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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 chapter integrates and summarizes our collective thinking on well-being among the old-old by answering five central questions: 1) What is old-old age?; 2) What is well-being in old-old persons?; 3) What affects well-being in old-old age?; 4) What theory, if any, is appropriate for old-old age?; 5) What interventions, if at all, are needed to enhance well-being in old-old age? It is hoped that our discourse will generate new research and directions toward well-being among old-old at the end stage of life.
We began this volume with a road map to increase our knowledge on well-being among the oldest old. We designed this volume to include different views on well-being, the impact of experiences and trauma accumulated over the lifetime, mediating and moderating influences, and measurement issues.
At the end of this journey of inquiry, we are able to summarize and integrate our effort. As a scientific endeavor, this book both answers questions and raises others. The book aims to answer questions about the essence of well-being in very old age and the predictors of such status. Some findings repeat and are consistent across populations and studies, whereas some of the chapters present diverse and conflicting points of view. To integrate the results of the different chapters and focus the discussion, we concentrate on five questions that traverse the chapters:
What is old-old age?
What is well-being in old-old persons?
What affects well-being in old-old age?
What theory, if any, is appropriate for old-old age?
What interventions, if at all, are needed to enhance well-being in old-old age?
The demographic and social structure of most industrialized and developing countries are changing rapidly as infant mortality is reduced and population life span has increased in dramatic ways. In particular, the oldest old (85+) population has grown and will continue to grow. This segment of the population tends to suffer physical and cognitive decline, and little information is available to describe how their positive and negative distal experiences, habits and intervening proximal environmental influences impact their well-being, and how social and health policies can help meet the unique challenges they face. Understanding Well-Being in the Oldest Old is the outcome of a four-day workshop attended by U.S. and Israeli scientists and funded by the U.S.-Israel Bi-National Science Foundation to examine both novel and traditional paradigms that could extend our knowledge and understanding of the well-being of the oldest old.
This chapter provides a road map to address the dearth of information and the central theme of this volume: well-being among the oldest old. A reality among the oldest old is the increasing variability in both subjective and psychological well-being found within an individual owing to variations in cumulative experiences and differences in strategies to survive into very old age. This chapter outlines the strategies in addressing the central theme by describing four different views on well-being among the oldest old (Section I), the influence of experiences and trauma on well-being at the end stage of life (Section II), examination of moderating and mediating influences (Section III), measurement issues (Section IV), and conclusions (Section V).
The life course is marked by individuality and diversity. An individual's life is a process that, if scrutinized at a singular instance, would yield incorrect assumptions about its trajectory. Instead, the gradual accumulation of events in a person's life provides perspective into how that person arrived at his or her present state of well-being. This chapter provides a road map of the contents in this edited volume on the well-being of the oldest old. Although the age of the oldest-old cohort is continually increasing as a result of the rectangularization of the population pyramid, this volume defines the oldest old as those individuals older than 75 years of age. This cohort deserves its own conception of well-being because of its distinctiveness in comparison with younger generations.
This chapter clarifies and differentiates changes in cognitive functioning among the oldest old at the group and individual levels. Cross-sectionally, the oldest old demonstrate normative differences of being more physically and cognitively frail compared to younger groups. More variation and successful aging is observed at the individual level. Some oldest-old individuals can perform at the same levels as adults 20 to 40 years younger. Recent literature has recognized that the concept of cognitive vitality transcends the absence of dementia or dementing processes. We seek to clarify the concept of cognitive vitality because it has not been well defined in the literature either theoretically or operationally. This chapter addresses the following questions: 1) What is cognitive vitality and how does it contribute to the well-being of older adults? 2) What factors or resources contribute to cognitive vitality among the oldest old? and 3) What new directions can be identified for future research?
COGNITIVE FUNCTIONING AND VITALITY AMONG THE OLDEST OLD: IMPLICATIONS FOR WELL-BEING
Lay people and professionals alike fall prey to aging stereotypes and myths (Ory, Hoffman, Hawkins, Sanner, & Mockenhaupt, 2003), namely that cognitive decline is inevitable and there is nothing we can do about it. Empirical research has focused on comparing the cognitive performance of younger and older adults, often noting “deficits” in older adults' abilities without taking into account context and potentially meaningful qualitative differences in older adults' approaches to cognitive problems (e.g., Marsiske & Margrett, 2006).
An ultrafast laser irradiation method for the removal of corrosion from Daguerreotypes without detrimentally affecting image quality has been developed. Corrosion products such as silver oxide and silver sulfide may be removed by chemical cleaning but these reactions are hard to control and are often damaging to the underlying silver, ruining the image. The Ti:Sapphire 150 fs laser pulses used in this study are focused to a beam diameter of 60 μm and are normally incident to the Daguerreotype. It was found that the corrosion layer has a lower material removal threshold than silver allowing for removal of corrosion with minimal removal of vital information contained in the silver substrate.
We find that sheet resistance of tungsten polycide can be reduced up to 40% by depositing thin polysilicon layers on the top of the films. Transmission electron microscopy shows no significant differences in the crystal structure, grain size, or dislocation density inside the films by adding a polysilicon cap, but it clearly shows roughening of the top interface. Auger depth profiling shows substantial reduction of the Si/W ratio in the capped films. Both results imply that the excess Si segregates to both polysilicon interfaces, effectively lowering the Si/W ratio and resulting in a low sheet resistance.
Lateral dopant diffusion is a well known problem in dual-gate W-polycide CMOS devices. We have recently demonstrated that RTA processing helps to alleviate this problem and at the same time ensures sufficient dopant activation. However, due to the complex micro-structural changes in both poly-Si and WSix (x˜2.5) layers during the RTA process, the time dependence of the diffusion processes and dopant distribution are difficult to predict. Consequently, the process optimization and device simulations are rather unreliable. We describe a new experimental technique to measure lateral dopant diffusion and 2-dimensional dopant distribution in RTA processed W-polycide structures using conventional SIMS analysis of lithographically defined test structures. Our experiments show that the technique is capable of measuring lateral dopant diffusion over distances between one and tens of microns without losing the vertical resolution of conventional SIMS profiling. The technique can be used to study diffusion processes in a variety of materials and multi-layer structures.
A nicrofabricated silicon-based chemical gas sensor with a discontinuous film of Pt / TiOx, as the active sensing component has been characterized by atomic force microscopy, environmental scanning electron microscopy, and transmission electron microscopy. A study of the device's multilayer structure and of the thin sensing film is undertaken to understand and control the sensing properties of the metal / semiconducting materials. The purpose of this research is to advance the understanding of the conduction mechanism and provide a basis for optimizing the sensing properties and microstructure of the sensing device.