Clinical Neurophysiology Fellowship Program Directors Survey on a Standardized Fellowship Match Process: A Call for Action.

PURPOSE: To survey US Clinical Neurophysiology (CNP) fellowship program directors on the nature of CNP and related training programs, current recruitment cycle, and views for a standardized process. METHODS: A 23-question electronic survey was sent to all 93 US Accreditation Council for Graduate Medical Education-accredited CNP fellowship program directors from December 2020 to January 2021. RESULTS: The response rate was 60%. There was great variability in the number of CNP positions and CNP tracks offered. The following tracks were identified: 48% EEG dominant, 26% EMG dominant, 22% split equally between EEG and EMG, and 2% and 1% were neurophysiologic intraoperative monitoring and autonomic dominant, respectively. Of the responding institutions, 43% offered a second year of training options to CNP fellows, mainly in conjunction with Epilepsy fellowship, which was pursued by 25% of CNP fellows. Many programs indicated flexibility in their design between different CNP tracks or between CNP and other related training programs based on the available candidates. The median percentage of CNP fellowship positions filled over the last 5 years was 80%, and there was great variation in the recruitment timeline across institutions. Overall, 86% of program directors favored a universal timeline and 71% favored a formal match for CNP. The respondents were split between an independent CNP match (39%) and joining the initiatives of affiliate societies on a standardized process (61%). CONCLUSIONS: There is significant heterogeneity in the makeup of the CNP fellowship programs and the recruitment process. The majority of CNP program directors are in favor of standardization of the recruitment process.

Comparing two sampling methods to engage hard-to-reach communities in research priority setting.

BACKGROUND: Effective community-partnered and patient-centered outcomes research needs to address community priorities. However, optimal sampling methods to engage stakeholders from hard-to-reach, vulnerable communities to generate research priorities have not been identified. METHODS: In two similar rural, largely Hispanic communities, a community advisory board guided recruitment of stakeholders affected by chronic pain using a different method in each community: 1) snowball sampling, a chain- referral method or 2) purposive sampling to recruit diverse stakeholders. In both communities, three groups of stakeholders attended a series of three facilitated meetings to orient, brainstorm, and prioritize ideas (9 meetings/community). Using mixed methods analysis, we compared stakeholder recruitment and retention as well as priorities from both communities' stakeholders on mean ratings of their ideas based on importance and feasibility for implementation in their community. RESULTS: Of 65 eligible stakeholders in one community recruited by snowball sampling, 55 (85 %) consented, 52 (95 %) attended the first meeting, and 36 (65 %) attended all 3 meetings. In the second community, the purposive sampling method was supplemented by convenience sampling to increase recruitment. Of 69 stakeholders recruited by this combined strategy, 62 (90 %) consented, 36 (58 %) attended the first meeting, and 26 (42 %) attended all 3 meetings. Snowball sampling recruited more Hispanics and disabled persons (all P < 0.05). Despite differing recruitment strategies, stakeholders from the two communities identified largely similar ideas for research, focusing on non-pharmacologic interventions for management of chronic pain. Ratings on importance and feasibility for community implementation differed only on the importance of massage services (P = 0.045) which was higher for the purposive/convenience sampling group and for city improvements/transportation services (P = 0.004) which was higher for the snowball sampling group. CONCLUSIONS: In each of the two similar hard-to-reach communities, a community advisory board partnered with researchers to implement a different sampling method to recruit stakeholders. The snowball sampling method achieved greater participation with more Hispanics but also more individuals with disabilities than a purposive-convenience sampling method. However, priorities for research on chronic pain from both stakeholder groups were similar. Although utilizing a snowball sampling method appears to be superior, further research is needed on implementation costs and resources.

Effectiveness of three interventions to improve participation in colorectal cancer screening.

BACKGROUND AND OBJECTIVE: Participation in colorectal cancer (CRC) screening varies widely among different countries and different socio-demographic groups. Our objective was to assess the effectiveness of three primary-care interventions to increase CRC screening participation among persons over the age of 50 years and to identify the health and socio-demographic-related factors that determine greater participation. METHODS: We conducted a randomized experimental study with only one post-test control group. A total of 1,690 subjects were randomly distributed into four groups: written briefing; telephone briefing; an invitation to attend a group meeting; and no briefing. Subjects were evaluated 2 years post-intervention, with the outcome variable being participation in CRC screening. RESULTS: A total of 1,129 subjects were interviewed. Within the groups, homogeneity was tested in terms of socio-demographic characteristics and health-related variables. The proportion of subjects who participated in screening was: 15.4% in the written information group (95% confidence interval [CI]: 11.2-19.7); 28.8% in the telephone information group (95% CI: 23.6-33.9); 8.1% in the face-to-face information group (95% CI: 4.5-11.7); and 5.9% in the control group (95% CI: 2.9-9.0), with this difference proving statistically significant (p < 0.001). Logistic regression showed that only interventions based on written or telephone briefing were effective. Apart from type of intervention, number of reported health problems and place of residence remained in the regression model. CONCLUSIONS: Both written and telephone information can serve to improve participation in CRC screening. This preventive activity could be optimized by means of simple interventions coming within the scope of primary health-care professionals.

Effectiveness of three interventions in improving adherence to cervical cancer screening.

In countries where cervical cancer screening programmes are conducted on an opportunistic basis, an active search for women at risk should be made to increase coverage. The objective of our study was to assess the effectiveness of three primary care interventions consisting of providing written, telephone and face-to-face information to increase screening participation among women over the age of 25 years. A randomized experimental study with only one post-test control group was conducted on women aged 25-70 years. A total of 1676 women were randomly distributed into four groups and the following interventions were implemented: written briefing; telephone briefing; an invitation to attend a group meeting and no briefing (control group). The women were evaluated 2 years after the intervention. The outcome variable was participation or nonparticipation in cervical cancer screening. It proved possible to interview a total of 1122 women. Among the groups, homogeneity was tested in terms of sociodemographic characteristics and health-related variables. Women who had undergone cytological testing in the 2 years preceding evaluation had a lower mean age (P<0.001) than women who had not done so (45.5±11.0 vs. 48.8±13.0 years). The proportion of women who had participated in screening was as follows: 35.3% in the written information group [95% confidence interval (CI) 29.8-40.9]; 38.4% in the telephone information group (95% CI 32.5-44.2); 29.3% in the face-to-face information group (95% CI 22.8-35.7) and 26.1% in the control group (95% CI 21.2-30.9), with this difference proving statistically significant (P=0.005). Logistic regression showed that only the interventions based on written or telephone briefing were effective vis-à-vis the control group. In conclusion, both written and telephone information can serve to improve women's participation in opportunistic cervical cancer screening. Current preventive strategies could be optimized by means of simple interventions within the scope of health professionals.

Characteristics of youth sexual and reproductive health and risky behaviors in two rural provinces of Cambodia.

BACKGROUND: The global number of youths has risen with a majority living in Southeast Asia. In Cambodia, rural youths often face difficult barriers to health, which include lack of sexual and reproductive health knowledge, information, and services. Risky behaviors are a threat to the health of many young people in Cambodia. METHODS: We studied a sample of 300 youths to describe sexual and reproductive health characteristics and risky behaviors in two rural provinces of Cambodia. Using a multi-staged sampling method, 30 villages were selected for interviewing. A peer-to-peer interviewing criterion was used that matched interviewer to interviewee based upon sex. Logistic regression models were used to compare risk between sexes and assess for associations between reproductive health variables, gender, youth attitudes, and risky youth social behaviors. RESULTS: A majority (90%) stated that a boy or girl should defer sex till marriage. A majority of youths (92%) also reported that they may or definitely will seek sexual and reproductive health services in the future. About 5.4% of youth had a prior sexual experience. Only 6.7% of youth reported having they traveled to a local health center, hospital or clinic to seek healthcare for a reproductive health problem. Overall, 27% reported alcohol use in prior 30 days. Relative to girls, boys were more likely to report alcohol use, going out late at night with friends, gambling, pornography use, gambling, and practicing risky behaviors with peers. Living with both parents and current school enrollment, had limited impact on rural youth's individual and social behaviors. CONCLUSION: Although there are favorable findings compatible with traditional Cambodian values and beliefs, the youth in this study are challenged with alcohol use, practicing risky behaviors with peers, and low condom use. Findings have implications for practice and policy to prevent substance abuse and improve outcomes for substance use, sexual and reproductive health.

Noninvasive assessment of retinal vascular oxygen content among normal and diabetic human subjects: a study using hyperspectral computed tomographic imaging spectroscopy.

PURPOSE: This pilot study was aimed to demonstrate the clinical feasibility of using hyperspectral computed tomographic spectroscopy to measure blood oxygen content in human retinal vessels. METHODS: All procedures were performed under a University of Southern California Institutional Review Board-approved protocol and after obtaining informed consent. Fifty-seven subjects with and without diabetic retinopathy were dilated for standard fundus photography. Fundus photographs and retinal vascular oxygen measurements (oximetry) were made using a custom-made hyperspectral computed tomographic imaging spectrometer coupled to a standard fundus camera. Oximetry measurements were made along arteries (Aox) and veins (Vox) within vessel segments that were 1 to 2 disk diameters from the optic disk. RESULTS: For all control subjects (n = 45), mean Aox and Vox were 93 ± 7% and 65 ± 5% (P = 0.001), respectively. For all diabetic subjects (n = 12), mean Aox and Vox were 90 ± 7% and 68 ± 5% (P = 0.001), respectively. In subjects with proliferative diabetic retinopathy, Aox was significantly lower, and Vox was significantly higher than other groups (85 ± 4% and 71 ± 4%, respectively; P = 0.04, analysis of variance). There was a highly significant difference in the arteriovenous difference between subjects with proliferative diabetic retinopathy and those in the control group (14 vs. 26%, P = 0.003). CONCLUSION: Hyperspectral computed tomographic spectroscopy is a clinically feasible method for measurement and analysis of vascular oxygen content in retinal health and disease. This study uses the techniques relevant to oximetry; however, the breadth of spectral data available through this method may be applicable to study other anatomical and functional features of the retina in health and disease.

Patterns of maternal tobacco use among Cambodian women: findings from a nationwide sample.

Although current trends indicate that the rate of cigarette smoking tends to be low among women in the Western Pacific Region (<10%), recent epidemiologic data from South Asia (India, Bangladesh) and Southeast Asia (Cambodia, Vietnam, Indonesia, Malaysia) identify that a large proportion of women of reproductive age and older chew tobacco--often as part of a betel quid mixture that includes other potentially harmful ingredients (eg, areca nut). Our findings from currently pregnant women identified during a nationwide survey of adult tobacco use in Cambodia indicate that 13.0% (95% confidence interval [CI] = 8% to 17%) were current users of smoked or smokeless (in the form of a betel quid) tobacco. Most pregnant women who used tobacco indicated that their habit was either initiated (29.1%; 95% CI = 16.3-46.3) or increased (33.7%; 95% CI = 18.3-53.5) during pregnancy. Pregnancy-related symptoms such as morning sickness were reported as the reason for more than half (54.9%; 95% CI = 34.8-73.4) of the currently pregnant users to have started a tobacco habit during their lifetime. Among those pregnant women who did not use tobacco, we found strong associations (odds ratios from 2 to 14) with beliefs about the harmful effects of tobacco on adult health, faith-based beliefs in addictive substances, and beliefs that influential members of the community, health professionals, and children should not use tobacco. Our findings indicate that tobacco cessation and prevention programs in Cambodia should specifically target pregnant and reproductive-age women.

Oral sodium phosphates solution versus polyethylene glycol for colon cleansing prior to radiological assessment.

A clean bowel environment is essential prior to radiological assessment of the colon. The objectives were to determine patient compliance and acceptability, physician satisfaction, overall clinical effectiveness and tolerability with the use of oral sodium phosphates (Fosfosoda) and polyethylene glycol solutions as bowel cleansing agents in a relatively large cohort of Spanish patients requiring radiologic examination of the colon. This was an observational survey involving 592 patients (> or =18 years and approximately 60% women) who received Fosfosoda or polyethylene glycol solutions according to data sheet instructions. Parameters measured included mucosal cleansing (presence of solid residues), patient acceptability (including any adverse effects to treatment) and compliance with the treatment regimen, and physician-rated satisfaction with the procedure. The date from the study demonstrated that Fosfosoda and polyethylene glycol solutions were found to be equally well tolerated in this study, although patients receiving Fosfosoda found it easier to complete the treatment regimen. Fosfosoda was significantly superior to polyethylene glycol solutions with regards to mucosal cleansing with 52% achieving an 'excellent' result compared with only 36% of the polyethylene glycol group (relative risk:1.43; 95% confidence interval: 1.12-1.82). Physician-rated assessment of the bowel cleansing procedure also significantly favored Fosfosoda (p = 0.014). In conclusion, while Fosfosoda and polyethylene glycol solutions were equally well tolerated when given to patients prior to radiologic examination of the colon, Fosfosoda was shown to be significantly more effective in terms of bowel cleansing. Based upon the available evidence this could provide significant cost benefit for Fosfosoda.

Assessment of groundwater contamination by landfill leachate: a case in México.

In México, uncontrolled landfills or open-dumps are regularly used as "sanitary landfills". Interactions between landfills/open-dumps and shallow unconfined aquifers have been widely documented. Therefore, evidence showing the occurrence of aquifer contamination may encourage Mexican decision makers to enforce environmental regulations. Traditional methods such as chemical analysis of groundwater, hydrological descriptions, and geophysical studies including vertical electrical sounding (VES) and ground penetrating radar (GPR) were used for the identification and delineation of a contaminant plume in a shallow aquifer. The Guadalupe Victoria landfill located in Mexicali is used as a model study site. This landfill has a shallow aquifer of approximately 1m deep and constituted by silty sandy soil that may favor the transport of landfill leachate. Geophysical studies show a landfill leachate contaminant plume that extends for 20 and 40 m from the SE and NW edges of the landfill, respectively. However, the zone of the leachate's influence stretches for approximately 80 m on both sides of the landfill. Geochemical data corroborates the effects of landfill leachate on groundwater.

Estudio del proceso de diseño curricular de la asignatura Analisis e Interpretacion de Estados Financieros de la Carrera de Administracion de Empresas / sss

El problema fue identificado en la carrera de adminsitarcion de empresas, la materia de analisis e interpretacion de estados financieros, donde los alumnos tienen la dificultad en plantear soluciones para optimizar la estructura financiera de las empresas, debido a la aplicacion mecanica de los metodos de analisis a los estados contables y por la insuficiencia de conocimientos del area de contabilidad y costos, en este sentido, el objeto de estudio es el proceso enseñanza-aprendizaje de la asignatura en cuestion, con el objeto de proponer un plan global en el que se integren y sistematicen los conocimientos y habilidades adquiridas en contabilidad y costos, para que el estudiante con una logica racional y critica sea capaz de proponer soluciones acertadas a los problemas financieros...