Coaching and Mentoring Experiences of Early Career Extension Agents in Florida Received from County Extension Directors

County Extension directors (CEDs) are Extension agents who have both programmatic and administrative responsibilities. A critical role of Florida CEDs is to coach and mentor new Extension agents in their county office. Most literature surrounding the onboarding process of new Extension hires focuses on Extension agents within their first year on the job, with little attention on their subsequent years on the job. This study sought to understand the coaching and mentoring experiences of early career Extension agents (one to three years on the job) received from CEDs. Findings revealed eight major themes, including CED years of experience as an agent, lack of CED onboarding, and intentionality of meeting regularly. Overall, CEDs were substantially more optimistic about their early career agents’ coaching and mentoring experiences than the agents themselves, revealing a major difference in perception regarding the impact of this critical CED role. UF/IFAS Extension should provide more resources to create needed onboarding training for new CEDs and tools to help CEDs be more effective coaches and mentors for new and early career Extension agents

Professional Development Needs of Early-Career Extension Agents Beyond the First Year: Florida County Extension Director Perspectives

Extension agents serve important roles in communities but often begin their careers lacking skills crucial for success. We aimed to understand the professional development needs of Florida early-career Extension agents beyond the first year as perceived by eight county Extension directors (CEDs). Through semistructured interviews, CEDs indicated that building community relationships, managing volunteers, communicating effectively, and other Extension-related skills are areas for which early-career Extension agents need professional development. These results suggest a need for additional development opportunities beyond the first year, with a professional development model that is continually adapted as an Extension professional\u27s skill set changes. Our findings have implications for those involved in Extension practice and research beyond Florida

Assessing Florida Early Career Extension Faculty\u27s Adoption of Design Principles to Communicate Messages

Extension faculty are tasked with developing and communicating educational programs to local clientele, and communication skills are a considerable piece of the Extension faculty job. Thus, UF/IFAS Extension included a communication portion to the on-board training for newly hired Extension faculty to develop their design skills so they can more effectively communicate through their educational and marketing materials. We used Rogers’ (2003) innovation-decision process to assess Florida early career Extension faculty’s adoption of design principles after completion of the 2019 UF/IFAS Extension Faculty Development Academy. Thirty-two Extension faculty completed the spring and fall sessions of the Academy. A mixed methods approach was utilized to gather survey data at the immediate completion of the Academy and qualitative, telephone interview data four to five months after completing the Academy. The faculty retrospectively perceived they increased their knowledge about design principles. They had an overwhelmingly positive attitude about learning design principles to better their communication efforts, but they decided not to fully adopt design principles in their work as other information and elements of learning their job took precedent

Leveraging Skype in the Classroom for Science Communication: A Streaming Science – Scientist Online Approach

A growing need exists to identify, implement, and research alternative methods to communicate with, educate, and engage youth about science, in order to increase science literacy and knowledge of future societal decision-makers. Electronic field trips (EFTs) are one channel of non-formal communication and education that have been introduced in agricultural and natural resources to reach youth audiences with science-based information in real-time. EFTs can be conducted in several different ways due to the proliferation of video production and web-streaming technologies. The following professional development article offers science communication professionals and scientists a detailed model and specific steps to develop and host an EFT via the Skype in the Classroom platform. The outlined model builds off of prior application and research from the Streaming Science online science communication platform and offers a secondary model for effective EFT implementation and research. The authors describe the establishment of an online science communication network, the development of the Streaming Science: Scientist Online format, content creation, the production team structure, and mobile production hardware and software. Scientist Online EFT program outcomes in terms of participation are noted, as well as student outcomes in the form of excerpts to demonstrate student engagement are shared

A systematic review and consensus definitions for standardised end-points in perioperative medicine: pulmonary complications

BackgroundThere is a need for robust, clearly defined, patient-relevant outcome measures for use in randomised trials in perioperative medicine. Our objective was to establish standard outcome measures for postoperative pulmonary complications research

Optimisation of Perioperative Cardiovascular Management to Improve Surgical Outcome II (OPTIMISE II) trial: study protocol for a multicentre international trial of cardiac output-guided fluid therapy with low-dose inotrope infusion compared with usual care in patients undergoing major elective gastrointestinal surgery.

INTRODUCTION: Postoperative morbidity and mortality in older patients with comorbidities undergoing gastrointestinal surgery are a major burden on healthcare systems. Infections after surgery are common in such patients, prolonging hospitalisation and reducing postoperative short-term and long-term survival. Optimal management of perioperative intravenous fluids and inotropic drugs may reduce infection rates and improve outcomes from surgery. Previous small trials of cardiac-output-guided haemodynamic therapy algorithms suggested a modest reduction in postoperative morbidity. A large definitive trial is needed to confirm or refute this and inform widespread clinical practice. METHODS: The Optimisation of Perioperative Cardiovascular Management to Improve Surgical Outcome II (OPTIMISE II) trial is a multicentre, international, parallel group, open, randomised controlled trial. 2502 high-risk patients undergoing major elective gastrointestinal surgery will be randomly allocated in a 1:1 ratio using minimisation to minimally invasive cardiac output monitoring to guide protocolised administration of intravenous fluid combined with low-dose inotrope infusion, or usual care. The trial intervention will be carried out during and for 4 hours after surgery. The primary outcome is postoperative infection of Clavien-Dindo grade II or higher within 30 days of randomisation. Participants and those delivering the intervention will not be blinded to treatment allocation; however, outcome assessors will be blinded when feasible. Participant recruitment started in January 2017 and is scheduled to last 3 years, within 50 hospitals worldwide. ETHICS/DISSEMINATION: The OPTIMISE II trial has been approved by the UK National Research Ethics Service and has been approved by responsible ethics committees in all participating countries. The findings will be disseminated through publication in a widely accessible peer-reviewed scientific journal. TRIAL REGISTRATION NUMBER: ISRCTN39653756.The OPTIMISE II trial is supported by Edwards Lifesciences (Irvine, CA) and the UK National Institute for Health Research through RMP’s NIHR Professorship

朝鮮干潟地利用論

Background: The Standardising Endpoints for Perioperative Medicine group was established to derive an appropriate set of endpoints for use in clinical trials related to anaesthesia and perioperative medicine. Anaesthetic or analgesic technique during cancer surgery with curative intent may influence the risk of recurrence or metastasis. However, given the current equipoise in the existing literature, prospective, randomised, controlled trials are necessary to test this hypothesis. As such, a cancer subgroup was formed to derive endpoints related to research in onco-anaesthesia based on a current evidence base, international consensus and expert guidance. Methods: We undertook a systematic review to identify measures of oncological outcome used in the oncological, surgical, and wider literature. A multiround Delphi consensus process that included up to 89 clinician–researchers was then used to refine a recommended list of endpoints. Results: We identified 90 studies in a literature search, which were the basis for a preliminary list of nine outcome measures and their definitions. A further two were added during the Delphi process. Response rates for Delphi rounds one, two, and three were 88% (n=9), 82% (n=73), and 100% (n=10), respectively. A final list of 10 defined endpoints was refined and developed, of which six secured approval by ≥70% of the group: cancer health related quality of life, days alive and out of hospital at 90 days, time to tumour progression, disease-free survival, cancer-specific survival, and overall survival (and 5-yr overall survival). Conclusion: Standardised endpoints in clinical outcomes studies will support benchmarking and pooling (meta-analysis) of trials. It is therefore recommended that one or more of these consensus-derived endpoints should be considered for inclusion in clinical trials evaluating a causal effect of anaesthesia–analgesia technique on oncological outcomes

Implication of Major Adverse Postoperative Events and Myocardial Injury on Disability and Survival: A Planned Subanalysis of the ENIGMA-II Trial.

BACKGROUND: Globally, >300 million patients have surgery annually, and ≤20% experience adverse postoperative events. We studied the impact of both cardiac and noncardiac adverse events on 1-year disability-free survival after noncardiac surgery. METHODS: We used the study cohort from the Evaluation of Nitrous oxide in Gas Mixture of Anesthesia (ENIGMA-II) trial, an international randomized trial of 6992 noncardiac surgical patients. All were ≥45 years of age and had moderate to high cardiac risk. The primary outcome was mortality within 1 postoperative year. We defined 4 separate types of postoperative adverse events. Major adverse cardiac events (MACEs) included myocardial infarction (MI), cardiac arrest, and myocardial revascularization with or without troponin elevation. MI was defined using the third Universal Definition and was blindly adjudicated. A second cohort consisted of patients with isolated troponin increases who did not meet the definition for MI. We also considered a cohort of patients who experienced major adverse postoperative events (MAPEs), including unplanned admission to intensive care, prolonged mechanical ventilation, wound infection, pulmonary embolism, and stroke. From this cohort, we identified a group without troponin elevation and another with troponin elevation that was not judged to be an MI. Multivariable Cox proportional hazard models for death at 1 year and assessments of proportionality of hazard functions were performed and expressed as an adjusted hazard ratio (aHR) and 95% confidence intervals (CIs). RESULTS: MACEs were observed in 469 patients, and another 754 patients had isolated troponin increases. MAPEs were observed in 631 patients. Compared with control patients, patients with a MACE were at increased risk of mortality (aHR, 3.36 [95% CI, 2.55-4.46]), similar to patients who suffered a MAPE without troponin elevation (n = 501) (aHR, 2.98 [95% CI, 2.26-3.92]). Patients who suffered a MAPE with troponin elevation but without MI had the highest risk of death (n = 116) (aHR, 4.29 [95% CI, 2.89-6.36]). These 4 types of adverse events similarly affected 1-year disability-free survival. CONCLUSIONS: MACEs and MAPEs occur at similar frequencies and affect survival to a similar degree. All 3 types of postoperative troponin elevation in this analysis were associated, to varying degrees, with increased risk of death and disability

Systematic review and consensus definitions for the Standardized Endpoints in Perioperative Medicine (StEP) initiative: cardiovascular outcomes.

BACKGROUND: Adverse cardiovascular events are a leading cause of perioperative morbidity and mortality. The definitions of perioperative cardiovascular adverse events are heterogeneous. As part of the international Standardized Endpoints in Perioperative Medicine initiative, this study aimed to find consensus amongst clinical trialists on a set of standardised and valid cardiovascular outcomes for use in future perioperative clinical trials. METHODS: We identified currently used perioperative cardiovascular outcomes by a systematic review of the anaesthesia and perioperative medicine literature (PubMed/Ovid, Embase, and Cochrane Library). We performed a three-stage Delphi consensus-gaining process that involved 55 clinician researchers worldwide. Cardiovascular outcomes were first shortlisted and the most suitable definitions determined. These cardiovascular outcomes were then assessed for validity, reliability, feasibility, and clarity. RESULTS: We identified 18 cardiovascular outcomes. Participation in the three Delphi rounds was 100% (n=19), 71% (n=55), and 89% (n=17), respectively. A final list of nine cardiovascular outcomes was elicited from the consensus: myocardial infarction, myocardial injury, cardiovascular death, non-fatal cardiac arrest, coronary revascularisation, major adverse cardiac events, pulmonary embolism, deep vein thrombosis, and atrial fibrillation. These nine cardiovascular outcomes were rated by the majority of experts as valid, reliable, feasible, and clearly defined. CONCLUSIONS: These nine consensus cardiovascular outcomes can be confidently used as endpoints in clinical trials designed to evaluate perioperative interventions with the goal of improving perioperative outcomes