Teaching Frailty to Medical Residents: A Needs Assessment Among Geriatrics Faculty.

BACKGROUND: Knowledge of frailty is essential for meeting the Accreditation Council for Graduate Medical Education core competencies for US trainees. The UK General Medical Council requires that frailty be included in undergraduate and graduate medical education curricula. Trainees are expected to appropriately modify care plans and help make patient-centered decisions, while incorporating diagnostic uncertainty, such as frailty, in older adults. Little is known about current needs for frailty instruction in graduate medical education in the US and beyond. OBJECTIVE: We sought to capture faculty perceptions on how frailty should be defined and identified, and what aspects and level of detail should be taught to residents. DESIGN: The authors developed a 4-item short response questionnaire, and faculty had the option to respond via electronic survey or via semi-structured interviews. SETTING AND SUBJECTS: Respondents included 24 fellowship-trained geriatricians based at 6 different academic medical centers in a single urban metropolitan area. METHODS: An invitation to participate in either an electronic survey or semi-structured virtual interview was e-mailed to 30 geriatricians affiliated with an academic multi-campus Geriatric Medicine fellowship. Responses were transcribed and coded independently by two authors. RESULTS: Responses were received from 24 geriatricians via a combination of digital questionnaires (n=18) and semi-structured online interviews (n=6), for a response rate of 80%. Responses revealed significant diversity of opinion on how to define and identify frailty and how these concepts should be taught. CONCLUSIONS: As frailty is increasingly incorporated into clinical practice, consensus is needed on how to define and teach frailty to residents.

Effect of sorption barriers on the radon fluence rate from soil.

The fluence rate of radon from soil as affected by active sorption barriers [activated carbon (AC) and mordenite], soil moisture content, and temperature was measured over a period of 964 d. (To limit the level of radon in indoor environments, an active sorption barrier potentially could be mixed with soil placed adjacent to the substructures of buildings.) AC, mixed with the top layer of soil in columns, markedly reduced the fluence rate of radon from soil over the entire time of the experiment and at all moisture contents and temperatures examined. Mordenite, on the other hand, was not effective in decreasing the fluence rate. AC also has a relatively high sorption capacity for aqueous lead species. (Stable lead isotopes are end-products in the uranium and thorium decay series of which radon isotopes are members.) Thus, the long-term (decades) efficacy of AC in sorbing radon in a soil environment will not be compromised by the blocking of its sorption sites by lead.

Fluence rate of radon from soil: effect of sorption barriers, moisture content, and temperature.

The effects of activated carbon (AC) and mordenite (termed additives here) on the fluence rate of Rn gas from soil over a range of moisture contents and temperatures were examined in an effort to develop mitigation strategies for Rn in indoor environments. It is possible that an additive--an effective sorbent for Rn--could be mixed with the layer of soil placed adjacent to the substructure of buildings during their construction. The following variables and levels within each variable were examined: additive--0, 25, and 50 wt% mixed with the top 20% of the soil in columns; degree of water saturation, S-5, 30, and 55%; and temperature--5, 13, and 21 degrees C. At any level, mordenite was not effective in decreasing the Rn fluence rate from soil. On the other hand, when AC was present at the 25% level (at S = 30% and temperature = 13 degrees C), the fluence rate was about 5 mBq m-2 s-1 compared to approximately 12 mBq m-2 s-1 for the soil with no additive or one containing mordenite. The fluence rate was even less for levels of AC greater than 25%. AC effectively reduced the Rn fluence rate over all moisture contents and temperatures that were examined. The fluence rate increased with increasing moisture content; this was likely due to an increase in the emanation coefficient for Rn with increasing moisture content. The fluence rate increased or decreased with increasing temperature depending on the amount of AC present in the soil. The results indicate the AC may be an effective additive to soil backfill materials to limit the migration of Rn from the soil into buildings.