Search results for: care knowledge
9071 Ethical Enhancement Strategies for Development of Mass Media Profession Conducted for the Ethical Promotion of Undergraduate Students in Communication Science
Authors: Supranee Wattanasin
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This research study was a qualitative documentary research by using an in-depth interview with many experts in the field who has both knowledge and experience to provide information to create a strategic plan to enhance the students’ ethics. The findings revealed that there were five areas that require an attention. The five areas included honesty, accurate fact, human right, speed, and responsibility. The development of the strategic plan to enhance the ethics for students who major in communication arts can be concluded as follows. First, the government, private, and religion sectors need to come up together and set up the activities to promote the ethical standard in schools, universities, and organizations. Second, it is important to cultivate the knowledge that ethics is important of the professional jobs, especially in the mass communication and media. Third, the Philosophy of Sufficiency Economy should be brought to explain to students in order for them to have some immunity to the negative attitude such as drinking alcohol, gambling, cut classes, and cheating at exams. Fourth, experts in the field of ethics should be found to provide more knowledge to students and allow students to participate in activities that will increase their experience and knowledge of the real world problem.Keywords: communication arts, ethics, mass communication, media, strategy
Procedia PDF Downloads 3379070 Socioeconomic and Demographic Factors Influencing Male Antenatal Care Participation in Zimbabwe
Authors: Lucia Mavudzi
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Socioeconomic and demographic factors influence male attendance of antenatal care (ANC) activities which are beneficial in improving maternal health and birth outcome. When a male, as the head of the family is expected to solely make decisions of how finances are managed, when and where health services are sought, it impacts on the woman’s health seeking behavior. Using the data from the Zimbabwe Demographic and Health Survey 2010-2011 this paper seeks to assess the prevalence of male ANC attendance in Zimbabwe and factors that influence male ANC attendance. We hypothesized that socioeconomic and demographic factors do not influence male ANC attendance. To achieve the objectives of this paper, descriptive analysis was used to describe the characteristics of men and the Binomial logistic modelling was used to assess the relationship between male ANC attendance and selected socioeconomic and demographic factors. Male ANC attendance was used as the dependent variable, and the independent variables are age, marital status, place of residence, wealth, education, religion and employment. A high percentage of males did not attend ANC with their pregnant partners. Religion, education, and place of residence were found to be significantly associated with male ANC attendance. There was no evidence to show that there was a difference in male ANC attendance by employment, marital status, and age. Findings from this paper are relevant to public health. They will be used to develop strategies and intervention programs to improve pregnant women’s attendance of ANC attendance by involving men in maternal health.Keywords: antenatal care, male participation, maternal health, socio-economic and demographic factors
Procedia PDF Downloads 3369069 Experimental Film Class: Watbangkapom School, Samut Songkhram
Authors: J. Areerut
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Experimental Film Class Project is supported by the Institute for Research and Development at Suan Sunandha Rajabhat University. This project is purported to provide academic and professional services to improve the quality standards of the community and locals in accordance with the mission of the university, which is to improve and expand knowledge for the community and to develop and transfer such knowledge and professions to the next generation. Eventually, it leads to sustainable development because the development of human resources is deemed as the key for sustainable development. Moreover, the Experimental Film Class is an integral part of the teaching of film production at Suan Sunandha International School of Art (SISA). By means of giving opportunities to students for participation in projects by sharing experience, skill and knowledge and participation in field activities, it helps students in the film production major to enhance their abilities and potentials as preparation for their readiness in the marketplace. Additionally, in this class, we provide basic film knowledge, screenwriting techniques, editing and subtitles including uploading videos on social media such as YouTube and Facebook for the participant students.Keywords: experimental film class, Watbangkapom School, participant students, basic of film production, film workshop
Procedia PDF Downloads 3379068 Scale up of Isoniazid Preventive Therapy: A Quality Management Approach in Nairobi County, Kenya
Authors: E. Omanya, E. Mueni, G. Makau, M. Kariuki
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HIV infection is the strongest risk factor for a person to develop TB. Isoniazid preventive therapy (IPT) for People Living with HIV (PLWHIV) not only reduces the individual patients’ risk of developing active TB but mitigates cross infection. In Kenya, IPT for six months was recommended through the National TB, Leprosy and Lung Disease Program to treat latent TB. In spite of this recommendation by the national government, uptake of IPT among PLHIV remained low in Kenya by the end of 2015. The USAID/Kenya and East Africa Afya Jijini project, which supports 42 TBHIV health facilities in Nairobi County, began addressing low uptake of IPT through Quality Improvement (QI) teams set up at the facility level. Quality is characterized by WHO as one of the four main connectors between health systems building blocks and health systems outputs. Afya Jijini implements the Kenya Quality Model for Health, which involves QI teams being formed at the county, sub-county and facility levels. The teams review facility performance to identify gaps in service delivery and use QI tools to monitor and improve performance. Afya Jijini supported the formation of these teams in 42 facilities and built the teams’ capacity to review data and use QI principles to identify and address performance gaps. When the QI teams began working on improving IPT uptake among PLHIV, uptake was at 31.8%. The teams first conducted a root cause analysis using cause and effect diagrams, which help the teams to brainstorm on and to identify barriers to IPT uptake among PLHIV at the facility level. This is a participatory process where program staff provides technical support to the QI teams in problem identification and problem-solving. The gaps identified were inadequate knowledge and skills on the use of IPT among health care workers, lack of awareness of IPT by patients, inadequate monitoring and evaluation tools, and poor quantification and forecasting of IPT commodities. In response, Afya Jijini trained over 300 health care workers on the administration of IPT, supported patient education, supported quantification and forecasting of IPT commodities, and provided IPT data collection tools to help facilities monitor their performance. The facility QI teams conducted monthly meetings to monitor progress on implementation of IPT and took corrective action when necessary. IPT uptake improved from 31.8% to 61.2% during the second year of the Afya Jijini project and improved to 80.1% during the third year of the project’s support. Use of QI teams and root cause analysis to identify and address service delivery gaps, in addition to targeted program interventions and continual performance reviews, can be successful in increasing TB related service delivery uptake at health facilities.Keywords: isoniazid, quality, health care workers, people leaving with HIV
Procedia PDF Downloads 999067 Prevalence of Chronic Diseases and Predictors of Mortality in Home Health Care Service: Data From Saudi Arabia
Authors: Walid A. Alkeridy, Arwa Aljasser, Khalid Mohammed Alayed, Saad Alsaad, Amani S. Alqahtani, Claire Ann Lim, Sultan H. Alamri, Doaa Zainhom Mekkawy, Mohammed Al-Sofiani
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Introduction: The history of publicly funded Home Health Care (HHC) service in Saudi Arabia dates back to 1991. The first HC program was launched to provide palliative home care services for patients with terminal cancer. Thereafter, more programs launched across Saudi Arabia most remarkably was launching the national program for HHC by the Ministry Of Health (MOH) in 2008. The national HHC MOH program is mainly providing long-term care home care services for over 40,000 Saudi citizens. The scope of the HHC service program provided by the Saudi MOH is quite diverse, ranging from basic nursing care to specialized care programs, e.g., home peritoneal dialysis, home ventilation, home infusion therapy, etc. Objectives: The primary aim of our study is to report the prevalence of chronic conditions among Saudi people receiving long-term HHC services. Secondary aims include identifying the predictors of mortality among individuals receiving long-term HHC services and studying the association between frailty and poor health outcomes among HHC users. Methods: We conducted a retrospective and cross-sectional data collection from participants receiving HHC services at King Saud University Medical City, Riyadh, Saudi Arabia. Data were collected from electronic health records (EHR), patient charts, and interviewing caregivers from the year 2019 to 2022. We assessed functional performance by Katz's activity of daily living and the Bristol Activity of Daily Living Scale (BADLS). A trained health care provider assessed frailty using the Clinical Frailty Scale (CFS). Mortality was assessed by reviewing the death certificates if patients were hospitalized through discharge status ascertainment from EHR. Results: The mean age for deceased individuals in HHC was 78.3 years. Over twenty percent of individuals receiving HHC services were readmitted to the hospital. The following variables were statistically significant between deceased and alive individuals receiving HHC services; clinical frailty scale, the total number of comorbid conditions, and functional performance based on the KATZ activity of daily living scale and the BADLS. We found that the strongest predictors for mortality were pressure ulcers which had an odds ratio of 3.75 and p-value of < 0.0001, and the clinical frailty scale, which had an odds ratio of 1.69 and p-value of 0.002, using multivariate regression analysis. In conclusion, our study found that pressure ulcers and frailty are the strongest predictors of mortality for individuals receiving home health care services. Moreover, we found a high rate of annual readmission for individuals enrolled in HHC, which requires further analysis to understand the possible contributing factors for the increased rate of hospital readmission and develop strategies to address them. Future studies should focus on designing quality improvement projects aimed at improving the quality of life for individuals receiving HHC services, especially those who have pressure ulcers at the end of life.Keywords: homecare, Saudi, prevalence, chronic
Procedia PDF Downloads 1189066 Method for Improving Antidepressants Adherence in Patients with Depressive Disorder: Systemic Review and Meta-Analysis
Authors: Juntip Kanjanasilp, Ratree Sawangjit, Kanokporn Meelap, Kwanchanok Kruthakool
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Depression is a common mental health disorder. Antidepressants are effective pharmacological treatments, but most patients have low medication adherence. This study aims to systematic review and meta-analysis what method increase the antidepressants adherence efficiently and improve clinical outcome. Systematic review of articles of randomized controlled trials obtained by a computerized literature search of The Cochrane, Library, Pubmed, Embase, PsycINFO, CINAHL, Education search, Web of Science and ThaiLIS (28 December 2017). Twenty-three studies were included and assessed the quality of research by ROB 2.0. The results reported that printing media improved in number of people who had medication adherence statistical significantly (p= 0.018), but education, phone call, and program utilization were no different (p=0.172, p=0.127, p=0.659). There was no significant difference in pharmacist’s group, health care team’s group and physician’s group (p=0.329, p=0.070, p=0.040). Times of intervention at 1 month and 6 months improved medication adherence significantly (p= 0.0001, p=0.013). There was significantly improved adherence in single intervention (p=0.027) but no different in multiple interventions (p=0.154). When we analyzed medication adherence with the mean score, no improved adherence was found, not relevant with who gives the intervention and times to intervention. However, the multiple interventions group was statistically significant improved medication adherence (p=0.040). Phone call and the physician’s group were statistically significant improved clinical outcomes in number of improved patients (0.025 and 0.020, respectively). But in the pharmacist’s group and physician’s group were not found difference in the mean score of clinical outcomes (p=0.993, p=0.120, respectively). Times to intervention and number of intervention were not significant difference than usual care. The overall intervention can increase antidepressant adherence, especially the printing media, and the appropriate timing of the intervention is at least 6 months. For effective treatment, the provider should have experience and expert in caring for patients with depressive disorders, such as a psychiatrist. Medical personnel should have knowledge in caring for these patients also.Keywords: depression, medication adherence, clinical outcomes, systematic review, meta-analysis
Procedia PDF Downloads 1349065 Analysis of Subordination: The Reproductive Sphere
Authors: Aneesa Shafi
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Reproduction is a complex term in a setting where it is continuously being shaped by epistemological shifts in knowledge. It denotes not just fertility, birth and childcare related practices but also the ideas that shape those practices. These ideas and practices figure into understandings of social and cultural renewal. Patriarchy continues to be a dominating force in the formation of these ideas and practices. Contemporary times are characterized by the resurgence of the whims of patriarchal politics in delineating the margins of women’s health care. This has further emboldened the struggle for reproductive rights on the global stage. The paper examines the subordination of the right to bodily autonomy of women within the ambit of their reproductive rights. Reproductive rights are recognized human rights and women’s rights. Why these rights of women face stiff opposition is established, as is the structure that creates hurdles to their enjoyment. The negotiation of this structure in the everyday life through women’s agency is also established. The reproductive sphere includes not just the process of reproduction but also social reproduction- domestic work, spheres of production and reproduction, population and birth (control) issues.Keywords: patriarchy, women, reproduction, gender
Procedia PDF Downloads 2289064 iSEA: A Mobile Based Learning Application for History and Culture Knowledge Enhancement for the ASEAN Region
Authors: Maria Visitacion N. Gumabay, Byron Joseph A. Hallar, Annjeannette Alain D. Galang
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This study was intended to provide a more efficient and convenient way for mobile users to enhance their knowledge about ASEAN countries. The researchers evaluated the utility of the developed crossword puzzle application and assessed the general usability of its user interface for its intended purpose and audience of users. The descriptive qualitative research method for the research design and the Mobile-D methodology was employed for the development of the software application output. With a generally favorable reception from its users, the researchers concluded that the iSEA Mobile Based Learning Application can be considered ready for general deployment and use. It was also concluded that additional studies can also be done to make a more complete assessment of the knowledge gained by its users before and after using the application.Keywords: mobile learning, eLearning, crossword, ASEAN, iSEA
Procedia PDF Downloads 3139063 Creative Skills Supported by Multidisciplinary Learning: Case Innovation Course at the Seinäjoki University of Applied Sciences
Authors: Satu Lautamäki
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This paper presents findings from a multidisciplinary course (bachelor level) implemented at Seinäjoki University of Applied Sciences, Finland. The course aims to develop innovative thinking of students, by having projects given by companies, using design thinking methods as a tool for creativity and by integrating students into multidisciplinary teams working on the given projects. The course is obligatory for all first year bachelor students across four faculties (business and culture, food and agriculture, health care and social work, and technology). The course involves around 800 students and 30 pedagogical coaches, and it is implemented as an intensive one-week course each year. The paper discusses the pedagogy, structure and coordination of the course. Also, reflections on methods for the development of creative skills are given. Experts in contemporary, global context often work in teams, which consist of people who have different areas of expertise and represent various professional backgrounds. That is why there is a strong need for new training methods where multidisciplinary approach is at the heart of learning. Creative learning takes place when different parties bring information to the discussion and learn from each other. When students in different fields are looking for professional growth for themselves and take responsibility for the professional growth of other learners, they form a mutual learning relationship with each other. Multidisciplinary team members make decisions both individually and collectively, which helps them to understand and appreciate other disciplines. Our results show that creative and multidisciplinary project learning can develop diversity of knowledge and competences, for instance, students’ cultural knowledge, teamwork and innovation competences, time management and presentation skills as well as support a student’s personal development as an expert. It is highly recommended that higher education curricula should include various studies for students from different study fields to work in multidisciplinary teams.Keywords: multidisciplinary learning, creative skills, innovative thinking, project-based learning
Procedia PDF Downloads 1089062 Poster for Sickle Cell Disease and Barriers to Care in South Yorkshire from 2017 to 2023
Authors: Amardass Dhami, Clare Samuelson
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Background: Sickle cell disease (SCD) is a complex, multisystem condition that significantly impacts patients' quality of life, characterized by acute illness episodes, progressive organ damage, and reduced life expectancy. In the UK, over 13,000 individuals are affected, with South Yorkshire having the fifth highest prevalence, including approximately 800 patients. Retinal complications in SCD can manifest as either proliferative or non-proliferative disease, with proliferative changes being more prevalent. These retinal issues can cause significant morbidity, including visual loss and increased care requirements, underscoring the need for regular monitoring. An integrated approach was applied to ensure timely interventions, ultimately enhancing patient outcomes and reduce ‘did not attend’ rates. Aim: To assess the factors which may influence attendance to Haematology and Ophthalmology Clinics with attention towards levels of deprivation towards non-attendance. Method : A retrospective study on 84 eligible patients, from the regional tertiary Centre for Sickle Cell Care (Sheffield Teaching Hospital) from 2017 to 2023. The study focused on the incidence of sickle cell eye disease, specifically examining the outcomes of patients who attended the combined haematology and ophthalmology clinics. Patients who did not attend either clinic were excluded from the analysis to ensure a clear understanding of the combined clinic's impact. This data was then compared with the United Kingdom’s Index of Multiple Deprivation (IMD) datasets to assess if inequalities of care affected this population. Results: The study concluded that the effectiveness of combining haematology and ophthalmology clinics was reduced following the intervention. The DNA rates increased to 40% for the haematology clinic. Additionally, a significant proportion of the cohort was classified as residing in areas of deprivation, suggesting a possible link between socioeconomic factors and non-attendance rates Conclusion: These findings underscore the challenges of integrating care for SCD patients, particularly in relation to socioeconomic barriers. Despite the intent to streamline care and improve patient outcomes, the increase in DNA rates points to the need for further investigation into the underlying causes of non-attendance. Addressing these issues, especially in deprived areas, could enhance the effectiveness of combined clinics and ensure that patients receive the necessary monitoring and interventions for their eye health and overall well-being. Future strategies may need to focus on improving accessibility, outreach, and support for patients to mitigate the impact of socioeconomic factors on healthcare attendance.Keywords: south yorkshire, sickle cell anemia, deprivation, factors, haematology
Procedia PDF Downloads 139061 An Educational Electronic Health Record with a Configurable User Interface
Authors: Floriane Shala, Evangeline Wagner, Yichun Zhao
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Background: Proper educational training and support are proven to be major components of EHR (Electronic Health Record) implementation and use. However, the majority of health providers are not sufficiently trained in EHR use, leading to adverse events, errors, and decreased quality of care. In response to this, students studying Health Information Science, Public Health, Nursing, and Medicine should all gain a thorough understanding of EHR use at different levels for different purposes. The design of a usable and safe EHR system that accommodates the needs and workflows of different users, user groups, and disciplines is required for EHR learning to be efficient and effective. Objectives: This project builds several artifacts which seek to address both the educational and usability aspects of an educational EHR. The artifacts proposed are models for and examples of such an EHR with a configurable UI to be learned by students who need a background in EHR use during their degrees. Methods: Review literature and gather professional opinions from domain experts on usability, the use of workflow patterns, UI configurability and design, and the educational aspect of EHR use. Conduct interviews in a semi-casual virtual setting with open discussion in order to gain a deeper understanding of the principal aspects of EHR use in educational settings. Select a specific task and user group to illustrate how the proposed solution will function based on the current research. Develop three artifacts based on the available research, professional opinions, and prior knowledge of the topic. The artifacts capture the user task and user’s interactions with the EHR for learning. The first generic model provides a general understanding of the EHR system process. The second model is a specific example of performing the task of MRI ordering with a configurable UI. The third artifact includes UI mock-ups showcasing the models in a practical and visual way. Significance: Due to the lack of educational EHRs, medical professionals do not receive sufficient EHR training. Implementing an educational EHR with a usable and configurable interface to suit the needs of different user groups and disciplines will help facilitate EHR learning and training and ultimately improve the quality of patient care.Keywords: education, EHR, usability, configurable
Procedia PDF Downloads 1579060 Construction of a Radial Centrifuge Pump for Agricultural Applications
Authors: Elmo Thiago Lins Cöuras Ford, Valentina Alessandra Carvalho do Vale
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With the evolution of the productive processes, demonstrated mainly by the presence every time larger of the irrigation and to crescent it disputes for water, accompanied by your shortage (distances every time larger), there is need to project facilities that can provide supply of water with larger speed and efficiency. Being like this, the presence of hydraulic pumps in an irrigation project or water supply for small communities, is of highest importance, and the knowledge of the fundamental parts to your good operation it deserves the due attention and care. Hydraulic pumps are machines of flow, whose function is to supply energy for the water, in order to press down her, through the conversion of mechanical energy of your originating from rotor a motor the combustion or of an electric motor. This way, the hydraulic pumps are had as generating hydraulic machines. The objective of this work was to project and to build a radial centrifugal pump for agricultural application in small communities.Keywords: centrifuge pump, hydraulic energy, agricultural applications, irrigation
Procedia PDF Downloads 3719059 Nurture Early for Optimal Nutrition: A Community-Based Randomized Controlled Trial to Improve Infant Feeding and Care Practices Using Participatory Learning and Actions Approach
Authors: Priyanka Patil, Logan Manikam
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Background: The first 1000 days of life are a critical window and can result in adverse health consequences due to inadequate nutrition. South-Asian (SA) communities face significant health disparities, particularly in maternal and child health. Community-based interventions, often employing Participatory-Learning and Action (PLA) approaches, have effectively addressed health inequalities in lower-income nations. The aim of this study was to assess the feasibility of implementing a PLA intervention to improve infant feeding and care practices in SA communities living in London. Methods: Comprehensive analyses were conducted to assess the feasibility/fidelity of this pilot randomized controlled trial. Summary statistics were computed to compare key metrics, including participant consent rates, attendance, retention, intervention support, and perceived effectiveness, against predefined progression rules guiding toward a definitive trial. Secondary outcomes were analyzed, drawing insights from multiple sources, such as The Children’s-Eating-Behaviour Questionnaire (CEBQ), Parental-Feeding-Style Questionnaires (PFSQ), Food-diary, and the Equality-Impact-Assessment (EIA) tool. A video analysis of children's mealtime behavior trends was conducted. Feedback interviews were collected from study participants. Results: Process-outcome measures met predefined progression rules for a definitive trial, which deemed the intervention as feasible and acceptable. The secondary outcomes analysis revealed no significant changes in children's BMI z-scores. This could be attributed to the abbreviated follow-up period of 6 months, reduced from 12 months, due to COVID-19-related delays. CEBQ analysis showed increased food responsiveness, along with decreased emotional over/undereating. A similar trend was observed in PFSQ. The EIA tool found no potential discrimination areas, and video analysis revealed a decrease in force-feeding practices. Participant feedback revealed improved awareness and knowledge sharing. Conclusion: This study demonstrates that a co-adapted PLA intervention is feasible and well-received in optimizing infant-care practices among South-Asian community members in a high-income country. These findings highlight the potential of community-based interventions to enhance health outcomes, promoting health equity.Keywords: child health, childhood obesity, community-based, infant nutrition
Procedia PDF Downloads 559058 Survey of Personality Characteristics in Adolescents under the Care of Tehran Juvenile Detention Center
Authors: Jamal Shokrzadehmadiyeh, Kambiz Kamkari, Shohreh Shokrzadeh
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According to the research topic, the purpose of the current paper is to research personality characteristics in adolescents under the care of the Tehran Juvenile Detention Centre, and a survey research method has been used. In this regard, through systematic random sampling, 120 people from the research population were selected as a sample, who were referred to Tehran Juvenile Detention Centre after the decision was reached by the court. Data collection was carried out by separate examination using NEO-PI-III personality inventory, and statistical analysis was done using a one-sample t-test. Finally, the results of the research revealed that the level of neuroticism is higher than the average level, the level of conscientiousness is lower than the average level, and the level of extraversion, agreeableness, and openness are at the average level.Keywords: personality characteristics, adolescents, Juvenile Detention Center, Tehran city
Procedia PDF Downloads 1059057 Scenario-Based Learning Using Virtual Optometrist Applications
Authors: J. S. M. Yang, G. E. T. Chua
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Diploma in Optometry (OPT) course is a three-year program offered by Ngee Ann Polytechnic (NP) to train students to provide primary eye care. Students are equipped with foundational conceptual knowledge and practical skills in the first three semesters before clinical modules in fourth to six semesters. In the clinical modules, students typically have difficulties in integrating the acquired knowledge and skills from the past semesters to perform general eye examinations on public patients at NP Optometry Centre (NPOC). To help the students overcome the challenge, a web-based game Virtual Optometrist (VO) was developed to help students apply their skills and knowledge through scenario-based learning. It consisted of two interfaces, Optical Practice Counter (OPC) and Optometric Consultation Room (OCR), to provide two simulated settings for authentic learning experiences. In OPC, students would recommend and provide appropriate frame and lens selection based on virtual patient’s case history. In OCR, students would diagnose and manage virtual patients with common ocular conditions. Simulated scenarios provided real-world clinical situations that required contextual application of integrated knowledge from relevant modules. The stages in OPC and OCR are of increasing complexity to align to expected students’ clinical competency as they progress to more senior semesters. This prevented gameplay fatigue as VO was used over the semesters to achieve different learning outcomes. Numerous feedback opportunities were provided to students based on their decisions to allow individualized learning to take place. The game-based learning element in VO was achieved through the scoreboard and leader board to enhance students' motivation to perform. Scores were based on the speed and accuracy of students’ responses to the questions posed in the simulated scenarios, preparing the students to perform accurately and effectively under time pressure in a realistic optometric environment. Learning analytics was generated in VO’s backend office based on students’ responses, offering real-time data on distinctive and observable learners’ behavior to monitor students’ engagement and learning progress. The backend office allowed versatility to add, edit, and delete scenarios for different intended learning outcomes. Likert Scale was used to measure students’ learning experience with VO for OPT Year 2 and 3 students. The survey results highlighted the learning benefits of implementing VO in the different modules, such as enhancing recall and reinforcement of clinical knowledge for contextual application to develop higher-order thinking skills, increasing efficiency in clinical decision-making, facilitating learning through immediate feedback and second attempts, providing exposure to common and significant ocular conditions, and training effective communication skills. The results showed that VO has been useful in reinforcing optometry students’ learning and supporting the development of higher-order thinking, increasing efficiency in clinical decision-making, and allowing students to learn from their mistakes with immediate feedback and second attempts. VO also exposed the students to diverse ocular conditions through simulated real-world clinical scenarios, which may otherwise not be encountered in NPOC, and promoted effective communication skills.Keywords: authentic learning, game-based learning, scenario-based learning, simulated clinical scenarios
Procedia PDF Downloads 1179056 New Knowledge Co-Creation in Mobile Learning: A Classroom Action Research with Multiple Case Studies Using Mobile Instant Messaging
Authors: Genevieve Lim, Arthur Shelley, Dongcheol Heo
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Abstract—Mobile technologies can enhance the learning process as it enables social engagement around concepts beyond the classroom and the curriculum. Early results in this ongoing research is showing that when learning interventions are designed specifically to generate new insights, mobile devices support regulated learning and encourage learners to collaborate, socialize and co-create new knowledge. As students navigate across the space and time boundaries, the fundamental social nature of learning transforms into mobile computer supported collaborative learning (mCSCL). The metacognitive interaction in mCSCL via mobile applications reflects the regulation of learning among the students. These metacognitive experiences whether self-, co- or shared-regulated are significant to the learning outcomes. Despite some insightful empirical studies, there has not yet been significant research that investigates the actual practice and processes of the new knowledge co-creation. This leads to question as to whether mobile learning provides a new channel to leverage learning? Alternatively, does mobile interaction create new types of learning experiences and how do these experiences co-create new knowledge. The purpose of this research is to explore these questions and seek evidence to support one or the other. This paper addresses these questions from the students’ perspective to understand how students interact when constructing knowledge in mCSCL and how students’ self-regulated learning (SRL) strategies support the co-creation of new knowledge in mCSCL. A pilot study has been conducted among international undergraduates to understand students’ perspective of mobile learning and concurrently develops a definition in an appropriate context. Using classroom action research (CAR) with multiple case studies, this study is being carried out in a private university in Thailand to narrow the research gaps in mCSCL and SRL. The findings will allow teachers to see the importance of social interaction for meaningful student engagement and envisage learning outcomes from a knowledge management perspective and what role mobile devices can play in these. The findings will signify important indicators for academics to rethink what is to be learned and how it should be learned. Ultimately, the study will bring new light into the co-creation of new knowledge in a social interactive learning environment and challenges teachers to embrace the 21st century of learning with mobile technologies to deepen and extend learning opportunities.Keywords: mobile computer supported collaborative learning, mobile instant messaging, mobile learning, new knowledge co-creation, self-regulated learning
Procedia PDF Downloads 2329055 Knowledge Required for Avoiding Lexical Errors at Machine Translation
Authors: Yukiko Sasaki Alam
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This research aims at finding out the causes that led to wrong lexical selections in machine translation (MT) rather than categorizing lexical errors, which has been a main practice in error analysis. By manually examining and analyzing lexical errors outputted by a MT system, it suggests what knowledge would help the system reduce lexical errors.Keywords: machine translation, error analysis, lexical errors, evaluation
Procedia PDF Downloads 3389054 Pattern of Refractive Error, Knowledge, Attitude and Practice about Eye Health among the Primary School Children in Bangladesh
Authors: Husain Rajib, K. S. Kishor, D. G. Jewel
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Background: Uncorrected refractive error is a common cause of preventable visual impairment in pediatric age group which can be lead to blindness but early detection of visual impairment can reduce the problem that will have good effective in education and more involve in social activities. Glasses are the cheapest and commonest form of correction of refractive errors. To achieve this, patient must exhibit good compliance to spectacle wear. Patient’s attitude and perception of glasses and eye health could affect compliance. Material and method: A Prospective community based cross sectional study was designed in order to evaluate the knowledge, attitude and practices about refractive errors and eye health amongst the primary school going children. Result: Among 140 respondents, 72 were males and 68 were females. We found 50 children were myopic and out of them 26 were male and 24 were female, 27 children were hyperopic and out of them 14 were male and 13 were female. About 63 children were astigmatic and out of them 32 were male and 31 were female. The level of knowledge, attitude was satisfactory. The attitude of the students, teachers and parents was cooperative which helps to do cycloplegic refraction. Practice was not satisfactory due to social stigma and information gap. Conclusion: Knowledge of refractive error and acceptance of glasses for the correction of uncorrected refractive error. Public awareness program such as vision screening program, eye camp, and teachers training program are more beneficial for wearing and prescribing spectacle.Keywords: refractive error, stigma, knowledge, attitude, practice
Procedia PDF Downloads 2639053 Developmental Differences of Elementary School Children in Knowledge Acquisition Following a Sexual Abuse Prevention Program
Authors: Chrysanthi Nega, Fotini-Sonia Apergi
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Child sexual abuse (CSA) in Greece is a highly prevalent phenomenon and yet remains largely underreported. CSA can negatively impact cognitive, emotional and psychosocial development, as well as personality formation and capacity for initiation and maintenance of healthy interpersonal relationships. It is particularly important for school-based prevention programs to be implemented early in elementary school, as they are reportedly effective in lowering abuse incidences and providing knowledge for coping in threatening environments. The purpose of the current study was to test the effectiveness of a school-based CSA prevention program (Safe-Touches) on Greek elementary school students (grades 1-3, N=272) and explore the effect of age and time of testing (academic term). There was a significant effect of age in the knowledge of Inappropriate Touch, when comparing pre and post-intervention assessments, with third graders showing greatest gains in knowledge, followed by second and first graders. Time of testing during the academic year also had a significant effect, as first graders tested later in the school year, scored higher on knowledge of Inappropriate Touch. The findings of the current study provide insight into the optimal timing to implement CSA prevention programs. Exposure to such programs and incorporation in the school curricula could largely benefit children of the Greek community in terms of safety and awareness.Keywords: child sexual abuse, Safe-Touches, school-based prevention, schooling
Procedia PDF Downloads 3189052 Work Life Balance Strategies and Retention of Medical Professionals
Authors: Naseem M. Twaissi
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Medical professionals play an important role in society, and in general, they care more about their patients than about their personal well-being. They need to take a professional approach to maintain a work-life balance. Through a collection of primary data from 1020 medical professionals and the application of relevant statistical tools, this paper explores the pressures on medical professionals with reference to their work-life balance. This study highlights how hospital management, in addition to economic reasons, needs to identify variables to enhance the work-life balance of medical professionals so that quality healthcare facilities may be provided to the citizens of Jordan. Results indicate that formulation and implementation of policies for enhancing work-life balance together with career and retention plans for medical professionals would enhance the performance of hospitals and the quality of health care in Jordan, leading to greater societal well-being.Keywords: work life balance, job environment, job satisfaction, employee well-being, stress, hospital industry
Procedia PDF Downloads 1419051 Curriculum for the Manufacturing and Engineering Course Programs in Industries
Authors: Muhammad Yasir Latif
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Industrial Engineering and Management (IEM) is a continuous, adaptable, and dynamic branch of engineering. The purpose of this study is to use a knowledge-based course classification method to investigate four IEM educational programs in Europe. Furthermore, the relative weight of each sector was determined using the credit value of the courses. IEM-specific locations and pooled areas were the two related kinds of areas that were used. The results show that, among the four program curricula, Production Management is the specific area with the largest weight, while the specialism field of IEM has a similar weight. This method has proved to be useful for curriculum analysis. The results show that one characteristic of IEM curriculum programs is diversity in the knowledge domains related to IEM specialism. The research also highlights the importance of an organized structure for defining IEM applications, allowing benchmarking efforts, and promoting communication between academics and the IEM community.Keywords: industrial engineering and management, knowledge areas, curriculum analysis, community
Procedia PDF Downloads 199050 Prevalence of Sexually Transmitted Infections in Pregnancy, Preterm Birth, Low Birthweight, and the Importance of Prenatal Care: Data from the 2020 United States Birth Certificate
Authors: Anthony J. Kondracki, Bonzo Reddick, Jennifer L. Barkin
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Background: Many pregnancies in the United States are affected each year with the most common sexually transmitted infections (STIs), including Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and Treponema pallidum (TP, syphilis), and the rate of congenital syphilis has reached a 20-year high. We sought to estimate the prevalence of CT, NG, and TP in pregnancy and the risk of preterm birth (PTB) (<37 weeks gestation) and low birthweight (LBW) (<2500g) deliveries according to utilization of prenatal care (PNC) during the COVID-19 pandemic. Methods: This study was based on the 2020 National Center for Health Statistics (NCHS) Natality File restricted to singleton births (N=3,512,858). We estimated the prevalence of CT, NG, TP, PTBand LBW across timing and the number of prenatal care (PNC) visits attended. In multivariable logistic regression models, adjusted odds ratios of PTB and LBW were assessed according to STIs and PNC status. E-values, based on effect size estimates and the lower bound of the 95% confidence intervals (CIs) of the association, examined the potential impact of unmeasured confounding. Results: CT (1.8%) was most prevalent in pregnancy, followed by NG (0.3%) and TP (0.1%). The strongest predictors of PTB and LBW were maternal NG (12.2% and 12.1%, respectively), late initiation/no PNC (8.5% and 7.6%, respectively), and ≤10 prenatal visits (13.1% and 10.3%, respectively). The odds of PTB and LBW were 2.5- to 3-fold greater for each STI in women who received ≤10 compared to >10 prenatal visits. E-values demonstrated the minimum strength of potential unmeasured confounding necessary to explain away observed associations. Conclusions: Timely initiation and receipt of recommended number of prenatal visits benefits screening and treatment of all women for STIs, including NG to substantially reduce infant morbidity and mortality related to PTB and LBW among infants born during the COVID-19 pandemic.Keywords: COVID-19 pandemic, sexually transmitted infections, preterm birth, low birthweight, prenatal care
Procedia PDF Downloads 1529049 Effect of Simulation on Anxiety and Knowledge among Novice Nursing Students
Authors: Suja Karkada, Jayanthi Radhakrishnan, Jansi Natarajan, Gerald, Amandu Matua, Sujatha Shanmugasundaram
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Simulation-based learning is an educational strategy designed to simulate actual clinical situations in a safe environment. Globally, simulation is recognized by several landmark studies as an effective teaching-learning method. A systematic review of the literature on simulation revealed simulation as a useful strategy in creating a learning environment which contributes to knowledge, skills, safety, and confidence. However, to the best of the author's knowledge, there are no studies on assessing the anxiety of the students undergoing simulation. Hence the researchers undertook a study with the aim to evaluate the effectiveness of simulation on anxiety and knowledge among novice nursing students. This quasi-experimental study had a total sample of 69 students (35- Intervention group with simulation and 34- Control group with case scenario) consisting of all the students enrolled in the Fundamentals of Nursing Laboratory course during Spring 2016 and Fall 2016 semesters at a college of nursing in Oman. Ethical clearance was obtained from the Institutional Review Board (IRB) of the college of nursing. Informed consent was obtained from every participant. Study received the Dean’s fund for research. The data were collected regarding the demographic information, knowledge and anxiety levels before and after the use of simulation and case scenario for the procedure nasogastric tube feeding in intervention and control group respectively. The intervention was performed by four faculties who were the core team members of the course. Results were analyzed in SPSS using descriptive and inferential statistics. Majority of the students’ in intervention (82.9%) and control (89.9%) groups were equal to or below the age of 20 years, were females (71%), 76.8% of them were from rural areas and 65.2% had a GPA of more than 2.5. The selection of the samples to either the experimental or the control group was from a homogenous population (p > 0.05). There was a significant reduction of anxiety among the students of control group (t (67) = 2.418, p = 0.018) comparing to the experimental group, indicating that simulation creates anxiety among Novice nursing students. However, there was no significant difference in the mean scores of knowledge. In conclusion, the study was useful in that it will help the investigators better understand the implications of using simulation in teaching skills to novice students. Since previous studies with students indicate better knowledge acquisition; this study revealed that simulation can increase anxiety among novice students possibly it is the first time they are introduced to this method of teaching.Keywords: anxiety, knowledge, novice students, simulation
Procedia PDF Downloads 1599048 Identifying Risk Factors for Readmission Using Decision Tree Analysis
Authors: Sıdıka Kaya, Gülay Sain Güven, Seda Karsavuran, Onur Toka
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This study is part of an ongoing research project supported by the Scientific and Technological Research Council of Turkey (TUBITAK) under Project Number 114K404, and participation to this conference was supported by Hacettepe University Scientific Research Coordination Unit under Project Number 10243. Evaluation of hospital readmissions is gaining importance in terms of quality and cost, and is becoming the target of national policies. In Turkey, the topic of hospital readmission is relatively new on agenda and very few studies have been conducted on this topic. The aim of this study was to determine 30-day readmission rates and risk factors for readmission. Whether readmission was planned, related to the prior admission and avoidable or not was also assessed. The study was designed as a ‘prospective cohort study.’ 472 patients hospitalized in internal medicine departments of a university hospital in Turkey between February 1, 2015 and April 30, 2015 were followed up. Analyses were conducted using IBM SPSS Statistics version 22.0 and SPSS Modeler 16.0. Average age of the patients was 56 and 56% of the patients were female. Among these patients 95 were readmitted. Overall readmission rate was calculated as 20% (95/472). However, only 31 readmissions were unplanned. Unplanned readmission rate was 6.5% (31/472). Out of 31 unplanned readmission, 24 was related to the prior admission. Only 6 related readmission was avoidable. To determine risk factors for readmission we constructed Chi-square automatic interaction detector (CHAID) decision tree algorithm. CHAID decision trees are nonparametric procedures that make no assumptions of the underlying data. This algorithm determines how independent variables best combine to predict a binary outcome based on ‘if-then’ logic by portioning each independent variable into mutually exclusive subsets based on homogeneity of the data. Independent variables we included in the analysis were: clinic of the department, occupied beds/total number of beds in the clinic at the time of discharge, age, gender, marital status, educational level, distance to residence (km), number of people living with the patient, any person to help his/her care at home after discharge (yes/no), regular source (physician) of care (yes/no), day of discharge, length of stay, ICU utilization (yes/no), total comorbidity score, means for each 3 dimensions of Readiness for Hospital Discharge Scale (patient’s personal status, patient’s knowledge, and patient’s coping ability) and number of daycare admissions within 30 days of discharge. In the analysis, we included all 95 readmitted patients (46.12%), but only 111 (53.88%) non-readmitted patients, although we had 377 non-readmitted patients, to balance data. The risk factors for readmission were found as total comorbidity score, gender, patient’s coping ability, and patient’s knowledge. The strongest identifying factor for readmission was comorbidity score. If patients’ comorbidity score was higher than 1, the risk for readmission increased. The results of this study needs to be validated by other data–sets with more patients. However, we believe that this study will guide further studies of readmission and CHAID is a useful tool for identifying risk factors for readmission.Keywords: decision tree, hospital, internal medicine, readmission
Procedia PDF Downloads 2569047 Perception of Health Care Providers: A Need to Introduce Screening of Maternal Mental Health at Primary Health Care in Nepal
Authors: Manisha Singh, Padam Simkhada
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Background: Although mental health policy has been adapted in Nepal since 1997, the implementation of the policy framework is yet to happen. The fact that mental health services are largely concentrated in urban areas more specific to treatment only provides a clear picture of the scarcity of mental health services in the country. The shreds of evidence from around the world, along with WHO’s (World Health Organization) Mental Health Gap Action Program (mhGAP) suggest that effective mental health services can be provided from Primary Health Care (PHC) centers through community-based programs without having to place a specialized health worker. However, the country is still facing the same challenges to date with very few psychiatrists and psychologists, but they are largely based in cities. Objectives: The main objectives of this study are; (a) to understand the perception of health workers at PHC on maternal mental health, and (b) to assess the availability of the mental health services at PHC to address maternal mental health. Methods: This study used a qualitative approach where an in-depth interview was conducted with the health workers at the primary level. “Mayadevi” rural municipality in Rupendehi District that comprised of 13 small villages, was chosen as the study site. A total 8 health institutions which covered all 13 sites were included where either the health post in- charge or health worker working in maternal and child health care was interviewed for the study. All the health posts in the study area were included in the study. The interviews were conducted in Nepali; later, they were translated in English, transcribed, and triangulated. NViVO was used for the analysis. Results: The findings show that most of the health workers understood what maternal mental health was and deemed it as a public health issue. They could explain the symptoms and knew what medication to prescribe if need be. However, the majority of them failed to name the screening tools in place for maternal mental health. Moreover, they hadn’t even seen one. None of the health care centers had any provision for screening mental health status. However, one of the centers prescribed medication when the patients displayed symptoms of depression. But they believed there were a significant number of hidden cases in the community due to the stigma around mental health and being a woman with mental health problem makes the situation even difficult. Nonetheless, the health workers understood the importance of having screening tools and acknowledged the need of training and support in order to provide the services from PHC. Conclusion: Community health workers can identify cases with mental health problems and prevent them from deteriorating further. But there is a need for robust training and support to build the capacity of the health workers. The screening tools on mental health needs to be encouraged to be used in the PHC levels. Furthermore, community-based culture-sensitive programs need to be initiated and implemented to mitigate the stigma related issues around mental health.Keywords: maternal mental health, health care providers, screening, Nepal
Procedia PDF Downloads 1279046 Evaluation of the Trauma System in a District Hospital Setting in Ireland
Authors: Ahmeda Ali, Mary Codd, Susan Brundage
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Importance: This research focuses on devising and improving Health Service Executive (HSE) policy and legislation and therefore improving patient trauma care and outcomes in Ireland. Objectives: The study measures components of the Trauma System in the district hospital setting of the Cavan/Monaghan Hospital Group (CMHG), HSE, Ireland, and uses the collected data to identify the strengths and weaknesses of the CMHG Trauma System organisation, to include governance, injury data, prevention and quality improvement, scene care and facility-based care, and rehabilitation. The information will be made available to local policy makers to provide objective situational analysis to assist in future trauma service planning and service provision. Design, setting and participants: From 28 April to May 28, 2016 a cross-sectional survey using World Health Organisation (WHO) Trauma System Assessment Tool (TSAT) was conducted among healthcare professionals directly involved in the level III trauma system of CMHG. Main outcomes: Identification of the strengths and weaknesses of the Trauma System of CMHG. Results: The participants who reported inadequate funding for pre hospital (62.3%) and facility based trauma care at CMHG (52.5%) were high. Thirty four (55.7%) respondents reported that a national trauma registry (TARN) exists but electronic health records are still not used in trauma care. Twenty one respondents (34.4%) reported that there are system wide protocols for determining patient destination and adequate, comprehensive legislation governing the use of ambulances was enforced, however, there is a lack of a reliable advisory service. Over 40% of the respondents reported uncertainty of the injury prevention programmes available in Ireland; as well as the allocated government funding for injury and violence prevention. Conclusions: The results of this study contributed to a comprehensive assessment of the trauma system organisation. The major findings of the study identified three fundamental areas: the inadequate funding at CMHG, the QI techniques and corrective strategies used, and the unfamiliarity of existing prevention strategies. The findings direct the need for further research to guide future development of the trauma system at CMHG (and in Ireland as a whole) in order to maximise best practice and to improve functional and life outcomes.Keywords: trauma, education, management, system
Procedia PDF Downloads 2439045 Knowledge Engineering Based Smart Healthcare Solution
Authors: Rhaed Khiati, Muhammad Hanif
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In the past decade, smart healthcare systems have been on an ascendant drift, especially with the evolution of hospitals and their increasing reliance on bioinformatics and software specializing in healthcare. Doctors have become reliant on technology more than ever, something that in the past would have been looked down upon, as technology has become imperative in reducing overall costs and improving the quality of patient care. With patient-doctor interactions becoming more necessary and more complicated than ever, systems must be developed while taking into account costs, patient comfort, and patient data, among other things. In this work, we proposed a smart hospital bed, which mixes the complexity and big data usage of traditional healthcare systems with the comfort found in soft beds while taking certain concerns like data confidentiality, security, and maintaining SLA agreements, etc. into account. This research work potentially provides users, namely patients and doctors, with a seamless interaction with to their respective nurses, as well as faster access to up-to-date personal data, including prescriptions and severity of the condition in contrast to the previous research in the area where there is lack of consideration of such provisions.Keywords: big data, smart healthcare, distributed systems, bioinformatics
Procedia PDF Downloads 1989044 Parents, Carers and Young Persons’ Views Regarding Nursing ‘Workarounds’ Within Clinical Electronic Patient Record Systems
Authors: Patrick Nurse, Professor Neil Sebire, Polly Livermore
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The use of digital systems in healthcare is now highly prevalent. With further advancement of technology, these systems will become increasingly utilised within the healthcare sector. Therefore understanding how clinicians (for example, doctors, nurses) interact with technology and digital systems is critical to making care safer. Seven members from the Parent/Carers’ Research Advisory Group and the Young-Persons’ Research Group at a healthcare Trust in London and three staff members contributed to an engagement workshop to assess the impact of digital systems on the practice of nurses. The group also advised on the viability of a research study to investigate this further. A wide range of issues within digital system implementation in healthcare were raised, such as ‘workarounds’, system’s training, and upkeep and regulation of usage, which all emerged as early themes during the discussion. Further discussion focused on the subject of escalation of issues, ‘workarounds’, and problem solving. While challenging to implement, digital systems are hugely beneficial to healthcare providers. The workshop indicated that there is scope for investigation of the prevalence, nature, and escalation of ‘workarounds’, this was of key interest to the advisory group. An interesting concern of the group was their worry from a patient and parental perspective regarding how nurses might feel when needing to complete a ‘workaround’ during a busy shift. This is especially relevant if the reasons to complete the ‘workaround’ were outside the nurse’s control, driven by clinical need and urgency of care. This showed the level of insight that those using healthcare services have into the reality of workflows of those providing care. Additionally, it reflects the desire for patients and families to understand more about the administration and methodology of their care. Future study should be dedicated to understanding why nurses deploy ‘workarounds’, as well as their perspective and experience of them and subsequent escalation through leadership hierarchiesKeywords: patient engagement/involvement, workarounds, medication-administration, digital systems
Procedia PDF Downloads 919043 Planning the Journey of Unifying Medical Record Numbers in Five Facilities and the Expected Challenges: Case Study in Saudi Arabia
Authors: N. Al Khashan, H. Al Shammari, W. Al Bahli
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Patients who are eligible to receive treatment at the National Guard Health Affairs (NGHA), Saudi Arabia will typically have four medical record numbers (MRN), one in each of the geographical areas. More hospitals and primary healthcare facilities in other geographical areas will launch soon which means more MRNs. When patients own four MRNs, this will cause major drawbacks in patients’ quality of care such as creating new medical files in different regions for relocated patients and using referral system among regions. Consequently, the access to a patient’s medical record from other regions and the interoperability of health information between the four hospitals’ information system would be challenging. Thus, there is a need to unify medical records among these five facilities. As part of the effort to increase the quality of care, a new Hospital Information Systems (HIS) was implemented in all NGHA facilities by the end of 2016. NGHA’s plan is put to be aligned with the Saudi Arabian national transformation program 2020; whereby 70% citizens and residents of Saudi Arabia would have a unified medical record number that enables transactions between multiple Electronic Medical Records (EMRs) vendors. The aim of the study is to explore the plan, the challenges and barriers of unifying the 4 MRNs into one Enterprise Patient Identifier (EPI) in NGHA hospitals by December 2018. A descriptive study methodology was used. A journey map and a project plan are created to be followed by the project team to ensure a smooth implementation of the EPI. It includes the following: 1) Approved project charter, 2) Project management plan, 3) Change management plan, 4) Project milestone dates. Currently, the HIS is using the regional MRN. Therefore, the HIS and all integrated health care systems in all regions will need modification to move from MRN to EPI without interfering with patient care. For now, the NGHA have successfully implemented an EPI connected with the 4 MRNs that work in the back end in the systems’ database.Keywords: consumer health, health informatics, hospital information system, universal medical record number
Procedia PDF Downloads 1969042 Identifying Organizational Culture to Implement Knowledge Management: Case Study of BKN, Indonesia
Authors: Maria Margaretha, Elin Cahyaningsih, Dana Indra Sensuse Lukman
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One of key success an organization can be seen from its culture. Employee, environment, and so on are factors for organization to achieve goals and build a competitive advantage. Type of organizational culture can be a guide to implementing Knowledge Management (KM) in organization especially in BKN. Culture will determine behavior of employees or environment to support KM. This paper describes the process to decide which culture does organization belong and suggestion and creating strategic moves in the future to implement KM. OCAI (Organizational Culture Assessment Instrument) and its framework (Competing Value Framework) were used to decide the type of organizational culture. To implement KM in organization, clan is an appropriate culture, because clan culture represent cultural values and leader type to implement a successful KM. Result of the measurement will be references for BKN to improve organization culture to achieve its goals and organization effectiveness.Keywords: organizational culture, government, knowledge management, OCAI
Procedia PDF Downloads 621