Echo Training Research Articles

Design and Pilot Implementation of an ECHO Module to Facilitate Treatment of Hepatitis C Virus Infection During Pregnancy

Abstract Background Pregnant patients are largely excluded from Hepatitis C virus (HCV) research and treatment. Studies show that pregnant patients want to discuss treatment while providers feel they lack the knowledge and training for these discussions. To bridge this gap, we designed an ECHO module about management of HCV in pregnancy and infancy. Methods Content experts from pediatric infectious diseases, hepatology, maternal-fetal medicine, bioethics and members of ECHO-Chicago discussed: prior data, potential topics, target audience and scheduling of sessions. We held 8 one-hour sessions with 20-30 minutes of didactics and 30-40 minutes of solicited case discussion. Participants included those who participated in prior ECHO training and prenatal providers in local and regional practices. A 7-point Likert scale pre- and post-training survey was administered to assess metrics of self-efficacy for management of HCV in pregnancy and childhood. Results The sessions were conducted from May to June 2023 on the following topics: HCV screening; HCV pathophysiology/clinical presentations; staging fibrosis in HCV; HCV Treatment in non-pregnant patients; harm reduction; clinical considerations of HCV in pregnancy; shared decision-making for HCV treatment in pregnancy; and HCV screening in infants & treatment for children. Fourteen participants completed pre- and post-surveys. In the pre-survey, participants had low ratings of self-efficacy (average 3.0). In the post-survey (Table 1), participants reported dramatic increases in all areas (average 5.2, increase of 2.2) with the largest in the following areas: “Ability to discuss and manage timing of hepatitis C treatment in a pregnant person”, average 5.1, increase of 3; “Ability to identify suitable pregnant candidates for treatment for Hepatitis C”, average 5.2, increase of 2.7. For context, a 1-point increase in self-efficacy is considered meaningful. All respondents reported increased ability to address HCV in a preconception, pregnant, postpartum, or neonatal population. Conclusion As pivotal studies of pan-genotypic antivirals indicate efficacy and safety during pregnancy, this ECHO module could be distributed to support providers who are discussing therapy initiation. Table 1: Average Change in Self-Efficacy between Pre- & Post-Series Surveys

The Support Hospital Opioid Use Disorder Treatment (SHOUT) Texas program implementation strategy for expanding treatment for hospitalized adults with opioid use disorder

IntroductionIn 2017, we launched the “B-Team” (buprenorphine team), the first hospitalist-led opioid use disorder (OUD) treatment program in Texas. Based on initial success, we obtained funding from Texas Health & Human Services to expand the model to other hospitals in Texas through the Support Hospital Opioid Use Disorder Treatment (SHOUT) Texas program. MethodsThis is a mixed methods study of the implementation of the SHOUT program, which is an OUD treatment intervention, in different hospitals in Texas. Our implementation approach combined training, tailoring, and technical assistance following the Replicating Effective Programs (REP) strategy with statewide telementoring delivered via Project ECHO. To evaluate the reach, adoption, and impact of SHOUT Texas, we assessed: 1) participating hospitals (adoption); 2) patients screened for OUD (impact); 3) patients started on medications for OUD (impact); 4) patients discharged with coordinated outpatient care (impact); 5) providers and staff trained via ECHO (reach); and 6) satisfaction with ECHO training (impact). Additionally, semi-structured interviews were conducted with key stakeholders at expansion sites to identify strengths and weaknesses of the implementation strategy and supports and barriers to successful implementation. Rapid qualitative analysis was completed by a team of analysts who transcribed and summarized interviews to identify key domains of interest and emergent themes. ResultsBetween 2020 and 2023, the SHOUT Texas program expanded to three additional Texas hospital sites, resulting in 3065 hospitalized adult patients starting treatment for OUD. More than 2500 interprofessional clinicians (physicians, nurses, physician assistants, social workers) received SHOUT training regarding inpatient initiation of OUD treatment, with 241 attending at least one hour-long Project ECHO session. Eight key stakeholders at expansion sites were interviewed. Successful components of the SHOUT program included training resources, in-person launches, and collaboration with specialized addiction treatment subject matter experts. Challenges included identifying outpatient follow-up, pharmacy and medication constraints, and nursing education barriers. Interviews also identified lessons learned, advice to other hospitals, and next steps to build capacity. ConclusionsImplementation of the SHOUT Texas model across diverse hospital settings using REP and Project ECHO resulted in significant provider engagement and rapid increase in the number of patients initiating OUD treatment during hospitalization. Lessons learned from this novel approach may be applicable in other states, particularly those that have not expanded Medicaid.

Experiences of Allied Health Clinicians Accessing a Pilot Project ECHO® Program to Support Learning in Pediatric Feeding.

Pediatric feeding disorder is increasing in prevalence, yet low clinician confidence regarding its management is a barrier to care. Targeted clinician training is needed as traditional didactic training programs are limited in both their accessibility and capacity to provide opportunities for the application of theory-based learning. This study examined the experiences of a group of clinicians involved in a multidisciplinary PedFeed ECHO® network, a virtual community of practice established to support speech pathologists, occupational therapists, dieticians, and psychologists in Queensland, Australia, working with children with pediatric feeding disorder. Sixteen clinicians (34% of the total PedFeed ECHO network) from different professional backgrounds, clinical settings, and locations participated in semistructured interviews three months post completion of eight ECHO sessions. Inductive thematic analysis revealed three themes: (1) broad-ranging outcomes of PedFeed ECHO, (2) participant experiences of PedFeed ECHO, and (3) facilitators for future success. PedFeed ECHO was viewed very positively and provided participants with a valuable opportunity for information sharing and collaboration as a multidisciplinary team. Participants described impacts on their professional practice, knowledge, confidence, and professional isolation, as well as service and patient-level impacts. Several facilitators for the success of future PedFeed ECHO cohorts were provided. Insights from participants will serve to improve the design and delivery of ECHO training for future cohorts. Monitoring clinical skill development over a longer period of time and exploring clinician perceptions regarding direct impact on patient care are needed to further validate the impact of ECHO.

GERIATRIC WORKFORCE ENHANCEMENT PROGRAMS AS AAA AGE-FRIENDLY INITIATIVES PARTNER

Abstract The Health Resources and Services Administration funded 48 Geriatric Workforce Enhancement Programs (GWEPs) to partner with community-based organizations in addressing gaps in health care for older adults, promoting Age-Friendly ecosystems, and addressing social determinants of health. This paper discusses three GWEPs collaborative projects with Area Agencies on Aging (AAAs) that deliver community-based programs . The University of Utah’s GWEP, a rural AAA, the Alzheimer’s Association, and the Utah Department of Veterans and Military Affairs provided a hybrid Dementia Caregiver Conference to six counties, reaching 65 in-person attendees and 10 senior centers online. Attendees agreed the content met their educational needs, would positively influence care, and was motivation to form a caregiver coalition. The University of Louisville Trager Institute (Trager), AAA, and Kentucky Coalition for Healthy Communities provided focused regional training and sharing of community resources utilizing the Project ECHO training model for 11 AAA regions, reaching 412 home and community-based services professionals. The University of North Texas Health Science Center, AAA, and emergency management services expanded evidence-based programs in falls prevention, medication safety, and dementia caregiving, serving an additional 23 urban postal codes, rural counties, and over 1,900 individuals. These examples utilize unique community relationships and partnership strategies to identify local needs, maximize older adult and family caregiver engagement, measure outcomes, and achieve GWEP goals to educate diverse, underserved and rural communities.

The Echo Triangle

Echocardiography is an essential investigation for cardiology services, with its activity directly correlated to cardiothoracic activity, morbidity, and mortality. Much research has been undertaken to show that most New Zealand echo departments are under performing. Three key areas are highlighted in this presentation: echo training, allocated scan times, and sonographer call duties. Three proposals make the three arms of “The Echo Triangle”: 1.All sites must train sonographers. Seventeen of 20 sites/hospitals should be training, regardless of perceived need.2.Echo scan times should be standardised to 45 minutes. Consider Parkinson’s Law as applied to “time taken to perform a task”. There is a direct correlation between 60-minute scan time and poor output/efficiencies.3.Sonographers should relinquish call duties. Cardiology Registrars to scan out of hours; sonographers are the vulnerable workforce, not Cardiology RMOs/Registrars. The Echo Triangle should be considered by all cardiology departments within New Zealand. Echocardiography is a vulnerable workforce. Paying attention to the three arms of The Echo Triangle will help with succession planning, department efficiencies, and general department health.

Strategies to increase primary care provider capacity for hepatitis C care: The California ECHO-PLUS study.

Expanding capacity to screen and treat those infected with the hepatitis C virus (HCV) is an essential element of the global elimination strategy. We evaluated the hub-and-spoke Project ECHO training versus telementoring models to educate, train and support HCV care by primary care providers in 13 targeted counties in northern California. A novel provider engagement strategy was used. Provider engagement and retention, time to readiness to treat HCV, and knowledge and confidence were the outcomes of interest. 94 participants from 60 unique clinics in the target counties participated in the ECHO-PLUS programme; 39.4% were physicians, 48.9% were advanced practice providers, and 11.7% were nurses. The median (range) participation time was 5 (1-49)hours. Confidence scores (minimum score=13 and maximum score=65) increased by a mean of 14.0 (SD:8.2) and 11.4 (SD:12.0) points for the hub-and-spoke and telementoring programmes, respectively (p= .53), with the largest changes in confidence seen in treating patients per guidelines, managing side effects and in serving as a consultant for HCV in their clinic. Among 24 participants with data on time to treatment, median time from beginner to experienced was 8h (IQR:6-12) for hub-and-spoke and 2h (IQR:1-2.4) for the telementoring programme (p= .01). A'boots on the ground' approach to recruiting HCV champions was effective within rural communities. Both tele-ECHO hub-and-spoke and telementoring approaches to training primary care providers yielded increase in knowledge and confidence in HCV care and amplified the number of patients who were screened and treated. Telementoring accelerated the timeline of novice providers being 'ready to treat'.

Project ECHO interprofessional telementoring: Using a novel case-based approach for building the U.S Public Health Service clinical response in pain and substance use disorder

The opioid overdose crisis is a US public health emergency that caused over an estimated 93,000 deaths in 2020. To build the clinical capacity of the Commissioned Corps of the US Public Health Service (USPHS), the US Centers for Disease Control and Prevention and Prevention (CDC) collaborated with Project ECHO in pain and substance use disorder (SUD). The purpose of this article is to describe the evaluation results of an interprofessional telementoring program using novel clinical vignettes. Interprofessional Project ECHO Pain faculty and the CDC recruited a diverse group of 163 USPHS clinical officers to join one (of two) 16-week, hour-long ECHO Opioid and Pain (OP) telementoring sessions. The structured curriculum included chronic pain, substance use, harm reduction and mental health-related didactics, as well as novel clinical vignettes. During this OP telementoring training, novel clinical vignettes were used successfully to train USPHS officers in an interprofessional “all-teach, all-learn” team-based, interdisciplinary learning environment. Over 30% (n = 48) of the USPHS officers attended at least 9 of the 16 sessions. Cohort surveys demonstrated that participants (n = 26) self-reported significantly increased knowledge regarding chronic pain, SUD, and mental health issues when compared to baseline. Focus group participants (n = 41) noted increased self-efficacy in clinical skills and compassion regarding patient care. This interprofessional ECHO training using novel clinical vignettes demonstrates the potential to increase clinical response capacity in pain management and SUD treatment by improving both knowledge and self-efficacy among participants.

Piloting the ECHO e-Skills and Training Toolkit

Piloting the ECHO e-Skills and Training Toolkit

Piloting the ECHO e-Skills and Training Toolkit

Piloting the ECHO e-Skills and Training Toolkit

Full agonist opioid prescribing by primary care clinicians after buprenorphine training

Background While primary care clinicians are being trained to use buprenorphine for the treatment of Opioid Use Disorder (OUD) in order to increase access to addiction treatment, it is not known what impact such training and subsequent experience treating patients with OUD has on full agonist opioid prescribing. Methods: This retrospective cohort study compares the full agonist opioid prescribing patterns of Drug Addiction Treatment Act (DATA)-waivered (“X-waivered”) primary care clinicians to non-trained, non-waivered clinicians in a rural health network. X-waivered clinicians also received Project ECHO training and telementoring support for one year. Using prescriber data generated by an electronic medical record system, opioid prescribing and morphine milligram equivalents (MME) per day per patient were calculated. A between-group analysis was used to compare the study groups six months pre-versus post-training. Results: Although the mean number of full agonist opioid prescriptions per clinician and per 100 patient encounters decreased among all clinicians, there was no change in full agonist opioid prescribing MME. As expected, buprenorphine prescribing by X-waivered, trained clinicians increased significantly post-training. Conclusions: X-waivers plus Project ECHO support for the treatment of OUD using buprenorphine had no effect on full agonist opioid prescribing by primary care clinicians.

A Case Study of the Initiation of Parallel Convective Lines Back-Building from the South Side of a Mei-yu Front over Complex Terrain

Parallel back-building convective lines are often observed extending to the southwest of some mesoscale convective systems (MCSs) embedded in the mei-yu front in China. The convective lines with echo training behavior can quickly develop into a stronger convective group of echoes, resulting in locally heavy rainfall within the mei-yu front rainband. The initiation mechanism of the back-building convective lines is still unclear and is studied based on high-resolution numerical simulation of a case that occurred during 27–28 June 2013. In the present case, the new convection along the convective lines was found to be forced by nonuniform interaction between the cold outflow associated with the mei-yu front MCSs and the warm southerly airflow on the south side of the mei-yu front, which both are modified by local terrain. The mei-yu front MCSs evolved from the western to the eastern side of a basin surrounded by several mesoscale mountains and induced cold outflow centered over the eastern part of the basin. The strong southwest airflow ahead of the mei-yu front passed the Nanling Mountains and impacted the cold outflow within the basin. The nonuniform interaction led to the first stage of parallel convective line formation, in which the low mountains along the boundary of the two airflows enhanced the heterogeneity of their interaction. Subsequently, the convective group quickly developed from the first stage convective lines resulted in apparent precipitation cooling that enhanced the cold outflow and made the cold outflow a sharp southward windshift. The enhanced cold outflow pushed the warm southerly airflow southward and impacted the mountains on the southeast side of the basin, where the roughly parallel mountain valleys or gaps play a controlling role in a second stage formation of parallel convective lines.

Abstract PO-014: Assessment of training needs for clinicians who provide reproductive health counseling for sexual and gender minority adolescents and young adults with cancer

Abstract Background: Adolescent and young adults (AYA) with cancer have distinct psychosocial needs, with reproductive health being a chief concern. Reproductive health includes fertility, contraception, romantic relationships, body image, sexuality and disease prevention. Along with the unique needs of AYAs with cancer, health disparities exist among sexual and gender minority (SGM) AYAs, and there is a gap in clinician training. Our NCI-funded R25 Enriching Communication skills for Health professionals in Oncofertility (ECHO) provides reproductive health communication training to psychologists, social workers, nurses, and physician assistants who provide care for AYA people diagnosed with cancer. To refine our curriculum to address the unique needs of SGM AYAs with cancer, we conducted a survey of prior ECHO trainees to evaluate knowledge and comfort in obtaining sexual orientation and gender identity (SOGI) information from patients and providing reproductive health counseling. Methods: A 28-item electronic survey was distributed to 601 prior ECHO trainees. Quantitative items assessed: SOGI data collection at their institution; SGM AYA cancer-related health knowledge; adequacy of ECHO training for SGM AYAs; desire for additional training; comfort discussing reproductive health with SGMs; and confidence in knowledge of SGM health needs (pre- and post-survey). Response options ranged from 1=strongly agree to 5=strongly disagree, or ‘prefer not to answer. Total knowledge score was computed and ranged from 0=no correct responses to 7=all correct. Self-perceived comfort and confidence were assessed with regard to specific patient subgroups (i.e., gay/lesbian; bisexual/queer; and trans/nonbinary patients). Four open-ended items invited respondents to describe personal experiences, reservations, and suggestions for improving SGM AYA cancer care. Quantitative responses were summarized with descriptive statistics. Paired t- tests were used to analyze changes in confidence. Content analysis was applied to qualitative responses. Results: Of the 346 who completed the survey (58% response rate), only 7.4% correctly answered all knowledge questions (M=3.76, SD=1.72). One- third thought ECHO training adequately addresses SGM needs, and the majority (89%) wanted additional training in SGM reproductive health. Confidence in knowledge of SGM health was neutral in all subgroups prior to survey completion (M=3.05, SD=1.02), but reduced significantly for bisexual/queer (M=-0.21 t(307)=4.70, p<.001) and transgender/nonbinary health(M=-0.12 t(307)=2.66, p=.008). Open-ended responses focused on experiences caring for SGM AYAs with cancer; training needs; and appreciation for the survey. Conclusions: Our findings demonstrate a need to expand our ECHO curriculum to include SGM reproductive health concerns and strong desire for SGM content among trainees. We are developing a module to improve reproductive health communication for the care of SGM AYAs with cancer and survivors. Citation Format: Rhyan J. Toldeo, Amani Sampson, Paige W. Lake, Megan E. Sutter, Ash B. Alpert, Matthew B. Schabath, Susan T. Vadaparampil, Gwendolyn P. Quinn. Assessment of training needs for clinicians who provide reproductive health counseling for sexual and gender minority adolescents and young adults with cancer [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-014.

COMMUNITY NETWORKS ADDRESSING AGING WITH LIFELONG DISABILITIES

Adults aging with lifelong developmental disabilities (I/DD: Down syndrome and other intellectual disabilities, cerebral palsy, etc.) continue to pose a challenge to the Aging Network, developmental services, and healthcare systems. Some funded projects, model programs, and episodic initiatives have helped advance intersystem collaboration but there is still scant federal or state public policy specific to aging with lifelong disabilities. The Area Planning and Services Committee (APSC), a product of three consecutive AoA grants on building and testing intersystem cooperation/collaboration between these systems, is a partnership of community based organizations and academe operating in metro Richmond since 2003. Its successful hands on, interdisciplinary management process has implemented needs assessments, statewide training, staff development, dementia awareness, etc., and been a model for the Virginia Geriatric Education Center (VGEC) Plenary overseeing all GWEP programs. The APSC history informs VGEC GWEP’s incorporating I/DD content into faculty development programs, microlearning, ECHO, and other practitioner training.

An Observational Analysis of Three Extreme Rainfall Episodes of 19–20 July 2016 along the Taihang Mountains in North China

Abstract This study examines the synoptic- and mesoscale processes leading to the generation of three extreme rainfall episodes with hourly rates of greater than 100 mm h−1 over the southern, middle, and northern portions of the eastern foothills of Mt. Taihang in North China on 19–20 July 2016. The extreme rainfall episodes took place over the 200–600-m elevation zones in the southern and northern portions but also over the lower elevations in the middle portion of the target region, sequentially during late morning, early evening, and midnight hours. Echo training accounted for the development of a linear convective system in the southern region after the warm and moist air carried by a southeasterly low-level jet (LLJ) was lifted to condensation as moving across Mt. Yuntai. In contrast, two isolated circular-shaped convective clusters, with more robust convective cores in its leading segment, developed in the northern region through steep topographical lifting of moist northeasterly airflow, albeit conditionally less unstable. Extreme rainfall in the middle region developed from the convergence of a moist easterly LLJ with a northerly colder airflow associated with an extratropical cyclogenesis. Results reveal that the LLJs and associated moisture transport, the intensifying cyclone interacting with a southwest vortex and its subsequent northeastward movement, and the slope and orientation of local topography with respect to and the stability of the approaching airflows played different roles in determining the timing and location, the extreme rainfall rates, and convective organizations along the eastern foothills of Mt. Taihang.

Overlooked Minorities: The Intersection of Cancer in Lesbian, Gay, Bisexual, Transgender, and/or Intersex Adolescents and Young Adults.

Journal of Adolescent and Young Adult OncologyVol. 8, No. 5 PerspectiveOverlooked Minorities: The Intersection of Cancer in Lesbian, Gay, Bisexual, Transgender, and/or Intersex Adolescents and Young AdultsMairghread Clarke, Jeremy Lewin, Smaro Lazarakis, and Kate ThompsonMairghread ClarkeAddress correspondence to: Mairghread Clarke, BSW, ONTrac at Peter Mac Victorian Adolescent and Young Adult Cancer Service, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne VIC 3000, Victoria, Australia E-mail Address: Mairghread.Clarke@petermac.orgONTrac at Peter Mac Victorian Adolescent and Young Adult Cancer Service, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.Search for more papers by this author, Jeremy LewinONTrac at Peter Mac Victorian Adolescent and Young Adult Cancer Service, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.Department of Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia.Search for more papers by this author, Smaro LazarakisHealth Sciences Library, Royal Melbourne Hospital, Melbourne Health, Melbourne, Victoria, Australia.Search for more papers by this author, and Kate ThompsonONTrac at Peter Mac Victorian Adolescent and Young Adult Cancer Service, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.Department of Social Work, The University of Melbourne, Melbourne, Victoria, Australia.Search for more papers by this authorPublished Online:10 Oct 2019https://doi.org/10.1089/jayao.2019.0021AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View articleFiguresReferencesRelatedDetailsCited byReinforcing or Disrupting Gender Affirmation: The Impact of Cancer on Transgender Embodiment and Identity23 January 2023 | Archives of Sexual Behavior, Vol. 104Effectiveness of immunological agents in non‐small cell lung cancer26 October 2022 | Cancer Reports, Vol. 6, No. 1The LOvE ECHO Training: Developing a Web-Based LGBTQ Cultural Competency Training Module for Oncology Allied Health Professionals Rebecca G. Block, Amani Sampson, Julia Gagliardi, Bianca Augusto, Waleska Santiago-Datil, Matthew B. Schabath, Susan T. Vadaparampil, and Gwendolyn P. Quinn5 December 2022 | Journal of Adolescent and Young Adult Oncology, Vol. 11, No. 6“It's Kind of Complicated”: A Qualitative Exploration of Perceived Social Support in Young Adult and Young Adult Lesbian, Gay, Bisexual, Transgender, and/or Queer Cancer Survivors Dana Ketcher, Maija Reblin, Kelly J. Mansfield, Rachael McCormick, Amber M. Skinner, Amy K. Otto, Karrin Tennant, Sarah E. Wawrzynski, Damon R. Reed, and Kristin G. Cloyes5 December 2022 | Journal of Adolescent and Young Adult Oncology, Vol. 11, No. 6LGBTQI cancer patients’ quality of life and distress: A comparison by gender, sexuality, age, cancer type and geographical remoteness20 September 2022 | Frontiers in Oncology, Vol. 12Gender- and Sexual Orientation– Based Inequities: Promoting Inclusion, Visibility, and Data Accuracy in OncologyAmerican Society of Clinical Oncology Educational Book, Vol. 0, No. 42Knowing to Ask and Feeling Safe to Tell - Understanding the Influences of HCP-Patient Interactions in Cancer Care for LGBTQ+ Children and Young People24 June 2022 | Frontiers in Oncology, Vol. 12“No one size fits all” A Multi-Method Survey of Oncology Allied Health Professionals Experiences with Lesbian, Gay, Bisexual, Transgender/Queer Questioning Adolescent, and Young Adult Patients with Cancer and Reproductive and Sexual Health” Amani Sampson, Rebecca Block, Paige W. Lake, Julia Gagliardi, Bianca Augusto, Waleska Santiago-Datil, Megan Sutter, Matthew B. Schabath, Susan Vadaparampil, and Gwendolyn P. Quinn22 June 2022 | Journal of Adolescent and Young Adult Oncology, Vol. 0, No. 0“Queer Insights”: Considerations and Challenges for Assessing Sex, Gender Identity, and Sexual Orientation in Oncofertility Research1 June 2022 | Annals of LGBTQ Public and Population Health, Vol. 3, No. 2Psychosocial Needs and Preferences for Care among Adolescent and Young Adult Cancer Patients (Ages 15–39): A Qualitative Study29 January 2022 | Cancers, Vol. 14, No. 3Adolescent and Young Adult Cancer Survivors3 January 2022LGBT Populations and Cancer in Australia and New Zealand22 August 2022Sex and Gender Influences on Cancer Immunotherapy Response21 July 2020 | Biomedicines, Vol. 8, No. 7Sex and Gender Considerations After Surviving Acute Lymphoblastic Leukemia: An Exercise Oncology Context Maxime Caru and Daniel Curnier8 June 2020 | Journal of Adolescent and Young Adult Oncology, Vol. 9, No. 3The Needs and Experiences of Post-Treatment Adolescent and Young Adult Cancer Survivors13 May 2020 | Journal of Clinical Medicine, Vol. 9, No. 5Advances in pediatric psychooncologyCurrent Opinion in Pediatrics, Vol. 32, No. 1 Volume 8Issue 5Oct 2019 InformationCopyright 2019, Mary Ann Liebert, Inc., publishersTo cite this article:Mairghread Clarke, Jeremy Lewin, Smaro Lazarakis, and Kate Thompson.Overlooked Minorities: The Intersection of Cancer in Lesbian, Gay, Bisexual, Transgender, and/or Intersex Adolescents and Young Adults.Journal of Adolescent and Young Adult Oncology.Oct 2019.525-528.http://doi.org/10.1089/jayao.2019.0021Published in Volume: 8 Issue 5: October 10, 2019Online Ahead of Print:June 14, 2019PDF download

Characteristic Features of the Evolution of a Meiyu Frontal Rainstorm with Doppler Radar Data Assimilation

During the Meiyu period, floods are prone to occur in the middle and lower reaches of the Yangtze River because of the highly concentrated and heavy rainfall, which caused huge life and economic losses. Based on numerical simulation by assimilating Doppler radar, radiosonde, and surface meteorological observations, the evolution mechanism for the initiation, development, and decaying of a Meiyu frontal rainstorm that occurred from 4th to 5th July 2014 is analyzed. Results show that the numerical experiment can well reproduce the temporal variability of heavy precipitation and successfully simulate accumulative precipitation and its evolution over the key rainstorm area. The simulated “rainbelt training” is consistent with observed “echo training” on both spatial structure and temporal evolution. The convective cells in the mesoscale convective belt propagated from southwest to northeast across the key rainstorm area, leading to large accumulative precipitation in this area. There existed convective instability in lower levels above the key rainstorm area, while strong ascending motion developed during the rainstorm process. Combined with abundant water vapor supply, the above condition was favorable for the formation and development of heavy rainstorm. The low-level jet (LLJ) provided sufficient energy for the rainstorm system, and the low-level convergence intensified, which was important for the maintenance of precipitation system and its eventual intensification to rainstorm. At its mature stage, the rainstorm system demonstrated vertically tilted structure with strong ascending motion in the key rainstorm area, which was favorable for the occurrence of rainstorm. In the decaying stage, unstable energy decreased and the rainstorm no longer had sufficient energy to sustain. The rapid weakening of LLJ resulted in smaller energy supply to the convective system, and the stratification tended to be stable in the middle and lower levels. The ascending motion weakened correspondingly, which made it hard for the convective system to maintain.

An Extreme Rainfall Event in Coastal South China During SCMREX‐2014: Formation and Roles of Rainband and Echo Trainings

AbstractIn this study, an extreme rainfall event of 451 mm in 20 hr that occurred in coastal South China on 11 May 2014 during the Southern China Monsoon Rainfall Experiment is investigated using integrated observations from the dual‐Doppler radar pair, polarimetric radar, extensive mesonetwork, and enhanced upper‐air soundings. Results show the generation of the extreme rainfall by two consecutive mesoscale convective systems (MCSs) consisting of multiple meso‐β‐scale rainbands. The two MCSs are maintained by lifting southerly oceanic flows over a quasi‐stationary mesoscale outflow boundary (MOB) along the coastline that are enhanced by convectively generated weak cold pool. Northeastward “echo training” of convective cells, under the influence of environmental southwesterly flows, leads to the formation of the multiple rainbands in each MCS. Their subsequent propagations in a “rainband training” form, together with the echo training, along the coastline account for the production of extreme rainfall. The second MCS is characterized with a leading bowing rainband showing a process of rapid splitting and reestablishment (RSRE), which contributes to the formation of the rainband training. The occurrence of the RSRE process requires ample supply of unstable upstream oceanic air mass, the quasi‐stationary MOB, and a bowing rainband intersecting with the MOB. The second MCS produces more precipitation than the first one as a result of more rainbands, stronger convective intensity, and more moderate‐sized raindrops with larger maximal sizes. The above findings, especially the RSRE process and its associated storm internal circulation, appear to add new Insights into the formation and maintenance of training rainbands and their roles in heavy rainfall production.

Are senior cardiac sonographers adequately prepared to provide echo training and supervision to students? Survey results from senior cardiac sonographers and echo educators in Victoria, Australia

AbstractIntroductionWorkplace supervision and training of cardiac sonographers in Victoria is largely undertaken by senior cardiac sonographers including echo educators. Effective clinical supervision is made difficult by a desire to maintain patient throughput and a lack of adequate staffing in the workplace. Many senior sonographers do not have the desired skills or adequate training to provide effective supervision.MethodsTwenty‐five senior cardiac sonographers and echo educators were surveyed to establish current trends in clinical supervision. Participants completed a survey regarding the frequency, perceived quality and confidence in providing echo training and supervision.ResultsThe majority of respondents provided workplace supervision to student cardiac sonographers as part of their usual duties. The time allocated to this varied from less than 1 day per month to up to 4 or 5 days per week. Most had no formal qualification in providing echo training and supervision while some had minimal training. All respondents rated the quality of the training and supervision provided as average or above.DiscussionSenior cardiac sonographers in Victoria suggest an increase in staffing levels and undertaking training in clinical supervision would assist them in providing effective workplace, training and supervision of student cardiac sonographers.

ECHOCARDIOGRAPHIC INTERPRETATION SKILLS OF GRADUATING CARDIOLOGY TRAINEES: ARE THEY COMPETENT?

Echocardiography (echo) is an important diagnostic and prognostic tool for managing patients with cardiac disease. Accurate interpretation of echo images is essential to provide high quality patient care. For decades, competence in echo has been conferred by the attainment of a predefined: (1) number of months of training, and (2) number of echo studies performed and interpreted. There is no information regarding the adequacy of a cardiology resident’s echo interpretation skills at the time of cardiology training program completion. The purpose of this study was to assess the proficiency of graduating cardiology trainees at echo interpretation. Sixty-six trainees within 2.5 months of completing a Canadian cardiology training program participated in voluntary testing. The mean number of months of training was 6.3 (range 5-12) months. 65% of trainees had completed the requisite 6 months of echo training to be eligible for Level 2 certification. Trainees were asked to interpret 14 echocardiographic studies that demonstrated important findings in the following categories: left ventricular (LV) size/function, right ventricular (RV) size/function, valvular abnormalities, pericardial disease, hypertrophic cardiomyopathy (HCM), and congenital heart disease. Images were chosen to be representative of those typically encountered in a community cardiology practice. Trainees were asked to: (1) identify any abnormalities, and (2) provide a corresponding interpretation. Evaluation criteria were pre-determined through the consensus of two experienced echocardiographers, who assembled a list of important and critical abnormalities and interpretations for each set of images. Scoring of trainees responses was blinded to identity and performed independently. The average scores for the accurate identification for each category of echo pathology were: LV size/function 45%; RV size/function 85%; valvular abnormalities 57%; pericardial disease 56%, HCM 17%; and congenital heart disease 52%. The average score for the identification of the predefined critical diagnoses was 68%. The average overall score for the cohort was 57.45% (+/−11.8%). 18.2% of trainees achieved the predefined passing grade of 70%. The ability of trainees trained at and graduating from Canadian cardiology training programs to accurately identify and interpret important abnormalities on echo is suboptimal despite having completed the necessary months of echo training required. These findings demonstrate an urgent need to re-evaluate the current approaches to echo training.

Is geographical location a barrier for echo training? An observational account of 10 student cardiac sonographers' pursuit to achieve accreditation

AbstractIntroductionTraining cardiac sonographers is a lengthy process involving a large commitment of time and resources. By facilitating successful trainee outcomes, accreditation can be achieved in the shortest time possible. The purpose of this observational piece is to highlight potential barriers to the timely completion of cardiac sonographer training leading to accreditation as a medical sonographer.MethodsTen trainee cardiac sonographers completed the Practical Echo Training Program between 2007 and 2011. The programme encompasses 154 hours of practical and theoretical training in the performance of adult transthoracic echocardiography (echo). Participants were followed up several years after completion of the programme and the Australian Sonographer Accreditation Registry was consulted online to determine the accreditation status of the participants.ResultsEight of the participants continue to perform echo in a clinical setting. Four of these work in metropolitan sites and four work in regional sites. Those from metropolitan sites have all been successful in achieving accreditation. The four participants working in regional sites have not achieved accreditation.ConclusionsGeographical location may be a barrier to achieving accreditation as a medical sonographer. Additional research is required to evaluate further and to investigate other potential barriers.