Search results for: inclusive practice

Authors: Belyihun Muchie

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This study investigates the low English oral communication skills of 5 second-year English major students at Debark University. It aims to identify the key factors contributing to their weaknesses and propose effective interventions to improve their spoken English proficiency. Mixed-methods research will be employed, utilizing observations, questionnaires, and semi-structured interviews to gather data from the participants. To clearly identify these factors, structured and informal observations will be employed; the former will be used to identify their fluency, pronunciation, vocabulary use, and grammar accuracy, and the later will be suited to observe the natural interactions and communication patterns of learners in the classroom setting. The questionnaires will assess their self-perceptions of their skills, perceived barriers to fluency, and preferred learning styles. Interviews will also delve deeper into their experiences and explore specific obstacles faced in oral communication. Data analysis will involve both quantitative and qualitative responses. The structured observation and questionnaire will be analyzed quantitatively, whereas the informal observation and interview transcripts will be analyzed thematically. Findings will be used to identify the major causes of low oral communication skills, such as limited vocabulary, grammatical errors, pronunciation difficulties, or lack of confidence. They are also helpful to develop targeted solutions addressing these causes, such as intensive pronunciation practice, conversation simulations, personalized feedback, or anxiety-reduction techniques. Finally, the findings will guide designing an intervention plan for implementation during the action research phase. The study's outcomes are expected to provide valuable insights into the challenges faced by English major students in developing oral communication skills, contribute to the development of evidence-based interventions for improving spoken English proficiency in similar contexts, and offer practical recommendations for English language instructors and curriculum developers to enhance student learning outcomes. By addressing the specific needs of these students and implementing tailored interventions, this research aims to bridge the gap between theoretical knowledge and practical speaking ability, equipping them with the confidence and skills to flourish in English communication settings.

Keywords: oral communication skills, mixed-methods, evidence-based interventions, spoken English proficiency

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Authors: Tshegofatso Galekgathege

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Poor water quality is of great concern to human health as it can cause disease outbreaks. A standard practice today, in developed countries, is that people should be provided with safe-reliable drinking water, as safe drinking water is recognized as a basic human right and a cost effective measure of reducing diseases. Over 1.1 billion people worldwide lack access to a safe water supply and as a result, the majority are forced to use polluted surface or groundwater. It is widely accepted that our water supply systems are susceptible to the intentional or accidental contamination .Water quality degradation may occur anywhere in the path that water takes from the water source to the consumer. Chlorine is believed to be an effective tool in disinfecting water, but its concentration may decrease with time due to consumption by chemical reactions. This shows that we are at the risk of being infected by waterborne diseases if chlorine in water falls below the required level of 0.2-1mg/liter which should be maintained in water and some contaminants enter into the water distribution system. It is believed that the lack of adequate sanitation also contributes to the contamination of water globally. This study therefore, assesses drinking water contamination from the source to the consumer by identifying the point vulnerable to contamination from the source to the consumer in the study area .To identify the point vulnerable to contamination, water was sampled monthly from boreholes, water treatment plant, water distribution system (WDS), service reservoirs and consumer taps from all the twenty (20) villages of Palapye region. Sampled water was then taken to the laboratory for testing and analysis of microbiological and chemical parameters. Water quality analysis were then compared with Botswana drinking water quality standards (BOS32:2009) to see if they comply. Major sources of water contamination identified during site visits were the livestock which were found drinking stagnant water from leaking pipes in 90 percent of the villages. Soils structure around the area was negatively affected because of livestock movement even vegetation in the area. In conclusion microbiological parameters of water in the study area do not comply with drinking water standards, some microbiological parameters in water indicated that livestock do not only affect land degradation but also the quality of water. Chlorine has been applied to water over some years but it is not effective enough thus preventative measures have to be developed, to prevent contaminants from reaching water. Remember: Prevention is better than cure.

Keywords: land degradation, leaking systems, livestock, water contamination

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Authors: Madjid Karimirad

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Floating solar was not very well-known in the renewable energy field a decade ago; however, there has been tremendous growth internationally with a Compound Annual Growth Rate (CAGR) of nearly 30% in recent years. To reach the goal of global net-zero emission by 2050, all renewable energy sources including solar should be used. Considering that 40% of the world’s population lives within 100 kilometres of the coasts, floating solar in coastal waters is an obvious energy solution. However, this requires more robust floating solar solutions. This paper tries to enlighten the fundamental requirements in the design of floating solar for offshore installations from the hydrodynamic and offshore engineering points of view. In this regard, a closer look at dynamic characteristics, stochastic behaviour and nonlinear phenomena appearing in this kind of structure is a major focus of the current article. Floating solar structures are alternative and very attractive green energy installations with (a) Less strain on land usage for densely populated areas; (b) Natural cooling effect with efficiency gain; and (c) Increased irradiance from the reflectivity of water. Also, floating solar in conjunction with the hydroelectric plants can optimise energy efficiency and improve system reliability. The co-locating of floating solar units with other types such as offshore wind, wave energy, tidal turbines as well as aquaculture (fish farming) can result in better ocean space usage and increase the synergies. Floating solar technology has seen considerable developments in installed capacities in the past decade. Development of design standards and codes of practice for floating solar technologies deployed on both inland water-bodies and offshore is required to ensure robust and reliable systems that do not have detrimental impacts on the hosting water body. Floating solar will account for 17% of all PV energy produced worldwide by 2030. To enhance the development, further research in this area is needed. This paper aims to discuss the main critical design aspects in light of the load and load effects that the floating solar platforms are subjected to. The key considerations in hydrodynamics, aerodynamics and simultaneous effects from the wind and wave load actions will be discussed. The link of dynamic nonlinear loading, limit states and design space considering the environmental conditions is set to enable a better understanding of the design requirements of fast-evolving floating solar technology.

Keywords: floating solar, offshore renewable energy, wind and wave loading, design space

Procedia PDF Downloads 79

Authors: Hamid Fallah

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Undoubtedly, flood is known as a natural disaster, and in practice, flood is considered the most terrible natural disaster in the world both in terms of loss of life and financial losses. From 1988 to 1997, about 390,000 people were killed by natural disasters in the world, 58% of which were related to floods, 26% due to earthquakes, and 16% due to storms and other disasters. The total damages in these 10 years were about 700 billion dollars, which were 33, 29, 28% related to floods, storms and earthquakes, respectively. In this regard, the worrisome point has been the increasing trend of flood deaths and damages in the world in recent decades. The increase in population and assets in flood plains, changes in hydro systems and the destructive effects of human activities have been the main reasons for this increase. During rain and snow, some of the water is absorbed by the soil and plants. A percentage evaporates and the rest flows and is called runoff. Floods occur when the soil and plants cannot absorb the rainfall, and as a result, the natural river channel does not have the capacity to pass the generated runoff. On average, almost 30% of precipitation is converted into runoff, which increases with snow melting. Floods that occur differently create an area called flood plain around the river. River floods are often caused by heavy rains, which in some cases are accompanied by snow melt. A flood that flows in a river without warning or with little warning is called a flash flood. The casualties of these rapid floods that occur in small watersheds are generally more than the casualties of large river floods. Coastal areas are also subject to flooding caused by waves caused by strong storms on the surface of the oceans or waves caused by underground earthquakes. Floods not only cause damage to property and endanger the lives of humans and animals, but also leave other effects. Runoff caused by heavy rains causes soil erosion in the upstream and sedimentation problems in the downstream. The habitats of fish and other animals are often destroyed by floods. The high speed of the current increases the damage. Long-term floods stop traffic and prevent drainage and economic use of land. The supports of bridges, river banks, sewage outlets and other structures are damaged, and there is a disruption in shipping and hydropower generation. The economic losses of floods in the world are estimated at tens of billions of dollars annually.

Keywords: flood, hydrological engineering, gis, dam, small hydropower, suitablity

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Authors: Mashad Maramaei, Behrooz Chogan, Reza Ahmadi

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Human health and the health of his watershed are inseparable. This is because a watershed is an interconnected system of "land", "water", "air" and "life". Nowadays, most of the world's watersheds show symptoms of unhealthiness and require a prompt solution. It is believed that suitable solution is a participatory and Integrated Watershed Management (IWM). In recent decades the Hyrcanian forests in the north of Iran, which belongs to the end of the third geological era, are suffering from many environmental challenges such as land degradation, increasing trends of flood, drought and accelerated soil erosion. These challenges in the main forested area of the country impose many tangible and intangible damages and human losses. This is despite the fact that in the past decades, forestry programs, watershed management and other activities in the region have been implemented in a parallel and uncoordinated manner. Therefore, recently; the Natural Resources and Watershed Management Organization has resorted to the concept of IWM planning the Hyrcanian watersheds. The Chelchai watershed as mostly degraded watershed in the eastern part of the Hyrcanian forests has been selected as a pilot watershed for implementation of the IWM. It has a drainage area of 25680 hectares and receives an average annual precipitation of 650 mm. In this mountainous region, the average temperature is 17.3 degrees Celsius. About 34% of the watershed is under cultivation, 64% under forest cover, 2% under built up areas and etc. In this research, the effectiveness or ineffectiveness of the IWM model implementation of the Natural Resources and Watershed Management Organization has been evaluated based on questionnaire method and field studies. The results indicated that IWM activities in the study area should be reconsidered and revived. Based on this research and the lessons learned during five years' experience in the Chelchai watershed; authors believe that seven important tasks are necessary for socially acceptable and successful implementation of IWM projects. These are: 1) Establishment of Local Coordination Committee (LCC) at the watershed level 2) working for development of a IWM law among government organizations to organize watershed management and eliminate parallel and contradictory activities 3) More investment on education of local communities, especially women and children 4) Development of trust builder and pattern projects that showing best agricultural and livestock management activities at each of 26 villages 5) Assigning forest protection to local communities. 6) Capacity building of government stakeholders. 7) Helping in the marketing of watershed products.

Keywords: integrated watershed management, Chelchai, Hyrcanian forests, Iran

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Authors: Genevieve Jorolan Quintero

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In Mindanao, the southern island of the Philippines, two provinces, Davao Oriental and Tboli of South Cotabato, respectively, are homes to indigenous communities known for their dream weavers. Davao Oriental is home to the Mandaya, while Lake Sebu is home to the Tboli. The dream weavers are mostly women who have continued the tradition of weaving, a spiritual practice of handicraft embodying the beliefs of the community. It is believed that a weaver is guided by the Tagamaling, or the nature spirit in Mandaya mythology, and Fu Dalu, or the spirit of the abaca among the Tboli. In the dream, the Tagamaling or Fu Dalu reveals to the weaver the design or the pattern of the dagmay as the abaca woven cloth is called among the Mandaya and the tnalak among the Tboli. The weaver then undertakes the production of this nature-spirit-inspired fabric based on her memory of the dream. This interaction between the spirit world and the human world inspired the theme of the short story with the title Loom of Dreams, published in 2015 by Kritika Kultura, an international peer-reviewed journal of language and literary/cultural studies of the Ateneo de Manila University in the Philippines. In Lake Sebu, a collection of the legendary tnalak with various designs is preserved by the cultural advocate and tnalak collector Reden S. Ulo. About a hundred tnalak designs are housed in a mini museum. The paper discusses how the dagmay and the tnalak of the two Philippine indigenous communities, the Mandaya and the Tboli, embody their folklore and cultural heritage. The specific objectives are: 1. To describe the role of the dreamweavers among the Mandaya and Tboli communities in the Philippines; 2. To analyse how folklore influences the designs on the woven fabric, the dagmay, and the tnalak, and 3. To discuss how dream-weaving helps preserve culture legacy. Ethnography was used in the conduct of this research. Specifically, the following data collection methods were done: 1. a series of visits to the Mandaya and Tboli communities; 2. face-to-face interviews with the respondents from the communities, and 3. the recording of the interviews with the knowledge-bearers and material culture keepers from both communities, the narratives of which were used as a basis for the data analysis. The influence of folklore in the culture and the arts of the indigenous communities is significantly evident in the designs of the dagmay and the tnalak. As the dream weavers continue to weave the dagmay and the tnalak, this cultural legacy will continue to prosper and be preserved for posterity.

Keywords: dreamweaver's, Mandaya, mindanao, Philippine folklore, Tboli

Procedia PDF Downloads 100

Authors: Leah Burton, Sara Cumming, Julianne DiSanto

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Homelessness is a widespread and complex problem in Canada and around the globe. Many Canadians will face homelessness at least once in their lifetime, with several experiencing subsequent bouts or cyclical patterns of housing precarity. While a Housing First approach to homelessness is a long-standing and widely accepted best practice, it is also recognized that the acquisition of life skills is an effective way to reduce cycles of homelessness. Indeed, when individuals are provided with a range of life skills—such as (but not limited to) financial literacy, household management, interpersonal skills, critical thinking, and resource management—they are given the tools required to maintain long-term Housing for a lifetime; thus reducing a repetitive need for services. However, there is limited research regarding the best ways to teach life skills, a problem that has been further complicated in a post-pandemic world, where services are being delivered online or in a hybrid model of care. More than this, it is difficult to provide life skills on a large scale without losing a client-centered approach to services. This lack of client-centeredness is also seen in the lack of attention to culturally sensitive life skills, which consider the diverse needs of individuals and imbed equity, diversity, and inclusion (EDI) within the skills being taught. This study aims to fill these identified gaps in the literature by employing a community-engaged (CER) approach. Academic, government, funders, front-line staff, and clients at 15 not-for-profits from across the Greater Toronto Area in Ontario, Canada, collaborated to co-create a virtual, client-centric, EDI-informed life skill learning management system. A triangulation methodology was utilized for this research. An environmental scan was conducted for current best practices, and over 100 front-line staff (including workers, managers, and executive directors who work with homeless populations) participated in two separate Creative Problem Solving Sessions. Over 200 individuals with experience in homelessness completed quantitative and open-ended surveys. All sections of this research aimed to discover the areas of skills that individuals need to maintain Housing and to ascertain what a more client-driven EDI approach to life skills training should include. This presentation will showcase the findings on which life skills are deemed essential for homeless and precariously housed individuals.

Keywords: homelessness, housing first, life skills, community engaged research, client- centered

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Authors: Johannes Gantner, Michael Held, Matthias Fischer

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The refurbishment of the building stock in terms of energy supply and efficiency is one of the major challenges of the German turnaround in energy policy. As the building sector accounts for 40% of Germany’s total energy demand, additional insulation is key for energy efficient refurbished buildings. Nevertheless the energetic benefits often the environmental and economic performances of insulation materials are questioned. The methods Life Cycle Assessment (LCA) as well as Life Cycle Costing (LCC) can form the standardized basis for answering this doubts and more and more become important for material producers due efforts such as Product Environmental Footprint (PEF) or Environmental Product Declarations (EPD). Due to increasing use of LCA and LCC information for decision support the robustness and resilience of the results become crucial especially for support of decision and policy makers. LCA and LCC results are based on respective models which depend on technical parameters like efficiencies, material and energy demand, product output, etc.. Nevertheless, the influence of parameter uncertainties on lifecycle results are usually not considered or just studied superficially. Anyhow the effect of parameter uncertainties cannot be neglected. Based on the example of an exterior wall the overall lifecycle results are varying by a magnitude of more than three. As a result simple best case worst case analyses used in practice are not sufficient. These analyses allow for a first rude view on the results but are not taking effects into account such as error propagation. Thereby LCA practitioners cannot provide further guidance for decision makers. Probabilistic analyses enable LCA practitioners to gain deeper understanding of the LCA and LCC results and provide a better decision support. Within this study, the environmental and economic impacts of an exterior wall system over its whole lifecycle are illustrated, and the effect of different uncertainty analysis on the interpretation in terms of resilience and robustness are shown. Hereby the approaches of error propagation and Monte Carlo Simulations are applied and combined with statistical methods in order to allow for a deeper understanding and interpretation. All in all this study emphasis the need for a deeper and more detailed probabilistic evaluation based on statistical methods. Just by this, misleading interpretations can be avoided, and the results can be used for resilient and robust decisions.

Keywords: uncertainty, life cycle assessment, life cycle costing, Monte Carlo simulation

Procedia PDF Downloads 286

Authors: J. Szpor, K. Witczak, M. Storman, A. Orchel, D. Hodorowicz-Zaniewska, K. Okoń, A. Klimkowska

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Core needle biopsy (CNB) is well established as an important diagnostic tool in diagnosing breast cancer and it is now considered the initial method of choice for diagnosing breast disease. In comparison to fine needle aspiration (FNA), CNB provides more architectural information allowing for the evaluation of prognostic and predictive factors for breast cancer, including histological grade—one of three prognostic factors used to calculate the Nottingham Prognostic Index. Several studies have previously described the concordance rate between CNB and surgical excision specimen in determination of histological grade (HG). The concordance rate previously ascribed to overall grade varies widely across literature, ranging from 59-91%. The aim of this study is to see how the data looks like in material at authors’ institution and are the results as compared to those described in previous literature. The study population included 157 women with a breast tumor who underwent a core needle biopsy for breast carcinoma and a subsequent surgical excision of the tumor. Both materials were evaluated for the determination of histological grade (scale from 1 to 3). HG was assessed only in core needle biopsies containing at least 10 well preserved HPF with invasive tumor. The degree of concordance between CNB and surgical excision specimen for the determination of tumor grade was assessed by Cohen’s kappa coefficient. The level of agreement between core needle biopsy and surgical resection specimen for overall histologic grading was 73% (113 of 155 cases). CNB correctly predicted the grade of the surgical excision specimen in 21 cases for grade 1 tumors (Kappa coefficient κ = 0.525 95% CI (0.3634; 0.6818), 52 cases for grade 2 (Kappa coefficient κ = 0.5652 95% CI (0.458; 0.667) and 40 cases for stage 3 tumors (Kappa coefficient κ = 0.6154 95% CI (0.4862; 0.7309). The highest level of agreement was observed in grade 3 malignancies. In 9 of 42 (21%) discordant cases, the grade was higher in the CNB than in the surgical excision. This composed 6% of the overall discordance. These results correspond to the noted in the literature, showing that underestimation occurs more frequently than overestimation. This study shows that authors’ institution’s histologic grading of CNBs and surgical excisions shows a fairly good correlation and is consistent with findings in previous reports. Despite the inevitable limitations of CNB, CNB is an effective method for diagnosing breast cancer and managing treatment options. Assessment of tumour grade by CNB is useful for the planning of treatment, so in authors’ opinion it is worthy to implement it in daily practice.

Keywords: breast cancer, concordance, core needle biopsy, histological grade

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Authors: Yoseph Halala Handiso, Zewdi Gebregziabher

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Background: Malnutrition in hospitalized patients remains a major public health problem in both developed and developing countries. Despite the fact that malnourished patients are more prone to stay longer in hospital, there is limited data regarding the magnitude of malnutrition and its effect on length of stay among surgical patients in Ethiopia, while nutritional assessment is also often a neglected component of the health service practice. Objective: This study aimed to assess the prevalence of malnutrition at admission and its effect on the length of hospital stay among adult surgical patients in Wolaita Sodo University Comprehensive Specialized Hospital, South Ethiopia, 2022. Methods: A facility-based prospective cohort study was conducted among 398 adult surgical patients admitted to the hospital. Participants in the study were chosen using a convenient sampling technique. Subjective global assessment was used to determine the nutritional status of patients with a minimum stay of 24 hours within 48 hours after admission (SGA). Data were collected using the open data kit (ODK) version 2022.3.3 software, while Stata version 14.1 software was employed for statistical analysis. The Cox regression model was used to determine the effect of malnutrition on the length of hospital stay (LOS) after adjusting for several potential confounders taken at admission. Adjusted hazard ratio (HR) with a 95% confidence interval was used to show the effect of malnutrition. Results: The prevalence of hospital malnutrition at admission was 64.32% (95% CI: 59%-69%) according to the SGA classification. Adult surgical patients who were malnourished at admission had higher median LOS (12 days: 95% CI: 11-13) as compared to well-nourished patients (8 days: 95% CI: 8-9), means adult surgical patients who were malnourished at admission were at higher risk of reduced chance of discharge with improvement (prolonged LOS) (AHR: 0.37, 95% CI: 0.29-0.47) as compared to well-nourished patients. Presence of comorbidity (AHR: 0.68, 95% CI: 0.50-90), poly medication (AHR: 0.69, 95% CI: 0.55-0.86), and history of admission (AHR: 0.70, 95% CI: 0.55-0.87) within the previous five years were found to be the significant covariates of the length of hospital stay (LOS). Conclusion: The magnitude of hospital malnutrition at admission was found to be high. Malnourished patients at admission had a higher risk of prolonged length of hospital stay as compared to well-nourished patients. The presence of comorbidity, polymedication, and history of admission were found to be the significant covariates of LOS. All stakeholders should give attention to reducing the magnitude of malnutrition and its covariates to improve the burden of LOS.

Keywords: effect of malnutrition, length of hospital stay, surgical patients, Ethiopia

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Authors: Wayne Tarrant, Ethan Petersen

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The concept of a flat tax goes back to at least the Biblical tithe. A progressive income tax was first vociferously espoused in a small, but famous, pamphlet in 1848 (although England had an emergency progressive tax for war costs prior to this). Within a few years many countries had adopted the progressive structure. The flat tax was only reinstated in some small countries and British protectorates until Mart Laar was elected Prime Minister of Estonia in 1992. Since Estonia’s adoption of the flat tax in 1993, many other formerly Communist countries have likewise abandoned progressive income taxes. Economists had expectations of what would happen when a flat tax was enacted, but very little work has been done on actually measuring the effect. With a testbed of 21 countries in this region that currently have a flat tax, much comparison is possible. Several countries have retained progressive taxes, giving an opportunity for contrast. There are also the cases of Czech Republic and Slovakia, which have adopted and later abandoned the flat tax. Further, with over 20 years’ worth of economic history in some flat tax countries, we can begin to do some serious longitudinal study. In this paper we consider many economic variables to determine if there are statistically significant differences from before to after the adoption of a flat tax. We consider unemployment rates, tax receipts, GDP growth, Gini coefficients, and market data where the data are available. Comparisons are made through the use of event studies and time series methods. The results are mixed, but we draw statistically significant conclusions about some effects. We also look at the different implementations of the flat tax. In some countries there are equal income and corporate tax rates. In others the income tax has a lower rate, while in others the reverse is true. Each of these sends a clear message to individuals and corporations. The policy makers surely have a desired effect in mind. We group countries with similar policies, try to determine if the intended effect actually occurred, and then report the results. This is a work in progress, and we welcome the suggestion of variables to consider. Further, some of the data from before the fall of the Iron Curtain are suspect. Since there are new ruling regimes in these countries, the methods of computing different statistical measures has changed. Although we first look at the raw data as reported, we also attempt to account for these changes. We show which data seem to be fictional and suggest ways to infer the needed statistics from other data. These results are reported beside those on the reported data. Since there is debate about taxation structure, this paper can help inform policymakers of change the flat tax has caused in other countries. The work shows some strengths and weaknesses of a flat tax structure. Moreover, it provides beginnings of a scientific analysis of the flat tax in practice rather than having discussion based solely upon theory and conjecture.

Keywords: flat tax, financial markets, GDP, unemployment rate, Gini coefficient

Procedia PDF Downloads 339

Authors: Ana Claudia de Souza Costa, Beatriz de Cássia Pinheiro Goulart, Karine de Cássia Cavalari, Henrique Ceretta Oliveira, Edineis de Brito Guirardello

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Background: During the COVID-19 pandemic, nursing represents the largest category of health professionals who were on the front line. Thus, investigating the practice environment and the job satisfaction of nursing professionals during the pandemic becomes fundamental since it reflects on the quality of care and the safety climate. The aim of this study was to evaluate and compare the nursing professionals' perception of the work environment, job satisfaction, and safety climate of the different hospitals and work shifts during the COVID-19 pandemic. Method: This is a cross-sectional survey with 130 nursing professionals from public, private and mixed hospitals in Brazil. For data collection, was used an electronic form containing the personal and occupational variables, work environment, job satisfaction, and safety climate. The data were analyzed using descriptive statistics and ANOVA or Kruskal-Wallis tests according to the data distribution. The distribution was evaluated by means of the Shapiro-Wilk test. The analysis was done in the SPSS 23 software, and it was considered a significance level of 5%. Results: The mean age of the participants was 35 years (±9.8), with a mean time of 6.4 years (±6.7) of working experience in the institution. Overall, the nursing professionals evaluated the work environment as favorable; they were dissatisfied with their job in terms of pay, promotion, benefits, contingent rewards, operating procedures and satisfied with coworkers, nature of work, supervision, and communication, and had a negative perception of the safety climate. When comparing the hospitals, it was found that they did not differ in their perception of the work environment and safety climate. However, they differed with regard to job satisfaction, demonstrating that nursing professionals from public hospitals were more dissatisfied with their work with regard to promotion when compared to professionals from private (p=0.02) and mixed hospitals (p< 0.01) and nursing professionals from mixed hospitals were more satisfied than those from private hospitals (p= 0.04) with regard to supervision. Participants working in night shifts had the worst perception of the work environment related to nurse participation in hospital affairs (p= 0.02), nursing foundations for quality care (p= 0.01), nurse manager ability, leadership and support (p= 0.02), safety climate (p< 0.01), job satisfaction related to contingent rewards (p= 0.04), nature of work (p= 0.03) and supervision (p< 0.01). Conclusion: The nursing professionals had a favorable perception of the environment and safety climate but differed among hospitals regarding job satisfaction for the promotion and supervision domains. There was also a difference between the participants regarding the work shifts, being the night shifts, those with the lowest scores, except for satisfaction with operational conditions.

Keywords: health facility environment, job satisfaction, patient safety, nursing

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Authors: Kasra Afsahi, Maryam Soheilifar, S. Hossein Hosseini

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Background: There is growing evidence that Cerebral Vascular Accident (CVA) can be a consequence of Covid-19 infection. Understanding novel treatment approaches are important in optimizing patient outcomes. Case: This case explores the use of Virtual Reality (VR) in the treatment of a 23-year-old COVID-positive female presenting with left hemiparesis in August 2020. Imaging showed right globus pallidus, thalamus, and internal capsule ischemic stroke. Conventional rehabilitation was started two weeks later, with virtual reality (VR) included. This game-based virtual reality (VR) technology developed for stroke patients was based on upper extremity exercises and functions for stroke. Physical examination showed left hemiparesis with muscle strength 3/5 in the upper extremity and 4/5 in the lower extremity. The range of motion of the shoulder was 90-100 degrees. The speech exam showed a mild decrease in fluency. Mild lower lip dynamic asymmetry was seen. Babinski was positive on the left. Gait speed was decreased (75 steps per minute). Intervention: Our game-based VR system was developed based on upper extremity physiotherapy exercises for post-stroke patients to increase the active, voluntary movement of the upper extremity joints and improve the function. The conventional program was initiated with active exercises, shoulder sanding for joint ROMs, walking shoulder, shoulder wheel, and combination movements of the shoulder, elbow, and wrist joints, alternative flexion-extension, pronation-supination movements, Pegboard and Purdo pegboard exercises. Also, fine movements included smart gloves, biofeedback, finger ladder, and writing. The difficulty of the game increased at each stage of the practice with progress in patient performances. Outcome: After 6 weeks of treatment, gait and speech were normal and upper extremity strength was improved to near normal status. No adverse effects were noted. Conclusion: This case suggests that VR is a useful tool in the treatment of a patient with covid-19 related CVA. The safety of newly developed instruments for such cases provides new approaches to improve the therapeutic outcomes and prognosis as well as increased satisfaction rate among patients.

Keywords: covid-19, stroke, virtual reality, rehabilitation

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Authors: Saem Lee, Thanh Nguyen, Hio-Jung Shin, Thomas Koellner

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Land-use management has an influence on the provision of ecosystem service in dynamic, agricultural landscapes. Agricultural land use is important for maintaining the productivity and sustainability of agricultural ecosystems. However, in Korea, intensive farming activities in this highland agricultural zone, the upper stream of Soyang has led to contaminated soil caused by over-use pesticides and fertilizers. This has led to decrease in water and soil quality, which has consequences for ecosystem services and human wellbeing. Conventional farming has still high percentage in this area and there is no special measure to prevent low water quality caused by farming activities. Therefore, the adoption of environmentally friendly farming has been considered one of the alternatives that lead to improved water quality and increase in biomass production. Concurrently, farm households with environmentally friendly farming have occupied still low rates. Therefore, our research involved a farm household survey spanning conventional farming, the farm in transition and organic farming in Soyang watershed. Another purpose of our research was to compare economic advantage of the farmers adopting environmentally friendly farming and non-adaptors and to investigate the different factors by logistic regression analysis with socio-economic and benefit-cost ratio variables. The results found that farmers with environmentally friendly farming tended to be younger than conventional farming and farmer in transition. They are similar in terms of gender which was predominately male. Farmers with environmentally friendly farming were more educated and had less farming experience than conventional farming and farmer in transition. Based on the benefit-cost analysis, total costs that farm in transition farmers spent for one year are about two times as much as the sum of costs in environmentally friendly farming. The benefit of organic farmers was assessed with 2,800 KRW per household per year. In logistic regression, the factors having statistical significance are subsidy and district, residence period and benefit-cost ratio. And district and residence period have the negative impact on the practice of environmentally friendly farming techniques. The results of our research make a valuable contribution to provide important information to describe Korean policy-making for agricultural and water management and to consider potential approaches to policy that would substantiate ways beneficial for sustainable resource management.

Keywords: organic farming, logistic regression, profitability, agricultural land-use

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Authors: N. Mahon, I. Crute, M. Di Bonito, E. Simmons, M. M. Islam

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Growing interest in the concept of the sustainable intensification (SI) of agriculture has been shown by, national governments, transnational agribusinesses, intergovernmental organizations and research institutes, amongst others. This interest may be because SI is seen as a ‘third way’ for agricultural development, between the seemingly disparate paradigms of ‘intensive’ agriculture and more ‘sustainable’ forms of agriculture. However, there is a lack of consensus as to what SI means in practice and how it should be measured using indicators of change. This has led to growing confusion, disagreement and skepticism regarding the concept, especially amongst civil society organizations, both in the UK and other countries. This has prompted the need for bottom-up, participatory approaches to identify indicators of SI. Our aim is to identify the views of British stakeholders regarding the areas of agreement and disagreement as to what SI is and how it should be measured in the UK using indicators of change. Data for this investigation came from 32 semi-structured interviews, conducted between 2015 and 2016, with stakeholders from throughout the UK food system. In total 110 indicators of SI were identified. These indicators covered a wide variety of subjects including biophysical, social and political considerations. A number of indicators appeared to be widely applicable and were similar to those suggested in the global literature. These include indicators related to the management of the natural resources on which agriculture relies e.g., ‘Soil organic matter’, ‘Number of pollinators per hectare’ and ‘Depth of water table’. As well as those related to agricultural externalities, e.g., ‘Greenhouse gas emissions’ and ‘Concentrations of agro-chemicals in waterways’. However, many of the indicators were much more specific to the context of the UK. These included, ‘Areas of high nature value farmland’, ‘Length of hedgerows per hectare’ and ‘Age of farmers’. Furthermore, tensions could be seen when participants considered the relative importance of agricultural mechanization versus levels of agricultural employment, the pros and cons of intensive, housed livestock systems and value of wild biodiversity versus the desire to increase agricultural yields. These areas of disagreement suggest the need to carefully consider the trade-offs inherent in the concept. Our findings indicate that in order to begin to resolve the confusions surrounding SI it needs to be considered in a context specific manner, rather than as a single uniform concept. Furthermore, both the environmental and the social parameters in which agriculture operates need to be considered in order to operationalize SI in a meaningful way. We suggest that participatory approaches are key to this process, facilitating dialogue and collaborative-learning between all the stakeholders, allowing them to reach a shared vision for the future of agricultural development.

Keywords: agriculture, indicators, participatory approach, sustainable intensification

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Authors: T. Suleiman, C. Mchugh, H. Ranu

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Background; Asthma continues to be associated with poor patient outcomes, including mortality. An audit of the management of acute asthma admissions in our hospital in 2020 found poor compliance with National Asthma and COPD Audit Project (NACAP) standards which set out to improve inpatient asthma care. Clinical nurse specialists have been shown to improve patient care across a range of specialties. In September 2021, an asthma Nurse Specialist (ANS) was employed in our hospital. Aim; To re-audit management of acute asthma admissions using NACAP standards and assess for quality improvement post-employment of an ANS. Methodology; NACAP standards are wide-reaching; therefore, we focused on ‘specific elements of good practice’ in addition to the provision of inhaled corticosteroids (ICS) on discharge. Medical notes were retrospectively requested from the hospital coding department and selected as per NACAP inclusion criteria. Data collection and entry into the NACAP database were carried out. As this was a clinical audit, ethics approval was not required. Results; Cycle 1 (pre-ANS) and 2 (post-ANS) of the audit included 20 and 32 patients, respectively, with comparable baseline demographics. No patients had a discharge bundle completed on discharge in cycle 1 vs. 84% of cases in cycle 2. Regarding specific components of the bundle, 25% of patients in cycle 1 had their inhaler technique checked vs. 91% in cycle 2. Furthermore, 80% of patients had maintenance medications reviewed in cycle 1 vs. 97% in cycle 2. Medication adherence was addressed in 20% of cases in cycle 1 vs. 88% of cases in cycle 2. Personalized asthma action plans were not issued or reviewed in any cases in cycle 1 as compared with 84% of cases in cycle 2. Triggers were discussed in 30% of cases in cycle 1 vs. 88% of cases in cycle 2. Tobacco dependence was addressed in 44% of cases in cycle 1 vs. 100% of cases in cycle 2. No patients in cycle 1 had community follow-up requested within 2 days vs. 81% of the patients in cycle 2. Similarly, 20% of the patients in cycle 1 vs. 88% of the patients in cycle 2 had a 4-week asthma clinic follow-up requested. 75% of patients in cycle 1 were the recipient of ICS on discharge compared with 94% of patients in cycle 2. Conclusion; Our quality improvement project demonstrates the utility of an ANS in improving performance in the management of acute asthma admissions, evidenced here through concordance with NACAP standards. Asthma is a complex condition with biological, psychological, and sociological components; therefore, ANS is a suitable intervention to improve concordance with guidelines. ANS likely impacted performance directly, for example, by checking inhaler technique, and indirectly as a safety net ensuring doctors included ICS on discharge.

Keywords: asthma, nurse specialist, clinical audit, quality improvement

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Authors: Dede Basturk, Metin Kaya, Halil Taskin, Nurtekin Erkmen

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In total, 29 students studying in Selçuk University Physical Training and Sports School who are recreationally active participated voluntarilyin this study which was carried out in order to examine effects of Vertimax trainings on agility, quickness and acceleration. 3 groups took their parts in this study as Vertimax training group (N=10), Ordinary training group (N=10) and Control group (N=9). Measurements were carried out in performance laboratory of Selçuk University Physical Training and Sports School. A training program for quickness and agility was followed up for subjects 3 days a week (Monday, Wednesday, Friday) for 8 weeks. Subjects taking their parts in vertimax training group and ordinary training group participated in the training program for quickness and agility. Measurements were applied as pre-test and post-test. Subjects of vertimax training group followed the training program with vertimax device and subjects of ordinary training group followed the training program without vertimax device. As to control group who are recreationally active, they did not participate in any program. 4 gate photocells were used for measuring and measurement of distances was carried out in m. Furthermore, single gate photocell and honi were used for agility test. Measurements started with 15 minutes of warm-up. Acceleration, quickness and agility tests were applied on subjects. 3 measurements were made for each subject at 3 minutes resting intervals. The best rating of three measurements was recorded. 5 m quickness pre-test value of vertimax training groups has been determined as 1,11±0,06 s and post-test value has been determined as 1,06 ± 0,08 s (P<0,05). 5 m quickness pre-test value of ordinary training group has been determined as 1,11±0,06 s and post-test value has been determined as 1,07±0,07 s (P<0,05).5 m quickness pre-test value of control group has been determined as 1,13±0,08 s and post-test value has been determined as 1,10 ± 0,07 s (P>0,05). Upon examination of 10 m acceleration value before and after the training, 10 m acceleration pre-test value of vertimax training group has been determined as 1,82 ± 0,07 s and post-test value has been determined as 1,76±0,83 s (P>0,05). 10 m acceleration pre-test value of ordinary training group has been determined as 1,83±0,05 s and post-test value has been determined as 1,78 ± 0,08 s (P>0,05).10 m acceleration pre-test value of control group has been determined as 1,87±0,11 s and post-test value has been determined as 1,83 ± 0,09 s (P>0,05). Upon examination of 15 m acceleration value before and after the training, 15 m acceleration pre-test value of vertimax training group has been determined as 2,52±0,10 s and post-test value has been determined as 2,46 ± 0,11 s (P>0,05).15 m acceleration pre-test value of ordinary training group has been determined as 2,52±0,05 s and post-test value has been determined as 2,48 ± 0,06 s (P>0,05). 15 m acceleration pre-test value of control group has been determined as 2,55 ± 0,11 s and post-test value has been determined as 2,54 ± 0,08 s (P>0,05).Upon examination of agility performance before and after the training, agility pre-test value of vertimax training group has been determined as 9,50±0,47 s and post-test value has been determined as 9,66 ± 0,47 s (P>0,05). Agility pre-test value of ordinary training group has been determined as 9,99 ± 0,05 s and post-test value has been determined as 9,86 ± 0,40 s (P>0,05). Agility pre-test value of control group has been determined as 9,74 ± 0,45 s and post-test value has been determined as 9,92 ± 0,49 s (P>0,05). Consequently, it has been observed that quickness and acceleration features were developed significantly following 8 weeks of vertimax training program and agility features were not developed significantly. It is suggested that training practices used for the study may be used for situations which may require sudden moves and in order to attain the maximum speed in a short time. Nevertheless, it is also suggested that this training practice does not make contribution in development of moves which may require sudden direction changes. It is suggested that productiveness and innovation may come off in terms of training by using various practices of vertimax trainings.

Keywords: vertimax, training, quickness, agility, acceleration

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Authors: Mónika Ditta Tóth, Ádám Fritz, Balázs Hankó, György Purebl

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Communication training about depression and suicide prevention for pharmacists – A Hungarian pilot study Mónika Ditta Tóth1, Ádám Fritz2, Balázs Hankó2, György Purebl1 1: Semmelweis University, Institute of Behavioural Sciences 2: Semmelweis University, University Pharmacy Department of Pharmacy Administration Background: Suicide rates in Hungary have been one of the highest in the European Union. Depression is one of the main risk factors for suicide and recognizing and treating depression is an effective way to prevent suicidal behaviour. In their daily practice, pharmacists meet patients with high risk of mental health problems. Therefore they have a key role in the prevention of depression and suicide. Aim: The main aim of this study is to raise pharmacists’ awareness about depression and suicide to enable better recognation of verbal and non-verbal signs of these deseases. Another important objective is to reduce their stigma about depression and increase their confidence in communication with depressed and/or suicidal patients. Methods: A 3-hour communication workshop has been delivered in this pilot study about the reasons, trigger factors, verbal and non-verbal signs of depression and suicide. The training includes communication techniques which have been developed to patients needs, as well as role-playing scenarios. Depression Stigma and Morris Confidence Scales were applied before, after and 6 weeks following the training. The results of the training group are then compared with two of the following pharmacist groups: 1. written material only (N=15), 2. no material (N=15). Results: One-way ANOVA revealed significant differences in the training group regarding the level of confidence in treating and communicating with patients with depression and/or suicide following the training, and after 6 weeks (F(2, 24)= 7,135, p=,004; baseline: 20,37, after training: 30,00, follow up: 27,66). After the 3-hour workshop the personal stigma about depression decreased (baselin: 19,75 after training: 17,00, p=0,075) in the training group (N=9), whilst the perceived stigma did not change (before: 33.54, after: 33,44, p=NS). Trainees assessed the workshop as ‘useful’ and ‘gap filling’. No significant differences was found in the group of pharmacisists who got written material only. Conclusions: Despite the high rates of depression and suicide in Hungary, pharmacists do not receive lectures or seminars about mental health during their university studies. Such half-day workshops could fill this gap and give practical help to recognize and communicate with depressed and/or suicidal patients in a more effective way. This way pharmacists, as community gate-keepers, could contribute to a more effective suicide prevention program in Hungary.

Keywords: communication training, pharmacists, depression, suicide

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Authors: Mustafa Metin Donma

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Metabolic syndrome (MetS) components are noteworthy among children with obesity and morbid obesity because they point out the cases with MetS, which have the great tendency to severe health problems such as cardiovascular diseases both in childhood and adulthood. In clinical practice, considerable efforts are being observed to bring into the open the striking differences between morbid obese cases and those with MetS findings. The most privileged aspect is concerning cardiometabolic features. The aim of this study was to derive an index which behaves different in children with and without MetS from the cardiac point of view. For the purpose, aspartate transaminase (AST), a cardiac enzyme still being used independently to predict cardiac-related problems, was used. One hundred and twenty four children were recruited from the outpatient clinic of Department of Pediatrics in Tekirdag Namik Kemal University, Faculty of Medicine. Forty-three children with normal body mass index, forty-one and forty morbid obese (MO) children with MetS and without the characteristic features of MetS, respectively, were included in the study. Weight, height, waist circumference (WC), hip C (HC), head C (HdC), neck C (NC), systolic and diastolic blood pressure values were measured and recorded. Body mass index and anthropometric ratios were calculated. Fasting blood glucose (FBG), insulin (INS), triglycerides (TRG), high density lipoprotein cholesterol (HDL-C) analyses were performed. The values for AST, alanin transaminase (ALT) and AST/ALT were obtained. Advanced Donma cardiac index (ADCI) values were calculated. The formula for the index was [(TRG/HDL-C) * (INS/FBG)] * [(WC+HC)/Height] * [(HdC+NC)/Height]. Statistical evaluations including correlation analysis were done by a statistical package program. The statistical significance degree was accepted as p<0.05. The index, ADCI, was developed from both anthropometric and biochemical parameters. All anthropometric measurements except weight were included in the equation. Besides all biochemical parameters concerning MetS components were also added. This index was tested in each of three groups. Its performance was compared with the performance of cardiometabolic index (CMI). It was also checked whether it was compatible with AST activity. The performance of ADCI was better than that of CMI. Instead of double increase, the increase of three times was observed in children with MetS compared to MO children. The index was correlated with AST in MO group and with AST/ALT in MetS group. In conclusion, this index was superior in discovering cardiac problems in MO and in diagnosing MetS in MetS groups. It was also arbiter to point out cardiovascular and MetS aspects among the groups.

Keywords: aspartate transaminase, cardiac, children, index, obesity

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Authors: Lydia Ouma Radoli

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The paradox of documenting history through visuals that objectify gruesome images to depict the prominence of stories intrigues media researchers. In East Africa, the topic has been captured in a variety of media frames, but scantly in scholarly work. This paper adopts Visual Rhetoric and Framing Theories to tease out the drivers behind the criteria for the selection of violent visuals. The paper projects that quantitative and qualitative literature regarding journalists’ personal and work-related exposure to PSTD will give insights into the concept of trauma journalism - reporting of horrific events, e.g., violent crime and terror. The data will be collected through methods such as document analysis (photographs and videos) and in-depth interviews to summarize the informational contents with respect to the research objectives and questions. The study is hinged on the background that the criterion for news production is constructed from the idea that ‘if there’s violence, conflict, and death involved, the story gets top priority.’ The anticipated outcome is to establish trauma experiences of visual rhetors, suggest mitigations, and address gaps in academic research. The findings of the study will sustain the critical role of visual rhetors. Further, media practitioners may find the study useful in assessing the effects and values of visual witnessing. Historically, the criterion for visual news production has been that if there’s violence, conflict, and death involved, the story gets top priority. To capture the goriness of the images, media theorists and sociologists have used the expression: “If it bleeds, it leads.” The statement assumes that audiences are attracted to pictures that show violent images. Further, research on visual aspects of Television news has shown its ability to hold viewers’ attention and cause aggression. This paper samples images and narratives from Journalists who have covered trauma-related events. The samples are indicative of the problem under study, which depicts journalists exposed to traumatic events as not receiving any Psycho-social support within newsrooms. It is hoped that the study could inform policy and practice within developing countries through the interpretations of theoretical and empirical explanations of existing trauma phenomena among journalists.

Keywords: visual-witnessing, media culture, visual rhetoric, imaging violence in East Africa

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Authors: Jared R. Chapman

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This study introduces a type of motivational information system called an educational engagement information system (EEIS). An EEIS draws on principles of behavioral economics, motivation theory, and learning cognition theory to design information systems that help students want to improve their performance. This study compares academic outcomes for course sections taught by part- and full-time instructors both with and without an EEIS. Without an EEIS, students in the part-time instructor's course sections demonstrated significantly higher failure rates (a 143.8% increase) and dropout rates (a 110.4% increase) with significantly fewer students scoring a B- or higher (39.8% decrease) when compared to students in the course sections taught by a full-time instructor. It is concerning that students in the part-time instructor’s course without an EEIS had significantly lower academic outcomes, suggesting less understanding of the course content. This could impact retention and continuation in a major. With an EEIS, when comparing part- and full-time instructors, there was no significant difference in failure and dropout rates or in the number of students scoring a B- or higher in the course. In fact, with an EEIS, the failure and dropout rates were statistically identical for part- and full-time instructor courses. When using an EEIS (compared with not using an EEIS), the part-time instructor showed a 62.1% decrease in failures, a 61.4% decrease in dropouts, and a 41.7% increase in the number of students scoring a B- or higher in the course. We are unaware of other interventions that yield such large improvements in academic performance. This suggests that using an EEIS such as Delphinium may compensate for part-time instructors’ limitations of expertise, time, or rewards that can have a negative impact on students’ academic outcomes. The EEIS had only a minimal impact on failure rates (7.7% decrease) and dropout rates (18.8% decrease) for the full-time instructor. This suggests there is a ceiling effect for the improvements that an EEIS can make in student performance. This may be because experienced instructors are already doing the kinds of things that an EEIS does, such as motivating students, tracking grades, and providing feedback about progress. Additionally, full-time instructors have more time to dedicate to students outside of class than part-time instructors and more rewards for doing so. Using adjunct and other types of part-time instructors will likely remain a prevalent practice in higher education management courses. Given that using part-time instructors can have a negative impact on student graduation and persistence in a field of study, it is important to identify ways we can augment part-time instructors’ performance. We demonstrated that when part-time instructors use an EEIS, it can result in significantly lower students’ failure and dropout rates and an increase in the rate of students earning a B- or above; and bring their students’ performance to parity with the performance of students taught by a full-time instructor.

Keywords: gamification, engagement, motivation, academic outcomes

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Authors: Zehra Gencel Efe, Fatma Susam Ozsayın, Satı Tas

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Background and Aim: It is not possible to teach all the knowledge related to operating room nursing in the nursing education process. Certified courses are organized by the Ministry of Health to compensate the lack of postgraduate training and the theoretical and practical training needs of working nurses. In this study; It is aimed to investigate the participants’ opinions and recommendations attending the certified course of operating room nursing that organized in İKCU AtaturkTraining and Research Hospital. Method: Two operating room nursing courses were organized in 2016. The 1st Operating Room Nursing Certified Course Program was organized between March 07, 2016 and April 6, 2016and the 2nd Operating Room Nursing Certified Course Program was organized between 07 November 2016 - 06 December 2016 at the İKCU Ataturk Training and Research Hospital. The first program was accepted for 29 participants, the second program was accepted for 30 participants. In the collection of the data, the 'Operating Room Nursing Certified Training Program Evaluation Form', 'Operating Room Nursing Certified Training Program Theoretical Training Evaluation Form' were used. Three point Likert-type scale is used for responses in the 'Operating Room Nursing Certified Training Program Evaluation Form’ (1=verygood, 2=good, 3=poor). Data is collected in five areas related to training program, operation room practice, communication, responsibility, experiences of learning. Four point Likert-type scale is used for responses in the 'Operating Room Nursing Certified Training Program Theoretical Training Evaluation Form' (1=verysatisfied, 2=quitesatisfied, 3=satisfied, 4=dissatisfied). Data is collected in two areas include presentation and content. Data were analyzed with SPSS 16 program. Findings and Conclusion: It was found that 93,22% of participants were female in addition, 62,7% had bachelor degree. It was seen that 33,87% of the work group had 1-5 years of experience in their field. It was found that; 88% of trainees participating in the first group to the operating room nursing-certified course program stated the training program was very good, 12% of them stated the training program was good. Nobody was signed the ‘poor’ choice. 81% of the trainees who participated in the 2nd group to the operating room nursing-certified course program stated the training program was very good, 19% of them stated the training program was good. Nobody was signed the ‘poor’ choice. It was found that there was no meaningful difference between the achievement ratios of the trainees and the learning status of the trainees when compared with the t test in the groups with success level of the operating room nursing certified course program according to the learning status of the participants (p ˃ 0,05). The trainees noted that the course was satisfied with theoretical and practical steps but the support services (lunch, coffee breaks etc.) were in adequate.

Keywords: certified courses, nursing certified courses, operating room nursing, training program

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Authors: Lily Farris, Chantel E. Canessa, Rena Heathcote, Susan Shumay, Suzanna V. McRae, Alissa Collingridge, Minna K. Miller

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Objective: To describe how the Lean approach can be applied to improve access, quality and safety of care in an ambulatory pediatric primary care setting. Background: Lean was originally developed by Toyota manufacturing in Japan, and subsequently adapted for use in the healthcare sector. Lean is a systematic approach, focused on identifying and reducing waste within organizational processes, improving patient-centered care and efficiency. Limited literature is available on the implementation of the Lean methodologies in a pediatric ambulatory care setting. Methods: A strategic continuous improvement event or Rapid Process Improvement Workshop (RPIW) was launched with the aim evaluating and structurally supporting clinic workflow, capacity building, sustainability, and ultimately improving access to care and enhancing the patient experience. The Lean process consists of five specific activities: Current state/process assessment (value stream map); development of a future state map (value stream map after waste reduction); identification, quantification and prioritization of the process improvement opportunities; implementation and evaluation of process changes; and audits to sustain the gains. Staff engagement is a critical component of the Lean process. Results: Through the implementation of the RPIW and shifting workload among the administrative team, four hours of wasted time moving between desks and doing work was eliminated from the Administrative Clerks role. To streamline clinic flow, the Nursing Assistants completed patient measurements and vitals for Nurse Practitioners, reducing patient wait times and adding value to the patients visit with the Nurse Practitioners. Additionally, through the Nurse Practitioners engagement in the Lean processes a need was recognized to articulate clinic vision, mission and the alignment of NP role and scope of practice with the agency and Ministry of Health strategic plan. Conclusions: Continuous improvement work in the Pediatric Primary Care NP Clinic has provided a unique opportunity to improve the quality of care delivered and has facilitated further alignment of the daily continuous improvement work with the strategic priorities of the Ministry of Health.

Keywords: ambulatory care, lean, pediatric primary care, system efficiency

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Authors: Hayley Lawrence, Nabi Shah, Sarah Dyer

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Aims: Lumbar punctures are a common bedside procedure performed in acute medicine. Published guidance exists on the standardised documentation of invasive procedures in order to reduce the risk of complications. The audit aim was to assess current standards of documentation in accordance with both the GMC and the National Standards for Invasive Procedures guidelines. A second cycle was conducted after introducing a standardised sticker created using current guidelines. This would assess whether the sticker improved documentation, aiming for 100% standard in each step of the procedure. Methods: An initial prospective audit of current practice was conducted over a 3-month period. Patients were identified by their presenting complaints and by colleagues assessing acute medical patients. Initial findings were presented locally, and a further prospective audit was conducted following the implementation of a standardised sticker. Results: 19 lumbar punctures were included in the first cycle and 13 procedures in the second. Pre-procedure documentation was collected for each cycle, whereby documentation of ‘Indication’ improved from 5.3% to 84.6%, ‘Consent’ from 84.2% to 100%, ‘Coagulopathy’ from 0% to 61.5%, ‘Drug Chart checked’ from 0% to 100%, ‘Position of patient’ from 26.3% to 100% and use of ‘Aseptic Technique’ from 83.3% to 100% from the first to the second cycle respectively. ‘Level of Doctor’ and ‘Supervision’ decreased from 53% to 31% and 53% to 46%, respectively, in the second cycle. Documentation of the procedure itself also demonstrated improvements, with ‘Level of Insertion’ 15.8% to 100%, ‘Name of Antiseptic Used’ 11.1% to 69.2%, ‘Local Anaesthetic Used’ 26.3% to 53.8%, ‘Needle Gauge’ 42.1% to 76.9%, ‘Number of Attempts’ 78.9% to 100% and ‘Traumatic/Atraumatic’ procedure 26.3% to 92.3%, respectively. A similar number of opening pressures were documented in each cycle at 57.9% and 53.8%, respectively, but its documentation was deemed ‘Not Applicable’ in a higher number of patients in the second cycle. Post-procedure documentation improved, with ‘Number of Samples obtained’ increasing from 52.6% to 92.3% and documentation of ‘Immediate Complications’ increasing from 78.9% to 100%. ‘Dressing Applied’ was poorly documented in the first cycle at 16.7%. This was not included on the standardised sticker, resulting in 0% documentation in the second cycle. Documentation of Clinicians’ Name and Bleep reduced from 63.2% to 15.4%, but when the name only was analysed, this increased to 84.6%. Conclusions: Standardised stickers for lumbar punctures do improve documentation and hence should result in improved patient safety. There is still room for improvement to reach 100% standard in each area, especially with respect to the clinician’s name and contact details being documented. Final adjustments will be made to the sticker before being included in a lumbar puncture kit, which will be made readily available in the acute medical wards. Future audits could be extended to include other common bedside procedures performed in acute medicine to ensure documentation of all these procedures reaches 100% standard.

Keywords: invasive procedure, lumbar puncture, medical record keeping, procedure checklist, procedure documentation, standardised documentation

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Authors: Teresa Wills, Geraldine Mccarthy, Nicola Cornally

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Background: Obesity is an emerging healthcare epidemic affecting virtually all age and socio-economic groups and is one of the most serious and prevalent diseases of the 21st century. It is a public health challenge because of its prevalence, associated costs and health effects. The increasing prevalence of obesity has created a social perception that overweight body sizes are healthy and normal. This normalization of obesity within our society and the acceptance of higher body weights have led to individuals being unaware of the reality of their weight status and gravity of this situation thus impeding recognition of obesity. Given the escalating global health problem of obesity and its co-morbidities, the need to re-appraise its management is more compelling than ever. It is widely accepted that the causes of obesity are complex and multi-factorial. Engagement of individuals in weight management programmes is difficult if they do not perceive they have a problem with their weight. Recognition of the problem is a key component of obesity management and identifying the main predictors of behaviour is key to designing health behaviour interventions. Aim: The aim of the research was to determine factors relating to motivation to change behaviours in individuals who perceive themselves to be overweight. Method: The research design was quantitative, correlational and cross-sectional. The design was guided by the Health Belief Model. Data were collected online using a multi-section and multi-item questionnaire, developed from a review of the theoretical and empirical research. A sample of 202 men and women who perceived themselves to be overweight participated in the research. Descriptive and inferential statistical analyses were employed to describe relationships between variables. Findings: Following multivariate regression analysis, perceived barriers to weight loss and perceived benefits of weight loss were significant predictors of motivation to change behaviour. The perceived barriers to weight loss which were significant were psychological barriers to weight loss (p = < 0.019) and environmental barriers to physical activity (p= < 0.032).The greatest predictor of motivation to change behaviour was the perceived benefits of weight loss (p < 0.001). Perceived susceptibility to obesity and perceived severity of obesity did not emerge as significant predictors in this model. Total variance explained by the model was 33.5%. Conclusion: Perceived barriers to weight loss and perceived benefits of weight loss are important determinants of motivation to change behaviour. These findings have important implications for health professionals to help inform their practice and for the development of intervention programmes to prevent and control obesity.

Keywords: motivation to change behaviours, obesity, predictors of behavior, interventions, overweight

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Authors: Gamze Safak, Umut Arslanoglu

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Cultural and tourism conservation and development zones and tourism centers are the boundaries declared for the purpose of protecting, using, and evaluating the sectoral development and planned development in areas where historical and cultural values are heavily involved and/or where tourism potential is high. The most rapidly changing regions in Turkey are tourism areas, especially the coastal areas. Planning these regions is not about only an economic gain but also a natural and physical environment and refers to a complex process. If the tourism sector is not well controlled, excessive use of natural resources and wrong location choices may cause damage to natural areas, historical values, and socio-cultural structure. Since the strategic decisions taken in the environmental order and zoning plans, which are the means of guiding the physical environment of the Ministry of Culture and Tourism, which have the authority to make plans in tourism centers, are transformed into plan decisions that find the spatial expression, comprehensive evaluation of all kinds of data, following the historical development and based on the correct and current data is required. In addition, the authority has a number of competences in tourism promotion as well as the authority to plan, leading to the necessity of taking part in the applications requiring complex analysis such as the management and integration of the country's economic, political, social and cultural resources. For this purpose, Tourism Inventory System (TES) project, which consists of a series of subsystems, has been developed in order to solve complex planning and method problems in the management of site-related information. The scope of the project is based on the integration of numerical and verbal data in the regions within the jurisdiction of the authority, and the monitoring of the historical development of urban planning studies, making the spatial data of the institution easily accessible, shared, questionable and traceable in international standards. A dynamic and continuous system design has been put into practice by utilizing the advantage of the use of Geographical Information Systems in the planning process to play a role in making the right decisions, revealing the tools of social, economic, cultural development, and preservation of natural and cultural values. This paper, which is prepared by the project team members in TES (Tourism Inventory System), will present a study regarding the applicability of GIS in cultural and natural heritage conservation.

Keywords: cultural conservation, GIS, geographic information system, tourism inventory system, urban planning

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Authors: Mostafa Shahriari, Theophile Chaumont-Frelet, David Pardo

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Resistivity measurements are used to characterize the Earth’s subsurface. They are categorized into two different groups: (a) those acquired on the Earth’s surface, for instance, controlled source electromagnetic (CSEM) and Magnetotellurics (MT), and (b) those recorded with borehole logging instruments such as Logging-While-Drilling (LWD) devices. LWD instruments are mostly used for geo-steering purposes, i.e., to adjust dip and azimuthal angles of a well trajectory to drill along a particular geological target. Modern LWD tools measure all nine components of the magnetic field corresponding to three orthogonal transmitter and receiver orientations. In order to map the Earth’s subsurface and perform geo-steering, we invert measurements using a gradient-based method that utilizes the derivatives of the recorded measurements with respect to the inversion variables. For resistivity measurements, these inversion variables are usually the constant resistivity value of each layer and the bed boundary positions. It is well-known how to compute derivatives with respect to the constant resistivity value of each layer using semi-analytic or numerical methods. However, similar formulas for computing the derivatives with respect to bed boundary positions are unavailable. The main contribution of this work is to provide an adjoint-based formulation for computing derivatives with respect to the bed boundary positions. The key idea to obtain the aforementioned adjoint state formulations for the derivatives is to separate the tangential and normal components of the field and treat them differently. This formulation allows us to compute the derivatives faster and more accurately than with traditional finite differences approximations. In the presentation, we shall first derive a formula for computing the derivatives with respect to the bed boundary positions for the potential equation. Then, we shall extend our formulation to 3D Maxwell’s equations. Finally, by considering a 1D domain and reducing the dimensionality of the problem, which is a common practice in the inversion of resistivity measurements, we shall derive a formulation to compute the derivatives of the measurements with respect to the bed boundary positions using a 1.5D variational formulation. Then, we shall illustrate the accuracy and convergence properties of our formulations by comparing numerical results with the analytical derivatives for the potential equation. For the 1.5D Maxwell’s system, we shall compare our numerical results based on the proposed adjoint-based formulation vs those obtained with a traditional finite difference approach. Numerical results shall show that our proposed adjoint-based technique produces enhanced accuracy solutions while its cost is negligible, as opposed to the finite difference approach that requires the solution of one additional problem per derivative.

Keywords: inverse problem, bed boundary positions, electromagnetism, potential equation

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Authors: Rozanne Janet Smith

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This article examined the corporate governance disclosures of the large and medium-sized auditing firms in South Africa. It is important that auditing firms disclose their practice of good corporate governance to the public, as they serve the public interest. The auditing profession has been criticized due to many corporate scandals in recent years. This has undermined the reputation of the profession, with experts and the public questioning whether auditing firms have corporate governance structures in place, and whether they are taking public interest into consideration. In South Africa there is no corporate governance code specifically for audit firms. Auditing firms are encouraged by IRBA to issue a transparency report in which they disclose corporate governance structures and application, but this is not compulsory in South Africa. Moreover, the information issued in these transparency reports is limited and often only focuses on audit quality, and not governance. Through a literature review it was found that the UK is one of only a few countries who has a corporate governance code for audit firms. As South Africa initially used the UK Cadbury report to develop the King IV Code, it was fitting to use the UK Audit Firm Governance Code as a benchmark to determine if audit firms in South Africa are disclosing relevant corporate governance information in their transparency reports and/or integrated reports. This study contributes to the existing body of knowledge by pursuing the following objective: To determine the improvement in the corporate governance disclosures of large and medium-sized auditing firms in South Africa through comparative research. Available data from 2019 will be used and compared to the disclosures in the 2023/2024 transparency and or integrated reports of the large and medium-sized auditing firms in South Africa. To achieve this objective a constructivist research paradigm was applied. Qualitative secondary information was gathered for the analysis. A content analysis was selected to collect the qualitative data by analyzing the integrated reports and/or transparency reports of large and medium-sized auditing firms with 20 or more partners and to determine what is disclosed on their corporate governance practices. These transparency reports and integrated reports were then read and analyzed in depth and compared to the principles stated in the UK Code. Since there are only nine medium-sized and large auditing firms in South Africa, the researcher was able to conduct the content analysis by reading each report in depth. The following six principles which are found in the UK Code were assessed for disclosure. (1) Leadership, (2) Values, (3) INED, (4) Operations, (5) Reporting, and (6) Dialogue. The results reveal that the auditing firms are not disclosing the corporate governance principles and practices to the necessary extent. Although there has been some improvement, the disclosure is not to the extent which it should be. There is still a need for a South African audit firm governance code.

Keywords: auditing firms, corporate governance, South Africa, disclosure

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Authors: Anne Prip, Kirsten Alling Møller, Dorte Lisbet Nielsen, Mary Jarden, Marie-Helene Olsen, Anne Kjaergaard Danielsen

Abstract:

Background: The development in cancer care has shifted towards shorter hospital stays and more outpatient treatment. Today, cancer care and treatment predominantly takes place in outpatient settings where encounters between patients and health care professionals are often brief. This development will probably continue internationally as the global cancer burden seems to be growing significantly. Furthermore, the number of patients who require ambulatory treatments such as chemotherapy is increasing. Focusing on the encounters between health care professionals and patients during oncology treatment has thus become increasingly important due to a growing trend in outpatient cancer management. Objective: The aim of the systematic review was to summarize the literature from the perspective of the patient, on experiences of and the need for communication and relationships with the health care professional during chemotherapy treatment in an outpatient setting. Method: The review was designed and carried out according to the PRISMA guidelines and PICO framework. The systematic search was conducted in Medline, CINAHL, The Cochrane Library and Joanna Briggs Institute Evidence Based Practice Database. Results: In all, 1174 studies were identified by literature search. After duplicates were removed, the remaining studies (n = 1053) were screened for inclusion. Nine studies were included; qualitative (n = 5) and quantitative (n = 4) as they met the inclusions criteria. The review identified that communication and relationships between health care professionals and patients were important for the patients’ ability to cope with cancer and also had an impact on patients’ satisfaction with care in the outpatient clinic. Furthermore, the review showed that hope and positivity was a need and strategy for patients with cancer and was facilitated by health care professionals. Finally, it revealed that outpatient clinic visits framed and influenced communication and relationships. Conclusions: This review identified the significance of communication and the relationships between patients and health care professionals in the outpatient setting as it supports patients’ ability to cope with cancer. The review showed the need for health care professionals to pay attention to the relational aspects of communication in an outpatient clinic as encounters are often brief. Furthermore, the review helps to specify which elements of the communication are central in the patient-health care professional interaction from the patients' perspective. Finally, it shows a need for more research to investigate which type of interaction and intervention would be the most effective in supporting patients’ coping during chemotherapy in an outpatient clinic.

Keywords: ambulatory chemotherapy, communication, health care professional-patient relation, nurse-patient relation, outpatient care, systematic review

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Authors: Lori Lioce, Gary Maddux, Norven Goddard, Ishella Fogle, Bernard Schroer

Abstract:

This paper presents the integration of technologies into nursing education. The collaborative effort includes the College of Nursing (CoN) at the University of Alabama in Huntsville (UAH) and the UAH Systems Management and Production Center (SMAP). The faculty at the CoN conducts needs assessments to identify education and training requirements. A team of CoN faculty and SMAP engineers then prioritize these requirements and establish improvement/development teams. The development teams consist of nurses to evaluate the models and to provide feedback and of undergraduate engineering students and their senior staff mentors from SMAP. The SMAP engineering staff develops and creates the physical models using 3D printing, silicone molds and specialized molding mixtures and techniques. The collaboration has focused on developing teaching and training, or clinical, simulators. In addition, the onset of the Covid-19 pandemic has intensified this relationship, as 3D modeling shifted to supplied personal protection equipment (PPE) to local health care providers. A secondary collaboration has been introducing students to clinical benchmarking through the UAH Center for Management and Economic Research. As a result of these successful collaborations the Model Exchange & Development of Nursing & Engineering Technology (MEDNET) has been established. MEDNET seeks to extend and expand the linkage between engineering and nursing to K-12 schools, technical schools and medical facilities in the region to the resources available from the CoN and SMAP. As an example, stereolithography (STL) files of the 3D printed models, along with the specifications to fabricate models, are available on the MEDNET website. Ten 3D printed models have been developed and are currently in use by the CoN. The following additional training simulators are currently under development:1) suture pads, 2) gelatin wound models and 3) printed wound tattoos. Specification sheets have been written for these simulations that describe the use, fabrication procedures and parts list. These specifications are available for viewing and download on MEDNET. Included in this paper are 1) descriptions of CoN, SMAP and MEDNET, 2) collaborative process used in product improvement/development, 3) 3D printed models of training and teaching simulators, 4) training simulators under development with specification sheets, 5) family care practice benchmarking, 6) integrating the simulators into the nursing curriculum, 7) utilizing MEDNET as a pandemic response, and 8) conclusions and lessons learned.

Keywords: 3D printing, nursing education, simulation, trainers

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