OBJECTIVE To describe the views of residency program directors regarding the effect of the 2010 duty hour recommendations on the 6 core competencies of graduate medical education. METHODS US ...residency program directors in internal medicine, pediatrics, and general surgery were e-mailed a survey from July 8 through July 20, 2010, after the 2010 Accreditation Council for Graduate Medical Education (ACGME) duty hour recommendations were published. Directors were asked to rate the implications of the new recommendations for the 6 ACGME core competencies as well as for continuity of inpatient care and resident fatigue. RESULTS Of 719 eligible program directors, 464 (65%) responded. Most program directors believe that the new ACGME recommendations will decrease residents' continuity with hospitalized patients (404/464 87%) and will not change (303/464 65%) or will increase (26/464 6%) resident fatigue. Additionally, most program directors (249-363/464 53%-78%) believe that the new duty hour restrictions will decrease residents' ability to develop competency in 5 of the 6 core areas. Surgery directors were more likely than internal medicine directors to believe that the ACGME recommendations will decrease residents' competency in patient care (odds ratio OR, 3.9; 95% confidence interval CI, 2.5-6.3), medical knowledge (OR, 1.9; 95% CI, 1.2-3.2), practice-based learning and improvement (OR, 2.7; 95% CI, 1.7-4.4), interpersonal and communication skills (OR, 1.9; 95% CI, 1.2-3.0), and professionalism (OR, 2.5; 95% CI, 1.5-4.0). CONCLUSION Residency program directors' reactions to ACGME duty hour recommendations demonstrate a marked degree of concern about educating a competent generation of future physicians in the face of increasing duty hour standards and regulation.
We introduce a notion of transitive family of projections in a type II1 factor and prove that there exists (i) a 5 element transitive family in the hyperfinite II1 and (ii) a 12 element free ...transitive family. We then prove that the group von Neumann algebras of the known infinite free Burnside groups are all type II1 factors. Our investigation of weak-amenability properties of Burnside groups leads us to consider the Connes theory of correspondences. From this investigation we are able to define a new Folner invariant for type II1 factors. We prove a monotonicity result and find a positive lower bound for the free group factor L(special characters omitted).
Taking into consideration the Institute of Medicine's 2008 recommendations regarding residents' duty hours,
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the 16-member Duty Hour Task Force of the Accreditation Council for GraduateMedical ...Education (ACGME) recently published proposed new recommendations,
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which, as eventually approved, would go into effect in July 2011. These recommendations represent a continuing commitment by the ACGME to both “foster a humanistic environment for graduate medical education” and ensure “excellent and safe patient care.”
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The ACGME has solicited comments from the educational community and will modify its proposal as needed.
The recommendations represent an attempt to address elements of the 2003 ACGME standards that generated . . .
A finite von Neumann algebra \(\mathcal{M}\) with a faithful normal trace \(% \tau \) has Haagerup's approximation property (relative to a von Neumann subalgebra \(\mathcal{N}\)) if there exists a ...net \((\phi_{\alpha})_{\alpha\in \Lambda}\) of normal completely positive (\(\mathcal{N}\)-bimodular) maps from \(\mathcal{M}\) to \(\mathcal{M}\) that satisfy the subtracial condition \(% \tau \circ \phi_{\alpha}\leq \tau \), the extension operators \(% T_{\phi_{\alpha}}\) are bounded compact operators (in \(<\mathcal{M%},e_{\mathcal{N}}>\)), and pointwise approximate the identity in the trace-norm, i.e., \(\lim_{\alpha}||\phi_{\alpha}(x)-x||_{2}=0\) for all \(% x\in \mathcal{M}\). We prove that the subtraciality condition can be removed, and provide a description of Haagerup's approximation property in terms of Connes's theory of correspondences. We show that if \(\mathcal{N}\subseteq \mathcal{M}\) is an amenable inclusion of finite von Neumann algebras and \(% \mathcal{N}\) has Haagerup's approximation property, then \(\mathcal{M}\) also has Haagerup's approximation property. This work answers two questions of Sorin Popa.
In this article we introduce an isomorphism invariant for type II_1 factors
using the Connes-Folner condition. We compute bounds of this number for free
group factors.
In this article we introduce an isomorphism invariant for type II_1 factors using the Connes-Folner condition. We compute bounds of this number for free group factors.
From 1983 to 1995, 72 patients with necrotizing pancreatitis were treated with a general approach involving planned reoperative necrosectomies and interval abdominal wound closure using a zipper.
...Hospital mortality was 25%. Multiple organ failure without sepsis caused early mortality in 3 of 4 patients and sepsis caused late mortality in 11 of the remaining 14. The mean number of reoperative necrosectomies/debridements was 2 (0 to 7). Fistulae developed in 25 patients (35%); 64% were treated conservatively. Recurrent intraabdominal abscesses developed in 9 patients (13%) but were drained percutaneously in 5. Hemorrhage required intervention in 13 patients (18%). Prognostic factors included APACHE-II score on admission <13 (
P = 0.005), absence of postoperative hemorrhage (
P = 0.01), and peripancreatic tissue necrosis alone (
P <0.05).
The zipper approach effectively maximizes the necrosectomy and decreases the incidence of recurrent intraabdominal infection requiring reoperation. APACHE-II score ≥13, extensive parenchymal necrosis, and postoperative hemorrhage signify worse outcome.
Previous reports have suggested that control of diabetes improves after successful parathyroidectomy for primary hyperparathyroidism. To investigate this proposition further, a review was made of all ...insulin-requiring diabetics undergoing curative parathyroidectomy at the Mayo Clinic between 1970 and 1984 (36 patients). All contemporary insulin-requiring diabetics undergoing thyroidectomy for benign euthyroid disease served as a control group (34 patients). One patient in each group had type I diabetes mellitus, and the remainder had type II diabetes mellitus. Preoperative insulin requirements, insulin requirements at follow-up, and change in insulin requirements did not differ significantly between the two groups. This study suggests that parathyroidectomy does not lead to a statistically significant reduction in the insulin requirements of diabetic patients with primary hyperparathyroidism and that coexistent type II diabetes mellitus should not be considered a further indication for parathyroidectomy in patients with primary hyperparathyroidism.
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