Financial Considerations After a Fully-Virtual Interview Season: A CERA Study of Family Medicine Residency Program Directors.

BACKGROUND AND OBJECTIVES: The COVID-19 pandemic led to the institution of virtual interviewing for nearly all family medicine residency programs in 2020 and 2021. This paradigm shift challenged the perspectives of family medicine program directors across the United States, in part because of the financial impact on the operations of many residency programs. We sought to investigate program directors' opinions on the 2020-2021 interview season, as well whether future interview season planning would be influenced by the financial outcomes of this season. METHODS: We conducted a cross-sectional survey, as part of the fall 2021 CERA Program Director omnibus online survey. Family medicine program directors were invited by email to participate. We conducted multivariate logistic regression of the likelihood of supporting a fully-virtual interviewing model. RESULTS: The module survey response rate was 41.7% (263/631); 91.3% of programs reported conducting a fully-virtual 2020-2021 interview season. Program directors who reported that the cost savings recouped from virtual versus in-person interviewing could be used for other residency operating costs (32.4%) were almost four times more likely to support moving to a fully-virtual interviewing model (odds ratio: 3.94, confidence interval: 1.69-9.18). When compared to a residency program's benefit from meeting and assessing applicants in person, applicants benefitting from less financial burden during a fully-virtual interview season was not seen by responding program directors as a significant reason to remain virtual. CONCLUSIONS: While family medicine residency program directors who recouped interview expenses during fully-virtual recruiting seasons are more likely to support ongoing, fully-virtual models, financial incentivization did not overall impact support for virtual interviewing among program directors with statistical significance.

Are Medical Students Adequately Trained to Care for Persons With Disabilities?

Background and Objectives: Insufficient provider training contributes to health care disparities for 61 million Americans with disabilities.2,4 This study examines medical students' perceptions of their disability training and the perceived effect training has on students' preparedness to care for people with disabilities (PWD) in future practice. Methods: Principles of the Core Competencies on Disability for Health Care Education5 generated 10 questions. The questions were included in a survey conducted by the Council of Academic Family Medicine Educational Research Alliance (CERA) and sent to medical student members of the American Academy of Family Physicians (AAFP). We compared responses using unadjusted χ2 tests. Results: One hundred forty-seven surveys were returned, with 126 used for this analysis; 36% of students reported that their medical training provided them with the knowledge necessary to provide high-quality, comprehensive health care for PWD in their future practice and 97.6% agreed or strongly agreed that they needed to learn more. Six of the curricular exposures demonstrating variations of the health care needs of PWD were associated with higher percentages of medical students agreeing they are trained to perform high-quality health care for PWD in future practice. Conclusion: Medical students continue to report deficiencies in training, knowledge, and preparedness to care for PWD. Based on the Core Competencies framework, we have identified six curricular exposures that increase readiness to care for PWD. Therefore, we recommend the Liaison Committee on Medical Education formally integrate requirements for disability training in the standards of accreditation.7.

A Model of Collaboration Can Expand the Opportunities in Adaptive Sports Equipment.

ABSTRACT: Physical medicine and rehabilitation requires teamwork and innovation to help patients reach their goals and to optimize their quality of life, and one way is through participation in sports ( Sports Med Arthrosc Rev . 2019;27:73-82; PM R . 2015;7(10):1081-8; PM R . 2012;4(11):851-6; Phys Med Rehabil Clin N Am . 2019;30(1):289-99). Unfortunately, people with disabilities participate in sports ~20% less than their peers, and reasons for this disparity include equipment cost and availability ( Sports Med Arthrosc Rev . 2019;27:73-82; PM R . 2015;7(10):1081-8; Pediatrics . 2008;121(5):1057-61; Res Dev Disabil . 2017;67:9-18). A unique way for physical medicine and rehabilitation clinicians to aid in overcoming these barriers is to collaborate with other fields to make adaptive equipment that meets patients' needs.A multidisciplinary team including a physical medicine and rehabilitation resident physician and biomedical engineer, physical therapist, and machinist collaborated through a local nonprofit organization to design and build adaptive equipment solutions. This team designed two types of adaptive putters that are useable by golfers of various ages and functional ranges and a removable golf club grip for a player with limited grip strength.Implementation of a design team for creating adaptive equipment solutions is possible and can be done in the community setting or as part of a hospital system. In the authors' experience, taking a multidisciplinary team approach allowed developing more innovative and diverse solutions, and the athletes benefited by being able to participate in their desired sports activities.

The Impact of Sustainability Goals on Productivity Growth: The Moderating Role of Global Warming.

The objective of this paper was to gain novel insights into the complex relationships among Sustainable Development Goals (SDGs) in shaping productivity (GDP/capita) growth. Using dynamic panel regressions on data collected in 138 countries between 2000 and 2017, we found that rising temperatures negatively affect growth and mitigate the impact of other SDGs on growth. We also found that CO2 emissions have a U-shaped relationship with growth; life expectancy negatively influences growth (positively moderated by rising temperatures), and food security positively impacts growth (negatively moderated by rising temperatures). This study highlights the difficulty of simultaneously implementing SDGs and elucidates novel research perspectives and policies to decrease the negative impacts of climate change on socio-economic and environmental well-being.

How effective are clinical pre-farrowing risk assessment and the use of soft rubber mats in preventing shoulder ulcers in at-risk sows?

BACKGROUND: Lameness, low BCS and scar tissue in the skin covering the tuber spina scapulae are known as risk factors for shoulder ulcer in sows. In a two-step study, the predictive ability of pre-farrowing clinical examination and the preventive effect of rubber mats on the development of shoulder ulcers in at-risk sows were evaluated. MATERIAL AND METHODS: The study included 659 sows that were clinically examined one week before farrowing to distinguish risk sows from no-risk sows. Sows with a BCS ≤ 2 and/or a locomotion score > 3 and/or scar tissue in the skin covering the tuber spina scapulae were classified as at risk of developing shoulder ulcers. The at-risk sows were randomly assigned to either a prevention group in which sows were stalled in farrowing crates equipped with rubber mats, or a non-prevention group in which sows were stalled in standard crates. The shoulder areas were photographed during the first two weeks of the lactation period. RESULTS: The chance of developing a shoulder ulcer was significantly higher for at-risk sows than for non-at-risk sows (OR 5.55, p < 0.0001). At-risk sows stalled in crates equipped with rubber mats as preventive substrates had a significantly lower chance of developing shoulder ulcers than did those stalled in standard pens (OR 0.54, p = 0.0358). CONCLUSIONS: The development of shoulder ulcers in sows can be predicted by clinical pre-farrowing risk assessment based on BCS, locomotion score and scar tissue scoring. Providing at-risk sows with farrowing crates equipped with rubber mats had a statistically significant protective effect.

Testing the Markov hypothesis in fluid flows.

Stochastic Markov processes are used very frequently to model, for example, processes in turbulence and subsurface flow and transport. Based on the weak Chapman-Kolmogorov equation and the strong Markov condition, we present methods to test the Markov hypothesis that is at the heart of these models. We demonstrate the capabilities of our methodology by testing the Markov hypothesis for fluid and inertial particles in turbulence, and fluid particles in the heterogeneous subsurface. In the context of subsurface macrodispersion, we find that depending on the heterogeneity level, Markov models work well above a certain scale of interest for media with different log-conductivity correlation structures. Moreover, we find surprising similarities in the velocity dynamics of the different media considered.

Who gets custody now? Dramatic changes in children's living arrangements after divorce.

This article reexamines the living arrangements of children following their parents' divorce, using Wisconsin Court Records, updating an analysis that showed relatively small but significant increases in shared custody in the late 1980s and early 1990s. These changes have accelerated markedly in the intervening years: between 1988 and 2008, the proportion of mothers granted sole physical custody fell substantially, the proportion of parents sharing custody increased dramatically, and father-sole custody remained relatively stable. We explore changes in the correlates of alternative custody outcomes, showing that some results from the earlier analysis still hold (for example, cases with higher total family income are more likely to have shared custody), but other differences have lessened (shared-custody cases have become less distinctive as they have become more common). Despite the considerable changes in marriage and divorce patterns over this period, we do not find strong evidence that the changes in custody are related to changes in the characteristics of families experiencing a divorce; rather, changes in custody may be the result of changes in social norms and the process by which custody is determined.

Testing the economic independence hypothesis: the effect of an exogenous increase in child support on subsequent marriage and cohabitation.

We examine the effects of an increase in income on the cohabitation and marriage of single mothers. Using data from an experiment that resulted in randomly assigned differences in child support receipt for welfare-receiving single mothers, we find that exogenous income increases (as a result of receiving all child support that was paid) are associated with significantly lower cohabitation rates between mothers and men who are not the fathers of their child(ren). Overall, these results support the hypothesis that additional income increases disadvantaged women's economic independence by reducing the need to be in the least stable type of partnerships. Our results also show the potential importance of distinguishing between biological and social fathers.

The evolution of family complexity from the perspective of nonmarital children.

We document the incidence and evolution of family complexity from the perspective of children. Following a cohort of firstborn children whose mothers were not married at the time of their birth, we consider family structure changes over the first 10 years of the child's life-considering both full and half-siblings who are coresidential or who live in another household. We rely on detailed longitudinal administrative data from Wisconsin that include information on the timing of subsequent births to the mother and father, and detailed information on earnings, child support, and welfare. We find that 60% of firstborn children of unmarried mothers have at least one half-sibling by age 10. Our results highlight the importance of having fertility information for both fathers and mothers: estimates of the proportion of children with half-siblings would be qualitatively lower if we had fertility information on only one parent. Complex family structures are more likely for children of parents who are younger or who have low earnings and for those in larger urban areas. Children who have half-siblings on their mother's side are also more likely to have half-siblings on their father's side, and vice versa, contributing to very complex family structures-and potential child support arrangements-for some children.

The ADA perspective.

BACKGROUND: The American Dental Association (ADA) has long relied on available scientific evidence in its commitment to use credible scientific data and analyses in policy-making, and its communications with the dental profession and the public. OVERVIEW: The evidence-based dentistry (EBD) process is a systematic approach that reviews and publishes the evidence relevant to specific clinical questions. The goal of this process is to help practitioners provide patients with quality oral health care. The ADA has developed a strategic plan of EBD initiatives and activities in order to increase the knowledge base and improve educational programs; to encourage significant collaboration on EBD-related issues from interested organizations, specialty groups, and various outside agencies; and to increasingly derive the best scientific evidence for use in clinical practice in concert with professional judgment and patient treatment preferences. CONCLUSION: The ADA endeavors to provide relevant information that can assist dentists in translating systematic-review findings and implementing an evidence-based approach in everyday clinical practice. This supports the Association's goal to continue supporting the best available evidence to assist health care teams in the provision of quality patient care and preventive techniques that improve oral health care outcomes.

Prediction of the adaptability of Pseudomonas putida DOT-T1E to a second phase of a solvent for economically sound two-phase biotransformations.

The strain Pseudomonas putida DOT-T1E was tested for its ability to tolerate second phases of different alkanols for their use as solvents in two-liquid-phase biotransformations. Although 1-decanol showed an about 10-fold higher toxicity to the cells than 1-octanol, the cells were able to adapt completely to 1-decanol only and could not be adapted in order to grow stably in the presence of a second phase of 1-octanol. The main explanation for this observation can be seen in the higher water and membrane solubility of 1-octanol. The hydrophobicity (log P) of a substance correlates with a certain partitioning of that compound into the membrane. Combining the log P value with the water solubility, the maximum membrane concentration of a compound can be calculated. With this simple calculation, it is possible to predict the property of an organic chemical for its potential applicability as a solvent for two-liquid-phase biotransformations with solvent-tolerant P. putida strains. Only compounds that show a maximum membrane concentration of less than 400 mM, such as 1-decanol, seem to be tolerated by these bacterial strains when applied in supersaturating concentrations to the medium. Taking into consideration that a solvent for a two-liquid-phase system should possess partitioning properties for potential substrates and products of a fine chemical synthesis, it can be seen that 1-decanol is a suitable solvent for such biotransformation processes. This was also demonstrated in shake cultures, where increasing amounts of a second phase of 1-decanol led to bacteria tolerating higher concentrations of the model substrate 3-nitrotoluene. Transferring this example to a 5-liter-scale bioreactor with 10% (vol/vol) 1-decanol, the amount of 3-nitrotoluene tolerated by the cells is up to 200-fold higher than in pure aqueous medium. The system demonstrates the usefulness of two-phase biotransformations utilizing solvent-tolerant bacteria.