Realization of simulations for blinded internal pilot study based on web

AbstractMisspecification of the designing parameters in the planning of a controlled clinical trial may yield an underpowered or an overpowered study. Internal pilot study, a kind of adaptive design, has gained increased attention for its allowing for sample size adjustment, especially blinded sample size adjustment that do not affect the type I error rate. Several methods were proposed to implement internal pilot design in recent years and some software emerges to simulate or implement it. But most of the software is only running on a stand-alone terminal or Client/Server(C/S) mode. We develop a system to simulate it based on Browser/Server(B/S) mode and realized on web. It allows the web users to input corresponding parameters from the web browser such as Internet Explorer to make simulations. The system was constructed with generic database schema design method and coded with Microsoft Visual Basic and Active Server Pages (ASP) programming languages. Web users on internet can use the system to make blinded variance estimate, sample size adjustment and randomization test for internal pilot study. The application of the simulation is demonstrated through an example. Not only blinded sample size adjustment is implemented but also a randomization test is performed. With applications of blinding one-sample variance for sample size recalculation and randomization test, the type I error rate is also controlled successfully

Assessing the preparedness and feasibility of an e-learning pilot project for university level health trainees in Ghana:a cross-sectional descriptive survey

BackgroundGhana is challenged with shortage of critical human resources for health particularly nurses and midwives in rural hard-to-reach communities. This shortage potentially hinders efforts towards attaining universal access to basic healthcare. More importantly, poor quality of pre-service training for health trainees has the potential to worsen this predicament. There is therefore the need to leverage emerging digital innovations like e-learning to complement existing efforts. This study was conducted several months before the outbreak of COVID-19 to investigate the preparedness, acceptability and feasibility e-learning innovation for nursing and midwifery trainees.MethodsThe study is a cross-sectional descriptive survey involving nursing and midwifery students (n = 233) in one of Ghana’s public universities, located in the Volta region of Ghana. Simple random sampling technique was used to collect responses from eligible respondents using a structured questionnaire. Descriptive statistical analysis was done using STATA software (version 12.0).ResultsIt was found that nearly 100% of respondents owned smartphones that were used mostly for learning purposes including sharing of academic information. Over 70% of respondents particularly used social media, social networking applications and internet searches for learning purposes. Health trainees were however constrained by low bandwidth and lack of seamless internet connectivity within their learning environments to maximize the full benefits of these e-learning opportunities.ConclusionRespondents were predominantly prepared for an e-learning pilot project. These feability findings suggest e-learning is a huge potential that can be used to augment existing approaches for pre-service training of health trainees in Ghana, when implementation threats are sufficiently addressed. Compelling findings of this study are therefore timely to inform evidence-based policy decisions on innovative digitial solutions for pre-service training of health workforce even as the world adapts to the "new normal" situation induced by COVID-19

Assessing the preparedness and feasibility of an e-learning pilot project for university level health trainees in Ghana:a cross-sectional descriptive survey

BackgroundGhana is challenged with shortage of critical human resources for health particularly nurses and midwives in rural hard-to-reach communities. This shortage potentially hinders efforts towards attaining universal access to basic healthcare. More importantly, poor quality of pre-service training for health trainees has the potential to worsen this predicament. There is therefore the need to leverage emerging digital innovations like e-learning to complement existing efforts. This study was conducted several months before the outbreak of COVID-19 to investigate the preparedness, acceptability and feasibility e-learning innovation for nursing and midwifery trainees.MethodsThe study is a cross-sectional descriptive survey involving nursing and midwifery students (n = 233) in one of Ghana’s public universities, located in the Volta region of Ghana. Simple random sampling technique was used to collect responses from eligible respondents using a structured questionnaire. Descriptive statistical analysis was done using STATA software (version 12.0).ResultsIt was found that nearly 100% of respondents owned smartphones that were used mostly for learning purposes including sharing of academic information. Over 70% of respondents particularly used social media, social networking applications and internet searches for learning purposes. Health trainees were however constrained by low bandwidth and lack of seamless internet connectivity within their learning environments to maximize the full benefits of these e-learning opportunities.ConclusionRespondents were predominantly prepared for an e-learning pilot project. These feability findings suggest e-learning is a huge potential that can be used to augment existing approaches for pre-service training of health trainees in Ghana, when implementation threats are sufficiently addressed. Compelling findings of this study are therefore timely to inform evidence-based policy decisions on innovative digitial solutions for pre-service training of health workforce even as the world adapts to the "new normal" situation induced by COVID-19

Resilience orchestration and resilience facilitation: how government can orchestrate the whole UK ports market with limited resources: the case of UK ports resilience

Government departments have limited resources but they are responsible for the healthy functioning of whole markets. This tension is amplified by the opportunities to generate, share and use information from new data sources and digital technologies. Huge increases in volumes and types of data produced by sensors and firms' IT systems can potentially be shared between firms which can cause information overload. This paper uses government orchestration theory to investigate the problems and opportunities of the UK's maritime transport ministry as it supports resilience planning for the whole country's ports system. We build on the developing Lean Government (l-Government) literature by theorizing on the differences between government and other stakeholders. We use a case study to investigate how these differences hinder as well as support the role of a government department. And how the special perspective of an orchestrator can integrate and filter information, motivate diverse collaborators and support the use of orchestration platforms in l-Government

NextGEM: Next-Generation Integrated Sensing and Analytical System for Monitoring and Assessing Radiofrequency Electromagnetic Field Exposure and Health

The evolution of emerging technologies that use Radio Frequency Electromagnetic Field (RF-EMF) has increased the interest of the scientific community and society regarding the possible adverse effects on human health and the environment. This article provides NextGEM’s vision to assure safety for EU citizens when employing existing and future EMF-based telecommunication technologies. This is accomplished by generating relevant knowledge that ascertains appropriate prevention and control/actuation actions regarding RF-EMF exposure in residential, public, and occupational settings. Fulfilling this vision, NextGEM commits to the need for a healthy living and working environment under safe RF-EMF exposure conditions that can be trusted by people and be in line with the regulations and laws developed by public authorities. NextGEM provides a framework for generating health-relevant scientific knowledge and data on new scenarios of exposure to RF-EMF in multiple frequency bands and developing and validating tools for evidence-based risk assessment. Finally, NextGEM’s Innovation and Knowledge Hub (NIKH) will offer a standardized way for European regulatory authorities and the scientific community to store and assess project outcomes and provide access to findable, accessible, interoperable, and reusable (FAIR) data

H0LiCOW - IX. Cosmographic analysis of the doubly imaged quasar SDSS 1206+4332 and a new measurement of the Hubble constant

We present a blind time-delay strong lensing (TDSL) cosmographic analysis of the doubly imaged quasar SDSS 1206+4332. We combine the relative time delay between the quasar images, Hubble Space Telescope imaging, the Keck stellar velocity dispersion of the lensing galaxy, and wide-field photometric and spectroscopic data of the field to constrain two angular diameter distance relations. The combined analysis is performed by forward modelling the individual data sets through a Bayesian hierarchical framework, and it is kept blind until the very end to prevent experimenter bias. After unblinding, the inferred distances imply a Hubble constant $H_0 = 68.8^{+5.4}_{-5.1}$ kms$^{-1}$Mpc$^{-1}$, assuming a flat Lambda cold dark matter cosmology with uniform prior on $\Omega_{\rm m}$ in [0.05, 0.5]. The precision of our cosmographic measurement with the doubly imaged quasar SDSS 1206+4332 is comparable with those of quadruply imaged quasars and opens the path to perform on selected doubles the same analysis as anticipated for quads. Our analysis is based on a completely independent lensing code than our previous three H0LiCOW systems and the new measurement is fully consistent with those. We provide the analysis scripts paired with the publicly available software to facilitate independent analysis. The consistency between blind measurements with independent codes provides an important sanity check on lens modelling systematics. By combining the likelihoods of the four systems under the same prior, we obtain $H_0 = 72.5^{+2.1}_{-2.3}$kms$^{-1}$Mpc$^{-1}$. This measurement is independent of the distance ladder and other cosmological probes.Comment: 30 pages, 17 figures, MNRAS published likelihood available here: http://shsuyu.github.io/H0LiCOW/site/notebooks/H0_from_lenses.html, all modeling and analysis scripts available upon reques

Adaptation and Validation of the Situation Awareness Global Assessment Technique for Student Registered Nurse Anesthetists

Anesthesia is a health care specialty fraught with high workload demands, stressful work environments, increased production pressure, work areas with many distractions, an increasing use of advanced technology, and the constant need to prioritize work actions. Effective clinical judgment in this dynamic environment necessitates that the provider demonstrate the ability to project what may occur secondary to actual or potential condition changes. These key elements operationalize situation awareness (SA). High level SA is an important characteristic for the successful development of student registered nurse anesthetists (SRNAs). With Endsley’s “Theory of Situation Awareness” as the foundation, the goal of this study was to adapt and validate the “Situation Awareness Global Assessment Technique” (SAGAT), to quantify SRNAs\u27 SA during a specific simulated anesthesia event. With IRB approval, purposeful sampling identified a group of CRNA, nurse educator subjects and an exploratory sequential mixed methods design utilized. Delphi methods during qualitative data collection and validation used a seven-member sample. Content analysis resulted in items for the adapted SAGAT. Quantitative methods utilized data collected from a second 40-member sample yielding item content validity and scale content validity indices (S-CVI/Ave. 0.92). Additionally, exploratory factor analysis provided further reliability with a Cronbach’s alpha of 0.937. Findings revealed that a SAGAT specific to the anesthesia domain and the SRNA subgroup was amenable to adaptation and validation, providing positive implications in SRNA education and training. Additionally, results support the further adaptation, validation, and use of this instrument in other anesthetic content areas, as well as other health care domains

Best Practices in High Fidelity Patient Simulation to Enhance Higher Order Thinking Skills

Undergraduate nursing education has begun to use very expensive and time intensive high fidelity simulation activities without making full use of the ability to build higher order thinking skills in students. Current research in high fidelity patient simulation has tended to be subjective and focus on critical thinking. However, reflective thinking habits of mind must be in place before full use can be made of critical thinking skills. A comprehensive search of all reflective thinking literature used in conjunction with simulated patient experiences by healthcare students was undertaken. A guideline was created for nurse faculty to use that outlined current best practices in simulation to maximize reflective thinking. Though the research on which the guideline was based has been mainly subjective, several analytical studies were found that supported the findings. Policy changes to incorporate reflective thinking and the associated activities were recommended for nursing students and continuing nursing education. Nurse researchers and educators should incorporate reflective thinking exercises with their simulated patient undertakings to maximize higher order thinking skills

Emergency medical dispatching : protocols, experiences and priorities

Each year, millions of people call the emergency number with a wide variety of symptoms and various levels of illness severity. At its’ core, emergency medical dispatching encompasses the answering of these calls, the assessment of the need for medical assistance, the dispatch of a resource with an appropriate priority level and the provision of instructions assisting the caller. Consequently, emergency medical dispatching is important in ensuring patient safety as well as for ascertaining the best use of limited resources. However, research on different aspects of emergency medical dispatch remains limited. Therefore, this thesis’s overall aim was to provide new knowledge in relation to dispatch protocols and the assessment and prioritization of emergency medical calls. Further, to bring light onto emergency medical dispatchers’ (EMDs) experiences of managing such calls thereby creating an understanding and foundation for further development and strengthening of this first link in the chain of emergency care. The thesis builds upon four studies based on different populations: Study I: a simulation study with the aim to compare the accuracy, in terms of correct dispatch priority, between two dispatch protocols; the Swedish Index and RETTS-A. Expert consensus was used as reference standard. A total of 1,293 calls was included. For priority level, 349 (54%) calls were assessed correctly with Swedish Index and 309 (48%) with RETTS-A (p=0.012). Sensitivity for the highest priority was 82.6% (95% CI: 76.6-87.3) for Swedish Index and 54.0% (95% CI: 44.3-63.4%) for RETTS-A. Overtriage was 37.9% (34.2.-41.7%) in Swedish Index and 28.6% (25.2-32.2) in RETTS-A. The corresponding proportion of undertriage was 6.3% (4.7-8.5) and 23.4% (20,3-26.9) respectively. The results demonstrate that although the Swedish Index had a higher accuracy than RETTS-A, the overall accuracy for both dispatch protocols is low. Study II: a retrospective observational study based on registry data from four Swedish regions in 2015. The aim was to compare calls assessed by an EMD with and without the support of a registered nurse (RN) with respect to priority level, accuracy, and dispatch category. Ambulance personnel’s assessment was used as reference standard. A total of 25,025 calls were included. Dispatch priority was in concordance with the reference standard in 11,319 (50.7%) for EMD and in 481 (41.5%) for EMD+RN, (p<0.01). Overtriage was equal for both groups; 5904 (26,4%) for EMD, and 306 (26.4%) for EMD+RN, (p=0.25). Undertriage was 5122 (22.9%) for EMD and 371 (32.0%) for EMD+RN (p<0.01). Sensitivity for the most urgent priority was 54.6% for EMD, compared to 29.6% for EMD+RN (p<0.01), and specificity was 67.3% and 84.8% (p<0.01) respectively. Dispatch category was in concordance with reference standard in 13,785 (66.4%) EMD and 697 (62.2%) EMD+RN (p=0.01). The results demonstrated that a higher precision was not observed for calls assessed with RN-support. Study III: a qualitative interview study aiming at exploring EMDs experiences of managing emergency medical calls. One main category emerged from the inductive content analysis of 13 interviews: “to attentively manage a multifaceted, interactive task”. The main category was in turn composed of three categories: “to utilize creativity to gather information”, “continuously process and assess complex information” and “engage in the professional role”. Study IV: a retrospective observational registry study on all primary ambulance missions within the Stockholm Region Aug 2019 to Sept 2022. The aim was to identify the proportion of time critical patients, defined as patients receiving time critical interventions in the prehospital setting, having an ambulance dispatched as Priority 1. Further, to describe dispatch categories and emergency department (ED) diagnoses. Of 571 163 included missions, 92 975 (16.3%) were time critical. Of these, 75 504 (81.2%) had an ambulance dispatched as Priority 1, 16 967 (18.2%) as Priority 2, and 504 (0.5%) as Priority 3. When stratified according to dispatch priority, the ranking of the most common dispatch categories differed. ED-diagnosis were mostly symptom-related. The results demonstrate that most patients with time critical conditions receive an ambulance dispatched as Priority 1. Those who are not identified as in need of an ambulance dispatched as Priority 1, differ in regard to their presentation, and often present to the EMCC with unspecific symptoms. In conclusion, this thesis sheds light on different aspects of emergency medical dispatching in regard to emergency calls with a wide range of symptoms. Specifically, it contributes to the evaluation of dispatch protocols and highlights the need for further investigations in relation to the established, yet understudied, practice of emergency medical dispatching performed predominantly by EMDs with and without the support of RNs. Given their key role in managing this multifaceted interactive task, the results can be used to inform future development of protocols and interview techniques. The results further indicate the need for regular feedback, as part of clinical routine. Finally, the thesis enhances the understanding of the population of patients with time critical conditions and contributes to the understanding and future establishment of a definition of time critical conditions in the pre-hospital setting