Search results for: voluntary audit

Authors: Victor Au, Khin Maung Than, Zaw Win Aung, Linawati Jumat

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Background & Objectives: Cardiac arrests can occur anywhere or anytime, and most of the cases will be brought to the emergency department except the cases that happened in at in-patient setting. Raja IsteriPangiran Anak Saleha (RIPAS) Hospital is the only tertiary government hospital which located in Brunei Muara district and received all referral from other Brunei districts. Data of cardiac arrests in Brunei Darussalam scattered between Emergency Medical Ambulance Services (EMAS), Emergency Department (ED), general inpatient wards, and Intensive Care Unit (ICU). In this audit, we only focused on cardiac arrest cases which had happened or presented to the emergency department RIPAS Hospital. Theobjectives of this audit were to look at demographic of cardiac arrest cases and the survival to discharge rate of In-Hospital Cardiac Arrest (IHCA) and Out-Hospital Cardiac Arrest (OHCA). Methodology: This audit retrospective study was conducted on all cardiac arrest cases that underwent Cardiopulmonary Resuscitation (CPR) in ED RIPAS Hospital, Brunei Muara, in the year 2019-2020. All cardiac arrest cases that happened or were brought in to emergency department were included. All the relevant data were retrieved from ED visit registry book and electronic medical record “Bru-HIMS” with keyword diagnosis of “cardiac arrest”. Data were analyzed and tabulated using Excel software. Result: 313 cardiac arrests were recorded in the emergency department in year 2019-2020. 92% cases were categorized as OHCA, and the remaining 8% as IHCA. Majority of the cases were male with age between 50-60 years old. In OHCA subgroup, only 12.4% received bystander CPR, and 0.4% received Automatic External Defibrillator (AED) before emergency medical personnel arrived. Initial shockable rhythm in IHCA group accounted for 12% compare to 4.9% in OHCA group. Outcome of ED resuscitation, 32% of IHCA group achieved return of spontaneous circulation (ROSC) with a survival to discharge rate was 16%. For OHCA group, 12.35% achieved ROSC, but unfortunately, none of them survive till discharge. Conclusion: Standardized registry for cardiac arrest in the emergency department is required to provide valid baseline data to measure the quality and outcome of cardiac arrest. Zero survival rate for out hospital cardiac arrest is very concerning, and it might represent the significant breach in cardiac arrest chains of survival. Systematic prospective data collection is needed to identify contributing factors and to improve resuscitation outcome.

Keywords: cardiac arrest, OHCA, IHCA, resuscitation, emergency department

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Authors: Carlos Gonzalez, Neil Slatcher, Marcus Properzi, Kan Seah

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In many underground mining operations, shotcrete is used for permanent rock support. Shotcrete thickness is a critical measure of the success of this process. 3D Laser Mapping, in conjunction with Jetcrete, has developed a 3D laser scanning system specifically for measuring the thickness of shotcrete. The system is mounted on the shotcrete spraying machine and measures the rock faces before and after spraying. The calculated difference between the two 3D surface models is measured as the thickness of the sprayed concrete. Typical work patterns for the shotcrete process required a rapid and automatic system. The scanning takes place immediately before and after the application of the shotcrete so no convergence takes place in the interval between scans. Automatic alignment of scans without targets was implemented which allows for the possibility of movement of the spraying machine between scans. Case studies are presented where accuracy tests are undertaken and automatic audit reports are calculated. The use of 3D imaging data for the calculation of shotcrete thickness is an important tool for geotechnical engineers and contract managers, and this could become the new state-of-the-art methodology for the mining industry.

Keywords: 3D imaging, shotcrete, surface model, tunnel stability

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Authors: Ghazwan Al-Haji, Adeyemi Adedokun

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Traffic safety at intersections is highly represented, given the fact that accidents occur randomly in time and space. It is necessary to judge whether the intersection is dangerous or not based on short-term observations, and not waiting for many years of assessing historical accident data. There are active and pro-active road infrastructure safety methods for assessing safety at intersections. This study aims to investigate the use of quantitative and qualitative pre-observational methods as the best practice for accident prediction, future black spot identification, and treatment. Historical accident data from STRADA (the Swedish Traffic Accident Data Acquisition) was used within Norrkoping city in Sweden. The ADT (Average Daily Traffic), capacity and speed were used to predict accident rates. Locations with the highest accident records and predicted accident counts were identified and hence audited qualitatively by using Street Audit. The results from these quantitative and qualitative methods were analyzed, validated and compared. The paper provides recommendations on the used methods as well as on how to reduce the accident occurrence at the chosen intersections.

Keywords: intersections, traffic conflict, traffic safety, street audit, accidents predictions

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Authors: Rabih Nehme, Abdullah Al Mutawa

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The general goal behind this research is to gain a better understanding of factors leading to dysfunctional behavior of auditors. Recent accounting scandals -Enron, Waste Management Inc., WorldCom, Xerox Corporation, etc. -provided an ample proof of how the role of auditors has become the basis of controversial debates in many circles and instances in our modern time. The majority of lawsuits and accounting scandals seem to have a central topic in focus, namely the question ''Where were the auditors? The survey we offer up for research is made up of 34 questions that are designed to analyse the perception of auditors and the cause of dysfunctional behavior. The object of this research is comprised of auditors positioned and employed at the Big Four audit firms in Kuwait. Dysfunctional behavior (DB) is measured against two signal proxies of dysfunctional behavior; premature sign-off and under reporting of chargeable time. DB is analysed against time budget pressure and time deadline pressure. The research results' suggest that the general belief among auditors is that the profession of accountancy predetermines their tendency to commit certain patterns of dysfunctional behavior. Having our investigation conducted at the Big Four audit firms, we have come to the conclusion that there is a general difference in behavior patterns among perceptions of dysfunctional behavior and normal skeptic professional behavior.

Keywords: big four, dysfunctional behavior, time budget, time deadline

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Authors: Hayley Lawrence, Nabi Shah, Sarah Dyer

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

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

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Authors: Brianna M. Soule, Jesslyn A. Bryk-Lucy, Linda M. Ritchie

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Colic, defined as abdominal pain in the horse, has several known predisposing factors. Decreased water intake has been shown to predispose equines to impaction colic. The objective of this study was to determine if offering flavored water (sweet feed or banana extract) would increase voluntary water intake in horses to serve as an assessable, noninvasive method for farm managers, veterinarians, or owners to decrease the risk of impaction colic. An a priori power analysis, which was conducted using G*Power version 3.1.9.7, indicated that the minimum sample size required to achieve 80% power for detecting a large effect at a significance level of α = .05 was 19 horses for a one-way repeated measures ANOVA with three treatment levels and assuming a non-sphericity correction of ε=0.5. After a three-day control period, 21 horses were randomly divided into two sequences and offered either banana or sweet feed flavored water. Horses always had a bucket of unflavored water available. A repeated measure study design was used to measure water consumption of each horse over a 62-hour period. A one-way repeated measures ANOVA was conducted to determine whether there were statistically significant differences among the means for the three-day average water intake (ml/kg). Although not statistically significant (F(2, 38) = 1.28, p = .290, partial η2 = .063), the three-day average water intake was largest for banana flavored water (M = 53.51, SD = 9.25 ml/kg), followed by sweet feed (M = 52.93, SD = 11.99 ml/kg), and, finally, unflavored water (M = 50.40, SD = 10.82 ml/kg). Paired-samples t-tests were used to determine whether there was a statistically significant difference between the three-day average water intake (ml/kg) for flavored versus unflavored water. The average unflavored water intake (M = 29.3 ml/kg, SD = 8.9) over the measurement period was greater than the banana flavored water (M = 27.7 ml/kg, SD = 9.8), but the average consumption of the sweet feed flavored water (M = 30.4 ml/kg, SD = 14.6) was greater than unflavored water (M = 24.3 ml/kg, SD = 11.4). None of these differences in average intake were statistically significant (p > .244). Future research is warranted to determine if other flavors significantly increase voluntary water intake in horses.

Keywords: colic, equine, equine science, water intake, flavored water, horses, equine management, equine health, horse health, horse health care management, colic prevention

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Authors: Jane N. O'Sullivan

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In most studies relating change in fertility to potentially causal factors (such as girls’ educational attainment, infant mortality or urbanization), the presence or nature of family planning efforts are not examined, potentially misattributing their contributions. Modest impacts of voluntary family planning programs on fertility change have been claimed, citing the near-term effects of historical quasi-experimental projects – notably in Bangladesh and in Ghana – where recipients and non-recipients could be contrasted. By their nature, such experiments lacked the wider cultural impacts of national programs. Concurrently, analyses relating population growth with economic advancement have been equivocal, discrediting previous widespread concern which prevailed before the 1980s. This neutral view has been revised more recently with demographic dividend theory crediting higher working-age proportion with some economic stimulus if supported by sufficient institutional and human capacity. In this study of country-level data, cross-country comparisons spanning six decades relate fertility decline with family planning effort, GDP per capita and female education, finding that the timing of rapid fertility decline aligns with commencement of voluntary family planning programs, while economic betterment came after substantial fertility fall. The relationship between fertility and primary education completion was inconsistent, with potential channels of causation operating in both directions. GDP per capita was unrelated to rate of fertility decline, but total fertility rates above three children per woman strongly impeded enrichment. By synchronizing countries with respect to their fertility transition, strong relationships are revealed which suggest lower fertility enables economic betterment, rather than the other way around. These results argue in favour of elevating voluntary family planning as a development priority.

Keywords: economic advance, family planning effort, fertility decline, population growth rate

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Authors: Gusa Hall, Barrie Keeler, Achal Khanna

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Introduction: NICE guidelines have highlighted the consequences of IV fluid mismanagement. The main aim of this study was to audit fluid prescribing post laparotomies to identify if fluids were prescribed in accordance to NICE guidelines. Methodology: Retrospective database search of eight specific laparotomy procedures (colectomy right and left, Hartmann’s procedure, small bowel resection, perforated ulcer, abdominal perineal resection, anterior resection, pan proctocolectomy, subtotal colectomy) highlighted 29 laparotomies between April 2019 and May 2019. Two of 29 patients had secondary procedures during the same admission, n=27 (patients). Database case notes were reviewed for date of procedure, length of admission, fluid prescribed and amount, nasal gastric tube output, daily bloods results for electrolytes sodium and potassium and operational losses. Results: n=27 based on 27 identified patients between April 2019 – May 2019, 93% (25/27) received IV fluids, only 19% (5/27) received the correct IV fluids in accordance to NICE guidelines, 93% (25/27) who received IV fluids had the correct electrolytes levels (sodium & potassium), 100% (27/27) patients received blood tests (U&E’s) for correct electrolytes levels. 0% (0/27) no documentation on operational losses. IV fluids matched nasogastric tube output in 100% (3/3) of the number of patients that had a nasogastric tube in situ. Conclusion: A PubMed database literature review on barriers to safer IV prescribing highlighted educational interventions focused on prescriber knowledge rather than how to execute the prescribing task. This audit suggests IV fluids post laparotomies are not being prescribed consistently in accordance to NICE guidelines. Surgical management plans should be clearer on IV fluids and electrolytes requirements for the following 24 hours after the plan has been initiated. In addition, further teaching and training around IV prescribing is needed together with frequent surgical audits on IV fluid prescribing post-surgery to evaluate improvements.

Keywords: audit, IV Fluid prescribing, laparotomy, NICE guidelines

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Authors: Yehia Manawi, Ahmad Kayvanifard

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Membrane distillation is an emerging technology which has been used to produce freshwater and purify different types of aqueous mixtures. Qatar is an arid country where almost 100% of its freshwater demand is supplied through the energy-intensive thermal desalination process. The country’s need for water has reached an all-time high which stipulates finding an alternative way to augment freshwater without adding any drastic affect to the environment. The objective of this paper was to investigate the potential of using the industrial low grade waste heat to produce freshwater using membrane distillation. The main part of this work was conducting a heat audit on selected Qatari chemical industries to estimate the amounts of freshwater produced if such industrial waste heat were to be recovered. By the end of this work, the main objective was met and the heat audit conducted on the Qatari chemical industries enabled us to estimate both the amounts of waste heat which can be potentially recovered in addition to the amounts of freshwater which can be produced if such waste heat were to be recovered. By the end, the heat audit showed that around 605 Mega Watts of waste heat can be recovered from the studied Qatari chemical industries which resulted in a total daily production of 5078.7 cubic meter of freshwater. This water can be used in a wide variety of applications such as human consumption or industry. The amount of produced freshwater may look small when compared to that produced through thermal desalination plants; however, one must bear in mind that this water comes from waste and can be used to supply water for small cities or remote areas which are not connected to the water grid. The idea of producing freshwater from the two widely-available wastes (thermal rejected brine and waste heat) seems promising as less environmental and economic impacts will be associated with freshwater production which may in the near future augment the conventional way of producing freshwater currently being thermal desalination. This work has shown that low grade waste heat in the chemical industries in Qatar and perhaps the rest of the world can contribute to additional production of freshwater using membrane distillation without significantly adding to the environmental impact.

Keywords: membrane distillation, desalination, heat recovery, environment

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Authors: Isa Raquel Alves Soeiro, Cristina Isabel Branco de Sá

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In Portugal, since 2008, there has been a requirement to export the Standard Audit File for Tax Purposes (SAF-T) standard file (in XML format). This file thus gathers tax-relevant information from a company relating to a specific period of taxation. There are two types of SAF-T files that serve different purposes: the SAF-T of revenues and the SAF-T of accounting, which requires taxpayers and accounting firms to invest in order to adapt the accounting programs to the legal requirements. The implementation of the SAF-T accounting file aims to facilitate the collection of relevant tax data by tax inspectors as support of taxpayers' tax returns for the analysis of accounting records or other information with tax relevance (Portaria No. 321-A/2007 of March 26 and Portaria No. 302/2016 of December 2). The main objective of this research project is to verify, through quantitative analysis, what is the cost of compliance of Small and Medium Enterprises (SME) in the district of Leiria in the introduction and implementation of the tax obligation of SAF-T - Standard Audit File for Tax Purposes of accounting. The information was collected through a questionnaire sent to a population of companies selected through the SABI Bureau Van Dijk database in 2020. Based on the responses obtained to the questionnaire, the companies were divided into two groups: Group 1 -companies who are self-employed and whose main activity is accounting services; and Group 2 -companies that do not belong to the accounting sector. In general terms, the conclusion is that there are no statistically significant differences in the costs of complying with the accounting SAF-T between the companies in Group 1 and Group 2 and that, on average, the internal costs of both groups represent the largest component of the total cost of compliance with the accounting SAF-T. The results obtained show that, in both groups, the total costs of complying with the SAF-T of accounting are regressive, which appears to be similar to international studies, although these are related to different tax obligations. Additionally, we verified that the variables volume of business, software used, number of employees, and legal form explain the differences in the costs of complying with accounting SAF-T in the Leiria district SME.

Keywords: compliance costs, SAF-T accounting, SME, Portugal

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Authors: Lucy Novianti

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The purpose of this study is to determine the effect of corporate governance, ownership structure, and cash holdings on firm value, either direct or indirect through profitability as an intervening variable for non-financial companies listed on the Indonesia Stock Exchange during 2006 to 2014. Samples of 176 firms are chosen based on purposive sampling method. The results of this study conclude that profitability, the size of Audit Committee, audit quality, and cash flow have positive effects on firm value. This study also shows that the meeting frequency of the Board of Directors and free cash flow have negative effects on firm value. In addition, this study finds that the size of the Board of Directors, Independent Commissioner, and ownership structure do not have significant effects on firm value. In this study, the function of profitability as an intervening variable can only be done on the impact of the meeting frequency of the Board of Directors and cash flow on firm value. This study provides a reference for management in decision making concerning the application of corporate governance, cash holdings, and financial performance. Moreover, it can be used as additional information for investors in assessing the feasibility of an investment. Finally, it provides a suggestion for the government regarding the regulation of corporate governance.

Keywords: cash holdings, corporate governance, firm value, ownership structure, profitability

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Authors: Gokulan Vethanayakam, Daniel Aston

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Introduction: The ReSPECT process supports healthcare professionals when making patient-centered decisions in the event of an emergency. It has been widely adopted by the NHS in England and allows patients to express thoughts and wishes about treatments and outcomes that they consider acceptable. It includes (but is not limited to) cardiopulmonary resuscitation decisions. ReSPECT conversations should ideally occur prior to ICU admission and should be documented in the eight sections of the nationally-standardised ReSPECT form. This audit evaluated the use of ReSPECT on a busy cardiothoracic ICU in an NHS Trust where established policies advocating its use exist. Methods: This audit was a retrospective review of ReSPECT forms for a sample of high-risk patients admitted to ICU at the Royal Papworth Hospital between January 2021 and March 2022. Patients all received one of the following interventions: Veno-Venous Extra-Corporeal Membrane Oxygenation (VV-ECMO) for severe respiratory failure (retrieved via the national ECMO service); cardiac or pulmonary transplantation-related surgical procedures (including organ transplants and Ventricular Assist Device (VAD) implantation); or elective non-transplant cardiac surgery. The quality of documentation on ReSPECT forms was evaluated using national standards and a graded ranking tool devised by the authors which was used to assess narrative aspects of the forms. Quality was ranked as A (excellent) to D (poor). Results: Of 230 patients (74 VV-ECMO, 104 transplant, 52 elective non-transplant surgery), 43 (18.7%) had a ReSPECT form and only one (0.43%) patient had a ReSPECT form completed prior to ICU admission. Of the 43 forms completed, 38 (88.4%) were completed due to the commencement of End of Life (EoL) care. No non-transplant surgical patients included in the audit had a ReSPECT form. There was documentation of balance of care (section 4a), CPR status (section 4c), capacity assessment (section 5), and patient involvement in completing the form (section 6a) on all 43 forms. Of the 34 patients assessed as lacking capacity to make decisions, only 22 (64.7%) had reasons documented. Other sections were variably completed; 29 (67.4%) forms had relevant background information included to a good standard (section 2a). Clinical guidance for the patient (section 4b) was given in 25 (58.1%), of which 11 stated the rationale that underpinned it. Seven forms (16.3%) contained information in an inappropriate section. In a comparison of ReSPECT forms completed ahead of an EoL trigger with those completed when EoL care began, there was a higher number of entries in section 3 (considering patient’s values/fears) that were assessed at grades A-B in the former group (p = 0.014), suggesting higher quality. Similarly, forms from the transplant group contained higher quality information in section 3 than those from the VV-ECMO group (p = 0.0005). Conclusions: Utilisation of the ReSPECT process in high-risk patients is yet to be well-adopted in this trust. Teams who meet patients before hospital admission for transplant or high-risk surgery should be encouraged to engage with the ReSPECT process at this point in the patient's journey. VV-ECMO retrieval teams should consider ReSPECT conversations with patients’ relatives at the time of retrieval.

Keywords: audit, critical care, end of life, ICU, ReSPECT, resuscitation

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Authors: Ruth Green, Samantha Milton, Rinal Desai

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Background/Aims: Eye pain/swelling/redness is a common presentation to Barnet General Hospital (a district general hospital), pediatric emergency department, and is managed by both the pediatric and emergency teams. The management of each child differs dramatically depending on the healthcare professional who reviews them. There also appears to be confusion in diagnosis between periorbital cellulitis, pre-septal cellulitis, and orbital cellulitis. Pre septal cellulitis refers to an inflammation of the eyelids and soft tissue anterior to the orbital septum. In contrast, orbital cellulitis is a serious, rapidly progressive infection of soft tissues located posterior to the orbital septum. Pre-septal cellulitis is more prevalent and less serious than orbital cellulitis, although it may be part of a continuous spectrum if untreated. Pre-septal cellulitis should there be diagnosed and treated urgently to prevent spread to the septum. For the purpose of the audit, the term periorbital cellulitis has been used as an umbrella term for all spectrums of this infection. The audit aimed to look at, how as a whole, the department is diagnosing and managing orbital and pre-septal cellulitis. Gold Standard: Patients of the same age and diagnosis should be treated with the same medication, advice, and follow-up. Method: Data was collected retrospectively from pediatric patients ( < 18years) who attended the emergency department from June 2019 to February 2020 who had been coded as pre-septal cellulitis, periorbital cellulitis, orbital cellulitis, or eye pain/swelling/redness. Demographics, signs and symptoms, management, and follow-up were recorded for all patients with any of the diagnoses of pre-septal, periorbital, or orbital cellulitis. A Microsoft Excel spreadsheet was used to record the anonymised data. Results: There were vast discrepancies in the diagnosis, management, and follow-up of patients with periorbital cellulitis. Conclusion/Discussion: The audit concluded there is no uniform approach to managing periorbital cellulitis in Barnet General Hospital Paediatric Emergency Department. Healthcare professionals misdiagnosed conjunctivitis as periorbital cellulitis, and adequate steps did not appear to be documented on excluding red flag signs and symptoms of patients presenting. There was no consistency in follow-up, with some patients having timely phone reviews or clinical reviews for mild symptoms. Advice given by the staff was appropriate, and patients did return when symptoms got worse and were treated accordingly. Plan: Given the inconsistency, a gold standard care pathway or local easily accessible clinical guideline can be developed to help with the diagnosis and management of periorbital cellulitis. Along with this, a teaching session can be carried out for the staff of the pediatric team and emergency department to disseminate the teaching. Following the introduction of a guideline and teaching sessions, patients notes can be re-reviewed to check improvement in patient care.

Keywords: periorbital cellulitis, preseptal cellulitis, orbital cellulitis, erythematous eyelid

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Authors: Nicolas Koslover, Tamara Levene

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Aims: Tonsilitis is one of the most common presentations to the A+E department. We aimed to assess whether patients presenting with tonsilitis are being managed in-line with current guidance. We then set out to educate A+E staff about tonsilitis management and then assessed for improvement in management. Methods: All patients presenting to A+E in one fortnight with a documented diagnosis of tonsilitis were included. We reviewed the notes to assess the choice of treatment in each case and whether a clinical score (CENTOR or FEVERPain score) was used to guide choice of treatment (in accordance with NICE guideline [NG84]). We designed and delivered an educational intervention for A+E staff covering tonsilitis guidelines. The audit was repeated two weeks later. Results: Over the study period, 49 patients were included; only 35% (n=17) had either a clinical score documented or had all components of a score recorded. In total, 39% (n=19) were treated with antibiotics. Of these, 63% (n=12) should not have been prescribed an antibiotic and 37% (n=7) were prescribed an inappropriate antibiotic. At re-audit, (n=50 cases), 58% (n=29) had a clinical score documented and 28% (n=14) were treated with antibiotics. Of these, 29% (n=4) should not have been prescribed antibiotics and 21% (n=3) were prescribed an inappropriate antibiotic. Thus, after this teaching session, there was a significant improvement in antibiotic prescribing practices (63% vs. 29%, p=0.026). Conclusions: A+E assessment and management of tonsilitis frequently deviated from guidelines, but a single teaching session vastly improved clinical scoring and antibiotic prescribing practices.

Keywords: tonsilitis, education, emergency medicine, ENT

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Authors: John Kong Shan Ho

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Senior executives’ remunerations of public companies have aroused much debate and attention in the media. In the aftermath of the Global Financial Crisis (GFC), excessive executive pay arrangements were blamed for contributing to excessive risk-taking, which caused the financial meltdown. Since then, regulators and lawmakers around the world have introduced regulations to strengthen the corporate governance of listed companies. A key aspect of such reform is by strengthening regulatory intervention over executives’ remunerations and increasing the transparency of such information. This article is written against such background and examines the recent proposal by the UK BEIS to ask the FRC to amend the UK Corporate Governance Code (UKCGC) to strengthen clawback provisions for directors’ remuneration in listed companies as part of its audit reform. The article examines the background and debates regarding the possible implementation of such a measure in the UK. Contrary to the BEIS’ proposal, it argues that implementing it through the UKCGC is unlikely to enhance overall corporate governance and audit quality. It argues that the UK should follow the footsteps of its US and Dutch counterparts by enacting legislation to claw back directors’ remunerations. It will also provide some recommendations as to the key factors that need to be considered in drafting such a statutory provision.

Keywords: company law, corporate governance, agency problem, directors' remunerations, clawbacks

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Authors: Siti Zabedah Saidin, Aidi Ahmi, Azharudin Ali, Wan Norhayati Wan Ahmad

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In today's increasingly complex and interconnected world, the concept of sustainability has transcended mere corporate social responsibility, evolving into a fundamental driver of organizational behaviour and disclosure. This content analysis study delves into the Malaysian federal-level statutory bodies’ annual report for the year 2021, aiming to elucidate the extent of sustainability disclosures within the non-financial sections of these reports. The escalating global emphasis on sustainability has prompted organizations to embrace transparency as a means to demonstrate their commitment to environmental, social, and governance (ESG) considerations. Voluntary sustainability disclosure has emerged as a crucial channel through which organizations communicate their efforts, initiatives, and impacts in these areas, thereby fostering trust and accountability with stakeholders. The study aims to identify and examine the types of sustainability information disclosed voluntarily by the federal-level statutory bodies, concentrating on the non-financial sections of the annual reports. To achieve this, the study adopts a simplified disclosure index, a pragmatic tool that quantifies the extent of sustainability reporting in a standardized manner. Using convenience sampling, the study selects a sample of annual reports from the federal-level statutory bodies in Malaysia, as provided on their respective websites. The content analysis is centred on the non-financial sections of these reports, allowing for an in-depth exploration of sustainability disclosures. The findings of the study present the extent to which Malaysian federal-level statutory bodies embrace sustainability reporting. Through thorough content analysis, the study uncovered diverse dimensions of sustainability information, encompassing environmental impact assessments, social engagement endeavours, and governance frameworks. This reveals a deliberate effort by these bodies to encapsulate their holistic organizational contributions and challenges, transcending traditional financial metrics. This research contributes to the existing literature by providing insights into the evolving landscape of sustainability disclosure practices among Malaysian federal-level statutory bodies. The findings underline the proactive nature of these bodies in voluntarily sharing sustainability-related information, reflecting their recognition of the interconnectedness between organizational success and societal well-being. Furthermore, the study underscores the potential influence of regulatory guidelines and societal expectations in shaping the extent and nature of voluntary sustainability disclosures. Organizations are not merely responding to regulatory mandates but are actively aligning with global sustainability goals and stakeholder expectations. As organizations continue to navigate the intricate web of stakeholder expectations and sustainability imperatives, this study enriches the discourse surrounding transparency and sustainability reporting. The analysis emphasizes the important role of non-financial disclosures in portraying a holistic organizational narrative. In an era where stakeholders demand accountability, and the interconnectedness of global challenges necessitates collaborative action, the voluntary disclosure of sustainability information stands as a testament to the commitment of Malaysian federal-level statutory bodies in shaping a more sustainable future.

Keywords: voluntary disclosure, sustainability information, annual report, federal-level statutory body

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Authors: Shang-Hen Wu, Yung-Chen Lin, Wei-Song Chang, Ming-Ju Lin

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This study investigated whether the repeated bout effect (RBE) of knee flexors (KF) eccentric exercise would be changed in muscle-tendon lengths. Eight healthy university male students used their KF of non-dominant leg and performed a bout of 60 maximal isokinetic (30°/s) eccentric contractions (MaxECC1). A week after MaxECC1, all subjects used the same KF to perform a subsequent bout of MaxECC2. Changes in maximal isokinetic voluntary contraction torque (MVC-CON), muscle soreness (SOR), relaxed knee joint angle (RANG), leg circumference (CIR), and ultrasound images (UI; muscle-tendon length and muscle angle) were measured before, immediately after, 1-5 days after each bout. Two-way ANOVA was used to analyze all the dependent variables. After MaxECC1, all the dependent variables (e.g. MVC-CON: ↓30%, muscle-tendon length: ↑24%, muscle angle: ↑15%) showed significantly change. Following MaxECC2, all the above dependent variables (e.g. MVC-CON：↓21%, tendon length: ↑16%, muscle angle: ↑6%) were significantly smaller than those of MaxECC1. These results of this study found that protective effect conferred by MaxECC1 against MaxECC2, and changes in muscle damage indicators, muscle-tendon length and muscle angle following MaxECC2 were smaller than MaxECC1. Thus, the amount of shift of muscle-tendon length and muscle angle was related to the RBE.

Keywords: eccentric exercise, maximal isokinetic voluntary contraction torque, repeated bout effect, ultrasound

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Authors: Vidya Iyer, Suresh Babu Loganathan, Yuan Hwa Lee, Kwong Fah Koh

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Introduction: It has been recommended that every patient undergoes careful preoperative evaluation in a preoperative clinic to improve theatre utilization, reduce bed occupancy and avoid unnecessary cancellation due to inadequate optimisation, communication and administrative errors. It also gives an opportunity to counsel patients regarding different aspects of anaesthesia. Methodology: A retrospective audit of all the patients seen in preoperative assessment clinic, referral letters of all the patients postponed / referred to other sub specialities in the perioperative period from June 2012 - June 2013 was done. In our clinic, we retrieved patient records who were awaiting surgery pending clearance by other sub specialities. Those patients, who could continue with their scheduled date of surgery after having been referred, were not included in the file. We also studied details of same day cancellations from the data base, during the same study period. The reasons for cancellation were examined and defined as avoidable and unavoidable. Results: Less than 0.5% was postponed from the scheduled day of surgery. Less than 0.5% was cancelled on the day of surgery. Conclusions: Patients who undergo pre anaesthetic evaluation in a well-established clinic results in adequate preoperative patient optimisation, avoids unnecessary preoperative admission, efficient theatre utilisation and greater patient satisfaction. The benefits are the result of guidelines and timely update of them which are used by the junior doctors and trainees who run the clinic and a dedicated specialist to supervise them.

Keywords: preoperative assessment, clinic, referrals, cancellation

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Authors: Fatemah Al-Baroud, Sudharani Shreenivas Kshatriya

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Kuwait Oil Company (KOC) is one of the companies for gas & oil production in Kuwait. The oil and gas industry is truly global; with operations conducted in every corner of the globe, the global community will rely heavily on oil and gas supplies. KOC has made many commitments to protect all due to KOC’s operations and operational releases. As per KOC’s strategy, the substantial increase in production activities will bring many challenges in managing various environmental hazards and stresses in the company. In order to handle those environmental challenges, the need of implementing effectively the health, safety, and environmental management system (HSEMS) is significant. And by implementing the HSEMS system properly, the environmental aspects of the activities, products, and services were identified, evaluated, and controlled in order to (i) Comply with local regulatory and other obligatory requirements; (ii) Comply with company policy and business requirements; and (iii) Reduce adverse environmental impact, including adverse impact to company reputation. Assessments for the Jurassic Production Facilities are being carried out as a part of the KOC HSEMS procedural requirement and monitoring the implementation of the relevant HSEMS procedures in the facilities. The assessments have been done by conducting series of theme audits using KOC’s audit protocol at JPFs. The objectives of the audits are to evaluate the compliance of the facilities towards the implementation of environmental procedures and the status of the KEPA requirement at all JPFs. The list of the facilities that were covered during the theme audit program are the following: (1) Jurassic Production Facility (JPF) – Sabriya (2) Jurassic Production Facility (JPF) – East Raudhatian (3) Jurassic Production Facility (JPF) – West Raudhatian (4)Early Production Facility (EPF 50). The auditing process comprehensively focuses on the application of KOC HSE MS procedures at JPFs and their ability to reduce the resultant negative impacts on the environment from the operations. Number of findings and observations were noted and highlighted in the audit reports and sent to all concerned controlling teams. The results of these audits indicated that the facilities, in general view, were in line with KOC HSE Procedures, and there were commitments in documenting all the HSE issues in the right records and plans. Further, implemented several control measures at JPFs that minimized/reduced the environmental impact, such as SRU were installed for sulphur recovery. Future scope and monitoring audit after a sufficient period of time will be carried out in conjunction with the controlling teams in order to verify the current status of the recommendations and evaluate the contractors' performance towards the required actions in preserving the environment.

Keywords: assessment of the environmental compliance, environmental and social impact assessment, kuwait environment public authority regulations, health, safety and environment management procedures, jurassic production facilities

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Authors: Akanle Florence Foluso

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Access to health care and people’s ability to have a responsible, satisfying and safe sexual life is clearly a defined human right of people with hearing impairment and others with disabilities. This paper investigates the extent to which the hearing impaired have a satisfying, safe sexual life and whether their human right in regard to information and education is violated. The study population consists of all hearing-impaired adolescents and young adults aged 10-24 years who are currently enrolled in primary and secondary schools in Nigeria. A sample of 389 hearing-impaired adolescents was selected, and an adapted version of the illustrative questionnaire for interview - survey by John Cleland was used to collect the data. A correlation of 0.80 was obtained at a P<0.05 level of significance. Teachers in the school of the deaf who used sign language were used in the administration of the questionnaire. The data generated were analyzed using Frequency counts. Summary of responses on access to information, education, voluntary testing, counseling and reproductive services. This is to be violated or protected. Findings show that a gap exists in the level of knowledge of SRH services and voluntary counseling because more than half the respondents are not aware of these services in their community. Access to information, education and health services are rights denied to the hearing impaired. So, their rights are violated.

Keywords: sexuality, gender, reproductive health, human right

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Authors: Cesar Julio Recalde

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Background: The role of intangible assets in today´s society is undeniable and continuously growing. More than 80% of corporate market is related to intellectual capital(IC). However, corporate governance principles and practices seem strongly based and oriented towards tangible assets. The impact of intangible assets on corporate governance might require prevention and adaptative actions. Adherence to voluntary mechanisms of intellectual capital reporting (ICR) seems to be a gateway towards adapting corporate governance to intangible assets influence and a conceptual cornerstone. The impact of adherence to intellectual capital reporting on corporate governance and performance needs to be evaluated. Purposes: This work has a sequential two folded purpose: (1) exploring the influences exerted by IC on corporate governance theory and practice, and within that context (2) analyzing the impact of adherence to voluntary mechanisms of ICR on corporate governance. Design and summary: This work employs the theory of the firm and agency theory in order to conceptually explore the effects of each dimension of IC on key corporate governance issues, namely property rights and control by shareholders and residual claims by stakeholders, fiduciary duties of management and the board, opportunistic behavior and transparency. A comprehensive IC taxonomy and map is presented. Within the resulting context, internal and external impact of ICR on corporate governance and performance is conceptually analyzed. IRC constraint and barriers are identified. Intellectual liabilities are presented within the context of IRC. Finally, IRC regulatory framework is surveyed. Findings: Relevant conclusions were rendered on the influence of intellectual capital on corporate governance. Sufficient evidence of a positive impact of IRC on corporate governance and performance was found. Additionally, it was found that IRC exerts a leveraging effect on IC itself. Intellectual liabilities are insufficiently researched and seem to have a relevant importance on IC measuring. IRC regulatory framework was found to be insufficiently developed to capture the essence of intangible assets and to meet corporate governance challenges facing IC. Originality: This work develops a progressive approach to conceptually analyze the mutual influences between IC and corporate governance. An epistemic ideogram represents the intersection of analyzed theories. An IC map is presented. The relatively new topic of intellectual liabilities is conceptually analyzed in the context of IRC. Social liabilities and client liabilities are presented.

Keywords: corporate governance, intellectual capital, intellectual capital reporting, intellectual assets, intellectual liabilities, voluntary mechanisms, regulatory framework

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Authors: Rachael Andrews, Viktoria McMillan, Shuaib Nasser, Christopher M. Roberts

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Background and objective: The National Review of Asthma Deaths (NRAD) found that asthma management and care was inadequate in 26% of cases reviewed. Major shortfalls identified were adherence to national guidelines and standards and, particularly, the organisation of care, including supervision and monitoring in primary care, with 70% of cases reviewed having at least one avoidable factor in this area. 5.4 million people in the UK are diagnosed with and actively treated for asthma, and approximately 60,000 are admitted to hospital with acute exacerbations each year. The majority of people with asthma receive management and treatment solely in primary care. This has therefore created concern that many people within the UK are receiving sub-optimal asthma care resulting in unnecessary morbidity and risk of adverse outcome. NRAD concluded that a national asthma audit programme should be established to measure and improve processes, organisation, and outcomes of asthma care. Objective: To develop a primary care dataset enabling extraction of information from GP practices in Wales and providing robust data by which results and lessons could be drawn and drive service development and improvement. Methods: A multidisciplinary group of experts, including general practitioners, primary care organisation representatives, and asthma patients was formed and used as a source of governance and guidance. A review of asthma literature, guidance, and standards took place and was used to identify areas of asthma care which, if improved, would lead to better patient outcomes. Modified Delphi methodology was used to gain consensus from the expert group on which of the areas identified were to be prioritised, and an asthma patient and carer focus group held to seek views and feedback on areas of asthma care that were important to them. Areas of asthma care identified by both groups were mapped to asthma guidelines and standards to inform and develop primary and secondary care datasets covering both adult and pediatric care. Dataset development consisted of expert review and a targeted consultation process in order to seek broad stakeholder views and feedback. Results: Areas of asthma care identified as requiring prioritisation by the National Asthma Audit were: (i) Prescribing, (ii) Asthma diagnosis (iii) Asthma Reviews (iv) Personalised Asthma Action Plans (PAAPs) (v) Primary care follow-up after discharge from hospital (vi) Methodologies and primary care queries were developed to cover each of the areas of poor and variable asthma care identified and the queries designed to extract information directly from electronic patients’ records. Conclusion: This paper describes the methodological approach followed to develop primary care datasets for a National Asthma Audit. It sets out the principles behind the establishment of a National Asthma Audit programme in response to a national asthma mortality review and describes the development activities undertaken. Key process elements included: (i) mapping identified areas of poor and variable asthma care to national guidelines and standards, (ii) early engagement of experts, including clinicians and patients in the process, and (iii) targeted consultation of the queries to provide further insight into measures that were collectable, reproducible and relevant.

Keywords: asthma, primary care, general practice, dataset development

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Authors: Elham Azimzadeh, Saeedeh Sepehri, Hamidollah Hassanlouei

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Obesity is associated with postural instability, might influence the quality of daily life, and could be considered a potential factor for falling in obese people. The fat body mass especially in the abdominal area may increase body sway. Furthermore, loss of visual feedback may induce a larger postural sway in obese people. Moreover, Muscle fatigue may impair the work capacity of the skeletal muscle and may alter joint proprioception. So, the purpose of this study was to investigate the effect of physical fatigue and visual feedback on body sway and strength of lower extremities in obese people. 12 obese (4 female, 8 male; BMI >30 kg/m2), and 12 normal weight (4 female, 8 male; BMI: 20-25 kg/m2) subjects aged 37- 47 years participated in this study. The postural stability test on the Biodex balance system was used to characterize postural control along the anterior-posterior (AP) and mediolateral (ML) directions in eyes open and eyes closed conditions and maximal voluntary contraction (MVC) of knee extensors and flexors were measured before and after the high-intensity exhausting exercise protocol on the ergometer bike to confirm the presence of fatigue. Results indicated that the obese group demonstrated significantly greater body sway, in all indices (ML, AP, overall) compared with the normal weight group (eyes open). However, when visual feedback was eliminated, fatigue impaired the balance in the overall and AP indicators in both groups; ML sway was higher only in the obese group after exerting the fatigue in the eyes closed condition. Also, maximal voluntary contraction of knee extensors was impaired in the fatigued normal group but, there was no significant impairment in knee flexors MVC in both group. According to the findings, peripheral fatigue was associated with altered postural control in upright standing when eyes were closed, and that mechanoreceptors of the feet may be less able to estimate the position of the body COM over the base of support in the loss of visual feedback. This suggests that the overall capability of the postural control system during upright standing especially in the ML direction could be lower due to fatigue in obese individuals and could be a predictor of future falls.

Keywords: maximal voluntary contraction, obesity, peripheral fatigue, postural control, visual feedback

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Authors: Mahmoud Tarek, Alaa Obeida, Mai Magdy, Khalid Hussein, Aly Shalaby

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Background: More doctors are complaining of burnout than before, Burnout is a state of physical and mental exhaustion caused by the doctor’s lifestyle, unfortunately, Medical errors are also more likely in those suffering from burnout and these may result in malpractice suits. Methodology: It is a retrospective audit of burnout response on all neonatologists over a 9 months period. We gathered data using burnout questionnaire, it was obtained from 23 physicians, the physicians divided into 5 categories according to the final score of the 28 questions in the questionnaire. Category 1 with score from 28-38 with almost no work stress, category 2 with score (38-50) who express a low amount of job related stress, category 3 with score (51-70) with moderate amount of stress, category 4 with score (71-90) those express a high amount of job stress and begun to burnout, category 5 with score (91 and above) who are under a dangerous amount of stress and advanced stage of burnout. Results: 33 neonatologists have received the questionnaire, 23 responses were sent back with a response rate of 69.6%. The results showed that 61% of physicians fall in category 4, 31% of the physician in category 5, while 8% of physicians equally distributed between category 2 and 3 (4% each of them). On the other hand, there is no physician present in category 1. Conclusion: Burnout is prevalent in SNICUs, So interventions to minimize burnout prevalence may be of greater importance as this may be reflected indirectly on medical conditions of the patients and physicians, efforts should be done to decrease this high rate of burnout.

Keywords: Cairo, work overload, exhaustion, surgery, neonatal ICU

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Authors: Prashant Neupane, Sumitra Kafle, Asmi Pandey, Laura Mitchell

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Pain following caesarean section can influence recovery, patient satisfaction, breast feeding success and mother-child bonding. Since the introduction of enhanced recovery protocols, mothers are often discharged 24 hours later. We identified concerns within our hospital with mothers tolerating poorly controlled pain in order to achieve earlier discharge and subsequently suffering significant pain at home with inadequate analgesia. Methods: We conducted a prospective audit of analgesic prescribing and post-operative pain scores after caesarean section. Mothers were seen on post-operative day one, their pain score recorded on a verbal analogue score from 0-10, and their prescription chart reviewed. A follow-up phone call was then made on post-operative day 3-7 to enquire about pain scores and analgesia use at home. Following this, a standardized proforma for prescribing after the caesarean section was introduced, including the addition of dihydrocodeine that patients can take home following discharge. There were educational update sessions for anesthetists and midwifes, and then a re-audit was conducted months later. Results: Data was collected from 50 women before and after the introduction of the change. Initial audit showed that there was considerable variation in prescribing, with four women prescribed no regular analgesia at all and inconsistency in the dose of oral morphine prescribed. Women were not given any form of analgesia to take home after discharge and were advised to take regular paracetamol and ibuprofen. However, 31/50 (62%) reported that they needed additional analgesia and eight women (16%) even sought prescription for additional analgesia from elsewhere. After the introduction of the change, prescribing was more consistent with all patients prescribed regular analgesia. 46/50 patients were given dihydrocodeine on discharge. Mean pain scores on post-operative day one improved from 5.16 to 3.9, and at home improved from 6.18 to 2.58. Use of dihydrocodeine at home significantly improved patients reporting of severe pain at home from 24% to zero. Discussion: Lack of strong analgesia out of the hospital and the increased demands on activity levels means that women are frequently in more pain at home after discharge. Introduction of a standardized prescription proforma, including the use of to-take-out dihydrocodeine, was successful in improving patient pain scores and the requirement for additional analgesia, both in hospital and at home.

Keywords: analgesia, caesarean section, post-operative pain, standardised

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Authors: Kamal Kaushik, Trisha, Dandapni, Sambit Nanda, A. Mukherjee, S. Pradhan

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INTRODUCTION: As complexity in radiotherapy practice and processes are increasing, there is a need to assure quality control to a greater extent. At present, no international literature available with regards to the optimal quality control indicators for radiotherapy; moreover, few clinical audits have been conducted in the field of radiotherapy. The primary aim is to improve the processes that directly impact clinical outcomes for patients in terms of patient safety and quality of care. PROCEDURE: A team of an Oncologist, a Medical Physicist and a Radiation Therapist was formed for weekly clinical audits of patient’s undergoing radiotherapy audits The stages for audits include Pre planning audits, Simulation, Planning, Daily QA, Implementation and Execution (with image guidance). Errors in all the parts of the chain were evaluated and recorded for the development of further departmental protocols for radiotherapy. EVALUATION: The errors at various stages of radiotherapy chain were evaluated and recorded for comparison before starting the clinical audits in the department of radiotherapy and after starting the audits. It was also evaluated to find the stage in which maximum errors were recorded. The clinical audits were used to structure standard protocols (in the form of checklist) in department of Radiotherapy, which may lead to further reduce the occurrences of clinical errors in the chain of radiotherapy. RESULTS: The aim of this study is to perform a comparison between number of errors in different part of RT chain in two groups (A- Before Audit and B-After Audit). Group A: 94 pts. (48 males,46 female), Total no. of errors in RT chain:19 (9 needed Resimulation) Group B: 94 pts. (61 males,33 females), Total no. of errors in RT chain: 8 (4 needed Resimulation) CONCLUSION: After systematic periodic clinical audits percentage of error in radiotherapy process reduced more than 50% within 2 months. There is a great need in improving quality control in radiotherapy, and the role of clinical audits can only grow. Although clinical audits are time-consuming and complex undertakings, the potential benefits in terms of identifying and rectifying errors in quality control procedures are potentially enormous. Radiotherapy being a chain of various process. There is always a probability of occurrence of error in any part of the chain which may further propagate in the chain till execution of treatment. Structuring departmental protocols and policies helps in reducing, if not completely eradicating occurrence of such incidents.

Keywords: audit, clinical, radiotherapy, improving functionality

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Authors: Sohail Ahmad Umer

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Since last few decades a question is raising on the subject of the importance of women in different societies of the world particularly in the developing societies of Asia and Africa. Female population constitutes almost 50% of the total population of the world and is playing a significant role in the economy with male population. In Pakistan, a developing country of Asia with majority of Muslim population, working women role is more focused. Women of rural background who are working as voluntary workers and their working hours are neither recorded nor recognized. Agricultural statistics shows that the female participation rate is below 40% while other sources claim them below 20%. Here in present study, another effort has been made to compare the women role in two different provinces of Pakistan to analyze the participation of women in agricultural activities like sowing, picking, irrigating the fields, harvesting and threshing of crops, caring and feeding of the animals, collecting the firewood and etc,as without these activities the farming would be incomplete. One hundred villages in the district Khushab (Punjab) and one hundred villages in district D.I.Khan (KPK) were selected and 33% of the families of each village have been interviewed to study their input in agriculture work. Another important feature is the social stratification therefore the contribution by different variables like the ownership, tenancy, education and caste has also been studied.

Keywords: caste, social stratification, tenancy, voluntary workers

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Authors: Sophie Sakka, Rénald Gaboriau

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This paper describes a preliminary work aimed at setting a therapeutic support for autistic teenagers using three humanoid robots NAO shared by ASD (Autism Spectrum Disorder) subjects. The studied population had attended successfully a first year program, and were observed with a second year program using the robots. This paper focuses on the content and the effects of the second year program. The approach is based on a master puppet concept: the subjects program the robots, and use them as an extension for communication. Twenty sessions were organized, alternating ten preparatory sessions and ten robotics programming sessions. During the preparatory sessions, the subjects write a story to be played by the robots. During the robot programming sessions, the subjects program the motions to be realized to make the robot tell the story. The program was concluded by a public performance. The experiment involves five ASD teenagers aged 12-15, who had all attended the first year robotics training. As a result, a progress in voluntary and organized communication skills of the five subjects was observed, leading to improvements in social organization, focus, voluntary communication, programming, reading and writing abilities. The changes observed in the subjects general behavior took place in a short time, and could be observed from one robotics session to the next one. The approach allowed the subjects to draw the limits of their body with respect to the environment, and therefore helped them confronting the world with less anxiety.

Keywords: autism spectrum disorder, robot, therapeutic support, rob'autism

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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: Emely J. Escala, Lolito C. Bestil

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An experiment was conducted to assess the potential of jackfruit by-product concentrate (JBC) in combination with two types of protein sources, soybean meal (SBM) and liquid acid whey (LAW), given at two different ratios as supplement for growing kids fed a basal diet of 70:30 napier grass (Pennisetum purpureum) and kakawate (Gliricidia sepium) soilage ratio. The experiment was set-up in randomized complete block design (RCBD) with sex-age combination as basis for blocking, with the following dietary treatments: T1 = 0.50:0.50% BW, DM basis, JBC:SBM, T2 = 0.75:0.25% BW JBC:SBM, T3 = 0.50:0.50% BW, DM basis, JBC:LAW, and T4 = 0.75:0.25% BW JBC:LAW. Analysis of JBC showed high contents of crude fiber with medium levels of crude protein and nitrogen-free extract, appearing to be fitting for ruminants and a potential energy source. Results showed significantly higher voluntary dry matter intake (VDMI), cumulative weight gain (CWG), and average daily gain (ADG) of growing goats supplemented with JBC in combination with SBM than with LAW. The amount of JBC can range from 0.50% to 0.75% BW with SBM making up the difference, but a JBC:SBM ratio of 0.75:0.25% BW, DM basis, is best in promoting highest voluntary dry matter intake and is, therefore, highly recommended in the light of savings in feed cost. A long-term study on the effects of JBC supplementation on meat qualities of growing kids (aroma, marbling characteristics and taste) is also recommended.

Keywords: jackfruit by-product concentrate, liquid acid whey, soybean meal, grower kids

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