Low Levels Of Confidence Research Articles

A survey of community pharmacy customers’ use and views of patient information leaflets for medicines in paper and electronic formats

Abstract Introduction Paper patient information leaflets (PILs) are currently required to accompany licensed medicines in the European Union. As paper PILs fail to meet the needs of many end-users,[1] their routine use at the current extent remains questionable – especially with sustainability in mind.[2] With the growing scope of electronic product information (ePI) for medicines, there is a clear need for greater end-user input to inform future paper PIL and ePI usage. Aim To explore community pharmacy customers’ (CPCs’) use and views of paper PILs, their views on ePI, and to examine whether CPCs’ characteristics influence these parameters. Methods A survey was conducted amongst a convenience sample of CPCs (aged ≥18 years) recruited from eleven Irish community pharmacies across 4 weeks in November and December 2022. Respondents were recruited via the primary researcher, pharmacy staff, or by following a quick response (QR) code on a poster in the pharmacy. Descriptive and inferential statistics (including chi-squared tests) were used to analyse the data, whereby p<0.05 meant statistically significant differences. Results There were 226 valid responses (58.7% female and 41.3% male; 29.2% using ≥5 regular prescription medicines). The mean age was 49 years, with 38% aged <45 years and 23% aged ≥65 years. Only 26.1% indicated that they ‘always’ read the paper PIL when they start on a new medicine, whilst 15% said it was difficult or very difficult to read the paper PIL. When asked about reading the paper PIL other than the first time, 24.8% reported that they never read the PIL again. Approximately three-quarters agreed it would be okay if paper PILs were only provided to them on the first time they received a medicine (74.8%). Half of respondents had used the internet to check information about their medicines (50.9%). Approximately one quarter (25.7%) reported that they had accessed the official electronic PIL online previously, whilst 61.1% did not know that the official PILs for all licensed medicines are available freely on the internet for people in Ireland. Older adults (≥65 years) reported lower levels of confidence in using the internet and were less likely to use it for obtaining medicines information (p<0.05). Compared to those in older age categories (45-64 years, ≥65 years), younger respondents (<45 years) were significantly more likely to prefer using an electronic device to read the PIL in its electronic format instead of in its current paper format (69.3% versus 29.7%, p<0.05). Conclusion This study has highlighted that greater consideration is needed for the extent of paper PIL usage for medicines in future. These findings indicate a high level of wastage that is exacerbating the medicines-related carbon footprint globally, and emphasise the need for more sustainable strategies to communicate medicines information. While this study’s sample size was small, it comprised views ranging from younger people on no regular medicines to older people with polypharmacy. There is a clear need to raise awareness on ePI availability and to focus greater attention on older people and those less technologically competent when designing ePI going forward.

Prevalence and nature of workplace bullying and harassment and associations with mental health conditions in England: a cross-sectional probability sample survey

BackgroundEvidence on workplace bullying and harassment (WBH) in the UK has not used probability-sample surveys with robust mental health assessments. This study aimed to profile the prevalence and nature of WBH in England, identify inequalities in exposure, and quantify adjusted associations with mental health.MethodsData were from the 2014 Adult Psychiatric Morbidity Survey, a cross-sectional probability-sample survey of the household population in England. Criteria for inclusion in the secondary analysis were being aged 16–70 years and in paid work in the past month (n = 3838). Common mental disorders (CMDs) were assessed using the Clinical Interview Schedule-Revised and mental wellbeing using the Warwick-Edinburgh Mental Wellbeing Scale. Analyses were weighted. We examined associations between past-year WBH and current CMD using multivariable regression modelling, adjusting for sociodemographic factors. Interaction terms tested for gender differences in associations. The study received ethical approval (ETH21220–299).ResultsOne in ten employees (10.6%, n = 444/3838) reported past-year experience of WBH, with rates higher in women (12.2%, n = 284/2189), those of mixed, multiple, and other ethnicity (21.0%, n = 15/92), and people in debt (15.2%, n = 50/281) or living in cold homes (14.6%, n = 42/234). Most commonly identified perpetrators of WBH were line managers (53.6%, n = 244/444) or colleagues (42.8%, n = 194/444). Excessive criticism (49.3%, n = 212/444), verbal abuse (42.6%, n = 187/444), and humiliation (31.4%, n = 142/444) were the most common types. WBH was associated with all indicators of poor mental health, including CMD (adjusted odds ratio [aOR] 2.65, 95% CI 2.02–3.49), and 11 of 14 mental wellbeing indicators, including lower levels of confidence (aOR 0.57, 0.46–0.72) and closeness to others (aOR 0.57, 0.46–0.72). Patterns of association between WBH and mental health were similar in men and women.ConclusionsThese findings reinforce a need for more cohesive UK legislation against WBH; guidance on recognition of bullying behaviours for employees, managers, and human resources, focusing on prevention and early intervention, and increased awareness of the impact of WBH on mental health among health service practitioners. Limitations include reliance on cross-sectional data collected before pandemic-related and other changes in workplace practices. Longitudinal data are needed to improve evidence on causality and the longevity of mental health impacts.

IMPLEMENTASI MODEL BIMBINGAN TEMAN SEBAYA UNTUK MENINGKATKAN KEPERCAYAAN DIRI (TEKNIK PROBLEM SOLVING DALAM PENENTUAN KARIR PADA SISWA KELAS XII MAS HIDAYATUL INSAN)

Self-confidence in determining one's career is something that often happens and is commonly discussed. Self-confidence is the ability to convince oneself of one's own abilities or the ability to develop positive values, either for oneself or for others. One of the teenage problems that often arise at this time is one related to career determination. Career determination is also influenced by whether or not a person's level of self-confidence is high. This study aims to look at the effect of peer relationships on self-confidence. The role of peers is to provide input in the form of instructions, reprimands, and directions. This study also aims to see the results of the application of peer guidance models to increase self-confidence using problem-solving techniques in determining student careers at MAS Hidayatul Insan Fi Ta'limiddin. This research is a combination of quantitative and qualitative (mixed methods). Qualitative data was obtained from interviews and observations, while quantitative data was obtained from questionnaires. From the results of the first questionnaire (pre-test), it can be seen that there are still many students who do not have a strong level of self-confidence and have not been able to determine their career planning. Furthermore, peer guidance is carried out in order to increase self-confidence and career determination. Based on the results (post-test) about self-confidence in determining students' careers that have been carried out, the results show that the majority have understood the guidance model that has been applied. So the results showed that based on the questionnaire that had been obtained, it was found that there was a low level of confidence in determining a career and experienced a significant increase in self-confidence after being given counseling guidance services in the form of treatment.

Sentiment Analysis - An optimized Weighted Horizontal Ensemble approach

Sentiment Analysis has gained authority as one of the primary means of analyzing feedbacks and opinion by individuals, organizations and governments. The result of sentiment analysis informs an organization on areas to improve and how best to manage customers. While sentiment analysis may be misleading as no algorithm has been considered 100% efficient, the choice of algorithms can optimize the result based on the dataset in question. This paper aims at studying various algorithms and implementing a weighted horizontal ensemble algorithm as a panacea to low confidence level in the results of sentiment analysis. We designed a system that implements the original Naive Bayes algorithm, Multinomial Naïve Bayes algorithm, Bernoulli Native Bayes algorithm, Logistic Regression algorithm, Linear Support Vector Classifier algorithm and the Stochastic Gradient Descent algorithm. Our dataset was sourced from the Stanford University. It contains fifty thousand (50,000) movie reviews. Dataset from the Nigerian movie review was used to test the models. The reviews were encoded as a sequence of word indices. An accuracy of over 91% was achieved. The Ensemble technique delivered an F1-measure of 90%. Ensemble technique provides a more reliable confidence level on sentiment analysis. The researchers also discovered that change in writing style can affect the performance of sentiment analysis

Working toward reunification in New South Wales: Professional perspectives on navigating complex systems

AbstractAchieving timely “permanency” for children after statutory child removal has become a key policy driver internationally. In New South Wales, child protection reforms include prioritising reunification; introducing time frames for resolution of legal proceedings; and outsourcing a substantial proportion of casework to the non‐government sector. In assessing the viability of reunification, courts place responsibility for behaviour change on parents and obscure the role of systems in supporting these changes. Professionals, as actors within a complex system, have an insider perspective on factors that influence reunification. A qualitative study was undertaken to elicit the perspectives of professionals working with parents involved in care proceedings. A total of 29 caseworkers and lawyers took part in focus groups. Complexity theory was used as an interpretive framework, and thematic analysis was completed. Themes about barriers to reunification exposed the unintended consequences of change in a complex adaptive system. Far from making reunification more achievable by streamlining the legal process, changes introduced impediments in the form of role, goal and process confusion and low levels of professional confidence in their capacity to help parents and achieve predictable legal outcomes. These results strengthen calls for a different approachto confront system‐induced barriers. Embedding interagency collaboration, challenging risk narratives about parents and offering them dedicated services are areas that demand urgent attention in order to ensure no child, whose safety and best interests could be met by reunification, remains in care.

A semi-supervised learning method based on pseudo-label iterative purification for intelligent fault diagnosis of rolling bearing

Bearing fault diagnosis based on semi-supervised learning shows good results in solving the scarcity of data in industrial scenarios. Pseudo-label samples can be used to expand labeled datasets, thereby to solve the shortage of training samples. However, when pseudo-labeling is employed to improve the performance of the model, the low confidence level of pseudo-labels will have a negative impact on the model. To solve this problem, the pseudo-label iterative purification method is proposed. Firstly, the graph neural network is employed to aggregate samples in order to increase the degree of dissimilarity among target domain data belonging to distinct categories. Subsequently, the pseudo-labeled samples are purified, while multiple positive-negative discriminators are trained on particular data from the source domain to accurately identify the target domain samples containing the pseudo-labels. Finally, the backbone network is fine-tuned by the purified pseudo-labeled samples. Results of experiments on the self-built bearing dataset and the Paderborn University bearing dataset validate that the method proposed in this article exhibits outstanding performance.

The Gender Publication Gap Revisited: Evidence from the International Political Science Review

ABSTRACTSince the 1990s, there has been consensus in the literature of a submission and publication gap that favors men. Important research in the intervening years has explored the many reasons for this output gap: imbalanced administrative workloads; bias in top journals against female-dominated subfields and methodological approaches; and lower confidence levels among women, sometimes known as the “Matthew effect.” However, in the intervening period, there has been a notable emphasis on recruiting more women into academia, and the importance of publishing for career development has intensified. Journal case studies have highlighted a growth in output by women academics but show that men are still overrepresented. Using a case study of the International Political Science Review (IPSR), we contribute to the emerging body of work that shows that the gender gap has diminished or even been eliminated. We present data on submissions and acceptances by gender, and we base our comparisons in the gender balance of the departments of submitting authors. The results are clear, for IPSR, the gender gap has closed and women now publish on a par with their men colleagues in their department.

Gender gap in standardized tests: What are we measuring?

Typically, in standardised tests, girls underperform boys in mathematics while boys underperform girls in reading. Can these educational inequalities be driven by specific testing practices? This study addresses this question by innovatively using data from the largest worldwide standardized test and exploiting the random variation in the format of the tests assigned to students. I find that there is a noticeable widening of the gender gap when a larger share of questions is multiple-choice, rather than filling-the-gap questions. A 10 percentage point increase in the share of multiple-choice questions inflates female under-performance in mathematics by 0.025 standard deviations and male under-performance in reading by 0.035 standard deviations. This accounts for nearly one-quarter of the overall gender disparity found in these subjects. I provide suggestive evidence that ruling out alternative options, rather than coming up with an entire answer, may contribute to cognitive information overload among students with lower confidence levels (generally girls in mathematics and boys in reading). These cognitive loads, in turn, have implications for a student's future level of effort and performance.

Supporting work participation for adults with hand and upper limb conditions: A survey of the British Association of hand therapists.

Musculoskeletal disorders affect over a third of the UK adult population and are a common reason for sick leave from work. The aims of this study were to describe the reported provision of work participation support for adults with hand and upper limb conditions by UK hand therapists, and to identify potential training needs in this area. A previous survey of the Australian Hand Therapy Association was adapted for the UK. The electronic questionnaire was distributed to members of the British Association of Hand Therapists. Eligible individuals were UK-based occupational therapists or physiotherapists whose role included the assessment and/or treatment of patients ≥18 years with hand or upper limb issues. There were 123 participants (17% response rate). The most frequently reported work participation interventions were discussing graded return to work and sign-posting patients to speak with their doctor. The Allied Health Professionals Health and Work Report and Fit Note were not regularly used, and respondents reported low levels of confidence in issuing these documents. Barriers to providing work recommendations included a perceived lack of time, skills, knowledge and training. Facilitators included the patient discussing work as a rehabilitation goal. Development opportunities for UK hand therapists include increasing patient awareness that they can ask for work-related advice and documentation, promoting existing health and work training, developing hand therapy-specific resources, and ensuring access to electronic Fit Notes. International opportunities include the continuation of this survey with a focus on generating exemplar work participation strategies to inform further research.

The impact of students’ individual differences on their communication apprehension in online classrooms: Empirical evidence from Iran

Hybrid learning is currently practiced in Iran’s Higher Education Institutions (HEIs), especially throughout the country’s business schools. Given the importance of Communication Apprehension (CA) as an inhibiting factor in student participation in online classrooms, this study aims to investigate CA in online classes among MBA students studying at the seven most prestigious Iranian business schools concerning their individual differences (the Big Five personality traits and demographic variables, namely, gender, year of study, and work experience). In this quantitative study, data was gathered through an online survey and analyzed using LISREL 8.80. The results indicate that extraversion and agreeableness negatively predict Communication Participation Avoidance (CPA) and Low Level of Communication Confidence (LCC) in an online class. While “neuroticism” predicts LCC and CPA positively and significantly, “conscientiousness” and “openness to experience” do not predict CA dimensions. The results demonstrate that the mean scores of LCC are higher for female students compared with male ones. The results of ANOVA tests also reveal that LCC is higher among first-year students. Finally, the accumulation of work experience reduces CA.

Regional anaesthesia education for consultants and specialists in the UK: a mixed-methods analysis

BackgroundRegional anaesthesia plays an important role in perioperative care, but gaps in proficiency persist among consultants and specialists. This study aimed to assess confidence levels in performing Plan A blocks among this cohort and to examine the barriers and facilitators influencing regional anaesthesia education. MethodsUtilising a mixed-methods design, we performed a quantitative survey to gauge self-reported confidence in performing Plan A blocks, coupled with qualitative interviews to explore the complexities of educational barriers and facilitators. UK consultant and specialist anaesthetists were included in the study. ResultsA total of 369 survey responses were analysed. Only 22% of survey respondents expressed confidence in performing all Plan A blocks. Specialists (odds ratio [OR] 0.391, 95% confidence interval [CI] 0.179–0.855, P=0.016) and those in their roles for >10 yr (OR 0.551, 95% CI 0.327–0.927, P = 0.024) reported lower confidence levels. A purposive sample was selected for interviews, and data saturation was reached at 31 interviews. Peer-led learning emerged as the most effective learning modality for consultants and specialists. Barriers to regional anaesthesia education included apprehensions regarding complications, self-perceived incompetence, lack of continuing professional development time, insufficient support from the multidisciplinary team, and a lack of inclusivity within the regional anaesthesia community. Organisational culture had a substantial impact, with the presence of local regional anaesthesia champions emerging as a key facilitator. ConclusionsThis study highlights persistent perceived deficiencies in regional anaesthesia skills among consultants and specialists. We identified multiple barriers and facilitators, providing insights for targeted interventions aimed at improving regional anaesthesia education in this group.

Education Research: Educating Child Neurology Residents About Psychogenic Nonepileptic Seizures

Background and Objectives Psychogenic nonepileptic seizures (PNES) are difficult to differentiate from epileptic seizures (ES) even for neurologists who see these conditions frequently. This difficulty is due to overlapping semiologic findings between the 2 diagnoses. Previous studies have shown that trainees, including neurology trainees, are not accurate in differentiating PNES from ES. Neurologists often find the communication of PNES difficult. Despite these challenges, most programs do not have formal curricula for teaching PNES, and there are no standards for residency curricula in this topic. The aim of this study was to understand the gaps in resident education on PNES. Methods This study was accomplished through a needs assessment of current pediatric neurology residents and residency program directors (PDs). Two unique surveys were distributed, 1 for child neurology trainees and 1 for PDs. Questions were designed to understand trainees' self-reported knowledge, confidence, current education received, and desired teaching. Similarly for PDs, questions were designed to assess the state of education on PNES at their programs, sufficiency of education, and their desire for standardized curriculum. Results Sixty-eight trainees and 21 PDs responded to the survey. Approximately one-quarter of trainees reported neutral to low levels of confidence and 38% reported neutral to low levels of knowledge in caring for patients with PNES. Trainees reported that directing patients with PNES to appropriate management was the most challenging aspect of care, followed by communicating the diagnosis, with 60% and 46% reporting difficulty, respectively. Only 21% of residents felt their current PNES education needs no improvement. One-fifth of PDs felt their current PNES education is not sufficient, and all reported they would incorporate a standardized curriculum. Trainees reported preferring to learn about this topic through lectures and simulation, while PDs preferred online modules and simulation. Discussion While residents and PDs report high confidence and knowledge in treating pediatric patients with PNES, respondents felt improvement is needed to their curricula regarding this topic. Multiple learning methods are preferred, with emphasis on communicating the diagnosis and management of patients once the diagnosis has been made. PDs desire a standardized curriculum and would incorporate one into their programs. Findings of this study could be used to create a national curriculum.

Enhancing Tracheostomy Care Proficiency: Evaluating the Impact of Online Interprofessional Tracheostomy Education Program

Background Evidence suggests that many clinicians lack confidence in managing tracheostomy patients effectively. This gap is further exacerbated by the influx of new healthcare providers who may have received insufficient training in tracheostomy care. Consequently, there is a pressing need to evaluate the effectiveness of training interventions to enhance clinicians’ confidence and competence in tracheostomy care. This study aims to assess the effectiveness of an interprofessional online training program in improving healthcare professionals’ confidence and proficiency in tracheostomy care. Local Problem Interprofessional healthcare providers’ have expressed lack of experience and confidence in managing tracheostomy patients. Method We used a pre-test, post-test approach, assessing self-reports of caregiver experience and confidence regarding tracheostomy care. Participants included nurses, allied health therapists, and respiratory therapists at a large urban inpatient rehabilitation hospital. Interventions An interprofessional online tracheostomy training program was developed for staff as the last step of a comprehensive quality improvement project. Results Ninety-eight (98) subjects responded to the pre-training survey, and 35 responded to the post-training survey. Prior to training, nurses reported being “very confident” in suctioning (70.9%) and stoma care (58.2%), but less so in other aspects of care. Fewer allied health therapists reported confidence in tracheostomy-related skills; however, respiratory therapists reported proficiency in most skills. Clinicians with more work experience exhibited higher levels of confidence compared to new graduates in stoma care and cleaning, emergency care, and capping and speaking valve precautions. However, 40-73% of clinicians still reported lower levels of confidence in tracheostomy-related skills. Following training, there was an increased trend of confidence in most skills, especially for nurses; however, confidence remained low in managing tracheostomy emergencies (17.6%) and identifying the differences between tracheostomy and laryngectomy (20%). Conclusions Online training may improve confidence in tracheostomy care, but critical content may necessitate multiple primary teaching methods to achieve mastery. Additional methods such as simulations, hands-on skills practice, and bedside rounds can be beneficial for material synthesis.

Very High-energy (>50 GeV) Gamma-Ray Flux Variability of Bright Fermi Blazars

Understanding the high-energy emission processes and variability patterns are two of the most challenging research problems associated with relativistic jets. In particular, the long-term (months to years) flux variability at very high energies (VHE >50 GeV) has remained an unexplored domain so far. This is possibly due to the decreased sensitivity of the Fermi Large Area Telescope (LAT) above a few GeV, hence low photon statistics, and observing constraints associated with the ground-based Cherenkov telescopes. This paper reports the results obtained from the 0.05−2 TeV Fermi-LAT data analysis of a sample of 29 blazars with the primary objective to explore their months-to-year-long very high-energy (VHE) flux variability behavior. This systematic search has led to, for the first time, the detection of significant flux variations in five blazars at the >99% confidence level, whereas eight of them exhibit variability, albeit at a lower confidence level (∼95%–99%). A comparison of the 0.05–2 TeV flux variations with that observed at 0.1–50 GeV band has revealed similar variability behavior for most of the sources. However, complex variability patterns that are not reflected contemporaneously in both energy bands were also detected, thereby providing tantalizing clues about the underlying radiative mechanisms. These results open up a new dimension to unravel the VHE emission processes operating in relativistic jets, hence sowing the seeds for their future observations with the upcoming Cherenkov Telescope Array.

The improvement and retention of skills in shoulder dystocia management with the use of high-fidelity simulation: The SAFE (SimulAtion high-FidElity) study

BackgroundShoulder dystocia is a relatively uncommon but serious childbirth-related emergency. AimTo explore the improvement and retention of skills in shoulder dystocia management through high-fidelity simulation training. MethodsThe SAFE (SimulAtion high-FidElity) study was a prospective cohort study that utilised a high-fidelity birth simulator. Registered midwives and final year midwifery students were invited to participate in a one-day workshop at 6-monthly intervals. There was a 30-minute initial assessment, a 30-minute theoretical and hands-on training, and a 30-minute post-training assessment on shoulder dystocia management. Pre-training and post-training values for the predetermined outcomes were compared. In each workshop we assessed the proportion of successful simulated births, the performance of manoeuvres to manage shoulder dystocia, the head-to-body birth time, the fetal head traction force, the quality of communication, the perception of time-to-birth, and the self-reported confidence levels. FindingsThe baseline workshop recruited 101 participants that demonstrated a significant increase in the proportion of successful simulated births (8.9% vs 93.1%), and a two-fold to three-fold increase in the score of manoeuvres, communication, and confidence after training. Those with low pre-training levels of competency and confidence improved the most post-training at baseline. There was a retention of manoeuvres, communication skills and confidence at 6 months. There was no reduction in fetal head traction force over time. Those being proficient before initial training retained and performed best at the 6-month follow-up. ConclusionThe SAFE study found a significant improvement in skills and confidence after the initial high-fidelity simulation training that were retained after 6 months.

Game on! Enhancing primary physical education through a Rosenshine-inspired approach

ABSTRACT Since Bunker and Thorpe (1982. A model for the teaching of games in secondary schools. Bulletin of Physical Education, 18(1), 5–8.) introduced Teaching Games for Understanding (TGfU), there has been a growing recognition of advocating approaches to pedagogy that addresses participant learning with games-based approaches (GBA) advocated. With little guidance of how to apply these approaches in practice, more support is needed for practitioners (Vinson, D., & Parker, A. (2019). Vygotsky and sports coaching: Non-linear practice in youth and adult settings. Curriculum Studies in Health and Physical Education, 10(1), 91–106. https://doi.org/10.1080/25742981.2018.1555003). This is pertinent in primary where teachers are challenged with teaching a variety of subjects and can struggle to adapt their good classroom practice to Physical Education (PE) (Morgan, K., Bryant, A., Edwards, L., & Mitchell-Williams, E. (2019). Transferring primary generalists' positive classroom pedagogy to the physical education setting: A collaborative PE-CPD process. Physical Education and Sport Pedagogy, 24(1), 43–58. https://doi.org/10.1080/17408989.2018.1533543). A criticism has been teachers lack of training and low confidence levels in being able to deliver high quality PE (Clohessy, L., Bowles, R., & Chroinin, D. N. (2020). Playing to our strengths: Generalist teachers' experiences of class swapping for primary physical education. European Physical Education Review, 26(2), 571–586. https://doi.org/10.1177/1356336X19877195). It is imperative that primary practitioners are given more support in applying PE specific pedagogies. Rosenshine's (2012. Principles of instruction - research-based strategies that all teachers should know. American Educator, 36(1), 12–39.) principles of instruction has gained traction in recent years to inform elements of Initial Teacher Training. It provides guidance on effective teaching; however, the examples are classroom focused, limiting application in PE. This paper explores Rosenshine's principles, provides suggestions of employing GBA, before presenting a conclusion that summarises the paper and provides suggestions for future exploration. The intention is to support trained and trainee primary teachers in developing their PE pedagogy.

Introduction to Tobacco Cessation and Motivational Interviewing: Evaluation of a Lecture and Case-Based Learning Activity for Medical Students.

Introduction Despite the fact that tobacco use continues to have significant public health impacts, most healthcare providers are notadequately trained to counsel patients on their tobacco use or to provide cessation resources. Although all healthcare providers have a role in providing tobacco cessation assistance, physicians and advanced practice providers are generally the only practitioners able to furnish tobacco cessation medications and bill insurance for their cessation services. Therefore, ensuring these practitioners are properly trained to offer tobacco cessation to their patients is critical to addressing this public health threat. In line with this goal, this study outlines the curriculum evaluation for an innovative student-facilitated tobacco cessation activity for medical students. Methods A lecture and case-based learning activity was created and piloted with a class of first-year medical students. The activity was facilitated by fourth-year medical students. Students took a pre-session survey to establish baseline experience and beliefs and a post-session survey to ascertain their confidence in applying what was covered in the session. Descriptive statistics were utilized to analyze the data. Results One hundred and twenty-eight students completed both surveys. Prior to the activity, students reported low levels of confidence in their ability to counsel patients and knowledge of cessation resources. Following the activity, more than 90% reported improvement in their ability to assess a patient's willingness to quit and counsel those ready to quit. Greater than 80% reported an improvement in their ability to counsel patients not ready to quit and to establish a quit plan. More than 90% of students reported that the session increased their self-efficacy in helping patients quit and that it was worth their time, with 96% committing to increasing their tobacco cessation efforts with their patients. Discussion Students valued the training and almost all reported that it increased their ability to help patients quit smoking. The use of student-facilitated case-based learning provided both an opportunity for students to practice cessation techniques and a low-stakes introduction to the OSCE format without the need for extensive faculty resources. Although this session was run with first-year medical students, the curriculum presented can be used for residents, nurses, and other healthcare professionals.

Asymptotic feature pyramid based YOLOv5s for birds detection

The detection of all sorts of birds has become increasingly important in the fields of ecological balance and biological protection. To tackle the problems of low accuracy, high omission rate and low detection confidence levels in the application of artificial intelligence and deep learning in bird detection, this paper proposes a bird detection method that leverages the YOLOv5s model and incorporates the asymptotic feature pyramid network module (AFPN). Diverging from the conventional pyramid network module (FPN), AFPN offers a more efficient solution, characterized by reduced computation time and memory consumption. It also minimizes conflicts that may arise during feature training. To further enhance the model’s performance and efficiency, the project introduces an object detection regression loss function along with several distinct loss functions. These functions are employed to train and analyze a standardized dataset, enabling the identification of an optimal solution. Through rigorous model construction, training, and repeated testing, notable improvements have been achieved in the accuracy rate and other relevant indicators, meeting the necessary application standards. This refined method exhibits great potential for fulfilling diverse bird detection requirements.

A randomised controlled trial of the effectiveness of parent-based models of language intervention for 2- to 3-year-old children with speech, language and communication needs (SLCN) in areas of social disadvantage.

Early language delay is exacerbated by social disadvantage. Factors such as parents' low levels of literacy, confidence and self-perception can affect the capacity to act on advice received, critical to empowerment. Methods used to achieve successful health outcomes in socially disadvantaged clinical populations may need enhancing. To compare the impact of standard parent-based intervention (PBI) to enhanced PBI for young children with speech, language and communication needs (SCLN) and their families living in more socially disadvantaged populations. A multicentre clustered blind randomised controlled trial was used to compare the effect of parent-based group interventions to improve early language development with children (mean age 27.5 months) from more socially disadvantaged populations with an expressive vocabulary of 40 or less single words. Intervention sessions were delivered by a speech and language therapist, over a 20-week period. Participants received one of two interventions: (1) Standard Care - indirect group PBI - (PBI) (2) Enhanced Care: indirect group enhanced PBI - (EPBI). Both standardised and non-standardised measures were used as outcomes. Parent engagement in the intervention was captured through analysis of attendance and the Parent Activation Measure - Speech & Language Therapy (PAM-SLT) (Insignia Health, 2014). The PAM measures a person's knowledge, skills and confidence to manage their own health and well-being (NHS England, 2018). In this study, activation referred to parents' knowledge, skills and confidence to manage their child's language development. One hundred fifty-five participants were randomised at baseline. Children in both groups made significant improvements in the outcome on MacArthur-Bates Communicative Development Inventories Sentence Length, from pre-intervention to post-intervention and 6 months post-intervention (p < 0.05). Changes in vocabulary and expressive language skills were more equivocal, showing wide variation in confidence intervals for both groups. Where parents attended at least one intervention session almost all effect sizes were in favour of the EPBI intervention. Parents' activation levels significantly increased for both groups (EPBI p < 0.001, PBI p = 0.003), with a moderate effect size in favour of EPBI (Hedges' G 0.37, confidence interval -0.02 to 0.76), although wide variation was found. This trial provides some evidence of facilitating the language development of children with SLCN from more socially disadvantaged areas through supporting caregivers. However, we found variation in outcomes; some children made excellent progress, whilst others did not. Further exploration of parent engagement and its relationship to child language outcomes will be valuable to understanding more about mechanisms of change in interventions that involve parents. What is already known on the subject Speech, language and communication needs (SLCN) have a knock-on effect on emotional well-being, school readiness, literacy and school attainment, putting children at increased risk of long-term consequences such as poor literacy, mental health problems and unemployment. In disadvantaged areas, the prevalence of language difficulties is higher than elsewhere. Factors such as parents' low levels of literacy, confidence and self-perception can affect the capacity to act on advice received, critical to empowerment. What this paper adds to existing knowledge Children with SLCN from more socially disadvantaged areas can make improvements in their language development through parent intervention, although wide individual variation was found. There was some evidence that children achieve better outcomes with EPBI, which employed an interagency collaborative approach. Parent's engagement (activation levels) increased significantly over time with intervention, with the increase twice as big for EPBI. What are the potential or actual clinical implications of this work? This trial provides some evidence that it is possible to facilitate the language development of children from more socially disadvantaged areas through supporting their caregivers. Further research would be useful to determine whether increases in parent engagement are related to adherence to intervention and change in child outcomes.

Evaluating the impact of training on therapeutic radiographer awareness of the signs and symptoms of neutropenic sepsis in patients undergoing concurrent chemoradiotherapy

IntroductionNeutropenic sepsis is a life-threatening combination of neutropenia and infection. Patients undergoing concurrent chemoradiotherapy are at a high risk of neutropenic sepsis and thus are likely to present in a clinical setting. This study aimed to evaluate levels of Therapeutic Radiographers' understanding of sepsis signs and response pathways along with the impact of a training session on this. MethodsA teaching session at the trust was conducted by the Sepsis Lead Nurse and utilised a range of active learning techniques including scenario-based questions and a sepsis game. Pre and post-training questionnaires were completed by participants which comprised of multiple-choice questions related to sepsis identification and response. Respondents were asked to rate their confidence in each answer. This enabled scoring to award penalties for higher levels of confidence in incorrect answers and reward high confidence in correct answers. Lower levels of confidence attracted or lost smaller marks. ResultsThere was a statistically significant (p < 0.0002) improvement in questionnaire scores after the training session from 42% to 66%. Lower scores on the pre-test responses mainly related to incorrect selection of responses to scenario questions. ConclusionThis service evaluation has highlighted a lack of sepsis awareness amongst Therapeutic Radiographers. It also demonstrates that an active learning based training session can significantly improve understanding of sepsis. Implications for practiceSepsis training utilising scenario and response questions should be provided to Therapeutic Radiographers more frequently who are likely to work with patients undergoing concurrent chemoradiotherapy.