Taking advanced clinical practice to the streets: an evaluation of the benefits and challenges in homeless health care

Homelessness in the UK continues to rise. People who are homeless are more likely to have poor health and die early, and face multiple barriers to accessing health care. Ten years have passed since the Marmot review recommended action on these disparities. In the context of significant health inequalities, advanced clinical practitioners (ACPs) offer a different approach to homeless health care, providing complete episodes of care in complex situations and leading in integrating multiple agencies, service development and strategic advocacy. ACPs can use their expertise in this specialty to deliver education that raises awareness and reduces prejudice. Their research skills can identify gaps and expand the evidence base to improve practice at local and national levels. However, ACPs must promote their own roles, work closely with people with lived experience and be supported by their employers to embrace all four pillars of advanced clinical practice for the full benefits to be realised.

1370 Classifying Morbidity and Error in Oral and Maxillofacial Trauma Using the Clavien-Dindo Classification: A Prospective Pilot Study

Introduction The collection of morbidity outcomes following surgery was recommended by the Royal College of Surgeons of England in 2014. They suggest a structure to stratify complications into groupings but do not include a classification this limits comparison. Our unit, a regionalised maxillofacial trauma service, introduced a standardised morbidity and error classification to be applied at M&M meetings. Method Prospective collection of data from March 2019 to February 2020. All patients discussed at our M&M meeting were then classified according to the Clavien-Dindo Classification (2004), assigned an error type and recommended action determined through a panel of between 5-10 consultants. Results 301 surgical procedures were carried out with a 7% complication rate. 26 cases were discussed at M&M. The commonest error type was ‘nature of the disease’ (48%) followed by ‘error in judgement’ (37%). Clavien-Dindo Classification IIIb (intervention under GA) was the most frequent morbidity (74%) Conclusions Standardised national data collection of morbidity and error can be used to analyse a single institution or between institutions to improve patient care. To our knowledge, this is the first standardised classification of morbidity in maxillofacial trauma and was of educational and service benefit. However, there was discussion of the appropriateness of the classification systems to facial fractures. We would therefore recommend further development of both a morbidity classification and an error type classification specific to treatment of facial fractures so that it can be used to improve outcomes for our patients in the future.

DUALISME KETENTUAN COST RECOVERY SEBAGAI DASAR PUNGUTAN NEGARA PADA INDUSTRI HULU MIGAS

This article traces and describes the changes made from time to time, to the calculation and determination of government share, as obtained from corporate revenues and tax deducted based on Production Sharing Contract, as used in the Indonesian natural gas and oil sector. Qualitative data is gathered by performing a legal audit and literature review. The issue discussed here is the disagreement existing between the government and contractor regarding the calculation of recoverable cost (based on the Production Sharing Contract) and amount of corporate income tax imposed based on the prevailing tax law. Based on the review of legal materials and literature, the recommended action is to harmonize these two different tax-revenue schemes.

Welfare problems of horses

The article presents an analysis of the basic concepts of animal welfare, which is a prerequisite for quality and successful innovative animal husbandry. The horses welfare should be considered from the standpoint of the concept of the "five freedoms", which should be reflected in the lives of animals. The aim of the article is to analyze the state of the horses welfare and the prospects of development and implementation at the national and European levels. The analysis indicates the need to develop a system for assessing the welfare of horses and its implementation in Ukraine, while, taking into account objective and subjective indicators, the system for assessing the welfare of horses should include owners, veterinarians (horse care) and experts. To assess the welfare of sport horses, the Veterinary Regulations (BP) of the International Equestrian Federation (FEI) must be used during the competition, which must be observed during the event. Methods for assessing the degree of welfare, characterize the condition of the animal in both external and internal indicators, but the dominant is stress, which through the nervous and endocrine systems adversely affect all parts of the immune system. In Ukraine, the horse population has tripled reduce in thirty years and continues to decline, but the analysis of horse welfare in Ukraine is either not conducted at all, or is sporadic and mainly aimed at assessing individual animal health indicators (assessment of body condition, lameness, etc.). Therefore, in Ukraine it is necessary to establish criteria and develop a system for assessing the welfare of horses, improving the legal framework and implementation in practice. A plan of recommended action for stakeholders (federations, veterinarians, horse owners, government services, etc.) was presented, and it was recommended to develop and implement criteria for assessing the welfare of horses that could be used to study animal welfare. We believe that the system of horse welfare assessment as a consulting tool is necessary for the standardization of survey and analysis of welfare, to develop measures to optimize the management of horses, which should be the main document of equestrian associations of Ukraine. In addition, legislation on the welfare of horses is crucial, but there is no legislation acts in the field of welfare. Undoubtedly, in combination with the welfare of horses, it is important to develop an algorithm for biosecurity in the horses management with an emphasis on the epizootology of diseases, vaccination conditions, disinfection and analysis of critical points of admission to animals, which should be the basis for the development of the National Standard for Welfare and Biosecurity at the level of horse farms in Ukraine.

Annual effective dose from radon-222 concentration levels in underground water in bungoma south sub - county, Kenya

This research measured the concentration levels of radon in groundwater and determined the ingestion and inhalation dose. The study used RAD7 detector with RAD7-H2O accessory from Durridge Company to determine the radon levels. Thirty water samples in granitic dominated regions were collected from various areas of Bungoma County: ten from boreholes (BH), ten from hand dug wells (WL) and ten from springs (SP). The water samples were collected in 250 ml bottles which were tightly covered with lid to avoid radon leakage. The highest value was 303±4.00 KBq/m3 recorded in Kanduyi well and the lowest was 126±11.4kBq/m3 from where most of the samples recorded a high radon concentration with a mean of 269±5.25 KBq/m3 in wells, 213±7.96 KBq/m3 in boreholes and 290±7.70 KBq/m3 in springs. The average ingestion dose was found to be 1.5±0.07mSv/yr, 1.9±0.09 mSv/yr and 2.1±0.1 mSv/yr. The average annual effective dose rate for the samples collected were 2±0.1 mSv/yr for boreholes, 2.6±0.13 mSv/yr for wells and 2.7±0.14 mSv/yr for springs. The samples reported an average value of AED higher than the world average of 1.15 mSv/yr but below the exception limit of recommended action level of 10 mSv/yr hence the radon concentration levels in underground water in the study area has minimal health implications to the population.

COMMON INSTRUCTIVES IN NETWORK DISCOURSE

The article devoted to speech genre «common instructives» in network discourse. They are understood as various types of advice. The main feature is the addresser desire of providing assistance to the addressee. The functional characteristics of the instructives are related with the following features: 1) the direction of the illocutionary act; 2) obligatory or non-obligatory of the expected action implementation; 3) participants attitude to the recommended action in the communication; 4) tone of utterance. The areas of instruction dissemination are wide and varied. They are often found in the form of requirements, regulations, instructions, and warnings. They are characterized by the asymmetric top-down relations model, in which the addressee superiority is found, but at the same time the actions of addresser are independent. Instructives can illustrate a positive or a negative addressee reaction i.e. they can be accepted or not. Instructives in the web often merge with entertaining genres of playful sayings such as absurd or "harmful" advice.

Associations Between School Characteristics and Classroom Radon Concentrations in Utah’s Public Schools: A Project Completed by University Environmental Health Students

Radon (²²²Rn), a radioactive gas, is the second leading cause of lung cancer deaths in the U.S. Classroom radon concentrations in public schools in our target area had never been measured or had not been measured in many years. We had university students, primarily enrolled in environmental health courses, measure radon concentrations in 2289 classrooms in 66 of Utah’s public schools and identify school characteristics associated with classroom radon concentrations. The geometric mean (GM) classroom radon concentration was 31.39 (95% confidence interval (CI): 27.16, 36.28) Bq/m3 (GM: 0.85; 95% CI: 0.72, 0.98 pCi/L). Thirty-seven (2%) classrooms in 13 (20%) schools had radon concentrations at or above the U.S. Environmental Protection Agency’s (EPA) recommended action level of 148 Bq/m3 (4.0 pCi/L). Number of classrooms had a u-shaped association with classroom radon concentrations. The year the heating, ventilation, and air conditioning (HVAC) system was installed was inversely associated with having classroom radon concentrations at or above the EPA’s recommended action level. Number of classrooms and number of students had u-shaped associations with having classroom radon concentrations at or above the EPA’s recommended action level. Classroom radon concentrations decreased when schools’ HVAC systems were on. Replacing HVAC systems and turning/keeping them on may be effective radon mitigation strategies to prevent radon-associated lung cancer, especially for small and large schools.

Compliance and Social Psychology

It is through the influence process that people generate and manage change. As such, it is important to understand fully the workings of the influence processes that produce compliance with requests for change. Fortunately, a vast body of scientific evidence exists on how, when, and why people comply with influence attempts. From this formidable body of work, one can extract six universal principles of influence that generate compliance in the widest range of circumstances. Reciprocation states that people are more willing to comply with requests (for favors, services, information, concessions, etc.) from those who have provided such things first. Commitment/Consistency states that people are more willing to be moved in a particular direction if they see it as consistent with an existing commitment. Authority states that people are more willing to follow the directions or recommendations of a communicator to whom they attribute relevant expertise. Social Proof states that people are more willing to take a recommended action if they see evidence that many others, especially similar others, are taking it. Scarcity states that people find objects and opportunities more attractive to the degree that they are scarce, rare, or dwindling in availability. Finally, Liking states that people prefer to say yes to those they like, such as those who are similar to them and who have complimented them.

Evaluation of Current Tarnished Plant Bug (Hemiptera: Miridae) Thresholds in Transgenic MON 88702 Cotton Expressing the Bt Cry51Aa2.834_16 Trait

The tarnished plant bug, Lygus lineolaris (Palisot de Beauvois), is an important pest of cotton in many areas of the southern United States. An experiment was conducted at two locations in Mississippi during 2016 and 2017 to evaluate action thresholds for tarnished plant bug on a novel Bacillus thuringiensis cotton that expresses the Cry51Aa2.834_16 toxin. Treatments included the current action threshold, a 2× threshold, and treatments where insecticides were only applied during the early season (preflower) or only during late season (during flowering) based on the current action thresholds. These were compared to an untreated control and a weekly insecticide use regime that received weekly insecticide sprays. All treatments were imposed on both Bt Cry1Aa2.834_16 cotton and a nontraited cotton. The Bt Cry1Aa2.834_16 trait reduced the number of tarnished plant bugs and injury, and improved yields compared to nontraited cotton. For all spray treatments except the weekly insecticide use regime, yields were greater for the Bt Cry51Aa2.834_16 cotton than the nontraited cotton. In terms of thresholds, Bt Cry1Aa2.834_16 cotton sprayed based on current action thresholds resulted in similar yields to the weekly insecticide use regime of both cotton types. In contrast, the 2× threshold resulted in lower yields than the current threshold for both cotton types. Though thresholds intermediate to the currently recommended action threshold and the 2× threshold were not tested, these data suggest that currently recommended action thresholds appear appropriate for Bt Cry51Aa2.834_16 cotton. These results suggest that this trait will be an important component of current IPM programs in cotton where tarnished plant bug is an important pest.

Debate on the Plan of Making ‘Fiqh Waria’: Framing Analysis in Online Media

<p><em><span lang="EN">This research is an online media study about the phenomenon of ‘waria’ (transgender) people in Indonesia. Okezone.com reports about plans to make ‘Fiqh Waria.’ Fiqh is expected to be a reference for ‘waria’ to perform religious rituals in Islam. Islam has different laws between men and women. Research using Robert N. Entman's Framing Analysis. According to Entman, framing is a selection process that highlights aspects: problem identification, causal interpretation, moral evaluation, and action recommendations. The results of the study mentioned that in identifying the problem, it was reported about the plan to make a special jurisprudence called ‘Fiqh Waria.’ In causal interpretation, making fiqh is needed so that they can perform worship after gender changes. In moral evaluation, transgenders are considered to have the same right to perform worship rituals. In the recommended action, it was reported that if the fiqh would become religious jurisprudence that humanizes humans.</span></em></p>