Action Points Research Articles

Elements of Environmental Education, Curriculum and Teacher’s Perspective: A Review

Environmental Education is a process that allows individuals to explore environmental issues, engage in problem solving and take action to improve the environment. As a result, individuals develop a deeper understanding of environmental issues and have the skills to make informed and responsible decisions. Environmental Education does not advocate a particular view point or course of action. Rather, it teaches individuals how to weigh various sides of an issue through critical thinking; and it enhances their own problem-solving and decision-making skills. Environmental Education helps to recognize values and clarify concepts relating to environment. It develops skills and attitudes necessary to understand and appreciate the inter relatedness of man, his culture and his biophysical surroundings. It helps to provide practice in decision making and self formulation of a code of behavior about issues concerning quality environment. Environmental Education helps to develop in the people awareness, concern and knowledge of the environment and learn to use this understanding to preserve, conserve and utilize the environment in a sustainable manner for the benefit of present and future generations. The Tbilisi Declaration set up recommendations for the broader application of Environmental Education in formal and non-formal education. It is the responsibility of Teacher Education Institutions to evolve the kind of methodology suitable for teaching Environmental Education in school programme and to work out strategies for involving students in conservation and regeneration of environment. Teachers play a crucial role in forming and establishing right attitudes and values that are important to develop environmentally responsible behavior among their students. Developing a positive attitude and awareness among the students on environmental issues has been thought of an effective strategy for taking care of environment for the long term. Further, these young people will be the citizens, leaders and policy makers in future societies. The current review illuminates a broad perspective on environmental education in the context of elements of environmental education, curriculum and the role of teacher’s to promote environmental education effectively.

A qualitative system model to describe the causes and drivers of frequent potentially avoidable presentations to the emergency department

Frequent potentially avoidable presentations to Emergency Departments (EDs) represent a complex problem, driven by multiple interdependent and interacting factors that change over time and influence one another. We sought to describe and map the drivers of frequent potentially avoidable presentations to a regional ED, servicing regional and rural areas, and identify possible solutions from the perspectives of key stakeholders. This study used a qualitative, community-based systems dynamics approach utilising Group Model Building (GMB). Data were collected from two 3-h online workshops embedded with small-group discussions and conducted with stakeholder groups operating within a regional health system. Stakeholders were guided through a series of participatory tasks to develop a causal loop diagram (CLD) using Systems Thinking in Community Knowledge Exchange software (n=29, workshop one), identify potential action points and generate a prioritised action list to intervene in the system (n=21, workshop two). Data were collected through note taking, real-time system mapping, and recording the workshops. Each action was considered against the Public Health 12 framework describing twelve leverage points to intervene in a system. A CLD illustrating the complex and interrelated factors that drive frequent potentially avoidable ED presentations was developed and classified into four categories: (1) access to services; (2) coordination; (3) patient needs; and (4) knowledge and skills. Nine action areas were identified, with many relating to care and service coordination. Most actions aligned with lower-level system impact actions. This study provides an in-depth understanding of influencing factors and potential solutions for frequent potentially avoidable ED presentations across a regional health system. The CLD demonstrates frequent potentially avoidable ED presentations are a complex problem and identified that a prevention response should engage with system- and individual-level solutions. Further work is needed to prioritise actions to support the implementation of higher-level system impacts.

Evaluation of the contribution of county characteristics to the rural mortality disparity in cancer.

173 Background: Rural disparities in cancer outcomes have been widely evaluated, but limited evidence is available to characterize what characteristics of rural environments contribute to the increased risk of poor outcomes. Therefore, we propose to estimate the mediating effects of county characteristics on the relationship between urban/rural status and mortality among patients with cancer, identify county profiles, and determine problematic county profiles alongside rural settings. Methods: Patients with cancers (known to be associated with rural disparities) between 2000 and 2016 were assessed using Surveillance, Epidemiology and End Results data. We then linked these data to the 2010 County Health Rankings (CHR) which ranks US counties into quartiles within their state based on measures of health: morbidity, mortality, health behaviors, physical environment, socioeconomic status, clinical care environment. We dichotomized each domain as least healthy (quartiles 3 and 4) and most healthy (quartiles 1 and 2). Rurality was defined using the 2010 Rural-Urban Commuting Codes. Using mediation analyses, we estimated 1) the direct contribution of rurality to five-year all-cause and cancer-specific mortality and 2) the contribution of the rural effect indirectly through each CHR domain. We then used latent class analysis to identify county groupings based on rankings. Using flexible parametric survival models, we estimated the hazard of mortality associated with class membership, rurality and the interaction between rurality and class. Results: Among the 757,655 patients representing 596 counties, 51% were female, the most frequent diagnoses were breast and prostate (21%, respectively), 52% were diagnosed with localized disease, and 54% were diagnosed between 55y and 65y. When setting the mediator at least healthy (quartiles 3 and 4) premature death, clinical care, and physical environment, the rural patients had 17.9% to 20.2% less survival time compared to those in rural counties. Of this, 4.1% to 12.6% of the total excess risk was mediated by these characteristics. Three county classes were identified: Class 1 (28%) had consistently poor rankings, Class 2 (32%) had moderate rankings but poor clinical care, and Class 3 (41%) had consistently high rankings except for physical environment. Patients living in rural-high risk counties (class 1 and 2) saw higher all-cause mortality than those in urban-lower risk counties (reference class 3; HR, 1.04, 95%CI 1.01-1.08 and 1.07, 95%CI, 1.03-1.11). Conclusions: County characteristics mediated the relationship between rurality and mortality among patients with cancer. Counties with poor rankings had increased mortality risks regardless of rurality; however, the poor rankings elevated the mortality risk for those in rural counties. Access to care and physical environment may be actionable points of intervention in the pathway from rurality to mortality.

Review existing strategies to improve circularity, sustainability and resilience of wind turbine blades – A comparison of research and industrial initiatives in Europe

To become the first climate-neutral continent by 2050, the EU is committing to ambitious targets such as reducing greenhouse gas emissions by at least 55% by 2030 (compared to 1990) and increasing the share of renewable energies in the EU energy mix to 45% by 2030. To meet these targets, the wind industry has to grow significantly while ensuring enough resources across the supply chains to scale the wind energy market and by striving to reduce its already shallow environmental impact. As material extraction and the production of wind turbines cause the most emissions, costs and risks on the scarcity of resources, the implementation of a circular economy could support the wind industry in meeting the EU target and improving its sustainability and resilience. However, the circular economy is a complex concept, and it can be challenging to translate it into precise action points, objectives and measurements. To clarify how a circular economy can support the wind industry, this paper takes the example of wind turbine blades, and it establishes a structured overview of research results and industrial initiatives aiming at implementing circularity for improving sustainability and resilience. The overview is used to investigate if objectives and clear actions are stated and how those differ between research and industry. By identifying gaps, future research and industry initiatives can be directed towards closing the bigger picture. The results show that many initiatives are ongoing, but only some circular strategies are comprehensively investigated, and clear objectives and measurements often remain to be included. The industry and research progressed the furthest on recycling. Future research and industry activities should further follow the path of closing the loop but need to also concentrate on reducing material use, extending the lifetime of blades and enabling a second lifecycle of blades.

A27Sustainable simulation: findings from audits assessing the environmental impact of clinical skills education and perceptions of solutions for awareness and action

Simulation and clinical skills teaching are core elements of University programmes to underpin authentic practice learning for healthcare professionals. It is estimated that 1 bag of (non-infected) ‘clinical waste’ is produced per student group at each skills session for students in one year for the adult nursing programme at one University (504 bags) and increases when other programmes are included in the calculation. As the health sector is one of the largest emitters of carbon dioxide equivalents to the atmosphere [1], embedding environmental sustainability into professional healthcare education works towards the NHS England target of a NetZero health service by 2040 [2]. Waste from teaching sessions includes plastic gloves, aprons, dressing packs, syringes, solution vials and associated outer packaging etc., depending on the skills simulated. Most of this is not clinically infected although it is discarded in this way. Methods for the identification of interventions to reduce waste and procure services to enable recycling and reuse of waste elements are needed to raise awareness of the problem and potential solutions, thereby reducing the carbon footprint of clinical education. The aim of the presentation is to report a collaboration between Universities to increase sustainable practice in skills education through sharing experiences of teaching practice, whilst maintaining the authenticity of educational practice. Project methods include audits of the quantity and nature of clinical waste from taught sessions to identify waste reduction targets and explore alternative climate-friendly solutions; use of a Climate café to enhance collaboration with relevant stakeholder groups to raise awareness and action; and carbon foot printing analysis to identify points of action and measure change, drawing from the Sustainable quality improvement framework [3]. Clinical waste audit findings will be described highlighting the carbon footprint impact and where sustainable improvements could be made. Key items that could be recycled, reused or managed through different disposal pathways will be identified with lessons for teaching and learning. Climate café qualitative data provide the perspectives of clinical skills teachers and simulation facilitators as well as student representatives. Potential cost savings will be estimated. Environmental sustainability is an emergency that needs prompt attention. The identification of the nature and amount of clinical waste from simulated education aids the strategic application of solutions to reduce, reuse and recycle key resources whilst maintaining the authenticity of clinical learning for students. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

Refined and Simplified Simulations for Steel–Concrete–Steel Structures

Steel–concrete–steel (SCS) sandwich structures have gained increasing interest in new constructions. The external steel plates increase the stiffness, the sustainability, and the strength of the structures under some extreme solicitations. Moreover, the use of these plates as lost prefabricated formwork makes SCS structures modular, enabling higher construction rates. However, for a better understanding of the complex behavior of these structures up to failure, refined numerical simulations are needed to consider various local phenomena, such as concrete crushing in compression and interface interactions. Indeed, the highly non-linear steel–concrete interaction around the dowels is the key point of the composite action. In this contribution, a refined methodology is first proposed and applied on a push-out test. It is especially demonstrated that a regularization technique in compression is needed for the concrete model. Interface elements are also developed and associated with a nonlinear constitutive law between steel connectors and external plates. From this refined methodology, simplified numerical modeling is then deduced and validated. Directly applied to an SCS wall-to-wall junction, this simplified strategy enables the reproduction of the overall behavior, including the elastic phase, the degradation of the system, and the failure mode. The response of each component is particularly analyzed, and the key points of the behavior are highlighted.

Mapping the stability of febrile illness hotspots in Punjab from 2012 to 2019- a spatial clustering and regression analysis

IntroductionFebrile illnesses (FI) represent a typical spectrum of diseases in low-resource settings, either in isolation or with other common symptoms. They contribute substantially to morbidity and mortality in India. The primary objective was to study the burden of FI based on Integrated Disease Surveillance Programme (IDSP) data in Punjab, analyze geospatial and temporal trends and patterns, and identify the potential hotspots for effective intervention.MethodsA retrospective ecological study used the district-level IDSP reports between 2012 and 2019. Diseases responsible for FI on a large scale, like Dengue, Chikungunya, Malaria (Plasmodium Falciparum, P. Vivax), Enteric fever, and Pyrexia of Unknown Origin (PUO), were included in the analysis. The digital map of Punjab was obtained from GitHub. Spatial autocorrelation and cluster analysis were done using Moran’s I and Getis-Ord G* to determine hotspots of FI using the incidence and crude disease numbers reported under IDSP. Further, negative binomial regression was used to determine the association between Spatio-temporal and population variables per the census 2011. Stable hotspots were depicted using heat maps generated from district-wise yearly data.ResultsPUO was the highest reported FI. We observed a rising trend in the incidence of Dengue, Chikungunya, and Enteric fever, which depicted occasional spikes during the study period. FI expressed significant inter-district variations and clustering during the start of the study period, with more dispersion in the latter part of the study period. P.Vivax malaria depicted stable hotspots in southern districts of Punjab. In contrast, P. Falciparum malaria, Chikungunya, and PUO expressed no spatial patterns. Enteric Fever incidence was high in central and northeastern districts but depicted no stable spatial patterns. Certain districts were common incidence hotspots for multiple diseases. The number of cases in each district has shown over-dispersion for each disease and has little dependence on population, gender, or residence as per regression analysis.ConclusionsThe study demonstrates that information obtained through IDSP can describe the spatial epidemiology of FI at crude spatial scales and drive concerted efforts against FI by identifying actionable points.

Current progress in developing a MARPOL Annex VI enforcement strategy in the Bonn Agreement through remote measurements

The harmful environmental and human health consequences of air pollution from ships are widely acknowledged, leading to their regulation under IMO’s MARPOL Annex VI, setting limits on the emission of SOx and NOx from ships. This article provides an overview of the current progress made by the Bonn Agreement (BA) in adopting a MARPOL Annex VI monitoring strategy. In 2019, the North Sea Ministers of the parties of the BA formally agreed to include MARPOL Annex VI within the jurisdiction of the BA. Through cooperation on MARPOL Annex VI enforcement at sea, the BA aims to attain a significant decrease in air pollution violations, similar to the accomplished outcomes observed in the past three decades regarding oil pollution. Subsequently, in 2021, a BA MARPOL Annex VI expert workshop was convened, which identified a series of action points. To effectively address these action points, two working groups (WGs) were established: the Strategic Operational WG and the Technical WG. The primary objective of the WGs is the exchange of best practices, monitoring outcomes and the harmonization of enforcement practices among the Parties of the BA, with the aim of implementing an efficient monitoring and enforcement strategy within the BA. The BA has recognized that remote monitoring operations play a pivotal role within this strategy. This article explores the extent to which remote measurements can contribute to the development of a regional enforcement strategy for MARPOL Annex VI within the framework of the BA.

Experimental analysis of a planing monohull model during forward acceleration: part II – evaluation of an indirect method for applying thrust angle in the experiments

ABSTRACT Most towing tank model tests conducted on planing hulls are not performed under self-propulsion conditions, and it is often not feasible to directly apply towing force at the corresponding point of action and along the thrust of the full-scale vessel. Therefore, it is essential to establish a well-defined method for accurately applying the thrust line in bare hull model tests using alternative loading solutions, such as CG shift, and understand how any deviation affects the model’s running attitude and performance. This article presents an analysis of the dynamic equilibrium equations of motion for the model, considering various variables that can be used to adjust the thrust line in towing tank tests. The proposed formalism can aid in determining the external loading requirements in resistance tests. Finally, the article discusses the challenges and provides an error estimation for a simplified method of applying a constant thrust angle in the accelerated tests.

A conserved metabolic signature associated with response to fast-acting anti-malarial agents.

In malaria drug discovery, understanding the mode of action of lead compounds is important as it helps in predicting the potential emergence of drug resistance in the field when these drugs are eventually deployed. In this study, we have employed metabolomics technologies to characterize the potential targets of anti-malarial drug candidates in the developmental pipeline at NITD. We show that NITD fast-acting leads belonging to spiroindolone and imidazothiadiazole class induce a common biochemical theme in drug-exposed malaria parasites which is similar to another fast-acting, clinically available drug, DHA. These biochemical features which are absent in a slower acting NITD lead (GNF17) point to hemoglobin digestion and inhibition of the pyrimidine pathway as potential action points for these drugs. These biochemical themes can be used to identify and inform on the mode of action of fast drug candidates of similar profiles in future drug discovery programs.

Gold Nanoparticles Capped with a Novel Titanium(IV)-Containing Polyoxomolybdate Cluster: Selective and Enhanced Bactericidal Effect Against Escherichia coli.

Bacterial infections are a public health threat of increasing concern in medical care systems; hence, the search for novel strategies to lower the use of antibiotics and their harmful effects becomes imperative. Herein, the antimicrobial performance of four polyoxometalate (POM)-stabilized gold nanoparticles (Au@POM) against Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus) as Gram-negative and Gram-positive bacteria models, respectively, is studied. The bactericidal studies performed, both in planktonic and sessile forms, evidence the antimicrobial potential of these hybrid nanostructures with selectivity toward Gram-negative species. In particular, the Au@GeMoTi composite with the novel [Ti2 (HGeMo7 O28 )2 ]10- POM capping ligand exhibits outstanding bactericidal efficiency with a minimum inhibitory concentration of just 3.12µm for the E. coli strain, thus outperforming the other three Au@POM counterparts. GeMoTi represents the fourth example of a water-soluble TiIV -containing polyoxomolybdate, and among them, the first sandwich-type structure having heteroatoms in high-oxidation state. The evaluation of the bactericidal mechanisms of action points to the cell membrane hyperpolarization, disruption, and subsequent nucleotide leakage and the low cytotoxicity exerted on five different cell lines at antimicrobial doses demonstrates the antibiotic-like character. These studies highlight the successful design and development of a new POM-based nanomaterial able to eradicate Gram-negative bacteria without damaging mammalian cells.

Analysing the Impact of Emerging Technology Course on Student Satisfaction by Exposing Freshmen to Dynamic Industry Trends

Abstract : Technology is an inescapable necessity; it dominates almost every aspect of human existence. Emerging technol ogy hel ps to unl ock new possibilities for connecting things/people. At the same time, technological advancement changes industrial trends and the demand for engineering graduates' expertise. Hence, it becomes necessary for the students to imbibe the skills of continuous learning and understand the emerging trends, right from the inception year of engineering education. Also, with an amendment to the national education policy (NEP), the Indian Government has shown its clear intention to promote a holistic and multidisciplinary approach to technological developments through engineering education. Therefore, to accomplish this, it is critical to bridge the gap between industry and academia. The proposed course in this article is an initiative taken by Chitkara University Punjab to bring industry mentors and first-year students face-to-face and promote holistic learning amongst themselves. A total of 1000freshman engineering students took part in this course and participated in the post-course survey to express their satisfaction level with the course thus introduced. The Cronbach's Alpha coefficient α = 0.957 shows the high Reliability of data obtained through a survey questionnaire. Students expressed high motivation levels after completion of the course. The survey shows that the course gave the students clarity about the attributes required by the industry, which can help them decide their action points towards their career development. In the future, a hybrid model of teaching-learning can be employed to provide an added advantage of industry mentor interaction with students in live physical space. Keywords:Emerging-technology, NEP2020, Reliability, Engineering, Student-satisfaction, Motivation.

Policy instruments to reduce food loss prior to retail – Perspectives of fruit and vegetable supply chain actors in Europe

Food loss and waste burdens the food system with an unnecessary use of natural resources such as soil, land and water as well as with the avoidable generation of further climate-relevant emissions. These negative externalities may provide a rationale for public sector intervention where feasible and efficient.Semi-structured interviews with 22 experts (farmers, producer organisations and retailers) in Germany and a questionnaire survey with 215 suppliers of a retailing company from Germany, Spain and Italy were conducted. The material reveals the perspectives and claims of relevant actors in upstream fruit and vegetable supply chains on political intervention.Stakeholders identified policy instruments from four overarching thematic categories: (I) communicative and cooperative policies, (II) subsidisation and food prices, (III) regulation and political framework conditions and (IV) questioning of necessity and effectiveness of food loss interventions. Four further categories of private sector measures were identified: (I) mechanisation, innovation and process optimisation, (II) communication and cooperation, (III) reconditioning and repackaging and (IV) processing, alternative marketing and redistribution.Issues that should be addressed by policy include consumer education and awareness, supply chain cooperation and power relations, food prices, marketing standards, alternative marketing and processing and promotion of technologies, infrastructure and agronomic practices to reduce food loss. The study shows that additional leverage points for policy action are still unrecognised and that stakeholders should be more involved in tackling the root causes of food loss. These policies should be holistically embedded in the sustainability transformation of the food system.

Unmet needs in countries participating in the undiagnosed diseases network international: an international survey considering national health care and economic indicators.

Patients, families, the healthcare system, and society as a whole are all significantly impacted by rare diseases (RDs). According to various classifications, there are currently up to 9,000 different rare diseases that have been recognized, and new diseases are discovered every month. Although very few people are affected by each uncommon disease individually, millions of people are thought to be impacted globally when all these conditions are considered. Therefore, RDs represent an important public health concern. Although crucial for clinical care, early and correct diagnosis is still difficult to achieve in many nations, especially those with low and middle incomes. Consequently, a sizeable amount of the overall burden of RD is attributable to undiagnosed RD (URD). Existing barriers and policy aspects impacting the care of patients with RD and URD remain to be investigated. To identify unmet needs and opportunities for patients with URD, the Developing Nations Working Group of the Undiagnosed Diseases Network International (DNWG-UDNI) conducted a survey among its members, who were from 20 different nations. The survey used a mix of multiple choice and dedicated open questions covering a variety of topics. To explore reported needs and analyze them in relation to national healthcare economical aspects, publicly available data on (a) World Bank ranking; (b) Current health expenditure per capita; (c) GDP per capita; (d) Domestic general government health expenditure (% of GDP); and (e) Life expectancy at birth, total (years) were incorporated in our study. This study provides an in-depth evaluation of the unmet needs for 20 countries: low-income (3), middle-income (10), and high-income (7). When analyzing reported unmet needs, almost all countries (N = 19) indicated that major barriers still exist when attempting to improve the care of patients with UR and/or URD; most countries report unmet needs related to the availability of specialized care and dedicated facilities. However, while the countries ranked as low income by the World Bank showed the highest prevalence of referred unmet needs across the different domains, no specific trend appeared when comparing the high, upper, and low-middle income nations. No overt trend was observed when separating countries by current health expenditure per capita, GDP per capita, domestic general government health expenditure (% of GDP) and life expectancy at birth, total (years). Conversely, both the GDP and domestic general government health expenditure for each country impacted the presence of ongoing research. We found that policy characteristics varied greatly with the type of health system and country. No overall pattern in terms of referral for unmet needs when separating countries by main economic or health indicators were observed. Our findings highlight the importance of identifying actionable points (e.g., implemented orphan drug acts or registries where not available) in order to improve the care and diagnosis of RDs and URDs on a global scale.

Numerical solution for nonlimit-state earth pressure considering interlayer shear stress and the soil arching effect

The earth pressure of multilayer cohesive soils is affected by interlayer interaction and the soil arching effect. However, only the soil arching effect is considered in the existing methods for calculating earth pressure, and the interlayer shear stress caused by principal stress deflection is ignored. For a vertical rigid retaining wall with a horizontal backfill surface, the trajectory of the minor principal stresses in the soil behind the wall takes the form of an arc of a circle. On this basis, the horizontal and vertical stress equilibrium equations of the differential soil elements behind the wall are derived. The interlayer shear stress, wall displacement and soil arching effect are incorporated into the horizontal slice model, and the numerical scheme of the nonlimit-state earth pressure, the resultant force and the location of the action point are determined with the numerical solution method. Furthermore, the rationality of the proposed solution is demonstrated through comparison with experimental data and other solutions.

Hotspurs in, sober bores out: A call and an agenda for entrepreneurship and innovation policies that foster rapidly scaling ventures

Our effort is motivated by the observation that European entrepreneurs who receive financial support from public entrepreneurship and innovation programs, set out as hotspurs (fiery highly motivated professionals) with a focus on innovation and scaling. However, over time their scaling ambitions erode, and efficiency starts to dominate ventures' strategies pursued with the financial support received becoming much more cautious managers (Sober Bores). We argue that European innovation and entrepreneurship policy fails to promote firm scaling because of the fundamental misunderstanding that innovation drives firms scaling, overlooking the crucial role of an entrepreneurial business model that ensures a fit between firms' market offerings and customer preferences throughout the firm development. We identify the underlying pain points that hamper firm scaling, deduct action points for scaling-oriented European innovation and entrepreneurship policies and suggest change agendas for policy and practice. Finally, we propose a novel approach for future research assessing innovation and entrepreneurship support schemes that can enhance our understanding and better inform evidence-based policies.

Transitioning a project-based course between onsite and online. An experience report

We present an investigation regarding the challenges faced by student teams across four consecutive iterations of a team-focused, project-based course in software engineering. The studied period includes the switch to fully online activities in the spring of 2020, and covers the return to face to face teaching two years later. We cover the feedback provided by over 1500 students, collected in free-text form on the basis of a survey. A qualitative research method was utilized to discern and examine the challenges and perceived benefits of a course that was conducted entirely online. We show that technical challenges remain a constant in project-based courses, with time management being the most affected by the move to online. Students reported that the effective use of collaborative tools eased team organization and communication while online. We conclude by providing a number of action points regarding the integration of online activities in face-to-face course unfolding related to project management, communication tools, the importance of teamwork, and of active mentor participation.

What matters to me: an equity lens on patient experience.

This commentary explores what matters to patients and their experience through an equity lens, with action points and recommendations given the current health care environment.

Translated article] Analysis of the appropriateness of antibiotic prophylaxis in surgical procedures in Spain. Protocol for the "ProA-Q" study

Surgical antibiotic prophylaxis is one of the most useful measures to prevent surgical wound infection. ObjectiveThe aim of this project is to evaluate the appropriateness of the use of antibiotic prophylaxis in surgical procedures performed in Spanish hospitals, both globally and according to the type of surgery performed. MethodFor this purpose, an observational, retrospective, cross-sectional, and multicentre study has been designed to collect all the variables that allow the evaluation of the appropriateness of surgical antibiotic prophylaxis by comparing the prescribed treatment, the recommendations included in the local guidelines, and the consensus document of the Spanish Society of Infectious Diseases and Clinical Microbiology and the Spanish Association of Surgeons. Indication, choice of antimicrobial, dose, route and duration of administration, timing, re-dosing, and duration of the prophylaxis will be taken into account. The sample will consist of patients who underwent scheduled or emergency surgery, either as inpatients or outpatients, in hospitals in Spain. A sample size of 2335 patients has been established to estimate, with 95% confidence and 80% power, a percentage of appropriateness that is expected to be around 70%. Differences between variables will be analysed using Student's t-test, Mann–Whitney U test, Chi-square test, or Fisher's test, as appropriate. The degree of agreement between the antibiotic prophylaxis recommended by the guidelines of the different hospitals and that recommended in the literature will be analysed by calculating the Cohen's kappa indicator. Binary logistic regression analysis using generalised linear mixed models will be performed to identify possible factors associated with differences in the appropriateness of antibiotic prophylaxis. DiscussionThe results of this clinical study will allow us to focus on specific surgical areas with higher rates of inappropriateness, identify key points of action and guide future strategies for antimicrobial stewardship programs in the area of antibiotic prophylaxis.

The added value of the artificial intelligence patient-reported experience measure (AI-PREM tool) in clinical practise: Deployment in a vestibular schwannoma care pathway

ObjectivesPatient-reported experience measures (PREMs) can be used for the improvement of quality of care. In this study, the outcome of an open-ended question PREM combined with computer-assisted analysis is compared to the outcome of a closed-ended PREM questionnaire. MethodsThis survey study assessed the outcome of the open-ended questionnaire PREM and a close-ended question PREM of patients with unilateral vestibular schwannoma in a tertiary vestibular schwannoma expert centre. ResultsThe open-ended questions PREM, consisting of five questions, was completed by 507 participants and resulted in 1508 positive and 171 negative comments, categorised into 27 clusters. The close-ended questions PREM results were mainly positive (overall experience graded as 8/10), but did not identify specific action points. Patients who gave high overall scores (>8) on the close-ended question provided points for improvement in the open-ended question PREM, which would have been missed using the close-ended questions only. ConclusionsCompared to the close-ended question PREM, the open-ended question PREM provides more detailed and specific information about the patient experience in the vestibular schwannoma care pathway. InnovationAutomated analysis of feedback with the open-ended question PREM revealed relevant insights and identified topics for targeted quality improvement, whereas the close-ended PREM did not.