Direct Supervision Research Articles

Nailfold Capillaroscopy Performed by Rheumatology Nurse-reliable and Delivering Significant Impact on Clinical Diagnosis Revision and Subsequent Major Medication Changes

Introduction: Nailfold Capillaroscopy (NFC) is a microscopic examination equivalent of an in vivo assessment of microcirculation. It is an invaluable examination in patients presenting with Raynaud’s phenomenon (RP) (triphasic color changes of fingers commonly on cold exposure) which might underlie a spectrum of rheumatic diseases e.g. scleroderma and mixed connective tissue diseases (CTD). Early diagnosis of these disease can allow investigation of other internal organ involvement and starting appropriate drug therapy e.g. immunosuppressants for immune-related part, and vasodilatory therapy as a symptomatic treatment. Methodology NFC was performed by Optilia[Formula: see text]Digital Video microscopy with 200x lens with LED illumination. Rheumatologists had performed NFC from 6/2020-11/2022 for existing scleroderma and mixed CTD patients. Rheumatology nurses started to perform NFC on patients with RP since 11/2022 (study period till 4/2024) after undergoing certified workshop training and having direct supervision from in-house rheumatologists. 3 rheumatology nurses had been involved in acquiring video images from NFC and 1 of them, an APN, drafted the reports which would be finally authorized by rheumatologists. Clinical data, revised diagnosis and drug changed of performed NFC patients were analyzed. Result: 56 female and 15 male with average 51 years old were performed NFC. All had abnormal NFC findings. Crucially there were accompanying diagnosis revision and subsequent major medication changes (rheumatologists’ initiation or stepping-up of immunosuppressants and vasodilatory agents): Rheumatologists verified all images and agreed on the final conclusions, except 1 (1.5%) reported as non-specifics findings by nurse and edited as late-stage scleroderma by rheumatologist. Conclusion: Rheumatology nurses are competent and reliable in performing NFC and had expanded patients’ group from known scleroderma and CTD to patients with RP in a wider scope. Waiting time was reasonably around 1 month. The significant clinical impact is apparent with the findings helping the rheumatologists to revise diagnosis timely and to adjust drug treatment accordingly.

Efeitos de dentifrícios contendo carvão ativado no esmalte dental: uma revisão da literatura

ABSTRACT The increased demand for white teeth has intensified the commercialization of new bleaching products, particularly those that can be accessed easily, do not require the direct supervision of a dentist, and are affordable. Among these new products, several dentifrices publicized as bleaching products have been developed, most recent of them being the activated charcoal toothpaste, which entered the market promising to whiten teeth. While it is portrayed as a healthy and ecological product, there is a paucity of scientific evidence supporting its alleged benefits. Therefore, this literature review aimed to evaluate activated charcoal containing oral hygiene products on their bleaching ability and effects on enamel. After analyzing several in vitro studies on the subject, it can be concluded that these products do not have a bleaching effect per se, but act by removing the extrinsic pigments from the teeth. However, most of the products containing activated charcoal could have abrasive effects on the surface of the enamel. Therefore, it is suggested caution about the indication of these dentifrices, especially for individuals predisposed to dental wear, such as gingival recession, reduced salivary flow, and high risk of caries or dental erosion.

Analysis of the Performance of Regional III Airport Authority Air Transport Inspector Personnel on Optimizing PT Minimum Service Standard Supervision. Wings Airlines

In order to achieve optimal aviation safety, security, and service, activities of control, supervision, and investigation are necessary by the Air Transport Inspector. Air transport services provided by Air Transport Companies to Scheduled Commercial Air Transport for Economy Class Passengers and domestic flights within the country. Passenger service standards cover aspects such as pre-flight service standards, in-flight service standards, and post-flight service standards. Pre-flight service standards include flight information, ticket reservations, ticket bookings, check-in processes, boarding procedures, handling of delays and flight cancellations, as well as the issuance of boarding passes. The number of inspectors available to conduct supervision is also a factor affecting the results of the Minimal Standard Inspection of these services. This research aims to identify factors that affect the optimization results of Air Transport Inspectors at Wings Air airline. This research method is descriptive with a qualitative approach, and data is collected through observation, interviews, and documentation. The research results indicate that one of the challenges in the supervision of Air Transport Inspectors for Wings Air airline is the insufficient number of Air Transport Inspector personnel, resulting in a lack of direct supervision of airline personnel in various sub-units of airline services.

Domain-Adaptive Graph Attention-Supervised Network for Cross-Network Edge Classification.

Graph neural networks (GNNs) have shown great ability in modeling graphs; however, their performance would significantly degrade when there are noisy edges connecting nodes from different classes. To alleviate negative effect of noisy edges on neighborhood aggregation, some recent GNNs propose to predict the label agreement between node pairs within a single network. However, predicting the label agreement of edges across different networks has not been investigated yet. Our work makes the pioneering attempt to study a novel problem of cross-network homophilous and heterophilous edge classification (CNHHEC) and proposes a novel domain-adaptive graph attention-supervised network (DGASN) to effectively tackle the CNHHEC problem. First, DGASN adopts multihead graph attention network (GAT) as the GNN encoder, which jointly trains node embeddings and edge embeddings via the node classification and edge classification losses. As a result, label-discriminative embeddings can be obtained to distinguish homophilous edges from heterophilous edges. In addition, DGASN applies direct supervision on graph attention learning based on the observed edge labels from the source network, thus lowering the negative effects of heterophilous edges while enlarging the positive effects of homophilous edges during neighborhood aggregation. To facilitate knowledge transfer across networks, DGASN employs adversarial domain adaptation to mitigate domain divergence. Extensive experiments on real-world benchmark datasets demonstrate that the proposed DGASN achieves the state-of-the-art performance in CNHHEC.

Reducing Supply Chain Management Risks in the Health Sector of Ghana: An Evaluation of the Central Level Supply Chain Management System of The Ghana Health Service

Supply Chain Management plays an indispensable role in any organization’s overall performance and success. The domain of Supply Chain Management has been of great research interest in recent years. In the ever-growing healthcare world, where most healthcare organizations are confronted with diverse SCM risks and growing customer demand trends, effective and efficient SCM has been identified as a tool to help them overcome this challenge. However, the main hurdle had been how to find innovative approaches to meet customer demands that will minimize operational costs. To address these concerns and deliver effective and efficient healthcare, the Government of Ghana represented by the Ministry of Health (MOH) and Ghana Health Service (GHS) in partnership with the Global Fund, GAVI, and the World Bank have deployed several interventions fundamentally founded on procurement and supply chain management to improve healthcare service delivery across the country. The interventions: Health commodity supply chain master plan (HCSCMP), the Last Mile Distribution (LMD), and the Ghana Integrated Logistics Management Information System (GhiLMIS), focus mainly on procurement, inventory, warehousing, and transportation of medical and non-medical products. The success and sustenance of these collaborative interventions in Supply Chain management within the health sector in Ghana hinges on key elements such as putting in place stringent procurement policies, ensuring availability of qualified personnel, transportation facilities to aid effective and efficient distribution, and paying attention to risk management practices. This study sought to examine the supply chain risk management practices at the central level of GHS and its regional and districts medical stores to identify the challenges of the existing SCM system and propose measures of addressing these challenges. The scope of the study was limited to the Ghana Health Service Supply Chain Practitioners (GHSSCP) at the central level and their collaborators at the regional levels (the Regional Health Directorates). Quantitative method was used in the study and the main research instrument used for the study was questionnaire administration. However, the study used convenience and purposive sampling techniques due to the sensitive nature of the subject matter. The target respondents were mainly Supply Chain Practitioners: supplies managers, procurement officers, general stores and pharmacy stores officers. The study relied on SPSS and used descriptive and inferential statistics to analyze data. The study found that notwithstanding the introduction of key interventions such as health commodity supply chain master plan (HCSCMP), the Last Mile Distribution (LMD) of health commodities from the Central level to Regional medical stores and to health facilities (Hospitals and the District Health Directorates), and the introduction of the Ghana Integrated Logistics Management Information System (GhiLMIS) as a technology tool for health commodity management at all levels across the public health sector SCM system which collective objective is to ensure the effectiveness and efficiency of the system through the minimization of SCM risks, interruptions, and vulnerabilities, there still exist a yawning underperforming gap due to the systems overly centralization and lack of priority for SCM risk reduction measures making the system still not performing at its full potential. The study concluded that there are basic weaknesses in almost all the supply chain dimensions covered: risk identification, risk assessment and mitigation, Supply Chain Risk Management Governance, impact of supply chain risk management, and employee supply chain risk routine activities because the much-needed attention is not given to SCM activities. The study recommended reforms including the establishment of a Supply Chain Risk Management Unit (SCRMU) at all levels (national, regional, and districts) under the direct supervision of Health Administration and Support services (HASS), the introduction of SCM performance contracts, and the implementation of a stronger but user-friendly technology driven SCM system including e-procurement, warehouse management tracking, supported by a robust feedback system to ensure risk free SCM

Barriers to reporting medical errors from the perspective of obstetric residents: A qualitative study.

Patient safety is one of the basic dimensions of quality of care. Medical errors are one of the most important and influential factors in the quality of care and clinical outcomes, which can have a significant economic effect. The aim of this study was to explore barriers to reporting medical errors from the perspective of obstetric residents. This was a qualitative study using a conventional content analysis approach. Data collection was performed through 18 semi-structured and in-depth individual interviews and a group discussion session with 13 obstetricians in Tabriz, Iran. Purposeful sampling started in December 2021 and continued until data saturation in October 2022. Findings were analyzed concurrently with data collection using MAXQDA 10 software. Four categories were obtained after analysis of the data: individual and organizational factors, the nature of the error, the educational hierarchy, and the fear of reactions and consequences of error reporting. Considering the importance of patient safety, it is necessary to improve the quality of education and awareness of residents and direct supervision of attending, emphasize promoting professional communication and changing educational policies and strategies to reduce errors, and remove barriers to error reporting. Instead of blaming those in error, the organizational culture should support error reporting and reform the error-prone system, through which positive results will be achieved for both patients and healthcare providers.

Implementation of Home-based Cardiac Rehabilitation Program in Patients with Coronary Artery Disease: A Literature Review

Introduction: Coronary artery disease (CAD) is the major cause of disability and death worldwide. The cardiac rehabilitation (CR) program is the management strategy for CAD patients with exercise as the main component to increase functional capacity. This program has been proven beneficial in reducing mortality and morbidity due to CAD. It also reduced the healthcare burden and improved the quality of life. Although the benefits of CR are widely proven, participation and adherence of CAD patients to this program are low. The home-based cardiac rehabilitation (HBCR) program is the strategy developed to increase the coverage of CR services. This program is equally effective as center-based cardiac rehabilitation (CBCR) and is considered safe. This review aimed to find out more about the HBCR program with a focus on its implementation in CAD patients.
 Methods: Original articles and systematic or narrative reviews were searched using PubMed, Google Scholar, and Research Gate databases. Further exploration of literature citations was also done to meet the inclusion criteria needed to explain the topic.
 Results: Compared to CBCR, the HBCR program provide comparable benefits, both in medical and functional outcomes. The HBCR program is proven to be feasible and safe with better adherence. The components of the HBCR program are generally the same as the CBCR program and direct supervision given in the CBCR program can be replaced by remote supervision through communication devices or home visits.
 Conclusion: The HBCR program can be used as an alternative to CBCR in managing patients with CAD.

Virtual Reality–Enabled Resident Education of Lateral-Access Spine Surgery

OBJECTIVELateral access spine surgery has many benefits, but adoption has been limited by a steep learning curve. Virtual reality (VR) is gaining popularity and lends itself as a useful tool in enhancing neurosurgical resident education. We thus sought to assess if VR-based simulation could enhance the training of neurosurgery residents in lateral spine surgery. METHODSNeurosurgery residents completed a VR-based lateral spine module on lateral patient positioning and performing lateral lumbar interbody fusion (LLIF) using the PrecisionOS VR system on the Meta Quest 2 headset. Simulation occurred 1x/week every other week for a total of 3 simulations over 6 weeks. Pre- and post-intervention surveys as well as intra-simulation performance metrics were assessed over time. RESULTSThe majority of resident participants showed improvement in performance scores, including an automated PrecisionOS precision score, number of X-rays used within the simulation, and time to completion. All participants showed improvement in comfort with anatomic landmarks for lateral access surgery, confidence performing lateral surgery without direct supervision, and assessing fluoroscopy in spine surgery for hardware placement and image interpretation. Participant perception on the utility of VR as an educational tool also improved. CONCLUSIONVR-based simulation enhanced neurosurgical residents’ ability to understand lateral access surgery. Immersive surgical simulation resulted in improved resident confidence with surgical technique and workflow, perceived improvement in anatomical knowledge, and simulation performance scores. Trainee perceptions on virtual simulation and training as a curriculum supplement also improved following completion of VR training.

The The Relationship between Intensity of Social Media and Learning with Learning Outcomes of Sociology in Ngawi Regency

Teenagers, one of Indonesia's primary consumers, mainly access social media using smartphones. As a student, they use it freely, even when the teachers are in classes. Schools fear unlimited access to social media because the distraction could affect their scores. However, it also could bring positive change. 2019 is the year when the global pandemic crippled the world. Schools are forced to operate online with no direct supervision of the teachers. Social media could be used as an alternative teaching method in such events. This study aimed to determine the relationship between the intensity of social media use and learning related to learning outcomes. The use of social media carried out by students regardless of time affects student learning outcomes, both positively and negatively. Teachers use social media to support the value obtained by students to the maximum through utilization in learning. This study uses correlational quantitative methods with problem characteristics in the form of relationships between 2 or more correlations. The data collection techniques used were questionnaires and interviews. The analysis techniques used are normality test, linearity test, double linear regression test, and Pearson correlation test. The results obtained are: (1) a positive and significant relationship exists between the intensity of social media use and student sociology learning outcomes. (2) there is a positive and significant relationship between learning and student sociology learning outcomes. (3) there is a positive and significant relationship between the intensity of social media and learning with the sociology learning outcomes of grade XI social studies students of SMA N 1 Ngawi. The use of social media can be beneficial for students in learning and learning outcomes of student sociology

Minimum Supervision Levels Required for Pediatric Cardiology Fellowship Graduation by Pediatric Cardiology Fellowship Program Directors.

Entrustable professional activities (EPAs) are "observable essential tasks expected to be performed by a physician for safe patient care in practice." Six PediatricCardiology (PC) EPAs and their level of supervision (LOS) scales were developed by medical educators in PC using a modified Delphi process and reviewed by the Subspecialty Pediatrics Investigator Network (SPIN). However, their general use in assessment for PC fellows for graduation requirements has yet to be studied. The objective of this study was to determine the minimum LOS required for PC fellows to graduate and compare it with the minimum LOS expected for safe and effective practice for the six PC EPAs, from the perspective of the PC Fellowship Program Directors(FPD). All FellowshipProgramDirectors(FPD) of ACGME-accredited PC fellowships were surveyed through SPIN between April 2017 and August 2017. For each of the PC EPAs, the FPDs were asked to indicate the minimum LOS expected for graduation and whether they would allow a fellow to graduate if this level was not achievedand the minimum LOS expected for a practicing pediatric cardiologist to provide safe and effective patient care. The minimum LOS was defined as the LOS for which no more than 20% of FPDs would want a lower level. The survey response rate was 80% (47/59). The majority of the FPDs did not require a minimum LOS of five corresponding to unsupervised practice in any of the six PC EPAs at graduation. For EPAs related to imaging, arrhythmia management, and management of cardiac problems, the minimum LOS for graduation was 3, corresponding to being "trusted to perform a task with indirect supervision for most simple and a few complex cases." For the EPAs related to interventional cardiology, heart failure pulmonary hypertension, and cardiac intensive care, the minimum LOS for graduation was 2, corresponding to being "trusted to perform a task only with direct supervision and coaching." The minimum LOS considered necessary for safe and effective practice for all but one EPA was 3. For the EPA related to the management of cardiac problems, the minimum LOS for safe practice was 4, corresponding to being "trusted to execute tasks independently except for few complex and critical cases." Most PC FPDs reported they would not require fellows to achieve the highest entrustment level for any of the six PC EPAs for graduation. It is crucial that educational programs evolve to address these essential activities during training better and that stakeholders ensure that graduating PC fellows have adequate resources and infrastructure to continue professional development as early career pediatric cardiologists.

Strategi Kepemimpinan Kepala Madrasah dalam Meningkatkan Kompetensi Profesional Guru di MI NU Raden Rahmat 95 Pasuruan

This research uses a qualitative method with a case study approach. Information collection techniques use observation, interviews and documentation. Meanwhile, the data analysis technique uses data collection, reduction and verification. Meanwhile, testing the validity of the data uses triangulation.The research results show that 1) the professional competence of teachers at MI NU Raden Rahmat 95 Pasuruan, all teachers are certified educators.2) Madrasah Head Leadership Strategies in improving teachers' professional competence include carrying out direct supervision and training for teachers, providing role models, creating a sense of togetherness, involving teachers in various training, training, seminars and KKG. 3) Factors inhibiting increasing professional teacher competence include students who are difficult to manage, students who disturb their friends and students who often come in and out of class. K

Analysis of environmental health risk of lead (Pb) pollution in marine products circulating at Sambu market Medan

Plumbum (Pb) is a heavy metal that damages and pollutes the environment. The presence of these heavy metal damages and pollutes the environment. The presence of these heavy metals changes marine biota's life and threatens human health through contaminated food chains. The results of measuring lead (Pb) levels in anchovies and squid circulating in the Sambu Market in Medan exceed the 2009 SNI threshold. This study aims to estimate the exposure to lead (Pb) of those who eat anchovies and squid in the Sambu Market with Desktop Risk Analysis of Environmental Health. The research results show that the risk magnitude (RQ) of exposure to Plumbum (Pb) in people who consume anchovies and squid is RQ>1. Based on risk management, the safe consumption rate is at least 0.06 grams per day for adults with a body mass of 55 kg. Risk management is also carried out by managing sources of reciprocal pollutants (Pb) by controlling the amount of industrial waste that may be discharged into waters, which requires direct supervision from the local Environmental Service.

The Effectiveness of Direct Supervision by an Attending Compared To a Senior Resident on Quality of Supervision of Novice Anesthesiology Residents: A Randomized Study.

New trainees are directly supervised by either an attending physician or a senior resident under indirect supervision from an attending physician. The main objective was to evaluate which type of direct supervision (attending vs. senior resident) would result in better quality of supervision to novice residents during their first month of training. Novice anesthesiology residents were randomized to receive direct supervision by an attending anesthesiologist or a senior resident during their introduction month of intraoperative anesthesia. The primary outcome was a validated instrument to evaluate supervision performance of the instructor. The secondary outcome was a validated anxiety scale. The overall mean supervision score across the study days was greater in the residents who were directly supervised by attendings, mean (standard error [SE]) of 3.88 ± 0.03 compared with direct supervision by a senior resident, mean (SE) of 3.77 ± 0.03 a mean difference of 0.11 (95% confidence interval [CI], 0.05-0.16), P = .0012. Five of 9 individual items on the supervision survey were significantly greater in the group directly supervised by attendings compared with residents. There was no difference between groups regarding anxiety scores. In contrast, there was a mild association between supervision scores and Spielberger State-Trait Anxiety Inventory-6 anxiety scores, correlation coefficient = 0.23 (95% CI, 0.08-0.39), P < .0035. We detected better supervision scores when novice anesthesiology residents were directly supervised by attendings when compared with senior residents. Nevertheless, direct supervision by senior residents still provided supervision scores consistent with a safe supervision practice.

The Alleged Culprit of Poor Coordination of Integration of Health and Social Care Services for Very Ill Older Persons in Sweden, 2000-2022

Abstract Despite numerous attempts to transform Swedish older adult care, similar problems regarding its coordination have persisted over the years. This literature review aims to identify which coordination mechanisms can be perceived as the alleged culprit of poor coordination of integrated health and social services for seriously ill older individuals in Sweden between 2000 and 2022. Classical and contemporary coordination theories are utilised to pinpoint these coordination mechanisms, and the analysis is based on the content of collected articles from this thematic area. This literature review reveals that the following coordination mechanisms are perceived as the primary cause of poor coordination in older adult care: (1) plans, programmes, rules, and standardised work processes. Research has confirmed that decentralisation, the autonomy of regional and local authorities, new regulations implemented in the spirit of NPM, and double principalship have hindered care integration for seriously ill older adults; (2) roles, standardisation of skills, and direct supervision. Neither organisational principal adequately addresses excess employee workloads and an insufficient number of employees providing care services, which generates stress, conflicts, and even occupational burnout among staff. They do not prioritise staff competency development; (3) proximity, feedback, and adjustments through mutual communication. Most studies have shown that communication among staff is crucial to achieving integration, but it could be more effective among staff members involved in providing care. Knowledge about “objects and representations” and “routines and standardisation of outcomes” is somewhat limited and deserves further research.

Key interpersonal skills of a game warden as part an employee soft skills assessment from a commitment and performance perspective

Abstract The study presents an innovative, proprietary concept of identifying soft skills predisposing individuals to occupy a forestry position, along with the definition and discussion of key factors constituting the assessment criteria. The authors provide their individual perspective on the specific personality traits and attitudes relevant to the assessment of an employee's soft skills concerning their suitability for the given position. Six fundamental categories of skills and attitudes within the realm of soft skills for foresters were identified and proposed for evaluation. These categories included the following: Collaboration and information flow management: This category assessed the ability to effectively collaborate with other company employees and the sense of responsibility for achieving the team's goals. Special attention was paid to how information was communicated, facilitating planning, making changes and executing task effectively. Initiative and engagement: This category focused on the ability and willingness to seek and implement new solutions. It identified and proposed an assessment system for actions such as the forester's submission of new ideas and solutions to emerging problems, their engagement and identification with the company, their drive to improve existing work methods, and their adaptability to new tasks and working conditions resulting from changes. Shaping a positive company image: This category involved evaluating the attitude that leads to dignified and ethical representation of the company through appropriate appearance, behaviour and attitude. It encompassed aspects such as building strong relationships with customers, business partners and the company's environment, making agreements aligned with the company's interests and taking active steps to enhance the positive image of the forestry operation. Collaboration with external entities: This category analysed constructive actions defined as the interaction of the forestry district with external entities aimed at creating a favourable business climate for forestry operations. Independence and decision-making: In this category, competencies for independently managing the Forest District were discussed, without the need for direct supervision. The proposed assessment system considered the traits predisposing the forester to make quick and accurate decisions, anticipate their consequences, take personal responsibility for task execution and accept the consequences of their own or their team's work results. Developing subordinates: The final category analysed teamwork skills, with a particular focus on actions aimed at the systematic development of subordinates, recognising potential, and identifying areas for improvement and providing subordinates with opportunities to gain experience and enhance their qualifications and professional competencies. The assessment of the forester's soft skills in each category was based on a descriptive classification of their behaviour, which was assigned to five groups: unacceptable, below expectations, good, very good and outstanding. An illustrative description of employee behaviour facilitating their classification into one of these groups was developed for each evaluation category. The research results are presented in a Table 1, which shows the identified traits, the system for their identification (specified behaviours subject to assessment) and the assessment system. A rating system based on descriptive indicators was proposed to facilitate a homogeneous and repeatable employee assessment process, which is one of the fundamental elements of human resource management. In today's world, the concept of sustainable development is being replaced by efforts to sustain the system through its regeneration at the economic, social and sociological levels. Therefore, the presented concept of identifying and evaluating soft skills was compared with the principles of management in the Volatility, Uncertainty, Complexity, Ambiguity (VUCA) environment.

Augmented reality for surgical skills training, update on the topic

Augmented reality (AR) combines digital information with physical reality, allowing users to interact with virtual data in their real environment. In medical education, this technology is attractive because it allows access to information without taking your eyes off the surgical field. The integration of surgical simulators in resident training offers flexible practice without direct supervision, with benefits such as objective performance evaluation, practice of unusual procedures, and the development of non-technical skills. In addition, simulators are useful for teaching new techniques to experts. In summary, AR and simulators offer valuable opportunities to improve surgical training. The objective of this review is to update the current state of augmented reality in surgical training. The use of augmented reality as an assessment tool in surgical training presents interesting perspectives that deserve consideration. AR can provide objective performance metrics by measuring the technical competency of surgical trainees, whether in a simulated operating environment or in real-world situations. This offers the opportunity to address subjective variability and potential bias in current assessment methods, which often rely on supervisor observation and rating. However, despite these advantages, there has not yet been a comprehensive review to evaluate the use of AR in surgical training. The cost-benefit and implications for data management have not yet been addressed.

Analysis of The Implementation of The Management Planning, Organizing, Actuating, Controlling in BES PPJA (Case Study of The Santri Executive Board of The Jagad ‘Alimussirry)

This research aims to analyze the application of the management functions Planning, Organizing, Actuating and Controlling at BES PPJA Pondok Pesantren Jagad 'Alimussirry. This research is a descriptive qualitative type and was conducted using interviews, observation and documentation. The results of the research show that the Executive Board of the Jagad 'Alimussirry Student Islamic Boarding School has implemented the POAC management function well. Activities in planning include establishing regulations, electing the BES PPJA president, work programs, and establishing AD/ART. Organizing involves the process of dividing tasks and job desks as well as the BES PPJA structure. The actuating function includes the realization of work programs in a ministry. Meanwhile, the controlling function includes direct supervision of the PSDM director by evaluating each work program. This shows that the implementation of planning, organizing, actuating, and controlling in the Executive Board of the Santri Islamic Boarding School Jagad 'Alimussirry can help improve the quality of the organization. Thus, it can be concluded that the management of the BES PPJA Executive Board for Santri Pondok Pesantren Jagad 'Alimussirry has implemented the POAC management function well. So that in its implementation it can improve the quality and productivity of the Jagad 'Alimussirry Islamic Boarding School Santri Executive Board.

Development of a Tool to Assess Surgical Resident Competence On-Call: The Western University Call Assessment Tool (WUCAT)

A central tenet of competency-based medical education is the formative assessment of trainees. There are currently no assessments designed to examine resident competence on-call, despite the on-call period being a significant component of residency, characterized by less direct supervision compared to daytime. The purpose of this study was to design a formative on-call assessment tool and collect valid evidence on its application. Nominal group technique was used to identify critical elements of surgical resident competence on-call to inform tool development. The tool was piloted over six months in the Division of Plastic & Reconstructive Surgery at our institution. Quantitative and qualitative evidence was collected to examine tool validity. A ten-item tool was developed based on the consensus group results. Sixty-three assessments were completed by seven staff members on ten residents during the pilot. The tool had a reliability coefficient of 0.67 based on a generalizability study and internal item consistency was 0.92. Scores were significantly associated with years of training. We found the tool improved the quantity and structure of feedback given and that the tool was considered feasible and acceptable by both residents and staff members. The Western University Call Assessment Tool (WUCAT) has multiple sources of evidence supporting its use in assessing resident competence on-call.

CRYPTOCURRENCY LAW: A STUDY OF FIQH AND FATWAS ABROAD AND A COMPARISON OF FATWAS IN INDONESIA

The discussion of fiqh and fatwa studies on cryptocurrency is still widely discussed both in Indonesia and abroad. Differences of opinion regarding cryptocurrencies are also often found so it is interesting to discuss. This research aims to find out the legal istinbãth method used by fatwa institutions in determining the cryptocurrency issue. This research is a qualitative study with library data collection techniques. The Malaysian state requires a report on every transaction, and State Bank of Malaysia is also not fully responsible for the use outside the crypto wallet service provider. Middle Eastern fatwa institutions such as in Egypt, Turkey, and Palestine prohibit cryptocurrencies because they are illegal, there is no direct supervision from the government or authorities so that money laundering can occur, and cryptocurrencies can also cause gharar. Fatwa institutions in Indonesia differ in determining the law of cryptocurrency. MUI's fatwa prohibits cryptocurrency according to government regulations and the sad al-dzariah legal istinbãth method, as well as the Muhammadiyah Tarjih Council which also prohibits cryptocurrency. The East Java PWNU Bahtsul Masail Institute prohibits cryptocurrency, while the Yogyakarta Special Region PWNU Bahtsul Masail Institute allows it, both institutions use the ilhãqi method because they refer to classical and contemporary books.

A Case Study of Secondary Science Teachers in Utilizing Online Tools in Blended Modality

Educational institutions are keeping up with changes in time. When COVID-19 hindered the traditional face-to-face classroom set-up, several forms of education, including blended learning, had to be implemented. Blended learning was possible due to the current advancement in science and technology. Applications and online tools are available for teachers and learners to ascertain the continuity of education. Hence, this study explores the online tools and applications utilized by science teachers, challenges encountered, and coping mechanisms teachers utilize to counter challenges. Moreover, this study employs a case study approach to ascertain that the data gathered are contextualized and specific. The results revealed that teachers utilized online tools like Class Point, Quizziz, E-class (Moodle), Kahoot, and Peer Deck. Challenges encountered by teachers include Lack of Digital Competence, Incompatibility of the application to the gadget used, Unstable internet connection, Lack of access to online tools premium features, and Lack of student engagement and direct supervision. Moreover, the teachers' coping mechanisms include Using differentiated and collaborative activities and emphasizing authentic submission of outputs. To effectively develop and implement these tools, it is necessary to comprehend and attend to the needs of secondary science teachers who have shared their experiences using online tools in a blended modality.