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Purpose Little is known about how board-certified physicians prepare for their periodic maintenance of certification (MOC) examinations. This qualitative study explores how physicians experience MOC exam preparation: how they prepare for the exams and decide what to study and how exam preparation compares with what they normally do to keep their medical knowledge current. Method Between September 2016 and March 2017, the authors interviewed 80 primary care physicians who had recently taken either the American Board of Family Medicine or American Board of Internal Medicine MOC exam. They analyzed transcripts and notes from these interviews looking for patterns and emergent themes, using the constant comparative method and a social practice theory perspective. Results Most interviewees studied for their MOC exams by varying from their routines for staying current with medical knowledge, both by engaging with a different scope of information and by adopting different study methods. Physicians described exam preparation as returning to a student/testing mindset, which some welcomed and others experienced negatively or with ambivalence. Conclusions What physicians choose to study bounds what they can learn from the MOC exam process and, therefore, also bounds potential improvements to their patient care. Knowing how physicians actually prepare, and how these activities compare with what they do when not preparing for an exam, can inform debates over the value of requiring such exams, as well as conversations about how certification boards and other key stakeholders in physicians' continuing professional development could improve the MOC process.

In this chapter, the impact of CO2 emissions from a specific industry, aviation, is detailed together with monitoring of CO2 by airlines. In addition, forward-looking schemes by the aviation industry, such as the European Union's Emission Trading Scheme, are presented. Technical discussions are provided related to (1) calculations of aircraft CO2 direct emissions from individual and national flights and worldwide records, and (2) an evaluation of the contribution and impact of some additions to CO2 greenhouse gases, such as of NOx and water vapor, on radiative forcing. The chapter also reviews natural and man-made sources of CO2 and the carbon cycle to provide a background for discussing CO2 emissions from the aviation industry. It further provides some basic background on traditional nondispersive infrared absorption techniques, as well as modern spectroscopic instruments used to quantify CO2 emissions by aviation. The chapter concludes by discussing some instruments mounted on satellites for monitoring greenhouse gases.

Background Since 2013, US residency programs have used the competency-based framework of the Milestones to report resident progress and to provide feedback to residents. The implementation of Milestones-based assessments, clinical competency committee (CCC) meetings, and processes for providing feedback varies among programs and warrants systematic examination across specialties. Objective We sought to determine how varying assessment, CCC, and feedback implementation strategies result in different outcomes in resource expenditure and stakeholder engagement, and to explore the contextual forces that moderate these outcomes. Methods From 2017 to 2018, interviews were conducted of program directors, CCC chairs, and residents in emergency medicine (EM), internal medicine (IM), pediatrics, and family medicine (FM), querying their experiences with Milestone processes in their respective programs. Interview transcripts were coded using template analysis, with the initial template derived from previous research. The research team conducted iterative consensus meetings to ensure that the evolving template accurately represented phenomena described by interviewees. Results Forty-four individuals were interviewed across 16 programs (5 EM, 4 IM, 5 pediatrics, 3 FM). We identified 3 stages of Milestone-process implementation, including a resource-intensive early stage, an increasingly efficient transition stage, and a final stage for fine-tuning. Conclusions Residency program leaders can use these findings to place their programs along an implementation continuum and gain an understanding of the strategies that have enabled their peers to progress to improved efficiency and increased resident and faculty engagement.

Background: Little is known about how physicians experience preparing for board recertification examinations. As women make up a growing proportion of the primary care physician workforce, we aimed to explore how primary care physicians experience the personal and professional impacts of recertification examination preparation activities, and whether these impacts differ by gender. Materials and Methods: We conducted exploratory qualitative semistructured interviews with 80 primary care physicians, who had recently taken either the American Board of Family Medicine or American Board of Internal Medicine recertification examination and who practice outpatient care. We used an iterative recruitment approach to obtain a representative sample. We applied a team-based constant comparative analytic approach to identify and categorize themes related to how preparing for the recertification examination impacted their personal or professional lives, and then compared these themes by physician gender. Results: We interviewed 41 male and 39 female participants. Physicians most frequently described taking time from personal rather than professional activities to study, but often said this was "no big deal." Physicians described impacts on personal life such as missing out on family or leisure time, conflicts with parenting responsibilities, and an increased reliance on their spouse for domestic and childcare duties. Female physicians more frequently described parenting and leisure time impacts than males did. Conclusions: Recertification examination preparation impacts physicians' personal lives in a variety of ways and are sometimes experienced differently along gendered lines. These findings suggest opportunities for employers, payers, and specialty boards to help physicians ease potential burdens related to maintaining board certification.

Many children often experience phases of picky eating, food aversions and/or avoidance. For families with children who have special needs, these experiences are often exacerbated, which can lead to feelings that negatively impact a caregiver’s relationship with their child. Within the scope of speech language pathology practice, knowledge of both emotional and feeding development is key. This paper will explore the significance of “messy play” within typical feeding development, and the challenges that may arise if a child does not have the opportunity to engage in this type of exploratory play. This paper will consider several contributing factors that can result in a “picky eater.” Further, research has shown that individuals with special needs, including autism, possess a neurological makeup that differs from that of a typical individual. Because autism is a disorder of relating and communicating due to differences in the limbic system, an individual with special needs may respond to a typical feeding experience as if it is a traumatic event. As a result, broadening one’s dietary repertoire may seem to be an insurmountable challenge. This paper suggests that introducing new foods through exploratory play can help broaden and strengthen diets, as well as improve the feeding experience, of individuals with autism. The DIRFloortimeⓇ methodology stresses the importance of following a child's lead. Within this developmental model, there is a special focus on a person’s individual differences, including the unique way they process the world around them, as well as the significance of therapy occurring within the context of a strong and motivating relationship. Using this child-centered approach, we can support our children in expanding their diets, while simultaneously building upon their cognitive and creative development through playful and respectful interactions that include exposure to foods that differ in color, texture, and smell. Further, this paper explores the importance of exploration, self-feeding and messy play on brain development, both in the context of typically developing individuals and those with disordered development.

The new RPAS (remotely piloted aerial systems) are mostly video cameras with wings whose ownership isn't enshrined in any constitution. Rulers are rushing to do regulate the lack of safety and accountability for RPAS. In Italy ENAC (aviation authority) legislated against random acts of stupidity and probable failures. For the current year of 2015, there is a forecast to sell $1bn worth of RPAS product. For these reasons the installation of RPS (Recovery Parachute System) on commercial RPAS is particularly interesting. A few RPS manufacturers have manufactured specific RPS systems for "drones" both rotary and fixed wing. However, these systems are designed with the same criteria of manned aerial vehicle. This paper demonstrates that the design criteria of RPAS are sensibly different from other applications. In particular the rate of descent during recovery should be reduced from 6m/s to 2m/s. This fact poses new challenges in parachute design. In fact RPS mass depends on parachute diameter that increases with low descent rates. This paper demonstrates that it is possible to design effectively RPS for RPAS up to 80kg by using nonwoven fabric in parachutes. In this way the RPS mass is a small fraction of the RPAS one. Deployment systems are not a problem for RPAS since masses are extremely small and the power necessity are accordingly limited.

The large majority of current trainers are piston engine aircrafts. Their engine lasts 2,000 hours maximum. The idea is to substitute the engine with a green electric powerpack with the same performance of the original unit, but with no emission and basically with no maintenance. The powerpack should be easy to install, safe and should provide sufficient autonomy. This last part is particularly easy for trainers, since they fly in a very standard way. At morning, with the battery fully charged, the instructor and the student perform a flight that lasts typically from 20 minutes to 2 hours. On landing a de-briefing of the student takes place. This phase is followed by the briefing of the new student. These two steps take at minimum of 30 minutes. During this time the battery can be partially recharged. The process will continue for a full day, with a longer recharge during break times. Therefore, it is perfectly possible to have a one day autonomy (about 10 hours). This project is intended to develop an experimental green trainer to validate the best configuration for this power pack and to find-out critical issues on installation, safety, reliability and maintenance. Finally, a minimum number of 300 hours of flight will be performed to perform an accelerated test to individuate critical safety issues on the new proposal. This part should be considered as in integral part of the University Career for those aviation students who want to get involved in testing and engineering, rather than only flying. At the same time, converting powerplants from the combustion ones into the electric ones will contribute to reduce the polluting emissions in the air that produce micro-climate changes.

Introduction Professionalism rests upon a number of individual, environmental, and societal level factors, leading to specific professional behavior in specific situations. Focusing on professional lapses to identify and remediate unprofessional physicians is incomplete. We explored professionalism in practicing internal medicine physicians in the context of everyday practice, to highlight how typical experiences contribute to positive, yet often unnoticed, professional behavior. Methods In-depth interviews were used to uncover 13 physicians' most meaningful experiences of professionalism. Data were collected and analyzed using a grounded theory approach. Results Results revealed several themes around which physicians embody professionalism in their daily lives. Physicians feel most professional when they are able to connect and establish trust with patients and colleagues and when they serve as positive role models to others. Physicians conceptualize professionalism as a dynamic and evolving competency, one that requires a lifelong commitment and that provides opportunities for lifelong learning. Discussion Focusing on actual perceptions of experiences in practice offers important insights into how physicians think about professionalism beyond a traditional remediation and lapses perspective. Physicians often go out of their way to connect with patients and colleagues, serving and modeling for others, often at the expense of their own work-life balance. These moments help to infuse energy and positivity into physician practices during a time when physicians may feel overburdened, overscheduled, and overregulated. Understanding professionalism as developmental helps frame professionalism as a lifelong competency subject to growth and modification over time.

Worldwide aviation is expected to grow by just under 5% per year for the next two decades. This growth will have environmental consequences via noise, air quality and climate impacts. Potential mitigation methods include regulations and standards, technological improvements involving aircraft and engine performance and/or the development of alternative fuels, operational improvements, and market based policies. Climate change may have several consequences for transport demand on a global and regional scale. Especially the predicted increases in temperature could have substantial effects on aircraft performance and the associated patterns in passenger transport. In the last Intergovernmental Panel on Climate Change (IPCC), the United Nations' scientific body on the issue, stated with high certainty that human causes lay behind most of the observed global temperature increases. Atmospheric CO2 concentrations have increased from approximately 280 ppm (parts per million) in the pre-industrial age to around 430 ppm today. At the level of 550 ppm, which could be reached as early as 2035, global average temperatures may rise by more than 2°C. Under a business-as-usual (BAU) scenario, the stock of greenhouse gases could more than triple by the end of the century, giving at least a 50% risk of temperatures rising by more than 5°C during the decades to follow. The scale of such an increase could be illustrated by the fact that the climate is presently 5°C warmer than in the last ice age, which was over 10,000 years ago. In 2009, the aviation industry set itself three ambitious climate goals. To achieve one of the goals such as to cap net aviation CO 2 emissions at 2020 levels, a global market based measure (MBM) has been developed. In addition to CO 2 emissions, aviation operations may influence climate via emissions of non CO2 gases and soot and sulfate particles which alter the atmospheric concentration of GHGs. Although some additional effects contribute to warming and others to cooling, non-CO2 effects are believed to contribute to warming in aggregate (Penner et al., 1999; Lee et al., 2009). Aviation climate impacts from non-CO2 sources are sometimes characterized by a metric — known as a multiplier — that divides the total impact of aviation on climate by the CO2 impact. Although proposals requiring airlines to purchase allowances for non-CO2 effects have been discussed in policy circles, such as the European Parliament, it remains uncertain whether such measures will be applied. To capture these uncertainties, we consider multiplier coefficients of one and two. When the multiplier is one, non-CO2 effects are not considered, while a multiplier of two is used to capture non-CO2 effects in our analysis. We refer to simulations employing a multiplier of one as “no aviation multiplier” scenarios and simulations with a multiplier of two as “aviation multiplier” scenarios. To reflect the increased scarcity of allowances in multiplier scenarios, we reduce economy-wide emissions caps based on estimates of the contribution of aviation to aggregate GHG emissions from Lee et al. (2009). To consider alternative offset and multiplier combinations, we consider four scenarios: full offsets with no aviation multiplier (F1), full offsets with an aviation multiplier (F2), medium offsets with no aviation multiplier (M1), and medium offsets with an aviation multiplier (M2). These scenarios capture a wide range of possible outcomes. The cap on cumulative emissions between 2012 and 2050 is 17% lower in full offset scenarios than in medium offset scenarios, and policy-induced aviation fuel price increases in multiplier scenarios are more than twice as large as fuel price increases in no multiplier scenarios. According to the Ministry of Energy announcement, the UAE released 199.65 million tonnes of carbon dioxide and other greenhouse gases in 2013. The purpose of this paper is to investigate, according to the increase foreseen in air transportation in the UAE, the CO2 emissions within Abu Dhabi airport and in the UAE in order to propose solutions to reduce as much as possible those types of emissions. Data sampling, calculation of aviation emissions, uncertainty in data and type of fuel are critical issues considering thousands of flights to be taken into account.

Purpose – The purpose of this paper is to document everyday practices by which hospitalist physicians negotiate barriers to effective teamwork. Design/methodology/approach – Ethnographic observation with a sample of hospitalists chosen to represent a range of hospital and practice types. Findings – Hospitals rely on effective, interprofessional teamwork but typically do not support it. Hospitalist physicians must bridge the internal boundaries within their hospitals to coordinate their patients’ care, but they face challenges – scattered patients, fragmented information, uncoordinated teams, and unreliable processes – that can impact the timeliness and safety of care. Hospitalists largely rely on personal presence and memory to deal with these challenges. Some invent low-tech supports for teamwork, but these are typically neither tested nor shared with others. Formal support for teamwork, primarily case management rounds, is applied unevenly and may not be respected by all team members. Research limitations/implications – The findings are drawn from observation over a limited period of time with a small, purposefully chosen sample of physicians and hospitals. Practical implications – Hospitals must recognize the issues hospitalists and other providers face, evaluate and disseminate supports for teamwork, and make interprofessional teamwork a core feature of hospital design and evaluation. Originality/value – The authors show the nuances of how hospitalists struggle to practice teamwork in a challenging context, and how the approaches they take (relying on memory and personal presence) do not address, and may actually contribute to, the system-level problems they face.

To assess physician views and perceived adoption of overtreatment guidelines and measure whether adoption of these guidelines influenced the recommendation of a targeted service.A cross-sectional survey mailed from July 2014 to January 2015 to 902 internists who completed residency between 2003 and 2013, randomly selected from the American Medical Association Masterfile.Poisson regression was used to model the rate of recommending a targeted service included in the guidelines, based on the level of guideline adoption.A total of 456 physicians responded (51% response rate). Most expressed familiarity with overtreatment guidelines (88.5%), a comfort level with discussing these guidelines with patients (79.9%), and described overtreatment guidelines as a useful tool in their practice (81.6%). Physicians in the highest tertile of guideline adoption reported double-digit rates of recommending antibiotics for sinusitis (29.7%), mammogram at end of life (16.5%), and electrocardiogram testing for asymptomatic patients (11.0%). Physicians in the bottom tertile of guideline adoption reported lower rates of recommending x rays (-12.0%; 95% confidence interval [CI], -19.4% to -4.5%; P = .002), magnetic resonance imaging for lower back pain (-4.8%; 95% CI, -8.1% to -1.5%; P = .004), and cardiac testing for asymptomatic patients (-10.2%; 95% CI, -18.9% to -1.5%; P = .02).US internal medicine physicians who completed residency between 2003 and 2013 reported high levels of adoption of overtreatment guidelines. Physicians who reported the highest levels of guideline adoption reported recommending services targeted by these guidelines in their practice.

Bernabeo, R. A., & Michaelides-Mateou, S. (2017). The use of interactive whiteboards as a pedagogical tool in teaching aviation courses. World Trans. on Engng. and Technol. Educ, 15(1), 78-81., Presentation tools are increasing in popularity for educators who want to share ideas and information with large or small groups of students, and interactive applications are in demand for educators wishing to involve their students in learning with technology. The electronic interactive whiteboard is a device that combines both attributes, offering shared learning experiences for large or small groups, as well as for distance learning. In this article, the authors firstly consider how aviation science lessons could be designed incorporating relevant and interactive software into a sound pedagogical strategy for aviation students. Based on their observations and discussions, the authors can state that there are some benefits to aviation students and faculty (academic staff) in the Department of Aviation at Abu Dhabi University, Abu Dhabi, United Arab Emirates, coming from the use of the interactive whiteboard (IWB) in the teaching process.