Implemented Programs Research Articles

Proposed correlation between effectively addressing quality issues and improving provider well-being

Abstract: Introduction: Quality assurance and performance improvement (QAPI) and performance improvement projects (PIP) are tools to ensure quality care, safety, and problem-solving standards are met and exceeded. This paper examines possible correlations between data gained from implemented QAPI programs at Robert C. Byrd Clinic (RCBC) and provider burnout. Methods: Two surveys were evaluated for this paper. The first survey, Quality Report, identified each respondent's department, the monthly quality reports’ satisfaction rating, and the reports’ perceived accuracy. 28 providers completed the first survey. The second survey was the Well Being Index (WBI), which assesses provider burnout. 38 providers completed the second survey. Results: More than half (53.57 %) of individuals were dissatisfied with using the monthly reports to calculate quality reimbursement for insurance companies, and (65.79%) of participants in the WBI indicated that they felt burned out from their work in the past month. Conclusion: The findings of these two surveys warrant future research to evaluate the possibility of a correlation between the perceived accuracy of quality reports and provider burnout.

Update on HPV Vaccination Policies and Practices in 17 Eastern European and Central Asian Countries and Territories.

In 2021, a survey was conducted as part of the regional program of the United Nations Population Fund (UNFPA) Regional Office for Eastern Europe and Central Asia (EECA) to assess the policies and practices relating to HPV vaccination and cervical cancer screening in the 17 countries and territories included in this region. Since then, very substantial progress has been made with HPV vaccination across the region so another survey was conducted establish the current situation. A 10 question survey covering the policies, plans and practices for HPV vaccination was prepared. As cervical cancer prevention is a priority for the UNFPA, its offices in the 17 countries and territories included in this study are well placed to identify the people who can provide authoritative data for this survey. Working with the UNFPA offices, the questionnaires were sent to these national experts in May 2023, with data collected until 30 June 2023. All countries and territories returned completed questionnaires. In the period from 30 June 2021 to 30 June 2023, the number of countries and territories that have implemented or are implementing HPV vaccination programs has doubled. As of 30 June 2021, only 6 of 17 countries and territories had implemented national HPV vaccination programmes, and by 30 June 2023, another 6 could be added to this list. Of the 4 countries with sub-optimal vaccination coverage rates in 2021, none showed substantial improvement over the 2-year period. The implementation of HPV vaccination programs across the region is progressing very rapidly with ≈70% of the countries and territories implementing or having implemented national programs. However, greater attention needs to be given to ensuring that both the old and the new programs will achieve high coverage rates.

معوقات التنمية المهنية المستدامة لدى مدرسي علم الاحياء في المرحلة الثانوية

The aim of the current research is to identify obstacles to sustainable professional development for teachers of biology at the secondary level. The research was limited to biology teachers at the secondary level who are affiliated with the General Directorate of Al-Qadisiyah Education, and for the academic year 2022-2023. The descriptive research method was adopted, and the size of the research sample was (450) teachers of biology at the secondary level, they were chosen at random. To achieve the goal of the research, the researcher prepared a scale of obstacles to sustainable professional development, which in its final form consisted of (28) items. The validity and constancy of the scale were verified, as the apparent validity of the scale and its logical validity were verified, and the construction validity of the scale was verified through indicators of the discriminatory strength of the scale’s items, and the internal consistency of the scale, which was verified by revealing the relationship between the degree of the items and the total degree of the scale, and the relationship between the degree of the items with the degree of the field to which it belongs, and the relationship between the degree of the field and the total degree of the scale. The constancy of the scale was also extracted by the half-segmentation method, as well as according to the Alpha-Cronbach equation. The data was statistically analyzed and processed, and the t-test was used for one sample. The results showed that all the obstacles to sustainable professional development among biology teachers in the secondary level that were identified in the current research tool are real obstacles, as their relative weights ranged between (50% - 79%), which are high percentages, and the most prominent of these obstacles were for science teachers. The issues at the secondary level are: (the content of sustainable professional development programs does not meet their actual cognitive and professional needs), (they are not involved in determining their needs for the types of sustainable professional development programs), and (the implemented professional development programs are short-term, intermittent, and unsustainable). In light of the results, the researcher recommended the necessity of forming specialized committees of education experts to examine all the obstacles to sustainable professional development among biology teachers at the secondary level, which were identified in the current study and work to address them, and work on a continuous and comprehensive evaluation of all sustainable development programs that have been implemented and will be implemented. As well as following up on the application of what teachers have learned from these programs in the classroom. She also suggested conducting studies similar to the current research in other topics such as chemistry and physics. Keywords: Sustainable professional development, obstacles to sustainable professional development, sustainable professional development programs, biology teachers

미국 Title I 프로그램이 학생 성취에 미치는 효과

[Purpose] This paper aims to empirically investigate the impact of the federally funded Title I program on the performance of students from low-income families, as assessed through the state's own assessments. Additionally, the study seeks to discern the relative effectiveness of two specific program, namely the school-wide program and the targeted assistant program, to see which program is more effective.
 [Methods] To accomplish these objectives, the research leverages two national data sets from 2008-09 to 2013-14, sourced from the U.S. Department of Education's EDFacts and the National Center for Education Statistics' Common Core of Data. Employing fixed-effects and mixed-effects models with the school-level data, the study conducts a rigorous examination of the program's impact across various grade levels.
 [Results] The findings of this study reveal that the Title I program exerts substantially positive effects on academic outcomes of economically disadvantaged students in lower grades, with moderate positive effects observed in middle grades. However, no discernible impact is observed at the high school level. In terms of the specific program effects, lower grade levels exhibited higher achievement when implementing the “school-wide program”, whereas high schools showed lower achievement. Conversely, transitioning from the “targeted assistant program” to the “school-wide program” demonstrated positive effects only at the high school level.
 [Conclusion] The results of this study demonstrate the importance of prioritizing investments in early grades when providing educational services or support to students in need. As students progress to higher grades, there is a need to design and implement programs that are tailored to their levels and circumstances. Furthermore, in allocating education finances for low-income groups, prioritize elementary schools for 'whole-school programs,' and support high schools in developing the capacity to run comprehensive programs.

Implementation of Gender and Ecology Mainstreaming Policies at Sekolah Penggerak and Eco Green Schools in Surabaya: Ecofeminism Study

This research aims to discuss the implementation of gender and ecology mainstreaming policies in Sekolah penggerak in elementary schools and eco-green schools in Surabaya through an ecofeminist approach. This research uses a qualitative multi-case study approach, with the research subjects being four schools, namely SD Negeri 2 Benowo, SD Muhammadiyah 4 Surabaya, SD Al Khairiyah Surabaya, and SD Kristen Kalam Kudus Surabaya. The research results show that schools with the Adiwiyata or similar labels can better implement ecological awareness programs such as green and eco-green schools. They adopt programs such as hydroponics, recycling, and zero-waste healthy canteens and integrate them into the curriculum with relevant themes. Apart from that, these schools also apply the principles of gender-oriented, child-friendly schools. This research examines how gender mainstreaming and ecology are practised in schools. Both in the form of policies, learning design and related infrastructure. The results of this research illustrate that although there has been progress in implementing gender mainstreaming and ecology policies in schools, further efforts are still needed to increase students' understanding and awareness of these issues. In some aspects, gender and ecological approaches still seem symbolic and insubstantial.

Benefits And Challenges for Young Australians with Epilepsy Transitioning Into Adult Healthcare: A scoping review

Transitioning from paediatric healthcare into an adult healthcare system is a high-risk time for people with complex epilepsy. This can be a period of significant upheaval as a young person moves away from familiar and safe paediatric environments into unfamiliar adult healthcare. This is compounded by normal adolescent development, the challenges of epilepsy and the lifestyle conditions it demands, including restrictions on driving and levels of independence. Such factors can contribute to suboptimal health engagement which result in increased seizure activity, hospital admissions and reduction in community participation. Effective, well implemented transition programs are key to reducing risks, however little is known about which features of transition pathways define success or best practice. A scoping review was used to examine a broad range of peer-reviewed literature published between 2017 and 2022. This review examined evidence-based literature relating to experiences of people with epilepsy as they transitioned between paediatric and adult healthcare environments. Specifically, exploring practices that offered benefits, recognising barriers, and identifying findings to inform future research and advance transition practices. This review found that key to reducing transition-related health impacts for young people was patient-centred, engaging care that acknowledges their psychosocial and mental health needs specific to their level of development. Evidence suggests that engagement is built through multidisciplinary clinics that facilitate education and self-management. This review found that successful programs can deliver this by focusing on four key areas; relationships and continuity, capacity building, processes, and health services and systems. At a paediatric level this involves timely, age-appropriate preparation that builds skills and knowledge through tailored care-plans. At the transfer phase this means coordinated teams that work together across systems to ensure handover continuity, reduce stressors, and to aid navigation. At the adult level, care-teams that welcome young patients with protocols for continued capacity building are required.

Exploring the relationships among stocks of community wealth, state farm to school policies, and the intensity of farm to school activities

Farm to School (FTS) is a widely implemented public food procurement program in the U.S., and the number of state and Federal policies promoting it continue to grow. However, previous research has found inconclusive results associated with state-level policies. One reason may be that FTS adoption is associated with different stocks of community wealth (assets including human, social, and financial capital, net of liabilities). This research leverages the U.S. Department of Agriculture’s 2019 FTS Census, a new disaggregated database on state-level FTS policies, and a new comprehensive dataset of stocks of community wealth to assess this relationship. We find positive associations between cultural and social capital and FTS intensity (an index representing the extent of FTS participation), highlighting community assets that are often overlooked in community development programs. Further, we find that different types of state FTS policies are associated with FTS intensity; procurement policies have positive associations and education policies have negative associations. Results provide rationale for more nuanced consideration of local assets in prioritizing the types of FTS policy.

Gender Roles in Groundnut Value Chain (GVC) among Households under USAID Groundnut Up-Scaling Project (GUP) in Sokoto State, Nigeria

This study investigates gender roles in the Groundnut Up-scaling Project (GUP) intervention in Sokoto State, Nigeria, focusing on three rural communities out of five participating local government areas (PLGAs). The main objective is to analyze gender participation in the Groundnut Value Chain (GVC) among households under the USAID-GUP. A multi-stage sampling procedure selected 100 (56 male and 44 female) GVC participants, and 100 (84 male and 16 female) non-participants using the snowball sampling method in the non-participating LGAs (NPLGAs). The objectives were achieved with a descriptive and inferential Chi-square. The findings show that female participants dominate processing activities (72.7%) in the PLGAs, while males dominate production (92.9%). In the NPLGAs, 90.5% of males and 75.0% of females are involved in production. Informal sources are the main credit providers for both PLGAs and NPLGAs. Male participants in both PLGAs and NPLGAs cultivate more of an improved groundnut variety (Samnut – 22), with 64.3% and 70.5% of males and females in PLGAs and 59.5% and 56.3% of males and females in NPLGAs sourcing their land through inheritance. The average mean household income is higher for males (₦892,410.71 and ₦1,008,907.14) compared to females (₦531,386.36 and ₦495,000.00) in both PLGAs and NPLGAs, respectively. Significant differences between male and female categorical variables are observed at different nodes of the GVC in both PLGAs and NPLGAs, including input supply, groundnut production, harvesting, post-harvest handling, marketing, processing, and household chores. In conclusion, the study finds that the USAID-GUP activities, which aimed to promote gender equality, have not fully bridged gender inequalities in all GVC nodes. Gender equity amongst GUP participants has not been fully achieved. The study recommends addressing social and cultural rigidities to enhance gender equity participation in GVC nodes and effectively implement programs.

The Perspective of Rehabilitation Nurses on Physical Exercise in the Rehabilitation of Older People in the Community: A Qualitative Study.

In the face of an increasingly aging population, nurses have to design and implement programs aimed at the elderly in order to keep them healthy and maintain their quality of life. Structured physical exercise and overall physical activity play a major role in maintaining an active lifestyle, improving health, preventing disease, and helping to maintain older people's quality of life. To investigate the importance of implementing physical exercise programs for the older person in the community, taking into account the perspective of the rehabilitation nurse specialist, this is a qualitative, exploratory, and descriptive study with nine rehabilitation nurses from various regions of Portugal who have experience of implementing physical exercise programs with the elderly. This study used semi-structured interviews, one of the most common data collection procedures in social and health research. Content analysis was used to analyze the data. The study received a positive opinion from the Ethics Committee. The participants' perspectives focused on the following subjects: "Physical exercise program for the elderly in the community", "Importance of physical exercise in the rehabilitation of the elderly in the community", "People's adherence to the programs", "Gains in health resulting from the implementation of these strategies" and "Gains from group activities". A set of indicators emerged from the analysis. Nurses recognize the importance of using structured physical exercise programs adjusted to the rehabilitation of the older person, with gains in promoting active and healthy aging.

Improving Reading Interest of Net Generation Cadets Through the Development of Innovative Library Facilities and Infrastructure

This study explores boosting the reading interest of net generation cadets through innovative library facility and infrastructure development. The independent variable is library facility and infrastructure development, while the dependent variable is next generation cadets' reading interest. Quantitative research employing the Likert scale gathered data from Indonesian Flight Academy cadets in Banyuwangi. Descriptive analysis reveals a positive impact of library facility and infrastructure development on cadets' reading interest, supported by high mean and median values. Inferential statistical analysis further confirms a significant relationship between these factors. These findings significantly contribute to understanding factors influencing net generation cadets' reading interest. Practical implications advocate increased investment in innovative library facility and infrastructure, including relevant book additions, technology for information access, and comfortable reading spaces. Identifying additional influencing factors and promoting literacy programs and reading habit development are recommended. In conclusion, innovative library facility and infrastructure development critically enhance net generation cadets' reading interest. Regular evaluation and updates of implemented facilities, programs, and policies are essential, requiring collaboration among educational institutions, libraries, government, and the community for optimal results in improving reading interest. in one or two sentences.

Implementation of Physical Therapist Services for Men Undergoing Radical Prostatectomy: An Administrative Case Report.

Prostate cancer is the most commonly diagnosed cancer among men in the USA, and radical prostatectomy (RP) is the primary surgical treatment option. With an increasing number of men undergoing RP and surviving prostate cancer, clinical management strategies have broadened to improve the preoperative and postoperative patient experience and minimize treatment-related functional consequences. Urinary incontinence is a predictable functional consequence of RP. Recent reviews recommend preoperative and postoperative physical therapist services as the standard of care for men undergoing RP to decrease the severity of urinary incontinence and improve patients' quality of life. Despite compelling evidence, the routine provision of physical therapist services preoperatively and postoperatively for men undergoing RP is limited. The purpose of this case report is to describe the implementation of preoperative and postoperative physical therapist services for men undergoing RP in a US health care system using the knowledge-to-action process and the Consolidated Framework for Implementation Research frameworks. The implementation process included 4 steps: (1) development of a preoperative and postoperative physical therapist services program; (2) identification of barriers and enablers for implementation; (3) implementation of the program; and (4) evaluation of the effectiveness of the implemented program. Outcomes from the implementation of a physical therapist services program for men undergoing RP included lower urinary incontinence rates, improved patient satisfaction, and increased physical therapist utilization. This case report documents the implementation of physical therapist services for men undergoing RP. The use of implementation frameworks enabled the identification of unique enablers, barriers, and strategies for the implementation of physical therapist services for men undergoing RP. Implementing preoperative and postoperative physical therapist services for men undergoing RP improves patient outcomes. The implementation process and outcomes can be considered by other health care systems when developing preoperative and postoperative physical therapist services for men undergoing RP.

Trauma-informed programs in Australian schools: A systematic review of design, implementation and efficacy

There is growing awareness in Australia of the need for trauma-informed programs and the role schools can play in addressing trauma. However, Australian best-practice guidelines informing the development and implementation of trauma-informed programs are currently lacking. This systematic review aims to provide an overview of studies depicting and evaluating trauma-informed programs implemented in Australian schools, with particular focus on the programs’ theoretical foundations, design, implementation and efficacy. Four peer-reviewed articles published between 2014 and 2022 were identified. The overall quality of all studies was found to be adequate through the use of the Mixed Methods Appraisal Tool. All studies reported positive effects of the implemented trauma-informed programs. Contrary to prior research, this systematic review found similarities in the theoretical foundations, design, and implementation, indicating the use of a unified framework. Differences in the focus of staff training and program implementation were also found; however, variances in evaluation methods and lack of reported outcomes specific to design and implementation elements hindered comparisons and evaluations of program elements. While findings support the continued implementation of trauma-informed programs, a deeper understanding of program elements and how they may impact the efficacy of trauma-informed programs could lead to improved trauma-informed care in Australian schools.

Desa Pekerja Bangunan: Pemberdayaan Masyarakat Menuju Desa Penghasil Pekerja Bangunan Profesional Dan Bersertifikat Dengan Pemasaran Jasa Online Di Kelurahan Gunungpati

The needs of construction workers play a very important role in society. However, based on the results of a survey of several construction workers from Gunungpati Village, problems were found such as never having received socialization and training, not having a craftsman skills certificate, lack of interest in learning and literacy among the residents, not really knowing the construction workers from Gunungpati Village and marketing of construction worker services is still conventional. To answer these problems, PPK Ormawa BEM Faculty of Engineering, University of 17 August 1945 Semarang implemented construction worker empowerment programs in the Gunungpati sub-district such as the "Construction Worker Socialization and Training" program, "Construction Worker Certification", construction of the "Construction Education House", "Gunungpati Building Cities” and “Marketing Online Construction Worker Services”. The results obtained from the implementation of the program were that 68 construction workers had received socialization and training, 10 construction workers had BNSP light steel applicator certificates, 28 construction workers had paint applicator certificates, a construction library was built, namely the Construction Education House, an increase in interest in learning from 33 % to 74%, increase in the level of recognition of construction workers from Gunungpati sub-district from 56% to 82%, marketing of online construction worker services using 3 social media, namely Instagram, Facebook and Whatsapp, and 10 construction workers have been ordered to construction companies. Apart from that, it produces a spirit of independence and awareness of the potential of society. Formation of construction workers' associations and collaboration between implementation teams, student organizations, universities, communities, sub-districts, departments, associations, construction companies and vendors.

Undernutrition among children and its determinants across the parliamentary constituencies of India: a geospatial analysis.

In India, undernutrition among children has been extremely critical for the last few decades. Most analyses of undernutrition among Indian children have used the administrative boundaries of a state or a district level as a unit of analysis. This paper departs from such a practice and focuses instead on the political boundaries of a parliamentary constituency (PC) as the unit of analysis. The PC is a critical geopolitical unit where political parties and party candidates make election promises and implement programmes to improve the socio-economic condition of their electorate. A focus on child undernutrition at this level has the potential for greater policy and political traction and could lead to a paradigm shift in the strategy to tackle the problem by creating a demand for political accountability. Different dimensions and new approaches are also required to evaluate the socio-economic status and generate concrete evidence to find solutions to the problem. Given the significance of advanced analytical methods and models embedded into geographic information system (GIS), the current study, for the first time, uses GIS tools and techniques at the PC level, conducting in-depth analysis of undernutrition and its predictors. Hence, this paper examines the spatial heterogeneity in undernutrition across PCs by using geospatial techniques such as univariate and bivariate local indicator of spatial association and spatial regression models. The analysis highlights the high-low burden areas in terms of local hotspots and identifies the potential spatial risk factors of undernutrition across the constituencies. Striking variations in the prevalence of undernutrition across the constituencies were observed. Most of these constituencies that performed poorly both in terms of child nutrition and socio-economic indicators were located in the northern, western, and eastern parts of India. A statistically significant association of biological, socio-economic, and environmental factors such as women's body mass index, anaemia in children, poverty, household sanitation facilities, and institutional births was established. The results highlight the need to bring in a mechanism of political accountability that directly connects elected representatives to maternal and child health outcomes. The spatial variability and pattern of undernutrition indicators and their correlates indicate that priority setting in research may also be greatly influenced by the neighbourhood association.

Implementasi Fungsi Manajemen Kepala Madrasah Tsanawiyah Negeri Model Praya Kabupaten Lombok Tengah

This study aims to obtain a description of the implementation of the management function of the Head of Madrasah Tsanawiyah Negeri Model Praya Central Lombok. The research uses a qualitative approach with a phenomenological type. Data collection is done by interviews, observation, and documentation. The validity of the data is carried out by means of credibility, transferability, dependability, confirmability tests. Data analysis using Miles, Huberman & Saldana's interactive model consisting of collection, data reduction, data display, and verifying. The results of the study are as follows. (1) Planning includes: (a) strategic plans in the form of vision, mission and objectives, priority programs, general programs, and development programs; and (b) operational plans in the form of work plans, budget year plans, school year plans, activity plans, schedules, and plans for the use of funds. (2) Organizing is arranged in the form of: (a) making organizational structure and task descriptions, and (b) utilizing human resources through training, teacher, and employee performance group forums, and developing extracurricular activities. (3) Mobilization is carried out by motivating and directing madrasah members through: (a) training and training. (b) division of duties and authorities. (c) manage programs to develop student character. (4) Control is carried out by monitoring, evaluating, and reporting on the implemented program.

Effect of a quality improvement program on compliance to the sepsis bundle in non-ICU patients: a multicenter prospective before and after cohort study.

Sepsis and septic shock are major challenges and economic burdens to healthcare, impacting millions of people globally and representing significant causes of mortality. Recently, a large number of quality improvement programs focused on sepsis resuscitation bundles have been instituted worldwide. These educational initiatives have been shown to be associated with improvements in clinical outcomes. We aimed to evaluate the impact of a multi-faceted quality implementing program (QIP) on the compliance of a "simplified 1-h bundle" (Sepsis 6) and hospital mortality of severe sepsis and septic shock patients out of the intensive care unit (ICU). Emergency departments (EDs) and medical wards (MWs) of 12 academic and non-academic hospitals in the Lombardy region (Northern Italy) were involved in a multi-faceted QIP, which included educational and organizational interventions. Patients with a clinical diagnosis of severe sepsis or septic shock according to the Sepsis-2 criteria were enrolled in two different periods: from May 2011 to November 2011 (before-QIP cohort) and from August 2012 to June 2013 (after-QIP cohort). The effect of QIP on bundle compliance and hospital mortality was evaluated in a before-after analysis. We enrolled 467 patients in the before-QIP group and 656 in the after-QIP group. At the time of enrollment, septic shock was diagnosed in 50% of patients, similarly between the two periods. In the after-QIP group, we observed increased compliance to the "simplified rapid (1 h) intervention bundle" (the Sepsis 6 bundle - S6) at three time-points evaluated (1 h, 13.7 to 18.7%, p = 0.018, 3 h, 37.1 to 48.0%, p = 0.013, overall study period, 46.2 to 57.9%, p < 0.001). We then analyzed compliance with S6 and hospital mortality in the before- and after-QIP periods, stratifying the two patients' cohorts by admission characteristics. Adherence to the S6 bundle was increased in patients with severe sepsis in the absence of shock, in patients with serum lactate <4.0 mmol/L, and in patients with hypotension at the time of enrollment, regardless of the type of admission (from EDs or MWs). Subsequently, in an observational analysis, we also investigated the relation between bundle compliance and hospital mortality by logistic regression. In the after-QIP cohort, we observed a lower in-hospital mortality than that observed in the before-QIP cohort. This finding was reported in subgroups where a higher adherence to the S6 bundle in the after-QIP period was found. After adjustment for confounders, the QIP appeared to be independently associated with a significant improvement in hospital mortality. Among the single S6 procedures applied within the first hour of sepsis diagnosis, compliance with blood culture and antibiotic therapy appeared significantly associated with reduced in-hospital mortality. A multi-faceted QIP aimed at promoting an early simplified bundle of care for the management of septic patients out of the ICU was associated with improved compliance with sepsis bundles and lower in-hospital mortality.

Family screening in hypertrophic cardiomyopathy - clinical and genetic yield at baseline

Abstract Background Hypertrophic cardiomyopathy (HCM) is an inherited cardiac disorder, often with monogenic inheritance and accordingly, familial aggregation of HCM is common. International guidelines recommend family screening of relatives of patients with HCM to allow pre-symptomatic identification and early interventions. The clinical and genetic yield of implemented screening programs have been scarcely described and might improve by adjustments. We hypothesized that screening can be improved. Purpose To assess the yield of clinical and genetic family screening in HCM at first screening visit. Methods The study was a retrospective study of clinical and genetic cascade screening of adult relatives (age ≥18 years) of HCM probands, screened for familial occurrence of HCM from 2006 to 2022 at a regional assembly of clinics for inherited cardiac diseases (population 2.6 million). We collected demographic, clinical, symptomatic, and genetic characteristics from electronic health records, and a national pedigree database. Diagnostic work-up included a 12-lead ECG, and echocardiography. Relatives of probands carrying a likely pathogenic (LP) or pathogenic (P) variant were also offered cascade genetic testing. Patients and relatives were diagnosed according to the 2014 ESC guidelines. Results We included 603 adult relatives (55% female, mean age 44±15 years) (table 1). At baseline, 118 relatives (20%) fulfilled diagnostic criteria for HCM, and 135 (22%) were carriers of LP/P variants; 78 (13%) of these did not fulfill diagnostic criteria for HCM. Thus, the combined clinical and genetic yield of baseline screening was 33%. A total of 108 (18%) clinically unaffected relatives did not carry the family’s LP/P variant and were discharged from follow-up. This indicates that 50% of the relatives at baseline could be categorized as affected, genetically predisposed or clinically and genetically not at risk. Relatives fulfilling criteria for HCM at baseline were older (51 vs. 42 years, p&amp;lt;0.001), more likely to report cardiopulmonary symptoms (46% vs 16%, p&amp;lt;0.001), be male (59% vs 41%, p&amp;lt;0.001), and have abnormal ECG features (40% vs. 12%, p&amp;lt;0.001), compared to relatives not fulfilling criteria for HCM at baseline. On echocardiography, relatives fulfilling criteria for HCM had a mean maximal wall thickness of 17±4 mm and 14% had left ventricular outflow tract obstruction (gradient at rest/Valsalva≥30 mmHg). Conclusion At baseline screening, one in three relatives of HCM patients were diagnosed with HCM or found to be genetically predisposed to the disease. One in five clinically unaffected relatives not carrying the proband’s disease-causing variant could be discharged from screening. Considering the pattern of inheritance in HCM, the theoretical risk of developing HCM in the remaining 50% of the relatives is low. The non-diagnostic findings may be useful for identification of the remaining truly at-risk relatives.Table 1:Baseline characteristics

Halstead’s Complexity Measure of a Merge sort and Modified Merge sort Algorithms

Complexity measuring tools in computer science are deployed to measure and compare different characteristics of algorithms in order to find the best one in solving a particular problem or that suits a particular situation. In view of this, Halstead’s complexity metrics is deployed to compare the efficiency of two external sorting methods; the Merge sort and the Modified Merge sort algorithms. The methodology used in achieving this, lies in the extraction of operators and operands from the C_sharp (C#) implemented program of the two algorithms. Six Halstead metrics are evaluated using these operators and operands as parameters. The results shows that the Modified Merge sort algorithm is much more efficient than the conventional Merge sort as it has a lower Program Volume, lower Program difficulty and a lower Program Effort even though the advantage of a higher Intelligence content goes to the Merge sort algorithm.

Cancer patients' expectations of advance care planning: Atypological content analysis of qualitative interviews.

Advance care planning (ACP) can help to elicit cancer patients'preferences in a discussion process to promote person-centred medical decision-making. Expectations are known to be highly relevant determinants of decisional processes. So far, however, little is known about cancer patients' expectations of ACP that lead to acceptance or refusal of the programme. Thepresented study, therefore, aims to explore cancer patients' expectations of ACP. Semi-structured interviews were conducted with a purposeful sample of 27 cancer patients consenting to or refusing a newly implemented ACP programme in a German university hospital. Data were analysed using typological content analysis. We identified five different expectation clusters in relation to ACP. Consenting participants held expectations about the impact of ACP that were either 'ego-centred' or 'family-centred'. Refusers had expectations based on ignorance and misinformation, or-if they had already completed an advance directive-expectations to avoid unpleasant redundancy, perceiving no additional benefit but a burden from ACP. Finally, refusers in particular expressed expectations of delegated responsibility at the end of life, including anticipation of proxy decision-making. Our study results suggest that expectation-modifying measures could be taken to positively influence cancer patients' expectations and thus the acceptance of ACP. In this respect, reducing ignorance and misguided expectations plays a decisive role. Especially in family constellations with expected delegation of responsibility and dependence at the end of life, it might be important to promote ACP as a family-intervention to improve family outcomes.

ПРОФЕССИОНАЛЬНАЯ РЕАБИЛИТАЦИЯ ИНВАЛИДОВ С АМПУТИРОВАННЫМИ КОНЕЧНОСТЯМИ – ВАЖНЫЙ ФАКТОР ИНТЕГРАЦИИ ИХ В ОБЩЕСТВО

Current: the primary task of any state is to take care of its citizens; among them, a special place is occupied by people with disabilities who have arisen for various reasons. The number of disabled people on average varies from 5 to 10% of the total population and depends on the territory of residence. All over the world, including in the Russian Federation, there are and actively implemented programs for an accessible environment for people with disabilities. However, the problem of their social rehabilitation remains quite acute. The aim of this study was identification of factors affecting the work activity of disabled people with amputated limbs of working age and the possibility of their integration into society. Materials and methods. An investigation was conducted among people with amputated lower limbs. The structure of the causes of disability, gender and age characteristics, medical and rehabilitation measures were studied, and a survey was conducted on the possibility of continuing work. The results of the study and their discussion. The leading diseases that led to amputation of the lower extremities were a combination of vascular atherosclerosis, diabetes mellitus and concomitant pathology of the musculoskeletal system. With age, the percentage of disability increases. Most patients receive adequate treatment in accordance with the available standards and adequate prosthetics. As a social rehabilitation and integration into society, mostly patients consider continuing their work. However, there are a lot of problems for its implementation: the need for retraining and obtaining a new profession, working conditions, transport costs, work at enterprises located far from home, lack of vacancies, difficulties communicating with the team, etc. At the same time, many people who want to work do not have the opportunity to realize themselves in this. Conclusion. People with disabilities due to amputation of the lower extremities require special social attention. Solving the problems of their vocational rehabilitation and employment requires a comprehensive approach on the part of government agencies, the disabled themselves and society as a whole.