Minimum Performance Standards Research Articles

Textile testing to assess the resistance to damage of long-lasting insecticidal nets for malaria control and prevention

BackgroundLLINs are susceptible to forming holes within a short time in use, compromising their ability to provide long-term physical protection against insect-borne vectors of disease. Mechanical damage is known to be responsible for the majority of holes, with most being the result of snagging, tearing, hole enlargement, abrasion and seam failure, which can readily occur during normal household use. To enable an assessment of the ability of LLINs to resist such damage prior to distribution, a new suite of testing methods was developed to reflect the main damage mechanisms encountered during normal use of LLINs.MethodsFour existing BS EN and ISO standards used by the textile industry were adapted to determine the ability of LLINs to resist the most common mechanisms of real-world damage experienced in the field. The new suite comprised tests for snag strength (BS 15,598:2008), bursting strength (ISO 13938-2:1999), hole enlargement resistance (BS 3423–38:1998), abrasion resistance (ISO 12947-1:1998) and new guidance around the seam construction of LLINs. Fourteen different LLINs were tested using the new suite of tests to evaluate their resistance to damage.ResultsThe resistance to mechanical damage of LLINs is not the same, even when the bursting strength values are comparable. Differences in performance between LLINs are directly related to the fabric design specifications, including the knitted structure and constituent yarns. The differences in performance do not primarily relate to what polymer type the LLIN is made from. LLINs made with a Marquisette knitted structure produced the highest snag strength and lowest hole enlargement values. By contrast, LLINs made with a traverse knitted structure exhibited low snag strength values when compared at the same mesh count.ConclusionsPrequalification of LLINs should consider not only insecticidal performance, but also inherent resistance to mechanical damage. This is critical to ensuring LLINs are fit for purpose prior to distribution, and are capable of remaining in good physical condition for longer. The new suite of test methods enables the performance of LLINs to be assessed and specified in advance of distribution and can be used to establish minimum performance standards. Implementation of these testing methods is therefore recommended.

Flow and Diffusion Characteristics of Typical Halon Extinguishing Agent Substitute under Different Release Pressures

To provide guidance towards reducing the weight of the HFC-125 storage vessel by reducing the release pressure and to reveal the effects of release pressure on the extinguishing efficiency of HFC-125, we investigated the flow and diffusion characteristics of HFC-125 under six release pressures in the present study. The influence of release pressure on the degree of superheat, injection duration, pressure loss, jet angle, and concentration distribution were analyzed. Results show that the degree of superheat and the injection duration both decreased with the release pressure. The bubble expansion in the HFC-125 could slow down the pressure decrease in the storage vessel. The flow process in the pipeline can be divided into three phases: pipeline filling, stable flow, and mixed gases release. Both of the maximum and mean values of the pipeline pressure loss increased with the release pressure. The maximum concentration value decreased with the increase of the distance from the nozzle. The maximum concentration value in the near field from the nozzle increased with the release pressure. The concentration and holding time (duration above 17.6% volume concentration) of HFC-125 in the near field from the nozzle met the requirements of minimum performance standards (MPS) for HFC-125.

Do financial penalties for environmental violations facilitate improvements in corporate environmental performance? An empirical investigation

AbstractEnvironmental regulations play an essential role in managing firm behavior and providing a reference point for the minimum standards of corporate environmental performance, yet certain firms fail to ensure their environmental performance meets these standards. This research focuses on public firms that the US government has penalized for violating environmental regulations and investigates whether these firms subsequently improved their environmental performance. Surprisingly, neither the receipt of a penalty for an environmental violation nor the imposition of a greater penalty was associated with improvements in environmental performance. Instead, a penalty for environmental violation predicted further, albeit mild, deterioration in environmental performance. While the existing literature has established that financial penalties deter most firms from committing environmental violations, this research contributes to this literature by revealing that these penalties fail to motivate firms that have violated environmental regulations to improve their environmental performance.

Developing an aeronautical English training unit based on the ADDIE model in an EFL context

The precision and effectiveness of the communication between air traffic controllers and pilots is quite literally a matter of life or death. Speakers of aeronautical English, the language of communication in the realm of aviation, are required by the ICAO to meet a minimum standard of language performance across the communication skills of listening and speaking, yet miscommunication and misunderstandings across channels persist, potentially resulting in catastrophic collisions and incidents. This English for Specific Purposes (ESP) paper reports on the creation of an aeronautical English training unit guided by principles of the ADDIE (analysis, design, development, implementation, and evaluation) model of instructional design developed to assist Korean army enlisted soldiers and noncommissioned officers who are serving as air traffic controllers in the improvement of integral aeronautical English skills. Designed materials were assessed with the assistance of four subject-matter experts (SMEs) as a pilot test, and results of the evaluation demonstrate the potential for application of the ADDIE model of instructional design for future ESP instructional units.

The carrot and the stick: Policy pathways to an environmentally sustainable rental housing sector

As the impacts from climate change are progressively being felt around the globe, there is an increasing urgency in the need for policymakers to find ways to reduce greenhouse gas emissions. The rental housing sector offers one such clear opportunity to reduce CO2 emissions. However, there has been a lack of consensus regarding the policies that would best deliver a sustainable rental sector. Building on calls in the literature to examine policy mix solutions for this conundrum, a Policy Delphi methodology, using both qualitative and quantitative techniques, identified seven key policy areas. These were divided into carrot policies (tax incentives, rebates and grants); cusp policies, that are neither clearly carrot nor stick, but often have a leaning towards one or other (loans, energy arrangements, improved rental rights); and stick policies (minimum standards, mandatory disclosure). Minimum performance standards, rebates and tax incentives were identified as the most effective policy solutions by the expert panel. Findings suggest that any policy mix should include both carrot and stick policies. When integrated with the existing ‘enabling forces’ literature, a model emerges that highlights the policy pathways to an environmentally sustainable rental housing sector.

Development and Validation of a Situational Judgement Test to Assess Professionalism

Objective. The purpose of this study was to develop, pilot, and validate a situational judgement test (SJT) to assess professionalism in Doctor of Pharmacy (PharmD) students. Methods. Test specifications were developed and faculty members were educated on best practices in item writing for SJTs. The faculty members then developed 75 pilot scenarios. From those, two versions of the SJT, each containing 25 scenarios, were created. The pilot population for the SJT was student pharmacists in their third professional year, just prior to starting their advanced pharmacy practice experiences. The students completed the two versions of the test on different days, approximately 48 hours apart, with 50 minutes allowed to complete each. Subsequently, students completed a questionnaire regarding the SJT at the conclusion of the second test. Results. Version 1 of the SJT was completed by 228 students, and version 2 was completed by 225 students. Mean scores were 390 (SD=20, range 318-429) and 342 (SD=21, range 263-387) on test versions 1 and 2, respectively. The reliability of the tests was appropriate (test version 1, α=0.77; test version 2, α=0.79). Students felt that the content of the tests was realistic with respect to pharmacy practice (90.1%), and that the tests gave them an opportunity to reflect on how to approach challenging situations (82.6%). Conclusion. We developed a reliable SJT to assess professionalism in PharmD students. Future research should focus on creating a personalized learning plan for students who do not meet minimum performance standards on this SJT.

Performance evaluation of nitrogen for fire safety application in aircraft

Fire suppression is an important safety certification requirement for aircraft as it is for all safety critical systems. Risk analyses are required at the design and certification stages to determine the probabilities and means of mitigating such risks. Apostolakis et al. (1995) shows an approach for spacecraft, Spyrou and Koromila (2020) for passenger ships and Arshi et al. (2010) for reactors. An important analysis tool for aircraft is the Zonal Analysis process (Chen and Fielding, 2018) Such analyses include investigation of means of fire suppression for which the use of Halon 1301 was a popular choice. The production of Halon and several halocarbons were banned under the Montreal Protocol in 1994, which necessitates an investigation for use of environmental-friendly agents for this application. The primary objective of this paper is to determine the ‘design concentration’11Design concentration is the volumetric concentration of the agent to achieve successful fire suppression in an enclosure. of nitrogen required for fire suppression. Computational Fluid Dynamics (CFD), in combination with experimental verification is described in this paper. The air flow rate in the cup-burner model was varied between 10 L/min and 40 L/min for a low-speed numerical model and was validated against the BS ISO 14520 cup burner test (BS ISO 14520 Annex, 2006) to determine the extinguishing concentration of nitrogen. The study revealed that the design concentration of nitrogen was 34% (14% oxygen concentration). Further investigation suggested that at low air flow rates (10 L/min and 20 L/min case), distortions produced in the flow led to erroneous measurement of oxygen concentration in experiments. The fire suppression model was extended to an n-heptane pool fire in a large enclosure. The recorded design concentration was approximately 39% additional nitrogen corresponding to 13% oxygen concentration by volume. It was observed that the weight of nitrogen required increased by 7.5 times compared to Halon 1301 use for this model. Future work can be explored in aircraft cargo and engine bay fire safety systems through Minimum Performance Standard (MPS) testing and simulations with nitrogen as the agent. Such work will feed directly into system safety assessments during the early design stages, where analyses must precede testing.

ANALISA PERBAIKAN KINERJA PENGIRIMAN PRODUK R754046 DI PT PELANGI ELASINDO DENGAN PENDEKATAN SAFETY STOCK

PT Pelangi Elasindo is one of the leading manufacturers in Indonesia specializing in webbing production, shoelaces, cords, high quality Molded Pulp, elastics and tape. As one of the vendors for leading shoe factories in the world, the accuracy of shipping goods both in terms of quantity and time is very important because this is a benchmark for calculating shipping performance. There was a delay in delivery at PT Pelangi Elasindo on the R7540460000 Molded Cardboard Shape size 2 product, making delivery performance decrease. Delivery performance in January is 93% while the minimum delivery performance standard is 95%. This study aims to analyze the factors that delay the delivery of goods to customers and improve delivery performance. Based on the results of the analysis, the factors that cause the delay in delivery are damage to the machine, manual cutting and demand variations and uncertainty of lead time. Among these factors, demand variations and lead time uncertainty are the most influential factors, so to improve delivery performance, safety stock must be prepared to avoid stock outs and delivery delays. Based on the results of the calculation of the safety stock that must be prepared is 8,403 prs per week. Key words : Delivery, performance, safety stock,improve

PERILAKU PEGAWAI DAN DAMPAKNYA PADA EFEKTIVITAS TENAGA KEPENDIDIKAN

The public spotlight on performance is getting bigger, especially regarding the sub-optimal and the minimum standard of apparatus performance. Therefore attention to the performance and effectiveness of the organization's work is a central topic to be a busy topic of discussion. This study examines the extent of the influence of employee performance on the organizational effectiveness of the District Education Office of Tanah Bumbu. To administer this condition, the apparatus's behavioral dimensions include abilities, skills, knowledge, attitudes, and motivations while the dimensions of organizational effectiveness on work productivity, efficiency, and job satisfaction. Skills, knowledge, attitudes, and motivation as an organizational asset, so that the quality of the human resources of the organization concerned can be relied upon in carrying out work and readiness to face changes and challenges in the future.Keywords: Employee behavior, work effictiveness, performance, performance appraisal, HR quality

Training upcoming academicians through interviews of pharmacy resident teaching certificate leaders.

Background:Discovering methods of Residency Teaching Certificate Programs (RTCPs) will allow for collaboration in developing best practices to ensure both high quality of programming and outcomes for participants.Objective:The primary objective of this project is to describe and compare how RTCPs are conducted in the state of Ohio. Secondarily, to identify current practices in assessing RTCPs in both programmatic effectiveness and individual resident teaching outcomes.Methods:The seven coordinators of the seven Ohio RTCPs (n=7) were contacted via email and asked to participate in an IRB-approved interview, either in-person or telephonically. Standardized questions were developed to inquire about six categories of interest: demographics/background, administration/logistics, content, assessment of the resident, program financing, and program continuous quality improvement (CQI). All seven programs participated in interviews. Data was coded by multiple members of the research team for presentation in aggregate form.Results:RTCPs include seminar days at the respective pharmacy colleges; however, the number, length, and content of seminars vary. The majority of programs (n=5) stated using inherited curriculum and materials passed down from previous coordinators. While each RTCP requires participants to submit a teaching portfolio, only three of seven programs assess the summative portfolios. All programs (n=7) award participants a certificate based on completion of requirements without a defined minimum performance standard. Two programs are collecting participant feedback after every session for CQI however no programs are completing an annual programmatic assessment of resident outcomes. The majority of coordinators (n=7) are interested in collaborating and sharing “best practices” between RTCPs in the state.Conclusions:Although published and available resources exist surrounding the development and delivery of RTCPs, in Ohio, their use varies greatly. The most striking outcomes highlighted the lack of resident and program assessment of outcomes in RTCPs. The research has brought forth ideas of ways to improve these programs through resident assessment, program assessment and also leads to reflection and innovation around the best way to deliver these programs.

Towards a Definition of Distinction in Professionalism

Phenomenon: Professionalism can be characterized by a particular set of attributes that clinicians demonstrate in practice. Although much has been described on those attributes that define acceptable professionalism, the characteristics that define distinction in professionalism have not yet been well defined. Approach: In this exploratory project, qualitative methods were used to triangulate three sources of data collected from three campuses of one medical school: student assessment summaries, teacher interviews, and an institutional policy. Findings: One hundred-thirty student assessment summaries, eight teacher interviews, and one institutional policy were analyzed. Three characteristics emerged that define distinction in professionalism: improvement of oneself, helping others learn, and teamwork. These characteristics are in addition to students demonstrating a clear minimum standard in all other aspects of professionalism. Insights: Findings from this project offer a first step toward a definition of distinction in professionalism for assessing student performance. The characteristics can be demonstrated by students to varying degrees of proficiency and are potentially achievable by all students. Finally, the characteristics would be required in addition to demonstrating a clear minimum standard of performance in all other aspects of professionalism and cannot be inferred by the absence of negative or unprofessional behaviors. Recognizing that conceptions of professionalism have contextual and cultural influences, the characteristics of distinction identified by this project expand the language available for teachers and learners to discuss professionalism. Teachers may use these characteristics to help inform their teaching, learning, and feedback practices. Students will gain clarity about the expectations regarding their professional behavior.

The Acute Flaccid Paralysis (AFP) Surveillance System in Yemen, 2010-2015: Descriptive Study Based on Secondary Data Analysis.

BackgroundAcute flaccid paralysis (AFP) surveillance is an essential strategy for poliovirus eradication.ObjectiveThis study aimed to evaluate the performance of the AFP surveillance system in Yemen from 2010 to 2015, identify components that require strengthening, and compare the indicators by year and governorates.MethodsThis descriptive study was based on secondary analysis of AFP surveillance data reported during 2010-2015 from all Yemeni governorates. The World Health Organization (WHO) minimum performance standards were used to evaluate the performance of the AFP surveillance system.ResultsA total of 3019 AFP cases were reported between January 2010 and December 2015. At the national level, AFP surveillance achieved WHO targets throughout the evaluating period for the nonpolio AFP rate of cases per 100,000 members of the population younger than 15 years of age, proportion of AFP cases reported within 7 days, proportion of AFP cases investigated within 48 hours of notification, proportion of AFP cases with two adequate stool specimens, and proportion of stool specimens from which nonpolio enterovirus was isolated. However, the proportion of specimens that arrived at the central level within 3 days of the first sample collection and the proportion of stool specimens with results sent from the reference laboratory within 28 days of receipt did not reach targets in 2011 and 2015, respectively.ConclusionsThe AFP surveillance system in Yemen has met most of the WHO indicator levels. Nevertheless, the evaluation showed areas of weakness regarding the arrival of specimens at the central level within 3 days of the first sample collection and delays in processing of the results and submitting feedback by the laboratory. Therefore, there is a need to strengthen the follow-up of specimens submitted to the laboratory.

Análise do desempenho acústico em sistemas de vedação e piso em edificações multifamiliares

A norma de desempenho NBR 15575 passou a exigir das construtoras padrões mínimos de qualidade e desempenho, a fim de atender as exigências dos usuários e buscar maior competitividade no mercado. Diferentemente do conforto térmico, o conforto acústico muitas vezes acaba tendo menor destaque, mesmo sabendo-se do desconforto e dos problemas causados pelos ruídos indesejados. Sendo assim, o presente trabalho tem por objetivo avaliar o desempenho acústico dos sistemas de vedação e de piso em edificações verticais multifamiliares. Para a coleta de dados, foram realizados ensaios de campo em edificações na cidade de Fortaleza conforme preconizado pela norma de desempenho ABNT NBR 15575:2013. Foram avaliados o isolamento a ruído aéreo nos sistemas de vedação e de piso e o isolamento a ruído de impacto no sistema de piso. Constatou-se que das 7 edificações analisadas, 2 não atendem ao desempenho mínimo em pelo menos um critério e que o uso da manta acústica melhora o desempenho acústico, notando-se uma relação estreita do conforto acústico com a espessura e o material do núcleo e do revestimento utilizados. Observa-se que os sistemas construtivos utilizados atualmente atendem apenas ao mínimo requisitado pela norma, sendo necessário o estudo de novas tecnologias para um melhor desempenho acústico das edificações construídas.

Physician Licensing and Disciplining: Lessons from Indiana

State medical boards use professional licensing and discipline to enforce minimum performance standards. Using forty-four years of data (1972-2015) on physician licensing and discipline obtained from the Indiana Professional Licensing Agency, we identify factors associated with a higher likelihood of being discipline. Only 1.3% of the sixty-three thousand licensed physicians in our dataset were disciplined. The most common reasons for disciplinary action were drug-diversion (25%); incompetence (18%); drug abuse (17%), alcohol-abuse (10%), and sexual misconduct (9%). The most common disciplinary sanctions were probation (26%); suspension (25%); and revocation (17%). Regression analyses indicated that the following factors were associated with a higher likelihood of being disciplined: male gender; earlier license year; holding more Controlled Substance Registrations; and specializing in family medicine/general practice, psychiatry, and obstetrics and gynecology. Psychiatrists, obstetricians and gynecologists are especially likely to be sanctioned for sexual offenses; family physicians or general practitioners for drug-diversion; and anesthesiologists for substance abuse. Negligence or incompetence cases are less likely to be severely sanctioned. Research continues on the degree of overlap between the medical malpractice and disciplinary systems.

Development of a Passive and Active Technology Package Standard and Database for Application to Zero Energy Buildings in South Korea

There is much research on zero energy buildings. In this paper, technologies and policies to improve the building energy efficiency of zero energy buildings are presented. The zero energy building certification system in Korea is introduced, and the evaluation is carried out based on the energy self-reliance rate that enables zero energy buildings. Zero energy buildings are able to minimize energy consumption due to the application of highly efficient building materials and equipment technology. In this research, to increase the prevalence of zero energy buildings in Korea, the authors propose a zero energy building technology package. Using a passive and active technology package, we confirmed the necessity and detailed requirements of each technology parameter. We analyze and classify Korean building material testing methods and performance standards, and propose passive and active technology packages, modules, material performance testing methods and minimum requirement performance standards. Finally, this study proposed a table presenting the test methods, standard and minimum value of performance. By these results, the authors confirmed the effectiveness and availability of passive and active technical packages.

Forecasting Indonesia's electricity load through 2030 and peak demand reductions from appliance and lighting efficiency

Indonesia's electricity demand is growing rapidly, driven by robust economic growth combined with unprecedented urbanization and industrialization. Energy-efficiency improvements could reduce the country's electricity demand, thus providing monetary savings, greenhouse gas and other pollutant reductions, and improved energy security. Perhaps most importantly, using energy efficiency to lower peak electricity demand could reduce the risk of economically damaging power shortages while freeing up funds that would otherwise be used for power plant construction. We use a novel bottom-up modeling approach to analyze the potential of energy efficiency to reduce Indonesia's electricity demand: the LOAD curve Model (LOADM) combines total national electricity demand for each end use—as modeled by the Bottom-Up Energy Analysis System (BUENAS)—with hourly end-use demand profiles. We find that Indonesia's peak demand may triple between 2010 and 2030 in a business-as-usual case, to 77.3 GW, primarily driven by air conditioning and with important contributions from lighting and refrigerators. However, we also show that appliance and lighting efficiency improvements could hold the peak demand increase to a factor of two, which would avoid 26.5 GW of peak demand in 2030. These results suggest that well-understood programs, such as minimum efficiency performance standards, could save Indonesia tens of billions of dollars in capital costs over the next decade and a half.

The Growth and Performance of Nursing Programs by Ownership Status

Introduction Since 2002, there has been dramatic growth in the number of registered nurse (RN) graduates from nursing programs in all types of institutional settings, with the largest increases in the for-profit sector. Aim To document trends in the growth of nursing programs and to compare their outcomes, as measured in first-time NCLEX® pass rates, by ownership type and degree, including bachelor of science in nursing, associate degree in nursing, and practical nurse. Methods We used 10 years of data (2007-2016) from the Integrated Postsecondary Education Data System (IPEDS) to track the number of programs and graduates by ownership type. We obtained 5 years of data (2011-2015) from state boards of nursing on first-time NCLEX pass rates by degree. We constructed a multivariate regression model with pass rates as the dependent variable and school ownership status as the independent variable. Covariates included a broad range of institution-level covariates obtained from IPEDS and county-level data on poverty obtained from the Area Health Resource File. Results From 2007-2016, there was a five-fold increase in the total number of for-profit nursing programs and a 14-fold increase in the number of graduates of for-profit nursing programs. Graduates of public nursing programs declined as a percentage of total graduates, whereas for-profit programs’ share grew from 1.7% to 14.2 %. After controlling for demographic and socioeconomic factors, for-profit ownership was a significant predictor of lower NCLEX pass rates for all three degree programs. Conclusions Additional research is needed to understand why ownership status affects performance, but it is incumbent upon nursing leaders to review federal, state, and accreditation oversight to ensure minimum performance standards for all nursing programs. Since 2002, there has been dramatic growth in the number of registered nurse (RN) graduates from nursing programs in all types of institutional settings, with the largest increases in the for-profit sector. To document trends in the growth of nursing programs and to compare their outcomes, as measured in first-time NCLEX® pass rates, by ownership type and degree, including bachelor of science in nursing, associate degree in nursing, and practical nurse. We used 10 years of data (2007-2016) from the Integrated Postsecondary Education Data System (IPEDS) to track the number of programs and graduates by ownership type. We obtained 5 years of data (2011-2015) from state boards of nursing on first-time NCLEX pass rates by degree. We constructed a multivariate regression model with pass rates as the dependent variable and school ownership status as the independent variable. Covariates included a broad range of institution-level covariates obtained from IPEDS and county-level data on poverty obtained from the Area Health Resource File. From 2007-2016, there was a five-fold increase in the total number of for-profit nursing programs and a 14-fold increase in the number of graduates of for-profit nursing programs. Graduates of public nursing programs declined as a percentage of total graduates, whereas for-profit programs’ share grew from 1.7% to 14.2 %. After controlling for demographic and socioeconomic factors, for-profit ownership was a significant predictor of lower NCLEX pass rates for all three degree programs. Additional research is needed to understand why ownership status affects performance, but it is incumbent upon nursing leaders to review federal, state, and accreditation oversight to ensure minimum performance standards for all nursing programs.

Graph-based ontology reasoning for formal verification of BREEAM rules

Globally, the need to check regulation compliance for sustainability has become central in the delivery of construction projects. This is partly due to policies by various governments requiring existing and new buildings to comply with certain standards or regulations. However, the verification of whether a building complies with any particular standard or regulation has proven challenging in practice. The purpose of formal verification is to prove that under a certain set of assumptions, a building will adhere to a certain set of requirements, for example the minimum performance standards of key environmental issues. Compliance checking requires different criteria often difficult to straightforwardly define and combine in an integrated fashion for providing holistic interpretation to facilitate easy decision-making. Such criteria, their various flows and combinations can easily be dealt with using conceptual graph theories and Semantic Web concepts which allow rules to be imbued to facilitate reasoning. The aim of this study is to tap on conceptual graphs and Semantic Web concepts to develop a system for checking Building Research Establishment Environmental Assessment Methodology (BREEAM) sustainability standard compliance in the French construction industry. A conceptual graph-based framework that formally describes BREEAM requirements and visually analyse compliance checking processes has been proposed. When implemented in a software that integrates conceptual graphs and Semantic Web knowledge, automatic reasoning allows both the logical specification and the visual interpretation to be displayed and further provides a semantic support for compliance checking information.

Detection of Influenza A and B Viruses and Respiratory Syncytial Virus by Use of Clinical Laboratory Improvement Amendments of 1988 (CLIA)-Waived Point-of-Care Assays: a Paradigm Shift to Molecular Tests

An accurate laboratory diagnosis of influenza, respiratory syncytial virus (RSV), and other respiratory viruses can help to guide patient management, antiviral therapy, infection prevention strategies, and epidemiologic monitoring. Influenza has been the primary driver of rapid laboratory testing due to its morbidity and mortality across all ages, the availability of antiviral therapy, which must be given early to have an effect, and the constant threat of new pandemic strains. Over the past 30 years, there has been an evolution in viral diagnostic testing, from viral culture to rapid antigen detection, and more recently, to highly sensitive nucleic acid amplification tests (NAAT), as well as a trend to testing at the point of care (POC). Simple rapid antigen immunoassays have long been the mainstay for POC testing for influenza A and B viruses and respiratory syncytial virus (RSV) but have been faulted for low sensitivity. In 2015, the first POC NAAT for the detection of influenza was approved by the Food and Drug Administration (FDA), ushering in a new era. In 2017, the FDA reclassified rapid influenza diagnostic tests (RIDTs) from class I to class II devices with new minimum performance standards and a requirement for annual reactivity testing. Consequently, many previously available RIDTs can no longer be purchased in the United States. In this review, recent developments in Clinical Laboratory Improvement Amendments of 1988 (CLIA)-waived testing for respiratory virus infections will be presented, with the focus on currently available FDA-cleared rapid antigen and molecular tests primarily for influenza A and B viruses and RSV.

Training Surgeons in the Current US Healthcare System: A Review of Recent Changes in Resident Education

This review highlights research focusing on the quality of surgical education within the current constraints of healthcare delivery in the United States. The Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST) trial has provided the first evidence from a randomized controlled trial regarding duty hour regulations. Results of the FIRST trial were instrumental in the 2017 ACGME Common Core Requirement changes that allow for more flexibility in clinical hours to encourage professionalism and accommodate both patient care and educational opportunities. Research focusing on resident autonomy has highlighted multiple factors necessary to ensure appropriate graduated levels of responsibility during training. Lastly, competency-based education provides a structured format to ensure minimum standards of performance in all graduates. More flexible hours, increasing autonomy, and competency-based evaluations may help improve confidence and competence of surgery residency graduates.