Journal articles: 'Graduated exposure'

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Miltenberger, Raymond G., Kathleen M. Wrigh, and R. Wayne Fuqua. "Graduated in Vivo Exposure with a Severe Spider Phobic." Scandinavian Journal of Behaviour Therapy 15, no. 2 (1986): 71–76. http://dx.doi.org/10.1080/16506078609455763.

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Hariri, Alfan, Ahmad Munir, and Syafiul Anam. "Lecturers' Attitudes towards English Varieties Exposure in Indonesia." NOBEL: Journal of Literature and Language Teaching 10, no. 2 (2019): 163–73. http://dx.doi.org/10.15642/nobel.2019.10.2.163-173.

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This study was established from the lack of research of English varieties concept in Indonesia. In this study, the lecturers’ attitude toward the English varieties is explored as well as their view about using the English varieties in the classroom. The study used a qualitative research design to seek the participants’ attitude toward the varieties. The subjects of the study are ten lecturers of three universities in Surabaya; they are two private and one state university with ten lecturers in total. The researcher used prompt-production to explore in-depth lecturers’ attitude. One of the most significant findings to emerge from this study is the differences between the international graduated lecturers and national graduated lecturers in terms of their attitude toward the English varieties. Furthermore, this attitude also influences their perception about teaching the varieties in English language teaching (ELT) classroom.

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Finseth, Tor T., Nir Keren, Michael C. Dorneich, Warren D. Franke, Clayton C. Anderson, and Mack C. Shelley. "Evaluating the Effectiveness of Graduated Stress Exposure in Virtual Spaceflight Hazard Training." Journal of Cognitive Engineering and Decision Making 12, no. 4 (2018): 248–68. http://dx.doi.org/10.1177/1555343418775561.

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Psychological and physiological stress experienced by astronauts can pose risks to mission success. In clinical settings, gradually increasing stressors help patients develop resilience. It is unclear whether graduated stress exposure can affect responses to acute stressors during spaceflight. This study evaluated psychophysiological responses to potentially catastrophic spaceflight operation, with and without graduated stress exposure, using a virtual reality environment. Twenty healthy participants were tasked with locating a fire on a virtual International Space Station (VR-ISS). After orientation, the treatment group ( n = 10) practiced searching for a fire while exposed to a low-level stressor (light smoke), while the control group ( n = 10) practiced without smoke. In the testing session, both groups responded to a fire while the VR-ISS unexpectedly filled with heavy smoke. Heart rate variability and blood pressure were measured continuously. Subjective workload was evaluated with the NASA Task Load Index, stress with the Short Stress State Questionnaire, and stress exposure with time-to-complete. During the heavy smoke condition, the control group showed parasympathetic withdrawal, indicating a mild stress response. The treatment group retained parasympathetic control. Thus, graduated stress exposure may enhance allostasis and relaxation behavior when confronted with a subsequent stressful condition.

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Lawm, Gerald D., Cynthia Schwartz, Daniel Houlihan, and Jeffrey E. Cassisi. "Graduated exposure plus feedback in the treatment of speech anxiety." Behavioral Interventions 9, no. 4 (1994): 213–23. http://dx.doi.org/10.1002/bin.2360090403.

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Thyer, B. A., and J. T. Stocks. "Exposure Therapy in the Treatment of a Phobic Blind Person." Journal of Visual Impairment & Blindness 80, no. 10 (1986): 1001–3. http://dx.doi.org/10.1177/0145482x8608001008.

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A persistent and irrational fear of riding elevators was handicapping a blind client's mobility. Brief treatment involving real-life graduated therapeutic exposure to elevator-related stimuli effectively alleviated these fears in a single treatment lasting 90 minutes. This case history illustrates that exposure therapy, the treatment of choice for most phobic disorders, can be readily adapted to meet the special needs of visually impaired and blind individuals suffering from irrational fears.

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Karaca-Mandic, Pinar, and Greg Ridgeway. "Behavioral impact of graduated driver licensing on teenage driving risk and exposure." Journal of Health Economics 29, no. 1 (2010): 48–61. http://dx.doi.org/10.1016/j.jhealeco.2009.10.002.

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Ranasinghe, Ruwan. "Antecedents of Job Performance of Tourism Graduates: Evidence from State University-Graduated Employees in Sri Lanka." Journal of Tourism and Services 10, no. 18 (2019): 16–34. http://dx.doi.org/10.29036/jots.v10i18.83.

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Each one in eleven jobs in the world are from tourism sector where a well trained, educated and skilled work force is mandetory. Despite the growth in provision of tourism higher education during past 40 years, uncertainties remain about the content and nature of tourism degrees and how these are aligned with tourism industry needs. Substantial evidence is available on designing tourism higher education curriculum but the extent to which tourism higher education meets the industry needs and the job performance of the graduates has not yet been closely investigated. This study aims to identify the impact of tourism education on the job performance of the tourism graduates. Self-administered questionnaire fielded across the Island secured 260 public sector university tourism graduates response. Data was analyzed using Structural Equation Modeling in Smart-PLS-3. The study found learning outcomes have a moderate positive relationship on job performance. Tourism graduates showed optimistic perception about tourism education in meeting industry requirements. As recommendations tourism curriculum must be well planned and enriched with supplementary practical exposure. Faculty members must provide a great support for the undergraduates in accomplishing their carrier objectives and the learning outcomes. Conducive learning environment should be facilitated to reach learning outcomes smoothly.

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Toledo, Tomer, Haneen Farah, Smadar Morik, and Tsippy Lotan. "Driving exposure of Israeli young male drivers within a graduated driver licensing system." Transportation Research Part F: Traffic Psychology and Behaviour 26 (September 2014): 180–89. http://dx.doi.org/10.1016/j.trf.2014.07.008.

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Salhi, Yahia, and Pierre-E. Thérond. "AGE-SPECIFIC ADJUSTMENT OF GRADUATED MORTALITY." ASTIN Bulletin 48, no. 02 (2018): 543–69. http://dx.doi.org/10.1017/asb.2018.4.

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AbstractRecently, there has been an increasing interest from life insurers to assess their portfolios' mortality risks. The new European prudential regulation, namely Solvency II, emphasized the need to use mortality and life tables that best capture and reflect the experienced mortality, and thus policyholders' actual risk profiles, in order to adequately quantify the underlying risk. Therefore, building a mortality table based on the experience of the portfolio is highly recommended and, for this purpose, various approaches have been introduced into actuarial literature. Although such approaches succeed in capturing the main features, it remains difficult to assess the mortality when the underlying portfolio lacks sufficient exposure. In this paper, we propose graduating the mortality curve using an adaptive procedure based on the local likelihood. The latter has the ability to model the mortality patterns even in presence of complex structures and avoids relying on expert opinions. However, such a technique fails to offer a consistent yet regular structure for portfolios with limited deaths. Although the technique borrows the information from the adjacent ages, it is sometimes not sufficient to produce a robust life table. In the presence of such a bias, we propose adjusting the corresponding curve, at the age level, based on a credibility approach. This consists in reviewing the assumption of the mortality curve as new observations arrive. We derive the updating procedure and investigate its benefits of using the latter instead of a sole graduation based on real datasets. Moreover, we look at the divergences in the mortality forecasts generated by the classic credibility approaches including Hardy–Panjer, the Poisson–Gamma model and the Makeham framework on portfolios originating from various French insurance companies.

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Jiang, Xinguo, and Richard W. Lyles. "Exposure-based assessment of the effectiveness of Michigan’s graduated driver licensing nighttime driving restriction." Safety Science 49, no. 3 (2011): 484–90. http://dx.doi.org/10.1016/j.ssci.2010.11.006.

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Nelson, Natalie G., Lise Montefiore, Cord Anthony, Laura Merriman, Emma Kuster, and Garey A. Fox. "Undergraduate Perceptions of Climate Education Exposure in Natural Resources Management." Transactions of the ASABE 62, no. 3 (2019): 831–39. http://dx.doi.org/10.13031/trans.13361.

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Abstract. To meet rising demands for climate-literate workers, undergraduate courses and curricula will require updates so that students are afforded opportunities to engage in climate science education. Previous research on undergraduate climate education has primarily focused on evaluating whether students have grounding in essential climate science principles, but these studies fail to capture the degree to which students feel they are exposed to climate education in their undergraduate programs and courses. In this study, we characterize recent trends in undergraduates’ perceived exposure to climate education across the U.S. by analyzing responses to a national survey of graduate students who attended undergraduate institutions in the U.S. (n = 423). Survey respondents scored the levels of exposure that they received to a variety of climatological topics during their undergraduate studies, which ranged from applied (e.g., earth observations, numerical modeling) to interdisciplinary (e.g., agricultural climatology, hydroclimatology) and specialized (e.g., boundary-layer climatology). Our results reveal that those who received bachelor’s degrees from programs related to human dimensions of natural resources management (e.g., geography, resource economics) generally felt that their undergraduate curricula provided them with exposure to climate education, whereas those who graduated from programs in engineering and the agricultural and life sciences largely reported a lack of climate coverage in their undergraduate studies. Students of all disciplinary backgrounds indicated that they received poor exposure to numerical modeling of historical and future climatic conditions. Findings from this study underline key areas in which curricular or course improvements are needed to ensure that future decision-makers are confident in their practical use of climate science. Keywords: Climate change, Climate science, Natural resources management, Postsecondary education, Undergraduate education, United States.

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Ferreira, Lis Campos, Rívia Siqueira Amorim, Fellipe Matos Melo Campos, and Rosana Cipolotti. "Mental health and illness of medical students and newly graduated doctors during the pandemic of SARS-Cov-2/COVID-19." PLOS ONE 16, no. 5 (2021): e0251525. http://dx.doi.org/10.1371/journal.pone.0251525.

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Introduction: SARS-Cov-2 virus pandemic causes serious emotional consequences. It has occurred widespread medical courses suspension, and graduations were anticipated. Field hospitals, set up to treat patients with mild to moderate COVID-19, were the main workplaces of newly graduated doctors. Objective: To assess the impact of SARS-Cov-2/COVID-19 pandemic on mental health of medical interns and newly graduated doctors. Method: This is a cross-sectional study performed using a digital platform. Links to forms were sent in two moments: moment 1 (M1), at the beginning of the pandemic, in the first half of April/2020 and moment 2 (M2), after six months of pandemic, in the second half of September/2020. All students from the medical internship and all doctors graduated since 2018 from the three medical schools in Sergipe-NE-Brazil were invited. Results: 335 forms were answered in April and 148 in September. In M1 88.9% considered themselves exposed to excess of information about COVID-19, which was associated with anxiety symptoms (p = 0.04). Long family physical distance was also associated with these symptoms, as increased appetite (p = 0.01), feeling shortness of breath (p = 0.003) and sweating (p = 0.007). Fear of acquire COVID-19 was reported as intense by almost half of participants, and of transmitting by 85.7% in M1. In M2 41.2% reported the death of friends or relatives. Psychiatric illness was described by 38.5% and psychotropic drugs use by 30.1% in M1, especially those who lived alone (p = 0.03) and the single ones (p = 0.01). Alcohol intake was reported by 54.3%, and among doctors graduated in 2020 it increased from 50% in M1 to 85% in M2 (p = 0.04). Conclusion: The pandemic had a negative impact on the mental health of medical students and newly graduated doctors. Exposure to excessive COVID-19 information and family physical distance were associated to anxiety symptoms. Among doctors graduated in 2020, alcohol intake increased during pandemic evolution.

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Tanner, Amy, and Bianca E. Andreone. "Using Graduated Exposure and Differential Reinforcement to Increase Food Repertoire in a Child with Autism." Behavior Analysis in Practice 8, no. 2 (2015): 233–40. http://dx.doi.org/10.1007/s40617-015-0077-9.

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Carter, Lauren, Jill M. Harper, and James K. Luiselli. "Dental Desensitization for Students with Autism Spectrum Disorder through Graduated Exposure, Reinforcement, and Reinforcement-Fading." Journal of Developmental and Physical Disabilities 31, no. 2 (2018): 161–70. http://dx.doi.org/10.1007/s10882-018-9635-8.

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AlEnezi, Saad H., Abdullah M. Alfawaz, Adi Mohammed Al Owaifeer, Saad M. Althiabi, and Khalid F. Tabbara. "Assessment of Ophthalmology Residency Programs in Saudi Arabia: A Trainee-Based Survey." Journal of Medical Education and Curricular Development 6 (January 2019): 238212051985506. http://dx.doi.org/10.1177/2382120519855060.

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Purpose: To assess the satisfaction and competency of Saudi ophthalmology residents and compare their performance against International Council of Ophthalmology (ICO) standards. Methods: A cross-sectional web-based survey of senior ophthalmology residents (postgraduate years [PGY] 3-4) and recent graduates (from 2010 to 2015) assessed various aspects of training. The questionnaire was sent to the participants and was divided into 3 main domains: demographics, training program evaluation, and preparedness for board exams and clinical practice. Results: Out of the 145 invitees, 120 (82.8%) responded. Fifty percent of respondents reported an overall satisfaction with the program. Adequate clinical exposure was reported in most subspecialties except refraction and low vision rehabilitation with inadequate exposure reported by 55.8% and 95.8%, respectively. Surgical exposure was reported as adequate for phacoemulsification (58.3%) and strabismus surgery (68.3%) only. Eighty-nine percent of respondents reported performing less than 80 cases of phacoemulsification. Of the respondents who had graduated, most (89.7%) passed the final board exam at the first attempt. There were 73.5% of respondents who reported that residency training prepared them well for the board exam. Ongoing clinical and call duties were reported as having a negative impact on exam performance. Conclusions: Saudi ophthalmology residents demonstrate a high level of clinical competency. However, additional efforts should aim at improving surgical training to increase the level of satisfaction among residents and improve the quality of training to meet international standards.

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Lai, Chi-Wan. "“Booster Shots” of Humanism at Bedside Teaching." Asia Pacific Scholar 5, no. 2 (2020): 45–47. http://dx.doi.org/10.29060/taps.2020-5-2/pv1085.

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I. INTRODUCTION Most medical education programmes in Taiwan accept students upon high school graduation. Medical education used to consist of seven years with the last year being an internship. Since 2013, medical students have graduated at the end of six years, and the internship has been moved to a postgraduate year. In both formats, students have been offered medical humanities courses in the “pre-med” phase, i.e. the first two years of medical school. From the third year onward, however, students rarely have exposure to subjects related to humanism, other than courses on medical ethics and some problem-based learning case discussions. Moreover, medical students have had very little exposure to humanities in high school. Such limited exposure to humanities during medical school can have detrimental effects on cultivating humanistic physicians in Taiwan.

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Rafsanjani, Mohamad Arief, and Etika Dhewi Rahmawati. "Stress Exposure and Psychological Well-being: Study on Beginning Teacher." JABE (JOURNAL OF ACCOUNTING AND BUSINESS EDUCATION) 3, no. 2 (2019): 162. http://dx.doi.org/10.26675/jabe.v3i2.5757.

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A beginning teacher is someone who has just started his/her career as a teacher or someone who has just graduated from college and is working as a teacher. This transition from student to worker (as a teacher) is a critical period since it is often associated with stress (Dicke et al., 2015; Smith and Ingersoll 2004). This study examines the relationship between stress exposure (seen from stress exposure in class and outside class) and the psychological well-being of beginning teachers (seen from work enthusiasm and emotional exhaustion). This study is conducted on 325 beginning teachers of senior high schools in Malang as samples collected using a random sampling technique. The data are analyzed by using a Structural Equation Modeling (SEM). The results show that stress exposure in class and outside class has negative effect on work enthusiasm but, on the other hand, had positive effect on emotional exhaustion. This shows that stress exposure has significant effects on beginning teachers’ psychological well-being.

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Röjdmark, Jonas, and Agko Mouchammed. "A Modified Closed-Open Approach as Part of a Graduated and Integrative Approach to Rhinoplasty." Indian Journal of Plastic Surgery 52, no. 03 (2019): 270–76. http://dx.doi.org/10.1055/s-0039-3401472.

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Abstract Introduction Open versus closed approach in rhinoplasty is a frequently debated topic in aesthetic plastic surgery. Although good results can often be achieved with either technique, both have unique advantages and disadvantages. In this investigation, we present our experiences of a modified closed-open approach that has been applied on 482 complex primary and secondary rhinoplasties. Three representative cases are described in more detail. Materials and Methods The procedure begins as a closed approach through an intracartilaginous incision allowing cephalic trimming of the lateral crura, dorsal rasping, and/or excision. Patients requiring extensive nasal tip maneuvers are subjected to exposure of the alar cartilage framework through a transcolumellar/limited marginal incision. This provides not only adequate exposure of the alar cartilages but also easy access to the septum. Conclusion In our hands, this approach is easy and expeditious. It requires less tip dissection, and therefore may avoid the prolonged postoperative edema that is often a consequence of open or extended closed tip delivery approaches.

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McCrae, Christina S., and Paul T. Ingmundson. "Using Graduated in Vivo Exposure to Treat a Claustrophobic Response to Nasal Continuous Positive Airway Pressure." Clinical Case Studies 5, no. 1 (2006): 71–82. http://dx.doi.org/10.1177/1534650103261203.

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Schmidt, Jonathan D., James K. Luiselli, Hanna Rue, and Katherine Whalley. "Graduated Exposure and Positive Reinforcement to Overcome Setting and Activity Avoidance in an Adolescent With Autism." Behavior Modification 37, no. 1 (2012): 128–42. http://dx.doi.org/10.1177/0145445512456547.

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Lee, B. Craig. "Infectious Diseases Training in Canada: One Size Does Not Fit All." Canadian Journal of Infectious Diseases 12, no. 2 (2001): 98–100. http://dx.doi.org/10.1155/2001/938156.

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PURPOSE:To evaluate training in infectious diseases, determining which components of the training program best prepare residents for their career choices and where improvements are needed.METHOD:A cross-sectional survey was mailed to all 14 physicians who had graduated from both the Adult and Paediatric Infectious Diseases Training Program at the University of Calgary from 1985 to 1998. Responses about the adequacy of training were measured using a Likert-type scale and a qualitative questionnaire.RESULTS:Of 14 mailed questionnaires, nine responses were received (64%). Two-thirds of respondents were in an academic setting, and seven (78%) graduates obtained postfellowship training. The specialists in academic settings were all engaged in multiple nonclinical activities. The clinical and diagnostic microbiological components of training received the highest scores in terms of adequacy of training.CONCLUSION:Graduates of the University of Calgary training program indicated an overall satisfaction with their training. However, improvements are needed in career counselling, health administration, antibiotic utilization, infection prevention and specialized outpatient clinics. Potential strategies for addressing these issues include didactic lectures, enhanced exposure to clinical outpatient settings and provision of designated faculty mentors.

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Patterson, Janet L., Barbara L. Rodríguez, and Philip S. Dale. "Dynamic Assessment Language Tasks and the Prediction of Performance on Year-End Language Skills in Preschool Dual Language Learners." American Journal of Speech-Language Pathology 29, no. 3 (2020): 1226–40. http://dx.doi.org/10.1044/2019_ajslp-19-00120.

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Purpose Early identification is a key element for accessing appropriate services for preschool children with language impairment. However, there is a high risk of misidentifying typically developing dual language learners as having language impairment if inappropriate tools designed for monolingual children are used. In this study of children with bilingual exposure, we explored performance on brief dynamic assessment (DA) language tasks using graduated prompting because this approach has potential applications for screening. We asked if children's performance on DA language tasks earlier in the year was related to their performance on a year-end language achievement measure. Method Twenty 4-year-old children from Spanish-speaking homes attending Head Start preschools in the southwestern United States completed three DA graduated prompting language tasks 3–6 months prior to the Head Start preschools' year-end achievement testing. The DA tasks, Novel Adjective Learning, Similarities in Function, and Prediction, were administered in Spanish, but correct responses in English or Spanish were accepted. The year-end achievement measure, the Learning Accomplishment Profile–Third Edition (LAP3), was administered by the children's Head Start teachers, who also credited correct responses in either language. Results Children's performance on two of the three DA language tasks was significantly and positively related to year-end LAP3 language scores, and there was a moderate and significant relationship for one of the DA tasks, even when controlling for age and initial LAP3 scores. Conclusions Although the relationship of performance on DA with year-end performance varies across tasks, the findings indicate potential for using a graduated prompting approach to language screening with young dual language learners. Further research is needed to select the best tasks for administration in a graduated prompting framework and determine accuracy of identification of language impairment.

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Hagopian, Louis P., and Keith J. Slifer. "Treatment of separation anxiety disorder with graduated exposure and reinforcement targeting school attendance: a controlled case study." Journal of Anxiety Disorders 7, no. 3 (1993): 271–80. http://dx.doi.org/10.1016/0887-6185(93)90007-8.

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Michelson, Larry, Karen Marchione, Norman Marchione, Sandra Testa, and Matig Mavissakalian. "Cognitive Correlates and Outcome of Cognitive, Behavioral and Physiological Treatments of Agoraphobia." Psychological Reports 63, no. 3 (1988): 999–1004. http://dx.doi.org/10.2466/pr0.1988.63.3.999.

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The primary aim of this investigation was to ascertain the cognitive correlates and outcome of cognitive, behavioral, and psychophysiological treatments of agoraphobia. 39 severe and chronic agoraphobics with panic attacks, diagnosed using DSM-III criteria, were randomly assigned to one of the three cognitive-behavioral treatments: paradoxical intention, graduated exposure, or progressive deep muscle relaxation training. The effects of the treatments on cognition measures with regard to differential outcome and maintenance were examined. Exploratory analyses were also performed to examine sex differences, demographic, clinical and historical measures, with regard to pretreatment cognitive measures.

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Meer, Shabnum. "Prof Mervyn Shear ... a towering presence in Oral Pathology." South African Dental Journal 75, no. 6 (2020): 285. http://dx.doi.org/10.17159/2519-0105/2020/v75no6a10663.

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Professor Mervyn Shear made immense contributions to the discipline of Oral Pathology and indeed was the founder of the speciality in South Africa, holding the first Chair of Oral Pathology in the country. He graduated BDS from Wits in 1964, Neil to MDS (Oral Pathology) in 1961 and to the FRC (Pathology) from the Royal College of Pathologists in 1965. His passion for the discipline motivated his determination that Oral Pathology should be affiliated to Anatomical Pathology, a relationship which has ensured maximum exposure for South African registrars in Oral Pathology.

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Alkan, Ömer, Şenay Özar, and Şeyda Ünver. "Economic violence against women: A case in Turkey." PLOS ONE 16, no. 3 (2021): e0248630. http://dx.doi.org/10.1371/journal.pone.0248630.

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The aim of this study was to determine the factors affecting the exposure of women in the 15–59 age group in Turkey to economic violence by their husbands/partners. The micro data set of the National Research on Domestic Violence against Women in Turkey, which was conducted by the Hacettepe University Institute of Population Studies, was employed in this study. The factors affecting women’s exposure to economic violence were determined using the binary logistic regression analysis. In the study, women in the 15–24, 25–34 and 35–44 age group had a higher ratio of exposure to economic violence compared to the reference group. Women who graduated from elementary school, secondary school, and high school had a higher ratio of exposure to economic violence compared to those who have never gone to school. Women’s exposure to physical, sexual and verbal violence was also important factor affecting women’s exposure to economic violence. The results obtained in this study are important in that they can be a source of information for establishing policies and programs to prevent violence against women. This study can also be a significant guide in determining priority areas for the resolution of economic violence against women.

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Gilavand, Abdolreza, Mohammad Shooriabi, and Mehrnoosh Malakootian. "INVESTIGATING THE FREQUENCY OF OCCUPATIONAL EXPOSURE IN DENTISTRY STUDENTS OF AHVAZ JUNDISHAPUR UNIVERSITY OF MEDICAL SCIENCES IN SOUTHWEST OF IRAN." Asian Journal of Pharmaceutical and Clinical Research 11, no. 2 (2018): 297. http://dx.doi.org/10.22159/ajpcr.2018.v11i2.23191.

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Objective: In spite of great developments in infection control during recent years, many problems are still seen at the level of faculties, private, and public hospitals. Therefore, this research was carried out to evaluate the frequency of occupational exposure in dentistry students of Ahvaz Jundishapur University of Medical Sciences, Southwest of Iran.Methods: This study was conducted using a descriptive and cross-sectional method in 2016. The population of the study included all the 124 dentistry students graduated from Ahvaz Jundishapur University of Medical Sciences (AJUMS), southwest of Iran, who started their clinical education. The data were collected through a researcher-developed questionnaire and were analyzed using SPSS 22 software.Results: A total of 84 (67.7%) of the participants were male and 40 (23.3%) were female. Of all the participants, 54.8% of the students had no occupational exposure, 17.9% had needle stick experience, 17.9% of them had splash exposure, and 8.9% had a history of exposure to both needlestick acid and patient discharge. In the current research, no significant relationship was found between job exposure and age, gender, and marital status (p<0.05). However, a significant relationship was found between occupational exposure, year of admission to university, academic semester, and educational environment (p<0.05).Conclusion: Given the relatively high prevalence of occupational exposure in students, the development of prevention and exposure to occupational protocols and requiring students to comply with these protocols in clinical dentistry environments is recommended.

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Fedyukin, Igor, and Salavat Gabdrakhmanov. "Cultural Capital and Education in St. Petersburg: The Noble Cadet Corps, 1732–1762." Journal of Interdisciplinary History 46, no. 4 (2016): 485–516. http://dx.doi.org/10.1162/jinh_a_00902.

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Two types of proxy indicators—father’s type of service to the state and previous exposure to Western learning—can help to assess the role that cultural capital played in the rank at which cadets graduated from the elite Noble Land Cadet Corps in post-Petrine Russia. The results suggest that even in the post-Petrine period, despite its overall institutional weakness, a framework that rewarded “Westernized” culture was still possible. Moreover, this analysis suggests that the post-Petrine state might have been able—as it promised—to sustain a meritocracy, at least within the confines of certain institutional and social oases.

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Davis, Thompson E., Thomas H. Ollendick, and Lars-Göran Öst. "One-Session Treatment of Specific Phobias in Children: Recent Developments and a Systematic Review." Annual Review of Clinical Psychology 15, no. 1 (2019): 233–56. http://dx.doi.org/10.1146/annurev-clinpsy-050718-095608.

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One-Session Treatment is a well-established evidence-based treatment for specific phobias in youths that incorporates reinforcement, cognitive challenges, participant modeling, psychoeducation, and skills training into a single, massed session of graduated exposure. This review begins by briefly examining the phenomenology, etiology, epidemiology, and assessment of specific phobias and then pivots to a description of One-Session Treatment. We examine the use of One-Session Treatment with children and adolescents, briefly discussing its components and application, and subsequently review almost two decades of research supporting its efficacy. Finally, we propose future directions for research and practice.

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O'Donnell, Holly K., Cari Berget, Jennalee S. Wooldridge, and Kimberly A. Driscoll. "Graduated exposure to treat fear of hypoglycemia in a young adult with type 1 diabetes: A case study." Pediatric Diabetes 20, no. 1 (2018): 113–18. http://dx.doi.org/10.1111/pedi.12791.

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Kamal, Syed Arif, and Shahid Ali Khan. "OVERCOMING VITAMIN-D DEFICIENCY IN MALE GYMNASTS DURING PRETEEN YEARS." SKY-International Journal of Physical Education and Sports Sciences (IJPESS) 2 (December 1, 2018): 12–32. http://dx.doi.org/10.51846/the-sky.v2i0.226.

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This paper addresses the issue of vitamin-D deficiency, which is approaching epidemic scale in the Asian countries. Lack of proper nutrition and awareness contributes to this problem. After an explanation of the mechanism of production of vitamin D, the authors list adverse effects of vitamin-D deficiency and propose mandatory testing of vitamin-D deficiency during physical examinations. The remedial measures to overcome this deficiency in the context of preteen male gymnasts include supplements, proper nutrition in the form of sun-ripe fruits and vegetables as well as guarded-graduated sun-exposure. The last two are preferred over supplements as the supplements may produce toxicity if taken in higher doses.

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Reader, Stacia, Elyse Gruttadauria, Victoria King, and Seher Atamturktur. "Promoting careers, transfer success and information use and literacy: Evaluation of a health career pipeline program at an urban community college." Information Services & Use 40, no. 1-2 (2020): 51–69. http://dx.doi.org/10.3233/isu-200075.

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There is an urgent need for employees from diverse backgrounds in the health field. Community colleges are where many low-income and under-represented students begin their academic career. A career pipeline program was implemented at a community college to promote rigorous health careers, facilitate transfer success and develop information literacy skills. We assessed students’ confidence with fitting into a career, the impact of the program on students’ academic and career choices, salient program components, successes and challenges, and suggestions for improvement. Fifty-nine students enrolled in the program and 64% (n = 38) completed, all were minority students. Students reported increased confidence with fitting into their career and a positive impact on their choice of academic and career paths. Important aspects of the program were exposure to health professionals, mentoring, peer connections, academic and professional skill building, developing information literacy and experiential learning. Most students are either pursing a bachelor degree or have graduated with the intent of pursing graduate degree. Our experience demonstrates the feasibility of implementing a health career pipeline at a community college. Future programs should focus on career and academic skill building, information literacy, mentoring, peer connection, experiential activities, targeted outreach to male students, and facilitating the transfer process.

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Silverberg, Emily L., Trevor W. Sterling, Tyler H. Williams, Grettel Castro, Pura Rodriguez de la Vega, and Noël C. Barengo. "The Association between Social Determinants of Health and Self-Reported Diabetic Retinopathy: An Exploratory Analysis." International Journal of Environmental Research and Public Health 18, no. 2 (2021): 792. http://dx.doi.org/10.3390/ijerph18020792.

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One-third of Americans with diabetes will develop diabetic retinopathy (DR), the leading cause of blindness in working-age Americans. Social determinants of health (SDOHs) are conditions in a person’s environment that may impact health. The objective of this study was to determine whether there is an association between SDOHs and DR in patients with type II diabetes. This cross-section study used data from the 2018 Behavioral Risk Factor Surveillance System (BRFSS). This study included people with self-reported diabetes in the US in 2018 (n = 60,703). Exposure variables included homeownership, marital status, income, health care coverage, completed level of education, and urban vs. rural environment. The outcome variable was DR. Logistic regression analysis were applied to calculate odds ratios (ORs) and 95% confidence intervals (CIs). Alaskan Native/Native American (OR 2.11; 95% CI: 1.14–3.90), out of work (OR 2.82; 95% CI: 1.62–4.92), unable to work (OR 2.14; 95% CI: 1.57–2.91), did not graduate high school (OR 1.91; 95% CI: 1.30–2.79), only graduated high school (OR 1.43; 95% CI 1.08–1.97), or only attended college or technical school without graduating (OR 1.42; 95% CI: 1.09–1.86) were SDOHs associated with DR in patients with diabetes. Health care providers should identify these possible SDOHs affecting their diabetic patients.

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Grider, Blake, James K. Luiselli, and William Turcotte-Shamski. "Graduated Exposure, Positive Reinforcement, and Stimulus Distraction in a Compliance-With-Blood-Draw Intervention for an Adult With Autism." Clinical Case Studies 11, no. 3 (2012): 253–60. http://dx.doi.org/10.1177/1534650112448921.

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Ferrari, L., FR de la Torre, and A. Salibián. "Water-balance response of Rhinella arenarum (Hensel, 1867) tadpoles to graduated increase in environmental osmolarity." Brazilian Journal of Biology 70, no. 1 (2010): 171–79. http://dx.doi.org/10.1590/s1519-69842010000100024.

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The water balance and the upper limit of osmotic tolerance of premetamorphic Rhinella arenarum larvae (Gosner's stage 26) was evaluated after semistatic incubation in electrolyte (NaCl) and non-electrolyte (mannitol) media following a protocol of progressively increased osmotic pressure. Wet and dry weights were measured to calculate the water content as a derived variable indicative of the hydric balance. Statistical analysis was performed using univariate and integrated multivariate analysis. Tadpoles survived in electrolyte and non-electrolyte solutions up to 200 mOsm. The discriminant function was the best tool to describe the responses of the animals to external environmental stress under experimental conditions. The results were compared with those obtained in previous studies using a protocol of acute exposure to the same media used in this study. It was concluded that a) multivariate analysis is an appropriate approach to describe the responses of tadpoles to changes in the environmental physicochemical parameters, and b) progressive and acute acclimation to the experimental solutions induced similar responses.

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Playford, Denese E., and Edwina Cheong. "Rural Undergraduate Support and Coordination, Rural Clinical School, and Rural Australian Medical Undergraduate Scholarship: rural undergraduate initiatives and subsequent rural medical workforce." Australian Health Review 36, no. 3 (2012): 301. http://dx.doi.org/10.1071/ah11072.

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Background. This study examined postgraduate work after an undergraduate clinical year spent in the Rural Clinical School of Western Australia (RCSWA), compared with 6 weeks Rural Undergraduate Support and Coordination (RUSC)-funded rural experience in a 6-year undergraduate medical course. Rural background, sex and Rural Australian Medical Undergraduate Scholarship (RAMUS)-holding were taken into account. Methods. University of Western Australia undergraduate data were linked by hand with postgraduate placements to provide a comprehensive dataset on the rural exposure history of junior medical practitioners working in Western Australia between 2004 and 2007. Results. Participation in the RCSWA program was associated with significantly more postgraduate year one rural work than RUSC placement alone (OR = 1.5, CI 0.97–2.38). The RCSWA workforce effect increased at postgraduate year two (OR = 3.0, CI 1.6484 to 5.5935 relative to RUSC). Rural-origin practitioners who chose the RCSWA program were more likely than other rural-origin practitioners to take rural rotations in both postgraduate years. RAMUS holders’ choice in relation to the RCSWA program predicted later rural work. There were no effects of sex. Conclusions. Rural initiatives, in particular the Rural Clinical School program, are associated with postgraduate rural choices. The real impact of these data rely on the translation of early postgraduate choices into long-term work commitments. What is known about the topic? Specific training of rural graduates is strongly related to subsequent rural workforce. In addition, rural educational placements affect medical students’ intentions to practise rurally. Retrospective data from rural relative to urban general practitioners link rural background, rural undergraduate experience and rural postgraduate experience with rural work. What does this paper add? Much of the Australian prospective outcomes research has looked at workforce intentions of graduates, or the workforce outcomes of small graduate cohorts of Rural Clinical Schools. This paper followed nearly 500 graduates by name through to their PGY1 and PGY2 workforce decisions. As this cohort comprised 80% of three completely graduated MBBS years, these data validly represent the outcome of a medical school which is comparable to all Australian medical schools in its RUSC, Rural Clinical School and RAMUS recipients. The paper provides the first peer-reviewed outcomes data for the RAMUS scholarship program. What are the implications for practitioners? Rural supervision of medical students is an effective way to recruit new workforce. The longer students are supervised in rural settings, the better. But undergraduate programs need to be linked with postgraduate initiatives that take graduates of medical student initiatives into vocational programs able to deliver a trained rural workforce.

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Hodges, Brian, Ava Rubin, Robert G. Cooke, Sandy Parker, and Edward Adlaf. "Factors Predicting Practice Location and Outreach Consultation among University of Toronto Psychiatry Graduates." Canadian Journal of Psychiatry 51, no. 4 (2006): 218–25. http://dx.doi.org/10.1177/070674370605100403.

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Objective: To identify the determinants of practice location and of outreach consultation of recently graduated psychiatrists. Methods: We surveyed 153 psychiatrists who graduated from the University of Toronto Department of Psychiatry between January 1990 and June 2002 (response rate 51%), on the basis of a self-administered mail questionnaire. The survey assessed factors that influenced practice location and outreach consultation, such as demographics, links to practice communities, and outreach experiences, including rural or northern electives as a resident. Results: Professional variables were rated as the most important factors in choosing a practice location. Variables such as age or sex were not significantly associated with location. Nine percent reported working in communities of less than 100 000, and only 1% practised in Northern Ontario. Eighteen percent practised in the same location where they were born or raised. Forty-four percent had rural or northern experience as a resident but almost exclusively in the form of short, fly-in consultation electives. Twenty-four percent indicated that they provide outreach consultation. Psychiatry residents who participated in outreach electives were 10 times as likely as those who did not participate to continue outreach as a consultant. Conclusion: Although early exposure to rural or northern medicine leads to significantly greater continued involvement in outreach activities after graduation, our findings suggest the need for more long-term, on-site residency training opportunities in rural and remote areas.

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Gilbert-Kawai, Edward, Adam Sheperdigian, Thomas Adams, et al. "Design and conduct of Xtreme Everest 2: An observational cohort study of Sherpa and lowlander responses to graduated hypobaric hypoxia." F1000Research 4 (April 10, 2015): 90. http://dx.doi.org/10.12688/f1000research.6297.1.

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Objective: Oxygen availability falls with ascent to altitude and also as a consequence of critical illness. Because cellular sequelae and adaptive processes may be shared in both circumstances, high altitude exposure (‘physiological hypoxia’) assists in the exploration of the response to pathological hypoxia. We therefore studied the response of healthy participants to progressive hypobaric hypoxia at altitude. The primary objective of the study was to identify differences between high altitude inhabitants (Sherpas) and lowland comparators.Methods: We performed an observational cohort study of human responses to progressive hypobaric hypoxia (during ascent) and subsequent normoxia (following descent) comparing Sherpas with lowlanders. Studies were conducted in London (35m), Kathmandu (1300m), Namche Bazaar (3500m) and Everest Base Camp (5300m). Of 180 healthy volunteers departing from Kathmandu, 64 were Sherpas and 116 were lowlanders. Physiological, biochemical, genetic and epigenetic data were collected. Core studies focused on nitric oxide metabolism, microcirculatory blood flow and exercise performance. Additional studies performed in nested subgroups examined mitochondrial and metabolic function, and ventilatory and cardiac variables. Of the 180 healthy participants who left Kathmandu, 178 (99%) completed the planned trek. Overall, more than 90% of planned testing was completed. Forty-four study protocols were successfully completed at altitudes up to and including 5300m. A subgroup of identical twins (all lowlanders) was also studied in detail.Conclusion: This programme of study (Xtreme Everest 2) will provide a rich dataset relating to human adaptation to hypoxia, and the responses seen on re-exposure to normoxia. It is the largest comprehensive high altitude study of Sherpas yet performed. Translational data generated from this study will be of relevance to diseases in which oxygenation is a major factor.

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ELLIS, E., S. ALAIROSALES, S. GLENN, J. ROSALESRUIZ, and J. GREENSPOON. "The effects of graduated exposure, modeling, and contingent social attention on tolerance to skin care products with two children with autism." Research in Developmental Disabilities 27, no. 6 (2006): 585–98. http://dx.doi.org/10.1016/j.ridd.2005.05.009.

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Cromartie, R. Samuel, William A. Flood, and James K. Luiselli. "Graduated Exposure and Compliance Training Intervention for Blood Draw Avoidance and Refusal in a Woman With Intellectual Disability and Schizoaffective Disorder." Journal of Mental Health Research in Intellectual Disabilities 7, no. 2 (2014): 95–103. http://dx.doi.org/10.1080/19315864.2012.750407.

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Schumacher, Sarah, Robert Miller, Lydia Fehm, Clemens Kirschbaum, Thomas Fydrich, and Andreas Ströhle. "Therapists' and patients' stress responses during graduated versus flooding in vivo exposure in the treatment of specific phobia: A preliminary observational study." Psychiatry Research 230, no. 2 (2015): 668–75. http://dx.doi.org/10.1016/j.psychres.2015.10.020.

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Greenberg, Samantha, and Melissa Nothnagle. "An “Invaluable Skill”: Reflections on Abortion Training and Postresidency Practice." Family Medicine 50, no. 9 (2018): 691–93. http://dx.doi.org/10.22454/fammed.2018.529396.

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Background and Objectives: The goal of this study was to explore family medicine residents’ experiences with abortion training and identify positive and negative influences, and facilitators and barriers to providing abortion care. Methods: We conducted a qualitative study of recent graduates of an urban family medicine residency in the Northeast United States with an opt-out abortion curriculum. Individual recorded interviews were conducted with two classes of graduated residents until data saturation was reached. Data were coded and interpreted by both authors using the template analysis method. Results: Twenty residents completed interviews. Most trainees had limited or no abortion exposure prior to residency but were open to learning abortion care. By graduation, residents reported confidence in providing options counseling for unintended pregnancy. Overall, residents felt more comfortable providing medication abortion than aspiration abortion. Many reported feeling less emotional reaction to medication abortion and noted more technical and logistical barriers to learning aspiration abortion. Logistical barriers impede integration of medication abortion into practice for many, but were perceived to be less difficult to overcome than barriers to aspiration abortion integration. All participants agreed abortion care fits into the scope of primary care. Due to a variety of barriers, few of those who had not previously planned to become abortion providers after graduation incorporated it in their practice. Conclusions: Abortion training prepared residents to counsel women with unintended pregnancy, but numerous barriers inhibit integration of abortion care into practice. Given limited abortion training resources and fewer perceived barriers to medication abortion provision, family medicine residencies may consider focusing training on medication abortion.

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Cake, Martin, Michelle L. McArthur, Caroline F. Mansfield, Sanaa Zaki, Kira Carbonneau, and Susan M. Matthew. "Challenging identity: development of a measure of veterinary career motivations." Veterinary Record 186, no. 12 (2019): 386. http://dx.doi.org/10.1136/vr.105510.

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BackgroundWhile little is known about the motivations underpinning veterinary work, previous literature has suggested that the main influences on veterinary career choice are early/formative exposure to animals or veterinary role models. The aim of this study was to develop and provisionally validate a veterinary career motivations questionnaire to assess the strength of various types of career motivations in graduating and experienced veterinarians.MethodsA cross-sectional sample of experienced veterinarians (n=305) and a smaller cohort of newly graduated veterinarians (n=53) were surveyed online using a long-form questionnaire. Exploratory factor analysis (EFA) was used to iteratively derive a final, short-form questionnaire for survey of a second cross-sectional sample of experienced veterinarians (n=751).ResultsEFA derived a final questionnaire with 22 items loading onto six factors (social purpose, animal orientation, vocational identity, challenge and learning, career affordances, and people orientation). While motivations based on animal orientation were predictably strong, those based on vocational identity were not universal and were weaker in younger and graduate veterinarians; both of these motivations were rated lower by male veterinarians. Motivations based on challenge and learning emerged as some of the strongest, most universal and most influential; people orientation and social purpose were also important, particularly for older veterinarians.ConclusionThe major motivations for pursuing a veterinary career may best be represented as an intrinsic passion for animal care and for learning through solving varied challenges. These motivations are largely intrinsically oriented and autonomously regulated, thus likely to be supportive of work satisfaction and wellbeing.

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Jones, Antwan. "INTERGENERATIONAL EDUCATIONAL ATTAINMENT, FAMILY CHARACTERISTICS AND CHILD OBESITY." Journal of Biosocial Science 48, no. 4 (2015): 557–76. http://dx.doi.org/10.1017/s0021932015000280.

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SummaryThis study used US National Longitudinal Study of Youth data to explore how exposure to different socioeconomic conditions (proxied by maternal education) before birth can shape child weight. Using endogenous selection regression models, the findings suggest that educational selectivity affects weight gain. Mothers whose mothers graduated from high school were more likely to complete high school, and mothers reared in an intact family had higher levels of education. However, mothers who had given birth as a teenager had the same educational outcomes as mothers who gave birth in their post-teenage years. Based on this intergenerational educational selectivity, caretaking (e.g. breast-feeding) was found to be associated with a lower child body mass index (BMI), while negative maternal characteristics (e.g. mothers with high BMIs) were associated with higher child BMIs. Thus, educational selectivity influences child health through values passed on to the child and the lifestyle in which the child is reared. Maternal education may be tied to parenting, which relates to child obesity risk.

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Jang, Sung Joon, Byron R. Johnson, Joshua Hays, Michael Hallett, and Grant Duwe. "Prisoners Helping Prisoners Change: A Study of Inmate Field Ministers Within Texas Prisons." International Journal of Offender Therapy and Comparative Criminology 64, no. 5 (2019): 470–97. http://dx.doi.org/10.1177/0306624x19872966.

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Research on incarcerated offenders trained to help prisoners change is rare because programs that equip inmates with practical capacities for helping others rehabilitate in prison hardly exist. An exception is the Field Ministry program in Texas, which enlists inmates who have graduated from a prison-based seminary to work as “Field Ministers” and serve other inmates in various capacities. We hypothesize that inmate exposure to Field Ministers is inversely related to antisocial factors and positively to prosocial ones. We applied manifest-variable structural equation modeling to analyze data from a survey of a random sample of male inmates at three maximum-security prisons where the Field Ministry program operated. We found that inmates exposed more frequently to the Field Ministry and for a longer time period tended to report lower levels of criminological risk factors and aggressiveness and higher levels of virtues and predictors of human agency as well as religiosity and spirituality.

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Ehsani, Johnathon P., Jeffrey Michael, and Takeru Igusa. "Public health principles to inform testing and build trust in automated vehicles." Injury Prevention 26, no. 5 (2019): 494–98. http://dx.doi.org/10.1136/injuryprev-2019-043136.

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Highly publicised crashes involving self-driving or autonomous vehicles (AVs) have raised questions about safety and eroded public trust in the technology. In this State of the Art Review, we draw on previous successes in injury prevention and public health to focus attention on three strategies to reduce risk and build public confidence as AVs are being tested on public roads. Data pooling, a graduated approach to risk exposure, and harm reduction principles each offer practical lessons for AV testing. The review points out how the eventual deployment of AV technology could have a substantial impact on public health. In this regard, inclusive testing, public education and smart policy could extend the social value of AVs by improving access to mobility and by directing deployments towards scenarios with the greatest population health impact. The application of these strategies does not imply slowing down progress; rather, their implementation could accelerate adoption and result in realising the benefits of AVs more quickly and comprehensively while minimising risks.

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Pang, Jing, Tanzir Mortuza, Catherine A. White, Srinavasa Muralidhara, Brian S. Cummings, and James V. Bruckner. "Toxicokinetics of cis- and trans-Permethrin: Influence of Isomer, Maturation, and Sex." Toxicological Sciences 174, no. 1 (2019): 25–37. http://dx.doi.org/10.1093/toxsci/kfz237.

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Abstract Permethrin exposure of children and adults is widespread in many populations, but knowledge of its relative toxicokinetics (TK) and health risks in immature age groups is lacking. Studies were conducted in rats to determine the influence of immaturity and sex (on plasma and target organ dosimetry of each of the insecticide’s 2 isomers, cis- and trans-permethrin [CIS and TRANS]). Postnatal day 15, 21, and 90 (adult), Sprague Dawley rats were orally administered a graduated series of doses of CIS and TRANS in corn oil. Serial sacrifices were conducted over 24 h to obtain plasma, brain, liver, skeletal muscle, and fat profiles of CIS and TRANS. Levels of TRANS decreased relatively rapidly, despite administration of relatively high doses. Concentrations of each isomer in plasma, brain, and other tissues monitored were inversely proportional to the animals’ age. The youngest pups exhibited 4-fold higher plasma and brain area under the curves than did adults. Little difference was observed in the TK of CIS or TRANS between adult male and female rats, other than higher initial plasma and liver CIS levels in females. Elevated exposure of the immature brain appears to be instrumental in increased susceptibility to the acute neurotoxicity of high-dose permethrin (Cantalamessa [1993]), but it remains to be established whether age-dependent TK is relevant to long-term, low-level risks.

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Rowan, Nicholas, Meghan Turner, Benita Valappil, et al. "Injury of the Carotid Artery during Endoscopic Endonasal Surgery: Surveys of Skull Base Surgeons." Journal of Neurological Surgery Part B: Skull Base 79, no. 03 (2017): 302–8. http://dx.doi.org/10.1055/s-0037-1607314.

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Objectives This study aimed to review endoscopic skull base surgeon experience with internal carotid artery (ICA) injuries during endoscopic endonasal surgery (EES) to provide an estimate of the incidence of ICA injury, the associated factors and identify the best training modalities for the management of this complication. Design Anonymous electronic survey of past participants at a well-established endoscopic skull base surgery course and a global online community of skull base surgeons. Main Outcome Measures Relative incidence of ICA injuries during EES, associated anatomic and intraoperative factors, and surgeon experience. Results At least 20% of surgeons in each surveyed population experienced a carotid artery injury. Reported carotid artery injuries were most common during tumor exposure and removal (48%). The parasellar carotid artery was the most commonly injured segment (39%). Carotid artery injuries were more common in high-volume surgeons, but only statistically significant in one of the two populations. Attendance at a skull base course or courses did not change the incidence of carotid artery injury in either surveyed population. In both surveys, respondents preferred live surgeries or active (not computer simulated) training models. Conclusions ICA injury is underreported and most common when manipulating the parasellar carotid artery for exposure and tumor dissection. Given the high morbidity and mortality associated with these injuries, vascular injury management should be prioritized and taught in a graduated approach by modern endoscopic skull base courses.

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Liu, James K., Qasim Husain, Vivek Kanumuri, Mohemmed N. Khan, Zachary S. Mendelson, and Jean Anderson Eloy. "Endoscopic graduated multiangle, multicorridor resection of juvenile nasopharyngeal angiofibroma: an individualized, tailored, multicorridor skull base approach." Journal of Neurosurgery 124, no. 5 (2016): 1328–38. http://dx.doi.org/10.3171/2014.12.jns141696.

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OBJECT Juvenile nasopharyngeal angiofibromas (JNAs) are formidable tumors because of their hypervascularity and difficult location in the skull base. Traditional transfacial procedures do not always afford optimal visualization and illumination, resulting in significant morbidity and poor cosmesis. The advent of endoscopic procedures has allowed for resection of JNAs with greater surgical freedom and decreased incidence of facial deformity and scarring. METHODS This report describes a graduated multiangle, multicorridor, endoscopic approach to JNAs that is illustrated in 4 patients, each with a different tumor location and extent. Four different surgical corridors in varying combinations were used to resect JNAs, based on tumor size and location, including an ipsilateral endonasal approach (uninostril); a contralateral, transseptal approach (binostril); a sublabial, transmaxillary Caldwell-Luc approach; and an orbitozygomatic, extradural, transcavernous, infratemporal fossa approach (transcranial). One patient underwent resection via an ipsilateral endonasal uninostril approach (Corridor 1) only. One patient underwent a binostril approach that included an additional contralateral transseptal approach (Corridors 1 and 2). One patient underwent a binostril approach with an additional sublabial Caldwell-Luc approach for lateral extension in the infratemporal fossa (Corridors 1–3). One patient underwent a combined transcranial and endoscopic endonasal/sublabial Caldwell-Luc approach (Corridors 1–4) for an extensive JNA involving both the lateral infratemporal fossa and cavernous sinus. RESULTS A graduated multiangle, multicorridor approach was used in a stepwise fashion to allow for maximal surgical exposure and maneuverability for resection of JNAs. Gross-total resection was achieved in all 4 patients. One patient had a postoperative CSF leak that was successfully repaired endoscopically. One patient had a delayed local recurrence that was successfully resected endoscopically. There were no vascular complications. CONCLUSIONS An individualized, multiangle, multicorridor approach allows for safe and effective surgical customization of access for resection of JNAs depending on the size and exact location of the tumor. Combining the endoscopic endonasal approach with a transcranial approach via an orbitozygomatic, extradural, transcavernous approach may be considered in giant extensive JNAs that have intracranial extension and intimate involvement of the cavernous sinus.

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Lesko, David, Jason Showmaker, Ceisha Ukatu, Qiwei Wu, and C. W. David Chang. "Declining Otolaryngology Resident Training Experience in Tracheostomies: Case Log Trends from 2005 to 2015." Otolaryngology–Head and Neck Surgery 156, no. 6 (2017): 1067–71. http://dx.doi.org/10.1177/0194599817706327.

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Objective To evaluate recent tracheostomy surgical experience among otolaryngology residents and general surgery residents. Study Design Retrospective database review. Setting Accreditation Council for Graduate Medical Education otolaryngology and general surgery programs. Subjects and Methods Accreditation Council for Graduate Medical Education case log data from 2005 to 2015 for resident graduates in otolaryngology and general surgery were used to obtain mean graduate tracheostomy numbers, mean graduate composite case numbers, and number of graduating residents. Market share for each specialty was estimated through the derived metric of nationwide total tracheostomy graduate experience, calculated by multiplying the number of graduating residents by the mean number of graduate tracheostomies. Linear regression analysis was used to calculate trends. Multiple linear regression analysis was used for pairwise comparison of trends. Results From 2005 to 2015, mean graduate tracheostomy numbers for otolaryngology residents declined 2.3% per year, while those for general surgery residents increased 1.8% per year. Accounting for changes in number of resident graduates, market share of tracheostomy decreased 1.0% per year for otolaryngology and increased 3.0% per year for general surgery. Mean graduate composite case numbers increased significantly by 1.8% and 1.0% per year for otolaryngology and general surgery residents, respectively. Conclusion Tracheostomy case volume in otolaryngology residency has decreased steadily in comparison with general surgery residency. However, current otolaryngology graduates have more experience in tracheostomy when compared with general surgery graduates. While otolaryngology residents have excellent exposure to tracheostomy, otolaryngology programs should be made aware of this declining trend as well as changing procedural trends, which may affect training needs.

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Journal articles on the topic 'Graduated exposure'

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