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This article reevaluates contemporary Ishin by comparing two policy entrepreneurs – managerialist guru Ōmae Ken'Ichi, and former Osaka governor Hashimoto Tōru. It argues that Ōmae's and Hashimoto's policy entrepreneurship put contemporary Ishin on a managerialist and neoliberal trajectory and fashioned it into a policymaking template for anti-establishment political reformers (kaikakuha). Despite using nationalist and anachronistic 'Ishin' terminology with his Heisei Ishin no Kai (Heisei Restoration) political movement of the early 1990s, Ōmae adapted ideational innovation and coalition building strategies from his experience in McKinsey & Company to diffuse managerialist and neoliberal policy ideas through the broader political system. Some two decades later, Hashimoto's Ōsaka Ishin (Osaka Restoration) politics reified many of Ōmae's ideas and practices through a form of 'technocratic populism', in which a seemingly incompatible pairing of anti-establishment populism and the reliance on technical 'experts' underpins the governing process. Using the 'policy entrepreneur' analytical framework', the first two sections of this article pinpoint the critical juncture where Ōmae inverted Ishin's state-building logic into an anti-establishment, neoliberal platform. The final section outlines Hashimoto's personalisation of the executive offices of local government and offers a novel look at populist governance in Japan. [ABSTRACT FROM AUTHOR]

This paper outlines innovative pedagogical approaches in chemical engineering safety education, utilising three key strategies: (1) Integration of the direct experiences of experienced professional engineers to teach expertise-aligned process safety case studies; (2) Shifting from traditional short oral presentations to more comprehensive and dynamic 'engineering meeting' formats to drive constructive student learning; and (3) The use of Generative AI to enhance (1) and (2), with cost/time scalability, improved student access and by accommodating greater learning-style diversity. Evaluation of these educational innovations is performed through a mixed-methods approach and reveals positive impacts on student learning and engagement. The paper provides a detailed outline of classroom implementation, with supporting resources, for straightforward integration by other academics. • Process safety education can be significantly enhanced by including late-career professional industry consultants and semi-retired engineers. • Generative AI roleplaying as industry consultants, can provide greater scale, student access and cater to more diverse learning styles of students. • Generative AI chatbots can be used to simulate in viva style assessment formats of process safety incident case studies. Vivas encourage more comprehensive understanding and root cause analysis of process safety incidents, when compared to commonly used short oral presentations, which can drive reductive cause-effect explanations. • A small subset of students express a preference for AI teaching tools (over in-person meetings) because of social or performance anxieties. [ABSTRACT FROM AUTHOR]

Copyright of Revista Româna de Dreptul Muncii is the property of Wolters Kluwer Romania and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

OBJECTIVES The primary objective of this study is to assess the degree of concordance and discordance between the interpretations of computed tomography (CT) brain images by resident and consultant radiologists while emphasizing the critical significance of accurate image interpretation for informed clinical decision-making. METHODOLOGY The evaluation of radiology reports for CT Brain interpretation through a prospective analysis at the Radiology Department of Rehman Medical Institute over two years, from 1st October 2020 to 31st October 2022. A total of 198 patients who underwent cranial CT scans were interpreted by residents (R1, R2, R3, R4). Following this, the consultant radiologists reviewed the images and completed their reports. The reports of the residents and the consultant radiologists were then compared, and concordance was achieved when the residents’ reports were consistent with the final radiologist’s reports. The data collected were recorded in Microsoft Excel. The statistical analysis was performed using SPSS version 22 (IBM Corp., Armonk, NY), and the kappa coefficient was used to determine the level of agreement between residents and consultants. RESULTS Among the 198 CT Head reports evaluated, 186 of them were in agreement with the final report of the consultant radiologist. Of the correctly diagnosed cases, R1 correctly diagnosed 46 cases, R2 correctly diagnosed 80 cases, R3 correctly diagnosed 54 cases, and R4 correctly diagnosed 6 cases. Our study achieved a percentage agreement of 93.93, with a Cohen's kappa coefficient of 0.8. CONCLUSION The overall concordance rate between residents and consultant radiologists was 93.93%, with a kappa coefficient 0.8. This high kappa coefficient indicates strong agreement between the two groups.

Construction waste issues have worsened globally due to the fast development of construction activities. The environment, expenditures, duration, productivity, and social dimension of the country are all negatively impacted by construction waste. The construction sector needs an in-depth knowledge of the development and construction management waste to minimize its detrimental effects. The infrastructure works of housing projects play a substantial role in many economies, including Saudi Arabia. Lean is presented as an improvement management approach for construction projects through lean techniques (less waste, time, and cost). Thus, optimizing project profitability is considered. This paper introduces the adoption of Lean in the construction of Housing infrastructure works in Saudi Arabia, in which waste can be eliminated or reduced when the causes are identified, thereby improving the reliability, stability, and optimizing profitability of construction operations. This article aims to establish the main sources of waste in Saudi Arabia's housing infrastructure projects. A questionnaire survey was conducted among owners, consultants, and contractors in Saudi Arabia. The Partial Least Square Structure Equation Model (PLS-SEM) and Relative Importance Index (RII) methods were used to analyze the collected data. The main finding revealed that the ten most important causes of waste are distributed among owners, consultants, and contractors by 20%, 10%, and 50% using the PLS-SEM method. At the same time, those percentages differ in the case of using the RII method as follows: 20%, 80%, and 0%. The consultant's causes have a mutual influence on the owner's causes and the consultant's causes. The research is considered one of the first such studies in the Kingdom of Saudi Arabia (KSA) and may enhance stakeholders' understanding of performance improvement from a lean system viewpoint in the Saudi Arabian construction industry.

Construction waste issues have worsened globally due to the fast development of construction activities. The environment, expenditures, duration, productivity, and social dimension of the country are all negatively impacted by construction waste. The construction sector needs an in-depth knowledge of the development and construction management waste to minimize its detrimental effects. The infrastructure works of housing projects play a substantial role in many economies, including Saudi Arabia. Lean is presented as an improvement management approach for construction projects through lean techniques (less waste, time, and cost). Thus, optimizing project profitability is considered. This paper introduces the adoption of Lean in the construction of Housing infrastructure works in Saudi Arabia, in which waste can be eliminated or reduced when the causes are identified, thereby improving the reliability, stability, and optimizing profitability of construction operations. This article aims to establish the main sources of waste in Saudi Arabia's housing infrastructure projects. A questionnaire survey was conducted among owners, consultants, and contractors in Saudi Arabia. The Partial Least Square Structure Equation Model (PLS-SEM) and Relative Importance Index (RII) methods were used to analyze the collected data. The main finding revealed that the ten most important causes of waste are distributed among owners, consultants, and contractors by 20%, 10%, and 50% using the PLS-SEM method. At the same time, those percentages differ in the case of using the RII method as follows: 20%, 80%, and 0%. The consultant's causes have a mutual influence on the owner's causes and the consultant's causes. The research is considered one of the first such studies in the Kingdom of Saudi Arabia (KSA) and may enhance stakeholders' understanding of performance improvement from a lean system viewpoint in the Saudi Arabian construction industry. [ABSTRACT FROM AUTHOR]

Copyright of Revista Kavilando is the property of Kavilando and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Brazilian Journal of Occupational Therapy / Cadernos Brasileiros de Terapia Ocupacional is the property of Cadernos de Terapia Ocupacional da UFSCar and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Due to the expansion of online businesses, it is necessary to use expert consultants in this field. Therefore, the present study was conducted to design a paradigm model of online competencies of online business consultants and its consequences. The research method was qualitative with a contextual approach. first the samples were selected purposefully and then in the form of snowballs. In-depth interviews were conducted semi-structured. Finally, with the process of open, pivotal and selective coding, 5 main components and 25 pivotal categories of competency components (obtaining up-to-date information, having multiple skills and ethics of consultants), causal conditions (online business includes five categories- Efforts to acquire specialized knowledge, mastery of information and communication technology, online business experience, having discipline in work and flexible management), background conditions (government management performance, government structural performance, growth of consulting culture in society), interventionist conditions ( Instability and unstructured economy in Iran, inefficient and cumbersome bureaucracy, lack of laws protecting business owners and restrictions and weaknesses within the job), strategies (systematic strategies and planned by the government, Acquisition of up-to-date knowledge and information in the field of online business, practical and applied training of online business, having the power of discernment, using the experience of others and reference groups in their field of work) and consequences (strategic thinking, self-empowerment, Civic ethics in job performance (performance management) were extracted. The categories obtained in this study, while differentiating the consultants' jobs, achieved a model that can be the basis for the performance of online business consultants.

The article is aimed at studying managerial consulting as a business and an effective method of sales and profitability of a firm, considering the importance of consulting in the passenger car market. The difference between the terms «managerial consulting» and «consulting» is considered. The characteristic features of managerial consulting for enterprises are identified. Consulting is considered on the example of passenger car sales and their growth rates during 2018–2022. The article describes what problems specialists and companies face in their work. It is found which brands of cars and in what quantity were sold during the specified years. It was further considered which car brands were sold the most, especially for such public structures as the National Police of Ukraine, the Security Service of Ukraine, the Ministry of Justice of Ukraine, the State Forest Resources Agency of Ukraine, the State Bureau of Investigation of Ukraine, and the Foreign Intelligence Service of Ukraine, also purchase of cars by the aforementioned agencies in the terms of quantity and amount. The article analyzes which car brands according to Prozorro are among the five most popular in sales among government bodies. The article allocates the factors (political, economic, social, technological, ecological, etc.) to influence the managerial consulting and what exactly can influence a decision to buy a passenger car. The article describes what functions a consultant should perform in his work, and what skills in psychology the consultant should have a good command of. The prospects of development of managerial consulting in the future are allocated, taking into account the current trends.

The purpose of this study was to analyze the narratives of a high school counselor, to investigate the causes of anxiety and its symptoms among high school pupils, and to propose suitable solutions for this field. The research was conducted using a qualitative approach and the method of narrative research. In the present narrative study, the data source is a 42-year-old female participant who has served as a consultant for two girls’ high schools in Bostanabad, East Azerbaijan Province, for the past 17 years. Narrative interview, semi-structured interview, field observation (attending some counseling sessions), and taking notes were used to collect data. Using thematic analysis, the narratives were analyzed. Age, education, and family circumstances were found to be the causes of anxiety in adolescent students. The analysis of student narratives revealed that the symptoms of this disorder manifest in four ways: physical, emotional, behavioral, and cognitive. Adjusting sleep patterns, physical activity, and diet, parental support, focusing on the positive, engaging in enjoyable activities, and talking to an anxious student are all strategies for reducing anxiety in students. The anxiety of adolescent students may not be entirely avoidable, but it can be mitigated by addressing some of their educational and domestic issues. The analysis and interpretation of this narrative have addressed a number of counseling-related obstacles. A review of the country’s educational system, particularly the school evaluation system, as well as the hiring of expert counselors in schools and placing a premium on these educational forces, as well as holding training courses for parents of children with anxiety disorders, will be crucial in reducing student anxiety, according to the research findings.

The article analyzes the theoretical and methodological foundations of psychological and pedagogical counseling in the sphere of today's education in the interdisciplinary aspects, in particular, neuropsychology and neuropedagogy. An attempt to substantiate psychological and pedagogical counseling as a service of providing psychological assistance to the client through training and forming a new experience of adaptive behavior in accordance with the requirements of the educational environment is made. Theoretical and methodological foundations of psychological and pedagogical counseling are analyzed on the basis of the works on the current issues of psychological counseling by foreign and domestic researchers. The importance of psycho-consultative interaction in the conditions of inclusive education and teaching special children, taking into account the competencies of neuropedagogy, neuropsychology and neurophysiology was substantiated. The personal approach in the methodology of today's psychological and pedagogical counseling is defined as the main one, which is integrated with psychological approaches to counseling. The methodological foundations of psychological and pedagogical counseling are defined by theoretical and methodological principles, psychological mechanisms for organizing and conducting counseling work and ethical principles and norms for manifestation of professional competence of a counselor. It was found that psychological approaches such as person-centered, problem-oriented, and professional-competence approaches are most often applied to psychological and pedagogical counseling. [ABSTRACT FROM AUTHOR]

The article discusses the use of network partnership in the process of interaction between the consultant and the client in the framework of the search, the client’s receipt of investments and further project support. Traditionally, the process of interaction between the client and the consultant is presented in such a way that only these two parties are the main participants in the consultation process. The article discusses the experience of building a multidisciplinary complex consulting process, in which many participants are involved. This experience is based on the practice of the Business Angels of Russia network community. This article analyses the practice of mainly small consulting organisations that are very different from large ones and provide significantly more customised services. The consulting related to investing funds in the client’s business is in the author’s focus. At the same time, only clients belonging to small and medium-sized enterprises naturally stand out in the work. As a rule, they do not seek advice from wellknown and renowned brands in the field of consulting services. As a rule, they do not have enough money for their services, and large consulting firms themselves choose mainly large clients to work with.

The quality and cost of constructed buildings are heavily influenced by the performance of design/auditing consultants. Thus, selecting the right design consultant and design auditing consultants is of utmost importance and not an easy task for any construction client. so, the client should specify the efficiency criteria and assess the performance levels of the design and design auditing consultant firm. The study aims to identify the selection criteria of the design consultant in construction projects and also identify the selection criteria of the design auditing consultant for the construction projects by using the Delphi survey with applying the principal components analysis (PCA). The results of the present study showed that there are 13 key criteria for selecting the design consultant, where the criterion of “Efficiency and experience of the company/consultant in previous work” was of the highest importance. While there are Ten key criteria for selecting the design auditing consultant for the construction project, where the criterion of “Credibility and professional integrity (transparency, professional conduct, and ethics)” was of the highest importance in the decision-making process. Moreover, the results of applying PCA on the Delphi survey outcomes showed that all the resulting selection criteria are most valuable and suitable for the selection process in construction projects.

Objective: To study the impact of a visiting consultant neurosurgeon on the management and outcome of neurosurgical patients in a hospital with no resident neurosurgeon. Methods: This is a 5-year retrospective study of neurosurgical conditions and their management outcomes by a visiting consultant neurosurgeon in a Nigerian Tertiary institution from January 2016 to December 2020. Results: Thousand two hundred and four (1,204) patients were reviewed. Patients' ages were between 1 h and to 86-year-olds, with a mean of 23 years and a mode of 32 ± 4 years. Children were 423 (35.1%), with 781(64.9%) adults. Males were 862 (71.6%), and Females were 342 (28.4%), with a Male to Female ratio of 5:2. Congenital problems were 170 (14.1% of 1204): meningocoeles (38, 22.4%), myelomeningocoeles (61, 35.9%), encephalocoeles (24, 14.1%), anencephaly (6, 3.5%), and hydrocephalus (41, 24.1%). Acquired conditions were 1034 (85.9% of 1204): Head injuries (486, 47%), spinal cord injuries (51, 5%), Pyogenic brain Abscess (3, 0.3%), Pott's disease (2, 0.2%), Hydrocephalus (63, 6.1%), brain tumour (5, 0.5%), degenerative spine (421, 40.7%), vascular (3, 0.3%). Surgery was indicated in 348(28.9%) patients. Two hundred and twenty-six (18.8% of 1204) had surgeries, while 978 (81.2% of 1204) had no surgeries. Referred to other facilities were 122 (10.1%). Overall, surgical intervention was 64.9% (226 of 348), with mortality of 13.5% (18 patients) among those who had surgical interventions. Conclusions: In countries with very few medical specialists, particularly neurosurgeons, such a regular visit can impact the care of neurosurgical patients in their environment.

Background: While breastfeeding rates have increased in the United States in recent years, racial and ethnic disparities persist. Telelactation may help reduce disparities by increasing access to lactation consultants, but there is limited research on acceptability among minoritized individuals. Objective: We aimed to explore experiences with telelactation among Black parents and identify strategies to make services more culturally appropriate. Methods: We selected 20 Black parents who were given access to telelactation services from an ongoing National Institutes of Health–funded randomized controlled trial (the Tele-MILC trial) to participate in semistructured interviews. Interviews addressed birth experiences, use and opinions about telelactation, comparison of telelactation to in-person lactation support, and recommendations to improve telelactation services. The thematic analysis was informed by a previously reported theoretical framework of acceptability and RAND Corporation's equity-centered model. Results: Users appreciated the convenience of telelactation and reported that lactation consultants were knowledgeable and helpful. Participants wanted more options to engage with lactation consultants outside of video visits (eg, SMS text messaging and asynchronous resources). Users who had a lactation consultant of color mentioned that racial concordance improved the experience; however, few felt that racial concordance was needed for high-quality telelactation support. Conclusions: While Black parents in our sample found telelactation services to be acceptable, telelactation could not, in isolation, address the myriad barriers to long-duration breastfeeding. Several changes could be made to telelactation services to increase their use by minoritized populations. [ABSTRACT FROM AUTHOR]

The article is devoted to the issue of consultants, an institution introduced in the Third Reich to represent Jews in legal matters. Some of the Jewish lawyers excluded from the German bar became consultants. The article presents the legal regulation, the reasons for its issuance and its eff ects. Based on the personal fi les of three consultants from the district of the Higher National Court in Katowice, the procedure of admitting them and the conditions of their activity were presented. On the basis of court fi les, the manner in which they conducted their work in criminal cases was analyzed and assessed. A signifi cant amount of anti-Jewish legislation was passed in Germany after Hitler seized power. Some of the newly introduced regulation also targetted lawyers of Jewish origin, whose professional activities were hindered, and eventually banned. In 1938 Jews were defi nitively removed from the German bar. At the same time, it was ensured that Jews would be provided with legal assistance and represented by consultants, i.e. lawyers of Jewish origin. There were clearly fewer consultants than Jewish lawyers (several in the districts in which individual higher national courts operated). Their admission was discretionary. According to sparse fi ndings in the literature, consultants were treated adequately by the German courts and were not hindered in their access to court fi les, contact with clients or the possibility of submitting lawsuits. Three examined cases of consultants from the district of the Higher National Court in Katowice indicate that they enjoyed similar freedoms while performing their functions in the courts, as described in the literature. In their daily activities, however, they had to struggle with diffi culties of an administrative or factual nature, which were a manifestation of discrimination and bans against Jews. Based on these three cases, it could be concluded that they were admitted to consular activity due to positive opinions among the population, the judiciary and the Gestapo, as well as their patriotic attitude during the First World War and during the Silesian Uprisings. Their exemplary professional conduct, war decorations, and even injuries sustained on the front of the Great War did not prevent the consultants from sharing the tragic fate of European Jews. [ABSTRACT FROM AUTHOR]

American governments spend $6 billion annually on management consulting, with steady growth. However, public-sector consulting receives little scholarly and public attention—especially for local governments. For which municipal projects are management consultants best suited? Svara asserts that complementarity promotes effective governance between city councils and their managers; sometimes, however, neither has the capability to lead the other. This study explores whether consultants can effectively fill this complementarity void by examining 205 strategic initiatives from 43 US municipalities. The analysis confirms that consultants are helpful when strategic and political-administrative contexts conflict, but only when key stakeholders are supportive. [ABSTRACT FROM AUTHOR]

Objectives. This research intends to investigate the responsibilities of the parties engaged in the implementation phase of the infrastructure projects in occupational health and safety, i.e., the consultant and contractor. Methods. A questionnaire was developed through the selection and modification of the responsibilities from the literature review. Results. The statistical analysis results show that the consultants and contractors both ranked the item 'The owner requires the contractor to implement the occupational safety standards within the bid' first in the owner responsibilities, having 0.67 relative importance index (RII). In the responsibilities of the consultant, the first ranked item was 'The consultant has a role in adopting occupational safety plans and contingency plans', having 0.66 RII. In the responsibilities of the contractor, the first ranked item was 'The contractor shall provide the insurance cover for all project crews', having 0.71 RII. In the responsibilities of the workers, the first ranked item was 'Workers know the handling of tools and equipment within the project', having 0.59 RII. Conclusion. Overall, there was general agreement between consultants and contractors to classify and arrange items because both face the same conditions and have the same working environment. [ABSTRACT FROM AUTHOR]

Objectives: We sought to assess the safety of training in cardiothoracic surgery comparing outcomes of cases performed by trainees versus fully trained surgeons.Methods: EmBase, Scopus, PubMed, and OVID MEDLINE were searched in August 2021 independently by two authors. A third author arbitrated decisions to resolve disagreements. Inclusion criteria were articles on cardiothoracic surgery reporting on outcomes for trainees. Studies were assessed for appropriateness as per CBEM criteria. Eight hundred and ninety-two results were obtained, 27 represented best evidence (2-meta-analyses, 1-RCT, and 24 retrospective cohort studies).Results: In all 474,160 operative outcomes were assessed for 434,535 coronary artery bypass grafting (CABG) (431,329 on-pump vs. 3206 off-pump), 3090 AVR, 1740 MVR/repair, 26,433 mixed, 3565 congenital, and 4797 thoracic procedures. In all 398,058 cases were performed by trainees and 75,943 by consultants. One hundred fifty-nine cases were indeterminate. There were no statistically significant differences in the patients' preoperative risk scores. All studies excluded extreme high-risk patients in emergency setting, patients with poor left ventricular function, and reoperation cases that were undertaken by consultants. There were no differences in cardiopulmonary bypass and clamp times for CABG. Times for valve replacement and repair cases were longer for trainees. There were no differences in the postoperative outcomes including perioperative myocardial infarction, resternotomy for bleeding, stroke, renal failure, intensive therapy unit length of stay, and total length of stay. One study reported no differences on angiographic graft patency at 1 year. There were no differences in in-hospital or midterm mortality out to 5-years.Discussion: Trainees can perform cardiothoracic surgery in dedicated high-volume units with outcomes comparable to those of fully trained surgeons. [ABSTRACT FROM AUTHOR]

Construction delay in projects is a common manifestation in the construction industry. Delay in construction will lead to a bad relationship between the parties involved and will also lead to an increase in the allocated completion time. Delay in the ongoing project might result in the loss of the money, time and other facilities by the client and cause a lot of financial damage to the contractor due to its investment in the purchase of equipment, construction materials and the hire of skilled workers. Delay in construction is a common problem that occurs mostly due to the unforeseen problems during the design & construction stages which often lead to delays in the completion of the project. Oman's construction industry is one of the most important industries for the country's economic development and growth. In this study, analysis of some available literature was conducted, and a questionnaire survey was floated among contractors, consultants, clients, project managers, and engineers involved in construction projects. All the collected responses were evaluated by using SPSS. The results of the study identified a total of 60 causes of delay out of which three factors have a «High» significance level for construction delays. These factors of «High» significance were associated with «Client related issues only» in which the initial design was altered by the client, delaying in deciding by the client and, scope change by the client. Majority of the delay (84 %) was observed to be lying in the range of 1-2 years. This study also recognized the effect and minimization of regular delay and delay resulted due to Covid-19. Minimizing construction delay criteria can be managed by having a proper control system in the project time and funds. [ABSTRACT FROM AUTHOR]

Background Appendicectomies are the most frequently performed acute general surgery. The risk of complications depends on several factors, including patient age, American Society of Anesthesiologists (ASA), duration of symptoms, serum inflammatory markers, and the grade of inflammation. Prior research failed to demonstrate a relationship between the rate of complications and the surgeon's level of experience. It is unclear if the assistant's level of experience influences complication rates. Methods We conducted a retrospective cohort study to investigate the relationship between the surgeon's and assistant's position and the rate of complications following appendicectomy. We also explored whether more experienced staff were involved in higher-risk cases and their relationship with resource utilization. Results There was no significant difference in total complication rates based on the surgeon's and assistant's position (p = 0.48 and p = 0.99, respectively). Post-operative bleeding was the only complication that correlated with the assistant's level of experience (p = 0.002). More experienced surgeons performed faster appendicectomies (p =0.002), while the assistant's position had no influence (p = 0.47). There was no statistically significant relationship between the surgeon's and assistant's position, and post-operative length of admission, or risk factors for complications as measured by age, days of abdominal pain, white blood cell count (WCC), C-reactive protein (CRP), ASA, radiographic and intra-operative American Association for the Surgery of Trauma (AAST). Conclusion Experienced surgeons performed faster appendicectomies. There was a trend toward higher rates of post-operative bleeding with less experienced assistants. Otherwise, there was no relationship between the surgeon's experience level and post-appendicectomy complication rates, length of post-operative stay, or patient risk factors for complications., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Bay of Plenty (BOP) Clinical Trials Unit issued approval 2024-267. We received ethics approval for this research to be conducted within Te Whatu Ora, Hauora a Toi Bay of Plenty. We also received approval from the Māori Research Review Panel on behalf of the 18 iwi that span Mai Ngā Kuri-a-Wharei Ki Tihirau, Maketu ki Tongariro (The boundaries of Te Whatu Ora Hauora a Toi | Bay of Plenty). Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Read et al.)

Institutional review board (IRB) expertise is necessarily limited by maintaining a manageable board size. IRBs are therefore permitted by regulation to rely on outside experts for review. However, little is known about whether, when, why, and how IRBs use outside experts. We conducted a national survey of U.S. IRBs to characterize utilization of outside experts. Our study uses a descriptive, cross-sectional design to understand how IRBs engage with such experts and to identify areas where outside expertise is most frequently requested. The survey response rate was 18.4%, with 55.4% of respondents reporting their institution's IRB uses outside experts. Nearly all respondents who reported using outside experts indicated they do so less than once a month, but occasionally each year (95%). The most common method of identifying an outside expert was securing a previously known subject matter expert (83.3%). Most frequently, respondents sought consultation for scientific expertise not held by current members (69.6%). Almost all respondents whose IRBs had used outside experts reported an overall positive impact on the IRB review process (91.5%). Just over half of the IRBs in our sample report use of outside experts; among them, outside experts were described as helpful, but their use was infrequent overall. Many IRBs report not relying on outside experts at all. This raises important questions about what type of engagement with outside experts should be viewed as optimal to promote the highest quality review. For example, few respondents sought assistance from a Community Advisory Board, which could address expertise gaps in community perspectives. Further exploration is needed to understand how to optimize IRB use of outside experts, including how to recognize when expertise is lacking, what barriers IRBs face in using outside experts, and perspectives on how outside expert review impacts IRB decision-making and review quality. [ABSTRACT FROM AUTHOR]

Industry, academia, and professional societies provide financial and in-kind support for physician-lead research; however, the prevalence and role remain unreported. From consultancies to leadership positions, foot and ankle surgeons receive a spectrum of support. To provide transparency between these relationships and published outcomes, journals report conflicts of interest (COI) and financial disclosures (FD). This investigation analyzes self-reported COIs and FDs in The Journal of Foot & Ankle Surgery (JFAS)®. A systematic review of manuscripts reporting COIs and FDs from the January 2008 through November 2020 issues of JFAS was conducted. Editorials, commentaries, and technique articles were excluded. Disclosure type, level of evidence, and affiliated country of authorship were collected. Trends and proportions of articles with disclosures were analyzed from before a published Open Payments Database (OPD) (2008-2013) through 2020. Among 2699 articles, 382 reported a COI or FD. The number of manuscripts with COIs and FDs increased since 2008 (p <.001). The proportion of articles with COIs or FDs was greater after the OPD was published compared to prior (p <.001). Overall, 86.35% of reported COIs were industry related while 37.09% of FDs were hospital, university, or state sponsor affiliated. International authorship was a negative predictor of COIs and FDs (p <.001). Level 3 and 4 studies were 4.60 (95%CI [0.85-24.85]) and 5.56 (95%CI [1.04-29.72]) times as likely to have self-reported a COI compared to level 1 studies, respectively. Level 2 and 5 studies were 0.33 (95%CI [0.04-3.16]) and 0.36 (95%CI [0.04-3.13]) times as likely to have self-reported a FD compared to level 1 studies, respectively. This investigation found an increase in the proportion of manuscripts with self-reported COIs and FDs since first documented in JFAS. These findings illustrate the ubiquity of author industry involvement, though future studies may examine the relevancy of these roles to published research. [ABSTRACT FROM AUTHOR]

The article analyzes the programs of educational and cultural nature, which are used in the practical activities of American higher educational institutions during the foreign students’ adaptive training. The aim of the article is to study these programs to formulate a potential direction for the development of the system of foreign students’ adaptive training in the HEIs of Ukraine. It is emphasized that the cultural training of representatives of other countries is an important component of the formation of competence of interpersonal interaction. However, the most effective is to use the cultural and educational programs simultaneously, which will allow to perform a rapid transition from the theoretical component to the practical and vice versa. The areas of educational and cultural nature that should be implemented to the Ukrainian educational space of foreign students’ adaptive training are picked out. These areas include: the formation of communication skills with help of discussion groups using, which allow to improve foreign student’ language skills and to conduct an informal communication with representatives of other countries, as well as the students of the host country; application of programs that provide historical and social immersion of foreign students to a new culture, that will reveal the distinctive features of their cultural characteristics and, thus, to accept the differences of the host country, which is necessary for overcoming the effects of culture shock; involvement of foreign students to the preparation of traditional holidays of the host country, which will help to get acquainted with the cultural features of the new society; organization of general education activities where foreign students can get the theoretical information about the host country, hold the discussions with experts and other students and, subsequently, extrapolate this knowledge to the practical flatness during the joint trips, etc.; attracting the foreign senior students who have overcome the effects of culture shock as an experts, because they can explain to the students who have entered the educational institution, what difficulties they will have to face and how the most effectively adapt to the features of the new socio-cultural space.

Abstract Background Burnout is a psychological syndrome defined as emotional exhaustion (EE), depersonalization (DP), and reduced personal accomplishment (PA) secondary to work stress. Burnout is widespread among medical workers. We aim to study the prevalence of burnout among neurologists in Saudi Arabia and describe some related personal and professional factors. Results A total of 62 consultants and 34 residents participated in the study. Having long working hours was a high source of stress among most of the participants. Consultants and residents reported high burnout rates in the three domains of the scale. In the emotional and exhaustion domain, more consultants (37.1%) showed high burnout compared to residents (23.5%). Regarding depersonalization domain, more residents (41.2%) showed high burnout compared to consultants (27.4%). Regarding the low personal accomplishment domain, more consultants (77.7%) showed high burnout compared to residents. Conclusion Residents and consultant neurologists showed high burnout rates, and results can be used as a baseline guidance to assist in reducing burnout by improving job satisfaction and working environment among neurologists.

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At teaching hospitals, consultants must provide effective supervision, including appropriate selection of teaching cases, such that the outcomes achieved by trainees are similar to that of consultants. Numerous studies in the surgical literature have compared patient outcomes when surgery is performed by consultant surgeons or surgical trainees but, to our knowledge, none exist in the field of anaesthesia. We aimed to compare analgesia outcomes of regional anaesthesia when performed by supervised trainees versus consultants. We designed a retrospective observational study using registry data. The primary outcome was inadequate analgesia, defined as a numerical rating scale (NRS) for pain >5 reported at any time in the post-anaesthesia care unit (PACU). Secondary outcomes included the maximum pain NRS, pain experienced in the PACU, and the requirement for systemic opioid analgesia in the PACU. Of the 1814 patients analysed, the primary proceduralist was a consultant for 514 (28.3%) patients and a trainee for 1300 (71.7%) patients. All trainees were supervised by an on-site consultant. There were no statistically significant differences between consultants and supervised trainees in terms of the primary outcome (NRS >5 in 24.9% and 24.5% of patients, respectively; P = 0.84) and secondary outcomes. Compared to trainees, consultants had a slightly higher rate of patients with a body mass index >30 kg/m2, an American Society of Anesthesiologists Physical Status Classification of 3 or 4, nerve blocks performed under general anaesthesia, paravertebral/neuraxial blocks and blocks with perineural catheter placement. Regional anaesthesia performed by supervised trainees can achieve similar analgesia outcomes to consultant-performed procedures. [ABSTRACT FROM AUTHOR]

Healthcare systems are facing unprecedented need to respond to an ever-evolving context of providing safe person-centred care to its citizens and staff. This transformation requires a rethink of healthcare leadership. Systems leaders are critical for culture change; to support safe patient care, facilitate innovation, build person-centred teams, and develop a collaborative workforce. Education has been considered the panacea for leadership growth with current models closely connected to qualifications, distinct courses and micro-credentialing. Yet systems leaders need skills, capacities and experience which augment interprofessional teams to work and innovate in ways which are creative, satisfying and sustaining. These leaders facilitate interprofessional partnerships vertically and horizontally within an organisation. One such role is the Multi Professional Consultant Practitioner, who are expert practitioners and embedded researchers, with a strategic whole system approach, and value all voices toward improving patient and staff experience. This role has been predominantly developed within the United Kingdom. However, a global model would translate this role within health systems more broadly. Potential exists for integrated expertise to enable quality care across the system to meet the needs of their local communities. With this in mind, this scoping review aimed at exploring the Multi Professional Consultant Practitioner role-what it is and how it contributes to system transformation., (© 2024 John Wiley & Sons Ltd.)