Front Line Research Articles

Workplace violence against junior doctors in Iraq: implications for job satisfaction and retention

IntroductionHealth workers worldwide report being exposed to workplace violence, but those in conflict settings (or post-conflict settings) are especially targeted, as political conflict shifts societal norms. Iraq has suffered war and conflict for decades. A 2013 study of 567 Iraqi-trained physicians found nearly 2/3 had emigrated to mostly English-speaking countries; further, half of those remaining wished to leave Iraq. While prior studies have examined the phenomenon of violence against health workers in Iraq, no qualitative study has characterized Iraqi front line junior doctors’ experiences of workplace violence within a workplace violence causal framework, to inform an educational and policy response.MethodsWe consented and interviewed 73 junior physicians at six teaching hospitals across Central Iraq between December 2021, and January 2022. We analyzed 22 of the 73 conversations, after rejecting 29 because they were terminated prematurely when doctors were called away for patient care, and 22 others where doctors indicated they had no experience with workplace violence. (Our goal was to understand these interactions, not to quantify them).ResultsThe physicians we interviewed had been practicing an average 3 years since graduating from medical school (ranging from 6 months to 7 years). Interviewees represented eight hospital departments, with most coming from internal medicine and surgery. Within a socio-ecological framework, we identified two primary individual-level factors prompting patient-associated violence: patients and their families don’t understand triage (and resent being pushed to the side when doctors focus on more serious cases), and junior doctors (by definition) are young and inexperienced. At the family level, doctors reported patient relatives often demonstrate their devotion to the patient by acting out. At the hospital level, institutions are operating in an environment of scarcity, which generates high emotions as patients compete for attention, supplies and space. At a societal level, doctors reported family attacks persist because perpetrators face no real legal consequences. In addition to causes of violence, there are consequences. Doctors who are targets of violence reported experiencing mental health problems, including depression and loss of self-esteem, and reported thoughts of leaving their positions and even their country. Doctors also expressed regret for choosing a career in medicine.ConclusionYoung, inexperienced junior doctors in Iraq are bearing the brunt of patient frustrations with the scarcity of resources in the health system. Hospitals would likely improve the job satisfaction of junior physicians, and their longevity in the health system, by attending to this problem.

Management of Diamondback Moth and Black Rot Disease in Cauliflower through Front Line Demonstration at Farmer’s Field in Doddaballapur Taluk, Bengaluru Rural District, Karnataka, India

A study on management of diamondback moth and black rot was carried at Doddaballapur taluk by ICAR-KVK, Bengaluru Rural District, through front line demonstration during 2022-2023. The results indicated that infestation of diamondback moth and black rot was observed both under farmer’s practice plots and front line demonstration plots. The infestation of diamondback moth was 7.36 per cent and 29.32 per cent in FLD plots and farmer’s practice plots, respectively. Similarly, black rot incidence was 5.21 per cent and 16.62 per cent in demonstration plots and farmer’s practice plots, respectively. The weight of curd and total yield obtained under front line demonstration was maximum (2.234 kg/ plant and 26.29 t/ha) and was minimum under farmer’s practice plots (1.258 kg/plant and 22.98 t/ha). The analysis of cost economics revealed that higher gross and net returns and BC ratio were obtained in FLD plots (4,73,220 Rs/ha, 2,87,043.20 Rs/ha, and 2.54, respectively); low gross and net returns and BC ratio were obtained under farmer’s practice plots (4,13,640 Rs/ha, 2,45,588.20 Rs/ha, and 2.46, respectively). The analysis of gaps: total yield gap, technological gap, extension gaps and extent of adoption after FLD revealed that there is a need to bridge the gaps through proper training, method demonstration, dissemination of technological interventions, instilling coordination and removal of circumstantial differences between the farmers, researchers, and scientists, and convincing the farmers to adopt improved practices for management of diamondback moth and black rot in cauliflower.

Yield Gap and Impact Analysis of Rice Variety CAU R-1 in Different Location of Leparada District of Arunachal Pradesh, India

Front Line Demonstration on rice variety CAU R-1 was conducted in the Leparada District of Arunachal Pradesh in the year of 2019 to 2022 by Krishi Vigyan Kendra, West Siang during the Kharif season. The demonstration was conducted in 40 farmers’ field covering 18 hectares of area. The study was conducted for Grain yield, Yield gap, Technological gap, Extension gap, Economic gains and Technology Index. The demonstration showed that the average grain yield was lowest in 2019 (43.00 q/ha) and highest in 2022 (46.50 q/ha). The average grain yield of farmers’ practice was lowest with 30.00 q/ha in 2019 and highest in 2022 with 34.86 ql/ha. Percentage of increased yield of the demonstration over the farmers’ practice ranges from 33.30% to 43.30%. In case of Technological gap/yield gap, extension gap and technological index the value decreased from 2019 to 2022 with the value of 27.00 to 23.50 (Technological gap/yield gap), 13.00 to 11.64 (extension gap) and 38.60% to 33.60 % (technological index). In term of economic study, the benefit cost ratio of the demonstration ranges from 1.72:1 (2019) to 1.76:1 (2022) whereas the farmers’ practice benefit cost ratio ranges from 1.16:1 (2019) to 1.28:1 (2022). The yield potential of rice can be increased to a great extent by using high yielding varieties with improved technologies through front line demonstration. Accordingly, the production and the productivity of rice will be increased resulting in sustainable and profitable farming at the same time reducing the technology gaps.

Crisis Management In Public Health: Responding To Emergencies And Disasters

The government has a lot of chances and challenges in the twenty-first century to improve public health and provide citizens with higher-quality services. Generally speaking, administrative officers oversee and carry out a variety of government activities at the local level. They are exposed to a variety of citizen-facing issues as well as the difficulties in carrying out ground-level project execution. They regularly handle a variety of crises. Pandemics, natural disasters, and any other scenario involving law and order present a serious challenge for the government. Officers in charge of public health services handle emergencies on the front lines. Communication, scenario assessment, and teamwork are essential for crisis management to be effective. Team procedures improve crisis management's responsiveness, velocity, and effectiveness. The brief duration of crisis situations means that little time remains for planning. Therefore, public servants need to be proactive and flexible enough to handle the situation. According to this work, an effort will be made to investigate the variables and how they interact to affect the government sector's ability to manage crises effectively as well as the interactions between the variables affecting the quality of e-governance services in public health administration.

Liver toxicity and repair evaluated by histopathology and electric modulus.

Detoxification is one of the most important liver functions. Therefore, liver is the front line of defense when the biosystem faces drug overdose, toxins, and anything that may cause harm. Some famous antibiotics are known for their side effects on liver; one of them is amoxicillin, AM. This work has investigated the toxic effect of amoxicillin on rat's liver with overdose (90mg/kg) and has studied the ameliorative role of protective and therapeutic Ashwagandha seeds extract (ASE) at doses (100, 200, and 300mg/kg) against this toxicity. To achieve this work, the authors used two modalities; the first is liver histopathology to figure out the amoxicillin and ASE effects and to detect the sensitivity of another modality; the electric modulus, and its related thermodynamic parameters of liver tissue. Histopathological examination showed that the role of therapeutic ASE in reducing amoxicillin (AM) toxicity was more effective than the protective one. Also, most dielectric and thermodynamic results achieved the same result. Histopathology confirmed the liver injury by amoxicillin and the partial repair by the biosystem using ASE. Moreover, electric modulus, related dielectric parameters, and their thermodynamic state functions showed different changes in their values under the effect of amoxicillin. Using ASE helped the biosystem to restore these changes near their control values.

French Dentists’ knowledge, attitudes and practices toward oral cancer detection: A national survey

BackgroundFrance is ranked 6th in Europe in terms of oral cancer incidence. Dental surgeons are on the front line in examining the oral mucosa, but little is known about the knowledge, attitudes and practices of French dental surgeons with respect to lesions suspected of malignancy. MethodsAn online survey including 18 self-administered questions was widely shared on social media using major networks of French dentists. Items included socio-demographic characteristics of the respondents, their self-assessed knowledge, screening practices and training on oral cancer detection and care. ResultsA total of 676 dental surgeons participated in this survey. The vast majority, 92.8 %, were general dental surgeons, 83.9 % had a private practice and 49.1 % had less than 5 years of dental experience. Almost 55 % declared that they did not conduct systematic examinations of the oral mucosa and 45 % reported that they did conduct such examinations. In-hospital practice, lower patient age, dental surgeon experience, and specialty were all positively associated with systematic examination of the oral mucosa. Conversely, absence of a patient complaint, absence of an obvious lesion, lack of time, and lack of training/skills were all negatively associated. DiscussionThis is the first survey to analyze the practices of French dental surgeons in oral cancer screening. Only half of the respondents, the best trained, performed systematic oral mucosa examinations which objectively help to early detect mucosal cancer lesions. To improve oral cancer early detection, we recommend mandatory screening training programs for all dental students and dental surgeons.

보건·의료계열 종사자의 정신적 웰빙을 저해하는 산업안전 유해요인 분석 - 의사, 간호사, 의료기사를 중심으로

The industrial safety of health and medical workers who struggling on the front lines of diseases and disasters to protect public health and life, is threatened by working environment hazard factors that damage health. Despite they are exposing to hazard factors and accumulating mental well-being risks frequently, the social discussions and national efforts for their health were insufficient due to complacent perceptions that “They would be safe from occupational diseases and industrial accidents because of the working environment characteristic that set as medical work”. Korean society needs to enhance the importance of industrial safety because if the mental well-being risk of health and medical workers is not healed in proper time, the deterioration of work engagement can harm personal health and patient life and threat public health and cause a national crisis. Therefore, this study analyzed occupational safety hazard factors that hinder health and medical worker's mental well-being focusing on doctor, nurse, medical technician based on Rutter's ‘Cumulated Risk Model’ that explaining the more accumulate of exposure to simultaneous risk factors, the greater ripple effect of human's internalization and externalization problem. The multiple regression analysis were performed with SPSS Statistics 29.0 for 749 health and medical workers who attended the 6th Korean Working Conditions Survey published by the Korea Occupational Safety and Health Research. As a result, the health and medical worker's mental well-being were hindered whey they exposure to occupational safety hazard factors, emotional labor and quantitative labor intensity were finally verified as occupational safety hazard factors that threatened the mental well-being of them. Based on the results, this study suggested ① services and policies to effectively counter occupational safety hazard factors that hinder the health and medical worker's mental well-being, ② prevention and solution plan about exposure problem to occupational safety hazard factors, ③ customized strategies to promote health and medical workers' mental well-being.

Advancing Redgram Productivity: Impact of Cluster Front Line Demonstrations in Wanaparthy District, Telangana, India

This study aimed to assess the productivity improvement of redgram under Cluster Front Line Demonstrations (CFLD) in Wanaparthy district in the operational area of YFA-KVK, Mahabubnagar-I. A total of 261 demonstrations were conducted over a seven-year period (2016-17 to 2022-23), covering 104.4 hectares during the kharif season under rainfed situation with protected irrigation. Results showed that with the introduction of improved high yielding short duration varieties -PRG176 and WRGE 97 when combined with seed treatment, recommended fertilizer doses, weed management, and plant protection, achieved an increase in average yield of 10.20 quintals per hectare, compared to 6.23 quintals per hectare with traditional farmers’ practices. Net returns averaged ₹35000 from CFLD demonstrations, significantly higher than the ₹14,230 from conventional methods, though variations were influenced by the Minimum Support Price (MSP) set by the Government of India. The study identified an average extension gap of 3.98 quintals per hectare between the demonstrated technology and traditional practices, with an average technology gap of 14.80 quintals per hectare across the years. This gap varied annually due to the performance of recommended varieties and interventions. The technology index correlated with the technology gaps. The findings suggest that redgram production can be significantly improved through the adoption of improved technologies via CFLD. Therefore, it is crucial to spread these improved technologies among farmers using effective extension methods such as awareness camps, farmers-scientist interactions, group discussions, trainings, demonstrations, field days, and exposure visits through CFLD.

The risk factors for burnout among nurses: An investigation study.

The objective of this investigation study is to examine the levels of burnout and work engagement among nurses working on the front lines of the COVID-19 pandemic. Additionally, we aim to analyze the risk factors associated with nurse burnout. This investigation study included a sample of 1764 registered nurses from 6 tertiary comprehensive hospitals in Wuhan. A total of 1800 questionnaires were distributed via email between January 2021 and July 2021, and 1764 completed questionnaires were returned. Nurses who had been on the front lines of the COVID-19 fight for more than six months were included in the study. The Maslach Burnout Inventory-General Survey (MBI-GS) scale was utilized to assess burnout levels among all nurses. Work engagement was measured using the Utrecht Work Engagement Scale (UWES). The general health of the nurses was evaluated using the General Health Questionnaire-12 (GHQ-12) score. Demographic and clinical data, including age, sex, hospital, department, education, years of experience, daily overtime, weekly rest time, number of night shifts per month, smoking or drinking habits, marital status, etc, were also collected. Statistical analyses were performed using SPSS 25.0. The GHQ-12 scores in the FC group were significantly higher than those in the non-frontline COVID-19 (NFC) group. Compared to the average value of the 2 groups, we found that the dimension 2 average value of UWES in NFC group (3.52 ± 1.07) were remarkably higher than that in FC group (3.40 ± 1.08, P < .05). Furthermore, the dimension 1 (emotional exhaustion) average value and dimension 2 (depersonalization) average value of MBI-GS in NFC group were remarkably declined than that in FC group. Spearman rank correlation showed that negative correlation among the average value of each dimension and the overall average values between MBI-GS and UWES. Logistic regression analysis showed that daily Overtime, fight against COVID-19, GHQ-12 score and dimension 2 of UWES were the risk factors for nurse burnout. In summary, this study showed that the dimension 1 (emotional exhaustion) average value and dimension 2 (depersonalization) average value of MBI-GS in NFC group were remarkably declined than that in FC group. This study may provide some basis for addressing nurse burnout.

Impact of Cluster Front Line Demonstration (CFLD) on Production and Productivity of Chickpea (Cicer arietinum L.) under Shivalik Foot Hills of District Reasi, Jammu and Kashmir, India

Impact of Cluster Front Line Demonstration (CFLD) on Production and Productivity of Chickpea (Cicer arietinum L.) under Shivalik Foot Hills of District Reasi, Jammu and Kashmir, India

Experience as a physician attending to traffic accident victims in hospitals in Managua, Nicaragua

Introduction: Every 23 seconds a person dies from a traffic accident in the world, that is about 3756 deaths per day, with the consequent impact on relatives and health personnel. Doctors are part of the health team that is on the front line of care. Although this is part of their daily work, their feelings and emotions are deeply affected. There is a deficit of research of this type carried out by doctors.Methodology: Qualitative study, under the constructivist paradigm with a phenomenological approach. The objective was; explore the lived experience of doctors who treat victims of traffic accidents. The sample was intentional with five participating physicians . The phenomenological interview was used as an information collection technique and analyses were carried out according to Van Manen.Results: From the analysis, 15 codes were obtained inductively, which gave rise to 6 sub-themes: Impacts of Tragedies; Communication of bad news; Becoming of emotion; Coping; Narratives that endure and Resignation that in turn made up the 3 central themes: Body Lived in the impact, Time Lived in the here and after and Human Relations lived: between narratives and resignation.Conclusion: The study reveals that doctors are indirect victims of adverse events in the face of damage to the patient and their family in the face of a traffic accident. Constant monitoring of their psychological and emotional well-being, training communication strategies and improving patient-centered curricular programs are recommended. Extending the study to other specialties would enrich this understanding..

Administrative and legal aspects of providing free legal aid under martial law

Abstract. In this article submitted for publication, the authors analyze and study the issues related to the provision of quality and timely free legal aid under martial law. The methodological basis of the study is a system of general scientific methods that provide an objective analysis and evaluation of the subject under study. The authors believe that it is now necessary to popularize free legal aid more, not only in the media, but also to attract the attention of public organizations and charitable foundations, in particular those engaged in providing assistance to internally displaced persons, since they understand better than anyone how difficult it is to live and work under martial law. In our opinion, it is advisable to revise the Law of Ukraine «On Free Legal Aid» and pay attention to the communities and regions located near the front line, because people living in such areas need much more support and attention from the state. The authors also emphasize that young people should be involved in the work of free primary and secondary care centers, and internship programs should be organized so that people really trust free aid and understand that free aid does not mean low-quality. We also consider it appropriate to note that the crucial issue of providing quality and timely assistance, in terms of free aid, has become even more urgent and painful for a significant number of our citizens under martial law. The problems of physical impossibility not only to receive legal aid, but also to access justice have been added to the existing problems. This problem has been exacerbated by the temporary occupation of the territories, the destruction of court buildings and the relocation of courts and law enforcement agencies to other regions.

“The Non-Combatant on the ‘Front Line’: British Servicewomen During the Troubles in Northern Ireland”

Critical scholarship recognises women’s longstanding but unacknowledged presence on the “front line” but tends to explore what it means for the individual rather than why the military institution is invested in this myth. This paper draws on 20 interviews with female veterans of the Troubles and extensive archival material. It examines how servicewomen’s war labour was controlled by the British Army, by policy that kept them unarmed and wearing skirts, labelled as “non-combatants.” Building on scholarly recognition of women’s unacknowledged presence in “front line combat,” this paper considers the implications of control over servicewomen for how we understand military power.

Disentangling the socio-technical impacts of digitalization: What changes for shop-floor decision-makers?

With the diffusion of Industry 4.0 technologies, firms can decentralize operational decisions, fostering a data-driven Digital Transformation (DT) across all organizational levels. Digitalized shopfloors can leverage an unprecedented availability of data for better and faster decision-making, resulting in enhanced operational performance. However, limited research has investigated the organizational and individual implications for those who run the manufacturing lines: production managers, supervisors, team leaders, and workers. By adopting a socio-technical framework, this study aims to disentangle the effects that digitalization has on shopfloors’ organizational structures, decision-making processes, and individual competencies, as well as the interdependencies among them. An exploratory approach was adopted, based on an empirical cross-country study involving 34 semi-structured interviews conducted in the Italian and Spanish automotive sectors. Analyzed through the lenses of information-processing, knowledge-based, and dynamic capability theories, our findings reveal through five propositions how digitalization induces a “polarization” of operational decision-making: shopfloors are run by knowledgeable data-empowered production managers and autonomous information-processing team leaders on the front line, with a reduced importance of supervisors. Upskilling needs appear for team leaders but not production workers, whose involvement, however, emerges as a key factor for a successful digitalization and overall performance in initial DT stages. This study contributes to literature on digitalization by exposing managerial tensions and dynamic capabilities, along with a deeper understanding of the micro-foundations of DT in terms of implications for shop-floor decision-makers. Managerial implications are directed at creating awareness about the centrality of production team leaders, and future research avenues are proposed.

FC-YOLO: an aircraft skin defect detection algorithm based on multi-scale collaborative feature fusion

Abstract Aircraft skin defects pose a threat to the safety and airworthiness of the aircraft. The front line of engineering has requirements of high precision and stable defect detection, which cannot be met by existing deep learning methods, due to conflicting information between multi-scale features. Herein, a Fine-Coordinated YOLO (FC-YOLO) algorithm is proposed to detect aircraft skin defects. Firstly, the ELAN-C module with Coordinate &amp; Channel Attention mechanism is applied to the backbone network to enhance multi-scale detection precision. Secondly, the Adaptive-Path Aggregation Network structure is proposed to make features containing more information by adding a shortcut weighted by the Adaptively Spatial Feature Fusion (ASFF) module. The ASFF adaptively allocates the weights of features with different sizes to reduce the inconsistency of features between different levels during feature fusion to improve detection precision. Finally, the SCYLLA-IoU loss function is introduced to calculate the directional loss between the bounding box and the ground truth box to elevate the stability of the training. Experiments are executed with a self-constructed ASD-DET dataset and the public NEU-DET dataset. Results show that the mAP of FC-YOLO is improved by 3.1% and 2.7% compared to that of the original YOLOv7 on the ASD-DET dataset and the NEU-DET dataset. In addition, on the ASD-DET dataset and NEU-DET dataset, the mAP of FC-YOLO was higher than that of YOLOv8, RT-DETR by 1.4%, 1.6% and 2.2%, 3.8%, respectively. By which, it is shown that the proposed FC-YOLO algorithm is promising for the future automatic visual inspection of aircraft skin.

Plant Growth and Yield Dynamics in Tomato Cultivation: Insights from Front Line Demonstrations

The present study was undertaken to assess the yield gap through Front Line Demonstrations (FLDs) on tomato crops. Krishi Vigyan Kendra, Malkangiri (Odisha), conducted 13 trials on tomatoes in 2015-16 and 2016-17 across different villages. The predominant grower practices were treated as controls, while recommended practices were implemented in demonstration fields. Over the two years, the average yield in the demonstration fields was 622.3 quintals per hectare (q/ha), compared to 305.2 q/ha in the control fields. The average technology gap, representing the difference between potential and actual yields in the demonstration fields, was found to be 377.7 q/ha. The technology index, indicating the percentage deviation from potential yield achieved averaged 37.77%.

The Impact Analysis on Productivity Enhancement of Blackgram through Front Line Demonstration in Chandel District of Manipur State

Background: Blackgram is the major pulse crop cultivated all over the India. The crop is resistant to unfavourable weather patterns and helps in enhancing soil fertility. It is a significant component of the Indian diet since it provides vegetable protein and balances the diet. About 26 per cent of it is protein, which is nearly three times more than cereal and other vitamins and minerals. In addition, it is utilised as nutrient-rich fodder, particularly for dairy cattle. A significant obstacle to expanding blackgram production in Chandel district, Manipur State is the technology gap. Frontline demonstration (FLD), is one of the most significant and effective methods for technology transfer. By using the newest technologies, Krishi Vigyan Kendra Chandel’s interventions aim to boost productivity and production. Methods: The study on Blackgram var. PU-31 under rainfed farming situations of Chandel district, Manipur was carried out by ICAR-Krishi Vigyan Kendra-Chandel, during Kharif 2017 to 2022 with the objectives to increase production and productivity of pulse in the district conducted in the farmers’ field for 118 hectares of land with all the scientific package of practices. Result: The average grain yield of 776.50 kg/ha was obtained in the demonstration plot with 38.13 per cent increase in yield over farmers practices. The technological and extension gap were 723.50 kg/ha and 214.33 kg/ha respectively. Similarly, technological index was decreased from 50.33 percent to 44.53 percent during the study period, revealing satisfactory performance of technological interventions which can further be improved by bridging the gaps with more efficient research and extension services.

Penanganan Guest Request oleh Guest Service Center di Department Front Office Hotel Sheraton Mustika Yogyakarta Resort &amp; Spa

Handling Guest Requests by the Guest Service Center in the Front Office Department at Sheraton Mustika Yogyakarta Resort &amp; Spa.In the era of globalization and rapid growth in the tourism industry, hotel service has become a crucial aspect in ensuring customer satisfaction. The COVID-19 pandemic has changed the dynamics of the hospitality industry, and as recovery progresses, it is important for hotels to enhance the quality of their services to attract customers back. Sheraton Mustika Yogyakarta Resort &amp; Spa, with its unique architecture and luxurious facilities, has seen an increase in occupancy post-pandemic, especially during high seasons like religious celebrations and major holidays. The task of ensuring customer satisfaction is handled by the Guest Service Center, and it is not an easy task. This department serves as the hub for all guest information and requests, acting as the front line in direct contact with hotel guests. Every agent in the Guest Service Center must possess skills such as proper speaking etiquette, telephone etiquette, quick response, and diplomatic actions to achieve a good image, ensuring that guests are satisfied with the service provided. The purpose of this research is to analyze the request handling process, identify the challenges, and find the solutions implemented by the Guest Service Center at Sheraton Mustika Yogyakarta Resort &amp; Spa. The results of this research are expected to be used to improve service quality and has been assisted with a good customer complaint handling system.

2311 Doing nothing is NOT an option—successful collaboration as part of wider quality improvement exercise in frailty services

Abstract Introduction Population is growing old worldwide and UK is no exception. Health service models designed to cater the needs of service users are under immense pressure due to the ageing phenomenon. With unprecedented demand, their often low acuity, hence low priority and delayed conveyance to hospital and unavailability of services to address their needs due to delayed arrival; frail older patients often have to wait longer in emergency department (ED) to receive care in ED. Innovation and news models of care are therefore need of the hour to address this challenging situation. Methods Quality improvement initiative to establish acute frailty service. Development of Older Person assessment unit (OPAU) in Oct 2022 with already established and functional acute frailty team. Plan for direct referral to OPAU from South East coast ambulance service (SECAmb) colleagues. Weekly meetings with SECAmb. Geriatrician of the Day supporting alternative pathways instead of ED. Development of frailty poster with criteria to referral and uploaded on SECAmb work iPads, displayed in ambulances delivery area and ambulance queuing area inside the hospital. Single point of access phone number launched April 2023 to access frailty team &amp; other alternative services from outside the hospital. SECAmb webinar for education and awareness of alternative pathways (UCR, SDEC, frailty, virtual ward), attended by 40 front line SECAMB staff. Results October 2022–0 patients. November 2022–2 patients. December 2022–8 patients. January 2023–18 patients. February 2023–32 patients. March 2023–33 patients. April 2023–39 patients. Conclusion With sustained efforts and effective collaboration, number of patients being referred to alternate pathway (frailty team) are increasing with anticipated significant reduction to SECAmb conveyance to ED in the long run, addressing overcrowding issues.

SECONDARY CHARACTERS IN A STORY BY GEORGIAN WRITER - GURAM DOCHANASHVILI

In the literary work, next to the main characters there are also literary characters who have a secondary role. However, their role is not often highlighted while analyzing the work. Our goal is to put the shaded characters on the front line and thus demonstrate their great role in the story. In the story of Georgian writer Guram Dochanashvili "A Lad from Tavparavani", there are several secondary characters next to the main ones: Grandpa Giorga, a mother of the lad from Tavparavani, Tebrone and Lame Ephemia. Grandpa Giorga is distinguished in portraying the personality of the main character. If he was not there, the lad would never hear about the woman sitting in a tower across the sea. "A Lad from Tavparavani" has been repeatedly studied by various researchers (N. Gogiashvili, I. Maisuradze, K. Barbakadze, etc.), but the role and place of secondary characters of the work have not been analyzed yet. We think our work is a novelty in this direction.