macOS Catalina (version 10.15) is the sixteenth major release of macOS, Apple Inc.'s desktop operating system for Macintosh computers. It is the successor to macOS Mojave and was announced at WWDC 2019 on June 3, 2019 and released to the public on October 7, 2019. Catalina is the first version of macOS to support only 64-bit applications and the first to include Activation Lock.[3][4] It is also the last version of macOS to have the major version number of 10; its successor, Big Sur, released on November 12, 2020, is version 11.[5][6] In order to increase web compatibility, Safari, Chromium and Firefox have frozen the OS in the user agent running in subsequent releases of macOS at 10.15.7 Catalina.[7][8][9]
Desktop Reminder 2 Pro Activation 58
Keep in mind that too many unsuccessful login attempts will get your account locked. As a quick reminder, your Apple ID locks automatically if you or someone else enters the wrong password, security questions, or other account information.
We classified the following three measures in category 1 (Patient engagement) the Health Literacy Questionnaire (HLQ); Patient Activation Measure (PAM); and the Participation Subscale (PS) (developed for the LUP-survey) assessing patient involvement in healthcare. These measures were used in six studies: HLQ,66 78 PAM66 70 71 78 79 and PS.55 Patient engagement was the primary aim and outcome of one study,55 patient involvement was the primary aim of three studies,62 74 84 and self-management, or patient activation, in two studies.66 78
Our findings are in keeping with those from established reviews of person-centred measurement6 8 indicating that supported self-management (plus PRO) interventions are researched independently from SDM (plus patient decision aids) interventions and person-centred care; there are seldom common measures used across intervention types.6 8 30 90 Different active components of these intervention types are assessed with measures aligned to their theoretical framework (eg, activation, decisional conflict, health professional communication), and judgements made about their effectiveness.45 However, these measures are not capturing patient perception of involvement in healthcare.46 91 Further, only one-third of the studies used measures assessing intervention impact on multiple stakeholder outcomes, or mechanisms of change, suggesting evaluations are not capturing findings to inform integration within healthcare pathways.
Of the 7640 identified studies, 41 were included in the review. Factors related to uptake (U), engagement (E), or both (B) were identified. Under capability, the main factors identified were app literacy skills (B), app awareness (U), available user guidance (B), health information (E), statistical information on progress (E), well-designed reminders (E), features to reduce cognitive load (E), and self-monitoring features (E). Availability at low cost (U), positive tone, and personalization (E) were identified as physical opportunity factors, whereas recommendations for health and well-being apps (U), embedded health professional support (E), and social networking (E) possibilities were social opportunity factors. Finally, the motivation factors included positive feedback (E), available rewards (E), goal setting (E), and the perceived utility of the app (E).
Systematic reviews that focused on one specific behavior or a certain type of health or well-being app suggest that the effectiveness of evidence-based smartphone apps can be improved by targeting the design and engagement features, such as user-friendly design, individualized and culturally tailored content, or health professional support [17-19]. A review based on experiential and behavioral perspectives conceptualized key factors that might affect engagement with digital behavior change interventions: the content (eg, behavior change techniques, social support, and reminders) and how the content is delivered (eg, professional support, personalization, and aesthetic features) [14].
No factors were coded directly under 4 out of the 14 TDF domains (optimism, social identity, beliefs about capabilities, and intentions). However, 2 of these were highlighted in this review. We described how several factors coded under different domains affect intentions (eg, having adequate app literacy skills or user guidance provided to the user), in a manner similar to how emotions, other than curiosity, affect engagement with an app (eg, lack of app literacy skills triggers negative emotions, some found reminders annoying, or some fear of social comparison related to sharing on social media). We also found that aspects of the factor personalization to needs also include social identity aspects. Some communities (LGBTQ+ and cancer patients) prefer an app that is personalized to their social identity. Although social identity, in this case, was judged to be a weak factor to list it independently. In terms of the other two absent domains, factors under beliefs in their capabilities and optimism might be less relevant for uptake and engagement with health apps, or the studies may have missed them out, or, potentially, we failed to identify them from the included studies.
Although some of the factors identified and presented in the Results section appear to have a positive influence on uptake and engagement, there are mixed findings that might benefit from further investigation, such as reminders, embedded social media, and social competition. In the studies included in the review, descriptions of notification-type messages, such as reminders, feedback, push notifications, and other notifications, were used interchangeably, and it was not always clear which notifications were being referred to. Consistent terminology would help eliminate doubt around these concepts in the future. Issues around equality and diversity were highlighted in a few studies as something future research should address. Further work is also needed to aid our understanding of how to avoid digital health widening inequalities through the exclusion of individuals who face a financial barrier to owning a smartphone or to purchasing an app, or who do not possess the skills to use one.
Given the rarity of in-hospital pediatric emergency events, identification of gaps and inefficiencies in the code response can be difficult. In-situ, simulation-based medical education programs can identify unrecognized systems-based challenges. We hypothesized that developing an in-situ, simulation-based pediatric emergency response program would identify latent inefficiencies in a complex, dual-hospital pediatric code response system and allow rapid intervention testing to improve performance before implementation at an institutional level. Pediatric leadership from two hospitals with a shared pediatric code response team employed the Institute for Healthcare Improvement's (IHI) Breakthrough Model for Collaborative Improvement to design a program consisting of Plan-Do-Study-Act cycles occurring in a simulated environment. The objectives of the program were to 1) identify inefficiencies in our pediatric code response; 2) correlate to current workflow; 3) employ an iterative process to test quality improvement interventions in a safe environment; and 4) measure performance before actual implementation at the institutional level. Twelve dual-hospital, in-situ, simulated, pediatric emergencies occurred over one year. The initial simulated event allowed identification of inefficiencies including delayed provider response, delayed initiation of cardiopulmonary resuscitation (CPR), and delayed vascular access. These gaps were linked to process issues including unreliable code pager activation, slow elevator response, and lack of responder familiarity with layout and contents of code cart. From first to last simulation with multiple simulated process improvements, code response time for secondary providers coming from the second hospital decreased from 29 to 7 min, time to CPR initiation decreased from 90 to 15 s, and vascular access obtainment decreased from 15 to 3 min. Some of these simulated process improvements were adopted into the institutional response while
Tele-echocardiography has the potential to bring real-time diagnoses to neonatal facilities without in-house pediatric cardiologists. Many neonates in rural areas, smaller cities, and community hospitals do not have immediate access to pediatric sonographers or echocardiogram interpretation by pediatric cardiologists. This can result in suboptimal echocardiogram quality, delay in initiation of medical intervention, unnecessary patient transport, and increased medical expenditures. Telemedicine has been used with increased frequency to improve efficiency of pediatric cardiology care in hospitals that are not served by pediatric cardiologists. Initial reports suggest that telecardiology is accurate, improves patient care, is cost-effective, enhances echocardiogram quality, and prevents unnecessary transports of neonates in locations that are not served by pediatric cardiologists. We report the largest series to evaluate the impact of telemedicine on delivery of pediatric cardiac care in community hospitals. We hypothesized that live telemedicine guidance and interpretation of neonatal echocardiograms from community hospitals is accurate, improves patient care, enhances sonographer proficiency, allows for more efficient physician time management, increases patient referrals, and does not result in increased utilization of echocardiography. Using desktop videoconferencing computers, pediatric cardiologists guided and interpreted pediatric echocardiograms from 2 community hospital nurseries 15 miles from a tertiary care center. Studies were transmitted in real-time using the H.320 videoconferencing protocol over 3 integrated services digital network lines (384 kilobits per second). This resulted in a frame rate of 23 to 30 frames per second. Sonographers who primarily scanned adult patients but had received additional training in echocardiography of infants performed the echocardiograms. Additional views were suggested as deemed necessary by the interpreting physician 2ff7e9595c
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