Search results for: cooperative guidance

Authors: Kieren Wilson, Gulnaz Majeed

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NHS constitution gives rights to the patient with suspected cancer to be seen by a cancer specialist within 2 weeks of referral. Guys and St Thomas Hospital (GSTT) is one of the largest cancer centres in London. NICE guidelines have provided guidance for health professionals to refer patients appropriately to RAC. In GSTT suspected gynae cancer referrals are mostly by NHS e-Referral Service with some fax, emails as well as paper referrals. The objective of this study was to evaluate compliance with 2-week referral pathway with emphasis on one stop diagnostic service with supporting efficient pathways. A prospective evaluation over 3 months (1 Jan 2017 to 31 Mar 2017) was undertaken. There were 26 clinics, 761 patients were booked in the clinics with a DNA rate of 13% (n=101) hence 606 patients were seen. Majority of referrals were for post menopausal bleeding (PMB) 25% (n=194) followed by cervical, vaginal, vulval reasons 23% (n=179) (abnormal cytology excluded as patients directly referred to colposcopy unit in GSTT), ovarian 7% (n=54) and endometrial 5% (n=41). Women with new or previous established diagnosis of cancer were 24, cervical (n=17), vulva (n=6) and vagina (n=1). Multifocal preinvasive disease vulva (VIN), vagina (VAIN) and cervix (CIN) was confirmed in twenty-six patients 4% (high prevalence in HIV patients). Majority of cervical referrals: PCB (n=14), cervical erosion (n=7), polyps (n=9) and cervical cyst were benign. However, two women with PMB had cervical cancer. Only 2 out of 13 referrals with vaginal concerns had VAIN. One case with non-cervical glandular cytology was confirmed to have endometrial cancer. One stop service based on the diagnostic support of ultrasound, colposcopy and hysteroscopy was achieved in 54% (n=359). Patients were discharged to GP, benign gynaecology, endometriosis, combined vulval/dermatology clinic or gynae oncology. 33% (n=202) required a second visit, 12% (n=70) third visit, 3% (n=19) fourth visit, 1% (n=4) fifth visit and 1% (n=6) sixth visit. Main reasons for follow ups were the unavailability of diagnostic slots, patient choice, need for interpreters, the discussion following gynae MDM review for triage to benign gynae, delay in availability of diagnostic results like histology/MRI/CT. Recommendations following this study are multi disciplinary review of pathways with the availability of additional diagnostic procedure slots to aim for one stop service. Furthermore, establishment of virtual and telephone consultations to reduce follow ups.

Keywords: multifocal disease, post menopausal bleeding, preinvasive disease, rapid access clinic

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Authors: Binay Pattanayak

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Multilingual state, Jharkhand is home to more than 19 tribal and regional languages. These are used by more than 33 communities in the state. The state has declared 12 of these languages as official languages of the state. However, schools in the state do not recognize any of these community languages even in early grades! Children, who speak in their mother tongues at home, local market and playground, find it very difficult to understand their teacher and textbooks in school. They fail to acquire basic literacy and numeracy skills in early grades. Out of frustration due to lack of comprehension, the majority of children leave school. Jharkhand sees the highest dropout in early grades in India. To address this, the state under the guidance of the author designed a mother tongue based pre-school education programme named Bhasha Puliya and bilingual picture dictionaries in 9 tribal and regional mother tongues of children. This contributed significantly to children’s school readiness in the school. Followed by this, the state designed a mother-tongue based multilingual education programme (MTB-MLE) for multilingual context. The author guided textbook development in 5 tribal (Santhali, Mundari, Ho, Kurukh and Kharia) and two regional (Odia and Bangla) languages. Teachers and community members were trained for MTB-MLE in around 1,000 schools of the concerned language pockets. Community resource groups were constituted along with their academic calendars in each school to promote story-telling, singing, painting, dancing, riddles, etc. with community support. This, on the one hand, created rich learning environments for children. On the other hand, the communities have discovered a great potential in the process of developing a wide variety of learning materials for children in own mother-tongue using their local stories, songs, riddles, paintings, idioms, skits, etc. as a process of their literary, cultural and technical enrichment. The majority of children are acquiring strong early grade reading skills (basic literacy and numeracy) in grades I-II thereby getting well prepared for higher studies. In a phased manner they are learning Hindi and English after 4-5 years of MTB-MLE using the foundational language learning skills. Community members have started designing new books, audio-visual learning materials in their mother-tongues seeing a great potential for their cultural and technological rejuvenation.

Keywords: community resource groups, MTB-MLE, multilingual, socio-linguistic survey, learning

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Authors: Li-Jia Chiu

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The purpose of this study is to integrate the content of professional ethics curriculum into life education. This course is a required course for the third-year students of the university. The curriculum is based on professional ethics, which can help students gain insights into a conceptual understanding of professional theory, learning the meaning and the value of life. This study enhances students' attitude toward learning through multi-teaching methods. It takes ‘professionalism’ as the subject of discussion. Additionally, the course combines the connotation and issues of the student's career development. Using the world cafe discussion method, students can think about the role of the future career, and inspire students to integrate their career development and life value reflection and connection. This study recruited the third-year undergraduate students as samples to collect data. This study was conducted in the course of the fall semester in 2016 for thematic discussions, classroom observations, course study forms, coursework, and results in publication reports, etc. The researcher conducted induction data analysis to reflect the practice and reflection of the course. The subjects included 117 students from two classes, including 54 male and 63 female students. The findings of this study comprised the following two parts: the student’s learning and teacher’s teaching reflection. The students’ gains were that: 1) The curriculum design is different from that of other subjects; 2) The curriculum is highly interactive with teachers and classmates; 3) These students are willing to actively participate and share ideas in group discussions; 4 ) They thought the possibility of further discussions with other groups of students through table-to-table discussions; 5) They experienced the respect from other students in the learning process and their appreciation of other students in the same group. The instruction reflections were as follows: 1) Students learned to get link to the value of life and future development through topical discussions; 2) After the main course design guided through gradual guidance, the students’ psychology reached a certain degree of cognition, and further themes then added would cause more sensuous learning effects; 3) Combining students’ expertise in drawing in this department (digital media design department) into curriculum design is effective in stimulating learning motivation and sense of accomplishment; 4) In order to compare and explore learning benefits, future researches are recommended to conduct the similar studies with different departments. Finally, the researcher looks forward to providing research results and findings to the related curriculum teachers as a reference for practical curriculum planning and teaching methods.

Keywords: life education, World Cafe, professional ethics, professionalism

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Authors: Burmansyah Muhammad, Supriyoto Supriyoto

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Crop yield, quality and food safety are three important components that all estate and food crops must put into consideration to lifting the economic value. These measurements should be evaluated because marketplace demand is simultaneously changing and farmers must adapt quickly to remain competitive. The increase in economic value could be done by producing high quality product that aligns with harvest collector preferences. The purpose of this study is to examine the causal effects of value added farming in agriculture economic aspects towards crop yield, quality and food security. This research is using descriptive survey research by employing data from small-scale cocoa farmers listed to off-taker company, located on Sulawesi area of Indonesia. The questionnaire was obtained from 650 cocoa farmers, selected randomly. Major findings of the study indicate that 78% of respondents agree that agriculture inputs have positive effect on crop yield, quality and food safety. The study recommended that cocoa stakeholders should ensure access to agriculture inputs in first priority and then followed by ensuring access to cocoa supply chain trader and micro-financing. Value Added Farming refers to lifting the economic value of a commodity through particular intervention. Regarding access to agriculture inputs, one of significant intervention is fertilization and plant nutrition management, both organic and inorganic fertilizer. Small-scale cocoa farmers can get access to fertilizer intervention through establishment of demo farm. Ordinary demo farm needs large area, selective requirements, lots of field resources and centralization impact. On the contrary, satellite demo farm is developing to wide-spread the impact of agriculture economic aspects and also the involvement in number of farmers. In Sulawesi Project, we develop leveling strata of small-scale demo farm with group of farmers and local cooperative. With this methodology, all of listed small-scale farmers can get access to agriculture input, micro-financing and how to deliver quality output. PT Pupuk Kaltim is member firm of holding company PT Pupuk Indonesia, private company belongs to the government of Indonesia. The company listed as Indonesia's largest producer of urea fertilizers, besides ammonia, Compound Fertilizer (NPK) and biological fertilizers. To achieve strategic objectives, the company has distinguished award such as SNI Platinum, SGS Award IFA Protect and Sustain Stewardship and Gold Rank of Environment Friendly Company. This achievement has become the strategic foundation for our company to energize value added farming in sustaining food security program. Moreover, to ensure cocoa sustainability farming the company has developed partnership with international companies and Non-Government Organization (NGO).

Keywords: fertilizer and plant nutrition management, good agriculture practices, agriculture economic aspects, value-added farming

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Authors: Per Blomqvist

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The overall aim of this study is to highlight how the degree project-course in teacher education has developed over time at Swedish universities, above all regarding changes in the formative assessment practices in relation to student's opportunities to take part in writing processes that can develop both their independent critical thinking, subject knowledge, and academic writing skills. Theoretically, the study is based on deliberative and transformative perspectives of teaching academic writing in higher education. The deliberative perspective is motivated by the fact that it is the universities and their departments' responsibility to give the students opportunities to develop their academic writing skills, while there is little guidance on how this can be implemented. The transformative perspective is motivated by the fact that education needs to be adapted to the student's prior knowledge and developed in relation to the student group. Given the academisation of education and the new student groups, this is a necessity. The empirical data consists of video recordings of teacher groups' conversations at three Swedish universities. The conversations were conducted as so-called collective remembering interviews, a method to stimulate the participants' memory through social interaction, and focused on addressing issues on how the degree project-course in teacher education has changed over time. Topic analysis was used to analyze the conversations in order to identify common descriptions and expressions among the teachers. The result highlights great similarities in how the degree project-course has changed over time, both from a deliberative and a transformative perspective. The course is characterized by a “strong framing,” where the teachers have great control over the work through detailed instructions for the writing process and detailed templates for the text. This is justified by the fact that the education has been adapted based on the student teachers' lack of prior subject knowledge. The strong framing places high demands on continuous discussions between teachers about, for example, which tools the students have with them and which linguistic and textual tools are offered in the education. The teachers describe that such governance often leads to conflicts between teachers from different departments because reading and writing are always part of cultural contexts and are linked to different knowledge, traditions, and values. The problem that is made visible in this study raises questions about how students' opportunities to develop independence and make critical judgments in academic writing are affected if the writing becomes too controlled and if passing students becomes the main goal of education.

Keywords: formative assessment, academic writing, degree project, higher education, deliberative perspective, transformative perspective

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Authors: Binay Pattanayak

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More than 9 out of every 10 children in Jharkhand struggle to understand the texts and teachers in public schools. The medium of learning in the schools is Hindi, which is very different in structure and vocabulary than those in children’s home languages. Hence around 3 out of 10 children enrolled in early grades drop out in these schools. The state realized the cause of children’s high dropout in 2013-14 when the M-TALL, the language research shared the findings of a state-wide socio-linguistic study. The study findings suggested that there was a great need for initiating a mother-tongue based multilingual education (MTB-MLE) programme for the state in early grades starting from pre-school level. Accordingly, M-TALL in partnership with department of education designed two learning packages: Bhasha Puliya pre-school education programme for 3-6-year-old children for their school readiness with bilingual picture dictionaries in 9 tribal and regional languages. This was followed by a plan for MTB-MLE programme for early primary grades. For this textbooks in five tribal and two regional languages were developed under the guidance of the author. These books were printed and circulated in the 1000 schools of the state for each child. Teachers and community members were trained for facilitating culturally sensitive mother-tongue based learning activities in and around the schools. The mother-tongue based approach of learning has worked very effectively in enabling them to acquire the basic literacy and numeracy skills in own mother-tongues. Using this basic early grade reading skills, these children are able to learn Hindi and English systematically. Community resource groups were constituted in each school for promoting storytelling, singing, painting, dancing, acting, riddles, humor, sanitation, health, nutrition, protection, etc. and were trained. School academic calendar was designed in each school to enable the community resource persons to visit the school as per the learning plan to assist children and teacher in facilitating rich cultural activities in mother-tongue. This enables children to take part in plethora of learning activities and acquire desired knowledge, skills and interest in mother-tongues. Also in this process, it is attempted to promote 21st Century learning skills by enabling children to apply their new knowledge and skills to look at their local issues and address those in a collective manner through team work, innovations and leadership.

Keywords: community resource groups, learning, MTB-MLE, multilingual, socio-linguistic survey

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Authors: Yonit Nissim, Eyal Weissblueth

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This research is the continuation of a process that began in 2010 with the goal of redesigning the training program for future early childhood teachers at the Ohalo College, to integrate technology and provide 21st-century skills. The article focuses on a study of the processes involved in developing a special educational unit which challenged students with the task of designing, planning and building an internet site for kindergartens. This project was part of their second-year studies in the early childhood track of an interdisciplinary course entitled 'Educating for the Future.' The goal: enabling students to gain experience in developing an internet site specifically for kindergartens, and gain familiarity with Google platforms, the acquisition and use of innovative skills and the integration of technology in pedagogy. Research questions examined how students handled the task of building an internet site. The study explored whether the guided process of building a site helped them develop proficiency in creativity, teamwork, evaluation and learning appropriate to the 21st century. The research tool was a questionnaire constructed by the researchers and distributed online to the students. Answers were collected from 50-course participants. Analysis of the participants’ responses showed that, along with the significant experience and benefits that students gained from building a website for kindergarten, ambivalence was shown toward the use of new, unfamiliar and complex technology. This attitude was characterized by unease and initial emotional distress triggered by the departure from routine training to an island of uncertainty. A gradual change took place toward the adoption of innovation with the help of empathy, training, and guidance from the instructors, leading to the students’ success in carrying out the task. Initial success led to further successes, resulting in a quality product and a feeling of personal competency among the students. A clear and extreme emotional shift was observed on the spectrum from a sense of difficulty and dissatisfaction to feelings of satisfaction, joy, competency and cognitive understanding of the importance of facing a challenge and succeeding. The findings of this study can contribute to increased understanding of the complex training process of future kindergarten teachers, coping with a changing world, and pedagogy that is supported by technology.

Keywords: early childhood teachers, educating for the future, emotions, kindergarten website

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Authors: Vanessa Casadella, Mourad Chouki, Agnès Ceccarelli, Sofiane Tahi

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Mentoring is positioned in an interpersonal and intergenerational perspective, serving the transmission of interpersonal skills and organizational culture. It echoes orientation, project, self-actualization, guidance, transmission, and filiation. It is available using a formal or informal approach. The formal dimension refers to a privileged relationship between a senior and a junior. Informal mentoring is unplanned and emerges naturally between two people who choose each other. However, it remains more difficult to understand. To study the link between formal and informal mentoring and to define the notion of “social” mentoring, we conducted a qualitative study of an exploratory nature with around ten SSE organizations located in the southeast region of Tunisia. The wealth of this territory has pushed residents to found SSE organizations with a view to creating jobs but also to preserving traditions and preserving nature. These organizations developed spontaneously to solve various local problems, such as the revitalization of deserted rural areas, environmental degradation, and the reskilling and professional reintegration of people marginalized in the labor market. This research, based on semi-structured interviews in order to obtain exhaustive and sensitive data, involves an interview guide with few questions mobilized to let the respondents, leaders of the different structures, express themselves freely. The guide includes questions on activities, methods of sharing knowledge, and difficulties in understanding between stakeholders. The interviews, lasting 30 to 60 minutes, were recorded using a dictaphone and then transcribed in full. The results are as follows: 1. We see two iterative mentoring loops. A first loop can be considered a type of formal mentoring. It highlights the support organized (in the form of training) by social enterprises with the aim of developing the autonomy, know-how, and interpersonal skills of members. A second loop concerns informal mentoring. This is non-formalized support provided by members or with other members of the entourage. This informal mentoring is mainly based on the observation of good practices and learning by doing. 2. We notice an intersection between the two loops. If the first loop is not done, the second will not take place. The knowledge acquired in the first loop is used to feed the second. 3. We note a form of reluctance on the part of some members to share their knowledge for reasons of competition. Ultimately, we retain the notion of “social” mentoring as a hybridization of formal and informal mentoring while dimensioning the “social” perspective by emphasizing the reciprocal character, solidarity, confidence, and trust between the mentor and the mentee.

Keywords: social innovation, social mentoring, social and solidarity economy, informal mentoring

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Authors: Naomi Sakamoto, Eisuke Fukuma, Mika Nashimoto, Yoshitomo Koshida

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Background: Selective localization of the metastatic lymph node with clip and removal of clipped nodes with sentinel lymph node (SLN), known as targeted axillary dissection (TAD), reduced false-negative rates (FNR) of SLN biopsy (SLNB) after neoadjuvant chemotherapy (NAC). For the patients who achieved nodal pathologic complete response (pCR), accurate staging of axilla by TAD lead to omit axillary lymph node dissection (ALND), decreasing postoperative arm morbidity without a negative effect on overall survival. This study aimed to investigate the ultrasound (US) identification rate and success removal rate of two kinds of ultrasound-visible clips placed in metastatic lymph nodes during TAD procedure. Methods: This prospective study was conducted using patients with clinically T1-3, N1, 2, M0 breast cancer undergoing NAC followed by surgery. A US-visible clip was placed in the suspicious lymph node under US guidance before neoadjuvant chemotherapy. Before surgery, US examination was performed to evaluate the detection rate of clipped node. During the surgery, the clipped node was removed using several localization techniques, including hook-wire localization, dye-injection, or fluorescence technique, followed by a dual-technique SLNB and resection of palpable nodes if present. For the fluorescence technique, after injection of 0.1-0.2 mL of indocyanine green dye (ICG) into the clipped node, ICG fluorescent imaging was performed using the Photodynamic Eye infrared camera (Hamamatsu Photonics k. k., Shizuoka, Japan). For the dye injection method, 0.1-0.2 mL of pyoktanin blue dye was injected into the clipped node. Results: A total of 29 patients were enrolled. Hydromark™ breast biopsy site markers (Hydromark, T3 shape; Devicor Medical Japan, Tokyo, Japan) was used in 15patients, whereas a UltraCor™ Twirl™ breast marker (Twirl; C.R. Bard, Inc, NJ, USA) was placed in 14 patients. US identified the clipped node marked with the UltraCore Twirl in 100% (14/14) and with the Hydromark in 93.3% (14/15, p = ns). Success removal of clipped node marked with the UltraCore Twirl was achieved in 100% (14/14), whereas the node marked with the Hydromark was removed in 80% (12/15) (p = ns). Conclusions: The ultrasound identification rate differed between the two types of ultrasound-visible clips, which also affected the success removal rate of clipped nodes. Labelling the positive node with a US-highly-visible clip allowed successful TAD.

Keywords: breast cancer, neoadjuvant chemotherapy, targeted axillary dissection, breast tissue marker, clip

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Authors: Teresa Sarmento de Beires, Sofia Padilha, Pedro Arantes, Joana Ribeiro, Andreia Eiras

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Background: Trichotillomania is a psychiatric condition that is very challenging to treat, with no first-line medications approved by any medical agency. It is defined as a recurrent compulsive habit of pulling out one's own hair, usually from the scalp and eyebrows area, but it can also affect eyelashes or any other hair-bearing area. N-acetylcysteine, a glutamate modulator, has been studied as a possible treatment for several psychiatric and neurological disorders, considering its role in attenuating pathophysiological processes responsible for compulsive behaviors and, therefore, trichotillomania. Objective: This study aims to determine the efficacy of N-acetylcysteine in the treatment of adults with trichotillomania. Methodology: The authors researched guidelines, standards of clinical guidance, systematic reviews, meta-analyses, and randomized clinical trials, published in the last 20 years using the MeSH terms: "Trichotillomania” and “N-acetylcysteine” in the following databases: PubMed, Cochrane library, National Guideline Clearing House, National Institute of Health and Care Excellence (NICE), Canadian Medical Association Practice Guidelines and Database of Abstracts of Reviews of Effectiveness (DARE). The Strength of Recommendation Taxonomy (SORT) Scale, from the American Family Physician, was used to evaluate the level of evidence and assign the strength of recommendation. Results: The research found fifteen articles, among which only three were eligible according to the inclusion criteria: 1. systematic review and 2. meta-analyses. There was evidence of a probable beneficial effect of N-acetylcysteine on treatment response and reduction of trichotillomania symptom severity in adults, with moderate certainty in the effect estimate. There was no evidence of effectiveness with the use of inositol, antioxidants, naltrexone, or selective serotonin reuptake inhibitors (SSRIs) in the treatment of adults with trichotillomania. Clomipramine and Olanzapine showed potential treatment benefits, with low certainty. N-acetylcysteine had the least severe side effect profile in adults compared with the other potentially beneficial pharmacological treatments. Conclusion: Evidence points towards the effectiveness of N-acetylcysteine in the treatment of adults with trichotillomania, which exhibits a good tolerability profile with minimal adverse effects. Therefore, the authors attribute a level of evidence 2, the strength of recommendation B, to the prescription of N-acetylcysteine in the treatment of adults suffering from trichotillomania (SORT analysis). Further investigation is needed in order to extract high-quality conclusions from the meta-analysis.

Keywords: trichotillomania, hair pulling, treatment, n-acetylcysteine

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Authors: R. Tariq, R. Lee

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Background: Additional demands placed on senior clinical teams with ongoing COVID-19 management has accelerated the need to harness the wider healthcare professional resources and upskill them to take on greater clinical responsibility safely. The UK NHS Long Term Plan (2019)¹ emphasises the importance of expanding Advanced Practitioners’ (APs) roles to take on more clinical diagnostic responsibilities to cope with increased demand. In acute settings, APs are often the first point of care for patients and require training to take on initial triage responsibilities efficiently and safely. Critically, their roles include determining which onward services the patients may require, and assessing whether they can be treated at home, avoiding unnecessary admissions to the hospital. Dem Dx is a Clinical Reasoning Platform (CRP) that claims to help frontline healthcare professionals independently assess and triage patients. It guides the clinician from presenting complaints through associated symptoms to a running list of differential diagnoses, media, national and institutional guidelines. The objective of this study was to compare the clinical referral rates and guidelines adherence registered by the HMR Urgent Community Care Team (UCCT)² and Dem Dx recommendations using retrospective cases. Methodology: 192 cases seen by the UCCT were anonymised and reassessed using Dem Dx clinical pathways. We compared the UCCT’s performance with Dem Dx regarding the appropriateness of onward referrals. We also compared the clinical assessment regarding adherence to NICE guidelines recorded on the clinical notes and the presence of suitable guidance in each case. The cases were audited by two medical doctors. Results: Dem Dx demonstrated appropriate referrals in 85% of cases, compared to 47% in the UCCT team (p<0.001). Of particular note, Dem Dx demonstrated an almost 65% (p<0.001) improvement in the efficacy and appropriateness of referrals in a highly experienced clinical team. The effectiveness of Dem Dx is in part attributable to the relevant NICE and local guidelines found within the platform's pathways and was found to be suitable in 86% of cases. Conclusion: This study highlights the potential of clinical decision support, as Dem Dx, to improve the quality of onward clinical referrals delivered by a multidisciplinary team in primary care. It demonstrated that it could support healthcare professionals in making appropriate referrals, especially those that may be overlooked by providing suitable clinical guidelines directly embedded into cases and clear referral pathways. Further evaluation in the clinical setting has been planned to confirm those assumptions in a prospective study.

Keywords: advanced practitioner, clinical reasoning, clinical decision-making, management, multidisciplinary team, referrals, triage

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Authors: Carlu Van Der Westhuizen

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The South African Agricultural Sector is of major socio-economic importance to the country due to its contribution in maintaining stability in food production and food security, providing labour opportunities, eradicating poverty and earning foreign currency. Against this reality, this paper investigates within the Agricultural Sector in South Africa the changes in Land Policies that the new democratically elected government (African National Congress) brought about since their takeover in 1994. The change in the agricultural environment is decidedly dualistic, with 1) a commercial sector, and 2) a subsistence and emerging farmer sector. The future demands and challenges are mostly identified as those of land redistribution and social upliftment. Opportunities that arose from the challenge of change are, among others, the small-holder participation in the value chain, while the challenge of change in Agriculture and the opportunities that were identified could serve as a yardstick against which the Sectors’ (Agriculture) Performance could be measured in future. Unfortunately, despite all Governments’ Policies, Programmes and Projects and inputs of the Private Sector, the outcomes are, to a large extend, unsuccessful. The urgency with the Land Redistribution Programme is that, for the period 1994 – 2014, only 7.5% of the 30% aim in the redistribution of land was achieved. Another serious aspect of concern is that 90% of the Land Redistribution Projects are not in a state of productive use by emerging farmers. Several reasons may be offered for these failures, amongst others the uncoordinated way in which different stakeholders are involved in a specific farming project. These stakeholders could generally in most cases be identified as: - The Government as the policy maker; - The Private Sector that has the potential to contribute to the sustainable pre- and post-settlement stages of the Programme by cooperating the supporting services to Government; - Inputs from the communities in rural areas where the settlement takes place; - The landowners as sellers of land (e.g. a Traditional Council); and - The emerging beneficiaries as the receivers of land. Mentorship is mostly the medium with which the support are coordinated. In this paper focus will be on three scenarios of different types of mentorship (or management support) namely: - The Taung Irrigation Scheme (TIS) where multiple new land beneficiaries were established by sharing irrigation pivots and receiving mentorship support from commodity organisations within a traditional land sharing system; - Projects whereby the mentor is a strategic partner (mostly a major agricultural 'cooperative' which is also providing inputs to the farmer and responsible for purchasing/marketing all commodities produced); and - An individual mentor who is a private person focussing mainly on farm management mentorship without direct gain other than a monthly stipend paid to the mentor by Government. Against this introduction the focus of the study is investigating the process for the sustainable implementation of Governments’ Land Redistribution in South African Agriculture. To achieve this, the research paper is presented under the themes of problem statement, objectives, methodology and limitations, outline of the research process, as well as proposing possible solutions.

Keywords: land reform, role-players, failures, mentorship, management models

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Authors: Olusegun F. Adebowale

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Research has confirmed that the emergence of information technology is significantly reflected in the field of psychology and its related disciplines due to its widespread use at reasonable price and its user-friendliness. It is consequently affecting ordinary life in many areas like shopping, advertising, corresponding and educating. Specifically the innovations of computer technology led to several new forms of communication, all with implications and applicability for counselling and psychotherapy practices. This is premise on which online counselling is based. Most institutions of higher learning in Nigeria have established their presence on the Internet and have deployed a variety of applications through ICT. Some are currently attempting to include counselling services in such applications with the belief that many counselling needs of students are likely to be met. This study therefore explored different challenges and preferences students present in online counselling interaction in a given Nigerian university with the view to guide new universities that may want to invest into these areas as to necessary preparations and referral requirements. The study is a mixed method research incorporating qualitative and quantitative methodologies to sample the preferences and concerns students express in online interaction. The sample comprised all the 876 students who visited the university online counselling platform either voluntarily, by invitation or by referral. The instrument for data collection was the online counselling platform of the university 'OAU Online counsellors'. The period of data collection spanned between January 2011 and October 2012. Data were analysed quantitatively (using percentages and Mann-Whitney U test) and qualitatively (using Interpretative Phenomenological Analysis (IPA)). The results showed that the students seem to prefer real-time chatting as their online medium of communicating with the online counsellor. The majority of students resorted to e-mail when their effort to use real-time chatting were becoming thwarted. Also, students preferred to enter into online counselling relationships voluntarily to other modes of entry. The results further showed that the prevalent counselling needs presented by students during online counselling sessions were mainly in the areas of social interaction and academic/educational concerns. Academic concerns were found to be prevalent, in form of course offerings, studentship matters and academic finance matters. The personal/social concerns were in form of students’ welfare, career related concerns and relationship matters. The study concludes students’ preferences include voluntary entry into online counselling, communication by real-time chatting and a specific focus on their academic concerns. It also recommends that all efforts should be made to encourage students’ voluntary entry into online counselling through reliable and stable internet infrastructure that will be able to support real-time chatting.

Keywords: online, counselling, needs, preferences

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Authors: Phillipa Denise Peart

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Black Asian and Minority Ethnic (BAME) people are more at risk of developing mental health disorders because they are more exposed to unfavorable social, economic, and environmental circumstances. These include housing, education, employment, community development, stigma, and discrimination. However, the majority of BAME mental health intervention studies focus on treatment with therapeutically effective drugs and use basic economic methods to evaluate their effectiveness; as a result, little is invested in the economic assessment of psychosocial interventions in BAME mental health. The UK government’s austerity programme and reduced funds for mental health services, has increased the need for the evaluation and assessment of initiatives to focus on value for money. The No Health without Mental Health policy (2011) provides practice guidance to practitioners, but there is little or no mention of the need to provide mental health initiatives targeted at BAME communities that are effective in terms of their impact and the cost-effectiveness. This, therefore, appears to contradict with and is at odds with the wider political discourse, which suggests there should be an increasing focus on health economic evaluation. As a consequence, it could be argued that whilst such policies provide direction to organisations to provide mental health services to the BAME community, by not requesting effective governance, assurance, and evaluation processes, they are merely paying lip service to address these problems and not helping advance knowledge and practice through evidence-based approaches. As a result, BAME communities suffer due to lack of efficient resources that can aid in the recovery process. This research study explores the mental health initiatives targeted at BAME communities, and analyses the techniques used when examining the cost effectiveness of mental health initiatives for BAME mental health communities. Using critical discourse analysis as an approach and method, mental health services will be selected as case studies, and their evaluations will be examined, alongside the political drivers that frame, shape, and direct their work. In doing so, it will analyse what the mental health policies initiatives are, how the initiatives are directed and demonstrate how economic models of evaluation are used in mental health programmes and how the value for money impacts and outcomes are articulated by mental health programme staff. It is anticipated that this study will further our understanding in order to provide adequate mental health resources and will deliver creative, supportive research to ensure evaluation is effective for the government to provide and maintain high quality and efficient mental health initiatives targeted at BAME communities.

Keywords: black, Asian and ethnic minority, economic models, mental health, health policy

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Authors: Rebecca Keyte, Helen Egan, Michail Mantzios

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It is well acknowledged that ongoing adherence is a major concern within CF. However recently literature has indicated that non-adherence should not be viewed just in terms of medical regimens. There are other damaging behaviours that some chronically ill patients engage in which can be viewed as a form of non-adherence, such as risky behaviours. Risky behaviours are a major concern within CF, as they can have adverse health effects on patients regardless of patients adherence to medical regimens. The risky behaviours this research is predominantly focusing on are smoking, excessive alcohol consumption, illicit drug use and risky sexual behaviour. This research investigates patient’s beliefs about their CF and the impact their CF has upon their life, exploring rationales for why some patients engage in risky behaviours. This research utilises qualitative semi-structured interviews taking an interpretive perspective. Twenty-four adult participants have been recruited (16 male, age range 19–66 yrs) from two UK regional CF centres, with a median FEV1 61.77% predicted. Participants were recruited via clinician guidance, with 13 participants identified by clinicians as partaking in risky behaviours. However, during the interviews 17 participants were identified as partaking in risky behaviours, illustrating that not all patients offer full disclosure of engagement in such behaviours to their clinicians. Preliminary findings illustrate a variety of reasons as to why some CF patients engage in risky behaviours, with many participants stating that one challenge in terms of living with CF is accepting their illness. Disclosure of illness was also an issue, the desire to be seen as ‘normal’ was important to many. It is often possible for CF patients to hide their illness as they do not always appear to be unwell. However, literature indicates a desire for normalcy can be accompanied with the engagement of normalised risky behaviours, enabling patients to retaliate against their illness identity. There was also evidence of a life-orientated perspective amongst participants, with some reporting that their desire for fun and enjoyment was the reason for why they were engaging in risky behaviours. Some participants did not acknowledge the impact their risky behaviours could have upon their CF, and others rationalised their continuation with the behaviours by suggesting that they were in fact beneficial to their health. There was an apparent lack of knowledge around the implications of risky behaviours, with participants indicating that they had not been informed of such potential consequences by their clinicians. Given the adverse health effects of risky behaviours within CF, more effective health promotion measures are needed to both reduce and more importantly prevent these behaviours. Due to the initiation of risky behaviours within the CF population commonly occurring during adolescence, the researcher now proposes to conduct semi-structured interviews with paediatric patients to investigate their awareness and beliefs towards risky behaviours. Overall, this research will highlight reasons why some CF patients engage in risky behaviours, in order to inform interventions aimed to prevent the initiation in risky behaviours by increasing patient awareness.

Keywords: cystic fibrosis, health beliefs, preliminary findings, risky health behaviours

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Authors: Kitty Kioskli, Theofanis Fotis, Nineta Polemi

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The European Union (EU) directive Artificial Intelligence (AI) Act in Article 9 requires that risk management of AI systems includes both technical and human oversight, while according to NIST_AI_RFM (Appendix C) and ENISA AI Framework recommendations, claim that further research is needed to understand the current limitations of social threats and human-AI interaction. AI threats within social contexts significantly affect the security and trustworthiness of the AI systems; they are interrelated and trigger technical threats as well. For example, lack of explainability (e.g. the complexity of models can be challenging for stakeholders to grasp) leads to misunderstandings, biases, and erroneous decisions. Which in turn impact the privacy, security, accountability of the AI systems. Based on the NIST four fundamental criteria for explainability it can also classify the explainability threats into four (4) sub-categories: a) Lack of supporting evidence: AI systems must provide supporting evidence or reasons for all their outputs. b) Lack of Understandability: Explanations offered by systems should be comprehensible to individual users. c) Lack of Accuracy: The provided explanation should accurately represent the system's process of generating outputs. d) Out of scope: The system should only function within its designated conditions or when it possesses sufficient confidence in its outputs. Biases may also stem from historical data reflecting undesired behaviors. When present in the data, biases can permeate the models trained on them, thereby influencing the security and trustworthiness of the of AI systems. Social related AI threats are recognized by various initiatives (e.g., EU Ethics Guidelines for Trustworthy AI), standards (e.g. ISO/IEC TR 24368:2022 on AI ethical concerns, ISO/IEC AWI 42105 on guidance for human oversight of AI systems) and EU legislation (e.g. the General Data Protection Regulation 2016/679, the NIS 2 Directive 2022/2555, the Directive on the Resilience of Critical Entities 2022/2557, the EU AI Act, the Cyber Resilience Act). Measuring social threats, estimating the risks to AI systems associated to these threats and mitigating them is a research challenge. In this paper it will present the efforts of two European Commission Projects (FAITH and THEMIS) from the HorizonEurope programme that analyse the social threats by building cyber-social exercises in order to study human behaviour, traits, cognitive ability, personality, attitudes, interests, and other socio-technical profile characteristics. The research in these projects also include the development of measurements and scales (psychometrics) for human-related vulnerabilities that can be used in estimating more realistically the vulnerability severity, enhancing the CVSS4.0 measurement.

Keywords: social threats, artificial Intelligence, mitigation, social experiment

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Authors: Ali Zaker, Zhi Chen

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Due to the concerns about the depletion of fossil fuel sources and the deteriorating environment, the attempt to investigate the production of renewable energy will play a crucial role as a potential to alleviate the dependency on mineral fuels. One particular area of interest is the generation of bio-oil through sewage sludge (SS) pyrolysis. SS can be a potential candidate in contrast to other types of biomasses due to its availability and low cost. However, the presence of high molecular weight hydrocarbons and oxygenated compounds in the SS bio-oil hinders some of its fuel applications. In this context, catalytic pyrolysis is another attainable route to upgrade bio-oil quality. Among different catalysts (i.e., zeolites) studied for SS pyrolysis, activated chars (AC) are eco-friendly alternatives. The beneficial features of AC derived from SS comprise the comparatively large surface area, porosity, enriched surface functional groups, and presence of a high amount of metal species that can improve the catalytic activity. Hence, a sludge-based AC catalyst was fabricated in a single-step pyrolysis reaction with NaOH as the activation agent and was compared with HZSM5 zeolite in this study. The thermal decomposition and kinetics were invested via thermogravimetric analysis (TGA) for guidance and control of pyrolysis and catalytic pyrolysis and the design of the pyrolysis setup. The results indicated that the pyrolysis and catalytic pyrolysis contains four obvious stages, and the main decomposition reaction occurred in the range of 200-600°C. The Coats-Redfern method was applied in the 2nd and 3rd devolatilization stages to estimate the reaction order and activation energy (E) from the mass loss data. The average activation energy (Em) values for the reaction orders n = 1, 2, and 3 were in the range of 6.67-20.37 kJ for SS; 1.51-6.87 kJ for HZSM5; and 2.29-9.17 kJ for AC, respectively. According to the results, AC and HZSM5 both were able to improve the reaction rate of SS pyrolysis by abridging the Em value. Moreover, to generate and examine the effect of the catalysts on the quality of bio-oil, a fixed-bed pyrolysis system was designed and implemented. The composition analysis of the produced bio-oil was carried out via gas chromatography/mass spectrometry (GC/MS). The selected SS to catalyst ratios were 1:1, 2:1, and 4:1. The optimum ratio in terms of cracking the long-chain hydrocarbons and removing oxygen-containing compounds was 1:1 for both catalysts. The upgraded bio-oils with AC and HZSM5 were in the total range of C4-C17, with around 72% in the range of C4-C9. The bio-oil from pyrolysis of SS contained 49.27% oxygenated compounds, while with the presence of AC and HZSM5 dropped to 13.02% and 7.3%, respectively. Meanwhile, the generation of benzene, toluene, and xylene (BTX) compounds was significantly improved in the catalytic process. Furthermore, the fabricated AC catalyst was characterized by BET, SEM-EDX, FT-IR, and TGA techniques. Overall, this research demonstrated AC is an efficient catalyst in the pyrolysis of SS and can be used as a cost-competitive catalyst in contrast to HZSM5.

Keywords: catalytic pyrolysis, sewage sludge, activated char, HZSM5, bio-oil

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Authors: Christelle E. Chua, Alicia L. Ho

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The development of a panel of differential gene expression signatures has been of interest in the field of biomarker discovery for radiation exposure. In the absence of the availability of exposed human subjects, lymphocyte cell lines have often been used as a surrogate to human whole blood, when performing ex vivo irradiation studies. The extent of variation between different lymphocyte cell lines is currently unclear, especially with regard to the expression of extracellular miRNA. This study compares the expression profile of extracellular miRNA isolated from different lymphocyte cell lines. It also compares the profile of miRNA obtained when different exosome isolation kits are used. Lymphocyte cell lines were created using lymphocytes isolated from healthy adult males of similar racial descent (Chinese American and Chinese Singaporean) and immortalised with Epstein-Barr virus. The cell lines were cultured in exosome-free cell culture media for 72h and the cell culture supernatant was removed for exosome isolation. Two exosome isolation kits were used. Total exosome isolation reagent (TEIR, ThermoFisher) is a polyethylene glycol (PEG)-based exosome precipitation kit, while ExoSpin (ES, Cell Guidance Systems) is a PEG-based exosome precipitation kit that includes an additional size exclusion chromatography step. miRNA from the isolated exosomes were isolated using miRNEASY minikit (Qiagen) and analysed using nCounter miRNA assay (Nanostring). Principal component analysis (PCA) results suggested that the overall extracellular miRNA expression profile differed between the lymphocyte cell line originating from the Chinese American donor and the cell line originating from the Chinese Singaporean donor. As the gender, age and racial origins of both donors are similar, this may suggest that there are other genetic or epigenetic differences that account for the variation in extracellular miRNA gene expression in lymphocyte cell lines. However, statistical analysis showed that only 3 miRNA genes had a fold difference > 2 at p < 0.05, suggesting that the differences may not be of that great a significance as to impact overall conclusions drawn from different cell lines. Subsequent analysis using cell lines from other donors will give further insight into the reproducibility of results when difference cell lines are used. PCA results also suggested that the method of exosome isolation impacted the expression profile. 107 miRNA had a fold difference > 2 at p < 0.05. This suggests that the inclusion of an additional size exclusion chromatography step altered the subset of the extracellular vesicles that were isolated. In conclusion, these results suggest that extracellular miRNA can be isolated and analysed from exosomes derived from lymphocyte cell lines. However, care must be taken in the choice of cell line and method of exosome isolation used.

Keywords: biomarker, extracellular miRNA, isolation methods, lymphocyte cell line

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Authors: Varsha Tol, Laila Garda, Neelam Bhardwaj, Malata Usar

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In India, differently- abled girls suffer from a “dual stigma” of being female and physically challenged. The general consensus is that they are incapable of standing on their own two feet. It was observed that these girls do not have access to educational programs as most hostels do not keep them after the tenth grade. They are forced to return to a life of poverty and are often considered a liability by their families. Higher education is completely ignored. Parents focus on finding a husband and passing on their ‘burden’ to someone else. An innovative, intervention for differently-abled adolescent girls with the express purpose of mainstreaming them into society was started by Helplife. The objective was to enrich the lives of these differently abled adolescent girls through precise research, focused intervention and professionalism. This programme addresses physical, mental and social rehabilitation of the girls who come from impoverished backgrounds. These adolescents are reached by word of mouth, snowball technique and through the network of the NGO. Applications are invited from potential candidates which are scrutinized by a panel of experts. Selection criteria include her disability, socio-economic status, and desire and drive to make a difference in her own life. The six main areas of intervention are accommodation, education, health, professional courses, counseling and recreational activities. Each girl on an average resides in Helplife for a period of 2-3 years. Analysis of qualitative data collected at various time points indicates holistic development of character. A quality of life questionnaire showed a significant improvement in scores at three different time points in 75% of the current population under intervention i.e. 19 girls. Till date, 25 girls have successfully passed out from the intervention program completing their graduation/post-graduation. Currently, we have 19 differently abled girls housed in three flats in Pune district of Maharashtra. Out of which 14 girls are pursuing their graduation or post-graduation. Six of the girls are working in jobs in various sectors. In conclusion it may be noted with adequate support and guidance the sky is the limit. This journey of 12 years has been a learning for us with ups and downs modifying the intervention at every step. Helplife has a belief of impacting positively, individual lives of differently abled girls in order to empower them in a holistic manner. The intervention has a positive impact on differently abled girls. They serve as role models to other differently abled girls indicating that this is a road map to success by getting empowered to live with full potential and get integrated in the society in a dignified way.

Keywords: differently-abled, dual-stigma, empowerment, youth

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Authors: Luay Jum'a

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Many challenges are facing third-party logistics (3PL) providers in the domestic and global markets which create a volatile decision making environment. All these challenges such as managing changes in consumer behaviour, demanding expectations from customers and time compressions have turned into complex problems for 3PL providers. Since the movement towards increased outsourcing outpaces movement towards insourcing, the need to achieve a competitive advantage over competitors in 3PL market increases. This trend continues to grow over the years and as a result, areas of strengths and improvements are highlighted through the analysis of the LSQ factors that lead to B2B customers’ satisfaction which become a priority for 3PL companies. Consequently, 3PL companies are increasingly focusing on the most important issues from the perspective of their customers and relying more on this value of information in making their managerial decisions. Therefore, this study is concerned with providing guidance for improving logistics service quality (LSQ) levels in the context of 3PL industry in Jordan. The study focused on the most important factors in LSQ and used a managerial tool that guides 3PL companies in making LSQ improvements based on a quadrant analysis of two main dimensions: LSQ declared importance and LSQ inferred importance. Although, a considerable amount of research has been conducted to investigate the relationship between logistics service quality (LSQ) and customer satisfaction, there remains a lack of developing managerial tools to aid in the process of LSQ improvement decision-making. Moreover, the main advantage for the companies to use 3PL service providers as a trend is due to the realised percentage of cost reduction on the total cost of logistics operations and the incremental improvement in customer service. In this regard, having a managerial tool that help 3PL service providers in managing the LSQ factors portfolio effectively and efficiently would be a great investment for service providers. One way of suggesting LSQ improvement actions for 3PL service providers is via the adoption of analysis tools that perform attribute categorisation such as Importance–Performance matrix. In mind of the above, it can be stated that the use of quadrant analysis will provide a valuable opportunity for 3PL service providers to identify improvement opportunities as customer service attributes or factors importance are identified in two different techniques that complete each other. Moreover, the data were collected through conducting a survey and 293 questionnaires were returned from business-to-business (B2B) customers of 3PL companies in Jordan. The results showed that the LSQ factors vary in their importance and 3PL companies should focus on some LSQ factors more than other factors. Moreover, ordering procedures, timeliness/responsiveness LSQ factors considered being crucial in 3PL businesses and therefore they need to have more focus and development by 3PL service providers in the Jordanian market.

Keywords: logistics service quality, managerial decisions, quadrant analysis, third party logistics service provider

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Authors: Jason Gica, Yi-Hsieng Samuel Wu, Deng-Jye Yang, Yi-Chen Chen

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Mycotoxins, harmful secondary metabolites produced by certain fungi species, pose significant risks to animals and humans worldwide. Their stable properties lead to contamination during grain harvesting, transportation, and storage, as well as in processed food products. The prevalence of mycotoxin contamination has attracted significant attention due to its adverse impact on food safety and global trade. The secondary contamination pathway from animal products has been identified as an important route of exposure, posing health risks for livestock and humans consuming contaminated products. Pork, one of the highly consumed meat products in Taiwan according to the National Food Consumption Database, plays a critical role in the nation's diet and economy. Given its substantial consumption, pork processing products are a significant component of the food supply chain and a potential source of mycotoxin contamination. This study is paramount for formulating effective regulations and strategies to mitigate mycotoxin-related risks in the food supply chain. By establishing a reliable analytical method, this research contributes to safeguarding public health and enhancing the quality of pork processing products. The findings will serve as valuable guidance for policymakers, food industries, and consumers to ensure a safer food supply chain in the face of emerging mycotoxin challenges. An innovative and efficient analytical approach is proposed using Ultra-High Performance Liquid Chromatography coupled with Temperature Control Fluorescence Detector Light (UHPLC-TCFLD) to determine multiple mycotoxins in pork meat samples due to its exceptional capacity to detect multiple mycotoxins at the lowest levels of concentration, making it highly sensitive and reliable for comprehensive mycotoxin analysis. Additionally, its ability to simultaneously detect multiple mycotoxins in a single run significantly reduces the time and resources required for analysis, making it a cost-effective solution for monitoring mycotoxin contamination in pork processing products. The research aims to optimize the efficient mycotoxin QuEChERs extraction method and rigorously validate its accuracy and precision. The results will provide crucial insights into mycotoxin levels in pork processing products.

Keywords: multiple-mycotoxin analysis, pork processing products, QuEChERs, UHPLC-TCFLD, validation

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Authors: Tracy L. F. Worley

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This presentation explores the environment that has limited leadership opportunities for Black women in cinema and advocates for autonomy among Black women filmmakers that is facilitated by strong internal and external networks and cooperative opportunities. Early images of African Americans in motion pictures were often conceptualized from the viewpoint of a White male director and depicted by White actors. The black film evolved in opposition to this context, leading to a Black film aesthetic. The oppositional context created in response to racist, misogynistic, and sexist representations in motion pictures sets the tone for female filmmakers of every hue – but especially for African American women. For them, the context of a male gaze, and for all intents and purposes, a White male gaze, forces them to create their own aesthetic. Theoretically, men and women, filmmakers and spectators have different perspectives across race, ethnicity, and gender. Two feminist theorists, bell hooks and Mary Ann Doane, suggest that female filmmakers are perceived as disparate from male filmmakers and that women, in general, are defined by what men see. Mary Ann Doane, a White feminist film theorist, has focused extensively on female spectatorship and women (White) in general as the object of the male gaze. Her discussion of the female body, male perception of it, and feminism in the motion picture industry support the suggestion that comprehending the organization and composition of Hollywood is critical to understanding women’s roles in the industry. Although much of her research addresses the silent film era and women’s roles then, Doane suggests that across cinematic periods, the theory assigned to “cinematic apparatus” is formulated within a context of sexuality. Men and women are viewed and treated differently in cinema (in front of and behind the camera), with women’s attractiveness and allure photographed specifically for the benefit of the “spectatorial desire” of the male gaze. Bell Hooks, an African American feminist writer and theorist with more than 30 published books and articles on race, gender, class, and culture in feminism and education, suggests that women can overcome the male gaze by using their “oppositional gaze” to transform reality and establish their own truth. She addresses gender within the context of race by acknowledging the realities faced by African American women and the fact that the feminist movement was never intended to include Black women. A grounded theory study led to the development of a leadership theory that explains why African American women are disproportionately represented in a mainstream motion picture leadership. The study helped to reveal the barriers to entry and illuminated potential strategies that African American female motion picture directors might pursue to reduce this inequity. Using semi-structured interviews as the primary means for data collection, the lived experiences of African American female directors and organizational leadership’s perceived role in the perpetuation of negative female imagery in major motion pictures led to the identification of support strategies for African American female motion picture directors that counter social stereotyping and validate the need for social networking in the mainstream.

Keywords: African American, cinema, directors, filmmaking, leadership, women

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Authors: P. T. Collett, M. Kershaw

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Introduction: The discussion regarding which method of anesthesia provides better results for lower limb arthroplasty is a continuing debate. Multiple meta-analysis has been performed with no clear consensus. The current recommendation is to use neuraxial anesthesia for lower limb arthroplasty; however, the evidence to support this decision is weak. The Enhanced Recovery After Surgery (ERAS) society has recommended, either technique can be used as part of a multimodal anesthetic regimen. A local study was performed to see if the current anesthetic practice correlates with the current recommendations and to evaluate the efficacy of the different techniques utilized. Method: 90 patients who underwent total hip or total knee replacements at Nevill Hall Hospital between February 2019 to July 2019 were reviewed. Data collected included the anesthetic technique, day one opiate use, pain score, and length of stay. The data was collected from anesthetic charts, and the pain team follows up forms. Analysis: The average of patients undergoing lower limb arthroplasty was 70. Of those 83% (n=75) received a spinal anaesthetic and 17% (n=15) received a general anaesthetic. For patients undergoing knee replacement under general anesthetic the average day, one pain score was 2.29 and 1.94 if a spinal anesthetic was performed. For hip replacements, the scores were 1.87 and 1.8, respectively. There was no statistical significance between these scores. Day 1 opiate usage was significantly higher in knee replacement patients who were given a general anesthetic (45.7mg IV morphine equivalent) vs. those who were operated on under spinal anesthetic (19.7mg). This difference was not noticeable in hip replacement patients. There was no significant difference in length of stay between the two anesthetic techniques. Discussion: There was no significant difference in the day one pain score between the patients who received a general or spinal anesthetic for either knee or hip replacements. The higher pain scores in the knee replacement group overall are consistent with this being a more painful procedure. This is a small patient population, which means any difference between the two groups is unlikely to be representative of a larger population. The pain scale has 4 points, which means it is difficult to identify a significant difference between pain scores. Conclusion: There is currently little standardization between the different anesthetic approaches utilized in Nevill Hall Hospital. This is likely due to the lack of adherence to a standardized anesthetic regimen. In accordance with ERAS recommends a standard anesthetic protocol is a core component. The results of this study and the guidance from the ERAS society will support the implementation of a new health board wide ERAS protocol.

Keywords: anaesthesia, orthopaedics, intensive care, patient centered decision making, treatment escalation

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Authors: Nynke de Jong, Inge G. P. Duimel-Peeters

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The flipped classroom as an instructional strategy and a type of blended learning that reverses the traditional learning environment by delivering instructional content, off- and online, in- and outside the classroom, has been implemented in a 4-weeks module focusing on ageing in Europe at the Maastricht University. The main aim regarding the organization of this module was implementing flipped classroom-principles in order to create meaningful learning opportunities, while educational technologies are used to deliver content outside of the classroom. Technologies used in this module were an online interactive real time lecture from England, two interactive face-to-face lectures with visual supports, one group session including role plays and team-based learning meetings. The cohort of 2015-2016, using educational technologies, was compared with the cohort of 2014-2015 on module evaluation such as organization and instructiveness of the module, who studied the same content, although conforming the problem-based educational strategy, i.e. educational base of the Maastricht University. The cohort of 2015-2016 with its specific organization, was also more profound evaluated on outcomes as (1) experienced duration of the lecture by students, (2) experienced content of the lecture, (3) experienced the extent of the interaction and (4) format of lecturing. It was important to know how students reflected on duration and content taken into account their background knowledge so far, in order to distinguish between sufficient enough regarding prior knowledge and therefore challenging or not fitting into the course. For the evaluation, a structured online questionnaire was used, whereby above mentioned topics were asked for to evaluate by scoring them on a 4-point Likert scale. At the end, there was room for narrative feedback so that interviewees could express more in detail, if they wanted, what they experienced as good or not regarding the content of the module and its organization parts. Eventually, the response rate of the evaluation was lower than expected (54%), however, due to written feedback and exam scores, we dare to state that it gives a good and reliable overview that encourages to work further on it. Probably, the response rate may be explained by the fact that resit students were included as well, and that there maybe is too much evaluation as some time points in the program. However, overall students were excited about the organization and content of the module, but the level of self-directed behavior, necessary for this kind of educational strategy, was too low. They need to be more trained in self-directness, therefore the module will be simplified in 2016-2017 with more clear and fewer topics and extra guidance (step by step procedure). More specific information regarding the used technologies will be explained at the congress, as well as the outcomes (min and max rankings, mean and standard deviation).

Keywords: blended learning, flipped classroom, public health, self-directness

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Authors: Hanee Ryu

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The supporting policies for renewable energy have been designed to deploy renewable energy technology targeting domestic market. The government encourages market creation through obligations such as FIT or RPS on an energy supplier. With these policy measures, the securing vast market needs to induce technology development. Furthermore, it is crucial that ensuring developing market can make the environment nurture the renewable energy industry. Overseas expansion to countries being in demand is essential under immature domestic market. Extending its business abroad can make the domestic company get the knowledge through learning-by-doing. Besides, operation in the countries to be rich in renewable resources such as weather conditions helps to develop proven track record required for verifying technologies. This paper figures out the factor to hamper the global market entry and build up the strategies to overcome difficulties. Survey conducted renewable energy company having overseas experiences at least once. Based on the survey we check the obstacle against exporting home goods and services. As a result, securing funds is salient fact to proceed to business. It is difficult that only private bank or investment agencies participate in the project under uncertainty which renewable energy development project bears inherently. These uncertainties need public fund such as ODA to encourage private sectors to start a business. Furthermore, international organizations such as IRENA or multilateral development banks as WBG play a role to guarantee the investment including risk insurance against uncertainty. It can also manage excavation business cooperating with developing countries and supplement inadequate government funding involved. With survey results strategies to obtain the order, the international organization places are categorized according to the type of getting a contract. This paper suggests 3 types approaching to the international organization project (going through international competitive bidding, using ODA and project financing) and specifies the role of government to support the domestic firms with running out of funds. Under renewable energy industry environment where hard to being created as a spontaneous market, government policy approach needs to motivate the actors to get into the business. It is one of the good strategies that countries with the low demand of renewable energies participate in the project international agencies order in the developing countries having abundant resources. This provides crucial guidance for the formulation of renewable energy development policy and planning with consideration of business opportunities and funding.

Keywords: exporting strategies, multilateral development banks, promoting in developing countries, renewable energy technologies

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Authors: Vaiddehi Bansal, Ridhi Sahai, Kareem Kysia

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Overseas labor migration is currently one of the most important contributors to the economy of Bangladesh and is a highly profitable form of labor for Gulf Cooperative Council (GCC) countries. In 2019, 700,159 migrant workers from Bangladeshtraveled abroad for employment. GCC countries are a major destination for Bangladeshi migrant workers, with Saudi Arabia being the most common destination for Bangladeshi migrant workers since 2016. Despite the high rate of migration between these countries every year, the OLR industry remains complex and often leaves migrants susceptible to human trafficking, forced labor, and modern slavery. While the prevalence of forced labor among Bangladeshi migrants in GCC countries is still unknown, the IOM estimates international migrant workers comprise one fourth of the victims of forced labor. Moreover, the onset of the global COVID-19 pandemic has exposed migrant workers to additional adverse situations, making them even more vulnerable to forced labor and health risks. This paper presents findings from a rapid assessment of the impacts of COVID-19 on OLR in Bangladesh, with an emphasis on the increased risk of forced labor among vulnerable migrant worker populations, particularly women.Rapid reviews are a useful approach to swiftly provide actionable evidence for informed decision-making during emergencies, such as the COVID-19 pandemic. The research team conducted semi-structured key information interviews (KIIs) with a range of stakeholders, including government officials, local NGOs, international organizations, migration researchers, and formal and informal recruiting agencies, to obtain insights on the multi-facted impacts of COVID-19 on the OLR sector. The research team also conducted a comprehensive review of available resources, including media articles, blogs, policy briefs, reports, white papers, and other online content, to triangulate findings from the KIIs. After screening for inclusion criteria, a total of 110 grey literature documents were included in the review. A total of 31 KIIs were conducted, data from which was transcribed and translated from Bangla to English, andanalyzed using a detailed codebook. Findings indicate that there was limited reintegration support for returnee migrants. Facing increasing amounts of debt, financial insecurity, and social discrimination, returnee migrants, were extremely vulnerable to forced labor and exploitation. Growing financial debt and limited job opportunities in their home country will likely push migrants to resort to unsafe migration channels. Evidence suggests that women, who are primarily domestic works in GCC countries, were exposed to increased risk of forced labor and workplace violence. Due to stay-at-home measures, women migrant workers were tasked with additional housekeeping working and subjected to longer work hours, wage withholding, and physical abuse. In Bangladesh, returnee women migrant workers also faced an increased risk of domestic violence.

Keywords: forced labor, migration, gender, human trafficking

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Authors: Nick Woodier, Iain Moppett

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Background: It is estimated that one in ten patients admitted to hospital will suffer an adverse event in their care. While the majority of these will result in low harm, patients are being significantly harmed by the processes meant to help them. Healthcare, therefore, seeks to make improvements in patient safety by taking learning from other industries that are perceived to be more mature in their management of safety events. Of particular interest to healthcare are ‘near misses,’ those events that almost happened but for an intervention. Healthcare does not have any guidance as to how best to manage and learn from near misses to reduce the chances of harm to patients. The authors, as part of a larger study of near-miss management in healthcare, sought to learn from the UK nuclear sector to develop principles for how healthcare can identify, report, and learn from near misses to improve patient safety. The nuclear sector was chosen as an exemplar due to its status as an ultra-safe industry. Methods: A Grounded Theory (GT) methodology, augmented by a scoping review, was used. Data collection included interviews, scenario discussion, field notes, and the literature. The review protocol is accessible online. The GT aimed to develop theories about how nuclear manages near misses with a focus on defining them and clarifying how best to support reporting and analysis to extract learning. Near misses related to radiation release or exposure were focused on. Results: Eightnuclear interviews contributed to the GT across nuclear power, decommissioning, weapons, and propulsion. The scoping review identified 83 articles across a range of safety-critical industries, with only six focused on nuclear. The GT identified that nuclear has a particular focus on precursors and low-level events, with regulation supporting their management. Exploration of definitions led to the recognition of the importance of several interventions in a sequence of events, but that do not solely rely on humans as these cannot be assumed to be robust barriers. Regarding reporting and analysis, no consistent methods were identified, but for learning, the role of operating experience learning groups was identified as an exemplar. The safety culture across nuclear, however, was heard to vary, which undermined reporting of near misses and other safety events. Some parts of the industry described that their focus on near misses is new and that despite potential risks existing, progress to mitigate hazards is slow. Conclusions: Healthcare often sees ‘nuclear,’ as well as other ultra-safe industries such as ‘aviation,’ as homogenous. However, the findings here suggest significant differences in safety culture and maturity across various parts of the nuclear sector. Healthcare can take learning from some aspects of management of near misses in nuclear, such as how they are defined and how learning is shared through operating experience networks. However, healthcare also needs to recognise that variability exists across industries, and comparably, it may be more mature in some areas of safety.

Keywords: culture, definitions, near miss, nuclear safety, patient safety

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Authors: Guan-Ying Chen, Han-Tsung Liou, Shou-Ren Hu

Abstract:

To address traffic congestion problems and encourage the use of public transportation systems in the Taipei metropolitan area, the Taipei City Government and the New Taipei City Government implemented a monthly ticket policy on April 16, 2018. This policy offers unlimited rides on the Taipei MRT, Taipei City Bus, New Taipei City Bus, Danhai Light Rail, and Public Bike (YouBike) on a monthly basis. Additionally, both city governments replaced the smart card discount policy with a new frequent flyer discount program (referred to as the loyal customer program) on February 1, 2020, introducing a differential pricing policy. Specifically, the more frequently the Taipei MRT system is used, the greater the discounts users receive. To analyze the impact of the Taipei public transport monthly ticket policy and the frequent user discount program on the passenger volume of the Taipei MRT system and the transferring behaviors of MRT users, this study conducts a trip-chain analysis using transaction data from Taipei MRT smart cards between September 2017 and December 2020. To achieve these objectives, the study employs four indicators: 1) number of passengers, 2) average number of rides, 3) average trip distance, and 4) instances of multiple consecutive rides. The study applies the t-test and Mann-Kendall trend test to investigate whether the proposed indicators have changed over time due to the implementation of the discount policy. Furthermore, the study examines the travel behaviors of passengers who use monthly tickets. The empirical results of the study indicate that the implementation of the Taipei public transport monthly ticket policy has led to an increase in the average number of passengers and a reduction in the average trip distance. Moreover, there has been a significant increase in instances of multiple consecutive rides, attributable to the unlimited rides offered by the monthly tickets. The impact of the frequent user discount program on changes in MRT passengers is not as pronounced as that of the Taipei public transportation monthly ticket policy. This is partly due to the fact that the frequent user discount program is only applicable to the Taipei MRT system, and the passenger volume was greatly affected by the COVID-19 pandemic. The findings of this research can serve as a reference for Taipei MRT Corporation in formulating its fare strategy and can also provide guidance for the Taipei and New Taipei City Governments in evaluating differential pricing policies for public transportation systems.

Keywords: frequent user discount program, mass rapid transit, monthly ticket, smart card

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Authors: David Tennison

Abstract:

In the wake of the Covid-19 pandemic, a new chronic illness emerged onto the global stage: Long Covid. Long Covid presents with several symptoms commonly seen in other poorly-understood illnesses, such as fibromyalgia (FM) and myalgic encephalomyelitis/ chronic fatigue syndrome (ME/CFS). However, while Long Covid has swiftly become a recognised illness, FM and ME/CFS are still seen as contested, which impacts patient care and healthcare experiences. This study aims to examine what the differences are between Long Covid and FM; and if the Long Covid case can provide guidance for how to address the healthcare challenge of contested illnesses. To address this question, this study performed comprehensive research into the history of FM; our current biomedical understanding of it; and available healthcare interventions (within the context of the UK NHS). Analysis was undertaken of the stigma and stereotypes around FM, and a comparison made between FM and the emerging Long Covid literature, along with the healthcare response to Long Covid. This study finds that healthcare for chronic contested illnesses in the UK is vastly insufficient - in terms of pharmaceutical and holistic interventions, and the provision of secondary care options. Interestingly, for Long Covid, many of the treatment suggestions are pulled directly from those used for contested illnesses. The key difference is in terms of funding and momentum – Long Covid has generated exponentially more interest and research in a short time than there has been in the last few decades of contested illness research. This stands to help people with FM and ME/CFS – for example, research has recently been funded into “brain fog”, a previously elusive and misunderstood symptom. FM is culturally regarded as a “women’s disease” and FM stigma stems from notions of “hysteria”. A key finding is that the idea of FM affecting women disproportionally is not reflected in modern population studies. Emerging data on Long Covid also suggests a slight leaning towards more female patients, however it is less feminised, potentially due to it emerging in the global historical moment of the pandemic. Another key difference is that FM is rated as an extremely low-prestige illness by healthcare professionals, while it was in large part due to the advocacy of affected healthcare professionals that Long Covid was so quickly recognised by science and medicine. In conclusion, Long Covid (and the risk of future pandemics and post-viral illnesses) highlight a crucial need for implementing new, and reinforcing existing, care networks for chronic illnesses. The difference in how contested illnesses like FM, and new ones like Long Covid are treated have a lot to do with the historical moment in which they emerge – but cultural stereotypes, from within and without medicine, need updating. Particularly as they contribute to disease stigma that causes genuine harm to patients. However, widespread understanding and acceptance of Long Covid could help fight contested illness stigma, and the attention, funding and research into Long Covid may actually help raise the profile of contested illnesses and uncover answers about their symptomatology.

Keywords: long COVID, fibromyalgia, myalgic encephalomyelitis, chronic fatigue syndrome, NHS, healthcare, contested illnesses, chronic illnesses, COVID-19 pandemic

Procedia PDF Downloads 47

Authors: Natalie Tyldesley-Marshall, Janette Parr, Anna Brown, Yen-Fu Chen, Amy Grove

Abstract:

It is widely recognised in policy and research that the provision of services for children and young people (CYP) with Special Educational Needs and Disabilities (SEND) is enhanced when health and social care, and education services collaborate and interact effectively. In the UK, there have been significant changes to policy and provisions which support and improve collaboration. However, professionals responsible for implementing these changes face multiple challenges, including a lack of specific implementation guidance or framework to illustrate how effective multi-agency working could or should work. This systematic review will identify the key components of effective multi-agency working in services for CYP with SEND; and the most effective forms of partnership working in this setting. The review highlights interventions that lead to service improvements; and the conditions in the local area that support and encourage success. A protocol was written and registered with PROSPERO registration: CRD42022352194. Searches were conducted on several health, care, education, and applied social science databases from the year 2012 onwards. Citation chaining has been undertaken, as well as broader grey literature searching to enrich the findings. Qualitative, quantitative, mixed methods studies and systematic reviews were included, assessed independently, and critically appraised or assessed for risk of bias using appropriate tools based on study design. Data were extracted in NVivo software and checked by a more experienced researcher. A convergent segregated approach to synthesis and integration was used in which the quantitative and qualitative data were synthesised independently and then integrated using a joint display integration matrix. Findings demonstrate the key ingredients for effective partnership working for services delivering SEND. Interventions deemed effective are described, and lessons learned across interventions are summarised. Results will be of interest to educators and health and social care professionals that provide services to those with SEND. These will also be used to develop policy recommendations for how UK healthcare, social care, and education services for CYP with SEND aged 0-25 can most effectively collaborate and achieve service improvement. The review will also identify any gaps in the literature to recommend areas for future research. Funding for this review was provided by the Department for Education.

Keywords: collaboration, joint commissioning, service delivery, service improvement

Procedia PDF Downloads 77