Implementation of a point-of-care ultrasound skills practicum for hospitalists

Introduction Point-of-care ultrasound is recognized as a safe and valuable diagnostic tool for patient evaluation. Hospitalists are prime candidates for advancing the point-of-care ultrasound field given their crucial role in inpatient medicine. Despite this, there is a notable lack of evidence-based ultrasound training for hospitalists. Most research focuses on diagnostic accuracy rather than the training required to achieve it. This study aims to improve hospitalists' point-of-care ultrasound knowledge and skills through a hands-on skills practicum. Methods Four skill practicums were conducted with pre-course, post-course, and six-month evaluations and knowledge assessments. Results The mean pre- vs. post-course knowledge assessment scores significantly improved, 41.7% vs. 75.9% (SD 16.1% and 12.7%, respectively, p < 0.0001). The mean ultrasound skills confidence ratings on a 10-point Likert scale significantly increased post-course (2.60 ± 1.66 vs. 6.33 ± 1.63, p < 0.0001), but decreased at six months (6.33 ± 1.63 vs. 4.10 ± 2.22, p < 0.0001). The greatest limitations to usage pre-course and at six months were knowledge/skills and lack of machine access. While knowledge/skills decreased from pre-course (82.0%) as compared to six-months (64.3%), lack of machine access increased from pre-course (15.8%) to six-months (28.6%) (p = 0.28). Conclusion Hospitalists agree that point-of-care ultrasound has utility in the diagnostic and therapeutic management of patients, though the lack of training is a significant limitation. Our study demonstrated that a brief skills practicum significantly improves hospitalists’ confidence and knowledge regarding ultrasound image acquisition and interpretation in the short term. Long-term confidence and usage wanes, which appears to be due to the lack of machine access

A Flexible and Secure Deployment Framework for Distributed Applications

This paper describes an implemented system which is designed to support the deployment of applications offering distributed services, comprising a number of distributed components. This is achieved by creating high level placement and topology descriptions which drive tools that deploy applications consisting of components running on multiple hosts. The system addresses issues of heterogeneity by providing abstractions over host-specific attributes yielding a homogeneous run-time environment into which components may be deployed. The run-time environments provide secure binding mechanisms that permit deployed components to bind to stored data and services on the hosts on which they are running.Comment: 2nd International Working Conference on Component Deployment (CD 2004), Edinburgh, Scotlan

Preparing Social Workers for Interprofessional Practice: A Conceptual Interprofessional Education (IPE) Competency-Based Model

Interprofessional education (IPE) continues to advance as the best method to prepare health care professionals for interprofessional collaborative practice (IPCP). Large numbers of US social workers enter the workforce unprepared for interprofessional collaborative practice (Taylor & Coffey, 2014; Jones & Phillips, 2016; Stanhope et al., 2015). Without a clear understanding of the redundancies between social work educational standards and IPE competencies it is difficult to design IPE based courses for social work students with adequate content. The study purpose was to (1) identify were there was redundancy between the IPEC core competencies and CSWE 2015 EPAS competencies, (2) identify gaps in the social work competencies requiring integration of the IPEC competencies and (3) develop and validate a conceptual model to guide the integration of IPEC core competencies into US social work education standards. A qualitative content analysis was conducted on the nine social work core competencies found in the CSWE 2015 EPAS utilizing the IPEC Core Competencies for Interprofessional Collaborative Practice sub-competencies as the coding scheme. The study found there was significant redundancy between the IPEC core competencies and the social work competencies. The study identified three gaps, (1) five sub-competencies were found in a document referenced within Social Work Competency 1, (2) seven sub-competencies were not found in the social work educational standards and (3) clarity issues from a lack of common terminology. The study findings were used to develop a conceptual model for IPE competency integration in to social work educational standards

Diagnosis and Management of COVID-19 Disease

SARS-CoV-2 is a novel coronavirus that was identified in late 2019 as the causative agent of COVID-19 (aka coronavirus disease 2019). On March 11, 2020, the World Health Organization (WHO) declared the world-wide outbreak of COVID-19 a pandemic. This document summarizes the most recent knowledge regarding the biology, epidemiology, diagnosis, and management of COVID-19

Credit-Allocation Programs and Intermediation Costs in an Agricultural Development Bank

International donors have strongly encouraged the creation of specialized credit institutions in the last decade to service the needs of agricultural development. These institutions have a portfolio highly concentrated in agriculture and further in medium to long-term loans, little if any deposit or savings services and an expensive infrastructure to service loan targeting requirements of donors. Analysis of the data from the National Agricultural Development Bank in Honduras show that, contrary to donor expectations, an increasing share of donor targeted funds for agriculture in the bank's liabilities has not led to an increased participation of agricultural loans in the total portfolio of the bank nor to an increase in the share of small sized loans in the agricultural portfolio. This must reflect the fungibility of finance. At the same time, regression analysis performed on the development bank's cost function indicates that there is a significant lagged ratchet type effect of donor and central bank targeted funds on the intermediation costs of the bank. These derive from increased resources devoted to accounting, monitoring, record-keeping and reporting requirements of targeted credit programs. International donors and local governments should seriously consider reducing their loan targeting policies in light of the limited portfolio impact and the significant cost increasing effects these policies have on financial intermediaries