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Exam Code: NCC Practice exam 2022 by Killexams.com team
NCC Certified in NeuroCritical Care (ABEM)

The following are specific diseases, conditions, and clinical syndromes commonly managed by a neurointensivist:
A. Cerebrovascular Diseases
1. Infarction and ischemia
• Massive hemispheric infarction
• Basilar artery occlusion and stenosis
• Carotid artery occlusion and stenosis
• Crescendo TIAs
• Occlusive vasculopathies (Moya-Moya, sickle cell)
• Spinal cord infarction
2. Intracerebral hemorrhage
• Supratentorial
• Cerebellar
• Brainstem
• Intraventricular
3. Subarachnoid hemorrhage - aneurysmal and other Vascular malformations
• Arteriovenous malformations
• AV fistulas
• Cavernous malformations
• Developmental venous anomalies
4. Dural sinus thrombosis
5. Carotid-cavernous fistulae
6. Cervical and cerebral arterial dissections
B.Neurotrauma
1. Traumatic brain injury
• "Diffuse axonal injury"
• Epidural hematoma
• Subdural hematoma
• Skull fracture
• Contusions and lacerations
• Penetrating craniocerebral injuries
• Traumatic subarachnoid hemorrhage
2. Spinal cord injury
• Traumatic injury (transection, contusion, concussion)
• Vertebral fracture and ligamentous instability
C. Disorders, Diseases, Seizures, and Epilepsy
1 . Seizures and epilepsy
• Status epilepticus (SE) Convulsive
Non-convulsive (partial-complex and "subtle" secondarily generalized SE) Myoclonic
2. Neuromuscular diseases
• Myasthenia gravis
• Guillain-Barre syndrome
• ALS
• Rhabdomyolysis and toxic myopathies
• Critical illness myopathy and neuropathy
3. Infections
• Encephalitis (viral, bacterial, parasitic)
• Meningitis (viral, bacterial, parasitic)
• Brain and spinal epidural abscess
4. Toxic-metabolic disorders
• Neuroleptic malignant syndrome/malignant hyperthermia
• Serotonin syndrome
• Drug overdose and withdrawal (e.g., barbiturates, narcotics, alcohol, cocaine, acetaminophen).
• Temperature related injuries (hyperthermia, hypothermia)
5. Inflammatory and demyelinating diseases
• Multiple sclerosis (Marburg variant, transverse myelitis)
• Neurosarcoidosis
• Acute disseminated encephalomyelitis (ADEM)
• CNS vasculitis
• Chemical or sterile meningitis (i.e. posterior fossa syndrome, NSAID induced)
• Central pontine myelinolysis
• Others
6. Neuroendocrine disorders
• Pituitary apoplexy
• Diabetes insipidus (including triple phase response)
• Panhypopituitarism
• Thyroid storm and coma
• Myxedema coma
• Addisonian crisis
D. Neuro-oncology
1 . Brain tumors and metastases
2. Spinal cord tumors and metastases
3. Carcinomatous meningitis
4. Paraneoplastic syndromes
E.Encephalopathies
1. Eclampsia, including HELLP Syndrome
2. Hypertensive encephalopathy
3. Hepatic encephalopathy
4. Uremic encephalopathy
5. Hypoxic-ischemic and anoxic encephalopathy
6. MELAS
F.Clinical syndromes
1.Coma
2. Herniation syndromes with monitoring & ICP
3. Elevated intracranial pressure and Intracranial hypotension/hypovolemia
4. Hydrocephalus detection & treatment
5. Cord compression
6. Death by neurologic criteria, end of life issues, and organ donation
7. Vegetative state
8. Dysautonomia (cardiovascular instability, central fever, hyperventilation)
9. Reversible posterior leukoencephalopathy
10. Psychiatric emergencies (psychosis)
G. Perioperative Neurosurgical Care
H.Pharmacotherapeutics
II. General Critical Care: Pathology, Pathophysiology, and Therapy
A. Cardiovascular Physiology, Pathology, Pathophysiology, and Therapy
1. Shock (hypotension) and its complications (vasodilatory and cardiogenic)
2. Myocardial infarction and unstable coronary syndromes
3. Neurogenic cardiac disturbances (ECG changes, stunned myocardium)
4. Cardiac rhythm and conduction disturbances; use of antiarrhythmic medications; indications for and types of pacemakers
5. Pulmonary embolism
6. Pulmonary edema: cardiogenic versus noncardiogenic (including neurogenic)
7. Acute aortic and peripheral vascular disorders (dissection, pseudoaneurysm)
8. Recognition, evaluation and management of hypertensive emergencies and urgencies
9. Calculation of derived cardiovascular parameters, including systemic and pulmonary vascular resistance, alveolararterial gradients, oxygen transport and consumption
B.Respiratory Physiology, Pathology, Pathophysiology and Therapy
1.Acute respiratory failure
• Hypoxemic respiratory failure (including ARDS)
• Hypercapnic respiratory failure
• Neuromuscular respiratory failure
2. Aspiration
3. Bronchopulmonary infections
4. Upper airway obstruction
5. COPD and status asthmaticus, including bronchodilator therapy
6. Neurogenic breathing patterns (central hyperventilation, Cheyne-Stokes respirations)
7. Mechanical ventilation
• Positive pressure ventilation (BIPAP)
• PEEP, CPAP, inverse ratio ventilation, pressure support ventilation, pressure control, and non- invasive ventilation
• Negative pressure ventilation
• Barotrauma, airway pressures (including permissive hypercapnia)
• Criteria for weaning and weaning techniques
8. Pleural Diseases
• Empyema
• Massive effusion
• Pneumothorax
9. Pulmonary hemorrhage and massive hemoptysis
10. Chest X-ray interpretation
11. End tidal C02 monitoring
12. Sleep apnea
13. Control of breathing
C. Renal Physiology,Pathology, Pathophysiology and Therapy
1.Renal regulation of fluid and water balance and electrolytes
2.Renal failure: Prerenal, renal, and postrenal
3.Derangements secondary to alterations in osmolality and electrolytes
4. Acid-base disorders and their management
5.Principles of renal replacement therapy
6. Evaluation of oliguria and polyuria
7.Drug dosing in renal failure
8. Management of rhabdomyolysis
9. Neurogenic disorders of sodium and water regulation (cerebral salt wasting and SIADH).
D. Metabolic and Endocrine Effects of Critical Illness
1. Enteral and parenteral nutrition
2. Endocrinology
• Disorders of thyroid function (thyroid storm, myxedema coma, sick euthyroid syndrome)
• Adrenal crisis
• Diabetes mellitus
Ketotic and hyperglycemic hyperosmolar coma Hypoglycemia
3. Disorders of calcium and magnesium balance
4. Systemic Inflammatory Response Syndrome (SIRS)
5. Fever, thermoregulation, and cooling techniques
E.Infectious Disease Physiology, Pathology, Pathophysiology and Therapy
1. Antibiotics
• Antibacterial agents
• Antifungal agents
• Antituberculosis agents
• Antiviral agents
• Antiparasitic agents
2. Infection control for special care units
• Development of antibiotic resistance
• Universal precautions
• Isolation and reverse isolation
3. Tetanus and botulism
4. Hospital acquired and opportunistic infections in the critically ill
5. Acquired Immune Deficiency Syndrome (AIDS)
6. Evaluation of fever in the ICU patient
7. Central fever
8. Interpretation of antibiotic concentrations, sensitivities
F.Physiology, Pathology, Pathophysiology and therapy of Acute Hematologic Disorders
1 . Acute defects in hemostasis
• Thrombocytopenia, thrombocytopathy
• Disseminated intravascular coagulation
• Acute hemorrhage (GI hemorrhage, retroperitoneal hematoma)
• Iatrogenic coagulopathies (warfarin and heparin induced)
2. Anticoagulation and fibrinolytic therapy
3. Principles of blood component therapy (blood, platelets, FFP)
4. Hemostatic therapy (vitamin K, aminocaproic acid, protamine, factor VIla)
5. Prophylaxis against thromboembolic disease
6. Prothrombotic states
G. Physiology, Pathology, Pathophysiology and Therapy of Acute Gastrointestinal (GI) and Genitourinary (GU)
Disorders
1. Upper and lower gastrointestinal bleeding
2. Acute and fulminant hepatic failure (including drug dosing)
3. Ileus and toxic megacolon
4. Acute perforations of the gastrointestinal tract
5. Acute vascular disorders of the intestine, including mesenteric infarction
6. Acute intestinal obstruction, volvulus
7. Pancreatitis
8. Obstructive uropathy, acute urinary retention
9. Urinary tract bleeding
H. Immunology and Transplantation
1. Principles of transplantation (brain death, organ donation, procurement, maintenance of organ donors, implantation)
2. Immunosuppression, especially the neurotoxicity of these agents
I. General Trauma and Burns
1. Initial approach to the management of multisystem trauma
2. Skeletal trauma including the spine and pelvis
3. Chest and abdominal trauma - blunt and penetrating
4. Burns and electrical injury
J. Monitoring
1. Neuromonitoring
2. Prognostic, disease severity and therapeutic intervention scores
3. Principles of electrocardiographic monitoring
4. Invasive hemodynamic monitoring
5. Noninvasive hemodynamic monitoring
6. Respiratory monitoring (airway pressure, intrathoracic pressure, tidal volume, pulse oximetry, dead space, compliance, resistance, capnography)
7. Metabolic monitoring (oxygen consumption, carbon dioxide production, respiratory quotient)
8. Use of computers in critical care units for multimodality monitoring
K. Administrative and Management Principles and Techniques
1. Organization and staffing of critical care units
2. Collaborative practice principles, including multidisciplinary rounds and management
3. Emergency medical systems in prehospital care
4. Performance improvement, principles and practices
5. Principles of triage and resource allocation, bed management
6. Medical economics: health care reimbursement, budget development
L. Ethical and Legal Aspects of Critical Care Medicine
1. Death and dying
2. Forgoing life-sustaining treatment and orders not to resuscitate
3. Rights of patients, the right to refuse treatment
4. Living wills, advance directives; durable power of attorney
5. Terminal extubation and palliative care
6. Rationing and cost containment
7. Emotional management of patients, families and caregivers
8. Futility of care and the family in denial
M. Principles of Research in Critical Care
1. Study design
2. Biostatistics
3. Grant funding and protocol writing
4. Manuscript preparation
5. Presentation preparation and skills
6. Institutional Review Boards and HIPAA
Ill. Procedural Skills
A. General Neuro-Critical Care
1 . Central venous catheter placement; dialysis catheter placement
2. Pulmonary artery catheterization
3. Management of mechanical ventilation, including CPAP/BiPAP ventilation
4. Administration of vasoactive medications (hemodynamic augmentation and hypertension lysis)
5. Maintenance airway and ventilation in nonintubated, unconscious patients
6. Interpretation and performance of bedside pulmonary function tests
7. Direct laryngoscopy
8. Endotracheal intubation
9. Shunt and ventricular drain tap for CSF sampling
10. Performance and interpretation of transcranial Doppler
11. Administration of analgosedative medications, including conscious sedation and barbiturate anesthesia
12. Interpretation of continuous EEG monitoring
13. Interpretation and management of ICP and CPP data
14. Jugular venous bulb catheterization
15. Interpretation of Sjv02 and Pbt02 data
16. Management of external ventricular drains
I 7. Management of plasmapheresis and IVIG
18. Administration of intravenous and intraventricular thrombolysis
19. Interpretation of CT and MR standard neuroimaging and perfusion studies and biplane contrast neuraxial angiography
20. Perioperative and postoperative clinical evaluation of neurosurgical and interventional neuroradiology patients
21. Performance of lumbar puncture and interpretation of cerebrospinal fluid results
22. Induction and maintenance of therapeutic coma and hypothermia

Certified in NeuroCritical Care (ABEM)
Certification-Board candidate
Killexams : Certification-Board candidate - BingNews http://www.bing.com:80/news/search?q=Certification-Board+candidate&cc=us&format=RSS Search results Killexams : Certification-Board candidate - BingNews http://www.bing.com:80/news/search?q=Certification-Board+candidate&cc=us&format=RSS https://killexams.com/exam_list/Certification-Board Killexams : ‘Vindicated:’ NC Greens rally outside federal court in Raleigh following certification No result found, try new keyword!I reject the term spoiler, but I embrace the term disrupter,” said Matthew Hoh, the Green party’s candidate for U.S. Senate. Mon, 08 Aug 2022 08:54:12 -0500 en-us text/html https://www.msn.com/en-us/news/politics/e2-80-98vindicated-nc-greens-rally-outside-federal-court-in-raleigh-following-certification/ar-AA10rV5M Killexams : State Board of Elections to take final vote on Green Party certification; ballot access up to courts

The North Carolina State Board of Elections voted unanimously to certify The Green Party as an official party.

“Some have suggested that we should make this decision quickly rather than ensure that it was done correctly,” Board Chairperson Damon Circosta, who initially voted against certification in June, said. “A hasty decision would have been a disservice to the voters of this state and the law. We spent the time and the effort to get it right.”

The board voted against certifying the Green Party in June, citing potential fraud in the petition campaign. While the board has now certified the party, the decision is somewhat moot as the filing deadline for new candidates passed on July 1. The only way for the Green Party to get on the November ballot now is through a court order or legislative action.

The state board directed all county boards of elections to complete a signature matching review of all Green Party petitions prior to Monday’s meeting. After doing so, the board found that the Green Party still had 1,607 signatures more than what was required to become a new party.

Although the party is now certified, board staff said the investigation into potential fraud continues and any criminal findings will be referred to prosecutors.

The Green Party has filed a lawsuit against the state board, alleging that by denying the it a spot on the ballot the board violated the party’s due process and First Amendment rights.

“NCSBE’s failure to certify NCGP as a new political party, despite NCGP’s compliance with all applicable requirements under state law, without providing NCGP with notice or an opportunity to defend the validity of the signatures on its petitions or the integrity of its petitioning process, violates Plaintiffs’ right to due process of law,” the lawsuit reads.

The board filed a response to the lawsuit on Friday, writing that it opposed the Green Party’s demand that a judge order its inclusion the 2022 ballot. But the NCSBE does not oppose the party’s request that the candidate filing deadline be extended, should the board certify the party at its meeting Monday.

The board’s response also included a declaration from Matthew Martucci, the board’s lead investigator.

“The Investigation Division elevated the Green Party investigation as a potentially criminal matter with high priority due to observing a pattern of petition pages submitted containing what appeared to be noticeably fraudulent signatures,” he wrote.

Oliver Hall, the Green Party’s lawyer, said the board had no legal basis to deny the party’s certification.

“Even if the board certifies NCGP tomorrow, as it is required to do, the harm that its unlawful and unconstitutional actions have caused NCGP is immeasurable,” he said in a text to The News & Observer.

A hearing is scheduled for Aug. 8 on the lawsuit.

The denial of the party’s certification, as well as the involvement of powerful organizations on both sides of the aisle have raised questions about political motivations in the process of certifying new parties.

Leading up to the board’s initial vote in June, the Democratic Senatorial Campaign Committee, which is represented by The Elias Group — a law firm tied to influential Democratic politicians — began contacting people who signed the Green party’s petition for ballot access and asking them to remove their signatures.

“If the Green Party is on the ballot it will supply Republicans a huge advantage that will help them win in North Carolina in 2022 and 2024,” texts from the DSCC to petition signers said.

Last week, the National Republican Senatorial Committee filed an amicus brief in support of the Green Party’s lawsuit.

“The Democratic Party has acknowledged that it would benefit politically if the Green Party does not appear on the ballot in North Carolina — the Green Party presents a separate option for left-leaning voters in the General Election,” the brief said. “Thus, it is not surprising that the Board’s vote on whether to certify the Green Party was directly split 3-2 along party lines.”

All three Democrats on the board voted against certification, with the two Republicans voting in favor.

Marc Elias, founder of the Elias Group, criticized Republican’s involvement in a Tweet last week.

“It is incredible how *whenever there is real fraud* in North Carolina, the Republican Party is all for it,” Elias wrote. “Pretend fraud, however, they must do everything in their power to make sure that can never happen.”

The Elias Group has not responded to multiple requests for comment from The N&O.

The state board maintains that its decision was not made for political reasons.

“There is nothing political about this that’s being performed by state board staff,” Karen Brinson Bell, executive director of the state board said. “This is us administering elections as prescribed by our law.”

For more North Carolina government and politics news, listen to the Under the Dome politics podcast from The News & Observer and the NC Insider. You can find it at https://campsite.bio/underthedome or wherever you get your podcasts.

Mon, 01 Aug 2022 00:00:00 -0500 en-US text/html https://www.aol.com/news/state-board-elections-final-vote-120000624.html
Killexams : Longtime incumbent faces newcomer for Santa Rosa County School Board District 3 seat No result found, try new keyword!Incumbent Carol Boston takes on challenger Alisabeth Janai Lancaster in the race for the Santa Rosa County School Board's District 3 seat. Mon, 08 Aug 2022 23:01:38 -0500 en-us text/html https://www.msn.com/en-us/news/us/longtime-incumbent-faces-newcomer-for-santa-rosa-county-school-board-district-3-seat/ar-AA10t6zc Killexams : Democrats plan to challenge Green Party certification

The final step in the N.C. Green Party's journey to be on the state's 2022 ballots may be in sight, as Judge James Dever, the federal judge overseeing the party's lawsuit against the N.C. State Board of Elections, released an order Monday signaling the case was made "moot" by the NCSBE's decision to certify the Greens as a party.


This likely indicates the Green Party's candidates will not be held to the July 1 candidate deadline and will be allowed on the ballot.
"The NCSBE's unanimous decision certifying the NCGP as a new political party appears to moot plaintiff's requests for a declaratory judgment and an injunction ordering NCSBE to certify NCGP as a new political party entitled to place its candidates on the ballot for the Nov. 8, 2022 general election," wrote Dever.
The order quotes an earlier statement from the NCSBE stating that they would not oppose setting aside the July 1 candidate filing deadline for N.C. Green Party candidates in the event the party was eventually recognized.
In an Aug. 2 conversation with Carolina Journal, N.C. Green Party U.S. Senate candidate Matthew Hoh said this was his understanding of the NCSBE's position in numerous statements related to the case. Because of this apparent agreement, Hoh said he expects to be included on the ballot by the end of the week. It is possible, though, if there are any issues raised by any of the parties, they would still need to show up for the Aug. 8 original court date.
Hoh said this is much less likely because, as far as he knows, the Democratic Senatorial Campaign Committee's "motion to intervene" filed in order to be added as a co-defendant was not accepted by the judge. So Democrats would not be able to object to the agreement among parties.
But the Democrats are not quite done fighting over the North Carolina Green Party's presence on the 2022 ballot, announcing on Monday that they will file a lawsuit in Wake County Superior Court in reaction to the NCSBE's unanimous vote to approve the Green Party as a recognized party in N.C.
“Given the North Carolina State Board of Elections’ own investigation finding widespread fraud in the North Carolina Green Party petitions and the ongoing criminal investigation, the NCDP is pursuing legal action to ensure North Carolina voters have not been deceived," said Meredith Cuomo, the NCDP executive director.
The statement went on to say that "The NCSBE’s vote today represents a sharp departure from how the board has treated past fraud cases, most notably in the 2018 election fraud scandal in North Carolina’s 9th Congressional District, in which the board ordered a completely new election after finding evidence of ballot tampering.”
Hoh said this lawsuit was "garbage." He said all the claims in the press release were debunked at the Aug. 1 NCSBE meeting, so they were not worried about any lawsuits based on them. He said the press release was "disingenuous and specious, the same sort of frivolous and unsubstantiated allegations that have been hurled at us for the last couple of months."
On the NCSBE approval, Hoh said that he's sad that it took two months to be certified, but he was also very grateful for the non-partisanship the Democrat-majority NCSBE, including Chair Damon Circosta, showed on Aug. 1 in finally approving them. He said he was also happy to see them firmly shut down further Democratic Party efforts to gum-up the process during the meeting with complaints against county boards for verifying signatures.
"Their demeanor was very changed from previous month," he said. "I'm grateful that they did the right thing, because I imagine that Circosta made some people unhappy in the Democratic Party. But he did the right thing by certifying us and did the right thing by throwing out those ridiculous complaints against the county boards, because they had no evidence."

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Fri, 05 Aug 2022 03:50:00 -0500 en-gb text/html https://www.hendersonvillelightning.com/four-seasons-politics/11871-g.html
Killexams : Trump adviser who tried to overturn election hosts NC fundraiser for US Senate candidate No result found, try new keyword!The months-long legal fight about the Green Party appears to be over, with a judge ruling in the party’s favor. Fri, 05 Aug 2022 12:42:26 -0500 en-us text/html https://www.msn.com/en-us/money/news/judge-rules-green-party-must-be-on-november-ballot-in-north-carolina/ar-AA10mCp8 Killexams : 4th county adds to ballot dispute as candidate sues to quit

HARRISBURG — A judge deciding if three Pennsylvania counties have to certify May primary vote counts including ballots lacking dates on their return envelopes learned this week that a fourth county is in the same situation — and there may be more.

The legal dispute has held up certification of primary results for governor and U.S. Senate, and created problems for a Republican state House member who has just filed a lawsuit seeking to withdraw from his reelection contest.

Rep. Matthew Dowling’s district is in Fayette County, where the primary results have not been certified. Until he is deemed the winner of the nomination, the state isn’t letting him withdraw, and there’s a looming deadline for local party officials to pick a substitute.

Gov. Tom Wolf’s administration is suing Berks, Fayette and Lancaster counties in an effort to force them to report ballots in envelopes without handwritten dates. Days after a lengthy hearing in the Commonwealth Court case, lawyers for the Department of State and Fayette County separately told Judge Renee Cohn Jubelirer that Butler County also has not officially reported such votes.

It is unclear how the oversight occurred. Butler County’s lawyer informed a high-ranking state elections official in a June 21 letter that Butler County “will not be canvassing ballots which are not compliant with the statutes of this commonwealth.”

“We followed the law,” the chair of Butler County’s Board of Commissioners, Republican Leslie Osche, said Thursday. Osche declined to comment on a statement in a Tuesday letter to Cohn Jubelirer from Michael Fischer, a lawyer representing the Department of State, that the agency “may take further action shortly with respect to Butler County if necessary.”

Department of State press secretary Grace Griffaton wrote in an email Thursday that state officials from her department were evaluating their options.

“It is disturbing that certain counties are refusing to certify valid ballots cast by their voters despite guidance on this issue from the department, and rulings from both state and federal courts,” Griffaton said.

State law requires handwritten dates on mail-in ballot return envelopes. But after a 3rd U.S. Circuit Court of Appeals decision in May that said the dates weren’t needed in a contested Lehigh County judge race, the Wolf administration told counties they must include the disputed ballots in their tallies reported to the Department of State. After the three counties did not, the state filed suit.

In addition to the official certification of primary winners in the races for governor and U.S. Senate, the issue has also held up certification of primary winners in congressional and state legislative contests in districts that include parts of the three counties, said Fayette County’s attorney Tom King.

There are also questions about the status of Bradford County, where officials sent in certification before being pressured by the state, after which the county’s election board submitted a separate document that describes the uncertified ballots from undated envelopes.

“We agreed early on, the three commissioners, not to certify nor to count illegal ballots, which we deem those to be,” Republican Bradford County Commissioner Doug McLinko said Wednesday. “They weren’t counted. But they were sent in separately because of the threat of a lawsuit.”

In the Fayette County contest, three-term incumbent Dowling announced he was dropping out last month after being charged with driving under the influence.

“It has been an extremely frustrating position to be in right now, having made the difficult decision to move on in my private life and not go through this election cycle already,” Dowling said Thursday.

On Monday, Dowling and four voters from the Republican majority district sued acting Secretary of State Leigh Chapman, one of Chapman’s lieutenants and the Fayette County Board of Elections, seeking a Commonwealth Court order that he be allowed to withdraw. The lawsuit says the deadline to replace him on the ballot is later this month.

Thu, 04 Aug 2022 08:57:00 -0500 en-US text/html https://triblive.com/news/pennsylvania/4th-county-adds-to-ballot-dispute-as-candidate-sues-to-quit/
Killexams : NC elections board certifies Green Party, reverses past vote No result found, try new keyword!The North Carolina State Board of Elections has unanimously voted to recognize the Green Party as a new political party, reversing its previous decision to reject the party’s petition while the board ... Fri, 05 Aug 2022 07:20:00 -0500 text/html https://www.newsobserver.com/news/nation-world/national/article264043561.html Killexams : Unintended Consequences of the PHM Board Certification Process

Pediatric Hospital Medicine (PHM) was designated a subspecialty by the American Board of Medical Specialties in 2016, with certification through the American Board of Pediatrics (ABP). While this recognition was a significant milestone, many hospitalists within the PHM community are concerned that the current certification process excludes competent individuals from our field and will have unintended consequences for physicians and the children we serve.

The narrow path to certification

With the introduction of PHM certification came a practice pathway whereby pediatric hospitalists could achieve certification without fellowship, provided they met a strict set of criteria set forth by the ABP. Although some modest concessions were made to these criteria in response to concerns by the community regarding gender bias and the impact of the COVID-19 pandemic, the criteria remained so strict that numerous experienced hospitalists remained ineligible. The reasons an experienced hospitalist may not have qualified for the practice pathway are myriad and often deeply personal, including family responsibilities, health issues, and non-clinical duties. 

Starting with the graduating residency classes of 2020, the practice pathway was closed altogether, requiring all physicians joining our field to participate in a two-year fellowship to become certified in PHM. Despite this requirement, the current PHM fellowship infrastructure is insufficient to accommodate a significant proportion of the candidates applying for positions; one-third of applicants did not match in the most recent cycle.1 The dearth of fellowship positions has left numerous physicians unmatched and unable to become certified in PHM.

Board-ineligible physicians face an uncertain future with only a few options: find a job with the hope of matching into a PHM fellowship in a subsequent cycle, work as a non-certified hospitalist, or forsake our field entirely.2

Consequences for the individual

One concern raised by board-ineligible trainees, early-career physicians, and experienced clinicians is whether they will be treated as second-class hospitalists compared to their board-certified peers.2,3 Board eligibility has started to become a requirement for employment at a growing number of institutions, limiting the opportunities available for career mobility and advancement, particularly in university-based settings. Dividing our workforce based on certification status without alternative avenues to obtain it devalues the individual and excludes qualified physicians from institutions and geographic locations where they would otherwise thrive as clinicians.

The closure of the practice pathway may cause additional harm to certain vulnerable individuals and limit the diversity of our field. Family responsibilities and medical school debt are disproportionately carried by women and minorities, respectively, and are both negatively associated with pursuing a subspecialty fellowship.4-6 Placing barriers in the way of groups that have historically been underrepresented could undo some of the progress PHM has made toward diversity, equity, and inclusion.

Just a few years ago, a physician could join our field and prove their competence through dedication to their patients and diligence in the craft. The vast majority of our field and leadership followed this career path. With the introduction of certification, the practice pathway rightly recognized the value of the clinician’s hands-on experience caring for hospitalized children. Now that the practice pathway is closed, many hospitalists with significant clinical experience (including during the height of the COVID-19 pandemic) feel they are being told that their skills and years of personal sacrifice do not matter.

Consequences for the workforce

To ensure children can continue to receive the care they need, we need to promote a resilient, diverse workforce and ensure future generations of physicians are well-trained. While many of the recent closures of inpatient pediatric units across the country are rooted in market forces exacerbated by the pandemic, we must recognize that any action that weakens our workforce has the potential to accelerate this trend. This could have an disproportionate effect on underserved pediatric populations.

The number of PHM fellowship positions available each year, although growing, is insufficient to train the number of pediatric hospitalists needed to maintain our workforce.7 If PHM board certification in its current form becomes a minimum standard for employment, staffing shortages may develop. Rural and community hospitals would likely be affected first, although university sites may not be spared if nocturnist coverage continues to expand and more physicians leave medicine.8,9 Alternatively, if PHM moves toward having certified hospitalists at university-based centers with non-certified hospitalists limited to community settings, a “two-tiered” PHM hierarchy would be almost inevitable.3

Mandating extended training in PHM may negatively affect trainees’ exposure to our field. Spurred by our field’s push toward a fellowship requirement to practice PHM, the Accreditation Council for Graduate Medical Education is contemplating reducing the time pediatric and family medicine residents spend on pediatric wards. Fewer residents will be available to care for patients in the near term. This gap will need to be filled by additional pediatric hospitalists, although the PHM board certification process may, actually, be discouraging residents from choosing PHM as a career.10

Solutions

We each know someone affected by the board certification process. These affected individuals are our colleagues, mentees, and friends, and they deserve to have their voices heard. We should monitor the impact of board certification on our workforce and proactively seek solutions that strengthen our discipline. An expanded practice pathway can and should coexist with fellowships to allow competent pediatric hospitalists from different backgrounds to practice in hospitals with diverse needs. Although this would be a departure from the precedent set by prior developing specialties, we believe bold action is needed to overcome the unprecedented challenges facing health care today.

Thomas B. Mike, MD

Thomas B. Mike, MD

Behnoosh Afghani, MD

Behnoosh Afghani, MD

Gabrielle Fisher, MD

Gabrielle Fisher, MD

Richard Vo, MD

Richard Vo, MD

Dr. Mike is a pediatric hospitalist at Akron Children’s Hospital and Wooster Community Hospital, and a clinical assistant professor of pediatrics at Northeast Ohio Medical University in Rootstown, Ohio.

Dr. Afghani is a professor of pediatrics and chief of the University of California Irvine School of Medicine pediatric hospitalist division, and she practices pediatric hospital medicine at Children’s Hospital of Orange County in Orange County, Calif. She is also a pediatric infectious disease specialist and the founding director of several medical education programs.

Dr. Fisher is a pediatric hospitalist at Holtz Children’s Hospital and assistant professor of clinical pediatrics at the University of Miami Miller School of Medicine in Miami.

Dr. Vo is a rural community pediatric hospitalist at Campbell County Memorial Hospital in Gillette, Wyo.

References

  1. National Resident Matching Program. Results and data: Specialties matching service 2022 appointment year. Washington, D.C. 2022. Published May 2022. Available online at https://www.nrmp.org/wp-content/uploads/2022/05/2022-Main-Match-Results-and-Data_Final.pdf. Accessed 6/27/22.
  2. Ezzio C. Inclusivity needed in PHM fellowships. The Hospitalist. 2021;25(3):12-13.
  3. Welsh G. The importance of community pediatric hospital medicine. The Hospitalist. 2021;25(1):27.
  4. Leyenaar J, Frintner M. Graduating pediatric residents entering the hospital medicine workforce, 2006-2015. Acad Pediatr. 2018;18(2):200-7.
  5. Frintner MP, et al. Pediatric resident debt and career intentions. Pediatrics. 2013;131(2):312-8.
  6. Association of American Medical Colleges. Physician Education Debt and the Cost to Attend Medical School 2020 Update. Association of American Medical Colleges. Washington, DC 2020.
  7. Wang ME, et al. The future of pediatric hospital medicine: Challenges and opportunities. J Hosp Med. 2020;15(7):428-430.
  8. Oshimura J, et al. Inpatient staffing within pediatric residency programs: work hour restrictions and the evolving role of the pediatric hospitalist. J Hosp Med. 2012;7(4):299-303.
  9. Sinsky CA, et al. COVID-related stress and work intentions in a trial of US health care workers. Mayo Clin Proc Innov Qual Outcomes. 2021;5(6):1165-1173.
  10. Chandrasekar H, et al. A changing landscape: Exploring resident perspectives on pursuing pediatric hospital medicine fellowships. Hosp Pediatr. 2021;11(2):109-115.
Mon, 01 Aug 2022 05:20:00 -0500 en-US text/html https://www.the-hospitalist.org/hospitalist/article/32814/pediatrics/unintended-consequences-of-the-phm-board-certification-process/
Killexams : Pinellas School Board candidate Carl Zimmermann pitches plan to increase student attendance, boost ESL training

'Make schools a place students want to be, supply them a reason to want to show up and change the climate.'

This is part of a series of profiles of candidates for Pinellas County School Board in 2022.

Florida Politics invited each contender in the race to take part in a seven-question interview — giving them an opportunity to talk about qualifications, platforms and priorities.

Carl Zimmermann is running for Pinellas County School Board District 3 at large.

Here is our conversation with Zimmermann:

FP: What are the three important qualities and or qualifications you have that will make you an effective asset on the Pinellas County School Board?

Zimmermann: Well, the No. 1 qualification is my classroom experience. I’m the only person in the race that’s actually taught in Pinellas County schools, that’s actually taught in public schools and that’s actually taught in K-12 schools, which considering that’s what the Board governs, I think that’s an important asset to have.

I know what works. I know what doesn’t work. I’ve been through it. I’ve been optimistic about some and then realized that it was a disaster approach.

Another thing is my time in the Legislature. I served on three education committees while I was there, and I was part of a lot of key pieces of legislation on the main education committee. On that committee, I had to visit the early learning classes all throughout Tampa and Pinellas, and then help set parameters to make sure they were preparing kids — not just doing day care, but preparing kids to enter kindergarten and start their public education career.

I also was part of the group that helped rename PTEC to Pinellas Technical College. And it wasn’t just in Pinellas, it was all of those schools like that throughout the state.

We wanted to make sure that kids were proud of choosing these schools after high school, because PTEC was not being chosen by a lot of high school students. We wanted to make sure that we gave them every reason to choose that. So we called it a college because I knew as a teacher that kids wanted to be able to respond to, “What college are you going to?”

We made arrangements with Saint Petersburg College so that these kids, while they go for welding at PTEC, they could also take some academic courses and within the two-year period have their associate’s degree and be licensed welders making great money. With that combination, they could pursue their careers or go to college as far as they wanted to go, keeping that pathway for higher education open for those who wanted that.

I also just recertified my teacher’s certificate. There are many strategies when you’re dealing with kids with special needs, whether it’s because English is not their first language or whether it’s because they have other special needs, physical or developmental. There are many strategies that are very effective for all kids to help them excel.

And honestly, I would like to make it a requirement that all School Board members should have to go through the same classes so that they understand the strategies for reaching these kids that are sometimes difficult or sometimes ignored and often fall between the cracks.

FP: Why do you want to serve on the Pinellas County School Board?

Zimmermann: Teachers, students and staff need help. They genuinely need help. We have never seen times like this, and I mean that because of building up to the pandemic, all the things that have been placed on teachers and staff to have to deal with the loss of security.

Teachers are now hired on a fire-at-will basis, and they deal with the loss of or changes in long-term retirement. So many of the benefits and reasons that teachers stayed have been abolished. Then, top that off with the issues the pandemic created and what we as teachers had to go through teaching during a pandemic — teaching kids that were online simultaneously with teaching kids in the classroom or one or the other was a huge challenge.

Students’ behavior was even more difficult to manage as were students who needed extra help while also giving the students who were performing the structure and challenges they needed to stay engaged.

Teachers are leaving because teachers need help. And that’s one of the reasons why I’ve had teachers thank me for running for the Pinellas County School Board as soon as I filed. Mostly, though, I want to serve because I care about education. It’s been my life for many years. It began in college when I got my degrees in education, and it’s carried through most of my life

FP: What are the top three primary issues you feel the Pinellas County School Board needs to address, and how do you believe they should be addressed?

Zimmermann: Well, changing the climate is number one. There are so many things we can’t do as a Board. You know, we are very restricted on salary and how we can allocate money. We are very restricted on how we can distribute that money for salaries.

That doesn’t mean we don’t have wiggle room there, but what we can do is we can change the attitude that has begun at the very top and trickled down from either the Superintendent or the people under the Superintendent. And it’s trickled down to all the principals, the assistant principals, and then dumped on teachers, which ultimately gets dumped on students.

This negative attitude, “I gotcha” type attitude, where people feel that they are set up to fail. You know, you are required to do these gazillion things or you’re going to get dinged on your evaluation.

The next is dealing with attendance since the pandemic. Attendance in school is horrendous. Kids get used to not having to show up.

And I’m speaking now in the higher grade levels. Elementary schools, thankfully those kids, they just love to show up. They love to be there. But kids in middle and high school grades have gotten used to not showing up through the pandemic. Overall, their attitude has changed, and they treat school like it’s not important.

On the Board, we need to make sure that we address that very quickly. We have to make schools a place that kids actually want to go to. We can’t keep putting them in a classroom situation and feeding them liver when they hate liver. We need to feed them things they want. And obviously I’m not speaking about food here, you know, but we need to present education to them in a way that they develop a hunger to learn.

My program was an example for most kids where they loved working with video, and they loved learning how to edit. They asked me how to do specific things in class long before I would ever show them. They were curious and motivated to learn. So that’s what we need to do.

And as a Board, what we do is we encourage more academies and we encourage general classroom activities to not just be project-based, which we already know is hugely successful, but based on reality, because you can sit there and cut little butterflies out of a piece of paper and post them on a wall. But that’s not connected to reality.

You know, when you start solving real-world problems, and then they send their solutions on to the presidents of companies, that’s where you can really light them up and really make a difference. So those are the priorities: make schools a place students want to be, supply them a reason to want to show up and change the climate.

FP: What will you do to advocate for teachers if elected to the Pinellas County School Board?

Zimmermann: Well, first of all, it’s listen, but really listen. Not just conduct the climate survey. Get into the schools and really listen to specific problems that teachers are dealing with, specific hurdles that are being thrown in front of them that are preventing them from doing the thing they crave and love to do.

You know, teachers don’t teach for the money. They teach because it’s a calling. We need to find out those hurdles, and we need to remove as many of them as we can.

I would also look for every way possible that, working within the system, we can get around things and supply more money, provide more money as raises — not as a bonus, which then digs us deeper into a hole the following year, but as genuine raises.

The other thing I think I would do is work with businesses. At a recent forum, I heard a lot of candidates say we need to lobby the Legislature. Well, let me tell you, having been there, you’re wasting your time lobbying the Legislature. Arizona just passed vouchers for all, and the disturbing thing is something I already knew, that they made no bones about saying vouchers for all because we are going to take down public education, we’re going to abolish it.

Now, I already knew that was the mission when I was in the Legislature. That was also the mission in Florida. So what we do is instead of lobbying the Legislature, why not lobby the companies that are very successful at lobbying the Legislature. Get them on our side and then the Legislature starts swinging the way we need them to swing.

You know, Disney obviously is not going to have any influence with the majority party right now in Tallahassee, but there are companies like Publix that have very powerful lobbying efforts with the Legislature and can steer things.

Even in industries like sugar, you look at every industry that’s successful with the majority party in the Legislature and work on lobbying them to help us correct things so that we can provide a well-trained workforce for them. This would be a win-win all around, but we’re trying to convince the wrong people. So, yeah, that’s the other thing I would do for teachers.

FP: Most Pinellas County school students are too young to vote, but if they could vote, why should they vote for you?

Zimmermann: Because I’m in it for them. And that’s the truth. And my former students all know this, and they all post on my Facebook pages supporting me because of it.

Our mission is for the students of all Pinellas County Schools. Our mission is to make them successful, supply them the opportunities to make school the place that they wanted to be. So that’s why they should vote for me, it is because I’m in it for them, and they are number one. Also, the teachers are in it for them. So what I’m helping the teachers do goes back to the students.

FP: What role does or can the School Board play to address performance gaps among students in the classroom, particularly those who have specific needs?

Zimmermann: Most teachers have to take the ESL training for recertification now. But I think administrators, specifically top administration, should all have to take ESL certification. They’re the ones making the rules. They should understand these strategies. And if they did, if they truly listened and understood them, then we’d be doing a lot more to help all kids using the same strategies.

I think, again, we need to supply the kids a reason to want to learn. You know, I don’t care what race, what background, what poverty level a child is from. If you supply them that reason, they light up.

And I’ll supply you a quick example. I had a special needs kid. We had a special program, a countryside high school, and the special ed teacher said, “Listen, we have a kid with very low cognitive functioning, but he loves your live in-school Daily Show. He worships the kids that anchor when they come by our room. He’s star-struck. They’re all movie stars, you know? Is there any way he could just kind of audit your class?”

And I said that I wasn’t sure. You know, I think if he’s in my class, he’s got to meet the standards, you know. Of course, I hadn’t taken the ESL training yet, and if I had, I would have known that he didn’t. But anyway, I said sure.

And the special ed teacher said that the student wants to be in the advanced class. I thought: how can I put him in the advanced class? He doesn’t have the basics that I’ve taught in the other classes. But they said you don’t even have to grade him, we’ll keep him in our class. This is just kind of like he can be a liaison.

Under those terms, I said that sounds fair.

The next school year started, and I had completely forgotten about this. We got started, we got the show going and we did assignments. Everybody started getting up to speed, and this one kid developed as a great audio guy. He was really sharp on audio. He knew when to bring up the mics, when to bring down the mics and how to fine-tune them.

About two months go by, and I see the special ed teacher who asks how so-and-so was working out? I said, “Why do you ask?”

She had to remind me about him and let me know that he had an IQ of something like 82. I said, “I can’t believe it. He’s like, the best audio guy we have. Everybody loves him.”

Giving students opportunities, letting them do things they love, make learning about real-world scenarios — taking actions that work. That’s how you successfully address performance gaps. Pull-out tutoring to help kids who are falling behind develop necessary skills to get back to grade-level. Utilizing volunteers, mentors and other community resources to supply kids the extra help they may need.

We must also continue to keep an eye on these students because kids who are hungry, who haven’t slept, who are embarrassed because of their hygiene or dirty clothes, kids who need mental health supports, et cetera are not going to perform well in the classroom if their basic needs aren’t being met.

Thank goodness we just approved a little over $4 million for mental health counselors in Pinellas County. And we’re going to get that support.

And the second part to that is I hope they create clear pathways for all staff members — not just teachers, but all staff members — to be able to refer these kids to get that help. Because right now there is no clear pathway.

You know, if I have a kid that’s being abused and clearly with sexual or physical abuse, there’s a pathway. I have a phone number. I call. I have to legally make that phone call and I can do it if I have a child that is ready to commit suicide. I have a clear pathway. You know, I can get that student into the hands of somebody that can help them right away and who doesn’t leave them alone.

But all those kids in the middle, the kids that are depressed because their girlfriend or boyfriend broke up with them, the kids that can’t function because their parents just split up. You know, all these other things that are affecting their mental health, we have no pathway. I’m hoping with this hire we’re going to get the person that will serve as the clear pathway for us to get those kids the help they need.

FP: School safety is a subject on many people’s minds, shootings and violence or bullying on campus, too. Just general disruptive behavior and even the need to keep kids safe from infectious diseases at best. These issues can be a major distraction to learning. At worst, they can be deadly. What are your thoughts on the needs and strategies to keep students safe at school?

Zimmermann: Well, first of all, in the Legislature, I filed a bill two years in a row on school safety. And at that time, it was to retrofit schools because in Pinellas County schools, we’ve got a Chief that’s really proactive and has done wonderful things.

There are still some doors in this school district, classroom doors, that cannot be locked from the inside. If you ever heard anybody talking about that problem, I’m the one that brought that thing up. And it was part of my bill.

And that’s the way I presented it: teachers had to leave the room if the announcement came that there’s an active shooter. We had to leave the classroom, stand in the hallway, in the line of sight, fiddle with our keys, lock the door, then go back in. Meanwhile, the shooter is at the end of the hallway at one of those hallways and has complete access to the students because the teacher has already been shot and is laying in the hallway.

So the bill I filed was a retrofit bill to retrofit all doorknobs, all door handles, to make them inaccessible and to take the glass in the windows and make them category five glass, which is also bulletproof. It allows penetration, but the bullet, if it gets through, it just kind of flops down. It doesn’t go anywhere.

Another idea that was not in the bill, which I just recently talked to some law enforcement about, was that I thought it would be great to cut holes in the block walls and have one-way glass. On the outside of the room, you have a locked door that can slide open so that nobody can just slide it open and look in the classroom. But the police or the principal could open it up, slide in and get the lay of the land and see where the shooter is.

This would be a simple thing that I think could enhance how quickly we can, if we were unfortunate enough to have a shooter actually in the classroom, we could quickly assess where they are so that the police would know where to penetrate.

The other thing that we have is that all of the school cameras can now be taken over by the local police. They pull in the parking lot with their big van, and they can immediately take control of all school security cameras. With this, they can steer people in exactly to where the active shooter is. Other security issues include maintaining locked, alarmed and surveilled exterior doors and guarded perimeters.

When students returned to class with the pandemic, controversy over masks and social distancing ran high. We had all of these kids that were going to be coming back in and making that work created a whole problem — social distancing was nearly impossible, and it was a total mixture of some kids wearing masks and others not.

Instead, we could have easily divided classrooms in half and said, “Those of you that want to wear masks, you will sit on that side of the room. Those of you that don’t, sit on this side of the room.” They have the choice.

If somebody says, “Well, I don’t want to wear a mask, and I want to be sitting by the door,” then, teachers could be flexible and alternate. We could be a little bit smarter on how we do it so that we’re not creating this massive division within our own community.

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Tue, 02 Aug 2022 01:10:00 -0500 en-US text/html https://floridapolitics.com/archives/543416-pinellas-school-board-candidate-carl-zimmermann-pitches-plan-to-increase-student-attendance-boost-esl-training/
Killexams : 4th County Adds to Pa. Mail-in Ballot Dispute as Candidate Sues to Quit

What to Know

  • A judge deciding if three Pennsylvania counties have to certify May primary vote counts including ballots lacking dates on their return envelopes learned this week that a fourth county is in the same situation — and there may be more.
  • The legal dispute is holding up certification of primary results for governor and U.S. Senate.
  • It has also created problems for Republican state House member Matthew Dowling, who's just filed a lawsuit seeking to withdraw from his Fayette County reelection contest. The Wolf administration is suing Berks, Fayette and Lancaster counties over the disputed ballots.

A judge deciding if three Pennsylvania counties have to certify May primary vote counts including ballots lacking dates on their return envelopes learned this week that a fourth county is in the same situation — and there may be more.

The legal dispute has held up certification of primary results for governor and U.S. Senate, and created problems for a Republican state House member who has just filed a lawsuit seeking to withdraw from his reelection contest.

Rep. Matthew Dowling's district is in Fayette County, where the primary results have not been certified. Until he is deemed the winner of the nomination, the state isn't letting him withdraw, and there's a looming deadline for local party officials to pick a substitute.

Gov. Tom Wolf's administration is suing Berks, Fayette and Lancaster counties in an effort to force them to report ballots in envelopes without handwritten dates. Days after a lengthy hearing in the Commonwealth Court case, lawyers for the Department of State and Fayette County separately told Judge Renee Cohn Jubelirer that Butler County also has not officially reported such votes.

It is unclear how the oversight occurred. Butler County's lawyer informed a high-ranking state elections official in a June 21 letter that Butler County “will not be canvassing ballots which are not compliant with the statutes of this commonwealth.”

“We followed the law,” the chair of Butler County's Board of Commissioners, Republican Leslie Osche, said Thursday. Osche declined to comment on a statement in a Tuesday letter to Cohn Jubelirer from Michael Fischer, a lawyer representing the Department of State, that the agency “may take further action shortly with respect to Butler County if necessary.”

Decision 2022

Coverage of the 2022 elections

Department of State press secretary Grace Griffaton wrote in an email Thursday that state officials from her department were evaluating their options.

“It is disturbing that certain counties are refusing to certify valid ballots cast by their voters despite guidance on this issue from the department, and rulings from both state and federal courts," Griffaton said.

State law requires handwritten dates on mail-in ballot return envelopes. But after a 3rd U.S. Circuit Court of Appeals decision in May that said the dates weren't needed in a contested Lehigh County judge race, the Wolf administration told counties they must include the disputed ballots in their tallies reported to the Department of State. After the three counties did not, the state filed suit.

In addition to the official certification of primary winners in the races for governor and U.S. Senate, the issue has also held up certification of primary winners in congressional and state legislative contests in districts that include parts of the three counties, said Fayette County's attorney Tom King.

There are also questions about the status of Bradford County, where officials sent in certification before being pressured by the state, after which the county's election board submitted a separate document that describes the uncertified ballots from undated envelopes.

“We agreed early on, the three commissioners, not to certify nor to count illegal ballots, which we deem those to be,” Republican Bradford County Commissioner Doug McLinko said Wednesday. “They weren't counted. But they were sent in separately because of the threat of a lawsuit.”

In the Fayette County contest, three-term incumbent Dowling announced he was dropping out last month after being charged with driving under the influence.

“It has been an extremely frustrating position to be in right now, having made the difficult decision to move on in my private life and not go through this election cycle already,” Dowling said Thursday.

On Monday, Dowling and four voters from the Republican majority district sued acting Secretary of State Leigh Chapman, one of Chapman's lieutenants and the Fayette County Board of Elections, seeking a Commonwealth Court order that he be allowed to withdraw. The lawsuit says the deadline to replace him on the ballot is later this month.

Fri, 05 Aug 2022 02:55:00 -0500 en-US text/html https://www.nbcphiladelphia.com/decision-2022/county-pa-ballot-dispute/3326409/
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