Optimizing the integration of advanced practitioners in a department of surgery: An operational improvement model

Physician assistants (PAs) and nurse practitioners (NPs) have established themselves as key members of the healthcare team to supplement practicing physicians in patient care. PAs and NPs are collectively referred to as “advanced providers” (APs) and work not only in primary care but in general surgery and surgical subspecialties. Studies have addressed AP integration into the profession of medicine and have examined cost and efficacy of APs, attitudes about APs among residents, and educational impact of APs, but very little literature exists that describes a formalized approach to AP integration into a department of surgery, specifically with AP/resident integration. The purpose of this paper is to describe an initiative for developing an operational improvement model for APs working with residents on surgical inpatient services in a large academic health center. The model consists of four components and each component is described in detail from discovery state towards continuous improvement. Formal professional development opportunities for APs as well as appointing a Clinical Director for Surgical APs have positively impacted AP integration into the department of surgery

Human factors issues in the use of artificial intelligence in air traffic control. October 1990 Workshop

The objective of the workshop was to explore the role of human factors in facilitating the introduction of artificial intelligence (AI) to advanced air traffic control (ATC) automation concepts. AI is an umbrella term which is continually expanding to cover a variety of techniques where machines are performing actions taken based upon dynamic, external stimuli. AI methods can be implemented using more traditional programming languages such as LISP or PROLOG, or they can be implemented using state-of-the-art techniques such as object-oriented programming, neural nets (hardware or software), and knowledge based expert systems. As this technology advances and as increasingly powerful computing platforms become available, the use of AI to enhance ATC systems can be realized. Substantial efforts along these lines are already being undertaken at the FAA Technical Center, NASA Ames Research Center, academic institutions, industry, and elsewhere. Although it is clear that the technology is ripe for bringing computer automation to ATC systems, the proper scope and role of automation are not at all apparent. The major concern is how to combine human controllers with computer technology. A wide spectrum of options exists, ranging from using automation only to provide extra tools to augment decision making by human controllers to turning over moment-by-moment control to automated systems and using humans as supervisors and system managers. Across this spectrum, it is now obvious that the difficulties that occur when tying human and automated systems together must be resolved so that automation can be introduced safely and effectively. The focus of the workshop was to further explore the role of injecting AI into ATC systems and to identify the human factors that need to be considered for successful application of the technology to present and future ATC systems

Efficacy of Mentalization-Based Group Therapy for adolescents:A pilot randomised controlled trail

oai:ojs.pkp.sfu.ca:article/2647Background: Suicide is the leading cause of death in adolescents. Furthermore, up to one quarter of adolescents who self-harm will repeat self-harm within one year, highlighting the need for evidence-based prevention and treatment services. Mentalization Based Therapy (MBT) has yielded promising outcomes for individuals who self-harm, however to date only one study has examined MBT in adolescents, wherein the treatment protocol consisted of individual and family therapy. Currently, there has been no development or examination of MBT-A in a group format for adolescents. Methods/Design: The present study is a randomised controlled single blind feasibility trial that aims to (1) adapt the original explicit MBT introductory group manual for an adolescent population (MBT-Ai) and to (2) assess the feasibility of MBT-Ai through examination of consent rates, attendance, attrition and self-harm. Participants are adolescents presenting to Child and Adolescent Mental Health Services (CAMHS) with self-harming behaviors within the last 6 months. Young people will be randomised to a 12-week MBT-Ai group plus treatment as usual (TAU) or TAU alone. Participants will be assessed at baseline and at 12-, 24- and 36-weeks post-baseline. Discussion: This paper describes the development of a treatment manual and the protocol of a randomised controlled feasibility trial of MBT-Ai aimed at treating adolescents who self-harm. Further investigation of a full-scale trial will be necessary to instill benefits if pilot results suggest efficacy. Trial registration: NCT0277169

A Sensitivity Analysis of the High-Temperature Solar Pretreatment of Calcite-Rich Manganese Ores

The modelling of high-temperature direct solar thermal treatment of manganese ores found that a heliostat field and tower process rated at 2.5 MWth will treat roughly ten thousand tons of material annually, producing calcined products of consistent grade. This paper looks at a sensitivity analysis of the results when changing the solar irradiance and financial parameters. The sensitivity analysis shows that a 10% decrease in solar irradiance increases the levelised cost of heat by 5% while decreasing the production by 5%. The levelised cost of heat (LCOH) was most influenced by the cost of the heliostat field as the largest component of capital expenditure. Changes in the interest rate also have a significant impact on the levelised costs of the pretreatment

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How to Persist While on the List

Kidney transplant recipients have the longest wait time and highest depression rates out of all solid organ transplants. Various strategies to help manage depression and anxiety in this patient population have been studied including mindfulness interventions, social support systems, and treatment with antidepressants. Studies have shown that mindfulness interventions lowered depression and anxiety scores in patients from baseline to six months. A strong support system in patients has also been shown to improve patients’ likelihood of receiving a kidney transplant. In addition, treatment with antidepressants improves patients’ overall outcomes without impacting their likelihood of receiving a kidney transplant