836 resultados para Health professional education


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This study was conducted to examine how occupational therapists (OTs) practicing in the physical disabilities area received their training in the use of physical agent modalities (PAMs); to determine the frequency of PAMs usage by those therapists; and to obtain their opinions regarding the training of OTs and OT students in the administration of PAMs. Three hundred OTs practicing in physical diabilities (n = 194 returned) were surveyed. The most frequently used modalities were hot and cold packs, paraffin, and ultrasound. The least frequently used modalities were transcutaneous electrical stimulation (TENS) and whirlpool. On-the-job training was the most common educational method received by the respondents for PAMs usage. The respondents considered a combination of undergraduate education, fieldwork, continuing education and on-the-job training as the most appropriate educational setting for training in modalities. While few of the respondents received preparation in PAMs during entry-level academic programs, the majority felt that OT students should be trained in PAMs usage as part of their education curriculum. ^

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The purpose of this study was to determine the knowledge and use of critical thinking teaching strategies by full-time and part-time faculty in Associate Degree Nursing (ADN) programs. ^ Sanders CTI (1992) instrument was adapted for this study and pilot-tested prior to the general administration to ADN faculty in Southeast Florida. This modified instrument, now termed the Burroughs Teaching Strategy Inventory (BTSI), returned reliability estimates (Cronbach alphas of .71, .74, and .82 for the three constructs) comparable to the original instrument. The BTSI was administered to 113 full-time and part-time nursing faculty in three community college nursing programs. The response rate was 92% for full-time faculty (n = 58) and 61% for part-time faculty (n = 55). ^ The majority of participants supported a combined definition of critical thinking in nursing which represented a composite of thinking skills that included reflective thinking, assessing alternative viewpoints, and the use of problem-solving. Full-time and part-time faculty used different teaching strategies. Full-time faculty most often used multiple-choice exams and lecture while part-time faculty most frequently used discussion within their classes. One possible explanation for specific strategy choices and differences might be that full-time faculty taught predominately in theory classes where certain strategies would be more appropriate and part-time faculty taught predominately clinical classes. Both faculty types selected written nursing care plans as the second most effective critical thinking strategy. ^ Faculty identified several strategies as being effective in teaching critical thinking. These strategies included discussion, case studies, higher order questioning, and concept analysis. These however, were not always the strategies that were used in either the classroom or clinical setting. ^ Based on this study, the author recommends that if the profession continues to stress critical thinking as a vital component of practice, nursing faculty should receive education in appropriate critical teaching strategies. Both in-service seminars and workshops could be used to further the knowledge and use of critical thinking strategies by faculty. Qualitative research should be done to determine why nursing faculty use self-selected teaching strategies. ^

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Exposure to certain bloodborne pathogens can prematurely end a person’s life. Healthcare workers (HCWs), especially those who are members of surgical teams, are at increased risk of exposure to these pathogens. The proper use of personal protective equipment (PPE) during operative/invasive procedures reduces that risk. Despite this, some HCWs fail to consistently use PPE as required by federal regulation, accrediting agencies, hospital policy, and professional association standards. The purpose of this mixed methods survey study was to (a) examine factors surgical team members perceive influence choices of wearing or not wearing PPE during operative/invasive procedures and (b) determine what would influence consistent use of PPE by surgical team members. Using an ex post facto, non-experimental design, the memberships of five professional associations whose members comprise surgical teams were invited to complete a mixed methods survey study. The primary research question for the study was: What differences (perceptual and demographic) exist between surgical team members that influence their choices of wearing or not wearing PPE during operative/invasive procedures? Four principal differences were found between surgical team members. Functional (i.e., profession or role based) differences exist between the groups. Age and experience (i.e., time in profession) differences exist among members of the groups. Finally, being a nurse anesthetist influences the use of risk assessment to determine the level of PPE to use. Four common themes emerged across all groups informing the two study purposes. Those themes were: availability, education, leadership, and performance. Subsidiary research questions examined the influence of previous accidental exposure to blood or body fluids, federal regulations, hospital policy and procedure, leaders’ attitudes, and patients’ needs on the use of PPE. Each of these was found to strongly influence surgical team members and their use of PPE during operative/invasive procedures. Implications based on the findings affect organizational policy, purchasing and distribution decisions, curriculum design and instruction, leader behavior, and finally partnership with PPE manufacturers. Surgical team members must balance their innate need to care for patients with their need to protect themselves. Results of this study will help team members, leaders, and educators achieve this balance.

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The term “functional food” (FF) has a variety of definitions resulting in term ambiguity. It is unclear Registered Dietitians’ (RDs) understanding and practices about FF. A descriptive, cross-sectional study investigated RDs’ perceptions, attitudes and practices regarding FF. A national random sample (n=1800) of RDs was mailed a FF questionnaire, 385 (22%) responded. Given five definitions from food-nutrition authorities, the majority of RDs did not agree on a definition, although three-fourths (n=292, 75.8%) perceived fortified foods as FF. Registered Dietitians agreed FF could improve health (n=266, 69.1%), prevent disease (n=282, 73.2%) and treat clientele (n=246, 63.9%), however were neutral (41.6%) or disagreed (37.7%) FF were herbs, or equivalent to medicine (32.7%, 49.2% respectively). Most RDs (n=290, 75.9%) ate FF; fewer (n=231, 61.4%) professionally recommended them. Nearly all (n=353) indicated interest in learning about FF. Registered Dietitians revealed inconsistencies between their perceptions, attitudes and practices regarding FF. Professional education is needed to resolve discrepancies regarding FF.

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This study aimed to construct and carry out a distance course of pedagogical training for health professional performing preceptorship functions in public health institutions. The preceptorship in health is a pedagogical practice that occurs in workplace, led by assistance professionals with teaching position or not, where the vast majority of these acts intuitively, reproducing their own training, confusing transmitting information with education. These preceptors often do not dominate the pedagogical knowledge, necessary for the organization of training activities, such as the various teaching-learning processes and the different assessment types. Student supervision is essential in the training process of students in the health field, and on the occasion of supervised internships that the teaching-learning process is based on practical experience with participation in real life situations and professional work. It was realized an exploratory study, descriptive with qualitative approach, with the development of tutoring teaching course in health as final product. Applied semi structured research instrument from may to july 2014. It were evaluated 162 health professionals who perform the preceptorship, which made it possible define the preceptor's profile and identify the educational requirements related to the educational process, which justified the construction of the program content and the professionals’ perception analysis about preceptorship through identification of three categories: clinic knowledge valuation; valuation of professional orientation and valuation of professional future. The course was available on distance mode through Moodle platform with forty hours of work load from October to November 2014. With the aim of capacitate the health professionals to development of necessary abilities and skills to tutoring performance through thoughts about tutoring concepts, professional training within the curricular guidelines and SUS precepts, the role of health professionals as educators, application of active teaching methodologies, and evaluation methods. The applications were done online through the provided link; 300 vacancies offered, 243 professionals applied, chosen 134 that works on tutoring, where 49 represented professionals that works on the location of the study. The course lasted 45 days, and counted with tutors responsible to interact and evaluate the students. 28 professionals joined the course, 12 concluded. Opportunities were identified to stimulate the involvement, however the professionals’ satisfaction shows that, make an investment on tutors education, starting from the Permanent Education precepts, will provide a bigger appropriation of the knowledge to the education and therefore the awareness of their role as an educator on work ambit, proportioning essential tools to tutors act while enabler of integration between theory and practice and result better teaching-learning process.

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The current conception of health deals with several influential factors, having education among them. Intersectoral organization is essential for Young and adult healthcare services. In this context the Healthcare in School Program was created which foresees a continuous articulation between health and education aiding the effectuation of the Healthcare Single System. The objective of this research is analyze the Healthcare in School Program (HSP) in Natal city in Rio Grande do Norte State taking into consideration the Intersectoriality of actions from the standpoint of the management. The chosen method was the case study, with qualitative approach. The sample was of the intentional kind including all components of the Natal city Intersectorial work group, composed by representatives of the Municipal Education Bureau, the State Education Bureau and Healthcare Municipal Bureau. The collecting data technique was the semi-structured interview. The data analysis was performed through the analysis of contents technique. For Data Show the following analysis categories were considered: Meaning of Intersectoriality; Actions Planning; Permanent and ongoing training for autonomy regarding to Healthcare Promotion; Difficulties and Potentials for actions operationalization. The outcomes allow us to indentify in Natal HSP intersectoral practices not developed yet. The manager professionals of Healthcare and Education do not get to acknowledge the power of Intersectoriality yet. The lack of commitment of some professionals stands out, planning is performed in a sectorial basis and without active participation of learners and community, there is duties accumulation and discouragement group, structural inadequacy and difficulty on the ongoing of the program actions. Despite the existing fragmentation, the program has contributed to the professional qualification and development of education actions regarding to healthcare along with learners. Therefore we conclude that healthcare, education and society have lots of challenges to face in order to consolidate Intersectoriality and the Healthcare in School Program and the and the implementation of the guidelines of the Healthcare Single System in Natal city in the state of Rio Grande do Norte.

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Background: Worldwide, it is estimated that there are up to 150 million street children. Street children are an understudied, vulnerable population. While many studies have characterized street children’s physical health, few have addressed the circumstances and barriers to their utilization of health services.

Methods: A systematic literature review was conducted to understand the barriers and facilitators that street children face when accessing healthcare in low and middle income countries. Six databases were used to search for peer review literature and one database and Google Search engine were used to find grey literature (theses, dissertations, reports, etc.). There were no exclusions based on study design. Studies were eligible for inclusion if the study population included street children, the study location was a low and middle income country defined by the World Bank, AND whose subject pertained to healthcare.

In addition, a cross-sectional study was conducted between May 2015 and August 2015 with the goal of understanding knowledge, attitudes, and health seeking practices of street children residing in Battambang, Cambodia. Time location and purposive sampling were used to recruit community (control) and street children. Both boys and girls between the ages of 10 and 18 were recruited. Data was collected through a verbally administered survey. The knowledge, attitudes and health seeking practices of community and street children were compared to determine potential differences in healthcare utilization.

Results: Of the 2933 abstracts screened for inclusion in the systematic literature review, eleven articles met all the inclusion criteria and were found to be relevant. Cost and perceived stigma appeared to be the largest barriers street children faced when attempting to seek care. Street children preferred to receive care from a hospital. However, negative experiences and mistreatment by health providers deterred children from going there. Instead, street children would often self treat and/or purchase medicine from a pharmacy or drug vendor. Family and peer support were found to be important for facilitating treatment.

The survey found similar results to the systematic review. Forty one community and thirty four street children were included in the analysis. Both community and street children reported the hospital as their top choice for care. When asked if someone went with them to seek care, both community and street children reported that family members, usually mothers, accompanied them. Community and street children both reported perceived stigma. All children had good knowledge of preventative care.

Conclusions: While most current services lack the proper accommodations for street children, there is a great potential to adapt them to better address street children’s needs. Street children need health services that are sensitive to their situation. Subsidies in health service costs or provision of credit may be ways to reduce constraints street children face when deciding to seek healthcare. Health worker education and interventions to reduce stigma are needed to create a positive environment in which street children are admitted and treated for health concerns.

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Students reflect more on their learning in course subjects when they participate in managing their teaching–learning environment. As a form of guided participation, peer assessment serves the following purposes: (a) it improves the student’s understanding of previously established learning objectives; (b) it is a powerful metacognitive tool; (c) it transfers to the student part of the responsibility for assessing learning, which means deciding which learning activities are important and choosing the degree of effort a course subject will require; (d) it emphasizes the collective aspect of the nature of knowledge; and (e) the educational benefits derived from peer assessment clearly justify the efforts required to implement activities. This paper reports on the relative merits of a learning portfolio compiled during fine arts-related studies in which peer assessment played an important role. The researchers analyzed the student work load and the final marks students received for compulsory art subjects. They conclude that the use of a closed learning portfolio with a well-structured, sequential and analytical design can have a positive effect on student learning and that, although implementing peer assessment may be complex and students need to become familiar with it, its use is not only feasible but recommendable.

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A presente dissertação – A Institucionalização no Feminino: que repercussões na Reintegração (Trajectórias de vida e dimensão dos factores de (des) protecção na transmissão intergeracional das jovens que saíram da CIJE de Castelo Branco no período de 1995-2000) – foi realizada no âmbito do VI Curso de Mestrado em Serviço Social. O objecto desta dissertação centrou-se na análise das trajectórias de vida de mulheres adultas que durante a sua infância estiveram internadas na Instituição Casa de Infância e Juventude de Castelo Branco e cuja desinstitucionalização ocorreu no período de 1995 a 2000, considerando como critério a residência das jovens no Distrito de Castelo Branco. Para a prossecução desta investigação, adoptou-se uma metodologia qualitativa. Recorreu-se à análise documental e a entrevistas semi-directivas efectuadas a nove jovens. Com esta investigação pretendeu-se estudar as trajectórias para a obtenção de dados sobre a experiência de vida, o seu processo de autonomização e de que forma a medida de institucionalização se reproduziu nos descendentes, e se estes constam igualmente das crianças e jovens com medida de protecção, nomeadamente de acolhimento institucional. Relativamente aos objectivos, pretendemos: analisar o percurso de vida das jovens com medida de acolhimento institucional; identificar a avaliação das jovens sobre o seu processo de internamento e a experiência de vida; identificar a forma como estas jovens se relacionam com a percepção do conceito formal da lei de “Perigo”; analisar a autonomia de vida face à família, à inserção profissional e eventual ligação face aos sistemas de protecção social; e analisar a situação e as expectativas face às jovens sem filhos. Dos resultados obtidos na presente investigação, podemos concluir que, após a medida de internamento, a maioria das jovens integrou a família de origem. Algumas valorizam este regresso, ressalvando as dificuldades de adaptação à sua família, e à própria comunidade. A maioria das jovens constituíram agregado próprio, revelando capacidades parentais na educação dos seus filhos, e proporcionando-lhes uma infância segura e feliz, assegurando de forma responsável as suas necessidades tendo em vista a sua segurança, saúde, formação, educação e desenvolvimento.

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Background: Maternal occupation as a proxy of environmental exposure has been consistently associated with specific congenital anomalies (CA) in the foetus and newborn. On the other hand, geographical location of the mother such as place of residence and place of work have not been used as proxy for environmental exposures during pregnancy. We designed a pilot study aiming to investigate the association between maternal place of residence and workplace during pregnancy and CA in Portugal. Methods: Cases and controls are identified in the maternity unit. Cases are all live births with at least one CA delivered in the Barreiro hospital located in a heavy industrial area near Lisboa. Controls are the two normal births following each case. Residents outside the study area, stillbirths and women who decline to participate or are incapable of giving consent are excluded. A health professional interviews the mothers using a questionnaire adapted from the registry form of the Portuguese national registry of CA and includes information on places during pregnancy (residence, workplace, leisure), and demographic characterization as place of birth, infant sex, weight, description of CA, age of mother, ethnicity, maternal birth place. Maternal health and obstetric history, education, smoking, alcohol, drugs and medication use is also collected as potential confounders. Results: The pilot study started in January 2016 and at the moment two cases and four controls have been recruited without refusals. The study will continue to be implemented and it is proposed to start in other hospital units during 2016.

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Despite increasing interest in the development of the accountancy profession and constitutive professional bodies in ex-colonies, little is known about the development of professional accountants as individuals. Similarly, although the continuing influence of the legacies of colonialism and imperialism on the accounting professionalisation trajectory in ex-colonies has been recognised, little attempt has been made to theorise such continuing colonial intervention as a postcolonial condition of accommodation and resistance, with implications for the development of professional accountants. This thesis fills this vacuum by employing four aspects of the critical lens of postcolonial theory – local-global nexus, psycho-existential complex, postcolonial hybridity and diaspora - to gain an insight into the development of accounting professionals in ex-colonies with specific reference to Sierra Leone. Specifically, it examines the current model of accounting professionalisation adopted in Sierra Leone and implications for the development of professional accountants in the country; investigates the historical and ideological legacies of colonialism that shaped and continue to influence the professionalisation trajectory in Sierra Leone; explores the perceptions of Sierra Leonean chartered and aspiring accountants of their professional identity in terms of their professional development within Sierra Leone; and explores the lived experiences of Sierra Leonean chartered and aspiring accountants in the diaspora and the diaspora effect on accountancy in Sierra Leone. The empirical evidence presented here emanated from two sources: a web-based survey and semi-structured interviews with Sierra Leonean chartered and aspiring accountants both within and outside the country at the time of the study. The model for developing professional accountants in Sierra Leone comprises a partnership between the local professional body, ICASL, and the British-based global body, the ACCA. A postcolonial analysis of the empirical evidence reveals that an unintended consequence of this model is that the local is co-opted within the global while the global becomes increasingly localised. The analysis also shows that the presence of a perceived global body ‘inferiorises’ the local body to the point of undesirability among local chartered and aspiring accountants. Thus the partnership has to date done little by way of developing ICASL’s capacity to ensure the development of a localised profession and professionals. Instead, it produces, within the Sierra Leone accountancy space, professional hybrids that at once pose as global as well as local accountants. This has significant implications for the local profession because many of the hybrid professional accountants who could potentially drive the local profession forward end up in the diaspora, which leaves the local profession in a weaker state. Also, given the established link between a robust accountancy profession and sustainable economic development, such professional diasporisation could negatively impact on the country’s economic development. In sum, Sierra Leone has failed to establish an accounting professionalisation model that develops professional accountants (through contextualised professional education and training) that meets the specific accounting needs of its growing economy.

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Enquadramento: A amamentação nutre, protege e favorece o desenvolvimento cognitivo e a criação do vínculo afetivo entre mãe e filho. No entanto, há vários fatores que dificultam a manutenção da amamentação como os psicológicos, socioculturais, profissionais, nível de educação, ação dos profissionais de saúde entre outros. Objetivos: Determinar o perfil sociodemográfico das puérperas; identificar as dificuldades mais frequentes associadas à amamentação ao 7º e 30º dia após o nascimento; analisar a influência das variáveis sociodemográficas associadas às dificuldades na amamentação nos dois momentos de avaliação; avaliar a influência das atitudes maternas e a da vinculação pós-natal nas dificuldades associadas à amamentação nos dois momentos de avaliação. Métodos: Estudo quantitativo, longitudinal em painel de curta duração, descritivo-correlacional, numa amostra não probabilística por conveniência de 255 participantes (média de idades de 30,78 anos). Utilizou-se um questionário para caracterizar sociodemograficamente e os contextos de amamentação da amostra, a escala de atitudes maternas face à amamentação (Pereira, 2004) e a escala de vinculação pós-natal (Airosa, Silva & Bachu, 2012), versão portuguesa de Gomez e Leal (2007). Este foi aplicado às participantes em dois momentos (7º e 30º dias após o nascimento do bebé). Resultados: As participantes são maioritariamente casadas, com o ensino superior, empregadas em tempo completo e residentes na cidade. Quanto às dificuldades mais frequentes associadas à amamentação nos dois momentos de avaliação do estudo (7º e 30º dia de vida do bebé) verificamos que as dificuldades sentidas ao 7º dia se mantêm no 30º, predominando as fissuras (7.º dia 41.7%; 39.3% 30.º dia), as dificuldades na pega (7.º dia 28.8%; 31.9% 30.º dia), o ingurgitamento mamário (7.º dia 16.7%; 14.8% 30.º dia). Em relação à influência das variáveis sociodemográficas nas dificuldades associadas à amamentação ao 7º e 30º dia após o nascimento, apurou-se que as diferenças são estatisticamente significativas em relação à escolaridade (p=0,000), situação profissional (p=0,034) e local de residência (0,042), sugerindo que estas variáveis têm poder explicativo sobre as dificuldades sentidas na amamentação pelas mães nos dois momentos de avaliação. Nenhuma das dimensões relativas às atitudes maternas face à amamentação e à vinculação pós-natal se assumiu preditora das dificuldades associadas à amamentação. Conclusão: Os resultados sugerem que os enfermeiros, especialmente no âmbito da saúde materna, obstétrica e ginecológica, estejam mais despertos para as dificuldades que as mães possam ter na amamentação sobretudo no primeiro mês, considerado o mais crítico na adaptação ao aleitamento materno, de modo a conseguirem que estas ultrapassem essas complicações, evitando assim, o abandono precoce da amamentação. Palavra-chave: Amamentação, Atitudes Maternas, Vinculação pós-natal, Dificuldades na amamentação.

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This position paper focuses on the current tensions and challenges of aligning inpatient care with innovations in mental health services. It argues that a cultural shift is required within inpatient services. Obstacles to change including traditional perceptions of the role and responsibilities of the psychiatrist are discussed. The paper urges all staff working in acute care to reflect on the service that they provide, and to consider how the adoption of new ways of working might revolutionise the organisational culture. This cultural shift offers inpatient staff the opportunity to fully utilise their expertise. New ways of working may be perceived as a threat to existing roles and responsibilities or as an exciting opportunity for professional development with increased job satisfaction. Above all, the move to new ways of working, which is gathering pace throughout the UK, could offer service users a quality of care that meets their needs and expectations.

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A inclusão de crianças com necessidades especiais nas escolas comuns é uma idealização voltada para a oportunidade e o respeito à diversidade. Com a Constituição Federal Brasileira (1988), no seu capítulo III, da Educação, da cultura e do desporto, Art. 205, rege que ―A educação, direito de todos e dever do Estado e da família [...]‖ denota que lugar de criança é na escola, independente de credo, deficiência, raça e cultura. O presente estudo de caso na escola pública Rui Barbosa, situada na cidade de Ribeira do Pombal, Bahia, Brasil, pretende conhecer a práxis educativa e o perfil dos profissionais sobre a proposta e a prática pedagógica inclusiva, como também analisar o espaço físico, observando se há ou não barreiras arquitetônicas e acessibilidade para os alunos com deficiência e também a participação da família, em inserir o filho no ambiente formal. Esta investigação tem como base a revisão da literatura sobre inclusão, com a utilização, no enquadramento teórico, da legislação brasileira, entre outros autores voltados ao tema. O desenvolvimento do estudo possui característica qualitativa, através de observação, questionário, entrevista, visitas, ou seja, uma construção através do diálogo e vivência diária realizada no turno matutino. Os participantes dessa investigação foram: gestores, coordenadora da Educação Especial e coordenadora do ensino comum, professores, agentes administrativos, representante da secretaria municipal, profissional da saúde (psicóloga), famílias e alunos do ensino comum e especial. A análise dos resultados obtidos revela que a proposta inclusiva encontra-se em processo de evolução humana e arquitetônica, mas também regista-se pontos positivos no aumento de número de matrículas, ou seja, os pais estão sendo conquistados e adquirindo confiança na instituição. Os professores, apesar da insegurança, da carência de auxílio, não tratam os alunos com desdém e buscam auxiliá-los como podem e sabem. Por fim, a escola aposta num trabalho que envolva o interpessoal e intrapessoal em busca da inclusão sem obstáculos.

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Pesticide residues in food and environment pose serious health risks to human beings. Plant protection laws, among other things, regulate misuse of agricultural pesticides. Compliance with such laws consequently reduces risks of pesticide residues in food and the environment. Studies were conducted to assess the compliance with plant protection laws among tomato farmers in Mvomero District, Morogoro Region, Tanzania. Compliance was assessed by examining pesticide use practices that are regulated by the Tanzanian Plant Protection Act (PPA) of 1997. A total of 91 tomato farmers were interviewed using a structured questionnaire. Purposive sampling was used in selecting at least 30 respondent farmers from each of the three villages of Msufini, Mlali and Doma in Mvomero District, Morogoro Region. Simple Random Sampling was used to obtain respondents from the sampling frame. Individual and social factors were examined on how they could affect pesticide use practices regulated by the law. Descriptive statistics, mainly frequency, were used to analyze the data while associations between variables were determined using Chi-Square and logistic regression model. The results showed that respondents were generally aware of the existence of laws on agriculture, environment and consumer health, although none of them could name a specific Act. The results revealed further that 94.5% of the farmers read instructions on the pesticides label. However, only 21% used the correct doses of pesticides, 40.7% stored pesticides in special stores, 68.1% used protective gear, while 94.5% always read instructions on the label before using a pesticide product. Training influenced the application rate of pesticide (p < 0.001) while awareness of agricultural laws significantly influenced farmers’ tendency to read information on the labels (p < 0.001). The results showed further that education significantly influenced the use of protective gears by farmers (p = 0.042). Education also significantly affected the manner in which farmers stored pesticide-applying equipment (p = 0.024). Furthermore, farmers’ awareness of environmental laws significantly (p = 0.03) affected farmers’ disposal of empty pesticide containers. Results of this study suggest the need for express provisions on safe use and handling of pesticides and related offences in the Act, and that compliance should be achieved through education rather than coercion. Results also suggest establishment of pesticide disposal mechanisms and structures to reduce unsafe disposal of pesticide containers. It is recommended that farmers should be educated and trained on proper use of pesticides. Farmers’ awareness on laws affecting food, environment and agriculture should be improved.