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New paediatric cardiology trainees are required to rapidly assimilate knowledge and gain clinical skills to which they have limited or no exposure during residency. The Pediatric Cardiology Fellowship Boot Camp (PCBC) at Boston Children’s Hospital was designed to provide incoming fellows with an intensive exposure to congenital cardiac pathology and a broad overview of major areas of paediatric cardiology practice.
The PCBC curriculum was designed by core faculty in cardiac pathology, echocardiography, electrophysiology, interventional cardiology, exercise physiology, and cardiac intensive care. Individual faculty contributed learning objectives, which were refined by fellowship directors and used to build a programme of didactics, hands-on/simulation-based activities, and self-guided learning opportunities.
A total of 16 incoming fellows participated in the 4-week boot camp, with no concurrent clinical responsibilities, over 2 years. On the basis of pre- and post-PCBC surveys, 80% of trainees strongly agreed that they felt more prepared for clinical responsibilities, and a similar percentage felt that PCBC should be offered to future incoming fellows. Fellows showed significant increase in their confidence in all specific knowledge and skills related to the learning objectives. Fellows rated hands-on learning experiences and simulation-based exercises most highly.
We describe a novel 4-week-long boot camp designed to expose incoming paediatric cardiology fellows to the broad spectrum of knowledge and skills required for the practice of paediatric cardiology. The experience increased trainee confidence and sense of preparedness to begin fellowship-related responsibilities. Given that highly interactive activities were rated most highly, boot camps in paediatric cardiology should strongly emphasise these elements.
This paper analyzes in detail the role of environmental and economic shocks in the migration of the 1930s. The 1940 US Census of Population asked every inhabitant where they lived five years earlier, a unique source for understanding migration flows and networks. Earlier research documented migrant origins and destinations, but we will show how short-term and annual weather conditions at sending locations in the 1930s explain those flows, and how they operated through agricultural success. Beyond demographic data, we use data about temperature and precipitation, plus data about agricultural production from the agricultural census. The widely known migration literature for the 1930s describes an era of relatively low migration, with much of the migration that did occur radiating outward from the Dust Bowl region and the cotton South. Our work about the complete United States will provide a fuller examination of migration in this socially and economically important era.
Hospital-acquired infections (HAIs) develop rapidly after brief and transient exposures, and ecological exposures are central to their etiology. However, many studies of HAIs risk do not correctly account for the timing of outcomes relative to exposures, and they ignore ecological factors. We aimed to describe statistical practice in the most cited HAI literature as it relates to these issues, and to demonstrate how to implement models that can be used to account for them.
We conducted a literature search to identify 8 frequently cited articles having primary outcomes that were incident HAIs, were based on individual-level data, and used multivariate statistical methods. Next, using an inpatient cohort of incident Clostridium difficile infection (CDI), we compared 3 valid strategies for assessing risk factors for incident infection: a cohort study with time-fixed exposures, a cohort study with time-varying exposures, and a case-control study with time-varying exposures.
Of the 8 studies identified in the literature scan, 3 did not adjust for time-at-risk, 6 did not assess the timing of exposures in a time-window prior to outcome ascertainment, 6 did not include ecological covariates, and 6 did not account for the clustering of outcomes in time and space. Our 3 modeling strategies yielded similar risk-factor estimates for CDI risk.
Several common statistical methods can be used to augment standard regression methods to improve the identification of HAI risk factors.
Infect. Control Hosp. Epidemiol. 2016;37(4):411–419
High-quality data from appropriate archives are needed for the continuing improvement of radiocarbon calibration curves. We discuss here the basic assumptions behind 14C dating that necessitate calibration and the relative strengths and weaknesses of archives from which calibration data are obtained. We also highlight the procedures, problems, and uncertainties involved in determining atmospheric and surface ocean 14C/12C in these archives, including a discussion of the various methods used to derive an independent absolute timescale and uncertainty. The types of data required for the current IntCal database and calibration curve model are tabulated with examples.
The advent of aberration correction for transmission electron microscopy has transformed atomic resolution imaging into a nearly routine technique for structural analysis. Now an emerging frontier in electron microscopy is the development of in situ capabilities to observe reactions at atomic resolution in real time and within realistic environments. Here we present a new in situ gas cell holder that is designed for compatibility with a wide variety of sample type (i.e., dimpled 3-mm discs, standard mesh grids, various types of focused ion beam lamellae attached to half grids). Its capabilities include localized heating and precise control of the gas pressure and composition while simultaneously allowing atomic resolution imaging at ambient pressure. The results show that 0.25-nm lattice fringes are directly visible for nanoparticles imaged at ambient pressure with gas path lengths up to 20 μm. Additionally, we quantitatively demonstrate that while the attainable contrast and resolution decrease with increasing pressure and gas path length, resolutions better than 0.2 nm should be accessible at ambient pressure with gas path lengths less than the 15 μm utilized for these experiments.
Strabismus represents a complex oculomotor disorder characterized by the deviation of one or both eyes and poor vision. A more sophisticated understanding of the genetic liability of strabismus is required to guide searches for associated molecular variants. In this classical twin study of 1,462 twin pairs, we examined the relative influence of genes and environment in comitant strabismus, and the degree to which these influences can be explained by factors in common with refractive error. Participants were examined for the presence of latent (‘phoria’) and manifest (‘tropia’) strabismus using cover–uncover and alternate cover tests. Two phenotypes were distinguished: eso-deviation (esophoria and esotropia) and exo-deviation (exophoria and exotropia). Structural equation modeling was subsequently employed to partition the observed phenotypic variation in the twin data into specific variance components. The prevalence of eso-deviation and exo-deviation was 8.6% and 20.7%, respectively. For eso-deviation, the polychoric correlation was significantly greater in monozygotic (MZ) (r = 0.65) compared to dizygotic (DZ) twin pairs (r = 0.33), suggesting a genetic role (p = .003). There was no significant difference in polychoric correlation between MZ (r = 0.55) and DZ twin pairs (r = 0.53) for exo-deviation (p = .86), implying that genetic factors do not play a significant role in the etiology of exo-deviation. The heritability of an eso-deviation was 0.64 (95% CI 0.50–0.75). The additive genetic correlation for eso-deviation and refractive error was 0.13 and the bivariate heritability (i.e., shared variance) was less than 1%, suggesting negligible shared genetic effect. This study documents a substantial heritability of 64% for eso-deviation, yet no corresponding heritability for exo-deviation, suggesting that the genetic contribution to strabismus may be specific to eso-deviation. Future studies are now needed to identify the genes associated with eso-deviation and unravel their mechanisms of action.
A model to describe the pore sizes in cement paste and mortar, as determined by high pressure mercury intrusion porosimetry, has been developed. The model describes porosity using a compound lognormal distribution. For given material under a given set of curing conditions, the weighing factors and shape parameters of two sub-distributions in the lognormal model may be considered as constants, while the location parameters may be related to curing time and the relationship can be quantified. Therefore, it is possible to predict both the pore size distribution in cement and mortar at any age as well as the evolution in pore size during curing.
Current plans for disposing various low-level radioactive and/or hazardous liquid wastes include solidification of the waste using cementitious materials. One process, known as grouting, involves mixing liquid wastes with a blend of cementitious materials and pumping the resultant slurry to lined, underground concrete vaults. As the grout slurry begins to solidify and harden, the temperature within the grout increases due to exothermic hydration reactions. Depending on the the particular grout composition and on the disposal conditions, the grout may be exposed to temperatures of around 90°C for extended time periods. Studies are being conducted to determine the effects of high-temperature curing on selected properties of grouts prepared with a simulated low-level liquid waste. Grout samples cured at temperatures up to 950C in the laboratory absorbed water during curing. The resultant leach resistance and compressive strength of these grouts decreased with increases in curing temperature and curing time.
The photoluminescence, time resolved spectra and kinetics of Yb implanted InP samples are studied under pulsed and CW excitations (above and below band-gap) at different temperatures and excitation intensity. The photoluminescence intensity and decay time as a function of temperature is explained by a proposed new quenching mechanism involving Fe ion. The rise and decay times depend on excitation intensity. The above experimental facts was explained using the kinetics model developed by H.J. Lozykowski . The numerically simulated luminescence rise and decay times show a good quantitative agreement with experiment, over a wide range of generation rates. The electric field InP:Yb photoluminescence quenching was investigated and reported for the first time.
The effects of varying the particle sizes of particulate reactants which form hydroxyapatite by a dissolution-precipitation reaction is considered. The effect of Mg2+ ion, known to inhibit hydroxyapatite formation in vivo. on the reaction to form hydroxyapatite is discussed.
The photoluminescence (PL) and time resolved spectra of Nd- and Yb-implanted CdS samples are studied under pulsed and CW excitations using Ar+ ion laser for different excitation intensities and temperature (9 - 300 K). The samples were annealed under different conditions using the thermal-pulse method. For CdS:Nd, the PL spectra was recorded in the range 890-930 nm (transitions 4F3/2→4I9/2) and for CdS:Yb it was recorded in the range 985 - 1010 nm (transitions 2F5/2 →2F7/2). The Rise time and decay time were studied for both CdS:Nd and CdS:Yb at different emission lines as a function of temperature and excitation power.
Hard human tissues, teeth, and bone are composite materials. These composites are primarily composed of impure, calcium-deficient hydroxyapatite and collagen. The formula for stoichiometric hydroxyapatite is: Ca10(PO4)6(OH)2. However, this compound exists over a range of compositions that may be characterized in terms of a Ca/P ratio. The Ca/P ratio of stoichiometric material is 1.67. Stable compositions may have Ca/P ratios extending to 1.5:Ca9(PO4)6HOH. Structurally, hydroxyapatite contains two types of calcium sites. Four of the calcium sites per unit cell are each coordinated with 8 oxygens. Six of the calcium sites per unit cell are 7-coordinated. Six of these seven bonds are with oxygens, while the 7th is with a hydroxyl ion. Calcium deficiency results in the formation of up to one vacancy per unit cell on one of these seven coordinated calcium sites. Charge balance is maintained by the removal of one of the hydroxyl oxygens. The remaining proton becomes bound to an oxygen that is also coordinated with a phosphate. As a result, it is common to express the formula of calcium-deficient hydroxyapatite having a Ca/P ratio of 1.5 as Ca9(PO4)5(HPO4)OH.