Search results for: appraisal of parents’ views and supervision
Commenced in January 2007
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Edition: International
Paper Count: 2512

Search results for: appraisal of parents’ views and supervision

802 Dependence of Androgen Status in Men with Primary Hypothyroidism on Duration and Condition of Compensation

Authors: Krytskyy T.

Abstract:

Introduction: The role of androgen deficiency in men as a factor in the pathogenesis of many somatic diseases is unmistakable. The interaction of thyroid and sex hormones with hypothyroidism in men is still the subject of discussions. The purpose of the study is to assess the androgen status of men with primary hypothyroidism, depending on its duration and the state of compensation. Materials and methods: 45 men with primary hypothyroidism aged 35 to 60 years, as well as 25 healthy men, who formed a control group, were under supervision. A selection of men for examination was conducted in the process of outpatient and in-patient treatment at the endocrinology department of the University Hospital in Ternopil. The functional state of the pituitary-gonadal system was evaluated in order to characterize the androgen status of patients. The concentration of follicle stimulating hormone, luteinizing hormone, prolactin, thyroid-stimulating hormone was determined in blood with the help of enzyme-linked method. Also, the content of hormones: total testosterone, linking sex hormones globulin were determined. Results: Reduced total testosterone (TT) content was found in 42.2% of patients with hypothyroidism. Herewith in 17.8% of patients, blood TT levels were lower than 8.0 nmol / L, and in 11 (24.4%) men, the rate was in the range of 8.0 to 12.0 nmol / L. Based on the results of the determination of the content of free testosterone (FT), the frequency of laboratory hypogonadism in men with hypothyroidism was higher than the results of the determination of TT. The degree of compensation of hypothyroidism probably did not affect the average levels of gonadotropic and sex hormones. Conclusions: Reduced total testosterone content was found in 42.2% of patients with primary hypothyroidism. Herewith, in 17.8% of patients blood TT levels were lower than 8.0 nmol / L, which is a sign of absolute deficiency of testosterone, and in 24.4% of men the rate ranged from 8.0 to 12.0 nmol / l , indicating partial androgen deficiency. Linking sex hormones globulin levels were believed to be lower in 46.7% of patients with hypothyroidism compared to control group. The average levels of E2 in the examined patients did not significantly differ from the mean of control group. FSH, LH, and prolactin levels in men with hypothyroidism were within the normal age limits and probably did not differ from those of control group. The degree of compensation of hypothyroidism probably did not affect the average levels of gonadotropic and sex hormones. The mean LH content in the blood was significantly increased in men with a duration of hypothyroidism up to 5 years and did not differ from that of the control group and in men with a duration of hypothyroidism over 5 years. In men with hypothyroidism, a probable reduction in T / LH coefficient is found. The obtained data may indicate a combined lesion of the central and peripheral parts of the pituitary-gonadal system in men with hypothyroidism.

Keywords: androgenic status, hypothyroidism, testosterone, linking sex hormones globulin

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801 Influences on Female Gender Identity and Role in Pre-School, Saudi Arabian: Analyzing Children's Perspectives through Narratives and Teachers' Pedagogies

Authors: Mona Alzahrani

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Microworld theories can help to define the many influences on female development. In this research, theories together with narratives have been used to discover the reality of children’s gender perceptions in Saudi Arabia. Today, Saudi Arabia is considered a ‘closed and conserved’ society due to tribal, cultural and religious factors. This study focuses on how young girls in Saudi Arabia learn about what is expected of them as females. Cultural beliefs and experiences contribute to children’s notions of identity. Moreover, significant others such as more experienced peers, teachers, parents, and other members of a society can influence a child’s development of knowledge through interactions within their social world. There are dominant influences from the Saudi State. These influences have very strong devices and perceptions of what or how a female should act and be. However, children may have other viewpoints, as it also needs to be considered that the Internet and other media sources could have an influence. Consequently, difficulties could exist for these young children to feel an authentic sense of belonging. The study gathered data using a multi-method approach that elicited the perspectives of the children using ‘multiple modes of expression’ such as observations, story-telling, picture prompt cards, group interviews, drawings and annotations. For this study, prompts and a book was devised, specifically, for use in a Saudi setting. It was found that Saudi young girls in preschool were heteronomous, mainly influenced by culture and society, in their perceptions of female gender and role.

Keywords: Saudi Arabia, pre-school, female, teachers, gender, identity, role

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800 Groupthink: The Dark Side of Team Cohesion

Authors: Farhad Eizakshiri

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The potential for groupthink to explain the issues contributing to deterioration of decision-making ability within the unitary team and so to cause poor outcomes attracted a great deal of attention from a variety of disciplines, including psychology, social and organizational studies, political science, and others. Yet what remains unclear is how and why the team members’ strivings for unanimity and cohesion override their motivation to realistically appraise alternative courses of action. In this paper, the findings of a sequential explanatory mixed-methods research containing an experiment with thirty groups of three persons each and interviews with all experimental groups to investigate this issue is reported. The experiment sought to examine how individuals aggregate their views in order to reach a consensual group decision concerning the completion time of a task. The results indicated that groups made better estimates when they had no interaction between members in comparison with the situation that groups collectively agreed on time estimates. To understand the reasons, the qualitative data and informal observations collected during the task were analyzed through conversation analysis, thus leading to four reasons that caused teams to neglect divergent viewpoints and reduce the number of ideas being considered. Reasons found were the concurrence-seeking tendency, pressure on dissenters, self-censorship, and the illusion of invulnerability. It is suggested that understanding the dynamics behind the aforementioned reasons of groupthink will help project teams to avoid making premature group decisions by enhancing careful evaluation of available information and analysis of available decision alternatives and choices.

Keywords: groupthink, group decision, cohesiveness, project teams, mixed-methods research

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799 Call-Back Laterality and Bilaterality: Possible Screening Mammography Quality Metrics

Authors: Samson Munn, Virginia H. Kim, Huija Chen, Sean Maldonado, Michelle Kim, Paul Koscheski, Babak N. Kalantari, Gregory Eckel, Albert Lee

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In terms of screening mammography quality, neither the portion of reports that advise call-back imaging that should be bilateral versus unilateral nor how much the unilateral call-backs may appropriately diverge from 50–50 (left versus right) is known. Many factors may affect detection laterality: display arrangement, reflections preferentially striking one display location, hanging protocols, seating positions with respect to others and displays, visual field cuts, health, etc. The call-back bilateral fraction may reflect radiologist experience (not in our data) or confidence level. Thus, laterality and bilaterality of call-backs advised in screening mammography reports could be worthy quality metrics. Here, laterality data did not reveal a concern until drilling down to individuals. Bilateral screening mammogram report recommendations by five breast imaging, attending radiologists at Harbor-UCLA Medical Center (Torrance, California) 9/1/15--8/31/16 and 9/1/16--8/31/17 were retrospectively reviewed. Recommended call-backs for bilateral versus unilateral, and for left versus right, findings were counted. Chi-square (χ²) statistic was applied. Year 1: of 2,665 bilateral screening mammograms, reports of 556 (20.9%) recommended call-back, of which 99 (17.8% of the 556) were for bilateral findings. Of the 457 unilateral recommendations, 222 (48.6%) regarded the left breast. Year 2: of 2,106 bilateral screening mammograms, reports of 439 (20.8%) recommended call-back, of which 65 (14.8% of the 439) were for bilateral findings. Of the 374 unilateral recommendations, 182 (48.7%) regarded the left breast. Individual ranges of call-backs that were bilateral were 13.2–23.3%, 10.2–22.5%, and 13.6–17.9%, by year(s) 1, 2, and 1+2, respectively; these ranges were unrelated to experience level; the two-year mean was 15.8% (SD=1.9%). The lowest χ² p value of the group's sidedness disparities years 1, 2, and 1+2 was > 0.4. Regarding four individual radiologists, the lowest p value was 0.42. However, the fifth radiologist disfavored the left, with p values of 0.21, 0.19, and 0.07, respectively; that radiologist had the greatest number of years of experience. There was a concerning, 93% likelihood that bias against left breast findings evidenced by one of our radiologists was not random. Notably, very soon after the period under review, he retired, presented with leukemia, and died. We call for research to be done, particularly by large departments with many radiologists, of two possible, new, quality metrics in screening mammography: laterality and bilaterality. (Images, patient outcomes, report validity, and radiologist psychological confidence levels were not assessed. No intervention nor subsequent data collection was conducted. This uncomplicated collection of data and simple appraisal were not designed, nor had there been any intention to develop or contribute, to generalizable knowledge (per U.S. DHHS 45 CFR, part 46)).

Keywords: mammography, screening mammography, quality, quality metrics, laterality

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798 Adopting the Community Health Workers Master List Registry for Community Health Workforce in Kenya

Authors: Gikunda Aloise, Mjema Saida, Barasa Herbert, Wanyungu John, Kimani Maureen

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Background: Community Health Workforce (CHW) is health care providers at the community level (Level 1) and serves as a bridge between the community and the formal healthcare system. This human resource has enormous potential to extend healthcare services and ensures that the vulnerable, marginalized, and hard-to-reach populations have access to quality healthcare services at the community and primary health facility levels. However, these cadres are neither recognized, remunerated, nor in most instances, registered in a master list. Management and supervision of CHWs is not easy if their individual demographics, training capacity and incentives is not well documented through a centralized registry. Description: In February 2022, Amref supported the Kenya Ministry of Health in developing a community health workforce database called Community Health Workers Master List Registry (CHWML), which is hosted in Kenya Health Information System (KHIS) tracker. CHW registration exercise was through a sensitization meeting conducted by the County Community Health Focal Person for the Sub-County Community Health Focal Person and Community Health Assistants who uploaded information on individual demographics, training undertaken and incentives received by CHVs. Care was taken to ensure compliance with Kenyan laws on the availability and use of personal data as prescribed by the Data Protection Act, 2019 (DPA). Results and lessons learnt: By June 2022, 80,825 CHWs had been registered in the system; 78,174 (96%) CHVs and 2,636 (4%) CHAs. 25,235 (31%) are male, 55,505 (68%) are female & 85 (1%) are transgender. 39,979. (49%) had secondary education and 2500 (3%) had no formal education. Only 27 641 (34%) received a monthly stipend. 68,436 CHVs (85%) had undergone basic training. However, there is a need to validate the data to align with the current situation in the counties. Conclusions/Next steps: The use of CHWML will unlock opportunities for building more resilient and sustainable health systems and inform financial planning, resource allocation, capacity development, and quality service delivery. The MOH will update the CHWML guidelines in adherence to the data protection act which will inform standard procedures for maintaining, updating the registry and integrate Community Health Workforce registry with the HRH system.

Keywords: community health registry, community health volunteers (CHVs), community health workers masters list (CHWML), data protection act

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797 Need for a National Newborn Screening Programme in India: Pilot Study Data

Authors: Sudheer Moorkoth, Leslie Edward Lewis, Pragna Rao

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Newborn screening (NBS) is a part of routine newborn care in many countries worldwide to detect early any rare treatable conditions and inborn errors of metabolism (IEM). India has not started this program yet. In an attempt to understand the challenges in implementing a national newborn screening program in India, we initiated a pilot newborn screening project funded by the Government of Canada. Along with initiating the newborn screening at Kasturba Hospital, Manipal in South India, for screening six disorders (Congenital Hypothyroidism(CH), Congenital Adrenal Hyperplasia (CAH), Galactosemia, Biotinidase deficiency, Glucose-6-Phosphate Dehydrogenase deficiency (G-6PD) and Phenylketonurea), we also studied the awareness of various stakeholders on the newborn screening. In a period of nine months from August 2017 to March 2018 we could screen 1915 newborns (999 male and 916 female). The result showed that there were seven babies screened positive. This interim result points to an incidence rate of 1 in 270 children for these rare disorders collectively. This includes three confirmed cases of CH, two cases of G-6PD deficiency, and one case each for Galctosemia and CAH. A questionnaire based study to understand the awareness among various stakeholders revealed that there is little awareness among parents, adolescents and anganwadi workers (public health worker). The interim data points to the need for a national newborn screening programme in India. There is also an immediate need to undertake large-scale awareness programme to create knowledge on NBS among the various stakeholders.

Keywords: awareness, inborn errors of metabolism (IEM), newborn screening, rare disease

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796 An Appraisal of Mining Sector Corporate Social Responsibility Processes in Mhondoro-Ngezi, Zimbabwe

Authors: A. T. Muruviwa

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To-date, the discourse on corporate social responsibility (CSR) has primarily centred on the actions and inactions of corporations; hence, the dominant focus on CSR has been on impacts and outcomes. The obscuring effect of this approach has, arguably, resulted in the emergence of what may be termed a ‘Northern’ agenda on CSR theory and practice, in contrast to an emergency ‘Southern’ discourse, which appears to highlight the crucial issues of poverty reduction, infrastructure development and the broader questions of social provisioning and community empowerment. Some scholars have explicitly called for a CSR research agenda that focuses on the 'reciprocal duties' of the stakeholders in the CSR process rather than fixate on the actions and inactions of business. It is against the backdrop of these contestations that this study assesses the reciprocal relationships amongst CSR stakeholders in a Zimbabwean platinum mining town, with a view to demonstrating how such relationships – and the expectations and obligations embedded in them – impact on the success or failure of CSR initiatives. The existence of mutual relations between the corporation and its stakeholders signifies the successes of CSR processes and hence the outcomes. The company is Zimplats Mining Company; the community is Mhondoro-Ngezi, and the stakeholders are clearly identified in the study. The study utilised a triangulated design, with data collected using a mini survey, focus groups, in-depth interview and observation. The key findings are that the CSR process in the study community is dominated by the mining company. Despite the existence of a CSR framework that recognises government, local leaders and community members as legitimate stakeholders, there is little evidence of concrete contributions made by these stakeholders towards the realisation of CSR objectives. As a result, the community development process – in so far as CSR is concerned – fails to address the developmental concerns of the various stakeholders. On the basis of these findings, the study concludes that there is a crisis of reciprocity in the CSR process in Mhondoro-Ngezi, and that a situation where the conceptualisation of local development needs and the deployment of specific development tools seems to be driven by one stakeholder almost to the exclusion of all others, can only present contradictory development outcomes. The significance of this study is that it allows for the development of a more nuanced and robust CSR discourse. Rather than focusing on the corporate and stakeholder perspectives and outcomes of CSR initiatives, this study examines the CSR- development nexus by interrogating the idea of reciprocal responsibility as a sin qua non to CSR success. This analytical strategy and focus allow the researcher to gain a clear understanding of how stakeholder relationships and duties influence CSR processes and also the overall outcome. At a more practical level, the findings of the study should help to shape the policy on corporate community relationships with a view to enhancing the role of mining in development.

Keywords: community development, processes, reciprocity, stakeholders

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795 Shariah Guideline on Value-Based Intermediation Implementation in the Light of Maqasid Shariah Analysis

Authors: Muhammad Izzam Bin Mohd Khazar, Ruqayyah Binti Mohamad Ali, Nurul Atiqah Binti Yusri

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Value-based intermediation (VBI) has been introduced by Bank Negara Malaysia (BNM) as the next strategic direction and growth driver for Islamic banking institutions. The aim of VBI is to deliver the intended outcome of Shariah through practices, conducts, and offerings that generate positive and sustainable impact to the economy, community and environment which is aligned to Maqasid Shariah in preserving the common interest of society by preventing harm and maximizing benefit. Hence, upon its implementation, VBI will experiment the current Shariah compliance treatment and revolutionise new policies and systems that can meritoriously entrench and convey the objectives of Shariah. However, discussion revolving VBI in the light of Maqasid analysis is still scarce hence further research needs to be undertaken. The idea of implementation of VBI vision into quantifiable Maqasid Shariah measurement is yet to be explored due to the nature of Maqasid that is variable. The contemporary scholars also have different views on the implementation of VBI. This paper aims to discuss on the importance of Maqasid Shariah in the current Islamic finance transactions by providing Shariah index measurement in the application of VBI. This study also intends to explore basic Shariah guidelines and parameters based on the objectives of Shariah; preservation of the five pillars (religion, life, progeny, intellect and wealth) with further elaboration on preservation of wealth under five headings: rawaj (circulation and marketability); wuduh (transparency); hifz (preservation); thabat (durability and tranquillity); and ‘adl (equity and justice). In alignment with these headings, Islamic finance can be innovated for VBI implementation, particularly in Maybank Islamic being a significant leader in the IFI market.

Keywords: Islamic Financial Institutions, Maqasid Index, Maqasid Shariah, sustainability, value-based intermediation

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794 Primary Level Teachers’ Response to Gender Representation in Textbook Contents

Authors: Pragya Paneru

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This paper explores ten primary teachers’ views on gender representation in primary-level textbooks altogether. Data was collected from the teachers who taught in private schools in Kailali and Kathmandu District. This research uses a semi-structured interview method to obtain information regarding teachers’ attitudes toward gender representations in textbook content. The interview data were analysed by using critical skills of qualitative research analysis methods, as suggested by Saldana and Omasta (2018). The findings revealed that most of the teachers were unaware and regarded gender issues as insignificant to discuss in primary-level classes. Most of them responded to the questions personally and claimed that there were no gender issues in their classrooms. Some of the teachers connected gender issues with contexts other than textbook representations, such as school discrimination in the distribution of salary among male and female teachers, school practices of awarding girls rather than boys as the most disciplined students, following girls’ first rule in the assembly marching, encouraging only girls in the stage shows, and involving students in gender-specific activities such as decorating works for girls and physical tasks for boys. The interview also revealed teachers’ covert gendered attitudes in their remarks. Nevertheless, most of the teachers accepted that gender-biased contents have an impact on learners, and this problem can be solved with more gender-centred research in the education field, discussions, and training to increase awareness regarding gender issues. Agreeing with the suggestion of teachers, this paper recommends proper training and awareness regarding how to confront gender issues in textbooks.

Keywords: content analysis, gender equality, school education, critical awareness

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793 Risperidone for the Treatment of Retentive Fecal Incontinence in Children and Adolescents: A Randomize Clinical Trial

Authors: Ghazal Zahed, Leila Tabatabaee, Amirhossein Hosseini, Somaye Fatahi

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Functional retentive overflow incontinence (Retentive FI) is the most common cause of fecal soiling in children. Affected patients may have more problems with their parents and peer group, self-esteem issues, and more psychiatric comorbidities than the general population. Therapeutic interventions for Retentive FI and related problems and comorbid conditions are needed at the same time. Based on the clinical experiences, patients with retentive FI and comorbid psychiatric disorders, were accelerated in their treatment of fecal incontinence when they were being treated with Risperidone for their psychiatric comorbidities, therefore this study was conducted to evaluate the effect of Risperidone in the treatment of Retentive FI in children and adolescents. In this double-blind randomized clinical trial, 136 patients aged 4-18 years eligible for the study were randomly divided into two groups receiving Risperidone and placebo. About half of these patients had newly diagnosed psychiatric disorders and were drug naïve, this was considered in their division. In addition to polyethylene glycol, all the participants received family counseling and education for withholding behaviors and related behavioral interventions, and nonpharmacological interventions for psychiatric comorbidities. A significant correlation was observed between the duration of treatment with risperidone and the presence of psychiatric comorbidities (P <0.001) for diurnal fecal incontinence. Based on our findings in this study, Risperidone, used commonly for psychiatric disorders in children and adolescents, may be useful in the treatment of retentive fecal incontinence in the presence of psychiatric comorbidities, and along with other interventions.

Keywords: Retentive Fecal Incontinence, Risperidone, Treatment, Pediatric, Encopresis, Atypical Antipsychotics, Fecal Soiling

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792 Using Dynamic Glazing to Eliminate Mechanical Cooling in Multi-family Highrise Buildings

Authors: Ranojoy Dutta, Adam Barker

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Multifamily residential buildings are increasingly being built with large glazed areas to provide tenants with greater daylight and outdoor views. However, traditional double-glazed window assemblies can lead to significant thermal discomfort from high radiant temperatures as well as increased cooling energy use to address solar gains. Dynamic glazing provides an effective solution by actively controlling solar transmission to maintain indoor thermal comfort, without compromising the visual connection to outdoors. This study uses thermal simulations across three Canadian cities (Toronto, Vancouver and Montreal) to verify if dynamic glazing along with operable windows and ceiling fans can maintain the indoor operative temperature of a prototype southwest facing high-rise apartment unit within the ASHRAE 55 adaptive comfort range for a majority of the year, without any mechanical cooling. Since this study proposes the use of natural ventilation for cooling and the typical building life cycle is 30-40 years, the typical weather files have been modified based on accepted global warming projections for increased air temperatures by 2050. Results for the prototype apartment confirm that thermal discomfort with dynamic glazing occurs only for less than 0.7% of the year. However, in the baseline scenario with low-E glass there are up to 7% annual hours of discomfort despite natural ventilation with operable windows and improved air movement with ceiling fans.

Keywords: electrochromic glazing, multi-family housing, passive cooling, thermal comfort, natural ventilation

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791 A Pilot Study on Integration of Simulation in the Nursing Educational Program: Hybrid Simulation

Authors: Vesile Unver, Tulay Basak, Hatice Ayhan, Ilknur Cinar, Emine Iyigun, Nuran Tosun

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The aim of this study is to analyze the effects of the hybrid simulation. In this simulation, types standardized patients and task trainers are employed simultaneously. For instance, in order to teach the IV activities standardized patients and IV arm models are used. The study was designed as a quasi-experimental research. Before the implementation an ethical permission was taken from the local ethical commission and administrative permission was granted from the nursing school. The universe of the study included second-grade nursing students (n=77). The participants were selected through simple random sample technique and total of 39 nursing students were included. The views of the participants were collected through a feedback form with 12 items. The form was developed by the authors and “Patient intervention self-confidence/competence scale”. Participants reported advantages of the hybrid simulation practice. Such advantages include the following: developing connections between the simulated scenario and real life situations in clinical conditions; recognition of the need for learning more about clinical practice. They all stated that the implementation was very useful for them. They also added three major gains; improvement of critical thinking skills (94.7%) and the skill of making decisions (97.3%); and feeling as if a nurse (92.1%). In regard to the mean scores of the participants in the patient intervention self-confidence/competence scale, it was found that the total mean score for the scale was 75.23±7.76. The findings obtained in the study suggest that the hybrid simulation has positive effects on the integration of theoretical and practical activities before clinical activities for the nursing students.

Keywords: hybrid simulation, clinical practice, nursing education, nursing students

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790 A Varicella Outbreak in a Highly Vaccinated School Population in Voluntary 2-Dose Era in Beijing, China

Authors: Chengbin Wang, Li Lu, Luodan Suo, Qinghai Wang, Fan Yang, Xu Wang, Mona Marin

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Background: Two-dose varicella vaccination has been recommended in Beijing since November 2012. We investigated a varicella outbreak in a highly vaccinated elementary school population to examine transmission patterns and risk factors for vaccine failure. Methods: A varicella case was defined as an acute generalized maculopapulovesicular rash without other apparent cause in a student attending the school from March 28 to May 17, 2015. Breakthrough varicella was defined as varicella >42 days after last vaccine dose. Vaccination information was collected from immunization records. Information on prior disease and clinical presentation was collected via survey of students’ parents. Results: Of the 1056 school students, 1028 (97.3%) reported no varicella history, of whom 364 (35.4%) had received 1-dose and 650 (63.2%) had received 2-dose varicella vaccine, for 98.6% school-wide vaccination coverage with ≥ 1 dose before the outbreak. A total of 20 cases were identified for an overall attack rate of 1.9%. The index case was in a 2-dose vaccinated student who was not isolated. The majority of cases were breakthrough (19/20, 95%) with attack rates of 7.1% (1/14), 1.6% (6/364) and 2.0% (13/650) among unvaccinated, 1-dose, and 2-dose students, respectively. Most cases had < 50 lesions (18/20, 90%). No difference was found between 1-dose and 2-dose breakthrough cases in disease severity or sociodemographic factors. Conclusion: Moderate 2-dose varicella vaccine coverage was insufficient to prevent a varicella outbreak. Two-dose breakthrough varicella is still contagious. High 2-dose varicella vaccine coverage and timely isolation of ill persons might be needed for varicella outbreak control in the 2-dose era.

Keywords: varicella, outbreak, breakthrough varicella, vaccination

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789 Baby Boomers and Millennials: Creating a Specialized Orientation Program

Authors: K. Rowan

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In this paper, the author will discuss how developing a specialized orientation has improved nursing satisfaction and decrease the incidence of incivility among staff. With the predicted shortages in nursing, we must provide an environment that reflects the needs of the current workforce while also focusing on the sustainability of nursing. Each generation has different qualities and methods in which he or she prefers to learn. The Baby Boomer has a desire to share their knowledge. They feel that the quality of undergraduate nursing education has declined. Millennials have grown up with 'helicopter parents' and expect the preceptor to behave in the same manner. This information must be shared with the Baby Boomer, as it is these staff members who are passing the torch of perioperative nursing. Currently, nurse fellows are trained with the Association of periOperative Nurse’s Periop 101 program, with a didactic and clinical observation program. There is no specialized perioperative preceptor program. In creation of a preceptor program, the concept of Novice to Expert, communication techniques, dealing with horizontal violence and generational gap education is reviewed with the preceptor. The fellows are taught communication and de-escalation skills, and generational gaps information. The groups are then brought together for introductions and teamwork exercises. At the program’s core is the knowledge of generational differences. The preceptor training has increased preceptor satisfaction, as well as the new nurse fellows. The creation of a specialized education program has significantly decreased incivility amongst our nurses, all while increasing nursing satisfaction and improving nursing retention. This model of program can translate to all nursing specialties and assist in overcoming the impending shortage.

Keywords: baby boomers, education, generational gap, millennials, nursing, perioperative

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788 Numerical and Sensitivity Analysis of Modeling the Newcastle Disease Dynamics

Authors: Nurudeen Oluwasola Lasisi

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Newcastle disease is a highly contagious disease of birds caused by a para-myxo virus. In this paper, we presented Novel quarantine-adjusted incident and linear incident of Newcastle disease model equations. We considered the dynamics of transmission and control of Newcastle disease. The existence and uniqueness of the solutions were obtained. The existence of disease-free points was shown, and the model threshold parameter was examined using the next-generation operator method. The sensitivity analysis was carried out in order to identify the most sensitive parameters of the disease transmission. This revealed that as parameters β,ω, and ᴧ increase while keeping other parameters constant, the effective reproduction number R_ev increases. This implies that the parameters increase the endemicity of the infection of individuals. More so, when the parameters μ,ε,γ,δ_1, and α increase, while keeping other parameters constant, the effective reproduction number R_ev decreases. This implies the parameters decrease the endemicity of the infection as they have negative indices. Analytical results were numerically verified by the Differential Transformation Method (DTM) and quantitative views of the model equations were showcased. We established that as contact rate (β) increases, the effective reproduction number R_ev increases, as the effectiveness of drug usage increases, the R_ev decreases and as the quarantined individual decreases, the R_ev decreases. The results of the simulations showed that the infected individual increases when the susceptible person approaches zero, also the vaccination individual increases when the infected individual decreases and simultaneously increases the recovery individual.

Keywords: disease-free equilibrium, effective reproduction number, endemicity, Newcastle disease model, numerical, Sensitivity analysis

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787 Pattern and Clinical Profile of Children and Adolescent Visiting Psychiatry Out Patient Department of Tertiary Health Center Amidst COVID Pandemic- a Cross Sectional Study

Authors: Poornima Khadanga, Gaurav Pawar, Madhavi Rairikar

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Background: The COVID 19 pandemic, with its unparalleled mental health repercussions, has impacted people globally and has catalyzed a Mental Health pandemic among the youth. The detrimental effects on mental health needs to be pondered at the earliest. Aims: To study the behavioral problems among children and adolescents visiting Psychiatry Outpatient Department Tertiary Health Care during COVID pandemic and its correlation with socio-demographic profiles. Methods: A cross sectional study was conducted by interviewing 120 participants between 4 to 17 years of age and their parents, visiting Psychiatry OPD. Behavioral problems were assessed using the Strength and Difficulties Questionnaire and diagnosed by DSM-5. Statistical analysis was done by SPSS-21. Results: Male participants showed significant association with conduct (t=2.36, p=0.02) and hyperactive problems (t=5.07, p<0.05). Increase in screen time showed a positive correlation with conduct problems (r=0.22. p=0.02). Attention Deficit Hyperkinetic Disorder (18.3%) was the most commonly diagnosed psychiatric illness. Total difficulty score was significantly associated with difficult temperament (F=68.69, p<0.05). Conclusion: The study brings to light the pattern of behavioral problems that emerged during recent times of uncertainties among the young ones, including those with special needs. The increase in disruptive behaviors with increase screen time needs to be addressed at the earliest.

Keywords: behavioral problems, pandemic, screen time, temperament

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786 The Negative Impact of the SARS-CoV-2 Pandemic on Maternal and Child Health, Considering Maternal Experiences of Abuse and Neglect in Childhood

Authors: Franziska Köhler-Dauner, Inka Mayer, Lara Hart, Ute Ziegenhain, Jörg M. Fegert

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Preventive isolation and social distancing strategies during the SARS-CoV-2 pandemic have confronted families with a variety of different restrictions and stresses. Especially during this stressful time, children need a stable parental home to avoid developmental disorders. Additional risk factors such as maternal childhood abuse and neglect (CM) experiences may influence mothers' psychosomatic health (pG) and children's physical well-being (kW) during times of increased stress. Our aim was to analyse the interaction between maternal CM, maternal pG and children's kW during the pandemic. Mothers from a well-documented birth cohort to study transgenerational transmission of CM, were included in an online 'pandemic' survey assessing maternal pG and children's physical health during the pandemic. Our mediation analysis showed a significant positive association between the extent of maternal CM experiences, mothers' psychosomatic symptoms and their children's kW. Maternal psychosomatic symptoms significantly mediate the interaction between CM and children's kW; the direct effect remains non-significant when maternal psychosomatic symptoms are included as mediators. Maternal CM appears to be a relevant risk factor for maternal pG and children's kW during the pandemic. Maternal CM experiences seem to influence the way parents cope with stressful situations and increase the risk of suffering from depressive symptoms. The latter also affect their children's kW. Our findings underline the importance of carefully assessing the specific situation of families with children and offering individually adapted help to help families survive the pandemic.

Keywords: pandemic, maternal health, child health, abuse, neglect, maternal experiences

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785 Investigating the Use of English Arabic Codeswitching in EFL classroom Oral Discourse Case study: Middle school pupils of Ain Fekroun, Wilaya of Oum El Bouaghi Algeria

Authors: Fadila Hadjeris

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The study aims at investigating the functions of English-Arabic code switching in English as a foreign language classroom oral discourse and the extent to which they can contribute to the flow of classroom interaction. It also seeks to understand the views, beliefs, and perceptions of teachers and learners towards this practice. We hypothesized that code switching is a communicative strategy which facilitates classroom interaction. Due to this fact, both teachers and learners support its use. The study draws on a key body of literature in bilingualism, second language acquisition, and classroom discourse in an attempt to provide a framework for considering the research questions. It employs a combination of qualitative and quantitative research methods which include classroom observations and questionnaires. The analysis of the recordings shows that teachers’ code switching to Arabic is not only used for academic and classroom management reasons. Rather, the data display instances in which code switching is used for social reasons. The analysis of the questionnaires indicates that teachers and pupils have different attitudes towards this phenomenon. Teachers reported their deliberate switching during EFL teaching, yet the majority was against this practice. According to them, the use of the mother has detrimental effects on the acquisition and the practice of the target language. In contrast, pupils showed their preference to their teachers’ code switching because it enhances and facilitates their understanding. These findings support the fact that the shift to pupils’ mother tongue is a strategy which aids and facilitates the teaching and the learning of the target language. This, in turn, necessitates recommendations which are suggested to teachers and course designers.

Keywords: bilingualism, codeswitching, classroom interaction, classroom discourse, EFL learning/ teaching, SLA

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784 A Case of Osteopetrosis Diagnosed with Nystagmus

Authors: Zerrin Orbak, Busra Demir

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Osteopetrosis is a rare genetic disease characterized by impaired bone resorption and increased bone sclerosis. Clinical presentation is very different in osteopetrosis. It can be asymptomatic or can be seen with typical symptoms. Here, a case of osteopetrosis was presented when evaluated for nystagmus. She was 10 months old. Parents were second-degree relatives. On physical examination, pigeon chest deformity and horizontal nystagmus were observed. There was a failure of thrive but no fracture. The cardiovascular examination was normal. Cranial, vertebral and long bone roentgenograms revealed characteristic deformities of osteopetrosis and diffuse sclerosis. The diagnosis was confirmed by genetic testing. A Homozygous mutation was detected in the TNFRSF11A gene (c.508A>G p.(Arg170Gly)). RANKL is encoded by the tumor necrosis factor ligand superfamily member 11 (TNFSF11) gene, and the binding to its receptor RANK, encoded by the TNFRSF11A gene, determines the activation of the downstream pathway that drives osteoclast differentiation and activation (51). The complete absence of osteoclasts is the key feature of the osteoclast-poor form of osteopetrosis (46). Patients are characterized by the absence of TRAP-positive osteoclasts in bone biopsies. The osteoclast-poor subtype of osteopetrosis caused by mutations in TNFSF11 gene is ultra-rare in humans. Clinical presentation is usually severe, with onset in early infancy or in fetal life. But here, a case was presented with horizontal nystagmus. A case presented with horizontal nystagmus, which was evaluated by neurology and diagnosed incidentally, was shared.

Keywords: osteopetrosis, nystagmus, bone, osteoclast-poor

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783 Fear-Mongering and Its Antidotes: The Case of the Hungarian Anti-Migrant Campaign

Authors: Zsofia Nagy

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A sharp increase in the number of refugees crossing Hungary during 2015, coupled with the Hungarian government’s agenda-setting strategy led to a powerful anti-migrant campaign in public, framing asylum-seekers as external threats to the country. While this campaign was, by and large, unchallenged by the Hungarian parliamentary opposition, Two-Tailed Dog Party, a Hungarian mock-party launched a counter-billboard campaign attacking the governmental discourse. Taking the latter as a case of digitally supported civic action, the paper first discusses two theoretical problems related to contemporary social movements: the problem of voice and the problem of participation. Afterward the paper presents the case of the Hungarian anti-migrant billboard campaign led by the government and the counter-billboard campaign and examines their action repertoires. It argues that a number of strategic differences are noteworthy: contrasts between traditional and digital methods, the reliance on the ’spirals of silence’ on the one hand and the breaking of this very silence on the other, where people are holding a minority opinion were given a platform and visibility in public. On a deeper level, the counter-campaign challenged the hegemonic views about public discourse. It effectively contrasted the government’s one-to-many, top-bottom approach to political communication with a campaign that relied on many-to-many communication and a bottom-up approach. While it is true that through memetic engineering, the original governmental messages were altered and the outcomes were brought back to the streets of Hungary; the effects of the two campaigns nevertheless reinforced the original anti-migrant focus of the political agenda.

Keywords: counterpublics, migration, refugees, social movements

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782 Views from Shores Past: Palaeogeographic Reconstructions as an Aid for Interpreting the Movement of Early Modern Humans on and between the Islands of Wallacea

Authors: S. Kealy, J. Louys, S. O’Connor

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The island archipelago that stretches between the continents of Sunda (Southeast Asia) and Sahul (Australia - New Guinea) and comprising much of modern-day Indonesia as well as Timor-Leste, represents the biogeographic region of Wallacea. The islands of Wallaea are significant archaeologically as they have never been connected to the mainlands of either Sunda or Sahul, and thus the colonization by early modern humans of these islands and subsequently Australia and New Guinea, would have necessitated some form of water crossings. Accurate palaeogeographic reconstructions of the Wallacean Archipelago for this time are important not only for modeling likely routes of colonization but also for reconstructing likely landscapes and hence resources available to the first colonists. Here we present five digital reconstructions of coastal outlines of Wallacea and Sahul (Australia and New Guinea) for the periods 65, 60, 55, 50, and 45,000 years ago using the latest bathometric chart and a sea-level model that is adjusted to account for the average uplift rate known from Wallacea. This data was also used to reconstructed island areal extent as well as topography for each time period. These reconstructions allowed us to determine the distance from the coast and relative elevation of the earliest archaeological sites for each island where such records exist. This enabled us to approximate how much effort exploitation of coastal resources would have taken for early colonists, and how important such resources were. These reconstructions also allowed us to estimate visibility for each island in the archipelago, and to model how intervisible each island was during the period of likely human colonisation. We demonstrate how these models provide archaeologists with an important basis for visualising this ancient landscape and interpreting how it was originally viewed, traversed and exploited by its earliest modern human inhabitants.

Keywords: Wallacea, palaeogeographic reconstructions, islands, intervisibility

Procedia PDF Downloads 179
781 Investigating Effect of Geometrical Proportions in Islamic Architecture and Music

Authors: Amir Hossein Allahdadi

Abstract:

The mystical and intuitive look of Islamic artists inspired by the Koranic and mystical principles and also based on the geometry and mathematics has left unique works whose range extends across the borders of Islam. The relationship between Islamic art and music in the traditional art is of one of the concepts that can be traced back to the other arts by detection of its components. One of the links is the art of painting whose subtleties that can be applicable to both architecture and music. So, architecture and music links can be traced in other arts with a traditional foundation in order to evaluate the equivalents of traditional arts. What is the relationship between physical space of architecture and nonphysical space of music? What is musical architecture? What is the music that tends to architecture? These questions are very small samples of the questions that arise in this category, and these questions and concerns remain as long as the music is played and the architecture is made. Efforts have been made in this area, references compiled and plans drawn. As an example, we can refer to views of ‘Mansour Falamaki’ in the book of architecture and music, as well as the book transition from mud to heart by ‘Hesamodin Seraj’. The method is such that a certain melody is given to an architect and it is tried to design a specified architecture using a certain theme. This study is not to follow the architecture of a particular type of music and the formation of a volume based on a sound. In this opportunity, it is tried to briefly review the relationship between music and architecture in the Iranian original and traditional arts, using the basic definitions of arts. The musician plays, the architect designs, the actor forms his desired space and painter displays his multi-dimensional world in the form of two-dimensions. The expression language is different, but all of them can be gathered in a form, a form which has no clear boundaries. In fact, in any original art, the artist applies his art as a tool to express his insights which are nothing but achieving the world beyond this place and time.

Keywords: architecture, music, geometric proportions, mathematical proportions

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780 Variability of the X-Ray Sun during Descending Period of Solar Cycle 23

Authors: Zavkiddin Mirtoshev, Mirabbos Mirkamalov

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We have analyzed the time series of full disk integrated soft X-ray (SXR) and hard X-ray (HXR) emission from the solar corona during 2004 January 1 to 2009 December 31, covering the descending phase of solar cycle 23. We employed the daily X-ray index (DXI) derived from X-ray observations from the Solar X-ray Spectrometer (SOXS) mission in four different energy bands: 4-5.5; 5.5-7.5 keV (SXR) and 15-20; 20-25 keV (HXR). The application of Lomb-Scargle periodogram technique to the DXI time series observed by the Silicium detector in the energy bands reveals several short and intermediate periodicities of the X-ray corona. The DXI explicitly show the periods of 13.6 days, 26.7 days, 128.5 days, 151 days, 180 days, 220 days, 270 days, 1.24 year and 1.54 year periods in SXR as well as in HXR energy bands. Although all periods are above 70% confidence level in all energy bands, they show strong power in HXR emission in comparison to SXR emission. These periods are distinctly clear in three bands but somehow not unambiguously clear in 5.5-7.5 keV band. This might be due to the presence of Ferrum and Ferrum/Niccolum line features, which frequently vary with small scale flares like micro-flares. The regular 27-day rotation and 13.5 day period of sunspots from the invisible side of the Sun are found stronger in HXR band relative to SXR band. However, flare activity Rieger periods (150 and 180 days) and near Rieger period 220 days are very strong in HXR emission which is very much expected. On the other hand, our current study reveals strong 270 day periodicity in SXR emission which may be connected with tachocline, similar to a fundamental rotation period of the Sun. The 1.24 year and 1.54 year periodicities, represented from the present research work, are well observable in both SXR as well as in HXR channels. These long-term periodicities must also have connection with tachocline and should be regarded as a consequence of variation in rotational modulation over long time scales. The 1.24 year and 1.54 year periods are also found great importance and significance in the life formation and it evolution on the Earth, and therefore they also have great astro-biological importance. We gratefully acknowledge support by the Indian Centre for Space Science and Technology Education in Asia and the Pacific (CSSTEAP, the Centre is affiliated to the United Nations), Physical Research Laboratory (PRL) at Ahmedabad, India. This work has done under the supervision of Prof. Rajmal Jain and paper consist materials of pilot project and research part of the M. Tech program which was made during Space and Atmospheric Science Course.

Keywords: corona, flares, solar activity, X-ray emission

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779 Management in the Transport of Pigs to Slaughterhouses in the Valle De Aburrá, Antioquia

Authors: Natalia Uribe Corrales, María Fernanda Benavides Erazo, Santiago Henao Villegas

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Introduction: Transport is a crucial link in the porcine chain because it is considered a stressful event in the animal, due to it is a new environment, which generates new interactions, together with factors such as speed, noise, temperature changes, vibrations, deprivation of food and water. Therefore, inadequate handling at this stage can lead to bruises, musculoskeletal injuries, fatigue, and mortality, resulting in canal seizures and economic losses. Objective: To characterize the transport and driving practices for the mobilization of standing pigs directed to slaughter plants in the Valle de Aburrá, Antioquia, Colombia in 2017. Methods: A descriptive cross-sectional study was carried out with the transporters arriving at the slaughterhouses approved by National Institute for Food and Medicine Surveillance (INVIMA) during 2017 in the Valle de Aburrá. The process of obtaining the samples was made from probabilistic sampling. Variables such as journey time, mechanical technical certificate, training in animal welfare, driving speed, material, and condition of floors and separators, supervision of animals during the trip, load density and mortality were analyzed. It was approved by the ethics committee for the use and care of animals CICUA of CES University, Act number 14 of 2015. Results: 190 trucks were analyzed, finding that 12.4% did not have updated mechanical technical certificate; the transporters experience in pig’s transportation was an average of 9.4 years (d.e.7.5). The 85.8% reported not having received training in animal welfare. Other results were that the average speed was 63.04km/hr (d.e 13.46) and the 62% had floors in good condition; nevertheless, the 48% had bad conditions on separators. On the other hand, the 88% did not supervise their animals during the journey, although the 62.2% had an adequate loading density, in relation to the average mortality was 0.2 deaths/travel (d.e. 0.5). Conclusions: Trainers should be encouraged on issues such as proper maintenance of vehicles, animal welfare, obligatory review of animals during mobilization and speed of driving, as these poorly managed indicators generate stress in animals, increasing generation of injuries as well as possible accidents; also, it is necessary to continue to improve aspects such as aluminum floors and separators that favor easy cleaning and maintenance, as well as the appropriate handling in the density of load that generates animal welfare.

Keywords: animal welfare, driving practices, pigs, truck infrastructure

Procedia PDF Downloads 184
778 School Context-Related Factors That Affect Principals’ Instructional Leadership Competence at Primary Schools in Tarcha Town, Ethiopia

Authors: Godaye Gobena Gomiole

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The purpose of this study was to investigate school context-related factors that affect principals' instructional leadership competence in primary schools in Tarcha Town, Ethiopia. A qualitative case study research design was used. The data were collected through semi-structured interviews and document analysis. Twelve senior principals were included in the study through purposive sampling. Interviews were used to collect in-depth data. The data was analyzed thematically. The findings of the study indicated that primary school principals face both internal and external challenges. Internally, they face limited knowledge and skills, a lack of courage and commitment, and administrative work overload. Their external challenges included negative attitudes from parents and teachers, a lack of instructional materials, and little support from local education authorities. Consequently, they can't serve effectively as instructional leaders or resource people. Based on the findings, it is recommended that the Ministry of Education, South West Regional Education Bureau, Dawuro Zone Education Department, and Tarcha Town Administration Education Officers and Cluster Supervisors regularly monitor and support school leaders and prepare and provide pertinent teaching materials and training so that the principals can lead in the capacity that is appropriate for the position.

Keywords: instructional leadership, primary school, principals, school context related factors

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777 The Image of Victim and Criminal in Love Crimes on Social Media in Egypt: Facebook Discourse Analysis

Authors: Sherehan Hamdalla

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Egypt has experienced a series of terrifying love crimes in the last few months. This ‘trend’ of love crimes started with a young man caught on video slaughtering his ex-girlfriend in the street in the city of El Mansoura. The crime shocked all Egyptian citizens at all levels; unfortunately, not less than three similar crimes took place in other different Egyptian cities with the same killing trigger. The characteristics and easy access and reach of social media consider the reason why it is one of the most crucial online communication channels; users utilize social media platforms for sharing and exchanging ideas, news, and many other activities; they can freely share posts that reflect their mindset or personal views regarding any issues, these posts are going viral in all social media account by reposting or numbers of shares for these posts to support the content included, or even to attack. The repetition of sharing certain posts could mobilize other supporters with the same point of view, especially when that crowd’s online participation is confronting a public opinion case’s consequences. The death of that young woman was followed by similar crimes in other cities, such as El Sharkia and Port Said. These love crimes provoked a massive wave of contention among all social classes in Egypt. Strangely, some were supporting the criminal and defending his side for several reasons, which the study will uncover. Facebook, the most popular social media platform for Egyptians, reflects the debate between supporters of the victim and supporters of the criminal. Facebook pages were created specifically to disseminate certain viewpoints online, for example, asking for the maximum penalty to be given to criminals. These pages aimed to mobilize the maximum number of supporters and to affect the outcome of the trials.

Keywords: love crimes, victim, criminal, social media

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776 Beyond Informality: Relocation from a Traditional Village 'Mit Oqbah' to Masaken El-Barageel and the Role of ‘Urf in Governing Built Environment, Egypt

Authors: Sarah Eldefrawi, Maike Didero

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In Egypt, residents’ urban interventions (colloquially named A’hali’s interventions) are always tackled by government, scholars, and media as an encroachment (taeadiyat), chaotic (a’shwa’i) or informal (gheir mokanan) practices. This paper argues that those interventions cannot be simply described as an encroachment on public space or chaotic behaviour. We claim here that they are relevant to traditional governing methods (‘Urf) that were governing Arab cities for many decades. Through an in-depth field study conducted in a real estate public housing project in the city of Giza called 'Masaken El-Barageel', we traced the urban transformations demonstrated in private and public spaces. To understand those transformations, we used wide-range of qualitative research methods such as semi-guided and informal interviews, observations and mapping of the built environment and the newly added interventions. This study was as well strengthened through the contributions of the author in studying nine sectors emerging by Ahali in six districts in Great Cairo. The results of this study indicate that a culturally and socially sensitive framework has to be related to the individual actions toward the spatial and social structures as well as to culturally transmitted views and meanings connected with 'Urf'. The study could trace three crucial principals in ‘urf that influenced these interventions; the eliminating of harm (Al-Marafiq wa Man’ al-Darar), the appropriation of space (Haqq el-Intefa’) and public interest (maslaha a’ma). Our findings open the discussion for the (il) legitimate of a’hali governing methods in contemporary cities.

Keywords: Urf, urban governance, public space, public housing, encroachments, chaotic, Egyptian cities

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775 Criminal Law and Internet of Things: Challenges and Threats

Authors: Celina Nowak

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The development of information and communication technologies (ICT) and a consequent growth of cyberspace have become a reality of modern societies. The newest addition to this complex structure has been Internet of Things which is due to the appearance of smart devices. IoT creates a new dimension of the network, as the communication is no longer the domain of just humans, but has also become possible between devices themselves. The possibility of communication between devices, devoid of human intervention and real-time supervision, generated new societal and legal challenges. Some of them may and certainly will eventually be connected to criminal law. Legislators both on national and international level have been struggling to cope with this technologically evolving environment in order to address new threats created by the ICT. There are legal instruments on cybercrime, however imperfect and not of universal scope, sometimes referring to specific types of prohibited behaviors undertaken by criminals, such as money laundering, sex offences. However, the criminal law seems largely not prepared to the challenges which may arise because of the development of IoT. This is largely due to the fact that criminal law, both on national and international level, is still based on the concept of perpetration of an offence by a human being. This is a traditional approach, historically and factually justified. Over time, some legal systems have developed or accepted the possibility of commission of an offence by a corporation, a legal person. This is in fact a legal fiction, as a legal person cannot commit an offence as such, it needs humans to actually behave in a certain way on its behalf. Yet, the legislators have come to understand that corporations have their own interests and may benefit from crime – and therefore need to be penalized. This realization however has not been welcome by all states and still give rise to doubts of ontological and theoretical nature in many legal systems. For this reason, in many legislations the liability of legal persons for commission of an offence has not been recognized as criminal responsibility. With the technological progress and the growing use of IoT the discussions referring to criminal responsibility of corporations seem rather inadequate. The world is now facing new challenges and new threats related to the ‘smart’ things. They will have to be eventually addressed by legislators if they want to, as they should, to keep up with the pace of technological and societal evolution. This will however require a reevaluation and possibly restructuring of the most fundamental notions of modern criminal law, such as perpetration, guilt, participation in crime. It remains unclear at this point what norms and legal concepts will be and may be established. The main goal of the research is to point out to the challenges ahead of the national and international legislators in the said context and to attempt to formulate some indications as to the directions of changes, having in mind serious threats related to privacy and security related to the use of IoT.

Keywords: criminal law, internet of things, privacy, security threats

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774 Lumbar Punctures: Re-Audit of Procedure Documentation Following the Introduction of a Standardised Procedure Checklist

Authors: Hayley Lawrence, Nabi Shah, Sarah Dyer

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

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

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773 Breaking Barriers: Utilizing Innovation to Improve Educational Outcomes for Students with Disabilities

Authors: Emily Purdom, Rachel Robinson

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As the number of students worldwide requiring speech-language therapy, occupational therapy and mental health services during their school day increases, innovation is becoming progressively more important to meet the demand. Telepractice can be used to reach a greater number of students requiring specialized therapy while maintaining the highest quality of care. It can be provided in a way that is not only effective but ultimately more convenient for student, teacher and therapist without the added burden of travel. Teletherapy eradicates many hurdles to traditional on-site service delivery and helps to solve the pervasive shortage of certified professionals. Because location is no longer a barrier to specialized education plans for students with disabilities when teletherapy is conducted, there are many advantages that can be deployed. Increased frequency of engagement is possible along with students receiving specialized care from a clinician that may not be in their direct area. Educational teams, including parents, can work together more easily and engage in face-to-face, student-centered collaboration through videoconference. Practical strategies will be provided for connecting students with qualified therapists without the typical in-person dynamic. In most cases, better therapy outcomes are going to be achieved when treatment is most convenient for the student and educator. This workshop will promote discussion in the field of education to increase advocacy for remote service delivery. It will serve as a resource for those wanting to expand their knowledge of options for students with special needs afforded through innovation.

Keywords: education technology, innovation, student support services, telepractice

Procedia PDF Downloads 219