Search results for: London’s Air Ambulance

Authors: Priyanka Patil, Logan Manikam

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Background: The first 1000 days of life are a critical window and can result in adverse health consequences due to inadequate nutrition. South-Asian (SA) communities face significant health disparities, particularly in maternal and child health. Community-based interventions, often employing Participatory-Learning and Action (PLA) approaches, have effectively addressed health inequalities in lower-income nations. The aim of this study was to assess the feasibility of implementing a PLA intervention to improve infant feeding and care practices in SA communities living in London. Methods: Comprehensive analyses were conducted to assess the feasibility/fidelity of this pilot randomized controlled trial. Summary statistics were computed to compare key metrics, including participant consent rates, attendance, retention, intervention support, and perceived effectiveness, against predefined progression rules guiding toward a definitive trial. Secondary outcomes were analyzed, drawing insights from multiple sources, such as The Children’s-Eating-Behaviour Questionnaire (CEBQ), Parental-Feeding-Style Questionnaires (PFSQ), Food-diary, and the Equality-Impact-Assessment (EIA) tool. A video analysis of children's mealtime behavior trends was conducted. Feedback interviews were collected from study participants. Results: Process-outcome measures met predefined progression rules for a definitive trial, which deemed the intervention as feasible and acceptable. The secondary outcomes analysis revealed no significant changes in children's BMI z-scores. This could be attributed to the abbreviated follow-up period of 6 months, reduced from 12 months, due to COVID-19-related delays. CEBQ analysis showed increased food responsiveness, along with decreased emotional over/undereating. A similar trend was observed in PFSQ. The EIA tool found no potential discrimination areas, and video analysis revealed a decrease in force-feeding practices. Participant feedback revealed improved awareness and knowledge sharing. Conclusion: This study demonstrates that a co-adapted PLA intervention is feasible and well-received in optimizing infant-care practices among South-Asian community members in a high-income country. These findings highlight the potential of community-based interventions to enhance health outcomes, promoting health equity.

Keywords: child health, childhood obesity, community-based, infant nutrition

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Authors: Karolina Wieczorek, Zofia Przypaśniak

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Climate change is a rapidly growing threat to global health, and part of the responsibility to combat it lies within the healthcare sector itself, including adequate education of future medical professionals. To mitigate the consequences, the General Medical Council (GMC) has equipped medical schools with a list of outcomes regarding sustainability teaching. Students are expected to analyze the impact of the healthcare sector’s emissions on climate change. The delivery of the related teaching content is, however, often inadequate and insufficient time is devoted for exploration of the topics. Teaching curricula lack in-depth exploration of the learning objectives. This study aims to assess the extent and characteristics of climate change and sustainability subjects teaching in the curriculum of a chosen UK medical school (Barts and The London School of Medicine and Dentistry). It compares the data to the national average scores from the Climate Change and Sustainability Teaching (C.A.S.T.) in Medical Education Audit to draw conclusions about teaching on a regional level. This is a single-center audit of the timetabled sessions of teaching in the medical course. The study looked at the academic year 2020/2021 which included a review of all non-elective, core curriculum teaching materials including tutorials, lectures, written resources, and assignments in all five years of the undergraduate and graduate degrees, focusing only on mandatory teaching attended by all students (excluding elective modules). The topics covered were crosschecked with GMC Outcomes for graduates: “Educating for Sustainable Healthcare – Priority Learning Outcomes” as gold standard to look for coverage of the outcomes and gaps in teaching. Quantitative data was collected in form of time allocated for teaching as proxy of time spent per individual outcomes. The data was collected independently by two students (KW and ZP) who have received prior training and assessed two separate data sets to increase interrater reliability. In terms of coverage of learning outcomes, 12 out of 13 were taught (with the national average being 9.7). The school ranked sixth in the UK for time spent per topic and second in terms of overall coverage, meaning the school has a broad range of topics taught with some being explored in more detail than others. For the first outcome 4 out of 4 objectives covered (average 3.5) with 47 minutes spent per outcome (average 84 min), for the second objective 5 out of 5 covered (average 3.5) with 46 minutes spent (average 20), for the third 3 out of 4 (average 2.5) with 10 mins pent (average 19 min). A disproportionately large amount of time is spent delivering teaching regarding air pollution (respiratory illnesses), which resulted in the topic of sustainability in other specialties being excluded from teaching (musculoskeletal, ophthalmology, pediatrics, renal). Conclusions: Currently, there is no coherent strategy on national teaching of climate change topics and as a result an unstandardized amount of time spent on teaching and coverage of objectives can be observed.

Keywords: audit, climate change, sustainability, education

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Authors: Nabil Omar, Farah Jibril, Oraib Amjad

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Purpose: Trabecatine is a is a potent marine-derived antineoplastic drug which binds to the minor groove of the DNA, bending DNA towards the major groove resulting in a changed conformation that interferes with several DNA transcription factors, repair pathways and cell proliferation. Trabectedin was approved by the European Medicines Agency (EMA; London, UK) for the treatment of adult patients with advanced stage soft tissue sarcomas in whom treatment with anthracyclines and ifosfamide has failed, or for those who are not candidates for these therapies. The recommended dosing regimen is 1.5 mg/m2 IV over 24 hours every 3 weeks. The purpose of this study was to comprehensively review available data on the safety and efficacy of trabectedin used as indicated for patients at a Tertiary Cancer Center at Qatar. Methods: A medication administration report generated in the electronic health record identified all patients who received trabectedin between November 1, 2015 and November 1, 2017. This retrospective chart review evaluated the indication of trabectedin use, compliance to administration protocol and the recommended monitoring parameters, number of patients improved on the drug and continued treatment, number of patients discontinued treatment due to side-effects and the reported side effects. Progress and discharged notes were utilized to report experienced side effects during trabectedin therapy. A total of 3 patients were reviewed. Results: Total of 2 out of 3 patients who received trabectedin were receiving it for non-FDA and non-EMA, approved indications; metastatic rhabdomyosarcoma and ovarian cancer stage IV with poor prognosis. And only one patient received it as indicated for leiomyosarcoma of left ureter with metastases to liver, lungs and bone. None of the patients has continued the therapy due to development of serious side effects. One patient had stopped the medication after one cycle due to disease progression and transient hepatic toxicity, the other one had disease progression and developed 12 % reduction in LVEF after 12 cycles of trabectedin, and the third patient deceased, had disease progression on trabectedin after the 10th cycle that was received through peripheral line which resulted in developing extravasation and left arm cellulitis requiring debridement. Regarding monitoring parameters, at baseline the three patients had ECHO, and Creatine Phosphokinase (CPK) but it was not monitored during treatment as recommended. Conclusion: Utilizing this medication as indicated with performing the appropriate monitoring parameters as recommended can benefit patients who are receiving it. It is important to reinforce the intravenous administration via central intravenous line, the re-assessment of left ventricular ejection fraction (LVEF) by echocardiogram or multigated acquisition (MUGA) scan at 2- to 3-month intervals thereafter until therapy is discontinued, and CPK and LFTs levels prior to each administration of trabectedin.

Keywords: trabectedin, drug-use evaluation, safety, effectiveness, adverse drug reaction, monitoring

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Authors: Helen Potkin

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This paper presents a practice-based case study of a project in which the student group designed and planned the curriculum content, classroom activities and assessment briefs in collaboration with the tutor. It focuses on the co-creation of the curriculum within a history and theory module, Researching the Contemporary, which runs for BA (Hons) Fine Art and Art History and for BA (Hons) Art Design History Practice at Kingston University, London. The paper analyses the potential of collaborative approaches to engender students’ investment in their own learning and to encourage reflective and self-conscious understandings of themselves as learners. It also addresses some of the challenges of working in this way, attending to the risks involved and feelings of uncertainty produced in experimental, fluid and open situations of learning. Alongside this, it acknowledges the tensions inherent in adopting such practices within the framework of the institution and within the wider of context of the commodification of higher education in the United Kingdom. The concept underpinning the initiative was to test out co-creation as a creative process and to explore the possibilities of altering the traditional hierarchical relationship between teacher and student in a more active, participatory environment. In other words, the project asked about: what kind of learning could be imagined if we were all in it together? It considered co-creation as producing different ways of being, or becoming, as learners, involving us reconfiguring multiple relationships: to learning, to each other, to research, to the institution and to our emotions. The project provided the opportunity for students to bring their own research and wider interests into the classroom, take ownership of sessions, collaborate with each other and to define the criteria against which they would be assessed. Drawing on students’ reflections on their experience of co-creation alongside theoretical considerations engaging with the processual nature of learning, concepts of equality and the generative qualities of the interrelationships in the classroom, the paper suggests that the dynamic nature of collaborative and participatory modes of engagement have the potential to foster relevant and significant learning experiences. The findings as a result of the project could be quantified in terms of the high level of student engagement in the project, specifically investment in the assessment, alongside the ambition and high quality of the student work produced. However, reflection on the outcomes of the experiment prompts a further set of questions about the nature of positionality in connection to learning, the ways our identities as learners are formed in and through our relationships in the classroom and the potential and productive nature of creative practice in education. Overall, the paper interrogates questions of what it means to work with students to invent and assemble the curriculum and it assesses the benefits and challenges of co-creation. Underpinning it is the argument that, particularly in the current climate of higher education, it is increasingly important to ask what it means to teach and to envisage what kinds of learning can be possible.

Keywords: co-creation, collaboration, learning, participation, risk

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Authors: Helga Heylen

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With dogs saving wildlife in New Zealand since 1890 and governments in Africa, Australia and Canada trusting them to give the best results, Conservation Dogs Ireland want to introduce more detection dogs to protect Europe's native wildlife. Conservation detection dogs are fast, portable and endlessly trainable. They are a cost-effective, highly sensitive and non-invasive way to detect protected and invasive species and wildlife disease. Conservation dogs find targets up to 40 times faster than any other method. They give results instantly, with near-perfect accuracy. They can search for multiple targets simultaneously, with no reduction in efficacy The European Red List indicates the decline in biodiversity has been most rapid in the past 50 years, and the risk of extinction never higher. Just two examples of major threats dogs are trained to tackle are: (I)Japanese Knotweed (Fallopia Japonica), not only a serious threat to ecosystems, crops, structures like bridges and roads - it can wipe out the entire value of a house. The property industry and homeowners are only just waking up to the full extent of the nightmare. When those working in construction on the roads move topsoil with a trace of Japanese Knotweed, it suffices to start a new colony. Japanese Knotweed grows up to 7cm a day. It can stay dormant and resprout after 20 years. In the UK, the cost of removing Japanese Knotweed from the London Olympic site in 2012 was around £70m (€83m). UK banks already no longer lend on a house that has Japanese Knotweed on-site. Legally, landowners are now obliged to excavate Japanese Knotweed and have it removed to a landfill. More and more, we see Japanese Knotweed grow where a new house has been constructed, and topsoil has been brought in. Conservation dogs are trained to detect small fragments of any part of the plant on sites and in topsoil. (II)Zebra mussels (Dreissena Polymorpha) are a threat to many waterways in the world. They colonize rivers, canals, docks, lakes, reservoirs, water pipes and cooling systems. They live up to 3 years and will release up to one million eggs each year. Zebra mussels attach to surfaces like rocks, anchors, boat hulls, intake pipes and boat engines. They cause changes in nutrient cycles, reduction of plankton and increased plant growth around lake edges, leading to the decline of Europe's native mussel and fish populations. There is no solution, only costly measures to keep it at bay. With many interconnected networks of waterways, they have spread uncontrollably. Conservation detection dogs detect the Zebra mussel from its early larvae stage, which is still invisible to the human eye. Detection dogs are more thorough and cost-effective than any other conservation method, and will greatly complement and speed up the work of biologists, surveyors, developers, ecologists and researchers.

Keywords: native biodiversity, conservation detection dogs, invasive species, Japanese Knotweed, zebra mussel

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Authors: Juan C. Pérez-Mesa, Emilio Galdeano-Gómez, Jerónimo De Burgos-Jiménez, José F. Bienvenido-Bárcena, José F. Jiménez-Guerrero

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Environmental cost and transport congestion on roads resulting from product distribution in Europe have to lead to the creation of various programs and studies seeking to reduce these negative impacts. In this regard, apart from other institutions, the European Commission (EC) has designed plans in recent years promoting a more sustainable transportation model in an attempt to ultimately shift traffic from the road to the sea by using intermodality to achieve a model rebalancing. This issue proves especially relevant in supply chains from peripheral areas of the continent, where the supply of certain agrifood products is high. In such cases, the most difficult challenge is managing perishable goods. This study focuses on new approaches that strengthen the modal shift, as well as the reduction of externalities. This problem is analyzed by attempting to promote intermodal system (truck and short sea shipping) for transport, taking as point of reference highly perishable products (vegetables) exported from southeast Spain, which is the leading supplier to Europe. Methodologically, this paper seeks to contribute to the literature by proposing a different and complementary approach to establish a comparison between intermodal and the “only road” alternative. For this purpose, the multicriteria decision is utilized in a p-median model (P-M) adapted to the transport of perishables and to a means of shipping selection problem, which must consider different variables: transit cost, including externalities, time, and frequency (including agile response time). This scheme avoids bias in decision-making processes. By observing the results, it can be seen that the influence of the externalities as drivers of the modal shift is reduced when transit time is introduced as a decision variable. These findings confirm that the general strategies, those of the EC, based on environmental benefits lose their capacity for implementation when they are applied to complex circumstances. In general, the different estimations reveal that, in the case of perishables, intermodality would be a secondary and viable option only for very specific destinations (for example, Hamburg and nearby locations, the area of influence of London, Paris, and the Netherlands). Based on this framework, the general outlook on this subject should be modified. Perhaps the government should promote specific business strategies based on new trends in the supply chain, not only on the reduction of externalities, and find new approaches that strengthen the modal shift. A possible option is to redefine ports, conceptualizing them as digitalized redistribution and coordination centers and not only as areas of cargo exchange.

Keywords: environmental externalities, intermodal transport, perishable food, transit time

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Authors: Sudikshya Bhandari, Jonathan K. London

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The earthquake of April 2015 was one of the biggest disasters in the history of Nepal. The epicenter was located near Barpak, north of the Gorkha district. Before the disaster, this settlement was a compact and homogeneous settlement manifesting its uniqueness through the social and cultural activities, and a distinct vernacular architecture. Narrow alleys with stone paved streets, buildings with slate roofs, and common spaces between the houses made this settlement socially, culturally, and environmentally cohesive. With the presence of micro hydro power plants, local economic activities enabled the local community to exist and thrive. Agriculture and animal rearing are the sources of livelihood for the majority of families, along with the booming homestays (where local people welcome guests to their home, as a business) and local shops. Most of these activities are difficult to find as the houses have been destroyed with the earthquake and the process of reconstruction has been transforming the outlook of the settlement. This study characterized the drastic transformation in Barpak post-earthquake, and analyzed the consequences of the reconstruction process. In addition, it contributes to comprehending a broader representation about unsustainability created by the lack of contextual post-disaster development. Since the research is based in a specific area, a case study approach was used. Sample houses were selected on the basis of ethnicity and house typology. Mixed methods such as key informant and semi structured interviews, focus groups, observations and photographs are used for the collection of data. The research focus is predominantly on the physical change of the house typology from vernacular to externally adopted designs. This transformation of the house entails socio-cultural changes such as social fragmentation with differences among the rich and the poor and decreases in the social connectivity within families and neighborhood. Families have found that new houses require more maintenance and resources that have increased their economic expenses. The study also found that the reconstructed houses are not thermally comfortable in the cold climate of Barpak, leading to the increased use of different sources of heating like electric heaters and more firewood. Lack of storage spaces for crops and livestock have discouraged them to pursue traditional means of livelihood and depend more on buying food from stores, ultimately making it less economical for most of the families. The transformation of space leading to the economic, social and cultural changes demonstrates the unsustainability of Barpak. Conclusions from the study suggest place based and inclusive planning and policy formations that include locals as partners, identifying the possible ways to minimize the impact and implement these recommendations into the future policy and planning scenarios.

Keywords: earthquake, Nepal, reconstruction, settlement, transformation

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Authors: I. Brezeanu, J. Mackrill, A. Cajo, C. Mogollon

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Modern Slavery is a serious crime, where often the victims are unable to leave their situation of exploitation, being controlled by threats, punishment, violence, coercion, and deception. In the UK, this term encompasses both Slavery and Human Trafficking. The number of potential victims who were referred to the National Referral Mechanism (NRM) increased exponentially in the past decade, passing from fewer than 700 potential victims referred in 2010 to more than 12.000 in 2021. Our study aims to explore how the concept of Trauma-Informed Care (TIC) approach can be adopted by services working with survivors of Modern Slavery and Trafficking (MST). Notably, in this paper, we will elaborate on how the complex needs of survivors are related to their traumatic experiences and what are the necessary steps and resources for implementing a Modern Slavery Trauma-Informed model. While there are relatively few services in the UK that have a deep understanding of the survivors’ and practitioners’ views of how trauma impacts their daily life, there is a strong need for developing services that are organised and delivered in ways that prevent retraumatisation and enable trauma survivors to engage safely with the right professionals at the right time, promoting healing through positive relationships. Such models, known as Trauma-Informed Approaches (TIAs), are seen as crucial to the empowerment of survivors, yet they remain a marginal implementation model by governments, law enforcement, judiciary, or care providers, who are frequently survivors’ first point of contact in the recovery process. In order to understand better how to provide best practice and to adopt the concept, this study is based on a multi-disciplinary approach, encompassing both theoretical perspectives and co-production. By combining qualitative and quantitative research and comparing different analysis of applied examples of TIC in the US and the UK, we gained important insights about the prevention and impact of trauma on survivors’ life. The articulation between more general expertise on Trauma-Informed Care developed by other institutions operating in the field, and the SJOG delivery, based on the Salvation Army’s Modern Slavery Victim Care and Coordination Contract (MSVCC) and the Care Quality Commission regulations, allowed to identify on one side what are the complex needs of survivors derived from their traumatic experiences, and on the other side, how could MST services prevent retraumatisation. Additional, two in-depth interviews with survivors, who receive support from one of our services at Olallo House in London, and a survey shared among all colleagues working with MST services completed the findings of the research with their personal experience and knowledge. Ultimately, we developed an evidence-based Trauma-Informed Care Pathway that aims to improve the wellbeing of survivors and to support them to live a meaningful life. The establishedpathway delivers three main outcomes belonging to the social determinants of health criteria – health and wellbeing, purpose and relationship, and covers key themes of the context of trauma, needs of individuals, and service support.

Keywords: trauma-informed care, modern slavery, human trafficking, trauma, retraumatisation

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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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Authors: Renu Satish Nair

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Indian higher education system is the third largest in the world next to United States and China. India is experiencing a rapid growth in higher education in terms of student enrollment as well as establishment of new universities, colleges and institutes of national importance. Presently about 22 million students are being enrolled in higher education and more than 46 thousand institutions’ are functioning as centers of higher education. Indian government plays a 'command and control' role in higher education. The main governing body is University Grants Commission, which enforces its standards, advises the government, and helps coordinate between the centre and the state. Accreditation of higher learning is over seen by 12 autonomous institutions established by the University Grants Commission. The present paper is an effort to analyze the strength, weakness, opportunities and threat (SWOT Analysis) of Indian Higher education system. The higher education in India is progressing ahead by virtue of its strength which is being recognized at global level. Several institutions of India, such as Indian Institutes of Technology (IITs), Indian Institutes of Management (IIMs) and National Institutes of Technology (NITs) have been globally acclaimed for their standard of education. Three Indian universities were listed in the Times Higher Education list of the world’s top 200 universities i.e. Indian Institutes of Technology, Indian Institute of Management and Jawahar Lal Nehru University in 2005 and 2006. Six Indian Institutes of Technology and the Birla Institute of Technology and Science - Pilani were listed among the top 20 science and technology schools in Asia by the Asia Week. The school of Business situated in Hyderabad was ranked number 12 in Globe MBA ranking by the Financial Times of London in 2010 while the All India Institute of Medical Sciences has been recognized as a global leader in medical research and treatment. But at the same time, because of vast expansion, the system bears several weaknesses. The Indian higher education system in many parts of the country is in the state of disrepair. In almost half the districts in the country higher education enrollment are very low. Almost two third of total universities and 90% of colleges are rated below average on quality parameters. This can be attributed to the under prepared faculty, unwieldy governance and other obstacles to innovation and improvement that could prohibit India from meeting its national education goals. The opportunities in Indian higher education system are widely ranged. The national institutions are training their products to compete at global level and make them capable to grab opportunities worldwide. The state universities and colleges with their limited resources are giving the products that are capable enough to secure career opportunities and hold responsible positions in various government and private sectors with in the country. This is further creating opportunities for the weaker section of the society to join the main stream. There are several factors which can be defined as threats to Indian higher education system. It is a matter of great concern and needs proper attention. Some important factors are -Conservative society, particularly for women education; -Lack of transparency, -Taking higher education as a means of business

Keywords: Indian higher education system, SWOT analysis, university grants commission, Indian institutes of technology

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Authors: Kyoungrean Kim

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Importance of deep-sea mineral resources is dramatically increasing due to the depletion of land mineral resources corresponding to increasing human’s economic activities. Korea has acquired exclusive exploration licenses at four areas which are the Clarion-Clipperton Fracture Zone in the Pacific Ocean (2002), Tonga (2008), Fiji (2011) and Indian Ocean (2014). The preparation for commercial mining of Nautilus minerals (Canada) and Lockheed martin minerals (USA) is expected by 2020. The London Protocol 1996 (LP) under International Maritime Organization (IMO) and International Seabed Authority (ISA) will set environmental guidelines for deep-sea mining until 2020, to protect marine environment. In this research, the applicability of washing/extraction treatment for the remediation of deep-sea mining tailings was mainly evaluated in order to present preliminary data to develop practical remediation technology in near future. Polymetallic nodule samples were collected at the Clarion-Clipperton Fracture Zone in the Pacific Ocean, then stored at room temperature. Samples were pulverized by using jaw crusher and ball mill then, classified into 3 particle sizes (> 63 µm, 63-20 µm, < 20 µm) by using vibratory sieve shakers (Analysette 3 Pro, Fritsch, Germany) with 63 µm and 20 µm sieve. Only the particle size 63-20 µm was used as the samples for investigation considering the lower limit of ore dressing process which is tens to 100 µm. Rhamnolipid and sodium alginate as biosurfactant and aluminum sulfate which are mainly used as flocculant were used as environmentally friendly additives. Samples were adjusted to 2% liquid with deionized water then mixed with various concentrations of additives. The mixture was stirred with a magnetic bar during specific reaction times and then the liquid phase was separated by a centrifugal separator (Thermo Fisher Scientific, USA) under 4,000 rpm for 1 h. The separated liquid was filtered with a syringe and acrylic-based filter (0.45 µm). The extracted heavy metals in the filtered liquid were then determined using a UV-Vis spectrometer (DR-5000, Hach, USA) and a heat block (DBR 200, Hach, USA) followed by US EPA methods (8506, 8009, 10217 and 10220). Polymetallic nodule was mainly composed of manganese (27%), iron (8%), nickel (1.4%), cupper (1.3 %), cobalt (1.3%) and molybdenum (0.04%). Based on remediation standards of various countries, Nickel (Ni), Copper (Cu), Cadmium (Cd) and Zinc (Zn) were selected as primary target materials. Throughout this research, the use of rhamnolipid was shown to be an effective approach for removing heavy metals in samples originated from manganese nodules. Sodium alginate might also be one of the effective additives for the remediation of deep-sea mining tailings such as polymetallic nodules. Compare to the use of rhamnolipid and sodium alginate, aluminum sulfate was more effective additive at short reaction time within 4 h. Based on these results, sequencing particle separation, selective extraction/washing, advanced filtration of liquid phase, water treatment without dewatering and solidification/stabilization may be considered as candidate technologies for the remediation of deep-sea mining tailings.

Keywords: deep-sea mining tailings, heavy metals, remediation, extraction, additives

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Authors: Brogan Guest, Amy Donaldson-Perrott

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The Master’s of Physician Associate Studies (MPAS) programme at St George’s, University of London (SGUL), is an intensive two-year course that trains students to become physician associates (PAs). PAs are generalized healthcare providers who work in primary and secondary care across the UK. PA programmes face the difficult task of preparing students to become safe medical providers in two short years. Our goal is to teach students to develop clinical reasoning early on in their studies and historically, this has been done predominantly though problem-based learning (PBL). We have had an increase concern about student engagement in PBL and difficulty recruiting facilitators to maintain the low student to facilitator ratio required in PBL. To address this issue, we created ‘Clinical Application of Anatomy and Physiology (CAAP)’. These peer-led, interactive, problem-based, small group sessions were designed to facilitate students’ clinical reasoning skills. The sessions were designed using the concept of Team-Based Learning (TBL). Students were divided into small groups and each completed a pre-session quiz consisting of difficult questions devised to assess students’ application of medical knowledge. The quiz was completed in small groups and they were not permitted access of external resources. After the quiz, students worked through a series of openended, clinical tasks using all available resources. They worked at their own pace and the session was peer-led, rather than facilitator-driven. For a group of 35 students, there were two facilitators who observed the sessions. The sessions utilised an infinite space whiteboard software. Each group member was encouraged to actively participate and work together to complete the 15-20 tasks. The session ran for 2 hours and concluded with a post-session quiz, identical to the pre-session quiz. We obtained subjective feedback from students on their experience with CAAP and evaluated the objective benefit of the sessions through the quiz results. Qualitative feedback from students was generally positive with students feeling the sessions increased engagement, clinical understanding, and confidence. They found the small group aspect beneficial and the technology easy to use and intuitive. They also liked the benefit of building a resource for their future revision, something unique to CAAP compared to PBL, which out students participate in weekly. Preliminary quiz results showed improvement from pre- and post- session; however, further statistical analysis will occur once all sessions are complete (final session to run December 2022) to determine significance. As a post-graduate healthcare professional programme, we have a strong focus on self-directed learning. Whilst PBL has been a mainstay in our curriculum since its inception, there are limitations and concerns about its future in view of student engagement and facilitator availability. Whilst CAAP is not TBL, it draws on the benefits of peer-led, small group work with pre- and post- team-based quizzes. The pilot of these sessions has shown that students are engaged by CAAP, and they can make significant progress in clinical reasoning in a short amount of time. This can be achieved with a high student to facilitator ratio.

Keywords: problem based learning, team based learning, active learning, peer-to-peer teaching, engagement

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Authors: Rhiannon Barker, Gregory Hartwell, Matt Egan, Karen Lock

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Background: Evidence suggests that mental health (MH) issues in children and young people (CYP) in the UK are on the rise. Of particular concern is data that indicates that the pandemic, together with the impact of school closures, have accentuated already pronounced inequalities; children from families on low incomes or from black and minority ethnic groups are reportedly more likely to have been adversely impacted. This study aimed to help identify specific support which may facilitate the building of a positive school climate and protect student mental health, particularly in the wake of school closures following the pandemic. It has important implications for integrated working between schools and statutory health services. Methods: The research comprised of three parts; scoping, case studies, and a stakeholder workshop to explore and consolidate results. The scoping phase included a literature review alongside interviews with a range of stakeholders from government, academia, and the third sector. Case studies were then conducted in two London state schools. Results: Our research identified how student MH was being impacted by a range of factors located at different system levels, both internal to the school and in the wider community. School climate, relating both to a shared system of beliefs and values, as well as broader factors including style of leadership, teaching, discipline, safety, and relationships -all played a role in the experience of school life and, consequently, the MH of both students and staff. Participants highlighted the importance of a whole school approach and ensuring that support for student MH was not separated from academic achievement, as well as the importance of identifying and applying universal measuring systems to establish levels of MH need. Our findings suggest that a school’s climate is influenced by the style and strength of its leadership, while this school climate - together with mechanisms put in place to respond to MH needs (both statutory and non-statutory) - plays a key role in supporting student MH. Implications: Schools in England have a responsibility to decide on the nature of MH support provided for their students, and there is no requirement for them to report centrally on the form this provision takes. The reality on the ground, as our study suggests, is that MH provision varies significantly between schools, particularly in relation to ‘lower’ levels of need which are not covered by statutory requirements. A valid concern may be that in the huge raft of possible options schools have to support CYP wellbeing, too much is left to chance. Work to support schools in rebuilding their cultures post-lockdowns must include the means to identify and promote appropriate tools and techniques to facilitate regular measurement of student MH. This will help establish both the scale of the problem and monitor the effectiveness of the response. A strong vision from a school’s leadership team that emphasises the importance of student wellbeing, running alongside (but not overshadowed by) academic attainment, should help shape a school climate to promote beneficial MH outcomes. The sector should also be provided with support to improve the consistency and efficacy of MH provision in schools across the country.

Keywords: mental health, schools, young people, whole-school culture

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Authors: Zi Y. Kang, Tracy D. Cassidy, Tom Cassidy

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3D apparel CAD is one of the remarkable products in advanced technology which enables intuitive design, visualisation and evaluation of garments through stereoscopic drape simulation. The progressive improvements of 3D apparel CAD have led to the creation of more realistic clothing simulation which is used not only in design development but also in presentation, promotion and communication for fashion as well as other industries such as film, game and social network services. As a result, 3D clothing technology is becoming more ubiquitous in human culture and lives today. This study considers that such phenomenon implies that the technology has reached maturity and it is time to inspect the status of current technology and to explore its potential uses in ways to create cultural values to further move forward. For this reason, this study aims to generate virtual costumes as culturally significant objects using 3D apparel CAD and to assess its capability, applicability and attitudes of the audience towards clothing simulation through comparison with physical counterparts. Since the access to costume collection is often limited due to the conservative issues, the technology may make valuable contribution by democratization of culture and knowledge for museums and its audience. This study is expected to provide foundation knowledge for development of clothing technology and for expanding its boundary of practical uses. To prevent any potential damage, two replicas of the costumes in the 1860s and 1920s at the Museum of London were chosen as samples. Their structural, visual and physical characteristics were measured and collected using patterns, scanned images of fabrics and objective fabric measurements with scale, KES-F (Kawabata Evaluation System of Fabrics) and Titan. Commercial software, DC Suite 5.0 was utilised to create virtual costumes applying collected data and the following outcomes were produced for the evaluation: Images of virtual costumes and video clips showing static and dynamic simulation. Focus groups were arranged with fashion design students and the public for evaluation which exposed the outcomes together with physical samples, fabrics swatches and photographs. The similarities, application and acceptance of virtual costumes were estimated through discussion and a questionnaire. The findings show that the technology has the capability to produce realistic or plausible simulation but expression of some factors such as details and capability of light material requires improvements. While the use of virtual costumes was viewed as more interesting and futuristic replacements to physical objects by the public group, the fashion student group noted more differences in detail and preferred physical garments highlighting the absence of tangibility. However, the advantages and potential of virtual costumes as effective and useful visual references for educational and exhibitory purposes were underlined by both groups. Although 3D apparel CAD has sufficient capacity to assist garment design process, it has limits in identical replication and more study on accurate reproduction of details and drape is needed for its technical improvements. Nevertheless, the virtual costumes in this study demonstrated the possibility of the technology to contribute to cultural and knowledgeable value creation through its applicability and as an interesting way to offer 3D visual information.

Keywords: digital clothing technology, garment simulation, 3D Apparel CAD, virtual costume

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Authors: Dana Zelicha

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A 6-week mindfulness programme was launched to improve the well being and performance of 20 managers (including the supervisor) of an international corporation in London. A unique assessment methodology was customised to the organisation’s needs, measuring four parameters: prioritising skills, listening skills, mindfulness levels and happiness levels. All parameters showed significant improvements (p < 0.01) post intervention, with a remarkable increase in listening skills and mindfulness levels. Although corporate mindfulness programmes have proven to be effective, the challenge remains the low engagement levels at home and the implementation of these tools beyond the scope of the intervention. This study has offered an innovative approach to enforce home engagement levels, which yielded promising results. The programme launched with a 2-day introduction intervention, which was followed by a 6-week training course (1 day a week; 2 hours each). Participants learned all basic principles of mindfulness such as mindfulness meditations, Mindfulness Based Stress Reduction (MBSR) techniques and Mindfulness Based Cognitive Therapy (MBCT) practices to incorporate into their professional and personal lives. The programme contained experiential mindfulness meditations and innovative mindfulness tools (OWBA-MT) created by OWBA - The Well Being Agency. Exercises included Mindful Meetings, Unitasking and Mindful Feedback. All sessions concluded with guided discussions and group reflections. One fundamental element of this programme was engagement level outside of the workshop. In the office, participants connected with a mindfulness buddy - a team member in the group with whom they could find support throughout the programme. At home, participants completed online daily mindfulness forms that varied according to weekly themes. These customised forms gave participants the opportunity to reflect on whether they made time for daily mindfulness practice, and to facilitate a sense of continuity and responsibility. At the end of the programme, the most engaged team member was crowned the ‘mindful maven’ and received a special gift. The four parameters were measured using online self-reported questionnaires, including the Listening Skills Inventory (LSI), Mindfulness Attention Awareness Scale (MAAS), Time Management Behaviour Scale (TMBS) and a modified version of the Oxford Happiness Questionnaire (OHQ). Pre-intervention questionnaires were collected at the start of the programme, and post-intervention data was collected 4-weeks following completion. Quantitative analysis using paired T-tests of means showed significant improvements, with a 23% increase in listening skills, a 22% improvement in mindfulness levels, a 12% increase in prioritising skills, and an 11% improvement in happiness levels. Participant testimonials exhibited high levels of satisfaction and the overall results indicate that the mindfulness programme substantially impacted the team. These results suggest that 6-week mindfulness programmes can improve employees’ capacities to listen and work well with others, to effectively manage time and to experience enhanced satisfaction both at work and in life. Limitations noteworthy to consider include the afterglow effect and lack of generalisability, as this study was conducted on a small and fairly homogenous sample.

Keywords: corporate mindfulness, listening skills, organisational well being, prioritising skills, mindful leadership

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Authors: Felix Lankester, Alicia Davis, Safari Kinung'hi, Catherine Bunga, Shayo Alkara, Imam Mzimbiri, Jonathan Yoder, Sarah Cleaveland, Guy H. Palmer

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Achieving the London Declaration goal of a 90% reduction in neglected tropical diseases (NTDs) by 2030 requires cost-effective strategies that attain high and comprehensive coverage. The first objective of this trial was to assess the impact on cost and coverage of employing a novel integrative One Health approach linking two NTD control programs: mass drug administration (MDA) for soil-transmitted helminths in humans (STH) and mass dog rabies vaccination (MDRV). The second objective was to compare the coverage achieved by the MDA, a community-wide deworming intervention, with that of the existing national primary school-based deworming program (NSDP), with particular focus on the proportion of primary school-age children reached and their school enrolment status. Our approach was unconventional because, in line with the One Health approach to disease control, it coupled the responsibilities and resources of the Ministries responsible for human and animal health into one program with the shared aim of preventing multiple NTDs. The trial was carried out in hard-to-reach pastoral communities comprising 24 villages of the Ngorongoro District, Tanzania, randomly allocated to either Arm A (MDA and MDRV), Arm B (MDA only) or Arm C (MDRV only). Objective one: The percentage of people in each target village that received treatment through MDA in Arms A and B was 63% and 65%, respectively (χ2 = 1, p = 0.32). The percentage of dogs vaccinated in Arm A and C was 70% and 81%, respectively (χ2 =9, p = 0.003). It took 33% less time for a single person and a dog to attend the integrated delivery than two separate events. Cost per dose (including delivery) was lower under the integrated strategy, with delivery of deworming and rabies vaccination reduced by $0.13 (54%) and $0.85 (19%) per dose, respectively. Despite a slight reduction in the proportion of village dogs vaccinated in the integrated event, both the integrated and non-integrated strategies achieved the target threshold of 70% required to eliminate rabies. Objective two: The percentages of primary school age children enrolled in school that was reached by this trial (73%) and the existing NSDP (80%) were not significantly different (F = 0.9, p = 0.36). However, of the primary school age children treated in this trial, 46% were not enrolled in school. Furthermore, 86% of the people treated would have been outside the reach of the NSDP because they were not primary school age or were primary school age children not enrolled in school. The comparable reach, the substantial reductions in cost per dose delivered and the decrease in participants’ time support this integrated One Health approach to control multiple NTDs. Further, the recorded level of non-enrolment at primary school suggests that, in remote areas, school-based delivery strategies could miss a large fraction of school-age children and that programs that focus delivery solely at the level of the primary school will miss a substantial proportion of both primary school age children as well as other individuals from the community. We have shown that these populations can be effectively reached through extramural programs.

Keywords: canine mediated human rabies, integrated health interventions, mass drug administration, neglected tropical disease, One Health, soil-transmitted helminths

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Authors: Dina Farran, Mark Ashworth, Fiona Gaughran

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Atrial fibrillation (AF), the most prevalent cardiac arrhythmia, is associated with an increased risk of stroke, contributing to heart failure and death. In this project, we aim to improve patient safety by screening for stroke risk among people with AF and co-morbid mental illness. To do so, we started by conducting a systematic review and meta-analysis on prevalence, management, and outcomes of AF in people with Serious Mental Illness (SMI) versus the general population. We then evaluated oral anticoagulation (OAC) prescription trends in people with AF and co-morbid SMI in King’s College Hospital. We also evaluated the association between mental illness severity and OAC prescription in eligible patients in South London and Maudsley (SLaM) NHS Foundation Trust. Next, we implemented an electronic clinical decision support system (eCDSS) consisting of a visual prompt on patient electronic Personal Health Records to screen for AF-related stroke risk in three Mental Health of Older Adults wards at SLaM. Finally, we assessed the feasibility and acceptability of the eCDSS by qualitatively investigating clinicians’ perspectives of the potential usefulness of the eCDSS (pre-intervention) and their experiences and their views regarding its impact on clinicians and patients (post-intervention). The systematic review showed that people with SMI had low reported rates of AF. AF patients with SMI were less likely to receive OAC than the general population. When receiving warfarin, people with SMI, particularly bipolar disorder, experienced poor anticoagulation control compared to the general population. Meta-analysis showed that SMI was not significantly associated with an increased risk of stroke or major bleeding when adjusting for underlying risk factors. The main findings of the first observational study were that among AF patients having a high stroke risk, those with co-morbid SMI were less likely than non-SMI to be prescribed any OAC, particularly warfarin. After 2019, there was no significant difference between the two groups. In the second observational study, patients with AF and co-morbid SMI were less likely to be prescribed any OAC compared to those with dementia, substance use disorders, or common mental disorders, adjusting for age, sex, stroke, and bleeding risk scores. Among AF patients with co-morbid SMI, warfarin was less likely to be prescribed to those having alcohol or substance dependency, serious self-injury, hallucinations or delusions, and activities of daily living impairment. In the intervention, clinicians were asked to confirm the presence of AF, clinically assess stroke and bleeding risks, record risk scores in clinical notes, and refer patients at high risk of stroke to OAC clinics. Clinicians reported many potential benefits for the eCDSS, including improving clinical effectiveness, better identification of patients at risk, safer and more comprehensive care, consistency in decision making and saving time. Identified potential risks included rigidity in decision-making, overreliance, reduced critical thinking, false positive recommendations, annoyance, and increased workload. This study presents a unique opportunity to quantify AF patients with mental illness who are at high risk of severe outcomes using electronic health records. This has the potential to improve health outcomes and, therefore patients' quality of life.

Keywords: atrial fibrillation, stroke, mental health conditions, electronic clinical decision support systems

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Authors: Alexandra Steed

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Alexandra Steed URBAN was commissioned to undertake the South Essex Green and Blue Infrastructure Study (SEGBI) on behalf of the Association of South Essex Local Authorities (ASELA): a partnership of seven neighboring councils within the Thames Estuary. Located on London’s doorstep, the 70,000-hectare region is under extraordinary pressure for regeneration, further development, and economic expansion, yet faces extreme challenges: sea-level rise and inadequate flood defenses, stormwater flooding and threatened infrastructure, loss of internationally important habitats, significant existing community deprivation, and lack of connectivity and access to green space. The brief was to embrace these challenges in the creation of a document that would form a key part of ASELA’s Joint Strategic Framework and feed into local plans and master plans. Thus, helping to tackle climate change, ecological collapse, and social inequity at a regional scale whilst creating a relationship and awareness between urban communities and the surrounding landscapes and nature. The SEGBI project applied a ‘land-based’ methodology, combined with a co-design approach involving numerous stakeholders, to explore how living infrastructure can address these significant issues, reshape future planning and development, and create thriving places for the whole community of life. It comprised three key stages, including Baseline Review; Green and Blue Infrastructure Assessment; and the final Green and Blue Infrastructure Report. The resulting proposals frame an ambitious vision for the delivery of a new regional South Essex Estuary (SEE) Park – 24,000 hectares of protected and connected landscapes. This unified parkland system will drive effective place-shaping and “leveling up” for the most deprived communities while providing large-scale nature recovery and biodiversity net gain. Comprehensive analysis and policy recommendations ensure best practices will be embedded within planning documents and decisions guiding future development. Furthermore, a Natural Capital Account was undertaken as part of the strategy showing the tremendous economic value of the natural assets. This strategy sets a pioneering precedent that demonstrates how the prioritisation of living infrastructure has the capacity to address climate change and ecological collapse, while also supporting sustainable housing, healthier communities, and resilient infrastructures. It was only achievable through a collaborative and cross-boundary approach to strategic planning and growth, with a shared vision of place, and a strong commitment to delivery. With joined-up thinking and a joined-up region, a more impactful plan for South Essex was developed that will lead to numerous environmental, social, and economic benefits across the region, and enhancing the landscape and natural environs on the periphery of one of the largest cities in the world.

Keywords: climate change, green and blue infrastructure, landscape architecture, master planning, regional planning, social equity

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Authors: Christine Wiesenthal

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This paper asks how to read a particularly vexed and complicated life writing text. For over half a century, the wartime journals of Ruth Andreas Friedrich (1901-1977) circulated as among a handful of more or less authoritative and “authentic” first-hand accounts of German resistance under Hitler. A professional journalist, Andreas Friedrich is remembered today largely through her publications at the war’s end, which appeared in English as Berlin Underground (published by Henry Holt in 1947), just before their publication in Germany as Der Schattenmann “The Shadow Man” (also in 1947). A British edition by the now obscure Latimer House Limited (London) followed in 1948; it is based closely on but is not identical to, the Henry Holt American edition, which in turn differs significantly from its German counterpart. Both Berlin Underground and Der Schattenmann figure Andreas-Friedrich as a key figure in an anti-fascist cell that operated in Berlin under the code name “Uncle Emil,” and provide a riveting account of political terror, opportunism, and dissent under the Nazi regime. Recent scholars have, however, begun to raise fascinating and controversial questions about Andreas-Friedrich’s own writing/reconstruction process in compiling the journals and about her highly selective curatorial role and claims. The apparent absence of any surviving original manuscript for Andreas-Friedrich’s journals amplifies the questions around them. Crucially, so too does the role of the translator of the English editions of Berlin Underground, the enigmatic June Barrows Mussey, a subject that has thus far gone virtually unnoticed and which this paper will focus on. Mussey, a prolific American translator, simultaneously cultivated a career as a professional magician, publishing a number of books on that subject under the alias Henry Hay. While the record indicates that Mussey attempted to compartmentalize his professional life, research into the publishing and translation history of Berlin Underground suggests that the two roles converge in the fact of the translator’s invisibility, by effacing the traces of his own hand and leaving unmarked his own significant textual interventions, Mussey, in effect, edited, abridged, and altered Andreas Friedrich’s journals for the second time. In fact, it could be said that while the fictitious “Uncle Emil” is positioned as “the shadow man” of the German edition, Mussey himself also emerges as precisely that in the English rendering of the journals. The implications of Mussey’s translation of Andreas Friedrich’s journals are one of the most important un-examined gaps in the shadowy publishing history of Berlin Underground, a history full of “tricks” (Mussey’s words) and illusions of transparency. Based largely on archival research of unpublished materials and methods of close reading and comparative analysis, this study will seek to convey some preliminary insights and exploratory work and frame questions toward what is ultimately envisioned as an experimental project in poetic historiography. As this work is still in the early stages, it would be especially welcome to have the opportunity provided by this conference to connect with a community of life writing colleagues who might help think through some of the challenges and possibilities that lie ahead.

Keywords: women’s wartime diaries, translation studies, auto/biographical theory, politics of life writing

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Authors: Jawaad Saleem, Hannah Wright, Peter Sommerville, Adrian Hopper

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Introduction: Inpatient falls are the most commonly reported patient safety incidents, and carry a significant burden on resources, morbidity, and mortality. Ensuring adequate post falls management of patients by staff is therefore paramount to maintaining patient safety especially in out of hours and resource stretched settings. Aims: This quality improvement project aims to improve the current practice of falls management at Guys St Thomas Hospital, London as compared to our 2016 Quality Improvement Project findings. Furthermore, it looks to increase current junior doctors confidence in managing falls and their use of new guidance protocols. Methods: Multifaceted Interventions implemented included: the development of new trust wide guidelines detailing management pathways for patients post falls, available for intranet access. Furthermore, the production of 2000 lanyard cards distributed amongst junior doctors and staff which summarised these guidelines. Additionally, a ‘safety signal’ email was sent from the Trust chief medical officer to all staff raising awareness of falls and the guidelines. Formal falls teaching was also implemented for new doctors at induction. Using an established incident database, 189 consecutive falls in 2017were retrospectively analysed electronically to assess and compared to the variables measured in 2016 post interventions. A separate serious incident database was used to analyse 50 falls from May 2015 to March 2018 to ascertain the statistical significance of the impact of our interventions on serious incidents. A similar questionnaire for the 2017 cohort of foundation year one (FY1) doctors was performed and compared to 2016 results. Results: Questionnaire data demonstrated improved awareness and utility of guidelines and increased confidence as well as an increase in training. 97% of FY1 trainees felt that the interventions had increased their awareness of the impact of falls on patients in the trust. Data from the incident database demonstrated the time to review patients post fall had decreased from an average of 130 to 86 minutes. Improvement was also demonstrated in the reduced time to order and schedule X-ray and CT imaging, 3 and 5 hours respectively. Data from the serious incident database show that ‘the time from fall until harm was detected’ was statistically significantly lower (P = 0.044) post intervention. We also showed the incidence of significant delays in detecting harm ( > 10 hours) reduced post intervention. Conclusions: Our interventions have helped to significantly reduce the average time to assess, order and schedule appropriate imaging post falls. Delays of over ten hours to detect serious injuries after falls were commonplace; since the intervention, their frequency has markedly reduced. We suggest this will lead to identifying patient harm sooner, reduced clinical incidents relating to falls and thus improve overall patient safety. Our interventions have also helped increase clinical staff confidence, management, and awareness of falls in the trust. Next steps include expanding teaching sessions, improving multidisciplinary team involvement to aid this improvement.

Keywords: patient safety, quality improvement, serious incidents, falls, clinical care

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Authors: Sweta Rout-Hoolash

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Each year, selected students from around 20 countries begin their degrees at Middlesex University with the International Foundation Program (IFP), developing the skills required for academic study at a UK university. The IFP runs for 30 learning/teaching weeks at Middlesex University Mauritius Branch Campus, which is an international campus of UK’s Middlesex University. Successful IFP students join their degree courses already settled into life at their chosen campus (London, Dubai, Mauritius or Malta) and confident that they understand what is required for degree study. Although part of the School of Science and Technology, in Mauritius it prepares students for undergraduate level across all Schools represented on campus – including disciplines such as Accounting, Business, Computing, Law, Media and Psychology. The researcher has critically reviewed the framework and resources in the curriculum for a particular six week period of IFP study (dedicated group work phase). Despite working together closely for 24 weeks, IFP students approach the final 6 week small group work project phase with mainly inhibitive feelings. It was observed that students did not engage effectively in the group work exercise. Additionally, groups who seemed to be working well did not necessarily produce results reflecting effective collaboration, nor individual members’ results which were better than prior efforts. The researcher identified scope for change and innovation in the IFP curriculum and how group work is introduced and facilitated. The study explores the challenges of groupwork in the context of the Mauritius campus, though it is clear that the implications of the project are not restricted to one campus only. The presentation offers a reflective review on the previous structure put in place for the management of small group assessed projects on the programme from both the student and tutor perspective. The focus of the research perspective is the student voice, by taking into consideration past and present IFP students’ experiences as written in their learning journals. Further, it proposes the introduction of a revised framework to help students take greater ownership of the group work process in order to engage more effectively with the learning outcomes of this crucial phase of the programme. The study has critically reviewed recent and seminal literature on how to achieve greater student ownership during this phase especially under an environment of assessed multicultural group work. The presentation proposes several new approaches for encouraging students to take more control of the collaboration process. Detailed consideration is given to how the proposed changes impact on the work of other stakeholders, or partners to student learning. Clear proposals are laid out for evaluation of the different approaches intended to be implemented during the upcoming academic year (student voice through their own submitted reflections, focus group interviews and through the assessment results). The proposals presented are all realistic and have the potential to transform students’ learning. Furthermore, the study has engaged with the UK Professional Standards Framework for teaching and supporting learning in higher education, and demonstrates practice at the level of ‘fellow’ of the Higher Education Academy (HEA).

Keywords: collaborative peer learning, enhancing learning experiences, group work assessment, learning communities, multicultural diverse classrooms, studying abroad

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Authors: Joanne DiFrancisco-Donoghue, Seth E. Jenny, Peter C. Douris, Sophia Ahmad, Kyle Yuen, Hillary Gan, Kenney Abraham, Amber Sousa

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Background: Guidelines for the maintenance of health of esports players and the cognitive changes that accompany competitive gaming are understudied. Executive functioning is an important cognitive skill for an esports player. The relationship between executive functions and physical exercise has been well established. However, the effects of prolonged sitting regardless of physical activity level have not been established. Prolonged uninterrupted sitting reduces cerebral blood flow. Reduced cerebral blood flow is associated with lower cognitive function and fatigue. This decrease in cerebral blood flow has been shown to be offset by frequent and short walking breaks. These short breaks can be as little as 2 minutes at the 30-minute mark and 6 minutes following 60 minutes of prolonged sitting. The rationale is the increase in blood flow and the positive effects this has on metabolic responses. The primary purpose of this study was to evaluate executive function changes following 6-minute bouts of walking and complete rest mid-session, compared to no break, during prolonged gameplay in competitive first-person shooter (FPS) esports players. Methods: This study was conducted virtually due to the Covid-19 pandemic and was approved by the New York Institute of Technology IRB. Twelve competitive FPS participants signed written consent to participate in this randomized pilot study. All participants held a gold ranking or higher. Participants were asked to play for 2 hours on three separate days. Outcome measures to test executive function included the Color Stroop and the Tower of London tests which were administered online each day prior to gaming and at the completion of gaming. All participants completed the tests prior to testing for familiarization. One day of testing consisted of a 6-minute walk break after 60-75 minutes of play. The Rate of Perceived Exertion (RPE) was recorded. The participant continued to play for another 60-75 minutes and completed the tests again. Another day the participants repeated the same methods replacing the 6-minute walk with lying down and resting for 6 minutes. On the last day, the participant played continuously with no break for 2 hours and repeated the outcome tests pre and post-play. A Latin square was used to randomize the treatment order. Results: Using descriptive statistics, the largest change in mean reaction time incorrect congruent pre to post play was seen following the 6-minute walk (662.0 (609.6) ms pre to 602.8 (539.2) ms post), followed by the 6-minute rest group (681.7(618.1) ms pre to 666.3 (607.9) ms post), and with minimal change in the continuous group (594.0(534.1) ms pre to 589.6(552.9) ms post). The mean solution time was fastest in the resting condition (7774.6(6302.8)ms), followed by the walk condition (7929.4 (5992.8)ms), with the continuous condition being slowest (9337.3(7228.7)ms). the continuous group 9337.3(7228.7) ms; 7929.4 (5992.8 ) ms 774.6(6302.8) ms. Conclusion: Short walking breaks improve blood flow and reduce the risk of venous thromboembolism during prolonged sitting. This pilot study demonstrated that a low intensity 6 -minute walk break, following 60 minutes of play, may also improve executive function in FPS gamers.

Keywords: executive function, FPS, physical activity, prolonged sitting

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Authors: Dr Grace Scaplehorn, Mr Muhammad Adeel Akhtar, Dr Jane Gibson

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Background: Canoe Slalom entails the skilful navigation of a carbon composite canoe or kayak through a series of 18-25 hanging gates, strategically positioned along the course, either upstream or downstream, amidst currents of whitewater rapids in natural and man-made river settings. Athletes compete individually in timed trials, competing for the fastest course time, typically around 80 to 120 seconds. In the new discipline of Kayak Cross, descents of the course are initiated by groups of four athletes freefalling simultaneously from a starting platform situated 3m above the river. Kayak Cross athletes, in contrast to Canoe Slalom, can make physical contact with suspended gates without incurring time penalties and are required to perform a kayak roll half way down the course. The Canoe Slalom World Championships were held at Lee Valley Whitewater Centre, London, from 19th to 24th September 2023. The event comprised 299 international athletes competing for 10 World Championship titles in Canoe/Kayak Slalom events (Olympic Debut Munich 1972), and the new Kayak Cross discipline (Olympic Debut Paris 2024). The inaugural appearance of Kayak Cross at the World Championships occurred in 2017, in Pau, France. There is limited literature surrounding Kayak Cross and the incidence of athlete injuries compared to traditional Canoe Slalom, hence it was felt important to undertake this review to address the perception that the event is dangerous. Aim: The study aimed to quantify and collate data collected from athletes presenting to the event medical centre. Methods: Athletes’ details were collected at initial assessments from the start of the practice period (16th–18th September) and throughout the event. Demographics such as age, sex and nationality were recorded along with presenting complaints, treatment, medication administered and outcome. Specifically, injuries were then sub-classified into body regions. The data does not include athletes who sought medical attention from their own governing body’s medical team. Results: During the 8-day period, there were 11 individual presentations to the medical centre, 3.7% of the athlete population (n=299). The mean age was 23.9 years (n=7), 6 were male (n=10). The most common presentation was minor injury (n=9), with 6 being musculoskeletal and 3 comprising skin damage, followed by insect sting/allergy (n=1) and pain relief requests (n=1). Five presentations were event-related, all being musculoskeletal injuries; 2 shoulder/arm, 1 head/neck, 1 hand/wrist and 1 other (data was not recorded). Of these injuries, the only intervention was 2 cases of 400mg Ibuprofen, which was given to both shoulder/arm injuries. Four of the 11 presentations were pre-existing injuries, which had been exacerbated due to increased intensity of practice. Two patients were advised to return for review, with 100% compliance. There were no unplanned re-presentations, and no emergency transfers to secondary care. Both the Kayak Cross and Canoe Slalom competitions resulted in 1 new event-related athlete presentation each. Conclusion: The event resulted in a negligible incidence of presentations at the medical centre, for both Kayak Cross and Canoe Slalom. This data holds significance in informing risk assessments and medical protocols necessary for the organisation of canoe slalom events.

Keywords: canoe slalom, kayak cross, athlete injuries, event injuries

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Authors: Denis Jordan, Daniel Golkowski, Mathias Lukas, Katharina Merz, Caroline Mlynarcik, Max Maurer, Valentin Riedl, Stefan Foerster, Eberhard F. Kochs, Andreas Bender, Ruediger Ilg

Abstract:

Introduction: So far, clinical assessments that rely on behavioral responses to differentiate coma states or even predict outcome in coma patients are unreliable, e.g. because of some patients’ motor disabilities. The present study was aimed to provide prognosis in coma patients using markers from electroencephalogram (EEG), blood oxygen level dependent (BOLD) functional magnetic resonance imaging (fMRI) and [18F]-fluorodeoxyglucose (FDG) positron emission tomography (PET). Unsuperwised principal component analysis (PCA) was used for multimodal integration of markers. Methods: Approved by the local ethics committee of the Technical University of Munich (Germany) 20 patients (aged 18-89) with severe brain damage were acquired through intensive care units at the Klinikum rechts der Isar in Munich and at the Therapiezentrum Burgau (Germany). At the day of EEG/fMRI/PET measurement (date I) patients (<3.5 month in coma) were grouped in the minimal conscious state (MCS) or vegetative state (VS) on the basis of their clinical presentation (coma recovery scale-revised, CRS-R). Follow-up assessment (date II) was also based on CRS-R in a period of 8 to 24 month after date I. At date I, 63 channel EEG (Brain Products, Gilching, Germany) was recorded outside the scanner, and subsequently simultaneous FDG-PET/fMRI was acquired on an integrated Siemens Biograph mMR 3T scanner (Siemens Healthineers, Erlangen Germany). Power spectral densities, permutation entropy (PE) and symbolic transfer entropy (STE) were calculated in/between frontal, temporal, parietal and occipital EEG channels. PE and STE are based on symbolic time series analysis and were already introduced as robust markers separating wakefulness from unconsciousness in EEG during general anesthesia. While PE quantifies the regularity structure of the neighboring order of signal values (a surrogate of cortical information processing), STE reflects information transfer between two signals (a surrogate of directed connectivity in cortical networks). fMRI was carried out using SPM12 (Wellcome Trust Center for Neuroimaging, University of London, UK). Functional images were realigned, segmented, normalized and smoothed. PET was acquired for 45 minutes in list-mode. For absolute quantification of brain’s glucose consumption rate in FDG-PET, kinetic modelling was performed with Patlak’s plot method. BOLD signal intensity in fMRI and glucose uptake in PET was calculated in 8 distinct cortical areas. PCA was performed over all markers from EEG/fMRI/PET. Prognosis (persistent VS and deceased patients vs. recovery to MCS/awake from date I to date II) was evaluated using the area under the curve (AUC) including bootstrap confidence intervals (CI, *: p<0.05). Results: Prognosis was reliably indicated by the first component of PCA (AUC=0.99*, CI=0.92-1.00) showing a higher AUC when compared to the best single markers (EEG: AUC<0.96*, fMRI: AUC<0.86*, PET: AUC<0.60). CRS-R did not show prediction (AUC=0.51, CI=0.29-0.78). Conclusion: In a multimodal analysis of EEG/fMRI/PET in coma patients, PCA lead to a reliable prognosis. The impact of this result is evident, as clinical estimates of prognosis are inapt at time and could be supported by quantitative biomarkers from EEG, fMRI and PET. Due to the small sample size, further investigations are required, in particular allowing superwised learning instead of the basic approach of unsuperwised PCA.

Keywords: coma states and prognosis, electroencephalogram, entropy, functional magnetic resonance imaging, machine learning, positron emission tomography, principal component analysis

Procedia PDF Downloads 313

Authors: Xu Fei (Philip) WU

Abstract:

As waste recycling concept been accepted more and more in modern societies, the organic portion of the municipal waste become a sires issue in today’s life. Depend on location and season, the organic waste can bee anywhere between 40-65% of total municipal solid waste. Also composting and anaerobic digestion technologies been applied in this field for years, however both process have difficulties been selected by economical and environmental factors. Beside environmental pollution and risk of virus spread, the compost is not a product been welcomed by people even the waste management has to give up them at no cost. The anaerobic digester has to have 70% of water and keep at 35 degree C or above; base on above conditions, the retention time only can be up to two weeks and remain solid has to be dewater and composting again. The enhancive waste water treatment has to be added after. Because these reasons, the voice of suggesting cancelling recycling program and turning all waste to mass burn incinerations have been raised-A process has already been proved has least energy efficiency and most air pollution problem associated process. A newly developed WXF Bio-energy process employs recently developed and patented pre-designed separation, multi-layer and multi-cavity successive bioreactor landfill technology. It features an improved leachate recycling technology, technologies to maximize the biogas generation rate and a reduced overall turnaround period on the land. A single properly designed and operated site can be used indefinitely. In this process, all collected biogas will be processed to eliminate H2S and other hazardous gases. The methane, carbon dioxide and hydrogen will be utilized in a proprietary process to manufacture methanol which can be sold to mitigate operating costs of the landfill. This integration of new processes offers a more advanced alternative to current sanitary landfill, incineration and compost technology. Xu Fei (Philip) Wu Xu Fei Wu is founder and Chief Scientist of W&Y Environmental International Inc. (W & Y), a Canadian environmental and sustainable energy technology company with patented landfill processes and proprietary waste to energy technologies. He has worked in environmental and sustainable energy fields over the last 25 years. Before W&Y, he worked for Conestoga-Rovers & Associates Limited, Microbe Environmental Science and Technology Inc. of Canada and The Ministry of Nuclear Industry and Ministry of Space Flight Industry of China. Xu Fei Wu holds a Master of Engineering Science degree from The University of Western Ontario. I wish present this paper as an oral presentation only Selected Conference Presentations: • “Removal of Phenolic Compounds with Algae” Presented at 25th Canadian Symposium on Water Pollution Research (CAWPRC Conference), Burlington, Ontario Canada. February, 1990 • “Removal of Phenolic Compounds with Algae” Presented at Annual Conference of Pollution Control Association of Ontario, London, Ontario, Canada. April, 1990 • “Removal of Organochlorine Compounds in a Flocculated Algae Photo-Bioreactor” Presented at International Symposium on Low Cost and Energy Saving Wastewater Treatment Technologies (IAWPRC Conference), Kiyoto, Japan, August, 1990 • “Maximizing Production and Utilization of Landfill Gas” 2009 Wuhan International Conference on Environment(CAWPRC Conference, sponsored by US EPA) Wuhan, China. October, 2009. • “WXF Bio-Energy-A Green, Sustainable Waste to Energy Process” Presented at 9Th International Conference Cooperation for Waste Issues, Kharkiv, Ukraine March, 2012 • “A Lannfill Site Can Be Recycled Indefinitely” Presented at 28th International Conference on solid Waste Technology and Management, Philadelphia, Pennsylvania, USA. March, 2013. Hosted by The Journal of Solid Waste Technology and Management.

Keywords: green fuel, waste management, bio-energy, sustainable development, methanol

Procedia PDF Downloads 243