Routine Daily Activities Research Articles

Abstract 17006: A Machine Learning Approach to Identify Predictors of Mortality in Patients With Atherosclerotic Cardiovascular Disease

Introduction: We investigated the predictive power of a machine learning (ML) algorithm for 5-year mortality in patients with atherosclerotic cardiovascular disease (ASCVD). Candidate features included clinical variables from the electronic health record (EHR) as well as self-reported health and lifestyle data. Methods: The study cohort included 4,689 patients (66±11 years, 62% male) with ASCVD enrolled in the Vascular Disease Biorepository, which recruits patients referred to noninvasive vascular evaluation at Mayo Clinic, Rochester, MN. Clinical variables including comorbidities, lab measurements, and medication use were obtained from the EHR using validated electronic phenotyping algorithms. Information regarding social habits, physical activity levels, and personal health was obtained from a survey filled by the participants. Mortality was ascertained from the national death index. Clinical variables (n=52) and self-reported variables related to health and lifestyle habits (n=48) were added as individual features to reinforcement learning trees (RLT), a sparse decision tree algorithm, to construct the prediction model. We assessed the impact of each feature on prediction accuracy by applying feature selection and computing variable importance (VI). Results: Features with trivial VI that made no contribution to prediction were excluded. A model with 15 features had an area under the ROC curve (AUC) of 0.82 [95% CI 0.79 - 0.83] in the test set. Among the top 10 predictors of 5-year mortality, 6 were self-reported health variables (Table) , including outlook on personal health, limitations on routine daily activities, and physical activity levels. Conclusions: A ML approach had robust discrimination (AUC 0.82) in predicting 5-year mortality in patients with ASCVD. Self-reported health variables were among the top predictive features in the final model.

CAN A LIFESTYLE INTERVENTION MODIFY REST ACTIVITY RHYTHMS AMONG BEREAVED OLDER ADULTS? RESULTS FROM A PILOT STUDY

The death of a spouse is a life-altering event that is associated with disruption in routine daily activities. Disruption of daily activities place substantial stress on individuals’ biological rhythm, thereby increasing the risk for mood disorders like depression. The goal of this study was to examine (1) whether a behavioral lifestyle intervention modified rest-activity rhythms in older spousally-bereaved adults; and (2) whether changes in rest-activity rhythms correlate with clinical benefit, namely depression symptom burden. The rest-activity rhythm (RAR) reflects the 24-hour rhythm of sleep and daytime activity and is an indirect indicator of individuals’ biological clock. Participants included X adults aged 60–86 years whose spouse or life partner recently died (M time since death = 4.3 months). Participants monitored their sleeping, eating, and physical activity behaviors via tablet technology for 12 weeks. RAR measures of timing, regularity, and amplitude were derived from actigraphy at the beginning and end of the intervention. Depression symptoms were measured using the Hamilton Depression Rating Scale with the sleep items removed. We observed a significant change in intra daily variability, a non-parametric measure of RAR regularity, from pre- to post-intervention (d=.47). Improvement in intra daily variability was, in turn, significantly correlated with less depression symptoms at post-intervention (r = .24). RAR timing and amplitude did not significantly change from pre-to post-intervention. Specific parameters of the RAR may serve as behavioral targets for depression prevention. In the context of spousal bereavement, strengthening the regularity of daily activities may decrease the risk of developing major depression.

Primary dysmenorrhea among the adolescents in Kwara state, Nigeria: The prevalence, knowledge and management

Background & Aim: Dysmenorrhea refers to the symptom of painful menstruation, which may be primary (occurring in the absence of pelvic pathology) or secondary (resulting from identifiable organic diseases). It is common gynaecological conditions that affect women of reproductive age group. The effect may be mild or severed on daily routine activities of women for one to three days of each menstrual cycle. It also has a significant effect on quality of life and personal health. This study aims to determine the burden and management of primary dysmenorrhea among the adolescent. Materials and Methods: The study was a descriptive cross-sectional study conducted among 400 randomly selected adolescent girls attending secondary schools. A semi-structured questionnaire was used to obtain data which was analysis using (SPSS) version 16.0. Data presentation was done through the use of tables and charts. Appropriate statistics test such as chi-square was used to analysis the association between the variables. The level of significance was determined at p < 0.05. Results: The mean age of respondents was 15.2 ± 0.14, and the prevalence of dysmenorrhea was found to be 287(71.8%). About 215(53.8%) had poor knowledge while others believed it to be a disease 10(2.5%), a curse from God 69 (17.2%) and 47(11.8%) do not know the meaning. Significant number 174(43.5%) of the participants exhibited negative attitude towards menstrual pain, as 122(42.5%) resorted to self-treatment and medication, only 97(33.8%) ever consulted healthcare worker. Paracetamol 54(32%) was the most used drug for self-treatment while others include Feldene 33 (19.3, Diclofenac 27(15.8) and Gelucee 25(14.6), About 103(61.7%) of subjects do not know the side effects of the drugs they used. Conclusions: The burden of primary dysmenorrhea was high, the knowledge and attitude exhibited was poor and most of the adolescent girls used a different kind of drugs whose side effects are not known. The need for in school awareness creation on the causes and it is management was emphasized.

Theory to Practice: Incorporating Positive Parenting Strategies Into the Daily Routine

Given the efficacy of parent behavioral management training (PBMT) in the treatment of problem behaviors in children and adolescents, several manualized treatments have been developed. These manualized treatments provide a framework for implementing PBMT in a variety of settings, but their length and complexity present significant knowledge and training barriers to the universal adoption of PBMT by child and adolescent psychiatrists engaged in busy office practices. In this Workshop, we will address these barriers for child and adolescent psychiatrists by demonstrating how the core principles of PBMT can be incorporated into a single, theoretically straightforward, and practically effective intervention that will enhance parental attention and reduce power struggles around routine daily activities.

Prioritizing positivity across the adult lifespan: initial evidence for differential associations with positive and negative emotions.

Prioritizing positivity (PP) has been presented as an effective mechanism to increase positive emotions and reduce negative emotions. The current study sought to explore the role of age as a moderator and identify selected situations facilitating the likelihood of routinely experiencing positive and negative emotions. This mixed methods study consisted of 604 adults between 17 and 87years who completed prioritizing positivity (PP) scale, positive and negative affect scale (PANAS), and demographic data. Aside from the study questionnaires, a subsample of 223 participants was presented with two open questions. 1037 responses to these two questions comprised the data for content analysis. PP was found to be associated with increasing positive emotions in old adulthood, but not in young adulthood, and more with decreasing negative emotions in young adulthood than in old adulthood. Content analysis revealed that interpersonal interaction is critical in both increasing positive and reducing negative emotions, across age groups. However, young adults were more likely to prioritize pleasurable activities as triggers of positive emotions. Older adults focused on avoiding unfulfilling situations, due to the negative emotions that they trigger. Integrating both qualitative and quantitative findings elucidates the role of daily routine situations and activities in the management of positive and negative emotions across the lifespan. PP was shown to be of significant emotional value for younger as well as for older adults, though for different reasons. For younger adults, PP serves as a potential 'buffer' to balance negative emotions related to daily stresses and hassles characterizing this life stage, whereas for older adults it serves as a mechanism to boost life's little pleasures on a daily basis based on the acknowledgment of one's limited time ahead.

The Semantic Structures Of Balinese Verb: Mabersih ‘To Clean’ Conveying Profane- Sacred Values

There are a number of lexicons relating to the meaning of to clean translated into mabersih or nelain in Balinese language. The fact shows that such lexicons are not only used to express the daily routine activities in Bali-Indonesia, but also to accommodate various values. This article aims at describing the semantic structures of Balinese verbs in order to find out the profane and sacred values. The data was taken from daily conversations and Balinese texts as the written data. The oral data was collected through interview and the written ones by observation and note-taking. The collected data was analyzed by using the metalanguage approach, proposed by Allan (2001). The result showed that most of the encountered verbs being used are carrying profane nuance, among others: mandus, mambuh, masugi, mabaseh, masikat, nyampat, ngepél, ngumbah. Some lexicons are implying sacred values, as the lexicon ngingsah ‘cleaning and washing rice’ carries two possible values, both profane and sacred in certain activities done for the different purposes (a) rice for cooking daily food or (b) rice for making ritual ceremony substances. The lexicon malukat, mabayuh, and masapuh are used to express the nuance done by people to clean them spiritually.

Bilateral Cricoarytenoid Joint Ankylosis with a Perplexing Etiology

Bilateral Cricoarytenoid Joint Ankylosis with a Perplexing Etiology

EFFICACY OF ORAL ZINC SULPHATE VERSUS TOPICAL APPLICATION OF SALICYLIC ACID (16.7%) & LACTIC ACID (16.7%) COMBINATION IN THE TREATMENT OF PLANTAR WARTS

Background; Warts are common epidermal growths caused by human papillomavirus that often cause significant discomfort and embarrassment. Current treatment options include topical therapies, cryotherapy, laser vaporization, and surgical excision. Objective: To compare the efficacy of oral zinc sulphate versus topical application of salicylic acid (16.7%) & lactic acid (16.7%) combination in the treatment of plantar warts. Material and Methods; One hundred and fifty six patients with warts fulfilling the inclusion and exclusion criteria coming in Medicine outpatient department were included in the study. Group A, having 78 patients, was given oral zinc sulphate (10 mg/kg/day) in two or three divided doses. In group B, 78 patients were advised to apply a combination of salicylic (16.7%) & lactic acid (16.7%) once at night daily. Results; Of these 156 study cases, 94 (60.3 %) were male patients while 62 (39.7 %) were female patients. Mean age of our study cases was 34.42 ± 9.87 years. Monthly family income up to Rs. 30000 was noted in 68 (43.6%) while 88 (56.4%) had monthly family income more than Rs. 30000. Mean weight of our study cases was 61.96 ± 10.29 kilograms. Mean height of our study cases 161.24 ± 12.23 centimeters. Mean BMI of our study cases was 26.52± 1.87 kg/m 2 and obesity was present in 31 (19.9%) of our study cases. Mean no. of lesions was noted to be 5.30 ± 2.45 lesions (with minimum no. of lesions was 4 and maximum no. of lesions was 10) and 131 (84%) had up to 5 lesions. Mean duration of disease was 4.69 ± 1.61 months and 112 (71.8 %) had disease duration up to 6 months. Efficacy was noted in 110 (70.5 %). Efficacy in group A was noted to be 83.3 % and in group B was 57.7 % (p= 0.001). Conclusion; Our study results support the use of oral Zinc Sulphate in the treatment of plantar warts as compared to the salicylic acid (16.7%) and lactic acid (16.7%) combination. Efficacy of Zinc Sulphate was significantly higher when compared with combination therapy and it was found to be safe and reliable mode of treatment having no side effects were observed in our study. Use of Zinc Sulphate can help to reduce chance of recurrence and disease morbidity. Being cost effective, it provides cheaper mode of treatment as compared with cryotherapy which is quite expensive which will provide economic relief to our large poor population. Early treatment can help patients to maintain routine daily lives and physical activities such as sports without any pain and side effects. Keywords; Plantar warts, Zinc Sulphate, Salicylic acid, lactic acid. DOI : 10.7176/JMPB/52-09

The Effect of 8 Weeks of Dynamic Neuromuscular Stability (DNS) Exercises on the Performance and Quality of Men and Women's Life with Apoplexy (Stroke)

Introduction: The instability in movement is one of the most important disorders after stroke. Dynamic Neuromuscular Stability (DNS) exercises can rebuild movement patterns and create postural stability, gravity overcoming, and rising up in these patients by simulating and recalling the growth patterns of a healthy baby in people with neuromuscular issues. Methodology: The present research is semi-experimental with random sampling. Thirty patients with stroke were randomly divided into two experimental (n = 15) and control (n = 15) groups based on their inclusion criteria. The quality of life (SF-36) and performance (Berg Balance Scale (BBS) Test) of samples were measured. DNS exercises were performed in the experimental group for 8 weeks (three sessions per week). The control group did not do the exercises and continued their daily routine activities. The post-test was repeated after eight weeks, similar to the pre-test. Results: There was a significant improvement in performance of samples and some indicators of quality of life (role disorder due to physical health, energy and fatigue, emotional well-being and pain). There was no significant difference in other indicators of quality of life (physical function, role disorder due to emotional health, social function and general health). Discussion and conclusion: DNS exercises were caused an improvement in the performance and quality of life of patients with stroke by calling the motor developmental patterns of healthy infants from birth to one year of age

The Influence of Exercise on Cardiovascular Health in Sedentary Adults With Human Immunodeficiency Virus.

Lifestyle physical activity (ie, moderate physical activity during routine daily activities most days of the week) may benefit human immunodeficiency virus (HIV)-positive adults who are at high risk for cardiovascular disease. The aims of this study were to describe lifestyle physical activity patterns in HIV-positive adults and to examine the influence of lifestyle physical activity on markers of cardiovascular health. Our secondary objective was to compare these relationships between HIV-positive adults and well-matched HIV-uninfected adults. A total of 109 HIV-positive adults and 20 control participants wore an ActiGraph accelerometer, completed a maximal graded cardiopulmonary exercise test, completed a coronary computed tomography, completed anthropomorphic measures, and had lipids and measures of insulin resistance measured from peripheral blood. Participants (N = 129) had a mean age of 52 ± 7.3 years, 64% were male (n = 82), and 88% were African American (n = 112). On average, HIV-positive participants engaged in 33 minutes of moderate-to-vigorous physical activity per day (interquartile range, 17-55 minutes) compared with 48 minutes in controls (interquartile range, 30-62 minutes, P = .05). Human immunodeficiency virus-positive adults had poor fitness (peak oxygen uptake [VO2], 16.8 ± 5.2 mL/min per kg; and a ventilatory efficiency, 33.1 [4.6]). A marker of HIV disease (current CD4+ T cell) was associated with reduced peak VO2 (r = -0.20, P < .05) and increased insulin resistance (r = 0.25, P < .01) but not with physical activity or other markers of cardiovascular health (P ≥ 0.05). After controlling for age, gender, body mass index, and HIV status, physical activity was not significantly associated with peak VO2 or ventilatory efficiency. Human immunodeficiency virus-positive adults have poor physical activity patterns and diminished cardiovascular health. Future longitudinal studies should examine whether HIV infection blunts the beneficial effects of physical activity on cardiovascular health.

Ultrasound-Mediated Gene Delivery Enhances Tendon Allograft Integration in Mini-Pig Ligament Reconstruction.

Ligament injuries occur frequently, substantially hindering routine daily activities and sports participation in patients. Surgical reconstruction using autogenous or allogeneic tissues is the gold standard treatment for ligament injuries. Although surgeons routinely perform ligament reconstructions, the integrity of these reconstructions largely depends on adequate biological healing of the interface between theligament graft and the bone. We hypothesized that localized ultrasound-mediated, microbubble-enhanced therapeutic gene delivery to endogenous stem cells would lead to significantly improved ligament graft integration. To test this hypothesis, an anterior cruciate ligament reconstruction procedure was performed in Yucatan mini-pigs. A collagen scaffold was implanted in the reconstruction sites to facilitate recruitment of endogenous mesenchymal stem cells. Ultrasound-mediated reporter gene delivery successfully transfected 40% of cells recruited to the reconstruction sites. When BMP-6 encoding DNA was delivered, BMP-6 expression in the reconstruction sites was significantly enhanced. Micro-computed tomography and biomechanical analyses showed that ultrasound-mediated BMP-6 gene delivery led to significantly enhanced osteointegration in all animals 8weeks after surgery. Collectively, these findings demonstrate that ultrasound-mediated gene delivery to endogenous mesenchymal progenitor cells can effectively improve ligament reconstruction in large animals, thereby addressing a major unmet orthopedic need and offering new possibilities for translation to the clinical setting.

Lemur Use of Hands Versus Mouth

Several hypotheses have been offered to explain handedness in primates. In prosimian primates, including lemurs, left-hand orientation has been demonstrated; however, few studies have examined hand vs. mouth orientation. We compared preference for use of hand vs. mouth, single hand over both hands, and right hand vs. left hand in captive ring-tailed lemurs (Lemur catta), black-and-white ruffed lemurs (Varecia variegata), and collared brown lemurs (Eulemur collaris). For a male and female of each species, plus twin female offspring of ring-tailed lemurs, we made 100 observations per individual, recording hand vs. mouth use every 30 seconds as individuals performed enrichment and routine daily activities. Overall, these lemurs tended to be more handed than mouth-oriented, preferred to use a single hand more than both hands, and used their left hand more than their right. Males were more left-handed than females. Analysis of specific activities showed that eating was hand-oriented, while grooming was mouth-oriented. Results are also reported by species. Research on lemur use of hands vs. mouth could provide insight into the evolution of handedness in primates.

Prevalence of self-reported musculoskeletal pain symptoms among school-age adolescents: age and sex differences.

Non-specific musculoskeletal pain symptoms are common in adolescents and may differ between the sexes, and be related to age and daily activities. It is critical to examine the prevalence and frequency of symptoms in adolescent students who tend to have pain which interferes with their routine activities. This study aimed to explore the prevalence and frequency of self-reported musculoskeletal pain symptoms by age and sex, and we also examined the association of symptoms with routine activities of school-age adolescents by area of pain. A cross-sectional survey was conducted among Thai students aged 10-19 years. All 2,750 students were asked to report previous 7-day and/or 12-month pain using the Standardized Nordic Questionnaire (Thai version) in 10 body areas. Multivariable logistic regression adjusted for age and sex was used to analyze the association between daily activity and musculoskeletal pain symptoms. A total of 76.1% (n=2,093) of students reported experiencing pain in the previous 7 days, 73.0% (n=2,007) reported in the previous 12-month period and 83.8% (n=2,304) reported pain in both 7-day and 12-month periods. The most common pain area was from a headache, with other areas being neck and shoulders, in that order, for both periods of time. The prevalence of musculoskeletal pain was especially higher in older groups and females. Participants reported frequency of pain as "sometimes in different areas" ranging from 78.4% to 88% and severity of pain at 3.82±2.06 out of 10 (95% CI 3.74-3.91). Routine daily activities associated with symptoms of headache, neck, shoulders, and ankles or feet pain were computer use (head, OR=2.22), school bag carrying (neck, OR=2.05), school bag carrying (shoulder, OR=3.09), and playing sports (ankle or foot, OR=2.68). The prevalence of musculoskeletal pain symptoms was high in both the previous 7-day and 12-month periods, especially in females and older adolescents, although most of them sometimes experienced pain. Computer use and school bag carrying were associated with headache, neck and shoulder pain, while playing sports was related to symptoms of the foot and ankle. The prevalence of pain was high, particularly in the older and female groups. Although they experienced mild symptoms sometimes, the related daily activities leading to these symptoms should be closely noticed.

Assessment of еnergy expenditure and energy intake of the military institute of physical training cadets associated with their academic and professional activities

High energy expenditure of daily activity of cadets trained at the Military Institute of Physical Training sets certain demands for cadets’ diet and correspondence of energy and nutrition value of the diet to energy expenditure. Calculated data on energy expenditures of daily routine activities of the Military Institute of Physical Training cadets, energy costs of academic training and sport-related activities are presented. Along with energy expenditure another issue of balance, namely energy intake, is considered. Calculated findings on nutrition and caloric value of a cadets’ food ration and the Military Institute of Physical Training cadets’ diet and energy consumption of cadets are presented. It is shown that cadets’ diet corresponds to average energy expenditure. A comparison of the energy value of the daily ration of cadets and their energy expenditure revealed that the food ration compensates the average energy expenditure. The exceptions are intensive training in the framework of improving athletic skills (2 trainings per day), as well as periods when individual training takes place at the same time with high energy expenditures of a daily routine (for example, snow cleaning). In these cases daily energy expenditure (up to 5000 kcal) was recorded, exceeding the energy cost of food rations and requiring increased energy supply. In addition, the vitamin status of cadets was investigated. No signs of vitamins deficiency in the food ration were revealed. However, in the spring period, a decrease in the content of ascorbic acid in urine is shown in 80% of the subjects.

A clinico-social study of functional disabilities among elderly in Palam Village of Delhi

Introduction: Aging, an integral part of living, typically is accompanied by gradual but progressive physiological changes and an increased prevalence of acute and chronic illness and is further compounded by impairment of special sensory functions like vision and hearing and difficulties in performing their routine daily activities seriously affecting the economic, social and psychological aspect of life of older people with disabilities. Objective: To estimate the magnitude of functional disability and its association with various socio-demographic variables among the elderly persons in Palam village of Delhi. Material and Methods: People aged more than 60 years of both sexes and willing to participate were included in this community based cross-sectional study. Barthel ADL index was used for assessment of activities of daily living disability, Snellen's distance vision chart for visual acuity assessment and whisper test was used for hearing assessment. The participants were categorized as functionally disabled if either ADL disability or better eye presenting vision

Genotoxic effects of daily personal exposure to particle mass and number concentrations on buccal cells

The aim of this study is to assess personal exposure to Particle Number Concentrations (PNC) in four size ranges between 0.3 and 10 μm, and particulate matter (PM1; PM2.5; PM4; PM10) in order to evaluate possible genotoxic effects through a comet assay in buccal cells. A convenience cohort of 30 individuals from a Brazilian medium-sized city was selected. These individuals aged between 20 and 61 and worked in typical job categories (i.e., administrative, commerce, education, general services and transport). They were recruited to perform personal exposure measurements during their typical daily routine activities, totaling 240 h of sampling. The 8-h average mass concentrations in air for volunteers ranged from 2.4 to 31.8 μg m−3 for PM1, 4.2–45.1 μg m−3 for PM2.5, 7.9–66.1 μg m−3 for PM4 and from 23.1 to 131.7 μg m−3 for PM10. The highest PNC variation was found for 0.3–0.5 range, between 14 and 181 particles cm−3, 1 to 14 particles cm−3 for the 0.5–1.0 range, 0.2 to 2 particles cm−3 for the 1.0–2.5 range, and 0.06 to 0.7 particles cm−3 for the 2.5–10 range. Volunteers in the ‘education’ category experienced the lowest inhaled dose of PM2.5, as opposed to those involved in ‘commercial‘ activities with the highest doses for PM10 (1.63 μg kg−1 h−1) and PM2.5 (0.61 μg kg−1 h−1). The predominant cause for these high doses was associated with the proximity of the workplace to the street and vehicle traffic. The comet assay performed in buccal cells indicated that the volunteers in ‘commerce’ category experienced the highest damage to their DeoxyriboNucleic Acid (DNA) compared with the control category (i.e. ‘education’). These results indicate the variability in personal exposure of the volunteers in different groups, and the potential damage to DNA was much higher for those spending time in close proximity to the vehicle sources (e.g. commercial services) leading to exposure to a higher fraction of fine particles. This study builds understanding on the exposure of people in different job categories, and provide policy makers with useful information to tackle this neglected issue.

Effects of Childhood Gymnastics Program on Spatial Working Memory.

A growing body of evidence has demonstrated the positive effects of physical exercise on cognition in children, and recent studies have specifically investigated the cognitive benefits of exercises involving cognitive-motor interactions, such as gymnastics. This study examined the effect of 8 wk of gymnastics training on behavioral and neurophysiological measures of spatial working memory in children. Forty-four children age 7 to 10 yr were recruited. The experimental group (n = 24; age, 8.7 ± 1.1 yr) was recruited from Yilan County in Taiwan, while the control group (n = 20; age, 8.6 ± 1.1 yr) resided in Taipei City. The experimental group undertook 8 wk of after-school gymnastics training (2 sessions per week, 90 min per session), whereas the control group received no intervention and were instructed to maintain their routine daily activities. Working memory was assessed by performance on a modified delayed match-to-sample test and by event-related potential including the P3 component. Data were collected before and after treatment for the experimental group and at the same time interval for the control group. Response accuracy improved after the experimental intervention regardless of working memory demands. Likewise, the P3 amplitude was larger at the parietal site after gymnastics training regardless of the task difficulty. Our results suggest that a short period of gymnastics training had a general facilitative effect on spatial working memory at both behavioral and neurophysiological levels in children. These finding highlight the potential importance of exercise programs involving cognitive-motor interactions in stimulating development of spatial cognition during childhood.

Patient Academy- A platform for collaborative working to improve Paediatric Child Health &amp; to empower patients in the role of educators

Introduction: The expertise of parents and patients is often under-valued. Collaborative working with patients/parents has given new meaning to patient-centred care. Involving healthcare users from the outset and engaging them in healthcare decision making and in the wider context of healthcare, promotes understanding of healthcare use and has the potential to facilitate more effective design and development of educational interventions to improve higlighted problems. We were keen to develop a platform whereby patients, parents and healthcare professionals could come together, to identify barriers to healthcare and to use co-design and co-production models to develop educational initiatives which could improve self-management, access to healthcare and other health outcomes. Practice Change: The Patient Academy initiative was piloted in a busy central London teaching hospital. The first phase of the project was a scoping exercise to understand local services and pathways in our hospital setting. The next phase involved a large-scale collaborative event held at London Zoo. The aim was to bring together all those involved in looking after a child’s health, to understand parental influences around healthcare decision-making, to define characteristics of a positive health encounter and to co-design educational strategies to improve the management of children with mild-moderate acute health problems. Approximately 25 parents and 35 healthcare professionals from a wide range of disciplines across primary and secondary care attended. Theory of change: We hypothesised that the event would provide unique insights from various perspectives which it did. With this widened lens we were able to collaboratively create a guide for the most effective health encounter and to design sustainable interventions to empower patients/parents in the role of educators and to improve healthcare encounters. Five work-streams led by teams of parents and healthcare professionals have emerged, each focusing on a different educational intervention. Targeted population & Stakeholders: Aligned to the national agenda of ‘Early Years’ the project was focused on improving a number of components of healthcare in 0-5 year olds. Stakeholders were extensive and included parents, patients, hospital paediatricians, nurses, GPs, health visitors, midwives, school nurses, mental health teams, public health, schools, pharmacists and behavioural insights specialists. Timeline: A six-month time frame was dedicated to the scoping exercise, the launch collaborative event and initial formation of workstreams and collaborative design of educational interventions. Highlights/Sustainability/Transferability: The greatest outcome from the Patient Academy has been the connections and relationships formed between patients, parents and various healthcare professionals and organisations. Five exciting workstreams have emerged including; 1) development of multi-disciplinary learning events, 2) a community based educational programe designed entirely by parents for parents and healthcare professionals. The other work-streams involve the 3) creation of a consultation tool, 4) a wardround tool and the 5) inception of a children and young person’s advisory board. To ensure sustainability, interventions have been incorporated into existing networks of patients/parents and integrated into routine daily activities. The tools created could easily be adopted by other Paediatric departments but are equally transferrable to any adult medical discipline in the UK or abroad.

A Comfortable Solution To Tracheal Anastomosis Protection: Tracheal Retention Sutures

Fixation of the chin to the anterior chest wall is the most commonly used method of reducing anastomotic tension following a segmental resection of the trachea and reconstruction with primary anastomosis. However, the sutures required for this method may lead to various organic and psychological problems. In five patients who underwent tracheal resection and primary anastomosis, retention sutures were placed on the proximal and distal-lateral edges of the anastomotic line rather than placing a Guardian chin stitch. All patients were mobilised in the early postoperative period and were able to perform their routine daily activities without restrictions. During their average 14.4 months of follow-up, no complications were found in their anastomotic lines during their clinical, radiological, and bronchoscopic assessments. The placement of tracheal retention sutures proved an inexpensive and reliable method to reduce anastomotic tension without additional surgical burden, and was effective in terms of patient comfort.

Teacher Conduct: A Survey on Professional Ethics among Chinese Kindergarten Teachers

Teacher professional ethics have recently become a much debated issue in China, which is in the wake of China’s new population policy that ends the ‘one-child’ policy after 35 years of stringent enforcement. With increasingly more children enrolled in early childhood services, the quality of the teaching force is to stand a tougher test of public scrutiny. Professional ethics is an integral and pivotal component of teacher quality. Utilizing questionnaire as the data collection method, this study examines self-reported professional conduct of 437 in-service teachers from 50 kindergartens across three provinces of China. It is found that: (1) The majority of the kindergarten teachers report themselves as compliant with the professional ethics when facilitating all the daily routine activities and when working with colleagues and parents; (2) Several ethical issues exist with some kindergarten teachers such as differentiated approach to children from different backgrounds, unawareness of the importance of parents as stakeholders, and unhealthy relationship with colleagues.   https://doi.org/10.26803/ijlter.16.9.8