Attending Physician Variability: A Model of Four Supervisory Styles

Purpose: There is wide variability in how attending physician roles on teaching teams, including patient care and trainee learning, are enacted. This study sought to better understand variability by considering how different attendings configured and rationalized direct patient care, trainee oversight, and teaching activities. 

Method: Constructivist grounded theory guided iterative data collection and analyses. Data were interviews with 24 attending physicians from two academic centers in Ontario, Canada, in 2012. During interviews, participants heard a hypothetical presentation and reflected on it as though it were presented to their team during a typical admission case review. 

Results: Four supervisory styles were identified: direct care, empowerment, mixed practice, and minimalist. Driven by concerns for patient safety, direct care involves delegating minimal patient care responsibility to trainees. Focused on supporting trainees’ progressive independence, empowerment uses teaching and oversight strategies to ensure quality of care. In mixed practice, patient care is privileged over teaching and is adjusted on the basis of trainee competence and contextual features such as patient volume. Minimalist style involves a high degree of trust in senior residents, delegating most patient care, and teaching to them. Attendings rarely discussed their styles with the team. 

Conclusions: The model adds to the literature on variability in supervisory practice, showing that the four styles reflect different ways of responding to tensions in the role and context. This model could be refined through observational research exploring the impact of context on style development and enactment. Making supervisory styles explicit could support improvement of team competence.

CSI 2264: Simultaneous Optical and Infrared Light Curves of Young Disk-bearing Stars in NGC 2264 with CoRoT and Spitzer—Evidence for Multiple Origins of Variability

We present the Coordinated Synoptic Investigation of NGC 2264, a continuous 30 day multi-wavelength photometric monitoring campaign on more than 1000 young cluster members using 16 telescopes. The unprecedented combination of multi-wavelength, high-precision, high-cadence, and long-duration data opens a new window into the time domain behavior of young stellar objects. Here we provide an overview of the observations, focusing on results from Spitzer and CoRoT. The highlight of this work is detailed analysis of 162 classical T Tauri stars for which we can probe optical and mid-infrared flux variations to 1% amplitudes and sub-hour timescales. We present a morphological variability census and then use metrics of periodicity, stochasticity, and symmetry to statistically separate the light curves into seven distinct classes, which we suggest represent different physical processes and geometric effects. We provide distributions of the characteristic timescales and amplitudes and assess the fractional representation within each class. The largest category (>20%) are optical "dippers" with discrete fading events lasting ~1-5 days. The degree of correlation between the optical and infrared light curves is positive but weak; notably, the independently assigned optical and infrared morphology classes tend to be different for the same object. Assessment of flux variation behavior with respect to (circum)stellar properties reveals correlations of variability parameters with Hα emission and with effective temperature. Overall, our results point to multiple origins of young star variability, including circumstellar obscuration events, hot spots on the star and/or disk, accretion bursts, and rapid structural changes in the inner disk. Based on data from the Spitzer and CoRoT missions. The CoRoT space mission was developed and is operated by the French space agency CNES, with participation of ESA's RSSD and Science Programmes, Austria, Belgium, Brazil, Germany, and Spain.

Young Stellar Object VARiability (YSOVAR): Long Timescale Variations in the Mid-infrared

The YSOVAR (Young Stellar Object VARiability) Spitzer Space Telescope observing program obtained the first extensive mid-infrared (3.6 and 4.5 μm) time series photometry of the Orion Nebula Cluster plus smaller footprints in 11 other star-forming cores (AFGL 490, NGC 1333, Mon R2, GGD 12-15, NGC 2264, L1688, Serpens Main, Serpens South, IRAS 20050+2720, IC 1396A, and Ceph C). There are ~29,000 unique objects with light curves in either or both IRAC channels in the YSOVAR data set. We present the data collection and reduction for the Spitzer and ancillary data, and define the "standard sample" on which we calculate statistics, consisting of fast cadence data, with epochs roughly twice per day for ~40 days. We also define a "standard sample of members" consisting of all the IR-selected members and X-ray-selected members. We characterize the standard sample in terms of other properties, such as spectral energy distribution shape. We use three mechanisms to identify variables in the fast cadence data—the Stetson index, a χ2 fit to a flat light curve, and significant periodicity. We also identified variables on the longest timescales possible of six to seven years by comparing measurements taken early in the Spitzer mission with the mean from our YSOVAR campaign. The fraction of members in each cluster that are variable on these longest timescales is a function of the ratio of Class I/total members in each cluster, such that clusters with a higher fraction of Class I objects also have a higher fraction of long-term variables. For objects with a YSOVAR-determined period and a [3.6]-[8] color, we find that a star with a longer period is more likely than those with shorter periods to have an IR excess. We do not find any evidence for variability that causes [3.6]-[4.5] excesses to appear or vanish within our data set; out of members and field objects combined, at most 0.02% may have transient IR excesses.

YSOVAR: Mid-infrared Variability in the Star-forming Region Lynds 1688

The emission from young stellar objects (YSOs) in the mid-infrared (mid-IR) is dominated by the inner rim of their circumstellar disks. We present IR data from the Young Stellar Object VARiability (YSOVAR) survey of ~800 objects in the direction of the Lynds 1688 (L1688) star-forming region over four visibility windows spanning 1.6 yr using the Spitzer Space Telescope in its warm mission phase. Among all light curves, 57 sources are cluster members identified based on their spectral energy distribution and X-ray emission. Almost all cluster members show significant variability. The amplitude of the variability is larger in more embedded YSOs. Ten out of 57 cluster members have periodic variations in the light curves with periods typically between three and seven days, but even for those sources, significant variability in addition to the periodic signal can be seen. No period is stable over 1.6 yr. Nonperiodic light curves often still show a preferred timescale of variability that is longer for more embedded sources. About half of all sources exhibit redder colors in a fainter state. This is compatible with time-variable absorption toward the YSO. The other half becomes bluer when fainter. These colors can only be explained with significant changes in the structure of the inner disk. No relation between mid-IR variability and stellar effective temperature or X-ray spectrum is found.

YSOVAR: Mid-infrared Variability of Young Stellar Objects and Their Disks in the Cluster IRAS 20050+2720

We present a time-variability study of young stellar objects (YSOs) in the cluster IRAS 20050+2720, performed at 3.6 and 4.5 μm with the Spitzer Space Telescope; this study is part of the Young Stellar Object VARiability (YSOVAR) project. We have collected light curves for 181 cluster members over 60 days. We find a high variability fraction among embedded cluster members of ca. 70%, whereas young stars without a detectable disk display variability less often (in ca. 50% of the cases) and with lower amplitudes. We detect periodic variability for 33 sources with periods primarily in the range of 2–6 days. Practically all embedded periodic sources display additional variability on top of their periodicity. Furthermore, we analyze the slopes of the tracks that our sources span in the color–magnitude diagram (CMD). We find that sources with long variability time scales tend to display CMD slopes that are at least partially influenced by accretion processes, while sources with short variability timescales tend to display extinction-dominated slopes. We find a tentative trend of X-ray detected cluster members to vary on longer timescales than the X-ray undetected members.

YSOVAR: Mid-infrared Variability Among YSOs in the Star Formation Region GGD12-15

We present an IR-monitoring survey with the Spitzer Space Telescope of the star-forming region GGD 12-15. More than 1000 objects were monitored, including about 350 objects within the central 5′, which is found to be especially dense in cluster members. The monitoring took place over 38 days and is part of the Young Stellar Object VARiability project. The region was also the subject of a contemporaneous 67 ks Chandra observation. The field includes 119 previously identified pre-main sequence star candidates. X-rays are detected from 164 objects, 90 of which are identified with cluster members. Overall, we find that about half the objects in the central 5′ are young stellar objects (YSOs) based on a combination of their spectral energy distribution, IR variability, and X-ray emission. Most of the stars with IR excess relative to a photosphere show large amplitude (>0.1 mag) mid-infrared (mid-IR) variability. There are 39 periodic sources, and all but one is found to be a cluster member. Almost half of the periodic sources do not show IR excesses. Overall, more than 85% of the Class I, flat spectrum, and Class II sources are found to vary. The amplitude of the variability is larger in more embedded YSOs. Most of the Class I/ II objects exhibit redder colors in a fainter state, which is compatible with time-variable extinction. A few become bluer when fainter, which can be explained with significant changes in the structure of the inner disk. A search for changes in the IR due to X-ray events is carried out, but the low number of flares prevented an analysis of the direct impact of X-ray flares on the IR light curves. However, we find that X-ray detected Class II sources have longer timescales for change in the MIR than a similar set of non-X-ray detected Class IIs.

YSOVAR: Mid-infrared Variability in NGC 1333

As part of the Young Stellar Object VARiability (YSOVAR) program, wemonitored NGC 1333 for ∼35 days at 3.6 and 4.5 μm using theSpitzer Space Telescope. We report here on the mid-infrared variabilityof the point sources in the ∼10‧ × ∼20‧ areacentered on 03:29:06, +31:19:30 (J2000). Out of 701 light curves ineither channel, we find 78 variables over the YSOVAR campaign. Abouthalf of the members are variable. The variable fraction for the mostembedded spectral energy distributions (SEDs) (Class I, flat) is higherthan that for less embedded SEDs (Class II), which is in turn higherthan the star-like SEDs (Class III). A few objects have amplitudes(10–90th percentile brightness) in [3.6] or [4.5] > 0.2 mag; amore typical amplitude is 0.1–0.15 mag. The largest color changeis >0.2 mag. There are 24 periodic objects, with 40% of them beingflat SED class. This may mean that the periodic signal is primarily fromthe disk, not the photosphere, in those cases. We find 9 variableslikely to be “dippers,” where texture in the disk occultsthe central star, and 11 likely to be “bursters,” whereaccretion instabilities create brightness bursts. There are 39 objectsthat have significant trends in [3.6]–[4.5] color over thecampaign, about evenly divided between redder-when-fainter (consistentwith extinction variations) and bluer-when-fainter. About a third of the17 Class 0 and/or jet-driving sources from the literature are variableover the YSOVAR campaign, and a larger fraction (∼half) are variablebetween the YSOVAR campaign and the cryogenic-era Spitzer observations(6–7 years), perhaps because it takes time for the envelope torespond to changes in the central source. The NGC 1333 brown dwarfs donot stand out from the stellar light curves in any way except there is amuch larger fraction of periodic objects (∼60% of variable browndwarfs are periodic, compared to ∼30% of the variables overall).

Test-retest variability in structural and functional parameters of glaucoma damage in the glaucoma imaging longitudinal study.

PURPOSE:

To determine the test-retest variability in perimetric, optic disc, and macular thickness parameters in a cohort of treated patients with established glaucoma.

PATIENTS AND METHODS:

In this cohort study, the authors analyzed the imaging studies and visual field tests at the baseline and 6-month visits of 162 eyes of 162 participant in the Glaucoma Imaging Longitudinal Study (GILS). They assessed the difference, expressed as the standard error of measurement, of Humphrey field analyzer II (HFA) Swedish Interactive Threshold Algorithm fast, Heidelberg retinal tomograph (HRT) II, and retinal thickness analyzer (RTA) parameters between the two visits and assumed that this difference was due to measurement variability, not pathologic change. A statistically significant change was defined as twice the standard error of measurement.

RESULTS:

In this cohort of treated glaucoma patients, it was found that statistically significant changes were 3.2 dB for mean deviation (MD), 2.2 for pattern standard deviation (PSD), 0.12 for cup shape measure, 0.26 mm for rim area, and 32.8 microm and 31.8 microm for superior and inferior macular thickness, respectively. On the basis of these values, it was estimated that the number of potential progression events detectable in this cohort by the parameters of MD, PSD, cup shape measure, rim area, superior macular thickness, and inferior macular thickness was 7.5, 6.0, 2.3, 5.7, 3.1, and 3.4, respectively.

CONCLUSIONS:

The variability of the measurements of MD, PSD, and rim area, relative to the range of possible values, is less than the variability of cup shape measure or macular thickness measurements. Therefore, the former measurements may be more useful global measurements for assessing progressive glaucoma damage.

Modeling the Western Iberian margin circulation: present and future

The purpose of this work is to carry out a comprehensive study on the Western Iberian Margin (WIM) circulation my means of numerical modeling, and to postulate what this circulation will be in the future. The adopted approach was the development of a regional ocean model configuration with high resolution, capable of reproducing the largeand small-scale dynamics of the coastal transition zone. Four numerical experiences were carried out according to these objectives: (1) a climatological run, in order to study the system’s seasonal behavior and its mean state; (2) a run forced with real winds and fluxes for period 2001-2011 in order to study the interannual variability of the system; (3) a run forced with mean fields from Global Climate Models (GCMs) for the present, in order to validate GCMs as adequate forcing for regional ocean modeling; (4) a similar run (3) for period 2071-2100, in order to assess possible consequences of a future climate scenario on the hydrography and dynamics of the WIM. Furthermore, two Lagrangian particle studies were carried out: one in order to trace the origin of the upwelled waters along the WIM; the other in order to portrait the patterns of larval dispersal, accumulation and connectivity. The numerical configuration proved to be adequate in the reproduction of the system’s mean state, seasonal characterization and an interannual variability study. There is prevalence of poleward flow at the slope, which coexists with the upwelling jet during summer, although there is evidence of its shifting offshore, and which is associated with the Mediterranean Water flow at deeper levels, suggesting a barotropic character. From the future climate scenario essay, the following conclusions were drawn: there is general warming and freshening of upper level waters; there is still poleward tendency, and despite the upwellingfavorable winds strengthening in summer the respective coastal band becomes more restricted in width and depth. In what concerns larval connectivity and dispersion along the WIM, diel vertical migration was observed to increase recruitment throughout the domain, and while smooth coastlines are better suppliers, there is higher accumulation where the topography is rougher.

MUSA: A Scalable Multi-Touch and Multi-Perspective Variability Management Tool

Variability management is one of the main activities in the Software Product Line Engineering process. Common and varied features of related products are modelled along with the dependencies and relationships among them. With the increase in size and complexity of product lines and the more holistic systems approach to the design process, managing the ever- growing variability models has become a challenge. In this paper, we present MUSA, a tool for managing variability and features in large-scale models. MUSA adopts the Separation of Concerns design principle by providing multiple perspectives to the model, each conveying different set of information. The demonstration is conducted using a real-life model (comprising of 1000+ features) particularly showing the Structural View, which is displayed using a mind-mapping visualisation technique (hyperbolic trees), and the Dependency View, which is displayed graphically using logic gates.

Does variability in temperature and chlorophyll concentration influence Wahoo and Yellowfin tuna landings in Bermuda (1990-2006)?

Dissertação de mest., Biologia Marinha, Faculdade de Ciências e Tecnologia, Universidade do Algarve, 2009

Spatial variability of macroinvertebrate assemblages and the influence of hydrological and environmental variables along the Sigi River, Tanzania-East Africa

The study of investigating the spatial and temporal variability of macroinvertebrate and their relation to hydrology, hydraulic and environmental factors was done along the Sigi River during two sampling periods in the dry (March) and wet (May) periods of 2012. The river was demarcated based on slope ranges and five river zones were identified as mountains streams (MS), upper foothills (UF), lower foothills (LF), rejuvenated foothills (REJ) and mature lower river (MR). Samples of macroinvertebrate were collected from the five river zones and measurements of hydrological (discharge), hydraulics (Depth, velocity and Froude number) and Environmental (pH, Temperature, substrate, conductivity) parameters were done in each zone. In characterizing the macroinvertebrate assemblages along the Sigi River diversity indices (number of taxa, total abundances, Margalef richness index and ShannonWiener index) were calculated and the most representative species for the spatial and temporal variation were identified. Melanoides and Afronurous showed differences in abundance in two samplings periods while Cleopatra, Potamonautes, Ephemerythus, Neoperla, Caenis, Ceratogomphus and Cheumatopsyche showed significant difference among the river zones. Spearman rank correlation and Distance Linear Model (DistLM) used to revealed physical factors governing the macroinvertebrate assemblages distribution. The study demonstrated that the variation of physical factors like discharge, temperature, conductivity and pH have an important role in the spatial distribution of macroinvertebrate assemblages along the river and the life cycle of macroinvertebrate (Afronurus) is important in determining the temporal variability.

Impacts of climate variability and extremes on carbon uptake by land ecosystems

Tese de doutoramento, Ciências Geofísicas e da Geoinformação (Deteção Remota), Universidade de Lisboa, Faculdade de Ciências, 2015