bluuebunny/crossref_metadata_2025 huggingface dataset:
Local Path Planning via Improved Fuzzy and Q(λ)-learning Algorithms for the Mobile Robot
Authors: Li Song Li Song , Li Song Da-Zi Li
Published: October 2023

With the complexity of the robot operating environment increases, there becoming higher demands on the optimal path planning for robots. Most of the path planning is performed in known environments and static models. However, there are still challenges for robots to perform path planning in complex unknown or dynamic environments, which will suffer from deadlock problems and obstacle avoidance failures. Reinforcement learning (RL) can help fuzzy algorithm to optimize the strategy. However, the difficulty of designing the rewards in RL makes the algorithm require a large number of samples to learn the strategy, resulting in computational complexity. To solve these problems, a new local path planning based on the improved fuzzy and Q(λ)-learning algorithms is proposed, aiming to plan the shortest path and avoid obstacles. For solving the problems of breaking through and avoiding obstacles, a fuzzy controller is designed. The distance of nearest obstacle in front of the mobile robot and the distance between the obstacles in the two breakout directions are regarded as the two inputs for this controller. And the two fuzzy quantities of the mobile robot’s running angle and the safe step length are outputted. In the path planning, the Q(λ)-learning algorithm are used to optimize the weights of the running angle and the safe step, obtaining a more accurate robot position and speeding up path planning efficiency. Furthermore, to solve the overlap problems among the starting point, end point, and obstacles, a safer running environment is designed considering radiuses of these objects. Besides, the mobile robot breakout scheme and sustainable obstacle avoidance scheme are designed to solve the deadlock problem and “large obstacle” avoidance problem, respectively. Simulation results in the sparse and complex operating environment show that our proposed algorithm can plan a relatively optimal and safe path, improving the success rate of path planning.

 
KÜRESELLEŞME, YENİ SAĞ VE NEOLİBERALİZMİN MUHAFAZAKÂR DÜŞÜNCEYE ETKİSİ
Authors: IŞIK Muhittin
Published: October 2023

Bu çalışma, 1980 sonrası dönemde küresel ölçekte yaşanan başlıca gelişmelerin muhafazakâr düşüne etkisini irdelemeyi amaçlamaktadır. Başka bir anlatımla, bu makalede dünya düzleminde etkisini gösteren küreselleşme, neoliberalizm ve yeni sağ düşüncesinin muhafazakâr değerler içerisinde yer alan gelenek, din, aile, toplum vb. unsurlara etkisi ele alınmıştır. Söz konusu muhafazakâr değerler küreselleşme, neoliberalizm ve yeni sağın etkisiyle değişim ve dönüşüme uğramışlardır. Muhafazakârlığı konu edinen çalışmalar incelendiğinde 1980 sonrasında yaşanan gelişmelerin muhafazakâr düşünüşe etkisini konu edinen akademik çalışmaların sayısının yok denilebilecek düzeyde olduğu müşahede edilmektedir. Bu çalışma, literatürdeki söz konusu boşluğu önemli ölçüde giderme iddiasındadır. Çalışmada öncelikle muhafazakârlığın kavramsal çerçevesi sunulmuş, sonrasında ise küreselleşme, yeni sağ ve neoliberalizmin muhafazakâr düşüncenin gelişmesindeki önemi ve etkisi müstakil başlıklar altında analiz edilmiştir.
Deep Learning for Precise Robot Position Prediction in Logistics
Authors: Che Chang , Liu Bo , Li Shulin , Huang Jiaxin , Hu Hao
Published: October 2023

This study presents an interdisciplinary investigation at the nexus of mechanical engineering and computer science, aimed at advancing the field of logistics automation. In response to the escalating demands of global cargo transportation, the integration of these disciplines assumes paramount importance. Conducted within the domain of Dortmund University of Technology’s Material Flow and Warehousing Chair, this research focuses on the precise control of robots, a task contingent on accurate positional information. Leveraging a controlled internal logistics precinct, the study delves into the transformation of raw sensor data, comprising accelerometers, gyroscopes, and magnetometers, into precise position predictions. This process entails meticulous data preprocessing, encompassing synchronization and calibration procedures, yielding crucial parameters such as absolute velocity and accelerations along both parallel and perpendicular axes. The study employs deep learning, specifically a 2D Convolutional Neural Network (2D-CNN), for predictive modeling. This architecture excels in extracting intricate spatial features from sensor data. Training is conducted under the guidance of an Asymmetric Gaussian loss function, custom-tailored to accommodate the idiosyn- crasies of real-world sensor data. The results evince the efficacy of this approach, evidenced by remarkably low mean squared errors in predicting robot positions. Beyond its immediate applications in logistics automation, this research underscores the potential of interdisciplinary collaboration in addressing complex sensor data challenges.
Analysis on the Application of Communicative Language Teaching in Senior High School English Class
Authors: Zhang Shuai
Published: October 2023

Communicative Language Teaching method is one of the main teaching methods in foreign language teaching. According to CLT, the foreign language classroom should be a place which is full of communication, and the final destination of English learning is communication. Compared with traditional teaching methods, communicative teaching method has its unique charm and characteristics. English is a language. The purpose of English teaching is to let students learn to communicate in English. As language becomes a means of communication, the acquisition of foreign language knowledge and communicative competence depends on specific communicative activities such as listening, speaking, reading and writing. The English syllabus also clearly requires that English teaching should cultivate students' communicative competence. However, looking at the current situation of English Teaching in China, it can be found that the vast majority of students' ability to communicate in English is relatively weak. In order to improve students' ability to communicate in English, communicative teaching method has been paid more and more attention by teachers. However, it is undeniable that everything has two sides. There are also many deficiencies in the implementation of communicative teaching method, which need us to further explore. Therefore, this thesis focuses on the evaluation and analysis of the application of Communicative Language Teaching of teaching practice.
What is said by what is not said: teaching perspective on violence in everyday school life and its marks
Authors: Coelho Carolina Goulart , Santos Roberto Ferreira dos , Copolillo Martha Lenora , Osborne Renata
Published: October 2023

The objective of this article is to present paths taken in research on violence at school, carried out in a public school. We developed a narrative review of the literature and semi-structured conversations/interviews with teachers from this school. We follow an evidentiary paradigm, which leads to individualized analyses, where each detail must have its place of visibility, because as an indication, it can leave the margins and assume the center of the discourses. The narratives are linked to the subjects' stories and there are signs that cannot be told with words, but with gestures, deep breaths, pauses, and eyes filled with tears. These “said by the unsaid”, an essential part of the results, suggest that experiencing situations of violence generates impacts that affect the emotional state of victims and can evolve into serious cases of depression. Although, when talking about school violence, what first comes to mind are physical attacks between students and between students and teachers, the data obtained shows that other forms of violence are more common at school and that they generate traumas and scars that are so profound that have repercussions on the lives of victims beyond the school walls.
Reduction in setup time for the POLO part on the MAUSA B CNC machine
Authors: Menecucci Diego Aloísio de Freitas , Florido Wesley Gustavo , Amaral Fabiano Resende do , Richetto Kátia Celina da Silva , Richetto Marco Rogério da Silva
Published: October 2023

With the increasing demand for industries to enhance production at reduced costs while minimizing lead time, adopting efficient tools and techniques to optimize the manufacturing process has become crucial. The primary objective of this study was to boost productivity and simplify the entire setup process for the Polo component on a MAUSA B CNC machine by introducing the SMED (Single Minute Exchange of Die) approach, which aims to minimize machine and tool setup duration. The process in question has a lengthy manufacturing cycle, necessitating the implementation of sophisticated approaches to achieve substantial outcomes in reducing the cycle. Additionally, the process requires well-structured planning, which differs from serial processes where minor solutions can yield significant benefits in terms of cost and production cycle reduction. This article outlines the solutions and enhancements utilized in the process.
Impact of photobiomodulation therapy in patients with diagnosis of head and neck câncer under antineoplasic treatment
Authors: Franzon Chini Camila , Santos de Melo Nilce
Published: October 2023

Assess the regimens of photobiomodulation therapy in clinical signal e symptoms of oral mucositis in patients with head and neck carcer during antineoplastic treatment. A retrospective search of medical records was carried out between the years 2016 to 2019 with patients diagnosed with head and neck cancer under prophylactic regimen with photobiomodulation therapy. Were collected demographic data, risk factors, oral condition, number of photobiomodulation therapy sessions, degree of mucositis, medical-hospital information. No statistically significant relationship was found between prophylactic photobiomodulation therapy and oral mucositis. But patients who used both prophylactic and therapeutic regimens were less chance to have severe lesions of oral mucositis. And the patients who underwent chemotherapy were more likely to have severe lesions. The absence of a statistically significant association between the prophylactic regimen of photobiomodulatation therapy contradicts the clinical evidence. But the overlap between the two regimens, therapeutic and prophylactic, treated severe mucositis and is in accordance with the literature. Future research to resolve this contradiction must be designed in a prospective models.
Teacher training courses at the Federal Institute of Education, Science, and Technology of São Paulo (IFSP): dropout rates
Authors: Faustino-Ferber Ana Paula , Martins Angela Maria
Published: October 2023

The objective of the study is to discuss dropout rates from the teacher training course at the Federal Institute of Education, Science and Technology of São Paulo (IFSP), a free public education institution maintained by the federal government, which offers technical courses at higher level. The data and analysis were obtained from the Nilo Peçanha Platform (PNP) from 2017 to 2021. The methodology is exploratory and quantitative research. As result, there was a reduction in the dropout rate during this period, possibly due to institutional actions and student assistance offered during the period, including the Covid-19 pandemic period.
Financial Technology, Transaction Efficiency and Financial Satisfaction: The Mediating Role of Financial Achievement
Authors: Al Syahrani Ariel Lisna , Sujianto Agus Eko , Latifah Nur Aini , Sulaiman Sulaiman Hasan
Published: October 2023

Financial technology has emerged as a powerful platform for financial activities and transactions. This study aims to investigate the role of financial technology in explaining financial satisfaction and transaction efficiency. This research also highlights the mediating role of financial achievement in its relation to financial technology, transaction efficiency, and financial satisfaction. This study adopted a quantitative study undergoing a path analysis. The research sample was approximately 250 students, which was determined purposively at the Islamic Economics Department of IAIN Tulungagung. The underlying rationale is that the course provided in the department focused on the micro and macroeconomics and the financial industry today. The findings of this study indicate that financial technology plays a crucial role in affecting transaction efficiency, financial achievement, and financial satisfaction. The study also confirms the act of financial achievement in mediating the relationship between financial technology and financial satisfaction as well as financial technology and transaction efficiency.
O significado prático de termos modais na filosofia moral kantiana
Authors: Beckenkamp Joãosinho
Published: October 2023

Na esteira de Leibniz e da escola wolffiana, Kant seguidamente emprega termos modais como "possível" e "possibilidade" num sentido prático ou moral (quer dizer, no sentido de "lícito" ou "permitido"). Como este significado prático dos termos cumpre uma função decisiva nos argumentos que Kant desenvolve em seusÂ Princípios metafísicos da doutrina do direito, cabe explicitá-lo antes de se aventurar numa interpretação de sua doutrina do direito. No intuito de mostrar que uma semântica prática de termos modais está em uso pelo menos desde Leibniz, retoma-se sua ideia seminal e aponta-se introdutoriamente para seu desenvolvimento na lógica deôntica contemporânea. O objetivo principal deste artigo é tornar disponível a semântica envolvida para uma posterior análise dos argumentos desenvolvidos por Kant em sua doutrina do direito, em particular de sua dedução do direito de propriedade.
Representações sensíveis e apercepção originária
Authors: Altmann Silvia
Published: October 2023

Embora seja bastante claro que Kant atribua a animais não-racionais algo pelo menos bastante próximo do que em nós chamamos de representação, bem como uma faculdade da sensibilidade, ele lhes nega entendimento e cognição ou conhecimento. Mais relevante, contudo, é observar que Kant nega aos animais não-racionais a possibilidade de cognição porque, segundo ele, eles não têm capacidade de consciência. Meu propósito nesse texto é examinar algumas observações kantianas sobre capacidades cognitivas visando a explicar por que mesmo nossa faculdade dos sentidos pode ser dita especificamente humana em função da relação dos sentidos com a apercepção, em particular, em razão da relação entre percepção e unidade originariamente sintética da apercepção.
Note sur deux moments de la finalité de la nature chez Kant
Authors: Figueiredo Vinicius Berlendis de
Published: October 2023

En dépit de ce qu'affirme Kant dans la dernière partie de l'"Introduction à la Logique transdendantale" de la Critique de la raison pure (KrV A 62-64/ B 87/88), la Dialectique Transcendantale investit les idées de la métaphysique spéciale d'une valeur positive, bien que non constitutive, concernant la connaissance empirique. Sans ces idées, il n'y a pas d'unité systématique possible de la nature et donc pas de connaissance empirique. De son coté, la Critique du Jugement (1790) à la fois rejette et approfondit cette solution. En radicalisant son cí´té critico-idéaliste, Kant redéfinit le statut du travail de la pensée sur les données, ce qui aboutit à un nouveau modí'le, "horizontal", de la réflexion.
Exploring the Cultural and Social Dimensions of School Uniform Policies and Their Effects on Student Conduct in Secondary Schools in the United Kingdom
Authors:   School of Education, University of Edinburgh, Fuller Dylan M.
Published: October 2023

The study investigated the cultural and social dimensions of school uniform policies and their effects on student conduct in secondary schools in the United Kingdom. Motivated by the growing debate around the necessity and impact of school uniforms, the study sought to provide empirical evidence to inform policy decisions. A mixed-methods approach was used, combining qualitative interviews with educational professionals and parents, along with a quantitative survey administered to 500 students from five different secondary schools. Interviews focused on the perceptions of school uniforms within the context of culture and social norms, while the survey aimed to quantify the impact of uniforms on student behavior, such as attendance rates, incidences of bullying, and academic performance. The results revealed that 60% of students believed that wearing a uniform reduced instances of bullying, while 55% reported increased focus on academics. Attendance rates improved by 8% in schools with a uniform policy compared to those without. However, 40% of students indicated feeling a loss of personal expression and 25% of parents expressed concerns about the financial burden of purchasing uniforms. In conclusion, the study found that school uniform policies have a largely positive impact on student conduct, reducing bullying and improving attendance. However, issues around personal expression and financial burden cannot be overlooked. The study recommends that the schools should implement a subsidized program for low-income families to alleviate financial stress, and introducing free dress days to allow for personal expression. Furthermore, schools should involve parents, teachers, and students in discussions about any changes to uniform policies to ensure that multiple perspectives are considered. Keywords: School uniform policies, student conduct, secondary schools, cultural dimensions, social dimensions
Aprendizaje solidario y liderazgo docente: desafíos al desarrollo profesional
Authors: Bello Domínguez Manuel
Published: October 2023

En este artículo se abordan temas relacionados con la enseñanza, el aprendizaje escolar y el desarrollo profesional de los docentes. En este marco, se destacan algunos conceptos y propuestas relacionados con los desafíos éticos y políticos de la educación actual tales como: la inclusión, la equidad, la cohesión social y la formación de ciudadanos críticos y autónomos. Se propone y discute el concepto de aprendizaje solidario como tarea colaborativa de sujetos colectivos en aulas y escuelas; como condición para hacer realidad la inclusión educativa y el bien común.
Layout ergonômico e eficiente para o setor de injeção de uma indústria de artefatos plásticos
Authors: Rodrigues Evelyn Magalhães , De Souza Giselen , Gonçalves Rafael Rodrigo , Do Vale Rosilda do Rocio , Da Silva Tailaine Pereira
Published: October 2023

O presente estudo é uma pesquisa de campo e tem como principal objetivo apresentar uma proposta para implantação de um layout ergonômico eficiente para o setor de injeção de uma empresa de fabricação de artefatos de material plástico para usos industriais. No desenvolvimento da pesquisa foram utilizadas das metodologias pesquisa de campo, observação não participativa, pesquisa bibliográfica, pesquisa de internet, entrevista informal e brainstorming, além do diagrama de Ishikawa para categorização das causas. Por meio do da observação não participativa e do brainstorming realizado entre os autores foram identificadas nove causas que estão contribuindo para a ocorrência do problema em estudo, com a utilização do gráfico de Pareto foram priorizadas as quatro causas que mais impactam no problema, sendo o espaço de trabalho desorganizado, o excesso de objetos nas bancadas, a ausência de ajuste de altura nas bancadas e a perda de tempo de deslocamento das peças finalizadas até os racks. Para o plano de ação foi utilizado o 5W2H e foram sugeridas como solução que: sejam retiradas as caixas ou objetos que estão espalhados embaixo ou nos arredores das bancadas e sejam realocadas nos locais corretos, aplicar um 5S nas bancadas juntamente com a colocação de painéis para ferramentas, alterar o layout dos racks para reduzir o deslocamento do operador e alterar as bancadas por modelos de mesas flutuantes. A implementação das ações propostas poderá agregar melhorias como a redução de 15% no desperdício de tempo com movimentação no setor, melhorar o desempenho dos colaboradores em até 40% e diminuir em 20% os riscos de acidentes ocupacionais, contribuindo para o bem-estar dos colaboradores e maior eficiência no processo produtivo.
IINCIDENCE OF POST-OPERATIVE NAUSEA AND VOMITING IN LAPAROSCOPIC CHOLECYSTECTOMY WITH A SINGLE DOSE OF PREOPERATIVE DEXAMETHASONE
Authors: NAEEMI MF
Published: October 2023

and vomiting (PONV). Dexamethasone, a synthetic glucocorticoid with potent anti-inflammatory, immune-modulating, analgesic, and anti-emetic effects, effectively reduces the incidence of PONV after laparoscopic cholecystectomy. In this double-blind, placebo-controlled study, we aimed to investigate the efficacy of a single 8 mg dose of dexamethasone in preventing PONV in patients undergoing laparoscopic cholecystectomy. Sixty patients were randomized into two groups: group A, who received an 8 mg dexamethasone injection in a 2-ml preparation, and group B, who received normal saline during induction. Both groups received standardized anesthesia. Post-operatively, the incidence of nausea and vomiting was observed in both groups. Our study's findings indicate that no substantial variances were observed between the two cohorts in terms of medical or demographic factors. However, a lower proportion of patients in group A exhibited post-operative nausea and vomiting (PONV), while group B had a higher demand for anti-emetic medications to alleviate PONV symptoms. Thus, we can infer that administering a solitary dose of dexamethasone before laparoscopic cholecystectomy can reduce the risk of post-operative complications in patients.
ASSESSMENT OF TIME MANAGEMENT SKILLS AMONG NURSES WORKING IN THE EMERGENCY DEPARTMENT
Authors: PERVEEN R , ASHIQ A , FAROOQ Z , PARVEEN I , MUNIR S , SEHAR S , NAEEM M
Published: October 2023

Nursing is a noble profession; time management is paramount to ensure the best patient care, effective management, quality education, and personal responsibilities. This study aimed to assess the time management skills of nurses working in the emergency department. A quantitative cross-sectional descriptive study design was used to assess the time management skills of nurses in the emergency department. The study was conducted at Lahore General Hospital (LGH) and Sir Ganga Ram Hospital Lahore, using purposive sampling techniques. Nurses aged over 25, working in emergency departments, having clinical experience of 3-5 years, and being registered by the Pakistan Nursing Council were included. Non-cooperative nurses and those working in departments other than emergencies were excluded. Data was collected through questionnaires that had two parts. Part I included biographic data, and Part II comprised 15 questions about time management skills. The results showed that over 50% of the nurses working in the emergency department, considered a hectic hospital unit, possessed time management skills. These skills included confidence, competence, prioritizing tasks, command and control, planning tasks or daily activities, learning from mistakes, feeling confident and competent, and writing appointments, following schedules, and rewarding themselves for their good job. The study concluded that most nurses working in the emergency department possess time management skills necessary for effective patient care. It is recommended that hospitals should provide training and resources to enhance these skills and that further research should be conducted to explore other factors that may affect time management in this setting. Overall, improving time management skills can lead to better patient outcomes, increased job satisfaction, and reduced stress for nursing staff.
Evaluation of Bacillus amyloliquefaciens as a biocontrol agent against oak decline disease in Quercus trees
Authors: GÓMEZ-GARAY Aranzazu , MANZANERA José A. , Del CAMPO Raquel , PINTOS Beatriz
Published: October 2023

Aim of study: This study aimed to investigate the biocontrol potential of Bacillus amyloliquefaciens against Phytophthora cinnamomi infection in Quercus suber (cork oak). Both in vitro and in planta experiments were conducted to assess the effectiveness of B. amyloliquefaciens as a biocontrol agent.
Area of study: The microorganism strains, B. amyloliquefaciens and P. cinnamomi, as well as the embryogenic lines of Q. suber used, have a Spanish origin.
Material and methods: In vitro experiments involved evaluating the inhibitory effects of B. amyloliquefaciens on P. cinnamomi growth through dual-inoculated agar plates. In planta, dual inoculation tests were performed by co-inoculating plantlets with both P. cinnamomi and B. amyloliquefaciens. Physiological parameters, such as photosynthetic activity, chlorophyll content, and oxidative stress markers, were measured. All experiments were conducted under controlled conditions.
Main results: In vitro experiments revealed the inhibitory effects of B. amyloliquefaciens on P. cinnamomi growth. Infected plantlets displayed symptoms of root infection. Dual inoculation tests resulted in plant survival against P. cinnamomi infection. Analysis of physiological parameters indicated variations among treatments and clones, highlighting the distinct response of Q. suber plantlets to the pathogen and underscoring the importance of genetic variability for disease management.
Research highlights: This study provides insights into the potential of a strain of B. amyloliquefaciens as a biocontrol agent against P. cinnamomi infection in cork oak. Further investigations are warranted to elucidate the underlying mechanisms of susceptibility and resistance in different clones of Q. suber.
ARCHITECTONIC REGIONALISME DALAM ARSITEKTUR OSING
Authors: Dharmatanna Stephanus Wirawan
Published: October 2023

Architectonic regionalism is an approach that seeks to incorporate regional identity into contemporary architecture. This study focuses on the application of architectonic regionalism in Osing architecture, a traditional architecture style found in the Banyuwangi region of East Java, Indonesia. Using a qualitative research method with a descriptive approach, the study analyzes three case studies of modern buildings - Hotel Sahid Osing, Blimbingsari Airport, and Polytechnic Banyuwangi Hall - that showcase reinterpretation, modification, and innovation of local architectural elements. The study finds that the architectonic regionalism approach in Osing architecture prioritizes the use of traditional materials such as wood from local mangrove forests, and construction techniques that are adapted from local practices. The topography of the site is also considered in the design process, with the buildings being responsive to the natural landscape. Moreover, local cultural values and symbolism are incorporated into the architecture, reflecting the unique identity of the Osing community. The findings of this research highlight the importance of preserving and promoting regional architectural traditions in the context of modern architecture. The reinterpretation, modification, and innovation of local architectural elements in contemporary buildings can contribute to the sustainability and cultural preservation of the region. Furthermore, the architectonic regionalism approach in Osing architecture serves as a case study for understanding how regional identity can be manifested in modern architectural design, and its implications for sustainable development and cultural heritage preservation.
The Implementation of Reading Aloud Strategy to Develop Student Skill Responding to Expression of Giving Good and Bad News
Authors: Putri Maudy Yuniarti , Gaffar Muhammad Andriana
Published: October 2023

Speaking skills are a very important aspect of learning English to establish good communication. However, many students still need help expressing what they want to convey, be it ideas, ideas in a reading, or opinions when communicating, because of a lack of confidence from students. Thus, this study aims to improve students' speaking skills and to find out the factors and causes of students' difficulties in understanding reading by applying the learning method of reading aloud in learning text reports. This research was conducted at SMKN 1 SOREANG class X-TKJ (Network Computer Engineering) 1 with 36 participants. This research uses qualitative methods with a Classroom Action research approach. Data collection techniques in this study used three techniques, namely, Instruments: observations, field notes, and interviews. Based on the results of the study, the researcher can conclude that the application of the aloud reading learning method carried out by the teacher can run smoothly because, by the procedure, application of reading aloud, students can follow the teacher's direction well. In this learning process, students are very enthusiastic, and this encourages student learning motivation, especially in reading English texts; besides that, students can improve significantly in student speaking skills In several aspects it has so that students can be responsive when answering questions related to the reading that the teacher gives quickly. Therefore, based on the results of the research, some of the consequences of students' difficulties in speaking skills can be overcome by applying the method of learning to read aloud by increasing aspects of speaking skills in students, namely: 1) Fluency, 2) Pronunciation; 3) Intonation; 4) Accuracy.
A56Using simulation to address staff wellbeing and retention in a global non-healthcare organization
Authors: Hamilton Carrie , Thame Anna
Published: October 2023

Stress, anxiety and depression affect one-fifth of the working age population and are a leading cause of staff attrition and loss of productivity [1]. Conversations between colleagues can help reduce stress, increase job satisfaction and productivity, build stronger relationships, and create a more positive work environment [2]. In spite of numerous policy initiatives in large organizations and fewer in small [3], it is reported, by colleagues, that hands on ‘practice’ in having conversations would be beneficial. We were approached to create a remote live four-hour workshop with authentic simulated scenarios, appropriate for a cross cultural global reach, aiming to enable staff to feel ‘at ease’ with having proactive conversations with their colleagues on a daily basis.

In 2021-2022, 120 hours were spent developing a live module for managers working in non-healthcare environments. This module was preceded by three online eLearning modules, ‘being aware, being proactive and being responsive’. After eight pilots, content and delivery was scrutinized, analysing feedback from participating managers, facilitators, and actors. In 2023, a further 24 workshops are underway, using the refined content and delivery structure; 144 actors, 24 facilitators and 24 simulation advisers are involved. Participants are global managers, clustered into geographical regions; module timings are amended to suit time zones and in total 192 participants are able to take part in small groups of eight. A 90 minute follow up a month later enables participants to discuss the personal areas of identified focus.

Creating a safe space has been essential, with ongoing facilitator alertness. Participants have immersed themselves in the six scenarios covering loneliness, disillusion, over-work, depression, crisis and acute anxiety. Participants key areas of focus have included: being sensitive to situations, being a better observer, sharing values with staff, spending time with colleagues, scheduling time to look after oneself.

Timekeeping to ensure equity of discussion and involvement, and arrival and integration of the six actors have both been challenging, although mitigated by the pilot experience.

This programme, incorporates online eLearning modules, a remote ‘live’ simulated module, and follow-up group sessions. By practising through simulated scenarios, there is significant potential to improve the support, retention and wellbeing of employees within this non-healthcare organization. The programme’s global scope, with five regions, highlights its relevance and applicability to a diverse range of workplaces. There is potential for replication in other organizations facing similar challenges, ultimately impacting on our society as a whole.

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.
A70Novel high-fidelity Surgical Simulation Educational Program (SSEP) – a systems-based approach for enhanced patient safety
Authors: Robinson Jayne , Prakesh Ajay , Foster Rachel , Rowson Mark , Bathla Sonia
Published: October 2023

Increased pressures within the NHS, shortened learning hours and disruptions caused by the COVID-19 pandemic has significantly impacted surgical training. Current courses focus on single training levels, but errors occur through systemwide failures [1]. We developed a SSEP targeting cross specialty and team-based patient management, focused on clinical knowledge and skills, cognitive simulation, leadership and human factors based upon real life events to optimize training in a system that lacks time and exposure.

A six-month pilot program was designed with monthly sessions, attended by surgical nurses, junior doctors and consultants, covering common surgical scenarios mapped to the ISCP curriculum [2], and topics highlighted through local clinical governance. Immersive interactive sessions were delivered by a dedicated consultant led education team to provide a mixed reality environment for each simulated scenario. Faculty encompassed emergency, anaesthetic and surgical consultants to facilitate realistic multidisciplinary team working. The professional identity and grade of participants were maintained during each simulation to ensure sessions were representative of real-life events with a clear mutual goal to improve knowledge and skills to transpose into safer patient care at all levels of seniority. Sessions combined simulated scenarios with structured teaching, clear learning objectives, detailed peer feedback and opportunity for juniors to complete work-based assessments with consultants. Senior trainees benefited from participation in the design and delivery of sessions providing opportunities to strengthen their leadership skills. We recorded participants pre- and post-simulation confidence, and knowledge, were measured using 5-point Likert scale feedback forms, and multiple-choice questionnaire (MCQ) paper respectively.

Two-paired T analysis showed statistically significant improvements in participant confidence across all 4 simulations (

Pooled two-paired T-Test analysis of participant self-rated confidence, in managing clinical scenarios and core topics, before and after participation in 4 high-fidelity simulated scenarios, at the 95% confidence interval (*Significance α = ≤0.05).

Our SSEP is an effective strategy for the improvement of trainees’ confidence and knowledge in managing challenging surgical scenarios, which actively contributes to the development of skills for clinical practice. Evaluation of long-term knowledge retention is necessary. Our ambition is to develop the program as a quality improvement project (QIP) that implements learning from significant events and demonstrate improved outcomes in these domains. We endeavour to embed this simulation training across the region.

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.
A109A simulation escape room: Does gameful training promote active learning and student engagement
Authors: Morgan Lucy
Published: October 2023

Gamification of learning is becoming increasingly popular within higher education [1]. Student activities described as ‘gameful training’, including Escape Rooms, have reported additional learner benefits including improved teamwork, creative thinking and communication skills compared to traditional session designs [2]. There is a small number of existing case studies demonstrating their utilization within healthcare professional education and the reported additional benefits included pertinent skills such as task delegation and leadership, as well as being an engaging teaching strategy that promotes active learning [3].

A trial simulation escape room was created and implemented for level 5 adult and mental health branch nursing students within a Higher Education Institution. 12 different teams of students entered the escape room and worked together to ‘treat Arthur’, a patient presenting with acute anxiety and chest pain. Students were required to assess, escalate and manage Arthur effectively and would ‘escape the ward’, once he had received all of the required treatment.

The learning outcomes for the scenario and subsequent puzzles and tasks were created based on recent curriculum teaching allowing students to apply prior learning within the escape room environment. Puzzles included coded locked boxes and students were required to apply relevant knowledge, such as answering pharmacology questions, to generate codes and progress throughout the scenario. Simulation equipment was utilized and students unlocked clinical treatments and medical devices which in turn had to be delivered to Arthur. The facilitator maintained an active role within the scenario and allowed students to practise communication skills such as escalating their concerns about Arthur via the telephone.

It must be noted that the design time was significant for one scenario and required several pilots to ensure that all components were cohesive. Full support and creative input was required from the simulation technicians to ensure the activity’s success.

Students fed back that they enjoyed the activity and were observed to work effectively together and prioritize and delegate throughout the task with minimal supervision. Students also stated the scenario context was helpful to apply their prior learning and were pleased that they had been able to manage this patient presentation together. Feedback from facilitators was also positive and both staff and students found it to be an engaging experience.

Simulation escape rooms offer an innovative and engaging way for students to apply learning and vital practice technical and non-technical skills. For educators, clear learning outcomes and allowing sufficient design time is a necessity.

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.
A93Addressing patient-safety themes and fostering cohesive teamwork through weekly multidisciplinary in-situ simulation in an Acute Care Unit
Authors: Ziegler Joseph , Stevens Lisa
Published: October 2023

The Acute Care Unit (ACU) is the busy admissions ward at the trust. Many junior doctors rotate through the ACU for their acute medicine training and the department frequently welcomes newly-qualified nurses or nurses new to the NHS. All staff are involved in managing acutely unwell admissions with a range of presentations.

In this dynamic environment, ensuring time is dedicated to teaching is an important part of staff development. In addition, it is important to create opportunities for team-building between disciplines, and evidence shows that this improves outcomes for patients [1].

Teaching for different professional disciplines is often delivered separately. Whilst sometimes preferable, we recognized the department could benefit from simulation sessions involving all members of the clinical team to represent realistic clinical practice. The aims were to:

Address recent clinical incidents

Practice managing common medical emergencies as a multidisciplinary team

Build a greater sense of team between the ACU staff.

We designed and implemented a programme of weekly multidisciplinary in-situ simulation on ACU. Sessions involve a range of nursing and medical staff and students and are delivered in an empty bed space on the ACU. Simulations focus on clinical scenarios that might reasonably arise in the department. We use iSimulate technology and re-use the simulation suite’s equipment to reduce resource burden and maintain sustainability.

Feedback is collected after each session to quality assure and improve the sessions, and 2 further quality improvement reviews completed to explore how to maximize engagement and learning. This has led to coordination of scenarios with the established weekly seminar-based departmental teaching, to consolidate learning across settings and this is reinforced with a ‘learning point of the week’.

Sessions have been successfully delivered on a near-weekly basis throughout the year, despite significant clinical pressures. This has been achieved through coordinated efforts from the simulation team, ACU fellows and registrars, charge nurses and Practice Development Nurse.

We estimate to have reached more than 50 colleagues, with typically 4-8 attendees per session. We have rotated through 15 different scenarios and counting, covering key topics including various medical emergencies, violence and aggression, and ‘soft signs’ of deterioration.

The programme has been well received, and feedback has specifically commented on the benefit of simulation in a multidisciplinary and in-situ setting.

We demonstrate it is possible to maintain an effective regular simulation programme in the department to support patient safety initiatives and team working.

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.
A81Advance Choice Documents: a Simulation for Service Users, Carers and Clinicians
Authors: Fisher Megan , Bignell Anita , Schilderman Marcela , Henderson Claire , Smith Shubulade , Babatunde Abigail , Galloway Selena , Ruiz Mariola
Published: October 2023

Advance Choice Documents (ACDs) are one of the important upcoming reforms to the Mental Health Act in the UK [1]. The aim of the document is to allow service users greater autonomy when they are well, to make decisions and guide what happens if they become unwell in the future. It is created by a service user and clinician in a shared decision-making process.

Maudsley Learning (ML) collaborated with an Institute of Psychiatry, Psychology and Neuroscience research team to provide a co-produced simulation day for service users, carers and clinicians. The aim was for participants to be able to gain a greater understanding of how to co-produce and implement ACDs.

ML ran two separate simulation days, alongside, members of the research team including a lawyer and facilitator with lived experience.

The initial part of the day included didactic teaching; allowing participants to learn more about ACDs and have a space to ask questions from those with lived experience, clinicians and lawyers. This ensured participants gained a baseline level of knowledge to undertake the scenarios.

There were four simulation scenarios written, but only three took place on both days because of limited time. These revolved around one patient; the participants followed the patient through their ACD journey. The patient was played by an actor. All scenarios were designed to involve a clinician, often with the presence of a carer and service user as well.

The debrief consisted of a modified Pendleton model with feedback from service user, carers and clinicians to allow feedback and learning from all involved.

Participants were asked to complete a pre-course and post-course questionnaire. Paired samples t-tests were conducted to analyse the difference between pre- and post-course questionnaires. Results demonstrated a significant difference in scores for course-specific questions between the pre (M = 3.17, SD = 0.81) and post (M = 4.21, SD = 0.20), t(5) = -5.26, p <.05, 95% CI [-1.55, -0.53], with a large effect size of d = -2.15. 100% of participants would recommend this course.

This was the first simulation that ML has run with a mixed group of learners that included not only clinicians, but also service users and carers taking part in the simulation and debrief. The feedback was positive and helped to improve the knowledge around ACD’s. It was also noticeable the positive difference it made having clinicians, service users and carers learning from one another.

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.
A92Sustained Quality in Simulation Training – ‘Step-Up’ to IMT3
Authors: Carnall Lia , Edward Roy , Atkinson Ben
Published: October 2023

Following the introduction of the ‘IMT3’ year as part of Internal Medicine Training in 2019, a ‘Step-Up’ simulation day was developed in 2021. Positive feedback from candidates reflected its usefulness in preparing to work as a medical registrar [1]. The scenarios were conducted with the subsequent cohort of IMT3 doctors and feedback assessed for sustained quality of training.

Simulation is recognized as an important tool in medical education [2]. It is now specified by the Royal College of Physicians that trainees participate in simulation inclusive of human factors and scenario training [3].

The ‘Step-Up’ simulation day continues to consist of four progressive, high-fidelity scenarios that replicate a day in the life of a medical registrar. Each scenario occurs in the simulation lab for individual candidates, with peers observing via video-link in the debrief room.

Each scenario requires the candidate to perform a medical assessment of an acutely unwell patient, facilitated by use of the computerized manikin (SimMan Essential), whilst simultaneously tackling difficult conversations with a live actor and managing interruptions from a bleep. Participants also had the opportunity to lead simulated cardiac arrests with peers forming the cardiac arrest team.

Debrief and teaching continued to be provided by a qualified simulation facilitator alongside a specialist registrar or consultant. Feedback provision was moved to an online format and accessed via a QR code to be more environmentally conscious and to readily allow analysis and storage for future comparison. In order to assess sustained quality, the same five aspects of the day were assessed by participants on a ten-point Likert scale: relevance, pitch, clarity, usefulness and overall quality. Scores of 1 reflected strong disagreement and 10 of strong agreement. Free text feedback allowed candidates to suggest topics for future sessions or identify valuable learning points.

Thirteen IMT3 or equivalent doctors participated in this round of ‘Step-Up’ simulation with 100% feedback rate. As in previous rounds median and modal scores were 10 in all 5 domains, ranging from 7 to 10. Free text feedback recorded multiple requests for further simulation sessions.

‘Step-Up’ simulation was demonstrated previously to be a useful tool in progression to IMT3. Overall quality and usefulness were sustained year-on-year and simulated challenging discussions were highly valued by participants.

Therefore, this programme will continue for future cohorts, with ongoing monitoring of sustained quality and development of new scenarios to provide increased frequency of simulation training.

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.