The aging population in the United States and greater access to healthcare due to recent legislative reforms will result in an increased demand for registered nurses. However, meeting this demand will challenge healthcare organizations due to an aging nursing workforce that will be retiring, a lack of new nurses entering the profession due to lack of employment opportunities related to the current macro-economic environment, and the lack of capacity to produce nursing graduates. Furthermore, reported turnover rates of newly graduated registered nurses range from 18 to 60% during the first year of employment. Healthcare organizations implementing structured nurse residency programs have reported success in stemming the tide of new graduate turnover. However, there is a lack of empirical evidence in the nurse residency literature regarding variables that have been shown to decrease turnover of registered nurses. The purpose of this study was to examine the outcome variables of job satisfaction, organizational commitment, and turnover among newly graduated nurse residents in Magnet, Magnet Aspiring, and Non-Magnet Hospital work environments across the US. A descriptive correlational retrospective secondary analysis was completed examining the outcome variables in a sample of 628 newly graduated nurses completing a structured nurse residency program between January 1, 2007 and December 31st, 2009 in general acute care hospitals. The findings from this study demonstrated the difference between job satisfaction at two months, six months, and 12 months among nurse residents in the different work environments. Furthermore, the influence of the residency program on organizational commitment in the context of differing work environments is reported. Moreover, turnover rates following the completion of the nurse residency were found to be lower than the national average for newly graduated nurses. Finally, the relationships between the outcome variables are explicated. The findings of this study will assist in informing healthcare executive’s decision making when considering interventions to decrease turnover of newly graduated nurses. / text

A report on the creation of a new program to improve family medicine residents' understanding, and quality of care, of anticoagulation patients. Patients requiring anticoagulation therapy pose unique issues requiring a systematic approach to their care, balancing the potential benefit from therapy with possible adverse events. Here, we describe a model that helps to standardize both the care received by patients on anticoagulation therapy as well as the training of family medicine residents caring for those patients. A team-based model of care (family medicine residents, clinical pharmacists, and nurses) is used to achieve the goals of improved care and education. Clinical pharmacists are used in concert with family medicine residents and attendings to assess patients' medication profiles and help direct patient care and resident learning. Both the idea itself and the formal structure are presented in a model for possible adaptation to other programs

Osteopathic physician (D.O.) residency programs that do not achieve accreditation under the new Single Accreditation System (SAS) standards by June 30, 2020 will lose access to their share of more than $9,000,000,000 of public tax dollars. This U.S. Centers for Medicare & Medicaid Services (CMS) funding helps sponsoring institutions cover direct and indirect resident physician training expenses. A significant financial burden would then be shifted to marginal costs of the residency program’s sponsoring institution in the absence of CMS funding. The sponsoring institution’s ability or willingness to bare these costs occurs during a time when hospital operating margins are at historic lows (Advisory.com /Daily Briefing /May 18, 2017 | The Daily Briefing / Hospital profit margins declined from 2015 to 2016, Moody's finds). Loss of access to CMS funding may result in potentially cataclysmic reductions in the production and availability of primary care physicians for rural and urban underserved populations. Which osteopathic residency programs will be able to survive the new accreditation requirement changes by the 2020 deadline? What are some of the defining attributes of those programs that already have achieved “initial accreditation” under the new SAS requirements? How can the osteopathic programs in the process of seeking the new accreditation more effectively “pivot” by learning from those programs that have succeeded? What are the potential implications of SAS to both access and quality of health care to millions of Americans? This report is based upon a study that examined and measured how osteopathic physician residency programs in the U.S. are accommodating the substantive structural, financial, political and clinical requirements approximately half way through a five-year adaptation period. In 2014, US Graduate Medical Education (GME) physician program accreditation systems formally agreed to operate under a single accreditation system for all osteopathic (D.O) and allopathic (M.D.) programs in the U.S. Since July 1, 2015, the American Osteopathic Association (AOA) accredited training programs have been eligible to apply for Accreditation Council for Graduate Medical Education (ACGME) accreditation. This agreement to create a Single Accreditation System (SAS) was consummated among the AOA, the American Association of Colleges of Osteopathic Medicine (AACOM) and ACGME with a memorandum of understanding. As this research is published, the ACGME is transitioning to be the single accreditor for all US GME programs by June 30, 2020. At that time, the AOA would fully relinquish all its GME program accreditation responsibilities. The new SAS operates under published ACGME guidelines and governance. Business policy and health care resource allocation question motivated this research. Failure of osteopathic programs to “pivot” to the new standards could result in fewer licensed physicians being produced in the high demand primary care field. Potential workforce shortage areas include urban and especially rural populations (CRS Report 7-5700 R44376 Feb 12, 2016). Large physician shortages already have been projected to care for a rapidly aging US population without considering the impact of the GME accreditation changes currently underway (Association of American Medical Colleges 2017 Key Findings report www.aamc.org/2017projections). The goal of this research is to provide osteopathic GME programs practical insights into characteristics of a sample of osteopathic GME programs that have successfully made the “pivot” into SAS requirements and been accredited by ACGME and those that have not. The study seeks to better understand the experiences, decisions, challenges and expectations directly from osteopathic programs directors as they strive to meet the realities of the new SAS requirements. Do programs that are already accredited differ significantly from those that have not? How do characteristics such as program size, geographic locations, clinical program components, program sponsor structure, number and experience of faculty and administration, cost planning and perceived benefits of the movement to SAS factor into successfully meeting the new requirements before the 2020 closing date? A cross-sectional research survey was designed, tested and deployed to a national sample of currently serving osteopathic GME program directors. The survey elicited data about each program’s “pivot” from AOA GME accreditation practices and guidelines to the new Single Accreditation System (SAS). The survey instrument was designed to obtain information about patterns in osteopathic GME program curricula, administrative support functions, faculty training, compliance requirements and program director characteristics shared by those programs that have been granted “initial accreditation” by the Accreditation Council for Graduate Medical Education (ACGME) who administer SAS. Thirty five (35) osteopathic GME program directors responded to the 26 question survey in June 2017. Descriptive statistics were applied and central tendency measures determined. The majority of survey respondents were Doctors of Osteopathic Medicine (D.O.s) from specialty residency programs sponsoring an average of 16 residents. Respondents were mostly non-profit, urban, multi-facility health system locations with an existing affiliation with a research college or university. About half of the programs had completed some form of fiscal due diligence related to the potential cost impact of SAS. None of those surveyed reported utilizing outside consultants to assist in the SAS “pivot” process. Most programs plan to keep the same number of residents while others expressed an interest in expanding or contracting. None of the respondents planned to close their program. The dichotomous dependent variable (DV) was whether or not the Osteopathic GME program had “achieved or not yet achieved initial SAS accreditation” at the time of the survey. A cross tabulation analysis of the DV with potential predictive variables (IV) was conducted and Chi-square and various exact significance tests were applied to gage goodness of fit. Results were grouped into categories that aligned with the five research questions and hypotheses. Several characteristics were shared by those programs that achieved SAS. GME sponsor institutions that currently have dually accredited programs by the AOA and ACGME seemed to be at a distinct advantage. Although they represented a smaller number of total survey respondents (20%), all primary care program participants reported SAS achievement. Directors reported an average of six (6) full-time paid faculty members teaching in their programs and twice that number of preceptor volunteers in the total sample. Realization of any operational cost savings or efficiencies as a result of moving to a single accreditation system was a principle concern for the majority (86%) of GME program director respondents, regardless of current accreditation status, although most felt SAS would result in offering medical student graduates access to all accredited US GME residency and fellowships programs.

The final thesis deals with cultural mobility, which is becoming an integral part of professional and private lives of a growing number of artists. Specifically, it concentrates on artist residencies as one of modern forms of the mobility. It describes their state, support and obstacles in the Czech Republic and in Denmark. The practical part of the thesis presents a comparison of two residential centers: MeetFactory in Prague and The Factory of Art and Design in Copenhagen.

Pourquoi, où et quand, des résidences d'artistes se sont implantées en Aquitaine et comment ont-elles abordé la mise en application des préconisations institutionnelles ? Quelles sont ces structures et comment s'organisent-elles en milieu rural, au profit d'une véritable visibilité de l'art contemporain ? Entre phénomène artistique, programmation culturelle et action sociale, comment l'immersion paysagère amène-t-elle à repenser la pratique artistique à partir des relations qu'elle noue avec le territoire, l'humanité et le milieu naturel ? C'est au travers de la mise en valeur et de l’ancrage de la résidence au cœur d’un terroir spécifique que peuvent se nouer des rencontres et des expériences inédites, entre création et vie sociale. La présence d’un artiste peut révéler ou réveiller des qualités et des potentialités latentes, à même de renvoyer une image insoupçonnée des lieux et des liens entre territoires et populations. C’est bien parce que le concept d’ « artiste en résidence » et le dispositif de « résidence d’artistes » ne convoquent pas de la même manière les notions de lieu et de contexte paysager que nous avons décidé d’examiner de plus près l’évolution du rapport de l’artiste au paysage et à l’espace tout au long de sa « trajectoire migratoire », pour appréhender l’effet de l’expérience de la mobilité sur la création artistique et sur le sentiment d’appartenance au lieu. En prenant nos distances vis-à-vis des définitions classiques du paysage, nous proposerons l’idée d’entité vivante et stimulante à partir de laquelle peut se dégager une nouvelle manière de voir et de concevoir le monde : révélant ainsi le « Génie du lieu », dynamique et complice de la création. / Why, where and when artist residencies have established in the Aquitaine region? How did they approach the implementation of institutional recommendations? What are these so-called structures and how are they organised in rural areas to ensure an actual visibility of contemporary art? Between art phenomenon, cultural programming and social actions, how does landscape immersion require to rethink art practice and its relationships with territorial collectivities, people and nature? Unprecedented encounters and experiences may happen thanks to showcase, design, life experience and key situation of artist residences in the heart of territories. The artist’s presence might reveal or wake up one’s qualities and full potential, enabling to give an unexpected picture of places and connections between territories and people. It is precisely because the “artist in residence” concept and the “artist residencies” facilities have different approaches to the ideas of places and landscape contexts that we decided to review the evolution of the artist’s relationship to space, landscape and populated areas – throughout his “migratory path” – so as to be able to understand the effect of mobility experience on artistic creation and connection to places. While distancing conventional definitions of landscapes, we will present the idea of a living and stimulating entity from which a new way of seeing and designing the world may occur. The revealed Genius Loci appears to have its temporary roots, dynamic and complicit with creative work.

Thesis advisor: Marilyn Cochran-Smith / This dissertation focuses on how the MAT program in Earth Science at the American Museum of Natural History (AMNH MAT), a one-of-a-kind, museum-based urban teacher residency, conceptualized and enacted the project of learning to teach science for urban school contexts. The AMNH MAT is situated within the two nested contexts. The first context is its emergence as one of a number of new, state-approved graduate schools of education that offer teacher preparation, endorse teachers for certification, and grant master’s degrees but are not part of or connected to universities. The larger study of which this case study is part termed this phenomenon “new graduate schools of education,” or nGSEs. The second context is the program’s mission of preparing teachers for urban schools, a goal that is shared by other teacher preparation programs within the domain of nGSEs. This descriptive, interpretive case study analysis poses two major questions: How and to what extent does the American Museum of Natural History infuse its long-standing beliefs about science learning and public service into a teacher preparation program? How and to what extent does the museum conceptualize and enact science teacher preparation for the specific context of urban high needs public secondary schools? Analysis of multiple data sources revealed that theAMNH’s mission of disseminating science knowledge in service of a more science-literate public was instantiated in a teacher preparation program that centralized and continually reinforced a vision of preparing science teachers but had a less central and more limited approach to preparing urban teachers. This case study analysis of an innovative teacher preparation program in one of our nation’s largest cities has important implications for urban science teacher education research and practice. First, the AMNH MAT’s model of science teacher preparation offered two key features that are useful for the field. The first feature was its coherence around the developmentof a science teacher identity that included deep science content knowledge and a commitment to bringing informal science teaching and learning practices into schools. The second model feature was the MAT program’s required four-residency structure, which essentially reinvented the “field” in teacher preparation fieldwork. At the same time, the project of learning to teach at the AMNH MAT, like that of many other urban teacher preparation programs, revealed the difficulties and dilemmas involved in preparing teachers for urban contexts, particularly the responsibility of developing a new generation of antiracist educators. / Thesis (PhD) — Boston College, 2022. / Submitted to: Boston College. Lynch School of Education. / Discipline: Teacher Education, Special Education, Curriculum and Instruction.

In February 2022 Russia’s invasion of Ukraine started the war that would lead to the largest refugee crisis in Europe since World War II. In response to the war, SWAN, the Swedish Artists Residency Network, initiated the project Emergency residencies. During 2022, the network’s artist residencies opened up to provide safety for Ukrainian artists fleeing the war. Through an ethnographic case study and in-depth interviews, this thesis explores the experiences of four Ukrainian musicians in times of war and displacement, that took part of the Emergency residencies. It also investigates the function of SWAN’s Emergency residencies for musicians facing forced migration. The purpose is to shed light on the experience of musicians in a refugee position and the residency as a space that may contribute to uphold music-making and musical labour for refugee artists.   This thesis uses a transdisciplinary approach. It draws on notions of music as an emotional resource, music becoming political, and theoretical concepts regarding identity, belonging, and detachment, as well as translocality and transcultural capital. SWAN’s Emergency residencies is shown to provide several benefits for musicians displaced during Russia’s war on Ukraine. It includes the contribution of economic resources, opportunities for artistic practice and development, and promotion of cultural understanding and social inclusion. It also suggests that typical benefits provided by artist residencies gain added value for artists experiencing war and displacement, as it answers to losses typically experienced in forced migration. The war and refugee position are embedded in the daily experience of musicians facing war and displacement. This thesis suggests that musicians can use various strategies to either enforce, dismiss, expand or change the view of their prescribed identity in relation to the war and the refugee position. A Ukrainian identity is enhanced to show pride of their country, create awareness of Ukraine’s situation or foster a sense of belonging. Music can also be used to detach from positions and preconceptions surrounding such labels and connections, either through performing other identities or releasing from all categories. Furthermore, music and music-making can act as an emotional resource that helps regulate emotions or become a vehicle for political mobilisation and support for Ukraine. The politicisation of music is also actualised by the refugee position in itself and public perceptions of such positions. Transcultural capital highlights the capacities and strategies of musicians to create various economic, cultural and social opportunities through links to both their host and home country.

This study investigates how gender, power and education affect how preventative measures against threats and violence as well as conflict management are discussed and used among care workers in specialized youth residencies in Sweden. Semi-structured interviews were held with fifteen care workers which were later thematically analyzed using hegemonic masculinity, total institutions and stigma as a theoretical framework. Our findings show that there are multiple hidden gendered practices. The use of physical measures against clients is constructed as inevitable, and that male care workers are most important in conflict management. By having the strength to physically overpower their clients. They are also framed as ideal with their relational advantage to the all-male youth group. Women instead are seen as a deviation from the norm, and a group that must be protected and kept away from dangerous situations. There is also depicted an experience of disorganization and distrust among care workers. Due to perceived poor choices in recruiting and high turnover among chief positions. Where choices for recruiting are based on nepotism and bias for men. We conclude that this removes agency from women in the greater workgroup. We also find that there is a great need for further training in conflict management for care workers as well as higher standards for the recruiting of care workers.

Submitted by LORENA MENDES DE CARVALHO LUCIO null (limcarvalho@yahoo.com.br) on 2016-09-12T13:56:26Z No. of bitstreams: 1 TESE FINAL LORENA POS BANCA Repositorio UNESP 12.09.16.pdf: 1673690 bytes, checksum: 578ad77e846c1bc6a83776f9b4d1b8bf (MD5) / Approved for entry into archive by Felipe Augusto Arakaki (arakaki@reitoria.unesp.br) on 2016-09-14T18:44:12Z (GMT) No. of bitstreams: 1 lucio_lmc_dr_bot.pdf: 1673690 bytes, checksum: 578ad77e846c1bc6a83776f9b4d1b8bf (MD5) / Made available in DSpace on 2016-09-14T18:44:12Z (GMT). No. of bitstreams: 1 lucio_lmc_dr_bot.pdf: 1673690 bytes, checksum: 578ad77e846c1bc6a83776f9b4d1b8bf (MD5) Previous issue date: 2016-08-25 / Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / O presente estudo objetivou determinar as concentrações dos resíduos de gases anestésicos (RGA) em salas de operação (SO) e o impacto dessa exposição ocupacional em relação aos danos genômicos e estresse oxidativo em profissionais recém-expostos. O estudo foi conduzido no Hospital das Clínicas, Faculdade de Medicina de Botucatu-UNESP. As concentrações de isoflurano, sevoflurano e óxido nitroso (N2O) foram medidas nas SO por espectrofotometria infravermelha, com equipamento portátil. Sessenta e três médicos residentes, ao final de três anos do Programa de Residência Médica, foram alocados em dois grupos: exposto (Anestesiologia e Cirurgia, n=32) e controle (Clínica Médica, n=31). Amostras de sangue periférico e células bucais foram coletadas e protegidas da luz. Avaliaram-se danos no material genético (teste do cometa - danos basais, purinas e pirimidinas oxidadas em linfócitos; 8-hidroxi-2’-desoxiguanosina no plasma), micronúcleo (MN) em células bucais, proteínas carboniladas, marcadores de lipoperoxidação (malonaldeído e 4-hidroxinonenal) e capacidade antioxidante plasmática (ferric reducing antioxidant power, oxygen radical absorbance capacity e total antioxidant performance). As concentrações médias dos RGA foram superiores aos limites internacionalmente recomendados (2,7 vezes: isoflurano; 4,9 vezes: sevoflurano; 7,2 vezes: N2O). Os grupos não diferiram quanto aos dados demográficos (p>0,05). Detectou-se aumento significativo de danos basais no DNA (p=0,01) e maior frequência de MN em células bucais (2,3 vezes; p=0,07) no grupo exposto em relação ao grupo controle, mas não houve diferença (p>0,05) entre os grupos em relação a todos os marcadores de estresse oxidativo. Em conclusão, o estudo mostra que médicos residentes expostos a altas concentrações de RGA apresentam aumento significativo de danos sistêmicos no DNA e frequência aumentada de instabilidade genômica (MN bucais), mas não de estresse oxidativo. Portanto, este estudo mostra que jovens profissionais já apresentam alterações genômicas, o que reforça a importância do biomonitoramento e da diminuição da exposição aos RGA. / This study determined the waste anesthetic gases (WAG) in operating rooms (OR) and evaluated the impact of the occupational exposure in genetic damage and oxidative stress in medical residents. The study was performed at “Hospital das Clínicas, Faculdade de Medicina de Botucatu-UNESP”. The concentrations of isoflurane, sevoflurane and nitrous oxide (N2O) were measured in ORs. Sixty-three medical residents completing their three-year Medical Residency Program were recruited for the study and were assigned to two groups: exposed group (n=32) of Anesthesiology and Surgery areas and control group (n=31) of Internal Medicine area. Blood and buccal cells were concomitantly collected from both groups and protected from light to measure genetic instability by buccal micronucleus (MN), basal and oxidized DNA damage (comet assay and 8-hydroxy-2′-deoxyguanosine), biomarkers of protein and lipid oxidation, and three different assays for plasma antioxidant activity. Mean WAG concentrations were above international thresholds (2.7-fold: isoflurane; 4.9-fold: sevoflurane; 7.2-fold: N2O). There was no significant difference between groups regarding demographic data. Basal DNA damage (p=0.01) and buccal MN frequency (by 2.3-fold; p=0.07) were increased in the exposed group compared to the control group. Results showed no significant difference for oxidative stress biomarkers between groups. In conclusion, this study shows that medical residents exposed to high WAG concentrations have increased systemic DNA damage and genomic instability (buccal MN), but not oxidative stress. Thus, these young professionals already have genetic damage in the beginning of their career. Our results reinforce the importance of the biomonitoring and also the adequate measures to decrease ambient air pollution in the OR. / FAPESP: 2013/21130-0 / CNPq: 472453/2013-0 / CAPES/PGCI: 14527-13-8

Orientador: Leandro Gobbo Braz / Resumo: O presente estudo objetivou determinar as concentrações dos resíduos de gases anestésicos (RGA) em salas de operação (SO) e o impacto dessa exposição ocupacional em relação aos danos genômicos e estresse oxidativo em profissionais recém-expostos. O estudo foi conduzido no Hospital das Clínicas, Faculdade de Medicina de Botucatu-UNESP. As concentrações de isoflurano, sevoflurano e óxido nitroso (N2O) foram medidas nas SO por espectrofotometria infravermelha, com equipamento portátil. Sessenta e três médicos residentes, ao final de três anos do Programa de Residência Médica, foram alocados em dois grupos: exposto (Anestesiologia e Cirurgia, n=32) e controle (Clínica Médica, n=31). Amostras de sangue periférico e células bucais foram coletadas e protegidas da luz. Avaliaram-se danos no material genético (teste do cometa - danos basais, purinas e pirimidinas oxidadas em linfócitos; 8-hidroxi-2’-desoxiguanosina no plasma), micronúcleo (MN) em células bucais, proteínas carboniladas, marcadores de lipoperoxidação (malonaldeído e 4-hidroxinonenal) e capacidade antioxidante plasmática (ferric reducing antioxidant power, oxygen radical absorbance capacity e total antioxidant performance). As concentrações médias dos RGA foram superiores aos limites internacionalmente recomendados (2,7 vezes: isoflurano; 4,9 vezes: sevoflurano; 7,2 vezes: N2O). Os grupos não diferiram quanto aos dados demográficos (p>0,05). Detectou-se aumento significativo de danos basais no DNA (p=0,01) e maior frequê... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: This study determined the waste anesthetic gases (WAG) in operating rooms (OR) and evaluated the impact of the occupational exposure in genetic damage and oxidative stress in medical residents. The study was performed at “Hospital das Clínicas, Faculdade de Medicina de Botucatu-UNESP”. The concentrations of isoflurane, sevoflurane and nitrous oxide (N2O) were measured in ORs. Sixty-three medical residents completing their three-year Medical Residency Program were recruited for the study and were assigned to two groups: exposed group (n=32) of Anesthesiology and Surgery areas and control group (n=31) of Internal Medicine area. Blood and buccal cells were concomitantly collected from both groups and protected from light to measure genetic instability by buccal micronucleus (MN), basal and oxidized DNA damage (comet assay and 8-hydroxy-2′-deoxyguanosine), biomarkers of protein and lipid oxidation, and three different assays for plasma antioxidant activity. Mean WAG concentrations were above international thresholds (2.7-fold: isoflurane; 4.9-fold: sevoflurane; 7.2-fold: N2O). There was no significant difference between groups regarding demographic data. Basal DNA damage (p=0.01) and buccal MN frequency (by 2.3-fold; p=0.07) were increased in the exposed group compared to the control group. Results showed no significant difference for oxidative stress biomarkers between groups. In conclusion, this study shows that medical residents exposed to high WAG concentrations have increase... (Complete abstract click electronic access below) / Doutor