Disabled People or Their Support Persons' Perceptions of a Community Based Multi-Sensory Environment (MSE): A Mixed-Method Study.

Multi-sensory environments (MSEs) are specialised spaces purposely designed to stimulate the senses, whilst providing a calming and relaxing environment for leisure and enjoyment, predominantly intended for disabled people. Most MSEs are in institutions, hospitals, or educational settings, with a few in community-based settings. We explored disabled users' experiences of a community based MSE in a large metropolitan area in New Zealand, with a view to expanding access to MSE-type environments within the area. We used a convergent mixed method design with a web-based electronic survey (e-survey; n = 105), as well as semi-structured interviews (n = 14) with disabled MSE users (adults and children), who were supported, where necessary, by their support person/s. We collected the MSE users' demographics, frequency of use with respect to age, disability, and ethnicity, and experiences of the room, equipment, and accessibility. The participants and their support persons' perspectives about their experiences of using the MSE were represented by four themes: (i) Self-determination; (ii) Enhancing wellbeing opportunities; (iii) the MSE itself; (iv) Accessibility. While the MSE was considered positively, the MSE experience could be enhanced by addressing access challenges and broadening the scope of equipment to improve the usability and make it a more inclusive environment for all.

The connections place: a job preparedness program for individuals with borderline personality disorder.

This article describes a pilot project that provided a job preparedness program specifically designed for individuals who suffer from borderline personality disorder (BPD). The program called "The Connections Place" or "TCP" was based on a 16-week curriculum that focused on both helping individuals with BPD overcome emotional barriers to employment and preparing these individuals to enter/reenter the work world. Ninety clients were enrolled in the pilot project that was conducted over three and one-half years. Almost all participants (n = 54) who completed at least 1 month of the program made significant strides in the following areas: obtained employment or achieved a similar goal (48 %), notably improved their job preparedness (22 %), or made some/limited progress toward job preparedness (26 %). These preliminary findings support the potential effectiveness of job preparedness programs targeted to individuals with BPD.

Phase behavior of CO2 in room-temperature ionic liquid 1-ethyl-3-ethylimidazolium acetate.

Carbon dioxide solubility (vapor-liquid equilibria: VLE) in an ionic liquid, 1-ethyl-3-ethylimidazolium acetate ([eeim][Ac]) was measured using a gravimetric microbalance at four isotherms (about 283, 298, 323, and 348 K) up to about 2 MPa. An equation-of-state (EOS) model was used to analyze the VLE data and has predicted vapor-liquid-liquid equilibria (VLLE: or liquid-liquid separations) in CO(2)-rich solutions. The VLLE prediction was confirmed experimentally using a volumetric method and likely the liquid-liquid equilibria will intersect with the solid-liquid equilibria such that no lower critical solution temperature can exist and the binary system may be classified as Type III phase behavior. Carbon dioxide solubility in the ionic-liquid-rich solution show extremely unusual behavior. CO(2) dissolves in the ionic liquid at large concentrations (up to about 20 mole % of CO(2)) with almost no vapor pressure above the mixtures. This result is similar to our previous findings with 1-butyl-3-methylimidazolium acetate ([bmim][Ac]) and 1-ethyl-3-methylimidazolium acetate ([emim][Ac]). In all three cases the CO(2) forms a molecular complex (or chemical reaction) with the ionic liquid. (13)C NMR spectroscopy has identified the structure for CO(2) absorbed in [eeim][Ac] to be [eeim]-2-carboxylate. Addition of water to the carboxylate leads to the dissolution of CO(2). The thermodynamic excess properties (enthalpy, entropy, and Gibbs energy) for all three systems have been calculated using the EOS and support the complex formation of the type AB(2) (where A is CO(2) and B is ionic liquid). Isothermal differential scanning calorimetry has verified the heat of reaction calculations and found for CO(2) absorbing in [emim][Ac], [eeim][Ac] and [bmim][Ac] to be about -38 kJ mol(-1). Additional experiments have examined the effect of water on the density, viscosity and CO(2) solubility in [eeim][Ac] and the CO(2) solubility in mixtures of [eeim][Ac] with other acetate salts.

Resident and program director gender distribution by specialty.

BACKGROUND: Although enrollment of women in U.S. medical schools has increased, women remain less likely to achieve senior academic rank, lead academic departments, or be appointed to national leadership positions. The purpose of this paper is to compare the gender distribution of residency program directors (PDs) with residents and faculty in the 10 largest specialties. METHODS: The gender distribution of residents training in the 10 specialties with the largest enrollment was obtained from the annual education issue of Journal of the American Medical Association. The gender distribution of the residents was compared with the gender distribution of PDs and medical school faculty. The number of programs and the names of the PDs were identified by accessing the Accreditation Council for Graduate Medical Education web site. Gender was confirmed through electronic search of state medical board data, program web sites, or by using internet search engines. The gender distribution of medical school faculty was determined using the Association of American Medical Colleges faculty roster database (accessed June 15, 2011). The correlation between female residents and PDs was assessed using Pearson's product-moment correlation. The gender distribution of female PDs appointed June 1, 2006, through June 1, 2010, was compared with the distribution appointed before June 1, 2006, using chi square analysis. RESULTS: Specialties with higher percentages of female PDs had a higher percentage of female residents enrolled (r=0.81, p=0.005). The number of female PDs appointed from July 1, 2006, through June 30, 2010, was greater than the number appointed before July 1, 2006, in emergency medicine (p<0.001), family medicine (p=0.02), and for all PDs (p=0.005). Female PDs were fewer than expected based on the gender distribution of medical school faculty in 7 of the 10 specialties. CONCLUSIONS: Women remain underrepresented in PD appointments relative to the proportion of female medical school faculty and female residents. Mechanisms to address gender-based barriers to advancement should be considered.

Characteristics of anesthesiology residency program directors.

The roles and responsibilities of anesthesiology core program directors have evolved, in part because the Anesthesiology Residency Review Committee of the Accreditation Council for Graduate Medical Education no longer requires that the department chair also serve in this role. We reviewed several core anesthesiology program director academic and demographic characteristics including age, academic rank, gender, duration of service, board certification and re-certification status, and whether the program director also serves as department chair. Anesthesiology core residency program directors range in age from 33 to 74 years, with a median of 52 years. Thirty-seven (28%) program directors are women. The majority (67%) have senior academic rank (professor or associate professor). The median appointment duration is 3.7 years. The core residency program director currently also serves as department chair in 24 of the 131 (18.3%) programs.

A historical perspective on resident evaluation, the Accreditation Council for Graduate Medical Education Outcome Project and Accreditation Council for Graduate Medical Education duty hour requirement.

BACKGROUND: The Accreditation Council for Graduate Medical Education (ACGME) Outcome Project, endorsed at the 1999 ACGME annual meeting, was intended to shift the focus of residency program requirements and accreditation from process-oriented assessment to an assessment of outcomes. The Outcome Project established six general competencies, each of which is supported by more specific competencies. METHODS: We compared contemporary resident evaluation based on the Outcome Project to faculty evaluation of a surgical resident at Mayo Clinic that was completed in 1917. RESULTS: The contemporary faculty assessment of resident performance was remarkably similar to the evaluation form and criteria used in 1917. All six general competencies, and nearly all of the more specific items listed under each general competency, were included in the 1917 evaluation. Duty hour data as a component of the 1917 resident evaluation included the number of hours per week spent in "practical work," "medical library," and "research work." CONCLUSIONS: The remarkable similarities between the qualities assessed in the 1917 evaluation and the assessment of contemporary ACGME competencies suggest that a common set of desirable physician characteristics and behaviors can be identified and measured.

Anesthetic care of the trauma patient: development of a Web-based resource.

Adequate preparation by anesthesia providers promotes quality care and decreases the likelihood of morbidity and mortality. Unfortunately, many trauma cases occur after hours when support resources are less readily available. At a large midwest academic medical center, it was determined that a website on the institution's Intranet relating to anesthetic care of trauma patients would be a readily accessible, user-friendly resource for improved care. In recent years, media tools such as computers have become increasingly popular and accessible as effective learning tools. A comprehensive literature search was completed on anesthetic care of trauma patients and on adult and Web-based learning principles. Information was gathered from textbooks, research journals, existing web links on the institution's intranet, and staff at the medical center. Assistance was obtained from the institution's Internet/website Development Department for creation of the website. The information was placed on the institution's Intranet. The web page contains 17 subject categories, including initial considerations, common trauma drugs, circulation and fluid resuscitation, management of pregnant trauma patients, and intraoperative death. It is our goal that the systematic developmental process described in this article may provide a model for other institutions wanting to develop websites.

The impact of parental leave on extending training and entering the board certification examination process: a specialty-based comparison.

OBJECTIVE: To study the impact of parental leave on extending residency training and the timing of entrance into the specialty board certification examination system. METHODS: From June 3, 2005, through December 28, 2005, primary specialty board policies regarding parental leave, absence from training, and the timing of entrance into the board certification examination process were reviewed for all American Board of Medical Specialties programs with a national enrollment of more than 100 residents. The impact of a 6-week parental leave on extending training and qualifying to enter the board certification examination system was compared among these specialties. RESULTS: All specialty boards studied, except for the American boards of neurosurgery, ophthalmology, psychiatry, neurology, and thoracic surgery, have defined limits on absences from training. The limits on absence from training among the 21 other residency programs studied are generally similar, but important differences exist. These differences include the maximum length of time away from training per year, whether absence from training can accumulate year to year, and whether the length of time away from training is consistent for each postgraduate year of the training program. The impact of a 6-week parental leave on qualifying for the board certification examination system on schedule varies from no impact to delaying entrance for 1 year. CONCLUSION: Specialty board policies regarding absence from training and entering the board certification examination process vary and could influence decisions about family planning, the length of time taken for parental leave, the use of vacation time for parental leave, and resident well-being.

Trends in gender distribution among anesthesiology residents: do they matter?

BACKGROUND: The number of women graduating from United States medical schools progressively increased during the 26 yr period from 1978 to 2004. This change was associated with shifts in the gender distribution of residents training in Accreditation Council for Graduate Medical Education-accredited residency programs. METHODS: We compared trends in the number and gender distribution of residents enrolled in the 10 specialties with the largest national enrollment of residents. RESULTS: The gender distribution of residents training in different specialty programs varies widely. The percentage of women enrolled in anesthesiology training programs is less than the national average, and the rate of increase is less than that of many other specialties. CONCLUSIONS: The reasons for this distribution are multifactorial. Contributing factors may include limited exposure to women role models (including fewer women with senior academic rank and in leadership positions), gender insensitivity leading to an unprofessional work environment, limited involvement of women anesthesiologists in undergraduate medical education, misperceptions of the physician-patient relationship in anesthesiology, and practice scheduling requirements that are inconsistent and inflexible.

Lung isolation, one-lung ventilation, and continuous positive airway pressure with air for radiofrequency ablation of neoplastic pulmonary lesions.

Radiofrequency ablation (RFA) is an emerging therapy that is increasingly being used for the treatment of many different types of tumors. RFA uses percutaneously placed image-guided probes to destroy tissues through localized heating. Injury to adjacent tissues with significant morbidity during RFA has been reported in the literature. We discuss our anesthetic management of patients undergoing RFA of lung tumors. Lung isolation, one-lung ventilation, and nondependent lung continuous positive airway pressure with air can be used to minimize damage to the heart and other important structures.

Modeling oncogenic translocations: distinct roles for double-strand break repair pathways in translocation formation in mammalian cells.

Reciprocal chromosomal translocations are implicated in the etiology of many tumors, including leukemias, lymphomas, and sarcomas. DNA double-strand breaks (DSBs) caused by various cellular processes and exogenous agents are thought to be responsible for the generation of most translocations. Mammalian cells have multiple pathways for repairing DSBs in the chromosomes: non-homologous end-joining (NHEJ), homologous recombination (HR), and single-strand annealing (SSA), which is a specialized pathway involving sequence repeats. In this review, we summarize the various reporters that have been used to examine the potential for each of these DSB repair pathways to mediate translocation formation in mammalian cells. This approach has demonstrated that NHEJ is very proficient at mediating translocation formation, while HR is not because of crossover suppression. Although SSA can efficiently mediate translocations between identical repeats, its contribution to translocation formation is likely very limited because of sequence divergence between repetitive elements in the genome.

A model of oncogenic rearrangements: differences between chromosomal translocation mechanisms and simple double-strand break repair.

Recurrent reciprocal translocations are present in many hematologic and mesenchymal malignancies. Because significant sequence homology is absent from translocation breakpoint junctions, non-homologous end-joining (NHEJ) pathways of DNA repair are presumed to catalyze their formation. We developed translocation reporters for use in mammalian cells from which NHEJ events can be selected after precise chromosomal breakage. Translocations were efficiently recovered with these reporters using mouse cells, and their breakpoint junctions recapitulated findings from oncogenic translocations. Small deletions and microhomology were present in most junctions; insertions and more complex events also were observed. Thus, our reporters model features of oncogenic rearrangements in human cancer cells. A homologous sequence at a distance from the break site affected the translocation junction without substantially altering translocation frequency. Interestingly, in a direct comparison, the spectrum of translocation breakpoint junctions differed from junctions derived from repair at a single chromosomal break, providing mechanistic insight into translocation formation.

Chromosomal translocation mechanisms at intronic alu elements in mammalian cells.

Repetitive elements comprise nearly half of the human genome. Chromosomal rearrangements involving these elements occur in somatic and germline cells and are causative for many diseases. To begin to understand the molecular mechanisms leading to these rearrangements in mammalian cells, we developed an intron-based system to specifically induce chromosomal translocations at Alu elements, the most numerous family of repetitive elements in humans. With this system, we found that when double-strand breaks (DSBs) were introduced adjacent to identical Alu elements, translocations occurred at high frequency and predominantly arose from repair by the single-strand annealing (SSA) pathway (85%). With diverged Alu elements, translocation frequency was unaltered, yet pathway usage shifted such that nonhomologous end joining (NHEJ) predominated as the translocation pathway (93%). These results emphasize the fluidity of mammalian DSB repair pathway usage. The intron-based system is highly adaptable to addressing a number of issues regarding molecular mechanisms of genomic rearrangements in mammalian cells.

Latex allergy: the perspective from the surgical suite.

Latex allergy in the perioperative setting presents unique challenges to the health care system. Specific needs of the latex-sensitive patient are paramount, but consideration must also include the impact on health care workers vis-a-vis latex sensitization, environmental allergen control, and barrier protection against blood-borne pathogens. It has been well documented that the greatest source of latex aeroallergen in the surgical setting is latex gloves (both sterile and nonsterile). Levels of latex aeroallergen correlate strongly with use of high-allergen and powdered gloves, total number of gloves used, and the hours of activity in a given environment. A significant reduction in aeroallergen (>10-fold) can be achieved by switching to low-allergen gloves. Ready availability of and encouragement to use nonlatex alternatives when appropriate can further reduce exposure to latex allergens. Since 1998, the Food and Drug Administration has required all medical devices (or their packaging) that contain natural rubber latex to be so labeled. In addition, industry has responded with a host of latex-free products for use in patient care. This has helped eliminate a great deal of confusion about which products are safe for use with latex-sensitive individuals. However, despite significant efforts to educate the public and the health care industry regarding latex allergies, considerable misinformation persists. Provision of a completely latex-free environment in most surgical suites may be unrealistic, but every effort should be made to minimize the unnecessary exposure of patients and health care workers to latex allergens in this high-risk arena.