Evaluation of Transbronchial Lung Cryobiopsy Freezing Time, Biopsy Size, Histological Quality, and Incidence of Complication: A Prospective Clinical Trial

Background: Transbronchial cryobiopsy (TBCB), a novel way of obtaining a specimen of lung tissue using a flexible cryoprobe, can obtain large lung biopsies without crush artifacts. The freezing time of TBCB was empirically selected from 3 to 7 s in the previous studies. However, no consensus has yet been reached regarding the optimal freezing time used in TBCB. Objectives: The primary endpoint was biopsy size in different freezing times. The secondary endpoints included sample histological quality, diagnostic confidence, and complications in different freezing times. Methods: Patients who were suspected of DPLD requiring histopathological examination for further evaluation were enrolled in this study. Distinct biopsies were obtained by using different freezing times increased from 3 to 6 s sequentially. Samples were reviewed by 2 external expert pathologists. Results: A total of 33 patients were enrolled, and 143 transbronchial cryobiopsies were taken in this trial. An average of 4.33 samples were taken from each patient. The mean biopsy size of different freezing times from 3 to 6 s was 9.10 ± 4.37, 13.23 ± 5.83, 16.26 ± 5.67, and 18.83 ± 7.50 mm2, respectively. A strong correlation between freezing time and biopsy size was observed (r = 0.99, p < 0.01). Statistically significant difference of biopsy size was detected in the freezing time of 3 s versus 4 s (p < 0.01) and 4 s versus 5 s (p = 0.02), but not in the freezing time of 5 s versus 6 s (p = 0.10). Overall bleeding in different freezing times from 3 to 6 s was 53.33%, 67.50%, 89.47%, and 77.14%, respectively. A significantly higher overall bleeding was observed when the freezing time exceeded 4 s (RR = 1.67, p < 0.01). Pneumothorax occurred in 4 cases (12.12%). One lethal case (3.03%) was noted 25 days after TBCB. Lung parenchyma was preserved well in all cryobiopsy samples. Thirty-one (93.94%) patients’ histopathological findings were identified as sufficient to establish a CRP diagnosis. There was no statistical difference in diagnostic confidence between different freezing times. Conclusion: A longer freezing time was associated with a larger size of the biopsy sample but a higher risk of bleeding. The optimal transbronchial cryobiopsy freezing time is 3–4 s, which is easily achievable and provides an adequate biopsy size whilst creating a safety threshold from complications.

A new blockchain system design to improve the supply chain of engineering, procurement and construction (EPC) companies – a case study in the oil and gas sector

Purpose This paper aims to propose a new blockchain system design to improve engineering, procurement and construction (EPC) companies’ supply chain for constructing oil and gas infrastructure, by mitigating cost and time inefficiencies. Design/methodology/approach A case study analyses the supply chain of a sample EPC company. First, a literature review is conducted to explore the subject in academic literature. Second, information flows are mapped using responsible, accountable, consulted and informed analysis and cross-functional process mapping. Third, inefficiencies are identified. Fourth, the root causes of the inefficiencies are pinpointed using fishbone and five-times-why analysis. Fifth, a comparison is made between the linear and the blockchain information system via force-field analysis. Sixth, a specific blockchain system design is identified based on three external expert interviews. Finally, the new system is designed and a cost-benefit analysis is conducted. Findings Major cost and time inefficiencies in oil and gas infrastructure developments are caused by a poor information flow in the supply chain. The new blockchain system design is a feasible solution, reducing cost inefficiencies by 12.4% and operation lead-times by 36.5%. Research limitations/implications The confidentiality of the sample EPC company’s information represents a limitation. Originality/value The research introduces a new blockchain system design, reducing cost and time inefficiencies in the project-development supply chain, including implementation processes.

Towards Sustainable Development in Education: Implementing a VET System for In-Service Teachers in Albania

The Albanian Strategy of Pre-University Education (2014–2020) stated the need to raise the competencies of in-service teachers in the non-university sector by asking Albanian universities to provide Vocational Education and Training (VET). The Erasmus+ project, entitled “Developing Teacher Competences for a Comprehensive VET System in Albania” (TEAVET, 2017–2020), contributed to the design and implementation of a VET system based on the previous literature of five dimensions: context, content, commitment, capacity and clients. The aim of this study was to assess the VET system for in-service teachers in Albania under these dimensions and identify key elements for sustainability. Through a mixed methods approach that merged quantitative and qualitative data (questionnaires and assessment reports), information was retrieved from the directors of lifelong learning (LLL) centres at eight Albanian universities, the Albanian Ministry of Education, Sports and Youth, in-service teachers (n = 1775, response rate 76%), teacher educators from universities (n = 44, response rate 82%) and an external expert. Results show that the VET system for in-service teachers in Albania accomplishes these five dimensions. The main elements for sustainability are that the VET system addresses specific Albanian educational priorities, the Ministry is highly committed and that universities have been empowered as LLL providers within their third mission strategy.

Enhancing Students’ Literacy Competence Through Writing Bilingual Folklore Book by IT: Process Approach

Writing bilingual storybooks based on local wisdom is a product of the Prose Appreciation course. The results of the evaluation so far indicate that students' low literacy skills in developing literary works such as short stories, novels, and bilingual folklore books with IT-based ISBN in 8 ethnic groups in North Sumatra. There is also a phenomenon of the influence of globalization from the use of the internet which removes boundaries between countries resulting in the spread of globalization itself which has led to increasing interest among teenagers or students towards modern literary works originating from outside Indonesia such as America, Europe, and from Asian countries. For this reason, this study will be developed to improve st udent literacy competencies through 6 types of Tasks KKNI in making IT-based ISBN-based folklore books for 8 ethnic groups in North Sumatra. Indirectly, this research explores the elements of the existing culture and is also a measure to preserve local culture. This study uses the Classroom Action Research Method (PTK). This activity is carried out through several stages of the process are a. Training in writing folklore literary works based on local wisdom in Taman Budaya. b. Review process by internal reviewers (students (peer review), and lecturers). c.Validation by internal and external expert teams. d. Publishes ISBN books of bilingual folk tales. e. Create a blog about bilingual folklore books.

An innovative pharmacology curriculum for medical students: promoting higher order cognition, learner-centered coaching, and constructive feedback through a social pedagogy framework

Background Ongoing developments in medical education recognize the move to curricula that support self-regulated learning processes, skills of thinking, and the ability to adapt and navigate uncertain situations as much as the knowledge base of learners. Difficulties encountered in pursuing this reform, especially for pharmacology, include the tendency of beginner learners not to ask higher-order questions and the potential incongruency between creating authentic spaces for self-directed learning and providing external expert guidance. We tested the feasibility of developing, implementing, and sustaining an innovative model of social pedagogy as a strategy to address these challenges. Methods Constructivism, communities of practice, and networked learning theory were selected as lenses for development of the model. Three hundred sixty-five first-year medical students participated between 2014 and 2018; they were introduced to pharmacodynamics and pharmacokinetics via 15 online modules that each included: learning objectives, a clinical vignette, teaching video, cumulative concept map, and small group wiki assignment. Five-person communities organized around the 15 wiki assignments were a key component where learners answered asynchronous, case-based questions that touched iteratively on Bloom’s cognitive taxonomy levels. The social pedagogy model’s wiki assignments were explored using abductive qualitative data analysis. Results Qualitative analysis revealed that learners acquired and applied a conceptual framework for approaching pharmacology as a discipline, and demonstrated adaptive mastery by evaluating and interacting competently with unfamiliar drug information. Learners and faculty acquired habits of self-directed assessment seeking and learner-centered coaching, respectively; specifically, the model taught learners to look outward to peers, faculty, and external sources of information for credible and constructive feedback, and that this feedback could be trusted as a basis to direct performance improvement. 82–94% of learners rated the social pedagogy-based curriculum valuable. Conclusions This social pedagogy model is agnostic with regard to pharmacology and type of health professional learner; therefore, we anticipate its benefits to be transferable to other disciplines.

An innovative pharmacology curriculum for medical students: promoting higher order cognition, learner-centered coaching, and constructive feedback through a social pedagogy framework

BackgroundOngoing developments in medical education recognize the move to curricula that support self-regulated learning processes, skills of thinking, and the ability to adapt and navigate uncertain situations as much as the knowledge base of learners. Difficulties encountered in pursuing this reform, especially for pharmacology, include the tendency of beginner learners not to ask higher-order questions and the potential incongruency between creating authentic spaces for self-directed learning and providing external expert guidance. We tested the feasibility of developing, implementing, and sustaining an innovative model of social pedagogy as a strategy to address these challenges.MethodsConstructivism, communities of practice, and networked learning theory were selected as lenses for development of the model. 365 first-year medical students participated between 2014-2018; they were introduced to pharmacodynamics and pharmacokinetics via 15 online modules that each included: learning objectives, a clinical vignette, teaching video, cumulative concept map, and small group wiki assignment. Five-person communities organized around the 15 wiki assignments were a key component where learners answered asynchronous, case-based questions that touched iteratively on Bloom’s cognitive taxonomy levels. The social pedagogy model’s wiki assignments were explored using abductive qualitative data analysis.ResultsQualitative analysis revealed that learners acquired and applied a conceptual framework for approaching pharmacology as a discipline, and demonstrated adaptive mastery by evaluating and interacting competently with unfamiliar drug information. Learners and faculty acquired habits of self-directed assessment seeking and learner-centered coaching, respectively; specifically, the model taught learners to look outward to peers, faculty, and external sources of information for credible and constructive feedback, and that this feedback could be trusted as a basis to direct performance improvement. 82-94% of learners rated the social pedagogy-based curriculum valuable.ConclusionsThis social pedagogy model is agnostic with regard to pharmacology and type of health professional learner; therefore, we anticipate its benefits to be transferable to other disciplines.

Assessment of Inclusive Process as a Tool for Designing Inclusion in Educational Institution

The paper presents results of a study aimed at exploring how comprehensive assessment of inclusive process may be used as a tool for designing inclusion The paper presents results of a study aimed at exploring how comprehensive assessment of inclusive process may be used as a tool for designing inclusion within an educational institution. The assessment technique is based on three methodological foundations: activity, participatory and human rights based approaches which imply active involvement of the key subject groups in joint activities aimed at developing inclusion. The assessment model is built into the development cycle of an inclusive process and includes, along with self-examination and external expertise, the analysis of the assessment results by the school community with the participation of an external expert, the design of changes, their implementation and re-assessment. The participatory approach enabled us to involve the parent community as one of the subjects of assessing the state of the inclusive process at school. We focused on the following research tasks: to describe the stages in the assessment of inclusive educational process by its participants; to show, using the case of one of the schools involved in testing as an example, how the assessment and its discussion by the participants of the educational process and by the external expert affect the choices in the design of changes, making the educational institution more inclusion-oriented. To analyze the results of applying the assessment technique, one of the Moscow schools was selected which has extensive experience in the implementation of inclusive education and has reached the stage of change design in the cycle of inclusion development. The participatory approach made it possible, on the one hand, to involve the parent community as one of the subjects of assessing the state of the inclusive process at school. On the other hand, the assessment by an external expert was used as a tool for developing the institution’s inclusiveness. All groups of respondents gave a fairly high level of assessment of the inclusive process, although there were statistically significant differences (p &lt;0.01) between the assessments of the teaching staff and parents (lower) in all indicators, except for Redeployment of Resources, Community Building, and Information Accessibility. These differences in the assessments, including the expert ones, were used by the institution to design changes and increase the involvement of the parent community in this process. Thus, the offered methodology can be used as a mechanism for self-analysis and a tool for designing inclusive process in an educational institution within the cycle of inclusive development.

Guidelines for Tracheostomy From the Korean Bronchoesophagological Society

The Korean Bronchoesophagological Society appointed a task force to develop a clinical practice guideline for tracheostomy. The task force conducted a systematic search of the Embase, Medline, Cochrane Library, and KoreaMed databases to identify relevant articles, using search terms selected according to key questions. Evidence-based recommendations for practice were ranked according to the American College of Physicians grading system. An external expert review and a Delphi questionnaire were conducted to reach a consensus regarding the recommendations. Accordingly, the committee developed 18 evidence-based recommendations, which are grouped into seven categories. These recommendations are intended to assist clinicians in performing tracheostomy and in the management of tracheostomized patients.

An innovative pharmacology curriculum for medical students: promoting higher order cognition, learner-centered coaching, and constructive feedback through a social pedagogy framework

Background Ongoing developments in medical education recognize the move to curricula that support self-regulated learning processes, skills of thinking, and the ability to adapt and navigate uncertain situations as much as the knowledge base of learners. Difficulties encountered in pursuing this reform, especially for pharmacology, include the tendency of beginner learners not to ask higher-order questions and the potential incongruency between creating authentic spaces for self-directed learning and providing external expert guidance. We tested the feasibility of developing, implementing, and sustaining an innovative model of social pedagogy as a strategy to address these challenges. Methods Constructivism, communities of practice, and networked learning theory were selected as lenses for development of the model. 365 first-year medical students participated between 2014-2018; they were introduced to pharmacodynamics and pharmacokinetics via 15 online modules that each included: learning objectives, a clinical vignette, teaching video, cumulative concept map, and small group wiki assignment. Five-person communities organized around the 15 wiki assignments were a key component where learners answered asynchronous, case-based questions that touched iteratively on Bloom’s cognitive taxonomy levels. The social pedagogy model’s wiki assignments were explored using abductive qualitative data analysis. Results Qualitative analysis revealed that learners acquired and applied a conceptual framework for approaching pharmacology as a discipline, and demonstrated adaptive mastery by evaluating and interacting competently with unfamiliar drug information. Learners and faculty acquired habits of self-directed assessment seeking and learner-centered coaching, respectively; specifically, the model taught learners to look outward to peers, faculty, and external sources of information for credible and constructive feedback, and that this feedback could be trusted as a basis to direct performance improvement. Conclusions This social pedagogy model is agnostic with regard to pharmacology and type of health professional learner; therefore, we anticipate its benefits to be transferable to other disciplines.

An Innovative Pharmacology Curriculum for Medical Students: Promoting Higher Order Cognition, Learner-Centered Coaching, and Constructive Feedback Through A Social Pedagogy Framework

BackgroundOngoing developments in medical education recognize the move to curricula that support self-regulated learning processes, skills of thinking, and the ability to adapt and navigate uncertain situations as much as the knowledge base of learners. Difficulties encountered in pursuing this reform, especially for pharmacology, include the tendency of beginner learners not to ask higher-order questions and the potential incongruency between creating authentic spaces for self-directed learning and providing external expert guidance. We tested the feasibility of developing, implementing, and sustaining an innovative model of social pedagogy as a strategy to address these challenges.MethodsConstructivism, communities of practice, and networked learning theory were selected as lenses for development of the model. 365 first-year medical students participated between 2014-2018; they were introduced to pharmacodynamics and pharmacokinetics via 15 online modules that each included: learning objectives, a clinical vignette, teaching video, cumulative concept map, and small group wiki assignment. Five-person communities organized around the 15 wiki assignments were a key component where learners answered asynchronous, case-based questions that touched iteratively on Bloom’s cognitive taxonomy levels. The social pedagogy model’s wiki assignments were explored using abductive qualitative data analysis.ResultsQualitative analysis revealed that learners acquired and applied a conceptual framework for approaching pharmacology as a discipline, and demonstrated adaptive mastery by evaluating and interacting competently with unfamiliar drug information. Learners and faculty acquired habits of self-directed assessment seeking and learner-centered coaching, respectively; specifically, the model taught learners to look outward to peers, faculty, and external sources of information for credible and constructive feedback, and that this feedback could be trusted as a basis to direct performance improvement. ConclusionsThis social pedagogy model is agnostic with regard to pharmacology and type of health professional learner; therefore, we anticipate its benefits to be transferable to other disciplines.