Development and roll out of the JETS e-portfolio: a web based electronic portfolio for endoscopists.
ABSTRACT: The JAG Endoscopy Training System (JETS) e-portfolio was designed to provide an electronic log of endoscopic experience, improve the effectiveness of training, streamline the JAG certification process and support the quality assurance of trainers, units and regional training programmes. It was piloted in 2008 with an 82.6% uptake in trainees offered the system. The system was released in the UK in September 2009. Steady adoption across the UK demonstrates the service finds it a valuable tool. In time it will be the only vehicle through which a trainee can achieve certification through JAG to practise independently.
Project description:Introduction In the UK, endoscopy certification is administered by the Joint Advisory Group on Gastrointestinal Endoscopy (JAG). Since 2011, certification for upper and lower gastrointestinal endoscopy has been awarded via a national (JETS) e-portfolio to the main training specialties of: gastroenterology, gastrointestinal surgeons (GS) and non-medical endoscopists (NME). Trends in endoscopy certification and differences between trainee specialties were analyzed. Methods This prospective UK-wide observational study identified trainees awarded gastroscopy, sigmoidoscopy, colonoscopy (provisional and full) certification between June 2011 - 2017. Trends in certification, procedures and time-to-certification, and key performance indicators (KPIs) in the 3-month pre- and post-certification period were compared between the three main training specialties. Results Three thousand one hundred fifty-seven endoscopy-related certifications were awarded to 1928 trainees from gastroenterology (52.3 %), GS (28.4 %) and NME (16.5 %) specialties. During the study period, certification numbers increased for all modalities and specialties, particularly NME trainees. For gastroscopy and colonoscopy, procedures-to-certification were lowest for GS ( P < 0.001), whereas time-to-certification was consistently shortest in NMEs ( P < 0.001). A post-certification reduction in mean cecal intubation rate (95.2 % to 93.8 %, P < 0.001) was observed in colonoscopy, and D2 intubation (97.6 % to 96.2 %, P < 0.001) and J-maneuver (97.3 % to 95.8 %, P < 0.001) in gastroscopy. Overall, average pre- and post-certification KPIs still exceeded national minimum standards. There was an increase in PDR for NMEs after provisional colonoscopy certification but a decrease in PDR for GS trainees after sigmoidoscopy and full colonoscopy certification. Conclusion Despite variations among trainee specialties, average pre- and post-certification KPIs for certified trainees met national standards, suggesting that JAG certification is a transparent benchmark which adequately safeguards competency in endoscopy training.
Project description:OBJECTIVE:The number of colonoscopies required to reach competency is not well established. The primary aim of this study was to determine the number of colonoscopies trainees need to perform to attain competency, defined by a caecal intubation rate (CIR) ?90%. As competency depends on completion, we also investigated trainee factors that were associated with colonoscopy completion. DESIGN:The Joint Advisory Group on GI Endoscopy in the UK has developed a trainee e-portfolio from which colonoscopy data were retrieved. Inclusion criteria were all trainees who had performed a total of ?20 colonoscopies and had performed ?50 colonoscopies prior to submission of data to the e-portfolio. The primary outcome measure was colonoscopy completion. The number of colonoscopies required to achieve CIR ?90% was calculated by the moving average method and learning curve cumulative summation (LC-Cusum) analysis. To determine factors which determine colonoscopy completion, a mixed effect logistic regression model was developed which allowed for nesting of patients within trainees and nesting of patients within hospitals, with various patient, trainee and training factors entered as fixed effects. RESULTS:297 trainees undertook 36?730 colonoscopies. By moving average analysis, the cohort of trainees reached a CIR of 90% at 233 procedures. By LC-Cusum analysis, 41% of trainees were competent after 200 procedures. Of the trainee factors, the number of colonoscopies, intensity of training and previous flexible sigmoidoscopy experience were significant factors associated with colonoscopy completion. CONCLUSIONS:This is the largest study to date investigating the number of procedures required to achieve competency in colonoscopy. The current training certification benchmark in the UK of 200 procedures does not appear to be an inappropriate minimum requirement. The LC-Cusum chart provides real time feedback on individual learning curves for trainees. The association of training intensity and flexible sigmoidoscopy experience with colonoscopy completion could be exploited in training programmes.
Project description:Instabilities play a prominent role in determining the inherent structure and properties of magnetized plasma jets spanning both laboratory and astrophysical settings. The manner in which prominent unstable modes dynamically evolve remains key to understanding plasma behavior and control. In astrophysical phenomena, self-similar jets are observed to propagate over vast distances while avoiding breakup caused by unstable mode growth. However, the production of stable dense plasma jets in the laboratory has been limited by the onset of unstable modes that restrict jet lifetime, collimation, and scalability. In this work, we visualize the formation of stable laboratory-generated, dense, super-magnetosonic plasma jets in real time, and we identify an underlying mechanism that contributes to this behavior. The current-driven plasma jets generated in our experiments form a flowing Z-pinch, which is generally unstable to the m = 1 kink instability. Our results indicate that a stable dense plasma jet can be maintained for timescales over which a steady pinch current can be sustained, even at levels which would otherwise lead to rapid unstable mode growth and resultant pinch disassembly.
Project description:Gigantic jets are atmospheric electrical discharges that propagate from the top of thunderclouds to the lower ionosphere. They begin as lightning leaders inside the thundercloud, and the thundercloud charge structure primarily determines if the leader is able to escape upward and form a gigantic jet. No observationally verified studies have been reported on the thundercloud charge structures of the parent storms of gigantic jets. Here we present meteorological observations and lightning simulation results to identify a probable thundercloud charge structure of those storms. The charge structure features a narrow upper charge region that forms near the end of an intense convective pulse. The convective pulse produces strong storm top divergence and turbulence, as indicated by large values of storm top radial velocity differentials and spectrum width. The simulations show the charge structure produces leader trees closely matching observations. This charge structure may occur at brief intervals during a thunderstorm's evolution due to the brief nature of convective pulses, which may explain the rarity of gigantic jets compared to other forms of atmospheric electrical discharges.
Project description:Pulsating twin jets mechanism (PTJM) was developed in the present work to study the effect of pulsating twin jets mixing region on the enhancement of heat transfer. Controllable characteristics twin pulsed jets were the main objective of our design. The variable nozzle-nozzle distance was considered to study the effect of two jets interaction at the mixing region. Also, the phase change between the frequencies of twin jets was taken into account to develop PTJM. All of these factors in addition to the ability of producing high velocity pulsed jet led to more appropriate design for a comprehensive study of multijet impingement heat transfer problems. The performance of PTJM was verified by measuring the pulse profile at frequency of 20 Hz, where equal velocity peak of around 64 m/s for both jets was obtained. Moreover, the jet velocity profile at different pulsation frequencies was tested to verify system performance, so the results revealed reasonable velocity profile configuration. Furthermore, the effect of pulsation frequency on surface temperature of flat hot plate in the midpoint between twin jets was studied experimentally. Noticeable enhancement in heat transfer was obtained with the increasing of pulsation frequency.
Project description:Self-propelled micro/nano-devices have been proved as powerful tools in various applications given their capability of both autonomous motion and on-demand task fulfilment. Tubular micro-jets stand out as an important member in the family of self-propelled micro/nano-devices and are widely explored with respect to their fabrication and functionalization. A few methods are currently available for the fabrication of tubular micro-jets, nevertheless there is still a demand to explore the fabrication of tubular micro-jets made of versatile materials and with the capability of multi-functionalization. Here, we present a facile strategy for the fabrication of mesoporous silica micro-jets (MSMJs) for tubular micromotors which can carry out multiple tasks depending on their functionalities. The synthesis of MSMJs does not require the use of any equipment, making it facile and cost-effective for future practical use. The MSMJs can be modified inside, outside or both with different kinds of metal nanoparticles, which provide these micromotors with a possibility of additional properties, such as the anti-bacterial effect by silver nanoparticles, or biochemical sensing based on surface enhanced Raman scattering (SERS) by gold nanoparticles. Because of the high porosity, high surface area and also the easy surface chemistry process, the MSMJs can be employed for the efficient removal of heavy metals in contaminated water, as well as for the controlled and active drug delivery, as two proof-of-concept examples of environmental and biomedical applications, respectively. Therefore, taking into account the new, simple and cheap method of fabrication, highly porous structure, and multiple functionalities, the mesoporous silica based micro-jets can serve as efficient tools for desired applications.
Project description:Turbulent curtains of smoke rise initially as flat plumes and, above a certain height, they become round plumes. The same evolution of cross-sectional shape is exhibited by jets issuing from flat nozzles. Here we predict based on principle that all such flows should evolve their cross-sectional shapes from flat to round (and not the other way) at a critical distance downstream, which is predictable. The principle is that the prevailing flow architecture provides greater access to the flow of momentum from the moving core (plume, jet) to the still surroundings. For turbulent plumes and jets, the transition distance scales with the long dimensions (L) of the two-dimensional (flat) heat sources and nozzles that drive them. For laminar jets, the transition distance scales with L Re, where Re is the Reynolds number based on nozzle velocity and the smaller dimension of the nozzle cross section. These predictions are confirmed by full numerical experiments of the three-dimensional flow fields of turbulent and laminar jets covering the Re range 10-10(4).
Project description:While studies on vegetated channel flows have been developed in many research centers, studies on jets interacting with vegetation are still rare. This study presents and analyzes turbulent jets issued into an obstructed cross-flow, with emergent vegetation simulated with a regular array of cylinders. The paper presents estimates of the turbulence diffusion coefficients and the main turbulence variables of jets issued into a vegetated channel flow. The experimental results are compared with jets issued into unobstructed cross-flow. In the presence of the cylinder array, the turbulence length-scales in the streamwise and transverse directions were reduced, relative to the unobstructed crossflow. This contributed to a reduction in streamwise turbulent diffusion, relative to the unobstructed conditions. In contrast, the transverse turbulent diffusion was enhanced, despite the reduction in length-scale, due to enhanced turbulent intensity and the transverse deflection of flow around individual cylinders. Importantly, in the obstructed condition, the streamwise and transverse turbulent diffusion coefficients are of the same order of magnitude.
Project description:The representation of upper tropospheric/lower stratospheric (UTLS) jet and tropopause characteristics is compared in five modern high-resolution reanalyses for 1980 through 2014. Climatologies of upper tropospheric jet, subvortex jet (the lowermost part of the stratospheric vortex), and multiple tropopause frequency distributions in MERRA (Modern Era Retrospective Analysis for Research and Applications), ERA-I (the ECMWF interim reanalysis), JRA-55 (the Japanese 55-year Reanalysis), and CFSR (the Climate Forecast System Reanalysis) are compared with those in MERRA-2. Differences between alternate products from individual reanalysis systems are assessed; in particular, a comparison of CFSR data on model and pressure levels highlights the importance of vertical grid spacing. Most of the differences in distributions of UTLS jets and multiple tropopauses are consistent with the differences in assimilation model grids and resolution: For example, ERA-I (with coarsest native horizontal resolution) typically shows a significant low bias in upper tropospheric jets with respect to MERRA-2, and JRA-55 a more modest one, while CFSR (with finest native horizontal resolution) shows a high bias with respect to MERRA-2 in both upper tropospheric jets and multiple tropopauses. Vertical temperature structure and grid spacing are especially important for multiple tropopause characterization. Substantial differences between MERRA and MERRA-2 are seen in mid- to high-latitude southern hemisphere winter upper tropospheric jets and multiple tropopauses, and in the upper tropospheric jets associated with tropical circulations during the solstice seasons; some of the largest differences from the other reanalyses are seen in the same times and places. Very good qualitative agreement among the reanalyses is seen between the large scale climatological features in UTLS jet and multiple tropopause distributions. Quantitative differences may, however, have important consequences for transport and variability studies. Our results highlight the importance of considering reanalyses differences in UTLS studies, especially in relation to resolution and model grids; this is particularly critical when using high-resolution reanalyses as an observational reference for evaluating global chemistry climate models.
Project description:Accretion onto the supermassive black hole in some active galactic nuclei (AGN) drives relativistic jets of plasma, which dissipate a significant fraction of their kinetic energy into gamma-ray radiation. The location of energy dissipation in powerful extragalactic jets is currently unknown, with implications for particle acceleration, jet formation, jet collimation, and energy dissipation. Previous studies have been unable to constrain the location between possibilities ranging from the sub-parsec-scale broad-line region to the parsec-scale molecular torus, and beyond. Here we show using a simple diagnostic that the more distant molecular torus is the dominant location for powerful jets. This diagnostic, called the seed factor, is dependent only on observable quantities, and is unique to the seed photon population at the location of gamma-ray emission. Using 62 multiwavelength, quasi-simultaneous spectral energy distributions of gamma-ray quasars, we find a seed factor distribution which peaks at a value corresponding to the molecular torus, demonstrating that energy dissipation occurs ~1 parsec from the black hole (or ~104 Schwarzchild radii for a 109M? black hole).