Insufficient Time Research Articles

“I'm completely off base here on what this child is capable of”: A qualitative analysis of how medical ableism manifests in PICU clinicians' care of children with severe neurological impairment

BackgroundChildren with severe neurological impairment (SNI) are at heightened risk of experiencing medical ableism from clinicians in the pediatric intensive care unit (PICU), where barriers such as time scarcity and heavy workloads limit clinicians’ ability to provide personalized care. ObjectiveTo examine medical ableism and strategies to support PICU clinicians in understanding the lives of children with SNI and their families. MethodsThis US-based, single-center, qualitative study included PICU clinicians identified by the parents/caregivers of a child with SNI. Semi-structured 1:1 60-min interviews about the challenges of caring for children with SNI were conducted virtually. Coded data were extracted, thematically analyzed, and further conceptualized using the Dual Process Theory (DPT) bias reduction framework. ResultsNineteen PICU clinicians participated. Three major themes emerged: 1) assumptions and misconceptions about children with SNI and their families, 2) barriers to providing personalized care, and 3) clinician-suggested strategies to honor the lives of children with SNI. These themes aligned with the DPT framework. As outlined in the DPT, system 1 “fast thinking” errors occur when quick observations inform decisions (e.g., snap judgments about a child's capabilities). Second, barriers (e.g., insufficient time for meaningful interactions) may prevent clinicians from providing unbiased care. Third, system 2 “slow thinking,” where complex decision-making occurs, and can be enhanced through personalization strategies (e.g., viewing visuals of the child at baseline health). ConclusionsIncreasing clinician awareness of their potential implicit biases and utilizing bias reduction strategies to mitigate medical ableism in care are critical areas for future research.

Nitric Oxide and Temperature Measurement Using Laser Absorption Spectroscopy in Arc-Heater Plenum

A mid-infrared tunable diode laser absorption spectroscopy (TDLAS) sensor to measure rovibrational temperature and nitric oxide (NO) mole fraction in the arc-heater plenum was developed and employed in the Arc Heated Combustion Tunnel-II (ACT-II) facility at the University of Illinois at Urbana-Champaign. From this study, TDLAS-inferred temperatures were found to differ from the conventional method to estimate temperature by over 13%. Chemical equilibrium simulations were performed at the TDLAS-inferred temperatures to understand how chemical relaxation timescales compare with plenum residence times. Results from this study show NO levels higher than equilibrium concentrations, with relaxation timescales that exceed plenum residence times. With insufficient time to reach equilibrium, elevated NO levels are expected to remain in the test gas and persist into the scramjet model.

PERCEPTIONS OF COOPERATING TEACHERS ON PRE-SERVICE TEACHERS’ MENTORING IN TEACHING PRACTICUM: EMPIRICAL EVIDENCE FROM INITIAL TEACHER EDUCATION

Although research on cooperating teachers mentoring pre-service teachers provides important findings in teacher education, there are few studies exploring cooperating teachers' perceptions of mentoring pre-service teachers in Indonesian teacher education. Grounded in narrative inquiry design, this research reports on cooperating teachers' perceptions of mentoring their pre-service teachers during teaching practicum. Two cooperating teachers voluntarily agreed to participate in this study. Data were derived from semi-structured interviews focusing on exploring critical incidents while they were mentoring pre-service teachers. The data were analysed qualitatively using thematic analysis. Findings revealed that pre-service teachers faced difficulties in using English to teach students. However, they benefited from applying strategies and media in their teaching. In terms of mentoring aspects, pre-service teachers were often unprepared with lesson plans, although their communication during teaching practicum was good. To better understand teaching material, pre-service teachers need to enhance their abilities. In addition, pre-service teachers have a limitation in reviewing material and assigning homework, and they struggled to manage class time effectively, leaving insufficient time to review material. This study implied that identifying the challenges faced by pre-service teachers during teaching practicum, as perceived by cooperating teachers, can inform the design of mentoring programs.

Significance of Life Skills Education for Students and Teachers in District Rahim Yar Khan

The study examines the impact of life skills education on students' and teachers’ personal development, social competence, and mental well-being. Utilizing a descriptive quantitative method, data was collected from 400 students and 100 teachers across four universities including KFUEIT RYK, IUB RYK Campus, NCBA&E RYK Campus, and Superior University RYK Campus in District Rahim Yar Khan, ensuring a representative sample through simple random sampling. To collect the data for this research study, two questionnaires (one for students containing 50 items, and one for teachers comprising 40 items) were used. Analysis via SPSS version 23 revealed that life skills education significantly enhances students' and teachers’ personal and social development and mental well-being, with high awareness levels among students and teachers. Despite this, barriers such as lack of resources, inadequate teachers’ training, and insufficient time allocation hinder effective implementation. To provide an accurate portrayal of the data descriptive statistics, such as the percentage, frequency, standard deviation, and mean, and inferential statistics, such as t-test and one-way ANOVA were utilized. The study found positive correlations between social skills development and successful outcomes, and between emotional skills development and mental well-being, underscoring the necessity of prioritizing life skills education and integrating these skills into the curriculum. The findings highlight the essential role of life skills education in fostering overall students’ success and well-being, calling for institutions and policymakers to address implementation, barriers and emphasize social and emotional skill development to better prepare students for academic, personal, and professional challenges.

Nurses' engagement in advance care planning practices: A descriptive cross-sectional study.

To describe and compare nurses' awareness of, attitudes toward, and participation in advance care planning, as well as related facilitators and challenges, in four types of healthcare settings. A cross-sectional descriptive study. Four hundred and ninety-eight registered nurses from tertiary, secondary and primary healthcare institutions, along with long-term care centres in South Korea, participated in an investigator-developed online survey. The collected data were analysed using descriptive statistics, chi-squared test, one-way ANOVA, and binary logistic regression. Participants were on average 30.6 ± 7.3 years old, mostly female (95.4%), employed as staff nurses (95.4%), held bachelor's degrees or higher (84.1%), and had worked for less than 5 years at their current institutions (69.7%). Overall, 49% of the participants were familiar with advance care planning. While most participants supported nurse involvement in advance care planning with patients and surrogates, fewer were willing to engage or recommend it. Less than half were actively engaged in advance care planning practices. A notable challenge was the lack of time due to excessive workload. Compared to those from tertiary healthcare institutions, participants from secondary and primary healthcare institutions and long-term care centres were less likely to be aware of advance care planning. Participants from secondary and primary healthcare institutions had lower odds of checking for the presence of advance directives and the physician orders for life-sustaining treatment. Nurses demonstrated low awareness and participation in advance care planning. Nurses' insufficient time and competency to conduct advance care planning in their practice should be addressed. Educational programs, initiatives (e.g. guidelines, position statements) and legal and policy-level efforts (e.g. nurse staffing, role clarification, reimbursement) are crucial to incorporate advance care planning into routine nursing practice. What problem did the study address? Nurses play an important role in advance care planning; however, limited is understood about their readiness and involvement in such practices. What were the main findings? Nurses' awareness of advance care planning practices and their participation in such practices is low across care settings. Although nurses have a positive attitude toward advance care planning, there are challenges (e.g. insufficient time to conduct advance care planning discussions and lack of relevant knowledge and skills) that impede their participation in practice. Where and on whom will the research have an impact? This study may serve as a foundation for nursing societies in countries, where advance care planning is emerging, to discuss strategies to increase nurses' competency in advance care planning and promote their participation in the practice. The STROBE checklist was followed. No patient or public contribution.

Surgical hip dislocation technique through the femoral head fovea fenestration and impaction bone grafting for the treatment of non-traumatic osteonecrosis of the femoral head: a retrospective study

BackgroundOsteonecrosis of the femoral head (ONFH) often leads to the collapse of the femoral head, ultimately resulting in patients undergoing premature total hip arthroplasty (THA). The surgical hip dislocation (SHD) technique is a type of hip-preserving surgery aimed at delaying or avoiding THA. This study aims to evaluate the clinical efficacy of SHD techniques through femoral head fovea fenestration and impaction bone grafting for the treatment of non-traumatic ONFH.MethodsA retrospective analysis was conducted on the clinical data of 39 patients (39 hips) with non-traumatic ONFH who underwent SHD for treatment from 2016 to 2017. The Harris hip score (HHS) and the minimum clinically important difference (MCID) are used to evaluate clinical outcomes, while radiographic evaluations are conducted using X-rays. Kaplan-Meier survival analysis defined clinical failure as further THA, and conducted univariate survival analysis and Cox regression analysis. Any complications were recorded.ResultsAll patients were followed up for 24–72 months, with an average of (60 ± 13.0) months. At the last follow-up, based on the HHS, 25 patients (64.1%) reported excellent and good clinical outcomes. 29 patients (74.3%) achieved MCID. Imaging evaluation of the postoperative femoral head status showed that 6 cases improved, 20 cases remained stable, and 13 cases showed progressed. Out of 39 hips, 12 hips had postoperative clinical failure, resulting in a clinical success rate of 69.2%. Association Research Circulation Osseous (ARCO) stage, China-Japan Friendship Hospital (CJFH) classification, and postoperative crutch-bearing time are risk factors for clinical failure. Postoperative crutch-bearing time of less than 3 months is an independent risk factor for clinical failure. After surgery, there was one case of sciatic nerve injury and one case of heterotopic ossification. There were no infections or non-union of the greater trochanter osteotomy.ConclusionThe SHD technique through the femoral head fovea fenestration and impaction bone grafting provides a safe and effective method for treating non-traumatic ONFH, with good mid-term clinical outcomes. ARCO staging, CJFH classification, and postoperative crutch-bearing time are risk factors that affect clinical outcomes after surgery and lead to further THA. Insufficient postoperative crutch-bearing time is an independent risk factor for clinical failure.

Process evaluation of comprehensive sexuality education programme in Zambia: a focus on contextual factors, mechanisms of impact, quality of development and implementation process

BackgroundComprehensive sexuality education (CSE) is critical in addressing negative sexual and reproductive health (SRH) outcomes among adolescents. Yet in many low- and middle-income countries (LMICs) including Zambia, little is known about the impact, realities of CSE implementation, the quality of teaching and the comprehensiveness of the content covered.MethodsOur approach was informed by a process evaluation incorporating recommendations by the European Expert Group guidance on evaluating sexuality education programmes and the Medical Research Council (MRC) guidelines on process evaluation. The development process and quality of CSE implementation were assessed using eight and six quality criteria respectively. In-depth interviews (IDIs), focus group discussions (FGDs), document analysis and classroom observation were employed to assess contextual factors, implementation process and mechanisms of impact of CSE. In-depth interviews (50) and focus group discussions (2) with seven pupils in each group were conducted among 64 purposefully selected participants. The sample comprised pupils (35), parents (4) and teachers (17) from nine secondary schools (four peri-urban, four urban and one rural), policymakers (4), and religious leaders (4). We employed deductive content analysis to analyse the data.ResultsContextual factors that influenced the implementation of CSE included: (1) piecemeal funding for the CSE programme; (2) lack of monitoring programmes in schools; (3) lack of community engagement; (4) religious and socio-cultural barriers; (5) lack of skills and competency to teach CSE; and (6) insufficient time allocation for CSE. The assessment of the quality of the development of CSE revealed: (1) a lack of sexual diversity; (2) no meaningful participation of pupils in programme implementation; (3) a lack of stakeholder engagement during programme implementation; (4) lack of gender sensitivity; and (5) lack of human rights approach. Assessment of the quality of the implementation of CSE revealed: (1) no evidence of skill-based CSE teaching; (2) no linkage between CSE and SRH services in the communities; and (3) a lack of incorporation of multiple delivery methods during CSE teaching. The mechanisms of impact of CSE were related to the acceptability and positive changes in pupils’ SRH practices.ConclusionThe complex influences of contextual factors during CSE implementation highlight the need for contextual analysis during the interventional design. Co-creation of the CSE programme through stakeholder participation could reduce social opposition and enable a culturally sensitive CSE. Comprehensive teacher training, a guiding curriculum as well as setting of appropriate monitoring tools and indicators are likely to enhance the quality of CSE implementation.

Optimization of Judicial Review System in Non-Prosecution for Corporate Compliance

As the reform of corporate compliance progresses, the system of non-prosecution for corporate compliance grants prosecutors significant discretionary power, making it inevitable for courts to participate in corporate compliance. Issues arising from corporate compliance reform, such as insufficient time for compliance rectification hearings, inadequate third-party supervision, judicial discretion abuse, and lack of unified standards for compliance effectiveness assessment, should be addressed. This can be achieved by establishing unified standards for compliance effectiveness, improving the transparency of public hearings, emphasizing the construction of a diversified institutional framework for multi-party participation in corporate compliance, enhancing coordination and constraints among public security organs, procuratorates, courts, administrative agencies, and third-party organizations, and improving the judicial review of corporate compliance to optimize the judicial scrutiny of the non-prosecution system for corporate compliance.

Healthcare professionals’ perceptions of challenges in vaccine communication and training needs: a qualitative study

BackgroundHealthcare professionals (HCPs) can play an important role in encouraging patients and their caregivers to be vaccinated. The objective of this qualitative study was to investigate HCPs’ perspectives on challenges in vaccine communication and unmet training needs in this domain.MethodsSemi-structured interviews were conducted with 41 HCPs (mainly nurses and physicians) with vaccination roles (23 in England; 18 in France), gathering information on: (1) HCPs’ approach to vaccine conversations with patients; (2) Challenges of communicating about vaccines; (3) Vaccine-related training and learning resources available to HCPs, and; (4) HCPs’ training needs around vaccine communication.ResultsHCPs described a range of communication experiences that indicated insufficient time, information, and skills to confidently navigate difficult conversations with vaccine-hesitant patients. Communication skills were especially important to avoid conflict that could potentially damage the patient-provider relationship. Some HCPs interviewed had received communication training, but for most, this training was not specific to vaccination. Although general communication skills were transferable to vaccine conversations, most HCPs welcomed specific training and informational resources to support countering patients’ misconceptions or misinformation about vaccines.ConclusionsHCPs would benefit from training tailored to address vaccine communication with patients, and this should be part of a systemic approach that also provides time and space to have effective vaccine conversations.

Posttranscriptional tuning of gene expression over a large dynamic range in synthetic tobacco chloroplast operons.

Achieving optimally balanced gene expression within synthetic operons requires regulatory elements capable of providing a spectrum of expression levels. In this study, we investigate the expression of gfp reporter gene in tobacco chloroplasts, guided by variants of the plastid atpH 5' UTR, which harbors a binding site for PPR10, a protein that activates atpH at the posttranscriptional level. Our findings reveal that endogenous tobacco PPR10 confers distinct levels of reporter activation when coupled with the tobacco and maize atpH 5' UTRs in different design contexts. Notably, high GFP expression was not coupled to the stabilization of monocistronic gfp transcripts in dicistronic reporter lines, adding to the evidence that PPR10 activates translation via a mechanism that is independent of its stabilization of monocistronic transcripts. Furthermore, the incorporation of a tRNA upstream of the UTR nearly abolishes gfp mRNA (and GFP protein), presumably by promoting such rapid RNA cleavage and 5' exonucleolytic degradation that PPR10 had insufficient time to bind and protect gfp RNA, resulting in a substantial reduction in GFP accumulation. When combined with a mutant atpH 5' UTR, the tRNA leads to an exceptionally low level of transgene expression. Collectively, this approach allows for tuning of reporter gene expression across a wide range, spanning from a mere 0.02-25% of the total soluble cellular protein. These findings highlight the potential of employing cis-elements from heterologous species and expand the toolbox available for plastid synthetic biology applications requiring multigene expression at varying levels.

A new Urbacodon (Theropoda, Troodontidae) from the Upper Cretaceous Iren Dabasu Formation, China: Implications for troodontid phylogeny and tooth biology.

Tooth attachment and replacement play significant roles in the feeding ecology of polyphyodont vertebrates, yet these aspects have remained largely unexplored in non-avialan paravians including troodontids. Here, we describe a new troodontid species, Urbacodon norelli sp.n., recovered from the Upper Cretaceous Iren Dabasu Formation of Inner Mongolia, China, based on an incomplete right dentary and 12 associated replacement teeth. Urbacodon norelli is distinguished from all other known troodontids, including its relative U. itemirensis from Uzbekistan, by several features: the presence of paired dentary symphyseal foramina, the presence of a relatively steep anterior margin of the dentary, the absence of a dentary chin, the presence of a common groove hosting the anterior 12 dentary teeth, and the presence of relatively larger dentary teeth. Phylogenetic analysis places both species of Urbacodon as sister taxa to Zanabazar junior, confirming their status as later-diverging troodontids. Radiographs revealed an alternating tooth replacement pattern in U. norelli, with a maximum Zahnreihen-spacing estimated to be 3. During tooth replacement, the anteriorly inclined interdental septa, which wedge between anterior dentary teeth, underwent frequent remodelling as the developing tooth moved upwards, particularly anterolabially. This rapid turnover left insufficient time for an interdental plate to form, resulting in the absence of such structures in this specimen. The frequent remodelling of periodontal tissues accompanying tooth replacement is likely to account for the absence of interdental plates. The discovery of this new troodontid expands our understanding of paravian theropods from the Upper Cretaceous Iren Dabasu Formation and provides valuable insights into troodontid tooth biology.

Students’ Sports Behavior in the Kahayan River Basin, Palangka Raya City

Sports are movement activities carried out by a person. Sports is an activity that is needed by a person to maintain physical fitness, so that these activities can be carried out optimally. Individuals who have carried out sports activities should be appreciated and made a matter of course, because if humans have done physical activities by exercising which is also accompanied by maintaining a healthy lifestyle, then later it will shape the body to be fit and not easily attacked by diseases that make the body healthy. The purpose of this study is to find out about Student Sports Behavior in the Kahayan River Basin, Palangka Raya City. This study uses a descriptive quantitative method. A total of 278 students living in the Kahayan River watershed were used as samples. The data collection technique in this study is a questionnaire in the form of indirect communication assisted by filling out through google forms. The conclusion obtained from this study is that every day students do sports activities with a minimum duration of 30 minutes in the afternoon. The purpose of students doing sports activities every day is to maintain a healthy body. In addition, there are also sports facilities around their homes, so parents or families always motivate them to do sports activities, especially around the house. At school, the majority of students have participated in extracurricular activities and like to watch sports matches. However, sometimes students are lazy to do sports activities due to insufficient time due to their individual busyness.

Moving from idea to reality: The barriers and enablers to implementing Child and Family Hubs policy into practice in NSW, Australia

BackgroundAdverse childhood experiences can impact physical and mental health throughout the lifespan. To support families experiencing adversity and improve child health and developmental equity, an integrated, multi-sector response is required. Child and Family Hubs (Hubs) are a feasible and acceptable approach to providing such a response. In the Australian context, a number of federal and New South Wales (NSW) state policies support an integrated, multi-sector response using Hubs to support families experiencing adversity. This study examined NSW policy stakeholder and health service manager perspectives on the barriers and enablers to translating policy into practice in the implementation of Child and Family Hubs.MethodsSemi-structured interviews were conducted with 11 NSW government policy stakeholders and 13 community health service managers working in child and family policy and planning or child and family community-based services. Interviews were of 30–60 min duration and explored stakeholder knowledge, perspectives and experiences around childhood adversity, and barriers and enablers to operationalizing policies supporting Hubs. Analysis of barriers and facilitators to implementation of Hub models of care was undertaken using the Consolidated Framework for Implementation Research (CFIR).ResultsKey barriers that emerged included short-term and inconsistent funding, lack of resourcing for a Hub co-ordinator, limited support for evaluation and insufficient time to plan for Hub implementation. Key enablers included flexibility and adaptability of Hub models to meet local needs, formal change management processes, strong governance structures and engagement among Hub practitioners. Key insights included the importance of targeted strategies to support sustained individual practice change and the need for organization-wide commitment to enable the successful adoption and maintenance of the Hub model of care.ConclusionsThis study provides valuable insights and contributes evidence around what is needed to strengthen and support the operationalization and scalability of the Hub model of care. Key recommendations for Hub practitioners include the importance of formal change management processes and establishment of strong governance structures, while key recommendations for policymakers include the need for sustainable Hub funding and a standardized, evidence-based framework to support Hub implementation and evaluation.

Analysis of myopia status and related factors among primary school students in a certain district of Beijing City in 2022

Objective: To analyze the current situation of myopia and its related factors among primary school students in a certain district of Beijing City in 2022, and provide a basis for the risk assessment of myopia among primary school students. Method: In June 2022, a cluster sampling method was used to include 376 third-grade students from a primary school in a certain district of Beijing. A questionnaire survey was conducted to collect basic information about students, including eye usage habits, reading and writing postures, and parents' myopia conditions. The examination of students' distant visual acuity and refractive status was performed. A multivariate logistic regression model was used to analyze the related factors of myopia occurrence. Results: The age of 376 primary school students was (8.87±0.417) years old, with 48.40% (182) being male. A total of 196 myopia cases were identified, with a myopia rate of 52.13%. The results of the multivariate logistic regression model analysis showed that students who sometimes read while lying down (OR=2.003, 95%CI: 1.128-3.555), often read while lying down (OR=18.853, 95%CI: 4.512-78.778), had outdoor activity time less than 120 minutes per day (OR=4.937, 95%CI: 2.4464-9.892), were engaged in indoor break activities (OR=4.995, 95%CI: 2.773-8.996), performed eye exercises less than once per day (OR=8.710, 95%CI: 4.464-16.995), had a reading distance from the book less than 30 cm (OR=5.098, 95%CI: 2.410-10.787), occasionally maintained a fist distance from the edge of the desk (OR=1.918, 95%CI: 1.086-3.385), and had high school desks and tables (OR=5.325, 95%CI: 1.465-19.359) could have a higher risk of myopia occurrence, compared with those who never read while lying down, had outdoor activity time more than 120 minutes per day, maintained outdoor break activities, performed eye exercises more than once per day, had a reading distance from the book more than 30 cm, always maintained a fist distance from the edge of the desk, and had short school desks and tables. Conclusion: The incidence rate of myopia among primary school students in a certain district of Beijing City. in 2022 is relatively high. The occurrence of myopia is related to insufficient outdoor activity time and poor eye usage habits.

Influence of Aeta Education in St. Francis Learning Center at Nibangon Subic, Zambales

The Aeta community is one of the indigenous peoples in the Philippines, and they face challenges in accessing quality education. These challenges include limited school infrastructure and resources, a lack of qualified teachers understanding their cultural context, and socio-economic barriers preventing Aeta children from attending school. Hence, this study explored the perception of Aeta students in their education at St. Francis Learning Center. Specifically, it determined the socio-demographic profile of the participants in terms of year level, gender, age, family members, and socio-economic status; their perception on course descriptions, laboratory experiences, and the quality of academic staff; the factors that influence their decision-making process; and their suggested intervention programs to motivate students to choose the specific Senior High School Strand and college. This study employed a mixed-method research design particularly the explanatory-sequential approach. The participants comprised 10 Aeta Students currently studying at St. Francis Learning Center for the academic year 2024-2025. Results showed that while some students find the course descriptions and teaching methods effective and engaging, others face significant challenges. Scenarios such as teachers being unprepared, insufficient class time, lack of learning materials, and ineffective repetition of lessons point to areas where the educational experience can be improved. Practical utility, economic potential, parental influence, peer relationships, personal interests, career aspirations, and familial roles all play critical roles influence the students’ decision-making processes when choosing their Senior High School tracks.

O-182 To err is human, also for those working in ART

Abstract Medically assisted reproduction (MAR) centers combine clinical and technical expertise with a very high complexity. Over the years, MAR centers have undergone increased intricacy due to incorporating laboratory techniques, such as cryopreservation of oocytes and embryos and micromanipulation, embryo culture, and pre-implantation genetic testing. Not only the technicality of the MAR laboratory profession is challenging, but the complexity of each phase has increased over the years; the patient population undergoing treatment has expanded, where not only the intended parents’ gametes are involved but also the utilization of gametes from egg and sperm donors, as well as including a gestational carrier receiving the embryo. These complexities have led to the implementation of rigorous control measures to mitigate the risk of errors. Nevertheless, a zero-risk fertility clinic is an illusion, given the many necessary interventions and manipulations in each treatment cycle. Errors in fertility practice involving gametes or embryos can be devastating to patients and clinical personnel, often raising psychological, legal, ethical, economic, and practical concerns. The most critical cases of risk of harm in MAR procedures involve misidentifying a patient, gamete, or embryo, called ‘mix-up,’ which could lead to dramatic consequences. Although the frequency is low, mix-up cases have been described worldwide. Other adverse events derive from preventable human actions, e.g., overlooking an embryo when carrying out assessments, dropping a dish, incorrect labeling, improper pipetting technique, unusually poor thawing, and inadvertent discard of the sample. Human error cannot be eradicated. In the old view, human error was perceived as the root cause of problems, with individuals being viewed as variables requiring control. Conversely, contemporary perspectives consider human error a symptom of deeper systemic issues. As suggested by the Institute of Medicine in 2000, which published the report “To Err Is Human,” the core of the problem lies not with the fallibility of healthcare personnel but the flawed systems within which they operate. Preventing errors is possible by incorporating safety into system processes and hospital structures. Latent errors are errors that arise due to system inefficiencies. In the context of MAR, these latent conditions can, amongst others, be work-related pressure, high workload, lack of communication between team members, distraction, a suboptimal setup of the lab, a lack of clarity in the procedures, and insufficient time for thorough communication. In the famous Reason’s Swiss cheese theory of error, these latent conditions are weaknesses (or gaps/ holes) in the system’s defense layers. When all the holes from each layer (i.e., policy, planning, design, communication) align, they will permit an error to cause harm. Understanding the theory of human errors and building safety into various layers of care processes in MAR are effective ways of reducing errors rather than blaming sentinel individuals. Errors within MAR centers can be prevented by designing the healthcare system at all levels to make it safer, making it hard for people to do the wrong thing and easy for people to do the right thing.

Nursing postgraduates learning experience of professional curriculum in China: A qualitative study.

This study adopted the qualitative research method, aiming to explore the learning experience of nursing graduate professional curricula in China from the perspective of students and provided a basis for the continuous improvement of nursing graduate training. A qualitative study. A purposive sampling method was employed to conduct semi-structured in-depth interviews with 14 nursing master's students enrolled in professional curricula from September 03, 2021, to December 8, 2022. The Colaizzi seven-step analysis method was utilized for data analysis, summarization and extraction. Four themes emerged from the study findings: (i) The study of professional curricula is the cornerstone of scientific research work, but it is relatively boring; (ii) The teaching methods and assessment methods of postgraduate education need to be diversified; (iii) The postgraduate education needs to increase the study time of specialized courses and highlight the specialty characteristics; (iv) the study of professional curricula can enhance the comprehensive ability of postgraduate students. The study of professional curricula for post-graduate nursing students plays an important role in the development of post-graduate research and can statistically significant improve their comprehensive ability, but there are some problems such as boring courses, single teaching assessment methods and insufficient time. In the future teaching reform, it is necessary to highlight the specialty characteristics of nursing scientific research, optimize curriculum education and improve students' scientific research knowledge and thinking. We thank all participants for their valuable input throughout the study.

Training Outcomes and Satisfaction in Canadian MD/PhD and MD/MSc Programs: Findings from a National Survey.

Despite the impact of physician-scientists on scientific discovery and translational medicine, several reports have signalled their declining workforce, reduced funding, and insufficient protected research time. Given the paucity of outcome data on Canadian MD/PhD programs, this study presents a national portrait of the sociodemographic characteristics, training trajectories, productivity, and satisfaction in trainees and alumni from Canadian MD/PhD and MD/MSc programs. Quantitative data were collected in a national survey launched in 2021. Respondents included 74 MD/PhD alumni and 121 trainees across 12 Canadian MD/PhD and MD/MSc programs. Among MD/PhD alumni, 51% were independent practitioners/researchers while others underwent residency training. Most trainees (88%) were in MD/PhD programs. Significantly more alumni identified as men than did trainees. Significantly more alumni conducted clinical and health services research, while more trainees conducted basic science research. Average time to MD/PhD completion was 8 years, with no correlation to subsequent research outcomes. Self-reported research productivity was highest during MD/PhD training. Concerning training trajectories, most alumni completed residency, pursued additional training, and practised in Canada. Finally, regression models showed that trainees and alumni were satisfied with programs, with significant moderators in trainee models. Survey findings showed Canadian MD/PhD and MD/MSc programs recruit more diverse cohorts of trainees than before, provide productive research years, and graduate alumni who pursue training and academic employment in Canada. Both alumni and trainees are largely satisfied with these training programs. The need to collect in-depth longitudinal data on Canadian MD/PhD graduates to monitor diversity and success metrics is discussed.

Using bioindicators to inform effective predator management for threatened species protection

AbstractIn Australia, most threatened species translocations conducted into areas where feral predators are present fail to establish viable, self‐sustaining populations despite intensive predator control. These translocations are occurring amidst a lack of understanding regarding the conditions required for native species to survive, including predator densities. This study investigated whether population trends of in situ common species could be used as bioindicators to determine the effectiveness of predator management for threatened species protection. We compared changes in capture rates of four small mammals and four reptile species inside and outside a predator‐proof reserve for 11 years after cat and fox removal to identify which species responded to cat and fox eradication at various time scales. We only used sites inside the reserve where threatened species had not yet been reintroduced to isolate the effects of cat and fox removal. The effectiveness of these bioindicators was then tested at an unfenced reserve where predators were controlled using baiting, trapping, and shooting. There was a significant increase in the abundance of native rodents (spinifex hopping mouse and Bolam's mouse) inside the fenced reserve compared to outside, however, these differences were not detected in the unfenced reserve possibly due to inadequate predator control or insufficient time for in situ species to recover with sustained predator control. Captures of the introduced house mouse were higher at sites inside the fenced reserve in some years, but the difference was not consistent. Native dunnarts and all four reptile species did not respond consistently over the 11‐year time frame at either reserve. Native rodent abundance was the best indicator of effective feral predator control and may provide a useful bioindicator for threatened species management, such as reintroductions.

CCN Activation and Droplet Growth in Pi Chamber Simulations with Lagrangian Particle–Based Microphysics

Abstract Numerical simulations of turbulent moist Rayleigh–Bénard convection driving CCN activation and droplet growth in the laboratory Pi chamber are discussed. Supersaturation fluctuations come from isobaric mixing of warm and humid air rising from the lower boundary with colder air featuring lower water vapor concentrations descending from the upper boundary. Lagrangian particle–based microphysics is used to represent the growth of haze CCN and cloud droplets with kinetic, solute, and surface tension effects included. Dry CCN spectra in the range between 2- and 200-nm radii from field observations are considered. Increasing the total CCN concentration from pristine to polluted conditions results in an increase in the droplet concentration and reduction in the mean droplet radius and spectral width. These are in agreement with Pi chamber observations and numerical simulations, as well as with numerous past studies of CCN cloud-base activation in natural clouds. The key result is that a relatively small fraction of the available CCN is activated in the Pi chamber fluctuating supersaturations, from about a half in the pristine case to only a 10th in the polluted case. The activation fraction as a function of the dry CCN radius is similar in all simulations, close to zero at the CCN small end, increasing to a maximum at CCN radius around 50 nm, and decreasing to close to zero at the large CCN end. This is explained as too small supersaturations to activate small CCN as in natural clouds and insufficient time to allow large CCN reaching the critical radius. Significance Statement Impact of turbulence on the formation and growth of cloud droplets is an important cloud physics problem. Laboratory experiments in the Michigan Technological University cloud chamber provide key insights into this problem. Numerical simulations of cloud chamber processes discussed in this paper complement laboratory experiments by providing insights difficult or impossible to obtain in the laboratory. The study contrasts the formation and growth of cloud droplets in the laboratory cloud chamber with processes taking place in natural clouds. The differences documented in this paper pose questions concerning the impact of turbulence on the formation and growth of cloud droplets as a result of interactions of clouds with their environment.