Current Shortage Research Articles

Productivity and consultation times in Portuguese primary care: trends and payment model variations

Abstract Background Portugal faces a shortage of primary care workforce resulting in an increase in patients without Family Physician (FP). While expanding the patient list per FP may help, it could also result in excessive workloads, compromising Consultation Times (CT) and quality of care. Furthermore, it is important to study the role of the primary healthcare (PHC) financing model in incentivizing their productivity. This study aims to analyse the productivity and CT in PHC units in Portugal, variation over time, and differences across PHC unit payment models. Methods 6,563 PHC units with different payment models (salary at UCSP, salary and group pay-for-performance at USF-A, and salary, capitation, and individual pay-for-performance at USF-B) from 2015 to 2022 were analysed, including the annual numbers of medical and nursing consultations and full-time equivalents (FTE) of physicians and nurses. Weekly productivity (WP) was calculated using the consultations per FTE physician and nurse. CT were determined by dividing each FTE’s weekly workload by WP. Multivariate analysis explored differences in CT between PHC units, temporal variations, and the influence of the patient population characteristics. Results FTE physicians had a mean WP of 117 consultations (SD 39) lasting 22.4 minutes (SD 7.0). FTE nurses had a mean WP of 56 consultations (SD 18) lasting 41.0 minutes (SD 14.3). Compared to UCSPs, USF-A and USF-B had shorter CT (p < 0.05) by 2.48 to 4.05 minutes for medical consultations and by 5.51 to 8.04 minutes for nursing consultations. CT increased over time, decreased with higher PHC age and favorable socio-demographic context, and increased with higher population density and elderly patients’ proportion (p < 0.05). Conclusions USF-B professionals showed higher productivity and shorter CT, suggesting that financial incentives are effective in enhancing productivity but that gains may be obtained with losses in visit duration. Key messages • Effective workforce management is crucial given the current primary care professionals shortages. • Physicians and nurses in PHC units pay-for-performance exhibit higher productivity and shorter consultation time.

Pediatric Cardiac Xenotransplantation and Expanded Access: Ethical Considerations.

Due to the current organ shortage waitlist, alternatives to allotransplantation are necessary. Xenotransplantation is currently being pursued as one such alternative in adults in need of kidney or heart transplantation. Cardiac xenotransplantation of genetically modified pig hearts has been conducted twice in adults under the United States Food and Drug Administration (FDA) expanded access criteria. Because of the shortage of transplantable hearts for children as well as the lack of mechanical circulatory support in this population, pediatric researchers are exploring FDA expanded access in high-risk neonates and infants who lack alternative options for survival. The adult cardiac xenotransplantation experience with expanded access can provide lessons and highlight nuances for researchers preparing pediatric application. This includes aspects of informed consent, biosurveillance, and protection of bystanders from potential xenozoonoses.

Genotyping for Weak and Partial D Rh Status to Optimize Usage of Limited Blood Supplies

Abstract Introduction The Rh antigen group, expressed on erythrocytes and encoded by highly polymorphic RHD and RHCE genes on chromosome 1 (1p36-p34), is notable in transfusion medicine due to its high polymorphism, strong immunogenicity and ability to cause hemolytic transfusion reactions in patients and hemolytic disease of the fetus and newborn (HDFN). The D antigen specifically contains multiple epitopes with variations that include decreased expression (weak D) or loss of certain epitopes (partial D) which expose patients to risk of alloimmunization depending on the subtype of the Rh(D) antigen. Hence, serologic weak D testing followed by molecular testing is not performed except for donors testing negative for Rh(D) antigen and newborns typing negative for Rh(D) and born to Rh(D) negative mothers. Given the current shortages of blood supplies, understanding patients’ genotypes in the context of weak or partial D-typing and risk of alloimmunization can be essential in the management of increasingly limited supplies of red blood cell (RBC) units. Objective To further characterize patients that initially type negative for Rh(D) but positive for weak D with molecular testing to investigate risk of alloimmunization, retype the Rh(D) and avoid unnecessary use of Rh(D) negative RBC units during critical shortages of RBC units. Methods We collected the results of ABO/Rh(D) typing for patients with negative Rh(D) testing but positive weak D test over a period of four weeks in December 2023 and had D-variant molecular testing performed by a reference laboratory. Initial serologic ABO/Rh(D) was performed in tube followed by weak D testing by indirect Coombs test in tube. Results The total number of patients who initially tested negative for Rh(D) but positive (weak to +4) for weak-D was three patients. Two patients showed a probable genotype of RHD*01W.1 (RHD* weak type 1, 809T>G (V270G)) homozygous which indicated the presence of weak D+ type 1. Patients with weak D+ type 1 can receive Rh(D) positive red cell units, and they are not at risk of alloimmunization and developing anti-D. The third patient showed a probable genotype RHD*DVI type 2 homozygous (lack of Rh(D) exons 4 through 6) and indicated the presence of partial D antigen. Patients with partial D antigen should receive RH(D) negative red cell units as they are at risk of alloimmunization and developing anti-D. Conclusions Although the vast majority of Transfusion Medicine services do not perform the serologic weak D test with reflex to molecular testing, characterizing patients who test negative with initial serologic Rh(D) testing with serologic and molecular D-tests may aid in retyping the Rh(D) of patients during critical shortages, particularly for patients with ABO blood group O.

"Everything's a Challenge": An Interview Study of ADHD Individuals in the Midst of the Prescription Stimulant Shortage.

The shortage of prescription stimulants is an ongoing issue that is impacting the ability of individuals with ADHD to access their medication. Amidst concerns that this shortage may have a substantial impact on individuals' ability to manage their symptoms effectively, this research seeks to understand the experiences and consequences for those affected. In this study, we interviewed individuals with ADHD who have been directly impacted by the stimulant shortage. Thematic analysis focused on identifying common themes related to challenges with medication access and the resulting effects on daily living. The study uncovered significant difficulties in accessing ADHD medication due to current shortages, leading to disruptions in the management of ADHD symptoms and subsequent detriments to individuals' professional, educational, and personal lives. Systematic controls aimed at reducing non-medical use were found to exacerbate these access issues, inadvertently compounding the challenges faced by those using medication for legitimate medical needs. Individuals also described ways they coped with the shortage, with some seeking ADHD medication via unofficial channels. Our findings highlight the urgency of addressing stimulant shortages to safeguard the wellbeing of individuals with ADHD. This study also calls for a critical review of policy measures regulating stimulant medication access, and their effectiveness at reducing non-medical use given the unintended consequences these regulations appear to have on individuals prescribed these medications for therapeutic purposes.

8169 Bilateral Inferior Petrosal Sinus Sampling Using Metyrapone as a Reliable Alternative to Differentiate Between Cushing Disease and Ectopic ACTH Syndrome- A Single Center Experience

Abstract Disclosure: M. Azmath: None. S. Faisal: None. C. Caetano: None. T. Vedere: None. H. Aftab: None. B. Tendler: None. C. Malchoff: None. Introduction: Bilateral IPSS is a crucial test in accurately diagnosing Cushing disease (CD) and differentiating it from ectopic ACTH syndrome (EAS). [1] CRH stimulated IPSS is the gold standard technique but cannot be performed due to current shortage of CRH. Metyrapone is a safe and reliable alternative to CRH that can stimulate corticotrophs to secrete ACTH and hence used for IPSS. [2] We would like to share a single center experience using a novel low dose metyrapone protocol for IPSS that successfully helped differentiate CD and EAS. Methods: This was a retrospective analysis of patients presenting with Cushing syndrome. Initial diagnosis was confirmed based on standard testing including 24-hour urinary free cortisol (UFC), late night saliva concentrations (LNSC) and MRI. Metyrapone 500 mg every 4 hours for 3 doses was administered orally starting midnight prior to IPSS performed in the morning. ACTH levels drawn during initial evaluation for Cushing syndrome was compared to ACTH values post metyrapone from the peripheral vein sample to calculate a gradient. Ultimately, pituitary CD or EAS was confirmed based on cure following surgery and /or positive ACTH of tumor staining on pathology and/or concordant results with CRH stimulated IPSS. Results: There were 9 patients, out of which 5 had pituitary CD, and 4 had EAS. Pre ACTH levels for patients ranged between 14.5 and1164 pg/ml (normal reference range 6-50). Following metyrapone, ACTH level rose to 40-4705 pg/ml (normal reference range 6-50). The increase in ACTH levels ranged from 81-547% pre and post metyrapone. An average of 5-6 ACTH samples were drawn during IPSS. Catheterization was successful in all patients and was confirmed by IR. The mean central to peripheral (C/P) ACTH ratio for patients with confirmed CD was 20.53 in comparison with a ratio of 1.34 in patients with EAS. IPSS was confirmed to be diagnostic for pituitary CD if the peak ratio after metyrapone administration was more than 3. No adverse effects were observed during or after the procedure and no hospitalization was required pre-procedure. Discussion: We present single center experience with a novel low dose metyrapone protocol for IPSS. Our protocol was successful in increasing ACTH/cortisol secretion by tumorous cells as evidenced by increase in ACTH levels post metyrapone. It is an easy oral protocol which proved to be safe without the risk for adrenal insufficiency that can occur with higher doses. It also mitigates the small thromboembolic risk that can occur with DDAVP administration. A clear distinction in C/P ACTH ratios was observed in patients with CD versus EAS as early as the 3rd sample. In conclusion, our low dose metyrapone protocol was safe and reliable in accurately differentiating between CD and EAS in small sample of patients at our institution. Presentation: 6/1/2024

Accounting students’ perceptions of teaching and assessment methods

Due to the current shortage of accountants and the various pipeline initiatives taking place, our research aims to address the instructor’s role in the accounting classroom. We survey students on their perceptions regarding teaching and assessment methods used in university accounting courses. Results for both in person and online courses suggest students prefer instruction that involves instructor demonstration of exercises and real-world examples, while relying on the instructor’s personal experiences with accounting. We offer valuable perspectives to educators aiming to improve both the caliber of accounting education and the student learning experience to help combat the drastic shortage.

MPC Optimization Algorithm and Strategy for HVAC System under Smart City Construction

As a giant in energy consumption, buildings urgently need to optimize control strategies for the main energy consuming equipment inside buildings. It is of great significance to design advanced control algorithms to improve the efficiency of the main energy consuming equipment in buildings, namely air conditioning, in the current energy shortage. The model predictive control algorithms and strategies were used in this study to control the HVAC system to improve the energy utilization of the city. Then linear matrix inequality with robust model predictive feedback controller was used to optimize and get the model predictive control optimization algorithm. The research results showed that, under the influence of different factors, the three regions controlled by the model predictive control optimization algorithm showed a little overshooting in the initial state. But it was quickly corrected after adjustment. Meanwhile, the average tracking error of temperature and humidity in each region was 0.139◦ C and 0.13g/kg dry air, respectively. The average predicted mean vote was 0.32. In actual office buildings, the proposed algorithm controlled the temperature within the reference value range of 0.1◦ C throughout the entire process. The total electricity consumption and electricity price costs were reduced by 12.11% and 22.54%, respectively. In summary, the proposed method has good performance for HVAC system application, which can effectively realize energy saving and emission reduction and improve human comfort. This method makes important contributions to promote the construction of smart cities and the development of green buildings.

A qualitative study of nurse participation in global health in the English NHS: participation, interest, and barriers to participation

BackgroundNurses contribute to the largest demographic of the healthcare workforce. However, given current global shortages of workforce capacity, this often leads to limited capacity to engage in extracurricular educational developments beyond their immediate role. Consequently, this significantly limits the range of workforce training and development opportunities that are available to them, which could enhance the variety of skills that are brought to the National Health Service (NHS).ObjectiveWe aimed to understand prior, current, and future participation in global health activities such as global health conferences, networks, and placements, among National Health Service (NHS) staff. Furthermore, we investigated the barriers and facilitators to participation in global health activities for nurses in our sample.MethodQualitative and quantitative data was gathered from an online survey conducted in England from July to November 2021. Thematic analysis was used to examine the qualitative data collected from one open-ended question, whereas statistical analysis was used to examine the remaining quantitative data.ResultsMost (84%) nurses in our sample had not participated in a global health activity. Our results highlighted three barriers to participation, including insufficient communication, a lack of awareness, and capacity issues.ConclusionThis study showed that, despite low levels of prior participation, there is a strong desire among surveyed nurses to be involved in global health activities and education. Our findings also suggest that enhanced communication of opportunities available is needed, in addition to organisational support which incorporates strategies to overcome capacity constraints.

Reducing the risk of social engineering attacks using SOAR measures in a real world environment: A case study

The global cost of successful cyberattacks is increasing annually, with there being a shift towards social engineering threats in recent years. Cybercriminals are increasingly targeting humans rather than technical systems, recognizing data as a critical resource, especially in the finance industry where breaches can lead to substantial losses and reputational damage. The present case study proposes measures to reduce human susceptibility to social engineering attacks, leveraging SOAR (Security Automation, Orchestration, and Response) technology for incident response automation. The study covers various issues in cybersecurity, SOAR, and social engineering, through analyzing interviews with expert practitioners in the field, addressing cybersecurity skills shortages and current cyber threats. Four social engineering vignettes were developed, representing real threats, along with specific SOAR measures implemented using Microsoft Sentinel. These measures were simulated to demonstrate their effectiveness by reducing the employee's vulnerability to social engineering attacks. The risk of social engineering attacks was successfully reduced by implementing a responsive approach through the developed SOAR measures. Some of the measures reduced the risk by locking user accounts or forcing password changes after a detected cyber incident while another measure was developed for awareness enhancements. Given the current shortage of cybersecurity professionals, technologies like SOAR are becoming increasingly relevant for security teams. However, SOAR alone cannot address all challenges posed by social engineering and should be viewed as a complementary measure rather than a standalone solution.

Sintering Mechanism and Leaching Kinetics of Low-Grade Mixed Lithium Ore and Limestone

With the rapid development of new energy fields and the current shortage of lithium supply, an efficient, clean, and stable lithium resource extraction process is urgently necessary. In this paper, various advanced detection methods were utilized to conduct a mineralogical analysis of the raw ore and systematically study the occurrence state of lithium; the limestone sintering process was strengthened and optimized, elucidating the sintering mechanism and analyzing the leaching process kinetics. Under an ingredient ratio of 1:3, a sample particle size of 300 mesh, a sintering temperature of 1100 °C, a sintering time of 3 h, a liquid–solid ratio of 2:1, a leaching temperature of 95 °C, and a leaching time of 1 h, the leaching rate of Li reached 90.04%. The highly active Ca–O combined with Si–O on the surface of β–spodumene to CaSiO4, and Al–O was isolated and combined with Li to LiAlO2, which was beneficial for the leaching process. The leaching process was controlled by both surface chemical reactions and diffusion processes, and Ea was 27.18 kJ/mol. These studies provide theoretical guidance for the subsequent re-optimization of the process.

Current status of lung cancer care in Germany in the context of treatment centralization and lack of personnel

Lung cancer is the malignancy with the highest mortality rate worldwide. In January 2025, the German public healthcare system will introduce a new regulation according to which a centre can offer surgery for lung cancer only if it carries out a minimum number of lung resections. The purpose of this directive is to reduce the number of centres offering surgical treatment for primary lung cancer, thus centralising and improving lung cancer care. It is expected that the introduction of this regulation will lead to a significant shift in the staffing of thoracic units. The purpose of this survey was to examine the current occupational structures behind the units of thoracic surgery and respiratory medicine. We performed an online survey through the German Society for Thoracic Surgery and the Association of Respiratory Physicians. The responding centres were divided in two groups, centres that were certified by the German Cancer Society or the Society for Thoracic Surgery and centres which were not certified. The response rate was 29.3% (respiratory physicians) and 31.9% (thoracic surgeons); 67% of the participating colleagues answered that their unit was an independent department. The majority of the participants reported having to share the on-call duty of the trainees with other departments in order to be able to cover the required shifts. 35% of the respiratory physicians and 57% of the thoracic surgeons reported having vacant job posts in their units. The introduction of the minimum quantity regulation will have significant consequences for the treatment of lung cancer in Germany. The current staff shortage in healthcare will lead to both medical and nursing staff needing to be redistributed in order to meet the needs that will arise in 2025. Operating lists, theatre days, and operative equipment will need to be redistributed as well, not only within hospitals but probably on a nationwide level. A negative impact of the new regulation is to be expected on research and academic activities since most university hospitals are not expected to reach the minimum number of lung resections that is required in order keep performing lung cancer surgery.

First principles study on photocatalytic water decomposition of ZnO/WS2 heterojunctions

The generation of clean energy hydrogen through solar-driven water decomposition is an effective solution to the current global energy shortage and environmental pollution. In this paper, ZnO/WS2 heterojunction is constructed based on first-principles. The effect of uniaxial strain and vacancy defects (VZn, VO, VS, V2S) on electronic and optical properties of ZnO/WS2 heterojunction are calculated. The results indicate that the bandgap of the heterojunction is decreased and the visible absorption range is expanding. Additionally, the built-in electric field of the heterojunction is determined to be oriented from ZnO to WS2, which enhances the efficiency of carrier separation. Band-edge position analysis indicates that ZnO/WS2 heterojunctions exhibit good redox water properties under an applied compressive strain of −2 %. Finally, the visible light absorption range of the heterostructures is also expanded by introducing VS and V2S vacancy defects. However, it exhibits a superior ability to oxidize and reduce water only under VZn defects. The corresponding photocatalytic mechanism of ZnO/WS2 heterojunctions is discussed.

To precept or not to precept: Perspectives from nurse practitioners.

Nurse practitioner (NP) preceptors are crucial to clinical education. Recent increases in the required direct patient care hours for NP students may worsen the current preceptor shortage. However, most studies of preceptorship only include NPs who are current preceptors and are therefore missing vital information from nonpreceptors. It is imperative to understand facilitators and barriers to preceptorship from the perspective of NPs who have stopped being or have never been preceptors. The purpose of this study was to understand the factors influencing NPs' decisions whether to precept. This was a descriptive, phenomenological study. Semistructured interviews were recorded in Zoom, transcribed verbatim, deidentified, and analyzed using thematic analysis. Sixty NPs participated in the study: 23 current preceptors, 22 previous preceptors, and 15 who had never been preceptors. Facilitators to preceptorship included institutional support of preceptorship, positive student characteristics, clear expectations from the educational facility, and incentives. Barriers to preceptorship included time constraints, specialty, negative student characteristics, no institutional support, and being uncomfortable in the clinical role. Preceptors and nonpreceptors shared similar themes-positive student characteristics and clear expectations as facilitators to preceptorship, and time as a barrier. However, other themes were unique to one preceptorship group. This provides new evidence for practice and research. Nurse practitioner programs can facilitate preceptorship by ensuring that students are well prepared and providing clear expectations. Strategies should be developed to manage the time burden of preceptorship. In addition, support for preceptorship by health care organizations and systems should be studied.

Eco-Efficient Mortars for Sustainable Construction: A Comprehensive Approach

Cement production is responsible for approximately 7% of global carbon dioxide emissions. Despite our efforts, we have not been able to find a competitive substitute that is both reliable and environmentally friendly. The easiest way to solve the issue is to rationalize resources and try to minimize their use by replacing them with other materials. The current market shortage and reduced initial strength have limited the availability of blends that contain a significant amount of fly ash. Given the current economic, political, and environmental circumstances, it is predicted that a solution may be ternary blends with cement, fly ash, and MTK. Despite being “ancient” materials, there have been no recent global performance assessments. In this context, an investigation was carried out with ternary blend mortars. A significant volume of cement has been replaced with fly ash and metakaolin. The results show that these blends’ performance is promising because they offer a wide range of possibilities for replacing cement, maintaining or even improving its properties. MTK and fly ash’s synergies significantly enhance mechanical performance and durability. Furthermore, the global sustainability analysis shows that ternary blends are 36% more efficient than binary blends of cement and fly ash or metakaolin.

Why School Bus Drivers Stay in Their Jobs

With the current shortage of school bus drivers in many states, access to education is at risk for the many students who get to and from school by bus. Despite the critical role drivers play, little is known about why they stay in their jobs, and what can be done to keep them. To learn more about school bus driver retention, 301 drivers in 32 districts in New York were surveyed. Drawing on an overarching model of person-environment fit, perspectives of job satisfaction, meaningful work and public service motivation were used to explore what aspects of the driver role relate to turnover intention. Findings indicated lower turnover intention when drivers reported higher extrinsic satisfaction, when they found their work to hold personal significance, and when they saw their work as a source of broader meaning for their lives. Drivers also viewed themselves as making a difference in the lives of students and considered themselves a significant part of their education. They also indicated that pay and benefits were important in their decision to stay or leave. Findings are discussed in terms of implications for school leadership practice and future research.

Emergency pediatric patients and use of the pediatric assessment triangle tool (PAT): a scoping review

BackgroundWe conducted a scoping review of the evidence for the use of the Pediatric Assessment Triangle (PAT) tool in emergency pediatric patients, in hospital and prehospital settings. We focused on the psychometric properties of the PAT, the reported impact, the setting and circumstances for tool implementation in clinical practice, and the evidence on teaching the PAT.MethodsWe followed the Joanna Briggs Institute methodology for scoping reviews and registered the review protocol. We searched MEDLINE, PubMed Central, the Cochrane Library, Epistemonikos, Scopus, CINAHL, Grey literature report, Lens.org, and the web pages of selected emergency pediatrics organizations in August 2022. Two reviewers independently screened and extracted data from eligible articles.ResultsFifty-five publications were included. The evidence suggests that the PAT is a valid tool for prioritizing emergency pediatric patients, guiding the selection of interventions to be undertaken, and determining the level of care needed for the patient in both hospital and prehospital settings. The PAT is reported to be fast, practical, and useful potentially impacting overcrowded and understaff emergency services. Results highlighted the importance of instruction prior using the tool. The PAT is included in several curricula and textbooks about emergency pediatric care.ConclusionsThis scoping review suggests there is a growing volume of evidence on the use of the PAT to assess pediatric emergency patients, some of which might be amenable to a systematic review. Our review identified research gaps that may guide the planning of future research projects. Further research is warranted on the psychometric properties of the PAT to provide evidence on the tool’s quality and usefulness. The simplicity and accuracy of the tool should be considered in addressing the current healthcare shortages and overcrowding in emergency services.Review registration: Open Science Framework; 2022. https://osf.io/vkd5h/

Laser-Constructed Bionic Composite Fog-Collecting Surfaces with Efficient Nucleation Sites and Enhanced Water Transport.

Fog collection effectively alleviates the current freshwater shortage; thus, enhancing its efficiency is crucial. Here, we report a novel bionic fog collection surface (Al@B-V) comprising composite superhydrophobic bumps integrated with superhydrophilic V-channel grooves. This surface, which has efficient fog nucleation points and enhanced water transport capabilities, effectively balances fog capture and water transport during the collection process, thereby achieving high-efficiency fog collection. Compared to ordinary aluminum-based surfaces, Al@B-V achieves a fog collection efficiency of up to 3.08 g·cm-2·h-1, three times higher than the original aluminum-based surface. Furthermore, the V-channel groove proposed in this study exhibits a water transport speed of up to 165 mm·s-1, which is remarkably approximately 80 times faster than the commonly used U-channel groove. Additionally, this V-channel groove can overcome gravity, transporting approximately 10 μL of liquid to the top even when placed at 90° inclination. It can directionally transport 10 μL of liquid over a distance of up to 151 mm on a plane. This novel microgroove design can be effectively applied in various fields, including liquid collection, directional transport, seawater desalination, microfluidics, and drug delivery.

The rare-earth elements recovered from the leachate of discarded phosphor by electrodeposition

ABSTRACT Recovering rare-earth elements (REEs) from discarded phosphors is an important solution to alleviate the current shortage of rare-earth resources, the aluminum element in discarded phosphors will badly affect the purity and recovery of rare-earth elements. An electrodeposition method for recovering the rare earth from the discarded phosphoric leachate was proposed to avoid the effecting of aluminum elements. The results show that the purity of the rare-earth oxides recovered reached 99.13% and the recovery rate of rare-earth elements reached 98.89% by adopting the optimal electrodeposition process with the help of the complexing agent glycine. Research has found that adding the complexing agent glycine can help rare-earth hydroxides precipitate at the cathode and inhibit aluminum ion precipitation by changing the aluminum deposition potential. Moreover, it was also found that the generation of OH- ions by reduction of NO3- in acid aqueous solution was a one-step irreversible reaction in the deposition process by cyclic voltammetry, which ensured the reliability of rare-earth hydroxide precipitation reaction.

The Geographic Distribution of Vascular Surgeons and Trainees by State in 2023

Approximately 1.4 vascular surgeons/100,000 persons are estimated to fulfill current patient needs in the United States (US), but an ongoing shortage exists. The aims of this study are to provide an updated nationwide state-by-state workforce analysis and compare the distribution of practicing vascular surgeons and training opportunities. Vascular surgeons in the US were identified using the National Provider Identifier registry in 2023. Only board-certified and actively licensed vascular surgeons were included. To estimate the number of vascular surgery graduates per year in each state, integrated residency and fellowship-matched positions (trainees) were ascertained from the National Resident Matching Program website. Surgeons and trainees were totaled by state, and densities were calculated using the 2020 US Census Bureau state populations. These two cohorts were also examined together using simple linear regression and geographic mapping. This study included 3399 board-certified vascular surgeons and 228 newly matched trainees. The average densities of vascular surgeons and trainees in the US are 1/100,000 persons and 0.06/100,000 persons, respectively. The five states with the lowest densities of vascular surgeons are AR, ND, NV, OK, and WY, averaging 0.4/100,000 persons. Eight states (AK, ID, KS, ND, NM, NV, RI, WY) had zero training programs offering positions in 2023 and ranked in the lowest quartile for the number of practicing vascular surgeons (Figure 1). Simple linear regression demonstrated a statistically significant correlation between state rates of vascular surgeons and trainees (p < 0.001). States with zero training positions also have the fewest vascular surgeons per capita. Statewide attention to expanding vascular surgery training opportunities targeted in these areas could positively impact the current maldistribution and shortage of vascular surgeons.

Optimized control of hybrid energy storage systems for microgrids

Abstract The development of new energy sources is considered to be one of the important ways to solve the current energy shortage problem. Clean energy sources such as wind and light have attracted much attention. Still, the volatility and uncertainty of their output power create difficulties for the large-scale connection of the system to the power grid. Based on the microgrid system, this paper focuses on the energy optimization control problem of storage batteries and supercapacitors. A low-pass filter is used based on the charge state SOC expressed as a formula. The working state of the supercapacitor charge is divided into five regions, with each region having a corresponding reference value for output power correction. The capacity optimization model of the hybrid energy storage device is constructed, and the Gaussian variational quantum particle swarm algorithm (GM-QPSO) is used to optimize the capacity of the hybrid energy storage device. It is found that the capacity optimization method proposed in this paper not only improves the stability of the operation of the system but also ensures the overall economy of the system.