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Kulasegaram KM, Grierson L, Barber C, Chahine S, Chou FC, Cleland J, Ellis R, Holmboe ES, Pusic M, Schumacher D, Tolsgaard MG, Tsai CC, Wenghofer E, Touchie C. Data sharing and big data in health professions education: Ottawa consensus statement and recommendations for scholarship. Med Teach 2024; 46:471-485. [PMID: 38306211 DOI: 10.1080/0142159x.2023.2298762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 12/20/2023] [Indexed: 02/04/2024]
Abstract
Changes in digital technology, increasing volume of data collection, and advances in methods have the potential to unleash the value of big data generated through the education of health professionals. Coupled with this potential are legitimate concerns about how data can be used or misused in ways that limit autonomy, equity, or harm stakeholders. This consensus statement is intended to address these issues by foregrounding the ethical imperatives for engaging with big data as well as the potential risks and challenges. Recognizing the wide and ever evolving scope of big data scholarship, we focus on foundational issues for framing and engaging in research. We ground our recommendations in the context of big data created through data sharing across and within the stages of the continuum of the education and training of health professionals. Ultimately, the goal of this statement is to support a culture of trust and quality for big data research to deliver on its promises for health professions education (HPE) and the health of society. Based on expert consensus and review of the literature, we report 19 recommendations in (1) framing scholarship and research through research, (2) considering unique ethical practices, (3) governance of data sharing collaborations that engage stakeholders, (4) data sharing processes best practices, (5) the importance of knowledge translation, and (6) advancing the quality of scholarship through multidisciplinary collaboration. The recommendations were modified and refined based on feedback from the 2022 Ottawa Conference attendees and subsequent public engagement. Adoption of these recommendations can help HPE scholars share data ethically and engage in high impact big data scholarship, which in turn can help the field meet the ultimate goal: high-quality education that leads to high-quality healthcare.
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Affiliation(s)
| | - Lawrence Grierson
- Department of Family Medicine, McMaster University, Hamilton, Canada
| | - Cassandra Barber
- School of Health Professions Education, Maastricht University, Maastricht, Netherlands
| | - Saad Chahine
- Faculty of Education, Queen's University, Kingston, Canada
| | - Fremen Chichen Chou
- Faculty of Education, Center for Faculty Development, China Medical University Hospital, Taichung City, Taiwan
| | - Jennifer Cleland
- Director of Medical Education Research & Scholarship Unit, Lee Kong Chian School of Medicine, Singapore
| | | | - Eric S Holmboe
- Accreditation Council for Graduate Medical Education, Chicago, IL, USA
| | | | - Daniel Schumacher
- Cincinnati Children's Hospital Medical Center/University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Martin G Tolsgaard
- Copenhagen Academy for Medical Education and Simulation, University of Copenhagen, Copenhagen, Denmark
| | - Chin-Chung Tsai
- Program of Learning Sciences, National Taiwan Normal University, Taipei, Taiwan
| | - Elizabeth Wenghofer
- School of Kinesiology and Health Sciences, Laurentian University, Sudbury, Canada
| | - Claire Touchie
- University of Ottawa/The Ottawa Hospital, Ottawa, Canada
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Zackoff MW, Cruse B, Sahay RD, Zhang B, Sosa T, Schwartz J, Depinet H, Schumacher D, Geis GL. Multiuser immersive virtual reality simulation for interprofessional sepsis recognition and management. J Hosp Med 2024; 19:185-192. [PMID: 38238875 DOI: 10.1002/jhm.13274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 12/12/2023] [Accepted: 12/22/2023] [Indexed: 03/02/2024]
Abstract
INTRODUCTION Sepsis is a leading cause of pediatric mortality. While there has been significant effort toward improving adherence to evidence-based care, gaps remain. Immersive multiuser virtual reality (MUVR) simulation may be an approach to enhance provider clinical competency and situation awareness for sepsis. METHODS A prospective, observational pilot of an interprofessional MUVR simulation assessing a decompensating patient from sepsis was conducted from January to June 2021. The study objective was to establish validity and acceptability evidence for the platform by assessing differences in sepsis recognition between experienced and novice participants. Interprofessional teams assessed and managed a patient together in the same VR experience with the primary outcome of time to recognition of sepsis utilizing the Situation Awareness Global Assessment Technique analyzed using a logistic regression model. Secondary outcomes were perceived clinical accuracy, relevancy to practice, and side effects experienced. RESULTS Seventy-two simulations included 144 participants. The cumulative odds ratio of recognizing sepsis at 2 min into the simulation in comparison to later time points by experienced versus novice providers were significantly higher with a cumulative odds ratio of 3.70 (95% confidence interval: 1.15-9.07, p = .004). Participants agreed that the simulation was clinically accurate (98.6%) and will impact their practice (81.1%), with a high degree of immersion (95.7%-99.3%), and the majority of side effects were perceived as mild (70.4%-81.4%). CONCLUSIONS Our novel MUVR simulation demonstrated significant differences in sepsis recognition between experienced and novice participants. This validity evidence along with the data on the simulation's acceptability supports expanded use in training and assessment.
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Affiliation(s)
- Matthew W Zackoff
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Center for Simulation and Research, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Bradley Cruse
- Center for Simulation and Research, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Rashmi D Sahay
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Bin Zhang
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Tina Sosa
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
- Division of Pediatric Hospital Medicine, University of Rochester Medical Center, Rochester, New York, USA
- UR Medicine Quality Institute, University of Rochester Medical Center, Rochester, New York
| | - Jerome Schwartz
- Patient Services, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Holly Depinet
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Daniel Schumacher
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Gary L Geis
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Center for Simulation and Research, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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Rutsky J, Schumacher D, Mallon D. Relevance, quick hits, and vibe: Features of meaningful teaching and learning during trainee consult interactions. J Hosp Med 2024; 19:24-30. [PMID: 38073059 PMCID: PMC10842903 DOI: 10.1002/jhm.13256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 11/15/2023] [Accepted: 11/29/2023] [Indexed: 01/04/2024]
Abstract
BACKGROUND Consults are increasingly frequent in inpatient pediatric services. Consult interactions between trainees provide a rich opportunity for teaching and learning. What constitutes meaningful teaching interactions with trainees has not been described. OBJECTIVE Explore how consulting fellows and residents define "meaningful teaching interactions" associated with inpatient consult interactions. METHODS Four focus groups were conducted with 21 pediatric trainees (11 subspecialty fellows and 10 residents) at one institution. Transcriptions were analyzed using thematic analysis to inductively create categories and themes. RESULTS Five factors define meaningful teaching interactions: (1) Relevance; (2) Quick Hits; (3) Vibe; (4) Face-to-face Interactions; and (5) Timing and Busyness. Meaningful content was described as relevant to current or future patient care. Residents valued content that would enable them to explain the reasoning behind recommendations and think through the next steps. Trainees highlighted brief clinical pearls as superior to longer teaching sessions. The "vibe" between resident and fellow was described as a prerequisite to meaningful teaching and included aspects of interest, receptivity, tone, and attitude. Face-to-face interactions were preferred by many trainees, from initial consults to seeing patients or co-rounding. Timing and workload reflected discordant schedules, including time of day and week, but setting a planned time for teaching was beneficial. CONCLUSION Relevant, bite-sized educational content combined with a good vibe and optimal timing creates a context in which consult fellows can foster meaningful teaching opportunities for residents.
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Affiliation(s)
- Jessica Rutsky
- Department of Pediatrics and Communicable Disease, Division of Pediatric Gastroenterology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor MI 48109, U.S.A
| | - Daniel Schumacher
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, Ohio 45229-3026, U.S.A
- Department of Pediatrics, University of Cincinnati College of Medicine, 331 Albert Sabin Way, Cincinnati, Ohio 45229-3026, U.S.A
| | - Daniel Mallon
- Department of Pediatrics, University of Cincinnati College of Medicine, 331 Albert Sabin Way, Cincinnati, Ohio 45229-3026, U.S.A
- Division of Gastroenterology, Hepatology, and Nutrition, Cincinnati Children’s Hospital Medical Center
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Loeb D, Shoemaker J, Parsons A, Schumacher D, Zackoff M. How Augmenting Reality Changes the Reality of Simulation: Ethnographic Analysis. JMIR Med Educ 2023; 9:e45538. [PMID: 37389920 PMCID: PMC10365567 DOI: 10.2196/45538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 04/11/2023] [Accepted: 05/24/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND Simulation-based medical education (SBME) provides key medical training for providers to safely and ethically practice high-risk events. Augmented reality (AR)-enhanced simulation projects digital images of realistic examination findings into a participant's field of view, which allows nuanced physical examination findings such as respiratory distress and skin perfusion to be prominently displayed. It is unknown how AR compares to traditional mannequin (TM)-based simulation with regard to influencing participant attention and behavior. OBJECTIVE The purpose of this study is to use video-based focused ethnography-a problem-focused, context-specific descriptive form of research whereby the research group collectively analyzes and interprets a subject of interest-to compare and categorize provider attention and behavior during TM and AR and provide suggestions for educators looking to delineate these 2 modalities. METHODS Twenty recorded interprofessional simulations (10 TM, 10 AR) featuring a decompensating child were evaluated through video-based focused ethnography. A generative question was posed: "How do the attention and behavior of participants vary based on the simulation modality?" Iterative data collection, analysis, and pattern explanation were performed by a review team spanning critical care, simulation, and qualitative expertise. RESULTS The attention and behavior of providers during TM and AR simulation clustered into three core themes: (1) focus and attention, (2) suspension of disbelief, and (3) communication. Participants focused on the mannequin during AR, especially when presented with changing physical examination findings, whereas in TM, participants focused disproportionately on the cardiorespiratory monitor. When participants could not trust what they were seeing or feeling in either modality, the illusion of realism was lost. In AR, this manifested as being unable to physically touch a digital mannequin, and in TM, participants were often unsure if they could trust their physical examination findings. Finally, communication differed, with calmer and clearer communication during TM, while AR communication was more chaotic. CONCLUSIONS The primary differences clustered around focus and attention, suspension of disbelief, and communication. Our findings provide an alternative methodology to categorize simulation, shifting focus from simulation modality and fidelity to participant behavior and experience. This alternative categorization suggests that TM simulation may be superior for practical skill acquisition and the introduction of communication strategies for novice learners. Meanwhile, AR simulation offers the opportunity for advanced training in clinical assessment. Further, AR could be a more appropriate platform for assessing communication and leadership by more experienced clinicians due to the generated environment being more representative of decompensation events. Further research will explore the attention and behavior of providers in virtual reality-based simulations and real-life resuscitations. Ultimately, these profiles will inform the development of an evidence-based guide for educators looking to optimize simulation-based medical education by pairing learning objectives with the ideal simulation modality.
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Affiliation(s)
- Daniel Loeb
- Division of Critical Care, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Jamie Shoemaker
- Center for Simulation and Research, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | | | - Daniel Schumacher
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
- University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Matthew Zackoff
- Division of Critical Care, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
- Center for Simulation and Research, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
- University of Cincinnati College of Medicine, Cincinnati, OH, United States
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Erdfelder F, Begerau H, Meyers D, Quast KJ, Schumacher D, Brieden T, Ihle R, Ammon D, Kruse HM, Zenker S. Enhancing Data Protection via Auditable Informational Separation of Powers Between Workflow Engine Based Agents: Conceptualization, Implementation, and First Cross-Institutional Experiences. Stud Health Technol Inform 2023; 302:317-321. [PMID: 37203670 DOI: 10.3233/shti230126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
German best practice standards for secondary use of patient data require pseudonymization and informational separation of powers assuring that identifying data (IDAT), pseudonyms (PSN), and medical data (MDAT) are never simultaneously knowable by any party involved in data provisioning and use. We describe a solution meeting these requirements based on the dynamic interaction of three software agents: the clinical domain agent (CDA), which processes IDAT and MDAT, the trusted third party agent (TTA), which processes IDAT and PSN, and the research domain agent (RDA), which processes PSN and MDAT and delivers pseudonymized datasets. CDA and RDA implement a distributed workflow by employing an off-the-shelf workflow engine. TTA wraps the gPAS framework for pseudonym generation and persistence. All agent interactions are implemented via secured REST-APIs. Rollout to three university hospitals was seamless. The workflow engine allowed meeting various overarching requirements, including auditability of data transfer and pseudonymization, with minimal additional implementation effort. Using a distributed agent architecture based on workflow engine technology thus proved to be an efficient way to meet technical and organizational requirements for provisioning patient data for research purposes in a data protection compliant way.
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Affiliation(s)
- Felix Erdfelder
- Staff Unit for Medical & Scientific Technology Development & Coordination (MWTek), Commercial Directorate; University Hospital Bonn, Germany
- Institute for Medical Biometry, Informatics, and Epidemiology, University of Bonn, Germany
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Germany
| | - Henning Begerau
- Staff Unit for Medical & Scientific Technology Development & Coordination (MWTek), Commercial Directorate; University Hospital Bonn, Germany
- Institute for Medical Biometry, Informatics, and Epidemiology, University of Bonn, Germany
| | - David Meyers
- Staff Unit for Medical & Scientific Technology Development & Coordination (MWTek), Commercial Directorate; University Hospital Bonn, Germany
- Institute for Medical Biometry, Informatics, and Epidemiology, University of Bonn, Germany
| | - Klaus-Jürgen Quast
- Staff Unit for Medical & Scientific Technology Development & Coordination (MWTek), Commercial Directorate; University Hospital Bonn, Germany
- Institute for Medical Biometry, Informatics, and Epidemiology, University of Bonn, Germany
| | - Daniel Schumacher
- Staff Unit for Medical & Scientific Technology Development & Coordination (MWTek), Commercial Directorate; University Hospital Bonn, Germany
| | - Tobias Brieden
- Data Integration Center, Central IT Department, University Hospital Essen, Germany
| | - Roland Ihle
- Data Integration Center, Central IT Department, University Hospital Essen, Germany
| | - Danny Ammon
- Data Integration Center, IT Department, Jena University Hospital, Germany
| | - Henner M Kruse
- Data Integration Center, IT Department, Jena University Hospital, Germany
| | - Sven Zenker
- Staff Unit for Medical & Scientific Technology Development & Coordination (MWTek), Commercial Directorate; University Hospital Bonn, Germany
- Institute for Medical Biometry, Informatics, and Epidemiology, University of Bonn, Germany
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Germany
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Affiliation(s)
- Dorene F Balmer
- D.F. Balmer is cochair, Research in Medical Education (RIME) Program Planning Committee, and professor of pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; ORCID: http://orcid.org/0000-0001-6805-406
| | - Meredith E Young
- M.E. Young is cochair, Research in Medical Education (RIME) Program Planning Committee, and associate professor, Institute of Health Sciences Education and Department of Medicine, McGill University, Montreal, Quebec, Canada; ORCID: https://orcid.org/0000-0002-2036-2119
| | - Andrea N Leep Hunderfund
- A.N.L. Hunderfund is incoming cochair, Research in Medical Education (RIME) Program Planning Committee, and tenured professor of neurology, Mayo Clinic, Rochester, Minnesota
| | - Daniel Schumacher
- D. Schumacher is incoming cochair, Research in Medical Education (RIME) Program Planning Committee, and tenured professor of pediatrics, Cincinnati Children's Hospital Medical Center/University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Zareen Zaidi
- Z. Zaidi is immediate past chair, Research in Medical Education (RIME) Program Planning Committee, and professor, George Washington School of Medicine and Health Sciences, Washington, DC; ORCID: https://orcid.org/0000-0003-4328-5766
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Zaidi Z, Sewell JL, Schumacher D, Sukhera J, Hunderfund ANL, Balmer DF, Park YS, Kulasegaram K, Young ME, Fung CC, LaDonna KA. Can I Ask a Question About URiM Awards That I Don't Know the Answer to? Designing an Award for Underrepresented Medical Education Researchers. Acad Med 2022; 97:S4-S7. [PMID: 35947477 DOI: 10.1097/acm.0000000000004902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Meaningful Equity, Diversity, and Inclusion (EDI) efforts may be stymied by concerns about whether proposed initiatives are performative or tokenistic. The purpose of this project was to analyze discussions by the Research in Medical Education (RIME) Program Planning committee about how best to recognize and support underrepresented in medicine (URiM) researchers in medical education to generate lessons learned that might inform local, national, and international actions to implement meaningful EDI initiatives. Ten RIME Program Planning Committee members and administrative staff participated in a focus group held virtually in August 2021. Focus group questions elicited opinions about "if and how" to establish a URiM research award. The focus group was recorded, transcribed, and thematically analyzed. Recognition of privilege, including who has it and who doesn't, underpinned the focus group discussion, which revolved around 2 themes: (1) tensions between optics and semantics, and (2) potential unintended consequences of trying to level the medical education playing field. The overarching storyline threaded throughout the focus group discussion was intentionality. Focus group participants sought to avoid performativity by creating an award that would be meaningful to recipients and to career gatekeepers such as department chairs and promotion and tenure committees. Ultimately, participants decided to create an award that focused on exemplary Equity, Diversity, and Inclusion (EDI) scholarship, which was eventually named the "RIME URiM Research Award." Difficult but productive conversations about EDI initiatives are necessary to advance underrepresented in medicine (URiM) scholarship. This transparent commentary may trigger further critical conversations.
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Affiliation(s)
- Zareen Zaidi
- Z. Zaidi is professor, George Washington School of Medicine and Health Sciences, Washington, DC; ORCID: https://orcid.org/0000-0003-4328-5766
| | - Justin L Sewell
- J.L. Sewell is professor of medicine, University of California San Francisco, San Francisco, California
| | - Daniel Schumacher
- D. Schumacher is associate professor of pediatrics, Cincinnati Children's Hospital Medical Center/University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Javeed Sukhera
- J. Sukhera is chair/chief of psychiatry, Institute of Living/Hartford Hospital, and associate clinical professor, Yale University School of Medicine, New Haven, Connecticut
| | | | - Dorene F Balmer
- D.F. Balmer is professor of pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Yoon Soo Park
- Y.S. Park is associate professor, Harvard Medical School, and director of health professions education research, Massachusetts General Hospital, Boston, Massachusetts
| | - Kulamakan Kulasegaram
- K. Kulasegaram is a scientist and associate professor, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Meredith E Young
- M.E. Young is associate professor, Institute of Health Sciences Education and Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Cha-Chi Fung
- C.-C. Fung is associate professor, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Kori A LaDonna
- K.A. LaDonna is assistant professor, Department of Innovation in Medical Education & Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Gaul S, Shahzad K, Medert R, Gadi I, Maeder C, Schumacher D, Wirth A, Fatima S, Boeckel JN, Khawaja H, Brune M, Nawroth PP, Isermann B, Laufs U, Freichel M. A novel direct inducible nongenetic murine model of diabetes-aggravated atherosclerosis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.3078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and aims
Atherosclerosis, the main pathology underlying cardiovascular diseases is accelerated in diabetic patients (1,2). Genetic mouse models require breeding efforts which are time-consuming and costly. Our aim was to establish a new nongenetic model of inducible metabolic risk factors that mimics hyperlipidemia, hyperglycemia, or both and allows the detection of phenotypic differences dependent on the metabolic stressor(s) on any genetic background.
Methods and results
Wild type mice were injected with gain-of-function PCSK9D377Y (proprotein convertase subtilisin/kexin type 9) mutant adeno-associated viral particles (AAV) and streptozotocin (STZ) and fed either a high-fat diet (HFD) or high-cholesterol/high fat-diet (Paigen diet, PD) for 12 and 20 weeks. LDLR KO mice were used as reference control. Combined hyperlipidemic and hyperglycemic mice (HGHCi), but not hyperlipidemia (HCi) alone, displayed characteristic features of aggravated atherosclerosis characterized by larger and less stable plaques (necrotic core area in HGHCi HFD: 24% vs HCi HFD: 13% vs LDLR KO HFD: 18% area, at 20 weeks p<0.05; fibrous cap thickness in HGHCi: 13 μm vs HCi HFD: 23 μm vs LDLR KO HFD: 17 μm, at 20 weeks, p<0.05) which contained more macrophages (MOMA-2 in HGHCi HFD: 27% vs HCi HFD: 19% vs LDLR KO HFD: 46% area/plaque, at 20 weeks, p<0.05) and less smooth muscle cells (α-SMA in HGHCi HFD: 12% vs HCi HFD: 25% vs LDLR KO HFD: 18% area/plaque, at 20 weeks, p<0.05), on both HFD or PD diet. Diabetic atherosclerotic mice (HGHCi) fed a HFD showed 37% plaque area (of total lumen) compared to 16% plaque area in non-diabetic mice (HCi HFD) and 17% in LDLR KO HFD after 12 weeks; and 43% (HGHCi HFD) vs. 29% (HCi HFD) vs 39% plaque area (LDLR KO HFD) after 20 weeks (Figure 1A, B). Differences between the diabetic HGHCi and non-diabetic HCi HFD mice were confirmed using RNA-seq analysis of aortic tissue, revealing that significantly more genes were dysregulated in mice with combined hyperlipidemia and hyperglycemia than in the hyperlipidemia-only group. The HGHCi-associated genes were related to pathways regulating inflammation (increased Cd68, iNos, and Tnfa expression) and extracellular matrix degradation (Adamts4 and Mmp14) (Figure 1C). When comparing HFD with PD, the PD aggravated atherosclerosis to a greater extent in mice and showed plaque formation after 8 weeks (HGHCi PD: 48% plaque area vs. HCi PD: 30% plaque area), therefore, representing a direct inducible hyperglycemic atherosclerosis model compared with HFD-fed mice, in which atherosclerosis is severe by 8 weeks.
Conclusion
We established a nongenetic direct inducible mouse model of diabetes-aggravated atherosclerosis allowing comparative analyses of atherosclerosis in diabetic and non-diabetic conditions and its modification by diet, allowing analyses of multiple metabolic hits in mice.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Deutsche Forschungsgemeinschaft (DFG)
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Affiliation(s)
- S Gaul
- University Hospital Leipzig, Klinik und Poliklinik für Kardiologie , Leipzig , Germany
| | - K Shahzad
- University Hospital Leipzig, Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostic , Leipzig , Germany
| | - R Medert
- University of Heidelberg, Institute of Pharmacology , Heidelberg , Germany
| | - I Gadi
- University Hospital Leipzig, Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostic , Leipzig , Germany
| | - C Maeder
- University Hospital Leipzig, Klinik und Poliklinik für Kardiologie , Leipzig , Germany
| | - D Schumacher
- University of Heidelberg, Institute of Pharmacology , Heidelberg , Germany
| | - A Wirth
- University of Heidelberg, Institute of Pharmacology , Heidelberg , Germany
| | - S Fatima
- University Hospital Leipzig, Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostic , Leipzig , Germany
| | - J N Boeckel
- University Hospital Leipzig, Klinik und Poliklinik für Kardiologie , Leipzig , Germany
| | - H Khawaja
- University Hospital Leipzig, Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostic , Leipzig , Germany
| | - M Brune
- University of Heidelberg, Internal Medicine I and Clinical Chemistry , Heidelberg , Germany
| | - P P Nawroth
- University of Heidelberg, Internal Medicine I and Clinical Chemistry , Heidelberg , Germany
| | - B Isermann
- University Hospital Leipzig, Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostic , Leipzig , Germany
| | - U Laufs
- University Hospital Leipzig, Klinik und Poliklinik für Kardiologie , Leipzig , Germany
| | - M Freichel
- University of Heidelberg, Institute of Pharmacology , Heidelberg , Germany
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Gerlach M, Schmitt S, Cyprys P, Kasper MA, Mai I, Vermeer MH, Horwitz SM, Fingerle-Rowson G, Vogl A, Schumacher D, Helma-Smets J. TUB-010, a novel antibody drug conjugate with reduced nonspecific toxicity profile based on Tub-tag technology widens the therapeutic window of targeting CD30. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)00604-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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10
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Huth K, Henry D, Cribb Fabersunne C, Coleman CL, Frank B, Schumacher D, Shah N. A Multistakeholder Approach to the Development of Entrustable Professional Activities in Complex Care. Acad Pediatr 2022; 22:184-189. [PMID: 34600114 DOI: 10.1016/j.acap.2021.09.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/01/2021] [Accepted: 09/06/2021] [Indexed: 01/30/2023]
Abstract
BACKGROUND Care of children with medical complexity (CMC) involves unique knowledge, skills, and attitudes. Previous work has identified curricular priorities in complex care for pediatricians yet there are no established competency frameworks to guide curriculum development. We aimed to develop and appraise Entrustable Professional Activities (EPAs) for the care of CMC with multistakeholder involvement. METHODS We recruited complex care practitioners to develop EPAs using a template for elaborating descriptive elements. A team of clinicians, educators, trainees, and family leaders refined EPAs and mapped content to the Accreditation Council for Graduate Medical Education Milestones. We conducted virtual focus groups to assess whether EPAs represented the essential skills of pediatricians caring for CMC. Focus group data were analyzed using content analysis. RESULTS Content experts developed 11 EPAs for the care of CMC describing knowledge, skills, and attitudes required for attaining competency. EPAs were mapped to 21 of the 21 (100%) reporting pediatric milestones. Focus group participants endorsed and refined EPA content. Categories of feedback included clarifying medical knowledge, expanding on interpersonal communication skills, emphasizing systems-based practice, and affirming family partnership. CONCLUSIONS A systematic approach to developing EPAs for the care of CMC provides a guide for curriculum development and assessment in complex care.
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Affiliation(s)
- Kathleen Huth
- Department of Pediatrics, Boston Children's Hospital (K Huth), Boston, Mass; Harvard Medical School, (K Huth), Boston, Mass.
| | - Duncan Henry
- UCSF Pediatric Residency Program, UCSF Benioff Children's Hospital (D Henry), San Francisco, Calif; Department of Pediatrics, University of California San Francisco (D Henry), San Francisco, Ca
| | - Camila Cribb Fabersunne
- UCSF Benioff Children's Hospital (CC Fabersunne), San Francisco, Ca; Department of Pediatrics, University of California San Francisco (CC Fabersunne)
| | - Cara L Coleman
- Family Voices, Inc. (CL Coleman), Lorton, Va; Virginia Commonwealth University School of Medicine (CL Coleman), Richmond, Va
| | - Brigit Frank
- Family Voices of Wisconsin (B Frank), Madison, Wis
| | - Daniel Schumacher
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center (D Schumacher), Cincinnati, Ohio
| | - Neha Shah
- Hospital Medicine Division, Children's National Hospital (N Shah), Washington, DC; The George Washington University, School of Medicine and Health Sciences (N Shah), Washington, DC
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Abstract
OBJECTIVES Although community-acquired pneumonia (CAP) is one of the most common infections in children, no standardized risk classification exists to guide management. The objective of this study was to develop expert consensus for factors associated with various degrees of disease severity in pediatric CAP. METHODS Using a web-based classical Delphi process, a multidisciplinary panel of 10 childhood pneumonia experts rated the degree of severity (mild, moderate, or severe) of clinical, radiographic, and laboratory factors, as well as outcomes relevant to pediatric pneumonia. Round 1 was open-ended, with panelists freely stating all characteristics they felt determined pneumonia severity. In rounds 2 to 4, panelists used a 9-point Likert scale (1-3, mild; 4-6, moderate; 7-9, severe) to rate severity for each item. Consensus was defined as 70% or greater agreement in ranking mild, moderate, or severe. RESULTS Panelists identified 318 factors or outcomes in round 1; the panel reached consensus for 286 (90%). The majority of items without consensus straddled levels of severity (eg, mild-moderate). Notable clinical factors with consensus included age, oxygen saturation, age-based respiratory rate, and gestational age. Severity classification consensus was also reached for specific imaging and laboratory findings. Need for and duration of hospitalization, supplemental oxygen/respiratory support, and intravenous fluids/medications were considered important outcomes in classifying severity. CONCLUSIONS This study presents factors deemed important for risk stratification in pediatric CAP by consensus of a multidisciplinary expert panel. This initial step toward identifying and formalizing severity criteria for CAP informs critical knowledge gaps and can be leveraged in future development of clinically meaningful risk stratification scores.
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Affiliation(s)
- Preston Dean
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center
| | - Daniel Schumacher
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Todd A. Florin
- Division of Emergency Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago
- Department of Pediatrics, North-western University Feinberg School of Medicine, Chicago, IL
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12
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Enkling N, Kokoschka F, Schumacher D, Kraus D, Schimmel M, Abou-Ayash S. Influence of the loading protocol and platform switching in two-implant bar-retained overdentures: 3-year results from a randomized controlled equivalence clinical trial. Clin Oral Implants Res 2021; 33:120-129. [PMID: 34676916 DOI: 10.1111/clr.13872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 10/06/2021] [Accepted: 10/13/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To test the null hypothesis that vertical peri-implant bone level alterations (ΔIBL) are equivalent in immediately (IL) and 3-month post-placement (DL) loaded implants in mandibular implant overdentures (IODs) on two implants. MATERIALS AND METHODS Thirty-two patients receiving two interforaminal implants, one with a platform-switched and one with a platform-matching abutment were randomly assigned to the IL or DL group (allocation ratio 1:1). All implants were primarily splinted with chairside-customized bars, converting the existing removable complete dentures to IODs. Standardized radiographs were recorded. The influence of the loading protocol (IL vs. DL), implant platform (platform switched vs. platform matching), implant site (43 vs. 33), participant age (≤65 vs. >65 years), and definition of baseline (implant placement vs. implant loading) were analyzed, applying linear regression analyses (α = 0.05). The equivalence range was [-0.4; 0.4]. RESULTS Three participants of the IL group were lost during follow-up. The overall mean ΔIBL was -0.96 ± 0.89 mm. The ΔIBL was equivalent in terms of the implant platform and implant site but not in terms of participant age (in favor of more elderly participants) and the loading protocol. A significantly smaller ΔIBL was observed in the IL when the baseline was considered to be implant placement (p = .017), but not when it was considered to be implant loading (p = .084). CONCLUSION Immediate loading of primary-splinted implants in two-implant bar-retained overdentures, seems beneficial relative to loading 3 months post-placement, with respect to ΔIBL. The ΔIBL were equivalent in terms of platform switching.
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Affiliation(s)
- Norbert Enkling
- Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland.,Department of Prosthodontics, Preclinical Education and Dental Materials Science, Medical Faculty, University of Bonn, Bonn, Germany
| | - Franziska Kokoschka
- Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Daniel Schumacher
- Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Dominik Kraus
- Department of Prosthodontics, Preclinical Education and Dental Materials Science, Medical Faculty, University of Bonn, Bonn, Germany
| | - Martin Schimmel
- Division of Gerodontology, Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland.,Division of Gerodontology and Removable Prosthodontics, University of Geneva, Geneva, Switzerland
| | - Samir Abou-Ayash
- Section for Digital Implant- and Reconstructive Dentistry [DIRecD], Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
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13
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Petosa JJ, Martini A, Klein M, Schumacher D. Resident Sensitive Quality Measures for General Pediatrics: Alignment With Existing Care Recommendations. Acad Pediatr 2021; 21:943-947. [PMID: 34051374 DOI: 10.1016/j.acap.2021.04.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 04/11/2021] [Accepted: 04/13/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Resident sensitive quality measures (RSQMs) are a new patient-focused approach to performance assessment. Their alignment with existing performance constructs is underexplored. OBJECTIVE Develop and prioritize RSQMs for outpatient general pediatrics in the areas of well visits (0-2 months, 1, and 5 years) and compare to the existing framework of the Bright Futures recommendations. METHODS Categorical pediatric residents, general academic pediatric fellows, and general pediatric faculty participated in nominal group technique (NGT) and Delphi processes to generate and prioritize RSQMs for 3 different well-child visits of interest. The author team then compared the content of the final RSQMs to the American Academy of Pediatrics Bright Futures recommendations. RESULTS From the list of 143 potential measures from the NGT groups, 15 RSQMs were prioritized for each well-child visit. RSQMs prioritized vaccine administration, documentation of screening, and medication management. Overall, RSQMs mapped well to Bright Futures recommendations. CONCLUSIONS The alignment of the RSQMs with Bright Futures frameworks supports their contribution as process measures for informing resident performance. RSQMs created from this study should be used for future investigations into resident performance assessment and to drive personal improvement efforts.
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Affiliation(s)
- John J Petosa
- Pediatric Residency Training Program, Cincinnati Children's Hospital Medical Center (JJ Petosa), Cincinnati, Ohio.
| | - Abigail Martini
- Division of Pediatric Emergency Medicine, Cincinnati Children's Hospital Medical Center (A Martini and D Schumacher), Cincinnati, Ohio
| | - Melissa Klein
- Division of General Pediatrics and Community Pediatrics, Cincinnati Children's Hospital Medical Center (M Klein), Cincinnati, Ohio; University of Cincinnati College of Medicine (M Klein and D Schumacher), Cincinnati, Ohio
| | - Daniel Schumacher
- Division of Pediatric Emergency Medicine, Cincinnati Children's Hospital Medical Center (A Martini and D Schumacher), Cincinnati, Ohio; University of Cincinnati College of Medicine (M Klein and D Schumacher), Cincinnati, Ohio
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14
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Touchie C, Kinnear B, Schumacher D, Caretta-Weyer H, Hamstra SJ, Hart D, Gruppen L, Ross S, Warm E, Ten Cate O. On the validity of summative entrustment decisions. Med Teach 2021; 43:780-787. [PMID: 34020576 DOI: 10.1080/0142159x.2021.1925642] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Health care revolves around trust. Patients are often in a position that gives them no other choice than to trust the people taking care of them. Educational programs thus have the responsibility to develop physicians who can be trusted to deliver safe and effective care, ultimately making a final decision to entrust trainees to graduate to unsupervised practice. Such entrustment decisions deserve to be scrutinized for their validity. This end-of-training entrustment decision is arguably the most important one, although earlier entrustment decisions, for smaller units of professional practice, should also be scrutinized for their validity. Validity of entrustment decisions implies a defensible argument that can be analyzed in components that together support the decision. According to Kane, building a validity argument is a process designed to support inferences of scoring, generalization across observations, extrapolation to new instances, and implications of the decision. A lack of validity can be caused by inadequate evidence in terms of, according to Messick, content, response process, internal structure (coherence) and relationship to other variables, and in misinterpreted consequences. These two leading frameworks (Kane and Messick) in educational and psychological testing can be well applied to summative entrustment decision-making. The authors elaborate the types of questions that need to be answered to arrive at defensible, well-argued summative decisions regarding performance to provide a grounding for high-quality safe patient care.
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Affiliation(s)
- Claire Touchie
- Medical Council of Canada, Ottawa, Canada
- The University of Ottawa, Ottawa, Canada
| | - Benjamin Kinnear
- Internal Medicine and Pediatrics, University of Cincinnati College of Medicine/Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Daniel Schumacher
- Pediatrics, Hospital Medical Center/University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Holly Caretta-Weyer
- Emergency Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Stanley J Hamstra
- University of Toronto, Toronto, Ontario, Canada
- Accreditation Council for Graduate Medical Education, Chicago, IL, USA
| | - Danielle Hart
- Emergency Medicine, Hennepin Healthcare and the University of Minnesota, Minneapolis, MN, USA
| | - Larry Gruppen
- Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Shelley Ross
- Department of Family Medicine, University of Alberta, Edmonton, AB, Canada
| | - Eric Warm
- University of Cincinnati College of Medicine Center, Cincinnati, OH, USA
| | - Olle Ten Cate
- Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, The Netherlands
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15
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Johnson KD, Schumacher D, Lee RC. Identifying Strategies for the Management of Interruptions for Novice Triage Nurses Using an Online Modified Delphi Method. J Nurs Scholarsh 2021; 53:718-726. [PMID: 34075688 DOI: 10.1111/jnu.12683] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE To use the Delphi Method to identify strategies used by triage nurses to effectively manage interruptions. DESIGN This study was based on the concepts of Benner's Novice to Expert Model. An online, modified Delphi approach was used to engage triage, education, and operational management experts in generating consensus recommendations on successful strategies to address triage interruptions in the emergency department. METHODS AND ANALYSIS A panel of nine triage, education, and operational management experts were selected based on their publication and presentation history. This panel participated in three Delphi rounds, providing individual responses during each round. All responses were entered into a RedCap database, which allowed research team members to synthesize the results and return summaries to the participants. Final consensus was reached among this panel regarding recommendations for successful strategies to address triage interruptions that can be encompassed in a training module. The experts were then asked to identify the best instructional modality for teaching each of the interruption management strategies. FINDINGS Eight strategies to mitigate the impact of interruptions were identified: (a) ensure nurses understand impact of interruptions; (b) ensure nurses understand consequences of interruptions on cognitive demands of healthcare workers that could influence behavior and lead to errors; (c) apologize to current patient before tending to interruption and give expectation of when you will return; (d) triage the interruption and decide to (i) ignore interruption, (ii) acknowledge, but delay servicing, interruption, or (iii) acknowledge and service interruption, delaying completion of interrupted task; (e) identify urgent communication as anything clinically significant that impacts the patient immediately or requires immediate intervention; (f) use focused questions to clarify whether interruption can wait; (g) redirect nonpriority interruptions; and (h) finish safety-critical task or tasks near completion before tending to an interruption. The Delphi participants recommended the best teaching modality was simulation for six of the strategies. CONCLUSIONS Participants agreed that there are strategies that can be taught to novice triage nurses to mitigate the impact of interruptions. The experts in operations management, emergency nursing, and education agree that creating simulations to teach each of these strategies is an effective way to educate nurses. CLINICAL RELEVANCE Interruptions impact the quality of care provided to patients. Training nurses to prevent interruptions and mitigate the impact of interruptions when they occur has the potential to improve patient outcomes.
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Affiliation(s)
- Kimberly D Johnson
- Beta Iota, Associate Professor, College of Nursing, University of Cincinnati, Cincinnati, OH, USA
| | - Daniel Schumacher
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Rebecca C Lee
- Beta Iota, Associate Professor, College of Nursing, University of Cincinnati, Cincinnati, OH, USA
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16
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Luhede L, Besser B, Schumacher D, Wilhelm M, Fritsching U. Continuous Multistep Encapsulation Process for the Generation of Multiple Emulsions. Chem Eng Technol 2020. [DOI: 10.1002/ceat.202000255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Laura Luhede
- Leibniz Institute for Material Engineering Badgasteiner Strasse 3 28359 Bremen Germany
| | - Benjamin Besser
- University of Bremen Advanced Ceramics Group Am Biologischen Garten 2 28359 Bremen Germany
| | - Daniel Schumacher
- University of Bremen Advanced Ceramics Group Am Biologischen Garten 2 28359 Bremen Germany
| | - Michaela Wilhelm
- University of Bremen Advanced Ceramics Group Am Biologischen Garten 2 28359 Bremen Germany
| | - Udo Fritsching
- Leibniz Institute for Material Engineering Badgasteiner Strasse 3 28359 Bremen Germany
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17
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Moni P, Deschamps A, Schumacher D, Rezwan K, Wilhelm M. A new silicon oxycarbide based gas diffusion layer for zinc-air batteries. J Colloid Interface Sci 2020; 577:494-502. [PMID: 32505008 DOI: 10.1016/j.jcis.2020.05.041] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 04/18/2020] [Accepted: 05/14/2020] [Indexed: 02/05/2023]
Abstract
Rational material designs play a vital role in the gas diffusion layer (GDL) by increasing the oxygen diffusion rate and, consequently, facilitating a longer cycle life for metal-air batteries. In this work, a new porous conductive ceramic membrane has been developed as a cathodic GDL for zinc-air battery (ZAB). The bilayered structure with a thickness of 390 μm and an open porosity of 55% is derived from a preceramic precursor with the help of the freeze tape casting technique. The hydrophobic behaviour of the GDL is proved by the water contact angle of 137.5° after the coating of polytetrafluoroethylene (PTFE). The electrical conductivity of 5.59 * 10-3 S/cm is reached using graphite and MWCNT as filler materials. Tested in a ZAB system, the as-prepared GDL coated with commercial Pt-Ru/C catalyst shows an excellent cycle life over 200 cycles and complete discharge over 48 h by consuming oxygen from the atmosphere, which is comparable to commercial electrodes. The as-prepared electrode exhibits excellent ZAB performance due to the symmetric sponge-like structure, which facilitates the oxygen exchange rate and offers a short path for the oxygen ion/-electron kinetics. Thus, this work highlights the importance of a simple manufacturing process that significantly influences advanced ZAB enhancement.
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Affiliation(s)
- Prabu Moni
- University of Bremen, Advanced Ceramics, Am Biologischen Garten 2, IW3, 28359 Bremen, Germany; CSIR-Central Electrochemical Research Institute-Madras Unit, CSIR Madras Complex, Taramani, Chennai 600 113, India
| | - Amanda Deschamps
- University of Bremen, Advanced Ceramics, Am Biologischen Garten 2, IW3, 28359 Bremen, Germany; Department of Materials Engineering, Federal University of Santa Catarina (UFSC), 88040-900 Florianopolis, SC, Brazil
| | - Daniel Schumacher
- University of Bremen, Advanced Ceramics, Am Biologischen Garten 2, IW3, 28359 Bremen, Germany
| | - Kurosch Rezwan
- University of Bremen, Advanced Ceramics, Am Biologischen Garten 2, IW3, 28359 Bremen, Germany; University of Bremen, MAPEX Center for Materials and Processes, Bibliothekstraße 1, 28359 Bremen, Germany
| | - Michaela Wilhelm
- University of Bremen, Advanced Ceramics, Am Biologischen Garten 2, IW3, 28359 Bremen, Germany.
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18
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Anderson B, Reid H, Schumacher D, Alwazzan L. Really Good Stuff Introduction. Med Educ 2020; 54:436-437. [PMID: 32323387 DOI: 10.1111/medu.14130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 02/11/2020] [Accepted: 02/13/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Brownie Anderson
- Medical Education Global Initiatives, National Board of Medical Examiners, Philadelphia, Pennsylvania, USA
| | - Helen Reid
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Daniel Schumacher
- Department of Pediatrics, University of Cincinnati, Cincinnati Children's Hospital, Cincinnati, Ohio, USA
| | - Lulu Alwazzan
- Department of Medical Education, College of Medicine, Al Imam Muhammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
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19
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Kelleher M, Kinnear B, Sall D, Schumacher D, Schauer DP, Warm EJ, Kelcey B. A Reliability Analysis of Entrustment-Derived Workplace-Based Assessments. Acad Med 2020; 95:616-622. [PMID: 31567170 DOI: 10.1097/acm.0000000000002997] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
PURPOSE To examine the reliability and attributable facets of variance within an entrustment-derived workplace-based assessment system. METHOD Faculty at the University of Cincinnati Medical Center internal medicine residency program (a 3-year program) assessed residents using discrete workplace-based skills called observable practice activities (OPAs) rated on an entrustment scale. Ratings from July 2012 to December 2016 were analyzed using applications of generalizability theory (G-theory) and decision study framework. Given the limitations of G-theory applications with entrustment ratings (the assumption that mean ratings are stable over time), a series of time-specific G-theory analyses and an overall longitudinal G-theory analysis were conducted to detail the reliability of ratings and sources of variance. RESULTS During the study period, 166,686 OPA entrustment ratings were given by 395 faculty members to 253 different residents. Raters were the largest identified source of variance in both the time-specific and overall longitudinal G-theory analyses (37% and 23%, respectively). Residents were the second largest identified source of variation in the time-specific G-theory analyses (19%). Reliability was approximately 0.40 for a typical month of assessment (27 different OPAs, 2 raters, and 1-2 rotations) and 0.63 for the full sequence of ratings over 36 months. A decision study showed doubling the number of raters and assessments each month could improve the reliability over 36 months to 0.76. CONCLUSIONS Ratings from the full 36 months of the examined program of assessment showed fair reliability. Increasing the number of raters and assessments per month could improve reliability, highlighting the need for multiple observations by multiple faculty raters.
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Affiliation(s)
- Matthew Kelleher
- M. Kelleher is assistant professor of medicine and pediatrics and associate program director, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio. B. Kinnear is assistant professor of medicine and pediatrics and associate program director, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio. D. Sall is assistant professor of medicine and associate program director, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio. D. Schumacher is associate professor of pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio. D.P. Schauer is associate professor of medicine and associate program director, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio; ORCID: https://orcid.org/0000-0003-3264-8154. E.J. Warm is professor of medicine and program director, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio; ORCID: https://orcid.org/0000-0002-6088-2434. B. Kelcey is associate professor of quantitative research methodologies, Department of Education, University of Cincinnati, Cincinnati, Ohio
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20
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Hurst WJ, Martin RA, Bueno M, Clemente H, DeVries JW, Levi C, Li B, Popovich DJ, Sheeley R, Schumacher D, Stewart K, Taylor J, Toomey P. High Performance Liquid Chromatographic Determination of Carbohydrates in Chocolate: Collaborative Study. J AOAC Int 2020. [DOI: 10.1093/jaoac/63.3.595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
A collaborative study determining sucrose, glucose, fructose, maltose, and lactose in chocolate products was conducted using a previously published high performance liquid chromatographic (HPLC) method. Five samples (2 milk chocolates, 1 dark chocolate, 1 powdered mix, and 1 sirup) were analyzed in duplicate by 7 collaborators. The results indicate adequate method precision. In addition, the HPLC method allows for the simultaneous determination of 5 saccharides in chocolate products in 15 min. The method has been adopted as official first action.
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Affiliation(s)
- W Jeffrey Hurst
- Hershey Foods Corp., Research Laboratories, PO Box 54, Hershey, PA 17033
| | - Robert A Martin
- Hershey Foods Corp., Research Laboratories, PO Box 54, Hershey, PA 17033
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21
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Michelson CD, Dzara K, Ramani S, Vinci R, Schumacher D. Keystone: Exploring Pediatric Residents' Experiences in a Longitudinal Integrated Block. Teach Learn Med 2019; 31:99-108. [PMID: 30303403 DOI: 10.1080/10401334.2018.1478732] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
PROBLEM Residency training in many specialties has traditionally been divided into short, discrete, single-specialty rotations. Although providing the learner with in-depth exposure to a specific discipline, educators have challenged this rotational model, citing problems with patient and team continuity and maladaptive coping. Longitudinal integrated clerkships, adopted by many medical schools, offer an alternative model and have demonstrated improved outcomes for students related to patient-centeredness, advocacy, and integration with teams. Despite this, longitudinal integrated training in residency is rare. INTERVENTION We developed a novel 3-month longitudinal integrated block for residents, called Keystone. The block combined 3 previously discrete, shorter rotations in developmental-behavioral pediatrics, advocacy, and emergency medicine into a longer and integrated experience. Within each week, the block utilized half-day sessions in the resident's primary care clinic, a new continuity Developmental Behavioral Pediatrics clinic where the resident worked with the same faculty preceptor and interprofessional team each week, shifts in the emergency department, and half-day sessions dedicated to clinic- and community-based advocacy activities. CONTEXT The context was a single, large pediatric urban residency program based at 2 university-affiliated hospitals, an academic freestanding children's hospital, and academic safety net hospital. OUTCOME Using a phenomenologic framework, we conducted interviews and a focus group discussion to explore residents' attitudes about the block; their perceptions regarding the block's impact on relationships with preceptors, peers, or patients; and the block's impact on learning and practice. Fourteen residents participated, 10 in interviews and 4 in the focus group discussion. Six themes emerged from thematic analysis: (a) the longitudinal nature of Keystone influenced professional relationships and as a result entrustment, (b) the longitudinal integrated design shaped engagement and learning, (c) flexibility promoted work-life balance and self-directed learning, (d) learners experienced time and space for professional identity development, (e) Keystone provided a unique opportunity to reclaim patient-centeredness, and (f) learners experienced important advantages and challenges related to the schedule. LESSONS LEARNED The longitudinal integrated nature of Keystone provided a novel structure for addressing important yet challenging educational goals in residency, including enhancing relationships, facilitating entrustment and engagement, encouraging patient-centeredness, and emphasizing the importance of self-directed learning.
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Affiliation(s)
- Catherine D Michelson
- a Department of Pediatrics , Boston University School of Medicine , Boston , Massachusetts , USA
| | - Kristina Dzara
- b Department of Pediatrics , Massachusetts General Hospital for Children , Boston , Massachusetts , USA
| | - Subha Ramani
- c Department of Medicine , Brigham and Women's Hospital and Harvard Medical School , Boston , Massachusetts , USA
| | - Robert Vinci
- a Department of Pediatrics , Boston University School of Medicine , Boston , Massachusetts , USA
| | - Daniel Schumacher
- d Division of Emergency Medicine , Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine , Cincinnati , Ohio , USA
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22
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Jahn D, Träger M, Kis M, Brabetz C, Schumacher D, Blažević A, Ciobanu M, Pomorski M, Bonnes U, Busold S, Kroll F, Brack FE, Schramm U, Roth M. Chemical-vapor deposited ultra-fast diamond detectors for temporal measurements of ion bunches. Rev Sci Instrum 2018; 89:093304. [PMID: 30278706 DOI: 10.1063/1.5048667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 09/09/2018] [Indexed: 06/08/2023]
Abstract
This article reports on the development of thin diamond detectors and their characterization for their application in temporal profile measurements of subnanosecond ion bunches. Two types of diamonds were used: a 20 μm thin polycrystalline chemical vapor deposited (CVD) diamond and a membrane with a thickness of (5 ± 1) μm etched out of a single crystal (sc) CVD diamond. The combination of a small detector electrode and an impedance matched signal outlet leads to excellent time response properties with a signal pulse resolution (FWHM) of τ = (113 ± 11) ps. Such a fast diamond detector is a perfect device for the time of flight measurements of MeV ions with bunch durations in the subnanosecond regime. The scCVD diamond membrane detector was successfully implemented within the framework of the laser ion generation handling and transport project, in which ion beams are accelerated via a laser-driven source and shaped with conventional accelerator technology. The detector was used to measure subnanosecond proton bunches with an intensity of 108 protons per bunch.
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Affiliation(s)
- D Jahn
- Institut für Kernphysik, Technische Universität Darmstadt, Schloßgartenstraße 9, D-64289 Darmstadt, Germany
| | - M Träger
- GSI Helmholtzzentrum für Schwerionenforschung, Planckstrasse 1, D-64291 Darmstadt, Germany
| | - M Kis
- GSI Helmholtzzentrum für Schwerionenforschung, Planckstrasse 1, D-64291 Darmstadt, Germany
| | - C Brabetz
- GSI Helmholtzzentrum für Schwerionenforschung, Planckstrasse 1, D-64291 Darmstadt, Germany
| | - D Schumacher
- GSI Helmholtzzentrum für Schwerionenforschung, Planckstrasse 1, D-64291 Darmstadt, Germany
| | - A Blažević
- GSI Helmholtzzentrum für Schwerionenforschung, Planckstrasse 1, D-64291 Darmstadt, Germany
| | - M Ciobanu
- GSI Helmholtzzentrum für Schwerionenforschung, Planckstrasse 1, D-64291 Darmstadt, Germany
| | - M Pomorski
- CEA-LIST, Diamond Sensors Laboratory, Gif-sur-Yvette F-91191, France
| | - U Bonnes
- Institut für Kernphysik, Technische Universität Darmstadt, Schloßgartenstraße 9, D-64289 Darmstadt, Germany
| | - S Busold
- GSI Helmholtzzentrum für Schwerionenforschung, Planckstrasse 1, D-64291 Darmstadt, Germany
| | - F Kroll
- Technische Universität Dresden, Mommsenstr. 13, 01069 Dresden, Germany
| | - F-E Brack
- Technische Universität Dresden, Mommsenstr. 13, 01069 Dresden, Germany
| | - U Schramm
- Technische Universität Dresden, Mommsenstr. 13, 01069 Dresden, Germany
| | - M Roth
- Institut für Kernphysik, Technische Universität Darmstadt, Schloßgartenstraße 9, D-64289 Darmstadt, Germany
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Alwan R, Beydoun A, Schumacher D, Jernigan S, Okay S, Vaughn L. 7.2-O7A qualitative health needs assessment of Syrian Refugees in a Non-traditional City of Migration. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky047.245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- R Alwan
- Cincinnati Children's Hospital and Medical Center, United States
| | - A Beydoun
- University of Cincinnati, United States
| | - D Schumacher
- Cincinnati Children's Hospital and Medical Center, United States
| | | | - S Okay
- University of Cincinnati, United States
| | - L Vaughn
- Cincinnati Children's Hospital and Medical Center, United States
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Schumacher D, Bedacht S, Blažević A, Busold S, Cayzac W, Frank A, Heßling T, Kraus D, Ortner A, Schaumann G, Roth M. Temperature measurement of hohlraum radiation for energy loss experiments in indirectly laser heated carbon plasma. Phys Rev E 2017; 96:043210. [PMID: 29347630 DOI: 10.1103/physreve.96.043210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Indexed: 11/07/2022]
Abstract
For ion energy loss measurements in plasmas with near solid densities, an indirect laser heating scheme for carbon foils has been developed at GSI Helmholtzzentrum für Schwerionenforschung GmbH (Darmstadt, Germany). To achieve an electron density of 10^{22}cm^{3} and an electron temperature of 10-30eV, two carbon foils with an areal density of 100μg/cm^{2} heated in a double-hohlraum configuration have been chosen. In this paper we present the results of temperature measurements of both primary and secondary hohlraums for two different hohlraum designs. They were heated by the PHELIX laser with a wavelength of 527nm and an energy of 150J in 1.5ns. For this purpose the temperature has been investigated by an x-ray streak camera with a transmission grating as the dispersive element.
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Affiliation(s)
- D Schumacher
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, Darmstadt, Germany
| | - S Bedacht
- Technische Universität Darmstadt, Darmstadt, Germany
| | - A Blažević
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, Darmstadt, Germany.,Helmholtzinstitut Jena, Jena, Germany
| | - S Busold
- Technische Universität Darmstadt, Darmstadt, Germany
| | - W Cayzac
- CEA - DAM Ile de France, Bruyères-le-Châtel, France
| | - A Frank
- Helmholtzinstitut Jena, Jena, Germany
| | - T Heßling
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, Darmstadt, Germany
| | - D Kraus
- Helmholtzzentrum Dresden-Rossendorf, Dresden, Germany
| | - A Ortner
- Technische Universität Darmstadt, Darmstadt, Germany
| | - G Schaumann
- Technische Universität Darmstadt, Darmstadt, Germany
| | - M Roth
- Technische Universität Darmstadt, Darmstadt, Germany
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25
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Schumacher D, Matka C, Sachdeva R, Dietrich N, Schlotterer A, Mathar I, Homberg S, Kriebs U, Stettner P, Nawroth PP, Gröne HJ, Hammes HP, Fleming T, Freichel M. Cation channels of the TRPC family contribute to development of nephropathy and retinopathy in the STZ model. DIABETOL STOFFWECHS 2016. [DOI: 10.1055/s-0036-1580892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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26
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Abstract
International data suggest that for-profit nursing homes tend to provide lower quality than not-for-profit nursing homes. In Germany, the relationships between profit orientation, price and quality of nursing homes have not been investigated. We performed an observational study using secondary data from statutory quality audits of all nursing homes in Germany. The relationships were analyzed bivariately via Mann–Whitney U-Test and Kruskal-Wallis Test respectively, followed by a multivariate variance analysis which also covered the interaction effect between quality, price and type of ownership. 41 % of 10,168 German nursing homes were for-profit charging on average about 10 % less than not-for-profit homes. In five out of six quality categories under study, for-profit nursing homes provided lower quality than not-for-profit homes. Quality of care in all quality categories improved with increasing prices per day. However, for four out of six quality categories examined, the quality difference between for-profit and non-profit nursing homes existed independent of the price charged. When selecting a nursing home it is therefore advisable to consider the profit orientation of the institution. German legislation should require that statutory public quality reports contain details on the profit orientation of nursing homes.
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Affiliation(s)
- Max Geraedts
- />Institute for Health Systems Research, School of Medicine, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Strasse 50, 58448 Witten, Germany
| | - Charlene Harrington
- />Department of Social and Behavioral Sciences, University of California, San Francisco, 3333 California St., Suite 410, San Francisco, CA 94143 USA
| | - Daniel Schumacher
- />Institute for Health Systems Research, School of Medicine, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Strasse 50, 58448 Witten, Germany
| | - Rike Kraska
- />Institute for Health Systems Research, School of Medicine, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Strasse 50, 58448 Witten, Germany
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27
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Geraedts M, Harrington C, Schumacher D, Kraska R. [Trade-off between quality, price, and profit orientation in Germany's nursing homes]. Z Evid Fortbild Qual Gesundhwes 2016; 112:3-10. [PMID: 27172779 DOI: 10.1016/j.zefq.2016.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 03/07/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND International data suggest that for-profit nursing homes tend to provide lower quality than not-for-profit nursing homes. In Germany, the relationships between profit orientation, price and quality of nursing homes have not been investigated. METHODS We performed an observational study using secondary data from statutory quality audits of all nursing homes in Germany. The relationships were analyzed bivariately via Mann-Whitney U- and Kruskal-Wallis test, respectively, followed by a multivariate analysis of variance which also covered the interaction effect between quality, price and type of ownership. RESULTS 41% of 10,168 German nursing homes were for-profit organizations charging on average about 10% less than not-for-profit homes. In five out of six quality categories under study, for-profit nursing homes provided lower quality than not-for-profit homes. Quality of care in all quality categories improved with higher cost per day. However, with four out of six quality categories examined, the quality difference between for-profit and non-profit nursing homes persisted, irrespective independently of the price. CONCLUSION When selecting a nursing home it is therefore advisable to consider the profit orientation of the institution. German legislation should require that statutory public quality reports contain details on the profit orientation of nursing homes.
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Affiliation(s)
- Max Geraedts
- Institut für Gesundheitssystemforschung, Fakultät für Gesundheit, Universität Witten/Herdecke, Witten, Germany.
| | - Charlene Harrington
- Department of Social and Behavioral Sciences, University of California, San Francisco, USA.
| | - Daniel Schumacher
- Institut für Gesundheitssystemforschung, Fakultät für Gesundheit, Universität Witten/Herdecke, Witten, Germany.
| | - Rike Kraska
- Institut für Gesundheitssystemforschung, Fakultät für Gesundheit, Universität Witten/Herdecke, Witten, Germany.
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28
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Heeg KP, Ott C, Schumacher D, Wille HC, Röhlsberger R, Pfeifer T, Evers J. Interferometric phase detection at x-ray energies via Fano resonance control. Phys Rev Lett 2015; 114:207401. [PMID: 26047250 DOI: 10.1103/physrevlett.114.207401] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Indexed: 06/04/2023]
Abstract
Modern x-ray light sources promise access to structure and dynamics of matter in largely unexplored spectral regions. However, the desired information is encoded in the light intensity and phase, whereas detectors register only the intensity. This phase problem is ubiquitous in crystallography and imaging and impedes the exploration of quantum effects at x-ray energies. Here, we demonstrate phase-sensitive measurements characterizing the quantum state of a nuclear two-level system at hard x-ray energies. The nuclei are initially prepared in a superposition state. Subsequently, the relative phase of this superposition is interferometrically reconstructed from the emitted x rays. Our results form a first step towards x-ray quantum state tomography and provide new avenues for structure determination and precision metrology via x-ray Fano interference.
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Affiliation(s)
- K P Heeg
- Max-Planck-Institut für Kernphysik, Saupfercheckweg 1, D-69117 Heidelberg, Germany
| | - C Ott
- Max-Planck-Institut für Kernphysik, Saupfercheckweg 1, D-69117 Heidelberg, Germany
| | - D Schumacher
- Deutsches Elektronen-Synchrotron DESY, Notkestrasse 85, 22607 Hamburg, Germany
| | - H-C Wille
- Deutsches Elektronen-Synchrotron DESY, Notkestrasse 85, 22607 Hamburg, Germany
| | - R Röhlsberger
- Deutsches Elektronen-Synchrotron DESY, Notkestrasse 85, 22607 Hamburg, Germany
| | - T Pfeifer
- Max-Planck-Institut für Kernphysik, Saupfercheckweg 1, D-69117 Heidelberg, Germany
| | - J Evers
- Max-Planck-Institut für Kernphysik, Saupfercheckweg 1, D-69117 Heidelberg, Germany
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29
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Heeg KP, Haber J, Schumacher D, Bocklage L, Wille HC, Schulze KS, Loetzsch R, Uschmann I, Paulus GG, Rüffer R, Röhlsberger R, Evers J. Tunable Subluminal Propagation of Narrow-band X-Ray Pulses. Phys Rev Lett 2015; 114:203601. [PMID: 26047228 DOI: 10.1103/physrevlett.114.203601] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Indexed: 06/04/2023]
Abstract
Group velocity control is demonstrated for x-ray photons of 14.4 keV energy via a direct measurement of the temporal delay imposed on spectrally narrow x-ray pulses. Subluminal light propagation is achieved by inducing a steep positive linear dispersion in the optical response of 57Fe Mössbauer nuclei embedded in a thin film planar x-ray cavity. The direct detection of the temporal pulse delay is enabled by generating frequency-tunable spectrally narrow x-ray pulses from broadband pulsed synchrotron radiation. Our theoretical model is in good agreement with the experimental data.
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Affiliation(s)
- Kilian P Heeg
- Max-Planck-Institut für Kernphysik, Saupfercheckweg 1, 69117 Heidelberg, Germany
| | - Johann Haber
- Deutsches Elektronen-Synchrotron DESY, Notkestraße 85, 22607 Hamburg, Germany
| | - Daniel Schumacher
- Deutsches Elektronen-Synchrotron DESY, Notkestraße 85, 22607 Hamburg, Germany
| | - Lars Bocklage
- Deutsches Elektronen-Synchrotron DESY, Notkestraße 85, 22607 Hamburg, Germany
| | | | - Kai S Schulze
- Institut für Optik und Quantenelektronik, Friedrich-Schiller-Universität Jena, Max-Wien-Platz 1, 07743 Jena, Germany
- Helmholtz-Institut Jena, Fröbelstieg 3, 07743 Jena, Germany
| | - Robert Loetzsch
- Institut für Optik und Quantenelektronik, Friedrich-Schiller-Universität Jena, Max-Wien-Platz 1, 07743 Jena, Germany
- Helmholtz-Institut Jena, Fröbelstieg 3, 07743 Jena, Germany
| | - Ingo Uschmann
- Institut für Optik und Quantenelektronik, Friedrich-Schiller-Universität Jena, Max-Wien-Platz 1, 07743 Jena, Germany
- Helmholtz-Institut Jena, Fröbelstieg 3, 07743 Jena, Germany
| | - Gerhard G Paulus
- Institut für Optik und Quantenelektronik, Friedrich-Schiller-Universität Jena, Max-Wien-Platz 1, 07743 Jena, Germany
- Helmholtz-Institut Jena, Fröbelstieg 3, 07743 Jena, Germany
| | - Rudolf Rüffer
- ESRF-The European Synchrotron, CS40220, 38043 Grenoble Cedex 9, France
| | - Ralf Röhlsberger
- Deutsches Elektronen-Synchrotron DESY, Notkestraße 85, 22607 Hamburg, Germany
| | - Jörg Evers
- Max-Planck-Institut für Kernphysik, Saupfercheckweg 1, 69117 Heidelberg, Germany
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30
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Robson J, Henry D, Moses J, Vinci R, Schumacher D. Integrating the learner's perspective in the refinement of competency-based assessments. Acad Pediatr 2015; 15:245-8. [PMID: 25906696 DOI: 10.1016/j.acap.2015.02.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 02/23/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Jacob Robson
- Department of Pediatrics, University of California, San Francisco, Calif.
| | - Duncan Henry
- Department of Pediatrics, University of California, San Francisco, Calif
| | - James Moses
- Department of Pediatrics, Boston Medical Center, Boston, Mass
| | - Robert Vinci
- Department of Pediatrics, Boston Medical Center, Boston, Mass
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31
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Freichel M, Schumacher D, Matka C, Mathar I, Kriebs U, Sachdeva R, Stettner P, Hammes HP, Gröne HJ, Nawroth P, Fleming T. Cation channels of the TRPC family contribute to development of nephropathy and retinopathy in the STZ model. DIABETOL STOFFWECHS 2015. [DOI: 10.1055/s-0035-1549559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Schumacher J, Schumacher D, Salmon M, Diercke M, Czogiel I, Claus H, Gilsdorf A. Erfolgreiche Gesetzesänderung: Meldedaten werden vom Gesundheitsamt schneller an das Robert Koch-Institut übermittelt. Gesundheitswesen 2015. [DOI: 10.1055/s-0035-1546919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Bretschneider T, Kosiek O, Damm R, Schumacher D, Mohnike K, Rogits B, Dudeck O, Ricke J. Sicherheit und Effektivität der CT-gesteuerten Radiofrequenzablation (RFA) in der Behandlung von Lungenmalignomen. ROFO-FORTSCHR RONTG 2014. [DOI: 10.1055/s-0034-1373050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Hicks PJ, Schumacher D, Guralnick S, Carraccio C, Burke AE. Domain of competence: Personal and professional development. Acad Pediatr 2014; 14:S80-97. [PMID: 24602666 DOI: 10.1016/j.acap.2013.11.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 11/05/2013] [Indexed: 11/24/2022]
Affiliation(s)
- Patricia J Hicks
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, The Children's Hospital of Philadelphia, Philadelphia, Pa; Boston Combined Residency Program in Pediatrics, Pediatric Emergency Medicine, Boston Medical Center, Boston, Mass; Graduate Medical Education and Student Affairs, Winthrop University Hospital, and Office of Graduate Medical Education and Student Affairs, and Department of Pediatrics, Winthrop University Hospital, Mineola, NY; Competency-Based Assessment, The American Board of Pediatrics, Chapel Hill, NC; Wright State University Boonshoft School of Medicine, Dayton, Ohio.
| | - Daniel Schumacher
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, The Children's Hospital of Philadelphia, Philadelphia, Pa; Boston Combined Residency Program in Pediatrics, Pediatric Emergency Medicine, Boston Medical Center, Boston, Mass; Graduate Medical Education and Student Affairs, Winthrop University Hospital, and Office of Graduate Medical Education and Student Affairs, and Department of Pediatrics, Winthrop University Hospital, Mineola, NY; Competency-Based Assessment, The American Board of Pediatrics, Chapel Hill, NC; Wright State University Boonshoft School of Medicine, Dayton, Ohio
| | - Susan Guralnick
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, The Children's Hospital of Philadelphia, Philadelphia, Pa; Boston Combined Residency Program in Pediatrics, Pediatric Emergency Medicine, Boston Medical Center, Boston, Mass; Graduate Medical Education and Student Affairs, Winthrop University Hospital, and Office of Graduate Medical Education and Student Affairs, and Department of Pediatrics, Winthrop University Hospital, Mineola, NY; Competency-Based Assessment, The American Board of Pediatrics, Chapel Hill, NC; Wright State University Boonshoft School of Medicine, Dayton, Ohio
| | - Carol Carraccio
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, The Children's Hospital of Philadelphia, Philadelphia, Pa; Boston Combined Residency Program in Pediatrics, Pediatric Emergency Medicine, Boston Medical Center, Boston, Mass; Graduate Medical Education and Student Affairs, Winthrop University Hospital, and Office of Graduate Medical Education and Student Affairs, and Department of Pediatrics, Winthrop University Hospital, Mineola, NY; Competency-Based Assessment, The American Board of Pediatrics, Chapel Hill, NC; Wright State University Boonshoft School of Medicine, Dayton, Ohio
| | - Ann E Burke
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, The Children's Hospital of Philadelphia, Philadelphia, Pa; Boston Combined Residency Program in Pediatrics, Pediatric Emergency Medicine, Boston Medical Center, Boston, Mass; Graduate Medical Education and Student Affairs, Winthrop University Hospital, and Office of Graduate Medical Education and Student Affairs, and Department of Pediatrics, Winthrop University Hospital, Mineola, NY; Competency-Based Assessment, The American Board of Pediatrics, Chapel Hill, NC; Wright State University Boonshoft School of Medicine, Dayton, Ohio
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35
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Kraus D, Vorberger J, Gericke DO, Bagnoud V, Blažević A, Cayzac W, Frank A, Gregori G, Ortner A, Otten A, Roth F, Schaumann G, Schumacher D, Siegenthaler K, Wagner F, Wünsch K, Roth M. Probing the complex ion structure in liquid carbon at 100 GPa. Phys Rev Lett 2013; 111:255501. [PMID: 24483747 DOI: 10.1103/physrevlett.111.255501] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Indexed: 06/03/2023]
Abstract
We present the first direct experimental test of the complex ion structure in liquid carbon at pressures around 100 GPa, using spectrally resolved x-ray scattering from shock-compressed graphite samples. Our results confirm the structure predicted by ab initio quantum simulations and demonstrate the importance of chemical bonds at extreme conditions similar to those found in the interiors of giant planets. The evidence presented here thus provides a firmer ground for modeling the evolution and current structure of carbon-bearing icy giants like Neptune, Uranus, and a number of extrasolar planets.
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Affiliation(s)
- D Kraus
- Institut für Kernphysik, Technische Universität Darmstadt, Schlossgartenstraße 9, 64289 Darmstadt, Germany
| | - J Vorberger
- Max-Planck-Institut für Physik komplexer Systeme, Nöthnitzer Straße 38, 01187 Dresden, Germany
| | - D O Gericke
- Centre for Fusion, Space and Astrophysics, Department of Physics, University of Warwick, Coventry CV4 7AL, United Kingdom
| | - V Bagnoud
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, Planckstraße 1, 64291 Darmstadt, Germany
| | - A Blažević
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, Planckstraße 1, 64291 Darmstadt, Germany
| | - W Cayzac
- Institut für Kernphysik, Technische Universität Darmstadt, Schlossgartenstraße 9, 64289 Darmstadt, Germany and Université de Bordeaux-CEA-CNRS CELIA UMR 5107, 351 Cours de la Libération, 33405 Talence, France
| | - A Frank
- Helmholtz-Institut Jena, Fröbelstieg 3, 07743 Jena, Germany
| | - G Gregori
- Department of Physics, University of Oxford, Parks Road, Oxford OX1 3PU, United Kingdom
| | - A Ortner
- Institut für Kernphysik, Technische Universität Darmstadt, Schlossgartenstraße 9, 64289 Darmstadt, Germany
| | - A Otten
- Institut für Kernphysik, Technische Universität Darmstadt, Schlossgartenstraße 9, 64289 Darmstadt, Germany
| | - F Roth
- Institut für Kernphysik, Technische Universität Darmstadt, Schlossgartenstraße 9, 64289 Darmstadt, Germany
| | - G Schaumann
- Institut für Kernphysik, Technische Universität Darmstadt, Schlossgartenstraße 9, 64289 Darmstadt, Germany
| | - D Schumacher
- Institut für Kernphysik, Technische Universität Darmstadt, Schlossgartenstraße 9, 64289 Darmstadt, Germany
| | - K Siegenthaler
- Institut für Kernphysik, Technische Universität Darmstadt, Schlossgartenstraße 9, 64289 Darmstadt, Germany
| | - F Wagner
- Institut für Kernphysik, Technische Universität Darmstadt, Schlossgartenstraße 9, 64289 Darmstadt, Germany
| | - K Wünsch
- Centre for Fusion, Space and Astrophysics, Department of Physics, University of Warwick, Coventry CV4 7AL, United Kingdom and Tessella, 26 The Quadrant, Abingdon OX14 3YS, United Kingdom
| | - M Roth
- Institut für Kernphysik, Technische Universität Darmstadt, Schlossgartenstraße 9, 64289 Darmstadt, Germany
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Blanchaud F, Schumacher D, Geraedts M. Qualitätsunterschiede in Pflegeheimen zwischen den alten und den neuen Bundesländern. Gesundheitswesen 2013. [DOI: 10.1055/s-0033-1354159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Geraedts M, Blanchaud F, Schumacher D. Qualität von Pflegeheimen in Abhängigkeit von der Trägerschaft. Gesundheitswesen 2013. [DOI: 10.1055/s-0033-1354008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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38
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Heeg KP, Wille HC, Schlage K, Guryeva T, Schumacher D, Uschmann I, Schulze KS, Marx B, Kämpfer T, Paulus GG, Röhlsberger R, Evers J. Vacuum-assisted generation and control of atomic coherences at x-ray energies. Phys Rev Lett 2013; 111:073601. [PMID: 23992063 DOI: 10.1103/physrevlett.111.073601] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Indexed: 06/02/2023]
Abstract
The control of light-matter interaction at the quantum level usually requires coherent laser fields. But already an exchange of virtual photons with the electromagnetic vacuum field alone can lead to quantum coherences, which subsequently suppress spontaneous emission. We demonstrate such spontaneously generated coherences (SGC) in a large ensemble of nuclei operating in the x-ray regime, resonantly coupled to a common cavity environment. The observed SGC originates from two fundamentally different mechanisms related to cooperative emission and magnetically controlled anisotropy of the cavity vacuum. This approach opens new perspectives for quantum control, quantum state engineering and simulation of quantum many-body physics in an essentially decoherence-free setting.
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Affiliation(s)
- Kilian P Heeg
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
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Frank A, Blažević A, Bagnoud V, Basko MM, Börner M, Cayzac W, Kraus D, Hessling T, Hoffmann DHH, Ortner A, Otten A, Pelka A, Pepler D, Schumacher D, Tauschwitz A, Roth M. Energy loss and charge transfer of argon in a laser-generated carbon plasma. Phys Rev Lett 2013; 110:115001. [PMID: 25166546 DOI: 10.1103/physrevlett.110.115001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Indexed: 06/03/2023]
Abstract
This Letter reports on the measurement of the energy loss and the projectile charge states of argon ions at an energy of 4 MeV/u penetrating a fully ionized carbon plasma. The plasma of n(e)≈10(20) cm(-3) and T(e)≈180 eV is created by two laser beams at λ(Las)=532 nm incident from opposite sides on a thin carbon foil. The resulting plasma is spatially homogenous and allows us to record precise experimental data. The data show an increase of a factor of 2 in the stopping power which is in very good agreement with a specifically developed Monte Carlo code, that allows the calculation of the heavy ion beam's charge state distribution and its energy loss in the plasma.
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Affiliation(s)
- A Frank
- Institut für Kernphysik, TU Darmstadt, Schlossgartenstraße 9, Darmstadt D-64289, Germany
| | - A Blažević
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, Planckstraße 1, Darmstadt D-64291, Germany
| | - V Bagnoud
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, Planckstraße 1, Darmstadt D-64291, Germany
| | - M M Basko
- ITEP, B. Cheremushkinskaja 25, Moscow 117259, Russia
| | - M Börner
- Institut für Kernphysik, TU Darmstadt, Schlossgartenstraße 9, Darmstadt D-64289, Germany
| | - W Cayzac
- Institut für Kernphysik, TU Darmstadt, Schlossgartenstraße 9, Darmstadt D-64289, Germany
| | - D Kraus
- Institut für Kernphysik, TU Darmstadt, Schlossgartenstraße 9, Darmstadt D-64289, Germany
| | - T Hessling
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, Planckstraße 1, Darmstadt D-64291, Germany
| | - D H H Hoffmann
- Institut für Kernphysik, TU Darmstadt, Schlossgartenstraße 9, Darmstadt D-64289, Germany
| | - A Ortner
- Institut für Kernphysik, TU Darmstadt, Schlossgartenstraße 9, Darmstadt D-64289, Germany
| | - A Otten
- Institut für Kernphysik, TU Darmstadt, Schlossgartenstraße 9, Darmstadt D-64289, Germany
| | - A Pelka
- Institut für Kernphysik, TU Darmstadt, Schlossgartenstraße 9, Darmstadt D-64289, Germany
| | - D Pepler
- STFC Rutherford Appleton Laboratory, Harwell Oxford OX11 0QX, United Kingdom
| | - D Schumacher
- Institut für Kernphysik, TU Darmstadt, Schlossgartenstraße 9, Darmstadt D-64289, Germany
| | - An Tauschwitz
- Institut für Theoretische Physik, Universität Frankfurt, Max-von-Laue-Strasse 1, Frankfurt 60438, Germany
| | - M Roth
- Institut für Kernphysik, TU Darmstadt, Schlossgartenstraße 9, Darmstadt D-64289, Germany
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Akli KU, Orban C, Schumacher D, Storm M, Fatenejad M, Lamb D, Freeman RR. Coupling of high-intensity laser light to fast electrons in cone-guided fast ignition. Phys Rev E Stat Nonlin Soft Matter Phys 2012; 86:065402. [PMID: 23367996 DOI: 10.1103/physreve.86.065402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Indexed: 06/01/2023]
Abstract
Cu wires attached to Al cones are used to investigate the energy coupling efficiency of laser light to fast electrons through a cone into a dense plasma. We present experimental and simulation results demonstrating the effect on the energy coupling of effectively placing the cone in a surrounding high density plasma as well as the effect of a large preformed plasma inside the cone. Thick cone walls, simulating plasma surrounding the cone in fast ignition, reduce the energy coupling by a factor of up to 4. An increase in prepulse inside the cone by a factor of 50 further reduces coupling by a factor of 3. Simulations with the pic code lsp that include the laser plasma interaction and the preformed plasma from the flash code show that electron refluxing in thin cone-wall targets enhances coupling to the wire. The implications for full-scale cone-guided fast ignition are discussed.
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Affiliation(s)
- K U Akli
- The Ohio State University, Columbus, Ohio 43210, USA
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Englander R, Burke AE, Guralnick S, Benson B, Hicks PJ, Ludwig S, Schumacher D, Johnson L, Carraccio C. The pediatrics milestones: a continuous quality improvement project is launched-now the hard work begins! Acad Pediatr 2012; 12:471-4. [PMID: 23159036 DOI: 10.1016/j.acap.2012.10.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 10/01/2012] [Indexed: 11/29/2022]
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Börner M, Fils J, Frank A, Blažević A, Hessling T, Pelka A, Schaumann G, Schökel A, Schumacher D, Basko MM, Maruhn J, Tauschwitz A, Roth M. Development of a Nomarski-type multi-frame interferometer as a time and space resolving diagnostics for the free electron density of laser-generated plasma. Rev Sci Instrum 2012; 83:043501. [PMID: 22559530 DOI: 10.1063/1.3701366] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
This article reports on the development and set-up of a Nomarski-type multi-frame interferometer as a time and space resolving diagnostics of the free electron density in laser-generated plasma. The interferometer allows the recording of a series of 4 images within 6 ns of a single laser-plasma interaction. For the setup presented here, the minimal accessible free electron density is 5 × 10(18) cm(-3), the maximal one is 2 × 10(20) cm(-3). Furthermore, it provides a resolution of the electron density in space of 50 μm and in time of 0.5 ns for one image with a customizable magnification in space for each of the 4 images. The electron density was evaluated from the interferograms using an Abel inversion algorithm. The functionality of the system was proven during first experiments and the experimental results are presented and discussed. A ray tracing procedure was realized to verify the interferometry pictures taken. In particular, the experimental results are compared to simulations and show excellent agreement, providing a conclusive picture of the evolution of the electron density distribution.
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Affiliation(s)
- M Börner
- Institut für Kernphysik, Technische Universität Darmstadt, Schlossgartenstrasse 9, 64289 Darmstadt, Germany
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Schumacher D. I have been changed for good. J Grad Med Educ 2012; 4:120-1. [PMID: 23451324 PMCID: PMC3312523 DOI: 10.4300/jgme-d-11-00168.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Hessling T, Blažević A, Frank A, Kraus D, Roth M, Schaumann G, Schumacher D, Stöhlker T, Hoffmann DHH. Time- and spectrally resolved measurements of laser-driven hohlraum radiation. Phys Rev E Stat Nonlin Soft Matter Phys 2011; 84:016412. [PMID: 21867327 DOI: 10.1103/physreve.84.016412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Indexed: 05/31/2023]
Abstract
At the GSI Helmholtz center for heavy-ion research combined experiments with heavy ions and laser-produced plasmas are investigated. As a preparation to utilize indirectly heated targets, where a converter hohlraum provides thermal radiation to create a more homogeneous plasma, this converter target has to be characterized. In this paper the latest results of these measurements are presented. Small spherical cavities with diameters between 600 and 750 μm were heated with laser energies up to 30 J at 532-nm wavelength. Radiation temperatures could be determined by time-resolved as well as time-integrated diagnostics, and maximum values of up to 35 eV were achieved.
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Affiliation(s)
- T Hessling
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, Darmstadt, Germany
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Guralnick S, Rushton J, Bale JF, Norwood V, Trimm F, Schumacher D. The response of the APPD, CoPS and AAP to the Institute of Medicine report on resident duty hours. Pediatrics 2010; 125:786-90. [PMID: 20211948 DOI: 10.1542/peds.2009-2149] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
In December 2008, the Institute of Medicine published new recommendations regarding duty hours and supervision of residents' training in the United States. These recommendations evoked immediate concerns from program directors and leadership in all surgical and medical disciplines, including pediatrics. To address these concerns, the Accreditation Council for Graduate Medical Education convened a Duty Hours Congress in Chicago, Illinois, on June 11 and 12, 2009. This report summarizes the opinions and testimony of the organizations (American Academy of Pediatrics, Association of Pediatric Program Directors, and Council of Pediatric Specialties) that were invited to represent pediatrics at the Duty Hours Congress. The American Academy of Pediatrics, the Association of Pediatric Program Directors, and the Council of Pediatric Specialties supported the basic principles of the Institute of Medicine report regarding patient safety, resident supervision, resident safety, and the importance of effective "hand-offs"; however, the organizations opposed additional reductions in resident duty hours given the potential unintended adverse effects on the competency of trainees, the costs of graduate medical education, and the future pediatric workforce. These organizations agreed that additional changes in graduate medical education must be data driven and consider residents within the broader system of health care. The costs and benefits must be carefully analyzed before implementing the Institute of Medicine recommendations.
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Affiliation(s)
- Susan Guralnick
- Association of Pediatric Program Directors, Department of Pediatrics, Stony Brook University Medical Center HSC T11-040, Stony Brook, NY 11794-8111, USA.
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Frank A, Blazević A, Grande PL, Harres K, Hessling T, Hoffmann DHH, Knobloch-Maas R, Kuznetsov PG, Nürnberg F, Pelka A, Schaumann G, Schiwietz G, Schökel A, Schollmeier M, Schumacher D, Schütrumpf J, Vatulin VV, Vinokurov OA, Roth M. Energy loss of argon in a laser-generated carbon plasma. Phys Rev E Stat Nonlin Soft Matter Phys 2010; 81:026401. [PMID: 20365659 DOI: 10.1103/physreve.81.026401] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2008] [Revised: 11/04/2009] [Indexed: 05/29/2023]
Abstract
The experimental data presented in this paper address the energy loss determination for argon at 4 MeV/u projectile energy in laser-generated carbon plasma covering a huge parameter range in density and temperature. Furthermore, a consistent theoretical description of the projectile charge state evolution via a Monte Carlo code is combined with an improved version of the CasP code that allows us to calculate the contributions to the stopping power of bound and free electrons for each projectile charge state. This approach gets rid of any effective charge description of the stopping power. Comparison of experimental data and theoretical results allows us to judge the influence of different plasma parameters.
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Affiliation(s)
- A Frank
- Institut für Kernphysik, Technische Universität Darmstadt, Schlossgartenstrasse 9, 64289 Darmstadt, Germany
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Schumacher D, Sörensen J, Brekkan E, Wassberg C, Malmström P. 794 THE VALUE OF 11C-ACETATE PET FOR LYMPH NODE STAGING IN PATIENTS WITH NEWLY DIAGNOSED PROSTATE CANCER – RESULTS OF A PROSPECTIVE STUDY. ACTA ACUST UNITED AC 2009. [DOI: 10.1016/s1569-9056(09)60782-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Spatz SJ, Rue C, Schumacher D, Osterrieder N. Clustering of mutations within the inverted repeat regions of a serially passaged attenuated gallid herpesvirus type 2 strain. Virus Genes 2008; 37:69-80. [PMID: 18516669 DOI: 10.1007/s11262-008-0242-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2008] [Accepted: 05/05/2008] [Indexed: 11/25/2022]
Abstract
Marek's disease (MD) is the leading cause of losses in chicken production in the world. Over the past 40 years significant progress has been made in the control of MD through the use of vaccines which reduce or delay tumor formation in vaccinated flocks. However, these vaccines fail to induce an immune response that protects against infection and virus shedding. Little is known about the genetic changes that lead to attenuation and are necessary for the generation of vaccine strains. Previous research has demonstrated that serial passage of virulent strains in cell culture results in the generation of attenuated progeny. Obtaining detailed knowledge of the changes which are needed for attenuation will be important for advancing our understanding of MD biology and should facilitate the development of more potent vaccines. We have determined the complete nucleotide sequence of a bacterial artificial chromosome (BAC) construct representing the 80th passage of a very virulent plus (vv+) MD virus strain termed 584A. Pathotyping studies have indicated that this strain (584Ap80) is indeed attenuated. Bioinformatic analysis of the sequencing data has identified numerous gross genetic changes clustering in the inverted repeat regions of the genome, as well as subtle changes (single nucleotide polymorphisms or SNPs) scattered throughout the genome. Relative to the parental strain (584Ap9), insertional mutations were identified in the MD-specific genes encoding RLORF1, RLORF3, RLORF6, 23 kDa, RLORF7 (Meq), vIL8, vLip, RSORF1, and five uncharacterized novel genes. Deletions were found in four locations within the 584Ap80 genome. A large deletion (297nt) was found in the diploid genes 85.6/98.6 and a 321 nt deletion within the intergenic region between the U(L)3 and U(L)3.5 genes is predicted to create a fusion polypeptide. A single nucleotide deletion was identified within the origin of replication. Both insertions and deletions were found in the dipoid genes MDV3.4/78.3 encoding the virulence factor RLORF4. The sequencing of the attenuated strain 584Ap80 and comparison to that of the virulent parent 584A passage 9 (584Ap9) has provided a wealth of information regarding genetic changes which have occurred during the attenuation process.
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Affiliation(s)
- Stephen J Spatz
- Southeast Poultry Research Laboratory, United States Department of Agriculture, Agricultural Research Service, 934 College Station Rd, Athens, GA 30605, USA.
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