Alternative Placement Research Articles

Real-Time Monitoring and Control System Enhances Drilling-Fluid Management

_ This article, written by JPT Technology Editor Chris Carpenter, contains highlights of paper SPE 216322, “Next-Generation Drilling-Fluid Management: Real-Time Monitoring and Autonomous Control,” by Zhicai Zhang, Rached M. Rached, SPE, and Yunbo Xun, Sinopec, et al. The paper has not been peer reviewed. _ Accurate measurement and control of drilling-fluid properties are crucial for safe and successful drilling operations. Traditional manual methods are slow and require significant manpower, underscoring the need for real-time monitoring. This paper highlights a new online system for monitoring drilling fluids, enabling intelligent control of drilling-fluid performance. The online monitoring system improves drilling-industry safety and success by measuring properties of drilling fluids in an accurate, timely, and automated matter. Introduction The primary objectives of this project are to develop an innovative online system for monitoring drilling fluids with a focus on facilitating intelligent control of drilling-fluid performance. The system aims at measuring 10 key parameters continuously, including apparent viscosity, plastic viscosity, yield point, density, pH, and ion concentrations. By incorporating online, real-time, continuous monitoring capabilities, the system offers several advantages, including improved data quality and frequency, reduced on-site labor requirements, and a corresponding decrease in associated health and safety hazards. System Description Overview of the Online Drilling-Fluid-Monitoring System. The online drilling-fluid-monitoring system is available in four distinct configurations: land modular, land skid-mounted, offshore cabin, and indoor small modular, providing customization options to meet specific space requirements. The system is designed to measure 10 crucial parameters essential for drilling operations. These include rheology factors, density, pH, sulfur ion content, and chloride ion content. Density and rheology measurements are performed at a 1-Hz sampling rate, offering near-continuous monitoring. The system is capable of operating within an ambient temperature range from –35 to 50°C, and the testing temperature can be adjusted between 4 and 80°C. Enabled by real-time data transmission, the system allows for the online, real-time monitoring of drilling-fluid properties. The system has proven its utility extensively, with more than 30 sets having been deployed successfully across more than 200 wells. Ideally, the monitoring system is positioned near the circulation tank to enable efficient fluid transfer (Fig. 1a). When space near the circulation tank is limited, an alternative placement can be on the opposite side of the blowout-prevention pipeline (Fig. 1b). However, this alternative may lead to a slight delay in data because of extended circulation times.

ID: 325138 Ultrasound-guided medial branch peripheral nerve stimulation: An alternative placement method treating refractory low back pain

ID: 325138 Ultrasound-guided medial branch peripheral nerve stimulation: An alternative placement method treating refractory low back pain

372 What we have learned and are still learning about enteric methane emission measurements in extensive grazing environments

Abstract Across the Western U.S., beef cattle spend considerable time grazing extensive rangelands. Enteric methane (CH4) production in grazing systems represents more than 80% of the total enteric CH4 emissions. However, more measured CH4 data from cattle grazing extensive rangelands is needed to inform measurement, reporting, modeled emissions, and to identify mitigation opportunities. The availability of pasture-ready automatic head-chamber systems (AHCS; C-Lock Inc, Rapid City, South Dakota) has allowed the determination of emissions in rangelands. In this regard, different methods to ensure an accurate determination of enteric CH4 using this measurement technique have been evaluated in recent years. An initial step to obtaining accurate enteric emissions data is ensuring efforts secure adequate AHCS visitation. Investigations in small (< 99 ac) pastures have shown that ≥ 15 visits to ≥ 55 visits in feedlot pens are adequate for robust enteric CH4 production data. Here, our goal is to examine AHCS visitation outcomes to inform the use of this technique in extensive rangeland. For two grazing seasons at the USDA ARS Central Plains Experimental Range (CPER), we have studied enteric CH4 emissions from yearling steer herds ranging in size from 26 to 60 animals in continuously stocked rangeland (Table 1). After 30 d of acclimation in 2022, 46% of individuals continued using an AHCS until the end of the drought-shortened grazing season, totaling 60 d of constant AHCS exposure. In 2023, individuals were measured first at post-weaning, and those with ≥ 15 visits to an AHCS were stocked at CPER. These steers were previously exposed to an AHCS on average 69 d earlier (range: 28 to 118). Of these 60 individuals, 68% used the two available AHCS ≥ 15 times when grazing rangeland for 76 d, totaling 137 d of discontinuous AHCS exposure. While grazing, individual visits per season were reduced in 2022 and substantially greater in 2023. At this point in our enteric CH4 emission investigation, we learned that either exposing an individual multiple times to an AHCS after weaning or doubling the days of exposure in the acclimation phase increases visitation during the measurement phase by about 20% at the herd level and 450% on an individual basis. Insights learned on rangeland have uncovered several considerations for measuring enteric CH4 emissions in extensive environments: lengthy past exposure to AHCS is ideal for adequate visitation during the measurement phase and visitation of unacclimated individuals is unlikely during the measurement phase. Further work should determine the true number of individual visits required for accurate methane measurement in extensive rangelands and evaluate 1) efficacy of different acclimation practices, 2) continued use of previously exposed animals and temporal visitation decay, and 3) alternative placement of AHCS, and use of palatable attractants to increase AHCS visitation may improve measurement of enteric CH4 emissions.

Phase change materials in building integrated photovoltaic (BIPV) envelopes: A strengths, weakness, opportunities and threats analysis

This paper examines the use of Phase Change Materials (PCM) in Building-Integrated Photovoltaic (BIPV) systems. To assess the performance of BIPV–PCM systems, the study employs a Strengths, Weaknesses, Opportunities and Threats (SWOT) analysis. The study features the advantages of using PCMs with BIPV envelopes. The benefits include lower heating and cooling requirements, shifted peak loads and increased thermal comfort. However, there are several challenges like heat loss and lower energy efficiency which needs to be addressed. Further, the potential for reduced PCM efficiency over time is recognized. The paper concludes by recommending further research on alternative PCM placement strategies, enhanced PCM formulations, gypsum board integration and the evaluation of PCMs combined with nanoparticles.

Auditory nerve fiber excitability for alternative electrode placement in the obstructed human cochlea: electrode insertion in scala vestibuli versus scala tympani

Objective. The cochlear implant (CI) belongs to the most successful neuro-prostheses. Traditionally, the stimulating electrode arrays are inserted into the scala tympani (ST), the lower cochlear cavity, which enables simple surgical access. However, often deep insertion is blocked, e.g. by ossification, and the auditory nerve fibers (ANFs) of lower frequency regions cannot be stimulated causing severe restrictions in speech understanding. As an alternative, the CI can be inserted into the scala vestibuli (SV), the other upper cochlear cavity. Approach. In this computational study, the excitability of 25 ANFs are compared for stimulation with ST and SV implants. We employed a 3-dimensional realistic human cochlear model with lateral wall electrodes based on a μ-CT dataset and manually traced fibers. A finite element approach in combination with a compartment model of a spiral ganglion cell was used to simulate monophasic stimulation with anodic (ANO) and cathodic (CAT) pulses of 50 μs. Main results. ANO thresholds are lower in ST (mean/std = μ/σ = 189/55 μA) stimulation compared to SV (μ/σ = 323/119 μA) stimulation. Contrary, CAT thresholds are higher for the ST array (μ/σ = 165/42 μA) compared to the SV array (μ/σ = 122/46 μA). The threshold amplitude depends on the specific fiber-electrode spatial relationship, such as lateral distance from the cochlear axis, the angle between electrode and target ANF, and the curvature of the peripheral process. For CAT stimulation the SV electrodes show a higher selectivity leading to less cross-stimulation of additional fibers from different cochlear areas. Significance. We present a first simulation study with a human cochlear model that investigates an additional CI placement into the SV and its impact on the excitation behavior. Results predict comparable outcomes to ST electrodes which confirms that SV implantation might be an alternative for patients with a highly obstructed ST.

“This should be a compulsory placement for all nursing students”: An evaluation of pre-registration nursing students’ perceptions of learning on a mental health clinical placement

AimTo conduct a longitudinal exploration of pre-registration nursing students’ perceptions of their learning on an immersive mental health clinical placement grounded in learning from people with a lived experience of mental illness (otherwise known as consumers). BackgroundEnriching mental health clinical learning environments are crucial for positive mental health nursing outcomes. Though non-traditional clinical placement (i.e. non-hospital-based) models effectively increase student learning in a range of domains, little is known about the specific features of contemporary non-traditional placement settings that may be supporting student learning over time. DesignA survey design in the form of a standardised evaluation tool with additional qualitative response questions was used to examine nursing students’ perceptions of learning whilst on a non-traditional clinical placement over a 5-year period. Non-traditional placement settings are alternative placement options to traditional inpatient/community mental health settings. The TREND Statement Checklist was adhered to. MethodsSecond- and third-year students studying a Bachelor of Nursing (N = 753) from eight Australian Universities completed a Student Placement Feedback Survey between 2019 and 2023. Data were collected via an evaluation survey including 7-items (rated on a 5-point agreement scale) and three free-response questions. Quantitative and qualitative responses were analysed over all observations and compared between the five years of student evaluations. ResultsAcross five years, the immersive mental health placement was consistently rated by students as a highly valuable learning experience. Utilizing a Multivariate Analysis-of-variance (MANOVA) for the quantitative component revealed that student ‘learning from lived experience’ remained uniformly high and steady throughout 2020–2023. This was despite disrupted learning that ceased face-to-face tuition caused by the COVID-19 pandemic. An increase in ‘student enthusiasm for nursing’ was identified after the return to face-to-face learning. Qualitative analysis identified a greater need for preparedness prior to attending the placement and wellbeing support amongst students. ConclusionsOver the five years, pre-registration nursing students report clinical skill improvement and enhanced knowledge following the immersive mental health placement alongside an increased desire for further skill development. Learning from people’s lived experience of mental illness and specialised facilitators was valuable for student learning outcomes. Increased support is needed for student mental health vulnerabilities and wellbeing ahead of clinical placements. Further research is recommended on the aspects of non-traditional clinical placements that may be protective for student learning.

The Increasing Adoption Potential of Undersocialized Cats and Kittens: Blessing or Curse?

The most appropriate management strategy for a cat entering a shelter environment varies based on many factors. Perhaps the most important of these is the cat's level of socialization to people. For unsocialized/poorly socialized cats, pathways such as TNR or alternative placement are typically considered more appropriate for their quality of life. This is particularly true for older cats, outside of the socialization phase. However, as supply of cats have declined and rates of pet ownership have increased, there is increasing pressure for shelters to find homes for cats with socialization histories that would not have been deemed adoptable previously, and adopters are more willing to adopt poorly socialized cats. There has been no investigation of the well-being of poorly socialized cats in their adoptive homes or the experience of these adopters. Adopters of 57 adult cats identified as undersocialized and 155 control cats (not suspected of being undersocialized) were surveyed about their cat’s behaviour and their own satisfaction. Control cats were rated as less fearful, more affectionate, more likely to engage when approached (by either a stranger or their adopter), and more likely to enjoy petting (by either a stranger or their adopter) than undesocialized cats. Owners of control cats also reported greater satisfaction and were more likely to state that their cat would be happier in a home environment than regularly fed outdoors. Adopters of 134 kittens identified as undersocialized and 591 control kittens (not suspected of being undersocialized) were surveyed about their kitten’s behaviour and their own satisfaction. In this survey, control kittens were rated as less fearful, and more likely to engage when approached by a stranger or enjoy a stranger petting them, but there was no difference in ratings of affection, relationship with their owner (either by engaging when approached or enjoyment of petting), adopter satisfaction, or what environment the adopter states the kitten would be happier. Results suggest that although it is becoming more possible to place undersocialized cats in homes, these environments may not be in the best interests of the cats’ or adopters’ quality-of-life. Results for undersocialized kittens suggest that while they may still be prone to fear, particularly towards strangers, both the kitten and the owners have good quality-of-life and satisfaction post-adoption.

Outcomes for high-risk young people referred to secure children’s homes for welfare reasons: a population record linkage study in England

PurposeSecure children’s homes (SCHs) restrict the liberty of young people considered to be a danger to themselves or others. However, not all young people referred to SCHs find a placement, and little is known about the outcomes of the young person after an SCH or alternative placement. The purpose of this paper is to understand which characteristics most likely predict allocation to an SCH placement, and to explore the outcomes of the young people in the year after referral.Design/methodology/approachA retrospective electronic cohort study was conducted using linked social care data sets in England. The study population was all young people from England referred to SCHs for welfare reasons between 1st October 2016 to 31st March 2018 (n = 527). Logistic regression tested for differences in characteristics of SCH placement allocation and outcomes in the year after referral.FindingsIn total, 60% of young people referred to an SCH were allocated a place. Factors predicting successful or unsuccessful SCH allocation were previous placement in an SCH (OR = 2.12, p = 0.01); being female (OR = 2.26, p = 0.001); older age (OR = 0.75, p = 0.001); and a history of challenging behaviour (OR = 0.34, p = 0.01). In the year after referral, there were little differences in outcomes between young people placed in a SCH versus alternative accommodation.Originality/valueThe study raised concerns about the capacity of current services to recognise and meet the needs of this complex and vulnerable group of young people and highlights the necessity to explore and evaluate alternatives to SCHs.

How Are Alternative Clinical Placements Performed Compared to Traditional Clinical Placements During the COVID-19 Pandemic? Sought Through a Systematic Review and Meta-Analysis.

Clinical placement is the essential method of learning in health professions education, but it has been the most disrupted by the COVID-19 pandemic. Institutions of higher education resorted to alternative learning such as telehealth, simulations, and blended-learning for clinical placement to ensure that educational activities continue without delay. However, this raises questions about student competency and necessitates making up for missed in-person hours. A thorough investigation of the effectiveness of alternative clinical placement learning is required. A systematic searching was conducted on ten electronic databases, and the quality of the included articles was assessed using the Medical Education Research Study Quality Instrument (MERSQI). A meta-analysis was conducted by pooling studies with examination mark outcomes. Twenty-four articles were included in the systematic review and nine were included in the meta-analysis. The average MERSQI score for included studies is 11.15. Outcomes on student performance favor alternative placement, whereas perceived-based outcomes have mixed results and are slightly prone to traditional clinical placement. Meta-analysis indicates that alternative learning is either more effective than traditional clinical placement or at least on par with it. There is a discrepancy between perceived outcome and performance assessment regarding the utility of alternative learning to conventional clinical placement. Nonetheless, objective measurement outcomes and the meta-analysis support alternative learning as a reliable learning strategy for clinical education. Alternative learning for clinical placement experience can be improved further by adding more synchronous sessions, and implementing various learning methods, learning activities based on strong instructional design, and at least a short real-setting attachment.

Alternative port placement in a complex surgical abdomen

Alternative port placement in a complex surgical abdomen

Experiences of Workplace Violence in Graduate Nursing Clinical Education.

Exposure to workplace violence (WPV) is common in health care, and little is known about nurse practitioner (NP) students' experiences during graduate nursing clinical education. This study described experiences of WPV among NP students during their clinical education. We conducted a cross-sectional, quantitative survey of a random sample of NPs licensed in Texas examining graduate nursing education experiences. A total of 334 NPs responded, a 12% response rate. More than a quarter (27%) experienced WPV during their graduate nursing clinical experience. Preceptors were the most reported perpetrators (44%). Most NPs remained in their clinical site after their WPV experience (55%); a majority felt they had no alternative clinical placement option. Nurse practitioner students experience WPV, and there may be implications for educational persistence and their careers. Future work should attempt to reduce the frequency of student WPV experiences and examine implications for NP careers.

Viral inactivation for pH-sensitive antibody formats such as multi-specific antibodies

Recently developed multi-specific antibody formats enable new therapeutic concepts. Conveniently, formats with an Fc domain allow purification in well-established mAb platform processes. However, due to the structural complexity of the formats, the assembled molecules may be sensitive to extreme pH commonly used for viral inactivation. An alternative to low pH incubation for virus inactivation is the use of a mixture of tri-n-butyl phosphate (TnBP, solvent) and Polysorbate 80 (PS80, detergent). While TnBP is toxic, this combination has a long history of use in the manufacturing of human plasma-derived products that are sensitive to low or high pH incubation.Data are provided demonstrating that the solvent/detergent (S/D) treatment using TnBP and PS80 can be successfully used for pH-sensitive, multi-specific antibody formats in the clarified cell culture fluid (CCCF). A different placement of the S/D within the purification process, namely during the capture by Protein A (PA), has been evaluated. This alternative placement allows effective viral inactivation by S/D while preserving the viral reduction and viral inactivation achieved through the PA step itself, enabling the cumulation of these effects. Furthermore, the process alternative simplifies the liquid handling by reducing the added volumes of the required S/D liquids, thus reducing the amount of toxic TnBP to a minimum. Data are shown demonstrating a complete removal of TnBP and PS80 in the process.

Accuracy and Feasibility of Real-time Continuous Glucose Monitoring in Critically Ill Patients After Abdominal Surgery and Solid Organ Transplantation.

Glycemia management in critical care is posing a challenge in frequent measuring and adequate insulin dose adjustment. In recent years, continuous glucose measurement has gained accuracy and reliability in outpatient and inpatient settings. The aim of this study was to assess the feasibility and accuracy of real-time continuous glucose monitoring (CGM) in ICU patients after major abdominal surgery. We included patients undergoing pancreatic surgery and solid organ transplantation (liver, pancreas, islets of Langerhans, kidney) requiring an ICU stay after surgery. We used a Dexcom G6 sensor, placed in the infraclavicular region, for real-time CGM. Arterial blood glucose measured by the amperometric principle (ABL 800; Radiometer, Copenhagen, Denmark) served as a reference value and for calibration. Blood glucose was also routinely monitored by a StatStrip bedside glucose meter. Sensor accuracy was assessed by mean absolute relative difference (MARD), bias, modified Bland-Altman plot, and surveillance error grid for paired samples of glucose values from CGM and acid-base analyzer (ABL). We analyzed data from 61 patients and obtained 1,546 paired glucose values from CGM and ABL. Active sensor use was 95.1%. MARD was 9.4%, relative bias was 1.4%, and 92.8% of values fell in zone A, 6.1% fell in zone B, and 1.2% fell in zone C of the surveillance error grid. Median time in range was 78%, with minimum (<1%) time spent in hypoglycemia. StatStrip glucose meter MARD compared with ABL was 5.8%. Our study shows clinically applicable accuracy and reliability of Dexcom G6 CGM in postoperative ICU patients and a feasible alternative sensor placement site.

(194) Midline Reservoir Placement of Infrapubic Inflatable Penile Prosthesis: A Step-by-Step Surgical Technique

Abstract Introduction Various alternative placements of inflatable penile prosthesis (IPP) reservoirs have been previously documented, differing from the traditional retroperitoneal placement in the Space of Retzius. Pelvic trauma, history of surgery in the pelvic region, and atypical anatomy can necessitate an alternative location for implantation of the IPP reservoir. The midline placement of the IPP reservoir provides numerous advantages in outcomes, patient experience, and versatility of implantation. This video demonstrates the surgical procedure for midline placement of the IPP reservoir. Objective We outline a surgical technique to place the IPP reservoir in an alternative midline location. Methods The patient was instructed to void his bladder prior to the procedure to circumvent Foley catheter insertion. A 2.5 cm-wide horizontal incision was made 2 finger widths cranially to the dorsal aspect of the base of the penis. The surgeon’s index finger was used for blunt dissection along the linea alba above the pubic tubercles. A tonsil clamp is used to pierce the rectus fascia at the midline, below the arcuate line, to leave a defect just wide enough to accommodate a 70 mm nasal speculum. The surgeon’s finger is used to assess the space to determine if a 9/10 mm Hegar dilator is necessary to expand the avascular space by sweeping it parallel to the fascia. The speculum is inserted and positioned with the blades pointed cranially parallel to the facial axis and the handles pointed superiorly. The reservoir is prepared and delivered into this space using a metal pediatric Yankauer suction tip through the open blades of the nasal speculum. A syringe filled with saline solution is connected to the reservoir tubing, and the fluid is transferred completely to the reservoir and the tubing is clamped. The tubes originating from the reservoir and implant cylinders are both clamped, trimmed to length, and connected to each other in a watertight fashion to permit the bidirectional flow of saline solution. Proper IPP cylinder inflation is tested prior to closing the incision. Results The reservoir is thus safely deployed cranially to the pubic bone and avoids interfering with the urinary bladder. No complications were observed in this patient, and he was discharged on the same day. Conclusions The midline surgical placement of the reservoir during the infrapubic implantation of an inflatable penile prosthesis is a safe and effective alternative placement for patients with prior pelvic surgery, injuries, or atypical pelvic anatomy. Patients with compromised pelvic, abdominal, or inguinal regions due to hernia repair, patulous inguinal rings, or dense lateral pelvic scarring stand to benefit the most from this reservoir placement. This procedure outlines the surgical steps of midline reservoir placement for new IPP implantation or relocation during a revision procedure. Disclosure No.

A qualitative evaluation of a student midwife placement teaching English to speakers of other languages (ESOL).

A shortage of UK midwives has put pressure on clinical placements and supervision of student midwives. Alternative placement solutions are needed to provide students with meaningful learning experiences. One such learning experience was a placement undertaken by student midwives who attended a program teaching English to speakers of other languages (ESOL). This study evaluated the impact of the placement on student midwife learning and experiences of the ESOL participants. The 2022 study employed a qualitative design using Kolb's model of experiential learning as a framework. Ten student midwives placed with the ESOL program and three women enrolled in the program participated. Data were collected via online focus groups with the student midwives and a face-to-face focus group with the women. Data were analyzed using thematic analysis and Kolb's model of experiential learning. Four themes were constructed: 'Putting the scripts aside: expectations versus the reality of being an educator', 'Adapting and personalizing teaching', 'We are learning too: an environment for mutual learning', and 'Taking our learning forwards'. Students faced barriers during their placement and had to adapt their teaching accordingly. They gained crucial knowledge of the challenges faced by women who speak other languages. The women valued the students' input and together they forged a reciprocal learning environment. This study demonstrates how placing student midwives in a unique non-maternity setting has benefits for student learning which are transferrable to future practice. Importantly, it confirms that quality of learning during a novel placement is not compromised for students or participants.

A103The Future of Aiding Student Placement Expansion: is it simulation, is it sustainable?

In recent years many Higher Education Institutions (HEIs) have recognized the benefits of Simulation Based Education (SBE) and incorporated it into their teaching programs, in some cases utilizing it to replace traditional ‘clinical placement’ hours [1]. This has been catalysed by the COVID-19 pandemic whereby there has been unprecedented demands on NHS services, forcing the industry to offer alternative placement models [2]. To contribute to placement expansion by offering a simulation-based student placement. We created a six week non-clinical, simulation placement designed to host two Physiotherapy students. The overarching objective of this placement was to enable students to create and run their own simulation training session by their final week. They were based in the simulation team and networked with other students and clinicians to guide their research and planning. We collated feedback from the students at the end of their six-week placement via anonymous, online Microsoft feedback forms. Throughout 2022 we ran this placement twice and collated data from the 4 Physiotherapy students, all who were in their second year of study. Thematic analysis suggested the most common skills students felt they gained were soft skills (i.e. organization and prioritization) and development of varied communication styles. Additional themes that were mentioned included simulation specific skills. There were two areas where students felt they were unable to develop due to the placement communicating with ‘real’ patients and clinical note writing. Students were asked to score their clinical knowledge relating to their chosen simulation topic area at the beginning and end of the placement. Scores increased from ‘Good’ (2 students) and ‘Average’ (2 students) at the beginning of the placement to ‘Good’ (1 student) and ‘Very Good’ (3 Students) at the end of the placement. Qualitative themes suggested the students felt the overall variety of activities and exposure to clinical scenarios/teams they may not have seen before was unique to this placement and both enjoyable and valuable. Previous studies have identified misconceptions relating to the purpose of simulation and its aims [1]. Our data reflected this concept as students rated their knowledge of simulation at the beginning of the placement as ‘Very Minimal’. However, our placement offering has proven to successfully increase this awareness and offer the opportunity to develop transferable skills and clinical knowledge in a way that is both exciting and aids placement expansion whilst incurring minimal cost. 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.

Challenges compounding foster care services in the Limpopo Department of Social Development, South Africa

Pre-Trial Diversion services by juvenile offenders from high density suburbs in Zimbabwe. Foster care as an alternative placement for children in need of care and protection comes with innumerable challenges in the Department of Social Development (DSD). This paper uses a scoping literature review method to discuss the challenges of foster care services in Limpopo DSD. Literature on foster care was perused, analysed and derived into two major themes which constituted the discussion of this paper; namely administration challenges such as backlog, ineffectiveness of newspaper advertisement, and CSG top-up; human resource challenges such as inadequate supervision/management and low morale and burnt-out of social workers. This paper suggests practical and possible ways in which the situation could be remedied, such as amending the newspaper advertisement regulation in the Children’s Act 38 of 2005 and capacitating social work managers and supervisors to be effective in supporting social workers underground to improve their performance.Key wordsHow to cite this article using ASWNet styleMamukeyani E. (2023). Challenges compounding foster care services in the Limpopo Department of Social Development, South Africa. People centred – The Journal of Development Administration (JDA), 8(3), 68-74. https://dx.doi.org/10.4314/jda.v8i3.3&#x0D; Visit journal website: https://jda.africasocialwork.net

While allied health students prefer face-to-face clinical placement, telehealth can support competency development: results from a mixed-methods study.

Student clinical placements are a mandatory requirement within most accredited health programs. During the COVID-19 pandemic, many health settings that had traditionally provided placements cancelled their offerings. Telehealth services however, increased and emerged as an alternative placement setting. To compare the learning experiences for allied health students provided by telehealth and face-to-face accredited health placements. Health students, from a university clinic between March to December 2020, delivering both face-to-face and telehealth consultations, were invited to complete a telephone survey with 3 demographic questions; and 10-items comparing their telehealth and face-to-face learning experiences. Pearson's chi-squared/Fisher's exact test was used to examine the association between each item and consultation setting. Qualitative survey data was thematically analysed using a descriptive approach. 49 students from 2 universities and 5 disciplines completed the survey. Students rated their face-to-face experiences significantly higher than their telehealth experiences across all items (all p-values <0.01). Across 9 items students reported positive learning experiences in both settings. Students had greater opportunities to work in a multidisciplinary team in a face-to-face setting. Four themes were generated: (1) placements can vary in quality regardless of setting; (2) telehealth can provide valuable learning experiences and support competency development; (3) enablers for telehealth placements and (4) barriers for telehealth placements. While telehealth can support student learning and competency development, in this study students preferred face-to-face experiences. To optimise telehealth placements consideration needs to be given to barriers and enablers such as technological issues and university curricula preparation.

Motor Function and Quality of Life Improvement following Asleep versus Awake Deep Brain Stimulation (DBS) Procedures (P4-11.009)

<h3>Objective:</h3> To compare real-world outcomes in patients with Parkinson’s disease (PD) whose Deep Brain Stimulation (DBS) leads were implanted using asleep procedures versus those patients that underwent the procedure using awake conditions. <h3>Background:</h3> DBS procedures are typically conducted with patients being awake to allow for intraoperative clinical testing and/or micro-electrode recording to confirm lead location. However, asleep DBS procedures (i.e., under general anesthesia) are becoming increasingly popular due, at least in part, to technological improvements in imaging allowing alternative lead placement confirmation and shorter procedure duration (Brodsky 2017, Chen 2018, Vinke 2022). <h3>Design/Methods:</h3> A sub-analysis of patients receiving their DBS lead implant under asleep versus awake conditions was conducted in an ongoing, large, multicenter, prospective real-world outcomes study (Vercise, Boston Scientific). Motor function (MDS-UDPRS III), quality of life (PDQ-39) and related outcomes (GIC) were collected at baseline and up to 3-years. Safety events were also collected. <h3>Results:</h3> To date, 157 patients (mean age 61.2±8.3 years; 69% male) were asleep and 433 (mean age 60.1±8.5 years; 66% male) were awake during lead placement. Patients in both groups presented with similar baseline age, duration of disease and disease state. Improvement in quality-of-life was noted in both groups with a 5.3-point improvement (n = 104) in asleep group and a 4.5-point improvement (n = 319) in awake group at 1-year. Similarly, an 18.8- and 20.9-point improvement in motor function was noted in the asleep and awake groups, respectively. <h3>Conclusions:</h3> Outcomes from this large dataset of real-world outcomes examining the outcomes following asleep versus awake DBS demonstrate an alignment with results from previous studies (Holewijn 2021; LaHue 2017). Patient outcomes show little to no difference between awake versus asleep groups. Sleep DBS procedures may offer potential for shortening the total time taken for DBS procedures and offer a viable alternative for patients. <b>Disclosure:</b> Jan Vesper has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Boston Scientific . Jan Vesper has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Medtronic . Jan Vesper has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Abbott . Jan Vesper has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Abbott . Jan Vesper has received research support from German Research Council. Dr. Deuschl has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Boston Scientific Cavion Functional Neuromodulation. The institution of Dr. Deuschl has received research support from Medtronic. Dr. Deuschl has received publishing royalties from a publication relating to health care. Lilly Chen has received personal compensation for serving as an employee of Boston Scientific . Roshini Jain has received personal compensation for serving as an employee of Boston Scientific. Roshini Jain has received stock or an ownership interest from Boston Scientific.

127 A formative usability evaluation of a community pharmacist-facing health information exchange (HIE) interface

OBJECTIVES/GOALS: To evaluate the usability of a HIE interface design among community pharmacists and technicians to identify opportunities for design improvements METHODS/STUDY POPULATION: Pharmacists and pharmacy technicians employed at Indiana community pharmacies participated in formative usability testing, via a Rapid Usability Evaluation (RUE), with an interactive, PDF prototype of the HIE interface. Participants were video-recorded to capture first impressions on the usability of the HIE prototype via the think aloud technique. Each participant had up to 1 hour to complete 4 clinical scenarios. Afterwards, participants completed the System Usability Scale (SUS; scale 0–100, with 100 being the best) to rate their satisfaction with the HIE prototype. RESULTS/ANTICIPATED RESULTS: Across 3 community pharmacies, 16 individuals participated in usability testing: 8 pharmacists and 8 technicians. The average SUS score for the HIE interface across participants from all sites was 70. Pharmacists on average scored the interface higher than technicians, 74 vs. 65, respectively. Initial findings from one pharmacy revealed that both pharmacists and technicians expressed a desire for improved efficiency (i.e. fewer clicks ) to access HIE data, alternative placement of HIE links within existing systems, and improved navigation to exit HIE links. DISCUSSION/SIGNIFICANCE: Initial results reveal opportunities to improve the HIE interface usability. Findings will inform design improvements to the interface and the creation of a toolkit to support the sustainable and scalable participation in HIE by community pharmacies.