Proactive Training Research Articles

Mental health of Filipino seafarers and its implications for seafarers' education.

This narrative review examines current academic literature on the mental health of Filipino seafarers working internationally, including the mental health effects of coronavirus disease 2019 (COVID-19). Framed within a rights-based approach, it aims to identify and analyse emerging themes on Filipino seafarers' mental health literature to understand what these studies potentially mean for the improvement of seafarers' education on mental health. Based on a broad selection criteria, 28 eligible papers demonstrate collectively three key findings: firstly, there is paucity in published research on seafarers' mental health; secondly, the majority of published studies are associated with a recent piracy crisis, where a significant number of mariners were attacked, taken as hostages, or killed; thirdly, three key areas emerged under which research on Filipino seafarers' mental health can be organized: the medical repatriation of seafarers, system of care for the mental health of seafarers including the diagnostic standards used, and seafarers' experiences and conceptions of mental health including the mental health effects of COVID-19. Though the bulk of the current understanding of the mental health problems is associated with piracy, several risk factors for which the quality of quantitative and qualitative evidence are patchy. The few sources of primary data to date lack focus on mental health needs which makes it difficult to grasp the extent of the problem. Developing policies and programmes for the promotion of mental health through mental health education among seafarers is important for a couple of reasons. Seafaring remains a dangerous and socially isolating occupation where work-related accidents are likely and will be potentially traumatic to mariners. Research on occupational stressors is increasingly providing evidence of their contributions to poor mental health outcomes among seafarers. Thus, mental health education of seafarers in the context of their work is important for proactive training and development.

Studying students’ opinions as a stage of designing proactive preparation for provid-ing moral education

Introduction. The article is devoted to the problem of taking into account students’ opinions (their attitudes, preferences and suggestions) in preparing future professionals in the social sphere for providing moral education. Traditionally, students are included in the assessment of the implemented degree program in order to evaluate its outcomes, but their capacity to influence the transformation of programs has not been properly investigated. The purpose of this article is to study students’ opinions about their satisfaction with university preparation for providing moral education in order to improve its quality. Materials and Methods. By adopting a systematic approach, the authors have used the following theoretical methods: systemic analysis, synthesis, and modeling. An online survey was conducted to collect empirical data. The study involved 674 undergraduate students (3rd, 4th and 5th years). For the mathematical analysis, Cramer V-test was used. Results. The authors justify the expediency of developing a proactive programme aimed at preparing undergraduates for providing moral education, within the framework of which students are involved in the interaction and transformation of themselves, educational practices and educational environment, responding to urgent tasks and challenges of the future. The study has revealed general satisfaction of students with their preparation for providing moral education, as well as a range of shortcomings. Significantly, there is a correlation between the dissatisfaction with university preparation and proposals for improving it. It is noted that students’ proposals are aimed at changes in all subsystems of proactive training: subject-environmental (ensuring engaged collaboration of stakeholders both on-campus and off-campus); contents (enhancing practical components of the curriculum and ensuring students’ personal development); procedural (using active and interactive teaching methods). However, the implementation of students’ proposals requires collaborative efforts of all the stakeholders who create conditions for the manifestation of students’ subjectivity. At the same time, students’ proposals is a valuable resource for the transition to proactive preparation for providing moral education. The research findings have enabled the authors to clarify the purpose, content, methods of ensuring students’ subject position in proactive preparation for providing moral education. Conclusions. The investigation of students’ opinions has expanded the understanding of risks and opportunities for improving preparation for providing moral education, indicated the significance of proactive training future professionals in the social sphere for providing moral education and the need to ensure the continuing development of students’ subjectivity in the process of studying, implementation, critical analysis and transformation of practical educational activities into interactions with other subjects. The introduction of tools for collaborative thinking and action in the process of practical training will enable students to influence its implementation and improvement.

FUTURE ENGINEERING EDUCATORS’ PROFESSIONAL MOBILITY: CHALLENGES AND OPPORTUNITIES

The paper substantiates the rationale for professional mobility formation in engineering educators. We emphasize the importance of professional mobility as a quality parameter of future engineering educators’ training. The research outlines the main modernization tendencies in engineering and pedagogical education content contributing to future specialists’ professional mobility. The study substantiates the principle of proactive training aimed at making engineering and pedagogical training oriented towards future professional activity of higher professional education seekers. We note that proactive training is crucial in determining educational program content as well as the choice of learning activity organization forms and educational technology for the intensification of engineering and pedagogical training and professional mobility formation.
 Keywords: professional education, engineering and pedagogical education, professional mobility, engineering educator, proactive training, engineering and pedagogical training, professional education content, integrative processes.

An Innovative Model of Behavior Management to Address Behavioral Emergencies in the Acute Medical Inpatient Setting: Pilot Data.

Workplace violence in healthcare is a significant and costly problem. The majority of violent events that occur in the medical inpatient setting are perpetrated by patients against staff and occur during a behavioral emergency. The primary purpose of this study was to evaluate the impact of an innovative model of behavior management on occurrence of behavioral emergencies and staff comfort and competence in managing difficult patient behaviors. This model consists of primary, secondary, and tertiary interventions provided by a clinical psychologist which include proactive training for hospital staff and consultation-liaison services for behavior management. Forty-six staff at the University of Virginia Medical Center completed a 1-h training on preventing and managing difficult patient behavior. Self-report data on comfort and competence in managing challenging patient behaviors was collected at baseline, immediately following the intervention, and one and three months post-intervention. Behavioral emergencies were tracked for the intervention unit and a comparison unit. The occurrence of behavioral emergencies decreased by 50% in the three months following the intervention compared to a 142% increase on the comparison unit. Staff reported the greatest increase in confidence from baseline to three months post-intervention on caring for patients with psychiatric illnesses, managing verbal abuse, being supported by medical center leadership, having clear roles and responsibilities, and effectiveness of the skills and strategies used to manage difficult patient behavior. The results of this study provide preliminary support for the use of a comprehensive model for managing the behavioral needs of medical inpatients.

Social Media and People With Traumatic Brain Injury: A Metasynthesis of Research Informing a Framework for Rehabilitation Clinical Practice, Policy, and Training.

Purpose The aim of the study was to investigate the experiences of people with traumatic brain injury (TBI) and rehabilitation professionals in use of social media after TBI. Design Metasynthesis of a multilevel mixed-methods research design was used in the study. Method A qualitative metasynthesis of (a) evidence in the literature regarding the use of communication technologies and social media after TBI, (b) Twitter data and network analysis, (c) interviews with people with TBI (n = 13), (d) focus groups with TBI rehabilitation professionals (n = 11), and (e) a review of current guidance on safe use of social media was conducted. Results People with TBI adopt a trial-and-error approach to using social media. Their meaningful use and a sense of connection enable them to develop social media mastery. TBI rehabilitation professionals' concerns regarding potential risks associated with using social media might lead them to restrict social media use during rehabilitation. Conclusions Access to proactive training in social media use and a supportive network of rehabilitation professionals, family, and friends can enable people with TBI to develop social media mastery through working collaboratively on social media goals. This metasynthesis of research culminates in an evidence-based protocol for assessing and supporting a person with TBI's social media goals to guide clinical practice and future research in the field.

Challenges facing building code compliance in New Zealand

Ensuring resilience in New Zealand built environment requires regular building code amendments. These amendments have caused some shortfall in complying with the changes. The compliance problems have limited the usefulness of building regulations in the country. This study aims to investigate and explore the challenges facing compliance with the building code amendments and how compliance could be improved. A closed-ended questionnaire was administered to the relevant stakeholders in the building industry to seek their individual opinions on the challenges facing compliance with the changes made to the building code. Some of the challenges considered in this study are within the areas of inadequate compliance features, organisational factors, lack of technical training and assistance, lack of building code enforcement, unforeseen consequences of building code amendment and inadequate awareness following building code changes. This study identified some of the challenges facing compliance with building code. The findings in this study reported a high level of respondents that agreed that complexities in the building code, lack of capacity building among the relevant stakeholder, lack of training need assessment, irregular building code update and lack of awareness. However, the study reported a low proportion of corruption, showing that corruption is not an issue in the New Zealand building control system. Improvement in the training of building code users on how to comply with the changes made to the building code should be considered in the future amendment. The paper concludes that most of the challenges confronting building code compliance could be minimised through proactive training, raising awareness and provision of resourceful technical supports to the code users. Also, the paper recommends that building code amendment process should be utilised to address the identified challenges facing building code compliance while simplifying the code requirements.

Formación de profesores de matemáticas en contextos de diversidad

Se ha reflexionado sobre la importancia de la formación de profesores de matemáticas en los procesos educativos de los estudiantes en contextos de diversidad, de tal manera que se favorezca y superen la visión de instituciones educativas que, marginan del sistema educativo a poblaciones vulnerables. Esta reflexión se realizó como estudiante del Doctorado Interinstitucional en Educación de la Universidad Distrital “Francisco José de Caldas” en la revisión de antecedentes correspondiente al proyecto de investigación que fue de carácter exploratorio con un enfoque mixto y multimetódico. Los procesos de formación son un componente esencial en el desarrollo profesional de los profesores, de ahí el énfasis en las disciplinas de la individualidad y de un trabajo fuera de la escuela a un desarrollo profesional colectivo y desde las instituciones educativas, en el cual se reconozca a cada uno de los estudiantes como sujetos activos en su proceso de formación y transformación proactivos y por ende proponer opciones educativas distintas que posibiliten excelencia de aprendizaje y donde la constante sea eliminar las barreras de todo tipo que pueden limitar su presencia, aprendizaje, participación y promoción en la vida escolar, con particular atención a aquellos más vulnerables, aspecto que responde en parte a las necesidades que se plantean desde una educación inclusiva.

Supportive and palliative care indicators tool (SPICT\u2122): content validity, feasibility and pre-test of the Italian version

BackgroundDifficulties in identifying patients at risk of clinical deterioration or death represent one of the main barriers to Palliative Care (PC) development in the community. Currently, no specific Italian tools aimed at identifying patients with PC needs are available. Of the different European tools available, the SPICT™ can be used easily in any kind of setting and does not include the Surprise Question. The purpose of the study was to translate, cross-culturally adapt and pre-test the Italian version of the SPICT™.MethodsThe Beaton recommendations for the cross-cultural adaptation of instruments were followed. Content validity was assessed using the Lynn method. A sample of Italian General Practitioners (GPs) assessed the SPICT-IT™ for feasibility and tested it.ResultsDuring the cross-cultural adaptation, some issues regarding semantic, experiential, idiomatic and conceptual equivalences were raised and resolved. The Scale-Content Validity Index/Ave was 0.86. Of the 907 GPs included in the sample, 71 (7.8%) agreed to test the SPICT-IT™ and to assess its feasibility. The participants provided care for 73,526 people in the community. Of these people, 1.7% (N = 1303) were identified as being in need of PC according to the SPICT-IT™. Sixty-six (93.0%) GPs stated they would use the SPICT-IT™ in their daily clinical practice.ConclusionsThe SPICT-IT™ demonstrated acceptable content validity. The percentage of patients identified through the SPICT-IT™ was comparable to findings from literature. The next phase of this project will investigate the impact of a proactive training programme aimed at supporting GPs in identifying patients with PC needs and delivering appropriate Primary Palliative Care (PPC).

Customer proactive training vs customer reactive training in retail store settings: Effects on script proficiency, customer satisfaction, and sales volume

Due to the rise of technology and the quest for productivity, retailers continue to expand customer coproduction initiatives and companies therefore need to train customers for their roles during their visit. This research aims to compare the effects of proactive training (before experience and before customer request) vs. reactive training (upon request during the experience) on customers' ability to coproduce (script proficiency), the total sales value per customer, and customer satisfaction. Which is the best solution for training customers? This research proposes three main contributions. First, we define the concepts of proactive and reactive training. Second, this research proposes a new way of measuring coproduction by adopting the company's perspective. Third, with this method, we establish that proactive training is the only type of training that increases script proficiency, which in turn positively influences the total sales value per customer, but not customer satisfaction. However, reactive training is still important to avoid critical situations.

РАЗРАБОТКА ИНТЕГРАТИВНОЙ МОДЕЛИ ОПЕРЕЖАЮЩЕГО ОБУЧЕНИЯ ПЕРСОНАЛА В РАМКАХ РЕАЛИЗАЦИИ НАЦИОНАЛЬНОГО ПРОЕКТА «ПРОИЗВОДИТЕЛЬНОСТЬ ТРУДА И ПОДДЕРЖКА ЗАНЯТОСТИ»

The implementation of the Labor Productivity and Employment Support national project for the period from 2019 to 2024 becomes a priority factor in the growth of labor productivity in enterprises of non-primary sectors of the Russian economy. The project provides for large-scale proactive training of staff of domestic enterprises in innovative methods of managing labor productivity. Proactive training is characterized by a wide range of potential effects, which are often not fully manifested in practice due to the prevalence of a fragmented approach to the development of corporate educational programs and the lack of a holistic understanding among managers of enterprises of the content of the staff training process. The aim of the study is to develop an integrative model of staff proactive training focused on the formation of transdisciplinary competencies necessary to solve complex managerial and economic problems in the field of increasing labor productivity. In the research, the authors used the methodology of an integrative approach to staff training, the methodology of critical thinking, the methodology of system analysis, the method of expert data analysis, and the statistical method. The authors conclude that the elaborated integrative model develops a model of staff competencies in the field of labor productivity management and contributes to a more efficient achievement of the goals of the Labor Productivity and Employment Support national project.

A Team Approach to Commissioning Online MRI-Guided Adaptive Radiotherapy

Magnetic resonance imaging guided adaptive radiation therapy (MRgART) has led to a major paradigm shift resulting in personalized daily patient treatment. Implementing a online MRgART program requires commissioning the adaptive process. This process is performed primarily by medical physicists. In this work, we propose an efficient team approach to the commissioning process. This approach involves dividing different aspects of the verification process among all individuals involved in the adaptive workflow including: qualified medical physicists (QMP), clinical medical dosimetrists (CMD), radiation therapists (RT), and radiation oncologists (RO). Phantom- and volunteer-based commissioning approaches were performed. The phantom based approach is not discussed here. We have implemented a team approach to verifying the ART workflow using volunteers. The commissioning process was divided into the verification of: 1) the treatment planning system (TPS), and 2) the treatment delivery system (TDS). MRI simulations were performed by the RT and images were imported into the TPS by a CMD. Target structures were drawn by a RO. Organ at risk (OAR) structures and structures specific to the ART workflow were drawn by a CMD; including density override and optimization structures. Boolean operations were added to minimize contouring time on the machine. Clinically acceptable plans were then generated by the CMD and reviewed by the QMP; this included verifying contours, Boolean operations, correct electron density override assignment, and appropriate settings. The RO then reviewed the plan quality and approved for delivery. Patient specific QA was then performed by the QMP. The second part was verifying the TDS by simulating a patient treatment. For each volunteer; set-up, image acquisition and registration were performed by the RT and reviewed by the RO. A CMD edited OAR structures followed by RO review. The QMP applied density overrides and Boolean operations who then re-calculated dose on the daily images. The RO reviewed the plan and made a decision on whether to re-optimize. The QMP performed the optimization and a secondary check using a Monte Carlo based algorithm. Volunteers were imaged to commission the adaptive workflow over a week. Daily MR images were acquired and image segmentation was performed. The volunteer approach for commissioning took 2.5 times longer than the phantom based approach. However, the time for commissioning was halved using volunteers with a team based approach. Team members gained more confidence and were better prepared to start the MRgART program. Efficiency was increased when a team approach to commission MRgART program was adapted. This approach served as a proactive training for individuals involved in the adaptive workflow. Patients treated during the initial implementation phase of the adaptive program benefit from this approach due to the confidence and deep understanding of their radiation therapy team.

Community-based health care is an essential component of a resilient health system: evidence from Ebola outbreak in Liberia

BackgroundTrained community health workers (CHW) enhance access to essential primary health care services in contexts where the health system lacks capacity to adequately deliver them. In Liberia, the Ebola outbreak further disrupted health system function. The objective of this study is to examine the value of a community-based health system in ensuring continued treatment of child illnesses during the outbreak and the role that CHWs had in Ebola prevention activities.MethodsA descriptive observational study design used mixed methods to collect data from CHWs (structured survey, n = 60; focus group discussions, n = 16), government health facility workers and project staff. Monthly data on child diarrhea and pneumonia treatment were gathered from CHW case registers and local health facility records.ResultsCoverage for community-based treatment of child diarrhea and pneumonia continued throughout the outbreak in project areas. A slight decrease in cases treated during the height of the outbreak, from 50 to 28% of registers with at least one treatment per month, was attributed to directives not to touch others, lack of essential medicines and fear of contracting Ebola. In a climate of distrust, where health workers were reluctant to treat patients, sick people were afraid to self-identify and caregivers were afraid to take children to the clinic, CHWs were a trusted source of advice and Ebola prevention education. These findings reaffirm the value of recruiting and training local workers who are trusted by the community and understand the social and cultural complexities of this relationship. “No touch” integrated community case management (iCCM) guidelines distributed at the height of the outbreak gave CHWs renewed confidence in assessing and treating sick children.ConclusionsInvestments in community-based health service delivery contributed to continued access to lifesaving treatment for child pneumonia and diarrhea during the Ebola outbreak, making communities more resilient when facility-based health services were impacted by the crisis. To maximize the effectiveness of these interventions during a crisis, proactive training of CHWs in infection prevention and “no touch” iCCM guidelines, strengthening drug supply chain management and finding alternative ways to provide supportive supervision when movements are restricted are recommended.

Risk assessments of work-related musculoskeletal disorders among the TFT-LCD manufacturing operators

The thin film transistor liquid crystal display (TFT-LCD) industry is one of the major industries in Taiwan, yet few studies addressed its work-related musculoskeletal disorders (WMSDs). Thus, this study aims to evaluate the risk of WMSDs among the operators of a TFT-LCD manufacturing company in Taiwan by using the subjective questionnaire and ergonomic assessment tools. First, the NMQ survey was conducted among 393 operators, accounting for 94% of all operators in the TFT-LCD plant. The results showed that the prevalence of WMSDs was 31.8%. Among the various body parts, the highest prevalence of WMSDs was found in neck and shoulders (20.4%), while upper limbs were with the lowest prevalence (9.2%). Besides, the prevalence of WMSDs tends to be affected by both work factors and operator factors. Those who were more experienced, working in day shift and involved in the Array process tend to have a higher prevalence of WMSDs. Further, female and domestic operators reported a higher prevalence of WMSDs than male and foreign operators. Moreover, the jobs of 50 employees were analyzed using ergonomic assessment tools including OSHA MSDs, BRIEF, OWAS, 3D SSPP, and NIOSH lifting equation. The findings indicated that inadequate working height, restricted working space, awkward postures, overweight load, and high repetition were the major risk factors of WMSDs. Thus, countermeasures such as redesigning the workstations and material handling carts, proactive training of manual material handling, and providing safety clearance are recommended to enhance the occupational health and safety of the TFT-LCD operators.

Agri-form: an innovative training model for safety in the agriculture and forestry sector

The following work offers and proposes the methodological foundations to develop a pro active and specific training model for the needs of the agricultural sector. The model was developed from a stage of gathering of information regarding the needs in the agricultural sector and adding to this what legal obligations which define a road map that can provide an efficient training programme for safety at work. After 2 years of experimentation the results achieved enable the model to be validated and also transferred and extended to similar sectors such as fishing and forestry.

Proactive training system for safe and efficient precast installation

The construction industry is a crucial component of the Hong Kong economy, and the safety and efficiency of workers are two of its main concerns. The current approach to training workers relies primarily on instilling practice and experience in conventional teacher–apprentice settings on and off site. Both have their limitations however, on-site training is very inefficient and interferes with progress on site, while off-site training provides little opportunity to develop the practical skills and awareness needed through hands-on experience. A more effective way is to train workers in safety awareness and efficient working by current novel information technologies. This paper describes a new and innovative prototype system — the Proactive Construction Management System (PCMS) — to train precast installation workers to be highly productive while being fully aware of the hazards involved. PCMS uses Chirp-Spread-Spectrum-based (CSS) real-time location technology and Unity3D-based data visualisation technology to track construction resources (people, equipment, materials, etc.) and provide real-time feedback and post-event visualisation analysis in a training environment. A trial of a precast facade installation on a real site demonstrates the benefits gained by PCMS in comparison with equivalent training using conventional methods. It is concluded that, although the study is based on specific industrial conditions found in Hong Kong construction projects, PCMS may well attract wider interest and use in future.

Acquiring Procedural Skills in ICUs

Providing appropriate training of procedural skills to residents while ensuring patient safety through trainee supervision is a difficult and constant challenge. We sought to determine how effective and safe procedural skill acquisition is in French ICUs and to identify failure and complication risk factors. Multicenter prospective observational study. Invasive procedures performed by residents were recorded during two consecutive semesters. Eighty-four residents. Eighty-four residents. None. Number of invasive procedures performed, failure and complication rates, supervision, and assistance provided. Five thousand six hundred seventeen procedures were prospectively studied: 1,007 tracheal intubations, 1,272 arterial and 2,586 central venous catheter insertions, 457 fiberoptic bronchoscopies, and 295 chest tube insertions. During the semesters, residents performed a median of 10 intubations, 14 arterial catheter insertions, and 26 central venous catheter insertions. Complication rates were low, similar to those in the literature: 8.6% desaturation and 7.4% esophageal placement during intubation; 0.4% and 2.3% pneumothorax with jugular and subclavian central venous catheter insertions, respectively. We identified risk factors for failure and complications. Higher rates of failure and complications for intubation were associated with residents with no or little previous experience (p < 0.001); failure of internal jugular vein catheterization was associated with left-side insertion (p = 0.005) and absence of mechanical ventilation (p = 0.007). Supervision and assistance were more frequent at the beginning of the semester and for intubation and chest tube insertion. Finally, residents had less access to fiberoptic bronchoscopy and chest tube insertion. Procedural skills acquisition by residents in the ICU appears feasible and safe with complication rates comparable to what has previously been reported. We identified specific procedures and situations associated with higher failure and complication rates that could require proactive training. Questions still remain regarding minimal numbers of procedures to attain competence and how best to provide procedural training.

Voice Problems of Group Fitness Instructors: Diagnosis, Treatment, Perceived and Experienced Attitudes and Expectations of the Industry

To determine the anatomical and physiological nature of voice problems and their treatment in those group fitness instructors (GFIs) who have sought a medical diagnosis; the impact of voice disorders on quality of life and their contribution to activity limitations and participation restrictions; and the perceived attitudes and level of support from the industry at large in response to instructor's voice disorders and need for treatment. Prospective self-completion questionnaire design. Thirty-eight individuals (3 males and 35 females) currently active in the Australian fitness industry who had been diagnosed with a voice disorder completed an online self-completion questionnaire administered via SurveyMonkey. Laryngeal pathology included vocal fold nodules (N = 24), vocal fold cysts (N = 2), vocal fold hemorrhage (N = 1), and recurrent chronic laryngitis (N = 3). Eight individuals reported vocal strain and muscle tension dysphonia without concurrent vocal fold pathology. Treatment methods were variable, with 73.68% (N = 28) receiving voice therapy alone, 7.89% (N = 3) having voice therapy in combination with surgery, and 10.53% (N = 4) having voice therapy in conjunction with medication. Three individuals (7.89%) received no treatment for their voice disorder. During treatment, 82% of the cohort altered their teaching practices. Half of the cohort reported that their voice problems led to social withdrawal, decreased job satisfaction, and emotional distress. Greater than 65% also reported being dissatisfied with the level of industry and coworker support during the period of voice recovery. This study identifies that GFIs are susceptible to a number of voice disorders that impact their social and professional lives, and there is a need for more proactive training and advice on voice care for instructors, as well as those in management positions within the industry to address mixed approaches and opinions regarding the importance of voice care.

Motivating and assisting physical exercise in independently living older adults: A pilot study

BackgroundWith age reaction time, coordination and cognition tend to deteriorate, which may lead to gait impairments, falls and injuries. To reduce this problem in elderly and to improve health, well-being and independence, regular balance and strength exercises are recommended. However, elderly face strong barriers to exercise. ObjectiveWe developed Active Lifestyle, an IT-based system for active and healthy aging aiming at improving elderly's balance and strength. Active Lifestyle is a proactive training application, running on a tablet, which assists, monitors and motivates elderly to follow personalized training plans autonomously at home, while integrating them socially. The objective is to run a pilot study to investigate: (i) the feasibility of assisting the autonomous, physical training of independently living elderly with the Active Lifestyle system, (ii) the adherence of the participants to the training plans, and (iii) the effectiveness of the motivation instruments built into the system. MethodsAfter three introductory meetings, 13 elderly adults followed personalized two-weeks strength and balance training plans using the Active Lifestyle app autonomously at home. Questionnaires were used to assess the technological familiarity of the participants, the feasibility aspects of the physical intervention, and the effectiveness of the motivation instruments. Adherence to the exercise plan was evaluated using the performance data collected by the app during the study. ResultsA total of 13 participants were enrolled, of whom 11 (85%) completed the study (mean age 77±7 years); predominantly females (55%), vocational educated (64%), and their past profession requiring moderate physical activity (64%). The Active Lifestyle app facilitated autonomous physical training at home (median=7 on a 7-point Likert scale), and participants expressed a high intention to use the app also after the end of the study (median=7). Adherence with the training plans was 73% (89% on the balance exercises and 60% on the strength exercises). The outcome from our questionnaires showed that without the app the participants did not feel motivated to perform exercises; with the support of the app they felt more motivated (median=6). Participants were especially motivated by being part of a virtual exercise group and by the capability to automatically monitor their performance (median=6 for both). ConclusionsThis study shows that the Active Lifestyle app prototype has valuable potential to support physical exercise practice at home and it is worthwhile to further develop it into a more mature system. Furthermore, the results add to the knowledge base into mobile-based applications for elderly, in that it shows that elderly users can learn to work with mobile-based systems. The Active Lifestyle app proved viable to support and motivate independently living elderly to autonomously perform balance and strength exercises.

TPM: High Quality International Training Program in Organ and Tissue Donation

Background: Knowledge transfer and development of professional competences in organ donation are key factors to maximize donor potentiality and conversion rates. Launched in 1991 under the auspice of the Universitat de Barcelona (UB) and with the support of the Organización Nacional de Trasplantes (ONT), Transplant Procurement Management (TPM) acquired soon an international dimension, due to the increasing demand in deceased donation programs. Methods: TPM applies the “Learning by doing” proactive training (D. Kolb) proved to increase the knowledge retention rate up to 75%. It uses face-to face, on-line and blended learning modalities and covers all the main scientific and technical aspects of organ and tissue donation. It counts with a wide network of international experts and the academic endorsement of the University of Barcelona, offering specialization certification, post-graduate diplomas and master degrees. It organizes yearly advanced courses in Spanish, English, Italian, French and Portuguese and when required, courses are adapted to local educational needs, language, legislation and current medical practice. TPM has designed and constantly updated its course contents developing a wide range of educational material such as: manuals, software and technical equipment for practical sessions. Results: TPM organized 184 face-to-face training courses (93 advanced, 32 intermediate and 59 introductory) and 40 on-line and/or blended learning editions as following: 8 Donor Detection System, 8 Brain Death Diagnosis, 6 Family Approach for Organ Donation, 3 Donor Management and Organ Viability, 3 Organ Retrieval, Preservation and Allocation Criteria, 9 Tissue Banking, 2 Training for Trainers and 1 Professional Training in Organ Donation. It has also organized 8 master editions. Out of the total of 8929 participants from 102 countries, 7876 attended the face to face courses and 1053 the on-line/blended training. Moreover, TPM encouraged the Training for Trainers participants to maximize the opportunity to disseminate knowledge in organ donation by carrying out Essentials on Organ Donation seminars. As a result, 91 seminars have been carried out and 5088 healthcare professionals trained from 11 different countries from Europe and Asia. Conclusions: Although multifactor approaches are needed to tackle organ donation, training of professionals is highlighted as a major factor in improving the number and quality of organs and tissues for transplantation. TPM provides demand-driven, high quality training that facilitates the transfer of knowledge and the development of professional competences as well as excellent framework for worldwide networks of donation professionals.

Deliberations and recommendations of the Pediatric Emergency Mass Critical Care Task Force: Executive summary

Despite difficult challenges during responses to the terrorist attacks of September 11, 2001, Hurricane Katrina, and the 2009 Pandemic Influenza A/H1N1 and severe acute respiratory syndrome outbreaks, no North American emergency to date has overwhelmed intensive care unit (ICU) services on a widespread basis since the modern development of the field of critical care. However, planners have recognized that in a future public health emergency we may not be so fortunate. To deal with very large emergencies involving many patients whose survival depends on immediate access to intensive care, an international Task Force for Mass Critical Care proposed recommendations in January 2007 to extend critical care resources for the adult population, referred to as the Emergency Mass Critical Care (EMCC) approach (1–5). The EMCC approach triples critical care capabilities for a period of up to 10 days in a very large public health emergency by focusing on immediately lifesaving interventions, while delaying or forgoing less urgent care. Crisis standards of care in a large public health emergency would attempt to optimize population outcomes, rather than use unlimited efforts to maximize survival of each individual. Available resources would be substituted or adapted for equivalent or nearly equivalent unavailable resources. Resources would be conserved, reused, and reallocated to those patients most likely to benefit from them. Modest increases in stockpiles and major changes in the organization of care would be essential. While planners in the field acknowledge that mass critical care is a reasonable concept, we lack evidence that such an approach is feasible. However, failure to begin operational planning for mass critical care guarantees a failed response. As public health emergency planners begin to consider the EMCC framework, it is urgent that pediatric implications be detailed for integration into these developing plans. This supplement represents the discussions of a multidisciplinary panel convened by the Oak Ridge Institute for Science and Education (supported financially by the Centers for Disease Control and Prevention), and provides guidance for pediatric EMCC (PEMCC). Work of the PEMCC Task Force was directed by a 17-member Steering Committee selected on the basis of their expertise and experience, and included representatives from the Task Force for Mass Critical Care, World Federation of Pediatric Intensive and Critical Care Societies, American Academy of Pediatrics, American College of Critical Care Medicine, American College of Emergency Medicine, Royal College of Physicians (Canada), and National Commission on Children and Disasters, as well as several unaffiliated disaster preparedness experts. This Steering Committee led development of all manuscripts and selected individuals for the PEMCC Task Force. The full PEMCC Task Force comprised 44 experts from fields including bioethics, pediatric critical care, pediatric trauma and surgery, neonatology, obstetrics, general pediatrics, emergency medicine, pediatric emergency medicine, disaster preparedness and response, emergency medical services (EMS), infectious diseases, toxicology, military medicine, nursing (including critical care nursing), pharmacy, veterinary medicine, information sciences, public health law, maternal and child public health, and local, state, and federal government emergency planning and response agencies. Priority topics were organized on the basis of MEDLINE and Ovid database literature searches, bibliographies, state and federal government planning documents, after-action reports of recent medical responses to catastrophes, and through participation in local, state, and federal government working groups on hospital and disaster preparedness. Where evidence was available, it was utilized in formulating recommendations. Where evidence was lacking, recommendations represent expert opinion. Wherever possible, recommendations are consistent with and easily integrated into prior recommendations of the adult Task Force for Mass Critical Care. The Steering Committee produced draft outlines by synthesizing information obtained in the evidence-gathering process and convened October 6–7, 2009, to review and Vice President, Medical Affairs, British Columbia Children’s Hospital and Sunny Hill Health Centre; BCCH and UBC Global Child Health, Department of Paediatrics and Emergency Medicine, University of British Columbia, Child and Family Research Institute, Vancouver, British Columbia, Canada. The Pediatric Emergency Mass Critical Care Task Force meeting was supported, in part, by the Centers for Disease Control and Prevention. Disclaimer: The views expressed in this article are those of the authors and do not represent the official position of the Centers for Disease Control and Prevention. The author has not disclosed any potential conflicts of interest. For information regarding this article, E-mail: nkissoon@cw.bc.ca Copyright © 2011 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies