Alignment between graduate medical education (GME) and health system priorities is foundational to meaningful engagement of residents and fellows in systems improvement work within the clinical ...learning environment. The Residents and Fellows Leading Interprofessional Continuous Improvement Teams program at the University of California San Francisco was designed over a decade ago to address barriers to trainee participation in health system-based improvement work. The program provides structure and support for health system-aligned trainee-led improvement projects in the clinic learning environment. Project champions (residents/fellows) from GME programs attend workshops where they learn improvement methodologies and develop proposals for health system-based improvement projects for their training programs. Proposals are supported by local faculty mentors and are reviewed and approved by GME and health systems' leaders. During the academic year, teams share their progress using visual management boards and interactive leader rounds. The health system provides a modest financial incentive for successful projects. Since the program's inception, thousands of trainees from 58 residency and fellowship programs have participated either as champions or participants in the program at least once, and in total over 300 projects have been implemented. Approximately three-quarters of the specific improvement goals were met, all projects meaningfully engaged residents and fellows, and many projects continued after the learners graduated. This active partnership between GME and a health system created a symbiotic relationship; trainees received education and support to complete improvement projects, while the health system reaped additional benefits from the alignment and impact of the projects. This partnership continues to grow with steady increases in participating programs, spread to partner health systems, and scholarship for trainees and faculty.
To determine whether microbial contamination of preservation solution (PS) in kidney transplantation is associated with donor-derived infections (DDIs).
We retrospectively analysed data from 1077 ...deceased kidney transplant recipients of 560 donors. In all, 1002 PS samples were collected for microbiological assessment to establish the incidence and distribution of contamination. Comparisons between patients with contaminated PS and those with sterile PS were performed to assess the impact of microbial contaminations in perfusate on probable donor-derived infections (p-DDIs), and potential risk factors for p-DDIs were examined.
The contamination rate of PS was 77.8% (402/517). Bacterial species accounted for 85.6% (887/1036) of the total 1036 isolated microorganisms and 26.5% (275/1002) of the recipients' PS were contaminated by ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacter spp.). Enterococcus predominated the microbiological pattern. The incidence of infection was significantly higher in patients with microbial contamination than in patients with sterile PS (13.8% (107/776) versus 7.1% (16/226), p 0.006). The prevalence of p-DDIs was significantly higher in patients with ESKAPE contamination than in patients with other bacterial contamination in PS (7.2% (18/251) versus 1.0% (4/405), p 0.000). Univariate analysis indicated that ESKAPE contamination increased the risk of p-DDIs (p 0.001, OR 3.610, 95% CI 1.678–7.764). Multivariate analysis determined ESKAPE contamination as the only independent risk factor associated with p-DDIs (OR 3.418, 95% CI 1.580–7.393).
The high rate of microbial contaminations in PS is unusual and probably due to poor surgical procedures. Patients whose PS are contaminated by ESKAPE pathogens could have a significantly increased risk of p-DDIs at early post-transplantation.
To investigate the clinical efficacy of acellular dermis matrix combined with cervical strap muscle (ADM-CSM) as a composite tissue flap for repairing the laryngeal defect after partial laryngectomy.
...The medical records of 33 patients with laryngeal cancer who were diagnosed and treated at the First Affiliated Hospital of Sun Yat-sen University from January 2014 to December 2016 were retrospectively reviewed. The patients consisted of 32 males and 1 female with age range from 39 to 76 years. Laryngeal defects were repaired with ADM-CSM in 14 patients (2 for supraglottic laryngeal cancer, 12 for glottic laryngeal cancer) and with CSM fascial flaps in 19 patients (3 for supraglottic laryngeal cancer, 16 for glottic laryngeal cancer). Kaplan-Meier method was used to calculate the 3-year overall survival and local control rate. The functions of voice and swallowing after operation were evaluated by voice handicap index-30 (VHI-30) and MD Anderson dysphagia inventory. Univariate logistic regression analysis,
-test
The linear and rotary axes of a five-axis machine tool are driven simultaneously to generate a specified tool position and orientation in workpiece coordinates. It is crucial that these ...servo-controlled axes are of balanced dynamics to achieve high tracking accuracy. In this paper, ballbar circular tests for all possible combinations of linear and rotary axes of a five-axis machine tool are investigated and total ballbar dynamic tests are proposed. Through the relational arrangement of the test sequence, the total ballbar dynamic tests can be employed to identify dynamic differences between linear and rotary axes. More importantly, the velocity gains of the position control loops of all servo-controlled linear and rotary axes can be tuned synchronously to eliminate gain mismatch errors. Experimental results have proved the effectiveness of the new methods.
ABSTRACT
We investigate the waiting time statistics of solar flares both in a flare-productive active region (AR 12673) of the solar cycle 24 and in a three-dimensional magnetohydrodynamic (MHD) ...simulated AR. The statistical models of a discrete random process and a continuous memory-dependent process are applied to interpret the waiting time distributions (WTDs) of solar flares. Our results indicate that the occurrence of a solar flare in an individual AR maintains a certain amount of memory, and probably arises from MHD turbulence rather than from intermittent avalanches in a self-organized criticality system. It differs from the occurrence of ‘super flares’ when treating the star/Sun as a single non-linear system.
Bimetallic can be more efficient than the corresponding monometallic catalysts in photocatalytic hydrogen production. The optimal bimetallic ratio is crucial to performance, and there is still little ...relative research on this problem. Noble metal as a bimetallic co-catalyst can improve the performance of photocatalytic hydrogen production of graphitic carbon nitride. Here, we successfully synthesized a series of carbon nitride (CN) loaded with gold and platinum by adjusting the Pt/Au ratio (total 0.5%). The results show that the optimal doping ratio of Pt-Au is 1 : 1, which displays an excellent H
2
production rate of 570.8 μmol/g. This is 32 times higher than CN. And higher than the H
2
production rate of 0.5% Pt/CN and 0.5% Au/CN, which is 409.2 and 359 μmol/g. Surface plasmon resonance (SPR) of the Au and Schottky barrier between Pt and CN may be the reason for enhanced Au–Pt/CN photocatalytic performances.
Objective
Secondary peristalsis is important for clearance of retained food bolus and refluxate from the oesophagus. We aimed to investigate whether patients with globus sensation have altered ...physiological characteristics of secondary peristalsis.
Design
Prospective case‐controlled study
Setting
Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.
Participants
Seventeen globus patients and 18 healthy controls.
Main outcome measures
After a baseline recording of primary peristalsis, secondary peristalsis was stimulated with slow and rapid mid‐oesophageal injections of air. Distension thresholds and peristaltic activities of secondary peristalsis were analysed and compared between the patients and healthy controls.
Results
The threshold volume for generating secondary peristalsis during slow air distension did not differ between the patient and control groups (P = .55). The threshold volume for generating secondary peristalsis during rapid air distension was significantly greater in patients with globus than healthy controls (7.0 ± 0.9 vs 5.0 ± 0.3 mL, P = .04). Secondary peristalsis was triggered less frequently in globus patients as compared with healthy control after rapid air distension (40% 30%‐65% vs 60% 60%‐83%, P = .001). There was no difference in any of peristaltic parameters for primary and secondary peristalsis between the groups.
Conclusions
Our work identifies functional defects of oesophageal secondary peristalsis in patients with globus sensation and such defects are characterised with defective triggering of secondary peristalsis during rapid air distension. Whether current findings have therapeutic implication in the management of patients with globus sensation warrants further investigation.
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