Limited Time Availability Research Articles

The Family Meeting as Therapeutic Intervention

Background: Acute care hospitals provide care for older adults who have complex medical needs and fluctuating caregiving demands. Often one's ability to live independently can be threatened when faced with an acute illness in a hospital setting. It is in this acute care setting that the family meeting is most needed and recommended for treatment planning. Areas of Uncertainty: Meetings are often needed to establish care plans. However, there are challenges to holding family meetings. Some families are unable or unwilling to participate and there may be limited availability of space and time to conduct an adequate family meeting. These can contribute to delays in decision making. Therapeutic Advances: A family meeting is, therefore, a form of therapeutic intervention to be used during a patient's hospital stay. This article highlights the importance of family meetings as a means of medical intervention; describing the purpose, challenges, and education on carrying out the intervention. The primary reason for a family meeting is to facilitate communication between the health care team, decision makers, and caregivers. Participants should prepare ahead and a successful family meeting should follow a structured format to help minimize barriers and maximize therapeutic goals, including why the meeting is being called, who will participate, and when/where it will be held. A structured format allows for information to be shared from care provider to patient/family, including diagnosis, prognosis, therapy, and discharge plans and needs. At the end of the meeting, a summary should be provided. Conclusions: The population is aging and therefore these meetings need to become more common. The family meeting is an increasingly important component of a patient's care plan for those living longer and with complex medical conditions. Family meetings have shown improved outcomes and patient satisfaction, and therefore, should be viewed as a medical intervention.

Productivity analysis to overcome the limited availability of production time in SME FBS

Good industrial development should pay attention to the human factor as the main driver. Condition of work procedures, work area, and environment can affect the production result because if not optimal, the production will run slowly. If the work system is less than optimal, the productivity will do so, the operator will work uncomfortably and be easy to undergo work fatigue, even it can cause work accidents. Thus, the optimal and ergonomic arrangement of the the overall work system mechanism and work environment design is required for workers to work well, regularly, safely and comfortably with the aim of improving work productivity. This research measures the performance in textile SME (Small and Medium Enterprise) located in Sukabumi which is SME FBS which produces children’s clothing. This performance measurement is aimed at improving the competitiveness of the textile IKM so that it has the equal competitiveness with other SMEs or with textile industries that already have their name in market. Based on the method of hour standard time and TOC calculation at 2 FBS CMT (Cut-Make-Trim) in Sukabumi, which are the CMT Margaluyu Village and CMT Purabaya Village, the result is that the standard time of shirt work on CMT Margaluyu Village is less than that of CMT Desa Purabaya. It can be seen that more effective in SME FBS production is by process method.

Self-Assessment of Skills and Competencies among Residents Participating in a Pediatric Hospice and Palliative Medicine Elective Rotation.

To describe our institutional experience with a four-week pediatric HPM elective rotation and its impact on residents' self-rated competencies. In the spirit of bolstering primary hospice and palliative medicine (HPM) skills of all pediatricians, it is unclear how best to teach pediatric HPM. An elective rotation during residency may serve this need. An anonymous online survey was distributed to pediatric and internal medicine/pediatrics residents at a single, tertiary academic children's hospital. Respondents were asked to rate education, experience, and comfort with five aspects of communication with families of children with terminal illnesses and six domains of managing the symptoms of terminal illnesses. Self-ratings were recorded on a 1-5 scale: none, minimal, moderate, good, or excellent. Demographic data, including details of training and prior HPM training, were collected. Respondents completed a set of six questions gauging their attitude toward palliative care in general and at the study institution specifically. All respondents desire more HPM training. Those residents who self-selected to complete a pediatric HPM elective rotation had significantly higher self-ratings in 10 of 11 competency/skill domains. Free-text comments expressed concern about reliance on the specialty HPM team. A pediatric HPM elective can significantly increase residents' self-rated competency. Such rotations are an under-realized opportunity in developing the primary HPM skills of pediatricians, but wider adoption is restricted by the limited availability of pediatric HPM rotations and limited elective time during training.

Cooperation in Public Goods Games: Stay, But Not for Too Long

Cooperation in repeated public goods game is hardly achieved, unless contingent behavior is present. Surely, if mechanisms promoting positive assortment between cooperators are present, then cooperators may beat defectors, because cooperators would collect greater payoffs. In the context of evolutionary game theory, individuals that always cooperate cannot win the competition against defectors in well-mixed populations. Here, we study the evolution of a population where fitness is obtained in repeated public goods games and players have a fixed probability of playing the next round. As a result, the group size decreases during the game. The population is well-mixed and there are only two available strategies: always cooperate (ALLC) or always defect (ALLD). Through numerical calculation and analytical approximations we show that cooperation can emerge if the players stay playing the game, but not for too long. The essential mechanism is the interaction between the transition from strong to weak altruism, as the group size decreases, and the existence of an upper limit to the number of rounds representing limited time availability.

Nonspecialist Raters Can Provide Reliable Assessments of Procedural Skills

Competency-based learning has become a crucial component in medical education. Despite the advantages of competency-based learning, there are still challenges that need to be addressed. Currently, the common perception is that specialist assessment is needed for evaluating procedural skills which is difficult owing to the limited availability of faculty time. The aim of this study was to explore the validity of assessments of video recorded procedures performed by nonspecialist raters. This study was a blinded observational trial. Twenty-three novices (senior medical students) and 9 experienced doctors were video recorded while each performing 2 flexible cystoscopies on patients. The recordings were anonymized and placed in random order and then rated by 2 experienced cystoscopists (specialist raters) and 2 medical students (nonspecialist raters). Flexible cystoscopy was chosen as it is a simple procedural skill that is crucial to master in a resident urology program. The internal consistency of assessments was high, Cronbach's α = 0.93 and 0.95 for nonspecialist and specialist raters, respectively (p < 0.001 for both correlations). The interrater reliability was significant (p < 0.001) with a Pearson's correlation of 0.77 for the nonspecialists and 0.75 for the specialists. The test-retest reliability showed the biggest difference between the 2 groups, 0.59 and 0.38 for the nonspecialist raters and the specialist raters, respectively (p < 0.001). Our study suggests that nonspecialist raters can provide reliable and valid assessments of video recorded cystoscopies. This could make mastery learning and competency-based education more feasible.

Diagnóstico acerca del uso del ocio y el tiempo libre entre los estudiantes de la Universidad Nacional Experimental del Táchira

Leisure and free time are two concepts of great importance in today’s world. On one hand, every day’s rhythm poses the challenge of successfully completing all activities resulting in exhaustion at the end of the day. On the other hand, technology has invaded every facet of life through its many applications, since many tasks can be performed within reach of a click. This reality was also especially found among students from The Universidad Nacional Experimental del Tachira (UNET); these students often complain about the limited availability of time to engage in recreational activities. Often they choose to seek alternatives in order to release the tension.They usually express inability to properly manage their time, neither their university has managed to define precise lines to frame this time. For this reason, the present study –whose main objective was to assess the use of leisure and free time by UNET students– was outlined. A quantitative paradigm for research was used, giving the descriptive nature of the study.A random sample of 365 students was taken, out of a 7145 UNET student’s popula¬tion from Engineering and Architecture majors. As data collection technique a questionnaire was used and the motivation and use of leisure and free time variables were established, both supported by corresponding sub-indicators. The questionnaire was validated by expert judges, and the reliability was determined through Cronbach’s Alpha obtaining a value of 0.72, which determined high reliability. The data were processed using the statistical program SPSS 15.0. Regarding motivation, the results showed that the need for achievement was not high, and the need for power, in relation to leisure activities, did not seem to be determinant in the sample. The need for affiliation prevailed, and recognition is strongly linked to academic and intellectual aspects. Going out with friends was the most often performed activity during leisure and free time; while reading posed the lowest interest. Leisure time occurred more of¬ten during weekends and students spent one to three hours per day in leisure time which they considered as sufficient. There were no major differences related to gender and degree in the selected options. The interpretation of these results provided the proposition of guidelines to start developing programs for the proper use of leisure and free time

Problematika Mediasi di Pengadilan Agama Gorontalo dan Pengadilan Agama Limboto Tahun 2015

The integration of mediation in court practices, on the one hand intended to avoid the accumulation of cases, but on the other hand increase the burden of the judges. For that reason, it is understandable if the success rate is very small mediation divorce case. Paramediator limited time availability, lack of skills/skill mediator, lack of motivation and persistence finish the case, the absence of a mediator from outside the court registered a problematic instrument relating to the judge mediator. This condition presupposes the involvement of non-judge mediators, who have local knowledge base to engage in mediation cases. In fact, the regulations will it also looked very normative-procedural. In addition, this type of divorce case is rather complicated, especially if motivated by domestic violence, disharmony, the presence of third parties into its own problematic when mediated. But the most decisive is the parties who appeared since the beginning has been shut down to peace, making its implementation more complicated problems of mediation in Gorontalo Religious Court and Limboto Religious Court.

Simple Interactions: Piloting a Strengths-Based and Interaction-Based Professional Development Intervention for Out-of-School Time Programs

Background Adult–child relational interactions constitute an essential component of out-of-school-time programs, and training staff to effectively interact with children is key to improving program quality. Efficient staff training, that meets the limited time availability of out-of-school time staff, is particularly needed.

Optimal maintenance level of equipment with multiple components

Purpose – The purpose of the paper is to provide a method for selection of an optimum level of repair by replacement of an equipment based on its cost. In a ship where the engineer has a vast variety of equipment and systems to operate and maintain within limited time frames and availability of human resources, it is often difficult to disassemble a whole equipment to replace a faulty component. It is instead a lot easier to just replace the faulty equipment with whole new equipment. However, such a decision comes at an enormous capital cost. Therefore, the key question is, can we have a model to help us arrive at a decision on the correct level of carrying out repairs? Design/methodology/approach – The paper uses a model based on cost and convolution of failure distributions of critical sub-components of an equipment. Necessary assumptions based on real life experience have been incorporated in the model. Findings – The paper used an example of a particular type of motor driven sea water centrifugal pump which was commonly used in main engine sea water system, firefighting system, air conditioning system, etc. The pump had one of the highest failure rates in the ship (approximately one failure per 150 days) and the engineers found it cost and time effective to replace the entire pump on failure rather than carrying out replacement of the failed components. The model analyzed that the engineer’s hunch was not off the mark. Research limitations/implications – The implication of the work presented in the paper will be savings in maintenance cost and downtime due to optimal level of repairs on a multi-component equipment. The limitations of the work are assumption of independence of failures of components. This may not be true in all the cases. Further, opportunity based maintenance has also not been considered. Originality/value – The originality of the paper lies in the presentation of a method for selection of an optimum level of maintenance for a multi-component equipment

Students' Anxiety in Speaking Class and Ways of Minimising IT

This study investigated the anxiety levels of ability groups streaming by yheir perceived ability. It also dealt with the investigation of possible factors which provoked the students' anxiety and finding out ways of minimizing the anxiety level. The study spproached the first problrm by conducting a survey study and the second and the third ones by a case study of two sample students. The results of the data collection showed that both groups, average and above average students felt anxious when they had speaking class. The results of the case study stated that factors like examination, individual presentation, spontaneous activity and limited availability of time were found to be the sources of students' anxiety. Conclusions and comment at the end of students' presentation, a tolerant teacher, and close relationship between the teacher and students in class were believed to help minimize students' anxiety level

Promoting articulated action from diverse stakeholders in response to public policy scenarios: A case analysis of the use of ‘scenario improvisation’ method

In this paper we present a novel application of scenario methods to engage a diverse constituency of senior stakeholders, with limited time availability, in debate to inform planning and policy development. Our case study project explores post-carbon futures for the Latrobe Valley region of the Australian state of Victoria. Our approach involved initial deductive development of two ‘extreme scenarios’ by a multi-disciplinary research team, based upon an extensive research programme. Over four workshops with the stakeholder constituency, these initial scenarios were discussed, challenged, refined and expanded through an inductive process, whereby participants took ‘ownership’ of a final set of three scenarios. These were both comfortable and challenging to them. The outcomes of this process subsequently informed public policy development for the region. Whilst this process did not follow a single extant structured, multi-stage scenario approach, neither was it devoid of form. Here, we seek to theorise and codify elements of our process – which we term ‘scenario improvisation’ – such that others may adopt it.

Streamlined Environmental Assessments: Picking the Greenest Option Despite Limited Time and Data at the Federal Environment Agency in Germany

The Federal Environment Agency of Germany (Umweltbundesamt: UBA) is expected to provide information regarding the environmental performance of products and technologies — even in cases with limited time and data availability. Therefore, the streamlined environmental assessment (StreamEA) methodology has been developed which combines the competences available throughout the agency. Based on scientific assessment models, a ranking of alternatives can be determined for 15 impact categories, like greenhouse gas (GHG) emissions, nuisance, pathogenic emissions or physical killing of animals. Since the overall environmental burden depends on the specific impact per product and the total number of products, a macroeconomic assessment at the level of the product entirety is included. The applicability of the method, which can be adapted to other regions, and the robustness of results have been tested by means of case studies. The method is currently applied in the daily work of the agency to provide guidance to the general public and policy makers.

Couplelinks - an online intervention for young women with breast cancer and their male partners: study protocol for a randomized controlled trial.

BackgroundYoung breast cancer survivors (aged 50 years and under) and their partners are at an elevated risk for relationship distress and poor psychological adjustment relative to older age couples. Limited availability of time and resources and the distance to travel are major barriers to engaging in evidence-based psychosocial support programs. This paper describes the study protocol of a novel, manualized online intervention called Couplelinks that was developed to improve relationship adjustment and psychological wellbeing of young couples affected by breast cancer. Couplelinks is a custom-designed website offering a professionally facilitated, couple-centered intervention that entails informational, experiential, and interactive components.Methods/DesignA total of 80 heterosexual couples from across Canada in which the female partner has been diagnosed with a primary breast cancer will be recruited and randomized to a treatment or waitlist control group. Six dyadic learning modules form the core of the program and will be undertaken on a weekly basis. The manualized online intervention involves psycho-education and experiential exercises to enhance communication, coping ability, mutual empathy, and perspective-taking in relation to cancer. An online facilitator who is a trained mental health professional will guide and support couples throughout the process. Data collection will occur at baseline, at post-treatment or eight weeks into the waiting period, and at the three-month follow-up assessment. Primary outcome measures include the Revised Dyadic Adjustment Survey (RDAS) and Dyadic Coping Inventory (DCI) scores, and secondary outcome measures include the Hospital Anxiety and Depression Survey (HADS) score.DiscussionCouplelinks is one of the first internet-based psychological interventions to improve the psychosocial adjustment of couples coping with a life-threatening illness such as cancer. If successful, the design of this program as described in this paper makes a valuable contribution to the literature on the delivery of couple-focused psychosocial interventions, both within and outside of oncology.Trial registrationThis trial was registered with ClinicalTrials.gov (identifier: NCT01089764) on 17 March 2010.

SIS.NET: a randomized controlled trial evaluating a web-based system for symptom management after treatment of breast cancer.

As cancer survivorship increases, health care systems will be challenged to meet patient needs. With the limited availability of clinician time and resources, novel methods of using patient-reported outcomes may improve the quality and efficiency of follow-up care in patients with breast cancer. The authors conducted a randomized trial in patients with TNM stage I to III breast cancer comparing standard care with SIS.NET (System for Individualized Survivorship Care, based on patient self-reported data, with review by Nurse practitioners, targeted Education, and Triage), a follow-up protocol including integration of online health questionnaires at 3-month intervals and the evaluation of self-reported symptoms monitored and addressed remotely by a nurse practitioner (NP). The primary endpoint was to quantify the time between symptom reporting and remote evaluation of symptoms. The secondary endpoint was to compare use of health care resources (breast cancer-related visits, total medical appointments, and laboratory and imaging studies) over an 18-month period. A total of 102 participants were enrolled; 2 patients were excluded due to cancer recurrence. In the SIS.NET arm, 74% of new or changed self-reported symptoms were reviewed by a NP in <3 days. SIS.NET patients reported more new or changed symptoms compared with standard care patients (7.36 vs 3.2; P = .0045). During the 18-month trial, there were no statistically significant differences noted between the SIS.NET and standard care arms with regard to oncology-related appointments (mean, 4.2 vs 4.1 appointments), number of physician visits (mean, 10.8 vs 9.6 visits), or medical tests (mean, 5.5 vs 5 tests). Integration of online health questionnaires with remote review by a NP facilitated symptom reporting and may provide a means of convenient symptom assessment, but it did not appear to reduce health care resource use.

Back to basics: tackling the challenges to bedside teaching.

Back to basics: tackling the challenges to bedside teaching Rizwan Dewji, Abbas Dewji , Dushyanth Gnanappiragasam Imperial College School of Medicine, Imperial College London, London, UKDear EditorIn recent times, there has been a declining trend in bedside teaching as part of the medical teaching curriculum.1 It is clear that this fundamental issue presents a potential barrier to the development of both current and future generations of doctors. Agreeable explanations for the decline in bedside teaching include a more rapid patient turnover, increased reliance on technology in the diagnostic process, and the limited availability of clinician time.

Participação masculina no planejamento familiar e seus fatores intervenientes

Doi: 10.5902/217976929998 Aims: to identify the forms of male participation in the family planning process, as well as the factors involved in their participation, to comprehend the men's knowledge about the method used by the couple and to describe how the process of negotiation happens when choosing the method. Method: exploratory research with qualitative approach carried out with 16 men. We used a form and semi-structured interview as instruments for data collection, which were organized by the Discourse of the Collective Subject Method. Results: the men participated in family planning as logistical support to their partners. The responsibility on contraception was women's, due to limited time availability of partners. They knew about condoms and oral contraceptive hormones, however discussed little about trading the use of contraception. Final remarks: family planning still happens unilaterally and guided by the gender hierarchy that imposes upon women the burden of symbolic and physical responsibility of contraception.

Perception of the importance of human-animal interactions on cattle flow and worker safety on Minnesota dairy farms

Proper cattle-handling techniques (stockmanship) are important to ensure calm animals and a safe work environment for dairy workers on farm. The objectives of this study were to (1) assess Minnesota dairy herd owners’ attitudes toward stockmanship, its perceived importance for cow comfort and worker health, and the establishment of calm cattle movement; and (2) identify current resources and methods of stockmanship training on Minnesota dairy farms. A stratified-random sample of Minnesota dairy farmers were contacted via mail to participate in a 28-question survey. One hundred eight bovine dairy producers participated. Most commonly, respondents learned their cattle handling skills from family members (42.6%) and 29.9% of producers had participated in previous stockmanship training. Producers thought that the skill of the human handler was the most important factor in establishing good cattle flow. Cattle-handling techniques was the third most common topic for new-employee orientation after training in milking parlor protocols and milking parlor disinfection. Time limitations and language barrier were considered serious challenges for worker training. Work-related injuries were responsible for lost work days in the previous year in 13.3% of dairy herds and 73.3% of those injuries occurred while working with cattle. Producers perceived that cattle-related injuries were predominantly the handler’s fault: either because of not paying enough attention to the animal or due to poor cattle handling skills. Facility design was considered the least important for the occurrence of worker injuries. Although no causal inference can be made, herds that had workers who had previously participated in stockmanship training had a 810±378kg (mean ± standard error of the mean) higher rolling herd average than those that did not, even after adjusting for herd size and bulk tank somatic cell count. However, 50% of respondents were not interested in attending future stockmanship training sessions. In conclusion, cattle handling skills are considered important by Minnesota dairy producers to ensure worker safety and cow flow. Limited availability of time, language barrier, and a perceived lack of training materials were considered challenges during the training of workers on farms.

Effective mentoring of undergraduates in an immunology research laboratory (EDU1P.252)

Abstract Rapid turnover, limited time availability, steep learning curve for bench skills, need for close supervision are challenges in the effective engagement of undergraduate students in active research laboratories. We have met this challenge in our immunology research group with early recruitment of first and second year students, year-round research activity and weekly lab meetings, scaffolded transition to independent bench work, peer-to-peer mentoring, an integrated majors’ research methods course, and a “5th year internship” for a selected student to work full-time for a year after graduation. Early recruitment allows motivated students to spend up to 3-4 years in the lab. Year-round journal clubs and lab meetings support a culture of productivity and accountability. Students collaborate, as appropriate, in the entire arc of research from generating preliminary data for grants to submitting manuscripts. In the past 7 years, 30% of 40 students trained have earned co-authorship on five peer-reviewed, published manuscripts to date. A critical outcome of this approach is an authentic ownership of research problems and motivation to contribute to the broader scientific community that is rare among undergraduates. This experience prepares them to pursue their own research careers after college. Of my 26 research students who have graduated, ten (38%) are currently enrolled in PhD programs in the biomedical sciences and 12 (46%) have worked in biomedical research.

Adaptive k-space sampling design for edge-enhanced DCE-MRI using compressed sensing

The critical challenge in dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is the trade-off between spatial and temporal resolution due to the limited availability of acquisition time. To address this, it is imperative to under-sample k-space and to develop specific reconstruction techniques. Our proposed method reconstructs high-quality images from under-sampled dynamic k-space data by proposing two main improvements; i) design of an adaptive k-space sampling lattice and ii) edge-enhanced reconstruction technique. A high-resolution data set obtained before the start of the dynamic phase is utilized. The sampling pattern is designed to adapt to the nature of k-space energy distribution obtained from the static high-resolution data. For image reconstruction, the well-known compressed sensing-based total variation (TV) minimization constrained reconstruction scheme is utilized by incorporating the gradient information obtained from the static high-resolution data. The proposed method is tested on seven real dynamic time series consisting of 2 breast data sets and 5 abdomen data sets spanning 1196 images in all. For data availability of only 10%, performance improvement is seen across various quality metrics. Average improvements in Universal Image Quality Index and Structural Similarity Index Metric of up to 28% and 24% on breast data and about 17% and 9% on abdomen data, respectively, are obtained for the proposed method as against the baseline TV reconstruction with variable density random sampling pattern.

Implant dentistry education in Europe: 5 years after the Association for Dental Education in Europe consensus report

To promote consensus on implant dentistry university education in Europe, a workshop amongst university teachers and opinion leaders was organised in 2008. As a result, guidelines on both under- and postgraduate education were issued. This study aims to investigate the current status of university teaching of implant dentistry and the impact of the recommendations for teaching and assessment, 5 years after the first consensus. Finally, this report attempts to identify future directions in education within the discipline. An online survey was distributed amongst 105 academic leaders in implant education in Europe, and 52 questionnaires were returned (response rate 50%). The average amount of implant dentistry in undergraduate curricula has increased to 74 h, compared to 36 h in 2008, and the inclusion of pre-clinical and clinical education has increased. No change occurred with regard to the aimed competence levels. It was suggested that certain implant procedures including surgery should be provided by dentists after attending additional courses, whilst complex treatments will still require specialist training. The 2008 workshop guidelines have been implemented to a varying extent (25-100%) in under- and postgraduate education. Main reported implementation barriers included limited time availability in the curriculum and limited financial/material resources. Future discussions about implant dentistry in Europe should be focused towards integration in current dental curricula, approaches to overcome barriers and the relations with and role of industrial partners. Implant dentistry is increasingly integrating in undergraduate dental education. Development of the consensus guidelines in 2008 may have facilitated this process. Nevertheless, further progress is needed on all educational levels to align training of professionals to the growing treatment needs of the population.