Continuing Professional Development via Social Media or Conference Attendance: A Cost Analysis.

BACKGROUND: Professional development is essential in the health disciplines. Knowing the cost and value of educational approaches informs decisions and choices about learning and teaching practices. OBJECTIVE: The primary aim of this study was to conduct a cost analysis of participation in continuing professional development via social media compared with live conference attendance. METHODS: Clinicians interested in musculoskeletal care were invited to participate in the study activities. Quantitative data were obtained from an anonymous electronic questionnaire. RESULTS: Of the 272 individuals invited to contribute data to this study, 150 clinicians predominantly from Australia, United States, United Kingdom, India, and Malaysia completed the outcome measures. Half of the respondents (78/150, 52.0%) believed that they would learn more with the live conference format. The median perceived participation costs for the live conference format was Aus $1596 (interquartile range, IQR 172.50-2852.00). The perceived cost of participation for equivalent content delivered via social media was Aus $15 (IQR 0.00-58.50). The majority of the clinicians (114/146, 78.1%, missing data n=4) indicated that they would pay for a subscription-based service, delivered by social media, to the median value of Aus $59.50. CONCLUSIONS: Social media platforms are evolving into an acceptable and financially sustainable medium for the continued professional development of health professionals. When factoring in the reduced costs of participation and the reduced loss of employable hours from the perspective of the health service, professional development via social media has unique strengths that challenge the traditional live conference delivery format.

Translating evidence to practice in the health professions: a randomized trial of Twitter vs Facebook.

Objective: Our objective was to compare the change in research informed knowledge of health professionals and their intended practice following exposure to research information delivered by either Twitter or Facebook. Methods: This open label comparative design study randomized health professional clinicians to receive "practice points" on tendinopathy management via Twitter or Facebook. Evaluated outcomes included knowledge change and self-reported changes to clinical practice. Results: Four hundred and ninety-four participants were randomized to 1 of 2 groups and 317 responders analyzed. Both groups demonstrated improvements in knowledge and reported changes to clinical practice. There was no statistical difference between groups for the outcomes of knowledge change (P = .728), changes to clinical practice (P = .11) or the increased use of research information (P = .89). Practice points were shared more by the Twitter group (P < .001); attrition was lower in the Facebook group (P < .001). Conclusion: Research information delivered by either Twitter or Facebook can improve clinician knowledge and promote behavior change. No differences in these outcomes were observed between the Twitter and Facebook groups. Brief social media posts are as effective as longer posts for improving knowledge and promoting behavior change. Twitter may be more useful in publicizing information and Facebook for encouraging course completion.

A Roundtable Discussion: Combination Products: Twice the Challenge?

Combination products are therapeutic or diagnostic medical products that combine drugs, devices, and/or biological products with one another. FDA developed a regulation (final rule) on Current Good Manufacturing Practices (CGMP) for combination products that became effective July 22, 2013 (21 CFR Part 4). AAMI recently developed a technical information report (TIR) that provides information on how to effectively implement FDA's regulation. The overall goal of the TIR is to aid informed, risk-based decisions in establishing CGMP operating systems that support development, manufacture, premarket regulatory evaluation, and ultimately commercialization of combination products. This article, a result of an discussion with industry and FDA representatives, explores the landscape of combination products, highlights important considerations in developing and seeking marketing clearance for these innovative products, and provides insight on trends in the area.

Community resilience assessment and literature analysis.

Earlier and current disaster-related research emphasised the sociological/behavioural perspective. This led to a significant amount of literature devoted to descriptive context of natural, man-made and technological disasters and sequelae. This paper considers a next step involving a more expanded approach in research methodology. The phases include: (1) the development of a comprehensive database of ideas provided by authors of scholarly and scientific papers; (2) the development of computer-supported algorithms to prepare an array of scenarios representing relationships, gaps and inconsistencies in existing knowledge; (3) a process for evaluating the scenarios to determine a feasible and interesting next research strategy or programmatic action that will provide enhanced description of the problems as well as possible insights to their correction by interventions. The intent is to develop interventions as an essential component for better prevention, mitigation, rehabilitation, reconstruction and problem-solving affected by disaster events. To illustrate this approach, community resilience, a relatively new and important idea was studied. The phrase was used to describe relationships and omissions. The ideas associated with this central idea were considered in the building of a new instrument for evaluation of community vulnerability and readiness. This methodology addresses the time constraints realised by practitioners and investigators. The methods should eliminate tedious, clerical functions and focus on the intellectual functions representing optimal use of human energy.

Translating Evidence Into Practice via Social Media: A Mixed-Methods Study.

BACKGROUND: Approximately 80% of research evidence relevant to clinical practice never reaches the clinicians delivering patient care. A key barrier for the translation of evidence into practice is the limited time and skills clinicians have to find and appraise emerging evidence. Social media may provide a bridge between health researchers and health service providers. OBJECTIVE: The aim of this study was to determine the efficacy of social media as an educational medium to effectively translate emerging research evidence into clinical practice. METHODS: The study used a mixed-methods approach. Evidence-based practice points were delivered via social media platforms. The primary outcomes of attitude, knowledge, and behavior change were assessed using a preintervention/postintervention evaluation, with qualitative data gathered to contextualize the findings. RESULTS: Data were obtained from 317 clinicians from multiple health disciplines, predominantly from the United Kingdom, Australia, the United States, India, and Malaysia. The participants reported an overall improvement in attitudes toward social media for professional development (P<.001). The knowledge evaluation demonstrated a significant increase in knowledge after the training (P<.001). The majority of respondents (136/194, 70.1%) indicated that the education they had received via social media had changed the way they practice, or intended to practice. Similarly, a large proportion of respondents (135/193, 69.9%) indicated that the education they had received via social media had increased their use of research evidence within their clinical practice. CONCLUSIONS: Social media may be an effective educational medium for improving knowledge of health professionals, fostering their use of research evidence, and changing their clinical behaviors by translating new research evidence into clinical practice.

The acceptability among health researchers and clinicians of social media to translate research evidence to clinical practice: mixed-methods survey and interview study.

BACKGROUND: Establishing and promoting connections between health researchers and health professional clinicians may help translate research evidence to clinical practice. Social media may have the capacity to enhance these connections. OBJECTIVE: The aim of this study was to explore health researchers' and clinicians' current use of social media and their beliefs and attitudes towards the use of social media for communicating research evidence. METHODS: This study used a mixed-methods approach to obtain qualitative and quantitative data. Participation was open to health researchers and clinicians. Data regarding demographic details, current use of social media, and beliefs and attitudes towards the use of social media for professional purposes were obtained through an anonymous Web-based survey. The survey was distributed via email to research centers, educational and clinical institutions, and health professional associations in Australia, India, and Malaysia. Consenting participants were stratified by country and role and selected at random for semistructured telephone interviews to explore themes arising from the survey. RESULTS: A total of 856 participants completed the questionnaire with 125 participants declining to participate, resulting in a response rate of 87.3%. 69 interviews were conducted with participants from Australia, India, and Malaysia. Social media was used for recreation by 89.2% (749/840) of participants and for professional purposes by 80.0% (682/852) of participants. Significant associations were found between frequency of professional social media use and age, gender, country of residence, and graduate status. Over a quarter (26.9%, 229/852) of participants used social media for obtaining research evidence, and 15.0% (128/852) of participants used social media for disseminating research evidence. Most participants (95.9%, 810/845) felt there was a role for social media in disseminating or obtaining research evidence. Over half of the participants (449/842, 53.3%) felt they had a need for training in the use of social media for professional development. A key barrier to the professional use of social media was concerns regarding trustworthiness of information. CONCLUSIONS: A large majority of health researchers and clinicians use social media in recreational and professional contexts. Social media is less frequently used for communication of research evidence. Training in the use of social media for professional development and methods to improve the trustworthiness of information obtained via social media may enhance the utility of social media for communicating research evidence. Future studies should investigate the efficacy of social media in translating research evidence to clinical practice.

A personal reflection on social media in medicine: I stand, no wiser than before.

Social media has enabled information, communication and reach for health professionals. There are clear benefits to patients and consumers when health information is broadcast. But there are unanswered questions on professionalism, education, and the complex mentoring relationship between doctor and student. This personal perspective raises a number of questions: What is online medical professionalism? Can online medical professionalism be taught? Can online medical professionalism be enforced? Is an online presence necessary to achieve the highest level of clinical excellence? Is there evidence that social media is superior to traditional methods of teaching in medical education? Does social media encourage multitasking and impairment of the learning process? Are there downsides to the perfunctory laconic nature of social media? Does social media waste time that is better spent attaining clinical skills?

The role of social media in clinical excellence.

BACKGROUND: The provision of excellent patient care is a goal shared by all doctors. The role of social media (SM) in helping medical students and doctors achieve clinical excellence is unknown. Social media may help facilitate the achievement of clinical excellence PURPOSE: This report aimed to identify examples of how SM may be used to help promote the achievement of clinical excellence in medical learners. METHODS: Three of the authors previously conducted a systematic review of the published literature on SM use in undergraduate, graduate and continuing medical education. Two authors re-examined the 14 evaluative studies to identify any examples of SM use that may facilitate the achievement of clinical excellence and to consider whether there were any aspects of clinical excellence for which no studies had been performed, and, if so, whether SM was relevant to these domains. RESULTS: Each study touched on one or more of the following domains of clinical excellence: communication and interpersonal skills; professionalism and humanism; knowledge; diagnostic acumen; exhibiting a passion for patient care; a scholarly approach to clinical practice; and explicitly modelling expertise to medical trainees. No study addressed the role of SM to promote the skillful negotiation of the health care system, and in collaboration with investigators to advance science and discovery; however, additional evidence suggested that SM may play an adjunctive role in promoting the achievement of these aspects of clinical excellence. CONCLUSION: This report supports the hypothesis that SM may help facilitate the achievement of clinical excellence; however, further research is needed into the role of SM in promoting the achievement of clinical excellence.

Analysis of dispersive and dissipative media with optical resonances.

In this paper we analyze the problem of light-matter interaction when absorptive resonances are imbedded in the material dispersion. We apply an improved approach to aluminum (Al) in the optical frequency range to investigate the impact of these resonances on the operating characteristics of Al-based nanoscale devices. Quantities such as group velocity, stored energy density, and energy velocity, normally obtained using a single resonance model [Wave Propagation and Group Velocity (Academic Press, 1960), Nat. Mater. 11, 208 (2012)], are now accurately calculated regardless of the medium adopted. We adapt the Loudon approach [Nat. Mater. 11, 208 (2012)] to media with several optical resonances and present the details of the extended model. We also show pertinent results for Al-based metal-dielectric-metal (MDM) waveguides, around spectral resonances. The model delineated here can be applied readily to any metal accurately characterized by Drude-Lorentz spectral resonance features.

Influence of film thickness on the optical transmission through subwavelength single slits in metallic thin films.

Silver and gold films with thicknesses in the range of 120-450 nm were evaporated onto glass substrates. A sequence of slits with widths varying between 70 and 270 nm was milled in the films using a focused gallium ion beam. We have undertaken high-resolution measurements of the optical transmission through the single slits with 488.0 nm (for Ag) and 632.8 nm (for Au) laser sources aligned to the optical axis of a microscope. Based on the present experimental results, it was possible to observe that (1) the slit transmission is notably affected by the film thickness, which presents a damped oscillatory behavior as the thickness is augmented, and (2) the transmission increases linearly with increasing slit width for a fixed film thickness.

The electromagnetics of light transmission through subwavelength slits in metallic films.

By numerically calculating the relevant electromagnetic fields and charge current densities, we show how local charges and currents near subwavelength structures govern light transmission through subwavelength apertures in a real metal film. The illumination of a single aperture generates surface waves; and in the case of slits, generates them with high efficiency and with a phase close to -π with respect to a reference standing wave established at the metal film front facet. This phase shift is due to the direction of induced charge currents running within the slit walls. The surface waves on the entrance facet interfere with the standing wave. This interference controls the profile of the transmission through slit pairs as a function of their separation. We compare the calculated transmission profile for a two-slit array to simple interference models and measurements [Phys. Rev. B 77(11), 115411 (2008)].

Injection allergen immunotherapy for asthma.

BACKGROUND: Allergen specific immunotherapy has long been a controversial treatment for asthma. Although beneficial effects upon clinically relevant outcomes have been demonstrated in randomised controlled trials, there remains a risk of severe and sometimes fatal anaphylaxis. The recommendations of professional bodies have ranged from cautious acceptance to outright dismissal. With increasing interest in new allergen preparations and methods of delivery, we updated the systematic review of allergen specific immunotherapy for asthma. OBJECTIVES: The objective of this review was to assess the effects of allergen specific immunotherapy for asthma. SEARCH STRATEGY: We searched the Cochrane Airways Group Trials Register up to 2005, Dissertation Abstracts and Current Contents. SELECTION CRITERIA: Randomised controlled trials using various forms of allergen specific immunotherapy to treat asthma and reporting at least one clinical outcome. DATA COLLECTION AND ANALYSIS: Three authors independently assessed eligibility of studies for inclusion. Two authors independently performed quality assessment of studies. MAIN RESULTS: Eighty-eight trials were included (13 new trials). There were 42 trials of immunotherapy for house mite allergy; 27 pollen allergy trials; 10 animal dander allergy trials; two Cladosporium mould allergy, two latex and six trials looking at multiple allergens. Concealment of allocation was assessed as clearly adequate in only 16 of these trials. Significant heterogeneity was present in a number of comparisons. Overall, there was a significant reduction in asthma symptoms and medication, and improvement in bronchial hyper-reactivity following immunotherapy. There was a significant improvement in asthma symptom scores (standardised mean difference -0.59, 95% confidence interval -0.83 to -0.35) and it would have been necessary to treat three patients (95% CI 3 to 5) with immunotherapy to avoid one deterioration in asthma symptoms. Overall it would have been necessary to treat four patients (95% CI 3 to 6) with immunotherapy to avoid one requiring increased medication. Allergen immunotherapy significantly reduced allergen specific bronchial hyper-reactivity, with some reduction in non-specific bronchial hyper-reactivity as well. There was no consistent effect on lung function. If 16 patients were treated with immunotherapy, one would be expected to develop a local adverse reaction. If nine patients were treated with immunotherapy, one would be expected to develop a systemic reaction (of any severity). AUTHORS' CONCLUSIONS: Immunotherapy reduces asthma symptoms and use of asthma medications and improves bronchial hyper-reactivity. One trial found that the size of the benefit is possibly comparable to inhaled steroids. The possibility of local or systemic adverse effects (such as anaphylaxis) must be considered.

Montelukast as an adjunct to oral and inhaled steroid therapy in chronic nasal polyposis.

OBJECTIVE: To examine the potential of montelukast, a leukotriene receptor antagonist, as an adjunct to oral and inhaled steroid in subjects with chronic nasal polyps. STUDY DESIGN: Prospective, randomized controlled trial. SUBJECTS AND METHODS: Thirty-eight consecutive adult patients with bilateral nasal polyps were randomized into two groups. Eighteen subjects were treated with oral prednisolone for 14 days and budenoside nasal spray for 8 weeks. Twenty subjects received similar treatment with additional oral montelukast for 8 weeks. Subjects completed a modified nasal ICSD symptom score at 8 and 12 weeks after beginning treatment and the SF-36 quality of life questionnaire at 12 weeks. RESULTS: Symptom scores improved in both groups after treatment. Subjects treated with montelukast reported significantly less headache (P = 0.013), facial pain (P = 0.048) and sneezing (P = 0.03) than controls. Four weeks after completing treatment, no significant differences were recorded. CONCLUSION: Montelukast therapy may have clinical benefit as an adjunct to oral and inhaled steroid in chronic nasal polyposis, but effects are not maintained after cessation of treatment.

The Brazilian time and frequency atomic standards program.

Cesium atomic beam clocks have been the workhorse for many demanding applications in science and technology for the past four decades. Tests of the fundamental laws of physics and the search for minute changes in fundamental constants, the synchronization of telecommunication networks, and realization of the satellite-based global positioning system would not be possible without atomic clocks. The adoption of optical cooling and trapping techniques, has produced a major advance in atomic clock precision. Cold-atom fountain and compact cold-atom clocks have also been developed. Measurement precision of a few parts in 10(15) has been demonstrated for a cold-atom fountain clock. We present here an overview of the time and frequency metrology program based on cesium atoms under development at USP São Carlos. This activity consists of construction and characterization of atomic-beam, and several variations of cold-atom clocks. We discuss the basic working principles, construction, evaluation, and important applications of atomic clocks in the Brazilian program.

Relative concentrations of organochlorines in adipose tissue and serum among reproductive age women.

Much of the available literature focusing on organochlorine exposure and human health effects has relied upon serum for quantifying exposure despite adipose tissue being the purported "gold standard". The accuracy of exposure status is dependent upon serum being a valid and reliable proxy for adipose tissue regardless of compound under study and served as the impetus for study. Serum and omentum fat concentrations for 62 polychlorinated biphenyls (PCBs) and 7 organochlorine pesticides (OCPs) were determined using gas chromatography with electron capture and compared to assess their relative abundance and correlation among 15 women aged 18-40 years undergoing laparoscopy. The relation between concentration in serum and fat was determined by linear regression. Of the 20 organochlorines (OCs) (29%) present in both serum and fat samples, moderate linear correlations (r > 0.6) were observed between lipid-adjusted serum and fat concentrations for PCBs #138, 153, 180, 188, 194, 206, and DDE. Forty-nine OCs were present in adipose samples but measured below the LOD in serum samples. Our findings underscore the potential for discrepant human health results associated with OC exposure on the basis of medium used for quantification purposes, especially for less ubiquitous compounds or when study samples include individuals with relatively low exposures. These data support earlier findings and argue for concerted methodological work aimed at developing standardized laboratory methods for epidemiologic studies.

"May contain traces of...": hidden food allergens in Australia.

More accurate food labelling would assist consumers and the food industry alike.

Using commercial telephone directories to obtain a population-based sample for mail survey of women of reproductive age.

In the United States, sampling women of reproductive age from the general population for research purposes is a challenge. Even more difficult is conducting a population-based study of couples attempting pregnancy to assess fecundity and fertility or related impairments. To address the problem of obtaining representative samples from the population in order to study such health-related issues, a commercially and readily available CD-ROM telephone directory was used and tested as a sampling framework for studies aimed at enrolling gravid women aged 18-44 years. A self-administered questionnaire (SAQ) was mailed to a stratified random sample of 10 005 (3%) households in Erie County, NY, USA. Overall, 17% of the questionnaires were undeliverable despite updating all addresses with residential software before mailing. Thirteen per cent (n = 1089) of the households returned completed questionnaires, of which 35% (n = 377) were completed by women aged 18-44 years. Using 1990 census information for zip code, respondents were more likely to be white and to have higher median household incomes than non-respondents. Of the 377 women who completed the questionnaire, 79% had been pregnant at least once, 5% reported being unable to become pregnant, and 16% reporting never trying to become pregnant. Despite the overall low response to the SAQ, the sampling framework captured a diverse group of women of reproductive age who reported various fecundity and fertility outcomes. The use of low-cost commercially available software linked to census data for selecting samples of women or couples for reproductive and perinatal research may be possible; however, oversampling of households, use of incentives and follow-up of non-respondents is needed to ensure adequate sample sizes.