Current Shortage Research Articles

THE US-EU TRADE AND TECHNOLOGY COUNCIL: FEATURES OF COOPERATION

Thе present paper focuses on a new form of cooperation built on the basis of coordination of approaches, within the US-EU Trade and Technology Council. TTC was launched by these countries in 2021 to promote their shared prosperity and competitiveness through collaboration in working groups. For these purposes 10 working groups were established on various topics. The TTC appears intent on avoiding tough issues that have stymied trans-Atlantic negotiators in the past. At the inaugural TTC summit, the EU and the US made the commitment to coordinate approaches to key global technology, economic and trade issues and to base policies on shared democratic values. The European Commission and the Biden administration established the TTC as a non-binding instrument. This simplifies negotiations and facilitates an agile approach to addressing common evolving challenges. However, it also means that the scope and applicability of TTC decisions are inherently limited. The US desire to turn the TTC into a geopolitical instrument aimed at China turned out to be incompatible with the reality of the EU. European foreign and security policy continues to be shaped predominantly in EU capitals-not in Brussels. One area of particular concern to both sides is the current global shortage of semiconductors. Parties have completed a joint early warning mechanism in addressing semiconductor supply chain disruptions. They are committed to sharing information on public support given to the semiconductor sector, aiming to avoid subsidy races, maintained a continuous exchange of best practices and also seek to collaborate further by expanding R&D.

Building a Better System to Support Family Caregivers: Engaging Multi-level Interdisciplinary Stakeholders in Micro, Meso, and Macro Level Learning Health System Design.  

The current Canadian healthcare workforce shortage and care crisis demands innovative solutions, yet it takes 17 years for healthcare innovations to reach 50% adoption in clinical practice. Healthcare workforce shortage solutions include expanding team-based care, moving integrated services closer to home[, and including Family Caregivers [FCGs] as partners on the care team, rather than treating them as visitors or patient accompaniments. Integrating FCGs as partners on the healthcare team improves patient care, health, and well-being, reduces the length of hospital stays, supports aging in the right place, promotes effective communication, and reduces healthcare providers’ workload. While FCGs and the people they care for require integrated care and services coordinated around their comprehensive needs, research confirms that FCGs remain invisible, and often marginalized by healthcare systems.
 Aim: Detail the micro-meso-macro-level elements and roles needed for building integrated FCG support systems.
 Results: As FCGs, the people they care for, and their care trajectories are diverse, an integrated system to support FCGs includes: 1) macro-level policy leadership 2) meso-level FCG-friendly communities, community organizations, health and social care systems, and providers trained to support FCGs; 3) micro-level assessment of FCGs needs and supports tailored to needs/goals, and 4) evaluation and practice improvement research. Three critical elements to Health Learning Approaches are: 1) Prioritize service needs and a design improvement approach; 2) Strengthen and link the assets required to operationalize rapid learning and a quality improvement approach, and 3) Establish a network of rapid-learning champions to drive and sustain action. Our Alberta-based Caregiver-Centered Care Research Program works at collaborating with stakeholders interested in enacting a collective impact approach to build a better system of all the essential elements of integrated health and social care programs and services needed to support FCG's well-being and sustain their caregiving. First, we convened a series of consultations to prioritize approaches to support FCGs. Stakeholders prioritized competency-based education for healthcare providers about person-centered care for FCGs. Accordingly, we engaged FCGs, researchers, health and social care providers/leaders, and policymakers to co-design and deliver free, online Foundational and Advanced education about providing person-centered care for FCGs to health and social care providers. Now, we need to strengthen our network and link assets. We convened a series of six webinars designed to raise awareness of FCGs' work, the need for systemic FCGs support, and to consult stakeholders about the next steps to integrate health and social care systems to support FCGs (October 20 – November 29, 2022). The webinars have also built our network of Canadian collaborators.
 Conclusions: The collaboration required to build a better system to support Canadian FCGs takes facilitation and time. The learning health system framework seems appropriate to approach the complex system and culture changes required more efficiently and effectively. 
 Implications: Learning Health Systems and co-design by communities of patients, FCGs, health and social care providers/leaders, and researchers are currently regarded as a superior approach to improving healthcare and health outcomes. A strength of our team is collaborative, trusting relationships. 

THE VALUE OF INTERNSHIPS IN CREATING AN AGE-SAVVY WORKFORCE

Abstract As the 65+ population continues to grow, so too does the need for an age-savvy workforce. There is not a field or profession that will not intersect in some way with older adults (Karasik, Donorfio, & Greenberg, 2023). Current work shortages and forecasts, however, raise considerable concern for a sustainable and adequately prepared workforce. With regard to preparation, gerontological field placements, internships, and practicums are becoming increasingly instrumental to workforce development. Both the Gerontology Competencies for Undergraduate and Graduate Education (2020) and AGHE’s Gerontology and Geriatric Curricular Standards and Guidelines (2021) strongly recommend internship, practicum, and/or field work experiences for students at all levels. Fostering a successful intergenerational experience, however, can be challenging. In this presentation, key components, core elements, necessary steps, best practices and logistical considerations will be discussed. For example, who are the key players and what are their roles in such experiences? What needs to happen at the programmatic and curricular levels? In addition to exploring the various facets of gerontological field placements, attention will be given to utilizing AGHE’s Standards and Guidelines and Gerontology Competencies to help identify several “interactional competencies” that relate to internships, practicums, and field experiences. This session also serves as an introduction to the range of perspectives (student, faculty, community agency) that follow.

PROVIDING DEMENTIA CARE ACROSS LOW-RESOURCE COMMUNITIES

Abstract The growing number of persons living with dementia (PLWD) require ongoing care and supportive services, but dementia care access and quality are more limited in communities with fewer health resources and these limitations are exacerbated by current dementia care workforce shortages. Across low-resource communities—including poorer urban and rural settings—health resources tend to be limited and PLWD are predominantly socioeconomically disadvantaged and have few personal financial resources to contribute to care provision. Although there is growing evidence about the consequences of care inequities for PLWD, less is known about key issues and opportunities for improving dementia care in low-resource communities. This symposium features presentations that highlight unique social and economic challenges and opportunities for providing dementia care in low-resource communities. The first presenter reports results from a community-based, participatory research study in four long-term care settings in federally designated medically underserved areas (two rural, two urban) that highlights strategies used by long-term care providers to recruit and retain dementia care staff and describes their perspectives on quality dementia care. The second presenter shares findings from an innovative pilot program of case management services to address challenges of PLWD who are living alone in the community through collaboration with local paramedicine services. The third presenter provides an overview of the Person-Centered Options Counseling Certification program with a discussion on strategies for implementing person-centered dementia care initiatives in low-resource communities. This symposium reveals complexities in providing care for PLWD in diverse low-resource communities and generates directions for addressing dementia care inequities.

FORETHOUGHT OR AFTERTHOUGHT? THE FUTURE OF GERONTOLOGICAL EDUCATION

Abstract The increasing population of older adults would suggest a comparable increase in the demand for gerontological education. The current workforce shortage and number of Gerontology programs that are struggling and/or closing, however, suggest this is not necessarily the case. Bass and Ferraro (2000) reported over 1,000 gerontology/aging or related programs in operation. Today, there are 537 programs in gerontology and/or aging including 31 Associate degrees; 185 Minors; 79 Undergraduate and 92 Graduate Certificates; 43 Majors; 57 Masters; and 16 doctoral programs (University of Nebraska Omaha, 2023). Many interrelated factors have been suggested to account for the decline. From an economic point of view, these factors are thought to include: decreasing enrollments in and revenue generation from gerontology programs; demographic shifts away from traditional age college students; and decreasing interest and value of higher education overall. From a pedagogical point of view, this might reflect a return to individual courses and programs ensconced in more traditional disciplinary approaches (e.g., family studies, psychology, and sociology). Pervasive ageism has also been thought to be an underlying societal factor. While none of these factors are easily remedied, understanding their impact is an important first step. GSA programming such as Ageism First Aid and Reframing Aging Initiative are taking the next Herculean step in tackling societal ageism. This presentation focuses on reframing the value of gerontological education to students, employers, and policymakers– moving it from an afterthought to a prioritized strategy for addressing the mounting demand for aging services and service providers.

Retesting Schemes That Improve Test Quality and Yield Using a Test Guardband

The digital integrated circuit (IC) testing model module is applied in this study to simulate the fabrication and testing of integrated circuits. The yield and quality of ICs are analyzed by assuming that the wafer devices under test conditions are normal probability distributions. The difficulties of testing and verification become increasingly great as the design function of the chip becomes remarkably complex. Conversely, the automotive industry chip supply chain has been substantially affected since the COVID-19 outbreak. The shortage of chips in the auto-market has always existed; therefore, increasing available chips under a limited production capacity has become a top priority. Therefore, this study applies the digital integrated circuit testing model (DITM) and proposes a retest plan. This method does not require considerable time to collect large wafer data, nor does it require additional hardware equipment. Furthermore, the required test quality parameters are set, and the test is repeated on the device by adjusting the test guardband (TGB). Moreover, three retesting schemes are proposed to improve the IC test quality (Yq) and test yield (Yt) to meet the requirements of consumers for product quality. A set of 2021 IEEE International Roadmap for Devices and Systems (IRDS) parameters is used to demonstrate the three proposed retesting schemes. The simulation results from the 2021 IRDS data prove that the retest method can effectively improve the test yield (Yt). A comparison of the estimated results of the three retest methods shows that using the repeat test method can maximize the test yield without sacrificing the test quality (Yq). By contrast, repeat testing can indeed improve the test yield (Yt) by 14% or more. Moreover, the increase in sellable ICs not only increases additional earnings for corporations, but also alleviates the current global shortage of automotive ICs.

Building a community of practice: shifting an M.Ed. program to a PDS school-based cohort model

PurposeThe purpose of this study was to examine how participants experienced and perceived an M.Ed. program that had a school-based design. In particular, the authors sought to understand: (1) how participants experienced being in a school-based cohort and (2) whether and how participants experienced the three designated tenets of the M.Ed. program: teacher inquiry, social justice and student engagement and motivation.Design/methodology/approachThis qualitative study used semi-structured focus group interviews (n = 7) to examine teachers’ perceptions, using a constant comparative method (Corbin & Strauss, 2008) of open coding to analyze the data and determine emergent themes.FindingsThe findings indicate the design of this school-based M.Ed. program provided both social and academic benefits including strengthening teachers’ working relationships and their understanding of students outside their own classroom and a transfer from individual learning to organizational benefit. Teachers positively perceived the three tenets that guided the first year of the program, especially the ability to study social justice and student motivation in depth.Practical implicationsThis study has implications for teacher education and retention as well as how boundary spanning roles in PDS schools can impact graduate students’ experiences in schools. Given the current teacher shortage concerns, it is important to understand how M.Ed. programs can be designed with teacher needs at the forefront so learning is relevant and rewarding, both to the individual and the school.Originality/valueWhile there are many studies that examine the use of cohorts in education, particularly in doctoral programs, few, if any, studies examine a school-based cohort M.Ed. program for practicing teachers. This study also puts a unique spotlight on how boundary-spanning roles can benefit not only teacher candidates but also practicing teachers in their M.Ed. programs.

The combination of nanotechnology and potassium: applications in agriculture.

Potassium fertilizer is indispensable for ensuring crop production, which in turn supports global food supply and safe farming practices. Potassium resources are primarily located in the Northern Hemisphere, leading to a current shortage of affordable potash and severe soil deficiencies in certain regions of the Southern Hemisphere. There is a shift away from mined salts in favor of locally available potassium resources. Utilizing potassium-rich silicates, for instance, could be a viable option to address this situation. The imperative of enhancing crop productivity and quality necessitates either increasing potassium availability or utilizing potassium more efficiently. Geneticists may find the development of plants that use potassium more effectively to be a valuable pursuit. Nanomaterials are increasingly becoming part of people's professional lives as a novel material category. This technology is gradually finding applications in agriculture to boost crop yields while reducing environmental pollution. This paper reviews the applications of common potassium-containing materials, explores the effects and mechanisms of nano-fertilizers on plants, and offers insights into future applications of nano-potassium fertilizers in agriculture. All in all, the application of nanotechnology in the production and utilization of potassium fertilizers is both necessary and effective. However, there are still many gaps in the current field of nano-potassium fertilizer application that require further research. It is hoped that this review can serve as a valuable reference for researchers working in this field.

Methotrexate Scarcity Among Children's Oncology Group Institutions: Results of a Multinational Survey.

Shortages of curative chemotherapy agents for children and adults with cancer are ubiquitous. These shortages directly result in compromised outcomes, increased medication errors, heightened cost to health systems, and patient deaths. Methotrexate is a staple of many curative childhood cancer regimens and is frequently in scarcity. No national guidance to manage methotrexate and other chemotherapy shortages exists. To assess the effect of the current methotrexate shortage, a multinational survey of Children's Oncology Group (COG) member institutions was conducted. Wide variation in the scope of methotrexate shortage in the US was demonstrated; some centers experienced significant scarcity while others experienced no shortage. Methotrexate mitigation strategies differed by COG site, resulting in potential to exacerbate differential access to life-saving medication and inequities in care. Preventing chemotherapy shortages remains a challenge. In the interim, standard guidance to assist clinicians to equitably and fairly cope with methotrexate and related drug shortages is needed.

Important issues of professional burnout among hematologists and hematology department nursing staff during the COVID-19 pandemic

Background. Professional burnout (PB) among medical staff, namely hematologists, is of major importance, especially given the current shortage of personnel. It is of extreme value during the COVID-19 pandemic.Aim. To determine the degree of PB development among hematologists and nursing staff of hematological departments of federal and regional medical institutions in the context of the COVID-19 pandemic and to identify the associated factors.Materials and methods. The study was conducted in the period from July 2022 to September 2022 in the form of a onetime online survey of hematologists and nursing staff of hematology departments of federal and regional medical institutions in different cities of the Russian Federation. To interview specialists, a special checklist based on an Internet resource (Google forms) was used. It included burnout questionnaire Maslach Burnout Inventory (MBI) and questions related to factors that may be associated with the formation of PB. Statistical analysis included pairwise and multiple comparisons, as well as χ2 test, correlation and logistic regression analysis.Results. A total of 162 specialists took part in the online survey. More than half of the specialists (52 %) had high degree of emotional exhaustion, high level of depersonalization was detected in 39.5 % of specialists, and low level of personal accomplishment – in one third of specialists (32.1 %). It was shown that physicians, compared with nurses, had significantly higher indicators of PB. The level of problems for all PB components was significantly lower among specialists working in federal health facilities than among specialists working in regional clinics. The specialists who worked in the “red zone” showed a greater degree of emotional exhaustion and depersonalization than the specialists who did not work in the “red zone” during the pandemic. The formed PB syndrome was observed in 16 % of specialists, and its signs – in 42 %. The risk of PB was significantly greater in hematologists than in nurses, as well as among specialists with increased levels of depression and anxiety and dissatisfaction with the level of personal protective measures.Conclusion. The high importance of PB and the need for preventive measures among specialists of hematological centers and hematology departments in the Russian Federation is shown.

PROSPECTS OF USING ALTERNATIVE FUELS FOR HEATING OF REGENERATIVE AIR HEATERS FOR BLASТ FURNACES

Landfill gas as one of the promising artificial gaseous fuels is analyzed for use in heating system of regenerative air heaters for blast furnaces. Increasing the temperature of blast is one of the most effective ways for metallurgical coke saving and increase the productivity of blast furnaces. To increase this temperature, a mixture of blast-furnace and coke oven gases is used as fuel for regenerative heat exchangers. Considering the current shortage of coke oven gas, landfill gas, the main combustible element of which is methane, is proposed as a high-calorie additive to the main fuel. Calculations were made for the combustion of a mixture of gaseous fuels in three combinations: blast-furnace gas, blast-furnace and coke gases mixture, blast-furnace and landfill gases mixture. The possibility of increasing the temperature of the hot blast to 1250 °C for the air supply system of a blast furnace with a volume of 1033 m³ was considered. Calculations showed that in order to achieve such a temperature, the adiabatic combustion temperature should be 1423 °C, and the flue gas temperature in the crown should be 1300 °C. Such temperatures cannot be reached using only blast-furnace gas, so two possible options were considered. The first option is the use of a coke and blast furnace gases mixture with a coke gas content of 6.3 % and combustion air heating to 180 °C by exhaust gases from blast furnace air heaters. The second option is combustion of a mixture of blast-furnace and landfill gas with combustion air heating to 180 °C (the content of landfill gas is 7.6 %). The flow rate of the fuel mixture for the second option is 68,523 m³ /h, and the required amount of landfill gas is 5208 m³ /h. The volumes of gas output from landfills in large cities are reported to be 5–10 MCM a year, which is less than the amount of biogas required to heat an air heater. Therefore, to achieve the required temperature it makes sense to consider a tree gas mixture that is blast-furnace, coke and landfill gases an appropriate proportions. The use of landfill gas contributes to the solution of an important environmental problem of land and atmosphere pollution during the accumulation of municipal solid waste.

‘There Is No Value’

This article draws on narratives from middle-class households in Beirut to examine their disenfranchisement amid the country’s financial collapse. A common expression, “There is no value,” is often used in allusion to extreme price fluctuation that has punctuated everyday life since the end of 2019. The phrase also speaks to the undoing of a middle-class lifestyle that emerged with the pegging of the Lebanese lira to the US dollar in the 1990s. Reflecting on how value is conceptualized at the level of the everyday leads into exploring some of the complex ways in which this middle-class milieu accessed credit following Lebanon’s civil war, and how everything has changed during the current dollar shortage.

Humanoid Robots administering Cognitive Stimulation Therapy to help improve cognition and reduce neuropsychiatric disorders

AbstractBackgroundDementia is a progressive disease that causes a continuous decline in cognition. People affected with dementia are also at high risk for neuropsychiatric disorders requiring frequent therapy sessions. The current healthcare worker shortages have made finding a therapist challenging, resulting in increased hospital admissions due to an increase in neuropsychiatric disorders in people affected with dementia. To address this problem humanoid robots and wearable sensors were programmed to administer Cognitive Stimulation Therapy(CST), a therapy that doesn’t require a clinician to be administered. CST is an evidence based therapy that is administered twice a week for seven weeks. The wearable sensors track and monitor the physiological data and are able to predict neuropsychiatric symptoms. The robots interact, communicate and administer the therapy while the participants are wearing the sensors along with artificial intelligence algorithms that track the physiological data to help predict any neuropsychiatric symptoms.MethodA humanoid robot, Pepper was programmed to administer Cognitive Stimulation Therapy to be deployed in nursing homes to help improve cognition and also help alleviate neuropsychiatric symptoms. The protocol involves conducting a cognitive assessment using the MMSE prior to initiation of the Cognitive Stimulation Therapy. The Cognitive Stimulation Therapy is administered twice a week for seven weeks. At the end of the fourteen sessions the MMSE is administered again to measure the cognition levels. Additionally pre and post surveys for depression, quality of life, Pittsburgh sleep index/ sleep quality and activities of daily living are conducted to monitor the neuropsychiatric symptoms. During the entire seven weeks the participants physiological data is tracked and analyzed using artificial intelligence algorithms to predict neuropsychiatric symptoms. The combination of the humanoid robots and the wearable sensors work in sync to improve cognition and reduce behavioral and psychological symptoms of dementia..ResultThe robot is successfully programmed and tested in the lab setting. The study is successfully designed.ConclusionRobots can be employed to administer cognitive stimulation therapy to help improve cognition and reduce neuropsychiatric symptoms in people affected with dementia. Robots have the potential to address healthcare worker shortages.

Backtalk: Removing artificial barriers to licensure could ease the teacher shortage

In this opinion essay, Jori S. Beck argues that current teacher shortages could be mediated by rethinking candidate licensure. She shares various examples of how local, state, and federal policy have prevented talented candidates from earning teacher licensure. She unpacks some of the requirements for licensure, including costs, and discusses actionable steps that could be taken by state and federal government agencies to support teacher licensure.

Humanoid Robots administering Cognitive Stimulation Therapy to help improve cognition and reduce neuropsychiatric disorders

AbstractBackgroundDementia is a progressive disease that causes a continuous decline in cognition. People affected with dementia are also at high risk for neuropsychiatric disorders requiring frequent therapy sessions. The current healthcare worker shortages have made finding a therapist challenging, resulting in increased hospital admissions due to an increase in neuropsychiatric disorders in people affected with dementia. To address this problem humanoid robots and wearable sensors were programmed to administer Cognitive Stimulation Therapy(CST), a therapy that doesn’t require a clinician to be administered. CST is an evidence based therapy that is administered twice a week for seven weeks. The wearable sensors track and monitor the physiological data and are able to predict neuropsychiatric symptoms. The robots interact, communicate and administer the therapy while the participants are wearing the sensors along with artificial intelligence algorithms that track the physiological data to help predict any neuropsychiatric symptoms.MethodA humanoid robot, Pepper was programmed to administer Cognitive Stimulation Therapy to be deployed in nursing homes to help improve cognition and also help alleviate neuropsychiatric symptoms. The protocol involves conducting a cognitive assessment using the MMSE prior to initiation of the Cognitive Stimulation Therapy. The Cognitive Stimulation Therapy is administered twice a week for seven weeks. At the end of the fourteen sessions the MMSE is administered again to measure the cognition levels. Additionally pre and post surveys for depression, quality of life, Pittsburgh sleep index/ sleep quality and activities of daily living are conducted to monitor the neuropsychiatric symptoms. During the entire seven weeks the participants physiological data is tracked and analyzed using artificial intelligence algorithms to predict neuropsychiatric symptoms. The combination of the humanoid robots and the wearable sensors work in sync to improve cognition and reduce behavioral and psychological symptoms of dementia..ResultThe robot is successfully programmed and tested in the lab setting. The study is successfully designed.ConclusionRobots can be employed to administer cognitive stimulation therapy to help improve cognition and reduce neuropsychiatric symptoms in people affected with dementia. Robots have the potential to address healthcare worker shortages.

Interactive Healthcare Robot Using Attention-Based Question-Answer Retrieval and Medical Entity Extraction Models.

In healthcare facilities, answering the questions from the patients and their companions about the health problems is regarded as an essential task. With the current shortage of medical personnel resources and an increase in the patient-to-clinician ratio, staff in the medical field have consequently devoted less time to answering questions for each patient. However, studies have shown that correct healthcare information can positively improve patients' knowledge, attitudes, and behaviors. Therefore, delivering correct healthcare knowledge through a question-answering system is crucial. In this article, we develop an interactive healthcare question-answering system that uses attention-based models to answer healthcare-related questions. Attention-based transformer models are utilized to efficiently encode semantic meanings and extract the medical entities inside the user query individually. These two features are integrated through our designed fusion module to match against the pre-collected healthcare knowledge set, so that our system will finally give the most accurate response to the user in real-time. To improve the interactivity, we further introduce a recommendation module and an online web search module to provide potential questions and out-of-scope answers. Experimental results for question-answer retrieval show that the proposed method has the ability to retrieve the correct answer from the FAQ pairs in the healthcare domain. Thus, we believe that this application can bring more benefits to human beings.

Collagen fiber centerline tracking in fibrotic tissue via deep neural networks with variational autoencoder-based synthetic training data generation.

The role of fibrillar collagen in the tissue microenvironment is critical in disease contexts ranging from cancers to chronic inflammations, as evidenced by many studies. Quantifying fibrillar collagen organization has become a powerful approach for characterizing the topology of collagen fibers and studying the role of collagen fibers in disease progression. We present a deep learning-based pipeline to quantify collagen fibers' topological properties in microscopy-based collagen images from pathological tissue samples. Our method leverages deep neural networks to extract collagen fiber centerlines and deep generative models to create synthetic training data, addressing the current shortage of large-scale annotations. As a part of this effort, we have created and annotated a collagen fiber centerline dataset, with the hope of facilitating further research in this field. Quantitative measurements such as fiber orientation, alignment, density, and length can be derived based on the centerline extraction results. Our pipeline comprises three stages. Initially, a variational autoencoder is trained to generate synthetic centerlines possessing controllable topological properties. Subsequently, a conditional generative adversarial network synthesizes realistic collagen fiber images from the synthetic centerlines, yielding a synthetic training set of image-centerline pairs. Finally, we train a collagen fiber centerline extraction network using both the original and synthetic data. Evaluation using collagen fiber images from pancreas, liver, and breast cancer samples collected via second-harmonic generation microscopy demonstrates our pipeline's superiority over several popular fiber centerline extraction tools. Incorporating synthetic data into training further enhances the network's generalizability. Our code is available at https://github.com/uw-loci/collagen-fiber-metrics.

ANALISA PELAKSANAAN PENINGKATAN PENGHASILAN MELALUI SUPPORT INDUSTRI KECIL MENENGAH BATU BATA DI DESA BLOK-15 KABUPATEN ACEH SINGKIL

This study aims to determine the implementation of increasing the income of the small and medium brick industry in Blok-15 Village, Aceh Singkil District, to find out how the government's efforts to support the implementation of small and medium industries in Blok-15 Village, Aceh Singkil District, and to find out how the efforts of activists bricks handle raw material shortages in Blok-15 Village, Aceh Singkil District. This research is a qualitative descriptive study. The data collection technique used was interviewing several brick activists, Pj. The Head of Blok-15 Village is accompanied by several Heads of Lorong Village Blok-15. Observations and documentation were carried out at the location of the small and medium brick industry in Blok-15 Village, Aceh Singkil District. The results of the research that have been obtained are that the implementation of increasing the income of the small and medium brick industry has been carried out well, but there are several obstacles that have become obstacles for them, namely the difficult supply of raw materials and until now there has been no government effort to support the industry which is the hope for activists. Both in terms of facilities and other. Then in an effort to deal with the current shortage of good raw materials it has been carried out effectively. If the supply of raw materials is always met, then activists will have no difficulty in producing these bricks again so that the needs of each household are met. Therefore, the role of government as a facilitator here is very much needed.

Characterizing Outpatient Classical Hematology Referrals at an Academic Healthcare System

BACKGROUND: Healthcare systems and delivery networks are experiencing an overwhelming number of Classical Hematology (CH) referrals. In our network, patients referred for CH consultation are facing increasing wait times and a shortage of available clinicians. In response to these workforce challenges, our institution is collaborating with advanced practice providers (APPs) to evaluate new patients using a tiered system that matches consults with corresponding years of clinical experience. This model is in use at one clinical site but its potential benefit when implemented across the entire network is unknown. To better inform this initiative, we sought to identify the most common diagnoses for outpatient CH referrals, determine the complexity level of these consults, and identify opportunities for alternative patient scheduling workflows. METHODS: A list of all new outpatient CH referrals evaluated in the Yale Smilow Cancer Network in Connecticut from 2019-2021 was compiled. ICD-10 codes assigned from each new patient encounter were combined into general diagnosis categories including iron deficiency anemia, other anemias, and thrombosis. After the 3 most common diagnoses were identified, 30 new patients evaluated in 2021 were randomly selected from each diagnosis group for manual chart review. Manual review focused on the details of each patient case and assigned a diagnosis level (Table 1). Diagnosis levels were matched with APP years of experience, ranging from level 1 (consults that could be evaluated within the first few years of practice) to level 3 (cases requiring more extensive experience or physician evaluation). These levels were predetermined by a committee of senior level CH physicians in the Smilow network. RESULTS: Based on grouped ICD diagnosis codes, the 3 most common CH referrals to our network from 2019-2021 were anemia (excluding iron deficiency, with an average of 22.4% of all new referrals), iron deficiency anemia (21.2%), and thrombosis (13.2%). Combined, these 3 diagnoses accounted for 56.8% of all incoming new referrals. Manual chart review of the anemia group showed that 3 patients had iron deficiency anemia with a diagnosis level of 1. After excluding these 3 patients, 1/27 (3.7%) anemia patients were level 1, 9/27 (33.3%) were level 2, and 17/27 (63.0%) patients were level 3 (Figure 1). In the iron deficiency group, after accounting for the 3 additional patients transferred from the anemia group, 16/33 (48.5%) were level 1, 7/33 (21.2%) were level 2, and 10/33 (30.3%) were level 3. In the thrombosis group, 12/30 (40.0%) patients were level 2, and 18/30 (60.0%) were level 3. 18.9% of all reviewed charts were level 1, 31.1% were level 2, and 50.0% were level 3. CONCLUSIONS: Manual chart review of the most common CH referrals (anemia, iron deficiency anemia, thrombosis) showed heterogeneity in diagnosis level. Thrombosis and anemia (excluding iron deficiency) had a higher proportion of more complex cases. In contrast, iron deficiency anemia contained a substantial number of level 1 cases (approximately 50% of all iron deficiency referrals). At one of our clinical sites, CH trained APPs have been evaluating new consults using the tiered system described within this study. Patients are then seen in follow-up by a collaborating physician. Manual chart review showed that 50% of consults in the 3 most common referral categories were either level 1 or 2, representing a substantial patient population that could be evaluated by an APP for initial consultation. In addition to increasing trainee and physician recruitment, implementing this model on a network-wide scale may be an invaluable strategy to address the current CH workforce shortage. Our study also identified that iron deficiency contained a large proportion of level 1 cases. This may be a consult population that is particularly amenable to non-traditional triage and evaluation algorithms. Strategies to consider include eConsultations to facilitate faster evaluation and iron infusions when indicated, or specialized provider and clinic creation. Our institution is piloting the use of triage algorithms to identify these uncomplicated iron deficiency cases and further optimize consult workflows.

A Literature Review Study of the Creative Structure of Oedipus the King

Oedipus the King is one of the three great tragedies of ancient Greece, and Aristotle gave it a high evaluation in his work Poetics. The core of this article is to study the creation structure and plots of Oedipus the King from Aristotles theory of tragedy. This article is divided into three parts: introduction, literature review and conclusion. Through these three parts, the author will summarize the current research status, research views and shortage of Oedipus the King. Through the research, the author finds that Oedipus the King has three main characteristics in the plot: the closed dramatic structure, the application of retrospective method and the perfect use of sudden turn and discovery. In addition, the current scholars research mainly focuses on the external drama conflicts of Oedipus the King, but the internal reasons for the series of action of Oedipus are not studied enough. Therefore, the author believes that only when scholars have a deep understanding of the definition of action in the Poetics can they obtain the creative research results of Oedipus the King.