Search results for: interpret children's drawings

Authors: Meilan Jin, Mary Jane Moran

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This study aims to introduce the framework of culturally responsive home visiting (CRHV) to head start teacher professional sessions in the Southeastern of the US and investigate its influence on the evolving beliefs of teachers about their roles and relationships with families in-home visits. The framework orients teachers to an effective way of taking on the role of learner to listen for spoken and unspoken needs and look for family strengths. In addition, it challenges the deficit model that is grounded on 'cultural deprivation,' and it stresses the value of family cultures and advocates equal, collaborative parent-teacher relationships. The home visit reflection papers and focus group transcriptions of eight teachers have been collected since 2010 throughout a five-year longitudinal collaboration with them. Reflection papers were written by the teachers before and after introducing the CRHV framework, including the details of visit purposes and actions and their plans for later home visits. Particularly, the CRHV framework guided the teachers to listen and look for information about family-living environments; parent-child interactions; child-rearing practices; and parental beliefs, values, and needs. Two focus groups were organized in 2014 by asking the teachers to read their written reflection papers and then discussing their shared beliefs and experiences of home visits in recent years. The average length of the discussions was one hour, and the discussions were audio-recorded and transcribed verbatim. Moreover, the data were analyzed using constant comparative analysis, and the analysis was verified through (a) the uses of multiple data sources, (b) the involvement of multiple researchers, (c) coding checks, and (d) the provisions of the thick descriptions of the findings. The study findings corroborate that the teachers become to reposition themselves as 'knowledge seekers' through reorienting their cynosure toward 'setting stones' to learn, grow, and change rather than framing their home visits. The teachers also continually engage in careful listening, observing, questioning, and dialoguing, and these actions reflect their care toward parents. The value of teamwork with parents is advocated, and the teachers recognize that when parents feel empowered, they are active and committed to doing more for their children, which can further advantage proactive long-term parent-teacher collaborations. The study findings also validate that the framework is influential for educators to provide the experiences of home visiting that is culturally responsive and to share collaborative relationships with caregivers. The long-term impact of the framework further implies that teachers continue to put themselves in the position of evolving, including beliefs and actions, to better work with children and families who are culturally, ethnically, and linguistically different from them. This framework can be applicable to educators and professionals who are looking for avenues to bridge the relationship between home and school and parents and teachers.

Keywords: culturally responsive home visit, early childhood education, parent–teacher collaboration, teacher professional development

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Authors: Banu Baybars Hawks

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To date, academic attention in social sciences remains inadequate with regard to research and analysis of public opinion in Turkey. Most of the existing research has assessed the public opinion during political election periods. Therefore, it is of great interest to find out what the public thinks about current issues in Turkey, and how to interpret the results to be able to reveal whether they may have any reflections on social, political, and cultural structure of the country. Accordingly, the current study seeks to fill the gap in the social sciences literature in English regarding Turkey’s social and political stand which may be perceived to be very different by other nations. Without timely feedback from public surveys, various programs for improving different services and institutions functioning in the country might not achieve their expected goal, nor can decisions about which programs to implement be made rationally. Additionally, the information gathered may not only yield important insights into public’s opinion regarding current agenda in Turkey, but also into the correlates shaping public policies. Agenda-setting studies including agenda-building, agenda melding, reversed agenda-setting and information diffusion studies will be used to explain the roles of factors and actors in the formation of public opinion in Turkey. Knowing the importance of public agenda in the agenda setting and building process, this paper aims to reveal the social and political tendencies of the Turkish public. For that purpose, a survey will be carried out in December of 2014 to determine the social and political trends in Turkey for that same year. The subjects for the study, which utilize a questionairre in one-on-one interviews, will include 1,000 individuals aged 18 years and older from 26 cities representing general population. A stratified random sampling frame will be used. The topics covered by the survey include: The most important current problem in Turkey; the Economy; Terror; Approaches to the Kurdish Issue; Evaluations of the Government and Opposition Parties; Evaluations of Institutional Efficiency; Foreign Policy; the Judicial System/Constitution; Democracy and the Media; and, Social Relations/Life in Turkey. Since the beginning of the 21st century, Turkey has been undergoing a rapid transformation. The reflections of the changes can be seen in all areas from economics to politics. It is my hope that findings of this study may shed light on the important aspects of institutions, variables setting the agenda, and formation process of public opinion in Turkey.

Keywords: public opinion, media, agenda setting, information diffusion, government, freedom, Turkey

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Authors: Anju Vaidya

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Sanitation is concerned with proper disposal of human excreta, waste water and promotion of hygiene. Lack of sanitation impacts our environment affecting our finance, schooling, health, and thus exacerbating poverty, discrimination and exclusion of the marginalized group. Sanitation can be a route and one of the most important factor to reach the goals of all Millennium Development goals. This study aims at exploring what are the rights to sanitation of the people, how it is enacted and what challenges are being faced while implementing the right to sanitation in South-Asian countries (India, Nepal, Pakistan, Bangladesh, Srilanka) at government, non-government and international level. This study also aims at finding how right sanitation is interlinked with children rights. The available reports submitted by government and civil society organizations working in South-Asian countries from the website of the Office of High Commissioner for Human Rights that were submitted under International covenant on economic, social and cultural rights and Convention on rights of the child have been selected and analyzed. The study uses Literature review to analyze these UN documents submitted from 2000 to 2015 in the context of South-Asian countries. Preliminary insight reveals that sanitation is recognized as one of the important factor to attain adequate standard of living. It has been found that inadequate sanitation has been a major factor that affects all aspects of life and one of its devastating impacts is increased child mortality. Many efforts have been made at national and international level in South-Asian countries to improve the state of sanitation and sanitation services. Various approaches such as Community led Total Sanitation, School led Total Sanitation, establishing Open Defecation free zone, water supply services and other sanitation and hygiene awareness programs are being launched. Despite different efforts and programs being implemented, sanitation and hygiene practices and behavior change remains to be a big challenge. Disparity in access and imbalance between urban and rural services and geographical regions, inadequate financing, clear policy framework and fragile functionality are some of the significant challenges faced while implementing these programs. Children are one of the most vulnerable group that are affected to a large extent. The study brings into light varied approaches that are being made and challenges that are being faced by government, non-government and civil society organizations while implementing the programs and strategies related to sanitation. It also highlights the relation of sanitation as a human right with child rights. This can help the stakeholders and policymakers better understand that improving sanitation situation is a process that requires learning, planning and behavior change and achieving sanitation coverage targets and motivating behavior change requires additional tools based on participation, non-discrimination and process approaches for planning and feedback.

Keywords: challenges, child rights, open defecation, sanitation as a human right

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Authors: Sanjaya Humagain, Rajendra Koju

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Background: Rheumatic heart disease (RHD) is the most common cardiovascular disease in children and young adults. Though declined and almost non-existent in developed nations, RHD is still one of the leading cause for premature death and disability in developing countries. Prevalence of RHD is high in both rural as well as urban area of Nepal. Present study is designed to look at the pattern of valvular involvement and demographic features in RHD. Methods: 326 patients indicated for inj. Benzathine penicillin were selected and echocardiograph performed to see the pattern of vavular involvement. Data analysis was done using SPSS 17. Result: The most common type of lesion was mixed type with mitral valve involvement. MR was the most common isolated lesion. MS was more commonly seen in females whereas AS was more common in males. Secondary prophylaxis was more common than primary prophylaxis. Conclusion: RHD still being a major problem and a preventable disease so extensive screening program is required to identify them early and prevent the complication.

Keywords: acute rheumatic fever, RHD, MS, MR, AS, AR, Inj benzathine penicillin

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Authors: Beverly Black

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Background: Adolescent dating abuse (ADA) is widespread throughout the world and negatively impacts many adolescents. ADA is associated with lower self-esteem, poorer school performance, lower employment opportunities, higher rates of depression, absenteeism from school, substance abuse, bullying, smoking, suicide, pregnancy, eating disorders, and risky sexual behaviors, and experiencing domestic violence later in life. ADA prevention is sometimes addressed through school programming; yet, parental responses to ADA can also be an important vehicle for its prevention. In this exploratory study, the author examined how mothers, including abused mothers, responded to scenarios of ADA involving their children. Methods: Six focus groups were conducted between December, 2013 and June, 2014 with mothers (n=31) in the southern part of the United States. Three of the focus groups were comprised of mothers (n=17) who had been abused by their partners. Mothers were recruited from local community family agencies. Participants were provided a series of four scenarios about ADA and they were asked to explain how they would respond. Focus groups lasted approximately 45 minutes. All participants were given a gift card to a major retailer as a ‘thank you’. Using QSR-N10, two researchers’ analyzed the focus group data first using open and axial coding techniques to find overarching themes. Researchers triangulated the coded data to ensure accurate interpretations of the participants’ messages and used the scenario questions to structure the coded results. Results: Almost 30% of 699 comments coded as mothers’ recommendations for responding to ADA focused on the importance of providing advice to their children. Advice included breaking up, going to police, ignoring or avoiding the abusive partner, and setting boundaries in relationships. About 22% of comments focused on the need for educating teens about healthy and unhealthy relationships and seeking additional information. About 13% of the comments reflected the view that parents should confront abuser and/or abusers’ parents, and less than 2% noted the need to take their child to counseling. Mothers who had been abused offered similar responses as parents who had not experienced abuse. However, their responses were more likely to focus on sharing their own experience exercising caution in their responses, as they knew from their own experiences that authoritarian responses were ineffective. Over half of the comments indicated that parents would react stronger, quicker, and angrier if a girl was being abused by a boy than vice versa; parents expressed greater fear for their daughters than their sons involved in ADA. Conclusions. Results suggest that mothers have ideas about how to respond to ADA. Mothers who have been abused draw from their experiences and are aware that responding in an authoritarian manner may not be helpful. Because parental influence on teens is critical in their development, it is important for all parents to respond to ADA in a helpful manner to break the cycle of violence. Understanding responses to ADA can inform prevention programming to work with parents in responding to ADA.

Keywords: abused mothers' responses to dating abuse, adolescent dating abuse, mothers' responses to dating abuse, teen dating violence

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Authors: Ankita R. Bansal, Naren S. Burade

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Idea is to create a cloud based virtual lab for Deaf Students, “A language acquisition program using Visual Phonics and Cued Speech” using VMware Virtual Lab. This lab will demonstrate students the sounds of letters associated with the Language, building letter blocks, making words, etc Virtual labs are used for demos, training, for the Lingual development of children in their vernacular language. The main potential benefits are reduced labour and hardware costs, faster response times to users. Virtual Computing Labs allows any of the software as a service solutions, virtualization solutions, and terminal services solutions available today to offer as a service on demand, where a single instance of the software runs on the cloud and services multiple end users. VMWare, XEN, MS Virtual Server, Virtuoso, and Citrix are typical examples.

Keywords: visual phonics, language acquisition, vernacular language, cued speech, virtual lab

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Authors: Radul Shishkov, Orlin Davchev

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The digital era has revolutionized architectural practices, with building information modeling (BIM) emerging as a pivotal tool for architects, engineers, and construction professionals. However, the transition from traditional methods to BIM-centric approaches poses significant challenges, particularly in the context of existing structures. This research introduces a technical approach to bridge this gap through the development of algorithms that facilitate the automated transformation of 3D point cloud data into detailed BIM models. The core of this research lies in the application of algorithmic modeling and computational design methods to interpret and reconstruct point cloud data -a collection of data points in space, typically produced by 3D scanners- into comprehensive BIM models. This process involves complex stages of data cleaning, feature extraction, and geometric reconstruction, which are traditionally time-consuming and prone to human error. By automating these stages, our approach significantly enhances the efficiency and accuracy of creating BIM models for existing buildings. The proposed algorithms are designed to identify key architectural elements within point clouds, such as walls, windows, doors, and other structural components, and to translate these elements into their corresponding BIM representations. This includes the integration of parametric modeling techniques to ensure that the generated BIM models are not only geometrically accurate but also embedded with essential architectural and structural information. Our methodology has been tested on several real-world case studies, demonstrating its capability to handle diverse architectural styles and complexities. The results showcase a substantial reduction in time and resources required for BIM model generation while maintaining high levels of accuracy and detail. This research contributes significantly to the field of architectural technology by providing a scalable and efficient solution for the integration of existing structures into the BIM framework. It paves the way for more seamless and integrated workflows in renovation and heritage conservation projects, where the accuracy of existing conditions plays a critical role. The implications of this study extend beyond architectural practices, offering potential benefits in urban planning, facility management, and historic preservation.

Keywords: BIM, 3D point cloud, algorithmic modeling, computational design, architectural reconstruction

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Authors: Asiye Nisa Kartal

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An attempt to recognize the undiscovered bounds of Istiklal Street in Istanbul between its sensory experiences (intangible qualities) and physical setting (tangible qualities) could be taken as the first inspiration point for this study. ‘The dramatic physical changes’ and ‘their current impacts on sensory attributions’ of Istiklal Street have directed this study to consider the role of changing the physical layout on sensory dimensions which have a subtle but important role in the examination of urban places. The public places have always been subject to transformation, so in the last years, the changing socio-cultural structure, economic and political movements, law and city regulations, innovative transportation and communication activities have resulted in a controversial modification of Istanbul. And, as the culture, entertainment, tourism, and shopping focus of Istanbul, Istiklal Street has witnessed different changing stages within the last years. In this process, because of the projects being implemented, many buildings such as cinemas, theatres, and bookstores have restored, moved, converted, closed and demolished which have been significant elements in terms of the qualitative value of this area. And, the multi-layered socio-cultural, and architectural structure of Istiklal Street has been changing in a dramatical and controversial way. But importantly, while the physical setting of Istiklal Street has changed, the transformation has not been spatial, socio-cultural, economic; avoidably the sensory dimensions of Istiklal Street which have great importance in terms of intangible qualities of this area have begun to lose their distinctive features. This has created the challenge of this research. As the main hypothesis, this study claims that the physical transformations have led to change in the sensory characteristic of Istiklal Street, therefore the Sensescape of Istiklal Street deserve to be recorded, decoded and promoted as expeditiously as possible to observe the sensory reflections of physical transformations in this area. With the help of the method of ‘Sensewalking’ which is an efficient research tool to generate knowledge on sensory dimensions of an urban settlement, this study suggests way of ‘mapping’ to understand how do ‘changes of physical setting’ play role on ‘sensory qualities’ of Istiklal Street which have been changed or lost over time. Basically, this research focuses on the sensory mapping of Istiklal Street from the 1990s until today to picture, interpret, criticize the ‘sensory mapping of Istiklal Street in present’ and the ‘sensory mapping of Istiklal Street in past’. Through the sensory mapping of Istiklal Street, this study intends to increase the awareness about the distinctive sensory qualities of places. It is worthwhile for further studies that consider the sensory dimensions of places especially in the field of architecture.

Keywords: Istiklal street, sense, sensewalking, sensory mapping

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Authors: Adam Johnbull

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The paper discusses ICT in Education as a quest for quality learning in the 21st century. Education is the key that unlock the door to development, without adequate education of the citizenry, the development of a nation becomes a sham. Information Communication Technologies (ICTs) has revolutionized the way people work today and are now transforming education systems. As a result, if schools train children in yesterday’s skills and technologies they may not be effective and fit in tomorrow’s world. This is a sufficient reason for ICT’s to win global recognition and attention and thus ensure desire quality in our school system. Thus, the purpose of the paper is to discuss amongst others, what is ICT. The roles of ICT’s in education, limitation and key challenges of integrating ICT to education in the enhancement of student learning and experiences in other to encourage policy makers, school administrators and teachers pay the required attention to integrate this technology in the education system. The paper concludes that regardless of all the limitation characterizing it. ICT benefit education system to provide quality education in the 21st century.

Keywords: ICTs, quest, information, global, sham, century

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Authors: Evy Rombaut, Marie-Anne Guerry

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Predicting voluntary turnover of employees is an important topic of study, both in academia and industry. Researchers try to uncover determinants for a broader understanding and possible prevention of turnover. In the current study, we use a data set based approach to reveal determinants for turnover, differing for blue and white collar workers. Our data set based approach made it possible to study actual turnover for more than 500000 employees in 15692 Belgian corporations. We use logistic regression to calculate individual turnover probabilities and test the goodness of our model with the AUC (area under the ROC-curve) method. The results of the study confirm the relationship of known determinants to employee turnover such as age, seniority, pay and work distance. In addition, the study unravels unknown and verifies known differences between blue and white collar workers. It shows opposite relationships to turnover for gender, marital status, the number of children, nationality, and pay.

Keywords: employee turnover, blue collar, white collar, dataset analysis

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Authors: Okechukwu Odinaka Ajaegbu

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In the recent past, discussing about sex among children and youths was frowned at by traditional norms and as such sexual discussions and behavior were approached with great respect. Things are actually falling apart with the increasing number of young people that engage in premarital sex. Due to lack of experience and sex education, many young people are becoming increasingly exposed to the risk of HIV infection. In the light of the above, this study discussed premarital sex, HIV and use of condom among youths in Nigeria. Data for this study came from 2013 Nigeria Demographic and Health Survey and other secondary data. The survey revealed that only 18.5 percent of young women that had sex in the 12 months preceding the survey used condom. Out of 3306 never-married sexually active men and women, 1728 representing 52 percent live in urban areas and 43 percent of them did not use condom during sexual intercourse in the 12 months preceding the survey. This study concludes that for there to be reduction in prevalence of HIV/AIDS among Nigerian youths, there is need for concerted effort to be made towards educating youths on the expedient of the use of condom during sexual intercourse.

Keywords: condom, HIV, Nigeria, premarital sex, youths

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Authors: Amel Chenafa, Sihem Boulenouar, Linda Aoued, Imane Sediri, Ismahan Djebbar, Mohamed Adil Selka

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Introduction: The specialties intended for adults are often inadequate marketed for pediatric use, such as for a galenic form or in the dosage. For an industrial, development of a pediatric drug is confronted to various problems. So, the hospital pharmacies have to respond to adaptation needs of pharmaceutical forms for pediatric use. The objective of our work is to develop an oral form of prednisone for pediatric use since no adapted form to children is commercialized. Materials and Methods: Therefore an extemporaneous syrup of prednisone was prepared at the concentration of 0,5mg/ml from 5mg tablets and stored in amber glass bottles. Organoleptic and microbiological stability was studied in two temperatures: 5°C and 25°C, and evaluated at D0, D15, and D30. Results: No organoleptic changes have been detected on the syrup conserved at 25 and 5°C. The results show that there is no presence of bacteria, yeasts, and molds in the syrups stored at both temperatures during the analysis period. Conclusion: Sheltered from light, the developed syrup of prednisone remained stable at room temperature and/or refrigerator for 30 days.

Keywords: extemporaneous syrup, pediatric drug, prednisone, stability

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Authors: Ippei Torii, Kaoruko Ohtani, Takahito Niwa, Naohiro Ishii

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This paper shows developing an objectivity index using the measurement of subtle eyeball movement to diagnose autism. The developmentally disabled assessment varies, and the diagnosis depends on the subjective judgment of professionals. Therefore, a supplementary inspection method that will enable anyone to obtain the same quantitative judgment is needed. The diagnosis are made based on a comparison of the time of gazing an object in the conventional autistic study, but the results do not match. First, we divided the pupil into four parts from the center using measurements of subtle eyeball movement and comparing the number of pixels in the overlapping parts based on an afterimage. Then we developed the objective evaluation indicator to judge non-autistic and autistic people more clearly than conventional methods by analyzing the differences of subtle eyeball movements between the right and left eyes. Even when a person gazes at one point and his/her eyeballs always stay fixed at that point, their eyes perform subtle fixating movements (ie. tremors, drifting, microsaccades) to keep the retinal image clear. Particularly, the microsaccades link with nerves and reflect the mechanism that process the sight in a brain. We converted the differences between these movements into numbers. The process of the conversion is as followed: 1) Select the pixel indicating the subject's pupil from images of captured frames. 2) Set up a reference image, known as an afterimage, from the pixel indicating the subject's pupil. 3) Divide the pupil of the subject into four from the center in the acquired frame image. 4) Select the pixel in each divided part and count the number of the pixels of the overlapping part with the present pixel based on the afterimage. 5) Process the images with precision in 24 - 30fps from a camera and convert the amount of change in the pixels of the subtle movements of the right and left eyeballs in to numbers. The difference in the area of the amount of change occurs by measuring the difference between the afterimage in consecutive frames and the present frame. We set the amount of change to the quantity of the subtle eyeball movements. This method made it possible to detect a change of the eyeball vibration in numerical value. By comparing the numerical value between the right and left eyes, we found that there is a difference in how much they move. We compared the difference in these movements between non-autistc and autistic people and analyzed the result. Our research subjects consists of 8 children and 10 adults with autism, and 6 children and 18 adults with no disability. We measured the values through pasuit movements and fixations. We converted the difference in subtle movements between the right and left eyes into a graph and define it in multidimensional measure. Then we set the identification border with density function of the distribution, cumulative frequency function, and ROC curve. With this, we established an objective index to determine autism, normal, false positive, and false negative.

Keywords: subtle eyeball movement, autism, microsaccade, pursuit eye movements, ROC curve

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Authors: Samuel O. Oduyela

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Over the last ten years, many studies have examined the media coverage of terrorism across the world. Nevertheless, most of these studies have been inclined to the western narrative, more so in relation to the international media. This study departs from that partiality to explore the Nigerian press and its coverage of the Boko Haram. The study intends to illustrate how the Nigerian press has reported its homegrown terrorism within its borders. On 14 April 2014, the Shekau-led Boko Haram kidnapped over 200 female students from Chibok in the Borno State. This study analyses a structured sample of news stories, feature articles, editorial comments, and opinions from the Nation newspaper. The study examined the representation of the Chibok girls kidnaps by concentrating on four main viewpoints. The news framing of the Chibok girls’ kidnap under Presidents Goodluck Jonathan (2014) and Mohammadu Buhari (2016-2018), the sourcing model present in the news reporting of the kidnap and the challenges Nation reporters face in reporting Boko Haram. The study adopted the use of qualitative news framing analysis to provide further insights into significant developments established from the examination of news contents. The study found that the news reportage mainly focused on the government response to Chibok girls kidnap, international press and Boko Haram. Boko Haram was also framed, as a political conspiracy, as prevailing, and as instilling fear. Political, and economic influence appeared to be a significant determinant of the reportage. The study found that the Nation newspaper's portrayal of the crisis under President Jonathan differed significantly from under President Buhari. While the newspaper framed the action of President Jonathan as lacklustre, dismissive, and confusing, it was less critical of President Buhari's government's handling of the crisis. The Nation newspaper failed to promote or explore non-violent approaches. News reports of the kidnap, thus, were presented mainly from a political and ethnoreligious perspective. The study also raised questions of what roles should journalists play in covering conflicts? Should they merely report comments on and interpret it, or should they be actors in the resolution or, more importantly, the prevention of conflicts? The study underlined the need for the independence of the media, more training for journalists to advance a more nuanced and conflict-sensitive news coverage in the Nigerian context.

Keywords: boko haram, chibok girls kidnap, conflict in nigeria, media framing

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Authors: Leigh Ann Wilson, Melanie Borrego

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The purpose of institutional learning outcomes (ILOs) is to assess what students across the university know and what they do not. The issue is gathering this information in a systematic and usable way. This presentation will explain how one institution has engineered this process for both student success and maximum faculty curriculum and course design input. At Brandman University, there are three levels of learning outcomes: course, program, and institutional. Institutional Learning Outcomes (ILOs) are mapped to specific courses. Faculty course developers write the signature assignments (SAs) in alignment with the Institutional Learning Outcomes for each course. These SAs use a specific rubric that is applied consistently by every section and every instructor. Each year, the 12-member General Education Team (GET), as a part of their work, conducts the calibration and assessment of the university-wide SAs and the related rubrics for one or two of the five ILOs. GET members, who are senior faculty and administrators who represent each of the university's schools, lead the calibration meetings. Specifically, calibration is a process designed to ensure the accuracy and reliability of evaluating signature assignments by working with peer faculty to interpret rubrics and compare scoring. These calibration meetings include the full time and adjunct faculty members who teach the course to ensure consensus on the application of the rubric. Each calibration session is chaired by a GET representative as well as the course custodian/contact where the ILO signature assignment resides. The overall calibration process GET follows includes multiple steps, such as: contacting and inviting relevant faculty members to participate; organizing and hosting calibration sessions; and reviewing and discussing at least 10 samples of student work from class sections during the previous academic year, for each applicable signature assignment. Conversely, the commitment for calibration teams consist of attending two virtual meetings lasting up to three hours in duration. The first meeting focuses on interpreting the rubric, and the second meeting involves comparing scores for sample work and sharing feedback about the rubric and assignment. Next, participants are expected to follow all directions provided and participate actively, and respond to scheduling requests and other emails within 72 hours. The virtual meetings are recorded for future institutional use. Adjunct faculty are paid a small stipend after participating in both calibration meetings. Full time faculty can use this work on their annual faculty report for "internal service" credit.

Keywords: assessment, assurance of learning, course design, institutional learning outcomes, rubrics, signature assignments

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Authors: Shakhawan K. Mawlood, Catriona Pickard, Benjamin Pickard

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In summer 2015 the remains of 800 children are among 1,967 bodies were exhumed by archaeologists at St Peter's Burial Ground in Blackburn, Lancashire. One hundred samples from these 19th century ancient bones were selected for DNA analysis. These comprised samples biased for those which prior osteological evidence indicated a potential for microbial infection by Mycobacterium tuberculosis (causing tuberculosis, TB) or Treponema pallidum (causing Syphilis) species, as well a random selection of other bones for which visual inspection suggested good preservation (and, therefore, likely DNA retrieval).They were subject to polymerase chain reaction (PCR) assays aimed at detecting traces of DNA from infecting mycobacteria, with the purpose both of confirming the palaeopathological diagnosis of tuberculosis and determining in individual cases whether disease and death was due to M. tuberculosis or other reasons. Our secondary goal was to determine sex determination and age prediction. The results demonstrated that extraction of vast majority ancient bones DNA samples succeeded.

Keywords: ancient bone, DNA, tuberculosis, age prediction

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Authors: Lauren Dhugga, Meena Parameswaran, David Blundell, Abbas Khushnood

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Context: A multidisciplinary weekly safety briefing was implemented at the Paediatric Cardiothoracic Unit at the Freeman Hospital in Newcastle-upon-Tyne. It is a tertiary referral centre with a quarternary cardiac paediatric intensive care unit and provides complexed care including heart and lung transplants, mechanical support and advanced heart failure assessment. Aim: The aim of this briefing is to provide a structured platform of communication, in an effort to improve efficiency, safety, and patient care. Problem: The paediatric cardiothoracic unit is made up of a vast multidisciplinary team including doctors, intensivists, anaesthetists, surgeons, specialist nurses, echocardiogram technicians, physiotherapists, psychologists, dentists, and dietitians. It provides care for children with congenital and acquired cardiac disease and is one of only two units in the UK to offer paediatric heart transplant. The complexity of cases means that there can be many teams involved in providing care to each patient, and frequent movement of children between ward, high dependency, and intensive care areas. Currently, there is no structured forum for communicating important information across the department, for example, staffing shortages, prescribing errors and significant events. Strategy: An initial survey questioning the need for better communication found 90% of respondents agreed that they could think of an incident that had occurred due to ineffective communication, and 85% felt that incident could have been avoided had there been a better form of communication. Lastly, 80% of respondents felt that a weekly 60 second safety briefing would be beneficial to improve communication within our multidisciplinary team. Based on those promising results, a weekly 60 second safety briefing was implemented to be conducted on a Monday morning. The safety briefing covered four key areas (SAFE): staffing, awareness, fix and events. This was to highlight any staffing gaps, any incident reports to be learned from, any issues that required fixing and any events including teachings for the week ahead. The teams were encouraged to email suggestions or issues to be raised for the week or to approach in person with information to add. The safety briefing was implemented using change theory. Effect: The safety briefing has been trialled over 6 weeks and has received a good buy in from staff across specialties. The aim is to embed this safety briefing into a weekly meeting using the PDSA cycle. There will be a second survey in one month to assess the efficacy of the safety briefing and to continue to improve the delivery of information. The project will be presented at the next clinical governance briefing to attract wider feedback and input from across the trust. Lessons: The briefing displays promise as a tool to improve vigilance and communication in a busy multi-disciplinary unit. We have learned about how to implement quality improvement and about the culture of our hospital - how hierarchy influences change. We demonstrate how to implement change through a grassroots process, using a junior led briefing to improve the efficiency, safety, and communication in the workplace.

Keywords: briefing, communication, safety, team

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Authors: Shradha Parsekar, Suma Nair, Ajay Bailey, Binu V. S.

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Background: Concealing of cancer-related information is seen in many low-and-middle-income countries and may be associated with multiple factors. Comparatively, there is lack of information about, how breast cancers diagnosed women disclose cancer-related information to their social contacts and vice versa. To get more insights on the participant’s experience, opinions, expectations, and attitudes, a qualitative study is a suitable approach. Therefore, this study involving in-depth interviews was planned to lessen this gap. Methods: Interviews were conducted separately among breast cancer patients and their caregivers with semi-structured qualitative interview guide. Purposive and convenient sampling was being used to recruit patients and caregivers, respectively. Ethical clearance and permission from the tertiary hospital were obtained and participants were selected from the Udupi district, Karnataka, India. After obtaining a list of breast cancer diagnosed cases, participants were contacted in person and their willingness to take part in the study was taken. About 39 caregivers and 35 patients belonging to different breast cancer stages were recruited. Interviews were recorded with prior permission. Data was managed by Atlas.ti 8 software. The recordings were transcribed, translated and coded in two cycles. Most of the patients belonged to stage II and III cancer. Codes were grouped together into to whom breast cancer status was concealed to and underneath reason for the same. Main findings: followings are the codes and code families which emerged from the data. 1) Concealing the breast cancer status from social contacts other than close family members (such as extended family, neighbor and friends). Participants perceived the reasons as, a) to avoid questions which people probe (which doesn’t have answers), b) to avoid people paying courtesy visit (to inquire about the health as it is Indian culture to visit the sick person) making it inconvenient for patient and caregivers have to offer something and talk to them, c) to avoid people getting shocked (react as if cancer is different from other diseases) or getting emotional/sad, or getting fear of death d) to avoid getting negative suggestion or talking anything in front of patient as it may affect patient negatively, e) to avoid getting stigmatized, f) to avoid getting obstacle in child’s marriage. 2) Participant concealed the breast cancer status of young children as they perceived that it may a) affect studies, b) affect emotionally, c) children may get scared. 3) Concealing the breast cancer status from patients as the caregivers perceived that they have fear of a) worsening patient’s health, b) patient getting tensed, c) patient getting shocked, and d) patient getting scared. However, some participants stressed important in disclosing the cancer status to social contact/patient to make the people aware of the disease. Conclusion: The news of breast cancer spreads like electricity in the wire, therefore, patient or family avoid it for many reasons. Although, globally, due to physicians’ ethical obligations, there is an inclination towards more disclosure of cancer diagnosis and status of prognosis to the patient. However, it is an ongoing argument whether patient/social contacts should know the status especially in a country like India.

Keywords: breast cancer, concealing cancer status, India, qualitative study

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Authors: Rashed Shah, Jeanne Koepsell, Dixmer Rivera, Eric Swedberg, David Marsh

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Success of primary health care goals of health promotion and disease prevention may well be determined by community based health workers’ overall job satisfaction. It is also important to understand the ways community health workers perceive their jobs and the importance they give to the various factors influencing their job satisfaction, which is critical before making a decision for task-shifting and for expanding their scope of work. Although brigadistas are unpaid volunteers, they are formally recognized and receive support and supervision from the Ministry of Health in Nicaragua. Brigadistas are responsible for classifying and diagnosing illnesses, administering treatment, counseling mothers and care givers within the community, encouraging referral in case of serious illness and making follow-up visits at home. Some brigadistas provide more technically advanced services, including treatment for pneumonia, diarrhea, malaria and tuberculosis and/or distribution of contraceptives. Expanding brigadistas’ duties could threaten their heretofore ‘job satisfaction’. This study primarily aims to report on job satisfaction of brigadistas in Nicaragua before expanding the scope of their work by adding more responsibilities. The study was guided by the following research questions: 1) What aspects of their job made the brigadistas satisfied or dissatisfied? 2) What is the job satisfaction level of brigadistas in Nicaragua? This cross-sectional study was conducted during March – July 2014, to assess brigadistas’ job satisfaction, prior to deciding on inclusion of care for sick newborns and young infants (<2 months of age) to brigadistas’ existing service package of community case management for children of 2-59 months of age. Following stratified random sampling strategy, 15 brigadistas were randomly selected from each of the following four strata: [(1) females under 25 years of age, (2) females over 30 years of age, (3) males under 25 years of age, and (4) males over 30 years of age. Out of 45 completed in-person interview with eligible and available brigadistas, 20 (44.4%) were with female and 25 (55.6%) were with male respondents; the mean age (±sd) was found as 32.0 (±3.2) years. About 53% (24/45) brigadista mentioned “Training” as the most helpful for performing their job. Another 31% (14/45) mentioned that “feeling of doing good, supporting community, women and children” was helpful to perform their job well. When asked about difficulty, about 35.5% (16/45) brigadistas mentioned about “Lack of time” due to their responsibilities in family, farm, other work places, study and such time constraint made their job performance difficult. Measured on a 0-5 scale, estimated average job satisfaction was 4.2. Current trends in task-shifting and integrated program delivery require community health workers (like the brigadistas) to deliver several essential services, including maternal, newborn and child health, and family planning, and thereby increasing their responsibilities. Given the reported level of job satisfaction among brigadistas (4.2 out of 5), and the mentioned difficulty in performing their current job (as ‘Lack of Time’) in this study results, the policy makers and program managers in MOH should be cautious enough before making a decision to expand current scope of work for brigadistas in Nicaragua.

Keywords: Brigadisata, job satisfaction, Nicaragua, task-shifting

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Authors: Haezreena Begum Abdul Hamid

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This article will explore the conflation between voluntary sex work and trafficked sex work. In doing so, the article will analyse the meaning of trafficking according to the United Nations ‘Protocol to Prevent, Suppress and Punish Trafficking in Persons, Especially Women and Children’ and the Malaysian Anti-Trafficking in Persons and Anti-Migrant Smuggling Act, 2007 (ATIP), and discuss the ambiguities that may arise in understanding the term. While the law on human trafficking has long been understood by scholars, key stakeholders, and enforcement officers, identifying a victim of trafficking is far from being straight forward. This is because of the diverse understanding on sex trafficking and sex work, and the fact that ‘consent’ by trafficked persons remains irrelevant in cases of trafficking. As a result, women who voluntarily engage in sex work are sometimes categorised as ‘trafficked’ and are ‘rescued’ by the authorities in the name of ‘protection’, while those who insist of having agency can be charged for violating the immigration laws. In light of such circumstances, this article aims to explore the conflation between voluntary sex work and trafficked sex work and how such conflation have succeeded in fostering distrust between sex workers and authorities.

Keywords: voluntary sex work, trafficked sex work, sex work, coercion, protection

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Authors: Kristina Gordon

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One in three children in the United States is a victim of a maltreatment investigation, and about one in nine children has a substantiated investigation. Home visiting is one of several preventative strategies rooted in an early childhood approach that fosters maternal, infant, and early childhood health, protection, and growth. In the United States, 88% of states report administering home visiting programs or state-designed models. The purpose of this study was to conduct a systematic review on home visiting programs in the United States focused on the prevention of child abuse and neglect. This systematic review included 17 articles which found that most of the studies reported optimistic results. Common across studies was program content related to (1) typical child development, (2) parenting education, and (3) child physical health. Although several factors common to home visiting and parenting interventions have been identified, no research has examined the common components of manualized home visiting programs to prevent child maltreatment. Child maltreatment can be addressed with home visiting programs with evidence-based components and cultural adaptations that increase prevention by assisting families in tackling the risk factors they face. An innovative approach to child maltreatment prevention is bringing together at-risk families with the aging community. This innovative approach was prompted due to existing home visitation programs only focusing on improving skillsets and providing temporary relationships. This innovative approach can provide the opportunity for families to build a relationship with an aging individual who can share their wisdom, skills, compassion, love, and guidance, to support families in their well-being and decrease child maltreatment occurrence. Families would be identified if they experience any of the risk factors, including parental substance abuse, parental mental illness, domestic violence, and poverty. Families would also be identified as at risk if they lack supportive relationships such as grandparents or relatives. Families would be referred by local agencies such as medical clinics, hospitals, schools, etc., that have interactions with families regularly. The aging community would be recruited at local housing communities and community centers. An aging individual would be identified by the elderly community when there is a need or interest in a relationship by or for the individual. Cultural considerations would be made when assessing for compatibility between the families and aging individuals. The pilot program will consist of a small group of participants to allow manageable results to evaluate the efficacy of the program. The pilot will include pre-and post-surveys to evaluate the impact of the program. From the results, data would be created to determine the efficacy as well as the sufficiency of the details of the pilot. The pilot would also be evaluated on whether families were referred to Child Protective Services during the pilot as it relates to the goal of decreasing child maltreatment. The ideal findings will display a decrease in child maltreatment and an increase in family well-being for participants.

Keywords: child maltreatment, home visiting, neglect, preventative, abuse

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Authors: Aline Woine, Moïra Mikolajczak, Virginie Dardier, Isabelle Roskam

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Background information: Becoming a parent is said to be the happiest event one can ever experience in one’s life. This popular (and almost absolute) truth–which no reasonable and decent human being would ever dare question on pain of being singled out as a bad parent–contrasts with the nuances that reality offers. Indeed, while many parents do thrive in their parenting role, some others falter and become progressively overwhelmed by their parenting role, ineluctably caught in a spiral of exhaustion. Parental burnout (henceforth PB) sets in when parental demands (stressors) exceed parental resources. While it is now generally acknowledged that PB affects the parent’s behavior in terms of neglect and violence toward their offspring, little is known about the impact that the syndrome might have on the children’s internalized (anxious and depressive symptoms, somatic complaints, etc.) and/or externalized (irritability, violence, aggressiveness, conduct disorder, oppositional disorder, etc.) behaviors. Furthermore, at the time of writing, to our best knowledge, no research has yet tested the reverse effect, namely, that of the child's internalized and/or externalized behaviors on the onset and/or maintenance of parental burnout symptoms. Goals and hypotheses: The present pioneering research proposes to fill an important gap in the existing literature related to PB by investigating the bidirectional effect between PB and the child’s internalized and/or externalized behaviors. Relying on a cross-lagged longitudinal study with three waves of data collection (4 months apart), our study tests a transactional model with bidirectional and recursive relations between observed variables and at the three waves, as well as autoregressive paths and cross-sectional correlations. Methods: As we write this, wave-two data are being collected via Qualtrics, and we expect a final sample of about 600 participants composed of French-speaking (snowball sample) and English-speaking (Prolific sample) parents. Structural equation modeling is employed using Stata version 17. In order to retain as much statistical power as possible, we use all available data and therefore apply the maximum likelihood with a missing value (mlmv) as the method of estimation to compute the parameter estimates. To limit (in so far is possible) the shared method variance bias in the evaluation of the child’s behavior, the study relies on a multi-informant evaluation approach. Expected results: We expect our three-wave longitudinal study to show that PB symptoms (measured at T1) raise the occurrence/intensity of the child’s externalized and/or internalized behaviors (measured at T2 and T3). We further expect the child’s occurrence/intensity of externalized and/or internalized behaviors (measured at T1) to augment the risk for PB (measured at T2 and T3). Conclusion: Should our hypotheses be confirmed, our results will make an important contribution to the understanding of both PB and children’s behavioral issues, thereby opening interesting theoretical and clinical avenues.

Keywords: exhaustion, structural equation modeling, cross-lagged longitudinal study, violence and neglect, child-parent relationship

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Authors: Mei Li, Victor Meddalena

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Background: Newfoundland and Labrador (NL) has rapidly aging population and is characterized by its vast geography with high proportion of dispersed rural communities when compared to other provinces in Canada. Structural, demographic and geographic factors have created big gaps for rural residents across NL with respect to accessing various health and social services. While the barriers are well documented for patients’ access to cancer care in rural and remote areas, challenges faced by family caregivers are not fully recognized. Caregiving burden coupled with challenges associated with relocation and frequent travels create situations where caregivers are vulnerable physically, emotionally, financially and socially. This study examines the experiences of family caregivers living in rural NL through a social justice lens. It is expected to identify the gaps existing in social policy and support for rural family caregivers. It will make a novel contribution to the literature in this regard. Methods: Design: This qualitative study adopted the hermeneutic phenomenology to best describe and interpret rural-based family caregivers’ living experiences and explore the meaning, impact, and the influence of both individual experience and contextual factors shaping these experiences. Data Collection: In-depth interviews with key informants were conducted with 12 participants from various rural communities in NL. A case study was also used to explore an individual’s experience in complex social units consisting of multiple variables of in-depth understanding of the reality. Data Analysis: Thematic analysis guided by the Voice-Centred Relational (VCR) method was employed to explore the relationships and contexts of participants. Emerging Themes: Six major emerging themes were identified, namely, overwhelming caregiving burden on rural family caregivers, long existing financial hardship, separation from family and community, low level of social support and self-reliance coping strategies, and social vulnerability and isolation. Conclusion: Understanding the lived experiences of rural-based family caregivers is critical to inform the policy makers the gap of health and social service in NL. The findings of this study also have implications for family caregivers who are vulnerable in other similar contexts. This study adds innovative insights for policy making and service provision in this regard.

Keywords: family caregivers, policy, relocation, rural

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Authors: Mirele Plenishti

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Revisionist powers are sometimes associated to revolutionary and status quo powers, this because along the line representing the level of satisfaction–dissatisfaction with the system, revisionist powers are located in between status quo and revolutionary powers. In particular, the case of revisionist powers seeking for social status adjustments (while having status quo intentions) can, in the first option, be refuted due to the disbelief that dissatisfaction could coexist with status quo intentions – this entailing the possibility to trigger a spiral effect by over-counter-reacting. In the second option, revisionist powers can be underestimated as a real threat, this entailing a potential inadequate reaction. The necessity to well manage international change entails the need to understand better how revisionist powers seek for changes in status, within the system. The complexity of this case is heightened by the propensity of both IR scholars and practitioners to infer states' aims and intentions – towards the system – by looking at their behaviours. This has resulted in the tendency to consider cooperative international behaviours as symptomatic of status quo intentions, and vice versa: status quo intentions as manifested through positive/cooperative behaviours. Similarly, assertive/competitive international behaviours are considered as symptomatic (and vice versa, as manifestations) of revolutionary intentions. Therefore, within complex and composite foreign policies, scholars who disbelieve the existence of revisionist powers with status quo intentions, tend to highlight the negative/competitive elements; while more optimist scholars tend to focus on conforming/cooperative behaviours. Both perspectives, while understanding relevant components of the complex international interaction, still miss a composite overview. In order to closely investigate the strategies adopted by (status quo aiming) revisionist states, and by drawing on sociological studies on peer relations, focused on children's behaviour, one could expect that the compresence of both positive (compliant/cooperative) and negative (competitive/assertive) behaviours, is deliberate, and functional to seeking social status adjustments. Indeed, at the end of 90s, peer relation studies focused on children's behaviour, discerned between the concept of social acceptance (that refers to the degree of social preference assigned to the child– how much is s/he liked) and popularity (which refers to the social status assigned to the child within the group). By building on this distinction, it was possible to identify a link relating social acceptance to prosocial (compliant/cooperative) behaviours and strategies, and popularity to both prosocial and antisocial (aggressive/assertive) behaviours and strategies. Since then, antisocial behaviours ceased to be considered as a proof of social maladjustment and were finally identified as socially recognized strategies adopted in function of the achievement of popularity. Drawing on these results, one can hypothesize that also international status seekers perform both positive (conforming/compliant/cooperative) and negative (assertive/aggressive/competitive) behaviours. Therefore, the link between aims and behaviours loses its strength, since cooperative and competitive behaviours are both means for status seeking strategies that aim at status quo intentions. By carrying out a historical investigation of Italy's foreign policy during fascism, the intent is to closely look at this compresence of behaviours, in order to better qualify its components and their relations.

Keywords: compresence of cooperative and competitive behaviours and strategies, revisionist powers, status quo intentions, status seeking

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Authors: Samaneh Abolli, Mahmood Alimohammadi

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The survey analyzed 71 bottled water brands in Tehran, Iran, examining 10 physicochemical parameters and 16 heavy metals. The water quality index (WQI) approach was used to assess water quality, and methods such as carcinogen risk (CR) and hazard index (HI) were employed to evaluate health risks. The results indicated that the bottled water had good quality overall, but some brands were of poor or very poor quality. The study also revealed significant human health risks, especially for children, due to the presence of minerals and heavy metals in bottled water. Correlation analyses and risk assessments for various substances were conducted, providing valuable insights into the potential health impacts of the analyzed bottled water.

Keywords: bottled wate, rwater quality index, health risk assessment, contamination degree, heavy metal evaluation index

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Authors: Simin Hosseinian, Roghieh Nooripour

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Introduction: Attention-deficit/hyperactivity disorder (ADHD) is a major neuropsychiatric disorder diagnosis in children, adolescents. This study was aimed to investigate the quality of life of mothers of adolescents with ADHD based on Lazarus-Folkman's coping. Method: Due to this purpose, 120 mothers were selected with convenience sampling method that referred to counseling centers with their adolescents with ADHD for treatment of their adolescents and then they completed Iranian Quality of Life Questionnaire and The Ways of Coping Questionnaire (WCQ). Data were analyzed by the Pearson correlation and stepwise regression methods with SPSS-19. Results: The result showed that there was a positive significant relationship between quality of life and self-controlling and also a negative relationship between quality of life and accepting responsibility (p < 0.05). Conclusion: According to these findings, we can suggest suitable intervention for mothers who have adolescents with ADHD and enhance their quality of life.

Keywords: ADHD, mother, adolescent, quality of life, Lazarus-Folkman

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Authors: Shereen Kamel

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This study explores the recent application of bilingual education in Egyptian public schools. It aims to provide an overall picture of bilingual education programs globally and examine its adequacy to the Egyptian social and cultural context. The study also assesses the current application process of teaching English as a Second Language in public schools from the early childhood education stage and onwards, instead of starting it from middle school; as a strategy that promotes English language proficiency and equity among students. The theoretical framework is based on Jim Cummins’ bilingual education theories and on recent trends adopting different developmental theories and perspectives, like Stephen Crashen’s theory of Second Language Acquisition that calls for communicative and meaningful interaction rather than memorization of grammatical rules. The question posed here is whether bilingual education, with its peculiar nature, could be a good chance to reach out to all Egyptian students and prepare them to become global citizens. In addition to this, a more specific question is related to the extent to which social and cultural variables can affect the young learners’ second language acquisition. This exploratory analytical study uses mixed-methods research design to examine the application of bilingual education in Egyptian public schools. The study uses a cluster sample of schools in Egypt from different social and cultural backgrounds to assess the determining variables. The qualitative emphasis is on interviewing teachers and reviewing students’ achievement documents. The quantitative aspect is based on observations of in-class activities through tally sheets and checklists. Having access to schools and documents is authorized by governmental and institutional research bodies. Data sources will comprise achievement records, students’ portfolios, parents’ feedback and teachers’ viewpoints. Triangulation and SPSS will be used for analysis. Based on the gathered data, new curricula have been assigned for elementary grades and teachers have been required to teach the newly developed materials all of a sudden without any prior training. Due to shortage in the teaching force, many assigned teachers have not been proficient in the English language. Hence, teachers’ incompetency and unpreparedness to teach this grade specific curriculum constitute a great challenge in the implementation phase. Nevertheless, the young learners themselves as well as their parents seem to be enthusiastic about the idea itself. According to the findings of this research study, teaching English as a Second Language to children in public schools can be applicable and is culturally relevant to the Egyptian context. However, there might be some social and cultural differences and constraints when it comes to application in addition to various aspects regarding teacher preparation. Therefore, a new mechanism should be incorporated to overcome these challenges for better results. Moreover, a new paradigm shift in these teacher development programs is direly needed. Furthermore, ongoing support and follow up are crucial to help both teachers and students realize the desired outcomes.

Keywords: bilingual education, communicative approach, early childhood education, language and culture, second language acquisition

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Authors: D. Estrella, A. Silva, R. Zapata, H. Rubio

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A total of 100 primary caregivers (mothers, fathers, grandparents) with at least one child or grandchild with a diagnosis of congenital bilateral profound deafness were assessed in order to evaluate the functionality of families with a deaf member, who was evaluated by specialists in audiology, molecular biology, genetics and psychology. After confirmation of the clinical diagnosis, DNA from the patients and parents were analyzed in search of the 35delG deletion of the GJB2 gene to determine who possessed the mutation. All primary caregivers were provided psychological support, regardless of whether or not they had the mutation, and prior and subsequent, the family APGAR test was applied. All parents, grandparents were informed of the results of the genetic analysis during the psychological intervention. The family APGAR, after psychological and genetic counseling, showed that 14% perceived their families as functional, 62% moderately functional and 24% dysfunctional. This shows the importance of psychological support in family functionality that has a direct impact on the quality of life of these families.

Keywords: deafness, psychological support, family, adaptation to disability

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Authors: M. Abdul Jalil

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Parents caring for a child with a profound disability encounter different experiences compared to the parents caring for a child without a disability. The aim of this paper is to develop a greater understanding of parenting of a child with profound disabilities in the context of developing countries with reference to Bangladesh. The paper reveals that parents caring for a child with a profound disability are experiencing increased financial burden, affiliate and courtesy stigma and negative impact on mothers in terms of additional caregiving role, instability of conjugal relations, giving up of involvement in economic activities, and shrinking kinship and social relationships. In addition, government and non-government services for children with disabilities are very limited. Moreover, the information about the services is also not available to the parents. Therefore, parents find it difficult to cope with the challenges that lead to the alienation of the parents. The paper recommended the strategies to address the issues in the context of Bangladesh, which in turn might be applicable to the developing countries as well.

Keywords: caregiving, coping, parenting, profound disability

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Authors: Salman Imran, Chris Healey

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Traditionally, medical care of children in England and Wales starts from primary care with a referral to secondary care paediatricians who may not investigate further. Many primary care doctors do not undergo a paediatric rotation/exposure in training. As a result, there are many who have not acquired the necessary skills to manage children hence increasing hospital referral. With the current demand on hospitals in the National Health Service managing more problems in the community is needed. One way of handling this is to set up clinics, meetings and huddles in GP surgeries where professionals involved (general practitioner, paediatrician, health visitor, community nurse, dietician, school nurse) come together and share information which can help improve communication and care. The increased awareness and education that paediatricians can impart in this way will help boost confidence for primary care professionals to be able to be more self-sufficient. This has been tried successfully in other regions e.g., St. Mary’s Hospital in London but is crucial for a more rural setting like ours. The primary aim of this project would be to educate specifically GP’s and generally all other health professionals involved. Additional benefits would be providing care nearer home, increasing patient’s confidence in their local surgery, improving communication and reducing unnecessary patient flow to already stretched hospital resources. Methods: This was done as a plan do study act cycle (PDSA). Three clinics were delivered in different practices over six months where feedback from staff and patients was collected. Designated time for teaching/discussion was used which involved some cases from the actual clinics. Both new and follow up patients were included. Two clinics were conducted by a paediatrician and nurse whilst the 3rd involved paediatrician and local doctor. The distance from hospital to clinics varied from two miles to 22 miles approximately. All equipment used was provided by primary care. Results: A total of 30 patients were seen. All patients found the location convenient as it was nearer than the hospital. 70-90% clearly understood the reason for a change in venue. 95% agreed to the importance of their local doctor being involved in their care. 20% needed to be seen in the hospital for further investigations. Patients felt this to be a more personalised, in-depth, friendly and polite experience. Local physicians felt this to be a more relaxed, familiar and local experience for their patients and they managed to get immediate feedback regarding their own clinical management. 90% felt they gained important learning from the discussion time and the paediatrician also learned about their understanding and gaps in knowledge/focus areas. 80% felt this time was valuable for targeted learning. Equipment, information technology, and office space could be improved for the smooth running of any future clinics. Conclusion: The acute paediatric outpatient clinic can be successfully established in primary care facilities. Careful patient selection and adequate facilities are important. We have demonstrated a further step in the reduction of patient flow to hospitals and upskilling primary care health professionals. This service is expected to become more efficient with experience.

Keywords: clinics, education, paediatricians, primary care

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