Training Background Research Articles

The long and the short of pediatric emergency department antibiotic prescribing: A retrospective observational study

BackgroundMost antibiotics prescribed to children are provided in the outpatient and emergency department (ED) settings, yet these prescribers are seldom engaged by antibiotic stewardship programs. We reviewed ED antibiotic prescriptions for three common infections to describe current prescribing practices. MethodsPrescription data between 2018 and 2021 were extracted from the electronic records of children discharged from the Children's Hospital of Eastern Ontario ED with urinary tract infection (UTI), community acquired pneumonia (CAP), and acute otitis media ≥2 years of age (AOM). Antibiotic choice, duration, as well as the provider's time in practice and training background were collected. Antibiotic durations were compared with Canadian guideline recommendations to assess concordance. Provider-level prescribing practices were analyzed using k-means cluster analysis. Results10,609 prescriptions were included: 2868 for UTI, 2958 for CAP, and 4783 for AOM. Guideline-concordant durations prescribed was generally high (UTI 84.9%, CAP 94.0%, AOM 52.8%), a large proportion of antibiotic-days prescribed were in excess of the minimally recommended duration for each infection (UTI 16.8%, 19.3%, AOM 25.5%). Cluster analysis yielded two clusters of prescribers, with those in one cluster more commonly prescribing durations at the lower end of recommended interval, and the others more commonly prescribing longer durations for all three infections reviewed. No statistically significant differences were found between clusters by career stage or training background. ConclusionsWhile guideline-concordant antibiotic prescribing was generally high, auditing antibiotic prescriptions identified shifting prescribing towards the minimally recommended duration as a potential opportunity to reduce antibiotic use among children for these infections.

Differences in race history by distance of recreational endurance runners from The NURMI Study (Step 2)

Few studies were developed to understand the relationship between running characteristics and motivation. The purpose of this study was to assess the relationship between running event history, running experience, and best race performances in recreational distance runners. We used a web survey to obtain information regarding running experience, racing history, and periodization training routines/exercise habits, including weekly volumes and daily mileage and duration across periods and conditions. Associations between variables were conducted with the Chi-square test (χ2; nominal scale) and Wilcoxon test. Multiple linear regression analysis and multivariate linear regression were performed. Concerning the participants’ motive for exercising, a significant difference was identified between the race distance subgroups (p < 0.001), where 58% of M/UM runners exercised for performance (n = 38) and 64% of HM runners (n = 57) and 57% of 10 km runners (n = 52) exercised for recreational purposes. A significant difference was found in the number of years of running completed without taking a break (p = 0.004), with marathoners/ultramarathoners reporting the most years. Runners competing in different race distances such as 10 km, half-marathon, marathon, and ultra-marathon presented differences in training background and habits according to the distance of preference.

ChatGPT 활용 교육에 대한 현장 교사의 인식 연구

Objectives The purpose of this study is to explore the direction of ChatGPT utilization in education for fostering future talents by analyzing teachers’ perceptions of ChatGPT awareness and its application in education. Methods A survey was conducted with 141 teachers as participants. The questionnaire was developed based on relevant prior studies and modified for improvement. The collected survey data were subjected to descriptive statistical analysis, independent samples t-test, and ANOVA analysis using SPSS 27 software. Additionally, word frequency analysis was conducted using Python 3 programming language. Results First, significant differences were found in the understanding of concepts and ethical issues related to ChatGPT based on teachers' experience, training, and educational background. Male teachers showed a higher understanding of ChatGPT compared to female teachers. Second, an analysis of the images associated with ChatGPT revealed the key keywords in order of frequency as follows: ‘Artificial Intelligence (AI)’, ‘questions’ and ‘answers’. Third, the analysis of criticisms and concerns about ChatGPT showed that 72.3% of teachers had critical views on utilizing ChatGPT in education. The identified keywords and frequency analysis of the concerns were ‘students’, ‘information’, ‘abilities’, ‘utilization’ and ‘ethics’. Fourth, the analysis of ChatGPT training showed that 88.7% of teachers expressed a desire for future ChatGPT training. The key keywords for desired training topics were ‘utilization’, ‘methods’, ‘lessons’, and the preferred training methods were remote training, face-to-face training, and self-paced learning using media. Conclusions To improve teacher perception of ChatGPT in education and boost their understanding, practical teacher training on ChatGPT should be offered. Furthermore, developing an educational program and usage manual for ChatGPT is essential. This study provides crucial data by analyzing teacher perceptions, facilitating ChatGPT's educational integration.

Influence of Intensity on Post-Running Jump Potentiation in Recreational Runners vs. Physically Active Individuals.

The aim of this study was to verify post-activation performance enhancement (PAPE) in jumping and sprinting after two endurance volume-equated running protocols with different intensities, in runners vs. active individuals. Nine recreational runners (age: 34.5 ± 9.3 years, body mass: 73.1 ± 11.9 kg, body height: 1.76 ± 0.06 m, 17.4 ± 4.4 %body fat; maximum aerobic speed [MAS]: 16.4 ± 1.0 km•h-1), and 9 active individuals (age: 34.1 ± 9.4 years; body mass: 83.2 ± 7.7 kg; body height: 1.79 ± 0.06 m; 25.6 ± 5.4 %body fat; MAS: 13.3 ± 1.2 km•h-1) volunteered for participation. The evaluations were performed over three days as follows: 1) anthropometric measures, physical fitness tests, and the University of Montreal Track Test (UMTT) to determine MAS and the distance to be covered in the running protocols; 2 and 3) the countermovement jump (CMJ) and the flying 20-m sprint (SPRINT) were assessed pre- and post-running at 70% of MAS or a time trial race (TTR), equated by volume and completed in random order. A three-way ANOVA (time*group*running) was performed to analyze the PAPE effects. The results showed a time effect (F = 10 .716; p < 0.01) and a group*running interaction (F = 12.094; p < 0.01) for the CMJ, indicating that active individuals demonstrated PAPE after running at 70% of MAS, while for runners both running interventions (70% of MAS and TTR) induced PAPE in CMJ performances. For the SPRINT, a time*group interaction (F = 4.790; p = 0.044) and a group effect were observed, with runners showing greater SPRINT performances than active individuals. From the current results, it can be suggested that training background and intensity can modulate PAPE responses in jumping and sprinting after volume-equated running protocols at different intensities.

Clinical aspects of virtual reality technologies application in cognitive rehabilitation of patients with cardiovascular diseases

This analytical review considers the clinical aspects of the application of virtual reality (VR) technologies in the cognitive rehabilitation of patients with cardiovascular diseases. It is shown that VR-training is one of the actively developing rehabilitation methods. Its use has great potential for the treatment of cognitive disorders of a wide range (stroke, vascular cognitive disorders, cardiac surgery patients). Promising in the development of personalized approach in the cognitive rehabilitation of cardiac patients is the estimation of the initial level of cognitive reserve as an indicator of the possible activation of neuroplastic processes against the background of cognitive training using a virtual environment.

Discretionary decision making in child welfare – An experimental vignette study of the use of interpreter services

This paper focuses on child welfare workers’ discretionary decision making. They can rely on routines, procedures and manuals as part of their work, but in the end, they still have to make a choice, based on the available information at the time. Discretionary decision making is a way of reasoning when facing uncertainty in professional work and when laws, rules and systematic knowledge must be applied in specific cases. A larger body of research on discretion and discretionary decision making in social work has developed, but there remains much ground to cover in terms of empirical analyses of how discretionary processes play out in real-life contexts.The two main research questions ask how the characteristics of each child and context and of social workers and their work situation affect the latter’s decision to use interpreter services in their work with unaccompanied minors and children from minority backgrounds. The decision to use or not to use interpreter services in different situations, as an act of discretionary decision making by child welfare workers, is analysed in this paper. To study discretionary decision making among child welfare workers, a combination of a traditional survey and a vignette experiment has been used, bringing together organisational features, individual traits and situational characteristics. The findings indicate that interpreter services are less likely to be used in acute situations and more likely to be used with the children whom the child welfare staff members know better, irrespective of the children’s language skills. The analyses also show varying effects of the staff’s training and educational backgrounds, and surprisingly, the negative effects of institutional guidelines. One possible interpretation of this is that the guidelines are perceived as rigid constraints, instead of positive recommendations for actions.

How Does the Jumping Performance Differs between Acrobatic and Rhythmic Gymnasts?

An increased jumping performance is key for gymnastics competition routines. Rhythmic gymnasts (RGs) use the jump as one of the main body elements. In Acrobatic Gymnastics (ACRO), top gymnasts must coordinate their jumps with the impulse provided by base gymnast(s). It is expected that the gymnasts’ discipline and role played impact their jumping skill. This work aims to investigate how the jumping performance differs between ACRO gymnasts and RGs, focusing on the Force–Velocity (F-V) profile mechanical variables. Gymnasts were divided in three groups: ACRO tops (n = 10, 13.89 (3.62) median (interquartile interval) years old), ACRO bases (n = 18, 18.24 (4.41) years old) and RGs (n = 15, 12.00 (3.00) years old). The F-V profile during countermovement jump and its mechanical variables were evaluated using MyJump2. A training background survey and anthropometric assessments were conducted. The significance level was set at p ≤ 0.05. Group comparisons showed that ACRO bases jump higher than ACRO tops and RGs, present a higher maximal force than RGs and a more balanced F-V profile, while RGs present high force deficits. Coaches can use this data to develop interventions that optimize the training stimulus to different gymnastics disciplines considering the individual characteristics and adaptability of each gymnast.

The effect of musical training and language background on vocal imitation of pitch in speech and song.

Vocal imitation plays a critical function in the development and use of both language and music. Previous studies have reported more accurate imitation for sung pitch than spoken pitch, which might be attributed to the structural differences in acoustic signals and/or the distinct mental representations of pitch patterns across speech and music. The current study investigates the interaction between bottom-up (i.e., acoustic structure) and top-down (i.e., participants' language and musical background) factors on pitch imitation by comparing speech and song imitation accuracy across four groups: English and Mandarin speakers with or without musical training. Participants imitated pitch sequences that were characteristic of either song or speech, derived from pitch patterns in English and Mandarin spoken sentences. Overall, song imitation was more accurate than speech imitation, and this advantage was larger for English than Mandarin pitch sequences, regardless of participants' musical and language experiences. This effect likely reflects the perceptual salience of linguistic tones in Mandarin relative to English speech. Music and language knowledge were associated with optimal imitation of different acoustic features. Musicians were more accurate in matching absolute pitch across syllables and musical notes compared to nonmusicians. By contrast, Mandarin speakers were more accurate at imitating fine-grained changes within and across pitch events compared to English speakers. These results suggest that different top-down factors (i.e., language and musical background) influence pitch imitation ability for different dimensions of bottom-up features (i.e., absolute pitch and relative pitch patterns). (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Assessing Knowledge, Perception, and Management Toward Traumatic Tooth Avulsion Among Dentists in Jeddah, Saudi Arabia: A Cross-Sectional Study.

The long-term prognosis of teeth that have experienced traumatic avulsion is highly dependent on appropriate and prompt emergency management taken immediately after the avulsion. The main goal in the treatment of traumatic permanent tooth avulsion is to replant as soon as possible in its correct anatomical position to maintain the viability of the periodontal ligament and neurovascular supply while restoring aesthetic and preserving the functional integrity of the tooth. General dentists can deal properly with emergency cases, such as tooth avulsion, and also should be aware of appropriate management to take care of avulsions and to determine the prognosis especially since such incidents often occur at times when dental professionals are least prepared to address them. The primary aim of this study was to evaluate the knowledge of dentists who are working in various hospitals, clinics, and dental schools in Jeddah, Saudi Arabia, with respect to traumatic permanent tooth avulsion and the appropriate methods for its management. The study design is a cross-sectional study with dentists working in various clinical settings in Jeddah, Saudi Arabia.The questionnaire used in the study consists of a total of 19 items: nine items about demographic data, including training background, and 10 multiple-choice questions regarding dental trauma and its management. Higher dental education and post-graduate training gave the dentists better judgment in dealing with dental emergencies compared to general dentists. Thus, the recommendation of this study is to include the comprehensive treatment of avulsion emergencies in the dental school curriculums and increase the exposure of dental students to such cases.

Static versus dynamic stretching; short term effects on physical performance in non-athletes- a randomized clinical trial

Background: Non-athletes have varying fitness levels, muscle characteristics, and training backgrounds, which can affect how different types of stretching exercises impact their physical performance. Objective: to compare the acute effects of static and dynamic stretching on physical performance of non-athletes. A single-blinded, cross-over, randomized clinical trial was conducted at Iqra National University, Peshawar for a period of 6 months. A total of n=54 male participants were randomly allocated into group A and B. Group A performed the static stretching while group B performed dynamic stretching. The physical performance measure was endurance, agility, strength, flexibility, and balance respectively. Result: The result of two-way RMANOVA showed that both stretches had significant interaction effects between interventions and all performance measures (p&lt;0.001) except for balance (p=0.23). The main effect showed that static stretching significantly reduced agility and balance (p&lt;0.05), while dynamic balance improved all measures significantly (p&lt;0.05). When comparing the mean differences of all variables, dynamic stretches showed significant improvement (p&lt;0.05) in all variables as compared to static stretching. Conclusion: Dynamic stretch has a significant contribution to improving all physical performance measures among non-athletes if incorporated before the activity. While static stretching negatively affects the agility and balance among this population. (NCT05053490) Keywords: agility; balance; dynamic stretching; endurance; flexibility; non-athletes; physical performance; static stretching.

Specialty Impact on Patient Outcomes: Paving a Way for an Integrated Approach to Spinal Disorders.

Spinal surgical procedures are steadily increasing globally due to broad indications of certain techniques encompassing a wide spectrum of conditions, including degenerative spine disorders, congenital anomalies, spinal metastases, and traumatic spinal fractures. The two specialties, neurosurgery (NS) and orthopedic surgery (OS), both possess the clinical adeptness to perform these procedures. With the advancing focus on comparative effectiveness research, it is vital to compare patient outcomes in spine surgeries performed by orthopedic surgeons and neurosurgeons, given their distinct approaches and training backgrounds to guide hospital programs and physicians to consider surgeon specialty when making informed decisions. Our review of the available literature revealed no significant difference in postoperative outcomes in terms ofblood loss, neurological deficit, dural injury, intraoperative complications, and postoperative wound dehiscence in procedures performed by neurosurgeons and orthopedic surgeons. An increase in blood transfusion rates among patients operated by orthopedic surgeons and a longer operative time of procedures performed by neurosurgeons was a consistent finding among several studies. Other findings include aprolonged hospital stay, higher hospital readmission rates, and lower cost of procedures in patients operated on by orthopedic surgeons. A few studies revealed lower sepsis rates unplanned intubation ratesandhigher incidence of urinary tract infections (UTIs) and pneumonia postoperatively among patient cohorts operated by neurosurgeons. Certain limitations were identified in the studies including the use of large databases with incomplete information related to patient and surgeon demographics. Hence, it is imperative to account for these confounding variables in future studies to alleviate any biases. Nevertheless, it is essential to embrace a multidisciplinary approach integrating the surgical expertise of the two specialties anddevelop standardized management guidelines and techniques for spinal disorders to mitigate complications and enhance patient outcomes.

Exploring Competency-Based Medical Education Through the Lens of the UME-GME Transition: A Qualitative Study.

Competency-based medical education (CBME) represents a shift to a paradigm with shared definitions, explicit outcomes, and assessments of competence. The groundwork has been laid to ensure all learners achieve the desired outcomes along the medical education continuum using the principles of CBME. However, this continuum spans the major transition from undergraduate medical education (UME) to graduate medical education (GME) that is also evolving. This study explores the experiences of medical educators working to use CBME assessments in the context of the UME-GME transition and their perspectives on the existing challenges. This study used a constructivist-oriented qualitative methodology. In-depth, semistructured interviews of UME and GME leaders in CBME were performed between February 2019 and January 2020 via Zoom. When possible, each interviewee was interviewed by 2 team members, one with UME and one with GME experience, which allowed follow-up questions to be pursued that reflected the perspectives of both UME and GME educators more fully. A multistep iterative process of thematic analysis was used to analyze the transcripts and identify patterns across interviews. The 9 interviewees represented a broad swath of UME and GME leadership positions, though most had an internal medicine training background. Analysis identified 4 overarching themes: mistrust (a trust chasm exists between UME and GME); misaligned goals (the residency selection process is antithetical to CBME); inadequate communication (communication regarding competence is infrequent, often unidirectional, and lacks a shared language); and inflexible timeframes (current training timeframes do not account for individual learners' competency trajectories). Despite the mutual desire and commitment to move to CBME across the continuum, mistrust, misaligned goals, inadequate communication, and inflexible timeframes confound such efforts of individual schools and programs. If current efforts to improve the UME-GME transition address the themes identified, educators may be more successful implementing CBME along the continuum.

Factors Influencing Surgical Decision-Making in the Posterior Laminectomy With Fixation for Degenerative Cervical Myelopathy (POLYFIX-DCM) Trial: Survey Study.

Degenerative cervical myelopathy (DCM) is estimated to affect 2% of the adult population. DCM occurs when degenerative processes cause compression and injure the spinal cord. Surgery to remove the stress caused by the compression of the spinal cord is the mainstay of treatment, with a range of techniques in use. Although various factors are described to inform the selection of these techniques, there needs to be more consensus and limited comparative evidence. The main objective of this survey was to explore the variation of practice and decision-making, with a focus on laminectomy versus laminectomy and fusion in posterior surgery of the cervical spine. We present the results of a survey conducted among the principal investigators (PIs) of the National Institute for Health and Care Research (NIHR) randomized controlled trial on posterior laminectomy with fixation for degenerative cervical myelopathy (POLYFIX-DCM). A series of 7 cases were shared with 24 PIs using SurveyMonkey. Each case consisted of a midsagittal T2-weighted magnetic resonance imaging and lateral cervical x-rays in flexion and extension. Surgeons were asked if their preferred approach was anterior or posterior. If posterior, they were asked whether they preferred to instrument and whether they had the equipoise to randomize in the NIHR POLYFIX-DCM trial. Variability in decision-making was then explored using factors reported to inform decision-making, such as alignment, location of compression, number of levels operated, presence of mobile spondylolisthesis, and patient age. The majority of PIs (16/30, 53%) completed the survey. Overall, PIs favored a posterior approach (12/16, 75%) with instrumentation (75/112, average 66%) and would randomize (67/112, average 62%) most cases. Factors reported to inform decision-making poorly explained variability in responses in both univariate testing and with a multivariate model (R2=0.1). Only surgeon experience of more than 5 years and orthopedic specialty training background were significant predictors, both associated with an anterior approach (odds ratio [OR] 1.255; P=.02 and OR 1.344; P=.007, respectively) and fusion for posterior procedures (OR 0.628; P<.001 and OR 1.344; P<.001, respectively). Surgeon experience also significantly affected the openness to randomize, with those with more than 5 years of experience less likely to randomize (OR -0.68; P<.001). In this representative sample of spine surgeons participating in the POLYFIX-DCM trial as investigators, there is no consensus on surgical strategy, including the role of instrumented fusion following posterior decompression. Overall, this study supports the view that there appears to be a clinical equipoise, and conceptually, a randomized controlled trial appears feasible, which sets the scene for the NIHR POLYFIX-DCM trial.

Academic anaesthesiology: a global perspective on training, support, and future development of early career researchers

As anaesthesiologists face increasing clinical demands and a limited and competitive funding environment for academic work, the sustainability of academic anaesthesiologists has never been more tenuous. Yet, the speciality needs academic anaesthesiologists in many roles, extending beyond routine clinical duties. Anaesthesiologist educators, researchers, and administrators are required not only to train future generations but also to lead innovation and expansion of anaesthesiology and related specialities, all to improve patient care. This group of early career researchers with geographically distinct training and practice backgrounds aim to highlight the diversity in clinical and academic training and career development pathways for anaesthesiologists globally. Although multiple routes to success exist, one common thread is the need for consistent support of strong mentors and sponsors. Moreover, to address inequitable opportunities, we emphasise the need for diversity and inclusivity through global collaboration and exchange that aims to improve access to research training and participation. We are optimistic that by focusing on these fundamental principles, we can help build a more resilient and sustainable future for academic anaesthesiologists around the world.

Individual Psychology as Second-Person Psychology: Heinz L. and Rowena R. Ansbacher Memorial Lecture

ABSTRACT: Exploring the membership archives of the North American Society of Adlerian Psychology (NASAP, initially ASAP) from 1952 until the early 2000s revealed many hidden treasures. The applications from the 1950s to the 1980s, most completed by hand, share applicants’ reasons for joining, their education and training background in Individual Psychology, their fields of interest, and their professional activities. Early files also contain letters of reference, each ending with a confirmation that an “applicant’s orientation can be classified as Adlerian” or a similar endorsement. This article presents the demographic profiles of the 6,357 NASAP applicants between 1952 and 2009, focusing on professional identity, theoretical orientation, and commitment to Adlerian values, as expressed in these application materials. The second-person interactions that were prominent and popular in the Adlerian movement in the United States through the 1990s—teaching, correspondence, mentorship, open forums, and other you -focused activities—likely contributed to high NASAP membership numbers between 1952 and the early 1990s.

Training in Neurorehabilitation Psychology: Defining Competencies, Requisite Skill Sets, and a Proposed Developmental Pathway

Psychologists have been applying neurorehabilitation models of care for many years. These practitioners come from different training backgrounds and use a variety of titles to refer to themselves despite considerable overlap in practice patterns, professional identification, and salary. Titles like ‘neurorehabilitation psychologist’ and ‘rehabilitation neuropsychologist’ are sometimes used by practitioners in the field to indicate their specialty area, but are not formally recognized by the American Psychological Association, the American Board of Professional Psychology, or by training councils in clinical neuropsychology (CN) or rehabilitation psychology (RP). Neither the CN or RP specialties alone fully address or define the competencies, skill sets, and clinical experiences required to provide high quality, comprehensive neurorehabilitation psychology services across settings. Therefore, irrespective of practice setting, we believe that both clinical neuropsychologists and rehabilitation psychologists should ideally have mastery of specific, overlapping competencies and a philosophical approach to care that we call neurorehabilitation psychology in this paper. Trainees and early career professionals who aspire to practice in this arena are often pressured to prioritize either CN or RP pathways over the other, with anxiety about perceived and real potential for falling short in their training goals. In the absence of an explicit training path or formal guidelines, these professionals emerge only after the opportunity, privilege, or frank luck of working with specific mentors or in exceptional patient care settings that lend themselves to obtaining integrated competencies in neurorehabilitation psychology.This paper reflects the efforts of 7 practitioners to preliminarily define the practice and philosophies of neurorehabilitation psychology, the skill sets and competencies deemed essential for best practice, and essential training pathway elements. We propose competencies designed to maximize the integrity of training and provide clear guideposts for professional development.

167. NATIONAL TRENDS IN TECHNIQUE UTILIZATION FOR ESOPHAGECTOMY: DOES PRIMARY SURGEON SPECIALTY MATTER?

Abstract Background Cardiothoracic surgeons (CTS) and general surgeons (GS; including surgical oncologists) perform the vast majority of esophagectomies nationwide. We hypothesize that different clinical focus and training background could lead to different distribution in the use of open and minimally invasive surgery (MIS) techniques. Furthermore, we sought to explore whether specialty driven differences in surgical approach affect outcomes. Methods In a retrospective review of the ACS-NSQIP esophagectomy targeted participant user file (2016–2018), patients who underwent esophagectomy were sorted into CTS and GS cohorts. Perioperative characteristics and postoperative outcomes were compared using chi-square analysis or independent t-tests. Multivariate logistic regression controlling for perioperative variables was performed to generate risk adjusted odds ratios of postoperative outcomes by specialty. Results Of 3247 patients included, 1792 (55.2%) underwent esophagectomy by CTS and 1455 (44.5%) by GS as primary surgeon. CTS were more likely to use traditional MIS (p = 0.0004) or open approach (p &amp;lt; 0.0001) and less likely to use robotic surgery (p = 0.04) or a hybrid robotic/traditional approach (p &amp;lt; 0.0001) (Figure). CTS performed more Ivor Lewis esophagectomies and fewer transhiatal and McKeown esophagectomies (p &amp;lt; 0.0001). After risk-adjustment, there were no differences in rates of post-esophagectomy complications or rate of positive margins between CTS and GS (all p &amp;gt; 0.05). However, CTS were more likely to treat anastomotic leaks with surgery rather than other procedural interventions. Conclusion CTS and GS use MIS subtypes differently within esophagectomy. However, all risk adjusted differences in postoperative complications were driven by patient and operative characteristics rather than surgical subspecialty. Esophagectomy is being performed safely by surgeons with different clinical specialties and training pathway, with no differences in perioperative and oncologic outcomes.

Prevailing practice patterns in keratoconus among Indian ophthalmologists.

The past few years have seen a rapid advancement in the management of keratoconus (KC). However, there is no prescribed standard of care for the management of KC. This study evaluated the prevailing practice patterns among Indian ophthalmologists in the diagnosis and treatment of KC via an online survey. This was a survey-based cross-sectional study in which a questionnaire (Supplement 1) was created. Questions pertaining to the practicing experience, setting of practice, and training background were asked in addition to the investigations done and decision making in KC management. Responses were collected via Survey Monkey (Survey Monkey, Palo Alto, California, USA) and statistical analysis performed using R software (4.1.3). The survey was answered by 273 ophthalmologists. Pentacam was the most used topographer (195 users), followed by Orbscan (41 users), Sirius (34 users), and Galilei (3 users). The lowest limit of pachymetry for performing collagen crosslinking (CXL) was 400μ for most practitioners. More than half the respondents (50.55%) did not perform photorefractive keratectomy (PRK) or intracorneal ring segment (ICRS) implantation in a suitable patient. Accelerated 10-minute protocol (9 mW/cm2 for 10 minutes) was the most commonly (54.21%) used for CXL, followed by Dresden protocol (3 mW/cm2 for 30 minutes) (36.63%). When a patient was unsuitable for CXL, 55.31% surgeons advise contact lens (CL) trial, 35.16% surgeons advise keratoplasty, 26.74% surgeons perform stromal augmentation, and 7.69% surgeons advise spectacle correction. Corneal scar was the most common indication (49.45%) for performing keratoplasty. Topography remains the most used diagnostic modality for initial diagnosis. Optical coherence tomography and epithelial mapping are increasingly being used for early diagnosis of KC. Not all ophthalmologists were comfortable performing ICRS or PRK. When patients are unsuitable for CXL, CL trial remains the most frequently advised option followed by keratoplasty.

Transcultural Nursing Analysis in The Concept of Health Tourism : A Literature Review

Background: Health tourism is a topic that is starting to be looked at in various parts of the world. The increase in the expectations of health tourists for the quality of health services certainly also has an impact on increasingly quality nursing care services for various clients from abroad. Nurses are required to handle the increasing number of visitors and migrants from abroad due to this globalization. This certainly has an impact on cultural factors which are a very important component of nursing competence where nurses are increasingly required to be able to carry out appropriate and appropriate nursing care to clients of foreign nationals. This study aims to describe health tourism and transcultural nursing concepts from the perspective of nurses and to find out how they interpret them. Methods: This literature uses inclusion and exclusion criteria using article data sources obtained and reviewed from the Google Scholar, PubMed and Willley Library databases. Results: The score obtained on the nurse's cultural sensitivity scale is a low average, cultural sensitivity also has no correlation with gender, marital status, age, educational level, professional title and background of transcultural nursing training. The cultural competency scores were significantly higher due to work experience treating foreign patients. Conclusion: Lack of language knowledge and experience of foreign cultures is an obstacle for nurses in caring for foreign patients. Improving foreign language skills, skills and work experience treating foreign patients is absolutely necessary in the context of meeting the needs for health tourism services.

Primary and Secondary Teachers’ Conceptions, Perceptions and Didactic Experience about Heritage: The Case of Andorra

In recent years, there has been a growing tendency to incorporate teaching proposals related to heritage education in both formal and non-formal contexts. However, heritage is approached from a limited perspective, often without considering a holistic perspective. In this sense, the present study aims to know the conceptions and perceptions of heritage and its teaching in 42 primary and secondary in-service teachers from the three educational systems of Andorra in order to identify, through a semi-structured interview, possible obstacles in their professional knowledge and practice. In general terms, the results show that Natural and Tangible Heritage are the ones most taught in the classrooms due to the previous teachers’ training and professional background. Likewise, regarding the most common methodologies used to learn heritage, teachers highlight visits in situ and the use of educational technologies. Moreover, in-service teachers perceive how heritage education plays a key role in different aspects of their development, such as identity, core values and interest in the subject, amongst others. In order to obtain a holistic approach regarding heritage education, this research is part of a greater-scope project that also considers other stakeholders in the education community that belong to formal and non-formal spheres.