Goal-Directed Therapy to Improve Gross Motor Function and the Quality of Life of Children with Cerebral Palsy: A Randomized Controlled Trial

Background: The multiplicity of interventions for the treatment of cerebral palsy (CP) can cause confusion about which are most suited to certain individuals. Hypothesis is that goal-directed therapy (GDT) can guide integrating therapies to improve clinical outcomes compared with conventional therapy (CT). Method: A prospective, assessor-blinded, randomized controlled trial was done with 23 children with CP (mean age, 4 years 4 months old; SD 1y4mo), who were divided into groups according to their level of gross motor function: GDT and CT. Both groups received 12 physiotherapy (PT) sessions and advice on daily home programs. The GDT group additionally had a team meeting to set a specific goal, and PT programs were shaped toward that goal. Assessments were done at baseline and after treatments, using the Thai-version Gross Motor Function Measure (GMFM-66), CP-Quality of Life (CP-QOL), caregiver burden, and home program compliance. Results: After the treatments, the GDT group showed significant improvements in GMFM-66, CP-QOL, and caregiver burden, while the CT group revealed improvements in caregiver burden and some domains of the GMFM, including sitting and crawling & kneeling. Comparisons between groups found GDT was more effective than CT in improving GMFM-66 and CP-QOL. Home program compliance was higher in the GDT (69%) than the CT group (42%). Conclusion: GDT demonstrated clear gains for children with CP regarding gross motor function and QOL improvements. Team communication toward a customized goal was crucial, empowering the children and their caregivers to comply with home programs to achieve the set goal.

Compliance and Fidelity With an Injury Prevention Exercise Program in High School Athletics

Background: Use of injury prevention programs (IPPs) by high school athletes has increased but their success in reducing injury depends on program compliance and fidelity of exercise performance. Hypothesis: Compliance with the 11+ IPP and exercise performance fidelity by high school athletic teams depend on sex, sport, and level of play. Study Design: Secondary analyses of data from a randomized controlled trial (RCT). Level of Evidence: Level 2. Methods: The 11+ IPP was implemented by 100 male and female high school athletic teams (American football, soccer, basketball, and lacrosse). Team compliance and fidelity with the program were evaluated by direct observation of warm-up routines and a weekly online survey completed by coaches. Differences in compliance and fidelity due to sport, sex, and level of play were assessed by analysis of variance. Results: Coaches reported that their teams performed the full IPP an average of 1.45 times per week, and 28% of observed warm-ups included all exercises in the IPP. Compliance differed by sport but not by level of play or the athletes’ sex. At the end of the season, cueing was observed 19% of the time and differed by sport. Good technique was observed 66% of the time and varied by level of play. Conclusion: Team compliance with the IPP varied by sport and was below the recommended number of sessions per week needed to reduce injury. Removal of implementation barriers and improved support from coaches are needed at all levels of play for IPPs to be effective. Clinical Relevance: Clinical and sports practitioners intending to implement an IPP at the high school level should anticipate and address barriers that affect program compliance and fidelity of exercise performance. Frequent follow-up and instruction may be necessary for successful adoption of the IPP.

European framework standards for study programs in food science and engineering

The role of European documents in the development of learning outcomes is described in the paper. In addition to the main European documents describing the qualification level of graduates, the sectoral frameworks provide a benchmark for learning outcomes in the profile of the program. Compliance with the framework standard is the foundation for a study program to receive a quality label. As an example, the EQAS-Food and EUR-ACE® standards for study programs in the field of food science and engineering are considered. The focus on the framework standards ensure transparency and harmonization of study programs with European best practice.

Optimization of REMS Program Compliance in a Large Academic Health System

Ensuring compliance with all applicable Risk Evaluation and Mitigation Strategies (REMS) programs within a health system is challenging. These FDA-mandated programs are numerous, unique, and ever-changing. Actions require several stakeholders and moving parts. In addition, the effectiveness and impact of these programs has been challenged and is not always clear, which hampers buy-in and therefore compliance. F&MCW is a health network in southeastern Wisconsin that includes five hospitals and almost 40 clinics. Since 2014, several system-wide approaches to medication use, including formulary alignment and REMS program optimization, have taken place with an over-arching goal of providing efficient, safe, and consistent care for the patients and populations served. This manuscript describes the steps that took place over the past six years or so related to REMS program optimization. It also offers practical tips for other health systems based on lessons learned through this one institution’s experiences.

The Impact of Ambiguity-induced Error in Offender Decision-making: Evidence from the Field

Objectives: To invoke behavioral economics theories of ambiguity in the context of offender decision-making, and to test the impact of ambiguity in punishment certainty on offender decisions. Methods: We leverage a quasi-experimental condition among a sample of drunk driving arrestees that are tested for alcohol use and subject to mandatory brief incarceration for a violation. The treatment condition relaxes a zero-tolerance alcohol rule, thereby introducing design-based ambiguity surrounding the certainty of punishment. We use Mahalanobis matching and propensity score weighting methods to estimate the impact of ambiguity on violations. We then interrogate this finding with complementary sensitivity analyses. Results: When facing the ambiguity condition participants are 27–28 percentage points (84–93 percent) more likely to violate program conditions after 30 days of supervision. We demonstrate that a statistical difference in violations due to ambiguity is still detectible at 90 and 180 days of supervision. These results are robust to alternative specifications and falsification tests. Conclusions: This study is the first to examine the impact of ambiguity on criminal justice program compliance using a quasi-experiment from the field. We further demonstrate the unintended costs to persons under supervision and jurisdictions of laxity in program design, which are applicable across criminal justice domains.

Analysis of Engineering Accreditation Process and Outcomes: Lessons Learned for Successful First Time Application

The aims of the paper are to share and analyze engineering accreditation experience starting from the preparation through the outcome, and to discuss lessons learned particularly for first-time applicants. Securing accreditation from a well-recognized international body, such as the Accreditation Board for Engineering and Technology (ABET) can indicate quality of an engineering program. To qualify for an accreditation up to six- to seven-year period, an engineering program must meet a set of accreditation standards or criteria. The article is not limited only for new engineering programs outside the United States who are willing to pursue engineering accreditation from ABET, but it is applicable for an existing accredited program who will undergo next accreditation cycle. The authors presented and analyzed detail accreditation experience for a new established Civil Engineering (CE) Program at Prince Mohammad bin Fahd University (PMU) in Saudi Arabia. Although the ABET website provides detail procedure for the accreditation steps, the detail cases experienced by the PMU CE program will enrich knowledge on how to prepare and handle successful international accreditation. The authors also discussed issues raised during the accreditation activities, including program compliance with the nine ABET criteria, and presented key lessons to prepare for a smooth accreditation process. The main significant result of the accreditation exercise about continuous improvement was summarized in term of the curriculum upgrade, including adding another semester for senior design course and offering new sustainability engineering course, and adding computer aided design course at the early semester.

Enhanced recovery for obese patients undergoing gynecologic cancer surgery

ObjectiveTo compare post-operative length of stay and complication rates of matched obese and non-obese patients in an enhanced recovery (ERAS) program after open gynecologic cancer surgery.MethodsWe performed an observational cohort study of patients (n=1225) undergoing open surgery from November 2014 to November 2018 at a tertiary cancer center. Patients undergoing multidisciplinary procedures, non-oncologic surgery, or procedures in addition to abdominal surgery were excluded (n=190). Obese and non-obese patients were matched by date, age, disease status, and surgical complexity. The primary outcome was post-operative length of stay. Secondary outcomes included 30-day peri-operative complications, re-operation, re-admission, opioid use, and program compliance.ResultsAfter matching, 696 patients (348 obese, 348 non-obese) with median age of 57 years (IQR 48–66) were analyzed. Obese patients had a longer median procedure time (218 min vs 192.5 min, p<0.001) and greater median estimated blood loss (300 mL vs 200 mL, p<0.001). Median (IQR) post-operative length of stay was the same for obese and non-obese patients: 3 days (IQR 2–4). Obese and non-obese patients had similar rates of grade III–IV complications (10.9% and 6.6%, respectively, p=0.06), re-operation (2.3% and 1.4%, respectively, p=0.58), and re-admission (11.8% and 8.0%, respectively, p=0.13). Grade I–II complications were more common among obese patients (62.4% vs 48.3%, p<0.001) because they had more wound complications (17.8% vs 4.9%, p<0.001). Obese patients received more opioids both during surgery (morphine equivalent dose 57.25 mg (IQR 35–72.5) vs 50 mg (IQR 25–622.5), p=0.003) and after surgery (morphine equivalent daily dose 45 mg/day (IQR 10–96.2) vs 29.37 mg/day (IQR 7.5–70), p=0.01). Obese and non-obese patients had similar ERAS program compliance (70.1% and 69.8%, respectively, p=0.32).ConclusionsNeither post-operative length of stay nor the rate of serious complications differed significantly despite longer surgeries, greater blood loss, and more opioid use among obese patients. An ERAS program was safe, effective, and feasible for obese patients with suspected gynecologic cancer.

Pengaruh Celengan Padjeg terhadap Kepatuhan WP Dengan Motivasi WP Sebagai Variabel Intervening (Studi Kasus Di Wilayah Kerja KPP Wonosari)

This study aims to determine the effect of Celengan Padjeg Program, on taxpayer compliance with taxpayer motivation as an inetervening variable. The population used is 116 taxpayers who have received the Celengan Padjeg Program in the working area of KPP Pratama Wonosari with a total sample of 89 respondents and 80 questionnaires that can be processed. The analysis tool used is multiregression with path analysis as a method of analysis of mediation variables. The result, Celengan Padjeg Program can have a significant positive effect directly on taxpayers motivation but not for taxpayers compliance. In addition, taxpayers Motivation can have a significant positive effect on taxpayers compliance. Finally, the Celengan Padjeg Program can have a significant positive effect through taxpayers motivation on taxpayers compliance with taxpayers motivation as a significant intervening variable mediating the Celengan Padjeg Program on taxpayers compliance.Keyword: Celengan Padjeg Program, Compliance, Motivation

THE CHALLENGES OF TEACHING FOREIGN LANGUAGES TO STUDENTS WITH SPECIAL EDUCATIONAL NEEDS

A modern university answering the challenges of the society does not remain aloof to introduce certain inclusive practices. Currently, the legislation of the Russian Federation clearly distinguishes between the concepts of “Disability”, “Special health opportunities “and” Special educational needs”. However, there is a demand to combine all three terms into one, that is “Special educational needs”. The author considers this substitution to be unlawful. The article attempts to analyze each term from the point of view of prospects for each group of students to get higher education, taking into account the peculiarities of their psychophysical development. In addition, the author reviews some difficulties (insufficient technical equipment of the classrooms, learned helplessness of students, lack of knowledge about various nosological groups of disabled people, etc.) and ways to overcome these and other problems such as development of an adapted educational program, compliance with the principles of health conservation, psychological readiness of the teaching staff to work with such students. The author draws the conclusion that only training of teachers and the creation of a special educational space, the inadmissibility of a formal approach to the integration of students with special educational needs can contribute to the successful provision of their right to education.