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The food industry has been widely regarded as an effective sector due to its contribution to the national economy, job creation, and people's welfare. Malaysia as one effective country in the food industry and leading country in Halal food brand emphasized the importance of food quality in both operation and supply chain. Despite the importance of the Halal food industry to countries' economy including Malaysia, this industry is facing multiple challenges. In addition, halal food literature still in the infant stage despite the rapid growth of this important industry. Therefore, this review study aims to identify the challenges that surrounded the Halal industry worldwide generally and Malaysian firms particularly. This study also aims to identify the potential solution to overcome Halal food challenges. The finding of this study uncovers multiple challenges surrounded the Halal food industry in operation, marketing, and certification processes. This study also suggests that the application of the manufacturing execution system can bring a new insight to overcome Halal food challenges. This study contributes to the body of knowledge by providing a clear understanding of Halal food industry operation and certification and their challenges and explains how MES can improve the efficiency of this industry.

This article uses the agency theory perspective to analyze governance, composed of a set of dimensions and measured by governance factors that influence donations to Brazilian environmental Nonprofit Organizations (NPOs). Data were collected predominantly from the documents available on the Internet, and the random sample consisted of 108 observations. We identified governance dimensions through Multiple Correspondence Analysis. From these dimensions, we verified, through Partial Least Squares Structural Equation Modeling, if governance affected donations. It was observed that governance positively affected donations and that public certifications provided to NPOs in Brazil did not moderate the relationship between governance and donations. These results showing that governance helps NPOs to have easier access to the donations market and that public certifications provided to NPOs do not contribute to increasing donations. These findings are important for practitioners and also to enrich the debate about public policies for the third sector in environments of low regulation. Resumo Este artigo analisa a governança composta como um conjunto de dimensões medidas por fatores de governança que influenciam as doações com restrições de doadores recebidas por Organizações Sem Fins Lucrativos (ONG) ambientais no Brasil, sob a perspectiva da teoria da agência. Os dados foram coletados predominantemente em documentos disponíveis na internet, e a amostra aleatória foi composta por 108 observações. Identificamos as dimensões de governança por meio da Análise de Correspondência Múltipla. A partir dessas dimensões, verificou-se, por meio de Partial Least Squares Structural Equation Modeling, se a governança afetou as doações. Observou-se que a governança afetou positivamente as doações e que as certificações públicas fornecidas às ONGs no Brasil não moderaram a relação entre governança e doações. Esses resultados mostram que a governança ajuda a ONG a ter acesso mais fácil ao mercado de doações e que as certificações públicas fornecidas à ONG não contribuem para o aumento das doações. Esses achados são importantes para os profissionais e também para enriquecer o debate sobre políticas públicas para o terceiro setor em ambientes pouco regulamentados.

We assess the effects of land markets on misallocation and productivity both empirically and quantitatively. Exploiting variation from a land certification reform across time and space in Ethiopia, we find that certification facilitates rentals and improves agricultural productivity. We calibrate a quantitative macroeconomic model with heterogeneous household farms facing institutional costs to land markets using the micro panel data. The effect of a counterfactual reallocation from no rentals to efficient rentals increases zone-level agricultural productivity by 43 percent on average. While our estimated institutional costs are strongly associated with land certification across zones, there are nontrivial residual frictions to rental market activity, implying that land certification only partially captures the overall effects of rentals. A full certification reform accounts for about one-fourth of the overall productivity gains from land rentals. This result highlights the importance of comprehensive reforms alleviating frictions to land transactions beyond the granting of certificates.

In the medication management process, storage methods constitute a step at risk of errors that needs to be secured. As part of an institutional project, computerized medicine cabinets (CMC) have been deployed in our hospital’s emergency and intensive care units. In order to meet the requirements of the certification, the deployment of CMC in all care units has been decided. Each deployment includes many steps and involves several trades that must be coordinated. We decided to formalize these steps in the form of a checklist. Two pharmacists listed all the tasks required to install a CMC. They were ordered chronologically, and a person responsible for each step is proposed. All those involved in the installation of CMC in the care units validated the checklist. The checklist is broken down into 13 major steps, from the assessment of the need to the installation of CMC in the care units. Before installation, several months are required, particularly in terms of the delivery time of the CMC. Support and training for the pharmacy technicians and caregivers are essential to ensure the teams enrolment. The checklist provides to boost CMC installations by involving and empowering more accountable all participants, coordinated by the pharmacist. Moreover, it contributes to save time and to improve the management of every ongoing deployments.

Indonesia has been known to have abundant natural resources and culture-based creative industries. The country is therefore vulnerable to the practice of fraud of origin. One of many industrial sectors susceptible to that particular crime is the wooden furniture businesses. In many cases, it is apparent that natural products and raw materials of Indonesia are being exported without listing the country as the place of origin. The most common Indonesian material falls within this illegal practice are timber products. In the province of Central Java, Jepara has been a prominent center of timber industry producing high quality timber products and wooden raw materials. From a unique standpoint, the timber industry in Jepara is deeply rooted to the culture and identity of the natives, making the attempt to separate the discussion between timber industry and the people of Jepara not only imprudent but virtually impossible. By looking at the statistic in which Jepara’s public education level is assessed to be still below the national standard, and as well bearing to the general fact that the timber actors in Jepara are more focused on product sales rather than important technical aspects such as certification of origin, it should be projected that crimes such as fraud of origin could be easily committed in Jepara. This study is using a comparative advantage theory and theories or models of H-O to investigate how the practice of fraud of origin in Jepara occurs and how to resolve such problem.

This study investigated the effects of applications of international quality assurance certification at farm level on the implementation of traceability along the shrimp supply chain with evidence from Vietnam. Descriptive statistics was explored to compare products, information flows, financial efficiency, and willingness to implement traceability between certified and noncertified quality assurance shrimp farms. A binary logistics model was applied to examine the effects of applications of international quality assurance certification and other factors on the willingness to implement traceability of shrimp farmers. Found results showed that the applications of international quality assurance certification of shrimp farmers supported traceability of shrimp products among stakeholders in the supply chain. The certified farmers indicated a higher willingness to implement traceability. However, the profitability of those applications for shrimp farmers was not statistically found. The economics incentives, including farm-gate price differentiation and minimization of production costs, should be carefully considered.

Background and objective Axial spondyloarthritis is an immune-mediated disease with a high cost, diagnostic delay and associated complications that makes it a particularly important condition. This work aims to establish a certification standard (SpACE Project) for monographic consultations in its diagnosis and treatment. Materials and methods Qualitative study of consensus, through the technique of the nominal group. First, a pragmatic review of the literature was carried out. Second, professionals involved throughout the care process (rheumatology, ophthalmology, gastroenterology, traumatology, family medicine, physical therapy, and nursing) were included. Results Thirty-seven possible standards were extracted from the pragmatic review of the literature. During the consensus phase only those standards with high feasibility and importance in the care process were prioritized. Finally, the group of 26 experts agreed on the inclusion of 14 standards. Discussion and conclusions SpACE is a consensus-based certification standard that seeks to improve health outcomes and more integrated care.

The purpose of this research study was to determine if green hotels actually benefited from undertaking environmental practices and integrating these practices into their marketing strategy. After looking at sustainable communications and marketing literature, a total of 2,248 structured surveys were administered to hotels across North America. Responses from 247 hotels (11% response rate) were analyzed using frequencies, t-tests, and regression analysis to examine significant differences. The results show that the extent to which hotels perceive they benefitted from marketing sustainability practices through guest visits, guest length of stay, guest satisfaction, revenue, profit, and average daily rate can be predicted by examining the extent to which a hotel believes that green marketing has been incorporated into a hotels green marketing strategy. Findings also show that hotels that are a part of the Green Key certification program have a higher perceived probability of attracting new customers and retaining old ones. This study provides support that there is a benefit to sustainability marketing and this study is the first to examine how perceived hotel sustainability management and marketing inform one another and could be beneficial to hotels in how they utilize this information to inform marketing decisions.

In this narrative review, we outline the literature describing the history, training, certification, and role of peer recovery support specialists working with people with substance use disorders at different stages of active use and recovery. We explore the impact of peer recovery support specialists serving people in various settings, including the community, hospitals and emergency departments, jails and prisons, and treatment and recovery agencies; and describes considerations for future expansion of peer recovery support services, including supervision needs, compassion fatigue and burnout, and scope of practice. Finally, we make recommendations to support the broad implementation of peer recovery support services as a sustainable, cohesive, and replicable component of harm reduction and addiction services. We also make recommendations for research to continue to evaluate peer recovery support specialist interventions across settings and outcomes.

Background: Although mobile apps are readily available for speech sound disorders (SSD), their validity has not been systematically evaluated. This evidence-based appraisal will critically review and synthesize current evidence on available therapy apps for use by children with SSD. Objective: The main aims are to (1) identify the types of apps currently available for Android and iOS mobile phones and tablets, and (2) to critique their design features and content using a structured quality appraisal tool. Methods: This protocol paper presents and justifies the methods used for a systematic review of mobile apps that provide intervention for use by children with SSD. The primary outcomes of interest are (1) engagement, (2) functionality, (3) aesthetics, (4) information quality, (5) subjective quality, and (6) perceived impact. Quality will be assessed by 2 certified practicing speech-language pathologists using a structured quality appraisal tool. Two app stores will be searched from the 2 largest operating platforms, Android and iOS. Systematic methods of knowledge synthesis shall include searching the app stores using a defined procedure, data extraction, and quality analysis. Results: This search strategy shall enable us to determine how many SSD apps are available for Android and for iOS compatible mobile phones and tablets. It shall also identify the regions of the world responsible for the apps’ development, the content and the quality of offerings. Recommendations will be made for speech-language pathologists seeking to use mobile apps in their clinical practice. Conclusions: This protocol provides a structured process for locating apps and appraising the quality, as the basis for evaluating their use in speech pathology for children in English-speaking nations. [JMIR Res Protoc 2016;5(4):e233]

This chapter provides the practical information regarding the aircraft certification with respect to the whirl flutter. First, the requirements of the regulation standards (FAR/CS 23 and FAR/CS 25) are summarised, and comments are made. The analytical approaches are then described. The chapter includes a standard approach to computing the flutter states directly and the optimisation-based approach to computing the critical structural parameters and the whirl flutter stability margins. The analysis procedure described is based on the usage of the NASTRAN program system.

Test Maturity Model integration (TMMi) is a popular model for maturity assessment and capability improvement of software testing practices in industry. Originally inspired by the Capability Maturity Model Integration (CMMI), and managed by the TMMi Foundation, the TMMi specification provides detailed guidelines for assessing and improving testing capabilities of teams and organizations. We present in this paper a status report about TMMi, motivations for and benefits of using TMMi, and how companies have been ranked in each of its process areas.

Airworthiness certification is a mandatory but expensive process in aircraft development. To reduce certification cost, it is desired to incorporate certification considerations into aircraft early...

Prevailing theory argues that more certifications increase performance. However, emerging empirical evidence implies that obtaining more certifications may actually decrease performance. How do we reconcile this tension? Practically speaking, why would ventures seek additional certifications in light of these recently identified risks? To address this gap between existing theory and recent empirics, we look more closely at ventures’ activities and performance outcomes after they receive their first certification. We posit that different patterns of certification reflect different forms of experimentation. In particular, ventures may be willing to experiment in ways that incur an inappropriateness penalty for the chance to gain a subsequent desirability premium if their experiments succeed. Inappropriateness means that certifications signal divergence from accepted market norms and standards. Desirability means that certifications signal activities that are in the perceived self-interest of the potential audience. We hypothesize that certifications reflecting broad experimentation incur initial inappropriateness penalties, yet when successful, they are more likely to lead to breakthroughs that generate desirability premia. We find support for this idea through an empirical analysis drawing from a sample of 7,440 U.S. ventures that receive one or more Small Business Innovation Research (SBIR) or Small Business Technology Transfer (STTR) grants to commercialize new technologies. This study advances institutional theory of certification to better account not only for its benefits but also for its costs.

We explore a key tension between certification and entrepreneurial entry. On the one hand, more stringent certifications may provide greater legitimacy. On the other hand, market entry may be facilitated by easing such standards. To reconcile this tension, we examine discontinued certifications. We draw on research into how new ventures use certifications to gain legitimacy, along with quantitative data from new venture credit records. We show that after a certification is discontinued, new ventures in emerging industries continue to conform to these discontinued certified standards. Our study shows that those whose attributes do not provide other sources of legitimacy (e.g., unconventional founders in emerging industries) are more likely than other new ventures to comply with discontinued certification. However, those with other legitimating attributes (e.g., elite institution alumni founders) can overcome such legitimacy deficits and take advantage of new rules easing entry. Overall, our findings show that discontinued certifications can become certification “relics” whose standards continue to linger and influence entry, even after they are no longer formally in effect. Our study and its findings enhance our understanding of institutional support for new ventures, as well as the repertoire of strategic actions available to new ventures to gain legitimacy and acceptance in the face of institutional change.

Purpose To evaluate the impact of the current structure and schedule of the American Board of Radiology (ABR) radiation oncology initial certification (RO-IC) examinations, with a primary focus on implications for family planning and early professional barriers among female radiation oncologists. Methods and Materials The Society of Women in Radiation Oncology (SWRO) conducted a survey of crowdsourced ABR candidates and diplomates for radiation oncology between June and July of 2020. The primary study cohort was early career female radiation oncologists of the 2016 through 2021 graduating classes. Results The survey response rate of early career female radiation oncologists was 37% (126 of an estimated 337). Among this cohort, 58% (73 of 126) reported they delayed or are currently delaying / timing pregnancy or adoption to accommodate the annual schedule of the four qualifying and certifying examinations required to achieve board certification in radiation oncology. One in every five respondents who had attempted to become pregnant reported experiencing infertility (25 of 79, 20%). Women who reported intentionally delaying pregnancy to accommodate the ABR RO-IC examination schedule were significantly more likely to experience infertility (46% versus 18%, p=0.008). Seven women (6%) reported at least a one-year delay in sitting for a RO-IC examination due to an unavoidable scheduling conflict related to childbirth and/or the peripartum period. A majority reported that full board certification had a significant impact on achieving academic promotion or professional partnership (52%), annual compensation (54%), and non-clinical professional commitments (58%)—these rates mirror those of surveyed early career male counterparts (n=101). Conclusions The current structure and scheduling of the ABR RO-IC examinations imposes noteworthy hurdles for many female radiation oncologists when entering the workforce. The recent transition to virtual examination platforms creates an important opportunity to increase flexibility in the structure and scheduling of the board examination process to improve equitable board certification practices.

OBJECTIVES: Reducing inappropriate nursing home (NH) antibiotic usage by implementing stewardship programs is a national priority. Our aim is to evaluate the influence of antibiotic stewardship programs on antibiotic use rates in NHs over time. DESIGN: Retrospective, repeated cross-sectional analysis. SETTING AND PARTICIPANTS: Long-term residents not receiving hospice care in freestanding NHs that participated in one or both surveys in 2013 and 2017. METHODS: Survey data were merged with the Minimum Data Set and the Certification and Survey Provider Enhanced Reporting data. Our outcome was a binary indicator for antibiotic use. The main predictor was the NH antibiotic stewardship policy intensity. Using multivariate linear regression models adjusting for resident and facility characteristics that differed between the two years, we calculated antibiotic use rates in 2013 and 2017 for all residents, those with Alzheimer’s disease, and those with any infection including urinary tract infections (UTIs). RESULTS: Our sample included 317,003 resident assessments from 2013 and 267,537 assessments from 2017, residing in 953 and 872 NHs, respectively. NH antibiotic stewardship policy intensity increased from 2013 to 2017 (p < 0.01) and among all NH residents, including those with Alzheimer’s disease, antibiotic use rate decreased (p < 0.05), with 45% of the decline attributable to strengthening stewardship programs. For most residents, policy intensity was associated with decreased usage in residents with UTI. However, among Alzheimer’s disease residents with a UTI, this association did not persist. CONCLUSIONS AND IMPLICATIONS: While there was a decrease in antibiotic use in 2017, more time is needed to see the full impact of antibiotic stewardship policy into practice. Adjustments to programs that directly address barriers to implementation and appropriate UTI antibiotic use for residents with Alzheimer’s disease are necessary to continue strengthening NH antibiotic stewardship and improve care.

Work-related diseases of the musculoskeletal and the peripheral nervous system are classified as overload cumulative microtrauma diseases, resulting from chronic overload and/or damage of specific neuromusculoskeletal structures. Occupational activities which predispose to them are characterised by monotypy (repetition of movements during a significant part of the working shift). Authors described 4 cases of women with musculoskeletal and peripheral nervous system disorders qualified as occupational background just in the 2nd instance of medical certification. Detailed analysis of occupational exposure and medical interview with individual diagnostic approach allowed to determine the occupational etiology of diseases, regardless of non-occupational risk factors in some cases, even if the workstation was not common. Difficulties in estimating the probability of disease process induction on the background of occupational exposure are caused by frequent coexistence of non-occupational risk factors. The 2-tier system of certification provides an independent evaluation of medical history and occupational exposure. Med Pr. 2022;73(1).

How does government licensing affect selling on online platforms? We examine the impact of China’s 2015 Food Safety Law on sellers and buyers on Alibaba, the largest e-commerce platform in that country., Quels effets l’obligation d’accréditation imposée par les pouvoirs publics a-t-elle sur les plateformes de commerce en ligne? Nous examinons l’impact de la loi chinoise sur la sûreté des aliments de 2015 auprès des vendeurs et acheteurs de la plus grosse plateforme de commerce en ligne de Chine, Alibaba.

For smart cities, the successful large-scale implementation of solar PV technology, Quality Certification and Standards are mandatory. The International Electrotechnical Commission (IEC) is a global organization for standardization consisting of all IEC national committees. The IEC PV standards comprise IEC technical committee 82 solar PV Energy System (IEC TC82) which develops and adopts all Photovoltaic related standards. There are nearly 80 standards applicable to photovoltaic and five working groups in IEC TC82. For necessary safety requirements ‘Quality and Standards’ technologically need to be revised and up to date. This paper presents PV standards developed by various technical committees worldwide, mainly focusing on various IEC PV standards, gaps identified by them and the recommendations provided by the committee in recent times. The breakup costs of the various sub-systems of a PV installation with an illustrative example for India is also discussed. It is intended to provide a guideline for consumers and investors, opting for solar PV installations.

As the acuity, complexity, and illness severity of patients admitted to cardiac intensive care units have increased, the need to recognize critical care cardiology (CCC) as a dedicated subspecialty in cardiovascular disease has received increasing support. Differing viewpoints exist regarding the optimal pathway for CCC training. Currently, all proposed CCC training pathways involve permutations of individual training years culminating in subspecialty certification across multiple disciplines; however, there are significant disadvantages to these training paradigms. We propose an innovative, pragmatic approach to CCC training through tailored subspecialty training in advanced heart failure and transplant cardiology (AHFTC), using elective time to enrich AHFTC training with skills and experiences necessary to become a highly skilled critical care cardiologist. The completion of this pathway would lead to completion of AHFTC training with a novel designation: distinction in critical care cardiology.

The emissions trading scheme (ETS) is considered an effective policy tool for achieving emission reductions. At present, China’s ETS pilots have completed several compliance periods and provided rich experience for a national ETS. Taking advantage of the variations in the regional ETS pilots across regions and sectors and over time, this study used a difference-in-difference-in-differences (DDD) model to examine the effects of ETS pilots and differential program design on industry risk and the impacts of risk on future investment horizon. First, we found that the ETS pilots significantly increase profit variability (total risk) in China’s industry; that is, ETS induces greater uncertainty in the covered sectors. In terms of industry heterogeneity, non-electricity sectors (specifically ferrous metal) engage in higher levels of risk taking. Second, the influence of such program features as the allowance allocation (total amounts and approaches), China Certification Emission Reduction (CCER) trading volumes, and penalties are heterogeneous. Finally, during the period around the treatment, industry risk can significantly encourage longer rather than shorter investment. In particular, the punishment mechanism and benchmarking allocation play a positive role in regulating the risk‒investment relationship.

The use of intraoperative transesophageal echocardiography (TEE) has become the standard of care for most cardiac surgical procedures. There are guidelines established for training, practice, and quality improvement in perioperative TEE by the joint efforts of the American Society of Echocardiography and Society of Cardiovascular Anesthesiologists. Cardiac point-of-care ultrasound (POCUS) increasingly is being incorporated into anesthesiologists’ training and practice. While a special “certification in Critical Care Echocardiography” was created by the National Board of Echocardiography in 2019, there currently exist no guidelines for training, certification, and practice of perioperative TTE by anesthesiologists. In this review, the authors describe the categories, indications and applications of perioperative TTE and provide a recommended sequence for performing an examination tailored to the evaluation of perioperative patients. Although the authors describe a protocol utilized at their institution, there are no standards described in the literature for PTTE. Cardiac anesthesiologists and cardiac anesthesia societies (Society of Cardiovascular Anesthesiologists, European Association of Cardiothoracic Anesthesiologists) must come forward to establish standards working in collaboration with echocardiography societies (American Society of Echocardiography, European Society of Cardiology).

Carefully considering the Capability Maturity Model Integration (CMMI) Level 2 specific practice to “define project life cycle phases” (SP 1.3) is a key requirement, particularly when it comes to small and medium-sized software development organizations. This is a necessary step to help these organizations get nearer to achieving CMMI Level 2 certification. In this paper, we, therefore, report on our latest empirical study that recently explored both the perceptions and experiences of practitioners about SP 1.3 implementation. During our research, we visited three firms and carried out three in-depth interviews. We developed a SP 1.3 model using the different experiences and opinions of practitioners regarding SP 1.3 implementation. The four essential stages of this model are plan, design, review, and update/rework. Practitioners will receive advice in this model about implementing SP 1.3 effectively.

Background COVID-19 is a global health crisis. Close contact with the mucous membranes and respiratory secretions of patients and aerosol-generating procedures renders dentists and other oral health professionals at high risk of exposure to SARS-CoV-2. We examined dentists’ knowledge, preparedness, and experiences of managing COVID-19 in Australia. Methods A cross-sectional online survey of dentists with a current membership with The Australian Dental Association (ADA) was conducted between March and April 2021. Results Of the 368 survey responses, most dentists (72.3%) reported having a good level of knowledge about COVID-19, with most visiting the ADA Federal COVID-19 (74.7%) and state/territory department of health websites (62.8%), respectively to source up-to-date information. Most dentists (87.6%) felt prepared to manage COVID-19 into the future, although 66% reported not receiving training or certification in the use of PPE. Over half (58.7%) reported not being concerned about contracting SARS-CoV-2 at work, with some (28.9%, n=98/339) feeling more stressed than usual and having heavier workloads. Conclusions COVID-19 had significant impact in oral healthcare in Australia. Dentistry has adapted to the varied challenges raised by the pandemic. Comprehensive training and detailed guidelines were fundamental for successful patient management during the COVID-19 outbreak.

Supplemental Digital Content is available in the text., Problem There is a shortage of addiction medicine (AM) physicians and a 9-year period (2017–2025) in which to build the workforce via a practice pathway enabling physicians to combine experiential hours with passing a board exam to become board-certified AM physicians. Afterward, AM specialists will need to complete the traditional fellowship pathway, requiring additional training. Approach The Michigan Collaborative Addiction Resources and Education System (MI CARES) was developed from February to June 2019 to support physicians in obtaining AM certification via the practice pathway. This program was originally planned for Michigan physicians but was quickly expanded nationally. This novel, asynchronous, self-directed online curriculum follows the knowledge blueprint for the board exam, including continuing medical education credits. The program also provides 1:1 coaching support to educate physicians on how to properly document their experiential hours on the application for the AM board exam. The first module, which describes the practice pathway, was released in January 2020, and 7 substance-specific content modules were released monthly from February to August 2020. Outcomes As of October 31, 2020, 231 physicians from 13 American Board of Medical Specialties in 37 U.S. states were enrolled in MI CARES. The longer a module was available, the more participants visited the module. Three early program adopters were approved to sit for the 2019 board exam, and 51 participants passed the board exam in 2020. Of these 51, 5 had previously been denied approval before participating in MI CARES. Next Steps It will be important to replicate preliminary evidence of feasibility for this novel model for expanding the workforce in a newly approved and underrepresented specialty to see if it holds promise for replication as other subspecialties are identified. The curriculum is being expanded to include modules on additional topics and adapted for graduate and undergraduate medical education students.

OBJECTIVE To survey occupational health-related activities conducted at hospitals certified by the Japan Council for Quality Health Care in the Kanto region of Japan. METHODS The survey tool was sent to 470 hospitals and comprised the following items: hospital size, occupational health system, infection control practices, mental health services, promotion of work system reforms, and priorities in achieving occupational health. RESULTS A total of 140 hospitals completed the survey. A monthly workplace inspection was conducted in approximately 60% of the hospitals. Testing of new employees for hepatitis and four other viruses was conducted in approximately 65% of the hospitals, and influenza vaccination was administered to the employees in all the hospitals. Most hospitals provided mental health services to their workers, which included consultation with an occupational physician. Work system reforms for changing conference time and task shifting or sharing were adopted in approximately 50% of the hospitals. Prevention of blood-borne pathogens, respiratory infections, and healthcare coverage for healthcare workers was identified as areas of improvement in several hospitals. CONCLUSIONS Legally required infection control and occupational health-related practices were conducted in most hospitals. Additionally, several hospitals undertook work system reforms, including the management of changes in conference time and task shifting or sharing.

Geriatric oncology is based on the synergy between several professionals whose common goal is to improve care for older patients with cancer. This requires sharing a common core of knowledge to facilitate collaboration between them. To date, training in geriatric oncology has been limited in scope and difficult to access for caregivers, particularly nurses and healthcare aides. To meet this need, a massive open online course (MOOC), in geriatric oncology has been developed in France. This kind of course aims to provide simultaneous access for a large number of participants and to foster communication with the pedagogical team through discussion forums. The first session of the MOOC, which has been set up in the Occitania region of France, went online nationwide from March 6 to June 23, 2020. Despite the SARS CoV-2 global health crisis, 1020 people subscribed to the first session and 417 (40.9%) were certified at the end of the course. Most are nurses (35.2%) and work outside Occitania (56.3%). A survey revealed a high satisfaction level regarding relevance of lessons (97.9%), pedagogical quality of teaching team (97.9%), knowledge acquisition (93.6%), meeting learners' needs (90.4%) and practical value of the course (88.3%). This preliminary experience demonstrates the ability of this MOOC to spread the culture of geriatric oncology and the educational potential of this new type of online training.

In the aircraft sector, Composite materials are becoming more popular for key structures for example engine Nosecones and fuselage panels. A bird strike is a serious threat that can cause significant structural damage. Using the explicit code AUTODYN, the current research focuses on composite structure finite element modelling and simulation of high velocity impact loads from soft body hits on composite structures. This study looks at how to use computational techniques for certification of an aircraft by initially proving the method's precision of bird hit on rigid target modelling and then extending the generated model to a more intricate situation. Because real bird hit testing is costly and time taking, it is proposed that simulation data be used in the early stages of design and for an aircraft certification of bird strike criterion under federal guidelines.

Sustainability has become a critical concern for the textile and apparel industry. Over years, a variety of initiatives and practices have been implemented in the industry to reduce the impact to the environment. Offering sustainable products has been an endeavor for many companies in the apparel industry, including the outdoor wear segment. While Consumers are increasingly aware of and interested in buying sustainable products, much research is still needed in terms of important attributes influencing consumers’ purchase decision as well as tradeoffs consumers make when important attributes conflicting against each other. Employing a conjoint analysis approach, this study aims to investigate how different product attributes (i.e., type of fabric, type of down, eco-label certification, and price) jointly affect consumers’ sustainable apparel purchase decision in more realistic settings. As a result of a full profile fractional factorial design, a parsimonious orthogonal array of eight profiles were generated, representing eight different realistic combinations of product attributes. Four hundred and four participants were recruited to participate in this study to evaluate and indicate their purchase intention toward each product profile. Results suggest that price, as expected, is still the most important attribute to consumers, followed by type of fabric(recycled), availability of eco-labels, and type of down (traceable). Moreover, the results reveal that the tradeoffs consumers made varied due to their demographics in terms of gender, education, income, and past purchase experience. This research provides insightful managerial implications to fashion practitioners in their efforts in formulating strategies for product development and marketing by identifying preferred product attributes from the consumer-centric perspective.

In the increasingly complex health care system, physicians require skills and knowledge to participate with multidisciplinary team members in quality improvement (QI) that adds value to health care organizations. The Educational and Clinical Leaders Improving Performance with Structured E3L training (ECLIPSE) program was developed to address this challenge. Clinically relevant components of lean management were leveraged to create an online, flipped-classroom curriculum, and this was paired with Kaizen adapted specifically for physicians and multidisciplinary clinicians to promote experiential skills utilization. The focus of each adapted Kaizen was a topic of institutional QI priority, such as improving patient throughput or reducing readmission rates. Participants were awarded certification in the E3 Leadership management system-a patient-centered, equity-focused system based on lean principles. After 4 years, 50 E3 Leadership certificates were awarded to multidisciplinary clinicians, including 30 to physicians; participants scored an average 85% on module quizzes. The ECLIPSE program has improved physician participation in multidisciplinary QI projects with institutional alignment.

In the scope of Behavioral Decision Theory, Accounting-based Earnings Management (AEM) may compromise the success of decision making of a firm’s stakeholders. Given that AEM constitutes a barrier to the decision-making process, we aim to identify the main motivations of the players of AEM. Besides, in this study we also intend to analyze the implementing and detecting of AEM practices in financial statements and to evaluate whether individual characteristics influence the ability to implement and detect creative accounting practices. To achieve the proposed objectives, a quantitative methodology approach was used. A survey was applied to Portuguese’s certified accountants. In the data analyses, we applied the univariate and multiple analysis. Based on 159 observations, we find that most certified accountants indicate the main motivations are related to the reduction of the cost of capital and tax burden, the strength of the “code law system”, and that the managers are the main players. Our evidence also shows that the AEM practices are easily implemented and detected in the financial statements. In addition, we find that age, professional experience, and academic qualifications of the certified accountant tend to have an impact on the ability to implement AEM in the financial statements, contrary to gender and training area. Furthermore, gender and academic financial statements. This research is important for the development of the literature, entities that operate in accounting standardization and for the users of accounting and financial information. This study contributes to a better understanding of AEM practice, and it originally combines individual characteristics of accounting professionals with AEM practice.

Contemporary commercial building’s demonstrate performance from a sustainability and environmental perspective. Usually, an appropriate energy performance is achieved using efficient mechanical systems, however the operation method with smart control is significant in the overall energy consumption. The research follows a two-year design and construction process of a commercial building where the integration of smart technology was a mandatory requirement by the owner, alongside with the prerequisites of the LEED® green building certification. The goal was to design, build and optimize the performance of the new Innovation Campus commercial office building complex using smart building solutions. The research was performed with energy modeling and dynamic simulation until completion of the building, where the design and investment decisions were constantly evaluated. The new optimized building’s performance demonstrated 42% of annual energy reduction and 34% of cost reduction according to the “ASHRAE 90.1 Appendix G” baseline Benchmark building.

Objective The use of basic transesophageal echocardiography (TEE) in critically ill and older surgical patients can change patient management and improve outcomes after noncardiac surgery. The authors hypothesized that educating the future generation on basic TEE skills by an intense two-month rotation will help them achieve basic TEE certification by the National Board of Echocardiography (NBE) and facilitate good use of their skills for patient care during their practice. Design This is a descriptive report of graduating anesthesiology residents who completed two months basic TEE rotation at the authors’ residency program between 2013 and 2019. The authors report the clinical training goals, NBE testamur and certification status, and a survey report on the use of basic TEE skills in their practice Settings University medical center. Participants Residents who completed two months basic TEE rotation during their Clinical Anesthesia (CA)-3 year. Interventions None. Measurements and Main Results Of a total of 115 residents, 67 (58%) elected basic TEE rotation. The NBE basic TEE certification and testamur status were achieved by 12 (21%) and 14 (24%) eligible residents, respectively. Residents (n = 43) personally performed 73 ± 21 (mean ± standard deviation) and reviewed 72 ± 28 (mean ± standard deviation basic TEE studies before graduation. The survey indicated that 63.4% of residents trained in basic TEE did not use their skills in their practice. Conclusions Two months’ basic TEE rotation was able to fulfill its educational goals (testamur status and clinical training) but fell short on achieving NBE certification rate and its ultimate impact on practice and patient care.

Basic life support (BLS) seminars’ knowledge declines over time. The Hellenic Cardiological Society (WG CPR), a principal BLS (European Resuscitation Council) organizer in Greece, interviewed 5.545 certified BLS providers of the previous 3 years’ HCS seminars through an online survey tool questionnaire. We evaluated knowledge scoring and examined any possible association with other factors. Certified BLS providers were predominantly female (68.7%) with a university-level education (50.2%), and registered nurses (40.1%). A better score was associated with female gender, younger age, medical profession and university education. Among healthcare professionals medical doctors reached higher scores. Time elapsed since the last attended BLS course did not affect the remaining knowledge in any subgroup.

The inaugural certifying examination for special competence in pediatric surgery in North America was given by the American Board of Surgery (ABS) in April 1975, the day before the sixth meeting of the American Pediatric Surgical Association at a resort near San Juan, PR. The event came after failed applications before the ABS and the Advisory Board for Medical Specialties in 1957, 1961, and 1967. The specialty had matured with a scholarly publication devoted to the field (Journal of Pediatric Surgery, 1965), the establishment of standards for training and training programs (1966), and a society independent of pediatrics and devoted solely to pediatric surgery (American Pediatric Surgical Association, first meeting 1970). Harvey Beardmore had guided the successful campaign for a certificate for pediatric surgery under the aegis of the ABS that was approved in June 1972. Pediatric surgery had thus gained full recognition as a specialty of surgery. A group photograph of its participants became one of the iconic images in our specialty. Thanks to Jim and Nancy Hopkins of Windsor Heights, IA, and to their many friends and colleagues, nearly half (71 of 151) of the pediatric surgeons in the photo were identified, marking their places in the history of pediatric surgery.

Background On December 7, 2020, the Acting Commissioner of the Connecticut Department of Public Health (DPH) issued an order authorizing eligible health professionals to administer coronavirus disease (COVID-19) vaccines provided they complete a vaccination training program. The University of Connecticut (UConn) School of Pharmacy was approached to collaborate with DPH to create a certification program to meet the needs of this order. Objectives To use a unique, pharmacist-led practice model to increase the number of competent vaccinators to administer the COVID-19 vaccine and to reduce vaccine hesitancy with timely vaccine information. Practice description A didactic and in-person training program was developed, with an evaluation completed by a vaccination-certified pharmacist. In addition, faculty members, staff, and students developed short videos answering questions about COVID-19 vaccines. Practice innovation We are aware of no other such programs using pharmacists and student pharmacists as primary creators of training and certification of health professionals to administer the COVID-19 vaccine. Evaluation methods Success was gauged by the rapid increase in the number of eligible health professionals who completed the developed training program and became certified as COVID-19 vaccinators. When addressing vaccine hesitancy, success was defined by the number of videos created and the number of views and likes the videos received. Results As of April 30, 2021, 1834 health professionals registered to administer the COVID-19 vaccine. A total of 1195 (65%) participants completed the online training developed by pharmacists, and 872 participants (48%) attended pharmacist-led, in-person competencies. As of July 29, 2021, efforts resulted in 14,972 views and 257 “Likes” for 79 videos promoted through social media platforms. Conclusion A partnership between the Connecticut DPH and the UConn School of Pharmacy allowed the rapid increase in capacity to administer the COVID-19 vaccine to citizens of Connecticut. Patients are receptive to accessing health information that pharmacists create on social media.

The objective of this research is to verify if through the management of public policy it will be possible to comply in a timely manner with the processes of child support in the courts of peace of the judicial districts of the country. For its development, the doctrine was analyzed and field work was conducted through surveys directed to judges of the courts of peace of the Superior Court of Justice of North Lima, due to the good practices that this judicial district has been carrying out and because it obtained the ISO 9001:2015 certification for the implementation of a quality management system in attention to the processes of child support. Regarding the research methodology, this is descriptive and correlational; and the method applied is the inductive and quantitative and qualitative approaches. From the study of the results obtained, it is concluded that there is a process management system for the celerity of processes of child support claims, established in the objectives of the National Plan for Access to Justice for Persons in Condition of Vulnerability 2016-2021, but it is not met, due to various factors related to the insufficiency of economic, technological, material and human resources in the judiciary.

Purpose:The purpose of this study was to identify the online resources that are frequently used by certified speech-language pathologists (SLPs) for dysphagia management and to evaluate these online resources against a standardized critical review metric.Method:Certified SLPs were surveyed and asked to describe their familiarity and confidence in critically reviewing online resources and to provide three online resources that they use to inform them about their management of patients with swallowing disorders. Three raters independently judged each online resource that was provided by survey respondents using the DISCERN Instrument. Relationships between respondent demographics and characteristics of online resources were explored.Results:Our results revealed that no patterns in DISCERN Instrument ratings for online resources were provided by the 48 respondents. There was no difference in who was more or less likely to choose credible online resources for dysphagia management when considering respondents' characteristics and familiarity and confidence in reviewing online resources. Most of the online resources provided by the respondents lacked a high level of reliability for most of the DISCERN Instrument review criteria.Conclusion:Professional training in the critical review of online resources used for managing dysphagia is needed across all levels of training.

Problem setting. The progressive digitalization of all spheres of life and their confident transition to fundamentally new forms of functioning and interaction between economic entities, public administration and international relations is based on digital tools that allow using digital technologies in the digitalization of the national economy. However, the experience of their application and effective use is insufficient in comparison with developed countries, so to ensure sustainable development of society, it is necessary to thoroughly and comprehensively study the features of digital tools and their use in government and to objectively assess the prospects of digitalization in all spheres of life in modern Ukraine.Recent research and publications analysis. The issue of digitalization and the increasing use of digital technologies is present in the research of many specialists. In particular, it is necessary to note significant achievements in this field of such scientists as V. Apalkova, O. Bernaziuk, S. Vereteniuk, N. Hrytsiak, N. Deieva, A. Dobrynin, N. Drahomyretska, O. Yemelyanenko, T. Kaminska, A. Kaminskyi, G. Karcheva, O. Kachnyi , S. Koliadenko, N. Kraus, V. Kuibida, S. Kutsenko, D. Layon, I. Lopushynskyi, V. Liashenko, A. Maslov, V. Nikolaev, V. Pysarenko, A. Semenchenko, K. Semiachkov, S. Chukut and many others. However, there is a necessity for complex research, which concern the use of digital tools for ensuring sustainable development.Previously unsettled parts of the general problem. The article aimed at substantiating the directions of intensification of the use of digital tools for ensuring sustainable development in Ukraine basing on the studies of features of the usage of digital tools, the analysis of its use in various fields at the present stage of the development of our state. Paper main body. The conceptual approach to understanding the essence of sustainable development makes it possible to consider this concept as “development that meets the needs of the current generation without compromising the ability of future generations to meet their own needs.” The answer to public demands is given by the Sustainable Development Goals, offering a new vision of economic growth of states and new values.In the context of the needs of today’s development and the implications for future generations, we need to look at the digital economy and the increasing use of digital tools. Digitalization can not only solve today’s problems but also generate new ones, the consequences of which may be felt by the next generation in the case of inefficient use of digital technologies. In the world, digitalization processes have significantly accelerated after quarantine and affected not only developed countries but also Ukraine and other developing countries. They relate to all spheres of public life, in particular, to the interaction of citizens with public authorities.In Ukraine, the introduction of digital tools in the work of state and municipal authorities has not become as widespread as abroad, but it is worth noting some steps in this direction. The following digital tools for interaction between the government and communities are already in force or will be implemented in the nearest future: for the government – feedback from the community population; involvement of people into the managerial process. For adult residents of communities – Centres for providing administrative services, which work as centres of “Action”; consulting zones for entrepreneurs; online population survey; local chatbots. For students and schoolchildren – the opportunity to get an IT profession online; career guidance online courses; electronic magazines.Along with public authorities, digitalization processes have confidently entered the business sphere, and this has become especially noticeable in the conditions of quarantine, according to which many employees were forced to switch to remote work. Digital tools allow businesses to adapt to new realities and build relationships between employees, customers and partners on a fundamentally new basis. They help to automate routine processes and business, and also to redirect free resources in the direction of finding new ideas for business development.Digitalization has also affected the scientific sphere – today it is difficult for the average scientist to imagine his work without the use of, for example, Google tools, in particular, such as Google Cloud Platform, Google Academy, etc. Thanks to them, it is possible to conduct comprehensive research and publish their results. And the use of such specialized digital tools for scientists as Google Public Data, Dataset Search and Google Data Studio makes it possible to work effectively with data sets.Along with the scientific sphere, digitalization is closely connected with the educational field. Responding to the quarantine requirements for distance learning, the State Education Quality Service of Ukraine has introduced the following distance forms: the study of practical experience of work of participants in the certification of pedagogical staff; conducting institutional audits of general secondary education institutions.Areas of intensification of the use of digital tools to ensure sustainable development are regulatory, organizational-managerial, labour, competency-based, project, infrastructure and international. The development of digitalization and the introduction of digital tools in social processes have become inevitable, so it is necessary to ensure the implementation of digitalization procedures with maximum effect.Conclusions and prospects for further studies. Digital tools can be defined as a tool, a mean to improve communication between individuals and legal entities and the state through digital technologies and online communications. In the direction for ensuring the sustainable development of society, digital tools are essential tools that minimize resource costs, which allows you to redirect their use in a more constructive direction and, if possible, to preserve the resource potential for future generations.

Objectives To describe the role of the clinical nurse specialist, an advanced practice registered nurse in the intensive care setting. The value and impact of the clinical nurse specialist role as a member of the ICU is presented along with a review of clinical nurse specialist education, licensure, and certification requirements as well as a description of the clinical nurse specialist role, scope of practice, and competencies. In addition, a selected review of clinical nurse specialist–led quality improvement and research that resulted in improved patient outcomes is provided. Data sources Review of published medical and nursing literature and expert opinion guidance from a collaborative effort between the Society of Critical Care Medicine, American Association of Critical-Care Nurses, and National Association of Clinical Nurse Specialists. Study selection Not applicable. Data extraction Not applicable. Data synthesis Not applicable. Conclusions The utilization of a clinical nurse specialist, an advanced practice role, in the ICU is a unique and valuable approach for organizations who strive to move evidence into sustainable practice and drive quality through an interprofessional approach. The valuable contributions made by the clinical nurse specialist efficiently and effectively meet the needs of patients, clinicians, and organizations while improving patient outcomes and optimizing cost avoidance strategies, which further lower economic demands on the healthcare system.

El siguiente artículo presenta una caracterización de agricultores de frutas y hortalizas del municipio de Argelia (Valle del Cauca, Colombia) y traza el insumo base para los requerimientos funcionales del diseño de una herramienta digital orientada al registro de las labores agrícolas aplicando buenas prácticas agrícolas (BPA). Se llevó a cabo una investigación de tipo cualitativa soportada con datos cuantitativos que consistió en entrevistar a asesores (Farm Assure) formados bajo la norma internacional GLOBALG.A.P.; además de realizar encuestas semiestructuradas a agricultores de la región y de revisar la reglamentación de dicha norma, que servirá para elaborar los requerimientos funcionales mencionados y que se implementarán en la herramienta digital. El estudio arrojó que todos los agricultores encuestados tienen algún tipo de conocimiento relacionado con la certificación de BPA, ellos reconocen que han aplicado las BPA para poder comercializar sus productos de acuerdo con las exigencias de las cooperativas de la región. Así mismo, se muestra la pertinencia del uso de una herramienta móvil capaz de alojar un registro de las actividades de campo, facilitando así el proceso de certificación en BPA. La adopción de herramientas tecnológicas en la agricultura permite avanzar a la inocuidad de los productos alimentarios en Colombia. Metodológicamente se llevó a cabo una investigación del tipo cualitativa soportada con datos cuantitativos y en este marco se realizó un trabajo de campo que consistió en: (I) entrevistas a 4 asesores (farm Assure) formados bajo la norma internacional GLOBALG.A.P.; (II) encuestas semiestructuradas realizadas a 30 agricultores de las regiones de Argelia del Valle del Cauca; y (III) revisión de la reglamentación de la norma GlobalG.A.P., con lo cual se elaboraron los requerimientos funcionales y algunas validaciones que se implementaran en la herramienta digital. Los resultados cualitativos y cuantitativos de esta investigación muestran que los agricultores encuestados tienen algún tipo de conocimiento en certificación de BPA, y que lo aplican en cierta medida, dado que pertenecen a cooperativas de la región que les exigen cumplirlas para comercializar algunos productos. Además, se evidencia la pertinencia del uso de una herramienta móvil que les permita llevar un registro diario de sus labores de campo, con miras a facilitar el proceso de certificación en BPA. Este trabajo hace un aporte al esfuerzo que se está realizando en Colombia en cuanto a la inocuidad de los productos alimentarios con miras a evitar adversidades que pongan en riesgo la salud de la población

Aim/purpose – The purpose of this paper is to clarify the certification process of the Good Clinical Practice (GCP) competencies based on a comparison with the project management (PM) certification process. This aim was accomplished by model development. Design/methodology/approach – The study was divided into three main phases: 1st phase – the identification of key characteristics of PM and GCP certification processes, 2nd phase – the development of certification models for PM and GCP, 3rd phase – the conclusions from in-depth interviews. Findings – As a result of the research, key characteristics of PM and GCP certification processes were identified, certification models for PM and GCP were developed. In addition, based on conclusions from in-depth interviews, solutions for organizing the way of confirming knowledge of GCP guidelines were proposed. Research implications/limitations – The proposed rules may be too complex and may exceed the needs and expectations of the clinical trial environment. The models focus on stakeholder relations, without the rules of certification granting procedures, to enable broader contextualization of the issues discussed in the paper. The analysis might be fragmented as it regards the sole certification process. The research refers to Poland only, hence it will be valuable to identify whether foreign authorities have the same attitude to the GCP competency certification model. It is recommended to increase the number of respondents’ interviews to obtain results of higher validity and reliability. Originality/value/contribution – The paper raises research topics at the crossroads of project management, clinical trials, and GCP, topics that have been underdeveloped so far. The results might be significant for all organizations involved in conducting clinical research projects. The findings contribute to the quality of clinical trials and provide public assurance that the rights, safety, and well-being of trial subjects are protected and the clinical trial data are credible. Keywords: project management, clinical trials, certification, Good Clinical Practice, GCP. JEL Classification: M10, O32, I11.

PURPOSE The grading scale for students in a physician assistant program of study is not standardized. Students may be evaluated on a traditional 5-tiered A to F scale or a pass-fail system. The decision to change from ordered grading to pass-fail at an established program in the southeast was done following a change in the affiliated School of Medicine. The purpose of this study was to review effects on student scores following such a change. METHODS The Physician Assistant National Certifying Exam (PANCE) and PACKRAT 2 exam scores for the last 2 cohorts of students scored in the 5-tiered system (2016, N = 60 and 2017, N = 59) were compared against the same for the first 2 cohorts (2018, N = 59 and 2019, N = 58) of the pass-fail system. Nonrandom sampling of all students in each cohort year was evaluated using 2-tailed t-testing. RESULTS A total of 236 student scores were evaluated using a 95% confidence interval. The traditionally scored classes outperformed all pass-fail cohorts (means 460.67/491.86 versus 503.34/493.92). P values were found to be significant at all values between the 5-tier scored classes and the pass-fail cohorts in PANCE scoring, resulting in failure to reject the null hypothesis. This was also true for the PACKRAT 2 with the exception of the 2019 cohort, which was significant only for outperformance of the other pass-fail cohort. For the purpose of this study, the only analysis performed was scoring. CONCLUSION For cohorts undergoing curricular change, unforeseen impacts on initial standardized exam scores may occur. In this study, PANCE scores for the first year of the 2 pass-fail cohorts decreased while the overall program scores remained at or above the national average. The pass-fail cohort did show an upward trend in the second year of the curriculum, suggesting that as programs become more familiar with the pass-fail system, steady improvements occur. This suggests that while an anticipated drop in initial scores may be expected, further studies are needed to evaluate the impact on stress reduction, long retention, and intraclass competition.

Food safety is vital for public health, influencing a country's economic development and international reputation. In recent years, Taiwan has encountered several food quality problems, with consequent public questioning and mistrust of food safety. If consumers are unaware of the quality of a product, their perception and demands can be influenced by the credibility of the food safety certification labels. This study uses the contingent valuation method (CVM) to analyze the factors influencing consumer willingness to pay (WTP) for food safety certification labels of packaged rice. Questionnaires are randomly adopted and assigned to 434 participants. The results indicate that product factors should be presented clearly on their packaging and advertisements. Consumers focus on certification labels for food safety perception. Gender, education level, place of purchase, certification cognition, and health cognition are all found to affect willingness to pay. These significant results indicate that women were more willing to pay than men; people were willing to pay a higher amount for purchases of packaged rice at supermarkets or hypermarkets; health cognition was estimated to be negative and significant, showing that health cognition negatively affected WTP, perhaps because participants did not sufficiently trust the foundation's assurance that the rice was safe. In the valuation of WTP for food safety certification, each person was willing to pay on average NT31.07 annually to reduce the risk of food safety problems.

Background and purpose The use of smartphone applications is ubiquitous within healthcare. Over recent years there have been multiple applications developed within the field of plastic surgery. In the UK, applications with a medical purpose should be registered with the Medicines and Healthcare products Regulatory Authority (MHRA) as a medical device. The aim of this study was to evaluate plastic surgery specific smartphone applications designed for healthcare professional usage, and determine what proportion meet the criteria of a medical device and are suitably certified. Methods A systematic review of the Apple and Google Play App stores was carried out using search terms relevant to plastic surgery. Data was extracted from the app store listing, developer website and the contents of each application. Each application was evaluated against the criteria given by the MHRA to determine whether it constituted a medical device. Results 215 applications for plastic surgery healthcare professionals were identified, of which 22 met the definition of a medical device. Only 14% (n = 3) of these applications were appropriately certified, 14% (n = 3) were validated in peer-reviewed literature and 45% (n = 10) had documented medical professional involvement. Conclusion Most applications with a medical purpose were not certified as a medical device, had not been validated in any peer-reviewed research, and did not have any documented involvement of medical professionals. The potential consequences of such applications operating incorrectly are stark and represent a risk to patient safety. Usage of multiple applications in a single patient encounter may compound error and safety of clinical care.

Objectives In Austria a national train-the-trainer programme (TTT) has been developed, implemented and evaluated with the aim of training and certifying participants for developing, implementing and delivering communication skills training (CST) for health professionals. Methods The programme included 5 in-person courses, application homework with feedback, peer work, and regular trainer network meetings. Global satisfaction with training and changes in self-efficacy among TTT-participants and their learners in the CST delivered as practice projects were evaluated. Results 18 participants have graduated from the TTT-pilot. 98 people took part in the 9 CST delivered by TTT-participants. Participants’ satisfaction has been rated very positively both for TTT and CST. At post-programme/post-training, statistically significant improvement was observed in self-efficacy for the TTT-participants and for the CST-participants. Additionally, valuable suggestions for programme/training improvement were identified. Conclusions This programme is an important step to sustainably improving CST in Austria. To guarantee high quality and consistency, a set of standards for certification have been developed for TTT and CST. Practice implications Implementation of best practices in training trainers and communication skills teaching can be guided by a structured approach. Those wanting to implement similar programmes can benefit from strengths and suggestions for improvement identified in this national project.

INTRODUCTION Cultural transformation is needed for health care to be sensitive to children's pain. The Pediatric Pain Practice Registered Nurses (PRN) Curriculum is the first free, open access, downloadable, interprofessional pain continuing education (IPPCE) curriculum developed to empower health care professionals to translate evidence-based pain care into clinical practice. To evaluate the curriculum and its experiential flipped-learning strategies, we used a mixed methods approach. METHODS Interprofessional pediatric teams from eight health care systems evaluated the curriculum after attending Pediatric Pain PRN Courses in the Fall of 2017 (N = 90). Qualitative methods were used to evaluate the acceptability, feasibility, and utility of the curriculum and IPPCE strategies. Pain knowledge and attitudes were measured pre-IPPCE/post-IPPCE with the Pediatric Healthcare Provider's Knowledge & Attitude Survey Regarding Pain (PHPKAS). Web analytics were used to describe dissemination for the first year after the curriculum's webpage launch. RESULTS Learners rated their achievement of course objectives as moderate-great. PHPKAS scores significantly increased (P < .0005); but significant differences in physician and nurse PHPKAS question responses pre-IPPCE/post-IPPCE were found. Within 2 years of the IPPCE, three health care systems were certified as Childkind Hospitals, five Pediatric Pain PRN Programs were established, and various practice changes and improved patient outcomes, such as decreased hospital lengths of stay and emergency department returns for pain, were realized. Curriculum dissemination was global. DISCUSSION Results support the acceptability, effectiveness, feasibility, utility, and global dissemination of the curriculum and IPPCE strategies. More rigorous patient outcome data are needed; however, this study demonstrated the benefit of a free, open-access, downloadable, interprofessional health care provider continuing education curriculum.