Active Participation Research Articles

Peculiarities and debatable aspects of the grounds for applying incentive measures to juvenile prisoners

Incentive measures may be applied to juvenile convicts for conscientious behavior and attitude to work and education, active participation in the work of amateur organizations and educational activities (paragraph 1, part 1, article 144 of the Criminal Executive Code of Ukraine). However, the legislator does not define the content of most of the grounds for the application of incentive measures established by him, therefore the article clarifies the essence and peculiarities of each of them. The author analyzed the difference between such reasons and the reasons for applying incentive measures to adult convicts, defined in paragraph 1, part 1, article 130 CECU. The article establishes the meaning of the evaluative nature of the grounds for applying incentive measures. The author revealed the meaning of the terms "conscientious" and "active". The author considered the interpretation of the essence of the analyzed grounds in the Methodological recommendations of the State Department of Ukraine for Execution of Punishments regarding the organization of work related to the application of parole to persons deprived of their liberty by 2005, in the Methodological recommendations of the SDUEP for drawing up a characteristic of convicts by 2008 and in the Methodological recommendations for assessing the degree of correction of convicts by 1979. The article reveals various views of scientists regarding the understanding of the content and scope of the researched grounds for the use of incentive measures. Therefore, the author clarified the criteria for determining the presence of signs of conscientiousness in the convict's behavior and characterized the essence of the conscientious behavior of the convict, his conscientious attitude to work and education; and features of active participation of convicts both in the work of amateur organizations and in educational activities were revealed. The article states the need to more clearly formalize the content and scope of the grounds for applying incentive measures to juvenile convicts at the legislative level. The author proposed to legally distinguish 5 types of the following grounds: 1) conscientious behavior; 2) conscientious attitude to work; 3) conscientious attitude to education; 4) active participation in the work of amateur organizations; 5) active participation in educational activities.

Adaptive backstepping sliding mode subject-cooperative control for a pediatric lower-limb exoskeleton robot

The passive-assist rehabilitation mode with a fixed desired trajectory neglects the subject’s active involvement and degrades the therapeutic performance in case of partial muscle strength. Therefore, this study proposes a novel subject-cooperative control based on a variable admittance control scheme and a robust trajectory control scheme for a pediatric lower-limb exoskeleton robot. Initially, the system description and dynamic modeling are briefly explained. Thereafter, a neural-fuzzy–based variable admittance control ( nf VAC) is designed to incorporate a realistic subject-exoskeleton interaction and consider the subject’s active participation. Finally, a robust adaptive backstepping sliding mode control with rapid reaching law is used to handle parametric uncertainties and external disturbances. A stepwise selection of Lyapunov functions is utilized to address the stability of the trajectory control. The effectiveness of the proposed adaptive backstepping sliding mode–neural-fuzzy variable admittance control (ABSM- nf VAC) scheme is compared with two contrast control schemes, namely, adaptive backstepping-fixed admittance control (AB-FAC) and adaptive terminal sliding mode-fuzzy variable admittance control (ATSM- f VAC) for the active-assist mode with the effect of sudden reflex. Based on the numerical results, the suggested cooperative controller has demonstrated favorable tracking performance, compliant interaction, and safety aspects during gait training.

Gamification as a Didactic Motivator in Low-Resource Public English as a Foreign Language (EFL) Classrooms in Ecuador

The present article explores the feasibility and impacts of Gamification as a motivational tool in classrooms within low-resource public institutions in Ecuador, particularly in teaching English as a Foreign Language. By integrating game design elements into the educational process, teachers tend to enhance student motivation, thus creating a more effective environment for language learning. Traditionally, educators in Ecuadorian public institutions face challenges in engaging students in their classes, often due to outdated teaching methodologies and limited access to educational and technological resources. This study focuses on how gamification can increase student motivation and foster a more stimulating and enjoyable learning environment in low-resource settings concerning English as a Foreign Language instruction. Through the incorporation of gaming elements, teachers can improve language acquisition, student engagement, and encourage collaborative learning, as evidenced by previous studies. The utilization of a qualitative-deductive approach allowed for data collection through an extensive literature review across various educational contexts. Results suggest that Gamification offers a promising perspective for overcoming challenges in traditional education, promoting active student participation. Additionally, the findings highlight the potential of Gamification to revolutionize teaching practice and enrich the entire educational experience.

Residents underestimate their robotic performance: evaluating resident robotic console participation time

Lack of formal national robotic curriculum results in a void of knowledge regarding appropriate progression of autonomy in robotic general surgery training. One midwestern academic surgical training program has demonstrated that residents expect to independently operate more on the robotic console than they perceive themselves to do. As such, our study sought to evaluate expectations of residents and faculty regarding resident participation versus actual console participation time (CPT) at a community general surgery training program. We surveyed residents and faculty in two phases. Initially, participants were asked to reflect on their perceptions and expectations from the previous six months. The second phase included surveys (collected over six months) after individual cases with subjective estimation of participation versus CPT calculated by the Intuitive Surgical, Inc. MyIntuitive application. Using Mann–Whitney U-Test, we compared resident perceptions of CPT to actual CPT by case complexity and post-graduate year (PGY). Faculty (n = 7) estimated they allowed residents to complete a median of 26–50% of simple and 0–25% of complex cases in the six months prior to the study. They expected senior residents (PGY-4 and PGY-5) to complete more: 51–75% of simple and 26–50% of complex cases. Residents (n = 13), PGY-2–PGY-5, estimated they completed less than faculty perceived (0–25% of simple and 0–25% of complex cases). Sixty-six post-case (after partial colectomy, abdominoperoneal resection, low anterior resection, cholecystectomy, inguinal/ventral hernia repair, and others) surveys were completed. Residents estimated after any case that they had completed 26–50% of the case. However, once examining their MyIntuitive report, they actually completed 51–75% of the case (median). Residents, especially PGY-4 and 5, completed a higher percentage than estimated of robotic cases. Our study confirms that residents can and should complete more of (and increasingly complex) robotic cases throughout training, like the transition of autonomy in open and laparoscopic surgery.

The Physical Activity Self-Advocacy Inventory for Adolescents with and without Disabilities: A Delphi Study

ABSTRACT Self-advocacy is a critical predictor of actual physical activity participation for children and adolescents with disabilities. Despite its reference within national standards for health and physical education, few practitioners are purported to promote self-advocacy among their students warranting the need for evaluation. However, no self-advocacy inventory exists for children and adolescents with robust psychometrics properties. The purpose of this study was to investigate the content and face validity for the Physical Activity Self-Advocacy Inventory (PASAI) within children and adolescents with and without disabilities. Experts in the fields of health and physical education (N = 12) participated in this Delphi study. Once experts established the content/face validity for the PASAI, children and adolescents (N = 18) provided feedback on the PASAI to further refine the questions and support comprehension/relevance for the target population. After the first round of questions, experts’ average feedback was a 3.99 out of 5.00 across all items. Due to low scores and based upon experts’ suggestions, four questions were deleted, and one question was added. After round two, experts’ average ratings increased to 4.8 out of 5.00. The PASAI appears to have reasonable content/face validity properties per expert- and population-based feedback. Future research should vet additional psychometric properties of PASAI scores.

Peran dan Tantangan Tenaga Pendidik dalam Menghadapi Kurikulum Merdeka di SMP Negeri 2 Sipoholon

The role and challenges faced by teaching staff in implementing the independent curriculum at Sipoholon State Middle School. In the learning process using the independent curriculum, teaching staff at SMP Negeri 2 Sipoholon have challenges, including: making clear and flexible schedules for teachers, holding regular training and workshops, forming teams or working groups of teachers, and encouraging active participation of students in the learning process. Solutions to face these challenges include increasing supervision and support from schools, regular training and workshops, as well as providing ongoing professional training and development. In this way, educators are expected to be able to overcome these challenges and improve student performance significantly. This research was conducted using qualitative methods, namely field observations and interviews. The results of the research show that the implementation of the independent curriculum at SMP Negeri 2 Sipoholon. The results of the research show that the implementation of the independent curriculum is less effective at SMP Negeri 2 Sipoholon because it causes many problems. The aim of this research is to identify the roles and challenges faced by teaching staff in implementing the independent curriculum at SMP Negeri 2 Sipoholon and to develop effective solutions to overcome these challenges. This research aims to provide an in-depth understanding of the important role of teaching staff in designing and implementing an independent curriculum, as well as to identify concrete obstacles that may hinder effective implementation.

The Digital Competences Necessary for the Successful Pedagogical Practice of Teachers in the Digital Age

The digital transformation of society is a reality. Technology is becoming integral to people’s daily lives and children are growing up in the digital age. The education systems have to reflect and adapt to the new digital reality to effectively engage and prepare students for the future. Teachers have to possess digital competences at a high level, meaning that they are successfully able to use digital tools and technologies in their teaching practices. Digital competences include digital literacy, experience using educational software and platforms, and the ability to seamlessly integrate information and communication technologies (ICT) into the organization of educational activities. The current paper aims to study the opinion of teachers in Bulgarian schools regarding the possibilities of using digital technologies to achieve educational goals and the extent to which teachers integrate digital tools in their teaching activities. Teachers’ opinions about the need for specific digital competences are important. The results of the survey show that teachers in Bulgaria actively use digital technologies in their daily teaching activities (84.8%) in order to create and provide learning content to students and to provoke their active participation, and is a convenient tool for evaluating their students’ knowledge and skills and for providing effective feedback. The conducted research also identifies the necessary competences that teachers of the digital generation of learners need—skills and competences for developing authored electronic resources in various formats for students with different learning styles, as well as for working in online environments—individually and collaboratively with other teachers.

"Walk me through the final day": A thematic analysis study on the family caregiver experience of the Medical Assistance in Dying procedure day.

Legalization of assisted dying is progressively expanding worldwide. In Canada, the Medical Assistance in Dying Act became law in 2016. As assisted dying regulations evolve worldwide, comprehending its subjective impact and broader consequences, especially on family members, becomes pivotal for shaping practice, policy, and training. The goal of this study is to understand the experience of family caregivers on the assisted dying procedure day. Qualitative, thematic analysis, research using semi-structured interviews. Family caregivers of patients who received assisted dying in two hospitals in Canada were recruited. Interviews were conducted at least 6 months after patient death. Conceptual saturation was achieved after analyzing 18 interviews. While caregivers expressed gratitude for the availability of Medical Assistance in Dying, they also described the procedure day as potentially jarring and unsettling. We identified five aspects that shaped their experience: attuned support from the clinical team; preparation for clinical details; congruence between the setting and the importance of the event; active participation and ceremony; and pacing and timing of the procedure. Together, these aspects impacted the level of uneasiness felt by caregivers on the procedure day. This study emphasized the importance of a family-centered approach to delivering Medical Assistance in Dying. It underscored recognizing the needs of family caregivers during the procedure day and offering strategies to ease their experience. Healthcare providers in jurisdictions where assisted dying is legal or deliberated should consider the applicability of these findings to their unique context.

A Short Paper about Fundamental Pedagogical Concepts of Constructivism Theory in Relation to TPACK Framework

The influence of constructivism as a pedagogical theory is mainly concentrated on adult education. Its main concepts stem from significant conclusions coming from other theories related to pedagogical and philosophical school practice. The key point is that knowledge is the desired learning outcome that can be accomplished through active learning participation which is closely related to construct. Also, some basic ideas of constructivism rely on idea-based interactions and ideas produced by learners. Certain aspects of the above-mentioned theory in learning and teaching seem to be very helpful for learners to develop their ideas and achieve learning outcomes. The basic aim of this paper is to examine the influence of Constructivism on adult education by utilising Technological Pedagogical Content Knowledge Framework’s (TPACK) dimensions in learning and teaching everyday practice. A mixed method analysis was conducted which contains a theoretical analysis, and experimentation through a quiz game. Our experimental approach through the quiz game was to study Newtonian physics and specifically the Law of Gravitation and the 2nd Law of Motion, finding that the mass terms cancel, and ending up making a prediction that all objects fall at the same rate. The experiment would then involve verifying the prediction and explaining any deviations from the prediction in terms of the intuitive idea of air resistance. The findings showed that students after answering the quizzes of the quiz game, were able to discuss their results using logical argument as opposed to when they did the experiment before the theory and their discussion was little more than guesswork. Thus, we could see how students performed on each question and use that information to figure out what needs to be readdressed or retaught.

The effect of scenario-based training versus video training on nurse anesthesia students’ basic life support knowledge and skill of cardiopulmonary resuscitation: a quasi-experimental comparative study

BackgroundPerforming CPR (Cardiopulmonary Resuscitation) is an extremely intricate skill whose success depends largely on the level of knowledge and skill of Anesthesiology students. Therefore, this research was conducted to compare the effect of the scenario-based training method as opposed to video training method on nurse anesthesia students’ BLS (Basic Life Support) knowledge and skills.MethodsThis randomized quasi-experimental study involved 45 nurse anesthesia students of Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran in 2022–2023. The practical room of the university formed the research environment. The participants were randomly divided into three groups of scenario-based training, video training, and control. Data were collected by a knowledge questionnaire and a BLS skill assessment checklist before and after the intervention.ResultsThere was a significant difference between the students’ scores of BLS knowledge and skill before and after the educational intervention in both SG (scenario group) (p < 0.001) and VG (video group) (p = 0.008) (p < 0.001). However, no significant difference was observed in this regard in the CG (control group) (p = 0.37) (p = 0.16). Also, the mean scores of BLS knowledge and skills in the SG were higher than those in the VG (p < 0.001).ConclusionGiven the beneficial impact of scenario-based education on fostering active participation, critical thinking, utilization of intellectual abilities, and learner creativity, it appears that this approach holds an advantage over video training, particularly when it comes to teaching crucial subjects like Basic Life Support.

Co-creation of a novel approach for improving supply chain management for SARS-CoV-2 point of care diagnostic services in Mopani District, Limpopo Province: nominal group technique

IntroductionEffective supply chain management (SCM) of point-of-care (POC) tests for diseases like severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) requires active participation from diverse stakeholders, government entities, and regulatory bodies. The responsibility for overseeing various aspects of POC tests, including procurement, quality assurance, storage, inventory management, distribution, and human resource capacity, lies with national, provincial, and local levels of government. This study aimed to collaboratively develop an innovative approach to enhance SCM for SARS-CoV-2 POC diagnostic services in resource-limited settings, using the Mopani District in Limpopo province, South Africa, as a case study.MethodsKey stakeholders were invited to participate in an online workshop using purposive sampling. The study employed the nominal group technique (NGT) for data collection, which consisted of two phases. Phase 1 focused on identifying barriers in the supply chain of COVID-19 rapid tests, while phase 2 aimed to devise strategies to overcome the priority barriers identified in phase 1. Participants used a Likert scale of 1–5 to rank barriers and strategies, and an overall ranking score was calculated for each. The participants were provided with the results of the ranking exercise for their feedback.ResultsEleven key stakeholders from national (n = 1), provincial (n = 4), and local government (n = 2) levels, research entities (n = 3), and non-governmental organizations (n = 1) took part in the study. Participants identified significant barriers in the supply chain, such as the availability of testing kits, unknown demand, information on SCM during a pandemic, methods of controlling stock, and procurement processes. Strategies suggested by key stakeholders included monitoring stock levels and optimizing stock visibility systems to improve test availability, enhancing information visibility and consistent data updates to address unknown demand and improve SCM during a pandemic, employing data capturing and digitization for effective stock control, and implementing demand planning and standardized procurement processes at the national level to enhance stock procurement.DiscussionThe successful collaboration with key stakeholders, facilitated by the NGT, resulted in the co-creation of a novel approach to enhance SCM for COVID-19 diagnostic services in resource-limited settings. This study holds the potential to support the provision of COVID-19 diagnostic services in such settings. A recommended follow-up study would assess the feasibility of implementing this approach.

Sensemaking and medical professional identity within the context of strategic change

Objective of the study: To identify how the physicians of a major Brazilian hospital perceive the proposed change in payment models for services provided and whether the proposed change affects elements of the professional identity of the physicians interviewed. Methodology / approach: This study draws on the sensemaking theory, medical professional identity and implementation of strategies in complex organizations. It was carried out a qualitative research through semi-structured interviews with a group of physicians who works in a large Brazilian hospital that was facing changes in the reimbursement model. Originality / Relevance: Research addressing the reasons why physicians tend to resist is important to help strategists to design an approach to obtain professional adherence. Main results: The research participants perceive threats to their autonomy in two attributes, Clinical Autonomy and Financial Autonomy. Regarding the change in the payment model for services rendered, some interviewees perceive their need, but demonstrate a desire for more active participation in the discussion and elaboration of new models, thus configuring the need to maintain their Political Autonomy. Theoretical / methodological contributions: This work contributes to the literature by advancing the process of understanding sensemaking triggers and demonstrating how and why threats to professional identity can hamper the process of implementing strategies in complex organizations. Social / management contributions: The implementation of strategies in hospital organizations is a topic of great relevance for the managers of the healthcare industry, due to its multiplicity of actors and interests, in addition to exponential technological evolution.

Do typologies of pesticide risk knowledge influence the adoption of IPM strategies? Evidence from rice farmers' behavior in northern Iran.

The active participation of farmers in adopting eco-friendly practices is vital to mitigate the environmental and health risks linked to pesticide usage. Farmers' awareness of these risks significantly influences their adoption of integrated pest management (IPM) methods over traditional pesticide applications. This study sought to explore the range of understanding on pesticide effects, categorize IPM strategies employed in pest management, and examine the correlation between knowledge levels and IPM strategy choices. Data was gathered through structured questionnaires from 391 rice farmers in Sari County, Mazandaran province, Northern Iran. Exploratory factor analysis revealed three distinct dimensions of pesticide risk knowledge: personal risk of pesticide, environmental risk of pesticide, and community risk of pesticide. Furthermore, the study identified three primary categories of IPM strategies: high familiarity, intermediate familiarity, and low familiarity. The results of the regression analysis indicated that the personal risk of pesticides (β = 0.556; P < 0.01) and the environmental risk of pesticides (β = 0.262; P < 0.01) are significantly correlated with the adoption of high familiarity IPM strategies. Furthermore, the study revealed that there was no significant statistical evidence to support the notion that different types of pesticide risk knowledge had any influence on the adoption of intermediate and low familiarity strategies. The findings of this study imply the critical importance for agricultural extension programs to focus on enhancing farmers' knowledge of pesticide risks and various IPM strategies. © 2024 Society of Chemical Industry.

Socio-Eco-Religio-Cultural Approaches in Addressing Environmental Damage: An Interpretative Analysis Based on The Quran and Hadith

Purpose: This article discusses the ecological verses that have been interpreted in efforts to maintain the existence of environmental conservation. Ecology is a discipline that explores the symbiotic mutualism between nature and living organisms. The Quran uses several terms related to ecology, such as living environment (al-bi'ah), the entire universe (al-'alamīn), the sky or cosmos (al-samā'), earth (al-arḍ), human beings (al-insān), fauna (al-an'ām or dābbah), flora (al-nabāt or al-harth), water (mā'), air (al-rīḥ), sun (al-shams), moon (al-qamar), stars (al-burūj), and mountains (jabal). Methods: This research is essential due to recent environmental crises leading to various natural disasters. This is a qualitative study employing a literature review approach. This paper emphasises that maintaining the existence of environmental conservation is vital for the natural balance and future generations as it is part of Islamic teachings. Result and Discussion: Therefore, verses concerning the existence of environmental conservation need to be actualised. The results of this research can provide input for policymakers on the importance of consistently promoting the preservation of the environment as commanded by the Quran, such as maintaining a clean environment, keeping nature in balance, preserving ecological equilibrium, reforestation for greener nature, and making land productive. Research implications: The findings suggest potential opportunities for agrarian reform to aid in protecting and preserving ecosystems, ensuring that they remain viable and beneficial for future generations. Originality/value: This paper offers valuable perspectives on Islamic eco-culture as a potential solution to environmental degradation, drawing from the teachings of the Quran and Hadith. It explores the commendable efforts of Muslim communities to conserve the environment, guided by these two key sources of Islamic teachings. This narrative aims to offer constructive ideas and empower active participation, emphasizing the shared responsibility of both the community and government in ensuring that environmental issues receive the due attention they deserve.

A critical analysis on quality-of-life in women with visible facial disfigurements.

This study aimed to examine whether surgical treatment for a facial disfigurement influenced an individual's quality of life. One-on-one interviews were conducted with the aim of synthesizing participant's medical experiences into common themes. Additionally, participants completed the World Health Organization's Quality of Life Brief Version (WHOQOL-BREF) questionnaire. The WHOQL-BREF is a standardized testing instrument with four domains of 26 questions, meant to analyze participants' overall quality of health, physical health, psychological status, social relationships, and environmental health. Our study revealed that women with visible facial differences experienced a quality of life below the average of the general population. However, in those who reported above-average quality of life, a key theme emerged: active participation in the choice to undergo surgical treatment. Participants who felt this sense of agency in the decision-making process also reported a more positive healthcare experience. They felt more respected by others, indicating a strong connection between personal agency, surgical choices, and overall well-being. These findings reveal that personal agency plays an important role in the decision-making process for patients undergoing surgical treatment for facial differences, as it improves quality of life and has a positive impact on overall healthcare experience and well-being.

Learning From Parents: Implementation of a Parent-Mediated Positive Behavior Support Program Targeting Challenging Behavior in Children With Autism

Challenging behaviors (CBs) are frequently observed in children with autism spectrum disorder (ASD) and are known to have negative effects on parents’ stress and well-being, as well as on overall family quality of life. Research has shown that professional support such as the Prevent-Teach-Reinforce (PTR) program has the potential to alleviate those effects. Although several studies have empirically demonstrated this positive behavior support program in managing children’s CB, its implementation by community-based educators among parents of children with ASD has yet to be examined. This study assessed the facilitators and obstacles to this program’s implementation as perceived by 19 parents using interviews and questionnaires. Participants emphasized the significance of setting clear expectations, defining roles, and providing continuous feedback during the implementation process to promote their initiative and enhance their active participation. They recognized the difficulties of implementing the program within a family setting but emphasized the valuable presence of educators in the home, which improved their understanding of family dynamics. Parents valued effective and respectful support from educators, although some encountered disagreements during coaching sessions, highlighting the need for improved educator training with practical coaching and a greater recognition of the family’s perspective.

Empirical Study on Hospitalist System: A Value Creation Perspective

This study investigates the impact of hospitalist system awareness, motivation, and behavior on value creation within the healthcare context of Taiwan. As population aging and the prevalence of chronic diseases continue to rise, accompanied by increased medical resource consumption, the Taiwan Ministry of Health and Welfare introduced the hospitalist system. Despite its implementation, the number of participating hospitals remains low. Using a questionnaire survey conducted from October 2021 to March 2022, data were collected from medical teams involved in the hospitalist system. A total of 324 valid questionnaires were analyzed. The results reveal that hospitalist awareness positively influences participation motivation (β = 0.846, p &lt; 0.001), which subsequently impacts participation behavior positively (β = 0.888, p &lt; 0.001). Moreover, participation behavior significantly contributes to value creation (β = 0.869, p &lt; 0.001), along with the direct effect of awareness (β = 0.782, p &lt; 0.001) on value creation. In conclusion, the successful promotion and implementation of the hospitalist system rely heavily on the support and active participation of medical staff. Effective interactions and comprehensive information dissemination are essential for maximizing healthcare value creation.

Online groups show how technology supports healthcare needs for patients and families: an illustrative model for COPD facebook groups

Introduction:This study examines how online technologies can support patients and their families address specific medical needs by creating an integrated theoretical framework based on the Health Belief Model, Social Exchange Theory, and Technology Acceptance Model.Methods:We obtained a total of 264 responses from an online survey posted in several COPD Facebook groups. After data preprocessing, we were left with 155 responses that met our inclusion criteria. Using the Partial Least Squares-Structural Equation Model (PLS-SEM), we evaluate how individuals in Chronic Obstructive Pulmonary Disease (COPD) Facebook groups seek information.Results:This study examines the relationship between demographic variables, psychological attributes (including emotional support and self-worth), perceived disease severity, benefits and barriers, and the perceived utility and ease of internet use in the information-seeking behavior of COPD patients on Facebook.Discussion:The findings underscore the importance of ease of internet use and intuitive platform design as a critical determinant that positively affects user engagement and fosters active participation among online participants. These findings offer critical insights into how online communities help patients and families obtain broad support and enhance the adoption and acceptance of emerging healthcare technologies. This also shows the advantages that online platforms offer individuals managing chronic diseases. Given these insights, we urge healthcare providers to recognize the beneficial effects of online health communities on patient well-being and health outcomes. This understanding is essential for healthcare professionals seeking to enhance patient care, aiming to improve the quality of life for individuals with chronic diseases in an increasingly digital landscape.

Studi Identitas Regional untuk Pariwisata Berkelanjutan di Kecamatan IV Koto Kabupaten Agam

Tourism is growing rapidly globally, making an important economic contribution in Indonesia. However, it is necessary to focus on sustainable tourism that considers ecological and cultural aspects. This research aims to identify regional identity for sustainable tourism in IV Koto Sub-district, Agam Regency based on the potential of natural and cultural resources. The research method used in this research is quantitative and qualitative approaches, this research analyzes primary and secondary data to evaluate the attractiveness of natural attractions and cultural elements of interest to local communities. The results showed that the Great Wall of Koto Gadang was the natural attraction with the highest potential as a regional identity, while traditional ceremonies, particularly batagak gala, became the most significant cultural identity. The findings emphasize the importance of utilizing natural and cultural resources in a sustainable manner, involving the active participation of local communities in tourism development.

The Impact of Epidural Analgesia on Immobility and extended Hospital Stay After Periacetabular Osteotomy.

Early mobilisation after periacetabular osteotomy (PAO) represents an important goal after surgery. The purpose of this study was to determine whether the use of epidural aznalgesia (EA)is associated with prolonged immobility and an increased length of stay (LOS) after PAO surgery. From January 2022 to July 2023,the study included a cohort of 150 PAO procedures all performedby the same surgeon (SSA).Patients were categorized into two distinct groups: those who received epidural analgesia (EA) (79 PAOs) and those who did not receive EA (71 PAOs). "Ready for discharge" was defined as the ability to ascend and descend a standardized flight of stairs independently. Multivariable linear regression was used to identify additional factors influencing LOS after PAO. Patients in the EA group were ready for discharge 5.95 ± 2.09 days after surgery which was significantly longer than in the No EA group´saverage of 4.18 days ± 2.5, (p < 0.001). While the reduction in the number of patients experiencing pulmonary embolism in theNo EA group did not reach statistical significance, it still demonstrated a relevant decrease from two patients within the EA group (2.53%) to 0 (0%) in the No EA group. The active engagement of the surgeon in mobilising patients led to a substantial reduction in LOS, decreasingit from 5.81 ± 2.18 days to 2.2 ± 0.77 days (p < 0.001). Multivariable analysis revealed five independent factors influencing the LOS following PAO which included absence of EA, surgeon-led mobilisation within 24h after surgery, postoperative hemoglobin levels, BMI, and prior experience with PAO surgery on the contralateral side. Opting against the use of EA in patients undergoing PAO is advisable, as it will result in extended postoperative immobility and the associated risks. Additionally, the active participation of the surgeon in the mobilisation process is strongly recommended.