Background Obesity is a chronic problem in Canada and although the Canadian Medical Association recognizes obesity as a disease, health care professionals (HCPs) are not necessarily proactively managing it as one. This study aimed to assess current obesity management knowledge and practices of Canadian family physicians (FPs) and evaluate the feasibility of an online self-directed learning platform, i-ACT™ in Obesity, in delivering learning and changing practice intentions to advance obesity management. Methods i-ACT™ in Obesity is an online self-directed learning program designed by Canadian obesity medicine experts to provide individualized learning curricula to participants. One hundred FPs, with an interest in weight management and managing patients with obesity, were recruited across Canada to participate in a pilot study. FP education was delivered in a stepwise manner. Each participant completed a practice profile assessment to determine knowledge gaps and educational needs. Learners then watched didactic videos across disciplines on topics assigned to their curriculum by the program algorithm based on the relative difference between indicated and desired current knowledge. FPs also completed 10 retrospective patient assessments to assess clinical management practices and planned behaviour change. Feasibility, acceptability, and satisfaction of the learning program were assessed to formulate the rationale for a more widespread deployment in the future. Survey responses and related data were analyzed using comparative measures and descriptive statistics. Results The program was piloted by ninety-one Canadian FPs, where 900 patients were assessed. FPs showed distinct differences between their current and desired levels of comfort in a variety of obesity-related topics. Participation was associated with an intention to use more obesity treatment interventions moving forward. The program received an overall satisfaction rating of 8.6 out of 10 and 100% of the evaluators indicated that they would recommend it to their colleagues. Conclusion The program was overall well received and successfully changed obesity management intentions among participating FPs, thus setting the stage for a larger more comprehensive study to examine the efficacy of i-ACT™ in Obesity in addressing knowledge gaps and advancing evidence-based, guidelines-aligned approach to obesity treatment.
L'elaborato si propone di offrire un contributo all'individuazione degli strumenti di risoluzione dei conflitti familiari alternativi al processo ovvero integrativi e com¬plementari del processo. Ci si è posti l'obiettivo di dare uno sguardo al tessuto normativo previgente la riforma del processo civile, introdotta dalla legge 26 novembre 2021, n. 206, e dai decreti attuativi, in particolare dal decreto legislativo 10 ottobre 2022, n. 149, nel tentativo di cogliere e tracciare l'evoluzione sociale e giuridica degli strumenti di riorganizzazione guidata delle relazioni familiari in crisi. La mediazione familiare, la coordinazione genitoriale e la negoziazione assistita sono esaminate in un percorso funzionale di lettura nell'ambito dei principi e delle novità introdotte dalla riforma processuale Cartabia.
The Royal College Comprehensive Objective Examination in Neurology provides certification for Canadian neurologists and consists of a written examination and the Observed Structured Clinical Encounter (OSCE). The OSCE portion of the certification involves residents visiting several patient stations where they address case scenarios with an examiner. Unfortunately, residents lack exam preparation time due to demanding work hours. In response to resident needs, we created a novel, virtual preparation OSCE program – “prepOSCE” – and evaluated its efficacy. The prepOSCE program employed a proprietary virtual solution from CTC Communications Corp. Ten virtual sessions accommodated 70 residents totally. Seven Canadian physicians and two co-chairs created case scenarios for the stations. On session day, seven residents arrived in a virtual plenary room for briefing followed by assignment to a station by CTC. Residents then moved virtually through prepOSCE stations a different examiner and case scenario in each. Following their session, residents and evaluators were surveyed to capture experiences. The average program rating was 4.22 out of 5 (n = 36 residents of 70 residents who participated in the program) and 4.35 (n = 17 evaluators). Ninety-two percent of residents agreed or strongly agreed that they would recommend this program to their peers; they would like prepOSCE to continue next year; and the program was relevant and added value to their studies. The positive feedback received from prepOSCE participants indicates there is a need for a program like prepOSCE. This model has potential for expansion and it is hoped that specialties outside of neurology could benefit from a similar program.
Our identity as architects is still bound with the image of nature that places architecture and other human constructs strictly outside of a “wild” nature that is pure, vibrant, and untamed. This has resulted in nostalgic, exclusionary eco-narratives that curtail the architectural imagination. Understanding our role as part of an evolving ecology and its omnipresent human influence has the potential to rein¬vigorate the practice. Coexisting as interdependent entities (both physical and conceptual), landscape and technology can define built form that imagines productive and healthy infrastructures for a collective ecology. This paper describes the first of a set of studios run by the University at Buffalo School of Architecture and Planning Ecological Practices Graduate Research Group, its collabora¬tion with a parallel techniques course, and a local partner and the design build project it initiated, Silo City Trellis. The studio explored how to formulate an eco-centric identity through small scale architectural interventions, garden struc¬tures that literally and figuratively entwine themselves with the local ecology of a site that is at once a burgeoning “urban wild” and a monument to the city’s post-industrial heritage. This apparently wild site is in fact a garden. Maintained and curated, it highlights the effort it takes to maintain a “natu¬ral” environment in the highly synthetic urban context. The architecture of the garden makes it into an interface where the boundaries between nature and the man-made are perpetually negotiated providing a pedagogical model that proposes alternative ideologies about our ecosystems-both environmental and socio-political. Silo City Trellis is a combined structure and landscape regen¬eration system that literally entwines architecture earth and vegetation. Emulating the work of the site’s Director of Ecology the growing infrastructure aims to suggest ecocentric solutions for the future of cities by pushing the boundaries of architecture as a provider of ecosystem services and social stewardship. The proposal envisions that in a post-nature environment architecture can play a role not only in societal enlightenment but also in the intentional cultivation and stewardship of biological ecologies.
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