Exploring success factors and relationships in virtual learning using ISM and fuzzy MICMAC analysis.

The COVID-19 pandemic's consequences have led to a global change in educational settings towards online learning. The utilization of virtual learning (VL) has increased significantly. This study aimed to extract the success factors of VL and also examine the relationships among them. The research method involves examining factors identified in the literature review and seeking confirmation from experts using the Content Validity Index (CVI) method. Ten success factors are extracted and confirmed, including Technological, Management, Learning Capability, Pedagogical, Ethical, Resource Support, Interface Design, Evaluation, Institutional, and Study Environment. Based on the Interpretive Structural Model (ISM) method and the fuzzy matrix of cross-impact multiplications applied to classification (MICMAC), which divides the factors into five levels, the relationship between these factors is examined. Level I emphasizes the importance of evaluation mechanisms. Level II stresses integrating pedagogical, ethical, resource support, and institutional aspects. Level III highlights the alignment of learner capabilities with platform interfaces. Level IV underscores the significance of the learning environment. Lastly, Level V emphasizes the interplay between technology and management in VL's expansion. The findings of this study can be developed and customized through collaboration among instructors, learners, and institutions. Moreover, the findings from correlating success factors can be applied in practical learning experiments or utilized to develop efficient modeling manuals.

A Contemporary Framework Update for Today's School Nursing Landscape: Introducing the School Nursing Practice Framework™.

School nursing is a unique nursing specialty that benefits from a practice framework that aids school nurses in explaining and accomplishing their role. In 2016, the NASN debuted its Framework for 21st Century School Nursing Practice™, which has shaped school nursing practice as well as education, leadership, research, and collaboration with stakeholders. However, practice frameworks are not meant to remain the same indefinitely. Therefore, NASN evaluated and updated the Framework to ensure its continued alignment with the education and healthcare landscape. The purpose of this article is to share the history of the Framework for 21st Century School Nursing Practice™ development, provide the rationale for the update, and discuss the strategic process NASN used to update its Framework now entitled the School Nursing Practice Framework™.

Media and information literacy as a model of societal balance: A grounded meta-synthesis.

Concerns about the spread of disinformation, information disorder, and fake news have grown to unprecedented proportions in recent years. This study aimed to explore how to mitigate this communication disorder and achieve a balance in the relationship among the public, the media, the dominant institutions, and the digital influencers in society. This study used the grounded meta-synthesis method, which relies on induction, to arrive at a new model according to the objective of the study. The process of open, axial, and selective coding included 101 studies, books, reports, and guides, starting with the Public Opinion by Walter Lippmann, issued in 1922, and ending with the 2022 Edelman Trust Barometer. The results led to the proposal of a new model to reduce communication dysfunction, in which media and information literacy (MIL) plays a crucial role in increasing an individual's ability to resist disinformation and enhancing their ability to monitor the performance of institutions, as well as expanding the circle of influencers in social media. To fulfil the three goals and contribute to achieving a degree of functional balance in communication within societies, the model recommends enhancing MIL. Other intervening variables, such as the fragility of political, cultural, and legal structures, should not be disregarded.

Do 21st-century skills make you less lonely? The relation between 21st-century skills, social media usage, and students' loneliness during the COVID-19 pandemic.

21st-century skills are a new category of competencies recommended for people to adapt to the digital era. Digital communication skills, particularly, are regarded as an important facet in a progressively moving online society. Empirical evidence of their actual value, however, is largely missing. Recently, the COVID-19 pandemic offered an appropriate testing ground for the possible beneficial role that such skills might play. Our results show that digital communication skills correlate with loneliness. However, social media usage, online contacts, and offline contacts only partially mediate the relationship between digital communication skills and the loneliness levels of students. In addition, we found substantial differences between the two waves of data collection and the types of contacts that influenced loneliness. While skills may have reduced loneliness, the precise mechanism of this effect needs to be clarified more. We offer suggestions for future research to examine the potential benefits of 21st-century skills.

Mapping the educational Frontier: Unleashing the Potential of artificial intelligence talents through cooperative planning in the Guangdong-Hong Kong-Macao greater bay area.

The Guangdong-Hong Kong-Macao Greater Bay Area (GBA) has become an important hub for technological innovation and economic development in China. With the growing demand for artificial intelligence (AI) and big data technology talents, it is essential to develop educational cooperation within the GBA to develop a talent pool that can meet the changing needs in the region. This paper focuses on the development of dynamic demand for AI talents and proposes a strategic planning framework for educational cooperation in the GBA. We use the research idea of common attributes and key chain clustering-factor association selection-analysis of the driving force and subordination among factors-the key characteristics of AI talents. Using collinear analysis of citations and grounded theory methods, an operational definition of the influencing factors of AI talent literacy characteristics is constructed. Using the Interpretative Structural Modeling(ISM) and MICMAC (Matrice d'Impacts Croises-Multipication Applique A Classement), analyze and identify the driving force and subordination of the influencing factors of key traits of talents, and present the combined effect of multi-level factors of key traits of talents. Combined with the educational differences and complementary advantages in the GBA, five strategies and seven implementation suggestions for the GBA's AI talent education cooperation plan are formulated to establish a collaborative ecosystem that promotes the growth and integration of AI in the GBA.

Factors contributing to dropping out of adults' programming e-learning.

Previous studies reported that acquiring computer programming skills is challenging and might result in high dropout rates. A quasi-experimental design was used to examine the role of different factors in dropping out of an e-based computer programming course. This study applied a knowledge in programming assessment test (20 multiple-choice questions covering the following topics: variables, loops, conditionals, functions, and general knowledge of Python), The Learning Motivating Factors Questionnaire, The Big Five-2, and The Basic Psychological Need Satisfaction & Frustration Scale. Ninety-four participants (38 males and 56 females) completed the course, while 305 participants started it. The mean age of e-learners was 29.96 years (SD 8.27), age range = 18 to 54. The results showed that e-learners who completed the course had higher initial knowledge assessment scores than those who dropped out after the first assessment. Reward and recognition as a motivator were significantly higher in males who completed the course than those who dropped out after the second knowledge assessment. Extraversion was significantly lower in females who completed the course than those who dropped after the first or second knowledge assessment test. Relatedness frustration was significantly higher in those who dropped out after the first knowledge assessment. Due to significant limitations of the sample size, cultural context, measures applied, and research design, the findings would preferably be regarded with caution.

Provider Perspectives on Adolescent Confidentiality and the Electronic Health Record Postimplementation of the 21st Century Cures Act Final Rule.

PURPOSE: The 21st Century Cures Act Final Rule mandates increased transparency and accessibility of the Electronic Health Record (EHR). This mandate has exacerbated tensions in adolescent healthcare between transparency and confidentiality. This study evaluates clinicians' perspectives on how well the EHR maintains confidentiality for adolescents in the post-Cures Act era. METHODS: A web-based survey was distributed via the national listserv of the Society for Adolescent Health and Medicine in March-April 2022. English-speaking members practicing in the Unites States who used an EHR to document clinical visits with minors were eligible. The survey included questions about EHR training, features, and approach to information sharing with adolescent patients and proxies. RESULTS: Participants included 97 respondents from 32 states. Most participants were physicians (98%) and identified themselves as attending (89%). Several EHR vendors were represented, although the majority used Epic (76%). As has been seen in prior studies, there remains significant variability in approaches to patient portal access for adolescent patients and their adult proxies. Respondents report that training around adolescent-specific privacy issues remains infrequent and is perceived as inadequate. Adolescent providers, despite feeling confident in navigating the EHR generally, continue to report low rates of confidence in how well their EHR may protect adolescent privacy. DISCUSSION: Clinicians have persistent concerns about adolescent confidentiality postimplementation of the 21st Century Cures Act. Sharing sufficient information while protecting adolescent confidentiality might require standardization by EHR vendors to improve granularity of proxy information sharing. Healthcare institutions must also commit to training providers on management of adolescent confidentiality.

Formando médicos para el siglo XXI: El rol crucial de la educación basada en competencias / Training physicians for the 21st century: The crucial role of competency-based education

A lo largo de la historia, el campo de la medicina se ha adaptado a las necesidades cambiantes de la sociedad y del sistema sanitario. Ante esa situación, surge la necesidad de plantear la transformación de la formación médica mediante un enfoque basado en las competencias y así definir el perfil de un médico para el siglo XXI. El presente artículo tiene por objetivo analizar y describir el rol de la formación basada en competencias en la formación médica en la preparación de los estudiantes de medicina. Para tal fin, se ha llevado a cabo una exhaustiva revisión bibliográfica en la que se analizan los conceptos clave de la formación médica basada en competencias. Los resultados destacan la importancia de integrar el desarrollo de habilidades en la formación médica teniendo en cuenta los factores sociales y culturales, así como fomentar la reflexión crítica en la formación médica. Se concluye que la educación médica debe adaptarse a las demandas cambiantes del campo, con la participación de diversas partes interesadas y la evolución de los métodos de enseñanza.

Throughout history, the field of medicine has adapted to the changing needs of society and the healthcare system. Faced with this situation, the need arises to consider the transformation of medical education through a competency-based approach and thus define the profile of a physician for the 21st century. The aim of this article is to analyze the role of competency-based training in medical education and its impact on the preparation of medical students. To this end, an exhaustive literature review has been carried out in which the key concepts of competency-based medical education are analyzed. The results highlight the importance of integrating skills development in medical education taking into account social and cultural factors, as well as encouraging critical reflection in medical education. It is concluded that medical education must adapt to the changing demands of the field, involving diverse stakeholders and evolving teaching methods.

Perpetuating the Gaps: 21st-Century Skills in Students With Learning Disabilities and Their Typically Developing Peers.

This study examined whether there are differences between students with learning disabilities (LD) and their typically developing peers with regard to their 21st-century skills according to their self-report and whether the differences between the two groups are greater in postsecondary education than in high school-an aim that had not been examined in depth in previous research. Findings suggest that overall (beyond type of learner), in most skills, postsecondary education students reported higher scores than high school students on questionnaires designed for self-assessment of 21st-century skills. Second, students with LD exhibited lower scores in most 21st-century skills than their peers. Third, a comparison of the gaps in 21st-century skills between students with LD and their peers in each of the examined educational settings (i.e., high school vs postsecondary education) revealed that some of the gaps expand over the years, resulting in differences in additional skills. Results are discussed in the context of educational environment and its role in cultivating 21st-century skills and preparing students for integration into the labor market.

Global employability skills in the 21st century workplace: A semi-systematic literature review.

This study conducts a semi-systematic literature review of research pertaining to employability to identify essential employability skills that employers seek in recent graduates. The comprehensive analysis of the existing literature review aims to present a set of global employability skills, identify similarities, variations, or changes in these skills across time, and explore the most relevant existing employability skills for the 21st-century workplace. The review includes 30 years of research articles and government reports published in English and considers 25 studies based on the Scientific Procedures and Rationales for Systematic Literature Reviews (SPAR-4-SLR). After removing duplicates, 87 unique skills were identified and listed under three distinct temporal themes (the 1990s, 2000s, and 2010s), with problem-solving, communication, teamwork, adaptability, and willingness to learn among the most commonly reported skills over time. The study found a mismatch between employers' expectations and graduates' possessed skills. Therefore, the list of employability skills identified in this study can serve as a valuable tool for addressing this mismatch. The study's findings can also help educators and employers to better align their efforts to prepare students for the modern workplace.

Artificial Intelligence to Improve Patient Understanding of Radiology Reports.

Diagnostic imaging reports are generally written with a target audience of other providers. As a result, the reports are written with medical jargon and technical detail to ensure accurate communication. With implementation of the 21st Century Cures Act, patients have greater and quicker access to their imaging reports, but these reports are still written above the comprehension level of the average patient. Consequently, many patients have requested reports to be conveyed in language accessible to them. Numerous studies have shown that improving patient understanding of their condition results in better outcomes, so driving comprehension of imaging reports is essential. Summary statements, second reports, and the inclusion of the radiologist's phone number have been proposed, but these solutions have implications for radiologist workflow. Artificial intelligence (AI) has the potential to simplify imaging reports without significant disruptions. Many AI technologies have been applied to radiology reports in the past for various clinical and research purposes, but patient focused solutions have largely been ignored. New natural language processing technologies and large language models (LLMs) have the potential to improve patient understanding of their imaging reports. However, LLMs are a nascent technology and significant research is required before LLM-driven report simplification is used in patient care.

Research trends of worldwide ophthalmologic randomized controlled trials in the 21st century: A bibliometric study.

Background: Randomized controlled trials (RCTs) are often considered the gold standard and the cornerstone for clinical practice. However, bibliometric studies on worldwide RCTs of ophthalmology published in the 21st century have not been reported in detail yet. This study aims to perform a bibliometric study and visualization analysis of worldwide ophthalmologic RCTs in the 21st century. Methods: Global ophthalmologic RCTs from 2000 to 2022 were searched in the Web of Science Core Collection. The number of publications, country/region, institution, author, journal, and research hotspots of RCTs were analyzed using HistCite, VOSviewer, CiteSpace, and Excel software. Results: 2366 institutions and 90 journals from 83 countries/regions participated in the publication of 1769 global ophthalmologic RCTs, with the United States leading in the number of volumes and research field, and the Moorfields Eye Hospital contributing to the most publications. Ophthalmology received the greatest number of publications and co-citations. Jeffrey S. Heier owned the most publications and Jost B. Jonas owned the most co-citations. The knowledge foundations of global ophthalmologic RCTs were mainly retinopathy, glaucoma, dry eye disease (DED), and cataracts, and anti-vascular endothelial growth factor (VEGF) therapy (ranibizumab), topical ocular hypotensive medication, laser trabeculoplasty. Anti-VEGF therapy for age-related macular degeneration (AMD), DME (diabetic macular edema), and DED, the use of new diagnostic tools, and myopia were the hottest research highlights. Anti-VEGF therapy, prompt laser, triamcinolone, and verteporfin photodynamic therapy for AMD, DME, and CNV (choroidal neovascularization), DED, myopia, and open-angle glaucoma were the research hotspots with the longest duration. The future research hotspots might be DED and the prevention and control of myopia. Conclusions: Overall, the number of global ophthalmologic RCTs in the 21st century was keeping growing, there was an imbalance between the regions and institutions, and more efforts are required to raise the quantity, quality, and global impact of high-quality clinical evidence in developing countries/regions.

Teachers' perspectives of utilizing distance learning to support 21st century skill attainment for K-3 elementary students during the COVID-19 pandemic era.

During the COVID-19 pandemic, Saudi Arabia, similar to other governments, discontinued face-to-face learning in favor of distance learning. The pandemic has had serious ramifications for K-3 education, and the impact of distance learning on 21st century skill attainment are important issues to explore. Using the Saudi Arabia context, this paper investigates teachers' perspectives regarding the implementation of online education to support 21st century skills in the COVID-19 pandemic era for K-3 elementary school students. A qualitative research methodology was applied in this study. A semi-structured interview was conducted to collect data from five K-3 female teachers who implemented online education during the pandemic. Three themes emerged from the findings: 1) effects of the pandemic as related to online teaching for attainment of 21st century skills, 2) elaboration of best practices for online teaching to facilitate such attainment, and 3) challenges that exist for distance learning and student acquisition of 21st century skills. Therefore, the findings suggest that elementary teachers should find opportunities for elementary students to experience distance learning as an ongoing learning solution in order to incorporate innovative strategies that enhance their 21st century skills.

Applying real-world data from expanded-access ("compassionate use") patients to drug development.

Our drug development process has produced many life-saving medications, but patients experiencing rare diseases and similar conditions often are left with limited options for treatment. For an approved treatment to be developed, research on a new candidate or existing drug must validate safety and efficacy based on contemporary research expectations. Randomized clinical trials are conducted for this purpose, but they are also costly, laborious, and time-consuming. For this reason, The 21st Century Cures Act mandates that the US Food and Drug Administration look for alternative methods for approving drugs, in particular exploring the uses of real-world data and evidence. Expanded access ("compassionate use") is a pathway for the clinical treatment of patients using drugs that are not yet approved for prescribing in the United States. Using real-world evidence generated from expanded-access patients presents an opportunity to provide critical data on patient outcomes that can serve regulatory approval in conjunction with other observational datasets or clinical trials, and in limited circumstances may be the best data available for regulatory review. In doing so, we may also support and encourage patient-centered care and a personalized medicine approach to drug development.

A study of the impact of project-based learning on student learning effects: a meta-analysis study.

Introduction: With the educational reform for skills in the 21st century, a large number of scholars have explored project-based learning. However, whether project-based learning can effectively improve the learning effect of students has not yet reached a unified conclusion. Method: This study uses a meta-analysis method to transform 66 experimental or quasi-experimental research papers based on project-based learning over the past 20 years into 190 effect values from the sample size, mean, and standard deviation of experimental data during their experiments, and to conduct in-depth quantitative analysis. Results: The results of the study showed that compared with the traditional teaching model, project-based learning significantly improved students' learning outcomes and positively contributed to academic achievement, affective attitudes, and thinking skills, especially academic achievement. Discussion: The results of the moderating effects test indicated that the effectiveness of project-based learning and teaching was influenced by different moderating variables, including country region, subject area, type of course, academic period, group size, class size, and experimental period : (1) from the perspective of country geography, the effects of project-based learning in Asia, especially in Southeast Asia, were significantly better than those in Western Europe and North America; (2) in terms of curriculum, project-based learning promotes student learning effects more significantly in engineering and technology subjects, and is better applied in laboratory classes than in theory classes; (3) from a pedagogical point of view, project-based learning is more suitable for small group teaching, in which the group size is 4-5 people teaching the best results; (4) in view of the experimental period, 9-18 weeks is more appropriate and has more obvious advantages for application at the high school level.

The role of gamified learning strategies in student's motivation in high school and higher education: A systematic review.

Gamification, defined as the integration of videogame components to promote a gameful experience, is increasingly being implemented in education with the aim of enhancing students' engagement and motivation. Accordingly, since 2010 it has constituted an area of growing interest for researchers and teachers. Following PRISMA 2020's methodology, a systematic review (SR) was conducted in November 2022 seeking to explore the influence of gamification strategies on students' motivation to learn. Having identified 548 articles, 40 studies were chosen based on the selection criteria set and analyzed to reveal that game elements such as points, badges and rankings are widely used to motivate students. From a theoretical perspective, gamification studies focus on the dichotomy of intrinsic and extrinsic motivation. The results suggest a positive influence of gamification strategies on students' motivation, although in the long run, such motivation can decline. Furthermore, the influence of a novelty effect and extrinsic rewards on motivation is identified, which can lead to greater motivation in the short term, followed by a decrease with further exposure to gamification. Future studies should focus on the influence of students' individual traits (e.g., gaming experience, openness to competition and cooperation) on gamification strategies. Moreover, long-term exposure to gamification as well as the novelty effect should be explored.

World Psychiatric Association-Asian Journal of Psychiatry Commission on Psychiatric Education in the 21st century.

Psychiatric practice faces many challenges in the first quarter of 21st century. Society has transformed, as have training requirements and patient expectations, underlining an urgent need to look at educational programmes. Meanwhile, awareness has grown around psychiatric disorders and there are evolving workforce trends, with more women going to medical school and specialising in psychiatry. Trainee psychiatrists carry different expectations for work-life balance and are increasingly becoming conscious of their own mental health. A tendency to see health as a commodity and the litigious nature of society has elicited additional pressures for healthcare professionals. Cartesian mind-body dualism has created further complexity and this can often be frustrating for patients and care-partners alike. In many cultures across Asia and beyond, patients can present with physical symptoms to express underlying psychological distress with increasing physical investigations. Simultaneously, in various countries, a shift from asylums to community-based interventions and then home treatments have changed psychiatric care in remarkable ways. These changes have added to pressures faced by mental healthcare professionals. However, trainees and other mental healthcare professionals continue to receive similar training as they did a generation ago. The tensions and differences in ideology/orientation between different branches of psychiatry have made responses to patient needs challenging. Recognising that it is difficult to predict the future, this World Psychiatric Association-Asian Journal of Psychiatry Commission makes recommendations that could help institutions and individuals enhance psychiatric education. This Commission draws from existing resources and recent developments to propose a training framework for future psychiatrists.

Assessing Cognitive Skills in Early Childhood Education Using a Bilingual Early Language Learner Assessment Tool.

In this article, we propose that basic cognitive skills may be fostered and assessed in early childhood educational (pre-K) settings using a technology-based approach to assessment. BELLA (Bilingual English Language Learner Assessment), designed for use with both monolingual (English or Spanish speaking) and bilingual (English and Spanish speaking) children, is designed to attend to cognitive skill development in addition to (pre-)academic knowledge. Specifically, BELLA assesses analytical, creative, and practical thinking in 3-5-year-old children through unique item content and delivery. BELLA is among the first tablet-based pre-K assessments designed to assess cognitive skills needed for the era of the Anthropocene.

The 21st Century Cures Act: Inpatient Clinician Perceptions of Changes to Information Sharing at an Academic Medical Center.

Introduction To comply with the Information Blocking Rule in the 21st Century Cures Act, many hospitals began to release inpatient electronic health information such as clinical notes and results to patients immediately, starting in April 2021. We sought to understand the perceptions of hospital-based clinicians regarding the impact of these changes in information sharing on clinicians and patients. Materials and methods We developed and distributed an electronic survey to 122 inpatient attending physicians, resident physicians, and physician assistants within the internal medicine and family medicine departments at an academic medical center. The survey asked clinicians to rate their comfort with information-sharing protocols and describe their perceptions of the impact of immediate information sharing on their documentation habits and patient interactions following the implementation of the Cures Act. Results The survey response rate was 37.7% (46/122). Of the respondents, 56.5% felt comfortable with the note-sharing process, 84.8% reported omitting specific information from their notes to prevent patients from reading it, and 39.1% of clinicians agreed that patients have found clinical notes "more confusing than helpful." Conclusions Immediate sharing of electronic health information has the potential to be a powerful tool for communicating with hospitalized patients. However, our results show many hospital-based clinicians report limited comfort with the note-sharing process and perceive it to be confusing to patients. Efforts are needed to educate clinicians regarding information sharing, understand patient and family perspectives, and develop best practices to enhance communication through electronic notes.

Impact of notification policy on patient-before-clinician review of immediately released test results.

The 21st Century Cures Act mandates immediate availability of test results upon request. The Cures Act does not require that patients be informed of results, but many organizations send notifications when results become available. Our medical center implemented 2 sequential policies: immediate notifications for all results, and notifications only to patients who opt in. We used over 2 years of data from Vanderbilt University Medical Center to measure the effect of these policies on rates of patient-before-clinician result review and patient-initiated messaging using interrupted time series analysis. When releasing test results with immediate notification, the proportion of patient-before-clinician review increased 4-fold and the proportion of patients who sent messages rose 3%. After transition to opt-in notifications, patient-before-clinician review decreased 2.4% and patient-initiated messaging decreased 0.4%. Replacing automated notifications with an opt-in policy provides patients flexibility to indicate their preferences but may not substantially alleviate clinicians' messaging workload.