摘要： The clinical learning environment (CLE) encompasses the learner's personal characteristics and experiences, social relationships, organizational culture, and the institution's physical and virtual infrastructure. During the COVID-19 pandemic, all 4 of these parts of the CLE have undergone a massive and rapid disruption. Personal and social communications have been limited to virtual interactions or shifted to unfamiliar clinical spaces because of redeployment. Rapid changes to the organizational culture required prompt adaptations from learners and educators in their complex organizational systems yet caused increased confusion and anxiety among them. A traditional reliance on a physical infrastructure for classical educational practices in the CLE was challenged when all institutions had to undergo a major transition to a virtual learning environment. However, disruptions spurred exciting innovations in the CLE. An entire cohort of physicians and learners underwent swift adjustments in their personal and professional development and identity as they rose to meet the clinical and educational challenges they faced due to COVID-19. Social networks and collaborations were expanded beyond traditional institutional walls and previously held international boundaries within multiple specialties. Specific aspects of the organizational and educational culture, including epidemiology, public health, and medical ethics, were brought to the forefront in health professions education, while the physical learning environment underwent a rapid transition to a virtual learning space. As health professions education continues in the era of COVID-19 and into a new era, educators must take advantage of these dynamic systems to identify additional gaps and implement meaningful change. In this article, health professions educators and learners from multiple institutions and specialties discuss the gaps and weaknesses exposed, opportunities revealed, and strategies developed for optimizin

摘要： BACKGROUND AND PURPOSE: Transient loss of consciousness is commonly evaluated in the emergency department. Although typically caused by epileptic seizure, syncope, or psychogenic nonepileptic seizure, the underlying etiology is frequently misdiagnosed. Lateral tongue bites are reportedly a specific clinical finding of seizure. We have observed tongue signal abnormality suggesting bite injury on brain MR imaging after seizures. We hypothesized an association between tongue signal abnormality and seizure diagnosis among patients in the emergency department imaged for transient loss of consciousness. Our purposes were to determine the prevalence of tongue signal abnormality among this population and the predictive performance for seizure diagnosis. MATERIALS AND METHODS: For this retrospective study including 82 brain MR imaging examinations, 2 readers independently assessed tongue signal abnormality on T2-weighted and T2-weighted FLAIR images. Discrepancies were resolved by consensus, and interrater reliability (Cohen ?) was calculated. The final diagnosis was recorded. Proportions were compared using the Fisher exact test. RESULTS: Tongue signal abnormality was present on 19/82 (23%) MR imaging examinations. Interrater reliability was ?substantial? (? = 0.77). Seizure was diagnosed among 18/19 (95%) patients with tongue signal abnormality and 29/63 (46%) patients without it (P < .001). In our cohort, tongue signal abnormality conveyed 97% specificity, 95% positive predictive value, and 63% accuracy for seizure diagnosis. CONCLUSIONS: Tongue signal abnormality was observed in 23% of the study cohort and conveyed 97% specificity and 95% positive predictive value for seizure diagnosis. By assessing and reporting tongue signal abnormality, radiologists may facilitate a timely and accurate diagnosis of seizure among patients imaged for transient loss of consciousness.

摘要： Purpose: Visual scene displays (VSDs) can support augmentative and alternative communication (AAC) success for children and adults with complex communication needs. Static VSDs incorporate contextual photographs that include meaningful events, places, and people. Although the processing of VSDs has been studied, their power as a medium to effectively convey meaning may benefit from the perspective of individuals who regularly engage in visual storytelling. The aim of this study was to evaluate the perspectives of individuals with expertise m photographic and/or artistic composition regarding factors contributing to VSD complexity and how to limit the time and effort required to apply principles of photographic composition. Method: Semistructured interviews were completed with 13 participants with expertise in photographic and/or artistic composition. Results: Four main themes were noted, including (a) factors increasing photographic image complexity and decreasing cohesion, (b) how complexity impacts the viewer, (c) composition strategies to decrease photographic image complexity and increase cohesion, and (d) strategies to support the quick application of composition strategies in a just-in-time setting. Findings both support and extend existing research regarding best practice for VSD design. Conclusions: Findings provide an initial framework for understanding photographic image complexity and how it differs from drawn MC symbols. Furthermore, findings outline a toolbox of composition principles that may help limit VSD complexity, along with providing recommendations for MC development to support the quick application of compositional principles to limit burdens associated with capturing photographic images.

关键词： Social capital   Consumer happiness   Consumer-brand identification   Organizational identification   Consumer loyalty  

摘要： The purposes of this study are to integrate organizational social capital theory and consumer happiness in a prior brand identification model and test the antecedents and consequences of consumer-brand identification over time. In the context of professional football, we collected data from 374 panel registrants of an online research service firm throughout a season. The results indicated consumer-brand identification was impacted to a greater extent by two social capital factors: (1) social interaction ties and (2) shared vision, than by brand prestige and brand distinctiveness. Both social interaction ties and consumer-brand identification were also predictive of future behavioral loyalty and purchase frequency. Further, our moderation analysis revealed the impact of consumer-brand identification on behavioral loyalty was contingent on consumer happiness. The proposed framework and results reinforce the importance of consumer-to-consumer social capital and consumer happiness and add new insights into the dynamics of consumer-brand identification, consumer happiness, and enduring consumer loyalty.

摘要： Objectives The relationship between the pet owners' desire for information and preference of alternative therapies and the veterinarians' ability to build partnership and communicate empathically was investigated using quantitative multifactorial analysis. Materials and Methods In an online survey, 1270 German pet owners were asked about their experience of veterinary appointments regarding communication and relationship building. Additional questions included the type and number of pets, years of animal husbandry, age, gender and education level. The factors associated with the pet owners' desire for further information and alternative therapies were analysed in two multivariable linear models. A recently published structural equation model consolidated the following as latent factors: veterinarian's empathic communication, veterinarian's partnership building, pet owners' desire for further information and pet owners' desire for alternative therapies (e.g. non-veterinary practitioners). Results The two veterinarian-related factors of empathic communication and partnership building were positively associated with each other, but negatively associated with the pet owners' desires. Dog owners and participants who owned animals for more than 2 years expressed less desire for further information. The desire for further information decreased with increasing age. The desire for alternative therapies was more among animal owners of more than 2 years and those visiting the same veterinary practice for over 2 years. Clinical Significance Veterinarians' empathic communication and partnership building are key factors that satisfy clients' desires for information and alternative therapies. This comprises communicational skills regarding information sharing, as well as emotional aspects.

关键词： Pandemic   Coronavirus disease   Disaster management   Telemedicine   Alternative care area   Emergency department  

摘要： Objective: Emergency departments face unforeseen surges in patients classified as low acuity during pandemics such as the coronavirus disease pandemic. Streamlining patient flow using telemedicine in an alternative care area can reduce crowding and promote physical distancing between patients and clinicians, thus limiting personal protective equipment use. This quality improvement project describes critical elements and processes in the operationalization of a telemedicine-enabled drive-through and walk-in garage care system to improve ED throughput and conserve personal protective equipment during 3 coronavirus disease surges in 2020. Methods: Standardized workflows were established for the operationalization of the telemedicine-enabled drive-through and walk-in garage care system for patients presenting with respiratory illness as quality improvement during disaster. Statistical control charts present interrupted time series data on the ED length of stay and personal protective equipment use in the week before and after deployment in March, July, and November 2020. Results: Physical space, technology infrastructure, equipment, and staff workflows were critical to the operationalization of the telemedicine-enabled drive-through and walk-in garage care system. On average, the ED length of stay decreased 17%, from 4.24 hours during the week before opening to 3.54 hours during the telemedicine-enabled drive-through and walk-in garage care system operation. There was an estimated 25% to 41% reduction in personal protective equipment use during this time. Conclusion: Lessons learned from this telemedicine-enabled alternative care area implementation can be used for disaster preparedness and management in the ED setting to reduce crowding, improve throughput, and conserve personal protective equipment during a pandemic.

关键词： Biogas   Energy   Human faecal   Acceptability   Organic wastes  

摘要： The use of wastes for biogas production has been restricted to few feedstock like cattle manure and food waste. Increasing the feedstock base for biogas production is capable of increasing the sustainability of feedstock availability. This study seeks to assess sociocultural and acceptability issues associated with the use of faecal waste (human excreta, cattle manure, etc.) as a source of energy in selected stakeholder areas in Benin City, Nigeria. Qualitative research methods were used for data collection as data were generated through survey questionnaire. Field responses were mined and analysed using Factor analysis and cluster plots generated from Factor plots were analysis using Statistical Program for Social Sciences to rank the variables in order of hierarchical means. Analyses from this study have shown that faecal waste is a dependable feedstock for biogas production while adding value to food production through digestate utilization. Furthermore, high factor loading of 0.759 for acceptance to the fact that biogas from faecal waste has the potential to improve environmental sanitation in Benin City. However, there exist considerable knowledge gap as shown in the analyses which suggest a need for continuous awareness creation, policy formulation and orientation on the importance of biogas production from a range of feedstock in tackling energy security and sustainability in line with SDGs 2, 6 and 7.