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Objectives/Goals: With qualitative interviews we aim to 1-Describe barriers and facilitators for post-transplant lymphoproliferative disease (PTLD) survivors’ access to late effects (LE) care. 2-Investigate clinicians’ perceptions of current and ideal PTLD LE care. Our long-term goal is to develop and pilot implementation strategies to standardize PTLD LE care. Methods/Study Population: Study population: We will recruit 20–25 PTLD survivors or their caregivers and 10–15 health care workers (HCW) from oncology, LE, and solid organ transplant (SOT) teams at St. Louis Children’s Hospital (SLCH). PTLD is a lymphoma-like cancer that occurs in solid organ transplant (SOT) recipients. PTLD survivors experience LE from cancer, yet many do not receive LE care. Research strategy: We will conduct qualitative semi-structured interviews based on the Consolidated Framework for Implementation Research (CFIR). A preliminary codebook will be based on CFIR and refined through transcript review. Team-based coding includes double coding and checking for intercoder reliability. We will generate coding reports to understand themes and identify barriers and facilitators of LE care. Results/Anticipated Results: We hypothesize survivors, caregivers, and HCWs will identify actionable factors to inform future studies to optimize LE care. We will examine the CFIR inner setting (resources, communication, and structural characteristics), outer setting (local attitudes and external pressures), innovation domain (adaptability, evidence base, and relative advantage), individuals domain (need, opportunity, and motivation), and implementation process domain. Our contribution will be novel. 1-This is the first assessment of barriers and facilitators for LE care in pediatric PTLD survivors. 2-We will consider input from HCWs across various disciplines delivering care to PTLD survivors. 3-We anticipate identifying unique contextual factors in PTLD survivors that will influence implementation of evidence-based LE care. Discussion/Significance of Impact: Pediatric cancer survivors experience LE. Coordinated care mitigates LE. PTLD survivors experience a high burden of LE, but less than 10% of PTLD survivors at SLCH follow in LE clinic. No studies have evaluated ideal delivery of LE care for PTLD survivors. Our findings will inform an implementation trial to improve delivery of LE care for PTLD survivors.
Despite its popularity, authentic leadership remains enigmatic, with both advantages and disadvantages. The connection between authenticity (an internal process) and leadership (an external influence process) is complex. We introduce a theory that connects these processes through self-regulation, suggesting that authenticity results from managing multiple identities regulated by factors such as active self-identity. Using ironic processes theory, we propose a model that encourages leaders to focus on their active self rather than suppressing misaligned aspects. We present authenticity as a dynamic process, adaptable across individual, relational, and collective levels, with self-identity shifting contextually. This perspective offers insights into developing leader authenticity, addresses the limitations of the authentic leadership approach, and provides a roadmap for future research.
Disaster Medicine (DM) is the clinical specialty whose expertise includes the care and management of patients and populations outside conventional care protocols. While traditional standards of care assume the availability of adequate resources, DM practitioners operate in situations where resources are not adequate, necessitating a modification in practice. While prior academic efforts have succeeded in developing a list of core disaster competencies for emergency medicine residency programs, international fellowships, and affiliated health care providers, no official standardized curriculum or consensus has yet been published to date for DM fellowship programs based in the United States.
Study Objective:
The objective of this work is to define the core curriculum for DM physician fellowships in the United States, drawing consensus among existing DM fellowship directors.
Methods:
A panel of DM experts was created from the members of the Council of Disaster Medicine Fellowship Directors. This council is an independent group of DM fellowship directors in the United States that have met annually at the American College of Emergency Physicians (ACEP)’s Scientific Assembly for the last eight years with meeting support from the Disaster Preparedness and Response Committee. Using a modified Delphi technique, the panel members revised and expanded on the existing Society of Academic Emergency Medicine (SAEM) DM fellowship curriculum, with the final draft being ratified by an anonymous vote. Multiple publications were reviewed during the process to ensure all potential topics were identified.
Results:
The results of this effort produced the foundational curriculum, the 2023 Model Core Content of Disaster Medicine.
Conclusion:
Members from the Council of Disaster Medicine Fellowship Directors have developed the 2023 Model Core Content for Disaster Medicine in the United States. This living document defines the foundational curriculum for DM fellowships, providing the basis of a standardized experience, contributing to the development of a board-certified subspecialty, and informing fellowship directors and DM practitioners of content and topics that may appear on future certification examinations.
We recently reported on the radio-frequency attenuation length of cold polar ice at Summit Station, Greenland, based on bi-static radar measurements of radio-frequency bedrock echo strengths taken during the summer of 2021. Those data also allow studies of (a) the relative contributions of coherent (such as discrete internal conducting layers with sub-centimeter transverse scale) vs incoherent (e.g. bulk volumetric) scattering, (b) the magnitude of internal layer reflection coefficients, (c) limits on signal propagation velocity asymmetries (‘birefringence’) and (d) limits on signal dispersion in-ice over a bandwidth of ~100 MHz. We find that (1) attenuation lengths approach 1 km in our band, (2) after averaging 10 000 echo triggers, reflected signals observable over the thermal floor (to depths of ~1500 m) are consistent with being entirely coherent, (3) internal layer reflectivities are ≈–60$\to$–70 dB, (4) birefringent effects for vertically propagating signals are smaller by an order of magnitude relative to South Pole and (5) within our experimental limits, glacial ice is non-dispersive over the frequency band relevant for neutrino detection experiments.
We estimate the impact of sporting events and franchises on local crime rates using the technique developed in Arellano and Bond (2001). For events, we consider the presence of Major League Baseball, National Basketball Association, National Football League and National Hockey League franchises as well as whether a city held one of the respective championships, the Olympics, or World Cup matches. We find little to no evidence that sporting events or franchises are correlated with changes in either property or violent crime with two notable exceptions. The Olympics Games are associated with roughly a 10 per cent increase in property crimes while the Super Bowl is associated with a 2.5 per cent decrease in violent crime. On the whole, however, the presence of spectator sports does not seem to automatically carry with it any improvements in citywide criminal behaviour.
Quantum mechanics is inherently a probabilistic theory, so we present a brief review of some important concepts in probability theory. We distinguish between discrete probabilities, encountered in spin measurements, and continuous probabilities, encountered in position measurements.
The meaning of time reversal can be reconstructed from the structure of time translations. "Instantaneous" time reversal is just its proxy in a state space representation.
The symmetries of time can be understood through the symmetries of motion, both in a sense that is familiar to philosophers andin the history of time reversal.
The structure of equilibrium thermodynamics, in harmony with statistical mechanics, does not contain a time asymmetry, except when it is trivially supplemented with one.
In the Representation View, time reversal has direct empirical significance, breaks the symmetry-to-reality inference, and can be violated in a time symmetric spacetime.
There are many representations of time reversal symmetry, including PT, CT, and CPT, but only the standard time reversal operator T is associated with an arrow of time itself.