Special Settings Research Articles

Children with autism exhibit similar longitudinal changes in core symptoms when placed in special or mainstream education settings.

Today, children with autism spectrum disorder (ASD) are placed in mainstream or special education settings somewhat arbitrarily with no clear clinical recommendations. Here, we compared changes in core ASD symptoms, as measured by the Autism Diagnostic Observation Schedule, 2nd edition (ADOS-2) clinical assessment, across ASD preschool children placed in special or mainstream education. Longitudinal changes in ADOS-2 scores did not differ significantly across settings over a 1- to 2-year period. While some children improved in core ASD symptoms, others deteriorated in both settings. This highlights the need to identify specific criteria for establishing meaningful placement recommendations.

Supporting in-Service Special Educational Needs Teachers to Stay Engaged: A Two-Step Hierarchical Linear Regression Analysis

This study aims to propose and evaluate a model for work engagement in Special Educational Needs (SEN) teachers in Greece, in order to get insights into the effect of parameters such as job satisfaction, burnout and other personal characteristics. The sample consisted of 503 female and 161 male teachers of both primary and secondary education, working in special and mainstream educational settings. Based on these data, a two-step hierarchical regression model was used to identify predictors of teachers’ work engagement. Moreover, confirmatory factor analysis indicated a good fit (TLI = 0.974 > 0.95, RMSEA = 0.043 < 0.08, CFI = 0.952 ≥ . 0.900, χ2/df = 1.3 < 2, p > 0.05 and SRMR = 0.027 < 0.08) of the first order structural model for work engagement (WE-JS-BO). The second-order structural model for the work engagement included teachers’ demographic parameters, labeled personal characteristics, which yielded a good fit (TLI = 0.978 > 0.95, RMSEA = 0.039 < 0.08, CFI = 0.964 ≥ 0.90, χ2/df = 1. 1 < 2, p >0.05 and SRMR = 0.024 < 0.08) Results are discussed for their possible applications in special education teachers’ training.

Diamond Message Set Groupcasting: From an Inner Bound for the DM Broadcast Channel to the Capacity Region of the Combination Network

Multiple groupcasting over the broadcast channel (BC) is studied in a special setting. In particular, an inner bound is obtained for the <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$K$ </tex-math></inline-formula> -receiver discrete memoryless (DM) BC for the diamond message set which consists of four groupcast messages: one desired by all receivers, one by all but two receivers, and two more desired by all but each one of those two receivers. The inner bound is based on rate-splitting and superposition coding and is given in explicit form herein as a union over coding distributions of four-dimensional polytopes. This inner bound is then shown to be the capacity for a certain class of partially ordered DM BCs with order defined via the less noisy condition. When specialized to the so- called combination network, which is a class of three-layer (two-hop) broadcast networks parameterized by <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$2^{K}{-}1$ </tex-math></inline-formula> finite-and-arbitrary-capacity noiseless links from the source node in the first layer to as many nodes of the second layer, our top-down approach from the DM BC to the combination network yields an explicit inner bound as a single polytope via the identification of a single coding distribution. This inner bound consists of inequalities which are then identified to be within the class of generalized cut-set outer bounds recently obtained by Salimi et al for broadcast networks. We hence establish the capacity region of the general <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$K$ </tex-math></inline-formula> -user combination network for the diamond message set, and do so in explicit and structured form. Such a result implies a certain strength of our inner bound for the DM BC in that it (a) produces a hitherto unknown capacity region when specialized to the combination network and (b) may capture many combinatorial aspects of the capacity region of the <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$K$ </tex-math></inline-formula> -receiver DM BC itself for the diamond message set. Moreover, we extend that inner bound by adding binning to it. As in the no-binning case, we provide the more general inner bound in explicit form.

Accessibility of Soil-transmitted Helminthiasis Control Strategies in Selected Indigenous People Communities in the Philippines

Background. Indigenous peoples (IPs) remain vulnerable to soil-transmitted helminthiasis (STH) due to limited access to sanitary toilets, clean water, quality health education, and services. The World Health Organization recommends periodic mass drug administration (MDA) of anthelminthics, health education, and improvements in water, sanitation, and hygiene (WASH) as control strategies to reduce morbidities caused by STH in target populations such as schoolage children (SAC). This paper complements the published results of the parasitological survey (prevalence and intensity of STH)conducted in selected Aeta and Ata-Manobo communities. Objectives. This study aimed to describe the accessibility of STH control strategies to respond to the needs of SAC in IP communities in Pampanga and Davao del Norte, the Philippines. It likewise intended to describe access of these IP communities to STH control strategies. Methods. Data on accessibility of and access to STH control strategies were collected using key informant interviews (KIIs) and focus group discussions (FGDs). Eleven officials and workers from the departments of health and education, local government units, and two IP leaders were interviewed on the existing STH burden in SAC, implementation of STH control strategies, particularly of MDA, health education campaigns, and improvements in WASH including good practices and challenges in program implementation. Three FGDs with parents, elementary school teachers of IP schools, and rural health midwives were conductedseparately. Guide questions focused on accessibility of and access to STH prevention and control strategies for SAC in IP communities. Informed consent to conduct and record KIIs and FGDs were obtained from participants prior to participation.Analysis of a multi-disciplinary team was based on the accessibility framework for IPs accessing indigenous primary health care services by Davy et al. (2016). Results. The characteristics of the STH control strategies and the target populations are interrelated factors thatinfluence accessibility. Challenges in the availability of the MDA program, particularly, inadequate staffing, drugshortages, and delays in delivery affect accessibility of and access to the free STH control strategies. Perceivedharm, adverse events, stigma, beliefs, and practices likewise affect access. Lack of information on the similarity of treatment through community- and schoolbased MDA programs also affected engagement of SAC. IP communities are special settings where geographic isolation, peace and order situation as well as watersupply need to be considered to help ensure access to STH control strategies, high MDA coverage, andimprovements in WASH leading to desired outcomes. Conclusions. Considering the context of IP communities and addressing the challenges in the accessibility of and access to STH control strategies are necessary to ensure successful implementation of an integrated approach in STH prevention and control strategies. Challenges in the accessibility of STH control strategies are inadequate staffing, poor inventory, and delays in the delivery of drugs, as well as poor sanitation and hygiene. Access of SAC is likewise affected by misconceptions on safety and efficacy of anthelminthics, including stigma and cultural practices. The similarity of the MDA programs based in school or community need to be disseminated. &nbsp

Translating measurement into practice: Brazilian norms for the Patient Health Questionnaire (PHQ-9) for assessing depressive symptoms.

To provide practical norms for measuring depressive symptoms using the Patient Health Questionnaire 9 (PHQ-9) in Brazil using a state-of-art psychometrics analysis. We used a large and representative Brazilian dataset from the 'Pesquisa Nacional de Saúde - 2019'(PNS-2019), which includes 90,846 Brazilian citizens. First, to assess the scale structure, we assessed the unidimensional model using Confirmatory Factor Analysis (CFA). Second, we used Item Response Theory (IRT) to characterize depressive symptoms´ distribution. Then, we linked summed- and meanbased PHQ-9 scores with the IRT-based score by using generalized additive models. Finally, we generated percentiles, T scores, and a newly developed score, called D scores (decimal scores), to describe the PHQ-9 norms for Brazilian population. CFA revealed a good fit to the unidimensional model, showing to be invariant to age and sex. IRT captured item-level information of the latent trait (reliable from 1 to 3 standard deviations above the mean). Brazilian norms were presented using summed-, T-scores, and D-scores. This is the first study to define Brazilian´s norms for the PHQ-9 among a large representative sample, using robust psychometric tools. More precise PHQ-9 scores are now available and may be widely used in primary and specialized clinical care settings.

특수체육 전공 교사의 행위 주체성(Teacher Agency) 탐색

Objectives This study explores how the teacher agency of adapted physical education teachers is expressed in their subject, and what contextual factors affect the teacher agency in various special education settings.&#x0D; Methods A qualitative case study method was used for six adapted physical education teachers working at special education sites in various regions. Educational data of research participants were collected through in-depth interviews. Data analysis was conducted inductively by harnessing Priestley et al.’s (2015) ecological perspective as a theoretical framework.&#x0D; Results Adapted physical education teachers proactively practiced physical education when they understood the context of the situation and formed their own firm belief, while endeavouring to teach their subject consistently in any environment. The manifestation of teacher agency was promoted when the belief and values of physical education formed from teachers’ previous life experience matched with any one of the cultural, structural, and social contexts. In addition, factors that facilitated the manifestation of teacher agency include the school culture that is permissive for major subjects, the support from fellow teachers and important people, and the proper physical environment for physical education classes. On the other hand, barriers to the manifestation of teacher agency were the discourse taking adapted physical education as an integrated subject and stressing individualised education for students subject to special education as opposed to school curriculum, on-site atmosphere that does not recognise adapted physical education, the absence of physical environment support, limited emphasis on their role as special teachers, and lack of reflection on their major subject. In addition, despite the agreement between the repetitive and evaluative dimensions, fear of the projective dimensions also acted as a barrier.&#x0D; Conclusions Based on the findings, this study suggested the possibility that adapted physical education teachers proactively manifest teacher agency, the need for incumbent teacher education for adapted physical education, and the atmosphere to recognise special education as a school curriculum and institutional measures to improve this.

Effectiveness of clinical decision support in controlling inappropriate red blood cell and platelet transfusions, speciality specific responses and behavioural change

BackgroundElectronic clinical decision support (CDS) within Electronic Health Records has been used to improve patient safety, including reducing unnecessary blood product transfusions. We assessed the effectiveness of CDS in controlling inappropriate red blood cell (RBC) and platelet transfusion in a large acute hospital and how speciality specific behaviours changed in response.MethodsWe used segmented linear regression of interrupted time series models to analyse the instantaneous and long term effect of introducing blood product electronic warnings to prescribers. We studied the impact on transfusions for patients in critical care (CC), haematology/oncology (HO) and elsewhere.ResultsIn non-CC or HO, there was significant and sustained decrease in the numbers of RBC transfusions after introduction of alerts. In CC the alerts reduced transfusions but this was not sustained, and in HO there was no impact on RBC transfusion. For platelet transfusions outside of CC and HO, the introduction of alerts stopped a rising trend of administration of platelets above recommended targets. In CC, alerts reduced platelet transfusions, but in HO alerts had little impact on clinician prescribing.ConclusionThe findings suggest that CDS can result in immediate change in user behaviour which is more obvious outside specialist settings of CC and HO. It is important that this is then sustained. In CC and HO, blood transfusion practices differ. CDS thus needs to take specific circumstances into account. In this case there are acceptable reasons to transfuse outside of these crude targets and CDS should take these into account.

A General Computational Approach for Counting Labeled Graphs

This paper presents a general recursive formula to estimate the number of labeled graphs as well as details to evaluate the formula for the following graph properties: number of edges (graph density), degree sequence, degree distribution, classification mixing, and degree mixing, i.e., the formula estimates the number of labeled graphs that have given values for graph properties. The proposed approach can be extended to additional graph properties (e.g., number of triangles) as well as properties of bipartite graphs. For special settings in which formulas exist from previous research, simulation studies demonstrate the validity of the proposed approach. In addition, we demonstrate how our approach can be used to quantify the level of variability in values of a graph property in the subset of graphs that hold a specified value of a different graph property (or properties) constant.

Challenging behaviour and its risk factors in children and young people in a special school setting: A four wave longitudinal study.

Longitudinal research is needed to strengthen evidence for risk factors for challenging behaviour in children with intellectual disabilities and to understand patterns of change over time. Data on challenging behaviour were collected for 225 students in one school over four annual time points and a range of potential risk correlates. Data were analysed using Generalised Estimating Equations. Prevalence of challenging behaviour, aggression and self-injury did not vary significantly over time. Stereotyped behaviours increased over the 4-year period. Challenging behaviour was associated with lower levels of adaptive skills and autism. Stereotyped behaviour increased with age. Self-injurious behaviour was less likely to be shown in children with profound intellectual disabilities over time. These findings are consistent with previous research in terms of potential risk factors identified. Implications for schools include proactive interventions for children with intellectual disabilities at high risk; especially those with autism and poorer adaptive skills.

Artificial Intelligence-Enabled End-To-End Detection and Assessment of Alzheimer's Disease Using Voice.

There is currently no simple, widely available screening method for Alzheimer's disease (AD), partly because the diagnosis of AD is complex and typically involves expensive and sometimes invasive tests not commonly available outside highly specialized clinical settings. Here, we developed an artificial intelligence (AI)-powered end-to-end system to detect AD and predict its severity directly from voice recordings. At the core of our system is the pre-trained data2vec model, the first high-performance self-supervised algorithm that works for speech, vision, and text. Our model was internally evaluated on the ADReSSo (Alzheimer's Dementia Recognition through Spontaneous Speech only) dataset containing voice recordings of subjects describing the Cookie Theft picture, and externally validated on a test dataset from DementiaBank. The AI model can detect AD with average area under the curve (AUC) of 0.846 and 0.835 on held-out and external test set, respectively. The model was well-calibrated (Hosmer-Lemeshow goodness-of-fit p-value = 0.9616). Moreover, the model can reliably predict the subject's cognitive testing score solely based on raw voice recordings. Our study demonstrates the feasibility of using the AI-powered end-to-end model for early AD diagnosis and severity prediction directly based on voice, showing its potential for screening Alzheimer's disease in a community setting.

Telemedicine in the Management of Parkinson's Disease: Achievements, Challenges, and Future Perspectives.

As the global population grows, there is an increasing demand for neurologic consultation that prompts new ways to reach more patients. Telemedicine can provide an accessible, cost-effective, and high-quality healthcare services. In this article, we highlight recent developments, achievements, and challenges regarding outcomes, clinical care, tele-education, teletreatment, teleresearch, and cybersecurity for telemedicine applied to Parkinson´s disease (PD) and other neurological conditions. A growing body of evidence supports the feasibility and effectiveness of telemedicine tools for PD and other movement disorders. Outcome variables regarding satisfaction and efficacy in clinical care and specific issues about education, research, and treatment are reviewed. Additionally, a specific legal framework for teleconsultation has been developed in some centers worldwide. Yet, the implementation of telemedicine is conditioned by the limitations inherent to remote neurological examination, the variable computer usage literacy among patients, and the availability of a reliable internet connection. At present, telemedicine can be considered an additional tool in the clinical management of PD patients. There is an increasing use of remote clinical practice regarding the management of PD and other neurological conditions. Telemedicine is a new and promising tool aimed at special settings and subpopulations.

In situ particle sampling relationships to surface and turbulent fluxes using large eddy simulations with Lagrangian particles

Abstract. Source functions for mechanically driven coarse-mode sea spray and dust aerosol particles span orders of magnitude owing to a combination of physical sensitivity in the system and large measurement uncertainty. Outside special idealized settings (such as wind tunnels), aerosol particle fluxes are largely inferred from a host of methods, including local eddy correlation, gradient methods, and dry deposition methods. In all of these methods, it is difficult to relate point measurements from towers, ships, or aircraft to a general representative flux of aerosol particles. This difficulty is from the particles' inhomogeneous distribution due to multiple spatiotemporal scales of an evolving marine environment. We hypothesize that the current representation of a point in situ measurement of sea spray or dust particles is a likely contributor to the unrealistic range of flux and concentration outcomes in the literature. This paper aims to help the interpretation of field data: we conduct a series of high-resolution, cloud-free large eddy simulations (LESs) with Lagrangian particles to better understand the temporal evolution and volumetric variability of coarse- to giant-mode marine aerosol particles and their relationship to turbulent transport. The study begins by describing the Lagrangian LES model framework and simulates flux measurements that were made using numerical analogs to field practices such as the eddy covariance method. Using these methods, turbulent flux sampling is quantified based on key features such as coherent structures within the marine atmospheric boundary layer (MABL) and aerosol particle size. We show that for an unstable atmospheric stability, the MABL exhibits large coherent eddy structures, and as a consequence, the flux measurement outcome becomes strongly tied to spatial length scales and relative sampling of crosswise and streamwise sampling. For example, through the use of ogive curves, a given sampling duration of a fixed numerical sampling instrument is found to capture 80 % of the aerosol flux given a sampling rate of zf/w∗∼ 0.2, whereas a spanwise moving instrument results in a 95 % capture. These coherent structures and other canonical features contribute to the lack of convergence to the true aerosol vertical flux at any height. As expected, sampling all of the flow features results in a statistically robust flux signal. Analysis of a neutral boundary layer configuration results in a lower predictive range due to weak or no vertical roll structures compared to the unstable boundary layer setting. Finally, we take the results of each approach and compare their surface flux variability: a baseline metric used in regional and global aerosol models.

Language gains in 4-6-year-old children with developmental language disorder and the relation with language profile, severity, multilingualism and non-verbal cognition.

Early and effective treatment for children with developmental language disorder (DLD) is important. Although a growing body of research shows the effects of interventions at the group level, clinicians observe large individual differences in language growth, and differences in outcomes across language domains. A systematic understanding of how child characteristics contribute to changes in language skills is still lacking. To assess changes in the language domains: expressive morphosyntax; receptive and expressive vocabulary; and comprehension, in children in special needs education for DLD. To explore if differences in language gains between children are related to child characteristics: language profile; severity of the disorder; being raised mono- or multilingually; and cognitive ability. We extracted data from school records of 154 children (4-6 years old) in special needs education offering a language and communication-stimulating educational environment, including speech and language therapy. Changes in language were measured by comparing the scores on standardized language tests at the beginning and the end of a school year. Next, we related language change to language profile (receptive-expressive versus expressive-only disorders), severity (initial scores), growing up mono- and multilingually, and children's reported non-verbal IQ scores. Overall, the children showed significant improvements in expressive morphosyntax, expressive vocabulary and language comprehension. Baseline scores and gains were lowest for expressive morphosyntax. Differences in language gains between children with receptive-expressive disorders and expressive-only disorders were not significant. There was more improvement in children with lower initial scores. There were no differences between mono- and multilingual children, except for expressive vocabulary. There was no evidence of a relation between non-verbal IQ scores and language growth. Children with DLD in special needs education showed gains in language performance during one school year. There was, however, little change in morphosyntactic scores, which supports previous studies concluding that poor morphosyntax is a persistent characteristic of DLD. Our results indicate that it is important to include all children with DLD in intervention: children with receptive-expressive and expressive disorders; mono- and multilingual children, and children with high, average and low non-verbal IQ scores. We did not find negative relations between these child factors and changes in language skills. What is already known on the subject Intervention studies indicate that intervention can be effective, but not for all children with DLD, and not in all language domains. Longitudinal studies on language development show stable growth patterns in children with DLD at the group level. A systematic understanding of how child characteristics contribute to changes in language skills is still lacking. What this paper adds to existing knowledge In this study, we report on the language gains of a cohort of 154 children with DLD (4-6 years old), in a special education setting for children with language disorders. Our sample includes children with receptive-expressive disorders and expressive-only disorders, and monolingual as well as multilingual children. Our results show that children's language skills improved. The co-normed tests we used revealed that the children had much lower growth in morphosyntax than in the other language domains. Language gains between children with receptive-expressive and expressive-only language disorders did not differ, children with lower initial test scores showed more improvement than children with higher initial scores, multilingual children showed more gains in expressive vocabulary than monolingual children, and there was no effect of non-verbal IQ on change in language scores. What are the potential or actual clinical implications of this work? The results suggest that catching up on language is possible for children with DLD. It is important to include all children with DLD in intervention: mono- and multilingual children; children with receptive-expressive and expressive disorders; and children with high, average and low non-verbal IQ scores. We did not find negative relations between these child factors and changes in language skills. The limited growth in morphosyntax compared with other linguistic areas warrants the attention of both practitioners and researchers, with a particular focus on the implementation of research findings in clinical practice.

Augmented Reality in Physics Education: Students with Intellectual Disabilities Inquire the Structure of Matter

Abstract Immersive technologies support educational activities and provide motivating contexts which are increasingly implemented in special education settings. Augmented Reality (AR) seems to improve the level of engagement in teaching and learning processes for all students, including students with Intellectual Disabilities (ID). However, there is a lack of research that investigates AR learning environments where students with ID can be involved in inquiry-based activities and acquire academic content linked to real situations. The purpose of this study was to implement a single-subject design and evaluate the effects of an AR system on students’ performance on the microscopic level of the structure of matter and especially the phase-states of water. A functional relationship was found between students’ correct responses during probe sessions and the AR inquiry-based intervention. In addition, a social validity assessment indicated that the AR glasses helped students with ID to acquire physics concepts, as well as inquiry skills in a vivid experience. The students also reported satisfaction from using the AR glasses. Suggestions for future research include the design of AR-based interventions for other science concepts for students with ID as well as other special educational needs.

SPECIAL EDUCATION LEADERSHIP PRACTICES IN THE RURAL SCHOOL SETTING

This study examined the best practices and insights gained that will impact future practice in the rural special education setting with the return to post-COVID instruction. Hattie (2021) highlighted the importance of reflecting on what went right and encouraged schools to discuss the evidence of success during the pandemic school year. Following the scholar-practitioner framework, two special education directors in the rural central Texas area share their experiences during the pandemic and offer insight into new practices and procedures they are implementing post-COVID. Four common themes emerged from the thematic analysis: (a) the importance of technology, (b) changes in instructional practices, (c) barriers to student success, and (d) communication structures. This article aims to guide rural special education leaders as they continue to navigate instructional and financial challenges post-pandemic.

Expectations of social workers for interprofessional practice in healthcare: qualitative insights from practicing physician, nurse, and social work professionals

ABSTRACT Expectations of the social work role within healthcare teams was explored utilizing perceptions of physicians, nurses, and social workers from a variety of healthcare settings and specialties. Thematic categories illuminated intraprofessional and interprofessional perceptions of experiences pertinent to the inclusion of social work services. Responsibilities for social work healthcare practice in specialist settings included providing assessments, counseling to address emotional and social wellbeing, assisting in coordination of systems, and management of systemic family issues. Traits expected of the social worker included expressing confidence, communication aptitude, and basic knowledge of medical terminology.

A unique case of commensalism: The beaver beetle Platypsyllus castoris (Leiodidae, Coleoptera) and its morphological adaptations.

Platypsyllus castoris is closely associated with beavers and displays a unique set of structural specializations. We document the morphology of adults with modern techniques, and interpret evolutionary changes linked with the specific life style. The small subfamily Platypsyllinae has evolved an entire suite of features correlated with a more or less close association with mammals, for instance a flattened body, a dorsal cephalic shield, flightlessness, eye reduction, and depigmentation. Within this small group, Platypsyllus displays numerous autapomorphic features, correlated with a close association with the beaver. Essential is a combination of mechanical stabilization and firm anchorage on the host, and efficient forward movement in the fur. Exo- and endoskeletal structures of the head and thorax are reinforced by vertical cuticular columns and by an array of internal ridges. The antennae are shortened and strongly modified, the mandibles distinctly reduced and flattened, unsuitable for cutting, scraping or grinding. The musculature of the mouthparts is simplified, whereas an enhanced set of prepharyngeal and pharyngeal dilators forms an efficient sucking pump. The prothoracic musculature is strongly developed. In contrast, the pterothoracic muscle system is distinctly simplified, even though leg muscles are strongly developed. Using the legs, the flattened beetles move sideways through the dense fur of the beaver, using posteriorly directed groups of setae and ctenidia to prevent being pushed backwards by the densely arranged hairs. In contrast to the anterior body, the cuticle of the abdomen is thin, and the entire tagma flexible, with thin layers of segmental muscles. The hind gut is not connected with the mid gut. The beetles probably consume liquid, possibly with emulgated minute skin debris. As the morphology of the mouthparts excludes damage to the skin of the host, the association should not be addressed as ectoparasitic but as commensalism.

Academic Writing and Publication Support Services: The Role of Librarians in Higher Learning Institutions

ABSTRACT Despite the presence of well-equipped libraries and committed librarians in higher learning institutions, the rate at which academicians produce and publish their work has slowed significantly in recent years. This is concerning since publication is important in decisions about promotion and contracts in academic and specialized settings. The purpose of this study is to investigate the role of librarians in the publishing process within academic institutions, the level of awareness among academicians regarding the research support services provided by librarians, the factors impeding academicians from actively engaging in writing and publishing, academicians' perceptions of the services offered in academic libraries, and, finally, academicians' recommended services that could improve their publication rate.

A quality improvement project (QIP) on the awareness of the revised anaphylaxis guidelines identified through simulation

Anaphylaxis is an important emergency which forms part of the adult Advanced Life Support guidelines. The guidelines for anaphylaxis have recently undergone a change in the 2021 revision, with steroids and antihistamine no longer advised for acute anaphylaxis and an adrenaline infusion included as part of the new refractory anaphylaxis algorithm [1]. Scenarios for the medical trainees run at our simulation centre identified a lack of awareness of the revised anaphylaxis guidelines among learners. A QIP was completed to improve the level of learners’ awareness and confidence of the revised anaphylaxis guidelines in conjunction with the simulation team. Online surveys were sent out to the medical registrars and internal medicine trainees regarding the revised anaphylaxis guidelines. This was followed by an email sent two weeks later with the revised guidelines highlighting key changes. The same group were subsequently re-surveyed two weeks following the intervention to identify changes in clinical practice. Concurrently, scenarios based on the revised anaphylaxis guidelines were run for the medical trainees with specific emphasis on whether trainees were aware of the need for an adrenaline infusion (managed in a specialist setting) if symptoms were ongoing despite two IM doses of adrenaline. In the post-simulation debriefing, discussion was focused on the change in the anaphylaxis guidelines. In the first cycle, 100% of 23 respondents felt confident managing anaphylaxis but only 50% of respondents were aware (and were confident) that the guidelines had been revised. 2/3 of respondents had not managed a case of anaphylaxis in the last 12 months. In the second cycle, 100% of 4 respondents were aware of the revised guidelines but only 75% of respondents were confident in following the guidelines. 75% of respondents had not managed a case of anaphylaxis in the last 12 months. The significant drop in number of responders is likely to be multifactorial but may reflect a change in focus of educational needs due to the ongoing COVID-19 pandemic leading to a change in the educational landscape. A survey done on the attitude of medical students during the COVID-19 pandemic towards online learning found that only 54.1% of respondents felt that interactive discussion could occur through e-learning [2]. Following the QI results, the cardiac arrest trolleys were checked and the emergency box with adrenaline now includes the revised anaphylaxis algorithm but not hydrocortisone and chlorphenamine. Refractory anaphylaxis is now a standard scenario for the medical trainees in our simulation centre. 1. Resuscitation Council UK. Emergency treatment of anaphylaxis: Guidelines for healthcare providers. 2021. 2. Alsoufi A, Alsuyihili A, Msherghi A, Elhadi A, Atiyah H, Ashini A, Ashwieb A, Ghula M, Ben Hasan H, Abudabuos S, Alameen H, Abokhdhir T, Anaiba M, Nagib T, Shuwayyah A, Benothman R, Arrefae G, Alkhwayildi A, Alhadi A, Zaid A, Elhadi M. Impact of the COVID-19 pandemic on medical education: Medical students’ knowledge, attitudes, and practices regarding electronic learning. PLoS One. 2020;15(11):e0242905.

DRUG UTILIZATION STUDY IN A RADIOTHERAPY UNIT OF A TERTIARY CARE TEACHING HOSPITAL IN RURAL WEST BENGAL, INDIA

Objective: Drug utilization studies lay special emphasis on the medical social and economic consequences of use of medications in special settings. This study was undertaken to identify the pattern of drugs prescribed frequently among patients attending the radiotherapy department. Methods: This is a prospective study undertaken between January 1, 2018, and December 31, 2018. Prescriptions and patient records were reviewed and analyzed using the World Health Organization (WHO) indicators for drug utilization studies. Results: We encountered a total of 618 patients during the study period. Among them, 340 (55.01%) were female. The most common age groups presenting were between 21 and 60 years. Carcinoma breast was the most common type encountered (total cases 181, 29.28%), followed by carcinoma lung (total cases 92, 14.88%), carcinoma cervix, hematological malignancies, carcinoma prostate, and carcinoma rectum. Total number of drugs prescribed was 3008 in total 618 prescriptions making it 4.86 drugs per prescription on average. Among them on average per prescription, 2.82 drugs were cytotoxic drugs (1745 total), whereas 2.04 drugs were supportive or adjunct drugs (1263 total). Among the drugs prescribed, 96.24% were in generic names, 6.95% prescriptions contained antibiotics, and 96.44% (596) prescriptions contained injections. About 85.23% of drugs were prescribed from essential drug list. Average consulting was 8.2 min and dispensing time for adjunct drugs was 4 min on average. On average, 52.42% of patients (324) had complete correct knowledge of the dosage and schedule prescribed. Adverse drug reactions were common, out of 618 patients, 542 (87.7%) experienced ADRs most common being gastrointestinal and dermatological ADRs. The most common implicated drug was cisplatin. Six serious adverse events were encountered. Conclusions: This study provides a clear picture of drug use in this special clinic in rural Bengal and paves the way for larger and long-term study.