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Prior research finds that clients of high-quality auditors report higher-quality GAAP earnings. We extend this research to investigate whether auditor quality is associated with the quality of voluntarily disclosed non-GAAP earnings measures. Using a sample of Australian firms disclosing annual non-GAAP metrics, we find that clients of high-quality auditors are more likely to voluntarily disclose non-GAAP earnings numbers. However, clients of high-quality auditors make adjustments in calculating non-GAAP earnings (non-GAAP exclusions) that are less predictive of future earnings and less value relevant than those of other firms. These results indicate that their adjustments are of higher quality. We also find similar results for U.S. firms using a sample of quarterly non-GAAP earnings disclosures. Overall, our evidence indicates that commonly used indicators of audit quality for GAAP reporting are positively associated with the quality of voluntarily disclosed non-GAAP earnings measures. JEL Classifications: J33; M41.

Many companies regularly disclose non-GAAP performance measures to communicate firm-specific information that does not fit within the mold of GAAP reporting. However, these non-GAAP measures may have low information content or even be misleading to investors. Thus, the question arises of whether auditors should play a larger role in the reporting of non-GAAP measures, which currently are not audited. We run an experiment to provide ex ante evidence on the effect of auditing non-GAAP measures. Specifically, we present investor-participants with a non-GAAP measure that should be used when making investment judgments (more informative) or should not be used when making investment judgments (less informative) and is either audited or is not audited. As predicted, we find that, when participants view a non-GAAP measure that is more informative, they appropriately use the non-GAAP measure in their investment-related judgments, regardless of whether the measure is audited. However, also as predicted, we find that, while participants appropriately do not use a less informative non-GAAP measure when it is not audited, participants inappropriately do use the less informative non-GAAP measure in their investment-related judgments when it is audited. Mediation results provide evidence consistent with audits affecting investors’ reliance on non-GAAP measures. Specifically, our results are consistent with audits of non-GAAP measures signaling more than is intended, evidenced by investors perceiving an audited non-GAAP measure as being useful in their investment decisions when the measure is less informative to them. Our findings suggest that regulators should exercise caution when it comes to prescribing assurance over non-GAAP measures.

Foram realizados três encontros, na Sala Alfredo Bosi do Instituto de Estudos Avançados da Universidade de São Paulo (IEA-USP). Coordenados pelo Prof. Dr. Rubens Russomanno Ricciardi, os debates adotaram um formato livre, em que todos aqueles que estavam presentes ou que acompanhavam de forma remota puderam dar opiniões e fazer perguntas. Nesse sentido, procurou-se promover a liberdade do debate, sem qualquer rigidez. Ressalta-se que os textos que compõem este dossiê estão em sua forma transcrita e concisa, a partir da gravação dos encontros. Em sua finalização, foram retirados os excessos da oralidade e as passagens pro forma. Também foram feitos ajustes no tocante aos recursos coesivos e normativos da língua portuguesa, mantendo-se o teor das argumentações, sem interferir no tom original.

Traditionally, there has been minimal interest on behalf of developers, land owners as well as private sector stakeholders to redevelop brownfields (De Sousa, 2000). The fears of real or perceived contamination have made the redevelopment project too expensive and risky to develop profitably. Limited government funding and assistance to the private sector for brownfield redevelopment further complicates brownfield redevelopment. This research investigated Ontario’s Community Improvement Plans with brownfield provisions and how they quantitatively aid investor returns. Hypothetical scenarios for a multifamily residential development were generated for both hypothetical brownfield and greenfield sites where brownfield incentives could be implemented. The pro forma analysis revealed that a full exemption from regional development charges (RDC) had the greatest effect on investor returns (NPV and IRR) followed by the joint TIEG offered in the City of Waterloo. Greenfield development is the most financially feasible option with no added costs or risks from contamination.

Introduction Long-term orthodontic retention using removable or fixed retainers is needed to maintain the outcome of orthodontic treatment. The aim of this article is to describe how long-term retention is managed and to report on a survey of general dental practitioners (GDPs) as to how this management currently operates in the UK. Materials and methods GDPs were invited to complete a short online survey on orthodontic retention using an open notice posted in the British Dental Journal and a direct email to the members of a local dental clinical society. Results Fifty-six GDPs completed the online survey. Overall, the findings highlighted poor levels of communication between orthodontists and GDPs with respect to the latter assuming responsibility for the management of long-term retention. Conclusion The management of long-term retention could be improved by more effective communication between the orthodontist and GDP. One solution might be a retention management pro forma. GDPs are in some instances willing to undertake more of the management of retention following further training and possible remuneration., Key points Outlines why long-term orthodontic retention is needed for stability of tooth positions after orthodontic treatment. Highlights the importance of the general dental practitioner's role in long-term orthodontic retention and the need for good communication between orthodontists and general dental practitioners. Suggests how communication between orthodontists and general dental practitioners might be improved.

Background and Aim: Nonsuicidal selfinjury (NSSI) was observed in both males and females, with higher rate among females. NSSI could increase the risk of future suicide attempts. Adolescence is considered as stressful period because of identity crisis, physical growth, coupled with set of decision regarding future profession and personality traits. The study is aimed to find suicidal thoughts, suicidal attempts, extent of the NSSI and its impact on the undergraduate health professionals. Materials and Methods: A cross-sectional study was carried out among medical, dental, and physiotherapy undergraduate college students of Jamnagar, Gujarat. A total of 1850 students were approached, out of them 1050 medical, 500 dental and 300 were physiotherapy students. Participants were requested to fill the pro forma containing following parts: (1) Demographic details, (2) Inventory of Statements about Self-injury, (3) Impact of Non-Suicidal Self-Injury Scale. Results: A total of 1408 students completed the pro forma. Overall 13.99% prevalence rate of NSSI was reported. Female participants had higher prevalence of self-harming behavior than male participants (χ2 = 24.226, P < 0.001). NSSI was related to suicidal thoughts and suicidal attempts with (χ2 = 263.050, P < 0.001) and (χ2 = 197.777, P < 0.001), respectively. A negative correlation was observed with age of onset of NSSI behaviors with and numbers of NSSI behavior (r = −0.317, P < 0.001). Conclusions: Participants engaged in different NSSI behaviors for affect regulation, interpersonal boundaries, sensation seeking, self-punishment, revenge, and self-care. High prevalence of NSSI among young health professionals needs independent clinical attention. There is a need of crisis interventions for the management of self-harming behaviors and to prevent future fetal suicidal attempts.

Purpose/audience: this study targets designers, clinicians and biomedical engineers who are involved in digital surgical planning and patient-specific medical device design, either in hospitals, universities or companies. A commonly accepted, standardized design process does not exist in this specialized but highly variable field, and this can make regulatory compliance via the implementation of quality standards more difficult. Methodology/approach: an article-based design pro-forma was created based on needs identified in previous work. It was structured in order to broadly standardize the design process; consolidate planning and modelling behaviours into discrete clusters; anticipate decision-making on key product requirements; facilitate focused discussion with clients (surgeons); create a pleasurable experience for the designer; and encourage detailed reporting of design decisions and therefore to lower barriers to Quality Management System (QMS) implementation and adherence. The performance of the pro-forma was verified using observation, simultaneous verbalization and semi-structured interviews. Three participants across two contexts were observed designing without and then with the pro-forma. Their behaviours and comments were recorded, their designed outcomes evaluated and their quality compliance assessed. Findings: The design workflow was shown to be segmented and contained within distinct and repeatable steps when using the pro-forma. Reported participant confidence increased and stress decreased. Contact time between participants and clients was consolidated. Designed outputs and documented records successfully complied with generalizable aspects of the International Organization for Standardization (ISO) 13485 standard. However, it did not, and by definition could never, wholly implement a complete certifiable QMS, which must be tailored to a specific organization. Implications for practice, society or research: as demand for patient-specific devices continues to rise, and as regulatory requirements about QMS adherence extend to cover all contexts, organizations will need to react accordingly. This pro-forma offers a clear direction for how to introduce evidence-based best practices, and a starting point for full QMS certification. Originality/value: this research marks the first attempt to standardize this highly specialized design process across users, tools and contexts.

Lifestyle modification is a pivotal intervention for Familial Hypercholesterolaemia (FH). This study aims to describe the lifestyles (physical activity and healthy diet) and their associations with sociodemography, illness characteristics, psychological elements, family support and level of barrier. 100 participants were given Pro forma questionnaires to assess sociodemography and illness characteristics. The lifestyles, psychological elements, family support and level of barrier were assessed using the Theory of Planned Behaviour questionnaire. The determinants of healthy lifestyles include the status of receiving treatment, level of barrier and intention for behavioural change. The findings may inform the strategy for lifestyle modification of FH patients.Keywords: Familial Hypercholesterolaemia; lifestyle; physical activity; healthy diet.eISSN: 2398-4287© 2020. The Authors. Published for AMER ABRA cE-Bs by e-International Publishing House, Ltd., UK. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Peer-review under responsibility of AMER (Association of Malaysian Environment-Behaviour Researchers), ABRA (Association of Behavioural Researchers on Asians) and cE-Bs (Centre for Environment-Behaviour Studies), Faculty of Architecture, Planning & Surveying, Universiti Teknologi MARA, Malaysia.DOI: https://doi.org/10.21834/ebpj.v5i14.2335

The complexity of the business and financial world in the 4.0 industrial revolution era, making decision making needs to pay attention to financial modeling and pro forma analysis. This research uses descriptive method by reviewing 15 articles about financial modeling and pro forma analysis in the last 5 years. The results of the analysis for 5 years have not shown the relationship between profitability and risky cash flow and its implications for financial modeling and its effect on proforma analysis. Related to further research, designing a model in the figure can be a relevant reference to the development of financial management science of the industrial revolution era 4.0. Abstrak– Kompleksnya dunia bisnis dan keuangan pada era revolusi industry 4.0, membuat pengambilan keputusan perlu memperhatikan financial modeling dan pro forma analysis. Penelitian ini menggunakan metode deskriptif dengan mengkaji 15 artikel tentang financial modeling dan pro forma analysis pada kurun waktu 5 tahun terakhir. Hasil analisis selama 5 tahun belum mengungkapkan hubungan antara profitability dengan cashflow at risk serta implikasinya pada financial modeling dan dampaknya pada proforma analysis. Sehingga dalam penelitian berikutnya, rancangan model pada gambar dapat menjadi rujukan yang relevan dengan perkembangan ilmu manajemen keuangan era revolusi industry 4.0.

The Adopt-A-Park Programme has Information on depression, anxiety and predictors for these mental illnesses among the staff of the academic institution is sparse. Hence, this study aimed to determine the prevalence of these mental illnesses and investigate possible predictors. Depression, Anxiety and Stress Scale 21-item and pro forma questionnaires were used to assess the presence of depression, anxiety, sociodemographic, personal and job-related factors. Of 278 participants, 27.7% had depression, and 26.7% had anxiety. Predictors for depression include inadequate workplace facilities, low-tier job category, working in urban campus and low income. Predictors for clinical anxiety were high workplace responsibility and low-tier job category. Keywords: Depression; Anxiety; Academic Institution; Staff 2398-4279 © 2019 The Authors. Published for AMER ABRA CE-Bs by E-International Publishing House, Ltd., UK. This is an open-access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Peer-review under responsibility of AMER (Association of Malaysian Environment-Behaviour Researchers), ABRA (Association of Behavioural Researchers on Asians) and cE-Bs (Centre for Environment-Behaviour Studies), Faculty of Architecture, Planning & Surveying, Universiti Teknologi MARA, Malaysia. DOI: https://doi.org/10.21834/ajqol.v4i17.197

Introduction: Emotional intelligence (EI) impacts many different aspects of daily life, such as the way one behaves and interacts with others. Empathy, one of the five elements of EI, is considered to be the most important psychosocial factor of inpatient care. An assessment of EI and empathy would help health-care professionals give better patient-centered care. Aims and Objectives: This study aims to assess the various components of EI among medical students and professionals and study its relation with personal and social factors. Materials and Methods: This is a cross-sectional study conducted with a sample that consists of 200 participants in Mamata Medical College, Khammam and Pratima Medical College, Karimnagar, Telangana during a period of 6 months (2018). A semi-structured pro forma is used to collect sociodemographic profile and the emotional quotient self-assessment checklist by Sterrett is used to measure EI and empathy. Results: There is a significant negative correlation between work hours and empathy, individuals with lesser work hours scored higher on empathy and social competence. There is also a significant negative correlation between motivation and sleep hours, individuals with more number of sleep hours scored lesser on motivation. Those who exercised scored higher on self-awareness and social competence as compared to those who never exercised. Individuals with a greater number of friends in the workplace scored significantly higher in confidence and motivation. Conclusion: The current study supports that good work relations, empathy, and exercise have a positive correlation with various domains of EI.

The Supreme Court of the Federation of Bosnia and Herzegovina had to determine the applicable law to the arbitration clause contained in general conditions of sale on seller's website. The sales agreement was concluded orally and the reference to the website with general conditions of sale was made on a pro forma invoice paid by the buyer. The arbitration clause provided for ICC Rules and seat of arbitration in Amsterdam, while French law was chosen to apply to the contract. The buyer, a domestic company from Bosnia and Herzegovina, filed for damages before domestic courts, claiming that the arbitration clause was not consented to, nor was it concluded in written. The Supreme Court of the Federation of Bosnia and Herzegovina issued in the "chicken breed" case in 2019 a pro-arbitration judgment with reference to the New York Convention of 1958 and European Convention on Interna New York Convention of 1958 and European Convention on International Commercial Arbitration of 1961. It is a landmark decision on one of the most difficult questions of applicable law to formal and substantive validity of the arbitration agreement.

Serbian local state-owned enterprises (SOEs) owed in excess of EUR 220mn in late 2015, with estimates reaching a much higher figure. According to the national Fiscal Council, underinvestment by local governments amounted to some EUR 250mn annually. This paper looks at insufficient commercial borrowing by local SOEs trying to identify the causes of this financing gap by looking at two aspects: on one hand, we look at quantitative and qualitative inputs provided by local SOEs for credit analysis that may cause significant information asymmetries, and, on the other, we consider the possibility that bank credit analyses, even if done properly, could reveal that these firms are unable to borrow from banks. The research has revealed that the length and efficiency of the bank credit approval process is dictated by: the need to properly organise qualitative and quantitative SOE information and ensure that it reflects the actual state of affairs; the poor quality of financial statements of SOEs and their pro forma annual business planning and reporting; a common lack of appropriate revaluation of future income; and an existent drawback related to ownership over fixed assets that are considered as a public property in Serbia (rather than as a property of the SOE that uses them). On the other hand, banks do not distinguish sufficiently between private firms and SOEs. This does not allow banks to account for issues specific to SOEs such as the spillover of fiscal risk, corporate governance, relationships between the owner and its SOEs, economic and social objectives, and the like. The frequent inability of local SOEs to provide mortgages as collateral, coupled with the restriction on guarantees from local governments, nearly completely preclude lending for large-scale and long-term investment. We conclude that local SOEs have a limited access to finance due to information asymmetries caused by unsuitable qualitative and quantitative inputs made by SOEs in the credit analysis process. Nevertheless, appropriate credit analyses reveal that these companies can be able to borrow commercially, especially in lower amounts and at shorter maturities which could mitigate underinvestment by local SOEs.

Refereed/Peer-reviewed Through systems thinking it is recognised that human error is not a matter of personal control, but an emergent property of overall system design. In the context of rail, Signal Passed at Danger (SPAD) incidents are a weak link in an otherwise safe system and one of the few points where a single failure can have catastrophic consequences. One area overlooked in SPAD research is the investigation process itself, specifically in terms of what investigators do and do not look at when investigating incidents. The aim of this study was to examine the document (i.e. pro forma) investigators use to capture information and attribute SPAD causation, in order to determine the extent which systems thinking is reflected in the information captured. A qualitative cross-sectional multiple-case design was used to categorise a large dataset comprising completed SPAD pro formas (n = 208) from 10 rail organisations across Australasia. Conventional content analysis identified two types of SPAD pro forma (modulated, narrative) varying in length (long, short), and a comprehensive hierarchical description revealed shallow methods of analysis, and the tendency to emphasise and attribute SPAD causation to the individual-level (human error, personal factors) without identification of deeper underlying factors and other system influences. Findings are discussed in relation to the idea that SPAD pro formas are educative tools shaping the focus of investigations, and the observed deficiencies limit the learning that can be drawn from incidents and real change that can be achieved. SPAD pro forma development is needed, scaffolded by further research

This article explores the theoretical foundations for a social justice���centric global law clinic movement. Our starting position is that law clinics, a type of clinical legal education (CLE), are in a unique position to engage in, and potentially promote, social justice issues outside their immediate communities and jurisdictions. To achieve this aim, it is necessary for law clinics to adopt a universal pro forma underpinned by the key concepts of CLE, namely social justice education and promoting access to justice through law reform. We argue that the main features of CLE are aligned with those of the Universal Declaration of Human Rights (UDHR) on issues such as human dignity and social justice. Incorporating UDHR values into CLE serves three purposes. First, it acts as a universal pro forma, which facilitates communication between clinics across jurisdictions, irrespective of their cultural or legal background. Second, it allows clinics to identify sources of global injustices and to share resources and expertise to collectively address injustices. Third, the theoretical approach advocated in this article argues that clinics have a Kantian moral right to engage in transnational law reform., Asian Journal of Legal Education, vol. 9, no. 1, p. 23

Introduction This project developed and analysed the impact of a ward round pro forma across three wards of a large tertiary hospital containing positive or high-risk COVID-19 patients. [...]pertinent information might be missed and patient care may suffer due to incomplete records. The primary aim was to increase the amount of information documented during ward rounds (20% increase in number of parameters) and increase junior doctor confidence in documenting (1 Likert point).

Purpose The purpose of this paper is to present scenarios of interactive trilateral foreign exchange (FX) exposure, where a company’s exposures to two foreign currencies depend on those currencies’ FX rate with each other. Design/methodology/approach A pro forma analysis of three-way FX rate changes illustrates interactive trilateral FX exposure and generates observations for a multivariate regression estimation of FX exposure coefficients. Findings The multivariate regression estimates of FX exposure provide the basis for a useful financial hedging strategy for interactive trilateral FX exposure. Some of the FX exposure estimates have surprising signs and magnitudes. Research limitations/implications Scenario analysis does not result in a general theory of interactive FX exposure, but the study’s diverse and rich scenarios may provide helpful insights to theoretical and empirical researchers. Practical implications The scenarios relate to many common real-world situations and thus may help managers and educators better understand how to manage FX exposure. Originality/value The topic of interactive FX exposure is under-researched and under-covered in contemporary textbooks or the applied finance literature.

INTRODUCTION: Good communication skills can increase the health-care providers' diagnostic efficiency and decision making ability, as well as lead to improved patient satisfaction. The aim of this study is to determine the attitude associated with learning communication skills among dental and medical students. MATERIAL AND METHODS: A descriptive study was conducted among 231 students, studying in Universal College Of Medical Sciences (UCMS), College of Dental Surgery, Bhairahawa, Nepal using a standardized pro forma which consisted of questions on general information and of communication skills using validated Communication Skills Attitude Scale. For statistical analysis, Mann-Whitney U test and Kruskal-Wallis test were applied. RESULTS: Students indicate high levels of positive attitudes and low levels of negative attitudes. Attitudinal scores differ insignificantly in relation to gender. CONCLUSION: Medical and dental students in our study show basically a positive approach. Further investigation is necessary to explore and understand attitudes towards communication skills of medical and dental undergraduates.

The study explored the influence of principals’ leadership styles on senior secondary school students’ achievement in chemistry in the Kogi State of Nigeria. It was guided by one research question and three hypotheses. Correlation survey research design was used. The target population was Senior Secondary Class Three chemistry teachers and students in all the public secondary schools in Kogi State. The sampling technique used was multiple stage samplings which included purposive and simple random sampling techniques. Based on the sampling technique, 42 teachers of 264 and 420 students of 4100 were selected. Two instruments were used to collect data, namely a questionnaire titled “Principals’ Leadership Style Questionnaire” (r = 0.88), and a pro forma designed to collect student’s results from the principal’s offices. Data were analyzed using mean, standard deviation, and Pearson product moment correlation coefficient. The results revealed that authoritarian leadership was the dominant leadership style used by the senior secondary school principals in Kogi State. In addition, chemistry students under the leadership of democratic principles performed better than their counterparts under authoritative and laissez-faire principals. It is recommended, among others, that principals of senior secondary schools adopt a democratic leadership style and that principals should be given orientation on the use of democratic leadership.

There is good evidence that dedicated early arthritis clinics (EACs) improve referral lag time and reduce delay in establishing disease-modifying therapy. However, it remains arguable whether such clinics improve relevant disease outcomes. Nationally, only 57% of units have dedicated EACs. Our rheumatology department established a centralised, patient-focused and multidisciplinary EAC to achieve key financial and clinical outcome targets the department was failing to meet. The EAC aimed to increase the department’s capacity to accommodate referrals from general practitioners (GPs) and other sources, decrease the time between diagnosis and starting therapy, establish standardised treatment algorithms and reduce biologic use. The EAC was established in January 2016 and comprised the introduction of a dedicated referral pro forma and an EA educational programme for GPs, pooling of all sources of referral, running of six EACs per week with availability of ultrasound and introduction of a standardised approach to the early initiation of therapy and timely review of treatment outcomes. The introduction of the EAC was associated with improved clinical outcomes (EA patients achieving a Disease Activity Score 28 (DAS28)

In this paper, we examine the effect of voluntary adoption of clawback provision on non-GAAP earnings disclosures. The extant literature documents that the voluntary adoption of clawback provisions improves financial reporting quality by increasing the costs of misstating GAAP earnings. However, managers may respond to perception of reduced discretion over GAAP reporting by increasing their reliance on non-GAAP earnings disclosures. We find that managers more frequently disclose non-GAAP earnings after the voluntary adoption of clawback provisions, relative to a propensity-matched sample of control firms. In addition, we find that the quality of non-GAAP earnings exclusions deteriorates after voluntarily adopting clawbacks, consistent with a more opportunistic use of non-GAAP reporting. Our results extend the growing literature on clawback adoption and suggest that the improvement in GAAP reporting quality associated with clawbacks may be achieved at the expense of deterioration in the quality of non-GAAP earnings. This unintended consequence has implications related to the mandatory adoption of clawbacks required under the Dodd-Frank Act of 2010.

Background: Personality of an individual can be influenced by a variety of factors, including parenting and mother–child interactions in childhood. Reduced time spent with mother due to early employment of mother can affect the personality development in a positive or negative way. Personality, in turn, can influence academic performance, learning, and coping in Bachelor of Medicine, Bachelor of Surgery (MBBS) students. This study aims at exploring the association of mother's employment in the initial period of life and personality traits in MBBS students. Methods: This was a cross-sectional study conducted in a tertiary care center. Consecutively selected 200 MBBS students of all the academic years were interviewed using a semi-structured pro forma and big five inventory scale. Data were statistically analyzed using mean, standard deviation, Chi-square test, and other tests. A P < 0.05 was considered statistically significant. Results: Mothers of 21% of the students worked during pregnancy, and mothers of 33% of the students started working within the first 6 months of delivery. Significantly, high score of extraversion, agreeableness, and openness was found in students whose mothers started working within the first 6 months of delivery. No significant correlation was found between early employment of mother and scores of neuroticism and conscientiousness. Neuroticism score was higher in final MBBS students, students living away from home, and those staying in nuclear families. Conclusion: Early employment in mother was associated with high extraversion, agreeableness, and openness in MBBS students.

Background: Major depressive disorder (MDD) is among the most common mental disorders. Apart from the high prevalence, depression has been found to contribute to a high degree of impairment in functioning, equalling or exceeding that associated with debilitating medical conditions. Despite this, research shows a large treatment gap and demonstrable benefits on addressing this gap. Hence, it becomes important to study the factors affecting help-seeking behaviors among patients with MDD. Our study aims to assess these factors. Methods: It was a cross-sectional study conducted on 100 consecutive consenting patients of MDD in the department of psychiatry of a tertiary care hospital. The instruments used were semi-structured pro forma for sociodemographic details, Big Five Inventory-10 Scale for personality traits, K10 rating scale for psychological distress, and Depression Stigma Scale to assess the stigma faced. Results: In our study, we found (a) sociodemographic factors such as higher family income, joint family type, and rural locality to be statistically significantly associated with late help seeking and (b) patient-related factors of higher levels of perceived stigma to be statistically significantly associated with late help-seeking behavior. Conclusions: Factors such as family type, stigma, and living in a rural area were significantly associated with late help seeking. Psychoeducation of family members and increased awareness and access to mental health-care professionals may help address these issues. Studying factors affecting help seeking on a larger scale may help with policy formulation in future.

The growing number of federal judicial vacancies impacts judiciary's ability to efficiently resolve litigation. This impact warrants an investigation of any factor that has the potential to affect the number of vacancies. This paper examines three factors in relation to the federal judicial nomination process. The examination is performed through a statistical analysis of judicial confirmation rates in relation to the elements. The elements of principal concern are: the National Labor Relations Board v. Noel Canning Supreme Court ruling, Harry Reid’s 2013 removal of the 60 vote requirement to invoke cloture on a nomination, and the mutable power assigned to blue slips. The data shows a complete stoppage of attempted recess appointments following the Supreme Court ruling. Due to calculated scheduling of pro forma sessions by Congress, there have been no recesses that exceed the necessary time frame established by the Supreme Court to make a recess appointment. The removal of the 60 vote requirement to invoke cloture resulted in a 267% increase in confirmed nominees during the 113th Congress. This increase was not sustained through a divided Senate and executive, and the 115th Congress’s confirmation rate does not indicate the trend will continue. However, the data set is currently insufficient to make a final judgement on its impact. Blue slipping, as an uncodified procedure, has a variable influence on judicial nominees. A correlation between the chair of the Senate Judiciary Committee and nominee ideology suggests that chairmen are more likely to expedite the appointment of nominees with ideologies similar to their own.

Introduction: According to the World Health Organization, more than 300 million people were estimated to suffer from depression in 2017. Many studies have observed that medical personnel have a higher level of depression, but studies among dentists are scarce. Early diagnosis will help in controlling the morbidity and mortality due to depression. Hence, this study was undertaken to estimate the prevalence of depression among students of Government Dental College (GDC), Thiruvananthapuram, the capital city of the state of Kerala, India. Materials and Methods: A cross-sectional study was conducted at GDC, Thiruvananthapuram, for a period of 3 months from September to December 2017, using the Patient Health Questionnaire-9 (PHQ-9) and a pro forma comprising 37 questions. Students having PHQ scores >9 were considered to have depression. The questionnaire was administered on 364 students comprising undergraduate students, paradental students, house surgeons, and postgraduates. Separate sessions were arranged for each group and four reminders were given. Results: The prevalence of depression was estimated as 26.9% (95% confidence interval: 22.4–31.8). Being married, having high and average level of course satisfaction, and having close friends were found to act as independent protective factors, whereas female gender and breakups in relationships were found to be independent risk factors. Conclusion: It is high time we provide supportive programs and implement preventive measures to help professional students, especially those who are at higher risk of mental ill-health. Further studies need to be conducted to explore the academic reasons for depression.

Introduction Within our Trust, Orthopaedic patients are clerked in on A&E notes via freehand text. Audit, clinical incidents, and root cause analysis revealed suboptimal documentation. Using RCSEng Best Practice Guidelines we designed, implemented, and evaluated the impact of an admission pro-forma on quality of clerking. Method An Orthopaedic clerking pro-forma was designed based on standards set by RCSEng and feedback from Orthopaedic colleagues. First- and second-cycle data collection involving quantitative analysis of clerking against RCSEng domains was conducted before (n = 23) and after (n = 25) intervention. Fisher’s exact test was performed to calculate the statistical significance of our data. A qualitative survey was performed to gain feedback on the pro-forma. Results Observations, allergies, and smoking history were omitted in over half of freehand documentations. Medical/surgical history and management plans were well documented regardless. Intervention resulted in statistically significant increases in 7 out of 12 RCSEng clerking domains, most notably allergies (p Conclusions Our study demonstrated that implementing an Orthopaedic pro-forma improved adherence to RCSEng best practice clerking guidelines compared to freehand documentation and standardised the process improving the level and quality of documentation.

Introduction. Templates and checklists have improved patient outcomes in multiple settings.1,2 There are barriers in junior doctors scribing complete entries using blank sheets; patient care might suffer due to incomplete records. This project implemented a ward round pro-forma across three wards of a tertiary hospital containing high risk COVID-19 patients, aiming to improve both documentation rates and subsequent ease in finding pertinent information. Methods. Respiratory consultants determined 11 key parameters that should be documented daily for COVID-19 patients. Baseline objective data collection analysed all high-care ward round entries (n = 15), recording parameters as present or absent. Multidisciplinary team (MDT) opinions were collected via questionnaire. The pro-forma was trialled for two-weeks; repeated subjective and objective analysis was performed. All (n = 12) inpatient notes on the COVID-19 high-care ward were analysed. Results/Discussion. Pro-forma compliance was 100%. The mean number of key parameters documented per ward round entry increased by 80%, from 5 to 9. Eleven (100%) of the key parameters showed increased completion rates (fig.1). Junior doctor confidence increased 1-Likert point: ‘average’ to ‘confident’ (fig.2). 97% of respondents (n = 31) reported the pro forma saved time. Information finding and swab tracking both increased by 1-Likert point: ‘average’ to ‘easy’ (fig.2). From a medico-legal perspective, documentation of basic information (date, time) improved by 13%. This project shows not only a 60% increase in ceiling of care documentation, but also improved ease in accessing such information. Conclusion. This pro-forma is a simple and acceptable intervention to improve documentation rates and information accessibility, giving junior doctors more confidence.

Introduction Venous Thromboembolism (VTE) is a source of significant preventable morbidity and mortality amongst hospital inpatients. NICE recommends considering VTE prophylaxis (VTEp) for patients receiving palliative care. This quality improvement project looked at the completion rate of VTEp assessment at Roxburghe House (RH), a Scottish Specialist Palliative Care Unit, where a VTEp pro forma was first introduced in 2018. Aim To assess the completion rate of VTEp assessment and decision documentation amongst admissions to RH. To subsequently implement a modified VTEp assessment form to improve VTEp assessment and decision documentation according to NICE guidance. Methods Admission documents for 36 consecutive patients to RH were reviewed from October to November 2020. Data including primary condition, admission medications, VTEp assessment, and VTEp decisions were recorded. A modified VTEp pro forma in an innovative flow chart format was introduced as the sole intervention. A further 27 consecutive patients‘ admission documents were subsequently reviewed. Results 23/36(63.9%) of all admissions during the initial cycle had VTEp decision documented. 7/36(19.4%) were for VTEp and 13/36(36.1%) were not. Only 15/36(41.7%) had both VTEp assessment and decision documented. Amongst those with no VTEp prescribed nor decision documented, 9/36(25%) may benefit from VTEp on review. The VTEp decision documentation rate increased to 23/27(85.2%) after the intervention. 14/27(51.9%) were for VTEp, 8/27(29.6%) were not. 23/27(85.2%) had both VTEp assessment and decision documented. Amongst those with no VTEp prescribed nor decision documented, 3/27(11.1%) may benefit from VTEp on review. Conclusion Two years after the implementation of VTEp assessment pro forma in RH in 2018, the VTEp assessment completion rate has decreased to pre-2018 level. The redesigned VTEp form has led to an increase in VTEp assessment and decision documentation rate in RH. Further work is required to assess the review of VTEp decisions on an ongoing basis during admission.