Critical care ultrasound training: a survey exploring the “education gap” between potential and reality in Canada

Background Critical care ultrasound (CCUS) is now a core competency for Canadian critical care medicine (CCM) physicians, but little is known about what education is delivered, how competence is assessed, and what challenges exist. We evaluated the Canadian CCUS education landscape and compared it against published recommendations. Methods A 23-item survey was developed and incorporated a literature review, national recommendations, and expert input. It was sent in the spring of 2019 to all 13 Canadian Adult CCM training programs via their respective program directors. Three months were allowed for data collection and descriptive statistics were compiled. Results Eleven of 13 (85%) programs responded, of which only 7/11 (64%) followed national recommendations. Curricula differed, as did how education was delivered: 8/11 (72%) used hands-on training; 7/11 (64%) used educational rounds; 5/11 (45%) used image interpretation sessions, and 5/11 (45%) used scan-based feedback. All 11 employed academic half-days, but only 7/11 (64%) used experience gained during clinical service. Only 2/11 (18%) delivered multiday courses, and 2/11 (18%) had mandatory ultrasound rotations. Most programs had only 1 or 2 local CCUS expert-champions, and only 4/11 (36%) assessed learner competency. Common barriers included educators receiving insufficient time and/or support. Conclusions Our national survey is the first in Canada to explore CCUS education in critical care. It suggests that while CCUS education is rapidly developing, gaps persist. These include variation in curriculum and delivery, insufficient access to experts, and support for educators.

PEMBUATAN MEDIA PEMBELAJARAN DASAR KREATIFITAS BERBASIS ANDROID (Studi Kasus Kelas X SMK Negeri 7 Padang)

This study aims to determine the effectiveness of Android-based learning media on basic creativity learning subjects at SMK Negeri 7 Padang. This study uses research & development methods. The research subjects were 35 students of the Department of Dance. This study uses a development model (ADDIE model), with the development steps as follows. (1) Analyze, (2) Design, (3) Development, (4) Implementation and (5) Evaluate. The results of the assessment of the effectiveness test of 87.20% can be interpreted as Very Effective, The results of the assessment of the practicality test are 88.57%, can be interpreted as Very Practical to use. The results of the assessment of the effectiveness test of 87.20% can be interpreted as Very Effective to use. In conclusion, based on the assessment and expert input as well as the results of the field trial of the Android-Based Learning Media Application as a learning medium, it has been tested for its feasibility, excellence, and can be used in the learning process in the Basic Creativity subject for class X SMK N 7 Padang.

Content validation of observer-reported sickle cell pain diaries (SCPD-CS and SCPD-CN): results from interviews with caregivers

Background Patients with sickle cell disease (SCD) experience daily pain and acute episodes known as sickle cell pain crises (SCPCs). The Sickle Cell Pain Diary-Caregiver Report (SCPD-C) is an observer-reported diary for use by caregivers of children ages < 12 years with SCD. This study reports on the content validity of the SCPD-C. Methods The SCPD-C was developed based on a literature review, measurement expert input, and a patient advisory board including clinicians. Three rounds of interviews (including both concept elicitation and cognitive debriefing methodologies) were conducted with caregivers of children with SCD aged < 12 to evaluate the content validity of the SCPD-C. Results Across three rounds of interviews, caregivers confirmed concepts in the SCPD-C and described observed impacts that were important and were added. Overall, caregivers evaluated the SCPD-C as easy to understand, with some minor adaptations for clarity. Additionally, the diary was split into two versions based on the child’s age and school enrollment status (SCPD-CS for school-aged and SCPD-CN for non-school age children). Conclusions Caregivers provided valuable input that led to important additions and changes to the measures. The SCPD-CS and SCPD-CN are appropriate and fit-for-purpose observer-reported outcome measures of SCPC-related pain frequency and severity, and impacts on health-related quality of life.

Update on the management of a newborn with a suspected difference of sex development

Differences or disorders of sex development are a group of heterogeneous conditions, which most commonly present in the newborn period, with the appearance of atypical genitalia on newborn examination. Over recent years, the improvement in our knowledge of these conditions has been accompanied by advances in diagnostic technology and therapeutic options, as well as societal shifts in attitudes and expectations. These factors have placed an even greater emphasis than before on the need for early expert input through a multidisciplinary service that can support the patient and the family; perform and interpret the investigations required to reach a diagnosis; and formulate a management plan that lays down the foundation for optimal long-term outcome. While providing a regional service, the expert team should also be committed to research and quality improvement through participation in national and international networks.

Digital medicines for adherence support: A conceptual framework and qualitative study of adherence among chronically ill patients

Digital medicine programs (DMPs) are emerging technologies that use sensor-enabled medicine to detect when patients have taken their medication and then provide feedback about adherence. We use qualitative methods to understand how patients change their behavioral patterns while participating in a DMP intervention. An influence diagram outlining the factors hypothesized to affect adherence in DMPs constructed from prior scientific research and expert input was created. Subsequently, we conducted semi-structured interviews with 10 patients to see if their experience supported the relationships outlined in the model. We identified three pathways by which DMPs are likely to change behavior around medication adherence: (1) providing patients and providers with accurate, personalized information about adherence; (2) improving patient–provider interactions by structuring them around this information; and (3) facilitating routines and habits for medication use. Chronically ill patients often fail to adhere to drug regimens. Patients in a DMP intervention used the DMP-provided information to better understand drug efficacy and collaborated with their physician to develop adherence strategies. DMPs can promote medication adherence among patients who are willing to use them and may be most effective if physicians are active partners in the DMP.

How COVID-19 Will Change Health, Hospitality and Senior Facility Design

Background: Based on recent experiences with the COVID-19 pandemic, designers and design researchers are crafting guidelines for the development of future environments. In this context, this paper focuses on future best practices regarding environments for health, hospitality and senior care.Methods: An extensive literature review was conducted, the results of which were distributed to a group of experts (N=12) specializing in health, hospitality and design. After receiving their input, expert focus groups were conducted to further explore the proposed concepts. The document was revised based on the contributions of these field experts, resubmitted for additional input, and ultimately summarized in this paper.Results: Based on the literature review and expert input, dozens of recommendations were made regarding post-COVID health, hospitality and seniors environments. Healthcare facilities will require additional space, access to the outdoors, service hubs, and additional infrastructure to all conversion of garages for emergency use. Hospitality settings will employ new cleaning methods, use of robotics, improved HVAC, Wellness programming, workspace options, and flexible food service operations. Senior facilities will engage more technology, socially distance visiting facilities, increase access to nature, and smaller scale residential clusters.Discussion: By considering health and hospitality simultaneously, we come to understand the symbiotic benefits of applying goals from one sector to the other. Senior living environments are an excellent example of this approach in action. By implementing some of the proposed design recommendations generated by this research, we will be better prepared to face future challenges.

AI - Based Framework for Private Cloud Computing

Artificial Intelligence (AI) systems are computational simulations that are "trained" using information and expert input to duplicate a professional's choice given the same data. Only using one private cloud storage service to store information can cause a variety of issues for the system administrator. Knowledge providers, scalability, efficiency, privacy, and the potential of vendor support are examples of such concerns. Distributing information across several cloud storage services, comparable to how data is dispersed between various physical disk drives to increase error detection and increase productivity, is a possible approach. Moreover, because multiple private cloud providers have varying pricing strategies and service quality, maximizing the efficiency and profitability of many cloud providers at the same time is difficult. Based on access permission behaviors, this study presents a methodology for dynamically modifying network management rules across several cloud providers. The goal of this research is to look into how to reduce both the estimated cost and delay periods for numerous cloud providers. The architecture was put into practice in a cloud storage systems emulator, which simulated the complexity and effectiveness of numerous cloud providers in a real-world context. In particular, the architecture was evaluated in a variety of cloud storage environments. The outcomes of the platform's testing revealed that many cloud methods were successful.

Development and Validation of Academic Writing Textbook Based on Process Genre Approach for University Students

The textbook is a practical learning tool for improving student writing skills; however, not all students learn from a textbook. For this reason, a lecturer must be able to design a textbook according to the needs of students. This paper describes developing and validating academic writing textbooks with a process genre approach in tertiary institutions. This research is part of the research development process, which consists of three phases: need assessment, design, and validation. Five experts were appointed to validate this academic writing textbook. Content Validity Index (CVI) is used to calculate the validity of textbooks quantitatively, with a score above 0.79 considered to meet the criteria. The validity test results state that the CVI of an academic writing textbook is 0.9, with a few revisions based on expert input and suggestions. These findings indicate that this textbook has good validity and reliability and can be used to write in college.

Content validation of observer-reported sickle cell pain diaries (SCPD-CS and SCPD-CN): results from interviews with caregivers

Background Patients with sickle cell disease (SCD) experience daily pain and acute episodes known as sickle cell pain crises (SCPCs). The Sickle Cell Pain Diary - Caregiver Report (SCPD-C) is an observer-reported diary for use by caregivers of children ages < 12 years with SCD. This study reports on the content validity of the SCPD-C. Methods The SCPD-C was developed based on a literature review, measurement expert input, and a patient advisory board including clinicians. Three rounds of interviews (including both concept elicitation and cognitive debriefing methodologies) were conducted with caregivers of children with SCD aged < 12 to evaluate the content validity of the SCPD-C. Results Across three rounds of interviews, caregivers confirmed concepts in the SCPD-C and described observed impacts that were important and were added. Overall, caregivers evaluated the SCPD-C as easy to understand, with some minor adaptations for clarity. Additionally, the diary was split into two versions based on the child’s age and school enrollment status (SCPD-CS for school-aged and SCPD-CN for non-school age children). Conclusions Caregivers provided valuable input that led to important additions and changes to the measures. The SCPD-CS and SCPD-CN are appropriate and fit-for-purpose observer-reported outcome measures of SCPC-related pain frequency and severity, and the impacts on health-related quality of life.