bluuebunny/crossref_metadata_2025 huggingface dataset:
The feasibility of preparing a clay solution on reservoir water
Authors: Mirzajanzade A. Kh.
Published: January 2022

In the AzII named after Azizbekov conducted studies of the physico-chemical properties of clay solutions prepared on seawater and reservoir water. The article considers the influence of these properties on the quality of clay solution. It was found that the clay solution prepared on reservoir water has better qualities compared to the clay solution prepared on seawater. It is shown that the need for chemical reagents for processing clay solution prepared on reservoir water is reduced by 20-50%. Keywords: Drilling; Viscosity; Filtration; Clay solution; Reservoir water.
Utilizing the Maximum Workload Range for Practice Periodization
Authors: Sanders Gabriel J. , Peacock Corey A.
Published: January 2022

Commentary
The maximum workload range (max range) is a concept suggested by Sanders et al.1 regarding a method used to prescribe adequate practice workloads based off wearable technology data. The max range is calculated as follows from game data:
Max Range = (Mean Total Distance + 1 St. Dev.) to (Maximum Total Distance)
While the example provided utilizes total distance, the max range can be applied to key performance indicators such as  high-speed distance, training load, jumps, etc. that are tracked throughout the competitive season in team sports. The max range concept was developed from research that found 12-17% of the time, football athletes, depending on position, accumulated game workloads outside their position’s mean + 1SD. Anecdotally, many coaches and practitioners use simple game averages as a control for ideal practice volumes. Based on previous research, using the game average as control training threshold may result in some high performing athletes being under-conditioned. It is reasonable to suggest that potential compound effects may occur throughout an entire season if athletes are not engaging in rigorous training loads that mimic game-like volumes and intensities.
Figure 1. Theoretical football periodization structure for a defensive back using the max range for high intensity training days.
Órale Oralia, con la Oralidad
Authors: Mejía-Arámbulo Cruz
Published: January 2022

El presente artículo es resultado de incontables años que llevamos reflexionando sobre el poder de la palabra, y con este pretendemos concientizar acerca del mal uso que muchas veces en la cotidianidad se da a las palabras en diferentes ámbitos.
Observamos en las conversaciones, en los diferentes medios masivos, muchas contradicciones, repeticiones, errores sintácticos; derivado de lo anterior se generan malentendidos y sobreentendidos que solo hacen que se pierda la belleza del lenguaje.
Es importante tener presente los localismos, utilizar adecuadamente anglicismos; de la misma manera es necesario el uso adecuado de las tecnologías relacionadas con la comunicación.
Educación rural en América Latina
Authors: Castrejón Celso Javier
Published: January 2022

Resumen: El propósito de este trabajo por un lado es dar cuenta de  la situación social del campesinado y la realidad rural en América Latina, y por otro lado, es aproximarse a ciertos casos de educación alternativa en la región,  de tal forma que podamos analizar la relación de la educación y el desarrollo rural. Para ello, se revisaron  diferentes fuentes bibliográficas sobre el tema y nos apoyamos en trabajo de campo etnográfico. Concluimos dando cuenta de los múltiples avances del proyecto educativo del Centro de Estudios para el Desarrollo Rural surgido en la Sierra Norte de Puebla, México.
Conductas de autocuidado y actitudes machsitas en adultos
Authors: Moreno-Jabalera José Angel , Barrera-Hernández Laura Fernanda
Published: January 2022

Las conductas de autocuidado y el machismo son factores importantes que pueden influir en la vida y la salud de las personas tanto en el ámbito individual como en el social, así como la manera en la que se interactúa con otros, no obstante, existen pocos estudios acerca de la asociación de estos dos factores entre sí. El presente estudio tuvo como objetivo indagar en la relación entre conductas de autocuidado y las actitudes hacia el machismo, además de comparar los resultados de estas variables en función del sexo de los participantes. Participaron 102 personas, 66.7% mujeres y 33.3% hombres, con una edad media de 27 años, DE = 9.6, quienes respondieron a un instrumento que incluyó un apartado de consentimiento informado, seguido de los datos demográficos y dos escalas, donde la primera consistió en la valoración de la capacidad de autocuidado y la segunda escala evalúo actitudes hacia el machismo. En los resultados se observó un nivel medio-alto en la capacidad de autocuidado, y un nivel bajo en actitudes hacia el machismo. Adicionalmente se encontró una relación negativa y significativa entre ambas variables de estudio. Respecto a la comparación en función del sexo, se encontraron diferencias estadísticamente significativas en las actitudes hacia el machismo y en el factor conductas de autocuidado acerca de la falta de capacidad para el autocuidado, donde los hombres obtuvieron medias más altas que las mujeres.
Subalternidade, representação e participação da comunidade LGBTQIAP+ no cenário político brasileiro
Authors: Goerch Alberto Barreto , Silveira Miguel Soares , Santos Everton Rodrigo , Silveira Gabriel Eidelwein
Published: January 2022

O artigo aqui estruturado apresenta-se em três partes distintas e entrelaçadas, a primeira debruça-se sobre a criação e trajetória do movimento “LGBT” e da emergência de um novo sujeito político como cerne de novas exigências políticas, a segunda, por sua vez, analisa e explica como se estabeleceu (e ainda se estabelece) a questão da subalternidade deste movimento e sua exclusão de debates politizados e decisórios comumente no Brasil e a terceira, estuda e observa como é engendrada a representação política brasileira de membros da comunidade LGBTQIAP+ e seus efeitos na elaboração de políticas públicas eficazes às minorias sexuais. Também propõe como finalidade primordial a análise da subalternidade e suas manifestações diversas pela comunidade LGBTQIA+, além de demonstrar como tal fenômeno se reflete no campo político, questionando acerca de sua representação e participação políticas. Traçando um breve histórico do Movimento LGBT, almeja-se entender como se consolida a posição desses grupos subalternos para, a partir daí, analisar, compreender e questionar a relevância da representação e participação política e social deste grupo considerado minoria sexual e se este apresenta detrimento aos direitos e causas heteronormativas no Brasil.
Violent Origins of Law
Authors: Cavallo Riccardo
Published: January 2022

The aim of this article is to analyse an issue discussed by philosophers and legal scholars since ancient times: the violent origins of law. In other words, it attempts to respond to the following questions: can we ultimately trace the origins of law back to violence, and could it be that law is in fact a continuation of violence by other means? To this purpose, there will be retraced the law-violence relation as portrayed in the Greek tragedy The Eumenides where Aeschylus focuses on Orestes’ trial, is of particular relevance when it comes to questioning the origins of law. At the same time, there will be followed the footsteps of Michel Foucault and Walter Benjamin who had the undoubted merit of having brought to light, within the tragic framework of the twentieth century, the relationship between law and violence.
Geneza społeczeństwa w myśli Bernarda Mandeville’a
Authors: Droś Agnieszka
Published: January 2022

W artykule przedstawiono paradoks prywatnych przywar i korzyści publicznych Bernarda Mandeville’a na przykładzie jego poglądów na genezę społeczeństwa w oparciu głownie o drugi tom Bajki o pszczołach i The Origin of Honour and the Usefulness of Christianity in War. Ewolucyjny proces rozwoju społeczeństwa ukazany w tekście różni się od poglądów prezentowanych przez autora w pierwszym tomie Bajki, kładzie bowiem nacisk na długotrwały i spontaniczny charakter postępu dokonanego przez ludzi o niewybitnych umysłach. W swoich rozważaniach Mandeville pozostaje przy kluczowym dla siebie temacie natury ludzkiej i istotności ludzkich przywar w poprawnym funkcjonowaniu grup społecznych. Kontynuuje dywagacje rozpoczęte w pierwszym tomie Bajki nad tym, kim człowiek w rzeczywistości jest. Temat powstania społeczeństwa wpisuje się w deklarowany przez niego cel, jakim jest sprawienie by ludzie lepiej rozumieli samych siebie.
Crime doesn´t pay: la intervención notarial como medio para prevenir el lavado de activos
Authors: Gutiérrez Brenes Oscar Manuel
Published: January 2022

El lector tiene en sus manos un artículo de investigación que versa sobre las nuevas y principales formas de Lavado de Activos que utiliza esta delincuencia moderna a través del mercado pluridimensional que ofrece este siglo. Sin duda alguna, en diferentes ordenamientos jurídicos existen medidas eficaces para su combate, pero ninguna tan vital y necesaria, como la Función Notarial para dar una solución segura para su prevención, que es realizada por un elemento intrínseco a su ejercicio “la seguridad jurídica” esto le permite al Notario llevar a cabo una función social preventiva que ejerce por naturaleza, ya que, no basta con impedir que la voluntad negocial de los otorgantes viole la legalidad, si no, evitar que con la Ley y con la Función Notarial se pretenda cometer actos ilícitos que perjudiquen los bienes jurídicos de los ciudadanos.
Trascendencia jurídica y práctica de la figura del levantamiento del velo corporativo de las sociedades anónimas en Nicaragua
Authors: Arostegui Useda María Luisa , Fonseca Ñurinda Nubia Auxiliadora
Published: January 2022

Históricamente, las sociedades anónimas han gozado de la protección del velo corporativo, figura que garantiza el anonimato de la identidad de sus socios, y por ende se constituye en la principal característica de esta sociedad capitalista, no obstante, este beneficio ha sido utilizado para llevar a cabo negocios ilícitos a nombre de la persona moral o jurídica. Circunstancia que ha obligado a varios países, entre ellos Nicaragua, a implementar el registro del beneficiario final, bajo las recomendaciones No. 10, 22 y 24, dadas por el Grupo de Acción Financiera Internacional (GAFI), por lo cual cabe preguntarnos si este registro atenta contra la naturaleza jurídica de las sociedades anónimas, y qué seguridad brinda a las sociedades sobre el resguardo y manejo de su información. Esta investigación documental, aborda estas interrogantes, porque ha sido desarrollada para analizar la naturaleza jurídica de las sociedades anónimas, el fundamento dogmático de la Teoría del velo corporativo, y la trascendencia jurídico-práctica de su levantamiento a través de la obligación de reporte del beneficiario final. Obligación que resulta necesaria ante la creciente evolución comercial y tecnológica, además, requiere que el Estado de Nicaragua resguarde adecuadamente la información que los socios proporcionan a través de este registro.
A Case Report on Progressive Supranuclear Palsy
Authors: Yatakarla Venkatesh , Deshmukh Janakraj , Patil Rajesh , Ruikar Devashish , Limbapure Amar
Published: January 2022

Progressive supranuclear palsy (PSP) is a quite rare neurodegenerative disease that affects mainly the brain stem, basal ganglia, and cerebellum in the central nervous system. PSP is classified in the rubric of parkinsonism plus syndromes, which causes progressive degeneration in the midbrain areas those controls eye movements. PSP often goes under diagnosed, hence making it essential for physicians to be well-known of this disorder. We present a case of PSP of a 65- year-old female, which came primarily with reiterative falls due to postural instability and speech disturbances. Radiodiagnosis with magnetic resonance imaging (MRI) of brain diagnosed a classical sign of PSP.
Efficacy of Bilastine in the Management of Urticaria- A Retrospective Study
Authors: L Eshwari , Kumari Pradeep
Published: January 2022

Background: Urticaria or hives is a common skin condition with a lifetime prevalence of 7.8–22.3%, a point prevalence of 0.5- 1.0%. This study focuses to determine the efficacy of bilastine in combination with other antihistamines or corticosteroids in the treatment and symptomatic relief from Urticaria in Indian patients. Objective: A retrospective study to evaluate the efficacy of bilastine in the management of Urticaria in an Indian population. Methods: A retrospective study was carried out on 99 patients (7 children and 92 adults) with urticaria. Bilastine, 20 mg once daily, was given in patients with other antihistamines such as levocetirizine, fexofenadine, and corticosteroids. The treatment outcome was assessed as recovered, unchanged, worsened, change in therapy, or lost to follow-up. Results: Bilastine was prescribed at 20 mg dose orally either once daily (91 patients) or twice daily (2 patients). About six patients were given bilastine in syrup formulation at a dose of 5 mL (2.5 mg/mL), OD. Out of the 99 patients, most (77/99- 77.78%) reported recovery during the follow-up visit. Seven patients were still on treatment, six patients still had rashes on exposure to the sun, one patient had rashes while swimming, three patients had no recovery, and four were lost to follow-up. Conclusion: Bilastine (20 mg OD), a new generation non-sedating H1-antihistamine, was highly effective in treating urticaria when given in combination with other second-generation antihistamines.
An extended distribution of three threatened plants from Tirunelveli District, Tamil Nadu
Authors: Rajakumar T.J.S. , Selvakumari R.
Published: January 2022

This paper highlights an extended distributional record of three threatened species like Coffea travancorensis Wall. ex Wight & Arn. (Rubiaceae), Neanotis rheedei (Wall. ex Wight & Arn.) W. Lewis (Rubiaceae) and Struchium sparganophorum (L.) Kuntze (Asteraceae) from Tirunelveli District, Tamil Nadu.
On the Occurrence of Eria Pulchella Lindl. (Orchidaceae) in India
Authors: Agrawala D. , Chowdhery H.
Published: January 2022

Present paper deals with the occurrence, nomenclature and taxonomy of Eria pulchella Lindl. (Orchidaceae) in India.
INFLUENCE OF SMARTPHONE USAGE ON HEALTH CAUSING INSOMNIA AND BINGE EATING
Authors: Aslam Maria , Dur e Najaf Seyeda , Arooj Fiza , Rai Sadia Asad , Abdul Manan Alina , Fatima Sehar
Published: January 2022

Background: Smart phone is an electrical device and its use is increasing day by day even in the growing countries like Pakistan. Difficulty in sleeping and disturbed sleep quality is termed as insomnia and binge eating is a psychological disorder characterized by overeating.
Objective: To access the influence of excessive use of smart phone on health causing insomnia and binge eating.
Method: A Cross Sectional Study design was done on 100 university students in Lahore to elucidate the influence of smart phone usage on health causing binge eating and insomnia. A self-formulated questionnaire was used including questions like (age, sex, weight, height, snacking while using smart phone and sleep quality). Purposive Sampling technique was used to collect data. Adolescent’s aging 20-25 years of age were participants of the study. Data was analyzed through latest version of SPSS.
Result: According to the findings of study, out of total 100 participants 69 were females and 31 were males. Majority 61% of the participants were having disturbed sleep quality due to smart phone usage and 64% were binging while on their smart phones using social media.
Conclusion: It is concluded from study that percentage of smart phone usage is contributing to sleep disturbances and high calorie intake in university students.The results suggest that students who were addicted to smartphones were having sleep disturbances and were also binging. In addition, it was also Affecting their weight as their BMI were increased.
Therapeutic effect of garlic containing S-allyl cysteine and Diallyl-di-sulfide on improving blood lipid profile
Authors: Siddiqa Ayesha , Basharat Shahnai , Mubarik Fizza , Farooq Fatima , Ali Muhammad
Published: January 2022

Cardiovascular-related diseases are considered as the major risk for health and may lead to many illnesses. Hyperlipidemia is the highest common cause of diseases related to heart known as CHD. Since ancient times, innumerable herbs and organic foods are used to treat diseases among which garlic has been shown beneficial for treating hyperlipidemia and normalizing lipid profile levels. Garlic may be used in different forms like powder, tablets, extracts or after ageing. Its sulfur containing compounds like allicin, S-allylcysteine, alliin, ajoene, diallyl disulfide are proven to have the pharmacological benefits. The main aim of the current review is to analyze and evaluate the studies regarding anti-hyperlipidemic effects of garlic and its supplements on normalizing lipid profile among hyperlipidemicsubjects.After analyzing different studies being carried out earlier, it is concluded that garlic is effective in managing lipid profile including total cholesterol, triglycerides, LDL, HDL levels among people with hyperlipidemia ranging from mild to moderate intensity.
CAUSES OF DYSFUNCTIONAL UTERINE BLEEDING IN PRE-MENOPAUSAL, PERI-MENOPAUSAL AND POST-MENOPAUSAL WOMEN; A SYSTEMATIC REVIEW OF WORLD LITERATURE BETWEEN YEAR 1992 TO 2017
Authors: Qureshi Ayesha , Khadija Syeda , Irshad Ayesha
Published: January 2022

To evaluate the causes of dysfunctional uterine bleeding in pre-menopausal, peri-menopausal and post-menopausal women.Material & methods: Data for this article was extracted from google scholar and PubMed, including 25 original articles published from 1992 to 2017.Conclusion: Dysfunctional uterine bleeding is a major source of anxiety among females of different age, as well as a frequent cause of emergency room visits and/or hospitalizations. The most prevalent causes of irregular uterine bleeding in perimenopausal women are benign endometrial and myometrial lesions, but endometrial hyperplasia and, in particular, uterine malignancies must be examined, especially as women get older.
Comparative effects of Core Stability Exercises and Endurance Training in Patients with Mechanical Low Back Pain
Authors: Khan Javairia , Khan Palwasha , Arshad Muhammad Umer , Javed Ahsan , Zia Wajeeha , Iqbal Ambreen , Jamshaid Ghazal
Published: January 2022

Low back pain is a major health problem resulting in psychosocial and physical disability. The prevalence of LBP and risk of recurrence is rising due to the sedentary life style, poor postural awareness and short term oriented intervention plans. It is the need of the time to design one or more exercise plans that can improve pain and functional disability and prevent recurrence of symptoms in patients with mechanical low back pain. Objective: The objective of this study is to compare the effects of core stability exercises and endurance training on the pain and functional disability in the population having mechanical low back pain. Materials and Methods: It was a quasi-experimental study with 74 patients with chronic low back pain, divided equally in two groups containing 37 patients each. Both groups were treated with baseline of moist heat pack in combination with interferential. Group A was treated with core stability exercises and group B was treated with endurance training for five times a week.  Pre and post treatment scores were compared with NPRS for intensity of pain and Oswestry Disability Index for functional disability scores. Results: Data was analysis by SPSS.25 on 74 patients. In type of pain, about 79% of patients were suffering from moderate and severe type of pain while there were only 21% of patients who came with mild pain in both groups. Independent t-test was applied for changes between the group on NPRS scale, the results shows significant results with p<0.05. In core stability group the difference between pretreatment and post treatment was 6.08 to 1.4 and in stability group the difference was 6.13 to 1.10. Endurance training exercises on ODI, there was no one with severe disability, and 94.6 %were with minimal disability and only 5.4 % were with moderate disability.  It shows that endurance training exercises were better than stability exercises. Conclusion: It is concluded that endurance training has more clinical difference on outcome measures of NPRS and ODI as compared to core stability exercises in patients with mechanical low back pain.
Empowerment of Coastal Communities through Socialization Of Entrepreneurship and MSME Development For The Economic Independence Of Communities, Pontang Sub-District, Serang Regency
Authors: Yazid Helmi , Ismawati Iis
Published: January 2022

To increase the economic independence of the people of Domas Village, Pontang District, Serang Regency, it is necessary to conduct socialization on entrepreneurship and the development of MSMEs. The method used in empowerment is active participatory empowerment of mothers and adolescents by transferring knowledge and understanding about ways and strategies for entrepreneurship and developing MSMEs to increase the economic independence of coastal communities through counseling and mentoring. This activity involves Lecturers, Students, Village Government as partners and target groups.
ANALISIS PENGARUH LATIHAN DRIBBLING CIRCUIT TERHADAP KELINCAHAN DRIBBLING SEPAK BOLA
Authors: Pardiman  , Bambang Yunanto  , Robby Putu Abdulquraesy
Published: January 2022

Sepakbola adalah permainan yang sangat menuntut dimana peserta mengalami berbagai tindakan yang memerlukan kekuatan keseluruhan dan daya produksi, kecepatan, ketangkasan, keseimbangan, stabilitas, fleksibilitas, dan tingkat yang memadai dari ketahanan. Dribbling circuit merupakantahapan-tahapan latihan menggiring bola dalam suatu latihan yang telah dirancang secara sistematis untuk meningkatkan kecepatan dribbling pemain sepakbola selain dribbling pemain sepakbola dituntuk kelincahan dalam bermain. Kelincahan merupakan salah satu komponen kesegaran motorik yang sangat diperlukan untuk semua aktivitas yang membutuhkan kecepatan perubahan posisi tubuh dan bagian-bagianya. Tujuan penelitian ini adalah untuk mengetahui Pengaruh Metode Latihan Dribbling Circuit Terhadap kelincahan Dribbling Sepakbola. Metode penelitian yang digunakan adalah penelitian studi literatur yang terdiri dari beberapa sumber seperti sumber primer dan sumber sekunder. Dengan hasil Terdapat Pengaruh Latihan Dribbling Circuit sebelum dan sesudah pelaksanaan dribbling sepak bola dengan menggunakan metode latihan dribbling circuit. Maka dapat disimpulkan bahwa metode Latihan dribbling circuit berpengaruh secara signifikan terhadap kelincahan dribbling sepak bola.
STRATEGI PENGEMBANGAN MUSEUM BALAPUTRADEWA UNTUK MENINGKATKAN PENDAPATAN PEMERINTAH KOTA PALEMBANG
Authors: Dwi Indah Lestari Andini , Santika Ida , Tarisa Wanda , Panorama Maya
Published: January 2022

Museum Balaputra dewa adalah salah satu Museum negeri yang ada Di provinsi Sumatra selatan yang dikelompokan kepada lima (5) pameran akbar serta menyimpan banyak sekali macam koleksi. Adapun yang menjadi Identifikasi masalah kurangnya sarana dalam mempromosikan Museum, kurangnya pemeliharaan serta supervisi Museum, kurangnya minat rakyat mengenal sejarah masa lampau, kurangnya penyediaan Cinderamata diMuseum. Penelitian ini bertujuan mengetahui bagaimana taktik Museum Balaputra dewa bisa dikembangkan supaya lebih maksimal dan hambatan-kendala apa saja yang dihadapi. strategi pengembangan objek museum Balaputra dewa dalam upaya menaikkan pendapatan kota Palembang Di sector pariwisata pasca pandemi. Pandemi covid-19 sangat berdampak pada pendapatan kota Palembang sebab adanya restriksi sosial bersiklus besar dan ditutupnya akses keluar masuk antar kota, hal ini mengakibatkan penurunan pendapatan kota Palembang Di sector pariwisata. cara lain strategi yang dipergunakan ialah strategi yang meminimalkan kelemahaan (weaknesses) untuk memanfaatkan peluang (Opportunities) itu wajib dimanfaatkan buat meminimalkan kelemahan yang dimiliki dan dipergunakan untuk mengurangi ancaman eksternal. strategi tersebut sebagai jawaban penelitian untuk mengatasi konflik yang ada pada Museum Balaputra dewa sehingga pengembangan di Museum bisa diterapkan menggunakan optimal.
22 Game On! Meeting the Mission of Gamification to Teach Human Factor Skills
Authors: Smith Gill , Holland Jonny
Published: January 2022

Failings in human factors are a significant contributory factor in accidents/incidents in aviation, energy and healthcare. There is no ‘one thing’ that will address human factor failings- it requires multiple interventions; including developing human factor awareness and skills to influence behavioural change. Local research in the Northern Health & Social Care Trust

This project deployed the application of Gamification to human factor learning in healthcare. Feedback from face-to-face Human Factor training is positive, but it is challenging in an organization of 13,500 staff to meet the capacity for this training. More recently, response to COVID-19 has challenged us all to think about how we make training more accessible outside of traditional methods.

The Gaming Strategy is centred around Dupont’s Dirty Dozen (Figure 1) – the 12 most common human factor elements which degrade a person’s ability for them to perform effectively and safely, which can lead to errors.

Dupont’s dirty dozen

Through a series of missions ‘gamers’ follow a patient (Joe) as he journeys through the healthcare system, and experiences a series of human factor errors. The five missions below, each incorporate Dupont’s Dirty Dozen:

communication and team working

lack of knowledge and assertiveness

situational awareness

complacency and norms

pressure and lack of resources

Each mission introduces characters and is scenario-driven, depending upon gamers’ responses they will either be successful in their mission (in which case they can proceed to the next step), or unsuccessful and have to restart the mission. At the end of each mission ‘gamers’ must complete a quiz, after which they are rewarded with access to the next mission. The gaming App includes additional learning resources, opportunity for reflection and generation of a completion certificate to support professional development. Psychological and behavioural experiences of gamers’ is captured by the App via quizzes at the start and completion of the Game. The project deployed Quality Improvement and Agile development methodologies. All scenarios and characters were developed by the NHSCT project team, with software development commissioned externally.

The Game is accessible via mobile phone from the App Store. Project testing completed in June 2021, with the launch of the Game in NHSCT thereafter. The App has potential for scale-up across NI and the UK.
194 Implementing a Simulation Training Programme for Physician Associates
Authors: Cowan Alicia , Oliver Nathan , O’Brien Richard
Published: January 2022

The physician associate (PAs) profession is a relatively new profession to the NHS. As such, there is no official national or regionally agreed further training to support PAs transitioning from PA school into clinical practice once they have graduated. Simulation training has proved to be an effective tool for developing clinical and non-clinical skills in other groups of clinicians

We aimed to describe the development and implementation of a novel PA-specific simulation training programme and present the evaluation of our initial work.

We designed and implemented a bespoke simulation training programme based on existing training for junior doctors. This model has three separate simulation sessions, spaced over 2 years, each session has three different clinical scenarios. Seventeen PAs have undergone the first two sessions. The first session contained three scenarios that highlighted important local protocols such as the major haemorrhage protocol and the sepsis

At this point in time, we have feedback from 16 candidates from session 1 and 11 from session 2. The results are overwhelmingly positive showing improved confidence, better team-working skills and a perceived perception of improved patient safety following the simulation training, as shown in graphs 1 and 2. The majority of candidates partaking in the session found the simulation training beneficial to their practise. The main negative feedback given was the lack of ‘senior support’ (i.e. from a senior doctor) in the scenarios that were unrealistic to actual practice.

The introduction of a novel PA simulation training programme has demonstrated improvements in clinical and non-clinical skills. This supports our aim of improving post-graduate PA training. Work continues to further develop our PA simulation programme and further evaluate its effectiveness with the aim of making this as a regional simulation programme that PAs can undertake when joining the healthcare workforce.
201 Genital Examination Education and Instruction: Lowering Anxiety and Raising Competence
Authors: Polonko Isle
Published: January 2022

Gynaecologic Teaching Associate (GTA) and Male Urogenital Teaching Associate (MUTA) methodology have been utilized for decades in effective breast, pelvic and urogenital examination clinical skill instruction. This methodology is recognized as the gold standard of instruction when educating learners on the sensitive, invasive clinical skills techniques associated with a genital examination. While research shows it is the most effective way to learn these procedures, outside of the USA and Canada, there are few GTA/MUTA programmes at medical learning institutions.

This methodology aims to provide hands-on, standardized instruction in an anxiety-free environment where learners safely practice the clinical skills techniques of breast, pelvic and urogenital examinations and have the unique experience of learning these techniques from the patient’s perspective.

The GTA/MUTA is both instructor and live simulated patient, using their own bodies as teaching tools, guiding learners through examination techniques and providing instant feedback. With this unique opportunity for skills acquisition, learners receive step-by-step instruction on an actual person in a quality-controlled environment. In addition to correct palpation techniques, this patient-centred form of instruction addresses the emotional reaction patients may have to these examinations. GTA/MUTA instruction also includes patient education and communication and relaxation techniques. The GTA/MUTA patient empowerment methodology is designed to provide an anxiety-free atmosphere for the learner so that the sensitive nature of the genital examination and the embarrassment often accompanying the examination do not become an obstacle to acquiring safe, effective clinical technique.

Decades of research prove that this method lowers learner anxiety and provides exceptional outcomes for learners in a multiplicity of learning criteria, including higher overall scores; superior communication skills; better ability to identify pathology; ‘better interpersonal skills than physician trained with lasting effects that can be demonstrated after clinical exposure’

The methodology has far-reaching implications. The specialized skills of these individuals mean that the teaching method can be brought outside of the well-patient experience; sexual assault providers can practice the trauma examination on live simulated patients; remediation can be provided to practitioners who must relearn techniques to maintain licensure; learners are more empathetic to their patients and more inclined to include their patients in the examination process thus improving patient care. This methodology can be utilized in any setting where invasive examination procedures, patient education and communication must be mastered.
92 Improving Knowledge and Human Factors Skills During a Pandemic: A Multimodal Covid-19 Educational Project
Authors: Sowole Luciana , Dunnell Liam , Maule Sophie P , El-Alami Wathik
Published: January 2022

Following a rise in COVID-19 cases and hospitalizations in autumn 2020, the resultant pressures on general medical wards galvanized the simulation education team at a London teaching hospital to create a multi-disciplinary educational programme aimed at ward staff caring for the surge in COVID-19 patients. This was especially important in the context of rapidly evolving clinical guidance and recognition of the importance of human factors in re-deployment of staff, thus a multimodal educational project was initiated to develop ward staff knowledge and human factors skills.

The aim of the study was to ascertain the effectiveness of the multimodal COVID-19 educational project in improving ward staff knowledge and human factors skills.

In October 2020, the team began creating the project – comprising e-learning to improve staff knowledge,

e-Learning surveys were completed by 108 learners with a significant difference (p < 0.01) in self-reported pre- and post-survey scores across the six domains. Learners demonstrated mean improvements across all areas of the HuFSHI for the

In a limited time frame, the simulation education team implemented a multimodal educational project that improved both ward staff knowledge and human factors skills amidst the second wave of the COVID-19 pandemic. Moreover, following restriction of face-to-face delivery, the project was successfully converted into a purely online format. This ability to be flexible and adapt accordingly is one that needs to be widely adopted going forwards, especially during these unpredictable times. Further challenges included staff release for training, time pressures, managing emotive discussions using the online modality and COVID-19 safety measures. A 6-month follow-up survey is planned to evaluate the benefit to staff’s clinical work and will be included at the presentation.
5 Core Care Skills Simulation Training for Undergraduate Medical Students
Authors: Ellis Laura , Joseph Jemma-Laura
Published: January 2022

Throughout the coronavirus pandemic, healthcare professionals have needed to rapidly adapt to changing demands. For some, this has involved adapting a ‘task-sharing’ approach which means that professionals undertake tasks that are not usually considered part of their job role, for example, Junior doctors giving medications and many were ‘redeployed’ completely to areas of greater need. In the same vein, the role of the medical student was expanded and explored and some medical students were given the opportunity to undertake paid work as healthcare support workers (HCSWs). It can be argued that the education and training of medical students are heavily focussed on a medical model of healthcare and often lacks depth insight into the caring aspects of patient care.

The aim of the study was to create an interactive practical care skills simulation training aimed at medical students.

We designed a practical simulation training programme based around the ‘fundamentals of care’ as defined by the nursing and midwifery council

Early versions of this course were used as part of a comprehensive induction programme that included testimony from HCSWs working within the site hospital, who were able to share real-life experiences and offer peer support. This helped influence the development of this course to shape it into an innovative multi-disciplinary training. The training course was developed reactively to meet the developing need of students to prepare for redeployment by April of 2020 and since then has grown and developed into the half-day simulation training that is outlined above. It has now been incorporated into the in-hospital clinical skills curriculum for third-year medical students passing through the trust on the understanding that, this course has helped medical students to better understand the role of other professionals and will enable closer multi-disciplinary working in future. Anecdotally, it is obvious from interacting with students that there is a need to incorporate training in basic care into the medical curriculum to prepare students for task-sharing in the future as well as to better understand the caring professions and improve multi-disciplinary working. However, there is not enough post-course data to establish a true effect from this course at present. We continue to run this training course as part of the year 3 undergraduate clinical skills programme and aim to collect more survey data to evaluate and adapt it.
175 Embracing a System-Based Approach to Simulation – The Experience of a Paediatric Hospital During a Global Pandemic
Authors: Broughton Emma , Ross Alasdair , Chigaru Linda , Nambyiah Pratheeban , Williams Sam , Ingram Chris
Published: January 2022

The GOSH Clinical Simulation Centre (CSC) delivers an established paediatric

The aim of the study was to expand the applications of our pan-trust

Over the course of 18 months, simulation exercises were designed to focus on rehearsal and refinement of processes and systems, towards uncovering latent safety threats or gaps in practice. A reporting tool was developed; to capture risks and identify mitigating actions. In addition to this, an established reporting structure enabled faculty to share findings and escalate risks to the local patient safety team. The COVID-19 pandemic presented healthcare workers with many new or unfamiliar working practices. This context further shifted our focus towards systems safety simulations (SSS) with the aim of enabling teams to focus on rehearsing and preparing for new ways of working.

Ten different exercises were delivered with clinical teams across the trust: successfully informing the development of five new clinical guidelines relating to COVID-19-specific practices. In one exercise alone, 11 latent safety threats (LSTs) were captured and managed with the appropriate teams (

Themes from LSTs captured during COVID-19 CT transfer simulation

SSS fire evacuation exercise in the IMRI suite

SSS fire evacuation exercise in the new sight and sound building

These exercises demonstrate the potential applications of simulation to support process and system improvement. Beyond the pandemic, we aim to continue to deliver SSS exercises to help make clinical systems and spaces safer for patients and teams. Following in the footsteps of successful simulation teams in the USA, we aim to advance this work to deliver SSS at the preconstruction level in future to inform the design of new clinical spaces.
170 Demonstrating Innovation Through the Skills Hub Initiative
Authors: Humphreys Melanie , Coulton Scott
Published: January 2022

In April 2020, Birmingham City University played a key role in the local response to the coronavirus pandemic by providing essential skills training to student nurses, existing National Health Service (NHS) staff who were returning to practice and staff being redeployed to critical care areas. The University’s action saw the rapid development, and delivery of a logistical plan involving staff mobilization, collaboration, skills mapping and prioritization of clinical service needs. Over 2,000 clinicians, including our own students, received a far-reaching training programme covering eight key skills needed to take on frontline NHS roles in the fight against COVID-19. The programme was innovative, sustainable and all risks to patients were eliminated, as the learning took place within the University’s state-of-the-art simulation facilities.

Our aim was to design and deliver a rapid skills development centre that could train a core mass of staff facing redeployment to the standard required to work, competently and confidently, within the teams on the frontline NHS.

The rapid development was a huge challenge, involving identifying an essential cohort of staff from the Faculty of Health who were willing and able to deliver such a wide range of clinical skills. Each skill was risk assessed and a COVID-19 lead was identified within the team. We ensured all essential personal protective equipment (PPE) was available and that social distancing could be assured, including reducing the number of students in a room at any one time. This was particularly challenging as it increased the teaching time required exponentially.

This was a difficult time globally, and the University’s action led to the demonstration of outstanding courage and commitment to care towards the community we serve. While the public was being urged to stay at home, our staff were constructing a Skills Hub to deliver in-person with personal risk. The Estates and Facilities team worked to create a one-way system throughout the complex building. The University worked closely with the skills teams in local NHS Trusts, especially University Hospitals Birmingham, to ensure the skills taught were in line with Trust requirements, and that the training would have the biggest impact in supporting patient care. The Skills Hub team worked tirelessly and in collaboration to ensure the efficacy of development and the safe delivery of the programme. The Skills Hub continues to operate as a huge success, proving sustainability, whilst continuing to provide an integral part of curriculum achievement for all healthcare students.
156 Practice Made Perfect: The Evolution of an LVAD Algorithm Through Clinical Simulation
Authors: Gamble Brigitte
Published: January 2022

In total, 70% of patients implanted with a left ventricular assist device (LVAD) will experience a life-threatening emergency within the first year of implantation

Develop and introduce an emergency algorithm that provides a standardized approach to LVAD patient emergencies.

Increase staff confidence, competence and clinical decision-making.

Use simulation to facilitate and enable staff to solve complex problems using standardized assessment and management while ensuring transparency and equitable treatment in situations of rapid clinical deterioration.

The LVAD Simulation and Algorithm project commenced through the trial of an out-of-hospital algorithm developed by Bowles that was adapted for in-hospital use. Direct feedback from staff attending low-fidelity ward-based simulations was used to consistently develop and adjust the algorithm from a three-page flowchart to a single page (

Practice made perfect

Simulation has proved to be essential in developing this innovative, unique, patient safety tool that has increased staff confidence and competence throughout the organization while providing a safe place for clarifying questions. The single-page algorithm continues to be practised via simulation weekly with an ever-increasing multi-disciplinary presence. Staff report increased confidence not only in dealing with LVAD emergencies but also in their ILS and ALS skills, all of which increase safety, quality care for patients. This one of a kind algorithm is now finalized and awaiting organizational review, following which a complete evaluation of its effectiveness will be conducted.
118 Simulation for Novice Anaesthetists: Addressing Training Gaps Created by a Global Pandemic
Authors: Frost Emily , Starnes Samuel
Published: January 2022

It is well documented that the COVID-19 pandemic is having a huge impact on doctors in training. Much of novice anaesthetists’ training is delivered during high turnover, elective theatre lists of low-risk patients

The aim of the study was to create a trust-wide high-fidelity simulation course for novice anaesthetists, focussing on confidence building and preparation for on-calls, together with clinical and non-technical management of specific anaesthetic complications.

A pre-course questionnaire aided a learning needs analysis and informed the learning objectives. Poor confidence due to lack of training was a common theme. Issues identified included limited case numbers, exposure to common emergencies and difficulty progressing to more distant supervision. Using a standardized scenario authoring platform (IRIS) we collaborated with a multi-professional faculty group to design a 1-day simulation course. To ensure an authentic learner experience, scenarios were designed for delivery in a high-fidelity simulation suite using Laerdal SimMan3G with LEAP software. Familiar clinical equipment, such as a Datex Ohmeda anaesthetic machine, was used and access to typical cognitive aids provided to mirror a real theatre environment.

Initially, participants prepared for an anaesthetic induction following standard operating procedures, including performing the World Health Organisation Surgical Safety Checklist. They then carried out this uncomplicated induction with the assistance of a trained Operating Department Practitioner. This aided in embedding good clinical practice and promoted patient safety. A second scenario followed, during which an emergency unfolded. The group observed each scenario through a video link and contributed to a consultant-led debrief. To assess course impact participants completed post-course questionnaires. Confidence universally improved after the course. Every attendee found the course useful and was highly likely to recommend it to a colleague. For several participants, this provided their first experience carrying out an emergency anaesthetic induction without direct supervision. In this setting, simulation has been used as a valuable tool to supplement clinical exposure where there were significant barriers to traditional training methods. We intend to further develop this course to become an integral part of novice anaesthetic training within our trust.
91 Can ‘Pop-Up’ Style Simulation Teaching Improve The Care That Our Children and Young People’s Emergency Department Team Provide for Children Presenting with Fever?
Authors: Collins Sandra , Arulampalam Nirmala , Dunn Helena , Thorpe Emma
Published: January 2022

We wanted to use simulation teaching to improve our multi-disciplinary team’s (MDT) management of children who presented to our Children and Young People’s ED (CYPED) with fever.

The aims of the study were: first, to use simulation teaching to train the MDT in our CYPED, to improve the care delivered to children presenting with fever, measured as an improvement in our compliance with the Royal College of Emergency Medicine’s (RCEM) standards

For cycle one of our audits, we looked at a sample of 136 children who presented to our CYPED with fever; 61 patients met the inclusion criteria and were included. To improve compliance to the RCEM standards

Staff’s self-rated knowledge of the RCEM standards

‘Pop-up’ style simulation teaching can be used to improve the care that we offer our patients, as reflected by an improvement in staff’s confidence and in the department’s compliance with RCEM standards