Search results for: surgical instruments

Authors: Amani M. Al-Hussan

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The current study aimed to explore the effects of science teaching strategies course (CURR422) on developing academic self efficacy and motivation towards teaching it in female primary classroom teachers in College of Education in Princess Nora Bint AbdulRahman University. The study sample consisted (48) female student teachers. To achieve the study aims, the researcher designed two instruments: Academic Self Efficacy Scale & Motivation towards Teaching Science Scale while maintaining the validity and reliability of these instruments.. Several statistical procedures were conducted i.e. Independent Sample T-test, Eta Square, Cohen D effect size. The results reveal that there were statistically significant differences between means of pre and post test for the sample in favor of post test. For academic self efficacy scale, Eta square was 0.99 and the effect size was 27.26. While for the motivation towards teaching science scale, Eta was 0.99 and the effect size was 51.72. These results indicated high effects of independent variable on the dependent variable.

Keywords: academic self efficiency, achievement, motivation, primary classroom teacher, science teaching strategies course, evaluation

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Authors: Rimel Mwamba, Mohan Gundeti

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Introduction: The use of robot-assisted laparoscopic surgeries (RALS) has largely increased in recent years, offering faster and safer treatment options for pediatric patients. In the field of urology, RALS has shown a significant advantage over laparoscopic and open surgeries but continues to be controversial in pediatric cases due to limited comprehensive data on its use. Methods: In this review, we aim to summarize the factors associated with RALS use in pediatric cases involving pyeloplasty, ureteral reimplantation, heminephrectomy, and lower urinary tract reconstruction. We used PubMed, EMBASE, and the Cochrane Database of Systematic Reviews to systematically search for literature on the topic. We then critically assessed and compiled data on RALS outcomes, complications, and associated factors. Results: To date, numerous comparative studies have been conducted on pediatric RALS, with only one randomized control trial investigating the nuances of robotic use against standard of care treatments. These robotic approaches have shown promise in post-surgical outcomes for pediatric patients undergoing upper and lower urinary tract reconstruction. Barriers to use still persist, however, showcasing a need to increase access to the technology, refine instruments for pediatric use, address cost barriers, and provide proper training for surgeons. Conclusion: RALS providesan opportunity to improve pediatric patient outcomes for numerous urologic complications. Additional studies are required to better compare the use of RALS with current standard practices. Due to the difficult nature of conducting randomized control trials, additional prospective observational studies are needed.

Keywords: pediatric urology, robot-assisted laparoscopic surgeries (RALS), pyeloplasty, ureteral reimplantation, heminephrectomy, and lower urinary tract reconstruction

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Authors: Yanuarti Retnaningrum, Cendrawasih A. Farmasyanti, Kuswahyuning

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Orthodontists find challenges in treating patients who have cases of macroglossia and multiple tooth agenesis because difficulties in determining the causes, formulating a diagnosis and the potential for relapse after treatment. Definition of macroglossia is a tongue enlargement due to muscle hypertrophy, tumor or an endocrine disturbance. Macroglossia may cause many problems such as anterior proclination of upper and lower incisors, development of general diastema and anterior and/ or posterior open bite. Treatment for such patients with multiple tooth agenesis and macroglossia can be complex and must consider orthodontic and/or surgical interventions. This article discusses an orthodontic non surgical approach to a patient with a general diastema in both maxilla and mandible associated with multiple tooth agenesis and macroglossia. Fixed orthodontic therapy with straightwire appliance was used for space closure in anterior region of maxilla and mandible, also to create a space suitable for future prosthetic restoration. After 12 months treatment, stable and functional occlusal relationships was achieved, although still have edentulous area in both maxilla and mandible. At the end of the orthodontic treatment was obtained with correct overbite and overjet values. After removal of the brackets, a maxillary and mandibular removable retainer combine with artificial tooth were placed for retention.

Keywords: general diastema, macroglossia, space closure, tooth agenesis

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Authors: Nicholas Bayfield, Liam Bibo, Kaushelandra Rathore, Lucas Sanders, Mark Newman

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INTRODUCTION: Surgical pulmonary embolectomy is an established therapy for acute pulmonary embolism causing right heart dysfunction and haemodynamic instability. Massive intraoperative airway haemorrhage is a rare complication of pulmonary embolectomy. We present our institutional experience with massive airway haemorrhage complicating pulmonary embolectomy and discuss optimal therapeutic strategies. METHODS: A retrospective review of emergent surgical pulmonary embolectomy patients was undertaken. Cases complicated by massive intra-operative airway haemorrhage were identified. Intra- and peri-operative management strategies were analysed and discussed. RESULTS: Of 76 patients undergoing emergent or salvage pulmonary embolectomy, three cases (3.9%) of massive intraoperative airway haemorrhage were identified. Haemorrhage always began on weaning from cardiopulmonary bypass. Successful management strategies involved intraoperative isolation of the side of bleeding, occluding the affected airway with an endobronchial blocker, institution of veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) and reversal of anticoagulation. Running the ECMO without heparinisation allows coagulation to occur. Airway haemorrhage was controlled within 24 hours of operation in all patients, allowing re-institution of dual lung ventilation and decannulation from ECMO. One case in which positive end-expiratory airway pressure was trialled initially was complicated by air embolism. Although airway haemorrhage was controlled successfully in all cases, all patients died in-hospital for reasons unrelated to the airway haemorrhage. CONCLUSION: Massive intraoperative airway haemorrhage during pulmonary embolectomy is a rare complication with potentially catastrophic outcomes. Re-perfusion alveolar and capillary injury is the likely aetiology. With a systematic approach to management, airway haemorrhage can be well controlled intra-operatively and often resolves within 24 hours. Stopping blood flow to the pulmonary arteries and support of oxygenation by the institution of VA ECMO is important. This management has been successful in our 3 cases.

Keywords: pulmonary embolectomy, cardiopulmonary bypass, cardiac surgery, pulmonary embolism

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Authors: Ching-Yuan Chen, Lung-Kwang Pan

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Objective: Back pain is a major health problem costing billions of health budgets annually in Taiwan. Thousands of back pain surgeries are performed annually with up to 40% of patients complaining of back pain at time of post-surgery causing failed back surgery syndrome (FBSS), although diagnosis in these patients may be complex. The aim of study is to assess the feasibility of using bone SPECT-CT imaging to localize the active lesions causing persistent, recurrent or new backache after spine surgery. Materials and Methods: Bone SPECT-CT imaging was performed after the intravenous injection of 20 mCi of 99mTc-MDP for all the patients with diagnosis of FBSS. Patients were evaluated using status of subjectively pain relief, functional improvement and degree of satisfaction by reviewing the medical records and questionnaires in a 2 more years’ follow-up. Results: We enrolled a total of 16 patients were surveyed in our hospital from Jan. 2015 to Dec. 2016. Four people on SPEC/CT imaging ensured significant lesions were undergone a revised surgery (surgical treatment group). The mean visual analogue scale (VAS) decreased 5.3 points and mean Oswestry disability index (ODI) improved 38 points in the surgical group. The remaining 12 on SPECT/CT imaging were diagnosed as no significant lesions then received drug treatment (medical treatment group). The mean VAS only decreased 2 .1 point and mean ODI improved 12.6 points in the medical treatment group. In the posttherapeutic evaluation, the pain of the surgical treatment group showed a satisfactory improvement. In the medical treatment group, 10 of the 12 were also satisfied with the symptom relief while the other 2 did not improve significantly. Conclusions: Findings on SPECT-CT imaging appears to be easily explained the patients' pain. We recommended that SPECT/CT imaging was a feasible and useful clinical tool to improve diagnostic confidence or specificity when evaluating patients with FBSS.

Keywords: failed back surgery syndrome, oswestry disability index, SPECT-CT imaging, 99mTc-MDP, visual analogue scale

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Authors: Roman Girma Teshome

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The intersection between development and human rights has been the point of scholarly debate for a long time. Consequently, a number of principles, which extend from the right to development to the human rights-based approach to development, have been adopted to understand the dynamics between the two concepts. Despite these attempts, the exact relationship between development and human rights has not been fully discovered yet. However, the inevitable interdependence between the two notions and the idea that development efforts must be undertaken by giving due regard to human rights guarantees has gained momentum in recent years. On the other hand, the emergence of sustainable development as a widely accepted approach in development goals and policies makes this unsettled convergence even more complicated. The place of sustainable development in human rights law discourse and the role of the latter in ensuring the sustainability of development programs call for a systematic study. Hence, this article seeks to explore the relationship between development and human rights, particularly focusing on the place given to sustainable development principles in international human right law. It will further quest whether there is a right to sustainable development recognized therein. Accordingly, the article asserts that the principles of sustainable development are directly or indirectly recognized in various human rights instruments, which provides an affirmative response to the question raised hereinabove. This work, therefore, will make expeditions through international and regional human rights instruments as well as case laws and interpretative guidelines of human rights bodies to prove this hypothesis.

Keywords: sustainable development, human rights, the right to development, the human rights-based approach to development, environmental rights, economic development, social sustainability

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Authors: Ahmed Gendia, Waseem Kamran

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Objective: Total Laparoscopic hysterectomy (TLH) remains a common approach among laparoscopic surgeons. However, this approach depends on the use of uterine manipulator to facilitate the surgery. Although many studies reported the effectiveness of TLH with uterine manipulator, only few reported TLH without the use of any uterine or vaginal manipulation. the aim of this report is to demonstrate our Technique (kamran's TLH) in performing TLH without the use of any uterine or vaginal manipulation in benign conditions and report our intra- and post-operative outcomes. Methodology : surgical technique will be demonstrated through a short video highlighting the easy and safe to learn surgical steps. Additionally, the data of 86 patients who underwent KTLH for benign condition were retrospectively analyzed. the data included intra- and postoperative finding and complications. Results : A total of 86 hysterectomies were performed utilizing the Kamran's TLH ( KTHL). Mean age was 52.2 (±11) years old and BMI was 28.2(±7). Mean operative time was 64.7(±27.9) minutes and estimated bloods loss was 46.2(±54.6) ml. No intraoperative complications were recorded and there was no conversion to open surgery. Only one patient required readmission and surgery for vaginal vault dehiscence. Conclusion & Significance: Uterine manipulator is a key component in performing laparoscopic hysterectomy. However, our approach demonstrated that TLH can be safely performed without the use of any uterine or vaginal manipulation.

Keywords: laparoscopic hystrectomy, TLH, uterine manipulator, surgery

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Authors: Leonore Robieux, Franck Zenasni, Marc Pocard, Clarisse Eveno

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Empirical data in health psychology studies show the necessity to consider the doctor-patient communication and its positive impact on outcomes such as patients’ satisfaction, treatment adherence, physical and psychological wellbeing. In this line, the present research aims to define the role and determinants of an effective doctor–patient communication during the treatment of patients with serious illness (peritoneal carcinomatosis). We carried out a prospective longitudinal study including patients treated for peritoneal carcinomatosis of various origins. From November 2016, to date, data were collected using validated questionnaires at two times of evaluation: one month before the surgery (T0) and one month after (T1). Thus, patients reported their (a) anxiety and depression levels, (b) standardized and individualized quality of life and (c) how they perceived communication, attitude and empathy of the surgeon. 105 volunteer patients (Mean age = 58.18 years, SD = 10.24, 62.2% female) participated to the study. PC arose from rare diseases (14%), colorectal (38%), eso-gastric (24%) and ovarian (8%) cancer. Three groups are defined according to the severity of their pathology and the treatment offered to them: (1) important surgical treatment with the goal of healing (53%), (2) repeated palliative surgical treatment (17%), and (3) the patients recused for surgical treatment, only palliative approach (30%). Results are presented according to Baron and Kenny recommendations. The regressions analyses show that only depression and anxiety are sensitive to the communication and empathy of surgeon. The main results show that a good communication and high level of empathy at T0 and T1 limit depression and anxiety of the patients in T1. Results also indicate that the severity of the disease modulates this positive impact of communication: better is the communication the less are the level of depression and anxiety of the patients. This effect is higher for patients treated for the more severe disease. These results confirm that, even in the case severe disease a good communication between patient and physician remains a significant factor in promoting the well-being of patients. More specific training need to be developed to promote empathic care.

Keywords: clinical empathy, determinants, healthcare, psychological wellbeing

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Authors: Suppawan Lertpongpakpoom, Anongnat Boonrat, Kunya BoontummoSuppawan

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This descriptive cost analysis aimed to analyze the unit cost of patients in medical intensive care unit. Purposive sampling was used to select 20 nurses, 6 practical nurses, 5 nurses aid and select samples 30 patients. Data were collected from both primary source (activity and average time of nursing care) and secondary source Z bill of payment and patient record). Instruments were cost recording form, activity observation form, and service recording form. Content validity of all instruments were evaluated by three experts (CVI = 0.87). Descriptive statistics was employed for data analysis. The results of the Activity-Based Costing Analysis showed that total activity cost of 4 service types for the patients was 14,776.92 Bath. The highest cost was nursing record was 5,674.78 Bath, followed direct nursing activity was 5,176.18 Bath, medical treatment was 1,976.6 Bath. The lowest cost was management activity was 1,003.64 Bath per visit. The result suggested that Activity-Base Costing Analysis could be applied to give better understanding of cost structure, enabling better consideration wasted expense and non-value-added activity, and improvement of effective utilization.

Keywords: activity-based costing, medical intensive care, nursing care, cost analysis

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Authors: Mohamed Ghoz, Hala Alsabeh

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Context: Macroscopic Nose Macroneedling (MNM) is a new non-surgical procedure for lifting and tightening the nose. It is a tissue-non-invasive technique that uses a needle to create micro-injuries in the skin. These injuries stimulate the production of collagen and elastin, which results in the tightening and lifting of the skin. Research Aim: The research aim of this study was to investigate the efficacy and safety of MNM for the treatment of nasal deformities. Methodology A total of 100 patients with nasal deformities were included in this study. The patients were randomly assigned to either the MNM group or the control group. The MNM group received a single treatment of MNM, while the control group received no treatment. The patients were evaluated at baseline, 6 months, and 12 months after treatment. Findings: The results of this study showed that MNM was effective in improving the appearance of the nose in patients with nasal deformities. At 6 months after treatment, the patients in the MNM group had significantly improved nasal tip projection, nasal bridge height, and nasal width compared to the patients in the control group. The improvements in nasal appearance were maintained at 12 months after treatment. Theoretical Importance: The findings of this study provide support for the use of MNM as a safe and effective treatment for nasal deformities. MNM is a non-surgical procedure that is associated with minimal downtime and no risk of scarring. This makes it an attractive option for patients who are looking for a minimally invasive treatment for their nasal deformities. Data Collection: Data was collected from the patients using a variety of methods, including clinical assessments, photographic assessments, and patient-reported outcome measures. Analysis Procedures: The data was analyzed using a variety of statistical methods, including descriptive statistics, inferential statistics, and meta-analysis. Question Addressed: The research question addressed in this study was whether MNM is an effective and safe treatment for nasal deformities. Conclusion: The findings of this study suggest that MNM is an effective and safe treatment for nasal deformities. MNM is a non-surgical procedure that is associated with minimal downtime and no risk of scarring. This makes it an attractive option for patients who are looking for a minimally invasive treatment for their nasal deformities.

Keywords: nose, surgery, tie, suture

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Authors: Mohamed Fairooz Abdul Khir

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The linkage between liability for risk and legitimacy of reward is a governing principle that must be fully observed in financial transactions. It is the cornerstone of any Islamic business or financial deal. The absence of risk taking principle may give rise to numerous prohibited elements such as ribā, gharar and gambling that violate the objectives of financial transactions. However, fiqhī domains from which it emanates have not been clearly spelled out by the scholars. In addition, the concept of risk taking in relation to contemporary risks associated with financial contracts, such as credit risk, liquidity risk, reputational risk and market risk, needs further scrutiny as regard their Sharīʿah bases. Hence, this study is imperatively significant to prove that absence of risk taking concept in Islamic financial instruments give rise to prohibited elements particularly ribā. This study is primarily intended to clarify the concept of risk in Islamic financial transactions from the fiqhī perspective and evaluate analytically the selected issues involving risk taking based on the established concept of risk taking from fiqhī viewpoint. The selected issues are amongst others charging cost of fund on defaulting customers, holding the lessee liable for total loss of leased asset under ijārah thumma al-bayʿ and capital guarantee under mushārakah based instruments. This is a library research in which data has been collected from various materials such as classical fiqh books, regulators’ policy guidelines and journal articles. This study employed deductive and inductive methods to analyze the data critically in search for conclusive findings. It suggests that business risks have to be evaluated based on their subjects namely (i) property (māl) and (ii) work (ʿamal) to ensure that Islamic financial instruments structured based on certain Sharīʿah principles are not diverted from the risk taking concept embedded in them. Analysis of the above selected cases substantiates that when risk taking principle is breached, the prohibited elements such as ribā, gharar and maysir do arise and that they impede the realization of the maqāṣid al-Sharīʿah intended from Islamic financial contracts.

Keywords: Islamic finance, ownership risk, ribā, risk taking

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Authors: Jiayun Shen, Lorenz Wyss, Thierry Golliard, Matthias Finger

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Innovation is widely recognized as the key for private enterprises to win the market competition. The state-owned-enterprises need to be innovative to compete in the market after the privatization as well. However, it is a lack of research to study how state-owned-enterprises manage innovation to create new products and services. Swiss Post, a Swiss state-owned-enterprises, has established a department to transform the corporate culture and foster innovation to achieve digital transformation. This paper describes the innovation management process at the Swiss Post and analyzes the impacts of the instruments, the organizational structure, and explores the barriers of innovation. This study used qualitative methods based on a review of the literature on innovation management and semi-structured interviews. Being established for over five years, the Swiss Post’s innovation management department has established a software-assisted modularized platform with systematic instruments to help the internal employees with the different innovation processes. It guides the innovators from idea creation to piloting in markets and supports with a separate financing source, with knowledge inputs and coaching, as well as with connections to external partners through the open innovation and venturing team. The platform also adapts to different business units within the corporate with a customized tailor for the various operational business units. The separate financing instruments enabled the creation and further development of new ideas; the coaching services contribute greatly to the transformation of teams’ innovation culture by providing new knowledge, thinking methods, and use cases for inspiration. It also facilitates organizational learning to help the whole corporate with the digital transformation. However, it is also confronted with a big challenge in twofold. Internally, the disruptive projects often hardly overcome the obstacles of long-established operational processes in the traditional business units; externally, the expectations of the public and restrictions from the federal government have become high hurdles for the company to stay and compete in the innovation track.

Keywords: empirical case study, innovation management, state-owned-enterprise, Swiss Post

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Authors: Obinna Emmanuel Nkomadu

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A major maritime problem in the African continent is the widespread proliferation of threats to maritime security, and one of which is the traffic in persons (TIP) at sea, which victims are sometimes assaulted, injured, killed, and in many cases go missing. The South African and Nigerian law on TIP at sea is the Prevention and Combating of Trafficking in Persons Act and the Trafficking in Persons (Prohibition) Enforcement and Administration Act, respectively. These legislation prohibits TIP at sea but does not provides effective and efficient national coordination structures and international cooperation measures against traffickers who engage on human trafficking on the African maritime domain. As a result of the limitations on the maritime security laws of most African States and the maritime security threats on the continent, the African Union in 2016 adopted the African Charter on Maritime Security and Safety and Development in Africa (Lome Charter). The Lomé Charter provides mechanisms for national and international cooperation on maritime security threats, including TIP at sea. However, the Charter is yet to come into force due to the number of States required to accede or ratify the Charter. This paper identifies gaps on existing instruments on TIP at sea by those States and justify on South Africa and Nigeria should adopt the Charter. The justification flow from analysing relevant international law instruments, as well as legislation on human trafficking.

Keywords: cooperation against trafficking in persons at sea, lomé charter, maritime security, Nigerian legislation on trafficking in persons, South African legislation on trafficking in person, and trafficking in persons at sea

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Authors: Zohreh Hajiha

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Culture affects the ability of the organization in expressing and achieving the goals. Organizational culture influences the selection of instruments applied in the management of organizations. All the instruments applied in organizations to control, promote and create innovations are influenced by organizational culture. This research studies organizational culture based on the cultural model of Muijen and its relationship with applying management accounting innovations in Iranian listed firms. Management accounting innovations of this study include activity-based costing, activity-based management, balanced scorecard, target costing, standard costing, quality costing, Kaizen costing and dimensions of organizational culture include support orientation, innovation orientation, rules orientation and goal orientation. 105 questionnaires were sent to financial executives of production companies and 73 questionnaires were returned. The findings show that there is a significant difference between organizational culture of firms that have applied management accounting innovations and those which have used these innovations less. Also, dimensions of support orientation and culture goal orientation are the highest in groups that apply management accounting innovations. The findings suggest that proper organization culture could promote the use od management accounting tools in Iranian firms.

Keywords: organizational culture, innovation, management accounting, muijen model

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Authors: Ahmed Mostafa, Mohamed Mahmoud, Nesreen H. Hafez, Mohamed Fahim

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This retrospective study includes 60 patients with pre-invasive breast cancer. Aim of the study: Evaluation of premalignant lesions of the breast (DCIS), different treatment methods and outcome. Patients and methods: 60 patients with DCIS were studied from the period between 2005 to 2012, for 38 patients the primary surgical method was wide local resection (WLE) (63.3%) and the other cases (22 patients, 36.7%) had mastectomy, fourteen cases from those who underwent local excision received radiotherapy, while no adjuvant radiotherapy was given for those who underwent mastectomy. In case of hormonal receptor positive DCIS lesions hormonal treatment (Tamoxifen) was given after local control. Results: No difference in overall survival between mastectomy & breast conserving therapy (wide local excision and adjuvant radiotherapy), however local recurrence rate is higher in case of breast conserving therapy, also no role of Axillary evacuation in case of DCIS. The use of hormonal therapy decreases the incidence of local recurrence by about 98%. Conclusion: The main management of DCIS is local treatment (wide local excision and radiotherapy) with hormonal treatment in case of hormone receptor positive lesions.

Keywords: ductal carcinoma in situ, surgical treatment, radiotherapy, breast conserving therapy, hormonal treatment

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Authors: K. P. v. R. de Silva, R. W. Senevirathna, M. M. A. J. Kumara, J. P. M. Kumarasinghe, R. L. Gunawardana, S. M. Uluwitiya, G. C. P. Jayawickrama, W. K. T. I. Madushani

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Introduction: The limited literature supporting the utilization of mechanical bowel preparation (MBP) for patients undergoing laparoscopic anterior resection (LAR) remains a notable issue. This study was conducted to examine the clinical consequences of anastomosis in colorectal surgery with MBP compared to cases where MBP was not utilized (no-MBP) in the context of LAR. Methods: This was a retrospective comparative study conducted in the professorial surgical wards of the teaching hospital karapitiya (THK). Colorectal cancer patients(n=306) participated in the study, including 151 MBP patients and 155 no-MBP patients, where the postoperative complications and mortality rates were compared. Results: The anastomotic leakage rate was 2.6%(n=4) in the no-MBP group and 6.0%(n=9) in the MBP group (p=0.143). The postoperative paralytic ileus rate was 18.5%(n=28) and 5.8%(n=9) in the MBP group and no-MBP group, respectively, displaying a statistically significant difference (p=0.001). Wound infection, pneumonia, urinary tract infection, and cardiac complication rates also were higher in the MBP group. The overall mortality rate was 1.3%(n=3) in the no-MBP group and 2.0%(n=2) in the MBP group. Conclusions: The evidence concludes that MBP increases post-operative complications. Therefore, prophylactic MBP in LAR has not been proven to benefit patients. However, further research is necessary to understand the comparative effects of MBP versus no preparation comprehensively.

Keywords: MBP, anastomosis, LAR, paralytic ileus

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Authors: Adeola Adejumo, Oluwole David Adebayo, Muraina Kamilu Olanrewaju

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The purpose of this study was to investigate the influence of some psychological factors (i.e, school climate, parental involvement and classroom interaction) on the learning gains of university undergraduates in Mathematics in Ibadan, Nigeria. Three hundred undergraduates who are on open distance learning education programme in the University of Ibadan and thirty mathematics lecturers constituted the study’s sample. Both the independent and dependent variables were measured with relevant standardized instruments and the data obtained was analyzed using multiple regression statistical method. The instruments used were school climate scale, parental involvement scale and classroom interaction scale. Three research questions were answered in the study. The result showed that there was significant relationship between the three independent variables (school climate, parental involvement and classroom interaction) on the students’ learning gain in mathematics and that the independent variables both jointly and relatively contributed significantly to the prediction of students’ learning gain in mathematics. On the strength of these findings, the need to enhance the school climate, improve the parents’ involvement in the student’s education and encourage students’ classroom interaction were stressed and advocated.

Keywords: school climate, parental involvement, ODL, learning gains, mathematics

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Authors: Li-Jun Zheng

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The use of drums as an accompanying instrument is a common phenomenon in traditional Chinese folk rituals and musical culture. Especially, some folk rituals construct ritual-related sounds and give them ritual-specific symbolic and meaningful systems through the combination and use of multiple percussion instruments. The Yue drum(岳鼓), an asymmetrically shaped thin waist drum, is currently used in Han Chinese Shigong（师公）rituals in Guangxi, China, and is an important ritual instrument in Shigong rituals. This paper examines the use of the Yue drum and other percussion instruments in Han Chinese Shigong rituals in Guangxi, China, and shows the current status of combining instrumental accompaniment forms with human voices in Shigong rituals. Through further analysis of the musical and dance forms of Han Chinese Shigong rituals, this paper shows how Han Chinese Shigong ritual performers construct the ritual field through "sound-human-dance" and further explains the relationship between the existing and fictitious performance fields in the rituals. In addition, this paper demonstrates the relationship between Han Chinese Shigong rituals and the religious beliefs they involve, such as Taoism and Buddhism. And it further explores how performers in Han Chinese Shigong rituals use Yue drums for the dual purpose of "entertaining the gods" and "entertaining the people".

Keywords: sound research, the Han Chinese Shigong ritual, the thin waist drum, folk beliefs, ritual music

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Authors: Anupam Sibal

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Apollo Quality Program(AQP) was launched across the Apollo Group of Hospitals to address the four patient safety areas; Safety during Clinical Handovers, Medication Safety, Surgical Safety and the six International Patient Safety Goals(IPSGs) of JCI. A measurable, online, quality dashboard covering 20 process and outcome parameters was devised for monthly monitoring. The expected outcomes were also defined and categorized into green, yellow and red ranges. An audit methodology was also devised to check the processes for the measurable dashboard. Documented clinical handovers were introduced for the first time at many locations for in-house patient transfer, nursing-handover, and physician-handover. Prototype forms using the SBAR format were made. Patient-identifiers, read-back for verbal orders, safety of high-alert medications, site marking and time-outs and falls risk-assessment were introduced for all hospitals irrespective of accreditation status. Measurement of Surgical-Site-Infection (SSI) for 30 days postoperatively, was done. All hospitals now tracked the time of administration of antimicrobial prophylaxis before surgery. Situations with high risk of retention of foreign body were delineated and precautionary measures instituted. Audit of medications prescribed in the discharge summaries was made uniform. Formularies, prescription-audits and other means for reduction of medication errors were implemented. There is a marked increase in the compliance to processes and patient safety outcomes. Compliance to read-back for verbal orders rose from 86.83% in April’11 to 96.95% in June’15, to policy for high alert medications from 87.83% to 98.82%, to use of measures to prevent wrong-site, wrong-patient, wrong procedure surgery from 85.75% to 97.66%, to hand-washing from 69.18% to 92.54%, to antimicrobial prophylaxis within one hour before incision from 79.43% to 93.46%. Percentage of patients excluded from SSI calculation due to lack of follow-up for the requisite time frame decreased from 21.25% to 10.25%. The average AQP scores for all Apollo Hospitals improved from 62 in April’11 to 87.7 in Jun’15.

Keywords: clinical handovers, international patient safety goals, medication safety, surgical safety

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Authors: Manoj Deepak, N. Mathivanan, K. Venkatachalam

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Nerve root stenosis is one of the main cause for back pain. There are many methods both conservative and surgical to treat this disease. It is pertinent to decompress the spine to a proper extent so as to avoid the recurrence of symptoms. But too much of an aggressive approach also has its disadvantages. We present one of the methods to effectively decompress the nerve with better results. Our study was carried out in 52 patients with foramina stenosis between 2008 to 2011.We carried out the surgical procedure of shaving off the medial part of the facet joint so as to decompress the root. We selected those patients who had symptoms of claudication for more than 2 years. They had no signs of instability and they underwent conservative treatment for a period of 2 months before the procedure. Oswersty scoring was used to record the functional level of the patient before and after the procedure. All patients were followed up for a period of minimum 2.5 years. After evaluation for a minimum of 2.5 years, 34 patients had no evidence of recurrence of symptoms with improvement in the functional level.7 patients complained of minimal pain but their functional quality had improved postop. Six patients had symptoms of lumbar canal disease which reduced with conservative treatment. 5 patients required spinal fusion surgeries in the later period. Conclusion: Thus, we can effectively conclude that our procedure is safe and effective in reducing the symptoms in those patients with neurogenic claudication.

Keywords: facetectoemy, stenosis, decompression, Lumbar Foraminal Stenosis, hemi-facetectomy

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Authors: Ola A. Nassr, Ali M. Abd Alridha, Rua A. Naser, Rasha S. Abbas

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Background: Excessive and inappropriate use of antimicrobial agents among hospitalized patients remains an important patient safety and public health issue worldwide. Not only does this behavior incur unnecessary cost but it is also associated with increased morbidity and mortality. The objective of this study is to obtain an insight into the prescribing patterns of antibiotics in surgical and medical wards, to help identify a scope for improvement in service delivery. Method: A simple point prevalence survey included a convenience sample of 200 patients admitted to medical and surgical wards in a government teaching hospital in Baghdad between October 2017 and April 2018. Data were collected by a trained pharmacy intern using a standardized form. Patient’s demographics and details of the prescribed antibiotics, including dose, frequency of dosing and route of administration, were reported. Patients were included if they had been admitted at least 24 hours before the survey. Patients under 18 years of age, having a diagnosis of cancer or shock, or being admitted to the intensive care unit, were excluded. Data were checked and entered by the authors into Excel and were subjected to frequency analysis, which was carried out on anonymized data to protect patient confidentiality. Results: Overall, 88.5% of patients (n=177) received 293 antibiotics during their hospital admission, with a small variation between wards (80%-97%). The average number of antibiotics prescribed per patient was 1.65, ranging from 1.3 for medical patients to 1.95 for surgical patients. Parenteral third-generation cephalosporins were the most commonly prescribed at a rate of 54.3% (n=159) followed by nitroimidazole 29.4% (n=86), quinolones 7.5% (n=22) and macrolides 4.4% (n=13), while carbapenems and aminoglycosides were the least prescribed together accounting for only 4.4% (n=13). The intravenous route was the most common route of administration, used for 96.6% of patients (n=171). Indications were reported in only 63.8% of cases. Culture to identify pathogenic organisms was employed in only 0.5% of cases. Conclusion: Broad-spectrum antibiotics are prescribed at an alarming rate. This practice may provoke antibiotic resistance and adversely affect the patient outcome. Implementation of an antibiotic stewardship program is warranted to enhance the efficacy, safety and cost-effectiveness of antimicrobial agents.

Keywords: Acute care, Antibiotic misuse, Iraq, Prescribing

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Authors: Akpokiere Ugbede Roseline

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Chemistry is an activity oriented subject in which many students achievement over the years are not encouraging. Among the reasons found to be responsible for student’s poor performance in chemistry are ineffective teaching strategies. This study, therefore, sought to determine the effect of guided inquiry, guided inquiry with demonstration, and demonstration with conventional approach on pre-service teachers’ cognitive attainment and practical skills acquisition on stoichiometry and chemical reactions in practical chemistry, Two research questions and hypotheses were each answered and tested respectively. The study was a quasi-experimental research involving 50 students in each of the experimental groups and 50 students in the control group. Out of the five instruments used for the study, three were on stimulus and two on response (Test of Cognitive Attainment and Test of Practical Skills in Chemistry) instruments administered, and dataobtained were analyzed with t-test and Analysis of Variance. Findings revealed, among others, that there was a significant effect of treatments on students' cognitive attainment and on practical skills acquisition. Students exposed to guided inquiry (with/without demonstration) strategies achieved better than those exposed to demonstration with conventional strategy. It is therefore recommended, among others, that Lecturers in Colleges of Education should utilize the guided inquiry strategy for teaching concepts in chemistry.

Keywords: instructional strategy, practical chemistry, learning outcomes, pre-service teachers

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Authors: Thomas Suarez, Anne-Sophie Grenouilleau, Erwan Autin, Alexandre Biosse-Duplan, Emmanuelle Blondet, Laurence Chazalette, Marie Coniel, Agnes Dessaigne, Sylvie Lascols, Andrea Lasserre, Candice Legris, Pierre Liot, Aline Metais, Karine Petitprez, Christophe Varlet, Christian Saout

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Background: The role of biological sex and gender identity -whether assigned or chosen- as health determinants are far from a recent discovery: several reports have stressed out how being a woman or a man could affect health on various scales. However, taking it into consideration beyond stereotypes and rigid binary assumptions still seems to be a work in progress. Method: The report is a synthesis on a variety of specific topics, each of which was studied by a specialist from the French National Authority for Health (HAS), through an analysis of existing literature on both healthcare policy construction process and instruments (norms, data analysis, clinical trials, guidelines, and professional practices). This work also implied a policy analysis of French recent public health laws and a retrospective study of guidelines with a gender mainstreaming approach. Results: The analysis showed that though sex and gender were well-known determinants of health, their consideration by both public policy and health operators was often incomplete, as it does not incorporate how sex and gender interact, as well as how they interact with other factors. As a result, the health and social care systems and their professionals tend to reproduce some stereotypical and inadequate habits. Though the data available often allows to take sex and gender into consideration, such data is often underused in practice guidelines and policy formulation. Another consequence is a lack of inclusiveness towards transgender or intersex persons. Conclusions: This report first urges for raising awareness of all the actors of health, in its broadest definition, that sex and gender matter beyond first-look conclusions. It makes a series of recommendations in order to reshape policy construction in the health sector on the one hand and to design public health instruments to make them more inclusive regarding sex and gender on the other hand. The HAS finally committed to integrate sex and gender preoccupations in its workings methods, to be a driving force in the spread of these concerns.

Keywords: biological sex, determinants of health, gender, healthcare policy instruments, social accompaniment

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Authors: Natasha Hazarika, Xiaoling Zhang

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Eco- innovations, unlike regular innovations, are not self-enforcing and are associated with the double externality problem. Therefore, it is emphasized that eco-innovations need government. intervention in the form of supportive policies on priority. Off late, factors like consumer demand, technological advancement as well as the competitiveness of the firms have been considered as equally important. However, the interaction among these driving forces has not been fully traced out. Also, the theory on eco-innovation is found to be at a nascent stage which does not resonate with its dynamics as it is traditionally studied under the neo- classical economics theory. Therefore, to begin with, insights for this research have been derived from the merits of ‘neo- classical economics’, ‘evolutionary approach’, and the ‘resource based view’ which revealed the issues pertaining to technological system lock- ins and firm- based capacities which usually remained undefined by the neo classical approach; it would be followed by determining how the policies (in the national level) and their instruments are designed in order to motivate firms to eco-innovate, by analyzing the innovation ‘friendliness’ of the policy style and the policy instruments as per the indicators provided in innovation literature by means of document review (content analysis) of the relevant policies introduced by the Chinese government. The significance of theoretical analysis lies in its ability to show why certain practices become dominant irrespective of gains or losses, and that of the policy analysis lies in its ability to demonstrate the credibility of govt.’s sticks, carrots and sermons for eco-innovation.

Keywords: firm competency, eco-innovation, policy, theory

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Authors: Bernett Nkwayi Mulungo

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There are vast community music projects in South African townships, and their courses range from music theory aural practical individual and ensemble lessons on orchestral instruments and recorders – these instruments being primarily “Western”. Despite this relative success – indeed one of the few in the realm of arts in post-apartheid South Africa – what remains troubling is the dominance of western thought (as music theory) and modes of teaching music that maintain the idea of music study as alien in black communities. This identified problem speaks to a significant theme, namely: Arts education for community development, which is my area of interest. Primarily for, it is a timely platform to firmly entrench appreciation, understanding, and, most undoubtedly, the value(s) of the arts to the youth. Drawing on one’s experience as a lecturer in (and graduate from) a South African tertiary institution and as a teacher in a community project, this research will interrogate the content of some of the program(s): from the theoretical material taught in music theory classes to the practical repertoire taught and/or performed. The focal point of this research is on how this content informs or speaks to its intended “beneficiaries” – the African youth. Through these and other considerations, the paper aims to sketch the potentially radical consequences that transformed music education at community and earlier levels will have for higher education music studies in South Africa.

Keywords: decolonization, Africanization, indigenous knowledge, community engagement

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Authors: Bahareh Arghand

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The establishment of rules and regulations for more effective energy-environment interactions are essential to achieving sustainable development. Sustainable development requires mechanisms that can promote compliance in energy-environment conventions. There are many binding agreements and non-binding instruments at regional and international levels on energy and the environment. These conventions try to decrease conflicts of interest between energy, environment and economic by legal principles and practical mechanisms. The major core of conventions is their implementations because the poor implementation and enforcement power affect their success. In this regard, the main goal of this study is proposing the effective implementation mechanisms. Energy service companies' (ESCOs) activities can improve energy efficiency and decrease the environmental degradations. Therefore, it can be proposed and assessed the merit mechanism of ESCO performance as a facilitator to implement energy-environment conventions. An assessment of ESCO performance, including its potentials, problems, and limitations, as a facilitator for effective implementation of the energy-environment convention, is included. This study is oriented towards effective development and application of laws and the function of ESCOs as appropriate economic instruments and facilitator for implementation of energy-environment conventions. The resulting system of close cooperation between the energy-environment conventions and ESCOs is geared toward advancing environmental protection and economic factors by the transfer of environmentally-sound technologies that meet sustainable development objectives.

Keywords: energy-environment conventions, energy service company, facilitator mechanism, sustainable development

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Authors: Shivalal Sharma, Sanjib K. Sharma, Madhab Lamsal

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Background: The aim of this study was to evaluate the clinical and laboratory changes three months after full-mouth scaling and root planing (SRP) in periodontitis patients with type 2 diabetes mellitus (DM). Methods: Forty-seven type 2 DM subjects with moderate to severe periodontitis were randomly divided into two groups. Treatment group (TG), 25 subjects, received full-mouth scaling and root planning; control group (CG), 22 subjects, received no treatment. At baseline and at the end of three months, glycated hemoglobin (HbA1c) values, fasting glucose, and clinical parameters like plaque index (PI), gingival index (GI), probing pocket depth (PPD), and clinical attachment level (CAL) were recorded in all the patients. Following SRP, the patients were enrolled in a monthly interval maintenance program for 3 months. Results: A statistically significant effect could be demonstrated for PI, GI, PPD, and CAL for the treatment group. HbA1c levels in the treatment group decreased significantly whereas the control group showed a slight but insignificant increase for these parameters. Conclusions: The results of this study showed that non-surgical periodontal treatment (SRP) is associated with improved glycemic control in type 2 DM patients and could be undertaken along with the standard measures for the diabetic patient care.

Keywords: periodontitis, type 2 diabetes mellitus, non-surgical periodontal therapy, SRP

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Authors: Krupali Mukeshkumar, Jinesh Shah

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Background: Bilateral Sagittal Split Osteotomy (BSSO), used for the correction of mandibular deformities, is a common oral and maxillofacial surgical procedure. Inferior alveolar nerve dysfunction is commonly reported post-operatively by patients as paresthesia or anesthesia. The current literature lacks a consensus on the incidence of inferior alveolar nerve dysfunction as patients are not routinely assessed pre and post-operatively with an objective assessment. The range of incidence varies from 9% to 85% of patients, with some authors arguing that 100% of patients experience nerve dysfunction immediately post-surgery. Systematic reviews have shown a difference between incidence rates at different follow-up periods using objective and subjective methods. Aim: To identify the incidence of inferior alveolar nerve dysfunction following BSSO. Gold standard: Nerve dysfunction incidence rates similar or lower than current literature of 83% day one post-operatively and 18.4% at one year follow up. Setting: A retrospective cross-sectional audit of patients treated between 2017-2019 at the Royal Stoke University Hospital, Maxillofacial and Orthodontic departments. Sample: All patients who underwent a BSSO (with or without le fort one osteotomy) between 2017–2019 were identified from the database. Patients with pre-existing neurosensory disturbance, those who had a genioplasty at the same time and those with no follow-up were excluded. The sample consisted of 121 patients, 37 males and 84 females between the ages of 17-50 years at the time of surgery. Methods: Clinical records of 121 cases were reviewed to assess the age, sex, type of mandibular osteotomy, status of the nerve during the surgical procedure, type of bony split and incidence of nerve dysfunction at follow-up appointments. The surgical procedure was carried out by three Maxillo-facial surgeons and follow-up appointments were carried out in the Orthodontic and Oral and Maxillo-facial departments. Results: 120 patients were treated to correct the mandibular facial deformity and 1 patient was treated for sleep apnoea. Seventeen patients had a mandibular setback and 104 patients had mandibular advancement. 68 patients reported inferior alveolar nerve dysfunction at one week following their surgery. Seventy-six patients had temporary paresthesia present between 2 weeks and 12 months post-surgery. 13 patients had persistent nerve dysfunction at 12 months, of which 1 had a bad bony split during the BSSO. The incidence of nerve dysfunction postoperatively was 6.6% after 1 day, 56.1% at 1 week, 62.8% at 2 weeks, 59.5% between 3-6 weeks, 43.0% between 8-16 weeks and 10.7% at 1 year. Conclusions: The results of this audit show a similar incidence rate to the research gold standard at the one-year follow-up. Future Recommendations: No changes to surgical procedure or technique are indicated, but a need for improved documentation and a standardized approach for assessment of post-operative nerve dysfunction would be beneficial.

Keywords: bilateral sagittal split osteotomy, inferior alveolar nerve, mandible, nerve dysfunction

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Authors: Yu-Chieh Chen, Kuei-Feng Shen, Chia-Ling Chao

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The purpose of this report was to present the nursing experience and case of an unexpected cerebellar hemorrhagic stroke with acute hydrocephalus patient after lumbar spine surgery. The patient had been suffering from an emergent external ventricular drainage and stayed in the Surgical Intensive Care Unit from July 8, 2016, to July 22, 2016. During the period of the case, the data were collected for attendance, evaluation, observation, interview, searching medical record, etc. An integral evaluation of the patient's physiological 'psychological' social and spiritual states was also noted. The author noticed the following major nursing problems including ineffective cerebral perfusion 'physical activity dysfunction' family resource preparation for disability. The author provided nursing care to maintain normal intracranial pressure, along with a well-therapeutic relationship and applied interdisciplinary medical/nursing team to draft an individualized and appropriate nursing plan for them to face the psychosocial impact of the patient disabilities. We also actively participated in the rehabilitation treatments to improve daily activity and confidence. This was deemed necessary to empower them to a more positive attitude in the future.

Keywords: family resourace preparation inability, hemorrhagic sroke, ineffective tissue cerebral perfusion, lumbar spine surgery

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Authors: Ayat E. Ali, Christeen R. Aziz, Merna A. Helmy, Mohammed M. Malek, Sherif H. El-Gohary

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Goal: Purpose of the project was to make a plastic surgery prediction by using pre-operative images for the plastic surgeries’ patients and to show this prediction on a screen to compare between the current case and the appearance after the surgery. Methods: To this aim, we implemented a software which used data from the internet for facial skin diseases, skin burns, pre-and post-images for plastic surgeries then the post- surgical prediction is done by using K-nearest neighbor (KNN). So we designed and fabricated a smart mirror divided into two parts a screen and a reflective mirror so patient's pre- and post-appearance will be showed at the same time. Results: We worked on some skin diseases like vitiligo, skin burns and wrinkles. We classified the three degrees of burns using KNN classifier with accuracy 60%. We also succeeded in segmenting the area of vitiligo. Our future work will include working on more skin diseases, classify them and give a prediction for the look after the surgery. Also we will go deeper into facial deformities and plastic surgeries like nose reshaping and face slim down. Conclusion: Our project will give a prediction relates strongly to the real look after surgery and decrease different diagnoses among doctors. Significance: The mirror may have broad societal appeal as it will make the distance between patient's satisfaction and the medical standards smaller.

Keywords: k-nearest neighbor (knn), face detection, vitiligo, bone deformity

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