Resident Comfort Level Research Articles

Abstract 11964: Implementation of a Near Peer ECG Didactic Curriculum in an Internal Medicine Residency Program

Introduction: Electrocardiogram (ECG) interpretation is a fundamental skill. Near-peer teaching improves knowledge acquisition and learner satisfaction. We previously demonstrated an improvement in resident comfort level in interpreting ECGs following structured didactics. Here, we aim to establish whether a longitudinal didactic curriculum objectively increases resident performance in ECG interpretation. Methods: This prospective cohort study surveyed Internal Medicine residents at University at Buffalo who participated in monthly ECG didactics over a 7-month period. Pre- and post-curriculum surveys were administered. Responses were anonymous and participation voluntary. Data collected included demographics, attendance, exposure to clinical cardiology, interest in cardiology, and number of sessions attended. Residents were asked to interpret sixteen unique ECGs, divided evenly among eight common rhythms into both surveys. Fall 2021 and Spring 2022 cohorts were compared using t-tests and chi-square analyses. Associations between attendance, comfort level in interpretation, and number of correct interpretations were analyzed using Pearson correlations. Multivariate linear regression determined the strongest predictor of the number of correct ECG interpretations. Results: Spring cohort correctly interpreted a significantly greater percentage of ECGs than Fall cohort (74.5% vs. 60.9% , p < 0.001). Didactic attendance was significantly associated with comfort level in interpreting ECGs (r = .328, p = .018) and a showed trend towards increased number of correct interpretations (r = .248, p = .077). Attending three or more sessions resulted in a greater percentage of correct ECG interpretations compared to those who attended two or fewer sessions (80.0% vs. 71.1%, p = 0.48). Number of clinical cardiology blocks taken was significantly associated with correct interpretations (r = .310, p < .001) and was the strongest predictor of accurately interpreting ECGs (β = 0.29, p = .037). Conclusions: Dedicated ECG didactics improve residents’ ability to interpret ECGs. A longitudinal curriculum which contains both didactic sessions and clinical exposure appears to offer the greatest benefit in improving ECG interpretation skills.

A simulation-enhanced, spaced learning, interprofessional “code blue” curriculum improves ACLS algorithm adherence and trainee resuscitation skill confidence

ABSTRACT In-hospital cardiac arrest resuscitation training often happens in silos, with minimal interprofessional training. The aim of this study was to implement and evaluate a simulation-enhanced, interprofessional cardiac arrest curriculum in a university hospital. The curriculum ran monthly for 12 months, training interprofessional teams of internal medicine residents, nurses, respiratory therapists, and pharmacy residents. Teams participated in a 90-min high-fidelity simulation including “code blue” (30 min) followed by a 30-min debriefing and a repeat identical simulated “code blue” scenario. Teams were tested in an unannounced mock Code Blue the following month. Advanced Cardiac Life Support (ACLS) algorithm adherence was assessed using a standardized checklist. In-hospital cardiac arrest (IHCA) incidence and survival was tracked for 2 years prior, during, and 1 year after curriculum implementation. Team ACLS-algorithm adherence at baseline varied from 47% to 90% (mean of 71 ± 11%) and improved immediately following training (mean 88 ± 4%, range 80–93%, p = .011). This improvement persisted but decreased in magnitude over 1 month (mean 81 ± 7%, p = .013). Medical resident self-reported comfort levels with resuscitation skills varied widely at baseline, but improved for all skills post-curriculum. This simulation-enhanced, spaced practice, interprofessional curriculum resulted in a sustained improvement in team ACLS algorithm adherence.

239 Project PANDA: An Individual and Systems Based Approach to De-Escalation

The safety of staff and patients are at risk during the de-escalation of acutely agitated patients. A strategy to address de-escalation events is the implementation of multidisciplinary de-escalation teams. This project aims to use a multi-tier simulation approach to improve resident comfort and address systems level issues that may be encountered during acute de-escalation.

A Peer-to-Peer, Longitudinal Reproductive Psychiatry Educational Curriculum for Obstetrics/Gynecology Residents.

Pregnant patients with psychiatric diagnoses are commonly advised to stop their psychiatric medications. Few studies assess the knowledge of, attitude toward, or comfort levels of obstetrics and gynecology (OB/GYN) residents in managing psychiatric conditions, which carry adverse and potentially life-threatening risks to mother and fetus. A gap remains between evidence advocating for active psychopharmacological treatment during pregnancy and implementation of curricula targeting OB/GYN physicians in mental health. The authors' goals are to assess the knowledge, attitude, and comfort that OB/GYN residents have toward assessing and managing active psychiatric conditions in pregnant/postpartum women and to develop an educational, case-based intervention targeting these conditions in the perinatal/postpartum period. Eight perinatal/postpartum psychiatric topics were developed into interactive cases designed for OB/GYN residents. Two weeks before the curriculum administration, OB/GYN residents were surveyed on prior knowledge in, attitudes toward, and comfort levels in assessing and discussing psychiatric conditions in pregnant patients. The assessment was administered again after the intervention to assess its effectiveness. Pre- (N = 19) and post-intervention (N = 15) surveys of residents were analyzed. Most residents (94%) felt it was both important and their responsibility to discuss mental health conditions with pregnant patients. Comfort levels with counseling psychiatric patients increased for all eight topics after the educational intervention was implemented, with statistically significant increases (p < 0.05) for five of the topics. OB/GYN residents feel responsible for caring for pregnant patients with psychiatric illness, and case-based interventions offer an interactive, helpful tool for increasing residents' knowledge and comfort level in treating this patient population.

Use of a Cardiopulmonary Resuscitation Video to Assist Intensive Care Unit Resident Physicians during Code Status Discussions.

Background:Code status discussions (CSDs) in the intensive care unit (ICU) are frequently conducted by resident physicians. Cardiopulmonary resuscitation (CPR) videos when used to aid ICU patients and families in code status decision making have been shown to have a positive impact. The purpose of this study is to evaluate the impact of a CPR video, when made available to supplement trainee–patient CSDs, on ICU residents' comfort level when conducting these discussions.Objectives:To assess whether a CPR video as an intervention tool would increase residents' comfort level when conducting CSDs.Methods:This is a pre- and postintervention pilot study. A presurvey querying details about trainees' comfort level when conducting CSDs was administered to the residents at the beginning of the ICU rotation, and a CPR video was availed to them to supplement their trainee–patient CSDs. A postsurvey was administered to trainees at the end of their ICU rotation to evaluate and analyze the impact of the CPR video on residents' comfort level when conducting trainee–patient CSDs.Results:A total of 118 trainees rotated through the ICU with 43 (36%) answering the presurvey and 28 (24%) answering the postsurvey. Twenty-two (51%) presurvey respondents felt extremely comfortable and 18 (42%) felt somewhat comfortable conducting CSDs. Thirteen (46%) postsurvey respondents felt extremely comfortable and 12 (43%) felt somewhat comfortable conducting CSDs. Most postsurvey respondents (79%) almost never used the video and (67%) neither agree nor disagree that the video was useful.Conclusion:In our small cohort, CPR video when made available to supplement trainee–patient CSDs did not impact resident physicians' comfort level when conducting these discussions. The residents' low level of engagement with this video, among other factors, could explain our results.

32840 Utilization of a cutaneous lymphoma primer to improve resident education

Background: Cutaneous lymphoma (CL) is a somewhat esoteric subject from the vantage point of the general dermatologist, however, rarity of a diagnosis is not an adequate reason to discount the benefit in learning more about this subject, particularly in residency. There is a lack of access to concise, relevantly organized educational materials pertaining to CL at the resident level. Furthermore, no data has been published regarding dermatology resident comfort level with diagnosis and treatment of CL. This study aims to improve resident understanding through the creation of a CL primer. Methods: A pre-test evaluated resident comfort level in understanding normal lymph node (LN) architecture and staining and recognizing clinical and histologic features of CL using a 10-point Likert scale (1 being not at all comfortable, 10 being very comfortable). The pre-test was administered to eleven Saint Louis University dermatology residents, followed by dissemination of an online CL primer. After reviewing the primer, a post-test assessing the same parameters was distributed, and post-test results were compared with pre-test scores. Results: Residents showed a significant improvement in their comfort level in understanding normal LN structure and CL, clinically and histologically after reviewing the CL primer. The mean comfort level score improved from 4.66 (95% Cl [3.88-5.44]) to 7.69 (95% Cl [7.43-7.95]), with a mean difference of 3.03 (95% Cl [2.24 – 3.81]) (P < .0001). Conclusion: Use of a CL primer improved resident understanding of normal LN architecture and staining patterns, and with recognition of clinical and histologic features of CL.

Courtyard configuration to optimize shading, daylight and ventilation in a tropical terrace house using simulation

PurposeThis study aims to identify the optimal configuration to enhance the environmental conditions of a terrace house courtyard space in a hot and humid climate. The use of the courtyard has declined in new housing developments although it is an effective element to bring in light and wind to promote passive ventilation to occupants. To achieve the comfort level, the courtyard needs to be open, but some occupants modify it with enclosures, such as polycarbonate, to increase the useable and shaded area. This affects bringing in daylight but deters the passive ventilation from happening. Thus, this research is important to create a courtyard that brings in daylight and wind as well as shades from the harsh sun of the tropics and to educate the occupants on the role of the courtyard as a passive ventilation system.Design/methodology/approachThe research method employed is a simulation study. A terrace house with a courtyard design in Penang was chosen as a case study of the baseline model. The courtyard configurations of the case study were evaluated, and 4 settings based on the literature review were established for simulation. The effects of the courtyard configurations were tested through daylight and CFD simulations. Daylight and ventilation requirements from Malaysia Standard were used to evaluate and compare the effectiveness of the proposed settings.FindingsThe results suggested that the semi-enclosed courtyard feature with a shading device could provide the optimal environmental conditions of the courtyard space in a terrace house in a hot-humid climate. This paper will benefit the architectural community in which it is intended to implement courtyard design in modern terrace houses and will also contribute to the discovery of the most suitable courtyard typology in a hot-humid climate.Research limitations/implicationsThe study does not include studies on thermal comfort, energy performance, or use behavior of occupants in this courtyard. The study only focuses on the influence of different courtyard configurations in improving the courtyard space's daylight availability and indoor air movement.Practical implicationsThe data from this study reveal that alteration of courtyard design needs to suit comfort level that should not alter the functions of the courtyard as a passive design. The simulation method offers data for microclimatic conditions according to the changes in design. This study attempts to design influence on multiple parameters of shading, daylighting and ventilation to optimize the use of tropical climatic conditions.Social implicationsThe terrace house with courtyard would create a passive design strategy that would naturally ventilate, provide daylight, and will save on energy usage. The courtyard then with its enhanced comfort for the user will be able to function as a useable space to foster family relationships.Originality/valueThe study on courtyard design using the simulation method mostly have been conducted using a single parameter. This study highlights the analysis and process of identifying the optimal configuration for the architectural feature of a courtyard to provide a comfort level for occupants in hot and humid climates using the simulation method using data from two pieces of software.

AuduBon-Bons: Bite-Sized Learning for Residents in the Ambulatory Obstetrics and Gynecology Clinic.

While most medical education happens in the inpatient setting, the vast majority of medicine is practiced in the outpatient setting. Graduates from our obstetrics and gynecology (OB/GYN) program consistently report lower confidence and comfort in the ambulatory, as opposed to inpatient, setting. To describe and evaluate a novel curriculum, delivered in an ambulatory clinic covering ambulatory care topics, and to assess its feasibility in a single site OB/GYN residency program. We created an ambulatory curriculum, comprising short modules delivered in the ambulatory clinic during the first 15 minutes of every half-day clinic session. Modules were delivered using a flipped classroom format with pre-session assignments during the 2019-2020 academic year. Outcomes were residents' pre- and post-session comfort and confidence and module developers' time to create the curriculum. Time tracking was performed. On average, 11 residents were present for the teaching session weekly. Twenty-four residents and 6 faculty were eligible to complete pre- and post-session surveys. For every weekly session, the average resident comfort level and the average resident confidence level with the module's topic increased from the pre-module survey to the post-module survey. Residents completed pre-module assignments 64.8% (236 of 364) of the time, and of residents who completed the pre-work, 89.4% (211 of 236) reported it was useful. Average survey completion rate was 70.5% (1398 of 1984). We showed that it is feasible to create and implement an ambulatory curriculum for residents in OB/GYN, and this curriculum increased resident's comfort and confidence with ambulatory practice.

A novel design approach for indoor environmental quality based on a multiagent system for intelligent buildings in a smart city: Toward occupant's comfort

AbstractIn a smart city, energy usage for sustaining indoor environmental quality (IEQ) and occupant comfort levels frequently clash. This research aims to design a novel approach to solve the conflict between the use of power and the comfort of the citizens. A multi‐purpose problem for minimum consumption of energy as well as maximum occupant's ease within the energy‐efficient construction for smart city as a future has been formulated. Across suggested design method, three variable namely temperature (°C), illumination level (lux), as well as Carbon dioxide (CO2‐ppm) have been undertaken for occupant's comfort. The Crisscross Search Particle Swarm Optimization (CSPSO), a revolutionary solution for the design method, has been applied to search for the optimal value of environmental factors (temperature, light level, CO2) in relation to user‐set preferences. In the heuristic method, the augmented particle swarm optimization strategy updates an initial solution before updating the best local solutions through length and breadth crossover operators. The CSPSO approach search explores the search space in all dimensions and reduces the stagnation trouble by through length and breadth crossover operators. The temperature, lighting, CO2 sensors data, and user‐defined parameters are all inputs to the CSPSO algorithm, and the optimized parameters are the outputs of the optimization method. Such optimized parameters will become an input to the fuzzy controllers that adjust various actuators' status according to the users' comfort. Utilizing the CSPSO technique, 22.74% energy of 625.372 kWhr energy was saved during a day, and the comfort level has increased from 0.51692 to 0.75685. Therefore, the proposed novel design approach is acceptable in managing building energy consumption by achieving maximum comfort.

Investigation of Natural Ventilation in the Existing Buildings of Qasimabd, Hyderabad

Environment is one of the biggest concerns around the globe as it affects every aspect of our lives, including the buildings used for residential and commercial purposes. A majority of people spend about 90% of their time indoors. In residential buildings, the existence of natural ventilation is essential to ensure the comfort level of residents. Recently, greater significance has been accorded to natural ventilation in building codes and planning policies. Today, many planning policies provide guidelines that stipulate the need for adequate natural ventilation in residential buildings. This paper aimed to investigate the occupants’ level of satisfaction with natural ventilation in residential buildings of Qasimabad, Hyderabad. Twenty (20) houses with a different opening design individuality were selected as sample for the current study. In terms of the occupants’ level of satisfaction with natural ventilation, the majority was neither satisfied nor unsatisfied. Further investigation demonstrated that the level of satisfaction is significantly related to the size of the openings. This study explored the residents’ satisfaction level using the questionnaire survey and case study methodology. Data was collected from the study area of Qasimabad in Hyderabad from 290 respondents. The results vouched for the implementation of building bye-laws in the designing of residential buildings in order to achieve the comfort level of their occupants.&#x0D; Keywords: Building bye-laws, natural ventilation, occupants, residential building, satisfaction level

Optimal Home Energy Management Considering Uncertainties in Occupancy, Consumption, and Electricity Price

Power utilities issue demand response (DR) during the hours of peak load in order to reduce the demand on the network and provide congestion relief to overloaded circuits. While traditional residential DR programs are mainly one-way in the form of remote on/off control of air conditioning (A/C) units, residential customers can adopt a more proactive role through utilizing the capabilities of smart meters and home energy management systems (HEMS). HEMS can monitor energy rates and DR incentives, and accordingly change the temperature setpoint of the A/C unit and/or shift appliance loads from peak to off-peak hours in order to maximize financial benefits. All this can be achieved in an automated human-out-of-the-loop fashion. From the HEMS’ standpoint, the task can be viewed as solving an optimization problem with the goal of reducing power consumption while maximizing financial gains. However, another equally important goal would be to ensure that the comfort level of residents, if present in the building, is not compromised. This is especially crucial during periods of extreme temperatures where maintaining an acceptable indoor temperature has a direct impact on the residents’ health, especially children and the elderly. What makes this multi-objective optimization problem more challenging is the uncertain nature of some model parameters, e.g., electricity rates, building occupancy levels, and demand. This paper presents a novel solution for energy management of a smart home using DR by considering the above factors. To ensure that the solution found is feasible against all possible uncertainties, a robust model is developed and solved for a given time horizon. As shown through simulation results, considering uncertainties are necessary, since they can change the solution in a nonnegligible way.

Assessment of Pediatric Residents' Comfort Level With CellScope Oto to Examine Pediatric Ear Exams.

Examining a child's tympanic membrane (TM) is challenging, but crucial for proper management of acute otitis media (AOM). CellScope Oto (CSO) is an attachment that turns a smartphone into an otoscope. We aimed to assess pediatric resident comfort level with ear exams using CSO to see whether comfort level and accuracy of diagnosis of AOM improved. A pre-post study of pediatric residents in a freestanding Pediatric Emergency Department was conducted to assess their comfort level of traditional otoscope and CSO via a Likert scale. Ear exams were recorded and rated by 2 faculty for accuracy of AOM diagnosis. A total of 18 pediatric residents participated, and 308 exams were collected, with 2% diagnosed as AOM. The median change in comfort level increased by +1.0 for interns and third years but remained unchanged for second years. There was substantial agreement by faculty raters of video ear exams. Overall, comfort level increased with accuracy of diagnosis of AOM.

Assessing comfort in the workplace: A unified theory of behavioral and thermal expectations

Assessing comfort and predicting occupant behavior in the workplace has been a major topic within built environmental research. Despite the vast knowledge, several studies have reported a performance gap between the predicted and the actual behaviors in buildings, together with a discrepancy between predicted and reported comfort levels of occupants within the working environment. To close these gaps, the inclusion of human behavioral and perceptual theories has been investigated to understand the drivers leading to adaptive behaviors and occupants' comfort preferences. As a result, expectations are hypothesized playing a relevant role in the perception of comfort. However, little is known about the formation of expectations towards the indoor climate and the impact on adaptive behaviors. Therefore, drawing on psychological and comfort theories, we built a research framework to study occupants' expectations in buildings and their influence on comfort-related responses and behaviors. A structural equation model was empirically tested using survey data collected from office workers in Germany. Results showed that occupant's expectations positively influenced comfort and adaptive behaviors. Cognitive mechanisms, such as attitudes, perceived control, self-efficacy, personal norms and thermal history, were needed to capture expectations of the indoor environment. The relationship between the expected interaction with a fan to modify the indoor environment and the current occupant behavior was mediated by occupants' previous experiences with fans. This paper contributes to the assessment of comfort and occupant behavior literature by developing a theoretical framework of behavioral and thermal expectations in the built environment. Findings may have implications on the design of adaptive opportunities to enhance occupant satisfaction with the workplace and to support design strategies to reduce the building energy consumption.

Effects of Bottom-Overhead Design Variables on Pedestrian-Level Thermal Comfort during Summertime in Different High-Rise Residential Buildings: A Case Study in Chongqing, China

The design of bottom-overhead (or lift-up) buildings is advantageous in improving the thermal environment of high-density cities and enhancing the comfort level of occupants’ activity space on the ground floor. This study aims to investigate the impact of multiple architectural design variables on the ground floor overhead area of slab-like and tower high-rise residential buildings from the perspective of pedestrian-level thermal comfort with ENVI-met simulations and Standard Effective Temperature (SET*) evaluation. The design variables of the 25 tested models include the number of continuously arranged buildings, aspect ratio, overhead form, overhead space height, positions of overhead space enclosures, and openness degree, derived from existing overhead buildings in Chongqing. The results demonstrate that when the number of continuously arranged buildings and the aspect ratio increase, the overhead area has a more comfortable environmental state, while the overhead height is negatively correlated. In addition, when the enclosures are on opposite sides and their openness degree is 0.75–0.5, the area tends to be more comfortable. For slab-like buildings, the thermal comfort of the partial-overhead form is the worst while the semi-overhead form is relatively better. However, the overhead form has no significant impact on the thermal comfort of tower buildings. These findings can provide some suggestions and inspiration for the design of overhead buildings to create a more sustainable and livable microenvironment.

Effects of different environment combinations on the comfort and productivity of researchers in winter

Indoor environmental quality is considered an important indicator of the sustainable development of architecture. It not only reflects the comfort level of occupants in the building but also affects their productivity, particularly in research institutions. However, due to the inherent correlation among various environmental indexes, it is difficult to evaluate the influence of specific physical parameters on the occupant’s comfort and research performance. This paper is based on an experiment conducted in a controlled research office in a pharmaceutical research company in the Northeast of China. The controlled research office was equipped with a radiant floor heating system that supplied heating in winter. We recruited 32 researchers and divided them into four subgroups. Each subgroup of researchers was required to conduct daily research activities under 12 different environment combinations. Data were collected from physical environment measurements, questionnaire surveys and performance tests. The results reflected that under the condition of radian floor heating in winter, changes in thermal, visual and acoustic environments could have a significant influence on occupants’ satisfaction with the environment. However, the research performance was affected only by thermal and acoustic conditions. There was a weak correlation among thermal, visual, acoustic and indoor air quality comfort.

EXTREME COLD DISCOMFORT IN EXTREME HOT CLIMATES, A STUDY OF BUILDING OVERCOOLING IN OFFICE BUILDINGS IN QATAR

Indoor cold discomfort in Qatar due to “building overcooling” is increasing, as air-conditioning prevails, and global temperatures rise. Overcooling is not dependent only on the inappropriate design of cooling systems, but on “international” thermal comfort standards that are not customized for warm climates. International standards are unintentionally biased towards cooler climates and cultures, the application of which in warm climates result in colder indoor temperatures observed by building occupants and increased cooling energy demand. Overcooling is an over-expenditure of energy, resulting in uncomfortably cold indoor thermal conditions, and unnecessary carbon emissions. In this study, the analysis of field data from 6 office buildings in Doha in a range of indoor thermal conditions and investigation of overcooling on occupant comfort and building performance is conducted. The analysis uncovers over 35% of occupants state being uncomfortably cold and a consensus across the surveys highlight comfortable temperatures higher by 2°C from current setpoint temperatures. Greater occupant comfort and energy efficiency are found by increasing the indoor temperature setpoints investigated through thermal comfort analysis and energy simulation models. Around 50% decrease in occupant discomfort and a 15% decrease in cooling energy demand is found. Such an adjustment in Qatar would improve occupant comfort levels and reduce cooling energy demand throughout the existing office building stock.

Perception Precedes Reality: A Simulation and Procedural Bootcamp Improves Residents' Comfort With Transitioning to Clinical Anesthesiology Training.

BackgroundThe transition from internship to clinical anesthesiology (CA) training is often difficult given the differences in workflow, procedures, environment, and clinical situations. The primary aims of this study were to determine if a standardized introductory bootcamp could improve clinical knowledge and self-perceived comfort level of new anesthesiology residents in performing common operating room procedures and management of common intraoperative problems. The secondary aim of the study was to see if a standardized bootcamp could be replicated at other programs.MethodsThe introduction to anesthesiology resident bootcamp was developed at one institution in 2015 then expanded to a second program in 2019. The bootcamp was a one-day experience consisting of simulation and task trainers that all rising first-year CA residents (CA-1) participated in during their first month of anesthesiology training. All participating residents were given a survey immediately before and after the bootcamp. The average ratings of the questions were calculated and used as the primary measure. The Anesthesia Knowledge Test (AKT) was used as a surrogate measure of participant knowledge.ResultsFrom 2015 to 2020, a total of 105 residents completed the pre-survey and 109 completed the post-survey across the two sites. The improvement in average rating was significant (Pre: 2.04±0.46 versus Post: 3.09±0.52 p<0.0001). Individual item analysis also showed significant improvement on all of the eight items (p<0.0001). Analyses by site revealed the same results at both average score and item level. There was no significant cohort difference in either AKT-0 (Control: 57.84±26.86 versus Intervention 50.13±25.14, p=0.14) or AKT-1 (Control: 41.06±26.42 versus Intervention 41.70±26.60, p=0.90) percentile scores.ConclusionsIncorporation of an introduction to anesthesia bootcamp for new residents significantly improves participant comfort level and is reproducible across institutions. However, it does not improve resident performance on standardized tests.

A Novel Task Trainer for Auricular Hematoma Repair.

Auricular hematoma drainage is a crucial skill that emergency medicine providers must be proficient in to prevent complications including permanent deformity of the ear. We aimed to develop and evaluate a cost-effective task trainer to allow emergency medicine (EM) residents to practice the key skills of auricular hematoma drainage and pressure dressing application.After creating a task trainer out of a bell pepper, we implemented this training during our EM simulation conference with a total of 20 PGY 1-3 EM residents. Prior to the simulation session, a survey of all 39 residents found a rated confidence level of auricular hematoma drainage as low on a five-point Likert scale (mean: 2.2 (standard deviation (SD): 1.08)). After the session, the 20 EM residents who participated were much more confident in their ability to perform this procedure (mean: 4.4 (SD: 0.6)).This low-cost, easy-to-create auricular hematoma drainage and repair task trainer was well received by our EM residents and led to an improved resident comfort level in performing this necessary EM procedure. This task trainer can be used by EM trainees of all levels as a tool to increase their skill and comfort level when performing the crucial procedure of auricular hematoma drainage and repair.

Livability Assessment of Tianjin Sino-Singapore Eco-City Based on Multi-Source Data

Evaluating the comfort level of residents’ lifestyles quantitatively and addressing living issues are the key to realizing a better regional life. Taking Tianjin Sino-Singapore eco-city as the study area, this paper establishes a livability evaluation framework consisting of 26 secondary index systems by using the technique for order preference by similarity to an ideal solution model. This paper identifies the livability evaluation framework and builds the TOPSIS model according to multi-source data including remote sensing images, basic geographic information, government operations, controlling detailed planning data, and point of interest data. As a result, this paper analyzes different data outcomes and thus concludes the livability evaluation spatial distribution of Tianjin Sino-Singapore Eco-city.

Multi-objective residential load scheduling approach for demand response in smart grid

• A novel scheduling approach is proposed for residential building DR programs. • A nondominated sorting genetic algorithm II (NSGA-II) is applied for multi-objective optimization. • Peak load reduction, occupant's comfort levels, and capital benefits are optimized. • Household appliances are promising flexible loads by rescheduling work time. In recent years, with the rapid growth of electricity demand and the development of smart grids, demand-side management had an important role. As the penetration rate of distributed renewable energy generation in the grid increases, the diurnal peak of the net load demand curve in the urban area is offset by renewable energy sources such as photovoltaics and the peak load time gradually shifts from afternoon to evening. The peak electricity load of residential buildings usually occurs in the evening, which aggravates the power balance problem. To this end, this study proposes a demand response (DR) scheduling approach for residential buildings, aimed for four types of residential building loads: interruptible and deferrable loads, noninterruptible and deferrable loads, noninterruptible and nondeferrable loads, and air conditioning loads. Nondominated sorting genetic algorithm II is used as a multi-objective optimization algorithm to search for the minimal electricity cost and minimal inconvenience index. Finally, the ASHRAE 140 standard building is used as a case and the proposed scheduling approach is evaluated under two scenarios of working and nonworking days. The proposed scheduling approach can effectively shave the peak load to off-peak load time, reduce electricity bills, and meet the occupants’ comfort.