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Background Radiation oncology (RO) is a high-risk environment with an increased potential for error due to the complex automated and manual interactions between heterogeneous teams and advanced technologies. Errors involving procedural deviations­­ can adversely impact patient morbidity and mortality. Under-reporting of errors is common in healthcare for reasons such as fear of retribution, liability, embarrassment, etc. Incident reporting is a proven tool for learning from errors and, when effectively implemented, can improve quality and safety. Crew resource management (CRM) employs just culture principles with a team-based safety system. The pillars of CRM include mandatory error reporting and structured training to proactively identify, learn from, and mitigate incidents. High-reliability organizations, such as commercial aviation, have achieved exemplary safety performance since adopting CRM strategies. Objective Our aim was to double the rate of staff error reporting from baseline rates utilizing CRM strategies during a six-month study period in a hospital-based radiation oncology (RO) department. Methods This quasi-experimental study involved a retrospective review of reported radiation oncology incidents between January 2015 and March 2016, which helped inform the development and implementation of a two-step custom CRM training and incident learning system (ILS) intervention in May 2016. A convenience sample of approximately 50 RO staff (Staff) performing over 100 external beam and daily brachytherapy treatments participated in weekly training for six months while continuing to report errors on a hospital-enterprise system. A discipline-specific incident learning system (ILS) customized for the department was added during the last three months of the study, enabling staff to identify, characterize, and report incidents and potential errors. Weekly process control charts used to trend incident reporting rates (total number of reported incidents in a given month /1000 fractions), and custom reports characterizing the potential severity as well as the location of incidents along the treatment path, were reviewed, analyzed, and addressed by an RO multidisciplinary project committee established for this study. Results A five-fold increase in the monthly reported number of incidents (n = 9.3) was observed during the six-month intervention period as compared to the 16-month pre-intervention period (n = 1.8). A significant increase (>3 sigma) was observed when the custom reporting system was added during the last three study months. Conclusion A discipline-specific electronic ILS enabling the characterization of individual RO incidents combined with routine CRM training is an effective method for increasing staff incident reporting and engagement, leading to a more systematic, team-based mitigation process. These combined strategies allowed for real-time reporting, analysis, and learning that can be used to enhance patient safety, improve teamwork, streamline communication, and advance a culture of safety.

The government, in light of the pressures being placed on businesses across the country, has put together a package of assistance for employers and employees, in an effort to keep as many people in employment as possible during the current Covid-19 emergency.

Purpose A good ‘fit’ with an organization is critical to a leader's success yet when searching for a new position assessment an evaluation of many aspects may be overlooked, such as culture. This paper presents key considerations around ‘fit’ that applicants for leadership positions should consider prior to, during, and after the interview. Suggestions are provided on how to approach an evaluation of ‘fit’. Conclusion The importance of assessing individual fit with an organization prior to accepting a leadership position cannot be over-emphasized.

This paper presents a comprehensive study on resume classification to reduce the time and labor needed to screen an overwhelming number of applications significantly, while improving the selection of suitable candidates. A total of 6,492 resumes are extracted from 24,933 job applications for 252 positions designated into four levels of experience for Clinical Research Coordinators (CRC). Each resume is manually annotated to its most appropriate CRC position by experts through several rounds of triple annotation to establish guidelines. As a result, a high Kappa score of 61% is achieved for inter-annotator agreement. Given this dataset, novel transformer-based classification models are developed for two tasks: the first task takes a resume and classifies it to a CRC level (T1), and the second task takes both a resume and a job description to apply and predicts if the application is suited to the job T2. Our best models using section encoding and multi-head attention decoding give results of 73.3% to T1 and 79.2% to T2. Our analysis shows that the prediction errors are mostly made among adjacent CRC levels, which are hard for even experts to distinguish, implying the practical value of our models in real HR platforms., Accepted by the 2020 Conference on Empirical Methods in Natural Language Processing (EMNLP 2020)

The Convention on International Trade in Endangered Species of Wild Fauna and Flora (CITES) requires that trade in species, including orchids, listed on Appendix II be authorised only if the level of export is not detrimental to their survival in natural environments. This paper describes how existing guidelines for a “non-detriment finding” (NDF) were adapted to provide a protocol for Jamaican orchids using the endemic Broughtonia sanguinea as a case study. The NDF format encompasses taxonomic and ecological information, statutory and conservation status, management practices, and trade data. As well as passing legislation to meet CITES requirements and conduct trade in all listed species, the government of Jamaica has approved a policy towards orchid conservation. The strategies in the policy cover conservation of species and their habitats, sustainable use of orchids, promotion of research and training, and public education. Although much is known of the morphology of Broughtonia sanguinea, an epiphytic orchid typically found in dry limestone forests, and insights into its distribution can be gleaned from sources such as herbarium records and incidental floral studies, a systematic survey has been conducted at only one of its known habitats. This highlights a fundamental issue in making NDFs, which is especially problematic in developing countries: lack of resources to adequately monitor populations of endangered and threatened species and particularly those traded on a relatively small scale. The available data on population density along with ongoing threats to its habitat indicate that the precautionary principle should be followed by progressively reducing the export quota for wild-sourced Broughtonia sanguinea. It is further recommended that artificial propagation of orchids be actively encouraged, and the export of all wild-sourced orchid species be phased out.

BACKGROUND Malnutrition increases the risk of mortality and morbidity in the pediatric intensive care unit (PICU). Barriers to adequate delivery of enteral nutrition (EN) include hemodynamic instability, feeding interruptions and intolerance, and lack of standardized feeding protocols. The most recent guidelines on nutrition support for the critically ill child describe a paucity of evidence around the best method to deliver EN. There is an untested clinical assumption that bolus gastric feeding (B-GF) in intubated patients is associated with aspiration events, lung injury, and associated morbidity compared with continuous gastric feeding (C-GF). This study compared the effectiveness and safety of C-GF vs B-GF in intubated pediatric patients. METHODS We enrolled randomized patients aged 1 month-12 years who were intubated within 24 hours and received EN starting within 48 hours of admission to a C-GF or B-GF group. Goal-directed EN volume and caloric density were increased every 3 and 12 hours, respectively, to target. Feeding interruptions and intolerance events were recorded. RESULTS Twenty-five subjects were enrolled (B-GF = 11; C-GF = 14). At 24 hours, B-GF was associated with higher energy and protein delivery (P

Entry into the Fellowship of Staff and Educational Development Association is through the production of a professional portfolio which evidences the applicant’s achievement of the Fellowship requirements. Supporting and Leading Educational Change takes participants through the Fellowship process. The 12-week online course combines theory of educational development and change management, with group exercises and individual application to practice. Participants are educational developers who are themselves often facilitators of courses for university teachers. In this reflective case study the course tutors provide a personal reflection based on their experience of two very different cohorts. They review the cohorts to identify successful experiences and good practice. Drawing on the literature surrounding online learning, communities of practice and Lizzio’s senses for student success, they situate their reflections in the context of professional development in general and in educational developmen...

Higher education has always aspired to be seen to encourage open access to all types of learner including those with vocational qualifications. The reality of participation rates for such vocational learners is low (about 18%), however the reasons for such levels appear to mainly be reflected in perceptive issues amongst employers, learners and educational staff rather than procedural or technical barriers within qualifications themselves. Key to aiding progression are staff in higher education and the associated development opportunities they can access. Accepting there are issues specific to certain occupational strands in higher education, it is a clear cross-party political intent to encourage further progression of vocational learners and indeed to increase the whole vocational delivery of such provision as apprenticeships. Recent announcements around fee levels and demands for visible efforts relating to widening participation make the requirement to increase progression levels critical to the future of educational pathways.There is also a clear demand for such vocational qualification pathways from a cohort of interested learners, supported by employers, all with an intention towards progression. Accepting there is a case for widening participation, associated change within Higher Education (HE) appears to require staff development support to ensure such change occurs. This paper outlines some of the key activities, operated by the Western Vocational Lifelong Learning Network, that can successfully be adopted to encourage such learners and ensure higher education meets the aspirations for widening participation to this key cohort.

Following Derek Bell’s overview in the previous article, Elaine Fisher describes the way in which the science curriculum is being developed in a special school setting. A strong element in this article is the emphasis placed on a creative, outward–looking approach to the curriculum and to the links being actively developed with mainstream schools and a range of relevant organisations.

Acute and chronic intestinal ischemia has been linked to the development of gastrointestinal symptoms such as abdominal pain, nausea and vomiting, bowel dysfunction and more seriously, the complications of sepsis, shock and death. Advances in electron paramagnetic resonance (EPR) oximetry have resulted in accurate and reliable in vivo measurement of the partial pressure of oxygen (pO(2)) in solid organs (e.g., muscle, heart) [1], but has yet to be tested in thin walled organs such as intestine. Our ultimate goal is to noninvasively monitor intestinal pO(2) during acute and chronic intestinal ischemia in a rat model. A series of experiments to deliver oxygen-sensitive indicator probes to the small/large intestine by intravenous, luminal and wall injection, as well as direct placement of a solid probe against the outer intestinal wall were attempted. Only the LiNc:BuO:PDMS chip sutured to the peritoneal wall and in direct contact with the intestine allowed for noninvasive pO(2) measurement by EPR. However, the validity of site-specific intestinal pO(2) measurement could not be confirmed and the obtained pO(2) value likely reflected peritoneal cavity oxygenation. Developing methods for probe placement on or inside the intestinal wall are needed for noninvasive, site-specific intestinal pO(2) measurement by EPR to track changes during acute and chronic intestinal ischemia.

Nurse executives play a key role in healthcare organizations. This study asked nurse executives whether there were particular experiences, events, or persons that influenced their leadership style. The answers to this question provide guidance for nurses who aspire to this role. Nurse administrators, leaders, and educators are in pivotal positions to influence the development of leadership in others.

1. The development of embryos of Ascidia nigra has been studied over a period of one year. Embryos were reared in water taken from three distinct areas, the open ocean, inshore harbor and mangrove lagoon.2. Eggs are available throughout the year and are always capable of successful development. Spawning probably occurs on a cyclical basis at least once per month.3. Embryos develop and hatch more successfully in open ocean water than in inshore waters. Differences in success of development and hatching are in part accounted for by differences in salinity and pH, but other factors may also be involved.4. There are no distinctive seasonal differences in embryonic survival.