La Porte Hospital

Introduction: Orthopaedic Residency Directors advised against visiting subinternship rotations in the peak of the pandemic. To adapt, programs offered multiple virtual experiences. The purpose of this study was to evaluate programs and applicants perceptions regarding the value of virtual experiences during the 2020 to 2021 application cycle and their utility in future application cycles.Methods: A survey was disseminated to 31 residency programs gathering data about virtual experiences offered in this cycle. A second survey was disseminated to interns who have successfully matched at those programs to identify how interns think to have benefited from the experiences.Results: Twenty-eight programs completed the survey (90% response rate). One hundred eight new interns completed the survey (70% response rate). Virtual information sessions and resident socials were the highest attended (94% and 92%, respectively). Interns and leadership agreed that virtual rotations provided students with a good understanding of program culture and what the programs offer educationally. Neither the leadership nor the interns would recommend replacing in-person aways with virtual experiences.Conclusion: Virtual experiences helped bridge the gap after away rotations were canceled. Alongside in-person aways, virtual experiences are likely to play a role in future cycles. However, virtual experiences remain incomparable to in-person away rotations and are not recommended as a replacement.

Abstract BackgroundFormal multidisciplinary team (MDT) discussions in clinical practice require time and space with unclear survival benefits for advanced gastrointestinal patients. This study aimed to investigate the long-term survival of patients with advanced gastrointestinal cancer after multidisciplinary team (MDT) decision-making.Materials and MethodsFrom June 2017 to June 2019, continuous MDT discussions on advanced gastrointestinal cancer were conducted in ten medical centers in China. MDT decisions and actual treatment received by patients were prospectively recorded. The primary endpoint was the difference in overall survival (OS) between patients in MDT decision implementation and nonimplementation groups. The secondary endpoints included the implementation rate of MDT decisions and subgroup survival analysis. ResultsA total of 461 MDT decisions of 455 patients were included in this study. The implementation rate of MDT decisions was 85·7%. Sex and previous treatment had an impact on MDT decision-making. The OS was 24·0 months and 17·0 months, respectively, in MDT decision implementation and nonimplementation groups. The implementation of MDT decisions significantly reduced the risk of death in the univariate analysis. The subgroup analysis showed a significant difference in survival analysis of patients with colorectal cancer, but no significant difference was found in patients with gastric cancer. The rate of secondary MDT discussion was very low. ConclusionMDT discussion can prolong the OS of patients with advanced gastrointestinal cancer, especially colorectal cancer. Scheduling of the next MDT discussion in time is necessary when the disease condition changes.

In small residential construction, the production of concrete is usually performed on the construction site, and concrete is used in elements of reduced volume, such as foundations and columns.In these cases, concrete production control is not common, which can result in pathologies, when the strength obtained in practice do not reach those considered in the design.The objective of this work was to analyze the compressive strength of concrete produced to residential buildings at Toledo-PR.During the production of the concretes, the proportion of materials used was quantified and samples of these materials were collected to carry out laboratorial tests, determining the physical properties and proportion of material in mixture.Slump tests were performed with the concrete in a fresh state and cylindrical specimens were molded to determine the compressive strength in the laboratory at 28 days.It was found that only 33.3% of the samples reached the minimum characteristic compressive strength recommended by the standard NBR 6118: 14, that may cause pathologies in small buildings.

Conan, abbot of Margam 202 Conches-en-Ouche (Eure) 36 Conishead, Augustinian priory (Cumbria) 295 Corbeil, Milo de, canon of Paris 60 Corbreuse (Essonne) 73 f. Cordoba (Spain) 133 Cormeilles-en-Parisis (Val-d'Oise) 91, 95 Cornwall 148 Coucy, family 231 Cour-Dieu, Cistercian abbey (Loiret) 77 Cour-Notre-Dame, Cistercian abbey (Yonne) 96 Coverham, Premonstratensian abbey (Yorkshire) 295 Cowick (Devon) 162 Cressonsacq (Oise) 83 Cressonsacq, lord(s) of 83-85, 94 Cromwell, Oliver 103 Cross-on-the-Sea (Wales) 205 Crouch, David 197 Crumpe, Robert 161 f.

O meio ambiente tem se tornado preocupação crescente na sociedade e nas empresas, que têm mobilizado suas competências para compatibilizar o crescimento econômico com a preservação ambiental. A inovação tecnológica tem sido chamada a resolver esses conflitos da elevada produção e consumo com a preservação ambiental. Este artigo tem como objetivo geral analisar a relação entre a gestão ambiental e as inovações tecnológicas voltadas ao meio ambiente. Para se atingir tal objetivo, segundo o autor Schmidt (2015) são necessárias atitudes de inovação ambiental e inovação radical. Este artigo revisa o estudo de diversos autores sobre a inovação ambiental em uma influência de regulação ambiental sobre o processo inovativo e a necessidade de uma maior coerência entre políticas ambientais e de desenvolvimento tecnológico, abrindo espaço para o processo de discussão sobre a inovação ambiental.

« Les Horti Tauriani, Etude topographique sur la region de la Porte Majeure » in MEFRA 53 (1936), p. 250-286.

Pediatricians' education debt has been increasing. Less is known about the pace of their debt repayment. The authors examined patterns of debt repayment for pediatricians who completed residency from 2002-2004. The authors analyzed weighted 2013 survey data from the American Academy of Pediatrics Pediatrician Life and Career Experience Study. They categorized participants based on education debt level at residency completion ($0; $1-$49,999; $50,000-$99,999; $100,000-$149,999; ≥ $150,000) and explored debt repayment and well-being by starting debt group using multivariable logistic regression. Of 830 pediatricians surveyed, 266 (32%) had no starting debt and 166 (20%) had ≥ $150,000 in starting debt. A decade after residency, the percentage of participants who completely repaid their debt varied from 76% (68/89) of those with $1-$49,999 of starting debt to 15% (25/164) of those with ≥ $150,000 of starting debt. The percentage of participants concerned about their debt increased with starting debt level, with over half of those in the highest group concerned. Starting debt was associated with all examined measures of debt repayment and with recent financial difficulties among those in the two highest debt groups ($100,000-$149,999: adjusted odds ratio = 3.82, confidence interval = 1.17-12.43; ≥ $150,000: adjusted odds ratio = 4.55, confidence interval = 1.47-14.14). A decade after completing residency, pediatricians had made progress repaying their debt, yet many still expressed concern, especially those with the greatest amount of starting debt. As debt levels continue to increase, these issues could worsen.