Do regions of interest location and type influence liver stiffness measurement using magnetic resonance elastography?

PurposeTo assess the variability of liver stiffness measurements using magnetic resonance elastography (MRE) at 1.5 T, depending on different approaches of regions of interest (ROIs) drawing.Material and methodsFifty consecutive patients with successful liver MRE were included. There were 32 men and 18 women with a mean age of 52 ± 14 (SD) years (range: 20–85 years). MRE was acquired using a gradient recalled-echo MRE sequence. At the level of the portal bifurcation, one observer drawn in the right liver first 3 elliptical ROI and then one free-hand ROI, as large as possible based on the confidence map and the anatomy. Three additional elliptical ROIs were further drawn on the slice above and 3 other on the slice below, for a total of 9 elliptical ROIs. The average value of liver stiffness in the 3 elliptical ROIs of the central slice and the one from the 9 elliptical ROIs were computed. Three liver stiffness values were obtained for each patient from the 3 measurement methods (one free-hand ROI, 3 elliptical ROIs and 9 elliptical ROIs). Inter-method variability was assessed using the intra-class correlation coefficient (ICC) and Bland-Altman analysis.ResultsThe variability between the 3 methods was excellent with ICC > 0.978 (P < 0.0001). The Bland-Altman analysis revealed high agreement between the 3 methods with bias < 0.45 kPa and limits of agreement < ±1.13 kPa. The variability was lower when comparing a large free-hand ROI and the 3-elliptical ROIs, than when comparing the 9-elliptical ROIs to one of the other methods.ConclusionOur results show that the variability between the 3 methods of ROI drawing and placement is very low.     

Healthcare assistants in EU Member States: An overview

With many European countries facing health workforce shortages, especially in nursing, and an increasing demand for healthcare, the importance of healthcare assistants (HCAs) in modern healthcare systems is expected to grow. Yet HCAs’ knowledge, skills, competences and education are largely unexplored. The study ‘Support for the definition of core competences for healthcare assistants’ (CC4HCA, 2015–2016) aimed to further the knowledge on HCAs across Europe. This paper presents an overview of the position of healthcare assistants in 27 EU Member States (MSs) and reflects on the emerging country differences.It is shown that most learning outcomes for HCAs across Europe are defined in terms of knowledge and skills, often at a basic instead of more specialized level, and much less so in terms of competences. While there are many differences between MSs, there also appears to be a common, core set of knowledge and skills-related learning outcomes which almost all HCAs across Europe possess. Country differences can to a large extent be explained by the regulatory and educational frameworks in which HCAs operate, influencing their current and future position in the healthcare system. Further investments should be made to explore a common understanding of HCAs, in order to feed discussions at policy and organisational levels, while simultaneously investments in the development and implementation of context-specific HCA workforce policies are needed.     

Green microwave-assisted procedure to generate bio-based pectin materials

New eco-friendly materials have been developed via esterification of several natural fatty acids by pectin alcoholic functions. The quaternization of the obtained pectin-fatty acid conjugates was performed as subsequent synthetic step. By using microwave heating and solvent-free conditions, the conjugation procedure of fatty acid chains and quaternary ammonium groups to the natural polysaccharide was clean, fast and efficient. In other words, it can be considered a low environmental impact process.     

《护理管理学》课程素材类教学资源建设及应用

教学资源建设是教育信息化的基础,也是高等教育中的重要内容.《护理管理学》作为护理专业的核心课程之一,在提高学生利用管理学理论知识来解决临床实际问题上占有重要位置[1],但关于护理管理课程的素材类教学资源建设在国内却鲜有报道.近几年来,我院护理管理教研组收集制作了有关护理管理的文本、图片、视频、试题、文献资料等各类素材类教学资源,并应用于护理管理课程教学中,取得满意的教学效果,报告如下.     

Developmental needs and early childhood education: evolutionary,my dear Watson

Examining the processes of natural selection, described by Darwin in The Origin of Species, casts light on our own species’ fundamental needs and on the far greater role that early childhood educators can play in their fulfillment. The second section of this paper analyzes how our fundamental needs emerge in a sequence underpinned by the processes of natural selection (goodness‐of‐fit, variation and replication), are thus developmental in a new sense and are fulfilled only as organisms interact with their immediate environment. The subsequent section presents a model of how, in accordance with natural selection, adults can practise collaborative behaviors that facilitate this developmental sequence throughout life. The fourth section shows how early childhood educators who practise this model in interaction with their immediate environment (which includes parents) help to fulfill the fundamental needs and increase the internal resources of all participants—themselves, parents and children. Substantiating evidence comes from the author’s studies.     

突发公共卫生事件形势下医学文献资源保障与服务

以上海交通大学医学院图书馆为例,介绍文献资源服务模式与内容,阐述新型冠状病毒肺炎疫情期间数字资源保障服务举措并提出相关建议,包括多平台结合保障远程资源获取,鼓励并规范出版商资源开放与公益服务,创新发展在线教育健全服务推广。     

An Integrated Model for Patient Care and Clinical Trials (IMPACT) to support clinical research visit scheduling workflow for future learning health systems

We describe a clinical research visit scheduling system that can potentially coordinate clinical research visits with patient care visits and increase efficiency at clinical sites where clinical and research activities occur simultaneously. Participatory Design methods were applied to support requirements engineering and to create this software called Integrated Model for Patient Care and Clinical Trials (IMPACT). Using a multi-user constraint satisfaction and resource optimization algorithm, IMPACT automatically synthesizes temporal availability of various research resources and recommends the optimal dates and times for pending research visits. We conducted scenario-based evaluations with 10 clinical research coordinators (CRCs) from diverse clinical research settings to assess the usefulness, feasibility, and user acceptance of IMPACT. We obtained qualitative feedback using semi-structured interviews with the CRCs. Most CRCs acknowledged the usefulness of IMPACT features. Support for collaboration within research teams and interoperability with electronic health records and clinical trial management systems were highly requested features. Overall, IMPACT received satisfactory user acceptance and proves to be potentially useful for a variety of clinical research settings. Our future work includes comparing the effectiveness of IMPACT with that of existing scheduling solutions on the market and conducting field tests to formally assess user adoption.