Effect of Initial Position and Crystallographic Orientation on Grain Selection Procedure in Z-Form Selector for Ni-Based Single-Crystal Superalloy.

The grain selection process in a Z-form selector for Ni-based single-crystal superalloy was simulated using a macro-scale ProCAST software (2013 version) coupled CAFE module combined with an experiment to investigate the grain selection procedure and mechanism with different grain positions and crystal orientation relationships. A non-stationary solidification process was found in the Z-form selector, and the liquid-solid (L-S) interface was tilted in the same direction as the selector channel during directional solidification. Given that the grain boundary was parallel to the Z-form selector, the overgrowth rate of the bi-crystal in the selector channel was very low. The initial position of the bi-crystal in the selector channel has a greater effect on the overgrowth rate than the effects of primary and secondary orientations. The grain selection was a result of the coupling of the competitive grain growth effect and geometrical restriction effect. Finally, the selection grain mechanism within the Z-form selector was discussed, coalescing the temperature field and the grain competition growth mechanism.

Contextual factors in understanding the jumping performance of young football goalkeepers

The aim of this study was to examine the effect of various contextual factors, such as relative age, biological maturation, or competitive level, on the jumping performance of young football goalkeepers. Vertical jump performance was evaluated in a selection of goalkeepers (n = 110) from U-14 and U-16 category teams. The sample was categorized by relative age, biological maturation, and competitive level. The results revealed a trend in the overall sample towards an overrepresentation of goalkeepers born in the early months of the year. Maturity status influenced the most in jumping performance of young goalkeepers (SJ: F = 11.27, p < .001, ηp2 = 0.187; CMJ: F = 8.72, p < .001, ηp2 = 0.162; AJ: F = 8.37, p < .001, ηp2 = 0.146), while the birth quartile had no effect on the jumping performance in the sample. Statistical differences were significant for SJ and CMJ between competitive level groups in the U-14 group only. (F = 5.37, p = .008, ηp2 = 0.186) and CMJ (F = 4.54, p = .016, ηp2 = 0.159). This study showed a greater association between maturation and jumping performance in young football goalkeepers rather than with relative age, which could influence the selection process in this field position at early ages. (AU)

Complex spherical fuzzy Aczel Alsina aggregation operators and their application in assessment of electric cars.

The multi-criteria decision-making (MCDM) tool is a robust decision-making technique utilized in several fields like networking, risk management, digital analysis, cybercrime investigation, artificial intelligence, waste management enterprises and many other selection criteria. Complex SFS (CSFS) is a new edition of the spherical fuzzy set (SFS) that offers substantial information about any item in terms of amplitude and phase terms in a wider range of real terms. Complex SFS (CSFS) can be an extension of the spherical fuzzy set (SFS). The Aczel-Alsina aggregation tools are more appropriate aggregation operators (AOs), and they are used to conquer the impact of inconsistent and uncertain data. In this paper, we reveal some new approaches based on Aczel-Alsina aggregation tools under consideration of Complex Spherical Fuzzy (CSF) information. These new approaches include the CSF Aczel-Alsina weighted average (CSFAWA) operator, and the CSF Aczel-Alsina ordered weighted average (CSFOWA) operator. In addition to this, we also introduce a list of novel techniques by making use of the theory of Aczel-Alsina aggregation tools such as CSF Aczel-Alsina weighted geometric (CSFAWG) and CSF Aczel-Alsina ordered weighted geometric (CSFOWG) operators. To demonstrate the resilience and efficacy of the approaches that have been mentioned, we will examine a few exceptional examples and remarkable properties of the methodology that we have devised. In addition, a characterization is provided for an approach to the MCDM issue using the CPF information system. We use the example of electric automobiles as a case study to illustrate the uniformity and dependability of the methodology that we have established. This example was chosen because of the high cost of fuel and the present economic challenges that are being encountered by families in the middle class. An empirical case study is also constructed to determine an electric car that is desirable based on the techniques that we have proposed. To evaluate the correctness and superiority of the established strategies, we compare the outcomes of previously used techniques with the AOs currently being provided.

Intrinsic signalling factors associated with cancer cell-cell fusion.

Cellular fusion e.g. between cancer cells and normal cells represents a stepwise process that is tightly regulated. During a pre-hybrid preparation program somatic cells and/or cancer cells are promoted to a pro-fusogenic state as a prerequisite to prepare a fusion process. A pro-fusogenic state requires significant changes including restructure of the cytoskeleton, e.g., by the formation of F-actin. Moreover, distinct plasma membrane lipids such as phosphatidylserine play an important role during cell fusion. In addition, the expression of distinct fusogenic factors such as syncytins and corresponding receptors are of fundamental importance to enable cellular mergers. Subsequent hybrid formation and fusion are followed by a post-hybrid selection process. Fusion among normal cells is important and often required during organismal development. Cancer cells fusion appears more rarely and is associated with the generation of new cancer hybrid cell populations. These cancer hybrid cells contribute to an elevated tumour plasticity by altered metastatic behaviour, changes in therapeutic and apoptotic responses, and even in the formation of cancer stem/ initiating cells. While many parts within this multi-step cascade are still poorly understood, this review article predominantly focusses on the intracellular necessities for fusion among cancer cells or with other cell populations of the tumour microenvironment. Video Abstract.

Extracellular Events Involved in Cancer Cell-Cell Fusion.

Fusion among different cell populations represents a rare process that is mediated by both intrinsic and extracellular events. Cellular hybrid formation is relayed by orchestrating tightly regulated signaling pathways that can involve both normal and neoplastic cells. Certain important cell merger processes are often required during distinct organismal and tissue development, including placenta and skeletal muscle. In a neoplastic environment, however, cancer cell fusion can generate new cancer hybrid cells. Following survival during a subsequent post-hybrid selection process (PHSP), the new cancer hybrid cells express different tumorigenic properties. These can include elevated proliferative capacity, increased metastatic potential, resistance to certain therapeutic compounds, and formation of cancer stem-like cells, all of which characterize significantly enhanced tumor plasticity. However, many parts within this multi-step cascade are still poorly understood. Aside from intrinsic factors, cell fusion is particularly affected by extracellular conditions, including an inflammatory microenvironment, viruses, pH and ionic stress, hypoxia, and exosome signaling. Accordingly, the present review article will primarily highlight the influence of extracellular events that contribute to cell fusion in normal and tumorigenic tissues.

Relative age effect among U14 football players in Portugal: do geographical location, team quality and playing position matter?

BACKGROUND: Relative age effect (RAE) has been found to be particularly pronounced between 13 and 15 years of age in male football. However, the extent to which the phenomenon varies within a country demands a more comprehensive approach. PURPOSE: To examine the effects of geographical location (north; centre-north; centre-south; south; islands), team quality (top-ranked; middle-ranked; bottom-ranked) and playing position (goalkeeper; defender; midfielder; forward) on the birthdate distribution (Q1: January-March; Q2: April-June; Q3: July-September; Q4: October-December) of U14 Portuguese players selected for the national inter-association tournament Lopes da Silva. METHODS: A total of 2,693 players (mean age: 14.12 ± 0.38 years), selected by the 22 regional football associations for the last seven editions of the tournament (2013-2019), was included in the sample. RESULTS: Chi-square analysis showed a small-to-medium RAE in the U14 cohort compared to the general Portuguese male population (p < .01). Furthermore, the multinomial logistic regression model revealed that the probabilities of selecting Q1 players (vs. Q4) differed (p < .01) based on geographical location (increases of 76.3% in the north and 87.3% in the centre-north zone compared to the regional teams from islands) and team quality (increase of 94.6% in top-ranked compared to the bottom-ranked teams). The playing position did not affect the magnitude of RAE. CONCLUSION: Our findings confirm that besides being present in U14 Portuguese male football, the magnitude of RAE is influenced by demographic factors. This study also supports the notion that coaching staffs tend to choose players based on attributes associated with chronological age, seeking to achieve short-term competitive outcomes.

Faculty and applicant perceptions of virtual interviews on subspecialty fellowship match in obstetrics and gynecology.

BACKGROUND: In response to COVID-19, the AAMC recommended that hospitals conduct interviews in a virtual setting. OBJECTIVE: To evaluate whether fellowship video conference interviews (VCIs) are an acceptable alternative to in-person interviews from both the applicant and program perspectives. METHODS: Applicants and faculty from a single academic institution with five OBGYN subspecialty fellowship programs were invited to complete surveys regarding their experience using VCIs during the 2020 interview season. Survey responses used a 5-point Likert scale (strongly disagree to strongly agree). Comparative analyses between faculty and applicants responses to survey questions were performed with two-tailed Student's t-tests. RESULTS: 45 faculty members and 131 applicants received the survey. Response rate for faculty members and applicants was 95.6% (n = 43) and 46.6% (n = 61), respectively. Faculty and applicants agreed that the VCIs allowed them to accurately represent themselves (83.7% vs. 88.6%, p = 0.48). Most applicants (62.3%, n = 38) reported a fundamental understanding of the fellowship's culture. The majority of applicants (77.1%, n = 47) and faculty (72.1%, n = 31) agreed that they were able to develop connections during the virtual interview (p = 0.77). Faculty and applicants stated that VCIs assisted them in determining whether the candidate or program, respectively, was a good fit (83.7% vs. 67.2%, p = 0.98). CONCLUSIONS: The VCI fellowship recruitment process allowed OBGYN fellowship applicants and programs to accurately represent themselves compared to in-person interviews. Most applicants and faculty were able to develop relationships over the virtual platform. Although not explicitly assessed, it is possible that the virtual interviews can achieve a suitable match between applicant and program across all OBGYN subspecialty fellowships. The VCI process may be a long-term resolution to minimize both the financial burden and time commitment presented by traditional in-person interviews. Follow-up studies should assess the performance of the virtually selected fellows compared to those selected in previous years using traditional in-person interviews.

Limiting Residency Applications to Dermatology Benefits Nearly Everyone.

With a 34-percent increase in dermatology residency applications in the past decade, residency programs are increasingly faced with the daunting task of reviewing more applications for a relatively fixed number of residency positions. Other specialty programs, including otolaryngology, orthopedics, plastic surgery, and ophthalmology, have called for limiting the number of residency applications. Dermatology programs have developed various ways to decrease the number of reviewed applications, from cutoffs for Step 1 board scores to Alpha Omega Alpha membership to secondary applications. While this can decrease the applicant pool, it limits a more holistic review of applications. We propose an application cap of 20 programs, which will decrease the number of applications each program receives 3- to 5-fold. Each applicant can approach the process more thoughtfully in choosing the best programs for them and will save money in application fees. As program directors rank "perceived interest" in their residency program as a primary factor for selecting applicants, a cap will allow program directors to know that all applicants are interested in their specific program. Ultimately, we contend that application caps would improve match outcomes with applicants receiving training in the best program for them, increasing the likelihood of successful fit for clinical training, opening the field to a more diverse set of applicants, and saving everyone time and money.

Cancer Cell Fusion and Post-Hybrid Selection Process (PHSP).

Fusion of cancer cells either with other cancer cells (homotypic fusion) in local vicinity of the tumor tissue or with other cell types (e.g., macrophages, cancer-associated fibroblasts (CAFs), mesenchymal stromal-/stem-like cells (MSC)) (heterotypic fusion) represents a rare event. Accordingly, the clinical relevance of cancer-cell fusion events appears questionable. However, enhanced tumor growth and/or development of certain metastases can originate from cancer-cell fusion. Formation of hybrid cells after cancer-cell fusion requires a post-hybrid selection process (PHSP) to cope with genomic instability of the parental nuclei and reorganize survival and metabolic functionality. The present review dissects mechanisms that contribute to a PHSP and resulting functional alterations of the cancer hybrids. Based upon new properties of cancer hybrid cells, the arising clinical consequences of the subsequent tumor heterogeneity after cancer-cell fusion represent a major therapeutic challenge. However, cellular partners during cancer-cell fusion such as MSC within the tumor microenvironment or MSC-derived exosomes may provide a suitable vehicle to specifically address and deliver anti-tumor cargo to cancer cells.

On inferring evolutionary stability in finite populations using infinite population models.

Models of evolution by natural selection often make the simplifying assumption that populations are infinitely large. In this infinite population limit, rare mutations that are selected against always go extinct, whereas in finite populations they can persist and even reach fixation. Nevertheless, for mutations of arbitrarily small phenotypic effect, it is widely believed that in sufficiently large populations, if selection opposes the invasion of rare mutants, then it also opposes their fixation. Here, we identify circumstances under which infinite-population models do or do not accurately predict evolutionary outcomes in large, finite populations. We show that there is no population size above which considering only invasion generally suffices: for any finite population size, there are situations in which selection opposes the invasion of mutations of arbitrarily small effect, but favours their fixation. This is not an unlikely limiting case; it can occur when fitness is a smooth function of the evolving trait, and when the selection process is biologically sensible. Nevertheless, there are circumstances under which opposition of invasion does imply opposition of fixation: in fact, for the [Formula: see text]-player snowdrift game (a common model of cooperation) we identify sufficient conditions under which selection against rare mutants of small effect precludes their fixation-in sufficiently large populations-for any selection process. We also find conditions under which-no matter how large the population-the trait that fixes depends on the selection process, which is important because any particular selection process is only an approximation of reality.

Proposal of a New Orange Selection Process Using Sensory Panels and AHP.

Although the consumption of fruits and vegetables is being promoted by different institutions as a key question of public health, their consumption is decreasing and their waste is increasing. To address this situation, we propose to include the consumer's perception of the quality (from a sensory point of view) of a fruit, in particular Valencian oranges, in the supplier's selection process by retailers. To do so, we use a combination of consumer and trained sensory panels and Analytic Hierarchy Process (AHP). This approach is completely novel in the literature. According to the expert panel, the most important criteria when evaluating the quality of an orange are fruity smell, juiciness, sweetness and acidity. These criteria are related to the freshness and taste of the oranges. Consumers found the methodology proposed useful and easy to develop. The application of the AHP methodology has helped to facilitate a participatory discussion among consumers on the concept of the quality of the oranges. The methodology proposed can help the agrifood sector in different ways up and down the supply chain. Specially, it can contribute to better meet consumer's demands, increasing the consumption of fruits and vegetables and reducing its waste.

Reasons for Choice of Antiretroviral Regimens in HIV Patients Presenting Late for Initial Treatment in Europe.

The choice of an optimal antiretroviral therapy (ART) in naive patients presenting late for initial therapy with advanced HIV infection, that is, with a CD4 cell count <200/µL and/or an AIDS-defining disease (late presenters, LPs), is still a challenge, even for HIV specialists. At present, there is little information on the decision process and selection criteria that physicians must take into account when choosing the presumably optimal initial ART for LPs. This study analyzes reasons for the individual choice of first-line ART in HIV LPs. We conducted a prospective multi-center study to analyze the decision-making process of physicians treating naive HIV patients presenting with a CD4 cell count <200/µL and/or an AIDS-defining condition. Two European HIV treatment centers based in Frankfurt (Germany) and A Coruna (Spain) participated in the study. Physicians documented the reasons that led to their decision for a specific first-line ART regimen. A questionnaire was designed for the study. Decisions of the participating physicians were evaluated. A total of 52 treatment decisions were analyzed. Evaluation of the choice of antiretroviral treatment demonstrated that for the overall group of physicians, simplicity of the regimen was the most important selection criterion in 34.6% of cases. The presence of comorbidities was given as the decisive selection criterion in 26.9%, followed by experience with the chosen drugs in 21.2% of cases. In the group of physicians choosing an integrase strand transfer inhibitor (INSTI)-based regimen for first-line ART, the same selection criteria were identified as in the overall group; 33.3% of clinicians selected an INSTI-based regimen because of its simplicity. The presence of comorbidities was the second most frequent decisive criterion (31.0%), followed by personal experience with the prescribed ART (23.8%). In the protease inhibitor group, simplicity was also the most common selection criterion with 40%. Results of clinical trials were stated as the most important criterion for the selection of ART in 38% of all cases, followed by the expected adherence of the patient (22%). Among the physicians who used a non-nucleoside reverse transcriptase inhibitor-based regimen, patients' desire to have children was the most frequent criterion for selection of ART (60%). An ongoing pregnancy was the second most frequent selection criterion, followed by ART's simplicity (8%). For patients treated with a single-tablet regimen, simplicity of ART was comprehensibly the most important decisive criterion (54.5%). Experience with the chosen drugs was the decisive selection criterion in 24.2%, followed by comorbidities in 18.2% of cases. Physicians' selection of individual ART in patients presenting late for first-line treatment seems to be predominantly dependent on patient-centered factors such as adherence issues as well as the clinical experience of physicians with the prescribed drugs.

Selection of right medical students to combat rural shortage of doctors: could it be a solution? In perspective of Bangladesh.

This article was migrated. The article was marked as recommended. This comparative cross-sectional study was conducted to find the association between duration of service in rural health facilities and physicians' background factors to redress geographic imbalances in physician distribution. Among 6898 participants, information of 989 were retrieved from Directorate General of Health Services (DGHS), Minsitry of Health and Family Welfare (MOHFW), Bangladesh, through systematic sampling. Physicians who worked in rural health facilities for less than 3 years were labelled as group A, and those worked 3 years or more in rural places were put in group B. Background factors of two groups were compared and proportion of doctors living and working in rural areas was sorted. Among the participants, eighty percent were working in urban facilities and 50% worked in rural areas for less than three years. Proportion of females was about 30% and there was no significant differences between male and female in terms of duration of stay in rural areas in both groups (p=0.07). The association between place of completion of secondary school certificate (SSC) examination and duration of services in the rural areas were found statistically significant (p=0.003). Apart from this, no other background factors were found to be significantly associated.

Impact of the Tumor Microenvironment on Tumor Heterogeneity and Consequences for Cancer Cell Plasticity and Stemness.

Tumor heterogeneity is considered the major cause of treatment failure in current cancer therapies. This feature of solid tumors is not only the result of clonal outgrowth of cells with genetic mutations, but also of epigenetic alterations induced by physical and chemical signals from the tumor microenvironment (TME). Besides fibroblasts, endothelial and immune cells, mesenchymal stroma/stem-like cells (MSCs) and tumor-associated macrophages (TAMs) intimately crosstalk with cancer cells and can exhibit both anti- and pro-tumorigenic effects. MSCs can alter cancer cellular phenotypes to increase cancer cell plasticity, eventually resulting in the generation of cancer stem cells (CSCs). The shift between different phenotypic states (phenotype switching) of CSCs is controlled via both genetic programs, such as epithelial-mesenchymal transdifferentiation or retrodifferentiation, and epigenetic alterations triggered by signals from the TME, like hypoxia, spatial heterogeneity or stromal cell-derived chemokines. Finally, we highlight the role of spontaneous cancer cell fusion with various types of stromal cells. i.e., MSCs in shaping CSC plasticity. A better understanding of cell plasticity and phenotype shifting in CSCs is a prerequisite for exploiting this phenomenon to reduce tumor heterogeneity, thereby improving the chance for therapy success.

The Intimate Relationship Among EMT, MET and TME: A T(ransdifferentiation) E(nhancing) M(ix) to Be Exploited for Therapeutic Purposes.

Intratumoral heterogeneity is considered the major cause of drug unresponsiveness in cancer and accumulating evidence implicates non-mutational resistance mechanisms rather than genetic mutations in its development. These non-mutational processes are largely driven by phenotypic plasticity, which is defined as the ability of a cell to reprogram and change its identity (phenotype switching). Tumor cell plasticity is characterized by the reactivation of developmental programs that are closely correlated with the acquisition of cancer stem cell properties and an enhanced potential for retrodifferentiation or transdifferentiation. A well-studied mechanism of phenotypic plasticity is the epithelial-mesenchymal transition (EMT). Current evidence suggests a complex interplay between EMT, genetic and epigenetic alterations, and clues from the tumor microenvironment in cell reprogramming. A deeper understanding of the connections between stem cell, epithelial-mesenchymal, and tumor-associated reprogramming events is crucial to develop novel therapies that mitigate cell plasticity and minimize the evolution of tumor heterogeneity, and hence drug resistance. Alternatively, vulnerabilities exposed by tumor cells when residing in a plastic or stem-like state may be exploited therapeutically, i.e., by converting them into less aggressive or even postmitotic cells. Tumor cell plasticity thus presents a new paradigm for understanding a cancer's resistance to therapy and deciphering its underlying mechanisms.

Altered Tumor Plasticity after Different Cancer Cell Fusions with MSC.

While cell fusion demonstrates an important pathway during tissue development and regeneration of distinct organs, this process can also contribute to pathophysiological phenotypes during tumor progression. Hybrid cell formation after heterofusion between cancer cells and various other cell types within the tumor microenvironment is observed in vitro and in vivo. In particular, mesenchymal stroma/stem-like cells (MSC) perform diverse levels of communication with cancer cells by exhibiting anti- and pro-tumorigenic effects. During these cellular interactions, MSC can eventually fuse with cancer cells. Thereby, the newly generated disparate hybrid populations display aneuploidy associated with chromosomal instability. Based upon a subsequent post-hybrid selection process (PHSP), fused cancer cells can undergo apoptosis/necroptosis, senescence, dormancy, or a proliferative state by acquisition of new properties. Consequently, PHSP-surviving hybrid cancer cells demonstrate altered functionalities within the tumor tissue. This is accompanied by changes in therapeutic responsiveness and a different metastatic behavior. Accordingly, enhanced tumor plasticity interferes with successful therapeutic interventions and aggravates patient prognoses. The present review article focusses on fusion of MSC with different human cancer cells, in particular breast cancer populations and resulting characteristics of various cancer hybrid cells. Moreover, some mechanisms of cancer cell fusion are discussed together with multiple PHSP pathways.

The 'nuts and bolts' of including service users and carers in the recruitment of health and social work students in an English university-An interdisciplinary critique.

BACKGROUND: The literature regarding inclusion of service users and carers (SUACs) in the recruitment processes for future health and social work professionals has primarily presented such inclusion as positive for all. This study is novel in its exploration of the detail of SUACs' involvement and in its reach across a whole university department of health and social care disciplines. OBJECTIVE: To examine the detail of ways in which SUACs were actually involved in student selection and whether they have any real influence on recruitment decisions. METHOD: This co-produced study took place in an English university. A qualitative, semi-structured interviewing approach was undertaken with 12 staff across social work, nursing, occupational therapy, physiotherapy, paramedicine and physician associate disciplines. Thematic analysis was employed independently with both researchers agreeing resultant themes. FINDINGS: A range of recruitment activities which included SUACs were found, evidencing both full and partial involvement in decision making. Nine themes emerged-The quality of SUACs' inclusion; Understanding reasons for including SUACs; SUACs being more knowledgeable than academic staff; SUACs influencing final decisions; The high expectations of candidates by SUACs; SUACs' need for training; Marketization and scepticism; and Logistics and the presumption of ableism. CONCLUSIONS: Transparent protocols are essential if SUACs are to be equitably included in student recruitment processes. A shared model of SUACs' inclusion should be attainable across disciplines, even if the 'nuts and bolts' of recruitment processes vary. PATIENT OR PUBLIC CONTRIBUTION: This work was co-produced with a SUACs' group from conception and design through to fieldwork and write-up.

Prosthodontic Resident Selection by Postdoctoral Dental Matching Program: A National Survey by Participating Program Director.

PURPOSE: The purpose of this study was to obtain information about the resident selection and Match process that occurred for the Commission on Dental Accreditation (CODA)-accredited Advanced Education in Prosthodontics program in North America from the program directors' perspective, after the first year of implementation. MATERIALS AND METHODS: The list of Advanced Education in Prosthodontics program in CODA-accredited North American institutions was obtained from the ACP central office, and the directors of each program were identified. The surveys were distributed to 48 program directors online and results were compiled. RESULTS: Out of 48 programs, 43 directors responded to and completed the survey (90.0%), where 35 programs participated in the Match process, 5 did not, and 3 were omitted due to incomplete surveys. While the majority of programs did not see any changes in their applicant pool or their quality, 10 programs (25.0%) observed a number of increases in the application and 13 programs (32.5%) observed an increase in the quality of the applications. Among the 35 programs that participated in the Match process, the main reasons for their participation were "fairness" (48.2%), "did not want to keep moving up interview dates" (23.2%), and "have applicants come to interview as planned" (21.4%). Thirty-three programs reported that 75% to 100% of the invited applicants came to the interview (76.7%). The majority of programs that participated in Match expressed satisfaction with the process (29/33, 80.6%). Sixteen programs (45.7%) reported that they matched with 100% of their first selections. CONCLUSION: Overall response of reintroduction of the Match process for advanced prosthodontic resident selection was very positive for majority of the program directors.

Reducing the length of clinic visits: A process analysis case report.

Because the University of Houston Student Health Center often had more demand for services than available appointments, the aim of this study was to streamline their clinic visit process. While appointments were scheduled for 20 minutes, the clinic's patient visit cycle time (from check-in to check-out) averaged 70 minutes. This report demonstrats how to perform process analysis using failure modes and effects analysis in order to identify the highest priority cause of waste and how to conduct a detailed evaluation of ideas using a prioritization matrix in order to select the best solution to help streamline a process. Analysis of this clinic's visit process identified that patients (mostly international students) asking many questions during their appointment regarding issues not directly related to their care led to long clinic visits. To address this issue, the clinic recruited a team of international students to create a frequently asked questions video with answers, and the final video was then uploaded to the clinic's Facebook page. Comparing before and after the video was posted showed the clinic's average time for a clinic visit was reduced by more than 15%, and it was able to accommodate nearly 100 additional patient visits per month.

What Do Program Directors Look for in an Applicant?

Program directors (PDs) are faced with an increasing number of applicants to emergency medicine (EM) and a limited number of positions. This article will provide candidates with insight to what PDs look for in an applicant. We will elaborate on the performance in the emergency medicine clerkship, interview, clinical rotations (apart from EM), board scores, Alpha Omega Alpha membership, letters of recommendation, Medical Student Performance Evaluation or dean's letter, extracurricular activities, Gold Humanism Society membership, medical school attended, research and scholarly projects, personal statement, and commitment to EM. We stress the National Resident Matching Program process and how, ultimately, selection of a residency is equally dependent on an applicant's selection process.