Our library can be accessed from certain countries only. Please, see if you are eligible to read or download our Forex Patterns And Probabilities Trading Strategies For Trending And Range Bound Markets content by creating an account. You must create a free account in order to read or download this book. Hardcover 2007 author ed ponsi PDF forex patterns and probabilities trading strategies for trending and range-bound markets PDF. The Ed Ponsi Forex Playbook offers a visual approach to learning specific trading strategies and. Written by the author of the hugely successful Forex Patterns and Probabilities. Ed Ponsi is the President of. Forex Patterns and Probabilities provides you with real-world strategies and a rare sense of clarity about the. Ed Ponsi is the President of FXEducator.com and is the former chief trading. Forex Patterns and Probabilities: Trading Strategies for Trending and Range-Bound Markets. Additional Information. Title: Forex Patterns And Probabilities Trading Strategies For Trending And Range Bound Markets By Ponsi Ed 1st Edition 2007 Hardcover Subject: forex patterns and probabilities trading strategies for trending and range bound.
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You must include on your return all items of income you receive in the form of money, property, and services unless the tax law states that you do not include them. Some items, however, are only partly excluded from. Emergency Unemployment Compensation Extension Act; Full title: To provide for the extension of certain unemployment benefits, and for other purposes. Introduced in: 113th United States Congress: Introduced on: December 17. This page provides information regarding other forms of assistance that may be available to disaster survivors. Please note that not all programs are available for all disasters. Additionally, some programs require an approved. Federal Emergency Management Agency. The Federal Emergency Management Agency (FEMA) is the federal agency responsible for coordinating emergency planning, preparedness, risk reduc. Tax Foundation Background Paper No. 61 For a PDF of the full study, click here. The new number of unemployment benefit claims decreased by 4,0. NY, MI, and LA mostly due to new jobs in Transportation, Warehousing, and Education. The four- week moving average decreased by 1,7. Insured unemployment fell by 7,0. The new number of unemployment benefits claims decreased by 1,0. CA. The four- week moving average fell by 1,0. Insured unemployment dropped by 3. The new number of unemployment benefits claims decreased by 1,0. CA. The four- week moving average fell by 1,0. Insured unemployment dropped by 3. For those who were not certifying for federal extension benefits due to going back to work, school or other situation but still had a remaining balance left on a federal extension claim, they have to reopen their claim if they are in need of extended benefits. The EDD recommends submitting a claims online to reopen their extension claims. The unemployment rate remains unchanged at 4. July of 2. 01. 6). August`s unemployment rates among population segments were as follows: for Asians 4. Whites 4. 4% (up 0. Hispanics 5. 6% (up 0. African Americans 8. July and down 1. 3% since Aug- 2. Non- farm, seasonally adjusted employment increased by 9. July). The number of long- term unemployment decreased by 1. August or 2. 5. 6% (down 0. The unemployment rate in August increased for short- term unemployed and decreased for long- term. There are currently 5. Economists don`t expect any significant changes in already thriving US economy in September and October of 2. Most of the month- over- month job gains came from Healthcare and Food Services with 6. August, followed by Professional and Business Services with 2. Mining and Logging lost 4,0. Staggering 1. 8 million of the high- paying US manufacturing jobs have been lost since 2. July 2. 01. 6 vs. January 2. 00. 7), and instead, have been replaced by considerably lower- paying service jobs. Further, the long- term unemployed (out of work for 2. Teenagers (1. 6- 1. June of 2. 01. 6) and the longest unemployment across all races, genders and age groups. In fact, the insights they provide are inadequate to determine why unemployed individuals may no longer be in the labor force. For example, 6. 5 million of US unemployed are still looking for jobs but no longer considered part of the 5. May unemployment rate. Women are also more pre- disposed to get trapped in low- paying jobs than their male counterparts. Here are some answers. That announcement came as a shocking surprise to individuals affected by layoffs in that industry. Based on alternative sources, the job losses were significantly understated in comparison to what was actually taking place. Industry review published by Challenger, Gray & Christmas proclaimed shocking 2. Here is why the figures are so different. Four major contenders, among them one Democrat and four Republicans, have already tossed their hats into the ring. Here is how these four presidential hopefuls propose to tackle the unemployment. The study suggests that a high unemployment rate isn’t just an economic issue. It is also a public health problem. Much of this notion is driven by the fact that lately claims have experienced a significant decline. While this is certainly good for the U. S. There are currently 2. Americans. These individuals may experience a reduction of their wages up to as much as 1. So what is the conclusion? Cut the unemployment benefits and unemployment will go down. The facts, as it turns out, are far more complex. Depression and suicidal thoughts start invading your mind? Well, you are not alone. According to the latest study conducted by Swiss scientists, about 2. Also, if you can recommend any local suicide help services, support groups or hotlines, please forward this information to us and we will share it with those in need. The labor participation rate grew to 6. December. Also, here is why the unemployment rate increased to 5. January. Our analysis indicates that Republicans will be focusing on cutting expenses rather than funding EUC this year. The overall expectation is that the unemployment rate will drop so low by mid- 2. Let’s take a look at some of the most important unemployment predictions. The economy generated an impressive 2. Joblessness rate fell to 1. People are getting hired, but wages are still stagnating. Projections indicate that wages will increase by 2. Long- term unemployment fell by 2. Still more must be done to boost stagnating wages. With over 6. 0 percent of employers checking credit scores before hiring or promoting, ineligibility for some federal jobs, and withheld educational transcripts, those who need employment most desperately, suffer the most. What is even worse, finding and keeping jobs can be particularly problematic for the long- term unemployed. Studies reveal discrimination towards the long- term unemployed, also known as an “unemployment trap”. The Bureau of Labor Statistics announced that the long- term unemployment situation hasn`t improved and approximately 2. While the underemployment crisis might seem like a problem of individual employees, it has economic implications for the entire country. That is the lowest level since March of 2. September of this year. Here is what keeps it so low and also why this may actually hurt Colorado`s economy. Will Obama’s Immigration Action Mean Fewer Jobs for Americans? Out of work for over 2. Why not to consider moving there? Studies show that white applicants with a criminal record are more likely to get employed than a black applicant with no criminal record. At the same time almost 1. Fusion Paperboard received notice that they will qualify for extended unemployment benefits. After exhausting their original 2. Fusion Paperboard employees will qualify to receive additional two and a half years of benefits. Are things really so bad? Take a look at these four countries with outrageously high unemployment rates. Either way, it is now up to Republicans to deal with the current economic issues. Here is how this will benefit you. Unemployment rate among the workers who remain jobless for more than six months is among the most persistent, negative effects of the Great Recession. Long- term unemployment remains above pre- recession levels in 4. Here’s why Obama and Boehner blame both the unemployed as well as lengthy Congressional recesses for missing the Unemployment Extension bill. It is estimated that federal and state governments are losing approximately $8. They tear at the very fabric of American society. According to the Census Bureau, the poverty rate in the United States declined to 1. It is cited more than any other statistical figure in the world. But now its accuracy has been challenged and here is the reason why. Continue Reading. August 8, 2. 01. 4. The portion of Americans between the ages of 2. April fell to a five- month low of 7. But what is the true nature of the unemployment rate? A record 9. 2. 5 million people are out of the work force, the cost of gas and food are at all- time sustained highs as is the stock market, and the failure to extend federal unemployment insurance benefits has a downward effect on the unemployment rate, making it look better than it actually is. Also can look at where jobs have been created, which, for the most part, aren`t in high- paying sectors.. Pell Grants Give Up to $5,5. Training. June 2. Unemployment Offers Opportunities for New Jobs Training. May 2. 7, 2. 01. 4. Unemployment Drops as Lawmakers Debate Benefits Extension. May 2. 4, 2. 01. 4. Federal Lawmakers Continue Wrangling Over Unemployment Extension. Federal tiers are determined by the state`s unemployment rate where the unemployed individual chooses to file for benefits. Do you feel that the economy is back to normal? Share with us your opinion. The EB Program is also relies on the state`s economic status to determine lengths & amounts. Extended benefit. The new Senate bill of December 2. EUC tiers (each tier defines how long your extension will last). These changes were enacted on June 1, 2. June, all tiers remained the same for claimants as was the case in 2. It. is important to note that in 2. The 2. 01. 3 legislation terms for the bill are as follows. Extended Benefits For 7. Weeks. (UNTIL END OF 2. Tier 1: 1. 4 weeks. Tier 2: 1. 4 weeks. Tier 3: 9 weeks. Tier 4: 1. State is 9% or higher - if your State is losing extended benefits, then you are entitled to 1. Four Sea Interludes - Benjamin Britten. Wishlist A- B - IMSLP/Petrucci Music Library: Free Public Domain Sheet Music. Return to Main Wishlist Page. Contents. 1Dall'Abaco, Joseph (Marie Cl. Atterberg, Kurt Magnus (1. Averkamp, Anton (1. Violin and Piano. La Jolie Fille de Gand (1. Piano reduction Le Filleule des Fees (1. Piano reduction 2 String Quartets Opp. Op. 1. 7 may be RISM 4. There may be two published qts no. Musica mechanica organoedi, 1. Das ist: Gr. Mahrenholz (Kassel, 1. Musikalisches Siebengestirn, das ist Sieben zu der edlen Tonkunst geh. November 1. 75. 1 Potsdam). Download free sheet music and scores: britten sea interludes. Il re pastore, Oper 3 Akte. Libretto: Pietro Metastasio. Oktober 1. 75. 2 Berlin. La citadella ingannata, Oper. Libretto: Giovanni Pietro Tagliazucchi, nach Friedrich II. September 1. 75. 5 Charlottenburg, zur Verm. Benjamin Britten Four Sea Interludes from the opera “Peter Grimes” EDWARD BENJAMIN BRITTEN was born in. THE SCORE OF THE “FOUR SEA INTERLUDES” calls for.Komponiert 1. 75. Die Auferstehung und Himmelfahrt Jesu, Oratorium. Libretto: Karl Wilhelm Ramler. Dezember 1. 75. 7 Berlin. L'ippocondriaco overo L'uomo fantastico, Intermezzo 3 Teile. Libretto: Pietro Metastasio. Britten Four Sea Interludes Score Pdf. Britten: Four Sea Interludes recordings. Britten loved the sea and got to know. Four Sea Interludes from Peter Grimes. Benjamin Britten IN SHORT Born:November 22, 1913, in. Although not explicitly cited in the libretto or score of Peter. Four Sea Interludes - Benjamin Britten. 5-50 (1) 50-100 (7) 100 (1) Sheet type. Full orchestra score: original: pdf: Suite164 (593) 87: Full score. England / Angleterre - Four Sea Interludes from 'Peter Grimes', Op. Leonard Bernstein 'Four Sea Interludes' Britten - Duration. Peter Grimes is an opera by Benjamin Britten. Yet when Peter Grimes opened in June. Peter Grimes Vocal Score - Ebook download as PDF File (.pdf). September 1. 76. 5 Berlin, zur Verm. Juni 1. 76. 7 Hamburg. Amor e Psiche, Opera seria 3 Akte. Libretto: Antonio Landi. Oktober 1. 76. 7 Berlin, zur Verm. Libretto: Antonio Landi. Neufassung: I Greci in Tauri: M. Also known as Joseph Agus.). Violin solos with . Ricordi). Op. 1 . Hayet.). Quintette- fantaisie, Op. Piano Quintet, Op. Durdilly). Der Mensch und das Leben, Op. Seejungfr. 8: 6 Balletti & 6 Sonate a tre (for 2 violins and basso continuo), 1. Lustspiel- Ouv., Op. Apollo- Verlag). 6 Concertos in 7 Parts, 1. Lemoine, 1. 89. 6). While works first published before 1. PD in Canada, the works of this composer are copyright in the EU. Only works published before 1. PD in the USA. String Quartet No. D major (1. 91. 8; pub. Tre Poemi di Rabindranath Tagore. L. Symphony No. 3 in E major, Op. Cantata op. 3. 6 Kantat vid Reformationsfesten i Uppsala den 3. Symphony No. 4 in C minor for vocalists and orchestra, Op. UE). Dala Rhapsody: Devil's Reel (Dj. Vallflickans Dans) (pub. Published 1. 99. 7 by Swedish Music Information Center. Concerto da camera PD EU, copyright in other countries (publ. Alkan in miniature. This is actually a collection of other works which we have (I think). Les Regrets de la Nonnette. Fantasticheria. Pas redoubl. A 1. 91. 0 bio gives his death year as 1. Wikipedia (German). Intermezzi for piano (pub. PD- CA, 1. 3- plus symphonies too . Symphony in C, Op. Hug). String Quartet No. Op. 3. 3 (pub. John Passion (1. Worldes Blis Ne Last No Throwe (Anonymous English tune, 1. Missa Caput (1. 44. Messe de Tournai (1. Piezas de clarines para trompeta y organ, uber Themen von Lully. Susanne von Soldt manuscript (1. British Library. Dublin manuscript (~1. Trinity College Library (TCD MS 4. Dublin. Rouen Gradual, BN latin 9. String Sextet, Op. String Quartet No. A. Dreililien, 1. Piano Sonata No. 3 in A major, Op. Simrock, 1. 90. 8). While works first published before 1. PD in Canada, the works of this composer are copyright in the EU. Only works published before 1. PD in the USA. Early Piano Works pub. Arrangement for piano 4 hands. In Memory of Suvorov March for orchestra. Subject of a book . Was later revised into an all sung oratorio in 1. A score of the final version still survives. Eight overtures in 8 parts, collection of overtures from various stage works by Arne including the overtures for Henry and Emma, Comus, and The Judgment of Paris. First used for a concert performance in 1. J. Herbage in 1. 93. VIII Sonatas or Lessons. Trio Sonatas, Op. Four New Overtures or Symphonies in 8 and 1. Parts, another selection of symphonic works mostly from Arne's stage works that were initially put together for concert performance in 1. Six Favourite Concertos, these keyboard concertos were part of various stage works by Arne and were compiled for publication in 1. Cello Concertos (parts for Nos. An index to these volumes would be quite nice! Richard Mix 1. 9: 5. January 2. 01. 5 (EST)). Under copyright worldwide, apart from earlier works (published before 1. PD in the USA. No posting without written permission from the copyright owner. Rhapsody for Piano and Orchestra Op. Score (1. 90. 9, rev. Symphony No. 4 in G minor, Op. Score (pub. 1. 92. C, Op. 3. 1 (pub. V. 3. 7 in B flat minor, Score (pub. Symphony No. 5 in D minor, Op. Score (1. 91. 9- 2. Basso contin del Sigr. Baal Partitura. Wq 1. Cello Concerto in A major (H 4. Cello part + full score. Wq 1. 71 Concerto for Violoncello in B flat major (H. PD- US, but..). Die Sechs Sammlungen von Sonaten, freien Fantasien und Rondos f. G major (H 6. 48). Symphonie Wq. 1. 74 in C major (H 6. Symphonie Wq. 1. 75 in F major (H 6. Symphonie Wq. 1. 79 in E flat major (H 6. Symphonie Wq. 1. 80 in G major (H 6. Symphonie Wq. 1. 81 in F major (H 6. Magnificat (full score. Flute Sonata in G major (Wq 1. Orchestersuite Ouvert. Moll Full Score. Orchestersuite Ouvert. G- Dur Full Score. Orchestersuite Ouvert. Moll Full Score. Orchestersuite Ouvert. D- Dur full Score. Ouvert! 6/6, W. C1. Sinfonias op. II 1. Johann Nikolaus Bach?) Full Score. Cantata . Wouters. Cantata parts in general, and specifically for BWV2. Schweigt stille Mass in b minor BWV 2. B. Krebs version); BWV 5. BWV 5. 45b; BWV 5. BWV 5. 66a; BWV 5. BWV 5. 74b; BWV 5. BWV 6. 30a; BWV 6. BWV 6. 67a; BWV 6. BWV 2. 49/I- IIIR (Concerto after Movements 1- 3 of BWV 2. BWV 1. 04. 6a I (BC O 5a); BWV 1. BWV 1. 05. 0a; BWV 1. BWV 1. 05. 3a (both Oboe and Oboe d'Amore versions); BWV 1. R (Both Oboe d'Amore and Viola d'Amore versions); BWV 1. R (Both Violin and Oboe versions); BWV 1. BWV 1. 06. 1a; BWV 1. R; BWV 1. 06. 7a. R; BWV 1. 06. 8a. R; BWV 1. 06. 9a. R; BWV 9. 7a. R; BWV 1. R; BWV BWV 1. 94. R. String Quartet, Op. Piano Trio No. 2, Op. Piano Trio No. 1 in C. Gallica/BNF, will reupload soon.) (no. Op. 1. 8 pub. 1. 81. While works first published before 1. PD in Canada, the works of this composer are copyright in the EU. Only works published before 1. PD in the USA. Symphony No. D minor (copy in Baillieu Library, Melbourne Uni). Symphony no. 3 in C minor. Three Pieces for Orchestra: Elegie, Intermezzo, and Humoresque. Three Pieces for Orchestra: Pavan, Idyll, and Bacchanal. While works first published before 1. PD in Canada, the works of this composer are copyright in the EU. Only works published before 1. PD in the USA. 1 in B minor (1. Cello Sonata No. 2 in F sharp minor (1. Dramatic Poem for cello and piano (1. Helena, variations on H. F. B. Those first published after 1. USA.(Music. Sack prefers Baryanski.). Piano quartet, Op. String quartet in A minor, Op. String quartet in E, Op. Piano Sonata, Op. Sep 2. 01. 4 - from Danish Royal Library. While works first published before 1. PD in Canada, the works of this composer are copyright in the EU. Only works published before 1. PD in the USA.(1. Violin Sonata No. Concertst. 1 (piano reduction). Sonata for Solo Violin. The Wooden Prince (A f. Any Works from the 1st and 2nd set of Opus numbers. While works first published before 1. PD in Canada, the works of this composer are copyright in the EU. Only works published before 1. PD in the USA. Hankowy pjsn. Two Songs (Nocturne & The Last Word) (pub. Star Trysts (pub. Coyote Song (pub. In the Country, op. Songs (Only of Thee and Me; A Little Lane; Phillis) (pub. Thoughts (pub. 1. The Driftwood Fire (pub. From the New Hampshire Woods, op. The White Birches pub. Fantasia Quasi una Sonata for Violin & Piano, Op. Schirmer. PD- CA only.). Wind Quintet, Op. Rondo, Op. 2. 74 (1. Bagatelle, Op. 3. Immortelle, Op. 4. Idyl, Op. 4. 03 (1. Sonata eroica for piano (pub. Leuckart). While works first published before 1. PD in Canada, the works of this composer are copyright in the EU. Only works published before 1. PD in the USA. Clarinet Sonata in D major (Parlett 3. Of a Rose I Sing a Song (choir, harp, cello and double bass) 1. Nonet (flute, oboe, clarinet, harp and string quintet) 1. Cello Concerto (1. Rhapsodic Ballad, for cello (1. Bax works for cello?). Folk- Tale, for cello & piano (1. Cello Sonata (1. 92. Cello Sonatina (1. Legend- Sonata, for cello & piano (1. Spring Fire: (based upon the first chorus in Swinburne's . Threnody and Scherzo (bassoon, harp and string sextet) (pub. String quartets (Quartets 1, 2, 3, 5 uploaded September 2. Violin Concertos (1- 5) - Full Orchestral Scores. La Ronde des Lutins, Op. Category: Beauvarlet- Charpentier. XIII) and rest of works for organ (Marche, Victory de l'armee d'Italie, etc.). N. Born 1. 79. 7 or 1. Duo de concert for violin and piano, Op. By a member of the Becqui? Piano Concerto No. Wo. O 4 (piano part). Lied: Que le temps me dure, Wo. O 1. 16 . Recorded performance on You. Tube (Erhard Fietz, mandolin; Amadeus Webersinke, piano). Note: IMSLP already has Wo. O 4. 3a, Wo. O 4. Wo. O 4. 4a. Arabesque for Violin (p. Arcadian Suite (p. La mort de Jeanne d'Arc (cantata, excerpts) (pub. From this: Historic scene for orchestra (pub. Leduc). Flute Concerto in E minor (possibly L 2. Flute Concerto in A major (poss. L 2. 1. 5 which we have?). Flute Concerto in A minor (poss. L 2. 1. 6 which we have?). Medea, melodrama. Any: Kirchenmusik; Sinfonien; Cembalokonzerten; Violinkonzerten. Passionen und Passionskantaten. Sinfonien in moll- Tonen. String Quartet, Op. Symphony, Op. 1. 01 (No. G minor) . Boston Symphony, 5th season, ca. Sometimes given as Joseph Benesch, 1. String Quartet in G major (composed? PD- CA?) (G major acc. The score- if this is the 1. G- dur.). 3 symphonies (acc. Piano Concerto No. Op. 1. Piano Concerto No. E flat major Op. 4. Piano Concerto No. Op. 9. Fantaisie in A major for Piano Op. Augener). Flute Concerto . String Quartets Opp. PD- CA only?). Preludio patetico for string quartet, Op. Kistner & Siegel) (PD- CA only?). Documenti Armonici. In Bolohna 1. 68. Discorsi musicali (1. Ragionamenti musicali (1. Arcani musicali svelati amicitia (. Janet et Cotelle, 1. Flute Concerto, Op. Etudes enfantines, Op. Those first published after 1. USA. 1. 97. 9 copyright worldwide)Evidently, Universal Edition committed copyfraud when it published its edition copyright 1. Helene Berg in 1. Hofmeister, like symphony also in complete edition. Parts at SBB.). String Quartet in G (the most complete - apparently entirely- of the . Free Excel Invoice ProgramsExcel Invoice Template, free download. Free invoice template that provides a Fill In The Blank invoice form in Excel. 3 screenshots along with a virus/malware test and a free download link. Excel Invoice Template. Our templates are now published on InvoicingTemplate.com, where you can search and download hundreds free invoicing designs in Microsoft Excel format. Please visit our new site by clicking. From Office-Kit: As a small business you may not need a fully featured invoicing system. This free invoice template is designed for auto body repair business, collision repair business or mobile refinisher business. Invoice Software that's incredibly easy to use! SliQ Invoicing is an easy-to-use invoicing software package letting you speed up your billing and still achieve professional results. Download a free trial! 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Arrange for three letters of reference to be sent directly to this office. Professionalism education of OB/GYN resident physicians: What makes a difference? ABSTRACTObjective: The aim of this study was to evaluate the efficacy of a new Professionalism curriculum in an Obstetrics and Gynecology (OB/GYN) residency after introducing Narrative Medicine and Professional Development/Support Group (PDSG) programs. Methods: 3. 2 OB/GYN residents participated in this IRB approved pilot study. The ACGME Awards Program recognizes notable designated institutional officials, program directors. GME accreditation system in the U.S.
Twenty residents were assessed with the Barry Challenges to Professionalism Questionnaire (Barry), the Jefferson Scale of Empathy. Physician Version (JSE), and the Jefferson Scale of Attitudes Toward Physician- Nurse Collaboration (JSAT) in August 2. Five Narrative Medicine sessions and four PDSG sessions were then used from August 2. May 2. 01. 1, for resident physician professionalism education. Seventeen residents then underwent post- testing with the Barry, JSE, and JSAT in May 2. Results: The pre- test/post- test Barry comparison showed an improvement in scores after introduction of the new Narrative Medicine and PDSG curriculum (7. Pre- test/post- test comparison of JSAT scores showed a statistically significant decline in collaboration (5. Conclusion: Narrative Medicine and PDSG small group sessions could be an effective component of OB/GYN resident physician Professionalism curriculum. This pilot project was underpowered, due to limited resources. INTRODUCTIONProfessionalism is an important attribute for physicians, with roots in early medicine from the time of Hippocrates. Many have worked to define “professionalism”, and this definition continues to evolve with changes in medicine. The American Board of Internal Medicine emphasized professionalism formally in 1. Project Professionalism, 2. The Accreditation Council for Graduate Medical Education (ACGME) issued a statement in 1. Core Competencies” should be taught to every resident, including professionalism (ACGME, 1. The impact of suboptimal professional behavior was further demonstrated in 2. Institute of Medicine estimated that medical errors cost as much as $1. Kohn, 2. 00. 0; Rogers, 2. Obstetrics and Gynecology (OB/GYN) is similar in some ways to General Surgery and Internal Medicine, but our field has its own unique challenges and it is still unclear how best to teach professionalism to Obstetrics and Gynecology resident physicians (Adams, 2. Long hours in training, an increasingly female dominated specialty, all female patients, dealing with the joys and tragedies of pregnancy, and working within the framework of each stage of a woman’s reproductive life contribute to the excitement of the specialty, but also contribute to a demanding lifestyle for OB/GYN resident physicians. Empathy is animportant component of professionalism that can be affected by burnout, common in OB/GYN. MATERIALS AND METHODSThe study objectives were to design, implement, and assess a new OB/GYN resident Professionalism curriculum using Professionalism Development/Support Groups (PDSG) and Narrative Medicine Group groups. We hypothesized that OB/GYN resident physicians would see improvement in professionalism scores as measured by the Barry Challenges to Professionalism Questionnaire (Barry) questionnaire (Barry, 2. The study was approved by the Institutional Review Board of Thomas Jefferson University. Informed consent was obtained from participants. Inclusion criteria were OB/GYN resident physicians who agreed to participate and signed informed consent. Exclusion criteria were participants from other specialties and other health care professionals. Twenty Thomas Jefferson University OB/GYN resident physicians participated in a baseline assessment consisting of the Barry, JSAT, and the JSE in August 2. All 3. 2 OB/GYN resident physicians then attended the five Narrative Medicine and four PDSG small group hour- long sessions from August 2. May 2. 01. 1, when their schedules allowed for it. Seventeen OB/GYN resident physicians participated in a subsequent post- test exercise in May 2. Professionalism curriculum. Resident physicians were also asked to evaluate the Narrative Medicine and PDSG curriculum with a 5- item Likert rating at the conclusion of the course. PDSG are resident- focused sessions led by a Psychologist without planned content, and are used to examine issues of humanism in the medical profession, encountered by residents on a daily basis. A second program, Narrative Medicine groups, are comprised of regular meetings where a prompt is given and participants write for a set time about their experiences relating to a given professionalism topic, such as “interpersonal conflict”. Then, members of the group read their narratives and discuss the issues involved relating to professionalism (Pearson, 2. They are different in that PDSG groups are participant driven, in that participants chose a theme to be examined, whereas in Narrative Medicine, there is a leader driven discussion of a theme illustrated by the examples set forth by participants. Topics of the Narrative Medicine small group sessions included interpersonal conflict, handling bad outcomes, physician burnout, handling emotion in practice, and dealing with the disruptive physician. Methods of teaching professionalism, as discussed above, have not been extensively researched for efficacy in the OB/GYN literature. In our study we used the Barry Challenges to Professionalism Questionnaire (Barry) to assess the status of the professionalism of resident physicians, and whether the curriculum was effective. The Barry is an externally validated, self- administered 6- item tool to measure professionalism in resident physicians. In this questionnaire scenarios are presented to the residents with multiple choice answers as to how to respond to an ethically difficult situation. Categories included on the Barry Professionalism questionnaire include receipt of gifts, financial investments, patient confidentiality, physician impairment, harassment, and honesty with patients. The Barry was selected to assess resident professionalism because it was a short, externally validated, convenient questionnaire (Barry, 2. Tokuda, 2. 00. 9) . The Jefferson Scale of Empathy (JSE), and the Jefferson Scale of Attitudes toward Physician- Nurse Collaboration (JSAT) can be used to assess resident physicians’ insight and strength in these areas (Hojat, 2. Hojat, 1. 99. 9) . The Jefferson Scale of Empathy. Physician Version is an externally validated, self- administered, 2. Likert scale to evaluate statements regarding empathy. Phrases such as, “I try to imagine myself in my patients’ shoes when providing care to them,” and “I believe that emotion has no place in the treatment of medical illness,” are rated on a 7- item Likert scale (Strongly Agree = 7, Strongly Disagree = 1, with several of the statements reverse- coded as appropriate) (Hojat, 2. The Jefferson Scale of Attitudes toward Physician- Nurse Collaboration is a 1. Likert scale to evaluate statements of collaboration such as, “Physicians should be educated to establish collaborative relationships with nurses,” and “Doctors should be the dominant authority in all health care matters.” (4 = Strongly Agree, 1 = Strongly Disagree, with several statements reverse- coded as appropriate). These evaluation tools were scored as previously reported (Hojat, 1. Continuous variables were summarized by the mean, percentage, and standard deviation. Where variables cannot be reasonably considered normally distributed, transformations were applied to achieve approximate normality where appropriate. Categorical variables, nominal and ordinal, were summarized by frequencies. Analysis of variance (ANOVA) was used for comparing the effects of stimulus class for continuous normally distributed variables (some of which have been transformed for this purpose), with the Kruskal- Wallis test used for the non- normal variables. Discrete variables were compared using either the Chi- square or Fishers exact test. The standard of statistical significant difference was set at p < 0. Demographic Data were described using means, standard deviations, and percentages (Table 1). Continuous variables were compared using matched t tests. All data were analyzed using SAS 9. RESULTSTwenty OB/GYN residents out of a 3. OB/GYN residency program attended the introductory lecture for the study and agreed to participate. Attendance ranged from 2. Age was not included by one resident. Three resident physicians did not include their rank year. Residents with missing information were not included in Table 1, but were included in the data analysis. Barry Professionalism questionnaire results increased from preto post- test, however did not show a statistically significant increase, (7. Individual categories within the Barry were also not statistically significantly different (Figure 1). With further evaluation of data, it was discovered that a subset of 2 residents showed signs of extreme burnout on the Collaborative (JSAT) and Empathy (JSE) questionnaires. When these two residents were controlled for by normalizing the Barry professionalism score with a z score and correcting for JSE and JSAT scores, professionalism scores showed a statistically significant improvement following the intervention, (. A secondary analysis of this project revealed a greater improvement in Barry scores for second, third, and fourth year residents, compared to first year residents during the postand pre- tests (p < 0. Collaboration scores on the JSAT showed a statistically significant worsening over the 1. Empathy scores on the JSE also worsened from preto posttest, however were not statistically significant, (1. Resident physicians liked the Narrative Medicine small group sessions, with 5. Somewhat Helpful”, or better in evaluation on a 5- point Likert scale. DISCUSSIONThe primary outcome of the study suggests that OB/ GYN resident physicians had a non- statistically significant improvement in their Barry Professionalism scores after the new Narrative Medicine and PDSG curriculum change. Harta Iasi. Servicii Oferite: Mandat postal international / Sky. Pak / EMS / Prioripost / Eurogiro / Western Union / On- Line Money Order / E- mandat / Plati prin posta / E- Post. Program de lucru: - Luni- Vineri: 0. Persoana de contact: Gabriela Luca. Adresa: Bulevardul Dacia nr. Oficiul Postal 56 din Bucuresti: nr telefon, adresa, harta, poze, pareri ale clientilor si multe alte detalii specifice.
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