Search results for: professional practice (PP)
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 5614

Search results for: professional practice (PP)

1684 Comparing the ‘Urgent Community Care Team’ Clinical Referrals in the Community with Suggestions from the Clinical Decision Support Software Dem DX

Authors: R. Tariq, R. Lee

Abstract:

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

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

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1683 Evaluating the Service Quality and Customers’ Satisfaction for Lihpaoland in Taiwan

Authors: Wan-Yu Liu, Tiffany April Lin, Yu-Chieh Tang, Yi-Lin Wang, Chieh-Hui Li

Abstract:

As the national income in Taiwan has been raised, the life style of the public has also been changed, so that the tourism industry gradually moves from a service industry to an experience economy. The Lihpaoland is one of the most popular theme parks in Taiwan. However, the related works on performance of service quality of the park have been lacking since its re-operation in 2012. Therefore, this study investigates the quality of software/hardware facilities and services of the Lihpaoland, and aims to achieve the following three goals: 1) analyzing how various sample data of tourists leads to different results for service quality of LihpaoLand; 2) analyzing how tourists respond to the service tangibility, service reliability, service responsiveness, service guarantee, and service empathy of LihpaoLand; 3) according to the theoretical and empirical results, proposing how to improve the overall facilities and services of LihpaoLand, and hoping to provide suggestions to the LihpaoLand or other related businesses to make decision. The survey was conducted on the tourists to the LihpaoLand using convenience sampling, and 400 questionnaires were collected successfully. Analysis results show that tourists paid much attention to maintenance of amusement facilities and safety of the park, and were satisfied with them, which are great advantages of the park. However, transportation around the LihpaoLand was inadequate, and the price of the Fullon hotel (which is the hotel closest to the LihpaoLand) were not accepted by tourists – more promotion events are recommended. Additionally, the shows are not diversified, and should be improved with the highest priority. Tourists did not pay attention to service personnel’s clothing and the ticket price, but they were not satisfied with them. Hence, this study recommends to design more distinctive costumes and conduct ticket promotions. Accordingly, the suggestions made in this study for LihpaoLand are stated as follows: 1) Diversified amusement facilities should be provided to satisfy the needs at different ages. 2) Cheep but tasty catering and more distinctive souvenirs should be offered. 3) Diversified propaganda schemes should be strengthened to increase number of tourists. 4) Quality and professional of the service staff should be enhanced to acquire public praise and tourists revisiting. 5) Ticket promotions in peak seasons, low seasons, and special events should be conducted. 6) Proper traffic flows should be planned and combined with technologies to reduce waiting time of tourists. 7) The features of theme landscape in LihpaoLand should be strengthened to increase willingness of the tourists with special preferences to visit the park. 8) Ticket discounts or premier points card promotions should be adopted to reward the tourists with high loyalty.

Keywords: service quality, customers’ satisfaction, theme park, Taiwan

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1682 Pride and Prejudice in Higher Education: Countering Elitist Perspectives in the Curriculum at Imperial College London

Authors: Mark R. Skopec, Hamdi M. Issa, Henock B. Taddese, Kate Ippolito, Matthew J. Harris

Abstract:

In peer review, there is a skew toward research from high-income countries, otherwise known as geographic bias. Research from well-known and prestigious institutions is often favored in the peer review process and is more frequently cited in biomedical research. English clinicians have been found to rate research from low-income countries worse compared to the same research presented as if from high-income countries. This entrenched bias, which is rooted in the perceived superiority of academic institutions in high-income countries is damaging in many regards. Crucially, it reinforces colonial roots by strengthening the dominance of knowledge bases in high-income contexts and perpetuates the perceived inferiority of research from low-income settings. We report on the interventions that Imperial College London is conducting to “decolonize” the higher education curriculum – a root and branch review of reading material in the Masters of Public Health course; identification of unconscious bias against low-income country research in faculty and staff; in-depth interviews with faculty members on their experiences and practices with respect to inclusion of low-income country research in their own teaching and learning practice; and exploring issues surrounding entrenched biases and structural impediments for enabling desirable changes. We intend to use these findings to develop frameworks and approaches, including workshops and online resources, to effect sustainable changes to diversify the curriculum at Imperial College London.

Keywords: curriculum design, diversity, geographic bias, higher education, implicit associations, inclusivity

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1681 The Discovery and Application of Perspective Representation in Modern Italy

Authors: Matthias Stange

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In the early modern period, a different image of man began to prevail in Europe. The focus was on the self-determined human being and his abilities. At first, these developments could be seen in Italian painting and architecture, which again oriented itself to the concepts and forms of antiquity. For example, through the discovery of perspective representation by Brunelleschi or later the orthogonal projection by Alberti, after the ancient knowledge of optics had been forgotten in the Middle Ages. The understanding of reality in the Middle Ages was not focused on the sensually perceptible world but was determined by ecclesiastical dogmas. The empirical part of this study examines the rediscovery and development of perspective. With the paradigm of antiquity, the figure of the architect was also recognised again - the cultural man trained theoretically and practically in numerous subjects, as Vitruvius describes him. In this context, the role of the architect, the influence on the painting of the Quattrocento as well as the influence on architectural representation in the Baroque period are examined. Baroque is commonly associated with the idea of illusionistic appearance as opposed to the tangible reality presented in the Renaissance. The study has shown that the central perspective projection developed by Filippo Brunelleschi enabled another understanding of seeing and the dissemination of painted images. Brunelleschi's development made it possible to understand the sight of nature as a reflection of what is presented to the viewer's eye. Alberti later shortened Brunelleschi's central perspective representation for practical use in painting. In early modern Italian architecture and painting, these developments apparently supported each other. The pictorial representation of architecture initially served the development of an art form before it became established in building practice itself.

Keywords: Alberti, Brunelleschi, central perspective projection, orthogonal projection, quattrocento, baroque

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1680 Research on Strategies of Building a Child Friendly City in Wuhan

Authors: Tianyue Wan

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Building a child-friendly city (CFC) contributes to improving the quality of urbanization. It also forms a local system committed to fulfilling children's rights and development. Yet, the work related to CFC is still at the initial stage in China. Therefore, taking Wuhan, the most populous city in central China, as the pilot city would offer some reference for other cities. Based on the analysis of theories and practice examples, this study puts forward the challenges of building a child-friendly city under the particularity of China's national conditions. To handle these challenges, this study uses four methods to collect status data: literature research, site observation, research inquiry, and semantic differential (SD). And it adopts three data analysis methods: case analysis, geographic information system (GIS) analysis, and analytic hierarchy process (AHP) method. Through data analysis, this study identifies the evaluation system and appraises the current situation of Wuhan. According to the status of Wuhan's child-friendly city, this study proposes three strategies: 1) construct the evaluation system; 2) establish a child-friendly space system integrating 'point-line-surface'; 3) build a digitalized service platform. At the same time, this study suggests building a long-term mechanism for children's participation and multi-subject supervision from laws, medical treatment, education, safety protection, social welfare, and other aspects. Finally, some conclusions of strategies about CFC are tried to be drawn to promote the highest quality of life for all citizens in Wuhan.

Keywords: action plan, child friendly city, construction strategy, urban space

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1679 Leveraging Positive Psychology Practices to Elevate the Impact of Check-In, Check-Out (CICO) in Schools

Authors: Kimberli Breen

Abstract:

Background Check-In, Check-Out is noted as the most widely implemented evidence-based intervention for youth at-promise within schools. Over twenty years of peer-reviewed research demonstrates the powerful effects of this Positive Behavioral Interventions and Supports (PBIS) practice when implemented with fidelity. However, literature to date has not explicitly connected this intervention with Positive Psychology. Aims This session will illustrate the powerful role Positive Psychology and core elements of PERMA play in the worldwide success of this intervention and how more explicitly aligning Positive Behavioral Interventions and Supports (PBIS) practices with Positive Psychology might remove common barriers to current implementation. Method Students receiving the Check-In, Check-Out intervention experience a warm, positive greeting from a caring adult (CICO Coach) before entering their first class of the day. Teachers then provide high frequency positive feedback to the students at the end of each time block, or segment, of the day. An “optimistic close” to the day is then provided by the same CICO Coach at the end of the school day via the “check-out” process, where students assess the day’s accomplishments and goal-set for the next day. Results CICO clearly aligns with the Positive Psychology core elements of PERMA (Positive Emotion, Engagement, Relationships, Meaning and Accomplishments) and could be further strengthened through explicit integration. Conclusion The already powerful impact and reach of the Check-In, Check-Out intervention can be further enhanced and expanded through greater alignment with Positive Psychology elements and practices. Initiating this important alignment with CICO also offers promise for further integration of Positive Psychology and Positive Behavioral Interventions and Supports.

Keywords: positive pscyhology, check-In check-out, schools, alignment

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1678 “It Just Feels Risky”: Intuition vs Evidence in Child Sexual Abuse Cases. Proposing an Empirically Derived Risk and Protection Protocol

Authors: Christian Perrin, Nicholas Blagden, Louise Allen, Sarah Impey

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Social workers in the UK and professionals globally are faced with a particular challenge when dealing with allegations of child sexual abuse (CSA) in the community. In the absence of a conviction or incontestable evidence, staff can often find themselves unable to take decisive action to remove a child from harm, even though there may be a credible threat to their welfare. Conversely, practitioners may over-calculate risk through fear of being accountable for harm. This is, in part, due to the absence of a structured and evidence-based risk assessment tool which can predict the likelihood of a person committing child sexual abuse. Such assessments are often conducted by forensic professionals who utilise offence-specific data and personal history information to calculate risk. In situations where only allegations underpin a case, this mode of assessment is not viable. There are further ethical issues surrounding the assessment of risk in this area which require expert consideration and sensitive planning. This paper explores this entangled problem extant in the wider call to prevent sexual and child sexual abuse in the community. To this end, 32 qualitative interviews were undertaken with social workers dealing with CSA cases. Results were analysed using thematic analysis and operationalised to formulate a risk and protection protocol for use in case management. This paper reports on the early findings associated with the initial indications of protocol reliability. Implications for further research and practice are discussed.

Keywords: sexual offending, child sexual offence, offender rehabilitation, risk assessment, offence prevention

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1677 Outcomes of Educating Care Giver in Tracheostomy Wound Care for Discharge Planning of Tracheostomy Patients at the Ear, Nose, Throat, and Eye Ward of Songkhla Hospital Thailand

Authors: Kingkan Chumjamras

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There are permanent and temporary tracheostomies, and in a permanent tracheostomy, care giver are important persons to know and be able to care for the tracheostomy patient. The objective of this quasi-experimental study was to evaluate outcomes of educating care giver in tracheostomy wound care for discharge planning of tracheostomy patients. The subjects of the study were relatives who directly cared for tracheostomy patients. Thirty subjects were selected according to specified criteria. The research instruments consisted of practice guidelines, manual for relatives in caring for the tracheostomy wound, an assisted model with a tracheostomy wound, a test, an observation form, and a patient’s relative satisfaction questionnaire. The instrument validity was tested by three experts, and the questionnaire reliability was tested with Cronbach’s alpha, and the reliability coefficient was 0.83; the data were analyzed using descriptive statistics, and paired t-test. The results of the study on educating relatives in tracheostomy wound care for discharge planning of tracheostomy patients revealed that the score for knowledge and ability in caring for the tracheostomy wound before receiving the education was at a low level (M= 19.23, SD= 1.57) compared with the very high score (M= 36.40, SD= 19.23) after receiving the education. The difference was statistically significant (p < .05), and relatives’ satisfaction was at a high level (80 percent). Knowledge and ability in caring for tracheostomy patients among patients’ relatives could cause tracheostomy wound complications for tracheostomy patients. One way to control such complications and returns to hospital from infection, in addition to care by the health care team, is educating relatives in tracheostomy wound care for discharge planning of tracheostomy patients.

Keywords: outcomes, educating, care giver, Tracheostomy Wound Care, discharge planning

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1676 A Review of Process Safety Management for Small and Medium Business in Malaysia

Authors: Muhammad Afiq Anaqi Bin Baharudin, Muhammad Izamuddin Bin Mohd Nasir, Syarifuddin Bin Sujuanda, Muhammad Syahmi Rusyaidi Bin Sham Suddin, Danish Hakimi Bin kamaruzaman, Muhammad Haqimi Nazim Bin Hasmanizam, Mohammad Akmal Zakwan Bin Amran, Muhammad Alparizi Bin Latif

Abstract:

In particular, for small and medium enterprises (SMBs) in Malaysia, process safety management (PSM) is a crucial component of industrial safety. Limited resources, a lack of technical know-how, and linguistic and cultural obstacles are just a few of the difficulties SMBs in Malaysia encounter while putting PSM programmes into practice. A number of studies have emphasised the significance of leadership commitment, hazard identification and assessment, and employee involvement in the execution of effective PSM programmes, which are crucial for preventing accidents and incidents. In the literature, there has been a lot of discussion on the creation of specialised PSM frameworks for SMBs in Malaysia. Several studies have proposed implementation frameworks for PSM programmes that are based on recognised worldwide standards. Despite the significance of PSM in ensuring industrial safety, there are still a number of gaps in the literature on PSM in Malaysian SMBs. These gaps include the need for additional research on the efficiency of PSM programmes in reducing accidents and incidents in SMBs as well as the development of more specialised approaches to implementing PSM programmes in SMBs with limited resources and technical expertise. The goal of this review is to give a thorough overview of the body of research on PSM in Malaysian SMBs while highlighting important findings, points of contention, and knowledge gaps that need to be filled in.

Keywords: process safety management, occupational safety and health (OSH), small businesses, medium businesses, malaysia

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1675 Exploring the Effects of Cuisine Experience, Emotions, Place Attachment on Heritage Tourists’ Revisit Behavioral Intentions: The Case Study of Lu-Kang

Authors: An-Na Li, Ying-Yu Chen, Yu-Lung Lin

Abstract:

Food tourism is one of the growing industries in the tourism industry today. The Destination Marketing Organizations (DMOs) are aware of the importance of gastronomy to stimulate local and regional economic development. From the heritage and cultural aspects, gastronomy is becoming a more important part of the cultural heritage of the region. Heritage destinations provide culinary heritage, which fits the current interest in traditional food, and cuisine is a part of a general desire for authentic experience. However, few studies have empirically examined antecedents of food tourists’ behavioral intentions. This study examined the effects of cuisine experience; emotions, place attachment and tourists’ revisit behavioral intentions. A total of 408 individuals responded to the on-site survey in the historic town of Lu-Kang in Taiwan. The results indicated that tourists’ cuisine experience include place flavor, media recommendation, local learning, life transfer and interpersonal share. In addition, cuisine experience had significant impacts on emotions and place attachment, emotions had significant effects on place attachment, furthermore, which in turn place attachment had significant effects on tourists’ revisit behavioral intentions. The findings suggested that the cuisine experience is a multi-dimensions construct. On the other hands, the good quality of cuisine experience could evoke tourists’ positive emotions and it could play a significant role in promoting tourist revisit intentions or word of mouth. Implications for theory and practice are discussed.

Keywords: culinary tourism, cuisine experiences, emotions, revisit intentions

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1674 Design and Modeling of Light Duty Trencher

Authors: Yegetaneh T. Dejenu, Delesa Kejela, Abdulak Alemu

Abstract:

From the earliest time of humankind, the trenches were used for water to flow along and for soldiers to hide in during enemy attacks. Now a day due to civilization, the needs of the human being become endless, and the living condition becomes sophisticated. The unbalance between the needs and resource obligates them to find the way to manage this condition. The attempt to use the scares resource in very efficient and effective way makes the trench an endeavor practice in the world in all countries. A trencher is a construction equipment used to dig trenches, especially for laying pipes or cables, installing drainage, irrigation, installing fencing, and in preparation for trench warfare. It is a machine used to make a ditch by cutting the soil ground and effectively used in agricultural irrigation. The most common types of trencher are wheel trencher, chain trencher, micro trencher, portable trencher. In Ethiopia people have been trenching the ditch for many purposes and the tools they are using are Pickaxe, Shovel and some are using Micro Excavators. The adverse effect of using traditional equipment is, time and energy consuming, less productive, difficult and more man power is required. Hence it is necessary to design and produce low price, and simple machine to narrow this gap. Our objective is to design and model a light duty trencher that is used for trenching the ground or soil for making ditch and used for agricultural, ground cabling, ground piping, and drainage system. The designed machine trenches, maximum of 1-meter depth, 30 cm width, and the required length. The working mechanism is fully hydraulic, and the engine with 12.7 hp will provide suitable power for the pump that delivers 23 l/min at 1500 rpm to drive hydraulic motors and actuators.

Keywords: hydraulics, modelling, trenching, ditch

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1673 Corporate Governance of Enterprise IT: Research Study on IT Governance Maturity

Authors: Mario Spremic

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Despite the financial crisis and ongoing need for cost cutting, companies all around the world heavily invest in information systems (IS) and underlying information technology (IT). Information systems (IS) play very important role in modern business organizations supporting its organizational efficiency or, under certain circumstances, fostering business model innovation and change. IS can influence organization competitiveness in two ways: supporting operational efficiency (IS as a main infrastructure for the current business), or differentiating business through business model innovation and business process change. In either way, IS becomes very important to the business and needs to be aligned with strategic objectives in order to justify massive investments. A number of studies showed that investments in IS and underlying IT resulted in added business value if they are truly connected with strategic business objectives. In that sense proliferation of governance of enterprise IT helps companies manage, or rather, governs IS as a primary business function with executive management involved in making a decision about IS and IT. The quality of IT governance is rising with the large number of decisions about IS made by executive management, not IT departments. The more executive management is engaged in making a decision about IS and IT, the IT governance is of better quality. In this paper, the practice of governing the enterprise IT will be investigated on a sample of the largest 100 Croatian companies. Research questions posed here will reveal if there are some formal IT governance mechanisms, are there any differences in perceived role of IS and IT between CIOs (Chief Information Officers) and CEOs (Chief Executive Officers) of the sampled companies and what are the mechanisms to govern massive investment in enterprise IT.

Keywords: IT governance, governance of enterprise IT, information system auditing, operational efficiency

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1672 The Importance of Developing Pedagogical Agency Capacities in Initial Teacher Formation: A Critical Approach to Advance in Social Justice

Authors: Priscilla Echeverria

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This paper addresses initial teacher formation as a formative space in which pedagogy students develop a pedagogical agency capacity to contribute to social justice, considering ethical, political, and epistemic dimensions. This paper is structured by discussing first the concepts of agency, pedagogical interaction, and social justice from a critical perspective; and continues offering preliminary results on the capacity of pedagogical agency in novice teachers after the analysis of critical incidents as a research methodology. This study is motivated by the concern that responding to the current neoliberal scenario, many initial teacher formation (ITF) programs have reduced the meaning of education to instruction, and pedagogy to methodology, favouring the formation of a technical professional over a reflective or critical one. From this concern, this study proposes that the restitution of the subject is an urgent task in teacher formation, so it is essential to enable him in his capacity for action and advance in eliminating institutionalized oppression insofar as it affects that capacity. Given that oppression takes place in human interaction, through this work, I propose that initial teacher formation develops sensitivity and educates the gaze to identify oppression and take action against it, both in pedagogical interactions -which configure political, ethical, and epistemic subjectivities- as in the hidden and official curriculum. All this from the premise that modelling democratic and dialogical interactions are basic for any program that seeks to contribute to a more just and empowered society. The contribution of this study lies in the fact that it opens a discussion in an area about which we know little: the impact of the type of interactions offered by university teaching at ITF on the capacity of future teachers to be pedagogical agents. For this reason, this study seeks to gather evidence of the result of this formation, analysing the capacity of pedagogical agency of novice teachers, or, in other words, how capable the graduates of secondary pedagogies are in their first pedagogical experiences to act and make decisions putting the formative purposes that they are capable of autonomously defining before technical or bureaucratic issues imposed by the curriculum or the official culture. This discussion is part of my doctoral research, "The importance of developing the capacity for ethical-political-epistemic agency in novice teachers during initial teacher formation to contribute to social justice", which I am currently developing in the Educational Research program of the University of Lancaster, United Kingdom, as a Conicyt fellow for the 2019 cohort.

Keywords: initial teacher formation, pedagogical agency, pedagogical interaction, social justice, hidden curriculum

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1671 The Study of Internship Performances: Comparison of Information Technology Interns towards Students’ Types and Background Profiles

Authors: Shutchapol Chopvitayakun

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Internship program is a compulsory course of many undergraduate programs in Thailand. It gives opportunities to a lot of senior students as interns to practice their working skills in the real organizations and also gives chances for interns to face real-world working problems. Interns also learn how to solve those problems by direct and indirect experiences. This program in many schools is a well-structured course with a contract or agreement made with real business organizations. Moreover, this program also offers opportunities for interns to get jobs after completing it from where the internship program takes place. Interns also learn how to work as a team and how to associate with other colleagues, trainers, and superiors of each organization in term of social hierarchy, self-responsibility, and self-disciplinary. This research focuses on senior students of Suan Sunandha Rajabhat University, Thailand whose studying major is information technology program. They practiced their working skills or took internship programs in the real business sector or real operating organizations in 2015-2016. Interns are categorized in to two types: normal program and special program. For special program, students study in weekday evening from Monday to Friday or Weekend and most of them work full-time or part-time job. For normal program, students study in weekday working hours and most of them do not work. The differences of these characters and the outcomes of internship performance were studied and analyzed in this research. This work applied some statistical analytics to find out whether the internship performance of each intern type has different performances statistically or not.

Keywords: internship, intern, senior student, information technology program

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1670 The Instrumentalization of Digital Media in the Context of Sexualized Violence

Authors: Katharina Kargel, Frederic Vobbe

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Sexual online grooming is generally defined as digital interactions for the purpose of sexual exploitation of children or minors, i.e. as a process for preparing and framing sexual child abuse. Due to its conceptual history, sexual online grooming is often associated with perpetrators who are previously unknown to those affected. While the strategies of perpetrators and the perception of those affected are increasingly being investigated, the instrumentalisation of digital media has not yet been researched much. Therefore, the present paper aims at contributing to this research gap by examining in what kind of ways perpetrators instrumentalise digital media. Our analyses draw on 46 case documentations and 18 interviews with those affected. The cases and the partly narrative interviews were collected by ten cooperating specialist centers working on sexualized violence in childhood and youth. For this purpose, we designed a documentation grid allowing for a detailed case reconstruction i.e. including information on the violence, digital media use and those affected. By using Reflexive Grounded Theory, our analyses emphasize a) the subjective benchmark of professional practitioners as well as those affected and b) the interpretative implications resulting from our researchers’ subjective and emotional interaction with the data material. It should first be noted that sexualized online grooming can result in both online and offline sexualized violence as well as hybrid forms. Furthermore, the perpetrators either come from the immediate social environment of those affected or are unknown to them. The perpetrator-victim relationship plays a more important role with regard to the question of the instrumentalisation of digital media than the question of the space (on vs. off) in which the primary violence is committed. Perpetrators unknown to those affected instrumentalise digital media primarily to establish a sexualized system of norms, which is usually embedded in a supposed love relationship. In some cases, after an initial exchange of sexualized images or video recordings, a latent play on the position of power takes place. In the course of the grooming process, perpetrators from the immediate social environment increasingly instrumentalise digital media to establish an explicit relationship of power and dependence, which is directly determined by coercion, threats and blackmail. The knowledge of possible vulnerabilities is strategically used in the course of maintaining contact. The above explanations lead to the conclusion that the motive for the crime plays an essential role in the question of the instrumentalisation of digital media. It is therefore not surprising that it is mostly the near-field perpetrators without commercial motives who initiate a spiral of violence and stress by digitally distributing sexualized (violent) images and video recordings within the reference system of those affected.

Keywords: sexualized violence, children and youth, grooming, offender strategies, digital media

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1669 Age-Stereotypes of Emerging Adults within the South African Work Environment

Authors: Bronwyn Bell, Lizelle Brink

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Workplaces of today are populated by employees from different generations; emerging adults being the most recent demographic group entering the workplace. These individuals form part of Generation Y and are between the ages of 18 to 25. Emerging adults bring unique and different characteristics to the workplace. These individuals also differ from other generations with regards to their employment desires and ways of working. Age-stereotypes of emerging adults is, therefore, a common occurrence within workplaces. The general objective of the study was therefore to explore age-related stereotypes experienced regarding emerging adults within the South African work context and to determine the influences thereof. A qualitative research design from the social constructivism paradigm was employed in order to reach the objectives of this research study. A phenomenological approach using a combination of purposive and snowball sampling was employed within this study. A sample of 25 employees (N = 25) from various South African organisations were interviewed for the purpose of this study and formed part of three generations namely Generation Y, Generation X and Baby Boomers. In order to analyse the collected data, the steps of thematic analysis were used. The main findings of this study indicated that emerging adults experience various positive and negative stereotypes within the workplace. Results further indicated that these stereotypes influence emerging adults in a behavioural, cognitive and emotional manner. These stereotypes also influence the way emerging adults are treated by older employees within the workplace. Recommendations based on the results of this study were made for future research and practice. This study creates awareness within organisations regarding age-stereotypes of emerging adults. By being aware, employees can manage the influences thereof within the workplace.

Keywords: age-stereotypes, baby boomers, emerging adults, generation x, generation y, South African work environment, stereotypes

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1668 Faculty Use of Geospatial Tools for Deep Learning in Science and Engineering Courses

Authors: Laura Rodriguez Amaya

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Advances in science, technology, engineering, and mathematics (STEM) are viewed as important to countries’ national economies and their capacities to be competitive in the global economy. However, many countries experience low numbers of students entering these disciplines. To strengthen the professional STEM pipelines, it is important that students are retained in these disciplines at universities. Scholars agree that to retain students in universities’ STEM degrees, it is necessary that STEM course content shows the relevance of these academic fields to their daily lives. By increasing students’ understanding on the importance of these degrees and careers, students’ motivation to remain in these academic programs can also increase. An effective way to make STEM content relevant to students’ lives is the use of geospatial technologies and geovisualization in the classroom. The Geospatial Revolution, and the science and technology associated with it, has provided scientists and engineers with an incredible amount of data about Earth and Earth systems. This data can be used in the classroom to support instruction and make content relevant to all students. The purpose of this study was to find out the prevalence use of geospatial technologies and geovisualization as teaching practices in a USA university. The Teaching Practices Inventory survey, which is a modified version of the Carl Wieman Science Education Initiative Teaching Practices Inventory, was selected for the study. Faculty in the STEM disciplines that participated in a summer learning institute at a 4-year university in the USA constituted the population selected for the study. One of the summer learning institute’s main purpose was to have an impact on the teaching of STEM courses, particularly the teaching of gateway courses taken by many STEM majors. The sample population for the study is 97.5 of the total number of summer learning institute participants. Basic descriptive statistics through the Statistical Package for the Social Sciences (SPSS) were performed to find out: 1) The percentage of faculty using geospatial technologies and geovisualization; 2) Did the faculty associated department impact their use of geospatial tools?; and 3) Did the number of years in a teaching capacity impact their use of geospatial tools? Findings indicate that only 10 percent of respondents had used geospatial technologies, and 18 percent had used geospatial visualization. In addition, the use of geovisualization among faculty of different disciplines was broader than the use of geospatial technologies. The use of geospatial technologies concentrated in the engineering departments. Data seems to indicate the lack of incorporation of geospatial tools in STEM education. The use of geospatial tools is an effective way to engage students in deep STEM learning. Future research should look at the effect on student learning and retention in science and engineering programs when geospatial tools are used.

Keywords: engineering education, geospatial technology, geovisualization, STEM

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1667 Planning and Management Options for Pastoral Resource: Case of Mecheria Region, Algeria

Authors: Driss Haddouche

Abstract:

Pastoral crisis in Algeria has its origins in rangeland degradation which are the main factor in any activity in the steppe zones. Indeed, faced with the increasing human and animal population on a living space smaller and smaller, there is an overuse of what remains of the steppe range lands, consequently the not sustainability of biomass production. Knowing the amount of biomass available, the practice of grazing options, taking into account the use of "Use Factor" factor remains an essential method for managing pastoral resources. This factor has three options: at 40% Conservative pasture; at 60 % the beginning of overgrazing; at 80% destructive grazing. Accessibility on the pasture is based on our field observations of a type any flock along a grazing cycle. The main purpose of these observations is to highlight the speed of herd grazing situation. Several individuals from the herd were timed to arrive at an average duration of about 5 seconds to move between two tufts of grass, separated by a distance of one meter. This gives a rate of 5 s/m (0.72 km/h) flat. This speed varies depending on the angle of the slope. Knowing the speed and slope of each pixel of the study area, given by the digital elevation model of Spot Image (MNE) and whose pitch is 15 meters, a map of pasture according to the distances is generated. Knowing the stocking and biomass available, the examination of the common Mécheria at regular distances (8.64 km or 12 hours of grazing, 17.28 km or 24 hours of grazing and 25.92 Km or 36 hours of grazing), offers three different options (conservation grazing resource: utilization at 40%; overgrazing statements for use at 60% and grazing destructive for use by more than 80%) for each distance traveled by sheep from the starting point is the town of Mécheria.

Keywords: pastoral crisis, biomass, animal charge, use factor, Algeria

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1666 Conversion from Catholicism to Islam in and out of Prison: A Comparative Study

Authors: Nerissa Gloria Balboa, Aire Yukdawan, Venice Gordula, Rhea Jannagen Curva

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This research examined the lived experiences and compared their similarities and differences of former Catholics turned Muslim converts in and out of prison. Qualitative comparative study with an Interpretative Phenomenological Analysis approach was used to explore the lives of Muslim converts. Interviews were conducted at Islamic Studies, Call and Guidance of the Philippines (ISCAG) and Tarbiyyah Islamic Female Institute for Muslim converts out of prison, New Bilibid Prison (NBP) and Correctional Institution for Women (CIW) for Muslim converts in prison. Results of the study show that first, for Muslim converts out of prison, exploration begins through (1) experiences of Catholicism as a norm in the family and eventual realization of its emptiness in practice, (2) experiences of Islam as a norm in the environment and discovery of meaningfulness of Islam (3) experiences of gradual holistic transformation of being a Muslim; and (4) experiences of extension of oneself towards family and society. Secondly, for Muslim converts in prison, exploration begins through (1) experiences of Apathy towards Catholicism and eventual deviation from moral standards, (2) experiences of prison condition as an environment of reflection on spirituality; and (3) experiences of positive effects of being a Muslim inside Prison. Comparisons show that there exists similarities and differences across the two settings in terms of (1) experiences of Catholicism and the degree of its internalization and actualization, (2) experiences of Islamic encounters and the process of conversion; and (3) experience of Islamic devotion and Islamic construct for the self. Theoretical bases of religious conversion found in unique contexts are discussed, initiating a paradigm shift of thinking that is needed to address the deeply rooted prejudices within Catholic and Islamic circles.

Keywords: Catholicism, Islamic conversion, social psychology, religion

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1665 Study of Expatriation as Countermeasure to Citizenship-Based Taxation

Authors: Gabriele Palumbo

Abstract:

This research empirically examines some of the reasons behind the fact that recently the number of people giving up their American citizenship for tax purposes has recently increased drastically. The United States Jurisdiction represents a unicum in the practice of taxing worldwide income not only to residents of the United States but also to U.S. citizens living abroad. The worldwide income taxation also affects people defined as “Accidental Americans” who are unaware that they are U.S. citizens. Those people are considered Americans even though they have not been to the United States. American residents abroad can rely on United States income tax treaties and some national law provisions, such as the exclusion of foreign income and foreign tax credits, which are designed specifically to avoid double taxation. However, this mechanism may prove unsatisfactory for people who have not been linked anymore or individuals who have never had relations with the United States. U.S. citizens who are determined to cut all of the ties between themselves and the United States, especially those that involve tax implications, can renounce their U.S. citizenship with the expatriation procedure. The expatriation process represents the extrema ratio and implicates several steps which must be followed carefully. This paper shows the complexity of the procedure that a U.S. citizen who is resident in a foreign country would have to follow to relinquish U.S. citizenship for tax purposes. The mechanism is intended to discourage people from renounce. Going beyond the question of whether U.S. tax regulation is fair or not, this principle nowadays characterizes a popular topic that many scholars and lawyers are discussing. The outcome provides interesting implications that could induce the Congress to rethink the definition of citizenship for both fiscal and nationality law purposes. Indeed, even if a sort of checks and balances has the task of mitigating the renunciation of U.S. citizenship, more and more U.S. citizens desire to get rid of their citizenship.

Keywords: double taxation, expatriation tax, international taxation, relinquishment of United States citizenship

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1664 Agroforestry Systems and Practices and Its Adoption in Kilombero Cluster of Sagcot, Tanzania

Authors: Lazaro E. Nnko, Japhet J. Kashaigili, Gerald C. Monela, Pantaleo K. T. Munishi

Abstract:

Agroforestry systems and practices are perceived to improve livelihood and sustainable management of natural resources. However, their adoption in various regions differs with the biophysical conditions and societal characteristics. This study was conducted in Kilombero District to investigate the factors influencing the adoption of different agroforestry systems and practices in agro-ecosystems and farming systems. A household survey, key informant interviews, and focus group discussion was used for data collection in three villages. Descriptive statistics and multinomial logistic regression in SPSS were applied for analysis. Results show that Igima and Ngajengwa villages had home garden practices dominated, as revealed by 63.3% and 66.7%, respectively, while Mbingu village had mixed intercropping practice with 56.67%. Agrosilvopasture systems were dominant in Igima and Ngajengwa villages with 56.7% and 66.7%, respectively, while in Mbingu village, the dominant system was agrosilviculture with 66.7%. The results from multinomial logistic regression show that different explanatory variable was statistical significance as predictors of the adoption of agroforestry systems and practices. Residence type and sex were the most dominant factor influencing the adoption of agroforestry systems. Duration of stay in the village, availability of extension education, residence, and sex were the dominant factor influencing the adoption of agroforestry practices. The most important and statistically significant factors among these were residence type and sex. The study concludes that agroforestry will be more successful if the local priorities, which include social-economic need characteristics of the society, will be considered in designing systems and practices. The socio-economic need of the community should be addressed in the process of expanding the adoption of agroforestry systems and practices.

Keywords: agroforestry adoption, agroforestry systems, agroforestry practices, agroforestry, Kilombero

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1663 Exploring Tourist’s Attitude towards Environmentally Friendly Practices

Authors: René Haarhoff

Abstract:

Consumers are constantly reminded of their responsibility towards the environment in a world where words such as global warming, carbon footprint, recycling or ‘green’’ everything has become common language. What was previously considered to be ordinary practices are in many instances frowned upon today and consumers are expected to individually contribute towards a greener mother earth. However unused recycle bins, single travelers in luxury cars, busy airports and vast deforested areas for new developments tell another story. The question arises whether the everyday man in the street really takes the responsibility to balance the three pillars of sustainability: the planet, its people and profit. Undeniably our activities impact on the environment where a healthy economy is needed in a fast paced global environment. The situation is further gloomed in instances where the consumer has paid for inclusive services which directly impacts on the environment. A prime example of this is the tourism industry: accommodation establishments or resorts include clean, daily washed towels and bedding, large bath tubs, inclusive use of electricity and water to name a few. This research evaluates environmentally friendly practices consumers follow at home and also when on holiday. Respondents at Bloemfontein airport, often using tourism products were included in the study. Results reveal that the majority of respondents state that they are concerned about the environment yet when questioned on donation towards endangered species, switching off lights in hotel rooms or using water sparingly a significant difference in results are evident. From the research results it is evident that consumers do not practice what they preach towards a greener environment.

Keywords: green, environment, consumer, tourism, sustainable practices

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1662 Development of a Consult Liaison Psychology Service: A Systematic Review

Authors: Ben J. Lippe

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Consult Liaison Psychology services are overgrowing, given the robust empirical support of the utility of this service in hospital settings. These psychological services, including clinical assessment, applied psychotherapy, and consultation with other healthcare providers, have been shown to improve health outcomes for patients and bolster important areas of administrative interest such as decreased length of patient admission. However, there is little descriptive literature outlining the process and mechanisms of building or developing a Consult Liaison Psychology service. The main findings of this current conceptual work are intended to be clear in nature to elucidate the essential methods involved in developing consult liaison psychology programs, including thorough reviews of relevant behavioral health literature and inclusion of experiential outcomes. The diverse range of hospital settings and healthcare systems makes a “blueprint” method of program development challenging to define, yet important structural frameworks presented here based on the relevant literature and applied practice can help lay critical groundwork for program development in this growing area of psychological service. This conceptual approach addresses the prominent processes, as well as common programmatic and clinical pitfalls, involved in the event of a Consult Liaison Psychology service. This paper, including a systematic review of relevant literature, is intended to serve as a key program development reference for the development of Consult Liaison Psychology services, other related behavioral health programs, and to help inform further research efforts.

Keywords: behavioral health, consult liaison, health psychology, psychology program development

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1661 Compliance of Systematic Reviews in Plastic Surgery with the PRISMA Statement: A Systematic Review

Authors: Seon-Young Lee, Harkiran Sagoo, Katherine Whitehurst, Georgina Wellstead, Alexander Fowler, Riaz Agha, Dennis Orgill

Abstract:

Introduction: Systematic reviews attempt to answer research questions by synthesising the data within primary papers. They are an increasingly important tool within evidence-based medicine, guiding clinical practice, future research and healthcare policy. We sought to determine the reporting quality of recent systematic reviews in plastic surgery. Methods: This systematic review was conducted in line with the Cochrane handbook, reported in line with the PRISMA statement and registered at the ResearchRegistry (UIN: reviewregistry18). MEDLINE and EMBASE databases were searched in 2013 and 2014 for systematic reviews by five major plastic surgery journals. Screening, identification and data extraction was performed independently by two teams. Results: From an initial set of 163 articles, 79 met the inclusion criteria. The median PRISMA score was 16 out of 27 items (59.3%; range 6-26, 95% CI 14-17). Compliance between individual PRISMA items showed high variability. It was poorest for items related to the use of review protocol (item 5; 5%) and presentation of data on risk of bias of each study (item 19; 18%), while being the highest for description of rationale (item 3; 99%) and sources of funding and other support (item 27; 95%), and for structured summary in the abstract (item 2; 95%). Conclusion: The reporting quality of systematic reviews in plastic surgery requires improvement. ‘Hard-wiring’ of compliance through journal submission systems, as well as improved education, awareness and a cohesive strategy among all stakeholders is called for.

Keywords: PRISMA, reporting quality, plastic surgery, systematic review, meta-analysis

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1660 Making Good Samaritans: An Exploration of Criminal Liability for Failure to Rescue in England and Wales

Authors: Usmaan Siddiqui

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In England and Wales, there is no duty to rescue strangers. We will be investigating whether this is correct, and whether we should introduce a Good Samaritan law. In order to explore this, firstly, we will be exploring the nature of our moral duties. How far do our moral duties extend? Do they extend only to our family and friends, or do they also extend to strangers? Secondly, even if there does exist a moral duty, should this duty be enforced by criminal law? To what extent should the criminal law reflect morality? Under English criminal law, the consensus is, that it is not the job of the English criminal law to perfect human behaviour, and whilst the law should prevent us from causing harm, it should not force us to be good. This approach is radically different from many other European countries that actually do have a Good Samaritan law. If there are compelling in principle reasons to introduce a Good Samaritan law how would we deal with the pragmatic institutional constraints? Such a law has been stated as being unworkable in practice and difficult in defining its limits. In order to verify this, we shall carry out a comparative analysis between England and selected states in the US to gauge how successful the Good Samaritan law has been in dealing with these institutional constraints. In terms of methodology, as well as a comparative analysis, we shall also be carrying out a doctrinal analysis exploring what the English criminal law’s position is regarding Omissions. In conclusion, the findings so far are, whilst it is not the job of the law to perfect human behaviour, both respect for the law and the level of social co-operation will be greatly improved if the law encourages morally desirable conduct. Whilst it is possible for society to exist without a duty to assist the distressed, a society which ignores the vulnerable is cold, callous, and uncaring. After all, we all need to face up to the possibility that we may be one day be vulnerable and in need of urgent aid, and it is about time English criminal law, catches up with the majority of Europe and protects the vulnerable.

Keywords: criminal, law, omissions, philosophy

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1659 Confess Your Sins to One Another: An Exploration of the Biblical Validity and the Psychological Efficacy of the Sacrament of Reconciliation in the Catholic Church

Authors: M. B. Peter

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The Sacrament of Penance and Reconciliation has long been upheld, by the Catholic Church, as one of the Sacraments of healing, mainly due to the sense of peace, tranquility and psychological quiescence it accords the penitent upon receiving Sacramental absolution of sin through the action of the priest. This paper explores the Sacramental character of this practice and the psychological benefits of the celebration of the Sacrament. This is achieved in two parts: firstly, by the intellectual engagement of Sacred Scripture and the consolidated Sacred Tradition that the Catholic magisterium protects and, secondly, via a broad survey of the works of Carl Gustav Jung and Orval Hobart Mowrer regarding confession and forgiveness. The former will serve to demonstrate the Catholic belief of the divine institution of the Sacrament whilst the latter will demonstrate how this belief, coupled with the existing benefit of confessing guilt, collectively bolsters the Sacrament’s overall psychological efficacy. Fundamentally, the analysis of Jung and Mowrer’s works demonstrate that man, as a naturally religious being, has an inherent need for the confession of his wrong that he might be alleviated of psychological guilt in obtaining forgiveness of a (divinely ordained) minister who is sanctioned to absolve, i.e. the priest. The paper also presents the curative effect of the celebration of this Sacrament, illustrating how, without the act of confession, man remains in moral isolation from God and man; and, that with it, man is relieved of the mysterious feeling of guilt which lies at the root of his disquiet of mind and disturbance of will. Thus, the paper penultimately establishes how the Sacrament of Reconciliation is positioned in that place where psychology and theology meet: man’s sense of guilt. It is Jung’s views on confession and forgiveness that ultimately bridge the chasm between psychology and Christianity.

Keywords: Catholic, confession, Jung, Mowrer, penance, psychology, Sacrament of Reconciliation

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1658 Empirical Analysis of the Relationship between Voluntary Accounting Disclosures and Mongolian Stock Exchange Listed Companies’ Characteristics

Authors: Ernest Nweke

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Mongolia has made giant strides in the development of its auditing and accounting system from Soviet-style to a market-oriented system. High levels of domestic and foreign investment desired by the Mongolian government require that better and improved quality of corporate information and disclosure consistent with international standards be made available to investors. However, the Mongolian Certified Public Accountants (CPA) profession is still developing, and the quality of services provided by accounting firms in most cases do not comply with International Financial Reporting Standards (IFRS) framework approved by the government for use in financial reporting. Against this backdrop, Accounting and audit reforms, liberalization and deregulation, establishment of an efficient and effective professional monitoring and supervision regime are policy necessities. These will further enhance the Mongolian business environment, eliminate incompetence in the system, make the economy more attractive to investors and ultimately lift reporting standards and bring about improved accounting, auditing and disclosure practices among Mongolian firms. This paper examines the fundamental issues in the accounting and auditing environment in Mongolia and investigates the relationship between selected characteristics of Mongolian Stock Exchange (MSE) listed firms (profitability, leverage, firm size, firm auditor size, firm listing age, board size and proportion of independent directors) and voluntary accounting disclosures in their annual reports and accounts. The selected sample of firms for the research purpose consists of the top 20 indexes of the MSE, representing over 95% of the market capitalization. An empirical analysis of the hypothesized relationship was carried out using multiple regression in EViews analytical software. Research results lend credence to the fact that only a few of the company attributes positively impact voluntary accounting disclosures in Mongolian Stock Exchange-listed firms. The research is motivated by the absence of empirical evidence on the correlation between the quality of voluntary accounting disclosures made by listed companies in Mongolia and company characteristics and the findings thereof significantly useful to both firms and regulatory authorities. The concluding part of the paper precisely consists of useful research-based recommendations for listed firms and regulatory agencies on measures to put in place in order to enhance the quality of corporate financial reporting and disclosures in Mongolia.

Keywords: accounting, auditing, corporate disclosure, listed firms

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1657 Labour Productivity Measurement and Control Standards for Hotels

Authors: Kristine Joy Simpao

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Improving labour productivity is one of the most enthralling and challenging aspects of managing hotels and restaurant business. The demand to secure countless productivity became an increasingly pivotal role of managers to survive and sustain the business. Besides making business profitable, they are in the doom to make every resource to become productive and effective towards achieving company goal while maximizing the value of organization. This paper examines what productivity means to the services industry, in particular, to the hotel industry. This is underpinned by an investigation of the extent of practice of respondent hotels to the labour productivity aspect in the areas of materials management, human resource management and leadership management and in a way, computing the labour productivity ratios using the hotel simple ratios of productivity in order to find a suitable measurement and control standards for hotels with SBMA, Olongapo City as the locale of the study. The finding shows that hotels labour productivity ratings are not perfect with some practices that are far below particularly on strategic and operational decisions in improving performance and productivity of its human resources. It further proves of the no significant difference ratings among the respondent’s type in all areas which indicated that they are having similar perception of the weak implementation of some of the indicators in the labour productivity practices. Furthermore, the results in the computation of labour productivity efficiency ratios resulted relationship of employees versus labour productivity practices are inversely proportional. This study provides a potential measurement and control standards for the enhancement of hotels labour productivity. These standards should also contain labour productivity customized for standard hotels in Subic Bay Freeport Zone to assist hotel owners in increasing the labour productivity while meeting company goals and objectives effectively.

Keywords: labour productivity, hotel, measurement and control, standards, efficiency ratios, practices

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1656 Analyses of Adverse Drug Reactions Reported of Hospital in Taiwan

Authors: Yu-Hong Lin

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Background: An adverse drug reaction (ADR) reported is an injury which caused by taking medicines. Sometimes the severity of ADR reported may be minor, but sometimes it could be a life-threatening situation. In order to provide healthcare professionals as a better reference in clinical practice, we do data collection and analysis from our hospital. Methods: This was a retrospective study of ADRs reported performed from 2014 to 2015 in our hospital in Taiwan. We collected assessment items of ADRs reported, which contain gender and age, occurring sources, Anatomical Therapeutic Chemical (ATC) classification of suspected drugs, types of adverse reactions, Naranjo score calculating by Naranjo Adverse Drug Reaction Probability Scale and so on. Results: The investigation included two hundred and seven ADRs reported. Most of ADRs reported were occurring in outpatient department (92%). The average age of ADRs reported was 65.3 years. Less than 65 years of age were in the majority in this study (54%). Majority of all ADRs reported were males (51%). According to ATC classification system, the major classification of suspected drugs was cardiovascular system (19%) and antiinfectives for systemic use (18%) respectively. Among the adverse reactions, Dermatologic Effects (35%) were the major type of ADRs. Also, the major Naranjo scores of all ADRs reported ranged from 1 to 4 points (91%), which represents a possible correlation between ADRs reported and suspected drugs. Conclusions: Definitely, ADRs reported is still an extremely important information for healthcare professionals. For that reason, we put all information of ADRs reported into our hospital's computer system, and it will improve the safety of medication use. By hospital's computer system, it can remind prescribers to think of information about patient's ADRs reported. No drugs are administered without risk. Therefore, all healthcare professionals should have a responsibility to their patients, who themselves are becoming more aware of problems associated with drug therapy.

Keywords: adverse drug reaction, Taiwan, healthcare professionals, safe use of medicines

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1655 Frenotomy for Tongue Tie: The Unlikely Benefit of Massage

Authors: Kailas Bhandarkar, Talib Dar, Laura Karia, Manasvi Upadhyaya

Abstract:

Introduction: Frenotomy for tongue tie is commonly performed in breastfed infants who experience difficulty in latching after failed conservative management for tongue tie. However, there is no consensus for the routine use of massage following frenotomy. Our aim was to assess the efficacy of massage in preventing recurrence following frenotomy. Methods: The tongue tie service in our tertiary referral hospital consists of 5 consultants and a breastfeeding (BF) midwife. 3 consultants routinely advice massage post procedure. Babies are assessed by the midwife after the procedure and a follow-up consultation after a week. After due ethical approval, data were collected by two staff members who were independent of TT service on a standardized questionnaire to avoid bias. Fischer exact test was employed (p < 0.05 considered significant). Results: Six hundred and thirty-two babies attended the clinic from January 2018 to December 2018. Thirty-three of these were excluded as the procedure was not needed. Parents were contacted at a median of six months post-procedure (range 2-10 months). 282/599 were advised massage. 92/282 could be contacted. 40/ 92 adhered to massage regimen. None of these had a recurrence. 52/92 (54%), although advised, did not perform massage. Reasons cited for lack of adherence to massage included difficulty in performing massaging and conflicting advice given by other health care professionals involved in patient care like paediatricians and group practice and lack of information on the internet). Overall, 4/599 (0.66%) had recurrences, and this difference was not statistically significant. Conclusion: In our experience, the rate of recurrence after frenotomy is low enough for us to conclude that there is no significant benefit of massage after frenotomy for tongue tie. We could also conclude that among parents who were advised massage more than half failed to adhere to the advice.

Keywords: tongue tie, frenotomy, massage, recurrence

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