at a Single Pediatric Residency Program,”2 we prospectively compared intern work hours, patient numbers, conference attendance, sleep duration, pattern, and quality in 2003 and 2011 ACGME duty hour compliant call schedules at a single pediatric residency program. We concluded that a shift schedule reduced intern work hours and improved sleep duration and pattern. Although intern didactic conference attendance declined significantly during high census months, opportunities for experiential learning in a shift schedule remained robust with unchanged or increased intern patient numbers. Since the publication of our study, the ACGME has removed the 16-hour intern work hour limit, but still requires a maximum 80-hour work week and limits consecutive time on-task to 24 hours, plus 4 hours to transition care.1 Educators aim to provide the best clinical education for residents, while meeting requirements. In this progress report, we consider our study's findings in light of what has been published since October 2016 and discuss innovative scheduling, didactic and experiential resident education, resident sleep, and wellness and areas for future work

The impact of aluminosilicate-based additives upon the sintering and melting behaviour of biomass ash

The composition of ash arising from biomass combustion can cause significant slagging and fouling issues in pulverised-fuel boilers, particularly if high concentrations of alkalis are present. Al–Si additives have shown promise in improving the ash deposition characteristics of troublesome biomass, converting volatile potassium to potassium aluminosilicates. This article presents results of lab-scale testing for two high-potassium biomass ashes, olive-cake (OCA) and white-wood (WWA), combined with two promising additives, coal pulverised fuel ash (PFA) and kaolin powder, at 5% mass fraction. Ash fusion testing results show that the use of these additives consistently increases flow temperatures. For WWA, kaolin was observed to reduce deformation temperatures and increase flow temperatures to far above combustion temperatures. Sinter strength testing showed that additive use significantly improves the deposition properties of OCA, preventing the precipitation of KCl and formation of deposits that are highly undesirable for removal via sootblower. Sintering was eliminated at all temperatures measured with the use of kaolin. Both additives had negative effects upon the sintering of WWA, indicating that Al–Si additive use should be restricted to high K, high Cl biomass. High temperature viscometry of OCA, combined with thermodynamic modelling, showed that viscosities at combustion temperatures were far below ideal values due high Mg concentration and silicate formation. Kaolin at 5% mass fraction was predicted to significantly improve this behaviour, with aluminosilicate formation producing favourable viscosities. Results indicate that kaolin addition to high K, high Cl biomass such as OCA shows promise in making the ash compositions viable for pulverised-fuel combustion

Neural Computation via Neural Geometry: A Place Code for Inter-whisker Timing in the Barrel Cortex?

The place theory proposed by Jeffress (1948) is still the dominant model of how the brain represents the movement of sensory stimuli between sensory receptors. According to the place theory, delays in signalling between neurons, dependent on the distances between them, compensate for time differences in the stimulation of sensory receptors. Hence the location of neurons, activated by the coincident arrival of multiple signals, reports the stimulus movement velocity. Despite its generality, most evidence for the place theory has been provided by studies of the auditory system of auditory specialists like the barn owl, but in the study of mammalian auditory systems the evidence is inconclusive. We ask to what extent the somatosensory systems of tactile specialists like rats and mice use distance dependent delays between neurons to compute the motion of tactile stimuli between the facial whiskers (or ‘vibrissae’). We present a model in which synaptic inputs evoked by whisker deflections arrive at neurons in layer 2/3 (L2/3) somatosensory ‘barrel’ cortex at different times. The timing of synaptic inputs to each neuron depends on its location relative to sources of input in layer 4 (L4) that represent stimulation of each whisker. Constrained by the geometry and timing of projections from L4 to L2/3, the model can account for a range of experimentally measured responses to two-whisker stimuli. Consistent with that data, responses of model neurons located between the barrels to paired stimulation of two whiskers are greater than the sum of the responses to either whisker input alone. The model predicts that for neurons located closer to either barrel these supralinear responses are tuned for longer inter-whisker stimulation intervals, yielding a topographic map for the inter-whisker deflection interval across the surface of L2/3. This map constitutes a neural place code for the relative timing of sensory stimuli

‘Demand pull’ government policies to support Product-Service System activity: the case of Energy Service Companies (ESCos) in the UK

Product-Service Systems (PSSs) constitute a family of service-based business models designed to satisfy our societal needs in an economically and environmentally sustainable manner. To date however PSS application has remained niche due to a variety of critical barriers. This paper explores how ‘demand pull’ national government policies could support PSS activity by addressing these barriers and cultivating market demand. Lessons are drawn from a case study of how regulatory, economic incentive, informative and procurement policies have supported Energy Service Company (ESCo) activity in the UK; a sub-set of the PSS family focused on energy service provision. Subsequently five policy recommendations are presented to support PSS activity: (1) balancing economic incentives and regulatory disincentives; (2) promoting indirect policy support; (3) redesigning existing market structures; (4) promoting locally-led PSS activity; and (5) creating stable policy frameworks. The paper warns however that national government policy cannot easily address all PSS barriers, such as customer preferences, international developments, technological progress and inherent business model weaknesses, pointing to the need for other complementary solutions. Furthermore, other governance actors beside national government could also implement PSS supporting policies

Ash agglomeration and deposition during combustion of poultry litter in a bubbling fluidized-bed combustor

peer-reviewedn this study, we have characterized the ash resulting from fluidized bed combustion of poultry litter as being dominated by a coarse fraction of crystalline ash composed of alkali-Ca-phosphates and a fine fraction of particulate K2SO4 and KCl. Bed agglomeration was found to be coating-induced with two distinct layers present. The inner layer (0.05–0.09 mm thick) was formed due to the reaction of gaseous potassium with the sand (SiO2) surface forming K-silicates with low melting points. Further chemical reaction on the surface of the bed material strengthened the coating forming a molten glassy phase. The outer layer was composed of loosely bound, fine particulate ash originating from the char. Thermodynamic equilibrium calculations showed slag formation in the combustion zone is highly temperature-dependent, with slag formation predicted to increase from 1.8 kg at 600 °C to 7.35 kg at 1000 °C per hour of operation (5.21 kg of ash). Of this slag phase, SiO2 and K2O were the dominant phases, accounting for almost 95%, highlighting the role of K-silicates in initiating bed agglomeration. The remaining 5% was predicted to consist mainly of Al2O3, K2SO4, and Na2O. Deposition downstream in the low-temperature regions was found to occur mostly through the vaporization–condensation mechanism, with equilibrium decreasing significantly with decreasing temperatures. The dominant alkali chloride-containing gas predicted to form in the combustion zone was KCl, which corresponds with the high KCl content in the fine baghouse ash

Murine Cytomegalovirus Infection of Neural Stem Cells Alters Neurogenesis in the Developing Brain

Congenital cytomegalovirus (CMV) brain infection causes serious neuro-developmental sequelae including: mental retardation, cerebral palsy, and sensorineural hearing loss. But, the mechanisms of injury and pathogenesis to the fetal brain are not completely understood. The present study addresses potential pathogenic mechanisms by which this virus injures the CNS using a neonatal mouse model that mirrors congenital brain infection. This investigation focused on, analysis of cell types infected with mouse cytomegalovirus (MCMV) and the pattern of injury to the developing brain.We used our MCMV infection model and a multi-color flow cytometry approach to quantify the effect of viral infection on the developing brain, identifying specific target cells and the consequent effect on neurogenesis. In this study, we show that neural stem cells (NSCs) and neuronal precursor cells are the principal target cells for MCMV in the developing brain. In addition, viral infection was demonstrated to cause a loss of NSCs expressing CD133 and nestin. We also showed that infection of neonates leads to subsequent abnormal brain development as indicated by loss of CD24(hi) cells that incorporated BrdU. This neonatal brain infection was also associated with altered expression of Oct4, a multipotency marker; as well as down regulation of the neurotrophins BDNF and NT3, which are essential to regulate the birth and differentiation of neurons during normal brain development. Finally, we report decreased expression of doublecortin, a marker to identify young neurons, following viral brain infection.MCMV brain infection of newborn mice causes significant loss of NSCs, decreased proliferation of neuronal precursor cells, and marked loss of young neurons

Methodologies for city-scale assessment of renewable energy generation potential to inform strategic energy infrastructure investment

In support of national and international policies to address climate change, local government actors across Europe and Asia are committed to reducing greenhouse gas emissions. Many recognise the contribution that decentralised renewable electricity production can bring towards reducing emissions whilst also generating revenue. However, these actors are often subject to significant financial pressures, meaning a reliable and compelling business case is needed to justify upfront investment. This article develops a method for rapid comparison of initial project viability for multiple city sites and installation options using data from wind and solar resource prediction techniques. In doing so, detailed resource assessments grounded in academic research are made accessible and useful for city practitioners. Long term average wind speeds are predicted using a logarithmic vertical wind profile. This employs detailed three-dimensional building data to estimate aerodynamic parameters for the complex urban surface. Solar resource is modelled using a Geographical Information System-based methodology. This establishes the location and geometry of roof structures to estimate insolation, whilst accounting for shading effects from other buildings and terrain features. Project viability for potential installations is assessed in terms of the net present value over the lifespan of the technology and associated Feed-in Tariff incentive. Discounted return on investment is also calculated for all sites. The methodology is demonstrated for a case study of 6,794 sites owned by Leeds City Council, UK. Results suggest significant potential for small-scale wind and solar power generation across council assets. A number of sites present a persuasive business case for investment, and in all cases, using the generated electricity on site improves financial viability. This indicates that initial installations should be sited at assets with high electricity demands. Overall, the work establishes a 2 methodology that enables large city-level asset holders to make strategic investment decisions across their entire portfolio, which are based on financial assessment of wind and solar generation potential accurate to the individual asset scale. Such tools could facilitate strategic planning within cities and help to ensure that investment in renewable energy is focused at the most viable sites. In addition, the methodology can assist with asset management at the city scale by identifying sites with a higher market value as a result of their potential for renewable energy generation than otherwise might be estimated

Large-Eddy Simulations of Magnetohydrodynamic Turbulence in Heliophysics and Astrophysics

We live in an age in which high-performance computing is transforming the way we do science. Previously intractable problems are now becoming accessible by means of increasingly realistic numerical simulations. One of the most enduring and most challenging of these problems is turbulence. Yet, despite these advances, the extreme parameter regimes encountered in space physics and astrophysics (as in atmospheric and oceanic physics) still preclude direct numerical simulation. Numerical models must take a Large Eddy Simulation (LES) approach, explicitly computing only a fraction of the active dynamical scales. The success of such an approach hinges on how well the model can represent the subgrid-scales (SGS) that are not explicitly resolved. In addition to the parameter regime, heliophysical and astrophysical applications must also face an equally daunting challenge: magnetism. The presence of magnetic fields in a turbulent, electrically conducting fluid flow can dramatically alter the coupling between large and small scales, with potentially profound implications for LES/SGS modeling. In this review article, we summarize the state of the art in LES modeling of turbulent magnetohydrodynamic (MHD) ows. After discussing the nature of MHD turbulence and the small-scale processes that give rise to energy dissipation, plasma heating, and magnetic reconnection, we consider how these processes may best be captured within an LES/SGS framework. We then consider several special applications in heliophysics and astrophysics, assessing triumphs, challenges,and future directions